Come on, Dr. Wu

Chapter 181 Human Organ Circulatory System
"The donor liver is almost ready!"

After more than an hour, Wu Xiaofu was almost done with the process. He looked at his two brothers who were processing the donor liver and asked, and they both nodded in response.

"it is ready."

Squeak!

The door to the operating room opened, Yu Shifu walked in, and everyone hurriedly looked over.

"Dean."

Yu Shifu nodded, came to the operating table, and looked at Wu Xiaofu's movements with a look of satisfaction on his face.

"It seems that you are not bragging. This recipient liver is really good at processing, so I don't need to use it. I will just watch your operation from the audience."

"Teacher, if you hadn't kept me in the dark, I wouldn't be so at ease."

Wu Xiaofu kept moving his hands, and soon the recipient liver was removed by Wu Xiaofu.

Blood vessels, bile ducts, ligaments...

The type of liver transplantation that Wu Xiaofu is currently doing is called classic orthotopic liver transplantation in liver transplantation. The specific method is to resect the diseased liver and then anastomose the inferior vena cava where the liver is transplanted with the inferior vena cava where the liver has been cut off. That is, the anastomosis method of the inferior vena cava is divided into classic and orthotopic liver transplantation.

However, installing the donor liver does not mean that everything will be fine.

"Come on, let's start the transplant."

The occurrence of blood flow reperfusion is very dangerous for liver transplantation. If secondary embolism occurs, it will not only be a failure of the operation, but also life-threatening.

After seeing that the circulation in the body was restored, the liver was supplying blood normally. Not only was there no problem with the newly rebuilt artery, but even the reperfusion of blood flow that Wu Xiaofu was worried about did not occur.

However, in actual work, due to special circumstances such as donor hepatic artery variation or recipient hepatic artery disease, it is impossible to reconstruct the donor-recipient hepatic artery according to conventional methods. In this case, special methods need to be used to complete donor-recipient hepatic artery reconstruction. That is a special type of hepatic artery reconstruction.

The next step is to let the blood flow to the liver to see if the liver can function normally. The most basic thing is to turn off the extracorporeal circulation and let the blood flow through the liver.

What Yu Shifu wanted to see most was this part, and it was also the part where he could best see Wu Xiaofu's level.

Become!

Wu Xiaofu felt a little happy in his heart. As a doctor, it is difficult not to have any feeling about the success of an operation, whether it is a major operation or a minor operation. It is just that after a major operation is completed, people are particularly happy, especially when it is no less than saving lives. , a rejuvenating surgery.

This method is the most commonly used. After all, the body size of adults is not very different, and even the sizes of the livers are exactly the same. This surgery is sufficient for liver transplantation.

Watching Wu Xiaofu perform surgery was like a kind of art, which was pleasing to the eyes and benefited them a lot.

Blood flow reperfusion means that within 5 minutes after the blood flow of the transplanted liver is recanalized, the mean arterial pressure drops sharply by more than 30% or by more than 30mmHg and lasts for more than 1 minute, which is called reperfusion syndrome.

As the blood flowed through the liver, Wu Xiaofu breathed a sigh of relief as he watched the blood vessels filling up and seeing that his anastomotic blood vessels had withstood the test.

Wu Xiaofu began the methodical pipeline reconstruction work, and soon the donor liver was connected by many pipelines and became an integral part of the patient.

Just like buying a new refrigerator when the refrigerator is broken, the important thing is that it can be powered on and can be used.

Therefore, it is basically impossible to expect the donor liver to achieve its own effects after entering the recipient's abdominal cavity.

"Not bad!"

The effective reconstruction of the donor-recipient hepatic artery that Wu Xiaofu is conducting is one of the core aspects of the liver transplant pipeline reconstruction surgery.

The two assistants next to him were also immersed in it.

Donor livers are generally obtained through donation and other conditions. After the liver is removed from the donor, it has to undergo a series of preservation. It is not known how long it will take before it can reach the recipient's abdominal cavity. This period in the middle After this trip, it will be difficult for the donor to maintain its original vitality, and its function will be reduced by several percent.

