Chapter 436

Zhang Fan touched and touched it. His slightly peristaltic intestines crawled on his hands like thick caterpillars. He even felt a little itchy.

Touch and touch, greasy fat is like boiled cream, which can't be found. It's all located. If it's not located, it can only stay in the stomach. If it lives for a long time, it may grow into something like a flesh pimple.

"Shrapnel has entered the intestines!" After about ten minutes, Zhang Fan spoke.

"Then complete the intestinal tract first, and then directly enema. You see, it's still round on the monitor. If you open the intestines again, the damage is too great. You see, the shrapnel has damaged your abdomen like this. " Lao Wang was deeply afraid that Zhang Fan would open his intestines again to find shrapnel.

Zhang Fan stared at the display of the C-arm and looked again and again, "what if he can't get out?" Zhang Fan asked, who can guarantee that this kind of thing will come out.

If you can't get out, whether it's round or not, as long as it's a foreign body, it will stimulate the intestines, and then there's diarrhea that can't be treated directly. You can pull it when you eat it, just like a lax faucet, and taking medicine doesn't work at all.

"So what? Cut? " Lao Wang is also tangled.

Zhang Fan gently pinched the iron sheet across the intestinal wall with one hand, looking at the monitor and conceiving it in his mind. What was conceived? Conceive the size of chrysanthemum and the structure of intestine.

"Open it with a spreader and Enema with soapy water!" Zhang Fan really said after reading and reading.

"You can't be sure. If the edema after closing the abdomen leads to intestinal stenosis, if you can't take it out, it's a medical accident." Lao Wang began to worry again at this time.

It's really a happy thing to have such an old doctor on the operating table who can think and give advice. If in other things, this kind of person is expected to be despised: just picking faults! But on the operating table, the old doctors who can find faults for you can look up to you and love you!

"Let's do the operation quickly. After anastomosing the intestines, we'll start enema immediately!" Zhang Fan looked at Lao Wang and said.

"All right?" No one has ever done such a thing, and Lao Wang is not sure.

"Can you do that? Look at his intestines. He can't afford to hurt them anymore. Match! " There's no way. It's the only way. Zhang Fan bit his teeth and said directly.

The shrapnel is not big, but its power is not small. It cuts through the intestinal tract, especially the small intestine. As long as it is crossed, a section of the intestinal tract is directly damaged in 34 or even more areas.

Moreover, this damaged repair is not just like a rubber pipe, which can be sewn up. Because of ischemia caused by long-term rupture, the thin intestinal wall has been necrotic, and there is no possibility of repair at all.

The necrotic intestines at both ends can only be intercepted, and then sutured from a good place. This method has no way. The biggest disadvantage is edema and obstruction.

"Intestinal forceps!" Now that it has been decided, it should be implemented. There is no need to hesitate. The longer the hesitation, the greater the probability of intestinal edema.

Don't hesitate to do what you say. Zhang Fan and the director of general surgery put a non-invasive Scudder forceps on the proximal and distal normal intestines of the intestinal segment to be removed, so as to control the blood supply and prevent serious pollution of intestinal arch I.

Then free 1 cm or more at the edge of the normal mesentery adjacent to the serosa, and then place a narrow straight forceps obliquely on the intestinal wall for resection. The left segment of free mesenteric bowel was treated with tl60 stapler with 4.8mm nail.

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

During the operation, the openings at the two broken ends of the small intestine were closed with a linear cutting closure device. The small intestine was cut obliquely, and the free mesentery 1 cm away from the cutting edge of the intestine was retained. A traction line is sewn on the mesangium and the opposite mesangial edge respectively, the two broken ends are close together, the opposite mesangial edge of the two segments of intestine is close together, and one arm of the linear cutting closure device is inserted into the intestinal cavity.

Before firing the nailing cutter, the intestines on the arm fork should be flat and close together. When firing, the intestinal canal is nailed with anastomotic nails, and the built-in cutter of the linear cutting closure device cuts the anastomotic mouth. If bleeding is found on the nailing line, intermittent suture can be used to control it.

Sew a needle of traction line a and a 'on the mesangial margin of the two intestinal segments, and sew the ends of the opposite mesangial margin nailing line on both sides at the midpoint of the other suture B, so that it can pull and pull the two ends of the opposite mesangial margin nailing line.

Then, the common intestinal end opening was closed with a non cutting linear closer. Remove the excess bowel outside the obturator. After removing the occluder, if there is bleeding point, it can be controlled by intermittent suture.

With the increase of application time and experience, it has been found that it is more desirable to align point a with point A1 and close from B to B 'in a vertical way. In this way, only two rows of anastomotic nails cross at both ends of the closure line, and then it shall be carefully checked, and reinforced suture can be carried out if necessary.

Similarly, if there is a bleeding point, it should be sutured intermittently to stop bleeding. Check the stapling line and remove more than the intestines outside the stapling line. Check whether the nailing line is reliable. If necessary, several stitches can be used to suture intermittently at an appropriate distance from the anastomosis to close the mesenteric edge of both intestinal tubes.

Intermittent suture was performed to completely close the mesenteric holes on both sides. The mesenteric foramen can also be closed before intestinal anastomosis. The mesenteric foramen must be completely closed to prevent intestinal hernia. Finally, check the contact with the thumb and index finger to make sure whether the anastomosis is unobstructed.

This operation is too difficult to understand in professional terms. To put it more popularly, there are two rubber tubes, and then use scissors to cut the wound with a length of about 5cm obliquely upward in the middle of the sections of the two rubber tubes. Then sew the two wounds. What's the stapler like? It's actually a large stapler.

