Chapter 2366: with translation of chapter title

2371.2285 guide

"Why not just do this for now, observe for two days then talk, maybe if it grows we'll see." Fang Lin also had no choice; seeing Zheng Lao Ban not speaking for a long time, he softly suggested.

"You still have the nerve to say you're a thoracic surgeon? With your Inpatient Chief position, one year isn't enough; you need at least three. Stay in the department and do Shou Bing every day." Su Yun said coldly.

"Yun Ge'er, let's speak nicely if we're going to speak; don't make me do another stint as Inpatient Chief. This one year has made me feel sick all over." Fang Lin said with a worried, bitter face.

For him, there's nothing more troubling than having to do another stint as Inpatient Chief.

If it's as Su Yun says, Fang Lin would rather not become a Team-leading Professor; it would be better to simply quit and go to a private hospital.

Fang Lin is still somewhat resistant; many doctors, upon hearing they'd have to become Inpatient Chief, would without hesitation choose to resign.

"What does the guide say?" Su Yun looked at Fang Lin with disdain, "Primary spontaneous pneumothorax with persistent air leak after 7 days of intercostal drainage; secondary spontaneous pneumothorax with persistent air leak after 14 days of intercostal drainage; essentially, it's a persistent bronchopleural fistula."

"Yun Ge'er..."

"The 2015 Europe Respiratory Society statement on spontaneous pneumothorax management points out: for patients with drainage time greater than 3-5 days who still have persistent air leak, further treatment should be undertaken." Su Yun looked at Fang Lin, seemingly finding his stethoscope too glaring, turned her head and said to Lin Yuan, "Xiao Linzi, tell him what other guides say."

"Oh, okay." Lin Yuan, while looking at the films together with Zheng Ren, said, "The 2010 Yingguo Thoracic Society guideline for spontaneous pneumothorax management states: if conservative drainage for 48 hours still shows persistent air leak, surgical intervention should be considered."

Fang Lin, with a worried, bitter expression, looked at the monster in Zheng Lao Ban's Medical Team.

Everyone knows these things, but who would memorize all those details? Memorizing treatment guides is useful only for boasting during hospital consultations; could it possibly have even the slightest effect on the patient before us?

It's utterly impossible; Fang Lin sighed in his heart, he sorrowfully looked at the image on the viewer, just about to speak, but his thought was directly cut off.

Because the topic about the guide hasn't ended yet.

"The 2018 Germany spontaneous pneumothorax management guideline proposes: whether it's primary or secondary spontaneous pneumothorax, if air leakage persists after 48 hours of drainage, a change in treatment plan should be considered." Lin Yuan continued.

"Stop!" Fang Lin saw she still wanted to speak, so he directly begged off, "Surgical Shou Bing? I'd need to ask the director. Even if this patient were to submit an emergency notice, the anesthesiologist wouldn't dare anesthetize."

"Boss, can you do it?" Su Yun leaned close to Zheng Ren and asked softly.

Zheng Ren didn't speak; he was trying to perform interventional treatment under bronchoscopy in the System Operating Room.

Generally speaking, there are several ways to treat pneumothorax.

First, the open-chest Shou Bing that was most common ten years ago; its advantages, as Su Yun said, are a clear Operating Field and bold, sweeping action. The downside is massive trauma and slow post-Shou Bing recovery for the patient.

If this already "crumbly" old patient were to undergo this Shou Bing, Zheng Ren isn't even sure he could get off the operating table. After all, he's already done related Surgical Training in the System Operating Room, and the Shou Bing completion degree is not high at all.

Low Shou Bing completion degree means many post-Shou Bing problems, which Zheng Ren has ruled out.

Secondly, it's minimally invasive Thoracoscope Shou Bing, which is now the preferred Shou Bing approach for Cardiothoracic Surgery in major hospitals. Not only for general thoracic cases, but even Zhao Yunlong, a Thoracic doctor with high aspirations, is beginning to prepare to perform type A aortic arch dissection Shou Bing via thoracoscope.

Major guides recommend it as the first-line treatment for refractory pneumothorax. However, this patient is not suitable; his overall baseline condition is poor, cardiopulmonary function is poor, lung lesions are extensive, and the Shou Bing completion degree of Thoracoscope Shou Bing remains low.

Moreover, the patient's pleural adhesions are severe, limiting the view when the Thoracoscope enters, and adhesiolysis must be performed first. If a blood vessel is accidentally ruptured, bleeding must be controlled first. Without an Operating Field, even a simple Shou Bing is impossible; this option is also ruled out.

Next is the pleural fixation Shou Bing used at the local hospital.

Though called a Shou Bing style, it's actually a very simple operation.

The principle is to irritate the pleura with chemical agents or surgical abrasion to produce a uniform, consistent sterile pleuritis, thereby completely sealing the pleural cavity. In the local hospital, injecting 50 ml of 50% hypertonic glucose into the pleural cavity is this Method.

Talc powder and doxycycline can both be used as first-line agents; other commonly used agents include autologous blood, mangiferin, hypertonic glucose, povidone-iodine, etc. (Note 1)

Another is argon plasma coagulation Shou Bing; some doctors categorize this treatment as internal medicine, but Zheng Ren disagrees.

However, this Technique is also unsuitable for the patient before us.

Lastly, which is the only treatment Zheng Ren can think of—intervention under bronchoscopy.

Using bronchial plugs, stents, one-way valves, autologous blood, biological protein glue, and gelatin sponge to occlude the airway, achieving the therapeutic goal.

Among these, autologous blood and biological protein glue can be absorbed on their own, but they are easily coughed up; currently, major guidelines do not recommend them as first-line choices.

Zheng Ren tried a full twenty times before finding a viable solution.

No matter big or small illness, once it becomes serious, it's quite tricky. Zheng Lao Ban, who is at the peak of interventional, the peak of General Surgery Department, and a top-level master of Cardiothoracic Surgery, actually performed over thirty Shou Bing trainings for a tiny pneumothorax.

Regarding this, Zheng Ren expressed helplessness.

"We can try interventional treatment." Zheng Ren said, "Anesthesia... we should still look for Lao He."

"Performing Interventional Shou Bing with a bronchoscope? The risk is high." Su Yun warned.

"But there's no better alternative." Zheng Ren said, "Use a laryngeal mask for general anesthesia, I'll go down the bronchoscope to seal."

Su Yun hesitated for a long time, then asked, "Boss, if the stimulation is a bit stronger, problems could arise."

Zheng Ren nodded, "There's no way around it; I'll try to be as gentle as possible. Fang Lin, what do you think?"

Actually, Fang Lin has nothing to consider; he simply doesn't dare to perform any overly traumatic treatment on the patient before him.

Besides anything else, just the elderly patient's severe COPD is enough to scare off 99% of doctors; of the remaining 1%, 99% are reckless daredevils, the kind of ignorant fearless types.

That is, Zheng Ren relied on the System Space to cheat, continually trying, and only after figuring out the correct method did he dare to operate on him.

Higher-level hospitals have their own difficulties; otherwise, Fang Lin wouldn't have sought Zheng Lao Ban to resolve this matter.

……

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Note 1: Before 2011, I asked a professor from Di Du to perform a lung cancer Shou Bing; the patient still had pneumothorax two weeks post-Shou Bing. On Lunar New Year's Day, I infused the patient with hypertonic glucose, and then it was resolved. This is a fairly common Method; it has many drawbacks, but it's also very effective.

As for mangiferin, it's truly a love-hate relationship. The specifics are another story, to be detailed later.