195. Cold White Bloom

The original technical content of the surgery is not high, and it is just a lack of experience for laymen, but intuitive limb cutting is not difficult to understand. Therefore, the wailing surgical performance can bring exciting experience to some people, and it can also serve doctors.

It brings a lot of income and reduces the treatment costs paid by the "patients".

Even if anesthesia has become a routine preoperative operation, the operation time has been greatly extended, and the fast in and out operation has become more and more refined, and those viewers who like blood will still buy it.

After all, the main surgery is Kawei who created miracles, and the surgical site is a rare abdominal cavity, and the patient is still a murderer who must be executed. On the scene, there is also the King and Queen who came here in person, which can attract many people.

The eyes are full of all the stimulating buffs.

At the beginning, people who are completely unwilling to care about the procedure are left, whether they are looking for trouble or supporting the show, their reactions are very uniform, that is, expectations.

They look forward to a complicated abdominal surgery to open their eyes, and they also hope that the disintegration of the belly can bring sensory stimulation to themselves, and they also hope that the life of the murderer can be ended on the premise that the operation is successfully completed.

However, until now, Kawei has not used any other equipment except hooking except for simple opening of the abdomen and pulling the intestines with his hands.

No cutting, no bleeding, no suture and a brief explanation.

Although Kawei has always emphasized that he is doing the exploration, is it really necessary to do such an exploration? Does it require an exploration before the abdominal surgery begins in the future?

Preoperative anesthesia has made the operation very boring. Add another investigation, is it still possible to do the operation? How troublesome is it?

If the audience is an alcoholic, then the previous surgical performance was mixed with ya tablets of strong wine, and it was immediately overwhelming after drinking it. Although the surgery after anesthesia was less irritating, it could also become ordinary wine on the table

, it is a drinkable level, and it is also good to treat it as an embellishment in life.

Even if the operation fails, it will be a spoiled and oxidized wine, and at least it has a little sour taste.

But the operation in front of me was too dull, without conflict, without climax, without even a trace of ups and downs. The surgeons led by Kavey stood around the operating table, constantly checking Fernan's belly, just like

A great master wrote a book that he had ordered for less than 100 times and rushed into the gutter.

Even if Kawei used a blood pressure monitor to suppress the opening scene and then used the cleft body to attract the attention of the wave, in the eyes of the audience, the beginning was just the beginning, and the parasite was just a one-time job.

The operation time can be extended or slightly dull, but the basic stimulation must be ensured. The source of stimulation is the focus of the operation, which is a flying scalpel, a splatter of blood, and a cut residual limb.

If these are missing, there is no ornamentality. Once there is a problem with the ornamentality, it will be useless to save it.

As early as twenty minutes ago, many people took the lead in discussing the surgical atmosphere that was as cool as a white air. As time passed, the audience's emotions finally came after experiencing suspicion, boredom, sighs and helplessness.

A wave of explosions.

Someone shouted, "Why does this boring operation cost more than 800 kronor?", and the same thought spread across the audience like a pile of straw that had lit fire.

Fortunately, those who can sit in the audience are either rich or noble, and their voices are quite restrained, not to the point of noisy.

On the other hand, the area where the surgeons are located is completely the opposite. At the beginning, there were many doubts caused by Mosier, Ferguson and Botini, but after the operation started, these voices completely disappeared.

All they have is surprise, admiration and confusion.

So after the audience had some dissatisfaction, someone immediately stood up: "Can you even feel bored with this kind of abdominal surgery?"

The first question is Ignaz. Kavi is now half the storefront of the Municipal General Hospital and a nominal student. He must support him at this time. Moreover, from a professional perspective, this rhetorical question is correct.

.

Soon, several chief physicians also came to the scene and expressed their attitude.

"The three drip bottles hanging on the arm of the death row are already at the forefront of world medicine." Watman added, "The combination of blood transfusion + infusion not only makes people live to this day, but also slowly stops."

