Chapter 358 What kind of little nurse is this? She has beautiful tissues and organs like the patient
"Then again, I haven't felt so relaxed for a long time. I feel that this anesthesia plan was almost entirely given by Dr. Xu."
"Dr. Xu doesn't even need help from other departments for consultation. I always feel that he can even kick out our anesthesia department in the future..."
"No more talking. Give Dr. Xu anesthesia every time!"
...
On the tenth day of hospitalization, Professor Yan was pushed onto the operating table.
Preoperative examination:
CT showed mediastinal encapsulation, direct invasion of central veins, adjacent to the aortic arch, brachiocephalic trunk, left common carotid artery, left subclavian artery and superior vena cava, and blocked innominate artery.
Electrocardiogram was normal.
Heart rate 78 beats per minute.
Type B blood.
Normal liver and kidney function, etc...
This tumor made all the doctors sweat.
The location was too dangerous. If the blade was slightly tilted, it might cut important blood vessels and cause heavy bleeding.
Xu Qiu looked indifferent.
God knows how much fun he had in the simulated operating room.
Not to mention scratching blood vessels, when simulating an accident, several blood vessels burst at the same time, and he performed the operation under the blood flow.
He relied on the manual hemostasis method to stabilize this extreme situation.
Although the patient had serious sequelae in the end, but... after such an accident, it was a miracle to survive, so why expect a perfect prognosis.
"Doctor Xu, get ready."
Beside the operating room, the anesthesia director waited for Xu Qiu's instructions.
Most of the anesthesia plan this time was polished with Xu Qiu. In this sense, Xu Qiu is not only the chief surgeon, but also half an anesthesiologist.
"Well, let's start."
"Here we go."
The anesthesia director said, acting as a vanguard.
Before being pushed into the operating room, Professor Yan was injected with 0.5mg of atropine intramuscularly.
At this time, it was evaluated again:
P79 times/min, R19 times/min, BP1Hg, oxygen saturation 98%. There was little oral and respiratory secretions. No obvious abnormalities were heard by auscultation of the heart and lungs...
After confirmation, anesthesia began.
"Midazolam 3mg, fentanyl 0.1mg, etomidate 18mg, cisatracurium 14mg." Induction first.
Then, oxygen and nitrogen were given in the supine position for three minutes, and tracheal intubation was performed using an ID7.0 hose.
"Intubation went smoothly."
"Blood pressure dropped, 107/69mmHg!" This is a normal manifestation after induction of anesthesia.
After induction, intravenous inhalation combined anesthesia was used to maintain the anesthesia state.
After machine-controlled breathing, the patient was turned over and turned to the right side to prepare for surgery.
...
Buzz——
The operating room was silent, and everyone seemed to be able to hear the sound of their own heartbeats.
Everyone's eyes also fell on Xu Qiu's hand. Seeing him raise the scalpel, their hearts also became nervous.
Before he could blink a few times, a six-centimeter-long incision extending along the skin grain and arc appeared two centimeters above Professor Yan's sternal notch.
"Gauze, stop... stop..."
The assistant grabbed the gauze, and before he could say the word "stop bleeding", he was stunned by the beautiful and clean incision.
After symbolically wiping it, he finally succeeded in seeing a trace of blood.
"Continue." Xu Qiu said.
There are four conventional surgical routes for thymoma and thymus removal.
The rougher one is to split the sternum.
Not only the scene of orthopedic surgery is like a slaughterhouse, but also cardiothoracic surgery and neurosurgery.
In addition, there are also routes for enlarged thymectomy and thymectomy below the TV chest diameter.
Xu Qiu chose the fourth one, which is also a rarely used procedure in clinical practice today - transcervical thymectomy.
Its advantages are obvious, with little trauma and low damage caused by surgery.
But the disadvantages are also extremely fatal - the surgical field is poorly exposed.
For clinicians, seeing the tumor and the resection site clearly is more important than anything else.
