Chapter 313： Please eat (1/4)
The hepatoduodenal ligament has been separated, Zheng Ren began to free the small omentum hole, and the colonic hepatic curvature and the right lobe adhesion were separated.
Subsequently, Zheng Ren pushed down the transverse mesenteric membrane, cut the lateral duodenum and the peritoneum, and bluntly separated.
Zheng Ren's blunt surgical technique was developed at the beginning of the training of appendectomy. It can be said to be a housekeeping skill.
He himself estimated that the individual skills have reached the level of the master.
But when others look at it, they are used to it, and they don’t feel much at all. Zheng Ren glanced at Yang Lei and saw that he did not notice this, and some regrets.
It seems that when he is fine, he can tell him the key points of the operation.
Zheng Ren bluntly separated the peritoneum, then separated the second and third segments of the duodenum forward until the duodenum and pancreatic head could be lifted to the shallow part of the surgical field, and the duodenum and the back of the pancreas were temporarily placed. Warm salt water gauze pad.
When doing Oddi sphincter angioplasty, you need to find the location of the duodenum.
However, this patient has done a common bile duct, duodenal lateral anastomosis, which does not have to bother to do it.
Zheng Ren began to prepare to cut the duodenum.
Clamp the sides with a mosquito-type vascular clamp, cut from the middle of the two clamps, clamp 1~2mm each time, and then suture the duodenal mucosa and bile duct mucosa with 3#0 line without injury suture, up to 2.0~2.5cm the distance.
In this step, Zheng Ren is very careful to avoid duodenal fistula in patients after surgery.
After the sphincter incision is made, the sutures of the two edges are pulled and examined for bleeding.
The opening of the pancreatic duct is then examined.
The opening of the pancreatic duct is located in the lower part of the position of the duodenum in Zhengren. At 3 o'clock, the pancreatic juice is seen to flow out.
Use a thin catheter to place the pancreatic duct and check for obstruction or stenosis.
The duodenal incision is sutured in two layers, and the suture must be carefully combined to prevent duodenal stenosis or duodenal fistula.
Zheng Ren did not directly suture the incision as usual, but treated the position transversely to the transverse joint to avoid complications such as duodenal stenosis and duodenal fistula.
【what? This kind of stitching is very special. 】
In the apricot forest garden, someone immediately noticed this.
After countless times of experience, people who watched the live broadcast of the operation subconsciously thought that the surgeon would not make mistakes and began to appreciate the benefits of this stitching.
There are not many barracks, and there are not many people calling 666.
Everyone is relishing and learning.
After the incision on the duodenum was sutured, Zheng Ren carefully pulled over the omentum, covered with a large omentum, and placed abdominal drainage in the subhepatic area and the small omentum.
The abdominal cavity was flushed with warm saline, and no active bleeding was detected. Three antibiotics were used locally. Zheng Ren did not directly close the abdominal cavity.
"B ultrasound machine, sterile film, 50ml syringe." Zheng Ren said.
"Are you really ready to get it now?" Su Yun hesitated.
"Nothing." Zheng Rendao.
Su Yun did not continue to insist, and soon the visiting nurse pushed the mobile B-machine in the operating room. The sterile mask covers the probe of the B-ultrasound and the connection, and Zheng Ren began to do the direct B-ultrasound.
Without the interference of skin and subcutaneous tissue, it is called a translucent look!
The 50 ml syringe needle was guided into the pus cavity of the liver along the B-ultrasound, and the yellow-green pus of a tube and a tube was withdrawn.
After about 125ml of pus was pumped out, the resistance of the syringe began to increase.
"Two cefoperazone, dissolved, rinsed." Zheng Ren said.
Immediately, the warm salt water was rinsed, and the patrolling nurse opened two cefoperazone tazobactam, dissolved and injected into the pus cavity of the liver by Zheng Ren.
This operation was finally finished. Zheng Ren carefully watched the area he had done. He did not see any bleeding or untreated inflammatory infections.
"Off the belly." Zheng Rendao.
The Xie Yi immediately changed a pair of gloves and began to hand it to Zheng Ren with a clean, reserved device.
The whole operation was slow and slow, when the pus was peeled off and the sphincter was formed, Zheng Ren was very slow and very careful.
When the abdomen is closed, the action is just like flying, and almost has a residual image.
Su Yun can follow his own speed, real people and be convinced of this.
[I am going, the only step I can understand, how to do it so fast? ! 】
[That is too weak for you, boy. 】
[It is simply the speed of light to close the abdomen, when the surgeon peels off the pus, it is called a slow. This is how fast it is, is it slow? 】
Surgery, not all doctors can understand.
But the steps to close the abdomen are all understood by everyone.
