[Extrahepatic bile duct atresia--an analytic assessment of prognostic factors. Contribution to a rational therapeutic approach].

Abstract

"Extrahepatic bile duct atresias" must be classified into 4 histopathological groups according to their characteristic numerical, metrical and morphological alterations of interlobular bile ducts. A prospective study based on an observation period of 5 and more years included 43 patients with "extrahepatic biliary atresia". It showed that prognosis generally depends on 3 factors: the duration of cholestasis, the prehilar structure of the bile ducts, and the histopathologically defined features of the interlobular bile ducts. The total diameter of all the prehilar bile duct structures is unmistakably the most dominant of all findings. A total diameter of more than 400 microns indicates a favourable prognostic subtype, while a total diameter of less than 400 microns indicates an unfavourable prognostic subtype. However, even if the prognostically favourable type of findings is present, the actual prognosis is finally determined by the histopathological features of the interlobular bile ducts. Therefore, these 4 characteristic groups must be taken into consideration when rationally evaluating the prognosis.