Chapter 150 147. Limited guidance

In addition to performing heavy physical labor immediately after delivery, trauma and surgery themselves are also a factor in uterine prolapse. In the past, when encountering female patients with abdominal trauma, Kawei often asked gynecologists to perform on the same stage and had some understanding of uterine prolapse.

However, the incidence of uterine prolapse in China is not high. At least Kawei has shown a significant decrease after working [1]. After the 21st century, prolapse has become very rare, so his experience of this disease also came from the 1980s and 1990s in the 20th century, and his memory is a bit vague.

But even so, remember some surgery. At least it is not one of them to reduce the broad ligament on both sides.

However, the problem now is not whether the broad ligament reduction surgery can be successful, nor whether it will be effective for uterine prolapse after reducing the broad ligament. It is not that Besim and Denever were both dumbfounded by the open abdominal cavity and had no idea how to start.

It was something Kawei didn't expect to recognize the broad ligament.

With years of clinical education experience, he was still calm. But the doctors in the hospital who came to watch the surgery were not so easy to talk to, and in this case he would not save his saliva: "Let's just close your stomach as soon as possible, the gynecologist is still thinking about the surgery."

"This is the most funny thing I have ever encountered this year. The surgeon cannot find the surgical site, which is ridiculous."

"It's so embarrassing, Dr. Besim, is this your proud effort?"

"It shrinks so much that it is invisible as soon as it opens. It is indeed the legendary broad ligament reduction surgery."

Besim didn't expect this to be the result. He believed that he had studied anatomy and had some minor bedside surgeries, but for the first time he faced the similar pelvis, he really couldn't figure out the north and south.

The patient is not light in weight, with thick subcutaneous fat and thick visceral fat. In addition, many years of uterine prolapse have caused the surrounding tissue to become very loose. The connective tissue, adipose tissue, muscle tissue, and visceral tissue, which are completely different in the text, are actually almost the same when you look at it and touch it.

They have memorized the anatomical picture and the broad ligament should be on both sides of the uterus.

The uterus that can be lifted into the pelvis is full of messy things. They can be broad ligaments, round ligaments, main ligaments, uterine sacral ligaments, inherent ligaments of the ovaries, uterine blood vessels, fallopian tubes, ureteral ureters

The extreme lack of experience and the basic responsibility attitude towards the patients were entangled inappropriately between the two, making Besim and Denever dare not make a judgment easily.

The more they dared not move, the more excited the doctors in the audience laughed, and even more so, they classified the incident as negligence in hospital management:

"I repeatedly emphasized at that time that the hospital's surgical theater is too kind to the surgeons who use knife. How could it be possible to catch up with the footsteps of the Municipal General Hospital and to have a stronger and more capable surgical department that can attract the disease source, just stay in your own hospital and refuse reporters and other audiences?"

"The Municipal General Hospital also moved the surgical theater to its own hospital." After hearing this, Orgi always felt a little harsh. "In my opinion, this professional-oriented and imitating the British and French surgical theater system is the general trend, but our hospital is ahead of the Municipal General Hospital."

"What is the general trend? It's not about making money for profit."

"Yes, the municipal general hospital has no charge for surgery, so they still allow journalists and audiences to enter the venue just to make money from tickets."

"Although the existence of the audience will infringe on the patient's privacy, the doctor can also urge them to make as few mistakes as possible."

"That's what I mean, all poor people who can't continue to live, and they are talking about privacy and not privacy. It is the most important to find the best doctor in Austria to do surgery clearly. If any audience and reporter see this ridiculous operation of simply opening the abdomen and doing nothing, they may have to be on the front page of the daily newspaper the next day."

"It's pretty good to go to the newspaper, but I'll soon forget the short memory of Vienna citizens. But if I lose my face in the hospital, it's all about whether I can stay in the hospital and continue working."

This is not the first time that Kawei has experienced the power of the audience. Someone was secretly talking about Olgi's cesarean section before. Afterwards, Watman was the president of the Academy of Surgery, and this voice was much less. But if the main surgeon was replaced by Hills and a young surgeon like Herman, there would never be less discussion in the audience.

In this environment surrounded by all sides of sight, it is not easy to explain while doing surgery to satisfy the audience. After all, it is a paid viewing project, so it is normal to get sprayed if you smash it.

