Chapter 336

In the early years of 2000, let alone in the border areas, even when making a phone call in the city, I had to shake my head from time to time to look for mobile signals.

It seems that after the Olympic Games, or a year before the Olympic Games, suddenly the national network has become powerful. The mobile phone signal is getting worse.

Even in mountainous areas, there can be strong signals. The network also began to spread to villages and towns in an all-round way. In this small town, China Mobile Unicom and Telecom are still fighting against each other either next door or door-to-door.

The development of network is also of great help to medical treatment. Network consultation is on the rise. For diseases that cannot be diagnosed in villages and towns, directly contact the superior hospital through the platform of the health system, and let experts consult through the network. A consultation is 30 yuan!

General chronic diseases can also be handled through online consultation, but there is still no good way for this emergency, especially life-threatening diseases. If there is no medical team tonight. Tusun Hanjiang has to go to the county hundreds of kilometers away. His life depends on his life.

There are doctors in rural health centers, but after several years of siphon phenomenon in the medical system, in a few years, township health centers have shrunk very badly. The doctors with a little skill went to the county. The doctors in the county, the more powerful or younger doctors, either went to the urban area or to the south. The small town can't support surgeons. The final result of development is that township health centers have become pharmacies.

There is no way to stop the brain drain. In the end, only by going to the countryside regularly can we solve the medical problems in small places. When there are no doctors in the countryside, once there is an emergency, it is a very troublesome thing. Then, the chain reaction is that the crowd converges towards the city more quickly. When it comes to why they want to go to the city, most people will say: for the education of children and the medical treatment of the elderly.

Perhaps this is urbanization!

Once abdominal organ bleeding is considered, it is necessary to quickly find the bleeding organ and stop bleeding. Abdominal organs, which are particularly prone to bleeding after being hit, are some substantive organs, such as liver, kidney and spleen.

These organs, first of all, are relatively fixed, and they are very brittle. The fresher they are, the softer and brittle they are. There is a car accident in the city. The speed is not high. After the collision, there is no trauma, but people have been in shock. This situation often causes the injury of abdominal organs and leads to massive bleeding.

In the early years, this surgical vehicle in China was made of imitation German goods. It seems that it was manufactured by a designated automobile factory. The price was super expensive in that year.

Later, the policy was open, and Yutong automobile was the latecomer. I don't know why. They didn't learn from Germany and took over the technology of Marubeni. After several years of development, they surpassed other automobile factories in China in a few years. Almost all these professional vehicles are contracted by them, except for some designated ones, of course.

Where the meatball country is big, the macro level is not good. But in this kind of small hand, small platform, I really have to admire others. What they do is quite powerful. Everything is very easy and reasonable, almost perfect.

Abdominal midline surgery, not a straight line. You have to avoid the navel. Because this place is a depression, it can be regarded as a place to hide dirty things. It is not easy to recover after operation. It is also easy to be infected. Abdominal surgery, this place is the focus of disinfection.

Open the skin, the skin is like a thin kraft paper. Cut the skin, followed by the superficial fascia. What is this thing? In fact, it is white fat and some loose hoof tissue, which is mainly walking superficial blood vessels and cutaneous nerves.

This is the advanced nature of human evolution. As long as there are large numbers of blood vessels or nerves, almost all soft fat and slightly harder hoof tissue can act as a protective layer. Without this layer of organization, maybe you can slap each other on the face.

"Electric knife, gauze." After entering the superficial fascia, the bleeding began to increase, and Zhang Fan said softly. Baoyinlisuo passed over what Zhang Fan needed. Be extra careful when passing things on the operating vehicle, because this platform is used for emergency after all, and almost all things are single.

After hemostasis, continue to enter“ Move faster. Your blood pressure won't rise. " The anesthesiologist, Dr. Liu Yaowen, looked at the monitor and gave Zhang Fan a return.

"OK." Zhang Fan has already been very fast and improved a step. Although he needs to be fast, he can't ignore the level. The abdominal structure is too complex.

Not to mention the internal organs, first of all, the abdominal muscle layer is very complex. The abdominal organs are too important. The abdominal muscle layer is stacked. Generally speaking, this abdominal muscle layer is like two doors, which are divided into two doors from the navel.

Many people think that by opening the muscles, the abdominal organs can be clearly seen. In fact, it is not. Simply put, the muscle is the door. When you open the door, there are also the door curtain and internal walls. The so-called door curtain is the greater omentum.

Therefore, when entering the muscle layer, you can only see a few organs, such as a small part of the liver and stomach, a small part of the large intestine and a small part of the small intestine. Other organs are invisible.

