Chapter 602: Stitching

Looking at the blood in the abdominal cavity, Fang Pingzhu asked Ling Ran in surprise, "Where are you going to sew?"

"B-Lynch suture." What Ling Ran was talking about was a special suture method for the 1st uterus. It was characterized by being simple and easy to perform, and it could preserve the fertility of the 2nd uterus while stopping bleeding.

Ling Ran had only learned this technique by himself, and had never practiced it, nor had he gained experience and skills from the system.

However, Ling Ran's suturing skills are enough to cover his unfamiliarity with the surgery itself.

This is not a very complicated suture method, but the idea is quite ingenious. With Ling Ran's master-level interrupted suture technique, it is very simple to deal with it well.

Fang Pingzhu did not doubt Ling Ran's ability to do b-lynch sutures. A doctor who can be called by this name, as long as he is not a rookie, can perform proper suturing operations without any problem.

The difference between high-end doctors and low-end junior doctors is that junior doctors know nothing, so when they see unfamiliar surgical procedures, they not only need academic methods, but also learn every step of the operation. High-end doctors are only good at surgery. After learning the method, it is not difficult to operate. Many scholars participated in an international conference and were amlied with a certain surgery. Then they can do it at home to see the effect.

Of course, some complicated ones can be done on the dog first, and the simpler ones, or just mutations, can be done directly, and there is no need to sacrifice a dog.

In fact, such as b-lynch suture, which means that the front and rear walls of the uterus are sutured and pressurized, which can not only stop bleeding, but also help preserve fertility, and there is nothing special about it.

However, Fang Pingzhu does not think that it is appropriate to suture the third uterus now.

Fang Pingzhu sorted out his mood, and said as calmly as possible: "Doctor Ling, if you suspect bleeding from the 4th uterus, the safest thing to do now is to remove the 5th uterus. The patient already has a child."

"The effect of suturing with b-lynch is the same as that of hysterectomy. Moreover, the prognosis of suturing is better." Ling Ran insisted on his own opinion.

The effect of b-lynch stitching is of course better. Although the most important function of the 5th uterus is fertility, it also affects women's endocrine system. To put it simply, after the hysterectomy, women will enter menopause instantly, and the series of consequences brought about by this are often difficult to predict.

In terms of prognosis, this is certainly not a good thing.

Speaking of his profession, Fang Pingzhu still shook his head, and said in the words just now: "Shouldn't you save your life first? Save your life first and then treat the disease.

"

"The effect of b-lynch suture is not bad, and it can save your life."

"But you're not sure about the extent of the internal bleeding, maybe it's outside the stitches?"

"The chance is very low." Ling Ran pondered for a few seconds, and then said: "The amount of bleeding is already very large, if b-lynch sutures can't stop the bleeding, I don't think it's okay to have an extra one or two hundred milliliters of blood The difference. It won’t be too late to remove the 6th house.”

Fang Pingzhu had to admit that Ling Ran was right. If you ask the patient, let alone one or two hundred milliliters of blood, even if there is an extra 1000 milliliters, the patient is probably willing to try it in order to preserve the 7th uterus.

However, this is not in line with the habits of doctors.

In places like obstetrics, if there is a problem with the uterus, the 8th uterus is removed. No one will make one operation into two operations, just to allow patients to try it.

On the bright side, doctors are decisive and confident that they have made good judgments. And from the not-so-good side, hospitals, like other industries, have dark sides that are not so glorious, and when these dark sides involve people, it often makes people feel that hospitals are bottomless...

Fang Pingzhu is not black, but after 30 years of working as a doctor, how to do things and the process of doing things have already been deeply rooted in his bones.

Fang Pingzhu didn't worry about suturing or excision anymore, but said slowly: "You still can't be sure it's the blood loss in the uterus."

This is back to the problem of diagnosis and diagnosis.

The reason why she always collects blood from pregnant women who have lost blood for examination is actually to diagnose amniotic fluid embolism.

Diagnosis is guesswork, diagnosis is medicine.

However, I can't be sure, it's just Fang Pingzhu's concept.

Ling Ran said decisively: "There is no bleeding in the abdominal cavity, it must be intrauterine bleeding."

Fang Pingzhu looked at the accumulated blood in the abdominal cavity and sighed, "How can you be sure that there is no bleeding in the abdominal cavity just by touching it once? There are many bleeding points that are covered up."

