The Godfather of Surgery

"Time waits for no one, how about I take a look first? I received training in this area when I was in advanced training, so I am confident." Li Min proposed again.

Director Zhang rolled his eyes at him: "Hold on, young people should be patient, Director Peng is fishing in the nearby reservoir, it only takes 20 minutes to drive here, wait a little longer."

The old dean did not dare to say anything. Director Zhang is a well-known surgeon in the county, with more than 30 years of surgical experience, and Li Min has just been sent to advanced training, and has not completed a year of advanced training. I believe it is self-evident that this has nothing to do with feelings.

"We can go first--" Li Min actively strives for it.

Director Zhang interrupted him: "Why are you so long-winded? It's good for young people to have ideas, but surgery requires experience. There is a big gap between theory and practice. High expectations and low skills will kill people."

Director Zhang has seen many examples of high expectations and low skills. A 30-year-old attending physician in his department went out for advanced training for a year and came back to start a big operation. As a result, he only performed three operations, two of which required Director Zhang to save the operation, and the lawsuit for another one has not been concluded yet. Other things can be allowed to be tried by young people, but surgery is not good.

"Can I move the large blood vessel clamp down 5 centimeters?" Li Min still insisted.

Seeing that he was so persistent, Director Zhang considered that this was someone else's territory, so it was no problem to move the clamp. Director Zhang asked for another large blood vessel clamp to block five centimeters below the original position, and then removed the original blood vessel clamp. After checking the abdominal cavity, there was still no obvious bleeding, which meant that the blockade at this position was also feasible.

What does it matter if it's a little higher or lower? Director Zhang thought to himself, since the effect is the same, then listen to him and save him from nagging.

Li Min looked at the new blocking position. It was no problem to hold on to this position for 45 minutes, and the maximum time could be extended to 60 minutes. Now Li Min was a little relieved. If Director Peng could arrive in less than 20 minutes, then the current situation would not cause too much impact on the patient, otherwise it would easily cause ischemia and necrosis of some organs.

Just now, Li Min repeatedly asked to fight, and not only Director Zhang was not happy, but several doctors around him also felt that Li Min was doing too much, which was completely inconsistent with his usual modesty and prudence. Maybe he was a little arrogant after further training. Can he intervene in this kind of operation? The level and grade are not enough, even Director Zhang is afraid of the operation, let alone Li Min.

Finally, there was a sound of conversation outside, the door of the operating room opened, and Director Peng came in wearing surgical gown. Director Zhang immediately said: "Old Peng, wash your hands!"

Director Peng just glanced at the patient's surgical area, then briefly understood the situation, and followed the doctor who led the way to wash his hands. The whole process seemed relaxed and very expert.

"The fish in your reservoir are quite big." Director Peng chatted while putting on surgical gown.

With the support of Director Peng, Director Zhang naturally relaxed a lot: "How is the record?"

"Three big guys, I will definitely make firewood fish later." Director Peng said.

Director Peng put on surgical gown and gloves, Director Zhang gave up the position of the main surgeon, and Li Min retreated to the position of the second assistant. Director Peng reached inside and touched it, and found out the situation clearly: "Your experience is still old Zhang, and the aorta is blocked in time, otherwise the consequences will be disastrous."

After touching for a few minutes, Director Peng finally found the rupture: "The rupture is not big, at the root of a branch of the aorta, just repair it. "

At this time, Director Peng was relieved. Although he looked calm on the surface when he came, he was still a little nervous. If the tear in the aorta was small, he could handle it if it only needed to be repaired. If the tear was large, simple repair could not solve the problem, and it would become a real large blood vessel surgery, which he could not handle at this time. Surgery is a real thing. If it works, it works. If it doesn't, it can't be forced. It's not like management work, where at least you can play it safe and pass the buck.

"Do you have nylon thread? It's better to have nylon thread, but it's also okay if you don't have silk thread. "Director Peng's requirements are not high, and this kind of easygoing attitude makes him look more capable.

If the aortic rupture is to be sutured, the blood vessels that supply the tumor must be cut off first, otherwise this part of the blood vessels will block the implementation of the repair work, so Director Peng began to separate this part of the blood vessels, because the separation of severe adhesions is not easy to do.

Director Peng's style is different from Director Zhang's. Director Zhang is completely wild, while Director Peng's operation method is standard and academic. He holds tweezers in one hand and tissue scissors in the other hand, and carefully separates. This adhesion area is full of dangers. If you are not careful, it may injure the blood vessels and cause bleeding.

"Anesthesiologist, report the vital signs!" Director Peng asked.

The anesthesiologist immediately reported the current vital signs. The blood pressure was slightly lower than normal. After all, the loss of so much arterial blood just now would definitely have a great impact on the blood pressure. It was only because of the timely hemostasis that no fatal losses were caused.

"How is the patient's heart function, is it okay?" Director Peng asked again.

The attending doctor who was still watching from the stage immediately replied: "It's okay, normal. ”

'Increase the intensity of fluid replacement, use 0.9% saline, and quickly fill up the volume. How much blood should be prepared?"

"Six units!"

Six units?

