Gou is practicing medicine in the clinic

This ability to determine the nature of a mass by palpation alone can only be mastered by a few extremely experienced doctors.

He benefited from the feedback of bone palpation and knife incision, which gave his hands an extremely keen sense of touch.

His judgment is far beyond that of ordinary chief physicians.

When I palpated this mass just now, I could even faintly feel that there was a certain cavity inside the mass due to its unique elastic feel.

Normal tumors, whether benign or malignant, are unlikely to have this weird feeling.

There is basically only one possibility for a true cavity to form inside the tumor, and that is suppuration.

Some abscess cavities located deep in the muscle layer can form a closed environment under certain circumstances. They form a delicate balance with the surrounding normal tissue. It will cause the patient to experience some inflammatory reactions and pain, but the abscess cavity will never be broken.

Eventually a huge swelling formed.

If it is inflammatory suppuration formed in the dermis or epidermis, it will not take long for a small white pus ball to form.

Use a needle to directly break the epidermis and squeeze out the pus.

Generally, you can recover quickly after squeezing out the pus.

This kind of epidermal pus ball is generally very small. The most common is pus produced by folliculitis.

However, this patient's abscess cavity is deep in the muscle layer, and the body itself has a certain absorption capacity.

Whether it is pus, internal bleeding, or other fluid accumulation, it can be absorbed slowly.

For example, some patients have intracranial hemorrhage resulting in fluid accumulation. After diagnosis, the doctor believes that the fluid can be absorbed by itself, so craniotomy can be avoided.

There is also postoperative bleeding after thoracic surgery.

A drainage tape or drainage tube will be installed in the first few days after surgery, and the drainage tube will be removed when it is almost done.

At this time, there may still be fluid accumulation in the chest cavity.

But the body will absorb it slowly.

The nature of pus is different from that of ordinary fluid accumulation. It has certain destructive and poisonous effects.

It can often cause normal tissue necrosis, suppuration, and may even cause sepsis, sepsis, etc.

Therefore, doctors are often cautious when dealing with patients' abscess cavities.

"Most of the tumors on the back of the neck are lymphomas, thyroid tumors, and metastatic tumors. Occasionally, there are lipomas, cystadenosteatomas, etc. But for such a big bag, and it has been as long as five years, there is pus in it. I have been working in general surgery for seventeen years, but I have never encountered it before."

After hearing Li Jingsheng's diagnosis, Dr. Lin obviously didn't agree with him.

There are many types of tumors.

The back of the neck is a place where tumors are more likely to appear.

The most feared tumor growing in this location is malignant lymphoma.

"What type does Dr. Lin think this mass belongs to?"

Li Jingsheng asked calmly.

"The patient reported that this mass has been present for more than five years. Recently, it has begun to increase rapidly and is accompanied by severe pain, so I think it is probably a bad tumor. Some tumors cannot be judged by their hardness to the touch. . I have had many malignant adenomas removed and they are soft to the touch, but the pathological test results are malignant."

This is the first time that Dr. Lin and Li Jingsheng have huge differences in diagnostic opinions.

The two usually had discussions about illnesses and causes, but this time they had the biggest disagreement.

"Doctor, what does malignant mean? Does it mean cancer?"

The patient was listening to the discussion between the two doctors. When he heard that the mass that felt far away might be a malignant tumor, he seemed very nervous.

These days, everyone is not afraid of the flu or various inflammations, but they are afraid of cancer.

Other diseases can be cured, but cancer is difficult to cure.

If it is in the advanced stage, the chance of surgical treatment will be lost directly.

"Don't worry yet. What is the nature of your mass? It can only be determined after it is cut out and pathologically tested."

Li Jingsheng comforted the patient.

In his opinion, the patient's mass was probably a benign mass.

"Can you help me cut it here?"

"can!"

Li Jingsheng answered simply.

"Then please ask the two doctors to cut it for me!"

"With such a big mass, why not consider going to a big hospital for surgery?"

Dr. Lin asked.

"Big hospitals talk nice, but they are extremely expensive, and the technology may not be as good as your Sunshine Clinic. I am an old resident here, and I know that your clinic's medical skills are very good. I will do the surgery here."

The patient insisted on having surgery here.

"Take a B-ultrasound and then arrange for surgery."

"Sure! Just get it for me. Let my wife pay how much it costs."

The patient was very generous.

……

A B-ultrasound was taken, which showed that there was a low-density shadow inside the mass.

This made Dr. Lin a little less confident.

Because low-density shadows, whether gray or dark shadows, may be fluid accumulation. Of course, it could also be a cyst.

Because this operation involves the head and neck, and the diameter of the mass is large, the risks of the operation are relatively low.

Dr. Lin did not dare to perform this operation alone.

