抄録
71 biliary atresia patients were treated in the period from 1969 to March 1984. 11(19.6%) of 56 patients (the first group), who had been explored the ventral side of the bifurcation of the portal vein and underwent hepatic porto-enterostomy, had disappearance of jaundice (serum bilirubin 1. 0 mg/dl) postoperatively. On the other hand, 10 (66.7%) of 15 (the second group) patients who underwent extensive portal exploration including the dorsal and cranial side of the 1st branch of the portal vein and had the anastomosis which was made not to obstruct the explored area with the anastomosed intestine had disappearance of jaundice. Intrahepatic bile ducts were studies with pecutaneous transhepatic cholangiographies (PTC) in 7 jaundice free patients (3 of the first groups, 4 of the second groups). PTC showed anatomically normal intrahepatic bile ducts in all patients, though their walls were irregular. Intrahepatic bile ducts connected with the intestine with a narrow communications, which seemed to be finer than normal intrahepatic bile ducts and to follow a different course from the portal tracts. The length of communications was 0.6, 0.8, 1.5 and 1.9mm in 4 patients of the second group respectively, on the other hand, 2.4, 8.3 and 11.0mm in 3 patients of the first group. Their difference was significant. Extensive portal exploration towards intrahepatic bile ducts, may result in shorter distance between intrahepatic bile ducts and the anastomosed intestine. This may explain the better biliary drainage into the intestine in the modified operation.
