The road to the rise of great doctors

Chapter 16: Twist

Liu Dong walked over to Zhang Bin closely, and confirmed with the doctor on duty in the emergency department that this lady was the one to be consulted.

"You go and collect the medical history first," Zhang Bin ordered, then inserted the CT onto the screen and started watching.

Liu Dong walked to the lady's bedside and asked, "Where do you feel pain? How long has it been? Have you had any serious illnesses before?"

The medical history collection was completed in a short time.

It turned out that the female patient was 33 years old. After eating dinner at home, she just started doing yoga. She developed severe waist pain when she exerted a little force on her waist.The family quickly drove her to the hospital.

After arriving at the hospital, I first held my urine and did an ultrasound. No abnormalities were found in my bladder, but I found a tumor on one kidney, and it looked like it had ruptured and started bleeding.

After the examination, my family helped me to urinate once, but everything was red, and when I lay back on the bed after urinating, the pain was even worse than before.This frightened the whole family.

He immediately decided to transfer to the largest hospital in the area.

Just such a process.

After coming to the emergency department, the doctor on duty in the emergency department was a very experienced senior attending doctor.He knew that when the urology department came for consultation, he would still need a CT, preferably enhanced CT.This is the most efficient and best for patients.

At that time, seeing that Dr. Zhang and the other two were busy changing the urinary catheter, the emergency doctor directly performed an examination and asked the auxiliary doctor to take the urgent order and accompany him to the imaging department for an enhanced CT examination.Moreover, the urology department was called for consultation as soon as possible after the examination.

Zhang Bin watched the film and then said to Liu Dong: "You have really earned your luck in our department these days."

"Come on, let's take a look at this plain scan and enhanced CT. Don't read the report first. Do you have any ideas?"

Liu Dong took the film, looked at it for a while, and said, "This kidney tumor is composed of several components. This is fat, and these are blood vessels. It seems that it should be renal angiomyolipoma, also called hamartoma."

He continued: "This is one of the most common benign tumors of the kidney. The key point of diagnosis is that the tumor has multiple components. If the fat component is found, the diagnosis will be almost indistinguishable."

Zhang Bin said: "You have a good grasp of knowledge. This patient is still very typical, with a typical medical history and imaging. What is more difficult to diagnose clinically is the type of small tumor that lacks fat, which is difficult to diagnose with kidney cancer. Identification and treatment decisions are difficult. What will you do with this patient?"

He lowered his head and started writing consultation opinions.

Liu Dong began to think about how to answer more comprehensively.

After pondering for a moment, he replied: "The patient has suffered a rupture and bleeding and will definitely need to be hospitalized. Whether it is surgery or temporary observation, he needs to be hospitalized."

"First of all, you should stay in bed absolutely, have ECG monitoring, pay attention to blood pressure, and deal with it promptly if there are symptoms of shock. You should also put in a urinary catheter, not only to reduce the aggravation of the patient's condition when getting out of bed or urinating in bed, but the most important thing is to observe the urine If the color of the fluid continues to be red, it must be treated urgently. If the color changes from dark to light, you will feel more at ease. In general, it is to reduce the aggravation of the situation, and at the same time, pay attention to whether emergency surgery is necessary.
"Secondly, check the anemia situation. If the anemia is severe or the hemoglobin continues to be low, blood transfusion is required; preventive anti-infection is also required.
"Again, such a large hamartoma, even if treated conservatively this time, is prone to bleeding again. Not every time is so lucky, and some severe bleeding may be fatal. I heard that some patients ruptured and bled after getting out of the car and twisting their waists. . And this patient also got sick while doing yoga this time, so she has to be active. So if the condition is stable, it depends on whether she agrees to surgery. Interventional treatment can also be chosen. Surgery and embolization have their own advantages and disadvantages."

Liu Dong touched his head and said, "That's all I know."

Zhang Bin said, "These are already very good, and you can communicate with patients individually."

Call the patient’s family members over and briefly explain the disease and the recommended treatment plan.

Then the family member walked up to the patient and communicated with her in a low voice.The patient still had obvious back pain and was frowning all the time.

After Zhang Bin issued the hospitalization slip, he asked Liu Dong to give it to the patient's family and told him to be hospitalized immediately.

When the family members rushed to go through the hospitalization procedures, Zhang Bin went back to the ward to prepare a set of pre-operative materials, leaving Liu Dong standing guard next to the patient.

At first, the patient was still lying down, but when Liu Dong was not paying attention, he saw that the patient might be tired from lying down, so he turned his lower body to one side. As a result, the color of the urine tube suddenly turned deep red, and the blood pressure also increased. Lower, the monitor starts to alarm...

Liu Dong hurriedly speeded up the rehydration speed, and at the same time asked the emergency doctor to prepare blood, give booster drugs, and urged the laboratory department to get the results quickly.Then report to Dr. Zhang Bin and prepare for surgery...

Soon, everything was ready, and the patient's blood pressure was barely maintained at 90/60mmHg, which basically met the surgical standards.

After the patient was pushed to the room, he was given general anesthesia. Zhang Bin also called Deputy Director Song Dachuan, who was attending today's class, and said he would be here shortly.

Then brush hands, disinfect, spread towels...

Zhang Bin said while doing it: "Most of the incisions used in open kidney surgeries are the current waist incisions, which are different from those in general surgery or hepatobiliary surgery.

"Mainly because the kidneys are in the retroperitoneal cavity, this kind of incision does not enter the abdominal cavity, which can reduce the impact on the abdominal cavity and avoid complications such as adhesive intestinal obstruction after surgery. Operating directly in the retroperitoneal cavity requires moving nearby organs There is also less tissue. The most important thing is that the field of view exposed in this way is okay, and the incision is shorter.

“Sometimes a trans-abdominal approach is used, it depends on which surgeon is good at or familiar with it!”

Liu Dong held the suction device in one hand and the retractor in the other hand, cooperating with Zhang Bin's operations.Separate layer by layer, and press the separated tissue underneath with large gauze.

Adjust as you go so that your field of vision is always clearly exposed.

A good field of vision is half the success of the operation.

With the cooperation of the two, the operation went smoothly and the kidney was gradually exposed.

At this time, Song Dachuan just finished brushing his hands and put on surgical clothes.He now took the position of chief surgeon, and Liu Dong retreated to the position of second assistant.

After taking the stage, Song Dachuan first checked the exposure of his field of vision and said: "Xiao Zhang, you are very skilled in this operation. You can complete the prelude so quickly with a trainee. Are you familiar with the following?"

"Xiao Liu cooperated well. You also said that a good assistant is the enjoyment of surgery. I am a little envious of Zhu Guoliang. Director Song, I also reviewed it before going on stage. I asked Xiao Liu to be an assistant and continue to help me. I The kidneys are free and the key arteries and veins need to be treated by you..." Regarding the opportunity given by the superior doctor, Zhang Bin immediately agreed.

Surgery is like this. Not many people are willing to let go. Only when superior doctors trust you will they gradually let go a little bit.And the more skilled you are, the more likely you are to let go if you can figure it out, and the one who can't figure it out won't dare to let it go at all.And this kind of superior doctor is the most loved by young people.

Zhang Bin continued to swim, while Song Dachuan watched attentively. Liu Dong also followed the surgeon's instructions to expose his field of vision and absorb the liquid in time.

Overall, the field of view is basically clean and refreshing, with a distinct sense of beauty...

　Please recommend and collect, thank you
　　


(End of this chapter)