After a cholecystectomy, Tanglou naturally knew something about cholecystolithiasis. After a preliminary examination, he had pain in the upper abdomen, and the B-ultrasound showed a strong echo light group, accompanied by sound shadows. It can be basically considered to be

Gallbladder stones.

Hecheng City No. 1 Hospital naturally has a specialized hepatobiliary surgery department, but the hepatobiliary surgery department treats more serious and serious patients. After all, medical resources are limited. Minor surgeries such as gallstones are basically handled by the general surgery department.

Cholecystectomy, to be honest, is a very simple operation for a resident like Ma En.

Hearing that Tanglou had just had an endoscopic retrograde appendicitis treatment called ERAT, Ma En was eager for surgery like never before.

"I remember that last time you served as Dr. Qing's assistant during a cholecystectomy. How about you help me with this operation?"

Ma En discussed with Tanglou so politely. One reason is that Tanglou itself is on rest today. The second reason is that Tanglou's current weight and status in the department are already a few points higher than his, so it is not easy to use.

Commanding tone.

"good."

Tanglou naturally accepts all comers for surgery.

"Then I'll make arrangements."

Ma En excitedly took the medical records and walked out to arrange various matters. Originally, some chores should be done by interns like Tanglou, but things are different now.

An hour later, everything was ready.

Both Ma En and Tang Lou entered the operating room.

Although cholecystectomy is a minor operation, it is generally slightly more difficult than appendectomy. In addition to Tanglou’s mirror assistant, Ma En also called in an intern, He Xiaozhuang, from Yan Ruoyun’s medical team as a

Ichisuke.

Together with the instrument nurse and anesthetist Chen Wenhao, the entire operation started step by step.

Cholecystectomy uses general tracheal anesthesia, and Chen Wenhao is naturally familiar with it.

However, when I looked at the surgical lineup, I was a little surprised. The operating room in the tenement house had such a crude lineup this time?

But I prepared an extra small stool for free.

After completing the anesthesia quickly, Chen Wenhao walked aside and sat down. He had just come from Qingping's operating room. Dr. Qing's major operation had been performed for 8 hours, and it was said that it would take another 10 hours to complete.

above.

Seeing Ma En being the surgeon, Chen Wenhao quickly yawned.

Compared with appendectomy, cholecystectomy uses the four-port method.

Maan made a 10mm incision at the patient's umbilicus as an observation hole, 2 incisions under the xiphoid process as the main operating hole, 2cm under the costal margin at the right midclavicular line, and 2 5mm incisions each at 5mm under the costal margin in the right anterior axillary line as auxiliary operating holes.

After completing the puncture, Ichisuke controlled the influx of CO2.

"Control the pneumoperitoneum pressure to 12~15mmHg..."

Ma En gave the order enthusiastically, and at the same time looked at Tanglou: "Start laparoscopic exploration."

Tang Lou nodded and inserted the laparoscope through the observation hole at the navel.

"There is no bleeding at any puncture point..."

"There are no lesions in the liver and spleen..."

"No gastrointestinal adhesion, tumor..."

Tanglou followed the regular path and advanced bit by bit. Under his control, the vision was naturally clear and the rhythm was smooth.

Soon the laparoscope explored the right upper abdomen, and yellow-green adhesions appeared in front of the camera, which was full.

As soon as he saw the picture of the patient's right upper abdomen, Ma En was immediately stunned, and Tang Lou's hand stopped immediately.

"It's bile, holy shit!"

Ma En's heart trembled, his whole body was tense, and a large amount of bile appeared in the right upper abdomen. This situation was completely beyond his expectation.

"He Xiaozhuang, please go out and contact Yan Ruoyun, the doctor. Tanglou and I will continue to investigate. The diagnosis is wrong. The patient may have a common bile duct rupture."

Ma En immediately issued the order, and He Xiaozhuang nodded heavily. Fortunately, Dr. Yan was on duty today.

Compared to Ma En's anxiety, Tanglou's mentality was much more stable due to his talent and concentration. While investigating, he activated the diagnostic technique.

[Patient: Liu Chunhua, female, 63 years old

Symptoms: A large amount of bile appeared in the patient's right upper quadrant, a 1.5cm×1.5cm stone was found on the outside of the lower section of the common bile duct, and 2/3 of the common bile duct wall near the duodenum was gangrenous and perforated, leaving only the posterior wall.

