Chapter 389 Red and Yellow Light
Yu Shifu no longer knew what he was going to say. After all, Wu Xiaofu had already said everything before he could say it.
To be honest, it’s a bit too worry-free.
"Xiao Fu, you are about to get engaged. As a teacher, you can't express your gratitude. Take this. This is something your teacher's mother has kept for many years. It's for Xiao Ying. Don't refuse. . ”
The news that Wu Xiaofu was getting engaged did not spread. After all, it was just an engagement, not a marriage. The energy of the two families was not ordinary, and the influence still had to be controlled.
Therefore, Wu Xiaofu only planned to tell a few close people the news.
Yu Shifu is one of them, and there is Duan Hao. There are only a few of them in the hospital.
Looking at what Yu Shifu handed over, Wu Xiaofu subconsciously refused. This is a bracelet, a jade bracelet. Don’t think that jade bracelets are not valuable. Everyone knows that it is this kind of jade bracelet. Only bracelets can command sky-high prices, and this jade bracelet looks like an old item at first glance.
I’m afraid it’s not a dowry from his wife. Yu Shifu doesn’t have a daughter. This bracelet should be passed on to their daughter in the future.
But Yu Shifu didn't want to say anything, so he put it directly into Wu Xiaofu's hand, and Wu Xiaofu was not allowed to refuse what he said.
Wu Xiaofu didn't know whether to refuse or what to do.
"Teacher, this is too precious."
"Why is it so precious? Your wife and I both regard you as our own child. To be honest, I am a little rich person in my life. Achieved, but to this day, the thing I am most proud of is having an outstanding disciple like you. Your marriage is a big deal. Teacher, I am lagging behind.
What, you. You don’t regard your teacher as a relative. If you don’t think so, don’t ask for it.”
Hearing this, Wu Xiaofu hurriedly took the jade bracelet over. He had already said this, so how could he refuse it? He must accept it. When his junior sister gets married in the future, he will just prepare a thick betrothal gift.
When Yu Shifu saw Wu Xiaofu accept it, he was also satisfied.
He nodded, "That's right."
The two chatted for a while, then Wu Xiaofu left, and he didn't watch the show anymore. With the scene between Wu Xiaofu and Glucose , the subsequent programs may be eclipsed, and people's attention has been diverted.
Wu Xiaofu shook his head. After all, Wu Xiaofu's focus was on work, on treating diseases and saving people, and he couldn't let this draw too much attention.
In the operating room.
Feng Lingling performed the surgery, which was just an ordinary laparoscopic cholecystectomy.
The patient is a 37-year-old young woman who was admitted to the hospital last Wednesday because of right upper quadrant pain, fever, and jaundice.
Looking at these three symptoms, at a glance, it seems to be Charcot's triad. However, it is worth noting that the patient's blood test showed that the patient has anemia. Such a case does not look like an ordinary case. , it was done in an outpatient clinic. Zhang Xuewen felt it was a bit inappropriate, so he was admitted directly to the hospital.
After admission, the blood biochemistry test showed that the patient's blood items were mainly elevated in indirect bilirubin, which further supported the diagnosis of anemia.
In particular, hemolytic anemia must be considered. When hemolytic anemia exists, there are still many considerations for cholecystectomy.
From the B-ultrasound, it can be clearly seen that the patient has cholecystitis with gallbladder stones and the common bile duct is not thick. As for whether there are stones at the lower end because the gastrointestinal gas is blocking the view, it is unknown.
Since he was already hospitalized, Zhang Xuewen further arranged an MRCP examination for the patient to confirm that there were no stones in the common bile duct.
The initial consideration for current patients is gallbladder stones, cholecystitis and hemolytic anemia. When such problems occur, hospitals generally have to have a way to deal with them. It is impossible to say that they will ignore anemia when they see it. Direct surgery is also required.
Even if it was just for regular sharing of responsibilities, the hematology department would have to be invited.
So Feng Lingling, as the doctor in charge, after further consultation with the hematology department, determined that the patient's hemolytic anemia was hereditary spherocytosis.
After careful review, the hematology department made it clear that the patient's anemia was tolerable and would not affect his life, and the patient also refused to undergo splenectomy.
According to the hematology department, it should not affect the cholecystectomy.
After all, current cholecystectomy is not a major operation. Even if it is performed by Feng Lingling, it will not take more than an hour. Such an operation will basically not cause the patient to suffer from anemia during the operation. Something unexpected happened.
