"Then let's use ethanol, hey! This surgery is so complicated." Old Zhao said helplessly. There is no way, this operation is too nonsense, the insect cyst bursts, and if you want to kill it completely, I guess the insect is not killed, but the person is killed first. If you don’t kill it completely, it may relapse after a while.
"Yeah." Zhang Fan replied softly. After stopping the bleeding and ligating, Zhang Fan and Zhao Jingjin quickly made preparations before entering the abdomen.
"Go ahead." Zhang Fan said to the traveling nurse.
The circulating nurse raised the salt water prepared early and started rinsing Zhang Fan's gloves and Zhao Jingjin's gloves in sequence.
This is a general surgical rule, because the surgical gloves have talcum powder on them to make them easier for doctors to wear. If this thing gets into the stomach, it can cause the patient's intestines to stick together after surgery, so it must be washed before putting it into the abdomen.
When entering the abdomen, you should not rush into surgery. You must first explore. To put it simply, it means turning over the various organs in a regular and sequential manner. Open the liver to see if there are worm cysts under the liver and gallbladder, and open the intestines to see if there are any in the retroperitoneum.
Zhao Jingjin cooperated with Zhang Fan to turn over the patient's organs. "Let's free the ligaments first." Zhang Fan turned over for a while and said after finding no obvious worm cysts. What is this kind of thing really? Searching the intestines for worm cysts sounds ridiculous, but this is the method of this kind of surgery, and there is no other way.
If it is multilocular echinococcosis, surgery is the only treatment, and the highest resection rate is 58%. In other words, almost every one of them will relapse. Once it relapses, the most thorough treatment is to completely remove the liver and then replace it. So, there is a price to pay for eating raw meat.
And this thing has varying numbers of testicles, uterus, and reproductive pores. In other words, this thing is probably capable of one-to-many, or many-to-one, and the bloodline will not be messed up. It is a super scary thing.
After the investigation, Zhang Fan said: "Change the gauze. Remove all the white gauze. Don't go on stage again."
"Okay!" Baoyin nodded, and then counted the number of gauze with the circulating nurse. There must be ten before you get on the stage, and you must have ten when you get off the stage. This is the rule.
The worm cysts on the skull are superficial and relatively small. The liver is generally deep and large. The cyst is the largest in the skull and looks like a small egg. If the liver is smaller than 4cm, it can be treated conservatively. In other words, it is not surprising at all that this thing grows into a small ball inside the liver.
If the ascus is like pearl jelly in the head, then in the liver it is about the same size as a small glutinous rice dumpling, a shiny little glutinous rice dumpling, a small glutinous rice dumpling that drips with water at the slightest touch.
After separation bit by bit, if any tissue adhesion is found, Zhang Fan will definitely open it to see if there is a uterine cyst hidden inside. Wait for Baoyin to bring the blue dressing to the table. Zhang Fan started to enter, and the periphery of the liver was clearly separated.
The liver is too complex. It is not only a synthesis and secretion organ, but also a detoxification and decomposition organ. Therefore, it is a super chemical factory with various pipelines. The worm cysts grow here and then secrete liquid that sticks to the liver. on various pipelines.
It doesn't matter if it's a small pipe. If it sticks to the inferior vena cava or hepatic vein, it will be super troublesome.
"Probe." After the separation was clear, Zhang Fan said to the traveling nurse. For this kind of surgery, it is necessary to clearly see the relationship between the internal structure of the liver and the worm cysts. There are still errors in performing color ultrasound through the belly, so after freeing the ligaments and blood vessels around the liver, Zhang Fan began to use color ultrasound to explore the situation inside the liver.
Zhang Fan and Zhao Jingjin looked at the color ultrasound screen carefully at the same time. Zhang Fan slowly moved the color ultrasound probe under his hand, and the probe was wrapped in sterile gloves.
"It's okay. No major blood vessels have been touched. Director Zhao, can you take another look?"
"Okay, let me take a look again." Be careful before the operation, and feel more at ease during the operation. Cross-checking by two people will be more secure.
"It didn't touch the major blood vessels." Zhao Jingjin confirmed after doing it once.
"Okay, let's get started, sharp knife." Zhang Fan said.
Holding a sharp knife, Zhang Fan slowly separated the worm cyst from the liver parenchyma. The liver had many ducts, so the operation was very slow. It was almost a single cut to remove several ducts.
Constantly ligating and cutting off, it can be considered the worst luck. If it relies on the hepatic vein, I can only pray to God or have a liver transplant.
After cutting off all the blood vessels and bile ducts entering the cyst, Zhang Fan directly used a blue dressing to gently remove the cyst with liver tissue from the liver.
Looking down from the shadowless lamp, the patient's liver was directly like a pit, and a pit the size of a small bowl was cut out by a knife. After taking off the insect cyst, Zhang Fan looked at the surroundings very carefully, fearing that there were other insect cysts nearby.
"No!" Zhang Fan looked at it once, and Lao Zhao looked at it again.
"Come to Dr. Lu and take a look. Are there any white insect cysts?" Zhang Fan said to Lu Shuyan.
"No!" Lu Shuyan said after looking at it.
"Okay, let's open the worm cyst." The contents of the worm cyst are very important for treatment. If the cyst fluid is clear and contains small fragments, it means that the cyst is active, and drugs must be used to kill the surrounding tissues of the cyst.
If the cyst fluid is milky, it means the cyst has weakened but is still infectious. If the cyst looks like toothpaste, it means that the echinococcosis inside is dead and there is no need to kill the surrounding area. This is the same as human amniotic fluid.
After Zhang Fan took the worm cyst away from the operating table, he cut open the worm cyst with a scalpel. A stream of milky liquid flowed out, with a watery consistency. There was a lot of pressure inside, indicating that there were a lot of reproductive bugs.
The moment I cut it open with a knife, it really felt like I had taken a small bite out of the sugar-water glutinous rice balls filled with finely ground white sesame seeds, and flowed out all over the plate.
"Bag." Zhang Fan directly put the entire plate into the tissue bag. Then he said to the tour: "This must be strictly disinfected."
"OK."
Then, Zhang Fan continued to change his gloves. The cyst had been removed, and no other cysts had been found through color ultrasound. Zhang Fan said to Old Zhao, "Director Zhao, do you need ethanol?" In this regard, he still didn't have as much experience as Old Zhao.
"Forget it, the operation was very clean, and no other worm cysts were found. If you look at this patient's liver, you can see that it has been tested by alcohol. It is too fragile. Use formalin."
"Okay!" After being advised to eat enough, Zhang Fan was relatively good at this.
Gently use gauze soaked in formalin and slowly wipe the inner wall gently. While wiping, check to see if there is any formalin left. If this thing remains, it will be a big trouble.
"Rinse!" A large amount of saline, more than a dozen bottles of physiological saline, was rinsed for several minutes. The originally vermilion liver was almost washed white.
After more than five hours, the operation was finally over.
