Chapter 23 Guided Surgery (Please collect and read)

Author: Jiangdi Youbai

Chapter 23 Guided Surgery (Please collect and read)

Splenectomy after splenic rupture is a common emergency surgery. According to the classification of general surgery by the National Health Commission, it is a third-level surgery.

Third-level surgeries can only be performed routinely by senior mid-level and deputy senior professional titles.

Routine operation is a routine operation, and there must be a prerequisite, that is, the hospital where the doctor is located. This type of surgery is a common operation and is a frequently performed operation.

Lu Junyin is the deputy chief, so there is definitely no problem with his level in performing this surgery.

However, the hospital where Lu Junyin works was formerly the town health center, and the surgeries that can be routinely performed here are simple first- and second-level surgeries, such as gallbladder stones, appendicitis, etc.

Splenectomy is not something often encountered in town hospitals.

Lu Junyin has only performed one surgery in so many years.

The main reason is that Sha Town is not far from Xuan County. If a car accident occurs on the road, the time to go to the town hospital is enough to go to the county hospital.

Delayed splenic rupture, or splenic rupture of a grade that does not require immediate surgery, will also be transferred to the county hospital!

Level 3 surgery is difficult, and there is a reason why it is difficult.

First of all, the purpose of splenectomy is to remove the spleen to save lives. As far as the organ is concerned, it is terminal.

Secondly, the surgical procedure of splenectomy is quite complicated and it is difficult to stop bleeding.

If you don’t have enough experience, the anatomy of the splenic artery and celiac trunk will give you a headache. The splenic artery branches off from the left side of the celiac artery

The celiac trunk is where the aorta bifurcates, in the abdominal cavity in front of the spine.

The starting point is at the bifurcation of the abdominal aorta, and the end point is at the origin of the left and right renal arteries. It is not difficult to find it, and it is not difficult to look at the branches of the celiac trunk in an anatomy book.

After the abdominal aorta divides into the celiac trunk, it further divides into the hepatic artery, left gastric artery, splenic artery, pancreaticoduodenal artery, and superior mesenteric artery. This is clearly visible in anatomy books.

However, in actual application, it is not easy to quickly clarify it on patients.

Splenectomy is mainly performed for splenic rupture and bleeding. The operating concept of hemostasis is mechanical clamping to stop bleeding. Naturally, the splenic artery is tied off first or clamped with vascular clamps.

Lu Junyin didn't have much experience, so he almost started on the left gastric artery, which is adjacent to the splenic artery.

Wu Xie stopped him.

Lu Junyin didn't say much or get angry. Wu Xie moved slightly, didn't say a word, and just gave silent guidance. This was the best attitude of an assistant, saving face.

Lu Junyin quickly clamped it, and then returned to the level of the spleen. Sure enough, he saw that the largest source of the artery had been tied, and the gurgling blood fountain had turned into a slow leak.

This is mainly because even after the main blood vessel, the splenic artery, is tied, there are still other vascular pathways in the spleen.

The blood supply of the spleen also includes the interconnection of the splenic vein, pancreatosplenic artery, pancreatosplenic vein, and short superior mesenteric artery, which will become the source of continued bleeding.

Similarly, the course of the splenic artery also has its downstream branches - the pancreatosplenic artery, gastroepiploic artery, short superior mesenteric artery, left hemicolic artery, combined splenic artery, etc.

These anatomical locations are only the anatomical basis for splenectomy, not the operation.

This is the reason why splenectomy is classified as a level 3 surgery.

Moreover, the reason why surgical operations consume so many knowledge points when upgrading their level is because the execution of the surgery requires a huge knowledge reserve as well as the key points and details of the surgical process...

But no matter what, the splenic artery is tied off first, which is equivalent to completing a small part of the splenectomy. The hemostatic operation is more than half completed!

The window period for rescue has also been extended, and subsequent operations can be carried out slowly.

The general principles of splenectomy include exploration, hemostasis, resection, and suturing.

Now that we have only completed the exploration and partial hemostasis, we still need to complete the ligation and suturing of other blood vessel lumens in the spleen to cut off the blood supply of the spleen. Only then can we wait for an opportunity to continue to explore whether the spleen organ needs to be cut and whether it can be rescued again.

