Chapter 490： Choledochoscope

On the operating table.

Ling Ran stood at the main knife position, Zhang Anmin stood at the first aid position, and Ma Yilin stood at the second help position, all in a state of full attention.

The patient on the table was covered with a green drape, and he could not see his face or his hands. Only the operation surface on the abdomen was exposed, which highlighted the liver part.

Zhang Anmin gasped, watching Ling Ran peel off a small piece of liver.

He has had a lot of liver surgeries. The era of the second aid did not say, since he became a senior resident, he had a liver resection with the first aid, and there were 80 out of 100.

To be excited, he was very excited when he was in the first few cases of liver resection. After following 20 to 30, he was quite calm.

However, Zhang Anmin today felt the excitement of a long absence.

Perhaps it is because of the resurgence of hope for hepatectomy?

"Okay, electric knife." Ling Ran reached out and lowered his head, and instantly treated the small blood vessels that were bleeding.

"Needle Holder." Ling Ran continued to demand equipment and continued processing, her hands dancing very rhythmically.

Zhang Anmin stared greedily.

It ’s not like Lu Wenbin and others who just came into contact with liver resection and did it with Ling Ran. Zhang Anmin has spent so long in hepatobiliary surgery. There are almost ten young directors who have attended the clinic. Not as pure as Ling Ran.

Zhang Anmin no longer considered why, he wanted to learn more now.

Doctors are rare occupations that are willing to take the initiative to work overtime. Don't watch doctors grumble overtime every day, but if the hospital does not allow doctors to work overtime, then it is not grumbles, it is Moncorroque. Ninety percent of the doctors will run away. Like Yunhua Hospital, it is estimated that there will be one week doctor left.

Of course, the night shift was really mournful.

"Okay. Check again for bleeding." Ling Ran finished checking the patient's abdominal cavity.

Zhang Anmin also quickly followed the inspection. He is a helper, and is doing these auxiliary tasks.

"Dr. Zhang, come to close the abdomen." Ling Ran finished the examination and was sure there was no problem, so he transferred the work out.

Zhang Anmin responded in a hurry, said "OK", and then put his hands together to send Ling Ran away.

Lu Wenbin didn't mean to stay, and said with a smile: "I'll go to the kitchen to see, Dr. Zhang, after you've done this, rush to the operating room 3, if you go early, maybe you can get help . "

Zhang Anmin's face became hot, and he said, "I have no intention of grabbing a helping hand."

"Oh, I'm not saying you grab it ..." Lu Wenbin paused for a moment, and smiled. "You will know when you go to the operating room 3, if you are willing to help, everyone will not pay special attention. In our group It ’s all in turns. Do n’t grab it. ”

Zhang Anmin laughed two times, thank you again, heart said: You can rotate in the group before, that is your rich resources, now I come in, I do half of the help alone, I want to see You can't grab it.

puff.

The airtight door closed tightly.

"call……"

"call!"

Zhang Anmin and Su Jiafu breathed out together, then looked at each other and smiled.

"Dr. Ling's gas field is a bit strong." Zhang Anmin said with a little embarrassment, even if he explained it.

Su Jiafu smiled and twisted his **** comfortably, saying, "I don't care if the gas field is strong or not, I want to sleep well. How long do we need?"

Surgeons are often called by anesthesiologists and visiting doctors.

Zhang Anmin smiled and said, "It takes only a few minutes to close the abdomen. However, I would like to appreciate more. You can take more time and sit for a while."

"Okay." Su Jiafu and Zhang Anmin also knew each other, but they basically did not talk, and they are not interested in chatting now.

Zhang Anmin asked the itinerant nurse to pull down the shadowless lamp a bit, changing his angle and observing.

After looking at it with naked eyes for a while, Zhang Anmin was still a little dissatisfied, and asked the nurse to bring the choledochoscope and carefully observe the stones in the intrahepatic bile duct.

For liver resection of intrahepatic bile duct stones, the core problem lies in the high residual stone rate of intrahepatic bile ducts, which means that it is difficult to remove the intrahepatic bile duct stones.

It has been reported that the residual stone rate of intrahepatic bile duct stones is as high as 31.3%, that is, after removing part of the liver, about 30% of the stones remain in the liver.

