Chapter 421

If this operation is combined with lymph node dissection, it is a combined abdominal perineal resection.

In other words, everything in the patient's lower abdomen should be cut off. Jiang awesome staff, to pull out in a timely manner, if slower, the damage is a little bigger, it will not need to save.

Zhang Fan Used toothless forceps to clamp up the remaining sigmoid colon. The forceps in the operation are divided into toothed and toothless. The tip of the tooth forceps is out because of the toothlike protrusion like a mouse's tooth, which is more stable when clamping, but this thing can't be used to clamp organs, especially the intestines. One clip is three small holes.

Intestinal bleeding is closed by all clamps. This is the first step. There are still many things to do. First, we should explore the ureter and vas deferens. Moreover, because it is not a dissection, we should also explore the pelvic autonomic plexus and sacral nerve. It can be said that this hand is similar to dissection.

If it breaks and cannot be repaired, these things will be removed. For example, one side of the ureter breaks and cannot be repaired. There is no way. The corresponding kidney must also be removed!

It is estimated that the drain is not very big. If it is a little bigger, it will be troublesome. Fortunately, the bleeding has been stopped, and there is no obvious damage to the ureter, vas deferens and other organs. At present, the silly child's life has been saved.

"The abdominal cavity and other pelvic organs are intact!" After probing once, Zhang Fan said something to the director of general surgery, and then asked, "how much is the bleeding now. How much solution is there in the aspirator. "

"3000ml of liquid, it's hard to estimate the bleeding now." The itinerant nurse looked at the liquid bottle on the ground and said to Zhang Fan.

"It's estimated that it's at least about 2000ml. When we came here, we had shock. Coupled with the bleeding during our operation, how can we have it?"

"Well, the amount of liquid increases. Now we're ready to remove the necrotic tissue. " After Zhang Fan finished talking to the anesthesiologist and the nurse, he began to remove the intestinal tract left in his stomach.

The broken intestines are spread out in the abdominal cavity like rotten cloth. Because of the ligation of blood, the color has turned white and has long lost its original ruddy color. The intestinal tract in the pelvic cavity has been destroyed, and the residual rectum and sigmoid colon can only be removed.

Sigmoid colon is easy to say. After closing the mesenteric artery, directly cut the stump with tissue“ Give me two sterile tissue bags. " After Zhang Fan cuts off the stump of the sigmoid colon, the cut off should be put into the tissue bag, which will have to be seen by other family members.

The other end was first ligated with a tissue bag, which contained a lot of E. coli. This thing is a normal flora in the intestine. Once it runs out, it is pathogenic bacteria. So wrap the other mouth first.

"The boy will be sad after this cut!" Zhang Fan looked at the sigmoid colon in the tissue bag and said to the director of general surgery with emotion.

"It's better to live than to die. Besides, a rich family doesn't have to worry about food and drink. He doesn't have to move bricks. Eating and drinking is a lifetime."

"People always do something!" Eating and drinking all his life is no waste. In the last sentence, Zhang Fan didn't mean to say it.

"Don't think about the future of others with your poor mind. I want to eat and drink all my life, but I can't meet the conditions. Ah! " The director of general foreign affairs is estimated to be tired of several deputy directors under his hand.

Got the sigmoid, then the rectum and anus. The rectum and anus are not as easy as the sigmoid colon. Zhang Fan is a two finger zen. He uses his middle finger and index finger to enter the anterior basal space, that is, the surrounding tissues of rectum and hip, and slowly separates first to identify the levator ani muscle.

"Vascular forceps!" The nurse handed Zhang Fan two pliers. The blood vessels of the human body are very smart. It knows that its body is thin, so it usually looks for a big brother, either bone or muscle, and then hides in or next to the big brother. Therefore, to cut the muscle, you must first clamp it at both ends, then tie a knot, and then release it.

In the past, when there was no electric knife, after the muscle was broken, the stump must be firmly sutured with suture, because it retracted after the muscle was broken, and then the bleeding could not be found.

Now with an electric knife, you can burn the wound like a pig skin and close the blood vessels directly. Then, after the rectum and surrounding tissues are completely free, we begin to deal with the anus.

