But the posterior branch of the gallbladder artery enters the gallbladder just below the cystic duct.Although this branch blood vessel is small, it is too thin to say that it is as thin as a hair.Anyway, it's a textbook-famous arteriole.If Xie Xun's operation just now was a little rougher, the posterior branch of the gallbladder artery would be able to bleed immediately, giving him a little color.Let him know what else is the most popular besides flowers.Xie Xun dealt with the posterior branch of the gallbladder artery without suspense, and Director Liang, who was worried about him, rubbed his hands on the hand wash clothes several times.Having treated the cystic duct and the posterior branch of the gallbladder artery, now it is enough to peel the gallbladder away from the gallbladder bed.During the process of stripping the gallbladder, he was careful not to rupture the gallbladder or damage the liver capsule.The operation went according to Xie Xun's expectations.He used his feet to precisely control the timing of the electric scissors to turn on the electricity, which was the key to the whole operation to determine whether there was a mistake or not.If the hands and feet are well coordinated, there will be no bad shear.He operates electric scissors with one hand and hemostatic forceps with the other.Since it was also the first time that Xiao Chen, the hospitalized director, had this kind of difficult gallbladder surgery, he had to remind Xiao Chen from time to time to pay attention to holding the laparoscope, and not to look at the screen and forget the movements of his hands that caused the laparoscope to deviate.But he was cautious and raised his vigilance to 120 percent, or when the gallbladder was about to leave completely, he cut the gallbladder wall.The gallbladder ruptures, and bile is left behind.Xie Xun controlled the hemostat with his other hand to clamp the gauze and immediately pressed it on the rupture.Fortunately, there is not much bile in the gallbladder, and after repeated several times, the remaining bile is absorbed.Falling short.Regret climbed between Xie Xun's eyebrows.The front is so difficult that it is perfectly done.As a result, in the relatively easy closing stage of the victory, he broke the gallbladder wall......
"Xiao Xie," Director Liang reminded him in time: "There is still a little left, be careful not to damage the liver capsule." ”"Yes."
Xie Xun put away his regrets and continued the operation.The entire gallbladder is completely free, and the liver capsule is not damaged.Xie Xun changed the electrocoagulation rod, carefully treated the wound of the gallbladder bed, cauterized the capillaries that were oozing blood from the gallbladder bed, and checked that there was no bleeding and bile leakage, and the operation was over."
Dirt bag."
The stripped gallbladder was placed in a dirt bag and removed, and Xie Xun placed a drainage tube under the liver.The surgery is done.Xie Xun stepped down.The finishing touches were handed over to his assistant, Dr.
Chen.* This operation is Xie Xun's self-assessment, and the imperfection of the gallbladder wall makes his face less relaxed and more reflective.He folded his elbows and landed on one leg, his shoulders resting against the wall to support him.He neither took off his surgical gown nor spoke, but only looked directly at the operating table and looked at Dr.
Chen, the chief resident who led the intern to pass the patient's bed.Director Liang waited for the patient to push him out, then walked to his side, patted Xie Xun on the shoulder, and praised loudly: "Good, well done."
Conventional surgery to remove the gallbladder, not to mention the length of hospitalization of the patient after surgery, and the trauma of the operation alone, cannot be compared with laparoscopic surgery. ”"Director," Xie Xun said regretfully and embarrassedly, "If the gallbladder is not broken, it will be perfect." ”"It's not what you think.It's like what it means if you insist on learning laparoscopy.This gallbladder can't be 100% avoided by surgery under direct vision, and the rupture of the gallbladder wall can't be 100% avoided." ”Xie Xun was very aware of the moment when he had just broken his gallbladder.His eyes were looking at Xiao Chen for a while, but in his heart, he was repeating the actions before that moment one by one.Director Liang smiled, others may not care about this mistake, but Xie Xun, I don't want him to be unable to think about it, and he can't get over it at this point."
Xiao Xie, I think this has something to do with your case selection.What happens if this is an acute simple cholecystitis patient with no adhesions around the gallbladder that are as dense as the adhesions?
