January 8th.

There are 14 operating rooms in the Surgery Building, which are the operating rooms of trauma surgery.

However, this afternoon, it was temporarily loaned to Fang Xian by Professor Lin Jiemo.

There are not many people brought by Fang Xian, only Wang Yang and Li Qiu, and naturally there is a superior, that is, Associate Professor Song Yu, who also followed the stage.

Fang Xian was checking the medical records very carefully at the moment, and Associate Professor Song Yu was laughing on the side: "Xiao Fang, you have to know how to delegate power in a timely manner." Don't always do everything yourself! ”

"The requirements for the participation of bed managers in the hospital are very strict, and even the admission system for operating room assistants has relative standards, and there are generally no low-level errors."

Fang Xian is now about to enter the trend of becoming a senior doctor, so he shouldn't continue to be obsessed with writing medical records, talking and signing these things, Li Qiu, as a bed doctor, if he can't do this well, he won't be able to mix it up now.

He was already scolded by Wang Chuntao in the department for being hospitalized and doubted his life, and even returned to the training office and asked the teachers there to return to the furnace to rebuild.

Each identity has its own center of gravity, even if there are occasional flaws in the medical record, as a superior, you must turn a blind eye, otherwise, everyone's energy is indeed limited.

Fang Xian turned his head: "Teacher Song, this is the first elective function reconstruction that our team has done, so naturally we should be cautious." ”

"After the first template is established, it won't have to be so troublesome in the future."

"Li Qiu and I are classmates, and I naturally have absolutely no doubt about his ability."

"Right, old ball?"

Li Qiu had been with Associate Professor Song Yu for a period of time, as his preparatory teaching student, and at this moment he was very aggrieved and complained: "No, Teacher Song, Brother Xian, he always bullies me, you see I have lost weight." ”

Li Qiu is also out of the box, and if you give a little sunshine, it will be brilliant.

Song Yu knew Li Qiu's personality, and he didn't eat this set at all: "It's good to lose weight, if you lose weight, you can only belong to a healthy BMI (obesity index)." ”

"Although we are men, we don't need to use our body as sexual characteristics, the bigger the better."

Song Yu is already talented, has extremely high emotional intelligence, extremely fast reaction speed, and driving speed is unparalleled.

In the area of driving, even the grumpy Professor Lin Jiemo occasionally has the upper hand, so after quickly reacting, Li Qiu instantly made a bitter gourd face.

Seeing this, Song Yu made up another knife: "Generally speaking, the surface area of a person's body is relatively fixed, and other places are large, and some places look small......"

"Teacher Song, I was wrong......" Li Qiu couldn't stand it and quickly apologized.

Wang Yang was taking the MRI and studying it carefully, and after reading it, he said, "Doctor Fang, I think this patient is actually more suitable for the second plan, how about it?" ”

Fang Xian made a final decision: "Just choose the first plan, stability is the most important thing, don't make extraneous branches!" ”

Fang Xian knew that Wang Yang, who had a detached temperament, would definitely still want to solve the patient's urine function and X function at one time.

But what the patient did not ask for before the operation, Fang Xian would never touch.

The patient's requirements and the surgical method should be strictly corresponding, otherwise they are all extraneous branches, in case something goes wrong, then his team will immediately fall apart, and Fang Xian may also be banned from the current 'team leader' qualification, and then follow other professors to cultivate himself honestly.

Wang Yang's brows furrowed slightly, but seeing Fang Xian's expression and gaze, he didn't say anything more.

Associate Professor Song Yu said at this moment: "Doctor Wang, do you still want to convince Xiao Fang? ”

"I'll tell you, don't bother, our hospital, there are not many people who can convince Xiaofang."

"And when the team is just starting to build, stability is the most important thing. If the patient's demands can be satisfied, they will do it, and if they can't be satisfied, they will not do it. ”

Fang Xian is his own person, Wang Yang has always been branded with thoracic surgery, even if he follows Fang Xian now, Associate Professor Song Yu will still treat him as an outsider and help his own people speak.

Wang Yang glanced at Song Yu and didn't mean much respect.

In his eyes, an ordinary associate professor is not qualified to discuss theoretical-related issues with him, even if it is operational, the associate professors may not be better than his operation, but the skill pool is a little wider, in the depth of the skill pool.

