Chapter 2483: 2396 Chatting During the Procedure

After removing 45 adult worms from the lower digestive tract, Zheng Ren said, "Director Luo, I and Su Yun will perform ERCP; could you guide us from the side?"

"Boss Zheng is being too polite," Director Luo said frankly. "I can't extract worms that deep."

After saying that, he paused, then laughed: "In the past, worms in that position could only be expelled with deworming medicine, waiting for them to die and then slowly pass out. Many couldn't be passed and directly turned into stones."

"If the bile duct is blocked, we'll see how it goes."

"Let's try; I might not be able to extract it either." Zheng Renyi said while preparing the ERCP equipment, "Well, I can't do it alone; I need to bring Su Yun along."

The patient lay on the left side; nurses and anesthetists wore lead clothing and stayed in the operating room, while others withdrew to the control area.

"Director Luo, won't you lend a hand?" Professor Yang asked softly.

"Boss Zheng is just being polite with me," Director Luo said. "If we really talk about doing ERCP, my skill level is barely better than my subordinates."

"Look at what you're saying."

"Frankly, at this age, some microscopic operations can't be performed properly. Boss Zheng at his age is really good—he can still work for at least another twenty years!" Director Luo said enviously.

Professor Yang let out a faint sigh in his heart.

Generally, someone Boss Zheng's age would be a graduate or doctoral student; saying anything wouldn't be much of an exaggeration, but they're definitely still learning surgery and can't possibly handle difficult cases on their own.

For ordinary surgery, just completing it without mistakes is already good.

Through the lead glass, watching Boss Zheng, Professor Yang sighed again. Whether it's interventional or open surgery, he handles it just as smoothly. How about liver cancer resection? They first do interventional surgery, then resection; gradually, hepatobiliary specialists have become accustomed to this approach.

These days, the director is preparing to assign someone to learn interventional surgery from Boss Zheng.

No need for excessive precision; just injecting medication and performing embolization will do. After all, we still need to do open surgery, so there's no need to be overly meticulous.

He had unknowingly changed a lot, and being in the midst of it, he didn't have a very clear feeling. Professor Yang recalled his encounters with Boss Zheng, looking back feeling somewhat lost.

On the screen, the ERCP procedure had begun. The duodenoscope entered through the mouth, passing sequentially through the esophagus, stomach, and into the descending duodenum, locating the duodenal RT.

Professor Yang had seen many ERCP procedures; the subsequent selective cannulation is a particularly difficult step. Yet watching Boss Zheng's operation, he felt nothing at all.

If Boss Zheng succeeds, it's expected; if he fails, that would be strange, and worth the whole hospital discussing together why.

Sure enough, after inserting the catheter through the biopsy channel, Boss Zheng adjusted the angle knob and lifted the forceps, making the catheter perpendicular to the RT opening, and then naturally inserted the catheter into the duodenal RT.

Then Zheng Ren began the contrast injection.

Retrograde cholangiography showed an abnormal image about 15 cm long in the intrahepatic bile duct near the right hepatic lobe; comparing with CT scans confirmed this as the source of the patient's severe pain.

The roundworm, stimulated, crawled from the duodenal RT all the way into the intrahepatic bile ducts. Each time the worm moved, the patient felt excruciating, heart-rending pain.

Why go through all this trouble? With such perseverance, one would be better off just eating less and exercising more.

Professor Yang silently examined the images, assessing the patient's condition in his mind. This ERCP procedure is quite difficult; anyway, Director Luo couldn't perform it.

Are there any domestic precedents of using ERCP to remove worms? There are some for the proximal area, which I recall. But none this deep; the difficulty is considerable.

"Little Yang, if you were to completely remove the worm, how would you do it?" Director Luo asked.

Although Professor Yang has never performed ERCP, he still understands the basic theory and operation. This is akin to armchair theorizing, offering a certain line of thought.

"Uh..." Professor Yang pondered carefully, then gave a wry smile: "Director Luo, you're putting me in a difficult spot."

"Just say something casually." Director Luo stared intently at Boss Zheng's operation and said offhandedly.

"Grasping the worm with forceps isn't difficult. At least for Boss Zheng, it's not a difficult task." Professor Yang said.

Not difficult, but it certainly varies by person.

The intrahepatic bile ducts are quite narrow; performing ERCP to extract stones there is already a difficult operation, let alone extracting a living creature.

"The difficulty lies in the fact that although the roundworm lacks obvious mouthparts, it clings tightly to the bile duct, but its outer layer… seems to have a protective layer, right?"

When discussing the fine details, Professor Yang hesitated a bit.

He couldn't clearly explain such fine points; he was just relying on memory and chatting with Director Luo.

"Well, the roundworm's outer layer has a cuticle; its physical strength and corrosion resistance can rival antelope horn and rhino horn, giving it strong resistance to mechanical, chemical, and biological damage. So although the worm doesn't survive in the stomach, it isn't digested by gastric juices either." Director Luo said.

"It's quite elastic; if you grab the worm's tail and pull outward, I'm afraid the worm might snap in the middle."

"When there's enough space, it's fine; although the worm lacks suckers, its outer wall has adhesive ability." Director Luo said, "Roundworms in the GI tract are easy to retrieve, but those in the intrahepatic bile ducts are extremely 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 a good method, but since he's here, it shows he already has an idea. I'm really curious—how is Boss Zheng going to extract the worm?"

"Open surgery? If Boss Zheng opens the abdomen, cuts the liver, and removes the worm, given his skill level, that could be possible."

"No way, if it were open surgery of this level, Boss Zheng's girlfriend would follow him onto the operating table." Director Luo said firmly.

"That's right," Professor Yang nodded.

The contrast imaging had long been finished, yet in the ERCP room, Boss Zheng and Su Yun had only performed a simple operation before stopping.

Director Luo found it a bit strange and pressed the intercom.

Immediately, Su Yun's voice came through the intercom.

"……Metformin, they'll eat anything. This stuff can even be used for weight loss—human imagination is truly astonishing."

"Metformin works by improving insulin resistance, lowering insulin levels, thereby reducing fat synthesis and body weight. But if ordinary people take metformin, wouldn't there be problems?"

"Sure there are. A few days ago, a classmate who went abroad for further study said that over there, an old man took metformin to lose weight and fell into a coma. No one was at home, and by the time they found him, he was almost a vegetable."

"What a mess—late at night, a crowd from two departments outside is watching, why aren't they doing surgery but instead talking about metformin here?" Professor Yang and Director Luo exchanged glances, seeing deep confusion in each other's eyes.