Nineteenth Century Medical Guide

At this stage of the operation, the audience was clearly divided into three parts.

Among them, the few chief doctors accounted for the smallest proportion.

Relying on solid anatomical skills and the telescope in his hand, he basically understood the whole process of the operation.Although the details are still a mess, and there are many operations that cannot be seen clearly, at least the general direction is grasped.

The rest of those other doctors who have a medical background make up the second part.

They have good knowledge of anatomy, but they don't know much about the abdominal cavity, a field that is not very involved, so a considerable part of the content is vague.

They have long skipped the details of the operation, and rhetoric such as "Attention here!", "You need xxx here", "Don't xxx here" are completely beyond their comprehension.These young doctors only hope that they can grasp the purpose and operation outline of each surgical procedure. Even if they complete the task, they are at least worthy of the thousands of crowns spent.

Unfortunately, it is not easy to do this.

Many people can only figure out a general framework while listening, watching and discussing. In addition, the live discussion is a double-edged sword under the same situation as the live broadcast. As a result, many people can actually understand very little. limited.

For them, apart from learning some basic skills of suturing, it is still too early to watch Carvey's operation, and it is still too early for the part involving surgical thinking and specific treatment methods.

Apart from these two categories, capitalists and aristocrats who have no medical background account for the highest proportion.I don't know how the operation has come to this point, I don't know when the operation will end, and I don't know how to deal with the vascular shunt.

The only thing they knew were two things, one was that Fernan's spleen was gone, and the other was that Fernan was still alive and well.

These people also included Edward sitting in the VIP seat.

Even if he doesn't know anatomy or surgery, he can still see some clues from the on-site response and the calmness of the surgery team.Leaving aside the difficulty, at least for now, the operation is still within a controllable range.

This feeling that the reality and the expectations in his mind are slowly derailed and gradually parted ways made Edward couldn't help asking the medical consultant beside him: "What do you think of the operation?"

"The operation itself is exciting enough. In addition, the blood transfusion and sphygmomanometer used are very creative. The recovery of spleen blood is also a pioneering work, and the effect is also very good."

Although what he said was true and emotional, the words he used were all polite words, because the consultant's attention was all on the operation, and he was afraid of missing the next vascular anastomosis.

Adorable Edward can't control these things: "So, when did the operation fail?"

".failed? Why did you fail?"

The consultant didn't understand what he meant for a while, and then he realized the original meaning of the operation: "Judging from the blood pressure and heart rate reported by the nurse just now, the patient is alive and well. Most of the operation is over, and since Judging from the previous surgical techniques and procedures, there shouldn't be any major problems."

"No problem? Isn't this operation very difficult? Isn't the success rate infinitely close to 0?"

Edward had this kind of premonition before, but he always felt that at Kawei's age, he couldn't handle this kind of surgery at all.In fact, even standing on such a stage at this age requires extraordinary courage, let alone surgery. …

Now, after hearing what his consultant said, Edward became more and more worried about what to do after the operation was successful?
After all, Carvey didn’t express it this way when he talked about the operation with him before. He compared the success of the operation to a young man who didn’t understand anything and suddenly cooked a table of luxurious French cuisine.It now appears that the so-called young man who "knows nothing" is actually a figure similar to Alphonse.

Edward was a little displeased: "He is a death row prisoner, this is the execution ground!"

"It's a pity that people are not dead yet. Death is the execution ground. If you are not dead, you can only count as the surgery square." The consultant knew that he was a little anxious, so he could only comfort him, "However, the next vascular anastomosis is very difficult. If it is not done well, It is estimated that it will be difficult for people to survive.”

"Are you serious?"

"Really. Probably."

The success rate of the operation in their eyes has long been changed because of the modification of the operation plan.

Previously, it was determined that there was a liver tumor and the difficulty of liver tumor surgery was considered to give such a success rate.Now there is no need to move the liver, splenectomy and venous diversion are not too difficult for Carvey.

Before the splenectomy, the success rate of the operation was over [-]%. Now after the splenectomy, Fernan's vital signs are still stable, and the success rate has already exceeded [-]%.

