Surgical artist

Chapter 273 The Mushy and Disorganized Bile Duct Area

Great Surgical Office.

Xiang Tan frowned after listening to the emergency department report.

"The patient's situation is so difficult?"

Complicated, critical, urgent!
The most important thing is that there are many "minefields" on the patient, making it difficult for the surgeon to start.

"Director Guo and the others, have they started treatment?"

"okay, I get it!"

After hanging up the phone, Xiang Tan frowned.

"There are many problems in the second half of this rescue operation!"

"Can Director Zhao solve it?"

The first thing he thought of was Zhao Peiru, which was a thinking habit he had formed recently.

Recently, Zhao Peiru has made too many achievements, as if he knows everything.

Xiang Tan even developed some bad habits of relying too much on Zhao Peiru.

But he thought about it carefully...

"Brother Zhao is good at gallbladder-preserving techniques, that is, he does the first half well. For the second half, he doesn't have a good way."

Xiang Tan has seen several recent gallbladder preservation operations performed by Zhao Peiru.

Basically, in the second half, Zhao Peiru also did routine processing.

It is no different from the way Chai Baorong and others dealt with it.

If Chai Baorong had no choice, then Zhao Peiru probably had no good solution either.

After thinking about it, Xiang Tan called Dean Tao Jiangtao of Jiren Hospital.

Tao Jiangtao is known as "No.1 in the field of gallstone disease", and his achievements in the field of biliary tract are also very high!Moreover, Jiren Hospital has a big business, and has seen many complicated and critically ill patients. Maybe it has treated similar patients.

"Fortunately, I have Dean Tao's phone number."

This contact was only obtained through the education and training center of the Fourth Academy.Otherwise, if you want to contact a top talent like Tao Jiangtao at this moment, it will be very difficult to talk to him.

Speaking of it, I have to thank Zhao Peiru for helping the Fourth Academy to find so many powerful teachers, who in disguise have become the network of the Fourth Academy.

Tao Jiangtao happened to be outside at the moment. He just finished the meeting and happened to be free. After receiving the call, he rushed back from the outside.

……

As one of the chief surgical directors, Zhao Peiru also received a call for emergency help.

After listening to the emergency report.

Zhao Peiru came to the emergency department.

At this moment, at the door of the emergency department, several family members of the patients cried together.

An emergency doctor and nurse had just given the critical illness notice to the family members.

The family members are anxious, flustered, restless, and desperate.

"Pfft!"

The family members knelt down to the young emergency doctor!
"Doctor, please, please..." The family members wailed and broke down emotionally.

The family members could no longer organize normal words. Under the grief, they only knew how to plead with the doctor.

The young doctor in the emergency department is not very old, he just came out to send a notice, and he can only try his best to appease the family members at the moment.

At this moment, he saw the savior at once, and his eyes lit up immediately!
"Director Zhao!"

Zhao Peiru just came out of the stairs.

His current physical condition is much better than before. The pain in Laohan's legs is no longer there, and the dull pain in his knees is also gone.

Walk like the wind!

A few steps came to the door of the emergency operating room.

The young doctor in the emergency room looked over as if he was asking for help.

Zhao Peiru asked, "How's the situation inside?"

The young doctor in the emergency department quickly said: "Director Guo and Director Hao are organizing rescue, and they are still in the stage of emergency rescue."

Zhao Peiru nodded: "That's fine."

When the family members heard the conversation between the two, they moved their knees and knelt in Zhao Peiru's direction.

Obviously, Zhao Peiru seems to be a leader no matter in terms of age or title.

Kneel this one, that's right.

Zhao Peiru hurriedly helped the family members up, and said a few words of comfort, "I understand your feelings. The patient is in a very urgent situation and needs to be quiet inside."

As soon as these words were said, the family members really shut their mouths, for fear of affecting the inside.

Zhao Peiru instructed the young doctor: "You first maintain the situation outside and comfort the patient's family."

Zhao Peiru entered the emergency room.

"Director Zhao!"

"Zhao!"

When a group of people saw Zhao Peiru come in, they all saw the backbone.

When Zhao Peiru saw the situation on the operating table, he felt certain.

"It's not a big problem."

Although this patient was critical and urgent, fortunately, Guo Jun and others in the emergency department treated him in time and did not delay his illness.

All that remains is to choose a suitable anastomosis plan to complete the second half of the operation.

In Zhao Peiru's mind, he learned the selected spells on the way in the future tense.

"Learn the 'portable method of cholangioenterostomy' and upgrade to the professional level."

