Chapter 466

People, in fact, only those years can work hard. Those years without marriage and children are the best time to lay a foundation. With a foundation, you may be able to sublimate over time. Once you wander through it, it will be very difficult to struggle again.

Zhang Fan has a system, eats and drinks enough, sleeps, and the power is full again! In the hospital, especially in the surgical system, because of excessive work, doctors who are a little old are really gritting their teeth and insisting, and even the life of husband and wife has become a luxury.

In the morning of general surgery, a group of attending doctors looked depressed. The high hanging hospital is always like the carrot hanging in front of the donkey. If you don't work hard, it belongs to others.

After arranging tomorrow's operation and explaining the work of some departments, Zhao Pingquan, director of general surgery, said to the doctor, "now let Zhang hospital say a few words."

"Today's operation is the removal of gastrolith in patients with gastrolithiasis. Are all the preoperative preparations ready? " After a period of confusion, Zhang Fan is now used to this position.

"Zhang Yuan, ready. Gastrointestinal decompression has been ready since the day before yesterday. I've been fasting since yesterday. All nutrition is outside the intestine. " The attending doctor of the tube bed reported.

"Director, are you ready for this operation?" Zhang Fan still respects Lao Zhao.

"Well, I'll give you a hand." Lao Zhao likes to have surgery with Zhang Fan. Except that he can't talk casually on the stage, it really seems to be an artistic enjoyment to have surgery with Zhang Fan.

"OK, call the operating room to pick up the patient number."

Zhang Fan and director Zhao went to the operating room together. As they walked along, they chatted, "the doctors in the Department recently are crying and rushing to collect the patient."

"It's all your support, director. Unlike other surgeons, the maturity cycle of doctors is too long."

They chatted and entered the operating room from the special elevator. When he built the building, Lao Huang was stingy and got four elevators. At that time, he thought these four elevators were a bit wasteful.

As a result, the elevator in the surgical building is not enough at all. Someone must organize a queue in the morning. Otherwise, people quarrel about taking the elevator every day.

Ouyang is more generous than Lao Huang in this regard. There are eight elevators in the emergency center, one for emergency patients in the operating room, one for doctors and nurses, and the remaining six are reserved for patients and their families.

Entering the operating room, uncle Jinya saw Zhang Fan and smiled at Zhang Fan to please him. He wanted to talk, but the little nurse who followed him didn't have such a good attitude as Zhang Fan. He didn't dare to run over and talk to Zhang Fan.

Gold teeth have long been in the family. Disinfect, brush hands, spread towels and go to surgery. The stomach, the stomach of the human body, is too boring to describe in professional terms.

When Zhang Fan took the course of human anatomy, he didn't like to learn the courses of abdominal organs and nerves. It was still simple orthopedics. The anatomy of abdominal organs is too many and complicated. Different forms. If you don't work hard, you'll get confused.

Neuroanatomy is just like listening to heavenly books. It is too abstract. One is electrical conduction, another is body fluid conduction, and there will be jumping conduction from time to time. If you don't understand in class and don't review after class, the exam is a piece of paste.

That is, later, with the system, Zhang Fan's liver had countless times to understand the anatomy of the two systems.

Esophagus and stomach can be described as cables in popular language. When it comes from the esophagus to the stomach, the cable becomes larger and thicker.

The outer skin is a wear-resistant protective layer, and the inner layer walks with blood vessels and nerves.

The structure of the stomach can be divided into four layers, from inside to outside into mucosal layer, submucosal layer, muscular layer and serosa layer. The muscular layer can be divided into three parts.

It's very complicated. The shape of the muscle layer is not the same. The innermost muscle is oblique, from the contact between the esophagus and the stomach to the duodenum.

This form makes sense. The oblique muscle type is conducive to the downward movement of food. If you get a circular muscle, maybe the food will be embedded in the stomach.

The middle layer is the circular muscle, which wraps the stomach circle by circle to increase the firmness of the stomach. The outermost layer is vertical, which is to reduce friction with other organs. Because the stomach is always active.

Circle by circle, it's really like a pile of wool.

The stomach can secrete many things, no less than a dozen. In the early years, the medical profession only thought that the stomach only had the function of digestion and grinding. Later, it was found that the stomach also had the function of secretion.

The most important secretion is HCl and some special enzymes. Its pH is about 0.5 ~ 1. Throw an iron tablet into this concentration of hydrochloric acid, and maybe it can be melted for you.

