My medical skills add experience

Chapter 557 Destruction Doesn't Equal Harm, A Comfortable Anesthesiologist
After finding out the condition of the patient's stomach, Zhou Can had a bottom line in his mind.

"Please show me the patient's preoperative esophagogram again."

He wants to take advantage of this opportunity to perform a gastroscopy on the patient to locate the specific location of the esophageal fistula, and it is best to find the real cause of the esophageal fistula.This can ensure that there will be no recurrence after the second operation.

"This is the esophagogram performed on the patient today. The esophageal fistula exceeds 1cm!"

Director Tan was somewhat ashamed when he said this.

The entire esophageal tear was about 6cm long, and now the fistula is more than 1cm long.

When Zhou Can controlled the endoscope to withdraw, he carefully searched for the position of the fistula according to the angiography, and found it after a lot of effort.

Viewed from the inner wall of the esophagus, the fistula is not obvious.

This position is located at the bottom of the suture gap, and there is a certain phenomenon of infection and collapse.

Relying on his experience in surgery and six-level suture, Zhou Can confirmed that other parts of the esophageal tear had initially healed after careful examination.This is a good sign.

Then there is no need to move it.

If you want to repair this fistula, you will definitely need to debride the wound and then suture it again.

First of all, there is no guarantee that infection and thread collapse will not occur after suturing.

In fact, as long as the esophageal wall is infected, even if it does not suppurate, it is still easy to break the suture for the second time.

To be more optimistic, Zhou Can has six-level debridement and six-level suture, and the fistula has been repaired and healed directly without breaking apart.But it still has a huge impact on patients.

What effect?

The patient's esophagus itself becomes hardened, brittle, and extremely poor in elasticity and toughness.This means that the maximum volume of food that can pass through the esophagus is much lower than normal.

Then a few days ago, a 6cm-long opening was torn in the esophagus. After suturing, the internal space of this section of the esophagus would be much narrower.

Zhou Can could feel it when he had a gastroscopy just now.

The part of the esophagus that has been repaired is obviously much narrower.

This will definitely affect the patient's postoperative eating, and it is easy to choke.

If debridement and secondary sutures are performed on this narrow basis, the space of this esophagus will become even narrower.

The patient may only eat liquid food in the future.

You need a thinner liquid food, if it is too viscous, it can directly block the esophagus.

The plan really can't keep up with the changes!

It is really necessary to check this gastroscope.

If you do not carefully understand the patient's condition, and directly repair the patient's esophageal fistula through thoracoscopic surgery, even if the operation is successful, it will definitely be a failure.

"I don't know what kind of second surgery your hospital plans to perform on patients?"

Zhou Can asked Director Tan and Song Qian.

It is necessary to consult the owner first.

"We asked Dr. Zhou to come over to help wipe our buttocks. Of course, it's up to Dr. Zhou." Song Qian answered on behalf of Director Tan.

"Because the fistula is not big, it would be best if the fistula can be repaired on the basis of the original operation. Before coming here, Dr. Zhou's surgical plan was thoracoscopic repair. This surgical plan is less traumatic to the patient. , belongs to minimally invasive surgery, I agree very much.”

Tan Shengli's surgical thinking should belong to the old and conservative kind.

This kind of surgical thinking prefers face to face when formulating a surgical plan, step by step.

The advantage is stability, and the disadvantage is that it lacks flexibility and is very rigid.

"Before I came here, I really thought that thoracoscopic surgery could be performed on the patient to directly repair the esophageal fistula. However, when I performed a gastroscopy on the patient just now, I found a problem. The patient's esophageal fistula occurred at the section of the previous breach. If two more I am worried that it will seriously affect the quality of life of patients after surgery. Therefore, I am more inclined to another solution.”

Zhou Can has a six-level pathological diagnosis level, which is of great help in formulating a better surgical plan.

"Is there another plan?"

Director Tan's eyes brightened slightly, but Song Qian's phoenix eyes flickered.

"The patient has an esophageal fistula now, and nutritional security has become an urgent problem to be solved. If nutrition is not guaranteed, the patient's wound recovery will be slower, and various problems will occur in the body. At that point, he The situation is quite dangerous.”

Zhou Can analyzed the reasons for everyone.

The patient leaks what he eats now, and only a small part of the food can enter the stomach.Moreover, all the food that leaked out through the esophagus entered the chest cavity. Even if a chest drainage tube was left during the operation, it would still pose a major safety hazard to the chest cavity.

If a chest infection is caused, I am afraid that even the most advanced antibiotics will not be able to save the patient's life.

