Chapter 2282 Guide

"Why don't we just do this first, observe for two days and then talk, maybe if it grows up." Fang Lin had no choice but to see that Boss Zheng didn't speak for a long time, so he suggested in a low voice.

"Do you still have the face to say that you are a thoracic surgeon? With you as the hospital chief, one year is not enough, at least three years. Squat in the department and perform surgery every day." Su Yun said coldly.

"Brother Yun, let's talk about it carefully, and don't let me be hospitalized again. Just this year, the whole person is disgusting." Fang Lin said with a sad face.

For him, there is nothing more distressing than being in the hospital again.

If it was like what Su Yun said, Fang Lin would rather not be a professor leading a group, it would be better to resign and go to a private hospital.

Fang Lin was quite resistant. Many doctors would resign without hesitation when they heard that they were going to be hospital chiefs.

"What did the guide say?" Su Yun looked at Fang Lin contemptuously, "Primary spontaneous pneumothorax still leaks air after 7 days of intercostal drainage; secondary pneumothorax still leaks air after 14 days of intercostal drainage Pneumothorax; essentially persistent bronchopleural fistula."

"Brother Yun..."

"The 2015 European Respiratory Society Spontaneous Pneumothorax Diagnosis and Treatment Statement pointed out: For patients who still have persistent air leakage after drainage for more than 3-5 days, further treatment should be taken." Su Yun looked at Fang Lin, as if feeling the stethoscope on his shoulder. It was too dazzling, so he turned his head and said to Lin Yuan, "Xiao Linzi, tell him what the other guides say."

"Oh, yes." Lin Yuan said while watching the film with Zheng Ren: "The 2010 British Thoracic Society Guidelines for the Management of Spontaneous Pneumothorax pointed out that if there is continuous air leakage within 48 hours of conservative drainage of spontaneous pneumothorax, it should be considered surgical intervention."

Fang Lin looked at the monster in Boss Zheng's medical team with a sad face.

Everyone knows these things, but who would memorize so many details. Memorizing the treatment guidelines is not only useful for the whole hospital consultation, but can it have even a slight effect on the patients in front of you?

It's impossible, Fang Lin sighed in his heart, he looked at the image on the film viewer sadly and just wanted to speak, but his thoughts were interrupted directly.

Because there is talk about guides that is not over yet.

"The 2018 German Guidelines for the Management of Spontaneous Pneumothorax proposes that whether it is a spontaneous or secondary pneumothorax, if there is still air leakage after 48 hours of drainage, it is necessary to consider changing the treatment plan." Lin Yuan continued.

"Stop!" Seeing that she was still going to say something, Fang Lin begged for mercy, "Surgery? I need to ask the director for instructions. The anesthetist would not dare to anesthetize this patient even if he submitted an emergency call."

"Boss, what can you do?" Su Yun approached Zheng Ren and asked in a low voice.

Zheng Ren didn't speak. He tried to perform interventional treatment under bronchoscope in the system operating room.

In general, there are several treatments for pneumothorax.

The first is the most common thoracotomy ten years ago. The benefits of this surgery are just like what Su Yun said, the surgery is wild and bold. The disadvantage is that the trauma is huge and the postoperative recovery of patients is slow.

Zheng Ren was not sure if he would be able to step down if the old patient who was already "scumbag" underwent this kind of surgery. After all, he has already done relevant surgical training in the operating room of the system, and the degree of completion of the operation is not high at all.

The low degree of completion of the operation means that there are many problems after the operation, which was ruled out by Zheng Ren.

Secondly, it is minimally invasive thoracoscopic surgery, which is the first choice for thoracic surgery in major hospitals. Not only general chest surgery, but even a high-minded cardiothoracic doctor like Zhao Yunlong is beginning to prepare for type 1 aortic arch dissection surgery with laparoscopic surgery.

The major guidelines recommend it as the preferred treatment for refractory pneumothorax. But the patient in front of him is not suitable. He has a poor general condition, poor cardiopulmonary function, and extensive lung lesions. The degree of completion of the operation performed by thoracoscopic surgery is still very low.

In addition, the patient's thoracic cavity had severe adhesions, and the field of view of the thoracoscope was quite limited, so the peeling had to be done first. If one is not careful, if a blood vessel breaks, the bleeding must be stopped first. It is also ruled out that there is no surgical field to perform a ball operation.

Next came the pleurodesis performed by the local hospital.

It is said to be a technique, but it is actually a very simple operation.

The principle is to rub the pleura with chemical drugs or surgical operations to form uniform aseptic pleurisy and completely close the pleural cavity. The patient injected 50ml of 50% high sugar into the chest cavity in the local hospital, which is this kind of operation.

Both talcum powder and tetracycline can be used as the first choice of drugs, and other commonly used ones include autologous blood, elemene, hypertonic glucose, and povidone iodine. (Note 1)

Then there is argon ion coagulation. Some doctors attribute this treatment to internal medicine, but Zheng Ren disagrees.

But this technique is also not suitable for the patients in front of them.

The last one is the only treatment that Zheng Ren can think of - interventional therapy under bronchoscope.

Use bronchial plugs, stents, one-way valves, autologous blood, bioprotein glue, and gelatin sponge to block the airway to achieve therapeutic purposes.

Among them, autologous blood and bioprotein glue can be absorbed by themselves, but they are easy to cough up. Currently, major guidelines do not recommend them as the first choice.

Zheng Ren tried a full 20 times before finding a feasible solution.

Regardless of whether the illness is serious or minor, as long as it gets serious, it will be very difficult. Boss Zheng, who is at the pinnacle of intervention, the pinnacle of general surgery, and a master of cardiothoracic surgery, faced a small pneumothorax and even performed more than 30 surgical trainings.

In this regard, Zheng Ren expressed his helplessness.

"You can try interventional therapy." Zheng Ren said, "For anesthesia... let's go to Lao He."

"Using a bronchoscope for interventional surgery? It's very risky." Su Yun reminded.

"But there is no other good way." Zheng Ren said, "Use a laryngeal mask for general anesthesia, and I will block it with a bronchoscope."

Su Yun hesitated for a long time, and asked: "Boss, if the stimulation is a little more serious, there may be problems."

Zheng Ren nodded, "I can't help it, I'll try to be as light as possible. Fang Lin, what do you think?"

In fact, Fang Lin didn't have any considerations. He didn't dare to do any traumatic treatment to the patient in front of him.

Not to mention anything else, the severe COPD of old patients alone is enough to scare away 99% of doctors, and 99% of the remaining 1% are stupid and bold, ignorant and fearless.

That is to say, Zheng Ren relied on the system space to open and hang, kept trying, and finally figured out the correct way before he dared to perform surgery on him.

The superior hospital has the difficulties of the superior hospital, otherwise Fang Lin would not have asked Boss Zheng to solve this matter.

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Note 1: Before 2011, Professor Didu was invited to perform a lung cancer operation, and the patient still had a pneumothorax 2 weeks after the operation. On the second day of the Lunar New Year, I injected high sugar into the patient, and then he was fine. This is a very common method with many disadvantages, but it is also very useful.

As for elemene, it's a love-hate relationship. The specific is another story, which will be described in detail later.