From small clinic to medical empire

Chapter 118 Zhang Zifan's Choice 【Favorites!Please recommend! 】

Although Zhang Zifan's words were a little crazy, but D-level anesthesia skills were enough to handle most surgical situations.

During the rapid intravenous induction anesthesia and laryngeal mask inhalation anesthesia given to Fang Guohua, except for a slight laryngeal orifice reaction, the other procedures went very smoothly.

Su Feixiang was basically in a dazed state throughout the whole process, and Zhang Zifan didn't expect him to perform well.

It is undoubtedly a huge challenge for Zhang Zifan to observe various physiological indicators such as dynamic electrocardiogram and central venous pressure while performing the operation.

Fortunately, now Yuan Qiang has been able to come in handy a lot, opening the operation area, dissecting fascia and other hard work, Zhang Zifan will leave all the hard work to Yuan Qiang, so he is very relieved.

He is on the operation, and more importantly, he observes and draws up the operation plan.

Fang Guohua underwent 14 operations in [-] years, and the remaining half of his head is no longer human.

But now the most worrying thing is whether the tumor cells will invade the skull base or the brain tissue!

Once this happens, then...

……

According to the traditional surgical method, ameloblastoma must be resected at 0.5 cm around the tumor because it has the characteristics of local invasion of the surrounding bone during surgical treatment.

But in the past ten years, with the improvement of people's living standards, everyone's pursuit of quality of life has become higher and higher.

Many doctors advocate that ameloblastoma should be fully considered that the probability of malignant transformation is low and the degree of malignancy is relatively low, and the bone wall curettage method with less damage should be adopted.

It cannot be said that this trend of thinking is necessarily wrong.

After all, in many cases, it is difficult to choose between the life and death of one life and the happy life of 99 lives.

There is no doubt that Fang Guohua belongs to the unfortunate one.

The characteristics of ameloblastoma with low malignancy but high invasion make him look neither human nor ghost, life would be better than death.

……

Yuan Qiang carefully separated the remaining temporal fascia on the left side of the patient, and did not dare to move the rest.

Due to repeated operations, Fang Guohua's left maxillofacial tissue was missing everywhere, and there were scars everywhere, and there was no way to deal with it.

The tumor had already crossed the midline and invaded to the right side.

If the right side of the jaw is also removed, whether the patient can survive is also a question.

This is why many hospitals persuaded Fang Guohua to give up the operation.

Even the hospital in Shanghai just planned to remove some tumor tissue symbolically after opening the right jaw.

But of course Zhang Zifan would not do this.

He did not open the operation area from the right side, but continued to attack the tumor's Maginot line from the left side based on Yuan Qiang's dissection.

The parotid gland is missing.

The facial nerve has been severed.

The external carotid artery has been ligated.

The veins behind the face remain, separated and protected.

The remaining 1/2 of the posterior abdomen of the digastric muscle is separated and protected.

A few remaining tendons of the lateral pterygoid muscle were separated and protected.

……

Any remaining tissue, as long as it is not contaminated by tumor cells, regardless of whether it has clinical value, Zhang Zifan will keep it.

Soon, Zhang Zifan continued to separate and protect the remaining tissue, and the surgical site reached the front line of the hypoglossal nerve and prevertebral muscles.

This is the central location of the cranium, and recurrent tumor cells are highly dense in this area.

Now that the surgery is here, it is also the most critical time.

Whether tumor cells have invaded the brain, the answer will be revealed soon!
……

The patient's veli palatini muscle group and pharyngeal constrictor muscles were mercilessly removed. Zhang Zifan was heartbroken to find that the patient's styloid process and surrounding muscles had also been infiltrated by tumor cells.

The styloid process refers to the thin and long bony protrusion that protrudes forward and downward from the underside of the temporal bone and is located between the internal carotid artery and the external carotid artery.

The temporal bone forms the base of the skull together with the sphenoid and occipital bones.

In other words, the styloid process is infected by tumor cells, and the skull base is also highly likely to be infected!
Do we need to further dissect the relevant structures to expose the skull base?

This is the problem facing Zhang Zifan.

At this time, Shi Xiaoya's cell phone rang in the corner.

