Chapter 505: Solutions to side effects, innovative surgical ideas
Anesthesiologist Ziqu and anesthesia nurse Qin Yue walked into the operating room together.
Although the reform of the Anesthesiology Department is still in the pilot stage, the two of them have basically been tied together with Zhou Can.
In other words, now whenever there is anesthesia surgery in the emergency department, both of them will be given priority care.
In the operating room of the emergency department, Dr. Xu basically has the final say.
Dr. Xu regards Zhou Can as his successor, and basically all affairs are centered around Zhou Can.
Zhou Can and Ziqu reached a consensus and formed a pair. Dr. Xu's attitude towards this matter was tacit approval and support. Whenever there was anesthesia surgery, he would directly ask Ziqu for help.
"What's wrong with this patient?"
Zhou Can asked Ziqu.
The anesthesiologist must have a detailed understanding of the patient's condition, physical condition, drug allergy history, etc. Before the operation, it is also necessary to talk to the family members and sign an informed consent form for anesthesia.
Usually, the anesthesiologist and the surgeon will discuss the patient's condition and determine the surgical plan.
Zhou Can is really busy today.
It is estimated that Dr. Xu drew up the surgical plan on his behalf and Ziqu.
"The patient has a stubborn duodenal ulcer and has very high stomach acid. I guess the fever made her feel uncomfortable. In addition, she is generally allergic to proton pump inhibitors. Her physique is quite special, so surgery is the only option."
Excessive stomach acid will burn the mucosa and stomach wall, duodenal mucosa and intestinal wall. The most common symptoms are heartburn, stomach pain, discomfort, nausea, loss of appetite, etc.
Duodenal ulcer, if there is no special cause, is often easier to cure.
However, there are a few patients who suffer from recurrent ulcers that cannot be cured.
At this time, it is necessary to further investigate the cause of duodenal ulcer.
The great thing about Western medicine is that it will treat whatever is wrong with you.
If the blood pressure is high, the blood pressure can be quickly lowered after taking antihypertensive drugs. If there is respiratory failure, the patient can be put on a ventilator directly. If the blood vessel bursts, surgery can be performed immediately to stop the bleeding and repair the blood vessel.
In short, as long as the cause of the disease is found, Western medicine can always find a solution.
Even terminal diseases like cancer have been conquered in many ways, and progress is still being made.
With current technology, as long as cancer can be detected in its early stages, very satisfactory treatment results can usually be achieved.
"High stomach acid is often related to excessive secretion of stomach acid. Do we need surgery to reduce her stomach acid secretion now?"
"good!"
Doctor Xu walked in.
"Which surgical option do you think is best?"
Dr. Xu probably wanted to not only test him, but also listen to Zhou Can's opinion on the surgery.
Now Zhou Can can give unique insights into many operations and even some novel surgical plans.
"Well...if it's a stubborn duodenal ulcer caused by excessive stomach acid, I think cutting the vagus nerve is a good option."
After thinking carefully, he gave surgical advice based on the patient's actual situation.
"Not bad. Your surgical skills and ideas are getting better and better."
Dr. Xu was full of praise.
His surgical plan is likely to be the same as Zhou Can's.
This is also the most commonly used surgical option for treating this disease.
Of course, we cannot apply it blindly, but must base it on the patient's actual situation.
The purpose of cutting the vagus nerve trunk is to block the gastric acid secretion caused by the vagus nerve, reduce the amount of gastric acid, and thus achieve the purpose of curing duodenal ulcer.
It must be pointed out that cutting the vagus nerve trunk is only a last resort surgical option. After it is cut, it will cause a series of side effects.
For example, the vagus nerve has an acid-supporting effect on the stomach wall muscles.
Once it is cut off, it can no longer control the stomach wall muscles, which will cause the stomach wall muscles to lose all functions, including contraction, expansion, and peristalsis.
The stomach is an important digestive organ in the human body and also an important organ for storing food.
Its role in the body is self-evident, and it can be called a 'granary'.
When it loses the above functions, a variety of adverse reactions will occur.
For example, patients may experience severe gastric emptying disorders and food retention.
Because the side effects of this surgery are so severe, it is basically not used clinically unless it is absolutely necessary.
Excessive gastric acid secretion is currently mainly treated clinically with drugs that inhibit gastric acid. Proton pump inhibitors and H2 receptor blockers are the two most commonly used drugs.
Omeprazole, rabeprazole, lansoprazole, etc. are commonly used drugs in clinical practice.
They are quite effective in inhibiting gastric acid secretion.
However, if you encounter a patient who is allergic to such drugs, or has a special body type that cannot absorb them, you can only think of other ways.
