The preoperative discussion system is one of the routine systems in hospitals, but most hospitals have not formalized it very seriously.

It is true that conventional surgery is not necessary, but Professor Min pays more attention to teaching, so the preoperative discussion on Tuesday and Thursday is a must. Originally, according to the regulations, the operation on Monday should be discussed before surgery on the weekend.

However, because it is a weekend, Professor Min usually only arranges some routine surgeries on Mondays.

For Wednesday's surgery, four have been confirmed. Another one has not yet been confirmed.

17 beds, right shoulder arthroscopy + rotator cuff suture.

21 beds, left total knee arthroplasty.

26 beds, right total hip arthroplasty.

31 beds, left knee arthroscopy + left knee disc-shaped meniscus suture.

The four surgeries are all common surgeries in the four wards of orthopedics, and there is not much to talk about.

After the five junior doctors arrived, Professor Min said directly.

"Today we are mainly going to discuss whether we will have left total hip replacement surgery tomorrow in the second bed. ”

"This patient is a bit special, so I want to hear what everyone means. "Professor Min is a very straightforward person, he usually makes decisions directly, but when he encounters different opinions, he will take the form of discussion, thoroughly analyze the condition, and then make a decision.

"Zhuoyuan, you report your medical history again. Let's look at this patient's condition in detail. ”

Straight to the point!

It's surgical.

Zhuo Yuan should have been informed that he would focus on the 2nd bed in the afternoon, so he printed out a total of nine copies of the medical records and placed them in front of everyone.

Zhuo Yuan began to summarize the medical records: "Professor Min, Professor Zhu, Brother You, Brother Hui, Brother Shi Ding." ”

"And the students and teachers, I have copied the medical records of the two beds in front of you in detail. ”

"First, let me give you a brief introduction. ”

"Patient characteristics: youth, female. ”

"Clinical manifestations: pain in both hips for 5 years, exacerbation with gait abnormalities for 1 year. ”

"Aggravating mitigating factors: pain worsening after walking, pain relieved by rest or taking pain medication. The patient had a history of oral hormonal drugs for 10 years, had worsened pain in the past three years, and had stopped taking hormonal drugs for 3 months. ”

"After a secondary bleeding of the gums and purpura of the skin, he continued oral hormone therapy after a visit to the hematology department of the local hospital. At present, the drug has been discontinued for 1 week, and immunoglobulin and TPO (platelet-stimulating factor) treatment have been given after admission. ”

"Physical examination: bilateral straight leg raise test (+), anterior hip tenderness, positive Thomas sign......"

"Plain pelvic radiograph: showing bilateral femoral head necrosis. ”

"The current diagnosis is clear: bilateral femoral head necrosis; ”

"Special examination data: platelet 17 at the time of admission, that is, immunoglobulin and TPO treatment, the blood draw results have been reported at 11 o'clock this morning, platelets have risen slightly, 25. It is considered to be a contraindication to the current surgery. ”

Speaking of which, Senior Brother Zhuo Yuan has almost finished summarizing the medical records.

He continued: "I have looked up the relevant literature, and it has been documented that the minimum number of platelets that have undergone joint replacement is 34. However, patients were treated with high-dose immunoglobulin HDIvIg before surgery, and platelets were recommended to rise to more than 70. Surgery is performed. ”

"At present, the patient has been on immunoglobulin for 3 days, and the platelet increase is not high, and it will take a long time to reach the level recommended by the article, and it may be better to be transferred to the hematology department. ”

"The same is true for the opinion of the hematology consultation. ”

Senior Brother Zhuoyuan put the medical records on the folder.

There is reason and evidence, there is theoretical support, and there is the support of the current cutting-edge articles, and the two eldest brothers who are studying for a while are impressed, but they are a little confused.

Originally, this kind of thrombocytopenia joint replacement surgery is not in the current Huaguo orthopedic surgery guidelines, and it is strange for them to know.

And another girl from the burn department, who is almost separated from the orthopedic department, is even more ignorant.

The literature that Senior Brother Zhuoyuan checked can be found by people.

Professor Min still said to Liu Zhi and Kwong Renqiang: "What do Dr. Liu and Dr. Kwong think about this case?"

Liu Zhi and Kuang Renqiang shook their heads almost at the same time and smiled bitterly: "Professor Min, we ......"

In my heart, I said, let's come here to learn surgery.

What the hell is this?

Let's go to the operating table.

Professor Min naturally didn't embarrass the two of them, and looked at Shi Ding and Chen Hui.

Chen Hui and Shi Ding are both doctors in this hospital, Shi Ding is the boss, and Chen Hui is the rear boss.

When the two of them saw Professor Min shift his gaze, they both said, "Professor Min, I think this patient is still discharged from the hospital, and at this current physical level, he may not be able to withstand the operation." Bleeding during or after surgery is a very troublesome thing. ”

"And just now Zhuo Yuan also mentioned the support in the literature, at least to reach 75 or more, and the 45 mentioned by the hematology department may only be the critical value of surgery. However, our joint surgery has relatively high requirements for various conditions, so ......"

Professor Min nodded.

Hematology says 45 and the literature says 75, which is not to say that whoever is right is wrong.

Hematology doctors are not surgical, and if you ask them to evaluate the indications for surgery, they can only evaluate according to the experience of the whole major surgery, and it is relatively normal for them to have errors.

Then, it's Lin You.

However, Professor Min skipped Lin You first, and directly saw Zhu Queguang's body: "Little Sparrow?"

Zhu Queguang said helplessly: "Professor Min, don't make fun of me, you should know that I know relatively little about scientific research and articles, and I am studying arthroscopy-related literature recently." ”

Although Suzaku is an associate professor, he is very skilled.

But to be honest, his understanding of such a scientific research frontier is really very limited, when he was studying for a doctorate, China has not paid so much attention to scientific research for the time being, and now how to improve the level, he has to follow up later, otherwise don't think about promotion.

But his surgical level is also first-class in the country.

Professor Min said, "Do you think that letting us engage in articles and scientific research is completely superfluous?"

"You know, we're a teaching hospital. ”

"Teaching hospitals naturally have to put a lot of effort into teaching. ”

"If you always teach surgery. ”

"How many can you learn in one operation?"

"And one of the surgeries you know can teach 100 percent to other people?"

"Ten years ago, if you continue to use it ten years later, you are not afraid of being poked in the back?"

"Isn't our current surgery necessarily the most perfect?"

"Is there anything that needs to be improved in our surgery? Is there anything that can be simplified? What are the places that are in the process of promotion, are the difficulties, are the key points, and how should they be simplified?"

"How many surgeries can we have in our lifetime?"

“2w？4w？”

"Let's not talk about the whole country, how many patients are there in our province? ”

"Then we must take on the heavy responsibility of teaching, since we are teaching, we must move forward, and we cannot turn back. ”

"If no one innovates in this operation, and no one innovates in that operation, then we are finished. ”

"The number of surgeries will always only improve proficiency, and it is the lower limit of surgery that determines it, and only reading, only by really innovating and improving the surgery, is the key to determining your surgery. ”

"Twenty years ago, some people thought that BB machines were the most convenient way to transfer information. ”

"Ten years ago, someone said that mobile phones had made their way into every home. ”

"Seven or eight years ago, smartphones replaced hard-shell phones. ”

"Five years ago, 4G almost completely replaced 3G. ”

"Do you still think that our current surgery, the research we have done, is useless?"