High hepatojejunostomy

High position hepatolithiasis for the treatment of hepatolithiasis complicated with hepatic bile duct stricture. Hepatobiliary stenosis, often associated with hepatolithiasis, and exacerbated each other. This stenosis is often annular and forms thickened scars around the bile duct, varying in length. Hepatobiliary stenosis can be single-shot, and it is most common in the first and second branch openings of the left hepatic duct. It can also be multiple, with the most common hepatic hilar ducts, namely the left and right hepatic ducts and the common hepatic duct opening. Due to the narrowing, the fibrosis, atrophy and compensatory hyperplasia of the liver tissue of the liver are irregular hepatic enlargement, which is called atrophic hyperplasia. The major hepatic bile duct stenosis, together with hepatolithiasis, is often the leading cause of severe biliary purulent infection, resulting in patient death and repeated or multiple surgery. The hilar biliary stricture includes the left hepatic duct opening, the right hepatic duct opening, and the stenosis of the upper end of the common hepatic duct. It is often complicated by hepatolithiasis, which is also a problem to be solved in the treatment of hepatolithiasis. Treatment of diseases: gallstones Indication High hepatic bile duct jejunostomy is suitable for: Right hepatic stenosis, left hepatic stenosis, common hepatic stenosis, left and right hepatic stenosis, and hilar bile duct stenosis. If the stenosis is obvious, it should be treated surgically when it causes obvious clinical symptoms or is accompanied by intrahepatic bile duct stones. Preoperative preparation Hepatolithiasis, hepatobiliary stenosis, especially those with recurrent seizures of severe cholangitis, long-term obstructive jaundice and biliary fistula, local and general conditions are often poor, and should be carried out at the same time as various examinations and diagnoses Thoughtful preoperative preparation. 1. Supplement blood volume, maintain water and salt metabolism and acid-base balance, especially pay attention to the correction of chronic water loss and hypokalemia. 2. Strengthen and improve the systemic nutritional status of patients. Give a high-protein, low-fat diet and add enough calories and vitamins. Patients with obstructive jaundice should be injected with vitamin K11. Some patients also need fluid replacement and blood transfusion. In patients with complete biliary fistula and hepatic insufficiency, intravenous nutritional support is often required. 3. Check the coagulation mechanism and correct any abnormalities that may occur. Comprehensive analysis was performed together with the results of liver function tests to evaluate liver reserve and metabolic function. 4. Pay attention to protect liver function. Repeated episodes of biliary tract infection and prolonged obstructive jaundice often cause varying degrees of liver damage. If you have biliary cirrhosis, you should pay attention to active liver protection. Patients with long-term external drainage tube, if the daily bile flow is many and the color is light, it is often a sign of liver dysfunction. The inversion of the ratio of white and globulin indicates that the compensatory function of the whole liver is in an unfavorable condition. If you have splenomegaly and ascites, you should first do liver protection treatment. After you have improved, consider the staged treatment. 5. Investigation of bile bacteriology and antibiotic susceptibility testing to use antibiotics more rationally. In some complicated cases, it is often necessary to start systemic application of antibiotics 2 to 3 days before surgery to help prevent surgery or angiography and stimulate cholangitis. If the operation is performed during the onset of cholangitis, penicillin or metronidazole (metidazole) should be administered to control the mixed infection of anaerobic bacteria. 6. Protect and support the body's emergency response capabilities to help smooth out the post-operative traumatic response. These patients have been repeatedly attacked by biliary tract infections and multiple operations, often with physical depletion; and most of them have a history of treatment with different degrees of glucocorticoids, systemic response is low, should pay attention to support and protection. In the operation, hydrocortisone 100 ~ 200mg was intravenously instilled, and 50-100 mg per day can be instilled within 2 days after surgery, which often receives good results. 7. For patients with external drainage, the preparation of the skin of the mouth should be carried out as soon as possible. For excessively long granulation tissue, it should be cut off. For local inflammation and skin erosion, the dressing should be changed frequently and wet if necessary. For mouthwashes with digestive juices, apply zinc oxide paste coating protection. Keep your mouth clean and perform surgery when your skin is healthy. Deworming should be routinely performed after admission. Stomach tubes and catheters should be placed before surgery. Surgical procedure 1. The oblique incision under the costal margin of the right upper abdomen. 2. Separate adhesions and reveal the hepatoduodenal ligament. 3. Separate and distract the liver lobe (section IV). If the lobes are hyperplasia, swelling, and the liver is deep and the liver is difficult to be revealed, hepatic lobectomy or hepatic fissure should be performed first, so that the anterior side of the hilar is completely exposed. 4. Longitudinal incision of the common bile duct and the common hepatic duct, and then guided by a right angle pliers, open the upper end of the narrow common hepatic duct. 5. Cut the opening of the left hepatic duct stenosis to the left and extend the incision to the anterior wall of the left hepatic duct. 6. Cut open the bile ducts above the stenosis and stenosis at the opening of the right hepatic duct, and pull them with thin wires to explore the intrahepatic bile duct openings one by one. 7. If the multiple openings of the hilar bile duct are narrow, it is often necessary to form and suture the adjacent side walls of the cut hepatic ducts by using a suture technique, so that the narrow hepatic duct openings are integrated into one body, and the opening is used as an integral The posterior wall of the bile duct completes the formation and suture of the stenotic hepatic duct, and then is flanked by a jejunum for lateral drainage.

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