Nineteenth Century Medical Guide

Chapter 123 120. Men and Women
Splenectomy was associated with preservation and degree of spleen injury.

In general, shallow small lacerations of the splenic parenchyma, small-scale capsular lacerations, subcapsular hematomas, and localized lacerations can be selected to preserve the spleen, and the damaged area can be sutured and ligated.

Olgi's is a small shallow laceration, the depth and length of the cut are very limited, no more than 1cm.

Surgery was a fantasy for Hills and Locard, because there are very few surgeons who can perform splenectomy, and spleen repair is too difficult.But for Carvey, this kind of surgery is done by a novice. The only difficulty is not the technique, but the surgical instruments.

However, it has been almost a month since he came here, and he has gradually gotten used to the things of the 19th century. Both the surgical technique and the specific movements of his hands have undergone new changes.

The sutures of the liver and spleen have to use catgut. When suturing, not only must face the fragile nature of catgut itself, but Carvey also needs to always pay attention to whether the tender liver and spleen will be torn again by the sutured knot. .

His movements must be as gentle as possible while tying the surgical knot.And on this basis, he also inserted some omentum between the sutures to further reduce the risk of laceration at the sutures. 【1】

This is a difficult task for Hills and Lockard, but the difficulty is completely invisible only through the actions shown by Kavey.Apart from the insertion of the greater omentum, suture of the spleen appears to be an easy procedure to perform.

And the story unfolded in such a slightly leisurely atmosphere, and the cause of the incident still had to start from a meeting half a year ago.

Olgi is the most famous surgeon at Graze Hospital and has been working for decades.

In the eyes of Hills, although he is not as good as Ignatz, and the surgery is difficult when he is old, he is definitely better than himself in terms of experience.Especially for the diagnosis and treatment of male urology, he has been immersed in it for a long time, and his technique can be called first-class.

However, surgery has many uncertainties, and surgical failure was a common thing in the 19th century.

The patient this time is a writer. He has several short stories, but the plots are boring, and the response after publication is mediocre.Because he had no grades, he gradually lost confidence in writing, and began to work as a newspaper writer for a living.

Just when he thought he would spend the rest of his life in such a daze, a turning point occurred.

By chance, he met a girl he liked in a newspaper office—Linette, who was the daughter of the owner of a dye factory in Vienna.

"Oh, not bad, it can be regarded as salted fish turned around." Kawei was doing spleen suturing in his hands, listening to the story in his ears, "Then why did the love he talked about disappear?"

"Three months ago, the writer came over and said that he was going to get married, but he needed to solve his personal problems before getting married." Hills helped pull the hook and said while working as an assistant, "He said that his lower body seemed to have a dull pain from time to time, There is a feeling of bulge, I hope Teacher Olgi can help to take a look."

"Below?" Carvey was stunned, "Yin bag?"

"Yes, vagina."

This thing has swelling and pain. Although the possible types of diseases are not as exaggerated as abdominal pain, the help of imaging is still needed to make a diagnosis.However, if you are an experienced urologist, you can still make a suspected diagnosis by relying on physical examination and some experiments.

"Hydrocele? Hernia? Inflammation? Varicocele?"

Carvey can think of these four for the time being. Of course, besides them, there are tumors, but the probability of tumors in young people is not high, so they are excluded.

"It turns out that Dr. Carvey also has research on male surgery." Lockard hadn't reacted yet, but Hills on the side noticed something was wrong, "Aren't you a specialist in cesarean section surgery? Why do you know so much about yin sacs?" ?”

"After all, I have it myself, so I was curious and learned from the book."

The reason is impeccable. After all, the exploration of the human body begins with interest, and Lockard soon believed it.But Hills knew that things were not that simple, but now that the story was important, he didn't ask too much: "The teacher did some tests and found out that it was a varicocele."

"Oh?" Carvey was very interested in Olgi's diagnosis method, "How did Dr. Olgi make the diagnosis?"

