Intraoperative application of fiberoptic choledochoscopy (IOC)

Fiber choledochoscopy is a new device mainly used to diagnose biliary diseases in recent years with the development of fiber optics. Like fiber endoscopy and fiber duodenoscopy, it is also composed of many optical fibers. Hollow tube. Fiber biliary endoscope is a special device for observing bile duct, hepatic duct and treating lesions under direct vision. It can directly look inside the biliary tract in biliary tract surgery or after biliary tract with "T" tube. Go to the bile duct of grade III and IV in the intrahepatic biliary tract, down to the duodenal papilla in the lower common bile duct, even in the duodenum, and directly see whether the mucosa in the bile duct is congested, edema, erosion and The shape, color, size, number and incarceration of gallstones can also distinguish blood clots, air bubbles, polyps and mites in the biliary tract, and take biopsy for pathological examination. It can be used for the diagnosis of biliary diseases, to understand the location and nature of the lesions, and whether there are Residual stones, etc., are a better method. Treatment of diseases: biliary tract biliary stones Indication 1. Common bile duct stones, intrahepatic stones. 2. Extrahepatic bile duct obstruction, cholangiocarcinoma. 3. Parasites, foreign bodies and other findings in the biliary tract, such as benign tumors, polyps, stress ulcers, granuloma, etc. 4. The thickening of the common bile duct wall, thickening more than 1cm; bile turbidity; the lower part of the common bile duct can touch the induration or the induration of the pancreas. 5. Obstructive jaundice, severe pancreatitis or gallstone pancreatitis. 6. Biliary postoperative syndrome; unexplained biliary bleeding; abnormal biliary pressure measurement. 7. Biliary stenosis, sclerosing cholangitis. 8. Intravenous cholangiography, percutaneous transhepatic cholangiography, duodenoscopy retrograde cholangiopancreatography and preoperative ultrasound showed abnormalities in the intrahepatic and extrahepatic bile ducts. 9. Verification of false positives such as air bubbles in intraoperative angiography. Contraindications The common bile duct is thin, the diameter is less than 0.5cm or the common bile duct wall is thin and brittle. Surgical procedure After the gallbladder is removed, the common bile duct is fully exposed, and if necessary, the duodenal descending portion can be separated to facilitate peeping at the end of the common bile duct. A 1 cm long straight incision was made in the anterior wall of the lower bile duct, and a traction line was sutured on each side. After removing the stones, insert the choledochoscope under aseptic operation and infuse the saline from the irrigation tube and absorb it at any time. Generally, the proximal bile duct is examined first, the left and right hepatic ducts, the second and third grade hepatic ducts, and sometimes the fourth grade hepatic ducts. When the mirror is removed, the confluence of the left and right hepatic ducts, the common hepatic duct and the cystic duct are examined. After seeing the stones in the bile duct under the speculum, insert the stone basket and remove the stones. Then, check the distal end of the common bile duct until you see the ampulla. The ampulla of the ampulla is seen by the choledochoscope, half of which is radial, and the others are fish-shaped, triangular and amorphous. The radial ampulla opening is relatively clean, the inflammation is light, and the fiber choledochoscope is easy to pass. When inserting the choledochoscope, if you encounter resistance, do not insert it hard to avoid complications. It is not necessary to insert the duodenum when examining the distal end of the common bile duct. Bile tract irrigation, in order to flush the bile, biliary mud, blood, etc. in the biliary tract, which is conducive to peeping lesions, flushing water pressure should not be too high, otherwise it may cause biliary tract infection, generally 20cmH2O pressure; or the saline suspension bottle is higher than the patient 1m can be. After choledochoscopy, the thick T-tube drainage (22~24 latex tube) is built in the common bile duct. The long arm is perpendicular to the common bile duct, and the T-shaped tube is thick, straight and short. Helps to perform choledochoscopy and stone removal operations when needed later.