duodenal papilla sphincteroplasty

The purpose of duodenal papillary sphincter angioplasty is to resolve the bile flow disorder caused by stenosis or obstruction of the lower common bile duct. The surgical method is to cut all the fibers of the biliary sphincter, and cut a part of the wedge, and then suture the duodenal mucosa. It is an operation to enlarge the lower end of the common bile duct and communicate the common bile duct and the duodenum. Treatment of diseases: duodenal injury Indication 1. Incarcerated ampullary stones, especially mud-like stones. 2, ampullary inflammatory scars, hyperplasia. 3, chronic recurrent pancreatitis, with Odd sphincter tendon or stenosis, in the sphincter angioplasty, the lower end of the common bile duct. Contraindications 1, secondary choledocholithiasis, bile clear, only a few large stones, nipple diameter greater than 3mm, choledochoscopy showed no abnormalities in the biliary tract, or normal cholangiography. 2. The lower end of the common bile duct is tubular and narrow, and the length exceeds the inner segment of the common bile duct of the common bile duct. 3, abnormalities in the proximal end of the bile duct (such as hepatic stenosis). 4, there are people who have a squatting pot. 5. Inflammatory diseases of the biliary tract including the pancreatic duct. Surgical procedure 1, position: supine position. 2, incision: right upper transabdominal rectus or median side incision. 3, exploration of the common bile duct: separation of adhesions, revealing the common bile duct, under the two needles of the anterior wall traction, the common bile duct is cut open about 1.5cm. Then, the lower end of the common bile duct was dilated with a small biliary dilator to enter the duodenum through the ampulla as a sign of the incision of the intestinal wall. 4. Incision of the duodenum: the peritoneum was cut along the lateral edge of the descending part of the duodenum to separate the descending part of the duodenum. Immediately with the finger on the anterior wall of the membrane biliary dilator head, in this area longitudinal or transverse incision about 2 ~ 3cm, with a suction device to suck the duodenal juice, ligation of bleeding points. 5. Exposing the duodenal papilla: Two tissue clamps were used to clamp and pull the bilateral intestinal wall of the duodenal incision, and the two saline gauze were respectively blocked in the upper and lower ends of the duodenal cavity. Find the duodenal nipple by finding the head of the biliary dilator. 6. Sphincter formation: Place the biliary dilator at the sphincter nipple as a guide. The anterior and lateral sides of the sphincter and the ampulla are equivalent to 10 o'clock. The scalpel or small scissors are used for wedge resection. The length of the incision is generally 1.5 to 2.0 cm, and the width of the bottom is 0.3 to 0.5 cm. Be careful not to make a wedge cut on the anterior medial or medial side to prevent damage to the pancreatic duct. Because the incision is long, it is easy to cause bleeding, and the bleeding point should be carefully sewed. Then, the sphincter incision was sutured with a 4-0 chrome gut for full-thickness suture, and the duodenal mucosa was combined with the mucosa of the lower end of the common bile duct. 7, sutured duodenal incision: incision of the duodenum, short can be horizontal suture, long should be sutured along the longitudinal axis of the duodenum, so as not to form an angle and tension. The inner layer is sutured in a full-thickness with a silk thread, and the knot is wound in the intestine cavity to make the intestine wall invert; the outer layer is sutured with a thin silk thread for intermittent muscle suture. 8. Place the drainage tube and suture the abdominal wall: place the t-shaped tube (or long-wall t-shaped tube) in the common bile duct, pass the sphincter at the lower end, put the upper end into the common hepatic duct, and suture the common bile duct incision and peritoneum. Cigarette drainage was placed near the suture of the duodenum, and a small incision was made from the right abdominal wall along the tibial tube along the liver. Cigarette drainage is fixed with a safety pin. The t-tube is fixed on the skin with sutures. Finally, the abdominal wall incision is sutured.