godfather of surgery

Song Zimo returned to the operating room with the medical records and all the informed consents had been signed.

After Xu Zhiliang washed his hands and came back, Yang Ping thought for a while and said: "Don't go on stage. Let Tang Fei bring a female coach to wash hands and come on stage. First, position yourself, then wash your hands and disinfect the sheets. Tang Fei! Come on stage, first put the clothes on the table." The endoscope is sent to the cecum. After it is completed, let me know and we will study the patient's color ultrasound next door."

Tang Fei immediately called her regular training girls to get ready. Once the anesthesia was completed, they would start working.

Passing the endoscope from the anus to the cecum is a basic operation of colonoscopy and is not difficult. As a general surgeon, Tang Fei has no problem at all.

Zhang Lin immediately understood: "Get ready to start the operation. Everyone, please go out. The sterility requirements for today's operation are very strict. Visits to the operating room are strictly prohibited. I repeat, it is strictly prohibited to visit the operating room. You can only go to the demonstration classroom to watch videos. Anyone found staying privately will be permanently punished." Not allowed."

A group of doctors in the general surgery department had already taken their respective positions, eagerly waiting for the operation to begin. Now Zhang Lin suddenly said that he wanted to clear the place. Everyone, look at me and I look at you. No one wants to leave.

Director Fang also wanted to stay and said to Zhang Lin: "Xiao Zhang, let's keep a few less."

Originally, endoscopic transcecal appendectomy was a relatively new operation. Director Fang has not performed it many times now and wanted to learn more. This operation is also accompanied by appendiceal necrosis and perforation, abscess formation, and intestinal adhesion. In this situation, it is almost impossible to perform endoscopic surgery. The operation was through the cecum, but Yang Ping insisted on using this method. Director Fang wanted to observe the entire operation.

"No! Everyone except the surgical team, clear the place!" Zhang Lin's answer was cold, leaving no room for negotiation.

When Director Fang heard Zhang Lin's tone, he didn't know what to say. He knew Zhang Lin's temper. This kid was very good now. He would fall out at any time. If he didn't listen to his arrangements, he would scold people on the spot.

Instead of waiting to be embarrassed and unable to get off the stage, it is better to take the initiative. Director Fang waved his hand: "Everyone, please go out, follow the arrangements, and abide by the sterility system."

As a result, the general surgery doctors reluctantly left the operating room and moved to the demonstration classroom.

"Thank you for moving, brothers. The sterility requirements for surgery are very high. There is no way, and I can't be in it." Xiao Wu reassured the general surgeon.

In this way, only Fatty Liang, Tang Fei, Zhou Can, Xiao Su, and the female trainee brought by Tang Fei were left in the operating room.

Fatty Liang needs anesthesia, which is irreplaceable; Zhou Can is on tour and cannot leave; Xiao Su is a device nurse, how could she not be in the operating room; Tang Fei takes the Pearson sterilization and draping, and also completes the first step of the operation, which is Participants in the surgery.

After driving everyone out of the operating room, Zhang Lin and Xiao Wu were like door gods, guarding the door of the operating room.

Everyone moved to the demonstration classroom in the operating room. There are many seats here, which can accommodate many people, and there is a large high-definition screen, which is usually used for surgical observation and teaching.

"I'm sorry, please understand. The surgical sterility requirements are strict, so we can only observe here." Song Zimo stood on the stage and apologized again.

Director Fang of the General Surgery Department was very puzzled. Acute appendicitis, a type III incision surgery, is a typical infectious surgery.

Are sterility requirements so strict?According to this situation, it is more stringent than artificial joint replacement surgery. Ordinary artificial joint replacement surgery would not drive people away like this.

Clearly bullying!
Surgical operations can be divided into three categories according to whether the surgical incision is contaminated or infected with bacteria:
Type I incision: clean wound, the most common ones are thyroid surgery, closed fracture surgery, etc. There is no wound at the surgical site, and there is no local infection. The sterility requirements can be basically met through local skin disinfection on the body surface.

Type II incision: Contaminated wound, generally refers to abdominal gastrointestinal surgery or biliary tract surgery, such as: gallbladder, pancreas, small intestine, gastroduodenal and other surgeries; there are also fresh wounds such as knife cuts, which are contaminated by bacteria , but the bacteria did not proliferate rapidly and massively, and no infection was formed for the time being.

Category III incisions: Infected wounds, usually abscesses or infectious diseases. Most of them require incision and drainage to drain the purulent secretions in time to control the infection, such as: suppurative appendicitis, abscess incision, intestinal perforation, Surgery for acute and chronic osteomyelitis.

In acute appendicitis, the surgical site has been infected and suppurated, so it is an infected surgery.

