Nineteenth Century Medical Guide

Chapter 251 247. Creativity is the upper limit of surgeons [1]

[Yang, 38.8, muscle pain below L4 is not good.However, after returning home, I found that codewords are much easier than going to work, and I can still update them after taking medicine.Anyway, I can’t sleep, it’s just that the code is a bit slow, so I’ll finish it slowly, forgive me】

In the early years, the operation method of emergency surgery was still similar to opening a blind box, and there was very little work that could be assisted by imaging.Surgery is exciting, but it is full of risks and choices for both doctors and patients.

However, with the development of modern medical equipment, the proportion of imaging in diagnosis is getting higher and higher. Evidence-based medicine also relies on a large number of sample data to standardize medical methods. There is a clear definition of what to do under what circumstances. Regulation.

This undoubtedly increases the survival rate of patients, but it also gradually loses the fun of opening the blind box.

Of course, Carvey is not a surgeon for this kind of fun. For him, the blind box is a small surprise in life and work, and its positioning is similar to the spicy and exciting seasoning in dishes.

Suddenly missing it will definitely make you uncomfortable at first, but as long as the time span is extended, you will gradually get used to it.Conversely, if it reappears suddenly after disappearing for a long time, the taste buds accustomed to the plain taste will cheer for this taste.

Carvey is probably in this wonderful state now, which is more exciting than the abdominal surgery performed on Fernan before.

After completing the blood matching and stabilizing his vital signs, he held forceps in his left hand and scissors in his right, and began to carefully cut open the membrane structure on the surface of the blood vessel, exploring towards the sutured blood vessel just now.

"Come closer with the lights."

In ordinary abdominal surgery, because the operative field is wide enough and the operative area is within the peritoneum, a dozen candlestick chandeliers placed together in the operating room can barely maintain the supply of light.

At present, the operation area is deeper behind the peritoneum under the intestine, and the common iliac artery is in the pelvic cavity. The incisions that can be opened are limited, so this kind of candlestick light source that can move up and down is not enough.

Carvey was incapable of inventing electric lights. Even if there were electric lights, it would be difficult to safely erect generators and wires in such a field hospital, and electric shock accidents were likely to occur.

All he could think of was this: "Go find a portable lamp, and bring me a mirror."

The light of the oil lamp entered the surgical field after reflection, and Kawei's heart felt a bit cold.

The abdominal aorta divides from the right common iliac artery and then divides into the right internal iliac artery and the right external iliac artery. At the intersection of the right internal iliac artery and external iliac artery, the posterior wall of the vessel is severed.The intima of the blood vessel is exposed and broken, and the simple repair and suture originally envisaged is no longer possible. The only correct way to deal with it is to do a good job of local blood vessel resection, and then do an anastomosis of the broken ends on both sides.

For Carvey, it is not difficult to deal with ordinary blood vessel disconnection as long as the vital signs are guaranteed.The real difficulty is to control the damage distance, because the continuity of blood vessels must be ensured after suturing, and useless tissue needs to be cut off before suturing butt joints.

Carvey had a headache, and the choice appeared in front of him again, whether to give up suturing for amputation, or choose to make it difficult for himself and try to keep his right leg.

"The broken distance exceeds 1cm, which is consistent with my previous judgment." Few people can hear the overtones of this sentence, so Carvey needs to make further explanations, "This section of blood vessel is seriously damaged and must be removed. Then kiss again"

The conversation suddenly stopped here, and the silent question followed his gaze to the three doctors on the stage.

Bergert was inexperienced, so he said something very ambiguous: "The anastomosis is very difficult. Will the suture line inwards cause vascular stenosis during suturing?"

"This is something that needs to be considered when suturing." Kawei looked at Damirgang, "What do you think?"

"The rupture of the blood vessel is too large, and a large segment of the ruptured blood vessel needs to be cut for final anastomosis." Damirgang seemed to have thought of this, but he couldn't express it in words.

Seeing him like this, Herman added: "The blood vessels are not long enough?"

"It's finally right." Carvey measured the length of the rupture again, and said, "The distance is too long. After cutting it off, the suture tension is too high. However, blood vessels are inherently elastic, and it is not a big problem to extend them a little. Everything is fine. You will know after you do it.”

Carvey only hesitated for a moment, and immediately gave the answer: "Try sewing first."

If it is modern surgery, allogeneic blood vessels and artificial blood vessels can be used as substitutes.Of course, this option is also troublesome and risky. First of all, there may not be an emergency department. Even if it does, after allogeneic or artificial blood vessel grafting, the patient will end up taking immunosuppressants for the rest of his life.

In such a large environment, immunosuppressants should probably not be the first choice.So no matter what age, Carvey seems to have two ways to go, but he has to choose direct suture.

Fortunately, the length of the ruptured blood vessel did not exceed the limit that could not be sutured. With a length of 1 cm and the physical fitness of the wounded, it should not be a big problem to rely on the elasticity of the blood vessel to suture.

"Two vascular clamps, blood vessel suture thread, ready for anastomosis."

"Get ready, Dr. Carvey."

