Doctor's Life Simulator

Chapter 220 Liu Peichun is the main swordsman, and another moth has appeared!
Liu Peichun grabbed Qin Lang excitedly and asked, his mind was ready for brain supplementation.

"It is to insert the endoscope, insert the catheter, and then insert the zebra guide wire"

Qin Lang explained the whole operation process to Liu Peichun very concisely. Listening to Qin Lang's vivid description, Liu Peichun could feel the thrill. After all, for a surgeon, it is really amazing to be able to perform a complicated operation. A supreme pleasure.

Until Qin Lang explained the whole process, Liu Peichun was still immersed in the atmosphere of the whole operation. This feeling was like a dormitory, and the next door was making a bowl of instant noodles. People who eat also enjoy.

"Doctor Liu, I seemed to see you were looking at a case file just now, and your brows were frowning."

One sentence from Qin Lang pulled Liu Peichun back from his intoxication.

Liu Peichun walked directly to his seat, and took the document on the table:
"Here, a strange case. The initial diagnosis was acute abdomen, and the specific cause was not found out. It is now admitted to the ward. After Director Pang's operation is completed, we will discuss it together."

Qin Lang took it over and looked at it, the preliminary physical examination and patient information:
Patient: Liu Chunhua, female, 63 years old

Complaints of right upper quadrant pain for 1 week, sudden exacerbation of abdominal pain with high fever for 1 day.

Vital signs: T38.8℃, P92 beats/min, BP16/12kPa,

There were tenderness, rebound tenderness, and muscle guarding throughout the abdomen, mainly in the right upper quadrant. WBC16×109/L.

Preliminary diagnosis: acute abdomen, possibly biliary disease.

"Have you arranged for a B-ultrasound examination?"

Qin Lang recalled that the location of tenderness may indeed be a lesion in the gallbladder. If it is really a problem with the gallbladder and bile duct, Zhang Nan, who specializes in the field of liver and gallbladder in the surgical team, may have to take over.

Zhang Nan, a senior attending physician in the surgical team of the emergency department, and a second-line on-duty physician, is very capable in the field of liver and gallbladder.

"It's already being checked, and it's estimated that there will be results in a while."

Although Liu Peichun has been a resident doctor for several years, there are really too many possibilities for acute abdomen. It is really difficult to diagnose many patients until the moment of laparotomy.

Soon, the B-ultrasound test came out.

"B-ultrasound showed multiple common bile duct stones, and a 1.5cm×1.5cm enhanced light group was seen outside and below the common bile duct cavity, with sound shadow behind it."

After reading it, Liu Peichun looked at Qin Lang: "Preliminary diagnosis: common bile duct stones, biliary tract infection?"

Apart from the appendicitis series, Qin Lang is also very familiar with gallbladder stones. After a preliminary examination of the symptoms, upper abdominal pain and B-ultrasound showed strong echo light clusters accompanied by sound shadows, which can basically be regarded as gallbladder stones.

The First Hospital of Hecheng City naturally has a specialized hepatobiliary surgery, but the hepatobiliary surgery treats more serious and severe patients. After all, medical resources are limited, and minor operations such as gallstones are basically digested by the emergency department.

Cholecystectomy, to be honest, is a very simple operation for a senior resident like Liu Peichun.

Hearing that Qin Lang had just used an endoscopic retrograde appendicitis treatment for ERAT, Liu Peichun's desire for surgery was unprecedented.

"Qin Lang, I'm going to perform this operation, how about you help me hold the mirror."

Liu Peichun discussed with Qin Lang so politely, one is that Qin Lang himself is resting today, and the second is that Qin Lang's current weight and status in the department are already somewhat higher than him, so it is not easy to use orders tone of voice.

"it is good."

Qin Lang naturally does not refuse anyone who comes for the operation.

"Then I'll make arrangements."

Liu Peichun excitedly took the medical records and walked out to arrange various matters. Originally, some chores should be done by newcomers like Qin Lang, but it is not what it used to be.

An hour later, everything was ready.

Both Liu Peichun and Qin Lang entered the operating room.

Although cholecystectomy is a minor operation, it is generally a little more difficult than appendectomy. In addition to Qin Lang's mirror assistant, Liu Peichun also called an intern He Xiaozhuang from Zhang Nan's side to serve as A help.

Together with the equipment nurse and anesthetist, the whole operation started step by step.

The cholecystectomy was performed with general tracheal anesthesia, and the anesthetist Chen Wenhao was naturally familiar with it.

