肝脏 For people in their 70s, even if they have a good health checkup, their livers are crisp and hard. Visceral aging, like skin aging, is an irreversible change over time.
The skin of young people is ruddy and elastic, and the liver is also a pink Q-bomb. When you are old, it is impossible to restore the skin to a younger level with more cosmetics and ex-boyfriend masks. The liver is the same. .
Ling Ran must be very careful to avoid secondary damage to the liver.
Xu Wen and Zhang Anmin widened their eyes and observed the exposed liver. Try to go beyond the point of possible bleeding.
"No."
"No."
The two have answered.
Ling Ran's "En" sound didn't end the inspection immediately, but took it seriously again.
Medical matters are often complicated in detail.
For example, if you are looking for a bleeding point now, you can't end it if you can't find it, or you can finish it when you find one or two places, but you have to check that there are no bleeding points before you can end.
The hepatic fossa is in the abdominal cavity and cannot be rotated at will. When checked, the psychological burden is more complicated than the actual operation.
"No bleeding. Let's continue." Ling Ran looked up at the watch. The time had passed 48 minutes, but the steps to be done could not be omitted.
If you don't check for bleeding or just check a little bit, you might save about two minutes, but whether the risk you take is worth another consideration.
The moment the surgeon stood on the operating table, he was constantly making judgment questions. However, the more complicated the surgery, the harder it is to make judgment questions. So there are all kinds of guidelines, all kinds of evidence-based medicine, all kinds of tree analysis ...
This is actually very much like Go. The loss of each step will affect the subsequent development, but how much influence it will have, and which step can be counted depends on the judge's judgment. On the other hand, in order to solve these difficult calculations, various formulas have appeared, such as the avalanche, the demon sword, and so on.
Use a good formula, allocate time, and make basic judgments. It is almost a high-level doctor, but it really has to be counted. It is just the level of amateur players.
If you really want to become a doctor equivalent to a professional chess player, you need more skills.
Ling Ran stopped bleeding with perfect bare hands, constantly judged the bleeding point, and even predicted the bleeding.
Whenever picking up the electric knife, the perfect level of thermal hemostasis technology will play a role, so that the fragile liver can not only stop bleeding but not get burned. The judgment of distance is enough to make amateurs call mothers.
Master-level intermittent sutures are always ready for remedy, and when the most important step in liver resection is to make a pre-cut line, the time and intensity of sutures inevitably affect the prognosis of this operation.
At the same time, master-level liver resection and perfect lymphadenectomy are the basic guarantees for the operation.
Local abdominal anatomy experience, MRI reading, X-ray reading skills, and even cardiopulmonary resuscitation skills are all techniques to improve the safety of surgery.
At this moment, even the senior doctors in the visiting room can only see that Ling Ran is handling the operation in an orderly manner, but cannot fully understand the difficulty of the operation.
Ling Ran, as usual, followed the established operation step by step. After disengaging the various ligaments, Ling Ran also suspended the duct with various bands of different colors, thereby showing the right anterior right hepatic artery. Right rear branch ...
At this time, if a villain falls on the liver below the right front branch, its feet will be a soft and crisp flesh floor. If you step on it hard, you may bleed, and the top of its head will be a ribbon The flesh and blood pipeline, trembling trembling, may also drop blood drops, and above it, there may be huge eyes passing by ...
The operation went very smoothly.
The operating room and the visit room are filled with calm smiles.
Everyone feels stable. Only Xu Wen, a little aware of the difficulties of some operations, meditation in his heart: It is really "the warrior has no great achievements", today's surgery ...
"The blood pressure rises." The anesthesiologist suddenly shouted, his voice was a bit sharp, like the alarm of a machine.
Didi Didi.
Followed closely by the machine alarm.
At that moment, if you look at the anesthesiologist's face, most people can see a mix of tension and "how am I so unlucky".
However, no one looked at the anesthesiologist.
Everyone's eyes rushed to Ling Ran.
The chief surgeon is the final decision-maker in the operation.
Ling Ran's thinking also paused for a moment.
After a brief moment, Ling Ran dropped the instrument in his hand and ordered clearly: "Don't move, everyone stops."
As soon as the words of the crickets fell, a fountain of blood spewed out of the abdominal cavity.
The height of Xunxuequan is not high. If it looks like a self-flowing spring, it rises from the position of the liver door.
The cold sweat of Xu Wen and Zhang Anmin came out.
Your sister, the blood vessel is broken?
Liver surgery, the most feared is the rupture of blood vessels.
For a moment, Zhang Anmin's hand was raised, trying to block blood vessels.
