297 The Pearl in the Crown (1/4)
Chapter 297 The Pearl in the Crown (14)
"Emergency?" Su Yun frowned upon hearing that it was TIPS surgery (Note 1).
TIPS surgery is the most difficult surgery in the interventional department, bar none.
Of course, there are many new surgical procedures that cannot be performed by existing medical conditions, such as prostate interventional embolization. But these operations are only "difficult". From a technical level, everyone should think that TIPS is the most difficult.
"In the Department of Gastroenterology, there is a difficult patient. The patient is Director Xia's classmate. He has already contacted the imperial capital for TIPS surgery, but before he left, he suddenly vomited blood, and the person was already in shock." Zheng Ren stood up and put on Putting on white clothes, he turned around and smiled apologetically at Xie Yiren.
Xie Yiren waved his hand and motioned for Zheng Ren to go to work, with curved eyebrows and gentle and virtuous eyes.
Zheng Ren felt at ease and strode out of the duty room.
"You will?" Su Yun followed and asked.
"You can give it a try." Zheng Ren thought to himself that although he had never done it before, he still had time for surgery. In order to save people, he should splurge.
The most difficult is that the complications after TIPS surgery are more difficult to manage.
For decompensated liver cirrhosis, gastric fundus esophageal varices, and hematemesis caused by splenomegaly, there are two treatment methods - one is surgery, such as splenectomy, portazygos devascularization; the other is TIPS surgery just said.
This kind of surgery has not entered the clinic for thirty years.
In 1988, German scholar Richter et al. first applied the intrahepatic stent portosystemic shunt via the jugular vein to the clinic, and in 1991 reported 16 cases of successful intrahepatic stent portosystemic shunt via the jugular vein approach.
Then Zemel (1991), Ring (1992) successively reported the results of successful intrahepatic stent portosystemic shunt through the jugular vein.
In 1993, the intrahepatic stent portosystemic shunt through the jugular vein was popularized and applied in various countries.
It was in the 21st century that the operation in China was initiated by Mr. Xu Ke of China Medical University.
Until now...it has not become routine surgery.
Why?
Because it's hard to do.
Extremely difficult to do.
Even after surgery, the postoperative mortality rate is extremely high.
However, if the patient can survive, the quality of life after surgery will be greatly improved, and it is a surgical procedure that benefits patients a lot.
Su Yun has recently studied interventional surgery, and naturally knows that TIPS surgery is known as the jewel in the crown of interventional surgery.
Is it going to start so soon? Are there any consumables? There is nothing, Zheng Ren is going to do wool?
"How about the consumables?"
"I'll call Manager Feng." Zheng Ren said as he took out his mobile phone.
"Manager Feng, it's me."
"I may have TIPS surgery on my side, and the related consumables will be delivered immediately."
"Well, in terms of formalities, Director Pan will handle it tomorrow. It is estimated that it is still the procedure of temporary mining."
"As soon as possible, 1 hour!"
After speaking, Zheng Ren hung up the phone.
"Do you feel confident after the operation?" Zheng Ren walked quickly, but still asked Su Yun.
"If there is no way to prevent hepatic encephalopathy, it can only be controlled with drugs such as amino acids." Su Yun recalled the process of TIPS surgery and the sinister nature of hepatic encephalopathy, and he did not dare to say too much.
The key is the clinical treatment of hepatic encephalopathy, which is still very simple.
Zheng Ren had an idea in his mind, so he quickened his pace and came to the Department of Gastroenterology.
Director Xia was still shrewd and capable. Seeing Zheng Ren rushing over so quickly, there was a hint of embarrassment on his face.
The floating gallbladder, that patient, Director Xia took Zheng Ren's face in the emergency department.
It was later proved that Zheng Ren was right. So Director Xia really didn't want to face this monstrous emergency department inpatient.
Even if there is an unexpected situation, she still passes through the old director Pan... Well, this is also a normal process, it is the communication between the chief directors.
"Director Xia, hello, which ward is the patient in?" Zheng Ren did not change his expression in the slightest, neither arrogant nor sarcastic, as if the previous incident had never happened.
"On this side." Director Xia put aside those messy thoughts and rushed to the emergency room with Zheng Ren.
It was a male patient in his fifties, with a sallow complexion and black air. He was lying on the hospital bed with a washbasin under it. He was vomiting black venous blood continuously.
The picture is eerie and eerie, like hell.
The strong smell of blood rushed to his face, Zheng Ren glanced at the system panel in the upper right corner of his field of vision.
A patch of red came into view.
The patient's diagnosis was: hemorrhagic shock, post-hepatitis B decompensated cirrhosis, refractory ascites, pleural effusion, electrolyte metabolism disorder, splenectomy and esophagocardium pericardial vascular disconnection.
I had splenectomy and portazygo devascularization done...
Zheng Ren was still hesitating between the two types of surgery, but now you don't have to think about it, just prepare for TIPS surgery.
"Three days ago, he vomited blood, because he had splenectomy and portazygos devascularization, so he could only choose conservative treatment." Director Xia Shen Sheng introduced the condition, "Three groups of intravenous hemostatic drugs and oral administration of Zhengshen ice saline caused bleeding. It was under control. I was going to transfer to the Imperial Capital for TIPS surgery, but when I called the ambulance, I vomited blood again."
Three groups of hemostatic drugs have been used, plus Zhengshen iced saline, which can be said to be an extreme amount.
Even adding four or five groups of hemostatic drugs had no effect. When complications such as cerebral infarction and myocardial infarction occur, it will be more difficult.
