What are the precautions for patients undergoing cholangioscopy?

Not suitable for people: patients with small common bile ducts with smaller diameters or thin and brittle walls of common bile ducts. It should be used with caution in patients with severe heart failure and bleeding tendency.

If the hyperthermia is caused by a cause other than the biliary tract, the examination should be postponed. Contraindications before examination: Stone removal is generally initiated 4 to 6 weeks after common bile duct exploration and T-tube drainage, when a strong fibrous fistula has formed around the T-tube.

Intramuscular fentanyl, luminal, and atropine one hour before surgery; or Valium 10 mg, Demerol 50 mg. Sometimes analgesics may not be used. Contraindications during examination:

1.Choledoscopy should always be performed under direct vision and with gentle movements to avoid penetrating the sinus tract. Directly observing whether the stone is caught in the net, and with the feeling when the net is closed, there is a resistance to limit the closure of the net, which is an important sign of successful stone removal.

Stones that are about 25px in size and hard are easier to remove. The stone is large, and although it has been put into the net, it is easy to get stuck at the junction of the biliary tract and the sinus tract and cannot be pulled out. At this time, the assistant can press the abdominal wall around the sinus opening, and the surgeon tightens the stone basket net, intermittently and slowly pulls outward, patiently and continuously increasing traction in the direction of the sinus.

Precautions for the use of choledoscope: when inserting the surgical attachment in the forceps pipeline, the angle of the front end of the mirror should be kept straight, that is, there is no angle, so as to avoid the attachment scratching the internal pipeline; The inside of the mirror is glass fiber, plastic pipes, and rubber parts, please use it with care to avoid bending, if it is really necessary to coil, the radius shall not be less than 25cm, and the insertion tube shall not be bent at an acute angle; Do not hang vertically in the special endoscope storage cabinet for the time being, and keep the inner and outer pipes of the endoscope dry; Carefully check the appearance of the endoscope before each cleaning, and if any abnormalities or damages are found, immediately avoid full immersion cleaning and disinfection, wipe it clean with a damp cotton cloth, and notify the relevant engineers of the manufacturer; If you need to send the lens during the operation, please try to send the lens by hand or other instruments with soft and apical ends, and it is strictly forbidden to use pliers or tweezers with a hard and sharp apex to send the lens; When connecting the adapter and the mirror, it is necessary to pay attention to maintaining uniform force, rotating smoothly to the end of the bayonet, and it is strictly forbidden to use the choledoch mirror when the adapter is not connected in place to prevent accidental falling; When the mirror and adapter are suspended on the trolley, the trolley should be pushed to a safe position and the mirror should be placed smoothly, taking care to avoid damage to the endoscope caused by human collision; When cleaning the endoscope, make sure that the ETO cap is removed.

Answer]:1Intraoperative cholangioscopy and preoperative preparation are the same as those for conventional biliary surgery. 2.The postoperative cholangioscopy was performed 3 weeks after surgery. Postoperative choledochoscopic lithotomy is performed 5 to 6 weeks after surgery, and trans-tube gallography should be routinely performed first.