> Xiao Rin took over the arterial clamp and clamped the iliac artery base, the internal iliac artery orifice was equivalent to the caliber of the renal artery, and 5-0, 6-0 sliding lines were used for two-point or intermittent sutures.

The needle pitch is about 1mm, and it is about 0.5-1mm away from the pipe edge. Use two-point continuous sutures to the last 1 stitch, inject 5-6ml with heparin saline with a right-angle flat-head fine needle, tighten the sutures, and check whether there is any water leakage.

With the same technique, a horn forceps was applied to the renal artery, and the root forceps of the root of the internal iliac artery were loosened, and after checking whether there was bleeding in the anastomosis, Xiao Rin said in a deep voice: "There is no problem." ”

"Doctor Xiao, you can see that the arteries here have atherosclerosis, which is not in line with the aging state of Danqing's age group." Li Jingyi pointed to a performance artery in Chapter 437 and told Xiao Rin about her doubts. Generally, the internal iliac artery has atherosclerosis, which is more obvious in older people, the blood vessel is brittle and easy to crack, and special care and care should be taken when suturing.

"Danqing's living conditions lead to a lack of nutrition in all aspects, coupled with her long-term fatigue and illness, her internal organs suffer from heavy burdens, which will lead to premature aging." Xiao Rin didn't have much of an accident about such a situation, on the contrary, the operation has not happened more accidents until now, which is already beyond his expectations, except for some minor problems, her internal organs are still quite well protected, which may be due to the cultivation of the Xuannu Heart Sutra. "Full-thickness sutures from the renal artery to the internal iliac artery can be done, and if the internal iliac artery is longitudinally dehisced due to suture, it should be transverse or figure-of-eight suture if necessary."

Perhaps because of the living conditions, there is very little fat under the surface layer of Danqing, and it is easy to separate the external iliac artery. Xiao Rin clamped the external iliac artery with the same part as the renal vein with his heart-appricular clamp, cut the diameter equivalent to the renal artery with a sharp knife, and cut off a small amount of artery wall to form an oval opening.

One stitch is placed above and below the artery, which is similar to the vein suture, and different from the stitch spacing of Li Jingyi's performance in Chapter 437. He never dropped the needles more than 1 mm apart and the stitches were 0.5 mm from the edge of the incision. After the last 1 stitch, Li Jingyi perfused heparin saline.

After clamping the renal artery with horn forceps, loosen the heart-ear forceps. Observe whether there is blood leakage from the anastomosis, and the two people cooperate with each other very tacitly.

"When doing arterial anastomosis, it is necessary to pay attention to whether the renal artery is twisted or rotated. When there are multiple renal arteries or heterovascular vessels, it is more advantageous to connect multiple blood vessels together with the aortic valve as much as possible to make a single anastomosis with the external iliac artery. ”

It is difficult for Li Jingyi to describe her mood at the moment in words, as she is also a doctor, she will definitely not describe in such detail the conditions and rescue methods that may be encountered during the operation in front of her companions. You must know that skill is the most undisclosed, the so-called truth of stealing teachers to learn to become fine, everyone understands, and the selflessness of the person in front of him is because he is too confident and his medical skills are incomparable? Or is it because of ......

"When anastomosis is performed in the external iliac artery, the suture time should be shortened as much as possible to prevent excessive ischemia of the lower extremities. Arterial anastomosis can also be done with a one-point continuous closure as a full-thickness arterial and intiminal-to-intimal suture. When the end is sutured, the medial side of the suture is selected. The thread is then flipped over and the rest is stitched together. After Xiao Rin exhaled deeply, the clock on the wall had already pointed to six thirty in the morning.

"Sister Jing, now we have to open up the blood flow. This process, I want you to be focused, is a crucial step. Compared with the first time, Xiao Rin obviously spoke much heavier this time, obviously expressing dissatisfaction with her distraction, but in fact, as a doctor, she really has no reason to refute, in the face of such a big operation, her distraction will lead to a crisis, and it is difficult for her to bear such a responsibility. …,

"I'm sorry!"

When the static and arterial anastomosis is complete. Xiao Rin clamped Jing and artery respectively with horn forceps, and checked the anastomosis again, and checked the anastomosis again to see if there was bleeding or oozing blood at the incision.

"Transfusion of 600 ml of type A plasma, 30 g of protein." According to Xiao Rin's instructions, Li Jingyi injected immunosuppressive drugs and 20% mannitol 250ml at the same time.

Xiao Rin first released the venous clamp, and then released the arterial clamp, and the kidneys turned from white to red. The color is ruddy, and it is swollen and swollen.

"Re-inject 70 mg of furosemide."

The arteries are pulsating, and the elbows of the kidneys are elastic. Xiao Rin observed the changes in the kidneys, and Li Jingyi held the good grave forceps in her hand, and quickly stopped the bleeding point at the hilum of the kidney and ligated it. When blood stains appeared on the small blood vessels on the capsule on the surface of the kidney, she immediately pressed them with gauze to stop the bleeding. "There is oozing blood at the end of the ureter, the ureteric artery has a good blood supply, and some of the mixed fluid is coming out."

Listening to Li Jingyi's report, Xiao Rin nodded, still frowning. From the time of surgery to the present, it can be said that it has been quite successful, but the beating of the arteries is a little weak. He re-examines the renal arteries to see if there are twists, angles, or problems with the iliac vessels.

"Any questions?"

