Pure doctor Wu Xie

Chapter 23 Guided Surgery (for collection, for further reading)

Splenectomy after rupture of the spleen is a common operation in emergency surgery. According to the classification of general surgery by the National Health and Health Commission, it is a third-level operation.

Level [-] surgery, only senior intermediate and deputy senior titles, can be performed routinely.

Routine operation is a routine operation, and there must be a prerequisite, that is, the hospital where the doctor is located, and this type of operation is a common operation that is often performed.

Lu Junyin is the deputy high-ranking officer, so he must be the one who performs the surgery at a high level.

However, the hospital where Lu Junyin works was formerly the town health center, and the operations that can be performed routinely here are simple operations of the first and second levels, such as gallbladder stones and appendicitis.

Splenectomy is not often encountered in the town hospital.

For so many years, Lu Junyin has only been the chief surgeon once.

The main reason is that Sha Town is not far from Xuan County. If there is a car accident on the road, the time to go to the town hospital is enough to go to the county hospital.

Delayed splenic rupture, or the grade of splenic rupture does not reach the point where immediate surgery is required, and it will also be transferred to the county hospital!

Tertiary surgery is difficult, and there is a reason why it is difficult.

First of all, the positioning of splenectomy is to remove the spleen to save lives. In terms of organs, it is terminal.

Secondly, the operation process of splenectomy is quite cumbersome, and hemostasis is not easy.

Without sufficient experience, the dissection of the splenic artery and the location of the celiac trunk can give you headaches.The splenic artery is the left branch of the celiac artery
The celiac trunk is located at the bifurcation of the aorta, in the abdominal cavity in front of the spine.

The starting point is at the bifurcation of the abdominal aorta, and the ending point is at the origin of the left and right renal arteries.It is not difficult to find it, and it is not difficult to look at the branches of the celiac trunk in the anatomy book.

After the abdominal aorta divides into the celiac trunk, it is further divided into the hepatic artery, left gastric artery, splenic artery, pancreaticoduodenal artery, and superior mesenteric artery. It is clear at a glance in the anatomy book.

However, in the actual application process, it is not easy to quickly clarify in patients.

Splenectomy is mainly for splenic rupture and bleeding. The operation concept of hemostasis is mechanical clamping to stop bleeding. Naturally, the splenic artery is first ligated or clamped with vascular forceps.

Lu Junyin didn't have much experience, so he almost attacked the left gastric artery adjacent to the splenic artery.

Wu Xie stopped him.

Lu Junyin didn't say much or get angry, Wu Xie moved slightly, didn't say a word, just guided silently, this is the best attitude of an assistant, saving face.

Lu Junyin clamped it quickly, and then returned to the level of the spleen, and he saw that the source of the largest artery was tied, and the gurgling blood spring that was oozing out had turned into a slow ooze.

This is mainly because even after the main blood vessel: the splenic artery is tied, the spleen still has other blood vessel access.

The splenic blood supply also includes the interconnection of the splenic vein, pancreatic splenic artery, pancreatic splenic vein, and short superior mesenteric artery, which will become the source of continued bleeding.

Similarly, the course of the splenic artery also has its downstream branches—pancreatic-splenic artery, gastroepiploic artery, short superior mesenteric artery, left semicolic artery, and splenic junctional artery.

These anatomical locations are only the anatomical basis of splenectomy, not the operation.

The reason why splenectomy is positioned as a grade 3 operation lies in the difficulty.

Moreover, the reason why surgical operation consumes a lot of knowledge points when upgrading the level is also because the operation requires a huge knowledge reserve as well as the main points and details of the surgical process...

But no matter what, the splenic artery was tied off first, which is equivalent to a small half of the splenectomy.More than half of the bleeding operation is completed!

The window period for rescue has also been extended, and follow-up operations can be done slowly.

The general principles of splenectomy include exploration, hemostasis, resection, and suture.

