title: Hepatic portocholecystostomy (HPC) is ineffective in the treatment of biliary atresia with patent distal extrahepatic bile ducts.
abstract: OBJECTIVE
  To compare the effects of hepatic portocholecystostomy (HPC) and the Kasai procedure for the treatment of biliary atresia with patent distal extrahepatic bile ducts (BA with PDEBD) and to determine the reasons for the differences between the two procedures.
  
  
  METHODS
  The case files of 29 patients with BA with PDEBD were reviewed retrospectively. Twenty patients were treated with the Kasai procedure, and 9 patients were treated with HPC. We compared the rate of jaundice clearance, the incidence of cholangitis, survival rates of the native liver, and clinical outcomes between the two groups. Healthy gallbladders were collected for comparison with the pathologic specimens. Van-Gieson stains were used to detect the severity of fibrosis, and immunohistochemical methods were used to investigate the expression of CD68. Image analysis technology was used to quantitatively analyze the results.
  
  
  RESULTS
  Six months after surgery, the rate of jaundice clearance was 85% in the Kasai group and 33.3% in the HPC group (p = .01). The three-year survival rates of the two groups were 73.68% and 33.3%, respectively (p = .009). According to the criteria that define a cured state, there was an obvious difference between the two groups (p = .0056). The fibrosis and CD68(+) cell infiltration were more severe in the gallbladders of patients with BA than in controls (p < .05).
  
  
  CONCLUSIONS
  HPC was inferior to the Kasai procedure in the treatment of BA with PDEBD. This result may be due to the progressive inflammation and fibrosis of the extrahepatic bile duct.
authors.affiliation: Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, PR China.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhao
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.forename: Chun
authors.initials: C
authors.lastname: Shen
authors.forename: Shan
authors.initials: S
authors.lastname: Zheng
authors.forename: Xianmin
authors.initials: X
authors.lastname: Xiao
mesh_terms: D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D017734:Bile Ducts, Extrahepatic / Q000473:pathology / Q000601:surgery*; D001656:Biliary Atresia / Q000473:pathology / Q000601:surgery*; D002761:Cholangitis / Q000209:etiology / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005704:Gallbladder / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000379:methods; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; C067980:CD68 antigen, human; D000097382:CD68 Molecule