The anesthesiologist has warned that the blood pressure can't go up, so the hemostasis of the muscle layer is very simple, and the gauze is compressed. Wait until the internal organs are treated, and then go back for treatment.

Open the curtain, it's the wall. This so-called wall is a double-layer plastic film derived from the abdominal wall, that is, the belly.

This thing is like a wall to separate all organs. The peritoneum is double-layer, with a small amount of liquid inside. It has many functions. The most important thing is to prevent friction and cushioning between abdominal organs.

Without this structure, people can't exercise violently, because once the activity is violent, the abdominal organs may be worn out after strong mutual friction, and then either a belly of blood or a belly of stool! It's terrible.

When the peritoneum was opened, a large amount of congestion appeared. Zhang Fan looked and said, "the bleeding is on the upper left side. It's not the liver, it's the spleen. " Then open the bottom of the stomach and start looking for the spleen.

The spleen, because it is a small organ, has not been studied much in the early years. It is simply considered to be an organ for hematopoiesis in childhood and fetus. In adulthood, it is an organ that degenerates like the appendix.

With the deepening of research, it was slowly found that this organ is a very important immune organ. In the original, once it was found that there was a problem with the spleen, it was removed directly. However, with the development of evidence-based medicine, the medical community defined this organ as the largest immune organ of the human body. It has many functions, such as hematopoiesis, blood storage, blood filtration, and the most important immune function.

The spleen is shaped as like as two peas, which are almost the same as the magnified beans, hidden under the tenth and eleventh rib arch of the left side. The upper part is covered with the stomach, next to the pancreas.

This thing also wears a thin coat on the surface. Many spleen injuries. When they were first injured, they had no symptoms at all. It is because of this thin coat. When the bleeding breaks through this layer of clothes, it is the time of shock.

After confirming the bleeding, Zhang Fanyi said to Baoyin, "scalpel!" Because the position of spleen is relatively high and Zhang Fan's incision is relatively low, the knife edge must be extended upward. In general, you must drive under the xiphoid.

"Full cut?" When Zhang Fan extended the knife edge upward, LV Shuyan asked.

"Let's see. If you can keep it, you can keep it. If you can't keep it all, you'd better do a partial resection." Zhang Fan said as he quickly extended the knife edge.

"Gauze!"

"Doctor Zhang, the blood pressure is dropping badly." When Zhang Fan opened his stomach and opened the peritoneum, the pressure around the wound suddenly decreased, the amount of bleeding increased, and the patient's blood pressure decreased significantly.

"The amount of venous fluid increases. Adrenaline and dopamine are combined with intravenous injection to prepare for blood transfusion. " Zhang Fan, who had goose bumps on his body, sweated down. The operation was not difficult, but the patient bled too much because of the delay.

"Doctor Zhang, the effect is not good. The blood pressure continues to drop." The anesthesiologist's tone was also rapid, and he could hardly pronounce clearly.

"Blood transfusion. Use O-type RBC directly. " Zhang Fan is really a dual-purpose man. He is rapidly processing the tissue and refueling into the spleen area while still giving oral medical orders.

In general, even in the hospital, blood transfusion is not easy. Today, this situation is even more troublesome. First of all, I don't know the patient's blood type, and it's too late to detect it. I'm not a technician in the laboratory department, and the speed under the general hands is even slower.

Such a life-saving moment, time is urgent, there is no room for delay, it all depends on the doctor's weighing, bold weighing. If the balance is good, it can save lives. If the balance is not good, it may be fatal directly!

Generally, there are stored blood and checked blood in large hospitals. But in the time of emergency rescue, where can we take care of it? Fortunately, there is type O plasma in the operating car. Otherwise, only doctors or nurses can take it on site. In such places, few people know their blood type. Only doctors and nurses know their blood type. Even if others know their blood type, not soldiers, not police, Zhang Fan dare not use it!

This is why at the critical moment, when the hospital is ischemic, the army or police force directly drives into the hospital! And this is an order, a military order that cannot be negotiated. Really, for these people, the state owes them and the people owe them.

Don't think that blood transfusion is saving lives. In fact, the risk of blood transfusion is not small. Even if there are many blood problems of the same type, generally, if you can't lose, try not to lose blood.

"The left venous channel increases hydroxyethyl starch. Give me fifteen minutes, just fifteen minutes. Come on! " Zhang Fan said loudly.

"Gauze, stuffing!" In the operating car, only Zhang Fan gave orders.

"Three bending pliers. Look! Did the urine come out? " Zhang Fan's words at this time are oral medical orders. Both nurses and anesthesiologists must implement them unconditionally, because the chief surgeon knows the condition best at this time.

"No urine!" Itinerant nurse, said briskly.

