Path of Medicine With a System

Zhang Fan touched and touched, the slightly squirming intestines crawled on his hands like thick caterpillars, and it felt a little itchy.

Touch and touch, the greasy fat is like cream that melts in boiling water, you can't find it no matter what. This has been positioned. If it is not positioned, it can only be kept in the stomach. If it lives for a long time, it may grow out like a lump.

"The shrapnel has entered the intestinal tract!" About ten minutes later, Zhang Fan spoke.

"Then fill up the intestinal tract first, and then enema directly. You can see that it is relatively round in the monitor. If you open the intestinal tract again, the damage will be too great. You can see that the shrapnel has already damaged the abdomen like this. "Old Wang was deeply afraid that Zhang Fan would open his intestines again to find shrapnel.

Zhang Fan stared at the monitor of the c-arm and looked again and again, "What if it can't come out?" Zhang Fan asked, who can guarantee this kind of thing, it will definitely come out.

If it doesn’t come out, no matter if it’s round or not, as long as it’s a foreign body, it will irritate the intestinal tract, and then you’ll have diarrhea that can’t be cured directly. does not work.

"Then what should I do? Cut it open?" Old Wang was also tangled.

Zhang Fan gently squeezed the iron plate with one hand through the intestinal wall, while looking at the monitor, thinking about it. What are you thinking about? Conceive the size of the chrysanthemum, the structure of the intestine.

"Open it with a spreader, soapy water enema!" Zhang Fan said with certainty after looking at it again and again.

"Are you sure, if the edema after closing the abdomen leads to intestinal stenosis, if you can't take it out, it's a medical malpractice." Lao Wang started to worry again at this time.

It is really a happy thing to have such an old doctor who can think and give opinions on the operating table. If it is about other things, this kind of person will probably be despised by others: just pick faults! But on the operating table, the old doctors who can find fault with you all think highly of you and love you!

"Let's do the operation quickly, and start the enema immediately after the intestinal anastomosis!" Zhang Fan looked at Lao Wang and said.

"Is it okay?" No one has done this kind of thing before, and Lao Wang is not sure.

"It's okay, I have to do this. Look at his intestines, it can't be hurt anymore. It fits!" There was no other way, this was the only way, Zhang Fan gritted his teeth and said directly.

The shrapnel is not big, but its power is not small. When this thing passes through the intestinal tract, especially the small intestine, it is relatively small. As long as it passes through, a section of the intestinal tract will directly damage 34 or even a larger area.

Moreover, the repair of the damage is not like a rubber pipe, just sew it up and finish the job. Due to ischemia caused by long-term rupture, the thin intestinal wall has been necrotic, and there is no possibility of repair.

We can only cut off the necrotic intestine at both ends, and then start suturing from the good place. This method has no other way, and the biggest drawback is edema obstruction.

"Intestinal forceps!" Now that the decision has been made, it will be implemented, and there is no need to hesitate any longer. The longer the hesitation time, the greater the chance of intestinal edema.

Do what you say, without hesitation, Zhang Fan and the director of general surgery placed a pair of non-invasive scudder forceps on the proximal and distal normal intestines of the intestinal segment to be resected, so as to control the blood supply and prevent intestinal Serious pollution caused by i.

Then free 1 or more of the normal intestinal mesenteric border adjacent to the serosa, and then place a narrow straight forceps obliquely on the intestinal wall to remove it. The left section of intestinal tube that has been freed from the mesentery is processed with a 48-pin tl60 stapler.

This kind of operation means that now there is an intestinal stapler. If sutures are used,

The surgery takes too long.

During the operation, the openings at the two ends of the small intestine are closed together with a linear cutting closure. The small intestine was properly cut obliquely, and the free mesentery at a distance of 1 from the intestinal resection margin was preserved. Suture traction lines at the mesentery and the opposite mesentery border respectively, bring the two broken ends together to bring the opposite mesentery borders of the two intestinal tubes together, and insert one arm of the linear cutting closer into the intestinal lumen.

The bowel tubes on the forks should come together flat before the staple cutter is fired. When firing, the intestinal tube is stapled, and the built-in cutter of the linear cutting closer cuts the anastomosis. If bleeding is found on the staple line, interrupted sutures can be used to control it.

Suture a traction line a and a' at the mesenteric border of the two intestinal segments, and suture the ends of the staple line on both sides of the mesenteric border at the midpoint of the other suture b, so that it can pull the mesenteric border Side ends of the staple line.

Then use a non-cutting linear occluder to close the opening of the common intestinal stump. Excision of excess bowel outside the occluder. If there is a bleeding point after removing the closer, it can be controlled with interrupted sutures.

With the increase of application time and experience, it has been found that it is more preferable to combine point a with point a1 and close from b to b' in a vertical manner. In this way, only the intersection of two rows of staples at both ends of the closure line should be carefully checked, and reinforced sutures can be performed if necessary.

Similarly, if there is a bleeding point, interrupted sutures should be used to stop the bleeding. Check the staple line, and resect the excess intestine beyond the staple line. Check whether the staple line is reliable, and if necessary, use a few stitches of intermittent suture at an appropriate distance from the anastomosis to close the mesenteric borders of the two sides of the bowel.

Interrupted sutures were performed to completely close the mesenteric foramen on both sides. The mesenteric foramen can also be closed prior to the intestinal anastomosis. The mesenteric foramen must be completely closed to prevent internal herniation of the bowel. Finally, check with the thumb and index finger to check whether the anastomosis is unobstructed.

This operation is too difficult to describe in technical terms. In layman's terms, there are two rubber tubes, and scissors are used to cut off the wounds about 5 in length obliquely upwards in the middle of the cross-sections of the two rubber tubes. Then the two wounds are sutured. What is the stapler? It is actually a large stapler.