Good donor-recipient hepatic artery reconstruction can not only reduce the incidence of hepatic artery complications after transplantation, but also prevent biliary complications. The incidence rate of arterial complications such as hepatic artery thrombosis or stenosis after liver transplantation is about 5%, and special types of hepatic arterioplasty and reconstruction are high-risk factors for hepatic artery thrombosis.

The current donor livers have this kind of problem. However, every donor liver is precious. Even if there are some problems with the pipeline, we must find a way to use it. Livers are rare. This is a special type of hepatic artery reconstruction.

Yu Shifu couldn't help but be surprised when he saw Wu Xiaofu's movements. Only a master of arts is really bold. Only a master dares to do this. Even he has to be cautious.

Just like watching Wu Xiaofu’s laparoscopic cholecystectomy before, Wu Xiaofu really has a kind of magic. After seeing Wu Xiaofu perform more surgeries, his trust in him has increased, and he even thinks that Wu Xiaofu may be able to do things that others cannot do. It can be done.

Wu Xiaofu has his own ideas in this regard. He takes the complete blood vessel part, reconstructs the donor hepatic artery blood vessel part, and then performs end-to-end anastomosis. Although the risk of vascular anastomosis rupture is greater after the internal circulation is restored, Wu Xiaofu is confident that he can With my own vascular anastomosis technology, this is not a problem at all.

After all, someone had tried it before, and the probability of failure was too high. But looking at Wu Xiaofu's vascular anastomosis and Wu Xiaofu's test vascular conditions, Yu Shifu actually had confidence in Wu Xiaofu again.

Don't underestimate the word "not bad". Wu Xiaofu didn't know it before, but later when Wu Xiaofu got to know Yu Shifu better, he knew that Yu Shifu was never easy to praise others, and even less so after Wang Buyi. It's a compliment, let alone saying it's good, it's hard to get an "average" rating.

Rebuilding the pipeline is the most difficult part of this surgery.

In whole liver transplantation, end-to-end anastomosis of the donor hepatic artery at a suitable location is usually used to reconstruct the blood flow of the transplanted hepatic artery, which is a conventional type of hepatic artery reconstruction.

At this time, another liver transplantation method is used, called reduced-volume liver transplantation. This transplantation method requires removal of part of the donor liver and then implanting it in situ. The most suitable method is living donor liver transplantation. From then on The left outer lobe of the liver was harvested in vivo and used as the original liver site for transplantation of the donor liver into the recipient.

The work of closing the abdomen has been handed over to two assistants. Wu Xiaofu and Yu Shifu stood aside and exchanged the advantages and disadvantages of the operation. In the end, Wu Xiaofu received a pleasing evaluation from Yu Shifu.

And this is just about function. The most important pipeline is damaged. A small part of it is due to damage during the liver removal, and a large part of it is because after the blood perfusion is lost, the pipeline no longer meets the conditions for reconstruction.

Orthotopic liver transplantation can be divided into several types. The most common type is standard liver transplantation. The conditions for this kind of transplantation are that the size of the donor liver matches the size of the recipient's abdominal cavity, and the entire donor liver is implanted into the recipient according to the original blood vessel anatomy. of the original liver site.

It's like this is the surgery in front of me.

The completed hepatic artery reconstruction is absolutely no different from the conventional hepatic artery reconstruction.

"Turn off the extracorporeal circulation."

Of course, sometimes there is a mismatch between the size of the donor liver and the size of the recipient's abdominal cavity.

In a busy life, for doctors, perhaps the greatest support and joy is the sense of accomplishment after a successful operation.

In fact, there is another complication that requires special attention after surgery - blood flow reperfusion.

Wu Xiaofu was afraid that after so many years, he would be the first person after Wang Buyi to receive a "good" evaluation.

However, Wu Xiaofu feels that he must continue to work hard and strive to go further and get an excellent evaluation.