At this moment, countless cases of gut-intestinal anastomosis flooded into his mind.

There are not only various conventional anastomotic techniques, but also various difficult diseases, including those who cannot cut the jejunum, those who cannot move the blood supply of the bile duct, those who have blind loop infection, and those who cannot move the mesenteric blood vessels...

All kinds of difficult cases have corresponding, suitable and mature biliary-enteric anastomosis plans!

"Director Zhao, the first half of the surgery is almost done."

Guo Jun, the director of the emergency department, wiped the sweat from his forehead with the help of the itinerant nurse.

"The next matching part... I'm afraid it will be a bit difficult!"

Everyone also looked sad.

Zhao Peiru smiled lightly and said, "It's okay, I'll take over."

Everyone in the operating room of the emergency department could only feel that Zhao Peiru's smile was warm and full of sunshine, bringing a wave of faith and strength out of thin air!
Seeing his smile, it was as if this difficult and complicated operation could be successfully performed!
"Mr. Zhao, do you want to take over?"

Zhao Peiru: "Yes."

With the help of the little nurses, he puts on the full outfit.

He said: "In addition to the conventional biliary-enteric anastomosis and the relatively excellent Roux anastomosis, there are many adjustments and changes in the anastomosis for each disease."

After hearing this, everyone was greatly moved!
This means...

Could it be that Director Zhao has already thought of a suitable anastomosis plan?

Especially Chai Baorong, who is good at Roux anastomosis, opened his eyes even wider, wanting to see what adjustments and changes can be made to Roux anastomosis.

Zhao Peiru went to the operating table and asked Guo Jun, the director of the emergency department, to be his assistant.

"Director Guo, let's do a side-to-side anastomosis of the gallbladder and jejunum first, and extract the jejunum first."

Although Guo Jun still doesn't understand what Zhao Peiru's plan is, but with years of experience in rescue, it is still completely fine to just execute Zhao Peiru's order.

After the jejunum was extracted, the two did not cut off the jejunum, but chose to perform a side-to-side anastomosis of the bile duct and the jejunum loop at a distance of 80 cm from the ligament of Trekker, in front of the colon.

Open the anterior wall of the bile duct, make an oblique opening of the bile duct, do not peel off the mesangium and mesangial blood vessels around the bile duct, use No. 1 silk thread to pull the anastomosis on both sides and the back layer, and suture the anastomosis with a uniform needle distance of [-] mm. When you're done, tie the knot once.

As the anastomosis begins...

The jejunum, bile duct, hepatic duct and other important ducts are all spread out in a mess!
It was like dozens of wire interfaces of various shapes, thicknesses, and colors, all of which rushed out at once and displayed in front of everyone.

Highlight a clutter!
Head-scratching!

"Gudong!"

Jiang Lan from the emergency department felt tremendous pressure seeing so many "interfaces" that needed to be anastomosed, and swallowed her saliva involuntarily.

"With so many interfaces, it is not easy to find the interfaces that match each other."

"And because the patient's condition is complicated and severe, many interfaces that could have been matched have now become restricted areas for matching!"

Once the anastomosis is wrong, it will cause retrograde infection, drainage blockage, and even bile leakage and obstruction!
Just like a wire, if it is wrongly connected, it will cause a short circuit, or it will bury hidden dangers, accumulate problems, and eventually cause a fire.

"This anastomosis is really difficult!"

Seeing so many "excuses", everyone's minds are in a mess!

"Can this all fit one-to-one?"

Everyone was a little confused.

Especially Guo Jun, the director of the emergency department, felt a little bit of self-blame in his heart.

Just now, he was only focused on rescuing the patient, and his priorities were alleviating the patient's painful symptoms and relieving the critical condition, but he did not consider how the second half of the anastomosis should end...

As a result, this mess came out!

Now this mess is hard to clean up!

If he was the one to clean it up... He saw the messy and messy interfaces, and his breathing froze!
……

Outside the operating room.

The emotions of the family members are not as irritable as before.

Although I didn't cry loudly anymore, the tension in my heart increased with the passage of time.

Facing the door of the operating room, the family members knelt at the door, clasped their hands together, closed their eyes, and kept praying.

The critical illness notice really frightened her!
Now I can only pray that the situation inside will improve even a little bit!

……

on the operating table.

With the gradual advancement of the matching work...

When Zhao Peiru fully exposed the jejunum loop.

A bile duct area with inflammation, mucus, fat accumulation, and difficult vision is gradually exposed!

