My medical skills add experience

Chapter 197 For the sake of the living, high risks and rich rewards coexist
"Director Mu, let's do it! You watch and study first, anyway, there will be opportunities in the future."

Director Jia gave Yisuke the opportunity to open his laparotomy.

This person is also the only deputy chief physician under Director Jia.Maybe there are others who have already graduated from the teacher. With the ability to independently preside over the third and fourth level surgeries, they no longer need to learn from Director Jia.

Deputy Director Mu successfully snatched the opportunity to exercise for laparotomy, and he seemed very happy.

The corner of Zhou Can's mouth raised slightly, thinking how powerful this deputy chief physician is.He was so happy to get a chance to have a laparotomy, no matter how strong the surgical ability is, there is a limit.

Just imagine, if a multi-millionaire picked up ten yuan on the street, would he laugh with joy?
In the same way, if Deputy Director Mu's surgical ability was really strong, he wouldn't take an opportunity to open his abdomen as a treasure at all.

At least with Zhou Can's current strength, he doesn't think much of the opportunity to open his stomach.

After Deputy Director Mu stood on the main knife position, everything was ready, and he couldn't wait to pick up the knife and cut.

Director Jia seemed very relieved of him.

Standing by and watching with a relaxed face.

He didn't look at Zhou Can's frightened look when he opened his stomach at all.

Deputy Director Mu cut open the cortex and subcutaneous tissue of the abdomen layer by layer, that is, the fascia layer, muscle layer, and parietal peritoneum that are often referred to in medicine.

The muscular layer involves muscles and tendons.

When cutting, there will be a certain degree of attention.

Theoretically speaking, the more skilled the doctor is, the less bleeding will be during the process of opening the abdominal cavity.The chance of injuring important blood vessels and nerves is almost zero.

It's hard to say for a novice.

Under normal circumstances, the muscle layer can be cut open with one knife.When a novice is nervous, he may only succeed by drawing two or three knives.

This can cause jagged cuts.

Very detrimental to wound healing.

Deputy Director Mu's incision technique is not bad, it should be at the excellent level of the attending physician.

However, whether it is the smoothness of the wound or the time to open the abdominal cavity, it is worse than Zhou Can.

Especially the operation time, Zhou Can opened the abdominal cavity in less than 5 minutes.This is also because a blood vessel was ligated midway.

It took Deputy Director Mu nearly 7 minutes from cutting the knife to opening the abdominal cavity.

This speed was comparable to that of the doctors in the cardiothoracic surgery department.

It's worrying to watch.

In addition to the slow speed, other aspects are not bad.

The amount of blood loss during the operation was not large, and there was no excessive incision when four layers of abdominal tissue were cut.

Generally speaking, Deputy Director Mu's incision technique is above the standard.Opening the abdominal cavity is completely enough.

No wonder Director Jia was particularly reassured about him.

After the abdominal cavity was opened, the next part of the colon was resected, which was still performed by Director Jia himself.

Both the resection and separation of the intestine have huge risks.

If the cut is not good, it will affect the intestinal anastomosis.

It's even worse if you cut too much.This is already a minor accident, but because the professional knowledge involved in the operation is extremely strong, and the doctor has great power during the operation, so no one can strictly supervise the doctor's treatment behavior.

Sometimes, let alone cutting a little more intestines, even if one of the patient's kidneys is accidentally removed, it is possible to hide the matter.

As long as the patient does not find out, no one will ever be held accountable.

Of course, this kind of behavior is already a serious violation of surgical regulations and medical practice guidelines.As long as it is discovered, the doctor involved will definitely be severely punished.

It is possible to revoke the medical license.

So under normal circumstances, no doctor dares to mess around.

Occasionally, there are novices who make trouble, and the hospital can hide the matter in order to suppress the matter.

As for the surgical records and the doctor's signature, this is too maneuverable.

Not much to explain.

"Remember, once a malignant tumor is found in the intestinal tract, it is basically difficult to cut it clean as long as it reaches the middle stage. The possibility of metastasis is very high. Theoretically, the early stage is the best. Among them, I once encountered advanced rectal cancer, and after resection, the patient's postoperative survival time exceeded ten years."

