Doctor’s Life Simulator

Liu Peichun grabbed Qin Lang excitedly and asked, the brain supplement was already prepared in his mind.

"It's inserting an endoscope, inserting a catheter, and inserting a zebra wire..."

Qin Lang explained the entire surgical procedure to Liu Peichun very concisely. Listening to Qin Lang's vivid description, Liu Peichun could feel the thrill. After all, for a surgeon, being able to perform a complex operation is really A supreme enjoyment.

Until Qin Lang explained the whole process, Liu Peichun was still immersed in the atmosphere of the whole operation. This feeling was like a dormitory, and the next door was making a bowl of instant noodles. Although Liu Peichun could not eat it, he smelled the aroma of instant noodles. People who eat it also enjoy.

"Doctor Liu, I seemed to frown when I saw you were looking at a case file just now."

Qin Lang pulled Liu Peichun back from intoxication with one sentence.

Liu Peichun walked directly to his seat and took the document on the table:

"Here, a strange case. The initial diagnosis was acute abdomen, and no specific cause was found. It is now in the ward. After Director Pang's operation is completed, we will discuss it together."

Qin Lang took it over and looked at it. The preliminary physical examination and patient information:

Patient: Liu Chunhua, female, 63 years old

Complaints of right upper abdominal pain for 1 week, abdominal pain suddenly intensified and high fever for 1 day.

Vital signs: t38.8℃, p92 times/min, bp16/12kpa,

There were tenderness, rebound tenderness, and muscle guarding throughout the abdomen, mainly in the right upper quadrant. wbc16×109/l.

Preliminary diagnosis: acute abdomen, possibly biliary disease.

...

"Have you arranged a b-ultrasound?"

Qin Lang recalled that the tenderness may indeed be a disease of the gallbladder. If it is really a gallbladder or bile duct problem, Zhang Nan, who specializes in the field of hepatobiliary surgery, may have to take over.

Zhang Nan, the senior attending physician of the emergency department surgery group, the second-line doctor on duty, is very powerful in the field of liver and gallbladder.

"It's already being checked, and it's estimated that there will be results in a while."

Although Liu Peichun has been a resident doctor for several years, there are really too many possibilities for acute abdomen, and it is really difficult for many patients to diagnose until the moment of abdominal opening.

Soon, the b-ultrasound check came out.

"B-ultrasound showed that there were multiple stones in the common bile duct, and a 1.5cm×1.5cm enhanced light group was seen below the outer cavity of the common bile duct, with acoustic shadows behind."

After reading it, Liu Peichun looked at Qin Lang: "Preliminary diagnosis: common bile duct stones, biliary tract infection?"

In addition to the appendicitis series, Qin Lang is also very familiar with gallbladder stones. He initially saw the pain in the upper abdomen of the disease, and the b-ultrasound showed strong echo light clusters with sound shadows, which can basically be considered as gallbladder stones.

Hecheng City No. 1 Hospital naturally has a special hepatobiliary surgery, but the hepatobiliary surgery treats more severe and severe patients. After all, medical resources are limited, and minor operations such as gallstones are basically digested by the emergency department.

Cholecystectomy, to be honest, is also a very simple operation for a senior resident like Liu Peichun.

Hearing that Qin Lang had just used an endoscopic retrograde appendicitis to treat erat, Liu Peichun's desire for surgery was unprecedented.

"Qin Lang, I'm going to perform this surgery. How about you help me with the mirror."

Liu Peichun discussed with Qin Lang so politely. One is that Qin Lang is resting today, and the second is that Qin Lang's weight and status in the department are already a bit higher than his, so it is not easy to use orders. 's tone.

"it is good."

Qin Lang is naturally open to anyone who comes for surgery.

"Then I'll make arrangements."

Liu Peichun happily took the medical records and walked out to arrange various matters. Originally, some chores should be done by a newcomer like Qin Lang, but it is not what it used to be.

After an hour, everything was ready.

Both Liu Peichun and Qin Lang entered the operating room.

Although cholecystectomy is a minor operation, it is generally a little more difficult than appendectomy. In addition to Qin Lang's mirror assistant, Liu Peichun also called in He Xiaozhuang, an intern from Zhang Nan's main department. A help.

With the equipment nurse and anesthesiologist, the whole operation started step by step.

Cholecystectomy uses general tracheal anesthesia, and the anesthesiologist Chen Wenhao is naturally familiar with it.

However, when I looked at the surgical lineup, I was a little surprised. The operating room where Qin Lang is haunted has such a simple lineup this time?

