"Time waits for no one, how about I take a look first? I received training in this area during my further studies, so I am sure." Li Min suggested again.
Director Zhang rolled his eyes at him: "Stand still, young people, please stay calm. Director Peng is fishing in a nearby reservoir. It only takes twenty minutes to drive here. Please wait."
The old director didn't dare to say anything. Director Zhang is a well-known surgeon in the county and has more than 30 years of surgical experience. Li Min was sent for further training. The one-year training has not been completed. I believe it is self-evident.
This has nothing to do with feelings.
"We can first ---" Li Min actively fought for it.
Director Zhang interrupted him: "Why are you so long-winded? It's good for young people to have ideas, but surgery requires experience. There is a big gap between theory and practice. A high-minded person but a low-handed person will kill people."
Director Zhang has seen many examples of high-mindedness and low-power. A thirty-year-old attending surgeon in his department went to study abroad for a year and came back. He started to carry out major surgeries in a big way. In the end, he only performed three surgeries, two of which required Director Zhang's rescue, and one more.
The lawsuit is still ongoing. Young people can try other things, but surgery is not an option.
"Is it okay to move the large blood vessel blocking clamp down 5 centimeters?" Li Min still insisted.
Director Zhang saw that he was so persistent. Considering that this was his territory, it was no problem to move the forceps. Director Zhang asked for another large blood vessel blocking forceps to block it five centimeters below the original position, and then removed the original blood vessel forceps.
, there is still no obvious bleeding after checking the abdominal cavity, indicating that it is feasible to block at this location.
What does the previous point have to do with the next point? Director Zhang thought to himself, since the effect is the same, then just listen to him and save him from rambling on.
Li Min looked at the new blocking position. There is no problem in holding this position for 45 minutes. The limit time can be extended to 60 minutes. Now Li Min is a little more relieved. If Director Peng can arrive in less than 20 minutes, then
The current situation will not have much impact on the patient, otherwise it will easily cause ischemic necrosis of some organs.
Just now, Li Min repeatedly asked Ying to fight. Not only Director Zhang was not happy, but also several doctors from the hospital around him felt that Li Min had gone too far and was completely inconsistent with his usual modesty and caution. It may be that he was a little drifting after further training. This kind of surgery is
Can he intervene? The level and skill level are not enough. Even Director Zhang is afraid of surgery, let alone Li Min.
Finally, there was the sound of someone talking outside, the door of the operating room opened, and Director Peng had come in wearing a surgical gown. Director Zhang immediately said: "Lao Peng, brush your hands!"
Director Peng just glanced at the patient's surgical area, then briefly understood the situation, and followed the leading doctor out to brush his hands. The whole process seemed relaxed and expert-like.
"The fish in your reservoir are quite big." Director Peng chatted while putting on surgical clothes.
With Director Peng's support, Director Zhang naturally felt much more relaxed: "How's the record?"
''Three big guys, the firewood fish will definitely be delicious when we get it later," Director Peng said.
Director Peng put on the surgical gown and gloves. Director Zhang gave up the position of the chief surgeon, and Li Min took the position of the second assistant. Director Peng reached inside and felt around to find out the situation: "It's better that you, Lao Zhang, have the experience to do it in time.
Block the aorta, otherwise the consequences will be disastrous."
After touching for a few minutes, Director Peng finally found the crack: "The crack is not big. It is at the root of a branch of the aorta. Just repair it."
At this time, Director Peng breathed a sigh of relief. Despite his calm appearance when he arrived, he was still a little nervous in his heart. If the aortic tear was small and only needed to be repaired, he could handle it. If the tear was large, simple repair would not be possible.
To solve the problem, it can become a real major blood vessel surgery. At this time, he can't handle it. Surgery is a real thing. If it works, it will work. If it doesn't work, it won't work. It's not like management work, at least it can be done casually.