But the stomach, won't it be corroded by HCl? Yes, it will be corroded, but it is because there is a weak alkaline protective layer on the inner surface of the stomach, with a bicarbonate barrier about 0.5mm thick, which is the most important protective layer of the stomach.

Without this protective layer, gastric acid can penetrate even if the stomach muscle is ten meters long. Eat pepper, drink wine, greedy for chocolate, and then have a stomachache, which means that there is an ulcer in the stomach.

Angry, especially young women, because the body secretes strong functions, various hormones produced after angry will also reduce this layer of mucosa, so this is also the cause of stomach pain after angry. A person with a bad temper has perforated his stomach, which is not without.

Ulcers are caused by the penetration of the protective layer of bicarbonate by gastric acid. I've been angry and corroded by gastric acid. When my stomach is open, it's perforation. The treatment of perforation is very simple. If the area is small, sew it, and if the area is large, cut the stomach.

Moreover, once the ulcer area is too large and has a certain depth, well, even if it is not perforated, it will become cancerous for a long time, and it can't run away at all.

Therefore, three meals on time, less drinking, less spicy food and less anger are the best protection for the stomach.

After anesthesia, the operation began“ This is a typical example of a minor illness becoming a serious illness. With such a big stone, the incision of the stomach will not be small, and the patient may have long-term chronic pain in the future. "

While preparing for the operation, Zhang Fan said something to the others. In fact, Zhang Fan said this sentence to see if others have any other ideas.

No result! Others just said, "yes, make a big incision!"

Zhang Fan smiled and didn't speak“ Alcohol cotton ball! " Zhang Fan took the cotton ball and began the last disinfection of the skin, and then opened a particularly small hole in the middle.

It's about the size of an ordinary appendix incision“ Zhang Yuan, the hole is a little small. How can you take out the stone? " The director of the bed wondered“ What is this? " He was confused and couldn't understand!

Lao Zhao understood it. But he didn't speak. Zhang Fan turned to see several doctors and said, "the operation is amorphous!"

“ＭＭＰ！ I haven't even finished learning the fixed operation. You're a resident and began to operate the fixed operation. What kind of world! " Several doctors who listened to Zhang Fan pretend to force collapsed.

It's not the doctor's fault. Apart from others, there are no fewer than six surgical methods for gastric ulcer in textbooks, and there are some that are not in textbooks. Now there is a surgical infinity, which still makes people live. Only a lot of learning, a lot of surgery can sublimate, or have super talent.

There are more and more diseases and doctors' disciplines are more and more detailed. This is a matter of no way, but people are a whole, so it is a very contradictory thing. This is also a problem for the future development of medicine.

Open the abdominal cavity, stop bleeding, open the omentum, and finally see the stomach. Because of the stone, although I haven't eaten for two days, the patient's stomach is full.

It's really like a pregnant woman waiting to give birth“ Sharp knife! " After receiving the scalpel, Zhang Fan opened a small hole in his stomach, a very small hole.

At this time, talent has opened a distance. Some doctors understand it, and some doctors are still confused.

The doctor who understood suddenly realized, "shit! I can't think of it. It's too simple and the damage is much smaller. "

The doctor, who couldn't understand, was still confused, "what is this! What can you do by opening a hole that can only be put into one finger! "

"Pliers, hold both sides of the incision." Muscle is different from skin and fat. Skin and fat open a small opening, if you don't use great strength, you won't let the incision derive.

But the muscle can't. as long as it splits, it will automatically become larger with the incision. Zhang Fan holds the incision with pliers to prevent the incision from becoming larger.

Surgical forceps, in the hands of doctors, Ka! Click! Click! Close the incision“ Gauze! Alice's pliers hold one end of the gauze. " Zhang Fan explained to the nurse.

This kind of operation has never happened to the nurse. Zhang Fan has to make it clear to the nurse. Otherwise, the nurse doesn't know the steps of the operation.

Surgery, too exquisite, the doctor's hard work and talent. Confused doctors continue to be confused. Doctors who understand have begun to actively cooperate.

The long Alice forceps hold the gauze and enter the stomach through the small hole in the stomach.

"Gently push the stone towards the nozzle." Zhang Fan said to the third assistant. The third assistant is a resident doctor. Although he doesn't work long, he has good talent. He has understood Zhang Fan's meaning of surgery.

With Zhang Fan's Alice pliers, Zhang Fan's Alice pliers to the left, he gently pushed the stone to the right, Zhang Fan to the right, he pushed to the left.

