Chapter 262 Bullets!
Modified radical mastectomy for breast cancer.
Fang Ying has seen Wu Xiaofu's skill in thyroid surgery, but she has never even heard about breast surgery. Now that she wants to see it with her own eyes, she is really looking forward to it.
Modified radical mastectomy for breast cancer also has many advantages. After radical mastectomy, the risk of breast cancer recurrence is greater, but the probability of recurrence after modified radical mastectomy is lower than that of radical mastectomy.
As for the appearance, the surgical trauma after radical mastectomy is very large, the appearance is ugly, and there may even be abnormal upper limb function, while modified radical mastectomy usually does not leave any major trauma. .
This patient had bilateral breast cancer, most severe on the left side. Compared with the patient in the outpatient clinic in the morning, the condition was milder. Wu Xiaofu was admitted to the hospital before Wu Xiaofu came to Jinhu County.
This surgery was a non-laparoscopic modified radical resection of bilateral breast cancer.
Yes, breast cancer can also be treated endoscopically, but the operation is more difficult and more expensive. In Wu Xiaofu's case, of course, it is not because of the difficulty of the operation, but because of the cost.
The patient in front of me is already fifty-nine years old. He said that he does not have many requirements for the appearance of the breasts and he is relatively poor. Naturally, he has to choose a more economical and affordable surgical method. General surgery, here at Wu Xiaofu, In fact, it won’t cause any more damage than laparoscopy.
Without the need for aesthetics, the entire operation cost can be saved by nearly a w.
This is also the reason why many breast cancer patients choose ordinary surgery.
There are actually many surgical methods for bilateral modified radical mastectomy. Of course, the current mainstream surgical method is modified radical mastectomy that preserves the pectoralis major and minor muscles.
It is also in the supine position. However, for the convenience of surgery, the patient's shoulder blade on the affected side should be raised a little, and then the upper limb on the affected side should be abducted 90° to allow the muscles to fully stretch and the breast to be fully exposed, because this is The posture during the examination not only facilitates exposure of the armpits and makes the operation smoother, but also makes it easier for the surgeon to locate the tumor.
Because there are cancer lesions on both sides, this patient had to stretch both arms.
“Okay, let’s prepare for general anesthesia.”
Wu Xiaofu confessed and went to wash his hands. In fact, local anesthesia can be used for breast surgery, but it also depends on the operation time. If it is a general breast nodule surgery, Wu Xiaofu can basically complete it within half an hour.
In this case, local anesthesia is enough, but breast cancer surgery usually takes more than an hour, and unexpected situations may occur during the process. And the patient is not too young, so complications may occur. There are still some, so general anesthesia is safer.
After general anesthesia, patients can also suffer less.
In this position, if general anesthesia is not performed, the patient will start to become restless within ten minutes, which is really uncomfortable.
Wu Xiaofu didn’t want to delay his life, so it was safer to go under general anesthesia.
After washing her hands, Fang Ying and her assistant had already started disinfecting the sheets.
Wu Xiaofu designed the incision, usually choosing a transverse fusiform incision or a longitudinal fusiform incision according to the location of the tumor.
This is selected based on the location and type of the tumor. For example, for a left breast tumor in the inner and lower quadrants, it is best to choose a transverse fusiform incision. The scalpel point is in the middle or upper middle 1/3 of the inner side of the breast. junction, and then start making a transverse fusiform incision.
As soon as Fang Ying saw Wu Xiaofu's incision without hesitation, she knew that Wu Xiaofu must be a veteran. If he hadn't done a few surgeries, it wouldn't have been so smooth. However, what he didn't know was that Wu Xiaofu No matter what kind of surgery it is, it's like this.
Wu Xiaofu has really never done breast surgery a few times, but the ideas are similar, and Wu Xiaofu is very confident.
After the subcutaneous incision, he began to free the skin flap. Hiss, Wu Xiaofu used the electric knife to free the skin flap, straight up the clavicle, then medially to the midline, lateral to the front edge of the latissimus dorsi, and down to the costal arch, completely exposing the surgical field. come out.
The smell of meat wafted out, which made Wu Xiaofu return to familiar territory.
To be honest, surgery and surgery are still different.
