"Pretty confident! To test you, where should the wound of this endoscopic surgery be chosen? ”

When Director Shang asked this, his eyes naturally looked at the patient's abdomen.

"If you're doing laparoscopic surgery, you're going to have to poke two holes in the area you're looking at. Only patients with medium-stage gastric cancer should consider this surgical modality. This patient is currently in the early stage of stomach cancer, and I think the endoscope can be done by entering the nose end. ”

Zhou Can has done so many endoscopic surgeries, but it was not done in vain.

It's such a small problem, Director Shang still has to test him.

It's just to give him points!

"Okay, it seems that you have indeed mastered the surgical method, and this operation will be handed over to you."

Director Shang only gave him a symbolic test, and then agreed to hand over the operation to him.

It feels more like deliberately releasing water.

In order to have an explanation in front of other doctors.

There are many doctors under Director Shang, and he has always advocated the principle of fair competition, and whoever is excellent will be allowed to be promoted.

Zhou Can wants to preside over this endoscopic operation alone, but his qualifications are actually insufficient.

If Director Shang agrees directly, then the other doctors in the group can only nod and agree to the next time they want to fight for the opportunity to operate.

Therefore, he deliberately set a threshold in order to gag other people's mouths.

After Zhou Can got Director Shang's consent, he was overjoyed, and the opportunity to pick up experience points came.

This surgery will definitely allow him to earn a lot of surgical experience.

An endoscope is inserted from the patient's nose and then through the esophagus and into the stomach.

[Implantation XP +1.]

It was not the first time he had operated from the nasal cavity to the stomach, so he had only earned 1 point of experience in insertion.

The whole operation process is also very skillful.

Manipulating the endoscope, it went straight to the cancerous part of the stomach.

It took almost no effort to find the cancerous site easily. The seemingly simple operation is completely one minute on the stage and ten years of work off the stage.

In addition to practicing endoscopic skills, he also needs to do his homework before surgery.

As for the cancerous site, he has already deeply remembered it in his mind.

At this moment, the operation can go straight to Huang Ting, which is extremely smooth.

After discovering the cancerous site, it was not directly controlled to cut the endoscope by dividing it by dividing it by two. Endoscopic surgery for stomach cancer is not that simple.

I saw that Zhou Can first manipulated the endoscope to mark the resection range around the cancer.

It can be understood as drawing a circle before fighting.

lest you accidentally hurt other places after the fight starts.

After the resection area is marked, normal saline is injected into the bottom of the cancer base.

What for?

In order to float the part of the mucosa that needs to be removed.

These valuable surgical skills and experience are all summed up by foreign predecessors after they have wasted the stomachs of countless patients.

The predecessors planted trees, and the descendants enjoyed the coolness.

Zhou Can learned these skills and used them all in actual surgery.

Strive to minimize the harm to patients.

After the normal saline was almost injected and the gastric mucosa under the base of the cancer fully floated, Zhou Can proceeded to the third step.

The endoscopic scalpel is operated to cut a complete circular tangent line along the marked excision circle.

If the stomach cancer is not round, the removed circle can also be of a different shape.

It doesn't have to be round.

In general, stomach cancer tends to grow in clusters in the early, and even mid, and late stages. It is mainly round.

Zhou Can marked a circle at the moment.

Stomach cancer is trapped.

As soon as the scalpel cut down, blood came out of the cut wound. Zhou Can did not hurry to stop the bleeding of the patient.

Until the circular cut is completed along the marked tangent.

At this time, the entire stomach cancer is removed along with the cancer base.

It must be noted that the cancerous area after resection needs to be removed. Take it out of the nasal cavity, it won't work at all, because the nasal cavity is too small.

In this case, removing the cancerous area from the patient's mouth is the best option.

During the procedure, the patient is under general anesthesia.

Generally keep their mouths closed.