I was stolen and vomited blood. Do you know what this means?"

"And the simple blood pressure meter he used was an ingenious move that could not be ignored," said Orgi. "Even if the surgery fails now, his name can be engraved in medical history books with blood transfusions and blood pressure meters.

.”

"Even without a sphygmomanometer and blood transfusion, his cesarean section would be enough to leave his name."

Looking at the crowds who were complimenting, Hills still insisted on his point of view and was skeptical about blood transfusions and blood pressure monitors. [1]

Before the application effect is clear, whether the blood pressure reading is really necessary to enter the clinical stage needs further research. Whether blood transfusion is really as safe as Kawei said also requires experiments and time verification.

However, putting aside these two points, because after Olgi's abdominal surgery and cesarean section and seeing Kavey's amputation, Hills has gradually understood the importance of standardizing the operation process in abdominal surgery.

Of course, he still has a very shallow understanding of this aspect, but he still says something fair to Kawei: "The abdominal cavity is not the arms or the thighs. In addition to a large number of blood vessels, it is also filled with various internal organs. We are

Doctors, if they use the prisoner's slaughtering technique to perform surgery on him, it would be a blasphemy to our profession."

"Okay, don't you know whose money you spent? "

After Masimov experienced the last brain surgery, he began to trust Kawei unconditionally: "Kavi will naturally give a satisfactory answer. Since he has done this, there must be a reason why he did this.

, I just don't understand it."

With the support of colleagues, especially those who have made many achievements in surgery, the field finally stopped.

In fact, they knew in their hearts that these were not just support among ordinary colleagues, but also out of their desire to learn new technologies. What really made these doctors realize the gap between them and Kawei was a passage he said after examining the abdominal cavity.

.

"Mr. Fernan has schizotomyosis, the liver portal system is damaged, and now there is portal hypertension, the spleen expands infinitely, and even the rectum has inflammatory nodules, and it has invaded the intestinal mucosa. The situation is not optimistic.

Although the patient's body is being attacked by parasites, I have also had a check on the esophageal and gastric vein just now, and the varicose is very serious."

Kavey gave a brief summary of Fernan's physical condition and said, "But I am confident that he can be cured with a surgery."

This situation has completely lost the opportunity for surgery for existing surgeons. Facing a mess of abdominal cavity, not many people are willing to use the knife.

In fact, when faced with upper gastrointestinal bleeding, half of the top doctors present would choose to give up, and the next half would basically choose conservative internal medicine treatment or simply not treatment.

No one will choose to open the abdomen, even if the other party is a death row prisoner, they will not open the abdomen. It is not because the operation fails, but because no one knows how to deal with portal hypertension after opening the abdomen. They don’t even know

Cirrhosis is the direct cause of portal hypertension.

Kawei made a collective jump in their medical knowledge, and the side effects brought about were a bunch of question marks.

It is hard for them to believe that such a young surgeon had found the cause and surgical solution to the varicose veins less than 7 years after the French discovered the esophageal and gastric varicose veins. [2]

How can you still have confidence in this severe situation? Before opening your stomach, you said you were not sure, so where did you come from now?

What they don’t know is that confidence is earned by previous investigations.

Unexplained diagnosis will greatly increase the difficulty of the operation, but once the diagnosis and lesion location are clarified, the nature of the operation will change.

Nowadays, surgery is no longer a chance cut in Kawei's hands, but a complete set of combat plans. The fast-forward and fast-flowing surgical performance has lost its passion under Kawei's standardized surgical operation process, but it has increased

Success rate.

Kawei didn't care about the questions from the people below, nor did he pay attention to Edward's crazy coughing behind him. He knew that as long as the speaker was still in his hand, the right to speak in the venue was his own: "I will choose to cut off the huge spleen first when the surgery was done.

, and then selectively perform peripheral blood vessel shunt or directly perform peripheral blood vessel cessation surgery.

This should be the first time he has clarified the basic surgical plan to the audience.

