Auto chess in the operating room

Chapter 154 The Perfect Solution of Tenement House

Professor Huang's complexion immediately darkened.

Mirizzi syndrome is a rare complication of gallstones, accounting for 0.7% to 1.4% of gallstones.

Mirizzi syndrome refers to a series of syndromes in which the cystic duct and common hepatic duct are too long or the confluence position is low, or the common bile duct is narrowed by incarcerated stones in the neck of the gallbladder, causing biliary colic and obstructive jaundice.

Clinically, Mirizzi syndrome is difficult to detect before surgery, and can only be diagnosed during surgery.

Cheng Jian's complexion was also ugly. Although he had undergone double enhancement before surgery, Mirizzi syndrome was still something that modern medicine could not accurately detect before surgery.

According to the Csendes classification method, Mirizzi syndrome is divided into five types. If it is type I, type II can barely be done through a single channel.

If it is type III, it is necessary to add a puncture hole in the abdomen. As for type IV and V, in order to ensure the safety of the patient, it has to be converted to laparotomy.

Once the puncture hole and laparotomy are added, it means that the first case of X-CONE single-channel laparoscopic cholecystectomy in the First Hospital of Hecheng City has failed.

Lost the meaning of minimally invasive.

Obviously, this situation is not what everyone wants to see.

When Cheng Jian and Professor Huang were in a low mood, the equipment nurse was still heartless. After all, after so many surgeries with Tang Lou, there was no operation or patient that Dr. Tang could not handle.

There is a certain sense of trust in this young and handsome doctor.

The only thing that made her dissatisfied was that Dr. Tang didn't know how to be compassionate and cherish jade. Because of his high concentration, he was sweating profusely after each operation.

"Professor Huang, what do you think?"

Cheng Jian deluded himself and asked Professor Huang, hoping to give him a different judgment. After all, there was still a little luck in his heart.

"If I went into battle in person, I would be able to judge the type based on experience and sense of touch, but now it is only through the screen, and pure vision is inaccurate. If the judgment is wrong, the consequences will be disastrous. To be on the safe side, I think it's better to switch to open the abdomen safe!"

Of course, Professor Huang does not want to switch to laparotomy, but if he insists on single-channel operation and misjudgment leads to postoperative infection and complications, he would rather choose a safe and complete cure of the patient than a little minimally invasive cosmetic surgery.

Cheng Jian frowned. Although he was very reluctant, this was indeed the most correct choice. After all, it was impossible to expect that a young doctor like Tang Lou, who happened to have studied such a rare Mirizzi syndrome, would be able to respond in such an unexpected situation. Next, keep calm and tell the correct one.

"Tang Lou, Professor Huang has the same opinion as me, turn the abdomen open. You have done it perfectly before, but it is the patient's life and our life to encounter such a small probability of Mirizzi syndrome."

"Tang Lou, open your stomach."

After Lin Dong heard Cheng Jian's order, he saw that Tang Lou was still observing the patient's common hepatic duct, and he didn't intend to give up, so he urged him.

Seeing that Tang Lou was still concentrating on designing the next operation plan and completely ignoring him, Lin Dong felt a little helpless:
"Professor Huang and Director Cheng have already made up their minds. Why are you wasting your time? Do you really think you are better than the professor?"

"Mirizzi syndrome is classified according to the Csendes classification method: Type I is gallbladder neck or cystic duct incarcerated stones oppressing the common bile duct, also known as the prototype of Mirizzi syndrome."

Tang Lou ignored Lin Dong's question and looked directly at Professor Huang and Cheng Jian.

Listening to what Tang Lou said, Lin Dong seemed to understand half-understood, as if he had a little impression, but he was not very familiar with it.

“Ⅱ型胆囊管-肝总管瘘形成且瘘口小于肝总管周径1/3，Ⅲ型形成且瘘口小于肝总管周径2/3。而患者的肝总管瘘口我已经仔仔细细的确认过，不到肝总管周径的1/3，也就是确认是Ⅱ型。”

Lin Dong was really stunned at this moment. How come such precise data and demarcated scope are so handy?

Of course the equipment nurse couldn't understand anything, but she thought Dr. Tang was amazing.

