Chapter 581: half

Chapter 581
Someone is good at handling things, someone is good at checking in the hospital, not to mention the head nurse in the hospital.
The nurses and sisters were very accommodating. After a day's work, the results of the preliminary examination came out, and the gastric cancer was diagnosed! ~
"Zhang Yuan is right, what should I do now?" The head nurse of the special needs department lost his rules.
"Go to Zhang Yuan, wait." After talking, he asked after thinking about it, "Do you Zhang Yuan smoke and drink?"
"I haven't seen smoking, but I know he can't drink it. It's not used ..."
The head nurse felt that she was her colleague. Although she was a superior, Zhang Fan was also very approachable. Not that she was reluctant to send things, or that she felt a little lack of face as soon as she sent something.
"What do you know! It doesn't matter if you ask someone to do the inspection. Now, in this case, you listen to me ..."
Sometimes people are too complicated, but it's better to be simple. Just when they are tangled, Zhang Fan has already seen the test results on the computer.
"Director Zhao, how is it, how do you evaluate the head nurse's mother-in-law?"
"It's okay, the anesthesia department said it can be anesthetized. We don't think there is a problem here." Lao Zhao replied.
"Then prepare for the operation! I will do it myself."
"Okay, Zhang Yuan."
Stomach, digestive tract, to be honest in the digestive tract, the stomach is actually very skinny, just like a car in a certain country, you take good care of it and can serve you for a lifetime.
It is not as delicate as other digestive organs. Let's talk about ulcers. In fact, gastric ulcers do not account for a high proportion of ulcers in the digestive tract.
Especially for young people, the most are twelve-finger ulcers. For example, some young people feel uncomfortable before meals, and their stomachs are uncomfortable. Take two meals. Okay!
This is the typical pain of hunger! Can not escape is duodenal ulcer. Moreover, this place is particularly vulnerable to ulcers.
This is for a reason. There is a lot of gastric acid in the stomach, but it has a bicarbonate barrier on the surface to protect the stomach wall.
But the intestine has no such thing. It relies on bile and pancreatic juice to neutralize gastric acid. The gallbladder and pancreas are opened together in the intestine, and the fluids they secrete are alkaline.
However, there is a distance from the stomach to the opening of the pancreas. This distance is the place that is prone to cause ulcers, which is the famous duodenal ulcer.
If you do n’t eat on time, you ’ll have a hungry meal, and when you encounter a delicious meal, you will go to the wall. If you do n’t like it, you will lose weight.
These are the killers of duodenal ulcers.
The stomach is not so coquettish, you can eat more and eat less, generally it can deal with it. However, when you drink and get angry, it is afraid. The most feared is H. pylori.
Cancer, in short, is actually a qualitative change in the amount of cells under an inducing factor.
Any cell of the human body has the potential to become cancerous, and inflammation is the biggest inducing factor, so doctors have a saying that diseases are nothing more than two categories, either inflammation or cancer.
Helicobacter pylori, in China, this gadget is the biggest inducer of gastric cancer.
Some patients said that in my life I have never eaten barbecue, never drank alcohol, and never been angry, but how did I get stomach cancer?
Results A look at the previous medical report showed that H. pylori was positive!
Is this bacterium contagious? Infected, the Chinese people have a bad problem. When eating, especially for young children, the elderly love to feed their children chewed food.
The child eats any meal at any age, eats chyle food without milk, and drinks milk.
Let him chew on his own if you have teeth. There is no need to chew your child's mouth full of H. pylori!
In addition, in order to reflect his enthusiasm and politeness, he has to add food to the guests. If you put food in the dish, the other party will not eat it. Be sure to watch your eyes until the other party eats.
This is the transmission route of Helicobacter pylori, and gastric cancer in other countries is mostly caused by other factors.
Most gastric cancers in China are caused by H. pylori.
The surgical requirements for gastric cancer are actually similar to gastric ulcers, and may be slightly more difficult than gastric ulcers.
Many people feel that gastric ulcers don't matter. To be honest, they usually don't pay attention. Once ulcers appear, it is super troublesome. Sometimes I do n’t have the chance to do surgery. Even if it is surgery, it is a super operation.
Stomach ulcer surgery and gastric cancer surgery are regarded as high-level operations.
For example, for refractory gastric ulcers, once surgery is performed, the stomach is generally chosen in China. What does it mean? It cuts the stomach for most of you, and it almost becomes the existence of the esophagus and intestine. .
You can think about the horror of eating a white bun, swallowing it, and swallowing it directly into stool. What's more terrible is, if you swallow half and then spit it out, what should you do?
Looking around the world, stomach cancer is quite high in countries that ca n’t finish eating more fish, such as Maruko and Iceland.
Although Maruko is a weird country, let alone Icelandic ratio in gastric cancer. Even in the world, their technology is the boss and their hands are familiar, but Iceland is not familiar with them.
