Anorectal disease is a common disease and frequently-occurring disease. The current incidence rate in China is 59.1%, of which hemorrhoids account for 87.25%. It has occupied a leading position in the incidence of surgical diseases. The number of doctors engaged in this subject in hospitals at all levels has increased significantly every year. proportion. When the symptoms of anorectal disease are severe, medications and other treatments are not good, and the local morphology of the anorectum changes significantly, and restorative changes are required, surgical treatment must be considered at this time, which is the basis for the purpose of surgery and the selection of indications. In general hospitals, under normal circumstances, the cutting and ligation techniques in hemorrhoid and fistula surgery are mostly, but various electrosurgical resections and special equipment operations are gradually being used in large hospitals, which brings many clinical problems. The grasp of gains and losses and the response is crucial.
1 Construction of doctor-patient contract
When the patient goes to the hospital to plan a surgical treatment, the doctor and the patient form a contractual relationship, which requires full communication and trust between Party A and Party B. Both doctors and patients have the common interests of pursuing the rehabilitation of patients, and they have the other side of mutual restriction of rights and obligations. Only in the attitude of mutual trust and courage to take responsibility for their actions can the two achieve unity of opposites. Signing the surgical consent form before the operation is used as evidence that the medical institution fulfills the obligation of explanation and notification, and it is also the written evidence that the patient and family members exercise their right to choose informed consent. The patient should understand the pros and cons of the surgical program, and make a choice based on the several options provided by the doctor. For example, when hemorrhoids bleeding and prolapse, there are methods such as ligation, injection, and PPH. For high anal fistulas, there are methods such as threading and not threading. The expected effect afterwards should be clarified so that you can make your own judgment and decision. Patients should not think that they are in an unequal position with the medical side, they are completely obedient to the medical side, and have no right to decide on their right to life and health. Surgical consent is not a sword or shield for doctors to shirk responsibility. The terms in the surgical consent can be understood as standard terms. From this, it can be considered that in the event of a medical dispute, if there is an exemption clause in the surgical consent, it will stand in court If you don’t hold back, whether the hospital assumes responsibility for medical malpractice or medical fault has nothing to do with whether or not to sign the surgical consent form. Therefore, surgeons should understand Article 33 of the "Regulations on the Management of Medical Institutions," Article 26 of the "Practicing Physician Law," Article 41 of the "Contract Law" and other relevant regulations , which will help doctors and patients communicate and reduce medical disputes.
2 The connotation of surgical gains and losses
Gains and losses are gains and losses. Different contexts have different understandings, including interpretations of success and failure, right and wrong, pros and cons, gain and loss, and right and wrong. It can also refer to failure and negligence. Gains and losses are a dialectical relationship, and the balance between gains and losses must be grasped. The gains and losses are reflected in the entire process before and after the operation. Both doctors and patients should understand what should be gained during the operation and what cannot be lost, that is, the upper line and the bottom line. The gains and losses of patients are reflected in the elimination of diseases and health recovery, and the quantitative performance is all or part; the gains and losses of doctors are reflected in the aspects of knowledge and technology, social value and economic benefits. Among them, the surgeon most cares about the success and failure of the operation. Success on the operating table is a decisive success, but not the final result. Failure on the operating table is a complete failure. Secondly, the maturity of the surgeon must not only be reflected on the operating table, but also cannot be ignored in terms of preoperative diagnosis, correct decision-making, selection of surgical methods, and postoperative treatment. It still plays an important role in the final results achieved by the operation.
3 The maximization basis of "get"
3.1 Positioning of "Get" No matter which side of the doctor and patient is concerned, the best result must be sought for surgery. To this end, communication and cooperation between doctors and patients is required, and before the operation, determine with the patient the extent of the "profit" of the operation, so that the patient's expectations have a reasonable positioning, so that the operation can continue.
3.2 Preoperative preparations Whether it is emergency, elective or limited-time surgery, patients should be fully prepared before surgery, including psychological, mental, and intestinal preparations. Medical diseases that affect surgical anesthesia should be actively treated, and the body should be adjusted to be able to bear it. Surgery status. Anorectal doctors must also be prepared, such as understanding the symptoms and signs of the patient, performing detailed local examinations, auxiliary examinations, and organizing necessary consultations in the undergraduate room and related departments. The surgeon also needs to review the information and understand the cutting-edge trends in the diagnosis and treatment of the disease. The inspection before the start of the operation is a necessary measure to avoid risks. The anorectal surgeon, anesthesiologist, and surgical nurse are present on the spot to check and sign for confirmation.