"Hey, didn't you teach yourself about andrology? Why don't you even know this?" Hills explained, "When a man has a varicocele, the swelling of the sac is different in the supine position and the upright position. It’s all in the textbooks, have you forgotten?”【2】

"Oh, so it's this."

Carvey smiled, and the stitching of the spleen has also reached the final stage, "I do have an impression, but I had a doubt when I saw it."

"What question?"

Carvey took away the suture needle, quickly tied a knot with both hands, and then took away the gauze lining underneath: "Well, it's good, the spleen should be fine. Nurse C, heart rate, heart rate, report the heart rate."

"115."

Kawei nodded in satisfaction, then turned around to look at the saline injection: "How much did you get in?"

"It's already 500ml."

"Okay, go ahead and pour out the remaining 500ml of water."

"understood."

Carvey seemed to have forgotten the topic just now. After finishing the stitches to remove the spleen, he began to focus on intestinal damage.Although the incision on the left abdomen only scratched the spleen, the lower colon and its adjacent stomach were ruptured to varying degrees.

"Come on, give me wet gauze."

Seeing him as if nothing happened, Hills couldn't help asking again: "What is the question you mentioned just now???"

"What question?" Carvey looked at him before he realized, "Oh, varicocele, in fact, I just have some doubts about the inspection method. After all, it is very troublesome to check when sitting and lying down for a while, and the symptoms Not too obvious."

"Although the examination is cumbersome, the accuracy rate is not low." Hills felt very strange, "If we just follow the habit of the doctors in the internal medicine department who don't do their hands, the most we can see is a swollen penis sac. You just said The same goes for inflammation, hernia, hydrocele.”

"In fact, we only need to ask the patient to do a simple movement, and we can see the varicose veins with the naked eye."

"What action?"

"Valsalva action."

Hills frowned, and looked at Locard, who was preparing to repair the surgical instruments for the gastrointestinal tract. The two had no impression of this strange name: "I haven't heard of it, where did I learn it?"

"It was invented by an Italian anatomist." Carvey said with a smile, "My father worshiped him at the time, and his profile portrait is still hanging at home."【3】

"How to do?"

A cumbersome noun and a profile set off the atmosphere, and the "Valsalva Movement" instantly became a big deal in the minds of the two, but in fact it is simply a sentence: "Hold your breath for 10 seconds, and use your chest and abdomen together. "

".That's it?"

"Yes, it's just holding your breath, nothing special." Carvey explained, touching his stomach with his hands, "Sure enough, there is a hole here, give me a needle and thread."

The opening of the stomach is slightly larger than that of the spleen, but the surface tissue of the stomach is tougher, and it is more comfortable to suture: "As long as you hold your breath, the varicocele will appear, like a group of earthworms entangled together. Of course, if You can feel it if you touch it with your hands, but some mild patients still have to hold their breath."

"Can it still be like this?" The two suddenly realized, "But from the perspective of blood circulation and physiology, there seems to be no problem."

"It's a very useful inspection method." Carvey explained, "There used to be a young man who was a glass blower. When he came to my father for an inspection, he mentioned that every time the blowing was done, the penis would swell and hurt. , It was later discovered that it was a varicocele."

"This method is good. I must introduce it to the teacher after he wakes up." Locard asked suddenly, "But the breath-holding movement discovered in the last century, why hasn't it become popular yet?"

"Because the Valsalva maneuver was originally used to treat otitis media." Carvey pointed to the ear and said, "The anatomist discovered that holding his breath can make it easier to discharge the pus in the ear. But unfortunately later because With a more convenient syringe for cleaning, it doesn't need to be so troublesome."

The content of the chat between the three of them circled around the varicocele examination, and finally returned to Olgi.

After confirming the author's illness, the experienced surgeon immediately drew up a surgical plan, that is, to perform partial yin capsule resection + winding vein ligation. 【4】

"Is it the left side?" Carvey only hooked three stitches on the rupture, and ended the suture of the stomach. 【5】

"No, both sides."