This requires the patient's mouth to be pried open with a crowbar. In addition, care must be taken when removing the cancerous part that has been cut out. The patient cannot be suffocated to death.

Zhou Can's operation is very skilled, and naturally there is no way to suffocate the patient.

The cancerous area is removed smoothly and then sent for testing after the surgery is over. The nature of the tumour and whether the margins are clear, can be further clarified.

In the process of removing the cancerous area, more normal tissue is usually removed.

Even so, there is still a possibility that the cut will not be clean.

Cancer cells can sometimes infiltrate surrounding organs or tissues, and can easily spread to other areas along the lymph and blood vessels.

It is very necessary to do pathological tests after surgery.

After Zhou Can successfully removed the stomach cancer, the patient's stomach was examined. Cleaning was done.

At this point, the operation is over.

If, after a period of time, the examination reveals that a new tumor has grown at the excision site or elsewhere, or if it has become cancerous, then a second or even a third surgery is required.

In general, when multiple surgeries are required, the treatment results are often poor.

Because the cancer tumor returns, it means that the cancer cells have spread to other parts of the body. The scary thing about cancer is that they are like weeds and have extremely tenacious vitality.

The more they are removed, the faster the cancer cells will grow.

And if one is cut off, cancer will grow in many other parts at the same time. It's like opening a terrible Pandora's box. In the end, the more the cancer is cut, the more the cancer spreads faster, and the patient dies very quickly.

This is why when doctors find out that cancer cells are likely to spread, they regret that they can't do any more surgery.

Only interventional therapy, radiotherapy, or chemotherapy can be chosen.

Either way, the treatment is a drug that kills or inhibits the cancer cells. At this point, it can basically only prolong the life of the patient, and there is no way to cure it.

For stage II or even stage III gastric cancer, as long as it is actively treated, the five-year survival rate can basically reach about 60%.

Many people don't understand why they have to endure great pain and spend huge amounts of money on treatment when they know that the cancer has spread. Does this dying throb make sense?

The answer is meaningful.

Not only can it provide doctors with more clinical trial data, but it is more likely to wait until new drugs come out and then completely cure cancer.

In this era of rapid development of science and technology, everything is possible.

Every year, a large number of new cancer treatment drugs are introduced, and they specifically target a certain type of cancer. Some lucky cancer patients have really succeeded in overcoming the disease and recovered after using the new medicine.

After Zhou Can successfully removed the patient's stomach cancer, he earned a 100-point experience point reward for incision and a 100-point experience point reward for dissection.

This made him very satisfied.

Endoscopic surgery has always been his favorite.

Because of endoscopic surgery, it is easier to get a high experience point reward from the system.

At present, his incision and separation techniques are moving towards the fifth level, and the anastomosis is much behind, and it is only at the inferior level of the main rule.

"Director Shang, do you think there is anything else that needs to be improved? If not, I'll remove the endoscope. ”

After Zhou Can finished the operation, he asked Director Shang for instructions.

"Well, the operation is very good, remove the endoscope and get ready to send the person to the recovery room to wake up! Can the patient's post-operative medical orders be completed independently? ”

Director Shang asked Zhou Can.

"You can give it a try, but I'll need you to check it for me."

Zhou Can has never independently completed the postoperative medical orders of gastric cancer patients.

Since Director Shang gave him this place to exercise, he was not polite. Try to prescribe a series of medical orders to the patient.

Director Shang checked on him and corrected some mistakes and omissions.

Eventually, a complete and correct medical order was issued.

[Pharmacological Pattern Differentiation Experience Value+1.]

[If you complete the postoperative order for gastric cancer for the first time, you will be rewarded with pharmacological pattern differentiation experience points +100.]

I really didn't expect that after the operation was completed, I also earned 100 additional experience points as a reward.

It is also a very difficult to upgrade pharmacological pattern differentiation experience points.

This made Zhou Can seem to see a broad road to rapidly upgrade pharmacological differentiation.

