Auto chess in the operating room

Chapter 124 Misdiagnosis?Hit the main knife
After a cholecystectomy, Tanglou naturally knew something about cholecystolithiasis. After a preliminary examination, he had pain in the upper abdomen, and the B-ultrasound showed a strong echogenic light group accompanied by sound shadows. It can be basically considered to be Gallstone.

Hecheng City No. [-] Hospital naturally has a specialized hepatobiliary surgery department, but the hepatobiliary surgery department treats more serious and serious patients. After all, medical resources are limited. Minor surgeries like gallstones are basically handled by the general surgery department.

Cholecystectomy, to be honest, is also a very simple operation for a resident like Ma En.

Hearing that Tang Lou had just received an endoscopic retrograde appendicitis treatment for ERAT, Ma En's desire for surgery was unprecedented.

"I remember that last time you were an assistant for a cholecystectomy performed by Dr. Qing. How can you help me with this operation?"

Ma En discussed with Tang Lou so politely. One is that Tang Lou himself is resting today, and the second is that Tang Lou's current weight and status in the department are already a bit higher than him, so it is not easy to use. The tone of command.

"it is good."

For the operation Tang Lou naturally does not refuse anyone who comes.

"Then I'll make arrangements."

Ma En excitedly took the medical records and walked out to arrange various matters. Originally, some chores should be done by interns like Tang Lou, but it is not what it used to be.

An hour later, everything was ready.

Both Ma En and Tang Lou entered the operating room.

Although cholecystectomy is a minor operation, it is generally more difficult than appendectomy. In addition to Tang Lou's mirror assistant, Ma En also called an intern He Xiaozhuang from Yan Ruoyun's attending medical team to serve as A help.

Together with the equipment nurse and anesthetist Chen Wenhao, the whole operation started step by step.

The cholecystectomy was performed under general tracheal anesthesia, and Chen Wenhao was naturally familiar with it.

However, when looking at the surgical lineup, I was a little surprised. The operating room haunted by Tang Lou actually had such a simple lineup this time?
It was a waste of time to prepare a small stool.

After quickly completing the anesthesia, Chen Wenhao walked aside and sat down.He had just come from Qingping's operating room. Dr. Qing's major operation had been performed for 8 hours, and it was said that it would take more than 10 hours to complete.

Seeing Ma En as the surgeon, Chen Wenhao quickly yawned.

Cholecystectomy uses the four-hole approach compared to appendectomy.

马恩在患者脐部做10mm切口为观察孔，剑突下2cm偏右做10mm切口为主操作孔，右锁骨中线肋缘下2cm、右腋前线肋缘下2各5mm切口做辅助操作孔。

After the puncture is done, the first aid is to control the CO2 rush.

"Control the pneumoperitoneum pressure to 12~15mmHg"

Ma En gave the order enthusiastically and looked at Tanglou: "Start laparoscopic exploration."

Tang Lou nodded and inserted the laparoscope through the observation hole at the navel.

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

"There is no disease in the liver and spleen"

"Gastrointestinal adhesions, tumors."

Tang Lou followed the conventional path and advanced little by little. Under his control, the vision was naturally clear and the rhythm was smooth.

Soon the laparoscope probed the upper right abdomen, and yellow-green adhesions appeared in front of the camera, filling them.

As soon as he saw the picture of the patient's upper right abdomen, Ma En was dumbfounded, and Tang Lou's hand also stopped immediately.

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

Ma En's heart trembled, his whole body tensed up, and a large amount of bile appeared in his upper right abdomen, which completely exceeded his expectations.

"He Xiaozhuang, hurry up and contact Yan Ruoyun. Tang Lou and I will continue to investigate. The diagnosis is wrong. The patient may have a ruptured common bile duct."

Ma En immediately gave the order, and He Xiaozhuang nodded solemnly. Fortunately, Dr. Yan was on duty today.

Compared to Ma En's anxiety, Tanglou's mentality was much more stable due to his talent and concentration. While investigating, he activated the diagnostic technique.

[Patient: Liu Chunhua, female, 63 years old

Symptoms: A large amount of bile appeared in the right upper quadrant of the patient, and a 1.5cm×1.5cm stone was found outside the lower part of the common bile duct. Two-thirds of the common bile duct wall near the duodenum had been gangrene and perforated, leaving only the posterior wall.

A 1.5cm×1.8cm stone in the distal common bile duct was incarcerated.The diameter of the common bile duct was 1cm, and the sphincter of Oddis was fibrotic.

