I can see the status bar

Chapter 223 Discussion
Surgery is graded.However, many ordinary people have never heard of this statement.

According to the corresponding laws and regulations, the difficulty of surgery is divided into one to four levels.Newly recruited resident physicians can preside over the first-level surgery under the guidance of superior physicians, and then move up through the ranks.For level [-] surgery, the chief surgeon is required to be at least the deputy chief physician.Moreover, newly promoted deputy chief physicians need to work in the deputy chief physician position for three years, and those with a postdoctoral degree need to work in the deputy chief physician position for two years before they can independently preside over the fourth-level surgery.But the precondition is that no new technology is applied in the fourth-level surgery presided over, or it does not belong to new project surgery or scientific research project surgery.

PCI is quite special, it is a tertiary surgery, and it is also a qualifying surgery item.Senior attending physicians can only perform the operation after obtaining the admission qualification for the operation.

According to the analysis of the four people, if Yao Zhuangxian is to perform an operation to repair an ectopic heart, at least one senior attending physician with access qualifications, two senior deputy chief physicians of the cardiac surgery department, and one general surgeon are required. A total of five junior deputy chief physicians in surgery can complete it.For such a large-scale operation, the deputy director of the anesthesiology department must be present. At the same time, the nursing department has to transfer a team of nurses who often cooperate with several doctors to participate in the operation. That is to say, there may be more than 20 people in the operating room at the same time. team.

"Of course, such a major operation will definitely not be completed at one time." Yuan Pingan explained to Sun Lien, "For example, PCI should be performed before heterotopic repair..."

"The patient's heart is in the abdominal cavity. This PCI is not something that ordinary doctors can do." Xu Yourong shook his head, "Maybe the heart needs to be separated before it can be dredged."

"Isn't it?" Zhou Ce frowned and asked, "After the heart is separated from the body, the blood vessels are all deflated. How can we intervene?"

This is why PCI procedures require special admissions.If it is not a doctor who specializes in this operation, the understanding of this operation will be very limited. Everyone knows the principle, which is to use a guide wire to poke along the artery to the coronary artery of the heart, and then find the blockage or severe stenosis. According to the situation, choose to suck thrombus, crush hardened plaque, or simply place a stent to expand the narrowed blood vessel.What kind of treatment to use specifically needs to be judged by a doctor who has obtained PCI admission qualifications.

"It's a big deal to build a bridge outside the body." Sun Lien bravely expressed his point of view in the discussion among a group of top scholars.Anyway, we all know each other well, and they all know that they are small regular trainees. Even if they say something wrong, it seems that there will be no serious consequences.

"Don't tell me, this is really a good idea." After everyone was silent for a while, Zhou Ce suddenly nodded and said, "It is definitely more beneficial for the bridge to be built after the heart is separated from the body. Insufficient blood supply, the only problem may be whether the blood vessels can be sewn well—the proliferated blood vessels are very thin.”

Yuan Ping'an thought for a while and added, "Be careful with the medication you take afterwards. Anticoagulant therapy is needed after bypassing the bridge, but anticoagulant therapy will increase the risk of bleeding in the later stage..."

Xu Yourong glanced at Yuan Ping'an, then shook his head in dissatisfaction, "That's wrong, every patient's situation is different, you can't just copy the contents of the book mechanically."

Seeing Yuan Ping'an's expression of bewilderment, Xu Yourong continued, "Short-term anticoagulant treatment is required after heart bypass surgery. This is the content in the textbook. But you have overlooked a very important prerequisite."

After all, Yuan Ping'an is not an academic research doctor with no clinical experience, he immediately understood what Xu Yourong meant. "You're right that this patient has a different etiology than the other patients who required bypass surgery."

The actual manifestation of coronary heart disease is that the blood vessels that wrap around the heart are narrowed or blocked.But there are many reasons for this behavior.Among them, the largest proportion is vascular sclerotic plaque caused by hyperlipidemia, or thrombus blockage caused by hypercoagulable state.For coronary heart disease caused by these two reasons, patients do need short-term anticoagulant therapy after bypass surgery.But the cause of Yao Zhuangxian's coronary heart disease is completely different-his blocked blood vessels should not have existed in the first place.The reason for the blockage is not blood viscosity, but the compensatory blood vessel diameter is too small and the blood vessel is excessively twisted.

The blood vessels in the human body can be regarded as natural river channels to some extent.Arteries, on the other hand, are like river channels in a state of flood discharge.A wide and straight river is the ideal situation, but it is inevitable to encounter some twisted and narrow rivers or weak slopes.

The slope is fragile, so it may be eroded a little bit under long-term erosion, and the result of erosion is an aneurysm.If it rushes to the slope and breaks, it means a ruptured aneurysm, which is a serious symptom that will kill people in minutes.

