Chapter 1823 Numerous Difficulties in Surgery (Monthly Ticket 27000 Plus More × 54)
At present, the treatment of Debakey type I dissecting aneurysm is mainly based on surgical replacement of artificial blood vessels.
Because the etiology of the patient's Marfan syndrome cannot be eradicated, and the distal residual disease may still develop further, there is a great possibility of recurrence after ascending aortic replacement.
It is estimated that Dr. Rudy had a premonition about this, and told his wife to go to the King's Hospital immediately if she felt unwell.
Therefore, the onset was discovered very early this time, and blood pressure should have been controlled in the intensive care unit to avoid further deterioration of the condition and wait for the next step of treatment.
The troublesome thing about Marfan syndrome is that the large blood vessels all over the body have the pathological manifestation of cystic necrosis in the middle layer. Even if this operation is successful, no one can predict when the disease will occur again next time.
Dr. Rudy went on to describe the results of various laboratory tests, which he knew well. Zheng Ren didn't speak, just pondered.
After getting into the car, Su Yun asked: "Boss, the operation is to split the sternum, it is very difficult."
Zheng Ren knew what he meant.
This is one of the main points and difficulties of the operation.
Generally speaking, for the second operation, the approach should be the original approach of the first operation, so that the patient's injury is relatively small.
Moreover, for aortic arch replacement surgery, the sternal split is almost the only approach, and other incisions have limited operative fields.
But when the sternum has grown, the callus is very thick, and it needs to be chopped against the side, and the sternum is sawed and slipped... then it is a tragedy.
If it is a normal operation, just change the incision. But if you want to have an aortic arch replacement surgery, you can't make it at all, and you can only choose the opening with the largest field of view.
The endoscopic aortic arch catheterization surgery that Zhao Yunlong is thinking about is just an idea, and I don't know when it will be really researched.
However, when the sternum is split vertically in the second operation, the heart, especially the right atrium, may suffer from secondary injury or hemorrhage, or the aneurysm ruptures and massive hemorrhage, and the prognosis is very poor.
This is speaking from experience. It seems that Su Yun has undergone a similar operation, and the effect of the operation is mediocre.
Zheng Ren nodded, and said, "I'll figure out the approach. It's not difficult. The difficulty lies in the latter part. I've thought about several methods. Among them, I think the method of heparinization and cooling down is safer."
"Heparinize, let's cool down first?" Su Yun was stunned for a moment.
This idea is a bit bizarre.
And to do this, the speed of the operation is extremely high.
The body's blood undergoes heparinization, which faces various complications. The patients who were rescued in the EICU two days ago are one of the examples.
"No, it's a little different from the usual surgery."
"How to do it?"
"Heparinized first, intubated through the right subclavian artery or femoral artery, followed by extracorporeal circulation and cooling. At this time, thoracotomy can reduce the chance of heart or blood vessel rupture, and is more conducive to the prevention of mediastinal adhesions during the second operation. Separation and revealing." Zheng Ren said.
Uh……
Cool down first...
After cooling down, all organs in the whole body, including the heart, will be impacted to a certain extent. In other words, the speed of splitting the sternum and opening the mediastinum must be fast enough. It is estimated that 2-3 minutes is the limit.
However, what Zheng Ren said seemed to be a train of thought, and Su Yun followed Zheng Ren's way of thinking.
Unconventional surgery, not for grandstanding.
Why is there a fixed technique? It is because countless surgeons are constantly groping for clinical operations, and have proved that a certain path is correct with countless surgical failures.
Once unconventional surgery is adopted, there will be huge risks.
But sometimes, the actual situation forces doctors to choose unconventional means to complete the operation.
However, compared with directly splitting the sternum, the boss's statement seems to have fewer complications. No wonder he asked Lao He and Yi Ren to come here together. Only a team that has cooperated many times can shorten this time to the limit.
"Ma Fang syndrome is difficult to deal with." Su Yun sighed.
"Well, I've thought about it, during the operation... I'll go, I forgot!" Zheng Ren suddenly patted his thigh.
"What did you forget?" Su Yun asked in surprise.
Zheng Ren didn't answer right away, but thought about it intently, and finally sighed.
"What's the matter? Seeing that you are in pain, is it because you can't get it out of the surgery?" Su Yun asked.
"No." Zheng Ren said: "I think that the pathological changes caused by a congenital disease such as Marfan Syndrome leading to necrosis of the middle layer of the aorta should be propped up with a stent during the operation to avoid similar problems."
"..."
"The second thoracotomy is okay, but the third time, the patient is probably sick enough." Zheng Ren said bluntly.
"During the operation? Do the aortic replacement first, and then the stent?" Su Yun asked.
"Yeah." Zheng Ren nodded, "Fu Gui'er can't come. There's still an operation to be done at home, neither he nor Lao Liu can move."
It turned out to be like this.
"The level of the King's Hospital is not bad." Su Yun said: "You can use their doctors to remove the stent."
"That's the only way to go." Zheng Ren said, "You should come to Lao Zhao. This is what you should do. If there is any problem during the operation, you can remove the stent, and Lao Zhao and I will perform the operation."
Su Yun's face twisted all of a sudden.
"Boss, I'm a doctor with a heart!" Su Yun complained.
"Lao Zhao doesn't know how to intervene. If I do, can you guarantee that you and Lao Zhao will successfully complete the operation?" Zheng Ren asked.
"..." Su Yun recalled the operation process, unconventional operation, can he do it himself?
never mind.
Still did as the boss said.
Seeing that Su Yun fell silent, Zheng Ren smiled and said, "It's okay, I'll check the situation when the time comes, and try not to delay your surgery study."
"Study?" Su Yun said contemptuously.
"If you can't do it, it's not learning. Do you still want to teach me how to do surgery?" Zheng Ren snapped back.
For this kind of confrontation, Su Yun has no chance of winning.
After all, he couldn't get the surgery done by himself, so Zheng Ren was sure of it.
"What about the anastomosis?" Su Yun abruptly changed the subject and talked about the key points of the next operation.
"I think that in order to reduce the complications of anastomotic stoma, the diseased aortic aneurysm should be long enough.
The rupture must be resected to ensure that the blood vessel is anastomosed to normal vessel wall tissue. At the same time, in order to increase the strength of vascular anastomosis, the method of internal and external reinforcement with dense felt strips along the entire circumference of the aortic anastomosis should be adopted. It not only increases the strength of the anastomotic stoma, but also ensures the complete sealing of the vascular dissection. "
"The internal and external reinforcement method of dense felt strips for the entire circumference of the aortic anastomotic port is very difficult." Su Yun said.
"It's okay, I'm here."
Su Yun didn't speak, but just glanced at Zheng Ren. His simple and honest face seems to have a layer of luster, which makes people trust.
"Okay, you seem to have thought very carefully about the operation." Su Yun said after a long time.
"One more thing, brain protection under hypothermic extracorporeal circulation." Zheng Ren said, "I have an idea, but I still want to ask Lao He if he has any opinions."