The operator's hand speed is fully open, and one can fully keep up with the help. The two close the abdominal cavity and use it for no more than 3 minutes.
This speed... is too skillful, it is called rocket speed.
With the end of the last needle, the patient was moved and the live broadcast was closed.
The doctors who saw the surgery were still reluctant to stay here, treating this as a chat room, and facing the empty background, everyone began to swear.
At the moment, things like driving at random are not a problem.
Because abdominal infections are often encountered, the reference value of this surgery is very large. In particular, the peeling of the pus and the B-ultrasound positioning on the table, direct puncture to absorb the pus, and then rinsed with antibiotics.
The only purpose of the surgeon is to try to make the patient's sepsis better.
Solved the source problem, the rest depends on the results of bacterial culture and the application of antibiotics.
The operation was almost perfect. Many doctors were still in love after being closed for more than an hour in the live broadcast room. They stayed here to chat, say their feelings, and see the feelings of others.
Cross-reference, improve the technical level.
If you can leave audio and video materials, how good it is, many doctors have to look forward to thinking.
This is a luxury, and someone can confidently send live a live broadcast, which is already a very lucky thing.
Those who dare to do this are really not many. Who can guarantee that there will be no problems in surgery?
Only the surgeons who are so anti-day will do live broadcasts.
In the live broadcast room, the doctors felt a long time, even if the surgeon did not know, shouted a lot of 666, which gradually dispersed.
Zheng Ren sewed the last shot and the patient has already recovered.
Whether it is Chu Yuran or Chu Yuzhi, the level of anesthesia is very high, and it is worthy of being a graduate student in critical medicine.
Zheng Ren stepped down torn off the sterile surgical gown and twisted his neck.
"Is not comfortable?" The Shea people were a little nervous.
Zheng Ren smiled. "No, it's an activity."
"Oh."
The Shea people began to clean up the surgical instruments, scrubbed them, and prepared them for disinfection.
"Zheng Ren, you are not on duty this evening, please eat." Xie Yi people back to Zheng Ren, said.
Zheng Ren’s blood rushed into his heart and almost did not go out from the already closed door.
"No need to treat today, there is a dinner in the evening." Zheng Ren has some regrets, although everyone said that it is more lively, but if you can eat with the Xie Yi people, how good?
It’s been so long, it seems that only when she first came, the two went out to eat a crayfish and met the Chu family sisters.
"Oh, okay." The Xie Yi replied.
Subsequently, Zheng Ren pushed down the transverse mesenteric membrane, cut the lateral duodenum and the peritoneum, and bluntly separated.
Zheng Ren's blunt surgical technique was developed at the beginning of the training of appendectomy. It can be said to be a housekeeping skill.
He himself estimated that the individual skills have reached the level of the master.
But when others look at it, they are used to it, and they don’t feel much at all. Zheng Ren glanced at Yang Lei and saw that he did not notice this, and some regrets.
It seems that when he is fine, he can tell him the key points of the operation.
Zheng Ren bluntly separated the peritoneum, then separated the second and third segments of the duodenum forward until the duodenum and pancreatic head could be lifted to the shallow part of the surgical field, and the duodenum and the back of the pancreas were temporarily placed. Warm salt water gauze pad.
When doing Oddi sphincter angioplasty, you need to find the location of the duodenum.
However, this patient has done a common bile duct, duodenal lateral anastomosis, which does not have to bother to do it.
Zheng Ren began to prepare to cut the duodenum.
Clamp the sides with a mosquito-type vascular clamp, cut from the middle of the two clamps, clamp 1~2mm each time, and then suture the duodenal mucosa and bile duct mucosa with 3#0 line without injury suture, up to 2.0~2.5cm the distance.
In this step, Zheng Ren is very careful to avoid duodenal fistula in patients after surgery.
After the sphincter incision is made, the sutures of the two edges are pulled and examined for bleeding.
The opening of the pancreatic duct is then examined.
The opening of the pancreatic duct is located in the lower part of the position of the duodenum in Zhengren. At 3 o'clock, the pancreatic juice is seen to flow out.
Use a thin catheter to place the pancreatic duct and check for obstruction or stenosis.
The duodenal incision is sutured in two layers, and the suture must be carefully combined to prevent duodenal stenosis or duodenal fistula.
Zheng Ren did not directly suture the incision as usual, but treated the position transversely to the transverse joint to avoid complications such as duodenal stenosis and duodenal fistula.
【what? This kind of stitching is very special. 】
In the apricot forest garden, someone immediately noticed this.
After countless times of experience, people who watched the live broadcast of the operation subconsciously thought that the surgeon would not make mistakes and began to appreciate the benefits of this stitching.
