Chapter 223 Unavoidable postoperative syndrome, tumor is an organ of the body
It was not until Zhou Can finished the operation on the patient and sent the patient out of the operating room that Elder Liu said seriously, "The inpatient department just called me and said that the patient who had the lipoma operation yesterday had a variety of abnormal symptoms!"
Hearing this, Zhou Can's heart skipped a beat.
What is coming cannot be avoided.
I felt an indescribable sense of crisis when I was performing surgery on that patient yesterday.
Zhou Can was so frightened that he was trembling with fear throughout the operation.
Fortunately, the operation went smoothly.
After get off work yesterday, Zhou Can was still a little worried, so he went to the ward to see the patient. Except for his pale complexion and listlessness, all other signs were normal.
I didn't expect that there would be a problem today.
Zhou Can couldn't help but think of Dr. Feng's reminder before he left, asking him to be careful about postoperative complications in patients.
Surgeons are actually quite afraid of the term "postoperative complications". They take various measures during the operation and practice surgical skills hard to reduce the occurrence of postoperative complications.
"It's already lunchtime. I'll go check on the patient first." Zhou Can said to Mr. Liu.
"Let's go together! The patient is likely to have postoperative complications, which will be very difficult to deal with."
Mr. Liu has rich experience in diagnosis and treatment.
I am well aware of the horror of postoperative complications.
"I'm going to buy food for the two teachers!"
Wu Ziyu now regards Zhou Can as her teacher.
During these two days, she followed Zhou Can and Master Liu in the operating room, and Zhou Can gave her a lot of guidance. She really deserves the title of teacher.
Doctors are sometimes very busy and it is very easy for them to miss meals.
If I can’t order food, I can only eat instant noodles.
"Okay! Thank you for your hard work. Mr. Liu doesn't like spicy food."
Zhou Can's words deeply moved Mr. Liu.
There was a look of relief and joy on his face, but he didn't say anything. Instead, he went into the dressing room of the operating room to change his clothes.
Normally, doctors need to wear white coats when working outside the operating room.
Except for disposable surgical gowns that can be worn out of the operating room, normal surgical gowns are not allowed to be worn out.
Otherwise, the sterile environment in the operating room cannot be effectively guaranteed.
Zhou Can changed into a white coat and rushed to the inpatient ward with Mr. Liu.
The patient who had undergone lipoma removal surgery was still pale, but his spirits had improved slightly.
Dr. Bu Shiren, the attending physician, and an intern were standing by the bed, and they seemed to be even more nervous than the patient's family.
This patient was a postoperative . If anything went wrong, Dr. Bu would not be able to report back.
"What's wrong with him?"
Zhou Can asked Bu Shiren.
"Starting around 8 a.m., the patient experienced abdominal distension, nausea, aversion to oil, and eventually vomiting. After that, the patient had diarrhea not long ago. Basic signs such as body temperature, heart rate, and breathing are relatively normal."
Bu Shiren took the initiative to give Zhou Can the ward's measurement records for review.
"In addition to the above symptoms, you also suffer from general fatigue, right?"
"Yes! The patient has been weak since the operation."
Bu Shiren's work is quite meticulous.
The answer was quick too.
After Zhou Can understood the patient's condition, he first conducted a series of elimination tests.
Are any important nerves or blood vessels injured?
The operation was performed very carefully, with Dr. Liu watching over it from the side. If any important blood vessels or nerves were damaged, he would definitely give timely warnings.
As it turned out, Zhou Can did not make any mistakes during the operation.
That facial subcutaneous lipoma removal surgery was done quite well.
Zhou Can decided to start with the patient's vomiting, aversion to oil, and nausea. There are many reasons for these symptoms. However, he only removed a facial lipoma, so even if there was an accidental injury during the operation, he could roughly lock down a very small area for investigation.
All the important nerves and blood vessels were excluded. He couldn't help but wonder, could the patient's throat be injured?