After the patient underwent skin removal, Li Jingsheng and Dr. Lin performed the surgery together.

This is also the first time that the two of them have done surgery together in a real sense.

"To remove such a large mass, I'm afraid he would have to have a skin graft on his neck."

Dr. Lin and Li Jingsheng were having preoperative discussions.

"I recommend incising the tumor first to see what's going on inside. If there is an abscess cavity, it needs to be incised and drained first, and then the abscess needs to be cleaned and debrided to determine the nature of the mass."

Li Jingsheng still believed that there was an abscess cavity in the mass.

"Okay then, I'll listen to you, let's cut it open and take a look first."

Dr. Lin agreed.

There was no way, Li Jingsheng was the boss, and in this case, he could only give in to the boss.

"Munro, lidocaine!"

"Give!"

Meng Luo and Li Jingsheng have set up the stage many times, and the cooperation between them is quite tacit.

She is an excellent surgical nurse. Not only does she have solid basic skills and a high level of professionalism, she is also good at cooperating with the surgeon at work.

Everyone has their own ideas.

So do nurses.

Most of the time, they don’t rely on the doctor’s opinion.

They are likely to stick to their own ideas when faced with obvious problems.

In this case, the cooperation between doctors and surgical nurses will become less tacit.

There may even be an argument.

During the operation, it is common for the chief surgeon to have a dispute with the traveling teacher.

Many people think that circulating nurses are only responsible for sterility management in the operating room. This is a very superficial understanding.

A good circulating nurse can even correct some fatal mistakes made by the surgeon during the operation.

In a top hospital in the imperial capital, there is a particularly awesome traveling nurse. In ten years, because of her persistence and foresight, she avoided at least forty-seven possible medical accidents.

It can't be said to be a medical accident.

If she hadn't insisted, the patient's life would have been in danger if the surgeon had followed the original operation.

Because the doctor operates according to procedures, even if the patient does die or is seriously injured or disabled, it does not constitute a medical malpractice.

At best, it was just a failed operation.

Human medicine can advance so rapidly because of human lives.

To give the simplest example, before Li Jingsheng invented endoscopic mucosal dissection, patients had to remove large tumors in the digestive tract, which might require removal of the stomach, duodenum, etc.

This can lead to a serious decrease in the patient's quality of life after surgery.

Nowadays, there is a new surgical procedure that no longer requires cutting off the intestines or stomach, allowing patients to have a very high quality of life after surgery.

There is almost no difference from before surgery.

So what about patients who have had surgery before?

Is it classified as a medical malpractice?

That certainly can't be the case. Therefore, the progress of medicine cannot be separated from the dedication of patients.

Just like amniotic fluid embolism, no one knew about this disease before. Later, many mothers died. After autopsies, it was discovered that the amniotic fluid caused the embolism.

Even today, the mortality rate from amniotic fluid embolism remains extremely high.

The only good thing is that we now know that there is such a disease.

During prenatal check-ups, if problems are discovered, timely intervention can be initiated. After delivery, doctors will also pay special attention to observing the mother's condition.

If you encounter amniotic fluid embolism, it is no longer like before, you can only watch the mother die. It is now possible to perform some active rescue operations, thereby greatly reducing mortality.

Li Jingsheng has Munro, an excellent surgical nurse. During the operation, he attaches great importance to some of Munro's suggestions.

After injecting local anesthesia into the patient, Li Jingsheng used a scalpel to cut open the patient's mass after the anesthesia took effect.

Peel off layer by layer.

Doctor Lin, who was watching from the side and acting as a medical assistant, couldn't help but his eyes brightened when he saw how powerful his incision skills were.

Before coming to join Li Jingsheng, he had already learned about some of Li Jingsheng's skills online.

I thought Li Jingsheng was only good at endoscopy.

Only now did I realize that Li Jingsheng’s incision technique was so brilliant.

“Dr. Li’s surgical skills are so strong!”

Dr. Lin praised sincerely.

"I am over-flattered!"

He cut the mass open while being modest.

Not only is there very little bleeding, but important blood vessels and nerves are perfectly avoided.

The depth of the cut is just right every time.

Even the Da Vinci robot would have difficulty achieving his level of accuracy.

The precision of robotic surgery is very high, and some capabilities are impossible for humans to possess. For example, when humans undergo surgery, they carry emotions, inevitable nervousness, or other concerns.

But robots don't.

As long as the settings are set, even if the organ is normal, it will be cut directly without hesitation.

It can be seen from this that robot surgery is relatively dull.

More suitable for intracavitary surgery.

Such as abdominal cavity, chest cavity, etc.

Because the surgical field of view in these places is limited, the space is also limited.

In particular, with the development of human surgery today, minimally invasive surgery is increasingly pursued, which also gives robotic surgery great development opportunities.

