Auto chess in the operating room

Chapter 136 The Magical Use of the Stone Basket

In the observation room, when all the experts were puzzled.

In the operating room, Tang Lou had already held the disposable stone extraction basket in his hand.

The stone extraction basket is composed of a nickel-titanium alloy wire basket, a sheath, and a control handle. The stone extraction basket is generally used for large-grained fecal stones.

And this patient, under the X-ray, clearly did not have large particles of bezoar, so everyone was very puzzled.

Under the endoscope, I saw that Tang Lou was controlling the handle of taking out the stone net basket, exerting force with his fingertips, and slightly rotating the net basket internally.

"Hey, what is that?"

In the observation room, everyone was attracted by the picture under the endoscope. The stone mesh basket was slightly rotated in the appendix cavity, stirring up the effusion, and then they saw a few silk thread-like things, which floated over and hung into the appendix. over the wire of the basket.

Tang Lou controlled the strength and rotated clockwise. The linear object slowly wrapped around the metal wire of the basket, getting tighter and tighter.

Under the endoscope, you can still feel the thread-like object wriggling, and all the experts naturally understood it when they saw this.

Everyone's scalp is numb!

"It's Demformids!"

Professor Liu directly shouted out that adult pinworms parasitize the ileocecal part of the human body, and are more common in the cecum, appendix, colon, rectum and lower ileum.

When a person sleeps and the anal sphincter relaxes, some females crawl out of the anus and lay eggs on the nearby skin.

After laying eggs, most females die due to dryness, and a few females can wriggle through the anus and return to the intestinal cavity.Obviously, the patient was the female worm that returned to the abdominal cavity and entered the appendix cavity, causing ectopic parasitism to cause abscess obstruction, and then acute appendicitis.

Parasitic appendicitis also accounts for a large proportion of childhood appendicitis.

However, no one expected that Tang Lou would be so bold to use the ERAT catheter to suck out the eggs, and then use the metal wire of the stone basket to wrap the adult worms and pull them out of the body.

In order to have enough space, agitate the extraction stone mesh basket, entangle the adults, and put the plastic holder in advance
At this moment, recalling the entire operation process of Tang Lou and the preparation of the operation, all the experts have endless aftertaste.

"This can be regarded as another variant of ERAT, isn't it?"

Dr. Huang, who is well-informed, was also stunned by Tang Lou's unrestrained creativity.

Under normal circumstances, for appendicitis caused by intestinal worms, laparoscopy is used to directly remove all the appendix parasitized by the worm.

Just like in a film and television drama, after being bitten by a poisonous snake, the bitten arm is immediately cut off, thereby cutting off the virus transmission path.

After using three disposable stone extraction baskets, six adult worms, 1–2 cm long, were placed on the plate, still wriggling.

The equipment nurses on the side didn't dare to take a second look, and the hairs on their bodies exploded.

Even Ma En didn't dare to look at the plate. Thinking of such a pile of worms in his abdominal cavity, Ma En felt sick.

"Second flush with normal saline."

After confirming that all the adult insects were hooked out by the stone net basket, Tang Lou went on to the next step, without any emotional fluctuations because of such an astonishing move.

The equipment nurse frowned, a little afraid to approach, and carefully handed the equipment to Tang Lou.

In order to thoroughly rinse off the remaining insect eggs, Tang Lou naturally rinsed carefully and repeatedly several times.

"Metronidazole and amoxicillin antibiotics are prepared while paying attention to postoperative prevention and treatment"

Although under the buff of a master surgeon, it is basically impossible to get infected, but Tang Lou still told Ma En, who will be in charge of follow-up and ward rounds, to pay attention to antibiotic prevention and treatment.

"Ah."

Ma En nodded, but his heart could not be calm for a long time.

In ERAT, the stone extraction basket is used to stir the pus through rhythmic rotation, so that the adult worms are wound on the wire and then lifted out of the body. How did this come up!
Ordinary parasites are either eliminated from the body by taking drugs, or the affected area is removed once and for all. There is no such purely physical method as Tang Lou, which is non-invasive.

No textbooks dare to write like this!

At this point, the entire ERAT has been completed, the pus has been sucked out, and the parasites have been caught. As soon as the anesthetic wears off, the patient can walk on the ground.

"Great!"

In the observation room, the experts also received a mental shock, and it was another surgical performance that broke through the routine.

Wen Dalong was silent. Even if he didn't like Tang Lou, he had to admire this kind of creative thinking.

