Chapter 253 Gastrectomy, the hero behind the scenes
"You seem quite confident! Let me test you. Where should the incision be made for this endoscopic surgery?"
When Director Shang asked this question, his eyes naturally looked at the patient's abdomen.
"If it's a laparoscopic surgery, then two holes will definitely be poked in the area you see. This type of surgery is only considered for patients with mid-stage gastric cancer. This patient is currently in the early stages of gastric cancer, so I think the surgery can be completed by inserting the endoscope through the nose."
Zhou Can has performed so many endoscopic surgeries, but it was not in vain.
It was just such a small question, but Director Shang still wanted to test him.
It's just to give him points!
"Okay, it seems that you have mastered the surgical method. I will leave this operation to you."
Director Shang just tested him symbolically and then agreed to let him perform the operation.
It feels more like they are letting the water out on purpose.
In order to have an explanation in front of other doctors.
Director Shang has many doctors under him, and he has always advocated the principle of fair competition and giving priority to those who are outstanding.
Zhou Can wanted to perform this endoscopic surgery alone, but he actually did not have enough qualifications.
If Director Shang agrees directly, then next time other doctors in the team want to fight for a chance to perform surgery, Director Shang will have no choice but to nod in agreement.
So, he deliberately set a threshold in order to shut up other people.
After Zhou Can got Director Shang's consent, he was overjoyed, as the opportunity to gain experience points had come.
This operation will definitely earn him a lot of surgical experience points.
The endoscope is first inserted into the patient's nasal cavity and then into the stomach through the esophagus.
[Implantation experience +1.]
It was not his first time to insert an endoscope into the nasal cavity and stomach, so he only earned 1 point of insertion experience.
The entire operation process was also extremely skillful.
The endoscope is manipulated all the way to the cancerous site in the stomach.
It took almost no effort to find the cancerous site. The seemingly simple operation is a result of ten years of hard work.
In addition to practicing endoscopic techniques, he also needs to do sufficient homework before the operation.
He already had the cancerous site deeply memorized in his mind.
The operation at this moment can reach the Huangting directly and be extremely smooth.
After the cancerous part is found, it is not possible to simply operate the endoscope and cut it out in a few seconds. Endoscopic surgery for gastric cancer is not that simple.
Zhou Can first operated the endoscope to mark the resection range around the cancer.
It can be understood as drawing a circle before going to war.
This is to avoid accidental injuries to other parts of the body after the fight starts.
After marking the resection range, normal saline was injected into the base of the cancer.
What are you doing?
In order to make the part of the mucosa that needs to be removed float up.
These valuable surgical techniques and experiences were summarized by foreign predecessors after they destroyed the stomachs of countless patients.
Those who plant trees will enjoy the shade.
Zhou Can learned these techniques and used them all in actual surgeries.
Strive to minimize harm to patients.
After the saline solution was almost completely injected and the gastric mucosa under the cancer base floated up fully, Zhou Can proceeded to the third step.
Operate the endoscopic scalpel along the marked resection circle to cut a complete circular tangent line.
If the stomach cancer is not round, the resected circle can also be other shapes.
It doesn't necessarily have to be round.
Generally speaking, gastric cancer in the early stage, or even in the middle and late stages, tends to grow in clusters, mostly in a round shape.
What Zhou Can marked out at this moment was a circle.
Gastric cancer is circled inside.
As soon as the scalpel cut, blood gushed out from the wound. Zhou Can calmly stopped the bleeding for the patient.
Continue until the circular cut is completed along the marked tangent line.
At this time, the entire gastric cancer along with the cancer base is removed.
I must point out that the cancerous part needs to be taken out after the excision. It is not feasible to take it out from the nasal cavity because the nasal cavity is too small.
At this time, removing the cancerous part from the patient's mouth becomes the best option.
During the operation, the patient is under general anesthesia.
Usually with mouth closed.
This requires using a crowbar to pry open the patient's mouth. Also, the removal of the cancerous part must be done carefully. The patient must not be suffocated to death.
Zhou Can's operation was very skilled, so there was no possibility of suffocating the patient.
The cancerous part is successfully removed and then sent for examination after the operation. This can further clarify the nature of the tumor and whether the edge is clear.
When removing the cancerous part, some normal tissue is usually removed as well.
Even so, it is still possible that the cut may not be clean.
Cancer cells are sometimes particularly cunning. They will quietly infiltrate the surrounding organs or tissues and easily spread to other areas along the lymph and blood vessels.
Postoperative pathological examination is very necessary.
After Zhou Can successfully removed the gastric cancer, he examined the patient's stomach and performed a cleanup.
The operation ends here.
If after a period of time, examination reveals that new tumors have grown in the resected area or other places, or cancer has occurred, a second or even a third operation will be required.
Generally speaking, when multiple surgeries are required, the treatment effect is often poor.
Because cancer tumor recurrence means that cancer cells have spread to other parts of the body. The scary thing about cancer is that it is like a weed, with extremely tenacious vitality.
The more you remove them, the faster the cancer cells grow.
