Side-to-side anastomosis of common bile duct and duodenum

1. Fibrous stenosis at the lower end of the common bile duct. 2. Congenital atresia or stenosis at the lower end of the common bile duct. 3. Congenital choledochal cyst. 4. It is difficult to repair the lower part of the common bile duct. Treatment of diseases: choledochal cyst Indication 1. Fibrous stenosis at the lower end of the common bile duct. 2. Congenital atresia or stenosis at the lower end of the common bile duct. 3. Congenital choledochal cyst. 4. It is difficult to repair the lower part 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, in general, when the situation is poor, the patient should be actively corrected before surgery, improve nutritional status, the application of high sugar, high vitamins 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 or median side incision. If the second operation is performed, the original incision should be avoided. 3. Separation of the duodenum: First, the liver, stomach, duodenum and pancreatic head are probed, and then the biliary system is explored to determine the anastomosis method. Carefully separate the adhesions to reveal the common bile duct and duodenum. The peritoneum was cut in the lateral edge of the duodenum, and the duodenal bulb and descending part were separated for easy anastomosis. 4. For the common bile duct and the anterior wall of the duodenum: take the anterior wall of the duodenal bulb and the anterior wall of the common bile duct as an anastomosis site, and both sides of the anterior wall of the common bile duct and the duodenum The upper edge of the front wall is used to fix the traction stitches with two needles. 5. Anastomosis: The upper part of the common bile duct is cut longitudinally 2 to 3 cm long between the traction lines to absorb bile. Further, an incision parallel to the longitudinal axis of the intestine is made on the upper edge of the duodenal bulb, and the length is equal to the common bile duct incision, and the intestinal fluid is removed at any time. Ligation of submucosal bleeding points. Using the thin wire at a distance of 0.2cm from the cutting edge, the posterior wall of the anastomosis is sutured (with or without suture), so that the midpoint of both sides of the common bile duct incision is close to the ends of the duodenal incision, and then 4- 03-0 chrome gut is used as the anastomosis of the posterior wall of the anastomosis. The inner layer of the anterior wall of the anastomosis is also used as a full-thickness varus suture with a chrome gut. The outer layer of the anterior wall of the anastomosis was sutured with a thin wire for the muscle layer. When suturing the anterior wall, a small longitudinal incision can be made in the anterior wall of the common bile duct, a t-shaped tube is placed inside, and then the anterior wall of the anastomosis is sutured. If the anastomosis is large enough, the t-shaped tube can also be omitted.