7 doctors in one department, five operations a day, one after another, from the early morning to the early morning, what have they experienced in 24 hours? Look at the journal records of the department nurses on June 28:
At 3:00 am on the 28th, the phone rings, the emergency department calls, and a patient with a car accident is injured. Please consult the peritoneal tumor surgery. On-duty doctor Zhang Zhanzhi immediately went to the emergency department. The patient, male, 40 years old, had a car accident in Fangshan on the night of the 27th. He was treated in the emergency department of Yuliang Township Hospital. The initial examination was diagnosed as “multiple trauma of head, chest and abdomen” and it is recommended to transfer to a higher level hospital. Referred to our hospital in the early morning of the 28th. Dr. Zhang Zhanzhi immediately carried out the corresponding examination. The patient’s blood pressure was low, the heart rate increased slightly, hemoglobin was 105g/L, the blood loss symptoms were not clear, while the abdominal ultrasound and CT examination were urgently performed, and the nurse on duty was contacted to make room for the emergency patient as soon as possible. The results of ultrasound and CT results showed that the patient’s peritoneal effusion was suspected of abdominal hemorrhage, but there were no signs of rupture in large organs such as liver and spleen.
4:00, the emergency department also admitted a patient transferred from a foreign hospital, female, 36 years old, on the 27th in the external hospital to remove the intrauterine sterilization device, postoperative persistent lower abdominal pain, fever, the highest At 39 °C, he was treated in several hospitals. The diagnosis was unknown. He was transferred to our hospital for emergency treatment in the early morning of the 28th. After the gynecological consultation in the emergency department, he also consulted the peritoneal tumor surgery joint consultation. Dr. Zhang Zhanzhi found that the patient had obvious abdominal pain and palpation. The tenderness, rebound tenderness, and muscle tension were all positive, and the patient was urgently scheduled for emergency CT and ultrasound examinations.
7:30, all doctors of peritoneal tumor surgery discuss the condition of two emergency patients:
A car accident with a review of hemoglobin 100g/L, suggesting a progressive decline in hemoglobin, combined with abdominal puncture, hemorrhagic Liquid, can confirm abdominal bleeding, but CT and ultrasound can not be clear of organ damage, then where is the bleeding point? The next step is to choose conservative treatment with small trauma, and stop bleeding and continue to observe. Or do a laparotomy to determine the location of the bleeding, stop bleeding during surgery? Director Li Yan, because there are two major operations, indicates that if the bleeding point cannot be specified, after the results of the examination are perfect, talk with the family members to open the stomach for hemostasis.
8:30, routine surgery for peritoneal tumor surgery begins.
Surgery 1: Female patient, 61 years old, more than 1 year after ovarian cancer surgery, had multiple radiotherapy and chemotherapy. Recently, he was diagnosed with peritoneal tumor surgery due to severe abdominal distension. Preoperative examination revealed peritoneal and omental thickening, multiple small nodules in the abdominal cavity and retroperitoneum, colon involvement, ascites, and pelvic fluid. At the request of the family, complete preoperative preparation, cytoreductive surgery plus intraperitoneal hyperthermic perfusion chemotherapy. In the operation, the omentum was completely tumorized, the diaphragmatic peritoneal tumor, the round ligament of the liver, the small mesenteric multiple nodules, the peritoneal pelvic and peritoneal pelvic thickening, the ascending and descending colon, and the bilateral paracolic plaque. Flaky tumor nodules. Surgery is extremely difficult.
Surgery 2: Female patient, 62 years old, more than 3 years after ureteral cancer surgery, postoperative radiotherapy, chemotherapy and cellular immunotherapy. Before February, the patient’s ascites suddenly increased, and multiple ascites drainage and drainage were performed to seek surgical treatment opportunities, control ascites, and improve the quality of life. Intraoperative ascites 2500ml, parallel cytoreductive plus hyperthermic perfusion chemotherapy.
9:00, after the department discussed and perfected the preoperative preparation and conversation, the injured in the car accident was pushed into the operating room, the laparotomy was carried out, the blood was cleared 2500 ml, and the organs in the abdominal cavity were thoroughly explored. And tissue, found ileal mesenteric rupture, mesenteric arteriolehemorrhage, accompanied by damage to the myometrium of the ascending colon wall. Peritoneal washing, intestinal repair, mesenteric repair, mesenteric vascular ligation and hemostasis. The operation was smooth.
