The road to the rise of great doctors

Chapter 24 Some people want to have recanalization, and some want to get sterilized

Liu Dong sat on a round stool in the operating room, savoring the operations he had participated in in the morning.

Compared with microscopic surgery, surgery under direct vision is almost a basic skill that every surgeon must be exposed to.It can be said that any surgeon will more or less perform operations under direct vision.

However, all surgical operations have one characteristic. Once the level of detail increases, the difficulty and requirements increase gradually.

For example, skin mass resection may be an operation experienced by all surgeons, each dealing with superficial tumors within their own anatomical scope, such as general surgery, orthopedics, urology, dermatology, etc.This type of surgery is less difficult.However, microsurgery or other operations performed with instruments, such as microscope, laparoscopy, arthroscopy, robotic surgery, etc., require a certain period of training. The training is adjusted from open surgery mode to eyes and hands (instruments). hand-eye coordination.

The surgery Liu Dong first encountered was conventional open surgery, and it was performed under direct vision.These are all things that surgeons come into contact with at the entry level. From this form, they begin to adapt to the structure of the human body and reflect each other with what they have learned about anatomy.

In microsurgery, what Liu Dong can do is actually very limited. Although he is an assistant, the operation is mainly completed by the surgeon alone. Here are the key steps.

However, participating in a new form of surgery gave Liu Dong a great touch and some excitement.Thinking about it, I have only been in clinical practice for a short period of time, and my experience is quite rich.The future development path is also starting to become clear.

"What are you thinking about?" Song Wei touched Liu Dong and then said, "The patient has been brought in. Once the anesthesia starts, you will brush your hands and go on stage."

"Okay, follow Teacher Song's instructions." Liu Dong raised his head and replied, then took the case and looked at it.

This patient is 28 years old. He has been married for 2 years without using contraception, but his wife has never been pregnant.So the couple went to the Medical College Affiliated Hospital together for a checkup.After the man arrived at the urology department, tests on male secretions revealed that there were no male germ cells. The outpatient doctor at that time was Song Wei.

He asked the patient if the lower part had ever been swollen before, and the reply was, "I had bilateral epididymitis before."

Male germ cells are produced from eggs, transported through the epididymis and vas deferens, discharged to the urethra through the ejaculatory duct, and then excreted out of the body along the urethra.The epididymis is an organ next to the eggs. Inflammation here will affect the discharge of male germ cells.

Song Wei checked the patient's multiple examination results. According to the medical history, the physical examination found that it was indeed a bit induration, and the preliminary diagnosis was "obstructive asexual germ cell disease".After an in-depth conversation with the patient, the proposed treatment plan was microscopic vaso-epididymistomy.

The patient entered the operating room, and after the anesthesiologist administered anesthesia, Song Wei and Liu Dong brushed their hands and went on stage.

During the operation, we first followed the established plan to confirm that the eggs were indeed capable of producing male germ cells. In other words, we clearly found full seminiferous tubules under the microscope and confirmed the presence of active male germ cells. .Therefore, it can be produced but not excreted out of the body. The problem lies in the transportation road.

Next, free the part of the vas deferens and inject dye and saline into the end of the vas deferens far away from the egg. You can feel that there is no resistance, and you can also see that the color of the urine bag turns blue, indicating that the injection site is unobstructed to the urethra. of.It was further verified that the location of the pipe blockage was above the injection site.

Then, gradually dissociate, and find under the microscope a section of the epididymal tubule that is tortuously expanded. The reason for the tortuous expansion is that the blockage below has "stretched" the blocked upper section.After finding the site of obstruction, the dilated epididymal tubules were opened under a microscope, and the fluid was extracted with a special needle and sent off the stage. After processing, the technician found viable male germ cells under the microscope under the stage.This shows that there is "goods" in the dilated epididymal tubules.

Then comes the critical step—epididymis-vas deferens anastomosis.This step is very difficult.

why?The vas deferens is a muscular tube with thick walls and a small cavity, about 30-35cm long, with one on each side but different lengths.The intraluminal diameter of the vas deferens is 0.2-0.35mm, and the outer diameter has nothing to do with the inner diameter.

Such a small cavity must be sutured together with the equally small epididymal cavity, which particularly tests hand-eye coordination and skill.

I saw Song Wei carefully sewing, placing the sutures in order, and telling Liu Dong to cooperate carefully and not to move casually.

Finally, the anastomosis of the epididymal duct and the vas deferens was completed using the industry-recognized longitudinal incision and insertion anastomosis method.

"The success of the operation now does not mean that the pregnancy will be smooth in the future. But this at least gives the patient the qualification and opportunity to conceive naturally." Song Wei said with emotion, and then said: "You still need to stay in bed for a period of time after the operation, because the pipeline is too tight." If it is too thin, if the range of motion is large, the tension on the thread may be greater, and the anastomosis may not grow properly.”

Today's surgery went very smoothly, and Song Wei was very chatty. He introduced his experience in related diseases and said: "This patient has obstruction, so this surgery solved his problem. But some patients are born with congenital If the sexual vas deferens is not developed or is missing, then assisted reproductive technology can only be used to realize the desire to become parents.

"After I gave birth to the child, I had a sterilization. Later, the child died in an accident or became ill, and I wanted to have another child. I went to the hospital where the sterilization was done before to see if there was any way. There is also a way now, just like This operation is the same, but the longer the ligation takes, and if a section of the vas deferens is cut off and the length is not short, the possibility of reconnecting it will be reduced, or even impossible.

"So, a vasectomy is done with great caution."

While cooperating, Liu Dong seized the opportunity and raised his own question: "Does anyone still do sterilization now?"

Song Wei smiled and said: "Yes, it is true that some people want to have a sterilization after sterilization, and some people want to have a sterilization as soon as they have a child. For young people with few children, I always advise them to use sterilization first." There are many places where you can get condoms and other methods of contraception for free."

During the conversation, Song Wei had already finished stopping the bleeding.It was left to Liu Dong to suture the skin subcutaneously.

While assisting, he continued: "But there are still people who want to get sterilized once and for all. You may have heard that women can have fallopian tube ligation, and men can also have vasectomy, both of which are effective birth control methods. There is a problem with them, and that is to think about it again. The success rate of recanalization is not 100%. The surgical method of vasectomy is direct vision forceps vasectomy, which is also the currently recognized gold standard approach for vasectomy. The overall difficulty is not high, and it can be done under local anesthesia.

"Applicable to married men who voluntarily request vasectomy without contraindications. However, considering that reversal surgery or assisted reproductive technology treatment is expensive and has uncertain success, it is usually not a realistic option in most areas, so it is Make it clear to the patient repeatedly, emphasizing the permanence of the surgery.

"Furthermore, contraception is not available immediately after the operation. There is still a stock in the tube. Generally, contraception is maintained for 3 months after the operation, or the most reliable method is to stop after the male secretion test confirms that there are no male germ cells. Use other contraceptive methods. If there are still male germ cells after 3 months, then recheck again in 6 weeks. If there are no male germ cells in the recheck, it is the beginning of peace of mind about not using contraception.

"Sometimes I read reports that people got pregnant despite having vasectomy. It's just that those patients didn't listen. After recovering from the surgery, they started to be unrestrained. It would be strange not to get pregnant."

While talking and laughing, Liu Dong completed the suturing, bandaged it with appropriate pressure, and lifted the egg tray.She also put on tight underwear.

(End of this chapter)