"Teacher, let me start the next one."

Yu Shifu nodded and looked no further. He was convinced of Wu Xiaofu's level. He would probably not be able to trouble Wu Xiaofu with liver transplantation in the future.

"Okay, you do it first. I still have something to do, so I'll leave first."

Reduced-volume liver transplantation is to transplant part of the liver. The liver has a strong regeneration ability. Even the transplanted part of the liver will grow back to the size of the original liver after half a year. After the transplant is successful, the liver function will return to normal and the liver can function like a normal person. Same life.

The patient of the second operation was a nine-year-old child. The size of his abdominal cavity did not match the size of the donor. The donor liver was donated by an adult. To put it into the patient's body, the liver had to be reduced in size, which was difficult. It is larger because the previous liver duct can no longer be used and needs to be redesigned.

However, this is not a problem for Wu Xiaofu.

Arteries are connected to arteries, veins are connected to veins, and bile ducts are connected to bile ducts. Important pipes are preserved, part of the liver is removed, and other minor pipes can be connected selectively or adaptively. When Wu Xiaofu reconstructs the pipes and the operation is completed, it is better than The last surgery only took an extra hour.

Five hours later, the operation was over.

The two operations combined, plus the preparation time in between, took more than twelve hours.

It starts at eight o'clock and ends at nearly nine o'clock in the evening.

Even with Wu Xiaofu's physique, he has some back pain. Look at his big feet, hey, they will collapse sooner or later.

However, after two surgeries, Wu Xiaofu had many new ideas.

Nowadays, organ transplants and cadaver livers are all cold transplants, which cause too much damage. If the so-called hot transplant can be performed without interrupting the blood flow, it will definitely be a big step forward in maintaining the functional activity of the organs.

It is also good news for many organ transplant recipients.

Thinking of this, Wu Xiaofu also came up with various ideas. No, he had to prepare and sort out the design when he went back.

The source of medical progress is ideas, and if there are ideas, they can be realized.

After returning at nine o'clock, Wu Xiaofu took a simple bite and then began to look up relevant literature.

Organ transplantation has been called "the most dazzling jewel in the crown of medicine."

However, while treating diseases and saving lives, traditional organ transplantation has always had its own shortcomings. Generally speaking, organ transplantation requires a "trilogy", which is the so-called organ acquisition, preservation and implantation. Well, it is like transplanting a large organ Putting an elephant into a refrigerator is, of course, more difficult than putting an elephant into a refrigerator.

When doctors remove the liver from the donor, they must first lavage and cool it with organ preservation solution. Then, the liver, which has turned yellow and white due to ischemia, will be placed in an organ preservation solution at 0-4 degrees Celsius. Only then can we ensure that damage is minimized during the organ transfer process and then implanted into the abdominal cavity of the transplant recipient.

The next step is the surgery, the so-called liver duct reconstruction, in which the blood vessels and bile ducts of the new liver are anastomized one by one with the patient's blood vessels and bile ducts. This process is maintained by extracorporeal circulation.

After the pipeline is rebuilt, the extracorporeal circulation is closed. As the blood flows into the new liver, the originally cold liver will become warm again and the surface will turn bright red. This is a sign that the liver is soaked with blood, as well as the bile duct. When the bile duct has gold When yellow bile flows out, it means that the transplant is successful and the patient regains his life.

The part that Wu Xiaofu wants to study now is that during this process, once the organ leaves the donor's body, it will be in a state of "no blood flow supply" ranging from several hours to dozens of hours, and will inevitably suffer from ischemia, cold preservation and regeneration. Perfusion injury leads to impaired liver function.

These unfavorable factors are the main reasons that affect the efficacy of transplantation and even lead to transplantation failure.

Therefore, Wu Xiaofu must find ways to avoid this.

After all, the quality of the donor liver and the length of storage time are key factors to ensure the success of liver transplantation.
Let the donor liver still have blood flow after it leaves the donor.

But this is easier said than done.

