Chapter 200 197. Half of the surgery

At this point in the operation, the audience was clearly divided into three parts.

Among them, the few chief-level doctors account for the smallest proportion.

With solid anatomy skills and the telescope in my hand, I basically understood the entire process of the operation. Although the details are still messy and I can't see many operations clearly, I at least grasped the general direction.

The remaining other doctors with medical foundations form the second part.

They have good anatomical knowledge, but they don’t know much about the field that does not involve much, so a considerable part of the content is confused.

They had long skipped the details of the surgery, such as "Be careful here!", "Enough xxx here", "Don't be xxx here", etc., which are completely beyond their understanding. These young doctors only hope that they can

Mastering the purpose and operation summary of each surgical procedure, even if you complete the task, you will at least be worth the kilograms spent.

Unfortunately, it is not easy to do this.

Many people can only find a rough framework while listening and discussing. In addition, live discussions are considered double-edged swords in this kind of live broadcast, which leads to many people who can actually understand it.

limited.

For them, in addition to learning some basic sewing skills in Kawei's surgery, it is too early to involve surgical ideas and specific treatment methods.

Apart from these two categories, the remaining capitalists and nobles with no medical foundation are all capitalists and nobles. They are completely unaware of how the surgery has been carried out, and they are completely unaware of when the surgery will end, and how to deal with vascular shunts in the future.

I don't know at all.

The only thing they know is two things, one is that Fernan's spleen is gone, and the other is that Fernan is still alive and lives well.

These people also include Edward sitting in the VIP seat.

Even if he doesn't understand anatomy or surgery, he can still see some clues from the on-site reaction and the calmness of the surgical team. Putting aside the difficulty, at least until now, the operation is still within a controllable range.

This feeling of reality and the expectation in my mind slowly derailing and gradually parting ways made Edward unable to help but ask the medical consultant beside him: "What do you think of the surgery?"

"The surgery itself is already exciting enough. In addition, the blood transfusion and blood sphygmomanometer used are very creative, and the recycled spleen blood is also considered a pioneering move, and the effect is also very good."

Although what I said was a real feeling, the words used were all polite words, because the consultant focused on the surgery, for fear of missing out on the next vascular anastomosis surgery.

Cute Dow can't control these: "So, when will the surgery fail?"

".Failed? Why did you fail?"

The consultant didn't understand what he meant for a while, and came back to his senses to realize the original meaning of the operation: "From the blood pressure and heart rate reported by the nurse just now, the patient lived well. Most of the surgery has passed, from

Judging from the previous surgical techniques and procedures, there should be no major problems."

"No problem? Isn't this surgery very difficult? Isn't it infinitely close to 0?"

Edward had this premonition before, but he always felt that at Kavi's age, he could not handle such surgery. In fact, even if he stood on such a stage at this age, it would take extraordinary courage, let alone surgery.

Now that he heard his consultant’s words, Edward is increasingly worried about what to do after the operation is successful?

After all, Kawei didn't express this when he talked about the operation before. He compared the success of the operation to a young man who knew nothing suddenly made a table of luxurious French cuisine. Now it seems that the so-called "everything is the case."

The young man who doesn't understand is actually a similar character to Alphonse.

Edward was a little displeased: "He is a death row prisoner, this is a execution ground!"

"It's a pity that the person is not dead yet. Only the execution ground is the death. If he doesn't die, he can only be considered an operation square." The consultant knew that he was a little anxious and could only comfort him, "But the next vascular anastomosis is very difficult. If it is not done well,

It is probably difficult for people to survive."

"You're serious?"

"Really.(probably)"

The success rate of surgery in their eyes has long been changed due to the modification of the surgical plan.

Previously, because we concluded that there was a liver tumor, we had such a success rate considering the difficulty of liver tumor surgery. Now there is no need for the liver to move, and spleen resection and venous diversion are not too difficult for Kavi.

Before the spleen was removed, the success rate of the surgery exceeded 70%. Now, after the spleen was removed, Fernan's vital signs were still stable, and the success rate had exceeded 80%.

Next, as long as the splenic vein and inferior vena cava are anastomosis, Kavi can turn to the rectum. It is stimulated by inflammatory stimulation from worm egg deposition, and it is necessary to judge the next surgical plan in a short time. That is, based on the location of the inflammation, choose

Should I protect the anus, abandon the anus or simply not operate?

"Give me the vascular suture," Kavey said to Bergt, "in a small bottle in the box drawer."

This is a silk thread that has been compounded and soaked in chromium solution to strengthen its toughness. It is three times thinner than the original intestinal thread, but has higher toughness. Although in Kawei's eyes, it is still under the industry in the 19th century.

It's a bad product, but no matter what, it's better than other silk threads.

At the same time, it is also the key to the next vascular suture.

Only sutures are not enough. Another key to vascular suture is the carrier on the thread, a smaller diameter vascular anastomosis needle and a slender needle holder.

