Chapter 180： Subtotal Gastrectomy

Wu Yuan and Liu Xuening put on surgical gowns and surgical caps, and then entered the operating room.

At this time, the patient Li Wenqiang was already lying on the operating table, and the anesthesiologist, instrument nurse and other personnel were already in place.

Wu Yuan stood on the main knife position, and Liu Xuening stood on the opposite side as a helper.

Li Wenqiang turned his head to look at Wu Yuan and asked, "Doctor, is this operation really okay?"

Wu Yuan: "There is a problem."

Li Wenqiang paled in shock, opened his mouth, but said nothing.

Wu Yuan: "In the future, you won't be able to eat so much, and you should drink less wine."

Li Wenqiang breathed a sigh of relief, Wu Yuan's words just now really startled him, and he thought that the operation would not be possible.

Unexpectedly, Wu Yuan was talking about eating and drinking.

Li Wenqiang smiled: "Doctor Wu, it's okay, I decided to quit drinking in the future, and I will never drink again! What's the matter, I heard people say that drinking can kill people, I still don't believe it, this time I know it, even if If you don't drink to death, you will lose half your life."

Wu Yuan sorted out the gloves and said, "It's good to know, it's not easy for the old lady, don't let her worry about it in the future."

Li Wenqiang nodded: "I see, doctor, I regret it, I will pay attention in the future!"

Wu Yuan glanced at Li Wenqiang: "Aren't you going to get married? Didn't your future daughter-in-law come?"

Li Wenqiang: "My daughter-in-law is still on a business trip. I didn't dare to tell her, for fear that she would be worried."

Wu Yuan gave a "hmm".

Li Wenqiang: "Doctor, you have to help me heal, I still want to live a good life."

Wu Yuan: "Don't worry, it will give you a good life."

Wu Yuan gestured to the anesthesiologist, and then said to Li Wenqiang, "Go to sleep first and wake up."

Li Wenqiang: "Okay!"

Liu Xuening looked at Wu Yuan and then at Li Wenqiang, feeling that Wu Yuan was really a strange surgeon.

Talking so much to a patient.

However, Liu Xuening quite liked this atmosphere, and felt that Li Wenqiang had completely trusted Wu Yuan.

For a surgeon, this is a rare doctor-patient relationship.

Liu Xuening even felt that he really opened his eyes. It turns out that a surgeon can still be like this?

Didn't he start the operation as soon as he came up without saying a word?

But what Liu Xuening is more curious about is, how is Wu Yuan's surgery level?

A doctor who is good at communicating with patients can only be regarded as an extra point. It really depends on how well the performance on the operating table is.

The key point is that Wu Yuan is not a doctor of Dr. Yanjiang Dongcheng, but was born in the Affiliated Hospital of Yanjiang University.

After a while, Li Wenqiang fell asleep, breathing smoothly.

Wu Yuan glanced at the monitor, his blood pressure was still a little high.

Wu Yun sighed secretly, still drinking.

Wu Yuan said to the anesthesiologist, "Can you lower your blood pressure a little?"

Anesthesiologist: "I'll try it."

To be honest, the communication between the surgeon and the anesthesiologist is also a problem.

Surgeons are skilled people, as are anesthesiologists.

The surgeon's request, if the anesthesiologist is not willing, is also difficult.

Fortunately, the anesthesiologist gave Wu Yuan face, and added a blood pressure drug to the intravenous injection.

The dose is not large, just a little control.

A few minutes later, Li Wenqiang's blood pressure dropped a little, and Wu Yuan looked at the time and announced the start of the operation.

Wu Yuan: "My surgical plan is a subtotal gastrectomy, combined with a vagus nerve resection. The purpose of the operation is to remove the ulcer area, gastric perforation area, and avoid excessive gastric acid secretion in the later stage."

Liu Xuening was stunned, he didn't expect Wu Yuan to make such an explanation, and the explanation was very clear, indicating that his thinking was clear.

Wu Yuan: "No. 3 scalpel."

The instrument nurse handed the scalpel to Wu Yuan.

At the same time, in the observation room beside the operating room, Zhu Yulong, Guo Fangxin, Liu Qiaojun and others were all staring at the screen and watching carefully.

Everything is difficult at the beginning, and it is right and wrong to put it on surgery.

The most difficult part of the operation is by no means the first operation, but the middle operation.

But if the first operation is not good, it means that the surgeon is not very qualified, and it is difficult to do the following operations well.