These types of surgeries will be strictly distinguished in the operating room and will not be mixed together. The operating room that does not perform appendicitis will perform closed fracture surgery, which can easily cause cross-infection.

There are also differences in the operating room sterility management system. For example, if there are more visitors for appendicitis surgery, the people in the operating room will not be conscientious about chasing people away.

However, if the number of visitors exceeds the limit for artificial joint replacement, the people in the operating room will definitely rush people and strictly limit the number of visitors.

Director Fang was unhappy, but he couldn't show it. As the director, he brought a group of doctors to observe and was driven out like sheep. It would definitely be difficult for him in terms of face, and the reason given by the other party was very far-fetched.

Does Professor Yang still want to keep this surgery a secret?Don't let us learn.

If you are not allowed to study and are shown videos, the videos are all performed under a microscope. The main part of the surgery is to do it under the microscope. As for the disinfection and draping, there is nothing interesting about inserting a camera.

Recently, Director Fang is also studying ETA and ERAT. ETA is endoscopic transcecal appendectomy, while ERAT is endoscopic retrograde appendiceal cavity treatment technology.

The little appendix is ​​a "little tail" on the colon. It is a tubular organ located between the human cecum and the colon. The distal end is a blind tube, and the proximal end communicates with the cecum. The so-called blind tube is like a super narrow tube. dead end.

Since it is an extremely narrow dead end, it is easy for traffic jams to occur for a long time. For example, fecal stones, food, foreign objects, or lymphocyte proliferation can easily enter this dead end and become blocked, leading to infection and appendicitis.

The incidence rate of appendicitis is actually quite high, as high as 10% in Western countries. In my country, the incidence rate is 4%-8.5%, accounting for 20%-30% of acute abdomen patients.

In ancient times, if you had appendicitis, you basically had to fight for your life. With luck, the body's immunity would control the infection and you would survive. If the body's immunity was not strong enough to control the infection, you would be hopeless.

Later, I had surgery to remove my appendix, and appendicitis was no longer scary.

The traditional surgical method is to open the appendix and remove it, also called appendectomy. This surgery has a history of more than 100 years. Later, with the development of laparoscopic minimally invasive technology, laparoscopic appendectomy was introduced.

In this way, there is no need to leave a scar on the abdomen, but there will still be a few small scars. After all, holes need to be made in the abdomen.

Later, some new surgical procedures were developed, such as transgastric appendectomy and transvaginal appendectomy. Whether transgastric or vaginal, a small incision needs to be made from the inside of the stomach or vagina, which can be used as an instrument and Through the entrance and exit of the lens, the lens and instruments enter the abdominal cavity and then go directly to the area where the appendix is ​​located to perform surgery.

These surgeries leave no scars on the outside, but leave scars on the inside and damage the stomach and vagina.

With the development of surgical technology, a new surgical technique has been developed. Endoscopic transcecal appendectomy does not require drilling inside or outside. The lens and instruments are inserted directly from the anus, retrograde along the anal canal, and pass through the rectum. , enter the colon, reach the cecum, find the opening of the appendix, make an incision from around the opening, and then remove the appendix.

This is the magical endoscopic transcecal appendectomy, suitable for super beauty lovers.

The endoscopic retrograde appendix cavity treatment technology is the so-called appendix-sparing surgery, which cures appendicitis without removing the appendix.In the past, everyone thought that the appendix was a useless organ and could be cut off without affecting anything.

Modern research believes that the appendix is ​​useful. It is an immune organ. Its specific function is similar to that of the mesenteric lymph node group and tonsils. It can kill some bacterial microorganisms and can also transmit its genetic information to lymphocytes, so that it can The body develops immunity to this microorganism and improves the body's immune function.

In addition, it can also store a large amount of probiotics, which can help prevent intestinal flora imbalance and reduce the incidence of intestinal inflammation; it can also improve digestive function and prevent indigestion.

So once there is a problem with the appendix, now it is not a one-size-fits-all approach, but also consider keeping it.

Of course, if the appendix is ​​necrotic and perforated, there is no way to save it. If the appendix is ​​not necrotic and perforated, instruments can be inserted through the internal opening of the appendix to remove the obstruction-causing substances, such as fecal stones, and then the appendix cavity is flushed and drainage is inserted. A few days later, the drainage was removed and the appendicitis was cured.

Director Fang also likes to delve into business. He likes to study new technologies in general surgery, such as da Vinci robotic surgery. He has carried out more in Sanbo. What about ETA and ERAT? How could he not do this kind of fancy surgery? Research.

"Director Fang, let's analyze the color ultrasound. Dr. Song, bring up the color ultrasound image." Yang Ping sat down next to Director Fang, and then brought up the color ultrasound image.

The internal systems of Sanbo Hospital are connected, and any images can be retrieved at any time in the operating room.

Analyze color Doppler ultrasound?

