Chapter 150 The operation was a great success, the most difficult skull base brain tumor operation
As Dr. Zou mentioned earlier, Chinese medicine is declining in China and is barely surviving under the pressure of the market. On the contrary, many developed countries abroad have begun to vigorously develop Chinese medicine, recruit talents, establish Chinese medicine planting bases, and conduct in-depth research on Chinese medicine.
This gave Zhou Can a sense of crisis.
There has also been a significant change in the view of traditional Chinese medicine.
In the future, when his status is higher, his economic strength is stronger, his medical skills reach a certain level, and he has great influence, his attitude towards traditional Chinese medicine will definitely bring great benefits to the development of traditional Chinese medicine.
The operation went smoothly and Director Wen was in a good mood.
He sat in a chair and chatted with everyone about the future development direction of medicine.
The atmosphere in the operating room was quite good.
Just then, a graduate student exclaimed, "The patient's finger seemed to move just now."
More than 15 minutes have passed since the patient stopped receiving anesthesia.
Under normal circumstances, the patient may indeed wake up.
However, the patient had been in a coma before the operation. If he really wakes up now, it will be great news for the doctors and his family.
Everyone's eyes turned to the patient's hand.
Just at this moment, the patient's right middle finger moved again.
"I'm awake, I'm really awake!"
Director Wen's face broke into a happy smile.
"Lin Lizhi, wake up! Lin Lizhi, wake up!"
The anesthesiologist patted the patient's shoulder and called out to him in his ear.
When a person is in a coma, it is very similar to being in deep sleep. At this time, calling the patient's name has a high chance of waking them up.
If the person cannot be awakened, he or she is usually in a severe coma, which means the condition is critical.
The patient's fingers can now move, indicating that the brain is functioning.
This is a very good phenomenon.
As the anesthesiologist called, the patient's eyelids trembled slightly, and then he slowly opened his eyes.
It just looks very strenuous.
His body was still very weak. He had just survived, and opening his eyes might really weigh more than a thousand pounds on him.
After opening his eyes, the patient's gaze looked slightly dull.
Turning slowly, looking at the people around him.
"Where am I?"
He began to speak.
"Lin Lizhi, you were in a car accident and are currently undergoing surgery in the hospital."
After Director Wen answered, he stared closely at the patient's reaction.
Generally speaking, there are some tests that must be performed when the patient wakes up after surgery.
The first thing is whether you are sane.
Then check whether the limbs are paralyzed, and finally check whether the patient's various body functions are normal.
Lin Lizhi fell into a brief silence.
After a moment, he seemed to remember the scene before the car accident.
"Doctor...is my girlfriend okay?"
The fact that he could remember that his girlfriend was also in the car showed that his brain was not seriously damaged.
Memory and mental state are normal.
"I really don't know about this! After you get better, you can ask your family." Director Wen is a chief physician and has a lot to do every day.
He would not pay any attention to these things that had nothing to do with the patient's condition.
Director Wen looked up at the anesthesiologist.
"You are right. Not only has he woken up, but he is also mentally normal. All signs indicate that the operation was very successful." After saying that, he looked at the patient again. "Young man, cooperate with the treatment. I believe you will be able to recover and be discharged from the hospital soon. Then you can go find your girlfriend."
"Okay! Thank you!"
The patient still has some difficulty speaking.
After waking up from anesthesia, he was observed for a few minutes and found nothing abnormal, so he was directly pushed out of the operating room.
When escorting such a key patient, the anesthesiologist and the doctor usually escort the patient in person, because they are afraid of any mishaps along the way. After sending the patient back to the ward, they also have to hand over the patient to the attending physician.
"Everyone take a short break. We will continue with the second operation in half an hour."
The operating room in a hospital is actually a very scarce resource.
For example, the surgery for this patient was originally planned to take four to eight hours, but it actually took less than two hours in total.
This means six hours of idle time.
At this time, if there are patients who need surgery but have been postponed due to the lack of an operating room, the patient can be scheduled for surgery.
More often than not, these are extremely difficult surgeries that are greatly delayed, leaving room for the next surgeries on the waiting list.
This vacant operating room can be put to great use.
…
Half an hour later, Zhou Can and everyone else returned to the operating room.
The patient is already lying on the operating table.
The patient was a fairly young woman, probably in her twenties. Her hair had been shaved, disinfected, and the surgical site marked.
Zhou Can has already read the information of this female patient.
At the age of 24, he was diagnosed with meningioma.
Generally speaking, the probability of malignant meningioma is not high. Endothelial, fibrous, and vascular types are more common. Mixed types are also more common.
Meningiomas occur more often in older patients.
It is quite rare for her to have a meningioma at such a young age.
According to the patient's description, he had suffered head trauma.
The medical community has long believed that head trauma is a risk factor for meningioma because after head trauma, intracranial cells are prone to mutation in the process of repairing damage.
