Five Hundred and Seventy-Eight Half

There are people in the court who are easy to handle, and there are people in the hospital who are easy to check, not to mention the head nurse in the hospital.

The nurses and sisters were very accommodating, and within a day, the results of the preliminary examination came out, and the diagnosis of gastric cancer was made! ~

"Yuan Zhang is right, what should we do now?" The head nurse of the Special Needs Department was at a loss for words.

"Go to Zhang Yuan, wait." While speaking, he thought for a while and then asked: "Do you Zhang Yuan smoke and drink?"

"I've never seen a cigarette, but I know he can't drink alcohol. It's not necessary..."

The head nurse felt that they were all her colleagues. Although she was a superior, Zhang Fan was usually very approachable. It wasn't that she was reluctant to give things away, or that she felt that she didn't have enough face after giving things away.

"What do you know! It doesn't matter if you ask someone else to do an examination. In this situation, you listen to me..."

Sometimes people are too complicated. In fact, it is better to be simpler. Just when they were struggling, Zhang Fan had already seen the inspection results on the computer.

"Director Zhao, how is it? How is the head nurse's mother-in-law's physical assessment?"

"It's okay, the anesthesiology department said it can be anesthetized. We don't think there is a big problem here." Old Zhao replied.

"Then prepare for the operation! I will do it myself."

"Okay, Zhang Yuan."

Stomach, digestive tract, to be honest, in the digestive tract, the stomach is actually very solid, just like a car in a certain country, if you take good care of it, it can serve you for a lifetime.

It is not as delicate as other digestive organs. Let’s talk about ulcers. In fact, among the ulcers in the digestive tract, gastric ulcers do not account for a high proportion.

Especially young people, duodenal ulcers are the most common. For example, some young people feel uncomfortable before the meal time, and feel uncomfortable in the stomach. After two bites of rice, it's good!

This is a typical hunger pain! What can't go away is duodenal ulcer. Moreover, this place is particularly prone to ulcers.

There is a reason for this, the stomach has a lot of acid inside, but it has a barrier of bicarbonate on its surface to protect the stomach lining.

But there is no such thing as the intestinal tract. It relies on bile and pancreatic juice to neutralize gastric acid. The gallbladder and pancreas open together in the intestinal tract, and the liquid they secrete is alkaline.

However, there is a distance from the stomach to the opening of the pancreas, and this distance is the place where ulcers are likely to occur, that is, the famous duodenal ulcer.

If you don’t eat on time, if you are hungry, you will be full. If you encounter a delicious meal, you will walk against the wall, and if you encounter something you don’t like, it is called losing weight.

These are the culprits that cause duodenal ulcers.

The stomach is not so delicate, you eat more and eat less, generally it can deal with it. However, if it drinks alcohol and gets angry, it will be afraid, and the most fearful thing is Helicobacter pylori.

Cancer, to put it simply, is actually an inducing factor that causes cells to change quantitatively to qualitatively.

Any cell in the human body may become cancerous, and inflammation is the biggest inducing factor, so doctors have a saying that diseases are nothing more than two categories, either inflammation or cancer.

Helicobacter pylori, in China, is the biggest inducer of gastric cancer.

Some patients said, I have never eaten barbecue, never drank alcohol, and never got angry, but why did I get stomach cancer?

As a result, the previous physical examination report was positive for Helicobacter pylori!

Is this bacteria contagious? Infection, Chinese people have a bad habit. When eating, especially for children, the elderly like to feed the food they chewed to the children.

Children can eat whatever meal they are at any age, eat celiac food and drink milk when they have no teeth.

If you have teeth, let him chew by himself. It is not necessary, let your mouth rich in Helicobacter pylori chew for children!

Also, in order to reflect my enthusiasm and politeness, I insist on serving food to the guests. If the food is served, the other party will not be able to eat it. You must watch the food until the other party eats it.

This is the transmission route of Helicobacter pylori. Most gastric cancers in other countries are caused by other factors.

Most stomach cancers in China are caused by Helicobacter pylori.

Surgical requirements for gastric cancer,

In fact, it is similar to gastric ulcer, maybe slightly more difficult than gastric ulcer.

Many people think that gastric ulcers are nothing. To be honest, if you don’t pay attention to them, once ulcers appear, it will be super troublesome. Sometimes there is no chance to have an operation, even if an operation is performed, it is a super major operation.

Gastric ulcer surgery and gastric cancer surgery are considered high-level surgeries in general surgery.

For example, for refractory gastric ulcer, once surgery is required, in China, the stomach is usually cut. What does it mean, most of the stomach is cut off for you, and the esophagus and intestinal tract are almost directly connected together? .

You can think about the horror of eating a white steamed bun and swallowing it and turning it into a stool. What is even more frightening is that if you swallow half of it and then spit it out, what should you do?

Looking around the world, stomach cancer is quite high in countries that eat too much fish and smoked fish, such as meatball country and Iceland.

Although Maruko Country is a rather weird country, let alone Iceland in terms of gastric cancer, even in the world, people are the best in technology, and they are familiar with it, but Iceland is not familiar with it.

