Chapter 916 Director, I feel a little uncomfortable
Now that the family members are all here, Director Fang is more cautious. He really talks to the family members again under real-time video recording, clearly explains every detail of the informed consent for the surgery, confirms that the other party has understood it, and then lets Jiang Li’s
The family representative---her brother signed and laid hands on it.
Moreover, other brothers and sisters were asked to sign a formal power of attorney, which means that all the brothers and sisters will hand over all decision-making rights to Jiang Li during her treatment in the hospital, so that they are legally ready, even if the family members turn against each other after the surgery.
, nor will it be limited to passive.
There is no way, if doctors are not careful now, they can easily fall into a trap. This society is made so complicated by rat shit.
After the pre-operative signature was completed, Director Fang checked in his mind whether there were any loopholes. Be cautious, which means that you need to be careful during the operation and the process of the operation.
After confirming that there were no loopholes, Director Fang asked the doctor in charge of the ICU to arrange the surgery.
The doctor in charge began to contact the nurse on duty in the operating room to inform the operation, and the nurses in the ICU ward also began preoperative preparations and sent the patient to the operating room.
Parasites are generally divided into worms and protozoa, and liver hydatid belongs to the category of worms.
Hepatic echinococcosis is relatively rare in the south, with high incidence areas in northwest my country, such as Xinjiang, Qinghai, Ningxia, Gansu, Inner Mongolia and Tibet, among which Nagqu in Tibet has the highest incidence rate.
The treatment process is roughly as follows. As a worm, the canine tapeworm parasitizes in the small intestine of dogs. The eggs excreted in the feces often adhere to the hair of dogs, sheep and other animals. If a person swallows food contaminated by the eggs, he will
, can be infected.
The eggs enter the digestive tract through the mouth. Under the action of the intestinal digestive juice, the larvae will escape from the shell and pass through the intestinal mucosa, enter the portal vein system, and enter the liver through the portal vein. Most of these larvae are retained in the liver.
It takes 3 weeks for the larvae to develop into hydatid cysts in the body. The hydatid cysts gradually grow in the liver. The grown hydatid cysts cause compression symptoms of adjacent organs, and may cause cavity organ obstruction, infection, rupture and dissemination, etc.
complication.
Judging from the medical history, Jiang Li has been to the livestock area in Nagqu, Tibet, where she may have been infected with liver hydatid. However, Jiang Li went there a year ago. If calculated according to this, the disease only took one year, but now it has eroded
Most of the liver is affected, and it also invades the abdominal and thoracic cavities. The onset of the disease is a bit too fast.
This is just an epidemiological speculation. Nowadays, some animals are relatively mobile, the number of stray animals in cities is increasing, and some sporadic cases will also appear in non-high-incidence areas.
Hepatic echinococcosis cyst ruptures into the abdominal cavity is a relatively rare complication of hepatic echinococcosis. Once the cyst ruptures into the abdominal cavity, the cyst fluid contains a large amount of foreign proteins. These foreign proteins can cause a strong allergic reaction, leading to peritonitis.
and anaphylactic shock.
CT is a common imaging examination used to confirm the diagnosis of this disease, and the CT imaging findings that are diagnostic of acute abdomen with ruptured liver cyst are the "snake sign" and "spinning sign". This characteristic image description is
Descriptions by European doctors in 1990 and 1991.
Now Jiang Li is in a state of shock. There are two reasons for her shock. Septic shock and anaphylactic shock are mixed together. It is very difficult to treat. It is almost impossible to rely solely on drugs. Emergency surgery is necessary to remove the liver hydatid from the body.
The liver tissue eroded by hepatic hydatid, the ruptured cysts and the cystic fluid scattered everywhere. Only by completely removing the pathogenic factors and adjunct anti-shock treatment during and after the operation can we hope to save Jiang Li's life.
It was impossible to get home on time for dinner, so Yang Ping called Xiao Su to explain the situation so that the family would not have to wait for him to have dinner.
After everything was arranged, Yang Ping and Director Fang hurried to the operating room. Director Fang got some dry food, and the two of them filled their stomachs in the dressing room and immediately changed their clothes.
Because there is a separate operating room at the Institute of Surgery, Yang Ping seldom performs operations here. When they heard that Yang Ping came to perform operations here, everyone was very happy. This god-like figure will be worshiped wherever he goes.
Besides, no matter they are anesthesiologists or operating room nurses, everyone wants to work at the Institute of Surgery. Not only is the income high, but the experience of working in the Institute of Surgery is very valuable. You can choose where to work in the future. Now, the Institute of Surgery
Not top in the country, but top in the world.
Not to mention anything else, the girlfriend of the anesthesiologist Fatty Liang is a stewardess. Everyone knows this. There is a wild rumor in the anesthesiologist circle of Sanbo Hospital that Fatty Liang is now prosperous with Yang Ping. Not only does he earn money, but he also
With so many resources, I have a bright future. If I don’t have a lot of money, I can fall in love with a flight attendant.
