My medical skills add experience

Chapter 526 Challenging top-level difficult surgery, a glimpse of understanding

Opening the barrier of the dura mater is basically a long drive.

Drain the accumulated blood in the brain first.

Even though it was just the simplest step, Director Wu Yongming was still cautious.When suctioning the effusion in the cranial cavity, it is very easy to make mistakes and damage important brain tissues.

Deputy Director Lu's intracranial environment is even worse, and the degree of accident-prone far exceeds that of ordinary patients.

Not to mention anything else, just the aging of blood vessels, hardening, and brittleness is enough to make surgeons tread on eggshells.

After the intracranial hemorrhage was almost absorbed, at this time, the intracranial pressure basically returned to normal.Or rather, lower than normal.

Because the original cranial cavity was closed, now two holes have been opened, which is equivalent to a semi-open type.

In medicine, this is called opening a window.

The operation is progressing smoothly.

It just quickly ran into trouble.

It is definitely not enough to just suck out the accumulated blood. If the blood does not stop, it will soon fill your cranial cavity again.

Director Wu Yongming tried to repair the ruptured blood vessels, not to mention the anastomosis, even encountered troubles in debridement.

"No, this blood vessel is too close to the brainstem. The operating space is even narrower, and I'm not sure about endoscopic hemostasis."

Beads of sweat the size of mung beans appeared on his forehead, and he shook his head repeatedly.

It seemed that there was a terrifying beast blocking the way ahead.

As far as the level of surgery is concerned, in general surgery, everyone is actually pretty much the same.At least as long as the normal level is reached, the operation can be successfully completed.

In the original words of a certain surgeon, surgery is to cut out the lesion and mend it.

Of course, this big surgeon still said this in the 60s.

With the development of surgical medical technology, it is no longer as simple as sewing and repairing and excision.Many new technologies have been applied, such as artificial blood vessels, vascular stents, artificial hearts, and so on.

Even the repair of blood vessels, organs, and tissues is a test of the doctor's skills.

Needless to say, it is necessary to perform vascular repair in the narrow cranial cavity or endoscopic surgery.It is simply the difficulty of hell level.

Next to it is the brain stem, and there are other important brain tissues around it. Doctors with poor psychological quality will tremble with fear when operating the endoscope arm.

It's not an exaggeration.

Doctors, especially chief surgeons, suffer psychological pressure and mental stress during the operation beyond imagination.

Because if something happens to the patient, the surgeon has to be responsible!

"The damaged area of ​​this blood vessel is not particularly large, the length is relatively short, and it is indeed very close to the brainstem, so it is extremely inconvenient to operate. Why don't you try a vascular stent to repair it, Master Wu?"

Director Gouqiong was at the side offering advice to him.

"If it's a small brain aneurysm, I can put a coil and it can be fixed. Even a larger aneurysm can be repaired with a stent. But this blood vessel can't use a stent at all."

He repeatedly shook his head and rejected the proposal.

Drilling holes and opening windows in the skull must first be to draw out intracranial fluid and reduce intracranial pressure.

The second is to repair blood vessels to stop bleeding.

Not all vascular repairs are suitable for placement of stents.

First, braces are expensive.Secondly, the difficulty of operation is also extremely high, especially for intracranial arteries to place stents, the difficulty is frighteningly high.

"How about... you can help me, move the brain tissue on the upper right side of the bleeding point, let me try it!"

When Zhou Can saw the bleeding cerebral artery, there was a trace of excitement in his eyes.

It was completely different from the fear shown in Director Wu Yongming's eyes.Director Wu was full of fear, and he didn't have any confidence to challenge at all, and he was indeed not sure.Zhou Can is full of determination, like a fearless brave man.

"Doctor Zhou, you must do what you can! Don't try to be brave. If it doesn't work, we can have another joint consultation to discuss other surgical options."

Wu Yongming said so, but in fact he knew in his heart that there was no other surgical plan.

If there is a better surgical plan, it will not be delayed all the time.

If it is an internal medicine drug, sometimes there may be other alternatives.There are really not many available solutions for this kind of rupture of intracranial arteries.Just two or three.

"I'll be extra careful."

Zhou Can answered sonorously, with a serious expression.

After changing to him as the chief surgeon, he first directed Director Wu to help move the brain tissue aside.This operation has a certain technical content, and it is more like a laborious work such as pulling a hook.

