U-shaped duct hepatobiliary drainage

U-tube hepatolithiasis is used for the treatment of hepatic bile duct stricture. Hepatic bile duct lesions are complicated, and hepatic bile duct jejunostomy or hepaticobiliary jejunostomy is difficult to complete due to technical reasons. It is difficult to ensure that the anastomotic and hepatic ducts are no longer stenotic. Use silicone tube or soft medical plastic tube or The special U-shaped tube with balloon is used for anastomosis of the hepatic bile duct or hepatobiliary tube, and the U-shaped tube is used for long-term support drainage. Treatment of diseases: benign biliary stricture Indication U-tube hepatic bile duct drainage is applicable to: 1. The left and right hepatic duct stenosis is long, and it is difficult to cut the stenosis or the incision is not sufficient. Although it is difficult to ensure the stenosis without stenosis through the hepatic bile duct jejunostomy. 2. Simple secondary hepatic stenosis or segmental hepatic stenosis. 3. Right posterior hepatic stenosis, right hepatic lobe atrophy and right hepatic hilar movement, right hepatic duct and right posterior hepatic duct stenosis, hepatobiliary jejunal anastomosis difficult. 4. Variation of the portal vein and its branches, hepatic bile duct stenosis caused by compression of the high bile duct. 5. Progressive secondary sclerosing cholangitis occurred after Roux-en-Y anastomosis of hepatobiliary jejunum, and hepatic bile duct or anastomotic stenosis occurred again. Preoperative preparation 1. Detailed medical history, especially history of surgery and recurrent episodes of cholangitis. 2. Check liver, heart, and kidney function, and if necessary, do gastrointestinal barium meal or fiber gastroscope. 3. B-mode ultrasonography to understand hepatic bile duct dilatation, presence of stones and mites; if necessary, hepatic biliary tract photographic; then percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (endoscopic) Retrograde cholangiopancreatography (ERCP) to obtain a clear biliary system X-ray image to identify the location of the biliary stenosis and the distribution of stones. 4. Give antibiotics to prevent and control lung or biliary infections. 5. Patients with jaundice should be injected intramuscularly or intravenously with vitamin K, and the original time of prothrombin should be determined. 6. Those with intestinal tsutsugamushi should be treated with sputum. 7. Place the gastrointestinal decompression tube and catheter before surgery. 8. Provide supportive care as appropriate, depending on the nutritional status of the patient. Surgical procedure 1. Simple U-shaped tube bile duct drainage The common bile duct is incision at high position. Under direct vision, the biliary tract stenosis is gradually expanded from small to large, so that it is equivalent to the outer diameter of the U-shaped tube. The left hand of the surgeon is placed on the face of the liver, and the right hand gently pushes the biliary probe out of the face. One end of the U-shaped tube is tied with the biliary probe suture, and then the biliary probe is gently pulled downward. The U-shaped tube enters the stenosis above the hepatic duct through the liver parenchyma, and then enters the left or right hepatic duct through the stenosis of the hepatic duct. To the main hepatic duct, common bile duct. 2. Hepatobiliary jejunostomy and U-tube support drainage Although the hepatic bile duct stenosis is incision, the hepatic duct dilatation is not obvious or the stenosis is not sufficient or the hepatic bile duct wall thickness is not ensured that the anastomosis and hepatic bile duct are no longer narrow. The U-tube should be placed at the same time to support the drainage to maintain the smoothness of the Roux-en-Y anastomosis of the hepatic bile duct. 3. Bilateral hepatic bile duct jejunostomy and double U-tube support drainage Bilateral hepatic bile duct stricture, bile duct wall thickness and biliary cirrhosis with portal hypertension and portal hypertension, although the portal shunt reduces the collateral circulation of the hepatic portal, but hepatic lobe resection, hepatobiliary stricture It is difficult to fully cut open; or because of the narrowing of the hepatic bile duct caused by the pressure variation of the portal vein and its branches, it is difficult to make a narrow incision. Appropriate expansion of bilateral hepatic bile duct stenosis, U-shaped tube support drainage in the double hepatic duct, or bilateral hepatic bile duct stenosis as far as possible, to make hepatic bile duct jejunal mucosa flap (mucosa graft) Roux-en-Y anastomosis and double U The tube supports drainage.