My medical skills add experience

Chapter 183 Learning the Experience of Difficult and Complicated Surgery, Director Hu's Praise
After entering the operating room, he found that the patient was already lying on the operating table.

Unlike the imagined supine position, the patient is in a left 90-degree lying position.

This supine position is based on the comprehensive consideration of the surgical field of view, site, and surgical content.It is by no means a stale supine position.Even Zhou Can once saw a manic patient undergoing general surgery. Several doctors pressed him on the operating table and forced him to wear a breathing mask to administer anesthesia.

Later, after the operation, the patient was sent back to the ward, and his hands and feet were directly tied to the bed with gauze.

Prevent him from going mad and hurting people.

The doctor will let the patient choose different lying positions according to the needs of the operation.

In the operating room, besides Zhou Can and Dr. Wu, there were three nurses and an anesthesiologist.

An anesthetist is administering anesthesia to a patient.

This preparation is usually done in advance.Nurses will enter the operating room in advance to organize items and check whether all the garbage has been disposed of.Then prepare the instruments and medicines needed for the operation, etc.

"Is he anesthetized and intubated with a double lumen?"

Zhou Can has never studied professional anesthesia operations.It's just that I have seen a lot, and I can basically guess the anesthesia methods for various operations.

Then the surgical training students need to go to the anesthesiology department for a month of training.

At that time, I will definitely learn some advanced anesthesia knowledge and specific operation methods.

"Correct!"

The anesthesiologist is a male doctor who is nearly fifty years old, with a zombie face, and he never speaks with a smile.

"Can I help you?"

What Zhou Can was interested in was the two-point insertion experience of intubation.

With the increasing number of departments he has trained, his knowledge is also increasing, and he has a clearer understanding of the future direction of medicine.

Minimally invasive, endoscopic surgery is transitioning from new trend to mainstream.

Forewarned is forearmed, without prejudging the waste.

In addition to practicing traditional surgery well, Zhou Can will also spare no effort to improve advanced medical skills whenever he has the opportunity.

"Do it!"

Anesthesiologists really cherish words like gold.In addition, there is no smile on his face, which makes it difficult to get close to him.

Doctor Guan is much more accommodating than this person.

Zhou Can was also polite, helping with intubation and putting on a breathing mask.

The anesthesiologist was a little surprised to see that he was intubating the bronchi as if he was playing, and couldn't help but look at Zhou Can more.

Without saying anything, the two silently made all the preparations for the patient before anesthesia.

Zhou Can stepped aside.

Not long after, Director Xue and Deputy Director Lu rushed to the operating room with the surgical team.

"Not bad, the patients have been anesthetized!"

Director Xue's personality was quite cheerful, and he boasted with a smile.

Then let the hand-washing nurse help her put on sterile gloves, check the knife position drawn on the patient's body, and the patient's physical signs. After the verification is correct, the operation begins.

"Who does routine disinfection?"

"I!"

The patrolling nurse replied.

"Remember to expand the range a little next time. I think you must be a frugal girl."

It was originally a word of criticism, but when it came out of Director Xue's mouth, people were very happy to accept it.

The atmosphere is also very relaxed.

The nurse girl smiled embarrassedly.

"Before incision, it is best to spread the drape first, and then extend the right posterolateral incision."

Director Xue patiently taught the doctors under him, and operated on the patients at the same time.

Her movements were as steady as ever.

Zhou Can found that the vast majority of doctors in cardiothoracic surgery, as long as they are of higher rank, have inherited Director Hu Kan's "stable" surgical style.

In addition to being steady, Director Xue also has the dexterity unique to female doctors.

"When cutting, you must remember that you can't seek speed, but you should cut layer by layer. First cut the skin layer, then cut the subcutaneous tissue layer, and then cut the muscle layer. At this time, you can see the ribs. After the fifth Just cut the ribs off."

After finishing speaking, she signaled Deputy Director Lu to cut off the ribs.

"Then enter the thoracic cavity through the fourth intercostal space for exploration."

No thoracotomy is simple.

Zhou Can stood under the operating table, watching and studying carefully.

