The road to the rise of great doctors

Chapter 17: Keep your heart steady and your hands ruthless

At the critical step, Song Dachuan took over and explained as he was doing it: "There are two key points in this operation. One is to fully mobilize the exposed parts of the hamartoma; the other is to mobilize the arteries and veins." If it comes out, in case of severe bleeding, it can be stopped in time and the danger can be turned into safety."

In a few clean strokes, he clearly separated the arteries, veins, and ureters at the renal hilum, and separated them first with a tape.

"The next step is the key step. Everyone, please be alert and don't let anything slip." Song Dachuan said. He used a "temporary blood vessel blocking clamp" to clamp the main blood supply and reminded the nurse to start timing.

This temporary blocking of the blood supply to the kidneys is to reduce bleeding during surgery.Studies have confirmed that short-term blockade has no damage to kidney function, and only long-term blockade can lead to renal ischemia.

When encountering an emergency and requiring long-term blocking, preventive measures are usually taken, such as placing some cooling substances around the kidneys, or stopping the operation in the middle, and temporarily opening the blocking clamp to allow congestion. a while.

However, the one that has the highest acceptance and the least impact on the patient's kidneys is the one just mentioned, which is to complete the operation quickly in the shortest time.

After blocking the blood supplying blood vessels, Song Dachuan then performed surgery along the edge of the hamartoma.Because it is a benign tumor, the surgical methods for this tumor may vary slightly in different medical centers.The first is the traditional nephron-sparing surgery method for renal tumors, which involves completely removing the hamartoma along the edge of the hamartoma with a little bit of normal kidney tissue.Another method is to resect within the scope of the hamartoma, which may leave some residue. However, benign tumors require complete resection, while malignant tumors have less demanding tumor-free principles.

The specific situation is still based on the size of the tumor, the difficulty of performing surgery, weighing the pros and cons of preserved kidney function and recurrence, etc., to comprehensively determine the method of surgery.

Liu Dong couldn't help but think that many things were similar.Just like when driving to change lanes, you should turn on your turn signal in advance to remind the vehicle behind you that the vehicle in front is preparing to change lanes - this is equivalent to being prepared in advance for what may happen.Then the speed should be fast and the lane change should be slow - the speed should be fast to avoid being rear-ended by the car behind you, and the lane change should be slow so that the vehicle behind you can have a certain reaction time after seeing it.If the speed is slow and the lane change is rapid, it may lead to a tragic rear-end collision.

Song Dachuan and Zhang Bin's operations today inspired Liu Dong a lot.

Repeated or multiple surgeries in the human body may cause adhesions, inflammation, etc. due to previous surgeries, making the anatomical boundaries unclear.However, for operations on some untouched and unaffected parts of the human body, anatomical gaps do exist. Except for unavoidable places, other operations are performed along the anatomical levels. On the one hand, it can reduce the impact on organs and tissues. On the other hand, less bleeding and clearer layers make it easier to find injuries, so the speed will naturally increase.

As for key parts, it is necessary to make a plan in advance for the occurrence of danger.When danger occurs, you must be bold, careful, and quick-sighted!
Or to be more precise, "When in danger, keep your heart steady and your hands ruthless."

The word "ruthless" not only means to be quick, but also to make decisions quickly.Especially in case of severe bleeding or other dangerous situations.

The hamartoma enucleation was successfully completed, followed by hemostasis, flushing, and suction of all the fluid.
"Director Song, your work is really good and fast!" Liu Jia, today's equipment nurse, praised.

Song Dachuan laughed and responded: "Men have to stand up in front of beautiful women. If it doesn't work now, then it won't work anytime."

As he said that, he gave up the position of the chief surgeon, and said to Zhang Bin and Liu Dong: "For the rest, you two can continue to do it, no problem."

"No problem, no problem, how many times have I done this." Zhang Bin responded quickly, his face was serious, but his heart was as peaceful as an old monk chanting scriptures.Liu Dong's first aid cooperated well, and he did it very easily.

Zhang Bin completed the closure of the retroperitoneal cavity and was about to continue.

Liu Dong remembered his task and quickly volunteered, saying: "Teacher Zhang, you have been busy all day. I will just suture the skin and subcutaneously. You can criticize anything I do wrong."

Zhang Bin thought of Liu Dong's performance during the operation and Zhu Guoliang's evaluation in the department, and he was probably relieved.

He handed the needle and tweezers to Liu Dong and picked up the scissors.I saw Liu Dong skillfully continuing the suturing, using instruments throughout the process, subcutaneous first, then skin. The suturing and knotting were fast and stable, and the distance was kept very appropriate.

After the subcutaneous suturing was completed, Zhang Bin checked it carefully and found that the suturing was quite good. He secretly sighed: This is really a feast for the ancestors.

"Dr. Liu's subcutaneous suturing operation is really good." Liu Jia said to Liu Dong, "Except for Dr. Liu, I have never seen other interns perform such beautiful operations, and some residents do not do it so fast."

"It's done." Liu Dong skillfully tied the last knot and cut the thread.Cover with sterile dressing.

Then, work with others in the operating room to change the patient's position from a recumbent position with the waist elevated to a supine position.

After the anesthesiologist extubates the tube and the patient wakes up, he can be returned to the ward.

I looked up at the clock in the operating room and found that it was already 2 o'clock in the morning.

Looks like I have to sleep in the duty room.

For emergency surgeries at night, if it is late at night, most of them will still take a shower in the operating room, change into a set of clean hand-washing clothes, then put on a white coat directly, and then go back to the duty room to sleep.

Of course, this is the case in urology, but even less so in breast surgery and thyroid surgery.General surgery, pediatric surgery, and neurosurgery are in a busy state again, while orthopedics, trauma, and hand and foot surgery are in a regular busy state.

Different surgeries have different fates.

Liu Dong remembered the TV series he had watched. The protagonists were either neurosurgery, emergency department, or cardiothoracic surgery. At that time, they were still discussing on the Internet. Why did other medical and surgical departments not appear so much?
After discussing and discussing, he finally felt that the following reasons were more pertinent.

First of all, most domestic medical dramas are urban romance dramas disguised as medical.It doesn’t really matter which department the male and female protagonists are in, but the plot requires that there need to be many stories, and there are more stories related to emergencies.

Secondly, these stories are relatively simple. Except for the ones that cannot contain blood, the others are all routine. Unlike urology, obstetrics and gynecology, and breast surgery, which are easy to miss, it would be embarrassing if they need to be mosaic or even deleted. .

Finally, there are many contents involving medical ethics in American and British dramas, and the doctor-patient relationship in China is inherently sensitive. Except for a few cases that have been concluded, the others may not be suitable for the public's taste.

At this time, the patient finally woke up.Liu Dong escorted her back to the ward and once again told her to stay in bed after the operation, not to do it again, and not to exert force on her waist to avoid the risk of further bleeding. After seeing that the patient and family members understood, they were relieved.

For diseases, surgery is very important, but perioperative preparation is also particularly important.

As he walked towards the bathroom, Liu Dong couldn't help but think of another story about another patient who underwent conservative treatment for renal hamartoma. He was completely bedridden for 2 weeks and was discharged after conservative treatment. However, he was hospitalized again after being discharged because of his marital life.
Worlds, full of wonders.Various instructions to avoid trouble still need to be repeated many times.
　Asking for recommendation, asking for collection, asking for tickets~~
　　


(End of this chapter)