Who's afraid of whom?

However, Fang Xian's personality has always been quite stable, and his personality is also paranoid, he has to do what he recognizes, and the persuasion of others, on Fang Xian's side, will make a circle, and only consider whether to adopt it after evaluating the pros and cons by himself.

Whether it's a professor or an ordinary person.

The anesthesiologist said at this moment: "The general anesthesia is already good, can you start the operation?" ”

"I see that the patient's urethral catheter and ostomy still exist, so I can rest assured that I can balance the electrolytes."

Hearing this, Fang Xian nodded and thanked him.

As soon as the anesthesiologist finished speaking, everyone moved when they heard the sound, Fang Xian and the others went to wash their hands and began to disinfect, while Li Qiu honestly went to get dressed first and helped lay out the sterile surgical sheet.

After the disinfection, laying orders, and pasting sterile skin films were completed, Fang Xian stood in the main knife position, letting Associate Professor Song Yu stand in the first assistant position and Wang Yang in the second assistant position.

"Traveling teacher, record the time of the operation, and at 10:35, the operation begins." Fang Xian unified the recording time of skin incision, so as to avoid inconsistency in the time of postoperative, touring, anesthesia and clinician's surgical records.

After everything was ready, Fang Xian chose to cut the patient's abdominal wall, and the selected incision was still the scar caused by the suture, so as to avoid new scars after this elective surgery.

Fang Xian took the initiative to expose and cut, and the speed was leveraged.

The exposure of the surgical approach is only a basic medical skill, so in just five minutes, the patient's lower abdomen has been wide open.

As soon as the abdominal opener was placed, Fang Xian saw that after the damage reconstruction, the patient's intra-abdominal intestinal tube was healed with scars, and there were also a lot of scar tissues adhesion in the peritoneum.

This is a necessary thing for scar healing after reconstructive surgery, and without these scars, there is no such thing as healing.

"We still follow the scheduled surgical procedure, first do fecal function reconstruction near the rectum, and then move to the anterior lower abdomen to do urinary function reconstruction."

"As shown on the preoperative MRI, there was a lot of scar hyperplasia in the abdominal cavity, and we tried our best to loosen the scar during this operation to avoid functional limitations during intestinal peristalsis."

"Electric knife." Fang Xian asked Li Qiu, who was closest to the electric knife, to order.

Li Qiu immediately handed it over, but his tone was hesitant: "Do you want to open a plasma electric knife?" ”

Li Qiu is not a layman, he is just not obvious enough when facing Fang Xian. But in fact, now he has come to the forefront in the seventh school year.

Therefore, Li Qiu still made a recommendation based on his own understanding.

"The plasma electro knife is a bit expensive, so you can save a little bit so as not to increase the burden."

"It's true that ordinary electric knives won't be as refreshing to operate, but it's okay." Fang Xian explained.

However, Fang Xian soon added: "If you want to start operating in the future, you should try to choose plasma electric knife, a better tool that can ensure the smoothness of your operation." ”

Song Yu earnestly helped to assist, carefully watching Fang Xian's operation.

Constantly amazed: "The operating room of the trauma center is worthy of being a training room for basic medical skills, and it is more than one level higher than the players who came out of the skills training room." ”

"Level 5 skills, the application in clinical practice, is really like a divine help."

Fang Xian glanced at Associate Professor Song Yu and explained: "Teacher Song, in fact, this kind of release can also be done by grade 4 incision and debridement, and the adhesion between the intestinal segment and the peritoneum is mostly focused on the scar at the peritoneum. ”

"The outermost anatomy of the intestinal tube is ......," Fang Xian said, explaining his understanding.

This is to take care of Associate Professor Song Yu and Li Qiu, these two people have been engaged in trauma surgery before, and now the reconstruction of urine and urine function is strictly a specialty of gastrointestinal surgery and urology.

Trauma surgeons only need to have a little understanding of the level of knowledge of gastrointestinal surgery and urology, know what is going on, and be able to guide patients to specialists.

It is not necessary to explore and understand the diseases and basic knowledge of these two specialties in depth.

Therefore, today's Fang Xian is also the first time to see that the original injured patients, even after anatomical reconstruction, in fact, the functional defects caused by scar adhesion are also an important factor affecting the postoperative function.

