There are people in the court who are easy to handle, and there are people in the hospital who are easy to check, not to mention the head nurse in the hospital.
The nurses and sisters were very accommodating. Within a day, the results of the preliminary examination came out, and gastric cancer was diagnosed! ~
"Yuan Zhang is right, what should we do now?" The head nurse of the special needs department was confused.
"Go find Zhang Yuan, wait." As he spoke, he thought for a while and then asked: "Does Zhang Yuan smoke and drink?"
"I've never seen him smoke, but I know he can't drink alcohol. There's no need..."
The head nurse felt that they were all her colleagues. Although she was a superior, Zhang Fan was usually very approachable. It was not that she was reluctant to give things away, but once she gave them away, she felt that she was not dignified enough.
"What do you know! It doesn't matter if you ask someone for a check-up. In this situation, you listen to me..."
Sometimes people are too complicated. In fact, simplicity is better. Just when they were struggling, Zhang Fan had already seen the test results on the computer.
"Director Zhao, how are you? Mother-in-law, head nurse, how is your physical assessment?"
"It's okay. The anesthesiology department said it's OK. We don't think it's a big problem here." Lao Zhao replied.
"Then get ready to schedule the surgery! I'll do it myself."
"Okay, Zhang Yuan."
The stomach, the digestive tract, to be honest, in the digestive tract, the stomach is actually very solid, just like a car in a certain country. If you take good care of it, it can serve you for a lifetime.
It is not as delicate as other digestive tract organs. Let’s just talk about ulcers. In fact, gastric ulcers do not account for a high proportion of ulcers in the digestive tract.
Especially among young people, duodenal ulcers are the most common. For example, some young people feel uncomfortable and have stomach discomfort before meal time. After eating two mouthfuls of food, they are fine!
This is a typical hunger pain! What cannot escape is duodenal ulcer. Moreover, this place is particularly prone to ulcers.
There's a reason for this. There's a lot of acid in the stomach, but it has a bicarbonate barrier on the surface to protect the stomach wall.
But there is no such thing in the intestine. It relies on bile and pancreatic juice to neutralize gastric acid. The gallbladder and pancreas open in the intestine together, and the liquids they secrete are alkaline.
However, there is a distance from the stomach to the opening of the pancreas. This distance is where ulcers are likely to occur, which is the famous duodenal ulcer.
If you don't eat on time, you'll eat when you're hungry and you'll be full when you're hungry. When you encounter something delicious, you'll have to hold on to it until you walk away. When you encounter something you don't like, you'll just call it weight loss.
These are the killers that cause duodenal ulcers.
The stomach is not so delicate. It can usually deal with it as long as you eat more or less. However, people become scared when they drink alcohol or get angry. The most scary thing is Helicobacter pylori.
Cancer, to put it simply, means that there is an inducing factor that causes the cells to change quantitatively and qualitatively.
Any cell in the human body has the possibility of becoming cancerous, and inflammation is the biggest inducing factor. Therefore, doctors all say that there are two major categories of diseases, either inflammation or cancer.
Helicobacter pylori is the biggest inducer of gastric cancer in China.
Some patients said, "I have never eaten barbecue, never drank alcohol, and I don't like to get angry in my life, so why did I get gastric cancer?"
As a result, the previous physical examination report showed that Helicobacter pylori was positive!
Is this bacteria contagious? Contagion, Chinese people have a bad habit. When eating, especially to children, the elderly like to feed their own chewed food to the children.
The child eats whatever food he wants at any age. If he has no teeth, he eats celiac food and drinks milk.
If he has teeth, let him chew them by himself. There is no need. Let your Helicobacter pylori-rich mouth be chewed by your children!
And in order to show your enthusiasm and politeness, you have to pick up food for the guests. Once you've picked up the food, you won't be able to eat it unless the other person eats it. You have to watch it until the other person eats it.
This is the transmission route of Helicobacter pylori. Most gastric cancers in other countries are caused by other factors.
Most gastric cancers in China are caused by Helicobacter pylori.
The surgical requirements for gastric cancer are actually similar to those for gastric ulcers, perhaps slightly more difficult than those for gastric ulcers.
Many people think that gastric ulcers are nothing. To be honest, if they don't pay attention to them at ordinary times, once ulcers appear, it will be super troublesome. Sometimes there is no chance for surgery. Even if surgery is performed, it is a huge operation.
Gastric ulcer surgery and gastric cancer surgery are both high-level surgeries in general surgery.
For example, for refractory gastric ulcers, once you need surgery, in China you usually choose a major gastrectomy. What does that mean? Most of your stomach is cut off, and the esophagus and intestines are almost directly connected. .
You can think about the horror of eating a white steamed bun, swallowing it and turning it into stool. What's even more terrifying is what if you swallow half of it and then spit it out?
Looking around the world, stomach cancer is quite high in countries that eat too much fish and smoke it, such as Meatball Country and Iceland.
Although the Country of Meatballs is a rather weird country, when it comes to gastric cancer, not to mention Iceland, even in the world, its technology is the best, and I am familiar with it, but I am not familiar with it in Iceland.
