When treating patients, medical staff should not only speak softly, but also build up the confidence to fight the disease for patients with their own professional knowledge. Nanfang Daily reporter Dai Jiaxin photo
"Many of the tiny blood vessels, nerves and other pipes we stitched under the microscope are less than 1 mm in diameter. The needle used is much thinner than the hair. " Gao Junqing, director of the Department of Repair and Reconstruction of Foshan Traditional Chinese Medicine Hospital, said.
Under the shadowless lamp, there are a group of doctors who complete the operation under the microscope. They have both the ingenuity of embroidered girls and the physical strength and perseverance of marathon runners; What they have practiced is superb technology and skillful hands. During the coming of the second Physician’s Day, the reporter took you near them to learn about the unknown side of surgery under the microscope.
Doctors who "fly needles and thread" on blood vessels and nerves
Neurosurgery is synonymous with "precision, precision and cutting-edge" in the surgical system. With the help of modern science and technology, neurosurgeons have been able to work in the most mysterious and precise organ of the human body — — Realize precise operation in the brain and complete all kinds of incredible operations.
Cui Lianxu, director of neurosurgery at the First People’s Hospital of Foshan, said that one of the difficulties in neurosurgery is to treat the focus as accurately as possible while minimizing the damage to the surrounding brain tissue. "The size of the lesions in the brain varies, from less than one centimeter to the size of an orange. There are no important blood vessels and nerves around." Cui Lianxu said, therefore, neurosurgical operations can be said to be completed between square inches, and the "important weapon" to accompany neurosurgeons in fighting is the neuromicroscope.
"Under the microscope, it belongs to a neurosurgeon ‘ Battlefield ’ There is no difference in surgery between millimeters. " Cui Lianxu said, "When neurosurgeons are training in microscopy, one of the examinations is to gently grind off the shell of raw eggs with a grinding drill, and at the same time, they must not hurt the membrane under the eggshell. Behind the technique like carving art is a sense of responsibility as heavy as Mount Tai. "
In the medical field, hand surgeons can be called "masters of micro-carving" under the microscope. Under the shadowless lamp, they hold a needle and thread invisible to the naked eye, hold their breath, and concentrate on "flying needles" on blood vessels and nerves as thin as hair, with a pair of skillful hands to pick up countless broken fingers and toes. Gao Junqing has been practicing this skill since the first day he entered orthopedics more than 20 years ago. For more than 20 years, he has reborn the severed blood vessels or tissues of many patients.
"Many of the tiny blood vessels, nerves and other pipes we stitched under the microscope are less than 1 mm in diameter." Gao Junqing said, "Compared with arteries, venous blood vessels are thinner and more difficult to connect." Doctors have to sew up such tiny blood vessels one by one. On the blood vessels of a few centimeters, it is generally necessary to sew 6 stitches, while for large blood vessels, it is necessary to sew more than a dozen stitches. This not only tests doctors’ eyesight, but also tests their endurance. In the long and arduous work, Gao Junqing not only trained the ingenuity of the embroidered girl, but also the physical strength and perseverance of the marathon runner, because many complicated operations took more than 10 hours at a time.
"If the vascular suture technology is not enough, the blood vessels will still be blocked after the operation, which will directly lead to tissue necrosis." Gao Junqing said that although all the doctors in the department have graduated from graduate school or above and have received standardized training during their medical studies, they still need to undergo rigorous training in the clinical department for about one year. "Doctors should train hard on mouse tails and rabbit ears. Even so, they only have the ability to replant basic severed fingers. It will take several years to improve their clinical skills."
Yan Shigang, director of the Eye Center of Foshan Second People’s Hospital, said that for ophthalmologists, surgery under the microscope is the coordination of hands, feet, brain and eyes.
Microsurgery can treat a variety of intractable diseases.
Cui Lianxu said that the seemingly thick blood vessels under the microscope may be only as thick as hair in reality. If the doctor can’t complete the operation accurately and controllably, it will have unimaginable consequences for the patient. Microscope is a sharp weapon in neurosurgery, and only people with sufficient strength can use it freely.
Under the microscope, neurosurgeons can perform a variety of operations for patients to treat nervous system tumors, cerebral hemorrhage, brain trauma, intracranial vascular malformations and other intractable diseases.
Cui Lianxu said that he also performed a difficult operation this year. Patient Ms. Liu (pseudonym) is a native of Foshan. In life, she gradually developed facial numbness, accompanied by symptoms of unstable walking. The examination in the outpatient clinic showed that Ms. Liu had a 3×4×5cm tumor on the left cerebellum. This orange-sized tumor oppressed Ms. Liu’s facial nerve and cerebellum at the same time, causing inconvenience in daily life.
