Chapter 151 148. Suggestions that are suitable for the other party’s abilities are good suggestions

[The work is a bit messy recently. My daughter just started school and the update frequency remains unchanged, but the release time will be unstable]

Uterine prolapse is caused by the weakness and relaxation of the supporting tissue around the uterus. According to the conventional idea of ​​"solve where the problem occurs", the elongated ligaments will be shortened, which will fundamentally improve the degree of uterine prolapse.

The ligament reduction surgery mentioned by Denephew will definitely be effective as long as it can be successful, and the reconstruction of pelvic floor function mainly based on suspension is considered a more advanced version.

However, because the probability of recurrence of uterine prolapse is very high, as long as the yd mouth below is still there, the returning uterus may still be released outward. Simple ligament reduction cannot completely solve all problems, and the difficulty of pelvic floor reconstruction is very high.

At this point, neither conventional ideas can be realized.

Since the routine is not good, based on the principle of solving the problem and solving the person who creates the problem, Kawei gave his own advice: "Or you might as well cut off the uterus. Anyway, the patient has menopause and cannot have children. ”

Hysterectomy is also a common surgical method to solve uterine prolapse in modern times. For women who have become menopause, the ovarian function has decreased and the uterus has lost its main fertility function. Another function that maintains the stability of the organs is also because of it. The prolapse disappeared.

Therefore, for such patients, removing the uterus can fundamentally cure prolapse without changing daily life too much.

If it is Kavi, you may not consider any ligament reduction or suspension, and you will plan a hysterectomy at the beginning.

However, even if the existence of the uterus has lost its original meaning, the patient's consent is still required before the operation. During the preoperative conversation, the patient needs to explain the possible problems after the resection and then make a decision.

Besim and Denever certainly had never talked, because the treatment plan doctors choose in this era has nothing to do with the patient.

The patient does not have the right to informed consent, and as long as he is on the operating table, the doctor can "do whatever he wants". Of course, any random act will be seen by the audience and will affect the reputation of the surgeon as soon as possible. Any highlight moment will follow the same The path is reflected in the eyes of every audience.

Hysterectomy is not difficult for Carve, but it is much more difficult for Denever and Besim.

Now the tissues in the pelvic cavity have already changed after a long period of pulling and prolapse. The method of resection must be different from the original one, so the difficulty of the operation will not be much worse than yesterday's pelvic adhesion. Even Olgi, who has decades of work experience, has The two of them will definitely not be able to do the surgical procedure that cannot be done.

Denefer was very confident in his medical level, but after hearing the "hysterectomy", he shook his head: "This surgery is too difficult. I can't do it without this ability, and Teacher Besim may not have it either."

"There are very few doctors in Vienna who have done hysterectomy, and Dr. Kavey and Orgi."

Unlike his own students, when Besim heard the "hysterectomy", another scene flashed in his mind: Kavi got off the audience amid the applause of others, walked towards the operating table and took away the position of the main surgery. , and then easily ended the complicated operation that made everyone difficult.

Besim admitted Kavi's strength, but did not allow others to intervene without authorization.

So after Kavey proposed a hysterectomy, he thought the young doctor wanted to go on stage to help, so he quickly refused: "Because the patient belongs to the gynecological ward of Graz Hospital, I still hope that we can complete the operation by ourselves. Hysterectomy is too dangerous.

, I think solving the bilateral broad ligament and main ligament is enough to achieve the purpose of the surgery.”

"Since that's the case." Kawei didn't think as much as he thought, and immediately gave a second suggestion, "It's okay not to cut off the uterus. Just close the yd mouth directly after the ligament reduction."

In just two or three minutes, Kawei changed his mind again.

If you can't solve the problem or create the problem, then you can solve the problem by helping you out. Kawei means to block the path of prolapse and hide the uterus in the pelvis forever.

The method is good, but in fact, there were similar treatment methods long ago.

"Is it just a simple stitch?"

"Can this hold the uterine body?"

"Everyone, what I'm talking about is definitely not a simple suture." Kawei explained, "The prolapsed cervix is ​​the thickened yd wall. You only need to remove a square mucosa from the upper and lower ends, and after pushing the cervix into the body, the cervix is ​​pushed into the body.

, sew the two mucosa together to form a perfect blocking piece." [1]

"."

The abstract text description made everyone present unable to react immediately. After thinking for a long time, many people took out paper and pen and began to use images to deepen their understanding: "Doctor Kavi, what you just said was to take a piece of mucous membrane from top to bottom.

?”

"Yes, cut out a piece of mucous membrane, and connect the tail to the yd wall." Kavi took Olgi's notebook beside him, "It's like turning on a piece of paper, flipping one on top, flipping one on the bottom, flipping one on the middle, flipping one on the middle

Push, and then sew the two sides together to hide the pages in the middle.”

".I see."

“What a creative idea!”

"The idea is so clear, how did you come up with this??"

This is actually a very traditional yd closure surgery, mainly targeting elderly patients with uterine prolapse who cannot undergo abdominal surgery. It can be regarded as a product of compromise. Since it is a compromise, there will be disadvantages.

The disadvantages are obvious.

"The patient is only 53 years old, and menopause does not mean that he has no X life, so the operation must be approved by the patient." Kawei said, "Besides, this is a surgery operated by yd, and both of them still need to practice. I will definitely not be able to do it today.

.You might as well wait for the patient to recover for a while after surgery. You can ask her for her opinion, and you can also do more exercises yourself."