”Xie Xun took a deep breath and replied: "The operation time can be shortened by more than half."
But if you are negligent, there is still a possibility of breaking the gallbladder wall......."
Yes, once the gallbladder is enlarged, if there is a lot of bile in it, even if it is flushed, although the possibility of causing biliary peritonitis is relatively small, it will also increase the burden on the patient's body after surgery."
That's what Xie Xun doesn't want to see."
It's good that you know.Eat a trench and grow a wisdom.This gallbladder triangle, gallbladder, and liver have dense adhesions, and the operation is difficult, but the advantage is that it can remind you to pay attention, but it is also the easiest to let your guard down when you are over.You say, don't you?
”Director Liang reminded Xie Xun earnestly."
Yes."
Xie Xun nodded in acknowledgement.Didn't I just go through all the difficulties, and on the eve of the final success, my spirit relaxed a little bit, which led to more electric scissors......
"gallbladder, that's a pit."
The bottomless pit, I don't know how many heroes have been buried. ”Director Liang sighed.Then he warmly greeted the anesthesiologist and others and said, "I have a treat at noon today, Sihai Restaurant, you are all here." ”The patrol nurses, instrument nurses, and anesthesiologists who were cleaning the operating room all cheered for him with Director Liang."
Okay, I'll go."
Thank you, Director Liang.After they finished cheering, Director Liang said to Xie Xun again: "Your imperfection today is enough to remind you to be careful in the future."
Let's go, I'll give you a celebration at noon.Congratulations on opening up a new surgical approach to gallbladder removal. ”"Thank you, Director."
Xie Xun was moved by Director Liang's heartfelt care and encouragement, he tried to land on the leg that controlled the pedal switch just now, and felt that the stiffness of the leg muscles had eased a little, and then slowly moved his steps and left the operating room behind Director Liang.
*Director Shi took Pan Zhishang's anastomotic fistula two weeks after surgery for esophageal cancer, but it was about the same as he estimated before the operation.The fistula, as seen on bronchoscopy, occurs near the left main bronchial bifurcation of the membranous region.The only thing to be thankful for is that the fistula is still small.However, current statistics show that the mortality rate of such anastomotic leaks is more than 99%, regardless of whether it is active surgical treatment or conservative treatment.The most important point is that such postoperative non-union accounts for more than 2%.Director Shi's face was serious, and no one dared to pant loudly in the entire operating room.Pan Zhi asked him in a low voice, "Repair?"
Or is it a fistula?
”"The results are all about the same.""
So what do we do?""
Let's fix it with the stomach lining first."
This is the operation of a dead horse as a live horse doctor, but Director Shi is still meticulous in repairing it.Director Zhou of the anesthesiology department came over, looked at his serious appearance and said, "Lao Shi, you have done more than 100 cases of lung cancer and esophageal cancer, and according to the proportion, you should encounter such a helpless thing." ”"I'm not going to be lucky.If it can appear later, the cardiothoracic surgery brand of our provincial hospital will be able to stand up a little better. ”"You can rest assured.This kind of thing is all probability.In a hospital that can do esophageal cancer above the second grade, as long as the cumulative number of cases is enough, you must be the main surgeon with the least complications. ”Director Shi couldn't count it, but Director Zhou's comfort still eased his emotions.After getting off the operating table, he instructed Pan Zhi: "Give him sensitive antibiotics to fight infection."
Supportive care is sufficient. ”"Give him fat milk?""
Yes.Let's take a look at it for a week. ”Pan Zhi went to the doctor's order according to Director Shi's instructions, and the anesthesiologist looked at Pan Zhi, who had forcibly occupied his small table, and said, "Why do you just give gentamicin?"
Why don't you have to be better. ”"I did a bacterial culture the day before yesterday, and gentamicin was the most sensitive."
The anesthesiologist was stunned for a moment, smiled and gave himself a round, and said, "This is too good at saving money!"
At least use a Vanguard V.
