Chapter 197: For the sake of the living, high risks and rich rewards coexist
"Director Mu, let us do it! You can watch and learn first. There will be opportunities in the future anyway."
Director Jia gave the opportunity to perform the laparotomy to his assistant.
This person is also the only deputy chief physician under Director Jia. Perhaps there are others who have already completed their studies and have the ability to independently conduct level 3 and 4 surgeries, and no longer need to learn from Director Jia.
Deputy Director Mu successfully grabbed the opportunity to do abdominal exercises and actually seemed very happy.
Zhou Can's mouth curled up slightly. He thought this deputy chief physician was very capable. He was so happy to get a chance to perform an abdominal surgery. Even the best surgical skills were limited.
Imagine, if a multi-millionaire picked up ten yuan on the street, would he laugh out loud with joy?
Similarly, if Deputy Director Mu’s surgical skills were really strong, he would not regard the opportunity of abdominal opening as a treasure.
At least with Zhou Can's current strength, he doesn't think much of the opportunity to have his abdomen opened.
After Deputy Director Mu stood at the main operating position, everything was ready and he couldn't wait to pick up the knife and start cutting.
Director Jia seemed very confident in him.
Standing nearby, watching with a relaxed look on his face.
There was no trace of fear or trepidation when he saw Zhou Can's abdomen being opened.
Deputy Director Mu cut open the skin and subcutaneous tissue of the abdomen layer by layer, which is commonly known as the fascia layer, muscle layer, and parietal peritoneum in medicine.
The muscular layer involves muscles and tendons.
There are certain requirements when cutting.
Theoretically, the more skilled the doctor is, the less blood will be lost during the abdominal opening process, and the chance of damaging important blood vessels and nerves is almost zero.
It’s hard to say for beginners.
Under normal circumstances, one cut is enough to cut through the muscle layer, but a novice may be nervous and may need two or three cuts to succeed.
This will result in an uneven cut.
It is very detrimental to wound healing.
Deputy Director Mu’s incision skills are pretty good, and should be at the excellent level of the attending physician.
However, both the flatness of the wound and the time to open the abdominal cavity are worse than Zhou Can's.
Especially the operation time, Zhou Can took less than five minutes to open the abdominal cavity. This was because a blood vessel was ligated in the middle.
It took Deputy Director Mu nearly seventeen minutes from the time he made the cut to the time he opened the abdominal cavity.
This speed is comparable to that of the doctors in cardiothoracic surgery.
It’s worrying just to look at.
Except for the slow speed, everything else is pretty good.
The amount of bleeding during the operation was not heavy, and there was no over-cutting when the four layers of abdominal tissue were cut.
In general, Deputy Director Mu's incision technique is above standard. It is completely sufficient to open the abdominal cavity.
No wonder Director Jia is so confident in him.
After opening the abdominal cavity, the next step was to remove part of the colon, which was still performed personally by Director Jia.
Both the resection and separation of the intestines involve huge risks.
If the cut is not done well, it will affect intestinal anastomosis.
If too much is cut, it will be worse. This is already a minor accident, but because the operation involves extremely high professional knowledge and the doctor has great power during the operation, no one can strictly supervise the doctor's treatment behavior.
Sometimes, let alone cutting off a little more intestine, even if one of the patient's kidneys was accidentally removed, it is possible to conceal the fact.
As long as the patient doesn't find out, no one will ever pursue the matter.
Of course, this behavior is a serious violation of surgical regulations and medical practice guidelines. Once discovered, the doctor involved will definitely be severely punished.
It is possible that your medical license will be revoked.
So under normal circumstances, no doctor dares to act recklessly.
Occasionally, a newbie would cause trouble, and the hospital would keep the matter secret in order to suppress it.
As for surgical records and doctor's signatures, this is very feasible.
No further explanation.
"Remember, once a malignant tumor is found in the intestine, it is basically difficult to remove it completely once it reaches the middle stage. The possibility of metastasis is very high. Theoretically, the early stage is the best. However, during surgery, I once encountered a patient with advanced rectal cancer. After resection, the patient's postoperative survival time exceeded ten years."