Because the sutured intestine will be edematous, if it is directly sutured, it will be obstructed, and the finally sutured intestine is originally a straight strip.

After sewing, it will be a T shape, or a Y shape. The two joints directly became a large pocket, which was originally a few centimeters in diameter, but was finally made into a dozen centimeters in diameter. In order to prevent obstruction.

After the sutures were completed, there were several protruding empty sacs in the abdominal cavity, which was originally a disc-shaped intestine. "Shut up! After this operation, we must tell the doctors and nurses in the department to pay attention to this patient.

Intravenous lactated Ringer's solution was used to maintain fluid balance. And continue blood transfusion until the pulse returns to normal, especially when the hematocrit is 30, blood must be used.

Apply dual antibiotics. Continue suction and decompression through the gastric tube until the intestinal emptying function returns to normal. Be sure to tell the doctor who is in charge of the bed that you must not remove the gastric tube if you are not ventilated. "Zhang Fan explained to Lao Wang while suturing the skin of his abdomen.

How the surgeon judges whether he is ventilated or not is simply to see if he farts.

"Okay! My Director Zhang, I asked you to come to general surgery, but you couldn't come to life. You see, you came to general surgery, and I directly retreated to the second line. You have the final say on the largest surgical department in the hospital.

It's not too late to come now, don't be an assistant to the director, the first deputy director will come directly, how about it. "

Lao Wang's desire to seduce Zhang Fan is not dead, Lu Ning watched the conversation between Lao Wang and Zhang Fan, and was very envious. "This little junior, you're such a good guy. Not to mention that the orthopedic surgeon does general surgery, and the director of general surgery keeps pulling people away. This is what you call a doctor, so comfortable!"

"Director, let's not be happy. The shrapnel hasn't come out yet!" Zhang Fan ignored Old Wang. Convenience and freedom.

"Yes, yes, please solve this matter quickly, otherwise it will always be a ticking time bomb."

"Don't worry, I've moved the shrapnel past the cecum opening, and now we're going to do the enema. Soapy water, a lot of soapy water." Zhang Fan said to the itinerant nurse.

2000L of soapy water was hung on the infusion stand, the needle was pulled out, and it was inserted straight into the anus and rectum. "Turn on the switch." Zhang Fan said to Xun Xun after inserting the plastic tube into his intestines.

If there is no necessary and special requirement for liquid, the general infusion is very slow, one is to prevent heart failure, and the other is afraid of causing adverse reactions to the infusion.

And this kind of enema, the infusion speed is very fast, like a small water flow from a faucet, 2000l of liquid quickly enters the wounded's intestinal tract.

"It's 1000l." The itinerant nurse reminded her.

"It's okay, continue." Zhang Fan, Lao Wang, Lu Ning, and even Juma Bek, the directors of internal medicine, all stared at the wounded anus.

As the pressure decreases, the liquid enters more and more slowly, and because it is soapy water, as the soapy water enters, the gas in the intestine is discharged, and a colorful bubble is blown out in the anus from time to time, just like The little girl eats bubble gum and blows bubbles, with pink lips.

"Okay!" While speaking, the itinerant nurse turned off the switch, and Zhang Fan slowly pulled out the plastic tube, "The spreader."

Although there is a spreader, because of the relationship between the pelvis, the range of the anus is actually not very wide, but it is not a problem to put a smaller bun into the extent of the spread.

With the opening of the spreader, like a dam opening a sluice, soapy water mixed with blood and feces, colorful, really colorful.

Under the shadowless lamp, bubbles of various colors rose up in the potty under the anus as the liquid poured down. Just like a pond stained with gasoline in summer, colorful and various bubbles.

All the people in the operation, including the instrument nurse, were on tiptoe looking into the bedpan.

"Why don't you come out, you come out!" The nurse was only a little younger in the operation, and the girl murmured to herself with her eyes wide open.

Waiting, the worst wave of liquid has come out, but there is no black iron sheet in the bedpan, Lao Wang is not reconciled, and takes a small stick to stir it over and over again in the bedpan.

There were more bubbles in the basin where there were already bubbles. "Don't stir it, it's full of foam, you can't even see it when it comes out." Ren Li was a little anxious to get angry.

"No more! The liquid is gone." Lu Ning said disappointedly.

"One more time!" Lao Wang said decisively.

"No, the wounded man's electrolytes will be disturbed again. Forget it, let's talk about it after his wound recovers. This is my mistake. I bear it. I will write the report after the operation."

"You are in charge of a calf. I have a higher professional title than you, and I have agreed to the operation plan. I will be in charge." Old Wang said firmly. Surgical accidents are not small things, and they are such heroic surgical accidents.

Zhang Fan looked at Lao Wang and wanted to speak, but he couldn't say anything, "Add me!" Lu Ning also stood up.

"And me!" Although Ren Li is not a surgeon, she also knows that Zhang Fan's difficulties are not easy. If there is one more person, the final punishment will probably be shared a little.

"Count me in, this wasn't intentional, shit!" Jumabek became angrier and sadder the more he thought about it. This is not credit, but everyone is unwilling to lag behind, for this promising young doctor, after all, there are still many good people in the world!

"Thank you! Thank you! I am responsible for my decision, thank you!" Zhang Fan's voice became much lower, and he didn't want to be like this. The things in his mind were sure and sure, but in the end, he failed.

Zhang Fan slowly pulled out the spreader. At this moment, as the spreader was taken out, everyone in the operating room heard a voice that Zhang Fan would never forget in his life, "Ding Dang!"