Maruko stomach cancer is done well, then the endoscope is also great. If you think about it, this country is very good at making dojos in this spiral lion shell, and the trick is very powerful.
People change people's hearts, and people's feelings change. The head nurse looked at the two cigarettes and two bottles of wine in her hand and complained to her husband: "Why do you think everyone is the same as us! Our Zhangyuan is different."
Zhang Fan did not hear this, because he had taken Ma Yichen, Zhao Quanping, and Lao Song into the operating room. If he heard this, he would be proud for a while.
The difficulty of gastric cancer surgery is not the removal of tumors. The stomach is not like the liver. The liver is like a honeycomb. There are various vascular pathways in it.
The stomach is a fleshy skin bag. The blood supply is ligated and cut. The difficulty lies in the suture and lymphatic dissection after removal.
In the operating room, Ma Yichen was preparing before the operation. The young man was suffering. When Zhang Fan was fighting the liver, he was also fighting the liver. The technology has improved very quickly, and now it has a bit of a headshot outside the general public.
"Zhang Yuan and Director Zhao, brush your hands!" Said the anesthesiologist to Zhang Fan.
"Okay!" Zhang Fan answered, and brushed his hands with Lao Zhao. Lao Zhao has been very comfortable in recent days.
Because several deputy directors did not rebel, they were all frightened by Zhang Fan. He didn't say high technology, and he was so capable. He was syncope, and it is estimated that there was no one.
At the beginning of the surgery, Zhang Fan was the first knife, Lao Zhao Yizhu, and Ma Yichen was originally a third assistant, also known as a hook, but he did not know how he had privately exchanged with Lao Song. Now Lao Song became a third assistant and he became a second assistant.
This kind of thing, Zhang Fan is hard to say, can only rely on whether he knows.
For resection of tumors, the blood vessel and stomach blood vessel are ligated first, which can be said to be divided into two large parts.
What is the shape of the stomach? In fact, it is crescent, long and thin people. The size of the stomach is thin crescent, and most people with short stomachs have fatty crescents.
The inside of the crescent is called a small gastric curve, and the outside of the crescent is called a large gastric curve. The small curved blood supply comes from the abdominal trunk hidden under the stomach. This thing is the thickest blood vessel in the abdomen, which is the main trunk from the heart.
The large curved blood supply comes from the splenic artery on the edge of the stomach.
The old woman's stomach cancer had not yet penetrated the body, but the area was too large, so Zhang Fan decided to perform a total gastric resection.
In other words, Zhang Fan dared to do it. There is a saying in cancer that the old, the weak and the disabled cannot do it, and they usually choose palliative care.
It means you can live for a few days! Not the doctor's cruelty, but the fear of the patient dying on the operating table.
Into the abdomen, stretched out, Zhang Fan began to ligate the blood vessels, and with the click of the metal of the pliers, the blood vessels were clamped by Zhang Fan.
The only thing that is a bit troublesome is that the blood vessels with large curved stomachs are all wearing yellow coats, which are all hidden inside the omentum.
What is the omentum, yellow fat, it is opaque, not stockings. "It's important to note here that no matter how confident you are, you must see it with your own hands before you can touch it with your own hands."
While Zhang Fan was doing it, she told Ma Yichen the point.
"Yeah!" Ma Yichen listened very carefully.
Passer-by Dr. Lao Song, envious of death, he had nothing to do and could not do, because he could not see the surgical field. This operation was performed with his hands, without using his brain.
"Hey, my horse is so good. I met such a good teacher! How good it would be if I had such a teacher to teach me."
Lao Song was young but embarrassed. He was seven or eight years younger than the deputy directors. When he entered the department, it was just when the deputy directors were rushing to practice their hands.
Therefore, he can be regarded as an appendix for many years. At the age of long technology, there is no chance, and the upper limit is not high.
The blood vessels were ligated and the ligaments hanging from the stomach were separated. Most of the abdominal organs were fixed with ligaments.
Without this ligament, a person cannot do strenuous exercise, or else the undulations, the kidneys may fall out of the urethra ...
After separation, he clamped the esophagus and intestine connecting the stomach body, "knife!" Zhang Fan said to the equipment nurse.
The scalpel, Zhang Fan holding the scalpel, cut the stomach directly from the esophagus and intestine along the edge of the forceps. Then Zhang Fan took a look with both hands and took the stomach out of the abdominal cavity like holding a watermelon.
At this time, looking out from the shadowless lamp, the abdominal cavity became a large hole, and the solitary spleen on the right and the large blood vessels below it all showed up.
Zhang Fan's general level can no longer be underestimated. If the surgical field is described by an adjective, it is clean! Yes, it's clean.
You can hardly see any blood stains, just like moving a knife on a rubber doll. This is level.
Some doctors don't pay attention to small blood vessels, but more small blood vessels are large blood vessels. After an operation, it is like a broken tomato sauce bottle. Regardless of the patient, even himself is stained with a red ball.