After the basic skills have been practiced, it is just a good foundation for surgery.If you want to complete such a major surgery independently, you still have a lot to learn.

In particular, the surgical skills and precautions are worth studying carefully.

Even if the same lung lobe is removed, the surgical method may be completely different.

This requires the surgeon to be knowledgeable and to use what he has learned so that he can be flexible.

"There are three main objectives of the investigation, to ensure that there is no adhesion between the chest wall and the lung, no pleural effusion, and the specific location of the tumor on the lung lobe."

Each of the above three items is very important.

Lung cancer in the middle and late stage, the lung and chest wall are prone to adhesion.At this time, if you want to operate, you must carefully separate them.

In fact, patients who have developed to this stage no longer need surgery.

Most have metastasized cancer cells.

A conscientious doctor will usually tell the patient that the patient's cancer cells have spread throughout the body, or spread widely, involving multiple organs and tissues in the chest cavity.There is no need to spend a lot of money on medical treatment, eat and drink whatever you want, hurry up.Then, if you use medicine, it is mainly for pain relief, and to improve the quality of life of patients with advanced cancer as much as possible.

After investigation, the patient was very lucky.

There was no adhesion between the lung and the chest wall, no pleural effusion, and the tumor was in the posterior segment of the right upper lobe, with a diameter of about 4 cm.

Not particularly big.

No tumor was found in the surrounding organs and tissues.

This is already an ideal situation.

During surgery, because the superficial pleura shrinks.The tumor is close to the hilum and is very close to the upper lobe trachea, so local resection cannot be done.

In addition, the upper mediastinal lymph nodes were enlarged and involved the innominate vein, and pericardial effusion was evident.

Basically consistent with the inspection results.

Director Xue performed a right upper lobectomy on the patient to ensure that the cancer cells were removed to avoid recurrence.

Looking at the removed lung lobes, the tumors on them made my scalp tingle.

Even though doctors deal with blood and pus every day, they still feel natural fear when they see cancerous tumors.

This is also an expression of reverence for life.

Ordinary people will feel fear and realize that their lives are threatened only when they hold a knife on their necks.

Doctors know much more medical knowledge than ordinary people, and they know that human life is very fragile.

Even today, cancer is still synonymous with death.

The main reason is that there are no obvious symptoms in the early stage of cancer. Most of the people in China are very frugal and don't like to do physical examinations.As long as cancer is detected, it is basically in the middle and late stage.

Developed countries are much better at this.

Their cancer mortality is low, not because their medical skills are many times better than Huaxia, but because of early detection and early treatment.

In the early stage of cancer, as long as it is removed and supplemented with radiotherapy and chemotherapy, satisfactory results can basically be cured.

Just like a forest fire, when it first burns, it is easy to put out.

When the fire grows bigger and spreads out a long line of fire, it will be difficult to extinguish it.

Zhou Can memorized Director Xue's skills in removing lung lobes one by one.

"Lymph is equivalent to the body's loyal guard. When there is inflammation and cancer cells attack, it will swell. The upper mediastinal lymph nodes are swollen like this, so it must be removed. This removal needs to be thorough. Before removing it, you can deal with pericardial effusion .”

Her movements were not fast, but she advanced steadily and clearly.

It's like fighting a war.

Which part of the enemy should be destroyed first, which part of the enemy should be dealt with next, and finally finish, there are certain strategies.

After opening the pericardium, she cut off part of the pericardial wall, and then deftly released the yellow transparent effusion.Then the mediastinal pleura was cut open circularly.

Lymph nodes in areas 10 and 11 were revealed.

After being swept away, the veins of the right upper lobe were dissected.

There are many application scenarios of incision, and what she performs now is basically incision.

Next, she performed a double ligation of the proximal superior lobe vein and severed it.

Then the pulmonary fissure was opened, and the right pulmonary artery trunk and upper lobe branches were dissected out.Reapply according to the law, after double ligation at the proximal end, cut off.

The purpose of doing all this is to dissect the right upper lobe bronchi.

After the right upper lobe bronchus was dissected, the bronchial stump was directly closed with a stump closure device.

This operation is simply too complicated.

