My medical skills add experience

Chapter 556 Preoperative understanding, the two most easily overlooked cancers

"This is Director Tan Shengli of our Gastroenterology Department!"

Song Qian took the lead in introducing a leading middle-aged man.

"This is Tuya's Dr. Zhou Can, and this is his surgical nurse Jiang Wei, Dr. Returnee. This is his colleague, come and learn."

When introducing the three, Zhong Ming was put last.

Zhong Ming's name was never asked during the whole process.

If it weren't for Zhou Can's face, Zhong Ming wouldn't even be able to enter the operating room.

"I've admired Dr. Zhou's name for a long time, I'm sorry!"

Tan Shengli did not shake hands with Zhou Can, but nodded and smiled in greeting.

In the operating room, everyone can talk, and physical contact rarely occurs.In theory, the area above the waist needs to be kept sterile.Gloves, surgical gowns, masks, headgear and other sterile consumables used in each operation are paid by patients.

Every penny should be spent wisely.

Random waste, although patients and family members may not pursue it because they do not understand, but there will be some supervision within the hospital.Of course, the operating room has always been the core of the hospital, and the supervision is relatively loose.

Few leaders from the medical department, quality control department, and hospital office went into the operating room to stare at the doctor performing the operation.

After all, it caused the doctor to be nervous. In case of an operation accident, whose responsibility is it?

Besides, the status of the chief surgeons is not low, and they are often the technical backbone of the hospital. If they work a little longer, they will also take up some administrative positions in the hospital.No department executive is willing to offend them.

At most, after the operation, people with hospital infection occasionally enter the operating room for spot checks.

Check whether the infection prevention and control work in the operating room is in place, and whether the garbage is littered?
In the operating room, medical waste and domestic waste must be separated, or you will be scolded and fined if you are caught.For convenience, some doctors throw medical waste into black plastic trash bins.

The more responsible itinerant nurse found out and often corrected it face to face.

It's just that she has her 'naps' too.

Especially when there is an accident in the patient during the operation, everyone is busy rescuing the patient, how can we have time to pay attention to these small things?

"Director Tan is polite!"

After Zhou Can said hello, he consciously looked at the patient on the operating table.

"That's our anesthesiologist, Director Hei."

"Hello Director Hei, it's a pleasure to work with you on the same stage."

Zhou Can obviously attaches great importance to anesthesiologists, and he is also extremely humble when greeting him.

Surgeons and anesthesiologists need to cooperate closely and cooperate highly during the operation.This person is equivalent to Zhou Can's comrade-in-arms in this operation.

It is natural to have a good relationship.

The chief surgeon has a very high status in the operating room, equivalent to the captain, but he cannot fight alone.In order to successfully complete an operation, at least the anesthesiologist, surgical nurse, medical assistant, and multi-party assistance are needed.

Neither party will work.

Especially this slightly larger operation.

A hero with three gangs is definitely not for nothing.

"Happy cooperation!"

Director Hei is a female doctor in her early 40s, wearing black-rimmed glasses, and looks quite serious.

When greeting Zhou Can, there was no smile on her face.

Basically, most anesthesiologists are in this tune.

It's not entirely because they are cold and arrogant by nature, but because the situation is ever-changing during the operation. Due to their professional habits, they keep their faces sullen for a long time and are always in a state of nervous tension.

Over time, I developed the habit of being serious at work.

"Is the patient under general anesthesia now?"

After Zhou Can came in, he found that the patient was in a coma.When he talked to other doctors, the patient was unresponsive.

"Yes, the patient has been under general anesthesia now, his signs are stable, and he can be operated on at any time."

Seeing that Zhou Can asked about the patient's situation, Director Hei answered in detail.

"I just noticed that there was an incision on the posterolateral side of the patient's left chest. Is this the incision from the last operation?"

In fact, Zhou Can carefully observed the condition of the patient's surgical incision, including the shape and length of the incision, whether it was red, swollen or suppurated, how well the suture was done, and so on.These can basically infer the level of the previous surgeon.

However, considering that the third- and fourth-level operations in large hospitals are often performed by multiple doctors, the incision is not good, and the sutures are rough, which cannot represent the level of the main surgeon.

It is possible that the doctor's assistant opened the chest for the patient.

As for closing the chest cavity, some excellent residents are fully capable of doing this job.

For a major operation, the number of people who can be on stage is very limited.

