289. Separation of human skills

Surgery in the 19th century was still in the middle stage of Pangu's opening up the world. Urology, obstetrics and gynecology were already divided on the surface, but the skills of many surgeons were general and there was no clear division of the subject.

For example, Ju Yong, who is now in the No. 2 surgical theater, studied under Mosier, who is Albaran's senior brother. His research direction is urinary stenosis and prostate. After Mosier temporarily left the main palace hospital, he was

Here, the director of the urology department is a serious urology surgeon.

But now, Ju Yong is asked to take the lead in this operation.

The surgery standing opposite him was Sedillo, the director of the University of Surgery, who was about the same age as Watman, and was doing a gap in surgical history - partial gastrectomy.

“What are you doing???”

Kavey thought he had heard it wrong, so he asked Albaran to repeat: "The patient suffered from gastric outlet cancer, and there was a clear mass in the upper abdomen. Professor Sediyo wanted to cut open his stomach and put the tumor and him.

All tissues at the distal gastric distal are removed together.”

It sounds very reliable. Although partial gastrectomy caused by modern pyloric cancer is complicated, the risk has been greatly reduced. Basically, general surgery departments in tertiary A hospitals can do it.

But it is November 10, 1866. Bill Rott, the founder of gastrointestinal surgery, is taking care of a large number of wounded soldiers at the Ormitz Fortress. It is still 14 years before the world's first gastrectomy was officially successful.

Of course, Kawei believes that the time for completing this operation with his own help will be greatly reduced, but even if the person who completed this operation is not himself, he should not be a French person.

Based on the current surgical technology and equipment in Paris, the success rate of surgery is infinitely close to 0.

"This surgery is not easy."

Kavey said it very tactfully, because you can find many difficulties that other surgeons cannot handle, including details of the free stomach and duodenum, spilling stomach acid, suitable anastomosis, etc.: "That person is a pussy."

Has Professor Diyo ever had this kind of surgery before?"

"I did it once, and the patient died on the operating table. But the professor has been practicing for several months today, so it should be fine." Albaran's eyes were full of admiration, "Of course, surgery is inherently damn risky, what

Things can happen."

The words are very pertinent, but as long as you are a sensible person, you should see from the face of the assistant who came to shake people that the operation is not very good.

"Where has the surgery been done?" General Surgery is a key project in emergency surgery, and the gastrointestinal tract is the highlight of it. Kawei cannot understand it. "Free duodenum? Or is the tumor being removed? Or is it already ready to do it.

It matches it?"

The assistant's face turned pale and shook his head repeatedly: "I, I don't understand very much. I just came to see Dr. Albaran as Teacher Ju Yong asked."

"All right."

In just two minutes, Kawei had come up with several surgical plans and possible problems in his mind, and quickly prepared various remedies. If he really needed to go to the stage by himself, he would not do anything.

No.

But surgery not only depends on technology, but also on support from all other aspects.

Kawei could think of the original intention of the other party to try this surgery, because of general anesthesia, which gave them more time to operate. Although the mortality rate of surgery is very high, as long as the number of patients willing to operate continues to increase, they will always encounter success.

of.

Unfortunately, Seidio did not recognize the diversity of preparations required for surgery.

There is no disinfection, no mask, no gloves, no blood transfusions, no first aid medicine and corresponding countermeasures, and even the monitoring of vital signs cannot be done. This kind of dangerous third-level surgery is always accompanied by

Full of traps

The three of them bypassed the abortion and opened the gate of the surgical theater. What directly impacted the eyeball was the tense surgical scene in the venue, and the surroundings were audiences similar to those of the Vienna Surgical Theater.

The main palace hospital is actually more like a church hospital. All projects in the hospital, including treatment, are free. Of course, the surgical theater is only open to the public, and the audience must at least be medical students coming to internships.

They were all wearing gray or black formal coats, holding pens and notebooks in their hands. Although they had communication, they were very restrained. Everyone's eyes were gathered on the 20cm-long cutout.

The only thing that could be heard in the audience was the cry of the surgeon Seidio: "Hurry, gauze! Hurry, press here, the bleeding is very serious!"

"Where is the suction? I can't see anything, so suck it quickly, suck it quickly!"

"Lower the light!"

Albaran didn't dare to say much. After entering the door, he changed into a surgical leather skirt with the help of his assistant. He walked over without passing Kawei: "Teacher, professor, I'm here."

"Where did you go just now?"

"I, I've gone"

"Forget it, hurry up and get another suction device and help suck it together, and there is too much bleeding."

There are a large number of blood vessels around the stomach and duodenum, so you need to be extra careful when freeing. Especially the duodenum, not only is it rich in blood supply, but it is also a structural intersection of many important abdominal organs.

On one side is the bile duct, the portal vein, and on the other side is the pancreas, and its position is also backward, making it difficult to escape. When the field of surgery is not clear enough, it is to complete the entire operation without bleeding or try to reduce bleeding.

The basis of

If you can't even do this, then surgery is almost like murder and there is no need to do it.

