Chapter 2194 Pepper in the Lungs

"Use freezing technology..." Su Yun asked at the beginning, then stopped.

"I've thought about it, but the patient is suffering from hemoptysis now, so it's more likely that there will be problems if the scale is not properly frozen." Fang Lin said with a frown.

"I think you can give it a try. The freezing technique should be more suitable for this position." Zheng Ren looked at the film and said softly.

Fang Lin thought carefully about the difficulties of performing bronchoscopy + cryotechnique, and was a little embarrassed.

Zheng Ren watched the film, entered the system space, and prepared to do a bronchoscopy.

The principle of freezing technology is to treat the lesion according to the Joule-Thomson effect to achieve the purpose required by the doctor.

After the high-pressure gas in the cryoprobe is sprayed out through the nozzle, it expands rapidly in the low-pressure area, so that when the probe touches the tissue, it exchanges heat with the tissue, takes away the heat of the tissue, and freezes the tissue.

The 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 bodies in the bronchus, or the stones are seriously adhered to the surrounding tissue, which has caused the rupture and bleeding of the bronchial wall.

Hemoptysis of 350ml means that the bleeding blood vessel is relatively large, at least a slightly larger blood vessel like a branch of the bronchial artery.

The adhesion is serious, and it is not a group of foreign bodies with clear boundaries. To be honest, it is difficult to completely remove the foreign body in the bronchi by freezing technology.

Fang Lin's concern is whether taking out the foreign body directly and preserving the lung tissue will cause more severe hemoptysis, which has never endangered the patient's life.

I can only try it.

Zheng Ren started the surgical training with an attitude of giving it a try. If it didn't work, he could only remove the lung lobes according to Fang Lin's advice.

Preoperative intramuscular injection of diazepam 10mg. Zheng Ren still felt uneasy, so he added 50 mg of meperidine and 0.5 mg of atropine intramuscularly, and gave 10 ml of 2% lidocaine nebulized inhalation.

After the medicine took effect, Zheng Ren operated a fiberoptic bronchoscope and inserted it into the right lung, into the problematic lower right lung.

Soon, Zheng Ren saw something foreign.

Mucosa edema, granulation hyperplasia, a foreign body at the far end, wrapped in granulation tissue, obvious bleeding after the lens touched the foreign body, accompanied by a large amount of purulent secretion overflowing.

What the hell is this? It looks like there is a problem. It looks... 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... chilli.

It sounds unbelievable that chili was inhaled into the lungs by mistake, but it has been reported intermittently over the years.

However, knowing what a foreign body is is of no use at all.

Combined with the medical history and the patient's repeated attacks, the foreign body should have been there for several years, and the granulation hyperplasia is obvious, resulting in a small orifice, and it is difficult to completely remove the foreign body inside. In addition to the adhesion of the foreign body and the surrounding area, the mirror bleeds after being touched, and it is quite difficult to remove it completely.

Without hesitation, Zheng Ren first removed the secretions and necrosis on the surface of the lesion so that the cryoprobe could fully contact the lesion.

Then insert a sterile cryoprobe through the biopsy hole. 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. Produces maximum freezing effect.

Step on the pedal to start the probe. After about 15-20s, a puck forms on the top of the probe. The tissue can be seen to be white and frozen. Release the switch and let it melt naturally.

1-3 freeze-thaw cycles, each cycle lasts 3-4 minutes in the same or adjacent area, larger lesions can be frozen more, 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 has to go through 4 freezing-thawing cycles, and the duration of each cycle is 3 minutes and 20 seconds.

Finally, with a small amount of bleeding, the entire foreign body was clamped out by Zheng Ren with foreign body forceps.

The chili has been rotten and exudes an unacceptable weird smell.

And because the bronchial wall was severely corroded, Zheng Ren placed another bronchial stent, and the operation was completed.

Looking at the reminder that the operation was 99% complete, Zheng Ren let out a sigh of relief.

He was curious about what happened to the pepper in the trachea.

Holding the hemostatic forceps, Zheng Ren began to open the mechanical layer wrapped around the pepper. But as soon as it was opened, the smell of rotten pepper rushed into the olfactory epithelium composed of supporting cells, olfactory cells and basal cells in Zheng Ren's nasal cavity.

Through the olfactory nervous system and the nasal trigeminal nervous system, it enters the olfactory bulb of the telencephalon.

After a daze, Zheng Ren almost fainted in the operating room of the system.

This smell... No wonder Quan Xiaocao doesn't eat, it's strange that if she smells this smell every day, she can eat something.

And not only is it smelly, it is also a poisonous gas. If it weren't for the enhanced physical fitness in the system space, Zheng Ren might faint in the operating room.

At that time, even if people can survive, countless surgical training time will be "wasted", Zheng Ren may even have the intention of dying.

Zheng Ren came out of the system operating room and finished his surgical training. After coming out, Zheng Ren still had lingering fears about the smell.

"Boss, are you good at freezing technology? I think you can try it. Although it is difficult, I am going to cut the lung lobes anyway. Why..."

"You can try it. In the hybrid operating room, the foreign body is first frozen and removed with a fiberoptic bronchoscope. If it succeeds, a bronchial shelf will be used to block the bleeding point."

Hearing what his boss said, Su Yun felt confident.

"Fang Lin, who are your second-line professors today?" he asked.

The inpatients are always in charge of the emergency department, and if there are dangerous operations that may not be able to be performed, of course the second line should be sought.

"I wish the second-line teacher, but he has a lot of operations today and he hasn't finished yet." Fang Lin said.

"Go and communicate with the patient's family, and then go to the second line to check the situation." Su Yun said.

Fang Lin didn't hesitate, since Boss Zheng said it was fine, he just took him to have a look. As for the second-line Teacher Zhu, if he wants to try it himself, he won't stop him.

Eight laparoscopic operations are performed a day, and it is said that three laparoscopic radical resections for esophageal cancer will be performed in the afternoon. He has no time to deal with a bronchial foreign body.

"Boss Zheng, Brother Yun, you two wait for me." Fang Lin said coquettishly, dangling a red stethoscope.

"Well, we'll wait for you back in the ward." Zheng Ren said, "Call Su Yun when you're ready, and we'll go up."

After finishing speaking, Zheng Ren thought for a while, and said to Su Yun: "What class is Lao He? Let's do the stage together. If there is heavy bleeding, you need emergency intubation."

Fang Lin started to have a headache at the thought of massive bleeding and emergency intubation.

Once this kind of operation is performed in an emergency department, the risk rises sharply.

Just seeing Boss Zheng's confident appearance, Fang Lin struggled for 3.2 seconds, and finally decided to explain carefully to the patient's family members that he must clearly explain all the risks during the operation and let the family members make their own choices.

...

...

Note: Ask for a comparison, ask for a monthly ticket~~~