But there is no way, clinical, save lives first, and then treat the disease.

There is currently no perfect solution to many problems caused by trauma, which is a limitation of the development of medical technology and is beyond the control of individual ability.

The adhesion between the intestinal tube and the peritoneum is not a small amount of scar tissue, so it is possible to remove a part of the peritoneal tissue, and after incision, the scar tissue that is close to the outer layer of the intestinal wall can be torn off.

This procedure requires extreme caution because the scars are already adhered together, which is a release procedure and an extension of the incision......

During the process of Fang Xian's operation, Li Qiu took the opportunity to ask: "Brother Xian, don't you need to clean up some of these scars?" ”

"Yes, as long as it does not particularly affect the intestinal peristalsis function, such as some adhesions in the posterior abdominal wall, there is a connection between the intestinal tube and the peritoneum in this part, and if you release it, intestinal obstruction will easily occur."

"Don't bother, we want to remove the adhesions for better function, not to completely cut out the scar and cosmetic the bowel."

"Well, there is a problem with the peristaltic function of this section of the intestine, but looking at the color of the blood, it is not necrotic, so it can be temporarily discontinued. There should be only local motor limitations, but vascularization remains. ”

The timeline of this operation...... "This operation must be very long, one or two hours, it is definitely impossible."

If you don't say a few words on the operating table for a long time, I'm afraid the operation will be boring.

Since Fang Xian started to operate, he has become more and more able to understand why many surgical professors are talkative.

“……”

Another two hours passed.

The operation finally came to the functional reconstruction of the stool, that is, the content related to nerve transposition and nerve transplantation.

At this moment, Professor Gong Ziye of the Department of General Surgery and Gastrointestinal Surgery, who heard the sound, stepped on the foot-operated sensor door and walked in from the outside.

After coming in, while rubbing the hand sanitizer in his hands, he raised his hands and asked, "Am I late, Doctor Fang?" ”

Hearing this, everyone hurriedly looked up, Associate Professor Song Yu was not very familiar with Professor Gong Ziye, and squinted his eyes.

Wang Yang hurriedly called out to Professor Gong.

Song Yu suddenly realized that Professor Gong Ziye retired from the general surgery group of the trauma center, and now he is a bigwig-level figure in gastrointestinal surgery.

Although he is not the director of the ward or the director of the department, he is also a veteran-level existence.

"Professor Gong, you've come just in time." Fang Xianyan smiled when he heard this, and he didn't wait, but after moving his neck slightly, he used his forehead to push the microscope for parietal nerve suturing again, and realigned the focus of the field of vision.

As soon as Professor Gong Ziye took the stage, Associate Professor Song Yu gave way.

smiled: "Hello Professor Gong." ”

Gong Ziye glanced at Song Yu, felt angry, and said politely: "Thank you, teacher, for giving me a place." ”

He knew that Song Yu was originally a helper, giving way is love, not giving in is duty, and he is here to rub the operation!

In the face of Gong Ziye's politeness, Song Yu hurriedly said that he didn't dare: "Professor Gong, I am Song Yu from trauma surgery, just call me Xiao Song." ”

Gong Ziye is a professor who has been famous for many years, and he must have been a level 4 specialist for many years before he can go to the operating room of the trauma center, and like Associate Professor Song Yu, he is not qualified to go over, he used up all the time in the operating room of the trauma center in order to be promoted to deputy high level.

Now I can only go to the operating room of the trauma center to receive the next step of experience and prepare for Zhenggao after slowly crawling and honing my professional skills in the clinic.

Knowing that the assessment of Level 4 professors is not easy, the more I respect it, and I respect Professor Gong Ziye's strength and the dedication of the students he has taught.

Gong Ziye naturally didn't come to greet him, if he came to greet him, then he didn't have to come to the operating room, there were more places outside for him to greet him.

However, after seeing Fang Xian find some very subtle nerve branches from the mesentery, and pierce them into some nerve stumps around the rectum that he couldn't find at all.

Gong Ziye was slightly stunned: "Fang Xian, these nerves, it's not difficult for you to find them in the emergency surgery, how can you find such an elective operation?" ”

Nerve exploration is indeed a specialized basic skill, but the applicability of specialized basic skills also has a moderate range, not that you can find what kind of nerve you want, you can find it.