But now it seems to be enough, Director Peng ordered: "First, two units of blood."

Director Peng was calm and his expert style was admirable. A tertiary hospital is a tertiary hospital, and they are obviously different.

"Old Dean, I heard that your waist has been cured? Where did you have the operation?" Director Peng learned about the old dean from Director Zhang.

The old dean smiled: "Provincial capital!"

"Which hospital?"

"Sanbo Hospital!"

"Sanbo Hospital? Is it the Overseas Chinese Hospital?"

"Yes, it's the Overseas Chinese Hospital."

"Xiao Li is currently studying at Sanbo Hospital." Director Zhang added.

"Oh——, I am studying in Sanbo. Your Sanbo Hospital is very popular now. I heard that there is a young Professor Yang Ping who won the Golden Knife Award and was named an Outstanding Youth not long ago? This Professor Yang is not even thirty years old. No, can it be done? Can I do the surgery? It is said that he is the son-in-law of Academician Su, is it true?" Director Peng asked while going through the surgery.

Li Min immediately replied: "Professor Yang is my teacher. His surgical skills are very high and can be said to be the best in the world."

How could one not say good things about his teacher? Director Peng was noncommittal and just smiled lightly, because not everyone believed in the legend of Yang Ping, and some people still doubted it. Even Director Peng, after all, was too dazzling and could easily attract criticism. , and after the news that Yang Ping was Academician Su's son-in-law spread, everyone had this idea even more. Whether it's a sour grapes mentality or other psychology, there will always be a small number of people who think this way, especially when Yang Ping received a degree in orthopedics. Orthopedic surgeons generally won’t question Yang Ping’s Golden Knife Award because many have watched Yang Ping’s surgery live broadcast. Some non-orthopedics majors will question it. Even if there is a video of the surgery, many people are too lazy to watch it. They are just questioning it anyway.

"Your teacher." Director Peng felt that he had to pay more attention to what he said.

In Director Peng's view, Yang Ping's affairs were more or less bragging. The Su family's son-in-law was a well-known family in the south. In order to put his son-in-law in power, he would not do anything.

"Have you had any surgery with him?" Director Peng asked curiously.

"I often perform surgeries with him, and he teaches me directly. However, most surgeries are now performed by his professors. He doesn't do general surgeries, and only performs difficult and high-risk surgeries." Li Min answered Director Peng truthfully. question.

He is young and quite impressive, Director Peng thought to himself, but some of his thoughts were only in his mind. If Li Min was not present, everyone could talk openly. However, Li Min was present, but he still had scruples and did not dare to fully express his opinions. .

"They heard about setting up a research institute to study what?"

Before Director Peng finished speaking, suddenly, in an instant, a large amount of blood poured out of the abdominal cavity that had just been cleaned. What happened?

Isn't there an aortic clamp on it? Even aortic occlusion won't work?

Director Peng remained calm and judged from the color of the blood that the inferior vena cava might be torn: "Large blood vessel blocking clamp!"

However, Director Peng took the large blood vessel blocking forceps from the equipment nurse and didn't know how to start. There were adhesions. They were all adhesions. Where was the breach? Where was the blockage? Even if it was blocked upward, where is the inferior vena cava now? Well, Director Peng was stunned.

But experts are experts, and they are not afraid in the face of danger: "Blood pads, lots of blood pads!"

Stuff gauze inside, stuff a large amount of gauze, and use packing to compress and stop bleeding. This is an effective method for emergency abdominal and pelvic bleeding, and it is usually the last resort.

Li Min judged from the color of the blood and the pattern of bleeding that there was both arterial blood and venous blood. It was very likely that the aorta had continued to tear up and down along the original tear, and the inferior vena cava had also torn, and the blood vessel had a very severe tear. It may be just on the dorsal side, which is difficult to detect. The two cracks are probably actively continuing to expand.

This is already a real major vascular surgery, and Director Peng cannot handle it at all. Only a few hospitals can perform major vascular surgery.

The gauze filled the abdominal cavity, but the blood pressure still dropped sharply. It was obvious that the packing was not effective at all, and a large amount of blood could be seen gurgling out from various gaps.

"Blood transfusion! Quick! Blood transfusion!"

Seeing the futility of stuffing, Director Peng's heart broke and he became anxious. His calm and calm expert demeanor just now was gone. It was too sudden and too dangerous.

"Director Peng, let me take a look? If this continues, someone will die." Li Min was rude at this time.

In Li Min's case, major vascular surgeries belong to the level of "mastering a batch" required by Yang Ping, because such surgeries are rarely encountered in rural hospitals, but this surgery is a rescue operation. Once there is such a surgery nearby, The patient, if he can do this kind of surgery, can save his life, so Yang Ping's plan for Li Min needs to master this kind of surgery.

"Take a look?" Director Peng did not refuse. After all, he had no choice now. His mind was completely confused and he passively accepted Li Min's suggestion.

