Fernan's rectal mass is similar to a single rectal tumor, but its properties are much better than those of malignant tumors. The boundaries are clear and smooth, and there is no vague feeling of difficult to define the range of malignant tumors. Considering the existence of schistosomiasis infection, Kawei

The diagnosis of inflammatory mass of schistosomiae was given.

In fact, if you are more serious in modern medicine, under the premise that Fernan has testicular cancer, these lumps need to be labeled as "tumor waiting to be discharged".

But whether it is a tumor or not, the surgical indications are similar now

Ordinary inflammatory masses deposited by insect eggs are not aggressive. If you have to compare them, this inflammatory mass is just a pile of debris that forcibly occupy public areas. It does not seem to have much harm except occupying public places.

.

Just like a lump on another colon, the inflammatory area does not penetrate deep into the lumen and does not affect daily life.

Malignant tumors are different. The difference is that the tumor will grow rapidly, invade the lumen, and transfer to other tissues. In comparison, it is like a foul-smelting sludge monster that will grow infinitely and be omnipresent. Now it is not

Eliminate it and one day it will occupy the entire city.

Although the lump on Fernan's rectum does not look like a malignant tumor, his lifespan does not require growth, and it does not have metastasis.

But its location is not good. Judging from the touch, it should have invaded the muscle layer inward and will soon be at risk of penetrating the mucosa. The lower edge has reached the near tooth line. As for the specific distance, it is still necessary

The peritoneum will be clear after opening it.

If debris are piled up in the corridors and streets, it is called debris. Once it is piled into the room, it becomes garbage that has to be cleaned.

However, this is only for long-term residents. If they can't hold on immediately, it's not impossible to endure it.

“The location of this lump is really subtle.”

At this time, Kawei was using his finger to penetrate Fernan's anus and repeatedly touched the surface of the mucosa attacked by the lump. The more he touched, the more he felt that the necessity of the operation was lower than expected. To put it bluntly, the operation can be done or not.

From the perspective of medical technology, there is no right or wrong in whether the operation will continue.

Judging from the size and degree of invasion of the masses, it is indeed at the point where it needs to be removed, and the surgical indications are clear.

However, from the perspective of postoperative recovery, rectal surgery has its own contamination properties. With existing conditions, postoperative infection is almost inevitable. Moreover, rectal surgery must touch the sphincter. Will the anus be preserved at that time and will the sphincter be protected?

Damage is a problem.

The most critical point is that no one knows whether there will be any accidents during the next 1-2 hours of surgery.

If it were in modern times, Kawei might consider continuing to do it for judicial procedural justice. But if it only starts from personal interests and considers the risks of surgery, it would be better not to do it.

First of all, Fernan is an unquestionable death row prisoner, and there is no doubt about this.

From the beginning, the purpose of the operation was to show everyone the surgical method of treating portal hypertension, rather than saving his life. Now that the portal hypertension has been treated, the spleen is cut very clean, and the blood vessels are well aligned. Kawei

Very satisfied.

Edinson sat in the audience, he was not a fool.

He had previously insisted on cesarean section and breast cancer removal was useless to the military doctor. He did not express his opinion on Olgi's abdominal surgery, and he could always suppress Kawei because of his identity.

Now that so many eyes are watching the abdominal surgery successfully end, Kawei has set a record again. If he still kicks him to the front line, it is obviously inappropriate. Not only will he be gossiped about, but he also has to worry about Morasso in the military doctor's office.

Energy on both sides of Franz.

Franz is not a fool either.

Even though he chose not to speak out due to the face of the Aidinson family, Kawei has now put a bargaining chip on himself. If such an operation doctor cannot get the position of the surgeon in the field hospital, he still needs to follow the battalion-level troops.

When you rushed to the front line, the joke became a big deal.

According to Edward, this is a waste of resources.

Since the preoperative goal has been completed, there is no need to take risks anymore.

Kawei sighed when he thought of this: "Forget it, after further examination, this should be just a benign mass. The surgical removal itself also has many dangers of postoperative complications, and it may be more troublesome."

After talking to several assistants, Kawei pulled out his fingers, turned around and walked to the front of the trumpet and said, "Dear Ambassador, the original surgical plan has been completed. It is a bit difficult to deal with the rectal lump. I personally

It is better not to move.”

Edward frowned, not knowing what Carvey meant to say this. It was not until the consultant next to him said, "The operation is about to be over." He realized the seriousness of the problem.

"Mr. Kavey, as a doctor who saves life and helps the wounded, you should challenge your limits." Edward picked up the horn and suggested, "Since the previous operation has been completed, it means you are fully capable of challenging the new difficulty. Why not just put the rest?

The lump you are under should be cut off as well."

This actually makes some sense. If Fernan was just an ordinary patient of his and had no death row inmate label, Kavi would have done so.

But there was a strange smell when it came out of Edward's mouth.

Obviously he was very dissatisfied with the success of the operation, but he did not want to break the current situation, so he hoped to extend the operation time and increase the risk of the operation, so that Fernan died peacefully on the operating table. This was not only his wish, but also

God's will, Kavi won the first half and lost the second half without any loss, it was perfect.

Cavi certainly knew what he meant.

"Mr. Edward, from a medical point of view, the risk of continuing the surgery is very high." Kavey showed blood on his fingertips and said, "It would be better if the patient was just closed to the abdomen, it would not last for a few days, so it said."

