Because it is two surgeries, Chen Wenqiang's arrangement is naturally simple and easy, and the other is relatively not complicated, so as to ensure that the operation will not take too long, and it can also ensure that the two of them have enough energy to work.But he and Li Min never expected that such a relatively uncomplicated operation would almost give the patient to the operating table.This is a patient with insular glioma, the first symptom is epilepsy, 2 years ago, there was no cause of shaking of the right upper limb, the duration is about a few seconds, the frequency of seizures is about one or two times a week, the patient does not care about and does not seek medical treatment and has no history of diagnosis and treatment.However, two months ago, the symptoms suddenly worsened, and the tremors of the upper limbs gradually became daily and lasted for one or two minutes, accompanied by nausea and vomiting.This is the patient they admit on an outpatient basis.No history of other hospital visits.Brain CT and MRI were performed in the outpatient clinic.CT scan showed patchy uneven low-density shadows in the left frontal insula, and multiple patchy calcifications in it.MRI showed long T1 and long T2 signals in the left frontal lobe and insular lobe.
FLAIR image is slightly hyper-signaling; DWI is slightly hyperintense, with little enhancement, and the left ventricle is slightly compressed, and no significant edema is seen.The reason why this surgery was put on the second unit is because the tumors are mainly concentrated in the insula.The insula is the "dumb zone" of the central nervous system, and its cortex has no specific function.The surgical plan was designed early, using a point-of-the-point approach to expose the tumor through the lateral fissure of the cerebral cortex.The first step is to open the lateral fissure extensively, and it is done smoothly.The exposure of the roundabout sulcus is consistent with preoperative expectations.The middle cerebral artery MCA is retained smoothly.After blocking the blood supply to the insular lobes, the tumor can be removed.But at this moment, the patient's heart suddenly stopped.Fortunately, in their operating room, all the rescue facilities are readily available, and after the electrical defibrillation, the heart has returned to sinus rhythm.Director Liu of the anesthesiology department asked the patrol nurse to find Director Zhou after the successful rescue, and she also said to Chen Wenqiang: "Dean Chen, I think you should stop for a while, the heartbeat just now stopped, why do I feel that my heart is still biblious." ”"Let's stop for a moment."
Chen Wenqiang decided, Li Min learned from him, took off the eyepieces, and rested with his hands.Director Zhou came over after a while."
Xiao Liu, what's going on?"
Director Zhou is like a fire brigade fighting a fire today, if he knows how to divide / body technique, he will definitely divide himself into three parts, no, now it is enough to divide into four parts."
When I blocked the insular blood vessels just now, I suddenly went into cardiac arrest.""
Old Chen?"
Director Zhou looked at Chen Wenqiang, who was recuperating with his eyes closed, and asked tentatively, "What do you mean?"
”"Lao Zhou, this island leaf, you know, that's the 'dumb zone'.There is currently no clear identification of central function.Now that there is such a reaction, I suspect that it is a lack of understanding of the function of the insula, which is not actually a 'dumb zone' in our cognition. ”"And what do you mean?"
Chen Wenqiang pondered for a while and said, "Continue the operation, you help me monitor the patient's vital signs."
I'm trying to find out what Shimaba's function corresponds to. ”Director Zhou frowned: "Then you have to be ready."
Not every cardiac arrest can be saved. ”Li Min stood up, lifted the saline gauze covered by the surgical field, pointed to the area of the tumor that had been exposed with dark color and dots of flaky white spots, and said to him: "Director Zhou, look at the color and extent of this glioma, this is a sign of low-grade glioma.Although she now has no signs except for epilepsy, the frequency of seizures has changed from once or twice a week to more than once or twice a day, and she found that the duration of seizures has changed from a few seconds to a minute or two.At this rate of progression and the level of the tumor, she didn't have much of a normal day left. ”"Lao Zhou, let's try it.If she could have removed a little more of the tumor, she would have survived longer. ”Chen Wenqiang enlisted Director Zhou's help.Director Zhou thought for a while and said, "Okay. ”But he reminded Chen Wenqiang again: "Old Chen, you are gambling big."
