Su Hongwen looked at everyone else with a confused look on his face, and no one could answer this question, in fact, when the meeting was held that day, Su Hongwen had already secretly said this answer when he was explaining, but he didn't say it too clearly, he just wanted everyone to use their brains to think about it themselves, but unfortunately, none of these people thought of it, or didn't think much about it at all.

Su Hongwen gently involved the gallbladder to the left with a pair of forceps, and then said, "Look at the adhesions here in the left corner of the gallbladder." After everyone saw it, Su Hongwen dragged the gallbladder to the right and asked them to see the adhesions on the right side.

Su Yushan's gallbladder is very small, and the adhesions are just as Gao Shengli said at the beginning, even after passing the inflammatory reaction period, there is still no obvious relief, and now the gallbladder is stuck with the liver, even if Su Hongwen pulls the gallbladder, there is not much surgical field leaking, so that other doctors see very little.

Su Hongwen waited for a while and said, "Do you see the difference between the adhesions on the two sides?" ”

Everyone shook their heads, and in their opinion, the adhesion between the two sides was no different at all, it was all the same.

Su Hongwen smiled bitterly, and then said, "Didn't you find that the amplitude of the gallbladder on the left side is greater than that on the right side?" What does this mean? Indicates that the adhesions on the left are looser than on the right. ”

Gao Shengli leaned on the endoscope and wondered: "But what does this mean?" ”

Su Hongwen said: "Everyone is engaged in surgery, I don't need to say whether the gallbladder arteriovenous and common bile duct are on the left or right side of the gallbladder, right?" ”

Gao Shengli thought for a while and was still confused, and opened his mouth and said: "The gallbladder arteriovenous and common bile duct of ordinary people are indeed on the left side of the gallbladder. But there are also mutations. ”

Su Hongwen said: "It's true, but if the gallbladder arteriovenous and common bile duct are on the right side, the adhesion on the right side is definitely tighter than the left, I just pulled the gallbladder left and right to confirm that the gallbladder arteriovenous and common bile duct are on the left or right, the position of the gallbladder arteriovenous and common bile duct is loosened because there is blood circulation and bile in and out, because the blood vessels and the common bile duct will secrete an enzyme called H2A to prevent the adhesions caused by inflammation from bending them, resulting in blood circulation and bile transportation. ”

Gao Shengli looked at the picture on the monitor and said, "But what does this have to do with you asking us if we know the specific location of the gallbladder arteries and veins and the common bile duct?" ”

Su Hongwen said: "Of course it matters, after determining the direction of the gallbladder arteriovenous and common bile duct, you can confirm their specific location." ”

Ding Juncai stood aside and pouted, "How can you confirm it?" Swim away from adhesion finding? Isn't that still the same as the usual practice, and it's not a gallbladder reversal. ”

Su Hongwen ignored Ding Juncai and directly handed over a pair of claw pliers in his hand to Fu Sen, and then asked him to gently pull the gallbladder up with the grasping forceps, and Su Hongwen directly replaced it with two special forceps for free adhesion and began to free the adhesion on the right side of the gallbladder, and his movements were very fast. After a short time, the right side of the gallbladder was basically swam away. This also made other doctors see Su Hongwen's skillful laparoscopic operation technique, and rushed to this technique, and the doctors present could not compare with Su Hongwen, whether they were old or young.

After the free on the right side, Su Hongwen said: "You can see the free on the right side clearly, right?" I'm starting to move away from the left side, and you can see how the adhesions on the two sides are different. ”

When Su Hongwen began to free the adhesions on the left side of the gallbladder, Gao Shengli was the first to find that the adhesions on the left side were looser in some places than on the right side, and when he thought of what Su Hongwen said just now, Gao Shengli suddenly said: "I understand." Where there is a gallbladder arteriovenous block, the adhesion to the common bile duct is looser than elsewhere. In this way, only both sides are slightly free. The location of the gallbladder arteries and veins and the common bile duct can be deduced. ”

Su Hongwen finally had an enlightenment and breathed a sigh of relief, if no one could understand this, then today's teaching operation would bring them over for observation. Thinking of this, he said: "Yes, that's it, the adhesions on both sides are different because of the presence or absence of gallbladder arteriovenous and common bile ducts, and the location of gallbladder arteries and common bile ducts can be quickly deduced according to this." ”

Speaking of this, Su Hongwen didn't say it, he had to leave time for other doctors to digest this knowledge, and after waiting for a while, he saw that many people showed expressions of sudden realization, and then said: "At the beginning, Dr. Gao insisted on using the open abdomen for the patient, the reason is naturally that the patient's gallbladder is too small, and the adhesions will not be relieved after the inflammatory reaction subsides, in this case, it is difficult to find the gallbladder arteriovenous and common bile duct with laparoscopy, and once the blood vessel or common bile duct is injured by rash surgery, the patient may die. It is really difficult to stop bleeding after gallbladder arteriovenous rupture, and bile flows into the abdominal cavity after the common bile duct is made an exception, which will cause serious intra-abdominal infection. But now we know how to find the common gallbladder vein and common bile duct according to the viscosity and tightness, and there is no fear of injuring the gallbladder arteriovenous and common bile duct. ”

Ding Juncai said at this time: "But now it's no different from ordinary laparoscopic surgery, right?" How can it be considered a gallbladder reverse cut? Ding Juncai tried every means to make trouble for Su Hongwen.