Guo Fangxin whispered to Zhu Yulong, "How many operations has this Doctor Wu done?"

Zhu Yulong: "He is very good at many operations, especially pancreatitis surgery, and is often temporarily transferred to general surgery to help."

Guo Fangxin: "Then I can feel more at ease."

Zhu Yulong thought to himself, do you think I am stupid? Wu Yuan was recommended by me, and I must have done some research before I dared to do so.

At this moment, Liu Xuening had routinely disinfected the operation area of ​​the patient's abdomen, and spread a sterile towel.

Wu Yuan glanced at Liu Xuening: "I'm going to start."

Liu Xuening nodded, and his heart was still inexplicably nervous.

At this moment, Liu Xuening noticed Wu Yuan's hand, the hand holding the scalpel to be exact.

When moving the scalpel, it is so stable!

Observing the people in the room, of course, they also saw this scene.

"Wow, his hands don't seem to be shaking at all!"

"It's really stable! It's like a stone arm."

"Is it possible that the camera is a little far away, and the shaking is not obvious?"

A person suddenly pointed to the image on the screen and said, "The knife is off! The knife is off! The incision is so straight!"

At this point, Wu Yuan had already made an incision about 20 cm long in the patient's abdomen, which was very straight.

Then Wu Yuan began to cut the skin and subcutaneous tissue layer by layer.

Finally, the abdominal cavity has been exposed.

Next, it's time for the formal subtotal gastrectomy.

To be honest, the difficulty of subtotal gastrectomy is still quite high. The surgeon must not only remove the lesion and diseased tissue, but also ensure that the scope of the resection of the stomach is not too large.

Too much stomach removal is likely to affect the patient's postoperative eating and nutritional status.

However, too little should not be removed. If too little is removed, the diseased tissue is left behind, which means that the gastric ulcer has not been rooted, and the postoperative gastric acid reduction is not enough, which will lead to the recurrence of gastric ulcer.

So in general, a subtotal gastrectomy removes two-thirds, or three-quarters, of the stomach.

But for Wu Yuan, a subtotal gastrectomy can be done better.

why?

Because Wu Yuan has the talent of "key locking", he can more accurately find the position and edge of diseased tissue and lesions.

Combined with Wu Yuan's extremely fine control of the fingers, the parts that need to be removed can even be minimized to the extent that they will not be accidentally removed.

If you change to other surgeons, you will never be able to do this, even those old surgical drivers.

Wu Yuan said that this is a plug-in effect, not the scope of surgical techniques.

At this time, in Wu Yuan's field of vision, the patient's chest is full of green, with red parts in the middle.

The red color is equivalent to the diseased tissue and lesions, which are mainly concentrated in the stomach area.

Wu Yuan glanced at it a little, and found that the red is also dark and light.

This shows that some parts of the patient's stomach have been severely diseased.

Stomach ulcers are very easy to evolve into cancer, so the diseased tissue must be removed.

Wu Yuan started.

Subtotal gastrectomy surgery generally has two types.

Wu Yuan used the so-called "Biro's Second Form".

Simply put, after a subtotal gastrectomy, the duodenal stump is closed, and the remainder of the stomach is anastomosed with the upper jejunum.

Therefore, this operation is not only difficult to remove, but also the degree of anastomosis is critical.

Wu Yuan didn't dare to be careless, and gathered at the meeting to perform the operation.

Wu Yuan first used a scalpel and surgical scissors to comb out the gastrocolic ligament, and then found the greater omentum along the gastrocolic ligament.

Wu Yuan: "No. 5 scalpel."

Wu Yuan specially chose a small scalpel for more precise surgical operations.

In the observation room, everyone looked at everything on the screen in amazement.

The screen displayed very clearly, and Wu Yuan's movements were fast and accurate, as if he had cut off the omentum with ease.

"So fast! This Doctor Wu's technique is really unusual!"

"I feel like he didn't move much, so he just cut it off. What's going on?"

Liu Qiaojun was very knowledgeable and said, "His hands really didn't move much, but his fingers moved, which shows that Dr. Wu's surgical skills are very solid. You should study more."

Although Liu Qiaojun was the director of the Department of Thoracic Medicine, he was born in surgery, but he was later transferred to the Department of Thoracic Medicine because his hand was injured and he was unable to go to the operating table.

It is precisely because of this that he is so concerned about surgery.

At this time, seeing Wu Yuan's state, Liu Qiaojun was actually very surprised. This is not only explained by good basic skills.

