Anesthesiologist Ziqu and anesthesiologist Qin Yue walked into the operating room together.

Although the reform of the anesthesiology department is still in the trial stage, the two of them have basically tied up with Zhou Can.

In other words, as long as there is anesthesia surgery in the emergency department now, both of them will be given priority.

In the operating room of the emergency department, Dr. Xu basically has the final say.

Dr. Xu regards Zhou Can as his successor, and basically all affairs are centered on Zhou Can.

Zhou Can and Ziqu reached a consensus and formed a pair, and Dr. Xu's attitude towards this matter was acquiescence and support. As long as there is anesthesia surgery, he now directly asks Ziqu for help.

"What's wrong with this patient?"

Zhou Can asked Ziqu.

The anesthesiologist must have had a detailed understanding of the patient's condition, physical condition, history of drug allergies, etc. Before the operation, you also need to talk to the family and sign the informed consent form for anesthesia.

Usually, the anesthesiologist and surgeon discuss the patient's condition and determine the surgical plan.

Zhou Can is too busy today.

It is estimated that Dr. Xu will draw up the surgical plan with Ziqu instead of him.

"The patient had a refractory duodenal ulcer with particularly high stomach acid. It is estimated that the burn made her uncomfortable. In addition, she is generally allergic to proton pump inhibitors, and her constitution is quite special, and she can only undergo surgery. ”

If the stomach acid is too high, it will burn the mucosa and stomach wall, and the duodenal mucosa and intestinal wall. The most common symptoms are heartburn, stomach pain, discomfort, nausea, loss of appetite, etc.

Duodenal ulcers, if not for a particular cause, tend to be relatively easy to heal.

However, there are also a small number of patients who have repeated ulcers and cannot be cured.

At this time, it is necessary to further investigate the cause of duodenal ulcer.

Western medicine is just this point, Niu B, whatever is not good, I will treat you wherever it is.

High blood pressure, blood pressure can be lowered quickly after the use of antihypertensive drugs. Respiratory failure, go straight to the ventilator. The blood vessel burst, and the blood vessel was immediately operated to stop the bleeding and repair the blood vessel.

In short, as long as the cause is found, Western medicine can always think of a solution.

Even a terminal disease such as cancer has been overcome in many ways. And it's still improving.

With current technology, as long as it can be detected at an early stage of cancer, it is usually possible to achieve a very satisfactory treatment effect.

"High stomach acid is often associated with excessive secretion of stomach acid. Is it time to have surgery to reduce her stomach acid secretion? ”

"Not bad!"

Dr. Koh walked in.

"What do you think is the best surgical option?"

Dr. Xu should not only test him, but also listen to Zhou Can's surgical opinions.

Now Zhou Can can give unique insights in many surgeries, and even some novel surgical plans.

"Uh...... If it is a recalcitrant duodenal ulcer and it is caused by high stomach acid, I think cutting the vagus nerve is a good option. ”

After thinking about it carefully, he gave an opinion on the operation according to the actual situation of the patient.

"That's right, your current surgical ability and surgical ideas are getting better and better."

Dr. Koh was full of appreciation.

His surgical plan is likely to be the same as Zhou's.

It is also the most common surgical option used to treat this condition.

Of course, it must not be rigid, it must be based on the actual situation of the patient.

The purpose of cutting the vagus nerve trunk is to block the gastric acid secretion caused by the vagus nerve and reduce the amount of gastric acid, so as to achieve the purpose of healing duodenal ulcer.

It must be noted that cutting the vagus nerve trunk is only a forced surgical option, and it will cause a series of side effects when it is severed.

For example, the vagus nerve has a branchic acid effect on the muscles of the stomach wall.

After cutting it off, it can no longer innervate the stomach wall muscles, which will cause the stomach wall muscles to contract, expand, and peristalsis, and all these functions are lost.

The stomach is an important digestive organ in the human body, and it is also an important organ for storing food.

Its role is self-evident to the body and can be called a 'granary'.

When it loses several of the above functions, a variety of adverse reactions occur.

For example, patients may have severe gastric emptying disorders and food retention.

Because the side effects of this surgery are too great, it is basically not used clinically.

Gastric acid secretion is excessive, and it is now mainly treated with gastric acid suppressant drugs in clinical practice. Proton pump inhibitors and H2 receptor blockers are the two major classes of drugs that are most commonly used.

Omeprazole, rabeprazole, lansoprazole, etc., are all commonly used drugs in clinical practice.

They are quite effective at suppressing gastric acid secretion.

However, if you encounter such patients who are allergic to such drugs, or have a special constitution that does not absorb them, you can only think of other ways.

Cutting the gastrovagus nerve is very appropriate for the patient at the moment.

