In the operating room, Tanglou is the chief surgeon and Lin Dong is the assistant.

After the anesthetist finished, he gave up the position to the tenement building.

ERCP+EST+LC combined surgery, the first step is to perform ERCP first.

"Duodenoscope..."

With talent and concentration, Tanglou quickly got into rhythm and steadily controlled the camera to enter the duodenum.

"Guide wire, contrast tube preparation..."

Tanglou calmly gave the order while controlling the equipment in his hand.

Since I have done dozens of ERATs, I am naturally familiar with the ERCP Tanglou of the same origin.

Lin Dong was very shocked as he cooperated with Tanglou's operation. Since the last cholecystectomy, he could clearly feel the progress of Tanglou.

Become more knowledgeable and sophisticated about the structure and anatomy of the gallbladder and common bile duct.

Lin Dong understands very well that although more than 80% of the anatomy of the bile and pancreatic ducts have a common channel, the length of the common channel, the angle of the RT opening and the angle of the bile and pancreatic duct convergence are different. In actual operations, it must be completely

It is difficult to achieve selective imaging, and only continuous practice can master it.

At Tanglou's age, he has obviously done a handful of surgeries. To be able to achieve this level of success, one is that he spends a lot of time studying anatomy knowledge, watching surgery videos, and even learning the experience and skills of Dr. Daniel. Another aspect is that

, it’s just pure talent.

In particular, he had just experienced Tanglou's first laparoscopic cholecystectomy. The last time Tanglou gave him a similar feeling, but this time, his operation and proficiency increased by more than one dimension.

"This kind of learning ability is amazing."

Lin Dong had to admire him.

"The diagnosis was made during ERCP: the patient has common bile duct stones. One stone is larger than 20mm and requires endoscopic mechanical lithotripsy. Five stones are smaller than 10mm. The stone can be removed through the mesh basket after EST incision."

Under ERCP, the situation in the patient's common bile duct is naturally hidden, which also avoids inaccuracies in preoperative physical examination and lays a solid foundation for subsequent stone removal.

The natural next step is to perform EST+LC. Compared with conventional laparotomy, the incision of laparotomy is too large, and lithotomy forceps are usually used during the surgery, which often leads to injury to the sphincter of Oddi.

The use of LC combined with EST is very suitable for terminal common bile duct stenosis like Hu Jie's. Moreover, this plan can cure gallbladder and small-diameter common bile duct stone lesions with one-time surgery, and can also preserve the function of Oddi's sphincter to the greatest extent.

"Shock wave gravel preparation..."

Tanglou issued an order non-stop, even the well-informed Lin Dong felt a little stressed.

This kind of high-speed efficiency can only be achieved when working with a chief physician-level partner.

"Get the stone basket and prepare..."

Under the combined surgery, since the first step of angiography accurately locates the number and size of the stones, not only the stones in the common bile duct are removed, but also the impacted stones in the ampulla are also cleaned.

As an expert, Lin Dong naturally pays close attention to the operation of Tanglou.

When pulling out stones, he obviously controlled the force accurately. Lin Dong once encountered a junior resident doctor who used too much force when pulling out stones, causing the patient's ampulla to be torn and injured.

It's such a pity.

Moreover, Tanglou's movements were very rhythmic, and the more he looked at Lin Dong, the more frightened he became.

I saw that when inserting the scope into the Tang Tower, turn right and downward, and the combined movements are always in the same direction as the axis of the bile duct.

This kind of operation is naturally very conducive to the removal of stones, and in the order of stone removal, Tanglou also follows the principle of "first down, then up, first small, then big", and is very calm and rigorous.

Lin Dong remembers that the first time he removed stones, he was too nervous and forgot this principle. As a result, too many stones were removed at one time, causing the stone removal basket to become incarcerated in the RT.

An operation has been completed here, and it has been mostly successful. The next step is regular LC, which is naturally not difficult for Tanglou.

