Reasoning diagnosis: Big brother, your wife has been prescribed medicine!

Chapter 294 The operation process as a teaching material!

"Give me another spatula." Lin Yi put the suction device aside, Wang Qiaoya quickly found the spatula and handed it to Lin Yi, holding a sterile gauze in her hand.

Lin Yi didn't suck up the thick juice directly, but poured the thick juice scraped from the surrounding area onto Wang Qiaoya's sterile gauze with a spatula. This is a specimen that needs to be cultured for bacteria and sent to laboratory and pathological examination.

Wang Qiaoya also understood that this was a sample, and after keeping the sample, Lin Yi picked up the suction device and began to suck the pus.

The barrage in the live broadcast room was immediately posted:

"This... the color is strong enough, it's actually copper green, how serious is the infection?"

"However, the boss left a sample. If I had done it differently, I might not have been able to resist using the suction device to wash off the thick juice. Seeing this kind of pus would cause obsessive-compulsive disorder."

"The infection is too serious, and the anti-positive coccus vancomycin may not be able to suppress it!"

The doctors all lamented that the severity of the patient's infection can be judged from the pus. This is the reason why the pustules appear in the human body, and local infection may spread.

After Lin Yi sucked up the pus, he continued to free the surrounding connective tissue and edematous adhesion tissue. The patient's gallbladder had been removed, so it took Lin Yi a little effort to find the bile duct and peel off the pancreas.

"Song Borui, record the signs of pancreas edema, ask Director Yu to give somatostatin for a period of time after stepping down, and use the normal amount for 3-5 days." Lin Yi ordered.

Song Borui nodded in response, and Lin Yi continued to separate the hepatic duodenal ligament, free the duodenum, and found the blind socket near the duodenum where the thick juice had been sucked out.

At this time, the blind nest was already covered with pus, Lin Yi reached out to Wang Qiaoya again for a spatula.

"This pus moss, if it is not treated well, it will cause inflammation and fever. I didn't treat it well last time. The patient had a fever for half a month, and the family members almost scolded me to death."

"The pus moss is too difficult to deal with, especially the pus moss in the blind socket of the duodenum. It seems to be seriously adhered to the nearby intestinal tissue, and it is impossible to peel off. Once peeled off, it is easy to break the intestine. Now The intestines were swollen like blisters, which would burst at the touch of a finger."

"I have a feeling that the boss may want to peel off this pus moss."

"It's moving, he's really moving, he's ready to strip!"

The doctor who said in the live broadcast just now that he couldn't peel off also held his breath and watched Lin Yi operate.

Lin Yi used a spatula to scrape the surface of the pus moss clean first, then asked Wang Qiaoya for tweezers and a small forceps, and began to operate on the thicker pus moss to separate the pus moss from the intestinal wall.

Without separation, Lin Yi didn't dare to have any unreasonable thoughts about the pus moss, after all, the edematous intestines are too fragile.

Once the intestine ruptures and Lin Yi destroys the intestinal wall, the tissue in the intestine will flow out. Even if Lin Yi sutures it, the patient's intestine cannot heal at all during the edema and inflammation stage. A second anastomotic resection was performed.

Song Borui watched with trepidation, feeling that Lin Yi was too bold, Song Borui would definitely not have dared to come by himself.

Lin Yi had already done the stripping in the operating room, and he was not as nervous as others. He patiently separated and stripped. Due to the small pus moss, Lin Yi's separation speed was very slow. The small forceps are not like the big forceps. alright.

Soon, 10 minutes passed, Lin Yi put away the tongs and spoon, and finally finished cleaning up all the pus moss.

On a piece of sterile gauze, a few pieces of irregular pus moss about 5 cm lay flat on it, which can be seen by everyone in the live broadcast room.

"This operation is too good!"

"I almost thought it was microscopic surgery. The moss is inside the abdominal cavity. It's hard to imagine that Brother Yi actually did it with the naked eye."

"Brother Yi doesn't use his eyes at all, okay, he just relies on what he stripped from his memory. This skill field is basically zero, and he can only rely on blind exercises."

Anyway, for the doctors in the live broadcast room, this operation is a dream that cannot be expected, and it is the kind that can't be learned after seeing it.

Separating the pus moss can be separated and stripped by an attending physician in general surgery, but it is undoubtedly a dream to do it successfully in the case of blind fossa or intestinal edema, and Lin Yi's operation cannot be replicated at all .

Lin Yi asked Wang Qiaoya to wipe his sweat. This operation is actually very risky. The patient has sepsis, and it is impossible not to peel off the pus moss, otherwise infection will easily occur.

Only by solving the pus moss can the patient have a better chance of surviving, not only in the eyes of others, this risk is very high, Lin Yi actually thinks so, but in order for the patient to recover faster after surgery, Lin Yi can only In this way, even if you are tired, it will be fine.