"Doctor Zhou, please interrupt. What do you think are the reasons for the patient's esophageal fistula?" After hearing this, Tan Shengli seemed to be enlightened in his surgical thinking, and interrupted Zhou Can aloud.

"During the gastroscopy just now, I saw ulcers and redness and swelling in the esophagus. I guess that the failure of the esophageal repair was due to edema and inflammatory necrosis of the esophageal wall, which caused the sutures to collapse and the wound could not heal."

Zhou Can can only tell the truth.

This happens from time to time, and it has something to do with the quality of the surgeon's operation.For example, the control of postoperative edema, if this is placed in Tuya Hospital, there are ways to take some preventive measures.

"Okay, let's continue talking about your treatment plan!"

After Tan Shengli asked the patient the cause of esophageal fistula, he seemed to give up his own ideas and was ready to listen to Zhou Can completely.

"Everyone knows that if the spontaneous rupture of the esophagus is not operated in time, the patient will soon die due to severe infection, nutritional deficiency, and systemic failure. Rupture occurs again within seven days. If the second rupture is smaller, nutrition can be strengthened, drainage can be maintained, antibiotics can be used rationally, the bottle can be blown to open the lungs, and gastrointestinal decompression can be maintained. As long as the fistula is handled properly, the fistula can heal on its own."

Zhou Can proposed a series of treatment measures.

His idea is very simple, since the esophageal fistula can no longer be repaired, let it grow by itself.

As long as the nutrition is in place and the infection is strictly controlled, this goal can be achieved.

At most, the treatment time will be longer.

"The series of measures proposed by Dr. Zhou are very good. However, the patient's esophagus has a fistula, and the food he eats will leak into the chest cavity. How to strengthen nutrition?"

Tan Shengli believes that if this problem is not resolved, it is purely empty slogans.

"It's simple, just give the patient a jejunostomy to solve it."

Zhou Can replied confidently.

"Jejunostomy?"

Director Tan's eyes widened suddenly, and the expressions of the others were also shocked.

It is very difficult to have an esophageal fistula, and the idea of ​​artificially creating a fistula on the jejunum is really daring.

Conservatives like Tan Shengli would definitely not be able to think of such a solution.

Because in his opinion, such an idea is too crazy.

Any operation will cause harm to the patient's body. It is unlucky enough for the patient to have postoperative esophageal fistula, and the doctor will make an incision in the jejunum. What evil is this?

"Yes, it is jejunostomy. Although making a fistula in the jejunum will cause some harm to the patient's body, the benefits for the patient far outweigh the harm. First of all, after jejunostomy, food can directly enter the stomach from here, no need After passing through the esophagus, it can reduce the persistent infection of the esophageal fistula and even cause the fistula to expand further. This creates a prerequisite for the gradual healing of the esophageal fistula."

Avoid water in the wound, afraid of infection.

If the patient wants to survive, he must eat and drink every day, which will cause continuous infection and even suppuration of the esophageal fistula.

Antibiotics can control infection, but they are not a panacea.

The best cure is always prevention.

Prevention of infection is far superior to control of infection.

The former is to prevent the wound from becoming diseased and deteriorated, while the latter is to wait until something goes wrong, and then find a way to treat and control it.

The reasoning behind this is equivalent to going to the doctor to treat a disease before it occurs, and to prevent it before it occurs.

The doctor treats the disease that is already sick, and waits until the patient is already sick before trying to save it.

A judgment is made between the two.

Zhou Can's surgical thinking has preliminarily possessed the thinking of going to a doctor, and Director Tan, if he can't change his thinking mode, I'm afraid he can only be a doctor for the rest of his life.

"Secondly, various foods are directly provided to the patient through the jejunum fistula, which can ensure the patient's adequate supply of nutrition. When the nutrition is improved, the patient's self-healing ability and immune ability will be greatly enhanced. As you can see now, the patient's nutritional Not good, the body has already experienced major problems, and there are signs of exhaustion."

The patient's face was extremely pale, and although his physical signs were stable, he was in a state of persistent high fever.

At this time, the state of the whole person is very poor.

Ordinary people have a bad cold, high fever, and runny nose, and already feel as if they are going to die.The patient has just finished a major operation, and being in this state is tantamount to making things worse.

If it is not resolved in time, the patient will die soon.

It is believed that the doctors and leaders of the First Hospital also sensed the danger, so they hurriedly sought rescue from the outer hospital.

"Dr. Zhou's surgical suggestion is very scientific and reasonable. I think it is much better than the secondary repair of the fistula through thoracoscopic surgery. It is of great benefit to the patient's postoperative recovery and quality of life in the future. Benefits. It seems to have carried out secondary damage to the patient's body, but it is actually scraping the bone to heal the poison, creating favorable conditions for the patient's complete cure."

