Chapter 784: Mastery of the Art, the God of Surgery
Xu Qiu explained casually: "What is exposed is the body of the pubic bone. The outer side is the outer edge of the pubic limb, and here is the ischial limb and the ischial tuberosity..."
Everyone was shocked.
How can the structure be recognized even if it is distorted like this?
"And here, the posterior femoral muscles, adductor muscles, and quadratus femoris muscles. The bleeding of these muscles will be minimized by cutting through the tendinous starting point." Xu Qiu's voice sounded again.
The faces of the experts present were a little strange.
Tendon starting point...
They didn't even find all the muscles, but they still expected them to find the tendinous starting point of the muscles. Is this the anatomical structure in the eyes of the big guys?
At this moment, everyone suddenly understood the mentality of those small attending doctors in the hospital when they looked at themselves.
The gap between people can be so big...
...
While Xu Qiu was talking, the knife in his hand moved faster and faster.
After peeling off the ischial tuberosity, Xu Qiu went around to the inner side and freed the sacrotuberous ligament.
In conventional surgery, the next step is to peel off the sciatic corpus cavernosum and obturator internus muscle from under the periosteum.
Because these areas are distributed with blood vessels and nerves of the perineum, this approach can avoid damage.
But the good news is that Dai Kai has no good blood vessels and nerves left, so there is no need for protection.
Xu Qiu went sideways and performed subosseous dissection from the medial edge of the ischium and the lower limb of the pubic bone. After a while, the transverse perineal muscle, the crura of the penis and the urethral sphincter in front of the body were separated.
Going down, he flexibly went around the lower edge of the pubic symphysis, cut the urethral genital diaphragm, and performed joint dissection with the pubic bone.
Swish——
The scalpel fell again, and the rectus abdominis and cone muscles at the pubic symphysis were also cut open one by one.
Another cut, the inguinal ligament was cut off.
When all the anatomical structures were disconnected from the body, Xu Qiu waved his hand gently.
"Bone biting forceps."
"Wire saw."
The two orthopedic instruments fell into Xu Qiu's hands one after another, and the upper pubic ramus and the lower ischium were finally removed!
"The first step is completed." Xu Qiu put down the wire saw.
The first step of the full pelvic resection is to remove the pubic bone and the ischium.
Next, the hip bone was removed.
Next, the ilium.
The sartorius muscle and inguinal ligament were cut near the anterior superior iliac spine.
After that, all ligaments, muscles, and tissues connected to the pelvic structure had to be removed, so that the pelvis became completely free, and then the entire pelvis was separated from the body.
Before the end, the digestive system, urinary system, and finally the pelvic ring were reconstructed.
This is a big project.
Therefore, when Xu Qiu announced that the first stage was successfully completed, everyone present did not relax at all, but became more solemn than before.
The complexity of the surgical area was beyond their imagination. It was extremely difficult to identify the structure from the bloody thigh and pelvis. They could not imagine how Xu Qiu successfully removed the pubic bone and ischium.
Even, they were not sure that Xu Qiu had really completed the separation of these two anatomical structures...
If the person in front of them was not Xu Qiu, but an unknown little doctor, they would even think that the surgeon was deceiving them, scratching the thigh randomly and then starting to describe it in a exaggerated way...
...
In the second hour of the operation, Xu Qiu followed the incision to expose the attachment points of the abdominal muscles, latissimus dorsi and gluteal muscles on the iliac crest, and then performed sharp separation and pushed them inward.
The step of exposing the ilium is not the most difficult in clinical surgery.
It has many landmark structures, such as the femoral blood vessels, femoral nerves and spermatic cord in front of the inner wing.
On the contrary, finding the ilium can also deduce the location of these structures.
But for Dai Kai, every time a layer of skin is cut open and an additional incision is made, there is only a piece of purple-red flesh and blood underneath, and the blood vessels are crushed by the strong impact force. Various structures have long been dislocated, which is a huge challenge for the surgeon.
Even Xu Qiu can only rely on experience and the foundation laid by various master-level lower limb surgeries to deduce the location of various anatomical structures.
Ka--
Xu Qiu exerted force on his hands, and all the muscles above the apex of the sacroiliac joint and below the attachment point were cut horizontally.
The nerves and blood vessels of the related muscles had already been ligated.
At the same time, the muscles on the greater trochanter and the tendinous attachment points on the fascia lata were cut off...
After all this, the ilium and the underlying bone were removed in one piece.
Everyone was so intoxicated by the sight.
During the operation, the twelve key points mentioned by Xu Qiu before, such as the ligation of the bilateral internal and external iliac arteries and veins, the ligation of the left lumbar vein, etc., were all completed with the progress of pelvic resection.
The next step is the reconstruction of the digestive tract.
To be more specific, it is actually the resection of the sigmoid colon and rectum, and then the establishment of an artificial anus, the reduction of intestinal fistula, the incision of the small intestine for decompression, and the resection of the greater omentum.
The reconstruction of the urinary system is also in this step.
Bilateral ureteral anastomosis, bladder repair fistula, stump flap transfer to cover the lower abdominal suture, etc., will also be carried out simultaneously.
"How to do this step?" Everyone had the same doubt in their hearts.
In addition to the complete pelvic resection, the most important part of this operation is actually the reconstruction of the digestive tract.
This is the core system of nutrition. The completeness of its repair and reconstruction directly determines the patient's prognosis and also affects the patient's survival to a certain extent.
However, this is also the most difficult to deal with.
The patient's injuries are too serious. The lower part of the digestive tract is almost completely destroyed. The reconstruction of the digestive tract will destroy the normal anatomical and physiological structure of the gastrointestinal tract.
Xu Qiu may be able to restore the function of the digestive tract as much as possible, but it is impossible to restore the defective mucosa.
The mucosa is related to blood supply, oxygen supply, permeability, and intestinal bacteria...
After digestive tract reconstruction surgery, the patient is likely to have insufficient blood and oxygen supply to the mucosa. While the permeability increases, the intestinal bacteria will also cause a large amount of endotoxins to grow, thereby destroying the barrier of the mucosa, causing gastrointestinal dysfunction and serious complications!
How should Xu Qiu deal with it?
While everyone was guessing, Xu Qiu had already thought everything through.
The colon replacement bladder surgery he pioneered before played an unexpected role at this moment.
The experience of the surgery was integrated and finally fed back to this extremely difficult step.
"The proximal colon has a significantly stronger ability to absorb water and electrolytes than the distal colon..."
"Partial resection can avoid gastrointestinal disorders to a certain extent and reduce the absorption of endotoxins!"
Xu Qiu put down the scalpel without hesitation.
Everyone's pupils contracted, and their attention was completely focused on the surgical area.
As time went by, a look of surprise appeared on their faces.
"The ileocecal part, ascending colon and part of the transverse colon were preserved?"
"This will increase the difficulty of reconstructing the artificial anus..."
Everyone felt incomprehensible.
Even the two directors of Union Hospital were a little confused at this moment.
Both of them participated in the total pelvic resection at the beginning, but they had never seen such an operation.
Why?
What is the effect?
Various questions arose in everyone's mind. Before, their eyes could not keep up with Xu Qiu's hand speed, and now their brains can't keep up...
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