My medical skills add experience

Chapter 253 Gastric cancer resection, the hero behind the scenes

"You're quite confident! Let me test you, where should I choose the incision for this endoscopic surgery?"

When Director Shang asked this question, he looked at the patient's abdomen naturally.

"If you are doing laparoscopic surgery, you must poke two holes in from the part you are looking at. This operation is only considered for patients with mid-stage gastric cancer. This patient is still in the early stage of gastric cancer. I think the endoscope should be inserted from the nose. Enter to complete the operation."

Zhou Can has done so many endoscopic surgeries, not for nothing.

For such a small question, Director Shang still wants to test him.

It's just to give him points!
"Okay, it seems that you have indeed mastered the operation method, and this operation is entrusted to you."

Director Shang just tested him symbolically, and then agreed to entrust him with the operation.

It feels more like deliberately releasing water.

In order to have an explanation in front of other doctors.

There are many doctors under Director Shang, and he has always advocated the principle of fair competition and the principle of letting whoever is excellent.

Zhou Can wants to preside over this endoscopic surgery alone, but his qualifications are actually not enough.

If Director Shang directly agrees, then the other doctors in the group want to fight for the chance of surgery next time, Director Shang can only nod in agreement.

Therefore, he deliberately set up a threshold in order to block other people's mouths.

After Zhou Can got Director Shang's consent, he was overjoyed, and the opportunity to gain experience points came.

This operation will definitely allow him to earn a lot of operation experience points.

The endoscope is inserted through the patient's nasal cavity first, and then into the stomach through the esophagus.

[Insertion experience +1.]

It was not the first time for him to insert the endoscope from the nasal cavity to the stomach, so he only earned 1 insertion experience point.

The whole operation process is also very skillful.

Manipulating the endoscope all the way to the cancerous part of the stomach.

With almost no effort, the cancerous part was found easily.The seemingly simple operation is exactly 1 minute on stage and ten years off stage.

In addition to hard training in endoscopic techniques, he also needs to do enough homework before the operation.

As for the cancerous part, he has already deeply remembered it,

At this moment, the operation can go straight to Huang Ting, which is very smooth.

After the cancerous part is found, it is not cut off by direct manipulation of the endoscope.Endoscopic surgery for gastric cancer is not that simple.

Zhou Can first manipulated the endoscope to mark the resection area around the cancer.

It can be understood as drawing a circle before fighting.

In order not to accidentally injure other places after the fight is started.

After marking the resection range, inject physiological saline at the base of the cancer base.

What are you doing?

In order to float the part of the mucosa that needs to be excised.

These valuable surgical skills and experience are the surgical skills summed up by the foreign predecessors after the stomachs of countless patients were crippled.

The predecessors planted trees, and the descendants enjoy the cool.

Zhou Can learned these skills and used them all in actual operations.

Strive to minimize patient harm.

After the normal saline was almost injected and the gastric mucosa under the cancerous base fully floated up, Zhou Can proceeded to the third step.

Operate the endoscopic scalpel along the marked resection circle, and cut a complete circular tangent.

If the gastric cancer is not round, this resected circle can also be of other shapes.

It doesn't have to be circular.

In general, early gastric cancer, even in the middle and late stages, tends to grow in clusters.Mostly round.

Zhou Can marked a circle at the moment.

Circle the stomach cancer in it.

As soon as the scalpel was cut, blood burst out from the incision.Zhou Can stopped the bleeding of the patient in a calm manner.

Until the circular cut is completed along the marked tangent.

At this time, the entire gastric cancer was removed together with the cancer base.

It must be explained that the cancerous part after resection needs to be taken out.Taking it out of the nasal cavity will not work at all, because the nasal cavity is too small.

At this time, it is the best choice to remove the cancerous part from the patient's mouth.

During the operation, the patient is under general anesthesia.

Usually keep your mouth shut.

This requires prying the patient's mouth open with a crowbar.Also, care must be taken when removing the excised cancerous part.Do not suffocate the patient to death.

