My medical skills add experience

Chapter 223 Unavoidable postoperative syndrome, the tumor is an organ of the body

Waiting until Zhou Can finished the operation on the patient and sent the patient out of the operating room, Elder Liu said seriously, "Just now the inpatient department called me, saying that the patient who underwent lipoma surgery yesterday had a variety of abnormal symptoms! "

Hearing this, Zhou Can's heart skipped a beat.

The one who should come can't escape.

When I operated on that patient yesterday, I felt an indescribable sense of crisis.

At that time, Zhou Can was so scared that he was trembling during the whole operation.

Fortunately, the surgery went well.

After get off work yesterday, Zhou Can was still a little worried, so he went to the ward to see the patient.Except for a little pale complexion and a little lethargy, all the physical signs are normal.

Unexpectedly, there is still a problem today.

Zhou Can couldn't help thinking of Dr. Feng's reminder before he left, telling him to be careful of postoperative complications in patients.

Surgeons are actually quite afraid of the term postoperative complications. They take various measures during the operation and practice surgical skills hard to reduce the occurrence of postoperative complications.

"It's already the noon break time, I'll go check on that patient first." Zhou Can said to Liu Lao.

"Let's go together! The patient is likely to have postoperative complications, and it will be very difficult to deal with."

Mr. Liu has rich experience in diagnosis and treatment.

I know the horror of postoperative complications.

"I'm going to buy food for the two teachers!"

Wu Ziyu now regards Zhou Can as a teacher.

In the past two days, Zhou Can and Liu Lao have been performing operations in the operating room, and Zhou Can has guided her a lot.It also deserves the title of teacher.

Doctors are sometimes busy and it is very easy to miss meals.

If you can't order a meal, you can only eat instant noodles.

"Okay! I'll thank you then. Mr. Liu doesn't like spicy food."

Zhou Can's words moved Mr. Liu very much.

There was a look of relief and joy on his face, but he didn't speak.Instead, I went into the changing room of the operating room to change clothes.

Under normal circumstances, doctors need to wear white coats to work outside the operating room.

Except for disposable surgical gowns that can be worn out of the operating room, normal surgical gowns are not allowed to be worn out.

Otherwise, the sterile environment in the operating room cannot be effectively guaranteed.

Zhou Can changed into a white coat and rushed to the inpatient ward with Liu Lao.

I saw that the patient who underwent lipoma resection was still pale, and his spirit improved slightly.

Dr. Bu Shiren, who was in charge of the bed, and an intern stood by the bed, looking even more nervous than the patient's family members.

This patient is a postoperative patient who Zhou Can specially ordered to be under intensive care. If something goes wrong, Dr. Bu can't handle it.

"What's up with him?"

Zhou Can asked Bu Shiren.

"From about eight o'clock in the morning, the patient experienced abdominal distension, nausea, oily, and even vomiting. After the end, the patient had diarrhea not long ago. The basic signs of body temperature, heart rate, and breathing were relatively normal. "

Bu Shiren took the initiative to show Zhou Can the physical records of the ward to check.

"In addition to the above symptoms, is it also accompanied by general fatigue?"

"Yes! The patient has been weak since the operation."

Bu Shiren's work is fairly meticulous.

The answer is also very fast.

After Zhou Can learned about the patient's situation, he first made a series of exclusions.

Have you injured important nerves or blood vessels?
At that time, the operation was performed very carefully, and Mr. Liu was on the sidelines to check. If an important blood vessel or nerve was injured, he would definitely be reminded in time.

Facts have proved that Zhou Can did not make any mistakes during the operation.

That facial subcutaneous fat aneurysm excision was done pretty well.

Zhou Can decided to start with the symptoms of the patient's vomiting, oily, and nausea.There are many reasons that can cause these symptoms.However, he only cut one facial lipoma, and even if there is an accidental injury during the operation, he can roughly focus on a small area for investigation.

