If lymph node dissection is included in this operation, it is directly a combined abdominoperineal resection.
In other words, everything in the patient's lower abdomen needs to be removed. Ms. Jiang’s staff were very capable and pulled it out in time. If it had been slower and the damage would have been greater, there would have been no need for resuscitation.
Zhang Fan used toothless forceps to pick up the remaining sigmoid colon. The forceps used in the operation are divided into toothed and toothless. The tip of the tooth forceps has rat-like tooth-like protrusions, which makes it more stable when clamping. However, this thing cannot be used to clamp organs, especially the intestines. There are three small holes in one clamp.
The intestinal bleeding has been completely clamped. This is the first step. There is still a lot to do next. First, we need to explore the ureters and vas deferens, and since it is not a dissection, we also need to explore the pelvic autonomic nervous plexus, and also With the sacral nerve, it can be said that this surgery is similar to dissection.
If it is ruptured and cannot be repaired, these things will have to be removed. For example, if one side of the ureter is ruptured and cannot be repaired, the corresponding kidney must be removed as well!
I guess the drain outlet is not very big, if it were any bigger it would be troublesome. Fortunately, the bleeding has been stopped, and there is no obvious damage to the ureter, vas deferens, or other organs. The silly boy's life can be considered saved for now.
"Other organs in the abdominal cavity and pelvic cavity are intact!" After Zhang Fan checked it again, he said to the director of general surgery, and then asked: "How much bleeding is there now? How much solution is in the aspirator."
"With 3000ml of liquid, it's difficult to estimate bleeding now." The circulating nurse glanced at the liquid bottle on the ground and said to Zhang Fan.
"It is estimated to be around 2000ml at least. I was already in shock when I came here. Plus we had bleeding during the operation. It's all there."
"Well, the amount of fluid has been increased. Now we are ready to remove the necrotic tissue." After Zhang Fan finished speaking to the anesthesiologist and nurse, he began to remove the remaining intestines in the stomach.
The sucked intestines were spread out in the abdominal cavity like pieces of rags. Due to the ligation of blood, the color had turned white and had long lost its original ruddy color. The intestines in the pelvic cavity had been destroyed, and the remaining rectum and sigmoid colon had to be removed.
The sigmoid colon is easy to say. After closing the mesenteric artery, just cut the stump with tissue scissors. "Give me two sterile tissue bags." After Zhang Fan cut off the stump of the sigmoid colon, he put the cut pieces into tissue bags and showed them to his family members later.
The other end was tied up with a tissue bag first, and it was soupy and watery, containing a large amount of Escherichia coli, which is a normal flora in the intestinal tract, but once it escapes, it becomes pathogenic bacteria. So we have to wrap up the other mouth first.
"This cut will make the young man sad from now on!" Zhang Fan said to the director of general surgery with emotion as he looked at the sigmoid colon in the tissue bag.
"It's better to die than to die. It's better to die than to live. Besides, he comes from a rich family and doesn't have to worry about food and drink. He doesn't have to move bricks and work. He can eat and drink for the rest of his life."
"You should do something!" After eating and drinking for a lifetime, Zhang Fan was too embarrassed to say the last sentence.
"Don't think about other people's future with your poor mind. I want to eat and drink for the rest of my life, but I can't meet the conditions. Alas!" The director of general surgery must have been tired from being manipulated by several deputy directors under him.
After taking care of the sigmoid colon, the rectum and anus are next. The rectum and anus are not as easy to deal with as the sigmoid colon. Zhang Fan first performed two-finger meditation, using his middle finger and index finger to enter the space in front of the base, which is the surrounding tissue of the rectum and buttocks, and slowly separated them first to identify the levator ani muscle.
"Vascular forceps!" The nurse handed Zhang Fan two pairs of forceps. The blood vessels of this human body are very smart. It knows that its body is weak, so it usually finds a big brother, either a bone or a muscle, and then hides it in or next to the big brother. Therefore, to cut the muscle, you must first clamp it at both ends, then tie it with a knot, and then release it.
In the past, when there was no electrosurgery, after this kind of muscle was severed, the stump had to be sewn firmly with sutures, because after the muscle was severed, it retracted, and then bleeding could not be found.
