On the screen, Lin Dong saw that Tanglou had begun to dissect the gallbladder triangle and very skillfully separated the cystic duct and cystic artery.

After clarifying the cystic duct, common hepatic duct and cystic artery, Tanglou directly chose to clamp the cystic artery.

"Electric coagulation knife is ready..."

Tang Lou gave the order very calmly, and Ye Kai naturally followed it immediately.

Tanglou is directly clamped 0.5CM away from the common bile duct, which is very precise.

"Scissors ready..."

There was basically no chance to breathe between movements. Ye Kai cooperated attentively. Even after following Lin Dong for so many cholecystectomies, he still felt a bit like Alexander.

The pace of Tanglou is really too fast.

Soon Tang Lou used scissors to cut off the cystic duct.

The next step is naturally a very critical step: removing the gallbladder.

Since the previous steps of Tang Lou were done very cleanly and the separation was very clear, the anatomical levels are very clear.

Ye Kai watched Tang Lou quickly peeling off the gallbladder from the neck, and was very shocked. Apparently Tanglou controlled the force very well. At a glance, the layers between the gallbladder and the gallbladder bed were very clear, so he was naturally very easy to peel off.

"Electric coagulation hook is ready..."

Tanglou issued another order.

Ye Kai quickly handed over the instruments, and soon Tanglou had stopped the bleeding.

After that, it was routine to pull out the puncture tool under the xiphoid process and evaluate the size of the stone. Tanglou directly chose to use blunt dilation with his fingers.

On the side, Lin Dong also didn't expect that Tanglou would be so decisive, using his fingers to expand bluntly, requiring very high control of the strength.

After the expansion is completed, the removed gallbladder is naturally taken out from the subxiphoid incision.

Looking at the stones on the screen, based on Lin Dong's experience, it was natural to see at a glance that such a large stone could not be removed by pulling it out directly.

Sure enough, Tanglou tried it but couldn't take it out.

Lin Dong was about to remind him when he saw that Tang Lou was already sucking the bile from the gallbladder.

"Pliers, specimen bag..."

Ye Kai didn't quite understand Tang Lou's intention, but he still obediently handed over the pliers and specimen bag.

On the screen, Tanglou placed the removed gallbladder into a specimen bag. After further absorbing the bile, he crushed the stones with forceps. After the processing was completed, the gallbladder was easily removed from the incision.

"What a sharp response."

Lin Dong secretly sighed. Generally, newbies would easily panic here. Suctioning out bile and crushing stones seemed to be very simple operations, but they were very unconventional. Only those who have encountered it before could handle it so calmly.

"Explore the abdominal cavity again for bleeding and exudation..."

After Tanglou completed his work, he gave instructions to Tian Linsheng.

Tian Linsheng immediately followed Tanglou's request and carefully checked it again to confirm that it was correct.

Lin Dong nodded slightly. Tanglou's control of the entire operation was very rigorous and thorough. Many novices simply checked that there was no bleeding after removing the gallbladder, and after counting the instruments, they directly chose to suture.

At this point in the surgery, it is naturally nearing its end.

Tang Lou performed the final sutures on the patient himself.

Looking at Tanglou's textbook-level stitching, both Lin Dong and Ye Kai were a little surprised, and then they felt faint admiration.

This hand suturing was obviously practiced countless times under the operating table.

...

[Ding, the first cholecystectomy performed by the surgeon, completed, rewarded 2 gold coins, card library refreshed]

[Cholecystectomy (one star, 2), Cholecystectomy (one star, 2), Choledochojejunostomy (one star, 2), Cholecystostomy (one star, 2), Cholecystostomy (one star)

Star,2)】

Tanglou directly clicked on two cholecystectomies (one star, 2).

[Cholecystectomy (one star, 2), Cholecystectomy (one star, 2), Cholecystectomy (one star, 2) Automatically synthesized cholecystectomy (two stars, 6)]

...

After completing the suturing, Tang Lou walked directly out of the operating room, leaving Tian Linsheng and Ye Kai to deal with the aftermath. Lin Dong also left the operating room together.

Tanglou changed his clothes and was about to go to the general surgery office. When he passed the general surgery clinic, he saw a female patient, leaning on the corridor and facing the trash can, retching. She wanted to vomit but couldn't.

The whole person was holding his abdomen, gasping for breath.

