136. The Taker (2)

Everything has its pros and cons, as well as its limitations of the times.

Orji and his team did make a lot of preparations. After completely disassembling the cesarean section surgery process demonstrated by Carvey, they practiced it repeatedly on cadavers. If there was not such a serious case of placenta accreta, this surgery would have been

Even if it's a little rough, it should still be successful.

Unfortunately, the problems caused by the uncertain factor of placenta implantation have gradually affected the direction of the surgery. Surgery is a success or failure, and hysterectomy can be declared a failure for this reason.

If he had seen such a hysterectomy two months ago, Kawei might have cursed in his heart for disregarding human life.

But now he has changed his mentality. The "failure" presented from a modern perspective is more like a kind of pioneering into the unknown in the wild and unexplored medical environment of the 19th century.

Surgery cannot spread all over the country instantly because of one person's success. Without the pioneering work of these people and the sacrifice of pregnant women, there would be no cesarean section in the modern sense, because success is based on thousands of failures.

"The bladder below the uterus is ruptured. Maybe not only the bladder is ruptured, but maybe something else was encountered while dealing with the separation of other parts."

Orji had a lot of excuses, but he still couldn't say them out in the face of failure: "Now the structure in the abdominal cavity has become chaotic, blood and urine are mixed together, and the vision is blurred. I have to declare the operation a failure."

I know that as a surgeon, I should not admit defeat before the patient dies, but I know my limits and hope to save her life as much as possible. So, if you are in the audience, who is sure to do a good job?

If this case of bladder repair is needed, I am willing to give up my position as the surgeon."

With Orgi's status, giving up the stage is equivalent to admitting that one's skills are not good, which is extremely embarrassing.

"Orgi, you can't be kidding."

"I'm not kidding, if you can fix it"

Dr. Corrigor who spoke immediately interrupted him: "No, no, no, no, no, no, no, no, no, no, you keep doing urological surgeries and you can't handle it. How can I, a plastic surgeon, handle this kind of surgery?"

There were indeed many doctors in the audience, and some of them had the ability and experience to perform hysterectomies. Three doctors came out and wanted to help, but after seeing the condition of the abdominal cavity, they all shook their heads and said, "There is nothing they can do."

" then left the surgical area.

They did not choose to take over, which made it clear how difficult the operation would be.

"I have never seen such a complicated pelvic surgery. There are too many things to do, and the patient will definitely not be able to survive that long."

"The anatomy is in a mess. Forgive me for my poor eyesight, I really don't know how to repair it."

"This situation may be difficult."

At this point, Orgi could only turn his attention to Kawei again: "Dr. Kawei, you are the best at abdominal surgery, can you do it?"

"I'll look at it first and then talk about it."

Kawei accepted Orji's invitation and left the auditorium, rarely becoming the pick-up man.

The situation was much worse than he expected. The distance from the auditorium really affected his observation of the operation.

Now that the organ is torn is a certainty, the incision is clearly in front of everyone's eyes, and blood can be seen slowly oozing around it. But this location is not like a bladder in the conventional sense. The surrounding connective tissue is thick, which makes the experience difficult.

The rich Kawi couldn't tell the difference between east, west and north for a moment.

Now the field of vision is full of a mixture of blood and urine. Orgi and Hills are a little at a loss. Only the suction device is still sucking out the liquid in Lockard's hand. Judging from the liquid ripples in the tissue gaps, urine seems to be

It was still being injected into the abdominal cavity continuously. The amount was not large and the speed was very slow, but Kawei could see it.

In this case, not only the bladder is damaged, but the ureter may also be broken during the separation of the uterine blood vessels.【1】

It was already very difficult for them to repair abdominal organs. Coupled with unclear vision, severed ureters, and the burden of the uterus, the difficulty of the operation suddenly increased. Orgi's courage to give in was commendable, but he had no choice but to do so.

For example, because this is a mess, and there is no way he could directly confine it without conscience.

"Dr. Orji, you did your best."

Kawei put on the cleaned rubber gloves, turned over the messy abdominal cavity, and said a fair word: "I am telling the truth, not to comfort you. It is already very good for a mother with such a pelvic condition to reach this point.

"

The enlarged uterus during cesarean section visually concealed the peasant woman's severe pelvic adhesions. After the uterus retracted, all the problems caused by the adhesions became apparent. Clusters of connective tissue covered the uterine appendages, connecting ligaments and blood vessels.

They all turned the whole thing into a ball of pink, and it was impossible to tell who was who.

The adhesion is so severe that it is difficult to connect the plate.

Kawei had to do a good job if he wanted to take over. He glanced at the operating area and found two unfamiliar young people: "Whoever is free, go and get me something."

"Let him go." Orgi pointed to a child who was younger than Kawei.

"Go to the preparation room of the operating theater of the Municipal General Hospital and find the instrument box I just took last week." Kawei said, "Move the whole box over. There is something I need in it. If anyone asks, just say yes

I asked you to go."

"good."

The patient must be taken over as if he were taking over. Now that the patient has become his own, Kawei made a simple arrangement in his mind of the risk factors of various areas in the abdominal cavity.