Director Jia must have performed thousands of surgeries.
Extremely experienced.
"When seeing a patient or making a surgical plan, if it is found that the patient has a malignant tumor, even if it is in the middle or late stage, as long as there is no obvious metastasis, you can still give it a try. Explain the risks and possible benefits of the surgery to the patient and let them decide for themselves. In my medical practice, I usually have a principle to save the young rather than the old."
"Anyone under 40 years old is considered a young patient. As long as there is a glimmer of hope, we should do our best to persuade them to actively seek treatment. If the patient is over 60 years old and the family situation is not good, then don't persuade them. As doctors, we should not only consider the patients, but also their families. The age itself is considered old, and knowing that the chance of cure is slim, we still persuade people to spend all their money on treatment. In the end, both the life and the money are gone. What will happen to the living people?"
Director Jia's soul-searching questioning made every doctor fall silent.
This was the first time Zhou Can received this kind of ideological education: to consider the living.
It's against human ethics, but very close to reality.
Behind the ruthlessness lies true compassion.
"Do you think my views are difficult for you to accept? It doesn't matter. If you think my views are not correct, you don't have to accept them. I am just sharing my personal views."
Director Jia continued the operation after saying this.
Tell you how to determine the location of the tumor and the range of resection.
This kind of practical teaching was of great help to Zhou Can.
He listened carefully, learned seriously, and even shamelessly asked Director Jia to let him get closer to take a closer look and press the tumor area with his hands.
"We have now determined that the tumor is in this section. During the resection, we will appropriately cut off some normal intestinal segments to ensure that the tumor is completely removed."
After the cancerous colon was removed, Director Jia's mission was accomplished.
"Who will anastomose the intestinal stump? This anastomosis is much more difficult than the previous operation."
"I'll do it!"
Before Director Jia finished speaking, Zhou Can seized the opportunity.
"The hungry wolf has started again."
The other doctors looked depressed.
They were still hesitating whether to take action or not, but Zhou Can took action directly.
That's competition.
Director Jia was actually not very willing to give this opportunity to Zhou Can.
Unfortunately, the doctor under his command was too late, so he could only give the training opportunity to Zhou Can.
"Zhou Can! How are you going to make it match?" Director Jia deliberately made things difficult for him.
If Zhou Can answered incorrectly, he would be disqualified from the training. The main reason was that a long section of the colon was cut off. The difficulty of anastomosis was too high, and he was afraid that Zhou Can would mess it up.
"I am going to perform a side-to-side anastomosis. Is that okay with you?"
After checking, Zhou Can asked the other party in return.
"Can!"
As soon as Director Jia said yes, Zhou Can immediately responded, "This is my first time using this method. Please give me some pointers!"
After saying that, he had already stood at the main operating position and started operating directly.
Fortunately, he had learned side-to-side end-to-end anastomosis when he was studying basic medical knowledge. This is an advanced anastomosis method for intestinal anastomosis.
The two sections of intestine now are very suitable for this anastomosis method.
Zhou Can first closed the two ends of the intestine with purse-string sutures.
The specific operation method is to make a purse-string suture around the intestinal end, tighten the suture to close the end, and then make another purse-string suture to turn the stump inward and bury it.
This type of suturing is neither difficult nor easy, but it mainly requires high-level suturing and ligation skills to support it.
Zhou Can was a little unsure about the next operation and looked at Director Jia.
The anastomosis was already half done, and Director Jia probably wouldn't be too embarrassed to kick him out.
"Your suturing and ligation skills are both good, and your anastomosis skills are also good. Do a good job! Next, seal the two ends of the intestine after resection, bring the two ends together about 10 cm apart, and use intestinal clamps to clamp and control them."
As he spoke, Director Jia patiently instructed him on what to do and what precautions to take.
Zhou Can had a strong understanding and hands-on ability, and he successfully put the two pieces of intestines together, with the length of the joint being exactly about ten centimeters.