After the patient is anesthetized, the urethral catheter is intubated and the operation is officially started.

Because the operation was quite large, Dr. Xu was somewhat uneasy and worked as an assistant to Zhou Can on the side.

He now rarely instructed Zhou Can on the specific surgical steps, just pure skimming. Let Zhou Can deal with it himself as much as possible.

After opening the abdominal cavity, the abdominal wall is pulled apart with an automatic hook retractor.

The ulcer site is then explored.

Once the location has been determined, preparations can be made for the next step of the amputation surgery.

This patient's duodenal ulcer is quite severe.

No wonder when I pulled it in for surgery, I kept humming.

The pain and discomfort of the human body is not unbearable only when giving birth.

Trigeminal neuralgia, for example, is the highest level of pain recognized in medicine. Or when the airway is blocked by more than a third, the pain caused by the feeling of suffocation is also severe.

This patient's duodenal ulcer is like this, but it is not perforated, and it is strange that he does not hum.

Stomach acid is much more corrosive than you think.

It can easily drain the stomach, duodenum, pylorus, and all of them.

The power is not weaker than that of ordinary strong acids.

"Yang Zhi, Dingdong, when you do this kind of surgery, you should pay attention to the location of cutting the gastric vagus nerve above the junction of the esophagus and the stomach. Otherwise, the desired surgical effect will not be achieved. ”

Zhou Can explained the essentials of surgery to the two.

He also learned some surgical skills and key points from the codex of Deputy Director Liu of the Department of General Surgery.

After determining the location, Zhou Can began to quickly free the left lobe of the liver.

The deltoid ligament was cut directly, and then Yang Zhi was instructed to pull the patient's left lobe of the liver to the upper right, and at this time, the lower esophagus and cardia were all exposed to the surgical field.

He quickly cut the serous membrane of the lower esophagus and the cardia, separated the upper part of the hepatogastric ligament, and cut it directly.

All the movements were unusually fast, and it was a complete pleasure for onlookers to watch him undergo surgery.

Immediately after, the lower esophagus is released.

He reached out and touched the anterior wall of his esophagus, looking for the vagus nerve.

In medical books, blood vessels are usually marked in red, and nerves are marked in yellow.

However, in actual surgery, the color of the nerve is often not much different from the surrounding tissue, and the surgeon needs to have rich surgical experience and touch it directly with his hands to find it.

Zhou Can quickly felt a nerve in the left front of his esophagus.

It is the left vagus nerve.

He felt again on the right back of his esophagus and determined where the right vagus nerve was located.

At this time, I already have a bottom in my heart.

"There are two left and right vagus nerves in this area, so you must pay attention to confirm them during surgery."

After the two of them have their hands cleaned, put on sterile gloves and touch the patient's esophagus and surrounding tissues to look for the vagus nerve.

Hands-on experience is invaluable.

When some surgeons take students, they don't want to make extraneous branches, let alone waste time, so they basically just point to the corresponding anatomical parts while performing the operation, and never let the doctors under them get started.

Think about it, can the students brought out in this way be amazing?

Many surgical residents who have been working for several years even act like novices when it comes to surgical dissection. It's not necessarily that they don't study hard, but that the teachers don't teach well.

Too few opportunities are given for practice.

"I feel like I feel it, it feels very special, like a fiber belt."

Yang Zhi was the first to touch the vagus nerve.

After touching the suspicious part, he immediately asked Zhou Can for verification.

"Dingdong, you can also touch it."

Zhou Can said to Pu Dingdong.

In terms of talent, Pu Dingdong is also not bad, and he is more pragmatic and meticulous than Yang Zhi.

For the two medical assistants under him, Zhou Can is quite satisfied.

Both of them usually perform very well.

After Pu Baodong touched it for a while, he felt out the left and right vagus nerves. He also carefully identified it with the naked eye.

"Alright, let's see how I remove the vagus nerve."

Zhou Can carefully separated the vagus nerve from the esophagus.

Then he instructed Yang Zhi to pick up the nerves with a nerve hook.

Then proceed to separate this nerve with scissors.

Not with a knife, but with scissors.

After the length of five or six centimeters has been separated, the gastric vagus trunk can be removed.

The length of the excision should not be too short, and it is generally required to cut off two or three centimeters of length. The removal of the other vagus nerve trunk is also a similar technique.

At this point, the gastric vagus nerve trunk has been removed.

"Xiao Zhou, after cutting the patient's gastric vagus nerve trunk, the food in the stomach is easy to retain, do you have a good way to solve it?"

Dr. Hui had been watching from the sidelines and was not easily distracted.

Now that the surgery is almost complete, he brought up the issue of solving the postoperative side effects.

