After the morning shift, Dr.
Yang grabbed Dr.
Wang and asked, "Why do you look at you so strangely?"
”After Dr.
Liu got off the night shift, he silently hung up his white coat and left the office with a calm face."
Xiao Liu is also so strange.I'm just one afternoon off, why are you all weird, what's going on?
”"I didn't come to work yesterday afternoon."
Doctor Wang forced himself to calm down, so many people looked at him with strange eyes, it must have been known to the people in Corey about his divorce.M's, is divorce a glorious thing?
Before it was too late for others to cover up, she couldn't wait to inform the trauma surgeon.Could it be that the woman really wants to kill them all, leaving no way for herself to live?
Doctor Yang is not stupid, he guessed that the matter was related to Dr.
Wang, but when he saw that Dr.
Liu's nose was not a nose and his face was not a face, he left, and directly thought that the matter must be related to Dr.
Liu.But after the morning meeting, he had to change the doctor's order and take the patient to the operating room, so he put it on something that had nothing to do with him and went to do what he should do.
*Li Min is going to follow Director Liang for rectal cancer surgery today.Before this major operation, I had to go to Director Li for a partial thyroidectomy (adenoma).This kind of surgical arrangement is also very common.The only bad thing is that lunch has to be postponed to the afternoon.As for what time you can have lunch, it depends on whether the rectal cancer is going well or not.When Director Li was brushing his hands, he carefully questioned Li Min about the thyroid anatomy, and then explained the key points of her operation in detail, and finally when he came to the stage, he gave the position of the surgeon directly to Li Min."
You do it, I'll show you."
After the huge ependymoma surgery, Director Li asked Chen Wenqiang about the last time he took Li Min for a second major thyroidectomy, so he was relieved to let Li Min go to be the main surgeon.In many cases, the lack of opportunities for surgery is the lack of opportunities for surgery, which leads to many low-seniority residents who cannot undertake secondary surgery.In Director Li's view, after entering the surgical work, as long as the senior physician recognizes his basic operation skills and passes the anatomy, it is completely okay to directly do secondary surgery.The difference between a low-seniority resident and a high-seniority is not only personal efforts, but also relying on the opportunities provided by senior physicians.And now the surgery for thyroid adenoma happens to belong to the surgery that Li Minqiao can be operated on.Director Liang moved a footstool to stand behind Li Min and watched the entire operation process in its entirety.The last stitch of the subcutaneous suture was fixed on the rubber bump.He opened his mouth to speak to Director Li."
Lao Li, I said she can do it, right?""
Well, you're right.Xiao Li's surgery is more careful than I did it myself, and I can get up faster if I do a few more cases. ”Director Li's words are comforting to the patients.Director Liang was affirmed by Director Li and smiled proudly like a child.He stretched out his hand to help fix the incision dressing with adhesive tape, looked up and asked Director Li: "Lao Li, Liantai's rectal cancer surgery, Lao Chen asked if you could get on?"
”"No.Tomorrow is going to do that esophageal cancer.Xie Xun: Today is also the day of surgery, and he can't spare time to see the postoperative liver rupture.I'm going back to Corey today.It's enough for you to do rectal cancer. ”"Whatever you want.I'll write you as a helper. ”"Hehe," Director Li smiled and took off his gloves and took off his surgical gown with the help of Director Liang."
It's no problem for you to write that I am a helper for every operation, and I'm happy to share a few more of my surgery fees.""
Xiao Li, the three assistants don't have a few surgery fees."
Li Min heard Director Liang call her, turned back with a lot of surgical lists, and when she heard such words, she immediately turned around and acted as if she hadn't heard what Director Liang said."
Lao Liang, it's good for you to provoke the relationship between me and Xiao Li, I see that you haven't been fighting for three days and are going to go to the house to uncover the tiles.We were one family 500 years ago, and your little trick is useless. ”Director Li threw the surgical gown into the corner of the room and replaced it with the screams of the nurses patrolling the station.Director Liang shook his head helplessly."
It's useless for you to call, he's been used to it for decades.You have the kung fu to help him throw the surgical gown into the bucket.Come on, get over the bed, and let Director Li take the patient back. ”*This patient was pushed out by the patrol nurse and handed over to Director Li, who had changed his clothes, to take back to the Department of Trauma Surgery.Over there, Chen Wenqiang had already come over with a patient with rectal cancer.The patient was the fat old lady who Li Min gave her an anal diagnosis before the holiday.In just a few days, the flesh on her cheeks went down.When she saw Li Min, she was about to sit up from the flat car, and Li Min was so frightened that she hurriedly stopped her."
