The patient's duodenum had two wounds, one in the middle of the duodenum and the other in the head of the pancreas.
If resection is to be performed, then the entire duodenum with the head of the pancreas must be completely resected.
Pancreaticoduodenectomy is a complex and high-risk surgical procedure.
Pancreaticoduodenectomy includes three main steps: exploration, resection, and digestive tract reconstruction.
Exploration is a necessary step to determine whether resection is possible. Resection is to remove the head of the pancreas, the gastric pyloric antrum, all the duodenum, the lower segment of the common bile duct and regional lymph nodes.
The reconstruction is to anastomose the common bile duct, pancreatic duct and stomach with the jejunum respectively.
But once the duodenum is removed, it has a great impact on the patient's postoperative recovery.
Or maybe have to live with the bag, poor quality.
"Director Qin, do you need to remove it?"
Seeing this, Zhang Qingquan also had a complicated expression and couldn't help asking.
Qin Feng pondered for a moment, did not answer, and then began to free the duodenum.
He wanted to keep the patient's duodenum!
The patient was young, in his twenties, and a police officer.
If there is no duodenum, then life in the future may be very difficult.
There is still a long way to go~~~
But now is not the time, because the physiological indicators are not yet up to standard.
…
The operation is still in progress, and Yu Shuang has completed the repair of the liver.
The operation time was more than 5 hours!
This can be regarded as one of Qin Feng's most time-consuming single operations, and the clothes in Yu Shuang's sterile clothes are already soaked.
Lu Mingming sat on a stool and rested on the side. Such an operation was exhausting.
And Zhang Qingquan next to him was also nervous, but fortunately, Qin Feng's surgical ability was too strong, and he hardly needed to operate too much.
Because he couldn't keep up, many operations were completed by Qin Feng first.
This hit him hard!
Although the young deputy director, whom he once despised and envied, had completed many difficult operations before, in Zhang Qingquan's view, it was only done on stage with the doctors who were critically ill.
But now, Qin Feng's ability has completely impressed him, and he is almost proficient in all operations, from extracerebral to extrathoracic, urology, obstetrics and gynecology.
Unprecedentedly powerful!
Zhang Qingquan even felt a little emptiness, maybe he would never reach such a level and height in his whole life.
Full of monsters!
Qin Feng was born for surgery and medicine.
No matter how awesome a genius is, he can't hold his head up and can't breathe in front of him.
It's too scary~~~
The operation continued, and Qin Feng quickly moved away from the duodenum and the head of the pancreas.
Bang!
"It's over for me."
Yu Shuang put down the needle-holding forceps in her hand and let out a long breath.
The liver and gallbladder were all sutured, and the veins and blood vessels were anastomosed.
"Okay, thank you both."
Qin Feng nodded to him and Lu Mingming when he heard the words.
Except for the pancreas and duodenum, all other parts have been sutured.
The physiological indicators have also recovered a lot, and have reached the critical value of the surgical safety standard.
According to the current situation, it should be able to last until the pancreas and duodenum are repaired.
"Then Director Qin, let's go first."
Yu Shuang took off the sterile gloves, smiled and nodded.
"That...Director Qin."
At this moment, Lu Mingming came over, hesitating.
"How could it be Dr. Lu?"
Qin Feng looked at him suspiciously.
"Are you going to have pancreaticoduodenal surgery next?"
Lu Mingming smiled awkwardly, seeing Qin Feng nodding,
"That...Director Qin, can I stay and observe?"
Hearing this, Qin Feng and Zhang Qingquan were both taken aback for a moment, then looked at each other and smiled.
"Okay, if you're fine, wait until the operation is over."
Qin Feng agreed to his request and gave Zhang Qingquan a look.
Zhang Qingquan also understood, quit the position of the first aid, and stood on the second aid.
Lu Mingming is the chief physician of gastrointestinal surgery. Since he wants to stay and observe, it is more suitable than him in terms of politeness and technical requirements.
Moreover, he is not very familiar with gastrointestinal surgery, and Lu Mingming is more confident in the operation as an assistant.
