It wasn't until Zhou Can finished the operation on the patient and sent the patient out of the operating room that Liu Lao said solemnly, "The inpatient department called me just now and said that the patient who had lipoma surgery yesterday had a variety of abnormal symptoms!" ”

Hearing this, Zhou Can's heart chuckled.

You can't hide from what you should have.

When I operated on that patient yesterday, I felt an indescribable sense of crisis.

At that time, Zhou Can was so scared that he was trembling during the whole operation.

Fortunately, everything went smoothly after the surgery.

After getting off work yesterday, Zhou Can was still a little uneasy, so he went to the ward to see a patient. Except for a little pale face and some malaise, all signs were normal.

I didn't expect something to go wrong today.

Zhou Can couldn't help but think of Dr. Xu's reminder before leaving, telling him to be careful of postoperative complications for patients.

Surgeons are actually quite afraid of the term postoperative complications, and take various measures during the operation and practice surgical skills hard to reduce the occurrence of postoperative complications.

"It's time for the lunch break, so I'm going to check on the patient first." Zhou Can said to Liu Lao.

"Let's go together! Patients are likely to have postoperative complications that can be tricky to manage. ”

Mr. Liu has rich experience in diagnosis and treatment.

I know how terrible the complications can be.

"I'm going to buy food for the two teachers!"

Wu Ziyu now regards Zhou Can as a teacher.

In the past two days, she followed Zhou Can and Liu Lao to operate in the operating room, and Zhou Can gave her a lot of guidance. He deserves the title of teacher.

Doctors are sometimes busy and it's easy to miss meals.

If you can't order a meal, you can only eat instant noodles to solve the problem.

"Okay! That's hard work for you. Liu Lao doesn't eat spicy food. ”

Zhou Can's words moved Liu Lao very much.

There was a look of relief on his face, but he didn't speak. Instead, I went into the changing room of the operating room to change clothes.

Normally, doctors are required to wear a lab coat to work outside of the operating room.

Except for disposable surgical gowns, which can be worn out of the operating room, normal surgical gowns are not allowed to be worn out.

Otherwise, the sterile environment in the operating room cannot be effectively guaranteed.

Zhou Can changed into a white coat and rushed to the inpatient ward with Liu Lao.

I saw that the patient who had undergone lipoma removal was still pale and his spirit had improved slightly.

Dr. Bu Shiren, who was in charge of the bed, and an intern, stood in front of the bed, looking more nervous than the patient's family.

This patient is a postoperative patient who Zhou Can specially told to focus on monitoring, and if something goes wrong, Dr. Bu can't make a difference.

"What's wrong with him?"

Zhou Can asked Bu Shiren.

"From about 8 a.m., the patient experienced bloating, nausea, oil aversion, and even vomiting eventually. After finishing, the patient had diarrhea not long ago. The basic signs of body temperature, heart rate, breathing, etc., are relatively normal. ”

Bu Shiren took the initiative to show Zhou Can the measurement record of the ward.

"In addition to the above symptoms, it is also accompanied by general malaise, right?"

"That's right! The patient has been suffering from weakness since the surgery. ”

Bu Shiren's work is quite meticulous.

The answer was also quick.

After Zhou Can understood the patient's situation, he first carried out a series of exclusions.

Did you hurt important nerves and blood vessels?

At that time, the operation was very careful, and Liu Lao was on the side to check it, and if it really hurt important blood vessels or nerves, he would definitely remind him in time.

As it turned out, Zhou Can did not make a mistake during the operation.

The subcutaneous lipatoma removal surgery on the face was done quite well.

Zhou Can decided to start with the symptoms of vomiting, oil aversion, and nausea. There are many reasons for these symptoms. However, he only cut a facial lipoma, and even if there was an accidental injury from surgery, he could roughly lock on a small area for investigation.

All the important nerves and blood vessels were eliminated, and he couldn't help but wonder, did it hurt the patient's throat?