Director Fang was very puzzled. What was there to see in the color ultrasound? Besides, how could a surgeon read the color ultrasound? He usually looked at the color ultrasound report.

"Actually, today's surgery is more convenient to do with laparoscopy, but the patient has very high aesthetic requirements because of the scarring constitution, and even a few small laparoscopy scars are not acceptable. We are forced to use endoscopic transcecal surgery. This method of operation The space is limited and can only be operated around the appendix. Once a large abscess forms and intestinal adhesion occurs, this surgery is very unsuitable." Yang Ping told Director Fang.

The more Director Fang listened, the less he understood. Since it was not suitable, it was a relative contraindication. Why was this method still used?
What's more, the patient's condition is so serious, no matter what tricks, direct surgery to save life is the best option. At most, laparoscopic surgery can be regarded as a show of skill.

"This patient has such a large abscess and intestinal adhesions. It is very difficult to pass the cecum under endoscopy. Professor Yang, let's switch to laparoscopy."

Director Fang also heard the reminder from the color ultrasound doctor just now, and now he reminds me again.

We are all colleagues. It is our duty and our character to remind each other to avoid stepping into pitfalls. Yang Ping has a high level and is amazing. Director Fang knows that, but this is an operation and the person lying on the stage is a patient. There is no joke. If it is delayed, Time, it’s too late to regret the loss of life.

You often walk along the river without getting your shoes wet. If you have the mentality to show off your skills, it is very dangerous.

"It doesn't matter much. Although it's difficult, it's not impossible." Yang Ping was very calm.
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Family waiting area.

Liao Yiyi's parents were anxious. After all, their child was on the operating table. How could any parent not be worried?

"Lao Liao, you think Yiyi should be fine."

"Don't worry, there is a trabecula. I didn't hear what Yihan said. The Sanbo comprehensive surgical team is world-class. Look at this trabecula. A medical helicopter can be dispatched with just one phone call."

The old couple also felt guilty, remorseful, and worried. They felt sorry for their daughter at the time, and asked around whether they could avoid surgery. As a result, they wasted a lot of time and delayed the condition. Now they are in shock, and they heard that their lives may be in danger at any time.

"Xiao Zhang, what do your father's friends say?" Liao Yiyi's mother asked Zhang Zikun.

Zhang Zikun just called his father's friend, who is the director of general surgery at the top hospital in the imperial capital. He heard about acute appendicitis, accompanied by necrosis and perforation, the formation of a large number of abscesses around it, and intestinal adhesions.

The director was furious on the phone: "That's nonsense. People are in shock and their lives are in danger at any time. Either surgery directly, or if you are skilled in laparoscopy, you can use laparoscopy. I have never heard of this kind of surgery using endoscopic transcecum. I thought I am a half-immortal, so I don’t know the depth—”

"People said that he was in shock and his life was at stake. To save his life was the most important thing. He either had an operation or a hole punch. That surgery was done through the anus. This is pure nonsense and could lead to loss of life." Zhang Zikun said angrily.

A fatal accident?

"Oops! -" Liao Yiyi's mother raised her head, leaned on the back of the chair, her whole body was like mud, and she started crying.

Liao Yiyi's father was much calmer: "Keep your voice down, why are you crying? He is not an expert. He has never even seen a person's face. Can you believe what he said on the phone? Isn't Xiaoliang in there? What are you worried about?"

Zhang Zikun became angry when he heard the word "Xiao Liang". He said, "How can experts talk nonsense?"

"Okay, Xiao Zhang, sit down and wait and see, it's only been ten minutes." Liao Yiyi's father was very dissatisfied with Zhang Zikun.

However, he was also beginning to beat his heart. When he was in Appendix [-], the doctor had said that Yiyi was in shock and needed surgery to save her life. He also suggested surgery as soon as possible, and even offered to help jump in the queue for surgery as soon as possible.

But later, because there was an emergency helicopter, it might be faster to transfer here, so I was transferred to the hospital quickly.

"Yihan, look at the time, what time is it?" Liao Yiyi's father also became nervous.

Human life is at stake, this is no joke.

Now it doesn't matter whether he has surgery or not, as long as the operation can be completed and my daughter is fine.

"Uncle and aunt, don't worry, Dr. Liang and the others are here."

Yu Yihan was not in a hurry. As a young girl, seeing Dr. Liang's aura and the roaring helicopter, Yu Yihan completely believed in Dr. Liang.

This time is really difficult. One minute seems like an hour, passing very slowly.

"Old Liao, you've been talking for so long, why haven't you come out yet? Will there be any trouble?" Liao Yiyi's mother stared at the door of the operating room.

Liao Yiyi's father said: "Don't talk nonsense!"

"Auntie, I've only been in for eighteen minutes," Yu Yihan said.