After figuring out the patient's stomach condition, Zhou Can had a bottom in his heart.

"Please show me the patient's preoperative esophagram again."

He wants to take this opportunity to give the patient a gastroscopy to determine the specific location of the esophageal fistula, and it is best to find the real cause of the esophageal fistula. This ensures that there will be no recurrence after a second operation.

"This is an esophagram done for a patient today, and the esophageal fistula is more than 1cm!"

Director Tan was somewhat ashamed when he said this.

The entire esophageal tear is about 6cm, and the fistula that appears now is more than 1cm long, and it is difficult for he, the chief surgeon, to get rid of it.

When Zhou Can controlled the endoscope to exit, he carefully searched for the location of the fistula on the angiography, and it took a lot of effort to find it.

Viewed from the lining of the esophagus, the fistula is not obvious.

This location is at the bottom of the suture tear and there is some infection collapse.

With surgical experience and sixth-grade suturing, Zhou Can determined that the rest of the esophageal fissure had healed after careful inspection. This is a good sign.

Then there's no need to touch it again.

If you want to repair the fistula, you will definitely need to debride and then close it twice.

First of all, there is no guarantee that there will be no further infection and collapse after suturing.

In fact, as long as the wall of the esophagus is infected, it is still easy to break the sutures a second time, even if it does not suppurate.

To be more optimistic, Zhou Can has sixth-level debridement and sixth-level suturing, and the fistula grew directly after repairing it, and it did not collapse again. But the impact on patients can still be huge.

What are the implications?

The patient's esophagus itself becomes brittle due to hardening, and its elasticity and toughness become extremely poor. This means that the maximum volume of food that the esophagus can pass through is much lower than normal.

Then, a few days ago, because of the esophagus tear a 6cm long incision, after suturing, it will cause the internal space of this section of the esophagus to narrow a lot.

When he did a gastroscopy just now, Zhou Can could feel it.

This section of the esophagus that has been repaired is significantly narrower.

This will definitely affect the patient's postoperative eating, and it is easy to choke.

If debridement and suture are performed again on the basis of this stricture, the space of this esophagus will become more narrow.

In the future, the patient may only be able to eat liquids.

It has to be a thinner liquid food, too viscous, and it can directly block the esophagus.

It's really a plan that can't keep up with the changes!

It is really necessary to check this gastroscopy.

If you do not have a careful understanding of the patient's condition and repair the esophageal fistula directly through thoracoscopic surgery, even if the operation is successful, it is definitely a failure.

"I wonder what kind of second surgery your hospital is going to do on patients?"

Zhou Can asked Director Tan and Song Qian.

It is necessary to consult the owner first.

"We asked Dr. Zhou to come over and help wipe our buttocks, and naturally it was all up to Dr. Zhou." Song Qian replied in place of Director Tan.

"Because the fistula is not large, it would be best if the fistula could be repaired on the basis of the original surgery. Before coming, Dr. Zhou gave a surgical plan for thoracoscopic repair. This surgical option is less invasive for the patient and is a minimally invasive surgery, which I very much agree with. ”

Tan Shengli's surgical thinking should belong to the relatively old and conservative kind.

This kind of surgical thinking prefers to drum in front of the gong and drum in front of the gong when formulating the surgical plan, step by step.

The advantage is stability, and the disadvantage is that it lacks flexibility and is very rigid.

"Before I came, I did think that I could do thoracoscopic surgery on the patient to repair the esophageal fistula directly. However, when I was doing a gastroscopy on the patient just now, I found a problem, the patient's esophageal fistula occurred in the last tear. If a second suture is performed, I am worried that it will seriously affect the patient's quality of life after surgery. So, I'm leaning towards another solution. ”

Zhou Can has a six-level pathological diagnosis level, which is very helpful for formulating a better surgical plan.

"Is there another way?"

Director Tan's eyes lit up slightly, but Song Qian's phoenix eyes flashed.

"The patient now has an esophageal fistula, and nutritional security has become an urgent issue to be solved. If nutrition is not guaranteed, the patient's wound recovery will become slower and various problems will occur. At that point, his situation is quite dangerous. ”

Zhou Can analyzed the reasons for it for everyone.

What the patient now eats and leaks, only a small portion of the food makes it into the stomach. Moreover, all the food that leaks out through the esophagus enters the chest cavity, and even if the chest drainage tube is left during the operation, it will still pose a major safety hazard to the chest cavity.

If a chest infection is triggered, it may be difficult to save the patient's life with advanced antibiotics.

