Cholescintigraphy in the evaluation of bile flow after Roux-en-Y hepatico-jejunostomy and hepatico-antrostomy in infants with choledochal cysts

Background. The study tests the hypothesis that stasis of bile in the Roux-en-Y hepatico-jejunostomy (RYJS) loop might facilitate biliary reflux and cause cholangitis, whereas quicker transit times in hepatico-antrostomy (HAST) might prevent cholangitis. Materials and methods. Cholescintigraphy was performed using Tc99m-trimethyl-Br-IDA in seven RYJS patients and in five HAST patients. Results. The time to peak (T_max) within the RYJS loop occurred between 18 and 50 min postinjection in all patients and the mean transit time (MTT) ranged between 42 and 69 min in 5/7 patients. Prolonged clearance of the tracer from the liver was seen in 2/7 RYJS patients, in whom the MTT was 77 and 240 min, respectively. In the HAST group, the T_max within the anastomosed antrum occurred between 5 and 33 min postinjection, and the MTT ranged between 42 and 44 min in 2/5 patients. Protracted tracer uptake in the liver in one patient and localised tracer retention in the left hepatic bile ducts in 2/5 patients caused prolonged MTTs. Recurrent cholangitis and diarrhoea occurred in 4/7 RYJS patients, but in none of the HAST patients. Elevated gastrin levels after RYJS contrasted sharply to normal gastrin levels after HAST. Conclusion. The findings on cholescintigraphy did not differ significantly between RYJS and HAST and provided no explanation for the distinctly different postoperative clinical course of both surgical methods. Nevertheless, we consider cholescintigraphy to be an efficient and cost-effective diagnostic modality for evaluation of the surgical outcome as regards biliary flow. Received: 20 March 1997 Accepted: 23 June 1997     

Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction during the surgical treatment of choledochal cyst: which is better?

We reviewed our experience of Roux-en-Y hepaticojejunostomy (RYHJ) and hepaticoduodenostomy (HD) performed for the surgical repair of choledochal cyst (CC), with special emphasis on postoperative complications related to the type of biliary reconstruction performed. Eighty-six patients underwent primary cyst excision for CC from 1986 to 2002 at our institution. Forty-six cases with concurrent intrahepatic bile duct dilatation (IHBD) were excluded because HD was not used for biliary reconstruction if IHBD was present. Thus, 28 cases had RYHJ, and 12 had HD. Differences between the RYHJ and HD groups with respect to type of CC, age at cyst excision, and length of follow-up were not statistically significant. However, the incidences of postoperative complications related to biliary reconstruction, such as endoscopy-proven bilious gastritis due to duodenogastric bile reflux [4/12 (33.3%) of the HD group], and adhesive bowel obstruction/cholangitis [2/28 (7.1%) of the RYHJ group] were significantly different (p<.05). Our experience suggests that HD is not ideal for biliary reconstruction in CC because of a high incidence (33.3%) of complications due to duodenogastric bile reflux. Currently, RYHJ is our exclusive technique of choice for biliary reconstruction during the surgical repair of CC.     

Duodenogastric reflux following biliary reconstruction after excision of choledochal cyst

Duodenogastric reflux (DGR) was assessed in patients surgically treated for choledochal cyst, with emphasis on two different biliary reconstruction methods: Roux-en-Y hepaticojejunostomy (HJ) and hepaticoduodenostomy (HD). Gastric bile monitoring with the Bilitec device revealed excessive DGR in patients in the HD group. Endoscopic findings demonstrated mild to moderate gastric mucosal erosion in patients after HD. In contrast, neither DGR nor gastritis was found in patients after HJ. This preliminary study suggests that HJ, rather than HD, should be recommended as a method of biliary reconstruction for pediatric patients with choledochal cyst. Careful observation of DGR should be continued in patients who have undergone HD.     

