"If we change to pectoralis major myocutaneous flap reconstruction, the operation will be more complicated! Before, I estimated it would take about ten hours. If we change to flap reconstruction, we need to make a myocutaneous island and modify and redo it. The operation time will be further extended, possibly up to twelve hours, or even more!" Director Hou took a deep breath. The difficulty of total laryngectomy is not too high. The previously planned operation was that Xu Qiu would do the resection, and Director Hou and another deputy director would undertake the laryngeal transplant. Therefore, the pressure is not too great. But now, If it is replaced with flap reconstruction, no doctor in the ENT department can do it! The director of burn surgery is good at flap transplantation, but he knows nothing about laryngeal transplantation...
Therefore, unless Xu Qiu takes on the entire ten-hour operation, otherwise - there is still no solution. But... Ten hours of full concentration, how can it be easily completed? Ordinary people can't even stay in a 45-minute class. The physical strength and energy required for surgery are several times more than learning, and there is no room for any mistakes. No one can withstand keeping the nerves tense for ten hours. "Or..." Director Hou looked at Xu Qiu and was about to cancel the operation. But at this moment, Xu Qiu showed a faint smile on his face, without any fear, and said: "Arrange the operation, Director Hou." ... Qiu Bo's laryngeal cancer has infiltrated too wide a range. Therefore, it cannot be delayed and must be operated as soon as possible. If he loses the opportunity for surgery, his life will be counted in months. After deciding to change the surgical plan, he quickly cheered up after a brief pessimism, readjusted his physical condition, and prepared for the operation. In a few days, the ENT and imaging departments made multiple assessments to escort Xu Qiu's operation. Neck and chest skin preparation. Barium swallow X-ray fluoroscopy or photography to examine the laryngopharynx and esophagus to determine the range of the tumor... The day before the operation, Xu Qiu took half a day off. When he came back, he was in great spirits and in the best condition. Before the operation.
Xu Qiu drank a bottle of primary physical potion and energy potion. He had never estimated his limit. However, for a high-difficulty operation lasting more than ten hours, no one could replace him throughout the whole process. He had to do it from beginning to end... Few people could bear it! As he walked to the operating room, Xu Qiu's mind flashed through the scenes of the operation. In the past few days, he had simulated this operation dozens of times in his mind. Master-level total laryngectomy. Master-level flap transplantation. For both operations, he mastered top-notch technology and experience. Combining the two relied on Xu Qiu's years of experience and clinical intuition honed from countless operations! ... Half an hour later, Qiu Bo was lying on the bed. After learning that he had cancer, he had aged a lot in the past few days, his hair had turned a little white, and the wrinkles on his face had deepened a little. "I told my daughter that the company suddenly had a big project and wanted to send me on a business trip... She believed it. Doctor, you must let me wake up, my daughter only has me." Qiu Bo's voice became more and more hoarse, and his words were full of the father's deep love for his daughter. In the past few days, everyone also knew Qiu Bo's situation. Qiu Bo is a single father. His son-in-law cheated during pregnancy, and his daughter was disheartened and decisively divorced. But the child was too old at the time, and it was impossible to abort, so she had to give birth. For the daughter, she only had her father who loved her. Similarly, for Qiu Bo, his daughter was his whole world. "Relax, after the operation is over, you can hold your grandchildren." The anesthesiologist said. "Can you tell me whether it is a boy or a girl?" Qiu Bo's voice was very unpleasant, and the throat cancer pressed on the vocal cords, making a narrow and cramped roar. "The hospital has regulations that the gender of girls cannot be revealed." Qiu Bo was stunned at first, and then a happy smile appeared on his face. Girls are good... Girls are considerate and know how to love people! Qiu Bo's face was filled with happiness. On the other side, the anesthesiologist began monitoring, first opening the superior vena cava, and then performing ECG, SpO2, ETCO2, BP, urine volume monitoring, etc. This operation is time-consuming and high-risk, so the anesthesia method is more particular.
The anesthesia department held several meetings before finally determining the anesthesia plan. "First, of dexmedetomidine is pumped for twenty minutes..." "Then intravenous injection of sufentanil, midazolam, propofol, and rocuronium bromide is induced..." "After that, a single-lumen endotracheal tube is inserted into the tracheostomy, connected to the anesthesia machine, and breathing is controlled at twelve times per minute, tidal volume 8mL/kg, airway pressure 13cmH2O, and end-tidal carbon dioxide partial pressure 32mmHg..." The anesthesiologist's operation is very skillful. Gradually, Qiu Bo's consciousness gradually lost, and his breathing was completely taken over by the anesthesia machine, and he fell into anesthesia. "The operation begins." At the same time, Xu Qiu's voice fell, and the atmosphere in the operating room immediately tightened, and all doctors were ready! … This combined operation has three stages. 1. Laryngeal incision. This is the prerequisite for reconstruction and is also a surgery to remove the tumor and the infiltrated larynx. 2. Lymph node dissection. This is related to the probability of tumor recurrence and directly affects the success or failure of the operation, and no mistakes are allowed. Finally, it was Xu Qiu's pectoralis major myocutaneous flap transplantation and reconstruction. The total laryngectomy was left to Director Hou. The process of this operation was too long. Even for Xu Qiu, even if he took drugs, it would be difficult to support it. Therefore, he did not try to be brave and let others take over the steps, and handed them over to the transplant team. After the laryngeal resection, the cleaning of the infiltrated lymph nodes was taken by Xu Qiu. He has master-level cleaning skills and perfect-level lymph node resection... No one is more suitable for cleaning than him. "Doctor Xu, I'm starting." Director Hou said on the stage. Everyone around was a little surprised. Director Hou actually used this reporting tone... This is the chief physician! "Okay, let's start." Xu Qiu nodded. When the scalpel fell, all duties lost their meaning, and only the skills in the hands showed their true strength. Director Hou has a deep foundation.
He made a vertical midline incision from the upper edge of the hyoid bone to the top of the sternal notch, then entered along the midline of the neck, cut the hyoid periosteum, separated the sternohyoid muscle, sternocervical muscle, thyroglossus muscle, and suprahyoid muscle group, ligated them, and finally cut them off. Next, the entire hyoid bone was removed. Peel off the mucosa of the pyriform sinus... "Stripper!" "Small gauze ball!" "Vascular clamp!" "Tissue scissors!" Each instrument was handed to Director Hou. As the operation progressed, after the trachea was cut off, everyone finally saw the larynx. When preparing to cut off the entire larynx, Director Hou's hand suddenly stopped above the surgical field, and the whole person was in great shock. "Oh no!"
