Chapter 324 Common bile duct stones with cholangitis
When Wei Ping left, Yang Ke kept stomping his feet there.
This man only cares about work, which is really worrying.
But he is a doctor, and when patients need him, he has to be at the forefront.
But he is just a doctor and has his own life, instead of putting all his energy into the hospital.
However, she forgot Wei Ping's original intention.
Wei Ping's pace was still very fast at this time.
If you are in a hospital, a lot of surgeries can be performed in a day.
As for hepatobiliary surgery, there may be more than a dozen operations in one department alone.
At present, Wei Ping cannot perform all surgeries.
But if there is an opportunity, he will not let it go.
Soon, he arrived at the hepatobiliary surgery department.
Director Chen was there at that time, and two attending doctors were beside him.
The three are discussing something.
At this time, Wei Ping's arrival made Director Chen signal to him.
"Doctor Wei is here!"
"Director Chen!" Wei Ping called out.
Then he nodded to the two doctors inside.
They responded very politely.
At this time, Director Chen said, "We are currently discussing a very difficult case that requires surgical treatment. I hope you can join us in the discussion."
"OK!"
Wei Ping walked aside.
Director Chen continued, "Let me repeat myself! This patient is an 80-year-old male who has been experiencing recurring abdominal pain for the past year. Three years ago, he had an acute attack and went to the Second Hospital for a checkup. They were diagnosed with common bile duct stones and cholangitis!"
Common bile duct stones with cholangitis mean that the stones block the bile duct, resulting in a large amount of bile accumulation and increased pressure in the bile duct, leading to acute cholangitis.
The most common treatment for this type of cholangitis is surgical removal of the stones, after which the inflammation will also be resolved.
The person will recover.
But that's generally the case.
The current patient's situation is very special.
Because I’m 80 years old!
Advanced age is generally considered a contraindication for surgery! If the patient is over 70 years old, the risk of surgery increases with each additional year.
It can be said that if surgery is performed rashly, the risks are extremely high.
Why?
Because surgery for elderly patients faces three major challenges:
First, the organ functions of the elderly gradually deteriorate, and their tolerance to surgery and anesthesia decreases;
Second, elderly patients usually have multiple underlying diseases;
Third, recovery after surgery is slow and prone to complications such as infection, pneumonia, and venous thrombosis.
No matter which problem it is, it is a test for elderly patients.
This may be the reason why Director Chen asked Wei Ping to come here.
But what Wei Ping didn't expect was that Director Chen said, "There's an even more serious problem. The patient has heart disease and had a pacemaker installed 20 years ago. He also has cerebral infarction and emphysema!"
So many diseases bring more uncertainty to the entire operation.
The main issue is the risk of anesthesia.
He was simply not suitable for conventional surgery.
Surgeries like stone removal are extremely risky.
Then Director Chen continued, "So, the anesthesiologist said directly that the patient is not suitable for conventional surgery. Let's think about other surgical options."
A surgical operation requires the coordinated efforts of multiple medical professionals, typically including the surgeon, anesthesiologist, nurses, and circulating nurses. The surgeon oversees the entire surgical process, the anesthesiologist administers anesthesia, and the nurses and circulating nurses are responsible for preparing surgical instruments, bed linens, surgical gowns, and ensuring patient safety.
Before the operation, the anesthesiologist will make rounds and assess the patient's condition.
If he says that surgery is not suitable, the surgeon can only cancel the operation.
The most frightening thing about an operation is that the anesthesiologist is busy.
I was also afraid that he would say no! After all, this was a plan that everyone had worked so hard to come up with, and if he said no, then it was no!
Of course, this is also for the sake of the patients.
If surgery is forced, it is very likely to put the patient at great risk.
Therefore, general surgery is not suitable for patients.
"The doctor at the Second Hospital suggested gallbladder puncture and drainage, but the patient did not agree with their plan, so he was transferred to our hospital," Director Chen added.
So that's how it is.
Gallbladder puncture and drainage is a procedure in which a needle is inserted into the gallbladder under ultrasound or radiographic guidance, a guide wire is inserted into the needle, the needle is removed, and a drainage tube is inserted into the gallbladder cavity along the guide wire.
This procedure, typically performed under local infiltration anesthesia, is minimally invasive and allows for adequate drainage of bile from the gallbladder cavity. It is performed in the vast majority of cases of acute cholecystitis. Gallbladder puncture and drainage can effectively control gallbladder inflammation and gradually improve the patient's physical condition.
However, it should be noted that this is only a temporary treatment method, because puncture cannot completely solve the patient's problem. After the gallbladder is punctured and drained, the inflammation may gradually subside.
The Second Hospital's plan is feasible.
However, this method only temporarily relieves the symptoms. Once bile accumulates again, the disease will relapse and the pain will recur.
But patients don’t agree, so even if they want to do it, they can’t.
At this time, the patient came to the First Hospital and asked Director Chen to give a different solution from theirs.
This is also the real reason why Director Chen asked Wei Ping to come here!
Maybe he just wanted to train Wei Ping.
I don't expect him to come up with a surgical plan.
"Right now, the most important thing is to treat the pain, and the primary goal is bile drainage. My idea is to create a fistula and place a tube! After the condition has completely stabilized, we can consider removing the stone within six months to a year to completely solve the problem. There are several issues here that we need to discuss."
Drainage methods include internal drainage and external drainage. Although external drainage can solve emergency situations, it has a higher risk of recurrence and bile flowing out of the body can no longer play a role in digestion.
Internal drainage uses a fistula tube to drain bile to where it needs to go (duodenum), allowing it to continue to play a digestive role and greatly reducing the possibility of recurrence.
When Wei Ping heard this, he felt that this method was still not perfect.
He thought that it was a common bile duct stone and the stone had to be broken.
If he were to do it, he could use his controlled strength to break the stone.
But with so many people watching, it would be considered a medical miracle.
If he performs the surgery himself, there is nothing to worry about.
And what method should be used to perform the surgery so that everything becomes very natural.
Rather than metaphysics.
His vast knowledge reserves gave him an idea.
This approach can minimize the impact on patients.
There is no need for surgery, no need to open a path, and no risk of surgery! The patient's life safety is guaranteed.
Just use local anesthesia and then treat it through imaging.
So, he spoke up, first pointing out the shortcomings of Director Chen's plan, and then expressing his thoughts.
When he told them this plan, everyone looked at him in disbelief.
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