The system takes me for surgery

After the operation plan was clarified, Director Xu Bowen was the chief surgeon, and Liang Yi and Qin Hanyun assisted in performing emergency abdominal exploratory surgery for the patient.

The protection of the abdominal structure is weak, and abdominal injuries are the main fatal injuries in wars. Whether Ouyang Pingan can survive this test smoothly, Liang Yi has no idea.

After laparotomy, it was found that Ouyang Ping’an’s intra-abdominal hemorrhage was massive, the left lobe of the liver was lacerated 5 cm, the beginning of the duodenum was broken, the digestive juice overflowed into the abdominal cavity, the neck of the pancreas was broken, the head of the pancreas was contused and lacerated, and retroperitoneal hematoma , a large amount of exudate and part of necrotic tissue behind the head of pancreas.

Due to the overflow of digestive juice into the abdominal cavity, Ouyang Ping'an's abdominal organs suffered from severe inflammation and edema. The operation is like operating on tofu. The risk of postoperative complications such as anastomotic leakage and bleeding is extremely high.

Xu Bowen evaluated for a long time and said, "Maybe the pancreas and duodenum are in trouble?"

Liang Yi and Qin Hanyun knew what he meant. Xu Bowen wanted to have a pancreaticoduodenectomy.

This operation is a very difficult routine operation in general surgery, and emergency pancreatoduodenectomy for abdominal trauma is even more difficult: hypovolemia and severe stress increase the risk of surgery and the incidence of complications; Pancreaticobiliary ducts have strict requirements for anastomotic techniques; auto-digestion of digestive juice and contamination of intestinal contents occur in the abdominal cavity, and the incidence of postoperative anastomotic leakage is extremely high due to tissue inflammation and edema.

Moreover, emergency pancreatoduodenectomy is also very rare, accounting for about 40 in [-] abdominal surgical emergencies, and the postoperative mortality rate is as high as [-]% or more!

But judging from the current situation, this is already the best choice. If this operation is done well, there is at least a 60% chance of survival.

Liang Yi said: "I want to keep the pancreas and duodenum."

"Are you crazy?" Xu Bowen pressed Liang Yi's scarlet eyes, knowing that he was extremely nervous and wanted to use his friend to save him, Xu Bowen said: "He is your friend, I know, but we still It has to be judged on the basis of objective facts."

Liang Yi said, "Director, I want to try."

"The pancreas is a normal tissue at the time of trauma, with soft texture, pancreatic duct and bile duct are not dilated, and the diameter of the duct is small. It is very difficult to anastomose the pancreatic duct and jejunum mucosa to the mucosa." Xu Bowen emphasized again.

"Director, I know it's difficult, but I want to do it." Liang Yi said,
Qin Hanyun struggled for a while, and said to Xu Bowen: "Director, let Liang Yi do it."

"You..." Xu Bowen kept shaking his head, and finally said, "It's up to you!"

Liang Yi closed his eyes, activated the system, and summoned Andy, [Andy]
[Andy: Yes. ]
[Start system microscopic assistance. ]
[Andy: This operation is extremely difficult, even if it is just an auxiliary function, it will cost a lot of Willow Yen Coins. ]
[How many willow leaf coins do I have left. ]
[Fifteen thousand. ]
[How many willow leaf coins are needed for assistance? ]
[Fifty thousand willow leaf coins. ]
This is too expensive!But there is no way now!

[Okay, start it. ]
Liang Yi opened his eyes and took a deep breath, his field of vision was magnified.

He held the lancet, and as long as he moved his hand slightly, it was like a high-speed train passing by in his field of vision.

Xu Bowen found that his movements were different from usual, something was wrong, so he said, "Liang Yi, are you okay?"

He knows the pressure of performing surgery on his loved ones. Under such tremendous pressure, it is very normal to feel nervous or even have a serious decline in the operating feel.
Liang Yi nodded and said, "I'm fine."

At this time, Ouyang Ping'an's physical condition was extremely poor, and Liang Yi couldn't bear to dawdle any longer. He concentrated his energy and quickly changed the microcosmic field of vision. The movements of his hands became smaller and more stable.

The normal tissue of the pancreas is soft, and the diameters of the pancreatic duct and bile duct are small. It is very difficult to anastomose the pancreatic duct and jejunum mucosa to the mucosa.

Moreover, pancreatic tissue is extremely fragile and is easily torn or cut by sutures.

Once a tear occurs, the function will be greatly reduced even after repair, and the whole operation is as dangerous as dancing on a spider's web.

The neck of the pancreas is the lack of blood vessels of the pancreas, only the dorsal pancreatic artery blood supply, and the entry point is at the head of the pancreas, once the neck of the pancreas is ruptured, the section of the neck of the pancreas may cause blood supply disturbance.

Xu Bowen and Qin Hanyun assisted, and their movements became cautious.

Pancreatic damage, coupled with pancreatic juice corrosion, can easily lead to infection of the pancreas and surrounding tissues. The whole operation is too difficult.

Such precise and subtle operations lasted for two hours, which required extremely high mental strength, and the roots of his ears were slightly congested and red.

When the pancreas was finally repaired, when Liang Yi raised his head, Xu Bowen smiled and said, "You're really good at it."

Liang Yi paused for a while, then nodded.

Qin Hanyun sensed his abnormality. Could it be that Liang Yi is also a system user, and his level seems to be far higher than her own. What kind of level is he?

After the repair of the pancreas, it was just over the first hurdle.

There is still the repair of the defect of the duodenal wall behind, this mountain weighs on his heart.

Xu Bowen said: "You take a break, Hanyun and I will deal with it first."

Clinically, intestinal wall defects caused by duodenal trauma, whether combined with pancreatic injury or not, are considered serious injuries.And the difficulty of this kind of surgery combined with severe damage to the pancreas can be imagined.

Qin Hanyun asked: "Teacher, this simple repair technique can't be done?"

Xu Bowen frowned and said, "Yes, simple repair is not suitable for this kind of injury. The reason is: on the one hand, the inner side of the duodenum is closely connected and fixed with the head of the pancreas, and it is not easy to draw and fit after the intestinal wall defect; On the one hand, the peristalsis of the duodenum is strong, the pressure in the cavity is high, and there is a large amount of bile and pancreatic juice in the intestinal cavity. The intestinal wall in the bare area of ​​the retroperitoneum is not covered by a serosa layer, and anastomotic leakage is prone to occur after suturing."

Liang Yi rested for a while, and asked the nurse to pass him water with a straw. After taking a big sip, Liang Yi went back to the operating table and added: "Director Xu is right, there is another point that the duodenal wall The blood supply to the gut is the peripheral artery, which can easily lead to insufficiency of the intestinal wall blood supply after injury. Based on the above three points, if simple repair is performed, the anastomotic stoma will easily rupture and cause serious consequences.”

"Then what should we do?" Qin Hanyun had never encountered such a complicated situation.

There are several options to choose from. Liang Yi said: "Repair with small intestine pedicled seromuscular layer transplantation."

Xu Bowen blurted out: "I just wanted to say this too. This method is difficult to operate, but the repair effect will be better for patients."

When using this method to repair the defect, the area of ​​the seromuscular layer should be appropriately larger than that of the duodenum to prevent intestinal stenosis caused by the contraction of the seromuscular layer after healing.