Chapter 2855

2761.2651 Want to expand on a large scale, sooner or later will cause trouble for Zheng Lao Ban.

Insert endoscopic ultrasound, show the cyst location, choose an appropriate puncture point, use color flow imaging to display the neighboring Blood Vessel structure.

The morphology is very ideal; this position, this image performance is exactly what Professor Yang imagined, with almost no deviation.

He knows, his level is constantly increasing. Every time he comes into contact with and learns a new technique, there is such an exciting process, and this feeling is also Professor Yang's favorite.

Growth, joy, truly makes one intoxicated.

Retract the puncture needle into the outer sheath, insert into the endoscopic ultrasound channel, then Professor Yang sends the puncture needle into the stomach, carefully extending the needle tip to avoid the joy turning to sorrow—before even performing the Shou Bing, a hole is poked in the stomach wall.

Although the hole is somewhat shocking, the stomach wall also recovers well, but Professor Yang still carefully pays attention to each step of the operation.

Afterwards, he identifies the needle tip's position on the ultrasound image, and under the guidance of the ultrasound image inserts the needle into the cyst cavity.

When the feeling of obvious emptiness arises, it indicates the puncture needle has entered the cyst. Professor Yang steadied his mind; this meant the cyst wall wasn't causing trouble. If puncture is difficult, one must connect the puncture needle to high-frequency electrocautery, passing a pure electrocautery current. If that happens, it would be really troublesome.

Today his luck was good; Professor Yang, during the preoperative assessment, already had the thought that puncturing the cyst wall might not go smoothly.

Everything went smoothly; he almost started humming a cheerful tune.

The 19G puncture needle successfully punctured the cyst wall and a 0.035-inch guidewire was inserted. Then, using 4mm and 6mm diameter dilators sequentially to dilate the puncture tract, under guidewire guidance a 24mm dual-lumen parallel metal stent was successfully placed.

The procedure was basically finished here; Professor Yang carefully observed the pancreatic pseudocyst with the B-ultrasound probe. He saw it beginning to shrink, which meant the fluid accumulated inside the cyst was being drained into the stomach and then into the intestinal tract.

Very smooth! The corner of Professor Yang's mouth under his mask slightly lifted.

The patient for this procedure had one of the largest pancreatic pseudocysts he had ever seen or treated. If it were a laparoscopic surgery, it would be hard to guarantee no complications.

However, endoscopic ultrasound-guided pancreatic pseudocyst drainage has few complications; it's just an internal drainage, what complications could there be? Professor Yang believed the biggest risk lay in the puncture step—who knows, even though the B-ultrasound shows no obvious blood vessels, could there be a puncture bleed?

If that really happened, it would be totally screwed.

People in the medical field are usually very cautious; Professor Yang is of the moderately cautious type.

If it were back when he first started work, pancreatic pseudocyst was a major disease, the surgery ranked high, and postoperative risk was extremely great. After laparoscopic surgery was introduced, the operative time and postoperative complications of this procedure were correspondingly reduced.

But nowadays, surgery is like child's play; Professor Yang is a doctor who has personally experienced these stages, so his feelings are extremely profound.

"Professor Yang, the procedure is basically over, huh?" the anesthesiologist asked with a smile.

"Well, almost done." Professor Yang, No Rush, observed for several Minute, confirmed the pancreatic pseudocyst had shrunk, he said with a chuckle: "All done."

"Professor Yang, can pancreatic pseudocysts be done like this from now on?" the anesthesiologist asked.

"How could it be!" Professor Yang finished the Shou Bing, his spirits also rose, he casually said: "Pseudocyst tightly adheres to the gastrointestinal wall, with no major blood vessel separation. The digestive tract locally bulges due to pressure from the cyst, and the mucosa with obvious discoloration is more ideal. This is the current necessary condition; to use minimally invasive for any situation, one needs Zheng Lao Ban's level. Me? I wouldn't want to even in the next life."

"You're being too modest." the anesthesiologist laughed.

"A person's value lies in self-awareness." Professor Yang said seriously: "This isn't modesty, it's the factual truth. Zheng Lao Ban is so awesome, I don't want to."

"Hey." The anesthesiologist, not knowing what he was thinking, gave a hehe chuckle.

"Don't doubt it, just talking about this Shou Bing. Whether the stent will be blocked after the procedure needs to be checked with Interventional angiography. I was just lucky, the patient selection was rigorous; if we really roll this out on a large scale, we will definitely eventually need to trouble Zheng Lao Ban." Professor Yang said.

Regarding the indications for endoscopic ultrasound-guided pancreatic pseudocyst drainage and how to treat complications, Professor Yang has done a careful analysis; when he was in the East, he also consulted his mentor.

The reason the Shou Bing can go smoothly, appearing simple and easy, is actually because there are reasons.

No success is obtained for no reason; Professor Yang firmly believes this. Seeing the cyst shrink, he began to withdraw the guidewire.

While withdrawing the guidewire, he said kindly: "Just now's remark, you must not tell anyone else, Zheng Lao Ban……"

Saying this, Professor Yang paused for a moment.

Guidewire…… actually cannot be pulled! Normally, at this point one should be holding the guidewire in hand and it would come out smoothly.

Can't pull it—what the hell is this!

Where is it stuck? No way, the guidewire is thin and smooth, how could it get stuck?

What complication is this? What unexpected situation? Professor Yang was dazed.

Originally fully prepared, but he didn't expect an accident to occur when the Shou Bing was already "finished".

Professor Yang panicked.

He immediately used the B-ultrasound to look, but B-ultrasound has its own Advantage and Disadvantage; really at this point it's useless.

"Professor Yang, what are you preparing to do?" the anesthesiologist asked strangely.

"……" Professor Yang felt like crying.

Damn, you can't show off at all; just showed off a bit and immediately something went wrong.

The key point is, I didn't even show off; just the anesthesiologist praised me a couple of sentences, and I still spoke to him earnestly.

The anesthesiologist realized something went wrong, he stopped his hand movements, didn't push medication to the patient; but if the patient wakes up, this Shou Bing has gone wrong, and there's no way to explain it.

He looked at Professor Yang's eyes, waiting for him to explain the situation.

"Well… well, the guidewire is stuck."

The anesthesiologist laughed all of a sudden.

"Professor Yang, don't joke with me." the anesthesiologist said, "The guidewire isn't some other toy; if you said the stent was stuck I'd believe it. The guidewire stuck? How could that be."

Professor Yang cursed silently, dammit, I fucking don't believe it either.

He tried again, but still couldn't pull the guidewire.

"Really stuck, no joke." Professor Yang steadied his mind and immediately said: "Is anyone in the Hybrid Operating Room?"

"There's an Orthopedics Department Shou Bing, with one Operating table free; please wait a moment, I'll go check." The anesthesiologist said and then ran off quickly.

Professor Yang stood on the Operating table, wanting to cry but no tears.

What exactly happened, he also looked confused. Was I not careful enough? Was there some operational mistake? Or……

None of the above!

At this point he simply didn't know what had happened.

……

……

Note: Sourced from the Yingguo Gastroenterology Society Journal, gastrointestinal endoscopy examination, September 27, 2015.