Chapter 557: Destruction does not mean harm, a soothing anesthesiologist
After understanding the patient's stomach condition, Zhou Can had a clear idea in mind.
"Please show me the patient's preoperative esophageal angiography again."
He wanted to use this opportunity to perform gastroscopy on the patient to locate the exact location of the esophageal fistula, and preferably find out the real cause of the esophageal fistula, so as to ensure that it would not recur after the second operation.
"This is the esophageal angiography we did on the patient today. The esophageal fistula is more than 1 cm!"
Director Tan felt somewhat ashamed when he said this .
The entire esophageal tear is about 6 cm long, and the fistula is now more than 1 cm long. It is difficult for him, the surgeon in charge, to absolve himself of responsibility.
When Zhou Can controlled the endoscope to withdraw, he compared the fistula position on the angiography and searched carefully. It took him a lot of effort to find it.
The fistula is not obvious when viewed from the inner wall of the esophagus.
This location is at the bottom of the sutured gap and has some infection line collapse.
With his surgical experience and sixth-level suture technique, Zhou Can carefully checked and determined that other parts of the esophageal rupture had healed initially, which was a good sign.
Then there is no need to touch it anymore.
If you want to repair this fistula, you definitely need to clean the wound and then suture it again.
First of all, there is no guarantee that infection and suture breakdown will not occur after suturing.
In fact, as long as the esophageal wall is infected, even if it does not become festered, it is still easy for the sutures to break for the second time.
To be more optimistic, Zhou Can performed level 6 debridement and level 6 suturing, and the fistula healed directly after repair without bursting again. However, it still had a huge impact on the patient.
What is the impact?
The patient's esophagus itself has become hardened, brittle, and its elasticity and toughness have become extremely poor, which means that the maximum volume of food that can pass through the esophagus is much lower than normal.
Then a few days ago, there was a 6cm tear in the esophagus. After the suture, the internal space of this section of the esophagus became much narrower.
Zhou Can could feel it when he was doing the gastroscopy just now.
The repaired section of the esophagus is significantly narrower.
This will definitely affect the patient's eating after surgery and it is easy to choke.
If debridement and secondary suture are performed again on the basis of this stenosis, the space in this section of the esophagus will become even narrower.
I'm afraid the patient can only eat liquid food in the future.
You have to eat thinner liquid food. If it's too thick, it will directly block the esophagus.
Plans really can’t keep up with the changes!
It is really necessary to have a gastroscopy.
If you do not understand the patient's condition in detail and directly use thoracoscopic surgery to repair the patient's esophageal fistula, even if the operation is successful, it will definitely be a failure.
“I wonder what kind of secondary surgery your hospital is going to perform on the patient?”
Zhou Can asked Director Tan and Victoria Song.
It is necessary to seek the employer's opinion first.
"We asked Dr. Zhou to come and help clean up the mess, so of course the decision is entirely up to Dr. Zhou." Victoria Song answered on behalf of Director Tan.
"Because the fistula is not big, it would be best if it could be repaired on the basis of the original surgery. Before I came, Dr. Zhou suggested a thoracoscopic repair surgery. This surgery is less traumatic to the patient and is a minimally invasive surgery. I agree with it very much."
Tan Shengli's surgical thinking should be considered old-fashioned and conservative.
This kind of surgical thinking prefers to deal with the situation face to face and take one step at a time when formulating a surgical plan.
The advantage is stability, while the disadvantage is lack of flexibility and rigidity.
"Before coming here, I did think that I could perform thoracoscopic surgery on the patient to directly repair the esophageal fistula. But when I was performing a gastroscopy on the patient just now, I found a problem. The patient's esophageal fistula occurred in the section of the last tear. If a second suture is performed, I am worried that it will seriously affect the patient's quality of life after the operation. Therefore, I prefer another solution."
Zhou Can has a level 6 pathology diagnosis level, which is of great help in formulating better surgical plans.
"Are there any other options?"
Director Tan's eyes lit up slightly, and Song Qian's phoenix eyes flickered.
"The patient now has an esophageal fistula, and nutritional support has become an urgent issue that needs to be addressed. If nutrition is not guaranteed, the patient's wound recovery will be slower and various problems will arise in the body. At that point, his condition will be very dangerous."
Zhou Can analyzed the reasons to everyone.
The patient now leaks whatever he eats, and only a small portion of the food can enter the stomach. Moreover, all the food that leaks out through the esophagus enters the chest cavity. Even if a chest drainage tube is left in during surgery, it will still cause major safety hazards to the chest cavity.
If a chest infection occurs, even the most advanced antibiotics may not be able to save the patient's life.
