Chen Bingsheng opened his mouth wide, and the whole person was dumbfounded.

It only took 10 minutes to complete the free colon!

This kid is a monster!

Before he came back to his senses, Li Xiyang had already continued to the next step.

"Now for the posterior wall of the rectum to be free, Dong Lin, you force the sigmoid colon and rectum to the side of your foot."

"Good!"

"Director Chen, please gently press down on the fascia of the patient's sacral promontory."

"Oh oh oh, okay!"

At this moment, Chen Bingsheng already completely believed in Li Xiyang.

Not to mention anything else, with the use of this scalpel and free forceps, even if you look at the entire imperial capital, you can't find ten people.

Li Xiyang, what a good boy!

Renhe has just experienced a major injury, and now that the new director has taken office, the entire hospital has regained its vitality.

The younger generation has such talents,

Chen Bingsheng was full of excitement.

Li Xiyang didn't know what the latter was thinking, and at the moment he was only focusing on the operation.

Replace the electric knife with scissors for separation, start to enter the presacral space at the sacral promontory, and use scissors to swim down the sacral depression under direct vision.

“st. The marks retractor pulls the rectum for easy exposure. ”

"Yes!"

"Dr. Li, what should I do if I encounter a rectosacral ligament at the sacral ligament of S3-S4?"

"Do you want to cut it directly?"

Li Xiyang shook his head, "This ligament cannot be separated by blunt hand, otherwise it is easy to tear the presacral venous plexus and bleed hemorrhage." ”

"The ligament should be sharply separated with an electric knife under direct vision, and the ligament should be cut and further opened along the presacral space, and then further separated downward over the tip of the coccyx to the levator ani muscle."

Note that when separating the ligament, place the patient flat or place the head high and foot low, and the suction device is separated by "rubbing", so that the pelvic plexus is not easily damaged.

"Okay!"

With the cooperation of the two of them, the posterior wall of the rectum was free again.

Next up

The anterior wall of the rectum is free, and the lateral ligament of the rectum is free.

The operation of these two steps is relatively simple, and Li Xiyang once again showed super surgical skills.

It only took fifteen minutes, and it was all free.

The next step is tumor removal,

"For the upper 1/3 of the rectum, total mesorectal resection is not necessary, and it is sufficient to remove 5cm of the distal rectum and mesangium of the cancer."

At this moment, all the tissues near the tumor are free, and all the arteriovenous blood vessels are ligated.

Li Xiyang's hand fell from the knife, and the tumor segment was successfully removed from the abdominal cavity.

"Dong Lin, rinse the rectum with iodophor solution to kill the cancer cells that have fallen off."

"Good!"

"Director Chen, use a closer to cut off the rectum and mesangium, and pay attention to the mesorectum and rectum should be cut off at right angles."

"Understood!"

Finally, there is rectal anastomosis.

"Anal 4 fingers, anastomosis with a 31-gauge tubular stapler."

After the anastomosis is completed, the gas injection test is used to check whether the anastomosis is complete or not, and whether the two circles cut by the stapler are complete.

The anastomosis should pay attention to the normal blood circulation of the intestinal tube, the stump should have active bleeding, the anastomosis should not have tension, and the colon should be able to lie loosely and naturally in the presacral space.

The pelvic floor peritoneum can be sutured or left open.

If the suture is tight, leave no gaps.

If it's open, it's completely open.

1 to 2 closed drains can be placed in the presacral space.

Chen Bingsheng stared at Li Xiyang's operation without blinking, and waited for Li Xiyang to finish dealing with everything.

He quickly turned another long-arm microscope to the place where the tumor was located and took a look.

Miracle, really miracle, the blood vessels did not suffer any damage, not even the slightest damage to the rectal mucosa.

I have been a doctor for more than 30 years, and it is the first time I have seen such a perfect tumor dissection.

You must know that this level of surgery is usually done by two people in turn, because the eyes need to be glued to the microscope all the time, and the average person really can't stand it.

It is not only a challenge for surgical skills, but also a great test for physical strength and concentration.

"Doctor Li, that's amazing!"

Li Xiyang smiled and shook his head, "Director Chen has won the award." ”

At this time, Dong Lin asked, "Dr. Li, is there anything that needs special attention to post-operative care?" ”

The patient is pregnant and cannot be sent to the proctology inpatient.

However, obstetrics and gynaecology have little experience in postoperative care of such diseases.

Li Xiyang understood what the other party meant, and said, "Remember it!" ”

"The gastric tube is removed after the patient is resuscitated by anesthesia, and the presacral closed drainage is generally removed in 4-5 days.

If hundreds of milliliters of fluid are drained, a test is done to see if there is a bladder or ureteral fistula.

If an anastomotic leak is present, drainage should be kept open, and if peritonitis is absent, it can be treated conservatively.