If the liver is ischemic for more than 30 minutes, it will become necrotic and cannot be transplanted. Wu Xiaofu calls the current traditional transplant model "cold transplant" and pays attention to the patient's condition before and after surgery. Transaminases in liver function are the best way to evaluate the degree of liver function damage. Intuitive indicators, almost all liver transplant patients have transaminases as high as hundreds or even thousands after surgery, which is a very common situation. This is the disadvantage of cold transplantation.

Since there is a cold transplant, he will definitely be able to create a hot transplant.

Wu Xiaofu is now full of confidence, and he already has the idea to study a "human organ circulatory system", which is the same as the extracorporeal circulation in the operating room, except that this human organ circulatory system is a self-contained cycle, but Simulates the body's mechanisms before surgery to provide blood to organs, thereby improving organ function.

When I thought about it this way, my thinking suddenly became much clearer.

Wu Xiaofu devoted himself wholeheartedly to reviewing literature, sorting out his ideas, and designing the human organ circulatory system. He didn't even know what time he fell asleep.

When he got up the next day, Wu Xiaofu went to the emergency department to check on the old man who had undergone surgery for gallbladder cancer.

Because it was a laparoscopic surgery, the patient recovered very quickly and could basically be discharged from the hospital next week, which made Wu Xiaofu very happy.

After the postoperative review, the old man's various indicators were steadily recovering. The X-ray was taken again, and there was no anastomotic leakage or the like in the abdominal cavity. In other words, Wu Xiaofu's operation was really successful. The next step is to see The old man’s quality of life and survival time after he was discharged from hospital.

Judging from the old man's surgery, the laparoscopic vascular resection and reconstruction performed by Wu Xiaofu has already reached the anatomical standards of open surgery. On the premise of ensuring the long-term curative effect of the patient, Wu Xiaofu also used the concept of accelerated recovery surgery after surgery. The old man's recovery speed after surgery was significantly faster than that of traditional laparotomy.

In the next few days, the old man's place will also be Wu Xiaofu's focus.

Saturday, after not being on duty, Wu Xiaofu's weekend is a complete weekend. After the old man finished reading here, Wu Xiaofu was ready to go back and do his own thing.

"Boss, please help us."

At this moment, Zheng Hua called directly. Duan Fei asked for leave today, and Wu Xiaofu directly asked Zheng Hua to take over the day shift. He helped to watch. Zheng Hua has grown up now, and ordinary diseases are no problem.

I guess I encountered some difficult patient at this time.

In the consulting room.

Wu Xiaofu pushed the door open and came in. A little boy on the bed, his face pale with pain, was lying on his side on the treatment bed, holding his stomach.

"what happened?"

Wu Xiaofu looked at Zheng Hua, who should have seen the patient first. In the consulting room, the superior doctor came to check on the patient. Usually, he did not ask about the patient's condition first, but communicated with the first-diagnosing doctor first, and then explained what the first-diagnosing doctor told him. Diagnosis and treatment will be done based on the condition.

"Boss, the patient just came in and had a stomachache. I wanted to check his stomach, but the child wouldn't let him go. He wouldn't listen to his mother's words. There was nothing I could do. I thought you were here, so I asked you to come over and take a look. of."

Wu Xiaofu nodded. It was not necessarily because of the intensity of the patient's pain. It could also be because the patient's pain threshold was relatively low. This situation often occurs among children.

Different people can tolerate the same pain differently, which is the so-called pain threshold.

The child's mother was still trying to persuade the child at this time, but the child just held his stomach and didn't move. Ordinarily, he looked about seven or eight years old, so he wouldn't be able to listen. It seemed that the pain was really severe. When he came to the child, Wu Xiaofu was not in a hurry to check his body and looked at the child.

"When did this happen?"

The child's mother looked at Wu Xiaofu and heard Zheng Hua calling Wu Xiaofu boss. She knew that Wu Xiaofu must be more powerful and hurriedly replied.