After finishing the blind socket, Lin Yi had completely separated the duodenum. After receiving the sharp knife, Song Borui held the suction device without a sheath.

"Insert it!" Lin Yi shouted the moment he cut open the common bile duct with a sharp knife.

Song Borui quickly stuffed the suction device in, and the suction device started to twitch, and the purulent, foul-smelling food residues and digestive juices with pus were sucked out.

Song Borui's hand trembled a little, Lin Yi quickly supported Song Borui's hand, shaking it slightly, making sure not to miss it.

The bile duct contained a lot of miscellaneous contents, and the suction device without a cover was blocked for about 15 seconds. Lin Yi began to take over the operation, after all, the substances in the suction device must not leak out.

Lin Yi took Wang Qiaoya's wet gauze, and the moment he pulled out the suction device, he covered it with the wet gauze. Wang Qiaoya prepared warm salt water and asked Song Borui to clean up the blockage in the suction device.

After repeated operations several times, the patient's bile duct was finally dredged.

With the end of suctioning the foreign body, Lin Yi also heaved a sigh of relief. At least half of the operation had been completed.

After the hepatoduodenal ligament had been separated and the contents of the bile duct cleaned up, Lin Yi began to free the lesser omentum foramen, separating the hepatic flexure of the colon from the right lobe of the liver.

Lin Yi continued to untie the transverse mesocolon, cut open the retroperitoneum on the outside of the duodenum, and performed blunt separation.

Needless to say, Lin Yi's blunt separation skills are at least at the master level, and they are extremely smooth.

It was not the first time that Song Borui saw Lin Yi's blunt separation, but every time he would have a shocked expression, because he did it so perfectly.

That guy seems to have watched his own surgery too much, and he didn't pay attention to his own operation at all, only paying attention to the surgery. He is really a boring person.

For blunt dissection of the peritoneum, Lin Yi separated the second and third segments of the duodenum forward, and then placed a warm saline gauze pad behind the head of the duodenum and pancreas.

Lin Yi is currently undergoing ODDI sphincteroplasty. The most important point of this operation is to find the positioning point of the duodenum.

The patient had already undergone lateral incision and anastomosis of the common bile duct and duodenum. Lin Yi only needed to find the entry point, and no more anastomosis was needed.

In the second section, Lin Yi found the entry point, clamped the two sides with mosquito hemostats, cut the middle, and sutured the duodenal mucosa and bile duct mucosa with 4#0 suture without damage, so that the two can reach the 2-3CM distance.

This step can only be clamped 1-2mm at a time, so Lin Yi did it very carefully to avoid duodenal fistula after the operation.

After cutting the sphincter, Lin Yi observed that there was no bleeding in the sphincters on both sides. He sutured and pulled the two edges with confidence, and then checked the opening of the pancreatic duct.

The opening of the pancreatic duct was located below the duodenal incision made by Lin Yi, and pancreatic juice could be vaguely seen flowing out. Lin Yi reached out to take the catheter from Song Borui, placed it in the pancreatic duct, and checked for obstruction and stenosis.

Lin Yi began to suture the incision on the duodenum in two layers. This suture cannot be sutured casually. Unlike blood vessel suture, the two edges must be sutured together, otherwise duodenal lumen stenosis and duodenal fistula will easily occur.

So this time, Lin Yi adopted the method of transverse incision and suture to deal with the duodenal incision, so as to avoid complications as much as possible.

After the incision of the duodenum was sutured, Lin Yi carefully pulled the greater omentum over, covered and strengthened it with the greater omentum, and placed abdominal drainage in the subhepatic area and the hole in the lesser omentum.

Lin Yi first flushed the abdominal cavity with warm salt water to check for active bleeding, and used three antibiotics in the local area. Generally speaking, the abdomen needs to be shut down after the antibiotics are used up, but Lin Yi did not do this.

"Sterile mantle, 50ml syringe and B-ultrasound machine."

Lin Yi said.

Song Borui asked the nurse to push the mobile ultrasound machine in the operating room, and the sterile mantle covered the probe and connection of the ultrasound machine, and Lin Yi began to do the liver ultrasound under direct vision.

Because there is no interference from the skin and subcutaneous tissue, the B-ultrasound can be seen very clearly. After finding the position, Lin Yi inserted the needle of the 50ML syringe into the abscess cavity of the liver along the B-ultrasound guide, and poured the yellow-green thick juice into the abscess cavity one by one. Pull it out.

After drawing three tubes of pus, the resistance of the syringe in Lin Yi's hand began to increase. Lin Yi turned his head and shouted: "Prepare two cefoperazone, dissolve and rinse."

Wang Qiaoya opened two cefoperazone sodium and sulbactam sodium, dissolved them and injected them into the abscess cavity of the liver by Lin Yi.