She currently has three symptoms: double vision, double vision when looking at things, numbness on the left side of her face. In daily life, many people even privately call her facial paralysis.
They also said she had a yin-yang face.
When he smiles, one side of his face has expression but the other side doesn't, which looks particularly weird.
Recently, a new symptom has emerged. I always choke when eating, and have .
Based on the symptoms she described, it can basically be determined that it is meningioma.
Later, after a CT scan, a tumor foreign body was found at the base of the skull.
This time surgical removal was required.
Among the many meningioma surgeries, skull base meningioma is probably the most difficult one.
Because skull base meningiomas are closely related to normal brain nerve and vascular tissues, and are difficult to expose during surgical resection, the operation is extremely difficult.
In fact, no operation that can be performed by a chief physician is simple.
Director Wen is the chief physician of neurosurgery. He faces a lot of difficult and critical cases every day. The pressure he bears is far greater than that of ordinary doctors.
The operation began soon.
Zhou Can's surgical position in the group has been initially established. Currently, he can stand behind the two attending doctors and observe as a third assistant.
Several residents and three graduate students were all pushed to the back by him.
Zhou Can stood in the position of the third assistant, and they were all very convinced.
Because Zhou Can's surgical skills are indeed far superior to theirs.
"You must have seen the film and the examination report. The patient's meningioma is a sphenoid ridge meningioma. It is the most difficult type of skull base meningioma to treat. It is extremely difficult to remove it completely without damaging the patient's neurological function."
Director Wen was performing surgery on patients while teaching them.
This operation should be between level three and four, and its difficulty is even greater than many level four operations.
"The incision is usually centered on the pterion, with the frontotemporal approach. Stop the bleeding!"
After the incision was made, blood gushed out.
Doctor Zou plays the role of an assistant. His ability to stop bleeding is not bad, close to the mid-level level of attending physicians. After all, he is a 40-year-old attending physician.
Weaker than Zhou Can's ability to stop bleeding.
But it's ok.
He steadily operated the electrocoagulation knife to stop the patient's bleeding, and Tang Li cooperated tacitly to suck out the gushing blood in time.
"Do you know why I emphasize that the patient's tumor should not exceed 2cm in diameter?"
Director Wen looked at his two attending physicians.
“It’s too big to cut.”
Tang Li's answer was a bit of a panacea.
"We're afraid of damaging the nerves and blood vessels." Doctor Zou is older, so his answer was more precise.
"Doctor Zou is right. It is almost impossible to completely remove a tumor that is too large. This is because it is very easy to damage important blood vessels and nerve tissues. So when you see patients in the future, as long as you find a suspected meningioma, you must ask the patient to diagnose and treat it early. When the tumor grows to a larger diameter, the difficulty of removing it will increase exponentially."
Director Wen gave an explanation.
Zhou Can took note of it secretly.
These are very valuable surgical experiences that are difficult to learn from books.
These are passed down by word of mouth from older doctors to younger doctors.
"Teacher, this patient's tumor has reached 2.1cm, so why do you still want to perform surgery on her?" asked a graduate student.
"Because she is still young. If we don't perform surgery on her, her life may be over. And her tumor is growing rapidly, which is a very bad sign. Generally speaking, only malignant tumors tend to grow rapidly. Benign tumors tend to grow more slowly."
Director Wen is somewhat concerned about his reputation and likes to do some superficial work.
But his behavior and his willingness to perform surgery on this female patient are enough to prove that there is something bright in his mind.
He is a respectable doctor.
As the epidermis and subcutaneous tissue are cut layer by layer, the tumor can now be seen.
The tumor was more than 2 cm in diameter.
Zhou Can felt itchy when he saw this.
His separation and incision skills have reached level four, all reaching the level of attending physician.
He was not completely sure about how to remove this large tumor, but he could give it a try.
Director Wen had already started to separate the tumor from the middle cerebral artery. He was extremely careful, and every cut was like walking on thin ice. He only stopped when he was about to separate the last part.
"This tumor is too tightly attached to the arterial wall. If we forcefully separate it, the blood vessel will definitely break. Even if it doesn't break now, it will easily cause serious problems after surgery. If it really doesn't work, I'm afraid only a small part of the tumor wall can be left."
Director Wen hesitated again and again, but finally gave up on the forced surgical separation.
"Immediately send this tumor to the pathology department for examination. Ask the laboratory to expedite the procedure. I will wait for 20 minutes. After the pathology results are out, we will decide whether to remove the tumor wall."
After making the arrangements, Director Wen checked the area around the lesion to see if there were any other tumors.
Zhou Can looked at the removed tumor and intuitively had a bad feeling.
He had seen some benign tumors, which usually looked more pleasing to the eye.
