Chapter 556: Preoperative understanding of the two most easily overlooked cancers
"This is Director Tan Shengli from our Department of Gastroenterology!"
Song Qian took the lead in introducing a middle-aged man who was in the lead.
"This is Dr. Zhou Can from Tuya, and this is his operating nurse Jiang Wei, a returned overseas doctor. This is his colleague, come and learn from him."
When the three people were introduced, Zhong Ming was placed last.
I never asked Zhong Ming's name during the whole process.
If it weren't for Zhou Can's sake, Zhong Ming wouldn't even be able to enter the operating room.
"I've long heard of Dr. Zhou's name. Thank you for your help!"
Tan Shengli did not shake hands with Zhou Can, but nodded and smiled to greet him.
In the operating room, everyone can talk and physical contact rarely occurs. In theory, the parts above the waist need to be kept sterile. The sterile consumables such as gloves, surgical gowns, masks, and headgear used in each operation are paid for by the patient.
Every penny should be spent wisely.
Although patients and their families may not pursue the issue because they do not understand, 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 Office, and Hospital Office would enter the operating room to watch doctors perform surgery.
After all, it makes the doctor nervous, and if it causes a surgical accident, who will be responsible?
Besides, the chief surgeons have high status and are often the technical backbone of the hospital. If they have worked for a little longer, they will also take on some administrative positions in the hospital. No administrative staff in any department is willing to offend them.
At most, after the operation, the hospital infection control personnel would occasionally enter the operating room for random checks.
Check whether the infection prevention and control work in the operating room has been implemented and whether garbage is thrown around randomly?
In the operating room, medical waste and domestic waste must be separated, otherwise you will be scolded and fined if caught. Some doctors, for convenience, throw medical waste into the trash can with black plastic bags.
If a responsible circulating nurse notices this, they will often correct the situation in person.
But she also has her moments of 'napping'.
Especially when an accident occurs to a patient during surgery, everyone is busy rescuing the patient. How can they have the time to pay attention to these minor details?
"Director Tan, you're too polite!"
After Zhou Can greeted him, his eyes were already consciously looking 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 attached great importance to the anesthesiologist and was extremely humble when greeting him.
The surgeon and the anesthesiologist need to work closely together and cooperate highly during the operation. This person is equivalent to Zhou Can's comrade-in-arms in this operation.
Of course, we have to maintain good relations.
The chief surgeon has a very high status in the operating room, equivalent to the captain, but he cannot fight alone. To successfully complete an operation, at least the anesthesiologist, surgical nurse, and medical assistant are needed to assist.
Neither one can be missing.
Especially for a slightly larger surgery like this.
It is not in vain that a hero needs three helpers.
“It’s a pleasure to work with you!”
Director Hei is a female doctor, in her early forties, wearing black-framed glasses and looking quite serious.
There was no smile on her face when she greeted Zhou Can.
Basically, most anesthesiologists have this tone.
It's not entirely because they are naturally aloof and arrogant, but rather that the situation during the operation is ever-changing, and out of professional habit, they keep a tense face for a long time and are always in a state of nervousness.
Over time, I developed the habit of always being serious at work.
"Is the patient now under general anesthesia?"
Zhou Can found the patient in a coma when he came in. When he talked to other doctors, the patient did not respond.
"Yes, the patient has now been successfully anesthetized, his vital signs are stable, and he can be operated on at any time."
Seeing Zhou Can asking about the patient's condition, Director Hei answered in detail.
"I just noticed that the patient has an incision on the posterior and lateral side of his left chest. Is this the incision from the last surgery?"
Zhou Can actually carefully observed the condition of , including its shape, length, whether it was red, swollen or festering, how the suture was done, etc. These can basically infer the level of the previous surgeon.
However, considering that level 3 and 4 surgeries in large hospitals are often performed by multiple doctors, poor incisions and rough sutures do not represent the surgeon's poor level of skill.
It is possible that the medical assistant under his command performed the chest surgery on the patient.
As for closing the chest cavity, some of the better residents are fully capable of taking on this job.
It is a major operation and only a limited number of people can perform it.
