The road to the rise of great doctors

Chapter 40 Traveling through the anterior gland
If one of them is met, you need to carefully consider whether to do a prostate biopsy to judge: first, the prostate is hard and has suspicious nodules during digital anal examination; second, the serum prostate-specific antigen is significantly elevated, or there are suspicious nodules. The ratio of free prostate-specific antigen to total prostate-specific antigen was abnormal during the interval; third, ultrasound suspected that there were suspicious nodules in the prostate.

To put it simply, if there is an abnormality in the digital anal examination, ultrasound or serum prostate-specific antigen, after ruling out infection and other factors, further examination or surgery is required to confirm the diagnosis.

Liu Dong recalled the conditions of the four patients who underwent surgery today. One had a significant increase in serum prostate-specific antigen during physical examination, one had an abnormality found during an outpatient digital anal examination, and two had surgery for other diseases. Ultrasound, then ultrasound reported suspected prostate disease.Therefore, it is very clear why these people do piercing.

After he took the patient to the operating room, he took the first one in first, while the others sat on the stools at the door of the operating room and waited.The reason why we brought down everyone who was going to be operated on was because this was a local anesthesia operation and did not require general anesthesia or epidural anesthesia. The process did not take long.

Under the guidance of Liu Dong, the patient came to the operating room and lay on the operating table waiting.Liu Dong went to the consumables warehouse to collect the puncture needles necessary for the operation and brought them back to the operating room.

After returning, Dr. Zhang has arrived. He is chatting with the patient, comforting him and explaining some precautions.After hearing the sound of the door of the operating room, he looked up and saw that it was Liu Dong, and signaled him to start.

Because the prostate is located deep in the pelvic cavity, there are two methods of prostate biopsy according to the different paths from the outside of the body to the prostate. One is through the front-perineal skin-prostate, and the other is through the anus-rectum- prostate.

Transperineal surgery is more commonly used in foreign countries, because the parts passed by this path are more sensitive to pain and will be more painful if not anesthetized, so anesthesia is generally used. The anesthesia method is similar to painless gastroscopy with drug anesthesia, which is better than the painless gastroscopy. The anesthesia is simple but more complicated than local anesthesia, and you will wake up quickly after stopping the medication.The method of locating the prostate is generally to locate it under magnetic resonance and then puncture it.

Another type of transrectal surgery is a commonly used method in the country.The night before the operation, you will drink some laxatives combined with an enema. The purpose is to clear the stool in the intestines. In this way, the operation will be relatively clean. When the puncture point of the rectum recovers after the operation, there will not be too much stool passing through. Reduce the risk of infection.

The advantage is that the operation is simple, does not require the assistance of a radiologist, and does not occupy magnetic resonance equipment. Moreover, the pain here is relatively dull, and intravenous sedation and analgesics are not required. Local anesthesia is sufficient.But it is not without discomfort. The uncomfortable part is that when the mirror and operating instruments are inserted into the anus, there will be some bulging feeling. However, before the operation, some lidocaine gel will be squeezed into the rectum to further Reduce pain and other uncomfortable feelings.This method is performed under the guidance of ultrasound. Once you have learned ultrasound, you can operate it by just one person. It is simple and easy.

Of course, regardless of the different approaches or techniques, there are still unified rules for prostate puncture.

Simply put, it is to avoid blind puncture, but make full use of ultrasound or magnetic resonance for positioning, so as not to miss anything and minimize the number of puncture needle operations to reduce damage.

In the past, many blind punctures were performed. After confirming the location of the prostate with a digital examination, the puncture needle was inserted into the prostate to obtain tissue.Later, with the improvement of ultrasound or magnetic resonance and other technologies, and the continuous exploration of urological surgeons, the accuracy and standardization have been significantly improved compared to before.

Nowadays, systematic puncture is usually used, which is equivalent to artificially dividing the prostate into different lobes, and then there are several partitions in different lobes. Systematic puncture means that each partition can basically find its correspondence on the punctured specimen. of.

Dr. Zhang asked the patient to pull his pants down to his knees, then lie down on his side, hold his knees with his hands, and push his butt up.He also reminded me again to maintain a good posture and not move. If I move, the puncture needle may go astray.Basically, most of them go smoothly.

At Dr. Zhang's instruction, Liu Dong first put on disposable gloves and squeezed the lidocaine gel into the rectum.

Then change into sterile gloves, disinfect and spread sterile drapes according to the standards for contaminated wounds.

At this time, Dr. Zhang set up the ultrasound, sterilized the long ultrasound probe and put on a condom. In some places, sterilized plastic bags will be used instead.

After the condom is applied, talk to the patient to prepare him or her.

Liu Dong stood nearby, arranged the small bottles for preparing tissue specimens, and continued to watch them carefully.

The surgeon first inserted the ultrasound probe into the anus. After finding the prostate, he first looked at the overall structure of the prostate and which parts were suspicious.After that, the puncture was completed according to the systematic puncture method.

After each piece was worn, Liu Dong took it off with a piece of paper and placed it one by one in a separate specimen bottle filled with formalin according to the number.The number of the puncture specimen is adapted to the position of the prostate, and the pathological results are also issued according to the number, and these are very important for the staging of the disease.

Liu Dong watched Dr. Zhang's skillful operation, paying careful attention to his technique, and looking at the puncture position on the ultrasound monitor from time to time.After one operation, he gained more insights into ultrasound-guided surgery.

After the operation, the patient was sent back to the ward. After returning, Liu Dong picked up the just-used puncture needle with gloved hands, studied it carefully, and then asked Dr. Zhang about the positioning and precautions of prostate puncture while the iron was hot.

Dr. Zhang also kept no secrets and answered questions one by one.Of course, the same is true for other people, but most of them can't understand ultrasound, and no matter how much they say, it's useless.

In the next few surgeries, Liu Dong cooperated more skillfully. During the operation, he also raised several questions based on his own understanding.

"Dr. Zhang, is this a suspicious nodule?"

"Doctor Zhang, is this a blood flow signal?"

"Dr. Zhang, is this the urethra?"

"Dr. Zhang, if there are many suspicious areas, do you need two more needles?"

……

Dr. Zhang is a very patient doctor, and he does not hide anything from the junior doctors who are eager to learn, and answered Liu Dong's questions one by one.

Moreover, the questions he asked were very valuable. After learning that he had also taught himself about ultrasound, he took the initiative to talk a lot about his experience in prostate biopsy.

In more than an hour, because of the good connection, all four prostate biopsy procedures were completed.

After the operation, a piece of gauze will be stuffed in the anus to compress and stop bleeding. The gauze is exposed outside the anus for easy removal.These are all discussed with patients and their families during pre-operative conversations or post-operative instructions.And I mentioned many times that I had an enema before the operation, and the feeling of wanting to defecate after the operation was due to the stimulation after the operation, not the actual need to go to the toilet.

Liu Dong returned to the ward and sat on the stool in the office, recalling today's prostate biopsy process and the ultrasound operation technique, savoring it carefully.

When in doubt, just look at Surgery.

The surgical teachings are concise and concise, and combined with the practical experience, it is very interesting to recall.

At this time, the system in Liu Dong's mind reminded:
Detecting the accumulation of experience and systematic learning, the skills are upgraded to "skilled-level abdominal ultrasound diagnosis", "skilled-level abdominal and urological ultrasound diagnosis, entry-level urinary system ultrasound interventional operation".

(End of this chapter)