Electromyographic study of the mechanism of postoperative cholangitis in congenital biliary atresia

Cholangitis after biliary reconstruction for congenital biliary atresia is a troublesome postoperative complication. In order to clarify its mechanism and the changes in intestinal movement after biliary reconstruction by Roux-en-Y anastomosis, we performed electromyographic (EMG) studies of the motility of the reconstructed intestine in dogs. Monitoring the basic electrical rhythm (BER) and migrating myoelectric complexes (MMC), EMG analysis was carried out. As most of the Y-loop MMCs were propagated smoothly to the anal side, according to the continuity of the intestine, the intestinal contents were transported without stagnation. These intestinal movements appear to be useful as a biliary drainage route and to prevent ascending cholangitis. A comparison of short- and long-term intestinal motility after biliary reconstruction showed adaptation of the intestinal movement following the procedure. The outflow of bile appeared to accelerate intestinal motility because of prolongation of the MMC interval in the duodenum and oral jejunum without bile flow. Offprint requests to: M. Yagi     

Estimation of postoperative fat absorption using the <Superscript>13</Superscript>C mixed-triglyceride breath test in children with choledochal cyst

No previous studies have focused on postoperative fat malabsorption in children with choledochal cyst (CC) who undergo cyst excision and Roux-en-Y (RY) hepatico–jejunostomy (HJ), a combination of procedures that can lead to the non-physiological mixture of food and bile juice. To examine the effect of RYHJ with cholecystectomy on the fat absorption ability of children with CC, we estimated postoperative fat-absorption ability using the carbon 13-labeled mixed triglyceride (¹³C-MTG) breath test. Twelve postoperative children with CC and 12 normal control children were administered ¹³C-MTG orally and asked to give breath samples at six time points: once before the ¹³C-MTG ingestion and at five 60-min intervals post-ingestion. Fecal chymotrypsin activity and fecal fat excretion were also measured. The delta value of breath ¹³CO₂ at 3, 4, and 5 h after administration and the 5-h cumulative breath ¹³CO₂ were significantly lower in the CC children than in the controls. There were no significant differences in the fecal chymotrypsin activity or fecal fat excretion of the two groups. Conclusion. Occult fat malabsorption occurs in patients with CC after RYHJ, even in the absence of clinical symptoms or abnormal laboratory data.     

Modified Kasai's procedure for a choledochal cyst with a very narrow hilar duct

Excision has been widely recognized as the treatment of choice for choledochal cysts. For biliary reconstruction after cyst excision, we have strongly recommended hepaticoenterostomy at the hepatic hilum with a wide anastomotic stoma to prevent postoperative cholangitis. However, we recently treated two infants in whom a wide anastomotic stoma could not be made due to a narrow hilar duct. Therefore, a hepatic portojejunostomy with Roux-en-Y anastomosis (Kasai's procedure) was performed after cyst excision in both case to permit free drainage of bile. The mucosa of the hilar duct was everted and fixed to the liver parenchyma to prevent stricture formation. Both babies have done well since the surgery.     

Experimental hepatoportoenterostomy: duct mucosal healing with hybrid biliary-intestinal epithelium forming an autoanastomosis

Permanent bile flow following hepatoportoenterostomy for biliary atresia is presumed to follow mucosal healing of the biliary tract to the intestinal epithelium, but the morphology of the anastomosis and the histology of the neo-biliary duct is not known. Experimental portoenterostomies were constructed in five normal 10-kg mini-pigs at approximately 3 months of age to study the healing of the anastomosis. The extrahepatic bile duct was resected in continuity with an en-bloc 1.5 × 0.3-cm segment of liver at the porta hepatis and biliary drainage was achieved with a Roux-en-Y jejunal limb. The bile duct remnant at the porta hepatis measured 3 mm in diameter. HIDA scan performed at 2 months showed prompt excretion of the radioisotope and normal function of the jejunal limb. Animals were killed at 2 weeks, 1 month, and 3 months following operation and the intact hepatobiliary anastomosis examined by routine histology and histochemical staining for acid and neutral mucins. At 2 weeks the biliary epithelial ducts were hyperplastic and showed evidence of cellular regeneration and cholangitis. By 1 month the biliary and intestinal epithelia were in close approximation. At 3 months the biliary-intestinal epithelium was healed, forming a funnel-like autoanastomosis with normal proximal biliary epithelium and distal intestinal epithelium. An intervening zone of hybrid biliary-intestinal epithelium showed basal crypts with characteristics of biliary epithelium, while the superficial glandular epithelium resembled intestinal villi. Mucin histochemistry of the hybrid epithelial lining revealed predominantly neutral mucins in the basal region of the mucosa characteristic of biliary mucosa. The luminal epithelium revealed a high acid mucin content, including goblet cells. A microvillus brush border, rich in neutral mucin, was also present apically on the luminal most cells. We conclude that: (1) hepatoportoenterostomy in normal mini-pigs is a reproducible model to study healing of the anastomosis; (2) a continuous, intact hepatobiliary-intestinal mucosa is present within 3 months following portoenterostomy; and (3) the neo-epithelium has a hybrid biliary-intestinal appearance. This study may have application to understanding the cause of cholangitis following portoenterostomy for biliary atresia.     

