The fishing truck was thrown down, and several people got into the helicopter.

Luo Hao took off his coat and wanted to put it on Boss Chai. When the clothes were handed over, I saw that Director Qian was also holding the coat and handing it to his boss.

"I'm young, Director Qian, you should also take care of your health." Luo Hao smiled and put his clothes on Chai Lao's body.

Director Qian didn't insist, just looked at Luo Hao, with a strange look on his fierce face.

Time flies to the site where the hospital helicopter landed.

Luo Hao was also taking a helicopter for the first time, and he was a little dizzy.

This thing doesn't look very safe.

After getting off the plane, several people hurried to the ERCP room.

Hybridization room, ready for surgery.

Surgery can be large or small, and indwelling drainage is generally the safest.

Previously, on board the helicopter, several people had already learned about the patient's medical records and the circumstances related to the operation.

Qin Chen was wearing a sterile hat, and the big back under the hat was a little messy.

Zheng Siyuan's face was not good-looking, serious and deep.

"It's fine." After Chai Lao came in, he patted Qin Chen's shoulder first, "The research that should be done should be done, and if something happens, admit it, and obtain the understanding and recognition of the patient's family." As for the future, do what you need to do, don't be tied. ”

"Boss Chai, we ...... I'm ......," Qin Chen stammered.

Boss Chai had a smile on his face, he was not nervous at all, and he didn't blame Qin Chen.

As for Zheng Siyuan, he belongs to the role of Keqing, and Boss Chai has no reason to let Zheng Siyuan take the blame.

"What did the Interventional Section say?"

"The tumor is too big for the interventional department to do." Qin Chen replied.

"I'm looking for a consultation, Director Pan is doing an emergency department, and he hasn't come down." Zheng Siyuan added.

"I'll try." Luo Hao said.

"You?" Qin Chen rolled his eyes, "Director Qian is here, you go aside." ”

"Director Qian, just now the guidewire leaked the bile duct, you can help with the palm, do you just leave a drain or ......?"

"I thought you tore open the duodenum, roaring, whatever." Boss Chai said lightly.

Qin Chen's face was black.

He glanced at Luo Hao, and Qin Chen swore that he would take a look!

When Chai Lao first came in, he gently comforted himself that this is a trivial matter, don't care, do a good job in the aftermath, and obtain the understanding of the family, and this kind of research surgery will continue in the future.

But after just one glance, Chai Lao changed his personality, faster than Sichuan Opera changed his face, and directly ridiculed.

In Boss Chai's eyes, he is not as good as Luo Hao's hair as a director.

"Boss Chai, look at what you said, at most you have a small eye, how hard you have to tear it apart." Although Qin Chen felt a little awkward in his heart, he still quickly explained.

For Boss Chai, Qin Chen gave the greatest respect.

Don't talk about Luo Hao, okay?

Don't use your eyelids, no!

"Don't know PTCD? The view of the portal is so heavy. Just because you can't do it doesn't mean that PTCD can't do it either. One is retrograde, the other is retrograde, so can it be the same? Chai Lao began to reprimand while looking at the video.

PTCD is percutaneous hepatic puncture biliary drainage.

It is a treatment method for "Minions" with obstructive jaundice before endoscopic ERCP, which belongs to the "work" of the interventional department.

"It doesn't matter if we in the Department of Hepatobiliary Surgery have opinions on intervention, your endoscopy also has opinions on intervention."

Listening to Boss Chai's chatter, Qin Chen and Zheng Siyuan both had black lines on their faces.

Chai Lao's next sentence is - you are also worthy.

The portal of hepatobiliary surgery is not at all a small and blatant.

Interlacing is like a mountain, and with the subdivision of the medical industry, even doctors know little about the sub-disciplines.

The biggest fear of interventional opinions is hepatobiliary surgery, Boss Chai, this is ......

Qin Chen, Zheng Siyuan, and even Director Qian didn't dare to speak.

They couldn't guess what Boss Chai meant.

Just doting on Luo Hao?

"Guidelines for the Treatment of Liver Cancer", Boss Chai is one of the editors-in-chief, and it has been more than 20 years.

The existence of interventional surgery is almost ignored in the guidelines, and only in recent years has a few words about interventional surgery mentioned in the corner, which is almost negligible.

If you want to talk about the portal, Boss Chai has a deep opinion on the intervention discipline.