"The pain started just two hours ago. I have a habit of doing morning exercises. I was worried about leaving him at home, so I took him with me for morning exercises. After running for a while, he complained of pain. At first, I thought it was because he got distracted while running. So I took him home first. Who would have thought that the pain would get worse and worse, and he would have to come to the hospital."

running!

"Has this happened before? Did he say where the pain was? Is there any other discomfort, vomiting, etc.?"

"Yes, I vomited on the way. I had stomach pain before, but it came away slowly and was not so severe. I saw that he was referring to the right lower abdomen. I wondered if it was appendicitis. Sometimes I I also feel pain in my lower right abdomen when I run fast.”

See, this is how common appendicitis is.

Among the many diseases in general surgery, the most popular one now is appendicitis.

Nowadays, even the elderly in rural areas basically know where the appendix is. Many patients can basically tell themselves that it is appendicitis before coming to the hospital. When faced with appendicitis, most patients no longer choose to delay it. Acceptance of the surgery was high.

As for the child in front of him, Wu Xiaofu looked like he had appendicitis.

This child had similar pain before, maybe he had chronic appendicitis, and running is a nightmare for patients with chronic appendicitis. It really hurts every time he runs. This is why so many children have their appendices removed. It’s unknown, but children nowadays are really the main group suffering from appendicitis.

Once you suffer from chronic appendicitis, children have to run, so the only option is to have the appendix removed.

"Is the child usually not very intolerant to pain?"

"Well, I usually have to cry for a long time if I scratch my skin."

Wu Xiaofu expressed understanding and looked at the little boy.

"Kid, would you please tell your uncle where it hurts?"

The facts told Wu Xiaofu that it was all in vain. Zheng Hua couldn't ask, and he didn't even bother to answer his mother's question, let alone Wu Xiaofu.

"Zheng Hua, prescribe a dose of painkiller injections, give them to the patient first."

Just take the painkiller!

Zheng Hua was also stunned, and then started to administer the medicine. Under normal circumstances, a physical examination must be done first. After all, the patient came here because of pain. After taking the analgesic injection, the pain symptoms disappeared, and physical examination would have no effect. .

But Zheng Hua would definitely not remind Wu Xiaofu of this. Wouldn't the boss know about such basic things? Just kidding, the boss must have his reasons.

The patient's family members picked up the medicine, and Wu Xiaofu carried the child directly to the ward.

After taking the painkiller injection, the little boy's pain symptoms were much better, and the child no longer just sat there, holding his stomach.

"Kid, can you tell me where it hurts now?"

The little boy looked at his mother, who naturally asked him to quickly say, then the little boy pointed to his right lower abdomen, where the appendix is.

"It's right here. It feels like a pinprick. It hurts so much. It's better now, but it still hurts."

Wu Xiaofu let the little boy continue to lie down and touched it with his hand, "Is it here?"

"Yes, it's right here, ah, it hurts."

Wu Xiaofu put down his hand, "Does it hurt anywhere else?"

"Nothing."

"Did you have anything to eat in the morning?"

……

After some questioning, Wu Xiaofu was basically sure that it was appendicitis.

Apart from the pain in the appendix and the vomiting I had before, there were no other symptoms.

I still have a slight fever, almost 38 degrees.

"Hello, I will write the order for the child. You first take the child to have a color ultrasound and blood draw."

"Okay, thank you doctor."

In medicine, there are actually many rules. For example, if a patient comes in because of pain, it is best not to get an injection without a physical examination or before the disease is confirmed, for fear of covering up the disease and causing misdiagnosis or missed diagnosis, which will cause trouble.

However, specific situations must be treated on a case-by-case basis.

Just like this little boy, according to the family members, it is basically confirmed that he has appendicitis. The patient is in severe pain and refuses to be examined, so he can only relieve the pain first. Moreover, the little boy obviously has a low pain threshold. Even if he is given analgesic injection, he will basically not be affected. It can completely eliminate the pain symptoms without delaying the examination. Therefore, it is also important to make appropriate adjustments when seeing a doctor.