His pharmacological differentiation is currently at the middle level of a resident, and his current experience value: level 3 705/1000, after increasing this 101 experience points, he is directly promoted to the excellent level of a resident. Two more of these great rewards, and you will be able to rise to the main level in no time.

"It's so cool to earn medical experience points in internal medicine."

Zhou Can smiled happily.

This operation is over, and Director Shang still has two more surgeries to do.

This time it was a 42-year-old male patient with an intestinal tumor.

Seeing Zhou Can's eyes again, he was greedy again.

He did very little bowel endoscopic surgery, and this surgery was a very good opportunity to exercise.

However, he has always been cautious and did not rush to the opportunity for surgery.

Instead, he carefully took the patient's examination data and looked at it to make sure that he was sure, and then said to Director Shang with a shy face, "Director Shang, if I want to fight for this operation, will you scold me for being insatiable?" ”

"Hmph, you kid is quite self-aware."

Director Shang snorted, although there was no expression on his face, there was a hint of a smile in his eyes when he looked at Zhou Can.

What kind of person is Zhou Can, a person who robbed surgery and had a thicker skin than the city wall.

In the past, even people as strict as Dr. Xu couldn't do anything about him.

Director Shang is only afraid that he will be even more unruly.

"Just now I carefully looked at the size and location of the patient's tumor, and I have done colon cancer surgery in both digestive surgery and general surgery. I'm sure I'll do this well, can you let me take care of your worries? ”

Zhou Can asked with a blank look.

"Are you sure?"

Director Shang stared at him with a serious expression.

Huang Xinggui secretly scolded this Gui Peisheng for being too shameless, and snatched one after another for surgical exercises.

It's just that his surgical ability as the attending physician is not as good as this regular trainee.

Huang Xinggui was not sure that these two operations would be completed.

Therefore, he could only watch Zhou Can grab the opportunity for surgery, and he was helpless at all.

If you don't have that ability, it's smartest to just stay around and watch. If you don't have the ability to snatch the opportunity for surgery, and if you mess up, you will not only destroy the credit that has been built up in the eyes of the senior doctor, but also your character.

It will be very difficult to try to have surgery in the future.

So, Dr. Huang Xinggui could only watch from the side.

As for the three graduate students led by Director Shang, they want to start endoscopic surgery on patients now, but they want to eat fart.

First learn the four major punctures honestly, and then practice the basic surgical skills well, and then think about other things.

"Without diamonds, I don't dare to work on porcelain. I don't dare to say that I am completely sure, at least I am very sure that I dare to ask you to fight. ”

Zhou Can looked at Director Shang seriously.

"Okay, let's go!"

Director Shang was happy. As long as his doctors really have this ability, it is too late for him to be happy.

It is also happy to leave the opportunity to exercise to young people.

……

In the morning, a total of three endoscopic surgeries were performed.

It is not a minor operation, and the technical difficulty has its own emphasis.

Zhou Can won the opportunity to perform two complete endoscopic surgeries and prescribed three complete postoperative medical orders. Of course, they were all opened under the one-on-one guidance of Director Shang.

Even so, he still feels that the gain is huge.

There has been some progress in pharmacological differentiation and postoperative medication. After issuing the third doctor's order, he even received a 10-point pharmacological pattern differentiation experience point reward.

He also won part of the surgical task for the third operation.

Among them, there was a difficult matching task, and he was not sure to do it well, so he honestly watched Director Shang do it.

After all, the patient with jejunum-toesophageal anastomotic leakage made a deep impression on him.

Before his anastomosis technique was promoted to level five, it was better to honestly admit it when encountering such a difficult anastomosis task, so as not to harm the patient.

It was past 12 o'clock at noon after the operation, and Director Shang was very generous and ordered meals for all the doctors and nurses involved in the operation.

Everyone ate together and discussed some problems during the operation, but they also had a good time.