Next, as long as the anastomosis of the splenic vein and the inferior vena cava is done, Carvey can turn to the rectum.There was an inflammatory stimulus caused by the deposition of worm eggs, and it was necessary to judge the next operation plan in a short time.That is, according to the location of the inflammation, the choice is whether to preserve the anus, abandon the anus, or simply not operate.

"Give me the vascular sutures," Carvey said to Bergett. "It's in a vial in the drawer of the suitcase."

This is a silk thread that has been compound-woven and soaked in a chromium solution to strengthen its toughness. It is three times thinner than the original gut, but its toughness is higher.Although in Carvey's eyes, it is still a clumsy product under the industry of the 19th century, it is still much better than other silk threads anyway.

At the same time, it is also the key to the subsequent suturing of blood vessels.

And only the suture thread is not enough, there is another key to vascular suture, which is the carrier on the line, the vascular anastomotic needle with a smaller diameter and the slender needle holder.

Compared with the location of the spleen and pancreas just now, the inferior vena cava is deeper into the abdominal cavity, surrounded by mesentery, omentum, and a large number of intestinal stacks.Not only is the field of view difficult to expose, but it is also very laborious to operate.

Human hands have too many joints, and the volume length is not suitable for exploring such areas.This is not obvious in the superficial layer of the abdominal cavity. Once the operation area reaches the deep layer, only instruments can be used to increase the length and reduce the volume.

Needle holders solve this problem.

Considering the grip strength and easy operation of the needle holder, as well as the increasing popularity of laparoscopes, needle holders are almost used in modern surgery.

"Because the position of the inferior vena cava is too deep, it is difficult for me to handle it with my hands, so I chose a pair of short-nosed forceps instead of holding the suture needle with both hands for suturing."

Carvey has long been accustomed to this surgical method, and directly holding the needle with his hands will affect the operation.But in the eyes of outsiders, the practice of fixing suture needles with pliers is too advanced.What is more advanced is Kavey's vascular anastomosis method, because it is necessary to consider the healing of the inner side of the blood vessel after suturing, and the vascular fiber capsule needs to be stripped off before suturing. 1】…

This practice of actively creating damage for better healing during surgery is actually very common.

"The vascular anastomosis itself is not too difficult, especially when you have these operating instruments." Carvey explained, "The important thing is how to keep the blood vessels open after the anastomosis. What you need to do to keep the blood vessels open is to prevent the blood from entering the blood vessel." Coagulation here is nothing more than preventing blood vessel narrowing."

Speaking of this, he lifted the vascular capsule with tweezers, cut it open with small scissors, and removed this layer of coating: "When suturing blood vessels, this layer of capsule is easily brought into the vessel wall. Once it enters the vessel wall, although it is not suitable for anastomosis The mouth itself doesn't affect it, but it does impede blood flow."

This is a set of theories that shouldn't have appeared in this era. In order to let them deepen their understanding, he can only add the set of explanations of the carriage congestion.

Many people understand right away, and immediately understand that once the carriage is congested, the driver will never be happy.The small ones swear at each other, and the big ones fight with each other. Once they scuffle together, the whole road will be impossible to pass.

The same goes for blood vessels.

"After stripping off, you need to clean the remaining vein lumen that needs to be anastomotic." Carvey took the syringe from Bergett and dripped the normal saline inside into the lumen, "These clots If it enters the lumen following the anastomosis of blood vessels, it is very likely that a thrombus will form right after the suturing is done, and the whole operation will be wasted.”

After all, he looked at the nurse.

"Heart rate 96, blood pressure 122/68."

Kavi nodded.

"After cleaning, first use silk thread to choose inversion suture. The suture technique is to fix the upper and lower points first, and then the middle, which helps to play a supporting role. It is also convenient for reference for incision alignment." Carvey said during his speech The posterior wall has been anastomosed with great effort, "After the posterior wall is finished, we will suture the anterior wall of the anastomotic stoma, which can be continuous or intermittent."

Suturing blood vessels is a technical job.