Wu Xiaofu was flipping through a book in the medical office. After the little boy and his mother came back, they took a closer look and found that it was indeed appendicitis.

In the blood test, the inflammatory indicators are not low.

"It is indeed appendicitis, and surgery is needed. Judging from the condition of the appendix, there should have been chronic appendicitis before. After this attack, the inflammation became very large. If I delay it, I am afraid of perforation. However, the inflammation can be reduced, but this time the attack is so severe. It's terrible. I'm afraid it will only be worse next time, and it's also possible to get a direct piercing.

The risk is too great, I recommend immediate surgery. "

Operation!

The patient's mother quickly shook her head, "No, he is allergic to anesthetics."

Allergy to anesthetics!
"how do you know?"

This person who has never had surgery doesn't know if he is allergic to anesthetics.

"When he was six years old, he broke his leg in a fall. During the operation and anesthesia, he suddenly had a reaction, which scared the doctor. He said it was fortunate that it was not under general anesthesia, otherwise he might not be able to be rescued. That was also the case. I stayed in the hospital for more than half a month. I was given anti-allergy medicine for a long time. I didn’t have any surgery on my legs. I had to put a cast on the back after setting the bones.”

Wu Xiaofu nodded when he heard this. He was allergic to anesthetics. To be honest, this group of people is really small. Of course, you can see one from time to time. It would be better if you see him in the clinic, but if you see him on the operating table, well , even the great experts were scared to death, and the anesthetist even broke into a cold sweat on the spot. He was anesthetized one second and had to be rescued the next.

Spinal anesthesia is okay. The patient is still conscious. If you feel uncomfortable, you can tell him in advance. An experienced anesthetist will realize that something is wrong and get anti-allergy treatment as soon as possible. However, general anesthesia is not good. The patient cannot speak and you will realize it by the time he or she feels it. Sometimes, cardiorespiratory arrest may occur due to allergic reaction to anesthesia.

There are also patients who are allergic to anesthesia and cannot be rescued.

Wu Xiaofu was lucky. Someone helped him try and make mistakes. If he had a laparoscopic appendectomy under general anesthesia on the operating table, Wu Xiaofu would be scared to death.

"Do you know what anesthetic you are allergic to?"

"They must all be allergic."

Wu Xiaofu also shook his head. It seems that he didn't check it. "Since he is allergic to anesthetics, then local anesthesia and surgery will be enough. If you agree, I will have the child do a skin test."

Local anesthesia!
The child's mother was shocked when she heard this, "You can also do it with local anesthesia, but only at the surgical site? Doesn't that hurt?"

That's the belly. The child's mother doesn't believe it. Normally, it's okay to sew a large piece of skin, but how can it be done like an appendix?

"It's okay, this is what it is now. During the war years, it was all done under local anesthesia."

The child's mother looked at Wu Xiaofu's confident look and began to believe it. "Isn't local anesthesia allergic?"

"Usually it's not allergic, but just in case, you still need to do a skin test."

Skin test!

The child's mother immediately understood that this was not the same as taking a cephalosporin infusion for a skin test, and she immediately felt relieved.

"It would be best if I could do it. This time it scared me so much. I also know that appendicitis is basically never cured and it will happen from time to time. If there is a real perforation next time, I don't know if it can be dealt with in time. Then It’s a problem for the doctor.”

Seeing that the patient's mother agreed, Wu Xiaofu started making arrangements without delay.

A skin test was done first. Fortunately, the child did not have an allergic reaction to the local anesthetic.

People who are allergic to anesthesia are allergic to most anesthetics, because people with such allergies are basically neurotic. Anesthetics deprive the brain and nerves of pain by inhibiting the nerve center. Once an allergic reaction occurs, it is Neurons are inhibited, and the brain, heart, etc. will quickly respond to stress and become dangerous.

But local anesthetics are different. This is skin infiltration anesthesia, which acts on the patient's local area or on the patient's nerve roots, blocking the patient's nerve conduction so that pain cannot be uploaded to the central system of the brain, so that the patient cannot feel pain. , will not involve the nerve center.

