Director Li and the others immediately put down the medical records in their hands and rushed to the pediatric ward.Sure enough, as he said, it was the child who had secondary supratentorial obstructive hydrocephalus and had an emergency ventriculoperitoneal shunt, and the diversion was blocked.I didn't see this little girl for two days, and after ventriculoperitoneal shunt, a series of symptoms caused by the decrease in hydrocephalus and increased cerebral pressure were significantly alleviated, and her spirit and appetite were greatly improved.The most obvious change is that the little girl's cheeks have grown a little fat, although they are still a little wilted, but the big round eyes are turning flexibly, looking at Director Li and his party who came in.Chen Wenqiang and Director Wu of Pediatrics and several pediatric doctors are all in the ward.The parents of the child anxiously gathered around Dean Chen, waiting for him to come up with an idea.Just now, the child vomited again and had increased cerebral pressure."
It's a clogged drain, right?"
Director Li got straight to the point and asked directly about the key points.Chen Wenqiang said with regret on his face: "Yes, this morning's ward round found that the diversion tube was not smooth.I had planned a shunt to buy her more time so that the child would have enough energy to withstand the next surgery. ”"First of all, if the brain pressure does not continue to increase, it can still be maintained for the time being."
Director Liang spoke.The child's mother said anxiously: "I vomited once just now, and the milk I drank at nine o'clock was almost all vomited." ”Alas, this child is such a calamity!"
Xiao Li, is your patient okay?"
Chen Wenqiang looked back at Li Min and asked her absentmindedly."
It's fine.I've taken care of everything that needs to be done. ”Li Min realized that Chen Wenqiang was going to send him a job."
Then you stay here and watch the kids."
Chen Wenqiang succinctly instructed Li Min."
The parents came to the office with me."
Director Li said, "I'll watch here, let Xiao Li make preoperative preparations with you." ”Chen Wenqiang nodded, and Li Min hurriedly stayed behind Director Liang and followed Chen Wenqiang to the pediatric doctor's office.In the office of the director of pediatrics, Director Wu had already prepared all the information of the child and inserted the brain CT film into the reader.Li Min stepped forward to turn on the switch of the reader, and took out the hand-bound note book to make a record.Chen Wenqiang scratched the film with his fingers."
Look here, this is the film before being admitted to the hospital.The medulla oblongata is compressed and displaced, and the four ventricles are compressed and deformed.Further ahead, the signal shadow in the right pontine cerebellar angle area and the right hole of the four ventricles is irregular in shape and the signal is uneven.I think that the primary disease should be ependymoma is more likely, and of course medulloblastoma is not ruled out. ”Chen Wenqiang said that everyone nodded their heads, and there were few people in a room who could understand brain CT films."
This is a post-shunt film.Here, we compare these images and can see that the medulla oblongata is basically reduced, and the four ventricles are basically back to their normal shape.This is an image of the deflector.Judging from the child's postoperative performance, the child's mental recovery and ability to eat normally proved that the degree of hydrocephalus was significantly relieved, and the shunt was successful. ”He took a deep breath and continued, "But now that the child is vomiting again, the only possibility is that the diversion tube is blocked."
If the drainage is not smooth, causing the child to continue to have symptoms of increased cerebral pressure, we have to urgently do the excision of the space-occupying lesion. ”The child's mother covered her mouth and began to cry.The young father, putting his arm around his wife's shoulders, pretended to be strong and asked, "Is it the same as a shunt?"
”How can it be the same!
In this operation, the space-occupying lesion was completely removed and the problem was fundamentally solved.The reason why neurosurgery can stand at the top of the chain of surgical contempt is not to rely on a simple skull drill two holes to make a drainage to lower cranial pressure, nor does it rely on a simple hemostasis of ruptured cerebral blood vessels.It depends on surgery in the center of life, removing a space-occupying lesion in the brain – saving lives.Behind such an operation, it is required to minimize the impact on the patient's postoperative quality of life.If the mental decline after the craniotomy becomes a fool, and other neurological and psychiatric symptoms appear, and even death, then the operation is not done, and that's it.It won't be what other surgeons look up to.The subordinated to the chain of contempt belongs to the general surgery.General surgery is the foundation of surgery.Its position is to look up to neurosurgery and to despise orthopedics, which is known as "doing the carpenter's work".As for the other small branches of urology, they have not yet been given a clear place in this chain, because they are all classified as appendages of general surgery.Simple and crude, but it is the most realistic division of surgical class."
The last shunt I did was a palliative operation.The purpose is to temporarily solve the symptoms of increased cerebral pressure, causing the child to vomit and unable to eat.Do you remember?
”Before the last operation, Chen Wenqiang explained these words to the parents of the child very clearly.The young couple nodded again and again, indicating that they still remembered Chen Wenqiang's explanation."
But this time, if we had to have surgery, we would have to remove the space-occupying lesion and completely eliminate the cause."
Chen Wenqiang explained to the young parents seriously."
Then our child ......," the child's mother asked worriedly."
There are certain risks associated with surgery, and we will do our best to control the risks.Dr.
