Chapter 437： Jingle

Chapter 437: Ding Dong

Zhang Fan touched it. The slightly creeping intestine crawled on his hand like a thick caterpillar, and it even felt a little itchy.

Touch it, greasy fat is like boiling water, and it's just like butter. This is all positioned. If it is not positioned, it can only be left in the stomach. If it lives for a long time, it may grow into a meat-like thing.

"The shrapnel has entered the intestine!" About ten minutes later, Zhang Fan spoke.

"Then complete the intestine first, then enema directly. You see it is relatively round in the display. If you open the intestine again, the damage is too great. You can see that the shrapnel has damaged the abdomen like this. Pharaoh was afraid that Zhang Fan would open his intestine again to find shrapnel.

Zhang Fan stared at the display of the C-arm and looked again and again, "If it can't come out?" Zhang Fan asked, who dare to guarantee such a thing, it will come out.

If you ca n’t get out, whether it is round or not, as long as it is a foreign body, it will stimulate the intestinal tract, and then there is no direct treatment for diarrhea. it does not work.

"What to do then? Cut open?" Pharaoh also tangled.

Zhang Fan gently squeezed the iron piece across the intestinal wall with one hand, while looking at the monitor, thinking in his mind. What do you think of? Conceive the size of the chrysanthemum and the structure of the intestine.

"Spread with a spreader, soapy water enema!" Zhang Fan really said after watching and watching.

"Can you be sure, if the intestinal stenosis is caused by closing the abdominal edema, if it is not taken out, it will be a medical accident." Pharaoh began to worry again at this time.

It is a happy thing to have an old doctor on the operating table who can think and give advice. If you are on other things, this kind of person is estimated to be despised: light fault! But on the operating table, the old doctors who can pick you up look at you and love you!

"Let's do the surgery quickly. After anastomosis to the intestine, we immediately start enema!" Zhang Fan said watching the Pharaoh.

"Okay?" No one had done such a thing, and Pharaoh was not sure.

"If you can do it, you have to do this. You can't hurt him anymore by looking at his intestines. It's a match!" There's nothing to do but Zhang Fan gritted his teeth and said directly.

The shrapnel is not big, but its power is not small. This stuff scratches the intestine, especially the small intestine, which is relatively small. As long as it is scratched, a section of the intestine is directly damaged by 3/4 or more.

And the repair of this damage is not to say that it is like sewing a rubber pipe and it is done. Because of prolonged rupture and ischemia, the thin bowel wall has been necrotic and there is no possibility of repair at all.

You can only cut off the necrotic intestines on both ends, and then start suture from a good place. This method has no way. The biggest drawback is edema and obstruction.

"Intestinal forceps!" Now that it is decided, implement it wherever you go, no more hesitation. The longer the hesitation, the greater the chance of intestinal edema.

Don't hesitate to talk about it, Zhang Fan and the general director, put a non-invasive scudder forceps on the normal and distal bowel of the bowel segment to be removed, so as to control the blood supply and prevent the bowel Severe pollution from bow I.

Then free 1cm or more near the serosal border of the normal mesentery, and then place a narrow straight forceps obliquely on the intestinal wall and remove it. The remaining intestinal canal with free mesangium was treated with a TL60 stapler with a 4.8 mm staple.

This kind of operation is now that there is an intestinal stapler. If a suture is used, the operation time will be too long.

During the operation, a straight-cut closure was used to bring the openings at the two ends of the small intestine together. The small intestine was cut off obliquely, and the free mesentery was kept 1 cm away from the intestinal margin. Separate the suture line between the mesentery and the mesangial margin, close the two broken ends together to close the mesangial margins of the two intestinal canals, and insert a straight line to cut one arm of the closer in the intestinal cavity.

Before firing the staple cutter, the intestines on the arm forks should be flat and close together. When firing, the intestine is stapled, and the built-in cutter of the straight-cut closure closes the anastomosis. If bleeding is found on the staple line, intermittent suture can be used to control it.

Stitch a thread A and A \ 'at the mesangial margin of both bowel segments, and sew the ends of the mesangial marginal staple line at the midpoint of the other suture B, so that it can be pulled and pulled against the mesangium. Both ends of the edge line.

The non-cutting linear closure was used to close the common intestinal stump opening. Remove excess bowel from outside the obturator. If there is a bleeding point after removing the obturator, it can be controlled by intermittent suture.

With the increase of application time and experience, it has been found that it is more preferable to match point A with point A1 and close it from B to B \ 'in a vertical manner. In this way, there is only the intersection of the two rows of staples at the two ends of the closed line, and then it should be carefully checked, and reinforced suture can be performed if necessary.

Similarly, if there is a bleeding point, intermittent sutures should be used to stop bleeding. Check the staple line and remove more than the bowel from the staple line. Check whether the staple line is reliable. When necessary, use a few stitches at an appropriate distance from the anastomosis to suture the mesentery margins on both sides of the intestine.

Intermittent suture was used to completely close the mesenteric foramen on both sides. It is also possible to close the mesenteric foramen before bowel anastomosis. The mesenteric foramen must be completely closed to prevent an intestinal hernia. Finally, use the thumb and the index finger to check the contact to make sure whether the anastomosis is smooth.

This operation is too difficult to understand in technical terms. To put it more succinctly, there are two rubber tubes, and then use scissors in the middle of the cross section of these two rubber tubes to cut the wound about 5CM long and obliquely upward. Then stitch these two wounds together, what the stapler looks like is actually a large stapler.

