Path of Medicine With a System

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If lymph node dissection is added to this operation, it is directly a combined abdominoperineal resection.

In other words, everything in the lower abdomen of the patient should be cut off. Ms. Jiang's staff worked hard and pulled it out in a timely manner. If it was slower and the damage was greater, there would be no need for rescue.

Zhang Fan picked up the remaining sigmoid colon with toothless forceps. The forceps used in the operation are divided into toothed and non-toothed. The tip of the tweezers has tooth-like protrusions like rat teeth, which makes it more stable when clamping. However, this thing cannot be used to clamp organs, especially the intestinal tract. There are three small holes in one clamp.

The intestinal bleeding has been completely clamped and closed. This is the initial stage. There are still many things to do. First, we need to detect the ureter and vas deferens, and because it is not a dissection, we also need to detect the pelvic autonomic plexus. With the sacral nerve, it can be said that this operation is similar to dissection.

If it is ruptured and cannot be repaired, these things must be removed. For example, one ureter is ruptured beyond repair. There is no way, the corresponding kidney must also be removed!

It is estimated that the drain port is not very big, if it is bigger, it will be troublesome. Fortunately, the bleeding has been stopped, and there is no obvious damage to the ureter, vas deferens, or other organs. The silly boy's life has been saved so far.

"Other organs in the abdominal cavity and pelvic cavity are intact!" Zhang Fan inspected once, then said to the director of general surgery, and then asked, "How much bleeding is there now? How much solution is in the aspirator."

"With 3000ml of liquid, it's hard to estimate the bleeding now." The roving nurse glanced at the liquid bottle on the ground and said to Zhang Fan.

"It's estimated to be at least about 2000ml. I was in shock when I came here. In addition, we were bleeding during the operation. There are all kinds of things."

"Well, the amount of fluid has been increased. Now we are going to remove the necrotic tissue." After Zhang Fan finished speaking to the anesthesiologist and the nurse, he began to remove the intestine remaining in his stomach.

The intestinal tract that had been sucked and torn was spread out in the abdominal cavity like rags. Because of the ligation of blood, the color had turned whitish, and the original rosiness had long been lost. The intestinal tract in the pelvic cavity has been destroyed, and the remaining rectum and sigmoid colon can only be removed.

The sigmoid colon is easy to say, after closing the mesenteric artery, it is OK to directly cut the stump with tissue scissors. "Give me two sterile tissue bags." After Zhang Fan cut off the stump of the sigmoid colon, the cuts were to be put into tissue bags, and the family members had to see them later.

The other end was ligated with a tissue bag first, and the soup inside contained a large amount of E. coli. This thing is a normal flora in the intestinal tract, and once it escapes, it will be a pathogenic bacteria. So first wrap the other mouth.

"This cut, the young man will be sad in the future!" Zhang Fan looked at the sigmoid colon in the tissue bag and said to the director of general surgery with emotion.

"It's better than being dead. It's better to die than to live. Besides, the rich family has no worries about food and drink, and he doesn't need him to move bricks and work. Eating and drinking is a lifetime."

"Humans, please do something!" After eating and drinking for a lifetime, he is no longer a waste, and Zhang Fan didn't have the nerve to say the last sentence.

"Don't use your poor people's thinking to think about other people's future. I want to eat, drink and drink for a lifetime, but I can't meet the conditions. Hey!" The director of general foreign affairs probably got tired of being manipulated by several deputy directors under him.

After the sigmoid is done, the rectum and anus are next. The rectum and anus are not as easy to handle as the sigmoid colon. Zhang Fan started with the two-finger meditation, using the middle finger and index finger to enter the anterior space, which is the surrounding tissues of the rectum and buttocks, and slowly separated first to identify the levator ani muscle.

"Vascular forceps!" The nurse handed Zhang Fan two pliers. The blood vessels of this human body are very shrewd. It knows that its body is thin, so it usually finds a big brother, either a bone or a muscle, and hides it in or next to the big brother. So to cut the muscle, you must first clamp the two ends, and then tie a knot,

to let go.

In the past, when there was no electrosurgical knife, after the muscle was severed, the stump had to be sewed up firmly with sutures, because the muscle retracted after the muscle was severed, and bleeding could not be found.

