My medical skills add experience

Chapter 630 The gray matter is to blame, this is a feeling

There was not much hemorrhage in the cranial cavity.

Typically, there are two sources of hemorrhage during craniotomy.One is that the patient had intracranial hemorrhage before surgery, resulting in effusion.The other is intraoperative bleeding, which is caused by surgery.

Zhou Can's incision technique is already at the level of a director, and his hand feeling is even more insanely strong.

It can identify blood vessels, nerves, tendons, etc. one by one.

This kind of hand feeling ability is by no means possessed by ordinary surgeons.It is often only possible to have it if the surgical experience is extremely rich and the level of incision is above the chief physician.

Its functions and benefits go without saying.

It allows the surgeon to minimize surgical bleeding during the operation.

Zhou Can is now undergoing various major operations, and the bleeding control is enough to make every doctor feel envious.

Others do a caesarean section, bleeding at least 300ml or more.

If Zhou Canlai operated the operation, not only would the operation be extremely fast, but the amount of blood loss would be pitifully small.In laparotomy, he can generally control the bleeding within 100ml.In fact, his laparotomy bleeding is usually less than 50ml.

This is not just as simple as cutting the abdominal cavity, but also includes intraoperative resection of abdominal tumors or appendixes and so on.

In the eyes of ordinary doctors, this is almost unimaginable.

Because it is too difficult to achieve so little bleeding.

It can only be said that surgery requires not only good skills, but also experience.

Before resecting a certain lesion, Zhou Can can clearly know which large blood vessels are around the lesion, and those that need to be ligated should be ligated in advance.For small blood vessels, he can directly electrocoagulate them to stop bleeding during the operation.

"The source of the bleeding was found, it was a broken artery."

After the accumulated blood was drained, the bleeding point was clearly visible.

Of course, finding the bleeding point is completely logical and easy for Zhou Can to operate.It took almost no effort and time to find the source of bleeding easily.

But for someone else to be the chief surgeon, unless it is the chief physician of neurosurgery like Wu Baihe, most people can't reach this level at all.

Seeing things is easy but doing things is difficult.

Watching Zhou Can operate with ease, but if other doctors on the scene are operating, it is likely to be nervous as if facing a big enemy, and may even jump around and cause various problems.

When performing such a fatal major operation, it is definitely the patient's luck to have surgeons of the level of Zhou Can and Wu Baihe perform the surgery.

Zhou Can didn't ask Wu Baihe at all this time, and directly electrocoagulated the bleeding point to stop the bleeding.

The blood vessels are not large, and the blood supply route is highly replaceable.

After electrocoagulation of this small artery to stop bleeding, this blood pathway is blocked.But don't worry, there is an extremely rich vascular system in the body, they are densely packed like tree roots, covering every corner of the body.

After this artery is blocked, other adjacent arteries and thinner blood vessels will automatically take on new blood supply tasks.

It won't be long before a new blood path will be formed.

However, larger blood vessels cannot be easily electrocoagulated or ligated to stop bleeding.Sometimes you have to find a way to fix it.

Because the larger blood vessels are equivalent to the main root of the tree root, if one is cut off, one will be missing.

It is difficult to form a new alternative blood route in a short period of time.

This can lead to rapid necrosis of ischemic organs and tissues, or severe impairment of function.

"Hey, there seems to be a narrowing and occlusion of a blood vessel here."

Zhou Can's words caught everyone's attention.

When everyone looked at the developing screen, they could only see the crimson intracranial tissue, and the white part was the brain.Blocked blood vessels are not visible at all.

Wu Baihe kept staring at the screen.

He himself assisted Zhou Can in the operation.

Some brain tissue needs to be pulled away, which is basically done by him.

Wu Baihe exhausted his eyesight, but he still couldn't find the problematic blood vessel.

"where?"

He could only lower his face and ask.

Don't think that these top chief physicians don't care about anything, what they care about most is face.Especially their authority and status in the field they are good at is even more important.

People, who have studied a certain field for most of their lives, must be proud of their achievements in this field.

Everyone is also mortal with naked eyes. Zhou Can has decades less medical experience than Wu Baihe, but Zhou Can discovered the problem, but Wu Baihe did not.He definitely couldn't hold it on his face.

What's more, he also called some of his team members over.

There are doctors and nurses, and they all respect and worship him like a god on weekdays.

Now that he is at a disadvantage, what do the doctors and nurses under him think of him?

"Actually, I was just guessing. Do you think there is a problem with this piece of gray matter?"

Zhou Can peeled away part of the brain tissue in order to allow Wu Baihe to gain a larger field of vision and see more clearly.

