Come on, Dr. Wu

Chapter 99: Bile Duct Stone Removal (Please subscribe)

Wu Xiaofu took a deep breath. The intern Wu Xiaofu was the surgeon, Duan Hao, the deputy chief physician of the emergency department, was the first assistant, and the attending physician Zhu Yun was the second assistant. This treatment would be like this for the rest of his life.

Watching Wu Xiaofu disinfect the sheets and then stand in the position of the surgeon, about to take action, the anesthesia, patrol and instruments were all shocked.

Could it be! Could it be!
  No way! No way!
  It's not what they think, is it?

No wonder Wu Xiaofu wanted to add a new channel. It was Saturday. Normally, the bosses in the operating room would be there. If he saw this, Wu Xiaofu would have to stop. After doing it for a long time, Wu Xiaofu really did it for himself. They are recruiting patients. To be honest, they are hesitating whether to stop it at this time. If it were other interns, no, even residents, they would have to stop it quickly.

But they really saw Wu Xiaofu's performance during the surgery, especially the abdominal closing operation, which even Zhu Yun might not be able to match. After all, he worked slowly and carefully.

Thinking about the laparoscopic appendectomy that Wu Xiaofu had done before, their hearts were relieved. How about taking a look first? Duan Hao was still there to support him. Maybe Wu Xiaofu would cut out the gallbladder and bile duct first, and Duan Hao would be the one to do it.

Thinking of this, several people felt relaxed, it must be like this.

Wu Xiaofu was really excited at this time. It was different from the last time he had his appendix removed. In Wu Xiaofu's opinion, this was his first true surgeon.

The patient had already completed anesthesia and was given a dozen of white milk. At this time, the patient slept soundly.

Wu Xiaofu still remembers that a patient specifically asked after an operation how to sell white milk. He wanted to buy some. It was so useful in curing insomnia. He often suffered from insomnia. That was the best sleep he had had in decades.

However, this is really not for sale.

Milk is a common name, and its real name is propofol. If you lose one, the entire operating room will be turned upside down to find it, let alone sell it.

The instrument nurse began to hand over tubes, light source lines, monopolar lines, etc. Seeing Wu Xiaofu skillfully assembling the laparoscope with the cooperation of the patrol, the instruments and the patrol station gave Wu Xiaofu a little more confidence.

The first step is to establish pneumoperitoneum. After the Veress needle enters the abdominal cavity, connect it to the carbon dioxide pneumoperitoneum machine. After watching the pneumoperitoneum pressure come up, take out the Veress needle.

Duan Hao and others nodded at this time.

Even though the pneumoperitoneum operation may not seem difficult, it is a typical example of someone who knows it at first glance and fails once he learns it. Without enough surgical training, he would never be able to do what Wu Xiaofu is.

Wu Xiaofu had already performed for him once last time, but when he saw it again, Duan Hao still had to sigh: genius.

At the very least, when he was at Wu Xiaofu's level, he would never be able to reach Wu Xiaofu's level.

Zhu Yun also felt less resentful. He didn't see it when Wu Xiaofu had his appendix cut out last time. Now that he saw Wu Xiaofu establishing pneumoperitoneum with his own eyes, he knew that Wu Xiaofu did have two skills and was able to win Duan Hao's favor. Sure enough, there is a reason.

Now Wu Xiaofu is like a beauty who outshines all other beauties. Skill is Wu Xiaofu's beauty, and it is also the key factor that pleases Duan Hao and allows Duan Hao to straighten things out in one step.

Wu Xiaofu didn't know that Zhu Yun was thinking about all this nonsense at this time. Otherwise, he would have asked Zhu Yun what kind of bloody harem drama he had watched during this period.

The second step is to place the Trocar.

That is to say, the casing, whether it is an electric knife or tweezers, will go through the casing.

Regarding the incision, Wu Xiaofu has long been aware of it. The midline of the upper abdomen is 3cm below the xiphoid process, the right midclavicular line is 3cm below the right costal margin, and the right anterior axillary edge is below. These are fixed positions. As for whether there are any changes, it is the surgeon's assessment. The patient's condition was fine-tuned. A small incision was made with a scalpel, and then the Trocar was delivered through the incision.

