Roux-Y cholangiojejunostomy

1. Common bile duct, common hepatic duct, or left and right hepatic duct inflammation and obstruction. 2. Intrahepatic bile duct stones, chronic recurrent suppurative cholangitis, the main intrahepatic calculi have been cleared, but there are still stones in the bile duct above the secondary branch. 3. Recurrent bile duct stones, and the bile duct is obviously enlarged. 4. Chronic recurrent suppurative cholangitis, a significant enlargement of the bile duct. 5. Reconstruction of biliary intestine drainage after biliary tumor resection. 6. If the bile duct injury is broken or the scar is narrow after the trauma, the bile flow is interrupted and blocked. 7. A small number of congenital extrahepatic biliary strictures or atresia. Treatment of diseases: biliary inflammatory stenosis extrahepatic bile duct injury Indication 1. Common bile duct, common hepatic duct, or left and right hepatic duct inflammation and obstruction. 2. Intrahepatic bile duct stones, chronic recurrent suppurative cholangitis, the main intrahepatic calculi have been cleared, but there are still stones in the bile duct above the secondary branch. 3. Recurrent bile duct stones, and the bile duct is obviously enlarged. 4. Chronic recurrent suppurative cholangitis, a significant enlargement of the bile duct. 5. Reconstruction of biliary intestine drainage after biliary tumor resection. 6. If the bile duct injury is broken or the scar is narrow after the trauma, the bile flow is interrupted and blocked. 7. A small number of congenital extrahepatic biliary strictures or atresia. Preoperative preparation 1. The patient's general condition is poor, and liver function is often damaged and needs to be corrected. 2. There are biliary tract infections, or more history of repeated biliary tract infections, even if there are no clinical symptoms, hidden infections often exist, antibiotics should be applied before surgery. 3. A small number of long-term biliary drainage, often water and electrolyte imbalance, should be properly corrected before surgery. 4. If the jaundice is serious, it is advisable to first make ptcd, wait until the jaundice is relieved, and the liver function is improved before surgery. 5. Need to pay attention to the correction of coagulation mechanism disorders. 6. Patients with intestinal ascariasis should be dewormed before surgery. 7. Prepare the upper digestive tract, 2g of neomycin 24 hours before surgery, orally every 6 hours. 8. In the morning, the gastrointestinal decompression tube. Surgical procedure 1. Position: supine position, the bile duct area is aligned with the lumbar bridge of the operating table. 2. Incision: Incision in the right upper abdomen through the rectus abdominis, or incision in the right upper abdomen. 3. Exploration and exposure: After entering the abdominal cavity, first exploration, confirmation of biliary tract lesions and indications of biliary jejunum roux-y anastomosis, according to the method described by the common bile duct incision exploration, the common bile duct area of the hilar is revealed. 4. Incision of the bile duct, treatment of bile duct lesions: incision of the duodenal hepatic ligament, revealing the common bile duct, suture two needles in the wall of the tube, one on each side. After the bile is first puncture between the traction lines, the common bile duct is cut longitudinally; the lesion is mainly in the upper segment, and the incision should be as far as possible; the common hepatic duct and the left and right hepatic ducts should be dissected as needed to facilitate removal of intrahepatic stones and hepatic hilum The department is narrow. The stenosis of the hilar should be cut and shaped. The stone application was taken with a stone clamp, the curette was scraped out, the mudstone was washed with saline, and the choledochoscopy was used to observe the intrahepatic bile duct lesion. If there is residual stone, it can be taken by stone basket or placed on the side of the stone to prepare for postoperative infusion of dissolved stone. 5. Transection of the common bile duct: In order to avoid the common bile duct blind syndrome, the common bile duct must be crossed before establishing a new bile duct. Before the transection, the distal end of the common bile duct should be determined to be unobstructed. The transverse site is preferably at the upper edge of the duodenum. The left common bile duct is the hepatic artery, and the back is the portal vein, which is adjacent to each other, with loose connective tissue connected. The transverse bile duct should be determined according to the characteristics of the common bile duct wall and the adhesion of the common bile duct to the surrounding. If there is no obvious inflammation and edema in the common bile duct, there is no obvious scar adhesion around, and the anatomical structure is clear. The common bile duct can be separated from the right margin, and sometimes separated from the right edge and the left margin to the center of the posterior wall. Apply a blunt hemostatic forceps with the tip of the forceps facing up and proceeding tightly against the wall of the common bile duct. Always take care not to damage the portal