Chapter 203 200. Inflatable experiment

[This chapter's statements and comments may not be restored until November, and it is painful]

The key points of intraperitoneal surgery are nothing more than free anatomical structures, clamp blocking, cutting and separation, sewing and anastomosis.

The seemingly simple words, each step is filled with the sweat of repeated practice, and also the health and life of the patients after the failure of the surgery. The difference between Kawei and all the doctors present is not only the history of medical development for more than 150 years.

I still have thirty years of experience in emergency treatment.

Doctors who have only undergone surface tumor resection, gravel and amputation cannot keep up with Kawei's ideas, nor can they understand the anatomy of his current surgical area, nor can they understand the distal anastomosis after rectal mass is removed.

Gold content.

They only know that rectal anastomosis is not easy, but they don’t know how difficult it is.

Among so many doctors in the audience, I'm afraid only a few surgeons who have challenged abdominal digestive tract surgery have a certain say. Among these people, those who have truly come into contact with and have publicly undergone rectal surgery are the only ones.

There is only one Bill Rot.

Since he took the position of chief doctor, he has determined that his future surgical path will never waste time on epidermal tumors and plastic surgery.

Bill Rott's goal has always been the digestive tract, and during his years in Switzerland, he specialized in rectal cancer. Although he only had four cases in total, two of them died within one month after the operation, and one of them died from

A year later, but there is still one case that survives to this day. [1]

He chose to have rectal cancer not because the rectal cancer surgery is simple and easy to get, but because the symptoms of rectal cancer are typical and obvious enough, bloody stools and intestinal obstruction are the most direct evidence.

At the same time, rectal cancer is the only gastrointestinal tumor that can be clearly diagnosed by non-invasive examinations. It only requires rectal dilation microscopy or simply a digital examination to clarify it.

The surgery method is always performed through the anus, whether in the early 18th century or in the mid-19th century. [2]

While everyone was shocked by Carvey's superb skills in abdominal surgery, Bill Rotter's shock stopped in the surgical method. Because only he knew how much anatomical structure it would take to go from the abdominal skin to the peritoneal cavity and then around the rectum.

"Dean, you should know how difficult the surgical path from the abdominal cavity to the rectum is. Not to mention living people, even dead bodies may not be able to do it well."

"I'm not familiar with the abdominal cavity"

Bill Rotter was holding a record book that had written several pages, and his eyes were staring blankly at the operating table not far away. The only thing he wanted to do was to rush to the operating table to see what was going on in the patient's abdominal cavity: "

You said, if I were on the operating table now, would Dr. Kavi give me the opportunity to be an assistant?"

"The operation should be almost over." Watman didn't expect that he was thinking, "Anyway, he has been in Vienna, so there are opportunities in the future."

"The key issue is not the doctor. Of course Dr. Kavey is also important, but" Bill Rotter sighed, "the point is that the next patient with rectal cancer who is willing to take surgery does not know when."

The reason why Kawei chose the transabdominal abdomen was because he did not deliberately prepare the leg frame in advance and could not make a stone cutter. The second was because the transabdominal abdomen and transanal abdomen were not much different for him, in order to match this operation

The topic is better to choose the menstrual abdomen.

Abdominal pelvic floor surgery is also an important foundation for general pelvic and obstetrics and gynecology. In Vienna, where cesarean sections are increasing, it is not harmful to show these doctors that pelvic floor surgery is not harmful.

Simple mass resection is indeed easier than rectal cancer resection, which eliminates the resection of the descending colon and sigmoid colon, and reduces the dissection of surrounding lymph. But there is not much difference, and the intestinal segment where the mass is located still needs to be cut off and disconnected.

The intestinal duct still needs to be consistent.

What truly reflects the difference between the modern and the 19th century is the stapler. [3]

Fortunately, Kawei is a veteran and has experienced the era of sewing intestinal ducts. If it were young doctors, almost every surgery would require an anastomosis, and many people might have forgotten how to perform manual analgesia intestines.

Of course, the existence of a stapler definitely outweighs the disadvantages, because it makes up for many technical defects caused by manual suture and reduces postoperative complications. [4]

It is certainly true that it is passing on part of the doctor's technology to the machine so that the doctor can pursue more advanced surgical techniques and ideas. But in Kawei's eyes, using staplers and practicing the original suture technique does not conflict.

Because staplers are commodities, since they are commodities, there will be prices, and often the prices of medical commodities are not low. Even if there is insurance and reimbursement, the patient will still need to pay a sum of money in the end.

For those poor people, the cost of equipment that others can bear in their eyes is likely to be their living expenses for several months. At this time, forcibly using the stapler is to make the patient feel uncomfortable and also to make themselves feel uncomfortable.

The best way is to give up the expensive stapler and choose to do the stapler manually.

The rectum is different from the small intestine. Anastomosis not only means connecting the two intestinal canals together, but also requires ensuring that it does not damage the rectal sphincter below.

This is also the reason why you need to determine the distance from the tooth line as soon as you see the lump.

"This is the lump on Mr. Fernan's rectum." Kavey opened the rectum and showed the rupture of the internal lump. "The lump grew so big that surgical removal was indeed the only way to treat it."

The audience burst into warm applause from the audience, and the operation, which lasted for nearly 4 hours, finally ushered in the end of the second phase.

But for Kavey, the beginning and end of the operation are the same, and there is no sloppy: "How is his blood pressure and heart rate now?"

