The gallbladder is located in the right upper quadrant, and the appendix is located in the right lower quadrant.

The patient is now feeling pain in the right lower quadrant, so Dr. Sun firmly believes that it is acute appendicitis.

A few decades ago, acute appendicitis had to be surgically removed, but with the advancement of medicine, appendicitis can even be controlled with drugs and treated conservatively.

Zhao Yuan didn't want to argue with Dr. Sun in public, so he set his sights on Tong Zheng.

Tong Zheng did not make an immediate decision and ordered Bai Lu to send the patient to the color ultrasound center.

Minutes and seconds passed.

Dr. Sun found that Zhao Yuan was calmer than he imagined, and secretly wondered where did this intern get his confidence?

"Director Tong, if Zhao Yuan's diagnosis is wrong, will this operation consider replacing the chief surgeon? Is it too dangerous for the patient to hand it over to a doctor who is not sure about the condition? When Dr. Sun talked to Tong Zheng, he immediately became honest and honest.

Tong Zheng couldn't see Dr. Sun's thoughts, "You want to have this surgery?" ”

Dr. Sun's face turned red and he hurriedly said, "I don't have to do this surgery, I just think that the operation should be handed over to a reliable person, so that I can be responsible for the patient." Otherwise, the patient's family may not agree, right? ”

Seeing that Dr. Sun was talking in a roundabout manner and was not frank at all, Tong Zheng was displeased and said lightly, "When the results of color ultrasound come out, I will naturally give you a satisfactory answer." ”

No one dared to delay the urgent order for emergency surgery, and it didn't take long for the color ultrasound to come out.

Tong Zheng took the film from Bai Lu's hand, glanced at it twice, his wrinkled face relaxed, and threw it to Dr. Sun.

"Can you read the film?"

From Tong Zheng's tone and attitude, Dr. Sun already had a premonition that it was not good, and after carefully studying the color ultrasound, the tip of his nose was sweating, and his brain was blank.

"Thickening of the gallbladder wall, enlargement of the gallbladder, deposits inside the gallbladder, acute cholecystitis!"

"No, is the film a mistake? The gallbladder is in the upper right abdomen, and the appendix is in the lower right abdomen, I'm not wrong! ”

Dr. Sun was skeptical about the accuracy of color ultrasound.

Tong Zheng glanced at Zhao Yuan and sighed, "You tell him the reason!" ”

Zhao Yuan knew that Tong Zheng was also testing himself, so he began to patiently explain: "The pain in the right lower abdomen, and it is a pain in a fixed area, is generally considered to be acute appendicitis. However, the onset of appendicitis generally begins around the navel and then shifts to the right lower quadrant. I just asked the patient and she didn't experience pain around her belly button! ”

"In addition, the location of the gallbladder is in the right upper quadrant, and there is another possibility that it may cause pain in the right lower quadrant. That's a gallbladder perforation! Not only appendicitis causes pain in the right lower abdomen, but if the gallbladder is perforated, gallbladder fluid flows into the right lower abdomen, which can also irritate the right lower abdomen and cause pain. ”

Gallbladder perforation?

Dr. Sun couldn't believe it!

Tong Zheng had a solemn expression next to him, "If it is a gallbladder perforation, the patient's condition is dangerous, and surgery is needed immediately!" ”

As soon as the words fell, Bai Lu shouted, "The patient is unconscious!" ”

Zhao Yuan's eyes fell on the blood pressure monitor, which was only 70/40mmHg.

He hurriedly touched the patient's belly, stiffly, and said in a deep voice: "Gallbladder perforation may cause diffuse biliary peritonitis, and surgery must be done as soon as possible!" ”

In this case, laparoscopic minimally invasive surgery is no longer possible, and open surgery is necessary!

Tong Zheng nodded at Zhao Yuan.

Zhao Yuan made correct judgments continuously, which made Tong Zheng more and more confident in his heart, and he decided to completely delegate power to Zhao Yuan.

……

Gallbladder perforation is a serious complication of acute cholecystitis, 10% of patients with acute cholecystitis will have gallbladder perforation, and the key to the success or failure of treatment is whether the correct diagnosis can be made in an early and timely manner.

The patient has already developed symptoms of shock, indicating that the condition has reached the most dangerous time.

Fortunately, the time from the onset of the patient's illness to the diagnosis is not too long.

If the treatment of appendicitis is carried out conservatively, it will delay the timing.

Tong Zheng wondered that the doctor had accumulated enough experience to determine what was wrong with the patient at the first time of the physical examination.

A high-level physical examination is not only done according to those steps in the textbook, but also respiratory rate, heart pulsation, pupil status, muscle response, etc.

It's like a sniper on the battlefield, before shooting a bullet, you have to consider the wind speed, humidity and other comprehensive factors.

Zhao Yuan is a fledgling, and he can tell that the patient does not have appendicitis by relying on his keen sense of smell alone.

There is only one explanation, he is also gifted in the field of diagnostics!

The medical department came forward, and Zhao Yuan and Tong Zheng told the patient's parents the truth.

The mother took the suggestion and signed it with tears in her eyes.