Moreover, if one part is cut off, cancerous tumors will grow in other parts at the same time. It is like opening a terrible Pandora's box. In the end, the more you cut, the more cancer cells will grow, and the cancer cells will spread faster, and the patient will die soon.
This is also why doctors will regretfully say that surgery is no longer possible after discovering that cancer cells may have spread.
The only options are interventional treatment, or radiotherapy and chemotherapy.
No matter which treatment method is used, drugs are used to kill or inhibit cancer cells. At this point, it can basically only prolong the patient's life, and there is no way to cure it.
For stage II or even stage III gastric cancer, as long as active treatment is provided, the five-year survival rate can basically reach about 60%.
Many people don’t understand why, knowing that cancer cells have already spread, they still have to endure great pain, spend huge amounts of money, and receive treatment. Is this dying struggle meaningful?
The answer is yes.
Not only can it provide doctors with more clinical trial data, it will also make it more likely that new drugs will become available and thus completely cure cancer.
In this era of rapid technological development and flourishing of all kinds of things, everything is possible.
Every year, a large number of new cancer treatment drugs are launched, which are specifically targeted at certain types of cancer. Some lucky cancer patients have successfully defeated the disease and recovered after using the new drugs.
After Zhou Can successfully removed gastric cancer for the patient, he earned 100 experience points for incision and 100 experience points for separation.
This made him very satisfied.
Endoscopic surgery has always been his favorite.
Because endoscopic surgery makes it easier to obtain high experience value rewards from the system.
At present, his incision and separation techniques are both moving towards level five, but his anastomosis technique lags far behind and is still only at the lower level of main treatment.
"Director Shang, do you think there is anything else that needs to be improved? If not, I will remove the endoscope."
After Zhou Can finished the operation, he asked Director Shang for instructions.
"Well, the operation went very well. Remove the endoscope and prepare to send the patient to the recovery room for recovery! Can you complete the patient's postoperative instructions independently ?"
Director Shang asked Zhou Can.
"You can give it a try, but I'll definitely need your help to check it."
Zhou Can has never independently completed postoperative medical instructions for gastric cancer patients.
Since Director Shang gave him this opportunity to exercise, he did not hesitate and tried to prescribe a series of medical instructions to the patient.
Director Shang was there to check on him and correct any mistakes or omissions.
Finally, a complete and correct medical order was issued.
[Pharmacological differentiation experience +1.]
[You have completed the postoperative medical instructions for gastric cancer for the first time, and are rewarded with +100 pharmacological differentiation experience points. ]
I really didn't expect that after the operation was completed, I would earn 100 extra experience points as a reward.
Moreover, the experience value of pharmacological dialectics is very difficult to upgrade.
This made Zhou Can seem to see a smooth road to quickly upgrade pharmacological diagnosis.
His pharmacological differentiation is currently at the mid-level of resident doctors, and his current experience value is: Level 3 705/1000. After adding these 101 experience points, he was directly promoted to the excellent level of resident doctors. With two more such generous rewards, he will be promoted to the attending physician level.
"It's really cool to earn medical experience points in Internal Medicine."
Zhou Can was so happy that he smiled from ear to ear.
This operation is over, and Director Shang still has two more operations to perform.
The patient sent in this time was a 42-year-old male with intestinal tumor.
Zhou Can felt envious again.
He has performed very few intestinal endoscopic surgeries, and this operation is a very good training opportunity for him.
However, he has always been cautious and did not rush to get the opportunity for surgery.
Instead, he carefully read the patient's medical records and made sure he was confident. Then he said to Director Shang with a shy face, "Director Shang, if I also want to apply for this operation, will you scold me for being greedy?"
"Humph, you are quite self-aware."
Director Shang snorted. Although there was no expression on his face, there was a hint of smile in his eyes when he looked at Zhou Can.
Who is Zhou Can? He is the man who snatched the surgery and has a thicker skin than a city wall.
In the past, even someone as strict as Dr. Xu couldn't do anything about him.
Director Shang is afraid that he will be even more helpless.
"I just carefully examined the size and location of the patient's tumor. I have performed colon cancer surgeries in both the digestive surgery department and the general surgery department. I am confident that I can do this operation well. Can you let me share your worries?"
Zhou Can asked eagerly.
"You're sure, right?"
Director Shang stared at him with a serious expression.
Huang Xinggui secretly cursed the intern for being so shameless as he snatched up one surgical training opportunity after another.
Unfortunately, the surgical skills of this attending physician are not as good as those of this intern.
Huang Xinggui was not sure he could complete these two operations.
Therefore, he could only watch Zhou Can scramble for the opportunity to have surgery and he could do nothing about it.
If you don't have the ability, the smartest thing to do is to just stand by and watch. If you don't have the ability but still insist on having the surgery, and mess it up, you will not only destroy the credit you have worked so hard to build in the eyes of the senior doctors, but also your character.
It will be extremely difficult to get an opportunity for surgery in the future.
So, Dr. Huang Xinggui could only watch from the side with envy.
As for the three graduate students led by Director Shang, they want to perform endoscopic surgery on patients right now. That is wishful thinking.
First learn the four major punctures honestly, then practice the basic surgical skills, and then think about other things.
