Rivilla F, Vázquez J, Ros Z, Jara P, Díez-Pardo J
Cir Pediatr. 1989 Jul;2(3):110-3.
From July 1976 to February 1988 52 cases of extrahepatic biliary atresia were treated at our institution and 16 patients underwent reoperation. The original procedure were portojejunostomy in 11 cases (68 for 100), portocholecystostomy in four (25 for 100) and omento-duodenopexy in one (6 for 100). Age average at operation was 61 days; twelve had bile excretion. The reoperation was performed due to absence of bile drainage in three cases, cholangitis in 9 and bile peritonitis in four. Surgical procedures used at reoperation were: excision of scar tissue at the porta hepatis (12 patients) and portojejunostomy (five patients). Age average at reoperation was 105 days. Seven cases excreted bile. Liver pathology studies showed fibrosis in 12 cases and precirrhosis in four. The porta hepatis showed biliary ducts less than 100 mu in 10 cases, between 100mu-200mu in two, and absence of bile ducts in four. Currently four children are doing well with a mean long-term follow-up of 48 months, five are awaiting liver transplantation and one patient is doing well sixteen months post-transplant. Six patients (38 for 100) died. The best results were observed in those cases with early bile flow excretion after the first operation.
1976年7月至1988年2月，我院共治疗52例肝外胆道闭锁患者，其中16例接受了再次手术。初次手术方式为：11例行肝门空肠吻合术（占68%），4例行肝门胆囊造瘘术（占25%），1例行大网膜十二指肠固定术（占6%）。手术时平均年龄为61天；12例有胆汁排出。再次手术的原因是：3例无胆汁引流，9例发生胆管炎，4例发生胆汁性腹膜炎。再次手术采用的术式为：肝门部瘢痕组织切除（12例）和肝门空肠吻合术（5例）。再次手术时平均年龄为105天。7例有胆汁排出。肝脏病理检查显示12例有纤维化，4例有肝硬化前期表现。肝门部胆管内径小于100μm的有10例，100μm至200μm的有2例，无胆管的有4例。目前，4例患儿情况良好，平均长期随访48个月，5例等待肝移植，1例患者移植后16个月情况良好。6例患者（占38%）死亡。首次手术后早期有胆汁排出的病例效果最佳。