Now that there is an electric knife, it is like burning pigskin on the wound, and the blood vessels are directly sealed. Then, after the rectum and surrounding tissues are all freed, the anus can be treated.

"Our hospital doesn't even have a plastic surgery department, otherwise people like this would definitely need a consultation from a plastic surgery department." After Zhang Fan and the director of general surgery treated the rectum, looking at the lonely anus, the director of general surgery sighed and said One sentence.

"What?" Zhang Fan didn't understand.

"Be a showman. If you do this, you won't lose everything."

"I'm not a child, and I don't wear crotch pants, who cares!" Zhang Fan said in surprise.

"Hey, don't tell me, there are patients who really need this. No matter who sees it or not, it's an organ."

"Hehe!" Zhang Fan didn't intend to argue with the old man.

After the rectum is separated, only the anus remains. In fact, the anus is very simple, except for the levator ani muscle, the rest is surrounded by fat.

This is why people in the early years liked to eat chicken butts and pork butts, because the meat here is all yellow fat, with a little orbicularis muscle, and it has a fat flavor and chewy texture. Take a bite, and you can feel full and satisfy your hunger.

The patient's position is a lithotomy position, that is, with the legs spread apart and the chrysanthemum facing the ground. "Sharp knife!" Zhang Fan said to the nurse.

"Make it more beautiful. It's just an organ." The director of general surgery specially reminded me.

Zhang Fan rolled his eyes and said nothing. How can this thing be beautiful! I can't get artificial eyebrow tattoos anymore.

The size of the anus is about the size of a dollar coin. Because of the orbicularis muscle, this thing is contracted, so it doesn't look big. Zhang Fan used the tip of the knife along the anus, gently drew an arc downward, and then drew an arc on the opposite side.

It is equivalent to drawing two connected arcs like a rugby row around the anus. Then, along the line drawn by the tip of the knife, start to cut the skin.

The yellow fat is crystal clear. The fat in the buttocks is relatively dense due to the long-term sitting posture. When the knife is cut on the fat, it is really crystal clear. When the fat is cut, the fat particles are crystal clear like yellow rice grains.

The Alice forceps held the anus and pushed it forward gently, the toothed tweezers opened the skin, and Zhang Fan used his fingers to gently release the fat near the anus and the levator ani muscle.

"Sutures! Saline, gauze, povidone iodine, alcohol." The dissociation is over, and at this time, the anus and a little rectum are directly attached to the fat. Because the anus is useless.

Washing, washing with a large amount of salt water, the anus that has been freed, like a rubber tube hanging on the wall, the anus droops pitifully on the buttocks.

After washing with a large amount of salt water, start to wipe with gauze, after wiping with gauze, wipe with iodophor, and then use alcohol after wiping with iodophor.

"Come on, give me more saline and gauze. You must wash it several times." Zhang Fan said to the nurse. This cleaning is definitely better than the restaurant chef cleaning the gourd head.

After cleaning, Zhang Fan went in and out with a needle along the anus, and sewed around the anus. Finally, he pulled the end and end of the thread, and the anus was completely closed. This is the so-called purse-string suture, and this method is generally used for suturing stumps, such as the appendix.

The stump was closed, and with a gentle tug in the abdominal cavity, the rectal stump and anus were pulled out.

"Tissue bag!" The equipment nurse handed the tissue bag to the itinerant nurse, who stretched it open, and Zhang Fan put the rectum and anus into the transparent tissue bag.

This thing doesn't look big when it's in the body, but when it's put into the tissue bag, it's a big lump. The whitish anus and bloody rectum directly fill a tissue bag.

The rectum and anus are very important organs. It is not a matter of cutting them out and throwing them away. If cancer is suspected, pathology is required.

If there is no doubt, the family members must have a look at it. For some sophisticated families, they are required to handle such important organs by themselves.

The place where the anus used to stay is now empty, like a black hole, and the rest is suturing, from the inside to the outside, and finally the skin. After the oval incision is sutured, it looks like a person's closed eyes. The chrysanthemum is gone, completely lost, replaced by a stitched scar.

Lighting a cigarette, sitting on the toilet, playing with his mobile phone, this kind of pleasant enjoyment, he will never be able to enjoy it in the future.

After the stitching was finished, Zhang Fan looked at it, um, yes, it's just short of a crooked willow leaf eyebrow!

"Change gloves!"