"Pay attention to the bleeding." Ling Ran used his hand to touch the patient's liver very gently.
Even if a person in his seventies had a healthy physical examination, his liver would still be brittle and hard when cut open. The aging of the internal organs was the same as the aging of the skin. It was an irreversible change with time.
Young people's skin was ruddy and elastic, and their livers were pink and bouncy. When they were old, no matter how many cosmetics and ex-boyfriend masks they used on their skin, it was impossible for their skin to return to how it was when they were young. It was the same for the liver.
Ling Ran had to be very careful to avoid secondary damage to the liver.
Both Xu Wen and Zhang Anmin widened their eyes and observed the exposed liver. They tried to go beyond the possible bleeding points.
"No."
"No."
Both of them answered one after another.
Ling Ran hummed in acknowledgment. He did not immediately end the examination. Instead, he seriously scanned the liver again.
Medical matters were often complicated in the details.
For example, looking for bleeding points now did not mean that they would end the examination if they could not find them. They also did not mean that they could end the examination after finding one or two bleeding points. They had to check that there were no bleeding points before they could end the examination.
However, the liver was in the abdominal cavity and could not be moved at will. The psychological burden of the examination was more complicated than the actual operation.
"There's no bleeding. Let's continue. " Ling Ran raised his head and looked at his watch. Forty-eight minutes had passed, but the necessary steps could not be omitted.
If they did not check for bleeding or did not check for bleeding points just now, they might be able to save about two minutes. However, whether the risk was worth it was another consideration.
The moment the surgeon stood on the operating table, he would be constantly making judgments. However, the more complicated the surgery was, the more difficult it was to make judgments. That was why there were all kinds of guidelines, evidence-based medicine, and tree-like analysis …
This was actually very similar to Go. Every move would affect the subsequent development, but how much of an impact it would have and how far it could be calculated would depend on the judgment of the player. On the other hand, to solve these difficult calculations, there were all kinds of formulas, such as the Big Avalanche, Demon Blade, and so on.
If they used the formulas well, allocated the time well, and made the basic judgment well, they could almost be considered as a senior doctor. However, if they really wanted to calculate, they were only at the level of an amateur player.
If he really wanted to become a doctor who was equivalent to a professional Go player, he would need to master even more skills.
Ling Ran used Perfect Level Barehanded Bleeding Control to continuously determine the bleeding point and even predict when it would bleed.
Every time he picked up the endotherm knife, the Perfect Level Hemostasis by Heat would come into play, allowing the fragile liver to stop bleeding and not burn. Just the judgment of distance was enough to make an amateur player cry for his mother.
His Master Level Interrupted Suture Technique was always ready to be used to remedy the situation. When it came to the most important step of hepatectomy, which was to make the pre-cut line, the time and strength of the suture would inevitably affect the prognosis of the surgery.
At the same time, Master Level Hepatectomy and Perfect Level Lymphadenectomy were the basic guarantee of the surgery.
Experience in regional abdominal dissection, reading MRI scans, X-ray scans, and even cardiopulmonary resuscitation were all techniques that could improve the safety of surgery.
At this moment, even the senior doctors in the visitation room could only see that Ling Ran was handling the surgery in an orderly manner, but they could not fully understand the difficulty of the surgery.
Ling Ran carried out the surgery step by step according to the established procedures as usual. After dissociating each ligament, Ling Ran also used strips of different colors to suspend the tube, thereby showing the right anterior and right posterior branches of the right hepatic artery …
At this time, if a small person were to land on the liver below the right anterior branch of the right hepatic artery, its feet would be on a soft and brittle floor of flesh, and if it stepped on it with force, it might bleed. Above its head would be a tube of flesh that was suspended by colorful strips, and if it trembled, blood might drip down. Above its head, there might be a huge eye that would pass by …
The surgery went extremely smoothly.
The operating theater and visitation room were filled with calm smiles.
Everyone felt that the surgery was stable. Only Xu Wen slightly noticed some of the difficulties in the surgery, and he thought, 'It's true that a good fighter has no illustrious achievements. Today's surgery …'
"High blood pressure," the anesthetist suddenly shouted. His voice was a little sharp, and it sounded like a machine's alarm.
* Beep, beep, beep. *
Right after that was the sound of a machine's alarm.
At that moment, if anyone looked at the anesthetist's face, they would mostly see a mixture of nervousness and "why am I so unlucky?"
However, no one looked at the anesthetist.
Everyone's gaze was directed at Ling Ran.
The chief surgeon was the final decision maker in the surgery.
Ling Ran's thoughts also paused for a moment.
In the blink of an eye, Ling Ran threw away the instrument in his hand and ordered clearly, "Don't move. Everyone, stop."
As soon as he finished speaking, a fountain of blood gushed out of the abdominal cavity.
The fountain of blood was not high, and it bubbled up from the hepatic portal like a self-flowing spring.
Xu Wen and Zhang Anmin broke out in cold sweat.
'F * ck, a ruptured blood vessel?
