When people twitch, the power of outbreak is still very considerable.


    Three or four people spent a lot of effort to control the old man!


    Before long, the role of stability began to play.


    The patient is quiet.


    But that doesn''t mean it''s safe.


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


    "The patient, male, 72 years old, after subtotal gastrectomy, has no reason for convulsion, history of hypertension, diabetes mellitus, oral administration."


    Hearing the patient''s words, Hou Rong looked low.


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


    The human body has a tolerance function for many situations.


    Some people don''t feel uncomfortable when their blood pressure is as high as 1700 or 180, while some people can''t see abnormalities when their blood sugar exceeds 33.3.


    This is that 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 quickly transferred the patient to the operating room to complete the esophageal repair operation in time. After all, at this time, the esophagus ruptured, and there will be a lot of bleeding flowing into the chest.


    Stop bleeding!


    Repair the esophagus and trachea.


    Clear the blood in the chest to prevent further infection.


    This is the most important thing to do at present.


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


    What''s the reason?


    But now the situation is urgent and time is limited. We can''t delay any more.


    The patient had gastric cancer. Is it brain metastasis?


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


    Chen Cang said at this time, "director Hou, is it cerebral hemorrhage?"


    In a word, he immediately woke Hou Rong up.


    Yes!


    The patient has a past history of hypertension. Can it be cerebral hemorrhage?


    It must be too late to do CT. The time to do CT may be lost. In that case... It must be inappropriate.


    Thinking of this, Hou Rong checked the meningeal stimulation sign. Sure enough!


    Positive!


    Of course, the positive meningeal stimulation sign does not mean that it must be intracerebral hemorrhage, but it is possible.


    But now, the patient must have surgery, or let alone intracerebral hemorrhage, ischemia will disappear directly!


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


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


    Chen Cang also directly followed up.


    After all, it''s about your task. You can''t ignore it.


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


    After anesthesia, the operation began.


    After passing through the opening of the neck, the esophagus, trachea, nerves... Are exposed to the public''s view.


    However, it is because of this that people look at the bad neck situation, which is really some shocking!


    The patient''s esophagus is damaged in many places, the wound is irregular, and the condition of the whole esophagus is very poor!


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


    The situation of the old man is obviously very poor!


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


    Hou Rong also couldn''t help feeling sorry.


    Now, the possibility that patients can be cured is low enough.


    During this period of time after the onset of the patient, with seizures, oral secretions must have been swallowed into the stomach. In this way, secretions containing a large number of bacteria enter the mediastinum or chest from the breach, which will aggravate the infection!


    "Broad spectrum antibiotics!"


    "High dose!"


    Hou Rong kept giving medical orders. At this time, blood transfusion and rehydration were carried out at the same time, and the electrolyte disorder was also corrected. The patient''s situation was stable.


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


    The patient''s surgical incision was at the front edge of the left sternocleidomastoid muscle, and in this way, the thyroid gland was exposed.


    Hou Rong carefully cut off the scapulohyoid muscle.


    Then free the middle thyroid vein.


    Pull the thyroid and common carotid sheath to both sides to free the esophagus!


    The perforation is too obvious to be seen without looking.


    Fortunately, the airway was not damaged, otherwise, the operation would be more troublesome.


    The next step is to repair the esophagus.


    But!


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


    There are too many and irregular ulcers, so it is definitely impossible to sew directly with absorbable thread.


    How to fix it?


    After resection, broken end anastomosis?


    This is simply unrealistic, because the patient has gastric cancer and has undergone subtotal gastrectomy, and the length of the digestive tract is not enough.


    It''s unrealistic to want to remove it and then sew it up.


    However, without resection, forced anastomosis is more dangerous.


    After forced anastomosis, most of them will even have reflux esophagitis, anastomotic fistula and so on.


    Looking at the inflammatory performance around the ulcer, Hou Rong hesitated.


    What should I do?


    By this time, the operation could not go on.


    Hou Rong quickly said to the nurse: "call director Yu and director Chang, the leader of the three groups."


    Director Chang is the master of thoracic surgery. Hou Rong can only hope on them at this time.


    The esophagus is broken and there is no way to operate. Suture is impossible and anastomosis is impossible


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


    These situations are often encountered in the emergency department, because the operation is urgent and there is no time to make adequate preparations. In case of these emergencies, we need to discuss them on the stage!


    Yu Yonggang and Chang Xiong came to the operating room soon.


    Looking at the patient''s situation, the three fell into a silence.


    Hou Rong couldn''t help asking, "is it feasible to replace esophagus with autologous colon?"


    Autologous abdominal organs such as stomach and colon are still the most commonly used method to replace esophagus.


    Chang Xiong shook his head directly: "no!"


    "There is subtotal gastrectomy itself. I watched the film. At the expense of the digestive tract, it has a great impact on the patient''s digestive system, and there are many surgical complications. The patient itself is after the operation of gastric cancer. In this way, the postoperative quality is too poor, and even... The basic digestive function can not be maintained."


    At this time, Yu Yonggang carefully separated the neck tissue with tweezers and suddenly said, "can you reconstruct and repair the cervical esophagus with the platysma flap?"


    As soon as this sentence came out, the eyes of the people around him also lit up!


    This is a good way!


    But Chang Xiong carefully looked at the platysma flap and suddenly frowned and said, "yes, but... In this way, blood circulation is a problem. In the long run, scar tissue will certainly form, resulting in esophageal wall contracture. There is basically no possibility of success in the next operation!"