Congenital dilatation of extrahepatic bile ducts in children. Experience in the central hospital of Hue, Vietnam.

BACKGROUND/PURPOSE: The authors present a study of a series of cases in children with congenital dilatation of the extrahepatic bile ducts (CDEBD). METHODS: Between November 1998 and October 2002, 38 children aged between 50 days and 15 years suffering from CDEBD, admitted to the Central Hospital in Hue, Vietnam, were treated surgically with a minimum follow-up of one year. RESULTS: Diagnosis was based only on ultrasonography which was 100% accurate. According to Miyano's classification, 26 cases presented as cystic dilatation of the main bile duct (MBD) associated with dilatation of the intrahepatic bile ducts, while in the other 12 cases the dilatation of the MBD was of the fusiform type. The surgical treatment of choice was extensive excision of the dilatated extrahepatic bile ducts and biliary drainage according to the Roux-en-Y method in 36/38 patients. The other two patients underwent surgery for internal biliary drainage without removing the cysts. During follow-up we observed one case of pancreatitis out of the 36 patients who underwent excision of the dilatated extrahepatic bile ducts, while the two patients who had internal biliary drainage without removal of the cysts suffered from numerous attacks of cholangitis. CONCLUSIONS: The reflux of bile in the dilated biliary tree plays an important role in the etiopathogenesis of CDEBD. Excision of the extrahepatic bile ducts and internal biliary drainage by Roux-en-Y has proved a satisfactory surgical method.     

Choledochoduodenostomy in pediatric liver transplantation

Campsen J, Zimmerman MA, Narkewicz MR, Sokol RJ, Mandell MS, Kam I, Dovel D, Karrer FM. Choledochoduodenostomy in pediatric liver transplantation. Pediatr Transplantation 2011: 15: 237–239. © 2011 John Wiley & Sons A/S. Abstract: Reconstruction of the bile ducts during pediatric liver transplantation is generally performed by a Roux‐en‐Y CDJ because direct duct‐to‐duct anastomosis CC is often not possible. Anastomosis of the donor liver bile duct to the duodenum CDD provides another option. We provide preliminary evidence that CDD is an alternative technique for biliary reconstruction when CC is not possible in pediatric liver transplant recipients that have a hostile abdomen or to preserve bowel length. Methods: From 2007 to 2008, a total of 19 pediatric cadaveric liver transplants were performed at our center. Four of the 19 had a bile duct reconstruction by CDD. Results: CDD reconstruction was used in patients who received a liver transplant for a diagnosis of PSC, congenital hepatic fibrosis, biliary atresia, and Alagille syndrome. The ages of the patients were 17 and 10 yr and 10 and 17 months. Three grafts were whole cadaveric livers, and one was a reduced left lobe. CDD was used to revise a prior anastomosis in one patient who had a previous Roux‐en‐Y that was unusable during the retransplant, and another to repair a stricture in a second patient with a CC. We also performed a CDD in a patient with a hostile abdomen from previous surgery, and another patient to avoid short gut syndrome that a Roux‐en‐Y may have created. All patients are alive with functioning grafts with a follow‐up of at least one yr. None of the patients developed clinically significant biliary complications (leak, stricture, cholangitis). Conclusion: Our preliminary experience suggests that CDD is an option for biliary reconstruction in pediatric transplant patients with hostile abdomens or to preserve bowel length.     