"Doing pyloroplasty should be able to solve the problem of retention of stomach contents."

Zhou Can has long mastered the solution.

"It seems that you are very careful in general surgery, so hurry up and do it!"

Dr. Koh was satisfied with his answer.

Zhou Can did no longer delay and performed a pylorus surgery on the patient.

In addition, after cutting the vagus nerve, he also performed sutures on both diaphragms to repair the diaphragm hiatus. This is done to prevent the formation of a diaphragmatic hernia.

During the suturing of the diaphragm, it is quite difficult to suture the diaphragm feet on both sides after bringing them closer together.

The requirements for sutures and ligations are high.

He also earned a lot of experience points for suturing and ligation.

Each time you ligature, you'll be rewarded with a lot of Ligation XP. He worked extremely hard to earn as much ligation experience as possible.

After the operation, his ligation experience points rose to more than 94,000, which was very close to 100,000 experience points.

Under normal circumstances, he would need to ligate the patient about 6,000 more times before he can successfully advance.

However, if he can encounter some surgical tasks such as suturing the peritoneum and meninges, or some surgical sites with extremely high ligation requirements, it will definitely greatly shorten his promotion time.

At the end of the day, it's still necessary to do more of this kind of major surgery, and difficult surgeries can have a chance to earn a large amount of experience point rewards.

"Dingdong, you come and close the abdominal cavity for the patient!"

Yang Zhi's level of closing the abdominal cavity is already very high now.

His own surgical level is not bad, and after following Zhou Can for so long, all kinds of exercise opportunities are soft. Surgical capabilities are also springing up.

Pu Dingdong's surgical ability is relatively poor.

Zhou Can treats the training of every doctor under him equally.

There is no such thing as favoritism.

Dr. Xu saw that the surgery had entered the final stage, so he was relieved to go out.

"Doctor Zhou, should we wait for Dr. Pu to finish sewing up the abdominal cavity, or do we change the table for surgery?"

"You and Qiao Yu go to another operating room to set up a table, I'll keep an eye on it for a while."

"Okay!"

Ma Xiaolan and Qiao Yu went to another operating room to lay the table.

Generally, in the afternoon, Zhou Can is the busiest person in the emergency operating room.

Anyway, Dr. Xu works unhurriedly every day, and other surgeons, only those who are a little stronger are qualified to enter this 100-level operating room for surgery. Those who are a little worse are basically operated on in the old operating room.

Therefore, the operating table in the 100-level operating room, as long as it is in the afternoon, will basically come out with an empty table.

Zhou Can watched Pu Dingdong suture the patient's abdominal cavity, but he didn't have anything to worry about.

Pu Dingdong's stitching level is quite good, and he is very serious about his work.

The abdominal anatomy of this patient was done by Zhou Can, the incision was flat, and the difficulty of suturing was much lower.

The inner and outer layers are relatively easy to suture.

He watched, and his mind gradually drifted to the patient who had come to him from the magic capital to treat his illness.

That patient had a tear zone of aortic dissection that was too long.

It's hard to think of anything other than to replace the aorta.

But the vagus nerve removal operation in the stomach just now gave him some inspiration.

When the vagus nerve is severed, it is necessary to cut it from the cephalic trunk in order to achieve the desired therapeutic effect.

In order to solve the problem of gastric content retention, pylorus plasty is performed.

It is equivalent to doing treatment at the bottom of the stomach to solve the problem.

So, can the patient with aortic dissection also find a way from the end of the aorta?

Blood vessels work very differently from nerves.

Nerves mainly conduct bioelectric signals.

This electrical signal is very complex.

If the circuit is wrong, it may directly cause a short circuit or other unpredictable problems.

Each nerve conducts a different electrical signal.

They form complex neural instructions.

But the blood vessels are different, and the blood in the blood vessels is no different.

The skin of the head and the blood on the soles of the feet are interoperable.

The blood of the human body itself is constantly circulating.

As long as you don't confuse arteries with venous blood, you'll be fine.

He seemed to have seized the slightest opportunity.

Find a way from the end of the aorta while arterial blood is universal throughout the body.

A bypass may be a very good idea, but it's a bit crazy.

In the treatment of heart disease, bypass is sometimes used.

This is not a new idea.

But from the end of the aorta, the bypass to transport the blood back to the upper end is quite innovative.

The diseased aortic vascular segment is long, which involves at least four or more arterial vascular branches. Those branches of blood are supplied to vital organs or other vital parts of the body.

Cutting them off doesn't work, and finding a way to get the blood back from the end of the aorta and anastomosis with these branch blood vessels to form a new blood circulation pathway may be a completely new surgical idea.

(End of chapter)