Vanguard VI. ”"He didn't save at all, even a week's worth of fat milk, how much money do you count?
If he heals well after surgery and does not have a fistula, then he will really save money. ”When he was taking a shower in the shower, Pan Zhi's intern quietly asked him: "Mr.
Pan, is this related to his postoperative nutrition?"
”The two □□ under a shower head, Pan Zhi wiped a handful of water from his face, and replied to him angrily: "Don't talk nonsense." ”After finishing speaking, he felt that he was too harsh, twisted the towel and let out the shower head and said: "Some people's skin and flesh are cut through a small opening, and they will grow the next day."
But some people may be infected, and it takes three to five days to get better. ”The showers on the left and right were full of doctors who had undergone surgery and were taking showers, and the interns closed their mouths very blindly.* Li Min slept for an hour and woke up naturally, and when she saw that the time was not yet five o'clock, she went to the twelfth floor to see patients whose conditions and doctor's orders had changed today.Not much has changed, and after walking around, she spends less time.Passing by the director's office, I saw Director Liang, Chen Wenqiang, and Director Shi chatting.She walked in and greeted Director Liang first: "Grandpa Liang is here." ”Grandpa Liang is the new title that Director Liang has recently received.He liked it very well that the young nurses called him that, and Li Min was as good as the little nurses.Director Liang nodded with a smile and asked her, "Xiao Li, how is your Mu Jie?"
”"He went to the railway hospital for a follow-up a few days ago, and the fracture was almost healed.""
Let him be careful, it's a weight-bearing foot, and it has to bear the weight of the body, which is different from a broken upper limb.""
Hmm.Thank you, Grandpa Liang. ”Chen Wenqiang looked at his watch and said, "I've been doing my rounds."
You two talk slowly. ”He stood up and was about to walk out, Li Min smiled at Director Liang and Director Shi, and prepared to leave after Chen Wenqiang.Director Liang said: "Lao Shi, you also have to do a ward round, I'll go back." ”Director Shi said, "Who is as good as you."
There's a Xie Xun in Corey, and he can do any job for you. ”"Why don't you say that I have taken care of everything for him."
Director Liang smiled and sneered at each other as he walked out."
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Be content."
Director Shi walked out behind Director Liang and said enviously, "I think your Xiao Chen is not bad." ”Director Liang stopped, turned around and glared at Director Shi and said, "Old Shi, you're almost fine."
Pan Zhi, I've given it to you, you still want to hollow out the general outside.If you see that you are no longer satisfied, you will change to the Buyi tribe (not relying on the feet). ”Director Shi didn't think it was wrong, and replied with a smile: "I want to ask for another person, but don't worry, I will never dig your Xiao Chen, really."
In two months, there will be new college students, and you have to let me pick two of the rotations last year. ”"Okay.Let's give Lao Chen one, how about it?
”"I'm afraid he won't want any of them."
Chen Wenqiang, who was in front of them, said: "The burn is going to be released, Lao Liang, Lao Shi, you two see who is suitable." ”Director Liang stopped Chen Wenqiang and said, "Lao Chen, Lao Shi, let Yang Yu burn, what do you two think?"
”Director Shi immediately said, "I think it's okay." ”Chen Wenqiang thought for a moment and replied to Director Liang: "Then you find an opportunity to reveal it to him."
Burns are a lot of work, and he has to be willing to do it.But at present, there is no specialist doctor with burns in our provincial hospital, he is a college student, and he is a veteran in the past, which is also a matter of pros and cons. ”Director Liang nodded and praised Chen Wenqiang for his thoughtfulness, then waved his hand at a few people and went back to the Department of General Surgery.Director Shi stopped Dr.
Yang after the ward round: "Old Yang, you come to my office." ”"What's the matter?
Old stone. ”There were only two of them in the office, and Dr.
Yang couldn't suppress the curiosity in his heart and asked."
Before the ward rounds just now, Dean Chen said that there should be a special person at the burn area, what do you think?""
You mean to let Xiaoyu go?"
Director Shi nodded."