Zhou Can's operation is very proficient, and naturally there is no such thing as suffocating the patient.

The cancerous part is successfully removed, and then it needs to be sent for inspection after the operation.The nature of the tumor can be further clarified and whether the margins are clear.

During the removal of the cancerous area, some extra normal tissue is usually removed.

Even so, there is still a possibility that the cut will not be clean.

Cancer cells are sometimes very thieves. They will quietly infiltrate the surrounding organs or tissues, and easily spread to other areas along the lymph and blood vessels.

Postoperative pathological examination is very necessary.

After Zhou Can successfully removed the gastric cancer, he checked the patient's stomach again.A dissection was done.

The operation is here, and it is declared over.

If after a period of time, the examination finds that new tumors have grown in the excision site or other places, or cancerous changes have occurred, then a second operation or even a third operation is required.

Typically, in cases where multiple surgeries are required, treatment outcomes are often poor.

Because cancer tumors come back, it means the cancer cells have spread to other parts of the body.The frightening thing about cancer is that they are like weeds with extremely tenacious vitality.

The more they are removed, the faster the cancer cells grow.

Moreover, if one part is cut off, cancerous tumors will grow in many other parts at the same time.It's like opening the dreaded Pandora's Box.In the end, the more cuts were made, the more cancer cells spread, and the patient died sooner.

This is why the doctor regrets that after discovering that the cancer cells may spread, there is no way to perform another operation.

The only options are interventional therapy, or radiotherapy and chemotherapy.

Regardless of the type of treatment, drugs are used to kill or inhibit cancer cells.At this point, it can basically only prolong the life of the patient, and there is no way to cure it.

For stage II and even stage III gastric cancer, the five-year survival rate can basically reach about 60% as long as it is treated aggressively.

Many people don't understand why they still have to suffer a lot and spend a lot of money to receive treatment even though they know that the cancer cells have spread.Does this dying struggle make sense?
The answer is meaningful.

Not only can it provide doctors with more clinical trial data, it is more likely to wait until the advent of new drugs, and then completely cure cancer.

In this era of rapid technological development and a hundred flowers blooming, everything is possible.

Every year, a large number of new cancer treatment drugs come out, which specifically target a certain type of cancer.Some lucky cancer patients really succeeded in overcoming the disease and recovering after using new drugs.

After Zhou Can successfully removed gastric cancer for the patient, he earned 100 experience points for incision and 100 experience points for separation.

This made him very satisfied.

Endoscopic surgery has always been his favorite.

Because of endoscopic surgery, it is easier to obtain high experience rewards from the system.

Currently, his incision and separation techniques are moving towards the fifth level, and his anastomosis is far behind, and is only at the lower level of attending.

"Director Shang, do you think there is anything that needs to be improved? If not, I will remove the endoscope."

After Zhou Can completed the operation, he asked Director Shang for instructions.

"Well, the operation was done very well. Remove the endoscope and prepare to send the person to the recovery room to wake up! Can you complete the patient's postoperative doctor's order independently?"

Director Shang asked Zhou Can.

"I can try it, but I definitely need you to help me check it."

Zhou Can has never independently completed postoperative doctor's orders for gastric cancer patients.

Since Director Shang gave him this place to practice, he is not polite.Tried to give the patient a series of medical orders.

Director Shang watched over him and corrected some mistakes and omissions.

In the end, a complete and correct doctor's order was issued.

【Pharmacological syndrome differentiation experience value +1.】

[It is your first time to complete the doctor's order after gastric cancer surgery, and you will be rewarded with +100 experience points in pharmacological syndrome differentiation.]

I really didn't expect that after the operation was completed, I would earn an extra 100 experience points as a reward.

Moreover, it is very difficult to upgrade the experience value of pharmacological syndrome differentiation.

This made Zhou Can seem to see a broad avenue for rapid upgrading of pharmacological syndrome differentiation.

