胆结石患者胆囊黏膜的组织病理学变化：与胆结石化学成分的相关性

Baig S J, Biswas S, Das S, Basu K, Chattopadhyay G

Medical College Hospital, Calcutta 700 073, India.

Trop Gastroenterol. 2002 Jan-Mar;23(1):25-7.

BACKGROUND

Cholelithiasis produces diverse histopathological changes in gallbladder mucosa namely acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia, and carcinoma. Gallstones have different chemical composition. They may be cholesterol, pigment or mixed stones. The aim of this prospective study was to see if any correlation existed between the chemistry of gallstones and any particular histopathologic picture.

METHODS

Between May 1997 and December 1997 we diagnosed and operated on 40 patients with cholelithiasis. Diagnosis was established by ultrasound. After operation gallstones were sent for chemical analysis to detect presence of calcium bilirubinate and cholesterol. Serial sections of gallbladder from fundus to neck were stained by haematoxylin and eosin, and studied.

RESULTS

Out of 40 patients (n = 40) 29 were females and 11 were males. The mean age of our patients was 38 +/- 21 years with a median of 40 years. Median age of males was 48 years compared to 38 years for females. Twenty-eight patients had mixed stones, 8 had pigment stones and 4 had cholesterol stones. Out of 28 patients with mixed stones 14 had histological picture of chronic cholecystitis, 8 had granulomatous cholecystitis, 4 had adenomatous hyperplasia, 1 had dysplasia and 1 had carcinoma. All 8 patients having pigment gallstones had chronic cholecystitis. Out of 4 patients with cholesterol gallstones, 2 had chronic cholecystitis, 1 had adenomatous hyperplasia and 1 had cholesterosis. Gallbladder having pigment stones were devoid of Rokitansky-Aschoff sinuses.

CONCLUSION

Adenomatous hyperplasia and Rokitansky-Aschoff sinuses were not seen in gallbladder containing pigment stones but seen in gallbladders containing mixed and cholesterol stones in our study. Cholesterol may be a more potent stimulus for glandular hyperplasia or glandular hyperplasia may responsible for formation of cholesterol rich stones.

背景

胆石症会在胆囊黏膜产生多种组织病理学变化，即急性炎症、慢性炎症、腺体增生、肉芽肿性炎症、胆固醇沉着症、发育异常和癌。胆结石有不同的化学成分。它们可能是胆固醇结石、色素结石或混合性结石。这项前瞻性研究的目的是观察胆结石的化学成分与任何特定组织病理学表现之间是否存在关联。

方法

1997年5月至1997年12月期间，我们对40例胆石症患者进行了诊断和手术。通过超声确诊。术后将胆结石送去进行化学分析，以检测胆红素钙和胆固醇的存在。对从胆囊底部到颈部的连续切片进行苏木精和伊红染色并研究。

结果

40例患者中，女性29例，男性11例。患者的平均年龄为38±21岁，中位数为40岁。男性的中位数年龄为48岁，女性为38岁。28例患者有混合性结石，8例有色素结石，4例有胆固醇结石。在28例有混合性结石的患者中，14例有慢性胆囊炎的组织病理学表现，8例有肉芽肿性胆囊炎，4例有腺瘤样增生，1例有发育异常，1例有癌。所有8例有色素胆结石的患者均有慢性胆囊炎。在4例有胆固醇胆结石的患者中，2例有慢性胆囊炎，1例有腺瘤样增生，1例有胆固醇沉着症。有色素结石的胆囊没有罗-阿窦。