All we can say is that robots and doctors each have their own advantages when performing surgeries.

Whether it is cutting into normal tissue or lesions, the range and depth can only be set in advance.

Even so, there is still the possibility of miscutting.

Many patients still have many concerns when choosing robot surgery.

When a doctor performs surgery on a patient, he or she can make timely adjustments based on the patient's actual physical condition.

Especially at Li Jingsheng's level, if you want to cut thicker, you can cut thicker.

If you want to cut less, you can cut less.

There is no need to mention peeling off lesions or important blood vessels and nerves.

Humans can completely defeat robots.

Some doctors boast about how advanced robotic surgery is, but this is actually somewhat irresponsible.

Let alone robotic surgery, even with the development of endoscopic surgery today, there is still no way to replace traditional surgery.

Even in ten or twenty years, traditional surgery will still be necessary.

"Pus, there is really pus!"

Han Siying, a female intern, saw that after her master cut open the patient's mass, there was actually an abscess cavity inside.

The rancid smell instantly filled the operating room.

Fortunately, Li Jingsheng's operating room bought a complete set of air conditioners from the People's Hospital last time. Can quickly achieve ventilation.

Even so, even the patients themselves were affected.

"Attractor!"

Li Jingsheng looked very calm and calm, and he was even prepared for the abscess cavity within the mass.

Only Dr. Lin's expression was quite complicated.

Before cutting open the mass, he thought that Li Jingsheng would definitely apologize to him later.

Only now do I realize that Li Jingsheng looks young, but his skills are probably far above that of his second-level chief physician.

There is only two words in Dr. Lin's heart, that is, convinced.

Just by touching the mass with his hand, he can know the nature of the mass and know that there is an abscess cavity inside. This ability makes Dr. Lin very envious.

Li Jingsheng didn't think about anything else, but concentrated on operating on the patient.

After cleaning up the pus, he examined it carefully and found no sinus tracts or anything like that.

"Dr. Lin, you are an expert in general surgery. Can you tell us what caused the abscess cavity to form inside this mass?"

After Li Jingsheng cleaned up the pus, he found some red granulations in the abscess cavity.

I'm a little worried about granuloma.

This is a rather difficult disease.

If the surgery is not handled well, the recurrence rate is extremely high.

"There is no way to determine the specific cause of formation, but I think his mass is probably just due to internal suppuration and constant irritation, leading to local inflammation. You can first debridement, then reduce inflammation, and observe for two or three days to see the effect. Scrape. The recovered tissue can be sent for pathology to determine its nature.

If the tumor is really malignant, it is completely possible to have a second surgery at that time. "

Dr. Lin gave the surgical plan.

This is a relatively safe plan.

"Just do as you say!"

Li Jingsheng directly debrided the patient and took some specimens for examination.

The diameter of the abscess cavity within the mass exceeds 3 cm.

And red granulations can be seen everywhere on the wall of the abscess cavity.

There's no way to tell if it's new flesh growth or a specific disease.

This can only be done for pathological testing.

After the operation, some suturing was done and a drainage strip was left.

For a suppurative cavity like this, even if it is deep in the muscle layer, it is generally not suitable to be sutured immediately after surgery.

Otherwise, if it rots inside, it will easily cause danger.

Instruct the patient to come to the clinic for infusion in the next few days, and then check the condition of the surgical wound.

The patient readily agreed.

When Li Jingsheng cut open the patient's mass and found that there was indeed an abscess cavity and pus, the patient's trust in him had reached its peak.

It just wasn't said out loud.

This is also reflected in the patient's words and deeds after surgery.

The patient didn't discount anything Li Jingsheng said, and he agreed to everything without even asking any questions.

At noon, Li Jingsheng and Dr. Lin were sitting in the office for dinner.

"Dr. Li, I have learned a lot today. I have heard that there are experts in breast surgery who can tell whether a patient's breast is malignant or benign just by touching it with his hands. Many breast cancers are diagnosed as 4A in other hospitals. Festival, if he says it is benign, then it is benign.

On the contrary, some nodules or pus that do not look dangerous are said to be dangerous and bad things, and the postoperative pathology can basically be fulfilled.

Just by touching the mass with your hand, you can tell that there is an abscess cavity inside. I am really impressed.

The hospital I am in is not bad, but no one in our general surgery department has your ability.

Even my teacher, after touching it with his hands, can roughly infer the condition of the patient's lesions, such as the size of the lesion, the depth of invasion, the extent of surgical resection, etc. But he couldn't tell the nature of the mass just by touching it.

Also, I see that when you perform bone setting on a patient, you can tell the fracture condition just by touching it.

Take an X-ray and the results will be exactly the same as your diagnosis. This ability is really great. If you have a chance, can you teach me? "

Dr. Lin looked eager for knowledge. (End of chapter)