The choledochoscopic instrument is ready and enters the abdominal cavity through a special cannula, and then enters the common bile duct through the common bile duct incision. The choledochoscopic light source is turned on, and the condition of the patient's common bile duct appears on the connected electronic display.
The various channels in the human body appear as cavities under an optical microscope, and when magnified, they resemble caves.
Similar to the intestinal examination of colonoscopy, the doctor mainly observes the inner wall of the bile duct and the various contents in the lumen through the choledochoscope. There are not only possible gallstones, but also bile secreted by the human liver and various growths including tumors that cannot be ruled out.
The surgeon controls the choledochoscopic examination by adjusting the focal length and the direction of the light source of the choledochoscopic examination, which is similar to the laparoscopic examination operation.
The difference is that laparoscope requires several people to work together while choledochoscope has only one tube and is operated by one person.
Once choledochoscopy finds abnormalities and further operations are required, unlike laparoscopy where there is an assistant to collaborate, the doctor has to work alone.
From this we can see that the number of skills a doctor needs to learn to become successful is beyond the imagination of ordinary people. The development of medical technology has led to the use of more and more high-tech equipment for traditional surgeons, and the ability requirements are getting higher and higher.
Without other tubes, if the doctor wants to use other instruments, he can only continue to use the same choledochoscope tube. For example, insert a stone removal blue from another hole on the head of the choledochoscope, extend it from the end where the light is, and net the stone and then drag it out of the bile duct. If the stone needs to be crushed, ultrasound can be used. Connecting the flushing tube can use saline irrigation to flush out the residual small stones in the duct.
These operations are more difficult than colonoscopy and gastroscopy because the bile duct is small. If the end of the bile duct is too far for a choledochoscope to work, surgical resection is the only option.
...
...
As soon as the choledochoscopy began, everyone's attention shifted from the laparoscope monitor screen to the electronic display screen of the choledochoscope.
As the light source shines through the patient's choledochoscope, people can see the relatively smooth inner wall of the bile duct and the sudden appearance of yellow-white flocs. 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 floating band-like object seemed to grow out of the tube wall, with a small head and a large tail, and its shape was like a comet, so it was called the comet sign.
"The appearance of the comet sign indicates that the stone is in the narrow opening at the back," the doctors concluded.
The comet sign was first discovered by domestic doctors. Its significance is that the choledochoscope can continue to search from the root of the "comet". Generally, a narrow bile duct opening can be found, and there must be blockages such as gallstones or roundworms behind it. This "comet" is actually formed when bile encounters a blockage and sprays from a narrow place to a spacious place. The hepatic duct is relatively small and the bile duct is relatively large. The former sprays into the latter, and the blockage often occurs in the hepatic duct.
Finding the comet sign is equivalent to finding the location of the stones. Next, the stones are removed with a choledochoscope to eliminate bile duct obstruction, and the patient's jaundice may be cured. However, to completely cure it, it is necessary to find out why the patient has stones.
Is it simply a dietary problem? Or is it a problem with the liver cell metabolism itself? Or is it caused by other reasons?
On this key multiple-choice question, He Guangyou and his colleagues suggested that the cause of the liver cell problem must be "not biliary obstruction caused by gallstones."
Continue read on readnovelmtl.com