"Is there a nylon thread? It's better to have a nylon thread, but it's fine without a silk thread." Director Peng is not demanding, and his easy-going attitude makes him look more professional.
If you want to suture the tear in the aorta, you must first cut off the blood vessels that separate the aorta and supply the tumor. Otherwise, these blood vessels will block the repair work, so Director Peng started to separate this part of the blood vessels, because severe adhesions are not enough to separate the blood vessels.
Very easy to make.
Director Peng's style is different from Director Zhang's. Director Zhang is completely wild, while Director Peng's operation methods are quite academic. He holds tweezers in one hand and tissue scissors in the other, and separates them carefully. This kind of adhesion area is full of dangers.
If you are not careful, you may injure blood vessels and cause bleeding.
"Anesthesiologist, report vital signs!" Director Peng asked.
The anesthesiologist immediately reported the current vital signs. The blood pressure was slightly lower than normal. After all, the loss of so much arterial blood would definitely have a great impact on the blood pressure. Only because the bleeding was stopped in time, fatal losses were not caused.
"How is the patient's heart function? Is it okay?" Director Peng asked again.
The doctor in charge who was observing from the audience immediately replied: "It's okay, it's normal."
''Increase the intensity of fluid replenishment, use 0.9% normal saline, and quickly replenish the volume. How much blood should be prepared?"
"Six units!"
Six units?
But now it seems that it is enough. Director Peng ordered: "First give blood to two units."
Director Peng is calm and unhurried, and his expert demeanor is admirable. A tertiary hospital is a tertiary hospital, obviously different.
"Old Director, I heard that your waist was cured? Where did you do the surgery?" Director Peng learned about the old Director from Director Zhang.
The old dean chuckled: "Provincial capital!"
"Which hospital?"
“Sanbo Hospital!”
"Sanbo Hospital? Is it the Overseas Chinese Hospital?"
"Yes, it's the Overseas Chinese Hospital."
"Xiao Li is currently studying at Sanbo Hospital." Director Zhang added.
"Oh ---, I am studying in Sanbo. Your Sanbo Hospital is very popular now. I heard that there is a young Professor Yang Ping who won the Golden Knife Award and was named an Outstanding Youth not long ago? This Professor Yang is not even thirty years old.
Even if it’s not possible, can it be done? Will he be able to do the surgery? It is said that he is the son-in-law of Academician Su, who is affiliated with the First Department of Surgery. Is it true?” Director Peng asked while going through the surgery.
Li Min immediately replied: "Professor Yang is my teacher. His surgical skills are very high and can be said to be the best in the world."
How could one not say good things about his teacher? Director Peng was noncommittal and just smiled lightly, because not everyone believed in the legend of Yang Ping. Some people still doubted it. Even Director Peng, after all, was too dazzling and could easily attract criticism.
, In addition, after the news that Yang Ping was Academician Su's son-in-law spread, everyone had this idea even more. Whether it's a sour grape mentality or other psychology, there will always be a small number of people who think this way, especially when Yang Ping obtained a degree in orthopedics.
Orthopedic surgeons generally won’t question Yang Ping’s Golden Knife Award because many have watched Yang Ping’s surgery live broadcast. Some non-orthopedics majors will question it. Even if there is a video of the surgery, many people are too lazy to watch it. They are just questioning it anyway.
"Your teacher." Director Peng felt that he had to pay more attention to what he said.
From Director Peng's point of view, Yang Ping's affairs were more or less bragging. The Su family's son-in-law was a well-known family in the south. In order for his son-in-law to ascend to the throne, nothing could be done.
"Have you had any surgery with him?" Director Peng asked curiously.
"I often perform surgeries with him, and he teaches me directly. However, most surgeries are now performed by his professors. He doesn't do many general surgeries, and usually only performs difficult and high-risk surgeries." Li Min answered Director Peng truthfully.
question.
He is young and quite impressive, Director Peng thought to himself, but some of his thoughts are only in his heart. If Li Min is not present, everyone can chat openly. However, with Li Min present, he still has some scruples and does not dare to fully express his opinions.
