in the operating room.

Li Xiyang took the electric scalpel and cut the patient's abdominal tissue layer by layer.

The abdomen was successfully opened, and the field was successfully exposed.

When the patient's small intestine was clearly seen, everyone's faces showed very solemn expressions.

It is clearly visible that the patient's small intestine has been necrotic in many places, and many tissues have ischemic lesions.

Li Xiyang looked at this scene and frowned slightly,

However, there was a psychological expectation, so I was not too surprised.

At this time, he kept moving his hands, and at the same time reminded everyone, "Prepare to stop the bleeding and remove the blood clot." ”

Huang Ping was also in the operating room, and Li Xiyang participated in the operation together.

While cooperating with Li Xiyang's operation, he directed Qian Min and others to work.

"Blade 8!"

"Hemostat!"

"Gauze stuffing!"

"Press it here!"

"See the blood clot, here!"

Huang Ping cooperated with Li Xiyang's operation, and all the work was orderly.

Renhe has recovered, and all the medical staff are together.

Li Xiyang took the hemostat from the instrument nurse and quickly stopped the bleeding of the superior small intestine artery.

The blood vessel was then cut and the clot was removed.

"Little money, I'll leave the blood vessel sutures to you, no problem, right?"

"Hehe, don't worry, Dr. Li."

Qian Min smiled sweetly, and her heart blossomed.

However, when the stitches were received, his expression became serious again.

Li Xiyang nodded, very satisfied.

Qian Min worked very hard during this time, and every day when he got off work, he would run to the operation room to practice.

She worked so hard, Li Xiyang was naturally willing to give more opportunities.

While Qian Min was suturing, Li Xiyang carefully observed the condition of the small intestine.

Together with Huang Ping, he pulled a piece of the patient's small intestine out of the abdominal cavity.

Carefully observe how well the blood runs,

It's not optimistic.

Only a little more than one meter of small intestine is still healthy.

The rest were all necrotic due to ischemia.

"What should I do?"

Huang Ping's expression was solemn, he looked at Li Xiyang and asked, "Is it cut or not?" ”

Hearing Huang Ping's words, Li Xiyang was also a little hesitant.

He is well aware that the possibility of the patient's small intestine restoring function is very slim.

Because the peristalsis of the small intestine has not recovered in the slightest, and the secretion of intestinal acid has not resumed, I am afraid that it has been completely necrotic.

To put it bluntly, there are only two options in front of us,

One is conservative treatment, which directly removes the five meters of diseased small intestine.

The advantage of this is that the patient is safe after surgery and does not have to worry about recurrence, but the disadvantage is that the small intestine is only more than one meter left, and the short bowel syndrome will definitely suffer after the operation, and the quality of life will become very poor.

The other option is more risky.

It is to continue to keep this section of intestine and continue to observe the condition of this section of intestine after surgery.

If the intestinal tract is reactivated, then the patient's life will not be affected.

However, if necrosis occurs again after surgery, it will be necessary to reperform the excision.

Seeing Li Xiyang's hesitation, Huang Ping said directly, "Then listen to me and cut it off!" ”

"There is almost no chance of survival of this part of the intestine, and if this small intestine is preserved, it is very likely that there will be extensive necrosis after surgery, causing severe infection, and then re-operated to remove it, which will also increase the risk and pain for the patient."

The most important point, Huang Ping didn't say.

It's the patient's aunt.

This woman is so yin and yang, it's better not to meet again in the future.

Hurry up and finish the patient's operation, and the family can be sent away.

At this time, Qian Min had just completed the blood vessel sutures, and after handing the stitches back to the instrument nurse, he said, "I think we should try not to remove it, after all, the patient is only 23 years old, and if there is only one meter of small intestine left, he will even have problems with normal life in the future." ”

And

"Even if it does recur later, it can be excised again at that time, as long as there is a little hope, don't sentence the patient to death so quickly!"

Qian Min thinks that the intestinal tube is retained, and the worst case is to remove it later, which is no different from the current situation, so why not give it a try?

After hearing this, Huang Ping shook his head, "Xiao Qian, this is not how this is calculated. ”

"Your idea is too idealistic, if the patient's intestinal condition can be detected earlier, of course I am in favor of conservative treatment, but now the mesenteric artery embolization has been too long, unless a miracle occurs, there is no possibility of this intestinal tube revitalizing."

"In addition, if the patient has already had an abdominal opening before, and if he does not remove it this time, and then he will have another surgery later, then the patient's infection will increase greatly.

And don't forget his aunt, in the face of such a family member, once something happens to the patient, she will definitely not be finished with us. ”

After Huang Ping's reminder, Qian Min remembered the yin and yang woman.

nodded heartily, "Then let's cut it!" ”

She didn't want to be fooled by that woman anymore.

Seeing that Li Xiyang didn't speak, Huang Ping sighed and said, "Xiao Li, although my words sound very irresponsible, after all, as a doctor, how can you not give the most suitable treatment to the patient because you are afraid of taking responsibility?

