Surgery is no joke, and each operation has its own appropriate indications.
It's not just an operation. As long as it sounds better, more sophisticated, and has enough skills, it can be done directly.
Puncture needle hematoma evacuation under CT monitoring.
Naturally, it is the least invasive, but it is only suitable for a single hematoma, especially if the patient suffers from a single, relatively large hematoma.
The problem can be solved quickly.
But if there are many hematomas like Lu Qianzhou's now, but they are not very big, it may be safer to remove them through craniotomy, or slowly do it under endoscopy!
This is Du Li's idea, and it is also a relatively conventional idea.
However, Lu Qianzhou's condition is different now. From a conventional perspective and thinking, he would just wait for death.
Therefore, from the beginning, Zhou Cheng's thinking never took the ordinary path!
The reason why medicine needs to develop is that the current level of inheritance and knowledge will never be able to analyze all existing diseases, no matter which type of medicine.
You are paralyzed!
Do you have to pay attention to the lower limit when insulting people?
But not Zhou Cheng!
"The high pressure dropped off a cliff to 50+, and we were able to rescue it. This really requires a very high level."
Professor Lu frowned when he heard this: "It is not an option to cut off a limb to save your life. You can leave the green hills without worrying about having no firewood."
In this way, even if a lawsuit is filed, things must be done within strict guidelines. Any operation outside the guidelines is an illegal operation!
Retract the rectus abdominis to both sides, pick up the posterior sheath of the rectus abdominis and the peritoneum, pick up the peritoneum with toothed forceps, and use a curved vascular forceps to pick up the peritoneum about one centimeter away from the opposite side of where the surgeon pinched it. , then the surgeon relaxes the clamped peritoneum, clamps another place again, repeats this process once and then cuts with a knife.
Then, at this moment, a lot of people suddenly gathered at the door of the operating room. However, these people just gathered around the door of the operating room and looked inside curiously. However, no one actually opened the operation. The door of the room was closed for fear of affecting the rescue operations!
When one of the circulating nurses saw this scene, she thought something was going on, so she immediately went to the door and opened it herself to ask about the basic situation.
After all, there are not many people like Zhou Cheng who have professors speaking and supporting him.
Professor Lu glanced at the blood pressure display on the anesthesia machine.
But Zhou Cheng's words directly made Fang Jingsheng, several people from the vascular surgery department, and even the neurosurgery people who knew what a sheath was, cursed in their hearts.
Intracranial hemorrhage is not a big problem if it does not continue to expand. If the spleen is ruptured, it can be cut off. Liver contusion and laceration are not particularly serious. For a professor of general surgery, it is just a piece of cake.
However, after Fu Youhan from the Department of Orthopedics recognized the identities of these people, he walked over silently and whispered: "Director Tong, Teacher Zhang, and Teacher Zeng Diwei's student Zhou Cheng are on the stage."
Of course, the procedure they have to go through is very simple.
The meaning of this is very simple. Remove the generated emboli, and use the remaining emboli to stop the unimportant bleeding points. For important bleeding points, after removing the thrombus, accurately target the bleeding points. Embolization stops bleeding.
There is good news from all sides.
An assistant next to Du Li seemed to be a little scared by Du Li's action, and said: "Teacher Du, the diameter of this hematoma is not easy to operate? Actually."
After doing this, Professor Fang Jingsheng blocked all the blood vessels in the limbs. Zhou Cheng breathed a sigh of relief at that time.
Some dangers should be taken when necessary, and we cannot let a young man fight alone here as a hero.
The leader was an old man with gray sideburns. After he entered the door, he shouted: "Professor Fang, how is the patient's current condition? I happened to invite an expert from Fuwai Hospital in Kyoto who came to Shanghai on a business trip.
"
However, this situation has returned to a scene that Zhou Cheng is familiar with.
…
Zhou Cheng himself is somewhat confident about his current technical level, but others don’t know that!
It's impossible for everyone to know, because this is due to lack of experience and resume.
