Chapter 259 Hidden submural lymphoma, consultation outside the department
The main team of gastrointestinal surgery is still composed of the original digestive surgery team.
Only some digestive surgery projects were separated out .
For example, pancreaticobiliary surgery and anorectal surgery.
In general, the continuous subdivision of departments has both advantages and disadvantages. The advantage is that it allows doctors and nurses to become more proficient in related medical fields and achieve true excellence.
This is also a major trend in the market.
As China becomes increasingly powerful, people's demands for medical treatment are getting higher and higher.
Nowadays, people go to the hospital that can cure a certain disease. For example, the oncology department of Tuya Second Affiliated Hospital has become stronger and bigger, attracting not only cancer patients from all over the province, but also many cancer patients from other provinces to seek treatment.
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 was already ready, with the anesthesiologist and operating nurse already in place. Not long after the patient was anesthetized, the deputy chief physician also rushed over.
"Director Mu!"
Zhou Can was very surprised that the person who came in was the arrogant and narrow-minded Deputy Director Mu of the Digestive Surgery Department.
"Hello, Dr. Zhou! It's an honor to work with you on this surgery."
Director Mu actually looked as if he had taken advantage of something. He smiled happily and walked forward to shake hands with Zhou Can.
In the past, Deputy Director Mu did not treat Zhou Can like this.
All we can say is that things have changed.
Zhou Can's great potential and his hidden status in Tuya Hospital at this moment were enough to change Deputy Director Mu's attitude towards Zhou Can. No one would refuse to have a good relationship with a future medical leader.
"Thank you Director Mu for your trust and support! I should be the one who feels honored to be able to perform surgery with you."
Zhou Can didn't dare to take advantage of this man.
You must give the other party enough face.
Especially when dealing with such narrow-minded people, you have to be extra careful. Sometimes a word you say is not said well, and people take it to heart.
"Old Mu, I'm really sorry to trouble you this time!" Doctor Chi and Director Mu obviously have a good personal relationship.
"What kind of trouble is it? I've asked you for help so many times. If you're being polite to me, that would be too formal." Director Mu waved his hand and walked to the patient to take a look.
At this point, the patient has begun to enter anesthesia.
But it will take some time.
"Anesthesia was successfully implemented, the patient's vital signs are stable, and surgery can be performed!" The anesthesiologist is always the most serious person during surgery. He is very methodical and all operations are carried out in strict compliance with safety regulations.
Even more serious than being the main surgeon.
It is understandable. After all, they are responsible for the patients' lives and safety, so they have to be serious.
"Doctor Zhou, please!"
Director Mu signaled to Zhou Can.
"good!"
Zhou Can stood at the operating position and began to perform laparotomy on the patient.
The scalpel seemed to come alive in his hands , agile, swift, and moving at will.
The length and depth of the cut are all done with perfection.
As the abdominal cavity was opened layer by layer, Zhou Can used electrocoagulation to stop bleeding for the patient, and all large blood vessels were perfectly avoided during the incision.
He specializes in medium-level incisions, and with his sharp knife skills, his incision skills are no less than those of deputy chief physicians. There is no need to worry about accidentally cutting large blood vessels and nerves.
"We'll help you pull the hook."
Deputy Director Mu and Doctor Chi took the initiative to serve as assistants to Zhou Can.
As the abdominal cavity was opened, Zhou Can first sucked out the accumulated blood and a small amount of abdominal fluid, and then began to carefully explore the lesion site.
Whether it is abdominal surgery or thoracic surgery, doctors need to have a strong sense of responsibility and rich surgical experience. Because when moving organs in the abdominal cavity, in theory, there is no big problem as long as they are not broken.
However, after the operation, the organs and tissues in the abdominal cavity may suffer from severe adhesions, which will cause a series of troubles for the patients.
This is what is commonly referred to as postoperative sequelae.
Almost all thoracotomy and laparotomy surgeries have some degree of sequelae.
For example, after thoracotomy, patients often experience chest tightness, shortness of breath and other problems.
If laparotomy is performed, the risk of intestinal adhesion and intestinal obstruction will increase significantly.
Many patients who underwent laparotomy reported a certain degree of constipation or unexplained abdominal bloating, gas depression, etc. in a survey six months after discharge.
Therefore, a responsible doctor will conduct a comprehensive evaluation when performing thoracotomy or laparotomy, and will only decide to perform surgery on the patient if he is sure that the benefits of the surgery far outweigh the possible impacts after the surgery.
Zhou Can tried his best to keep other organs in the patient's abdominal cavity from being moved. He had done his homework when choosing the knife position before the operation.
At this moment, open the abdominal cavity and directly take the diseased area.
Because the patient was still in the early stage of the disease, the lesions were not obvious at this stage. So even though the location had been done before the operation and small nodules were felt when touched, nothing was found when the abdominal cavity was opened for exploration.