"Use 3-0 non-absorbable sutures to suture the seromuscular layer of the two intestinal loops continuously for about 4 to 5 cm at a distance of about 0.8 to 1 cm from the longitudinal midline on the anti-mesenteric surface. Interrupted sutures can also be used, but I recommend continuous sutures."
The most feared thing about intestinal anastomosis is fluid leakage.
The so-called liquid leakage is actually feces leakage.
The consequences are very serious.
Every year, patients die from peritonitis and various infections caused by feces entering the abdominal cavity.
I believe every surgeon knows that if a wound is contaminated with fecal water, it will be very difficult to heal.
In ancient times, concubines who were fighting in the palace would even deliberately splash "golden water" on the wounds of their opponents.
The purpose is to kill the other party.
In fact, in ancient times when medical technology was relatively backward, after a concubine was whipped, she was already covered with scars, and then being splashed with feces was basically a death sentence, and she would soon die of infection.
Following Director Jia's instructions, Zhou Can sutured the seromuscular layer of the intestine.
"The full layer of the intestinal wall of the two sections is cut along the central axis midline to reach the intestinal cavity. Be careful when cutting, and don't be brave if you are not sure. The selection of the point and length of this incision are very particular. The incision should be about 2cm away from the sutured stump to prevent circulatory disorders and affect the healing of the anastomosis. If too much stump is retained, it is easy for intestinal contents to remain and cause symptoms."
Director Jia was reluctant to let Zhou Can do the anastomosis this time, mainly because he was worried that something might go wrong when cutting the intestines.
He must have known that Zhou Can needed to use this side-to-side kissing method.
Zhou Can picked up the scalpel and carefully followed Director Jia's instructions to cut open the two sections of the intestinal wall.
The feeling of cutting through the intestinal wall is completely different from cutting through the abdominal skin.
When cutting, it feels light and effortless, but it is very tough.
This is actually very difficult to control.
It's easy to make a very large incision.
Fortunately, Zhou Can didn't make a mistake and the cut was just right.
[Cut experience points +1, +1. ]
[Congratulations on your first successful incision of the intestinal wall and construction of the docking window. Incision experience points +100, anastomosis experience points +100. ]
It's not that the system is generous, but that the window for building the broken end of the intestine is very difficult to operate.
The difficulty and risk are even higher than the subsequent suture.
Fortunately, Zhou Can successfully completed this high-risk and difficult operation.
In fact, all actual operations on patients are very risky, especially when using a knife.
Operating on the intestines is even riskier.
"Well, the young man has good understanding and technique, and the cutting is pretty good."
Director Jia's heart was finally at ease.
If Zhou Can messed up this step, the patient would probably need to lose 20cm of intestine. The total length of the large intestine is only about 1.5 meters, and part of the ascending colon and transverse colon have already been cut off. It is unimaginable to shorten it by another 20cm.
Even if the operation is ultimately successful , it will have lifelong consequences for the patient.
For example, the stool is unformed, the actual function of the colon is lost, etc.
"Slightly trim the incised intestinal mucosa edge and ligate the active bleeding point to stop bleeding. Use absorbent sutures to continuously suture the full layer of the two incised intestinal walls."
Zhou Can trimmed the incision on the intestinal wall, which is equivalent to debridement!
[Debridement experience +1, +1. ]
[Congratulations on completing the first intestinal mucosal edge trimming, and you will be rewarded with +100 debridement experience points. ]
I made a lot of money by grabbing this colon anastomosis surgery today.
However, the operation of each step is really difficult.
Risks and rewards coexist.
The more difficult the operation, the greater the reward.
The key is not to make any major mistakes, otherwise during his subsequent training in gastrointestinal surgery, he will only be able to watch others perform surgery.
“After the back wall is sutured, the entire layer of the front wall can be sutured. Then, the seromuscular layer can be sutured intermittently with non-absorbable sutures.”
Director Jia was standing by and guiding Zhou Can through the operation step by step.
Why can't you learn many surgical steps by watching teaching videos? Because all the key parts need to be taught by the teacher step by step. This method of teaching by example is the easiest way for people to learn.
