Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Generally, CT scan of the accessory spleen shows a mass with smooth edges less than 2 cm, and the feeding arterial connection of the splenic artery can be seen.

B-ultrasound does not have the function of CT, so it cannot be diagnosed as accurately as CT.

It's just that the patient's condition is urgent, and it is an emergency patient. It is impossible to give Lin Yi time to do a CT scan. Lin Yi can only choose to have a laparotomy.

After changing the isolation suit, since it was past eleven o'clock in the evening, Lin Yi called the medical office and asked his colleagues in the pathology department to work overtime. The tumor in the patient's body was too far away from the upper abdomen. Lin Yi suspected that there was something wrong with it. possibility of tumors.

To rule out that the tumor is not tumor tissue, only pathological diagnosis can be made. Lin Yi explained to the patient in detail when he explained before the operation.

It is afraid that the tumor is a tumor.

Lin Yi has also considered laparoscopic surgery, which is less harmful to the patient, but if the small hole in the laparoscopic surgery is determined to be the patient's accessory spleen, this small hole cannot remove the accessory spleen.

As for the smashing treatment, Lin Yi didn't dare to take any risks. Once there is tumor tissue in the secondary spleen, it will spread directly after smashing, and the patient will become a terminal cancer.

Everything was ready, Lin Yi called Zhang Ting, and then brushed his hands to prepare for the operation.

The anesthetist had finished anesthesia, and since Zhang Ting hadn't arrived yet, Lin Yi began to sterilize by himself, laid out sterile sheets, and was ready to open the stage.

Turning on the shadowless lamp, Lin Yi glanced at the confirmed operation area, and frowned. The patient is still a little girl, and the operation directly on the abdomen may have a bad effect on the patient.

After thinking about it for a while, Lin Yi decided to make an incision from the left rectus abdominis near the lower abdomen. The length of the incision is about 7cm, which is a medium-length incision.

This incision is the smallest incision Lin Yi can accept. During the operation, blood vessels must be explored. The incision is too small, and the extension of the incision during the operation is even worse for the patient.

The scalpel gently scratched the patient's skin, and Lin Yi bluntly separated the subcutaneous tissue and fat all the way to the peritoneum.

The patient is not obese, his figure is well maintained, and the fat layer is not thick, so the operation is relatively easy.

After Lin Yi had his abdomen cut open, Zhang Ting walked in wearing the isolation suit. Seeing Lin Yi walking up to the operating table alone, she asked, "Doctor Lin, can I go on stage?"

Lin Yi nodded, it is better to have an assistant than no assistant.

Zhang Ting came to the stage to help Lin Yi hold the large retractor, and pulled the patient's lower abdominal skin and muscle tissue away. Lin Yi found the lump while gradually opening the operative field.

A dark red soft tissue rests next to the ovary.

Seeing the dark red soft tissue, Zhang Ting also widened her eyes, admiring Lin Yi from the bottom of her heart.

If according to Zhang Ting's own idea, the operation method of ectopic pregnancy is used on the stage, I am afraid that Zhang Ting will be dumbfounded by opening the abdomen, and can only close the abdomen to explain to the patient's family.

Lin Yi held the pliers in his hand and began to carefully separate the soft tissue. Fortunately, the soft tissue did not appear to be adhered to other organs.

The barrage in the live broadcast room was immediately posted:

"Is this the vice spleen? Why is it in such a deep place, shouldn't it be in the upper abdomen?"

"Brother Yi is probably worried that the secondary spleen has a malignant tumor. The method of separation is the method of separating the tumor."

Lin Yi carefully freed the secondary spleen. After the separation, he wrapped the secondary spleen with wet gauze, and then moved his fingers up along the blood supply artery to find the point that needed to be ligated, and then cut and ligated it.

...

"This vice spleen is a bit strange. It actually has a spleen pedicle. This is the first time I've seen it."

"Isn't it just a surgery to ligate the accessory splenic artery? How do you do it so cautiously? Two people are required to do it. Is the surgeon too old?"

"In the past, operations that were more difficult than this one were performed by the operator alone. Is there anything special about this operation?"

Some friends who are doctors in the live broadcast room expressed their doubts. This operation is really a simple ligation of the secondary spleen, and it will be fine after the ligation. What is he trying to do?

Lin Yi is still freeing the connective tissue next to the blood vessels that support the accessory spleen, all the way up.

The itinerant nurse suddenly walked in and said, "Dr. Lin, the pathology department is here."

"Let them wait for 5 minutes." Lin Yi said.

Zhang Ting exposed the operative field to Lin Yi, and Lin Yi found that the blood vessels feeding the accessory spleen were a bit long, and the adhesion of the surrounding tissues was not serious, only a twisted section of the blood vessels was seen in the level part of the duodenum.