The tumor was indeed quite large, but it did not directly affect the area of the throat during surgery.

Direct injury to the throat is very small.

The last possibility is that the wound develops a hematoma and compresses the throat. As a result, the patient had obvious nausea, anorexia, and vomiting reactions during eating.

Doctors usually use a tongue depressor to press the base of the tongue, which is a relatively common way to induce vomiting.

In fact, you can also press the base of the patient's tongue directly with your fingers.

However, there is a risk of being bitten by doing so.

When the patient finds it unbearable, it is easy to reflexively close the mouth. In this case, it is very easy to bite the doctor's hand. So doctors don't dare to take this risk with their own fingers.

This is where the tongue depressor comes in handy.

If yesterday's surgery caused a certain degree of hematoma in the mouth and irritated the throat, it may really cause the patient to feel nauseous and want to vomit.

Liu Lao was also frowning at the moment, carefully checking the patient's postoperative signs monitoring records.

You want to empirically identify the specific cause of the patient.

Many postoperative complications are caused by inadequate doctor's operation, or postoperative infection, thrombosis, ischemia and necrosis.

It can only be diagnosed comprehensively based on clues and pathological mechanisms.

"Come, open your mouth and let me see!"

Zhou Can said to the patient.

The patient opened his mouth cooperatively, Zhou Can put on a mask, and took out a small flashlight from his pocket as if by magic, and irradiated it into the patient's mouth.

There is a slight blood phenomenon.

However, this level of hematoma is not enough to compress the patient's throat and base of the tongue.

The hematoma causes nausea and vomiting, which can be ruled out.

The patient's larynx appears normal and does not show any lesions. Only on the side that was compressed by the lipoma did a lot of teeth fall out.

The color of the tongue coating is whitish with a dull yellow tinge.

"That's it!"

Zhou Can motioned for the patient to shut up.

I didn't find the answer I was looking for in my mouth. He carefully removed the gauze from the wound on the patient's face. The wound was sutured by his own hands, and a certain degree of flap repair was done.

Nothing out of the ordinary seems to be there.

There is no redness or swelling of the wound caused by infection, and the patient's body temperature is not elevated, which is enough to indicate that the possibility of wound infection is very small.

"It's really weird, the wound is fine, and there is no problem in the mouth. Where would that be the problem? ”

Thinking that the patient also had symptoms of abdominal distention, diarrhea, and general fatigue, Zhou Can began to jump out of the local range of the wound, and according to all the symptoms, a comprehensive diagnosis.

There are too many causes that can cause all of the above symptoms.

For example, the most common colds and food poisoning can cause vomiting, nausea, diarrhea, and malaise.

The human body is like a delicate machine, and any failure of any link may cause serious adverse reactions to the human body.

"He should have had a post-lipoma resection syndrome! The incidence of this disease is as high as 30%, and it can cause patients to have indigestion symptoms such as intractable diarrhea, bloating, nausea, vomiting, and oil aversion, as well as malnutrition symptoms such as general fatigue, paleness, and fatigue. There is currently no effective treatment for this syndrome. ”

After pondering for a long time, Liu Lao made a diagnosis.

"What caused it?"

It was the first time Zhou Can had encountered such a situation.

It is not the first time that a superficial lipoma has been removed, and there has been no postoperative syndrome.

However, this time it was a large lipoma that occurred on the head and face, so the situation was far more complicated than the previous minor surgery.

"The pathological mechanism is not clear, and it may be related to tumor cells. Surgery to remove a large lipoma, or a lipoma in the skull, chest and abdomen, vital organs, or near the collar, is very prone to many adverse symptoms. He has this syndrome, which cannot be avoided, and can only be treated with some corrective treatment. ”

Liu Lao prescribed some medical orders on the spot.

And ask the nurse to draw blood for testing and do a blood routine to avoid misdiagnosis.

After coming out of the ward, Zhou Can and Liu Lao went to eat together.