"Dr. Zhou, excuse me, what do you think are the causes of esophageal fistula in patients?" After Tan Shengli listened, his surgical thinking seemed to be enlightened, and he interrupted Zhou Can in a loud voice.

"When I had a gastroscopy just now, I saw an ulcer in my esophagus, and it was red and swollen. I suspect that the cause of the failure of esophageal repair is edema and inflammatory necrosis of the esophageal wall, which causes the sutures to break open and the wound to not heal. ”

Zhou Can could only tell the truth.

This happens from time to time, and it has a certain relationship with the quality of the surgeon's surgery. For example, the control of postoperative edema, if this is placed in Tuya Hospital, there are ways to do some preventive measures.

"Alright, then you can move on to your treatment plan!"

After Tan Shengli asked the reason for the patient's esophageal fistula, he seemed to have given up his thoughts and was ready to listen to Zhou Can completely.

"Everyone knows that if the esophagus ruptures spontaneously are not operated on in time, the patient will soon die due to severe infection, nutritional deficiencies, and general failure. However, after esophageal repair treatment, it is very easy for a variety of reasons to rupture again within 3 to 7 days after surgery. If the second rupture of the crack is small, nutrition can be strengthened, drainage can be maintained, antibiotics can be used reasonably, and the lungs can be blown to keep the gastrointestinal decompression unobstructed. With proper treatment, the fistula can heal on its own. ”

Zhou Can proposed a series of treatment measures.

His idea was simple: since he could no longer repair the esophageal fistula, he would let it grow on its own.

As long as nutrition is in place and infection is strictly controlled, this can be achieved.

At most, the treatment time will be a little longer.

"Dr. Chow's approach is very good. However, the patient now has a fistula in the esophagus, and the food eaten will leak into the chest cavity, how to strengthen nutrition? ”

Tan Shengli believes that if this problem is not solved, it is purely shouting empty slogans.

"It's simple, and a jejunostomy surgery can be done on the patient."

Zhou Can replied confidently.

"Jejunostomy?"

Director Tan's eyes widened suddenly, and the expressions of the others were equally shocked.

It is very tricky to have an esophageal fistula itself, and the idea of artificially creating a fistula on the jejunum is really daring.

A conservative like Tan Shengli would never have thought of such a solution.

Because in his opinion, such an idea is crazy.

Any surgery will cause harm to the patient's body, and the patient is unlucky enough to have a postoperative esophageal fistula, and the doctor will make a hole in the jejunum, what kind of evil is this?

"Yes, it's a jejunostomy. Although creating a fistula in the jejunum can cause some harm to the patient's body, the benefits to the patient far outweigh the harm. First of all, after jejunostomy, food can be fed directly into the stomach from here without passing through the esophagus, which can reduce the persistent infection of the esophageal fistula and even cause the fistula to further expand. This creates a prerequisite for the gradual healing of esophageal fistula. ”

Avoid water in the wound for fear of infection.

If the patient wants to live, he must eat and drink every day, which will cause the esophageal fistula to continue to infect and even suppurate.

Antibiotics can control infections, but they are not a panacea.

The best treatment is always prevention.

Preventing infection is much better than controlling it.

The former is to prevent the wound from having the chance of lesions and deterioration, while the latter is to wait until there is a problem and then find a way to treat and control it.

The truth in this is equivalent to treating the disease before it happens, and preventing it before it happens.

Treat the sick and wait until the patient is already sick, and then find a way to save it.

The superiority between the two is decided.

Zhou Can's surgical thinking has initially possessed the thinking of going to medicine, and Director Tan, if he can't change his thinking mode, I'm afraid he can only be a doctor for a lifetime.

"Secondly, the direct supply of food to the patient through the jejunal fistula ensures that the patient is provided with adequate nutrition. If nutrition is improved, the patient's self-healing ability and immunity will be greatly enhanced. As you can see now, patients have developed major problems and signs of failure due to poor nutrition. ”

The patient's face is extremely poor, and although his signs are stable, he is in a state of persistent high fever.

At this time, the state of the whole person is very poor.

Ordinary people have a severe cold, high fever and runny nose already feel like they are going to die. The patient has just undergone major surgery, and being in this state is tantamount to adding insult to injury.

If not addressed in time, the patient will die quickly.

It is believed that the doctors and leaders of the First Hospital also sensed the danger, so they hurriedly sought rescue from the outer hospital.

"Dr. Zhou's surgical proposal is very scientific and reasonable, and I think it is much stronger than the second repair of the fistula through thoracoscopic surgery that we conceived before. It is beneficial for the patient's postoperative recovery and quality of life in the future. It seems that the patient's body is destroyed twice, but in fact, it scrapes the bones to cure the poison, creating favorable conditions for the complete cure of the patient. ”

At this time, Director Hei, an anesthesiologist, spoke out in support of Zhou Can's new plan.