What Ms. Liu doesn’t know is that the tumor in the cerebellopontine angle has always been a complicated type in neurosurgery. Because tumors often wrap important nerves and blood vessels, a little carelessness will lead to hearing loss, serious imbalance and other complications, and even death. At the same time, the cerebellopontine angle area provides the surgeon with an operable gap, which is only about the size of a dime. Cui Lianxu personally performed microsurgery for Ms. Liu. After the operation, Ms. Liu’s facial feeling improved obviously, and she was discharged from the hospital in just one week, and her walking balance basically recovered when she was discharged. Ms. Liu’s postoperative wound was only 5 cm, which was well hidden in the hairline and could not be found after her hair grew out.
"A neurosurgeon usually needs more than 10 years of experience before he dares to say that he has certain confidence in the structure and function of the brain, the design of surgery and the grasp of surgery." Cui Lianxu said.
Surgery related to saving lives and improving the quality of life can be encountered by Gao Junqing almost every week. Last year, Foshan Hospital of Traditional Chinese Medicine also joined the "China Trauma Treatment Alliance Trauma Treatment Center". After joining the national platform for trauma treatment, severe trauma treatment centers in Foshan and surrounding areas will be sent to the hospital.
"Many patients sent to us are not simply skin injuries and fractures. They are often serious injuries to their limbs. There are serious injuries to the skin, muscles, nerves, blood vessels, tendons and deepest bones, all of which need to be repaired. " Gao Junqing said.
Surgery for more than ten hours in a row is a common occurrence.
Under a high-power microscope, facing the bloody stump and finger of the injured, holding a needle and thread that is almost invisible to the naked eye, he is absorbed in sewing tiny blood vessels and nerves. This is Gao Junqing’s daily work.
Although the little finger is small in area, it has fine structure and complex functions. Once it is injured, it is difficult to treat it, and it is even more difficult to recover and rebuild its function. It requires doctors to make great efforts in surgery and postoperative rehabilitation.
Gao Junqing said that referring to "living" is both fine and abundant. To live a finger, you may need to sew countless blood vessels and nerves. Except for some cases where stump repair is necessary, most operations take seven or eight hours, or even more than ten hours.
Liang Lihan, a repair and reconstruction surgeon at Foshan Traditional Chinese Medicine Hospital, said, August 5 — On the 7th, doctors in the department operated all night for three consecutive nights.
He told reporters that August 6 was an ordinary day, and he participated in six operations, four of which were major operations. "I received a notice of surgery before I went to work on the morning of August 6." He said. It turned out that at 10 o’clock the night before, a patient whose lower limbs were injured by agricultural machinery was sent to the operating room for rescue. After the previous group of doctors operated on the patient all night, Liang Lihan immediately participated in another part of the operation, and the operation lasted until 10 am before the patient’s blood vessels were reopened. At 12 noon, the operation was over and the patient was sent to ICU (intensive care unit).
It was not an easy day for Liang Lihan. Later, there were patients who were crushed by wheels, resulting in severe trauma to the left limb and lung fracture, as well as patients with limb damage and separation of muscles and bones. He went on the operating table at 7: 35 am on August 6 and didn’t get off the operating table until 9: 00 on August 7. "In the meantime, I only took a break for more than 10 minutes during the surgical handover." Liang Lihan said.
Gao Junqing said that every minute counts in the operating room. "We must focus on saving lives. Many patients have traumatic hemorrhagic shock, multiple limb injuries, excessive blood loss, and problems with organ function." He said that after saving lives, it is the treatment for physical trauma.
"There is a time limit for blood vessel connection, which must be between 6 and 6— Connect in eight hours. If it is not connected in time, the limb will be necrotic. " He said that the reason why the operation takes a long time is that there is still a lot of work to be done besides stitching the blood vessels a little bit. For example, debridement may cost 1-mdash; Two hours. "Many times the wound is open, and we must clean up the pollutants a little bit, otherwise it will be infected after surgery."
After many years of clinical career, Gao Junqing has not only developed a pair of dexterous hands, enough physical strength and patience, but also developed a pair of "iron stomach and copper intestines". As long as he is on the operating table, he can stop drinking water, eating and going to the toilet for hours, and concentrate on his work.
Although most of the patients admitted by the department are socially vulnerable groups with work-related injuries and car accidents, in Gao Junqing’s view, there is no distinction between the status of patients and the interests of patients are more important than everything else. "Many patients are seriously injured and complicated when they arrive, but as long as there is a 1% possibility, we will do our best to save the limbs, even every finger and toe, and repair and rebuild the function of their limbs."
"move a knife" on the eye
Ophthalmic surgery is indispensable in surgery. Yan Shigang, who has more than 30 years of clinical experience in ophthalmology, often works overtime, and there are always more than 40 surgeries a week.
