Zhang Fan touched and touched, and the slightly wriggling intestines crawled on his hands like a thick caterpillar, and there was a little itchy feeling.

Touching and touching, the greasy fat is like cream that melts in boiling water, and you can't find it. This is all positioned, if not positioned, can only let it stay in the stomach, if it lives for a long time, it may be able to grow as a lump of flesh.

"The shrapnel has entered the intestines!" Zhang Fan spoke after about ten minutes.

"Then first complete the intestines, and then go directly to the enema. You can see that it is still relatively rounded in a monitor. If you open the intestines again, the damage is too great, and you can see that the shrapnel has already damaged the abdomen like this. Lao Wang was afraid that Zhang Fan would open his intestines again to find shrapnel.

Zhang Fan stared at the monitor of the C-arm and looked at it again and again, "What if you can't get out?" Zhang Fan asked, who dares to guarantee this kind of thing, it will definitely come out.

If it can't come out, whether it is round or not, as long as it is a foreign body, it will stimulate the intestines, and then there is diarrhea that cannot be treated directly.

"What should I do then, cut it open?" Lao Wang was also entangled.

Zhang Fan gently pinched the iron piece through the intestinal wall with one hand, while looking at the monitor, thinking in his mind. What to conceive? Conceive of the size of the chrysanthemum, the structure of the intestines.

"Open it with a stretcher, soapy water enema!" Zhang Fan really said affirmatively after looking at it again and again.

"Are you sure no, if the edema causes intestinal stricture after the abdomen, if you can't take it out, it's a medical accident. Lao Wang began to worry again at this time.

It is really a happy thing to have such an old doctor on the operating table who can think about and give advice, if in other things, this kind of person is estimated to be despised: just find faults! But on the operating table, the old doctors who can find fault with you all look up to you and love you!

"Let's do the operation quickly, after the intestines are anastomized, we will start the enema immediately!" Zhang Fan said as he looked at Lao Wang.

"Okay?" No one has ever done such a thing, and Lao Wang is not sure.

"If it doesn't work, you have to do it, you look at his intestines, he can't afford to hurt anymore. "There is no way, it can only be like this, Zhang Fan gritted his teeth and said directly.

The shrapnel is not big, but the power is not small, this thing crosses the intestines, especially the small intestine, which is relatively small, as long as it is crossed, a section of the intestine is directly 34 or even a larger area of damage.

And this repair of damage does not mean that it is like a rubber pipe, sewn up and finished. Because of the prolonged rupture and ischemia, the thin intestinal wall has become necrotic, and there is no possibility of repair.

It is only possible to remove the necrotic intestine at both ends, and then start suturing from the good place, this method is no way, and the biggest disadvantage is edema obstruction.

"Intestinal forceps!" Now that it has been decided, it will be implemented, and there is no need to hesitate, the longer the hesitation, the greater the chance of intestinal edema.

Zhang Fan and the director of the general surgery department placed a pair of non-invasive scudder forceps on the normal intestines on the proximal and distal sides of the intestinal segment to be resected, which can control the blood supply while preventing serious contamination of the intestinal arch.

It is then removed by dissociating 1 or more of the normal mesangial limbus adjacent to the serous membrane, and a narrow straight forceps diagonally placed on the intestinal wall is removed. The remaining free mesangial bowel was treated with a 48-nail TL60 stapler.

This kind of surgery means that now there is a bowel stapler, and if you use sutures, the operation will take too long and too long.

During the procedure, a straight incision closure device is used to align the openings at the two severed ends of the small intestine. Appropriately cut the small intestine obliquely, leaving the free mesentery 1 from the intestinal margin. Suture the traction line at the mesangial and paramesangial margins respectively, bring the two broken ends together to bring the contramesangial margins of the two sections of the intestinal tube closer, and insert one arm of the closure device in a straight line in each intestinal lumen.

Before firing the nail cutter, the bowels on the arm fork should be flat together. When fired, the bowel is nailed together by a staple, and the cutter built into the straight-cut closure cuts the anastomosis open. If bleeding is found on the nail line, it can be controlled with intermittent sutures.

Suture a and a' at the mesangial limbus of each of the two intestinal segments, and suture the ends of the mesangial limbal pinning lines on both sides at the midpoint of the other suture B so that the two ends of the mesangial limbal side can be pulled together.

A non-cutting linear closure is then used to close the common intestinal disconnected opening. Excision of excess bowel outside the closure. If there is a bleeding point after the closure is removed, it can be controlled with intermittent sutures.

With the increase of application time and experience, it has been found that it is preferable to close point A with point A1 in a vertical way from B to B'. This allows only the two rows of anastomosis to cross at either end of the closed line, which should then be carefully inspected and strengthened sutures if necessary.

Similarly, if there is a bleeding point, it should be stopped by intermittent sutures. Check the pinned lines and remove more than the bowel. Check that the pins are reliable, and if necessary, close the mesangial limbus of both bowels with a few intermittent sutures at an appropriate distance from the anastomosis.

Interrupted sutures are performed to completely close the mesenteric foramen on both sides. The mesenteric foramen may also be closed prior to intestinal anastomosis. The mesenteric foramen must be completely closed to prevent herniation in the bowel. Finally, the thumb and index finger are used to check whether the anastomosis is patency.

This surgery is too difficult to understand in technical terms. If it is put in layman's terms, there are two rubber tubes, and then use scissors to cut off the wound about 5 long in the middle of the section of the two rubber tubes. And then the two wounds are sutured, and the stapler is actually a large stapler.

Because the sutured intestine is edematous, obstruction occurs if it is sutured directly, and the final sutured intestine is originally a long strip in a straight line.

