total bile duct resection

Surgical treatment of choledochal cysts for cholangiocarcinoma cystectomy. Common bile duct cysts, also known as congenital choledochal cystic dilatation, are more common in children, but some patients have clinical symptoms in biliary tract infections, stone formation, biliary obstruction and other complications in adulthood. Treatment of diseases: iatrogenic bile duct injury in biliary tumors Indication Common cholangiocarcinoma resection is applicable to: 1. Types I, II, and IV of the common bile duct cyst, the patient can withstand more complicated surgery. 2. Adult choledochal cysts. 3. Adult patients have undergone cyst duodenal anastomosis at an early age. 4. Once the cyst was drained in the intestine but the symptoms continued. 5. Have undergone reoperation of cyst drainage. 6. Cysts are cancerous and can still be surgically removed. Contraindications 1. The patient's physical condition is difficult to tolerate complex surgery. 2. Combined with high portal hypertension of cirrhotic portal vein, numerous vessels around the cyst, severe bleeding, difficult to perform a first-stage operation. 3. It is not suitable for complicated cystectomy for technical reasons. Preoperative preparation 1. Ask your medical history in detail. 2. A comprehensive system of physical examination. 3. Laboratory tests, in addition to routine items, should have serum bilirubin, alanine, aspartate aminotransferase (GPT, GOT), alkaline phosphatase, plasma protein, prothrombin time and activity before and after application of vitamin K11 , HBsAg, alpha-fetoprotein (AFP), serum potassium, sodium, chlorine, creatinine, urea nitrogen, blood glucose and other items. 4. Evaluation of important organ functions such as heart, lung, liver and kidney. 5. Patients with jaundice or recurrent cholangitis history, or have done biliary tract surgery one or more times, must make a correct evaluation of the patient's general condition, elderly patients should be carefully examined for the function of various organs of the body, Perform the necessary treatment. 6. Correct malnutrition, anemia and hypoproteinemia. Hemoglobin is above 100g/L, and plasma albumin protein is safer than 30g/L. 7. Imaging diagnosis to understand the type of cyst, especially with or without intrahepatic biliary cysts and other intrahepatic lesions. 8. Liver function tests to understand the state of liver function, especially for patients with long course and complicated conditions, some patients may have cirrhosis, and some patients with intrahepatic cysts may have liver fibrosis. 9. Apply vitamin K. 10. Preoperative antibiotics, those who have undergone cyst drainage, apply antibiotics that are effective against aerobic and anaerobic bacteria (such as metronidazole). If the time of surgery is long, it should be added once during surgery. Surgical procedure 1. Generally, the right rectus abdominis incision is used. If the original surgical scar is used, the original incision or another incision may be selected. After the abdomen, the intra-abdominal adhesions were separated, and the peritoneal slits of both sides of the incision were disinfected to reduce the endogenous contamination of the incision during the operation. 2. Separate the choledochal cyst or the original cystic anastomosis, and pay attention to the relationship between the cyst and the hepatic artery, portal vein, duodenum and pancreas. 3. If drainage has been performed in the line, the original anastomosis should be removed and sent to the wall for pathological examination. The pathological changes of the adult choledochal cyst are often complicated. The relationship between the cyst and the surrounding structure, such as the portal vein and the hepatic artery, is often difficult to distinguish. The cyst wall and the surrounding blood vessels are more numerous, especially when combined with cirrhosis and portal hypertension. The time is more prominent, and the lesions in the intrahepatic bile duct are often more complicated. Therefore, in the extracapsular and intracapsular exploration, it is necessary to carefully identify the key points of the lesion and plan the operation steps. 4. For the first operation, the patient with less inflammation of the wall and clear separation from the surrounding tissue, after evacuating the bile in the capsule, the peritoneal layer of the medial edge of the cyst is cut, and the cyst is separated from the hepatic artery and portal vein, up to the left and right liver. 2cm below the tube, cut off the bile duct, it is best to retain a circle of about 0.5cm wide enlarged part, in order to facilitate the biliary anastomosis and reduce the chance of anastomotic stenosis in the future. The gallbladder must be removed at the same time. 5. Down the cyst wall to the pancreatic head of the common bile duct after the duodenum. At this time, the narrower part of the lower end of the common bile duct can be reached, but it can not be blindly clamped to prevent damage to the pancreatic duct. At this point, the wall of the capsule should be cut open and the opening of the pancreatic duct should be observed from the inside of the capsule. Some patients have a pancreatic duct opening in the lower end of the common bile duct because the pancreatic duct meets the high bile duct outside the duodenum. The lower edge of the cyst was cut under direct vision, the distal end was closed with a non-absorbent suture, and the outer layer was sutured with a pancreatic head capsule. 6. For cases with severe inflammation, multiple adhesions around, and complete resection of the cyst, it is difficult to completely remove the cyst, and a large number of blood loss and side damage may occur, such as damage to the portal vein and hepatic artery. A safer method is to preserve the fibrous wall of the posterior medial wall of the cyst to protect the portal vein, where the wall of the capsule is only submucosally separated. 7. According to the method of Roux-en-Y total jejunum anastomosis, a jejunum fistula was released, and the intestinal fistula was placed 50 cm long. The end-to-side anastomosis was performed with the common hepatic duct before the colon, and one layer was sutured intermittently. The two arms of the T-shaped tube are placed on the left and right hepatic ducts respectively, and the long arm is led out through the jejunum. 8. Stitching closes the gap between the mesentery. Place the abdominal drainage in the subhepatic area. complication 1. Early postoperative complications may have intra-abdominal hemorrhage, acute pancreatitis, bile, pancreatic juice leakage, acute cholangitis. 2. In the advanced stage, it is mainly anastomotic stenosis, hepatobiliary infection, stone formation and so on.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.