"What are you going to do next?" Fang Jingsheng had a headache at this moment. Although the temporary life-threatening situation was temporarily solved, how to deal with the embolization of the lower limbs and upper limbs? Now even if the embolization thing was removed,
The blood probably won't flow anymore, and the bleeding won't come out.
However, Fang Jingsheng can also understand that Zhou Cheng only wants them to have a better sense of participation. Don't make everyone look so ugly on the surface.
Do what you can, should and shouldn't do, there is no need to take risks.
Could you please speak less casually?
However, it seems that their reaction at this moment is not as big as before. After all, everything has a process of getting used to. Slowly getting used to it, it is not as shocking as before. Zhou Cheng even blindly operated the femoral artery into the cerebral blood vessels.
Okay, so blindly perform a lower extremity artery thrombectomy, isn't it a piece of cake?
What else should they be surprised about?
Every doctor's first reaction is that they must not leave any flaws in the surgical process to cause trouble for others. They must choose the best solution based on the most standard surgical indications!
Even people at Huashan Hospital know Zhou Cheng.
At this time, Zhou Cheng was no longer polite or modest. Time was urgent now. If he were to be humble a few more times, the people of Lu Qianzhou would all be gone.
However, no one who came in responded to his words. People from other specialties went to the direction of the reader and were reading the medical conditions carefully.
After replying, Professor Chu immediately followed his students: "If you continue to draw electrolytes and replenish so much blood, you must pay attention to hyperkalemia and metabolic alkalosis."
There is a teacher named Zeng Diwei in the Ninth Courtyard.
"Don't worry, I can definitely do this!" Du Li replied very calmly.
If this were at the Shonan University Affiliated Hospital, Zhou Cheng would have the home field advantage. When there were people behind him, Zhou Cheng wouldn't even have to create opportunities himself, but would directly tell Ding Changle and Cai Dongfan.
Fuwai Hospital is the best hospital for vascular surgery and has strong strength, while the best hospital for neurosurgery is Tiantan Hospital in Kyoto. At least that's the official definition.
Zhou Cheng nodded at that time, his mind turned slightly, and he suddenly realized, and he said to himself, Brother Zhou Cheng, you better not be too arrogant!
You are now in Huashan Hospital. This is not a place where you can be unscrupulous. There are more professors and experts here than you see.
But avascular necrosis is about to come. If it is not treated in time and muscle necrosis occurs in all limbs, the patient will die, unless amputation can solve all the troubles at once.
However, seeing how powerful Zhou Cheng was, he had almost begged for their opinions humbly and tried all kinds of extreme methods.
And according to the most conventional thinking, if Du Li and Professor Ni didn't scold Zhou Cheng when he interrupted their own surgical design ideas, or even kicked him out, they were extremely well-educated.
"Bring over two more doses of dopamine and adjust the speed of intravenous medication."
However, the comprehensive strength of Huashan Hospital's neurosurgery ranks second in the country, and Professor Du Li is a well-known top expert and professor.
Then Zhou Chenggong said: "Tourist, can you push the computer for reading the film over for me? I want to see the specific location of the bleeding point. Now I need to put gel to stop the bleeding in the skull, thank you!"
For this operation, because the director personally spoke, there is no upper limit on the number of circulating nurses and hand-washing nurses. If there are ten, she will call ten people to come to the operating room! If there is a shortage of people, she can do it herself.
The damage caused by these words to Fang Jingsheng made the doctors from the vascular surgery department standing next to Fang Jingsheng start to look away and smile helplessly!
And if Zhou Cheng was not a little-known doctor, but a very well-known associate professor in the industry, Zhou Cheng wouldn't have to be so humble and make various suggestions. He would just get started and say this.
This is my specialty, please feel free to leave it to me.
At this time, Professor Yan from the Department of Thoracic Surgery also gave good news, saying: "The bleeding in this chest is not quite large, and the drainage volume here is not too much."
Zhou Cheng was being modest, but it was just a little too much.
