Chapter 1036 【1036】Knock on the Key Points of the Textbook

Many doctors who have experienced it agree with this doctor's words.

Doctors in other hospitals are like martial arts masters who show their faces when they talk about problems and speak out in a logical manner, while teachers in their own hospitals don't give lectures. The medical students who came to the lecture for the first time were going to be confused. For example, the trainee Fan Yunyun felt that her head could hardly tell the difference between east, west, and north.

It is not easy to learn from Senior Sister Xie. Senior Sister Xie has been able to enter such an important operation to help show her face in front of colleagues across the country, but she has not yet figured out how this operation is done.

Sister Xie told her that if you want to gnaw hard bones, the teacher said that it is better to spend more energy to explore. Only by understanding anatomy can you understand all surgical problems.

Fan Yunyun hurriedly lowered her head, took out a thick book of anatomy atlas from her schoolbag, and opened the relevant pages.

Geng Lingfei, who was sitting next to her, looked at the big textbook in her hand in surprise, and finally realized why she had to bring a big schoolbag when she came to the lecture. People take lectures as self-study classes in schools.

Looking at her movements, Geng Lingfei frowned and turned his head back: Well, all the actions of this trainee seem to be intentionally or unintentionally robbing him of the teacher.

"You said they were talking about where the liver portal is." Fan Yunyun seemed to be asking herself.

Geng Lingfei didn't even look at her, and didn't discuss with someone like her who robbed the teacher.

If Dai Nanhui is interested, look at the different expressions on their faces. I always feel that it is strange and strange that these two people have never heard of studying with an intern.

Turning the page, Fan Yunyun whispered the key points in her heart to the book: the hepatic vein is formed by the portal vein system and the hepatic artery system of the liver through the central vein and the inferior lobular vein, mostly at the second and third hepatic portals The location joins the inferior vena cava.

When a patient has Budd-Chiari syndrome, the outflow part of the hepatic vein is obstructed, so between the unobstructed hepatic vein and the obstructed hepatic vein, between the subcapsular arch of the liver and the sinusoidal space of the liver parenchyma, between the phrenic vein and the hepatic vein, the liver Between veins and short hepatic veins, between lobules and perihepatic adhesions, and perihepatic ligaments, etc., the collateral circulation that the doctor at the foreign hospital just mentioned can be widely formed.

Then there is the third portal of the liver, there are a large number of small and medium-sized veins called short hepatic veins, and there are as many as thirty or fifty branches. If the above factors are not handled properly by the doctor during the operation, the bleeding will be difficult to control, resulting in a huge risk of the patient dying on the operating table.

The significance of needing to establish extracorporeal circulation in this operation is here. The inferior vena cava is a large channel for blood to flow back to the heart. Once blocked, venous congestion in the lower segment may occur. How serious this problem is, sometimes it will cause kidney failure in the lower segment. In addition to this, the collateral circulation formed in patients with Budd-Chiari syndrome during the lesion process is mostly small blood vessels. Once the large channel is stuck, these small blood vessels will be detonated like a large minefield. When the time comes, there will be a sea of ​​blood, and the doctor only has a few hands, so how can he deal with such a large minefield bursting blood vessels.

The bleeding is uncontrollable, which is the terrible consequence.

Got it. Fan Yunyun nodded, Senior Sister Xie is amazing, it really is the most important thing to read and understand anatomy well.

That being the case, why do doctors hesitate to use this extracorporeal circulation.

The reason is very simple. It is definitely not a good thing to do things such as deep hypothermia anesthesia and circulatory arrest for patients when it is not necessary.