The little girl leaned listlessly on her mother's arms, with big furry eyes and dark round eyes, vigilantly avoiding Chen Wenqiang, who stepped forward for a physical examination.Chen Wenqiang took her hands, she struggled slightly, and when she saw that she was unable to break free, she held her mouth and wanted to cry.The parents hurried to reassure the child not to cry.After Chen Wenqiang gave the child a careful physical examination, he said to Li Min: "Only the muscle strength of the right hand is slightly weaker than the left side. ”Director Wu stepped forward and grabbed the child's hands and used a little force to do the test.Then he said to Chen Wenqiang: "Dean Chen, there are no such obvious signs in the morning.It's better to have surgery sooner. ”Chen Wenqiang nodded, put his elbows in his hands and said to the child's parents: "This child's hydrocephalus is more serious, and we are going to do ventriculoperitoneal shunt for her." ”When the child's mother heard that she was going to have surgery, she subconsciously hugged the child and asked, "Do I have to have surgery?"
Is it okay not to do it?
I don't vomit as much as I did in the morning.Well, I haven't vomited since I hit the drip. ”Director Wu nodded and replied for Chen Wenqiang: "Now that the child's condition has improved a little, we have used dehydration medicine.This can only treat the symptoms but not the root cause, and it is only used for temporary emergency relief.You see, the child's head circumference is larger than that of a normal child, and the fontanelle bulges out here.If the cerebrospinal fluid is not shunted to reduce the pressure in the skull, the child's cerebral cortex will be thinned. ”Leng Xiaofeng has already told this truth to the young parents once, and the young couple also knows the consequences of cerebral cortex thinning.The child's father hugged the two of them, "Dean Chen, Director Wu, is it true that after this shunt, the child will be fine?"
”"It's not.A shunt is a procedure to temporarily drain excess cerebrospinal fluid into the abdominal cavity, but your child cannot rely on medication to lower the pressure in the abdomen.This shunt allows your child to eat normally.When the child is better, we will consider surgery to remove the space-occupying lesion of the fourth ventricle to remove the cause. ”The tears of the child's mother rolled down one by one, and the little girl was so frightened by her mother's tears that she began to cry.The young mother hurriedly wiped her tears on her face, hugged the child and whispered: "Don't be afraid, don't be afraid." ”"Okay.We do surgery. ”The young father resolutely responded to Chen Wenqiang, and immediately asked, "Dean Chen, when will the operation be done?"
”"We're going to get ready now, and after a while, you can sign the consent form for the operation, and you can do the surgery."
Chen Wenqiang gave this affirmative reply and walked out."
Old Wu, is it okay for you to prepare the surgical consent form?"
Director Wu smiled: "I'm afraid it's not comprehensive, so let's come." ”Chen Wenqiang glanced at Director Wu, "That's it, you are still a pediatric surgeon?!"
”Director Wu was unimpressed with his attitude."
I've been working in pediatric internal medicine for more than 20 years, and where can I get a surgical set."
Chen Wenqiang ignored him and said to Li Min: "You arrange all the preoperative preparations, and I will go and inform Lao Liang to go on stage together." ”"Yes.Xiaofeng, do you have an operation notice or something?
”"No, there are no surgeries in our department, and the head nurse should not have received these.""
Then, Dean Chen, I'll go back to Cory to get it.You also need to fill out a form for the examination you just did, as well as skin preparation, catheterization and other things. ”Neurosurgical patients fill out a special medical record form."
Then you go back and get all your things, and I'll write the consent form and give the preoperative order here.Let Sister Luo find you the smallest urinary catheter.If you don't have one, you can get it. ”Chen Wenqiang nodded and agreed that after Li Min went back to Corey, he went back to the office side by side with Director Wu.Leng Xiaofeng watched Li Min stride towards the stairs of the safe passage, while she herself held her medical records and followed behind Chen Wenqiang and Director Wu.Li Min quickly returned to Director Wu's office with all the things he needed."