"Return to around 120/70, with a heart rate of 95."

"Okay, keep monitoring"

Kavey was surprised by Fernan's body and breathed a sigh of relief.

Open-air surgery has various risks, and the light source alone is a big problem. Not only is the air disinfection useless, but it also requires facing the continuous falling dust. Repeated use of ether will cause unimaginable consequences, and Fernan can persist.

It's still a miracle.

"The next thing we need to anastomosis of the intestinal canal is that it takes some skill."

Kawei used a needle holder to bring silk thread and said, "I did traction and fixing sutures on both sides of the intestinal tube, so that the two broken ends were close together. Then, using the silk thread to make continuous sutures of the back wall, one for each seam.

The thread must be tightened when needled. This is related to the closure of the anastomosis and no gaps can be left." [5]

After saying that, he quickly completed the suture of the back wall, and then knotted the suture with the thread for traction: "The method of the front wall is the same as the back wall, and you also need to do continuous suture inward and finally suture with the other side.

Wire knots. This is done to prevent continuous suture contractions from being too severe, resulting in stenosis of the lumen."

In fact, the stitching technique is as simple as before, and there is nothing particularly outstanding. The real thing worth letting Kawei say "skills" is actually after the stitching.

"The rectal segment lacks serosal wrapping, and anastomosis is prone to occur at the break-end anastomosis."

Kawei put down the suture needle and thread, carefully examined the anastomosis, and said, "Everyone also knows what the rectum is used for. Once an anastomosis occurs, the patient has no other way to deal with it except for another surgery to perform a secondary anastomosis. So here

In addition to finger suture, the technique also refers to an experiment to check whether the anastomosis is rigorous. Get me a basin of normal saline."

While preparing the salt water in Bergt, Kavey chose an enema device.

"Populate the water into your stomach."

"Drink it all?"

"First pour 200ml, I'll see if I can bury the anastomosis."

Bergt nodded and poured saline into Fernan's abdomen until the rectal anastomosis was completely submerged by water before stopping.

When Kawei poured salt water, Damirgaon asked Fernan's rectum to give Fernan a tube of air. More than 100 ml of air entered Fernan's rectum, which was within the pressure relationship, and some of the tiny air passed through.

The gap in the anastomosis penetrated into the abdominal cavity.

"Did you see the bubble?"

"See it."

Kavey put on the horn and said loudly: "When you have the final anastomosis of the rectal surgery, please remember to do an air enema experiment. No matter who is the main surgery, everyone is a human, and it is difficult for them to get rid of the possibility of making mistakes. For example, now,

A small string of bubbles entered the salt water pool in the abdominal cavity, which is the manifestation of the needle leakage."

After saying that, he asked Herman to suck away the saline from his stomach with a metal suction tube.

"It is common for stitching to cause problems, as long as remedial measures are taken in time."

Kawei gently reached into the position of the rectum and exposed the surgical position in front of him again. He gently kneaded the suture ports on both sides of the broken end, and then he found that one stitch was leaked at one corner of the suture. Perhaps it was just half a needle.

.

"There is indeed a leak, but it is not difficult to remedy it. You just need to hang a stitch." Kawei said while doing the sewing: "I have some water, I have to do it again."

After the second inflatable test is successful, the operation enters the final final stage.

Before this time, Kavi will summarize the gains and losses of today's surgery: "First of all, I have to thank Mr. Fernan for his body. Although his soul was betrayed to the demon, this body made me fully show two surgeries.

The whole process. Secondly, what I want to talk about is the medicine in the infusion bottle.”

The No. 1 infusion bottle is adrenal extract, which is the invisible protagonist of today's surgery.

Without it, the whole operation might end when the spleen is cut off, because Fernan consumed most of his energy in the first hour. It is precisely because the adrenal extract contains not only adrenaline and

Those messy hormone products can only allow the surgery to be displayed until now.

The infusion bottle No. 2 is pituitary extract.

Compared with adrenaline, the pituitary gland has less domineering effect, but for Fernan's upper gastrointestinal bleeding, pituitary gland extract can quickly solve his bleeding problem. Because posterior pituitary gland has always been very useful in hospitals.

It is also a very common hemostatic drug.

"The 4-hour surgery is not based on my technology, but on these two drugs."

Karachi once again started advertising for himself: "I have mentioned before that the price of these two drugs is 10 kronor, which is very cheap. If you want to choose a package with two bottles together, Karachi Pharmaceutical Factory will give you a special offer.

, We will also launch a surgical gift package for blood pressure monitor + adrenal gland + pituitary gland together with Mr. Laslow's steel factory. For the specific price, you can go to Karachi Pharmaceutical Factory for consultation."

Sales is also a feature of Kavey's surgery. Since he got the patent, he will intersperse some advertisements during the surgery.

The original intention is not only to increase your income, but also to make money while allowing doctors to develop good habits of using drugs and equipment.

In order to ensure the popularity of these drugs, the patent time is not long, and he will announce the preparation method one year later. This is not to give money. You can earn anything if you want to make money. Kawei is not short of money. Just before

The ventricular shunt surgery performed at St. Mary's Hospital brought Carvey 400 kroner income.

In this case, it will be smaller if you keep tying up the patent.

After suturing the peritoneum, re-examine the various organs in the abdominal cavity. After confirming that there are no remaining gauze instruments, rinse the abdominal cavity twice, and then start closing the abdomen.
To be continued...