Not to mention that the audience couldn't understand it, even the three assistants standing by the operating table were confused.

They just felt that Carvey's sutures were repeatedly interspersed between the two ends of the pink ball, joining two unrelated structures together.Because the anastomosis is small, the operation appears to be performed at one point.

If it was someone else's surgery, they would have started asking questions if they had any questions.

But Kavey's operation does not allow questions, not only to interrupt the train of thought, but more importantly, they don't know how to ask to make themselves less stupid.

"Is there anything you don't understand?"

"That." In terms of suturing, Damirgang is more experienced than the other two, "Why do the sutures go from the lumen to the outside? Not from the outside to the inside?"

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"In order to prevent the residual tissue around the blood vessel from being substituted into the inside." Carvey explained, "Although the blood vessel is almost free, there are still a lot of fat and soft tissue on the surface. If it is from the outside to the inside, it only needs to be brought in a little Causing a chain reaction."

"It turned out to be to prevent blood clots."

Carvey quickly completed the anastomosis of the splenic vein and the inferior vena cava, and immediately entered the stage of postoperative finishing and inspection.

The first is the position and shape of the splenic vein. In order to keep the splenic vein unobstructed, let this collateral share the pressure for the entire high-pressure portal system as much as possible.At least the splenic vein cannot be twisted, oppressed by other organs, let alone bent. …

"Release the hemostat."

After Carvey's inspection, the first thing to do is the blood circulation.

In essence, the quality of suture needles is still not enough to perfectly complete a venous anastomosis.The needle hole at the anastomosis itself is an injury, and it will definitely bleed: "There is bleeding here, give me gauze"

The bleeding point at the anastomosis was stabilized after two consecutive pressures.

"Come on, bring up the pressure gauge just now."

"it is good."

“Splenectomy and venous shunt are excellent procedures for portal hypertension,” Carvey explained. “The results are immediate.”

I saw that the people in charge of the experiment just now were replaced by Bergett and Damirgang. The long glass tube was still used, and the mesenteric blood vessel was still pierced: "It has dropped to 23cm."

This is the most intuitive manifestation of the effect of the operation, and it also allows Carvey to finally announce: "Now I would like to inform the audience that the patient's splenectomy and splenoportal vein shunt operation has basically been completed. The patient's vital signs are very good, and the operation was successful."
Half of the success, there is another troublesome part. "

The splenectomy and shunt operation took Kawei a full one and a half hours. Counting the previous half-hour of exploration, Fernan had already been infused with ether twice.If rectal surgery is performed again, this number will have to be doubled again.

And rectal surgery does not mean surgery 1, the same 1 also has surgical incisions.

The herringbone-shaped incision in the upper abdomen is no problem to reach into the abdominal cavity for exploration, but there is no way to solve the delicate surgery on the lower abdomen.Carvey needs to suture the upper herringbone incision first, and then make a lower abdominal midline incision on the lower abdomen. The overall trauma is very large.

Long-term use of ether is inherently dangerous. Although the vital signs are stable now, when the surgical incision is further enlarged, no one can tell when the numbers will change drastically.

Amor was sitting in the preparation area outside the operating area, because the four assistant nurses surrounded Fernan tightly, so he could only solve the problem of anesthesia records by entering repeatedly.

Records include vital signs during anesthesia, as well as the supply and refill of infusion drugs, blood transfusion, and urine output.At the same time, it is also necessary to record the various reflex intensities during the anesthesia, and grasp the timing of continuing to add ether, so that the mid-term of the operation is overly stable.

Judging from individual reactions, Fernan's physical condition is not bad, at least he won't have too many side effects like other people.Coupled with the proper dosage, the stimulation to the body of an overdose in the middle is also minimized.

So when Carvey asked about the anesthesia, Amor relied on the experience he had accumulated these days, and replied: "I can still persist."

"Okay then, Damirgang sutures the herringbone incision, and we continue to work on the rectum." Kavi and Damirgang switched positions and came to the lower abdomen, "Disinfect it again, and make the incision after I check again, this time We're going to pick up speed."

The second half of the operation officially began.