As for Song Zimo, Xu Zhiliang, Zhang Lin, and Xiao Wu, they are the envy of the whole academy. Yang Ping's preparations to participate in the evaluation for academicians and Nobel Prizes are public. According to this trend, Song Zimo and Xu Zhiliang will become academicians sooner or later. The new
Tang Shun, who came here, would become an academician sooner or later.
"Professor Yang!"
Whether it was the anesthesiologist or the operating room nurse, they greeted Yang Ping politely. One after another, many people gathered in the operating room. Most of these general surgery doctors came to observe Yang Ping's surgery because they could usually observe Yang Ping's surgery at close range.
There are not many opportunities.
Because of Yang Ping's reputation, the traveling nurse couldn't chase people away, so she acquiesced that these guys gathered in the operating room. Fortunately, these doctors were more knowledgeable and paid attention to the concept of sterility, and tried not to cause trouble in the operating room.
Yang Ping had just come in, and everyone was preparing to move a stool for Yang Ping to sit on, but the sharp-eyed traveling nurse rushed to bring the stool.
"The blood pressure is not very stable and can't go up." The anesthetist was quite worried.
Now he is a dead horse and a living doctor. He is in severe shock and his blood pressure cannot rise without surgery to remove the lesions.
"The blood pressure is unstable. Our operation must be as fast as possible." Yang Ping nodded.
Director Fang is self-aware that this kind of surgery is extremely difficult. If he performs the surgery himself and is guided by Yang Ping, he will definitely not be as fast as Yang Ping. When life is at stake, it is not the time to learn by yourself. Director Fang still has this awareness.
of.
"Professor, you do the surgery!"
Director Fang is not afraid of taking responsibility, but he is really afraid that his speed will delay his condition. Elective surgeries can be done slowly, as long as the operation time is not too outrageous and the quality of the surgery can be guaranteed, it will generally not affect the effect of the surgery. However, emergency surgery is against the clock, how is it possible?
Let yourself take your time. One minute faster and one minute slower may be the difference between life and death.
"Let me do it! The patient's blood pressure has been unable to rise. If this low perfusion state is maintained, multiple organ failure will soon occur."
Yang Ping decided to take charge of the operation himself and achieve a quick victory.
Xiao Chen, a graduate student led by Director Fang, and another young doctor had already brushed their hands and began to disinfect and spread the sheets.
Yang Ping has been conducting various surgical trainings regularly in the system operating room, so there is no delay in surgery due to scientific research. The level of surgery has been rising, and the cases trained in the system operating room are becoming more and more difficult.
For complex and difficult surgeries like Jiang Li's, Yang Ping used to rely on the simulation surgery function of the system space, but now there is no need for the simulation function at all. In reality, the so-called difficult cases are just simple surgeries for Yang Ping.
The preparations for the operation were almost done. Yang Ping and Director Fang went to wash their hands and get dressed before going on stage.
"Doctor Luo, please help me keep an eye on my blood pressure." Yang Ping told the anesthesiologist Dr. Luo.
"rest assured!"
Dr. Luo, the anesthesiologist, said he was relieved, but he was feeling guilty.
Dr. Luo is about the same age as Fatty Liang. He is under a lot of pressure now. He originally wanted to show off in front of Yang Ping. Maybe he would be picked up by Professor Yang and selected to go to the Institute of Surgery. From then on, his life would rise step by step. But this is the first time with
Professor Yang's surgery is like this. It's not easy to perform well. What if something life-threatening happens during the surgery?
Yang Ping used an incision on the right upper rectus abdominis muscle and cut it layer by layer until it reached the abdominal cavity.
"I heard that she has been to Nagqu, Tibet? That is the place with the highest incidence of hepatic echinococcosis in the world."
"There is an anesthesiologist in our department who just went to Tibet this year, and it seems that he was in Nagqu."
"In fact, some parasitic diseases are not caused by traveling to high-incidence areas, but by eating raw animal meat."
"The last time I gave anesthesia to a patient with neurocysticercosis, I saw this kind of patient once. I will never dare to eat sashimi again."
“Not many people eat it.”
The anesthesiologist and circulating nurse were chatting. Professor Yang's operation was very fast and stable, which made people feel very reassured.
The liver was exposed, and the huge, deformed liver filled the entire surgical field, pushing the surrounding organs aside.
Yang Ping used a suction tube to remove the cyst fluid that flowed into the abdominal cavity. It was the inflow of cyst fluid that caused peritonitis, which in turn led to anaphylactic shock.
The cracked naan bun was only part of it, and there were still unbroken cysts. Yang Ping continued to separate them. These white cysts, large and small, were squeezed together and bulged out. They were so densely packed that it made people’s scalp numb to look at them.
Of course Yang Ping won’t have scalp numbness.
This is not a liver, this is a worm's nest.
Director Fang was a veteran, and the two young doctors who were his assistants saw this scene for the first time, and they felt extremely uncomfortable.
Xiao Zhou, a young doctor who works as an assistant, has a stomachache and feels like acid water is constantly coming out. He doesn't know why he started sweating on his forehead, but he's embarrassed to say it.