Zheng Ren pondered, thinking about whether the surgery time he had reserved was enough.
TIPS surgery, after all, is the most difficult surgery in interventional disciplines, and Zheng Ren is not sure.
Seeing Zheng Ren pondering, Director Xia also smiled bitterly and said, "In our hospital, you are the only one doing interventional surgery. There is no way to do this. It's hard for you."
Her unexpected but reasonable attitude softened and was very logical. Zheng Ren understood Director Xia's mind.
"As long as you can be 10% sure, it's always right to give it a try." Director Xia said firmly: "The patient is my classmate, and his lover is also my classmate. Dr. Zheng, don't worry, even if you can't step down, you will die in surgery. On stage, there will be no problem.”
The last sentence is to reassure Zheng Ren.
Nothing else, because emergency TIPS surgery is the only option at this time. If Zheng Ren said he would not do it, the patient could only vomit blood while waiting for death to come.
Maybe a few minutes later, a mouthful of venous blood vomited out, sprayed on the wall, sprayed on the roof, and the person was gone.
However, the difficulty factor of TIPS surgery for normal slow diagnosis exceeds the limit threshold of 10, reaching 11 or more, not to mention emergency TIPS surgery.
"Director Xia, to be honest, I haven't done it." Zheng Ren pondered, "The patient is in critical condition, and he doesn't have many options. Let's try emergency surgery. I can't guarantee it, I can only do my best."
"Thank you." Director Xia sincerely thanked.
It would be a shame to ask the director of a university to say thank you in front of the patient's family.
A triumphant smile appeared on the corner of Su Yun's mouth.
Zheng Ren frowned.
"Are there any consumables?" Director Xia immediately asked the most acute question.
"I've already contacted, and it will be sent to the emergency operating room in dozens of minutes." Zheng Ren said, "Get ready to send the patient, sign before the operation..."
"I can sign." Director Xia said.
It seems that she and the patient and his wife are indeed familiar to a certain extent.
"Okay." Zheng Ren said, "Prepare for emergency surgery!"
At the same time, "Ding Dong~~" a task prompt sounded in Zheng Ren's ear.
[Main quest: The first stage of the jewel in the crown.
Task content: Complete a trans-jugular intrahepatic portosystemic shunt, which is the most difficult interventional operation and known as the crown jewel.
Task reward: The average time to complete the TIPS operation is 4 hours and 23 minutes. If the host completes the task longer than the average time, there will be no special reward. If the time to complete the operation is shorter than the average time, you will be rewarded handsomely.
In addition, the reward is +2 lucky value, two golden treasure chests, and 200000 experience points.
Task time: 6 hours. 】
Zheng Ren originally wanted to ignore this task, but after a glance, he was stunned.
Seeing the long list of numbers, the reward of lucky value +2, and the "rich reward" that the big pig's hoof in the system said, Zheng Ren felt in a trance that he had returned to the imperial capital.
Is TIPS surgery also a main task?
Among the existing interventional surgeries, TIPS surgery is indeed the most difficult one. If one climbs the technological tree, it is indeed an operation that must be completed to reach the top.
Main quest... well.
I just don't know what the main task of general surgery is.
I have never done TIPS surgery, whether it is for the purpose of saving people or completing the task, I have to think about it carefully.
There seems to be still some time for surgical training, and it seems that it must be desperate.
Zheng Ren's brain was running at a high speed, thinking about all the steps of the TIPS operation.
The procedure of surgery is simple.
After successful puncture through the right jugular vein under local anesthesia, the hepatic vein and portal vein channel were opened with a catheter guide wire and a puncture needle, the portal vein puncture channel was ballooned and the stent was accurately released.
The difficulty of TIPS operation is that the puncture needle can open the channel between the hepatic vein and the portal vein.
This is blind wear, it can only be based on experience...and luck.
No matter how high the level is, in the face of TIPS surgery, if you are a little bit unlucky, you will not be able to complete this kind of surgery.
Therefore, it makes sense that TIPS surgery is the most dazzling pearl in the crown of interventional surgery.
What Zheng Ren thought was how to rely on luck as little as possible.
For Zheng Ren, who didn't even want to open the system treasure chest and tried his luck, trying his luck on the operating table was undoubtedly an extremely difficult thing to accept.
"Not sure?" Su Yun followed behind Zheng Ren. Seeing that his footsteps were not very fast, he seemed to be lost in thought, so he approached and asked.
"In the world, no one has absolute certainty." Zheng Ren said.
"Professor Rudolf Wagner is sleeping in Shangri-La," Su Yun reminded.
"Uh..." Zheng Ren had forgotten Professor Rudolf Wagner to the back of his head.
The professor is the world's top interventional surgeon. Since he is staying, no matter what the purpose is, he should always help.
Zheng Ren nodded and picked up the phone.
"Professor Rudolph, I'm Zheng Ren." The phone rang for nearly half a minute before the professor answered the phone.
Zheng Ren directly ignored his slightly getting up-tempered German and said things directly.
"There is a TIPS operation here, please take a look."
After speaking, Zheng Ren hung up the phone.
...
Note 1: Transjugular intrahepatic portosystemic shunt, referred to as TIPS surgery. In the introduction of this chapter, I said it several times, in order to deepen the impression. In the future, only the abbreviation, not the word count.
In addition, the four characters of TIPS should only be counted as one word. I also heard it from others~~ Please ask for a recommendation ticket, thank you.