"Why don't you speak?" Boss Chai stretched out his right hand, opened his thumb and middle finger, pressed on both sides of his reading glasses, and straightened his glasses.

"Boss Chai, the location of the tumor is not good, and PTCD may not work. In addition, Director Pan has the emergency task of the health care team, so we ...... I pondered it or took a look at it at a surgical palm. Qin Chen explained.

"You guys." Boss Chai smiled slightly, "Foolish." ”

“……”

“……”

Whether it was Qin Chen or Zheng Siyuan, he didn't squeak when Boss Chai said it.

Boss Chai's seniority and status in the rivers and lakes are there, and they have to endure even if they are unhappy.

"Little Snail, let's see if PTCD can be done." Chai Lao beckoned.

"Boss, you can do it." Luo Hao had long followed behind Boss Chai and watched the image, but he didn't speak. When Boss Chai asked, Luo Hao immediately replied.

"Go and try, if you don't have anything, go to the catheterization lab and get it yourself."

Boss Chai watched all the images again, turned around and sat on the sofa.

Luo Hao saw that Qin Chen was sullen wearing a mask, so he beckoned and asked Qin Chen to go with him to get the consumables.

"Director Qin, a few years ago, I asked my boss how to choose a direction in the future." Luo Hao dragged Qin Chen to the interventional catheterization laboratory to get something, and "chatted" with Qin Chen as he walked.

"What's the matter? Boss Chai suggested that Lingxue intervene? Qin Chen said disdainfully, "He is the one who has the biggest opinion on the Interventional Department." ”

Out of the door, behind Chai Lao, Qin Chen still had the courage to complain.

"Yes, at that time, my boss suggested that if I wanted to study surgery, it would be better to get in touch with interventional departments first."

“？？？”

“？？？”

Qin Chen and Zheng Siyuan were stunned.

"Minimally invasive is the direction of the future, and the boss has long had a clear judgment. No matter how small the trauma of surgery is, it is limited, and the two of you know it. ”

"Then why did Boss Chai let you learn interventional surgery?" Zheng Siyuan asked.

"Mr. Zheng, at that time, the boss took me to the door of the circulatory interventional operating room to see it a few times. There is a group of people squatting there and waiting, and if there is a problem with the operation, they will immediately go on it. ”

Zheng Siyuan was dumbfounded.

This kind of thing Boss Chai actually cares so much.

When there was a cardiac intervention at the beginning, the cardiac surgeons didn't take it seriously and did the surgery on their own.

However, fewer and fewer surgeries are performed, and simple congenital heart disease is first taken away by circulatory intervention, and none of the patients with atrial and ventricular deficiencies are left, leaving only complex tetralogy of Fallot's and so on.

Since then, coronary artery bypass grafts have become less and less, and the physical condition of patients who have been sent to surgery for surgery is extremely poor, and the difficulty of surgery has suddenly increased.

On the one hand, there is a lack of simple surgery practice, and on the other hand, the difficulty of complex surgery has suddenly increased, which makes cardiac surgery in a dilemma.

Subsequently, the national cardiac surgery department fell one by one, and so far there is almost no cardiac surgery in the prefecture-level hospitals.

Even if there were, they were combined with the general chest, and the cardiac surgery mainly relied on the flying knives of experts outside the heart of the imperial capital and the demon capital.

Cardiac surgery, it can be said that only one breath was left after being beaten.

What about Boss Chai? Could it be that he has been aware of this for a long time?

"At that time, the boss told me that if one day the liver and gallbladder and gastrointestinal surgery were reduced to such a field, he would not be able to die." Luo Hao scratched his head and smiled slightly.

"Harm, not really." Qin Chen said sneeringly.

Director Qin Chen and Qin seem to have forgotten what he had said at the annual meeting - all general surgeries can be replaced by endoscopy.

"Boss Chai was afraid, so he suggested that I get involved first, and then go back and make up the surgery. Minimally invasive can be done well, and surgery is not difficult. ”

“……”

Qin Chen and Zheng Siyuan were dumbfounded.

"Actually, if the interventional surgery is done well, not only the surgical operation is not difficult, but the endoscopic surgery is really not difficult."

！！！

If he hadn't been familiar with Luo Hao, Qin Chen would definitely kick Luo Hao's ass.

What's that?

Is it provocative in front of the two masters of the north and south of the endoscope?