12:30, 25-bed patient in the ward complained of blood clots in the stoma and discharged bloody fluid, about 1000ml, bright red. (Patient mainly due to pelvic recurrence after rectal cancer invaded the bladder and prostate. In 1 week before, I underwent total pelvic organ resection and ileal bladder.) The patient reported dizziness, unclear vision, blood pressure 75/51mmHg, heart rate 80 After /minute, breathing 22 times /min, blood oxygen 100%. Give Baquting, fibrinogen, Kang Shu Ning to stop bleeding, pressurizing fluid to expand, and anti-shock treatment. Immediately contact the blood transfusion department for blood preparation and blood transfusion. In order to save time, Dr. Li Bing personally went to the Department of Blood Transfusion to send blood samples and take blood.
14:00, after a series of anti-shock treatments such as hemostasis, infusion and blood transfusion, the patient’s blood pressure rose back to 90/60mmHg, the symptoms improved after the self-report, the amount of stoma bleeding decreased, and the condition became stable.
At 15:00, the accident of the injured car was successfully completed and returned to the ward. The operation lasted more than 5 hours.
17:00, 25 patients with postoperative bleeding suddenly deteriorated, in addition to laparoscopic bleeding, abdominal drainage tube also appeared blood drainage.
17:30, urgent consultation, interventional doctors consider the current specific bleeding position is uncertain, interventional treatment is difficult to stop bleeding and cause intestinal ischemic necrosis and other risks, it is not recommended interventional therapy. Department of Gastroenterology, Liu Yuliang, deputy chief physician consultation and asked Director Wu Jing to think that colonoscopy can be used to determine whether the colon is bleeding. The consultation doctor brought the colonoscopy equipment to our department. When the preparation for colonoscopy is completed, the patient’s bleeding suddenly increases. The perineal wound oozing, the drainage tube bloody fluid progressively increased, the patient’s abdominal distension was obvious, and the bedside B-ultrasound showed a large amount of effusion in the abdominal cavity. The patient’s blood pressure was low, the general condition was poor, and he could not tolerate it. The colonoscopy failed.
At 18:30, patients with recurrence of ureteral cancer were successfully operated and returned to the ward. The operation lasted 10 hours.
19:50, the doctor on duty reported the 25-bed patient consultation to Director Li Yan on the operating table. Director Li considered that the patient had a large amount of intra-abdominal hemorrhage and should not continue conservative treatment. He decided to immediately detect the hemostasis.
20:00, 25 beds postoperative bleeding patients into the operating room, laparotomy, after opening the abdomen can be seen in the abdominal pelvic cavity with a large amount of blood with blood clots, the amount of about 4000ml, clear the abdominal pelvic blood, after a thorough and detailed investigation It was found that the inferior epigastric artery ruptured spontaneously, and pulsatile bleeding was observed. Hemostasis. It is speculated that this bleeding may be related to the patient’s multiple use of anti-angiogenic drugs before surgery.
At 20:00, patients with recurrence of ovarian cancer recurred successfully and returned to the ward. The operation lasted 11 and a half hours.
21:00, patients who have undergone intrauterine sterilization in the external hospital, after repeated consultations and discussions with the gynecology, consider the patient’s intra-abdominal infection is clear, but the reason is difficult to determine between acute pelvic inflammatory disease and colonic perforation, patients The signs of peritonitis were clear and laparoscopic exploration was decided. As the bed in the ward is full, the patient is negotiated with the heart surgery to treat the patient. Intraoperative exploration found that patients with pelvic inflammatory disease and fallopian tube empyema, intraoperative gynecological consultation, after the telephone communication between Director Tu Jinghui and Director Bai Wenpei, it is recommended to perform a puncture to confirm the diagnosis. Laparoscopic tubal puncture was presided over by Director Wang Yan. The yellow turbid pus was taken out, and the fallopian tube abscess was opened. The pus wall was sent for examination. The 6000 ml saline was used to flush the abdominal pelvis to the rinse solution for clearing and re-exploration. Abnormalities such as perforation of the digestive tract
At 12:30 on the 28th, the female patient with abdominal pain was examined and returned to the heart surgery ward. The operation lasted for 3 hours.
At 3:00 am on the 29th, patients with 25 bed bleeding were hemostasis and transferred to the ICU with tracheal intubation. The operation lasted 4 hours and was observed for 3 hours.
(peritoneal tumor surgery Wei Wenpeng)