Li, you go to make preoperative preparations. ”Director Liang stood up and said, "Dean Chen, I'll do it with Dr.
Li. ”Chen Wenqiang nodded gratefully to Director Liang.He understood that Director Liang stood up at this time to increase the convincing of the parents of the child."
You go back to the ward first, we're ready, and the nurse will come and sign it."
The couple thanked each other in every way and walked out with each other's arms.Director Wu saw that Chen Wenqiang and Director Liang were staring at the CT films, while Li Min began to prepare the surgical consent form and preoperative summary.He suddenly felt that it didn't seem appropriate to leave the child in the pediatric department of the provincial hospital, and it seemed that too much energy had been put into it."
Old Chen?""
What's the matter?"
Chen Wenqiang retracted his gaze and turned his head to look at Director Wu."
Why don't we transfer the child to the hospital?""
Transfer?"
Chen Wenqiang immediately raised his eyebrows, "Old Wu, you didn't drink."
What's the nonsense?
If the child doesn't have a shunt in our provincial hospital, you can transfer to the hospital no matter what.But now, I'll tell you that whoever dares to touch that kid will turn against whomever I want. ”Director Liang and Xi Ni said: "Don't worry, Lao Chen.Lao Wu is also thinking about you. ”"You're worried I won't be able to take this surgery?""
No, no.I just think that this one child has taken too much of your energy.Director Li, isn't this still watching the children in the ward?
”"Who made our hospital have no neurosurgery?"
Chen Wenqiang's momentum fell a little, "If there is a neurosurgery, it is okay to take this child in."
Xiao Li, don't rest this afternoon, come with me for surgery. ”Director Liang immediately objected: "I'll accompany you to the stage."
What can you ...... too" "You're also worried that I won't be able to take it?"
”"Look at you, how can you be like a mad dog, catch and bite whom."
Chen Wenqiang grinned and conceded: "Then you just go over and watch, can't you go up again?"
”Director Liang thought about it and nodded in agreement.Then he asked him, "Do you want to give corticosteroids to your child now?"
”"Give it.Xiao Li, why corticosteroids?
”"Alleviate perioperative brainstem responses."
Li Min finished writing the programmed preoperative summary and surgical consent and handed it to Chen Wenqiang for review."
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Dean Chen, do you think this is okay?"
Chen Wenqiang looked at it carefully, "Okay, so be it."
Say hello to the operating room, this surgery may be done in the afternoon, no, it may be done in the evening.Let Lao Zhou come to the stage for anesthesia. ”"Okay, I'll go back to the department to get the operation notice."
Director Wu stopped Li Min: "Doctor Li, I have the operation notice here."
Last time, I asked the head nurse to get a copy. ”"Thank you, Director Wu."
It's good to have one less trip."
Old Wu, are you determined to do a pediatric surgery?""
Yes.Without pediatric surgery, what is the difference between the pediatrics of our provincial hospital and the municipal hospital?
The district-level hospitals are not much worse than us. ”Director Wu admitted frankly.Director Liang ignored Director Wu's words, and he asked Chen Wenqiang: "Judging from the film, there may be all lesions here, can they be cut clean?"
Down there is the respiratory center. ”"It should be.You see, I approached from here, isolated the space-occupying lesions in the right pontine cerebellar angle area, removed them at the right medulla interface, and then explored the fourth ventricle for abnormalities. ”"It's good if you have a plan."
Director Liang was worried.I'm afraid that this tumor is not easy to peel.Chen Wenqiang nodded heavily to make a promise to Director Liang, but it seemed that this guarantee was also to encourage himself."
Lao Liang, Lao Wu, I really hope that I don't need surgery today.Even if it can't be dragged on for a month as I had hoped, if it can be delayed for two weeks, the child's body will improve a lot, and the risk of surgery will be reduced a lot.Alas, too small. ”It's not too young, it's only been a few days since my first birthday."
Dean Chen, don't worry, I will definitely watch it myself after the operation.I asked the head nurse to get ready to get a private room for the child and to do intensive care. ”Chen Wenqiang smiled with relief when he saw Director Wu say this."
Thank you for that.A single room can reduce complications such as lung infection after surgery. ”No matter how good the operation is, whether the patient can be cured and discharged from the hospital depends to a large extent on postoperative care.Throughout the afternoon, Li Min followed Chen Wenqiang and Director Liang in the pediatric ward, to be precise, Chen Wenqiang took her to lie in Director Wu's office, and Director Liang stayed in front of the child's bed.Li Min held the "Neurosurgery" that Chen Wenqiang temporarily lent to her, and Chen Wenqiang and Director Wu were chatting.Director Li went back to Corey to look after the family.There are eight clinical doctors in the Department of Trauma Surgery, two people who are resting on and off the night shift, and Dr.
Yang, who has the name of "sick leave", went home after two consecutive night shifts.Zhang Zhengjie did the same thing as him.So Corey is the only one left, Director Li, but fortunately nothing happens.When it was about to get off work, Chen Wenqiang stood up and said, "Xiao Li, don't read the book yet, let's go see the kid."
Lao Wu, are you going?
”"Go."
Director Wu responded immediately.() The distance is a bit far