Chapter 630 Gray matter is to blame, this is a feeling
There is not much blood accumulation in the cranial cavity.
Generally, there are two sources of blood accumulation during craniotomy. One is intracranial hemorrhage before the operation, which causes fluid accumulation. The other is intraoperative bleeding, which is caused by the operation.
Zhou Can’s incision skills are already at the director level, and his touch sensitivity is abnormally strong.
Blood vessels, nerves, tendons, etc. can be identified one by one.
This kind of touch is not something that ordinary surgeons can have. Usually only those with extremely rich surgical experience and incision skills at the level of chief physician or above can have it.
Its functions and benefits are self-evident.
It allows the surgeon to minimize surgical bleeding during the operation.
Zhou Can now performs all kinds of major surgeries, and his bleeding control is enough to make every doctor envious.
When others have a caesarean section, they bleed at least 300ml.
If Zhou Can performs the operation, not only will the operation be extremely fast, but the amount of blood loss will also be pitifully small. In laparotomy, he can usually control the amount of blood loss to less than 100ml. In fact, the amount of blood loss in his laparotomy is usually less than 50ml.
This is not as simple as just cutting open the abdominal cavity, but also includes the removal of abdominal tumors or appendix during surgery.
To ordinary doctors, this is almost unimaginable.
Because it is very difficult to achieve such little bleeding.
All I can say is that surgery requires not only good skills, but also experience.
Before removing a lesion, Zhou Can can clearly know which larger blood vessels are around the lesion and ligate those that need to be ligated in advance. For small blood vessels, he can directly use electrocoagulation to stop bleeding during the operation.
"The source of the bleeding has been found. It's a ruptured artery."
After the accumulated blood was drained, the bleeding spots were clearly visible.
Of course, Zhou Can found the bleeding point naturally and easily. He found the bleeding source easily without much effort or time.
But if someone else were to perform the surgery, unless it was a chief physician like Wu Baihe, an ordinary person would not be able to reach this level.
It is easy to see things but difficult to do them.
It seemed that Zhou Can was extremely relaxed when performing the operation, but if other doctors on the scene were to perform the operation, they would most likely be very nervous as if facing a great enemy, and there might even be chaos and various problems.
It is absolutely a blessing for the patient to have a surgeon of the caliber of Zhou Can or Wu Baihe perform such a life-threatening operation.
This time, Zhou Can didn't ask Wu Baihe at all, and directly used electrocoagulation to stop the bleeding.
The blood vessels are small and the blood supply pathways are highly replaceable.
After the small artery was electrocoagulated to stop bleeding, the blood passage was blocked. But don't worry, the human body has an extremely rich vascular system, which is as dense as tree roots and spreads throughout every corner of the body.
Once this artery is blocked, other adjacent arteries and thinner blood vessels will automatically take on new blood transport tasks.
It won’t be long before a new blood path is formed.
But larger blood vessels cannot be easily electrocoagulated or ligated to stop bleeding. Sometimes they must be repaired.
Because the larger blood vessels are equivalent to the taproots of a tree, if one is cut off, there is one less root.
It is difficult to form a new alternative blood route in a short period of time.
This can cause ischemic organs and tissues to quickly die or their functions to be severely affected.
"Hey, there seems to be a narrow and blocked blood vessel here."
Zhou Can's words attracted everyone's attention.
Everyone looked at the developing screen and could only see the bloody red intracranial tissue and the white part of the brain. The blocked blood vessels were not visible at all.
Wu Baihe kept staring at the screen.
He himself was assisting Zhou Can in the operation.
Some brain tissue needs to be pulled apart, and he is basically the one who does the operation.
Wu Baihe tried his best to look, but still couldn't find the problematic blood vessel.
"Where?"
He had no choice but to ask with a serious face.
Don't think that these top chief physicians don't care about anything. What they care about most is their reputation. Especially the authority and status in their field of expertise, which they take very seriously.
As a person, if you have studied a certain field for most of your life, you will definitely be proud of your achievements in this field.
We are all mortals, Zhou Can has decades less medical experience than Wu Baihe, but Zhou Can found the problem while Wu Baihe didn't. He must be embarrassed.
What's more, he also called some of his team members over.
There are doctors and nurses, and they all respect and worship him like a god.
Now that he is at a disadvantage, how will his medical staff view him?
"I'm just guessing, actually. Do you think there's something wrong with this gray matter?"
Zhou Can peeled away some brain tissue to allow Wu Baihe to have a wider field of view and see more clearly.
