choledochoduodenal anastomosis

Common bile duct duodenal anastomosis has been used as an early clinically widely used method of biliary drainage for nearly a hundred years. There has been a long-standing controversy over the existence of a certain degree of biliary "retrograde infection" and "blind end syndrome". However, this procedure is convenient to operate, relatively simple and safe, and the indications are appropriate, have good effects, and still have clinical application value. Treatment of diseases: cholangitis stenosis Indication It is difficult to remove the lower end of the common bile duct, stenosis, obstruction and significant expansion of the common bile duct (diameter > 2cm). Especially suitable for older, infirm, heavier conditions, can not tolerate more complicated surgery such as bile duct jejunal Y-shaped anastomosis, may be the first choice. Preoperative preparation Antibiotics are routinely used before surgery. Surgical procedure Common bile duct duodenal anastomosis: 1 lateral anastomosis, easy to operate, but may be complicated by "blind end syndrome." The 2-end side anastomosis operation is slightly complicated, but the "blind end syndrome" can be avoided. 1. Abdomen incision. Same as "choledochal incision exploration". 2. Incision in the common bile duct. On the basis of the stones in the common bile duct, the peritoneum on the outside of the descending segment of the duodenum is cut, and the descending section of the duodenum is reduced to reduce the anastomotic tension, which is convenient for operation. 3. Select the side anastomosis. The longitudinal incision of the common bile duct should be 2.5~3cm long. Close to the lower end of the common bile duct incision, longitudinally or transversely cut the length of the duodenum corresponding to the common bile duct incision. The common bile duct and the duodenal incision mucosa were sutured to the mucosa with a 0-gauge thread. The suture could be sutured in a single layer, or the anastomotic stoma could be sutured with a discontinuous pulp layer. 4. Select the end side anastomosis. The outer edge of the duodenum should be carefully removed and the common bile duct should be traversed, and the distal end of the common bile duct should be sutured. Be careful not to damage the hepatic artery and portal vein. The proximal end of the common bile duct was anastomosed to the duodenal end. Use the entire line of 0 line to suture or double-layer suture of the muscle layer. If the inner diameter of the common bile duct is less than 2.5 cm, the longitudinal anastomosis and duodenal anastomosis should be properly performed to ensure the width of the anastomosis. 5. Carefully check the anastomosis, confirm that the suture is tight, no leakage, and place the drainage under the liver.

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