It depends on what you and Xiaoyu mean.Dean Chen will not be reluctant. ”Dr.
Yang thought about it and said, "This is a good place."
We don't have a specialist doctor over there, so there is no harm in Xiaoyu in the past. ”"Burns are hard work.In the case of severe disease, within a few months, the patient does not see any effect.Usually it may be because there are no patients, well, you know. ”Director Shi reminded Dr.
Yang that the implication may be that there is little money."
We work in surgery, and that specialty is not hard.Even if it is an outpatient clinic, I dare not say that it is easy. ”Dr.
Yang pondered for a while and said, "I went to the burn department of the Affiliated Hospital of the Medical University, and I also had some plastic surgery.The plastic surgeons in Beijing and Shanghai were all born with burns in the past. ”Director Shi said with a smile: "If you think so, then let Xiaoyu and Li Min learn suture techniques as soon as possible."
That's one of the basics of plastic surgery. ”"Good.I'll talk to him when I get back tonight.But the two patients in the burn ward on the eleventh floor are now undergoing scar release surgery, and when he passes by the end of July, there will be nothing to do, so what did he do in the past?
”"It's unfounded."
Director Shi smiled: "Dean Chen won't let him be idle and have nothing to do."
Besides, there is no separation between the upstairs and the downstairs.However, Lao Yang, let me remind you, your son is coming, you have to ......"
"Mmmm, I understand, I will be careful. ”Dr.
Yang didn't want to make his son lose face because of his mistakes.* After dinner, Mu Jie followed Li Min to the opposite door.His thoughts are very direct, Minmin and Yan Hong have a good relationship, and they must contribute to the good relationship between the two.Especially since his foot injury is almost healed, and he is about to return to the team, he can consolidate and strengthen the relationship with the opposite door and his wife, and he can't wait to put it in front of his busy procedures day and night.When the couple passed, Pan Zhi had not yet served the rice bowl, and he was coaxing his son to eat a bottle.However, Pan Jia has recently reached the growth stage of "making it dusk", and if he doesn't exercise his lung capacity at this time every day, he won't let everyone's ears be quiet."
Give me a hug.You go to eat. ”Mujay took Pan Jia.Pan Zhi knew that Mu Jie had good intentions, but his own son knew it.The child cried in the evening, and no one could hold or coax him.Even if Yan Hong hugged it, it was just a little quieter.Pan Zhi was reluctant to let his son cry, but he was also afraid that Yan Hong would be tired.So this Pan Jia cried for a while, and then went to his mother's arms to slow down, and then went to his father's arms to practice his voice.Yan Hong saw Pan Zhi holding the child hesitantly and refused to hand it to Mu Jie, so he said: "Whoever hugs is crying, let them practice first." ”Mu Jie took the child and held the child firmly in his arms with two big hands.Probably because his breath was too unfamiliar, Pan Baobao, who was grinning with his eyes closed, stopped crying.The little man opened his eyes and stared at Mu Jie, as if he wanted to see who was holding him, and seemed to be brewing an explosive octave.Li Min took advantage of his pause to stuff the bottle into his mouth and blocked his small mouth.Pan Zhi stared at it from afar and couldn't help feeling distressed, for fear that his son would be blocked by the pacifier and have reflexive vomiting.And Mu Jie stared at the baby's eyes close at hand, and whispered affectionately and gently: "Baby, eat and eat, eat as fast as you eat."
Eat, eat, eat.Baby, eat, eat, eat. ”Li Min glared at Mu Jie, this person was crazy!