Cutting the gastric vagus nerve is very appropriate for this patient.
After the patient was given general anesthesia, a urinary catheter was inserted and the operation officially began.
Because the operation was quite major, Dr. Xu was somewhat worried and stood by to assist Zhou Can.
He now rarely instructs Zhou Can on the specific steps of the operation, and just does it purely as a pretext, letting Zhou Can handle it himself as much as possible.
After opening the abdominal cavity, use an automatic abdominal wall retractor to pull open the abdominal wall.
The ulcer site is then explored.
Only after the position is determined can the next step of preparation for the cutting operation be carried out.
This patient has a rather severe duodenal ulcer.
No wonder he kept humming when he was brought in for surgery.
The pain and discomfort of the human body are not only unbearable during childbirth.
For example, trigeminal neuralgia is the highest level of pain recognized by medicine. Or when more than one-third of the airway is blocked, the suffocating feeling will also cause severe pain to the patient.
This patient's duodenal ulcer is so severe that it's almost perforated. It would be strange if he didn't hum.
Stomach acid is more corrosive than you might think.
It can easily destroy the stomach, duodenum, and pylorus.
The power is no weaker than that of ordinary strong acid.
"Yang Zhi, Ding Dong, when you perform this type of surgery, you must be careful to cut the gastric vagus nerve above the junction of the esophagus and stomach. Otherwise, you will not achieve the desired surgical effect."
Zhou Can explained the key points of the operation to the two of them.
He also learned some surgical techniques and key points from the notebook of Deputy Director Liu of General Surgery.
After determining the position, Zhou Can began to quickly free the left lobe of the liver.
He directly cut the triangular ligament and then instructed Yang Zhi to pull the patient's left lobe of the liver to the upper right. At this time, the lower esophagus and the cardia were all exposed to the surgical field of view.
He quickly cut open the serosa at the lower esophagus and the cardia, separated the upper part of the hepatogastric ligament and cut it directly.
All his movements were extremely quick, and it was a complete enjoyment for the onlookers to watch him perform the surgery.
Next, release the lower esophagus.
He reached out and felt the anterior wall of the esophagus, searching for the vagus nerve.
In medical books, blood vessels are usually marked in red and nerves in yellow.
However, in actual surgery, the color of nerves is often not much different from that of surrounding tissues. At this time, the surgeon needs to have rich surgical experience and can find them directly by feeling with his hands.
Zhou Can quickly felt a nerve in the left front of the esophagus.
It is the left vagus nerve.
He then felt around the right back of the esophagus and located the right vagus nerve.
At this time, I already had a rough idea in my mind.
"There are two vagus nerves in this area, left and right. You must be careful to confirm them during the operation."
After two people wash their hands, put on sterile gloves, and feel the patient's esophagus and surrounding tissues to find the vagus nerve.
Practical experience is invaluable.
Some surgeons do not want to cause any unnecessary trouble or waste time when guiding students. Basically, they just point to the corresponding anatomical parts and explain while performing the operation, and never let their doctors do it themselves.
Just imagine, can the students trained in this way be successful?
Many surgical residents who have worked for several years still act like novices during dissection. It is not necessarily because they did not study hard, but because their teachers did not teach them well.
There are too few opportunities to practice.
"I think I touched it. It feels very special, like a fiber belt."
Yang Zhi was the first to touch the vagus nerve.
After touching the suspicious part, he immediately asked Zhou Can for confirmation.
"Dingdong, you try it too."
Zhou Can said to Pu Dingdong.
In terms of talent, Pu Dingdong is equally good, and he is more pragmatic and meticulous in doing things than Yang Zhi.
Zhou Can was quite satisfied with his two medical assistants.
Both of them usually perform very well.
After Pu Baodong felt around for a while, he was able to find both the left and right vagus nerves. He also carefully identified them with his naked eyes.
"Okay, now watch me remove the vagus nerve."
Zhou Can carefully separated the vagus nerve from the esophagus.
Then he instructed Yang Zhi to use a nerve hook to pick up the nerve.
Then continue to separate the nerve with scissors.
Not with a knife, but with scissors.
After separating a length of five or six centimeters, the gastric vagus nerve trunk can be removed.
The length of the resection cannot be too short, generally requiring a length of two to three centimeters. The resection of the other vagus nerve trunk is done in a similar manner.
At this point, the gastric vagus nerve trunk has been resected.
"Xiao Zhou, after the patient's gastric vagus nerve trunk is cut, food is easily retained in the stomach. Do you have a good way to solve this problem?"
Dr. Xu was watching from the side and didn't easily make a sound to interfere.
