Start with the emergency physician

The removal of the gastric omentum is relatively easy, but it is a test of strength, especially when separating, a careless separation failure will lead to blood vessels or tissue rupture.

After easily separating the omentum from the transverse colon, Zhou Yuan began to separate the transverse mesangium.

Special attention is needed here, the transverse mesangium is easily disconnected.

“Electric knife, blunt separation.” Zhou Yuandao.

Blunt separation?

Everyone, including Jiang Xiaoqi, frowned.

However, because Zhou Yuan was concentrating on separation, no one said the doubts in their hearts.

I saw that Zhou Yuan picked up the uncharged electric knife head, carefully cut the transverse mesangium left and right, and then put down the electric knife, separated the gastrointestinal ligaments in turn, and performed gastroomentectomy.

After all this was over, Jiang Xiaoqi coughed lightly.

“What’s going on?” Zhou Yuan guessed.

“Why choose blunt separation with an uncharged electric knife head?” Jiang Xiaoqi asked.

He Jianyi was also a little curious: “Sharp separation has the least damage to tissue, why choose blunt separation?” ”

Zhou Yuan explained: “The uncharged electric knife head is not sharp, and using it for separation can save time, in addition, it can ensure that the separation plane is advanced in parallel to avoid tearing the mesangium due to uneven force.” Many doctors choose to use a sharp scalpel for separation, which is naturally prone to problems. ”

He Jianyi and Jiang Xiaoqi looked at each other, and they both saw the shock in their eyes.

“Stunned… What are you doing stunned, ocean, write it down in a book! He Jianyi shouted.

Haiyang quickly took out a small book with the words “Junior Brother Zhou Yuan’s Special Experience Book for Surgery” and brushed it up.

Several people present were excited.

That’s the benefit of having a specialist for surgery.

In textbooks, you can only learn that uncharged electric blade heads are blunt and not sharp, and what are the advantages and disadvantages of mixed cutting and pure cutting, respectively.

However, with an expert, he can let you know when to do what to do, when to do high frequencies, and when to turn up the output power.

“Next is pyloric vascular ligation.”

Zhou Yuan cut the peritoneum at the lower edge of the duodenum, revealing the pancreas.

In the surgical field, an upward bulge is clearly visible on the surface of the pancreas, and the tip of the bulge is the root of the right blood vessel of the omentum.

This is a marker used to determine arteries and veins, and some experienced doctors often use this to distinguish them. Walking up the bulge are arteries, and downward walking are veins.

At the top of the bulge, the right omentum vein and the right colonic vein merge into a trunk, and Zhou Yuan carefully ligated it with line seven.

“Scalpels, scissors.”

Hearing the utensils, Haiyang asked curiously, “Do you want to separate sharply this time?” ”

Zhou Yuan nodded: “The subpyloric lymph nodes are separated, and careful cutting is required here, otherwise it is difficult to separate successfully.” ”

Zhou Yuan slowed down his movements, increased his strength slightly, pulled the tissue to the sides to make it tense, and then used a scalpel to make a vertical, short-distance cut along the tissue gap.

In some places where the tissue gap is very small, Zhou Yuan replaced it with surgical scissors, with the tip of the scissor deep into the tissue space, open the scissor handle, separate the tissue, and then cut it.

He Jianyi and the others widened their eyes.

Whether it is separation or cutting, Zhou Yuan’s movements are textbook level, simply art!

“In the future, can I often come as a second assistant?” Jiang Xiaoqi swallowed his saliva and said.

Sun Meng’s eyes refused to blink: “I also want to come, I will be a fourth assistant.” ”

Zhou Yuan did not notice the conversation between the two, and after completing the separation, he found the lower edge of the duodenum, stretched the duodenal wall to the right, and ligated the right omentum artery at the root.

“Groove… It can still be like this! ”

At this time, the ocean finally understood why Zhou Yuan separated the duodenum instead of cutting it directly.

By doing so, the dense subpyloric veins are directly avoided, reducing the risk of surgery!

“The next step is to cut the duodenum.” Zhou Yuan said.

Without waiting for Zhou Yuan to speak, Haiyang immediately handed over the non-invasive intestinal forceps.

Zhou Yuan smiled, it seems that the ocean has caught up with the rhythm.

Zhou Yuan moved his stiff neck and re-entered the operation.

About 2.5 cm from the anterior pyloric vein, Zhou Yuan clamped the duodenum with a noninvasive intestine.

“Kocher pliers.”

Kocher forceps are toothed vascular forceps for their purpose as the name suggests.

After Zhou Yuan took it, he clamped the Kocher forceps to the proximal end of the duodenum.

Then, the duodenum was easily cut between the two forceps.

As soon as Zhou Yuan was about to stretch out his hand, Haiyang immediately handed over the hemostat with a smile on his face: “Do you want this?” Hey, hey…”

Zhou Yuan’s face froze, “Yes.” ”

Taking the hemostats, Zhou Yuan began to separate the fibrous tissue between the posterior wall of the duodenum and the head of the pancreas.

“Zhou Yuan, how do you choose now?” He Jianyi couldn’t help but ask.

It is time to choose which GI reconstruction procedure to use, and if jejunum is a gastric substitute, then the duodenal stump should be closed. If the jejunum and duodenal anastomosis are placed between the rows, the duodenal amputation needs to be preserved for later anastomosis.

The choice made will directly affect the patient’s digestion and quality of life.

Everyone, including He Jianyi, focused their eyes on Zhou Yuan.

———

The eighth more is sent, and the ninth more is started!

Brothers, we are already very close to the first place in the monthly ticket list, whether this book can land on the first place in the Feilu monthly ticket list, it depends on everyone, ask for a monthly pass! Ask for a monthly pass! Ask for a monthly pass!