Now only the detection and partial hemostasis have been completed, and the operations such as ligation and suturing of other blood vessel lumens in the spleen have to be improved to cut off the blood supply of the spleen, so as to wait for an opportunity to continue to explore whether the spleen organ should be cut and whether it can be rescued again !
"Xiao Wu, change places with Liu Chengshan." After Lu Junyin completed the splenic-pancreatic artery, he ordered to push Liu Chengshan away, at least to make it look good on the surface.

Liu Chengshan had no objection.

The gap between deputy chief physicians and deputy chief physicians is particularly large. For example, Lu Junyin and some associate professors are both deputy senior and deputy chief physicians, but there is a gap in the types of operations that can be performed?
It is not an exaggeration to describe it like a moat.

The same is true for Liu Chengshan. As his main doctor, he doesn't have many types of surgeries at present. There are reasons for the limited number of surgeries in the hospital, and there are also personal reasons.

Although Wu Xie didn't say anything, he found the splenic artery so quickly just now, and corrected Lu Junyin's operation, which meant that Wu Xie was knowledgeable about this operation.

Lu Junyin didn't ask Wu Xie to be the first assistant right away, for the sake of looking good.

Wu Xie did not refuse. After handing over the negative pressure suction device and retractor to Liu Chengshan, he took over Liu Chengshan's retractor and a pair of vascular forceps.

Lu Junyin had undergone a splenectomy, so he was naturally familiar with the operation process and principles, but it was difficult to deal with each operation one by one.

"Let's look for the splenic-pancreatic artery again." Lu Junyin confessed to Wu Xie.

"Okay, Director Lu." Wu Xie nodded, and he didn't respond excitedly. All he thought about was the idea of ​​exploring the splenic-pancreatic artery.

To stop bleeding, the first operation to be done is exploration.

Splenectomy is a level 3 operation. Wu Xie clicked it from entry to proficiency, and the cost was 1.5 times that of suture and surgical infectious disease.

It takes three points to get started, and fifteen points to become proficient.

The corresponding time is equivalent to splenectomy. If Wu Xie wants to get started, he needs a month of solid study, and if he wants to become proficient, he needs up to five months of hard work.

This kind of correspondence gave Wu Xie a deep enough understanding of splenectomy!
Maybe he can't handle all splenectomies, but Wu Xie is sure about this emergency room.

The pancreaticosplenic artery is a branch of the splenic artery.

Originates from the left branch of the celiac artery, goes up into the pancreas, supplies part of the pancreas and continues up into multiple smaller splenic artery branches.

At present, the proximal segment of the splenic artery is punctured with vascular forceps. During splenectomy, even the subordinate branches of the splenic artery must be ligated or sutured in advance to avoid postoperative rupture and bleeding.

Wu Xie still found it easily based on the anatomy. It is no longer difficult for proficient splenectomy and blood vessel detection!

Lu Junyin's eyes flickered, and while cooperating with Wu Xie to ligate the blood vessels with silk thread, he asked, "Xiao Wu, you should have a master's degree in orthopedics before, right?"

Splenectomy is a level 3 procedure in general surgery, not in orthopedics.

Wu Xie raised her head slightly when she heard the words, and answered firmly and naturally: "Well, I am an orthopedic surgeon. During my internship, I performed a splenectomy. I followed the stage a few times..."

"No wonder." Lu Junyin seemed to speak casually, but was extremely nervous inside.

You can do this just by seeing it a few times. Then you have been in orthopedics for several years. When you do orthopedic surgery, don’t you want to fly?

At this moment, Lu Junyin had doubts in his heart——

When Deputy Director Liu of the County Health Committee sent Wu Xie here, the look of seeing the plague god was the director of the orthopedics department of Xuan County People's Hospital.

Or is there really a misunderstanding here that I don't know about.

Just found the treasure?
Lu Junyin didn't ask about the confusion in his heart, Wu Xie continued to guide the operation process properly, for example, he happened to find arteries, veins, etc., and left it to Lu Junyin to operate...

The development of tertiary surgery is not authorized by the deputy chief physician, and everyone knows this in their hearts!
　Thank you Bai Yifei for the 500 rewards, please recommend tickets!

　　


(End of this chapter)