Chapter 798: : Deadlocked!

The power of a man's outburst during convulsions is still considerable.
It took a lot of energy for three or four people to control the old man!
After a while, the role of stability began to play out.
The patient was quiet.
Alas, this does not mean that it is safe.
Here, a doctor from the second group constantly explained the patient's condition.
"Patient, male, 72 years old, recovery period after major gastrectomy, unknown convulsions, previous history of hypertension, diabetes ... oral ..."
When Hou Rong heard what the patient said, Hou Rong's face was low.
The patient has a history of hypertension, but at this time the blood pressure is less than 80mmHg, which means that such blood pressure is difficult to provide the patient with sufficient blood supply.
The human body has a tolerance function for many situations.
Some people don't feel uncomfortable when their blood pressure reaches 1700 or 180, while others don't see abnormality when their blood sugar exceeds 33.3.
This is how the human body has tolerated this abnormal environment.
So at this time, after the patient has only 80 of systolic blood pressure, he has brought shock!
Here, after the patient's condition is stable, Hou Rong quickly took the patient to the operating room to complete the esophageal repair operation in time. After all, at this time, the esophagus ruptures, and there will be a lot of bleeding into the chest cavity.
Hemostasis!
Repair esophagus and trachea.
Clean up the blood in the chest cavity to prevent further infection.
This is the best thing to do now.
Here, Hou Rong is still thinking about the question, why do patients develop epilepsy?
Where is the reason?
But now the situation is urgent and time is limited and I can't delay it anymore.
The patient originally had gastric cancer. Is it brain metastasis?
I thought of this, Hou Rong could not help but have a headache.
Chen Cang said at this time: "Director Hou, is it a brain hemorrhage?"
In a word, Hou Rong immediately woke up.
Yes indeed!
If the patient has a history of hypertension, could it be cerebral hemorrhage?
肯定 It is definitely too late to do CT. The time to do CT may be directly lost. In that case ... it is definitely not appropriate.
Thinking of this, Hou Rong performed a meningeal stimulus check, and sure enough!
Positive!
Of course, a positive meningeal irritation does not necessarily mean cerebral hemorrhage, but it is possible.
But now, the patient must have surgery, otherwise let alone cerebral hemorrhage, the ischemia will be gone!
Here, the blood transfusion department has completed the blood distribution and sent it directly.
He and his team pushed the patient directly toward the operating room.
Chen Cang also followed directly.
After all, it's about your own task, you can't ignore it.
Moreover, Chen Cang felt that this patient did not seem to be as simple as imagined.
手术 After anesthesia, surgery begins.
After passing through the neck opening, the esophagus, trachea, nerves, etc. were all exposed to everyone's vision.
However, because of this, everyone is really shocked to see the bad neck condition!
The patient's esophagus was damaged at this time, the wound was irregular, and the condition of the entire esophagus was very poor!
In general, the success or failure of esophageal perforation depends on the site of the perforation, the size of the fissure, the time of diagnosis, and whether the treatment is appropriate.
And the situation of this old man is obviously very poor!
Not only are there many cracks, but the damage is still irregular. If it is not timely to send to the emergency center, once it exceeds 12 hours, basically no treatment is needed!
Hou Rong also couldn't help but feel sorry.
For now, the likelihood of a patient being cured is low enough.
During the period after the onset of the patient, the oral secretions must have been swallowed with the seizures. In this way, secretions containing a large number of bacteria from the breach into the mediastinum or chest cavity will worsen the infection!
"Broad-spectrum antibiotics!"
"Big dose!"
Hou Rong continuously issued doctor's orders, at this time blood transfusion and fluid replacement were performed simultaneously, electrolyte disorders were also corrected, and the patient's condition was stabilized.
At this moment, what is needed is to separate the esophagus and repair it.
The patient's surgical incision was at the anterior edge of the left sternocleidomastoid mastoid muscle, and the thyroid was exposed.
Hou Rong carefully cut off the scapula hyoid muscle.
游离 Then free the middle thyroid vein.
Retract the thyroid and common carotid artery sheaths to both sides to free the esophagus!
The perforated area is too obvious, and it can be seen basically without searching.
Fortunately, there is no damage to the airway, otherwise, the operation will be more troublesome.
The next step is to repair the esophagus.
But!
At this moment, a difficult problem appeared in front of everyone.
There are too many ulcers and irregularities, and it is definitely impossible to sew directly with absorbable thread.
How to fix it?
After resection, anastomosis?
This is simply unrealistic, because the patient has gastric cancer, and a major gastric resection has been performed, and the length of the digestive tract is simply not enough.
It is unrealistic to want to sew after excision.
However, if you do not remove it, forcing an anastomosis is even more dangerous.
After forced anastomosis, most will even occur reflux esophagitis, anastomotic fistula and so on.
Hou Rong hesitated, watching the inflammatory manifestations around the breach.
How to do?
Surgery has been carried out to this time, and there is no way to proceed.
Hou Rong quickly said to the nurses on the side: "Call Director Yu, and there are also three group leaders and directors."
Director Chang Chang is a major in the Department of Thoracic Surgery ~ EbookFREE.me ~ Hou Rong can only put hope on them at this time.
Esophageal rupture, and no surgery, suture is impossible, anastomosis is not possible,
At this time, several doctors in the second group were also agitated.
Emergency departments often encounter these situations, because the surgery is more urgent, and there is no time to make adequate preparations. When encountering these unexpected situations, you need to discuss on the stage!
Yu Yugang and Chang Xiong came to the operating room not long after.
Looking at the patient, all three fell into silence.
Hou Rong could not help asking: "Is it possible to replace the esophagus with an autologous colon?"
The replacement of the esophagus by abdominal organs such as the stomach and colon is still the most commonly used method.
Ji Changxiong shook his head directly: "No!"
"There is a major gastrectomy in itself. I took a look at the film and sacrificed the digestive tract at the expense of the patient's digestive system. The surgical complications were also many. The patient was postoperative for gastric cancer. Poor, even ... the basic digestive function cannot be maintained. "
At this time, Yu Yonggang took the tweezers and carefully separated the neck tissue, and suddenly said, "Can you repair the cervical esophagus with the cervical platysma flap?"
一 As soon as this sentence came out, the eyes of the people around them suddenly lit up!
This is a good way!
But Changxiong took a closer look at the flap of the broad neck muscle and suddenly frowned, "It can be, but ... In this way, blood flow is a problem. After a long period of time, scar tissue will definitely form, resulting in esophageal wall contracture. , There is basically no chance of success in the next operation! "