My medical skills add experience

Chapter 259 Hidden submural lymphoma of the bowel, out of the department for consultation
The main team of gastrointestinal surgery is still composed of the original digestive surgery team.

It's just that some digestive surgery projects have been allocated.

Such as pancreaticobiliary surgery, anorectal surgery.

Generally speaking, the continuous subdivision of departments has both advantages and disadvantages.The advantage is that it can make doctors and nurses more proficient in related medical fields, and can truly strive for excellence.

This is also a major trend in the market.

As the Huaxia Kingdom grows stronger and stronger, the common people's requirements for medical treatment are also getting higher and higher.

Now everyone runs to that hospital wherever they can be optimistic about a certain disease.For example, the oncology department of Tuya Attached Second has become stronger and bigger. It attracts not only cancer patients from the whole province, but also many cancer patients from other provinces.

Zhou Can and Dr. Chi pushed the patient into the operating room, while the patient's family members waited outside the operating room.

It can be seen that the couple are very nervous, and their faces are full of anxiety.

The operating room has already been prepared, and the anesthesiologist and surgical nurse are already in place.Not long after the anesthesia was given to the patient, the deputy chief physician also arrived in a hurry.

"Director Mu!"

Zhou Can was surprised that the person who came in turned out to be the lonely fellow from the digestive surgery department.Deputy Director Mu is still a bit narrow-minded.

"Hello, Dr. Zhou! It's a great honor to cooperate with Dr. Zhou in the operation."

Director Mu actually had an expression of taking advantage, and smiled happily and stepped forward to shake hands with Zhou Can.

In the past, Deputy Director Mu didn't treat Zhou Can like this.

It can only be said that this moment and that moment.

Zhou Can's great potential, as well as his hidden status in Tuya Hospital at this moment, are enough to make Deputy Director Mu change his attitude towards Zhou Can.No one would say no to being on good terms with a future medical mogul.

"Thank you Director Mu for your trust and support! I am the one who should feel honored to be able to operate with you."

Zhou Can didn't dare to take advantage of this man.

You must leave enough face for the other party.

Especially when dealing with such narrow-minded people, you must be extra careful.Sometimes I didn't say a word well, and I just took it to my heart.

"Old Mu, I'm going to trouble you this time!" Dr. Chi and Director Mu obviously have a good personal relationship.

"What's the trouble? Don't I ask you for help less often? If you want to be polite to me, you'll be offended." Director Mu waved his hand and walked over to the patient to have a look.

At this moment, the patient has begun to enter the anesthesia state.

But it will take some time.

"The anesthesia was successfully implemented, the patient's signs were stable, and the operation is possible!" The anesthesiologist is always the most serious person during the operation, and he is strict in observing safety regulations in all operations.

Even more serious than the main knife.

I can understand, after all, they are responsible for the life safety of the patients, not serious.

"Doctor Zhou, please!"

Director Mu motioned to Zhou Can.

"it is good!"

Zhou Can stood at the chief surgeon's position and began to perform laparotomy on the patient.

When the scalpel was in his hands, it was as if it was alive. It was nimble, fast, and it acted according to its heart.

No matter how long or how deep the stroke is, it's all wonderful.

As the abdominal cavity was opened layer by layer, Zhou Can electrocoagulated the patient to stop bleeding.Large blood vessels are perfectly avoided during incision.

With the blessing of quick-knife knife technique, the incision of the middle level is not inferior to the incision level of the deputy chief physician.There is no need to worry about accidentally cutting large blood vessels and nerves.

"We help you pull the hook."

Deputy Director Mu and Dr. Chi took the initiative to act as assistants to Zhou Can.

As the abdominal cavity was opened, Zhou Can first sucked away the accumulated blood and a small amount of peritoneal fluid, and then began to carefully explore the lesion.

Whether performing abdominal surgery or thoracic surgery, doctors need to have a strong sense of responsibility and rich surgical experience.Because when pulling the organs in the abdominal cavity, in theory, as long as they don't break, there is no big problem.