Seeing this, Li Jingyi asked Xiao Rin, who shook his head, and he checked Danqing's blood pressure.

The reason for the weakness of the beating of the arteries may be because she has symptoms of low blood pressure, and it is not very likely that the color of the kidneys will be bad, and after hesitating for a moment, a force gathered in the palm of his hand, and it was injected into Danqing's body at a slow speed, maybe this effect was not so effective, but for Danqing, it was enough for her to support her for a while.

Urine is constantly flowing out of the ureteral orifice, squirting out, and this is only after the blood vascularization is opened, the kidney function begins to recover. Xiao Rin did not delay any longer, but continued to complete the operation to reconstruct the urinary tract passage.

About a distance from the bladder of the transplanted kidney, cut off the excess ureter, put a single J catheter, the end of which is 4-5cm more than the broken end of the ureter, cut the ureter longitudinally and longitudinally about 0.7cm, flip and sew it. Cut 2 cm of muscle layer at the top of the bladder to expose the bladder mucosa underneath, and poke a small hole with a sharp knife to pass the ureter into the bladder.

The ureter is intermittently sutured with a 4-wire intermittent stitch, the ureter is submerged under the muscular layer for about 2 cm, and finally 2 stitches are fixed at the ureter-bladder with a thin thread. In this way, the ureter has the same submucosa of the bladder, which has the effect of anti-reflux, and the bladder and the ureter are fixed in two places to ensure smooth urine flow, without the risk of anastomotic stenosis, and have the function of anti-reflux, the incision is small, and the operation is convenient. Vesicoureteral reflux, stenosis of the anastomosis.

"Done!"

"Congratulations to Dr. Shaw!" Li Jingyi also exhaled, her legs were weak, she just wanted to find a stool to sit down, and she was about to collapse due to nervousness.

"Sister Jing, you go and rest first, there is still some work to be done to deal with the aftermath." Xiao Rin thoughtfully moved his mouth at Li Jingyi.

Although the ureteral anastomosis is complete, the kidney transplant is over. However, Danqing has a poor coagulation mechanism, few platelets and poor function, hemodilution, and bleeding tendency. Xiao Rin didn't dare to slack off, and carefully searched for the incision, the wound was oozing blood, and the bleeding was there.

"I'll do the rest."

Li Jingyi took the utensils in Xiao Rin's hand, the physical strength required to complete the entire surgical project by one person was much greater than she thought, although Danqing's condition was stable, but if the coagulation degree was poor, it would also affect the postoperative hemorrhagic problem, only after ensuring that there was no bleeding, a drainage tube could be placed inside the iliac blood vessels and outside the bladder, which was led out from the incision and cut by layer closure.

Xiao Rin nodded, sat down on the cabinet on the side, only then did he feel the cold, the surgical gown had been soaked with his sweat, and the habitual sleepiness began to slowly climb into his heart, he leaned against the wall and closed his eyes, but he didn't dare to sleep, if he didn't do it in the end, there might be a crisis, he crawled his hair and walked to the operating table, watching Li Jingyi carefully check every anastomosis point, and platelets, repeatedly to ensure that there was no problem, Li Jingyi began to do the final epidermal suture. …,

"Pushing into the intensive care unit, these three days are quite critical periods, if the urinary tract is functioning normally and there is no rejection, it can be considered a real success." Xiao Rin was holding on to the wall, a little overdrawn in his physical strength, which made him a little weak to speak.

"Are you alright?" Li Jingyi asked with concern, she could understand his state at the moment: "I'll send you back to rest first." ”

"No need!" Xiao Rin waved his hand at Li Jingyi, the key of these three days, he must stay in the hospital.

"Doctor Xiao!" Watching Xiao Rin open the door of the operating room and walk inside, Li Jingyi didn't chase after her, she couldn't say what it felt, it was as if the condiments had been knocked over, all kinds of flavors were mixed in it, and she really wanted to sort out something, but she couldn't find it.

"Mom, are you alright?" Niuniu stood outside the door of the operating room with the doll bear given to him by Xiao Rin, with tears hanging from the corners of her eyes, she woke up in the middle of the night and couldn't find her mother, crying alone in the ward, fortunately, Zhengbo passed by and learned that her mother came down, and came to the door of the operating room scared, looked at the red light on the top of the door, and sat on the bench silently.

"Why did you get here alone?" Xiao Rin squatted down and stroked Niuniu's hair, wiping the tears from the corners of her eyes with her thumb. "Crying nose?"

"Where's Mom?"

"Mom is going to the intensive care unit, don't worry."

"Brother Xiao, will Mom get better?"

"Niu Niu, my brother will take you to see your mother!" A big hand picked up Niu Niu and turned from the other end of the corridor to the intensive care area on the third floor.

"Brother Xiao!" Halfway through, Niuniu suddenly stopped, and her round eyes glared at Xiao Rin without blinking: "Thank you, Doctor Xiao." Suddenly, her legs bent and she was about to kneel on the ground, and Xiao Rin instantly grabbed her arms with both hands and lifted her up.

"What are you doing here?" Xiao Rin picked up Niuniu to prevent her from doing anything again.

Niuniu was frightened by Xiao Rin's roar, aggrieved tears hung in the corners of her eyes, and her small mouth pursed. A small hand pulled out a fruit gummy from his pocket, and put it on Xiao Rin's big hand: "This is the candy that Sister Xiaoyuan gave me, I will give it to you now." ”