The tumor was indeed quite large, but during the operation it did not directly affect the throat area.
The possibility of direct injury to the throat is very small.
The only possibility left is that the wound has hematoma, which compresses the throat, causing the patient to experience obvious nausea, aversion to oil, and vomiting during eating.
Doctors usually use a tongue depressor to press the root of the tongue, which is a common way to induce vomiting.
In fact, you can also directly press the root of the patient's tongue with your fingers.
However, there is a risk of getting bitten by doing so.
When patients find it unbearable, they tend to close their mouths reflexively. In this case, it is very easy to bite the doctor's hand. Therefore, doctors dare not take this risk with their own fingers.
The tongue depressor comes in handy.
If yesterday's surgery caused a certain degree of hematoma in the mouth and irritated the throat, it might really cause the patient to feel nauseous and want to vomit all the time.
At this moment, Mr. Liu was also frowning and carefully checking the patient's postoperative vital signs monitoring records.
I want to find out the specific cause of the patient's illness through experience.
Many postoperative complications are caused by the doctor's inadequate operation, or postoperative infection, thrombosis, local ischemic necrosis and other reasons.
It can only be diagnosed comprehensively based on clues and pathological mechanisms.
"Come on, open your mouth and let me see!"
Zhou Can said to the patient.
The patient cooperated and opened his mouth. Zhou Can put on a mask, took out a small flashlight from his pocket like a magician, and shone it into the patient's mouth.
There is a slight blood species phenomenon.
However, this degree of hematoma is not enough to compress the patient's throat and tongue root.
Nausea and vomiting caused by hematoma can basically be ruled out.
The patient's throat looked normal without any pathological changes. Only a lot of teeth had fallen out on the side compressed by the lipoma.
The tongue coating is white with a hint of dull yellow.
“Okay!”
Zhou Can signaled to the patient to shut up.
He did not find the answer he was looking for inside the mouth. He carefully removed the gauze covering the wound on the patient's face. He personally sutured the wound using the traceless suture method and also performed a certain degree of skin flap repair.
It looks normal.
There was no redness or swelling of the wound caused by infection, and the patient's body temperature was not elevated, which was enough to show that the possibility of wound infection was very small.
"It's really strange. There's nothing wrong with the wound, and there's nothing wrong with the mouth. So where could the problem be?"
Considering that the patient also had symptoms of abdominal distension, diarrhea, and general fatigue, Zhou Can began to look beyond the local area of the wound and make a comprehensive diagnosis based on all the symptoms.
There are so many possible causes that can lead to all of the symptoms listed above.
For example, the most common cold and food poisoning may cause vomiting, nausea, diarrhea, and general fatigue.
The human body is like a precision machine. Any failure in any link may cause serious adverse reactions in the body.
"He should be suffering from the syndrome after lipoma removal! The incidence of this syndrome is as high as 30%, and the patient will experience intractable diarrhea, abdominal distension, nausea, vomiting, aversion to oil and other indigestion symptoms, as well as general fatigue, pale complexion, tired expression and other malnutrition symptoms. There is currently no effective treatment for this syndrome."
After pondering for a long time, Mr. Liu made a diagnosis.
"What caused it?"
This was the first time Zhou Can encountered such a situation.
This is not the first time I have removed a superficial lipoma, and I have never experienced any postoperative syndrome.
However, the tumor that was removed this time was a huge lipoma located on the head and face, so the situation was much more complicated than the previous minor surgeries.
"The pathological mechanism is still unclear, but it may be related to tumor cells. Surgery to remove a giant lipoma, or a lipoma in the brain, chest or abdomen, or in or near important organs, is very likely to cause many adverse symptoms. His syndrome cannot be avoided, and only corrective treatment can be performed."
Old Liu gave some medical instructions on the spot.
And ask the nurse to draw blood for testing and do a routine blood test to avoid misdiagnosis.
After coming out of the ward, Zhou Can went to eat with Mr. Liu.