But now it is the internal surgery of the hospital. Although the process is a bit outrageous, these people are too merciless, which is far from the modern hospital full of human nature.

But if you think about it carefully, the remarks just now are not without reason.

In the 19th century, when there were no medical rules and regulations and diagnosis and treatment procedures, the audience's regulatory group did have its rationality. Otherwise, problems such as "amputation and wrong leg amputation", "intestinal obstruction and a section of healthy intestinal ducts", "leftover gauze, scissors, vascular forceps", "appendicitis cuts off the spleen and pancreas" will appear in large numbers.

Of course, the audience's non-professional reactions will indeed affect the mood and judgment of the surgeon. It is only a matter of opinion.

Kawei has no way to talk about the medical system yet, and the surgery itself can be confused.

Now that the stomach is opened, the patient does have serious uterine prolapse, and it is troublesome to close the abdomen or not. Of course, according to his own wishes, since the patient has taken the risk of open abdominal infection, it is better to continue the operation directly.

Last time, Kawei chose to take over to save his life. This time the patient is far from this point, and Kawei has no intention of helping. Besides, the two people at the operating table said nothing, and it was obviously inappropriate to enter the venue rashly, and it was not in line with Kawei's usual style.

Looking back on when he was in the gynecological ward, Besim said he would come and provide guidance.

Since it is a guide, try to talk more and do less. First, you have to change the concept of the two: "The broad ligament is on both sides of the uterus, can't the uterus be found?"

Denef was already desperate, and it was nothing to be scolded by himself, but he felt really uncomfortable when he was implicated by Besim. Suddenly, he heard Kavi's voice, and finally caught a life-saving straw and started to search again:

"The uterus has just been pushed and pulled up, and both sides of the uterus are filled with various soft tissues."

"Think more about the location where the broad ligament covers, then think about the differences between other tissues, and then feel them one by one with your fingers."

Denever and Besim pinched the surrounding tissue according to his intentions, and suddenly reacted: "Are they these two things that look like butterfly wings?"

"Yes, that's it."

The ligaments in their hands were completely different from those of the dead, but the experience in less than five minutes had already taken their anatomical knowledge to a higher level: "The broad ligament is found, and then."

"Next, put down the broad ligament in your hands."

Kawei stopped what they said about the broad ligament reduction surgery in time. While the audience was still surprised, he said his surgical plan: "There are so many uterine ligaments, and the ligaments that can really play a fixed uterus are not the broad ligaments."

"Not a broad ligament?"

"The broad ligament is so thin, it is only responsible for preventing the uterus from tilting to both sides. What can really fix the uterus is the main ligament below it." [2]

Kawei's advice has already gained some weight. As long as it is pelvic surgery, few people dare to question him. At least these doctors present do not have the ability.

This is what Besim wants. Performing the surgery under Kavey's guidance will definitely increase a lot of persuasion. By then, uterine prolapse will no longer be a single treatment disease. Compared to placing pessary in yd [3], many patients still prefer to do it once and for all.

As the main surgeon and assistant, they will also become celebrities who will set a precedent for surgical treatment for gynecology after ovarian removal [4].

However, Denefer seemed to believe in his judgment and suddenly spoke: "The broad ligament is much wider than the main ligament. No matter how you look at it, it should be that the broad ligament is stronger, right?"

Kawei always thinks that it is a good thing for young people to have their own opinions, but if they can't see clearly, blindly have their own opinions and overconfidence, they will be a little stupid: "Are you so sure?"

"Although you are a great doctor who founded the principle of cesarean section, you are definitely not as familiar with uterine ligaments as I have done many experiments."

Denever became bolder and bolder, until he was kicked by Besim on the side: "What are you talking nonsense? Dr. Kavi is the audience I invited. Can you speak well?"

"I'm just doing well."

Besim raised his leg and kicked him again: "Doctor Kavi has a very deep pelvic surgery skills, and this is also a suggestion for us. I think we can try to reduce part of the main ligament first, and then consider the broad ligament."

"No, the broad ligament is the important anatomy for maintaining the position of the uterus."

"In fact, we didn't recognize where the broad ligament was."

"That's two different things."

