common bile duct duodenal anastomosis

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: congenital choledochal cyst in children with congenital 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, 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. Separation of the common bile duct: the hepatic duodenal ligament is incised, and the common bile duct is exposed. Be careful not to damage the hepatic artery and portal vein. Close to the duodenum, two needles are sewed on both sides of the common bile duct, and the separated common bile duct is cut below the suture. Then, the distal end of the common bile duct is sewn. The inner layer is made of a thin wire as a full-layer intermittent varus suture, and the outer layer is sutured with a thin silk thread for serosal suture. 2. Separation of the duodenum: incision of the peritoneum of the lateral margin of the duodenal descending, blunt dissection of the duodenal bulb and descending, so that the duodenum moved upwards, so that it is close to the proximal end of the common bile duct, So as not to have tension in the anastomosis. 3. Stitching the anastomosis: the two sides of the proximal end of the common bile duct and the upper front wall of the duodenal bulb are fixed by two needles to pull the anastomosis. The anastomosis is the same as the lateral anastomosis. Finally, after using the finger to probe the size and patency of the anastomosis, the anastomosis area was covered with a large omentum, and several needles were fixed around the anastomosis. 4. Drainage and suturing: a cigarette is placed near the anastomosis, and is taken out from the lower incision of the right abdominal wall and fixed with a safety pin. Finally, the abdominal wall is sutured layer by layer.

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