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With the advent of laparoscopic surgery and advances in anesthetics, cecal and exenteration surgery is no longer required to be hospitalized.
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However, the cooperation of patients is indispensable for the success of day surgery.
[Surgery can be done so far on a day trip] # 2 This time, what is the difference between the previous surgery and the "day surgery"? → Continue reading
Daily Gendai Healthcare
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Wikipedia related words
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手術(Surgery,English: surgical operation) IssurgicalEquipment andFemaleUsingAffected areaTo make an incision and give therapeutic treatment..As a common name or abbreviationOperationAlso called (alone: SurgeryDerived from).
- Purpose of surgery
The purpose of surgery is to control the condition and restore lost function.[Source required]..Some surgeries lead to treatment indirectly rather than directly.
- To excise[Source required]
- Surgery to cut and remove the lesion is localInflammation,tumorIs done against[Source required].appendicitisAgainstAppendectomy,Gastric cancerAgainstGastrectomy,Pancreatic cancerAgainstPancreaticoduodenectomyAndBreast cancerAgainstMastectomyな ど[Source required].
- Form[Source required]
- 組織,organSurgery to shape the disorder is performed to improve the function of the injured area[Source required].AnginaAgainstCoronary artery bypass surgery,Inguinal herniaHernia radical surgery for[Source required].
- To transplant[Source required]
- Tissues / organs collected from oneself or otherstransplantSurgery is performed to restore impaired function[Source required].. Chronickidney failureKidney transplantation for a wide rangeBurnAgainstSkin graftArt etc.[Source required].
- inspect[Source required]
- Endoscope,Diagnostic imagingIt is performed when the diagnosis cannot be confirmed by a non-invasive method such as[Source required].
Type of surgery
- Expansion surgery and reduction surgery
Surgeons have a history of continuing to expand highly invasive surgery, claiming to "improve treatment outcomes."However, from around the 1990sEvidence-based medicine (EBM)The importance ofprognosis, Post-surgery resultsEpidemiologyA survey (objectively, statistically and scientifically for a large number of people) shows that extended surgery does not actually contribute to improving treatment results, and on the contrary, it causes harm to the body. It became clear that he was giving many things, and there were voices of remorse for the extended surgery.alsoQOLHas become more important and the awareness of patients has increased.2004/Today, surgery is shrinking as a whole.
- Minimally invasive surgery
EndoscopeSurgeryEndovascular surgerySuch as surgery that is less invasive than before.Thanks to the technological improvements in surgical instruments, it has become safer to operate than before.Also utilize the computer during surgeryComputer assisted surgeryHas come to be used in some parts.Regarding arthroscopic surgery, although the incision on the body surface is small, the content of the surgery itself is almost the same as that of conventional surgery, so it is controversial whether it is really minimally invasive.Also, even if relatively safe equipment and techniques are developed (as is the case with all surgeries), safe surgery cannot be performed unless the doctor who uses them is proficient in it. By an inexperienced surgeonMedical accidentIs also occurring.
- Polypectomy (polypectomy)
Is one of the endoscopic surgery.Can be used as a gastrointestinal tract that can accommodate thick endoscopes such as the stomach and large intestinepolypIt is an operation to remove an elevated lesion such as an endoscopically.
- Palliative surgery
Surgery performed for the purpose of alleviating symptoms or prolonging life in pathological conditions that cannot be completely curedPalliative surgeryThat is.In the abdominal cavitycancerbyBowel obstructionOn the other hand, this is a bypass technique that allows food to pass through.
- Single thoracotomy, single laparotomy
A thoracotomy or laparotomy for the purpose of treatment, but the surgery is completed without surgical treatment, such as when the lesion has progressed unexpectedly and it is judged that surgery is not indicated.
- Experimental thoracotomy
Surgery to open the chest and abdomen to confirm the diagnosis, not for the purpose of treatment, is called trial thoracotomy or laparotomy.There is no direct therapeutic purpose, and surgery may be terminated without surgical treatment.
