Almost all of these patients are of unknown origin! Not to mention signing, even the family members don’t know where it is. This means that no one will pay, and if an accident occurs later, the hospital will be almost 100% responsible... but, Subsequently, government staff came forward and issued a written document, requiring the hospital to provide full treatment and all costs and consequences would be borne by the government. Only then did the hospital dare to officially carry out rescue operations, surgeries, etc. This side of Linhai Hospital, Xu Qiu is in charge of a patient with small intestinal perforation and rupture. Routine surgical procedures require strict control of water and electrolyte balance, blood volume, anti-infection and other preoperative preparations. But I couldn't care about that much at this time. If I didn't carry out the operation, it would be a dead end.
… Continuous epidural anesthesia. Supine position. "The operation begins." Xu Qiu picked up the scalpel and made an abdominal incision. Preoperative examination revealed that the patient's small intestine had perforation, rupture, and some intestinal hematoma and necrosis. In addition to repair surgery, part of the intestine must be removed. "Hook." After the laparotomy is completed, the instruments open the surgical field. Xu Qiu began to explore the entire abdominal cavity. "Get ready, I'm going to investigate." Xu Qiu reminded. Touching the intestines with hands can easily cause patients to vomit. One must always be wary of suffocation—a professional habit developed by surgeons. Although the patient may not have chyme in his stomach. "Ready!" the anesthesiologist stood ready. Xu Qiu nodded, and then started to explore in order. Starting from the duodenojejunal flexure, from top to bottom. From the ligament of Treitz to the terminal ileum and cecum of the right lower quadrant. Xu Qiu moved very quickly.
But it was unambiguous and accurately marked intestinal loop hematoma, mesenteric hematoma, seromuscular injury, intestinal rupture and other locations. The damaged area was quickly clamped with intestinal forceps to prevent continued contamination of the abdominal cavity. After the exploration, a complete surgical plan appeared in Xu Qiu's mind. However, just before the operation officially started, he was suddenly stunned. Something's wrong! He quickly explored again. At this time, the assistant was a little confused, what was happening! Xu Qiu's voice sounded again: "This is... an ectopic pancreas." He was a little surprised. It was not discovered during the previous examination that this patient not only had all kinds of problems, but also had a rare ectopic pancreas! Just at the edge of the small intestine mesentery and the wall of the small intestine, there was an exophytic mass, soft in texture, protruding into the intestinal lumen. Those who are not experienced may mistake this for a hernia sac. However, it is actually an ectopic pancreas! The so-called ectopic pancreas is also called the vagus pancreas. This is isolated pancreatic tissue outside the normal pancreatic anatomy. This is a congenital malformation, the cause of which has not yet been identified, and the prevalence is only about . In this patient's case, it was between the stomach and duodenum. "Looking at it this way, the obstruction is actually caused by the ectopic pancreas!" Ectopic pancreas can easily induce intussusception and intestinal obstruction. Clinically, many patients with this disease are admitted to the hospital due to intussusception and incomplete obstruction. Fortunately, Xu Qiu discovered it in advance. Otherwise, after the small intestine operation, it is found that the patient still has obstruction! Who would have thought that the patient actually had an ectopic pancreas hidden in his body! … "continue." This unexpected discovery did not affect Xu Qiu's surgical process. It's just one more resection. He looked inside the patient's abdomen again. The intestinal mucosa was severely damaged, and it was torn apart piece by piece, like a thin layer of paper.
The muscle layer is also exposed. The only good news is that the mucosa is not damaged and there is no herniation. "3-0 does not absorb the line." Xu Qiu dropped stitches one after another, and made interrupted sutures along the horizontal axis of the serosa edge to retract the mucous membrane. "Dr. Xu, why don't you suture longitudinally?" The assistant was puzzled. Xu Qiu didn't even raise his head: "Longitudinal suturing will cause the inner diameter of the intestine to shrink and cause stenosis." This is a problem that even the best doctors cannot avoid. Clinically, many doctors may choose longitudinal suturing. Because it's simple. Horizontal suturing requires adjusting the suture at any time according to the shape of the small intestine, and constantly changing the suture strength to control the entire tension. Once it fails, you have to start over. Therefore, unless there is complete certainty, the doctor will choose the safer longitudinal suture. After all, if there is a slight stenosis, it will not affect anything, but if it cannot be sutured, it will be a huge surgical accident. … "Scalpel." After completing the repair of the serosal damage, Xu Qiu began to remove the hematoma on the intestinal wall. This step requires incision of the serosa. While cleaning the entire layer, also check for any punctures. Transverse incision and suturing in situ. If the hematoma is large, the supply blood vessels will be directly found and ligated, and then intestinal resection and anastomosis will be performed. "There are 13 piercings in total." The assistant counted them one by one, with a shocked expression on his face. Too much! With so many perforations, do they really need to be repaired? Is there any need to repair it? On the operating table, Xu Qiu's expression remained unchanged after hearing this number. He just said calmly: "Continue." He began to repair them one by one. The tear is less than half of the intestinal tube and has neat edges, which is the easiest. Xu Qiu lifted the rupture of the intestinal wall and pulled it to both sides of the intestinal tube. Keep it perpendicular to the longitudinal axis of the intestinal tube.
Then, double-layer suture was performed. The inner layer is the intestinal wall, and the outer layer is the seromuscular layer. The assistant was stunned. Such a thin intestinal tube can be sutured in two layers! The sutures and suture techniques used between different layers are completely different! What a sophisticated suture technique! … The operation continued. Xu Qiu's movements became more and more handy. Every time he put the needle, he adhered to the basic principles. 1. Avoid stenosis. 2. Prevent intestinal fistula. 3. Beware of necrosis. Three hours later, the operation was over. Xu Qiu calmly arranged the follow-up care: "Continue to fight shock and correct hypovolemia." "Strengthen anti-infection treatment, especially drainage of abdominal wall incision, and give additional cephalosporins and aminoglycosides. The patient is likely to have mixed infection of Gram-negative bacilli and anaerobic bacteria." "Give albumin after surgery..." ... After leaving the operating room, Xu Qiu had not had time to rest, and one of the operating rooms was a bit overwhelmed. Not every operating room is Xu Qiu. Many doctors were rushed to the operating table temporarily. Without sufficient preparation, facing such a dangerous patient, the probability of accidents is very high. Therefore, Xu Qiu went on stage to save the scene again. When he was done, it was already more than seven o'clock in the evening. "It's finally over." Xu Qiu left the operating room and walked in the empty corridor. It was different from the past. For the rescue of these eleven operations, no family members were waiting outside. Perhaps, these are people who are not expected to survive.
But standing in front of the operating table, wearing that white coat, Xu Qiu couldn't think too much. It didn't matter whether the patient wanted to live or not, or whether the family members wanted them to live or not. If modern medicine can save them, then save them! This is the only standard! Xu Qiu took a shower, and before he packed up and left work, an urgent call suddenly sounded from the inpatient department. Not long after, Liu Susu hurried to the doctor's office. "Doctor Xu, something happened!" Xu Qiu stood up instinctively, "What's going on?" "The poisoned patient you admitted this morning has been coughing up blood clots!" That brother and sister? Xu Qiu couldn't figure it out. The other party was just poisoned, and he had evaluated it before leaving, and it wasn't that serious. How could he cough up blood! What happened in the meantime? —— Vote! Brothers, remember to vote!