Chapter 799 In a Deadlock!

The power that a person explodes when he twitches is quite impressive.

It took a lot of effort for three or four people to control the old man!

Before long, the role of stability also began to play.

The patient is quiet here.

However, that doesn't mean it's safe.

Here, a doctor in the second group kept explaining the patient's condition.

"Patient, male, 72 years old, recovering from subtotal gastrectomy, unknown cause of convulsions, past history of hypertension, diabetes... Oral..."

Hearing the patient's words, Hou Rong's face was gloomy.

The patient has a history of hypertension, but the blood pressure at this time is less than 80mmHg, which means that such blood pressure is difficult to provide the patient with an adequate blood supply.

The human body has a tolerance function for many situations.

Some people's blood pressure is as high as 170, 180 and they don't feel any discomfort at all, while some people's blood sugar exceeds 33.3 and can't see any abnormality.

This is how the human body has tolerated this abnormal environment.

So at this time, the patient's systolic blood pressure is only 80, which has brought shock!

Here, after the patient's condition was stable, Hou Rong hurriedly transported the patient to the operating room to complete the esophagus repair operation in time. After all, at this time, the esophagus ruptured, and a large amount of bleeding would definitely flow into the chest cavity.

Stop the bleeding!

Repair the esophagus and trachea.

Clears the blood in the chest cavity to prevent further infection from developing.

This is the best thing to do right now.

And here, Hou Rong is still thinking about a question, why does the patient have epilepsy?

Where is the reason?

But now the situation is urgent and time is limited, so there is no longer any delay.

The patient originally had gastric cancer. Could it be brain metastasis?

Thinking of this, Hou Rong couldn't help but have a headache.

And Chen Cang said at this time: "Director Hou, could it be a cerebral hemorrhage?"

In a word, Hou Rong woke up immediately.

Yup!

The patient has a history of hypertension, will it be cerebral hemorrhage?

It's definitely too late to do CT, and the time for CT may be lost. In that case...it's definitely not appropriate.

Thinking of this, Hou Rong performed a meningeal irritation test, and sure enough!

positive!

Of course, a positive meningeal irritation sign does not necessarily mean cerebral hemorrhage, but it is possible.

But now, the patient must have surgery, otherwise, let alone cerebral hemorrhage, the ischemia will be gone!

Here, the blood transfusion department has completed the distribution of blood and sent it directly.

A group of people pushed the patient and walked directly towards the operating room.

Chen Cang also followed directly.

After all, it's about your own task, so you can't ignore it.

Moreover, Chen Cang felt that this patient did not seem to be as simple as he imagined.

After anesthesia, the surgery begins.

After passing through the neck opening, the esophagus, trachea, nerves... are all exposed to everyone's field of vision.

However, it is precisely because of this that everyone is shocked to see the poor neck condition!

At this time, the patient's esophagus was damaged in many places, the wound was irregular, and the condition of the entire esophagus was very poor!

Generally speaking, the success or failure of the treatment of esophageal perforation depends on the location of the perforation, the size of the tear, the time of diagnosis, and whether the treatment measures are appropriate.

And the situation like this old man is obviously a very poor situation!

Not only are there many cracks, but the damage is also irregular. If it is not sent to the emergency center in a timely manner, once it exceeds 12 hours, there is basically no need for treatment!

Hou Rong also couldn't help but feel a little pity.

For now, the chances of a patient being cured are low enough.

During the period after the onset of the patient, along with epileptic seizures, oral secretions must have been swallowed into the stomach, so the secretions containing a large amount of bacteria enter the mediastinum or chest cavity from the rupture, which will aggravate the infection!

"Broad Spectrum Antibiotics!"

"Large dose!"

Hou Rong continued to issue doctor's orders. At this time, blood transfusion and rehydration were carried out at the same time, and the electrolyte disturbance was also corrected. The patient's condition was considered stable.

At this moment, what is needed is to separate the esophagus and repair it.

The patient's surgical incision was made at the anterior border of the left sternocleidomastoid muscle, which also exposed the thyroid gland.

Hou Rong carefully cut off the scapulohyoid muscle.

The middle thyroid vein was then dissociated.

The thyroid and common carotid sheaths are retracted to both sides to free the esophagus!

The perforation site is so obvious that you can see it without looking for it.

Fortunately, there is no damage to the airway, otherwise, the operation will be more troublesome.

The next step is to repair the esophagus.

But!

At this time, a problem appeared in front of everyone.

There are too many ulcers and irregularities, and it is absolutely impossible to suture directly with absorbable thread.

How to fix it?

After the excision, is the broken end anastomosed?

This is not realistic at all, because the patient has gastric cancer and has already undergone a subtotal gastrectomy, and the length of the digestive tract is simply not enough.

It is not realistic to want to suture after excision.

However, if it is not excised, forcible anastomosis is more dangerous.

After forced anastomosis, most of them even develop reflux esophagitis, anastomotic leakage and so on.

Looking at the inflammation around the ulcerated mouth, Hou Rong hesitated.

How to do?

At this point in the operation, there is no way to proceed.

Hou Rong hurriedly said to the nurse beside him, "Call Director Yu, and the third group leader, Director Chang."

Director Chang is a leader in thoracic surgery, and Hou Rong can only pin his hopes on them at this time.

The esophagus is ruptured, and there is no way to operate, suturing is impossible, and anastomosis is not possible,

At this time, several doctors in the second group were also a little restless.

These situations are often encountered in the emergency department. Because the operation is more urgent, it is too late to make adequate preparations. When encountering these emergencies, you need to discuss them on stage!

Yu Yonggang and Chang Xiong came to the operating room not long after.

Looking at the patient's condition, the three fell silent for a while.

Hou Rong couldn't help but ask, "Is it feasible to replace the esophagus with an autologous colon?"

Abdominal organs such as autologous stomach and colon are still the most commonly used methods to replace the esophagus.

Chang Xiong shook his head directly: "No!"

"There is a subtotal gastrectomy in itself. I watched the film, and at the expense of the digestive tract, the impact on the patient's digestive system is too great, and there are many complications in the operation. The patient itself has undergone gastric cancer surgery. Poor, even...basic digestive functions are not maintained."

At this time, Yu Yong just took the forceps and carefully separated the neck tissue, and suddenly said, "Can we use the platysma flap to reconstruct and repair the cervical esophagus?"

As soon as these words came out, the eyes of the people around them also lit up!

This is a good way!

But Chang Xiong took a closer look at the flap of the platysma, and suddenly frowned and said, "It's possible, but... in this way, blood supply is a problem. After a long period of time, scar tissue will definitely form, resulting in contracture of the esophagus wall. , the next surgery basically has no chance of success!"