If this surgery is combined with lymph node dissection, it is directly a combined abdominoperineal resection.

In other words, everything in the patient's lower abdomen is cut off. Ms. Jiang's staff is strong, and the pull out is timely, if it is slower, the damage is a little bigger, and there is no need to rescue.

Zhang Fan used toothless forceps to pick up the remaining sigmoid colon, and the forceps in the operation were divided into toothed and edentulous. The tip of the tooth tweezers has a tooth-like protrusion like a rat's tooth, which is more stable when clamped, but this thing cannot be used to clamp organs, especially the intestines, and there are three small holes in one clip.

Intestinal bleeding is considered to be completely clamped and closed, this is the most preliminary, there is still a lot to do, first of all, the ureters and vas deferens must be explored, and because it is not dissection, it is necessary to explore the pelvic autonomic plexus, as well as the sacral nerve, so to speak, this operation is similar to dissection.

If it is ruptured and cannot be repaired, these things will be removed, such as one side of the ureter ruptured to the point that it cannot be repaired, there is no way, the corresponding kidney must also be removed!

It is estimated that the drain is not very large, and if it is a little bigger, it will be troublesome. Fortunately, the bleeding has been stopped, and there is no obvious damage to the ureters, vas deferens, and other organs, and the life of the stupid child is currently saved.

"The abdominal cavity and other organs of the pelvis are intact!" Zhang Fan said to the director of the general surgery after probing, and then asked, "How much is the bleeding now?" How much solution is in the suction device. ”

"3000ml of liquid, now it is difficult to estimate bleeding. The itinerant nurse glanced at the liquid bottle on the ground and said to Zhang Fan.

"It is estimated that it is at least about 2000ml, and when I came, I was already in shock, plus we had bleeding during the operation, so I had it. ”

"Well, the amount of liquid has increased. Now it's time to remove the dead tissue. After Zhang Fan finished speaking to the anesthesiologist and nurse, he began to remove the intestines remaining in the stomach.

The sucked intestines are spread out in the abdominal cavity like pieces of rotten cloth, and because of the ligation of blood, the color has turned white, and it has long lost its original ruddyness. The bowel in the pelvis has been destroyed, and only the remaining rectum and sigmoid colon can be removed.

The sigmoid colon is easy to say, after closing the mesenteric artery, it is OK to directly cut the stump with tissue scissors. "Sterile tissue bags give me two. After Zhang Fan cut off the stump of the sigmoid colon, he had to put the cut into a tissue bag, and then he would have to show it to his family.

The other end is ligated with a tissue bag, which contains a large amount of E. coli, which is a normal flora in the intestines, and once it escapes, it is a pathogenic bacteria. So first wrap the other mouth.

"This scissor will make the young man sad in the future!" Zhang Fan said to the director of general surgery with emotion as he looked at the sigmoid colon in the tissue bag.

"It's better than dying, it's better to die than to live, besides, the family of the rich doesn't have to worry about eating or drinking, and he doesn't need to move bricks to work, and eating and drinking is also a lifetime. ”

"People should do something!" Eat and drink for a lifetime, no waste will be made, the latter sentence, Zhang Fan is embarrassed to say it.

"Don't think about the future of other people with your poor mindset. I want to eat and drink for the rest of my life, but I can't meet the conditions. Hey!" The director of general foreign affairs estimated that the minds of several deputy directors under his hands were tired.

The sigmoid colon is done, followed by the rectum and anus. The rectum and anus are not as easy to handle as the sigmoid colon. Zhang Fan first used his two fingers to enter the anterior space of the bottom, that is, the surrounding tissues of the rectum and buttocks, with his middle finger and index finger, and slowly separated them to identify the levator ani muscle.

"Vascular forceps!" The nurse handed Zhang Fan two pairs of forceps. The blood vessels of this human body are very shrewd, and it knows that its body is thin, so it usually finds a big brother, either bones or muscles, and then hides it in the big brother or next to the big brother. Therefore, to cut the muscle, you must first clamp the ends and then tie the knot before you can let go.

In the past, when there was no electric knife, after this kind of muscle was broken, the stump had to be firmly sutured with sutures, because after the muscle was broken, it retracted, and then the bleeding could not be found.

Now with the electric knife, I walked through the wound like a pig's skin, and the blood vessels were directly scalded and closed. Then, after the rectum and surrounding tissues are completely free, the anus is treated.