What he said was just to save face for Wu Baihe.

Which doctor will guess whether a certain blood vessel is diseased when performing an operation?

It's hard to even guess.

Wu Baihe stared at the gray matter of the brain and observed carefully, and soon discovered the problem.

"Atrophy, seems to show signs of degeneration... This is obviously a problem with the nutritional supply. From an anatomical analysis, this gray matter has only one large artery to provide blood supply, and two venous circuits..."

As he spoke, Wu Baihe's eyes suddenly lit up.

Yes, there must be something wrong with the arteries supplying blood to this gray matter of the brain.

Only then did he realize that Zhou Can was giving him a step down and helping him save face.

"Enlarge the examination film of the patient's head. I knew that I should have a color Doppler ultrasound to be more accurate, but the CT film can barely do it."

One of the biggest advantages of color Doppler ultrasound is that it can scan the blood flow in blood vessels in real time.

It is used to check whether the blood supply of blood vessels is smooth, and its accuracy and diagnostic significance are even stronger than many high-precision instruments.

Some young doctors blindly advocate the high definition and high accuracy of MRI.

In fact, this is an incorrect clinical diagnosis thinking.

Color ultrasound, B-ultrasound, and X-ray each have their own advantages. They can be used all the time and have not been eliminated. Naturally, they have their merits.

It only costs more than 100 yuan for a patient to take a color Doppler ultrasound, how much is it for an MRI?
At least a few hundred, higher precision is as high as more than 2000 yuan.

To check whether the blood vessels are unobstructed, apart from CT angiography, there should be no other inspection method that is more intuitive than the diagnosis of color Doppler ultrasound.

Wu Baihe stared at the CT scan of the patient's head and examined it carefully.

"Enlarge this place a little more."

After zooming in and looking at it for a while, Wu Baihe still couldn't make up his mind.

"The patient also had a head MRI done in another hospital, right? Check it out too."

He looked very serious.

Even though the problem has been discovered under Zhou Can's reminder, he still wants to obtain inspection data to support it.This is also the inertial thinking of most old doctors.

Just two words, sure.

Why do you say this way?
Because many old doctors have been sued by patients and their families, when they go to court, they must talk about evidence!

When the doctor defended, no one would believe what he said with empty teeth.

At this time, provide the inspection data, and then tell the judge or the staff of the competent department that the basis for my treatment of the patient is based on the inspection data.I strictly followed the medical protocol.

Then the leaders saw that it was indeed the case.

As long as it is found that the doctor is not at fault in the diagnosis and treatment, the lawsuit will basically be won.

Surgery has strict indications.

Doctors can't think that there is a problem with the artery that supplies blood to the gray matter in the patient's brain, so they can directly perform surgery on others to solve it.

That's definitely not in the rules.

The problem has to be identified from the inspection data before deciding on a surgical solution.

The presence of lesions in this blood vessel was not found before the operation, which is actually considered a missed diagnosis.

However, this is very common in clinical operations.

Some lesions are so hidden that even experienced doctors can't easily find them.

There is a test called an intraoperative exploration.

Just in the operation to further explore the lesion site.

It can also be seen from this point that doctors have great power in surgery.The rules and regulations in various aspects are relatively loose for doctors' operations.

Quite a bit of strict access, which means completely delegating power after starting the operation.

This is basically an unspoken rule in current medical operations.

However, in recent years, the competent authorities have also formulated some stricter regulatory systems.For example, during the operation, nurses, anesthesiologists, and medical assistants all need to sign for confirmation.And the operation process will be accurately recorded.

If the records are not standardized, or if something is concealed, after finding out, not only the doctors and nurses involved will be held accountable.

And even hospitals are punished.

It's just that the hospital is for doctors and nurses after all. If there is any problem, it is usually dealt with behind closed doors.Therefore, it is almost impossible to achieve real transparency in the operating room.

It’s like installing surveillance in kindergartens. Parents ask to check how the teacher teaches their children at any time. I’m afraid no kindergarten dares to agree.

"County-level hospitals are just unreliable, and they can't even do an MRI. At this level, their medical technicians should be laid off and retrained."

Wu Baihe complained that the MRI of the county-level hospital was not done well.

Everyone was silent.

Some people are smiling.

"Although the examination is a bit blurry, it can be vaguely discerned that the blood vessel is indeed narrowed, and it looks quite serious. This blood vessel is not big, and the blood supply task of supplying blood to the gray matter of the brain is usually light. I didn't expect it to be able to Something went wrong, but we were negligent before the operation. Director Zhou, how are you going to deal with this narrow artery?"

