Doctor's Life Simulator

Chapter 227 Cleverly extracting parasites, even textbooks dare not write like that! (two in one)

In order to ensure the success rate of the operation, nurses have been arranged before the operation to prepare the bowel with 1mL warm water three times to clean the enema, and give antibiotics intravenously 500 minutes before the operation.

After everything is ready, anesthesia is naturally performed first. Due to the child's reason, Qin Lang naturally adopts a new anesthesia method: general anesthesia, endotracheal intubation.

According to Qin Lang's request, Chen Wenhao quickly completed anesthesia on the child.

After finishing everything, he stepped back and handed the operating table to Qin Lang.

Qin Lang's first step was naturally very proficient. He directly used the transparent cap of the endoscope to push away the Gerlach flap. Before the experts could react, the opening of the appendix had been exposed.

"So easy?"

In the observation room, all the bosses were a little surprised. From Qin Lang's action, many things were reflected. First, he was very familiar with the anatomical structure of the appendix, and second, his finger pulp and wrist For the control of the endoscope, the strength and angle have been perfected.

"Without hundreds of operations, there would be no such instinctive operation."

Dr. Huang has the most research on ERAT. Seeing Qin Lang's cleanliness, he is a little envious!

"Could it be that Qin Lang did all these surgeries alone?"

As a result, an absurd thought came to him, but he still insisted that it is impossible for one person to complete so many surgeries in five days. The only possibility is that Zhuang Tong was preparing early, and these surgeries have been prepared for a long time. .

In the observation room, when thoughts are different.

Qin Lang said another command that surprised everyone: "LoopTip with loop guide wire"

Since Qin Lang's understanding of ERAT has reached a perfect level, he can make adjustments and modifications in a timely manner for specific cases.

He used the zebra guide wire in the previous ERATs, but this time the case is a bit special, the patient is young, the appendix is ​​thin-walled, and the opening is large. If the zebra guide wire is used, the straight guide wire is relatively harder It is easy to penetrate the soft mucosa of the appendix in children and enter the false lumen.

The second reason is naturally that the patient's appendix is ​​caused by parasites. If the ordinary straight guide wire encounters the parasites and eggs in the appendix cavity, its tip may tear the parasites and crush the eggs. , can cause secondary infection and unforeseen pollution.

However, the use of LoopTip loop guide wire has good bending resistance, and it is easy to achieve deep intubation through the gap in the obstruction site in the appendix cavity.

In the observation room, several experts naturally only know one thing but don't know the other, but it's amazing enough!

"It is conceivable that the straight tip of the zebra guide wire may penetrate the soft inner mucous membrane of the appendix in children. Qin Lang has really worked hard on ERAT."

"If I remember correctly, the LoopTip loop guide wire has not appeared in all the previous case materials, which means that this time it is Qin Lang's on-the-spot decision again."

Han Hu narrowed his eyes, a little unable to see through this young man.The on-the-spot reaction ability in the operating room is really too mature.

After listening to Director Han's narration, the rest of the experts were silent, but there was already a hint of appreciation in their eyes.

"Even if Qin Lang really slightly exaggerated the amount of surgery, his surgical talent and on-the-spot response are still worth cultivating. This kid has a bright future."

Dr. Huang, fully born with a heart of cherishing talents, set up the steps ahead of time.

"Medical skills are important, but medical ethics cannot be neglected."

The result was a little dissatisfied and whispered, and he was naturally displeased with Dr. Huang's defection.

"Catheter placement."

In the operating room, Qin Lang's hand movements did not stop, and went directly to the next step. After the catheter was inserted, purulent secretions had already begun to gush out.

"Appendix Cavity Rinse"

Qin Lang continued to send out the next order, and after dozens of times of cooperation, Liu Peichun was also very familiar with it.

Moreover, for some unknown reason this time, apart from working as an assistant, Liu Peichun also had a deeper understanding of the operation of Qin Lang as the chief surgeon. He had a feeling that if he continued to do this with Qin Lang, he would also be confident that he could be the chief surgeon independently.

