The Godfather of Surgery

After Song Zimo's meticulous treatment, Yu Shuilian finally did not suffer from liver and kidney failure, the hemoglobin rose to over 90g/l, and the biochemical, liver and kidney functions, and coagulation functions were all within the normal range.

The artificial liver and the bedside hemodialysis machine that were prepared at all times were not in use, and the wound was kept dry and clean, and more than a dozen drainage tubes were gradually pulled out.

When I was transferred from the ICU to the general ward, there was only one drainage tube left on my body, which was used for bilateral ureteral catheter stent renal pelvis drainage.

Cleanliness is an important aspect of quality assurance. It is also applicable in medical activities. High cleanliness can reduce the occurrence of infection and prevent bacterial colonization and division. This is the same as removing stagnant water and reducing mosquitoes and flies.

As long as the sheets are contaminated with a little secretion or excrement, the nurses will change them immediately, and change the sheets more than ten times a day.

If there is exudation from the wound, Song Zimo immediately brings the nurse to change the dressing. Sometimes the dressing change takes up to an hour, changing the medicine more than ten times a day, and the doctors and nurses are so tired that they can't straighten their waists.

Song Zimo will keep a specimen for bacterial culture for every bit of exudation. Once the bacteria are cultured, Song Zimo will use sensitive antibiotics accurately according to the drug sensitivity test to eliminate the bacteria and avoid the escalation of infection.

In order to allow the residual liver to gradually adapt to its functions, Song Zimo accurately calculated the proportion of intravenous nutrients ingested every day to minimize the load on the liver.

Director Pan of the ICU asked Dr. Meng to make a PPT about Yu Shuilian's ICU treatment process, as a classic case, to explain to the ICU doctors repeatedly.

What it means to nip danger in the bud, what it means to observe meticulously, and what it means to know the details and plan ahead, all of these cases have explanations.

Finally, Yu Shuilian was transferred from the ICU to the Department of General Orthopedics. Cai Qiaojun prepared a single ward for Yu Shuilian in advance, and selected three nurses to be responsible for the nursing work of Yu Shuilian. Among these three nurses, one of them was an ostomy specialist and obtained the certificate of an international ostomy specialist. , has extensive experience in stoma management.

Yu Shuilian is about to eat gradually. The excretion of stool depends on the colostomy in the abdomen, but this fistula has no contraction function and cannot be controlled. If there is no meticulous care, the stool will be everywhere. Two fistulas on her body.

Another fistula is a cystostomy, which is the current passage of urine. Drainage tubes left in the kidneys and ureters will be pulled out after the ureteral bladder has healed.

Before the artificial urethra and anus were reconstructed, the management of her excretion was the responsibility of the ostomy specialist.

In the medical team, Song Zimo arranged a few people. Because Zhang Linxiaowu wanted to take care of the patients, Song Zimo transferred Xu Zhiliang and Gao Qiao, and then selected a few graduate students and Gu Piansheng to form a full-time medical team.

In the comprehensive orthopaedic ward, Yu Shuilian finally saw her husband and son again.

Both her husband and son were emaciated and thin, especially the son, who was standing beside the bed with a pitiful appearance, which made Yu Shuilian feel distressed.

"Have you eaten enough these days?" Yu Shuilian touched her son's hand.

The son shook his head: "No, I have some cold rice in the morning. At noon and at night, the dishes that Dad's fried are either very salty or burnt."

Fu Xiayang was on the side, and was embarrassed by what his son said, and what his son said was true. These days, he has no heart to do anything, and he is absent-minded when cooking. fire.

"Wait for Mommy, I'll cook something delicious for you." Yu Shuilian touched the child's face, her heart pounding like a knife.

Looking at her husband beside him, like a child who made mistakes, Yu Shuilian said emotionally, "Thank you for your hard work, Xia Yang!"

"It's okay, we'll wait for you to go back." Fu Xiayang touched his son's head.

"Mom, let me take a look." When the son was about to lift the quilt, Fu Xiayang immediately took his son's hand.

He was afraid of scaring the child, and Yu Shuilian also winked, telling her husband not to let his son know. The son insisted on watching, and sooner or later, he would know that the fire could not be covered by paper. Yu Shuilian sighed and signaled her husband to let go.

Fu Xiayang let go of his son's hand, and the son lifted the quilt and saw his mother, who was only half-length, with two holes in her stomach, and then the bag.

Not only did the son not frighten away, but he also looked like a little man: "Mom, I'm not afraid. I'll carry you in the future. Wherever you want to go, I'll carry you. I'll carry you to see the national flag hoist and climb the Great Wall."

"Okay, take your mother to see the flag raising and climb the Great Wall."

Yu Shuilian was completely touched, and the warmth of her family made her firmer in her belief that she must live and never give up on herself.