Generally speaking, nerve exploration is only suitable for relatively large nerve branches.

Like the mesenteric nerves, I don't know what level of nerve branches it is, or even nerve branches......

Fang Xian only smiled back.

When it comes to how to find it, there are actually two important factors.

One is the basic theory of level 5, and the other is thanks to the fact that he has done whole nerve anatomy of the human body before, so he probably knows the shape of some nerves and what position they are.

Gong Ziye didn't get a reply, so he didn't continue to ask.

Ask Fang Xian, isn't this boring?

Fang Xian's basic theory of general surgery and gastrointestinal surgery are both level 5, which is a height that Professor Gong Ziye has not reached at present, and it is not so detailed.

That is to say, at present, Fang Xian's skill pool in general surgery and gastrointestinal surgery has not gone far, otherwise, Gong Ziye's ability as a professor is probably just a foil in this operation.

However, now Gong Ziye is very accurate, and in the process of Fang Xian's operation, he used some particularly ingenious means to expose Fang Xian's vision.

Three years of studying surgery, a lifetime of exposure, this sentence is not false.

Time is like water, and another two hours have passed.

After Fang Xian finished doing it, he muttered: "The sensory nerves of the intestinal tube are actually not very sensitive to cutting, but only sensitive to the feeling of tension, such as pain allergy during intestinal obstruction. ”

"However, after the bowel resection, the patients themselves did not react much."

"Such a mechanism is fundamental to allowing patients to have a functional alternative to wanting to defecate and knowing that they want to defecate stool. However, it is not known whether these nerve branches of the colon and rectum remain functional. ”

"Actually, it stands to reason that there should be. Professor Gong. ”

Fang Xian asked.

Gong Ziye frowned slightly: "Generally speaking, after trauma, the residual rate of nerve function, without the occurrence of avascular necrosis, loses innervation and atrophy, is a relatively slow process. ”

"Aren't you orthopedic? Isn't some nerve transposition surgery in hand surgery also done electively? It's the same if you do it after three months? ”

Gong Ziye asked rhetorically.

Fang Xian said: "Professor Gong, I don't have enough understanding of hand surgery, and I can only talk about my own theories at present, and I have no experience. ”

"In addition, some nerve transpositions in hand surgery involve god-level transpositions."

"For example, after the amputated limb injury, functional reconstruction is still an unsolved problem."

There are not only large damages, but also small damages, which still exist, and after the occurrence of small damages, the general limbs are just decorations.

There's no way, the destruction and damage of the limbs, the nerves and blood vessels, etc., are all rotten to you.

Moreover, the number of cases of dismemberment and injury of limbs that occur every day is definitely not a small number.

If the burial and urinary function reconstruction is successful, it can also be introduced into trauma surgery and hand surgery, which can have a great effect.

This is also the significance of the Department of Functional Reconstruction.

“……”

And in this discussion and uncertainty, Fang Xian, Professor Gong Ziye and others slowly approached the end of the operation.

At twelve o'clock in the evening, at the end of the twelve-hour operation, Fang Xian looked at the surgical field and said, "That's it, I can only be a dead horse as a live horse doctor." ”

"The theory has been combined to the limit, and the operation has reached the current capability limit, and it is impossible to pursue better functional remodeling."

"Anesthesia teacher, we are ready to close the abdomen, this patient will be transferred to the ICU after surgery, we have already contacted the bed, and then choose to transfer from the ICU to our department or the rehabilitation department."

"Okay." The current anesthesiologist is no longer the anesthesiologist he was when he first came to power, he came to take over the shift at night.

At the moment, I was drowsy, and I didn't really understand the difficulty, beginning, and process of this operation.

For him, it is the task of the anesthesiology department to ensure that the patient does not die.

Fang Xian thought for a while, and still said: "Anesthesia teacher, pay a little attention to the dispensing of the postoperative analgesic pump, don't use it too hard." ”

Fang Xian knew that there were some analgesic pump drugs that had a strong continuous effect and a large amount of medication, but such an operation required precise control of the drug dosage to avoid accidents.

The current neural connections can't stand any toss.

"Okay, I know, Professor Zhu reminded me when he took over the class before."

"If you are transferred to the ICU, you don't have to be accompanied by your specialist. That's a great job. "It was almost midnight before the operation was over.

