My medical skills add experience

Chapter 505 Solutions to side effects, innovation in surgical thinking
Anesthetist Zi Qu and anesthetist Qin Yue walked into the operating room together.

Although the reform of the anesthesiology department is still in the trial stage, the two of them have basically tied up with Zhou Can.

In other words, as long as there is an anesthesia operation in the emergency department, both of them will give priority to care.

In the operating room of the emergency department, Dr. Xu basically has the final say.

Dr. Xu regards Zhou Can as his successor, and basically all affairs are centered on Zhou Can.

Zhou Can and Ziqu reached a consensus and formed a pair. Dr. Xu's attitude towards this matter is tacit approval and support.As long as there is an anesthesia operation, he now directly asks Ziqu for help.

"What's wrong with this patient?"

Zhou Can asked Ziqu.

The anesthesiologist must have had a detailed understanding of the patient's condition, physical condition, drug allergy history and other information.Before the operation, you need to talk to your family members and sign an informed consent form for anesthesia.

Usually, the anesthesiologist and the chief surgeon will discuss the patient's condition and determine the surgical plan.

Zhou Can is really busy today.

It is estimated that Dr. Xu drew up the operation plan with Ziqu instead of him.

"The patient has a refractory duodenal ulcer, and the stomach acid is particularly high. It is estimated that she has a bad fever. In addition, she is generally allergic to proton pump inhibitors, and her constitution is quite special, so she can only be operated on."

Excessive gastric acid can burn the mucous membrane and stomach wall, duodenal mucosa and intestinal wall.The most common symptoms are heartburn, stomach pain, discomfort, nausea, loss of appetite and so on.

Duodenal ulcers, if there is no specific cause, are often relatively easy to heal.

However, there are also a small number of patients who have repeated ulcers and cannot be cured.

At this time, it is necessary to further investigate the cause of duodenal ulcer.

Western medicine is awesome on this point, if it is not good, it will treat it for you.

High blood pressure, after antihypertensive drugs are used, blood pressure can be lowered quickly.Respiratory failure, directly on the ventilator.The blood vessel burst, and the operation was performed immediately to stop the bleeding and repair the blood vessel.

In short, as long as the cause is found, Western medicine can always think of a solution.

Even terminal illnesses like cancer have already been overcome in many ways.And it's still making progress.

With the current technology, as long as the cancer can be detected in the early stage, it can usually achieve a very satisfactory treatment effect.

"High gastric acid is often related to the excessive secretion of gastric acid. Is it necessary to reduce her gastric acid secretion through surgery now?"

"Not bad!"

Doctor Xu walked in.

"Which surgical option do you think is the best?"

Dr. Xu should not only test him, but also be interested in listening to Zhou Can's surgery opinion.

Now Zhou Can can give unique insights and even some novel surgical plans in many surgeries.

"Uh... If it's a refractory duodenal ulcer and it's caused by hyperacidity, I think it's a good choice to cut the vagus nerve."

After thinking about it carefully, according to the actual situation of the patient, he gave an operation opinion.

"Not bad, your current surgical ability and surgical thinking are getting better and better."

Dr. Xu is full of appreciation.

His surgical plan is likely to be the same as that of Zhou Can.

This is also the most commonly used surgical option for the treatment of this disease.

Of course, it must not be applied mechanically, it must be based on the actual situation of the patient.

The purpose of cutting off the vagus nerve is to block the secretion of gastric acid caused by the vagus nerve, reduce the amount of gastric acid, and achieve the purpose of curing duodenal ulcer.

It must be explained that cutting off the vagus nerve trunk is only a forced surgical solution. After it is cut off, it will cause a series of side effects.

For example, the vagus nerve has a branching effect on the stomach wall muscles.

After it is cut off, it can no longer control the muscles of the stomach wall, which will cause the contraction, expansion, and peristalsis of the stomach wall muscles, and all these functions will be lost.

The stomach is an important digestive organ of the human body, and it is also an important organ for storing food.

Its function is self-evident to the body, and it can be called the 'granary'.

When it loses the above-mentioned functions, various adverse reactions will occur.

For example, patients will experience severe gastric emptying disorders and food retention.

Because the side effects of this kind of surgery are too great, it is basically not used clinically unless it is absolutely necessary.

Excessive gastric acid secretion is mainly treated clinically with drugs that inhibit gastric acid.The two main classes of drugs, proton pump inhibitors and H2 receptor blockers, are the most commonly used.

Omeprazole, rabeprazole, lansoprazole, etc., are commonly used clinical drugs.

They inhibit gastric acid secretion quite well.

However, if you encounter a patient who is allergic to this type of drug, or has a special constitution that does not absorb it, you can only think of other ways.

