Chapter 1082: : Persistence of twenty-two degrees

Is the perfect level of large blood vessel anastomosis really perfect?
Chen Cang looked at his stitching and began to ask himself such a question!
What is perfect?
Perfection is a threshold reached using current methods.
But the current means are inherently limited.
There is room for improvement and improvement in both surgical techniques and surgical procedures.
This is a process that requires continuous research and improvement.
Is still perfect, not to mention the master class.
Cang Cang's aortic dissection surgery and total aortic arch replacement are masters at this time.
It takes a long distance to break through to perfection.
"Line four."
"Natural saline rinse!"
"Clamp!"
……
The operation is continuing.
Facing the repair of the intercostal artery, Chen Cang began to calm down and observe carefully, the third rib ... the fourth rib ...
Cang Chen suddenly asked Xu Ziming: "Does the intercostal artery have a big difference in the time limit for blood supply to the spinal cord?"
Xu Ziming nodded: "Well, according to the 2009 version of the guideline, it can be completed within 60 minutes, but later research found that in fact, around 45 minutes, the spinal nerve tissue ischemic hypoxia reaction has begun, although there is no intuitive Performance, but there are some problems with the post-fix! "
Cang Cang looked at such complicated intercostal arteries: "How long is the best time?"
He Chao from the side blurted out: "Professor Wu of Ruijin Hospital can complete the repair of all intercostal arteries in 35 minutes! That's ... my teacher."
Xu Ziming nodded: "Well, indeed, Professor Wu Nan has extensive experience with Marfan syndrome and has long been devoted to it. He is also constantly practicing for the repair of intercostal arteries."
Chen Cang nodded when he heard it!
More than 20 arteries, 30 minutes!
All time is counted in, and a blood vessel only takes one and a half minutes, which also needs to include handling the thread knot, needle insertion ... and so on!
The treatment of intercostal blood vessels also involves the problem of an intercostal nerve to avoid damage.
Is much more troublesome than the large blood vessels in the chest cavity.
Chen Cang holds the abrasive tool for a maximum of thirty or forty seconds, but how long does it take to put it in this situation?
Chen Cang decided to find some time to practice.
……
After the operation, the anesthetist Zhou He has been monitoring the vital signs of the patient because of the long operation time, it is necessary to choose appropriate brain protection.
In fact, if the patient does not have Marfan syndrome, just an acute type I aortic dissection, he can only perform ascending aortic replacement or half-bow replacement.
However, under Marfan syndrome, the originally damaged ascending aorta and aortic arch have already changed in the fibrous layer. If it is not controlled, it must be a problem!
The use of total arch replacement is definitely good, or the use of the common "elephant surgery" is also very effective!
But this is actually very demanding on both the patient and the surgeon.
Not only requires the surgeon to be skilled, but also requires the patient to have a better overall condition for stable operation.
Athlete Tian Zhengkai is very good, and Chen Cang is also skilled enough, so this time, full bow replacement surgery is actually the best choice!
The ascending aorta is finished!
The patient's vital signs are completely normal, ready for full bow replacement surgery!
Chen Cang breathed and said, "Cool down!"
Hypothermia, circulatory arrest, and retrograde perfusion of the superior vena cava are effective brain protection strategies!
Everyone is busy!
"How many degrees Celsius?" Zhou He looked at Chen Cang and asked directly.
"Adjust to 20 degrees Celsius!" Chen Cang said decisively!
Zhou He was surprised!
There is a direct correlation between low temperature and stop circulation.
The lower the temperature, the longer the time allowed to stop the cycle. When it is 15 ~ 18 degrees Celsius, it can be maintained for 60-80 minutes!
In this way, the operable time becomes ample.
If the temperature is high, the time is limited, but ... the patient's damage may be slightly smaller.
But again, if you have enough time, the patient may need some price!
Why is medicine difficult?
Because the time we fight for is actually given by the patient, and the patient's time is swallowed by death!
Every time we consume an extra minute, the disease damages for a minute, the death is swallowed a little!
This is a tug-of-war, and the chips are the time.
Whoever grabs the patient first will win!
Perhaps at this moment, this feeling of competing with death for time will become more apparent!
Chen Cang chose 20 degrees Celsius, the requirements for doctors have been increased suddenly, because the operable time has become shorter, but also, the patient's damage has also become smaller.
Zhou He glanced at Chen Cang's firm expression and nodded!
And Xu Ziming and He Chao also expressed emotion: Chen Cang, this is Chen Cang!
He Chao even had a little more anticipation and excitement.
When the temperature is lowered to temperature 20 ℃, stop circulation or add retrograde infusion of superior vena cava at the same time!
Chen Cang began to separate the aortic arch!
Tense atmosphere!
The feeling of low temperature coming from my hands!
Anxious time!
The sound of Didi Di from the monitor!
The breath of several doctors became clearer.
All signs indicate that this is a difficult operation.
Free distal aortic arch is a precision operation.
Carefully confirm the vagus and recurrent laryngeal nerves, free the nerves first and then place a drawstring traction, pay special attention to prevent damage to the recurrent laryngeal nerves when the distal end of the free lower arch is free.
Chen Cang, a dexterous and stable blesser, carefully avoided the danger.
Took less than 8 minutes to successfully separate!
Xu Ziming and He Chao who looked at each other looked at each other with surprise.
Such a fast and accurate free aortic arch ~ EbookFREE.me ~ saves a lot of time for the replacement surgery in a while.
The seemingly ordinary operation is full of details and invisible technology.
However, this is also an opportunity for the experienced Xu Ziming to learn and exercise.
He Chao was a little excited.
Cang Cang's free time was no less than that of his teacher.
Next, Chen Cang lowered the separation forceps and began to trim the aortic arch!
Then select a suitable artificial blood vessel and suture the descending aortic opening with 4-0 polypropylene thread.
This process, Chen Cang spent less time. As the champion of the Cardiac Surgery Skill Competition and Large Vessel Suture Competition, Chen Cang had little pressure to deal with these things.
Then, the suture began to contain the posterior wall of the opening of the three branch blood vessels. These are the branches and directions of the blood vessels. The suture needs to be tight to prevent blood leakage.
But here is the aorta, the blood pressure is very high, if there is a crack or something, this is a potential disaster for the patient!
Therefore, the anastomosis of artificial blood vessels and blood vessels is the key to surgery!
Not only to be fast!
And keep it secret!
The tone of the whole operation is like this!

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