The Pathologic Changes Of Bile Ducts In The Children With Biliary Atresia After Kasai Portoenterostomy

Objective: To study the changes of the intrahepatic bile duct stucture in the children with biliary atresia(BA) after kasai portoenterstomy(KP), and analysis the relationship with cholangioitis, in additionto to explore the differences between the hepatic lilar change and the pathological changes of liver, provide the basis for clinical treatment of cholangioitis and improving Kasai operation.Methods: 1. Liver specimens after KP were collected intraoperatively in 16 patients with liver transplantation(LT)as LT group. Besides another liver biopsy specimens were collected intraoperatively in 16 patients with Kasai procedure as Kasai group. Measurement technique included Hematoxylin and eosin(HE) staining and immunohistochemical(IHC) staining to detecting the portal area about the interlobular bile duct diameter, lumen number; interlobular bile duct hyperplasia degree; interlobular bile thrombi; inflammatory cell infiltration; bile duct plate malformation; collect clinical situation of cholangitis and analysis the relationship with cholangioitis. 2. Liver specimens were divided into two groups. The first group(the poor drainage group) includes those with poor biliary drainage, last postoperative jaundice, progressive deterioration of liver function among these 13 cases with BA who received LT due to cholestatic cirrhosis after KP. Take biopsy from their porta hepatis and liver tissue. The second group(the good drainage group) includes 3 cases with BA who received LT due to recurring cholangitis caused by cyst in hepatic hilar region which after KP jaundice fade and liver function recovery. Take biopsy from 1 cm to hepatic duct in both sides.Results: 1. The pathologic changes of autologous liver specimen compared with two groups: bile duct diameter increased, open bile duct lumen decreased, bile duct epithelial hyperplasia degree aggravated, bile plugs and inflammatory cells infiltration degree reduced, more mass type ductal plate malformation(DPM) after KP. The number of bile duct lumen in LT group was obviously less, and the inflammatory cellsinfiltration was significantly lower than the Kasai group, but bile duct epithelial hyperplasia was significantly heavier than the Kasai group, the difference was significant(P <0.05); The pathologic changes of bile ducts at different positions of liver in the LT group: The left liver lobe(LL) diameter smallest, bile duct damage severest; The right liver lobe(RL) biliary injury is lighter, but inflammatory cells infiltration heaviest; porta hepatis bile duct diameter largest, but bile plugs severest; The LT group:the sum of bile duct diameter with BA children>300μm, which underwent KP <60 days, longer survival with autologous liver, the time of LT was late, less cholangitis, with better clearance of jaundice. 2. The poor drainage group: the pathological changes of intrahepatic were primarily found in liver fibrosis, bile duct hyperplasia and vascular hyperplasia. cholestasis and inflammatory cells infiltration was lighter, and found small bile lake. But portal fibrosis was more severe than the intrahepatic, especially more isolated false flocculus, hyperplasia bile duct gradually invasive lobular with liver cell degeneration, porta hepatis cholestasis relatively worse; The good drainage group: from anastomotic gradually spread to intrahepatic, the LL inflammation and bile thrombi gradually reduced, with bold tube, few open lumen relatively, large bile duct diameters up to 750μm; The good drainage group: various parts of the RL damage degree was no significant difference, bile duct hyperplasia obviously, more open bile duct lumen, but the diameter were small, maximum of 390μm.Conclusions:The children with BA after KP which intrahepatic bile duct changes including the hyperplasia of periportal bile duct, open bile duct diameter had an impact on the frequency of cholangioitis; it was suggested to proceed early Kasai operation to reduce bile duct injury, extend autologous liver survival time. The LL with a large bile duct diameter, may indicate the need to strengthen the breadth of hilar dissection.