3.3 Surgical operation Reasonable surgical design, the choice and number of local anal incisions, and the fine operation and style of the operation are inseparable from the talent, experience, number of operating tables, and working hours of the surgeon. Communicate with the patient and family members as appropriate during the operation. The pre-operative estimate changes during the operation. If it is considered simple before the operation, it is actually very complicated. The plan should be adjusted in time, that is, the "get" changed, then we must strive for To maximize, if you do not communicate, you will have a divergent understanding of the results. During the operation, avoid over-treatment for the patient. For example, when treating anal fistula, because there is no obvious symptoms of hemorrhoids before the operation, and the problem of hemorrhoids is not mentioned, do not cut the hemorrhoids at the same time. During the operation, avoid discussing the quality of the operation and avoid accusing the assistant of the flaws. If the patient hears it, it will lay many hidden dangers and mistrust for the future.
3.4 Operation time Everything in the world is governed by space and time, and anorectal surgery is no exception. The operating room and the operating table are the stage where the surgeon performs his skills. The operation from the beginning to the end of the operation is first recorded in the form of "operation time". American doctor Robeter E. Booth, Jr pointed out: Surgeons can be divided into three categories: fast operation and good curative effect; fast operation and poor curative effect; slow operation and poor curative effect. He believes that there are no doctors in this world who have slow surgery but good results . Obviously, the ability to perform operations quickly and efficiently is a prerequisite for being an excellent anorectal surgeon. The operation time is long, short, fast, and slow, whether the results of the operation are perfect, different doctors perform operations under different conditions, and different surgical treatments for the same disease are different. The operation time cannot be completely compared with the surgical trauma. The treatment results are equalized. However, for some routine hemorrhoids and fistula operations, most doctors do it in the standard way in less than 1 hour, some doctors can complete it in 10-30 minutes, and another doctor performs more than 1 hour, it is easy to doubt the doctor’s skills , Or thought that something went wrong with the operation. It is unimaginable for a surgeon with awkward movements, unclear surgical areas in the anus, and slow operation speed.
4 The delay of gains and losses
The "relapse" of the gains and losses of anorectal surgery means that the effect of the operation can only be fully manifested until a certain time later, and it has a certain time effect. The success or failure of anorectal surgery can only be given a preliminary judgment after the operation. The conclusion at this time is very subjective and empirical, and should not be the final conclusion. Because many factors after surgery can make the prediction of the success of the operation zero. Anorectal surgery is different from surgery in other disciplines. There are many factors affecting the healing of open wounds after surgery. For example, if you think that the operation of complicated anal fistula is successful, after a certain period of time after the operation, the external mouth is not closed, there are cavities or ducts, and there is an ulcer in the anus. What should a doctor diagnose at this time? There is no doubt that it is an anal fistula. Therefore, postoperative treatment is an important measure to ensure "gains" and avoid "loses". Dressings should be changed actively and seriously, and deviations in the healing process should be continuously corrected.
5 Treatment strategy and grasp of gains and losses
As an anorectal surgeon, he should be precise and select the treatment indications. There should be a clear understanding of the final effect of surgical treatment, and there should be no blind and over-treatment. Some operations are only to improve and relieve symptoms, and some operations are only preliminary treatments and require a secondary process. Some operations are completely functional and functional Injury is closely related, these situations should be fully grasped, and the control of "degree" is very important. In recent years, the concept of minimally invasive treatment has gradually become popular. Compared with traditional surgery, minimally invasive surgery has the characteristics of small incision, less trauma, quick recovery, and less pain. Minimally invasive treatment of anorectal surgery should have the characteristics of individualization, full pain control, protection of anal function, minimize the loss of skin and mucous membrane of the surgical anal canal, repair or restore the anus and lower end of the rectum, and regulate the anus and rectum Physiological function to achieve the purpose of rapid recovery. Academia has different understandings on how to understand minimally invasive anorectal surgery, but patients should not be deceived under the guise of minimally invasive surgery. Traditional injection, ligation (ligation, cook gun), endoscopic polyp resection, PPH, and high-frequency electrical instrument therapy (hcpt) can all be associated with minimally invasive surgery. Minimally invasive surgical treatment of anorectal is a good aspect to grasp the gains and losses.
6 Reflections on "Lost"
The development trajectory of surgery is from simple to complex, and then from complex to simple. Anorectal surgery is simple but complex. Due to many factors, there are still many unsatisfactory places. After the operation, doctors and patients often regret and regret. As a patient, sometimes you can choose, and sometimes you cannot choose the result. From the point of view of the surgeon, every surgeon needs to improve his own level and perform his own professional surgery as efficiently and perfectly as possible. The improvement of state and skill is the goal that surgeons should pursue in their lifetime, and the keen awareness of risk avoidance is also an important requirement for anorectal surgeons, so that "loss" can be minimized.
7 Statement of gains and losses
Medical gains and losses---valuable, persistent
Life gains and losses --- bearish, let go, and be comfortable
Life gains and losses, let the flow go
Life gains and losses are always zero, contented people often enjoy
Life's gains and losses are zero, but the gain is only the mood
Laugh at gains and losses, indifferent to honor and disgrace, happy life
Live a whole life happily and easily see the gains and losses
Owning between gains and losses
Don't care too much about the short-term gains and losses