In this case, it is entirely possible to publish a special paper. Wen Dalong even thought up the title of the paper: In the treatment of pinworm appendicitis in children, non-invasive extraction of worms by taking stone net baskets during ERAT surgery.

Cheng Jian and Qingping were naturally a little surprised, but they were still very tight on the surface. Cheng Jian took a sip of coffee and said lightly: "Everyone is laughing at me, this brat just doesn't worry. Routine operation, routine operation. "

Hearing Cheng Jian's seemingly humble, but actually raised his tail to the sky answer, Wen Dalong almost spit out a mouthful of blood!

Qingping took the hot water pot, filled Wen Dalong with a cup of tea, and smiled at him.

In order to hide his embarrassment, Wen Dalong hurriedly took a sip of boiling tea.

An old face was flushed, he suppressed the heat, swallowed it, and raised his thick lips slightly to Qingping to express his gratitude.

Laughing is uglier than crying.

There was not much pause, just to allow time for the preparation of the next operation, Tang Lou appeared in the operating room again.

Soon a third patient appeared on the operating table.

The patient's case information was sent to various experts.

Patient: Liu Fengjuan, female, 23 years old

Brief medical history: Because of "transferred right lower abdominal pain for more than 2 days", he was admitted to the hospital with "the cause of the abdominal pain is unknown (acute appendicitis?)".

Previously denied any special medical history; more than 2 days ago, there was no obvious inducement for pain around the umbilical cord, which was persistent dull pain, paroxysmal intensification, no radiating pain, the pain shifted and fixed in the right lower abdomen a few hours later, nausea, no vomiting, No diarrhea, frequent urination, urgency, dysuria, gross hematuria, cough and other symptoms.

Physical examination: T: 36.0℃, P: 84 beats/min, R: 21 beats/min, BP: 120/90mmHg;

Abdominal obesity type is full, no abdominal wall varicose veins, gastrointestinal type and its peristaltic waves; McBurney's point tenderness, rebound tenderness and muscle tension in the right lower abdomen.

No mass was palpable, liver and spleen were not under the ribs, and Murphy's sign was negative; abdominal percussion showed a drum sound, no percussion pain in the liver and spleen area, no percussion pain in the kidney area, negative shifting dullness, bowel sounds 3 times/min, there is no sound of air passing through water.

Auxiliary examination: Abdominal CT showed a tubular soft tissue density shadow with a diameter of about 0.8cm in the ileocecal area, within which fecal stone shadows were seen, exudative lesions were seen around, adjacent fat density increased, and the right retroperitoneum thickened;

It was obviously a typical acute appendicitis. Since the patient was young and liked to wear navel-baring clothes, he was still debating whether to go to the provincial capital hospital.

Hearing that the city's No. [-] Hospital can do non-invasive ERAT, it was natural that he immediately chose to perform this operation in his own city.

Chen Wenhao soon administered anesthesia to the patient, and after finishing, Tang Lou stood in the chief surgeon's position.

With his talent, focus and tenacity, Tang Lou was naturally not affected in the slightest. After two difficult surgeries, he felt like an athlete had warmed up, and his whole body was radiant.

The first step is still the most difficult intubation among the steps of ERAT. After all, the position of the appendix varies a lot, and the internal opening of the appendix is ​​not necessarily at the position facing the endoscope.

Sure enough, Tang Lou, who had been going smoothly before, also encountered trouble in the intubation of this patient.

After several pushes but failed to find the patient's Gerlach flap, Tang Lou frowned and paused slightly.

In the observation room, seeing Tang Lou stop to think for the first time, all the experts became a little interested, and finally stumped Tang Lou.

But this idea itself made these experts a little depressed
"This patient should be due to the obesity and fullness of the abdomen, and the appendix is ​​directly wrapped by the fat pendant. If it is a conventional laparotomy, the fat pendant needs to be dissected to see the appendix."

Dr. Huang carefully looked at the film on the case and the endoscopic picture on the screen, and put forward his own ideas.

As for the situation where the angiography catheter cannot approach the inner opening of the appendix, intubation alone is no longer possible. The experienced Dr. Huang has encountered it before and knows how to deal with it, but this method requires another operation. tools to solve.

Therefore, it is a test of the operator's divergent thinking and familiarity with various surgical instruments in the operating room.

Dr. Huang straightened his chest, ready to see Tang Lou's reaction, and if he couldn't solve it, he would remind through the microphone.

(End of this chapter)