Carvey slowly separated the blood vessels in the normal areas on both sides downwards, fastened the blood vessel clamps on them, and locked the blood flow.Only then did he see the whole picture of the blood vessels: the bullet shattered the vertebrae, the bone fragments and the bullet wounded the iliac vessels in front of the bones.The vessel wall is fragile, and the posterior wall is completely damaged, with no possibility of repair.

As for the bullet should have been shot into the abdominal cavity, but no one knows exactly where.Now the priority of vascular injury is higher. After analyzing the damaged area, Kawei knew that his choice was not wrong.

This is not the first time he has performed pelvic vascular resection and anastomosis without preparation. Surgical emergencies often encounter such wounded patients.The emergency operation is more direct than the elective operation, and the effect of limb salvage can only be achieved by stopping the bleeding and restoring the blood supply as soon as possible with the cooperation of intervention.

There is no problem in experience, but he still feels pressured.

Different from the emergency surgery team who cooperated tacitly at the beginning, Carvey now has ordinary cards in his hands, even uncrafted young people.What he did was more like a vanguard with no supplies, and if the match failed, it would be a blow to his prestige.

"Amor, I blocked the blood vessel, calculate the time for me, and then guarantee his vital signs."

"kindness."

"Herman helped me fix these two non-injury forceps, and Damirgang continued to drip sodium citrate into the broken end of the blood vessel to ensure that the wound was not coagulated enough." Kawei gave the task to the two of them, and immediately got their response.

"Ok."

"Ok."

Vascular anastomosis itself is a handy job that requires attention to many details, but in the eyes of outsiders, it seems that it is not much different from suturing other tissues.There was a silent battlefield in front of Kawei, and without a surgical magnifying glass, Kawei could only bend over and get as close to the wound as possible to distinguish the layers of the vascular intima.

Under the silent operation, one needle after another, the broken ends of the blood vessels were finally anastomosed successfully.

"The suturing of the blood vessels is completed." Carvey looked at the somewhat tight blood vessels and the tension of the suture thread, and was quite satisfied, "Next, Herman, you slowly and gently bring the two hemostats together in the middle, don't let The vessel wall against which the forceps fit is pulled to the suture, minimizing tension."

"Okay." Herman agreed, pinching the buckle of the hemostat with both hands
"let's start."

This was originally a finishing operation. Although it was delicate, it was not difficult. According to Carvey, Herman should be able to do it.But he didn't know whether it was because he didn't spend a lot of space to emphasize the meaning of "close together gently", or because Herman's hand strength was inherently strong, and his "lightly" and Carvey's "lightly" were two different strengths. different concept.

The moment Herman released the hemostat, a scene that did not appear in all the rehearsal plans in Carvey's mind happened.

The teeth of the hemostat on his right hand were adhered to the wall of the blood vessel, but he didn't pay attention to it. Before Kavi could stop it, the blood vessel that had just been sutured was suddenly broken by him.In an instant, hundreds of ml of blood spurted out from the severed end of the abdominal aorta, which shocked everyone, including Kawei.

At this time, among everyone's shock, only Carvey reacted the fastest. Relying on instinct, he pinched the broken blood vessel with his fingers and quickly clamped a pair of hemostatic forceps.The second was Damirgang, who followed Kawei to start the work of pumping blood from the abdominal cavity.

Even Bergett had prepared a blood transfusion bottle and a hemostatic gauze, and was there to help immediately.

"What's the matter with you?" Carvey was a little annoyed, "I've been with me for half a year, and I can't do this operation well? I don't know how to loosen the hemostat when you have to be gentle?"

"I know, it's just that as soon as my heart relaxes."

"Substitution, Damirgang will be the first assistant, Bergett will be the second assistant, and you go prepare for the blood transfusion." Kavi looked back at Amor, "How is it?"

With the heavy bleeding, the blood pressure dropped again: "86/49, heart rate 117, I'm already working on it, give me some time."

"kindness."

Being able to stop the bleeding immediately and stabilize the blood pressure at the same time is good news for Kawei.But this does not mean that there is no bad news. The most terrible redemption has just been a tear at the anastomosis of blood vessels. The original defect of about 1cm has now expanded to 3.8cm.

The defect distance has quadrupled, no matter how strong Kavey is, it is impossible to connect the blood vessels on both sides.

It's no use scolding Heman now, being downgraded to three assists is already a big punishment, the key now is how to save limbs.

Carvey's brain was running at high speed, and several possibilities and plans came to mind.

The first thing we can do is to stop the loss as soon as possible, cut off the right lower limb, and save the life of the wounded.But this deviates from Carvey's original intention, and giving up at this time is not in line with his surgical style.

The allograft and artificial blood vessel transplantation that can be done now are impossible to realize. Could it be that autologous blood vessels are used?
But this is the right common iliac artery, the blood vessels are thick and thick, and the radius of the veins that can be harvested is not suitable for transplantation here.

How to do?
Looking at the increasingly clear surgical field, Carvey suddenly thought of something. Apart from these conventional treatment methods, there may be other ways.
"Come on, give me the scalpel."

"Scalpel?"

The strange order made the equipment nurse a little overwhelmed, but instinct still made her pass the knife to Carvey.

"In order to anastomose this vessel, we now enlarge the incision."

　A simple schematic diagram of various drug names is attached, which is more convenient to buy

　　
　
(End of this chapter)