【1142】The opinion of the boss must be treated with caution
This was the first time the two of them had met each other since Xiao Yazhi's surgery that day when the envelope was dropped.
Xie Wanying's attention falls on the patients.
The heart rate is 126 beats/minute and the blood pressure is a little low. It is estimated that there are signs of intestinal incarceration. Xie Wanying speculated.
Soon, Dr. Liu Chengran arrived at the hospital.
"Bring the CT scan." Liu Chengran walked into the operating room and commanded.
Submit various preoperative patient information.
Liu Chengran checked the patient information and asked about Xie Wanying: "Tell me, what is the condition of this patient?"
The emergency room teacher’s torture at night made people nervous. Xie Wanying quickly expressed her understanding of the case: “The preliminary diagnosis was paraduodenal hernia PDH. This disease is very easy to be misdiagnosed and missed, so the patient was treated in other hospitals when the symptoms were not obvious.
Medical treatment did not reveal any findings. This time, the patient’s symptoms aggravated due to strenuous exercise after eating a full meal and could not be alleviated by medication. The family rushed the patient to our hospital for emergency help. After taking a CT scan, there was no major obstacle to diagnosis. Duodenum
Paralateral hernias are divided into left and right sides. Judging from the CT results, this patient should have occurred on the left side, with the jejunum entering the Landzert recess. On CT, a slightly obvious bursa between the pancreas and stomach in the upper abdomen can be seen.
Sexual intestinal loops.”
"How do you think this surgery can be done?" Liu Chengran continued to ask her.
"The patient has symptoms of intestinal obstruction, vomiting, intestinal volvulus, intestinal strangulation and necrosis cannot be ruled out. The digestive endoscope cannot enter, so a laparotomy is required. Incision is made from the midline of the abdomen, and the intestinal tube in the hernia sac is taken out and given
Correct and close the hernia ring. I hope the intestinal tube has not been ruptured and necrotic, otherwise it will be peritonitis. Now the patient has no symptoms of peritonitis for the time being, so this operation should be performed as soon as possible."
Hearing her quick and steady answer, Liu Chengran was sure that Tan Kelin's order could be carried out and ordered: "You do it."
What did the teacher say? It was so sudden that even the students couldn't react.
Liu Chengran waved his hand: "Go and wash your hands, you will be the one doing the surgery tonight."
Li Qian took a sharp breath: What?! Didn't you hear that a surgical student tried to perform an appendicitis operation?
Appendicitis? Appendicitis is basically severe diffuse peritonitis if exploratory laparotomy is performed, and their attending doctors may not be able to save such patients. All elective appendicitis operations are now laparoscopic, so where are the opportunities for interns?
It is best to first learn to perform traditional laparotomy surgery to lay a solid foundation, and then perform laparoscopy.
Now that I have such an opportunity, I quickly give it to the interns to try. After passing this store, there is no next one.
Is this surgery difficult? It’s not necessarily much more difficult than the appendicitis surgery we used to practice on interns. In fact, the previous appendicitis surgeries were quite difficult. Some interns had to go in and find the location of the appendix for a long time. For surgical interns,
How to quickly find the lesion site after laparotomy is a threshold. Interns need to associate the imaging films with the thinking experience of the actual anatomical locations of the various organs in the patient's abdomen.
You can take it for granted in your mind, but it's another matter when it comes to actual operation. Otherwise, why do seniors often say that juniors have high ambitions and low abilities. They can speak clearly and logically, but when they do it, they are all bad.
"Didn't you do it with your teacher Sun?" Liu Chengran said to the student.
Teacher Xiao Sun had done a surgical case before, and she discovered a paraduodenal hernia and had to deal with it. She was lucky enough to participate in it. She had an impression that she knew the steps of this operation better.