经腹腔镜手术治疗Ⅰ、Ⅱ型胆道闭锁

目的 对经腹腔镜手术治疗Ⅰ型及Ⅱ型胆道闭锁的效果进行探讨.方法 自2003年3月至2007年7月,共收治患Ⅰ型及Ⅱ型胆道闭锁并胆管囊性扩张的患儿10例,其中Ⅰ型8例,Ⅱ型2例;男4例,女6例;年龄23～160 d,平均53.8 d.患儿均有黄疸、陶土样便等症状;伴有总胆红素、转氨酶明显升高;术前经B超等影像学检查证实有肝门部囊性扩张的胆管存在,平均直径1.5 cm(1.0～1.8 cm);10例经术中证实为Ⅰ、Ⅱ型胆道闭锁伴有肝外胆道囊性扩张.本组10例患儿行经腹腔镜扩张的胆管底部切除胆管空肠Roux-en-Y吻合术.术后平均随访26个月(4～51个月).结果 本组10例患儿行经腹腔镜手术全部成功,无中转开腹.手术时间平均为3.0 h(2.4～3.2 h),术中出血量5～10ml.术后胃肠平均通气时间为18 h(16～28 h),进食时间平均20 h(16～30 h);平均术后3 d(2～4 d)排黄色大便;腹腔引流放置时间平均58 h(48～72 h),平均术后10 d(7～16 d)黄疸减轻,6例患儿术后14 d总胆红素直接胆红素降至正常水平,3例患儿3个月降至正常水平,1例手术年龄5.5个月患儿虽获良好胆汁引流,胆红素水平有所降低,但因肝硬化严重,后来仍维持高水平,胆汁引流后肝功能改善不佳,术后28 d死于肝功能衰竭.转氨酶术后不同程度的下降.术后平均住院时间6.8 d(5～9 d).术后随访4～51个月,1例患儿于术后4周发生胆管炎,经抗炎后痊愈.其余患儿肝功能各项指标均正常,无胆管炎、吻合口狭窄、粘连肠梗阻等术后并发症.结论 经腹腔镜囊性扩张的胆管底部切除胆管空肠吻合术治疗Ⅰ、Ⅱ型胆道闭锁是一种安全有效、可靠的方法.     

Perioperative factors affecting the outcome following repair of biliary atresia

The records of all patients with biliary atresia seen at the Childrens Hospital of Los Angeles during a 14-year period were reviewed. Of the 41 patients who could be evaluated, 32 were treated with trimethoprim and sulfamethoxazole prophylaxis, five were given other agents, and four received no prophylaxis after surgery. At least one episode of cholangitis occurred in nine patients. With one exception, all patients destined to have cholangitis did so within 9 months of surgery. Of the nine patients, five were receiving prophylaxis at the time the disease developed, but two were no longer receiving any prophylaxis. The other two patients in whom cholangitis developed never received antibiotic prophylaxis. In the 24 patients who had a Kasai type of portoenterostomy, cholangitis developed in three of the five (60%) with a Roux-en-Y limb length less than 40 cm and in two of the 19 (10.5%) with limb lengths greater than 40 cm (P less than .02). When performed earlier than 61 days after birth, surgery resulted in adequate bile flow in 64.7% (11/17) of patients who could be evaluated as compared with 31.8% (7/22) for surgery at 61 days or later (P less than .05). Of the patients with adequate biliary drainage 11 had no apparent liver disease, but only two of the patients with poor drainage were free of clinical liver disease. The conclusion from this series is that a combination of timely surgery, intestinal conduit at least 40 cm in length, and subsequent long-term antibiotic prophylaxis favors the best bile flow and reduces the occurrence of cholangitis, resulting in the best outcome.     

Intrahepatic biliary cysts after hepatic portoenterostomy in four children with biliary atresia

We report our experience with 4 cases of cystic dilatation of intrahepatic bile ducts following hepatic portoenterostomy for biliary atresia. Two of the cases did not achieve satisfactory bile excretion and all four cases developed recurrent cholangitis after hepatic portoenterostomy. The attacks of cholangitis seemed to be associated with the presence of intrahepatic cysts. Although one case resulted in death from hepatic failure, three other cases are now outpatients. Patients who develop recurrent cholangitis following hepatic portoenterostomy, should be examined to exclude the presence of intrahepatic biliary cysts. Ultrasonography, computed tomography and percutaneous transhepatic cholangiography were all effective in detecting cysts and provided valuable information for planning treatment. Percutaneous transhepatic or surgical drainage of the bile ducts was effective in reducing jaundice, and recurrent cholangitis.     