Finally, Xiao Zhou couldn't help it anymore: "Director, I feel a little uncomfortable!"
Director Fang saw that he was sweating slightly on his forehead and knew that this was because he was disgusted by the disgusting scenes in the surgical area: "Isn't it a shame? You're still a surgeon. You don't have any immunity at all. Let's go and have a rest before putting on a retractor."
Director Fang said impatiently that he was most annoyed by such squeamish students, who couldn't hold on to any disgusting scene.
Xiao Zhou had no choice but to bear it. It would be bad if he couldn't help but vomit on the operating table, so he hurried down and another graduate student immediately went to clean his hands to fill the gap.
Hepatic echinococcosis is not as scary as cysticercosis. If someone with trypophobia sees an X-ray of cysticercosis, they will faint immediately, because on the X-ray, the muscles of the patient's limbs are densely covered with white calcifications of cysticercosis.
Images, this kind of X-ray, once you see it, you will never forget it.
As the dissection progressed, the liver and surrounding tissues that had been eroded by hydatid were quickly exposed. They were filled with white follicle-like hepatic hydatid cysts, which were crowded together and looked extremely scary.
Where is the liver? This is a pile of worms and cysts, countless white things, I don’t know if they are worms or cysts, crowded together.
"When I was a child in the countryside, I went to the toilet and saw piles of maggots piled up and tumbling in the toilet. Now I feel like this. I now think that some people even eat maggots as vegetables."
Director Fang's graduate student Xiao Chen said calmly.
When Xiao Zhou heard what Dr. Chen said, his stomach and intestines, which had calmed down a little, started to churn again. He couldn't help but started retching in the corner. Director Fang raised his head and said, "Which of you will go out with him to have a rest? I'm not a surgeon."
These must be immunized. Not only must there be no reaction, but it is best to be able to eat a bowl of pork liver after surgery, then it will be considered qualified.”
Director Fang turned around and scolded Dr. Chen again: "Can you stop saying a few words? You are just picking on the disgusting ones. You are eating meat maggots as food. They are specially cultivated under sanitary conditions. They are no different from the maggots in your toilet cake."
Is it the same? Your brain is like a maggot."
"Director, didn't I just say this out of emotion?" Xiao Chen quickly explained.
''Please, can you two stop talking about this? I feel like vomiting right now."
The circulating nurse immediately stopped Director Fang's disgusting topic.
The liver has many blood vessels, and many places are eroded by hydatid. If you are not careful, it is easy to damage the blood vessels and cause massive bleeding. The three hepatic portal blood vessels and nerves are complex and intertwined.
But Yang Ping is very skilled in anatomy and has encountered all kinds of pathological anatomy, so this operation was very easy.
In order to keep up with the speed, Yang Ping moved very quickly. When Director Fang couldn't keep up with the rhythm, Yang Ping had to operate alone.
This chapter is not over yet, please click on the next page to continue reading! Soon, before Director Fang could react, Yang Ping had dissected out the entire liver. After removing the liver, the field of vision immediately broadened, and the hydatid tissue around the liver could be easily removed.
.
Yang Ping asked Director Fang to go to another sterile station to process the isolated liver, cut off all the liver lobes eroded by hydatid, and leave the healthy liver lobes for autologous transplantation. He took Dr. Chen to deal with the hydatid hydatid in the abdominal and thoracic cavities.
invaded tissue.
In order not to contaminate normal organs and tissues, Yang Ping used gauze to strictly isolate the surgical area from the surrounding area.
Why is this girl's condition so serious? How many years did it take for it to become like this? It was only a year ago that he went to Tibet. How could the condition develop so quickly?
Yang Ping opened the diaphragm upwards and entered the chest cavity. This made it easier to clean out all the hydatid, vesicles and hydatid-infested tissues around the liver, and then rinsed it repeatedly with normal saline.
Then Yang Ping worked with Director Fang to deal with the liver. Director Fang was no longer unfamiliar with autologous liver transplantation. Abdominal organ cluster transplantation included autologous liver transplantation. If he hadn't been in a hurry, Director Fang would have really wanted to perform this surgery, but with this
Director Fang can actually learn a lot if Yang Ping does it.
Autologous liver transplantation is an extremely difficult operation for others, but for Yang Ping, it is very simple. It is just a matter of anastomosis of several pipes, including several blood vessels and a bile duct, whether it is an allogeneic liver transplant or an autologous liver transplant.
In order to reduce the possibility of cholestasis, Yang Ping not only anastomosed the bile ducts, but also carefully anastomized the bile capillaries.
This can keep the biliary system unobstructed and minimize the complications of cholestasis.
As for the hepatic arteriovenous anastomoses, Yang Ping is also very particular. He not only considers the number of arteriovenous anastomoses, but also tries to maintain the original pressure of the hepatic arteriovenous circulation.
On the sterile table, Yang Ping and Director Fang quickly completed the liver lobectomy. Only two of the five lobes of the liver are now healthy. Now these two lobes need to be transplanted back into the patient's body to continue to function.
