"If this is the choice... the patient does save money, but who will bear the risk? The mortality rate of severe acute pancreatitis is very high. This is only achieved with the support of delayed and selective surgery, somatostatin, early enteral nutrition and continuous blood purification, which barely reaches about 20%~40%! And now, the patient's condition is not optimistic, almost like forcing a duck to climb a tree! At this time, high-risk routine surgery is still carried out-- Xu Qiu, do you want to end your medical career?" Director Xiao said the last sentence with a tone of regret. Everyone present knew Xu Qiu. It is also understood that Xu Qiu frequently performed major operations in various departments and has strong surgical skills. But...
It is impossible for him to handle even severe acute pancreatitis, right? However, at this time, Director Jiang's phone suddenly rang. He took a look and quickly picked it up. After a moment, he put down the phone, his face pale, and said: "The patient has developed septic shock! The condition has worsened! If early surgery is not performed, the patient will suffer from multiple organ failure and the surgery cannot save him!" Everyone's face changed at the same time. Wang Ping was still decisive. He quickly walked to Xu Qiu, questioning in his eyes, and asked: "Are you sure?" Xu Qiu nodded: "Yes." "Okay, then arrange an operating room!" Wang Ping seemed to have gotten used to this scene. It's good to be a tool man... At the end, he added: "I will bear the consequences of the operation." Director Xiao and others were going to say a few more words, but after hearing the last sentence, they kept silent. Just curious in my heart... Why does Xu Qiu have such trust from a director? Last week, a patient with severe acute pancreatitis died under Director Xiao's hands. You can imagine how difficult it is to save him! In the meeting room, Director Xiao watched Xu Qiu and others leave in a hurry. At this moment, he suddenly remembered something, and he hurriedly said: "Don't worry, Professor Gao hasn't arrived yet!" ...
... Preoperative conversation and signature. An hour later, Ma Pingchuan was pushed into the operating room. Patient diagnosis: 1. Severe acute pancreatitis 2. Septic shock 3. Abdominal infection ... Planned surgery: pancreatitis debridement and drainage + Chen's pancreaticojejunostomy ... Preoperative preparation: 1. Strengthen monitoring, active fluid replacement, and organ function support. 2. Improve systemic condition, intravenous nutrition, and strengthen anti-infection. 3. Imaging examination to clarify the anatomical location of the abscess and determine the surgical route... ... Before the operation, Director Xiao called Gao Pei'an. Gao Pei'an said slowly, "Young man, don't be in a hurry. It will take at least an hour and a half to do the debridement and drainage. It only takes me 40 minutes to get there from here. I can make it in time. I'll have a cigarette first and I can make it in time." "Professor Gao, please come earlier and give me some guidance on the debridement surgery..." Gao Pei'an raised his eyebrows, "It will cost extra." "The key to the success of the operation is the debridement. If you can come earlier to check, the success rate of the patient's operation can be greatly improved..." Gao Pei'an took a puff of the cigarette, extinguished it, put the remaining half back into the cigarette box, and said while blowing smoke rings, "Okay, I'll be right over." Director Xiao was relieved. Thank goodness Professor Gao is an expert with medical ethics! ... Operating room. Supine position, general anesthesia. Ma Pingchuan soon became motionless. The rough man who used to carry a few cement slabs was now pale and thin, with shriveled cheeks and sunken eye sockets like a mummy.
If it weren't for the heart rate and breathing on the monitor, no one would have thought that the person on the operating table was a living person. "Everyone is here." Wang Ping glanced and saw that there were not too many people in the operating room. He frowned immediately. In the emergency department, doctors such as Chen Qiao, Wang Fan, and Yun Mei heard that Xu Qiu was going to have another operation, and they signed up bravely, hoping to get a chance to observe. Wang Ping considered that: this operation, the doctors in the emergency department are not needed, it is better to give more opportunities to the people in the digestive, hepatobiliary and pancreatic departments. In the end... where are the people! He looked at Director Xiao and frowned: "Aren't the doctors in your department supposed to come here to learn? Why didn't they come?" Director Xiao showed a puzzled expression first, and said as a matter of course: "Professor Gao hasn't arrived yet!" Wang Ping stopped talking. At this time, everything was ready in the operating room. Xu Qiu ignored the others and gently grasped the scalpel. Every bit of understanding brought to him by the perfect pancreatitis debridement and drainage, the mechanical memory engraved in every muscle fiber, at this moment, all merged with the knife in his hand... He opened his eyes and said calmly: "The operation begins." At this moment, everyone's heart tightened, and they quickly changed to a focused look and entered the state. A conventional upper abdominal arc incision. Incise the abdominal wall layer by layer. Then, open the lesser omentum sac and retroperitoneum, and enter all pancreatic necrosis and fluid accumulation areas. Preoperative imaging shows that Ma Pingchuan's pancreatic necrotic tissue and exudate accumulate in the lesser omentum sac. Some others are in the pancreatic head, anterior pancreatic and other areas. "It's very complicated. You need multiple approaches to find all the necrotic areas..." Director Xiao said with emotion. This operation was a bit difficult for him to perform. Without a solid foundation in gastroenterology surgery, it would be difficult to find all the necrotic areas, let alone debridement!
However, Xu Qiu seemed to have not heard it. He made a Kocher incision to free the back of the pancreatic head. The first necrotic area was successfully opened! Director Xiao was amazed. So fast? He focused a little more and stared at Xu Qiu's scalpel. Under the shadowless lamp, the knife moved again! Looking at the location, Director Xiao judged that it should be intended to cut off the gastrocolic ligament from the greater curvature of the stomach outside the gastroepiploic vascular arch to enter the second area. However, The patient's abdominal cavity has already developed a high degree of inflammatory edema, various anatomical structures are blurred, and there are necrotic black liquids, gray-yellow substances, etc., which are difficult to distinguish! Director Xiao looked embarrassed and said, "This is very difficult... At least we have to clean it first, and it will take seven or eight minutes to locate it, right?" "Found it." Xu Qiu's voice suddenly sounded. His knife was fast and accurate. In the blink of an eye, he cut off a ligament that was stuck together by various substances and could not be distinguished from its original shape. The second area was successfully opened up! Then the third area. Xu Qiu found the root of the mesentery again miraculously, and cut off the transverse colon mesentery at the left Treitz ligament, and the most important omental sac appeared in front of him. As the three necrotic areas were exposed, a foul smell rose with the heat, and the disgusting smell penetrated everyone's nose. Everyone looked into the patient's abdominal cavity again, and their pupils suddenly shrank and their faces changed drastically!