Returning to ’90s, She Became Famous in Major Surgical Fields

   Chapter 742 [742] Found a problem

   After the choledochoscope is ready, enter the abdominal cavity through a special cannula, and then enter the common bile duct through the common bile duct incision. The light source of the choledochoscope was turned on, and the connected electronic display showed the situation in the patient's common bile duct.

  The various pipes of the human body are shown as a cavity under the optical microscope, and when magnified, it is a landscape like a cave.

  Intestinal examination analogous to colonoscopy, the doctor mainly observes various contents in the inner wall and lumen of the bile duct through the choledochoscope. There are not only possible gallstones in it, but also bile normally secreted by the human liver, and various proliferative organisms including tumors that cannot be excluded.

  The surgeon controls the choledochoscope for inspection by adjusting the focal length and the direction of the light source of the choledochoscope, which is similar to the operation of laparoscopy.

   The difference is that the laparoscope is operated by several people, while the choledochoscope has only one tube and is operated by a single person.

  Once the choledochoscopy is abnormal and the next step is required, unlike laparoscopy, there are assistants who can cooperate to handle it, and only one doctor can continue to do it alone.

   It can be seen from this that the number of skills that a doctor needs to learn in order to achieve a positive result is beyond the imagination of ordinary people. The development of medical technology has led to the use of more and more high-tech equipment that traditional surgeons have to master, and the requirements for their abilities are getting higher and higher.

   There are no other tubes. If the doctor wants to use other instruments to operate, they can only continue to pass through the same choledochoscope tube. For example, insert the stone blue from another hole on the lens of the biliary duct, and stick out from the end where the light and shadow are located to catch the stone and drag it out of the biliary duct. Ultrasound can be used for crushed stones if needed. Connect the irrigation tube to flush out the residual small stones in the tube with saline irrigation.

   These operations can be imagined to be more difficult than colonoscopy and gastroscope because the bile duct lumen is small. If it reaches the end of the biliary tract where the choledochoscope cannot function, it can only be surgically cut.

   The focus of everyone's attention was as early as the beginning of the choledochoscope, from the laparoscope monitor screen to the electronic display screen of the choledochoscope.

  With the illumination of the light source in the patient's choledochoscope, people can see the relatively smooth inner wall of the bile duct, and the sudden appearance of yellow-white floccules. what is this? Is there something strange growing in the patient's body?

   "This should be the comet sign."

   A group of doctors were discussing: the ribbon-like floating thing seems to grow from the wall of the tube, with a small head and a big tail, and the shape is like a comet, so it is called the comet sign.

   "There is a comet sign, indicating that the stone is in the narrow opening at the back." The doctors concluded.

The   comet sign was first discovered by domestic doctors, and its significance is that the choledochoscope can continue to search from the root of the "comet". Generally, a narrow opening of the bile duct can be found, followed by a blockage such as gallstones or roundworms. This "comet" is actually formed when bile encounters a blockage and is ejected from a narrow place to a spacious place. The hepatic duct is too small and the bile duct is too large. The former sprays into the latter, and the blockage often occurs in the hepatic duct.

   The discovery of the comet sign is equivalent to the discovery of the stone. Next, a choledochoscope is used to remove the stone to rule out obstruction of the bile duct, and the patient's jaundice may be cured. However, in order to completely cure it, it is necessary to understand why the patient develops stones.

   Is it just a matter of diet? Or is there a problem with the liver cells' own metabolism? Or other reasons?

   On this key multiple-choice question, He Guangyou and the others suggested that the reason for the liver cell problem must be "not biliary obstruction caused by gallstones".

   (end of this chapter)

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