Chapter 319 Life at your fingertips! (Please subscribe)

Pelvic hematoma, or retroperitoneal hematoma in the pelvis, is a very dangerous condition.

The official definition is that retroperitoneal hematoma is a common complication of abdominal and waist injuries, which can be caused by direct or indirect violence. The most common cause is pelvic and spinal fractures; followed by retroperitoneal organs (kidney, bladder, duodenum

and pancreas, etc.) rupture and damage to large blood vessels and soft tissues. Because it is often combined with severe compound injuries, hemorrhagic shock, etc., the mortality rate can reach 35% to 42%.

What is the concept of a disease with a mortality rate as high as 35%?

Moreover, according to textbooks and knowledge, such retroperitoneal hematoma is mostly treated with interventional treatment or conservative treatment. The traditional incision method has a higher mortality rate.

However, everyone also understood why Zhou Cheng wanted to go under the knife.

The pelvic fracture has caused damage to the venous plexus. At present, arterial damage cannot be completely ruled out. If blood loss continues, the patient will undoubtedly die. Conservative treatment is ineffective, and surgery can only be used for rescue!

The second intervention I chose was Tianjin People's Hospital, which was not equipped with this equipment, so naturally there was nothing we could do.

The director of the general surgery department immediately cheered up, and then saw that although Zhou Cheng had used the knife, the blade he controlled was not as he thought in his heart, and he violently pulled it in, and blood spattered everywhere.

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Instead, Zhou Cheng used the blade of a knife to cut away the swollen outer layer of peritoneum with appropriate force.

The peritoneum is the largest and most complex serous membrane in the body, and its area is approximately the same as the skin!

It is composed of mesothelium and its outer connective tissue. It is thin, smooth and translucent. It covers the inner surface of the abdominal wall and pelvic wall as well as the surfaces of the abdominal and pelvic organs. The former is called parietal peritoneum or peritoneal parietal layer, which consists of the body

It develops from the parietal mesoderm; the latter is called the visceral peritoneum or visceral peritoneum, which develops from the visceral mesoderm. The parietal layer and the visceral layer migrate to each other to form a very irregular potential cavity, called the peritoneal cavity.

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What Zhou Cheng is incising now is not the peritoneal layer...

"Aspirator, suck some blood for me." Zhou Cheng noticed that the director of the general surgery department seemed a little distracted and quickly reminded him.

The director of the general surgery department did not say much. In the current situation, the patient has already been on the operating table, so we still have to fight for what we should fight for. We are afraid of this and that. In the end, the patient is afraid of dying on the operating table and the operation process.

There is no essential difference between dying on the operating table.

When the pelvis is fractured, a lot of blood leaks out, so in fact, inside the pelvic cavity, there is a scarlet mass, and there are blood clusters in some places that have coagulated into lumps.

The retroperitoneal space is very large, so it represents the amount of bleeding. Before solving and exploring such a hematoma, you must not define which blood vessels are injured. You must explore the abdomen one by one.

.

Perhaps seeing Zhou Cheng's hesitation, Mo Youcheng said: "Dr. Zhou, do you want me to help you explore the arterial structure?"

Zhou Cheng shook his head and asked: "Director Mo, you have already done an abdominal exploration and closed the abdomen before. It should be that no vascular damage was found in the abdomen? Right?"

If it was when he first stepped down, Mo Youcheng would definitely say that he had not missed any clues, but now, seeing such a large peritoneal hematoma, he was not sure.

Just kidding, how can he dare to say that he has completely ruled out this real retroperitoneal hematoma?

"Dr. Zhou, let's investigate one by one to avoid errors." Mo Youcheng did not answer directly, but he also reassured Zhou Cheng that I may not understand clearly. At this time, we must be careful!

Zhou Cheng is a little bit worried. This is the disadvantage of lower-level hospitals. If you are in the No. 9 Hospital of Shanghai, then the professors and doctors of the general surgery department can give you a clear answer to reduce your workload.

But now, it is not the time to complain or care about these things. Zhou Cheng took a deep breath and said, "Then let's continue to investigate."

"Move the lamp!" Zhou Cheng told the patrol.

Tour does the same.

In fact, the best approach to explore the abdominal contents is the one opened by Mo Youcheng before, but he sutured it up. Now it is a bit difficult to explore upward through the pelvis.

However, things have come to this point. No matter how difficult it is, we must go forward. If it doesn't work, just open the previous gap!

With Zhou Cheng's ingenious technique, Mo Youcheng discovered that Zhou Cheng actually completed part of the exploration of the retroperitoneal space through such a narrow approach!

Moreover, Zhou Cheng detected the hematoma, which was relatively limited. In other words, the blood vessels he detected before were correct and there were no mistakes. There was no arterial damage elsewhere.

Most of the blood vessel ruptures are concentrated in the pelvis!

My previous surgery, yes!

Zhou Cheng also saw this, so he stopped exploring further and wasting time.

Because if there is blood oozing from the upper organs from top to bottom, there will definitely be traces left by the blood pool. Now after the patient is opened, these traces are not seen, which proves that it comes from below.

upward source.

The pelvis is just at the bottom of the abdomen, and the source is clear.

However, the time wasted in this operation is real.

Zhou Cheng breathed a sigh of relief and then continued to explore the arteries and veins near the pelvis.

