"Keep the steel door?"
Changwu glanced at Lin Feng in surprise.
The protégé disciple next to him Zhang Yang looked at Lin Feng in amazement.
Especially Zhang Yang, when he first read the medical record materials, the teacher Changwu specifically asked him what he should do. Although Zhang Yang also wanted to keep the steel door, he felt that the difficulty was too high, so he chose the MILES surgical plan (this operation, the steel door is removed).
As a result, Lin Feng chose to keep the steel door.
Changwu asked in surprise, "Are you sure?" "
In fact, when Changwu received this patient, he also considered retaining the steel door, which was a high requirement for him as a big man in the imperial capital.
This incident also involved a suicide incident in a hospital eight years ago.
Eight years ago, Changwu underwent a colon cancer operation, the patient was an old man, before the operation, the patient's family did not tell the old man about the condition specifically, afraid that he would not be able to accept it, so he lied that it was a minor operation.
Then, the surgery was successful, and the tumor was successfully removed.
But!
The steel door was also cut off at the same time!
After the operation of the elderly patient and the anesthesia passed, he woke up and found that he had no steel door, and the feces could not be controlled and often leaked out.
On the third day after the operation, the old man had a nervous breakdown and committed suicide by jumping directly off the building.
At that time, this incident shocked Changwu's heart and felt guilt in his heart, and he couldn't let go for a long time.
Since then, he has put forward high requirements for himself, as long as the operation involving this part is involved, he will try to keep the steel door.
Lin Feng nodded: "Seventy percent." "
(Actually, it's nine out of nine, and the rest is given to luck)
"Hmm?!!" Changwu glanced at Lin Feng in shock: "There are seventy percent? "
So high?
In fact, Director Changwu himself is only seventy percent sure of this operation.
Lin Feng can even have seventy percent?
So powerful?
Changwu glanced at Lin Feng and thought, "Wait a minute, do you want Lin Feng to try it?" Look at his strength? Probe the bottom? "
Lin Feng looked at Director Zhangwu's eyes and felt a little wrong: "The director looks at me like this, why does it feel a little strange?" Do you think I'm bragging? "
......
9:40
Preparation for surgery.
The patient is pushed from the ward to the operating room.
Outside the hall of the operating room, the patient's family wife, two college and high school sons and daughters, and a grandmother thanked Director Zhangwu one by one, hoping that Director Zhangwu could do his best to perform the operation.
Of course, the family's goal is only to remove the tumor and save the lives of their loved ones, and they do not understand whether to protect the steel door or not the steel door, and they give Dr. Changwu the greatest expectation and trust.
......
10:00
The patient is pushed into the operating room.
Anaesthesia......
Cleaning (shaving)...
Disinfect, spread towels, disinfect...
Surgery: For rectal cancer, first take the Miles surgical protocol, complete removal including the steel door. If possible, new surgical modalities are used.
Difficulty: extremely low position, high fibrosis, high difficulty laparoscopic surgery.
Medical care: Director Changwu (main knife), Lin Feng (first assistant), Zhang Yang (second assistant), anesthesiologists, itinerant nurses, instrument nurses, onlookers including interns...
......
End of anesthesia.
Surgery begins.
The first step is laparoscopic hole selection.
Director Changwu fixed four holes, then opened the holes, freed, penetrated tools (laparoscope, forceps, suctioners), and entered the tumor position...
Because the difficulty of this operation is relatively high, the maintenance time will be relatively long, and the chief surgeon also has to sit in the middle of the patient's legs (open the two * legs, put a stool in the middle of the chief surgeon, or stand), the posture is awkward, to do the operation, so Director Zhangwu in order to save physical strength, the front opening is completed by Zhang Yuan.
When all this is ready, 50 minutes have passed.
Director Changwu looked disgusted.
Lin Feng looked disgusted.
Too slow!
Zhang Yang: ".................."
Feel offended by the scorn ~~~
......
The second step is to free the tumor.
