1824 The countless difficulties in surgery
At present, the treatment for Debakey type 3 aortic dissection tumor was mainly through artificial blood vessel replacement surgery.
Since the cause of Marfan syndrome could not be completely eradicated, and the residual lesions at the distal ends still had the possibility of further development, there was a great possibility of recurrence after the heart vessel replacement surgery.
Dr. Ludi probably had a premonition about this and told his wife to go to The King’s Hospital immediately if she felt unwell.
So this time, she was discovered very early and should have already started to control her blood pressure in the intensive care unit to prevent her condition from deteriorating further and wait for the next treatment.
The more troublesome part about Marfan syndrome was that all the major blood vessels in the body had pathological signs of middle layer cystic necrosis. Even if this operation was successful, no one could predict when the disease would act up again.
Dr. Ludi continued to talk about the results of various laboratory tests, which he knew like the back of his hand. Zheng Ren didn’t say anything and was in deep thought.
“Boss,” Su Yun asked after they got into the car,”the surgery was right in the middle of the spine and sternum. It’s very difficult.”
Zheng Ren knew what he meant.
This was the main point and one of the difficulties of the surgery.
Generally speaking, for the second surgery, the operative approach should be the same as the first surgery, so that the patient’s damage would be smaller.
Moreover, for an aortic arch replacement surgery, the spine and sternum were almost the only approach, and the surgical field for other incisions was limited.
However, the scabs on the regrown sternum were very thick and stuck to the bones next to it. The saw slipped … And then it was a tragedy.
If it was a normal surgery, he could just change the incision. However, if he wanted to perform an aortic arch replacement surgery, he would not be able to make do with it. He could only choose the incision with the largest surgical field.
Zhao Yunlong was still mulling over the idea of using a laparoscope to insert a tube into the aortic arch. He did not know how long it would take for him to develop it.
However, when the second surgery was to strike the sternum, the heart, especially the right atrium, might suffer secondary bleeding or aneurysm, and the prognosis would be very bad.
This was based on his experience. It seemed like Su Yun had done similar surgeries before, and the results were average.
Zheng Ren nodded and said,”I’ll take care of the route. It’s not difficult.” The difficulty lies in the latter part. I’ve thought of a few ways. Among them, I think that the method of transforming your body into liver and lowering your temperature first is more reliable. “
“Should I lower the temperature first after undergoing heminification?” Su Yun was stunned.
This train of thought was somewhat bizarre.
Moreover, to achieve this, the speed of the surgery was extremely high.
The body’s blood would face many complications when it was heminated. The patient he rescued in EICU two days ago was one of the examples.
“No, it’s a little different from the usual surgery.”
“What do we do?”
“First, undergo heminification. Insert tubes through the right inferior clavicles artery, femoral artery, and vein, and perform external circulation to lower the temperature. Opening up the chest at this time can reduce the chance of the heart or blood vessels rupturing. At the same time, it will be more beneficial for the separation and exposure of the medial adhesion during the second surgery. ” Zheng Ren said.
Uh …
He had to lower his temperature first …
After the temperature was lowered, all the organs in the body, including the heart, would be affected to a certain extent. In other words, the speed of breaking through the sternum and opening the diaphragm had to be fast enough. Two to three minutes was the limit.
However, Zheng Ren’s explanation seemed to be a logical train of thought. Su Yun continued to think along with Zheng Ren’s explanation.
Unconventional surgeries were not meant to attract attention.
Why did fixed surgical methods exist? It was because countless surgeons were constantly groping around in clinical surgeries, using countless surgical failures to prove that a certain path was correct.
Once he used an unconventional surgery, he would face huge risks.
However, there were times when the actual situation forced the doctor to choose unconventional means to complete the surgery.
However, compared to directly breaking through the sternum, the boss’s statement seemed to have fewer complications. No wonder he wanted old he and his woman to come together. Only a team that had worked together many times could shorten the time to the limit.
Marfan syndrome is very difficult to deal with.” Su Yun sighed.
“Yes, I’ve thought about it. In the spell … Damn, I forgot!” Zheng Ren suddenly slapped his thigh.
“What did you forget?” Su Yun asked in surprise.
Zheng Ren didn’t answer immediately. Instead, he focused his mind and thought for a while, then finally sighed.
“What’s wrong? You look like you’re in so much pain that you wish you were dead. Is it because you can’t take it off during the surgery?” Su Yun asked.
“No.” “I think that a congenital disease like Marfan’s syndrome causes the middle layer of the aorta to undergo a pathological change,” Zheng Ren said.”It should be supported by a stent during the operation to avoid similar problems from happening again.”
“……”
“It’s okay to open up the chest for the second time, but the patient will probably be in trouble if he opens it for the third time. ” Zheng Ren said bluntly.
“During surgery? Do you want to perform an aortic dissection before you remove a stent?” Su Yun asked.
“Yes.” Zheng Ren nodded.”Fugui ‘er can’t come. There’s still surgery to be done at home, so he and old Liu can’t be touched. “
So it was like this.
“The King’s Hospital’s standard is not bad.” “We can use their doctor to remove the stent,” Su Yun said.
“I guess this is the only way.” “It’s only right that you ask elder Zhao to come,”Zheng Ren said. If there’s any problem during the operation, you can go and remove the stent, and I’ll perform the surgery with old Zhao. “
Su Yun’s face twisted.
“Boss, I’m a physician for the heart!” Su Yun complained.
“Old Zhao doesn’t know how to perform interventional surgeries. If I do it, can you guarantee that you can successfully complete the surgery with old Zhao?” Zheng Ren asked.
“…” Su Yun recalled the process of the surgery. ‘Can I do an unconventional surgery?’
Forget it.
He still did as the boss said.
Seeing that Su Yun had gone silent, Zheng Ren smiled and said,””It’s fine. I’ll see how things go and try not to delay your surgery learning. “
“Learn?” Su Yun said in disdain.
“If you can’t do it, you’re not learning. Are you going to teach me how to perform surgery?” Zheng Ren retorted casually.
Su Yun did not have any chance of winning in such a confrontation.
After all, he could not handle the surgery on his own, and Zheng Ren was always right.
“What about the anastomosed area?” Su Yun stiffly changed the topic and talked about the main point of the next surgery.
“I think that if we want to reduce the complications of the anastomosed area, the diseased aortic tumor removed during the surgery should be long enough.
The rupture must be removed to ensure that the blood vessel anastomosed on the normal blood vessel wall tissue. At the same time, in order to increase the strength of the blood vessel anastomosis, the full – Circle dense felt strip should be used to reinforce the inside and outside of the anastomosed artery. It can not only increase the strength of the anastomosed area, but also ensure that the vascular mezzanine is completely sealed. “
“It’s very difficult to use the internal and external reinforcement method with full – circumference dense felt strips at the anastomosed end of the aorta. ” Su Yun said.
“Don’t worry, I’m here. “
Su Yun did not say anything and only glanced at Zheng Ren. There seemed to be a layer of luster on his simple and honest face, which made people trust him.
“Alright, you seem to have thought about the surgery very thoroughly.” Su Yun said after a long time.
“There’s one more thing. The brain is protected by the low – Temperature external circulation.” Zheng Ren said,”I have an idea, but I still want to ask old he if he has any opinions.”