Just like us humans, appearance is determined by the heart. People with kind faces are mostly upright and kind-hearted. Those with fierce and violent faces are mostly vicious and cruel.
Tumors can also be identified through vision and touch.
Experienced old doctors can basically determine whether breast cancer, lymphoma, etc. are good or bad just by touching them.
However, the final result is subject to pathological examination.
Intraoperative pathology testing is the fastest one.
The results can be obtained in twenty minutes.
For ordinary pathology tests, you need to wait in line, and the results are often not available until the next day.
About twenty-four or twenty-five minutes later, the pathology test results came out.
Vicious!
Everyone was stunned by the result.
This is the result that doctors least want to face.
Such a young girl actually got a malignant tumor.
"But there is good news. Pathological examination found that the tumor has clear edges and should not have spread to other surrounding tissues. As long as it is completely removed, the patient should be able to recover."
Looking at the pathological test results, Director Wen was troubled.
The last remaining layer of tumor wall is too difficult to remove.
"Let's work together to see if there is a better solution?"
Director Wen asked everyone.
Anything can happen during surgery, and it is ever-changing.
Before the operation, there was no way to perform pathological testing and no one knew whether it was benign or malignant.
Now the results are out, and it is a very cruel result for the patients.
If the operation is not done thoroughly, the cancer cells will surely spread quickly throughout her body.
By then, death is almost certain.
Director Wen was hesitant because it concerned the life and death of this little girl.
Save, I definitely want to save.
But how to save?
Several doctors offered suggestions, but they were all rejected by Director Wen.
None of these solutions are practical.
"Can we prepare for both scenarios? Take a section of vein and be ready for vascular anastomosis. Then try to separate the remaining tumor wall surgically."
Zhou Can has learned a lot of similar surgical knowledge from Dr. Xu.
A good teacher will produce good students, and the solution given should be one of the more feasible ones.
He did not propose the use of artificial blood vessels because the patient was only 24 years old and although artificial blood vessels were already very good, no one knew how long they would last.
Even if its lifespan is thirty years, it is still a huge hidden danger for this female patient.
Taking veins from other parts of the patient's body to repair the blood vessels here is troublesome, but there will be no rejection reaction to the patient's own blood vessels. The success rate of the operation is high.
There are no hidden dangers afterwards.
"The solution of using a vein to repair this section of blood vessel faces many difficulties. First, the two ends need to be anastomosed, which will take a long time. The brain's tolerance to ischemia is about three minutes. Even with my anastomosis skills, it will take at least twenty minutes just to anastomose the two ends. This is when the vein is prepared in advance. Secondly, there is a wealth of nerve tissue around this central cerebral artery. If you want to anastomose it, you need to separate it first, at least 3 cm. The risk of this process is also extremely high."
Skull base meningioma surgery is known to be one of the most difficult surgeries among meningiomas.
Sphenoidal spinal meningioma resection is the most difficult surgery among skull base meningioma surgeries.
It is extremely difficult and it is not in vain.
The entire operation is full of huge unpredictable risks.
"If you want to solve the blood supply problem during the arterial anastomosis surgery, there is a way to solve it. That is bypass surgery."
Zhou Can gave another plan.
"Aren't you just creating trouble for yourself?"
Director Wen smiled bitterly, but he admired the boy's audacity.
"I've studied it. This branch blood vessel also supplies blood to the brain. But it supplies more blood to the scalp. From here, the blood is diverted and connected to this blood vessel. Even if the central artery of the brain is cut off for an hour or two, there won't be any major problems."
The solution Zhou Can proposed is to solve the problem of blood supply to important brain tissues during the period of anastomosis of the central blood vessels in the brain.
The blood is drained from the branch vessels of that artery, although there will be insufficient blood supply.
But the purpose is just to buy time for the operation to anastomose the central artery, so it is enough to ensure that the brain tissue does not die due to ischemia.
Director Wen fell into deep thought.
"Although the plan proposed by Dr. Zhou is troublesome and risky, it is feasible to a certain extent. It gives me the feeling that we should make various arrangements first, and then start the siege when everything is ready."
For the first time, Dr. Zou supported the surgical plan proposed by Zhou Can.
To be honest, he admired Zhou Can very much.
A resident trainee can have such clear and precise surgical ideas. I am afraid there is only one such person in the whole Tuya.
If he knew that Zhou Can's teacher was the "fast knife" Xu Yidao who was once famous both at home and abroad, he probably wouldn't think so.
A good teacher produces good students.
Can the apprentice taught by Xu Yidao be bad?
Dr. Xu really taught Zhou Can everything he knew.
The treatment Jin Mingxi enjoys is much worse.
"This plan is indeed feasible. Let's talk to the family. If they are willing to accept it, we will implement it. If not, then we have no choice but to clean the surgical wound and suture it directly."
Director Wen made the decision.