Director Shotake appears, operating the free tongs...
Lin Feng supports the mirror to maintain the intra-abdominal vision of the laparoscope...
Free......
Free......
Continue to wander...
Constantly separating rectal cancer tissue from other healthy tissues around it.
There are many fibrosis, so the difficulty of surgery is very high, so Director Changwu's free speed is very slow.
An hour...
Two hours......
Because doing free itself requires careful care, once the free is wrong and breaks the blood vessels, it will be a disaster.
Therefore, Director Zhangwu should be careful to wander, and most of the postures stay in a certain posture, which leads to a certain weight-bearing part (waist) will accelerate consumption and strain.
Director Changwu felt that his old waist was a little unbearable!
"Xiao Zhou, grab my waist for me..."
"Huh?" The itinerant nurse Xiao Zhou Mei was at a loss.
"Backache... Pinch it, relieve it..." said Director Changwu.
"Oh oh~~~"
Little Zhou girl quickly helped pinch.
Three hours...
Four hours...
Nurse Xiao Zhou, who has already helped Professor Zhangwu, has pinched it ten times, and the frequency is getting higher and higher.
"Teacher, or... I'll do it..."
"You?"
Changwu glanced at Zhang Yang in disgust.
"I'm coming?" Lin Feng said.
Lin Feng judged that there were still 20% of them not free and clean, let Director Zhangwu continue to engage, I am afraid that the old waist will soon be unable to bear it.
Changwu: "Okay, Lin Feng, you come..."
A series of commands.
Lin Feng took the two pliers and stood in the position of the main knife.
Zhang Yang: "........."
Why don't you let me come? I'm awesome!
Crying chirp~~
Teacher, have you abandoned me?
Changwu felt Zhang Yang's 'pleading' gaze and was unmoved.
"Zhang Yang, you hold the mirror, Xiao Zhou (itinerant nurse), you come to grab the suction device...
......
The operation continues.
Free!
As soon as Lin Feng started, the momentum suddenly became different.
Master aura!
World class!
Confident, confident, confident! Full of style!
I saw Lin Feng operating pliers, like a dragon, like a flower butterfly, like an embroidery master...
It's like a master of fish killing, a few knives down, the flesh and bone are separated, chopped and chopped a few times, and a fish is divided into several dishes.
The pliers are in Lin Feng's hands, playing with flowers!
Pieces of necrotic, cancerous tissue are quickly stripped out, while avoiding the location of blood vessels perfectly. Even if he encounters the location of blood vessels, Lin Feng can still quickly liginate, cut off and free blood vessels.
Zhang Yang shut up.
Because he feels a huge gap!
Don't say that you can't compare to Lin Feng, even the speed and skill of the teacher can't compare to Lin Feng!
And Professor Changwu was also shocked in his heart at this time.
He had seen Lin Feng's surgery video and felt that Lin Feng was very strong, but he only thought that he was 20 floors and Lin Feng was 10 floors...
As a result, now that he was undergoing surgery with Lin Feng, he clearly felt Lin Feng's strong strength!
Just talking about this free technique, speed,
Is this 10 floors?
No!
This is the 30th floor!
Higher than your own 20th floor!
Incredible!
However, the doctors of gastrointestinal surgery around have cooperated with Lin Feng before, and they are as calm and stable as dogs.
"Oh, we have already been mentally prepared!"
"This is just Dr. Lin's basic practice!"
"That's right, we just need to be salted fish and shout 666!"
As for the interns,
"Groove!"
"Groove, groove, groove!"
“666!!"
"Dr. Lin is awesome!!"
Floating wildly overhead, 666~~~
......
It only took a short 20 minutes...
The remaining 20% of the adhesions are completely freed out.
Lin Feng was delighted.
After fully freeing the rectum, he saw hope for Baogang.
No more MILES surgery.
......
Stop the surgery.
Lin Feng gave up his position to Director Changwu.
