Ten minutes later, Qian Min hurried back.

"Dr. Li, our hospital's matching library has a suitable spleen for this patient."

That's great.

In the operating room, everyone clenched their fists excitedly.

The hanging hearts finally let go.

Li Xiyang didn't delay, and said directly, "Now start the total skin excision surgery!" ”

No. 13 scalpel ready.

First, the contents of the spleen are pumped clean through the spleen tube, and the spleen is bent and pulled downward to flatten the spleen.

At a distance of 5 cm from the knife edge, the slurry base that cuts through the wall of the spleen runs horizontally.

Pay attention to protect the mucous membranes, and be sure to ensure that they prevent cutting the mucous membranes.

Li Xiyang reminded everyone while operating.

Ligation of the splenic artery begins.

Intestinal forceps!

Gradually clamp and cut the left mesoscocolic ligament and most of the spleen and stomach ligament, and ligate the bleeding one by one with 2-0 silk sutures.

Hook!

Use the retractor hook to retract the stomach body to the upper right, pull the left costal margin open, and block the transverse colon with a gauze pad, exposing the tail of the pancreatic body and the splenic hilum.

Change the electric knife!

The pulsating splenic artery is palpated at the upper edge of the tail of the pancreatic body, and the peritoneum and splenic artery are slightly cut to separate the splenic artery by about 1 cm.

Vascular clamp!

Passage through the splenic artery margin, lead the No. 4 silk thread from the back to ligate the splenic artery.

Note that if the artery is not incised, it should be separated close to the back of the splenic artery to prevent damage to the splenic vein behind it.

Qian Min was a little puzzled, "Doctor Li, why do you want to ligate the splenic artery here?" ”

Li Xiyang kept moving his hands, and patiently explained at the same time, "At this time, the purpose of ligating the splenic artery is to block the blood flow into the spleen, which can not only make the spleen blood flow from the spleen vein to be recovered, but also make the spleen shrink and soft, which is easy to operate."

Keep in mind that if double ligation is performed, the splenic artery needs to be free 1.5~2.0cm, and the distance between the two nodes is 3~5mm. ”

Qian Min nodded and secretly noted down these important points.

"The next step is to free the spleen, but the order should not be messed up, it should be carried out in order by the colonic ligament→ spleen-kidney ligament→ spleen-diaphragmatic ligament→ suprasplenic and spleen-stomach ligament!"

"Deal with the spleen and colon ligaments first!"

First, the colon and spleen are bent inward and downward, and the spleen is turned outward and upward.

unveil

cut off

Ligation of the spleen and colon ligaments.

"Care should be taken not to injure the collateral vessels of the splenic surface and the colon and its mesangial vessels, and some of the splenic and colic ligaments can be left for treatment when the spleen is removed from the incision."

"Next, deal with the spleen-kidney ligaments."

"Xiao Qian, you will use your right hand to lift it from the outer lower part of the spleen and turn it to the inner front side, so that the spleen and kidney ligaments can be exposed."

Qian Min nodded, and sure enough, the process went very smoothly.

Qian Min felt from the bottom of his heart that only Li Xiyang would teach his assistant so seriously in the whole Renhe, and it would not affect his own operation at all.

"Electric knife!"

The spleen-kidney ligament is cut with an electric knife.

Note that if the adhesions are loose and the collateral circulation is small, blunt separation can be performed with fingers pressed against the spleen.

If the adhesions are tight and the collateral circulation is more, the retroperitoneal separation is carried out along the posterior lateral edge of the spleen, and the blood vessels are clamped and ligated.

Soon the spleen-kidney ligament was treated, followed by the spleen-diaphragmatic ligament.

"Small money, pulling the spleen inward and downward, can reveal the spleen and ligament."

Qian Min nodded, but he encountered difficulties in the operation.

"Dr. Li, mediastinal blockade is difficult to reveal!"

Li Xiyang smiled slightly, and calmly picked up the scalpel, "If you encounter this situation during the operation, you can first cut off the left liver deltoid ligament and coronary ligament, and pull the left liver to the right, so that it can be well exposed." ”

The words fell, and the spleen and diaphragmatic ligaments were successfully revealed.

Li Xiyang took the knife and cut the spleen and diaphragmatic ligament.

"Note that when encountering this adhesion is not tight, it can be blunt separation,

But if it is tightly adhered to, attention should be paid to the layer,

After cutting with forceps, suture to stop bleeding, or cut with an electric knife, then lift the spleen inward and upward, and fill the spleen bed with hot saline gauze pads to stop bleeding. ”

At every step, Li Xiyang explained to Qian Min as much as possible the problems that may be encountered during the operation.