Zhou Can was mentally prepared for this.
"There doesn't seem to be any obvious tumor or nodule! When Dr. Zhou touched it, was it because the person was a young woman that something unusual happened?" Dr. Chi asked from the side.
Before opening the abdominal cavity, Dr. Chi was confident in his diagnosis of Zhou Can.
But after actually injecting the abdominal cavity, I found that it was not the case.
He couldn't help feeling a little disappointed.
The main thing is that it is difficult to explain to the family members.
"Do I look like someone who has never seen a woman?" Zhou Can curled his lips in silence. If he was so useless, he wouldn't be a doctor. "My touch at that time could never be wrong. Now that we open the abdominal cavity and don't find the lesion, there is only one possibility. The tumor or nodule is very small and hidden in some tissue."
Zhou Can has extremely rich surgical experience and has cut many tumors and nodules.
Although the current situation was somewhat unexpected, he quickly calmed down and sorted out his thoughts.
The first round of search just now yielded no results because he was very cautious and careful during the operation, fearing that he might injure her abdominal tissue.
"Put on some thin sterile gloves for me. The thinner the better."
Zhou Can said to the operating nurse.
All the gastrointestinal surgeons knew Zhou Can and had witnessed his skills.
They were not worried at all about the surgery being thwarted at this moment.
The nurse on duty quickly came over to help Zhou Can take off the glove on his right hand, and the instrument nurse replaced Zhou Can with an ultra-thin sterile glove.
"Doctor Zhou, are you trying to find the lesion by touching it with your hands?"
Dr. Chi was stunned for a moment, and instantly understood Zhou Can's intention.
After putting on new thin gloves, Zhou Can began to pinch the patient's abdominal tissue directly with his hands, mainly around the jejunum.
"Tumors usually occur in the ileum. Could it be that Dr. Zhou got the wrong location?"
Deputy Director Mu asked.
Zhou Can shook his head. "The patient had a gastrointestinal radiography before the operation, which showed that the lesion was in the jejunum. When I did the tenderness test, there was a strong tenderness reflex in this area. There should be no mistake."
He didn't dare to say anything too decisive.
His eyes searched around, identifying the tissues most likely to contain tumors.
When he lifted up part of the jejunum, his eyes were fixed on one part, but his mind was quickly recalling the human anatomy that he had learned in the general anatomy class.
"If a tumor really occurs, it is most likely to appear in the lymph. The lymphatic tissue in the lower layer of the intestinal wall is usually more abundant. Could it be in here?"
He vaguely felt that he had found the site of the lesion.
Try to gently pinch the tissues with your hands.
"It's a nodule, hard and a bit slippery... No, it doesn't feel like a lymph nodule, but more like a tumor." Zhou Can's face showed excitement. After searching for so long, he finally found it.
Tumors occurring in this area are the most hidden and difficult to detect through examination methods.
By the time cancer is discovered, it is often already in its late stages.
"It turns out that the tumor is hidden in the lymph nodes in the lower layer of the intestinal wall. No wonder it can't be found!"
Lymphoma under the intestinal wall can easily develop in depth along the intestinal wall, invading the serosa, mesentery and lymph nodes outward, and infiltrating 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 delayed for two or three months, and she would definitely have lost the opportunity for surgery.
[Pathological diagnosis experience value +1. ]
[You successfully diagnosed a difficult hidden case, and are rewarded with +100 pathology diagnosis experience points. ]
The reward of 100 experience points should be given to Zhou Can.
You know, this saved a young life.
"I never thought that such a young patient would develop small intestinal lymphoma. The mortality rate of this disease is extremely high. The difficulty lies in the fact that the disease is extremely difficult to detect in the early stages. Many patients do not have obvious early symptoms."
Deputy Director Mu’s surgical skills are not very good, but his theoretical knowledge is very strong.
He has published several influential papers in the field of intestinal tract.
"Dr. Zhou is indeed worthy of his reputation. Now that the tumor has been found, the family has a very good explanation." Dr. Chi began to flatter Zhou Can.
Just recently, he questioned Zhou Can's abnormality during palpation because he had never touched a girl before.
Now I understand that too much talk will lead to mistakes.
Unfortunately, the damage is done.
Once you say something, you can never take it back.
Dr. Chi broke out in a cold sweat when he thought about how he almost treated the patient's illness as intestinal tuberculosis.
It's really amazing.
At that time, both he and Director Mo 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, he confirmed that there was no spread, and then he stopped the operation.
[Experience points for separation +1, experience points for incision +1. ]
[You have successfully separated the lymph node tumor under the jejunal wall for the first time, and you will be awarded +100 separation experience points. +100 incision experience points. ]
One operation earned 300 medical experience points, and these were all medical skills that were extremely difficult to improve under normal circumstances.