Don't move."
Li Min stepped forward to hold the car."
Falling is no joke.""
Dr.
Li, will you also come to the stage for my surgery?"
The patient's anxiety is palpable."
Come on stage.I do all the disinfection.When the key parts are completed, Director Liang and Dean Chen will do it.Don't worry, they won't be able to see you exposed. ”"That's good, that's good."
The old lady / lay back in peace.The patrol nurse smiled and looked at Li Min, how to operate without revealing her body?
Li Min coaxed people to die and didn't pay for their lives.Li Min knew what she was laughing at, "She's just asking for comfort."
If you can take care of it, take care of it a little. ”This operation has been discussed before the operation, because the patient strongly requested to preserve the anus/incis, and the distance between the tumor and the anus/indicum happened to be 7 cm, which also met the conditions for choosing to retain the anus/incis, for this reason, Director Liang also took Li Min to have a serious conversation with the old lady.The old lady said firmly: "Artificial anus/door?
Then I won't have surgery.I'm discharged!
I go home and eat meat every day, and I can live for a few days. ”When encountering such a patient who persists and regards her pursuit and immediate quality of life as more important than the length of her life, the doctor can only try her best to satisfy her.Therefore, the colonoanal anastomosis procedure with anal/portal sphincter preservation was decided before the operation.Director Liang came forward, and Director Zhou arranged for Director Liu to give the patient general anesthesia.With the help of the patrol nurse, Li Min tossed for a while before setting up the bladder lithotomy position for the patient.After washing his hands again, he stood with a curved plate and against the wall waiting for Director Liu's instructions.Director Liu said while adding medicine to the infusion kettle: "Cunning children eat more milk, but it's not bad at all."
You see, this doesn't want a male doctor, and I didn't even bring a new person in under anesthesia.Sister, you can disinfect it. ”Li Min stepped forward with three large gauze cotton balls that had been stained with iodine and began to disinfect.Director Liu smiled and adjusted the tilt angle of the operating table so that the operating table was in a position with his head down and his feet high, and then leaned over the anesthesia table to make records.* "Senior sister, your mother came yesterday?
”"Yes.Come and see me. ”"I heard that you took him home the day after tomorrow?
What your mom asked for?
”"Yes."
Li Min glanced at Director Liu."
Let's talk about it when we get down.""
Okay, let's stop talking."
This abdominal disinfection is the same as normal abdominal surgery, but the □□ sterilization is stricter than the usual abdominal surgery.Li Min also had to use chlorhexidine to disinfect the whole □□, and to leave a counter at the cervix, because the preoperative B ultrasound, abdominal CT, and gynecological consultation all showed that the posterior wall of the uterus was eroded by tumors, and this operation also required subtotal hysterectomy.Enough will □□ sterile protection sheet and replace the urinary catheter again, Li Min completed it meticulously and carefully, and Director Liang was relieved to brush his hands.Chen Wenqiang took Li Min to the stage first, and the two of them were one on the right and one on the left.Chen Wenqiang clamped 10 cm above the patient's umbilicus with a small curve, and then used the back tip of a large round knife to wrap around the left side of the navel until the top of the pubic symphysis, and drew a white line for Li Min."
I'll press this for a moment.""
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Wash your hands."
Xu Li shouted and stopped Director Liang, who was about to wear gloves and go on stage, and Chen Wenqiang and Li Min also hurriedly stepped down from the stage to wash their hands."
I said how many times have you all had surgeries, and you're ready to open before you wash your hands, huh?"
Even if the little girl pretends to be fierce, she is not disgusting when she speaks softly.Dr.
Liang smiled and said, "We have to wait for you to shout." ”"Yes, you old man is waiting for the little girl to greet you.""
Aren't you also a little girl, and you'll be so happy that you can't find the north."
Li Min turned a deaf ear to the bickering between them and Xu Li, and asked Director Liu with a scalpel, "Is it okay?"
”"Yes."
Director Liang and Chen Wenqiang immediately used gauze to help Li Min tighten the skin of the patient's abdomen.Li Min held the scalpel and pressed the white line drawn by Chen Wenqiang, and between the skin tensed by Chen Liang and the others with gauze, the whole layer of the skin was cut at once."
Little Bend.""
Electric knife.""
Electrocoagulation.""
