The road to the rise of great doctors

Chapter 18 Approaching the Prostate

Liu Dong had a good night's sleep, and the alarm clock rang just before he was about to become the head of the department.
I went to the hospital cafeteria to have breakfast, and then quickly returned to the ward, where I skillfully handled all the dressing changes and medical orders for the patients in my group.

I went to see the hamartoma patient who had just undergone surgery yesterday. I saw that this person's vital signs were very stable, and his blood pressure, heart rate, and pulse were all within normal ranges. Occasionally, his heart rate would be faster when he was in pain, which is normal.

I looked at the urinary catheter again and found that it was clear and slightly reddish in color, which is also normal after surgery.What are you most afraid of after surgery?The biggest fear is that the urine suddenly turns red and gets redder and redder, which may require another surgery!

As long as there's no sudden and persistent redness, it's still fine.

Although Liu Dong was busy for most of the day last night, he could not leave the night shift.

One is because he took the initiative to work overtime last night, and the other is because their group has not finished their work today.Surgeons can relax only after ensuring that everything in their team is fine.

However, when Liu Dong saw the task display showing 2/10, he was still very satisfied and happy.

Today is the surgery day for Deputy Chief Physician Wang Peng, the leader of Liu Dong’s medical team.

He was on vacation for the past two weeks, so the team was relatively free. The surgeries were either done by others, or they were small and medium-sized surgeries that Zhu Guoliang could handle himself.

On the eve of Wang Peng's return, he asked Zhu Guoliang to notify several prostate cancer patients who had been issued hospitalization certificates and were waiting for surgery to come to the hospital.

Now that the preoperative preparations have been completed and the bowel preparation has been done, I am just waiting to have a big fight with Deputy Chief Physician Wang Peng today.

Today’s surgery is dedicated to prostate cancer.

Tumors in urological surgery mainly include prostate cancer, kidney cancer, renal pelvis cancer, ureteral cancer, bladder cancer, and cancer of the male reproductive system.

Prostate cancer is the cancer with the highest incidence rate in urology, and it is also a very interesting disease.

It is interesting mainly because this disease has several characteristics.

First of all, prostate cancer has something to do with heredity.If a close relative like a father, grandfather, or brother has the disease, the risk of getting the disease is several times higher than that of someone whose family has no one with this cancer.With early detection and early treatment, this disease may be curable.Therefore, early screening for this disease is particularly emphasized.People with family history and those without family history start early screening at different ages.

Secondly, although there is no particularly precise screening method like the "missile", there are currently more practical and proven screening methods, namely digital anal examination, blood test for prostate-specific antigen, and prostate ultrasound. Check the combination of these three. If there is a problem with any of them, it is worth checking carefully.Moreover, these screening methods are not expensive and troublesome.

Except for particularly remote border areas and poor areas, it can basically be done, and the results are quick.

Thirdly, prostate cancer is similar to breast cancer in that they are both related to sex hormones. Breast cancer is more common in women, while prostate cancer is exclusive to men.

Breast cancer is based on endocrine therapy, and the basic treatment for prostate cancer is also endocrine therapy - anti-androgen therapy.In other words, the basic treatment for prostate cancer is to control male hormones to very low levels, so that the cancer can be controlled.

If you still don't understand, just think about the evil swordsmanship in martial arts novels.What supports this treatment method is that, first, epidemiological surveys have found that basically no one in the last batch of uterine uterus people in China or those overseas who are born with congenital hypoplasia has this disease.Second, basic research also supports this view.Third, clinical research has truly proven that this treatment method is effective, safe and controllable.

Last but not least, this disease is divided into two stages. In the early stage, it is somewhat inert and progresses very slowly. Some low-risk cases do not require treatment, and regular and active monitoring is enough.In the later stage, it was contrary to the previous characteristics and deteriorated very quickly.In the indolent stage, some people have not taken medicine for more than ten years, and the cancer has not recurred or metastasized.But some quickly reach the second stage. Not only do the pain after bone metastasis require medical treatment, but the overall survival time is also very short.

There are currently many treatment methods for prostate cancer, and there are many effective methods, but generally speaking, its definite rules are still unclear.

After checking the room, Liu Dong followed Zhu Guoliang directly to the operating room.

He followed Zhu Guoliang closely. When he looked up, he found that Zhu Guoliang was a little serious today, and judging from the sweat soaked corner of his clothes on his back, Zhu Guoliang should be a little nervous.

Liu Dong realized that "today's surgery is probably very difficult." He became alert.

Radical surgery for prostate cancer was one of the most difficult surgeries in urology, along with total cystectomy + bowel replacement surgery, before open surgery or when laparoscopy began to be used.

It is difficult, not only does it place higher demands on the surgeon, it also takes a very long time, and the amount of bleeding is also very large.In addition, the place where the tumor grows is located deep in the pelvic cavity, so the space available for surgery is relatively small.

There are also more complications after surgery than kidney surgery, although they are generally controllable.

Patients after prostate cancer surgery may develop urinary incontinence and need to be guided to recover through pelvic floor muscle exercises. However, the recovery time varies, and the patient's persistence also varies.

Precisely because the operation is difficult, when the operation does not go well, when the operation time is too long and the people involved in the operation are too tired, even if there are many people watching, the surgeon may still give him the surgery because of a lack of cooperation. Yisuke and the people around him put on eye drops, and if they swear at people on stage, they can be called autistic.

In addition to swearing, another situation involves questions from superior doctors.Don't be afraid of being a top student, but you will feel ashamed if you are a bad student or a weak student if you don't do your homework properly.Even if you have done your homework, sometimes it will be extended to scientific research topics or the latest developments, and some of them cannot keep up with the professors.

This is nothing. The most uncomfortable thing is open surgery. Except for the main surgeon and at most one assistant, almost no one else can see the surgical field.

It's like putting on a pantomime, you can't see the performance, you can only listen to the limited discussion between the two audience members.

Going back to today’s surgery, what’s going on?

The first patient had undergone surgery for prostatic hyperplasia before, and the pathological finding was incidental cancer. The prostate-specific antigen was normal at that time, but during the follow-up, it was found that the prostate-specific antigen was significantly elevated. A puncture review was performed and pathology confirmed that it was prostate cancer. cancer.Therefore, for the surgery this time, the surgical method was open surgery.

The second patient's physical examination revealed that the prostate-specific antigen was significantly elevated, which ruled out urinary tract infection and various recent operations to squeeze the prostate. Therefore, he was hospitalized for a systematic examination, and the final diagnosis was that there was no metastasis. Localized prostate cancer.This is very suitable for laparoscopic radical surgery for prostate cancer.

The third patient, also an elderly person, had difficulty urinating for a long time and could not urinate completely, so he found time to come to the hospital for a check-up.Cancer was suspected during digital anal examination and ultrasound.A hospitalization note was issued, hospitalization was completed, and then an ultrasound-guided prostate biopsy was performed under local anesthesia. The postoperative pathology confirmed cancer.And according to the score, the risk is relatively high.

These three patients all underwent the same surgery on the prostate and surrounding organs and tissues.

Just from the skin to the surgical site, some require incision, some use laparoscopy, and some still need to enlarge the incision in the later stage when the urethra and bladder are sutured and the prostate is removed.

(End of this chapter)