There are many arteries and veins near the pelvis, and they are intricate. The abdominal aorta itself has visceral wall branches, which supply various organs. The wall is divided into the left and right common iliac arteries, and the common iliac artery is divided into the internal iliac artery and the external iliac artery.

The external iliac artery has its branches, the internal iliac artery has more branches, and finally it continues as the femoral artery...

External iliac artery, inferior epigastric artery, and deep circumflex iliac artery.

The internal iliac artery is further divided into visceral branches, which include the iliolumbar artery, the lateral sacral artery, the superior gluteal artery, the inferior gluteal artery, and the obturator artery.

The visceral branches include: superior vesical artery, inferior vesical artery, uterine artery, umbilical artery, inferior rectal artery and internal pudendal artery.

Moreover, this is just the front and middle part of the pelvis. The back part of the pelvis is adjacent to the rectum, bladder, etc...

In addition to the arteries, there are also accompanying meridian branches! In addition to the left side, there is also the right side!

What does this mean? This means that there are at least dozens of blood vessels in the small pelvis, intricately moving!

This is the reason why it is so difficult to damage blood vessels after a pelvic fracture.

However, Zhou Cheng was very patient and quickly explored one by one.

Moreover, Mo Youcheng also discovered that Zhou Cheng's exploration speed was incredibly fast. He could almost quickly distinguish their specific locations from the messy pelvic blood vessels and tissues.

Then stroke it to see if it is ruptured or damaged, and then move on to the next blood vessel.

This is true for arteries and veins.

It's like a machine that works quickly to identify blood vessel damage.

About four minutes later, Mo's friend Chengdu forgot which artery or vein Zhou Cheng had detected, but Zhou Cheng suddenly became overjoyed: "I found it, the silk thread!"

What Zhou Cheng said was not a response, but everyone's surprise.

Including Mo Youcheng, the people from the orthopedics department, and the equipment nurses who set up the tables.

"Silk thread, ligation, thank you!" Zhou Cheng saw that no one was paying attention to him, so he emphasized his tone and also used some polite words.

"oh oh!"

"Silk thread!" The equipment nurse who liked to watch the excitement handed over the silk thread belatedly.

Zhou Cheng took it and did not argue. He just said: "Continue to prepare the next one. Such a large hematoma should damage more than one blood vessel."

Zhou Cheng knows that he is not a member of the work unit, so he can be angry, but he should not rise to other heights. He can push him to solve the problem, not to solve the person who created the problem.

All I can say is that this nurse is a bit unprofessional and can’t stand up to a big occasion!

Then, after Zhou Cheng ligated two arteries and veins, he slowly breathed a sigh of relief: "Director Mo, I now need to find the specific location of the breach and suture it!"

"But before that, we must first resolve the retroperitoneal hematoma. You cooperate with me in suctioning, be careful of the hematoma suddenly bursting!"

Zhou Cheng reminded, but Mo Youcheng was obviously much calmer: "Dr. Zhou, I will try my best to cooperate with you."

He knew that when he came here, he was just a tool. Zhou Cheng's operating speed and blood vessel exploration speed were beyond his ability to keep up with, and the gap between them was even greater than if he were an intern himself!

No wonder the orthopedics department would invite him down for consultation and surgery.

Mo Youcheng glanced at the director of the Department of Orthopedics. The director of the Department of Orthopedics did not say much, but continued to focus on the surgical process.

Zhou Cheng chose a rather special angle. After opening the hematoma, the blood inside immediately burst out. Even though Mo Youcheng put the suction device in time and was ready for it, the suction was still not done in time, resulting in

Lots of blood splattered!

Fortunately, Zhou Cheng was prepared in advance and covered the incision with his hands in advance, so a large amount of blood did not spurt out, but was only confined to the wound.

After the impact of the pressurized jet, the inside became a mess again.

Zhou Cheng then waited quietly until Mo Youcheng had almost sucked all the blood inside, then released his hand again and observed the blood flow in the original hematoma.

Then you see that the blood is still slowly pouring out, and when there is a tendency that the bleeding will not stop, move quickly!

Zhou Chengdu didn't have time to use a hemostatic forceps. Instead, he directly grabbed a certain artery with his hands. Only then did the flow of blood slow down!

This is the scary thing about opening a hematoma, because you don't know where the blood vessels may be injured, and multiple blood vessels may be injured.

"Hemostatic forceps!" Zhou Cheng reminded the instrument nurse as he handed over the silk thread.

She immediately handed over a hemostatic forceps, and Zhou Cheng took it with his own hands, clamped the blood vessel, then continued to observe, and then, like catching a loach, pinched a blood vessel again.

Only then can the force of extravasated blood be stopped!

It's like this. Originally, the hematoma exists and the pressure inside the hematoma is high, so blood loss will be reduced to a certain extent. However, once the hematoma is broken and the pressure drops, a large amount of blood will be lost in a short period of time.

If all damaged blood vessels cannot be found during this process, the patient will quickly bleed to death or die of shock!

This is also the reason why retroperitoneal hematoma cannot be opened hastily!

Zhou Cheng clamped five blood vessels, and now he has caught four more, which has slowed the bleeding trend. Most people may not be able to find the previous five blood vessels before opening the hematoma!
To be continued...