All important nerves and blood vessels were removed, and he couldn't help but think to himself, did he hurt the patient's throat?
The tumor was indeed quite large, but the surgery did not directly affect the throat area.

The possibility of direct injury to the throat is very small.

There was only one last possibility, hematoma occurred in the wound, and the throat was compressed.Lead to obvious nausea, oily, and vomiting reactions in patients during eating.

Doctors usually use a tongue depressor to press the base of the tongue, which is a relatively common way to induce vomiting.

In fact, you can also directly press the base of the patient's tongue with your fingers.

However, there is a risk of being bitten.

When the patient finds it unbearable, he tends to close his mouth reflexively.In this case, it is very easy to bite the doctor's hand.So doctors dare not take this risk with their own fingers.

The tongue depressor also came in handy.

If yesterday's operation caused a certain degree of hematoma in the mouth and irritated the throat, it may really cause the patient to feel nauseous all the time.

At this moment, Mr. Liu was also frowning and carefully checking the monitoring records of the patient's postoperative signs.

Want to empirically find out the specific etiology of the patient.

Many postoperative complications are caused by improper operation by doctors, postoperative infection, thrombosis, ischemic necrosis and other reasons.

Can only be comprehensively diagnosed based on clues and pathological mechanisms.

"Come on, open your mouth and let me see!"

Zhou Can said to the patient.

The patient opened his mouth cooperatively, Zhou Can put on a mask, took out a small flashlight from his pocket as if by magic, and irradiated the inside of the patient's mouth.

There is a slight blood phenomenon.

However, this degree of hematoma is not enough to compress the patient's throat and base of the tongue.

Nausea and vomiting caused by hematoma can basically be ruled out.

The patient's larynx appeared normal without any pathological changes.Only the side oppressed by the lipoma lost a lot of teeth.

The color of the tongue coating is whitish with a hint of dull yellow.

"That's it!"

Zhou Can signaled the patient to shut up.

No answer was found in the mouth.He carefully removed the gauze from the wound on the patient's face.The wound was sutured by the seamless suture method he personally implemented, and a certain degree of skin flap repair was also done.

It doesn't look abnormal.

There is no redness and swelling of the wound caused by infection, and the patient's body temperature has not risen, which is enough to show that the possibility of wound infection is very small.

"It's really strange. There is no problem with the wound, and there is no problem found in the mouth. What could be the problem?"

Reminiscent of the patient's symptoms of abdominal distension, diarrhea, and malaise, Zhou Can began to jump out of the local area of ​​the wound and make a comprehensive diagnosis based on all the symptoms.

There are many causes that can cause all of the above symptoms.

For example, the most common colds and food poisoning may cause vomiting, nausea, diarrhea, and general fatigue.

The human body is like a precision machine, and any link failure may cause serious adverse reactions to the human body.

"What he developed should be the syndrome after lipoma resection! The incidence rate of this kind is as high as 30%. It will cause patients to have indigestion symptoms such as intractable diarrhea, abdominal distension, nausea, vomiting, and oilyness, as well as general fatigue, pale complexion, and facial expression." Symptoms of malnutrition such as burnout. There is currently no effective treatment for this syndrome.”

After pondering for a long time, Mr. Liu made a diagnosis.

"What caused it?"

This was the first time Zhou Can encountered such a situation.

It is not the first time that superficial lipoma has been removed, and there has been no postoperative syndrome.

However, what was removed this time was a huge lipoma, which also occurred on the head and face, so the situation was far more complicated than the previous minor surgery.

"The pathological mechanism is not yet clear, and it may be related to tumor cells. Surgical resection of giant lipomas, or lipomas in the brain, thoracic cavity, important organs, or nearby, is very prone to many adverse symptoms. His syndrome , can not be avoided, only some corrective treatment can be carried out."

Mr. Liu issued some medical orders on the spot.

And ask the nurse to draw blood and send it for examination, and do a routine blood test to avoid misdiagnosis.

After coming out of the ward, Zhou Can and Mr. Liu went to eat together.

It's getting closer now.