"Doctor Zhou, excuse me, what do you think are the reasons for the patient's esophageal fistula?" After hearing this, Tan Shengli seemed to have some inspiration in his surgical thinking and interrupted Zhou Can.
"When I was doing the gastroscopy just now, I saw ulcers in the esophagus, and there was redness and swelling. I guess the reason for the failure of the esophageal repair surgery is the edema and inflammatory necrosis of the esophageal wall, which caused the suture line to collapse and the wound could not heal."
Zhou Can could only tell the truth.
This happens from time to time, and it has something to do with the quality of the surgery performed by the surgeon. For example, if it were Tuya Hospital, there would be some preventive measures to control postoperative edema.
"Okay, then go on and tell me about your treatment plan!"
After Tan Shengli found out the cause of the patient's esophageal fistula, he seemed to give up his own ideas and was ready to listen to Zhou Can completely.
"As we all know, if spontaneous esophageal rupture is not treated with surgery in time, the patient will soon die from severe infection, malnutrition, and systemic failure. However, after esophageal repair surgery, it is very easy for the esophageal fistula to rupture again within three to seven days after the operation due to various reasons. If the second rupture is small, you can strengthen nutrition, keep drainage unobstructed, use antibiotics reasonably, blow a bottle to expand the lungs, and keep the gastrointestinal tract decompressed and unobstructed. As long as it is handled properly, the fistula can heal itself."
Zhou Can proposed a series of treatment measures.
His idea was simple. Since it was impossible to repair the esophageal fistula, he would just let it heal on its own.
As long as nutrition is adequate and infection is strictly controlled, this goal can be achieved.
At most the treatment time will be longer.
"The series of measures proposed by Dr. Zhou are all good. However, the patient now has a fistula in his esophagus, and the food he eats will leak into his chest cavity. How can we improve his nutrition?"
Tan Shengli believes that if this problem is not solved, it will be just empty slogans.
"It's simple. We can solve the problem by performing a jejunostomy on the patient."
Zhou Can answered confidently.
"Jejunostomy?"
Director Tan's eyes suddenly widened, and the others looked equally shocked.
The existence of an esophageal fistula is already troublesome enough, and the idea of artificially creating a fistula in the jejunum is really audacious.
Conservatives like Tan Shengli would never be able to think of this solution.
Because in his opinion, such an idea is too crazy.
Any surgery will cause harm to the patient's body. It is unfortunate enough that the patient has postoperative esophageal fistula, but the doctor also makes a cut in the jejunum. What kind of sin is this?
"Yes, it is jejunostomy. Although creating a fistula in the jejunum will cause certain harm to the patient's body, the benefits to the patient far outweigh the harm. First of all, after the jejunostomy, food can enter the stomach directly from here without passing through the esophagus, which can reduce the persistent infection of the esophageal fistula and even cause the fistula to expand further. This creates the prerequisite for the gradual healing of the esophageal fistula."
The wound should not be exposed to water to prevent infection.
If the patient wants to survive, he must eat and drink every day, which will cause persistent infection and even suppuration of esophageal fistula.
Antibiotics can control infections, but they are not a panacea.
The best treatment is always prevention.
Preventing infection is far better than controlling infection.
The former is to prevent the wound from becoming diseased and worsening, while the latter is to wait until problems occur and then find ways to treat and control them.
The principle behind this is equivalent to the best doctor treating the disease before it occurs and preventing the disease before it occurs.
The lower doctor treats the disease that has already occurred, and only when the patient is already ill will he try to find a way to save him.
The difference between the two is obvious.
Zhou Can's surgical thinking has already begun to acquire the thinking of a superior doctor, but Director Tan, if he cannot change his thinking mode, he may only be a lower-level doctor for the rest of his life.
"Secondly, by providing patients with a variety of foods directly through the jejunal fistula, we can ensure that patients have adequate nutrition. With improved nutrition, the patient's self-healing ability and immune ability will be greatly enhanced. As you can see now, the patient has developed major problems with his body due to poor nutrition and is showing signs of exhaustion."
The patient looked extremely pale, and although his vital signs were stable, he was in a state of persistent high fever.
At this time, the whole person's condition is very bad.
When an average person gets a severe cold, with a high fever and runny nose, they feel like they are dying. For a patient who has just undergone a major operation, being in this state is like adding insult to injury.
If not resolved in time, the patient will die soon.
I believe that the doctors and leaders of the First Hospital also realized the danger, so they quickly sought help from other hospitals.