"Come on! Scissors! " Whether total or partial splenectomy, the spleen must be completely free, because the tissue here is too complex.

The stomach, pancreas and intestines are all in this area, and the blood vessels here communicate with each other and accompany each other. It is very rich. If you don't carefully dissociate, a mutated blood vessel will come out and go down with a pair of scissors, which will really make things worse.

Moreover, the upper pole of the spleen is the splenogastric ligament. This ligament is too short. The short arteries and short veins of the stomach are out of shape. The separation is not clear. A little traction will break these two vessels.

"Support the spleen with a gauze cloth. Pay attention to the ligaments here. Move gently. Don't pull." After dissociating the spleen and gently holding it up with gauze, Zhang Fan specially explained to LV Shuyan.

The spleen is shaped like a broad bean. It has a door, which is where the inner side bends. This place is where the broad bean sprouts. The same is true in the spleen. Its inner bend is the splenic hilum, with arteries and veins.

With the clamp of the bending pliers, the bleeding is significantly reduced until the bleeding stops. This time is a little better than the first ten minutes. This can be regarded as a disguised hemostasis.

"Doctor Zhang, the blood pressure has risen. It's been 9 minutes!" The anesthesiologist said it specially.

"Yes!" Zhang Fan responded. He was in no hurry at this time. How much can the spleen be cut to retain its immune function. At present, there is no clear definition in the medical community. However, at least more than two-thirds, otherwise it will be meaningless.

All the parenchymal organs, their blood vessels are like two big trees. At the door, it is a thick trunk, and then after entering the interior of the organ, it begins to branch and disperse leaves, and then a connected capillary network is formed at the end of the arteriovenous, one in and one out.

The arteries of the spleen are generally divided into two to three parts at the splenic hilum, and then into two or three levels to enter the essence of the spleen. The venous arteries of the spleen, like brothers, walk together hand in hand.

The longest spleen of Chinese men is about 14 cm, but the blood vessels and arteries inside the spleen of ordinary people are 15 cm. You can imagine how slender and tortuous this thing is.

After the lower pole of tusun Hanjiang's spleen was violently hit by the male deer, it directly opened a hole the size of popcorn. The spleen is too fragile, and the male deer has great strength. There's no chance of suturing. It can only be partially removed.

This partial resection is not to cut along this piece where the wound is, but to see the blood vessels. Zhang Fan carefully identified which was the artery of the lower pole and which was the vein of the lower pole, and slowly ligated them one by one.

"I tie a knot!" In general surgery, after the operator sends the thread head in with the needle holder, the assistant will hold the back thread and tie the knot. But Zhang Fan doesn't trust LV Shuyan. This is a blood vessel knot. If you have less strength, you will break the blood vessel. If you have less strength, the blood vessel cannot be ligated.

LV Shuyan helped Zhang fan support the needle holder while dipping blood in gauze. No one would refute or be dissatisfied at this moment. The surgeon can do whatever the master knife asks. This is the minimum professional ethics of the surgeon.

The blood vessels to be ligated were ligated one by one, and Zhang fancai took a little breath“ Wipe my sweat. " It's too tight. Zhang Fan feels that his eyelids are sweating!

This time is waiting, waiting for the boundary between the area with blood supply on the surface of the spleen and the area without blood supply after ligation. As long as the ligation passes, the areas with and without blood in the spleen will be particularly clear in a few minutes.

One side is still red or pink, while the bloodless area on the other side is obviously pale.

"Scalpel." Three or four minutes later, the boundaries are clear. In order to maintain the vitality of the spleen, Zhang Fan cut the coat of the spleen with a scalpel one centimeter from the intersection line, and then cut into the spleen parenchyma with a knife handle.

The spleen is particularly fragile. It is easy to hurt blood vessels with the blade. Although the handle is blunt, it is safe. Slowly form a V-shaped incision at the anterior and posterior edges of the spleen, extending inward bit by bit.

While cutting, Zhang Fan's left thumb and index finger always hold and compress the edge of the spleen, which is to fix the spleen. This can effectively control and reduce the bleeding in the book.

It's simple to say, but it's actually very difficult to operate. Simply put, wear plastic gloves with grease on them. Then hold the round soap stained with water or oil. This force should not be too strong, and make sure that the soap is fixed.

This is the skill of the surgeon. Without more than ten years of exercise, let alone surgery, a simple grip can't be done.

Bit by bit, there is a small amount of bleeding on the surface of the spleen, which is the residual blood in the capillary network“ Dip! " Zhang Fan whispered to LV Shuyan.

Although this kind of bleeding does not need special treatment, it must be removed, otherwise it will affect the operation field. Moreover, this kind of wound can not be wiped. It should be dipped gently with gauze. Once wiped, it will not only damage the organs, but also change the position of the spleen.