In general, 50% of leaks can be cured with drainage, so that surgical treatment is minimized.

The urethral catheter is usually removed 5-6 days after surgery.

Liquid diets can be given in the 2nd to 3rd periods, gradually increasing the amount and transitioning to a regular diet.

Postoperative bowel function may be problematic, and colonic clustering may occur due to factors such as free loss of nerve in the colon and ligation of the inferior mesenteric artery. Frequent and urgent stools may be associated with anastomotic stenosis, new rectal spasm, and radiation therapy.

Fibre supplementation for several months and anticonvulsant medication before meals are required.

If chemotherapy is completed, a low-fat, high-fiber diet is given.

Anastomostomosis stenosis caused by early stapler anastomosis can be dilated with digital examination 3 to 4 weeks postoperatively, and monthly as needed.

Dilated strictures are followed by a high-fiber diet to keep the lumen dilated. ”

After talking about postoperative care, Li Xiyang thought about it and said, "Although the tumor on the body has been removed, the patient has obvious prenatal depression, which needs more care and care from her lover!" ”

Dong Lin nodded, the pregnant woman is only five months old now, if the psychological problem is not solved, maybe something will happen in the future.

"Doctor Li, I'll do the ideological work of the family!"

"Good!"

After explaining everything, Li Xiyang planned to go back to the emergency department directly.

I didn't want to be pulled by Chen Bingsheng to the anorectal department to exchange postoperative experiences.

Seeing that it was almost time to get off work, if it weren't for the emergency department calling and saying that there was an emergency patient, it was estimated that Chen Bingsheng would still be able to pull Li Xiyang to chat for another three hours.

……

Back at the emergency room, Qian Min was waiting anxiously at the door of the emergency room.

Li Xiyang stepped forward and asked, "What's the situation?" ”

Qian Min said quickly, "The patient has fever, nausea, vomiting, lower abdominal pain, tenderness, rebound tenderness and muscle tension in the right lower abdomen, and the preliminary diagnosis is acute appendicitis, but the patient and the patient's family are deaf and mute, and there is no complaint at all." ”

Deaf-mute?

Li Xiyang frowned slightly, "I have to find someone who can speak sign language to come over!" ”

Qian Min was helpless, "But where to find it now?" ”

Li Xiyang thought for a while and said, "Didn't there be a few volunteers in the hospital, I remember that one of them was dedicated to providing communication services for the deaf and mute." ”

Qian Min's eyes lit up, "Great, then I'll contact you now!" ”

"By the way, Dr. Li, the patient is pregnant, and she is still in the third trimester of pregnancy!"

Li Xiyang was stunned, is she pregnant again?

"Okay, I know, you go find someone quickly!"

"Uh-huh!"

……

When he entered the rescue room, Li Xiyang saw a pregnant woman lying on the hospital bed, her face pale and frightening.

The little nurse was busy, and there was a man standing next to her, dancing at everyone.

But no one understood.

"Dr. Lee!"

Seeing Li Xiyang walk in, the little nurses seemed to see a savior.

Li Xiyang could only open his mouth to the man and said a few times slowly, don't worry, don't worry.

After reassuring the family a little, Li Xiyang walked to the hospital bed to check on the pregnant woman.

The pregnant woman was pale and covered in cold sweat, and although she couldn't make a sound, she could still tell that she was in pain.

But the patient is now in the third trimester, and any painkiller can cause contractions and miscarriage to the pregnant woman.

"Hello patient, I am your attending doctor, I need to give you a check-up now, it may be a little painful, you bear with it!"

Although he knew that the other party couldn't hear, Li Xiyang still habitually explained the situation to the patient first.

Then reach out and begin palpation on the patient's abdomen, pregnancy with appendicitis is a very dangerous acute surgical disease,

Due to the congestion of the pelvic organs during pregnancy, the appendix is also congested, and the inflammation develops rapidly, and the appendix necrosis and perforation are prone to occur.

Because the omentum is enlarged by the uterus, it is difficult to wrap the inflammation, and once perforated, it is not easy to localize the inflammation, resulting in diffuse peritonitis.

If the inflammation spreads to the uterus, the serous membranes can induce uterine contractions, causing miscarriage, premature birth, or uterine tonic contractions.

The release of toxins during the process may lead to hypoxia or even death of the fetus, and even threaten the life of the mother.

At this moment, the light screen in front of him flickered.

[Brain: uh-uh-uh...]

[Heart: uh-uh-uh...]

[Appendix: Uh-uh-uh...]

Seeing the dialogue of the organs, Li Xiyang couldn't help but be surprised.

I didn't expect that the organs of the deaf and dumb could not speak.

However, after palpation, Li Xiyang found that the patient's tender point was elevated, and it had reached the liver area under the right cost, which was undoubtedly acute appendicitis.

The patient must be operated on immediately, otherwise the child will also be in danger.