Zhou Can even felt that his head was not enough.

Director Xue is so young, he can stand out from thousands of troops, get a high professional title, and his surgical ability is even stronger than Zhou Can expected.

Of course, her academics may be even stronger.

This is a super good female doctor.

"After it is removed, the lymph nodes and mediastinal pleura in areas 1, 2, 3, 4, 7, and 8 can be cleaned. Finally, this involved bloodless vein is removed. The spread and cunning of cancer cells , concealment, all of which are far beyond imagination. If the operation cannot be done meticulously and the fish that slip through the net are missed, it is easy to relapse after the operation.”

She warned everyone.

"Once a relapse, it means the end of a life. If the patient chooses to trust us, then we must also be highly responsible, as attentive and caring as we are doing our own affairs."

Tuya's doctors can basically be promoted to the title of deputy director, and they are all very good in medical ethics.

At least none of the chief physicians that Zhou Can had come into contact with took the patient's life as a joke.

"Finally, the lower pulmonary ligament was opened, and the lymph nodes in area 9 were removed. At this point, the operation is complete. After careful inspection, the operation can be concluded if there is no missing fish."

The whole operation was successfully completed, and Deputy Director Lu took over the rest of the work.

She sat beside her and rested with a contented face.

"Director Lu, can I do the stitching?"

Zhou Can's hands were already itchy after watching it for so long.

It is impossible for him to get started with those high-risk sweeps and excisions, but he is fully capable of suturing in the finishing work.

And have the confidence to do well.

"Your suture level is no worse than mine, I leave it to you."

Deputy Director Lu has seen Zhou Can's suture technique before, and his level is high enough to beat all the attending physicians.

"thank you for your trust!"

Zhou Can gleefully began to suture the patient.

Deputy Director Lu was also happy to relax, and gave a few words of guidance from time to time.

After several hours, this level four operation finally came to an end.

It started at 27 o'clock in the morning, and now it is [-]:[-] in the afternoon.

During this period, everyone did not eat or drink water.

They have always remained on the job.

Whether it is a doctor or a nurse, it is a very hard job.

"Okay, everyone go to eat first and rest for a while. After about half an hour, we will come back for the next operation."

Director Xue had two major surgeries today.

Whether it is this cancer patient or another patient who underwent tracheal fistula closure, it cannot be delayed.

Surgery must be performed as soon as possible.

No matter how hard and tired she is, she has to grit her teeth and persevere.

Therefore, it is very important to train several successors.

With a capable assistant, the chief surgeon can be much easier.Everyone cooperates with each other to maintain energy and physical strength well.

The operation just now was basically performed by Director Xue, and she should be the hardest of all.

It may be that he wants to accumulate more surgical experience while he is young, so as to prepare for promotion to the second-level director and first-level director in the future.

It must be explained here that the third-level, second-level, and first-level directors belong to a post level set by a top-level hospital like Tuya, not a professional title.There are only four professional titles for physicians: resident physician, attending physician, deputy chief physician, and chief physician.

On the contrary, the directors valued post level more.

Because it is judged internally, theoretically speaking, the gold content should be higher.

Why is the status of the attending physician far inferior to that of the deputy chief physician?
It's not that their levels are different, but because as long as the attendings pass the exam and have enough working years, they will be automatically promoted.

The evaluation of deputy senior titles is much more difficult.

As for the evaluation of the higher-level senior professional title, it is many times more difficult than the deputy senior professional title.And the current trend seems to be getting harder and harder.

There are reasons for the serious involution, and there are also reasons for the rapid development of China's medical technology.

Huaxia has already caught up with international developed countries in many fields, and even surpassed them. It is estimated that it will become more and more difficult to evaluate high professional titles in the future.

Director Xue is so young and highly rated, and his own efforts are also inseparable.

The operation just now is enough to fully demonstrate her surgical ability.

Everyone changed their clothes and walked out of the operating room one after another.

A few doctors walked towards them, the leader was calm and steady, with an extremely strong aura.

It is none other than Director Hu Kan.

Followed by Director Le and others.

"Director Hu, Director Le, are you guys going to have that extremely difficult surgery?" Xueyan seemed to know what surgery they were going to do.