"Director, the patient's condition is better than I thought, I explored the specific situation in the pelvis, and this surgery may consider the ISR (intersphincter-sphincterectomy) method, which not only ensures the radical removal of the tumor, but also minimizes trauma."
Director Changwu Yixi: "Let me see..."
He stepped forward and looked through the speculum to see the free results around the rectal cancer.
Evaluated,
ISR surgery is indeed possible!
The tumor is excised and the specimen is dragged out through the steel door, so that the distant incision margin of the tumor can be ensured; It is also possible to avoid an auxiliary incision in the abdominal wall; And finally, the digestive tract can be reconstructed by manual anastomosis, and it can also directly save patients nearly 15,000 yuan.
Kill three birds with one stone!!
But!
This operation is even harder!
It's very difficult to fit by hand!
On the one hand, the long time is a test for the doctor's physical strength, and it is easy to have sore shoulders and lumbar muscle strain!
On the other hand, the technical level of doctors is extremely demanding!
Changwu looked at Lin Feng: "I'm afraid I won't be able to last such a long time, can you take my operation?" "
Although Lin Feng had just shown his free ability, the difficulty of the next manual matching was increased by more than one notch!
Changwu was still a little worried about Lin Feng's behavior.
He needed Lin Feng to give him an affirmative answer.
When Lin Feng heard this, he said confidently: "Don't worry, if Director Zhang can't hold on, it's no problem to hand it over to me..."
Changwu nodded: "Good!" "
Remembering the old man who committed suicide eight years ago, Changwu decided to use the ISR surgical plan!
Lin Feng: "Then let's start..."
......
Continue surgery.
Surgical plan: from miles (no steel protection) to ISR (steel protection)!
In the first step, the tumor is removed and removed from the body.
Professor Changwu began to remove the tumor and surrounding necrotic tissue, and then dragged the tumor out through the steel door to complete the tumor removal.
The second step is the reconstruction of the digestive tract.
30 minutes...
An hour...
Professor Changwu gritted his teeth and insisted, his shoulders and waist were already extremely sore at this time.
However, the operation is also fast, as long as the anastomosis is over, the operation can be over.
Lin Feng felt that he might not have to go up to help.
outcome
In the final anastomosis stage...
"Not good!"
Suddenly, Professor Changwu was taken aback.
When it coincided, he realized that he had made a mistake!
He found that the anastomosis circle was not very complete, and there was a place on the anterior wall of the anastomosis because of the retraction of the proximal bowel, and there was a leakage of needles during suturing, and the re-suturing was not ideal!
What happens if the stitching is not ideal?
May leak!
Then intestinal and pelvic contamination, infection, inflammation ... Heavy is life-threatening!
"It's difficult!"
On the one hand, his physical strength is already insufficient, and back pain is not a joke, especially since he is in his fifties, not young.
On the other hand, he is faced with two choices:
Option 1: Revert to the MILES surgical method.
Option 2: Cut off the anastomosis and re-anastomose.
At this time, it is time to manifest the conscience of the doctor.
Option 1 is undoubtedly the simplest, most convenient, direct and fast method, for doctors, a hundred.
Option 2 will undoubtedly delay the operation for a long time, energy, physical strength, exhaustion, and the risk of failure. What's more, re-excision of the anastomosis and re-anastomosis will be more difficult!
Changwu doesn't need to choose at all!
He didn't think about the 1st at all, and directly chose the 2nd!
Changwu: "Lin Feng, you come!" Slow down, I can see clearly, if there is a problem, I can stop it in time..."
Lin Feng: "No problem. "
Akitake stepped down.
Lin Feng came to power.
Lin Feng agrees with Changwu's choice and continues the more difficult ISR approach.
The longer he was a doctor, the more Lin Feng loved this profession.
Every time I save a patient, I will try my best to think about the patient, on the one hand, for the patient, on the other hand, but also for myself, in order to be worthy of the white coat on my body, in order to be worthy of my conscience!
。
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