Come on, Dr. Wu

Chapter 40 Spleen Rupture

"Go and call Dr. Zhu."

After speaking to the nurse in charge, Wu Xiaofu went to the nurse's cart, took out a syringe and disinfectant cotton, and looked at the man's wife. At this time, the man's wife was already in a panic and at a loss.

"I suspect that your husband may have intra-abdominal bleeding and needs to be investigated now."

Then he motioned to the syringe in his hand, and the man's wife nodded quickly.

Qu Ying also came at this time, and Wu Xiaofu immediately said to her, "Sign the consent form."

For invasive procedures, if conditions permit, it is necessary to communicate with the patient and their family members and sign a consent form.

Arriving in front of the man, Wu Xiaofu directly started abdominal puncture.

Clinically, abdominal puncture is the most commonly used method to determine whether there is rupture and bleeding of abdominal organs. Generally speaking, the puncture point can be selected anywhere in the abdomen, but there are various organs in the abdominal cavity, so the location must be chosen It is best to avoid the original surgical scars or organs in the abdomen, especially the enlarged liver, spleen and full bladder, to avoid damage to abdominal organs due to puncture.

Under normal circumstances, in teaching, the puncture point is often selected at the intersection of the middle and outer 1/3 of the line connecting the navel and the anterior superior iliac spines on both sides or the vertical intersection of the horizontal line of the umbilicus and the front axillary line on both sides.

These two puncture points are where peritoneal fluid often accumulates. Once there is rupture and bleeding of abdominal organs, these two puncture points can be aspirated until blood does not coagulate.

Under normal circumstances, after blood leaves the human body, blood clots will form due to the coagulation reaction of platelets, coagulation factors, etc. in the blood. When the spleen ruptures, the spleen will produce a large amount of bleeding in a short period of time, and the blood will flow into the abdominal cavity, part of which The blood will form a blood clot due to autocoagulation, while the other part of the blood will form flowing non-coagulant blood under the action of anticoagulant substances produced by the peritoneum.

Of course, it is also possible that the puncture needle will be blocked by the omentum and intestinal tube, causing the blood and fluid accumulation in the abdominal cavity to be unable to be aspirated. Therefore, even if the abdominal cavity puncture cannot aspirate liquid, it does not mean that there is no fluid in the abdominal cavity. For organ damage, the patient's condition still needs to be comprehensively evaluated using abdominal color ultrasound and CT.

The operation Wu Xiaofu is currently performing often appears in some medical dramas.

It's just that in medical dramas, everyone is basically sharp, and the same goes for Wu Xiaofu. An experienced doctor can almost always find the right position and determine the patient's condition.

Seeing the non-coagulated blood in the syringe, Wu Xiaofu's face became serious. The most likely cause was a ruptured spleen.

Splenic rupture is the most common car accident injury after a car accident, especially delayed splenic rupture, which is even more hidden and difficult to detect.

Judging from the patient's condition, I am afraid that the amount of bleeding is quite large, and it cannot be ruled out that it is a serious splenic rupture.

Fortunately, we were in the hospital. If we were at home, the risk would be huge. After the car accident, the patient drove his wife directly to the hospital. He looked so lively and lively. In the fast-paced emergency room, people subconsciously gave him away. Ignore it, let alone notice it, but the fact is that no one can ignore it as long as it is a person in a car accident.

Zhu Yun also came over immediately. Seeing this situation, he quickly explained.

"Urgent abdominal color ultrasound and CT scan, emergency surgery, I'll call Director Duan."

Wu Xiaofu asked Qu Ying to make preoperative preparations, and then took the patient directly for abdominal color ultrasound. Looking at the color ultrasound results, Wu Xiaofu was even more anxious. For a spleen rupture of this degree, the entire spleen would probably have to be removed. It was too broken. I am afraid that the blood volume in the abdomen is already thousands of milliliters at this time, no wonder he fainted directly.

CT images show it more clearly. Except for splenic rupture, which has a relatively complete capsule and can be treated conservatively, other cases basically require surgical treatment. Once the doctor says that surgery is needed, there is basically no need to hold anything more. It's just a fluke, especially in this situation.

While Wu Xiaofu was reporting the patient's condition to Zhu Yun on the phone, he walked through the green channel and directly entered the operating room.

Today, Duan Hao is preparing for a splenic rupture surgery. Duan Hao is an expert. Duan Hao was in the hospital and had already entered the operating room. The operations in the operating room were very fast. After the patient entered the operating room, preparations were carried out quickly.

Duan Hao had already viewed the patient's color Doppler ultrasound and CT scan on the computer.

"Xiao Fu, you can be my assistant."

Wu Xiaofu nodded quickly when he heard this. In his dream, Wu Xiaofu had also undergone many spleen rupture surgeries. Compared with the gallbladder and appendix, splenectomy was undoubtedly a major surgery.

Wash your hands and disinfect, now the patient is in shock, time is of the essence.

Wu Xiaofu skillfully disinfected and spread the drapes very quickly. Duan Hao took one look and started the formal operation.

The first step is to open the abdomen for exploration.

The real danger of spleen rupture lies in bleeding. Like the patient in front of me, the spleen is severely damaged and the amount of bleeding is rapid and large. If the bleeding is slow to stop, it may not be possible to endanger his life soon.

The main bleeding site is the splenic pedicle.

Of course, the most important purpose of laparotomy is to determine whether other organs besides the spleen are damaged, especially the liver. If the spleen is damaged after a car accident, and the spleen is still so badly broken, there is a high chance that the liver will also be damaged. Thankfully, the patient's liver was fine.

At this time, the patient's spleen is still bleeding. An experienced doctor can quickly find the splenic pedicle.

Duan Hao was among them. It was almost just his first try. Duan Hao had already found the location of the splenic pedicle and quickly performed the ligation. Wu Xiaofu could not help but admire him. At this level of accuracy and ruthlessness, no one could compare with him. of.

The splenic pedicle is the splenic artery and vein, and the bleeding rate will be very fast. In severe cases, hemorrhagic shock will occur within a few minutes. It is the splenic pedicle that bleeds and the patient suddenly falls to the ground.

Now that the splenic pedicle was successfully ligated, the continuous bleeding in the abdominal cavity was quickly relieved.

However, this was not the time to relax. After all, this was only the first step, and the spleen had not been completely removed. With Wu Xiaofu's assistance, Duan Hao began to free the ligaments around the spleen.

"What are the ligaments around the spleen?"

The questions suddenly started. Wu Xiaofu looked at Duan Hao. The movements in his hands not only did not slow down, but became faster and faster. Wu Xiaofu saw only confidence and calmness on his face. This meant that Duan Hao had already determined that he The patient can be brought back from the brink of death, otherwise he would not have the heart to ask questions at this time.

"Splephrenic ligament, splenorenal ligament, splenocolic ligament, splenogastric ligament."

Duan Hao nodded, even more appreciative in his heart. Wu Xiaofu had a good foundation and a solid foundation. He could see it from the process of retracting the hook, because Wu Xiaofu basically didn't need to mention anything about his surgery when retracting the hook. Between the movements of the knife, Wu Xiaofu was able to predict the next step, and even Duan Hao was somewhat doubtful whether Wu Xiaofu could also perform this kind of surgery.

Of course, this must be impossible, and Duan Hao can only attribute it to Wu Xiaofu's good foundation, solid foundation, and extremely high talent.

"The spleen is down."

(End of this chapter)