Nineteenth Century Medical Guide

Fernand's rectal mass resembled a solitary rectal tumor, but it was much better than those malignant tumors.The boundary is clear and smooth, without the moldy feel of malignant tumors that are difficult to define.Considering the presence of schistosome infection, Carvey gave the diagnosis of schistosome colitis mass.

In fact, according to modern medicine, if Fernan has testicular cancer, all such tumors need to be labeled as "tumor to be excreted".

But regardless of whether it is a tumor or not, the indications for surgery are similar now

Ordinary inflammatory lumps with egg deposits are not invasive. If you have to make a comparison, this kind of inflammatory lumps are just a pile of debris that forcibly occupies the public area. Apart from occupying the public area, it seems that there is not much harm. .

Like another mass in the colon, the inflammatory area did not protrude deep into the lumen and did not interfere with daily life.

Malignant tumors are different. The difference is that the tumor will grow extremely fast, invade the lumen, and metastasize to other tissues.In comparison, it is like a foul-smelling ooze monster that will grow infinitely and penetrate everywhere. If it is not eliminated now, it will one day occupy the entire city.

Although the mass on Fernan's rectum didn't look like a malignant tumor, his life span didn't need to consider its growth, and it wasn't metastatic either.

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But its location is not good. Judging from the tactile sensation, it should have invaded the muscular layer inward, and there is a risk of penetrating the mucous membrane soon.The lower edge has reached the vicinity of the dentate line. As for the exact distance, the retroperitoneum needs to be opened to clarify.

The sundries are only called sundries when they are piled up in the corridors and streets. Once they are piled up in the room, they become garbage that has to be cleaned.

However, this is only for long-term residents. If they can't live immediately, it is not impossible to endure it for a while.

"The location of this lump is really subtle."

At this moment, Carvey was probing into Fernan's anus with his fingers, repeatedly touching the surface of the mucous membrane invaded by the lump, and the more he touched, the more he felt that the necessity of surgery was lower than expected. To put it bluntly, it was optional.

From the perspective of medical technology, there is no right or wrong whether to proceed with the operation.

Judging from the size and degree of invasion of the tumor, it was indeed necessary to remove it, and the indications for surgery were clear.

But from the perspective of postoperative recovery, rectal surgery has its own pollution properties. Under the existing conditions, postoperative infection is almost inevitable.Moreover, rectal surgery must touch the sphincter. Whether the anus can be preserved and whether the sphincter will be damaged are all problems.

The most critical point is that no one knows whether there will be any accidents during the next 12 hours of surgery.

If it was in modern times, Carvey might consider continuing to do it for the sake of judicial procedural justice when encountering such a situation.But if you only proceed from personal interests and consider the risks of surgery, it is better not to do it.

First of all, Fernand is undoubtedly a death row prisoner, there is no doubt about it.

From the very beginning, the purpose of the operation was to show the world how to treat portal hypertension, not to save his life.Now that the portal hypertension has been dealt with, the spleen has been cut cleanly, and the shunt vessels are anastomosed well, so Carvey is very satisfied. …

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【Nineteenth Century Medical Guide】 【】

Edinson was sitting in the audience, and he was no fool.

Before, he insisted that cesarean section and breast cancer resection are useless to military doctors, and he did not express his opinion on Olgi's abdominal surgery, relying on his own identity to keep suppressing Carvey.

Now so many pairs of eyes are watching this abdominal surgery successfully concluded, and Carvey once again set a record.It is obviously inappropriate to kick him to the front line. Not only will he be gossiped, but he will also have to worry about Morazo's energy on both sides of the military doctor's office and Franz.

Franz was no fool either.

Even if he chose not to speak out because of the face of the Edinson family, now Kawei has placed a bargaining chip on himself.If such a surgeon can't get the position of the chief surgeon in the field hospital, and needs to rush to the front line with the battalion-level troops, the joke will become big.

According to Edward, this is a waste of money.

Now that the preoperative goal has been achieved, there is no need to take risks.

Carvey thought of this and sighed: "Forget it, after further examination, it should be just a benign mass. Surgical resection itself has the risk of many postoperative complications, and it may be more troublesome."

After speaking to several assistants, Carvey pulled out his finger, turned around and walked to the speaker and said, "Dear Mr. Ambassador, the original operation plan has been completed. The rectal mass is difficult to deal with. My personal suggestion is to It's better not to move."

