My Medical Skills Give Me Experience Points

Chapter 1400 - 556: Preoperative Assessment—The Two Most Easily Overlooked Types of Malignant Transformation (2)

The occurrence of dual-surgery is quite rare.

It’s usually only in life-saving emergencies where surgery is needed on two parts simultaneously, then there’s no choice.

Otherwise, priority is given to the life-threatening portion of the surgery, and the less urgent part is postponed as much as possible.

Performing surgery on two sites of a patient simultaneously causes significant harm to the patient and exponentially increases the risks.

It takes an experienced and highly skilled lead surgeon to even dare to take this risk.

In fact, it’s more common to have two teams relay on performing surgeries for the patient.

For example, performing surgery on a pregnant woman with an aortic dissection.

It might require obstetricians to first perform a cesarean and remove the fetus, followed by cardiovascular surgeons to carry on with the aortic dissection operation.

Zhou Can’s team is still new and relatively inexperienced.

He aims to create his ideal comprehensive surgical team composed of multiple top-tier teams, such as a cardiac surgical team, thoracic surgical team, general surgery team, orthopedics team, anesthetics team, nutritional nursing team, surgical nursing team, postoperative care team, etc.

There’s still a significant gap to achieve that.

For now, it’s just a thought, but he’s quietly striving towards this goal.

Take, for instance, the cardiac and thoracic teams, which are currently being developed.

In the future, when he becomes strong enough, he could directly absorb two top-notch cardiothoracic teams. The same goes for General Surgery.

On that day, Tu Ya would present the most powerful surgical team in history.

Its surgical capabilities might become the best in the country.

"Last time when a patient underwent an esophageal repair surgery, it was approached via a left posterolateral thoracotomy, entering through the fourth intercostal space into the thoracic cavity."

Tan Shengli answered from the side.

It seems he might have led the previous surgery.

"The incision was standard, and the suturing was excellent. It shows that your hospital had a very high-level physician performing that surgery, and the lead surgeon was very conscientious. I dare say, without twenty to thirty years of suture experience, it would be impossible to achieve this level."

Zhou Can tactfully praised the other side.

It was an unnamed compliment, also known as blind praise.

It is a way of complimenting that targets the work done rather than any specific person. By doing so, it eliminates suspicion of flattery, making the concerned parties feel particularly pleased.

Zhou Can had a reason for praising Director Tan before starting the surgery.

Being unfamiliar with the situation and having to clean up after others, gaining the previous surgeon’s cooperation could significantly reduce the risks. Details that might not be seen in reports, medical records, and surgical records will be promptly shared with them.

"You’re flattering, really. To be honest, during the surgery for that patient, I personally handled both the incision and closure."

Although Director Tan was wearing a mask, his eyes were smiling.

The compliment from Zhou Can made him feel extremely gratified.

"So it was you who did the incision and suture; no wonder it was so high-level! Were there any difficulties during the surgery?"

Zhou Can took the opportunity to inquire about the last surgery.

Since the patient was returning, the previous lead surgeon worried about face, might intentionally hide some facts.

But it might be precisely these hidden issues that could be the key reasons for the esophageal fistula formation.

"In terms of difficulties, there were some. After opening the thoracic cavity, I remember the patient’s thoracic cavity had a lot of food residues, mix of alcohol and various foods, which had a strong odor."

Director Tan tried hard to recall the last time’s situation.

"Cleaning the thoracic cavity required significant effort; together with my assistant, I cleaned the food residues inside before rinsing the thoracic cavity. While suturing the torn esophagus, it felt much harder compared to a regular esophagus. Based on experience, a hard esophagus is often brittle, so I opted for a cautious suturing method with a denser stitch spacing to prevent secondary tearing. But unexpectedly, a fistula formed on the third day post-operation."

Talking about the issues post-surgery, Director Tan seemed quite aggrieved.

It was more about unwillingness.

Sometimes it’s just like this.

The lead surgeon and other medical staff might have diligently performed the surgery for the patient, with no issues with the operation and with rich experience. Postoperative care was also conducted meticulously, but sometimes fate is against them, and the patient develops postoperative complications.

It is truly unavoidable.

"The information you provided is extremely valuable. I suspect that the patient’s esophageal fistula has nothing to do with the surgery’s quality; it is entirely due to the patient’s own physique. Has the patient undergone an endoscopy examination?"

While comforting the other side, Zhou Can became more convinced that there were issues with the patient’s esophagus.

If not thoroughly investigated, rashly repairing the fistula might form a second esophageal fistula.

According to his clinical surgical experience, it’s wise to examine the esophagus and stomach.

"We were really focused on saving the patient’s life at that time and didn’t perform an endoscopic examination."

Director Tan’s eyes flickered as he shook his head.

When the patient’s esophagus is torn, conducting an endoscopy isn’t easy either.

"Hmm, I see that the patient hasn’t had a nasogastric tube placed yet. How about I conduct a gastroscopy examination first? Director Hei, is that okay?"

Zhou Can smartly bypassed soliciting opinions from Song Qian and Director Tan, choosing instead to ask the anesthesiologist directly.

To put it more calculatively, he has never let his guard down at First Hospital.

Actually, it’s not just him; every doctor on duty would be cautious.

Especially when surgery is required, all the more so.

"Yes."

Director Hei nodded in agreement.

"But be particularly careful during the procedure; the patient’s esophageal wall might be fragile and prone to perforation."

Out of responsibility for the patient, she gave a kind reminder.

If she knew about Zhou Can’s endoscopic surgery talents, she might have refrained from saying that.

The gastroscope was soon brought over, with little need for additional preparation. Zhou Can maneuvered the endoscope’s probe steadily into the patient’s esophagus.

While conducting this examination, it’s best to have the patient’s head tilted back.

Because the human throat is actually curved.

Tilting the head back facilitates forming a straight line through the throat, trachea, and esophagus. This helps with examinations or inserting a gastrostomy tube, among other operations.

As the endoscope gradually delved in, Zhou Can watched the screen intently.

The esophageal inner wall’s condition was clearly visible.

"There are ulcers in his esophagus!"

Zhou Can noticed some ulcerative traces, surmising that this was likely a significant cause of the esophageal fistula formation.

The human esophagus is, indeed, much narrower than expected.

Because it’s elastic.

When patients chronically abuse alcohol and consume spicy foods frequently, their esophagus gradually loses elasticity and becomes fragile under repeated assault.

The esophageal condition of this patient is the worst Zhou Can has ever observed.

As the gastroscope pressed further, the condition of the stomach also became apparent.

Consistent with prior ultrasounds and CT results, the stomach’s condition remained somewhat ideal.

Nothing particularly severe was identified.

There were a few superficial gastric ulcers, which can be controlled with medication and proper postoperative diet, allowing for gradual recovery.

If gastric ulcers occur over a long term, they are prone to cancerous change.

This isn’t an exaggeration; it’s due to their unique environment.

If oral ulcers persistently occur at the same location and don’t heal, heightened vigilance is warranted, as mouth cancer can easily develop.

According to a study by the International Health Organization, patients with prolonged oral ulcers often indicate a weakened immune system.

These patients are more susceptible to oral cancer.

Chewing betel nut is widely acknowledged as a major cause of oral cancer domestically, as it causes fibrosis inside the mouth.

Many severe patients, by the time cancer is detected, have had their mouths reduced to half the normal opening size.

Much like oral cancer, stomach cancer often gets overlooked.

Many people merely endure occasional stomach pain, bloating, and a burning sensation, unaware that these could be warning signs of impending cancerous change.