Line 1, wire cutter."
The three of them immediately began to get busy.When Li Min cut open the subcutaneous fat, she found that the patient was probably due to a relatively good nutritional status and a very rich blood flow in the capillary network, so she simply used an electric knife for small blood oozing, and only the small arterial blood vessels were ligated with a 1 wire to speed up the operation.Layer by layer, it goes straight to the pubic symphysis to the peritoneum, and the front layers are opened by Li Minlai.Director Liang knotted and Dean Chen cut the thread."
Xiao Li's abdomen is becoming more and more proficient.""
You taught well."
Chen Wenqiang rarely praised Director Liang once.Director Liang was stunned for a moment before he said proudly, "That's right."
Naturally, I taught it well.But are you saying that with some other intentions?
”"What?
Who did not train from outside the ordinary. ”Director Liang nodded and said thoughtfully, "What you said to Lao Li has been implemented?"
”"Half of the implementation is done, and the rest is for Director Qin of the hospital office to do.""
Okay, you old boy wilted officer to Mali.Lao Li has taught you a good student in this life, which is a great help. ”"You too, you won't be vague when you have the chance.""
Why do I always think something is wrong with you today?
Come on, fill the bladder with water. ”"Is 500ml enough?""
That's enough."
Director Liang slowly pushed the full bladder down, "Put the water, put it slowly."
That's right, that's the speed.Peritoneal pads. ”Two large gauze pads were thrown onto the operating table, and Li Min and Chen Wenqiang clamped the incised peritoneum to stop bleeding and folded it back to the side."
It's not bad, I didn't see ascites.Hand washing. ”Director Liang was ready to explore the abdominal cavity, and this time he didn't need instruments to wash his hands, and the nurse called him."
The liver didn't feel the metastasis."
Director Liang looked at and touched it, and kept muttering, "There are no metastatic nodules in the omentum, and the pancreas, spleen, and stomach are fine." ”"Give me a little more water to wash my hands.The quality of this glove is really not very good.Give me a new glove.For such a big operation, I was reluctant to give me a new pair of gloves, Xu Li, I was going to sue Li Qinqin. ”Xu Li pursed her lips and smiled: "There is a new No. 8 here, you don't take it, you go and bring the old one."
You can go to whoever you like to sue. ”Director Liang didn't think it was wrong, changed his gloves and went on stage again, muttering in his mouth: "A fat person is a belly of oil."
It's boring to touch everywhere. ”Chen Wenqiang had already beckoned Li Min to stand opposite, and when he muttered like this, he said, "You should hurry up and investigate, so as not to have many complications after surgery."
Xiao Li, remind you Director Liang of what are the complications. ”Li Min knew that this was another time to test herself."
The first is that the bladder lithotomy site is prone to common peroneal nerve injury, deep vein thrombosis of the lower extremities, and calf fascial hypertension syndrome.The longer the surgery, the more likely it is that these complications will occur. ”"Listen, Lao Liang, hurry up and get to work.It's greasy and greasy, it doesn't get into the colon and rectum, and it doesn't bring tumor cells. ”"Lao Chen, didn't you notice that Xiao Li raised this patient's calf today?"
The nurse who patrolled the station answered: "Your department is verbose, and people who do rectal cancer in a position outside the general area are not as much as you ask for." ”"You don't understand that.You girls are usually careful, and you can't put the patient in the most beautiful position for such a big operation.Xiao Li, tell her what is so good about this beautiful posture. ”"Elevating the calf to a horizontal position can avoid and reduce the injury caused by compression of the common peroneal nerve, and can also reduce the pressure directly on the popliteal fossa, thereby improving the venous blood return of the calf, reducing the pressure in the blood vessels, preventing endothelial damage in the blood vessels leading to thrombosis, and thus reducing the incidence of calf fascial cavity hypertension syndrome.""
Look, we can avoid so many postoperative complications by raising our calves.This is the real intention of the surgeon.Those big men outside the general world just think about removing the tumor, and these postoperative complications are also fatal. ”"Is it useful, Dr.
Li?""
It is useful in theory, but the actual effect depends on the postoperative.Whether it can be promoted or not, it is necessary to make statistics on the postoperative complications of the two lithotomy positions. ”Director Liang participated in the Q&A while doing an abdominal probing, and finally changed a pair of gloves and said, "I just said that patients will not get sick according to the book."
Look at it, her rectal cancer has invaded the posterior wall of the uterus.M's, how did this pass?