Of course, with the help of the endoscopic arm, the actual physical exertion is not great.

Next, Zhou Can tried to operate in this extremely small and limited space.

"No, I have to move it a little bit to the side, about 0.5cm should be enough."

"Okay, I'll try."

Director Wu gritted his teeth, his eyes were extremely focused, and he squeezed and moved the brain tissue little by little to make room for Zhou Can's operation.

"I can't move anymore, this is already the limit. If you move any further, you may seriously damage the brain tissue."

Director Wu didn't dare to move his eyelids from the screen, and he was trying to control the volume of his speech, for fear that the strength of his hands would increase and his brain tissue would be damaged.

Regardless of whether it is in the abdominal cavity or the cranial cavity, moving the surrounding tissues during surgery is itself a kind of injury to the body.

The abdominal cavity and thoracic cavity that have been operated on often have serious adhesions between various tissues and organs, which will bring a series of bad long-term effects to patients.It can be called postoperative complications, or sequelae.

For example, after chest surgery, some people often feel chest tightness and shortness of breath. This is the sequelae of the operation.

There is no way to treat it, and it will basically be with you for life.

Doctors with rich experience and good skills often try to avoid moving other tissues and organs when performing thoracic and abdominal surgery.Treat only lesions.

Of course, the idea is beautiful, but in practice, doctors have no choice at all.

For example, when performing an appendectomy in the abdominal cavity, if you don’t lift out the intestines, how can you perform the operation?

Just looking for the appendix can take quite a while.

"It should be enough to keep the size of the surgical space."

After Zhou Can gestured, this time he showed a rather satisfied expression.

"Beforehand, when repairing this blood vessel, it will definitely cause a certain amount of damage to some tissues on the upper left side. However, I think that in exchange for the smooth repair of blood vessels, damage these less fatal and non-disabled brain tissues. , It should be worth it. The human body has a strong self-healing ability, I believe that after ten days and a half months, these injuries can basically return to normal."

In order not to scare Director Wu, Director Mingxin and others, Zhou Can vaccinated them in advance.

The way of thinking in surgery needs to be ever-changing.

Surgically repairing an artery in such a small space is an almost impossible challenge in itself.It is equivalent to driving a car onto a narrow dead end road, and then complete a U-turn on this dead end road that is only two meters wide.

It is impossible for ordinary drivers to complete this task.

If you have superb driving skills, it is possible to complete this impossible task.

Zhou Can's challenge now is to successfully complete the almost impossible task of blood vessel repair in a very limited space.

"Is the risk manageable?"

After hearing this, Director Wu still didn't dare to turn his head or move his gaze.

"It's hard to say about other unknown risks. At least I can be sure that some damage to the brain tissue in this range will not be fatal or disabled."

Zhou Can replied truthfully.

No one dared to make any promises and guarantees.

Even first-level surgery carries risks.Not to mention this kind of endoscopic surgery.

"Doctor Zhou's plan is highly feasible!"

Director Mingxin actually supported Zhou Can's adventure at this time.

Her words carry a lot of weight.

After getting her support, Director Wu Yongming didn't hesitate any longer, and directly agreed, "You can start the operation! You don't need to have too much mental burden, just be bold and careful."

"I see, thank you!"

While Zhou Can nodded in agreement, he also thanked the two chief physicians.

Without their strong support, he would not have this surgery opportunity.

He tried to manipulate the endoscope arm to start debridement, and then to anastomose the broken blood vessel.The whole process was extremely slow, revealing not only stability, but also a strong concentration that only top doctors possess.

This kind of concentration is somewhat similar to commanding thousands of troops to fight on the battlefield, facing a powerful enemy army and a complicated battlefield environment, and always sitting firmly in the top camp of the Chinese army.

[Suture experience reward +100, ligation experience reward +100...]

His experience point rewards are soft.

And every time it is a reward of one hundred and one hundred.

When the anastomosis is about to be completed, the air and congestion that may exist inside need to be exhausted.Because Director Wu has to keep that part of the brain tissue still, it is quite difficult for Zhou Can to operate it.

After all, a person only has one pair of hands. One can imagine how difficult it is to complete the work of four hands, or even six hands.

"No, it will be troublesome if there is air in the blood vessels that have been anastomosed in this way."