It's getting closer.

The doctor's job is quite hard, and meals are often not on time. In particular, doctors in the operating room and emergency room, including anesthesiologists.

Sometimes it is common to work for more than ten hours in order to save patients in a row.

This is also the case that many doctors, who obviously studied medicine themselves, eventually found cancer at a young age and in their forties.

Sometimes, these diseases are really abused.

If you don't eat in time after the meal, your stomach and intestines can't stand it, and you are prone to stomach problems and ulcers. Staying up late at night to work, resting poorly, and irregular work and rest are more harmful to the body.

Therefore, being a doctor is a very hard and high-risk job.

"Elder Liu, is the situation of that lipoma patient unavoidable during the operation?"

Zhou Can asked a little unwillingly.

After many careful recalls, there were some areas that could be improved during the operation, but there were no major mistakes.

How did the patient develop the syndrome?

Finding the reason and avoiding it in the future is what Zhou Can wants to do the most.

"Based on my experience in surgery and national and international case reports, this postoperative syndrome cannot be avoided. It has nothing to do with the doctor's technique, but rather with the symptoms caused by the tumor itself. ”

Liu Lao explained to him in a calm tone.

"Wasn't the tumor completely removed? Can you still be weird? ”

Zhou Can was even more puzzled.

His medical knowledge is still shallow, and his diagnosis and treatment experience is not very rich. At least compared to those old doctors who have forty or fifty years of experience, it is far behind.

"Have you heard it all over your body? Isn't there a classic game of dominoes? Drawing one of the dominoes will create a chain reaction that will eventually cause all the dominoes to collapse. ”

Liu Lao gave an example to explain why some postoperative syndromes cannot be avoided.

"That lipoma has grown for many years, and it is even possible that it was born with the patient. It has formed a delicate balance with the patient's body, and to remove it is to break this balance. Therefore, the patient's body will have a series of adverse reactions. You have to remember that when you do any surgery, don't look at the lesion as a superfluous part of your body. ”

"Just like that lipoma, you should think of it as an organ of the body. It can grow so big that it is already an important body organ in the patient's body. ”

Liu Lao's explanation to Zhou Can made him refreshed.

This knowledge is only possible for an extremely experienced veteran expert to comprehend in practice. You can't learn it from books at all.

It is impossible for any medical classics or retrieval to record this kind of theoretical knowledge.

Because it does not conform to the formal content of medicine.

It's like the official history and the wild history, there must be a difference.

Wild history allows readers to learn about some interesting things that cannot be recorded in the official history.

Older medical experts are a living history of medicine.

Many of their theories are not found in medical books, but they have some truth.

And it's real in practice.

"According to you, a mole, a tumor, or an extra finger is an organ of the body. It's just that ordinary people don't have this organ, and it belongs to a unique organ that patients have, is that what it means? ”

Zhou Can has a hint of enlightenment.

Listening to your words is better than reading a book for ten years.

This unique theory that Liu Lao said made him suddenly open his mouth and have a new understanding of the disease.

It's like opening a new window.

"You have a very strong understanding, that's what it means. The extra fingers, even the third hand and the third leg, are easily identified by doctors as an organ in the patient's body. However, a tumor, or an intradermal nevus, is often thought to be just a lesion by doctors. This is a misunderstanding in diagnosis and treatment. ”

Liu Lao smiled and nodded slightly.

"In the future, when you practice medicine independently, you must take this aspect into account. Before cutting a tumor, consider its relationship with the surrounding organs and its effect on the body. This is more helpful in treating the patient's disease correctly. It would be better for this lipoma patient to be transferred to internal medicine in two days. ”

Internal medicine and surgery are two completely different medical departments.

The study of pathology and pharmacology in internal medicine is far superior to that of surgery. The patient who developed postoperative syndrome was transferred to an internal medicine for treatment that was more beneficial to his condition.

It's so novel to treat a tumor as an organ.

