blenderwars Chapter 373
Chapter 373
Chapter 373
On the podium, Lin Feng gave the surgical information and said:
“The hospital has prepared a small intestine donor for the patient. It is a terminal patient with brain cancer. He knows that the operation is hopeless, and he voluntarily signed an organ donation letter…Thank you to this patient…”
“Donors are usually given immunosuppressive agents, such as cyclosporine A (CsA), FK506, etc., before surgery. Laxatives and antibiotics are used to remove intestinal contents, and heparin is injected to prevent blood clotting during surgery. symptom.”
“As for the recipients, they must also receive immunosuppressive therapy before the operation, inject prophylactic broad-spectrum antibiotics intravenously before the operation, and give a large dose of methylprednil after the operation…”
“The intravenous dose is three times that of oral preparations, ATG, OKTs, Snapdragon, Zenapax, etc…”
…
Apart from Lin Feng’s voice in the meeting room, there is only the sound of the pen tip running fast on the paper.
“Zero Fifty Seven” everyone is like a long drought and meets the rain, greedily absorbing Lin Feng’s clinical experience.
Extremely responsible, obscure medical knowledge, in front of Lin Feng like a few treasures.
What kind of man is the most attractive, he is naturally knowledgeable.
Conquer not only female interns, but also male interns.
I couldn’t understand it anyway, so I put all my attention on Lin Feng.
Two hours later, Lin Feng concluded the case study.
“Next, we will carry out the actual operation. I will take the initiative. The two regular doctors in the gastrointestinal surgery department will be the first and second assistants, and the attending doctor will be on the sidelines.”
…
…
10 minutes later,
Operating room,
All interns, 12, were transferred to the operating room.
·Surgery: Allogeneic small bowel transplantation
· Chief Sword: Lin Feng
·Onlookers: all interns in gastrointestinal surgery + video recording·
…
The first step of the operation,
Take out the small intestine from the donor…
First general anesthesia,
Then disinfect the towel…
Because the donor suffered brain death (also regarded as death), but the physical function happened to be still there, it brought great convenience to the transplantation.
“Scalpel!”
The sharp blade makes a large cross-shaped incision in the patient’s abdominal wall.
Open abdomen…
Exposing the entire abdominal cavity in the field of vision, Lin Feng immediately poured a large amount of sterile crushed ice into the patient’s abdominal cavity.
Separate the upper abdominal aorta from the bifurcation of the iliac artery, quickly ligate the lower end, insert a catheter, and infuse 100ml of Ringer’s solution at 4 degrees Celsius.
After the pressure in the abdominal artery is 120cmH2O, the UW fluid is infused immediately.
The abdominal aorta was ligated and blocked under the patient’s diaphragm, and the perfusate was injected retrogradely into the superior mesenteric artery.
Cut the posterior peritoneum along the right colon and the left paracolonic groove.
The palm of his hand leaned into the abdominal cavity, and he lifted the entire intestines, spleen, pancreas, duodenum, and stomach together.
In this scene, Lin Feng abruptly pulled out almost all the organs in the donor’s abdominal cavity with one hand!
It’s exciting just thinking about it!
“Clamp!”
Lin Feng clamped the patient’s hilar duodenal ligament with forceps and then cut it off.
The clamp cuts off the renal blood vessels on both sides, followed by the aorta above and below the upper mesenteric artery segment and the inferior vena cava.
The duodenum under the pylorus and the ileum of the donor were sealed with a vascular clamp and cut off.
After taking out the entire small intestine, spleen, pancreas and other organs in turn, soak them in CUW solution at 4 degrees Celsius.
Insert the catheter again into the aortic segment and infuse 1000ml UW solution.
In just two minutes, Lin Feng completed the lavage of the donor mesenteric vascular bed.
The excised small intestine donor is transferred to the operating room where the recipient is located.
This paragraph,
Lin Feng’s operation is very slow, deliberately slowed down three or four times.
At the same time with explanation…
All interns: experience+100+100+100+100……
…
at this time,
When it comes to the second step of the operation,
The recipient patient is opened, and the failing small intestine is removed and replaced with the donor’s small intestine.
Lin Feng quickly took the cold and warm small intestine,
Transfer to the recipient operating room.
As for the donor, other doctors in gastrointestinal surgery will take over…
Because the donor’s cold ischemia is time-dependent, once it exceeds, the donor loses its original effect.
at this time,
The recipient has already completed general anesthesia.
Lin Feng washed his hands again, put on surgical coats, hats, gloves…
Before stepping on the operating table
“Scalpel!”
Lin Feng raised the knife in his hand and made an incision in the center of the patient’s abdomen.
The scalpel glowing with a little cold light quickly removed the patient’s intestines.
Lift the patient’s entire pancreas and duodenum inward.
Lin Feng was undergoing surgery,
While explaining…
“The donor intestine is the first choice for small bowel transplantation. It can be used for whole small bowel transplantation. In patients without colon disease, the ileocecal, cecum, ascending colon, and more colons can be transplanted together with the small intestine, which is conducive to postoperative fluid removal. Absorption reduces the rejection of allograft, and the relative risk of bacterial translocation and infection also increases by 0 ……..”
“Arterial catheterization is used to infuse 1800ml of plasma at 4 degrees Celsius! (Avoid sudden hypovolemia.)”
The donor was implanted, and the vascular anastomosis was continuously turned outwards and anastomosed with a 5-0 polymer thread.
“Usually the second-stage transplantation can be completed. In the first-stage operation, the arteries and veins are anastomosed first, and the two stumps of the donor intestine are temporarily externalized, which is conducive to observation and experimental research. Anastomosis with the recipient’s intestines completes the transplant.”
While Lin Feng was explaining, he had already started the anastomosis of the recipient’s small intestine.
Intern in Gastrointestinal Surgery,
Hearing mesmerized…
30 minutes……
40 minutes……
The anastomosis is complete…
The next step is to rinse, disinfect and sterilize…
“Intravenous injection of immunosuppressants cyclosporine A and azathioprine, and adrenal cortex hormones!” (After bowel transplantation, there is a higher incidence of intestinal bacterial translocation, and a large number of immune preparations can play a preventive role.)
“Glutamine is poured into the intestine to promote the recovery of the intestinal mucosa!”
50 minutes……
60 minutes……
70 minutes…
Lin Feng did it very carefully…
…
At 80 minutes, Lin Feng was basically rinsed and disinfected at 2.3…
Explain and do it at the same time,
Under the imperceptible influence of skills passed down from generation to generation, many interns in gastrointestinal surgery have entered a peculiar state.
It is as if it is not Lin Feng who is in the main surgery position, but himself.
I feel very rewarded!
The operation is here,
It’s basically over!
Suture the incision layer by layer.
The operation is over.
…
After leaving the operating room, everyone returned to the conference room again.
“Next, I will answer your questions, and if you have any questions, just ask.”
Lin Feng took a sip of water and said.
“The postoperative complications of small bowel transplantation are not recorded in detail in the books.” A female intern stood up and asked.
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ps: Three shifts are over!
. .