bookpower Chapter 371
Chapter 371
Lin Feng was on the podium and explained the surgical information:
"The hospital has prepared a small intestine donor for the patient, a patient with advanced brain cancer, knowing that surgery is hopeless, voluntarily signing an organ donation letter... Thank you to this patient..."
"Donors are usually given immunosuppressants, such as cyclosporine A (CsA), FK506, etc., before surgery, laxatives and antibiotics to achieve the purpose of removing intestinal contents, and heparin injection to prevent hemocoagulation symptoms during surgery."
"As for the recipient, immunosuppressants should also be treated before surgery, intravenous broad-spectrum antibiotics should be given before surgery begins, and high-dose methylprednis after surgery begins..."
"The intravenous dose is three times that of the oral preparation, ATG, OKTs, Xiaoxi, Seniper, etc..."
......
In addition to the sound of Lin Feng, only the sound of the tip of the pen running rapidly on the paper remained in the conference room.
Everyone was like a long drought, greedily absorbing Lin Feng's clinical experience.
Extremely responsible, obscure medical knowledge was gushing like several treasures in front of Lin Feng.
What kind of man is the most attractive, that is naturally knowledgeable.
Not only female interns, but also male interns.
Anyway, he couldn't understand it, so he focused all his attention on Lin Feng's body.
Two hours later, Lin Feng ended the case study.
"Next, we carry out the operation practice, I take the initiative, the two training doctors of the gastrointestinal surgery are one or two assistants, and the attending doctor is watching."
......
......
After 10 minutes,
operating room
All interns, 12, were transferred to the operating room.
Surgery: Allogeneic small bowel transplantation
Main knife: Lin Feng
·Onlookers: All interns in gastrointestinal surgery + video recording·
......
The first step of surgery,
From the donor, remove the small intestine...
General anesthesia first,
Then disinfect the cloth ...
Because the donor has brain death (also considered death), but the physical function is still there, it brings great convenience to transplantation.
"Scalpel!"
A sharp blade cuts a large cross-shaped incision in the patient's abdominal wall.
Open belly...
The entire abdominal cavity was exposed to view, and then Lin Feng poured a large amount of sterile crushed ice into the patient's abdominal cavity.
Separate the bifurcation of the artery of the upper abdomen, quickly ligate the lower end, insert the catheter, and infuse 100ml of four-degree Celsius Ringer's solution.
After the intra-abdominal pressure is 120 cm H2O, UW fluid is perfused.
Subdiaphragmatic ligation is performed to block the abdominal aorta and infuse the perfusion fluid retrograde into the superior mesenteric artery.
The posterior peritoneum is incised along the right colon and the left paracolonic sulcus.
The palm of the hand probed into the abdominal cavity, and the entire intestine, spleen, pancreas, duodenum, and stomach were lifted abruptly.
In this face, Lin Feng pulled out almost all the organs in the abdominal cavity of the donor with one hand!
It's exciting just to think about it!
"Clamp!"
Lin Feng clamped the duodenal ligament at the hilar part of the patient's liver with the head of the family and then cut it off.
The clamp cuts off the renal vessels on both sides, followed by the upper and lower aorta of the superior mesenteric artery segment and the inferior vena cava.
The donor inferior pyloric duodenum, as well as the ileum, is closed with vascular forceps and severed.
After the entire small intestine, spleen, pancreas and other organ tissues are removed in turn, soaked in CUW solution at four degrees Celsius.
Insert the catheter into the aorta segment again and infuse 1000 ml of UW fluid.
In just two minutes, Lin Feng completed the lavage of the donor mesenteric vascular bed.
The excised small bowel donor is transferred to the operating room where the recipient is located.
This paragraph,
Lin Feng's surgery was very slow, deliberately slowed down three or four times.
At the same time, with explanation...
Interns: Experience +100+100+100+100...
......
At this point,
When it comes to the second step of surgery,
The recipient patient is given an open abdomen, the failed small intestine is removed, and replaced with the donor's small intestine.
Lin Feng quickly carried the cold warm small intestine,
Transfer to the recipient operating room.
As for the donor, it will be taken over by other doctors in the gastrointestinal surgery ...
Because the cold ischemia of the donor is time-sensitive, once exceeded, the donor loses its original effect.
At this point,
The receptor has already completed general anesthesia.
Lin Feng washed his hands again, changed into surgical coats, hats, gloves...
Just walked up to the operating table
"Scalpel!"
Lin Feng's hand rose and fell, and in the middle of the patient's abdomen, he made an incision.
A scalpel glowing with a little cold light quickly removes the patient's intestinal apprentice.
The patient's entire pancreas and duodenum are lifted inward.
Lin Feng while operating,
While explaining...
"Donor donor intestine is the first choice for small intestine transplantation, which can achieve total small bowel transplantation, and in patients without colic disease, it can be transplanted back to the cececal part with the small intestine, cecum, ascending colon and more colons, which is conducive to postoperative fluid absorption, reduces allogeneic transplantation rejection, and increases the risk of relative bacterial translocation and infection."
"Arterial catheterization perfuses 1800ml of plasma at four degrees Celsius! (Avoid sudden hypovolemia.) ）"
The donor is implanted, and the vascular anastomosis is anastomosed with a 5-0 polymer line continuously turned outward.
"Usually the second stage can be used to complete the transplant, in the first stage of surgery, first anastomosis the arteriovenous, the two broken ends of the donor intestine are temporarily externalized, which is conducive to observation and experimental research, and after the survival of the donor intestine is confirmed, the second stage of surgery is performed, and the donor intestine and the recipient intestine are anastomosed to complete the transplantation."
While Lin Feng was explaining, he had already begun to anastomosis the small intestine.
Gastrointestinal Surgery Intern,
It was mesmerizing to hear...
30 minutes...
40 minutes...
The fit is complete...
Next, it is rinsing, disinfection and sterilization...
"Intravenous immunosuppressants cyclosporine A and azathioprine, as well as adrenocortical hormones!" (There is a high incidence of intestinal bacterial translocation after intestinal transplantation, and a large number of immunological agents can play a preventive role.) ）
"The intestine is filled with glutamine liquid to promote the recovery of the intestinal mucosa!"
50 minutes...
60 minutes...
70 minutes...
Lin Feng did it very carefully...
......
After 80 minutes, Lin Feng basically rinsed and disinfected...
While explaining, do it,
Under the subtle influence of passing on skills, many interns in gastrointestinal surgery have entered a strange state.
It is as if it is not Lin Feng who is in the main surgical position, but himself.
It feels very rewarding!
The operation is here.
It's basically over!
Suture the incision layer by layer.
End of surgery.
......
After leaving the operating room, everyone returned to the conference room.
"Next, I will answer your questions, if you have any questions, please do not hesitate to ask."
Lin Feng took a sip of water and said.
"The postoperative complications of small bowel transplantation are not well documented in books." A female intern got up and asked.
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PS: Three more ends!
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