"It's true." Luo Hao said seriously, "When the microguide wire is in the 3rd and 4th grade blood vessels, it can almost be regarded as a miniature version of the endoscope traveling in the digestive tract. ”

"The interventional surgery is well overselected, and the endoscopy is no problem."

"Cut." Qin Chen habitually raised his hand and landed on the sterile cap, "Can you indwell double drainage for hepatic hilar bile duct malignant tumors?" Don't talk nonsense. Boss Chai spoils you, you are really heavenly. ”

"I heard from Director Qian that Director Qin and Professor Zheng are going to study the operation of double drainage of hilar malignant tumors, and they need surgical escort." Luo Hao smiled, "Surgery, I'm also good at it." ”

Qin Chen and Zheng Siyuan were stunned.

The grumbling words in the stomach were stuffed back by Luo Hao's words that sounded a little off-topic.

Interventional and surgical, Luo Hao grasped both hands, and both hands were hard.

If there is a problem during the operation, Luo Hao will operate on his own in the hybrid operating room.

This is also a regret left by the Department of Cardiac Surgery, it seems that Boss Chai has fully learned the lessons and has always wanted Luo Hao to start from minimally invasive.

As for surgery, Chai Lao estimated that after seeing Luo Hao's talent, he thought that as long as Luo Hao came under his command, it would not matter how thousands of eight hundred surgeries could be performed a year.

"Luo Hao, why did you go back to your hometown back then?" Qin Chen asked.

"The competition is too fierce, I don't want to roll up."

“……”

“……”

"Just kidding." Luo Hao smiled, "The main reason for going home is to accumulate some money, starting from the medical office." ”

“？？？”

"A lot of grassroots work has special significance, for example, the 912 medical office will not face the problems of my hometown mine." Luo Hao said, "If you miss many things when you are young, you really miss them." ”

"Grassroots exercise?" Zheng Siyuan asked intently.

Doctors never follow this path, they always choose a certain category of specialization.

"2-3 years, almost." Luo Hao replied, "I have probably figured out all the complex contradictions and small methods often used by clinicians. Medical, clinical, is the most important, but not only clinical. ”

"The boss often says this." Qin Chen said, "Did the boss suggest you go back?" ”

Luo Hao smiled and didn't speak.

When he came to the interventional catheterization laboratory, Luo Hao chose what he needed, and several people carried him back to the endoscopy room.

After some exchanges, both Qin Chen and Zheng Siyuan were a little confused.

They didn't expect Boss Chai, one of the top bosses in general surgery back then, to think so much.

On his side, he is still thinking about replacing all surgical procedures with endoscopic surgery, although this long-term goal sounds unreliable, both Qin Chen and Zheng Siyuan regard it as an ideal.

But the general surgery side was not idle, and Boss Chai had already dealt with it.

A sense of urgency arose, and Qin Chen looked at Zheng Siyuan.

Qin Chen saw that Zheng Siyuan was also looking at him, his eyes were full of worry.

This is not the time for discipline infighting, and in the face of the pressure brought by the extremely powerful general surgery boss, the discipline must first unite within it.

Indeed, for the sake of discipline, endoscopy is ......

Bah!

Qin Chen immediately reacted, how could he and Zheng Siyuan feel sorry for each other!

Solidarity with him?

Unite the big-headed ghosts!

He raised his hand and pulled his big back together, and although he was through the sterile cap, he still made a movement.

Which green onion are you Zheng Siyuan!

Luo Hao is our concord!!

Qin Chen immediately stood with Luo Hao.

"Xiao Luo." Zheng Siyuan was also aware of Qin Chen's psychological fluctuations, and said to Luo Hao with a smile, "PTCD, are you sure?" The tumor almost blocked the hepatic hilar bile duct, and it was difficult for the guidewire to pass. ”

"It should be fine." Luo Hao said, "The next stent will open all the ground and tumors that were pierced before, and the operation is not big." ”

"Besides, PTCD is an intrahepatic puncture, and if it is punctured, there is liver tissue around it, and the pressure is high, so it will not be a big deal."

Zheng Siyuan saw that Luo Hao was sure of what he said, so he fell silent.

At this point, it doesn't make sense to say anything, just watch the surgery.

Luo Hao prepared all kinds of equipment, concentrated on it, and did not communicate with anyone again, including Chen Yong.

It was simple to say to Qin Chen and Zheng Siyuan, but Luo Hao knew very well the difficulty of the operation.