"Xia Yang, you are sometimes too busy in the morning, you take him to the breakfast restaurant next to our store, or you simply let him eat breakfast at school, the rainy season is coming, close the windows, especially the wardrobe, Don't move the things in the vacuum bag, otherwise it will easily get wet, there is half a black chicken in the refrigerator, you can get some longan and lotus seed stew and eat it with your son."

Yu Shuilian explained to her husband one by one, that now she was lying on the bed and could only move her mouth. Even if she moved her mouth, she could help her husband a little.

Yu Shuilian was really distressed when she saw the unhappy grandfather and his father.

Song Zimo, Xu Zhiliang, and Takahashi gathered together to discuss the next reconstructive surgery when they had time.

The function of the bladder is still there, and the urination function is reconstructed, and only an artificial urethra needs to be reconstructed.

But for anal reconstruction, Yang Ping intends to rebuild an artificial anus that can control stool autonomously. How can it be done?

In order to complete the homework assigned by Yang Ping, the three of them felt that it was very difficult to design the operation plan separately, so they decided to gather their wisdom and solve this problem together.

Defecation may seem simple, but it is a complex process.

When feces enter the rectum, the receptors in the rectal wall are stimulated, and the impulse is transmitted to the primary defecation center in the lumbosacral region of the spinal cord along the afferent fibers in the pelvic and hypogastric nerves.

At the same time, the afferent impulses are also uploaded to the cerebral cortex, causing defecation.

If defecation conditions permit, the impulse is transmitted through the efferent fibers (parasympathetic fibers) of the pelvic nerve, causing contraction of the descending colon, sigmoid colon, and rectum, and relaxation of the internal anal sphincter.

At the same time, the efferent impulse of the pudendal nerve decreases, the external anal sphincter relaxes, and feces are excreted.

In addition, the nerves innervating the abdominal muscles and the diaphragm are excited, the abdominal muscles and the diaphragm are contracted, the intra-abdominal pressure is increased, and defecation is promoted.

If defecation conditions are not permitted, the cerebral cortex sends out impulses, which descends to inhibit the activity of the primary center of the spinal cord and lumbosacral region, and inhibits the outflow of the impulses along the efferent fibers of the hypogastric nerve, which increases the tension of the anal sphincter, dilates the sigmoid colon, and inhibits the defecation reflex.

In this way, the stool is temporarily retained in the body and is not uncontrollable.

Now the patient has no anal sphincter and no rectum. There is no rectal-like receptor in the wall of the sigmoid colon, so the reflex arc cannot be reconstructed. How to simulate the normal defecation process?

Xiao Chuanguo's Xiao's reflex arc has discarded body nerves that can be used, and the bladder and anus are anatomically complete, that is, once connected, they have a complete neural arc.

This patient's neural arc has lost both receptors and effectors, and the two indispensable terminals are gone, and reconstruction surgery is simply impossible.

As an international trauma master, Takahashi racked his brains and couldn't come up with a surgical plan.

"Dr. Song, Dr. Xu, unfortunately, I can't think of how to do this operation for the time being. If I were to perform this operation, the patient would have to use an uncontrollable tube to defecate for the rest of his life."

Takahashi put down his pencil and leaned back in his chair in frustration.

There are only three of them in the conference room now.

Xu Zhiliang also shook his head: "Me too, I boldly imagined that a part of the bladder sphincter would be used to replace the anal sphincter, and then rehabilitated, but, even if this is possible, what nerve is used to complete the nerve connection for muscle contraction?"

Song Zimo was very happy. When Xu Zhiliang and Gao Qiao didn't come before, they discussed with Yang Ping? This guy doesn't need to be discussed at all, just listen to his lectures.

Now, with Xu Zhiliang and Gaoqiao, Song Zimo is finally no longer alone, and he can have a real discussion with someone.

"You two, what if an artificial device with electronics, such as a silicone device, was implanted at the end of the descending colon to do the anus? That device could close and open in response to a certain stimulus? "Song Zimo stared at Xu Zhiliang and Gao Qiao.

"You mean artificial anus?" Takahashi and Xu Zhiliang asked at the same time.

Song Zimo nodded: "Have we gone astray and walked into a dead end? We must use the structure of the human body to complete the reconstruction."

"If you follow this line of thinking, designing an artificial anus will be no less difficult than rebuilding with human body structures," Takahashi said.

Xu Zhiliang disagreed: "Designing an artificial anus is difficult, but at least it can be done."

Song Zimo, Xu Zhiliang, and Takahashi, this trio, closed the door of the conference room, and the discussion was in full swing. Everyone felt that they had found a soulmate.

How fortunate it is that this kind of person who is usually at a high place can find a bosom friend.

The two chapters that were promised were later suspended due to recent work. Two chapters will be resumed tomorrow. Today, it has been posted on the starting point website and APP. This is the result of everyone's support and love. You must work hard and write a Thanks again for the high-quality doctor's article!