Judgment before surgery
In large hospitals, for individual patients治療The strategy involves experts from related fieldsconferenceWill be considered in a consensus manner.Surgery is invasive and risky, so other treatments are recommended if the treatment is not commensurate with it.Decades ago, there was a time when a surgeon made decisions at his own discretion, but this approach has been declining because it tends to cause problems.
- Is preoperative diagnosis valid?
- Whether surgery can control the condition
- Whether the patient's general condition is well tolerated by surgery
- Comparison of effects and risks with treatments other than surgery
- What kind of surgery is suitable
The validity of surgery is examined mainly based on the above points.
Doctor's explanation to the patient and judgment on the patient's side
As a general rule, all examination results are communicated to the patient.Based on that information, patients are required to make their own choices about what kind of surgery they will undergo or whether they want another treatment.In recent years even in JapanInformed consentIt is said that the doctor should give a thorough explanation and fully understand the patient, and then, in principle, make the final decision on his / her own will whether or not to undergo surgery. ing.Also, there is a possibility that the explanation by one hospital may be biased or misjudged, so just in case, listen to the explanations and opinions of other doctors, that is,Second opinionIt is also becoming common to ask for.
In order to improve safety during surgery, it is necessary to maintain the general condition as good as possible.principleIn general, the surgery is performed after being hospitalized and managing the general condition before the surgery.exceptionIn recent years白内障One-day surgery is performed for relatively minimally invasive surgery (minimally invasive surgery) such as surgery and laparoscopic cholecystectomy.
* Maintaining a general condition that can withstand surgical invasion
- Autologous blood storage (at the time of surgerytransfusionIf it is known in advance that it is necessary, the patient's own blood may be taken 2-3 weeks before surgery and used as blood for transfusion.Autologous blood transfusionSee. )
- Suspension of drugs that adversely affect surgery (suspension of drugs), change to other drugs
- Confirmation / evaluation of allergies
- Oral cavitycare
Perform surgeryDoctor, Perform intraoperative whole body managementAnesthesiologyDoctor, involved in surgerynurseEvaluate patients and surgery and develop a perioperative management plan[Source required].
General anesthesiaIf is planned, at the time of induction of anesthesiaaspirationTo prevent this, fast food for a certain period before surgery.In addition, for the purpose of cleaning the intestinal tract during intra-abdominal surgery, etc.laxativeIs administered.Of the surgical siteshaveIt used to be done, but shaving has been shown to increase skin infections and is no longer done with some exceptions.Immediately before entering the operating room, for the purpose of suppressing airway secretion, analgesia, and relieving tension during surgeryAnticholinergics,Analgesics,SedativeIs administered (these arePremedicationIn some cases, but recently, we are moving in the direction of not doing it as much as possible.
Entering the operating room
A room for surgeryOperating roomSay.The operating roomAmerican Englishで operating room Because it is calledabridgementIs in shapeOR(OR), orJapaneseIn the mixture with "Operation roomMay be called.Also,German Of Operations saal Omitting "SaarSometimes called.
In Western hospitals, generally, each departmentOperating roomThere is a section.In Japanese hospitals,Operating roomIs a centralized type and is integrated into one place as a central surgery department.
Since the operating area including the operating room is a clean area, the staff is required to reduce foreign bacteria as much as possible when entering the room.ScrubChange clothes, change shoes, and wear a hat and surgical mask.As for the color of the surgical gown, just look at the red color of the surgical fieldColor afterimageIn general, "green" or "blue" is the most common in consideration of the occurrence of.
The patient is a ward stretcher (stretcher) Can be transferred to a stretcher in the operating room.Depending on the symptoms, it may be possible to enter the room by walking.
Prior to the operation麻 酔Will be enforced.The main purpose of anesthesia is to suppress harmful reflexes and control pain, and in principle, the doctor in charge of anesthesia is assigned separately from the surgeon (in local anesthesia surgery, the surgeon also manages anesthesia. is there).In surgery, the anesthesia doctor manages the patient's general condition andBreathe-CirculationFrom managementbody temperatureAdjustment, drug administration,InfusionControl, bleeding volume monitoring,transfusionTake care of all the treatments up to.We will also provide this information to the surgeon as needed to support safe surgery.
