Doctor's Life Simulator

Chapter 242 Professor Huang's Invitation: How about Come to Our Provincial Military Hospital for Advanced Study

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.

Zhuang Tong's complexion is also ugly. Although double enhancement was done before the operation, Mirizzi syndrome is still something that modern medicine cannot accurately detect before the operation.

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 Zhuang Tong and Professor Huang were in a low mood, the equipment nurse was still heartless. After all, after so many surgeries with Qin Lang, there was no operation or patient that Dr. Qin 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. Qin 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?"

Zhuang Tong asked Professor Huang some self-deception, hoping to give him a different judgment from his, after all, there is 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.

Zhuang Tong 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 Qin Lang, 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.

"Qin Lang, 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."

"Qin Lang, open your stomach."

After hearing Zhuang Tong's order, Li Ming saw that Qin Lang was still observing the patient's hepatic duct, so he urged him without giving up.

Seeing that Qin Lang was still concentrating on designing the next operation plan and completely ignoring him, Li Ming frowned and reminded again:
"Professor Huang and Director Zhuang have reached a conclusion, so let's not waste any time and turn around quickly."

"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."

Qin Lang ignored Li Ming's question and looked directly at Professor Huang and Zhuang Tong.

Listening to what Qin Lang said, Li Ming 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。”

Li Ming was really stunned at this moment. How could such precise data and scope be so easy to come by?

Of course, the equipment nurse couldn't understand anything, but she felt that Dr. Qin was very good.

Professor Huang's already dim eyes lit up. If Qin Lang 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 Qin Lang has a lot of research on Mirizzi syndrome.

Zhuang Tong 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: "Xiao Qin, continue."

Of course, Qin Lang knew about the patient's condition through diagnostics before the operation, but Mirizzi syndrome cannot be demonstrated through symptoms, so he could only hold it in his heart, and did not explain it to Professor Huang and Zhuang Tong until this moment.

And a foolproof best solution is proposed:
"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."

Qin Lang spoke out his operation plan with confidence and certainty.

Li Ming looked at Qin Lang in a daze, as if at this moment, this young man was shining!

Professor Huang pondered for a while, then looked at Zhuang Tong: "Director Zhuang, I think Xiaoqin's plan is theoretically feasible, but performing Roux-en-Y anastomosis of the common hepatic duct and jejunum in a single channel is difficult for the operator. Suture technology requires extremely high requirements, constantly requiring strength, accuracy, and high stability, and requires a lot of physical strength for the flexibility of fingers."

Zhuang Tong naturally has his own judgment. He is not worried about Qin Lang's suture technique, but is it really possible to do it in a single channel?
"Director Zhuang, I am the chief surgeon. I know the direction of the operation best, and I have the right to decide whether to proceed."

Qin Lang continued to fight, under the aura of the chief swordsman, every word was perfect.

Zhuang Tong hesitated for a while, and finally said: "Qin Lang, just try your best, don't force it. If it doesn't work, just turn around."

"T-pipe"

Qin Lang went directly to the next step and gave instructions to the equipment nurse.

Crowd: …

"okay."

Li Ming stabilized his mind and began to cooperate with Qin Lang.

"Scalpel"

"Needle forceps, microscopes."

"4-0 absorbable thread"

When Qin Lang was stitching, Zhuang Tong still felt pleasing to the eye even after watching it so many times.

Not to mention Professor Huang who saw Qin Lang's suture for the first time, is this still a difficult Roux-en-Y anastomosis that baffles countless novices?
After solving the problem of fistula and stenosis of the common hepatic duct, Li Ming did the simple operation of T-tube drainage.

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 Qin Lang who was about to leave and sighed.

"What's wrong, Professor Huang?"

"Director Zhuang, this little Doctor Qin under your command is really amazing!"

[Congratulations to the host for completing the mission: Rescue the field, performing the first single-port laparoscopic cholecystectomy in the First Hospital of Hecheng City, and gaining the appreciation of Professor Huang.Mission reward: 1.1 life simulation points]

10 minute later.

The first X-CONE single-channel laparoscopic cholecystectomy in Hecheng First Hospital was successful!
Lai Meiyun naturally heard all the arguments in the operating room, and she was very grateful to Qin Lang. If it weren't for Dr. Qin's persistence, she might have left some regrets in her career.

"Doctor Qin, thank you."

Lai Meiyun expressed her sincere thanks.

On the way to push the flat car to the ward, Tang Qichen, who was the organizer of the surgery, was very excited. He had already arranged for a photographer to capture some important moments.

Tang Qichen walked up to Professor Huang and Qin Lang: "Professor Huang, this operation was a success, thank you very much for coming. Of course, it was all thanks to Dr. Qin to turn the tide. Didn't you know that it was said during the operation that the laparotomy was to be performed? How nervous I am."

"Fortunately, fortunately, everything is perfect."

Tang Qichen recalled the thrilling operation process that day, and his heart was still beating:

"There is no more publicity effect than such a case of ups and downs."

Tang Qichen looked at Qin Lang's appearance after taking off the mask, and was even more amazed.

With good looks and strength, Qin Lang is a veritable star doctor!
Sensing Tang Qichen's fiery eyes, Zhuang Tong frowned slightly: "Manager Tang, in the subsequent publicity of today's operation, I hope Professor Huang will be the main one, and Qin Lang's pen and ink can be passed on."

Professor Huang naturally understands Zhuang Tong's good intentions. After all, the promotion of this kind of surgery is promoted at the level of Professor Huang, and it is worthy of the name and convincing in the medical field.

If Qin Lang was the protagonist, it would be nondescript, hard to convince, and even cause unnecessary controversy.On the contrary, it is not good for Qin Lang and the first hospital of the city.

After all, Qin Lang is really too young!Let a young doctor perform X-CONE single-channel laparoscopic cholecystectomy, and resolve Mirizzi syndrome during the operation, even if it is a fact.

I'm afraid he will still be sprayed to death by those old professors!
Sometimes being too good is a mistake.

Tang Qichen had already thought about how to describe Qin Lang's efforts to turn the tide, such a young genius, but it came to an abrupt end.

I was a little disappointed, but I was very excited when I thought of the success of the operation. As the leader and vane of the Hecheng medical field, the First Hospital of the city, once the X-CONE single-channel laparoscopic cholecystectomy is carried out, it will be promoted to other hospitals. It's smooth sailing.

Tang Qichen had already seen the wonderful scene of the tigress carrying herself from the sofa to the big bed she hadn't slept in for a long time when she was about to get promoted and raise her salary.

Professor Huang looked at Qin Lang with a smile: "Xiao Qin, today's operation is very beautiful."

"Are you interested? Come to our provincial military hospital for further study in the general surgery department, and I still have a doctoral student quota under my name."

Professor Huang is also persuasive and persuasive.

Zhuang Tong's face darkened, Qin Lang was like the red rabbit among horses and Lu Bu among people, each of them coveted it.

Ah bah, Lu Bu is a professional Ketai, and Qin Lang is his own lucky general, it's different, it's different.

When Zhuang Tong finished his mental journey in an instant, Qin Lang gave his reply: "Thank you, Professor Huang, for your appreciation. I am still a part-time postgraduate student in Zijingang No. [-] College. I will think about it later."

After listening to Qin Lang's words, Professor Huang was slightly disappointed, but in his heart, he had a higher evaluation of Qin Lang.

(End of this chapter)