In the subsequent operation, as expected by Tang Lou, the patient suffered very little intraoperative bleeding due to the combined method.

Moreover, since there is no need to use T-tubes for drainage, negative effects such as bile duct bleeding, damage, loss of electrolytes and bile caused by T-tubes can be avoided.

Hu Jie, who had just undergone rescue, barely survived the operation, and the rest was post-operative recovery.

"Tanglou, congratulations."

As an assistant, Lin Dong, of course, always monitors the patient's vital signs. If the amount of bleeding is larger, the patient may suffer from a second shock. This shows how accurate Tanglou's previous prediction was.

If he were to perform the surgery and use conventional LC, the consequences would be disastrous due to excessive blood loss and Hu Jie's current physical condition.

When Lin Dong pushed the trolley out of the operating room, Hu Jie's husband was still communicating with Fa Xiao. Regarding this complicated operation, Fa Xiao's prediction was that it would be at least as good as the first hospital in the city.

It takes two and a half hours.

Hu Jie's husband checked the time after a few minutes. It had only been an hour and a half, and he was anxious and worried.

While he was suffering, Lin Dong and Tang Lou came out pushing a flat cart.

Hu Jie's husband checked the time again, but his mind went blank. He was so panicked that he didn't see the patient on the flat car behind Lin Dong:

"Doctor, why did you come out so quickly? If you don't do surgery inside, why did you come out?"

Lin Dong turned his head, pointed at Hu Jie on the flat car, and signaled to him: "The operation is completed, very successful."

"What did you say! It worked, really!"

Hu Jie's husband followed Lin Dong's guidance and saw Hu Jie still recovering from anesthesia on the flat car.

"Why don't you come over and help me take the patient to the ward?"

"Alas, alas, good."

Hu Jie's husband hurried over, holding the car with one hand and holding Hu Jie's hand with the other: "It's okay, it's okay."

Hu Jie was lying on the flat car, the corners of her mouth twitched slightly, and she blinked.

"Dr. Tang, I was a bastard before. I had a bad attitude and questioned you. You are like Hua Tuo's rejuvenation when he was still alive."

After Hu Jie's husband comforted his wife, he saw the tenement building at the end. At this moment, he was ashamed and ashamed, but also full of gratitude.

His doctor told him how difficult this combined surgery was. Even the most powerful surgeon in his hair department would take at least two hours to complete the procedure. They were from the provincial capital hospital, so Dr. Tang only used one.

Half an hour is not much better than the experts from the provincial capital hospital.

"What a blessing."

Recalling what happened on this day, Hu Jie's husband became more and more frightened. Fortunately, he met Dr. Tang, otherwise his wife might not survive.

[Ding, new task: Complete treatment of dissatisfied patients. Patients and their families are sincerely convinced. 2 gold coins will be awarded, and the card library will be refreshed once.]

Tanglou glanced at Hu Jie's husband, who nodded his thanks and scolded himself a few times.

After Lin Dong and Tang Lou sent the patient to the ward, they gave a few more instructions.

This time, Hu Jie and her husband were naturally respectful and wrote down what Tanglou said.

Before Tang Lou and Lin Dong left, Hu Jie stood up slightly and said to Tang Lou:

"Dr. Tang, thank you."

Tanglou and Lin Dong did not look back and quickly walked out of the ward. Especially Lin Dong, they had seen too many patients who were arrogant but respectful.

I feel grateful and accept it with peace of mind, but I will not forgive the previous harshness.

Seeing the two doctors walking out of the ward without looking back, Hu Jie was slightly stunned.

The interns will naturally assist with the rest. All Tang Lou and Lin Dong have to do is check the apartment regularly.

...

...

The next day, Tanglou received a call from Tang Qichen early in the morning. Professor Huang from the provincial capital was already on his way to Hecheng No. 1 Hospital.

Professor Huang expressed that he was very satisfied with their early physical examination, enhanced CT, and contrast-enhanced ultrasound.
Chapter completed!