This may not be able to get off the stage. ”Chen Wenqiang nodded.He was unwilling to step down like this.If it were to be accepted so simply, then the neurosurgery department would have to close its doors and stop admitting patients.Because any brain tumor, don't look at the brain CT, magnetic resonance MRI, enhancement, imaging and other auxiliary examinations, that is to provide a reference.As for what you see when you open your head, it may not be the information provided by imaging that allows you to perform surgery.The surgery continued.
*Li Min changed the direction of surgery to block the blood supply to the tumor.But things didn't go well.After a few minutes, Director Liu stopped: "Induce epilepsy." ”Li Min stopped, and Chen Wenqiang asked the intern who was watching the operation: "Why did you induce epilepsy?"
”The intern snorted, "It has something to do with the seahorse back." ”Li Min looked at him like that and added: "It is related to the stimulation of the hippocampal gyrus and the amygdala."
Teacher, I'm going to block this blood vessel completely.At the very least, postoperative seizures are less likely. ”"Well, let's break it.Otherwise, the tumor cannot be removed. ”Li Min used the spike signal monitored by the brain waves to use coagulation to disconnect the distal end of the short perforator artery that supplied the tumor, and she still put on an extra layer of silver clip at the proximal end as insurance.Director Zhou praised: "Xiao Li is careful. ”Li Min turned a deaf ear, she didn't raise her head and her eyes and asked Director Liu: "Senior sister, brain wave reaction?"
”"The spikes disappeared in a group."
Director Liu replied briskly this time."
Senior sister continues."
Li Min continued to look for perforators that could induce epilepsy.Chen Wenqiang waited for a while and said, "Xiao Li, it's almost."
I'll talk about it when I met it. ”"Okay."
Li Min obeyed the command.Director Zhou smiled and said, "If you two do this, you can write a thesis after surgery." ”"I think so.Relationship between branch vessels of insular MAC and epilepsy.Without proper medical records, no one would do experiments and studies in this area. ”Li Min changed again, and continued to separate and block blood vessels along the dividing line between the tumor and normal brain tissue.After a few minutes, I went into cardiac arrest again.…… The preoperative surgical plan was abandoned.Under the command of Chen Wenqiang, Li Min began to tentatively circle around the tumor.She tentatively clamped each blood vessel to block its blood supply.If the epileptic waveform is induced, dissection treatment should be done immediately.But several cardiac arrests in a row made Li Min's range of movements smaller and smaller.The only thing that is fortunate is that the branch blood vessels of the MAC are re-branched and do not get thinner and thinner like other arteries in the body."
Xiao Li, if you do this, you won't be able to finish this operation after dark."
Director Zhou said Li Min."
Uh-huh.I wanted to find out exactly what it was that could cause cardiac arrest. ”"Lao Chen, if you have an idea, Xiao Li will follow you to experiment, do you two want to have an operation to determine the 'function' of the insula leaf?""
If only I could."
Chen Wenqiang is not in a hurry.He can be a magician with Li Min, and he is not afraid to do it when it gets dark.Although this surgery is risky, at the same time, the rewards of this surgery are also great.If he can get the results of the preliminary study of the function of the insula, which was previously considered a "dumb area", it will be a boost to his promotion to Zhenggao this year, and it will greatly promote the development of neurosurgery.Fortunately, there was only one cardiac arrest after that, but the glioma was not completely removed.Because the M2 of the middle cerebral artery MCA and several longer arterioles will induce changes in the heartbeat after a tentative clamp test.Seeing this, Director Zhou issued the most severe warning: "Chen Wenqiang, let me tell you, stop the operation!"
If you insist on going on, if your heart can't beat again, you will have zero research. ”Chen Wenqiang retorted, but he still refused to stop.Director Zhou was not used to him at this time, so he directly gave him a slap in the face."
Do you think that there are not enough troubles in the provincial hospital, or do you think that patients in brain surgery die less and die slowly?