"Thank you, Director Qin."
Seeing this, Lu Mingming's eyes showed joy, and he quickly thanked him, and then took a support position.
"Scalpel."
"Richardson."
Qin Feng picked up the scalpel and separated the liver lobe, the retractor pulled the gallbladder and the right lobe of the liver to the head, and the second one retracted the left lobe of the liver.
The duodenum and pancreatic head have been mobilized with the Kocher maneuver before. In this process, the soft tissues on the vena cava and aorta should be removed, and the left renal vein should be exposed.
However, the soft tissue and lymph nodes between the vena cava and aorta are not routinely removed.
When mobilization of the duodenum proceeds distally, it must be separated from the hepatic flexure of the colon so that the mesoclonium is fully exposed.
It would be helpful to insert another retractor at this location to draw the hepatic flexure and right colon caudally.
At this moment, Qin Feng superbly turned to the anterior part of the pancreatic head and the transverse mesocolon still adhered to it, which needed to be further dissected to expose the superior mesenteric vein.
The smoothness of the whole process is perfect!
Lu Mingming, who was on the side as a helper, was shocked when he saw his whole technique.
He had only seen such a beautiful technique on the stage of the department director and deputy director, it was like performing an art.
Pancreaticoduodenal preservation is more difficult than resection, and its difficulty is at least one step higher.
You should know that resection is a difficult level 4 operation in gastrointestinal surgery. Apart from the director and deputy director, only one deputy senior attending doctor can take the stage.
Lu Mingming is 36 years old this year. It has been nearly ten years since he entered the gastroenterology department at the age of 27, but he has not completely led a pancreaticoduodenectomy operation.
Not to mention sparing surgery for serious injuries!
Qin Feng in front of him, at the age of 28, has become the deputy director of the hospital department that countless doctors dream of, and he is also one of the most powerful departments!
This news has had a far-reaching impact on the medical community so far, and some people even reported and complained to the Medical Council.
Xiehe Hospital, as the leading top three in the country, even let a young student who did not graduate with a doctoral degree to lead the extremely important and huge emergency department.
This is a serious violation and irresponsible behavior to patients.
Some people from relevant departments jointly signed a letter to report, requesting the hospital to revoke this appointment and decision.
Even if Qin Feng's grades and operating room are here, they don't care.
Because Qin Feng has become a rule breaker.
Beyond cognition!
But unfortunately...
There are not a few people who support Qin Feng, and the biggest assistant is intensive care medicine.
Meng Dawei and Yuan Bin are leaders and pioneers, and their teachers are the founders of Jiuzhou's severe illness.
More than 80% of the country's top experts come from here!
This alone can almost shake the medical world!
And when the name Qin Feng appeared, those who had been in contact with Qin Feng before expressed their support overwhelmingly.
This is a test for young people. As a national leader, Xiehe should have a pioneering spirit.
What's more, Qin Feng is not the chief executive of the emergency department. He is currently only the deputy director of the office, mainly leading the clinical work.
Several top tertiary hospitals also expressed their support.
In addition, in Qin Feng's short period of three or four years, none of the top surgery cases that were as thick as a book failed.
In the end, the hospital affairs put up the pressure, saying that they would give Qin Feng a year to test.
If there is any problem or bad influence during the one-year test period, the Xiehe Academy will revoke his position as deputy director and he will not be promoted for three years.
But at the same time, the Xiehe Academy Council also countered to the top. If Qin Feng passed the test a year later, his position would be officially confirmed.
At the same time, after Qin Feng graduated with a Ph.D., he was exempted from the two-year work requirement and made an exception to be promoted to a professional title.
30 years old, deputy senior title!
Qin Feng will become the youngest deputy chief physician in a top tertiary hospital!
You know, this is Xiehe Hospital!
Of course, this news is limited to the upper layer, and it is still in the confidential stage.
"Operation Line 0."
In the operating room, Qin Feng has already started suturing the wound.