He said this just to save face for Wu Baihe.
Which doctor would guess whether a blood vessel is diseased when performing surgery?
It's hard to guess even if you want to.
Wu Baihe stared at the gray matter in that area and observed it carefully, and soon discovered the problem.
"It's atrophied and seems to be showing signs of degeneration... This is clearly a problem . From an anatomical analysis, this area of gray matter has only one large artery to supply blood, and two venous circuits..."
As he spoke, Wu Baihe's eyes suddenly lit up.
Yes, there must be something wrong with the arteries that supply blood to this area of gray matter.
Only then did he realize that Zhou Can was giving him a way out and trying to save his face.
"Enlarge the patient's head scan. I should have done a color ultrasound to be more accurate, but the CT scan will do."
The biggest advantage of color ultrasound is that it can scan the blood flow in blood vessels in real time.
It is used to check whether the blood flow in blood vessels is unobstructed. Its accuracy and diagnostic significance are even stronger than many high-precision instruments.
Some young doctors blindly admire the high definition and high precision of magnetic resonance imaging.
In fact, this is an incorrect clinical diagnostic thinking.
Color ultrasound, B-ultrasound, and X-rays each have their own advantages. The fact that they have been used all the time and have not been eliminated naturally has their merits.
A color ultrasound only costs more than 100 yuan for a patient, how much does an MRI cost?
It costs at least several hundred yuan, and the ones with higher precision can be as high as more than two thousand yuan.
When it comes to checking whether blood vessels are unobstructed, apart from CT angiography, there is probably no other examination method that is more intuitive than color ultrasound diagnosis.
Wu Baihe stared at the patient's head CT film and examined it carefully.
"Enlarge this area a little more."
After zooming in and looking at it for a while, Wu Baihe was still undecided.
"The patient also had a head MRI done in another hospital, right? Let's take a look at that, too."
He seemed very serious.
Even though Zhou Can had already discovered the problem, they still wanted to obtain examination data to support their conclusion. This is also the inertial thinking of most veteran doctors.
Just two words: safe.
Why do I say so?
Because many veteran doctors have been sued by patients and their families, when it comes to lawsuits, they definitely need evidence!
When the doctor defended himself, naturally no one believed his empty words.
At this time, I provide the examination data and then tell the judge or the staff of the competent department that the basis for my treatment of the patient is based on the examination data. I strictly abide by the medical standards.
Then the leaders took a look and saw that it was indeed the case.
As long as it is proven that the doctor is not at fault in the diagnosis and treatment, the lawsuit is basically won.
There are strict indications for surgery.
A doctor cannot just perform surgery on a patient just because he or she thinks there is something wrong with the artery in the patient's brain that supplies blood to the gray matter.
That's definitely against the rules.
Problems must be identified from the inspection data before a surgical solution can be decided.
The failure to detect the presence of lesions in this blood vessel before the operation was actually a missed diagnosis.
However, this is very common in clinical surgery.
Some lesions are extremely hidden and difficult to detect even by experienced doctors.
There is a test called intraoperative exploration.
The lesion site was further explored during the operation.
This also shows that doctors have great power during surgery. Various regulations and rules are also relatively relaxed for doctors' surgery.
It seems like strict access, but complete delegation of authority after the operation begins.
This is basically an unspoken rule in current medical surgery.
However, in recent years, the competent authorities have also formulated some stricter supervision systems. For example, during the operation, nurses, anesthesiologists, and medical assistants must sign and confirm. And the operation process will be accurately recorded.
If the records are not standardized or there is concealment, once it is discovered, not only the doctors and nurses involved will be held accountable.
Even hospitals will be punished.
But the hospital is ultimately on the side of doctors and nurses, and if there is a problem, it is usually handled behind closed doors. So it is almost impossible to achieve true transparency in the operating room.
It’s like installing surveillance cameras in a kindergarten, and parents ask to check at any time how the teachers are teaching their children. I’m afraid no kindergarten would dare to agree.
"County hospitals are simply unreliable. They can't even do an MRI properly. With this level of skill, their medical technicians and doctors should be laid off and retrained."
Wu Baihe criticized the county hospital for not doing a good job with the MRI.
No one said anything.
Some people smiled.
"Although the examination is a bit fuzzy, we can vaguely tell that this blood vessel is indeed narrowed, and it looks quite serious. This blood vessel is not large, and its normal blood supply task is relatively light to supply blood to the gray matter of the brain. I didn't expect it to have problems. It was our negligence before the operation. Director Zhou, how do you plan to deal with this narrowed artery?"