There should be thousands of surgeries performed by Director Jia.

Very experienced.

"When receiving a doctor or formulating a surgical plan, if a patient is found to have a malignant tumor, even if it is in the middle or late stage, as long as no obvious metastasis is found, you can still try it. The risk and the possible benefits of surgery , explain it clearly to the patients, and let them make their own decisions. In the process of practicing medicine, I usually have a principle, to save the young, not the old."

"Anyone under the age of 40 can be defined as a young patient. As long as there is a slight chance, we should try our best to persuade the patient to actively treat. If the patient is over 60 years old and his family situation is not very good, then don't persuade him. We are doctors. , in addition to thinking about the patient, you should also think about the patient's family. Age itself belongs to the elderly. Knowing that the chance of cure is slim, they persuade others to use up their wealth for treatment. In the end, people and money are empty. What should the living people do? ?”

Director Jia's soul torture made every doctor fall into silence.

For the sake of the living, this is the first time Zhou Can has received this kind of ideological education.

Unethical, but very close to reality.

Behind the ruthlessness lies true compassion.

"Do you think my views are difficult for you to accept? It doesn't matter. If you think my three views are not correct, you don't have to accept them. It's just sharing my personal views."

After Director Jia finished speaking, he continued the operation.

Tell everyone how to determine the tumor site and the extent of resection.

This kind of practical teaching is of great help to Zhou Can.

He listened carefully, studied hard, and even brazenly asked Director Jia to come closer to him and observe carefully, and pressed the tumor with his hands.

"We have now confirmed that the tumor is in this section. During the resection, some normal intestinal sections were properly cut off to ensure that the tumor was cut clean."

After the cancerous colon was removed, Director Jia's mission was complete.

"Who will anastomose the stumps of the intestine? This anastomosis is much more difficult than the previous operation."

"I come!"

Director Jia's voice hadn't finished yet, and Zhou Can immediately grabbed the opportunity.

"The hungry wolf has started again."

The other doctors looked depressed.

They were still hesitating whether to make a move, but Zhou Can did it directly.

This is competition.

In fact, Director Jia was not willing to give this opportunity to Zhou Can.

However, the doctors under his command were too late, so he could only give Zhou Can the opportunity to exercise.

"Zhou Can! How do you plan to match?" Director Jia deliberately made things difficult for him.

If Zhou Can answered incorrectly, Zhou Can's training qualification could be disqualified logically.The main reason is that a longer section of the colon was cut off.The matching was too difficult, and he was afraid that Zhou Can would screw it up.

"I'm going to perform a side-to-side anastomosis, do you think it's okay?"

After Zhou Can checked, he asked the other party in turn.

"can!"

Just as Director Jia said yes, Zhou Can immediately answered, "This is the first time I have used this method to match, please give me some pointers!"

After finishing speaking, he had already stood on the main knife position, and started to do it immediately.

Fortunately, he learned side-to-side anastomosis when he crammed into the basics of medicine.This is an advanced anastomosis method in intestinal anastomosis.

The two sections of intestines at present are very suitable for this anastomosis method.

I saw that Zhou Can first performed purse-string sutures to close the two broken ends of the intestines.

The specific operation method is to perform a purse-string suture along the circumference of the intestine, tighten the suture and close the stump, and then do a purse-string suture to embed the stump inward.

This kind of suturing is not difficult to say, but it mainly requires high-level suturing and ligation medical skills to support it.

Zhou Can was a little uncertain about the next operation, and looked at Director Jia.

The anastomosis has already been done halfway, and it is expected that Director Jia will be too embarrassed to kick him out of the stage.

"Your suturing and ligation are good, and the anastomosis is also on the line. Do it well! Next, after closing the two ends of the intestinal resection, the two ends are close to each other and weigh about 10cm, and clamped with intestinal forceps."

As he spoke, Director Jia patiently instructed him on what to do and what precautions to take.

Zhou Can's savvy and hands-on ability are very strong, and he successfully put the two pieces of intestines together, and the length of the joint was just about ten centimeters.