This time it was Carvey's turn to be surprised: "I didn't expect Dr. Olgi to be so powerful that he can treat bilateral varicose veins at once?"

"As long as it's an operation related to andrology, the teacher is quite famous in the whole of Austria." Locard looked at Olgi who was still in a coma, and said, "It's just that this operation is..."

Gao pills are the top priority of male fertility. Conservative Austria often chooses more secure conservative treatments, such as bloodletting and vaginal pouches or simple buto.Even if it is really severe enough to require surgery, surgeons often only do one side, and leave the side with relatively milder symptoms still.

The fear is that there will be a surgical accident.

Olgi's surgery plan can be said to be very bold, not because he wants to create any history, but because the writer's varicose veins are very serious.No matter if you do one side or both sides, once you fail, the outcome is actually the same. Anyway, you have to do the other side sooner or later.

"The surgery was a success."

"The operation was not successful."

Lockard and Hills once again disagreed on the success of the operation: "The wound healed well after the operation, and there were no mistakes in the operation of the bilateral yin sacs. This is the performance of the operation. You were an assistant at the time, and you should be better than me. It should be more clear."

"I do see clearly, but I don't agree with you."

Lockard retorted: "The success of the operation does not depend on the incision, nor on the surgeon's technique. What depends on the specific effect in the end! Even the teacher admitted that the operation effect was not good. Still small and soft."

"We treat varicose veins with surgery, not the size of the gao pill. What's more, a large number of operations have proved that once the gao pill gets smaller, it can't get back!"

"But this still can't change the fact that he can't have children." Lockard said, "They were together before they got married, but they haven't been pregnant for more than three months. This can't be Linette's problem, She checked it, it must be that the writer's gao pills haven't returned to normal."

Severe bilateral varicocele will affect the development of gao balls, thereby affecting the quality of sperm, resulting in male infertility [6].However, the operation itself will accidentally injure lymphatic vessels and arteries, and the effect of the operation varies from person to person.

"Did the varicose come back?" Carvey asked.

"He came back for a follow-up visit half a month ago, and varicose appeared on both sides of the yin sac."

"It does seem to be a relapse."

"In fact, I reviewed the operation process twice later, and felt that there might be some mistakes in the operation." Lockard seemed to recall some details, "When Mr. Olgi performed the high-level vein ligation, he may have missed something. branch."

"It's inevitable to miss it." Carvey comforted, "This should be regarded as a complication. The recurrence rate of varicocele is quite high."

The operation has been over for nearly half a year. Because there is no operation record, the only ones who could understand the operation process at that time were the chief surgeon Orgi and his assistant Locard.So whether the operation failed, or whether there were any mistakes during the operation, is actually a muddled account.

Moreover, recurrence of surgery was very common at that time, and being able to get off the operating table alive was considered a success.

"The real problem isn't surgery at all," Lockard said. "The problem is keeping the secret!"

Although the marriage between the writer and the daughter of the dye factory was based on love, love needs to be crystallized, and the infertility is unacceptable to Lynette.

That's why the writer came to have varicocele surgery before getting married, hoping to cure it, and then live happily with Linette, and by the way inherit the dye factory worth tens of thousands of crowns in the future.

Unfortunately, he met an upright surgeon.

"The teacher has actually helped him once." Lockard said, "When Linette brought him for a review a month ago, Mr. Olgi said to the two of them that there is a great hope of recovery. Although it is It’s cheating, but it’s also something that can’t be helped.”

"But this practice made the teacher very painful!!!" Hills retorted, "Just two days ago, he was still talking about it."

"Keeping personal privacy is the most basic moral bottom line for doctors." Locard argued, "If you can't even do this, how can you treat patients?"

"Keeping one person's so-called privacy and making another person's life miserable?" Hills shook his head at this statement, "If it were me, I would tell Lynette loudly that he will never be able to have children in his life. If you want to have children, get another man."

(End of this chapter)