Many residents only get a chance to stand on the stage and observe and learn, which is already very good.
Even in a Class 100 laminar flow operating room, the number of medical staff entering the operating room will be minimized.
If it is not necessary, it will often be strictly controlled.
For example, in a level 3 surgery, there are a maximum of three anesthesiologists. In practice, there are usually two people, one experienced anesthesiologist and one anesthesia nurse.
Sometimes I might take an apprentice with me, so that means there are three of us.
Then there are one or two surgical nurses and one circulating nurse. The circulating nurse is equivalent to the housekeeper of an operation and is an indispensable and important role.
As for doctors, there is more flexibility.
There is usually only one surgeon in charge, but in special cases there may be two surgeons in charge, each doing a part. For example, if a patient needs surgery on both the abdomen and chest at the same time, there may be two surgeons in charge.
It must be said that the probability of having two main surgeons is not high.
It is often an emergency life-saving case and requires surgery on two parts at the same time. There is no other way.
Otherwise, priority will be given to the life-threatening parts of the surgery, and the less critical parts will be postponed as much as possible.
Because surgery is performed on two parts of the patient's body at the same time, the harm to the patient is very great, and the risks in all aspects are also multiplied.
If the surgeon was not experienced and had extremely high surgical skills, he would not dare to take such a risk.
In fact, it is more common for two teams to perform surgery on the patient at the same time.
For example, performing surgery on a pregnant woman with aortic dissection.
It may be necessary for an obstetrician and gynecologist to perform a cesarean section to remove the fetus, and then a cardiovascular surgeon to perform the aortic dissection surgery.
Zhou Can's team was established only recently and is still very immature.
In order to achieve his ideal comprehensive surgical team, it is composed of multiple top teams, such as cardiac surgery team, thoracic surgery team, general surgery team, orthopedic team, anesthesia team, nutritional care team, surgical nurse team, postoperative care team, etc.
There is still a big gap here.
At present, he just has this idea and is silently working in this direction.
For example, the cardiac surgery team and the thoracic surgery team are currently being trained.
When he becomes stronger in the future, he can directly absorb the two top teams of cardiothoracic surgery. The same is true for general surgery.
When that day comes, Tuya will have the most powerful surgical team in history.
Its surgical capabilities are likely to become the best in the country.
"The last time I performed surgery to repair an esophageal rupture 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 answered from the side.
It seems that the last operation was most likely performed by him.
"The incision was very standard and the suture was done very well. It can be seen that the doctors in your hospital were very skilled in this operation and the surgeon was very attentive. I dare say that without 20 to 30 years of suture experience, it would be impossible to achieve this level of suture."
Zhou Can praised the other person without leaving any trace.
Praising someone without naming them is also called blind praising.
When you praise someone, don't praise them for anyone, just praise the work they have done. This can eliminate the suspicion of flattery to the greatest extent, which is enough to make the person concerned feel particularly comfortable.
Zhou Can praised Director Tan highly before the operation even started, and he naturally had his own purpose.
I just arrived and the situation is unclear.
If you can get the cooperation of the surgeon who performed the previous operation, you can greatly reduce the risk of cleaning up others' butts. Some details that cannot be seen from the report, medical records, and operation records will be reminded in time.
"Thank you very much. To be honest, when I was operating on this patient, I personally made the incision and closed the cavity."
Despite wearing a mask, Director Tan's eyes were still smiling.
He was extremely grateful for Zhou Can's praise.
"So you cut and sewed the wound yourself. No wonder your skills are so high! Did you encounter any difficulties when operating on the patient?"
Zhou Can took the opportunity to talk about the last operation.
Because this is the patient's second visit, the surgeon who performed the surgery last time may be worried about being embarrassed and may deliberately conceal something.
But it is possible that these concealed things may be the key cause of esophageal fistula.
"To be honest, we did encounter some difficulties. I remember that after the thoracotomy, there were a lot of food residues in the patient's chest cavity, including a mixture of alcohol and various foods, which smelled very bad."
Director Tan tried hard to recall what happened last time.
