Zhang Fan touched and touched, and the slightly squirming intestines crawled on his hands like thick caterpillars, and it actually felt a little itchy.
I touched and touched, but the greasy fat was like butter melted by boiling water, and I couldn't find it. This has been positioned. If it is not positioned, it can only stay in the stomach. If it lives for a long time, it may grow into something like a fleshy pimple.
"Shrapnel has entered the intestines!" Zhang Fan spoke after about ten minutes.
"Then the intestines should be repaired first, and then the enema should be administered directly. You can see that it is relatively rounded on the monitor. If you open the intestines again, the damage will be too great. You can see that the shrapnel has damaged the abdomen like this. "Old Wang was deeply afraid that Zhang Fan would open his intestines again to look for shrapnel.
Zhang Fan stared at the monitor of the C-arm again and again, "What if it can't come out?" Zhang Fan asked, who can guarantee that it will come out?
If it cannot come out, regardless of whether it is round or not, as long as it is a foreign body, it will irritate the intestines, and then there will be diarrhea that cannot be cured. You will have diarrhea after eating, and you will have diarrhea after eating, just like a faucet that is not tightly closed, and it is impossible to take medicine. does not work.
"What should we do? Cut it open?" Lao Wang was also confused.
Zhang Fan gently held the iron piece through the intestinal wall with one hand, while looking at the monitor, thinking in his mind. What are you imagining? Think of the size of a chrysanthemum, the structure of your intestines.
"Use a spreader to open it up and give it an enema with soapy water!" Zhang Fanzhen said with certainty after looking at it again and again.
"Are you sure? If the edema after closing the abdomen causes intestinal stenosis, if it cannot be removed, it will be a medical accident." At this time, Lao Wang began to worry again.
It is really a blessing to have such an old doctor on the operating table who can think and give advice. If it were for other things, this kind of person would probably be despised: he only finds faults! But on the operating table, the old doctors who can find problems for you all look up to you and love you!
"Let's do the operation quickly. After anastomosis of the intestines, start the enema immediately!" Zhang Fan looked at Lao Wang and said.
"Is it okay?" No one has ever done this kind of thing, and Lao Wang is not sure.
"You have to do this no matter what. Look at his intestines, they can't be hurt anymore. Anastomosis!" There was no other choice but to do this. Zhang Fan gritted his teeth and said directly.
The shrapnel is not big, but it is powerful. This thing cuts through the intestines, especially the small intestine, which is relatively small. As long as it cuts through, a cross-section of the intestine will be directly damaged to an area of 34 or more.
And the repair of this damage is not just like a rubber pipe, just sew it up and it's done. Due to ischemia caused by long-term rupture, the thin intestinal wall has become necrotic, and there is no possibility of repair.
You can only cut off the necrotic intestine at both ends, and then suture it from the good part. This method is impossible. The biggest drawback is edema and obstruction.
"Intestinal forceps!" Now that you have decided, implement it without hesitation. The longer you hesitate, the greater the chance of intestinal edema.
Just do it without hesitation. Zhang Fan and the director of general surgery placed a pair of non-invasive scudder forceps on the normal intestine proximal and distal to the intestinal segment to be resected. This can control the blood supply while preventing the intestinal tract from being removed. Severe pollution caused by bow i.
Then dissociate 1 or more parts of the mesenteric border of the normal intestine adjacent to the serosa, and then place a narrow straight forceps obliquely on the intestinal wall for resection. The remaining free mesenteric intestine was treated with a 48-staple TL60 stapler.
This kind of surgery is now available with intestinal staplers. If sutures are used, the operation time will be too long.
During the operation, a linear incision and closure device is used to close the openings at both ends of the small intestine. The small intestine was appropriately cut obliquely, leaving the free mesentery 1 distance from the intestinal resection edge. Sew traction threads on the mesentery and the anti-mesometrial edge respectively, bring the two broken ends together, bring the anti-mesometal edges of the two sections of intestine together, and insert one arm of the linear cutting closure device into the intestinal lumen.