"Don't move first." Ling Ran's voice came again, preventing Zhang Anmin's movement.
Ling Ran, did not immediately start.
So, a main knife, two assistants, an equipment nurse, and an anesthesiologist who had just stood up all looked at the patient's wound in the middle stiffly, and looked at the blood. Cooing out ...
Ling Ran looked down without blinking.
This is a scene that never appeared when using a simulated person.
Ling Ran did not use a simulated person to perform a complete operation, and it was impossible to know that there would be such a moment. In other words, even if he performed a complete operation with a simulated person, because of the different anesthesiologists around him, he might get different results.
I had countless thoughts, which rang in Ling Ran's mind.
Why? Why does blood pressure rise? This was the first thought that came out of Ling Ran's mind.
However, Ling Ran did not follow this line of thinking. There may be many reasons for high blood pressure during the operation. Pain, hypoxemia, hypercapnia, or hypothermia may cause excessive blood volume. Time is not the time to worry about why blood pressure rises. The key to the problem is that the blood must be stopped in time.
As long as there is no conflict between the cause of increased blood pressure and hemostasis, the problem of blood pressure can be thrown to the anesthesiologist.
Immediately afterwards, more problems appeared in Ling Ran's mind.
"Why do blood vessels rupture?"
This problem was stunned by Ling Ran. He stared at the bleeding port below, thinking and thinking before slowly speaking: "Zhang Anmin, **** first, from the edge. Don't touch any tissue."
Purr ...
Purr ...
Upstairs and downstairs, the breath sound came almost at the same time.
For the past five or six seconds, it was a torture for everyone present. Many people thought that Ling Ran was frightened or stiffened.
Similar scenes, doctors don't actually see or hear much.
Vascular blood vessels rupture and the pressure of blood surges is not affordable by every surgeon.
In fact, Ling Ran rarely had such experience, and the system did not give him similar skills.
However, in the emergency department for more than a year, Ling Ran has never been under a lot of determination pressure.
Ling Ran pointed his finger at the gushing blood in the familiar "bitter library ..." and said, "The blood vessels here may be crisp, and because of the erosion by cancer cells, they were previously oppressed by other tissues. Now that the oppression is lost, the blood spurts out. "
"The blood vessels are all… crippled?" Xu Wen couldn't help but whisper to himself, this concept is actually a bit shocking to the liver and gallbladder doctor.
The doctor who was present at this time realized that Ling Ran had emphasized "don't move" twice.
If the blood vessels are really crisp, as soon as the hand is pressed, the blood vessel fragments may break into the blood vessels, which can easily cause blood clots in other parts of the body.
Ling Ran's eyes looked at the rolling blood flow, but did not immediately stop it, but said steadily: "It doesn't matter if the blood vessels are crippled. It is sutured and can be used, but the suture is more difficult. Attention. Anesthesiologist, how long can it take to lower blood pressure? "
"Effective right away ... that ... too much blood loss ..." The scalp of the anesthesiologist was all blown up, and the patient's body was too dregs, it was tofu dregs, no wonder other hospital doctors Willing to perform surgery on him.
Ling Ran didn't understand anaesthesia and did not have the command to do it. With a sound of "En", he still watched the wound bleeding stably, saying: "Our first half of the operation went smoothly. It's okay to bleed a little bit now. Okay. It's exposed, tweezers. "
The instrument nurse quickly handed the tweezers to Ling Ran.
Ling Ran clamped a piece of blood vessel fragments exposed from blood stains with small movements.
"Scissors ~ www.novelhall.com ~". Ling Ran put the cut pieces into a small transparent bowl, dropped the scissors, and asked for needle clamps, and started to sew blood vessels on the spot.
As the blood pressure decreased, the blood flow from Cooing also lost its power, and the blood loss soon stopped.
"880 ml." The anesthesiologist whispered a number.
Ling Ran smiled: "Beyond expectations, but it doesn't matter."
"It's all about Dr. Ling's decision." Xu Wen relieved and licked by the way.
Zhang Anmin learned the tone of his predecessor and said, "This kind of accident may be dead when meeting other people."
After the patrolling nurses expressed their heart licking, they asked, "Do you want to send the cut tissue for inspection?"
"No," Ling Ran said.
His voice just came down, and the intercom heard Feng Zhixian's voice in the room: "Ling Ran, if the cut blood vessel fragments are useless, let us see them?
"Everyone is curious, um, academic curiosity." Zhu Tongyi also said.
Ling Lingran nodded and said, "Send another person to come in."
After finishing talking, Ling Ran continued to do stuffy surgery.
Everyone in the visit room looked at the high-definition screen in front of them, and their hearts were curious and fiery.