It's just that Lin Yi didn't separate the twisted blood vessel, because once the feeding blood vessel is opened, the blood supply can be restored before the auxiliary spleen has confirmed whether there is tumor tissue, which will easily cause the tumor tissue inside to spread out, and may even cause bacterial infection. blood disease.

"I see. It turns out that Brother Yi is looking for this twisted blood vessel."

"This blood vessel is too long, and the twisting time should not be long. The surgeon should be preparing for a pathological examination of the secondary spleen."

Lin Yi reached out, and Wang Qiaoya patted the hemostatic forceps into Lin Yi's hands. Lin Yi followed the blood vessels to find the hilum of the spleen, which is the birthplace of the branch of the accessory splenic artery.

"The hook goes up a little bit," Lin Yi said.

Zhang Ting nodded quickly, and continued to expand her field of vision with the hook. Lin Yi found the position she wanted.

But Zhang Ting couldn't see the situation at all because of the hook. When she saw Lin Yi stop, she thought that Lin Yi was going to do Yankou.

"Doctor Lin, are you going to do Yankou?"

"No need." Lin Yi stretched out his hand to touch it, and wanted to pass the sharp knife with the other hand, so he started to practice blindly in the wild.

A section of blood vessel was pulled out from the abdominal cavity by Lin Yi, and the tissue on the front blood vessel had been dissociated and cleaned by Lin Yi. After Lin Yi took care of the secondary spleen, he threw the secondary spleen with a long pedicle into the pathological basin.

"Send it for a frozen biopsy." Lin Yi said.

The itinerant nurse hurried over and took away the pathology basin.

Lin Yi patted the sharp knife aside, reached out to take the needle holder, and began to suture in the narrow space.

"Doctor Lin, are you sure to suture like this?" Zhang Ting looked at Lin Yi's operation in shock.

Zhang Ting knew that the operating field he had opened, and the artye that could be sutured for Lin Yi could be said to be a little bit. In such a little bit of artye, complete all blood vessel sutures. Zhang Ting can only say that it is incredible.

When the last blood vessel was sutured, Lin Yi began to flush the abdominal cavity.

"Doctor Lin, why don't you check and clean it again? Could it be a malignant tumor?" Zhang Ting reminded.

"No, it's not a malignant tumor." Lin Yi began to close the abdominal cavity, "Because the surface of the accessory spleen is smooth, there is no adhesion with the surrounding tissues. If it is a malignant tumor, it should have metastasized."

The real report still has to wait for the pathology department to come out.

...

In the operating room, Lin Yi did not leave. Lin Yi could only officially end the operation after waiting for feedback from the pathology department.

After waiting for more than an hour, the pathology results came out and were negative.

Lin Yi ended the operation with peace of mind. The patient woke up from general anesthesia and was sent out of the operating room.

After returning to the consulting room, the door was slammed open.

A doctor came in immediately.

"Hello, Dr. Lin. I'm Wang Qiang, the chief neurosurgery doctor."

"Is there a problem?"

Lin Yao looked at him and couldn't help asking.

"That's right. In the morning, a patient with an intracranial vascular malformation came to our neurosurgery department and needed interventional angiography to confirm the diagnosis."

"But I didn't expect that when the contrast agent was pushed, the operation error pushed the guide wire in!"

"what?!"

Lin Yi suddenly took a breath.

If it was just a radiography, it would be enough in ten to twenty minutes.

But such a simple radiography, not to mention how long it takes, will only push the guide wire in carelessly.

The guide wire is smooth, with very little resistance, and it travels in the blood vessels, whether it is the blood supply arteries to the heart or the brain, once it becomes blocked, the patient will undoubtedly die.

"The situation is a bit difficult, and we thought of you. I wonder if you can handle it?"

Wang Qiang looked at Lin Yi and said.

"Let's go then!"

After Lin Yi finished speaking, he asked Wang Qiang to take him to the operating room.

Entering the operation room, all the doctors from the interventional department who were not on stage came, and the director of the vascular surgery department had a sullen face, walking back and forth in the operation room with his hands behind his back.

The advent of vascular surgery means that once interventional doctors cannot remove the guide wire that is wandering in the blood vessel, they will have to step up to the stage and operate to remove the guide wire.

Surgery to remove the guide wire, intracranial surgery, this is not a joke.

If you have an operation, you have to pray for good luck. The guide wire does not flow in the blood vessel.That is dead!
This kind of surgery is easy to open many openings, and the operation is extremely difficult.

At this time, the deputy director of the Intervention Department was very angry, and he wanted to drag the doctor out to scold him!

No one in the operation room dared to talk too much, and talking now is courting death.

