After the choledochoscope is prepared, it enters the abdominal cavity through a special cannula, and then enters the common bile duct through the common bile duct incision. The light source of the choledochoscope is turned on, and the situation inside the patient's common bile duct appears on the connected electronic display.
The various tubes of the human body appear to be a cavity under an optical microscope. When magnified, it looks like a cave-like landscape.
Analogous to the intestinal examination of a colonoscopy, the doctor mainly observes the various contents in the wall and lumen of the bile duct through a choledochoscope. There are not only possible gallstones, but also bile normally secreted by the human liver, and unexcluded bile.
Various growths including tumors.
The surgeon controls the choledochoscope for inspection by adjusting the focal length and the direction of the light source of the choledochoscope, which is similar to the inspection operation of laparoscopy.
The difference is that laparoscopy requires several people to cooperate with the operation, while choledochoscopy has only one tube and is operated by a single person.
Once an abnormality is detected during choledochoscopy and the next step is required, unlike laparoscopy, where an assistant can collaborate, the doctor can only continue to work alone.
From this we can see that the number of skills a doctor needs to learn to become a successful doctor is beyond the imagination of ordinary people. The development of medical technology has led to the use of more and more high-tech equipment that traditional surgeons need to master, and the requirements for their abilities have become higher and higher.
There are no other channels. If the doctor wants to use other instruments, he can only continue to use the same choledochoscope tube. For example, insert the sapphire blue through another hole in the lens of the biliary tract, extend it from the end where the light and shadow are, catch the stone, and drag it out of the biliary tract.
.If gravel is needed, ultrasonic waves can be used. Connect the irrigation pipe and use saline irrigation to flush out the remaining small stones in the pipe.
These operations can be imagined to be more difficult than colonoscopy and gastroscopy because the bile duct lumen is small. If the end of the bile duct is inoperable, the only option is surgical resection.
As early as the beginning of choledochoscopy, the focus of everyone's attention left the laparoscopic monitor screen and fell on the electronic display screen of the choledochoscope.
With the light source irradiating the patient's choledochoscope, people can see the relatively smooth inner wall of the biliary tract, as well as the sudden appearance of yellow-white floc. What is this? Is there something strange growing in the patient's body?
"This should be the comet sign."
A group of doctors discussed: The ribbon-like floating thing seemed to grow out of the wall of the tube, with a small head and a big tail, and was shaped like a comet, so it was called the comet sign.
"The presence of the comet sign means that the stone is in the narrow opening at the back." The doctors concluded.
The comet sign was first discovered by doctors in China. Its significance is that the choledochoscope can continue to search from the root of the "comet". Generally, the narrow bile duct opening can be found, and there must be obstructions such as gallstones or roundworms behind it. This "comet" actually
It is formed when bile encounters a blockage and ejects from a narrow place to a spacious place. The hepatic duct is small and the bile duct is large. If the former sprays into the latter, blockage often occurs in the hepatic duct.
Discovering the comet sign is equivalent to discovering the location of the stones. Next, use a choledochoscope to remove the stones and rule out bile duct obstruction, and the patient's jaundice may be cured. However, in order to achieve a complete cure, it is necessary to understand why the patient develops stones.
Is it just a simple diet problem? Or is there a problem with the metabolism of the liver cells themselves? Or is it caused by other reasons?
On this key multiple-choice question, He Guangyou and others suggested that the cause of liver cell problems must be "not bile duct obstruction caused by gallstones."