"When cleaning the chest cavity, I took a lot of effort to clean the food residue in the chest cavity with my assistant, and then flushed the chest cavity. When I sutured the patient's torn esophagus, I felt that his esophagus was much harder than that of ordinary people. According to experience, a hard esophagus is often brittle, so in order to prevent secondary tearing during repair, I deliberately adopted a more stable suture with a close spacing between needles. But I didn't expect that a fistula would form on the third day after the operation."
When talking about the problems that occurred after the operation, Director Tan seemed quite aggrieved.
More of it is unwillingness.
That's how it is sometimes.
The surgeon and other medical staff had performed the surgery very carefully, and their surgical skills were perfect and they were very experienced. The postoperative care was also very careful, but unfortunately, the patient had postoperative complications.
This really cannot be completely avoided.
"The information you provided is very valuable. I suspect that the patient's esophageal fistula has nothing to do with the quality of the surgery, but is entirely due to the patient's own physical condition. Has the patient ever undergone an esophageal endoscopy?"
While Zhou Can was comforting the other person, he became more certain that there was a problem with the patient's esophagus.
If the fistula is repaired rashly without thorough investigation, a second esophageal fistula may form again.
At least according to his clinical surgical experience, he should check the inside of the esophagus and stomach first.
"I was in a hurry to save people at the time, so I really didn't check it."
Director Tan 's eyes flashed and he shook his head.
In fact, the patient's esophagus was torn, making endoscopic exploration difficult.
"Hey, I see the patient hasn't been given a gastric tube yet. How about I do a gastroscopy on the patient first, Director Hei? Is that okay with you?"
Zhou Can was very smart. He did not ask for the opinions of Victoria Song and Director Tan, but directly asked the anesthesiologist.
To be frank, up to now, he has never given up his vigilance against the First Hospital.
In fact, it's not just him. I believe every doctor who sees patients will be extremely careful.
This is especially true when surgery is required.
"Can."
Director Hei nodded in agreement.
"However, you must be extremely careful when operating, as the patient's esophageal wall should be very fragile and easy to puncture."
She gave a kind reminder out of her responsibility to the patient.
If she knew Zhou Can's endoscopic surgery skills, she probably wouldn't say that.
The gastroscope was quickly pushed over, and there was basically no need to do any additional preparation. Zhou Can operated the endoscope probe and inserted it into the patient's esophagus little by little.
When doing this test, try to keep the patient's head in the backward position.
Because the human throat is actually curved.
Try to tilt your head back so that the larynx, trachea and esophagus form a straight line, which is convenient for examination or insertion of a gastric tube.
As the endoscope moved in little by little, Zhou Can stared at the display screen.
The inner wall of the esophagus can be clearly seen.
"He has an ulcer in his esophagus!"
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 you think.
Because it is elastic.
When patients indulge in alcohol for a long time and frequently eat various heavy-tasting foods, the esophagus gradually loses its elasticity and becomes fragile due to repeated damage.
This patient's esophageal condition was the worst one Zhou Can had ever seen.
As the gastroscope goes deeper and deeper, the situation inside the stomach becomes clear.
The results of the previous ultrasound and CT scans are similar, and the situation inside the stomach is still ideal.
No particularly serious problems were found.
There are some superficial gastric ulcers, which can be controlled and recovered slowly as long as they take medicine and eat a proper diet after surgery.
If gastric ulcer occurs for a long time, it is particularly prone to cancer.
This is not alarmist, but is caused by its special environment.
If you have oral ulcers for a long time, in the same place every time, and the ulcers are difficult to heal after they occur, you need to be highly vigilant. Oral cancer is very easy to occur.
According to a scientific research survey and statistics from the World Health Organization, patients whose oral ulcers do not heal for a long time often have low immunity.
These patients are more likely to develop oral cancer.
It is currently recognized in China that chewing betel nut is an important cause of oral cancer, because chewing betel nut can cause fibrosis inside the mouth.
For many seriously ill patients, by the time cancer is discovered, their mouth can only open to half its normal size.
The occurrence of gastric cancer is as easy to be ignored as oral cancer.
Many people just put up with occasional stomach pain, bloating, or burning sensations, but little do they know that these may be warning signs before cancer develops.
