Baiyun ambition

In Harbin, it has been snowing heavily recently, and the birds have been grounded.Shen Zhi's flight was cancelled, and now he is still looking at the ice sculptures on the Songhua River, and he doesn't care about his son anymore.Yan Xiru was so happy that he didn't eat, took off his coat, fell on the bed, and fell asleep with his head depressed.This day, everything is busy, and nothing is busy.

But someone disturbed his dream, Lao Zhuang made a phone call to confirm whether he was still alive: "Let me reserve a seat, but I won't come by myself, Yan Xiru, don't try so hard, I'm not afraid of your sudden death, I'm afraid no one will help you settle the bill."

Yan Xiru asked in a daze, "Have you finished discussing the matter over there?"

"It's done. The place vacated by the theatrical troupe has been cleaned up, and I'm waiting for you to inspect it. But I said, although the two shops are on Yushu Street, they are so remote that there is no traffic at all. You Can someone come to take over and open the shop? The smell of wine is also afraid of deep alleys!"

"The owner of the troupe is my friend. I don't want the last place to be taken over after the troupe disbanded. I haven't figured out what to do with it. How about I go sing the show myself?"

"Pull it down, just your tone-deficient, unreliable voice, don't scare people."

Yan Xiru was not in a good mood: "Then I can sell Guiling jelly?!"

Early the next morning, Yan Xiru was late for work in order to go to the real estate bureau, and missed the shift.The head nurse blocked him at the elevator entrance and waited for a signature. Fortunately, Director Jiang was not here today, otherwise Yan Xiru would be absent early in the morning, and the entire department would be scolded for him.

Yan Xi was like a flying phoenix: "The old lady was not there yesterday, no one lifted the quilt for me, so I can't get up."

"Then get a wife and go back, and lift the quilt for Mrs. Yan." The head nurse pouted, "Choose one of our nurse sisters, well, they all look tender and tender."

"That won't work, honest rabbits like us don't eat grass beside the nest, let alone young grass."

Just as he was talking, Liao Sijun finished checking the wards, walked by and teased him: "Hey, it's rare for Director Yan to go to work so early today."

Yan Xiru nodded: "Hey, it's rare for Director Liao to be the director of the department."

Liao Sijun lifted his leg from under his white coat and kicked him.The director of the department, Jiang Yidao, was on a business trip, and it was finally his turn to be the leader of the general foreign affairs department. Unfortunately, it was only today.

Yan Xiru gave the patient ascites before returning to the office. He glanced at the operation schedule on the wall. There are four channels today. It seems that he won't be able to get home before ten o'clock in the evening. Shen Zhi has to curse online thousands of kilometers away.As soon as he walked away a few steps, the pen on the table disappeared in an instant, and Yan Xiru said angrily: "Jiang Jian, where is my pen?!"

As soon as the words were finished, someone slapped him hard on the shoulder. Yan Xiru almost opened his mouth to greet someone, but turned around and saw Director Fang smiling at him: "Yan Xiru, I gave you a gift. The doctoral students recruited yesterday were ordered by their superiors to be newcomers. All of them have to study in other departments for three months, and one will be sent to you."

Yan Xiru cared about his pen, and didn't give him a look: "I don't want it, I have Jiang Jian, and I don't know how to teach it."

"It was originally arranged to go to Dr. Shen, but you have a lot of surgery opportunities and you have learned a lot."

Yan Xiru turned his head: "Shen Weizhou don't want it?"

"He has so many students that he can't bring him here, but you don't bring graduate students. The office is deserted, and there is a shortage of people, right?" Fang Guangming pinpointed that he said this on purpose. The whole hospital knows that Yan Xiru and Cardiovascular Shen Weizhou didn't deal with it. "Xiao Yu is a doctoral student of Academician Li, and Academician Li was your father's student, so he is still your nephew."

Yan Xiru recalled the face of his father Yan Chengsong. Except for the multiplication formulas when he was a child, he had never taught him anything else, so he entered a teacher for no reason. "Old Fang, you are my boss' junior brother, and I am your senior nephew too. If this is the case, he can't call you grandpa."

"Yeah, they're all one family." Fang Ming is worthy of being an administrator, so he just opened his mouth and said, "If you don't accept me, I'll tell Dean Sun's wife that you've been very free recently, and the prodigal son is looking for someone again, you have a look." Will she comfort you every day?"

"Fang Guangming!" Yan Xiru turned around angrily, brought something to the floor, and it rolled with a crisp sound of impact.

The black pen was picked up again, and the palm on the opposite side was spread out, and the object was handed to him: "Master, your pen."

When Yan Xiru met those clear eyes, he was so preoccupied for a moment that he couldn't remember to reach out his hand.

With his back to the light, Yu Fangyun called him again: "Master Uncle." Then he stuck the pen into Yan Xiru's breast pocket.