One 1.5cm×1.8cm stone was lodged in the distal end of the common bile duct. The diameter of the common bile duct was 2.5cm, and the sphincter of Oddis was fibrotic.

Diagnosis: The patient had spontaneous perforation of the common bile duct, which is extremely rare in acute abdomen. Spontaneous perforation of the common bile duct is more common in children and rare in adults.

System prompt: Possible reasons: 1. The patient's common bile duct stones repeatedly damaged the wall tube, and the bile duct was infected multiple times, causing the tube wall to lose elasticity due to fibrosis. 2. The patient was older, and arteriosclerotic changes affected the bile duct blood vessels and local tissue blood supply

Reduced, 3. The patient's common bile duct wall is congenitally weak.

Due to severe local inflammation after the patient's common bile duct perforation, measures such as repairing the bile duct are often counterproductive. Since the patient's common bile duct has a large puncture that cannot be repaired, and fibrosis occurs in some parts, it is recommended to use choledochojejunal ROux-en-y anastomosis.

Technique]

"System, do you think I have a bad face?"

[No, the one with a black face is Ma En. In your human terms, you, the host, have defeated the master's sword!]

"???"

...

After understanding the condition, the investigation of Tanglou was also completed simultaneously:

"Intraoperative exploration revealed: a large amount of bile appeared in the patient's right upper quadrant, and was found under the common bile duct..."

After Tanglou's exploration results came out, he looked at Ma En: "Dr. Ma, the best way now is to use choledochojejunostomy ROux-en-y anastomosis. Can you do it?"

Ma En looked at Tang Lou and twitched the corner of his mouth, and pondered for two seconds: "Well, I think it would be better for us to wait for Yan Ruoyun to come over."

"Oh~"

The director of Tanglou said oh and directly entered the system space.

"Neither will he."

[Ding, new task: eliminate the second surgeon and replace it. Completing the operation will reward 2 gold coins. The card library is refreshed once. Whether the host refreshes the card library ROux-en-y choledochojejunostomy]

"refresh!"

[Card library refreshed: choledochojejunostomy (one star, 2), choledochojejunostomy (one star, 2), choledochojejunostomy (one star, 2), cholecystostomy (one star, 2

), cholecystostomy (one star, 2)]

Tanglou directly selected three choledochojejunostomy procedures (one star, 2).

[Cholechochojejunostomy (one star, 2), Choledochjejunostomy (one star, 2), Choledochjejunostomy (one star, 2) Automatic synthetic choledochjejunostomy (two stars, 6)]

Duang! Duang! Duang!

The panel of the tenement building:

Level 5: Upgrade 24

Surgery column (5/5): suture (three stars, 9), diagnostic surgery (one star, 3), appendectomy (three stars, 18), cholecystectomy (one star, 2), choledochojejunostomy

(two stars, 6)

Gold coins: 10

Bond(2/2):

1. Surgical Master (Level 2, 4/5): Reduce infection rate by 30%, increase healing by 30%, and reduce patient pain by 30%

2. Chief surgeon's aura (level 1, 2/2): The host obtains the chief surgeon's aura, with a 20% probability of making other surgeons obey his command, a 20% probability of increasing the assistant's confidence and keeping his mentality stable, a 20% probability of improvement

Assistant success rate.

Talents (4/4): 1. Sewing the assembly line (activated) 2. Listening 3. Focus 4. Resilience

Storage column (6/9): Exposure (three stars, 9), Hemostasis (three stars, 9), Emergency Comprehensive Surgery (three stars, 9), Debridement (two stars, 6), Dressing change (three stars, 9), Cut

Surgery (three stars, 9)

...

...

When Dr. Yan Ruoyun scolded Ma En, sprayed He Xiaozhuang in the face, and rushed towards the operating room.

"Young doctors are just unreliable. The examination was so sloppy. Bile was found during the operation. It is very likely that the common bile duct is perforated. Fortunately, I was sensible and asked me to come to the rescue. Otherwise, if I thought I was smart and tried to repair the bile duct, it would be counterproductive. This kind of

If the breach in the common bile duct is small, simple bile duct outflow will be the main method. If the breach is large, choledochojejunostomy ROux-en-y should be used. Do you understand!"

As Dr. Yan walked away, he cursed. If he hadn't happened to be on duty today and encountered this rare spontaneous rupture of the common bile duct, he would have really had a medical accident.

He Xiaozhuang kept nodding, feeling aggrieved: I am an intern, I can't even hold a mirror well, I know how to use a hammer.

...
Chapter completed!