Chapter 2285

"Why don't you do it first and observe it for two days. Maybe it will grow in case." Fang Lin couldn't help it. Seeing boss Zheng's hesitation, he whispered his suggestion.

"Do you still have the face to say that you are a thoracic surgeon? As far as your total hospitalization is concerned, one year is not enough, at least three years are needed. Squat in the Department and have surgery every day." Su Yun said coldly.

"Brother Yun, let's have a good talk and let me stay in the hospital again. In this year, the whole person was disgusted." Fang Lin said with a sad face.

For him, there is nothing more distressing than doing another hospitalization.

If, as Su Yun said, Fang Lin would rather not be a professor of the group than resign and go to a private hospital.

Fang Lin is still resistant. Many doctors will not hesitate to resign as soon as they hear that they want to be the general manager of hospitalization.

"What does the guide say?" Su Yun looked at Fang Lin contemptuously, "primary spontaneous pneumothorax still leaks after 7 days of intercostal drainage; secondary pneumothorax still leaks after 14 days of intercostal drainage; in essence, it is a persistent bronchopleural fistula."

"Brother Yun..."

"The 2015 European Respiratory Association statement on the diagnosis and treatment of spontaneous pneumothorax pointed out that for patients with continuous air leakage after drainage for more than 3-5 days, further treatment should be taken." Su Yun looked at Fang Lin and seemed to feel that the stethoscope on his shoulder was too dazzling. He turned his head and said to Lin Yuan, "Xiao Linzi, tell him what other guides say."

"Oh, OK." While watching the film with Zheng Ren, Lin Yuan said: "the 2010 British Thoracic Society's management guide for spontaneous pneumothorax points out that if there is continuous air leakage after 48 hours of conservative drainage of spontaneous pneumothorax, whether surgical intervention should be considered."

Fang Lin looked at the monster in boss Zheng's medical group with a sad face.

We all know these things, but who will memorize so many details. Memorizing the treatment guidelines is useful in addition to talking freely during the consultation of the whole hospital. Can it have even a little effect on the patients in front of us?

It's impossible. Fang Lin sighed in his heart. He looked at the image on the film reader sadly. He just wanted to talk, but he was directly interrupted.

Because the topic of the guide is not over.

"The 2018 German management guidelines for spontaneous pneumothorax proposed that whether it is spontaneous or secondary pneumothorax, if there is still air leakage after 48 hours of drainage, it is necessary to consider changing the treatment plan." Lin Yuan continued.

"Stop!" When Fang Lin saw that she wanted to say more, he directly told her, "surgery? I have to ask the director. Even if the patient puts forward the emergency list, the anesthesiologist dare not anesthetize."

"Boss, can you do it?" Su Yun gathered around Zheng Ren and asked in a low voice.

Zheng Ren didn't speak. He tried interventional therapy under bronchoscope in the system operating room.

Generally speaking, there are several treatments for pneumothorax.

The first is the most common thoracotomy ten years ago. The advantages of this operation are like what Su Yun said. The operation field is bright and bold. The disadvantages are huge trauma and slow postoperative recovery.

Zheng Ren is not sure whether he can step down if the old patient who has "fallen residue" does this kind of operation. After all, relevant surgical training has been done in the system operating room, and the degree of surgical completion is not high at all.

The low degree of surgical completion means that there are many postoperative problems, which was ruled out by Zheng Ren.

Secondly, minimally invasive thoracoscopic surgery, which is now the preferred method of thoracic surgery in major hospitals. Not only general chest, but also cardiothoracic doctors like Zhao Yunlong began to prepare for type 1 aortic arch dissection with endoscopy.

Major guidelines recommend it as the first choice for the treatment of refractory pneumothorax. However, this patient is not suitable at present. His basic condition of the whole body is poor, his cardiopulmonary function is poor, his lung lesions are extensive, and the completion of the operation with thoracoscopy is still very low.

In addition, the patient's chest adhesion is severe. The field of vision of thoracoscopy is quite limited, and stripping must be done first. If a blood vessel breaks accidentally, stop bleeding first. There was no surgical field to perform a ball operation, which was also ruled out.

The next step is the pleural fixation adopted by the local hospital.

It is a simple operation.

The principle is to rub the pleura through chemical drugs or surgery to form uniform aseptic pleura inflammation and complete closure of the pleura. The patient injected 50% high sugar 50ml into the chest of the local hospital, which is this kind of operation.

Talc powder and tetracycline can be used as the first choice drugs. Other commonly used drugs include autologous blood, elemene, hypertonic glucose, iodophor, etc. (Note 1)

Another is argon ion coagulation. Some doctors attribute this treatment to medical treatment, which Zheng Ren disagrees with.

But this technology is also not suitable for immediate patients.

The last is the only treatment that Zheng renneng thought of - interventional therapy under tracheoscopy.

The airway was blocked with bronchial plug, stent, unidirectional valve, autologous blood, biological protein glue and gelatin sponge to achieve the purpose of treatment.

Autologous blood and biological protein glue can be absorbed by themselves, but they are easy to cough up. At present, the major guidelines are not recommended as the first choice.

Zheng Ren tried 20 times before he found a feasible scheme.

No matter serious or minor illness, it's difficult to get back. Boss Zheng, who has been involved in the peak, the peak of general surgery and the top level of cardiothoracic surgery, has done more than 30 surgical training in the face of a small pneumothorax.

In this regard, Zheng Ren said he was very helpless.

"You can try interventional therapy." Zheng Ren said, "anesthesia... Let's find Lao he."

"Interventional surgery with bronchoscope? High risk." Su Yun warned.

"But there's no other good way." Zheng Rendao, "general anesthesia with laryngeal mask, I'll block it under tracheoscopy."

Su Yun hesitated for a long time and asked, "boss, if the stimulus is a little more important, there may be a problem."

Zheng Ren nodded, "there's no way. I'll try to light it. Fang Lin, what do you think?"

In fact, where does Fang Lin have any consideration? He doesn't dare to do any traumatic treatment for the patients in front of him.

Not to mention anything else, the serious COPD of old patients alone is enough to scare 99% of doctors, and 99% of the remaining 1% are stupid, bold and fearless.

That is, Zheng Ren opened and hung up with the system space, tried constantly, and finally found out the correct way before he dared to operate on him.

The superior hospital has the difficulties of the superior hospital, otherwise Fang Lin would not find boss Zheng to solve this matter.

……

……

Note 1: Professor DIDU was invited to have a lung cancer operation before 2011. The patient still had pneumothorax 2 weeks after the operation. On the second day of the lunar new year, I filled the patient with high sugar, and then it was fine. This is a very common method with many disadvantages, but it is also very easy to use.

As for elemene, it's a mixture of love and hate. It's another story, which will be described in detail later.