Just like thyroid surgery, due to the distribution of subcutaneous fat, the taste of meat is far inferior to that of places with higher fat content such as the breast.
The eyes fell on another assistant.
"Does it smell good?"
"Ah!"
The second assistant was stunned when he heard this, and Fang Ying glared at him directly, "You are smoking, what are you waiting for."< br>
“Oh!”
This is when Erzhu knew that Wu Xiaofu’s kind smile was filled with accusations. She lost her mind and didn’t smoke in time. Damn it. , how could this be the first time to perform surgery on an idol and disgrace such a big person, he was going to die, he was going to die.
Quickly lower your head and start working hard.
Wu Xiaofu didn’t pay much attention and began to disconnect and ligate the first and third perforating branches of the internal mammary artery and vein.
This is the most important branch of blood circulation around the tumor. After disconnecting this branch, the surgery can be done more safely and boldly. There is no need to worry about a stream of hot blood spraying onto the face during the operation.
The pectoralis major muscle is the part that the surgeon directly faces.
“Vascular Clamp!”
Clamp and lift the breast with several vascular forceps. Fang Ying has already taken it easily. Wu Xiaofu frees up his hand to pick up the electric knife and begins to remove the breast and surrounding fat tissue from top to bottom and from inside to outside behind the pectoral muscle fascia to the chest. The outer edge of the major muscle.
Looking at the equipment nurse aside.
“You can breathe.”
Phew!
Different from the previous two nurses who performed thyroid surgery, there was actually a different nurse for the third surgery. She was still young and looked about the same age as him, or even younger.
After taking the stage, she was obviously very nervous. Her brows were furrowed as if facing a formidable enemy, which made Wu Xiaofu a little unable to bear it. Not to mention her breathing difficulty, Wu Xiaofu was afraid that she would fall down on the stage due to lack of oxygen. .
So, I kindly reminded you.
The equipment nurse took a deep breath and said a little embarrassedly, "I'm sorry, Teacher Wu, Sister Yuan has something to do at home and has to leave first. I'm here temporarily, but don't worry, I'll be training while I , who has undergone several breast cancer surgeries.”
Study!
Have you studied further at such a young age? sure.
Wu Xiaofu didn't criticize her too much. This nurse was indeed well-educated and had never made any mistakes.
"Well, it's okay, just relax, I don't eat people."
While speaking, Wu Xiaofu did not stop his operation, and had already begun to free the outer edge of the pectoralis major muscle and The tissue behind the pectoralis major muscle is loose. After lifting the pectoralis major muscle upward, the pectoralis minor muscle is exposed.
At this time, it is time to start removing Rotter’s lymph nodes.
Rotter's lymph node is an axillary lymph node, also called an intermuscular lymph node. It is divided into three areas with the pectoralis minor muscle as the boundary. It is an important channel for the drainage of bilateral breasts and the return of lymph fluid in the thoracic cavity.
This step of surgery is very important. The most common way for breast cancer to metastasize is lymphatic metastasis. Therefore, when breast cancer metastasizes, the closest way it can metastasize is to the axillary lymph nodes, which manifests as swollen lymph nodes and unclear lymphatic hilus-like structures.
In breast cancer surgery, this part of the lymph nodes must be dissected.
Of course, the inner and outer edges of the pectoralis minor muscle must be freed first, and the dorsal side of the pectoralis minor muscle must also be bluntly separated to facilitate lifting with a retractor, so that the axillary lymph nodes can be completely removed.
"Do you see it? What's the difference if I clean the lymph nodes?"
Wu Xiaofu looked at Fang Ying beside him and asked.
Fang Ying is indeed very perceptive. After hearing the question, she didn't even hesitate and said directly, "Doctor Wu, when you clean the lymph nodes, you clean them from the outside to the inside."
Wu Xiaofu News Yan nodded. This is different from the current mainstream method of lymph node removal. The effect is obvious. Wu Xiaofu's way of cleaning is more obvious and complete. The more he scans, the more he feels at ease. Unlike other methods of cleaning lymph nodes, the more he cleans, the more he feels. If you don't feel at ease, you have to go back and check twice before you can feel at ease.
