Auto chess in the operating room

Chapter 135 Rare!pinworm appendicitis
"Don't worry, Director Wen. We have made enough preparations before the operation. If ERAT is really impossible, we will change it to the conventional Stryke 30-degree laparoscopy and three-port method."

Qingping explained.

"Since Doctor Qing is so confident, let's start."

Wen Dalong snorted coldly and stopped talking.

In the operating room, in order to ensure the success rate of the operation, Tang Lou naturally used diagnostic techniques before the operation:

[Patient: Cao Xiaodou, male, 7 years old

Symptoms: due to persistent right lower quadrant pain, accompanied by nausea, vomiting, clear mind, poor spirits, acute facial appearance, no yellow staining of skin and mucous membranes all over the body, pathological murmur of superficial lymph nodes, flat and soft abdomen, tenderness and rebound tenderness in the right lower quadrant Positive, limited muscle tension, no obvious abnormal mass, negative Murphy's sign,
Drum sound to percussion, negative shifting dullness, physiological curvature of the spine, free movement of limbs, physiological reflex exists, but pathological reflex is not elicited.

Routine blood test: white blood cell count 12.3 × 109/L, neutrophil 0.81; B ultrasound shows "right lower quadrant appendix enlargement".

Diagnosis: acute appendicitis, pinworm appendicitis
Special reminder: The main cause of appendicitis is caused by parasite obstruction. The scientific name of pinworms is worms, and the ectopic parasitism of pinworms forms worms and eggs in the appendix, causing pinworm appendicitis.

The ERAT can be used to suck out the pus. Due to the obvious inflammation, a plastic stent needs to be placed, and the worms and eggs should be completely removed using the stone extraction basket. 】

In order to ensure the success rate of the operation, nurses have been arranged before the operation to prepare the bowel with 1mL warm water three times to clean the enema, and give antibiotics intravenously 500 minutes before the operation.

After everything was ready, anesthesia was naturally performed first. Due to the child's reason, Tang Lou naturally adopted a new anesthesia method: general anesthesia and endotracheal intubation.

Chen Wenhao followed Tanglou's request and quickly completed the anesthesia on the child.

After finishing everything, he stepped back and handed the operating table to Tang Lou.

Tang Lou's first step was naturally very proficient. He directly used the transparent cap of the endoscope to push away the Gerlach flap. Before the experts could react, the opening of the appendix had been exposed.

"So easy?"

In the observation room, all the bosses were a little surprised. From this action of Tang Lou, many things were reflected. Firstly, he was very familiar with the anatomical structure of the appendix, and secondly, his finger pulp and wrist For the control of the endoscope, the strength and angle have been perfected.

"Without hundreds of operations, there would be no such instinctive operation."

Dr. Huang has the most research on ERAT. Seeing the neatness and cleanliness of the tenement building, he is a little envious!

"Could it be that these surgeries were all done by Tang Lou alone?"

Wen Dalong also came up with a ridiculous idea, but he still insisted that it is impossible for one person to complete so many surgeries in five days. The only possibility is that Cheng Jian was preparing early, and the materials of these surgeries have already been prepared. for a long time.

In the observation room, when thoughts are different.

Tang Lou said another command that surprised everyone: "LoopTip with loop guide wire"

Since Tang Lou's understanding of ERAT has surpassed the three-star surgical procedure, he can make adjustments and modifications as soon as possible for specific cases.

He used the zebra guide wire in the previous ERATs, but this time the case is a bit special, the patient is young, the appendix is ​​thin-walled, and the opening is large. If the zebra guide wire is used, the straight guide wire is relatively harder It is easy to penetrate the soft mucosa of the appendix in children and enter the false lumen.

The second reason is naturally that the patient's appendix is ​​caused by parasites. If the ordinary straight guide wire encounters the parasites and eggs in the appendix cavity, its tip may tear the parasites and crush the eggs. , can cause secondary infection and unforeseen pollution.

However, the use of LoopTip loop guide wire has good bending resistance, and it is easy to achieve deep intubation through the gap in the obstruction site in the appendix cavity.

In the observation room, several experts naturally only know one thing but don't know the other, but it's amazing enough!

"It is conceivable that the straight end of the zebra guide wire may penetrate the soft mucous membrane of the appendix in children. Tang Lou really worked hard on ERAT."

"If I remember correctly, the LoopTip loop guide wire has not appeared in all the previous case materials, which means that this time it is Tang Lou's on-the-spot decision again."

Professor Liu narrowed his eyes, a little confused about this young man.The on-the-spot reaction ability in the operating room is really too mature.

After listening to Professor Liu's narration, the rest of the experts were silent, but there was already a hint of appreciation in their eyes.

"Even if Tang Lou really slightly exaggerated the amount of surgery, his surgical talent and on-the-spot response are still worth cultivating. This kid has a bright future."

Dr. Huang, fully born with a heart of cherishing talents, set up the steps ahead of time.

"Medical skills are important, but medical ethics cannot be neglected."

Wen Dalong whispered with some dissatisfaction, naturally unhappy with Dr. Huang's sudden defection.

"Catheter placement."

In the operating room, Tang Lou's hand movements did not stop, and he went directly to the next step. After the catheter was inserted, purulent secretions had already started gushing out.

"Appendix Cavity Rinse"

Tang Lou continued to send out the next order, and after dozens of times of cooperation, Ma En was also very familiar with it.

Moreover, for some unknown reason this time, apart from working as an assistant, Ma En also had a deeper understanding of Tang Lou's operation as the chief surgeon. He had a feeling that if he continued to work with Tang Lou like this, he would also be confident that he could be the chief surgeon independently.

The thought of the possibility that he could complete an ERAT on his own made Ma En even more motivated. In the past, he would have felt that he had lost points for being a resident doctor in the tenement building, but now he was only secretly happy that he had picked up a bargain.

Sure enough, licking the dog, licking the dog, licking to the end, everything!
"Contrast media, plastic stent preparation"

Tang Lou's next order was issued non-stop. Just as Ma En was about to lose his mind, he immediately dispelled his wild thoughts and continued to focus on cooperating.

Of course he understands the contrast agent, but the plastic stent has never been used before.

Ma En was slightly confused and looked up at Tanglou, who explained casually:

"For patients with a lot of pus in the appendix cavity or a narrow appendix cavity seen in angiography, under X-ray and endoscopic monitoring, a plastic stent is placed along the guide wire, the stent drains the pus and supports the stenosis of the lumen. Continue to reduce the pressure in the appendix cavity."

Of course, what Tang Lou didn't say was that in order to be able to use the stone extraction net to take out parasites and eggs in the next step, it provided enough room for manipulation.

"F8.5 plastic bracket, straight with side wings, length 5cm."

Tang Lou added another sentence.

The equipment nurse on the side nodded immediately.

Dr. Tang is caring, always able to understand the audience, when he is the first assistant, he can think in front of the chief surgeon, and when he is the chief surgeon, he can take into account the emotions and reactions of all the assistants.

Soon, Tang Lou prepared the plastic stent and contrast medium.

As for the foreshadowing of Tang Lou, the bosses in the observation room naturally didn't fully understand it. Of course, they were embarrassed to say it, and they all kept silent, waiting for the first person who couldn't hold back.

"Preparation for taking stone nets"

Under another unexpected instruction from Tang Lou, everyone finally couldn't help it.

"What is he doing? Take a bezoar, so complicated?"

(End of this chapter)