However, after the operation, the organs and tissues in the abdominal cavity may be seriously adhered, which will bring a series of troubles to the patient.

That is commonly referred to as postoperative sequelae.

Almost all thoracotomy and laparotomy have some degree of sequelae.

For example, after thoracotomy, patients often feel chest tightness, shortness of breath and other problems.

If the abdomen is opened, the risk of intestinal adhesion and intestinal obstruction will increase significantly.

Many patients who underwent laparotomy indicated that they had a certain degree of constipation or inexplicable abdominal distension and depression in the survey half a year after discharge from the hospital.

Therefore, a responsible doctor will conduct a comprehensive assessment when performing thoracotomy and laparotomy, and will decide to perform surgery on the patient only after confirming that the benefits of surgery are far greater than the possible impact of surgery.

Zhou Can tried his best to keep the organs in other parts of the patient's abdominal cavity from being moved. He did his homework when choosing the location of the knife before the operation.

At this moment, the lesion area was taken directly after opening the abdominal cavity.

Because the patient is still in the early lesion stage, the lesion in this period is not obvious yet.So even though the positioning has been done before the operation, and small nodules can be felt when touched, but when the abdominal cavity is opened, there is still no discovery.

Zhou Can was mentally prepared for this.

"It seems that there are no obvious tumors or nodules! When Dr. Zhou touched it, would it be because the other party was a young woman that something strange appeared?" Dr. Chi asked beside him.

Before opening the abdominal cavity, Dr. Chi was full of confidence in Zhou Can's diagnosis.

But after the abdominal cavity was really beaten, it was discovered that this was not the case.

He was inevitably disappointed.

The main reason is that the family members are not easy to explain.

"Am I like the kind of person who has never seen a woman?" Zhou Can curled his lips a little speechlessly. If he was so worthless, he wouldn't be able to be a doctor. "At that time, my hand feeling would never go wrong. There is only one possibility that no lesion can be found when the abdominal cavity is opened. The tumor or nodule is very small, and it is hidden in a certain tissue."

Zhou Can's surgical experience is extremely rich, and he has cut many tumors and nodules.

Although the current situation was a little unexpected, he quickly calmed down and cleared his mind.

The first round of search just now didn't yield any results, that's because he was very cautious during the operation, worried about hurting her abdominal cavity tissue.

"Put me on thin sterile gloves, the thinner the better."

Zhou Can said to the surgical nurse.

All the operations in digestive surgery know Zhou Can and have seen his abilities.

At this moment, the operation was frustrated, and they were not worried at all.

The nurse on tour hurried over to help Zhou Can take off the glove on his right hand, and the equipment nurse put on an ultra-thin sterile glove for Zhou Can.

"Doctor Zhou wants to find the lesion through the touch of his hands?"

Dr. Chi froze for a moment, and instantly understood Zhou Can's intentions.

After putting on new thin gloves, Zhou Can began to directly pinch the patient's abdominal tissue with his hands.Mainly around the jejunum.

"Tumors usually occur in the ileum. Could it be that Dr. Zhou made a mistake?"

Deputy Director Mu asked.

Zhou Can shook his head, "The patient had a gastrointestinal radiography before the operation, which indicated that the lesion was in the jejunum area. I also had a strong tenderness reflex in this area when I did the tenderness test. There should be no mistake."

He didn't dare to speak too harshly.

His eyes searched around, identifying the tissues most likely to have tumors.

Eyes fixed on one spot as he lifted part of the jejunum.In my mind, I was quickly recalling the anatomical structure of the human body that I learned in the general class.

"If there is a tumor, it is most likely to appear in the lymph. The lymphatic tissue in the lower layer of the intestinal wall is usually richer. Could it be in it?"

Faintly, he felt that he had found the lesion.

Try to gently pinch those tissues with your hands.

"It's a nodule. It's hard and slippery... No, it doesn't feel like a lymph node, but a tumor." Zhou Can showed excitement on his face. After searching for so long, he finally found it.