Insert the observation glass into the casing and start observing. Sharpen the knife and chop wood. At this time, don’t rush to do anything. Wait for a while and check the situation. One is to check the position of the casing. If it is inappropriate and uncomfortable, then check the condition of the patient's abdominal cavity, cystic duct and common bile duct.

The position of these organs in some people is really different from normal people. Of course, Wu Xiaofu was not so lucky, so how could he be the one who won the lottery?

Seeing that everything was fine, Wu Xiaofu knew what was going on.

"Sister, the head is high and the feet are high, leaning 30 degrees to the left."

At this point, the preliminary work is basically completed, and they will start looking for the chief bile later. Duan Hao and the others are also holding their breath and concentrating so as not to affect Wu Xiaofu. Duan Hao's ability to hold the mirror is naturally needless to say. Wu Xiaofu doesn't have to worry about anything. , walking at night, the lights always shine forward, you are so panicked.

Dissection of the gallbladder triangle is also a focus of this surgery.

First, the cystic artery and cystic duct are treated.

Clamp the bottom of the gallbladder with toothed grasping forceps, separate hooks of the electrocoagulator to free the cystic duct and cystic artery, and place titanium clips at the proximal and distal ends of the cystic duct respectively.

"this!"

Duan Hao couldn't help but scream, because in his field of vision, the common bile duct had already appeared.

This operation is called bile duct lithotomy. The focus is on the bile duct. If you want to cut or remove the bile duct, you have to find the bile duct first. Even if you understand the anatomy and want to find the bile duct in the abdominal cavity, it is not possible. It was an easy process. Wu Xiaofu was able to establish pneumoperitoneum proficiently and operate laparoscopy proficiently. The speed of finding the bile duct was probably difficult to achieve without a few years of experience.

happen?

"Teacher, I want to cut out the bile duct."

The voice fell and the action had already begun. Duan Hao looked at Wu Xiaofu's confident eyes and serious expression, and felt inexplicably certain in his heart that there was no coincidence, everything was strength.

He suddenly felt ridiculous in his heart. The word strength was suitable to be used on him, but why was it so shocking when used on Wu Xiaofu.

Although I have a lot of ideas, the movements of my hands will not be slow.

It gave him the most comfortable view for cutting the bile duct. However, at this time, Duan Hao was also hesitating whether he should remind Wu Xiaofu that it was best to explore first before cutting. Even as an experienced surgeon like him, he had to be careful. .

However, Duan Hao soon realized that his worries were unnecessary.

Wu Xiaofu had already asked for a No. 7 needle. After the puncture, the bile was extracted, and there was no problem. It was definitely the common bile duct. If the cut was wrong, it would not exist.

What Duan Hao appreciated the most was Wu Xiaofu's attention to detail.

"Sister, a piece of gauze."

After talking to the instrument, Wu Xiaofu placed a piece of gauze at the omental hole to prevent stones and bile from flowing into the omental sac. Concubine Zhu was so shocked at this time that she didn't know how to express her words. "It's too thin."

Not to mention that the speed of finding the bile duct is not slower than him, but even the details are the true inheritance of him. It's just that he has many slow jobs, but Wu Xiaofu's movements are not slow at all.

Is this really a newbie? Or is it that the medical level in North District has advanced so rapidly in recent years that graduate students have the opportunity to perform surgeries? At this level, if Wu Xiaofu had never performed surgery before, Zhu Yun would not believe it.

When everything is ready, cut the common bile duct 8-10mm lengthwise with scissors.

At this time, the anesthesia, patrol and equipment were shocked. They originally wanted to remind Duan Hao that it was time to take over. After all, this was cutting the bile duct, but seeing Wu Xiaofu's movements in one go, they actually forgot about it. Then Wu Xiaofu cut the bile duct. It was cut open.

However, at this time, they felt that they might not need to remind them anything.