The scariest thing in liver surgery was ruptured blood vessels, and what they feared the most happened … '
In an instant, Zhang Anmin raised his hand and wanted to block the blood vessel.
"Don't move first." Ling Ran's voice was heard again, and he stopped Zhang Anmin's action.
The chief surgeon, Ling Ran, did not immediately move.
Hence, the chief surgeon, two assistants, a scrub nurse, and an anesthetist who had just stood up stiffly stared at the patient's wound in the middle of the operating table. They watched as streams of blood gushed out of the wound …
Ling Ran looked down without blinking.
This was a scene that had never happened when he used a Sim.
Ling Ran did not use a Sim to perform a complete surgery, and he did not know that this would happen. In other words, even if he used a Sim to perform a complete surgery, the results might be different because of the different anesthetists around him.
Countless thoughts exploded in Ling Ran's mind.
'Why? Why did blood pressure rise? ' This was the first thought that popped up in Ling Ran's mind.
However, Ling Ran did not follow this train of thought. There could be many reasons for intraoperative hypertension, such as pain, hypoxemia, hypercapnia, hypothermia, or excessive blood volume. However, this was not the time to think about why blood pressure rose. The key to the problem was that the bleeding must be stopped in time.
As long as there was no conflict between the cause of blood pressure rise and hemostasis, the problem of blood pressure could be left to the anesthetist.
Then, more questions popped up in Ling Ran's mind.
'Why did the blood vessel rupture?'
This was a problem that Ling Ran had grasped. He stared at the bleeding wound below and thought for a while before he slowly said, "Zhang Anmin, aspirate from the side first. Don't touch any tissue. "
* Phew … *
* Phew … *
Sounds of relief came from upstairs and downstairs almost at the same time.
The past five or six seconds were torture for everyone in the operating theater. Many people thought that Ling Ran was scared or frozen.
In fact, the doctors had seen and heard of similar scenes quite often.
The pressure of a ruptured blood vessel and blood gushing out was not something that every surgeon could withstand.
Ling Ran rarely had this kind of experience, and the system did not give him a skill like this.
However, in the more than one year in the Emergency Department, Ling Ran had always been under a lot of pressure to make decisions.
Amid the familiar sounds of "ku ku …", Ling Ran pointed at the spot where the blood was gushing out and said, "The blood vessels here may have become brittle. Furthermore, they were eroded by cancer cells. Previously, they were pressured by other tissues. Now that the pressure is gone, blood gushed out."
"The blood vessel … is brittle?" Xu Wen could not help but mutter to himself. This concept was actually a little shocking to doctors who worked in the field of hepatobiliary and pancreatic surgery.
The doctors in the operating theater only realized at this moment why Ling Ran had repeatedly emphasized not to move.
If the blood vessel was really brittle, the blood vessel fragments might break into the blood vessel when the hand pressed on it, and it could easily cause thrombosis in other parts of the body.
Ling Ran looked at the blood gushing out, but he did not immediately stop it. Instead, he said steadily, "It's okay if the blood vessel is brittle. It can still be used after suturing it. It's just that suturing is more difficult, and you have to pay attention to the medication after the surgery. Anesthetist, how long do you need to lower the blood pressure? “
"It's going to take effect soon … Um … the blood loss is too much …" The anesthetist's scalp was about to explode. This patient's body was too weak. It was no wonder that the doctors from other hospitals were not willing to perform surgery on him.
Ling Ran did not know how to anesthetize himself, and he did not intend to give orders. He hummed in acknowledgment and looked at the blood gushing out of the wound. He said, "The first half of the surgery was very smooth, and it's okay if you bleed a little now. Alright, it's exposed. Tweezers. "
The scrub nurse quickly handed a pair of tweezers to Ling Ran.
With nimble movements, Ling Ran picked up a piece of blood vessel that was exposed from the bloodstains.
"Scissors."
"Done." Ling Ran put the cut fragment into a small transparent bowl. He then threw away the scissors and asked for a needle holder. He started suturing the blood vessel on the spot.
As the blood pressure decreased, the gushing blood also lost its power, and the blood loss quickly stopped.
"880 milliliters," the anesthetist whispered a number.
Ling Ran smiled. "It exceeded expectations, but it's okay."
"It's all thanks to Doctor Ling's decisiveness in the face of danger." Xu Wen breathed a sigh of relief and flattered him.
Zhang Anmin imitated the tone of a senior and said, "If this kind of accident happened to other people, they might have died."
The circulating nurse waited for them to express their flattery before she asked, "Do you want to send the cut tissue for examination?"
"No need," Ling Ran said.
Right after he finished speaking, Feng Zhixiang's voice came from the walkie-talkie in the visitation room. "Ling Ran, if the cut blood vessel fragment is useless, can you let us take a look?"
"Everyone is more curious. Yes, academically curious," Zhu Tongyi also said.
Ling Ran nodded and said, "Send another person in to get it."
After he finished speaking, Ling Ran continued to carry out the surgery in silence.
The people in the visitation room looked at the high-definition screen in front of them. They were curious and passionate.
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