Doctor's Life Simulator

Chapter 239 The Patient Apologizes: Physician Qin Hua Tuo is Reborn!
ERCP+EST+LC combined operation, the first step is to perform ERCP first.

"Duodenoscope"

With talent and concentration, Qin Lang quickly entered the rhythm, and steadily controlled the camera to enter the duodenum.

"Guide wire, contrast catheter preparation."

Qin Lang calmly gave instructions while controlling the equipment in his hand.

Since dozens of ERATs have been built, it is easy to grasp the ERCP Qinlang of the same origin.

Cooperating with Qin Lang's operation on the side, Li Ming was very shocked. Since the last time he saw his operation, he clearly felt Qin Lang's progress again.

He is really proficient in the organizational structure and anatomy of the gallbladder and common bile duct.

Li Ming is well aware that although more than 80% of the bile duct and pancreatic duct have a common channel anatomically, the length of the common channel, the angle with the opening of the RT, and the angle at which the bile-pancreatic duct joins are different. It is difficult to achieve selective contrast imaging, and only continuous practice can be mastered.

At Qin Lang's age, it is obvious that there are only a handful of surgeries he has performed. One of the reasons for being able to do this is that he spends a lot of time studying anatomy knowledge, watching surgical videos, and even learning from Dr. Daniel's experience and skills.Another aspect is pure talent.

"Such learning ability is too terrifying."

Li Ming had to admire.

"Diagnosed during ERCP: One of the common bile duct stones of the patient is more than 20mm, and mechanical lithotripsy is required under endoscopy. Five stones are less than 10mm, and the stones can be removed through the basket after incision by EST."

Under ERCP, the situation in the patient's common bile duct is naturally invisible, which also avoids inaccurate preoperative physical examination and lays a solid foundation for subsequent stone removal.

The next step is naturally EST+LC. Compared with conventional laparotomy, the incision in laparotomy is too large. Lithotomy forceps are usually used during the operation, which often leads to Oddi sphincter injury.

The use of LC combined with EST is very suitable for Hu Jie’s stenosis of the end of the common bile duct, and this program can cure gallbladder and small common bile duct stone lesions with one operation, and can also preserve the function of Oddi’s sphincter to the greatest extent.

"Shockwave Lithotripsy Preparation"

Qin Lang issued an order non-stop, even the well-informed Li Ming was slightly stressed.

This kind of high-speed efficiency can only be found with a partner at the chief physician level.

"Get the stone basket ready."

Under the combined operation method, because the number and size of the stones are precisely located by the contrast in the first step, not only the stones in the common bile duct are removed, but also the incarcerated stones in the ampulla are also cleaned up.

As an expert, Li Ming naturally paid close attention to Qin Lang's operations.

When pulling out the stone, he obviously controlled the strength precisely. Li Ming once encountered a resident doctor with a low seniority who used too much force when pulling out the stone, which caused the ampulla of the patient to tear and damage. What a pity.

Moreover, Qin Lang's movements were very rhythmic, and the more he looked at Li Ming, the more frightened he became.

I saw that Qin Lang inserts the mirror, rotates to the right, and turns downward. The direction of the combined action is always consistent with the axis of the bile duct.

This kind of operation is naturally very conducive to the removal of stones, and in the order of stone removal, Qin Lang also follows the principle of "first down, then up, first small, then large", very calm and rigorous.

In Li Ming's memory, the first time he took stones, he was too nervous and forgot this principle, which led to the removal of too many stones at one time, which caused the stone extraction basket to get stuck in the RT.

A surgery has been completed here, and most of it has been successful, and the next step is the regular LC, which is naturally no difficulty for Qin Lang.

In the subsequent operation, it was as expected by Qin Lang. Due to the combination method, the patient's blood loss during the operation was very small.

Moreover, since there is no need to use a T-tube for drainage, negative effects such as bile duct bleeding, damage, electrolyte and bile loss caused by the T-tube are avoided.

As a result, Hu Jie, who had just been rescued, barely survived the operation, and the rest was recovery after the operation.

"Qin Lang, congratulations."

As an assistant, Li Ming is of course monitoring the patient's vital signs at all times, but if the amount of bleeding is larger, the patient may go into a second shock, which shows how accurate Qin Lang's previous prediction was.

If he were to perform the surgery and use conventional LC, the consequences would be unimaginable due to the excessive amount of bleeding and Hu Jie's current physical condition.

When Li Ming walked out of the operating room with the flat trolley, Hu Jie's husband was still communicating with Fa Xiao. For this complicated operation, according to Fa Xiao's prediction, at least at the level of the city's first hospital It will take two and a half hours.

Hu Jie's husband checked the time within a few minutes, and it was only an hour and a half later, feeling restless and apprehensive.

While he was suffering, Qin Lang and Li Ming pushed the flat cart out.

Hu Jie's husband confirmed the time again, his mind went blank, and he was so panicked that he didn't see the patient on the flat car behind Li Ming:
"Doctor, why did you come out so soon? You are not doing surgery inside, what are you doing out here?"

Li Ming turned his head, pointed to Hu Jie on the flat car, and signaled him: "The operation is complete, very successful."

"What did you say! It worked, really!"

Following Li Ming's guidance, Hu Jie's husband saw Hu Jie still recovering from anesthesia on the flat car.

"Come over and help me, and send the patient to the ward."

"Oh, oh, good."

Hu Jie's husband hurried over, holding the car with one hand, and holding Hu Jie's hand with the other: "It's okay, it's okay."

Hu Jie was lying on the flat car, the corners of his mouth moved slightly, and he blinked his eyes.

"Doctor Qin, I was the bastard before. I had a bad attitude and still questioned you. You are simply Hua Tuo alive and rejuvenated."

After Hu Jie's husband finished comforting his wife, he saw Qin Lang at the back. He was ashamed and grateful at the same time.

His childhood friend told him about the difficulty of this joint operation, even the most powerful attending in his department would take at least two hours to complete. They are from the provincial capital hospital, so Dr. Qin only used one. Half an hour, it's not much better than the experts in the provincial capital hospital.

"It's so lucky."

Recalling what happened that day, Hu Jie's husband became more and more afraid. Fortunately, he met Dr. Qin, otherwise his wife might not survive.

Qin Lang glanced at Hu Jie's husband, and while the latter nodded his thanks, he scolded himself a few words for not knowing Mount Tai.

After Qin Lang and Li Ming sent the patient to the ward, they gave a few more instructions.

This time, Hu Jie and her husband were naturally respectful of what Qin Lang said, and took it down seriously.

Before Qin Lang and Li Ming left, Hu Jie got up half of his body slightly, and said to Qin Lang:
"Thank you, Doctor Qin."

Qin Lang and Li Ming didn't look back, and quickly walked out of the ward, especially Li Ming, they had seen too much of this kind of condescending patients.

For gratitude, accept it with peace of mind, and will not forgive the previous meanness.

Seeing the two doctors walk out of the ward without looking back, Hu Jie was slightly taken aback.

The rest will naturally be assisted by interns.All Qin Lang and Li Ming had to do was check the house regularly.

The next day, Qin Lang received a call from Tang Qichen early in the morning. Professor Huang from the provincial capital was already on his way to the First Hospital of Hecheng City.

Professor Huang said that he was very satisfied with their previous physical examination, enhanced CT and contrast-enhanced ultrasound.

I have to say that Lu Yu still has two brushes.

After he arrives, he will see the patient himself and communicate with him. If there is no problem, the operation can be carried out and Qin Lang and the others will prepare.

(End of this chapter)