Sacrificing the surgical field to reduce trauma is meaningless and not worth it.
But for Xu Qiu, both small trauma and surgical field can be taken into account...
Swish -
The sharp tip of the knife cut all the way to the sternocleidomastoid muscle.
Then, Xu Qiu freed the skin flap deep in the platysma muscle, and controlled the range extremely accurately.
The skin flap just touched the thyroid plane above and reached the sternal plane below. At this time, the sternothyroid muscle was pulled apart to both sides, and the thymus below was neatly displayed in front of everyone.
From here, you can also see an irregular fibrous tissue, which is brown as a whole and gray-red in part. It is attached to the position of the anterior mediastinum of the thymus, which is dazzling and shocking.
It is thymoma!
After a brief joy, everyone in the operating room frowned again.
This tumor is worse than expected. The area invaded is large and includes many important blood vessels.
It is probably not an easy task to remove it.
"Continue."
Xu Qiu didn't waste words. He glanced at it and judged the range of resection, and then he started immediately.
Start from the left upper pole of the thymus.
There is the inferior vein of the thyroid here.
"Ligation, cutting."
Then, using this ligature as a traction, blunt separation is performed downward in sequence to free the right upper pole.
Then move downwards, insert your finger at the sternal notch, and separate the thymus and the pleura behind the sternum, on both sides, and the innominate vein on the posterior wall...
The removal of thymoma is more complicated.
First, peel and separate the tumor and the surrounding important blood vessels.
Then cut the left common jugular vein and the left subclavian vein.
After completing all this, the operation had already lasted two hours.
Everyone in the operating room stared at the operating area, their mouths dry.
"So fast."
"The lower pole of the thymoma was lifted up... and the fat tissue was removed!"
"How did you find the area around the upper pole of the neck? Doctor Xu has some knowledge..."
At the main surgeon's position, Xu Qiu's face remained unchanged, as if he had planned everything, and his movements were steady and smooth.
The atmosphere in the operating room became more and more relaxed, and the intraoperative racing began.
"Wipe off the sweat." The assistant stretched his neck.
In the operating room, only Xu Qiu had a dedicated person to serve him, and those ugly people had to call them in person.
"Oh, where is it from?" The circulating nurse came over and asked casually.
The assistant helped Xu Qiu pull the hook and said, "Wipe the forehead first, and then wipe the water in other places."
The operating room suddenly became cheerful.
Only Xu Qiu remained calm. After a few minutes, he smiled happily and said intoxicatedly: "Not bad, the large blood vessels and pericardium are completely cleaned."
What a beautiful aortic arch, the superior vena cava, the brachiocephalic trunk, the trachea...
Everyone in the operating room stood in awe.
...
At the same time, Linhai International Friendship Hospital.
After returning from his studies, Director Huo also held a consultation at Guoyou Hospital. Following Xu Qiu's style, he discussed Professor Yan's medical records.
The sentence "The rare manifestations of common diseases are more common than the common manifestations of rare diseases" became a golden sentence for a while.
And Xiao Liu, who led the whole hospital's diagnosis astray, also accepted severe criticism and became more cautious and careful.
At this time, Director Huo was drinking tea in his office, and told a few young interns about the story of how he had a back-and-forth debate with Dr. Xu Qiu, and finally lost slightly and confirmed that it was not Creutzfeldt-Jakob disease.
Bang bang bang!
Suddenly, there was a knock on the door.
Director Huo jumped up immediately, as if he had done something wrong, but when he saw that the person who came was Xiao Liu, he breathed a sigh of relief, but at the same time he was furious.
"Another Ke Ya is sick?" Director Huo laughed twice and asked.
Xiao Liu's face changed, and he looked at Director Huo in horror: "How did you know?"
"???"
——
Brothers, please give gifts! The fried chicken that has been stable and steady at three o'clock in the morning is worth the reward of gifts!