Thinking of the possibility that he could complete an ERAT by himself, Liu Peichun became more and more motivated. Before, he would feel that he was so experienced that he would lose points to Qin Lang, but now he can only secretly delight in picking up a cheap one.

Sure enough, licking the dog, licking the dog, licking to the end, everything!
"Contrast media, plastic stent preparation"

Qin Lang's next order was issued non-stop, and Liu Peichun, who was about to lose his mind, immediately dispelled his wild thoughts and continued to focus on cooperating.

Of course he understands the contrast agent, but the plastic stent has never been used before.

Liu Peichun was slightly puzzled, and looked up at Qin Lang, who explained very casually:

"For patients with a lot of pus in the appendix cavity or a narrow appendix cavity seen in angiography, under X-ray and endoscopic monitoring, a plastic stent is placed along the guide wire, the stent drains the pus and supports the stenosis of the lumen. Continue to reduce the pressure in the appendix cavity."

Of course, what Qin Lang didn't say was that in order to be able to use the stone extraction net to take out parasites and eggs in the next step, it provided enough room for manipulation.

"F8.5 plastic bracket, straight with side wings, length 5cm."

Qin Lang added another sentence.

The equipment nurse on the side nodded immediately.

Dr. Qin is caring, always able to understand the audience, when he is the first assistant, he can think in front of the chief surgeon, and when he is the chief surgeon, he can take into account the emotions and reactions of all the assistants.

Soon, Qin Lang finished preparing the plastic stent and contrast agent.

As for the foreshadowing of Qin Lang, the bosses in the observation room naturally didn't fully understand it. Of course, they were embarrassed to say it, and they all kept silent, waiting for the first person who couldn't hold back.

"Preparation for taking stone nets"

Under another unexpected instruction from Qin Lang, everyone finally couldn't help it.

"What is he doing? Take a bezoar, so complicated?"

In the observation room, when all the experts were puzzled.

In the operating room, Qin Lang had already taken the disposable stone extraction basket in his hand.

The stone extraction basket is composed of a nickel-titanium alloy wire basket, a sheath, and a control handle. The stone extraction basket is generally used for large-grained fecal stones.

And this patient, under the X-ray, clearly did not have large particles of bezoar, so everyone was very puzzled.

Under the endoscope, I saw Qin Lang controlling the handle of the stone net basket, exerting force with his fingertips, and slightly rotating the net basket internally.

"Hey, what is that?"

In the observation room, everyone was attracted by the picture under the endoscope. The stone mesh basket was slightly rotated in the appendix cavity, stirring up the effusion, and then they saw a few silk thread-like things, which floated over and hung into the appendix. over the wire of the basket.

Qin Lang controls the strength, rotates clockwise, and the linear object slowly wraps around the metal wire of the basket, becoming tighter and tighter.

Under the endoscope, you can still feel the thread-like object wriggling, and all the experts naturally understood it when they saw this.

Everyone's scalp is numb!

"It's Demformids!"

Han Hu directly shouted that adult pinworms parasitize the ileocecal part of the human body, and are most common in the cecum, appendix, colon, rectum and lower ileum.

When a person sleeps and the anal sphincter relaxes, some females crawl out of the anus and lay eggs on the nearby skin.

After laying eggs, most females die due to dryness, and a few females can wriggle through the anus and return to the intestinal cavity.Obviously, the patient was the female worm that returned to the abdominal cavity and entered the appendix cavity, causing ectopic parasitism to cause abscess obstruction, and then acute appendicitis.

Parasitic appendicitis also accounts for a large proportion of childhood appendicitis.

However, no one expected that Qin Lang would be so daring to use the ERAT catheter to suck out the eggs, and then wrap the adult worms with the wire of the stone basket and pull them out of the body.

In order to have enough space, agitate the extraction stone mesh basket, entangle the adults, and put the plastic holder in advance
At this moment, recalling the entire operation process of Qin Lang, the preparation of the operation, all the experts have endless aftertaste.

"This can be regarded as another variant of ERAT, isn't it?"

Even the well-informed Dr. Huang was also stunned by Qin Lang's unrestrained creativity.