Don't forget that a bradycardia died yesterday.If you die on stage today, do you want the neurosurgery to stop for a while?
”Therefore, the operation can only cut as much as possible, and then the skull can only be closed with great regret.As for the remaining residual tumor tissue, even if they see arteries and blood vessels passing through and nourishing, they can't and dare not touch it again.After stepping down, Li Min's mood was not high, and Chen Wenqiang was also in a heavy mood.Because the residual tumor tissue has enough nourishing blood vessels, it means that the tumor will come back quickly.Recurrence has been the most dreaded cause of death for glioma.* They were about to shut up their heads, so the nurses who patrolled Taiwan dared to tell the death of Dr.
Wang's daughter.For Li Min, although Dr.
Wang is not likable, his little daughter is very likable.She inevitably sighed with everyone, and then said some words of sympathy for Dr.
Wang.But she is more sympathetic to Wang Qiuyun.The ex-husband committed suicide by jumping off the building with stomach cancer, the eldest daughter had congenital heart disease, and now the second daughter died again, this person is simply soaked in bitter water.Director Zhou said: "Lao Chen, what's going on with the toddler?"
We have two nurse anesthesiologists in the anesthesiology department, and we went home with the children yesterday during break.It seems that the nurses in the operating room have also gone home.This affects the mental stability of medical staff. ”Chen Wenqiang stared at Li Min to do the final surgical field examination of the patient, and said unhappily: "The public health has been tracking for a day, and I called at ten o'clock last night to tell me: It was a child from Toban, who was taken to grandma's house last Sunday to celebrate the old man's birthday, and played with several children of similar size for most of the day.The kid got sick.In the past 10 days, none of the other children in the nursery have left the family area of the provincial hospital, nor have they been in contact with relatives or other people from outside. ”Is this the source of infection found?
Chen Wenqiang's expression was indistinguishable, and he continued: "The public health personnel went to investigate today to see if the children of those relatives of their family were ill.If there is, then it proves that this infection is not a problem in our nursery. ”Director Zhou nodded and said, "Eight or nine times out of ten, that's the case."
The other children in the nursery have no history of outside exposure, and it is impossible for the nursery to conjure up the virus out of thin air. ”"yes."
Chen Wenqiang nodded."
The nursery schools and kindergartens in our provincial hospital have been disinfected according to the strictest standards over the years.""
It's useless to disinfect it.Which of us has been working in the hospital for a day, and dare to say that our hair is cleaner than that of people who work at school?
When I got home, I washed my hands and changed my clothes, and sanitized myself from head to toe without entering the door. ”"There are pros and cons.We have a lot of bacteria, but the child has already been stimulated to produce antibodies in the body.Ordinary viruses and bacteria can resist it. ”Chen Wen strongly supported the provincial court."
Like the child in Dr.
Wang's family, there are personal reasons for the child.Because she has patent ductus arteriosus and atrioventricular regurgitation. ”Sister Feng, a nurse patrolling Taiwan, said: "No wonder, I heard that more than 20 children are sick, why are their children dying immediately?!"
But Dean Chen, I think who is the source of this infection, if Dr.
Wang and his family know, then they have to go to the door. ”Director Liu sighed: "They didn't mean it, besides, other people's children are also infected and sick." ”"What kind of virus infection is that?
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Dean Chen, it's been two days, are there any results?
”"Tendency to syncytial virus with the respiratory tract.X-rays, signs and symptoms of the child with the onset of the disease support this diagnosis.Virus isolation will have to wait a little longer. ”"Then hurry up and give the right medicine."
Xu Li, the instrument nurse, packed up her things and spoke."
There's no cure.If there is, the provincial hospital can not use it.Only symptomatic supportive care is currently available.Immunoglobulins are all used. ”As they spoke, the finishing touches were done.After passing the patient over the bed, Li Min took Dr.
Deng and the intern to the ICU.Chen Wenqiang went to explain the operation to the family.In this way, not only in the operating room, but also in the departments of the provincial hospital, they are also talking about this matter.Only Director Liu of the Department of Pediatric Surgery couldn't bear it, so he went to Director Hu of the Radiology Department.