This is also a natural idea. For most doctors, the exposed bleeding points may not be found, let alone the unexposed ones.

Ling Ran didn't argue with her about his own judgment, but changed his angle and said, "The patient's uterine contraction is very poor. This should be an indicator."

Different organs will show blood loss, Fang Pingzhu doesn't know anything else, Zigong is very familiar with it.

Now being reminded by Ling Ran, Fang Pingzhu immediately started to press on the bottom of the palace.

"The contraction is relatively weak, but..." Fang Pingzhu still hesitated.

To be honest, if she had a hysterectomy, she would probably do it, but she would rather not have a B-Lynch suture. Because the only explanation for B-Lynch suture is intrauterine bleeding, and functional bleeding cannot be diagnosed 100% now, and there is even the possibility of amniotic fluid embolism. Therefore, there is a risk of misdiagnosis when doing B-Lynch suture.

On the contrary, if a hysterectomy is performed, the patient's bleeding stops, and she can explain the intrauterine bleeding and remove it. The bleeding didn't stop, and she could explain other complications, anyway, the evidence had been cut away.

Ling Ran didn't know these doctors' little tricks of self-protection, and he didn't seek to reach an agreement with each other through verbal communication.

In Ling Ran's experience, the gap in understanding between people is huge. Between unfamiliar people, the efficiency of verbal communication is low enough to kill 300 bleeding people.

"Increase the suction speed, and expose the surgical field." Ling Ran gave the order self-consciously.

Fang Pingzhu stepped aside without saying a word, completely giving up the right to be the chief swordsman, and also giving up the responsibility.

Ling Ran didn't wait for the hemoperitoneum to be completely emptied, so he took the needle-holding forceps, cut into the anterior wall of the uterus, pulled it directly to the fundus of the uterus, and then circled to the posterior wall...

Although it is an unfamiliar surgical procedure and unfamiliar organs, Ling Ran is so familiar with abdominal anatomy that when he lifts the uterus, he is as proficient as lifting the gallbladder—the liver is still not comparable, he Hundreds of livers have been made, and they are more familiar.

"Intra-abdominal bleeding of 1,800 ml." The female doctor who was the second assistant was automatically upgraded to the first assistant, and finally sucked up the blood in the abdominal cavity.

The big bottle next to the operating bed was half full of thick blood, like a secret treasure of an old wizard.

With an "en" sound, Ling Ran sewed a figure 8 on the front wall, and said, "Pay attention to the liquid and crystal supplements."

"Yes. 1,000 ml of colloid, 2,000 ml of crystalloid, and 400 ml of plasma have been transfused..." the female doctor reported. For these details, some chief surgeons like to master them by themselves, while others will delegate power to subordinate doctors.

Fang Pingzhu said on the sidelines at this time: "You can inject carboprost trometamol into the uterus, which is beneficial for postpartum hemorrhage..."

"Yes." After being reminded, Ling Ran agreed, and then began to tie the stitches.

The B-Lynch suture is complete.

All the people in the operating room set their sights on the wizard bottle.

"It seems that there is still bleeding." The female doctor whispered.

"Observe again." Ling Ran's expression was relaxed. The amount of bleeding at this time was already very small. Even if there was still bleeding, it would be a big deal to cut the uterus again. It was nothing more than wasting a few sutures. .

The few people present were stunned for a moment, and soon realized that the bleeding was under control, which is already a great thing.

Jingle Bell.

The phone in the operating room rang.

The itinerant nurse went to pick it up, turned her head, and said, "Director Fang. No evidence of amniotic fluid embolism was found."

If there is amniotic fluid embolism, there should be signs of vellus hair in the venous blood collected many times, which is the most direct pathological evidence.

Fang Pingzhu said "En", without any expression change.

Amniotic fluid embolism is a low-probability event, and it has attracted such attention mainly because of the high mortality rate. It is also because of the emphasis that amniotic fluid embolism has dropped from about 90% before to 60% now. The mortality rate of amniotic fluid embolism in Yunyi Obstetrics Department was 30% before, which is so much better than the average level. It all depends on the screening of each case...

"The bleeding has stopped." The anesthesiologist reported again.

Fang Pingzhu was stunned, and couldn't help but let out a sigh of relief, but the first thing that came to her mind was: In the future, if something happens to her family, she should go to Ling Ran first.