Under normal circumstances, for appendicitis caused by intestinal worms, laparoscopy is used to directly remove all the appendix parasitized by the worm.

Just like in a film and television drama, after being bitten by a poisonous snake, the bitten arm is immediately cut off, thereby cutting off the virus transmission path.

After using three disposable stone extraction baskets, six adult worms, 1–2 cm long, were placed on the plate, still wriggling.

The equipment nurses on the side didn't dare to take a second look, and the hairs on their bodies exploded.

Even Liu Peichun didn't dare to look at the plate. Thinking of such a pile of worms in his abdominal cavity, Liu Peichun felt sick.

"Second flush with normal saline."

After confirming that all the adult insects were hooked out by the stone basket, Qin Lang went on to the next move, without any emotional fluctuations because of such an astonishing move.

The equipment nurse frowned, a little afraid to approach, and carefully handed the equipment to Qin Lang.

In order to thoroughly rinse off the remaining insect eggs, Qin Lang naturally rinsed carefully and repeatedly several times.

"Metronidazole and amoxicillin antibiotics are prepared while paying attention to postoperative prevention and treatment"

Qin Lang asked Liu Peichun, who was in charge of subsequent follow-up and ward rounds, to pay attention to the prevention and treatment of antibiotics.

"Ah."

Liu Peichun nodded, but his heart could not be calm for a long time.

In ERAT, the stone extraction basket is used to stir the pus through rhythmic rotation, so that the adult worms are wound on the wire and then lifted out of the body. How did this come up!
Ordinary parasites are either eliminated from the body by taking drugs, or the affected area is removed once and for all. There is no such purely physical method as Qin Lang, which is non-invasive.

No textbooks dare to write like this!

At this point, the entire ERAT has been completed, the pus has been sucked out, and the parasites have been caught. As soon as the anesthetic wears off, the patient can walk on the ground.

"Great!"

In the observation room, the experts also received a mental shock, and it was another surgical performance that broke through the routine.

As a result, the whole person has been silent. Even if he doesn't like Qin Lang anymore, he still has to admire this kind of creative thinking.

In this case, a special paper could be published, and the results even thought of the title of the paper: In the treatment of pinworm appendicitis in children, non-invasive extraction of worms by taking stone net baskets during ERAT surgery.

Zhuang Tong and Director Pang were naturally a little surprised, but they were still very tight on the surface. Zhuang Tong took a sip of coffee and said lightly: "Everyone is laughing at you, this brat just doesn't worry. Routine operation, routine operation. "

Listening to Zhuang Tong's seemingly modest answer, but in fact his tail is up to the sky, the result is only a mouthful of old blood!

Director Pang took the hot water pot, filled the teacup full of results, and smiled at him.

In order to hide his embarrassment, Director Cheng hurriedly took a sip of boiling tea.

An old face was flushed, he suppressed the heat, swallowed it, and raised his thick lips slightly to Director Pang to express his gratitude.

Laughing is uglier than crying.

There was not much pause, just to allow time for the preoperative preparation of the next operation, and Qin Lang appeared in the operating room again.

Soon a third patient appeared on the operating table.

The patient's case information was sent to various experts.

Patient: Liu Fengjuan, female, 23 years old

Brief medical history: Because of "transferred right lower abdominal pain for more than 2 days", he was admitted to the hospital with "the cause of the abdominal pain is unknown (acute appendicitis?)".

Previously denied any special medical history; more than 2 days ago, there was no obvious inducement for pain around the umbilical cord, which was persistent dull pain, paroxysmal intensification, no radiating pain, the pain shifted and fixed in the right lower abdomen a few hours later, nausea, no vomiting, No diarrhea, frequent urination, urgency, dysuria, gross hematuria, cough and other symptoms.

Physical examination: T: 36.0℃, P: 84 beats/min, R: 21 beats/min, BP: 120/90mmHg;

Abdominal obesity type is full, no abdominal wall varicose veins, gastrointestinal type and its peristaltic waves; McBurney's point tenderness, rebound tenderness and muscle tension in the right lower abdomen.

