120. Men and women

Splenicectomy is associated with retention and the extent of spleen damage.

Generally, small shallow lacerations of the spleen, small-scale envelope lacerations, subcapsular hematoma and localized tears can be selected to retain the spleen and suture and ligation of the damaged area.

Olgi is a shallow minor laceration, with very limited depth and cutting length, no more than 1cm.

The surgery is a fantasy for Hills and Locard, because there are very few surgeons who can perform splenectomy, and it is too difficult to repair the spleen. But for Kavey, this kind of surgery is a novice. The only difficulty lies in the technology, but in the surgical instruments.

But he has been here for almost a month and has gradually become accustomed to things from the 19th century. There have been new changes in both surgical techniques and specific movements in his hands.

The suture of the liver and spleen must be done using sheep intestinal thread. When suturing, not only should we face the characteristics of the sheep intestinal thread itself being easily broken, but Kawei also needs to always pay attention to whether the tender liver and spleen will be torn again by the sewn knots.

His movements must be as gentle as possible while putting surgical knots on them. On this basis, he also put some large omentum between the sutures, further reducing the risk of lacerations at the sutures. [1]

This is a difficult task for Hills and Lockard, but the difficulty is not visible only through the movements shown by Kawei. In addition to the padding of the large omentum, it seems that the spleen suture is an easy surgery.

The story unfolds in such a slightly leisurely atmosphere, and the cause of the matter still starts with a meeting half a year ago.

Olgi is the most famous surgeon at Gretz Hospital and has been working for decades.

Although Hills' eyes are not as good as Ignaz, and he is too slow to do surgery when he is old, he is definitely better than himself in terms of experience. Especially for the diagnosis and treatment of men's urinary diseases, he has been immersed in it for a long time and his techniques can be called first-class.

However, surgery has many uncertainties, and failure of surgery was a common thing in the 19th century.

This time the patient was a writer and had several short stories, but the plot was boring and the response was mediocre after it was published. Because he had never achieved any results, he gradually lost confidence in writing and began to make a living as a contributor for the newspaper.

Just when he thought he would go on like this in the rest of his life, the turning point appeared.

By chance, he met a girl he liked at the newspaper, Rinette, the daughter of the owner of a dye factory in Vienna.

"Ha, it's not bad, it's a salted fish that has turned over." Kawei was doing a spleen stitch in his hand, listening to the story in his ears, "Then why is the love he said is gone?"

"Three months ago, the writer came over and said he was going to get married, but he needed to solve his personal problems before getting married." Hills helped pull the hook and said while being an assistant. "He said that there seemed to be hidden pain and a swelling feeling under him from time to time. I hope Mr. Olgi can help me."

"Low?" Kawei was stunned, "yin bag?"

"Yes, yin bag."

This thing has swelling and pain. Although the type of disease that may occur is not as exaggerated as abdominal pain, it still requires imaging help to be diagnosed. However, if you are an experienced urologist, you can still make a suspected diagnosis through physical examinations and certain experiments.

"Hydroxyflux? Hernia? Inflammation? Or varicocele?"

Kawei can think of these four types for the time being. Of course, in addition to them, there are tumors, but the probability of tumors in young people is not high, so they are excluded.

"It turns out that Dr. Kavey also has research on male surgery." Before Locard could react, Hills, who was still beside him, noticed something was wrong. "Aren't you specializing in cesarean section? Why do you know so much about Yin sac?"

"After all, I have this myself, so I was curious to read it."

The reason is impeccable. After all, the exploration of the human body begins with interest, and Locard soon believed it. But Hills knew that things were not that simple, but now it is important to tell stories, so he didn't ask much: "The teacher did some examinations and found that it was a varicocele."

"Oh?" Kawei was very interested in Olgi's diagnosis. "How did Dr. Olgi make the diagnosis?"

"Hey, haven't you taught yourself androids? Why don't you even know this?" Hills explained, "When a man has varicocele, the yin cyst swelling in the supine and upright positions is different. This is available in textbooks, did you forget?" [2]

"Oh, it's this."

Kavi smiled, and the suture of the spleen reached the end stage. "I do have an impression, but I had a question when I watched it."

"What's the question?"

Kawei took out the suture needle, quickly tied a knot with both hands, and then took away the gauze lined underneath: "Well, it's great, the spleen should be fine. Nurse C, heart rate, heart rate, heart rate."

“115.”

Kawei nodded with satisfaction, then turned around and looked at the salt water injection: "How many have you been shot in?"

"It's already 500ml."

"Okay, keep on working on it and beat all the remaining 500ml of water."

"knew."

Kawei seemed to have forgotten the topic just now. After finishing the suture of the spleen, he began to focus on intestinal damage. Although the knife in the left abdomen only abrasion to the spleen, the colon below and its adjacent stomach both ruptured to varying degrees.

"Come on, wet the gauze."

Seeing that he was like nothing happened, Hills couldn't help but ask again: "What is the question you just mentioned??"

"What's the question?" Kavey looked at him and then realized, "Oh, varicocele, I actually have some questions about the examination method. After all, sitting for a while and lying down is very troublesome to check, and the symptoms are not obvious."

"Although the examination is troublesome, the accuracy is not low." Hills felt very strange. "If we just follow the habit of the doctors in the internal medicine, the most we can see is a swollen Yin sac. The inflammation, hernia, and hydrocele that you just mentioned will also be like this."

"In fact, we only need to let the patient do a simple movement and we can see the varicose veins with the naked eye."

"What action?"

“Valsalva action.”

Hills frowned and looked at Locard, who was preparing to repair the gastrointestinal surgical instrument. The two had no impression of the strange name: "I haven't heard of it, where did I learn it?"

"It was invented by an Italian anatomist." Kavey said with a smile, "My father admired him at the beginning, and his side portrait was still hanging at home." [3]

“How to do it?”

