Doctor's Life Simulator

Chapter 244 Master level, treatment skills for massive bleeding in chest tumor surgery

When Dr. Yan was surprised, Han Hu beside him was also a little surprised. After all, he was much better than Dr. Yan in terms of experience and eyesight.

"Qin Lang did not choose the conventional anterior neck pedicled flap, but chose the anterior cervical fascia flap for repair?"

Han Hu quickly understood Qin Lang's thinking. The patient's tumor was only limited to one part of the vocal cords, and the laryngeal chamber was not involved. Therefore, as long as a suitable restoration is selected, there is a high probability of recovery of laryngeal functions such as pronunciation after surgery. of.

In contrast, the appearance and function of the anterior cervical pedicle flap are not satisfactory, and it also increases the potential danger of the communication between the laryngeal cavity and the outside world from the neck. The structure is close to the original anatomical structure, which greatly reduces the risk factor that the laryngeal cavity communicates with the outside world from the neck.

The vocal cords of the larynx are the vibrating organs that produce sound. The vocal cords are a layered vibrating body. From the perspective of functional anatomy, from the outside to the inside, the vocal cords are divided into the envelope layer, the transition layer and the body layer. This is the same as the anterior cervical fascia. The petals are very similar.

The only problem is that the free transplantation of the anterior cervical fascia flap is much more complicated than the anterior cervical pedicled flap, and the requirements for subsequent suturing are also very high.

This shows Qin Lang's attainments in skin flap transplantation.

After all, Yan Zhengqi's skills are limited, and he only mastered the repair of the pedicled skin flap in front of the neck before, so he has a vague understanding of Qin Lang's operation.

On the operating table, before the restoration was sutured, Qin Lang removed the corresponding part of the residual vocal cord tissue near the anterior joint and the corresponding part to avoid mutual interference between the restorations.

Afterwards, the size, length, and tension of the restoration are controlled appropriately.

".3-0 Gut"

After completing the previous step, Qin Lang chose the most suitable gut. If it is too thin, it is easy to come off and break. If it is too thick, foreign objects may cause phlegm and cough.

Seeing Qin Lang's perfect stitching, Yan Zhengqi also felt admiration in his heart. Although Qin Lang has little experience in laryngeal dehiscence tumor resection, in terms of certain basic skills, he is indeed far superior to ordinary people.

After suturing the cervical fascia flap and the defect margin formed after the resection of the vocal cord tumor, Qin Lang looked at the size of the pedicle, on the same side as the myofascial flap at the edge of the median split of the thyroid cartilage, and at the same level as the vocal cord on the uninjured side. A little cartilage is removed in a "C" shape, and the corresponding part of the residual vocal cord tissue near the anterior joint and the affected side is removed to accommodate the pedicle components that make up the fascia flap.

Watching Qin Lang's operation, Yan Zhengqi changed color slightly:
"This Qin Lang, what a meticulous operation and a sophisticated way of handling. He is so awkward in laryngeal dehiscence tumor resection, but he is like a senior old director in skin flap transplantation and repair. It seems that he was in burn plastic surgery before. The accumulation of subjects is indeed profound.”

Yan Zhengqi felt a sense of urgency, but fortunately, he was able to stabilize Qin Lang with his years of experience in laryngeal dehiscence tumor resection.

Thinking of this, Dr. Yan breathed a sigh of relief. After all, the improvement of a surgical technique requires a lot of time and the accumulation of surgical volume.

After calming down, the next step was some operations of laryngeal cleft tumor resection. Sure enough, the Qin corridor was cut off again.

The whole operation became awkward, and Yan Zhengqi also found some opportunities to give Qin Lang some guidance and tips.

After a while, Yan Zhengqi also handmade a latex finger cot soft support for Qin Lang, which was filled with iodoform gauze. After Qin Lang took it, it was placed in the throat cavity to prevent postoperative adhesion.

Fix the No. 10 silk thread at the upper and lower ends of the finger cuff hanging in the throat cavity. The upper part is drawn from one nostril through the pharynx, and fixed on the same side of the face with medical adhesive tape.

The lower silk thread is led out from the tracheal incision and tied to the ear hole of the tracheal cannula.

The whole set of operations is quite satisfactory.

The next step is to suture the thyroid cartilage and various layers of soft tissue, and bandage with moderate pressure.

Five minutes later, Qin Lang's first laryngeal dehiscence tumor resection was completed.

[Ding, use your own ability to complete five laryngeal dehiscence tumor resections, task progress 1/5]

After watching Qin Lang's entire operation, Yan Zhengqi didn't have much in-depth understanding, so he just encouraged him:
"Doctor Qin, although you are not familiar with laryngeal dehiscence tumor resection, and some operations are a bit jerky, but overall, your flaws are not concealed, especially your basic skills are still very good. Next, as long as there are suitable patients, I will I will assist you and continue to be the chief surgeon. I believe that after accumulating some surgeries, you will be able to master this technique as soon as possible."

Professional Qin Lang smiled, but he was calculating the progress in his heart. After completing five sets, he would directly simulate to the perfect level:
"Okay, I will work hard and strive for Asahi to master laryngeal dehiscence tumor resection."

Yan Zhengqi finally regained some of the majesty of an old doctor, but before he could continue to instruct him, Han Hu interrupted him.

"Qin Lang, your operation is very good."

Han Hu looked at Yan Zhengqi again, with a slight disappointment in his tone: "Dr. Yan, you need to learn more from Dr. Qin. After you go back, reflect on Qin Lang's operation. There are many highlights and flashes in it." place."

Han Hu looked at the problem differently from Yan Zhengqi. He stood at a higher level. Many of Qin Lang's operations, especially the selection of skin flaps, were far beyond conventional operations.

