Chapter 421: Card Break

"Puff up, hurry up." Ling Ran's order was clear and precise.

Removal of the right lobe of the liver is an absolute major operation in any hospital of any grade. Everyone in the operating room is excited and nervous.

Comrade Huo Congjun, who was still brushing his hands outside the door, was nervous, not to mention excited.

But he didn't wash his hands clean, and it was useless to go in, so he could only ask loudly: "What's the situation now?"

"The blood flow has been blocked with the prgle technique." Ling Ran replied.

The prgle maneuver is the most commonly used hepatic blood flow occlusion method in surgery, and it is also the easiest method. The breakpoint is at the hepatic hilum and hepatic pedicle, but it cannot completely control the hemorrhage at the section.

Considering the warm ischemic injury of the liver, blocking the blood flow for one hour is the limit. In the county hospital, the doctors in the emergency department did not dare to use this method even if they watched the patient continue to lose blood. Because there is no follow-up, using the prgle technique can only cause greater damage.

Huo Congjun was also full of doubts.

However, he couldn't convey his worries to Ling Ran outside the door.

In emergency surgery, sometimes the worst decision is better than no decision. Huo Congjun could only raise his voice to release his worries: "What about now?"

"The amount of bleeding is decreasing." Ling Ran paused, and then said: "The condition of the liver is very bad, it's too late for a normal right hemihepatectomy."

Huo Congjun thumped in his heart, and asked, "How bad is it?"

"Hemoglobin is 16, blood pressure is 45, and it's still dropping." Ling Ran answered very quickly, and he himself was thinking while looking at the monitor.

A few seconds, if it is used to solve the problem, this is the shortest time, but on the operating table, in the emergency operation, a few seconds is enough to make everyone doubt.

Lu Wenbin, Yu Yuan, and Zuo Cidian looked at Ling Ran at the same time, with the same sentence in their eyes: What should we do now?

For them, the main knife is the backbone.

Everyone knows how to suture, cut, and use instruments. However, where to suture, where to cut, and where to use instruments, they all need the guidance of the chief surgeon.

Ling Ran's brain was spinning rapidly.

He was thinking of one plan after another.

Ordinary right hemihepatectomy does not need to be considered. Normal regular hepatectomy takes one and a half hours. This patient may not even be able to wait for 15 minutes.

So, what about simple repairs and then resection?

Looking at the exposed field of vision, Ling Ran didn't feel that there was any plan that could be executed within a few minutes.

"How's the situation?" The one who spoke this time was a hepatobiliary surgeon who hurried over.

"Where's He Yuanzheng?" Huo Congjun asked the director of the Department of Hepatobiliary Surgery.

The little attending took the time to brush his hands, and said again: "A patient had a sudden biliary tract hemorrhage and entered the palace for the second time. Director He went to do it, and several other directors are also undergoing surgery."

The prognosis of liver surgery has always been a difficult problem, and it must be dealt with urgently.

Director Huo curled his lips, glanced at the little attendant who he didn't know very well, and felt that he was really not as good as his own Ling Ran.

"Hemoglobin 14...12." Su Jiafu yelled loudly as a reminder.

Ling Ran's face still couldn't tell, Huo Congjun outside the door was already anxious: "Why did you fall so fast?"

"The liver injury is serious, and the stuffed gauze won't work." Ling Ran replied.

"Then why are you in a hurry to remove the stuffed gauze?" The face of the little attending doctor outside the door also changed, the value is so low, if not, he will die.

Huo Congjun glanced over from the corner of his eyes: "The stuffing didn't work to stop the bleeding. If you don't remove the gauze, the inside will be washed away. Now is the time to race against the clock. Do you have confidence in the blood loss of 11,000 milliliters?"

"Ten thousand?" The little attendant stopped brushing his paws.

"Eleven thousand, it is estimated that the blood loss is almost twelve thousand." Huo Congjun snorted and asked, "Are you sure?"

"Director Huo,

It's been two rounds of blood changes all over my body, I..." How can the little attending doctor dare to say something with confidence.

"I'm starting to separate the right half of the liver now." Ling Ran shouted loudly. This is for notification. He is now the chief surgeon in the operating room and has the greatest clinical power. He can't see the situation outside, and the condition of the patients inside is getting worse the longer they wait, and the lower the probability of survival. .

Huo Congjun didn't even put on his surgical gown now, and he didn't even get angry when he saw the shrinking look of the little attending surgeon next to him. What he looked down on the most was this kind of irresponsible doctor.

The doctor was standing on the operating table, fighting for his life back from the Hall of Yama. If he was afraid of wolves and tigers, what could he do?

Recalling the liver surgery that Ling Ran had just done with himself, Huo Congjun shouted outside the door: "First judge whether there is any damage to the hepatic vein, and then divide the round ligament and hepatic falx ligament..."

Ling Ran didn't mind Huo Congjun's explanation, if a novice was in the operating room now, he would probably be very grateful.

Of course, if you change to a novice, you may not even be able to find the round ligament and falx ligament of the liver.

Huo Congjun has taught countless novices, and he was also worried that Ling Ran would be nervous for a while and commit a novice's mistake, so he continued: "You first look for the hepatic falx ligament, and then follow the portal vein..."

The little attending surgeon of the hepatobiliary surgery was frowning, he was really timid, so, listening to Huo Congjun's words, knowing that Huo Congjun asked Ling Ran inside to do the surgery, he didn't make a sound.

He is also not happy to have one more death under his command.

At that time, the death discussion alone will kill people.

However, the junior head of the hepatobiliary surgery department was not optimistic about Ling Ran either. He did know Ling Ran, and Dr. Yun probably knew that no one knew about him, but the bleeding volume of 11,000 milliliters was just a joke. The current record of the highest amount of blood transfusion in Yunyi is a pregnant woman with amniotic fluid embolism, who transfused more than 18,000 milliliters of blood. However, the director of the gynecology department used all the strength of the whole department to rescue him, and even used his personal relationship to get the blood. The feat, and then the pregnant woman with amniotic fluid embolism, was not so lucky.

The little attendant of the hepatobiliary surgery department has no lack of malicious conjectures. The patient in front of him is sent from another county, and the blood bank of the local blood station is probably in a hurry...

"The round ligament and hepatic falx ligament are severed." Ling Ran's voice came from inside the door.

"Untie it?" Xiao Zhizhi was surprised.

Before he had any more thoughts, Ling Ran's voice came again: "The perihepatic ligament is separated."

"The upper and lower veins are not dissociated."

"Deactivated liver tissue excised."

The voice came from the inside sentence by sentence, with a calming momentum.

Huo Congjun finally washed his hands, stepped on the airtight door and entered, and saw Ling Ran on the operating table, holding the patient's ruptured liver in his right hand, using his fingers and the handle of the knife, along the edge of the laceration, to remove the inactivated and blood The poorly transported liver tissue was broken piece by piece.

From a layman's point of view, this kind of action can be called rough, but Huo Congjun and the little attending surgeon of the hepatobiliary surgery were all stunned.

"Now the university has started to teach this?" The little attendant was dumbfounded.