Hepatic Fibrosis and Its Surgical Outcome in Extrahepatic Cholestasis

肝外性膽汁滯之肝纖維化及引流後預後

柯成國(Cjem-Guo KER) ； 黃宗人(Tsung-Jen HUANG) ； 沈柏青(Pai-Ching SHEEN)

《The Kaohsiung Journal of Medical Sciences》 1卷1期 (1985/01) Pp. 12-19

https://doi.org/10.6452/KJMS.198501.0012

摘要

肝纖維化的發生在肝外阻塞性黃疸是經常有的後遺症。本文將研究36位肝外阻塞性黃疸患者，利用電子顯微鏡觀察在肝細胞間隙及微細胆管中膠原纖維之分布，另外以11位無黃疸病患者當對照組作比較研究。全部病例分成四組：A組：對照組、B組：恢復組、C組：遲延組、D組：死亡組。
肝外胆管阻塞時，會發生肝內胆管壓力上升，因而肝細胞間發生解離，給纖維束有機會進入，如果阻塞時間延長，此纖維化程度愈嚴重，甚至於進入肝微細胆管，若此時才施胆管引流減壓手術，則肝細胞膜間隙已被纖維束積塞而無法恢復到密閉，造成型態上變化，如膠原纖維束出現有肝微細胆管及Disse間隙之肝細胞間，而其結合複合體尚完整者稱為I型，另外如結合複合體已被破壞且纖維束已進入微細胆管者稱為II型，此II型在A組不會出現，在恢復組有10.52%，遲延組為 9.09%，而在死亡組高達57.14%。在死亡組之黃疸發生時間亦較長，其血清胆紅素也較高，比較其他組是為有意義之差別，所以膠原纖維束沈積在肝細胞間隙之程度會因阻塞時間及程度而增加其嚴重性。在血液之Disse間隙之纖維束出現，會使肝細胞膜之微細突起平坦化，亦會阻礙肝細胞與血掖液側之交換，因而造成惡性循環。
從本文之研究報告了解，肝臟纖維化程度之期待，能預測肝細胞代謝之可能機會，及減黃術後對肝外阻塞性黃疸恢復之預後之了解，所以在高度阻塞性黃疸時，若能及早施腿管引流術才可以防止肝臟過度纖維化，因此造成之肝細胞機能障礙而無法恢復。

並列摘要

Ultrastructural observations of collagen fibers in the intercellular space and canaliculi of extrahepatic cholestasis were studied in thirty - seven cases of periampullary malignancy with jaundice and eleven cases of non-biliary tract disease and non-jaundice which served as a control group.
Bundles of collagen fibers appearing in the intercellular space between the cancliculi and the space of Disse ( type I) as well as in the canaliculi themselves ( type II) were classified. The results of the study showed that type II was not encountered in non- jaundiced patients , but encountered in 10.25% of the recovery group, 9.09% of the delayed recovery group and 57.14% of the fatal group in jaundiced patients. Unlike the other groups, the fatal group demonstrated an unusually long chronicity and high bilirubinemia. The results also revealed that the dsposition of collagen bundies in the space of Disse along with a reduce-tion of microvilli of the hepatic cytoplasmic membrane is frequently found in prolonged cholestasis.
The observations presented here may be useful in developing clinical parameters for determining the surgical outcome of extrahepatic cholestasis. We conclude that it is benificial to administer life-saving decompression for patients with severe obstructive jaundice as early as possible in order to prevent excessive formation of collagen fiber and/or hepatocyte damage.

並列關鍵字

hepatic fibrosis ； obstructive jaundice ； cholestasis