Splenectomy is associated with preservation and the degree of splenic damage.
Generally, for superficial small lacerations of the spleen parenchyma, small capsular lacerations, subcapsular hematomas and localized tears, the spleen can be retained and the damaged area can be sutured and ligated.
Orgi's was a small, shallow laceration, and the depth and length of the cut were very limited, no more than 1cm.
Surgery was a fantasy for Hills and Lockard because there were only a handful of surgeons who could perform splenectomy and spleen repair was too difficult. But for Kawei, this kind of surgery is new to him. The only difficulty is not the technique, but the surgical instruments.
However, he has been here for almost a month, and he has gradually become accustomed to the things of the 19th century. There have been new changes in surgical techniques and specific movements of his hands.
The liver and spleen must be sutured using catgut. When suturing, not only does the catgut itself have to be easily broken, but Kawei also needs to always pay attention to whether the tender liver and spleen will be torn again by the knots tied up by the sutures. .
His movements must be as gentle as possible while tying the surgical knot. On this basis, he also inserted some omentum between the sutures to further reduce the risk of laceration at the sutures. 【1】
This is a difficult task for Hills and Lockard, but the difficulty cannot be seen only through the actions shown by Carvey. In addition to omentum insertion, spleen suturing seems to be an easy operation.
The story unfolds in such a slightly leisurely atmosphere, and the origin of the matter still has to be told from a meeting half a year ago.
Orji is the most famous surgeon at Graz Hospital and has been working for decades.
In Hills's eyes, although he is not as good as Ignatz, and his surgery skills are getting worse as he gets older, he is definitely better than him in terms of experience. Especially for the diagnosis and treatment of male urology, he has been immersed in it for a long time, and his techniques can be regarded as first-class.
However, there are many uncertainties in surgery, and surgical failure was common in the 19th century.
The patient this time is a writer. He has written several short stories, but the plots are boring and the response after publication has been mediocre. Because he never achieved results, he gradually lost confidence in writing and began to work as a newspaper writer to earn a living.
Just when he thought he was going to be in such a state of confusion for the rest of his life, a turning point occurred.
By chance, he met the girl he liked in a newspaper office - Linette, the daughter of the owner of a dye factory in Vienna.
"Oh, that's good. He's turned over." Kawei was suturing the spleen in his hands, listening to the story in his ears, "Then why is the love he said disappear?"
"Three months ago, the writer came over and said that he was getting married, but he needed to resolve some personal issues before getting married." Hills helped pull the hook and said as an assistant, "He said that he seemed to have a dull pain in his lower body from time to time, and there was also... I feel bloated, I hope Teacher Orji can help me take a look."
"Down there?" Kawei was stunned, "Yin bag?"
"Yes, vagina."
This thing causes swelling and pain. Although the possible types of diseases are not as exaggerated as abdominal pain, the diagnosis still requires the help of imaging. However, if you are an experienced urologist, you can still make a suspected diagnosis based on physical examination and certain experiments.
"Hydocele? Hernia? Inflammation? Or varicocele?"
Kawei can only think of these four types for the time being. Of course, there are tumors besides them, but the probability of tumors appearing in young people is not high, so they are excluded.
"It turns out Dr. Carvey also has research on male surgery." Before Lockard could react, Hills noticed something was wrong, "Aren't you specialized in cesarean section surgery? How come you know so much about the vaginal sac?" ?”
"This...after all, I have it myself, so I was curious and read the book to learn it."
The reason is impeccable. After all, the exploration of the human body begins with interest, and Lockard soon became convinced. But Hills knew that the matter was not that simple, but telling the story was more important now, so he didn’t ask any more questions: “The teacher did some tests and found that it was varicocele.”
"Oh?" Kawei was very interested in Orji's diagnosis method, "How did Dr. Orji make the diagnosis?"
"Hey, haven't you taught yourself men's medicine? How come you don't even know this?" Hills explained, "When a man has varicocele, the degree of swelling of the vaginal sac is different in the supine and upright positions. This is all in the textbooks, have you forgotten?" [2]
"Oh, so that's it."