The master and apprentice who were just helping each other to fight the ridicule of the outside world, but now focus the conflict on the target of the surgery. Besim knew that his students were stubborn enough that half of the reason why this surgery was performed was actually attributed to this personality.

"Doctor Kavey."

"It's okay." Kavi didn't care. Since he was so persistent, he couldn't say much, even an outsider. "The patient is yours, the surgery is yours, and it is yours, so you should be the one who decides. Of course, if the surgery fails, the responsibility is yours."

Although Denefer is stubborn and has bad surgical techniques, he is at least not too stupid.

After Kawei questioned the function of the broad ligament, he did not rush to use the broad ligament, but first folded the extended broad ligament to see how it would be after the reduction: "Doctor Kawei, colleagues, you can see the location of the uterus after the ligament is reduced."

The uterus was between his hands, and was maintained in the center of the pelvic cavity with the shortened broad ligament.

It seemed that the operation was reasonable, but someone quickly raised a new question: "Although the broad ligament is wide, it is very thin. Can you really rely solely on the reduced broad ligament to maintain the entire uterus?"

"I don't think it's a problem, the ligaments have very good toughness."

"Ha, if the ligaments are really as perfect as you say, you won't be able to prolapse your uterus to this point. Think about how many ligaments there are around the uterus, and you can completely escape from yd, there is really nothing to expect."

"Indeed, with the thickness of the broad ligament, it may recur soon after it is reduced."

"In my opinion, since you want to do it, do the full set, reduce the loose ligaments around you, and keep the uterus in its original position again."

Kawei shook his head at this idea of ​​no clinical basis: "Some ligaments have blood vessels passing through. After shrinking, are these blood vessels sewn or not? The seams are not at this level and do not sew, because the short-term blood flow is not smooth, and the surrounding soft tissues will inevitably experience edema.

If this is done in other surgeries, there will be no problem with blood supply and side branches. But now the ligament is reduced, and it is always under the weight of the uterus. If the ligament has problems, the surgery will inevitably fail."

There is no such blood vessel passing through in the main ligament, so it is not difficult to reduce it.

Of course, like the broad ligament, although only doing the main ligament reduction is more effective and firmer, it is only better than the broad ligament reduction. Uterine prolapse is easy to recur, and simple surgical procedures cannot be perfect. If it is time to recur, it will still recur.

Therefore, modern gynecology advocates considering surgery only when it is severe.

According to the situation of this III prolapse patient, if you really want to achieve complete cure, you need to do a complete preoperative evaluation in advance [5] and then make a surgery.

In Kawei's judgment, the patient may need to undergo uterine suspension surgery to completely solve the torture of prolapse. The uterus is about hanging a certain position in the pelvic cavity, such as: transabdominal uterine sacral ligament suspension surgery, transyd sacral spondylosis ligament suspension surgery, transyd main sacral spondylosis ligament suspension surgery, etc.

At the current surgical level, these surgeries are still too troublesome because they are not enough to threaten life, and Kawei has no desire to try it for the time being.

In comparison, although the main ligament shrinkage is prone to recurrence, the advantage is that it is simple to operate and has obvious results after surgery. Even if it really recurs, the degree will not be so serious. Just use pessary support.

Denefer was a little unwilling to give up, but he was not idle and had already started working: "Is there no better way?"

The operation is just a simple treatment of ligaments. It does not involve large blood vessels, nor does it require suturing organs. It is very difficult. Even if he and Besim have no surgical experience, so many surgical rehearsals and trainings were not in vain. There is no room for complaints about the remaining surgical operations.

Soon the middle part of the broad ligament on both sides was cut off by scissors, and then reconnected with sutures.

"A better method still needs to be explored, but this should be the most perfect surgical method to think of."

Denever did not consider the recurrence factor: "If it recurs, she will continue to use a pessary."

"It's better than random surgery to cause more serious pelvic damage."

"Do you think using pessary is not good?" Kawei suddenly interrupted and asked.

"After all, a foreign object was stuffed," Denefer said.

"If you find it troublesome, it's not impossible not to use pessary." Kavey looked at the patient on the bed, "I remember the patient is 53 years old now?"

"right."

"I'm almost the same age." Kawei calculated the time and continued to ask, "Then is she amenorrhea?"
Chapter completed!