It was almost one o'clock now.
Doctors have very hard work and often do not have regular meal times, especially those working in operating rooms and emergency rooms, including anesthesiologists.
Sometimes it is common to work for more than ten hours in order to continuously rescue patients.
This is also the case for many doctors. They studied medicine, but ended up being diagnosed with cancer at a young age, in their forties.
Sometimes, these diseases are really caused by abuse.
If you don't eat in time after mealtime, your stomach and intestines can't stand it, and you are prone to stomach problems, ulcers, etc. Staying up late to work, not getting enough rest, and irregular work and rest will cause greater harm to your body.
Therefore, being a doctor is a very hard and risky job.
"Mr. Liu, is the condition of the lipoma patient unavoidable during surgery?"
Zhou Can asked somewhat unwillingly.
After thinking about it carefully many times, there were some areas that could be improved during the operation, but no major mistakes occurred.
How did the patient develop the syndrome?
Finding the cause and avoiding it in the future is what Zhou Can wants to do most.
"Based on my surgical experience, as well as domestic and international case reports, this postoperative syndrome cannot be avoided. It has nothing to do with the doctor's skills, but is a symptom caused by the tumor itself."
Old Liu explained to him in a calm tone.
"Wasn't the tumor completely removed? Could it still be causing trouble?"
Zhou Can was even more confused.
His medical knowledge was limited, and his experience in diagnosis and treatment was not that rich, at least not as good as those old doctors who had 40 or 50 years of experience in diagnosis and treatment.
"You've heard of a chain reaction, right? Isn't there a classic domino game? Pulling out one domino will trigger a chain reaction, eventually causing all the dominoes to fall down."
Mr. Liu gave him an example to explain why some postoperative syndromes are unavoidable.
"That lipoma has grown for many years, and it may even have been born with the patient. It has formed a delicate balance with the patient's body. Removing it is equivalent to breaking this balance. Therefore, the patient's body will have a series of adverse reactions. You have to remember that when performing any surgery, do not regard the lesion as a superfluous part of the body."
"Like the lipoma, you should think of it as an organ of the body. It can grow so big that it even becomes an important organ of the patient's body."
Mr. Liu’s explanation to Zhou Can was refreshing.
This knowledge can only be learned through practice by experienced experts. It cannot be learned from books.
It is impossible for any medical book or search to record this kind of theoretical knowledge.
Because it does not conform to the formal content of medicine.
Just like official history and unofficial history, there is definitely a difference.
Unofficial history can allow readers to learn some interesting content that cannot be recorded in official history.
The elderly medical experts are a living medical unofficial history.
Many of their theories are not found in medical books, but they do make sense.
And it really exists in practice.
"According to you, a mole, a tumor, or an extra finger is an organ of the body. It's just that this organ is not found in ordinary people, but is a unique organ that only patients have. Is that what you mean?"
Zhou Can had a glimmer of enlightenment.
Listening to your words is better than reading for ten years.
This unique theory of Mr. Liu opened his eyes and gave him a completely new understanding of the disease.
It's like opening a new window.
"You have a very good understanding, that's what I mean. Doctors can easily identify an extra finger, or even a third hand or leg, as an organ of the patient. However, doctors often easily regard a tumor or an intradermal nevus as just a lesion. This is a misunderstanding in diagnosis and treatment."
Old Liu smiled and nodded slightly.
"When you practice medicine independently in the future, you must take this into consideration. Before you cut a tumor, you can consider its relationship with the surrounding organs and its effect on the body. This will be more helpful for the correct treatment of the patient's disease. It would be better for this patient with lipoma to be transferred to the internal medicine department for treatment in two days."
Internal medicine and surgery are two completely different medical departments.
Internal medicine is far better than surgery in terms of pathology and pharmacology. For the patient who developed postoperative syndrome, it would be more beneficial for him to be transferred to internal medicine for treatment.
It is so novel to treat a tumor as an organ.
