Chapter 646: A Cake

"Pay attention to the bleeding." Ling Ran touched the patient's liver very lightly with his hand.

People in their 70s, even if they have a healthy physical examination, their livers are brittle and hard when cut open. The aging of internal organs, like the aging of skin, is an irreversible change over time.

The skin of young people is rosy and elastic, and the liver is also pink and Q-bomb. When you are old, no matter how much cosmetics and ex-boyfriend masks you use, it is impossible for the skin to return to the level of youth, and the same is true for the liver. .

Ling Ran had to be very careful in order to avoid secondary damage to the liver.

Xu Wen and Zhang Anmin stared wide-eyed, observing the exposed liver. Try to get past the point of possible bleed.

"No."

"No."

The two responded one after another.

Ling Ran said "En", but did not end the inspection immediately, but scanned again seriously.

Medical matters are often complicated in the details.

For example, looking for bleeding spots now doesn't end when you can't find them, nor does it end when you find one or two places, but you have to check that there are no bleeding spots before you can end.

However, the liver is nested in the abdominal cavity and cannot be rotated at will. The psychological burden of inspection is more complicated than the actual operation.

"There is no bleeding. Let's continue." Ling Ran looked up at his watch, 48 minutes had passed, but none of the steps that should be done could be omitted.

If you didn't check for bleeding just now, or if you checked a little bit more briefly, you might be able to save about two minutes, but whether the risk is worth it is another consideration.

The moment the surgeon stands on the operating table, he is constantly making judgment questions. However, the more complicated the operation is, the more difficult it is to make judgment questions. That's why there are all kinds of guidelines, all kinds of evidence-based medicine, all kinds of tree analysis...

This is actually very similar to Go, every move will affect the subsequent development, but how much impact it will have, and which move can be counted depends on the judgment of the player. On the other hand, in order to solve these difficult calculations, various fixed formulas have appeared, such as the big avalanche, the demon sword and so on.

If you use the formula well, allocate your time well, and make basic judgments, you can almost be regarded as a high-level doctor, but if you really want to calculate it, it is only at the level of an amateur player.

To really become a doctor equivalent to a professional chess player, you need to master even more skills.

Ling Ran stopped the bleeding with his bare hands at the perfect level, constantly judging the bleeding point, and even predicting the bleeding.

Whenever the electric knife is picked up, the perfect heat hemostasis technology will play a role again, so that the fragile liver can stop the bleeding without being burned. The judgment of the distance alone is enough to make amateur players call their mothers.

Master-level interrupted sutures are ready for salvage at any time, and when the most important step of liver resection is pre-cutting, the time and strength of sutures will inevitably affect the prognosis of this operation.

At the same time, the master-level liver resection and perfect-level lymphadenectomy are the basic guarantee for the operation.

Partial abdominal anatomy experience, MRI film reading, X-ray film reading skills,

Even the skills of cardiopulmonary resuscitation are techniques to improve the safety of surgery.

At this moment, even the senior doctors in the viewing room could only see Ling Ran handling the operation in an orderly manner, but could not fully understand the difficulty of the operation.

As usual, Ling Ran proceeded step by step according to the established operation. After freeing the various ligaments, Ling Ran also used strips of different colors to suspend the pipeline, thus showing the right front of the right hepatic artery. right posterior...

At this time, if a villain lands on the liver below the right anterior branch, there will be a soft and crisp floor of flesh and blood under its feet, blood may flow out if it is stepped on hard, and a ribbon will be hung on top of its head The flesh and blood pipe trembling tremblingly, may also drop blood drops, and above, there may be huge eyes passing by...

The operation went extremely smoothly.

The operating room and the visiting room are full of calm smiles.

Everyone felt stable, except Xu Wen, who was slightly aware of the difficulty of some operations, and thought to himself: "It is true that "a good fighter has no great achievements", today's operation...

"Blood pressure is rising." The anesthesiologist suddenly shouted, the voice was a little high, like a machine alarm.

Drip, drop, drop.

Then came the machine alarm.

At that moment, if you look at the face of the anesthesiologist, most of you can see a mixture of nervousness and "why am I so unlucky".

However, no one looked to the anesthetist.

All eyes were on Ling Ran.

The chief surgeon is the final decision maker during the operation.

Ling Ran's thinking also paused for a moment.

In a blink of an eye, Ling Ran threw away the equipment in his hand, and ordered in a clear voice: "Don't move, everyone stop."

As soon as the words fell, a fountain of blood spurted out from the abdominal cavity.

The height of the blood spring is not high, like an artesian spring, gurgling up from the liver door.

Xu Wen and Zhang Anmin broke out in cold sweat.

Your sister, a broken blood vessel?

For liver surgery, the most feared thing is the rupture of blood vessels, so whatever you are afraid of, you will come...

In an instant, Zhang Anmin raised his hand, intending to block the blood vessel.