Because the sutured intestine is edema, if it is directly sutured, the obstruction will occur. The last sutured intestine is a long strip.

After stitching it is a T-shape, or a Y-shape. The two interface places became a large pocket directly, which was originally a few centimeters in diameter, and finally made a dozen centimeters in diameter. To prevent obstruction.

After the suture was completed, the abdominal cavity was originally a disc-shaped intestine. As a result, there were a few protruding empty sacs. "Cut the abdomen! After this operation, you must tell the doctors and nurses in the department to pay attention to this patient.

Lactate Ringer's solution was used intravenously to maintain fluid balance. And continue to transfusion until the pulse returns to normal, especially when the hematocrit & amp; lt; 30%, be sure to use blood.

Apply two antibiotics. Suction through the gastric tube continues to reduce pressure until the bowel returns to normal emptying function. The doctor on the tube bed must make it clear that the gastric tube cannot be pulled without ventilation. Zhang Fan, while suture the skin of the abdomen, explained to Pharaoh.

How to judge whether ventilation is inoperative is simple, just to see if he is farting.

"Okay, my director Zhang, when I asked you to come to the general public, you can't live or die. You see that you have come to the general public, I directly retired to the second line, the hospital's largest surgical department, you have the final say.

It ’s not too late to come, let alone the assistant director. It ’s the first deputy director. "

Pharaoh tempted Zhang Fanzhi to die, Lu Ning watched the dialogue between Pharaoh and Zhang Fan, and was very envious. "This little master, a good cow, the orthopedic surgeon will not do general surgery, and the general director will keep pulling people. This is called a doctor, so comfortable!"

"Director, let's not be happy first. The shrapnel hasn't come out yet!" Zhang Fan ignored the Pharaoh. Pu Wai is like the Warring States Period. Several deputy directors jumped one by one. They really want to go to general surgery. Convenient and free.

"Yes, yes, quickly get rid of this, or it will always be a time bomb."

"Rest assured, I have moved the shrapnel over the cecum. We are now preparing the enema. Soapy water, a lot of soapy water." Zhang Fan said to the visiting nurse.

2000ml of soapy water was hung on the infusion stand, the needle was pulled out, and the **** and **** were plugged. "Turn on the switch." After Zhang Fan inserted the plastic tube into the intestine, he said to the tour.

If there is no necessary and special required liquid, the general infusion is very slow, one is to prevent heart failure, and the other is to cause adverse reactions to the infusion.

And this kind of enema, the perfusion speed is very fast, just like the small water flow of the faucet, 2000ml of liquid quickly enters the wounded intestine.

"It's 1000ml," the circuit nurse reminded.

"It's okay, continue." Zhang Fan, Pharaoh, Lu Ning, and even Jumabek, their internal medicine directors were staring at the wounded anus.

As the pressure decreases, the liquid enters more and more slowly, and because it is soapy water, as the soapy water enters, the gas in the intestine is discharged, and a multicolored bubble is blown from the **** from time to time, just like The little girl eats bubble gum and blows bubbles like pink lips.

"Okay!" Talking, the circuit nurse turned off the switch, Zhang Fan slowly pulled out the plastic tube, "spreader."

Although there is a spreader, because of the pelvic relationship, the scope of the **** is not very wide, but there is nothing wrong with putting a small bun into this spread.

With the spreader spreading, like the dam that opens the sluice, the soapy water is mixed with blood and feces, colorful and really colorful.

Under the shadowless lamp, with the liquid falling down, it was placed in the bedpan under the anus, and bubbles of various colors rose. Just like a pond filled with gasoline in summer, there are all kinds of bubbles.

Everyone, including the instrument nurse, was tiptoeing into the bedpan.

"Why not come out, you come out!" During the operation, the little nurse was a little younger, and the girl stared at herself with big eyes.

Wait, the fiercest wave of liquid has come out, but there is no black iron in the potty. Pharaoh is unwilling to hold the stick in the potty and stir it again and again.

There were bubbles in the basin, and there were more bubbles. "Don't bother, it's all foam, you can't see it anymore." Ren Li was anxious.

"Nothing! The liquid is over." Lu Ning said in disappointment.

"One more time!" Pharaoh said decisively.

"No, the electrolytes of the wounded will be disturbed again. Forget it, let's talk after his wound recovers. This is my mistake. I assume. I will write a report when I have surgery."

"You are in charge of a calf. I have a higher job title than you, and I agree to this surgical plan. I am responsible." The old man said firmly. Surgical accidents are not trivial, but they are also heroic surgical accidents.

Zhang Fan looked at Pharaoh and wanted to speak, but he couldn't say anything. "Add me!" Lu Ning also stood up.

"And me!" Although Ren Li was not a surgeon, she also knew that Zhang Fan was not easy for them and could have one more person. It is estimated that the final punishment would be shared a little.

"Including me, this is not intentional, **** it!" Jumabek, the more he got angry, the more he felt sad. This is not credit, but everyone is not willing to lag behind, for this young doctor with great future, after all, there are still many people in the world!

"Thank you! Thank you! I'm responsible for my decision, thank you!" Zhang Fan's voice was much lowered, he didn't want to do that, and his mind was absolutely stable. As a result, he failed.

Zhang Fan slowly pulled out the spreader. At this time, as the spreader was taken out, everyone in the operating room heard a sound, which is also Zhang Fan's life, and he will never forget the voice "Ding Dong!"

(The picture of the intestinal anastomosis was posted in the author's comment. This is not easy to understand. If you are interested, you can check it out.

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(End of this chapter)