The tumors in this part are the most hidden, and it is difficult to find them with the inspection methods.

By the time it can be discovered, it is often already at an advanced stage.

"It turned out that the tumor was hidden in the lymph in the lower layer of the intestinal wall, no wonder it couldn't be found!"

Lymphoma under the intestinal wall can easily develop in depth along the intestinal wall, invade the serosa layer, mesentery and its lymph nodes outward, and infiltrate the mucosa inward, making the mucosal folds stiff.

Fortunately, Zhou Can discovered it in time, otherwise the girl's illness would have been treated as small intestinal tuberculosis, and if it dragged on for two or three months, she would definitely lose the chance of surgery.

[Pathological diagnosis experience value +1. 】

[You successfully diagnose a difficult recessive case, and reward pathological diagnosis experience +100.]

The reward of [-] experience points should be given to Zhou Can.

You know, this saved a young life.

"I didn't expect the patient to get small intestinal lymphoma at such a young age. The mortality rate of this disease is extremely high. The difficulty is that the disease is extremely difficult to detect in the early stage. Many patients have no obvious early symptoms."

Deputy Director Mu's surgical ability is not very good, but his theory is very strong.

In the field of intestinal tract, several influential papers have been published.

"Dr. Zhou really lived up to his reputation. Now that the tumor has been found, the family members have a very good explanation." Dr. Chi began to flatter Zhou Can.

Not long ago, he questioned Zhou Can because he had never touched a girl before, so the abnormality appeared during palpation.

Only now do I understand that too much talk is bound to fail.

It's a pity that it's hard to get overwhelmed.

What is said can never be taken back.

When Dr. Chi thought that he almost treated the patient's disease as intestinal tuberculosis, he couldn't help breaking out in a cold sweat.

It is really a god.

At that time, he himself and Director Mo all pressed the patient's abdomen, but unfortunately, they failed to find a tumor in the patient's abdominal cavity.

Zhou Can concentrated on the operation and removed all the diseased lymph nodes.After careful examination, it was confirmed that no spread had occurred, and he stopped the operation.

[Separation experience +1, Incision experience +1.]

【For the first time, you successfully separated the submural lymphatic tumor of the jejunum, and you will be rewarded with +100 experience points for the separation operation.Incision experience +100.]

One operation earned [-] medical skill experience points, and all of them were extremely difficult to improve medical skills.

Zhou Can's heart blossomed with joy.

What made him even happier was that he saved the little girl's life.A family tragedy was avoided.

"Doctor Chi, Director Mu, the patient's diseased lymph has been completely removed. Do you want to suture the cavity now?"

"Shut up!"

Director Mu has the highest status, and he gives orders.

The patient's abdominal wound was quickly sutured, and Zhou Can sewed her up as beautifully as possible.There is a long scar on the girl's stomach, and it is very easy for the man to mistakenly think that she has had an abortion or had a caesarean section.

This is certainly detrimental to the married life of the patient.

But this kind of thing can be explained clearly.Patients have the right to copy and keep the treatment receipts and inspection results.These are strong evidences.

Of course, the best thing is to be in good health without any surgery.

It's just that nine out of ten unsatisfactory things in the world, malignant tumors occur in the body, which also means that cancer secretly takes root and sprouts in the body.In this case, survival is the most important thing.

No matter how serious the scar left on the abdomen is, it is worth it.

"I really didn't expect it. The patient has done so many tests but failed to find out the cause. I have studied gastroenterology for so many years and worked in clinical practice for so many years, but I started to be afraid. No matter how careful I am in the diagnosis, there is still a possibility There were omissions and misdiagnoses.”

Dr. Chi's problem happened to almost all old doctors.

The more skilled the doctor is, the more experienced he is in diagnosis, and the more careful he is when diagnosing patients.Always walk on eggshells, afraid of a little mistake or omission.

