The operating room was not as smelly as expected, and the patrol nurses had already turned on the ventilation to the maximum.The laminar flow operating room is much more advanced than the original simple air conditioner to adjust the temperature and ventilate the exhaust fan."
Old Pan, how's it going?"
Xie Xun brought two layers of masks, and asked angrily with his mouth covered.Pan Zhi on the stage also wore two layers of masks, and he said without looking back: "I suspect that there is a malignant transformation in the middle of the lower colon, Director Xie, you come up and palm your eyes."
If you don't come again, I'll have to ask the nurse to invite you. ”Xie Xun still spoke venomously: "What colon cancer."
If you do it yourself, it's over. ”Pan Zhi on the operating table smiled bitterly.He felt like he hadn't been so sad since he became a surgeon.Orthopedic Dr.
Jin couldn't help much, and the two newcomers were much worse than Xiao Jin; Standing and selling stupid interns, he will not dare to use it.The point is that the patient is not at all what he complains of: constipation for a week.The accumulation of fecal stones and other substances in the intestines can be more than two months, to say the least.I was cheated by the patient's complaint again......
From opening the abdominal cavity and opening the descending colon, for such a long time, he has been cleaning up the feces accumulated in the intestines, which can be regarded as almost now."
Director Xie, do you think this is a stoma?"
Xie Xun stepped forward, swept the scene on the stage slightly, and said to the nurse patrolling the stage: "Dr.
Li came with me."
You go to the locker room and ask her to brush her hands on stage. ”Dr.
Jin asked, "Director Xie, are you also on it?"
”Xie Xun didn't reprimand him in Director Liang's face, nodded and said, "I'll do it too."
I'm going to brush my hands. ”Including Pan Zhi, they all felt relaxed.followed to the stage by Pan Zhi and Xie Xun, the two of them were stunned after Pan Zhi opened his abdominal cavity.Xie Xun put on the surgical gown and said, "You two go down."
Little Kim, you choose. ”Dr.
Jin knew that this was to give himself face, so he immediately stepped back obediently and said, "I'll step down, and if something happens in the ward, I'll find someone." ”Li Min then also came over to put on a surgical gown.Pan Zhi said to Li Min, who was rinsing his gloves with salt water: "Senior sister, I'll rest for a while, you and Director Xie will do it." ”He gave up the sorcerer's place."
Okay, Teacher Pan is at his own convenience, and I am also an assistant to Teacher Xie."
Li Min's tone was very respectful.Xie Xun didn't stand in the position of the sorcerer, but said to Li Min, "You stand there."
See what you're ready to do. ”The intestinal tract in the surgical field was congested, edematous, and dilated, and at the place where Pan Zhi chose to cut the lower colon intestine to clean the feces, a slightly raised, cauliflower-like mass of suspected tumor was visible to the naked eye.occupies less than half of the lumen of the bowel of the descending colon."
Mr.
Pan's choice of position was too accurate, and he immediately picked out the cause of the obstruction.Mr.
Xie, I don't think this intestinal edema is too bad, let's try to cut the left half of the colon, and then anastomoses the transverse colon with the sigmoid colon, is it okay?
”"Not afraid of anastomotic fistula and infection?""
I'm afraid.Try it.He also has to undergo a second-stage radical surgery for his stoma, which may not be better than doing it now.If it is not anastomosis for a while, then we can do a transverse colostomy and sigmoid atresia, okay?
”Li Min lowered his posture very low."
Then try it.Xiaojin, you go and explain to your family, can you explain it?
”"Yes."
Dr.
Kim agreed very happily."
Look at the surgery information form, if it is not written colon cancer, make up for it immediately, and then ask the family to sign it."
Pan Zhi saw Xie Xun instructing Xiaojin like this, so he said, "I'll go talk to my family." ”"Okay, thank you.Tonight's surgery was supposed to be for me and Dr.
Li, and we'll wait for you to come back and cut it. ”Pan Zhi went out, and Xie Xun asked for gauze to cover the intestines."
Senior sister, you are idle, tell them about colon cancer.""
Yes."
Li Min never threw away the book, and even told the intern according to what he saw so far."
The case we are experiencing now is suspected to be acute obstructive colon cancer, which is clearly ulcerative to the naked eye.I won't say much about the specific description, as you see it.This type generally accounts for more than 50% of colon cancers, and the cancer grows into the muscular layer of the intestinal wall.Ulcers are usually present early and bleed easily.You go back and ask the patient if there is any blood in the stool. ”The intern nodded stupidly."
Pathologically, this ulcerative type differentiates less and metastasizes earlier.So in this case, we're going to sweep the abdominal lymph nodes in a moment. ”The newcomer nodded."
Then there's the bulging one, which grows into the lumen of the intestine, and when the lump is large enough, it can also form an ulcer on the surface.But it's different from what we just saw with the naked eye that the muscle layer is invaded.The eminence has little peripheral infiltration and a good prognosis.Unlike this muscle, which has a stiff change after being infiltrated.The last is infiltrative growth in the layers of the intestinal wall, resulting in thickening of the intestinal wall and narrowing of the intestinal lumen, but there are often no obvious ulcers and bulges on the surface.It is the earliest of the lowest differentiation metastasis. ”"Clinical manifestations, you go back and read the book yourself, and now talk about surgical treatment.""
For tumors in the cecum, ascending colon, and liver flexure, we usually choose right hemicolectomy.Scope of the terminal ileum and the corresponding intestinal tube, mesangium, lymph nodes. ”"In the transverse colon, we remove the transverse colon, including hepatic and/or splenic flexure, as well as the omentum, corresponding mesentery, and lymph nodes.""
