Chapter 2197

"Use freezing technology..." Su Yun asked at the beginning and stopped.

"I've thought about it, but the patient has hemoptysis now. If he is frozen, he can't grasp the scale well, and there is a greater possibility of problems." Fang Lin frowned and said.

"I think we can have a try. This position should be more suitable for refrigeration technology." Zheng Ren looked at the film and said softly.

Fang Lin carefully pondered the difficulties of tracheoscopy + freezing technology, which was somewhat difficult.

Zheng Ren watched the film, entered the system space and prepared to do tracheoscopy.

The principle of freezing technology is to treat the focus according to Joule Thomson effect to achieve the purpose required by doctors.

After the high-pressure gas in the frozen probe is ejected through the nozzle, it expands rapidly in the low-pressure area, so that when the probe contacts the tissue, it exchanges heat with the tissue to take away the heat of the tissue and freeze the tissue.

The tissue damage caused by freezing can occur at the cell level and tissue level, and will not cause more damage.

The difficulty of the patient's condition lies in the serious adhesion between bronchial foreign bodies or stones and surrounding tissues, which has led to the rupture and bleeding of bronchial wall.

A * * 350ml can mean a larger blood vessel, or at least a larger artery of the bronchial artery.

The adhesion is serious, and it is not a mass of foreign body with clear boundary. To tell the truth, it is difficult to completely remove the foreign body in the bronchus.

Fang Lin's concern is whether removing foreign bodies directly and retaining lung tissue will cause more severe hemoptysis, which has never endangered the patient's life.

I can only try.

Zheng Ren started surgical training with a try attitude. If he couldn't, he had to remove the lung lobes according to Fang Lin's advice.

Preoperative intramuscular injection of zediazepam 10mg. Zheng Ren still felt uneasy, added meperidine 50mg, atropine O.5mg intramuscular injection, and gave 2% lidocaine 10ml atomization inhalation.

After the drug took effect, Zheng Ren operated a fiberoptic bronchoscope to insert into the right lung and enter the problematic right lower lung.

Soon, Zheng Ren saw a foreign body.

Mucosal edema, granulation hyperplasia, a foreign body at the distal end can be seen, wrapped by granulation tissue, obvious bleeding after the lens touches the foreign body, and accompanied by a large amount of purulent secretion overflow.

What the hell is this? There seems to be a problem. Looks... Seems familiar.

Zheng Ren carefully looked at the wrapped foreign body with a fiberoptic bronchoscope and suddenly thought of several case reports published in China.

It's... Pepper.

It sounds incredible to eat pepper and inhale it into the lungs by mistake, but it has been reported intermittently in recent years.

However, it's no use knowing what the foreign body is.

Combined with the medical history and repeated attacks of the patient, the foreign body should have been for several years. The granulation hyperplasia is obvious, resulting in a small orifice. It is difficult to completely remove the foreign body inside. In addition, the foreign body adheres to the surrounding, and the mirror bleeds after touching. It is very difficult to take it out completely.

Zheng Ren did not hesitate. First, he cleared the secretions and dead objects on the surface of the lesion so that the cryoprobe could fully contact the lesion.

Then insert the sterile cryoprobe through the biopsy hole. The metal end of the cryoprobe is placed in the center of the lesion. The probe is more than 5mm away from the distal end of the bronchoscope. The top of the probe can act on the tissue vertically or tangentially, or directly inside the lesion, so as to produce the maximum freezing effect.

Press the pedal to start the probe. After about 15-20s, an ice hockey is formed at the top of the probe. The tissue is white and frozen with the naked eye. Release the switch and let it melt naturally.

1-3 freezing ablation cycles, each cycle lasts for 3-4min in the same or adjacent area. Larger lesions can be frozen at multiple points until the visible part is completely frozen.

After several failures, Zheng Ren summed up his experience.

The freezing time is about 18 seconds. There are four freezing ablation cycles, and the duration of each cycle is 3 minutes and 20 seconds.

Finally, in the case of a small amount of bleeding, the whole foreign body was clamped out by Zheng Ren with foreign body forceps.

The pepper is rotten and gives off an unacceptable strange smell.

Because the bronchial wall was severely corroded, Zheng Ren put down another bronchial stent, which completed the operation.

Looking at the hint of 99% completion of the operation, Zheng Renchang breathed a sigh.

He was curious about what happened to the pepper in the trachea.

Holding the hemostatic forceps, Zheng Ren began to open the organic layer wrapped around the pepper. But as soon as it was opened, the smell of rotten pepper rushed into the olfactory epithelium composed of supporting cells, olfactory cells and basal cells in Zheng Ren's nasal cavity.

It enters the olfactory bulb of the telencephalon through the olfactory nervous system and the nasal trigeminal nervous system.

In a trance, Zheng Ren almost fainted in the system operating room.

This smell... No wonder Quan Xiaocao doesn't eat. It's strange to smell it every day.

And it's not just a smell, it's also a toxic gas. If not for the enhancement of physical quality in the system space, I'm afraid Zheng Ren would faint in the operating room.

At that time, even if people can survive, countless operation training time will be "wasted". I'm afraid Zheng Ren will even have the heart to die.

Zheng Ren came out of the system operating room and finished the operation training. After coming out, Zheng Ren was still terrified of the taste.

"Boss, are you good at freezing? I think you can try it. Although it's difficult, you're ready to cut the lung lobe anyway. Why..."

"You can try it. In the hybrid operating room, freeze the foreign body with fiberoptic bronchoscope. If it is successful, you have to plug the bleeding point with a next bronchial frame."

Su Yun heard what his boss said. He had a bottom in his heart.

"Fang Lin, who are your second-line professors today?" He asked.

The inpatient is always responsible for the emergency. Of course, the second-line should be found for operations that are dangerous and may not be taken down.

"I wish the second-line teacher, but he has many operations today and hasn't finished yet." Fanglin road.

"Go and communicate with the patient's family members, and then find the second-line to see the situation." Su yundao.

Fang Lin didn't hesitate. Since boss Zheng said it was ok, just take him to have a look. As for the second-line teacher Zhu, he wants to have a try. He won't stop himself.

Eight endoscopic operations a day. It is said that three endoscopic radical esophagectomy will be performed in the afternoon. How can he have time to deal with a bronchial foreign body.

"Boss Zheng, Brother Yun, wait for me." Fang Lin said with a red stethoscope dangling and coquettish.

"Well, we'll wait for you in the ward." Zheng Ren said, "when you're ready, call Su Yun and we'll go up."

With that, Zheng Ren thought for a moment and said to Su Yun, "what class does Lao he have? Let's go with the stage. If there is a massive hemorrhage, we need an emergency intubation."

At the thought of massive bleeding and emergency intubation, Fang Lin began to have a headache.

This kind of operation, once it needs to be done in the emergency department, the risk rises sharply.

Just looking at the confident appearance of boss Zheng, Fang Lin tangled for 3.2 seconds. Finally, he decided to explain carefully to the patient's family members. He must make clear the risks in the operation and let the family members choose by themselves.

……

……

Note: for comparison, for monthly ticket~~~