"If you don't have the right tools, you won't dare to take on a job. I can't say I'm completely sure, but at least I'm very sure before I dare to ask you for a job."
Zhou Can looked at Director Shang seriously.
"Okay, go ahead!"
Director Shang was relieved. As long as the doctors under him really had this ability, he would be overjoyed.
We are also happy to leave training opportunities to young people.
…
A total of three endoscopic surgeries were performed in the morning.
These are not minor operations, and each has its own level of technical difficulty.
Zhou Can obtained two complete endoscopic surgeries and wrote three complete postoperative medical instructions. Of course, all of them were written under the one-on-one guidance of Director Shang.
Even so, he still felt that he had gained a lot.
I have made some progress in pharmacological differentiation and postoperative medication. After writing the third medical order, I even received 10 points of pharmacological differentiation experience points.
He also secured part of the surgical mission for the third operation.
There was a difficult matching task, which he was not sure he could do well, so he just watched Director Shang do it.
After all, the patient with jejunal to esophageal anastomotic fistula left a very deep impression on him.
Before his anastomosis technique is upgraded to level five, it is better for him to just give in when faced with such a difficult anastomosis task, so as not to harm the patient.
It was already past noon when the operation ended. Director Shang was very generous and ordered meals for all the medical staff involved in the operation.
We ate together and discussed some issues encountered during the operation, and it was quite enjoyable.
Zhou Can thoroughly let Director Shang and others know his surgical ability through the three endoscopic surgeries in the morning. Director Shang seemed to be in a very good mood, with a smile on his face from time to time.
Any chief physician would be happy to have recruited such an excellent intern, who will provide him with a capable assistant for the next two or three months.
After all, for attending physicians and chief physicians, interns, trainees and continuing education students are all free helpers.
After dinner, Zhou Can returned to the office and turned on the computer to complete the patient's medical records.
I also took the opportunity to check the treatment status and new test results of the seven patients under my care.
"The patient in bed 79 is indeed suffering from portal vein thrombosis."
After checking the results of the female lawyer in bed 79, he breathed a sigh of relief. The real cause of the patient's illness was finally found. It was chronic portal vein thrombosis accompanied by splenic vein thrombosis.
[Diagnosis experience value +1.]
[You have successfully diagnosed a hidden high-difficulty case, and are rewarded with +100 pathology diagnosis experience points. ]
Having successfully obtained another 100 experience points reward, and a pathological diagnosis, he couldn't help but grin with an unprecedented happy smile.
Internal medicine is really his blessing.
Various medical skills that could not be promoted in the surgical department began to be promoted rapidly after entering the internal medicine department.
At this rate, it is not a dream to upgrade the two most important medical skills, pathology and pharmacology, to level five within a year.
It would be unimaginable if he could complete his three-year training and upgrade all his important medical skills to level five.
By then, his return to the emergency department will definitely be a comeback and will bring great surprises to Dr. Xu and Director Lou.
If you want to help the emergency department grow in a short period of time, you must have excellent skills. It is best to cultivate both internal and external skills, and have a high level of attainment in all aspects of medical skills.
Only in this way can we quickly open up the situation and gain popularity in a very short period of time.
The real cause of the illness of the female patient in bed 79 has been found. She only needs surgery and I believe she will recover soon...
Seeing the patients under his care making significant progress in treatment and returning to health, Zhou Can's heart is filled with a sense of accomplishment and anticipation.
He likes the profession of doctor more and more.
The more skills you learn, the more difficult and complicated diseases you can solve. For patients, the birth and rapid growth of such an excellent doctor is undoubtedly a great blessing.
For Zhou Can himself, continuous improvement in the field of medicine is exactly the life he wants.
China's medical community also desperately needs talents like him to contribute to China's medical cause.
…
Days passed like this. One week later, the patient in bed 71 with esophageal anastomotic fistula and jejunal anastomotic occlusion was able to eat.
After more than half a year, he finally succeeded in drinking his first sip of water.
The operation was very successful.
Not only did the blocked section between the patient's esophagus and jejunum get unblocked, but the anastomotic fistula was also repaired. No more worrying about food escaping from the fistula.
After the patient successfully drank the first sip of water and felt the food entering his intestines, he was so excited that tears welled up in his eyes.
Total gastrectomy prevented the spread of cancer cells and saved his life.
However, because the operation was not done well, it seriously affected his quality of life for the rest of his life.
Now, Tuya Hospital has solved his problem.
The patient's spouse also cried with joy.
The medical skills of Zhikuatuya Hospital are superb and he is a living Bodhisattva who saves lives.
The patient's daughter, who had been frowning for more than half a year, smiled from the bottom of her heart. Seeing her father regain the ability to eat, she told the medical staff and the family members of the patients in the adjacent beds that it was like a pie in the sky.
Unexpectedly, a medical miracle really happened.
On that day, she went to some place to order a silk banner with the eight characters "saving the world and doing immeasurable merit" written on it. Next to it was a line of words thanking Director Shang of Tuya Hospital for his superb medical skills and for curing her father.
Another hero in this treatment, Zhou Can, was hiding behind the scenes and was unknown to the public.
Zhou Can didn't care about this.
