【1346】外科异议
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不要以为人家教授问这句话,是认为解决问题的希望在消化内身上。
医生基本会对自己的专科专业十分自信,因为研究的最多。
实际上,临床很多吻合口瘘病人是自己家属去找的内科医生帮忙。一般外科医生对内科方案并不感兴趣。像邵佳良,应该是被逼到无奈才如此做法。
外科医生对消化内镜堵瘘的方式怨言颇多,譬如韩永年教授现在所提出的种种内镜手术缺陷:“想怎么做?用生物蛋白胶来堵吗?这个成功率不是很高。堵不全常有发生。用钛夹夹闭,内科好像试过一次了吧,没成功?植入食管内覆膜支架?这种方式不太好,后续会继续再瘘的。”
内镜操作方式是较为局限,医生操作几乎等同于束手束脚似的,看着都叫人不爽。局部视野和狭窄的操作空间,导致操作医生想拿针去缝超级困难,于是应运而生很多种辅助器械。包括之前说的钛夹。
钛夹是由钛合金或纯钛的夹子和夹尾两部分组成的医疗器械,由于其金属部分是钛,因此统称钛夹。钛夹其实有多种,各个医疗器械公司对自己钛夹的产品各有命名,如有的叫Clip,有的止血夹、有的叫和谐夹诸如此类。这些产品名称和各自用途,身为手术医生是需要懂的。医生不止要学人体知识,对作为工具的医疗器械必须一样十分熟悉,因为需要用到。
在人家教授指点江山的时候,谢婉莹跟随于师兄进行现场学习。暂未去过消化内镜室,没见过没体会过这些内镜工具,她对此可以说是陌生。于学贤当场就着人家医院现有的物品,抓住时间给她讲讲课。因为之后如果要她提意见,她若是连消化内镜如何操作器械有哪些不知道怎么行,会贻笑大方的。
钛夹钛夹,简单来说是个夹子,夹头的作用是夹“东西”夹组织,创面等等,夹尾的作用是在夹闭的过程中提供力臂空间,说明钛夹是要配合钛夹释放器使用。钛夹释放器好比垃圾取物钳,开合下,夹头可以夹到“东西”,不一样的是,钛夹可以释放出整个夹留在人体里头起组织缝合的固定作用。夹尾不够长的话,医生使不上力夹闭。太难理解的话,可以尝试在家里用夹子夹个玩意儿试试,是不是夹尾长一点,比较好捏住闭合,夹尾太短,捏都捏不稳力气使不上。
所以,经过内镜手术后病人身上留下钛夹的,可以看见患者管腔内留下一个个长短不一的夹尾。
“外科手术腹腔镜有用钛夹。”谢婉莹说起自己在外科轮科见过的经历。
“是不是看着没有留尾巴?”于学贤问她。
不要以为内科医生什么都不懂,实际上内科经常接外科后续的活儿,内科大牛对外科的东西是很了解的。只是技术活的话没有外科医生天天干,没法像外科医生一样干外科的手活而已。手活只能是熟能生巧。
“是。”
说明外科手术和内科手术是有许多大同小异的地方,具体需要亲手试了方才知道差异性在哪里大不大。
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