Instead, he prepared a small stool for nothing.

After the anesthesia was completed quickly, Chen Wenhao just walked aside and sat down. He just came over from Director Pang's operating room. Director Pang's major operation has been done for 8 hours, and it is said that it will take more than 10 hours to complete.

Seeing Liu Peichun taking the lead, Chen Wenhao quickly yawned.

Cholecystectomy is performed using the four-port method compared to appendectomy.

Liu Peichun made a 10mm incision in the umbilicus of the patient as the observation hole, 2cm below the xiphoid process to the right and a 10mm incision as the main operation hole, 2cm below the costal margin of the right midclavicular line and 2 5mm incisions below the costal margin of the right anterior axillary line as auxiliary operation holes.

After the puncture, Ichisuke controlled the rush into co2.

"Control the pneumoperitoneum pressure to 12~15mmhg..."

Liu Peichun gave an order in high spirits, and at the same time looked at Qin Lang: "Start laparoscopy."

Qin Lang nodded and put the laparoscope through the observation hole at the umbilicus.

"There is no bleeding at each puncture point..."

"The liver and spleen have no lesions..."

"No gastrointestinal adhesions, tumors..."

Qin Lang followed the normal path and pushed forward little by little. Under his control, he naturally had a clear vision and smooth rhythm.

Soon the laparoscope detected the right upper abdomen, and a yellow-green adhesion appeared in front of the lens, filling.

As soon as he saw the picture of the patient's upper right abdomen, Liu Peichun was immediately dumbfounded, and Qin Lang's hand stopped immediately.

"It's bile, I rely on it!"

Liu Peichun's heart froze, his whole body tense, and a large amount of bile appeared in his right upper abdomen, which was completely beyond his expectations.

"He Xiaozhuang, hurry up and contact Dr. Zhang. Qin Lang and I will continue to investigate. The diagnosis is wrong, and the patient may have ruptured the common bile duct."

Liu Peichun immediately gave the order, and He Xiaozhuang nodded solemnly. Fortunately, Dr. Zhang Nan was on duty today.

Compared with Liu Peichun's anxiety, Qin Lang's mentality was much more stable. While investigating, he began to conduct further intraoperative diagnosis:

A large amount of bile appeared in the right upper quadrant of the patient, and a 1.5cm×1.5cm stone was found on the outer side of the lower segment of the common bile duct. Two-thirds of the wall of the common bile duct near the duodenum had been gangrenous and perforated, and only the posterior wall remained.

One incarcerated stone 1.5cm×1.8cm distal to the common bile duct. The diameter of the common bile duct was 2.5 cm, and the sphincter of oddis was fibrotic.

Seeing this, Qin Lang was also a little surprised. It turned out to be another rare case of spontaneous perforation of the common bile duct, which was encountered once at the opening ceremony of the postgraduates of Zijingang First College.

Qin Lang has been very experienced with this symptom. The cause may be as follows: 1. The patient's common bile duct stones repeatedly damage the wall duct, and the bile duct is repeatedly infected, causing the duct wall to lose elasticity due to fibrosis. 2. The patient is older, arteriosclerotic changes involve bile duct vessels, and the blood supply to local tissues is reduced. 3. The patient's common bile duct wall is congenitally weak.

Due to the severe local inflammation after the patient's common bile duct perforation, measures such as repairing the bile duct are often counterproductive. Because the patient's common bile duct rupture is too large, it cannot be repaired, and some fibrosis occurs. The best way is the common bile duct jejunum roux- en-y anastomosis.

After learning about the condition, Qin Lang told Liu Peichun his judgment: "Doctor Liu, the best way now is to use roux-en-y anastomosis of the common bile duct and jejunum. Would you know?"

Liu Peichun watched Qin Lang twitch at the corner of his mouth, and pondered for two seconds: "I think it's better for us to wait for Zhang Nan to come over."

Doctor Zhang is on duty today, so Liu Peichun's mentality is relatively stable.

...

...

Physician Zhang scolded Liu Peichun and sprayed He Xiaozhuang on his face as he rushed towards the operating room.

"Young doctors are unreliable. The examination is so sloppy, and there is bile during the operation. It is very likely that the common bile duct is perforated. Fortunately, a sensible person called me to save the scene. If the common bile duct rupture is small, simple biliary outflow will be the main method. If the rupture is large, then roux-en-y anastomosis of the common bile duct and jejunum should be used. Do you understand!"

