Hirooka N, Iwasaki I, Horie H, Ide G
Acta Pathol Jpn. 1986 Mar;36(3):375-87. doi: 10.1111/j.1440-1827.1986.tb01027.x.
Changes of hepatic microcirculations in 22 autopsy cases of liver cirrhosis were analyzed by corrosion cast/scanning electron microscope (SEM) examination. By this method, the site of arterioportal (A-P) communication in liver cirrhosis was clearly demonstrated between proliferated portal venules and arterial capillaries. The communications were observed at the same site as in the normal liver and were not at larger arterial and portal vein branches. The findings indicate that the increase of A-P communication in liver cirrhosis may be called "capillary shunting". On the basis of the findings, it was postulated that the A-P shunt could not assist in the development of portal hypertension by the transmission of high arterial pressure to the portal vein but could only compensate for decreased portal flow and/or elevate the oxygen concentration in the sinusoids to improve the hypoxic state of the liver parenchyma. It was also demonstrated that the arterial capillarization of the interstitial septa in micronodular wide septal cirrhosis was more prominent than that in macronodular thin septal cirrhosis. A grade of portal vein reduction and compensatory arterialization in a fibrous septum have been regarded as an index to estimate the advancement of liver cirrhosis. Therefore, if alcoholic micronodular cirrhosis could change into macronodular, the process should have occurred at least before the establishment of micronodular wide septal cirrhosis.
通过铸型腐蚀/扫描电子显微镜（SEM）检查，分析了22例肝硬化尸检病例的肝微循环变化。通过这种方法，在肝硬化中增殖的门静脉小支与动脉毛细血管之间清晰显示了动门（A-P）交通的部位。这些交通在与正常肝脏相同的部位观察到，而非在较大的动脉和门静脉分支处。这些发现表明，肝硬化中A-P交通的增加可能被称为“毛细血管分流”。基于这些发现，推测A-P分流不能通过将高动脉压传递至门静脉来促进门静脉高压的发展，而只能补偿门静脉血流减少和/或提高肝血窦中的氧浓度，以改善肝实质的缺氧状态。还表明，小结节宽间隔肝硬化间质隔的动脉毛细血管化比大结节薄间隔肝硬化更明显。纤维间隔中门静脉减少和代偿性动脉化的程度被视为评估肝硬化进展的一个指标。因此，如果酒精性小结节性肝硬化能够转变为大结节性肝硬化，那么这个过程至少应该在小结节宽间隔肝硬化形成之前就已经发生。