Wanziguo's gastric cancer is good, and endoscopy is also very good. If you think about it carefully, this country is very good at doing dojos in this kind of snail shell, and the small tricks are very powerful.

Hearts change hearts, favors change favors, the head nurse looked at the two cigarettes and two bottles of wine in her hand, and complained to her husband, "You think everyone is the same as you! Our Zhang Yuan is different."

Zhang Fan didn't hear this, because he had already brought Ma Yichen, Zhao Quanping, and Lao Song into the operating room. If he heard this, he would probably be proud for a while.

The difficulty of gastric cancer surgery is not the tumor resection. The stomach is not like the liver. The liver is like a honeycomb with various vascular passages inside. Whether one is done properly is...

The stomach is just a bag of fleshy skin. After the blood supply is ligated, it can be cut. The difficulty lies in the suturing and lymphatic cleaning after the resection.

In the operating room, Ma Yichen was making preoperative preparations. The young man worked hard. When Zhang Fan was working hard, he was also working hard. The technology has improved rapidly, and now it feels like it is a bit of a head in the general public.

"Yuan Zhang, Director Zhao, brush your hands!" the anesthesiologist said to Zhang Fan.

"Okay!" Zhang Fan replied, and went to wash hands with Old Zhao. Old Zhao has been living a very comfortable life recently.

Because the deputy directors didn't rebel anymore, they were all frightened by Zhang Fan, not to mention their high skills, and being so capable, they fainted, and there was probably no one left.

At the beginning of the operation, Zhang Fan was the chief surgeon, Lao Zhao was the first assistant, and Ma Yichen was originally the third assistant, that is, pulling the hook, but I don't know how he and Lao Song secretly mingled, and now Lao Song became the third assistant, and he became the second assistant.

It's hard for Zhang Fan to say about this kind of thing, it can only depend on whether he is enlightened or not.

In tumor resection surgery, the blood vessel ligation is always the same for thousands of years. The blood vessels of the stomach can be divided into two main parts.

How to say the shape of the stomach, it is actually a crescent. For slender people, most of them have thin crescents, and for short and stout people, most of them have fat crescents.

The inside of the crescent is called the lesser curvature of the stomach, and the outside of the crescent is called the greater curvature of the stomach. The blood supply of the lesser bend comes from the abdominal trunk hidden under the stomach. This thing is the thickest blood vessel in the abdomen, and it is the main artery from the heart.

The blood supply to the greater curvature comes from the splenic artery on the side of the stomach.

The old lady's stomach cancer had not penetrated the stomach body yet, but the area was too large, so Zhang Fan decided to have a total gastrectomy.

Zhang Fan dared to do it. There is a saying about cancer that the old, weak, sick and disabled cannot do it, and palliative care is usually chosen.

It means how many days you can live count as a few days! It's not that the doctor is cruel, but that the patient is afraid of dying on the operating table.

After entering the abdomen and stretching it open, Zhang Fan began to ligate the blood vessels. With the sound of the metal clacking of the forceps, Zhang Fan and the others clamped the blood vessels one by one.

The only troublesome thing is that the blood vessels in the greater curvature of the stomach are all covered with yellow coats, that is, they are all hidden in the omentum.

What is the omentum, yellow fat, it is opaque, not stockings. "It should be noted here that no matter how sure you are, you must see it with your own eyes and touch it with your own hands before you can hold it."

While doing it, Zhang Fan told Ma Yichen the key points.

"En!" Ma Yichen listened very seriously.

Lao Song, a passer-by doctor, Lagou, is so envious. He has nothing to do, and he can't do much, because he can't see the surgical field, and this operation is done with his hands, without his brain.

"Hey, Xiaoma is lucky to meet such a good teacher! If only I had such a teacher who taught me by hand."

Lao Song was young, but it was embarrassing. He was seven or eight years younger than the deputy directors. When he entered the department, it happened to be the time when the deputy directors were scrambling to practice.

Therefore, he has been doing appendectomy for many years. At the age of long skills, there is no chance, and the upper limit will not be high in the end.

The blood vessels were ligated, the ligaments hanging from the stomach were separated, and most of the abdominal organs were fixed by ligaments.

Without this ligament, one cannot do strenuous exercise. Otherwise, the kidneys might fall out from the urethra with one ups and downs.

After separation, clamp the esophagus and intestines connected to the stomach body, "Knife!" Zhang Fan said to the equipment nurse.

Scalpel, holding the scalpel, Zhang Fan cut the stomach from the esophagus and intestinal tract directly along the edge of the forceps, and then Zhang Fan reached out with both hands, like holding a watermelon, and took the stomach out of the abdominal cavity.

At this time, looking down from the shadowless lamp, the abdominal cavity became a big hole, and the solitary spleen on the right side and the large blood vessels below were all exposed.

Zhang Fan's level of general surgery can no longer be underestimated. If the surgical field can be described with an adjective, it would be clean! Yes, it is clean.

Almost no blood can be seen, just like using a knife on a rubber doll, this is the level.

Some doctors don't pay attention to small blood vessels, but if there are too many small blood vessels, they become large blood vessels. After an operation, it is like a broken tomato sauce bottle. Not to mention the patient, even he himself is dyed into a red ball.

