This doctor is very stable

Chapter 290 Congenital biliary atresia
The extrahepatic operation area and dressing room of the Third Hospital.

Boss Gu took out the buzzing mobile phone from the work closet after washing his hands.

Take a look, good guy!
More than a dozen missed calls.

All of them were at the level of vice president and department director, which made Boss Gu very happy.

Lin Ran is really his lucky general!
Although these may also know Lin Ran's background, it's possible to not give up or call to contact him!
Lin Ran walked into the bathroom, and Boss Gu took the phone and began to call back.

"Hey, Vice President Li! Are you calling me for something?"

"Oh! That's it! You also know the situation in our hospital! If you are free, you should come to the Tianhe Division of the Tiansan Hospital in Yangcheng! I will personally help you when I arrive."

"Hey……"

"Hey……"

"Hey……"

Lin Ran could hear Boss Gu's hearty laughter in the bathroom, intermittently.

Not to mention the other people in the locker room who didn't come in to take a shower.

Zhang Ningyu and Xu Congwen couldn't help laughing when they saw Boss Gu making a phone call.

His old Gu has made a fortune by relying on Lin Ran.

In the afternoon, at 03:30, Lin Ran took a comfortable shower and walked out of the locker room.

Boss Gu was still chatting on the phone incessantly. Just as Lin Ran walked out of the dressing room, he bumped into Xu Congwen who had also changed into a clean white coat.

Seeing Lin Ran walking out, Xu Congwen said directly, "Dr. Lin, let me treat you to a meal, let's chat!"

Xu Congwen, a deputy director of a department, is now called Lin Ran and uses the title of Doctor Lin.

This meant that he treated Lin Ran as an equal, and he was not putting on airs as a superior doctor.

"Well, of course there is no problem."

There is no conflict between Lin Ran and Xu Congwen, he wants to talk to himself, so let's talk!As long as you don't talk about sex.

Walking in the corridor of the operation area, Xu Congwen laughed at himself and said, "Lin Ran, I have to thank you for today's operation. If you hadn't turned the tide, this operation might have been suspended!"

Although the risks in the operation cannot be fully anticipated, if today's live broadcast operation really overturns, his reputation in the Zhongshan medical system will probably be ruined.

The old yellow mud fell into the bosom, it is shit if it doesn't smell!
Isn't reputation the most important thing for an old doctor?

"Where, Mr. Xu, you are very polite. I can save patients in the operating room. Of course, I am sure that you are not a careless person. As long as it is an operation, there will inevitably be unexpected accidents! You don't have to blame yourself .”

The facts are no longer important.

The patient was safely sent to the intensive care unit. This result is more important than anything else, and the operation is expected to be completed, so this operation is a very successful operation!
…………

After a hasty meal with Xu Congwen in the cafeteria, Lin Ran returned to the outside of the liver again, originally planning to go to the emergency department to see patients.

Unexpectedly, Lin Ran and Xu Congwen had just entered the gate of liver surgery.

Hu Jingxian at the nurse's station stopped Lin Ran.

"Lin Ran, wait a minute. A child with congenital biliary atresia came to the pediatric department. The director has already gone back for consultation. He told you to go to the pediatric department as well."

"Pediatrics, children with congenital biliary atresia?"

After muttering something, Lin Ran's mind instantly burst out information about the disease of congenital biliary atresia.

[Congenital biliary atresia is clinically called biliary atresia.

Refers to the bile duct from the liver to the gallbladder, which is blocked when the fetus is still in the womb or the mother is in the perinatal period, resulting in the inability to discharge bile, and long-term cholestasis causes liver function damage;

The disease is only seen in infants, and its typical symptoms are persistent and aggravated jaundice, kaolin-colored stools, and yellow-brown urine. If it is not treated in time, it may progress to liver cirrhosis, or even liver failure, which is life-threatening. 】

Hu Jingxian urged again, "Yes, hurry over, the situation is probably quite urgent, you hurry over."

Lin Ran nodded, and was about to go to the gate outside the liver, only then did he realize that Xu Congwen next to him hadn't left yet, so he said, "Director Xu, want to go and have a look together?"