Compared to the location where the spleen and pancreas are located just now, the inferior vena cava is deeper into the abdominal cavity, and there is also a mesangial, omentum and a large number of intestinal ducts around it. Not only is the visual field difficult to expose, but it is also very laborious to operate.

Human hands have too many joints, and the volume and length are not suitable for exploring such areas. This is not obvious in the superficial layer of the abdominal cavity. Once the surgical area reaches the deep layer, only the equipment can be used to increase the length and reduce the volume.

The needle holder solves this problem.

Considering the grip strength and simple operation methods of the needle holder, as well as the increasingly popular laparoscope, almost everyone in modern surgery uses needle holder.

"Because the inferior vena cava is too deep and it is difficult to deal with my hands, I chose to use a pair of 'short head' forceps instead of clamping the suture needle for suture." [1]

Kawei has long been used to this surgical method, and using his hands to directly take the needle will affect the operation. However, in the eyes of outsiders, the method of fixing the suture needle with forceps is too advanced. The more advanced is Kawei's vascular anastomosis method, because

The medial healing of the blood vessel after suture needs to be considered, and the vascular fiber membrane needs to be peeled off before suture.

This practice of actively creating damage in order to better heal during surgery is actually very common.

"Vascular anastomosis itself is not too difficult, especially when you have these operating devices." Kavey explained, "What is important is how to keep blood vessels unobstructed after anastomosis. What needs to be done to keep blood vessels unobstructed is to prevent blood from being in the process of

Coagulation here is nothing more than to prevent blood vessel stenosis."

Speaking of this, he used tweezers to lift the blood vessel mask, cut it with small scissors, and removed the mask [2]: "When suturing the blood vessels, this mask is easily brought into the blood vessel wall. Once it enters the blood vessel wall,

Although it has no effect on the anastomosis itself, it will hinder blood flow."

This is a theory that should not have appeared in this era. In order to make them deepen their understanding, he could only put on the explanation of the congestion of carriages.

Many people can understand it at a glance and immediately understand that once a carriage is congested, the driver will never be happy. In the smallest, they will be scolded by each other, and in the large, they will be fist-and-footed. Once they fight together, they will not be able to pass the whole road.

The same is true for blood vessels.

"After peeling off [3], the remaining venous lumen that needs to be anastomotic should be cleaned."

Kawei took the syringe from Bergt and dripped the saline inside into the lumen [4]: ​​"If these clots are anastomotic with blood vessels and enter the lumen, it is very likely that they will be formed just after being sutured.

The blood clots made the entire operation was wasted.”

After saying that, he looked at the nurse.

“Heart rate 96, blood pressure 122/68.”

Kawei nodded.

"After cleaning, use the thread to choose inward suture. The suture technique is to fix the upper and lower points first, and then the middle, which helps to play a supporting role and facilitates reference for the incision pairing."

The skill of the kung fu has already matched the back wall. "After the back wall is finished, we can suture the anastomosis front wall, and choose continuous or intermittent." [5]

Summing blood vessels is a technical job.

Not to mention that the audience couldn't understand, even the three assistants standing next to the operating table were confused.

They only felt that Kavi's suture was repeatedly interspersed at both ends of a ball of pink, connecting two irrelevant structures together. Because the anastomosis was very small, the operation was like being performed at a point.

If it was someone else's surgery, they would have started asking questions long ago if they had problems.

Kekawei's surgery is not allowed to ask questions, not only to not interrupt one's own thinking, but more importantly, they don't know how to ask to make themselves less stupid.

"Do you don't understand?"

"That." Damilgaon is more experienced in suturing than the other two, "Why does suturing always involve the needle from the lumen to the outside? Instead of from the outside to the inside?"

"To prevent the residual tissue around the blood vessel from being brought into the interior," Kavey explained. "Although the blood vessels are almost free, there are still many fat and soft tissues on the surface. If brought in, you only need to bring in one

Dimensions will cause a chain reaction.”

"It turns out to prevent blood clots."

Kavi quickly ended the anastomosis between the splenic vein and the inferior vena cava and immediately entered the postoperative collation and examination stage.

First of all, the position and shape of the spleen vein. In order to maintain the unobstructed splenic vein, this lateral branch should try to share the pressure for the entire high-pressure portal system. At least the spleen vein cannot be twisted, nor can it be compressed by other organs, let alone

Bending occurs.

"Relax the hemostatic forceps."

After Kawei's examination, the first thing he needs to do is blood circulation.

Essentially, the quality of the suture needle is still not enough to perfectly end a venous anastomosis. The needle hole at the anastomosis itself is a damage, and it will definitely cause bleeding: "There is a bleeding point here, give me gauze."

After two consecutive pressures, the bleeding point at the anastomosis mouth was stabilized.

"Come on, bring the pressure gauge we just now."

"good."

"Splenectomy and venous shunt are both excellent surgeries for treating portal hypertension," Kavey explained, "The effect is immediate."

I saw that the person who was in charge of the experiment just now was replaced by Bergate and Damiergaon, which were still long glass tubes and still pierced into the mesenteric blood vessels: "It has dropped, it has dropped to 23cm."
To be continued...