Zhang Fan and the surgeons began to change gloves. In general operations, it is rare to change the operation, but for this kind of contaminated operation, the gloves must be changed.
This kind of surgery is complex, but it is not as complicated as tumor resection. It is simple. The intestines explode into flowers like flowers, which can save lives. The surgeon is already very good. If he moves a little slower, his life may be lost.
Now that the bleeding has been stopped and the remaining intestines and anus have been removed, the rest is self-evident. We have to find a way out for the digestive system.
As the saying goes, water and fire are merciless, just as urination and defecation are merciless. Holding it in for a while will make you feel uncomfortable to death. So this reconstruction channel is also very important.
Now that life-saving has been achieved, the rest is about the patient’s quality of life. It had been more than three hours since the surgery, and Zhang Fan had already exercised. He could not stand for long periods of time under six hours.
Anxiety, the anxiety before the operation has slowly subsided, and what is left is suffering. "No news is good news." Ms. Jiang, with a livid face, leaned on the plastic bench outside the operating room and said to herself. .
Assistants and secretaries stood far away and dared to come around. They know that at this time, they must not get into trouble by looking for trouble. However, when several people communicated with each other through their eyes, they felt not only rejoicing in others' misfortune, but also feeling unspeakable helplessness.
The silly boy's parents have already left their hometown in Jiangsu and Zhejiang. The calls came in one after another from people who cared, were polite or had interests, and Ms. Jiang really wanted to smash the phone. It's already annoying enough, and I have to deal with some people.
Several transfer doctors in the emergency department looked at the disclaimer, which was as thick as a book, and quietly stuck out their tongues, "Director Xue is really amazing. He has done almost everything he can. How brave he is!"
"You know what the heck, is this cowardice? He didn't do the surgery, and the hospital is not his home. What does he have to be afraid of? This is called responsibility. Do you understand? He is ignorant and has no skills!" Transfer to another department! The female doctor said a few words to another male transfer doctor who always harassed her.
Regardless of whether he is timid or responsible, as long as Ouyang is satisfied.
"I didn't see it. This kid is so smart. I was worried that he didn't understand it. Not bad!" Ouyang looked at the signed liability waiver. Although he didn't say anything, he was satisfied with Xue Fei. It has probably entered her notebook.
I changed my gloves and rinsed the talc off my gloves. Zhang Fan and the others continued the surgery, and they originally received the surgery patient just before getting off work at noon. By this time, it was already past meal time, and the anesthesiologist and circulating nurse had already had their meal.
The surgeons and instrument nurses can only endure it. At this time, the operation is not so urgent. Zhao Pingquan, the director of general surgery, also wanted to speak.
"Old Chen, what is the food in the cafeteria today? Why did I ask? It smells like tofu." The long operation, coupled with Zhang Fan's weird surgical habits, made it too hard for Old Zhao to endure. Even if he is not allowed to eat, he is not even allowed to speak!
"Stewed braised pork and boiled tofu, hey! I used to be able to resist eating the meat, but today I have completely lost my appetite. Your surgeon is a bit better. You can eat out after the operation. We will fight to the death. Oh, it tastes terrible."
"That's all you're after!" Lao Zhao sneered. He was also hungry. He was nauseated during the operation, and then the gastric mucosa was stimulated to secrete a lot of gastric acid. At this time, his old stomach disease recurred.
Most surgeons have stomach problems. They don't eat on time all year round, and they suffer from gastric ulcers when they are hungry and full after meals. The pain starts when they don't eat after meal time.
"Gauze, Director Zhao, bear with me, the operation is almost over." Zhang Fan knew that Old Zhao had a gastric ulcer, so he also speeded up.
"It's okay. He won't die even if he eats later. This is the child. I don't know if he can accept it after the operation." Before the operation, Lao Zhao had a dark face to save his life, but after he actually saved his life, he felt a bit cruel.
"Generally, for this kind of reconstructive surgery, the patient must be given psychological counseling before the operation, so that the patient can undergo it in advance, but there is nothing that can be done about emergency surgery. Although the quality of life will drop a lot in the future, people will still be alive, right?" Zhang Fan In turn, he began to persuade Lao Zhao.
The difference in the characters of Lao Zhao and Zhang Fan can be seen from this point. Zhang Fan hesitated before taking action, while Lao Zhao hesitated after taking action. At best, he was kind, at worst, he was a woman. There was a war in the department. It has something to do with his character.
The abdomen should be flushed, and the abdomen should be ligated. The lower abdomen has been cleaned up, and the operation has truly entered the final step, including the fistula and abdominal closure.
There is a very troublesome thing about intestinal fistula. Although the intestine seems to be more than ten meters long when spread out, there are ligaments hanging around it and a plexus of blood vessels like a spider web around it, which makes the intestine firmly fixed. , which means that the intestines are actually not very mobile.
