The Godfather of Surgery

Director Zhang's level is quite good, especially under the conditions of a grassroots hospital. He can independently perform some major surgeries, such as radical surgeries for digestive tract tumors such as liver cancer. This is of great significance in a remote county like Nanqiao, where transportation is difficult in mountainous areas. It is convenient. It takes two or three hours for patients to be sent to municipal tertiary hospitals. Therefore, solving problems nearby can relieve a lot of financial pressure on patients. This is also the reason why Shipo County People's Hospital can develop.

The patient was fifty years old, male, with advanced colon cancer. He had obvious intestinal obstruction, so he had to undergo surgery. Due to financial constraints, because the reimbursement rate of the new rural cooperative medical system was the highest in the township first-level hospital, the family decided to ask the old director to help him stay. Surgery at Guandu Hospital.

After the abdominal cavity was opened, Director Zhang's skills were deft and everything showed the level of Zhang Yidao. He quickly found the location of the tumor, used his fingers as a separation artifact, and began to perform blunt separation, going through many twists and turns in the abdominal cavity. After several separations, Zhang was able to remove the tumor. The director quickly found a breakthrough to isolate the tumor.

"Surgery is something that practice makes perfect. Do it more and practice more. There is no special trick. We were just 18 years old when we graduated from technical secondary school! We started to use knives at 18 years old. What is the concept? Today's doctors only use knives in their thirties. Do you think your experience is better than ours?”

Director Zhang was teaching Li Min while performing the surgery. Lao Zhang was very confident in his surgical skills, and he believed in experience. In Director Zhang’s opinion, papers, new technologies, and evidence-based medicine were all nonsense. Kung fu is the essence of surgery, traditional surgical methods are the most reliable, and decades of clinical experience are stronger than anything else.

"I have gone to the provincial capital for further study before, and I saw young doctors performing surgeries. The hands holding the knife were like chicken feet. I looked anxious."

"I started practicing when I was in my thirties. Can I get good at it?"

Director Zhang completely ignored whether Li Min responded and continued the class.

''Director Zhang! How about having a local chicken and frying it with camellia oil for dinner here today? "The old dean saw Director Zhang's relaxed expression, so he suggested.

Director Zhang refused directly: "After I finish this surgery, I have to go to Crossroads Hospital for another thyroid surgery. I'll let the relatives of our hospital logistics colleagues have dinner next time."

Director Zhang is an easy-going person and doesn't mince words, so when he said this, the old dean stopped mentioning it.

Li Min seemed to be quite relaxed as an assistant, and he could easily perform knotting and cutting of threads. In the past, Li Min was not qualified to be an assistant for this kind of surgery. He had never seen it before, let alone being an assistant. But now Li Min is no longer the same. Compared with the past, this kind of surgery was nothing in Li Min's hands. It could only be regarded as an ordinary surgery, one that Professor Yang positioned him as a skilled group.

The proficiency required by Professor Yang is not ordinary proficiency. Although he has not been studying for a long time, he is still Professor Yang's direct disciple.

Ten minutes into the operation, Director Zhang's hands gradually slowed down. He touched the pulsating abdominal aorta and then the tumor: "Oh my God, the tumor is adherent to the abdominal aorta. I Look at the inferior vena cava."

The inferior vena cava in the abdomen is also adherent to the tumor. How can this be done? The wall of the inferior vena cava is thin. If the separation is not careful, there will be no rescue measures in the event of massive bleeding.

Director Zhang looked rough and arrogant, but he was still very thoughtful. He stopped separating and began to look for a new breakthrough. His hands were still very flexible, and he quickly touched something thick and cord-like, and he squeezed it.

"Isn't this a blood vessel? Why are there such thick blood vessels?" Director Zhang said to himself.

Li Min looked at the position of Director Zhang's hand. This was a bundle of blood vessels supplying the tumor. There were adhesions between each other and with the surroundings. Judging from the feel, it was undoubtedly a vascular bundle. If you encountered this difficulty, it was obviously not right to shrink back. Zhang Yidao's style and reputation are accumulated through one operation after another, and they are not just random claims.

Since this is a vascular pedicle, Director Zhang decided to make a breakthrough from here, otherwise the operation could not proceed further. He also had his own method, which was to trust his own feel, so he used his fingers and tissue scissors to cooperate with each other, touched them repeatedly, and then performed the surgery again. Scissors, push forward bit by bit like this, opening roads over mountains and building bridges over rivers. This is Director Zhang's strategy.

"How much blood should I prepare?" Director Zhang asked.

The old director moved a stool and sat in the corner: "There are 6 units. It is inconvenient for our grassroots hospital to get blood, so we can only prepare so much."

6 units is enough for ordinary surgery, and ordinary surgery may not require blood at all, but this kind of surgery involves large blood vessels, and 6 units is not enough in case of bleeding.

