The complications of choledochotomy T-drainage also include intraoperative intestinal Chi worm, bile peritonitis, re-putting the common bile duct T-shaped drainage. Due to the bile duct wall edema and fragile suture in a patient, male, 24 years old, with diagnosis: chronic cholecystitis and too many gallbladder knots, mistaken for the T-shaped wall suture fixation. One month after extubation, trapped stones and common bile duct stones occurred. The gallbladder was cut, and the glands as well as the common bile duct were involved, but it was difficult. Not daring to pull forcibly, after 2 months of slow, continuous traction, the final T-shaped drainage tube was placed. 12 days after cholangiography post-surgery, there were no exceptions, so it was pulled out, without bile duct injury or biliary Xinjiang meningitis, thus disconnecting the T-shaped pipe. Immediately after extubation, pain on the right side occurred and quickly spread. Throughout the abdomen, abdominal puncture indicated bile peritonitis. Again surgery was performed, finding that the fibers of the abdominal wall at the fall Road interrupted the common bile duct partially torn. The re-release T-shaped pipe bow I stream discharged three weeks after surgery extubation treatment lessons learned: the T-shaped tube saved the wall too long, the middle window was not big enough, too much force caused this. The thickness of the T-shaped pipe should be away from both ends to save the wall a long stay in each 1.5-2.5cm, the cross-wall cut or cut a drain at the intersection of the contralateral, making extubation easier.
2T-shaped pipe put too high, blocking the hepatic duct bifurcation or side of the liver camp, affecting the total drainage of the gallbladder in patients, female, aged 45, with the same diagnosis as before. The surgery is basically the same, just after surgery, patients had fever, right upper quadrant pain and discomfort, and it was found that the T-shaped tube was placed too high on one side of the hepatic duct and poor drainage due to the T-tube cholangiography. The lessons learned: the T-shaped pipe should be placed close to the duodenum leads to shop between Ether-A. Prevent the duodenum, the oppressed, the formation of fistula, the T-shaped tube to the original incision should be placed on the outside of another stamp incision leads to the skin being fixed, preventing prolapse. If you fall off within a week, reoperation to re-put the T-shaped pipe, and after a week off. Guide feces tube inserted into the abdominal cavity lead to Tibet, if the T-shaped tube placed in the common bile duct too long, more than six months or more than 1 year or T-shaped camp has gone, pulling glance should be gentle. To prevent the break.
3T-shaped pipe acts wrong, I encountered one case of patients with T-shaped pipe too small, too soft. Distorted in the common bile duct, discount, resulting in poor drainage. Also see walk the line is too long one case of T-shaped tube reasonable by the liver under the abdominal drainage tube oppression, so that after surgery jaundice, found by cholangiography. Pull out the abdominal drainage tube, jaundice gradually subsided. Lessons learned: the T-shaped tube to select thickness to the right. Too small and poor drainage, too rough common bile duct is barely stitched, pull over too common bile duct wall can cause compression of avascular necrosis, and easy to form bile fistula or bile duct stricture. The general adult available 1720-24 T-shaped pipe, women or small bile duct can be used F18, 22. T-shaped pipe, recent airbag T-shaped pipe, expansion, choledochoscope.
4 pull out the T-shaped tube difficult lessons learned: the suture of common bile duct bow T-tube fixed in the common bile duct on the 5T-shaped tube on the common bile duct dissection women, 3o-year-old acute attack of cholelithiasis biliary colic, gallbladder death in the emergency downlink acute necrotic gallbladder cut gland surgery after surgery 4d pancreatitis, surgical drainage and colostomy, postoperative T-shaped tube bile flow, obstructive jaundice, the line is again surgical exploration found that the T-shaped pipe is not within the common bile duct in the common bile duct sandwich, resulting in bile Explorer narrow bile duct external drainage. Experience: common bile duct is first to try out the bile, and then sewn onto the support line, and began to cut the common bile duct to prevent wear left. Above and below the common bile duct exploration, with or without the seedling narrow and residual stones can also be intraoperative cholangiography or application choledochoscope. Put completion of the T-shaped suction with or without bile flow, the injection of physiological salt bearing, with or without resistance, the tube beyond the pylorus, showing whether the bile flow.
6T-shaped tube pulled out of the experience ① pull the T-shaped tube indications: first, the inflammation subsided. The temperature is not high. The pain disappeared, the bile clear floc and purulent secretions. Apply normal white blood cells, bacterial culture negative. Followed the end of the open common bile duct. Bile daily flow reduction angiography. Closed T-shaped tube 3 ~ 4d, the absence of any reaction before extubation. ② T-shaped tube cholangiography: the best with 19% diatrizoate 506Oral, take the head-down 30 to the left lateral position, the 15o slow injection, showing the right half of the hepatobiliary duct system. Re-head-down 30o prostrate bit to continue injection, showing the right half of the hepatobiliary duct system. Last supine head 30 ~ to display the common bile duct. If residual stones or common bile duct the end of a narrow, choledochoscope the 0d hit s sphincterotomy stone extraction or non-extubation. ③ the Extubation method: patient supine, the abdominal muscles relax, a little T-shaped tube mobile, sub gently pull out the common bile duct extubation, add 1 ~ 2d, so that the residual bile outflow. If the resistance must carefully identify the cause, to prevent accidents caused injury.