If he could move a little, Zhang Fan really wanted to make an artificial anus for this stupid kid. Now we can only rebuild near the fracture. Open in the remaining upper end of the sigmoid colon.
This place is projected on the abdomen, which is actually on the upper left side of the navel. In professional terms, it is the opening at the midpoint of the line connecting the navel and the left anterior superior iliac spine.
Fistula is simple, very simple, and can be done by general surgeons with some experience. However, this kind of permanent fistula is not something that ordinary doctors can do.
First of all, we must consider the stability and application of this external anal bag. This is not a trivial matter. It does not matter if the patient wears the bag for a day or two. However, if the design of this permanent thing is unreasonable, it will bring serious consequences to the patient. It's endless trouble.
Because the cecum and anus have strong contractility, the mucous membranes inside are smooth, and have a certain self-cleaning ability. Except for people who are not particular about hygiene, the human body generally does not have odor.
But the same cannot be said for this permanent anal bag. First of all, the airtightness of this thing is not comparable to that of the anus, and it lacks the closure of the orbicularis muscle. So, a permanent stench will accompany it.
"Foreign patients like this will have psychiatrists intervene during their stay in the hospital, and the rehabilitation doctor will provide him with some training for future life. We are still short of doctors!" The anesthesiologist looked at Zhang Fan and started to prepare for drilling, as if he had thought of something. Just like that, he started to hiccup while talking.
"That's because their clinicians are not good enough. We clinicians have done all this work." Old Zhao didn't want to hear this. The old man and Ouyang were from the same generation, and their generation was also the strangest generation. When he is fine, he often says that this is not okay and that something is not okay, but when he hears other people say it, he immediately becomes unhappy.
To create a fistula, Zhang Fan prepared a fistula just outside and below the navel. "Knife!" The nurse handed Zhang Fan the sharp knife. Zhang Fan put one hand in the abdominal cavity and held the sharp knife in the other hand and opened a two-finger-wide incision on the patient's belly, directly penetrating the abdomen.
Then use babcock forceps to clamp the colon and slowly pull it outward. The biggest fear of the intestines is ischemia. Although the intestines are very flexible and flexible, let alone folding or twisting them at all, it will cause intestinal ischemia.
After pulling out the colon, Zhang Fan started suturing. This stitching is very particular. The colon must be sutured to the abdominal wall opening without puncturing the intestines.
This suturing is not about repairing clothes. Even though the needle is very small, as long as it penetrates the intestines, as time goes by, the intestines, a proud thing, will get bigger and bigger with the small opening, and eventually it will become necrotic.
You can only use a small needle and thin thread to slowly attach it to the opening on the membrane outside the intestine. Suturing is actually an auxiliary function, which is to make the two tissues contact and then fuse.
After Zhang Fan stitched a circle very carefully, he took a long breath, really took a long breath. If you don't pay attention to this thing, something will go wrong, and it's not a small one. question. After all, the intestines are just that little bit, not leeks. If you cut them off, they won't grow back.
After suturing the intestines and the interface, Zhang Fan began to trim the skin opening. The two-finger opening is for better suturing, but if you leave a hole, the opening is a bit too big.
What is being reconstructed is the anus, so it is best to keep all sizes according to the size of the original device. For example, a normal adult only has a finger inserted into his anus. Note that this is a normal person.
Therefore, when trimming this skin, you can also insert the size of a finger. Because there is no orbicularis muscle, the suture should be slightly smaller. When it is necessary to insert a finger, it should be a little tighter.
"Uh! Director, are your fingers a little thick?" Old Zhao had done manual labor in his early years, and his fingers were half as thick as Zhang Fan's.
"Is it thick? Not thick! There is no levator ani muscle or sphincter. It would be better to be thicker."
"Haha!" Zhang Fan thought for a moment and smiled helplessly, a forced smile. Although it was remade, it was just the same product, lacking many things.
In the end, Zhang Fan put his own fingers in instead of using the director's fingers. Then gather the sutures from both ends of the incision. A little bit of recycling. When it feels a little tight, the reconstruction is complete.
This suturing is no easier than Zhang Fan's suturing of blood vessels. Feces, especially those of omnivorous animals, contain a large number of bacteria and viruses. As long as there is some space for them to remain, it will be a very terrible thing.
Infection and death are possible. Even if there is no infection, as long as there are gaps in this thing, it will corrode and slowly form a fistula. Therefore, Zhang Fan was very careful when suturing, so as not to suture too tightly to cause ischemic necrosis. , and there should be no gaps, so the operation was not fast at all.
After pressing the anal bag, Zhang Fan took a look and said, "Not bad! There should be no big problem. Prepare to close the abdomen!"
Like cattle and sheep returning home, after Zhang Fan closed his abdomen, the nurses and anesthesiologists began to work. With the cutting of the last needle, the operation was over!
The operation that took more than four hours was finally over.