Before firing the stapling cutter, the gut tubes on the forks should be flat together. When fired, the intestinal tube is stapled with staples, and the built-in cutter of the linear cutting closure device cuts the anastomotic stoma. If bleeding is found on the staple line, interrupted sutures can be used to control it.
Sew a suture suture a and a' on each of the mesangial margins of the two intestinal segments, and sew the ends of the stapled lines on both sides of the mesangial margins at the midpoint of the other suture b so that they can pull the mesangial margins together. The ends of the side staple lines.
Then use a non-cutting linear closure device to close the common intestinal stump opening. Remove the excess intestine outside the closure device. If there is bleeding after removing the closure device, it can be controlled with interrupted sutures.
With the increase of application time and experience, it has been found that it is more preferable to align point a with point a1 and close it vertically from b to b'. In this way, only the intersection of the two rows of staples exists at both ends of the closure line, which should be carefully inspected and reinforced sutures can be performed if necessary.
Similarly, if there is a bleeding point, discontinuous suturing should be performed to stop the bleeding. Check the staple line and remove any excess intestine beyond the staple line. Check whether the staple line is reliable. If necessary, use a few interrupted sutures at an appropriate distance from the anastomosis to bring the opposing mesangial edges of the intestinal tubes on both sides together.
Interrupted sutures were performed to completely close the mesenteric holes on both sides. The mesenteric hole can also be closed before intestinal anastomosis. The mesenteric foramen must be completely closed to prevent intraductal herniation. Finally, touch the thumb and index finger to check whether the anastomosis is smooth.
This surgery is too difficult to understand in technical terms. To put it more simply, there are two rubber tubes, and then use scissors to cut off about 5 inches of the wound diagonally upward in the middle of the cross-section of the two rubber tubes. Then the two wounds are sutured. What does the stapler look like? It's actually a large stapler.
Because the sutured intestine will edema, obstruction will occur if it is sutured directly. The final sutured intestine is originally a straight strip.
After sewing, it will be a T-shape or Y-shape. The place where the two interfaces are located directly becomes a large pocket. It was originally a few centimeters in diameter, and finally became a dozen centimeters in diameter. This is to prevent obstruction.
After the sutures were completed, the disc-shaped intestine in the abdominal cavity ended up with several protruding empty sacs. "Close your abdomen! After this operation, you must tell the doctors and nurses in the department to pay attention to this patient.
Intravenous lactated Ringer's solution was administered to maintain fluid balance. And continue the blood transfusion until the pulse returns to normal, especially when the hematocrit is 30, blood must be used.
Use a combination of antibiotics. Continue suction and decompression through the gastric tube until the intestinal tract returns to normal emptying function. Be sure to make it clear to the doctor who tubes the tube that the gastric tube cannot be removed if there is no ventilation. "Zhang Fan explained to Lao Wang while suturing the skin on his abdomen.
How does a surgeon determine whether a patient is ventilated or not? It is simply to see if he farts.
"Okay! My Director Zhang, when I asked you to come to the general surgery department, you didn't come alive or dead. But now that you have come to the general surgery department, I will directly take a back seat. You have the final say in the hospital's largest surgical department.
How about it's not too late to come now, and instead of being an assistant to the director, you can directly become the first deputy director when you come. "
Lao Wang seduces Zhang Fan, and Lu Ning looks at the conversation between Lao Wang and Zhang Fan with great envy. "This little junior brother is so good at it. Not only does the orthopedic surgeon do general surgery, but the director of general surgery keeps recruiting people. This is what you call a doctor. It's so comfortable!"
"Director, let's not be happy for now. The shrapnel hasn't come out yet!" Zhang Fan ignored Lao Wang. The general surgery department was like the Warring States Period. Several deputy directors were jumping up and down. They really wanted to go to the general surgery department. How could they compare to the current orthopedics department? Convenience and freedom.