“在抗肠系膜面距纵轴中线约0.8～1.cm处以3-0不吸收线连续缝合两肠襻的浆肌层约4～5cm。也可用间断缝合法，不过我更推荐连续缝合法。”

The most feared thing about intestinal anastomosis is leakage.

The so-called leakage is actually leakage of feces.

The consequences are very serious.

Every year, patients die from peritonitis and various infections caused by feces entering the abdominal cavity.

I believe every surgeon knows that if the wound is contaminated with fecal water, it will be very difficult to heal.

In ancient times, there were even concubines of Gongdou who deliberately poured "golden water" on the wounds of their opponents.

The purpose is to let the opponent die.

In fact, in ancient times when the medical level was relatively backward, the concubine was already covered in scars after being whipped, and then she was splashed with feces.Basically tantamount to a death sentence, soon to die from infection.

Following Director Jia's instructions, Zhou Can sewed up the seromuscular layer of the intestines.

"Incision along the midline of the central axis and the full-thickness of the two sections of intestinal wall directly to the intestinal lumen. Be careful when cutting, and do not try to be brave if you are not sure. The selection of the incision point, length, and attention are all paid attention to. The distance between the incision and the closed suture The stump is about 2cm to prevent circulatory disturbance and affect the healing of the anastomosis. If the stump is too much, it is easy to cause symptoms caused by the retention of intestinal content.”

Director Jia was unwilling to entrust this anastomosis to Zhou Can, mainly because he was worried that there would be problems when cutting the intestines.

He must have known that Zhou Can needed to use this side-to-side anastomosis.

Zhou Can picked up the scalpel, carefully followed Director Jia's instructions, and cut open two sections of intestinal wall.

Cutting through the gut wall feels completely different than cutting through the cortex of the abdomen.

When cutting, it feels light and light, and there is no effort, but the toughness is very strong.

This is actually very difficult to control.

It is easy to make very large cuts.

Fortunately, Zhou Can finally didn't have a frame, and the incision was just right.

[Cutting experience value +1, +1.]

[Congratulations on successfully cutting the intestinal wall for the first time, building a docking window, cutting experience +100, matching experience +100.]

It's not that the system is generous, but that the broken-end construction window of this intestine is very difficult to operate.

The difficulty and risk are even higher than the next suture.

Fortunately, Zhou Can successfully completed this high-risk and difficult operation.

In fact, all actual operations on patients have great risks.Especially with knives.

With a knife in the intestines, the risk is even higher.

"Well, the young man's comprehension and skill are good, and he cuts well."

Director Jia's hanging heart fell to the ground a little bit.

If Zhou Can messes up in this link, the patient may need to lose 20cm of intestines.The total length of the large intestine is only about 1.5 meters. It is hard to imagine that a part of the ascending colon and transverse colon has been cut off, and then shortened by 20cm.

Even if this operation is finally successful, it will have a lifelong impact on the patient.

For example, the stool is not formed, the actual function of the colon is lost, and so on.

"Slightly trim the incisional intestinal mucosal border and ligate the active bleeding point to stop bleeding. Continuously suture two sections with absorbable sutures to incise the full thickness of the intestinal wall."

Zhou Can trimmed the incision on the intestinal wall, which is equivalent to debridement!

[Debridement experience +1, +1.]

[Congratulations on completing the trimming of the intestinal mucosa for the first time, reward debridement experience +100.]

Today, the anastomosis of the colon part can be regarded as profitable.

However, the operation of each step is really difficult.

Risk and reward go hand in hand.

The more difficult the operation, the greater the reward.

The key is not to make major mistakes, otherwise he will have to watch other people's operations for his next digestive surgery training.

"After the posterior wall is sutured, the full-thickness anterior wall can be sutured. Then, the seromuscular layer is sutured intermittently with nonabsorbable sutures."

Director Jia was next to him, guiding Zhou Can's operation almost hand in hand.

Why can't I learn many surgical steps after watching the teaching video?Because all the key parts need to be taught by the teacher.This way of teaching by precept and example is the easiest way for people to learn.

Nearly an hour later, Zhou Can completed all the operations.