Wan Ziguo does a good job in gastric cancer, and endoscopy is also very good. If you think about it carefully, this country is very good at building a dojo in this kind of snail shell, and its small tricks are very powerful.
People's hearts change people's hearts, and people's feelings change people's feelings. The head nurse looked at the two cigarettes and two bottles of wine in her hands, and complained to her husband: "You think everyone is the same as you! Our Zhangyuan is different."
Zhang Fan didn't hear this, because he had already brought Ma Yichen, Zhao Quanping, and Lao Song into the operating room. If he had heard this, he would probably be proud for a while.
The difficulty in gastric cancer surgery is not the removal of the tumor. The stomach is not like the liver. The liver is like a honeycomb with various vascular pathways. Whether one is done well or not...
The stomach is just a fleshy bag. Once the blood supply is tied off, it can be cut. The difficulty lies in the suturing and lymphatic dissection after the removal.
In the operating room, Ma Yichen was making pre-operative preparations. The young man was struggling. When Zhang Fan was fighting for his liver, he was also fighting for his liver. Technology has improved rapidly, and now it seems to have emerged in general surgery.
"Yuan Zhang, Director Zhao, brush your hands!" the anesthesiologist said to Zhang Fan.
"Okay!" Zhang Fan responded, and went to brush hands with Lao Zhao. Lao Zhao has been living a very comfortable life recently.
Because several deputy directors stopped rebelling, they were all frightened by Zhang Fan. Not only was he highly skilled, but he was also so capable that they almost fainted, and probably no one else.
When the operation started, Zhang Fan was the surgeon, and Lao Zhao was the first assistant. Ma Yichen was originally the third assistant, the retractor, but I don't know how he got along with Lao Song in private. Now Lao Song is the third assistant, and he is the second assistant.
It's hard for Zhang Fan to say anything about this kind of thing. He can only rely on himself to see if he can figure it out.
In tumor resection surgery, the blood vessels have always been ligated first. The blood vessels of the stomach can be said to be mainly divided into two major parts.
How do you describe the shape of the stomach? In fact, it is a crescent. For slender people, most of the stomachs are thin crescents. For short and stout people, most of the stomachs are fat crescents.
The inner side of the crescent is called the lesser curvature of the stomach, and the outer side of the crescent is called the greater curvature of the stomach. The blood supply of the lesser curvature comes from the abdominal trunk hidden under the stomach. This thing is the thickest blood vessel in the abdomen and is the main artery coming from the heart.
The blood supply to the greater curvature comes from the splenic artery on the side of the stomach.
The old lady's gastric cancer had not eroded the gastric body, but the area was too large, so Zhang Fan decided to have a total gastrectomy.
Only Zhang Fan dares to do it. There is a saying about cancer that the elderly, weak, sick and disabled cannot do it, so they usually choose palliative care.
It means how many days you can live count! It's not that the doctor is cruel, but that he is afraid that the patient will die on the operating table.
After entering the abdomen and opening it, Zhang Fan began to ligate the blood vessels. With the metallic click of the pliers, each blood vessel was clamped by Zhang Fan and the others.
The only troublesome thing is that the blood vessels in the greater curvature of the stomach are all covered in yellow coats, that is, they are all hidden in the omentum.
What is the omentum? It's yellow fat. It's opaque, not stockings. "It should be noted here that no matter how confident you are, you must see it with your own eyes and touch it with your own hands before you can clamp it."
While Zhang Fan was doing this, he explained the key points to Ma Yichen.
"Yeah!" Ma Yichen listened very seriously.
Dr. Lao Song, a passer-by, was envious to death. He had nothing to do and couldn't do anything because he couldn't see the surgical field. This surgery was done with his hands, and he didn't need to use his brain.
"Hey, Xiao Ma is so lucky to have met such a good teacher! I wish I had a teacher who could teach me so hand-in-hand."
Lao Song is not very old, but he is very embarrassed. He is seven or eight years younger than the deputy directors. When he entered the department, the deputy directors were rushing to practice.
So, he had an appendix for many years. There is no chance at an age when skills are high, and the upper limit will not be high in the end.
The blood vessels were ligated and the ligaments hanging the stomach were separated. Most of the abdominal organs were fixed with ligaments.
Without this ligament, people would not be able to do strenuous exercise, otherwise the kidneys might fall out of the urethra first.
After separation, the esophagus and intestines connected to the stomach body were clamped. "Knife!" Zhang Fan said to the instrument nurse.
Zhang Fan, holding the scalpel, cut the stomach directly from the esophagus and intestines along the edge of the forceps. Then Zhang Fan reached out with his hands and took the stomach out of the abdominal cavity as if holding a watermelon.
At this time, looking out from the shadowless lamp, the abdominal cavity became a big hole, with the lone spleen on the right side and the large blood vessels below all exposed.
Zhang Fan's general surgery skills can no longer be underestimated. If the surgical field can be described with one adjective, it is clean! Yes, it's clean.
There is almost no blood visible, just like operating a knife on a rubber doll. This is the level.
Some doctors don't pay attention to small blood vessels, but if there are too many small blood vessels, they become large blood vessels. After an operation, they are like a broken ketchup bottle. Not only the patient, but also himself is dyed into a red ball.