Zhou Can is well aware that there is air in blood vessels, especially intracranial blood vessels, which are very easy to form blood clots.This is a ticking time bomb.

Director Wu couldn't move, so another hole was drilled to insert another endoscope arm?
Not to mention the huge harm to patients, there are not so many instruments and equipment.

It was originally just a small problem in the matching process, but it stumped Zhou Can.

"The air is not clean, it is indeed a huge hidden danger."

Wu Yongming looked at the soon-to-be-successful operation, full of unwillingness.

It is definitely not possible to complete the operation carelessly.

Everyone is a top expert in the field of surgery, and they pay great attention to some surgical details.

Everyone is racking their brains for a solution.

"Maybe there is a way to try. I will save the knotting of the last stitch and not operate it. Director Wu will not need to care about the brain tissue on the right side. He will just free up his hand to help me exhaust the air in the blood vessel, and then I will open the Knot to complete the final vessel wall anastomosis."

Zhou Can proposed a solution.

Suturing blood vessels requires more operating space, and he is sure to complete the final knotting in a limited space.

At most, it will damage a little left brain tissue.

This is also a forced way.

The tissue on the left side of the brain itself has already been damaged, so it doesn't hurt to add some new injuries.

"good idea."

After Wu Yongming listened, he readily nodded in agreement.

Next, complete the final step according to the surgical idea designed by Zhou Can.

The final knot was a little more difficult than imagined.

But for Zhou Can, who has a sixth-level ligation, he was able to complete it smoothly in the end.

【结扎术经验值+1，奖励经验值1000。吻合术经验值+1，奖励经验值10000。病理诊断经验值奖励+10000。】

Looking at the huge reward after the operation, Zhou Can was stunned.

Immediately, there was a glimmer of understanding in his heart.

It seems that innovation in surgery, or under extremely harsh conditions, has conceived some new surgical solutions and successfully implemented them.

All can get a huge amount of pathological diagnosis experience value rewards.

The last time Zhou Can found a way to create a surgical plan for the patient with aortic dissection without having to replace the aorta, Zhou Can also received a very considerable reward for pathological diagnosis experience.

This also made him understand a truth, no matter internal medicine or surgery, in the end, they all lead to the same goal by different routes.

They can all improve Zhou Can's level of pathological diagnosis.

To put it bluntly, pathological diagnosis is equivalent to a doctor's diagnosis level and treatment thinking level.

Pharmacological syndrome differentiation and various surgical techniques are equivalent to two sharp swords for treatment.

It belongs to the weapon to eliminate diseases.

Undoubtedly, no matter how powerful a weapon is, if you don't know how to use it, it will definitely be difficult to exert its power.

Can a sharp sword in the hands of a three-year-old child kill a chicken or a duck?
If you don't even know how to use it, you might hurt yourself.

If it fell into the hands of a strong man, it would be enough to kill ordinary beasts.

If it falls into the hands of a martial arts master, it will be terrible.It can directly kill tigers and even dragons.

Therefore, the improvement of the level of pathological diagnosis is more important than pharmacological syndrome differentiation and surgical skills.

One is the level of thinking, and the other is the weapon.

After Zhou Can's pathological diagnosis was upgraded to level six, it was frighteningly difficult to advance again.

The experience value of 100 million is difficult to achieve in almost a lifetime.

But with an increase of 100 like this, it is not easy to make up [-] million.

In addition, he has proved the usefulness of pathological diagnosis through countless clinical experiments.The sixth level is completely different from the fifth level.He is now at the sixth level, that is, the director level. Whether it is in consultation, consultation, or surgery, his level can already be on par with those powerful chief physicians.

This shows that using the medical experience value system to improve medical skills is not the so-called puffiness.

If one day, he raised his pathological diagnosis to level seven, he would probably be one of the top experts in the country.

Now it is only equivalent to the level of an ordinary director.

Barely able to be called an expert.

After the final anastomosis of the blood vessels, the blood test showed that everything was normal.

"Okay! The patient's signs have obviously stabilized a lot. If there is no problem, the operation can be ended and sent to the recovery room for observation."

Director Ming Xin said.

Wait until the endoscope is withdrawn, and the wound is sutured to seal the cranial cavity.

Then came the good news.

"The patient's brain waves have changed significantly, and they are changing in a good direction."

Director Mingxin said with some surprise.

For comatose patients, brain recovery is the key.

(End of this chapter)