Professor Huang's already dim eyes lit up. If Tang Lou just had no reason, of course he wouldn't be able to convince him, but now there are reasons and evidences. It is obvious that Tang Lou has a lot of research on Mirizzi syndrome.

Cheng Jian was also a little surprised. When did this stinky boy secretly know Mirizzi syndrome, a symptom that ordinary doctors would never encounter in a lifetime.

Professor Huang also came alive: "Little Tang, continue."

Of course, Tanglou understood the patient's condition through diagnostic techniques before the operation, but Mirizzi syndrome could not be demonstrated through symptoms, so he could only keep it in his heart and did not explain it to Professor Huang and Cheng Jian until this moment.

And a mature plan that he has deduced several times:

"For Mirizzi syndrome type II, in principle, the stricture and defect of the biliary tract should be repaired as much as possible after removal of the incarcerated stone. In view of the patient's symptoms, I think Roux-en-Y anastomosis of common hepatic duct and jejunum can be selected."

"Counting the steps that have been performed, my entire process arrangement: laparoscopic cholecystectomy + common hepatic duct-jejunum Roux-en-Y anastomosis + T-tube drainage."

Tang Lou spoke out his surgery plan with great confidence and certainty.

Lin Dong looked at Tang Lou in a daze, as if at this moment, this young man was shining!

Professor Huang pondered for a while, then looked at Cheng Jian: "Director Cheng, I think Xiaotang's plan is feasible in theory, but the Roux-en-Y anastomosis of the common hepatic duct and jejunum in a single channel is difficult for the surgeon. Technology requires extremely high requirements, constantly requires strength, accuracy, and stability, and requires a lot of physical strength for the flexibility of the fingers."

Cheng Jian naturally has his own judgment. He is not worried about Tanglou's stitching technology, but can it really be completed in a single channel?
"Director Cheng, I am the chief surgeon. I know the direction of the operation best, and I have the right to decide whether to proceed."

Tang Lou continued to fight, under the aura of the chief swordsman, every word was perfect.

Cheng Jian hesitated for a while, and finally said: "Tang Lou, just try your best, don't force it. If it doesn't work, just turn around."

"T-pipe"

Tang Lou went straight to the next step and gave instructions to the equipment nurse.

Crowd: …

"okay."

Lin Dong stabilized his mind and began to cooperate with Tang Lou.

"Scalpel"

"Needle forceps, microscopes."

"4-0 absorbable thread"

When Tang Lou was stitching, even after watching it so many times, Cheng Jian still felt pleasing to the eye.

Not to mention Professor Huang who saw Tang Lou suturing for the first time. Is this still a difficult Roux-en-Y anastomosis that baffles countless novices?
The problem of fistula and stenosis of the common hepatic duct was solved, and the following simple operation of T-tube drainage was performed by Lin Dong.

At this point, it has basically been announced that the first X-CONE single-channel laparoscopic cholecystectomy in the First Hospital of Hecheng City has been successful!
Next, there is the routine finishing, which is handled by an assistant.

Professor Huang looked at Tang Lou who was about to leave and sighed.

"What's wrong, Professor Huang?"

"Director Cheng, this little Doctor Tang under your command is really amazing!"

[Ding, new mission: the rescue is complete.Successfully performed the first case of single-port laparoscopic cholecystectomy in the First Hospital of Hecheng City, and was appreciated by Professor Huang.Reward 5 gold coins, refresh the card library once]

Tang Lou looked at the deck of cards:
[Indirect inguinal hernia repair (one star, 2), indirect inguinal hernia repair (one star, 2), indirect inguinal hernia repair (one star, 2), choledochoduodenostomy (one star, 2 ), choledochoduodenostomy (one star, 2)]

Seeing that the repair of indirect inguinal hernia can be upgraded directly to two stars, and it is a very popular surgery in general surgery, Tang Lou was moved:
【Indirect inguinal hernia repair (one star, 2), indirect inguinal hernia repair (one star, 2), indirect inguinal hernia repair (one star, 2) automatically synthesized indirect inguinal hernia repair (two stars, 6)! 】

(End of this chapter)