No mass was palpable, liver and spleen were not under the ribs, and Murphy's sign was negative; abdominal percussion showed a drum sound, no percussion pain in the liver and spleen area, no percussion pain in the kidney area, negative shifting dullness, bowel sounds 3 times/min, there is no sound of air passing through water.

Auxiliary examination: Abdominal CT showed a tubular soft tissue density shadow with a diameter of about 0.8cm in the ileocecal area, within which fecal stone shadows were seen, exudative lesions were seen around, adjacent fat density increased, and the right retroperitoneum thickened.

It was obviously a typical acute appendicitis. Since the patient was young and liked to wear navel-baring clothes, he was still debating whether to go to the provincial capital hospital.

Hearing that the city's No. [-] Hospital can do non-invasive ERAT, it was natural that he immediately chose to perform this operation in his own city.

Chen Wenhao soon administered anesthesia to the patient, and after finishing, Qin Lang stood at the chief surgeon's position.

Under the stamina potion, Qin Lang was naturally not affected in the slightest. After the two difficult operations, he felt like an athlete had warmed up, and his whole body was radiant.

The first step is still the most difficult intubation among the steps of ERAT. After all, the position of the appendix varies a lot, and the internal opening of the appendix is ​​not necessarily at the position facing the endoscope.

Sure enough, Qin Lang, who had been going smoothly before, also encountered trouble in the intubation of this patient.

After several pushes but failed to find the patient's Gerlach flap, Qin Lang frowned and paused slightly.

In the observation room, seeing Qin Lang stop to think for the first time, all the experts became a little interested, and finally stumped Qin Lang.

But this idea itself made these experts a little depressed
"This patient should be due to the obesity and fullness of the abdomen, and the appendix is ​​directly wrapped by the fat pendant. If it is a conventional laparotomy, the fat pendant needs to be dissected to see the appendix."

Dr. Huang carefully looked at the film on the case and the endoscopic picture on the screen, and put forward his own ideas.

As for the situation where the angiography catheter cannot approach the inner opening of the appendix, intubation alone is no longer possible. The experienced Dr. Huang has encountered it before and knows how to deal with it, but this method requires another operation. tools to solve.

Therefore, it is a test of the operator's divergent thinking and familiarity with various surgical instruments in the operating room.

Dr. Huang straightened his chest, ready to see Qin Lang's reaction, and if he couldn't solve it, he would prompt through the microphone.

But before Dr. Huang came to the rescue, Qin Lang had already issued the next order:
"I want to change the operation plan and prepare for ERCP incision."

After Qin Lang's words fell, Dr. Huang's eyes widened slightly, a little unbelievable, and the method Qin Lang proposed was naturally exactly what he thought.

ERAT was originally inspired by ERCP. Senior physicians like Dr. Huang mastered ERCP first, and then learned the newly launched ERAT. Naturally, it is easy to think of the incision knife of ERCP to solve the problem that cannot enter the inner opening of the appendix. question.

But young people like Qin Lang basically start with ERAT, and have never been exposed to the more difficult ERCP, so Dr. Huang was astonished to be able to think of using an incision knife for ERCP.

The colonoscope used by ERAT does not have a forceps lifter, and the direction of the catheter cannot be adjusted with the forceps lifter after the catheter extends out of the endoscopic end during intubation.

Therefore, to deal with the situation of dislocation of the internal opening of the appendix, it is necessary to use a curved ERCP incision knife to approach the internal opening of the appendix, and adjust the internal opening of the appendix to the most convenient position by adjusting the size of the colonoscope screw and rotating the mirror body.

However, after trying a bit, he was still unable to enter, and did not reach Qin Lang's satisfactory operating position and angle. Qin Lang looked at Liu Peichun calmly again:

"Help me fine-tune the patient's position, turn him slightly to the left, stop"

With the tacit cooperation of Qin Lang and Liu Peichun, the most difficult intubation was quickly completed.

In the observation room, Dr. Huang licked his lips and couldn't help applauding: "Even if I do this operation, I can't do it better than him."

(End of this chapter)