In terms of danger, the most troublesome thing is the uterus, because if this time bomb is not taken away, no one knows when it will bleed again. As for the ureter, if the bladder is ruptured, the bleeding will be limited. The urine in the ureter is very clean. Although the urine in the bladder is susceptible to

Pollution, but it’s not a big problem in comparison.

So the first problem is the uterus.

"Now I am the chief surgeon." Kawei glanced at Orji in front of him, then at Hills and Lockard. Seeing no one objected, he said to the audience, "Considering the possibility of continued bleeding from the uterus,

I decided to get the hysterectomy done first."

After saying that, he took the hook and helped them find the position to press it open one by one, fully exposing the gap between the cervix and bladder.

"Because there is no peritoneal covering in the lower segment of the uterus, a peritoneal depression forms between the bladder and the uterus. There are loose adhesions between the folded peritoneum and the cervix. Only by finding the gap between the bladder fascia and the cervical fascia can the bladder be separated."

Kawei talked about an important knowledge point in obstetrics and gynecology surgery, which is also a key factor in the success or failure of the operation: "Because this woman has severe pelvic adhesions, it is very difficult to find the separation level. At this time, some small skills are needed. You can push down on the bladder.

Observe the bleeding on the separation surface to determine whether the position you are looking for is correct.

If the separation level is correct, there will be no or very little bleeding, and the surface of the separation is smooth, and the bladder can easily move downward. If it is wrong, the separation surface will definitely enter the bladder or myometrium, resulting in large amounts of bleeding and difficulty in bladder control.

Promote.”【2】

Those spectators who wanted to truly learn the skills left the table and walked around the surgical area.

Every word he said was a key point, and every operation was enough for everyone to watch attentively.

The bladder with a tear was pushed down by Kawei while separating it, and it was slowly separated. Then he felt the cervix with his fingers and determined the horizontal line for cutting and separation: "Doctor Orji has already processed the uterus just now.

The surrounding ligaments were cut quite well."

Kawei checked the entire area around the uterus again. After confirming that everything was correct, he began to make the final incision: "Scalpel, we will directly cut open the yd fornix and take out the uterus."

Less than 10 minutes after taking the stage, the uterus, which had caused great trouble to Orji's team, was taken out of the abdominal cavity. Everything seemed so easy, not only was the treatment clean, but there was very little bleeding. The same operation was done in Kawei's hands.

It's easy to get used to it.

The people watching were relieved, but Kawei was not relieved: "Then you will report your heart rate every three minutes. If there are obvious changes in your heart rate or breathing, you must notify me as soon as possible."

He placed the nurse next to the patient, wearing a stethoscope and constantly monitoring the two vital signs: "I understand."

After the uterus is removed, the yd stump needs to be sutured. The operation is not difficult. The innermost mucosal layer is sutured first, then the front wall of the stump is sutured, and finally a complete set of continuous sutures is used to finish. Only then did Carvey announce: "

The hysterectomy is completed, and now we deal with the bladder." [3]

The tear in the bladder was very obvious and it was not difficult to suture.

But Kawei was not in a hurry to take action: "Why hasn't the child come back yet?"

"The Municipal General Hospital is not far from here, so it should be soon."

"He wouldn't just run away just to save money." Kawei waited for the equipment box and simply went to find the ureters on both sides first. "I just discovered that Dr. Orji didn't do the uterine artery suturing.

Notice the ureter on the side."

"ureter?"

"On both sides of the uterus, the ureters and arteries run parallel and are very susceptible to damage during resection."

Orji looked at the uterus that had long been badly adhered and explained: "Considering the anesthesia time, I did not do too detailed separation. And even if I did separation, it would be easy to damage, after all, the surrounding tissue is sticky.

It’s even too serious.”

Kawei also had to admit that he would get a headache if he went on stage. What the abdominal surgery department is afraid of is that the anatomical structures caused by adhesions cannot be clearly displayed.

But in the face of difficulties, there are always ways: "You can use the touch of your fingers to judge the arteries and ureters. Of course, this requires some experience. If you are not sure, you can only do the ligation as close to the uterine isthmus as possible, and if you are far away, you can do it."

It’s easy to hit the ureter.”

"What now?"

Orgi's problem is also the problem of everyone present.

Because the severed ureter is softer than the blood vessels, what flows out is not bright red blood but urine. The kidneys flow out very little urine, and it is difficult to find the source based on this alone. In addition, the pelvic adhesions are severe, even if

It was also difficult for Kawei to find the ureter in the mess of tissue.【4】

"That's why I need that equipment box." Kawei looked at the time and said, "It's almost done. Let's add some ether to her."

Just when the nurse was anesthetizing the peasant woman with ether again, the door of the operating theater was pushed open: "Doctor, I brought the things!"

"Did you bring them all?"

"Yes, I brought it."

"Open the box. There are three bottles of dye in the box in the lower left corner. Find the blue one, put it in the syringe, and pump out 1ml. I will use it right away." Kawei said, reaching into the broken bladder and finding the disconnection
To be continued...