From small clinic to medical empire

Chapter 233 Wang Bin's Confusion

Although it is wrong to say that, it is even a bit disrespectful to patients.

But when Zhang Zifan looked at an open skull up close for the first time from a coronal view, the pink brain tissue inside really reminded people of a fresh monkey brain.

Especially in order to fully immobilize the patient's skull, the entire head is firmly fixed by a grill-like head frame, which makes people shudder to watch.

Even a professional like Zhang Zifan, who has sufficient experience in cranio-maxillary surgery, will be heartbroken when he sees such a scene. If ordinary people observe it, it will indeed leave a lifelong shadow.

This may be one of the reasons why most operations in modern medical institutions do not allow unrelated personnel, including patients' family members, to watch.

Not only to prevent disputes, but also to protect the hearts of family members.

This has to mention how ignorant European medicine was in the barbaric era.

Nowadays, at any rate, everyone still wants to watch the surgery of their loved ones through the screen.

In the past, doctors in Europe performed their skills in public and even charged tickets.

That's right.

They have no concept of sterility at all, no privacy protection.

The midwives in the East still know how to find a clean room and get a basin of clean hot water.

But these European doctors who firmly believe that "a gentleman's hands must be clean" not only never wash their hands all year round, but also choose to perform operations in the lecture hall of the university, the city theater, or the so-called "operating room" that he personally owns.

Patients who need surgery, without anesthesia, are used by doctors to use various instruments of torture that can be seamlessly connected to the top ten tortures of the Qing Dynasty. Oh no, the surgical instruments are slaughtered in public.

The audience watching the operation cheered and applauded along with the howling of the patient in pain.

Rather than saying that they came to see the operation, it is better to say that they came to see the horror show.

Of course, unlike a horror show, a doctor who tortures a patient to death on the spot will not be well received.

Everyone is more willing to give applause and honor to those surgical masters who have the least bleeding but cut the largest limb area.

If the current Zhang Zifan could travel back to that era, he would definitely become the most famous doctor in Florence and Venice.

At this time, he carefully separated the subarachnoid structure under the microscope using micro scissors.

This is different from the requirements of many surgeries.

For example, operations on head and neck glands such as the thyroid gland and parotid gland generally require the operator to separate the loose tissue as much as possible by blunt dissection.

The so-called blunt dissection is simply to separate the tissue without using scissors or cutting.

Instead, use vascular forceps, knife handles, the blunt side of scissors, or the doctor's fingers to stretch, squeeze, and slightly tear off the tissue bit by bit.

Corresponding to blunt separation is sharp separation.

Sharp separation is very simple. It is just a literary term for cutting and cutting with a scalpel or scissors. It is essentially the same thing.

Clearly, there are many benefits to blunt dissociation.

First, it can reduce the risk of rupture of microvessels, nerves, and muscle fibers.

Anyone who has eaten beef jerky knows that it is easy to bluntly separate the beef fiber along the texture, but it is very difficult to destroy the fiber and tear it perpendicular to the direction.

Second, and more importantly, blunt dissection minimizes tissue bleeding.

Bleeding is always the surgeon's worst enemy.

Whether it is bleeding that causes blood volume to drop, or bleeding that affects local vision, or spilled blood that causes local airway blockage, it is a headache and dangerous thing.

"The first surgery in XX Hospital", this kind of appellation is usually called out by the nurses in the operating room.

The doctors who have won this honor are not only familiar with human anatomy, but also have excellent blunt dissection techniques.

Of course, blunt separation technology also has limitations, and there are always some places that must be cut.

Therefore, in clinical practice, in most cases, the combination of the two is used, and blunt dissection is preferred.

But when it comes to brain surgery, things are reversed.

The reason is simple, blunt dissection is essentially more damaging than sharp dissection.

A cut in the tissue, as long as it does not cut nerves and blood vessels, it will heal in four or five days, and the damaged area is very limited.

However, if it is a stretch injury, crush injury, or even local tissue tear caused by blunt separation, it may not be able to heal within half a month.

The aggravation of this kind of injury is indifferent to most operations, anyway, the advantages far outweigh the disadvantages.

But brain surgery is different.

Brain tissue is too fragile.

It doesn't matter if the muscles and connective tissue are crushed, even if they are crushed, the brain tissue is not.

The brain is the most fragile organ in the human body.

The reason why the human body has an extremely hard skull is to prevent the brain from being damaged by external forces.

Any improper extrusion may cause serious consequences, such as iatrogenic epilepsy.

In conclusion, the brain is a delicate and extremely important organ that must be treated with care.

……

To be honest, the neurosurgeons who have dealt with in the past few years are not mediocre, so the tissue on the surface of Schumacher's cerebral cortex has been repaired.

But for neuron reconnection, it can be said that no one in the world is better at it than Zhang Zifan.

In the first half hour of the operation, with the help of microscopic instruments, Zhang Zifan sharply separated the damaged tissue and reconnected it tightly.

However, in Wang Bin's view, the scene is very strange.

First of all, he found that even without his own guidance, Zhang Zifan could always find the original repaired wound area very accurately.

In some areas, even Wang Bin himself didn't find any traces of repairs due to the lack of vision, but Zhang Zifan still found them quickly.

This shows that either Zhang Zifan has an extraordinary understanding of the anatomical structure of the brain, or he has other secrets.

The former can basically be ruled out, because if that is the case, Zhang Zifan has no reason to ask himself to open the brain.

Then the only possibility is that Zhang Zifan does have his own unique judgment skills for nerve damage.

This reminded Wang Bin of Kong Xiang's paper "Clinical Application and Related Evidence of Analysis of Nerve Tract Properties".

In this relatively rough paper, Kong Xiang proposed a method to initially distinguish the nature of the optic nerve under microscopic conditions.

Wang Bin has read this paper, but has doubts about the feasibility of this method, because it has no quantitative standards at all.

There are countless schools of clinical judgment methods in the world.

Once there is a lack of quantitative standards, it will naturally be questioned.

Take the pulse diagnosis of traditional Chinese medicine, which is the most talked about and constantly cited as an example.

In Wang Bin's view, in essence, pulse diagnosis is to touch the patient's wrist to feel the pressure changes on the wall of the radial artery caused by the beating of the heart.

Therefore, from many perspectives, pulse diagnosis is equivalent to listening to the heartbeat with an earpiece, and the latter is obviously more intuitive.

At most, your fingertips are extremely sensitive, and you can feel information such as blood vessel elasticity and blood viscosity.

But at best, this is just a glimpse of the leopard and a part of the information of the cardiovascular system, which is far less valuable than the valve information contained in the heart sound.

It is completely unrealistic to rely on this to judge the condition of a person's whole body.

Wang Bin felt that the clinical classification method for the nature of the optic nerve tract proposed by Kong Xiang was also unreliable.

Although Kong Xiang said in the paper that after a period of training, the correct rate of judgment can be increased to more than 63%.

He even designed a double-blind test and attached the results to the paper.

But in Wang Bin's view, there are only more than 20 cases in this experimental study, the sample is too small, the P value is too large, and the regression degree is not enough.

There are only two kinds of optic nerves, and the correct rate of blind guessing is 50%. It is not surprising that if you are lucky, it will reach 63%.

But seeing Zhang Zifan's quick and skillful judgment, Wang Bin's faith was a little shaken.

In fact, if you put aside your initial prejudices and think about it carefully, the basic examination methods commonly used in modern medicine, such as listening to heart sounds, breath sounds, and percussion, are also full of subjective judgments.

Whether an atypical percussion sound is voiceless or voiced still requires long-term study and experience accumulation by the doctor.

(End of this chapter)