"Small intestinal lymphoma is indeed a very difficult disease to detect. In the future, when encountering such a similar case, endoscopic examination reveals upper gastrointestinal or colonic bleeding, you can try to perform small intestinal gas barium double-contrast examination on the patient. And Even the thread swallowing test, which is more popular recently, can also be used in clinical practice. If you still can’t find out the cause of the disease after using these methods, then don’t hesitate to learn from Dr. Zhou and decisively perform laparotomy on the patient.”

Deputy Director Mu shared his valuable experience.

Although he is a surgeon, his diagnostic ability is not inferior to that of a physician.

Therefore, there are no absolutes in the world.

It is an irresponsible random guess that a physician must have a strong diagnostic ability and a surgeon must have a poor diagnostic ability.

The wire swallowing test is simple and easy, and it is a non-invasive test, and the cost is very low.

It is more commonly used in some large hospitals.

On the contrary, some hospitals or departments that only think about how to generate income rarely use this method.

After all, before the cause of the patient is found out, the doctor can openly ask the patient to do all the checks.After all the inspections are completed, there will be an income of two to three thousand yuan.

Doctors don't care about whether the patient suffers terribly during the barium radiography, or if some invasive examinations will aggravate the condition.

……

The moment the patient was pushed out of the operating room, the couple who were guarding outside rushed over immediately.

"Doctor, how is my daughter's illness?"

"The operation went very well. The small intestinal lymphoma removed from the patient has been sent for pathological biopsy. The biopsy can be used to determine whether the boundary is clear, whether there is spread, whether it has been completely removed, and the nature of the tumor. The results are usually available after 24 hours. , When the results come out, I will arrange the next treatment plan according to the test results."

Dr. Chi said to the family.

"It's really a tumor! Thank you Dr. Chi, thank you Dr. Zhou!"

The girl's father thanked the two doctors repeatedly.

"This is Deputy Chief Physician Mu, who is also the patient's chief surgeon." Dr. Chi knew Deputy Director Mu's temperament, and quickly introduced the identity of Deputy Director Mu to the family.

"Thank you, Deputy Director Mu!"

The girl's father, who was more or less sophisticated in the world, hurriedly thanked Deputy Director Mu.

"The operation was mainly done by Dr. Zhou, and I was just guiding. If you want to thank, please thank Dr. Zhou. The patient has just finished the operation and may need to fast for about six hours. Then you can eat some liquid food. Pay attention to the abdominal wound maintenance, do not scrub."

Deputy Director Mu was very busy, so he left in a hurry after a few words.

The family members learned that the operation was mainly performed by Zhou Can, and their gratitude to Zhou Can has reached a new level.

Back at the Department of Gastroenterology, before Zhou Can's butt was hot, Luo Jingyi, Director Shang's subordinate, came running over.

"Doctor Zhou, if you are not busy now, Director Shang invites you to the Department of Vascular Medicine to attend a consultation on a critical case."

Luo Jingyi was just passing on a message.

Calculating the time, Director Shang should be in the outpatient clinic right now.

Zhou Can was going to drink saliva, so he hurried to the outpatient clinic to help with the consultation.

"I'm just a regular trainee. Director Shang asked me to go to the Department of Vascular Medicine for consultation. It's not appropriate!" Zhou Can has performed very well in the Department of Gastroenterology recently.

Especially the diagnosis of various cases has won the appreciation and attention of Director Shang.

In other words, the doctors in the Department of Gastroenterology, whether they are chief physicians, deputy chief physicians, attending physicians, or residents, all highly recognize Zhou Can's diagnostic ability.

"Director Shang has already calculated that you will decline. He asked me to tell you that you will go to the Department of Vascular Medicine on behalf of him for this consultation. The boss also said that your level is not inferior to his. You must be confident and not weaken his name. head."

This trust is really heavy.

Zhou Can was lifted to an unprecedented height by Director Shang.

It was also the first time that he officially stepped out of the department and participated in consultations with other departments in a special capacity.

　Thank you book friend, Yi, for your support.

　　
　
(End of this chapter)