*Chen Wenqiang explained to the patient's family that the tumor could not be completely removed after surgery, and the family heard that the tumor was left because the heart stopped beating because it moved, so they had no choice but to accept this situation.When asked by the family about the postoperative survival time, Chen Wenqiang said, "Look at the pathological results."
Chemotherapy is done for the type of tumor.It is hoped that chemoradiotherapy will work and will inhibit the growth of tumors. ”Chen Wenqiang went back to the locker room to change clothes, and the head nurse of the operating room shouted outside the curtain: "Dean Chen, Director Liang has something to do with you."
He let you eat and call him. ”"Hmm.I know. ”Chen Wenqiang had lunch and asked Director Liang to go to the director's office on the twelfth floor.When Director Liang saw him, he first talked about business: "Lao Chen, I see that Dr.
Wang usually likes his little girl's appearance, so I will divide Dr.
Wang's hospital bed." ”Chen Wenqiang immediately said: "It's good."
Just now I was looking at the duty records in the hospital office, and Director Qin is on duty, do you two know?
In the last 24 hours, a total of 11 people died in various departments of our provincial hospital.Including Dr.
Wang's little daughter.Although there is no mistake on the part of our medical staff, we should still be more careful at this time. ”"Do you want him to take annual leave?"
Director Liang tentatively proposed.Director Shi reminded: "It's the operation season, and he may not be willing." ”Chen Wenqiang said without hesitation: "Let him take a break."
If he refuses, he will have to rest.It's also for his good.If something goes wrong, not to mention that he can't bear it personally, the impact on the provincial hospital is not good.Like the anesthesia accident the year before last, wasn't it turned out for investigation recently?
No one wants medical malpractice, so we can only avoid possible hidden dangers. ”"Is there going to be a change in duty?""
No change.Let's see how your department makes up for Dr.
Wang's shortcomings.Xiao Li is going to set up a stage for Director Liu on Sunday, and Lao Shi is also going to be on the stage, so we can't change with it. ”The Department of Surgery of the Provincial Hospital now has a total of eight deputy chief physicians, seven days a week, eight shifts, each with one group.But for the operation of pediatric cardiac surgery, Director Shi and Li Min want to go.Director Liang pondered for a while when he heard this, and said, "In that case, I'll take a look at how to get out of the way." ”He thought for a while and said, "Forget it, I was on the night shift for Dr.
Wang last night, and there are three deputy chief physicians in Puwai, and one more for him is fine." ”Chen Wenqiang nodded and said, "Then you look at the arrangement."
Don't work the night shift in a row, the mental head will not have an accident again, and the gains outweigh the losses. ”"Well, I'll take notice.That Xie Xun was on the day shift on Sunday, and I asked him to add a night shift on Thursday.But Wednesday and Friday are Lao Bian and Lao Xu's night shifts,!
”Director Liang scolded a swear word, and then said helplessly: "Wang Dazhi rested, and Xie Xun and I substituted for him." ”"You two are section heads."
Chen Wenqiang did not say the rest of the words.Director Shi smiled and persuaded Director Liang: "Your night shift on Monday is okay if you go on another one on Thursday."
Thursday night is the attending physician, you will not worry too much about Xiao Chen when you drive Xiao Chen up. ”Such comfort is better than nothing.However, for the sake of Wang Dazhi's temporary affairs, it is obviously impossible to greatly adjust the surgical duty during the operation season.※※※※※※※※※※※※※※※※※※※※* The incubation period for RSV is 3-7 days.
**The insula lobe, previously thought to be the "dumb zone", has been found to be associated with visceral sensation, motor, vestibular function, and speech function.The definition of functions in the field of advanced cognition is also gradually deepening, such as addiction dependence, reward and punishment game, memory, etc.Due to the deep location of the insular lobe, the complexity of the adjaculation, and the uncertainty of the function, the surgical treatment of lesions in this area is still one of the difficulties in the field of neurosurgical research today, 2020