Although they are not professionals or practitioners, looking at Wu Xiaofu, a skilled worker, and seeing the astonished looks in Duan Hao and Zhu Yun's eyes, it goes without saying that there is no need to worry about Wu Xiaofu's skills.

Most importantly, time.

It was time. This was not the first time they had to incise and remove stones from the bile duct. They knew how to control the time. The bile duct had been cut at this time. Wu Xiaofu's speed could be counted in the entire general surgery department. I'm on the first echelon.

Wu Xiaofu didn't know what everyone was thinking right now. At this moment, he seemed to be practicing martial arts and entering a state of enlightenment.

The two souls have never been so compatible. Now Wu Xiaofu has entered a state of no self and no other. In his eyes, there is only surgery.

The bile duct has been cut, and the next step is exploration.

There are a lot of stones in the patient's bile duct. What Wu Xiaofu has to do now is to find all these stones and remove them. This is also the most important thing. Otherwise, if there are really a few stones left, no, even if it is just one, you can do it before No matter how beautiful she is, the surgery will always fail.

Combined with the preoperative examination and some exploration, you can actually have an idea.

During the exploration process, try to be gentle. The bile duct will not scream. If you are rough, you can easily injure it.

Redness and swelling are trivial, but mechanical damage, tearing, and bleeding are alarming.

Wu Xiaofu carefully used stone forceps to take out the stones one by one. When flushing the bile duct, remember to be gentle and not flush frequently. Otherwise, it may easily cause mechanical damage.

Then, under laparoscopy, a choledochoscope is inserted through the Trocar puncture hole, and the bile duct pops out.

The stones were put into the specimen bag and the instruments were taken away.

When everyone saw this, they couldn't help but heave a sigh of relief, because at this point, the most difficult part of the operation was over.

Wu Xiaofu didn't even raise his head. Before suturing, he must not forget the T-tube drainage.

According to the size of the wound, Wu Xiaofu cut a suitable T-tube and inserted it into the common bile duct with separation forceps.

"Line 40."

The instruments had been prepared for a long time. Wu Xiaofu used 4-0 absorbable sutures to suture the common bile duct intermittently, and then led the T-tube out of the body through barbs.

This is also an improvement in surgical instruments. In the past, they had to be introduced out, but now they come out in one set.

"50ml normal saline."

Zhu Yun was already ready to inject directly. Seeing that there was no leakage around the common bile duct suture, Wu Xiaofu also nodded.

Now you can start to remove the gallbladder.

Nowadays, patients with bile duct stones usually have gallbladder stones. The gallbladder will also be removed during the operation. Otherwise, if the removal is completed this time, the stones in the gallbladder may enter the bile duct again next time. But it's time to have surgery again, so it's better to get it done once and for all.

The removal of stones from the bile duct was completed, and the rest of the procedure was no more difficult for Wu Xiaofu.

The cystic duct and cystic artery are severed by electrocoagulation, the gallbladder bed is separated, and the gallbladder is placed on the liver bed.

At this time, there is also something to pay attention to. Use an electrocoagulation rod to carefully stop bleeding on the liver bed to prevent bleeding and bile leakage.

Finally, the gallbladder and the puncture cannula are pulled out from the umbilical incision. After checking that there is no blood or fluid accumulation in the abdominal cavity, the laparoscope can be pulled out.

Open the cannula valve, expel the air in the abdominal cavity, and finally suture the wound.

As soon as Wu Xiaofu handed over the things, Duan Hao stared at him. Who were he talking to? He really regarded him as his assistant.

Wu Xiaofu finally woke up and quickly apologized.

"Just kidding, just kidding."

Once the wound is sutured, the operation is completed.

One hour.

The patrolman set the time, from start to finish, it was just one hour.

What speed!

Duan Hao and Zhu Yun also looked at each other. Although Duan Hao was faster than Wu Xiaofu, could it be compared? Who was Duan Hao and who was Wu Xiaofu?

As for Zhu Yun, forget it, there is nothing comparable to Zhu Yun.

(End of this chapter)