Zhou Can's heart was filled with joy.
What made him happier was that he saved the little girl's life and prevented a family tragedy from happening.
"Doctor Chi, Director Mu, the patient's diseased lymph nodes have been completely cleared. Should we sew up the cavity now?"
"Shut up!"
Director Mu has the highest status and he is the one who gives the orders.
The patient's abdominal wound was quickly sutured, and Zhou Can tried to make it as beautiful as possible. A girl with a long scar on her belly can easily be mistaken by a man as having had an abortion or a caesarean section.
This is definitely not good for the patient's married life.
But this kind of thing can be explained clearly. The patient has the right to copy the treatment documents and examination results for his/her files. These are all strong evidence.
Of course, the best thing is to be healthy and not have to undergo any surgery.
However, there are many things in the world that are not as you wish. If a malignant tumor occurs in the body, it also means that cancer has secretly taken root in the body. In this case, saving life is the most important thing.
No matter how severe the scar left on my abdomen is, it's worth it.
"I never expected that the patient had so many tests but still couldn't find the cause of the disease. I have studied gastroenterology for so many years and have been working in the clinic for so many years, but I am starting to get scared. Even if I am very careful in diagnosis, there is still the possibility of omissions and misdiagnosis."
Dr. Chi's problem occurs to almost all old doctors.
The more skilled the doctor is, the more experience he has in diagnosis, and the more careful he is when diagnosing patients. He is always walking on thin ice, afraid of making any mistakes.
"Small intestinal lymphoma is indeed a very difficult disease to diagnose. In the future, if similar cases are encountered and endoscopic examinations have ruled out upper gastrointestinal or colonic bleeding, you can try to perform a small intestinal barium double contrast examination on the patient. In addition, the recently popular swallowing thread test can also be used more in clinical practice. If these methods still cannot find the cause, do not hesitate, 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 no less than that of an internist.
Therefore, nothing in the world is absolute.
The idea that internists must have strong diagnostic abilities and surgeons must have poor diagnostic abilities is just irresponsible and random guesswork.
The wire swallowing test is simple and easy to perform, and it is a non-invasive examination with very low cost.
It is commonly used in some large hospitals.
On the contrary, some hospitals or departments that only think about how to generate revenue rarely use this method.
After all, before the cause of the patient's illness is found, the doctor can openly ask the patient to undergo all the examinations. After all the examinations are completed, there is a revenue of two to three thousand yuan.
As for whether the patient feels extremely uncomfortable during barium angiography or whether the condition is aggravated by invasive examinations, the doctors don't care about that.
…
The moment the patient was pushed out of the operating room, the couple who were waiting outside rushed over first.
"Doctor, how is my daughter's illness?"
"The operation went very smoothly. The small intestinal lymphoma removed from the patient has been sent for pathological biopsy. The biopsy can determine whether the boundaries are clear, whether it has spread, whether it has been completely removed, and the nature of the tumor. The results are usually available in 24 hours. When the results come out, I will arrange the next treatment plan based on the test results."
Dr. Chi said to the family members.
"It really is 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, and also the patient's chief surgeon." Doctor Chi knew Deputy Chief Physician Mu's personality and quickly introduced him to the family.
"Thank you, Deputy Director Mu!"
The girl's father was somewhat knowledgeable about the ways of the world, and he hurriedly thanked Deputy Director Mu.
"The operation was mainly performed by Dr. Zhou. I was just there to give some guidance. If you want to thank someone, 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 maintenance of the abdominal wound and do not scrub it."
Deputy Director Mu was very busy and left in a hurry after giving a few instructions.
When the family learned that the operation was mainly performed by Zhou Can, their gratitude to Zhou Can reached a new level.
After returning to the Department of Digestive Surgery, Zhou Can hadn't even sat down yet when Luo Jingyi, Director Shang's subordinate, came running over.
"Doctor Zhou, if you are not busy now, Director Shang would like you to go to the Department of Vascular Medicine to participate in a consultation on a critically ill case."
Luo Jingyi was just passing on a message.
Judging from the time, Director Shang should be seeing patients in the outpatient clinic now.
Zhou Can was just about to drink some water when he hurried to the outpatient clinic to help with the auxiliary diagnosis.
"I'm just a resident intern, and Director Shang asked me to go to the Department of Vascular Medicine for consultation. Isn't this inappropriate?" Zhou Can has performed very well in the Department of Gastroenterology recently.
Especially in the diagnosis of various cases, he has won the appreciation and respect 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 had already predicted that you would refuse. He asked me to tell you that you will represent him in this consultation at the Department of Vascular Medicine. The boss also said that your level is not inferior to his. You must be confident and not let down his reputation."
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.
