Fernand's rectal mass was similar to a solitary rectal tumor, but it was much better than those malignant tumors. The border is clear and smooth, and there is no moldy feel like malignant tumors that are difficult to define. Considering the presence of schistosomiasis infection, Kawei gave the diagnosis of schistosomiasis inflammatory colonic mass.
In fact, if modern medicine is more realistic, on the premise that Fernan has testicular cancer, such lumps need to be labeled as "tumor to be diagnosed."
But regardless of whether it’s a tumor or not, the indications for surgery are now pretty much the same.
Ordinary inflammatory lumps deposited with insect eggs are not aggressive. If we have to compare them, this kind of inflammatory lump is just a pile of debris that forcibly occupies a public area. Apart from occupying a public area, it does not seem to do much harm. .
Like another mass on the colon, the inflammatory area does not penetrate deep into the lumen and does not affect daily life.
Malignant tumors are different. The difference is that tumors can grow extremely fast, invade into the lumen, and metastasize to other tissues. In comparison, it is like a foul-smelling slime monster that will grow infinitely and become all-pervasive. If it is not eliminated now, it will one day occupy the entire city.
Although the mass on Fernand's rectum does not look like a malignant tumor, his lifespan does not need to be considered for growth, and it does not metastasize.
Recommended, Chai Shu is really easy to use, download it here... Come and give it a try. 】
But its location is not good. Judging from the touch, it should have invaded the muscle layer inwards, and there is a risk of penetrating the mucosa soon. The lower edge has reached near the dentate line. As for the specific distance, the retroperitoneum needs to be opened to clarify.
Debris is only called debris when it is piled up in corridors and streets. Once it is piled in a room, it becomes garbage that has to be cleaned.
However, this is only for long-term residents. If they no longer live there soon, it is not impossible to endure it for a while.
"The location of this mass is really subtle."
At this time, Kawei was using his fingers to probe into Fernand's anus, repeatedly touching the mucosal surface invaded by the mass. The more he touched, the more he felt that the need for surgery was lower than expected. To put it bluntly, the surgery was optional or not.
From a medical technical perspective, there is no right or wrong answer to whether or not to proceed with the operation.
Judging from the size and degree of invasion of the mass, it has indeed reached the point where it needs to be removed, and the indications for surgery are clear.
However, from the perspective of postoperative recovery, rectal surgery has its own contamination properties. Under the existing conditions, postoperative infection is almost inevitable. Moreover, rectal surgery must touch the sphincter. Whether the anus can be saved and whether the sphincter will be damaged are questions.
The most critical point is that no one knows whether there will be any accidents during the next 12 hours of surgery.
If it were in modern times, if faced with this situation, Kawei might consider continuing to do it for the sake of judicial procedural justice. But if we only consider personal interests and the risks of surgery, it would be better not to do it.
First of all, there is no doubt that Fernand is a death row prisoner.
From the beginning, the purpose of the surgery was to demonstrate the surgical method for treating portal hypertension, not to save his life. Now that the portal hypertension has been treated, the spleen has been cut cleanly, and the shunt blood vessels have been well anastomotic, Kawei is very satisfied.
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[Medical Guide in the 19th Century] []
Edinson was sitting in the audience and he was no fool.
Previously, he insisted that cesarean section and breast cancer removal were useless for military doctors, and he did not express his opinion on Orji's abdominal surgery. He relied on his status to keep suppressing Kawei.
Now so many pairs of eyes are watching this abdominal surgery come to a successful conclusion, Carvey has once again set a record. It is obviously not appropriate to kick him to the front line. Not only will he be gossiped about, he will also have to worry about Morasso's energy in the military doctor's office and Franz.
Franz was no fool either.
Even though he chose not to speak out before due to the face of the Edinson family, now Kawei has put a bargaining chip on him. If such a surgeon cannot get the position of chief surgeon in a field hospital and needs to rush to the front line with battalion-level troops, the joke will be big.
According to Edward, this is a waste of resources.
Now that the preoperative goals have been accomplished, there is no need to take risks anymore.
Kawei sighed thinking of this: "Forget it, after further examination, it is probably just a benign lump. The surgical removal itself also has many risks of postoperative complications, and it may be more troublesome..."
