Nineteenth Century Medical Guide

The original technical content of the operation is not high, and it is just a lack of experience for laymen, but the intuitive limb cutting is not difficult to understand.Therefore, surgical performances with wailing can bring exciting experiences to some people. At the same time, they can also bring a lot of income to doctors and reduce the treatment expenses paid by "patients".

Even if anesthesia has become a routine preoperative operation, the operation time has been greatly extended, and the fast-in and fast-out operations have become more and more refined, those audiences who like blood will still buy it.

After all, the surgeon is Kavey who has created miracles, and the surgical site is the abdominal cavity, which is rarely seen. The patient is still a murderer who must be executed. There are kings and queens on the scene. These conditions can attract many people. The eyeballs are full of all the exciting buffs.

At the beginning of the show, those who didn't care about the operation process were excluded, and the remaining people, whether they came to find fault or to cheer, the people's reaction was very unified, that is, anticipation.

They were looking forward to a complicated abdominal operation to open their eyes, and also hoped that disembowelling would bring them sensory stimulation, and they hoped that the murderer's life could be ended on the premise that the operation was successfully completed.

However, until now, except for the simple laparotomy and pulling the intestines with his hands, Carvey has not used other instruments except retractors.

No cutting, no bleeding, no stitching and easy to understand commentary.

Although Carvey has always emphasized that he is doing investigations, is such an investigation really necessary?Is it necessary to do an exploration before abdominal surgery in the future?
Preoperative anesthesia has already made the operation very boring, plus an investigation, can the operation still be done?How troublesome is this?
If the audience is an alcoholic, then the previous surgical performances were spirits mixed with tincture of ya tablets.Although the operation after anesthesia is less exciting, it can still become an ordinary wine on the table, which belongs to the level of drinking, and it is not bad as an embellishment in life.

Even if the operation really failed, it would still be spoiled and oxidized wine, with a sour taste anyway.

But the operation in front of me was too dull, without conflict, without climax, not even a trace of transition.The surgeons headed by Carvey stood around the operating table, constantly checking Fernan's stomach, like a great master who wrote a book that couldn't be ordered more than a hundred, and threw himself into the gutter.

Even if Carvey used the sphygmomanometer to calm down the opening scene, and then used the schizoplasma to attract Bo's attention, in the eyes of the audience, the opening is just the beginning, and the parasite is just a one-time job.

The operation time can be prolonged and it can be a little dull, but the basic stimulation must be guaranteed.The source of the stimulus is the focus of the operation, the flying scalpel, the splashing blood, and the severed stump.
Without these, there will be a lack of appreciation. Once there is a problem with the appreciation, it is useless to save it.

As early as 10 minutes ago, many people took the lead in discussing the cool atmosphere of the surgery.As time slowly passed, the emotions of the audience finally ushered in a wave of explosion after experiencing suspicion, boredom, sighs and helplessness.

Someone yelled, "Why does this boring operation cost more than 800 kroner?", and suddenly the same thought spread among the audience like a straw pile on fire. …

Fortunately, those who can sit in the auditorium are either rich or expensive, and their voices are quite restrained, let alone noisy.

On the other hand, the area where the surgeon is located is completely opposite. At the beginning of the game, driven by Mosier, Ferguson, and Bottini, there were a lot of doubts, but these voices completely disappeared after the operation started.

All they have is surprise, admiration and incomprehension.

So after the audience had various dissatisfaction, someone immediately stood up and said, "Even this kind of major abdominal surgery is boring to you?"

The first to raise doubts was Ingnac. Karvey is now considered half the face of the Municipal General Hospital, and he is also a student in name. At this time, he must be supported.What's more, from a professional point of view, this rhetorical question is also correct.

Soon, several chief physicians also left the stage one after another, expressing their attitudes.

"The three hanging bottles hanging on the arms of the condemned prisoner alone have stood at the forefront of world medicine." Watman added, "The combination of blood transfusions not only keeps people alive until now, but even slowly stops them. He vomited blood, do you know what that means?"

"And the simple sphygmomanometer he used is a feat that cannot be ignored," Orgi said. "Even if the operation fails now, blood transfusions and a sphygmomanometer can put his name in the history books of medicine." .”

"Even without blood pressure monitors and blood transfusions, his caesarean section is enough to leave his name on it."

Seeing the compliments from the crowd, Hills still insisted on his point of view and had doubts about blood transfusions and blood pressure monitors. 【1】

Whether blood pressure readings are really necessary to enter the clinic before the application effect is clear requires further research.Whether blood transfusion is really as safe as Carvey said still needs to be verified by experiments and time.

But putting these two points aside, after experiencing Olgi's abdominal surgery and cesarean section, and seeing Carvey's amputation, Hills has gradually understood the importance of standardized operating procedures in abdominal surgery.

Of course, his understanding of this aspect is still very shallow, but he still wants to say a fair word for Carvey: "The abdominal cavity is not an arm or a thigh. In addition to a large number of blood vessels, it is also full of various internal organs. We are Doctor, it would be a blasphemy to our profession if we use this prisoner's butchering technique to operate on him."

"Okay, whose pocket the money you spent went into, don't you know?"

Massimov began to trust Carvey unconditionally after undergoing the last brain surgery: "Carvey will naturally give a satisfactory answer. Since he has done this now, there must be a reason for him to do so , you are bored because you just don’t understand.”

】

With the support of colleagues, especially those who have made many achievements in surgery, the field finally stopped,
In fact, they know in their hearts that these are not just the support among ordinary peers, but also out of the desire to learn new technologies.What really made these doctors realize the gap between themselves and Carvey was what he said after checking the abdominal cavity.