Anesthesiologist Director Hei spoke out in support of Zhou Can's new plan at this time.

With the support of anesthesiologists, the possibility of implementation is immediately N times higher.

An anesthesiologist is inseparable from the checks of any operation.

She said that if this operation can be done, then it can be done.

She objected, even if the chief surgeon thought the operation plan was perfect, there was no way to implement it.At this time, it is often the time when the chief surgeon and the anesthesiologist are tearing apart, and it is common to have red faces in the office.

Just like a quarreling couple, the head of the bed quarrels with the end of the bed.

They'll snap back together quickly, so don't worry at all.

After all, everyone is doing it for work, and there is no need to rise to the level of personal grievances.

"The solution proposed by Dr. Zhou seems to be... destructive. After thinking about it, I also think that this treatment plan is safer and has better curative effect." Tan Shengli did not say that he agreed with Zhou Can to perform this operation. if.

Because Zhou Can was invited to be the chief surgeon, the decision-making power must be given to Zhou Can.

If they still hold on to the right to make decisions, then instead of asking Zhou Can to come over to be the chief surgeon, he would act as an assistant.

"Since Director Hei has agreed to Dr. Zhou's operation plan, let's hurry up and start! We will fully support and cooperate with you if you need anything."

Song Qian's identity has always been vague, and she did not introduce it.

Even Jiang Wei did not tell Zhou Can what position this old classmate currently holds in the First Hospital.Just based on feeling, her status should not be low.

Otherwise, there is no way to talk to the two chief physicians, Tan Shengli and Director Hei, in such an extremely calm tone.

Moreover, she fully acts as a senior leader in various decisions and has the power to make decisions.

Therefore, it is inferred that her position should not be low.

"I don't have any other requirements. This colleague of mine can be my medical assistant, and Jiang Wei can be my equipment nurse."

Zhou Can only had this small request, to use his own people during the operation.

"absolutely okay."

Song Qian signaled slightly to the equipment nurse and the original medical assistant, and the two stepped aside.

Surgery begins soon.

Zhou Can showed these people in the First Hospital what a first-class surgical level is.The entire operation took less than 10 minutes to complete.

At the end of the operation, he was rewarded with 1000 pathological diagnosis experience points.

It should be related to his new surgical plan.

It's not an innovative surgical plan, but it has some new ideas.It is a flexible use of a variety of surgical knowledge and medical knowledge.

This ability is difficult to learn through reading.

What books can teach is general knowledge and various theories.To make full use of knowledge in diagnosis and treatment requires continuous practice and accumulation.

After the operation, Zhou Can carefully checked the patient again to make sure there was no problem.

Only then did he take off the gloves and throw them into the trash can.

"Okay, push it to the recovery room to wake up from anesthesia, and observe it for about 10 minutes. If there is nothing abnormal, you can send it back to the ward for nursing. Starting tomorrow, you can feed through the jejunal fistula, and it is best to be operated by an experienced nurse. It is estimated that The patient's hospitalization period will be relatively long, and his esophageal fistula may take more than a month to heal."

Zhou Can confessed to Tan Shengli and Song Qian.

"It's nothing, I'll take the people out first."

"I'll see you off. It's been a hard day for the three of you today."

Song Qian was very happy to see that the operation was successfully completed.

Before leaving, Zhou Can looked at Director Hei, the anesthesiologist.

"It's a pleasure working with you. Your intraoperative management is excellent. It is the most relaxing operation among the anesthesiologists I have worked with."

Zhou Can did not say that he was the anesthesiologist who made him most relaxed.

I can only say that it is the most relaxing operation.

"Thank you for the compliment!"

She smiled subtly, and this was the first time Zhou Can saw her smile.

"goodbye!"

He took Jiang Wei and Zhong Ming to the outside.

Director Hei is indeed the best anesthesiologist Zhou Can has ever seen. He is professional, meticulous, and cooperates well with the chief surgeon.She can even budget for what Zhou Can needs to do next, and then provide corresponding life support or corresponding preparations.

In short, during the whole operation process, Zhou Can felt as comfortable as it came naturally.

Even Director Feng of Tuya Hospital had never let Zhou Can relax so much during the operation.

It's not that director Feng's professional level is not as good as this black director, but that director Feng lacks the spirit of her dedication to the main knife.

She always put Zhou Can first in everything she did during the operation, and provided the best service for the surgeon.

(End of this chapter)