When Wu Yuan excised internal organs, he was impeccable in both power control and the choice of cutting position. He was simply gifted.

Then, Wu Yuan entered the next stage, that is, along the greater curvature of the stomach, began to ligate the blood vessels of the gastric wall in sequence.

You must know that there are many blood vessels in the stomach. If ligation is not performed, excessive blood loss is likely to occur during the excision process, resulting in serious consequences.

Left gastroepiploic artery and vein, right gastroepiploic artery and vein...

Next, Wu Yuan ligated the right gastric artery at the lesser curvature of the stomach.

Liu Xuening had the best vision in the position of first assistant, and Wu Yuan's series of operations made her stunned for a while.

Wow, this is too neat.

Liu Xuening is also a surgeon, so she can't imagine that she can achieve Wu Yuan's level.

Not only that, of course, Liu Xuening has seen other old surgeons perform operations, but in my impression, it doesn't seem to have reached the level of Wu Yuan.

And most of the stomach surgery procedures are actually very cumbersome. It seems that Wu Yuan has not only done a few, but countless ones can be so proficient.

Wu Yuan is still so young, which hospital will give him so many opportunities?

Difficulty Is this the level of surgeons at Dongcheng Hospital?

No, he's not a doctor from Doctor Dongcheng, but from the Affiliated Hospital of Yanda University.

Why is Wu Yuan's surgical level so high?

At this time, Liu Xuening understood why Zhu Yulong dared to recommend Wu Yuan.

If nothing else, Wu Yuan's level, if placed in the city's third hospital, is properly the core of the surgeons.

At this time, Wu Yuan has completed the ligation of blood vessels, so that the most important step can be carried out, that is, the resection of the gastric diseased tissue.

Wu Yuan did not act immediately, but made an observation first.

Because of this subtotal gastrectomy, it is not just a light excision, but also the remaining part is anastomosed with the jejunum and duodenum stump.

In other words, a surgeon who performs this type of operation is equivalent to a tailor and needs to be "designed".

If the anastomosis is not good, it will not only have serious sequelae, but also cause various complications.

Liu Xuening didn't dare to take a sip, watching Wu Yuan thinking there.

After a while, Wu Yuan seemed to have determined the plan: "Scalpel, the smallest."

After hearing this, the instrument nurse gave Wu Yuan a No. 3 scalpel with a No. 11 blade on it.

This is the smallest model of the scalpel and is designed to cut through blood vessels, nerves, the gastrointestinal tract and heart tissue.

But the average surgeon can't use such a small scalpel. It is too thin, too small, and too difficult to use.

But for Wu Yuan, it was just right. After all, his fingers were different from ordinary people and belonged to superhuman abilities.

Of course, there are smaller scalpels, those with a 12-blade blade, but that's only used in facial plastic surgery, and it's a subtle shape.

At this time, Wu Yuan started to use the knife.

Not only Liu Xuening, but everyone in the observation room didn't dare to let out a sigh of relief.

Because Wu Yuan's movements were so delicate, everyone's eyes were straightened, and some opened their mouths wide enough to fit an ostrich egg.

Wu Yuan cut off a small piece of diseased tissue and placed it in a tray.

Liu Xuening glanced at it and couldn't help being surprised.

It's completely diseased tissue, without a shred of disease-free tissue attached.

Liu Xuening took another look at the remaining stomach tissue near the patient's incision, and there was no residue left in that area!

In other words, Wu Yuan's resection range was very precise.

This is amazing, how did Wu Yuan do it?

Although Liu Xuening was close, he couldn't see clearly.

In the observation room, someone asked, "He's moving so fast, are you sure there's nothing wrong with it?"

Liu Qiaojun shook his head: "No, it's very fine, it's amazing! Very fine!"

Wu Yuan continued to remove other gastric lesions Liu Qiaojun had already seen it.

He was also an excellent surgeon before and knew how difficult Wu Yuan's hands were.

I didn't expect such a young doctor to have very good skills. When I think about it, this is really a bit inconsistent.

I don't know how Wu Yuan practiced it.

In the blink of an eye, Wu Yuan had already cut out three pieces of diseased tissue.

Wu Yuan tried his best to keep the scope of resection to a minimum, and tried to remove only the diseased tissue, not the healthy stomach tissue.

Liu Xuening's eyes were almost unable to catch up with Wu Yuan's movements.

Suddenly, Wu Yuan's movements stopped.

Liu Xuening felt strange, this was a bit abrupt.

Liu Xuening: "What's wrong?"