Found the problem, the next step is to deal with it.

There are two sets of solutions.

Zhou Can also had some troubles.

"Placing a vascular stent will be safer and faster, but the cost may be higher. The cost of directly replacing this section of blood vessel will be lower, but the operation is difficult, the risk is high, and the trauma to the patient is also great. The current condition of the patient is very serious. Weakness, I am afraid it would be better to choose to place a vascular stent.”

After deep thinking, he finally leaned towards a more comprehensive and costly treatment method.

This is basically the choice of all doctors.

Because everyone doesn't want anything to happen.

"I also tend to place a bracket to solve it. The tour teacher adjusted the bracket urgently according to Director Zhou's needs."

"Ok."

The itinerant nurse asked Zhou Can the specific size of the bracket, and immediately called to start adjusting the length.

"Director Wu, let me check here. If there is nothing wrong, the endoscopic surgery will be over." Zhou Can greeted.

"Ah."

Wu Baihe nodded.

Zhou Can secretly sighed in his heart, fortunately he didn't check the brainstem directly when he came up.

Who would have thought that the problem is not in the brain stem, but in the gray matter of the brain.

The patient's thalamus is bleeding, which leads to an increase in intracranial pressure, which then further compresses the already narrowed artery.The blood supply to the gray matter of the brain is almost blocked, which is the main reason for the patient to become unconscious.

The truth is now out in the open.

The next step is to do interventional surgery, place a vascular stent, and dredge the almost occluded artery.

"Director Qu, has the patient's brain wave changed?"

Before Zhou Can removed the endoscope, he was still a little worried.

"Brainwaves have become a little more active and seem to be recovering."

she replied.

Under general anesthesia, brain waves are actually relatively calm.However, as the accumulated blood in the patient's brain was pumped out, the bleeding stopped, and after the intracranial pressure decreased, the compressed arteries slowly bounced up, and the blood supply recovered a little.

Gray matter functions that had nearly ceased were restored again.

"It seems right, it's the gray matter in the brain that caused the trouble." Zhou Can felt more confident in his heart.

……

Interventional surgery is Zhou Can's forte.

The entire stent placement process took less than 10 minutes.

At the end of the operation, the patient had severe stenosis, and the nearly occluded artery was dredged and blood supply was restored.

After waking up from the anesthesia, good news came.

The patient has woken up from a coma.

After several twists and turns, the risky intracranial surgery was finally a complete success.It also gave Zhou Can a deeper understanding of intracranial surgery and neurosurgery.

He deeply felt that there is no limit to medicine, and he can never finish learning in a lifetime.

"Director Zhou, please tell me, how did you find out that there was a problem with that artery during the operation?"

Shenwai is a doctor in his 40s, his hair is half white, and he looks very down-to-earth.

After the operation, he took the opportunity to ask Zhou Can for advice.

Watching Zhou Can perform intracranial surgery today shocked him in many ways.

I also have a deep understanding of what it means to be a surgical master.

Whether it is craniotomy, hemostasis in the cranial cavity, or finding lesions, Zhou Can's various endoscopic operations have opened their eyes.What surprised them most was that Zhou Can discovered that there was a problem with the artery.

Only a small portion of the gray matter was visible at the time.

He thinks it is possible to infer arterial lesions from the gray matter of the brain, but it is very small.

At least even their teacher, Wu Baihe, came to this diagnosis after carefully observing the brain tissue for a long time.

"Would you believe me if I said it was a feeling?"

Zhou Can looked at this dear friend.

There are many doctors with a few gray hairs in the clinic. They are under a lot of pressure to study, to do scientific research, to take postgraduate entrance examinations, and even more clinically after practicing medicine.

Sometimes when a critically ill patient is received, the doctor is not the family member who worries the most.

Every doctor who has gray hair at the age of 40 or [-] is worthy of respect.

Because they put all their body and mind into the cause of medicine, contributing their meager strength to promote the medical progress of mankind.

"I believe! Can you tell me more about it? I really want to have this feeling."

After the doctor finished speaking, other doctors, even nurses, surrounded him.Surround Zhou Can in the middle like stars holding the moon.

"You guys should go back to rest after asking Director Zhou for advice. You have worked hard today. I am getting old, so I will go home and sleep first." Wu Baihe was actually a little uncomfortable.

Today's operation, he is by the side to check for Zhou Can.

He even called most of the elites of the entire team over to help.

Unexpectedly, it became Zhou Can's home show.

To say that jealousy is definitely not enough, but his authority as a leading fighter has been shaken to a certain extent, that's for sure.

(End of this chapter)