There are not many barracks, and there are not many people calling 666.
Everyone is relishing and learning.
After the incision on the duodenum was sutured, Zheng Ren carefully pulled over the omentum, covered with a large omentum, and placed abdominal drainage in the subhepatic area and the small omentum.
The abdominal cavity was flushed with warm saline, and no active bleeding was detected. Three antibiotics were used locally. Zheng Ren did not directly close the abdominal cavity.
"B ultrasound machine, sterile film, 50ml syringe." Zheng Ren said.
"Are you really ready to get it now?" Su Yun hesitated.
"Nothing." Zheng Rendao.
Su Yun did not continue to insist, and soon the visiting nurse pushed the mobile B-machine in the operating room. The sterile mask covers the probe of the B-ultrasound and the connection, and Zheng Ren began to do the direct B-ultrasound.
Without the interference of skin and subcutaneous tissue, it is called a translucent look!
The 50 ml syringe needle was guided into the pus cavity of the liver along the B-ultrasound, and the yellow-green pus of a tube and a tube was withdrawn.
After about 125ml of pus was pumped out, the resistance of the syringe began to increase.
"Two cefoperazone, dissolved, rinsed." Zheng Ren said.
Immediately, the warm salt water was rinsed, and the patrolling nurse opened two cefoperazone tazobactam, dissolved and injected into the pus cavity of the liver by Zheng Ren.
This operation was finally finished. Zheng Ren carefully watched the area he had done. He did not see any bleeding or untreated inflammatory infections.
"Off the belly." Zheng Rendao.
The Xie Yi immediately changed a pair of gloves and began to hand it to Zheng Ren with a clean, reserved device.
The whole operation was slow and slow, when the pus was peeled off and the sphincter was formed, Zheng Ren was very slow and very careful.
When the abdomen is closed, the action is just like flying, and almost has a residual image.
Su Yun can follow his own speed, real people and be convinced of this.
[I am going, the only step I can understand, how to do it so fast? ! 】
[That is too weak for you, boy. 】
[It is simply the speed of light to close the abdomen, when the surgeon peels off the pus, it is called a slow. This is how fast it is, is it slow? 】
Surgery, not all doctors can understand.
But the steps to close the abdomen are all understood by everyone.
The operator's hand speed is fully open, and one can fully keep up with the help. The two close the abdominal cavity and use it for no more than 3 minutes.
This speed... is too skillful, it is called rocket speed.
With the end of the last needle, the patient was moved and the live broadcast was closed.
The doctors who saw the surgery were still reluctant to stay here, treating this as a chat room, and facing the empty background, everyone began to swear.
At the moment, things like driving at random are not a problem.
Because abdominal infections are often encountered, the reference value of this surgery is very large. In particular, the peeling of the pus and the B-ultrasound positioning on the table, direct puncture to absorb the pus, and then rinsed with antibiotics.
The only purpose of the surgeon is to try to make the patient's sepsis better.
Solved the source problem, the rest depends on the results of bacterial culture and the application of antibiotics.
The operation was almost perfect. Many doctors were still in love after being closed for more than an hour in the live broadcast room. They stayed here to chat, say their feelings, and see the feelings of others.
Cross-reference, improve the technical level.
If you can leave audio and video materials, how good it is, many doctors have to look forward to thinking.
This is a luxury, and someone can confidently send live a live broadcast, which is already a very lucky thing.
Those who dare to do this are really not many. Who can guarantee that there will be no problems in surgery?
Only the surgeons who are so anti-day will do live broadcasts.
In the live broadcast room, the doctors felt a long time, even if the surgeon did not know, shouted a lot of 666, which gradually dispersed.
Zheng Ren sewed the last shot and the patient has already recovered.
Whether it is Chu Yuran or Chu Yuzhi, the level of anesthesia is very high, and it is worthy of being a graduate student in critical medicine.
Zheng Ren stepped down torn off the sterile surgical gown and twisted his neck.
"Is not comfortable?" The Shea people were a little nervous.
Zheng Ren smiled. "No, it's an activity."
"Oh."
The Shea people began to clean up the surgical instruments, scrubbed them, and prepared them for disinfection.
"Zheng Ren, you are not on duty this evening, please eat." Xie Yi people back to Zheng Ren, said.
Zheng Ren’s blood rushed into his heart and almost did not go out from the already closed door.
"No need to treat today, there is a dinner in the evening." Zheng Ren has some regrets, although everyone said that it is more lively, but if you can eat with the Xie Yi people, how good?
It’s been so long, it seems that only when she first came, the two went out to eat a crayfish and met the Chu family sisters.
"Oh, okay." The Xie Yi replied.
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