Chapter 1824: Countless difficulties in surgery

At present, the treatment of debakey type 1 dissecting aneurysm is mainly based on surgical replacement of artificial blood vessels.
Because the cause of the patient's Ma Fang syndrome can not be eradicated, and the distal residual lesions still have the possibility of further development, there is a possibility of great recurrence after ascending aortic replacement.
It is estimated that Dr. Rudy has had a premonition for this. If his wife feels unwell, she will go to the King's Hospital immediately.
Therefore, the onset of the disease was found very early, and blood pressure should be started in the intensive care unit to prevent the disease from worsening and wait for the next treatment.
One of the more troublesome aspects of Ma Fang syndrome is that the whole body and large blood vessels have pathological manifestations of cystic necrosis in the middle. Even if this operation is successful, no one can predict when the disease will be ill again next time.
Dr. Rudy continued to talk about the results of various laboratory tests, and he is well aware of this. Zheng Ren did not speak, just meditation.
When I got on the bus, Su Yun asked: "The boss, the surgery is in the middle of the sternum, it is very difficult."
Zheng Ren knows what he means.
This is one of the main points and difficulties of surgery.
In general, for the second operation, the approach should take the original approach of the first operation, so that the patient's injury is relatively small.
Moreover, for aortic arch replacement surgery, the sternum is almost the only approach, and other incisions are limited.
But the long sternum, the bones are very thick, to be next to the cockroach, the sternum saw slips... and then it is tragedy.
If you have a normal operation, just change your incision. However, if you want to do aortic arch replacement surgery, you can't do it at all. You can only choose the mouth with the largest view.
Zhao Yunlong is doing aortic arch placement in the honing of the endoscope. It is just an idea. I really can study it and I don't know when.
However, in the second operation of the sternum, the heart, especially the right atrium may have secondary bleeding or aneurysm rupture. The prognosis is very poor.
This is a matter of experience. It seems that Su Yun has done similar surgery and the effect is general.
Zheng Ren nodded and said: "I am here to get it. This is not difficult. The difficulty lies in the latter. I have pondered several methods. Among them, I think heparinization and the first method of cooling are relatively safe."
"Heparinization, first cool down?" Su Yun stunned.
This idea is somewhat bizarre.
And to do this requires a very high speed of surgery.
Heparinization of the body's blood can face a variety of complications. One of the examples is the patient who was rescued in eicu two days ago.
"No, there are some differences in the surgery at peacetime."
"How to do it?"
"Heparinization first, through the right subclavian artery or femoral artery, venous cannula, parallel extracorporeal circulation and cooling. At this time, opening the chest can reduce the chance of heart or blood vessel rupture, and is more conducive to the mediastinal adhesion during the second operation. Separated and revealed." Zheng Rendao.
Uh……
Cool down first...
After cooling down, all organs in the body, including the heart, will be affected. In other words, the speed of the sternum and the opening of the mediastinum must be fast enough, and it is estimated that 2-3 minutes is the limit.
However, Zheng Ren’s statement seems to be also an idea. Su Yun thought about Zheng Ren’s statement.
Unconventional surgery is not for the sake of the public.
Why is there a fixed surgery? It is because countless surgeons are groping for clinical surgery, and countless surgical failures have confirmed that a certain road is correct.
Once unconventional surgery is used, there is a huge risk.
But sometimes, the actual situation forces the doctor to choose unconventional means to complete the operation.
But compared with the direct sternum, the boss's statement seems to have less complications. No wonder he wants Laohe to come over with the Iraqis. Only a team that has worked with many times can shorten this time to the limit.
"Ma Fang syndrome, it is very difficult to deal with." Su Yun sighed.
"Well, I figured it out, I was in the surgery... I went, forgot!" Zheng Ren suddenly took a thigh.
"Forgot something?" Su Yun asked in surprise.
Zheng Ren did not answer immediately, but he thought about it and finally sighed.
"What's wrong? See if you don't want to be born, can't the surgery be taken?" Su Yun asked.
"No." Zheng Rendao: "I think that the congenital disease of Ma Fang Syndrome causes pathological changes in the middle layer of necrosis of the aorta should be in the surgery, with brackets to avoid similar problems."
"..."
"Second open chest is OK, three times, the patient is estimated to be enough." Zheng Ren said bluntly.
"Intraoperative? Do aortic replacement first, then the lower bracket?" Su Yun asked.
"Yeah." Zheng Ren nodded. "The rich and the poor can't come. There is surgery to do at home, and he and Laoliu can't move."
It turned out to be the case.
"The level of King's Hospital is not bad." Su Yundao: "You can use their doctor to get off the stent."
"It can only be like this." Zheng Rendao: "You look for Lao Zhao, this is what it should be. Once there is a problem in the operation, you go to the lower bracket, and I am doing surgery with Lao Zhao."
Su Yun’s face was twisted.
"Boss, I am a doctor!" Su Yun complained.
"Old Zhao will not intervene, if I go to do it~EbookFREE.me~ Can you guarantee the successful operation with Lao Zhao?" Zheng Ren asked.
"..." Su Yun recalls the surgical procedure, unconventional surgery, can he do it?
Forget it.
Still do as the boss said.
Seeing Su Yun’s silence, Zheng Ren smiled and said:
Nothing, I will look at the situation and try not to delay your surgery.

"Learning?" Su Yun said.
"You can't do it, don't learn, do you still have to teach me to do surgery?" Zheng Ren snorted back.
For this kind of confrontation, Su Yun has no win rate.
After all, the surgery can't take it down, and Zheng Ren is a must.
"What to do with the anastomosis?" Su Yun bluntly reversed the topic and talked about the main points of the next operation.
"I think that in order to reduce the complication of the anastomosis, the lesion of the aortic aneurysm should be long enough.
The rupture must be removed to ensure that the vessel is anastomosed to normal vessel wall tissue. At the same time, in order to increase the strength of the vascular anastomosis, the method of strengthening the inner and outer layers of the full length of the aortic anastomosis end should be used. It not only increases the strength of the anastomosis, but also ensures the complete closure of the vascular sandwich.

"The aortic anastomosis end of the full circumference of the dense felt strip inside and outside the reinforcement method, this is very difficult." Su Yundao.
"Nothing, there is me."
Su Yun did not speak, just took a look at Zheng Ren. His simple, honest face seems to have a layer of luster, which makes people feel trust.
"Well, surgery, you seem to think very well." Su Yun said after a long time.
"There is another point, brain protection under hypothermic cardiopulmonary bypass." Zheng Rendao, "I have an idea, but I still want to ask Laohe, see if he has any opinions."
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