Hello everyone. It's really a pleasure for me to come here to share the experience of our medical team in treatment of the surgical patients and doing surgical operation during this special time. My name is Che Xiangming. I'm from the Department of General Surgery First Affiliated Hospital of Xian Jiaotong University. My topic is the challenges under the pandemic of COVID-19 for the surgical operation. In my speech I will be talking about the following four topics; the etiology and epidemiology, pre-hospital screening, time for operation, and prevention of the nosocomial infection. As we know, from the December 2019, there's a new coronavirus infection appear in Wuhan, Hubei province of China and these infections were soon spread all over the country, and now in the world more than 90 countries has reported the cases and more than 100,000 of patients suffered from this infection. The World Health Organization have given the name for this new coronavirus as a corona viral disease 2019, in brief, COVID-19. Concerning about the source of infection of course, the patients who suffer from this infection, is a source for the infection and the transmission of the disease was from the respiratory tract and the personal contact for all the people are susceptible to this disease and especially for children and old people. Those people with the underlying disease, when infected with this virus, will appear severe. Our critical units in very short time and that there's an incubation period for the disease is about one week and as long as 14 days. Some patients in the incubation period may still have infectious ability. So this makes the disease spread very fast and then difficultly in control. Under this situation, how to protect the doctors and the nurses, and how to protect the surgical patients during the treatment in the hospital become very important, and really tough materials we will need in the hospital. So for the surgical doctor, we think that if we do well in the following steps we may prevent the cross-infection in the hospital. First it's about the pre-hospital screening. As we know that once the infected patient get into surgical ward, the ward will be closed and the doctors and nurses who have closely contacted the patient will be isolated. Of course, this is a very bad situation. So we have done two things. One is what we do for the patients and the second is where we do for the patients during the admit. As we know that this is a serious infectious disease and when we taking the history of the patients, except for the surgical history, the epidemic history is very important for patients and we should ask patients whether he has the experience for going to the epidemic area or have close contact with persons who come back from the epidemic area. Because the patients will suffer from the virus infection may appear fever, cough, and fatigue, so temperature measure is very important and also blood routine test. Because it's a virus infection, the white blood cell count may be normal or lower and especially if the lymphocyte count is lower, and due to the special topical changes in the lung, the chest, the CT scanning is very important in the process. So what should we do for the patients? That is the epidemic history, the temperature measure, blood routine test, and very important chest CT scanning, and where we do this first is before the patients get into the hospital, we just measure the temperature and ask for the history of the patients, especially the epidemic history, and then that patient will go to the outpatient department, and at the outpatient department we will ask her and do this again. Also we will apply for the chest CT scanning and the blood routine test and finally the patients to the ward we check the menu again to make sure whether the patient had suffered the virus infection or not. The next is concerning the time of operation. We know that for the surgical patients we have elective operation, limited operation, emergency operation. Of course for the elective operation is better. Do not do the elective operation until the disease is over. But for some patients, even though he has suffered from the benign disease such as the chronic appendicitis or inguinal hernia, this may have some symptoms for pain or even incarceration. So in this situation, we have to do the operation. So for these patients, first for the elective operation, if we confirm that the patient didn't have the virus infection, all the operation procedures were as normal. For those with the suspected diagnosis although patients who have close contact with the persons who suffered from the virus infection we will wait until as long as the incubation period, that is 14 days after the meet. If the patient at that time have no symptoms of the virus infection of course operation can be conducted. For the confirmed cases of the virus infection, we should first treat the pneumonia at first and after the patient cures from the virus infections, we do the elective operation. The second is about the emergency. In emergency cases, sometimes it's very dangerous to the life. So in this situation, first we also confirm whether the patient has a virus infection or not. For now, infected patients with emergency cases, we'll do as the normal acute process. For the suspected and confirmed patients, we do operation under the strict protection procedure, which I will teach later. Limited operation is a merely those patients with malignant disease and we will depend on the classification of the tumor and give the suggestion for the adjuvant chemotherapy or neoadjuvant chemotherapy and the proper plan for the day of operation. Of course operation also is necessary in the patients with malignant disease and here we'll talk about the protection during operation. This is really for the confirmed and suspected infected patients with surgical disease. In this situation, negative pressure operating room is needed and for the doctors and the nurses and the anesthetist should have the three-level protection equipments. Here's a table showing what is the protection requirement, that is the personal protection equipments. For the COVID-19 concerned patients, close contacted or suspected patients and for the confirmed cases you should have either standard protections, include glove, gown, eye protection, N95 mask and for the confirmed one, even what we call, the enhanced protection include the double glove and gown with protecting clothes outside and so on. This is showing you the preparation for the doctors and the nurses and anesthetist before and during operation. During operation for the various infected patient we should work carefully for the process to avoid more blood and more damage. We should pay attention to the blood and extent of the patient's contamination to ourselves. Then when we use the electric knife and coagulation, we should lower the part to the sector lowest value and the to make a small smack during the operation. The suction apparatus and aspirator is very important for sucking the smog from the operation field and maybe the virus will continue to smog, which is harmful to the doctors and the nurses during operation. After operation for these patients, all the materials including the mask, glove, gowns for the doctors and nurse must be disinfected and the operating room must be disinfected thoroughly. Even in some hospital it was suggested that relevant person including the doctors and nurses should be isolated and observed for 14 days and after operation prevention of the nosocomial infection it's very important. For the patients who received a surgical operation, who has no virus infection, after operation, especially big operation for the surgery, we know that the common immunity of the patient's will decrease and the patient's ability to resist infection will decrease. In this situation, we'll do the supporting treatment, even use antivirus treatment, pre-operatively and for the severe cases isolation maybe certainly better to prevent the cross infection. Also restricting the visiting of the patient's family is very important, this is a very good way to prevent the cross infection. For the suspected and confirmed cases, patients after operation, isolation is very important and better is transferred to the infectious disease department and consulted by the specialist for the virus infection and the surgeons there go too for further surgical treatment if necessary. It's a brief instruction for our experience concerning about the surgical treatment and surgical diagnosis and a surgical work during this special time. I hope this [inaudible] some help to use. Thank you very much for your attention. Thank you.