This is another saying. Edward suffered a loss once, and he would not believe him. Before he could finish his words, he interrupted: "Doctor Kavey, this is called the surgical square. Since Fernan still has physical problems, it should be solved.

The problem is right."

"Well? How do I remember Mr. Ambassador called this execution desk before?"

Edward was not stolen by this sentence.

He looked at Franz, then looked at the crowded audience in front of him, and raised his voice: "I am just a diplomatic ambassador and have no right to decide. I think the most important thing to ask is whether to perform surgery or perform hanging directly or not.

The citizens of this great city are the audience here.”

This question is meaningless. Whether Fernan dies is secondly. The main problem is how can a fee-based surgery be good for hanging.

Even though Kawei's first half of the operation was very boring, the spleen was removed in the second half of the operation was still quite exciting. Now the surgical area was moved down to the rectum, and the audience naturally did not want to give up based on the principle that one more was to see.

"Doing surgery! Doing surgery! Doing surgery"

Edward looked at Kawei with a smile: "Whether it is the surgical square or the execution stand, the audience will naturally have the final say after paying the money. Please continue the operation."

Carvey wanted to refute that he did not receive the money, and it was a free performance, but considering Franz's role in the charging process, he still kept the words in his heart. What war mobilization lacked the most is money, and now it is with

When Franz talks about money, the meaning of using surgery to replace the death penalty will disappear.

The surgery is good too.

He quickly changed his mood and adjusted himself to the state of surgery: "Since everyone wants to see it, I will continue to do it."

Hearing this sentence, there was a burst of warm applause from the scene. The sound of the sound just now rang again, but this time it was changed to Kawei's name: "Kawei! Kawei! Kawei."

The country was very safe in the 21st century, but if time was moved forward for a while, it would not be peaceful.

Trauma in the abdominal cavity is always accompanied by intestinal damage. Although rectal is rare, there are more cases over time. Rectal foreign bodies are also frequent visitors in the emergency department, and they have changed their patterns over time, so Kawei uses rectal

He is also a skilled worker in the operation.

Rectal tumor resection seems to be just a resection surgery at a certain part, but due to the functional positioning and special anatomical structure of the rectum, the surgical methods appear diverse.

There are more than a dozen types of Kawei still remembers. [1]

As for which one to use, you must also choose between available instruments and the specific location of the tumor you see after the visual field is exposed later.

"Give me a scalpel." Before Kawei could finish suturing the upper herringbone, he had already taken the scalpel and made a central incision in Fernan's lower abdomen. "Hemostatic forceps, warm gauze, tissue anatomy forceps. Report the heart rate

blood pressure."

“98,124/73.”

Kawei nodded, his hands began to accelerate, and ignored some small bleeding points and entered the abdominal cavity directly: "Prepare warm saline, rinse the abdominal cavity twice before surgery."

"good."

Berger added another bowl of spleen blood to Fernan's blood transfusion bottle, turned around and prepared normal saline, and prepared wet gauze for the operation. Two basins of water were used to make some blood coagulation remaining in the abdominal cavity.

The piece and the ascites that had just leaked were pumped out together.

Kawei once again checked the location and range of the lump and found that the distance from the tooth line was not too close. If you grasp the cutting range of the lower edge of the lump, you will still have a chance to protect the anus.

The surgery is a variant of dixon surgery, that is, there is no need to expand the range of the outer edge of the mass, nor does it need to remove the surrounding meses. It is only a simple intestinal resection where the mass is located, and then intestinal anastomosis is performed. [2]

"After entering the abdominal cavity, we first get the small intestine [3], and then find the sigmoid colon and rectum."

Kawei gently pinched the sigmoid colon in his hand, and incited the posterior peritoneum along both sides of its mesangial root, revealing the root of the submesenteric artery: "We began to clean up the lymph nodes and fat tissue around the intestines downwards." [4]

If you are undergoing traditional rectal cancer resection, the submesenteric artery needs to be disconnected, because the descending colon, sigmoid colon and rectum are all removed. But now what Kawei does is just a simple mass cutting, and there is no need to expand the range, so these blood vessels can be completely preserved.

Live.【5】

"When we clean up lymph and fat, we must pay attention to the left ureter." Kawei was doing it while freeing downwards, "and then we can cut the posterior peritoneum and enter the gap in the front of the sacrum." [6]

When you reach the anterior sacral space, directly look Kawei closes to the dorsal side of the rectum and begins to perform sharp separation to the pelvic floor. The separation must exceed the tip of the coccyx to avoid damaging the anterior sacral nerve plexus and venous plexus. [7]

Considering Fernan's physical tolerance, Kawei did not tell too much about it here, but greatly accelerated the operation according to his muscle memory. The operation itself was not within the scope of preoperative exercises, and the two assistants could only rely on

Intuition to start.

"We cut the rectum sacral fascia, and then we can see the rectum, fully freeing the rectum, and we can see the lump right in front of our eyes."

The feeling of touching the abdomen with the herringbone incision was blurry because there were many soft tissue barriers and other intestinal ducts to interfere. Kawei's judgment on the location of the lump was different.

Now that I have done a full freeze, Kawei can fully see the position of the lump, just 3cm up the tooth line, which is very thrilling. If I sink 1-2cm further, Kawei will find it difficult to ensure Fernan's

Anal function is now.【8】
To be continued...