The gallbladder is located in the upper right abdomen, and the appendix is located in the lower right abdomen.
The patient now feels pain in the right lower abdomen, so Dr. Sun firmly believes that it is acute appendicitis.
A few decades ago, acute appendicitis required surgical resection, but with the advancement of medicine, appendicitis can even be controlled with drugs and treated conservatively.
Zhao Yuan didn't want to argue with Dr. Sun in public, so he turned his attention to Tong Zheng.
Tong Zheng did not make an immediate decision and ordered Bai Lu to send the patient to the color ultrasound center.
Time passes minute by minute.
Dr. Sun found that Zhao Yuan was calmer than expected, and wondered where did this intern get his confidence?
"Director Tong, if Zhao Yuan's diagnosis is wrong, should we consider changing the surgeon for this operation? Is it too dangerous for the patient to leave it to a doctor who is not sure about the condition?" When Dr. Sun was talking to Tong Zheng,
He immediately became honest and honest.
Tong Zheng couldn't tell what Dr. Sun was thinking, "Do you want to do this surgery?"
Dr. Sun's face turned red and he said quickly, "I don't have to do this surgery. I just think the surgery should be left to a reliable person so that they can be responsible for the patient. Otherwise, the patient's family may not agree, right?"
Seeing that Dr. Sun was talking in a roundabout way and not at all candid, Tong Zheng felt unhappy and said lightly, "When the color ultrasound results come out, I will naturally give you a satisfactory answer."
No one dared to delay the urgent order from the emergency surgery, and the results of the color ultrasound did not take long.
Tong Zheng took the film from Bai Lu's hand, glanced at it twice, his wrinkled face relaxed, and then handed it to Dr. Sun.
"Can you understand the movie?"
Judging from Tong Zheng's tone and attitude, Dr. Sun already had a premonition that something was not good. He studied the color ultrasound carefully, sweating on the tip of his nose, and his mind went blank.
"Thickening of the gallbladder wall, enlargement of the gallbladder, internal deposits in the gallbladder, acute cholecystitis!"
"No way, did I get the wrong film? The gallbladder is in the right upper quadrant, and the appendix is in the right lower quadrant. I was right!"
Dr. Sun actually doubted the accuracy of color ultrasound.
Tong Zheng glanced at Zhao Yuan and sighed, "Tell him the reason!"
Zhao Yuan knew that Tong Zheng was also testing himself, so he began to patiently explain: "The pain in the right lower abdomen, and the pain is in a fixed location, is generally considered to be acute appendicitis. However, the onset of appendicitis generally starts around the belly button, and in the later stages
It just moved to the right lower abdomen. I just asked the patient and she did not experience pain around the belly button!"
"In addition, the gallbladder is located in the right upper quadrant, and there is another possibility of causing pain in the right lower quadrant. That is gallbladder perforation! Not only appendicitis will cause pain in the right lower quadrant, but if the gallbladder is perforated, the gallbladder fluid will continue to flow into the right lower quadrant, which will also irritate the right lower quadrant.
Cause pain."
Gallbladder perforation?
Dr. Sun couldn’t believe it!
Tong Zheng looked solemn next to him, "If it is a perforated gallbladder, the patient's condition is very dangerous and requires immediate surgery!"
As soon as he finished speaking, Bai Lu shouted, "The patient has lost consciousness!"
Zhao Yuan's eyes fell on the blood pressure monitor, which was only 70/40mmhg.
He quickly touched the patient's belly and said in a deep voice, "Perforated gallbladder may cause diffuse biliary peritonitis. Surgery must be performed as soon as possible!"
In this case, laparoscopic minimally invasive surgery is no longer possible and laparotomy is necessary!
Tong Zheng nodded towards Zhao Yuan.
Zhao Yuan made consecutive correct judgments, which made Tong Zheng feel more confident, and he decided to completely delegate power to Zhao Yuan.
…
Gallbladder perforation is a serious complication of acute cholecystitis. Ten percent of patients with acute cholecystitis will have gallbladder perforation. The key to successful treatment lies in making a correct diagnosis in an early and timely manner.
The patient has already developed symptoms of shock, indicating that the condition has reached its most critical stage.
Fortunately, the time from the onset of the patient's illness to the diagnosis is not too long.
If you follow the treatment of appendicitis and adopt conservative treatment, it will delay the opportunity.
Tong Zheng was surprised that doctors had accumulated enough experience to be able to determine what was wrong with the patient immediately during the physical examination.
A high-level physical examination not only follows the steps in the textbook, but also includes respiratory rate, heart pulse, pupil status, muscle reactions, etc.
Just like a sniper on the battlefield, before firing a bullet, he must consider wind speed, humidity and other comprehensive factors.
Zhao Yuan was just starting out and could tell that the patient was not suffering from appendicitis just by relying on his keen sense of smell.
There is only one explanation: he is also extremely talented in the field of diagnosis!
The medical department came forward, and Zhao Yuan and Tong Zheng told the patient's parents the truth.
The mother took the suggestion and signed the letter with tears in her eyes.