In terms of endoscopy, the two grandmaster-level bigwigs in the north and south have not taken down the operation, and if they want to complete it, they must open it up.

Although the negative state was weakened, it still existed after all, and Luo Hao didn't dare to be careless.

That state of weakness is really uncomfortable, and the operation time can be reduced by one second.

"Luo Hao."

Luo Hao didn't talk to Chen Yong, but Chen Yong came over.

"Huh? What's wrong? ”

"I've also studied PTCD surgery."

"Oh?" Luo Hao frowned.

"Put me alone?" Chen Yong took the initiative to ask, "I'm not talking about the most critical step, the guidewire passes through, and you can rest when you get off the bracket." ”

"No ......"

Luo Hao just wanted to say no, but then he thought of a possibility - open it up by himself, only do the most critical steps, and leave the rest to Chen Yong.

But I haven't seen Chen Yong do it, which is a headache.

"Okay? Can you give me some trust? Chen Yong saw that Luo Hao didn't speak, so he continued to beg.

"This is Concord ......" Luo Hao was helpless, "You said you, do it at home." ”

That being said, Luo Hao was already ready to let Chen Yong go once.

If it doesn't work, you can open it directly and finish the PTCD surgery.

"Then I'll give you one, don't be careless!"

"Huh? Did you really agree? Chen Yong was stunned.

Luo Hao was also stunned for a moment, what does Chen Yong mean by this?

"I thought you wouldn't agree, and you were embarrassed to say 'no' when I went home like this."

"!"

Luo Hao scolded.

"I'm really good, I'll try it this time!" Chen Yong hurriedly rounded the conversation back.

Whether this product is reliable or not, Luo Hao is a little sad.

Anyway, if you have a back hand, you are not afraid, Luo Hao said in a deep voice, "The senior doctor performs the operation, if you can't take it, you know the consequences." ”

Chen Yong hesitated.

Luo Hao also felt that what he said was too serious, which would add a certain amount of psychological pressure to Chen Yong.

"If I do too well, will you lose face?" Chen Yong asked.

“……”

Luo Hao looked at Chen Yong, why is this product not forced at all?!

It turned out that he hesitated because he was afraid that he would lose face.

What do you think!

Luo Hao glanced at the system panel, and really didn't believe that a Taoist priest who knew magic could do surgery better than himself.

"Don't worry, I'll be happy if you do a good job. Remember, don't do it if you can't do it! Luo Hao warned.

"You know, you can just let me do the surgery."

Sterilize, lay sterile towels, close the airtight lead door, and the operation begins.

B-ultrasound positioning.

Luo Hao chose the position under the xiphoid process, 1% lidocaine, and local infiltration anesthesia.

A 1 mm incision is made with a sharp knife and subcutaneous expansion is performed with mosquito forceps.

The main purpose is to stably control the advance of the puncture fine needle without interference from skin resistance; Avoid injury to the inferior costal border artery; This reduces resistance when the catheter is passed through the skin and subcutaneous tissue into the liver.

Although Luo Hao was ninety percent sure, he still chose the most secure way, not pretending to be forced or careless.

21 G FINE NEEDLE PUNCTURE INTO THE LIVER.

The speed at which the thin needle entered the liver was extremely fast, and after sensing the resistance, Luo Hao suddenly asked, "Chen Yong, do you know why the needle is advancing faster?" ”

"Avoid the tip of the needle from scratching the liver capsule on the surface of the liver. For patients with hyperemia and enlargement of the liver, congestive heart failure or early Budd-Chiari's syndrome. ”

“？！” Luo Hao was surprised.

Chen Yong really knew.

"There is an animated video of the up master on station B." Chen Yong was not proud, he seemed to be engrossed in the operation, although Chen Yong felt that anything was okay before going on stage, but once the operation was done, he was still inevitably a little nervous.

"There is a description of the slow needle insertion in the animation video of the up master, and the liver is scratched and the flesh is opened."

Luo Hao sighed, indeed, Chen Yong was not wrong.

After getting off the stage, I will also go to station B to take a look.

After inserting the needle, Luo Hao immediately began to step on the thread.

Under fluoroscopic guidance, the tip of the puncture needle reaches 2 cm above the hepatic door, and the fluoroscopy is stopped and the needle is slowly withdrawn while aspirating with a syringe.

Bile appeared in the syringe, Luo Hao stepped on the thread again, and injected a small amount of diluted contrast agent under fluoroscopy to observe whether the needle tip was in the biliary tract.