"Mr. Fernand suffers from schistosomiasis, the hepatic portal system has been violated, and now he has portal hypertension, the spleen expands infinitely, and even the rectum has inflammatory nodules, which have invaded the intestinal mucosa. The situation is not optimistic. .Although the patient’s body is suffering from parasitic attacks, I also checked the esophageal and gastric fundus veins just now, and the varicose is very serious.”…

Carvey made a brief summary of Fernan's physical condition, and then said, "But I am confident that I can cure him with one operation."

This situation has completely lost the chance of surgery for the existing surgery. Facing the mess of the abdominal cavity, not many people are willing to use the knife.

In fact, when faced with upper gastrointestinal bleeding, half of the top doctors present would choose to give up, and the next half would basically choose conservative medical treatment or no treatment at all.

Nobody chooses to have their stomachs opened, not even if the other party is a death row inmate.Not because I was worried about the failure of the operation, but because no one knew how to deal with portal hypertension after laparotomy.Even, they don't know that liver cirrhosis is the direct cause of portal hypertension.

Carvey gave their medical knowledge a collective leap, with question marks as a side effect.

It was hard for them to believe that such a young surgeon had found the cause of the varicose veins and a surgical solution less than 7 years after the French discovered them. 【2】

How can there be confidence in such a dire situation?Before the laparotomy, you said you were not sure, so where did your confidence come from now?
What they don't know is that confidence is earned from previous investigations.

Unknown diagnosis will greatly increase the difficulty of surgery, but once the diagnosis and lesion location are clarified, the nature of surgery will change.

In the hands of Kawei, the current operation is no longer a random cut, but a complete set of battle plans.Fast forward and fast, the bloody surgical performance was lost under Kawei's standardized surgical operation process, but it increased the success rate.

Carvey didn't care about the questions from the audience, nor did he pay attention to Edward's crazy coughing behind him.He knows that as long as the speaker is still in his hand, he has the right to speak in this venue: "I will choose to cut off the huge spleen first, and then selectively perform peripheral vascular shunt or directly perform perigastric vascular devascularization."

This should be the first time he has clarified the basic surgical plan to the audience.

Spleen removal is easy to understand. In today's abdominal surgery, cutting out a damaged or swollen spleen is a relatively common surgical procedure, and the difficulty is not too high.But what is the shunt after that?What is a disconnection?
Can surgery that has been performed on limbs and organs also be used on blood vessels?

Since the concept of aneurysm appeared in the 18th century [3], the most direct and only way to deal with blood vessels clinically is ligation.

Broken blood vessel?ligation.

Broken blood vessel?ligation.

Need to cut some tissue, disconnect blood vessels?Still do the ligation.

Even if Carvey has done simple blood vessel repair or compression to stop bleeding, ligation is still the absolute mainstream.

They also thought about anastomosis of blood vessels, but soon this fantasy idea was defeated by the crude surgical suture needle and thread.In fact, even if modern vascular surgery is handed over to them, due to the lack of anatomical and clinical understanding of the vascular wall, even if the blood vessels are really anastomosed, there will probably be stenosis of the lumen caused by inward hyperplasia at the suture.

Ke Wei still put the sutured blood vessel on his lips, and said confidently: "Don't get excited, if you have any questions, we can talk about it after the operation is over. Whether the operation is successful or not, I will try my best to answer your questions." …

After saying this, he began to ask Bergett to prepare the equipment, and at the same time continued to talk about the next operation plan:

"After the spleen and blood vessels are processed, we will choose a solution for the rectal mass based on the patient's blood pressure, heart rate, and extent of nodule invasion. Before that, we still need to focus on the spleen, which is not an ordinary spleen. , it’s not easy to deal with.”

Before working on the spleen, Carvey needed a simple portal pressure measurement to demonstrate the effect of the surgical protocol on portal hypertension.

Damirgon and Bergett folded the skin at the herringbone incision, and then spread the omentum over the incision.Carvey chose a thicker omental vein as the measurement point, and Herman filled the long J-shaped glass tube (composed of glass tube, rubber tube and needle) brought by Bergett with normal saline. Pierce the vein from bottom to top. 【4】

The liquid level of the saline in the tube gradually drops along the needle into the blood vessel until it stops at 31cm.

"Normal portal pressure is around 13-24cm water column, 31 is already very high." Carvey removed the pressure glass tube, and then asked Herman to suture the veins with needles and threads, "After the spleen is removed, we can Then look at the pressure in the blood vessel, if the pressure returns to the normal range at that time, then the shunt operation can be avoided."

He found the spleen and stomach ligament with forceps while talking: "Next, according to the basic procedure of splenectomy, we need to ligate the splenic artery. Give me the scissors."

The scissors accurately found the avascular area on the spleen-gastric ligament in Carvey's hands, cut a small hole gently, and then clamped the blood vessel with vascular forceps to separate the ligament. 【5】

"Here is the splenic-gastric ligament, next to it is the splenic-colic ligament, which is cut off to better separate the spleen."

Carvey clamped the blood vessels on both sides with pliers, then cut open the ligament in the middle with a knife, and then Heman and Damirgang worked together to suture the broken ends at the same time.

Carvey continued to explore around the spleen, and there were schistosomes, although it would not cause serious inflammation in the abdominal cavity, there would be a lot of adhesions.If these adhesions are ignored and violent dissection is performed forcibly, it will definitely cause massive bleeding, which is not the style of modern surgery.

However, when he was investigating the adhesion of the spleen, Herman's move almost killed Fernand.

"What are you doing?" Carvey asked, holding Herman's arm with his hand.

Herman was a little confused: "I want to turn up the fundus and greater curvature of the stomach to increase your surgical field of view."

"We don't have this step in our cadaver practice, so don't move around." Carvey moved his hand away and lifted his stomach slightly, saying, "You all see what's down there."

[General surgery should be very familiar, gastrointestinal surgery must be taught on stage]

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