Severing the gastric vagus nerve is very appropriate for this patient.

After the patient was given general anesthesia, the urinary catheter was intubated, and the operation officially began.

Because the surgery was quite a big one, Dr. Xu was a little worried, so he acted as Zhou Can's assistant by the side.

Now he seldom guides Zhou Can on the specific operation steps, just pure raiding.Let Zhou Can handle it by himself as much as possible.

After the abdominal cavity is opened, the abdominal wall is pulled apart with an automatic abdominal wall retractor.

Then inspect the ulcer site.

After the location has been determined, the preparations for the next step of amputation can be carried out.

This patient's duodenal ulcer is quite severe.

No wonder when Lai came in for the operation, he kept humming.

The pain and discomfort of the human body are not unbearable only when giving birth.

For example, trigeminal neuralgia is the highest level of pain recognized in medicine.Or when the airway is blocked by more than one-third, the pain caused by the oppressive feeling is also very serious.

This patient's duodenal ulcer is like this, only there is no perforation, so it is strange not to hum.

Stomach acid is much more corrosive than imagined.

It can easily dry up the stomach, duodenum, and pylorus.

The power is not weaker than the general strong acid.

"Yang Zhi, Dingdong, you should pay attention when performing this type of surgery. The location for cutting the gastric vagus nerve should be above the junction of the esophagus and the stomach. Otherwise, the desired surgical effect will not be achieved."

Zhou Can explained the essentials of the operation to the two.

He also learned some surgical skills and key points from the handbook written by Deputy Director Liu of the Department of General Surgery.

After confirming the location, Zhou Can quickly mobilized the left lobe of the liver.

Cut the triangular ligament directly, and then instruct Yang Zhi to pull the left lobe of the patient's liver upward to the right. At this time, the lower esophagus and cardia are all exposed to the surgical field of view.

He quickly cut open the serosa at the lower esophagus and cardia, separated the upper part of the hepatogastric ligament and cut it off directly.

All the movements are extremely fast, and it is a kind of enjoyment for the bystanders to watch him perform the operation.

Next, loosen the lower esophagus.

He reached out and felt the anterior wall of the esophagus, looking for the vagus nerve.

In medical books, blood vessels are usually marked in red, while nerves are marked in yellow.

However, in actual surgery, the color of the nerve is often not much different from that of the surrounding tissue. At this time, the surgeon needs to have rich surgical experience and can only find it by touching it with his hands.

Zhou Can quickly felt a nerve in the left front of the esophagus.

It's the left vagus nerve.

He felt again at the right rear of the esophagus to locate the right vagus nerve.

At this time, I already had a bottom in my heart.

"There are two left and right vagus nerves in this part. During the operation, you must pay attention to confirm it."

After the two people cleaned their hands, they put on sterile gloves and touched the patient's esophagus and surrounding tissues with their hands to find the vagus nerve.

Practical experience is invaluable.

When some surgeons lead students, they don’t want to cause extra problems, let alone waste time. Basically, they just point to the corresponding anatomical parts while performing the operation and explain, and never let the doctors under them do it.

Just imagine, can the students brought out in this way be good?
Many surgical residents who have been working for several years even act like a novice when performing surgical anatomy.It's not necessarily that they didn't study hard, but that the teacher didn't teach well.

There are too few opportunities for practice.

"I seem to have touched it. It feels very special, like a fiber ribbon."

Yang Zhi was the first to touch the vagus nerve.

After touching the suspicious part, he immediately asked Zhou Can for confirmation.

"Dingdong, touch it too."

Zhou Can said to Pu Dingdong.

In terms of talent, Pu Dingdong is also not bad, and he is more pragmatic and meticulous in doing things than Yang Zhi.

Zhou Can is very satisfied with the two medical assistants under his command.

Both of them usually perform very well.

After groping for a while, Pu Baodong felt both the left and right vagus nerves.He also carefully identified with the naked eye.

"Okay, let's see how I remove the vagus nerve."

Zhou Can carefully separated the vagus nerve from the esophagus.

Then direct Yang Zhi to pick up the nerve with a nerve hook.

Proceed to separate this nerve with scissors.

Not with a knife, but with scissors.

After separating the length of five or six centimeters, the gastric vagus nerve trunk can be resected at this time.

The length of resection should not be too short, and it is generally required to cut off a length of two or three centimeters.The removal of the other vagus nerve trunk is similar.

So far, the gastric vagus nerve trunk has been resected.

"Xiao Zhou, after the patient's gastric vagus nerve is cut off, the food in the stomach tends to be retained. Do you have a good solution?"

Dr. Xu has been watching from the side, not easily disturbing.