Now that the operation is almost completed, he brought up the issue of solving the postoperative side effects.
"Pyloroplasty should be able to solve the problem of gastric content retention."
Zhou Can had already figured out the solution.
"It seems that you are very careful in general surgery. Hurry up and do it!"
Dr. Xu was very satisfied with his answer.
Zhou Can did not delay any longer and performed pyloroplasty on the patient.
In addition, after cutting the vagus nerve, he also sutured the patient's diaphragm on both sides to repair the diaphragmatic hiatus. This was done to prevent the formation of diaphragmatic hernia.
During the suturing of the diaphragm, it is quite difficult because the diaphragm legs on both sides need to be brought together and then suturing.
The requirements for suturing and ligation are very high.
He also earned a lot of experience points in suturing and ligation.
Every time he sterilized a woman, he could get a lot of sterilization experience points as a reward. In order to earn as much sterilization experience points as possible, he worked extra hard.
After the operation, his ligation experience points increased to more than 94,000, which was very close to 100,000 experience points.
Under normal circumstances, he would need to perform sterilization on the patient about 6,000 times before he could successfully advance.
However, if he could encounter some surgical tasks such as suturing the peritoneum and meninges, or some surgical sites with extremely high ligation requirements, his promotion time would definitely be greatly shortened.
After all, you still need to perform more major and difficult surgeries to have a chance to earn large experience value rewards.
"Dingdong, you come and close the patient's abdomen!"
Yang Zhi’s level of abdominal cavity closure has now reached a very high level.
His own surgical skills were not bad, and after following Zhou Can for so long, he had plenty of opportunities to practice. His surgical skills also improved rapidly.
Pu Dingdong's surgical skills are relatively poor.
Zhou Can treats every doctor under him equally in his training.
There is no favoritism.
Seeing that the operation had entered its final stage, Dr. Xu left with peace of mind.
"Doctor Zhou, should we wait for Doctor Pu to finish stitching up the abdominal cavity, or should we switch to another station for surgery?"
"You and Qiao Yu go to the other operating room to set up the table. I'll stay here for a while."
"OK!"
Ma Xiaolan and Qiao Yu went to another operating room to set up the table.
Usually in the afternoon, Zhou Can is the busiest person in the emergency operating room.
Doctor Xu works leisurely every day. Only the stronger surgeons are qualified to perform surgery in this Class 100 operating room. The less skilled surgeons basically perform surgery in the old operating room.
Therefore, in the class 100 operating room, there will basically be an empty operating table in the afternoon.
Zhou Can watched Pu Dingdong suture the patient's abdomen, but there was actually nothing particular to worry about.
Pu Dingdong's suture skills are quite good and he is very serious in his work.
The abdominal dissection of this patient was completed by Zhou Can. The incision was smooth and the suturing difficulty was relatively much lower.
Both the inner and outer layers are easier to sew.
As he watched, his thoughts gradually drifted to the patient who had come from Shanghai specifically to see him for treatment.
The tear strip of the aortic dissection in that patient was too long.
Apart from replacing the aorta, it is difficult to think of any other good solution.
But the gastric vagus nerve resection surgery he just performed gave him some inspiration.
When cutting the vagus nerve, it is necessary to cut it from the head trunk to achieve the ideal therapeutic effect.
In order to solve the problem of gastric content retention, the pylorus is treated with an angioplasty.
It is equivalent to treating the bottom of the stomach and solving the problem.
So, can the patient with aortic dissection also find a solution from the end of the aorta?
There are major differences in how blood vessels and nerves work.
Nerves mainly conduct bioelectric signals.
This electrical signal is very complex.
If the circuit is connected incorrectly, it may directly cause a short circuit or other unpredictable problems.
Each nerve conducts electrical signals differently.
They form complex neural instructions.
But the blood vessels are different , but the blood inside them is no different.
The skin on the head and the blood on the soles of the feet can be used interchangeably.
The blood in the human body circulates continuously.
As long as you don't confuse arterial and venous blood, you'll basically be fine.
He seemed to have grasped an opportunity.
Find a way from the end of the aorta, while arterial blood is available throughout the body.
A bypass surgery might be a very good, but somewhat crazy, surgical idea.
A bypass surgery is sometimes used to treat heart disease.
This is not a new idea.
However, the idea of bridge the aorta from the end to the upper end to transport blood back to the end is still quite innovative.
The diseased aorta is a long segment involving at least four arterial branches, which supply blood to important organs or other important parts of the body.
Cutting them off doesn't work, so finding a way to connect the blood at the end of the aorta and anastomose it with these branch blood vessels to form a new blood supply pathway may be a completely new surgical idea.