There are more people in the office, and Jiang Jian, who arrived late, silently calculated the current situation—his boss actually took in a new younger brother behind his back, and even tidied up a desk for someone, and then left him aside in the cold, He didn't hear or ask, and he didn't have the bearing of being a big brother at all. He was obviously resentful towards the leader of this business of forced buying and selling.A sense of responsibility welled up in Jiang Jian's heart, and the job of bringing newcomers in could only fall on his shoulders.

Yu Fangyun learned everything quickly, and after being taught a few words, he started to find a job by himself. Jiang Jian pointed to the air behind him: "If you have anything you can't do, come to me again, but for your and my safety , if you don't mess with him, don't mess with him."

It was Yan Xiru who was talking, Yu Fangyun nodded.

Yan Xiru tapped the keyboard and pressed Enter.Glancing to the opposite side from the corner of the eye, Yu Fangyun's body was buried in a large white coat, making him look younger.That's right, it was a child.Lao Fang said that he skipped three grades and got a doctorate at the age of 22.

Yan Xiru has never brought any students, one is because he is impatient, and the other is that he feels that he has no skills to pass on, so he can't afford to be a master, and the same goes for his uncle.These twists and turns, divisions and departments have their own systems. In Yan Xiru's view, they are all red tape in the hospital, with superfluous warts.Moreover, Yu Fangyun is still a doctor who is used to working in the laboratory, and his relationship with the operating room is just such a short few months. With so many subjects in hand, why bother to do rough work and make trouble for himself.

So even the cardamom on a fragrant tip leaf is just a pleasing trouble to him.Yan Xiru stood up holding the glasses case, passed by Yu Fangyun without looking sideways, and knocked on Jiang Jian's desktop: "Let's go, go downstairs."

Jiang Jian was taken aback: "I'm on the second line today."

After hearing this, Yan Xiru became angry again: "Knowing that our group has few people, Liao Sijun still has so many second-line shifts for you on three days of operation a week. He thinks everyone is the same as his group, with seven gourds hanging on a vine?! "

Who can blame you for not being able to grow gourds yourself.Jiang Jian dared to think about it, and then saw the newcomer Hulu stand up: "Master, let me go with you."

"Yan Xiru—it's you again." The anesthesiologist sighed deeply. No matter how handsome the doctor in the general surgery department of their hospital was, he looked like a black watermelon in the field when he saw him every day.

"How many sets are there today?"

"Three sets."

The anesthetist took a closer look, and found that Yan Xiru had shaved seriously today, and finally looked more handsome than ordinary watermelons. "Hey, I heard that you have a doctoral student here? Sun Qi is still Fang Guangming's student? You don't like him, do you?"

"Academician Li's doctor, I'm afraid he'll look down on me, so don't talk nonsense." Yan Xiru raised his eyebrows while holding the oval pliers, "I'm such a humble, introverted and hardworking person, you're the one who looks down on me, stop talking It’s bad for my reputation, and I haven’t married a wife yet.”

Everyone waited for a while, but Yu Fangyun hadn't come in yet, Yan Xiru took off his coat and went out to look for him, went down to the first floor, and saw him waiting foolishly outside the security door after changing his clothes.He was not angry: "Why don't you come in?"

Yu Fangyun looked at him: "I can't get in."

Yan Xiru was already impatient with waiting, so he said, "No legs or something? Can't walk in?!"

"Oh, you are so fierce!" The old horse came out from behind the table, "He doesn't have a badge. I asked him which operating room he was in, and he said it was the sixth. I think when will you pass on the operating table?" The assistant is gone, so I didn’t put it in. I’m calling you Liujian right now!”

Yan Xiru was stunned for a moment, then tore off his badge and threw it on the stage: "Old Ma, I bet you my badge, and I'll take him in."

The old horse immediately threw it back: "Who dares to ask for your badge, it's hot to hold."

The person in front took two flights of stairs one step at a time, and Yu Fangyun's slippers were too big, so he dragged his feet and dragged behind Yan Xiru: "Master, I haven't got my work card on the first day of work today. knew."

Yan Xiru glanced at him, always avoiding his gaze intentionally or unintentionally—it looks good, but it's a pity that it's a piece of wood. "Go out and get this." He stuffed his badge into Yu Fangyun's pocket and strode away, before he could hear a whisper of "thank you" behind him.

Today both are laparoscopic surgery, no need to pull the hook, Yan Xiru asked Yu Fangyun to stand there to support the mirror, the anesthetist booed him: "I don't know how to get a stool for someone, what kind of uncle."

"I've been standing there for so long, and I haven't seen you bring me a stool." Yan Xiru was speechless, these people were overwhelmed with maternal love when they saw a younger handsome guy.

The intern nurse couldn't turn her eyes when she saw Yu Fangyun, and stood closer and closer.Yu Fangyun was dumbfounded again, all his attention was on the patient's belly, he didn't realize it.Yan Xiru preferred to find trouble, so he inserted himself between the two of them calmly: "Give me the dressing tweezers."