vein. The transverse branch of the common bile duct should not be too high, because it is easy to damage the portal vein; but if it is too low, it will easily damage the pancreas and cause more bleeding. The separation of the common bile duct does not need to be too long, 0.5cm, in order to avoid stump ischemia. If the common bile duct is mildly edematous and there is adhesion around it, the appropriate amount of normal saline can be injected close to the common bile duct wall, and then the above method crosses the common bile duct. If the wall of the common bile duct is thick and can not be separated from the surrounding dense adhesion, the intima of the common bile duct can be cut open to the plane outside the wall of the common bile duct, and the side seam, side sill, side cut, side pull, transversely enlarge the incision, and gradually cross the biliary General manager. Close the distal end of the common bile duct, such as the diameter of the common bile duct is less than 1.5cm, and the distal end of the common bile duct is closed with 8-shaped perforation. If the diameter of the common bile duct is large, the wall of the common bile duct is thick, and the distal end can be interrupted or continuously sutured by a wire. If the distal end of the common bile duct cannot pass the No. 2 biliary dilator, the Russian sphincter can be used as appropriate, or the common bile duct is not cut. In the process of transverse transection of the common bile duct, if the portal vein is inadvertently torn, the hepatic duodenal ligament tourniquet may be tightened first, and the portal vein tearing portion is pinched with the index finger and the thumb, and the surgical field blood is sucked up, and the portal vein hole is pinched. Near the hepatic end, with 5-0 non-invasive vascular suture continuous or intermittent suture, can stop bleeding. The proximal end of the common bile duct is temporarily clamped with a non-invasive forceps, or the lumen is temporarily blocked with gauze to prevent bile from flowing into the abdominal cavity. 6. Cut the upper part of the jejunum: Lift the transverse colon, and follow the mesentery down to find the duodenal jejunum. Cut the jejunum about 15cm away from the duodenal suspensory ligament, but pay attention to retain the first jejunal artery on the mesenteric membrane, cut off the second jejunal artery, separate and cut the ligament of the jejunum, and make the jejunum have sufficient freeness in the far segment. There is no tension after the above-mentioned biliary anastomosis. It is generally not advisable to use the jejunal stump when anastomosis, because it is not necessarily suitable for the caliber of the bile duct, and anastomotic stenosis is likely to occur after surgery. The distal end of the free jejunum is sutured and closed, and the colon is lifted to the hepatic hilum for anastomosis. 7. The proximal end of the jejunum is consistent with the distal jejunum incision: 60 cm at the distal jejunum is anastomosed to the proximal end of the jejunum. The jejunal bile duct arm is preferably 45-50 cm. The content of the short jejunum may be reversed into the biliary tract. If it is too long, the intestinal fistula may be flexed to increase the intrabiliary pressure. The inner layer of the anastomosis was sutured by a full-thickness suture of the silk thread, and the outer layer was sutured with a broken suture muscle layer. After the suture was completed, the proximal end of the jejunum and the upper part of the distal end of the jejunum were sutured for 3 to 4 needles, so that the intestinal contents were smoothly entered into the distal part of the jejunum from the proximal end of the jejunum. The jejunal mesangial hole is sutured to avoid postoperative internal hemorrhoids. The transverse mesenteric hiatus is also sewn. 8. The bile duct and the jejunum end-to-side anastomosis: the distal jejunum lifted from the transverse mesenteric fissure, cut a small opening on the lateral side of the mesenteric to the suture stump, the direction is parallel to the long axis of the intestine, the size and after the repair The bile duct mouth corresponds and conforms to it. Biliary jejunal anastomosis with a thin layer of full-thickness mucosa to the mucosal valgus anastomosis. Depending on the condition of the disease, it is advisable to place the t-shaped drainage tube in the anastomosis. The t-shaped tube is placed by suspending the purse on the jejunal wall about 12 cm away from the anastomosis before the anterior wall of the anastomosis is closed, and then cutting it in the center, thereby placing a small hole in the center. The t-shaped tube is placed into the left and right hepatic ducts through the anastomosis. Then, the purse is sutured and the drainage tube is fixed. Sew the front wall of the anastomosis. The mesentery at the end of the jejunum can be properly sutured with the hepatoduodenal ligament to reduce the tension of the anastomosis. 9. Drainage: Place a cigarette drainage in the hypohepatic space, and poke the wound from the right upper abdominal wall together with the t-shaped tube. 10. Close the abdomen: stratified suture abdominal wall incision.

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.