.
"They heard that a research institute was set up to study what?"
Before Director Peng finished speaking, suddenly, in an instant, a large amount of blood poured out of the abdominal cavity that had just been cleaned. What happened?
Isn’t there an aortic occlusion forceps on it? Even aortic occlusion will not work?
Director Peng remained calm and judged from the color of the blood that the inferior vena cava might be torn: "Large blood vessel blocking clamp!"
However, Director Peng took the large blood vessel blocking forceps from the instrument nurse and didn’t know how to start. There were adhesions. They were all adhesions. Where is the breach? Where is the block? Even if it is blocked upward, where is the inferior vena cava now?
Well, Director Peng was stunned.
But experts are experts, and they are not afraid of danger: "Blood pad, lots of blood pad!"
Stuff gauze inside, stuff a large amount of gauze, and use packing to compress and stop bleeding. This is an effective method for emergency abdominal and pelvic bleeding, and it is usually the last resort.
Li Min judged from the color of the blood and the pattern of bleeding that there was both arterial blood and venous blood. It was likely that the aorta had continued to tear up and down along the original tear, and the inferior vena cava had also torn, and the tear in the blood vessel was extremely severe.
It may be just on the dorsal side, which is difficult to detect. The two cracks are probably actively continuing to expand.
This is already a real major vascular surgery, and Director Peng simply cannot handle it. Only a few hospitals can perform major vascular surgery.
The gauze filled the abdominal cavity, but the blood pressure still dropped sharply. It could be seen that the packing was not effective at all, and a large amount of blood could be seen gurgling out from various gaps.
"Blood transfusion! Quick! Blood transfusion!"
Seeing that stuffing was useless, Director Peng became worried and became anxious. His calm and calm expert demeanor just now was gone. It was too sudden and dangerous.
"Director Peng, let me take a look? If this continues, someone will die." Li Min was rude at this time.
In Li Min's case, major vascular surgery is a surgery at the "master batch" level required by Yang Ping, because this kind of surgery is rarely encountered in rural hospitals, but this kind of surgery is a rescue operation. Once there is such a surgery nearby,
The patient, if he can do this kind of surgery, can save his life, so Yang Ping's plan for Li Min needs to master this kind of surgery.
"Take a look?" Director Peng did not refuse. After all, he had no choice now. His mind was completely confused and he passively accepted Li Min's suggestion.
Li Min took over and took a second or two to make a rough judgment on the bleeding situation. He immediately asked the instrument nurse for another blocking forceps, clamped directly on the uppermost section of the abdominal aorta, and then opened several suction machines to suck blood.
The aorta was explored and separated all the way down. The surgical thinking was clear and the movements were extremely skillful. The extent of the aortic tear was quickly detected. At the same time, the inferior vena cava was also separated, and a large blood vessel blocking forceps was inserted.
Accurate judgment and extremely fast operation quickly stopped the bleeding and pulled the patient out of danger immediately. Otherwise, the patient would definitely die if he were bleeding like he just did.
''Can we find artificial blood vessels for major vascular surgery? It would be better if we could implant artificial blood vessels."
Li Min asked Director Peng and Director Zhang.
The two directors thought for a while. Not to mention the county hospital, even the central hospital in the city did not carry out major vascular surgeries. Patients could only be sent to the provincial capital. How could there be artificial blood vessels?
It took more than ten hours for the goods to arrive.
"No, it will probably take more than ten hours to find someone to transfer the goods." Director Zhang was a little frightened.
Li Min thought, without extracorporeal circulation support, how could the patient wait for more than ten hours on the stage? His teacher had taught him about this situation because he considered how to save the patient's life in this special situation.
"That can only be repaired!" Li Min said.
Through Li Min's examination, it was found that the scope of the blood vessel tear was large, but most of the blood vessel walls were originally healthy, and only a small part was invaded by the tumor. Most of the tears were neat, which made the repair necessary.