Doctors work very hard, and meals are often not on time.Especially the doctors in the operating room and emergency room, including anesthesiologists.

Sometimes in order to continuously rescue patients, it is common to work continuously for more than ten hours.

This is also a lot of doctors, who obviously studied medicine themselves, and finally diagnosed cancer at a young age, in their 40s.

Sometimes, these diseases are really caused by abuse.

If you do not eat in time after the meal time, the stomach and intestines will not be able to bear it, and stomach problems and ulcers will easily occur.Staying up late at night to work, not having a good rest, and irregular work and rest will do more harm to the body.

Therefore, being a doctor is a very hard and risky job.

"Old Liu, is the condition of the lipoma patient unavoidable during the operation?"

Zhou Can asked a little unwillingly.

After carefully recalling it many times, there are some areas that can be improved in the operation, but no major mistakes occurred.

How did the patient develop the syndrome?

Finding the reason and avoiding it in the future is what Zhou Can wants to do most.

"According to my surgical experience, as well as domestic and international case reports, this postoperative syndrome cannot be avoided. It has nothing to do with the doctor's technique, but the symptoms caused by the tumor itself."

Liu Lao explained to him in a calm tone.

"Hasn't the tumor been completely removed? Can it still cause trouble?"

Zhou Can was even more puzzled.

His medical knowledge is still shallow, and his experience in diagnosis and treatment is not so rich.At least compared with those old doctors with 50 to [-] years of experience in diagnosis and treatment, it is far behind.

"Have you ever heard of it? Isn't there a classic game of dominoes? If one of the dominoes is removed, there will be a chain reaction that will eventually cause all the dominoes to collapse."

Mr. Liu gave an example to explain why some postoperative syndromes cannot be avoided.

"The lipoma has grown for many years, and it may even be born with the patient. It has formed a delicate balance with the patient's body, and removing it is tantamount to breaking this balance. So the patient's body will A series of adverse reactions occurred. You have to remember that when performing any operation, do not regard the lesion as a redundant body part."

"Like that lipoma, you should think of it as an organ of the body. It can grow so big that it even belongs to an important body organ of the patient's body."

Mr. Liu's explanation to Zhou Can made him feel refreshed.

This kind of knowledge can only be comprehended by experienced experts in practice.You can't learn it from books at all.

It is impossible for any medical classics or searches to record this theoretical knowledge.

Because it does not conform to the formal content of medicine.

Just like official history and unofficial history, there must be a difference.

Unofficial history allows readers to learn some interesting content that cannot be recorded in official history.

Aged medical experts are a living unofficial history of medicine.

Many of their theories are not found in medical books, but they have some truth.

And it's real in practice.

"According to what you said, a mole, a tumor, or an extra finger all belong to an organ of the body. It's just that this organ is a unique organ that ordinary people don't have. Is that what you mean? ?”

Zhou Can had a glimmer of understanding.

Listening to your words is better than reading ten years of books.

The unique theory that Mr. Liu said gave him a sudden enlightenment, and he had a new understanding of the disease.

It's like opening a new window.

"You have a very strong comprehension, that's what it means. Extra fingers, even the third hand, or the third leg, are easily recognized by the doctor as an organ on the patient's body. But a tumor, or an intradermal nevus , but it is often easily regarded by doctors as just a lesion. This is a misunderstanding in diagnosis and treatment."

Old Liu smiled and nodded slightly.

"When you practice medicine independently in the future, you must take this factor into consideration. Before cutting a tumor, you can consider its relationship with the surrounding organs of the body and its effect on the body. This is more important for the correct treatment of the patient's disease. Helpful. The patient with lipoma just now, it would be better to transfer him to the internal medicine department for treatment in two days.”

Internal medicine and surgery are two completely different medical departments.

Internal medicine is far superior to surgery in terms of pathology and pharmacology.For the patient with postoperative syndrome, it would be more favorable for his condition to be transferred to internal medicine.

It is so novel to treat a tumor as an organ.

