Enterotomy surgery begins.

"Tissue pliers!"

"According to the pulse of the artery, the common hepatic artery and the hepatic artery propria are separated, and the lymphadipose tissue around the artery is separated and removed along with the pancreas and duodenum."

"Doctor Li, the field of vision of the duodenum is a little narrow, it's not easy to start!"

Lin Yue cooperated with the search for the duodenum and encountered problems.

Li Xiyang said, "By pulling the common hepatic artery upward, the gastroduodenal artery can be separated. ”

"The main trunk of the gastroduodenal artery is short and can be pulled first through a silk thread and then separated distally until the free artery is of sufficient length; Double silk thread ligation. ”

"Alright, Dr. Li, I've found it!"

"Ligation successful!"

Li Xiyang nodded with satisfaction, "Yes, cut it off after clamping with the distal forceps." ”

"The severed end of the artery is then sutured with a 4-0 vascular suture needle to reduce the chance of secondary bleeding."

Seeing this step, Yu Bing on the side couldn't help but wonder, "Doctor Li, don't you need to remove your gallbladder?" ”

In general, enterectomy is usually removed along with the gallbladder to cut the bile duct in the common hepatic duct and anastomosis with the jejunum.

Li Xiyang said, "In the early stage of duodenal cancer, the bile duct can be directly transsected at the common bile duct, and the gallbladder is not removed, unless the gallbladder is opened at a low level, the gallbladder must be removed."

In addition, cholecystectomy often causes prolonged obstruction of the lower end of the common bile duct, gallbladder enlargement, wall thickness, hyperemia, and edema.

So unless necessary, the gallbladder can be preserved. ”

Li Xiyang was completely sure of his own judgment, so he chose to keep the patient's gallbladder.

This can also reduce some inconvenience for the patient's normal life after surgery.

Yu Bing nodded, the truth is true.

But if you really want to be as comfortable as Li Xiyang, the average surgeon may need decades of experience to do it.

Awesome!

After a while, the duodenal lesion was completely removed and the operation was completed.

Yu Bing felt that he had watched a surgical performance, and every cut and stitch, and even the operation of intra-abdominal exploration, could not find a single flaw, which can be called a textbook-level demonstration.

No wonder the doctors who have worked with Li Xiyang are full of praise for him, he is so strong!

Li Xiyang put down the scalpel and explained some postoperative precautions.

Although early-stage carcinoid tumors are not fatal, pancreaticoduodenectomy is a complex and invasive operation.

Before surgery, most patients have obvious malnutrition and severe obstructive jaundice, so after surgery, patients should be admitted to the surgical intensive care unit to carefully observe vital signs and various clinical indicators.

Adjust the intake according to circulatory conditions, urine output, wound exudate, and various drainage volumes, and be sure to keep blood pressure stable, urine output > 1500 ml/day, and electrolyte balance.

If the circulation is stable after surgery and the urine output is small, furosemide 10~20mg can be given;

Ranitidine 50mg intravenously is injected twice a day to maintain gastric juice acidity pH 5.0, and the drug can be discontinued after 2 weeks.

……

After getting out of the operating room, Li Xiyang was pulled by Yu Bing to exchange some surgical experiences.

Li Xiyang didn't mind this, and answered his questions without reservation.

This sincerity and openness made Yu Bing admire it even more.

After the exchange between the two ended, Li Xiyang received a call from Qian Min.

He said that he was in the processing room and that there was a patient who needed him to take a look.

Li Xiyang hung up the phone and went to the disposal room.

Entering the disposal room, Li Xiyang saw Qian Min sitting in front of a girl.

The girl was about eighteen or nineteen years old, and she was still holding a little boy of two or three years old in her arms.

Li Xiyang walked over and asked, "Xiaoqian, what's the situation?" ”

Qian Min pointed at the little boy and said, "It's this child!" ”

Li Xiyang looked at the little boy when he came in, and his big eyes blinked and blinked, giving people a very clever feeling.

I don't look sick!

At this time, Qian Min said, "Doctor Li, this kid has stuffed a toy into his nostrils, and I have taken it out." ”

Li Xiyang was slightly stunned, but fortunately, he was not too surprised.

After all, children at this age are curious about everything in the world and are in the stage of exploration.

But

"Why did you call me over when you took out all the toys?"

Qian Min pulled Li Xiyang aside and said, "Doctor Li, although the things have been taken out, I think this child is a little strange. ”

"Strange?"

"Well, you take a look at this first!"

Qian Min walked to the treatment table and picked up a tray.

There is a small plastic model on the tray, about the size of a grain of rice, but it is so delicate that you can see at a glance that it is the shape of a police officer.

"That's what he shoved into his nostrils?"

"Well, but that's not the weirdest thing, the strange thing is that the child's sister said that he also stuffed something into his nose yesterday, and it was a firefighter model, but fortunately, he found it in time and took it out."

"His sister was worried about whether the child had a problem with IQ, and always felt that his younger brother was stupid and not very smart."

Li Xiyang did not check, so it is difficult to draw conclusions for the time being.

However, children at this age usually do not know how to express their thoughts and often behave in a way that seems strange to adults.

A lot of times, it's because they're feeling uncomfortable.

"I'll do a check-up first!"

Li Xiyang took out a stethoscope from his pocket and put it on the child's chest and back.

There is no imaginary anxiety and crying.

The child just stared at the stethoscope curiously, and looked at Li Xiyang from time to time.

Bring's big eyes are not stunned at all!

Suddenly, Li Xiyang heard something, and his expression was solemn.

thoracoabdominal rales,

But there seems to be something else going on.

Then, Li Xiyang put the stethoscope on the child's neck.

Sure enough, the sound came from the neck.

This is the sound of filial piety.

The upper respiratory tract makes a sound of filial piety, which is a sign of obstruction of the respiratory tract.

"Doctor, what's wrong with my brother?"

The girl noticed the change in Li Xiyang's face and suddenly felt a little uneasy.

Li Xiyang raised his head, "What about your parents?" ”

The girl looks like she should be a college student, not her bringing her brother to the hospital.

The girl said, "My parents have returned to their hometown, and the school is on vacation these days, so I just have time to help take my younger brother." ”

"Doctor, what's wrong with my brother, didn't the toys come out? He can't be okay, or my parents will kill me when they come back!" ”

Li Xiyang smiled, "It's not so exaggerated!" ”

The girl pursed her mouth, "Hmph, they have always been patriarchal, and now they are old and have children, and they can't wait to hold it in their hands every day, and they are usually nervous with a small cold." ”

Li Xiyang shook his head, it may not be that her parents are too nervous, but that this girl is too sensitive.

After all, children's immunity is not perfect, and children's tolerance for colds and fevers is far less than that of adults.

But it wasn't his turn to say these words.

Picking up a pair of tweezers from the instrument tray next to him, he squatted in front of the boy and said softly, "Little one, lift your head up and let Uncle Doctor examine you!" ”