As for experience and skills, Qin Lang is only new to him and not yet proficient, but this operation fully demonstrated his potential. The thinking and concept of the operation are much more important than the actual operation.

Moreover, with Qin Lang's learning ability, it won't take long for him to be able to master this technique proficiently.

On the contrary, Yan Zhengqi, who has been tempered for so many years, has fallen into a rut with a limited upper limit on the idea and concept of surgery, but is still complacent.

Han Hu looked at the modest and motivated Qin Lang, and suddenly had an urge to change his student with Shen Xi, Yan Zhengqi had already lost his training.

Yan Zhengqi was also taken aback by his teacher's obedience, but he didn't understand that Qin Lang's operation was obviously a novice, and his basic skills were strong. Is it really so good?
Yan Zhengqi recalled the operation process. I'm afraid it wasn't for Director Han to save face for Professor Shen, it must be like this.

Oral dissatisfaction perfunctory: "Got it, Director Han, after I go back, I will definitely review Qin Lang's operation."

"Ah."

Han Hu looked away from his apprentice with a little disgust, and looked at Qin Lang again:

"Qin Lang, Professor Shen and I will continue to arrange suitable patients for you. I look forward to your early mastery of laryngeal dehiscence tumor resection."

Han Hu encouraged Qin Lang again.

Shen Xi was on the side, and was quite satisfied with Qin Lang's performance, but after all, Qin Lang was indeed a bit clumsy in some operations: "Qin Lang, although Director Han praised you, you still have to know your own shortcomings. In terms of operation, you are still very jerky, you need to communicate and learn more with Dr. Yan."

Hearing Shen Xi's words, Yan Zhengqi felt a little more comfortable, this is a fair evaluation.

"Qin Lang, look forward to our second surgery."

Yan Zhengqi is also going to see if the progress of Qin Lang's next surgery is as strong as the legend.

Shen Xi also encouraged Qin Lang: "Progress step by step, and don't be too eager for quick success. Doctors need a lot of time to accumulate."

After Qin Lang bid farewell to Professor Shen, Director Han and others, he met a familiar figure when he passed the general surgery department.

It was Wang Heng, Deputy Director Wang, who was introduced by the Department of General Surgery of Zijingang No. [-] Hospital.

After such a short period of time, Wang Heng has already gained a firm foothold in the general surgery department with his own medical skills. Although he is a young student, all the attending doctors and deputy directors are in admiration for him.

Wang Heng brought a few doctors to carry out a case routine, and behind him were several attending physicians and several junior doctors. Lu Min, who had a good relationship with Qin Lang before, and Ma Shuya also followed Behind Wang Heng.

The whole group was mighty, with Wang Heng leading the way.

"Director Wang, we have conducted a preliminary physical examination and diagnosis on the patient, but we cannot determine the real cause of the patient."

Lu Min is now convinced of Wang Heng. He may be able to fight some surgical operations, but in more comprehensive diagnosis, scientific research, management, and other aspects, Wang Heng is completely worthy of his current title of deputy director.

As Lu Min walked, he continued to report the patient information they had sorted out before:
"The patient, female, 61 years old, was admitted to the hospital due to cough and sputum production for one month with fatigue and hyperhidrosis. The symptoms were not relieved after 5 days of anti-infection treatment."

"Physical examination: the left chest chatter weakened, the left middle and upper lung had solid sounds to percussion, and the breath sounds of both lungs were coarse."

At the same time, the patient's X-ray chest film and CT impact data were also handed over to Wang Heng.

Wang Heng also looked carefully:
"A massive high-density shadow in the middle and upper fields of the left lung, with clear borders, and a slight rightward shift of the trachea. CT: Enclosed lesions were seen in the left chest cavity. The plain scan CT value was 34 HU, and there was no obvious enhancement in enhancement."

Looking at the patient's condition, Wang Heng also frowned. The cause of the disease is really difficult to diagnose.

Looking at Wang Heng, he was a little embarrassed, and Lu Min, Ma Shuya and others beside him were even more clueless.

When a group of people were preparing to go to the conference room for a consultation, Lu Min immediately spotted Qin Lang walking:
"Qin Lang, why are you in our general surgery department?"

Hearing Qin Lang's name, several people looked over, even Wang Heng took the initiative to say hello.

Ever since he knew that Lu Yu had been taught a lesson by Qin Lang, Wang Heng paid more and more attention to Qin Lang.

"Doctor Qin!"

Wang Heng also greeted very politely.

"Director Wang, Doctor Lu, Doctor Ma."

Qin Lang also didn't expect such a coincidence, just happened to meet Wang Heng and his party. They were all young people, and they had met several times, and they all had some sympathy for each other.

Wang Heng thought about it, and invited Qin Lang to participate in the consultation:

"Doctor Qin, if you have time, go to our consultation together."

Of course, Qin Lang was disrespectful to Wang Heng's invitation.

Soon, several people came to the conference room, and Lu Min also took advantage of the preparations to introduce the patient's situation to Qin Lang.

"We have performed radiographic examinations on the patient, as well as enhanced CT and MRI. However, we still cannot distinguish the specific symptoms of the patient."

Lu Ming was a little helpless, but also a little depressed.

[Ding, new task: Propose a new diagnosis plan for Wang Heng's team, use CT simulation tracheal endoscopy technology, assist CT enhancement and MRI enhancement, and find the real cause of the patient.At the same time, work out the best treatment plan with Wang Heng.Task reward: 1.1 life simulation points, 2. Handling skills of massive bleeding during chest tumor surgery: master level. 】

(End of this chapter)