Edward frowned, not knowing what Carvey meant by saying that. He didn't realize the seriousness of the problem until the consultant beside him said, "The operation is about to end."

"Mr. Carvey, as a doctor who saves lives and heals the wounded, you should challenge your limits." Edward picked up the loudspeaker and suggested, "Since the previous operation has been completed, it shows that you are fully capable of challenging new difficulties. Let’s cut off the lump under it as well.”

This actually makes some sense. If Fernan was just an ordinary patient of his, without the label of a death row prisoner, Carvey would indeed do this.

But there was a peculiar smell coming out of Edward's mouth.

Obviously, he was very dissatisfied with the success of the operation, but he didn't want to break the current situation, so he hoped to prolong the operation time and increase the risk of the operation, so that Fernan could die on the operating table with peace of mind.This is not only his wish, but also God's will. Carvey won the first half and lost the second half without any loss. It was perfect.

Of course Carvey knew what he meant.

"Mr. Edward, from a medical point of view, the risk of continuing the operation is very high." Carvey showed the blood on his fingertips and said, "It's better to close the abdomen like this and the patient can't last for a few days, so I say"

It’s this kind of rhetoric again. Edward suffered a loss once, so it is impossible to believe him. Before he finished speaking, he interrupted: "Dr. Carvey, this is called the surgery square. Since Fernan still has problems, it should be solved." That's the right question."

"Huh? How do I remember that Mr. Ambassador called this place the execution platform?"

Edward was not stopped by this sentence.

He glanced at Franz, then looked at the densely packed audience in front of him, and raised his voice: "I am just a diplomatic ambassador, and I have no right to decide. I think the most important thing to ask is whether it is an operation or a direct execution. Citizens of this great city, that is, all of you in this audience."  …

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【Nineteenth Century Medical Guide】 【】

This question is meaningless. Whether Fernand is dead or not is a secondary issue. The main question is how can hanging be as good as a fee-based operation.

Even though the first half of Carvey's surgery was boring, the second half, when he had his spleen removed, was brilliant.Now that the surgical area has moved down to the rectum, in line with the principle of being able to see one more, the audience is naturally unwilling to give up.

"Do surgery! Do surgery! Do surgery"

Edward smiled and looked at Carvey: "It doesn't matter whether it's the surgery plaza or the execution platform. The audience pays the money, so the audience has the final say. Please continue the operation."

Carvey originally wanted to refute that he had not received any money, and that the performance was completely free, but considering Franz's role in the charging process, he kept his words in his heart.The most important thing in war mobilization is money. If you talk about money with Franz now, the meaning of replacing the death penalty with surgery will disappear.

Surgery is also good.

He quickly changed his mood and adjusted himself to the state of the operation: "Since everyone wants to watch it, then I will continue to do it."

Hearing this sentence, the scene burst into warm applause, and the sound just now sounded again, but this time it was replaced by Kawi's name: "Kavi! Kawei! Kawei."

The country in the 21st century is very safe, but if the time is moved forward, it is actually not peaceful.

Incision trauma of the abdominal cavity is always accompanied by damage to the intestines. Although the rectum is rare, the number of cases accumulates over time.Rectal foreign bodies are also frequent visitors to the emergency department, and they have changed their methods over time, so Carvey can be regarded as a skilled worker in rectal surgery.

Rectal tumor resection seems to be a resection of a certain part, but because of the functional positioning and special anatomical structure of the rectum, there are various surgical methods.

Carvey still remembers a dozen or so. 1】

As for which one to use, the choice must be made in combination with the available equipment and the specific location of the tumor that will be seen after exposing the field of vision later.

"Give me the scalpel." Carvey took the scalpel and made a central incision on Fernan's lower abdomen before the upper herringbone incision was sutured. "Hemostatic forceps, warm gauze, tissue dissection forceps. Report your heart rate blood pressure."

"98, 124/73."

Kavey nodded, his hands began to speed up, and he ignored some small bleeding points and directly entered the abdominal cavity: "Prepare warm saline, rinse the abdominal cavity twice before performing surgery."

"it is good."

