Under all the above circumstances, ordinary doctors will be intimidated. As long as the cervical scraping is suspected to be cancer, ordinary doctors will not take the risk and will cut it out completely. They are most afraid that if the removal is not clean, the recurrence will be more serious.
A highly skilled doctor will bravely go through the trouble for his patients, provided he has the ability.
When Zuo Liang asked this question, he was actually considering whether to cut off the cervix directly. Total cervixectomy also preserves the uterus for the patient, but seals the cervix so that the patient cannot have children in the future. If the patient is older, there should be no need to preserve fertility, and there is no problem in removing the cervix.
The less trouble, the better.
However, Du Haiwei approved the surgical plan provided by Geng before the operation.
The plan Geng Yongzhe submitted was cone cutting rather than full cutting.
"Teacher Zuo, Yingying and I have discussed cutting within this range." As he spoke, Geng Yongzhe took out the prepared notebook and showed the surgical anatomy diagram he had drawn to the surgical teacher.
Zuo Liang had actually seen this picture before. Now he checked it carefully with his eyes and asked, "How did you determine the range?"
"The size of this tumor is about 1.9 centimeters, which is just the critical value. Therefore, the range of incision should be expanded. It is necessary to ensure that the distance between the negative margin and the tumor is 3 millimeters."
Numbers sound great but are hard to do. Once again, we come back to the key issue of differentials. Three millimeters is a slight difference in itself. To ensure this standard deviation of three millimeters, the doctor's naked eye must first be able to accurately determine the actual edge line of the tumor. Secondly, it is best to reach the value of three millimeters when operating the knife, and neither undercut nor overcut will be performed. .
Thinking about it this way, it seems that it is not as refreshing and easy as cutting it all off.
Don't think like this. If you cut it right and get it right with one cut, it will save you a lot of effort and time. There are a lot of steps involved in the complete resection, which may lead to a lot of bleeding, which is very troublesome. So the biggest difference between the two is that the doctor chooses to use his brain or his hands.
Zuo Liang felt that he had no choice. With his relatively little clinical experience, he was not sure whether he could perform the cut very accurately.
A tumor of 1.9 centimeters is not considered small. Doctors with some qualifications know that such a tumor is like a cavity. It may be just a black spot on the surface, but it may actually be rotten to the root after the black spot is opened. Because the electric knife cannot cut deep enough, it has to be eliminated and traditional cold knives are used for cutting. The cold knife should be used to cut deeply in a circular motion to completely dig out the tumor. This sword technique is too difficult.
Zuo Liang frowned, not knowing how to express himself. The classmate Geng who answered him failed to answer the key points and help him achieve the above requirements.
I don’t blame the students. The difficulty lies in the fact that the surgeon has to do it himself. Others cannot replace the surgeon’s hands and certainly cannot be of any help.
"Teacher Zuo, why don't you let Mr. Geng take a cotton swab and draw an incision area around the tumor for you?" Xie Wanying, who was watching, saw this and took the initiative to suggest.
Zuo Liang looked at her deeply: This classmate Xie could guess what he was thinking just by hearing him ask a question.
Unlike Geng, she has worked with many teachers on the operating table and has a good understanding of how to observe and understand the surgeon's thoughts.
Du Haiwei stood silently beside him, seemingly not objecting to the two interns' suggestions.
The superior's opinion did not change. Zuo Liang turned to classmate Geng and said, "Okay, you do the painting."
The teacher stepped aside and Geng Yongzhe sat on the bench. He dipped a cotton swab in gentian violet and carefully marked the incision site along the perimeter of the tumor in the exposed surgical field.