The biliary tract and the lower end of the pylorus were partially resected where the wound was severe, and then the distance was shortened and the anastomosis was performed to reconstruct the continuity of the gastrointestinal tract.
An end-to-side anastomosis of the pancreas and jejunum is performed first, usually placing the jejunum behind the SMA and SMV, similar to where the original retroperitoneal duodenum was located.
The sewing speed is fast and the precision is so high that there is almost no deviation in the position of the needle every time.
The knot is perfect, and the two fingers flutter like butterflies.
The pancreatic stump was then freed 2-3 cm from the retroperitoneal tissue, where some splenic vein branches were ligated and severed.
The pancreatic duct is probed and its patency is ensured beyond the site of an earlier hemostatic polypropylene suture closure at the superior border of the pancreas.
"Pancreatic duct."
Qin Feng stretched out his hand and took a pancreatic duct.
Carefully insert an 8Fr pediatric feeding tube into the pancreatic duct to ensure easy visualization of the tube during the anastomosis, continue the anastomosis, and then remove the tube when the anastomosis is almost complete.
Bang!
The anastomosis was successful, and the pancreatic duct was removed.
"Gauze, suck blood."
"3-0 needle with thread."
Holding the suction device in hand, Lu Mingming quickly cleaned up the surgical field of vision, and his heart was shocked.
Qin Feng took over the needle-holding forceps again, and began to anastomose the pancreas to the intestine with the rear row of horizontal mattress sutures to start the double-layer anastomosis.
"Come on, hold on."
After the stitching was over, Qin Feng said in a low voice.
When Lu Mingming carefully pulled the intestines to the pancreas, he tied the sutures in a knot to minimize the chance of tearing the pancreatic parenchyma.
Bang!
"Electric knife."
Qin Feng put down the pliers and stretched out his hand.
After receiving the electrocoagulation knife, the jejunum was incised using electrocautery about 1 cm before the row of mattress sutures where the silk sutures had been knotted.
Two 3-0 or 4-0 polydioxanone (polydioxanone, PDS) sutures were sutured at the posterior upper edge of the anastomosis...
After the intestinal anastomosis is completed, the bile duct anastomosis is started...
And finally the duodenal anastomosis...
The time passed by every minute and every second, and the operation time was close to 7 hours.
Bang!
He doesn't know how many times he put down the needle-holding forceps. In Qin Feng's eyes, there are only constant anastomoses.
And this night, the patient's physical signs kept beating and struggling on the safety line.
As if the patient knew that someone was saving him, he stubbornly never stopped.
"Huh~"
Qin Feng breathed a sigh of relief and looked at the sutured duodenum.
It finally ended successfully.
Only the final operation remains, drainage and closure.
He placed a closed suction drain (Jackson Pratt drain) close to the anastomosis of the hepatic and pancreatic ducts and started the anastomosis.
The tip of the drainage tube was placed behind the hepatic duct jejunostomy, and guided to the back of the stomach (between the pancreaticojejunostomy and the left lobe of the liver), and finally led out from the left abdomen.
Finally, a T-tube was passed through the right abdomen, and the drain and T-tube were sutured to the skin.
Rinse the abdomen and close the abdomen.
Bang!
The moment the needle-holding pliers fell into the plate, everyone's hearts vibrated with the sound.
The operation is over!
"Okay, send it to the ICU for 24 hours of close observation."
Qin Feng's hanging heart fell slightly, and he said.
"OK."
Zhang Qingquan nodded in response.
Lu Mingming, on the other hand, was still immersed in the operation just now, unable to extricate himself.
Such a beautiful operation is simply rare in life~~~
"Okay, Doctor Lu, we're done."
Seeing that he was still in a daze, Qin Feng couldn't help reminding him.
"Ah? Oh! Okay Director Qin, thank you! Thank you so much!"
Lu Mingming came back to his senses when he heard the words, and said gratefully with excitement on his face.
This kind of operation can be called a textbook.
Immediately, Qin Feng took off his gloves, walked out of the operating room, and began to clean and disinfect.
And outside the operating room at this moment, several people in police uniforms waited for a long, long time...