Hepatobiliary in situ plasty

Hepatic bile duct in situ angioplasty is used for the treatment of hepatic bile duct stricture. Hepatobiliary stricture is mostly caused by biliary infection, bile duct wall ulcer and fibrous scar. Statistics of 3 938 cases of liver bile duct stones with clear records in the country, 956 cases of hepatic bile duct stricture, accounting for 24.28%. Hepatic bile duct stenosis is located at the left and right hepatic duct openings, the upper end of the common hepatic duct, the left hepatic duct transverse, and the left and right hepatic ducts at the level 2 branch; the left hepatic bile duct stenosis is more common than the right side, sometimes multiple stenosis; Stenosis often combined with intrahepatic bile duct stones, liver pathological changes such as hepatic lobe compensatory increase, hepatic lobe atrophy, etc., long course of disease is prone to biliary cirrhosis, portal hypertension; therefore, hepatobiliary stricture surgery is often very difficult, Especially in the right posterior segment of the hepatic duct stenosis is more difficult. Treatment of diseases: benign biliary stricture Indication 1. The annular stenosis of the localized common hepatic duct or the left hepatic duct opening, the upper and lower bile ducts of the stenotic ring are obviously dilated, the bile duct wall is not significantly thickened, and the bile duct mucosa is intact. 2. There is no stone or stenosis in the intrahepatic bile duct, and there is no atrophy of the liver. 3. The extrahepatic biliary tract and Oddi sphincter function normally. 4, no acute cholangitis. Preoperative preparation 1, detailed medical history, especially the history of surgery and recurrent episodes of cholangitis. 2, check liver, heart, kidney function, if necessary, do gastrointestinal sputum meal or fiber gastroscope. 3, B-mode ultrasound examination, understanding of hepatic bile duct dilatation, presence of stones and mites; if necessary, hepatic biliary tract photographic; then percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (endoscopic Retrograde cholangiopancreatography (ERCP) to obtain a clear biliary system X-ray image to identify the location of the biliary stenosis and the distribution of stones. 4. Give antibiotics to prevent and control lung or biliary infections. 5, those with jaundice should be intramuscular injection or intravenous infusion of vitamin K, and determine the original time of prothrombin. 6, those with intestinal tsutsugamushi disease should be treated with sputum. 7, placed gastrointestinal decompression tube and catheter before surgery. 8. Provide supportive care as appropriate, depending on the nutritional status of the patient. Surgical procedure 1, incision: often use the right upper rectus abdominis incision, the upper end of the incision to the right side of the xiphoid. Patients with obesity or high liver position should use a right inferior oblique incision. If necessary, extend the incision to the left costal margin and cut off part or the entire left rectus abdominis. 2. Exposing the common hepatic duct and the left hepatic duct: After comprehensive exploration of the liver and biliary system, along the fibrous sheath in front of the common bile duct, the common hepatic duct and the left hepatic duct are exposed; the anterior wall of the common hepatic duct is cut upward along the common bile duct incision, And gradually approach the left hepatic duct opening. The right hepatic duct was probed with a right angle forceps, and the left hepatic stenosis ring and the left anterior wall of the left hepatic duct were accurately cut longitudinally, about 2 cm above the stenosis, and the left hepatic stenosis ring and the dilated left hepatic duct were fully cut. open. The middle hepatic artery often traverses the anterior wall of the left hepatic duct and needs to be properly sutured, ligated, and severed. The bleeding point on the wall of the bile duct should be sutured with 3-0 silk suture to stop bleeding. 3. After the annular stenosis of the common hepatic duct or the left hepatic duct is opened, the wall of the hepatic bile duct is open in the shape of a petal, and the scar tissue of the stenosis is appropriately removed, so that the bile duct mucosa has a complete bile duct mucosa, which will be 3-0. The incision of the narrow annular upper and lower bile duct wall is interrupted and sutured. The suture is passed through the bile duct mucosa as little as possible, and the knot is outside to reduce restenosis and avoid stones around the knot. The anterior wall of the bile duct was then sutured longitudinally with a 3-0 line and drained through the left hepatic canal with a short arm of an appropriately sized T-tube. complication Inappropriate choice of surgical indications, surgical operation is not detailed or the support of the T-shaped drainage tube is removed too early, etc. will cause restenosis of the hepatic bile duct. Under normal circumstances, there is still a relative stenosis after biliary plastic surgery, which is easy to cause recurrence of intrahepatic stones, so it has been used less frequently.

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