Using cryogenic technology … "Su Yun started to ask and then stopped.
"I've considered it, but the patient has hemoptysis now. If we don't control the volume properly, it's more likely to cause problems," Fang Lin said with a frown.
"I think we can give it a try. This position should be more suitable for cryosurgery," Zheng Ren said softly as he looked at the scans.
Fang Lin carefully pondered the difficulty of performing a bronchoscope and cryosurgery technique.
Zheng Ren looked at the scans and entered the System to prepare for the bronchoscope.
The principle of cryosurgery was based on the Joule-Thomson effect to treat the lesion and achieve the doctor's goal.
The high-pressure gas in the cryoprobe expanded rapidly in the low-pressure region after being ejected through the nozzle. When the probe came into contact with the tissue, it carried away the tissue heat and froze the tissue.
Tissue damage caused by freezing could occur at the cellular and tissue level and would not cause further damage.
The difficulty of the patient's condition was that the bronchial foreign body or stone had serious adhesion to the surrounding tissue, which had caused the bronchial wall to rupture and bleed.
Hemoptysis of 350ml meant that the bleeding vessel was relatively large, or at least a slightly larger branch of the bronchial artery.
The adhesion was serious and it was not a well-defined foreign body. To be honest, it was difficult to completely remove the bronchial foreign body with cryosurgery.
Fang Lin's concern was that directly removing the foreign body and preserving the lung tissue would cause more severe hemoptysis. It had never endangered the patient's life.
He could only give it a try.
Zheng Ren started the surgical training with an attitude of giving it a try. If it did not work, he could only follow Fang Lin's advice and remove the lung lobe.
Thirty minutes before the surgery, 10 mg of diazepam was injected intramuscularly. Zheng Ren still felt uneasy and added 50 mg of meperidine, 5 mg of atropine, and 10 ml of 2% lidocaine.
After the drug took effect, Zheng Ren inserted the bronchoscope into the right lung and the problematic lower right lung.
Soon, Zheng Ren saw the foreign body.
The mucous membrane was edematous and granulation hyperplasia. There was a foreign body wrapped in granulation tissue at the distal end. When the lens touched the foreign body, there was obvious bleeding accompanied by a large amount of purulent secretion.
What the hell was this? There was something wrong with it. His appearance … seemed very familiar.
Zheng Ren carefully looked at the wrapped foreign body with the bronchoscope and suddenly thought of a few case reports published in China.
It was … chili.
Eating chili and accidentally sucking it into the lungs sounded unbelievable, but it had been reported intermittently over the years.
However, it was useless to know what the foreign object was.
Based on the patient's medical history and the patient's recurrent episodes, the foreign body should have been there for a few years. The granulation hyperplasia was obvious, resulting in a small orifice, and it was difficult to remove the foreign body completely. In addition, the foreign body was adhering to its surroundings, and the mirror would bleed upon contact. It would be extremely difficult to remove it completely.
Without hesitation, Zheng Ren cleared the secretions and necrosis on the surface of the lesion so that the cryoprobe could make full contact with the lesion.
Then, a sterile cryoprobe was inserted through the biopsy hole. The metal end of the cryoprobe was placed in the center of the lesion, and the probe was more than 5mm away from the bronchoscope. The tip of the probe could be used to act on the tissue vertically or tangentially, or directly inside the lesion to produce the greatest freezing effect.
He stepped on the pedal to activate the probe. About 15-20 seconds later, an ice ball formed at the top of the probe. It was visible to the naked eye that the ice ball was frozen. After releasing the switch, it melted naturally.
Perform 1-3 cycles of cryoablation, each cycle lasting 3-4 minutes in the same or adjacent area. Larger lesions can be frozen more until the visible part is completely frozen.
After a few failures, Zheng Ren summed up his experience.
The freezing time was about 18 seconds, and it had to go through four cycles of cryoablation, each lasting 3 minutes and 20 seconds.
Finally, with a small amount of bleeding, the entire foreign body was removed by Zheng Ren with foreign body forceps.
The chili had already rotted and emitted a strange smell that was unacceptable to people.
Due to the severe corrosion of the bronchial wall, Zheng Ren inserted another bronchial stent to complete the surgery.
Looking at the 99% completion rate, Zheng Ren let out a long sigh.
He was curious about what happened to the chili in the trachea.
Holding the hemostatic forceps, Zheng Ren began to open the organic layer of the chili. However, as soon as he opened it, the smell of the rotting chili rushed into the olfactory epithelium, which was composed of the supporting cells, olfactory cells, and basal cells in his nasal cavity.
It passed through the olfactory nervous system and trigeminal nervous system and entered the olfactory bulb of the telencephalon.
Zheng Ren was stunned for a moment and almost fainted in the System's operating theater.
This smell … No wonder Quan Xiaocao did not eat. It would be strange if she could eat anything with this smell every day.
Not only did it have a smell, but it was also poisonous. If not for the enhancement of his physical fitness in the System, Zheng Ren would have fainted in the operating theater.
Even if he could survive, countless surgical training time would have been 'wasted'. Zheng Ren might even want to die.
Zheng Ren came out of the System's operating theater and ended his surgical training. If he fainted in the System's operating theater, all the surgical training time would be wasted. Zheng Ren would be devastated.
"Boss, are you good with cryonics? I think we can give it a try. Although it's difficult, we're preparing to remove the lobe anyway. Why … "
"We can give it a try. In the hybrid operating theater, we'll first use cryonics to remove the foreign body using a fiberoptic bronchoscope. If it's successful, we'll have to use a bronchial frame to block the bleeding point. "
Su Yun was confident when he heard his boss's words.
"Fang Lin, who's your second-string professor today?" he asked.
The chief resident was in charge of the emergency department. Dangerous surgeries that could not be completed had to be carried out by second-string doctors.
"Professor Zhu is a second-string doctor, but he has a lot of surgeries today and hasn't finished yet," Fang Lin said.
"Talk to the patient's family and find a second-string doctor to check on the situation," Su Yun said.
Fang Lin did not hesitate. Since Boss Zheng said it was okay, he would drag him along to take a look. As for the second-string Professor Zhu, he would not stop him if he wanted to give it a try.
There were eight laparoscopic surgeries a day. It was said that there were still three laparoscopic esophageal cancer radical surgeries in the afternoon. How could he have time to deal with a bronchial foreign body?
"Boss Zheng, Brother Yun, wait for me," Fang Lin said coquettishly with a big red stethoscope hanging on his neck.
"Okay, we'll go back to the ward area and wait for you," Zheng Ren said. "Call Su Yun when you're ready. We'll go up."
After saying that, Zheng Ren thought for a moment and said to Su Yun, "What class is Old He in? Let's go together. If there's a lot of bleeding, we need emergency intubation. "
Fang Lin started to have a headache at the thought of massive bleeding and emergency intubation.
Once this kind of surgery was performed in the emergency department, the risk would suddenly increase.
However, seeing Boss Zheng's confident look, Fang Lin was conflicted for 3.2 seconds. In the end, he decided to explain the risks to the patient's family in detail and let the family choose for themselves.
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