Zhou Can completely let Director Shang and others know his surgical strength through three endoscopic surgeries in the morning. Director Shang's mood seemed to be quite good, and a smile appeared on his face from time to time.

If you recruit such an excellent trainee, you will be able to have a right-hand man in the next two or three months, and you will be happy to be replaced by any chief physician.

After all, for the attending physician and chief physician, interns, trainees, and advanced trainees are all free helpers.

After eating, back in the office, Zhou Can turned on the computer and prepared to complete the patient's medical records.

By the way, I also checked the treatment status of the seven patients in my management and the results of the new examination.

"The patient in bed 79 was indeed a portal vein embolism."

After checking the results of the female lawyer in bed 79, he breathed a sigh of relief. The true cause of the patient has finally arrived. It is a chronic thrombosis of the portal vein, along with splenic vein embolism.

[Diagnosis XP +1.]

[If you successfully diagnose a hidden and difficult case, you will be rewarded with +100 experience points for pathological diagnosis.]

After successfully reaping another 100 experience points and a pathological diagnosis, he couldn't help but grin with a happy smile like never before.

Internal medicine is truly a blessed place for him.

All kinds of medical skills that could not be promoted in surgery, after entering the internal medicine department, began to be promoted rapidly.

At this rate, it is not a dream to upgrade the two most important medical skills, pathology and pharmacology, to level 5 within a year.

If by the end of his three-year training, all his important medical skills had been upgraded to level five, it would be unimaginable.

When the time comes, his return to the emergency department will definitely be the return of the king, and it will bring a huge surprise to Dr. Xu and Director Lou.

If you want to help the emergency department grow in a short period of time by yourself, you must have excellent skills. It is best to cultivate both internally and externally, and all aspects of medical skills can have quite high attainments.

Only in this way can we quickly open up the situation and gain popularity in a very short period of time.

The true cause of the 79-bed female patient was found and only surgery was required, and it is believed that she will recover soon......

Seeing that the patients under his management have made significant progress in treatment one by one and can return to a healthy state, Zhou Can's heart is full of a sense of accomplishment and expectation.

He grew fond of the profession of a doctor.

The more skills you learn, the more incurable diseases you can solve. For patients, it is undoubtedly a great blessing to have such an excellent doctor as him born and grow rapidly.

For Zhou Can himself, continuing to improve in the medical field is exactly what he wants in life.

The medical community in China also needs talents like him very much to contribute to the medical cause of Huaxia.

……

The days went on like this. A week later, the patient with the esophageal anastomotic fistula and jejunal anastomosis occlusion in bed 71 was able to eat.

For more than half a year, he finally managed to drink his first sip of water.

The surgery was done very successfully.

Not only was the occlusion between the patient's esophagus and jejunum successfully opened, but also the anastomotic leakage was successfully repaired. No more worrying about eating food and escaping all the food out of the fistula.

The patient himself drank the first sip of water and felt the food enter his intestines, and he was so excited that he burst into tears.

Total gastrectomy prevented the cancer from spreading and saved life.

However, because the operation was not done well, it seriously affected the quality of life for the rest of his life.

Now, Tuya Hospital has solved his problem.

The patient's wife also cried tears of joy.

The medical skills of Zhikua Tuya Hospital are exquisite, and it is a living bodhisattva who saves people.

The patient's daughter began to frown for most of the year, and a heartfelt smile appeared on her face. Seeing her old father regain her ability to eat, she told the medical staff and the family members next to her bed that it was like being hit by a pie falling from the sky.

I didn't expect a medical miracle to really happen.

On the same day, she didn't know where to run and ordered a pennant, with eight big characters written on it: 'Helping the world and saving people, with immeasurable merits', and next to it was a line of thanks to Director Shang of Tuya Hospital for his superb medical skills and cured her father.

Another hero in this treatment, Zhou Can, is hidden behind the scenes.

Zhou Can didn't care about this.

(End of chapter)