Path of Medicine With a System

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Zhang Fan and the surgeons began to change gloves. In general surgery, surgery is rarely changed, but for this kind of pollution surgery, gloves must be changed.

This kind of operation is complicated, but it is not as complicated as tumor resection. It is simple, the intestinal tract is blown up like a flower, and it can save the life.

Now the hemostasis is complete, and the remaining intestines and anus have been removed. The rest is self-evident, and the digestive system has to find a way out.

As the saying goes, water and fire are ruthless, and urine and urine are ruthless. If you hold it in for a while, you will die of discomfort. So this channel of reconstruction is also very important.

The life-saving has now been achieved, and the rest is about the quality of life of the patients. It has been more than three hours since the operation, and Zhang Fan has already exercised, and less than six hours is not considered to be standing for a long time.

Anxiety, the anxiety before the operation has gradually subsided, and the rest is suffering, "No news is good news." Ms. Jiang leaned on the plastic bench outside the operating room with a livid face, and said to herself .

Assistants and secretaries stood far away, but dared to surround them. They know that at this time, they must not make troubles for nothing. But several people communicate with each other through eyes, it is not just a kind of schadenfreude, but also a kind of unspeakable helplessness.

The silly boy's parents have already set off from their hometown in Jiangsu and Zhejiang. People who cared, or because of politeness and interests, called one after another, and Ms. Jiang really wanted to smash the phone. It's annoying enough, but also have to perfunctory some people.

A few transfer doctors from the emergency department looked at the book-like thick waiver, and stuck out their tongues quietly, "Director Xue is really good, he almost got out everything he could. You are so timid!"

"You know what the hell, is that cowardly? He didn't do the surgery, and the hospital didn't belong to his family. What should he be afraid of? The female doctor said a few words to another male doctor who was always harassing her.

Whether it's timidity or responsibility, it's enough for Ouyang to be satisfied anyway.

"I didn't see it, this kid is so smart. I was worried that he didn't understand, not bad!" Ouyang looked at the signed waiver, although he didn't say anything, but he was satisfied with Xue Fei, It is estimated that it has entered her small notebook.

Changed gloves and rinsed the talc off the gloves. Zhang Fan and the others continued with the operation. They were originally patients who were only received when they were about to get off work at noon. At this time, it was already past the meal time, and the anesthesiologist and the itinerant nurse had already had their meals.

The surgeons and equipment nurses can only bear with it, and the operation is not so urgent at this time. Zhao Pingquan, the director of the general surgery department, was also in the mood to speak.

"Old Chen, what's the food in the cafeteria today? Why did I ask that it smells like tofu?" The long-term surgery, coupled with Zhang Fan's weird surgery habits, Lao Zhao endured too much hard work. It's fine if you don't let me eat, but you don't even let me talk!

"Braised pork and boiled tofu without hair loss, hey! I used to be able to resist eating meat, but today I have no appetite at all. You surgeons are better, you can go out to eat after surgery, we will fight to the death Ah, it's really unpalatable."

"That's all you pursue!" Old Zhao mocked. He was also hungry, and felt nauseous during the operation, which stimulated the gastric mucosa to secrete a lot of gastric acid. At this time, his old stomach problem relapsed.

Most surgeons have stomach problems. They don't eat on time all the year round, and they get stomach ulcers when they are hungry and full. The pain starts when they don't eat after the meal.

"Gauze, Director Zhao bear with it, the operation is almost over." Zhang Fan knew that Lao Zhao had a stomach ulcer, so his subordinates also accelerated.

"It's okay, I can't die if I eat later. It's this child, I don't know if he can accept it after the operation." Lao Zhao saved his life with a black face before the operation, but after he really saved his life, he felt a little cruel.

"Usually this kind of reconstructive surgery,

Psychological counseling must be given to the patient before the operation, so that the patient can accept it in advance, but there is no way for emergency surgery. Although the quality of life will drop a lot in the future, people will still live, right? "Zhang Fan in turn began to persuade Lao Zhao.

The difference between Lao Zhao and Zhang Fan's personalities can be seen from this point. Zhang Fan hesitates before making a move, and Lao Zhao hesitates after making a move. At best, it is kindness, but at worst, it is the benevolence of women. It has nothing to do with his personality.

The abdomen should be rinsed and ligated, and the lower abdomen has been tidied up. The operation has really entered the final step, the fistula and abdominal closure.

There is a very troublesome thing about the fistula of the intestine. Although the intestine is stretched out, it seems to be more than ten meters long, but there are ligaments hanging around the thing, and the vascular plexus around it is like a spider web, which makes the intestine firmly fixed. , that is to say, the intestinal tract is actually not very mobile.