As an anesthesiologist, he felt tired, let alone these surgeons who hadn't eaten dinner.

Professor Gong Ziye came to study sincerely, so he stayed up until the end of the operation.

Fang Xian hurriedly asked, "Professor Gong, let's go to dinner together, it's quite late." ”

"Good!"

"Actually, I can take a leave on the day of the operation, and I don't have to accompany my daughter at home, so I have to go back to eat with my daughter." Gong Ziye said.

When Fang Xian heard this, he was a little curious: "Professor Gong's daughter is still very young?" ”

"I got married late, and now my daughter is in junior high school." Gong Ziye smiled and replied like this.

Fang Xian nodded and said with a smile: "Then we are blessed." ”

For medical students, it is normal to start a family late, and the study cycle is super long.

If you had completed your bachelor's, master's, and doctoral studies 20 years ago, if you wanted to enter a super-first-class hospital, you had to enter a postdoctoral mobile station, and you had to go abroad, you would have to be 33 or 4 years old before you could officially start working and complete the basic structure such as buying a house and a car.

A girl who can wait for this age, except for the same medical monk, it is estimated that there are no girls in other majors who can wait.

When a group of people walked out, Gong Ziye gave a thumbs up: "Let's not talk about the prognosis of this operation, but the operation of this operation can definitely be regarded as a textbook." ”

"I really want to record it."

"Xiao Fang, do you think it's okay?"

When Wang Yang heard this, he immediately said: "Professor Gong, we have cameras that we carry with us, and these operations are recorded in video, so that they can be used as materials for academic exchanges in the future." ”

"We can make a copy to you if you want."

When Gong Ziye heard this, he turned his head and glanced at Wang Yang: "I forgot that you were also there, these things, you are better than me......"

Although Wang Yang is a thoracic surgeon, his reputation in the field of surgery is not small.

If he has surgery, then many people can not dump him, but when it comes to doing scientific research, academic research, and theory, then ordinary people really can't do him.

Some people even said that if it had been placed in the early 20 years, with Wang Yang's current academic achievements and theoretical research efforts, he would have become a professor a long time ago, and he might even have reached the academician level in half a step.

At that time, surgeons didn't have to do too many surgeries, and they needed the help of the associate professor of the subject of the article.

On the contrary, now, because of the limitations of professional ability, Wang Yangcai is only a small attending physician, not even the deputy chief physician. Of course, not an associate professor.

The hospital didn't dare to let Wang Yang take the students at all.

Song Yu only had time to laugh at this time and said: "Professor Gong, I know that there is a place where the porridge is good, although it has not yet arrived in Laba, but it is actually quite good to drink some porridge at this point." ”

"What do you think?"

"Yes. I'm ...... at will."

So Gong Ziye led the team to set off at the suggestion of Associate Professor Song Yu.

None of us drive, but the staff at the Shonan University Hospital rarely drive to commute, and it's so congested that they usually live nearby.

A little farther away, the e-donkey departs, and a little farther away, it is the subway commute.

There is not much to talk about at dinner, but more about this operation, functional reconstruction, and the development of this discipline and the next step of planning, which can be too expansive.

Functional reconstruction in paralyzed patients, functional reconstruction in amputated patients.

Functional reconstruction of patients without lifting ......

Expanding a little further, amputated limb reconstruction, amputated limb transplantation, etc., can be functional reconstruction in a broad sense, so to speak, this is a multidisciplinary intersection and pivot point.

If Fang Xian can really build this discipline, it will definitely be the hottest center in the future.

Why, just go to the sanatorium and see it, I don't know how many people live in it because of dysfunction, although there are people who serve, but compared to freedom, especially the freedom of personality function.

There are too many people who are willing to spend more money to get such freedom.

It's just that medical technology is limited, and the overcoming of this topic is a discipline that has been carried out for many years and has not yet made progress.

In the end, Fang Xian and Li Qiu took a taxi to catch up.

At this moment, Li Qiu said quite seriously: "Brother Xian, I found that the connections that can be accessed by following you are too strong, right?" ”

"I just searched, this Professor Gong Ziye is the former director of the Department of Gastrointestinal Surgery, and later went to the trauma center, and now in the Department of General Surgery, they all belong to the veteran level."

"Hey, it's just that he's in his forties, why did he retire?"