Director Zhang paused for a moment to think about the next step. For complex surgeries, Director Zhang always takes it one step at a time. He has experienced dangerous surgeries over the years, but he has always managed to turn dangers into good fortunes.

If this tumor is to be completely removed, the adhesion to the aorta and inferior vena cava must be separated. This risk is too great, so we can only take a step back, leave the tumor close to the blood vessels alone, leave it in place, and remove most of the other parts of the tumor. This can solve the symptoms of tumor compression and achieve the goal.

Just like that, Director Zhang continued to separate, his fingers cooperated with the tissue scissors, and his movements were skillful and sophisticated. It took a lot of effort for Director Zhang to separate the whole rope-like thing. At this time, there was a slight sweat on his forehead: "Fuck, It’s quite tricky. Let’s reduce the scope of the resection, remove most of the tumor, relieve the compression symptoms, and leave the rest alone for the time being. ”

Director Zhang asked Li Min, as well as the old director, this is the usual practice of the chief surgeon. When encountering difficulties, he would discuss it with everyone. Li Min felt that the tumor was so rich in blood vessels that it would be safer to perform an en bloc resection. If Zhang The director's idea of ​​partial resection would inevitably involve the inside of the tumor. There are so many alienated blood vessels inside, and hemostasis is a big problem. Township hospitals lack various rescue equipment and cannot afford unexpected treatment.

So either give up the surgery now, or do a total resection of the tumor. This is Li Min's judgment. He wants to compromise and perform partial resection to relieve the symptoms of intestinal obstruction. The idea is good, but this will fall into a trap, and it will be very difficult during the operation. It is difficult to stop bleeding, and severe bleeding will endanger the patient's life.

"It is safer to perform a total resection. If you perform a partial resection, the bleeding from the cross-section of the tumor cannot be controlled. If you do not plan to perform a total resection, give up the surgery as soon as possible." Li Min gave his own advice. Medicine is factual science, and human life is at stake. There is no hypocrisy at all, so Li Min will not agree with Director Zhang just to please him, he must express his own opinion.

Director Zhang originally discussed with everyone that he wanted to find a place to go down the stairs. He raised the question and everyone agreed that this was the way to go. But now Li Min disagrees.

Director Zhang raised his head and stopped what he was doing: "There are too many adhesions inside, involving large blood vessels. I'm afraid that if the blood vessels are torn, I won't be able to stop it. The patient is only in his fifties, and he is not too old. He can drive with caution." Boat, let’s be conservative.”

"I guess I can't be conservative now, unless I stop the operation and close the abdomen now." Li Min is also straightforward. He has a straightforward personality, and the education he received at Sanbo Hospital is the same. There is no worldliness at critical moments on the operating table.

Director Zhang hesitated for a moment. He was a little unwilling to close his abdomen now. Judging from experience, partial resection should not be a big problem, but he still kept a cautious eye: "In this way, turn on my mobile phone, the power-on password -——, and find Director Peng's phone number , I’ll tell him about the situation.”

Director Peng is the director of general surgery at a regional tertiary hospital. He is from Nanqiao County and is visiting relatives in his hometown. Director Zhang and Director Peng had dinner together last night. Generally speaking, as a department director, who does not have his own "backer"? , County-level hospitals generally maintain a stable relationship with experts from regional hospitals through further training or pulling a flying knife, so that if something happens, they can come to the rescue or wipe the mess.

The general "backers" of regional hospitals are provincial hospitals, and the "backers" of provincial hospitals are the top hospitals in the country. Many doctors at provincial hospitals have master's and doctorate degrees from these hospitals, and their own mentors are their "backers."

The circulating nurse helped dial Director Peng's phone number. Director Zhang briefly explained the patient's condition on the phone, and then ordered the doctors in the audience to take photos of the CT films and medical records and send them to Director Peng's email address.

When encountering difficulties on the operating table, it is common to seek temporary consultation and guidance from a "backer", especially in grassroots hospitals, because preoperative diagnosis is one thing, and intraoperative diagnosis may be another. When encountering difficulties, the operation cannot be performed and the abdomen is directly closed. This kind of "switching surgery" means that nothing is done. This is also something that cannot be helped. Of course, doctors will try to avoid this kind of "switching surgery".

Director Peng was very fast and responded to the call after ten minutes: try not to perform partial resection. Although there are no CT images of angiography, it feels that the tumor has rich blood supply and the cross section will not be able to stop the bleeding.

The reason is very simple, just like heavy intrauterine bleeding during childbirth. When there is really no other way, the only option is to perform a total hysterectomy.

Director Zhang thought for a while and planned what to do next. No one took action. Everyone put their hands outside the surgical area. Suddenly, a large amount of blood suddenly poured out of the patient's abdominal cavity. Director Zhang was quite experienced. The knife was not called for nothing. He grabbed the upper section of the abdominal aorta, and Li Min immediately used a suction device to suck the blood. It took a while to wash away the blood.

