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The gastroenterology department of our hospital completed the first mirror ERCP operation
Author:xaszxyy  Release date:2018-09-03


    Recently, a special consultation form made the Gastroenterology Department of Xi’an Central Hospital both "worried" and "excited". Patient Yao, who had abdominal pain, high fever, and jaundice for a few days, was admitted to the Department of General Surgery. Combined with liver function examination and imaging examination, the diagnosis of obstructive jaundice in patients was clear, and the cause of obstruction might be duodenal ampullary malignant tumor. So we invited the Department of Gastroenterology for treatment. What made the digestive doctor "excited" was that the patient was an absolute indication for ERCP endoscopic treatment. Endoscopic treatment could quickly resolve biliary obstruction in the minimally invasive condition and relieve the patient's symptoms. What made the digestive doctor "worried" was that the patient was a “mirror person” with a probability of about one in a million. "Mirror person" is related to the simultaneous mutation of a gene in the parent's body during the development of human embryo. The position of the heart, liver, spleen, gallbladder and other organs is opposite to that of normal people. The heart and spleen are on the right and the liver is on the left. The position of the heart, liver, and spleen seems to be the mirror image of a normal organ. Such a physiological anatomy is contrary to the normal structure, which greatly increases the difficulty of the operation and has high requirements for the experience and technology of the operator.

 

    If the obstruction could not be relieved as soon as possible, the liver function of the patient would be further deteriorated, and even liver failure may occur, and there was also a risk of complicated acute pancreatitis. However, due to the patient's special anatomy, it brought unexpected difficulty to the endoscopic treatment. All the techniques performed by the right hand under the endoscope should be handed to the left hand to complete, and the patient's nipple ampulla tumor from the image From the academic point of view, the duodenum ring had been impregnated, and it was difficult to enter the country under normal conditions. It was more difficult to exchange the left and right hands. The patient's life is above everything else! The department quickly established a treatment team, combined with the Department of General Surgery and the anesthesiology department, they conducted a trade-off analysis of various treatment options. At last, they thought that ERCP had minimal trauma to patients and did not change the normal bile circulation pathway to maximize the patient's digestive function. Although the ERCP operation was performed by left and right hands and we had never tried it, but we would try our best.

  

    After communicating with the patient's family and weighing the risks and benefits, on March 16, protected by attending physician Chen Zheng, anesthetized by Deputy Chief Physician Rui Wang, operated by Kun Han, and cooperated by two nurses, Yali Fang and Sijun Wu, successfully completed the first "mirror" biliary obstruction ERCP biliary metal stent implantation. The whole operation lasted for 45 minutes. The difficulty of intraoperative entry, the direction of intubation and the change of incision direction were all overcome one by one. Looking at the brown-black bile flowing smoothly into the intestine, the intraoperative worry, nervousness, exhaustion, all were successfully relieved of biliary obstruction, and everyone applauded. Postoperative fever and jaundice were quickly relieved and recovered well. The patient have been discharged from the hospital and was actively followed up.