But let me tell you, as doctors, we should not only be responsible for patients, but also for our careers, if you can no longer continue to practice medicine in the future because of a patient, you can no longer treat diseases and save people, that is the biggest irresponsibility. ”

Li Xiyang smiled bitterly and nodded, "Doctor Huang, I understand what you said, I was just thinking about how to cut the intestines just now!" ”

If it was in Yuncheng, Li Xiyang might have to fight for conservative treatment for the patient.

As Dr. Huang said earlier, as a doctor, how can you give up a treatment plan that is more beneficial to the patient because you are afraid of being held responsible.

But after the baptism in the imperial capital, Li Xiyang gradually understood one thing.

It is true that a doctor treats the sick and saves people, but the responsibility of a doctor is not reflected in a patient.

Only by maximizing the medical gains of more than ten years on every patient can we be most responsible for patients and ourselves.

Now, for this patient, Li Xiyang is not sure that he will be cured with conservative treatment.

After that, it will cause the other party's life to threaten, as well as more pain, including more medical expenses.

So weighing the pros and cons, excision is the best option.

After making up their minds, Li Xiyang and Huang Ping glanced at each other and began to remove the diseased intestine.

Qian Min and others cooperated.

"Lift the small intestine and look at the blood supply to the mesentery in the affected area."

"Note that the mesentery does not have to be excised from the root, but can be separated at the junction of the mesangium and bowel, or farther away to make the mesangial incision fan-shaped."

Segmented mesangium...

Intramesangial vessels are ligated with wire 4 or 7...

"Note that there must be a definite arterial pulse at the mesenteric margin to preserve the mesentery."

"Yes!"

Isolate the attached mesentery outside the proposed small bowel resection line about lcm to facilitate anastomosis...

Take 1 kocher plier,

1 non-traumatic forceps,

Clamp the proximal and distal side of the diseased bowel...

The two forceps should be used to form an angle with the intestinal tube to increase the anastomosis and ensure the blood supply here.

Cutting the small intestine between the two forceps...

Cut off the other side in the same way ...

Remove the resected small intestine and mesangium, wipe the stump with alcohol, bring the two forceps closer together and gently flip over...

The posterior wall serous membrane was exposed, and the posterior wall serous muscle layer was intermittently sutured with line 1...

"After the intestinal tube is removed, put it in the tray, and immediately let the nurse send it for pathological analysis."

"Yes!"

"Now start the intestinal anastomosis, pay attention to cooperate with me!"

"Good!"

Take 2 non-damaging intestinal forceps to clamp the intestinal tubes on both sides...

Remove 2 non-traumatic hemostats at the broken end, suck up the intestinal fluid, and close the posterior wall with intermittent full-thickness suture with line 1...

Suture the anterior wall in the same way...

The anterior plasmosis muscle layer is additionally sutured horizontally mattress to strengthen the anastomosis...

Closing the mesangial incision with intermittent sutures with line 1 to close the mesangium...

Finally, the serous muscle layer at the two ends of the small intestine and the serous muscle layer of the nearby small intestine were sutured and fixed with a few stitches, and the mesenteric incision door was intermittently sutured with the 1st line...

"Done!"

"Okay, I'll do the rest of the abdomen, you count the gauze equipment!"

"Hmm!"

At this time, Qian Min suddenly asked, "By the way, I have a question, is there nothing else to replace the small intestine tissue?" ”

It is well known that damage to the human esophagus can be replaced with a small intestine transplant.

People who have had a gastrectomy can also reset the stomach with the small intestine,

So why can't the small intestine be replaced with something else?

Hearing this question, Li Xiyang and Huang Ping looked at each other and smiled.

"Xiaoqian, first of all, what are the functions of this small intestine?"

Huang Ping did not answer directly, but asked rhetorically.

Qian Min thought for a while and said, "The small intestine is the organ for the digestion and absorption of important nutrients in the human body, and it is also the longest section of the digestive tract, and the small intestine of most adults is 5-7 meters long; There are also a large number of folds and villi in the intestinal tract of the small intestine, which greatly increases the surface area of the intestine, all in order to facilitate the digestion and absorption of nutrients.

Clinically, the small intestine is divided into three segments, namely duodenum, jejunum and ileum.

The length of the duodenum is only 25-30 cm, and there is a common opening between the common bile duct and the pancreas, from which bile and pancreas flow into the small intestine and participate in the digestion of food.

The inner diameter of the jejunum is enlarged, the wall of the tube is thickened, and it contains abundant blood vessels, which is conducive to the absorption of nutrients; The ileum is connected to the jejunum and the colon and is also an important part of nutrient absorption.

The structure of the intestinal wall of each part of the small intestine is similar, divided into the mucosa, submucosa, and muscle layers, which contain a large number of blood vessels, lymphatic vessels, and nerves.

The small intestine is constantly peristalsis under the action of the small intestinal plexus, which fully mixes chyme with various digestive juices, and constantly pushes the food downward.

The residence time of chyme in the whole intestine is about 3-8 hours, which is conducive to the full digestion and absorption of food by the intestines.