"Yes, yes, please resolve this matter quickly, otherwise it will always be a time bomb."
"Don't worry, I have moved the shrapnel past the cecal opening. Now we are going to enema. Soapy water, lots of soapy water." Zhang Fan said to the circulating nurse.
Hang 2000l of soapy water on the infusion stand, pull out the needle, and insert it directly into the anus and rectum. "Turn on the switch." Zhang Fan said to the tour after inserting the plastic tube into the intestine.
If there are no necessary or special requirements for liquids, the general infusion is very slow, firstly to prevent heart failure, and secondly for fear of causing adverse reactions to the infusion.
This kind of enema has a very fast infusion speed, and 2000 liters of liquid quickly enters the injured person's intestines like a small stream of water from a faucet.
"It's 1000l." the traveling nurse reminded.
"It's okay, continue." Zhang Fan, Lao Wang, Lu Ning, and even Jumabek, the chiefs of internal medicine, all stared at the wounded man's anus.
As the pressure decreases, the liquid enters slower and slower, and because it is soapy water, as the soapy water enters, the intestinal gas is expelled, and from time to time a colorful bubble is blown out of the anus, like The little girl has pink lips as if she were blowing bubbles while eating bubble gum.
"Okay!" As she spoke, the circulating nurse turned off the switch, and Zhang Fan slowly pulled out the plastic tube, "Stander."
Although there is a spreader, due to the pelvis, the range of the anus is actually not very wide. However, if you put a smaller bun into it, there will be no problem at all.
As the spreader opens, like a dam opening a floodgate, the soapy water mixes with blood and feces, making it colorful, really colorful.
Under the shadowless lamp, as the liquid poured down, bubbles of various colors rose in the bedpan under the anus. It's like a pool stained with gasoline in summer, full of colorful bubbles.
Everyone in the operation, including the instrument nurse, was standing on tiptoes looking into the bedpan.
"Why don't you come out? You should come out!" The nurse who was the younger one in the operation muttered to herself with her eyes wide open.
After waiting, the most violent wave of liquid had come out, but there was no black iron piece in the bedpan. Lao Wang was unwilling to give in and stirred it over and over again with a small stick in the bedpan.
In the basin that originally had bubbles, there were even more bubbles. "Stop stirring it up. It's all foam and you can't even see it when it comes out." Ren Li was a little anxious and angry.
"No more! The liquid has run out." Lu Ning said disappointedly.
"Do it again!" Lao Wang said firmly.
"No, the wounded person's electrolyte will be disturbed again. Forget it, let's wait until his wound recovers. This is my mistake. I will take responsibility for it. I will write a report after I perform the operation."
"You are in charge, I have a higher professional title than you, and I agreed to the surgical plan, so I am responsible." Lao Wang said firmly. A surgical accident is not a trivial matter, but it is also a heroic surgical accident.
Zhang Fan looked at Lao Wang and wanted to speak, but couldn't. "Add me!" Lu Ning also stood up.
"And me!" Although Ren Li is not a surgeon, she also knows that it is not easy for Zhang Fan and the others. With one more person, the final punishment will probably be shared a little more.
"Count me in, this wasn't intentional, damn!" Jumabek became angrier and sadder the more he thought about it. This is not a credit, but everyone is not far behind, because of this promising young doctor. After all, there are still many good people in the world!
"Thank you! Thank you! I am responsible for my decision, thank you!" Zhang Fan's voice became much lower. He didn't want to be like this. The things he was sure about in his mind failed in the end.
Zhang Fan slowly pulled out the spreader. At this moment, as the spreader was taken out, everyone in the operating room heard a sound that Zhang Fan would never forget in his life: "Ding Dong!"
(The picture of the intestinal anastomosis is posted in the author's comments. This is difficult to understand. If you are interested, you can take a look.
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