Basically, by studying with Yang Ping, Li Min is no longer the young boy he used to be. He has strong ability to deal with complex problems.
"Is there nylon thread? For suturing blood vessels?" Li Min asked.
The old director was so frightened that his heart was beating fast. He stood on tiptoe to look at the operation side and replied: "There are nylon threads, but I don't know if they are suitable for anastomosis of this kind of blood vessel."
"Bring them all to me to see." Li Min's expression was clear and firm, and the aura of the surgeon was clearly revealed.
This chapter is not finished yet, please click on the next page to continue reading the exciting content! The circulating nurse immediately took action and took out all the existing nylon threads in the hospital to show to Li Min. Li Min selected a few packs that were barely suitable. Anyway, at this time
There is nothing to criticize, I can only make do with it. It is impossible to standardize everything and use it smoothly like a large hospital.
As for the understanding of various sutures, from materials, specifications, craftsmanship, etc., they all received training from Yang Ping, so Li Min is very familiar with how to use some threads cross-wise and how to use them in situations that are not their normal situations.
Li Min began to repair the blood vessels with nylon thread, repairing the longitudinal cracks first. The longitudinal cracks were the main ones, while the horizontal and irregular cracks were concentrated at the location where the tumor blood vessels branched off from the aorta.
The suturing technique is a bit cool, fast, good and stable. Director Zhang, who was working as an assistant on the opposite side to cut threads and tie knots, looked at Li Min's cool sutures and was stunned for a moment. This may be his impression of big hospitals.
The most intuitive technical understanding of Sanbo Hospital.
Compared to Li Min's suturing skills, Director Zhang felt that his decades of surgical experience were instantly worthless and that his previous surgeries were like shit.
A young doctor with less than a year of training can perform major vascular surgery. Li Min's level is unrivaled in the entire region. Even Director Peng cannot catch up with him. This guy is Li Min? Director Peng of Guandu Hospital.
Director Zhang had to look up and re-examine Dr. Li in front of him. He even wondered if he was possessed by the god of medicine.
"Director Peng --- cut the thread!" Li Min reminded the distracted Director Peng, who immediately woke up and continued to cut the thread.
In fact, in Li Min's eyes, Director Peng's thread-cutting movements and effects were unqualified. Some were too long, and some were too short. Threads that were too long left more foreign matter, and threads that were too short were easy to loosen.
Standardized actions are not for good looks, but large sample statistics show that before new methods and standards emerge, doing so can ensure the best results.
Compared with the neat sutures that Li Min had sutured, the uneven threads left by Director Peng were very conspicuous. Director Peng himself felt very ashamed. Decades of accumulated surgical experience were lost to less than a year of training.
Even though he is now in his fifties, Director Peng still has the idea of going out to study. After all, there is no limit to technology.
The whole process was very smooth. The long longitudinal tear was sutured by Li Min. Now Li Min had to deal with the irregular tear. He frowned slightly. In fact, he had already planned it in his heart. Foresight and planning are essential for surgeons.
Even if you encounter unexpected dangers, don't be led by the disease. Try to think ahead of the disease, so you can have more initiative.
Cut off this part of the invaded blood vessel and discard it, and then suture it end to end. This is Li Min's plan. This can not only ensure postoperative safety, but also allow the tumor blood vessel to break away from the aorta. Of course, after cutting off a part
, the aorta can still be anastomotic without tension, which is what Li Min calculated.
The length of a person's abdominal aorta is related to his or her height. The length of the abdominal aorta can be calculated from the height, and then a fraction of the blood vessels can still be sutured without tension. These data are not only memorized, but also practiced too much in practice.
times, so Li Min knew it well.
Director Zhang, who had just been shocked by Li Min's surgical skills, couldn't believe that this was Li Min from Guandu Hospital. He was completely possessed by the god of medicine.