A cumbersome noun and a profiling set off the atmosphere. The "Valsalva movement" became taller in the minds of the two, but in fact, it was just a simple sentence: "Store your breath for 10 seconds, just use force together with your chest and abdomen."

".That's it?"

"Yes, it's just holding your breath, nothing special." Kavey explained, touching his stomach with both hands, "Sure enough, there is a break here, give me a needle."

The stomach rupture is slightly larger than the spleen, but the surface tissue of the stomach is tougher and more comfortable to suture: "As long as you hold your breath, the varicocele will appear, like a group of earthworms. Of course, if you touch it, you can also touch it, but some mild patients still have to hold your breath."

"Can this still happen?" the two suddenly realized, "but from the perspective of blood circulation and physiology, there seems to be no problem."

"It's a very useful test method," Kavey explained. "In the past, a young man was a glass blower. When he came to my father for examination, he mentioned that every time he was blown and peeled, the yin sac would swell and hurt. Later, he found that it was varicocele."

"This method is good. You must introduce it to the teacher after he wakes up." Lockard suddenly asked, "But why is the breath-holding action that I discovered in the last century not popular yet?"

"Because Valsalva's movements were used to treat otitis media at the beginning," Kavey pointed to his ears and said, "At the beginning, the anatomist discovered that holding his breath could easily drain the pus from his ears. Unfortunately, because of the more convenient syringe for cleaning, it would not be so troublesome."

The content of the chatting of the three people went around a long way to the varicocele examination, and finally returned to Orgi.

After confirming the writer's condition, the experienced surgeon immediately formulated a surgical plan, namely, partial yin capsule removal + vein ligation. [4]

"Did you do it on the left side?" Kawei only hooked three needles on the rupture, and ended the suture of the stomach. [5]

"No, it's both sides."

This time it was Kawei's turn to be surprised: "I didn't expect Dr. Olgi to be so powerful, and he could do bilateral varicose veins at one time?"

"As long as it is an oral-related surgery, the teacher is quite famous in Austria." Lockard looked at Orgi, who was still sleeping, and said, "but this surgery is not the case."

As the top priority for male childbirth, conservative Austria often chooses more stable conservative treatments, such as bleeding and slack bags or simple bhuttos. Even if it is so serious that surgery is required, surgeons often only do one side and keep moving on the side with the lesser symptoms.

What I fear is an accident in surgery.

Olgi's surgical plan can be said to be very bold, not because he wanted to create any history, but because the writer's varicose veins are very serious. Whether it is one side or two side, once it fails, the ending is actually similar. Anyway, the other side has to do it sooner or later.

“The surgery was successful.”

"The operation is not successful."

Locard and Hills once again had a difference on the success or failure of the operation: "The wound healed well after the operation, and there were no errors in the surgery process of the bilateral yin capsule. This is the manifestation of the successful operation. You were the assistant at that time, and you should know better than me."

"I do see it very clearly, but I don't agree with you."

Locard retorted: "Whether the surgery is successful depends on the incision or the surgeon's technique. The final thing is to look at the specific effect! Even the teacher admitted that the surgery was not effective, and that guy's two-sided gao pills were still small and soft."

"We are treating varicose veins in the surgery, not the size of gao pills, not to mention that a large number of surgeries prove that once gao pills become smaller, they will not be able to come back!"

"But this still cannot change the fact that he cannot have children," said Lockard. "They were together before they got married, but they had not been pregnant for more than three months. This could not be Rinette's problem. She went to the test and it must be that the writer's gao pill has not returned to normal."

Severe bilateral varicocele can affect the development of gao pills, thereby affecting sperm quality, and causing male infertility [6]. However, the operation itself can also accidentally damage lymphatic vessels and arterial vessels, and the effect of the operation varies from person to person.

"Did the veins relapse?" Kawei asked.

"He came for a follow-up visit half a month ago, and varicose appeared on both sides of the Yin capsule."

"It seems that it has a relapse."

"Actually, I reviewed the surgery twice later and felt that there might be some mistakes in the surgery." Locard seemed to remember some details, "When Teacher Olgi had an intravenous high ligation, some branches might have been missed."

"It's inevitable to miss it." Kavey comforted, "This should be considered a complication. The recurrence rate of varicocele is quite high."

The operation has been over for nearly half a year. Because there is no surgical record, the only ones who can understand the operation process clearly at that time were the chief surgeon Orgi and his assistant Locard. So whether the operation failed or whether there were any mistakes during the operation was actually a confusing account.

Moreover, it was very common for surgery to relapse at that time, and it was already considered successful if you could get off the operating table alive.

"The real problem is not the surgery at all," Lockard said. "The problem is keeping the secret!"

Although the marriage between the writer and this dye factory daughter is based on love, love needs to be crystallized, and it is unacceptable to Rinette.

That's why the writers will have varicocele surgery before getting married, hoping to cure it, and then live happily with Rinette, and then inherit the dye factory worth tens of thousands of kronors in the future.

Unfortunately, he met a straightforward surgeon.

"The teacher has actually helped him once," said Locard. "When Rickart came to take him to review a month ago, Teacher Orgi said to them both, 'There is a great hope of recovery'. Although it is a deception, there is nothing we can do about it."

"But this approach makes the teacher very painful!!!" Hills retorted, "just two days ago, he was talking about this."

"Conserving personal privacy is the most basic moral bottom line for doctors." Lockard argued reasonably, "If you can't even do this, how can you treat patients?"

"Conserve someone's so-called privacy and make another person suffer misfortune for the rest of his life?" Hills shook his head at this statement. "If it were me, I would have told Rinette loudly that he would never be able to have children in this life. If you want to have children, change a man as soon as possible."
Chapter completed!