Kawei smiled, and the suturing of the spleen was in the final stage. "I did have an impression, but I had a question when I saw it."
"What questions?"
Kawei took away the suture needle, quickly tied a knot with his hands, and then took away the gauze lining underneath: "Well, very good, the spleen should be fine. Nurse C, heart rate, heart rate, heart rate report."
"115."
Kawei nodded with satisfaction, then turned around and looked at the saline injection: "How much has been injected?"
"Already 500ml."
"Okay, keep on pumping and pour out the remaining 500ml of water."
"knew."
Kawei seemed to have forgotten the topic just now. After finishing the suturing of the spleen, he began to focus on intestinal damage. Although the knife on the left abdomen only scratched the spleen, the lower colon and its adjacent stomach were ruptured to varying degrees.
"Here, give me wet gauze."
Seeing him as if nothing was wrong, Hills couldn't help but ask again: "What kind of question is the question you mentioned just now???"
"What questions?" Kawei looked at him and then realized, "Oh, varicocele, actually I just have some questions about the examination method. After all, sitting and lying down for a while, it is very troublesome to check, and the symptoms are not obvious. It’s not obvious.”
"Although the examination is troublesome, the accuracy is not low." Hills felt very strange. "If we just follow the hands-off habit of the internal medicine doctors, the most we can see is a swollen vaginal sac. You just said The same goes for inflammation, hernia, and hydrocele."
"In fact, we only need to ask the patient to make a simple movement, and we can see the varicose veins with the naked eye."
"What action?"
"Valsalva maneuver."
Hills frowned and looked at Lockard, who was preparing to repair gastrointestinal surgical instruments. The two of them had no impression of this unfamiliar name: "I've never heard of it. Where did you learn it?"
"It was invented by an Italian anatomist." Carvey said with a smile. "My father admired him now, and his profile portrait is still hanging in the house." [3]
"How to do?"
A cumbersome noun and a profile heightened the atmosphere. The "Valsalva maneuver" instantly became taller in the minds of the two people, but in fact it is simply a sentence: "Hold your breath for 10 seconds and use your chest and abdomen together." "
"......That's it?"
"Yes, it's just holding your breath, nothing special." Kawei explained, touching his stomach with his hands, "Sure enough, there is a break here, give me a needle and thread."
The gastric tear is slightly larger than that of the spleen, but the surface tissue of the stomach is tougher and suturing is more comfortable: "As long as you hold your breath, the varicocele will appear, like a group of earthworms entangled together. Of course, if You can feel it if you touch it with your hands, but some mild patients still have to hold their breath."
"Can it still be like this?" The two of them suddenly realized, "But from the perspective of blood circulation and physiology, there seems to be no problem."
"It's a very useful examination method." Kawei explained, "There used to be a young man who was a glass blower. When he came to my father for examination, he mentioned that every time he blew the glass, his vagina would swell and hurt. , and it was later discovered that it was varicocele.”
"This method is good. I must introduce it to the teacher when he wakes up." Lockard suddenly asked, "But how come the breath-holding movement, which was discovered in the last century, has not become popular yet?"
"Because the Valsalva maneuver was originally used to treat otitis media." Carvey pointed to the ear and said, "The anatomist originally discovered that holding one's breath can make it easier to drain pus from the ear. But unfortunately, because of With a more convenient syringe for cleaning, there is no need to be so troublesome.”
The content of the three people's chat circled around the varicocele examination, and finally returned to Orji.
After confirming the writer's illness, the experienced surgeon immediately formulated a surgical plan, which was to perform partial vaginal sac resection + winding vein ligation. 【4】
"Is it done on the left side?" Kawei only hooked three stitches on the rupture and ended the suturing of the stomach. 【5】
"No, it's both sides."
This time it was Kawei's turn to be surprised: "I didn't expect Dr. Orji to be so powerful that he could treat bilateral varicose veins at one time?"