”"Posterior uterine position?
Uterine prolapse?
Or do you like to hold your pee?
”"Don't talk nonsense.Fortunately, the big blood vessels in this area are fine.The plexus was also not violated.Lao Chen, look at how we are: remove all the intestinal tubes within a range of 4 cm under the tumor, and then do a subtotal hysterectomy, sweep the lymph nodes in the pelvis, anastomize, and call it a day.Success?
”"I think so.What do you think, Xiao Li?
”"Me?"
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Li Min smiled: "According to Director Liang's wishes, I came." ”"Look, Xiao Li has agreed with you, hurry up with the automatic retractor, the big gauze pad, and the gauze belt."
Li Min watched Director Liang and Chen Wenqiang operate, and asked the nurse for "two 5-FU250mg." ”"Ready."
Director Liang stretched out his hand, and Xu Li handed him the syringe.Director Liang found a submesenteric vein and injected another into the lower rectal lumen.The free sigmoid colon is smooth.Li Min carried two free ureters and watched Director Liang and Chen Wenqiang free and reveal the root of the inferior mesenteric artery."
This one is the terminal branch of the sigmoid colonic artery, and we will ligate and cut the superior rectal artery and then the inferior mesenteric vein.There are several different methods of ligation, and Xiao Li went to the back after surgery. ”"Yes."
Li Min has memorized several different methods, and she understands that the important thing is for her to watch now, to remember the differences between Director Liang's operation and what she saw during the internship, and then she will slowly ponder it when she has time.After cleaning the fatty lymphoid tissue in front of the left and right common iliac arteries, Chen Wenqiang suggested: "Let's cut the uterine appendage first." ”"That's fine.Anyway, this piece has to be removed.Xiao Li, have you ever had a total uterine resection?
”"I've done two helps."
Chen Wenqiang stepped back to the side, "I'll give you a help this time."
That little Director Liu, lend me your round stool to sit on for a while. ”Director Liu immediately pushed his round stool over."
Sit down, sit as you please, sit until the end of the operation.""
Want to help your junior sister grab the stage?""
My junior sister still uses me to help, you have taken the initiative to let it out."
The operation went smoothly, and the patient was very stable after anesthesia, and Director Liu was in the mood to chat with Chen Wenqiang."
You do subtotal hysterectomy, don't you want gynecology to come to the stage?""
What do you want them to do?
Our Lao Liang can take all these surgeries.He, except that he can't have children, there's nothing he can't do. ”"But I can deliver babies.Two catheters are given. ”Director Liang's movements were fast, and Li Min could only follow his direction to chase down.The bladder was quickly pushed open, sutured, cut the round tenacity of the uterus, and cut the posterior lobe of the open ligament along both sides of the uterus to the uterine isthmus, and the arteriovenous and ovarian suspensory ligaments of the uterus were dealt with."
I'm from this side, and you're from the other side."
Chen Wenqiang stood back in place, stared at the middle bend in Li Min's hand, and saw that the middle bend was in the right position, before he retreated back and sat down."
Sharp knives, large gauze pads."
Li Min used gauze pads to wrap the two tissues that were free from the middle bend and were about to be severed, and signaled that Director Liang could use the knife."
Stone carbonic acid, gut."
The nurse on patrol used a stainless steel basin to pick up the uterine attachment wrapped in Li Min's gauze, Director Liang quickly buried the uterine stump, and Chen Wenqiang stood back in place."
Lao Liang, do you want to rest for a while?""
No, I don't.The pathology application form was sandwiched in the medical record, and the uterine attachment just now was sent for pathology. ”"Okay."
The patrol nurse agreed, and took the pathology sheet handed over by Director Liu, "It's cool to see your surgery do hysterectomy, and it will be cut in just a while." ”"That's it.Our old Liang is a big man from the outside. ”Li Min stepped back to the side, watched Chen Wenqiang and Director Liang stop at the mesorectum from the lower end of the tumor more than 4 cm according to the TME principle of total mesorectal resection.Director Liang raised his head and said, "That's it." ”"Then let's stop here.Sharp knives, intestinal forceps, right-angle forceps.Prepare the new Jieer to extinguish the irrigation. ”The sigmoid colon is severed, and pots of new Jieer liquid are poured from the stump of the sigmoid colon to the rectum."
Lao Chen, you see that Xiao Li's intestines are very well prepared.""
Well, that's good.""