After speaking to several assistants, Kawei pulled out his finger, turned around and walked to the speaker and said: "Dear Mr. Ambassador, the original surgical plan has been completed. The rectal mass is a bit difficult to deal with. Personally, I It’s better not to move.”
Edward frowned, not knowing what Kawei meant by saying that. He didn't realize the seriousness of the problem until the consultant beside him said, "The operation is about to end."
"Mr. Kawei, as a doctor who saves lives and heals the wounded, you should challenge your own limits." Edward picked up the speaker and suggested, "Since the previous operation has been completed, it means that you are fully capable of challenging a new level of difficulty. Why not just leave the rest?" Let’s also cut off the lump underneath.”
This actually makes sense. If Fernand was just an ordinary patient of his and did not have the label of a death row prisoner, Kawei would indeed do this.
But there was something strange coming out of Edward's mouth.
Obviously he was not satisfied with the success of the operation, but he did not want to break the current situation, so he hoped to prolong the operation time and increase the risk of the operation, so that Fernand could die peacefully on the operating table. This was both his wish and God's will. Kawei won the first half and lost the second half without losing anything. It was perfect.
Of course Kavi knew what he meant.
"Mr. Edward, from a medical point of view, the risk of continuing the operation is very high." Kawei showed the blood on his fingertips and said, "It would be better to just close the abdomen like this and the patient won't be able to survive for a few days, so... ..”
It was this kind of rhetoric again. Edward had suffered a loss once and it was impossible to believe him. Before he could finish speaking, he interrupted: "Dr. Carvey, this is called the surgical square. Since Fernand still has physical problems, they should be solved." That’s the right question.”
"Huh? Why do I remember that Mr. Ambassador called this place the execution platform before?"
Edward was not stopped by this question.
He glanced at Franz, then at the dense audience in front of him, and raised his voice: "I am just a diplomatic ambassador and have no decision-making power. I think the most important question to ask is whether it is surgery or direct execution. Citizens of this great city, that is, all of you in the audience.”
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[Medical Guide in the 19th Century] []
This question is meaningless. Whether Fernand should die or not is another question. The main question is how can hanging be as good-looking as a paid operation?
Even though the first half of Kawei's surgery was boring, the second half, when he was removing his spleen, was quite exciting. Now the surgical area has been moved down to the rectum. Based on the principle of seeing one more time, the audience is naturally unwilling to give up.
"Do the surgery! Do the surgery! Do the surgery..."
Edward smiled and looked at Kawei: "Whether it is the surgery square or the execution platform, the audience has paid and the audience has the final say. Please continue with the operation."
Kawei wanted to retort that he had not received any money and that the performance was completely free, but considering Franz's role in the charging process, he kept it to himself. The most lacking thing for war mobilization is money. If he talks about money with Franz now, the significance of using surgery as an alternative to the death penalty will disappear.
Surgery is fine too.
He quickly changed his mood and adjusted himself to the state of surgery: "Since everyone wants to see it, I will continue to do it."
Hearing this sentence, the scene burst into warm applause, and the sound just now rang out again, but this time it was replaced by Kavi's name: "Kavi! Kavi! Kavi..."
...
In the 21st century, China was very safe, but if we move the time forward, it was actually not peaceful.
Abdominal cutting trauma is always accompanied by damage to the intestines. Although the rectum is rare, the number of cases increases over time. Foreign bodies in the rectum are also frequent visitors to the emergency department, and as time goes by, they change their methods, so Kawei is also considered a skilled worker in rectal surgery.
Rectal mass resection seems to be just a resection of a certain part, but due to the functional positioning and special anatomical structure of the rectum, the surgical methods appear to be diverse.
There are more than ten kinds that Kawei still remembers. 1】
As for which one to use, the choice must be made based on the available instruments and the specific location of the tumor that will be seen after the visual field is exposed later.
"Give me the scalpel." Before Kawei could finish suturing the upper lambdoid incision, he took the scalpel and made a midline incision on Fernan's lower abdomen. "Hemostatic forceps, warm gauze, tissue dissection forceps... ..Check your heart rate and blood pressure.”
"98,124/73."
Kawei nodded, started to speed up his hand, and went directly into the abdominal cavity ignoring some small bleeding spots: "Prepare warm saline, flush the abdominal cavity twice first, and then perform the operation."
"good."