Many residents can only get one chance to observe and learn from the audience, which is already very good.

Even the [-]-level laminar flow operating room will minimize the number of medical staff entering the operating room.

If it is not necessary, it is often strictly controlled.

For example, for a tertiary operation, there are up to three anesthesiologists.In fact, it is often an experienced anesthetist, a nurse anesthetist, two people in total.

Sometimes I may bring an apprentice, that is, three people.

Then for the surgical nurses, there are one or two equipment nurses and one itinerant nurse.The itinerant nurse is equivalent to the status of a housekeeper in an operation, and is an essential and important role.

Then the doctors are more flexible.

Usually there is only one chief surgeon, but in special cases there may be two chief surgeons.There are two chief surgeons, each doing a part.For example, if a patient needs to perform operations on both the abdomen and the chest cavity at the same time, there may be two surgeons.

It must be said that the probability of dual main swords appearing is not high.

It is often an emergency rescue, and it is really necessary to operate on two parts at the same time, so there is no way.

Otherwise, the surgical part that is life-threatening will be prioritized, and the less critical part will be postponed as much as possible.

Because the operation is performed on two parts of the patient at the same time, the damage to the patient is very great, and the risks in all aspects are also multiplied.

Doctors who are not experienced and highly skilled surgeons dare not take such risks at all.

In fact, it's more common for two teams to relay operations on patients at the same time.

For example, operating on a pregnant woman with aortic dissection.

It may be necessary to take out the fetus by cesarean section by an obstetrician and gynecologist, and then a cardiovascular surgeon will perform aortic dissection surgery.

Zhou Can's team has not been established for a short time, and it is still immature for the time being.

To achieve his ideal comprehensive surgery team, it is composed of several top teams, such as cardiac surgery team, thoracic surgery team, general surgery team, orthopedic team, anesthesia team, nutritional nursing team, surgical nurse team, postoperative nursing team, etc. .

There is still a big gap in this.

At present, he only has this idea, and is silently working towards this direction.

For example, the extra-cardiac team and the extra-thoracic team are being cultivated.

When he becomes stronger in the future, he can directly absorb the two top teams of cardiothoracic surgery.The same goes for general surgery.

On that day, Tuya will have the most powerful surgical team in history.

Its surgical capabilities are likely to become the number one in the country.

"The last time I performed an esophageal rupture repair operation on a patient, I made an incision from the posterolateral side of the left chest and entered the chest through the fourth intercostal space."

Tan Shengli replied beside him.

It seems that the last operation was probably presided over by him.

"The incision is very standard, and the suture is also in place. It can be seen that the level of doctors invested in this operation in your hospital is very high, and the chief surgeon is very attentive. I dare say that without 30 to [-] years of suturing experience, there is no suture at all." out of this level."

Zhou Can complimented the other party indiscriminately.

Praise without naming names is also called blind praise.

It means that when you praise, you don't target anyone, but only the work you do.This can eliminate the suspicion of flattery to the greatest extent, which is enough to make the parties feel very comfortable listening.

Zhou Can praised Director Tan before the operation started, so he had his purpose.

When I first arrived, the situation was unknown.

Wiping other people's asses, if you can get a high degree of cooperation from the chief surgeon of the last operation, you can greatly reduce the risk.For some details that cannot be seen from the report card, course records, and operation records, they will be reminded in time.

"It's too much to say, to be honest, when I performed the operation on this patient, I did all the incisions and closure of the cavity myself."

Despite wearing a mask, Director Tan still smiled.

Zhou Can's praise has greatly benefited him.

"It turned out that you cut and sewed it yourself, no wonder the level is so high! Did you encounter any difficulties when operating on the patient?"

Zhou Can took the opportunity of the last operation.

Because the patient is now in the second palace, the doctor who performed the surgery last time was worried about losing face, and might deliberately conceal some things.

But it is possible that it is precisely these hidden things that may be the key reason for the occurrence of esophageal fistula.

"If you want to talk about difficulties, I really encountered some. At that time, I remember that after the chest was opened, there were many food residues in the patient's chest cavity, including a mixture of alcohol and various foods, which smelled very strong."

Director Tan tried hard to recall the last scene.