Now that the operation is almost completed, he proposed to solve the problem of postoperative side effects.

"Doing pyloroplasty should be able to solve the problem of gastric content retention."

Zhou Can has already mastered the solution.

"It seems that you are very careful in general surgery, hurry up and do it!"

Dr. Xu was very satisfied with his answer.

Zhou Can did not delay any longer and performed plastic surgery on the patient's pylorus.

In addition, after cutting the vagus nerve, he also sutured the diaphragm on both sides of the patient to repair the diaphragm hole.This is done to prevent the formation of a diaphragmatic hernia.

During the suturing of the diaphragm, it is still quite difficult because the diaphragm legs on both sides must be brought together before suturing.

The requirements for suturing and ligation are very high.

He also earned quite a lot of suturing and ligation experience points by the way.

Every time you have a ligation, you can get a lot of ligation experience rewards.In order to earn as much ligation experience as possible, he worked extraordinarily hard.

After the operation, his ligation experience value rose to more than 94000, which is very close to [-] experience points.

Under normal circumstances, he needs to ligate the patient about [-] times before he can successfully advance to the next level.

However, if he can encounter some surgical tasks such as suturing peritoneum and meninges, or some surgical sites that require extremely high ligation, his promotion time will definitely be greatly shortened.

In the final analysis, it is still necessary to do more major surgeries like this, only with difficult surgeries can there be a chance to earn a large amount of experience rewards.

"Dingdong, come and close the abdominal cavity of the patient!"

Yang Zhi's level of closing the abdominal cavity is already very high.

His own surgical skills are not bad. After working with Zhou Can for so long, he has been given various training opportunities.Surgical capabilities are also springing up steadily.

Pu Dingdong's surgical ability is relatively poor.

Zhou Can trains every doctor under his command equally.

There is no favoritism.

Dr. Xu saw that the surgery had come to an end, so he went out with confidence.

"Doctor Zhou, should we wait for Dr. Pu to finish sewing up the abdominal cavity, or switch to another stage for surgery?"

"You and Qiao Yu go to another operating room to set up a stage. I'll just stare here for a while."

"Ok!"

Ma Xiaolan and Qiao Yu went to another operating room to set up a stage.

Usually in the afternoon, Zhou Can is the busiest person in the emergency operating room.

Anyway, Dr. Xu works in a leisurely manner every day. For other surgeons, only stronger ones are eligible to perform operations in this [-]-level operating room.Those who are not as good are basically operated in the old operating room.

Therefore, as long as the operating table in the [-]-level operating room arrives in the afternoon, there will basically be an empty table.

Zhou Can watched Pu Dingdong suture the patient's abdominal cavity, but he didn't really have any particular worries.

Pu Dingdong's sewing skills are quite good, and he is very serious in his work.

The abdominal dissection of this patient was completed by Zhou Can, the incision was smooth, and the difficulty of suturing was relatively much less.

Both the inner and outer layers are better stitched.

He watched and watched, and his thoughts gradually drifted to the patient who came to him from Shanghai for treatment.

That patient's aortic dissection tear was too long.

In addition to replacing the aorta, it is difficult to think of other good ways.

But the stomach vagotomy just now gave him some inspiration.

When cutting the vagus nerve, it needs to be cut from the head to the trunk, so as to achieve the desired therapeutic effect.

In order to solve the problem of gastric content retention, the pylorus is treated with plastic surgery.

It is equivalent to doing treatment at the bottom of the stomach to solve the problem.

So, can the patient with aortic dissection also find a way from the end of the aorta?
Blood vessels and nerves work very differently.

Nerves mainly conduct bioelectrical signals.

This electrical signal is very complex.

If the circuit is wrong, it may directly cause a short circuit or other unpredictable problems.

Each nerve conducts electrical signals differently.

They form complex neural instructions.

But the blood vessels are different, and the blood in the blood vessels is the same.

The skin of the head and the blood of the soles of the feet can be used interchangeably.

The blood of the human body itself is constantly circulating.

As long as you don't confuse arterial with venous blood, you'll be fine.

He seemed to have seized a glimmer of opportunity.

Find a way from the end of the aorta, and arterial blood is common throughout the body.

A bridge may be a very good, but somewhat crazy surgical idea.

When treating heart disease, bridges are sometimes used.

This is not a new idea.

But from the end of the aorta, the bridge is used to transport blood back to the upper end. This idea is quite innovative.

The diseased aortic segment is very long, involving at least four or more arterial branches.The blood from those branches goes to vital organs, or other important parts of the body.

Cutting them off won't work, and finding a way to bring back the blood at the end of the aorta and anastomose with these branch vessels to form a new blood supply pathway may be a brand new surgical idea.

(End of this chapter)