Su Feixiang, who had been in a daze all this time, suddenly became alert and ran over to answer the phone.

……

The call was from Zhou Wei, to the effect that he said, I'm sorry, there is a traffic jam on the road, and we will be there in 10 minutes.

Zhang Zifan told Su Feixiang to put off the phone.

For this kind of person who has no spirit of contract, Zhang Zifan feels that it is a waste of saliva to say one more word.

Looking at Su Feixiang's cell phone put back in the corner, Zhang Zifan became more and more hesitant about exposing the base of his skull.

……

Many people think that the operating room is completely sterile, but it is not!

Whenever doctors post photos of operating rooms, scenes during operations, or photos of specimens, some people will always say that the operating room is sterile. How can doctors bring their mobile phones in and take pictures?
In fact, they are all wrong, the operating room is not 100% sterile.

Everyone has bacteria on their body, and there are a lot of bacteria.

Since patients are not disinfected all over their bodies and are directly pushed into the operating room, bacteria cannot be completely avoided.

Although bacteria are inevitable, there are still strict standards for the number of bacteria in the operating room.

The operating room can be divided into 5 categories according to the degree of sterility from high to low, namely:
Type 1 operating room: It is a sterile and clean operating room, which mainly accepts top-level operations such as brain, heart, and organ transplants. (<100 per cubic meter)
Category 2 operating room: Sterile operating room, which mainly accepts sterile surgeries such as organ removal surgery, intraocular surgery, and head and neck surgery. (<1000 pieces per cubic meter)
Type 3 operating room: operating room with bacteria, accepting operations on stomach, gallbladder, liver, appendix, kidney, lung and other parts. (<100000 pieces per cubic meter)
Type 4 operating room: Infected operating room, which mainly accepts operations such as appendix perforation peritonitis, tuberculous abscess, abscess incision and drainage. (<300000 pieces per cubic meter)
Type 5 operating room: that is, the special infection operating room, which mainly accepts operations for infections such as Pseudomonas aeruginosa, gas gangrene, and Tetanus bacillus. (no request)
At present, 【Primary Operating Room】has an advanced laminar flow system, which uses uniform airflow to carry dust and bacteria out of the operating room, but it can only reach the standard of a Class 2 operating room.

The standards of Type 2 operating rooms are actually quite good, and can meet the needs of most surgeries. Only organ transplants and heart and brain surgeries, which require the most stringent surgeries, cannot be performed.

Now, the patient's tumor cell invasion has reached the base of the skull, where there are a series of perforations such as the foramen magnum, foramen magnum, and sieve holes, which directly lead to the cranial cavity.

Inside the cranial cavity are the cerebrum, cerebellum and brainstem!

Once an intracranial infection occurs, the consequences will be disastrous!

How to do!
Is it possible to give up this operation because of the risk?

Zhang Zifan felt deeply unwilling.

If the dissection of the skull base is given up, it will not only mean the failure of Haoran Hospital's first operation, but also mean that a patient has lost hope of survival.

Zhang Zifan knew very well that if this operation could not change his fate against the sky, then the only thing waiting for the patient was death!
"Peipei, wipe off the dean's sweat!"

At this moment, Shi Xiaoya's voice sounded.

She carefully discovered that Zhang Zifan, who had always been calm, had some fine beads of sweat on his forehead.

Shi Xiaoya immediately ordered the traveling nurse to wipe Zhang Zifan's sweat.

"By the way! Shi Xiaoya! I still have Shi Xiaoya!"

Zhang Zifan suddenly thought of the key point, which made Yuan Qiang tremble.

"Director, what do you want me to do?"

Shi Xiaoya asked strangely.

"Well, come here and wash the patient's wound with dilute iodophor!" Zhang Zifan nodded and said.

"what?"

Shi Xiaoya was a little dumbfounded.

As an instrument nurse, I really have the responsibility to supervise the aseptic operation of the surgical staff.

But she has never done disinfection and sterilization of patients herself.

Seeing that Shi Xiaoya hesitated, Zhang Zifan straightened his face and said, "If you are told to do it, you do it, don't be coy, if we go to rescue and rescue in the future, we will have a share so clearly, you have to know everything, Yuan Qiang, come and show Xiaoya!"

(End of this chapter)