Gilloteaux J, Hawkins W S, Gilloteaux L C, Jasso J, Kelly T R
Summa Health System Foundation, Akron, Ohio 44304, USA.
Microsc Res Tech. 1997 Oct 1;39(1):22-38. doi: 10.1002/(SICI)1097-0029(19971001)39:1<22::AID-JEMT3>3.0.CO;2-1.
Although there is a large body of data on the gallbladder and the importance of the cystic duct in surgical procedures, there is insufficient data regarding the morphology of the human cystic duct. In the present study, transmission electron microscopic (TEM) and scanning electron microscopic (SEM) survey of several surgical and autopsy cystic ducts in cholelithiasis and cholesterolosis is reported. In cholelithiasis, similar to gallbladder epithelium, the cystic duct epithelial cells display minor-to-severe alterations of the epithelial surface accompanied by variable erosion of the epithelium. Areas of intact surface epithelium demonstrate microvilli-covered cells coated by a rich glycocalyx and mucous production. In other areas, apical excrescences are associated with mucus hyperproduction and secretory events. Lipoid bodies are also present in many cells and especially in many of the cells' subliminal apical areas. In cholesterolosis, mucous secretory granules appear dilated, fatty deposits are infrequent, and peculiar intracellular cholesterol deposits can be detected in the apical and subapical region of cells and around condensed mitochondria. Following elective cholecystectomies, predominantly in association with cholelithiasis, eroded areas were detected; therefore, it appears that the action of intraluminal calculi may be a principal causative factor in discrete epithelial erosions of the cystic duct. Intraluminal calculi/ debris, along with the alteration of mucus, cell sloughing, and a decreased pool of bile acids and motility may participate in the gallstone nucleation process. The peculiar cholesterol inclusions may also play a role in that nucleating process.
尽管有大量关于胆囊以及胆囊管在外科手术中的重要性的数据，但关于人类胆囊管形态学的数据却不足。在本研究中，报告了对几例胆石症和胆固醇沉着症患者手术切除及尸检的胆囊管进行透射电子显微镜（TEM）和扫描电子显微镜（SEM）观察的结果。在胆石症中，与胆囊上皮相似，胆囊管上皮细胞呈现出上皮表面从轻微到严重的改变，并伴有不同程度的上皮侵蚀。完整的表面上皮区域显示微绒毛覆盖的细胞被丰富的糖萼和黏液分泌所包裹。在其他区域，顶端赘生物与黏液过度分泌和分泌活动有关。许多细胞中也存在脂滴，尤其是在许多细胞的顶下区域。在胆固醇沉着症中，黏液分泌颗粒出现扩张，脂肪沉积较少，并且在细胞的顶端和顶下区域以及浓缩线粒体周围可检测到特殊的细胞内胆固醇沉积。在择期胆囊切除术后，主要与胆石症相关，发现了侵蚀区域；因此，腔内结石的作用似乎是胆囊管离散性上皮侵蚀的主要致病因素。腔内结石/碎片，连同黏液的改变、细胞脱落以及胆汁酸池减少和蠕动减弱，可能参与胆结石的成核过程。特殊的胆固醇包涵体也可能在该成核过程中起作用。
