Gou is practicing medicine in the clinic

For example, the most common postoperative problems include pleural effusion and even fluid pneumothorax.

Some doctors believe that removing one lung will have minimal impact on the patient's health. This is definitely a relatively one-sided perception.

The weight of an adult's lungs is about one kilogram.

Li Jingsheng has seen people with relatively small lungs weighing only five or six hundred grams.

The weight of their whole lungs is only equivalent to the weight of other people's right lungs.

The size of the lungs is closely related to the patient's height and weight. Under normal circumstances, the size of the lungs is 'tailor-made' based on the person's height and weight.

Some obese people will find that they are out of breath after just climbing stairs or going up a slope.

This is related to the fact that after the body becomes fat, it needs to consume more energy and oxygen during exercise.

The original lungs only need to supply the oxygen consumption required by the body of 110 pounds. After this person's body becomes fat, his lungs are still the same as before, but they already need to supply the body's oxygen consumption of 150 pounds.

At this time, it will suffer from insufficient oxygen supply.

Especially when the body is exercising, its oxygen consumption increases, and its oxygen supply becomes even more stretched.

So the owner of the body breathes heavily, takes big breaths, and inhales hard to improve its respiratory function.

Like the heart, lung capacity increases with exercise.

This patient had a lobe of his left lung removed. It is not yet known whether it was the upper lobe or the lower lobe.

But it is certain that this will have an adverse effect on the patient's respiratory function.

Now, the patient's lung cancer has recurred and metastasized to another lobe of the left lung.

It is difficult to say whether the patient's left lung can be saved.

After cutting off the entire left lung, this patient will have symptoms of breathlessness when doing heavier work or going up stairs.

The left lung has a total of eight lung segments.

After you get lung cancer, the doctor will evaluate the actual situation and decide whether to remove the entire diseased lung lobe or only part of the lung segment.

Just like intestinal surgery, if more normal lung tissue can be preserved for the patient, more will definitely be preserved.

In order to save trouble, some doctors may take drastic measures and directly cut off the entire lung lobe.

After all, there are only a very small number of doctors who only want to save trouble.

"Dr. Li, the surgical incision has been made. You can do the surgery!"

Director Zhang trained him very hard.

As Li Jingsheng displayed more and more surgical skills during operations, Director Zhang had a comprehensive understanding of his surgical abilities.

When there is a suitable training opportunity, he will often be given a burden to hold the sword.

This kind of decentralization in surgery is extremely rare.

Because there are huge risks in operation and they are uncontrollable. Superior doctors generally do not dare to delegate power easily.

That is to say, Director Zhang was willing to give him a chance because of Li Jingsheng's outstanding performance, calm behavior and excellent skills in previous surgeries.

"Thank you, Director Zhang, for your cultivation!"

Li Jingsheng didn't refuse and cut directly with the knife according to the marked position.

Generally, major thoracotomy is not required to cut the left lobe of the lung. In order to minimize the harm to the patient, an incision is often made from the intercostal space.

If necessary, a rib can be amputated.

If you are doing heart surgery, you will need to split the sternum.

All surgeries that require thoracotomy are major surgeries, and they are basically Level [-] surgeries. The difficulty is high and the risks are high.

But even if it’s a big chest opening, don’t be afraid.

Today's thoracotomy surgery technology is quite mature. After thoracotomy treatment, it usually only takes more than [-] days to basically recover.

For many serious diseases, doctors don’t have to worry too much when they propose thoracotomy.

Definitely still rely on the doctor’s opinion.

Even in beautiful countries, when serious emergencies such as cardiac arrest occur, the traditional surgical method of thoracotomy is still the main method.

Minimally invasive and interventional treatments are relatively powerless in the face of many diseases.

Nowadays, almost all patients are pursuing minimally invasive and interventional treatments, which is a big challenge to traditional surgeries.

However, traditional surgery is still an important means to rescue patients, and it is the main means.

Many people believe that interventional treatment and minimally invasive surgery have become the trend. Even if the disease clearly requires a thoracotomy, the patient still asks the doctor to perform minimally invasive surgery.

However, in order to pursue performance, some hospitals will deliberately cater to patients and encourage minimally invasive surgeries and interventional treatments.

In the end, after the operation was completed, the treatment effect was greatly reduced, and many complications and sequelae even occurred.

The rights of patients are not protected at all.

This is also a phenomenon worthy of vigilance in the current medical community.

When those traditional surgeries are squeezed, minimally invasive, and interventional become the mainstream treatment method, the real loser is the patient.

By the time the treatment is over, no one will pay for the patient's losses.

The hospital makes money, the doctor gains reputation, and only the patient is unlucky.

Li Jingsheng followed strict instructions, cleaned his hands, applied disinfectant, then put on gloves and surgical gown, stood at the surgeon's position and began to incise the patient's chest.

The other doctors on Director Zhang's team worked closely together, and no one had any objections.

On the contrary, they watched Li Jingsheng calmly cut open the patient's chest cortex, fat layer, and muscle layer layer by layer... They admired Li Jingsheng from the bottom of their hearts. Including Director Zhang, no one can achieve such a small amount of bleeding.