The patients were all lying on the operating table, their life and death uncertain. Although they seemed to be fine, once the guide wire wandered to the key parts, the patients might die at any time.

This is equivalent to a time bomb in the patient's body that may explode at any time, and no one is sure when it will be bandaged.

Once an outbreak occurs, both doctors and patients will pay a heavy price.

In the operating room, two interventional doctors were sweating profusely "fishing" for the guide wire, and a doctor stood behind him, seeming to be directing the two of them.

On the screen in the operating room, two guide wires were entangled, and the intervening doctor kept changing the angle, trying to take out the guide wire.

Wang Qiang glanced at Lin Yi, Lin Yi's expression was calm, but Wang Qiang was panicked.

On the screen, the black shadow of the guide wire under the X-ray is trying to touch the free guide wire. The object that hooks the guide wire has a kickback on its head, trying hard to hold the free guide wire.

But after doing a winding action, the two guide wires were not entangled, but separated with the operator's operation.

...

In an instant, there were neat sighs from the operating room.

This must be out of play!
The guide wire falls off in the blood vessel because the surface is extremely smooth, and the possibility of it being removed is very small. Most of them are involved in vascular surgery, and the success rate is [-] to [-]%, which is pitifully low.

The best way is to use interventional techniques to remove the guide wire, but their interventional doctors basically tried all of them, and they couldn't remove it.

The director of the vascular surgery department frowned more and more, and his face became more gloomy. This was making the situation worse. He was ready to go on stage.

The two doctors on the operating table raised their heads and looked at the operating room through the leaded glass. Deep despair could be seen in their eyes.

"I'll try it."

Suddenly, Lin Yi who was standing beside said.

Everyone immediately looked at him.

"Doctor Lin, can you handle it?"

The deputy director of the Intervention Department immediately asked Lin Yao.

"Let me try it, prepare a 5F micro guide wire for me." Lin Yi said to Wu Ming.

"Well."

The deputy director of the intervention department nodded.

The nurse quickly found a micro guide wire and handed it to Lin Yi.

Lin Yi stood in his position, and instead of rushing for surgery, he picked up the micro-guide wire, asked for a hemostatic forceps, and slightly rolled up the front end of the micro-guide wire to form a barb.

This method is actually what they tried just now, but the guide wire is too slippery and cannot be removed at all.

After Lin Yi completed this step, he began to follow the microguide wire along the arterial sheath.

Lin Yi sent the micro-guide wire in and began to step on the wire.

In 30 seconds, the micro guide wire reaches the vicinity of the free guide wire.

For 1 minute, the guide wire floating in the blood vessel was directly caught by Lin Yi's micro guide wire.

The deputy director of the Intervention Department held his breath when he saw this scene. He also observed Lin Yi's movements just now. Except for a slight movement of his wrist, there was no unnecessary movement. It was not like fishing like the operation just now.

Lin Yi pulled out the guide wire bit by bit, and everyone in the operating room was stunned.

How long has it been? 2 minutes?The guide wire was pulled out?
The doctor who worked as Lin Yi's assistant became short of breath, and his whole body became excited. After the tension in his heart was released, all that remained was unstoppable trembling.

"Don't shake, shake and shake!" Lin Yi roared.

You must know that this kind of precise interventional surgery will affect the movements of the assistants. Once they are decoupled, all previous efforts will be wasted.

Lin Yi would not be polite to him in front of the operation.

Hearing this, the assistant quickly suppressed the excitement in his heart and held his breath again.

Lin Yi crossed his hands, hooked out the guide wires smoothly, put the two guide wires on the sterile sheet, stopped stepping on the wires, turned around and stepped off the stage.

"Doctor Lin, wait for me!" Wang Qiang came to his senses and quickly chased after him.

"Doctor Wang, your neurosurgery operation is not finished yet, let them continue to do it first." Lin Yi changed his clothes and said.

Wang Qiang nodded, and Lin Yi changed his clothes and returned to the operating room.

In the operating room, people all over the room stared blankly at Lin Yi who came in, they still looked in disbelief.

Even though the guide wire on the image has disappeared, they still feel like they are in a dream.

Several department directors had tried before, but none of them had a solution, otherwise the director of the medical affairs department would not have chosen the most risky method - surgery to remove the guide wire.

But that young unbelievable doctor took out the guide wire within 2 minutes. Many people even found that the operation was over before they looked carefully.

They were greatly shocked in their hearts.

It never occurred to him that Lin Yi, a doctor in the emergency department, would have such a superb technique, and he could do such a difficult operation with ease!
Simply incredible!

Afterwards, they intensively started the surgery again!

After the operation was successful, everyone couldn't help but breathe a sigh of relief, and Lin Yi walked out of the operating room.