"This field of vision is terrible!"

Everyone's heart skipped a beat!
"It's a mess of mud, how to sort it out? How to distinguish it? How to separate it?"

"It is too easy to accidentally touch, accidentally injure, and accidentally damage during anastomosis and ligation!"

Everyone's headache is endless!

Although before the operation, it has been fully considered that the patient has severe malnutrition, hypoproteinemia, anemia, cardiovascular disease, hyperbilirubinemia, water and electrolyte disorders and many other problems.

But I didn't expect that when these problems were reflected in the bile duct area and concentrated here, it would become serious like this!

This undoubtedly added a lot of difficulty to the following anastomosis work!

It is equivalent to making the interface that is not easy to match become "fuzzy and invisible", "difficult to distinguish which is which"...

Several younger doctors felt a little timid and fearful when they saw this paste-like bile duct area.

What if one day they had to face this messy bile duct area?Where to start?
Others are at a loss.

A bit of worry flashed in Chai Baorong's eyes.

"The situation in the bile duct area is so complicated, can Director Zhao do it?"

"His brain is probably about to explode right now?"

Not only have to identify and sort out each bile duct and hepatic duct, but also have to fully consider the "forbidden zone" between them due to their illness.

There are so many things to consider!Too complicated!

A little less consideration of one factor will lead to the failure of this operation!

Guo Jun, the director of the emergency department who is acting as an assistant, is also uneasy at the moment.

He himself has no idea at all, and can only pin all his hopes on Zhao Peiru who is next to him.

I hope that director Zhao Peiru's mind can still remain clear, and he can sort out a correct matching plan from this intricate situation.

Under everyone's gaze, Zhao Peiru began to kiss.

Everyone held their breath and their eyes widened!
……

And at the same time.

Xiang Tan, director of the Department of Surgery, also arrived outside the operating room of the emergency department.

He anxiously asked the emergency nurse: "Where's Dean Tao Jiangtao? Are you here?"

The emergency nurse shook her head: "She said she was in the car and just passed the Jiangnan Bridge."

Xiang Tan knew that it was useless to be anxious.

When he called just now, Tao Jiangtao was still in a meeting outside, and it would take at least four, five, and 10 minutes by car to come here.

The little nurse said: "Director Zhao has already arrived one step ahead and went in."

Nodding to Tan, he thought to himself, Brother Zhao moved really fast.

He entered the emergency operating room and looked towards the operating table at first glance.

When I saw this, I was stunned.

There was actually Zhao Peiru on the operating table.

"Brother Zhao took over the operation? What's going on? Is he doing the first half of the gallbladder preservation work? Or is he taking over the second half of the anastomotic work?"

He hurriedly asked Chai Baorong beside him, "How is the situation now?"

Wait for Chai Baorong to explain the situation.

Surprised Tan!
"Director Zhao is going to do the second half of the anastomosis work?"

In his eyes, Zhao Peiru is synonymous with reliability and prudence. Once he chooses to take over the operation, he must have a certain degree of certainty.

"Brother Zhao."

Xiang Tan still felt a little uneasy. He took a look at the gap and reminded Zhao Peiru: "I have invited Dean Tao Jiangtao to come over, and I should be there in about half an hour. Are you sure you want to continue with the anastomosis later on?" ?"

Zhao Peiru performed side-to-side anastomosis of the jejunum and jejunum without stopping, and inserted the jejunum loop intestinal tube on the side near the biliary-enteric anastomosis for full-thickness suture...

He said with a relaxed smile, "There's no need to ask Dean Tao, I've almost finished solving this little problem."

It's all...almost finished?

Everyone was stunned for a moment, and they were greatly surprised!

Xiang Tan also hurriedly looked at the operating table and at the patient's surgical field.

Sure enough, the end-to-side anastomosis of the bile duct and jejunum has been completed, and the jejunum and jejunum have also been anastomosed. The input jejunum loop is also basically closed, and the inner cavity of the output jejunum loop is narrow at the top and wide at the bottom.

In short, the numerous and complicated "interfaces" just now...

At the moment, most of them have found each other's "match".

The bile duct area, which was covered with inflammation, mucus, and fat accumulation just now, blurred the vision and could not be distinguished, has become orderly and neat without knowing it!

Every important pipe and excuse has returned to its proper position!
"What kind of anastomosis is this?"

Xiang Tan was stunned.

At first glance, it looks a lot like the Roux anastomosis, but upon closer inspection, there are too many differences.

(End of this chapter)