"Our hospital doesn't have a plastic surgery department, otherwise people like this must need a plastic surgery department for consultation. After Zhang Fan and the director of general surgery dealt with the rectum, they looked at the lonely anus, and the director of general surgery sighed.

"What?" Zhang Fan didn't understand.

"Be a good thing, you don't have nothing. ”

"I'm not a child, and I don't wear open crotch pants, who looks!" Zhang Fan said in surprise.

"Hey, don't say it, there are really patients who have this need, no matter who looks at it or not, it's not an organ after all. ”

"Hehe!" Zhang Fan had no intention of raising the bar with the old man.

Once the rectum is separated, the anus remains. In fact, the anus is very simple, except for the levator ani muscle, the rest is surrounded by fat.

This is also why people in the early years liked to eat chicken butts and pig butts, because it was full of yellow fat, with a little orbicularis oris muscle, and there was a fat aroma, and it was chewy. If you take a bite, you can be considered to be able to satisfy your stomach and satisfy your cravings.

The patient's position is a lithotomy position, that is, the legs are spread apart, and the chrysanthemum is flat on the ground. "Sharp knife!" Zhang Fan said to the nurse.

"You do it nicely. It's all an organ. The director of general foreign affairs specially reminded him.

Zhang Fan rolled his eyes and didn't speak. How can this thing be pretty! I can't tattoo a personal eyebrow anymore.

The size of the anus is the size of a dollar coin, and because of the orbicularis oris muscle, this thing is contracted, and it doesn't look big. Zhang Fan used the tip of the knife along the anus to gently draw an arc downward, and then also drew an arc on the opposite side.

It is equivalent to drawing two connected arcs around the anus like a rugby row. Then, follow the line that the tip of the knife has crossed, and begin to cut through the skin.

The yellow fat is crystal clear, the fat on the buttocks is relatively dense because of the long-term sitting posture, and the knife is scratched on the fat, which is really crystal clear, and the fat particles are as crystal clear as yellow rice grains.

Alice forceps clamped the anus and gently advanced, the tooth forceps pulled the skin apart, and Zhang Fan gently used his fingers to slowly free the fat near the anus and the levator ani muscle.

"Sutures! saline, gauze, iodophor, alcohol. "At the end of the free, the anus at this time with a little rectum is directly attached to the fat. Because the anus is useless.

Washing、Salt water cleans the anus that has been freed.,Like a rubber tube hanging on the wall.,The anus is pitifully drooping on the buttocks.。

After cleaning with a large amount of salt water, start wiping with gauze, wipe with iodine, and use alcohol after wiping with iodine.

"Come, give me more saline and gauze. Be sure to wash it several times here. Zhang Fan said to the nurse, this cleaning is definitely cleaner than the restaurant chef cleaning the gourd head.

After cleaning, Zhang Fan went in and out with a needle along the anus, went in and out, sewed a circle around the anus, and finally pulled the end of the thread and the end of the thread, and completely sutured the anus to death. This is also known as purse suturing, and this method is generally used to suture stumps, such as the appendix.

The stump was closed, and with a gentle tug in the abdominal cavity, the rectal stump and anus were pulled out.

"Tissue bag!" The instrument nurse handed the tissue bag to the itinerant nurse, the itinerant nurse stretched it open, and Zhang Fan put the rectum and anus into the transparent tissue bag.

This thing doesn't look big when it's in the body, but when it's put into the tissue bag, it's directly a big lump, a whitish anus, and a bloody rectum, which is directly filled with a tissue bag.

The rectum and anus are very important organs, and they are not cut off and thrown away.

If there is no suspicion, it is necessary to let the family members look at it, and some people who are particular about it, this important organ, they are required to deal with it themselves.

The place where the anus used to stay is now empty, like a black hole, and all that remains is sutures, sewn from the inside out, and finally the skin is sutured, and the oval incision is sutured like a person's closed eyes. The chrysanthemum is gone, completely lost, and replaced by a suture scar.

Lighting a cigarette, sitting on the toilet, and playing with his mobile phone, this kind of comfortable enjoyment will not be able to be enjoyed by him in the future.

After the stitching was completed, Zhang Fan looked at it, well, yes, it's almost a curved willow eyebrows!

"Change gloves!"