"Don't move yet." Ling Ran's voice came again, stopping Zhang Anmin's movements.

Ling Ran, the chief swordsman, did not strike immediately either.

So, a chief surgeon, two assistants, an instrument nurse, and an anesthetist who just stood up around the operating table all stared at the wound of the patient in the middle, looking at the streams of blood, gushing out...

Ling Ran looked down without blinking.

This is a scene that has never appeared when using Simulator.

Ling Ran did not use the simulator to perform a complete operation, and he had no way of knowing that such a moment would come. In other words, even if he uses a simulator to perform a complete operation, because the anesthesiologists around him are different, he may get different results.

Countless thoughts exploded in Ling Ran's mind.

Why? Why does blood pressure rise? This was the first thought that popped into Ling Ran's mind.

However, Ling Ran did not follow this line of thought. There may be many reasons for intraoperative hypertension, pain, hypoxemia, hypercapnia, or hypothermia, hypervolemia are all possible. However, this Time is not the time to worry about why blood pressure rises. The key to the problem is that bleeding must be stopped in time.

As long as there is no conflict between the cause of increased blood pressure and hemostasis, the problem of blood pressure can be left to the anesthesiologist to deal with.

Immediately afterwards, more questions appeared in Ling Ran's mind.

"Why did the blood vessel burst?"

This question was caught by Ling Ran. He stared at the bleeding hole below, thought and thought, and then slowly opened his mouth: "Zhang Anmin, suck first, from the edge. Don't touch any tissue."

call……

call……

Upstairs and downstairs, there was a sound of relief almost at the same time.

The past five or six seconds were a torment for everyone present. Many thought that Ling Ran was frightened or froze.

Doctors have actually seen or heard similar scenes.

Not every surgeon can bear the pressure of bursting blood vessels and gushing blood.

In fact, Ling Ran rarely had such experience, and the system did not give him similar skills.

However, during the more than a year in the emergency department, Ling Ran has never been under a lot of decision-making pressure.

Amidst the familiar sucking sound of "Kuku...", Ling Ran pointed at the place where the blood was gushing out, and said, "The blood vessels here may be brittle, plus they were eroded by cancer cells and oppressed by other tissues before. Now that the oppression is gone, the blood comes out."

"All the blood vessels...are crisp?" Xu Wen couldn't help but muttered to himself. This concept is actually a bit shocking to a doctor who is a liver and gallbladder doctor.

Only then did the doctors present realize why Ling Ran had repeatedly emphasized "don't move".

If the blood vessels are really brittle, once the hand is pressed, the blood vessel fragments may break into the blood vessels, which can easily cause thrombus in other parts of the body.

Ling Ran stared at the gushing blood flow, and did not stop it immediately, but said steadily: "It doesn't matter if the blood vessel is broken, it can be used if it is sutured, but it is more difficult to suture, and the postoperative medicine is easy to use." Attention. Anesthesiologist, how long will it take to bring down the blood pressure?"

"It will take effect immediately...that...too much blood loss..." The anesthesiologist's scalp was blown up, and the patient's body is too scumbag, it's like tofu, no wonder doctors in other hospitals don't Willing to operate on him.

Ling Ran himself didn't understand anesthesia, and he didn't mean to command. He said "En" and looked at the wound with a steady voice, and said: "Our first half of the operation went well, and it doesn't matter if there is some bleeding now. Okay. There, exposed, tweezers."

The instrument nurse quickly handed the tweezers to Ling Ran.

With delicate movements, Ling Ran clamped a fragment of a blood vessel exposed from the blood.

"Scissors. "

"Okay." Ling Ran put the cut pieces into a small transparent bowl, then dropped the scissors, asked for needle forceps, and started to sew up the blood vessels on the spot.

As the blood pressure dropped, the gushing blood also lost its power, and the blood loss stopped quickly.

"880 milliliters." The anesthesiologist whispered a number.

Ling Ran smiled: "Exceeded expectations, but it's okay."

"It all depends on Dr. Ling's decision in the face of danger." Xu Wen breathed a sigh of relief, and licked it by the way.

Zhang Anmin imitated the senior's tone, and said: "This kind of accident, if you encounter other people, you may die."

The itinerant nurse waited for them to express their licking hearts, and asked, "Do you want to send the cut tissue for inspection?"

"No need." Ling Ran said.

As soon as he finished speaking, the voice of Feng Zhixiang, who was visiting the room, came from the intercom: "Ling Ran, if the cut blood vessel fragments are useless, can you show us?"

"Everyone is more curious, um, academically curious." Zhu Tongyi also said.

Ling Ran then nodded and said, "Send another person to fetch it."

After finishing speaking, Ling Ran continued to perform the operation in silence.

Everyone in the viewing room looked at the high-definition screens in front of them, with curiosity and passion in their hearts.