334. Surgery is more than just cutting

Author: Hao Xifeng

334. Surgery is more than just cutting

In modern domestic tuberculosis, effective anti-tuberculosis treatment can often be obtained in the early to middle stages. The chance of developing hemoptysis is not high. Even if it does occur, it will be a small amount of hemoptysis. It is not difficult to control and the risk is not high.

The reason for this is not that patients have a rich understanding of tuberculosis, nor that they have a stronger awareness of prevention. The main reason is that domestic anti-tuberculosis treatment is free.

Of course, there is a limit to the free fee, the selection of drugs must be relatively basic, and many examinations cannot be completely exempted.

Under such a policy, the chance of severe hemoptysis is low.

Of course, there are no clinical absolutes. If you really encounter this kind of patient, there are more ways to deal with it than in the crude 19th century. Generally, you usually go to internal medicine first and use hemostatic drugs for conservative treatment. Unless conservative treatment is really ineffective, surgery will be chosen.

.

Modern surgical operations have long been out of the era of drastic changes, especially in locations such as the chest, where blood vessel rupture is related, so vascular intervention and endoscopy are the mainstream.

This is not just about doctors showing off their skills or using more expensive medical equipment to increase their income. The main reason is to consider the trauma caused during the operation and the recovery effect after the operation. After all, the operation only combats hemoptysis and cannot really solve tuberculosis.

In the era in which Kawei lives, apart from some unscientific empirical methods, he doesn't even have a vague understanding of tuberculosis. Patients are often seriously ill, and surgery can have good curative effects.

However, limited by equipment and emergency medicines, Kawei could only perform old-fashioned surgeries that appeared in the 1950s and 1960s.

Fortunately, this kind of surgery is not difficult to perform, and the effect is not bad. Even for those patients whose effects are not very good, it is better than leaving it to internal medicine. What's more, Kawei also has pituitary extract in his hands, which can be more or less effective.

Hemostatic effect.

Golf balls are the key to this kind of surgery. In fact, if table tennis had not yet emerged, choosing elastic table tennis balls would be better for the ribs and mediastinum.

There is a golf course not far from the Palais-Dieu Hospital. It is not large in area, but it is the property of the Depo Club, the earliest golf club in France and even Europe. Those who can enjoy it here are the elites of Paris's upper class.

Professor Dieu is one of them, as well as the director of the Diocesan Hospital and several famous internal medicine doctors.

Within half an hour after Sneijder decided to trust Kawhi, ten golf balls were gathered inside and outside the hospital.

At this time, we must thank the evil capitalism for evolving the original lacquered leather ball into a gutta-rubber ball, which is at least much better in terms of safety and flexibility, and is less irritating to the body.

"First of all, we need to be clear that tuberculosis can cause lung inflammation, and then a considerable part of it will cause tissue necrosis, and finally form cavities."

Kawei and several others squatted by the basin to clean the golf balls, while explaining the principle of the operation: "Whether it is inflammation, necrosis or cavities, it can cause hemoptysis. The difference lies in the degree. The blood vessels in the lungs are inherently thin, and there are

If the chest is blocked, direct ulceration cannot effectively stop the bleeding."

"Doctor Kawei, the pituitary gland extraction solution has been administered." Kallen said at the side, "The blood clots in the throat have been removed, and the breathing is temporarily stable."

"Well." Kawei raised his head and looked at Amor, "Prepare for anesthesia, be sure to pay attention to his breathing, and be ready to deal with hemoptysis at any time. Also pay attention to his weight, don't give him too much."

"OK."

Only halfway through Kawei's explanation, questions from people around him arose: "The amount of hemoptysis is not large, it is similar to usual bloodletting. The surgical wound is larger and the amount of bleeding is greater. Why must surgery be performed to stop the bleeding?"

"Dr. Sneijder is indeed a top student at the University of Paris. This is a good question."

At this time, Sneijder took off his black coat, wearing only breeches and a shirt, and was playing football with Cediyo and three assistants. Although he still had a grudge against surgery, the patient was in the hands of Kawi.

There was no hemoptysis after that, and the effect was immediate.

"I apologize for being rude just now."

"I told the truth, I didn't mean to make fun of you."

Kawei explained: "First of all, it must be clear that the amount of hemoptysis is not the real amount of bleeding. What we see is only the blood expelled from the body, and there is also a lot of blood blocked in the lungs that will soon form blood clots. Now

It's not bad, but if he continues to cough up blood and doesn't position himself properly, the patient will be suffocated to death by his own blood."

"So, that's what these balls are for."

"It's just compression to stop bleeding," Kawei said. "My father tried it twice when he was practicing medicine in Lombardy. I've seen it, and the effect was okay. It's just that some patients were wrapped in gauze that could absorb fluid.

The fat is used to fill the lungs and squeeze the lungs to stop bleeding."

"So that's it." Several doctors squatting beside the basin nodded, "Since it was effective then, it's natural to try it now."

The surgical plan proposed by Kawi once again went beyond Sedillo's imagination. After all, the first operation in history that relied on inserting something into the chest to treat hemoptysis would still take 25 years. And the choice of using balls instead of other foreign bodies was

The plan had to wait until 1945, but at that time plastic balls made of methacrylate were used.【1】

"Thorax surgery, Dr. Carvey is so brave."

"What else should we do? The final outcome of tuberculosis and hemoptysis is not good."

Sneijder still has a typical conservative thinking in medicine: "Now I think he is stable. Can he just lie down like this?"