Li Min took over and took a second or two to make a rough judgment on the bleeding situation. He immediately asked the instrument nurse for another blocking forceps, clamped directly on the uppermost section of the abdominal aorta, and then opened several suction machines to suck blood. The aorta was explored and separated all the way down. The surgical idea was clear and the movements were very skillful. The extent of the aortic tear was quickly detected. At the same time, the inferior vena cava was also separated, and a large blood vessel blocking clamp was inserted.

Accurate judgment and extremely fast operation quickly stopped the bleeding and pulled the patient out of danger immediately. Otherwise, the patient would definitely die if he were to bleed like he did just now.

''Is it possible to find artificial blood vessels for major vascular surgery? It would be better if artificial blood vessels can be implanted. "

Li Min asked Director Peng and Director Zhang.

The two directors thought for a while. Not to mention the county hospital, even the central hospital in the city did not carry out major vascular surgery. Patients could only be sent to the provincial capital. How could there be artificial blood vessels? If the supplier was required to help with the supply, it would probably be It took more than ten hours for the goods to arrive.

"No, it will probably take more than ten hours to find someone to transfer the goods." Director Zhang was a little frightened.

Li Min wondered, without extracorporeal circulation support, how could the patient wait for more than ten hours on the stage? His teacher had taught this situation before, because he considered how to save the patient's life in such a special situation.

"The only way is to repair it!" Li Min said.

Through Li Min's examination, the blood vessel tear was very large, but most of the blood vessel wall was originally healthy, and only a small part was invaded by the tumor. Most of the tear was neat, which provided a certain foundation for repair. Through learning from Yang Ping, Li Min was no longer the young boy he used to be. He had a strong ability to deal with complex problems.

"Do you have nylon thread? For suturing blood vessels?" Li Min asked.

The old dean was so scared that his heart was beating fast. He stood on tiptoe to look at the operation and replied: "There is nylon thread, but I don't know if it is suitable for anastomosis of this kind of blood vessel."

"Bring them all to me." Li Min's expression was clear and firm, and the aura of the chief surgeon was revealed.

The circulating nurse immediately took action and took out all the nylon threads in the hospital for Li Min to see. Li Min picked a few packs that were barely suitable. Anyway, there was nothing to be picky about at this time, so he could only make do with it. It was impossible for everything to be standardized and smooth like in a large hospital.

As for the knowledge of various sutures, from materials, specifications, processes, etc., these were all trained by Yang Ping, so Li Min was very familiar with how to cross-use some threads and how to use them in non-normal scenes.

Li Min began to repair the blood vessels with nylon threads, first repairing the longitudinal lacerations. The longitudinal lacerations were the main ones, while the transverse and irregular lacerations were concentrated in the part where the tumor blood vessels branched off the aorta.

The suturing technique was a bit cool, fast, good and stable. Director Zhang, who was cutting and knotting the threads as an assistant on the opposite side, looked at Li Min's cool suturing and was stunned. This might be his most intuitive understanding of the large hospital and Sanbo Hospital from a technical perspective.

Compared with Li Min's suturing technique, Director Zhang felt that his decades of surgical experience were instantly worthless, and his previous operations were as bad as shit.

A young doctor who has been training for less than a year can perform large blood vessel surgery. Li Min's current level is invincible in the entire region. Even Director Peng can't catch up with his level. Is this guy Li Min from Guandu Hospital? Director Peng and Director Zhang had to look up and re-examine Dr. Li in front of them. He even suspected that he was possessed by the God of Medicine.

"Director Peng - cut the thread!" Li Min reminded Director Peng who was distracted. Director Peng woke up immediately and continued to cut the thread with his head down.

In fact, in Li Min's eyes, Director Peng's thread cutting action and effect were unqualified. Some were too long, and some were too short. Too long threads left more foreign matter, and too short threads were easy to loosen. Qualified and standardized actions are not for good looks, but large sample statistics show that before new methods and standards appear, doing so can guarantee the best results.

Compared with the neat sutures sutured by Li Min, the uneven thread ends left by Director Peng are very conspicuous. Director Peng himself is very ashamed. Decades of surgical experience accumulation have been defeated by less than a year of training. Even now in his fifties, Director Peng still has the idea of ​​going out for further study. After all, there is no end to technology.

The whole process was very smooth. The long longitudinal laceration was sutured by Li Min. Now Li Min had to deal with the irregular laceration. He frowned slightly. In fact, he had already planned it in his mind. Foresight and planning are essential qualities for surgeons. Even if they encounter unexpected dangers, they should not be led by the condition. Try to think ahead of the condition, so that they have more initiative.

It was Li Min's plan to cut off this part of the invaded blood vessels and discard them, and then suture them end to end. This can not only ensure postoperative safety, but also allow the tumor blood vessels to be separated from the aorta. Of course, after cutting off a part, the aorta can still be anastomosed without tension. This is what Li Min calculated.

The length of a person's abdominal aorta is related to height. The length of the abdominal aorta can be calculated from the height, and then removing a few parts of the blood vessels can still be sutured without tension. These data are not only memorized, but also trained many times in practice, so Li Min has a good idea.

Director Zhang, who was just shocked by Li Min's surgical level, didn't believe that this was Li Min from Guandu Hospital. This was completely possessed by the god of medicine.