45 adult worms were removed from the lower digestive tract. After completion, Zheng Ren said: "Director Luo, Su Yun and I are doing ERCP. Can you give us some guidance?"
"Boss Zheng is too polite." Director Luo said very matter-of-factly: "I can't take out the worms from such a deep place."
After saying that, he paused and said with a smile: "In the past, you could only use anthelmintics for bugs in this position, and then wait for them to die and then excrete them bit by bit. Many of them cannot be excreted and directly turn into stones. ”
"If the bile duct is blocked, then it depends on the situation."
"Try it, but I may not be able to take it out." Zheng Ren said while preparing the ERCP things, "No, I can't do it alone, I have to bring Su Yun with me."
The patient was lying on his left side. The nurses and anesthetists all wore lead suits and stayed in the operating room, while the others retreated to the operating room.
"Director Luo, don't you want to help me?" Professor Yang asked in a low voice.
"Boss Zheng is just being polite to me," Director Luo said, "Really speaking of doing ERCP, my level is even lower than that of the people under me."
"Look at what you said."
"To be honest, I am getting older and some microscopic operations cannot be done well. Boss Zheng is really good at his age. He can still work for at least 20 years!" Director Luo said enviously.
Professor Yang sighed slightly in his heart.
Generally, people of Boss Zheng's age are graduate students or doctoral students. It would not be an exaggeration to say anything, but they are definitely still in the process of learning surgery, and there is no way to go on stage to solve difficult and complicated diseases.
It would be good if ordinary surgery can be performed smoothly without any errors.
But looking at Boss Zheng through the leaded glass, Professor Yang sighed again. Whether it is interventional surgery or surgical surgery, it is done equally well. How about liver cancer resection? People perform interventional surgery first and then perform resection. Gradually, people with liver and gallbladder become accustomed to this method of operation.
These days, the director is preparing to arrange for someone to learn interventional surgery from Boss Zheng.
There is no need to be particularly meticulous, just apply medicine and embolize. After all, there is still surgery to be done, so there is no need to do it too delicately.
He had changed a lot unknowingly, and he didn't have a clear feeling about it. Professor Yang recalled every scene he had with Boss Zheng, and felt a little confused when he looked back.
On the screen, the ERCP surgery has begun. The duodenoscope is passed orally through the esophagus, stomach, and into the descending duodenum to find the duodenal RT.
Professor Yang has seen many ERCP surgeries, and the next step of selective intubation is quite difficult. But when he looked at Boss Zheng's operation, he felt nothing at all.
Boss Zheng should have done it, but it would be strange if he couldn't. It is worth discussing with the whole hospital why.
Sure enough, after inserting the catheter through the biopsy hole, Boss Zheng adjusted the angle knob and forceps lifter to make the catheter perpendicular to the RT opening, and then inserted the catheter into the RT duodenum naturally.
Then Zheng Ren started taking pictures.
Retrograde cholangiography showed an abnormal image of about 15cm in the proximal right liver segment of the intrahepatic bile duct. Compared with the CT film, it was determined that this was the source of the patient's severe pain.
The roundworms are stimulated, crawl all the way from the RT of the duodenum, and burrow into the intrahepatic biliary tract. Every time the roundworm moves, the patient will feel heartbreaking pain.
Why did this come about? If you have this perseverance, I really believe it is better to eat less and move more.
Professor Yang watched the images silently, mentally assessing the patient's condition. This kind of ERCP surgery is quite difficult, and Director Luo couldn't do it anyway.
Is there any domestic precedent for ERCP insect removal? There are proximal ones, and I have the impression. But it's so deep that it's very difficult.
"Xiao Yang, remove the worm completely, what would you do if it were you?" Director Luo asked.
Although Professor Yang has never done ERCP, he still understands the basic theory and operation. This is equivalent to sitting down and discussing and providing a certain idea.
"Uh..." Professor Yang thought carefully, but then smiled bitterly and said: "Director Luo, you are making things difficult for me."
"Just say anything." Director Luo stared at Boss Zheng's operations closely and said casually.
"It is not difficult to catch roundworms with pliers. At least for Boss Zheng, it is not a difficult task." Professor Yang said.
It’s not difficult, and it does divide people.
The intrahepatic biliary tract is quite thin. It is very difficult to perform ERCP to remove stones from the intrahepatic biliary tract, let alone remove living objects.
"The difficulty is that although the roundworm has no obvious mouthparts and clings to the bile duct, its outer layer... seems to have a protective layer, right?"
When it comes to details, Professor Yang hesitates.
He was too detailed and couldn't explain clearly, so he just chatted with Director Luo based on his memory.
"Well, the outer layer of roundworms has a cuticle, and its physical strength and corrosion resistance are comparable to antelope horns and rhinoceros horns. It is very resistant to mechanical damage, chemical damage, and biological damage. So although roundworms do not survive in the stomach, they do. It will not be digested by gastric juice." Director Luo said.
"It's very elastic. If I grab the end of the tapeworm and pull it out, I'm afraid the bug will snap in the middle."
"It's okay when the space is large. Although the roundworms don't have suckers, their outer walls have adsorption capabilities." Director Luo said, "The roundworms in the gastrointestinal tract are easy to remove, but the intrahepatic bile duct is too difficult."
"I don't understand."
"I don't understand either." Director Luo said: "At first I just wanted to ask Boss Zheng if he had any good ideas, but now that he's here, it proves that he already has an idea. I'm really curious, how does Boss Zheng get rid of the bugs? come out."
"Surgery? If Boss Zheng opens the abdomen and cuts out the liver to remove the worms, it is possible given his level."
"No, if it's a surgical operation, or a surgical operation of this level, Boss Zheng's girlfriend will follow him on stage." Director Luo said with certainty.
Yes, Professor Yang nodded.
The angiography was over long ago, but in the ERCP room, Boss Zheng and Su Yun only performed simple operations and then stopped.
Director Luo felt a little strange and pressed the intercom.
Immediately, Su Yun's voice came from the intercom.
"...Metformin, you dare to eat anything. This thing can also be used to lose weight. Don't admire human imagination too much."
"Metformin improves insulin resistance and lowers insulin levels, thereby reducing fat synthesis and reducing weight. But will there be no problems if ordinary people take metformin?"
"It must be true. A classmate who went abroad to study two days ago also said that a gentleman there was in a coma after taking metformin to lose weight. No one was at home, and he was almost in a vegetative state when he was found out."
This is all a mess. In the middle of the night, a bunch of people from the two departments outside were watching. Why don't we just do surgery and talk about metformin here? Professor Yang and Director Luo looked at each other and saw deep confusion in each other's eyes.