Confirm that the needle tip is injected into the biliary tract and the contrast is continued until the target puncture bile duct is visualized.

With the assistance of Chen Yong, Luo Hao did not cross his left and right hands, and twisted the guidewire with both hands and began to seek to pass through the compressed part of the tumor.

The tumor is large and compresses so tightly that it almost tightly compresses the bile ducts.

No wonder Qin Chen and Zheng Siyuan failed to pass the guidewire after repeated attempts, and Luo Hao confirmed his previous guess.

Go big!

Luo Hao did not hesitate to turn on the [Flow] after trying it once.

……

Qin Chen stared at the screen, seeing that Luo Hao's first attempt to pass the guidewire through the tumor compression position was unsuccessful, his mouth was nagging.

"Boss Chai, you just let Xiao Luo go to Donglian City? You don't know what he's learning. ”

"Xiao Luo is too young, if you don't let him learn from my boss, you have to keep him by your side."

"Look at him, now you know how to pretend, and what bile ducts are as wide as the sea in his eyes."

"Huh? That's what the little snail said? Boss Chai asked intently as he looked at the screen.

"That's not what I said, but that's basically what it means."

"I just said, how can Xiaoluo say such things if he doesn't watch basketball." Boss Chai said lightly, "It's hard to watch, but I guess the little snail should be fine." ”

"Boss Chai, you really have confidence in Luo Hao, I ......"

Qin Chen didn't finish a word, but he saw the guidewire slowly but firmly passing along the bile duct under the pressure of the tumor.

How did it pass?

Qin Chen was stunned, he didn't see clearly.

Immediately, Qin Chen looked sideways at Zheng Siyuan.

Zheng Siyuan's eyes were also confused, and he didn't understand.

The self-expanding stent then went down the guidewire, and the whole procedure was uneventful.

If it weren't for the countless attempts before, Qin Chen would have thought that the difficulty of the operation was actually not high.

But both he and Zheng Siyuan tried, and finally repeated attempts to puncture the bile duct with the guidewire, but they were also unsuccessful.

Luo Hao actually tried it for the second time......

When Qin Chen turned his head, he saw Luo Hao getting off the stage in a lead coat and sitting on a stool in the corner of the operating room.

Qin Chen's pupils narrowed, as if he had seen something incredible.

"Look, I'll just say it's not that hard." Boss Chai said lightly, "Luo Hao has done the key steps, and let his assistant do the rest." ”

“……”

Qin Chen suddenly thought of what he said when he was pretending to be forced in the first hospital of the Medical University.

I just borrowed the momentum, borrowed Luo Hao's momentum.

Now Luo Hao actually sat directly on the stool with a big grin!

He really looked more and more like a top magician, Qin Chen looked at Luo Hao through the leaded glass, and then his gaze fell on Luo Hao's assistant Chen Yong.

Chen Yong's operation was not fast, he was cautious, and it was obvious that he was a new hand.

But his operation was very accurate, slow was a little slow, but there was no mistake.

Luo Hao was also watching Chen Yong's operation.

The negative state of [Flow] has been partially weakened, and Luo Hao also has the blessing of [Energy Conversion], Luo Hao's body is much more comfortable.

The time to open this time was not enough, Chen Yong's finishing movements were still slow, and by the time Chen Yong finished the operation, Luo Hao had already stood up.

"Not bad." Luo Hao praised from the bottom of his heart.

"yes." Chen Yong was a little weak, and it seemed that the end of a PTCD operation would be more expensive than the one he prayed for.

"You...... Nervous? Luo Hao asked.

"Okay." Chen Yong connected the drainage bag to the external drainage.

Luo Hao noticed that Chen Yong's hands were shaking a little.

But Luo Hao didn't ridicule this matter, even if it was well-intentioned.

The first time I did an unfamiliar operation, it was not easy, and Chen Yong's pressure was just imaginable.

However, the surgical process started today is not bad, and I will open it myself in the future, control the time, and let Chen Yong complete the rest of the finishing work.

Otherwise, while opening up, doing the finishing work of inconsequential surgery, including skin sewing and the like, Luo Hao always felt that it was not worth it.

"Alright." Chen Yong sighed.

"Yes, you're amazing." Luo Hao praised.

Chen Yong was stunned.

He imagined that Luo Hao would say the phrase "count you awesome" countless times, but he never thought that it would appear in such a scene.

(End of chapter)