However, it is not easy to scan like this.
The operation is obviously more difficult. The premise is that you have to free yourself more completely and leave out all the parts you want. Only then can you dare to work from the outside in. Otherwise, who can be sure that you have not left any parts behind? .
At the very least, Fang Ying didn’t dare to learn it yet. Wu Xiaofu didn’t even ask for any prerequisites and just started cleaning from the outside in. Fang Ying was not at ease at first, so Wu Xiaofu showed her the From Fang Ying's experience, it can be clearly seen that the lymph node plexus has been completely cleaned.
This is outrageous. Can she learn this idea?
Incise the coracoclavicular fascia, protect the medial cutaneous nerve of the forearm and intercostobrachial nerve, free it from the serratus anterior fascia outward and downward, cut off the intercostal nerve and intercostal perforating branches of blood vessels, and dissect and expose the Protect the long thoracic nerve, thoracodorsal nerve and subscapular blood vessels.
Wu Xiaofu went faster and faster, and it seemed that the further back he went, the more he entered the state.
Finally, the breast and axillary lymphatic fat tissue were removed en bloc, and the operation on one side was basically completed.
Half an hour.
Fang Ying looked at the time. This speed was a bit too fast.
Looking at Wu Xiaofu, "Boss, do you want to do it slower? This will make me think this operation is very simple."
"It is very simple."
< br>Hmm!
Fang Ying and her assistant were stunned. It was really simple! Is this like human speech? They finally saw that Wu Xiaofu was just a walking fork-loading machine, so they shouldn't have any illusions.
Suddenly I remembered what Fan Xin had chatted with them. No matter who had followed Wu Xiaofu for a long time, they would be used to being a good compliment for Wu Xiaofu, um, or a perfect compliment.
No, it’s only been one afternoon, and they have already entered the state.
"Look at this side first, I'm going to do the other side."
Fang Ying hurriedly agreed. The big work was done, and the next step was to check the wound for active bleeding. Afterwards, rinse the wound, place porous drainage tubes in the armpits under the pectoral muscles and in the inner breast area, lead them out through the lowest point and secure them properly.
If you want to sew the skin, just wait until Wu Xiaofu finishes the other side and sew them together.
On the other side, Wu Xiaofu seemed to be moving faster. The steps were obviously similar. Fang Ying read them again, but her understanding was not as good as on the previous side because Wu Xiaofu stopped explaining to him and the pace suddenly accelerated.
This is like a good student giving a lecture to her. The first time, she seemed to understand but not understand. She wanted to ask the good student to teach her again, but the good student stopped teaching and just stood in front of her. I did it again. I looked at it and recognized the words, but I really didn’t know how to do it.
Looking at Wu Xiaofu, there was some resentment in her eyes. After all, she thought Wu Xiaofu would explain it to her thoughtfully, but after all, she paid by mistake. "Huh, it's done. Let's take a side and sew quickly. It's almost six o'clock."
Huh?
Fang Ying was stunned when she heard this and looked at the time. It would be six o'clock in ten minutes. What do you mean? The reason why Wu Xiaofu worked so fast couldn't be because he was rushing to get off work before six o'clock!
Hey guys, are you a part-time worker who doesn’t want to work overtime at all?
Thinking of this, Fang Ying suddenly understood. Well, that's good. On this point, Wu Xiaofu seemed to be the same as her. They finally found one thing in common: they were unwilling to work overtime.
It was time to get off work and start virtue. Fang Ying didn't waste any time and hurriedly started processing it.
After the resection, the suturing tension of both breasts is relatively high, so tension reduction suturing is required. This is a small job for Wu Xiaofu and Fang Ying. If they are not in a hurry to get off work, they can just leave it to the assistant. .
The poor second assistant looked at the two of them pitifully, and didn't give her a chance to finish the finishing work?
After suturing, negative pressure suction and pressure bandaging, the operation was finally over.
Wu Xiaofu looked at the time. It was perfect. There were still five minutes until six o'clock. He changed his clothes and just clocked in.
Well, I forgot, in Jinhu County Hospital, there is no need to clock in.
Phew!
Wu Xiaofu took off his surgical gown and took just two steps when he heard the sound of breathing heavily behind him and couldn't help but look back.