So Feng Lingling arranged the LC as planned. Zhang Xuewen would basically not participate in such a small operation, so Feng Lingling took the intern to perform the operation.
Feng Lingling didn't care in her heart. After more than a year in the job, she was no longer the Feng Lingling who had just entered the clinic. Now she is rich in experience. She has done countless laparoscopic cholecystectomies. It can be said that he is familiar with it. Even if this case is a little special, Feng Lingling thought that it would not be a problem if it was solved as soon as possible.
However, who would have thought that the patient's current medical history was already a bit special, and something even more special would happen later.
I really answered the saying, "Things go quickly."
I saw that Feng Lingling routinely performed the three-hole method to separate adhesions step by step. Both Feng Lingling and Yuna can be said to be in the same line as Wu Xiaofu in laparoscopic cholecystectomy.
Whether it's a separation, or a formal resection.
“Every time I see you doing surgery, we all think we are seeing Director Wu. You have simply absorbed all the essence of Director Wu’s surgery.”
The patrol nurse said with a smile. Feng Lingling raised her lips when she heard this, but she said it was still far from enough.
It is indeed far from enough. When Wu Xiaofu performs surgery, he always aims directly at the target. What he pays attention to is simplicity, directness and precision.
After seeing it a lot, Feng Lingling basically adheres to this principle. Because of Wu Xiaofu’s teaching of various techniques, Feng Lingling and the others are not only quick to get started, but the efficiency and success rate of surgery are also extraordinary. The attending physician can compare.
After seeing the common bile duct clearly, Feng Lingling skillfully dissected the gallbladder triangle, exposed the cystic duct and cystic artery, and then separated them respectively. The gallbladder was separated from the gallbladder bed by a combination of antegrade and retrograde methods until the gallbladder body. At the end, only a bunch of tissue was connected to the gallbladder bed, and everything went smoothly.
At this moment, Feng Lingling just wanted to say, if Wu Xiaofu helps.
Although they are not as good as Wu Xiaofu, they think they have learned some essence. When it comes to laparoscopic cholecystectomy alone, under the director, Feng Lingling dares to say that no one is convinced.
With only one last step left, the operation is basically over, and we are about to give the operation a perfect ending. But accidents always happen at the last moment.
Feng Lingling's hand fell, and the electric hook also fell together. The bundle of tissue was directly severed, and the specimen came down smoothly, but what was frightening was that the yellow liquid also followed. flowed out.
There is no reason why Feng Lingling is not frightened.
Among hepatobiliary surgeries, laparoscopic cholecystectomy is definitely the most common operation. After all, Chinese people have a better diet and have adopted various habits. It can be said that the number of gallbladder stones is increasing day by day and remains high. There are so many Cases are piling up. In terms of cholecystectomy level, Chinese doctors say it is second in the world, but no country dares to say it is first.
Although laparoscopic cholecystectomy is only an entry-level operation for hepatobiliary surgeons, you should not underestimate it at any time, otherwise you will be tempted to take a look at it as soon as it is given to you.
Well, that’s the literal meaning, really just to give it some color.
Either red or yellow.
Note, this is not a traffic light, red and yellow are not just a sign.
The red color naturally means bleeding. There are blood vessels around the gallbladder. With one cut, the blood vessels are severed, or some blood vessels were carelessly dropped during the previous dissociation. If there is no clamping, the bleeding will be limited. It's normal.
In the eyes of the surgeon, the red color is not bad. After all, it is just bleeding and there are no big blood vessels here. There is no need to panic. After seeing it clearly, it can be dealt with.
But yellow is more deadly than red, just like a traffic light. When you see a red light, you stop at a distance, but after seeing a yellow light, many times, the first reaction is not to stop and wait. , but kicked the accelerator and rushed over, but who knows what the consequences of this rush will be.
With luck, I rushed over and saved dozens of seconds.
If you are unlucky, it will result in a car crash and death.
Just like the yellow liquid in front of him, the patient really shed bile and sweated, each of which was enough to impress the doctor.
After all, the yellow liquid is bile. If you cut it with a knife, the bile will leak out. What is the reason?
Burst gallbladder? Don't make trouble. Before the operation, the root of the gallbladder must be exposed and then cut. With Feng Lingling's skills, how could it be wrong? Therefore, there is a high probability that the gallbladder is not ruptured.
Look carefully, the gallbladder is indeed complete.
What else is possible?
It’s over! The bile duct is damaged!
This was Feng Lingling's first reaction. There are only two parts that can leak bile. If it's not the gallbladder, it's naturally the bile duct.