I sweated profusely and broke out several times, and the harvest was also very great.

In particular, anastomosis, incision, and debridement have all improved by leaps and bounds.

It's like a soldier going to the battlefield, killing the enemy and not killing the enemy are completely two concepts.Killing one general of the enemy army is a different concept than killing two soldiers of the enemy army.

Zhou Can used to anastomose most blood vessels with a few nerves and tendons.

The successful anastomosis of the colon this time has achieved multiple firsts, which is equivalent to successfully slaughtering a general on the battlefield, which is of great significance.

"That's right! It's the first time you've performed an intestinal side-to-side anastomosis. It's very good. Your comprehension and surgical skills are the only ones I've ever seen in my life."

After Director Jia praised him, he pointed out many things that were not done well, and Zhou Can remembered them all in his heart.

After boasting, he immediately pointed out the shortcomings, probably because he was afraid of Zhou Can's pride.

It can also be seen from this point that Director Jia has already developed a strong love for Zhou Can and wants to train him well.

It was really not easy to win Director Jia's approval through two surgeries.

"Otherwise, it's up to you to close the cavity!"

Director Jia's cultivation of him has obviously increased a lot.

"The anastomosis just now was really too difficult. My physical strength is seriously exhausted. I'm afraid of messing up. It's better for other senior brothers to close the mouth!"

Zhou Can cleverly found an excuse and gave up the opportunity to close his mouth.

This ingenious way of showing weakness made other doctors feel good about him.

The look in his eyes softened a lot.

"I'm going to shut up!"

Qiu Hong saw that Zhou Can could complete such a difficult side-to-side anastomosis at the regular Peisheng stage. She was greatly stimulated and directly took over the task.

No one wants to be left behind.

She also has to work hard to improve her surgical skills and become a veritable attending physician.

Strive to prepare for the impact of the deputy senior title in the future.

……

By the time the operation was finished, it was already past ten o'clock in the evening.

This is still a smooth operation, otherwise it will be done later.

Now I hope that this young female patient can recover soon, and it is best not to have tumor recurrence or metastasis.

Six months after surgery is a high-risk period for recurrence.

A tumor is like a monster. If you don't move it, it may just develop insignificantly.Once you cut it, it bounces back with terrifying speed.If it spreads, it will grow wildly in many important organs of the body like weeds.

At this point, it is impossible for a miracle doctor to save him.

This is why after the patient undergoes surgical resection, as long as the patient's physical condition permits, the doctor will advise the patient to take chemotherapy in an effort to completely kill all potential cancer cells.

According to statistics, cancer in my country presents a high incidence and younger trend.

In recent years, the number of new cases of cancer has reached a staggering 380 million people per year, which is equivalent to more than 1 people suffering from cancer every day.And that number is growing at an alarming rate.

This year it has reached a frightening 400 million people/year.

In one year, new cases surged by 20.

You know, behind this is a family!In any case, it would be an unprecedented disaster for any family.

Due to the continuous deterioration of the environment, the aggravation of air and drinking water pollution, and excessive pesticide residues, all kinds of unscrupulous and unscrupulous traders use various chemicals in food, and wax the fresh-keeping and anti-corrosion of the picked fruits. If these problems cannot be effective Solved, the number of new cancer patients will continue to grow rapidly.

Taking the country's 14 billion population as an example, even if an increase of 400 million cancer patients is added every year, it is an extremely terrifying figure.

Zhou Can feels the heavy burden on his shoulders, and he will redouble his efforts to improve his medical skills and strive to cure more patients one day.

Through today's operation, he also realized the usefulness of early diagnosis.

In the future, he will work hard on diagnosis and find ways to improve his diagnosis ability.

Detecting a case of cancer early can potentially save a life and save a family.

After the operation was over, he returned to the apartment after get off work. He resisted his exhaustion and wrote the summary of today's operation.

Then take a bath and turn on the lamp to read at night.

There are only a dozen days until the first exam of medical comprehensive examination, and his time is very tight.

Almost every second counts.

This feeling of being submerged in the sea of ​​questions and books made him relive the tension that only happened in the college entrance examination.

(End of this chapter)