Bergert added another bowl of spleen blood to Fernan's blood transfusion bottle, then turned around to prepare saline solution and wet gauze for the operation. Two basins of water were put into the abdomen, and some blood clots remaining in the abdominal cavity and the newly leaked ascites were removed together.
Kawei checked the location and scope of the mass again and found that it was not too close to the dentate line. If the lower edge of the mass was properly cut, there was still a chance to save the anus.
The surgery was a variant of the Dixon surgery, which meant that there was no need to expand the incision range around the outer edge of the mass or remove the surrounding mesentery. It only required a simple resection of the intestine where the mass was located, and then performed an intestinal anastomosis. 2】
"After entering the abdominal cavity, we find the sigmoid colon and rectum."
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[Medical Guide in the 19th Century] []
Kawei gently held the sigmoid colon in his hand and cut the retroperitoneum along both sides of its mesenteric root to reveal the root of the inferior mesenteric artery: "We started to clean down the lymph nodes and fatty tissue around the intestines." 3]
If traditional rectal cancer resection is performed, the inferior mesenteric artery needs to be severed because the descending colon, sigmoid colon, and rectum are all resection areas. But now Kawei is only doing simple tumor incision, there is no need to expand the scope, so these blood vessels can be completely preserved. 4]
"When we are cleaning lymph and fat, we must pay attention to the left ureter." Kawei dissociated downward while doing it. "Then we can incise the retroperitoneum and enter the space in front of the sacrum." 5]
When reaching the presacral space, under direct vision, Kawei placed close to the dorsal side of the rectum and began to perform sharp dissection to the pelvic floor. The separation must exceed the tip of the coccyx to avoid damage to the presacral nerve plexus and venous plexus. 6]
Taking into account Fernand's physical tolerance, Kawei did not tell much here, but greatly accelerated the operation according to his own muscle memory. The operation itself was not within the scope of preoperative practice, and the two assistants could only perform the operation based on intuition.
"We cut through the rectosacral fascia, and then we can see the rectum, fully mobilize the rectum, and we can see the mass right in front of our eyes..."
The feeling of touching the abdomen through the lambdoid incision was very strange because there were many soft tissue obstructions and interference from other intestinal tubes. Kawei’s judgment of the location of the mass was inconsistent.
Now after sufficient dissection, Kawei can completely see the location of the mass, which is just 3cm above the dentate line, which is very thrilling. If it sinks another 12cm, it will be difficult for Kawi to ensure Fernand's anal function.
“The mass was very large, but the rectovesical pit in front of the rectum also needed to be mobilized before removal.”
Kawei extends forward and downward along the retroperitoneal incision at the root of the sigmoid colon, continues to incise the peritoneum in the depression, and then separates along the fascia, pushing the vagina and somewhat enlarged prostate forward: "We can now The mass is completely visible, give me two vascular clamps."
Damirgaon handed over the instruments, and Kavi exposed the lateral ligaments of both rectums and clamped them along the pelvic wall.
"Scalpel."
"Give."
"Needle holder and thread."
"Give."
After two rounds, all the ligaments on both sides were severed. However, due to problems with the use of the needle holder, Kawei could only handle the entire ligation process. The only thing Hermann and Damirgang can do is to retract the hook, pass the instruments, and expose the necessary vision at any time: "We continue to clean up the fat and connective tissue around the mass..."
In rectal surgery, because the rectum is too deep and deep, problems with the surgical field of view inevitably arise. In order to ensure the illumination of the surgical area, Bergt had to put down his work and picked up the prepared oil lamp.
But when the ligament blood vessels were cut off, Fernand, who had persisted for nearly three hours, seemed to have reached his limit.
"Doctor! His heart rate suddenly became faster just now."
"How many?"
The nurse hesitated for a moment and said, "...probably around 105."
Kawei frowned: "Take your blood pressure again."
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[Medical Guide in the 19th Century] []
"good......"
Kawei stopped what he was doing, called Amor up, and checked the area where he had just been operated on. There was no sign of bleeding. He looked at the hanging bottle again, and saw that there was still some medicine inside, and the infusion speed had not changed: "How is your blood pressure?"
"104 on the top...55 on the bottom..."
"The blood pressure is dropping. It seems that bottle No. 1 needs to be accelerated."
I have blocked this chapter and said that I have become lazy. I haven’t even marked the symbol for the past two days]