After this step, Lin Yijian could no longer pump out the pus, and he was relieved.

Lin Yi carefully looked at the area that had been done, and found that there was no bleeding or untreated inflammatory infection, so the abdomen could be shut down.

After the operation was completed, Lin Yi's speed flew up when he closed his abdomen.

Not every doctor can understand the whole operation performed by Lin Yi, but everyone can understand it.

But Lin Yi's speed was so fast that he didn't even need to look at it. Taking over the equipment was a fierce operation.

After the operation was over, the live broadcast screen was also closed.

The doctors in the live broadcast room were reluctant to part. Every time this time came, they wanted the surgeon to perform another operation. It was so cool to watch.

The video of this operation was also recorded. After all, every general surgeon will encounter abdominal infection. Lin Yi’s operation is of great reference value, especially the operation of peeling off pus moss and on-stage B-ultrasound. Positioning, directly using a puncture needle to draw thick juice, and then washing with antibiotics, all these operations are to restore the patient's sepsis to normal.

After Lin Yi sewed the last stitch, the patient's anesthesia gradually came to life, and the anesthetist Lao Ma's anesthesia level gradually improved.

Lao Ma has become Lin Yi's queen anesthetist, as long as it is Lin Yi's operation, he must be the anesthetist.

As soon as Lin Yi walked out of the operating room, he received a call from Wu Jiang.

"Dr. Lin, there is a 17-year-old girl in the department of gynecology with pain in the lower abdomen. An emergency B-ultrasound examination is suspected to be rupture of the corpus luteum."

Lin Yi didn't have time to change clothes, so he went straight back to the emergency department.

Rushing to the first aid room of the emergency department, Lin Yi saw a pale girl curled up on the first aid bed clutching her stomach, standing next to Zhang Ting, the chief resident of the obstetrics and gynecology department.

Lin Yi didn't exchange pleasantries, and asked directly: "How do you judge?"

Seeing Lin Yi coming back, Zhang Ting replied: "At first I thought it might be ectopic contractions, but the patient and the patient's family members denied any history of close contact."

Lin Yi looked at the doctor who was doing B-ultrasound and asked, "What does the B-ultrasound show?"

"Judging from the blood vessels, the pain point is not caused by the separation of the ovary, so it can be ruled out as a gynecological disease." The B-ultrasound doctor said.

The couplant was applied to the patient's abdomen. Lin Yi looked at the B-ultrasound image. No abnormalities were found in the uterus and double-layered ovaries, but a lump about 5 cm in size could be seen next to the right ovary.

Lin Yi lightly pressed the patient's abdomen hard, and found that during the pressing process, the mass would separate from the ovary, and the thick blood vessels inside could be vaguely seen.

The judgments of the B-ultrasound doctor and Zhang Ting, the head of the obstetrics and gynecology department, are based on evidence and are not made up.

"Where are the family members?" Lin Yi put down the B-ultrasound probe and asked.

A middle-aged woman hurriedly stood up and asked anxiously, "Doctor, how is my daughter?"

"There is a mass in the patient's body, the source is unknown, and surgical exploration is required."

"Huh? Still need surgery?" The middle-aged woman became anxious. For her, having surgery proved that her daughter was seriously ill.

The patient's family is most afraid of hearing about surgery.

"Doctor Lin, can I be your assistant for this operation?" Zhang Ting asked.

"Yes." Lin Yi nodded.

In fact, under normal circumstances, doctors are not willing to perform surgical explorations. After all, no one knows what is going on inside the abdomen when the abdomen is cut open, and B-ultrasound is only an auxiliary means.

Once opened, the doctor will be caught in a dilemma when encountering a difficult situation.

Unless it is the kind of surgeon with rich experience in clinical operations, he dares to speak out about surgical exploration at will. They are confident in their own skills.

Zhang Ting was Lin Yi's assistant. Apart from wanting to see the operation, she was also worried about the patient's ectopic pregnancy.

Lin Yi is a male doctor in the emergency department, and he certainly has never done ectopic pregnancy surgery. When encountering an ectopic pregnancy, it is better to do it himself.

Lin Yi arranged for the doctors in the emergency department to go through the admission procedures for the patient, and Lin Yi took the patient directly to the emergency ward to start preoperative preparations.

Listening to what Lin Yi said, the patient's mother was so frightened that tears came out, sobbing and signing her name on the operation consent form.

Wang Qiaoya had also placed a gastric tube and urinary catheter in the patient, and Lin Yi directly arranged to push the patient to the operating room.

The anesthetist Lao Ma first anesthetized, and Lin Yi went directly to the dressing room to change.

The anesthesia took a little long, about 8 minutes, and the anesthetist needed to configure the dosage according to the patient's condition, while Lin Yi thought about the anatomical structure of the spleen in his mind.

(End of this chapter)