Nowadays, with the electric knife, you can go over the wound surface as if you were branding pig skin, and the blood vessels will be immediately burned and closed. Then, after all the rectum and surrounding tissues are freed, treatment of the anus begins.
"Our hospital doesn't even have a plastic surgery department, otherwise a family like this would definitely need a plastic surgery department for consultation." After Zhang Fan and the director of general surgery treated the rectum, the director of general surgery said with a sigh as he looked at the lonely anus. One sentence.
"What?" Zhang Fan didn't understand.
"Just be a show-off. If you do this, you won't lose everything."
"I'm not a child, and I don't wear crotchless pants. Who's watching?" Zhang Fan said in surprise.
"Hey, don't tell me, there are really patients who have this need. No matter who sees it or not, it is still an organ."
"Haha!" Zhang Fan had no intention of arguing with the old man.
The rectum is clearly separated, leaving only the anus. In fact, the anus is very simple. Except for the levator ani muscle, the rest is surrounded by fat.
This is why people in the early years liked to eat chicken butts and pork butts, because the meat here is all yellow fat, with a little orbicularis muscle, and has the aroma of fat and chewy texture. After taking one bite, you can feel full and satisfy your craving.
The patient's position is a lithotomy position, that is, the legs are spread apart and the anus is flat on the ground. "Sharp knife!" Zhang Fan said to the nurse.
"You should be more beautiful. It's just an organ." The director of general surgery specially reminded him.
Zhang Fan rolled his eyes and said nothing. How can this thing be beautiful! I can never get another artificial eyebrow tattoo.
The size of the anus is about the size of a one-yuan coin. Because of the orbicularis muscle, this thing is contracted, so it doesn't look very big. Zhang Fan used the tip of the knife to gently draw an arc downwards along the anus, and then also drew an arc on the opposite side.
It is equivalent to drawing two connected arcs like a rugby ball around the anus. Then, start to cut the skin along the line drawn by the tip of the knife.
The yellow fat is crystal clear. The fat on the buttocks is relatively dense due to long-term sitting. When the knife is scratched on the fat, it is really crystal clear. When the fat is cut open, the fat particles are as crystal clear as yellow rice grains.
The Alice forceps held the anus and gently advanced it. The toothed tweezers pulled open the skin. Zhang Fan used his fingers to gently free the fat and levator ani muscles near the anus.
"Sutures! Saline, gauze, iodine, alcohol." After the dissociation, the anus with a little rectum is directly attached to the fat. Because the anus is no longer useful.
Clean and rinse the anus with plenty of salt water. It is like a rubber tube hanging on the wall. The anus is pitifully hanging on the buttocks.
After cleaning with a large amount of salt water, start wiping with gauze. After wiping with gauze, wipe with iodophor, and then use alcohol after wiping with iodophor.
"Here, give me more saline and gauze. You must wash this place several times more." Zhang Fan said to the nurse. This cleaning is definitely cleaner than the gourd head cleaned by the restaurant chef.
After cleaning, Zhang Fan used the needle to go in and out along the anus, went in and out, and sewed a circle around the anus. Finally, he pulled the thread ends and tails to completely sew the anus shut. This is the so-called purse string suture, and this method is generally used to suture stumps, such as the appendix.
The stump was closed, and then with a gentle tug in the abdominal cavity, the rectal stump and anus were pulled out.
"Tissue bag!" The equipment nurse handed the tissue bag to the circulating nurse. The circulating nurse opened it and Zhang Fan put the rectum and anus into the transparent tissue bag.
This thing doesn't look big when it's in the body, but when it's put into the tissue bag, it looks like a big lump, with the white anus and bloody rectum filling the tissue bag.
The rectum and anus are very important organs. They cannot be cut off and thrown away. If cancer is suspected, pathology must be done.
If there is no doubt, it must be shown to the family members. Some discerning families require them to handle such important organs themselves.
The place where the anus used to be is now empty, like a black hole. All that's left is suturing, from the inside to the outside, and finally the skin. After the oval incision is sutured, it looks like a person's closed eyes. The chrysanthemum is gone, completely lost, replaced by a suture scar.
He would no longer be able to enjoy this pleasant experience of lighting a cigarette, sitting on the toilet, and playing with his mobile phone.
After the suturing was completed, Zhang Fan took a look and said, well, not bad, just missing the curved eyebrows!
"Change gloves!"
