Analysis of the bile flow in biliary atresia

Objective To assess the prognostic values of intraoperative bile flow and bile components in patients with biliary atresia. Methods The intrahepatic bile of 27 children with biliary atresia (BA) were collected intraoperatively. The bile collected from 17 children with choledochal cysts in surgery were studied as the control group. Bile flow was monitored in 7 cases. The concentrations of phospholipid, total protein (TP), bile acid (TBA), the total bilirubin (TBIL), direct bilirubin (DBIL),total cholesterol (TC), aspartate aminotransferase (AST), alanine aminotransferase ( ALT), γ- glutamine (GGT),alkaline phosphatase (ALP) in bile were measured. Patients with BA were followed for 1-6 months post-operatively. The information collected during the follow-up included the time when the jaundice disappeared,the blood biochemistry and onset of cholangitis. Results The bile flow of children with BA were significantly lower than that in the control group (P 60 days or preoperative blood ALT > 150 U/L were significantly lower than that in the control group (P<0. 05). The jaundice-relieving rate 2 months post-operatively in children with BA whose bile flow ≥0. 19 ml/min was significantly higher than that in patients whose bile flow <0. 19 ml/min (P<0. 05). The concentrations of phospholipid,TBA and DBIL in bile of children with BA were significantly lower than those in the control group (P<0. 05). The concentration of ALT in bile of patients with BA was significantly higher than that in the control group (P<0. 01 ). The concentrations of AST and TC in bile of children with BA whose jaundice have been relieved before the third month postoperatively were significantly lower than those in with persistent jaundice (P<0. 05). Conclusions The correlation between the intraoperative bile flow and the prognosis is significant in children with BA: the faster the bile flow, the better of prognosis. This suggested that the intraoperative bile flow can effectively predict the long-term prognosis of BA after Kasai operation. The change of bile components in bile of BA indicated that the hepatic function of BA is poor, the lower concentrations of phospholipid,TBA and DBIL in bile may be due to poor hepatic function. The correlations between the concentrations of AST and TC in bile and prognosis were significant:, the lower of the concentration of AST and TC, the better of prognosis. Key words: Biliary atresia;  Bile;  Bile excretion