Looking at each other, the equipment nurse couldn't help but froze, and stammered, "I, I'm not nervous."
Haha!
Wu Xiaofu couldn't help being amused and left without saying anything.
But I heard the equipment nurse talking to the people next to me, as if to prove something, "I'm really not nervous."
After getting the mobile phone, Wu Xiaofu saw Fan Xin's message and asked if he wanted to have dinner with him.
Not only Fan Xing, but also many other information.
Wu Xiaofu looked at the message Wu Mingjie sent and asked him to call back after get off work.
“Hey, second brother, do you have a problem with me?”
At this time, Wu Mingjie was still in the office. When he received a call from Wu Xiaofu, he remembered to check the time. , it turned out that it was almost six o'clock, and he had been crazy busy these two days.
"I can't look for you if I have nothing to do. You should get off work and wait in the hospital. I will pick you up and we will have dinner together in the evening."
Wu Xiaofu agreed wholeheartedly. He was originally planning to leave quickly, but now he still If he had to wait for Wu Mingjie, he might as well take a shower first.
The entrance of the hospital.
Wu Xiaofu sat cross-legged on the table and replied to the message.
Wu Xiaofu has two mobile phones and receives countless messages every day, some from colleagues and friends, and some from patients.
Among these information, the patient’s information is the most important.
No matter whose information it is, Wu Xiaofu will take the time to go back to it. Of course, for some advertising messages, the owner of the information will be deleted directly.
First of all, I sent four sixty-second voice arrays to Qu Ying. They mainly introduced today's life and things I encountered. Well, I reported it frequently so that my daughter-in-law, who is in a long-distance relationship, can maintain a sense of security. , this is necessary.
Not only Wu Xiaofu, but also Qu Ying. Neither of them asked the other.
But this tacit understanding was formed somehow. It seems that Qu Ying started it first.
Needless to say, it has become one of the fun things in their lives.
Hey!
Wu Xiaofu looked at Linlin's name, which was written on it. Linlin sent Wu Xiaofu a lot of messages, most of which were photos.
Looking at the sunny girl with a sweet smile in the photo, Wu Xiaofu couldn't help but laugh.
This Linlin was the first radical surgery for pancreatic cancer performed by Wu Xiaofu after coming to Donghai, and it was also the first time she climbed Mount Everest.
Wu Xiaofu, a girl in her early thirties, still remembers the look of despair in her eyes. However, now Linlin has found the meaning of life again. According to Linlin's information, she went to Yunzhou with her best friend a week ago. I am still planning to stay there for a while, saying that it is really relaxing there and I also met a very interesting young man.
Wu Xiaofu started to feel happy for her. Linlin seemed to have really forgotten her condition. However, she did not forget to review her. The results of these reviews were sent to him regularly. There has been no recurrence so far.
This is the importance of mentality. You know, after Wu Xiaofu performed the operation on Linlin, even other colleagues in the hospital were not optimistic about it.
But it has been half a year, and the recovery effect is better than that of their patients who had undergone surgery in the early stages of pancreatic cancer.
Tell Linlin to take more pictures of the scenery in Yunnan Province for him in the future. He likes to see it.
"County Magistrate, is this really Professor Wu?"
Wu Xiaofu sat cross-legged on the table and frantically replied to messages. To outsiders, he looked like he was working hard with his cell phone, his expression changed, and he was playing games? Still chatting with your girlfriend? No one can tell.
After Wu Mingjie came over, he was planning to call Wu Xiaofu, but at a glance he saw Wu Xiaofu sitting there with no burden at all.
The secretary beside him, as well as the Propaganda Minister and his secretary who were coming off work together, also knew at this time that this was Wu Mingjie’s legendary younger brother. During this time, they were all interested in Wu Xiaofu’s name. , like thunder piercing the ears.
All kinds of reputations have given them high expectations for Wu Xiaofu.
But now this meeting is a bit overwhelming. This person seems to be no different from the lazy guys in the county.
Although the halo was shattered, it also made them feel closer.
"You don't understand my little brother. Xiaofu is not delicate. He grew up on the grassland and is good at horse riding and wrestling. If you want to learn horse riding or something, find a horse farm some other time. Let Xiaofu teach you.”