actually wanted to perform hypnosis on a child less than two months old, where could Pan Jia understand what he was saying.What he didn't expect happened under Li Min's nose.Panjay closed her eyes and began to drink in Mujay's deep, magnetic voice.Pan Zhi breathed a sigh of relief and hurriedly picked up his rice bowl to eat.Sister Luo was relieved, Pan Jia could coax her day and night, but in the evening of the past few days, when the sun began to set, he began to cry, and he had to cry until it was completely dark.Now seeing that Mu Jie coaxed the child, she whispered to Pan Zhi and Yan Hong: "I didn't expect the baby to fall in love with Head Mu." ”Yan Hong pursed her lips and smiled: "The two children of the Dou family upstairs heard that Mu Jie was back, and they haven't heard a word for two months.I guess I'm afraid that he will become a mouse, and he will hear that the cat is coming. ”Pan Zhi said: "Children are sensitive, and they can best perceive who is dangerous and who is good to him." ”Li Min quietly teased Mu Jie: "Pan Baobao is afraid of you, so he doesn't dare to cry." ”Mu Jie shook his head and denied: "This kid is a bold man.I'm not afraid of my children, I haven't really seen a few. ”"Then I'll be a soldier with you when I grow up."
Pan Zhi joked."
Okay.It's also pretty good to go to military school.But you two have to watch him and don't be short-sighted. ”"It wasn't easy."
Yan Hong answered: "I wasn't myopic before I went to college, and I couldn't see the blackboard clearly after my sophomore year." ”"I was nearsighted before I went to college.At that time, I was in middle school in the county, and I didn't know eye hygiene or anything. ”Pan Zhi regretted his myopia."
If I hadn't been short-sighted, I would have applied to the military academy at that time."
Li Min also lamented a few regrets about his early myopia.Then she saw that Pan Jia was eating faster than usual, so she asked Yan Hong: "Is your son tired of crying, or is the amount of food rising?"
”"The amount of food has increased a little, but he has been crying for more than half an hour, and he is probably tired."
Before Pan Zhi and the others finished dinner, the villain ate all the 80ml milk in the bottle.Li Min took the bottle and put it on the table, stood up Pan Baobao and leaned on Mu Jie's shoulder, and gently burped him.Sister Luo finished eating first, and she came over and said, "Give me the baby, and I'll go and pee for him." ”Mu Jie handed the child to her.Yan Hong asked Li Min: "We want to go to Liu Na's house to see, will you go?"
”"Okay."
Li Min agreed to Yan Hong, turned to Mu Jie and said, "Don't go."
Upstairs and downstairs, the total amount of exercise adds up to exceedance. ”"Good.Then I'm going to go. ”* Li Min, Yan Hong and Pan Zhi went to Liu Na's house together.Pan Zhi saw that Gong Hai was no longer there, so he asked Sister Liu, who was busy in the inner and outer rooms: "Where is Gong Hai?"
”"He's working the night shift tonight.""
He didn't take maternity leave?""
Hmm.Their director Kehu said that it was not good to change shifts, and said that I would come over to take care of Dr.
Liu. ”Pan Zhi nodded and said, "Then I'll go back first."
You tell Liu Na that I won't go in to see her. ”"Okay."
The man was not there, Pan Zhi was not good at entering the confinement room, he left first, Yan Hong and Li Min asked Liu Na in the room what happened last night.Liu Na finished talking about the matter angrily, grabbed Yan Hong's hand and said gratefully: "Rainbow, thanks to you for helping me invite Sister Liu."
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Otherwise, I can't help it. ”Yan Hong said with a smile: "I have worked in obstetrics for so long, so I naturally have more experience in this area.You should have hired someone to serve the confinement child.Look at my house, Xiaoyan is here, my mother came the next day, and thanks to Sister Luo's help with the children. ”Liu Na nodded wildly: "It's not like that."
Liuliu also relied on Sister Liu to change his diaper and clean up.I've had three meconiums a day this day.I have to wash my ass every time I pull it, and I really feel sorry for me. ”"Then you can ask for a few more days, please wait until the full moon."
Li Min persuaded Liu Na."
Well, I told Sister Liu to ask her to help until the full moon.Rainbow, where are you?
”"Pan Zhi's family gave money, so I will keep Sister Luo for one more month."
Yan Hong replied very naturally, with that kind of appearance, if Li Min didn't know the inside story, she would have been deceived by her.Liu Na smiled and said, "Rainbow, you are so blessed."