Kawei shook his head slightly, and walked into the audience alone as a Chinese medicine student in the eyes of an outsider, finding a seat in the corner, wanting to see what will happen next.

However, not long after he stood still, the patient's condition took a sharp turn for the worse. The experienced nurse on the side just took a pulse and knew that something was wrong: "Professor."

Sediyo was concentrating at this time, staring at the huge incision in the upper abdomen: "Very good, the blood seems to have stopped. Please give me some gauze and work harder! After the vision is clear, we will do the tumor edge again.

Pliers, and then."

"Professor Sediyo!"

The nurse couldn't help calling him again, and the 62-year-old surgeon finally responded: "Hmm? What's wrong?"

"Patient He" the nurse sighed lightly, then shook her head, a signboard movement that tactfully expressed the patient's death.

Seidio guessed the result immediately, but he still didn't give up: "What the hell is wrong?"

"Mr. Poris's pulse disappeared."

Albaran dropped the suction device and put his blood-stained hand on the patient's carotid artery. After a while, he moved his fingers to his mouth and nose. The result was self-evident, and the patient's heartbeat and breathing stopped completely, and he had never carried a lot of them.

Shock caused by blood loss.

As he stopped, everyone stopped.

Seidio could not accept this fact for a moment, his head was buzzing, and he couldn't even stand up. But due to the self-esteem of the director of the surgical department of the oldest hospital in Europe, he still stabilized with the help of other assistants.

scene:

"I have to announce the death of Mr. Poris, who failed to survive the heavy bleeding during the operation. Unfortunately, it is a pity that the operation is just a few times before the tumor is cut off. I have not saved his life

.”

At this time, the other two suction tubes that penetrated the patient's abdominal cavity were still working, and the blood in the abdominal cavity was sucked clean. The gauze in Juyong's hand did not stop, but carefully wiped off the remaining blood.

The tumor was exposed: "Albalan, go get the tissue forceps."

"good."

Sadieyo was unwilling to accept that he really hoped that another patient with a similar condition and urgently needed surgery would be available.

However, abdominal tumors can only be diagnosed if they grow to the point where they can be palpated by hand. In addition, the patient is still resistant to the operation, so it depends entirely on luck to find such a surgical target.

well.

Suddenly, some fragmented applause rang out in the audience on the stage, accompanied by the sentence "Professor Saidio's innovative spirit is really refreshing", and the rainbow farts of everyone gushed out, and it became more and more harsh amid the gradually fierce applause.

Unlike Kavey, Seidio seems to like this kind of praise very much. Perhaps this is the inner driving force behind his insistence on surgery.

His surgery was not over, and the surgical theater did not allow half-stop surgery: "Next we will remove the tumor for Mr. Poris. Then remove the distal end of the stomach and part of the duodenum that it invaded."

Another typical separation of human skills. After Kavey increased the overall success rate of Vienna's surgery, he had not seen this for a while. Now it seems that he is full of emotion.

However, unlike when he first saw Hills, he no longer looked at this phenomenon with a simple critical perspective, but became more objective.

Most surgeons, including Seidio, are not stupid. They all know that the patient's life and death are the most important purpose, but they still choose to retain their original understanding of the operation.

That is, the patient's life and death belong to the patient, and the doctor must care, but he doesn't care so much. The doctor's surgery belongs to the doctor. Whether the surgery is successful depends on whether the original surgical goal can be completed, and the patient's survival can be regarded as completing the established goal.

An accident at the time.

This is not their cold-blooded, ignorant, or psychological distortion, but a special excuse to alleviate the guilt caused by the failure of the surgery.

After all, in this era, it is an accident when a patient dies, and in a sense it is also an accident.

Unexpectedly, after Mr. Poris was pronounced dead, the originally busy surgical team became much calmer. The weight of lifelessness made their techniques gradually become more sophisticated and skillful, and everyone's face no longer had the tension he had just now.

It seems that they are more accustomed to dissecting dead bodies than treating living people.

Kawei has never seen such an exaggerated visceral tumor. Even if the distance is so far, he can still see the patient's pylorus swollen into an apple. There are ulcers around him and adhesions, and the abdominal cavity must have metastases. From a modern perspective

Look, it is not suitable for surgery.

If this is aside, Kawei is more inclined to type I surgery in terms of surgical methods.

The source of this name "Billroch" is Billroch. The surgery has been improved and fine-tuned since it was created more than 140 years ago and is still active on the operating table of general surgery.

The Bi-I type directly anastomosis of the residual stomach and duodenum, with simple operation, and the gastrointestinal tract is close to the normal anatomical physiological state after anastomosis, so there are relatively few complications. [1]

There are many advantages, but the disadvantages are also obvious.

Because the tumor has adhesion, the duodenum itself is dragged down by the surrounding complex structures, so it is definitely difficult to escape. In addition, the tumor range is large, if the range of gastrectomy is increased, the tension will be performed during gastroduodenal anastomosis.

Get bigger.

If the tumor really affects the anastomosis after resection, Kawei will still change to the Bi-II style, which is more flexible.
To be continued...