Spleen removal is easy to understand. In today's abdominal surgery, cutting off damaged or swollen spleen is a common surgical procedure, and the difficulty is not too high. But what is the subsequent shunt surgery? The flow cut is also

What?

Can surgery that has been operating on the limbs and organs be used in the same blood vessels?

Since the concept of aneurysm appeared in the 18th century [3], the most direct and only way to treat blood vessels in clinical practice is ligation.

The blood vessel is broken? Ligation.

Blood vessels are broken? Ligation.

Do you need to cut off certain tissues and cut off blood vessels? Or do you have a ligation?

Even if Kawei has done simple vascular repair or compression to stop bleeding, ligation is still the absolute mainstream.

They also thought about anastomosis of blood vessels, but soon this fantasy idea was defeated by the simple surgical suture needles. In fact, even if they handed over the modern vascular surgery stuff, it was because of the anatomy and clinical understanding of the vascular walls.

Even if the blood vessels are really connected, the lumen stenosis will occur due to inward hyperplasia at the suture.

Kekawei still put the suture vessels beside his mouth and said confidently: "Don't be excited. If you have any questions, then we will talk about it when the operation is over. At that time, no matter whether the operation is successful or not, I will try my best to answer your questions."

After saying this, he began to ask Beggot to prepare the equipment, and continued to talk about the next surgical plan:

"After the spleen and blood vessels are processed, we will choose the solution to rectal lumps based on the patient's blood pressure, heart rate and nodule invasion range. Before this, we still need to focus on the spleen, which is not an ordinary spleen.

, it is not easy to deal with."

Before treating the spleen, to demonstrate the effect of the surgical procedure on portal hypertension, Kavi also needs to do a simple portal pressure measurement.

Damilgaon and Begate turned the skin at the herringbone incision downwards, and then spread the large omentum flat at the incision. Kavey chose a thicker omentum vein as the measurement point, while Hermann went to Beg

The elongated J-shaped glass tube (composed of glass tube, hose and needle) brought by Gert was filled with normal saline, and the needle was stabbed into the vein from bottom to top. [4]

The saline liquid in the tube gradually descends along the needle and stops until it falls at 31cm.

"The normal portal pressure is around 13-24cm water column, and 31 is already very high." Kawei removed the pressure glass tube and then asked Herman to sew the venous blood vessels with needle and thread. "After the spleen is removed, we can

Let’s look at the pressure in the blood vessels. If the pressure returns to the normal range, then shunt surgery will be avoided.”

He used forceps to find the spleen and stomach ligament: "Next, according to the basic procedure of splenectomy, we need to ligate the splenic artery. Give me scissors."

The scissors accurately found the avascular area on the spleen and stomach ligament in Kawei's hand, gently cut a small hole, and then clamped the blood vessels with blood vessels to separate the ligament.

"This is the spleen and stomach ligament, and next to it is the spleen and colon ligament. The cut is to better separate the spleen."

Kawei used forceps to clamp the blood vessels on both sides, then cut the ligament in the middle with a knife, then Herman and Damirgaon were each one, and at the same time, the sewing of the broken end was done.

Kawei continued to investigate around the spleen. There was schistosomiasis, and although it did not cause serious inflammation in the abdominal cavity, there would be many adhesions. If you ignore these adhesions and forcefully free them, it would definitely cause a lot of bleeding.

, This is not the style of modern surgery.

However, just as he was investigating the adhesion of the spleen, Hermann's move almost killed Fernan.

"What are you going to do?" Kavi asked, blocking Herman's arm with his hands.

Herman was a little confused: "I want to turn up the stomach fund and stomach curvature to increase your surgical vision."

"We don't have this step in our corpse practice, so don't move around." Kavey moved his hand away, and gently lifted his stomach with his own, and said, "You all come and see what's underneath."

[General foreign medicine should be very familiar with it. The content must be discussed on the stage of gastrointestinal surgery]
Chapter completed!