He is right, Su Hongwen is indeed looking for gallbladder arteries and veins and common bile ducts first, which is no different from ordinary laparoscopic surgery.

Su Hongwen said directly: "The reason why I first looked for gallbladder arteriovenous and common bile ducts is because this is a teaching operation, don't let them figure out what's going on, how do you learn?" ”

Gao Shengli was a little impatient at this time and said, "Ding Juncai, can you say a few words?" ”

Everyone else also glared at Ding Juncai, everyone is a doctor who doesn't want to improve their surgical skills, but now Ding Juncai is always making trouble, which is really annoying.

Ding Juncai was stunned by everyone, and he knew that he had committed public anger, and he didn't dare to say anything for a while.

At this time, Su Hongwen said: "When you encounter this kind of small gallbladder in the future, at the beginning, as long as you use adhesions to determine the location of the gallbladder arteries and veins and common bile ducts, you can quickly find these things that we must ligate, and then you can rest assured that you can boldly free other adhesions, first free the gallbladder, and then ligate these things, which is also the so-called reverse gallbladder resection." ”

After speaking, Su Hongwen began to free the other positions of the gallbladder, the place where the gallbladder and the liver are adhered is called the gallbladder fossa, and the upper part of the gallbladder is connected here, which is not adhesion, it is a normal tissue, and its function is to fix the gallbladder.

Since these tissues have the function of fixing the gallbladder, there are naturally blood vessels in them, so when these tissues are freed, an electric knife must be used.

Conventional laparoscopic cholecystectomy is to first find the gallbladder arteriovenous and common bile duct ligation, and then peel off the gallbladder, but Su Hongwen used reverse incision this time, so the gallbladder was first freed and then the gallbladder arteriovenous and common bile duct were ligated.

When most of the gallbladder is freed, there is only the adhesion that did not move just now, now everyone knows that there are gallbladder arteries and veins and common bile ducts in the canal, according to the conventional surgical procedures Su Hongwen should carefully free these positions, find out the gallbladder artery, gallbladder vein and common bile duct and then ligate them respectively, which is very safe, which can avoid bleeding from the ligated blood vessels after surgery as much as possible, and the ligated gallbladder exudes bile.

But Su Hongwen didn't do this, he directly grabbed the gallbladder with forceps and rotated it twice, and then used two titanium clamps to ligate the tissue containing the gallbladder arteries and veins and common bile ducts at a distance of three centimeters from the gallbladder.

Seeing this scene, Gao Shengli couldn't help but say: "Director Su, it's too unsafe for you to do this, what if the titanium clip at the ligation place falls off after surgery and causes bleeding or bile?" "The reason why Gao Shengli said this is that Su Hongwen's ligation is too rough, and the arteries and veins and common bile ducts inside should be separated and ligated separately, so that it is safe.

Su Hongwen said: "I just rotated the gallbladder twice, and the arteries and veins and common bile ducts have cut off the flow of blood and bile, which is like a plastic tube with water, if you hold it and screw it twice at both ends, the tube will naturally not be flowing water, of course, the plastic tube is not the same as the blood vessels." Speaking of this, Su Hongwen said: "Pay attention to the position of my titanium clip." After saying that, he turned his gallbladder in the opposite direction twice, and then made a third titanium clip about a centimeter away from the first two titanium clips.

Get these Su Hongwen said: "I first rotated the gallbladder to make the blood vessels, bile ducts follow the middle, and the plastic tube that was screwed in the middle is generally not circulating blood and bile, and then put on a titanium clip, when I rotate in the opposite direction, the blood vessels and bile are open, but because of the titanium clip, the blood and bile on the upper side can't flow down, but there is still this certain amount of blood and bile in the gallbladder, so that these blood and bile will flow backwards, and then I use a third titanium clip to ligate the bottom, This also leads to the blood and bile that just flowed in to stay in the blood vessels and common bile duct, and now both ends are not passed, and the blood and bile in it will form thrombosis and stones, these things are harmful to the human body in the eyes of most doctors, but at this time these things are beneficial to the human body, because these things can play a role in blocking the blood vessels and common bile duct, even if the titanium clip on the top falls off, the blood in the gallbladder arteriovenous and common bile duct will not flow out. ”

Su Hongwen said that other doctors understood the benefits of his doing, Su Hongwen's seemingly rough ligation method is actually very strong, and it is also very wonderful, making full use of the harmful blood clots and stones produced by the human body, and also reducing the operation time.

The shorter the operation time, the better it is for the patient, because the longer the operation time means that more narcotic drugs will be used, and the side effects of these drugs can be not small, and the more they are used, the greater the damage to the patient's body, and even lead to the patient not waking up and eventually the operation fails.

But now with Su Hongwen's method, the operation time is greatly reduced.

At this time, a nurse suddenly ran in in a panic and shouted: "Qiming, Qiming is no good!" (To be continued......)

PS: The third watch is over, ask for a monthly pass, the back is so tight, ask for support!