ROUX-EN-Y total hepaticoenterostomy

ROUX-EN-Y total hepatic duct anastomosis is the most common procedure for drainage in bile. This procedure has a large free jejunum sputum and a wide range of adaptation. There are few "retrograde infections" and "blind end syndromes". Set the subcutaneous jejunum blind. It is currently the most frequently used biliary drainage method. Adapted to benign bile duct stricture, more common in bile duct stones and stenosis and bile duct injury stenosis. Treatment of diseases: bile duct stones extrahepatic bile duct injury Indication Surgical indications: 1. Benign bile duct stricture, more common in bile duct stones and stenosis and bile duct injury stenosis. 2. Complex, multiple primary bile duct stones are difficult to remove. 3. Congenital bile duct malformation. Such as congenital extrahepatic bile duct stricture, atresia, biliary cystic dilatation and so on. 4. Bile duct damage. Transverse injury, lateral wall injury or restenosis after primary surgery. 5. Biliary reconstruction or palliative surgery after radical resection of biliary tumors. 6. Often combined with liver partial resection, stenosis and bile duct incision and other surgical procedures. Contraindications 1. Older, weaker and unable to tolerate surgery. 2. The upper bile duct of the anastomosis has severe stenosis and has not been relieved. 1. Incision. The right upper abdomen can be through the rectus incision or the oblique incision under the costal margin. However, it is expected that patients with hepatic hilar or intrahepatic lesions should be treated with a right oblique incision. 2. Touch to explore the hepatobiliary system and surrounding organs, to understand the anatomy of the surrounding organs, pathology and the condition of the small omentum. 3. Expose and cut the extrahepatic bile duct exploration, remove the stone, relieve the stenosis, flush and clean the bile duct. It is best to use a fiber cholangioscopy to remove stones during surgery. 4. According to different etiology and pathology, choose different bile duct sites and jejunum anastomosis (such as bile duct section of extrahepatic, hepatic, intrahepatic or hepatectomy). According to different parts and pathology, different anastomosis methods are selected (such as end, end, side, cutaneous jejunum, etc.). 5. Preparation of jejunal "Y" . At the 20~30cm below the duodenal jejunum ligament (Treitz ligament), the appropriate jejunum mesenteric vascular arch was selected to cut and ligature the corresponding blood vessels. Cross the jejunum. Free jejunal Y , in order to not affect the blood supply of the Y-shaped sputum and the bile duct anastomosis without tension. In the Y40~50cm transverse section, the semicircular and proximal (duodenal end) jejunal end-to-side anastomosis was performed. The suture is closed to the mesangial space, and the proximal jejunum and the Y-shaped jejunum are sutured together for about 8 cm, or artificially nested in the jejunum Y-shaped sputum to prevent intestinal reflux. 6. Bile duct jejunostomy. It is recommended to cross the common bile duct and suture the closed distal end. The proximal bile duct is anastomosed to the end or end of the jejunum. If you choose the latter, you need to suture the closed jejunum. Another cut of the jejunum on the side wall of the mesangium is anastomosed to the bile duct. If necessary, the bile duct should be cut longitudinally from the broken end to ensure a large anastomosis. Generally, a small round needle thin line is used for intermittent anastomosis. If the anastomosis is large enough, the absorption line can be continuously anastomosed. If necessary, the sarcoplasmic layer of the jejunum can be reinforced with the tissue surrounding the bile duct. 7. Setting of subcutaneous jejunal blindness. The jejunum rupture end was closed, and the jejunum and bile duct anastomosis were performed on the edge of the mesangium at 8-10 cm from the broken end. The blind end of the jejunum fistula was placed under the subcutaneous anastomosis and the silver clip was placed. 8. Place the F22~F24 T tube in the bile duct, and the long arm is taken out from the jejunum through the anastomosis. Place the abdominal cavity under the liver or near the anastomosis. Preoperative preparation Antibiotics are routinely used before surgery.