Zhou Can quietly thought about the new theory he had learned.
After dinner, the two took a short rest and then went into the operating room again.
Keep fighting.
All the backlog of surgical patients in general surgery must be resolved as soon as possible.
The crazy operation began again.
This is a male patient in his thirties. He had pus discharge from his ear and a lump below and behind the mandibular angle. When pressed, the ear secretions increased. After secondary infection, he developed symptoms such as pain and fever.
This was the first time Zhou Can encountered such a case.
General surgery is the most complex department, and all kinds of patients may be seen.
"His condition is called branchial fissure fistula, and it requires surgery to clear the fistula to cure it."
Mr. Liu explained to Zhou Can, Wu Ziyu and others.
"When diagnosing this disease, in addition to the symptoms of pus discharge from the ears and a mass below the lower jaw angle, the patient often feels a foul odor in the mouth. During surgery, it was found that the second, third, and fourth branchial cleft fistulas had fistulas at the front edge of the sternocleidomastoid muscle."
This disease is relatively rare.
Zhou Can observed the patient carefully and understood his condition and symptoms.
To accumulate experience for future independent practice.
In fact, before all surgical patients undergoing surgery, he would review their medical records and understand their condition and cause of illness.
This patient with branchial cleft fistula also specially looked up a lot of information and studied it.
"Sometimes, the fistula on the patient's body is very thin, as thin as a needle tip or a small depression, which is easy to be ignored. Even if it is not squeezed, there will often be a small amount of secretion. This is also the reason why the patient feels that there is a bad smell in the mouth."
Mr. Liu continued to explain to them.
Zhou Can was still the surgeon in charge of the operation, and Elder Liu was there to provide guidance.
"During branchial cleft fistula surgery, in addition to being extra careful during the operation, you must also be careful about breathing difficulties caused by edema of the lateral pharyngeal wall and parapharyngeal hematoma after the operation. Close observation should be carried out, and postoperative monitoring and hospitalization management should be done well. If problems are found, they must be dealt with in a timely manner, otherwise it is easy to cause irreversible serious consequences."
This irreversible and serious consequence is actually death.
But in front of patients, doctors tend to speak in a rather obscure way.
It’s pretty much the same in every industry .
It is like asking a lawyer to help you with a lawsuit. If the lawyer, after listening to the case, says that you can try to fight the case and the chances of winning are quite high, then you can basically win.
If a lawyer says the case will take a long time to litigate, be careful.
Perhaps it is a subtle reminder to you that the chances of winning this case are not high. If you really want to fight, you will most likely lose.
Doctors are more oblique than lawyers when speaking to their patients.
For example, after a physical examination, if someone frowns and says, "Be careful about this situation, it's not good, very bad," then it is most likely a malignant tumor or other terminal illness.
At this time, as long as there is still a chance for surgery or the opportunity for treatment has not been missed, then get treatment as soon as possible.
If you delay any further, it will probably be a failure.
Zhou Can was already helping the anesthesiologist perform anesthesia surgery on the patient.
Soon, anesthesia was successfully implemented.
Zhou Can earned another 1 anesthesia experience point.
Compared with the 100 experience points reward, Zhou Can was somewhat dissatisfied with only earning 1 point at a time. However, he also understood that there were not many opportunities to get the 100 experience points reward.
It's pretty good if you can catch one or two fish a day.
For anesthesia, the chance to get this kind of reward is even rarer.
Maybe if I go into the anesthesiology department for a month or two of regular training and follow Dr. Feng, I'll have more chances to get the 100-point anesthesia experience reward.
Surgeons need to undergo at least one month of regular training in the anesthesiology department. This is to allow doctors to deeply learn anesthesia knowledge and understand the entire process and precautions of anesthesia surgery.
In particular, the practical experience of anesthesiologists in supporting and protecting patients' vital signs is very worth learning.
In terms of life protection, if we really trace the roots of critical care medicine, the department of anesthesiology is its master.