Pan Zhi's parents were farmers, and his family turned out to be the richest. ”"Your Gong Hai also earns a lot.I heard Minmin say that Gong Hai helped publish the book.When Pan Zhi can publish a book, I don't envy you. ”In front of Li Min, Liu Na said very modestly: "Gong Hai didn't do anything about Minmin's book.He also helped Minmin check the CT film. ”Li Min said with a smile: "All the films in that book, whether they are CT or MRI, are all picked by your Gong Hai."
He's done a lot of work. ”After talking for a while, Li Min stood up and said, "Nana, you rest, I'll go back with Caihong'er." ”"Sit down a little longer."
Liu Na retained.Li Min insisted: "Today's operation stood until three o'clock, I was tired and wanted to go back and lie down for a while." ”When Liu Na saw Li Min say this, she hurriedly said, "Then go back and rest." ”Then she reminded Li Min again: "Minmin, you are not the year before last now, you still have Mu Yu in your stomach, you take it easy, be more careful." ”"Mm-hmm, I'll be careful."
Leaving Liu Na's house, Li Min and Yan Hong walked back holding hands.Yan Hong said: "Minmin, do you know how much money Pan Zhi's family gave me when I gave birth?"
”"How much?"
Li Min knew that Pan Zhijia didn't seem to care much about this grandson, so Pan Zhicai was angry and wanted to name his son Pan Jiabao."
A hundred.This includes hospitalization. ”"Why?"
Li Min was puzzled."
His parents want a bowl of water."
Yan Hong said stupidly: "Because when his sister-in-law gave birth to his first child, his parents gave 100, and the later children also gave 100 yuan."
Let me tell you that I am not dwelling on how much money his family gives, but I feel that this so-called bowl of water is level, but in fact it has done the most unfair thing.You might as well not give us that hundred dollars. ”Li Min agrees with Yan Hong."
You're right, a hundred dollars ten years ago is not the same as a hundred dollars now.So what did Pan Zhi say?
”"What can he say.It's all gone.I told him to return the hundred. ”"What are you kidding, that's not going to be a good way back.""
I'm testing Pan Zhi.Guess what he said?
”"How so?
Caihong'er, you wait first, I guess Pan Zhi agreed to return, right?
”"Yes.So guess what he said?
”Li Min thought for a while and replied: "He said that you have money now, and you don't need your parents' help?"
”Yan Hong nodded and said, "That's what he said."
Then his father took the hundred back.Rare, right?
”"Rare.Thanks to your broad-mindedness, you can't fight with Pan Zhi if you change someone. ”"Minmin, you don't have to put a top hat on me.I've always figured out that his house is his house, and he's him.I'm telling you that a fool can't get along with his partner at home for this kind of thing.Quarrels hurt feelings.It's even less worth arguing for money. ”"Yes, it's good to have a quarrel to make money."※※※※※※※※※※※※※※※※※※※※ a little bit of anatomy, the trachea is located in the anterior median of the neck, in front of the esophagus, and is a lumen composed of cartilage, muscle, mucous membranes and connective tissue.The upper end originates from the inferior border of the cricoid cartilage, equivalent to the level of the 6th cervical vertebra, and descends into the thoracic cavity.Its lower end is equivalent to the upper edge of the 5th thoracic vertebrae, where it is divided into two main bronchus, the left and right bronchus, and the bifurcation is called tracheal convexity, and its edge is smooth and sharp.
(The left main bronchus is horizontal, and the right side is steep and straight, so foreign bodies tend to fall into the right main bronchus.) ）The tracheal cartilage is supported by a horseshoe-shaped incomplete cartilage ring that opens posteriorly, and is connected to each other by a tracheal ring ligament.The notch of the tracheal ring accounts for about 1/3 of the circumference of the tracheal cross-section, which is closed by longitudinal elastic connective tissue fibers and transverse and oblique smooth muscles, which is called the tracheal membrane, forming the posterior wall of the trachea, which is immediately adjacent to the anterior wall of the esophagus.Tracheoesophageal fistulas occur there.() The distance is a bit far