Medical road

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

Touch and touch, the greasy fat is like boiling cream, you can't find it.This is all positioned. If you don't position it, you can only let it stay in your stomach. If you live for a long time, it might grow out like a pimple.

"The shrapnel has entered the intestines!" Zhang Fan spoke after about ten minutes.

"Then fill up the intestines first, and then directly enema. You see it is still relatively round in the display. If you open the intestines again, the damage is too great, you can see that the shrapnel has damaged the abdomen like this. "Pharaoh was afraid that Zhang Fan would open his intestines again to look for shrapnel.

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

If you can’t get out, no matter if it is round or not, as long as it is a foreign body, it will irritate the intestines, and then there will be diarrhea that can’t be treated directly. Pull it when you eat it, and pull it when you eat it, just like a lax faucet, and taking medicine at all it does not work.

"What do you do then? Cut it?" Old Wang also struggled.

Zhang Fan gently squeezed the iron piece across the intestinal wall with one hand, while looking at the monitor, thinking about it in his mind.What is the idea?Conceive the size of the chrysanthemum and the structure of the intestine.

"Use the spreader to open it, and the soapy water enema!" Zhang Fan said definitely after looking at it again.

"You can be sure no, if the edema after closing the abdomen causes intestinal stenosis, if it can't be taken out, it is a medical accident." At this time, Lao Wang began to worry again.

It is really a happy thing to have an old doctor on the operating table who can think about and give advice. If in other things, this kind of person will probably be despised: just pick the fault!But on the operating table, the old doctors who can pick you up are all looking at you and loving you!

"Let's do the operation quickly. After the intestine is anastomosed, we will start the enema immediately!" Zhang Fan said while looking at Lao Wang.

"Can it work?" No one had done such a thing before, and Lao Wang was not sure.

"You have to do this too, look at his intestines, he can't hurt it anymore. Anastomosis!" There is no way, it can only be done, Zhang Fan gritted his teeth and said directly.

The shrapnel is not big, but the power is not small. This thing passes through the intestine, especially the small intestine, which is originally relatively small. As long as it is drawn, a cross section of the intestine is directly damaged by 34 or even larger areas.

Moreover, the repair of this damage is not like a rubber pipe.Because of prolonged rupture leading to ischemia, the thin intestinal wall has been necrotic, and there is no possibility of repair.

You can only cut off the necrotic intestine at both ends, and then start stitching from a good place. This method is no way. The biggest drawback is edema and obstruction.

"Intestinal forceps!" Now that it is decided, it will be implemented. There is no need to hesitate. The longer the hesitation, the greater the chance of intestinal edema.

Just do it without hesitation. Zhang Fan and the director of General Wai placed a non-invasive Scudder forceps on the proximal and distal normal intestines of the intestinal segment to be removed. This can prevent the intestinal tube while controlling the blood supply. Serious pollution caused by this.

Then free 1cm or more at the margin of the normal mesentery adjacent to the serous membrane, and place a narrow straight forceps diagonally on the intestinal wall to remove.The remaining section of intestinal tube with free mesangium is treated with a 4.8mm stapled TL60 stapler.

This kind of surgery is now equipped with an intestinal stapler. If stitches are used, the operation time will be too long.

During the operation, a linear cutting closure was used to close the openings of the two broken ends of the small intestine.Cut off the small intestine obliquely appropriately, leaving the free mesentery 1cm from the intestinal cut edge.Sew traction lines on the mesangium and the mesangial margin respectively, bring the two broken ends together to bring the mesangial margins of the two sections of intestine closer together, and insert one arm of the closer into the intestinal cavity.

Before firing the stapler, the intestines on the arms should be flattened together.At the time of firing, the intestine is stapled, and the knife built in the linear cutting closer cuts the anastomosis.If bleeding is found on the staple line, it can be controlled with interrupted sutures.

Sew a stitch of traction threads A and A'on the mesangial limbus of the two intestinal segments, and suture the ends of the mesangial limbus stitching threads on both sides at the midpoint of the other suture B, so that they can be drawn to the mesangial limbus The two ends of the side stapled line.

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

With the increase of application time and experience, it has been found that it is more advisable to align point A with point A1 and close it vertically from B to B'.In this way, only the cross of two rows of staples exists at both ends of the closing line, and then it should be carefully checked and strengthened sutures can be carried out if necessary.

Similarly, if there is a bleeding point, it should be sutured to stop the bleeding.Check the staple line and remove more than the bowel outside the staple line.Check whether the staple line is reliable. If necessary, use a few intermittent sutures at a proper distance from the anastomosis to close the mesangial edges of the intestines on both sides.

Perform intermittent sutures to completely close the mesenteric holes on both sides.It is also possible to close the mesentery hole before the intestinal anastomosis.The mesentery hole must be completely closed to prevent intestinal hernia.Finally, use the thumb and index finger to check the touch to determine whether the anastomosis is unobstructed.