Just in the face of two deaf and mute people, how to communicate has become the biggest problem.

At this moment, the door of the rescue room was pushed open, and Qian Min came with volunteers.

The volunteer is a young man in his twenties, a company employee, who volunteers at the hospital in his free time.

Because his grandmother was deaf and mute, he was exposed to sign language from a very young age.

On the way here, Qian Min had already told the young man about the general situation.

So after coming in, the young man found the pregnant woman's family and made a few simple exchanges.

"Doctor, he said that he is the patient's husband, and wants to know what happened to his lover?"

"It's acute appendicitis!"

Li Xiyang replied very simply, and at the same time said to the young man, "The patient's condition is very dangerous, I need to ask the patient's family a few questions now, you can help me interpret in sign language." ”

"Good!"

"You asked him if the patient had a history of acute appendicitis episodes before pregnancy?"

As soon as Li Xiyang finished asking, he saw the young man make a few gestures towards the man.

I saw that the man nodded again and again, and he didn't need the young man's translation, and he knew that he had answered.

"You ask him again how long this time has lasted?"

The young man understood, and replied, "He said that it was a day, and it had been hurting since last night. ”

Li Xiyang frowned, it took so long to come.

But now it's not the time to say this, "You tell him that his wife's condition is very dangerous, that the appendix may be perforated at any time, that antibiotics alone are no longer enough, and that surgery must be done immediately." ”

"By the way, if you ask his wife what blood type she is, she will probably have to have a blood transfusion during the operation!"

After finishing speaking, Li Xiyang instructed Qian Min, "You go to prepare the operating room first." ”

Qian Min nodded, and then walked outside the rescue room.

But at this time,

"Wait a minute,"

The volunteer suddenly said, "The family does not agree to the operation!" ”

"Huh?"

Li Xiyang was stunned, and Qian Min also stopped.

What do you mean?

The two looked at the patient's family suspiciously, only to see that he kept waving his hand, indicating that he did not agree to the operation.

Seeing this, Li Xiyang's brows furrowed, and he said to the volunteer with a puzzled expression, "Ask him why?" ”

After a few quick sign language sessions, the volunteer saw the man on the other side suddenly clasp his hands together and become religious.

This made several people even more confused.

"What the hell is he talking about?"

The volunteer scratched his head, "He said that he is a member of what religion, their church has faith, and blood transfusion is against their faith, so he does not agree to the operation!" ”

Follower?

Qian Min whispered, "What kind of belief is this, it shouldn't be some kind of cult, right?" ”

Li Xiyang's expression was serious, and he pointed to the woman on the hospital bed and said, "You tell him that in the case of his wife, if he doesn't have surgery, he will definitely die.

Once the appendix with inflammation ruptures and perforates, and the pus with bacteria flows into the abdominal cavity and uterus, the pregnant woman and the child will not be able to save their lives. ”

The volunteer immediately relayed it to the man, but the man still looked pious, saying that even if he died, he would not transfuse blood, and he would never violate his faith.

Li Xiyang was speechless, what faith is more important than his wife's life.

However, before Li Xiyang could reprimand, he heard the little nurse behind him shout, "Doctor Li, the patient has something to say!" ”

Li Xiyang turned his head and saw the pregnant woman on the hospital bed gesturing at him.

Li Xiyang asked the volunteers, "What is she talking about?" ”

The volunteer scratched his head, "She also didn't agree to the operation, and she said that she would not have a blood transfusion if she died!" ”

"What kind of person is this..."Qian Min snorted, "Forget it, Doctor Li, don't worry if they don't want to treat us themselves!" ”

The first time he encountered such a desperate patient, Qian Min was also angry.

Li Xiyang shook his head, patients have the right to choose life or death, but as a doctor, they can't just give up.

Li Xiyang thought for a moment, "In this way, you tell them that this operation is only operated on, no blood transfusion, can it be done?" ”

Qian Min was taken aback, "Doctor Li, how can this operation not be transfused." ”

Li Xiyang waved her hand and motioned for her to settle first.

Then he explained, "The condition of the pregnant woman is very dangerous, but I just palpated and found that the appendix has not ruptured, so we just need to operate immediately and remove the appendix before the perforation."

In addition, if you try to control the amount of blood transfusion within 1000 ml during the operation, there will be no need for blood transfusion. ”

Although the weakness of the pregnant woman will have some effect on the child to a greater or lesser extent, at least it will not be life-threatening.

Qian Min nodded, that's right.

But what if the appendix ruptures during surgery?

And in the third trimester of pregnancy, where can the patient be 100% sure of the amount of bleeding.

Li Xiyang smiled, "Leave this to me." ”

At this time, the volunteers also conveyed Li Xiyang's meaning to the patients and their families.

The faces of the two immediately became a little less panicked.

"Dr. Li, they agreed to the operation!"