Dean Chen, Aunt Luo is going to get the smallest urinary catheter.I asked her to take the catheter to the operating room. ”Chen Wenqiang handed over the surgical consent form written in his hand to Director Wu."
Old Wu, you went to talk to the parents of the patient.""
Okay, I'm sure I can do that."
Director Wu took the thing and gave Chen Wenqiang an affirmative answer.Director Liang hurriedly came in with a few lunch boxes."
Lao Chen, Xiao Li, this is lunch for the two of you.You two eat first.I went back and changed my clothes, so I came with Lao Li. ”Director Liang and Director Wu nodded and said hello, and left in a hurry without waiting for Chen Wenqiang to say that they should listen to Xin'er."
Hey, Dean Chen and Dr.
Li haven't had lunch yet?"
Director Wu was surprised."
I had a breast cancer in the morning, and I was about to go to dinner, and I saw your urgent consultation list.Doctor Li, let's eat first.The preoperative conversation was handed over to Director Wu.Wait for Lao Liang to come back and let him do other things. ”The two of them put down their pens and washed their hands to eat.Leng Xiaofeng came to Li Min's side and looked through the form of neurosurgery."
What's here?""
Negative."
Chen Wenqiang asked Li Min: "Do you have any impression of ventriculoperitoneal shunt?"
”Li Min nodded, "I'll follow you as the head group?"
”"Hmm.Let Director Li and Director Liang do the celiac group. ”"Xiaofeng, you put it down first, I'll fill it out myself in a while, and you can help write a preoperative summary."
Li Min understands Leng Xiaofeng's psychology of wanting to help, but when it comes to neurosurgery, in case of mistake, the child is so young, it is really not a joke.Leng Xiaofeng put down the form in his hand, sat next to Li Min, and wrote a preoperative summary while asking, Chen Wenqiang saw that Li Min was cautious and knew the severity, so he ate his own lunch with peace of mind.The two of them were almost finished eating, and Director Wu came back with the child's father."
Dean Chen, he still has some questions for you.""
This is lunch?
I'm going to disturb you eating. ”The father of the child showed surprise on his face."
There was an operation in the morning, and it was delayed for a while.Sit down and talk about it.I'm almost done eating. ”Chen Wenqiang didn't care, and Li Min also sped up his chewing speed."
Dean Chen, I would like to ask how likely is it that the child will be cured?
So many accidents, complications. ”The man pointed to the surgical consent form in Director Wu's hand, and the preoperative explanation on it made him feel uneasy.Chen Wenqiang pondered for a while and decided to talk to the child's father about being ruthless."
You're a responsible person who understands that the younger the child, the more difficult the operation is, right?"
The child's father nodded with a white face."
So to tell you the truth, the difficulty of this operation is that the child is too young.I told you that people choke to death when they drink water, and if they get stuck in eating fish, they will also die.This is a thing of this world.No one would dare to pack a ticket 100 percent.If all the accidents above don't happen, the child will be 100% cured.If there is an accident, it is difficult to say. ”Li Min put down her chopsticks and filled out the operation notice and sorted out all the necessary forms that should be filled in.Seeing that the child's father was holding the surgical consent form, he was still hesitant and couldn't put down the pen, so he became anxious.When is this, why is this person not at a critical time.She interjected and said to the child's father, "If you decide to have surgery, we'll send you a notice of surgery."
The operating room and anesthesiology department also need to be prepared.If you hesitate, and your child is like this now, every minute of delay, the difficulty of the operation increases a little, and the child's prognosis after surgery is a little worse. ”"This, this ......" the man's forehead began to sweat.Director Li and Director Liang pushed the door in."
Lao Chen, are you ready?"