Especially lidocaine, there are not many people who are allergic to lidocaine. Even if it is allergic, it is a simple skin reaction, redness and swelling.

Since local anesthesia can work, Wu Xiaofu will not delay.

Directly admitted to the hospital to start arranging surgery.

In the boy's case, the sooner the treatment is done, the better. Next time the appendix really perforates, peritonitis cannot be cured without surgery, and the anesthesia is allergic, then it will be really troublesome. A simple appendix removal, and The intensity of surgery to produce peritonitis varies.

As for the little boy's surgery, for Wu Xiaofu, it only took ten minutes from incision to suturing.

This was also the reason why Wu Xiaofu dared to perform local anesthesia. If he couldn't even find his appendix for a while, local anesthesia would be really unbearable.

In the operating room.

Wu Xiaofu brought You Ruiming up, and the preoperative preparations were almost done. Local anesthesia did not require fasting or drinking, and the child did not eat in the morning. It was suitable. There was no need to prepare skin or anything on the belly. But in the end, If you are performing an operation on a child, you still need to give sedative and anti-convulsant drugs.

Otherwise, it would be very troublesome if the local anesthesia was not enough during the operation, causing pain and stimulation.

Wu Xiaofu gave the little boy intramuscular injections of 10 mg of diazepam and 0.5 mg of atropine.

You Ruiming began to disinfect the sheets, and Wu Xiaofu went on stage directly after washing his hands.

Appendicitis surgery has really been done less recently. In fact, Wu Xiaofu has only been to the hospital for two years. When he first saw the gall bladder and appendix surgery, he wanted to do it like crazy. But the result was good. Not long after the surgery, he started to look down on it. On.

Local alcohol disinfection of the surgical field.

"profitable."

The instrument nurse handed over the diluted lidocaine. The pain relief effect of lidocaine was quite good. When cutting the appendix, Wu Xiaofu did not want to use too many tubes. It was just right to use it after dilution.

Although the child's pain threshold is low, skin infiltration anesthesia will basically not be affected too much.

To administer local anesthesia, it is inserted into the subcutaneous tissue from Max's point and extends to the left and right, with one bump per centimeter.

The child still has pain in his appendix, and the effect of the painkiller injection will become weaker and weaker. Wu Xiaofu did not take any more supplements, and the time should be enough.

Under the cover of the pain of the appendix, the pain of local anesthesia is not so sensitive. Otherwise, local anesthesia would be very troublesome for children.

"sharp knife."

The small incision is 3cm. After the last blind visit, Wu Xiaofu has become more and more comfortable with the appendix surgery. As long as the surgery is performed, it is basically a small incision.

The forceps were inserted into the abdominal cavity, and the pain made the child start to become restless. Fortunately, he had been given sedatives in advance, otherwise, it would have been even more intolerable.

However, Wu Xiaofu did not cause the patient much pain. Basically, he just felt the pain and subconsciously twisted his body. The patient's appendix was already clamped by Wu Xiaofu.

Blind Detective!

If last time it was about installing a fork, then this time it was about doing it.

Entering with tweezers in hand, Wu Xiaofu instantly felt as if his eyes were on tweezers. He felt really sensitive and basically went straight to the appendix.

Add some lidocaine to the root of the appendix, and directly start to treat the mesentery, protect the appendix and cecum, and perform purse-string suturing.

You Ruiming looked at Wu Xiaofu's movements in horror. The last time Wu Xiaofu blindly explored the appendix, he hadn't come yet. This time, he really saw with his own eyes what a master of appendectomy is. He probed and pulled, ligated, and cut off. Done in one go.

You Ruiming didn't even need to look at his watch to know that it would only take a few minutes.

"Put on the gauze and close the abdomen."

Ah!
The patrol nurse was stunned when she heard this. He had just sat down and was about to fill out the form. Wu Xiaofu was about to have his abdomen cut off?
(End of this chapter)