Fang Xianneng roughly guessed the reason: "Professor Gong has been at the professor level for many years, and if he wants to go further, he will be the leader of the discipline." ”

"If you become a discipline leader, it doesn't matter if you are the director of the hospital, what experts and professors you are, that is the cornerstone and foundation of the hospital, and there is no need for a department director to add icing on the cake."

"If you want to jump to this step, you must calm down and give up your trivial mundane affairs."

"Oh." Li Qiu nodded.

sighed: "Alas! ~”

"It's too hard."

"In the Shonan University Hospital, it is not easy to get a graduate student, and if you want to further your PhD, you have to cross the single-plank bridge."

"If you want to stay in the hospital, there is a so-called ladder to the sky, but after climbing the ladder, I entered the hospital, only to find that the other bigwigs in the department were all people who came out of the ladder."

"The main treatment is another hurdle, if you want to go to the deputy high school, you need to learn a lot of surgeries, as well as teaching tasks, and more scientific research tasks, all of which must go hand in hand......"

When Li Qiu was so emotional, Fang Xian explained: "Li Qiu, you must not give up on scientific research." ”

"Scientific research is not high-level, if you want to write a paper and engage in research, the premise is that you need to know where the frontier of the discipline is and where the boundary is."

"You're in the process of understanding this boundary, and your perception is different."

"Based on this, another breakthrough is scientific research, and it is also the output of scientific research and articles."

"Today's medical associations, in fact, are not not not paying attention to scientific research, but dividing scientific research, you know?"

Li Qiu looked at Fang Xian and explained, "I know. ”

"In the hospital, we are blindly asked to improve our theories, one is for the needs of work, the second is for diagnosis, and the third is for scientific research."

"If you don't understand in advance, at your current stage, Brother Xian, it will be difficult, and every step you take, it will become more and more difficult. And the process of step-by-step exploration is originally the stage of research. ”

"Without any precedent to refer to, it's like walking a tightrope."

"Mr. Wang Yang is too radical, because his theory is very solid, and he believes in his theoretical derivation. But in fact, many times, if you go too fast, you may be in endless trouble, and you must move forward slowly step by step. ”

Li Qiu can have such an understanding, which makes Fang Xian very surprised!

"Let's practice the surgical skills first, practice slowly, practice well, and don't be in a hurry anyway."

……

Time is like water.

Another few days passed.

When Fang Xian came to the trauma surgery again, he found a completely different scene.

Many people directly surrounded Fang Xian.

"Doctor Fang, Doctor Fang......"

"Doctor Fang, you can be regarded as here." At first glance, the people who were patients and their families gathered Fang Xian in one center, making Fang Xian unable to move at all.

Fang Xian raised his hand, for fear of hitting someone: "Everyone slow down, slow down." ”

"I'm here to find Professor Lin for something, and then I'll come back to talk to you, okay?"

"I need to do my job well first." Fang Xian knew that these people had seen that the previous patient had good postoperative function and could have a fart and urine feeling, so they came to Fang Xian one after another.

If you see that the first patient has been getting better, then they are not an experiment.

When I saw hope, I naturally gathered around.

Choosing to wait and see like this, in fact, Fang Xian can also understand that not everyone, like Professor Hu's eldest brother, can take money to make it.

Li Qiu also helped explain on the periphery: "Let's let go first, we really have something." ”

But the patients didn't quite understand: "Doctor Fang, we have something to do with you, we want to hang your number......"

"My clinic was yesterday, yesterday is over, and I can only wait for next week."

"Don't be in a hurry! If you don't let me do things, what will I do when I work? ”

"What should I do if I lose my job and can't be a doctor?" Fang Xian patiently explained, with a little impatience.

Strictly speaking, these people have not established a diagnosis and treatment relationship with him, and it is definitely not appropriate to block him like this now.

These patients gradually dispersed.

Fang Xian looked at them and patiently explained, "I'm sorry, I'm really looking for Professor Lin to have something, I'm in a hurry." ”

"When I'm done, you'll come back to me, okay?"

"Okay, Doctor Fang." Only then did someone nod, just afraid that Fang Xian would run away like this, and let them fall into despair again.

Although it is actually a normal function of normal people, for them, it is a kind of enjoyment......

(End of chapter)