"Our hospital doesn't have a plastic surgery department, otherwise people like this must need a plastic surgery department for consultation." After Zhang Fan and the director of general surgery treated the rectum, looking at the lonely anus, the director of general surgery sighed.

"What?" Zhang Fan doesn't understand.

"Look good. You don't have nothing."

"I'm not a child, and I don't wear open crotch pants. Who can see!" Zhang Fan said in surprise.

"Hey, don't tell me, there are really patients who need it. No matter who doesn't see it, it's always an organ."

"Ha ha!" Zhang Fan has no intention of quarreling with the old man.

The rectum is separated clearly, leaving the anus. In fact, the anus is very simple. In addition to the levator ani muscle, the rest is surrounded by fat.

This is why people in their early years liked to eat chicken ass and pig ass, because all the meat here was yellow fat, with a little orbicularis muscle, fat smell and chewiness. If you take one bite, you can satisfy your stomach and satisfy your cravings.

The patient's position is a stone cutting position, that is, his legs are bifurcated and the chrysanthemum is flat to the ground“ Sharp knife! " Zhang Fan said to the nurse.

"Be beautiful. Everything is an organ. " The director of general foreign affairs specially reminded me.

Zhang Fan rolled his eyes and didn't speak. How can this thing be beautiful! You can't tattoo artificial eyebrows anymore.

The size of the anus is as big as a dollar coin. Because of the orbicularis muscle, this thing shrinks and looks small. Zhang Fan gently drew an arc downward with the tip of a knife along his anus, and then drew an arc on the opposite side.

It is equal to drawing two connected arcs such as a football line around the anus. Then, follow the line drawn by the tip of the knife and start cutting the skin.

The yellow fat is crystal clear. Because of the long-term sitting posture, the density of the fat on the hips is relatively large. The knife is drawn on the fat, which is really crystal clear. The fat particles are crystal clear like yellow rice grains.

Alice clamped the anus gently in advance, opened the skin with tooth tweezers, and Zhang Fan gently dissociated the fat and levator ani muscle near the anus with his fingers.

"Suture! Salt water, gauze, iodophor, alcohol. " At the end of dissociation, the anus with a little rectum is directly attached to the fat. Because the anus is useless.

Washing, saline, a lot of washing has been free of the anus, like a rubber tube hanging on the wall, the anus is pitifully drooping on the hip.

After washing with a large amount of salt water, wipe with gauze. After wiping with gauze, wipe with Iodophor, and then wipe with alcohol.

"Come on, give more normal saline and gauze. You must wash it a few more times. " Zhang Fan said to the nurse that this cleaning is definitely cleaner than the restaurant chef cleaning the gourd head.

After cleaning, Zhang Fan went in and out with a needle along the anus, went in and out, and sewed around the anus. Finally, as soon as the thread head and tail were pulled, he completely closed the anus. This is the so-called purse string suture. This method is generally used for stump suture, such as appendix.

The stump is closed, and then gently pulled in the abdominal cavity, the rectal stump and anus are pulled out.

"Tissue bag!" The instrument nurse handed the tissue bag to the itinerant nurse. The itinerant nurse opened it. Zhang Fan put his rectum and anus into the transparent tissue bag.

This thing doesn't look big in the body, but when it is put into the tissue bag, it is directly filled with a large lump, white anus and bloody rectum.

Rectum and anus are very important organs. They are not cut and thrown away. If cancer is suspected, pathology should be done.

If there is no doubt, they must let their families have a look. Some people who pay attention to this important organ require them to deal with it by themselves.

The place where the anus used to stay is now empty, like a black hole. The rest is suturing, from inside to outside, and finally suturing the skin. After the oval incision is sutured, it is like a person's closed eyes. Chrysanthemum is gone, completely lost, instead of a suture scar.

He can't enjoy the pleasant enjoyment of lighting a cigarette, sitting on the toilet and playing with his mobile phone in the future.

After the stitching, Zhang Fan looked. Well, it's good. It's almost a curved willow eyebrow!

"Change your gloves!"