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Stomach and Intestine(Tokyo) Volume 20, Issue 4 （April 1985）

胃と腸 20巻4号（1985年4月発行）

Japanese English

研究

胆嚢造影陰性胆嚢結石例の臨床病理学的検討―特に腸上皮化生からみた Intestinal Metaplasia of the Gallbladder Mucosa in Chronic Cholecystitis-Especially on Malignant Potentiality in Cases of Negative Cholecystogram 浅野栄一 ¹ , 永川宅和 ¹ , 宮崎逸夫 ¹ , 小西二三男 ² Eiichi Asano ¹ , Takukazu Nagakawa ¹ , Itsuo Miyazaki ¹ , Fumio Konishi ² ¹金沢大学医学部第2外科 ²金沢医科大学病理 ¹The Second Department of Surgery, School of Medicine, Kanazawa University ²Department of Pathology, Kanazawa Medical University pp.441-446

発行日 1985年4月25日 Published Date 1985/4/25

DOI https://doi.org/10.11477/mf.1403109793

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Abstract 文献概要
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要旨　慢性胆嚢炎合併胆嚢結石506例について，光顕組織学的に胆嚢粘膜の腸上皮化生を結石の種類，年齢，胆嚢像描出の有無別に調べた．特に杯細胞のみられる腸上皮化生の出現頻度を比較検討した結果，胆嚢造影陰性胆嚢結石例では胆嚢癌周辺粘膜にみられるような腸上皮化生が高率に出現していた．更に，この腸上皮化生の特性ならびに分布をみるために慢性胆嚢炎合併胆嚢結石54例の新鮮摘出胆嚢標本を用いて，酵素化学的活性法による検討を行った結果，この腸上皮化生はALP活性を欠いており，胆嚢造影陰性例ではびまん性の分布状態を呈していた．以上の成績からみると胆嚢造影陰性胆嚢結石における胆嚢粘膜は癌発生の素地になる可能性があると推察された．

　We investigated the malignant potentiality of the gallbladder mucosa in cases of gallstone from the aspect of intestinal metaplasia. Intestinal metaplasia was decided by hematoxyiin-eosin, PAS-alcian blue and Grimelius stainings.

　506 cases of cholelithiasis with chronic cholecystitis were evaluated. There were cholesterol stones in 342 cases (67.6%), calcium bilirubinate stones in 138 cases (27.3%) and pure pigment stones in 26 cases (5.1%). Negative cholecystogram was found in 171 cases (33.8%) of them. 36 (7.1%) of gallstone cases possessed the goblet cell typed intestinal metaplasia in superficial epithelium. The incidence of the intestinal metaplasia in cholelithiasis was proved as follows from cholecystogram or age (Table 3, 4, 5). The intestinal metaplasia evidently occurred frequently in patients below 60 years with negative cholecystogram. In aged patients, however, the intestinal metaplasia was predominant either they had positive cholecystogram or not.

　We, furthermore, examined the extension of intestinal metaplasia and its histochemical characteristics in cases of cholelithiasis (Fig. 4). Then we examined the distribution of intestinal metaplasia detected by sucrase method that was most closely correlated with intestinal metaplasia (Fig. 5).

　In conclusion, the case of cholelithiasis with negative cholecystogram showed a high incidence of such intestinal metaplasia that can be seen in the mucosa surrounding gallbladder cancer. The changes exhibited characteristics of incomplete intestinal metaplasia and diffuse distribution according to the histochemical study.