However, in cholecystectomy, bile ducts must not be cut. The bile ducts will be used in the future. This patient is only thirty-seven years old. For such a young woman, if you cut someone's bile duct, what do you do? Explain!
Even though Feng Lingling has been cultivating her Qi for so long, she still breaks out in sweat in an instant.
With a bit of luck in my heart, I put the gauze into the abdominal cavity and dipped it into the gallbladder bed. There was indeed bile flowing out.
What else can you do? Call your superiors.
That’s not to say that after the bile duct is cut, the patient is doomed. As a hepatobiliary surgeon, he will almost certainly encounter bile leakage. As long as the common bile duct is unobstructed and the drainage is smooth, then there will be no problem. At least life is guaranteed. No need to worry.
But how to keep the common bile duct unobstructed and how to minimize the patient's loss after bile duct removal, in this regard, Feng Lingling was far behind.
“Call Director Zhang.”
The patrol nurse also knew something was wrong and hurriedly called, but when the call was connected, she said that Zhang Xuewen was also undergoing surgery.
Feng Lingling did not dare to delay and hurriedly asked Wu Xiaofu to call again. She knew that Wu Xiaofu would definitely not have surgery at this time.
When Wu Xiaofu received the call, he had just come out of Yu Shifu's office a few minutes ago. He was originally planning to go back to sign, but he did not dare to delay at this time and went directly to the operating room.
“Hey! Luschka bile duct!”
Luschka bile duct?
Feng Lingling suddenly realized why she was so unlucky.
The Luschka bile duct was named after it was first described by the anatomist Luschka in 1863. It is also called the gallbladder hepatic duct or the vagus small bile duct in the gallbladder bed. This is very common in textbooks. Whoever discovered it first will be named after him. However, the characters accompanying these nouns are basically from the last century.
After all, with the development of medicine now, there are very few things that have not been discovered in terms of anatomy.
The Luschka bile duct is a tube that directly connects the gallbladder and the intrahepatic bile duct. The gallbladder opening is usually located in the middle and lower part of the gallbladder body. The intrahepatic duct often merges into the posterior segment of the right lobe of the liver. The diameter of the gallbladder is about 1 to 2 mm. The rate is actually neither high nor low, ranging from 5% to 30%.
When encountering the Luschka bile duct, if the gallbladder is not discovered in time when separating the gallbladder from the gallbladder bed of the liver fossa during cholecystectomy, it is cut off, and the stump is not treated, it may cause A series of complications.
For example, bile from the gallbladder bed overflows and flows out along the drainage tube to form a bile leak after surgery;
For another example, failure to place a drainage tube can cause biliary peritonitis;
or improper treatment of postoperative bile leakage can lead to subhepatic infection and abscess formation;
At the same time, due to the Luschka bile duct There are often accompanying small arteries. If they are cut together and handled improperly, such as electrocoagulation to stop bleeding, the blood clot may fall off or melt after surgery, which can cause bleeding.
So, when performing cholecystectomy, you must pay more attention. Once the Luschka bile duct is found, it cannot be treated like ordinary cholecystectomy.
The correct way to handle Luschka's bile duct is to first incise the capsule covering the gallbladder wall, then use blunt force to gently separate and pull apart the gallbladder from the gallbladder bed in the liver fossa.
At this time, you should pay attention. If after pulling the gallbladder, a cord-like object appears, you must not cut it off at will. You should ligate both ends first, and then cut it off in the middle. At this time, the stump will retract, and it will self-contained later. heal.
“If it has been cut off inadvertently, the stump must be found where the bile has overflowed and clamped and ligated, or the surrounding liver parenchyma must be sutured in a figure of 8. In this way, most of the cases It can prevent the occurrence of bile leakage."
Wu Xiaofu said while performing the operation. Yes, Feng Lingling had a problem at this step. She did not do a detailed dissection or complete separation. One knife cut directly cut off Luschka's bile duct.
Feng Lingling watched carefully, but her mood was very low. She was really in a state of despair. Wu Xiaofu would never underestimate any gallbladder removal operation. She had not yet started her surgery. Even Wu Xiaofu She didn't even have 30% of the skills, and she actually failed. She didn't know about Luschka's bile duct.
But Gui Gui knew that she didn’t know whether it was good luck or bad luck, but she had never encountered it before, and then today, Luschka’s bile duct really appeared, and it was performed on her directly. One of the best lessons in life.
(End of this chapter)