Director Li came in and went straight to Li Min's side, snatched the notice in her hand, and after reading it, he said, "I'll do the head group with you, and let Lao Liang take Xiao Li to do the abdominal group." ”Chen Wenqiang understood that Director Li's move was to share the pressure on his head in case the operation failed, and he nodded to Director Li to thank him for his kindness.He hurriedly pulled the remaining mouthfuls of rice into his mouth, swallowed it heavily, grabbed the notice and signed his name.Then he introduced the child's father: "This is Director Li of our provincial hospital, my teacher when I first became a doctor.This is Director Liang, who also guided me.You see, our provincial hospital attaches great importance to your child, and we have gathered the best doctors in the provincial hospital in order to successfully complete your child's surgery. ”The child's father's eyes changed from Director Li to Director Liang, and his mouth thanked him, but he did not sign immediately.Leng Xiaofeng said on the side: "You can think about it slowly, and when you think about it, the child's cerebral cortex is thinned......
"Okay, I'll sign it, and I'll do it now." ”The man grabbed his pen and signed his name under "I already know and understand the above accident".The children who had had their hair shaved were given general anesthesia by Director Zhou.A small child, with various intubations on his head and body, and electrodes on his chest, lay unconsciously on the operating table.The skinny little appearance made people feel countless pity in their hearts."
Alright, you can disinfect."
Under Director Zhou's order, Director Li and Li Min disinfected their heads and abdomen respectively.The sound of the bone drill sounded, and Li Min knew that this operation was only to drill a small hole in the skull plate, but her heart became nervous with the sound of the bone drill.At the same time, Director Liang and Li Min's abdominal group also began to work according to the procedure.They only need to make a 4 cm incision under the midline of the xiphoid process, cut to the anterior sheath of the abdominal muscle, make a subcutaneous tunnel along the subcutaneous strip to the neck, make a small incision on the clavicle, lead the strip out, tie it to the tip with a thick thread, and lead the thread to the incision in the abdomen.The upper end of the silicone drain placed in the abdominal cavity is then tied to the line and led to the incision in the neck.The peritoneum is implanted at that end of the abdominal cavity.The rest is for the head group to connect the ventricular canal to the abdominal canal with an accommodating instrument.The difficulty of the operation is all on Chen Wenqiang's body and the puncture of the fourth ventricle.Chen Wenqiang called Director Li and Director Liang all because there was a patient who had just turned one year old on the stage.The celiac group successfully completed the set content.Li Min asked for a piece of saline gauze to cover the wound on the child's abdomen.She lowered her head and made a contemplative appearance, trying her best to suppress her desire to see the progress of the head group, and patiently waited for the debugging results of Dean Chen of the head group.For a few minutes, Li Min was almost unbearable.※※※※※※※※※※※※※※※※※※※※ ventriculoperitoneal shunt is a commonly used surgical method in neurosurgery, mainly used for the treatment of hydrocephalus, especially obstructive hydrocephalus, of course, for normal pressure hydrocephalus in some elderly people, ventriculoperitoneal shunt is also a very effective treatment.Its principle is mainly through minimally invasive surgery, inserting a relatively thin silicone tube with good histocompatibility in the ventricular area, and then the silicone tube passes through the subcutaneous tunnel and drains into the abdominal cavity, that is, the excess cerebrospinal fluid in the brain is drained into the abdominal cavity, and then absorbed into the blood through the omentum of the abdominal cavity, so as to effectively alleviate the symptoms of hydrocephalus.Surgical steps for the head: shaving the hair.
After successful anesthesia.According to the positioning, the scalp is incised, the skull is incised, the dura mater is inserted, the catheter is placed into the ventricles, and the dura mater is fixed and sutured.The drain is placed under the scalp, the shunt pump is partially fixed on the scalp, the distal end is placed under the skin of the abdominal wound, and the scalp is sutured in layers and layers through the subcutaneous wound of the abdominal wound.Abdomen: Cut open the whole thickness of the abdominal skin, find the peritoneum, make a small incision, insert the distal end of the shunt led by the scalp into the peritoneum, and suture the peritoneum and other layers of the abdominal skin.There is a lot of controversy about whether to do this surgery for children who are six months old and one year old, and the complications after surgery are about 25%.The main thing is that the various drainage tubes are blocked.() The distance is a bit far