A large number of operations does not mean poor quality. In clinical work, Yan Shigang insisted on ensuring the quality of medical care, carefully examining the patient’s condition before operation, carefully designing the operation, strictly controlling disinfection and isolation during the operation, and striving for perfection. In the past ten years, he has had the least infection and surgical complications.
August 7th was Chinese Valentine’s Day, but it was not easy for Yan Shigang. At 7: 00 in the morning, Yan Shigang, who suffered from renal colic at night and stayed up all night, came to the B-ultrasound room for examination, and soon the result came out. The result was kidney calculi. Immediately, the doctor advised him to rest and treat, but Yan Shigang said, "There are still many patients waiting for me to check in the ward. I can’t delay the treatment of patients because of me." Later, he came to the examination room of the ward.
That day, he endured his illness and continued his work. Unable to stand the severe pain, with the help of the head nurse and other doctors, he injected an analgesic needle into the muscle. After the pain was relieved, he went on to the operating room for surgery.
Yan Shigang’s operations are mainly cataract phacoemulsification and intraocular lens surgery, surgery for fundus diseases such as vitreous body, retina and optic nerve, medicine and laser treatment, treatment of complex eye trauma, diagnosis and treatment of various glaucoma diseases, ophthalmic plastic surgery and treatment of orbital diseases. He said that the "moving knife" incision on the eye is only between millimeters, so it requires Excellence.
■ portraits of doctors
The man who guards life under the shadowless lamp
Many people praise a good doctor for "rejuvenation with wonderful hands" and "getting rid of diseases with hands". Behind the seemingly cold hand surgery, it is the hard work of countless doctors. They have high work intensity, high work pressure, high surgical risk and physical and mental fatigue, but every time the operation is successful, they have great joy in their hearts. Now, let’s approach this group of doctors who guard their lives under the shadowless lamp, listen to their stories and listen to their voices.
Liu Hongzhen, Director of the Day Surgery Center and Director of the Endoscopy Center of Foshan First People’s Hospital: the "patron saint" of life in the operating room.
Liu Hongzhen has been a doctor for 34 years and keeps improving his medical skills. In 2010, he successfully completed the anesthesia of the first liver transplantation operation, and so far he has completed more than 200 cases of anesthesia of liver transplantation operation, which has revived patients. He also undertook the anesthesia of the first coronary artery bypass surgery in Foshan First People’s Hospital.
"As an anesthesiologist, in addition to knowing anesthesia knowledge, you should also know about surgery and internal medicine. An anesthesiologist is equivalent to a physician in the operating room. " Liu Hongzhen said that the patient’s vital signs, respiratory system, circulatory system and internal environment are all maintained by anesthesiologists. At the same time, the anesthesiologist also needs to deal with various complications during the operation. Surgeons cure diseases and anesthesiologists save lives, so anesthesiologists are also the "patron saint" of life in the operating room. In addition, anesthesiologists also undertake comfortable medical care (painless gastrointestinal examination, fiberoptic bronchoscopy, etc.), painless delivery, postoperative analgesia, pain treatment and other tasks, and anesthesiologists have traveled all over the hospital.
Xu Zhaoyan, Chief Physician and Assistant Director of Cardiovascular Department of Foshan First People’s Hospital: Never give up on patients with myocardial infarction.
"Cardiovascular medicine is a place to test the energy and endurance of doctors. Many patients encountered here are in dangerous conditions, but if they are treated in time, they will get better very quickly and the prognosis is still very good." Xu Zhaoyan said.
"Patients with acute myocardial infarction need timely rescue and interventional surgery, otherwise they may face death at any time. Such patients are also a great test for doctors. " Xu Zhaoyan said.
He once treated a patient with acute myocardial infarction in his forties. "At that time, he had repeated ventricular fibrillation, but we still didn’t give up the treatment. We gave him cardiopulmonary resuscitation and gave him interventional surgery." Xu Zhaoyan said, "In the end, such patients turned the corner. Now that 10 years have passed, he is still very healthy. "
Zhu Min, Director of Ophthalmology, Foshan First People’s Hospital: Respecting every patient’s "Light Messenger"
"When I was a child, I watched the movie" Man to Middle Age ".The scene in which the protagonist helped others to see the light again was deeply engraved in my mind. Since then, I have been determined to become an ophthalmologist." Zhu Min said that after becoming an ophthalmologist, when the patient uncovered the gauze, the doctor’s most fulfilling and proud moment was when he saw the bright smile on his face.
Zhu Min, who has been engaged in ophthalmology clinical work for more than 30 years, has won the praise of patients and colleagues with his rich clinical experience, skillful surgical skills and delicate way of getting along with others, and is called "the messenger of light".