……

Gallbladder removal surgery is not considered a major surgery in emergency surgery, but the special feature of this surgery is the perforation of the gallbladder.

Dr. Sun offered to stay in the operating room, smiling on the surface, but resentful inside.

He still thinks that Tong Zheng's decision to let Zhao Yuan be the chief knife is outrageous.

Tong Zheng personally acts as an anesthesiologist, and a good anesthesiologist is the foundation of a successful operation.

Tong Zheng's technique is gentle and accurate, and from the details of pushing the medicine, Zhao Yuan can see that his level is extremely high.

Zhao Yuan began to cut the skin.

All eyes were on the incision.

The incision is very small, only about three centimeters, and it is generally about three centimeters to know that the incision of laparoscopic minimally invasive surgery is generally about three centimeters.

And it's not in the right place!

Did you make a mistake?

Tong Zheng beat the drum in his heart, but he decided to believe in Zhao Yuan first and wait and see what happened.

Zhao Yuan began to bluntly separate the subcutaneous tissues and muscles, and open the peritoneum.

Because the incision is so small, only small forceps are allowed to penetrate it.

Before everyone could react, Zhao Yuan suddenly clamped out the gallbladder.

Tong Zheng's eyes lit up, and he realized that Zhao Yuan had just completed a difficult operation in an instant!

Blind!

Normally, the position of the gallbladder can be determined with the naked eye or with the help of a laparoscopic surgical field.

But Zhao Yuan accurately locked the position with his senses.

Child administration may be able to do it, but not so fast!

No wonder he dared to open such a small opening in a non-traditional position, and it turned out that he had the strength of blind exercise.

Any ability that Zhao Yuan showed was nothing to hide in the eyes of Tong Zheng, an expert.

I had thoughts before, and I would give Zhao Yuan remedies at any time.

Look at it now, it's too much to worry about! Zhao Yuan is too stable!

"Little Curved Pliers!"

Zhao Yuan patted the middle bend to Bai Lu, and Bai Lu handed the small bend to Zhao Yuan as instructed.

Bai Xiaohu has been in the operating room for more than ten years, and has experienced many times like gallbladder removal surgery, but today's operation is different.

Nothing is right, but it is unusually smooth and smooth.

As soon as you raise your hand, the instrument can accurately fall into your hand.

Zhao Yuan also secretly admired Bai Lu's cooperation, worthy of being an instrument nurse in a big hospital, although it was the first time to cooperate, but the tacit understanding was incomparable.

In the blink of an eye, Zhao Yuan removed the swollen gallbladder and began to stitch the artery.

The next step is to wash the abdominal cavity with saline.

Although the patient was perforated, because of the timely detection, coupled with the fact that the patient was relatively young and had strong immunity, there were no other complications, and there was no large-scale exudation of inflammation.

Wash repeatedly until clean......

Before you know it, you have reached the last step......

"5-0 sutures!"

Zhao Yuan's request was like seeing through the clouds.

Solved the mystery in the hearts of Tong Zheng and Bai Lu.

No wonder Zhao Yuan opened the incision so small!

The patient is a young woman, not married and has children, and if the incision on the abdomen is too large, it will definitely affect the appearance and avoid unnecessary misunderstandings on some occasions.

4-0 absorbable sutures are generally used for child administration, and 5-0 for higher specifications is rarely used.

The thinner the thread, the thinner the needle, the smaller the window for suturing, and the geometric increase in difficulty.

Of course, the better the recovery effect.

After recovery, you can basically do it without scarring.

Zhao Yuan's mind is delicate and meticulous, and he has considered everything carefully as early as when cutting the skin.

"Alright, the operation is complete!"

It took only 30 seconds to suture the 5-0 gut, and Zhao Yuan cut off the sutures.

Tong Zheng subconsciously looked at the electronic clock in the operating room, from the beginning to the end, the operation took eight minutes and thirty-five seconds!

A normal gallbladder removal surgery takes 10 to 20 minutes.

Fast, it's too fast......

Zhao Yuan breathed a sigh of relief, and suddenly found that the atmosphere didn't seem to be right!

The silence before the outbreak......

Tong Zheng was the first to applaud, followed by Bai Lu.

Dr. Sun, who was sluggish on the side, clapped his hands in anger in this atmosphere, and his face was piled up with an embarrassed smile to hide his loss.

You have to admit that you lost to an intern.

Moreover, the loss is incomplete!

In addition, Xie Changtian got up from the corner and applauded!

When he heard that Tong Zheng had decided to let Zhao Yuan complete an operation independently, he was not very relieved, so he quietly came to the operating room after the operation began.

Looking back at the surgery just now, there are too many details worth scrutinizing.

This is an atypical cholecystectomy.

The biggest controversy is the location of the incision, normal people would choose the "right rib arch" (gallbladder surgery point), but Zhao Yuan chose the "McT's point" (appendix surgery point) as the incision, so that the abdominal cavity can be cleared more quickly and the infection problem after the perforation can be solved.

The controversy is also a highlight.

Without the help of any auxiliary tools, the gallbladder is extracted from the Mai's incision by blind manipulation, how coquettish and bold!

Of course, all this is based on the fact that he has enough strength to be strong!