Cholecystoduodenal anastomosis

1. Congenital or bile duct stones with bile duct infection leading to stenosis or atresia of the lower common bile duct. 2. Pancreatic cancer, ampullary cancer, duodenal cancer or lower common bile duct cancer. 3. Chronic recurrent pancreatitis with stenosis of the common bile duct. Treatment of diseases: cholangitis stenosis and bile duct stones Indication 1. Congenital or bile duct stones with bile duct infection leading to stenosis or atresia of the lower common bile duct. 2. Pancreatic cancer, ampullary cancer, duodenal cancer or lower common bile duct cancer. 3. Chronic recurrent pancreatitis with stenosis of the common bile duct. Preoperative preparation 1. Emergency surgery: All patients must be preoperatively prepared for 6 to 24 hours to improve the general condition and tolerate surgical treatment. (1) fasting; intestinal paralysis bloating patients with gastrointestinal decompression. (2) Intravenous infusion to correct water, electrolyte and acid and alkali balance disorders, if necessary, blood transfusion or plasma. (3) Appropriate application of broad-spectrum antibiotics. (4) Astragalus patients are injected with vitamins b1, c, and k, and those with bleeding tendency are intravenously injected with hexaamino own acid and p-carboxybenzylamine. (5) When there is toxic shock, shock should be actively rescued. 2. Selective surgery: When the patient has long-term jaundice, dehydration, liver and kidney function damage, when the general condition is bad, the patient should actively correct before surgery, improve nutritional status, and apply high blood sugar, high vitamin and other liver protection treatment. 3. The surgeon should carefully understand the medical history, physical examination, laboratory tests and various auxiliary examination data, and have sufficient analysis and estimation of the condition. 4. Patients with stones should review b-ultrasound on the morning before surgery to observe the movement of stones, in order to prevent stones from draining the biliary tract and perform surgery. Surgical procedure 1. Position: supine position. 2. Incision: right upper transabdominal rectus incision. 3. Exploration: first explore the liver, stomach, duodenum and pancreas, and then explore the nature and condition of the lower end of the common bile duct or obstruction, to confirm whether the gallbladder and common bile duct are unobstructed. If the tumor is a tumor, the size of the tumor should be explored, whether it can be moved, whether there is a lymph node or liver in the vicinity, and if necessary, a biopsy is taken. According to the investigation, choose the appropriate surgical method. 4. Traction of the gallbladder and decompression: puncture the bile at the base of the inflated gallbladder to reduce the tension of the gallbladder. Then, use the tissue forceps to pull the bottom of the gallbladder and pull down to the duodenum. 5. Separation of the duodenum: Incision of the peritoneum of the lateral margin of the duodenum, fully separating the duodenal bulb and descending part, so as to avoid tension in the anastomosis. 6. Gallbladder duodenal anastomosis: Use the intestinal clamp to control the distal end of the duodenal anastomosis to avoid leakage of intestinal fluid. The bottom of the gallbladder is brought close to the upper part of the duodenum, and the two ends of the anastomosis of the anterior wall of the gallbladder and the anterior wall of the duodenum are fixed by two wires, which are 2.5 to 3 cm apart. The outer layer of the posterior wall of the anastomosis was sutured or sutured with a No. 0 silk thread. The gallbladder and the duodenum are cut at a distance of about 0.2 cm from both sides of the suture (the gallbladder wall is preferably cut to a fusiform shape to keep the anastomosis open). Duodenal submucosal hemostasis. The inner layer of the posterior wall of the anastomosis was made with a 2-0 chrome gut line as a full-thickness or continuous suture. Thereafter, the inner layer of the anterior wall was sutured intermittently, and the outer pulp muscle layer was sutured intermittently. Finally, the omentum is placed over the anastomosis and a few needles are placed around it to prevent leakage of bile at the anastomosis.

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