先天性胆总管囊肿合并门脉高压症

目的 探讨先天性胆总管囊肿（ＣＣ）合并门脉高压的原因、类型及转归。方法 将１７例ＣＣ合并门脉高压与１３例ＣＣ不合并门脉高压者进行比较,项目包括病程、胆源性发热、胆总管囊肿的最大前后径、胆道压力、肝组织病理变化、病理图像分析,对门脉高压患儿进行随访。结果 门脉高压组（ＰＨ）胆源性发热发生率高,胆道压力高于非门脉高压组（ＮＰＨ）,门脉高压组肝组织病理观察发现：１４例肝小叶完整,门静脉及肝静脉分支走行正     

Periodic bile cultures and irrigation of the external jejunostomy for cholangitis in biliary atresia

We retrospectively investigated the use of periodic bile cultures and irrigation of the external jejunostomy for prevention or treatment of postoperative cholangitis in 11 infants who had undergone the Suruga II modification with external jejunostomy for biliary atresia. Periodic cultures obtained from bile in the external jejunostomy were done weekly in all patients. Staphylococci were first cultured 1 week after operation, followed by intestinal flora such as enterococci, Pseudomonas, Klebsiella, or Enterobacter. Most of the cultures revealed two or more microorganisms. Susceptibility testing indicated the effective antibiotics for the treatment of each case of cholangitis. Therefore, periodic bile cultures and irrigation of the external jejunostomy provide important information for prevention or treatment of postoperative cholangitis, especially in the early postoperative period.     

Ductoplasty for an aberrant hepatic duct in a choledochal cyst

The confluence of the right and left hepatic ducts at the hepatic hilum frequently shows normal anatomic variations. Choledochal cysts (CC) are also accompanied by similar variations, and devices for free drainage of bile are occasionally required in biliary reconstruction. We present a CC that had an aberrant posterior branch of the right hepatic duct draining into the distal common hepatic duct. A capacious hepaticoduodenostomy at the hilum was performed after joining the hilar and aberrant ducts.     

Out-of-reach obscure bleeding: single-balloon enteroscopy to diagnose and treat varices in hepaticojejunostomy after pediatric liver transplant

Obscure gastrointestinal (GI) bleeding is defined as bleeding from the GI tract that persists or recurs, with no obvious etiology, after esophagogastroduodenoscopy (EGD), colonoscopy, and radiologic evaluation of the small bowel. We present the case of a 17-yr-old girl who for two years had been suffering from recurrent episodes of melena and/or enterorrhagia. Fifteen yr earlier she had undergone a split-liver transplant with Roux-en-Y biliary reconstruction. A series of endoscopic and radiologic investigations had failed to find the source of the bleeding. Suspecting the presence of ectopic varices, we decided to perform single-balloon enteroscopy (SBE). We observed and aspirated a large amount of fresh red blood in the afferent loop until we found the hepaticojejunostomy. On the edge of the biliary-enteric anastomosis we observed a vascular lesion 5 mm in diameter. Judging this ectopic varix to be the source of bleeding, we placed two endoclips. The second clip placement caused varix rupture with a consequent massive hemorrhage, emergently and successfully treated with cyanoacrylate sclerotherapy. No episodes of rebleeding were observed, and no complications occurred during the entire hospital stay, and after six months of follow-up. This report highlights the importance of afferent loop examination in patients with obscure GI bleeding who have undergone liver transplant with Roux-en-Y biliary reconstruction.     

腹腔镜下手术治疗先天性胆总管囊肿198例分析

目的探讨腹腔镜下手术治疗先天性胆总管囊肿的中短期效果,总结临床体会。方法回顾性分析2006年10月至2014年4月我们收治的198例腹腔镜下胆总管囊肿患儿临床资料。其中男性53例,女性144例;年龄1个月至13岁,平均年龄38.2个月。临床特征:102例为间歇性右上腹痛,25例黄疸,7例排陶土便,13例存在腹部包块,45例有肝功能损害,31例血淀粉酶升高。均予囊肿切除、肝管-空肠Roux-en-Y吻合术。总结分析术中、术后及随访情况。结果 198例患儿囊肿直径1~20 cm,平均4.26 cm,其中囊状扩张186例,梭型扩张12例。Todari's分型Ⅰ型191例,Ⅳ型7例。198例中,19例中转开腹手术,其中9例炎症粘连剧烈,4例肝总管细小,2例囊肿突入十二指肠,2例囊肿巨大术野暴露不清楚,1例腹腔镜下无法确认肝管,1例见右副肝管。其余179例顺利完成腹腔镜下胆总管囊肿切除、肝管-空肠Roux-en-Y吻合胆道重建术。手术时间130~480 min,平均255 min。术后6例出现胆漏,3例出现吻合口狭窄,其中5例再次行开腹手术。1例出现输入袢粘连绞窄坏死,重新行Roux-en-Y吻合。1例出现粘连性肠梗阻,经保守治疗好转。其余病例随访3个月至8年,无并发症,肝功能均正常。结论腹腔镜下手术治疗先天性胆总管囊肿具有切口小、暴露清晰、恢复快等优点,但对术者要求较高,术中操作困难时及时中转开腹手术,可降低手术风险,减少并发症的发生。     

