| 特集名 | 原発性胆汁性肝硬変 -- 最近の話題 | |
|---|---|---|
| 題名 | 原発性胆汁性肝硬変の診断 (3) 腹腔鏡像 | |
| 発刊年月 | 2003年 05月 | |
| 著者 | 大野 明彦 | 埼玉医科大学第三内科 |
| 【 要旨 】 | 原発性胆汁性肝硬変（以下，PBC）は小葉間胆管の破壊と消失による肝内胆汁うっ滞疾患である．この肝内病変の分布は不均一であり，部位によって進行度に差が存在する．腹腔鏡検査は，異なる部位より複数の生検標本を実視下で安全に採取できることから，病変の不均一性に基づく病理学的検査の不確定さを向上でき，PBCは今もよい適応疾患の一つである．PBCの腹腔鏡像では，(1) reddish patch，(2) 黄白色斑，(3) 淡い輪郭の白色紋理，(4) 粗大な起伏性変化の四つの所見が特徴的である．このうち，前の三所見は肝表面が平滑な初期にみられ，(4)はそこから進行した段階で出現する．また肝硬変期では，緑色調を呈する丈の低い結節と幅の広い間質が特徴である． | |
| Theme | Primary Biliary Cirrhosis : update 2003 | |
|---|---|---|
| Title | Laparoscopic Diagnosis of Primary Biliary Cirrhosis | |
| Author | Akihiko Ohno | Third Department of Internal Medicine, Saitama Medical School |
| [ Summary ] | The distribution of findings for primary biliary cirrhosis (PBC) is not equal in the liver. The progress of the disease also differs from area to area. Since laboratory and imaging tests have developed greatly in recent years, the number of liver diseases for which laparoscopy is effective in making diagnoses has gradually decreased. However, this method is effective for PBC, as well as autoimmune hepatitis, at the present time. The characteristic findings for PBC in laparoscopy are as follows: 1) reddish patches, 2) yellowish-white spots, 3) mesh-like white markings, and 4) protuberance formation. The first three findings are observed on smooth and flat surfaces of the liver in the early stages. Protuberance formation, identical to gentle undulations, appears in the next stage. In the cirrhotic stage, low green nodules with broad interstitial fibrosis are characteristic. |
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