Diagnosis: Spontaneous perforation of the common bile duct in the patient is extremely rare in acute abdomen. Spontaneous perforation of the common bile duct is more common in children but rare in adults.

System prompt: Possible reasons: 1. The patient’s choledocholithiasis repeatedly damaged the wall duct, and the biliary tract was infected repeatedly, which made the duct wall lose its elasticity due to fibrosis. 2. The patient is older, the arteriosclerotic changes involve the bile duct vessels, and the blood supply of local tissues is reduced. 3. The patient's common bile duct wall is congenitally weak.

Due to the severe local inflammation after the perforation of the common bile duct, measures such as repairing the bile duct are often counterproductive. Since the common bile duct in the patient is too large to repair, and some fibrosis occurs, ROux-en-y anastomosis of the common bile duct and jejunum is recommended. surgery]

"The system, do you think my face is dark?"

[No, Ma En is the one with a black face.In your human terms, you, the host, will defeat the master's sword! 】

"???"

After understanding the condition, the investigation of Tanglou was also completed simultaneously:
"Intraoperative exploration found: a large amount of bile appeared in the patient's right upper abdomen, and it was found under the common bile duct"

After Tang Lou's investigation results came out, he looked at Ma En: "Dr. Ma, the best way now is to use common bile duct jejunum ROux-en-y anastomosis. Do you know it?"

Ma En looked at Tanglou and twitched the corner of his mouth, and pondered for two seconds: "Well, I think it would be better for us to wait for Yan Ruoyun to come over."

"Oh~"

Tang Lou let out an oh, and directly entered the system space.

"Neither will he."

[Ding, new mission: Get rid of the second main knife and replace it.Gold coins are rewarded for completing the operation. 2. The card library is refreshed once.Does the host refresh the card library common bile duct jejunum ROux-en-y anastomosis]

"Refresh!"

[Card library refreshed: choledochojejunostomy (one star, 2), choledochojejunostomy (one star, 2), choledochojejunostomy (one star, 2), cholecystostomy (one star, 2) ), cholecystostomy (one star, 2)]

Tang Lou directly selected three choledochojejunostomies (one star, two).

[Choledochojejunostomy (one star, 2), choledochojejunostomy (one star, 2), choledochojejunostomy (one star, 2) automatic synthetic choledochojejunostomy (two stars, 6)]

Duang! Duang! Duang!

Tenement panel:
Level 5: Upgrade 24
Operation column (5/5): Suture (three stars, 9), diagnosis (one star, 3), appendectomy (three stars, 18), cholecystectomy (one star, 2), choledochojejunostomy (two stars, 6)

Gold: 10
Bonds (2/2):
1.外科圣手（二级，4/5）：减少30%感染率，增加30%愈合，减少患者30%疼痛
2. Chief knife aura (Level 2, 2/20): The host obtains the main knife aura, with a 20% chance to make other operators obey their command, a 20% chance to increase the assistant's confidence and keep their mentality stable, and a [-]% chance to increase assistant success rate.

天赋（4/4）：1.缝合流水线（已激活）2.聆听3.专注4.韧性

Storage column (6/9): exposure surgery (three stars, 9), hemostasis (three stars, 9), emergency comprehensive surgery (three stars, 9), debridement (two stars, 6), dressing change (three stars, 9), cutting Surgery (three stars, 9)

When Dr. Yan Ruoyun scolded Ma En, sprayed He Xiaozhuang in the face, and rushed towards the operating room.

"Young doctors are unreliable. The inspection is so sloppy. Bile is found during the operation. It is very likely that the common bile duct will be perforated. Fortunately, I am sensible and asked me to come to the rescue. Otherwise, I will rashly think that I am smart and try to repair the bile duct. It will be counterproductive. This kind of If the breach of the common bile duct is small, simple biliary outflow should be used. If the breach is large, ROux-en-y anastomosis of the common bile duct should be used. Do you understand?”

Dr. Yan scolded as he walked, if he hadn't happened to be on duty today, he had encountered such a rare spontaneous rupture of the common bile duct, there would really be a medical accident.

He Xiaozhuang kept nodding, feeling aggrieved in his heart: I'm an intern, I can't even do mirrors well, I know a hammer.

In the operating room, Tang Lou squinted his eyes and looked up at Ma En: "Dr. Ma, I know ROux-en-y choledochojejunostomy!"

　I specially set the timed release, but it turned over, ahhh
　　
　
(End of this chapter)