Just like this, he is still complacent! I'm having surgery! Those who didn't know thought he was killing pigs.

Old Zhao admired Zhang Fan's level very much, and he took out his stomach in his free time.

He said: "Zhang Yuan's surgery is like art, as far as the cleanliness of the surgery field is concerned, it is perfect."

But I didn't talk too much, because the difficulty of surgery came, cancer surgery is difficult, where is the difficulty? Lymphatic dissection.

It can be said that lymph is like yellow sesame seeds sprinkled near blood vessels. When there are many, seven or eight dozen or so gather together, and when there are few, three or four.

Cancer surgery pays attention to cleanliness, because most cancers metastasize through lymph nodes.

If you want the patient to live a few years longer, the lymph must be cleaned up. These things are hidden in the fat.

Not to mention that it is hidden in fat, it also relies on blood vessels to clean up lymph, which is not only slow, but also dangerous.

This thing is either lying on the big blood vessel, or it is hidden near the big blood vessel.

It is probably not dangerous to use a needle during cleaning, but it is estimated that the patient will die after the needle is picked, because it takes too long.

It is to use a curette, an enlarged ear pick, and scrape along the large blood vessels one by one.

It's dangerous, let's put it this way, let alone a large blood vessel like the celiac trunk, a smaller celiac artery is a fatal thing if it is dug out.

This kind of artery is like the head of a snake. Once it is broken, it will not only nourish blood, but its powerful muscles will also retract, which is particularly difficult to serve.

Zhang Fan started digging around the abdominal cavity with a curette.

The force should be quite stable, if it is light, the scraping will not come off, and the scraping will not be clean, and the surgery will be done in vain. If it gets worse, the blood vessels will be scratched, and the surgery is just as useless.

Zhang Fan shaved very quickly, and the patient was too old, so she couldn't hold on for too long. Zhang Fan must be fast.

Crash!

Crash!

Zhang Fan scraped it off one by one, as fast as a greedy fat man scooped up ice cream.

Not to mention Ma Yichen, Old Zhao clenched his hands into fists. It was so frightening. The metal curette is visibly doing things on the thick abdominal shaft, and Zhang Fan is faster than each other.

Old Zhao, who was in a cold sweat, couldn't help looking at Zhang Fan. Although he saw Zhang Fan's expression of concern, he was still worried.

Because Zhang Fan's operation is too fast, he has never seen anyone with such a fast technique.

He wanted to persuade him, but seeing Zhang Fan's slap on his abdominal cavity, his mouth was so dry that he dared not speak.

He was deeply afraid that the most taboo would disturb Zhang Fan.

"It's going to die, it's going to die!" Old Zhao's hands were shaking a little.

But Ma Yichen, who was the second assistant, was excited.

He shouted in his heart, "This is called technology, this is called technology, handsome!"

A newborn calf is not afraid of tigers. Although he knows how dangerous the operation is, Zhang Fan's technique is so handsome.

"I don't know when I can learn this hand!"

Zhang Fan's hand was too steady.

After cleaning the lymph, the inside of the curved plate is like a plate of ice cream with strawberry juice added to the yellow cream. There are even small particles on the surface of the strawberries. The red is blood, and the small particles are lymph. It's so fucking similar.

After cleaning up, Zhang Fan checked again, and then started to sew again. What was sewed up?

The esophagus is sutured to attach the esophagus to the small intestine.

The esophagus has no coat, because it does not have to squeeze together to wriggle like the intestine, so it has no serosa layer on the outside.

The esophagus does not move, so what is used to clean up the residue in the esophagus is saliva. Some people like to spit when they have nothing to do.

Without this layer of coat, it is very troublesome to sew, and it is directly on the exposed muscles.

At this time, the muscles are like wires without insulating tubes, and the steel wires inside are loose.

Doctors with poor skills in suturing, not to mention suturing the esophagus on the intestine, are not bad at cutting the esophagus.

"Line 0! Open the imported absorbable thread." Zhang Fan said nonsense to the equipment.

This line is imported more expensive than domestic ones, the difference is more than ten times, but this line is really easy to use.

Layer by layer of stitches, thread ends flying around Zhang Fan's surgery, the esophagus and intestines were sutured so beautifully. It is as if they had grown together in the first place, and there is no way to see that they were stitched twice.

After suturing, the elevated duodenum must be fixed, because the stomach is missing, if the duodenum is not fixed.

It's terrible, maybe with a cry, one body pulls, the intestines are broken, and then a bloody intestine is spit out from the mouth.

After six hours, Zhang Fan and the others finally completed the total gastrectomy. After the abdominal cavity was closed with sutures, Zhang Fan took a knife and wanted to do something to the severed stomach.

At this time, due to the lack of blood, the temperature has been lost, and the fat on the surface of the stomach has become wet. If it is steaming, it will be like the French meal of pork belly and foie gras.

Open the stomach, and the tumor inside is exposed, just like the nest of heterosexual insects in the movie, the surface is blood vessels, and the inside is rotten like yellow thick phlegm.

"Take it and show it to the family members, and then do a medical examination!"

"it is good."

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