On the morning of March 15, the originally scheduled gastrointestinal endoscopy was done at 1: 00 noon. Professor Guo arrived at An Children's Hospital without rest after lunch. After reading and consulting the medical history in detail, he gave a clear consultation opinion.
Child A, who is only 4 years old, has recurrent pancreatitis with unknown causes and difficult treatment. The young parents are very anxious. After watching the film in detail, Professor Guo thinks that the child has the possibility of congenital abnormal confluence of biliary and pancreatic ducts, and if it can be diagnosed clearly, it can be treated surgically. But the problem is that although CT magnetic resonance examination has been done, it is still unclear that we can't rush the operation. In order to make a definite diagnosis and get treatment, it is necessary to make a definite diagnosis through ERCP (endoscopic retrograde cholangiopancreatography).
B, a child who has just turned 5, has experienced a lot of pain. Previously, because of sediment-like stones in bile duct, common bile duct incision and T-tube drainage were done. Recently, I have recurrent abdominal pain, and my skin and sclera are stained with yellow. The parents of sick children looked at their children suffering from illness and yellow all over. They said helplessly that the child had been afraid to eat meat and eggs for more than a year because he was afraid of getting sick. Now his skin and sclera are yellow, and he is obviously malnourished. He has become a skinny little yellow child and can no longer stand surgery. After consultation, Professor Guo suggested that multiple light-transmitting areas in the child's bile duct block the bile duct, which is the cause of the disease, and foreign bodies in the bile duct must be surgically removed. However, the child's body nutrition is too poor and the risk of surgery is high, so ERCP treatment can be considered.
The diagnosis and treatment of the two children are clear, but the problem is also coming. Although ERCP is a minimally invasive technique, which has been proved to be effective in clinic, it is very high in technology, which is difficult and dangerous even for adults. Doctors in children's hospitals have limited experience, and if they are unsuccessful, they may bring fatal complications. Moreover, at present, there is no endoscope for children's ERCP in China, so it is more difficult and risky to operate with conventional endoscope.
What shall we do? There are many difficulties ahead. Looking at the helpless eyes of young parents, Professor Guo, as the deputy director of the National Digestive Endoscopy Branch, the deputy head of the ERCP study group and the chairman of the Shaanxi Endoscopy Branch, deeply felt the pressure on his shoulders. After careful consideration and weighing, Professor Guo resolutely decided to shoulder this burden and personally do a difficult ERCP minimally invasive diagnosis and treatment for children. With the strong cooperation of Fang Ying, director of the Department of Gastroenterology of Children's Hospital, anesthesiology department and radiologist, the operation began that afternoon.
Facing the weak patients under anesthesia, Professor Guo picked up the mirror for adults and started minimally invasive surgery with his skillful operation technology and gentleness. You know, the child's esophagus and duodenum are as narrow as paper, and a little carelessness will lead to fatal perforation. Professor Guo is really an expert and bold. The first fetus was successfully operated in only 10 minutes, which confirmed the diagnosis of abnormal confluence of bile duct and pancreatic duct and provided a clear basis for the next surgical treatment. It took only 15 minutes for the second child to take out a large number of yellow-white foreign bodies similar to ascaris residues from the child's bile duct, and the child's bile duct was cleaned and dredged.
Two children with complicated conditions were diagnosed and treated safely by endoscopic minimally invasive technique. After the operation, Professor Guo gave a detailed explanation to the family members of the children, regardless of the wet surgical gown. In particular, he told the parents of children with foreign bodies in bile ducts that children who can't eat nutritious food such as meat and eggs for more than a year can eat supplementary nutrition such as meat and eggs after discharge. Hearing the news, the child's young parents left tears of excitement. Seeing this scene, the exhausted Professor Guo also smiled enthusiastically. While successfully treating the child, he also gained a sense of accomplishment.
Professor Guo's student and director of the Department of Gastroenterology, An Children's Hospital said excitedly: Thank you to Professor Guo and his team for their strong support and selfless dedication to children's digestive endoscopy. This afternoon, two wonderful cases of ERCP made everyone present appreciate the charm of minimally invasive treatment, which really benefited our little patients. In the past, I always felt that there were too few patients who needed ERCP diagnosis and treatment, the technology was too difficult, the equipment was too thick and stupid, and there was no professional duodenoscope and accessories suitable for children. But now, one after another, small patients come one after another. There is a two-year-old child in the ward who has recurrent abdominal pain and vomited a worm at five in the morning. Tomorrow morning, we will further confirm whether it can be treated by endoscopic minimally invasive treatment. Successful cases have strengthened our determination and pace to accelerate the development of endoscopic minimally invasive diagnosis and treatment for children.
Wang Xiangping, the attending physician of Xijing Department of Gastroenterology, said that I am also a doctor of ERCP, and I do it almost every day, knowing the difficulty of ERCP operation. On the same day, I cooperated with Professor Guo as an assistant to complete these two special ERCP operations. First of all, this is my first direct participation in children's ERCP. The digestive tract of children aged 4-5 years old is delicate, and the duodenoscope used by adults is thick and sideways. When entering the endoscope, you can't see the front view. You need to control the endoscope more carefully and gently according to your own feelings and experience to avoid the risk of bleeding and perforation, which requires the operator's endoscopic skills. In the process of cooperation, I am also highly concentrated, observing and pondering Professor Guo's gestures. Secondly, the diseases of these two children are also quite special. One case is abnormal confluence of bile duct and pancreatic duct, which is congenital dysplasia, and the other case is biliary ascaris, which is also rare. Professor Guo made a prediction and analysis when he took me to see the film before the operation, and also made detailed communication with the parents of the children. This makes us fully prepared for the possible situations in the operation. The operation was actually very smooth, which confirmed Professor Guo's preoperative diagnosis. When the treatment was over, the endoscope was taken out of the child's body and the nasobiliary drainage tube was fixed, everyone breathed a sigh of relief and felt very gratified. Especially when seeing the young parents of their children crying happily, the sense of accomplishment is even more indescribable. Of course, I also learned a lot from Professor Guo in this process, and my professional vision and surgical mentality have been improved. More importantly, I was moved by Professor Guo's dedication to overcoming all difficulties and paying attention to patients, which strengthened and promoted my determination to learn ERCP well, do ERCP operation and perioperative management well, and strive for the greatest benefit for patients.
As of press time, the reporter contacted the attending physician of the Department of Gastroenterology, Children's Hospital by telephone. She told reporters that the vital signs of the two children were stable after operation, their body temperature was normal, bile drainage was smooth and there was no abdominal pain. The second child's suspected biliary ascaris obstruction basically subsided.