Fiberoptic choledochoscopy via T-tube sinus (postoperative choledochoscopy, POC)

Anyone with T-tube drainage and suspected biliary residual stones is suitable for this method. If the patient is caused by stone obstruction and biliary tract, the stone should be taken decisively. Treatment of diseases: gallstones and gallstones Indication Anyone with T-tube drainage and suspected biliary residual stones is suitable for this method. If the patient is caused by stone obstruction and biliary tract, the stone should be taken decisively. Contraindications Use with caution in patients with severe heart failure and bleeding. High fever caused by reasons other than biliary tract, and suspended inspection. Preoperative preparation 1. Generally, the stone is taken from the common bile duct exploration and T-tube drainage 4 to 6 weeks after the T-shaped tube has formed a relatively firm fibrous sac. 2. One hour before surgery, intramuscular injection of fentanyl 0.1 ~ 0.2mg, luminal 0.1g, atropine 0.5mg; or diazepam 10mg, dulidine 50mg. Sometimes you don't need an analgesic. Surgical procedure 1. Use a surgical adhesive film attached to the right side of the sinus, and then tilt the patient to the right by 5° to 10° to prevent the saline that perfuse the biliary tract from flowing out of the sinus and soaking the patient's plaque. 2. Pull the T-shaped tube and operate the field disinfection and toweling. 3. Under sterile conditions, the choledochoscope is slowly inserted into the sinus, and a dark red granulation wound can be seen. After reaching the common bile duct, the color is reddish. First visit the no-stone end, then explore the stone end. When examining the upper end, the intrahepatic bile duct, the posterior extrahepatic bile duct, and the stepwise branch are examined in order, focusing on the presence or absence of dilatation, stenosis, inflammation, residual stones, worms, cellulose, granuloma and tumors in the bile duct. Pay attention to the viscosity and turbidity of bile, and estimate the diameter and nature of the sacral canal, bile duct lumen and stone. The treatment methods include foreign body net extraction, stenosis expansion and inflammatory drainage. 4. During the operation, the saline is continuously instilled into the biliary tract (80,000 U of gentamicin in 500 ml to fill the bile duct to keep the visual field clear. 5. After determining the position of the stone, place the stone in the lower left corner of the choledochoscope field, so that the stone and the mirror surface are kept at a distance of about 1 cm to prevent the stone from blocking the field of view. 6. Under direct vision, the left hand mirror control knob, the right hand to master the basket. Through the choledochoscope, insert the closed stone basket to slide it from the upper right corner of the stone. When the top of the casing exceeds the stone position, the stone basket is opened and the continuous movement of the entrance and exit, opening and closing is repeated, and the left hand is used for choledochoscopy. The spin and the up and down movements cause the stones to roll continuously outside the open basket. Once the stone enters the net, it will tighten the net, but it should be noted that the force can not be too strong, otherwise the stone is brittle. 7. After holding the stone, pull it out together with the sight glass. When the stone is not easily caught by the net, you should pay attention to the size of the stone basket. A small number of common bile duct incarcerated stones can be pushed into the duodenal cavity. 8. After removing the stone, place the drainage tube through the sinus to the common bile duct to retain the channel for taking the stone, and drain the bile for 24 hours to avoid postoperative fever. Straight tube placement is often easy to fall off and needs to be properly fixed. The Foley balloon catheter can be inserted with a suitable thickness and the balloon can be inflated to prevent the escape. When the catheter is placed, the length of the sinus can be measured by choledochoscopy, and then placed in the direction and length, and violent insertion should be avoided. 9. After the stone is removed, the X-ray cholangiography should be taken to prevent the residual stone. complication Chronic purulic cholangitis.