Dr. Zhang scolded as he walked. If he didn't happen to be on duty today, he had encountered such a rare spontaneous rupture of the common bile duct, and he would have had a medical accident.

He Xiaozhuang couldn't help nodding his head, but his heart was full of grievances: I'm an intern, and I can't even hold mirrors well. I know a hammer.

In the operating room, Qin Lang's tone was flat, and he looked up at Liu Peichun: "Doctor Liu, I will perform roux-en-y anastomosis of the common bile duct and jejunum!"

In the operating room, Qin Lang's words were loud and clear.

Chen Wenhao, who was still sitting on the small bench, suddenly woke up from a drowsiness. Every operation in Qin Lang that he participated in was so worry-free, but every time Qin Lang used solid surgical techniques to solve the problem.

Chen Wenhao wanted to say, "Do you still have a Japanese name: Conan!"

Seeing Qin Lang come forward, Liu Peichun hesitated for a moment, would you do this too?

"The patient has already opened the abdominal cavity, and under pneumoperitoneum, the longer the delay is, the more likely the patient will be left with sequelae.

"This kind of operation for spontaneous perforation of the common bile duct, I have encountered it once in Zijingang First Hospital before, and I have experience."

Qin Lang directly opened the aura of the main knife, and glanced at the instrument nurse: "To perform roux-en-y anastomosis of the common bile duct and jejunum, scalpel, needle forceps are ready..."

Qin Lang's unquestionable gaze swept to Liu Peichun again, and Liu Peichun obediently shrank to one side.

After all, in the profession of doctors, as long as you have the skills, you have the confidence to solve the problem, and you can't accept it.

Liu Peichun took the laparoscope directly from Qin Lang and started to hold the mirror.

After Qin Lang and Liu Peichun performed the operation for a while, Dr. Zhang finally finished the preoperative disinfection preparation.

As soon as he entered the operating room, his face was extremely ugly, and he looked at He Xiaozhuang with sharp eyes.

"You didn't say they were waiting for me to come and deal with it, what's the situation!"

He Xiaozhuang was also stunned, and he clearly saw Liu Peichun holding the mirror beside him. Isn't the one who was in charge of the knife the mirror assistant?

Dr. Zhang scolded He Xiaozhuang and stepped forward directly: "Stop, do you know what you are doing! The patient has a rare spontaneous perforation of the common bile duct, you must not try to repair the common bile duct wisely, it will not work. ."

Dr. Zhang took three steps and took two steps, and all at once arrived at the monitor port of the laparoscope.

Liu Peichun naturally recognized Physician Zhang, but he felt guilty. Although Physician Zhang was not his direct superior, he was almost as senior as Director Pang, especially in the field of liver and gallbladder.

Liu Peichun looked at Physician Zhang, and the movement of his hands stopped, explaining: "Doctor Zhang, the patient has already had an abdominal opening, if..."

It's just that before Liu Peichun's explanation, Qin Lang frowned when he saw Shuye who had not kept up with him, and scolded directly: "Shuye! Shuye! Liu Peichun, be serious!"

Under the aura of the main knife, Liu Peichun moved his sight back conditionedly, and continued to assist Qin Lang to give enough vision.

Qin Lang looked at Liu Peichun's readjusted vision for five seconds.

The operating room was quiet. Seeing that Qin Lang was silent for a while, Liu Peichun suddenly panicked: "What's wrong with Qin Lang, what happened again?"

Qin Lang nodded.

Liu Peichun's legs suddenly softened, and cold sweat broke out on his head. He was afraid for a while, but knowing that Dr. Zhang was behind him, his heart was a little more stable.

Doctor Zhang shook his head slightly when he saw the two young men who were in a dilemma, and was ready to go to the position of the main swordsman team. This was naturally what he expected.

In the process of preoperative preparation, according to He Xiaozhuang's description, he already had a surgical plan. Qin Lang could think that the roux-en-y anastomosis of the common bile duct and jejunum had already won him approval, but the young man was always inferior to himself.

Sure enough ~www.readwn.com~ finally had to go out on his own, Doctor Zhang was ready to go to the main knife position and open his mouth.

Liu Peichun was about to remind Qin Lang to give up his operating position obediently.

Qin Lang's voice sounded calmly:

"Using end-to-side anastomosis in conventional choledochojejunostomy roux-en-y anastomosis is really not feasible."

Physician Zhang paused slightly on his feet.

"Because the patient is older and not suitable for conventional end-to-side anastomosis, I need to simplify the procedure."

Zhang Nan's whole body froze, and he got stuck in the middle of it.

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