"As long as it's an andrology-related surgery, the teacher is quite famous throughout Austria." Locard glanced at Orgi, who was still sleeping, and said, "It's just that this surgery... "
Gao pills are the top priority for male fertility, and conservative Austrians tend to choose more reliable conservative treatments, such as bloodletting and vaginal surgery or simple buttocks. Even if it is really serious enough to require surgery, surgeons often only operate on one side, leaving the side with less severe symptoms untouched.
What I'm afraid of is a surgical accident.
Orgi's surgical plan can be said to be very bold, not because he wants to create any history, but because the writer's varicose veins are very serious. Regardless of whether it is done unilaterally or bilaterally, once it fails, the outcome is actually the same. Anyway, the other side will have to be done sooner or later.
"The operation was successful."
"The operation was not considered a success."
Lockard and Hills once again disagreed on the success or failure of the operation: "The wound healed well after the operation, and there were no mistakes in the operation on both sides of the vagina. This is a sign of the success of the operation. You were the assistant at the time, and you should be better than me." It’s better to know better.”
"I do see it clearly, but I don't agree with you."
Lockard retorted: "The success of the operation does not depend on the incision or the surgeon's skills. The final thing to look at is the specific effect! Even the teacher admitted that the effect of the operation was not good. The guy had gao pills on both sides. Still small and soft.”
"What we operate on is varicose veins, not the size of the gao pills. What's more, a large number of surgeries have proven that once the gao pills become smaller, they will never change back!"
"But this still can't change the fact that he can't have children." Lockard said, "They were together before they got married, but they haven't gotten pregnant for more than three months. This can't be Linette's problem. She went for a check-up, and it must be that the writer's pills have not returned to normal."
Severe bilateral varicocele will affect the development of gallstones, thereby affecting sperm quality and causing male infertility [6]. However, the surgery itself can accidentally injure lymphatic vessels and arteries, and the effects of surgery vary from person to person.
"Did the varicose relapse?" Kawei asked.
"He came for a follow-up visit half a month ago, and varicose veins appeared on both sides of the vagina again."
"It seems that he has indeed relapsed."
"Actually, I reviewed the operation process twice later and felt that there might be some mistakes in the operation." Lockard seemed to have remembered some details, "When Teacher Orji performed the high venous ligation, he might have missed some mistakes. Branch.”
"It's inevitable to miss it." Kawei comforted, "This should be regarded as a complication. The recurrence rate of varicocele is quite high."
The operation had been completed for nearly half a year. Since there was no operation record, the only people who could understand the operation clearly at that time were the chief surgeon Orgi and his assistant Lockard. Therefore, whether the operation failed or whether there were errors during the operation is actually a confusing matter.
Moreover, recurrence during surgery was very common at that time, and being able to get off the operating table alive was considered a success.
"The real problem isn't the surgery at all," Lockard said. "The problem is keeping it secret!"
Although the marriage between the writer and the daughter of the dye factory is based on love, love needs to be crystallized, and Linette cannot accept being infertile.
That's why the writer had varicocele surgery before getting married, hoping to cure it, live happily with Linette, and inherit the dye factory worth tens of thousands of crowns in the future.
Unfortunately, he met an upright surgeon.
"The teacher has actually helped him once." Lockard said, "When Linette came to take him for a review a month ago, Teacher Orji told them that 'there is a lot of hope for recovery.' Although It’s deceiving, but there’s nothing we can do about it.”
"But this approach makes the teacher very painful!!!" Hills retorted, "Just two days ago, he was still talking about this."
"Protecting personal privacy is the most basic moral bottom line for doctors." Lockard argued, "If you can't even do this, how can you treat patients?"
"To keep someone's so-called privacy and make another person suffer misfortune for the rest of his life?" Hills shook his head at this statement, "If it were me, I would also loudly tell Linette that he will never be able to have children in his life. If you want to have children, just find another man."