"It's just temporary." Carvey explained, "Dr. Sneed should know the dangers of long-term unilateral bed rest. If pressure sores develop, you may be able to walk faster."

".really."

What seemed to be a simple hemoptysis turned out to be extremely complicated when it came to Kawei, who needed to consider many aspects. In the end, surgical treatment was the last resort. The amount of hemostatic drugs was limited, and Kawei couldn't bear to use it for a long time on this patient.

"Dr. Kawei, the surgical method is indeed very attractive, but I want to learn more about the drugs you use and this unique method of administration." Sneijder has a good eye, "I think this is the most important thing in the entire treatment process.

part."

"The medicines are produced by a pharmaceutical factory in Vienna called Karachi." Kawei said, "If you think the effect is good, you can choose to buy it there."

"How much does a bottle cost?"

"Emmmm, I forgot about it, it's not very expensive anyway." Kawei smiled awkwardly, and then recommended something else, "For specific use, you need to check your blood pressure. You can use the sphygmomanometer I brought.

It was produced by the Laszlo Foundry in Vienna."

"blood pressure?"

"Yes, there will be some fluctuations in blood pressure." Kawei explained, "But don't worry too much. Drugs are originally used to stop bleeding. Patients are often in a state of massive blood loss. Raising blood pressure is also a hedge."

"Oh, I got it."

Sneijder seemed to feel that he had learned a lot, so that in the process of disinfecting golf balls and surgical instruments, he recounted recent new discoveries in the treatment of tuberculosis in internal medicine: "Just in the first half of the year, we successfully cured tuberculosis using mercury nitrate.

A case of lip tuberculosis.”

"Mercuric nitrate is not bad and is effective in treating ulcers."

Kawei still agrees with this powerful medicine. The method is similar to the use of heavy metals in traditional Chinese medicine to remove pus and putrefaction. It uses the mechanism of heavy metal salts to limit cell oxygen uptake. The effect is definitely good. However, its use is limited, and it is suitable for topical use and requires

Control dosage.

But the enema that follows doesn't make much sense.

"We have also tried using milk, a small amount of almond oil and the yolk of an egg with a certain amount of water to prepare the enema. Then put creosote in it, about 50ml of milk with 5g of creosote, which can form 2-

3 days of diarrhea.”

In a manner of exchanging medical practice experiences with each other, Sneijder spoke in great detail, basically handing over all the information.

But in Kawei's view, the only useful one is probably creosote. It has a sterilizing and antiseptic effect. It is actually similar to carbolic acid, but the effect of enema on tuberculosis should be very limited.

"No, no, Dr. Carvey!" Sneijder was very excited. "In the past half a year, we have used this therapy on more than 20 patients with pulmonary tuberculosis combined with pleural tuberculosis and peritoneal tuberculosis."

"result?"

"The results are encouraging."

"oh???"

Kavi also didn't expect that this treatment would be useful. Even if creosote is a carcinogen, just like carbolic acid, if the two powers harm each other, whichever is less, he will definitely choose to suppress the white plague first.

But in fact, this is just wishful thinking on Sneijder's part.

Because many of the more than 20 patients who were successfully "cured" slowly returned to normal after 3-5 months of physical conditioning and nutritional support. There may be a small amount of creosote,

But more factors are due to the increase in body immunity and the improvement of the environment.

Moreover, the rate of "cures" is not particularly high, only 10. The remaining patients are either on the way to treatment, have been unable to be contacted, or have died quietly.

But this ratio was still good at the time, and at least it made people less desperate.

"There is no rush in terms of medical treatment. Now that the golf balls have been cleaned, let's start the surgery."

The full name of the surgery is extraperiosteal plastic ball tamponade, a method created abroad and carried forward by Gu Kaishi, a pioneer in domestic thoracic surgery. He is one of the founders of domestic cardiothoracic surgery and is also a famous connoisseur and collector of cultural relics.

It can be said that much of Kawei's impromptu intention to participate in the auction came from the cultural influence he received when he was teaching.

Extraperiosteal plastic ball tamponade was a technique taught by Gu Kaishi. At that time, it had actually been replaced by lobectomy, but Kawei still learned it and even learned the process of making this unique hollow plastic ball.

But this operation is just a compromise for the disease. From its inception in the 1950s to the rapid decline after the glory of the 1960s, and then to the tepid situation in the 1970s and 1980s. Compared with the rapid decline abroad, the difficult situation in China is

The environment still gives this kind of surgery a certain environment for survival.

Of course, it was inevitable that he would be eliminated by the general trend of surgical development in the end.

"The location of the cavity is most likely the location of bleeding." Kawei repeatedly auscultated and determined the location of the cavity. "From auscultation, we can roughly determine that the location of the lesion is at the apex of the right lung, which should be closer to the rear. So our incision is also on the right rear.

My scalpel."

Because the patient had just suffered from hemoptysis, lying on his side would worsen the condition, so he chose the prone position for the surgery to expose the right rear side.

"We make a posterolateral incision and peel off the rib periosteum from top to bottom, starting from the outside and inside of the first rib." Kawei hasn't done this kind of surgery for many years, but he still has a deep memory of it, and with his rich experience, he restored the surgery.

It's not difficult at all. "After peeling it off, pack it when it collapses with breathing. Give me gauze."

Quickly pack gauze to reduce lung capacity, and continue to peel off the periosteum in the direction of the spine: "Here we should pay attention to protecting the pleura as much as possible. If the pleura is ruptured, we also need to use gauze to pack quickly. Especially the side of the spine, we must be careful to handle it, so as to produce a lot of damage."
To be continued...