!

"Xiao Wu, you and Liu Chengshan change places." After Lu Junyin completed the spleen and pancreatic artery, he gave instructions and moved Liu Chengshan away, at least to make it look good on the surface.

Liu Chengshan has no objection.

The gap between deputy chief physician and deputy chief physician is very large. For example, Lu Junyin and some associate professors are both deputy senior and deputy chief physicians, but there is a gap in the types of surgeries they can perform?

It is not an exaggeration to describe it as like a natural moat.

The same is true for Liu Chengshan. As a specialist, he currently does not have many types of surgeries. This is due to the limited number of surgeries in the hospital and personal reasons.

Although Wu Xie didn't say anything, the fact that he found the splenic artery so quickly and corrected Lu Junyin's operation meant that Wu Xie was knowledgeable about this operation.

Lu Junyin did not immediately let Wu Xie become the first assistant because he wanted to look good on the outside.

Wu Xie did not refuse. After handing over the negative pressure suction device and the retractor to Liu Chengshan, he took over Liu Chengshan's retractor and a pair of vascular forceps.

Lu Junyin has had a splenectomy, so he is naturally familiar with the operation process and principles, but he is not able to handle each operation one by one.

"Let's look for the splenic and pancreatic arteries again," Lu Junyin told Wu Xie.

"Okay, Director Lu." Wu Xie nodded and didn't respond excitedly. All that came to his mind were ideas for exploring the spleen and pancreatic arteries.

To stop bleeding, the first operation to be performed is exploration.

Splenectomy is a level 3 operation. Wu Xie ranks it from basic to advanced, and the cost is 1.5 times that of suturing and surgical infectious diseases.

It takes three points to get started and fifteen points to become proficient.

The corresponding time is equivalent to splenectomy. If Wu Xie wants to get started, he will need a month of solid study, and if he wants to become proficient, it will take up to five months of hard work.

This kind of correspondence gave Wu Xie a deep understanding of splenectomy!

It may not be possible to cope with all splenectomies, but Wu Xie is still confident about this emergency.

The pancreatosplenic artery is a branch of the splenic artery.

It originates from the left branch of the celiac artery, enters the pancreas upward, branches to supply part of the pancreas, and then continues upward to branch into multiple small branches of the splenic artery.

Currently, the proximal segment of the splenic artery is ligated with vascular clamps. During splenectomy, even the branches of the splenic artery must be ligated or sutured in advance to avoid postoperative rupture and subsequent bleeding.

Wu Xie still found it easily based on the anatomy, and it was no longer difficult to perform splenectomy and blood vessel exploration at a skilled level!

Lu Junyin's eyes flickered, and while cooperating with Wu Xie to tie the blood vessels with silk thread, he asked: "Xiao Wu, you must have been a master of orthopedics before, right?"

Splenectomy is a level 3 surgery performed by general surgery, not an orthopedic specialist.

When Wu Xie heard this, he raised his head slightly and answered firmly and naturally: "Well, I am an orthopedic surgeon. I performed splenectomy during my internship. I have been on stage several times..."

"No wonder." Lu Junyin seemed to have a casual tone, but he was very nervous inside.

If you can do this just after seeing it a few times, then you have been in the orthopedics department for several years and you have to fly when you perform orthopedic surgery?

Lu Junyin had doubts in his heart at this moment——

When Deputy Director Liu of the County Health Committee sent Wu Xie, he looked like he was a plague. Was it the director of the Department of Orthopedics of Xuan County People's Hospital who was up to something?

Or is there really some misunderstanding here that I don't know about.

Did you just find a treasure?

Lu Junyin ignored the confusion in his mind, and Wu Xie continued to guide the operation process just right. For example, he happened to find arteries, veins, etc., and left them to Lu Junyin to operate...

You cannot perform third-level surgeries with the authorization of the deputy chief physician. Everyone knows this!

Thank you Bai Yifei book friend for the 500 reward, please vote for recommendation!
Chapter completed!