"That's right! This is a rare learning opportunity. You just finished your operation, why don't you come with us?"

Director Le rushed to answer because he knew that Director Hu was not very talkative.

"I can't help it, I still have a major operation today, and it will probably be night when I finish my work."

Director Xue was very helpless.

The workload of each chief physician is very heavy, two major surgeries are scheduled a day, and they are basically too busy to have time for meals.

Generally speaking, at her level, there will be teaching and scientific research tasks.

That's even more busy.

"It seems that you are very busy today. It's okay. I will make a teaching video at that time. I will put Director Hu's operation explanation in it. If you take the time to watch the teaching video, you can also have a certain learning effect."

Director Le comforted her.

Female doctors, especially those who are beautiful and temperamental, are still very popular in the department even in their 40s.

Director Le obviously had the intention of being courteous and courteous to her.

This kind of show of favor is a kind of instinct of a man, and it doesn't have to be an extramarital affair.

"Thanks! Goodbye!"

She smiled and waved.

"This Dr. Zhou in your group is very unusual!" Director Le did not intend to end the conversation immediately.

"What's wrong with him? Is he young and reckless, and his words offended you or other doctors?"

Director Xue is quite protective of his doctors.

Even though Zhou Can has just worked in her group for a few days, she still has a strong desire to protect him.

"No, no. He reminded me in the morning that the 54-bed heart bypass surgery patient may have taken painkillers with anticoagulant effect. Later, after I asked the patient to find out before the operation, the patient really took it five days ago Aspirin. Although coagulation screening was done before surgery, no obvious abnormalities were found."

Director Le obviously wanted to praise Zhou Can in front of Director Hu and Director Xue.

For Zhou Can's kind reminder, there is a sense of gratitude in it.

Otherwise, I would not choose to talk about it on this occasion.

"If it wasn't for his carefulness, neither I, the bed doctor, or the receiving doctor would have discovered this matter. It can be regarded as a safety hazard. You also know that we do some minor operations and invasive examinations, as long as the patient's medical history does not prompt If there is obvious coagulation disorder, we will not do coagulation function test. Because screening coagulation function before minor surgery will do more harm than good."

The blood coagulation function mainly checks platelet count and prothrombinase.

"With Dr. Zhou's reminder, and asking the patient to confirm that he had taken aspirin, and the interval was very short, there was a potential risk of massive bleeding during surgery. So I made preparations to prevent massive bleeding, including fresh platelets that are rarely prepared, in case."

Director Le had a trace of joy on his face when he said this.

"During the operation, the patient's bleeding volume was significantly higher than normal. The prepared fresh platelets and anticoagulant drugs came in handy, which ensured the smooth completion of the operation. Dr. Zhou is really good."

At this point, Director Le smiled gratefully at Zhou Can.

Surgery is like fighting a war. Being prepared and not being prepared are completely different concepts.The ending could have been very different too.

When Director Xue heard that Zhou Can had done a good deed, she couldn't help showing a relieved smile.

"Is the 54-bed patient under Zhou Can's care?"

Director Hu Kan, who has been silent all this time, asked.

"It's not under his control. It's a patient in our group. He can find the problem, and he mustered up the courage to tell me specifically that he is very good at being careful, responsible, and character."

Director Le knew what Director Hu Kan meant by asking this question.

"Well, it is indeed very well done! Such an excellent young man deserves to be vigorously cultivated. I can take him along with me when I do some important operations in the future." Director Hu Kan regarded it as a great compliment.

Being able to perform surgery with Director Hu Kan is definitely the dream of many doctors.

There will be more things to learn.

Especially some advanced surgical techniques and methods.

"Thank you Director Hu! Director Le!"

Zhou Can was secretly delighted that he had more and more opportunities in cardiothoracic surgery.

The learning experience of these major operations will have unimaginable benefits for him to operate alone in the future.

The rapid growth of surgical ability requires not only talent and hard work, but also opportunities.

Watching top experts perform surgery every day is definitely different from watching ordinary directors and attending doctors perform surgery.

(End of this chapter)