In the face of difficult and complicated cases, she will examine the patients in detail and make treatment and surgical plans. Ophthalmology often receives patients with myopia, cataracts and blindness caused by other diseases. Because they are worried about blindness or have been plagued by blindness for many years, many patients will be anxious when they come to see a doctor, and some will be grumpy. "To treat these patients, our ophthalmologists should speak softly and build up confidence in the fight against the disease with their own professional knowledge." Zhu Min said, "The pain of the patient’s blindness can’t be described in words. Therefore, we should be patient with the patient and relieve his anxiety. At the same time, we should tell the patient his illness realistically. Let him not despair and not lose heart. "
At the peak of summer vacation, ophthalmology has to face more than 300 patients every day, and the work is very heavy. Zhu Min often reminds the medical staff in the department to be serious and responsible. "If any one of the patients is neglected, it is 100% negligence for the patient. Therefore, we must respect every patient and treat every patient sincerely. " Zhu Min said.
In recent years, the situation of prevention and control of juvenile myopia is grim, and Zhu Min led the medical staff in the department to carry out prevention and control of juvenile myopia, and achieved remarkable results.
Wang Junhua, Chief Physician of Biliary Surgery, First People’s Hospital of Foshan: A skilled aid doctor in Xinjiang.
"As a doctor, is to save lives. The medical level there is relatively backward and needs us more. " Wang Junhua said. In August 2018, Wang Junhua took the initiative to sign up for Xinjiang and set foot on Jiashi County, Xinjiang, thousands of miles away to carry out a one-and-a-half-year aid work.
Shortly after arriving in Xinjiang, I received a 28-year-old patient, Gulinur Abulimiti. Her severe abdominal pain has lasted for half a year, and her weight has dropped from 50 kg to 30 kg, as thin as a paper man. In order to cure the disease, Gulinur Abulimiti had to quit his favorite job, and seven hospitalizations cost tens of thousands of yuan before and after, and the family was in trouble. Considering that the patient may have intestinal adhesion and chronic incomplete intestinal obstruction, surgery must be performed immediately. However, there are different opinions in the consultation. Some voices believe that the risk of surgery is too great, and Wang Junhua should not take this risk. However, Wang Junhua faced the difficulties and finally, the operation was successfully completed.
When Wang Junhua first arrived at the General Surgery Department of Jiashi County People’s Hospital, the professional strength of the department was very weak. He began with the refinement of departments, dividing the original general surgery into hepatobiliary surgery and gastrointestinal surgery, in which patients with gastrointestinal tumors specialize in gastrointestinal surgery. He founded hepatobiliary surgery, gastrointestinal surgery and ultrasonic interventional diagnosis and treatment technology in Jiashi County People’s Hospital, which filled 13 technical gaps in Jiashi County People’s Hospital. At the same time, through mentoring and other means, a medical team that can’t be taken away gradually grew up in Jiashi County People’s Hospital.
Dong Julang, Director of Obstetrics and Gynecology, Foshan Second People’s Hospital: It’s like clockwork at work.
Dong Julang said that she likes obstetrics and gynecology. "The joy of the mother after the smooth delivery, the crying of the baby, the challenges of various gynecological operations and the joy of successful surgery, as well as the same feeling from patients to friends and from friends to relatives." Dong Julang said.
Dong Julang and his wife are both doctors, and their clinical work is very busy, so their daughter, who was only three months old at that time, can only be sent to a nursery. When both of them work shifts, her daughter will live in the neighbor’s house upstairs as a teacher … … The daughter is less than two years old, and Dong Julang’s husband has gone to other places for a master’s degree. She has to work shifts, have surgery and further study. In those three years, she often took her daughter on duty together. When there is an operation in the middle of the night, she can only knock on the door of the neighbor’s house to take care of her daughter.
As their daughter grows up slowly, they put all their energy into their work, all day long, including patients, medical records, surgery, meetings and study. The department is growing day by day, and more and more operations are done. Because the husband is doing MR (nuclear magnetic resonance), it is his job to evaluate all patients with gynecological tumors before operation, to implant obstetric placenta and to check venous thrombosis. With the increasing diagnostic accuracy, benign/malignant tumors, borderline tumors, lymph node metastasis/how many metastases, scar pregnancy implantation, and the choice of surgical opportunity for pelvic abscess & HELIP; … Her husband’s work and hers complement each other.
"As a doctor, I feel particularly happy every time I succeed in surgery. After being happy, I often reflect on the surgical process and what is not done well enough. " Dong Julang said, "Before each operation, we will make full preparations to predict possible complications and injuries."
Dong Julang said that as a doctor, his daily work is full, including outpatient service and surgery. When he goes to work, the whole person is like clockwork. (Nanfang Daily reporter Xia Xiaoyu)