Li Jingsheng's knife sense is too keen.

He also has a very good understanding of human anatomy and is able to avoid larger blood vessels and nerves to ensure the safety of the surgery.

After opening the patient's lung cavity, it can be seen that the lower lobe of the patient's left lung is missing.

It must have been removed during the last surgery.

After investigation, Li Jingsheng found a tumor in the upper tongue segment of the upper lobe of the patient's left lung.

The diameter is about 3 cm.

It can be seen that it has invaded the surrounding normal lung tissue.

"Dr. Li, please help make a good diagnosis and find out what is the cause of this patient's recurrence of lung cancer."

Director Zhang and several doctors on his team also began to conduct in-depth research.

They started discussions with Li Jingsheng.

“The entire lower lobe of the lung was removed during the last operation, and the tumor now grows in the upper tongue segment of the upper lobe of the left lung. I personally think that the surgical instruments were contaminated with cancer cells, so the possibility of tumor recurrence is very small.

If the surgery is not clean, the possibility of recurrence is also very small.

Because the site of occurrence is in the upper tongue segment of the left lung lobe.

No obvious signs of infiltration were found in the surrounding blood vessels and lymph. Therefore, I personally believe that the recurrence of lung cancer in the patient is likely due to the cancerous lesions already existing here during the last surgery.

It's just that it's small, so it's overlooked.

After cutting off the lower lobe of the left lung, this lesion may have been stimulated, causing it to grow rapidly and complete mutation in a very short period of time. "

After careful observation, Li Jingsheng gave his own opinion.

"I personally prefer Dr. Li's opinion. What about you?"

Director Zhang asked his doctors for their opinions.

"It may also be metastasis through lymphatic infiltration. I have seen a paper specifically studying lymphatic metastasis of lung cancer, which mentioned that in clinical practice, it was found that some patients' lung cancer tumors showed jumping characteristics. The entire lung lobe, even the left and right lungs, was removed. After removing the lung on the right side, after laboratory examination and analysis, it was finally determined that the lung cancer tumors that occurred in non-adjacent areas spread through lymph nodes, and this is why skip lesions appeared."

The second assistant, Dr. Tang, expressed his opinion.

Dr. Tang is a stuffy person and doesn't like to talk much.

But he is extremely knowledgeable and has a wide range of knowledge.

When discussing the condition, Dr. Tang always makes a big splash.

"In practice, we have indeed encountered some lung cancer patients whose lesions jumped close to each other. During pathological biopsy, they are more likely to spread to lymph nodes. I think the analysis of Dr. Li and Lao Tang is very reasonable."

Dr. Isuke He always speaks so arbitrarily.

When discussing the cause of the disease, Dr. He never refutes anyone's opinions face to face.

"Last time, the lesion was not discovered and ignored. This is basically certain. Because this tumor is three centimeters in size, within eight months, if the lesion had not been there for a long time, it would be difficult to grow to such a large size. .

If it is really caused by lymphatic spread, then this operation may require cutting out the entire left lung, and then it will be necessary to do another lymph node dissection. "

Director Zhang made a concluding speech.

It also provides guiding surgical advice.

"I support Director Zhang's plan. This time, we must do it thoroughly. Removing the left lung will have some impact on the patient's quality of life in the future. However, considering the risk of tumor recurrence, it is worthwhile to remove the left lung."

Dr. He then spoke.

The cause of the disease is basically clear, and the surgical plan has been decided. There is nothing more to say next. The left lung is removed and all surrounding lymph nodes are cleaned.

Then the surrounding area was examined and no new lesions of lung cancer metastasis or spread were found.

"Director Zhang, the removal of the left lung has been completed. Do you think it is necessary to explore the right lung again?"

Li Jingsheng came over to participate in the operation today and got most of the operation tasks.

The benefits to his personal surgical experience were huge.

Especially the removal of the entire left lung was very difficult, and almost all of it was performed by him.

"I took a X-ray of the right lung and found no problems. It is very difficult and risky to explore from here. There is no need to go through any more trouble. Just shut up!"

Director Zhang knew very well that even if a problem was found in the right lung, it would be impossible to cut it out.

The patient's entire left lung has now been removed. If the remaining right lung is not moved, normal blood oxygen exchange in the patient's body can still be ensured.

For the sake of surgical safety, cavity closure is now the best option.

Not bothering is also a surgical principle that Director Zhang wants Li Jingsheng to learn.

After the operation was over, several people were having post-operative discussions.

Wait for the patient to wake up from anesthesia.

"After being returned to the ward, you must be closely monitored. One is to check the drainage situation, and the other is to prevent lung infection. Cutting off one lung is particularly prone to infection. In other words, the patient's family conditions do not allow it. Otherwise, he should be sent to the intensive care unit. Just stay for a few days."

Director Zhang said.

The cardiothoracic surgery department has its own small ICU, which often admits patients with serious conditions.

There are also patients who have just undergone heart surgery and need to stay for a few days.

Generally, patients cannot be transferred to a general ward until the next day after the life monitoring equipment is removed. Some stay in the hospital directly until they are discharged. (End of chapter)