Even so, he was so proud of himself! I'm having surgery! Those who didn’t know thought he was killing pigs.
Lao Zhao, who admired Zhang Fan's level very much, took out his stomach during Zhang Fan's free time.
He said: "Zhang Yuan's surgery is like art. The cleanliness of the surgical field is so perfect."
But I didn’t say much because the difficulty of the operation came. Cancer surgery is difficult. What is the difficulty? Lymphatic dissection.
It can be said that lymph is like yellow sesame seeds sprinkled near blood vessels. Sometimes there are seven or eight dozen people gathered together, sometimes there are three or four people gathered together.
Cancer surgery is all about cleanliness, because most cancers metastasize through lymph nodes.
If you want the patient to live a few more years, you must clean up the lymph nodes. These things are hidden in fat.
Not only is it hidden in fat, it also relies on blood vessels to clean lymph nodes, which is not only slow, but also dangerous.
This thing is either lying on the big blood vessels or hiding near the big blood vessels.
It is probably not dangerous if you use a needle to pick during cleaning, but it is estimated that the patient will die after the needle is picked out because it takes too long.
Just use a curette or an enlarged earpick to scrape along the large blood vessels.
How dangerous, let's put it this way, not to mention large blood vessels like the celiac artery, even the smaller celiac artery can be fatal if it is dug out.
This kind of artery is like a snake's head. Once it is broken, not only will it bleed, but its powerful muscles will also retract, making it particularly difficult to serve.
Zhang Fan took the curette and began to dig around the abdominal trunk.
This force should be quite steady. If it is too light and cannot be scraped off, and the scraping is not clean, the operation will be in vain. If it is severe, the blood vessels will be scratched and the surgery will be in vain.
Zhang Fan scraped very quickly. The patient was too old and she couldn't hold on for long. Zhang Fan must be fast.
Wow!
Wow!
Zhang Fan scraped it off one at a time, as fast as a greedy fat man scooping ice cream.
Not to mention Ma Yichen, Lao Zhao clenched his hands into fists. It was so frightening. The metal curette was visibly working on the thick abdominal shaft, and Zhang Fan was faster than the others.
Lao Zhao, who was breaking out in a cold sweat, couldn't help but look at Zhang Fan. Although he saw Zhang Fan's expression of concern, he was still worried.
Because Zhang Fan's operation was so fast, he had never seen anyone with such a fast technique.
He wanted to persuade him, but as he watched Zhang Fan thrust into his abdominal cavity, he was too dry to say anything.
He was deeply afraid of disturbing Zhang Fan.
"It's fatal, it's fatal!" Old Zhao's hands were shaking a little.
As the second assistant, Ma Yichen was excited.
He was shouting in his heart, "This is called technology, this is called technology, handsome!"
Newborn calves are not afraid of tigers. Although he knew how dangerous the operation was, Zhang Fan's skills were so cool.
"I don't know when I will learn this skill!"
Zhang Fan's hand was too steady.
After cleaning the lymph, the inside of the curved plate looks like a plate of yellow cream with strawberry juice added to the ice cream. Even the small particles on the surface of the strawberry are there. The red color is blood and the small particles are lymph. It's so damn similar.
After cleaning, Zhang Fan checked again and started suturing again. What to sew?
Suture the esophagus and sew the esophagus to the small intestine.
The esophagus does not have a coat because it does not have to be squeezed together to move like the intestines, so it does not have a serosal layer on the outside.
If the esophagus does not peristaltic, then what does it take to clean up the esophageal residue? It depends on saliva. Some people like to spit when they have nothing to do. Stop spitting. If you spit again, the esophagus will become sick.
Without this outer layer, it would be very troublesome to sew, as it would directly expose the muscles.
The muscles at this time are like wires without the insulation tube, and the steel wires inside are loose.
For this suturing, a doctor with poor skills would be fine, let alone sew the esophagus to the intestine, or split the esophagus.
"No. 0 thread! Open the imported absorbable thread." Zhang Fan said nonsense about the equipment.
This thread is more expensive than the domestic one, with a difference of more than ten times, but this thread is really easy to use.
Layer after layer of sutures, threads were flying during Zhang Fan's surgery. The esophagus and intestines were sewn so beautifully. It's as if they were originally grown together, and you can't tell that they were sewn twice.
After suturing, the elevated duodenum must be fixed because the stomach is missing if the duodenum is not fixed.
It's very scary. Maybe with a cry, the intestines will be severed by pulling the whole body, and then a bloody intestine will be spit out from the mouth.
After six hours, Zhang Fan and the others finally completed the total gastrectomy. After the abdominal cavity was closed with sutures, Zhang Fan took a knife to cut off the stomach.
At this time, due to the lack of blood and loss of temperature, the fat on the surface of the stomach has become steamy. If it is steaming, it will be like a French feast of pork belly and foie gras.
The stomach was opened, and the tumor inside was exposed. It was as terrifying as the heterosexual insect nest in the movie. The surface was blood vessels, and the inside was rotten like yellow thick phlegm.
"Take it to your family and let your family members take a look at it, then do a medical examination!"
"good."