- Local anesthesia: Anesthesia that works only on certain parts of the body.Drugs that block nerve transmission are usually injected.In some cases, the anesthetic is injected directly into the target site (infiltration anesthesia), and in other cases, the anesthetic is applied to the nerves that control the target site (conducting anesthesia).
- General anesthesia: Effective for the whole body = Anesthesia that causes loss of consciousness.Usually refers to anesthesia for obtaining pain relief, sedation, and muscle relaxation.When anesthetized, he first loses consciousness and eventually stops breathing spontaneously.Then, the anesthesia doctor intubated the endotracheal tube,Artificial respiratorsConnected to.Drugs are continuously administered during surgery to maintain anesthesia.
Hand wash / gown technique
Surgery is performed by forming a sterile area (clean area) to prevent infection by foreign bacteria.The parts (upper limbs, precordium, abdomen) that the staff involved in the surgical operation also touch the clean area must be sterile.Therefore, it is a surgeonDoctor, Doctor acting as an assistant, Inner loop (instrument delivery)nurseEveryone should wash their hands or arms, wear sterile gowns, etc.Sterilized glovesPut on.
To wash hands for surgery, first thoroughly wash the area from the fingertips to the elbows with sterile water and antiseptic solution.The purpose of surgical hand washing is to remove pathogens adhering to the fingers.Each facility has its own method of hand-washing for surgery. Classically, it is a scrubbing method using a sterile brush, but there are also facilities that perform a simple kneading hand-washing for the purpose of protecting the skin.
After surgical hand washing, wear a sterile gown.Wear with the help of a caregiver to prevent re-contamination of surgically washed hands.Then put on sterile gloves.As for gloves, general glovesIodineThere are compounded antibacterial gloves.In addition, there are cases where double gloves (double gloves) are used to reduce surgical site infection due to perforation of gloves..
Anesthesia management doctors, nurses around the world, ME (Clinical engineer), Etc., do not wash hands if you are not directly involved in the clean field.
Disinfection / clean field formation
Focusing on the site where the incision is madePovidone iodineOralcoholSufficient disinfection is performed.After disinfection, the disinfected area is covered with sterilized sheets (drapes) to form a clean field.
When the environment for performing surgery is prepared in this way, surgery is started.The number of doctors who participate in surgery is about 3-4 in the case of general laparotomy and thoracotomy, for example.University hospitalIn a large hospital, it may be done by about 4-5 people, and in a hospital with few people, it may be done by 2 people.In addition, a nurse who assists surgery will participate.
First, a scalpel is placed on the skin by the surgeon (surgeon).The surgeon proceeds with the surgery according to the preoperative plan.If the actual findings differ from the preoperative expectations (eg, progressed more than expected,tumorThe adhesion is strong), and the plan (operative method) may be changed or added at the discretion during the operation.However, it is desirable to explain to the patient in advance the possibility of this intraoperative plan change or addition.As of 2021, the mainstream idea is that a completely different disease discovered by chance during an operation should not be treated without the consent of the person (or agent), even if it is medically valid. Is.However, in general, it is often done and often takes the form of ex post facto consent.
After surgery, after surgeryadhesionPrevention,BacteriaAnd warmed for the purpose of removing residual cancer cellsPhysiological salineThe surgical field is cleaned by.Adhesions occur frequently after the incision, but there is a possibility of repeated laparotomy.Caesarean sectionAdhesion prevention sheet materials are used in such cases.Before closing the wound, careful counting is done primarily by surgical assistant nurses to prevent residuals such as surgical instruments, gauze and needles.If this does not match, the principle is not to close the wound and continue searching until it can be confirmed that there are no remnants in the body.Also, in consideration of human error, it is often the case that an X-ray photograph of the surgical site is taken immediately after the operation to check for any remnants.
After wound closure, sterile sheets (drapes) are removed, anesthetic administration is discontinued, and the patient recovers from anesthesia.
What happened to the final procedure after surgery is determined and recorded.
After surgery, treatment is continued until recovery from surgical damage.Surgical wounds are treated and the general condition is improved by intravenous drip or medication.Great care is taken to prevent postoperative complications, but if unfortunately it does occurToadIs performed.
