Today's right hemihepatectomy for liver cancer is a fourth-level surgery, which is very difficult and extremely difficult to do.The liver after severe sclerosis is like the touch of the forehead scalp and bones, which is what the medical and surgical teachers have said in their lectures.But the liver under Li Min's hand not only has such hardness, but also can feel nodules of different sizes.It felt like touching the ping-pong ball hidden underneath the thin quilt and countless glass balls of different sizes mixed in the middle.The voids of these spheres, in addition to hardened fibrous tissue, are healthy liver cells."
I remember that.It's not just a hard forehead. ”Director Li reminded Li Min."
Well, I remember."
Li Min nodded."
It's very different from the normal liver sewn that night, right??"
Director Liang poured out the void and would also teach Li Min a few words.Unfortunately, in today's surgery, there are not many such opportunities."
It's huge.Its liver is very soft.Really like lips. ”Li Min understood that Director Liang was asking about the ruptured liver and spleen of Xie Xun's main surgeon on a rainy night, but what she immediately thought of was Mu Jie's lips, which were warm, soft, and slightly dry.But Director Liang followed and wiped her sweat, which made her immediately retract her association.Director Liang turned his head and called the nurse, and the nurse who patrolled the station hurriedly took gauze to wipe his sweat.…… After this operation opened the abdominal cavity, it began to make Director Liang taste great.It also allowed Li Min to accumulate the patient's coagulation time and other conditions that are most likely to occur in the surgical wound when the patient's coagulation time is at the lower threshold: bleeding and oozing.This is the result of the treatment of the patient with platelet transfusions before surgery and supportive therapy to improve his general condition.The results that can be achieved are too small, and they are very different from the minimum expectations in Director Liang's mind.But no matter what, the tiny blood vessels of the surgical wound must be properly handled, otherwise the bleeding of a single wound will turn the entire surgical field into a red piece and drag the blood pressure down.The portal hypertension that occurs with the change of liver structure in cirrhosis also leads to an increase in the fragility of blood vessels and a disorder of intrahepatic vascular structure, which doubles the difficulty of this operation, which requires ligation of many blood vessels and liver tubes.The process of separating the right half of the liver from the initial and upward turning of the liver has many bleeding points, which consumes a lot of time and energy for Director Liang.But he only sat for a while before he stood up and said, "Lao Li, you rest, I'll keep coming." ”"Okay."
Director Li went down to rest.Li Min took advantage of the exchange between the two of them to move his steps slightly, moving his stiff legs.The faint backache and the throbbing pain in the lower abdomen made her understand that her cycle had arrived, and the preparation before the operation did not seem to be useless.Her job now is similar to that of Xie Xun that night when he had a segmentectomy.Holding the small bend and suction device, the thread scissors are also hung on the fingers, first to ensure that the surgical field is clear, then follow the operation process of the two directors on the hemostat, and finally cut the sutures after the director sutures and ligates the blood vessels.When the three of them were on stage, Director Li would pull the hook with one hand, but now there are only two people left, and they have to rely entirely on automatic hooking.To tell the truth, the exposure of the field is not good.It's not a job that two of them can do.Director Zhou timely suggested, "It would be nice to have an intern student." ”Director Li occupied his round stool and answered his proposal very consciously and in a timely manner: "Borrow one of the undergraduates who graduated from your department this year to pull the hook." ”Director Zhou hurriedly begged for mercy: "It's me who is too talkative."
Lao Li, don't be like me. ”Just kidding, can such a liver resection be casually pulled on stage?
Director Li smiled and let Director Zhou go.But he only rested for ten minutes, and then stood on the operating table again.The three of them worked together, and Shuye immediately became brighter, and Director Liang's movements also sped up a little.
*"I still don't have to do liver surgery." ”Director Liang laughed at himself."
You're already good.Blame yourself for what you do. ”Director Li understands Lao Liang too well.He's not the kind of good guy who smiles on the surface.Just like himself now, in order for his wife and children to live a stable life, he hid his former fortitude and persistence in the depths of his heart.lest the old wife remind me every day not to remember to eat or fight.Director Liang knocked on Director Li's hook, "Lao Li, a little further back, it's not exposed enough." ”Director Li immediately straightened the position of the hook and slapped himself twice in his heart, he was getting old, and he was still distracted on the operating table thinking about these messes.Fortunately, the first step of removing the gallbladder, inserting a T-shaped tube using the stump of the cystic duct, and performing a choledochostomy was generally successful.…… Director Liang asked Li Min while working, "Where are we here?"
”"Expose the first liver gate.""
This?""
Gallbladder artery."
After separating, ligating, and cutting off the right hepatic canal and the right hepatic artery, the right branch of the portal vein made Director Liang stop his movements."
Lao Li, be his liver alone, catch up with two.M, this position is so deep, the blood vessels are so brittle, ""The venous pressure is still great.However," Director Li leisurely continued: "Do you have a choice?"
The patient's medical unit is in the provincial doctor, and he is hospitalized in the general surgery department, and the final operation will have to be transferred to you for the next operation.Xie Xun is not qualified enough to do this kind of liver cancer resection now, Lao Cheng can't stand up, and the rest are not as good as them.The provincial court is up to you. ”Director Li was excited."
Xiao Li, what should I do?"
Director Liang asked Li Min."
Operatively speaking, in such a situation, the right branch of the portal vein can be ligated first, and it will not be severed for the time being.Wait for the right hemiliver to be completely separated before processing. ”Director Zhou laughed at Director Liang: "Old Liang, did you bring Xiao Li to the stage so that she could endorse you?"