The intestine itself also has a large number of glands that secrete intestinal fluid, which, together with bile and pancreatic juice, form a component of intestinal digestive juice.

These digestive juices contain a large number of digestive enzymes, which are responsible for the digestion of proteins, sugars, and fats, respectively.

Proteins, sugars, and fats must be broken down by digestive juices into small molecules that can be absorbed into the blood or lymph by the intestines.

The macromolecular nutrients we eat are not directly used by the human body, and can only become a part of our body through the breakdown of the intestines and the synthesis and transformation of other organs.

Food is digested and absorbed in the intestines, which is the basic function of the small intestine. ”

Qian Min said a lot of nonsense, and indeed expounded all the functional characteristics of the small intestine.

But now that you know all the functions of the small intestine, why ask this question?

Li Xiyang explained, "It is because this small intestine integrates the functions of peristalsis, secretion, digestion and absorption, and is closely related to drug metabolism, and it is precisely because of these characteristics that the small intestine replaces the functions of the esophagus and stomach."

But because it has so many functions, there is no other part of the human body that can replace the work of the small intestine. ”

After listening to this explanation, Qian Min was stunned.

At the same time, I am also a little embarrassed, I am very familiar with the theory, but I often can't combine it with reality.

No wonder Dr. Lee is about the same age as himself, but he is so much better than himself.

However, Qian Min is not disappointed, since she started with Li Xiyang, she has seen a lot of wonderful techniques, as long as she is willing to work hard, she will definitely gain something.

Seeing the latter's undiscouraged eyes, Li Xiyang nodded with satisfaction.

Soon after the operation, Li Xiyang instructed the doctor, "After the operation, the patient will take a semi-sitting position, continue gastrointestinal decompression, and stop after the intestinal peristalsis is restored.

It usually takes 2~3 days,

A liquid diet can then be given, gradually increasing to a normal diet.

Intravenous fluids are given to maintain water and electrolyte balance, and colloids can be given appropriately.

Broad-spectrum antibiotics are used throughout the body to control infection. ”

"Okay Dr. Lee!"

After instructing everything, Li Xiyang and Huang Ping went out of the operating room first.

……

As soon as she arrived at the office, before her ass was hot, Jiang Lan hurriedly ran in.

"Dr. Li, Dr. Dong Lin from the Department of Obstetrics and Gynecology wants you to go!"

"Dong Lin?"

Li Xiyang quickly remembered the proud female doctor.

So he asked, "What is the matter?" ”

Jiang Lan recalled, "I didn't say anything specifically, but it seems that there is something wrong with a pregnant woman over there, please go over for a joint consultation!" ”

"Pregnant?"

"Hahaha!"

Huang Ping next to him laughed, "Okay, Xiao Li, I know you did a good job, but I didn't expect you to have a baby!" ”

"Poof~"

Jiang Lan was also amused.

Li Xiyang rolled his eyes angrily, "What a mess." ”

"Okay, I know, Xiao Jiang, you go get busy first!"

"Uh-huh!"

After filling in the cases in his hand, Li Xiyang left the office and went to the obstetrics and gynecology department.

As soon as I arrived at the gate, I saw Dong Lin standing there.

Li Xiyang was stunned, "Doctor Dong... Is this waiting for me? ”

Dong Lin smiled, "I heard that you just had surgery, it's really troublesome for Dr. Li!" ”

The other party's attitude was suddenly so good, so that Li Xiyang couldn't help but be a little surprised.

I still remember the last time we met, the latter was very harsh to himself.

Dong Lin smiled awkwardly.

"Alright, let's talk about the patient!"

"Good!"

"The patient is a pregnant woman who is almost 20 weeks pregnant, and yesterday she suddenly had to go crazy at home and had to have her own caesarean section, but fortunately her husband found out and sent her to the hospital in time.

You know, a pregnant woman at 20 weeks of pregnancy can't be anesthetized, and the wound hasn't been sutured until now, but fortunately, the pregnant woman didn't hurt the big blood vessels by caesarean section, so we bandaged her, and it barely didn't pose too much danger.

But it's not a problem to drag on like this, we really can't help it.

Director Xu said that you have a good brain and are a clinical genius, see if you have any solutions? ”

Self-caesarean section?

Li Xiyang's face changed.

The gestational week is 20 weeks, that is, just about five months,

At this time, the fetus has just been finalized and is already considered an adult.

However, most of the fetal organs in this time period have not fully grown, and if he is really dissected at this time, he will definitely not survive.

"Is there some family conflict?"

In addition, Li Xiyang really couldn't think of how a mother could hurt her child so ruthlessly.

But Dong Lin shook her head, "I asked the pregnant woman's family, and there is no contradiction, and during the hospitalization of the pregnant woman, the pregnant woman's husband and family have always been with her, and they are very concerned." ”

Li Xiyang smacked his lips, "That's weird." ”

"Why don't I take you over first?"

"Good!"

followed Dong Lin, and the two went to the inpatient department of obstetrics and gynecology.