His pharmacological syndrome differentiation is currently at the middle level of the resident doctor, and the current experience value is 705/1000 at the third level. After adding this 101 experience points, he is directly promoted to the excellent level of the resident doctor.Two more generous rewards like this will immediately raise you to the Indication level.

"It's really cool to earn experience points in internal medicine."

Zhou Can smiled happily.

This operation is over, Director Shang still has two operations to do.

This time, a 42-year-old male patient with intestinal tumor was sent in.

Seeing Zhou Can's eyes was greedy again.

He has done very little intestinal endoscopic surgery, and this operation is a very good exercise opportunity.

However, he has always been cautious in doing things, and he is not in a hurry to win the opportunity for surgery.

Instead, he took the patient's examination data and read it carefully, and he was sure that he was sure. Then he said to Director Shang with a shy face, "Director Shang, if I also want to fight for this operation, will you call me greedy?"

"Hmph, you're pretty self-aware, kid."

Director Shang snorted, although there was no expression on his face, there was a hint of a smile in his eyes looking at Zhou Can.

What kind of person is Zhou Can? He steals surgery and has a thicker skin than a city wall.

In the past, even someone as strict as Dr. Xu couldn't do anything about him.

Director Shang is afraid that he will have nothing to do with him.

"Just now I took a closer look at the size and location of the patient's tumor. I have performed colon cancer surgery in both digestive surgery and general surgery. I am sure I can do this surgery well. Do you think I can relieve your worries?"

Zhou Can asked anxiously.

"You're sure, aren't you?"

Director Shang stared at him with a serious face.

Huang Xinggui secretly scolded this Gui Peisheng for being too shameless, for stealing one after another for surgery opportunities.

However, his attending physician's surgical ability is not as good as that of Gui Peisheng.

Huang Xinggui was not sure about completing these two surgeries.

Therefore, he could only watch Zhou Can grab the opportunity for surgery, and he had no choice but to do anything.

If you don't have that ability, it's the smartest way to just stay by and watch.If you don't have the ability to grab the opportunity for surgery, if you screw up, you will not only destroy the credit you have finally established in the eyes of the superior doctor, but also your character.

It will be very difficult to fight for the chance of surgery in the future.

Therefore, Dr. Huang Xinggui could only stand by and look jealous.

As for the three graduate students led by Director Shang, if they want to start performing endoscopic surgery on patients now, they are just wanting to eat.

First learn the four major punctures honestly, then practice the basic surgical skills well, and then think about other things.

"Without diamonds, I dare not take on porcelain work. I dare not say that I am absolutely sure, at least I dare to ask you to fight if I am very sure."

Zhou Can looked at Director Shang seriously.

"Okay, let's go!"

Director Shang felt relaxed.As long as the doctors under him really have this ability, it's too late for him to be happy.

I am also happy to leave exercise opportunities to young people.

……

In the morning, a total of three endoscopic operations were performed.

None of them are minor surgeries, each with its own emphasis on technical difficulty.

Zhou Can won two complete endoscopic surgeries and issued three complete postoperative doctor's orders.Of course, they were all opened under the one-to-one guidance of Director Shang.

Even so, he still felt that the gains were huge.

He has made some progress in pharmacological syndrome differentiation and postoperative medication.After issuing the third doctor's order, he was even rewarded with 10 points of pharmacological syndrome differentiation experience points.

He also won part of the surgical tasks for the third operation.

Among them was a difficult anastomosis task, which he was not sure about doing well, so he honestly watched Director Shang do it.

After all, the patient with jejunum-to-esophageal anastomotic leakage left a deep impression on him.

Before his anastomosis technique has been promoted to level five, when encountering such a difficult anastomosis task, it's better to admit it honestly, so as not to harm the patient.

It was already past twelve noon after the operation. Director Shang was very generous and ordered meals for all the doctors and nurses involved in the operation.

Everyone ate together and discussed some problems in the operation, which was very enjoyable.