Sigmoidectomy went back to reading a book.The various surgical methods coincide, that is, the broken ends are connected.Left hemicolectomy you can see in a moment.In the case of acute obstruction in this case, if the patient is admitted for laparotomy to relieve the obstruction, because the intestinal tube is not prepared, it is a contaminated wound, and depending on the degree of edema and dilation of the intestinal tube, ostomy can be selected, and then radical resection can be done in the second stage. ”Li Min hurriedly picked up the main point, and Pan Zhi slammed the door and came in."
Director Xie, the family agreed to undergo left hemicolectomy and signed up.I asked for another 400 whole blood. ”"Okay.Then come up. ”Pan Zhi changed into a surgical gown and gloves and stood back on the operating table."
Gauze strips.Large gauze. ”Li Min stood in the position of the surgeon and began to ask for things.With Xie Xun's cooperation, she tightened the intestinal tube with gauze strips and wrapped it in large gauze, and then treated the arteriovenous vessels of the mesentery.Here, she and Xie Xun buried their heads in surgery, and Pan Zhi pulled the hook on the side to explain.After Li Min freed the left half of his colon, Pan Zhi's voice was a little hoarse, and Xie Xun took it and talked about it.But he was impatient when he said two words, and pointed to the two newcomers who entered the department this year and said, "You two will talk about one and add one." ”The two of them stumbled, and Li Min reminded Xie Xun with a smile: "If you haven't had colon cancer resection for more than three months, you may not remember the full anastomosis." ”finally stopped Xie Xun's swearing that he was about to blurt out.When it was time for the match, Xie Xun still reached out and took it......
Li Min retreated to the position of the second assistant, allowing Pan Zhi to cooperate with Xie Xun to complete the anastomosis.The whole operation was risk-free.After the operation, Pan Zhi said, "Senior Brother Xie, fortunately you took over tonight, otherwise I would have to find Director Liang." ”"It's nothing, you just chose the ostomy technique, which is also in line with the principles of textbook treatment.Go back and talk to the patient's family that today's anastomosis is also a gamble, and if it does not heal after surgery, it will still have a second operation. ”"My family and I have highlighted this situation in particular.""
That's good.Senior sister, the medical representative who came to promote parenteral nutrition last time, you can call him tomorrow.Ask him to bring you a set of materials to Senior Brother Pan.I think that if you can use parenteral nutrition for a week after this surgery, it will be beneficial for anastomosis and healing. ”"Good.But I don't know if Director Fan has fat milk there.The medicine was cut off after the Spring Festival. ”"Without you, let Dean Chen urge.Be sure to use it tomorrow night. ”Xie Xun suddenly became impatient.Li Min was stunned, but Xie Xun walked away with his neck stalked.She couldn't help but think that if the pharmacy didn't take the medicine in time, it would be better to tell Chen Wenqiang about Xie Xun's words, or to tell Su Ying.After working in the Provincial Academy for a year, Li Min has somewhat understood the twists and turns of interpersonal relations in the Provincial Academy: Director Fan is a person that Dean Shu can trust, and the relationship between Dean Chen and Dean Shu is extraordinary.Xie Xun asked himself to instigate Dean Chen to urge Director Fan, did he not deal with Director Fan?
I couldn't think about this matter before I got involved, why did I talk to Dean Chen about the general external medicine.Li Min felt that killing could not be mixed up.
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*"Senior Brother Pan, do you know that a *Rui Pharmaceutical Factory recently launched a three-liter bag, right?
”"I haven't heard of it.""
There is a bowelless girl who has had all her small intestines removed, and she relies on their products mainly fat milk, as well as supporting complex amino acids, complex vitamins, etc., to maintain her life, and she also gave birth to a little daughter.They have been in surgery for the first half of the year to talk about their product, fat milk.At the end of last year, our department used it for a short time, and then it was out of stock. ”"It works?""
The use of lipid emulsions to provide high calories to postoperative patients is theoretically helpful in promoting wound healing.However, in fact, the time for trauma surgery is very short, and I have not gained enough experience in comparison.But if those few are infected, especially the one with intestinal resection, ...... parenteral nutrition support," Li Min thought divergently according to his own thoughts.Pan Zhi used to be in municipal hospitals, and new technologies and drugs often had to lag for a year or even several years before they could be used.So he was very interested in Li Minti's three-liter bag.He thought for a moment and asked, "Why is it out of stock?"
”Li Min shook his head: "I don't know.Director Liang should know that he was in the trauma surgery department at that time. ”"Then you don't have to worry about it, I'll ask Director Liang directly.""
Thank you, Senior Brother Pan.""
You're welcome.This patient is not in your hands, and you are not in your department.Let you urge Director Fan to enter fat milk through Dean Chen, even if it is a panacea, it is not easy for you to speak. ”Pan Zhi bluntly pointed out the key points, and said in his heart that Xie Xun wanted to pit Li Min to watch the excitement, or was he just pouting blindly?
But from Li Min's words of thanking him, he also judged that Li Min did not agree with Xie Xun's opinion.That's enough.Pan Zhi took the matter over, and Li Min went back to the duty room of the trauma surgery department without incident.Although she didn't read all night, she was satisfied with half of the left hemicolectomy.Tomorrow I will have a lobectomy and turn off the lights to rest.In the second half of the night, everything was solved by Pan Zhi and Xiao Jin.Li Min had a good night's sleep on the twelfth floor.It had long been planned to perform hemihepatectomy, and Li Min went to the general surgery department to pick up the patient and follow Xie Xun to the operating room without any pressure.() The distance is a bit far