medical road high rise

Chapter 275 Setting up a vascular bridge ([-])

Chapter 275 Setting up a vascular bridge ([-])

Qin Feng entered the operating room, and after changing into the surgical gown with the help of the nurse, he became a little dazed.

"Dr. Xiao Qin, what's wrong with you? Are you scared by 100 million?" Li Xuewen couldn't help but laugh when he saw Qin Feng's look.

"No, I was wondering where to start the surgical approach." Qin Feng smiled.

After the operation is completed, Qin Feng will not ask for money from the patient's family. If the money is collected, it will be ruined if it is caught by someone with a heart.

Small red envelopes and the like are common in hospitals, but so many in one breath, or the words "money and silk" touch people's hearts, and the hospital is a small society.

Qin Feng stood on the operating table, and the instrument nurse was counting the surgical instruments.

"The patient does not have a large ventricular septal defect, so I am going to perform constriction resection and end-to-end anastomosis directly." Qin Feng said.

This procedure is for assistants and instrument nurses, and they will act as assistants to Qin Feng and deliver surgical instruments at different stages according to their own habits and procedures.

Before the operation, you must make it clear to the equipment nurse and assistant, otherwise it will be very tiring for the surgeon to speak all the time.

In a high-intensity operation, if you make the doctor talk for more than five hours without drinking water, no one else will do it.

"Oxygen inhalation, cardiotonic and diuretic treatment have been given before the operation." Li Xuewen said.

This is to control the patient's congestive heart failure, and Qin Feng recalled the operation steps in his mind.

In the end-to-end anastomosis of the constricted segment, it is necessary to block the upper and lower descending arteries of the constricted segment during the operation, so other parts may be ischemic and cause damage.

In order to protect the spinal cord and distal organs from ischemia during occlusion of the descending artery, Qin Feng needed to find the best protection measures from the surgical steps.

Generally, there are three conventional methods of protection, hypothermia protection, erection of temporary vascular bridges, and circuitous left heart perfusion.

The principle of cryoprotection is very simple, that is, when cells are at extremely low temperature, their metabolism and other activities will slow down, so the spinal cord and distant organs will have less demand for blood flow, even if there is no blood passing through. It won't do too much damage either.

The second type of vascular bridge is to build a temporary blood flow channel in the descending aorta at the upper and lower ends of the constricted section to communicate with the blocked aorta and maintain blood circulation.

The third method, circuitous left ventricular perfusion, has the advantage of being easy to operate. It can not only protect the spinal cord and abdominal organs, but also adjust the flow according to the blood pressure of the upper limbs at any time, so as to avoid cerebrovascular accidents caused by high blood pressure in the upper body.

After thinking over and over again, Qin Feng chose to erect a temporary vascular bridge.

In terms of surgical procedures, Qin Feng's blood vessel transplantation is definitely at the master level, and the erection of blood vessel bridges must be far higher than other protective measures.

Qin Feng has done difficult blood vessel transplants before, but now he just erects a temporary blood vessel to maintain blood circulation, just like a mathematics professor doing math problems for junior high school students, it is not so easy!

Of course, in addition to proficiency, there is another reason that the degree of difficulty of erecting a vascular bridge is the highest. On the contrary, as long as the operation is done properly, the risk factor of the patient is also the smallest.

This is a combination of risk and reward.

Low temperature protection only reduces the activity of organs, thereby reducing the demand for nutrients and making it difficult to stabilize in an emergency.

Detoured left heart perfusion may cause excessive blood flow and blood pressure in the upper body, resulting in massive congestion of cerebral blood vessels and fatal accidents.

"Prepare to build a vascular bridge for protection," Qin Feng said.

Li Xuewen looked at Qin Feng with surprise on his face.

For vascular bridges, there are very few vascular surgeons in Ruijin Hospital, no more than a handful, and most of them are not in the hospital.

Li Xuewen didn't raise any doubts, and watched Qin Feng's operation quietly.

The anesthetist performs general anesthesia with endotracheal intubation, which also takes into account that the patient has congestive heart failure to prevent high blood pressure due to anesthesia.

Li Xuewen and the equipment nurse helped to adjust the body position. After the adjustment, under the shadowless lamp, Qin Feng picked up the shining scalpel.

After a few minutes.

"The anesthesia is complete, and the operation is ready." The anesthesiologist checked it one last time, and after finding that there was no problem, he stood next to the instrument.

Qin Feng picked up the scalpel and made an incision directly behind the fourth rib on the patient's left side

The skin was cut open with a scalpel and separated layer by layer, exposing the descending aorta inside.

Qin Feng then made a longitudinal incision along the descending aorta and the surrounding mediastinal pleura, and then extended the incision upward to the left subclavian artery and the uppermost intercostal artery.

Another transverse incision was made with a scalpel, and the upper and lower descending arteries of the constricted section were freed.

"Wrap the tape, free ligate the catheter."

Tape wrapping is to control bleeding in order to prevent accidental damage to blood vessels. Li Xuewen heard the command and immediately went up to complete the tape wrapping of the descending aorta.

Qin Feng continued the operation, free ligation of the arterial duct and arterial ligament, Qin Feng's movements were very light, because there is a recurrent laryngeal nerve near the duct, once the recurrent laryngeal nerve that controls the laryngeal muscle is accidentally injured, it may cause hoarseness and even lead to shortness of breath Cause suffocation.

This kind of nerve damage is difficult to recover, and doctors try to avoid this situation as much as possible during surgery.

After freeing the arterial catheter, Qin Feng ligated the catheter exposed in the surgical field.

"Catheter forceps."

Li Xuewen clamped both ends of the catheter with catheter forceps, Qin Feng's scalpel fell, and cut off the arterial catheter directly at the ligation site, and cut off the arterial ligament ligation in the same way.

After suturing the broken ends, Qin Feng began to free the intercostal arteries, which will form collateral circulation after the aorta narrows to compensate the body for blood.

Even if the constriction is completely closed, the collateral circulation can still transport blood, but the collateral circulation cannot replace the original blood circulation. Once the aorta is blocked and blood rushes in, the intercostal artery may burst at any time.

Taking this into consideration, Qin Feng carefully separated to reveal the constricted aorta of the intercostal artery, and then ligated and cut it off. A series of movements flowed smoothly.

"Start freeing the intercostal artery." Qin Feng said.

Li Xuewen became serious in an instant, staring at Qin Feng's movements, seeing Qin Feng's skillful movements, Li Xuewen was a little dazed.

It seems that Qin Feng is extremely proficient in every operation he participated in, as if he has done it hundreds of times.

But Qin Feng doesn't seem to be 30 years old, and he hasn't been officially active for a long time, so it's impossible for him to undergo so many surgeries.

This question, destined no one can answer him.

Qin Feng's operation is still continuing. The scalpel separates the distal aorta and intercostal arteries to ensure that the intercostal arteries will not be damaged.

What Li Xuewen saw was a jump in front of his eyes. The intercostal artery is one of the most fragile arteries in the human body. Are you sure there will be nothing wrong with Qin Feng's strength?

(End of this chapter)