Through the three endoscopic surgeries performed in the morning, Zhou Can thoroughly let Director Shang and others know his surgical prowess.Director Shang seemed to be in a good mood, with a smile on his face from time to time.

Having recruited such an excellent Gui Peisheng, he will be able to have a right-hand assistant in the next two or three months. Any chief physician will be happy.

After all, for attending and chief physicians, interns, training students, and advanced students are all free helpers.

After dinner, returning to the office, Zhou Can turned on the computer and prepared to complete the patient's medical records.

By the way, I also checked the treatment status of the seven patients I managed and the results of the new examination.

"The patient in bed 79 really had portal vein thrombosis."

After checking the examination results of the female lawyer in bed 79, he breathed a sigh of relief.The real cause of the patient finally arrived.Is chronic portal vein thrombosis, but also accompanied by splenic vein thrombosis.

[Diagnostic experience +1.]

[You have successfully diagnosed a hidden and difficult case, reward pathological diagnosis experience +100.]

He successfully obtained another 100 experience point reward, and it was a pathological diagnosis. He couldn't help grinning with unprecedented happiness.

Internal medicine is really his blessing.

Various medical skills that were not promoted in surgery began to be promoted rapidly after entering internal medicine.

According to this speed, it is not a dream to upgrade the two most important medical skills of pathology and pharmacology to the fifth level within a year.

It would be unimaginable if he waited until the end of his three-year training and all his important medical skills were upgraded to level five.

When the time comes, his return to the emergency department will definitely be the return of the king, and will bring great surprises to Dr. Xu and Director Lou.

If you want to help the emergency department grow in a short period of time by yourself, you must have excellent skills.It is best to practice both internally and externally, and you can have quite high attainments in all aspects of medical skills.

Only in this way can we quickly open up the situation in a very short period of time and gain popularity.

The real cause of the disease was found out in the 79-bed female patient, and she only needed to be treated with surgery. I believe she will recover soon...

Seeing that the patients he manages have made significant progress in treatment and are able to return to a healthy state, Zhou Can is full of sense of accomplishment and expectation.

He likes the profession of doctor more and more.

The more skills you learn, the more intractable diseases you can solve.For patients, it is undoubtedly a great blessing to have an excellent doctor like him born and grow up rapidly.

For Zhou Can himself, continuous improvement in the medical field is exactly the life he wants.

Huaxia's medical community also very much needs talents like him to contribute to Huaxia's medical career.

……

The days passed like this day by day.One week later, the patient in bed 71 with esophageal anastomotic leakage and jejunal anastomotic occlusion could eat.

After more than half a year, he finally managed to drink his first sip of water.

The surgery was done very successfully.

Not only the occlusion between the patient's esophagus and jejunum was successfully opened, but also the problem of anastomotic leakage was successfully repaired.No longer have to worry about eating all the food coming out of the fistula.

The patient himself drank the first sip of water smoothly, and after feeling the food enter the intestinal tract, he was so excited that tears filled his eyes.

Total gastrectomy prevented the spread of cancer cells and saved his life.

But because the operation was not done well, it seriously affected his quality of life for the rest of his life.

Well now, Tuya Hospital has solved his problem.

The patient's wife also wept with joy.

Zhikua Tuya Hospital has superb medical skills and is a living Bodhisattva who saves people.

The patient's daughter unfolded the frown that had been frowned for more than half a year, and there was a smile from the heart on her face.Seeing her old father regaining the ability to eat after being reunited, she told the doctors, nurses and family members in the next bed that it was like being hit by a pie falling from the sky.

Unexpectedly, a medical miracle really appeared.

On the same day, she went somewhere and ordered a pennant, with the words "helping the world and saving people, immeasurable merit" written on it, and next to it was a line of thanks to Director Shang of Tuya Hospital for his superb medical skills and cured her father.

Another hero in this treatment - Zhou Can, is hidden behind the scenes and unknown.

Zhou Can didn't care about this.

(End of this chapter)