Professor Chu, the anesthesiologist, also took a long breath and said: "CVP has finally stabilized. We are still slowly transfusing blood here, so it should be more stable. For the time being, we are out of the period where shock may occur at any time."
He could only shave his head.
Obviously he also knows Fang Jingsheng. There are many international conferences in Kyoto and Shanghai, and there are many collisions and exchanges between top professors, so basically all the big guys in the world know each other.
"This doesn't look like it, does it?"
"Professor Ni, can you help me make the guide sheath port for the lower arterial sheath? I haven't done it yet." Zhou Cheng answered very quickly, but also a little embarrassed. He seemed a little shy.
He can start the operation immediately. Even in the Ninth Hospital, Zhou Cheng can directly say that I want to go on stage, instead of asking several professors for their opinions and getting permission before going on stage.
Dean Wang had just finished speaking. The professor he introduced, an old man with clear eyes but age spots all over the bridge of his nose, spoke: "Dean Wang, I won't go on stage. Professor Du is here. The current surgery
The progress is very good.”
The only bad news is that the lower limbs that were previously embolized have begun to become embolized.
These steps are indispensable, plus the process of stopping bleeding, this speed is already considered the ultimate speed, okay?
Zhou Cheng actually wanted to start directly from the beginning, but he couldn't.
The speaker was the director of Huashan Hospital. When he spoke, Du Li and Fang Jingsheng were still working.
"The vital signs have also stabilized."
Fang Jingsheng opened and closed his mouth slightly, nodded, and moved away: "Then you start first. Starting from the last upper arm that I embolized, there may be fewer embolisms to encounter, and the operation will be more difficult.
Lower."
Immediately afterwards, Du Li also took charge of his own work: "Xiao Zhou, I will do the puncture needle drilling, you only need to be responsible for stopping the bleeding!"
"What?" Tong Dawei immediately turned his head and looked towards the operating table.
However, in most cases, due to the current medical environment, these professors are unwilling to touch or try many things.
When Zhou Cheng said this, Du Li immediately said: "Tour, quickly push the computer over and transfer the MRA images to him."
Fang Jingsheng said politely: "Professor Lu has good eyesight. The patient's current blood supply to the limbs is cut off. We did it ourselves in order to stop the bleeding quickly and easily."
This is Huashan Hospital. This operating room is only open to doctors from Huashan Hospital!
Even if Zeng Diwei comes for surgery, he still has to go through the procedure.
If you are very capable, you can get 30% by eating, 60% by hiding to protect yourself, and 10% by God's will. Isn't this life wonderful?
In this way, the most deadly places have been solved first.
It can be said that in fact, the professors in major teaching hospitals may be able to perform a much wider range of surgeries than they can actually perform, and they also have many ideas in their hearts and minds.
For six minutes, sterile draping is applied, a sterile film is pasted on the incision site, and the skin and subcutaneous tissue are incised. Use a knife to cut a small opening in the anterior sheath of the rectus abdominis, and then use scissors to cut the anterior sheath upward and downward.
Zhang Xingze, who was next to Tong Dawei, also felt that the word Zhou Cheng was familiar.
After all, Du Li is also a well-known professor of neurosurgery at Huashan Hospital. It’s not like he doesn’t know how to remove puncture-guided hematoma!
You know, under normal circumstances, who would embolize the arteries of the limbs?
This surgical idea is already in progress, so what’s wrong with the idea of interventional hemostasis and using a puncture needle to remove intracranial hematoma? However, the premise is that you must be able to do it yourself.
This speed is no longer slow. After all, only more than six minutes have passed since Zhou Cheng made the decision.
However, he was not absolutely sure.
This sounds a bit nice, but also a bit awkward.
But the professor of vascular surgery frowned slightly, looked at the condition of Lu Qianzhou's limbs, and said in disbelief: "Professor Fang, the blood supply to these limbs is so neatly cut off, could it be caused by trauma?"