If he could move a little, Zhang Fan really wanted to give this silly kid an artificial anus. Now it can only be reconstructed near the fracture. Opens at the remaining upper end of the sigmoid colon.

This place is projected on the abdomen, which is actually at the upper left of the navel. In technical terms, it is the opening at the midpoint of the line connecting the navel and the left anterior superior iliac spine.

Fistula is simple, very simple, and experienced general surgeons can do it, but this kind of permanent fistula is not something ordinary doctors can do.

First of all, the stability and application of the external anal bag should be considered. This is not a trivial matter. It doesn’t matter if the patient hangs a bag for a day or two. It's endless trouble.

Because the cecum and anus have a strong contraction ability, the mucous membrane inside is smooth and has a certain self-cleaning ability. Except for people who do not pay attention to hygiene, the general human body will not have peculiar smell.

But this permanent anal bag will not work. First of all, the airtightness of this thing cannot be compared with that of the anus, and it lacks the closure of the orbicularis muscle. So, a permanent stink will go with it.

"Overseas patients like this will be intervened by a psychiatrist during their stay in the hospital, and the rehabilitation doctor will give him some training for future life. We still lack doctors!" The anesthetist looked at Zhang Fan and started to get a hole, as if thinking of something Same, started to hiccup while talking.

"That's because their clinicians can't do it. Our clinicians have done all the work." Lao Zhao didn't want to hear this. The old man and Ouyang belonged to a generation, and their generation can be regarded as the strangest generation. I am fine and often say that this is not okay, but when I hear others say it, he immediately becomes unhappy.

For the fistula, Zhang Fan prepared the fistula a little below the belly button. "Sharp knife!" The nurse handed the sharp knife to Zhang Fan. Zhang Fan put one hand in the abdominal cavity, and with the other hand, Zhang Fan made an incision two fingers wide on the patient's belly, directly penetrating into the abdomen.

Then clamp the colon with forceps and slowly pull it outward. The intestinal tract is most afraid of ischemia. Although the intestinal tract has good toughness and flexibility, it will not work even if it is twisted, let alone folded. If it is not done well, it will be intestinal ischemia.

After the colon was pulled out, Zhang Fan started stitching. This seam is very delicate. The colon must be sutured at the opening of the abdominal wall without puncturing the intestine.

This suture is not mending clothes, although the needle is very small, as long as it penetrates the intestine, as time goes on, the precious thing of the intestine will become bigger and bigger with this small opening, and eventually it will be necrotic.

It can only be hung on the opening with a small needle and thin thread slowly on the membrane outside the intestinal tract. The suture is actually an auxiliary function, which is to make the two tissues contact and then fuse.

One lap, after Zhang Fan sewed a lap very carefully, he let out a long breath, really a long sigh of relief, this thing will go wrong if you don't pay attention to it a little bit, and it's not a small thing. question. After all, the intestines are just a little bit, not leeks, and if they are cut off, they will not grow again.

After suturing the intestines and the interface, Zhang Fan began to trim the skin opening. The two fingers are opened for better suturing, but if the opening is left, the opening is a bit too big.

The reconstruction is the anus, so it is best to choose the size of the original device for all sizes. For example, a finger is inserted into the anus of a normal adult. Note that this is a normal person.

Therefore, when the skin is trimmed, it can be inserted into the size of a finger. Because there is no orbicularis muscle, the suture should be slightly smaller. When it is necessary to insert a finger, it should be a little tighter.

"Ah! Director, are your fingers a little thicker!" Lao Zhao had done physical labor in his early years, and his fingers were half as thick as Zhang Fan's.

"Is it thick? Not thick! No levator ani muscle, no sphincter, thicker is better."

"Hehe!" Zhang Fan thought for a while, then smiled helplessly, directly with a wry smile. Although it was remade, it was just the same product, missing many, many things.

In the end, Zhang Fan didn't use the director's finger, but put his own finger in it. Then gather the sutures from both ends of the incision. A little recycling. When it feels a little tight, it is considered to be the end of the reconstruction.

This suture is not as simple as Zhang Fan suturing blood vessels. Feces, especially the feces of omnivorous animals, contain a large number of bacteria and viruses. As long as there is a little space for them to remain, it will be a very terrible thing.

Infection and death are possible. Even if there is no infection, as long as there is a gap in this thing, it will corrode and gradually form a fistula. Therefore, when Zhang Fan sutures, he is very careful not to suture too tightly and cause ischemic necrosis. , and there can be no gaps, the operation is not fast at all.

Pressing the anal bag, Zhang Fan looked at it, "Not bad! There should be no major problem. Prepare to close the abdomen!"

Like cattle and sheep returning home, after Zhang Fan closed his abdomen, the nurses and anesthesiologists began to work. With the last stitch cut, the operation was over!

The surgery, which took more than four hours, was finally over.