Interposed jejunohepatic duodenal anastomosis

Interstitial jejunal duodenal anastomosis for the surgical treatment of inoperable orthostatic bile duct atresia. Congenital biliary atresia is a congenital or partial atresia or absence of the bile duct system. The cause is still unclear and may be the result of cholecystectomy in embryonic development. In recent years, some people think that this disease is closely related to neonatal hepatitis. Both can exist at the same time, or first develop into bile duct atresia for giant cell hepatitis. It is also believed that due to infectious, vascular or chemical causes of the embryo, the bile duct system is harmed, and the bile duct is occluded, hardened or partially disappeared. This course of disease can continue from the time of embryonic development to the time of birth. Bile duct atresia can be divided into intrahepatic type and extrahepatic type, in which intrahepatic type is intrahepatic bile duct system atresia, there are only irregular small bile ducts in the liver with stenosis or atresia, and there is no good treatment method; extrahepatic bile duct The lock can be divided into VI type according to the position of the lock. Among them, type I-III is a type, accounting for 80%-90% of extrahepatic bile duct atresia, which is called uncorrectable type; type IV-VI is another type, which is adjuvant type and has a good prognosis. Treatment of diseases: congenital biliary atresia in congenital biliary atresia in neonates Indication Interstitial jejunal duodenal anastomosis is suitable for type I, II, and III inoperable biliary atresia. Contraindications More than 3 months of biliary atresia, due to irreversible cirrhosis, should be listed as a relative contraindication for the operation, even if the surgery to obtain bile drainage, the sick child will die of cirrhosis. Preoperative preparation 1. Quickly correct anemia and hypoproteinemia in sick children. A small amount of multiple blood transfusions and plasma. 2. Intramuscular injection of vitamin K, while supplementing a large amount of vitamin B1 and vitamin C. 3. Liver treatment is given when liver function is impaired. It can be given a high protein, high sugar, high vitamin diet and low fat diet. Surgical procedure 1. Open laparotomy, after the diagnosis, the gallbladder and hepatic portal fibrous connective tissue (including enlarged lymph nodes) were removed in one piece, and the jejunum anastomosis was performed. 2. Cut the jejunum from the 15cm and 45cm below the duodenal jejunum. Separate the corresponding jejunal mesentery to ensure adequate blood supply to the jejunal fistula. 3. The proximal end of the jejunum and the distal end of the end of the anastomosis. 4. Poke the right side of the colonic artery in the transverse mesenteric membrane, and drag the intervening jejunum to the hilum. The proximal end is sutured with 2-0 silk sutures and closed. 5. The jejunum is anastomosed at the proximal end 5 cm from the hepatic portal connective tissue cutting edge. 6. Distal jejunostomy. The cigarette is drained behind the hepatic jejunal anastomosis, and then the incision is closed layer by layer. Some authors advocate a one-stage jejunal duodenal descending end-to-side anastomosis. After 7.1 to 3 months, the jejunostomy was closed, and the jejunum duodenum (or jejunum jejunum) was anastomosed. Incision from the original abdominal wall into the abdominal cavity. When cutting the peritoneum, care should be taken that the intestine may stick to the peritoneum to prevent the intestine from being cut. Remove the jejunostomy from the abdominal wall, trim the jejunal stump, remove the scar at the stump, make an end-to-side anastomosis between the jejunum and the duodenum, or do an end-to-side anastomosis 10 cm below the anastomosis of the jejunal jejunum jejunum. . complication 1. Hepatic damage is aggravated. 2. The anastomosis is split. 3. The incision is cracked. 4. Ascending cholangitis.