godfather of surgery

Chapter 325 The Threesome

After Song Zimo's meticulous treatment, Yu Shuilian finally did not suffer from liver and kidney failure, her hemoglobin rose above 90g/l, and her biochemistry, liver and kidney functions, and blood coagulation functions were all in the normal range.

The artificial liver and bedside hemodialysis machine that were always on hand were not used, and the wound was kept clean. 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, and it is also applicable in medical activities. A high degree of cleanliness can reduce the occurrence of infection and prevent bacterial colonization and division. This is the same as removing garbage and water and reducing mosquitoes and flies.

As long as the bed sheets are contaminated with a little secretion or excrement, the nurse will change them immediately, and the number of bed sheets is changed more than ten times a day.

If the wound oozes, Song Zimo immediately takes the nurse to change the dressing. Sometimes it takes up to an hour to change the dressing, and the dressing is changed more than a dozen times a day, so tired that the doctors and nurses can't straighten their backs.

For every bit of exudation, Song Zimo will keep specimens for bacterial culture. Once the bacteria are cultured, Song Zimo will accurately use sensitive antibiotics based on the drug sensitivity test to eliminate the bacteria and prevent the infection from escalating.

In order to allow the remaining 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 of Yu Shuilian's ICU treatment process, as a classic case, and repeatedly explained it to the ICU doctors.

What is meant to nip danger in the bud, what is meant to observe in detail, what is meant to see the details and plan ahead, all are explained in this case.

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 take charge of Yu Shuilian's nursing work. Among the three nurses, one is an ostomist who has passed the international ostomy certificate. , 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 get everywhere. The task of the ostomy is to manage Two fistulas on her body.

Another fistula is the cystostomy, which is the current excretion channel for urine.The drainage tubes left in the kidneys and ureters will be removed after the ureteral bladder wound has healed.

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

In the medical team, Song Zimo arranged a few people, because Zhang Lin Xiaowu had to take care of the patients, Song Zimo called Xu Zhiliang and Gao Qiao out, and selected a few graduate students and Gui Peisheng to form a full-time medical team.

In the general orthopedic ward, Yu Shuilian finally saw her husband and son again.

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

"Are you full 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 night, the dishes my father stirs up are either very salty or burnt."

Fu Xiayang was at the side, embarrassed by what his son said, and what his son said was true. These days, he was out of his mind and didn't have any thoughts about doing anything. He was also absent-minded when cooking. fire.

"When mom is well, I'll make something delicious for you." Yu Shuilian touched the child's face, feeling like a knife was twisting her heart.

Looking at her husband at the side, like a child who made a mistake, Yu Shuilian said emotionally: "Thank you, Xia Yang!"

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

"Mom, let me see." The son was about to lift the quilt, and Fu Xiayang immediately held his son's hand.

He was afraid of scaring the child, so Yu Shuilian also winked, telling her husband not to let her son know. The son insisted on watching, and he would find out sooner or later.

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

Not only did the son not scare him away, but he also acted like a little man: "Mom, I'm not afraid. From now on, I will carry you on my back. Wherever you want to go, I will carry you on my back. I will carry you to see the national flag raising and climbing the Great Wall."

"Okay, okay, take your mother to watch the national flag raising and climbing the Great Wall."

Yu Shuilian was so moved that the warmth of her family made her more determined that she must live on and never give up on herself.

"Xia Yang, sometimes you are too busy in the morning, you take him to the breakfast shop next to our shop, or you just let him have breakfast at school, the rainy season is coming, close the windows, especially the closet, Don’t touch the things in the vacuum bag, or they will get damp easily, there is half a black-bone chicken in the refrigerator, you can make some stewed longan and lotus seeds, and eat it with your son.”

Yu Shuilian explained to her husband exactly that, now that she is lying on the bed, she can only move her mouth, and even if she moves her mouth, she can still help her husband a little.

Yu Shuilian really felt distressed seeing her father and father looking helpless and downcast.

Song Zimo, Xu Zhiliang, and Gao Qiao got together and discussed the next step of reconstructive surgery when they had time.

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

But for anal reconstruction, Yang Ping intends to rebuild an artificial anus that can control defecation independently, 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, and decided to pool their wisdom to 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 along the afferent fibers in the pelvic and hypogastric nerves to the primary defecation center in the lumbosacral spinal cord.

At the same time, the afferent impulse is also uploaded to the cerebral cortex, causing the desire to defecate.

When defecation conditions permit, impulses are transmitted through the efferent fibers of the pelvic nerve (parasympathetic fibers), 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 expelled from the body.

In addition, the nerves that control the abdominal muscles and diaphragm are excited, the abdominal muscles and diaphragm contract, the intra-abdominal pressure increases, and defecation is promoted.

If the defecation conditions are not allowed, the cerebral cortex sends out an impulse, which descends to inhibit the activity of the primary center of the lumbosacral region of the spinal cord, inhibits the impulse from being transmitted along the efferent fibers of the hypogastric nerve, increases the tension of the anal sphincter, relaxes the sigmoid colon, and inhibits the defecation reflex.

In this way, the stool is temporarily left in the body, so that it will not be uncontrollable.

Now the patient has no anal sphincter and no rectum. There is no rectal-like receptor in the wall of the sigmoid colon, and the reflex arc cannot be reconstructed. How can we 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 nerve arc.

The patient's nerve arc has lost both receptors and effectors. The two indispensable terminals are gone, and reconstruction surgery cannot be performed at all.

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

"Doctor Song, Doctor Xu, unfortunately, I can't figure out how to do this operation. If I perform this operation, this patient will only have to defecate through an uncontrollable pipe for the rest of his life."

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

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

Xu Zhiliang also shook his head: "I am the same. I boldly imagined taking a part of the bladder sphincter to replace the anal sphincter and then undergoing rehabilitation training. But even if this is possible, what kind of nerve is used to complete the nerve connection for muscle contraction?"

Song Zimo was very happy. Before Xu Zhiliang and Gao Qiao didn't come, did they discuss with Yang Ping?This guy doesn't need to discuss at all, only to listen to his lectures.

Now, with Xu Zhiliang and Gao Qiao, Song Zimo is finally no longer alone, and has someone to start a real discussion with.

"You two, what if a man-made device with electronic components, such as a silicone device, is implanted at the end of the descending colon to complete the mission of the anus? This device can be closed and opened according to certain stimuli? "Song Zimo stared at Xu Zhiliang and Gao Qiao.

"You mean an artificial anus?" Gao Qiao and Xu Zhiliang asked at the same time.

Song Zimo nodded: "Have we gone astray and entered 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 is no less difficult than reconstructing it with human body structure," Takahashi said.

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

Song Zimo, Xu Zhiliang, Gao Qiao, the 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 for such a person who is usually too cold to be able to find a bosom friend.

　The two chapters that were originally promised were suspended due to recent work reasons. The two chapters will be resumed tomorrow, and today they have been posted on the Qidian website and APP. This is the result of everyone's support and love. I must work hard and write a High-quality doctor text, once again express my sincere thanks to everyone!
　　
　
(End of this chapter)