| Budget Amount *help |
¥4,700,000 (Direct Cost: ¥4,700,000)
Fiscal Year 1986: ¥500,000 (Direct Cost: ¥500,000)
Fiscal Year 1985: ¥4,200,000 (Direct Cost: ¥4,200,000)
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| Research Abstract |
Eight livers surgically resected for intrahepatic gallstones were submitted to graphic reconstruction from serial histological sections to correlate the peculiar ductal changes with the pathogenetic aspects of this disease. Reconstruction was aided by a microcomputer system we have developed. Further, morphometric analysis was added to relate the obstruction of portal veins with parenchymal atrophy, thereby to establish the therapeutic significance of hepatic resection. Each liver specimen was divided into maximally 13 blocks, from each of which serial sections were prepared and staind with Elastica-Goldner stain. The images of bile ducts, arteries and portal veins were serially input into the microcomputer system that integrated 3-D images of these structures in the CRT screen or into hard copies.
Three-dimensionally, the ducts in these livers were strikingly transformed into a chain of ampullar dilatations interposed by either bendings or strictures. The dilated ducts were classified
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into spindle, cystic and flat types and the stenosis, usually found at bifurcations, was either bottleneck or slit type. Morphometrically, even a stenotic segment was wider than a corresponding normal one, showing that it was a relative stricture. The parenchymal lobule was atrophic or even completely destroyed due to the freguent thrombotic obstruction of portal veins about 0.5mm diameter. These 3-D morphology of intrahepatic bile ducts provided little evidence of congenital bile duct anomaly for the origin of intrahepatic gallstones. The basic ductal changes were dilations, alternated with "stenoses" that were more apparent than real. On the other hand, both the frequent obstruction of small portal veins and the lobular atrophy reflected a severely reduced portal blood flow. Not only the recurrent cholangitis that is apt to occur upon dilated ducts, but this functional incompetence of a stone-harboring, atrophic liver lobe strongly suggests a surgical indication for hepatic resection. Less
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