Chapter 490 Choledochoscopy

on the operating table.

Ling Ran was at the main knife position, Zhang Anmin was at the first assistant position, and Ma Yanlin was at the second assistant position, all of them were in a state of full concentration.

The patient on the stage was covered with a green drape. He couldn't see his face or his hands. Only the operating surface of his abdomen was exposed, especially the liver.

Panting heavily, Zhang Anmin watched as Ling Ran peeled off a small piece of liver.

In fact, he has performed quite a few liver surgeries, not to mention the time when he was the second assistant. Since he became a senior resident, he has performed 80 liver resections with the first assistant, if not 100.

In terms of excitement, he was still very excited when he followed the first few liver resection operations on the stage, and after he followed the stage to twenty or thirty, he was quite calm.

However, today's Zhang Anmin felt the long-lost excitement again.

Perhaps, it was because of the resurgence of hope for liver resection?

"Okay, electric knife." Ling Ran stretched out his hand, lowered his head, and treated the few small blood vessels that were leaking in an instant.

"Needle holder." Ling Ran continued to ask for the equipment and continued to handle it, his hands dancing very rhythmically.

Zhang Anmin stared greedily.

It’s not like Lu Wenbin and others who just learned about liver resection and followed Ling Ran to do it. Zhang Anmin has been in the hepatobiliary surgery for so long, and he has worked with nearly ten old attending and young directors. Not as pure as Ling Ran.

Zhang Anmin no longer had time to think about why, he wanted to learn more now.

Doctors are one of the few professions who are willing to take the initiative to work overtime. Although doctors complain and complain about working overtime every day, if the hospital does not allow doctors to work overtime, it will not be complaining, it will be a crowd. Ninety-nine out of ten doctors would run away. Like Yunhua Hospital, it is estimated that there will be only one Doctor Zhou left.

Of course, the night shift is really complaining.

"Okay. Check again for any bleeding." After Ling Ran finished speaking, he began to check the condition of the patient's abdominal cavity.

Zhang Anmin also hurriedly checked. He is the first assistant, and what he does is these auxiliary tasks.

"Doctor Zhang, you come to close the abdomen." After Ling Ran finished the examination, he was sure that there was no problem, so he transferred the work out.

Zhang Anmin responded hastily again, said "Okay", tied his hands again, and sent Ling Ran away.

Lu Wenbin also had no intention of staying, and said with a smile: "I'll go to the kitchen to have a look, Doctor Zhang, after you finish here, go to No. 3 operating room, if you go early, you might be able to get some help .”

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

"Oh, I didn't mean you rob..." Lu Wenbin paused, then smiled for a moment, and said, "Go to operating room No. 3 and you'll find out. If you're willing to be an assistant, everyone won't particularly care. They all come in turns, so there’s no need to fight.”

Zhang Anmin laughed twice, thanked him again, and said in his heart: You can take turns in your group before, because you have abundant resources, now I come in, and I will do half of the first aid by myself, I want to see Do you want to grab it or not.

puff.

The airtight door was closed tightly.

"call……"

"call!"

Zhang Anmin and Su Jiafu exhaled together, then smiled at each other.

"Doctor Ling's aura is a bit strong." Zhang Anmin sighed with embarrassment, as an explanation.

Su Jiafu chuckled, twisted his buttocks comfortably, and said, "I don't care if my aura is strong or not, I just want to have a good sleep. How long do we need?"

Surgeons are often urged by anesthesiologists and circuit doctors.

Zhang Anmin smiled and said: "It only takes a few minutes to close the belly, but I want to experience it more. Please bear with me and sit down for a while."

"Okay." Su Jiafu and Zhang Anmin also know each other, but they basically haven't spoken to each other, and they are not interested in chatting now.

Zhang Anmin asked the roving nurse to pull down the shadowless lamp a little, and changed the angle to observe.

After looking at it with naked eyes for a while, Zhang Anmin was still a little dissatisfied, so he asked the nurse to bring the choledochoscope over.

Carefully observe the stones in the intrahepatic bile duct.

The core problem of liver resection for intrahepatic bile duct stones is the high rate of residual stones in the intrahepatic bile duct, that is, it is difficult to remove the stones in the intrahepatic bile duct.

