The road to the rise of great doctors

Chapter 35 The Dangerous Adrenal Gland
Medicine is a practical science. Drawing nutrients from past experiences and lessons is the only way for medical students to grow into excellent doctors.

Doctors like Song Dachuan who are willing to teach are rare, so Liu Dong is filled with gratitude for being able to learn from these experiences.

Seeing that Song Dachuan didn't say anything, Liu Dong left his time to Dr. Song himself.

He walked to the operating bed, picked up the medical record, and checked the nursing records and laboratory test orders.After several days in the hospital, patient Wang Wen's blood pressure has been controlled within the normal range of below 130/80mmHg under the treatment of a drug.Other examination indicators, such as blood potassium, have also been corrected within the normal range.

The vital signs are under control, the examination indicators are also under control, the patient's physical condition is also in a state where he can take care of himself, and overall he can tolerate the surgery.

The anesthesia method used in this operation was general anesthesia. After the anesthesia was completed, the surgeon and assistants washed their hands, dressed, and went on stage.Song Dachuan is the surgeon, the first assistant is the attending physician of Song Dachuan's group, and the second assistant is Liu Dong.Intern doctor Shan Jiajia watched from the audience.

The patient's position is a side-lying position with a raised waist, which is common in urology departments. This way, the organs in the waist can be fully exposed, and the operating space for the operation will be larger under the pressure of carbon dioxide pneumoperitoneum.The surgical approach was through the retroperitoneal approach, with three holes in the skin, one for the mirror and two for the operating instruments.

After entering the body, Song Dachuan was seen performing the operation skillfully. He separated layer by layer according to the anatomical levels, and soon saw the fat sac of the kidney.

Separate along the outside of the fat sac, and open it at the upper side to easily see the adrenal glands.Then it's time to free the adrenal artery and find the location of the adenoma.

When preparing to treat the adenoma, Song Dachuan greeted the anesthesiologist and said, "I'm going to treat the adrenal gland. It will be squeezed during the operation and the blood pressure may change. Please control the blood pressure with medicine."

The anesthesiologist responded and said he was ready.

During the process of removing the adenoma, Song Dachuan said to his assistants: "The adrenal glands secrete hormones. It turns out that there are adenomas that cause excessive hormone secretion, so the adenomas have to be removed. But it turns out that when there are adenomas, hormone secretion By the way, it will send a "too much" signal to the pituitary gland, and the pituitary gland will receive negative feedback, and then the hormone secretion function of the normal adrenal tissue will be lowered. After the adenoma is surgically removed, this adjustment will not recover so quickly. Normally, the hormones secreted by the remaining adrenal tissue and the normal adrenal tissue on the other side may not play a normal role. This is why appropriate supplementation of glucocorticoids is required during and after the operation."

After successfully removing the tumor, Song Dachuan raised his voice and said to the circulating nurse: "The hydrocortisone brought from the ward can be given to the patient. Just drip it slowly."

When the nurse heard this, she went to get ready.

After completing the key steps, Song Dachuan stepped aside and handed over the finishing work to Yisuke. This was a very valuable growth opportunity for Yisuke.If the first assistant performs well, the surgeon who is willing to teach may slowly let go.However, if the performance is not satisfactory to the surgeon, the surgeon will not provide more opportunities.

After all, if a risk occurs, the surgeon is still responsible.

After the doctors and nurses on the stage carefully checked that the number of surgical instruments and gauze were complete, they started to stop the bleeding and checked that there were no new bleeding points. They placed the prepared drainage tubes in the surgical area and connected the drainage tubes. bag.

Because the incisions in laparoscopic surgery are relatively small and the technical requirements for suturing are relatively low, Liu Dong actively fought for it and left it to him to complete independently.Mission progress updated to 3/20.After the operation is completed, the patient is sent to the observation room to wait for him to wake up, and the next patient is notified to come over.

The operation went well, and Song Dachuan was in high spirits today.Out of the idea of ​​supporting young people, he did not leave the operating room. Instead, he continued to chat with the attending physician in his group, Liu Dong, and Shan Jiajia about the key points and precautions of adrenal surgery, ". The adrenocortical gland that secretes too much cortisol For tumors, the adrenal gland should be preserved as much as possible during surgery; for adrenocortical carcinoma, total adrenalectomy should be performed.”

"We try to preserve the adrenal tissue as much as possible, but we still need to supplement some hydrocortisone during and after the operation to prevent adrenal crisis."

Liu Dong nodded yes, and asked, "The removed adrenal glands are different, so how do you control the replenishment? How do you adjust the amount?"

Song Dachuan paused leisurely and then continued: "This is a good question. There are no strict standards for hormone supplementation, but surgery still provides a generally applicable method, and novices can follow that. The rest is Observe the clinical manifestations, review cortisol hormone levels, and make dynamic adjustments.”

"Even if you supplement hormones, you still need to pay more attention. In special circumstances, you must consider the possibility of crisis and deal with it in time to save lives!"

Time passed quickly, and the second patient also started surgery.

They are all diseases of the adrenal gland, but they secrete different hormones, so the names of the diseases are also different. The same thing is that they are all adrenal adenomas.

The operations are very similar, but the preoperative preparation and intraoperative preparation for adrenal pheochromocytoma and adrenal Cushing's syndrome are quite different.

Pheochromocytoma is a neuroendocrine tumor composed of adrenal chromaffin cells that secrete catecholamines.The typical manifestation is persistent or paroxysmal hypertension. If you test for hormones such as catecholamines during an attack, you will find that they are particularly high. When there is no attack, the test may be normal.

So, under what circumstances might an attack occur?
Several conditions may cause paroxysmal development, such as touching the tumor, changing body position, abdominal compression or massage, induction of anesthesia, emotional trauma, and unprotected beta-blockade.

In addition, pheochromocytoma may occur in other organs besides the adrenal gland.

Treatment is mainly surgical.However, the risk of this disease is very high, and the preparation requirements before surgery are also very strict. If there is no preparation before surgery, most doctors will refuse to operate immediately after suspicion, because if there is no preoperative preparation for volume expansion, they will directly operate. , it is possible that refractory shock occurred after the tumor was removed on the operating table, resulting in the patient's death.

But if you are prepared, the possibility of death risk is greatly reduced.

When this patient was hospitalized for suspicion of pheochromocytoma, he began to prepare for pheochromocytoma. When the test results came back and confirmed that it was indeed pheochromocytoma, the preparations were basically completed. The hospitalization period was arranged very reasonably and in line with the requirements. The country's requirements for the assessment of the weekly management rate of hospital beds and the average length of stay.

(End of this chapter)