Zhou Can quietly pondered the new theory he had learned.

After eating, the two took a short break and walked into the operating room again.

Keep fighting.

It is necessary to eliminate all the surgical patients that have accumulated in the general area as soon as possible.

The crazy surgery started again.

This is a male patient in his thirties with pus in his ear, a mass in the lower back of the mandibular angle, and an increase in secretions in the ear, followed by secondary infection, pain and fever.

Zhou Canshang is the first time he has been exposed to this case.

General surgery is one of the most miscellaneous departments, and any kind of patient can be treated.

"His disease is called a cleft parot fistula, and it requires surgery to remove the fistula to cure it."

Liu Lao explained to Zhou Can, Wu Ziyu and others.

"When diagnosing this disease, patients often feel a rancid taste in their mouths, in addition to pus in their ears and a mass in the lower back of the jaw angle. At the time of surgery, the second, third, and fourth branchial fissure fistulas are found to have a fistula at the anterior border of the sternocleidomastoid muscle. ”

This disease is relatively rare.

Zhou Can carefully observed the patient and understood the patient's condition and symptoms.

Gain experience for future individual consultations.

In fact, before the operation, he has read the examination data of all the patients and understood their condition and cause.

This patient with cleft parot fistula, he also deliberately checked a lot of information and studied it.

"Sometimes, the fistula on the patient's body is so thin that it is as thin as a pinpoint or a small depression that is easy to overlook. Even if you don't squeeze it, there will often be a small amount of discharge there. This is also the reason why patients feel that they have a foul smell in their mouths. ”

Liu Lao continued to explain to them.

The chief surgeon is still Zhou Can, and Liu Lao is guiding beside him.

"In addition to being extra careful during the operation, we should also be careful about the dyspnea caused by the edema of the lateral pharyngeal wall and the parapharyngeal hematoma after surgery, and should be closely observed, and postoperative monitoring and hospitalization management should be done. If a problem is found, it must be dealt with in a timely manner, otherwise it is easy to cause irreparable serious consequences. ”

This irreversible and serious consequence is actually death.

It's just that in front of patients, doctors often speak in a more subtle way.

It's pretty much the same in every industry.

It's like looking for a lawyer to help fight a lawsuit, if the lawyer says that the case can be tried after listening to the cause of the case, the odds of winning are quite high. That's basically winning.

If the lawyer says that the case will be long, then be careful.

Perhaps it is a subtle reminder that the success rate of this case is not high. If you really want to fight, most of them will lose.

When doctors speak to their patients, they are more subtle than lawyers.

For example, after the physical examination, his brows were furrowed, "Be careful of this situation, the situation is not good, it is very bad." "Most of them are malignant tumors or other terminal diseases.

At this time, as long as there is still a chance for surgery, or the opportunity for treatment has not been missed, then treat it quickly.

If you drag it out any longer, it's mostly cool.

Zhou Can is already helping the anesthesiologist to perform anesthesia surgery on the patient.

Soon, the anesthesia was successfully administered.

Zhou Can earned another 1 anesthesia experience point.

Compared with the 100 experience point reward, only 1 point is earned at a time, which makes Zhou Can somewhat dissatisfied. However, he also understands that there aren't many opportunities to reward 100 XP.

It's good to catch it once or twice a day.

Anesthesia wants to get this kind of reward, and it is even more rare.

Maybe in the future, if you enter the anesthesiology department for a month or two, and follow Dr. Xu, you can have a better chance of getting this 100 anesthesia experience point reward.

Surgeons need to go to the anesthesiology department for at least one month, which is to let doctors deeply learn anesthesia knowledge and understand the whole process of anesthesia surgery and precautions.

In particular, the practical experience of anesthesiologists in supporting and guaranteeing patients' vital signs is worth learning.

In terms of life support, if the Department of Intensive Care Medicine really wants to go back to its ancestors, the Department of Anesthesiology is its master.

(End of chapter)