However, when looking at the surgical lineup, I was a little surprised, the operating room where Qin Lang haunted, this time the lineup is so simple?
It was a waste of time to prepare a small stool.

After finishing the anesthesia soon, Chen Wenhao walked aside and sat down.He just rushed over from Director Pang's operating room. Director Pang's major operation has been done for 8 hours, and it is said that it will take more than 10 hours to complete.

Seeing Liu Peichun in charge, Chen Wenhao quickly yawned.

Cholecystectomy uses the four-hole approach compared to appendectomy.

刘培春在患者脐部做10mm切口为观察孔，剑突下2cm偏右做10mm切口为主操作孔，右锁骨中线肋缘下2cm、右腋前线肋缘下2各5mm切口做辅助操作孔。

After the puncture is done, the first aid is to control the CO2 rush.

"Control the pneumoperitoneum pressure to 12~15mmHg"

Liu Peichun gave the order vigorously, and looked at Qin Lang at the same time: "Start laparoscopic exploration."

Qin Lang nodded, and inserted the laparoscope through the observation port of the navel.

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

"There is no disease in the liver and spleen"

"Gastrointestinal adhesions, tumors."

Qin Lang followed the conventional path and advanced little by little. Under his control, he naturally had a clear vision and a smooth rhythm.

Soon the laparoscope probed the upper right abdomen, and yellow-green adhesions appeared in front of the camera, filling them.

Seeing the picture of the patient's upper right abdomen, Liu Peichun was dumbfounded, and Qin Lang's hand also stopped immediately.

"It's bile, I rely on it!"

Liu Peichun's heart trembled, his whole body tensed up, and a large amount of bile appeared in his upper right abdomen, which completely exceeded his expectations.

"He Xiaozhuang, hurry up and contact Dr. Zhang. Qin Lang and I will continue to investigate. The diagnosis is wrong. The patient may have a ruptured common bile duct."

Liu Peichun immediately issued an order, and He Xiaozhuang nodded solemnly. Fortunately, Dr. Zhang Nan was on duty today.

Compared to Liu Peichun's restlessness, Qin Lang's mentality was much more stable. While investigating, he began to conduct further diagnosis during the operation:

A large amount of bile appeared in the right upper quadrant of the patient, and a 1.5cm×1.5cm stone was found outside the lower part of the common bile duct. Two-thirds of the common bile duct wall near the duodenum had been gangrene and perforated, leaving only the posterior wall.

A 1.5cm×1.8cm stone in the distal common bile duct was incarcerated.The diameter of the common bile duct was 1cm, and the sphincter of Oddis was fibrotic.

Qin Lang was also a little surprised to see here. It turned out to be another rare case of spontaneous perforation of the common bile duct, which was encountered once at the opening ceremony of the graduate students of Zijingang No. [-] College.

Qin Lang has been very experienced in this kind of symptom, and the etiology may be as follows: 1. The patient's choledocholithiasis repeatedly damaged the wall duct, and the biliary tract was infected repeatedly, which made the duct wall lose its elasticity due to fibrosis. 2. The patient is older, the arteriosclerotic changes involve the bile duct vessels, and the blood supply of local tissues is reduced. 3. The patient's common bile duct wall is congenitally weak.

Due to the severe local inflammation after the perforation of the common bile duct, measures such as repairing the bile duct are often counterproductive. Since the common bile duct in the patient has a large breach and cannot be repaired, and some fibrosis occurs, the best way is to use the common bile duct jejunum ROux- en-y anastomosis.

After learning about the condition, Qin Lang told Liu Peichun his judgment: "Doctor Liu, the best way now is to use choledochojejunum ROux-en-y anastomosis. Do you know?"

Liu Peichun watched Qin Lang's mouth twitch, and pondered for two seconds: "Well, I think it's better for us to wait for Zhang Nan to come over."

Doctor Zhang is on duty today, so Liu Peichun's mentality is relatively stable.

Dr. Zhang scolded Liu Peichun severely, and even sprayed He Xiaozhuang on the face, when he rushed towards the operating room.

"Young doctors are unreliable. The inspection is so sloppy. Bile is found during the operation. It is very likely that the common bile duct will be perforated. Fortunately, I am sensible and asked me to come to the rescue. Otherwise, I will rashly think that I am smart and try to repair the bile duct. It will be counterproductive. This kind of If the breach of the common bile duct is small, simple biliary outflow should be used. If the breach is large, ROux-en-y anastomosis of the common bile duct should be used. Do you understand?”

Dr. Zhang scolded as he walked, if he hadn't happened to be on duty today, he had encountered such a rare spontaneous rupture of the common bile duct, there would really be a medical accident.