"What are you doing? Don't move if you don't understand." Director Zhang cursed, because he had been doing fine just now, but he had stopped operating. When this happened suddenly, he thought it was caused by Li Min doing the operation in private.

Li Min immediately explained: "I didn't move anything just now."

The other assistants and doctors in the audience just saw that everyone stopped working. Li Min put his hands on the protective bag on his chest and did nothing. Director Zhang pinched the blood vessel and did not pursue the matter further.

"Large vessel occluding forceps."

Although Director Zhang does not have the theoretical knowledge to block the abdominal aorta, he has experience. This is his unique skill. Once there is bleeding that cannot be found, first cut off the main switch, and then slowly find the cause to avoid being stupid. He had to find blood spots everywhere, wasting a lot of time.

Experience is experience, and the empirical ascending zone theory is different. For example, when blocking large blood vessels, at what plane, how long, and how to block are all particular. But Director Zhang doesn’t know this. He only knows how to do it. Can stop bleeding.

"Let me see where the bleeding is. The bright red blood is so fierce, it must be the aorta. Other blood vessels are not so dangerous, but where is the breach." Director Zhang spared his hand to find the blood vessel.

At this time, Li Min had already judged where the bleeding outlet was based on the pattern that had just appeared. He gave his own suggestion: the breach was on the back side of the connection between the cord and the aorta that you just touched. The cord just came from the aorta. The blood supply blood vessels of the tumor that were directly separated may have been a little affected during the separation. There have been tears at some levels. Now it is just the blood pressure breaking through the weak point under high pressure.

Director Zhang was a little tired of young Li Min always giving guiding opinions: "Theory is theory, and there is a big gap between theory and practice."

It's so bloody, you can still accurately judge the bleeding point, it's true, but Director Zhang still reached out and touched the place Li Min said, but he didn't touch anything.

Now when it comes to the tearing of large blood vessels, I'm afraid it's beyond my ability. Before, I could just close the abdomen to deal with it. Now I have no choice but to bite the bullet and deal with it. At least the bleeding must be stopped, otherwise the patient will die from blood loss. .

Director Peng called again: "How are you doing now?"

"He's bleeding heavily now. I don't know where the bleeding site is, but I'm sure it's on the aorta. I'm pinching the upper section of the abdominal aorta to stop the bleeding and see if I can find the bleeding site and repair it." Director Zhang was originally afraid of heat, but now he keeps bleeding on his forehead. His back was also wet with sweat, and the circulating nurse kept wiping his sweat.

"Tear the aorta?" Director Peng was startled over there, "Old Zhang, I'm still in Nanqiao, not far from you. Do you need help?"

Director Peng is the director of the regional tertiary hospital, and has been a good brother with Director Zhang for more than ten years. At this time, he does not mince words. If he really hurts the aorta, he doesn’t know how serious the injury is. If a few stitches can solve the problem, maybe Zhang The director can handle it so-so, but if the tear is serious, Director Zhang cannot handle it at all. Treating large blood vessels is not something ordinary hospital doctors can do. Even if Director Peng comes, if it is really serious, he probably won't be able to handle it.

Director Zhang got what he wanted: "That's the best. The patient's vital signs are still stable. I'll wait for you to come over."

"Young people, don't panic. Surgeons must have good psychological quality." Director Zhang gave Li Min some on-site education, but Li Min did not panic. Director Zhang himself was covered in sweat on his forehead.

In fact, this time it was a disaster. I thought it was just an ordinary abdominal tumor. I cut out the tumor and cleaned the lymph nodes and called it a day. I didn't expect it to be so complicated. How did the aorta tear? Director Zhang still hasn't figured it out yet.

"Director Peng from the Central Hospital is visiting relatives in Nanqiao. Let's wait for him to see if it's safe to see if the patient's blood pressure is okay." Director Zhang said as he turned around and went out to let the circulating nurse wipe away his sweat.

The anesthesiologist immediately reported that the blood pressure had just dropped a little and was still normal. Fortunately, Director Zhang blocked the aorta in time.

"Let's learn another trick today. Many people don't know how to deal with this situation. Cutting off the aorta can stop the bleeding. It works with every trial." Director Zhang took a break and waited for the arrival of reinforcements. As long as the bleeding does not continue, , the patient's vital signs can still remain normal.

"The blocking time of this part cannot exceed half an hour. By moving the blocking part down 5 centimeters, the blocking time can be extended to 45 minutes. We'd better end the battle within 45 minutes. How about I take a look." Li Min took the initiative. Please take a tassel.

Director Zhang was quite disgusted with the way he thought he was an expert after only a few days of training: "Are you coming? There is a life on this stage."

If he hadn't known about Dr. Li's status as a "good doctor", Director Zhang would have called him a bastard. He has only been studying for less than a year. It's really ignorant to pretend to be an expert here. He used the scalpel that I have used for decades for nothing. .