This operation is too difficult to understand in professional terms.In layman's terms, there are two rubber tubes, and then use scissors in the middle of the cross section of the two rubber tubes, and cut the wound up about 5cm in length.Then stitch the two wounds together, what the stapler looks like, is actually a large stapler.

Because the sutured intestine will be edema, if it is directly sutured, it will be obstructed, and the last sutured intestine is originally a straight long strip.

After stitching, it will be a T-shape or Y-shape.The place where the two interfaces are located directly becomes a big pocket, originally with a caliber of a few centimeters, and finally made into a caliber of ten centimeters.To prevent obstruction.

After the suture was completed, the abdominal cavity was originally a disc-shaped intestine, but as a result, there were a few more empty sacs protruding."Close your abdomen! After this operation, you must tell the doctors and nurses in the department to pay attention to this patient.

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

Use dual antibiotics.Continue to draw pressure through the gastric tube until the intestinal tract returns to its normal emptying function.Be sure to tell the doctor of the tube bed clearly that the gastric tube must not be removed without ventilation."Zhang Fan sutured the skin on his abdomen, while explaining to Lao Wang.

How does the surgeon judge if he is not ventilated? Simply, it depends on whether he farts.

"Okay! My Director Zhang, I asked you to come to General Surgery at first, and you can't come alive. You see you come to General Surgery. I just retreated to the second line. You have the final say in the largest surgical department in the hospital.

It’s not too late anymore. Don’t be an assistant to the director. When you come, you will be the first deputy director."

Lao Wang tempted Zhang Fan's heart not to die. Lu Ning looked at the conversation between Lao Wang and Zhang Fan, very envious."This little brother, he's so good, the orthopedic surgeon doesn't talk about doing general surgery, and the general surgery director still keeps pulling people. This is a doctor, so comfortable!"

"Director, let's be unhappy, the shrapnel hasn't come out yet!" Zhang Fan ignored Lao Wang. General Foreign Affairs was like the Warring States Period. Several deputy directors were jumping about each other. I really want to go to General Surgery. Convenient and free.

"Right, right, right, quickly solve this matter, otherwise it will always be a time bomb."

"Relax, I have moved the shrapnel through the cecum, we are now preparing to enema. Soapy water, a lot of soapy water." Zhang Fan said to the visiting nurse.

2000ml of soapy water was hung on the infusion stand, the needle was removed, and the anus and rectum were plugged straight."Turn on the switch." Zhang Fan said to the tour after inserting the plastic tube into the intestine.

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

And this kind of enema, the infusion speed is very fast, like a small stream of water from a faucet, 2000ml of liquid quickly enters the intestine of the wounded.

"1000ml." The visiting nurse reminded.

"It's okay, go on." Zhang Fan, Lao Wang, Lu Ning, and even Jumabek's medical directors all stared at the wounded's 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 intestines is discharged, and a colorful bubble is blown out from time to time in the anus, just like The little girl has pink lips like eating bubble gum and blowing bubbles.

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

Although there is a stretcher, because of the pelvis, the range of the anus is actually not very wide, but if you put a smaller bun into this stretch, there is no problem at all.

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

Under the shadowless lamp, the liquid flowing down with the collapse was placed in the potty under the anus, and bubbles of various colors rose.Just like a pool of gasoline in the summer, colorful bubbles.

All the people involved in the operation, including the instrument nurse, were tiptoeing and looking into the potty.

"Why haven't you come out yet? You did come out!" During the operation, the young nurse was a little younger, and the girl muttered to herself with her big eyes.

Waiting, the most ferocious wave of liquid has come out, but there is no black iron in the potty, and Lao Wang is unwilling to stir it over and over again with a small stick in the potty.

There are more bubbles in the basin that originally contained bubbles."Don't worry, it's all bubbles, you can't see it when you come out." Ren Li got angry a little anxiously.

"No! The liquid is over." Lu Ning said disappointedly.

"Do it again!" Old Wang said categorically.

"No, the electrolytes of the wounded will be disordered again. Forget it, let's talk about it after his wound has recovered. This is my mistake. I will bear it. When I have the operation, I will write a report."

"You are in charge of a calf, I have a higher title than you, and I have agreed to this surgical plan, I am responsible." Lao Wang said firmly.Surgical accidents are not trivial, but also such heroic surgical accidents.

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

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

"Counting me, this is not intentional, damn it!" Jumabek, the more he thinks, the more angry, the more he thinks, the more sad.This is not credit, but everyone is not to be left behind, for this young doctor with a promising future, 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 that. He was sure of everything in his mind, and finally failed.

Zhang Fan slowly pulled out the spreader. At this moment, as the spreader was taken out, everyone in the operating room heard a sound. It was Zhang Fan's voice that he would never forget "dingdong!"

(The picture of the intestinal anastomosis is posted in the author's statement. This is not easy to understand, and those who are interested can take a look.

Watching piracy is like eating a king's meal, and it's a evil force!Everyone, hurry up and give a subscription!)