Do you want me to get this surgery to read to you here?
”"Don't say it, when I was first sent to the commune hospital, I met them who had an acute abdomen, a stomach perforation for a day, and the person was in shock, and had to have emergency surgery.There are really people who are holding a book on the side and reading the surgical procedures to the surgeon. ”"Oh, isn't that a chance to stand up for you?"
Director Zhou exclaimed exaggeratedly."
That's not it.Otherwise, how will you and I live well in the following days?
It's not me who blows, except for me, the county hospital can do every head-to-toe operation that dares to say it.When I first went down, my third child was only a few months old, and her mother returned to milk in a fire, and she was all fed by eating hundreds of milk.Xiao Li, what side injuries should we pay attention to avoid in this piece?
”"The short veins of the liver and the blood vessels of the right adrenal gland.When lifting the right liver, avoid tearing the short hepatic vein and the right adrenal vein that drains into the inferior vena cava. ”Director Liang is really willing to teach Li Min for being able to hold the position of an assistant and let himself and Lao Li take turns to rest.Director Zhou saw that Director Liang was focusing on teaching, so he stopped gagging.…… After the right posterior lobe of the liver turned to the left side, Director Liang asked Li Min to come around and pick up the surgeon, and instructed her to carefully separate and cut the residual part of the posterior layer of the coronary ligament of the right liver and the liver-kidney ligament.Being able to go around the operating table for most of the time, Li Min felt a lot more relaxed all of a sudden.And Director Zhou pinched a sweat - this old Liang dared to let go.Li Min was very excited, and handled the small blood vessels in the surgical field more carefully."
Why don't you use electrocoagulation here?""
I'm worried about rebleeding from the electrocoagulation site after surgery.Or ligation is relieved. ”Li Min fluttered the residual thread in his hand, and the rubber gloves dipped in blood were particularly sticky when they were not dry.She tugged on a piece of wet gauze to wipe off her gloves, reached out and shouted to the nurse, "No. 0 pliers with wire, ligation." ”The branches of the short hepatic veins are very small, not to mention the thin walls of the blood vessels.In accordance with the requirements of surgery, Li Min tried his best to ligate the blood vessels on the parenchyma side of the liver, away from the inferior vena cava.After she dealt with the branch of the short hepatic vein, she tried her best to calm down the position of the first assistant she walked back to, looked at Director Liang's severed short hepatic vein and inferior vena cava, and sewed a stump of the inferior vena cava.The surgery moves forward slowly.It's very solid every step of the way.The separation of the second hilum was very smooth, and the right hepatic vein was also very well exposed.Even so, Director Liang also took a prudent approach and separated and ligated the right hepatic vein in the parenchyma of the right lobe.Director Li looked at the difference between the right liver that began to change color in the field and the liver he wanted to keep, and exhaled deeply.He said to Director Liang with appreciation: "Your surgery today is steady and steady, with less bleeding, and you have done a good job." ”"I think so myself.It's more stable to be slower, and in the end, it not only saves a lot of work, but also makes it faster overall. ”Director Liang stinks."
Xiao Li, how about we specialize in liver in the future?"
Li Min looked at the stark contrast between the right half of the liver, which had become gray due to ischemia, and the liver he wanted to preserve, and avoided answering Director Liang's question, and asked the next step: "Do you use your hand or the handle of the knife?"
”"Handle it."
The nurse immediately hit the handle of a scalpel with a sharp blade into Director Liang's palm.Director Li took out the hook, adjusted the position of the automatic hook, and did not forget to remind Director Liang."
Slow down."
Director Liang nodded and cut open the liver capsule, and Li Min followed Director Li to the hemostat to clamp the small blood vessels and liver ducts in the liver parenchyma.When the discolored right half of the liver was severed, the three of them let out a long breath.M's, although the operation went well, I was still very nervous just now.Director Li and Director Liang began to check the treatment of blood vessels and liver ducts in the liver section.Li Min retracted his hand, retracted his shoulders slightly, relaxed his tense back, and then slowly supported his body alternately with his left and right feet, soothing his stiff legs, but suddenly he felt a hot current flickering under his body, God, this time the amount is not small.Thankfully, the surgery was in its final stages."
Xiao Li, you come and fix the sickle ligament and round liver ligament that you just severed in place."
After checking with Director Li, there were no small blood vessels and small bile ducts, and the wound was covered with omentum, and he clapped his hands and stepped down to grab Director Zhou's round stool."
Lao Liang, you are embarrassed to sit by yourself.Lao Li is still standing on the stage. ”Director Zhou teased him.Director Liang sat on the round stool and stretched his legs, and shot back with a disdainful face: "What do you know?
I'll rest for two minutes, and the rest won't have to work hard for Lao Li. ”Sure enough, after Li Min fixed the two ligaments, Director Liang came back, and Director Li took off his gloves and stepped down.Director Liang watched Li Min programmatically handle the subsequent abdominal closure steps, and the operation ended smoothly."
Don't move the gauze.I'm going to use it. ”Li Min stopped Xu Li and exchanged glances that both of them understood.Xu Li hurriedly reached out to help Li Min untie the straps of the surgical gown, Li Min hurriedly took off his gloves and took off his robe, grabbed the stack of gauze and rushed out.Director Li and Director Liang were stunned, what happened to Xiao Li today?
It doesn't even matter if the patient is out of bed.※※※※※※※※※※※※※※※※※※※※ life is a hundred states here + one * for 7 consecutive days, three days, and the second day () is a little far away