Take full responsibility, pay compensation, apologize, be demoted, affect promotion, and may even no longer be able to work as a doctor.
"We're now looking to recanalize it."
It was at this time that the general surgeon opened the abdomen.
And such a bitter smile is the kind of bitterness that makes bile flow backwards.
Just as he was saying this, the door of the operating room was pushed open.
Zhou Cheng's words were calm, but the professional difficulty was something that others could not understand.
"Thank you, Professor Du."
First use vascular forceps along the direction of the muscle fibers and then use the handle or fingers to separate the rectus abdominis muscle bundle. The tendon should be cut with forceps and then tied with silk thread.
It's just that the speed at which Zhou Cheng performed the splenic artery hemostasis and intracranial artery hemostasis was a little too fast!
Professor Chu said: "Thanks to the limited blood loss, otherwise, the patient's heart rate would definitely have been in ventricular fibrillation now. It had jumped to 160 at the highest point, and the cardioversion had just happened not long ago."
He did not intend to retain his strength anymore and was always thinking about protecting himself. He decided that since Zhou Cheng wanted to save people with all his strength, he would take a risk to cooperate with him and save him time.
Du Li didn't say much, and immediately began to change the surgical method, and then began to draw a positioning line by comparing the location of the intracranial hematoma.
After all, the flow of blood in blood vessels relies solely on the pump circulation of the heart. After the flow stops, it stagnates. The blood does not move in the body, but other traumas will stimulate the endogenous and exogenous coagulation systems.
activated, which then causes blood to clot.
Dean Wang and others did not pay attention to Professor Chu's intervention and ignored the matter. However, for the sake of safety, Dean Wang still asked: "Professor Lu, Professor Nong, please don't refuse. Today's show
Surgery is an extremely difficult emergency surgery, and I sincerely request the two professors not to hold anything back without scruples."
Zhou Cheng said: "Professor Fang, now we will make another small opening at the far end of the femoral artery sheath entrance, and then remove the thrombus in the artery, and then pass through the bleeding point collected by the previous MRA.
, selectively perform precise hemostasis, and then remove the embolus. If the bleeding point is really difficult to deal with, local opening can be used to stop the bleeding."
Because, if you don’t hide your six-point ability and ideas, if one of the hundred patients has an accident and goes to court, it will not be said that you did not act in accordance with medical principles and did not treat according to the guidelines!
"Then this is Professor Nong from Tiantan Hospital in Kyoto. He."
"At that time, there was a rupture of the splenic artery and an intracranial hematoma. It was difficult to maintain the balance of blood flow through precise debridement and hemostasis, so Xiao Zhou and I chose to violently cut off the blood flow!"
Zhou Cheng nodded and said, "I can do it!"
Everything you do should be firmly framed under the so-called expert consensus and the so-called guidelines, because only in this way can you be exempted from responsibility and blame all accidents on the limitations of medical technology.
Zhou Cheng was also very quick at stopping the bleeding. It took only two or three minutes to treat several intracranial bleeding points.
"Shave your hair!" Du Li just replied.
The operation continues.
Why bother?
Therefore, under such circumstances, Zhou Cheng was a little touched that Du Li could say such things.
"The oxygen flow can be reduced..."
"How much fluid replacement?" He was already busy.
Then a large number of middle-aged and elderly people in green clothes, surgical masks and hats crowded in.
"What about the hematoma removal surgery?" Zhou Cheng asked one more question, mainly because the hematoma might be fatal. Zhou Cheng didn't want his legs and hands to be saved while he was doing the surgery to remove the thrombus from his limbs, but he would be dead.
"Zhou Cheng, he has already gone to the operating table for surgery. He embolized all the arteries in his limbs first, saying that the treatment will be postponed." Fu Youhan continued to explain.
Then after Tong Dawei saw Zhou Cheng's figure, he lowered his head and explained to Zhang Xingze: "Teacher Zhang, this Zhou Cheng is..."
As a result, the two people from the orthopedics department were no longer involved, and the operation continued.