"Why don't we just observe it for two days? What if it grows?" Fang Lin had no choice. Seeing that Boss Zheng did not speak, he suggested in a low voice.
"You still have the cheek to say that you're from the thoracic surgery department? A year isn't enough for a chief resident like you. You need at least three years. Squat in the department and perform surgeries every day, "Su Yun said coldly.
"Brother Yun, let's talk nicely. Why don't you ask me to be a chief resident again? I'm disgusted with this one year, "Fang Lin said with a frown.
To him, there was nothing more distressing than being a chief resident again.
If it was as Su Yun said, Fang Lin would rather not be a group professor. It would be better to resign and go to a private hospital.
Fang Lin could be considered resistant. Many doctors would choose to resign without hesitation when they heard that they were going to be chief residents.
"What does the guide say?" Su Yun looked at Fang Lin with disdain. "Primary spontaneous pneumothorax continues to leak air after seven days of intercostal drainage; secondary pneumothorax continues to leak air after 14 days of intercostal drainage; in essence, it is a persistent bronchopleural fistula."
"Brother Yun …"
"The 2015 European Respiratory Society Diagnosis and Treatment Statement states that patients who continue to leak air after more than three to five days of drainage should be given further treatment." Su Yun looked at Fang Lin and seemed to feel that the stethoscope on his shoulder was too dazzling. He turned his head and said to Lin Yuan, "Little Lin, tell him what the other guides say."
"Oh, okay." Lin Yuan looked at the radiographic films with Zheng Ren and said, "The 2010 British Thoracic Society Management Guide states that if spontaneous pneumothorax continues to leak air after 48 hours of conservative drainage, surgical intervention should be considered."
Fang Lin looked at the monster in Boss Zheng's medical team with a frown.
Everyone knew about these things, but who would memorize so many details? Memorized treatment guidelines were useful for the whole hospital consultation. Could it be of any use to the patient in front of him?
It was impossible. Fang Lin sighed in his heart. He looked at the image on the radiographic film viewer and was about to speak when his thoughts were interrupted.
Because the topic of the guide was not over.
"The 2018 German guidelines for the management of spontaneous pneumothorax state that regardless of whether it's spontaneous or secondary pneumothorax, if there's still air leakage after 48 hours of drainage, consider changing the treatment plan," Lin Yuan continued.
"Stop!" Fang Lin saw that she still wanted to say something, so he begged for mercy. "Surgery? I'll have to ask the director. The anesthesiologist wouldn't dare to anesthetize this patient even if he brought up the emergency list. "
"Boss, can you do it?" Su Yun asked in a low voice.
Zheng Ren did not say anything. He tried to perform an interventional bronchoscope in the System's operating theater.
Generally speaking, there were several ways to treat pneumothorax.
First, it was the most common thoracotomy ten years ago. The advantage of this surgical method was just as Su Yun had said. The surgical field was bright and decisive. The disadvantage was that the trauma was huge, and the patient recovered slowly after surgery.
If the old patient in front of him were to undergo this kind of surgery, Zheng Ren was not sure if he would be able to step down. After all, he had already done the relevant surgical training in the operating theater of the System, and his surgery completion rate was not high at all.
The low completion rate of the surgery meant that there would be many postoperative problems, which Zheng Ren ruled out.
Second, it was minimally invasive thoracoscopic surgery, which was now the preferred surgical method for thoracic surgery in major hospitals. It was not just general thoracic surgery. Even an ambitious cardiothoracic surgeon like Zhao Yunlong was preparing to perform type 1 aortic arch dissection with a laparoscope.
Major guidelines recommended it as the first choice for refractory pneumothorax. However, the patient in front of him was not suitable. His basic physical condition was poor, his cardiopulmonary function was poor, and his lung lesions were widespread. The surgery completion rate using a laparoscope was still very low.
Moreover, the patient's thoracic cavity was severely adhered, so the thoracoscope's field of vision was quite limited. Stripping was also necessary. If a blood vessel was accidentally ruptured, the bleeding would have to be stopped first. The fact that there was no surgical field and he could only perform a ball surgery was also ruled out.
Next was the local hospital's pleural fixation surgery.
It was called a surgical method, but it was actually a very simple operation.
The principle was to use chemicals or surgery to rub the pleura to form a uniform, aseptic pleural inflammation and complete closure of the pleural cavity. The patient would be injected with 50% glucose 50 ml into the thoracic cavity in the local hospital.
Talc and tetracycline were the first choice of drugs. Other commonly used drugs included autologous blood, elemene, hypertonic glucose, iodophor, and so on. (Note 1)
Then there was argon ion coagulation. Some doctors classified this treatment as internal medicine treatment. Zheng Ren did not agree with it.
However, this technique was also not suitable for the patient in front of him.
The last method, which was the only way Zheng Ren could think of — interventional treatment under the tracheoscope.
He used bronchial plugs, stents, one-way valves, autologous blood, biological protein glue, and gelatin sponge to block the airway to achieve the goal of treatment.
Among them, autologous blood and biological protein glue could be absorbed by themselves, but it was easy to cough it out. At present, the major guidelines did not recommend it as the first choice.
Zheng Ren tried it 20 times before he found a feasible solution.
Whether it was a serious or minor illness, as long as it was serious, it would be very troublesome. Boss Zheng, who was at the peak of interventional surgery, the peak of general surgery, and the top level of cardiothoracic surgery, had actually done more than 30 surgical training sessions in the face of a small pneumothorax.
Zheng Ren expressed his helplessness regarding this.
"We can try interventional treatment," Zheng Ren said. "Anesthesia … Let's look for Old He."
"Interventional surgery with a bronchoscope? The risk is very high, "Su Yun reminded.
"But there's no other good way," Zheng Ren said. "General anesthesia with a laryngeal mask. I'll block it with a bronchoscope."
Su Yun hesitated for a long time and asked, "Boss, if the stimulation is a little more intense, there might be a problem."
Zheng Ren nodded. "There's no other way. I'll try to be as gentle as possible. Fang Lin, what do you think? "
In fact, Fang Lin did not have any considerations. He did not dare to do any treatment that was too traumatic to the patient in front of him.
Not to mention anything else, just the serious COPD of the old patient was enough to scare off 99% of doctors. Of the remaining 1%, 99% were the kind who were stupid and bold, ignorant, and fearless.
It was also Zheng Ren who relied on the System space to cheat and keep trying. Finally, he found the right way to perform surgery on him.
High-level hospitals had their own difficulties. Otherwise, Fang Lin would not have looked for Boss Zheng to solve this matter.
..
..
Note 1: Before 2011, I asked a professor from the Imperial Capital to perform a lung cancer surgery. The patient still had pneumothorax two weeks after the surgery. On the second day of the New Year, I gave the patient a high glucose infusion and then he was fine. This was a very common method. There were many shortcomings, but it was also very useful.
As for elemene, it was really a love-hate relationship. The specifics were another story, which would be explained in detail later.
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