Shimada H, Niimoto S, Matsuba A, Miwa K, Nakagawara G, Kobayashi M, Tsuchiya S
Nihon Geka Gakkai Zasshi. 1985 Oct;86(10):1426-33.
The liver histology of acute cholangitis was studied in order to determine whether microscopic changes correspond to clinical status. Patients with acute cholangitis were divided into mild cholangitis (1st group, n = 18) and severe cholangitis (2nd, 3rd and 4th groups) accompanied by hypotension. The 2nd group consisted of 6 surviving patients who underwent liver biopsy during hypotension. The 3rd group consisted of 3 non-surviving patients with biopsy during hypotension. The 4th group consisted of 7 patients with biopsy during autopsy. The frequency of endotoxemia, gram negative bacteremia, disseminated intravascular coagulopathy and hepatic failure were significantly higher in severe cholangitis than in mild cholangitis. The incidence of neutrophilic infiltration in the sinusoid and microabscess in lobule were significantly higher in severe cholangitis than in mild one. The incidence of portal thrombosis and massive necrosis of hepatic cells were also significantly higher in severe cholangitis, especially in the 3rd and 4th groups. It was suggested that the neutrophilic infiltration in the sinusoid and microabscess in lobules which proved the existence of endotoxemia or bacteremia were characteristic findings in severe cholangitis.
为了确定微观变化是否与临床状况相符，对急性胆管炎的肝脏组织学进行了研究。急性胆管炎患者被分为轻度胆管炎（第1组，n = 18）和伴有低血压的重度胆管炎（第2、3和4组）。第2组由6名在低血压期间接受肝脏活检的存活患者组成。第3组由3名在低血压期间进行活检的非存活患者组成。第4组由7名在尸检期间进行活检的患者组成。重度胆管炎患者的内毒素血症、革兰氏阴性菌血症、弥散性血管内凝血和肝衰竭的发生率显著高于轻度胆管炎患者。重度胆管炎患者肝血窦中性粒细胞浸润和小叶微脓肿的发生率显著高于轻度胆管炎患者。重度胆管炎患者门静脉血栓形成和肝细胞大片坏死的发生率也显著更高，尤其是在第3组和第4组。提示肝血窦中性粒细胞浸润和小叶微脓肿证明存在内毒素血症或菌血症，是重度胆管炎的特征性表现。