This patient cooperates.After hospitalization, let me eat what I eat.I also did two more enemas last night. ”"No wonder.Change saline.Dutchman. ”After rinsing the rectum again, Director Liang directly put the stainless steel basin in his hand under the tissues to be cut off, and severed the distal end of the rectum."
Let's send it for pathology."
The patrol nurse took the specimen and left.
*Director Liang wiped his hands in front of his abdomen, "Lao Chen, are you going to match?"
Xiao Liu, give me your stool to rest. ”Director Liang retreated, and Li Min turned around and stood in Director Liang's position to cooperate and match.It's nice to be able to walk in such a lap, and both legs are numb."
Circular needle line 1."
Chen Wenqiang stitched a needle on each side of the colon and rectum, tied the knot on the inside of the intestinal wall, and then he held one in one hand, "Xiao Li, first suture the back wall and do full-thickness sutures." ”Director Liang stood up and watched Li Min stitch a few stitches before sitting back, "Lao Chen, let you do the stitching, you leave it to Xiao Li to do, you said that you took the money of the second assistant but did the work of the first assistant, bullying Xiao Li, the third assistant, are you embarrassed?"
”"I'm sorry.Or you can pick it up. ”After Li Min sutured the anterior and posterior walls with full thickness sutures, he changed to line 0 for intermittent suturing of the serous muscle layer for a week."
Lao Liang, come and check it out.""
Okay."
Director Liang stood up and asked for saline to fill his abdomen, "Cheer up." ”The patrol nurse hurriedly went up and was busy, and after waiting for a while, no bubbles came out of the abdominal cavity."
Alright.OK.Suction device.Rinse.Prepare a 5-Fu saline rinse. ”After several rounds of saline rinsing, Director Liang began to guide Li Min to suture layer by layer, and Chen Wenqiang went directly to the doctor's order."
Director Liang, you and Dean Chen are very comfortable with this operation, and the two of you are resting back and forth."
Director Liu joked."
That's right.Otherwise, why didn't Director Li come?
He was afraid that we would both run away, leaving him and Xiao Li to finish.Give me a silicone drain. ”Chen Wenqiang said: "The upper four are also two people operating two people to pull the hook.Our surgery is only done from the abdomen, and there is an automatic retractor, which is the most suitable. ”"Are you tired, Xiao Li?"
While watching Li Min suture, Director Liang cut the silicone tube short, placed it in the pelvis, and drilled another hole from the left lower abdomen."
Tired.The legs are all wooden. ”Li Min told the truth."
Our surgery is good, everything is smooth.How long does Lao Chen remember the rectal cancer that year?
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”Chen Wenqiang said without raising his head: "Eight and a half hours."
I want to put a urinary tube on myself. ”Except for the older patrol nurse who said a word to the two old men, no one else should have heard it.......
"Lao Chen, come over and help." ”The instrument table was removed, and three or four people worked together to move the patient's lower legs from the lithotomy position to the recovering operating table.Six people worked together to lift the fat old lady back to the flat car.Director Liang hugged his waist and said, "If there are a few more like this, I have to take off my waist." ”Chen Wenqiang stuffed the medical record book under the patient's head and said, "Xiao Liu sent the patient to give this to the nurse, and we will take a shower and go back." ”Xu Li asked, "Dean Chen, it's two o'clock, is there any food?"
”"Let Director Liu ask the family."
Li Min hurriedly said: "Before the operation, the family said that they had ordered lunch at Sihai Restaurant, and I ordered your favorite food."
Why don't I go out and ask if there's anything changed?
”Director Liu said, "Senior sister, let's take a bath, I'll ask." ”*In this day's work diary, Li Min remembered the following sentences: Director Liang and Dean Chen's surgery not only followed the basic principles of the textbook, but also had the flexibility to adapt to the situation, such as the left turn of the tail tumor of the pancreatic body, like the change of surgical steps today.The same is true for the use of surgical instruments.Chen Wenqiang abandons ion stripping in cranial surgery, etc., and likes to use Wen's forceps, and Pu Wai Xie Xun uses scalpels in tissue separation......
In a standardized internship, this is forbidden and reprimanded by the teacher.However, in the actual work and in the years that followed, with the increase of Li Min's contact with other doctors, she realized more that no matter what kind of academic background, those unique and leading department directors have unique working methods and personalities.- There are few similarities.※※※※※※※※※※※※※※※※※※※※ saw a liver transplant for the first time, and it started at 7:30 p.m....... () The distance is a bit far