Bergett added another bowl of spleen blood to Fernand's blood transfusion bottle, turned around and went to prepare normal saline, and prepared wet gauze for the operation at the same time.Two basins of water were placed in the stomach, and some blood clots remaining in the abdominal cavity and ascites that had just leaked out were pumped out together.

Carvey checked the location and range of the lump again, and found that the distance from the dentate line was not too close. If the lower edge of the lump was properly cut, there was still a chance to keep the anus.

The operation is a variant of the Dixon operation, that is, there is no need to expand the cutting range of the outer edge of the tumor, and it is not necessary to remove the surrounding mesentery. Only a simple bowel resection where the tumor is located is performed, and then intestinal anastomosis is performed. 2】

"After entering the abdominal cavity, we find the sigmoid colon and rectum."…

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【Nineteenth Century Medical Guide】 【】

Carvey gently pinched the sigmoid colon in his hands, cut the retroperitoneum along both sides of its mesenteric root, and exposed the root of the inferior mesenteric artery: "We started to clean the lymph nodes and fatty tissue around the intestines downward." 3]

If traditional rectal cancer resection is performed, the inferior mesenteric artery needs to be cut off, because the descending colon, sigmoid colon, and rectum are all resection areas.But what Carvey is doing now is simply cutting the tumor, there is no need to expand the scope, so these blood vessels can be preserved. 4]

"We must pay attention to the left ureter when we are doing lymphatic and fat removal." Carvey moved downward while doing it, "Then we can cut the retroperitoneum and enter the space in front of the sacrum." 5】

At the presacral space, under direct vision, Carvey is close to the dorsal side of the rectum and begins to make a sharp separation to the pelvic floor.The separation must exceed the tip of the coccyx to avoid damage to the presacral plexus and venous plexus. 6]

Considering Fernan's physical tolerance, Carvey didn't talk too much here, but greatly accelerated the operation speed according to his own muscle memory.The operation itself was not within the scope of preoperative practice, and the two assistants could only do it based on their intuition.

"We cut the recto-sacral fascia, and then we can see the rectum, free the rectum enough, and you can see the mass right in front of your eyes."

The feeling of touching the abdomen with the herringbone incision before is very strange, because there are many soft tissue barriers and other intestinal tubes interfering, and Kavey's judgment on the location of the tumor is different.

Now after a full dissociation, Carvey can already see the location of the tumor clearly, just 3cm above the dentate line, which is very thrilling.If it sinks another 12cm, it will be difficult for Carvey to guarantee Fernand's anal function.

"The mass was very large, but the recto-vesical depression in front of the rectum needed to be mobilized before it could be resected."

Carvey extends forward and downward along the retroperitoneal incision at the root of the sigmoid mesentery, continues to incise the peritoneum in the depression, and then separates along the fascia, pushing the vagina and the somewhat enlarged prostate forward: "We can now Now that the mass is clearly seen, give me two vascular clamps."

Damirgon handed over the instruments, and Kavi exposed the lateral ligaments of both rectums and clamped them along the pelvic wall.

"Scalpel."

"Give."

"Needle holder and thread."

"Give."

After two back and forth, all the ligaments on both sides were cut off, but because of the problem of using the needle holder, the ligation could only be handled by Kawei.The only thing Herman and Damirgon can do is to pull the hook, pass the instrument, and expose the necessary field of view at any time: "We continue to clean up the fat and connective tissue around the mass."

In rectal surgery, because the rectum is too deep, it is inevitable that there will be problems with the surgical field of view.In order to ensure the light in the operation area, Bergett had to put down his work and picked up the prepared oil lamp.

But when the ligaments and blood vessels were cut off, Fernan, who had persisted for nearly three hours, seemed to have reached his limit.

"Doctor! His heart rate suddenly increased just now."

"How many?"

The nurse hesitated for a moment, then said, "...about 105."

Carvey frowned: "Take another blood pressure test."

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【Nineteenth Century Medical Guide】 【】

"it is good"

Carvey stopped what he was doing, called Amor up, and checked the area he had just operated on, and there was no sign of bleeding.Looking at the hanging bottle again, there is still some medicine in it, and the speed of instillation has not changed: "How is the blood pressure?"

"Up pressure 104 down pressure 55"

"Blood pressure is dropping, it seems that bottle No. 1 needs to be accelerated."

I blocked this chapter and said that I have become lazy, and I haven’t even marked the symbols in the past two days]