He Xiaozhuang kept nodding, feeling aggrieved in his heart: I'm an intern, I can't even do mirrors well, I know a hammer.

In the operating room, Qin Lang's tone was flat, and he looked up at Liu Peichun: "Doctor Liu, I can perform ROux-en-y anastomosis of common bile duct and jejunum!"

In the operating room, Qin Lang's words resounded loudly.

Chen Wenhao, who was still sitting on a small bench, suddenly woke up from a doze. Every operation he performed on Qin Lang was so troublesome, but every time Qin Lang used solid surgical techniques to solve the problem.

Chen Wenhao really wanted to call out: "Do you still have a Japanese name: Conan!"

Seeing Qin Lang stepping forward, Liu Peichun hesitated, will you do it too?

"The patient's abdominal cavity has been opened. Under the pneumoperitoneum, the longer the time is delayed, the more likely the patient will have sequelae. If it is not done properly, there will be a medical accident."

"I have encountered this kind of surgery for the spontaneous perforation of the common bile duct in Zijingang No. [-] Hospital before, and I have experience."

Qin Lang directly opened up the aura of the surgeon, and glanced at the equipment nurse: "Perform common bile duct and jejunum ROux-en-y anastomosis, scalpel, and needle forceps to prepare."

Qin Lang's unquestionable eyes swept towards Liu Peichun again, and Liu Peichun shrank obediently to the side.

After all, for an industry like a doctor, as long as you have the skills, you have the confidence to solve the problem, and you can't accept it.

Liu Peichun directly took over the laparoscope from Qin Lang and began to hold the mirror.

After Qin Lang and Liu Peichun performed the surgery for a while, Dr. Zhang finally finished the pre-operative disinfection preparations.

As soon as he entered the operating room, his complexion was extremely ugly, and he looked at He Xiaozhuang with sharp eyes.

"Didn't you say that they are waiting for me to come and deal with it, what's the situation!"

He Xiaozhuang was also in a daze, and he clearly saw Liu Peichun holding the mirror at the side, so the one doing the surgery was not the assistant holding the mirror?

Doctor Zhang scolded He Xiaozhuang, and walked up directly: "Stop, do you know what you are doing! The patient is a rare case of spontaneous perforation of the common bile duct, so don't be smart and try to repair the common bile duct, it won't work .”

Dr. Zhang took three steps and two steps in parallel, and he arrived at the monitor port of the laparoscope in no time.

Liu Peichun naturally recognized Dr. Zhang and felt guilty. Although Dr. Zhang was not his direct superior, he was almost as senior as Director Pang, especially in the field of liver and gallbladder.

Liu Peichun looked at Dr. Zhang, stopped the movement of his hands, and explained: "Dr. Zhang, the patient has already opened his abdomen. If"

But before Liu Peichun could explain, Qin Lang frowned when he saw Shuye who was not keeping up, and directly scolded: "Shuye! Shuye! Liu Peichun, be serious!"

Under the main knife's aura, Liu Peichun reflexively moved his sight back, and continued to assist Qin Lang to give him enough vision.

Qin Lang looked at Liu Peichun's readjusted vision for five seconds.

The operating room became quiet, and seeing Qin Lang not moving suddenly, Liu Peichun panicked: "What's wrong with Qin Lang, another accident happened?"

Qin Lang nodded.

Liu Peichun's legs went limp all of a sudden, and cold sweat broke out on his head. He was afraid for a while, but knowing that Dr. Zhang was behind him, he felt a little more at ease.

When Dr. Zhang saw the two young men in trouble, he shook his head slightly, and was about to go to the position of the chief surgeon. All of this was naturally within his expectation.

In the process of preoperative preparation, through He Xiaozhuang's description, he already had a surgical plan.Qin Lang could think that the ROux-en-y anastomosis of the common bile duct and jejunum has already made him very appreciative, but young people are not as old-fashioned as he is.

Sure enough, in the end, he had to do it himself, and Dr. Zhang was ready to walk to the position of the chief surgeon and open his mouth.

Liu Peichun was about to remind Qin Lang to obediently give up his operating position.

Qin Lang's voice sounded calmly:

"Using end-to-side anastomosis according to the conventional choledochojejunum ROux-en-y anastomosis is really not possible."

Doctor Zhang paused slightly with his feet.

"Because the patient is relatively old, the conventional end-to-side anastomosis is not applicable, so I need to simplify the operation."

Zhang Nan froze and got stuck halfway.

(End of this chapter)