Surgical instruments are extremely diverse depending on the clinical department, facility, and surgeon, and their names vary.Here, we will explain the most basic equipment.
- Female: Surgical instruments are so well known that "surgery is a scalpel", but they are only used when making incisions in the skin.There are scalpels of various sizes, which can be used according to the preference of the surgeon.A scalpel with a sharp edge is called a sharp sword, and a scalpel with a round edge is called a circular sword.
- Electric knife: A device that burns off tissue with high-frequency current.It is the most frequently used device because it can stop bleeding and make an incision at the same time.In addition, there are ultrasonic scalpels that cut with a slight vibration of the cutting edge and laser scalpels that burn with a medical laser.
- scissors(Sento): Scissors.Bent-edged scissors are preferred.It is useful not only for cutting, but also for peeling operations that peel off the tissue.Typical examples are Cooper scissors, Mayo scissors, and Metzenbaum scissors.
- Tweezers(Sesshi): Tweezers.There are various shapes of tweezers according to the tissue to be gripped, and the names are also various.Swedish tweezers, dubeky tweezers, adson forceps, tweezers McCando, etc.
- forceps(Kanshi): An instrument that grips tissue.It looks like scissors and has a stopper (ratchet) at hand so you can keep it sandwiched.It is used for various purposes such as pinching, towing, crushing, opening, scooping, and blocking.Kochel forceps, Pean forceps, Kelly forceps, mosquito forceps, Alice forceps, etc.
- needle : yarnUsed for suturing.Usually, a curved needle with a curve is used.The size, thickness, degree of curvature, and cross-sectional shape differ depending on the tissue to be sewn.Generally, a round needle is used for tissue connection such as the intestinal tract, and a square needle is used for skin suturing.Some are used through a thread, such as a sewing needle for sewing, and some are sutures with a needle, which have a thread behind the needle.
- Needle holder(Jishinki): An instrument with a needle.Used when sewing tissues together.Mathieu needle holder, Hegar needle holder, etc.
- Hook(Kou): An instrument whose tip is bent like a key.Used to hook and tow tissue.Muscle hooks, nerve hooks, abdominal wall hooks (Zatter), liver hooks, etc.
- : An instrument that automatically sutures and anastomoses.Instead of sutures, automatic and uniform sutures are possible, and at the same time, anastomosis is possible, which is expected to improve the procedure and improve QOL.Linear stapler, circular stapler, etc.
- (Kaisoki): An instrument that expands surgical wounds.
Surgical risks and complications
Is that infection by bacteria etc. occurs at the part where the wound of surgery is sewn (suture part)., The sewn area becomes red and swollen, causing pus, pain, and fever...If a wound infection occurs, remove the thread or make a skin incision to get pus.AntibioticsIs administered, etc..
Patients often sleep after surgery and have pain in the back of the lungs.sputumHowever, if you do not produce sputum, the bacteria that should have been released from the body together with sputum will stay in your lungs.pneumoniaMay cause..It is important to consciously produce sputum after surgery.
During surgeryPainkillerと麻 酔There is no pain thanks to this, but if the anesthesia is cut off after surgery, the wound (cut part) may hurt...If it hurts, painkillers are prescribed..The patient does not have to put up with the pain, just tell the nurse or doctor that it hurts and get a prescription for painkillers..
There are also delicate and difficult surgeries in which the result changes even if the deviation is 1 mm, assuming that it is preoperative..
- ^ Kojien XNUMXth Edition [Surgery]
- ^ Double gloves to prevent intraoperative infections Are the gloves punctured? Nikkei Medical Online 2016/1/26
- ^ a b c d e f g h i j Cancer information, surgery (surgical treatment)
- ^ "Eyelid ptosis surgery | Cosmetology clinic 1 minute walk from Urawa station | OZI SKIN CLINIC". www.ozi-skin.com. 2021/11/26Browse.
- Anesthesia science,Anesthesiologist
- Operating room
- Yoshitomo Otomo-Allowed the first surgical operation in Japan in 1557.