v3 Chapter 2651： Want to carry out a lot, sooner or later, trouble Mr. Zheng

Endoscopic ultrasound was inserted to show the location of the cyst, the appropriate puncture site was selected, and the adjacent blood vessel structure was displayed with a color blood flow chart.

The shape is ideal. This position and this image performance are what Professor Yang imagined, and there is almost no deviation.

He knows that his level is constantly increasing. Every time I touch and learn a new technique, there will be such an exciting process. This feeling is also Professor Yang's favorite.

Growth, joy, is really intoxicating.

The puncture needle was retracted into the outer sheath and inserted into the ultrasound endoscopy tube, and then Professor Yang delivered the puncture needle to the stomach, carefully extending the tip of the needle, so as not to sorrowfully pierce a hole in the stomach wall before the operation.

Although the caves are sensational and the stomach wall is well restored, Professor Yang is still very careful about each step.

Subsequently, he identified the position of the needle tip on the ultrasound image and guided the needle into the cyst cavity under the guidance of the ultrasound image.

When you feel a clear sense of emptiness, it indicates that the puncture needle has entered the cyst. Professor Yang's heart was stable, this is because the sac wall has not troubled himself. If the puncture is difficult, connect the puncture needle with high-frequency resection and pass pure resection current. If that's the case, it will be a mess.

I'm feeling lucky today. During the pre-operative evaluation, Professor Yang had the idea that the puncture of the capsule wall was not smooth.

Everything went well, he almost hummed a brisk song.

The 19G puncture needle successfully punctured the sac wall and placed a 0.035 inch guidewire. After using 4mm and 6mm diameter dilators to expand the puncture channel, a 24-mm double-lumen juxtaposed metal stent was successfully inserted through the guide wire.

The operation is basically over here. Professor Yang carefully observed the pancreatic pseudocyst with a B-mode probe. It was found to be shrinking, which meant that the fluid in the area of ​​the cyst was drawn into the stomach and subsequently into the intestine.

very smooth! The corners of the lips under Professor Yang's mask raised slightly.

The patient in this operation was the largest pancreatic pseudocyst he had ever seen and had done. With laparoscopic surgery, it is difficult to ensure that no complications occur.

However, endoscopic ultrasound-guided pancreatic pseudocyst drainage has few complications. It is only an endoscopic drainage. What complications can there be? Professor Yang believes that the biggest risk lies in the puncture step. God knows that the ultrasound will see that there are no blood vessels, and whether there will be puncture bleeding.

If that's the case, it's fucking.

People engaged in medical treatment are very cautious, Professor Yang is a kind of modest person.

On the other hand, at work, pancreatic pseudocysts are a serious disease. The surgical grade is very high and the postoperative risk is great. After the laparoscopy was performed, the procedure and postoperative complications of this operation were reduced.

But now, the operation is the same as "play". Professor Yang is a doctor who has experienced these stages firsthand, so his feelings are extremely profound.

"Professor Yang, the operation is over." The anesthetist asked with a smile.

"Well, it's almost there." Professor Yang was not anxious, and observed for a few minutes, and determined that the pancreatic pseudocyst had become smaller. He smiled and said, "It's over."

"Professor Yang, will the pseudocyst be able to do this in the future," the anesthesiologist asked.

"How could it be!" Professor Yang finished his operation and his emotions were high, he said casually: "The pseudocyst is tightly attached to the wall of the gastrointestinal tract, and there is no large blood vessel blockage. The digestive tract is locally uplifted by the cyst compression, and the mucosa has Obviously, the color change is more ideal. This is a necessary condition now. Everything is done with minimally invasive conditions, and has the level of Boss Zheng. I? I do n’t want to in my next life. "

"You are too modest." The anesthetist smiled.

"Human beings have self-knowledge." Professor Yang said seriously: "This is not modest, it is the truth. Boss Zheng is so awesome, I don't want to."

"Hey." The anesthesiologist didn't know what he was thinking, hey grinned.

"Don't believe it, just talk about this operation. If the stent is not blocked after the operation, you need to have an angiogram. I have good luck and the patient screen is very good. If it is carried out in large quantities, it must be troublesome for boss Zheng. "Professor Yang said.

Professor Yang has done a careful analysis of the indications for endoscopic ultrasound-guided pancreatic pseudocyst drainage and how to treat them after the accident. When I was in Toyo, I also consulted with my mentor.

There are reasons for the smooth operation, which seems simple and easy.

No success can be inexplicable, and Professor Yang firmly believes that. He saw the cyst shrink and began to withdraw the guide wire.

While drawing the guide wire, he said kindly, "Just then, don't tell others, Boss Zheng ..."

Having said that, Professor Yang froze for a moment.

The guide wire ... can't move! Normally, you should hold the guide wire in your hand and take it out smoothly.

What a ghost!

Where is it stuck? No, the guide wire is thin and slippery. How can it get stuck?

What are the complications? What's the unexpected situation? Professor Yang froze suddenly.

I was fully prepared, but I did not expect an accident when the operation was "finished."

Professor Yang panicked.

He immediately looked at the B-ultrasound, but the B-ultrasound has its own strengths and weaknesses. It is really when P is not used at this time.

"Professor Yang, what are you going to do?" The anesthesiologist asked strangely.

"..." Professor Yang felt like crying.

It's so special that you can't show it at all. Just after you showed it, something happened immediately.

The most important thing is that he didn't show up, so the anesthesiologist boasted two sentences, and he also spoke to him carefully.

The anesthesiologist realized that something had happened and he stopped moving and didn't push the patient. But don't wake up, but the operation is wrong, and there is no way to explain it.

He looked into Professor Yang's eyes, waiting for him to explain the situation.

"Okay ... I think the guide wire is stuck."

The anesthetist smiled suddenly.

"Professor Yang, don't joke with me," said the anesthesiologist. "The guide wire is not another thing. If you say the stent is stuck, I still believe it. The guide wire is stuck? How could it be."

Professor Yang scolded himself. I don't believe in MMP.

He tried again ~ www.novelhall.com ~ still unable to pull the guide wire.

"It's really stuck, no kidding." Professor Yang calmed down and said immediately: "Is anyone inside the hybrid operating room?"

"There is an orthopedic operation, and the remaining operating table is empty. Wait a minute, I'll take a look." After the anesthesiologist said, he ran out quickly.

Professor Yang stood on the operating table, crying without tears.

What exactly happened, he also looked aggressive. Am I not careful enough? Is there any operation error? Yes……

neither!

He didn't know what was happening at this time.

...

...

Note: Quoted in British Journal of Gastroenterology, Gastrointestinal Endoscopy, September 27, 2015.

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