J.Jpn. Surg. Soc.. 60(12): 1923-1931, 1960

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STUDIES ON CHOLELITHIASIS
Ⅰ. A STATISTICAL ANALYSIS OF CHOLELITHIASIS (AUTOPSY CASES)

The author has made a detaield analysis of autopsy cases of cholelithiasis from various angles, selected out of 4,744 necropsies studied in the pathological laboratories of the Tokyo University and of Tohoku University during the past 10 years, as well as those of the Nippon Medical School during the past 9 years. The results of these observations may be summarized as follows :
1) The incidence of cholelithiasis was 4.5%, which is much higher than that hitherto published in the Japanese medical literature, such as 3.05% reported by Professor Miyake.
2) In regard to the sex difference, the females were predominant, the ratio being 1 : 1.26 as compared with the males.
3) As to the site of gall-stone formation, the gall-bladder was the most frequent involved location. Cases of intrahepatic calculi occurred in 7.9% at the Tokyo University, an incidence which is much lower than 17.8% reported by Professor Motsuo but closer to 8.3% observed by Professor Beer. However, the incidence of 18.6% seen at the Tohoku University approaches that recorded by Matsuo.
4) In examining the chemical nature of the calculi as being either cholesterol or bilirubin recorded in autopsy cases, the incidence of cholesterol stones was 63% at the Tokyo University, while it was 55.8% at the Tohoku University. Thus, the figure from the Tokyo University is greater by nearly 20% as compared with that published by Professor Miyake but only slightly so than that from the Tohoku University.
The foregoing results of observations are in harmony with the remarks made by Professor Matsukura in his work on the limitation of surgical treatment of cholelithiasis : "Although it is difficult to state categorically at present as to which of the two varieties of gall-stones, cholesterol or bilirubin, predominates among the Japanese people as a whole, it is increasingly becomiog clear that the peculiarity of the high incidence of bilirubin calculi, as compared to cholesterol stones, in the Japanese population, is gradually losing its grounds and approaching that found among the European and American peoples, as a result of general improvement in social conditions and dietary habits".
Perhaps one of the most important contributory factors in the etiology of cholelithiasis in the Japanese is the dietary improvement which showed a great progress during the past 20 years. This problem has been investigated in the light of the table prepared by the Welfare Ministry showing the amount of nutrients ingested by the Japanese. The greatest increase in the amount of fat ingested is indicated for the year of 1956, as compared with a period from 1934 to 1938, far more than the increase in the ingestion of protein. While the daily amount of fat ingested during 1934-1938 was 16.6 g, it showed a striking increase to 23.9 g in 1956. This increased amount of ingested fat necessarily results in a higher concentration of fat in the blood and bile. This situation is believed to favor the formation of cholesterol gall-stones, thus causing a marked rise in their incidence.
(Author's abstract)

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