Xu Congwen shook his head and smiled lightly: "I won't go, I still have something to do, Lin Ran, you should go there quickly!"

The child with congenital biliary atresia cannot be solved by a large number of people, and he does have other things to do.

Lin Ran nodded and ran towards the gate of the liver surgery department.

Run out the door and go straight to the pediatrics.

The triage desk on the first floor of the Pediatric Department.

"Which floor is the consultation place for children with congenital biliary atresia?"

If something goes wrong in the hospital, it is right to ask the nurse.

Several young front desk nurses saw Lin Ran's eyes light up.

"You are Dr. Lin Ranlin outside the liver!"

"That's right, but I'm in a hurry. Do you know where the consultation room is? I'm in a hurry."

Lin Ran doesn't have time to get in touch with the little nurses in the pediatrics department right now.

Children with congenital biliary atresia may enter the countdown to life at any time when their condition is uncertain.

Maybe Lin Ran would be of good use if he went.

There are two surgical options for the treatment of children with congenital biliary atresia.

The first is liver transplantation.

The second type is hepatic portojejunostomy, also called Kasai operation.

According to the national conditions, it is necessary to perform transplantation for all children with congenital biliary atresia.

Speaking of portojejunostomy, we have to start with the classification of congenital biliary atresia.

Bile duct atresia can be divided into intrahepatic type and extrahepatic type. The intrahepatic type is the atresia of the intrahepatic biliary system. There are only irregular small bile ducts combined with stenosis or atresia in the liver. At present, there is no good treatment method;

Extrahepatic biliary atresia can be divided into type VI according to the location of the atresia.Among them, type Ⅰ～Ⅲ belongs to one category, accounting for 80%～90% of extrahepatic bile duct atresia, and is called uncorrectable type; type Ⅳ～VI belongs to the other type, which belongs to curable type, and the prognosis is better, accounting for about 10%～ 20%.

Portojejunostomy for inoperable biliary atresia was designed by Japanese scholar Kasai in 1968.

The author originally wanted to delay the time of liver transplantation for patients with biliary atresia as much as possible, but did not want to be able to treat some patients with biliary atresia when choosing this operation.

It can be regarded as a kind of sowing melons and reaping fruits.

Isn't it Lin Ran's dream to develop a new type of surgery to benefit tens of millions of patients?
For uncorrectable extrahepatic bile duct atresia, after careful dissociation and en bloc resection of fibrous tissue in the hilar area, some sick children have small bile ducts in the hilar section.

By anastomosis of the hilar stump with the bile duct to the intestinal tract, about 30% of cases can obtain persistent bile flow, thereby reducing the jaundice to normal.

sick children can be cured.

However, some sick children who have recently obtained bile drainage often cause ascending cholangitis due to reflux after hepatic portojejunostomy, which interrupts bile flow, and even causes liver failure and secondary sepsis and death.

In order to prevent ascending cholangitis, the ascending branch of the jejunum was stomaed first, and the stoma was closed after 1 to 3 months after the operation.

Some scholars perform operations such as ascending jejunum anti-reflux rectangular valve and intussusception anti-reflux to prevent ascending cholangitis.

According to statistics, it has a certain anti-reflux effect.

Let's talk about liver transplants.

Hepatic portojejunostomy can cure some children, but it is not used for all children with congenital biliary atresia, and how to prevent after the operation of the jejunum, a small number of children will develop ascending cholangitis after the operation, resulting in die.

This is one of the important reasons why you choose a liver transplant.

Of course there are other possibilities.

For example, the best treatment time has been exceeded, and the degree of cirrhosis is relatively serious. In this case, liver transplantation should be selected as soon as possible.

For various reasons, the absolute majority of children with congenital biliary atresia still choose to undergo liver transplantation.

At present, the technology of liver transplantation for congenital biliary atresia is very mature, and the probability of success is relatively high.

In foreign countries, children with congenital biliary atresia will directly choose a method of biological liver transplantation, and most of the children can grow up healthily.

However, the biggest problem in choosing a liver transplant in China is the cost of treatment, so many parents often can only choose to perform liver-enteric or biliary-enteric anastomosis, or take traditional Chinese medicine for conditioning.

(End of this chapter)