He took off the mask of the hippie smiling face on the operating table, and didn't talk much. Yu Fangyun was quieter, watching the screen intently, and his subordinates adjusted their vision very skillfully.The operating room was quiet, with only the sound of instruments colliding and instruments. Yan Xiru's forceps passed through the free liver and arrived at the position where the root of the hepatic vein was dissected, and the ECG monitoring suddenly made two beeps.

Yan Xiru's fingers trembled sharply, and a drop of hot sweat trickled down her temples instantly.

Yu Fangyun immediately looked up at him, and said in a deep voice, "It's bleeding, stuff it with gauze."

The blood on the liver and face on the screen came out very quickly, gushing out in pulses, covering the entire field of vision in just a few seconds, and it was still spreading.Bleeding under laparoscopy is very troublesome, and the actions that can be easily and quickly completed for bleeding problems under laparotomy are much more difficult at this time.The scene was horrifying all of a sudden, the hands of the intern nurse who handed the hemostat shrank, and said in a panic, "This is... an artery was cut? There is so much blood."

Yan Xiru didn't have time to talk to her: "Give me Sha's forceps."

"The short hepatic vein ruptured, and the wall of the vessel was not suitable for contraction under the liver parenchyma, and the amount of bleeding was also large. Now we can't force clamp immediately, we can only expose the vessel wall first, and judge the diameter and course of the rupture." Yu Fangyun explained .

The itinerant nurse came up to push the intern: "Do you need a B-ultrasound positioning?"

Yan Xiru never took his eyes off the screen: "Not yet, prepare the hook. Yu Fangyun..."

Before I ordered, the suction device handed over had already been replaced with a flushing head—in addition to flushing accumulated blood and blood clots, sufficient pneumoperitoneal pressure must be ensured during the operation, and many people couldn't remember this in a panic.Yan Xiru glanced at Yu Fangyun and said, "I'll stop the bleeding, you rush."

Yan Xiru seldom handed over the knife to others on stage, and it was the first time he was on stage, but the situation was urgent and he had no time to think about it.

Yu Fangyun's vision was very clear, and the pressure continued for several 10 minutes before the bleeding was gradually stopped locally. Yan Xiru separated the two sides of the broken blood vessel and finally began to stitch it up.

It's almost over, with some twists and turns, but fortunately, it was a near miss.Yan Xiru breathed a sigh of relief, but saw Yu Fangyun opposite, still frowning like a little old man.It is rare for him to praise: "You reacted very quickly just now."

"Ah." The little old man stretched his eyebrows, revealing his two small rabbit teeth, "During the internship before, the teacher taught us how to deal with hepatic vein bleeding." The rabbit also expressed his admiration, "Uncle, you really Great, fortunately you are so proficient in suturing under the microscope, otherwise the blood volume may need to be repaired by laparotomy."

Yan Xiru was flustered when he was praised.Little scenes, he has never seen anything.

"However, if the low central venous pressure had been controlled in the first place, maybe that wouldn't have happened."

"What do you mean?" Yan Xiru was still praising himself in the first sentence, but started to find fault with the next sentence, Yan Xiru thought he had heard it wrong.

Yu Fangyun said with reason and evidence: “The hepatic venous pressure is positively correlated with the central venous pressure, and the hepatic sinusoidal pressure is directly affected by the hepatic venous pressure. If the central venous pressure is too high, hepatic venous blood vessels will not be damaged during the operation, and hepatic sinusoidal pressure will also occur. Severe bleeding from the section caused by the high pressure."

"So you mean, this patient is bleeding because I didn't control the venous pressure well before the operation?" Yan Xiru was so angry that his voice split.

Yu Fangyun nodded and said something about his uncle.

... What kind of uncle are you still a teacher, I will call you uncle.Yan Xiru sewed a needle: "Don't use the set in your book to press me. The pneumoperitoneum pressure is here. The value monitored during laparoscopic surgery is inaccurate. It can only be used as a reference and has no clinical significance."

Yu Fangyun paused for a few seconds and continued: "According to Poiseuille's laminar flow formula, the amount of bleeding caused by hepatic vein injury during liver resection is proportional to the fourth power of the pressure gradient inside and outside the hepatic vein wall and the radius of the hepatic vein. Lowering the hepatic venous pressure is reducing the risk of bleeding..."

"Pa——" A sound of surprise interrupted his voice. It was Yan Xiru's pliers that fell into the plate, causing a lot of resentment—a good cardamom, why did it open its mouth!

The author has something to say: make up the references for this chapter:

[1]常业恬,林梁.低中心静脉压在肝脏切除手术中的应用[J].中国现代手术学杂志,2003,007(001):68-70.

[2]郑树国.腹腔镜肝切除术肝静脉系统出血处理策略[J].中国实用外科杂志,2017(05):29-33.

[3]蔡伟晖,元云飞,黎志钦.调控中心静脉压减少大肝癌切除术中出血的临床研究[J].腹部外科,2009,022(002):108-109.