It's good to know the operation and assist. Zhang Fan did it very smoothly. Lao Zhao looked at the young inpatient in surprise“ Ma Yichen, yes. Have you had this operation before? " Lao Zhao spoke.

The second assistant is the attending. He's not confused yet. Unexpectedly, the boy has learned to understand the operation. One has been working for less than half a year and the other has been working for ten years. This is the talent gap.

"Director, I haven't had such an operation." Ma Yichen said to Director Zhao Quanping with a smile.

Ma Yichen is a graduate student of Sanchuan North Medical College. Because his father does business in the frontier, he is a graduate student of general gastroenterology in northern Sichuan. If you want to stay in Xihua, graduate students are not enough.

After graduation, he simply came to frontier tea. Originally, I was going to go to class for several years, and then Kaobo continued to study. Unexpectedly, the small hospital in this small place was so powerful.

Zhang Fan also looked up at the young man. Although wearing a mask, you can see that the young man should be very beautiful and in good health.

Zhang Fan holds the gauze with Alice pliers and slowly changes direction. The previous operation was carried out quickly, and it slowed down at this time. This is a patient work. You can't be anxious. If you are anxious, you have to start all over again.

Ma Yichen cooperated well and Lao Zhao was moved. Zhang Fan is the best example of the hospital. Zhang Fan's emergence, together with Lao Gao, suppressed several orthopedic directors. This is the apprentice cow, and the master began to cow.

"Which direction do you want to go in the future?" Before Lao Zhao spoke, Zhang Fan spoke first.

"Continue to do gastroenterology. I like gastroenterology very much." Ma Yichen said with a smile.

"You..." old Zhao Gang opened his mouth, and Zhang Fan then said, "don't be limited to the gastrointestinal tract. Although you are a master of Gastroenterology, you'd better broaden your horizons. I have several liver tumor operations in the Affiliated Hospital of niaoshi at the weekend. You go and have a look with me. "

"OK, Zhang Yuan." Ma Yichen estimated that his mouth was laughing.

This is not an interrogative sentence, but an affirmative sentence. Zhang Fan is also moved. He has good talent and is young. This is Miao Zi. If Zhang Fan had an operation with Xue Fei, he would have killed Zhang Fan.

It's not Xue Fei's bad skills, but his talent. He didn't think through a lot of things. This young man can think through Zhang Fan's intention in such a short time. This is talent.

"Zhang Yuan, it's not appropriate!" Lao Zhao is not happy“ MMP, the operation is overbearing, so I don't say anything. Now they are beginning to hit my apprentice's attention. " In the past, Lao Zhao had not found Ma Yichen's talent so good.

"It's good for him to have more knowledge. After all, there are still few patients in our place. The director pulled the hook and quickly used the suction device to suck blood. The blood came out. " Old Zhao's mouth was crooked when he was crushed by the first level of the official university. What might he do?

Bit by bit, Zhang Fan finally wrapped the stone with gauze“ oh I see! " The doctor in charge of the bed now understands Zhang Fan's intention.

He is an apprentice of Lao Zhao. "You just understand!" Lao Zhao's liver hurts.

"Ha ha!" The doctor in charge of the bed smiled a little embarrassed. My heart has long scolded my mother, "I don't know clearly. Who wants to know what you want!"

"Electric drill! Wide draw hook! " The incision has been pulled out on the four sides of the gauze. At this time, Zhang Fan uses the gauze to pull up the stone in Uncle Jinya's stomach and hang it in the air.

The electric drill is to decompose the stones in the stomach, and the wide retractor is to protect the incision from being damaged by the electric drill.

Picking up the electric drill, Zhang Fan began to drill along the small incision towards the stone in his stomach. Protein mixed with calcium and hair, very strong.

After the drill bit goes down, it splashes like gypsum powder. Because there is hair, the high temperature of the drill bit directly produces a smell of burning hair. Drill up, drill down, drill left, drill right. Several assistants pulled the gauze hard.

The gauze must be removed with great strength. Once the hand slides, the drill may enter the body. Finally, with a click, the stone cracked.

"Cow! That's great. It's a good idea. The damage is small and simple, which is equivalent to a minimally invasive operation. " The attending doctor said with envy. His heart is also a MMP, "how can I not think of it. In this way, the operation is too simple. "

Then drill, put the larger stone and continue to drill smaller. At this time, it's not very easy to drill, "pick it up a little more!" Zhang Fan said.

Several other doctors were carrying gauze vigorously.