Chapter 742 [742] Found a Problem

After the choledochoscope is prepared, a special cannula is used to enter the abdominal cavity, and then the common bile duct is entered through the common bile duct incision. Turn on the light source of the choledochoscope, and the situation inside the patient's common bile duct appears on the connected electronic display.

The various channels of the human body appear as a cavity under an optical microscope, and when viewed under magnification, it is a landscape like a cave.

Similar to intestinal examination with colonoscopy, doctors mainly observe the inner wall of the bile duct and various contents in the lumen through the choledochoscope. There are not only possible gallstones in it, but also bile normally secreted by the human liver, and various growths including tumors that cannot be ruled out.

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

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 abnormalities are found in the choledochoscopy, when the next step is needed, unlike laparoscopy with assistants who can cooperate with it, the doctor can only continue to do it alone.

It can be seen from this that a doctor needs to learn more skills than ordinary people can imagine. The development of medical technology has led to the use of more and more high-tech equipment that traditional surgeons must master, and the ability requirements are also getting higher and higher.

There is no other pipeline, and if the doctor wants to use other instruments to operate, he can only continue to pass through the same choledochoscope tube. For example, insert stone blue from another hole on the head of the biliary lens, extend from the end where the light and shadow are located to net the stones, and then drag out the biliary tract. Ultrasound can be used for crushing stones if necessary. Connect the irrigation tube to wash out the residual small stones in the tube with saline irrigation.

It is conceivable that these operations are more difficult than colonoscopy and gastroscopy, because the lumen of the bile duct is small. If it reaches the end of the biliary tract where the choledochoscope cannot work, surgical resection is the only option.

The focus of everyone's eyes had been on the electronic display screen of the choledochoscope from the laparoscopic monitor screen as early as the beginning of the choledochoscope.

With the irradiation of the light source in the patient's choledochoscope, people can see the relatively smooth inner wall of the biliary tract, as well as the sudden appearance of yellow-white flocs. what is this? Is there something strange growing in the patient's body?

"This should be a sign of a comet."

A group of doctors discussed: the band-shaped floating things seem to grow out of the tube wall, with a small head and a big tail, shaped like a comet, so it is called a comet sign.

"A comet sign appeared, indicating that the stone was in the narrow opening at the back." The doctors inferred.

The comet sign was first discovered by domestic doctors. Its meaning is that the choledochoscope can continue to search from the root of the "comet". Generally, narrow bile duct openings can be found, and there must be blockages such as gallstones or roundworms behind. 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 small and the bile duct is too large. The former sprays to the latter, and the blockage often occurs in the hepatic duct.

Finding the comet sign is equivalent to finding where the stones are. Next, use choledochoscopy to remove the stones to rule out biliary obstruction, and the patient's jaundice may be cured. However, if you want to cure it completely, you must figure out why the patient develops stones.

Is it simply a matter of diet? Or is there a problem with the metabolism of the liver cells themselves? Or other reasons?

On this key multiple-choice question, He Guangyou and the others raised the problem of liver cells and thought that the reason must be "not biliary obstruction caused by gallstones".