Nearly an hour later, Zhou Can completed all the operations.
I was sweating a lot and the gains were great.
In particular, there has been a leap forward in anastomosis, incision and debridement.
It is like a soldier going to the battlefield. Killing the enemy and not killing the enemy are two completely different concepts. Killing an enemy general is also different from killing two enemy soldiers.
In the past, Zhou Can mostly anastomosed blood vessels and a few nerves and tendons.
The successful anastomosis of the colon achieved many firsts, which was equivalent to successfully killing a general on the battlefield and was of great significance.
"Not bad! You were able to do such a good job in the first intestinal side-to-side anastomosis. Very good. Your understanding and surgical skills are unprecedented in my life."
After Director Jia praised him, he pointed out many areas where he had not done well, and Zhou Can kept them all in mind.
After praising him, he immediately pointed out the shortcomings, probably because he was afraid that Zhou Can would become proud.
From this point, it can be seen that Director Jia has developed a deep love for Zhou Can and wants to train him well.
It was not easy for him to win Director Jia's recognition through two operations.
"Why don't you do the closing?"
Director Jia has significantly increased his training efforts.
"The anastomosis just now was too difficult. I am seriously exhausted and I am afraid of messing it up. It would be better if other brothers could do it!"
Zhou Can cleverly found an excuse and gave up the opportunity to speak out.
This clever way of showing weakness made other doctors like him more.
The look she gave him also softened a lot.
"I'll shut up!"
Qiuhong was greatly inspired when she saw that Zhou Can, who was still a regular trainee, could complete this difficult side-to-side intestinal anastomosis, and she immediately took over the task.
No one wants to be left behind.
She also has to work hard to improve her surgical skills and become a true attending physician.
Strive to prepare for the goal of obtaining associate senior professional title in the future.
…
By the time the operation was completed, it was already past ten o'clock in the evening.
This is because the operation went smoothly, otherwise it would have been much later.
Now we just hope that this young female patient can recover soon, and preferably not have a recurrence or metastasis of the tumor.
The six months after surgery is a high-risk period for recurrence.
Tumors are like demons. If you don't treat them, they may just grow in a creepy way. Once they are cut off, they will rebound at a terrifying speed. If they spread, they will grow like weeds in many important organs of the body.
At this point, even the best doctors can’t save you.
This is why after the patient undergoes surgical resection, as long as the patient's physical condition allows, the doctor will recommend chemotherapy to the patient in order to completely kill all potential cancer cells.
According to statistics, cancer in my country is showing a trend of high incidence and younger age.
In recent years, the number of new cancer cases has reached an astonishing 3.8 million per year, which is equivalent to more than 10,000 people suffering from cancer every day. And this number is still growing at an alarming rate.
This year it has reached a terrifying 4 million people per year.
In just one year, the number of new cases surged by 200,000.
You know, these represent families! Any case would be an unprecedented disaster for any family.
Due to the continuous deterioration of the environment, the worsening pollution of air and drinking water, the excessive pesticide residues, and the unscrupulous use of various chemical agents in food by various illegal and unscrupulous vendors, the spraying and waxing of picked fruits for preservation and protection. If these problems are not effectively solved, the number of new cancer patients will continue to grow rapidly.
Taking the country's population of 1.4 billion as an example, even if the number of cancer patients increases by 4 million each year, it is an extremely scary number.
Zhou Can feels the heavy burden on his shoulders. He will redouble his efforts to improve his medical skills and strive to cure more patients one day.
Through today's operation, he also realized the usefulness of early diagnosis.
In the future, he will work hard on diagnosis and find ways to improve his diagnostic ability.
Early detection of cancer can potentially save a life and a family.
After the operation, he returned to the apartment after get off work. He suppressed his fatigue and wrote a summary of today's operation.
Then I take a bath and read by lamplight at night.
There are only a dozen days left before the first comprehensive medical examination, and his schedule is extremely tight.
Almost every second counts.
The feeling of being submerged in a sea of questions and books made him relive the nervousness of the college entrance examination.