"Ligation, this is a small artery. Be careful not to slip. " Zhang Fan held the spleen in one hand and the scalpel in the other. He found a small artery. He couldn't tie the knot, so he asked LV Shuyan to tie the knot. Before tying the knot, Zhang Fan gave a special explanation.

"Yes!" After Lu Shu Yan replied, she began to tie knots. Zhang Fan looked at it motionless. She was deeply afraid of a loose knot or a hole in her spleen. The spleen is crisper than the kidney. If you don't use a little force, it's a hole. This is also the reason why the spleen is easy to rupture.

Finally, the damaged part of the spleen was removed. After putting the excised spleen into the tissue bag, LV Shuyan often breathed a sigh of relief.

The operation was too nervous, and Zhang Fan's tone on the operating table was too severe. She was frightened. At this time, if you look at the spleen from below, it is like a V-shaped duck mouth with large mouth and small inside.

This shape is for later stitching. The spleen is very fragile. It was made into this shape for good suture. Therefore, a good surgeon constructs a perfect surgical process in the brain before surgery.

"I sew, I knot, Dr. Lu, you cut the thread." Zhang Fan said to LV Shuyan.

"OK."

LV Shuyan didn't dare to tie a knot. This very fragile organization is real kung fu. It's like pulling a wire on another piece of paper. If it doesn't pull well, it's a tear.

And this kind of suture can't use small needle and fine thread. Because the small needle and fine thread will lead to the inability of capillaries to climb and lead to ischemic necrosis. Therefore, the general healers dare not guarantee that they can sew well.

"Liver needle! Thick line! " Baoyinlisuo put on the needle and thread and handed it to Zhang Fan. It's true that the technology industry has a specialty. In the past, a simple threading seemed to be a very simple thing.

Not necessarily on the operating table. First, wear gloves, and when stopping bleeding quickly, you must ensure agility under your hands, one needle and thread in three seconds and one needle and thread in three seconds. Therefore, the operation nurse can't work a little older. First of all, she can't look at her eyes.

This kind of Kung Fu is also a skilled action after nurses practice countless times under the operating table. If you don't bear hardships, you can't work at all.

The liver needle thick line horizontal mattress suture combined with intermittent suture finally closed the incision. Originally, a broad bean became a cone. After suturing, Zhang fan used adhesive foam on the wound to stop bleeding.

"Finally finished!" LV Shuyan was relieved when Zhang Fan covered the greater omentum in her spleen. Zhang Fan on the operating table is too cruel. The more the crisis, the more cruel it is. But the more responsible she was, she looked at Zhang Fan and risked flowers in her eyes!

"When the arterioles were knotted, if I had torn my spleen, would you hit me?" LV Shuyan is at the end of the operation. She doesn't speak through her brain.

"Where are you? Do you want aseptic operation? " Zhang Fan turned LV Shuyan's eyes.

"Hit the chest, that place is sterile!" The anesthesiologist's old man Liu Yaowen got into trouble. At this time, the atmosphere was active. Although everyone said something out of tune, his heart seemed to be filled with a sense of achievement. He didn't want to be proud or complacent, but it was really uncomfortable not to release, so ~ ~, this feeling was really beautiful!

"Hooligans!" Baoyin and LV Shuyan scolded together.

"Hey, hey!" The old man smiled obscene.

The operation is over!

Outside the operating car, after the operation began, the people of tusun Hanjiang tribe and the relatives of tusun Hanjiang's wife also learned the news.

Riding a horse with a lantern, they gathered outside the operating vehicle from everywhere. More and more people comfort sun Hanjiang's wife and care about the operation.

The township head also came, "everyone is quiet. Don't affect the doctors in the car to perform surgery. Pull the horses away. "

Because before the operation, Zhang Fan asked Zhang Yanfeng of the respiratory department to inform sun Hanjiang's family that the situation was very dangerous. So sun Hanjiang's fierce wife was crying and sat soft under the wheels of the operating vehicle.

No matter how tough you are, you are also a woman, and no matter how tough you are, you are also a wife. Her mouth kept talking and praying.

"Isn't it? Let people go home. If it's an accident ~ ~ "Dr. Zhang Yanfeng said to the township head with a little worry looking at more and more people.

"It's okay, don't worry. Adaxi, if it hadn't been for you, sun Hanjiang would have died. We are all reasonable. Don't worry, there's nothing to do. Every spring, animals kick him to death. He's lucky. Hu Da bless you! "

With that, the township head stood in the crowd and said, "the doctors operated overnight. This is a benefactor. No matter what the situation is, if anyone is careless, I am a whip! See? "