Abstract
Twenty-eight patients with externally draining conduit following Kasai procedure for biliary atresia were subjects for quantitation of bile flow and for assessment of the physiologic respons to choleretics. Bile acids were determined by using an enzymatic method and high-perfomance liquied chromatography(HPLC). Schedule of choleretics is given as follows. Administration of dehydrocholic acid is continued until serum bilirubin falls less than 3mg/dl. Prednisolone is given on 7th postoperative day. The dose of prednisolone is reduced every two days and ceased 8 days later. When bile flow is not significant and serum bilirubin level does not fall by 2 weeks after operation, we given glucagon, prostaglandin E_2 and prostaglandin F_2α as alternative choleretics. 1) We devided our cases into 4 types based on their postoperative course. 2) Serum bile acids level before operation was higher in jaundice-cleared group than in group with persistent jaundice. 3) Bile flow and bilirubin excretion correlated significantly with bile salts excretion. This suggested a presence of bile salts dependent and independent bile secretion mechanism. Bile salts excretion was more than 0.9m mol/day and bilirubin excretion was more than 10mg/day in jaundice-cleared group. 4) The composition of bile acids in each group was mainly glycocholic acid and ratio of free bile acids was higher in group with persistent jaundice than in jaundice-cleared group. 5) We examined thoroughly efficacy of each choleretics after jaundice was dissapeared. Volume and concentration of bile salts in bile increases markedly after dehydrocholic acid infusion, but bilirubin excretion decreased. Bile flow increased slightly after glucagon infusion. Bile flow, bilirubin and bile salts excretion increase also after prednisolone infusion. These results suggest that measurement of bile acids in serum and bile is useful to presume prognosis. Dehydrocholic acid and prednisolone infusion is effective in early stage after operation, and administration of optimum choleretics based on pathophysiology of liver is important.