"The surgical suggestion proposed by Dr. Zhou is very scientific and reasonable. I think it is much better than the secondary repair of the fistula through thoracoscopic surgery that we had previously conceived. It is of great benefit to the patient's postoperative recovery and future quality of life. It seems to have caused secondary damage to the patient's body, but in fact it is scraping the bone to cure the poison, creating favorable conditions for the patient's complete cure."
At this time, Director Hei, the anesthesiologist, spoke out in support of Zhou Can's new plan.
With the support of the anesthesiologist, the possibility of implementation immediately increases N times.
Any surgery cannot be performed without the help of an anesthesiologist.
If she says the operation can be done, then it can be done.
She objected, and even if the surgeon thought the surgical plan was perfect, it could not be implemented. At this time, the surgeon and the anesthesiologist would often quarrel in the office, and it was common for them to argue until their faces turned red.
Just like a quarreling couple, they quarrel at the head of the bed and make up at the foot of the bed.
They will snap back together quickly, so don't worry.
After all, everyone is here for work, so there is no need to escalate it to the level of personal grudges.
"The solution proposed by Doctor Zhou seems...destructive. After careful consideration, I also think that this treatment plan is safer and more effective." Tan Shengli did not say anything like he agreed to Zhou Can having this operation.
Since Zhou Can was invited to perform the surgery, the decision-making power must be given to Zhou Can.
If they still want to give up the decision-making power, then they should not invite Zhou Can to perform the surgery in person, but to act as an assistant.
"Since Director Hei has agreed to Dr. Zhou's surgical plan, let's get started as soon as possible! We will fully support and cooperate with you if you need anything."
Song Qian’s identity has always been vague and she has not introduced herself.
Jiang Wei didn't even tell Zhou Can what position this old classmate currently holds in the First Hospital. But based on her feeling, her position should not be low.
Otherwise, there would be no way to speak to the two chief physicians, Tan Shengli and Director Hei, in such an extremely calm tone.
Moreover, she plays a senior leadership role in all decision-making and has the final say.
Therefore, it can be inferred that her position should not be low.
"I don't have any other requests. My colleague can be my medical assistant, and Jiang Wei can be my equipment nurse."
Zhou Can only had this small request, to use his own people in the operation.
"Absolutely."
Victoria Song gave a slight signal to the instrument nurse and the original medical assistant, and they made way.
The operation began soon.
Zhou Can showed the people at the First Hospital what first-class surgical skills are. The entire operation was completed in less than 40 minutes.
At the moment the operation was over, he was rewarded with 1,000 pathology diagnosis experience points.
It should be related to the new surgical plan he proposed .
It is not an innovative surgical plan, but it is innovative to a certain extent. It also flexibly applies a variety of surgical and medical knowledge.
This skill is difficult to learn by reading books.
What books can teach is general knowledge and various theories. To put knowledge into practice in diagnosis and treatment, we need to practice and accumulate knowledge continuously.
After the operation, Zhou Can examined the patient again carefully to make sure there were no problems.
Only then did he take off his gloves and throw them into the trash can.
"Okay, push him to the recovery room to wake up from anesthesia and observe for about 30 minutes. If there is nothing abnormal, you can send him back to the ward for nursing. Starting tomorrow, you can feed him through the jejunal fistula. It is best to have an experienced nurse do it. It is estimated that the patient's hospitalization period will be relatively long. It will probably take more than a month for his esophageal fistula to heal."
Zhou Can told the truth to Tan Shengli and Song Qian.
"Nothing, I'll take my people away first."
"I'll see you off. You three have worked really hard today."
Song Qian seemed very happy to see that the operation was completed successfully.
Before leaving, Zhou Can looked at the anesthesiologist, Director Hei.
"It was a pleasure to work with you. Your intraoperative management was excellent. This was the most relaxing surgery I've ever had with any anesthesiologist."
Zhou Can did not say that he was the anesthesiologist who made him most relaxed.
I just said it was the most relaxing surgery.
"Thank you for the compliment!"
She smiled implicitly, and this was the first time Zhou Can saw her smile.
"goodbye!"
He took Jiang Wei and Zhong Ming outside.
This Director Hei is indeed the best anesthesiologist Zhou Can has ever seen. She is professional, meticulous, and well-coordinated with the surgeon. She can even estimate what Zhou Can needs to do next, and then provide the corresponding life support or corresponding preparations.
In short, during the entire operation, Zhou Can felt very comfortable as if everything was going smoothly.
Even Director Feng of Tuya Hospital had never allowed Zhou Can to be so relaxed during surgery.
It’s not that Director Feng’s professional level is not as good as Director Hei’s, but that Director Feng lacks her spirit of devoting all her efforts to the main surgery.
Everything she did during the operation, she always put Zhou Can first and provided the best service to the surgeon.