When subdivided, the residual stone rate in the left liver is 17.3%, and the right liver is 54%.

The reason why the right liver is about three times that of the left liver is because doctors usually perform a left external lobe resection of the liver, which removes a large amount of left liver remnants and leaves a large number of left liver stones.

Of course, this is an average ratio. In the hands of a master, reducing the residual stone rate of the left liver below 10% is considered a basic operation.

How much it is reduced is often the main point of this type of surgery.

Zhang Anmin also intends to use this method to identify how Ling Ran's surgery is.

He put out the choledochoscope, followed the talented passage, and watched silently.

No residual stones.

No residual stones ...

No residual stones!

Zhang Anmin looked more and more shocked.

When working as an assistant, he had to take a large part of the workload, so he couldn't see all the operations of Quan Ran. Because of this, he took advantage of the opportunity to close his stomach and quickly resumed trading.

However, even if Zhang Anmin's gallbladder was bloated, he could not imagine that he would see such a bile duct.

It can be disguised as a normal person.

laugh.

The operating room door was opened again.

The three attendants of the hepatobiliary surgery teamed in together. First look at the left, look at the right, and make sure that Ling Ran is not there, and then laugh out: "Lao Zhang, I just watched through the door and thought, what is your kid doing alone? What is it? Close the belly? "

"The resident in the Ling Ran treatment group has gone back, but they left you closed?"

"It's okay to close the abdomen, and there is nothing shameful to close the abdomen."

The qualifications of the three attendants are slightly deeper than Zhang Anmin. They either have already begun liver resection or they are trying to get in touch with liver resection. I heard that Zhang Anmin helped Ling Ran to help, and they all came to see.

Hepatobiliary surgery at Yunhua Hospital is no better than an emergency department or an elite department such as hand surgery. It is a small department divided into general surgery.

A small department means less staff, fewer resources, and fewer patients, and the job is more likely to turn into a radish and a pit situation.

In the case that the director He Yuanzheng was not satisfied with the liver resection, the deputy chief physicians who were in front of Zhang Anmin were insufficient. Following the attending directors of the deputy directors, the chances of liver resection were even lower.

In the situation where the other attendants are obediently lined up, Zhang Anmin wants to get out of the game, which is naturally unwelcome.

Zhang Anmin also knew that he laughed twice and continued to look at the screen, operating the biliary mirror without making a noise.

Biliary endoscopes are similar to other endoscopes in that they use a top camera to spread the image to a screen on the operating table.

The three attendants of the hepatobiliary surgery only glanced at one, and UU reading knew that it was a choledochoscope.

The highly qualified attendant standing in the middle was joking with a smile: "What's the matter, the liver was cut, only to find that there is no stone in the bile duct?"

The person immediately followed:

"It's a medical accident without stones."

"It's okay, just put a few on yourself, let alone we didn't teach you."

Zhang Anmin silently moved for dozens of seconds before pointing to a small dot on the screen, saying, "Here, this is bile duct stones."

The three attendants froze and made a laugh.

"If this is the cause of a liver resection, I will die with a smile."

"No, no, I already have a stomachache when I laugh."

"Just cut the liver for such a small stone? The cut tissue is sent to the pathology department, you guys, this is a medical accident."

Zhang Anmin looked at the three indifferently.

In fact, he can understand the three of them. If it were not for Ling Ran's operation, he would not believe that the residual stone could be taken so cleanly.

However, the fact is that the industry's top 2% residual stone rate is not difficult for Ling Ran.

"These are the residual stones after the operation." Zhang Anmin said.

The others still laughed: "It's just a little stone in all, what's the difference without surgery?"

"Troublesome, put the patient's CT film." Zhang Anmin finished, and the anesthesia doctor Su Jiafu quickly released the CT film on the computer in front of him.

The smiles of the attendants gradually converged.

"Is it the same person?"

"Look at the biliary tract is the same."

"Are you so clean, are you afraid that the relatives of the gallstone family are not nice?"

Zhang Anmin looked at them with a smile.

Although he had the same expression a few minutes ago, at this moment, Zhang Anmin felt that his smile should be very mysterious.