Zhou Can was quietly thinking about the new theory he had learned.

After eating, the two of them took a short rest and walked into the operating room again.

keep fighting.

It is necessary to get rid of all the surgical patients accumulated in general surgery as soon as possible.

The crazy operation started again.

This is a male patient in his 30s. There was pus in the ear, and there was a mass behind the mandibular angle. The secretion in the ear increased due to pressure, and symptoms such as pain and fever appeared after secondary infection.

Zhou Can is still the first to come into contact with this case.

General surgery is the most complicated department, and it is possible to receive any kind of patients.

"His disease is called parotid fistula, and surgery is needed to clean up the fistula before it can be cured."

Mr. Liu explained to Zhou Can, Wu Ziyu and others.

"When diagnosing this disease, in addition to the symptoms of pus in the ear and a mass in the lower part of the mandibular angle, the patient often feels a rancid smell in the mouth. During the operation, fistulas of the second, third and fourth gill clefts will be found There is a fistula at the anterior border of the sternocleidomastoid."

This disease is relatively rare.

Zhou Can carefully observed the patient to understand the patient's condition and symptoms.

Accumulate experience for future independent consultations.

In fact, he has read the examination data of all the patients before the operation, and learned about their conditions and causes.

For this parotid fistula patient, he also checked a lot of information and studied it.

"Sometimes, the fistula on the patient's body is very thin, as thin as a needle tip or a small depression, which is easily overlooked. Even if it is not squeezed, there will often be a little secretion. This is also the reason why the patient feels that there is a bad smell in the mouth. "

Elder Liu continued to explain to them.

Zhou Can was still the chief surgeon, with Mr. Liu guiding beside him.

"When performing parotid fistula surgery, in addition to being extra careful during the operation, you must also be careful of dyspnea caused by lateral pharyngeal wall edema and parapharyngeal hematoma after surgery. You should be closely observed, and do a good job of postoperative monitoring and hospital management. If you find a problem, you must Handle it in time, otherwise it will easily cause irreparable and serious consequences.”

This irreversible serious consequence is actually death.

It's just that in front of patients, doctors often speak in a subtle way.

It's pretty much the same in any industry.

It’s like asking a lawyer to help you fight a lawsuit. If the lawyer listens to the case and says that you can try to fight the case, the chances of winning are quite high.That's basically winning.

Watch out for lawyers who say the case will be litigated for a long time.

Maybe it's a veiled reminder that this case doesn't have a high chance of winning.If you really want to fight, you will probably lose.

Doctors are more subtle than lawyers when speaking to patients.

For example, after the physical examination, the brows are frowned tightly, "Be careful in this situation, the situation is not good, very bad." Most of them are malignant tumors or other incurable diseases.

At this time, as long as there is still an opportunity for surgery, or if the opportunity for treatment has not been missed, then treat it as soon as possible.

If you drag it on, it will probably be cool.

Zhou Can is already helping anesthesiologists to perform anesthesia operations on patients.

Soon, anesthesia was successfully implemented.

Zhou Can earned another 1 point of experience in anesthesia.

Compared with the reward of 100 experience points, Zhou Can was somewhat dissatisfied with earning only 1 point at a time.However, he also understands that there are not many opportunities to reward 100 experience points.

One or two times a day is considered pretty good.

There are very few opportunities for anesthesiologists to obtain such rewards.

Maybe after one or two months of regular training in the anesthesiology department, if you hang out with Dr. Feng, you will have more opportunities to earn this 100-point anesthesia experience reward.

Surgeons need to go to the anesthesiology department for at least one month of training. This is to allow doctors to learn anesthesia knowledge deeply, understand the whole process of anesthesia surgery and the precautions.

In particular, the set of practical experience of anesthesiologists in supporting and guaranteeing patients' vital signs is very worth learning.

In terms of life support, if the Department of Critical Care Medicine really wants to trace its roots, the Department of Anesthesiology is its master.

(End of this chapter)