Tanglou directly used diagnostic techniques:

[Patient: Hu Jie, female, 34 years old

Symptoms: Abdominal pain for 4 days, worsening with breathlessness for 3 hours

4 days ago, there was sudden abdominal pain without obvious triggers, accompanied by nausea, loss of appetite, no diarrhea or fever, and no attention was paid. 3 hours ago, the abdominal pain worsened with breathlessness, sweating, but no chest pain, syncope, etc.

Past: I have been diagnosed with gallbladder stones for more than 10 years, but have never had cholecystitis. I have had hyperlipidemia for 5 years, and I usually take statin drugs.

She is clear, her cardiopulmonary examination is unremarkable, her Mohs syndrome is positive, and her lower limbs are not swollen.

...

Diagnosis: acute cholecystitis, acute myocardial infarction.

Special reminder: Due to the long-term inflammatory reaction of cholecystitis, long-term hypotension, and hypoxia, the patient has damaged the myocardium and suffered myocardial infarction. It needs to be diagnosed and treated as soon as possible, otherwise it will cause shock.】

Hu Jie retched for a while and continued into the consulting room.

Tanglou thought about it and realized that acute cholecystitis could still be detected, while acute myocardial infarction could easily be ignored, so he decided to go in and have a look.

It happened to be Ma En who was treating the patient. Ma En was a little surprised when he saw Tanglou and said hello.

The patient also turned his head and looked at the tenement building, but because he was really uncomfortable, he was not in the mood to appreciate the appearance of the tenement building.

"Doctor, I feel so uncomfortable. Please give me an infusion as soon as possible. Since it is confirmed to be cholecystitis, the surgery should be performed. I feel really uncomfortable."

Hu Jie weakly covered her abdomen.

Ma En nodded slightly: "Okay, you have had gallbladder stones for more than ten years. This time it turned into acute cholecystitis, coupled with vomiting, resulting in a lack of water in the body. I will arrange fluid rehydration for you first, and then perform gastrointestinal decompression.

Anti-infection, acid suppression, of course, if you want a radical cure, the best option is to remove the gallbladder.”

The patient nodded: "Then I'll trouble Dr. Ma."

Tanglou looked at Ma En's diagnosis. As expected, he ignored acute myocardial infarction. He said to Ma En: "Dr. Ma, the patient has such severe vomiting, high blood fat, and shortness of breath. Have you done anything for him?"

Electrocardiogram and cardiac enzymes were checked, as well as cardiac ultrasound.”

In the past, Ma En would have ignored Tanglou's opinions on his diagnosis. However, after several impressive rare cases were diagnosed, Ma En immediately looked at the patient's case information.

"That has never been done before. Do you suspect that the patient has other complications besides acute cholecystitis?"

"But the patient did not have chest pain or fainting, just abdominal pain and nausea. And according to the patient's past medical history, he had gallbladder stones for more than 10 years, and with these abdominal films, it was basically confirmed to be acute cholecystitis."

Based on conventional inferences, Ma En felt that Tanglou was a little too cautious.

"The patient's long-term cholecystitis inflammation, long-term hypotension, and hypoxia may damage the myocardium. I recommend that you do a heart ultrasound and electrocardiogram."

Tanglou looked at Ma En, his tone was very convinced.

Looking at Tang Lou's serious expression, Ma En thought for a while, then looked at the patient and discussed: "What Dr. Tang said makes sense. Either do another cardiac color ultrasound and electrocardiogram. After that, I will arrange for fluid replenishment and so on.

"

After all, it's just Tanglou's guess now. Adding additional examinations still requires the patient's consent.

She was already preparing to go for treatment, but when she heard that she was going to have a bunch of tests, Hu Jie frowned.

She looked at Tanglou somewhat unkindly. She was not convinced by such a young doctor.

"Doctor Ma, I feel so uncomfortable. You should hurry up and get me rehydration treatment."

Hu Jie clutched her abdomen, a little impatient, and instinctively rejected the thought of having to queue up for an electrocardiogram and cardiac color Doppler ultrasound.

Hu Jie's husband was on the side and couldn't stand it anymore: "Doctor, are you mistaken? My wife has cholecystitis. You can't be wrong. Arrange treatment quickly. Check the electrocardiogram and cardiac color Doppler ultrasound. She just has abdominal pain.

It’s not like my heart hurts.”

"It's electrocardiogram and cardiac color ultrasound again. Do you want to steal our money? What does this little doctor know? We won't do these unnecessary tests."

The patient's husband yelled a few words, and Hu Jie thought for a while, covering her abdomen, and became impatient: "That's right, I know my own disease well, I just have abdominal pain, it's an old problem, cholecystitis, why check the heart?
Chapter completed!