Clinical Analysis Of The Blind Loop Bile Duct Jejunum Roux-en-Y Anastomosis In The Treatment Of Complex Hepatolithiasis

Objective Explore the indications, advantages and disadvantages of thebile duct jejunum Subcutaneous blind loop type Roux-en-Y anastomosisin the treatment of complicated hepatolithiasis.Methods Retrospective analysis of August2006January2013china-Japan Union Hospital, Jilin University, admitted to8cases ofsubcutaneous blind loop type bile duct jejunum Roux-en-Y anastomosisin the treatment of complicated bile duct stones, to analyze the generalinformation, medical history, clinical manifestations, imaging, laboratorytests, and the residual rate of postoperative complications, recurrence rateand reoperation rate.Results8patients are due to varying degrees of fever, chills,abdominal pain, jaundice admission, the stones of varying duration from1week to12years, including one case in2005because of "gallstones" inthe local hospital."cholecystectomy,"one case in2003because of"gallstones, bile duct stones "at the First Affiliated hospital of JilinUniversity lines" cholecystectomy, common bile duct, T-tube drainage."After admission for patients undergoing routine, routine coagulation, liverfunction, a full set of other conventional biochemical examination,8patients hospitalized liver function tests have different levels of transaminases and bilirubin, direct bilirubin bilirubin increased mainlynormal prothrombin time, ultrasound examination revealed no obviousascites; Child-Pugh classification of liver function are class A,8patientshave varying degrees of elevated white blood cells, preoperative liver andanti-infection treatment, symptomatic and supportive treatment.Preoperative ultrasound, CT, MRCP imaging studies, according to the2007Chinese Medical Association Biliary Surgery Branch Surgery Groupto develop a "diagnosis and treatment of bile duct stones Guide" forgenotyping, which area type (I type): the left hepatic duct stones0cases,the right hepatic duct stones0cases; diffuse type (II type): left and righthepatic duct were stones0cases; additional (E type): Merge extrahepaticbile duct stones in8cases. This group of patients had varying degrees ofliver bile duct dilatation. There are three cases with biliary stricture,which left hepatic duct stricture one case, two cases of bile duct stricture(biliary stricture choledochoscope under intraoperative findings). Eightpatients under stones parting underwent surgical treatment, includingbiliary lithotomy+Subcutaneous blind loop-type duct jejunumRoux-en-Y anastomosis seven cases, hepatic lobe (segment) resection andsubcutaneous blind loop-type biliary anastomosis one case, with the useof intraoperative choledochoscope, electrohydraulic lithotripsy device.After giving anti-inflammatory, hepatoprotective, nutritional support andsymptomatic treatment, vital signs and close observation of the drainage tube drainage situation, review the B-, CT, clear whether the residualstones. Postoperative complications occurred in4patients: two cases ofpostoperative wound infection, the wound dressing after getting healed;2cases of bile leakage after drainage leakage through the mouth is closed.After two weeks by B ultrasound, CT examination, an intrahepatic bileduct stones can be positive as residual stones.8patients,4patients withresidual stones, residual stones was50%, residual stones in the lefthepatic two cases, one case in the right hepatic, located about one case ofliver, bile duct residual stones are located in the three and above.8patients,3patients because of the review found residual stones, recurrentback to the hospital, fever, abdominal pain, total bilirubin and othersymptoms, the blind loop choledochoscope stone to good effect, to avoidthe re-laparotomy. Which numbered1, respectively, after3months,6months,14months, three times a blind loop through choledochoscopestone. Stone not found in the course of biliary-enteric anastomosisstenosis.Conclusion Recurrent stones, stones to make it difficult for patients totake one viable subcutaneous blind loop type bile duct jejunumRoux-en-Y anastomosis. Subcutaneous blind loop type bile duct jejunumRoux-en-Y anastomosis patients can reduce the risk of re-operation, canbe repeated subcutaneous blind loop biliary endoscopic stone extraction.But Subcutaneous blind loop type bile duct jejunum Roux-en-Y anastomosis difficult reoperation, complications, indications should bestrictly controlled.