After stitching, it is a T-shape, or Y-shape. The place where the two interfaces directly became a big pocket, which was originally a few centimeters in diameter, and finally made into a dozen centimeters in diameter. In order to prevent obstruction.

After the sutures were completed, the abdominal cavity was originally a disc-shaped intestine, and there were several more protruding empty sacs. After this operation, you must explain it to the doctors and nurses in the department to pay attention to this patient.

Intravenous lactated Ringer's solution is used to maintain fluid balance. Blood must also be continued until the pulse returns to normal, especially if the hematocrit is 30.

Two antibiotics are used. Suction and decompression through the gastric tube is continued until the bowel returns to normal emptying function. Be sure to make it clear to the doctor who is in charge of the bed that the gastric tube must not be removed without ventilation. Zhang Fan sutured the skin of his abdomen while explaining to Lao Wang.

How to judge whether the surgeon is ventilated or not, is simple, is to see if he has farted or not.

"Okay! My Director Zhang, I asked you to come to Puwai, but you didn't come, you saw that you came to Puwai, I directly retreated to the second line, and you directly had the final say in the largest surgical department of the hospital.

It's not too late to come now, and there's no assistant to the director, and when you come, you're directly the first deputy director, how about it. ”

Lao Wang tempted Zhang Fan's heart not to die, Lu Ning looked at the conversation between Lao Wang and Zhang Fan, and was very envious. "This little junior brother, what a good cow, the orthopedic surgeon does not talk about general surgery, and the director of general surgery is still pulling people hard. That's called a doctor, it's so comfortable!"

"Director, let's be unhappy first, the shrapnel hasn't come out yet!" Zhang Fan didn't care about Lao Wang, the general outside was like the Warring States Period, several deputy directors were jumping more than one another, and they were really going to the general surgery, how could they have the convenience and freedom of orthopedics now.

"Yes, yes, get rid of this matter quickly, otherwise it's always a time bomb. ”

"Don't worry, I've moved the shrapnel through the cecum, and we're going to get the enema now. Soapy water, lots of soapy water. Zhang Fan said to the itinerant nurse.

2000L of soapy water was hung on the infusion stand, the needle was removed, and the anorectum was plugged straight in. "Turn on the switch. Zhang Fan inserted the plastic tube into the intestine and said to the tour.

If there is no unnecessary and special requirement of liquid, the general infusion is very slow, one is to prevent heart failure, and the other is afraid of causing adverse reactions of infusion.

And this kind of enema, the perfusion speed is very fast, like a small stream of water from a faucet, 2000L of liquid quickly enters the intestines of the wounded.

"1000l. The itinerant nurse reminded.

"It's okay, go ahead. Zhang Fan, Lao Wang, Lu Ning, and even Jumabek and several of their internal medicine directors were staring at the anus of the wounded.

As the pressure decreases, the liquid enters more and more slowly, and because it is soapy water, with the entry of soapy water, the gas in the intestines is discharged, and from time to time a colorful bubble is blown out at the anus, just like a little girl eating bubble gum and blowing bubbles, pink lips.

"Okay!" As she spoke, the itinerant nurse turned off the switch, and Zhang Fan slowly pulled out the plastic tube, "Stretcher." ”

Although there is a stretcher, because of the relationship between the pelvis, the range of the anus is not very large, but there is no problem at all when this degree of stretching is put into a smaller bun.

As the opener opens, like a dam that opens a sluice, the soapy water is mixed with blood and feces, and it is colorful, really colorful.

Under the shadowless lamp, bubbles of various colors rise as the liquid that bubbles down as it spills down into the potty under the anus. It is like a gasoline-stained pond in summer, with flowers and bubbles.

All the people in the operation, including the instrument nurse, were tiptoeing into the bedpan.

"Why haven't you come out yet, but you're coming out!" The little nurse was a little younger in the operation, and the girl muttered to herself with big eyes.

Waiting, the most ferocious wave of liquid has come out, but there is no black iron in the bedpan, Lao Wang is unwilling, and takes a small stick to stir it over and over again in the bedpan.

There were more bubbles in the basin where there were already bubbles. "Don't stir it, it's all foam, you can't see it when you come out. Ren Li was a little anxious.

"No! the liquid is gone. Lu Ning said disappointedly.

"One more time!" said Lao Wang categorically.

"No, the wounded man's electrolyte will be out of order, forget it, let's talk about it after his wound recovers, this is my mistake, I bear it, and when I have surgery, I will go and write a report." ”

"You're in charge of a calf, I'm in charge of it, and I'm in charge of it, and I'm in charge of agreeing to the surgical plan. Lao Wang said firmly. Surgical accidents, not trivial, but also such heroic surgical accidents.

Zhang Fan looked at Lao Wang and wanted to speak, but he couldn't speak, "Add me!" Lu Ning also stood up.

"And me!" Although Ren Li is not a surgeon, she also knows that it is not easy for Zhang Fan to be them, and if there is one more person, the final punishment is estimated to be shared a little.

"Count me, this is not intentional, damn!" Jumabek, the more he thought about it, the more angry he became, and the more he thought about it, the more sad he became. This is not a credit, but everyone is not far behind, for the sake of this promising young doctor, after all, there are still many good people in the world!

"Thank you! Thank you! I am responsible for my decision, thank you!" Zhang Fan's voice was much lower, he didn't want to do this, he had nine things in his mind, and as a result, he failed in the end.

Zhang Fan slowly pulled out the opener, and at this time, with the removal of the opener, everyone in the operating room heard a voice, and it was also Zhang Fan's life, the voice he would never forget "Ding Dong!"

(The picture of intestinal anastomosis was posted in the author, which is not easy to understand, and you can take a look if you are interested.)

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