“That’s a good feeling.”
Wu Mingjie smiled and shouted to Wu Xiaofu.
"Xiao Fu, let's go."
Wu Xiaofu then realized that Wu Mingjie was coming, put his phone away, and got in the car directly.
"Xiao Fu, this is Minister Zhou and her secretary, having dinner together tonight."
Minister Zhou!
Wu Xiaofu looked at this sister who was about forty years old and immediately took the initiative to say hello. When Wu Xiaofu first came to Jinhu, Wu Mingjie came to pick him up, followed by Minister Zhou. Now it seems that Wu Mingjie is Won this guy over.
"Hello, Minister Zhou."
"Hello, Professor Wu, I didn't even have a good chat that day. We have to have a good chat together for dinner today."
Of course Wu Xiaofu agreed, After saying hello to the two secretaries, we set off.
On the way, Wu Mingjie asked Wu Xiaofu how his work was going. Wu Xiaofu told Wu Mingjie what happened in the past two days. Wu Mingjie was dumbfounded, "Are you in too much of a hurry?" You can’t be exhausted yourself. Where did we get so many patients in Jinhu?”
Wu Mingjie was a little surprised when he thought about Wu Xiaofu saying that in just one morning, he had admitted more than thirty patients. .
"County Magistrate, Jinhu doesn't have it, but it does in other places. I heard that Professor Wu is here, but there are many patients who come here because of his reputation."
"Sister Zhou, don't call me Professor. "Well, if you don't mind, I'll call you sister, and you can just call me Xiaofu. I think you're kind, so don't be so harsh."
Minister Zhou was stunned when he heard this, and then he was happy. laughed.
"Okay, Xiaofu, I think you are very kind. I'm afraid you might mind. In this way, we will eat out today and let your brother-in-law cook the food in person someday and eat at home. You My brother-in-law is a good cook.”
“Then I’ll remember that I must try my brother-in-law’s cooking skills.”
...
Wu Mingjie watched Wu Xiaofu become warm with Minister Zhou in a short time, as if they were siblings, and couldn't help but shook his head. To be honest, in his opinion, even if Wu Xiaofu is not a doctor, As Wu Jinglue said, entering politics is absolutely the same.
No matter what people do, what they actually compete for is their EQ, IQ and background.
Wu Xiaofu lacks none of these three things, and they are all top-notch. In terms of emotional intelligence and IQ, Wu Mingjie is ashamed of himself.
During dinner, Wu Xiaofu discovered that Wu Mingjie had invited other people.
He is a senior political and legal official from Jinhu, named Jiao Yang. He is about fifty, tall and tall, looks very capable and speaks eloquently.
During the second half of the drinking, Wu Mingjie told Wu Xiaofu that Jiao Yang’s father was an old policeman. He was now in his seventies. He had been feeling unwell recently, but no problem could be found, and he wanted Wu Xiaofu to help. look.
“It’s just a stomachache. I’ve been to the provincial capital to see it before, but I’m still not sure what’s going on. At first, I said it might be a cold or something like that. It’s possible for the elderly, but It’s been a month and it’s still not getting better. The county magistrate said you might have something to do, so I was wondering if I could ask you for help.”
My stomach hurts!
Can't you find out in the provincial capital?
Wu Xiaofu was also interested and hurriedly asked about the specific situation, but Wu Mingjie looked at Jiao Yang with deep meaning. It was obvious that he was rushing to introduce Wu Xiaofu to Jiao Yang, but in Jiao Yang's mouth, it was Jiao Yang who took the initiative. He helped.
Well, none of them are bad in emotional intelligence.
“Ever been shot?”
“Well, it happened more than 20 years ago. It was not taken out at that time, but it has been fine after so many years of reexamination. This time I went to the provincial capital. During the examination, the doctor also said that it should not be related to the bullet."
Wu Xiaofu nodded.
"Let's do it this way. I've been drinking today, so I won't bother you. I'll contact Secretary Jiao after the operation tomorrow afternoon and go to the old man's house to have a look." After get off work, please contact me and I will come to pick you up.”
(End of this chapter)