Chapter 493 Two tricky cuts, the problem is solved!

The positions of five and seven o'clock correspond to the proximal and distal urethra!

Director Liao nodded and said, "Yes, it is almost impossible to preserve the urethra conventionally, but Dr. Xu has found another way. He entered from the posterior fornix, accurately locked the two sections of the urethra, and perfectly avoided the nerves of the urethral sphincter!"

Qin Qiyin was awakened. At this time, she looked at Xu Qiu's inexplicable operation of transecting the fornix and vagina, and immediately understood the mystery.

The female external urethral sphincter is divided into smooth muscle sphincter and striated muscle sphincter.

The former is controlled by the autonomic nerves of the pelvic plexus.

The latter is regulated by the somatic nerves of the pudendal nerve.

And Xu Qiu, entering from the posterior fornix, avoided damage to the pelvic plexus nerves with one cut.

Transecting the fornix and vagina, another cut avoided damage to the pudendal somatic nerves...

After two tricky cuts, the problem that troubled countless clinicians was solved!

"Doctor Xu, you are done with the palm and finger regeneration surgery, right? When will you come to our urology department to perform a new surgery?" Director Liao's face was immediately filled with smiles.

Qin Qiyin was right, it was really comfortable to hug someone's thigh!

...

The operation continued.

Soon, it was time to remove the bladder.

This step also made everyone's heart hang in their throats.

As we all know, this kind of operation must be a total cystectomy.

If the bladder neck is forcibly retained, it will be a very difficult problem.

If too much is retained, it will be over-controllable, resulting in the inability to excrete urine in the bladder, causing urinary retention.

If too little is retained, symptoms similar to neurogenic bladder will appear. Although the causes are different, the result is urinary incontinence...

"This is simple, just control the balance." Xu Qiu said as a matter of course.

He gently pushed the peritoneum with gauze, clamped the four corners of the bladder with four tissue forceps, and then slowly peeled off the top and rear peritoneum of the bladder.

Posterior peritoneal incision...

Gradually separate downward until the bottom of the bladder...

Cut and ligate the superior vesical artery...

Separate and cut the bladder body after preserving the pubic ligament...

This series of operations is actually an ordinary cystectomy.

It is mostly used in clinical treatment of malignant bladder tumors.

Xun Yu has no tumor, so there is no need to consider infiltration, metastasis, etc., and there is no need to remove the surrounding peritoneum.

So from the naked eye, this cystectomy is actually simpler.

However, in the operating room, Qin Qiyin, Director Liao and others are all on high alert, and no one dares to relax at all...

Balance!

These two words cannot be seen from a few cuts and cuts. Even Director Liao can only judge the prognosis after the patient recovers.

This is also the reason why no one dares to preserve the bladder neck.

Just like the palm and finger regeneration surgery, which requires a good balance between the number of vascular cuts and blood circulation, the preservation of the bladder neck also has a subtle point. If it is further controlled, it will be over-controllable, and if it is retreated, it will cause urinary incontinence...

But if it is stuck at a certain precise point and the neck is preserved just right, the transplanted bladder can quickly take root and adapt, and play a more superior role.

"Done."

"Remove the colon and prepare for bladder replacement surgery."

When Xu Qiu's voice fell again, this elusive step was completed.

Except for him, Qin Qiyin and others were silent. They could not see whether the length of the bladder neck was appropriate, so they could only wait for observation after the operation.

"Okay." Qin Qiyin hurriedly cooperated.

...

The operation time came to the second hour.

Everyone was amazed.

A total cystectomy alone would conservatively take three to five hours of operation time.

However, Xu Qiu still performed a more difficult resection that preserved part of the bladder neck.

And it's not all over. He has to consider the transplantation and anastomosis of the new bladder in the future. Every cut must pave the way for the subsequent transplantation. It's not an exaggeration to describe it as step by step.

Under so many restrictions, Xu Qiu actually completed the resection in just two hours...

"Although the capacity is large, the storage capacity of the sigmoid colon is still a little different from that of the bladder." Director Liao was a little regretful.

The capacity of a normal adult bladder is 300~500ml, and the maximum storage capacity can even reach 800ml.

But if a section of the sigmoid colon is cut to replace the bladder, it can have a storage capacity of 150ml, which is already very good.

It is a miracle to reach half the urine storage capacity of a natural bladder.

After all, compared with frequent urinary incontinence, it's just a few more trips to the toilet a day. The choice is obvious.

"Director Liao, be quiet." Qin Qiyin's eyes were full of Xu Qiu's tumbling hands.

"Oh." Director Liao immediately calmed down.

He still knew who was the thigh in the operating room.

Director Liao put his mind back on the operation.

As the operation progressed, a look of doubt slowly crept up on his face.

Xu Qiu's method was still unprecedented.

It was a bit like the Alcini method, but it seemed different.

Xu Qiu removed 15 cm of sigmoid colon as a new bladder. During the resection, the omental band and independent band of the sigmoid colon, along with the circular muscles of the intestinal wall between the two bands, were completely removed, and a three-centimeter-long colon band was retained at both ends of the intestinal tube.

The central part was also specially treated, and Xu Qiu retained a 2×2 cm colon band.

After detubing, Xu Qiu began the anastomosis.

A three-centimeter colonic band was anastomosed to the ureter through a tunnel under the colonic band.

The 2×2cm colonic band was anastomosed to the preserved urethra.

Five interrupted needles are used from the urethral side through the dorsal venous complex...

As soon as the miraculous suturing method was revealed, everyone present was delighted.

"It would be great if I came here to get a circumcision. It would definitely be famous." Qin Qiyin said with emotion.

Although she does not perform this kind of minor surgery, suturing without leaving scars is the goal of any surgery.

"No, you are wrong." Director Liao said in the tone of an experienced person.

"Ah?" Qin Qiyin was puzzled.

"All other surgeries can leave no scars, but for circumcision surgery, it is not a good thing if the suturing technique is too good." Director Liao smiled knowingly.

The other urologists also had stern faces, as if they wanted to laugh but were afraid to laugh out loud.

Qin Qiyin was stunned for a moment, and after reacting for a long time, he realized what Director Liao meant, and his face turned red quickly.

"Xu, Doctor Xu..."

As soon as Qin Qiyin shouted, a question appeared in his mind for no reason.

Has Dr. Xu performed any incision? Is there any scar?

She had no experience in this area, and she really didn’t understand what other female colleagues said about the difference between having scars and not having scars...

"No no no!"

Qin Qiyin shook her head, her eyes turned from hazy to cold, and she quickly said: "Why do you need to leave two colon belts?"

Director Liao and others also pricked up their ears.

This is what they can't understand.