In this regard, he was proud of himself! I have surgery! I didn't know he thought he killed a pig.
Lao Zhao, admiring Zhang Fan's level very much, took out his free time in Zhang Fan.
He said: "Zhang Yuan's surgery is like art, and the cleanliness of this field is perfect."
However, I didn't talk much, because the difficulty of the operation came, and the cancer surgery was difficult. Where is the difficulty? Lymphatic dissection.
It can be said that the lymph is like yellow sesame sprinkled near the blood vessels. In many cases, seven or eight dozens gather together, and in young cases three or four.
Cancer surgery is all about cleanliness, because many of the cancer's metastases are lymphatics.
Lymphatics must be cleared if the patient is to live longer. These things are hidden in fat.
Besides hiding in the fat, it also relies on blood vessels to sweep the lymph, which is not only slow but also dangerous.
This thing is lying on the big blood vessels or hiding near the big blood vessels.
It may not be dangerous to pick with a needle during cleaning, but it is estimated that after the needle is picked, the patient also hangs because it takes too long.
Just use a spatula, an enlarged ear spoon, and scrape along the large blood vessel.
It ’s more dangerous. Let ’s say that, let alone a large blood vessel like the abdominal cavity, a smaller abdominal artery is a life-threatening.
This kind of artery is like a snake head. Once broken, it will nourish the blood, and its powerful muscles will retract, which is particularly difficult to serve.
Zhang Fan began to dig around the celiac trunk with a curette.
This force must be quite stable, it cannot be scraped off lightly, it cannot be cleaned, and the operation is done in vain. If it is heavy, the blood vessels will be scraped and the operation will be as white.
Zhang Fan scraped very quickly. The patient was too old, and she couldn't hold it for too long. Zhang Fan must be fast.
Wow!
Wow!
Zhang Fan scraped it down just as fast as a chubby fat man digging ice cream.
Not to mention Ma Yichen, Lao Zhao had his hands fists. Too scary. The metal curette is visible to the naked eye to do things on the thick abdominal cavity, and Zhang Fan is faster than it is.
Lao Zhao, who had come down in cold sweat, couldn't help looking at Zhang Fan. Although he was very concerned about seeing Zhang Fan's expression, he was still worried.
Because Zhang Fan's operation is too fast, he has never seen anyone with such a fast method.
He wanted to persuade, but watching Zhang Fan on the abdominal cavity, he was afraid to say.
He was very afraid of disturbing Zhang Fan.
"It's terrible, it's terrible!" Old Zhao's hands shook a little.
As the second assistant, Ma Yichen was excited.
He shouted in his heart, "This is called technology, this is called technology, handsome!"
The newborn calf is not afraid of tigers. Although he knows the danger of surgery, Zhang Fan's hand is too handsome.
"I don't know when I can learn this hand!"
Zhang Fan's hand is too stable.
After cleaning the lymph, inside the curved plate, such as ice cream with strawberry juice added to the same plate of yellow cream, even small particles on the surface of the strawberry, red is blood, and small particles are lymph, which is too TM.
After cleaning, Zhang Fan confirmed again, and then started suture again. What was sutured?
Suture the esophagus and sew the esophagus to the small intestine.
The esophagus has no coat, because it is not like the intestine, it must squeeze together and move, so it has no serosa.
The esophagus does not move, so what to clean up the residue of the esophagus depends on saliva. Some people like to spit on nothing, don't vomit, and then vomit, the esophagus is sick.
Without this coat, it is very troublesome to sew, directly on the exposed muscles.
At this time, the muscles are like the wires without the insulation tube, and the wires inside are loose.
This suture is not good for doctors, let alone esophageal suture in the intestine, don't chop the esophagus.
"Line 0! Open the imported absorbable line." Zhang Fan said nonsense to the instrument.
This line is more expensive than domestic imports by a factor of ten, but this line is really easy to use.
The stitches are layer by layer, and the thread ends are flying in Zhang Fan's surgery. The esophagus and intestine are sutured too beautifully. It is as if it had been grown together, and it is not obvious that it is secondary stitching.
After the suture, the raised duodenum must be fixed because the stomach is missing if the duodenum is not fixed.
What a terrible thing, maybe a shout, pulled together, the intestine was broken, and then spit out a section of hula rubbing intestine.
Six hours later, Zhang Fan and them finally ended the total gastrectomy. After the suture closed the abdominal cavity, the matter was not over yet, Zhang Fan took a knife and tried to strike the cut stomach.
At this time, because of the lack of blood and the loss of temperature, the fat on the surface of the stomach has become fat. If it is hot, it will be like a French meal, pork belly and foie gras.
Open the appetizer, the tumor inside is exposed, as terrible as the heterosexual insect nest in the movie, the surface is blood vessels, and the inside is rotting like yellow thick sputum.
"After taking the family to see the same, do a medical examination!"
"it is good."
(End of this chapter)