It has been reported that the residual stone rate of intrahepatic bile duct stones is as high as 31.3%, which means that after partial liver removal, about 30% of the stones still remain in the liver.

If it is further subdivided, the residual stone rate in the left liver is 17.3%, and that in 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 left lateral hepatic resection, thus removing a large number of residual stones in the left liver, while leaving a large number of stones in the right liver.

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

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

Zhang Anmin also planned to use this method to evaluate how Ling Ran's surgery was.

He released the choledochoscope, followed the passage just now, and looked at it silently.

There are no residual rocks.

no remnants...

No residual rocks!

The more Zhang Anmin watched, the more frightened he became.

When he was an assistant, he needed to undertake a large part of the workload, so he couldn't watch all of Lingran's operations. Because of this, he took advantage of the opportunity of shutting down and quickly resumed the game.

However, even if Zhang Anmin's gallbladder was swollen, he never imagined that he would see such a bile duct.

It is said that the level of normal people can be pretended.

laugh.

The operating room door was stepped open again.

Three attending hepatobiliary surgeons came in together, looked left and right first, made sure that Ling Ran was not there, and then laughed: "Old Zhang, I just looked through the door and thought, what are you doing alone? What's the matter? Shut up the abdomen?"

"All the residents in Ling Ran's treatment team have gone back, and you're left to shut down?"

"If you shut your belly, you just shut your belly. There's nothing shameful about shutting your belly."

The qualifications of the three attendants are slightly higher than Zhang Anmin's. They either have already started liver resection, or they are trying their best to get in touch with liver resection. When they heard about Zhang Anmin's assistance to Ling Ran, they all came to see him.

The hepatobiliary surgery department of Yunhua Hospital is no better than the emergency department, let alone an elite department like hand surgery. It is just a small department separated from the general surgery department.

A small department means fewer staff, less resources, and fewer patients, and it is easier to become a situation of one carrot and one pit.

When director He Yuanzheng's liver resection operations were not fully booked, the deputy chief physicians in front of Zhang Anmin couldn't get enough to eat. Following the deputy directors' attendings, the chances of being able to perform liver resection were even lower.

In the situation where other attendings are obediently queuing up, it is naturally unwelcome for Zhang Anmin to jump out of the game.

Zhang Anmin knew it himself, chuckled a few times, then continued to look at the screen, operating the biliary tract mirror without saying a word.

The choledochoscope is similar to other endoscopes in that the camera on the top transmits the image to the screen on the operating table.

The three attending surgeons in the Department of Hepatobiliary Surgery knew it was a choledochoscope at a glance.

Standing in the middle, the highly qualified attending doctor even joked with a smile: "What's the matter, after the liver was cut, it was discovered that there are no stones in the biliary tract?"

The people next to him immediately followed:

"It's a medical malpractice if there are no stones."

"It's okay, it's okay, just put a few on your own, don't say we didn't teach you."

Zhang Anmin moved silently for dozens of seconds before pointing to a small dot on the screen and said, "Here, this is a gallstone."

The three attendants were stunned for a moment, and they all let out bursts of laughter.

"If this was the reason for the liver resection, I would die laughing."

"No, no, my stomach hurts from laughing."

"The liver was cut just for such a small stone? The cut tissue should be sent to the pathology department. This is a medical malpractice."

Zhang Anmin looked at the three of them calmly.

In fact, he could understand the three of them very well. If he hadn't stared at Ling Ran's surgery, he wouldn't have believed that the residual stone could be removed so cleanly.

However, the fact is that the residual stone rate of 2%, which is regarded as the top in the industry, is not difficult for Ling Ran.

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

The others still laughed: "There are only so many stones in total, what difference does it make if there is no operation."

"Trouble, put the patient's CT scan down." After Zhang Anmin finished speaking, the anesthesiologist Su Jiafu quickly released the CT scan on the computer in front of him.

The smiles of the attendants gradually faded.

"Is it the same person?"

"Look at the biliary tract is the same."

"It's so clean, is it because you are afraid that your relatives will not look good if you have gallstones?"

Zhang Anmin looked at them with a half-smile.

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