Once the problem is discovered, the next step is to deal with it.
There are two sets of solutions.
Zhou Can was also a little troubled.
"Placing a vascular stent is safer and faster, but the cost may be higher. Directly replacing this section of blood vessel is cheaper, but the operation is difficult and risky, and it is also more traumatic to the patient. The patient is in a very weak condition, so I'm afraid it would be better to choose to place a vascular stent."
After deep thought, he ultimately opted for a more comprehensive and expensive treatment.
This is basically the choice of all doctors.
Because no one wants anything to happen.
"I also tend to use a stent as the solution. The itinerant teacher urgently adjusted the stent according to Director Zhou's needs."
"OK."
The circulating nurse asked Zhou Can about the specific size and length of the stent he needed and immediately made a phone call to start adjusting it.
"Director Wu, let me check this. If there is no problem, the endoscopic surgery will be concluded." Zhou Can greeted.
"Um."
Wu Baihe nodded.
Zhou Can secretly sighed in his heart, fortunately he didn't directly check the brain area right away.
Who would have thought that the problem was not with the brain stem, but with the gray matter.
The patient's thalamus was bleeding, which increased the intracranial pressure and further compressed the already narrowed artery, causing the blood flow to the gray matter of the brain to be almost blocked, which was the main reason for the patient's coma.
Now the truth is out in the world.
The next step is to perform an interventional surgery to insert a vascular stent to clear the nearly blocked artery.
"Director Qu, are there any changes in the patient's brain waves?"
Zhou Can was still a little worried before removing the endoscope.
"The brain waves have become more active and seem to be recovering."
She replied.
Under general anesthesia, brain waves are relatively flat. However, as the blood in the patient's brain is drained, the bleeding stops, and the intracranial pressure decreases, the compressed arteries slowly rebound and blood circulation is restored.
The almost stopped function of the gray matter in the brain was restored.
"It seems that I'm right. It's the gray matter in the brain that's to blame." Zhou Can felt more confident.
…
Performing interventional surgery is Zhou Can’s strong point.
The entire stent placement process took less than twenty minutes.
After the operation, the patient's severely narrowed and nearly blocked arteries were cleared and blood circulation was restored.
After waking up from anesthesia, good news came.
The patient has woken up from his coma.
This intracranial surgery, which was full of twists and turns and risks, was finally a complete success, and it also gave Zhou Can a deeper understanding of intracranial surgery and neurosurgery.
He deeply felt that medicine is boundless and one cannot learn enough in a lifetime.
"Director Zhou, may I ask how you discovered the problem with that artery during the operation?"
A neurosurgeon in his forties, with mostly white hair, looks very down-to-earth.
After the operation, he found an opportunity to ask Zhou Can for advice.
Watching Zhou Can perform intracranial surgery today, he was shocked by many aspects.
I also got to know what a master surgeon is.
Zhou Can's endoscopic operations, whether opening the skull, stopping bleeding in the skull, or finding lesions, opened their eyes. What surprised them most was that Zhou Can discovered that there was something wrong with the artery.
Only a small portion of the gray matter was visible at the time.
He felt that there was a possibility of inferring arterial disease from the gray matter of the brain, but it was very small.
At least even their teacher, Wu Baihe, had to peel open the brain tissue and observe carefully for a long time before coming to this diagnosis.
"If I say it's a feeling, would you believe it?"
Zhou Can looked at this gentleman.
There are many doctors with premature graying of hair in clinical practice. They are under great pressure from studying, doing scientific research, taking postgraduate entrance exams, and even greater clinical pressure after becoming a doctor.
Sometimes when a critically ill patient is seen, the person who is most worried is not the family members, but the doctor.
Every doctor who has gray hair in his thirties or forties deserves respect.
Because they devote their entire body and mind to the medical profession and contribute their own meager efforts to promoting human medical progress.
"I believe it! Can you tell me more about it? I also want to have this feeling."
After the doctor finished speaking, other doctors, including nurses, gathered around him, surrounding Zhou Can like a group of stars surrounding the moon.
"After you finish consulting with Director Zhou, go back and have a rest. You've all worked hard today. I'm old, so I'm going home to sleep first." Wu Baihe actually felt a little embarrassed.
During today's operation, he was by Zhou Can's side to supervise.
He even called over most of the team's elite members to help.
Unexpectedly, it became Zhou Can's home show.
It's definitely not to say that he was jealous, but it is certain that his authority as a leader has been shaken to a certain extent.
