慢性肝炎並びに肝硬変症における十二指腸粘膜生検組織の病理組織学的研究第1編 慢性肝炎並びに肝硬変症を中心とした肝疾患の十二指腸粘膜の計測値について

For the purpose of clarifying the pathological conditions of the intestinal tract in liver diseases, histopathological examinations were conducted with the biopsy specimens of mucosa from 10 cases of chronic hepatitis and 10 cases of liver cirrhosis with the use of multipurpose suction biopsy tube (Brandborg, L, L. and Rubin, C. E.). The biopsy was made in the early morning at the time of empty stomach and the specimens were taken from the duodenum (third part) by oral suction biopsy under fluoroscopic view. In order to cut down the contraction to minimum, the specimens were fixed for 24 hours in 10 % formalin solution mixed with physiological saline solution kept at 4℃, and then the specimens were washed for three hours with tap water and embedded in paraffin in the routine manner. Abont 10 serial sections were prepared for each staining. Hematoxylin-eosin, Azan blue, a modified method Bielschowsky silver impregnation Pap. Van Gieson's stain and PAS-Schiff reaction were emplolyed for histopathological observations. In addition, about 100 serial sections of 15μ in thickness were prepared for each case and these were stained with hematoxylin-eosin for the reconstruction model of the mucosa to observe three dimensional aspects of mucosa. With this reconstruction model, the width of villi, the thickness of grandular layer and the mucosal surface area were measured. For the height of villi the distance from the plane of muscularis mucosae to the tip of villi was taken; the widest part of villi in the serial sections was taken for the width of villi; the thickness of lamina propria exclusive of villi on muscularis mucosae was taken as the thickness of grandular layer; and the surface area of mucosal epithelium per 1mm(2) of muscularis mucosae was also measured. The rcsults of these observations are briefly summarized in the following. 1. The height of villi in the chronic hepatitis group (500±4.3μ) did not show any significant difference from that (487±4.9μ) of normal control group, but that (447±5.2μ) in the liver cirrhosis group revealed a significant decrease, and this decreasing tendency was in the order of chronic hepatitis and liver cirrhosis. 2. As for the width of villi, there was no significant difference between normal control (140±3.6μ) and chronic hepatitis (143±3.2μ), but there was an increase in the liver cirrhosis group (162±3.7μ). 3. The thickness of grandular layer in the chronic hepatitis group (149±1.6μ) was increased as compared with normal control (142±1.8μ), whereas in the liver cirrhosis group (136±1.8μ) it was markedly decreased. This decreasing tendency was observed in the order of chronie hepatitis and liver cirrhosis, revealing that the decrease tends to become proportionately marked with advance in chronic state. 4. As for the surface area of mucosal epithelinm there was no significant difference between normal control (7.8±0.05mm(2)) and acute hpatitis group (7.2±0.20mm(2)), while it was decreased in the chronic hepatitis group (7.3±0.09mm(2)) and liver cirrhosis group (6.6±0.25mm(2)), and this decrease in the surface area was especially marked in five out of the ten cases of liver cirrhosis. This implies that along with the decrease in the surface area of mucosal epithelium in liver cirrhosis the swelling of spleen and the disturbances of absorption-function tend to aggravate. 5. Although histopathological pictures of the duodenal mucosa showed no marked changes in chronic hepatitis, in liver cirrhosis there were recognized such atrophic processes as fusion and atrophy of villi, fibrosis of tunica propria, the proliferation of reticular fibers and the degeneration and disappearance of Lieberkuhn's gland.