The surgery is not complicated and is much easier than uterine cleavage, but it is a little more difficult than ligament reduction, which is a new challenge for both Besim and Denever.

This is the suggestion given after Kawei's consideration.

If the person standing in the audience is an ordinary surgeon like Hills who has seven or eight years of surgical experience, then Kawei will definitely not propose uterine closure and may ask him to try a total hysterectomy.

If Olgi has some experience in pelvic floor surgery, Nakavi will recommend that he perform folding and reduction repair surgery on the basis of hysterectomy.

If the main surgery becomes more successful Ignaz or Watman, then Kavi will go a step further. Uterine suspension + complex pelvic floor function repair will be a good challenge for them.

There is no omnipotent surgery in the world, only the one that suits patients is the best, and this sentence also applies to doctors who are climbing the peak of surgery.

The operation ended quickly at Kavey's advice.

The whole process was simple and unremarkable, and Kawei could not find any flash points. But for these two new surgeons, the operation was quite successful. At least the patient's uterus did retract into the abdominal cavity and prolapse was greatly improved.

As for what the patient said after waking up, what the surgery was talking about, and the people around him were not interested in the praises, and he left the theater after the operation.

At two o'clock in the afternoon, Kawei had just walked out of the Grez Hospital gate and wanted to return to the medical school quickly, and then plunged into the laboratory to find out the effective ingredients of the two bottles of herbs in his hand. He never thought that he was behind him just after he opened the car door.

The young man stopped: "Doctor Kavi, I finally saw you."

What comes to me is Amor Goldwin, a surgical assistant at Graz Hospital who wanted to learn anesthesia techniques before.

"Mr. Amor." Kavey stopped, greeted the coachman, and took the other party to the side of the road, asking, "Why didn't you go to the surgery just now? I thought I could see you."

"Surgery?" Amor shook his head, "I've been too busy with work recently and I don't have time to see the surgery."

"Aren't you an assistant?"

Kawi has also done this kind of miscellaneous work, just some repetitive and simple work. In fact, Amor was similar at the beginning, and he could finish his own work and then rely on watching the surgery to increase his clinical experience.

But the present is different from the past.

"I was recently taken away by the army. Hills and Lockard also need to go to and from the Military and Political Department and the Military Medical Committee frequently." Amor couldn't say anything, "I'm the only one who works in the entire surgery department now.

Just now, Teacher Olgi asked me to go out and buy things again."

“What to buy?”

"The ureter-lined copper tube you used yesterday." Amor took out the sample from his pocket. "He said he would prepare ten pieces first, and buy more after he was proficient."

"I just thought of an emergency solution." Kawei was very troubled by this follow-up operation. "The impact of the copper tube on the human body cannot be confirmed, and the tube itself has no support and will leave its original position at any time.

, it is not actually safe."

“Unsafe?”

"Maybe it will get stuck downward in a narrow position [2]," Kawei explained, "It would be fine if there is no instillation. Once instillation or squeezing occurs, it will also be a kind of damage to the ureteral wall. Over time, copper will also be the same as a result of the copper.

It will be oxidized, and whether it can remain unobstructed depends entirely on luck.”

"This" Amor immediately wrote this passage in his notebook, "I will tell Dr. Olgi when I go back later."

"Don't think of Orgi, think of yourself." Kavey sighed, "Think about what is the purpose of being an assistant?"

Every intern or assistant who is willing to be a lower-level labor force has the determination to become a real doctor, and so is Amor. He has never been a pitiful salary of 30 kronor per month, nor is he for a stable job.

It is the ability to stand on the operating table.

"I want to go to the operating table, but now there are too many miscellaneous work and I don't have a chance at all."

"I can give you a chance," said Kavey. "As long as you are interested, I will teach you, including the anesthesia I talked about in the last letter."

Anesthesia failure is a scar in Amor's heart. Now the number of assistants has dropped sharply. Considering the number of surgical patients and the probability of anesthesia accidents at Graz Hospital, the scar will soon expand. If you want to heal the scar, you have to let it go

The anesthesia process becomes standardized.

This statement is equivalent to poaching. Thinking about the scene when I first entered the surgical theater, Kawei seemed familiar.

Amor has concerns about poaching. Originally, Amor was the only one left in the surgical assistant. If he was dug out, Olgi would fall into the point where no one was available: "This is not good."

"Sometimes they should also taste the working people at the bottom."

Amor's living standards are slightly better than Carvey before and are not eligible to be unemployed. Besides, Gretz Hospital has signed a contract with him, and a large amount of liquidated damages are required to breach the contract. He does not want to pay the liquidated damages and has no money at all.

Pay, Kawei, who was standing by, didn't want to pay at all.

Kawei doesn't value money, and life is simple and can't be used much, but he will be depressed if he wants to pay a sum of money for no reason: "Otherwise, my surgery frequency is low anyway, so you can come here to be an assistant temporarily.

It won't take much time."

"Is this really OK?"

"sure."

"Teacher Hills is afraid he will scold me to death."

Kawei didn't have time to talk to him more, so he took a note and stuffed it into Amor's hand, and opened the carriage door again: "This is the time for my next surgery. If you are interested, come to me a day in advance.

, I'll let you go on stage to be an assistant."

Amor is just an undergraduate graduate of a miscellaneous medical school in other places. He was not attracted by the professor to continue his studies. His abilities are very average. This disadvantage is more obvious in the Graz Hospital, which is full of masters and doctoral graduates.
To be continued...