"Using freezing technology..." Su Yun started asking and then stopped.
"I have considered it, but the patient is currently suffering from hemoptysis. If the freezing is not done properly, there is a greater possibility of problems." Fang Lin said with a frown.
"I think we can give it a try. The freezing technology at this location should be more suitable." Zheng Ren looked at the film and said softly.
Fang Lin carefully thought about the difficulties of doing bronchoscopy + cryotechnology, and he was a little embarrassed.
Zheng Ren looked at the film, entered the system space, and prepared to do a bronchoscopy.
The principle of cryotechnology is to treat lesions based on the Joule-Thomson effect to achieve the purpose required by the doctor.
After the high-pressure gas in the cryoprobe is ejected through the nozzle, it expands rapidly in the low-pressure area. When the probe contacts the tissue, it exchanges heat with the tissue and takes away the heat from the tissue, causing the tissue to freeze.
Tissue damage caused by freezing can occur at the cellular level and tissue level and will not cause more damage.
The difficulty of the patient's condition is that the foreign body in the bronchus or the serious adhesion of the stone to the surrounding tissue has caused the bronchial wall to rupture and bleed.
Being able to cough up 350ml of blood means that the bleeding blood vessel is relatively large, at least a blood vessel like a slightly larger bronchial artery branch.
The adhesion is severe and it is not a lump of foreign body with clear boundaries. To be honest, it is difficult to completely remove the bronchial foreign body using cryotechnology.
Fang Lin's concern was whether directly removing the foreign body and preserving the lung tissue would cause more severe hemoptysis, which never endangered the patient's life.
I can only give it a try.
Zheng Ren started surgical training with the attitude of giving it a try. If it didn't work, he could only remove the lung lobes according to Fang Lin's advice.
Intramuscular injection of 10 mg of cedipam was given 30 minutes before surgery. Zheng Ren still felt uneasy, so he added 50 mg of meperidine and 0.5 mg of atropine for intramuscular injection, and gave 10 ml of 2% lidocaine for atomized inhalation.
After the drug took effect, Zheng Ren inserted the fiberoptic bronchoscope into the right lung and entered the problematic right lower lung.
Soon, Zheng Ren saw a foreign object.
Mucosal edema, granulation hyperplasia, a foreign body at the distal end, wrapped in granulation tissue, obvious bleeding after the lens touched the foreign body, and a large amount of purulent secretions overflowed.
What the hell is this? There seems to be a problem. The appearance... seems familiar.
Zheng Ren carefully looked at the wrapped foreign body with a fiberoptic bronchoscope, and suddenly thought of several case reports published in China.
It’s…peppers.
It sounds unbelievable that eating chili peppers and accidentally inhaling them into the lungs, but there have been reports intermittently over the years.
However, knowing what the foreign body is is of no use at all.
Based on the medical history and the patient's repeated attacks, the foreign body should have been present for several years. The granulation proliferation was obvious, resulting in a small orifice, making it difficult to completely remove the foreign body inside. Coupled with the foreign body and surrounding adhesions, the mirror bleeds after being touched, making it very difficult to completely remove it.
Zheng Ren did not hesitate and first removed the secretions and necrosis on the surface of the lesion so that the cryogenic probe could fully contact the lesion.
Then a sterile cryoprobe is inserted through the biopsy hole, and the metal end of the cryoprobe is placed in the center of the lesion. The probe is more than 5mm away from the distal end of the bronchoscope. The tip of the probe can be used to act on the tissue vertically or tangentially, or directly inside the lesion, so that Produces maximum freezing effect.
Press the pedal to start the probe. After about 15-20 seconds, an ice ball will form on the top of the probe. The tissue can be seen to be white and frozen. After releasing the switch, let it melt naturally.
1-3 freeze-ablation cycles, each cycle lasting 3-4 minutes in the same or adjacent area. For larger lesions, multiple freezing points can be used until the visible part is completely frozen.
After several failures, Zheng Ren summed up his experience.
The freezing time is about 18 seconds, and it takes 4 freeze-thaw cycles, with the duration of each cycle being 3 minutes and 20 seconds.
Finally, with a small amount of bleeding, Zheng Ren used foreign body forceps to remove the entire foreign object.
The peppers were rotten and gave off a weird smell that was unacceptable.
Because the bronchial wall was severely corroded, Zheng Ren inserted another bronchial stent and completed the operation.
Zheng Ren let out a sigh of relief when he saw the indication that the operation was 99% complete.
He was curious about what happened to the pepper in the trachea.
Holding the hemostatic forceps, Zheng Ren began to open the mechanized layer wrapped around the pepper. But as soon as he opened it, the smell of rotten peppers rushed into the olfactory epithelium in Zheng Ren's nasal cavity, which is composed of supporting cells, olfactory cells and basal cells.
Through the olfactory nervous system and the nasal trigeminal nervous system, it enters the olfactory bulb of the telencephalon.
After being in a daze, Zheng Ren almost fainted in the system operating room.
This smell... No wonder Quan Xiaocao doesn't eat. It's strange that he can eat something if he smells this smell every day.
And not only is it smelly, it's also a toxic gas. If his physical fitness had not been enhanced in the system space, Zheng Ren would have fainted and died in the operating room.
Even if the person can survive by then, countless surgical training time will be "wasted", and Zheng Ren may even want to die.
Zheng Ren came out of the system operating room and ended his surgical training. If he fainted and died in the system operating room, so much surgical training time would be wasted in vain, and Zheng Rende would be heartbroken.
"Boss, are you good at freezing technology? I think you can give it a try. Although it is difficult, I am ready to cut the lung lobes anyway. Why..."
"We can give it a try. In the hybrid operating room, we can first use cryotechnology to remove the foreign body with a fiberoptic bronchoscope. If successful, we will need to install a bronchial shelf to block the bleeding point."
Su Yun felt confident after hearing what his boss said.
"Fang Lin, who is your second-tier professor today?" he asked.
The inpatient general is in charge of emergency care, and surgeries that are dangerous and may not be performed will of course go to the second line.
"I wish the teacher the best, but he has a lot of surgeries today and hasn't finished yet." Fang Lin said.
"Go and communicate with the patient's family, and then find the second line to check on the situation." Su Yundao said.
Fang Lin didn't hesitate. Since Boss Zheng said it was okay, just drag him along to take a look. As for the second-tier teacher Zhu, if he wants to try it, he won't stop him.
There were eight laparoscopic surgeries a day, and it was said that three laparoscopic radical surgeries for esophageal cancer would be performed in the afternoon. How could he have time to deal with a bronchial foreign body
"Boss Zheng, Brother Yun, wait for me." Fang Lin said coquettishly while hanging a red stethoscope.
"Well, let's go back to the ward and wait for you." Zheng Ren said, "When you're ready, call Su Yun and we'll go up."
After saying that, Zheng Ren thought for a while and said to Su Yun: "What class does Lao He belong to? Let's set up the table together. If there is severe bleeding, emergency intubation is needed."
Fang Lin started to have a headache at the thought of massive bleeding and emergency intubation.
Once this kind of surgery needs to be performed in an emergency, the risk increases suddenly.
Just looking at Boss Zheng's confident look, Fang Lin struggled for 3.2 seconds, and finally decided to explain carefully to the patient's family. He must clearly explain all the risks during the operation and let the family members make their own choices.