"When cleaning the chest cavity, I took a lot of effort to clean up the food residue in the chest cavity with my assistant, and then flushed the chest cavity. When suturing the torn esophagus of the patient, I felt that his esophagus was bigger than that of ordinary people. It is much harder. According to experience, the esophagus is hard and often very brittle, so in order to prevent secondary tears during the repair, I deliberately adopted a relatively safe suture with a very close spacing between the needles. But I did not expect that it would end up after the operation On the third day a fistula formed."

Talking about the problems after the operation, Director Tan seemed quite aggrieved.

More is not reconciled.

That's how it is sometimes.

The chief surgeon and other medical staff have obviously put great effort into performing surgery on the patient, and the level of surgery is not a problem at all, and the experience is also very rich.The postoperative care is also cautious, but the sky fails, and the patient has postoperative complications.

There's really no way to completely avoid this.

"The information you provided is very valuable. I suspect that the patient has an esophageal fistula, which has nothing to do with the quality of the operation. It is entirely a problem with the patient's own physique. Have you ever done an esophageal endoscopy for the patient?"

While comforting the other party, Zhou Can was more sure that there was a problem with the patient's esophagus.

If the fistula is repaired without a clear investigation, a second esophageal fistula may form again.

At least according to his clinical operation experience, he should check the inside of the esophagus and stomach.

"I was in a hurry to save people at the time, so I really didn't check it."

Director Tan's eyes flickered and he shook his head.

In fact, the patient's esophagus was torn, and it was not easy to do endoscopic exploration.

"Hey, I don't think the patient has been intubated yet. Why don't I check the patient's gastroscope first, Director Hei, do you think it's okay?"

Zhou Can was very smart, he didn't ask Song Qian and Director Tan for their opinions at all, but asked the anesthesiologist directly.

To put it a little darker, until now, he has never given up his vigilance against the No. [-] Hospital.

In fact, not only him, I believe that every doctor who visits will be more careful.

This is especially true when the main knife is needed.

"can."

Director Hei nodded in agreement.

"However, special care must be taken during the operation. The patient's esophageal wall should be very fragile and easy to puncture."

Out of responsibility for the patients, she gave a kind reminder.

If she knew Zhou Can's endoscopic surgery skills, she probably wouldn't have said that.

The gastroscope was pushed over quickly, and there was basically no need to do additional preparations.Zhou Can operated the endoscopic probe and inserted it into the patient's esophagus little by little.

When doing this test, try to keep the patient's head in a reclined position.

Because the throat of the human body is actually a bend.

Try to tilt your head back so that your throat forms a straight line with your trachea and esophagus.Conducive to doing checks or inserting gastric tubes and other operations.

As the endoscope penetrated a little bit, Zhou Can stared at the display screen.

The inner wall of the esophagus can be seen clearly.

"His esophagus has an ulcer!"

Zhou Can found some traces of ulcers, and secretly guessed that this should be an important reason for the formation of esophageal fistula.

The human esophagus is actually much thinner than imagined.

Because it is elastic.

When a patient suffers from alcoholism for a long time and often eats a variety of heavy-tasting foods, the esophagus gradually loses its elasticity and becomes fragile in the repeated devastation.

The patient's esophagus was the worst case Zhou Can had ever seen.

With the deepening of the gastroscope, the situation in the stomach also came out.

The results of B-ultrasound and CT were similar to those of the previous B-ultrasound and CT, and the situation in the stomach was still ideal.

No particularly serious problems were found.

There are some superficial gastric ulcers, which can be controlled and recovered slowly as long as you take medicine and eat a reasonable diet after surgery.

Gastric ulcers are particularly prone to cancer if they occur for a long time.

This is not alarmist talk, but caused by its special environment.

People have long-term oral ulcers, if they are in the same place every time, and it is difficult to heal after the ulcer occurs, this requires a high degree of vigilance.Oral cancer is very easy to occur.

According to a scientific research survey and statistics by the International Health Organization, patients with oral ulcers that do not heal for a long time often indicate low immunity.

Such patients are more prone to oral cancer.

It is currently recognized in China that chewing betel nut is an important cause of oral cancer.Because chewing betel nuts can cause fibrosis inside the mouth.

In many serious patients, when the cancer is discovered, the mouth can only open half of the normal size.

Stomach cancer is the most easily overlooked as oral cancer.

Occasional stomach pain, bloating, and stomach burning sensation, many people just endure it and pass it.As everyone knows, this may be a warning signal before cancer.

(End of this chapter)