…
Cholecystectomy surgery is not considered a major surgery in emergency surgery, but the special feature of this surgery is that the gallbladder is perforated.
Dr. Sun volunteered to stay in the operating room. He looked smiling on the outside, but was actually angry inside.
He still believed that Tong Zheng's decision to let Zhao Yuan serve as the chief surgeon was an outrageous decision.
Tong Zheng personally serves as an anesthesiologist. A good anesthesiologist is the basis for a successful operation.
Tong Zheng's technique was gentle and precise. From the details of pushing the medicine, Zhao Yuan could tell that his level was extremely high.
Zhao Yuan started to cut the skin.
Everyone's attention is focused on the incision.
The incision is very small, only about three centimeters. You must know that the incision of laparoscopic minimally invasive surgery is generally only about three centimeters.
And the location is wrong!
Made a mistake?
Tong Zheng was worried in his heart, but decided to trust Zhao Yuan first and wait and see what happens.
Zhao Yuan began to bluntly separate the subcutaneous tissue and muscles, and open the peritoneum.
Because the incision is so small, only small pliers are allowed to penetrate it.
Before anyone could react, Zhao Yuan suddenly took out the gallbladder.
Tong Zheng's eyes lit up and he realized that Zhao Yuan had just completed a difficult operation in an instant!
Blind exercise!
Normally, the location of the gallbladder needs to be determined with the naked eye or with the help of the surgical field provided by laparoscopy.
But Zhao Yuan accurately locked the position by feeling.
Tong Zheng may be able to do it, but not as fast!
No wonder he dared to make such a small opening in an unconventional position. He turned out to have the ability to perform blindly.
Any ability that Zhao Yuan showed was invisible to an expert like Tong Zheng.
I have had thoughts before, so I can help Zhao Yuan at any time.
Look now, you are worrying too much! Zhao Yuan is too stable!
"Little curved pliers!"
Zhao Yuan handed the middle bend to Bai Lu, and Bai Lu handed the small bend to Zhao Yuan as instructed.
Bai Xiaohu has been in the operating room for more than ten years and has experienced many cholecystectomy surgeries, but today's surgery was different.
Nothing was wrong, but it was unusually smooth and smooth.
As soon as you raise your hand, the instrument will fall accurately into your hand.
Zhao Yuan also secretly admired Bai Lu's cooperation. She was worthy of being a device nurse in a large hospital. Although it was her first time to cooperate, her understanding was incomparable.
In the blink of an eye, Zhao Yuan removed the swollen gallbladder and began to suture and tie the artery.
The next step is to clean the abdominal cavity with saline.
Although the patient had a perforation, due to the timely discovery and the fact that the patient was relatively young and had a strong immune system, there were no other complications and the inflammation did not leak out on a large scale.
Wash repeatedly until clean...
Unknowingly, we reached the last step...
"5-0 stitches!"
Zhao Yuan's request was like clearing the air.
The mystery lingering in the hearts of Tong Zheng and Bai Lu was solved.
No wonder Zhao Yuan made the incision so small!
The patient is a young woman who has not yet married and has children. If the incision on the abdomen is too large, it will definitely affect the appearance and avoid unnecessary misunderstandings on certain occasions.
Tongzheng generally uses 4-0 absorbable sutures, and the higher specification 5-0 is basically not used.
The thinner the thread, the finer the needle, the smaller the sewing window, and the difficulty increases geometrically.
Of course, the recovery effect will also be better.
After recovery, basically no scars will be left.
Zhao Yuan's mind is delicate and meticulous, and he has considered everything carefully before cutting the skin.
"Okay, the operation is complete!"
It only took thirty seconds to suture the 5-0 catgut, and Zhao Yuan cut off the suture.
Tong Zheng subconsciously looked at the electronic clock in the operating room. From start to finish, the operation took eight minutes and thirty-five seconds!
A normal cholecystectomy operation takes ten to twenty minutes.
Fast, too fast...
Zhao Yuan breathed a sigh of relief, and suddenly realized that something was wrong in the atmosphere!
The silence before the explosion...
Tong Zheng took the lead in applauding, followed closely by Bai Lu.
Dr. Sun, who was standing aside in a daze, clapped his hands in frustration in this atmosphere, with an awkward smile on his face to hide his disappointment.
I must admit that I lost to an intern.
Moreover, he lost completely!
In addition, Xie Changtian stood up from the corner and applauded!
Hearing that Tong Zheng decided to let Zhao Yuan complete an operation independently, he felt uneasy, so he quietly came to the operating room after the operation started.
Reviewing the surgery just now, there are too many details worthy of scrutiny.
This is an atypical cholecystectomy surgery.
The biggest controversy lies in the location of the incision. Normal people would choose the "right costal arch" (gallbladder surgery point), but Zhao Yuan chose "McFarland's point" (appendix surgery point) as the incision, which can clean the abdominal cavity more quickly and solve the problem.
Infection issues after piercing.
The controversy is also the highlight.
How coquettish and daring it is to blindly clip out the gallbladder through McLaren's incision without using any auxiliary tools!
Of course, all this is based on his strong enough strength!