Because the sutured intestines will be edema, obstruction will occur if sutured directly. The last sutured intestines are originally a long strip in a straight line.

After stitching, it's a T-shape, or a Y-shape. The two interfaces directly became a large pocket. Originally, it was a few centimeters in diameter, and finally it was made into a dozen centimeters in diameter. To prevent obstruction.

After suturing, the abdominal cavity was originally a disk-shaped intestine, resulting in several protruding empty sacs“ Close your stomach! After this operation, be sure to tell the doctors and nurses in the Department to pay attention to the patient.

Ringer lactate solution was used intravenously to maintain fluid balance. And continue blood transfusion until the pulse returns to normal, especially when the hematocrit is &30%, be sure to use blood.

Two antibiotics were used. Continuous suction and decompression through gastric tube until the intestinal emptying function returns to normal. We must make it clear to the doctor of the tube bed that we must not pull out the gastric tube without ventilation. " Zhang Fan explained to Lao Wang while sewing the skin of his abdomen.

How to judge whether the surgeon is ventilated or not is simply to see if he farts.

"OK! My director Zhang, I first asked you to come to the general hospital, you would not live. You see, you came to the general hospital, I directly retired to the second line, the largest surgical department in the hospital has the final say.

Well, it's not too late now. Don't be an assistant to the director. If you come, you'll be the first deputy director. How about it? "

Lao Wang seduces Zhang Fan. Lu Ning looks at the dialogue between Lao Wang and Zhang Fan and is very envious“ The younger martial brother is a good boy. The orthopedic doctor doesn't say anything about general surgery, and the director of general surgery keeps pulling people. That's a doctor. It's so comfortable! "

"Director, I'm not happy first. The shrapnel hasn't come out yet!" Zhang Fan ignored Lao Wang. Ordinary foreigners are like the Warring States period. Several deputy directors jump one by one. They really want to go to general surgery. How can they have the convenience and freedom of orthopedics now.

"Right, right, get rid of this matter, or it will always be a time bomb."

"Don't worry, I've moved the shrapnel through the cecal orifice. Let's prepare an enema now. Soapy water, lots of soapy water. " Zhang Fan said to the itinerant nurse.

Hang 2000ml soapy water on the infusion rack, pull out the needle and plug it straight into the anus and rectum“ Turn on the switch. " After Zhang Fan inserted the plastic tube into his intestines, he said to him.

If there is no need and special requirements of the liquid, the general infusion is very slow, one is to prevent heart failure, the other is afraid of causing adverse reactions of infusion.

This enema, the perfusion speed is very fast, like the small water flow of the faucet, 2000ml of liquid quickly enters the intestines of the wounded.

"1000ml." The itinerant nurse reminded me.

"It's okay, go on." Zhang Fan, Lao Wang, Lu Ning, and even jumabek, their internal medicine directors all stared at the anus of the wounded.

With the decrease of pressure, the liquid enters more and more slowly, and because it is soapy water, with the entry of soapy water, the gas in the intestine is discharged, and from time to time, a colorful bubble is blown out in the anus, just like a little girl eating bubble gum and blowing bubbles, with pink and tender lips.

"All right!" With that, the itinerant nurse turned off the switch, and Zhang Fan slowly pulled out the plastic pipe, "spreader."

Although there is a spreader, because of the pelvis, the scope of anal opening is not very large, but there is no problem putting a smaller steamed stuffed bun into the degree of opening.

With the opening of the spreader, like the dam opening the sluice, the soapy water is mixed with blood and feces. It's colorful. It's really colorful.

Under the shadowless lamp, with the liquid pouring down, it is placed in the bedpan under the anus, and bubbles of various colors rise. Like a pool stained with gasoline in summer, there are all kinds of colorful bubbles.

All the people in the operation, including the instrument nurse, were looking into the bedpan on tiptoe.

"Why don't you come out? You come out!" In the operation, the nurse was a little younger, and the girl stared with big eyes and muttered to herself.

Waiting, the fiercest wave of liquid had come out, but there was no black iron in the bedpan. Lao Wang was unwilling and stirred it again and again with a small stick.

There are more bubbles in the basin with bubbles“ Don't disturb it. It's all bubbles. You can't see it out. " Ren Li is a little worried and angry.

"No! The liquid has run out. " Luning said disappointed.

"One more time!" Lao Wang said firmly.

"No, the wounded will have electrolyte disorder again. Forget it. Wait until his wound recovers. It's my fault. I'll bear it. I'll write a report when I have an operation."

"You are in charge of a calf. I have a higher professional title than you, and I agree to the operation plan. I am in charge." Lao Wang said firmly. Surgical accidents are not small things, but also such heroic surgical accidents.

Zhang Fan looked at Lao Wang and wanted to talk, but he couldn't say anything, "add me!" Lu Ning also stood up.

"And me!" Although Ren Li is not a surgeon, she also knows that Zhang Fan's is not easy. If there is one more person, the final punishment is estimated to be shared.

"Count me, this is not intentional, shit!" Juma Buick, the more you want to be angry, the more you want to be sad. This is not a credit, but everyone is unwilling to fall behind for this promising young doctor. After all, there are still many good people in the world!

"Thank you! thank you! I am responsible for my decision, thank you! " Zhang Fan's voice was much lower. He didn't want to be like this. He was sure of something in his mind. As a result, he failed in the end.

Zhang Fan slowly pulled out the spreader. At this time, with the removal of the spreader, everyone in the operating room heard a sound, which is also the voice "jingle bell" that Zhang Fan will never forget in his life

(the picture of intestinal anastomosis is posted in the author's statement. It's hard to understand. You can have a look if you are interested.

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