The impact of solid-phase gastric emptying studies in the management of children with dyspepsia

Information on the utility of solid-phase gastric emptying studies (SPGES) in the evaluation of children with symptoms of upper gastrointestinal (GI) motor dysfunction is limited. This study was conducted to evaluate the impact of SPGES in the clinical management and outcome of children with upper GI symptoms suggestive of gastroparesis. The records of 45 children who underwent SPGES (31F; 3-17 years) were reviewed. All patients had GI symptoms suggesting gastroparesis. Patients were fed with Tc-99m-sulfur colloid-labeled chicken liver. Adult normal half-life (T1/2) values (F 103 +/- 14 minutes; M 66 +/- 13.6 minutes) were used. The relationships among symptoms, treatment, and outcome were evaluated. Of the 45 patients 9 had delayed, 16 had rapid, and 20 had normal gastric emptying. Six of 9 patients with delayed gastric emptying responded to cisapride. Four of 16 patients with rapid emptying were diagnosed with the dumping syndrome. Of the children with rapid gastric emptying, 87% were females. Twenty patients with normal emptying were diagnosed with gastroesophageal reflux (8), nonulcer dyspepsia (5), irritable bowel syndrome (2), Helicobacter pylori (1), lactose intolerance (1), eosinophilic gastroenteritis (1), duodenitis (1), and constipation (1). In patients who had SPGES for possible gastroparesis, 20% had gastroparesis, 36% had rapid gastric emptying, and 44% had normal gastric emptying. The high number of females in the rapid gastric emptying group might be secondary to normal adult female T1/2 values that were used. The practice of using adult normal T1/2 values in prepubertal girls may need to be revised. Patients with delayed gastric emptying responded to cisapride.     

Hepatobiliary scintigraphy for cholestasis in congenital hepatic fibrosis. Diagnosis and treatment

A 9-year-old child with congenital hepatic fibrosis had dilated intrahepatic bile ducts and recurrent cholangitis. Choleretic agents were administered to prevent recurrent cholangitis. Response to treatment was monitored with serum bile acid concentrations and computer-assisted technetium Tc 99m iprofenin (Pipida) scintigraphy. Dehydrocholic acid with meals improved hepatobiliary excretion of the radioactive isotope and lowered serum bile acid levels but did not prevent cholangitic attacks when used alone. Sulfamethoxazole and trimethoprim used alone prevented infection, but a steady rise in serum bile acid concentrations suggested increasing cholestasis. During combined drug treatment, the patient remained free of cholangitis for at least two years. Optimal therapy of congenital hepatic fibrosis with cholestasis but without mechanical biliary obstruction may involve the combined use of a choleretic such as dehydrocholic acid plus a suppressive antibiotic.     

胆道闭锁术后早期胆管炎风险因素分析

目的 探讨影响胆道闭锁术后早期胆管炎发作的风险因素. 方法 对本院2007年1月至2011年12月收治胆道闭锁患儿临床资料进行回顾性分析.所有患儿均采用统一治疗方案,包括手术方式为标准Kasai手术或肝管空肠吻合术,术中胆支引流肠襻45 cm,术后使用激素、抗菌素和利胆药物.将病例以手术年龄、术后黄疸清除效果、Ohi分型和肝纤维化病理分级进行分组,分析影响早期胆管炎发作的原因. 结果 共有139例BA患儿进行手术,124例获得随访.术后35例早期胆管炎发作,发生率为28.3％.术后黄疸完全清除率早期胆管炎发作组低于未发作组（28.2％∶71.8％,P=0.004）,术后1年、2年自体肝生存率早期胆管炎发作组低于未发作组（分别为44.5％±8.5％∶86.5％±3.6％,44.5％±8.5％∶76.3％±4.5％,P=0.003）.Logistic分析显示黄疸清除速度（P=0.000）,肝纤维化病理分级（P =0.029）和Ohi分型基本型（P =0.042）影响早期胆管炎发作而与手术年龄（P=0.579）,Ohi分型亚型（P=0.511）和肝外胆管详细分型（P =0.224）无关.结论 良好的肝门部病变类型,术后较好的胆汁引流和较轻的肝纤维化有利于减少胆道闭锁术后早期胆管炎的发生.