With the support of an anesthesiologist, the likelihood of implementation is immediately N times higher.

The anesthesiologist is indispensable for any operation.

She said that if this surgery can be done, then it can be done.

She objected, and even if the surgeon thought that the surgical plan was perfect, there was no way to implement it. At this time, it is often the time when the chief surgeon and the anesthesiologist tear up, and they fight in the office, which is a common thing.

It's like a quarrelsome couple, a quarrel at the head of the bed and at the end of the bed.

They'll meet again soon, so don't worry about it at all.

After all, everyone is doing their job, and there is no need to rise to the level of personal grudges.

"The solution proposed by Dr. Chow seems to be ...... It's destructive, and after I think about it, I think it's safer and more effective. Tan Shengli didn't say anything like agreeing with Zhou Can to do this surgery.

Because Zhou Can was invited over to be the main knife, the decision must be given to Zhou Can.

If they still have the right to make decisions, then they will not ask Zhou Can to come over and take the lead, but to act as an assistant.

"Since Director Hei has agreed with Dr. Zhou's surgical plan, let's hurry up and get started! Whatever is needed, we fully support and cooperate. ”

Song Qian's identity has been unknown, and she has not introduced it.

Including Jiang Wei did not mention to Zhou Can, what position this old classmate currently holds in the First Hospital. Just by feeling, her status should not be low.

Otherwise, there would be no way to speak with Tan Shengli and Director Hei, the two chief physicians, in such an extremely calm tone.

And in all decisions, she completely plays a senior leadership position and has the power to make decisions.

Therefore, it is inferred that her position should not be low.

"There are no other requirements, this colleague of mine can be a medical assistant for me, and Jiang Wei can be an instrument nurse for me."

Zhou Can only has this small request, to use his own people in the operation.

"Absolutely."

Song Qian gestured slightly to the instrument nurse and the original medical assistant, and the two of them gave way to their positions.

The surgery began soon.

Zhou Can showed these people in the First Hospital what it means to be a first-class surgical level. The entire surgery took less than forty minutes to complete.

At the end of the operation, he was rewarded with 1,000 XP for pathological diagnosis.

It should have something to do with him coming up with a new surgical plan.

It's not an innovative surgical plan, but it has a certain novelty. In addition, he made flexible use of a variety of surgical knowledge and medical knowledge.

This skill is very difficult to learn by reading a book.

What books can teach is general knowledge, all kinds of theories. The use of knowledge in diagnosis and treatment requires continuous practice and accumulation.

After the operation, Zhou Can carefully examined the patient again to ensure that there was no problem.

Then I took off my gloves and threw them in the trash.

"Okay, push it to the awakening room to wake up to anesthesia, observe for about thirty minutes, and if there is nothing abnormal, you can be sent back to the ward for nursing. Starting tomorrow, feeding through a jejunal fistula is possible, preferably by a more experienced nurse. It is estimated that the patient's hospitalization period will be relatively long, and his esophageal fistula may take more than a month to heal. ”

Zhou Can gave Tan Shengli and Song Qian the bottom.

"It's nothing, I'll take someone to withdraw first."

"I'll send you off. It's been a hard day. ”

Song Qian was very happy to see that the operation was successfully completed.

Before leaving, Zhou Can looked at the anesthesiologist Director Hei.

"It was a pleasure to work with you, and your intraoperative management was excellent, and it was the most relaxing operation I have ever worked with among the anesthesiologists."

Zhou Can did not say that it was the anesthesiologist who made him the most relaxed.

Let's just say that it is the most relaxing operation.

"Thanks for the compliment!"

She smiled implicitly, this was the first time Zhou Can had seen her smile.

"Goodbye!"

He took Jiang Wei and Zhong Ming and walked outside.

This Director Hei is indeed the most skilled anesthesiologist Zhou Can has ever seen, professional, meticulous, and very well cooperating with the chief surgeon. Even what Zhou Can needs to do next, she can budget, and then provide corresponding life support, or corresponding preparations.

In short, during the whole operation, Zhou Can was as comfortable as water.

Even Director Yu of Tuya Hospital has never let Zhou Can be so relaxed during the operation.

It's not that Director Xu's professional level is not as good as this black director, but Director Xu's lack of her spirit of dedication to the main knife.

In everything she did during the operation, she always put Zhou Can first and provided the best service for the main surgeon.

(End of chapter)