Because every operation is not static, because the tissue condition of the organs will be different depending on the individual's constitution.

Correspondingly, the surgical method should also be changed.

The anesthetic Lao Xu on the side couldn't stop nodding, he had been in Renhe for so long, and he had followed more surgeries and seen more surgeries than Renhe and any chief doctor.

But there is really only one person like Li Xiyang who is so young and has super surgical ability.

Looking at his surgery, just one word, comfortable!

Finally, the suprasplenic and spleen-stomach ligaments are treated.

"Xiao Qian, after severing the lower and middle sections of the spleen and stomach ligaments, stretching the stomach can expose the gastrophrenic ligament."

The gastric diaphragmatic ligament is a continuous part of the serous membrane of the stomach and the parietal peritoneum of the diaphragm, which is close to the posterior peritoneum, and is convenient for handling the spleen and stomach ligaments at the upper end of the spleen and fundus after incision.

The upper part of the spleen and stomach ligament is exposed, and one by one it is clamped, cut off, and ligated.

It should be noted that in some cases of portal hypertension and megasplenism, the short gastric blood vessels of the upper spleen-gastric ligament are thick and short, and it is difficult to clamp and ligate, so it can be treated after the spleen is free, removed from the incision, and pulled out of the stomach to avoid massive blood loss or damage to the gastric wall.

When the spleen is removed, the untreated part of the splenic and colonic ligaments under the spleen will be exposed, which can be further clamped, severed, and ligated.

At this point, the spleen is completely free.

Finally, the spleen was removed!

Slowly lift the spleen out of the abdominal cavity and turn it medially, revealing the back of the spleen pedicle and the tail of the pancreas.

Push the tail of the pancreas from the pedicle of the spleen with a gauze ball clamped with forceps, separating the splenic pedicle from the tail of the pancreas.

Then turn the spleen to the left side to expose the front of the spleen pedicle, and carefully dissect and separate the spleen arteries and veins.

It should be noted that excessive traction should not be done when dealing with the spleen pedicle, and if the distal portal vessel is accidentally torn and bleeding, it should be immediately clamped at the tail of the pancreas, with needle splenic arteries and veins with atrial appendage forceps or pediatric intestinal forceps with thin hoses.

Then, on the splenic side of the clamp, the splenic blood vessels are separated, and they are double-ligated after being severed. The tail of the pancreas is then removed from the needle clamp and the severed end is sutured.

Also, take care to control bleeding.

For those with a large spleen and a large blood content, spleen blood can be recovered:

Hold the spleen, loosen the splenic hilar vascular clamp, and collect the blood meridian filter in a container with maintenance solution, and then it can be reinfused.

At this point, the spleen was finally removed.

"Xiao Qian, you are responsible for flushing and stopping the bleeding."

"Take out the gauze pad of the spleen bed, carefully examine the posterior peritoneum, diaphragm, gastric curvature and pancreatic tail, etc., and if there is bleeding, it should be ligated to stop the bleeding."

"Yes!"

……

Fifteen minutes later, all the sterilized sutures were completed and the operation was over.

"Dr. Li, when will a spleen transplant be performed?"

Li Xiyang said, "Four weeks later!" ”

However, during these four weeks, it is very important for patients to take care of and recuperate.

"After surgery, the patient should go to the pillow and lie flat with the head tilted to one side to prevent vomit from being inhaled into the trachea.

If the blood pressure is stable after awakening, the condition allows the semi-recumbent position to facilitate abdominal drainage, reduce pain, and improve respiratory and circulatory function.

Patients should not get up too early to move, and generally need to stay in bed for 10~14 days.

Based on ultrasonography or CT examination, the degree of spleen healing is observed to determine whether it can get up and move.

In addition, the changes in vital signs are closely monitored and the patient's surgical incision is observed.

In some splenectomy patients, the body temperature lasts at 38C~40C for 2~3 weeks, and the white blood cell count is not high in laboratory tests, which is called "spleen fever".

For patients with "spleen fever", physical cooling should be given in time according to hyperthermia care, and water and electrolytes should be supplemented.

In addition, it is necessary to keep the large venous indwelling catheter unobstructed at all times, keep it sterile, and disinfect it regularly.

The drain should not be higher than the abdominal drainage outlet to avoid retrograde infection,

If a large amount of fresh bloody fluid is draining from the drain, it indicates active bleeding and should be reported to me. ”