Compared with the fragile slope bank, the sedimentation caused by the twisted and narrow river channel progresses relatively slowly.The siltation will cause the river to gradually narrow, and when the river is completely blocked, it will cause coronary heart disease.

Compensatory hyperplasia of blood vessels has a characteristic, no matter which organ it appears in, the bending and narrowing of blood vessels is inevitable.This kind of compensation occurs in the brain is moyamoya disease, and occurs in the liver, which indicates the middle and late stage of liver cirrhosis.In general, although it can guarantee the normal operation of the human body in the short term, it is not a good thing.

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Speaking of which, this discussion should be regarded as Sun Lien's medical team's first collective consultation and discussion after the bird flu.Although Dr. Pascal didn't participate, it was not easy to gather such people - although Zhou Ce was not a member of the treatment team, he had a close relationship with Xu Yourong and liked to chat with Sun Li'en.Basically, it can be regarded as half of non-staff personnel.

"Speaking of which, didn't Dean Song ask Professor Liu to take over the treatment team?" Yuan Ping'an was present when Song Wen made this decision.He is almost the most concerned about the treatment group among the four, "But it's been such a long time, and I haven't seen Professor Liu come to the group once..."

"Don't speak ill of Dean Liu so blatantly!" Zhou Ce coughed lightly twice, and said seriously, "Be tactful, be tactful."

"For example, Dean Liu has recently become obsessed with a newly opened noodle restaurant." Xu Yourong said without changing his expression, "The old man eats noodle noodles three times a day recently, and I almost turn into jaggery."

The three of them turned pale with shock, but they couldn't figure out what kind of disease the noodles were like fried sauce.

"Is this joke not funny?" Xu Yourong was stunned for a while, then shook his head, "I'm still not very good at telling jokes."

Sun Li'en sighed, "Anyway, the treatment group is temporarily disbanded. When Dr. Xu sorts out the thesis, I guess Dean Liu will make some moves."

The original purpose of setting up the treatment team was to pave the way for Xu Yourong's promotion.When this thesis has a clue, there is a high probability that Liu Pingchuan will transfer Xu Yourong to the neurosurgery department.Even if there is a position in the diagnostic department in the future, it will have to wait a year or two.

"The thesis outline is estimated to be out in two days." Xu Yourong nodded and replied, "Chen Wen's surgery plan is probably already in place. What Teacher Liu means is that intervention is the main approach. The cerebral blood vessels are used as the operation channel. The batch of worm cysts in the white matter of the brain."

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Complicated surgeries, surgeries that cause major trauma to the human body, are best performed in several sessions.This is a very important conceptual progress in modern medical surgery.Chen Wen's condition was complicated and serious, not only Sun Lien heard of it for the first time, even Xu Yourong saw it for the first time.The Department of Neurosurgery of the Fourth Central Hospital has not been relaxed in designing Chen Wen's surgery plan during this time. Liu Pingchuan even contacted his old friends from the same association to help with the operation plan.At the same time, Liu Pingchuan ordered two sets of 3D printed models of Chen Wen's brain from Shenzhen, which were specially used to practice the operation plan.

But the real big head is still to come. For this operation, the Fourth Central Hospital decided to use the newly purchased ROSA neurosurgery robot system.

This time, there were many wounds and the location was deep. It was obvious that the neurosurgeon's hands alone couldn't achieve the required accuracy—even if the first few worm cysts could be removed with Xu Yourong's steady hands, no one knew about Xu Yourong. How long can the stability of the hands be maintained.

Once Xu Yourong's hands lost stability due to the long operation time, the sharp sampling needle would injure normal brain tissue, or puncture the internal cerebral artery causing severe bleeding.This kind of mistake must never happen.

"I've used the ROSA system a few times in the United States, but I'm not particularly proficient." Xu Yourong stretched, and then put her loose hair back behind her ears. "I have been practicing these days, so I don't have much time to come to the emergency department."

Sun Li'en has never heard of what ROSA is, but he has heard that there is a Da Vinci system in the courtyard.He asked curiously, "Isn't there Da Vinci in the courtyard? Why not use that?"

"The kind of things used for thoracic and abdominal surgery are not accurate enough." Without Xu Yourong's answer, Yuan Ping'an replied directly, "And Da Vinci can't walk in the arteries. If you want to do neurosurgery, that lump is Scrap."

Speaking of it, the positioning of the Da Vinci surgical robot is really a bit embarrassing.After being introduced into the country as an advanced device, the unacceptable phenomenon of the Da Vinci robot is more serious than everyone estimated at the beginning.During thoracoabdominal surgery, although Da Vinci can achieve advantages such as less trauma and faster recovery, Da Vinci surgery has not yet entered the coverage of medical insurance.Many commercial insurance policies will not cover this huge additional expense.Compared with general laparoscopic surgery, Da Vinci's advantages are not so great as "revolutionary subversion".

And remote surgical support, another huge advantage of the da Vinci system, is even less meaningful.None of the hospitals that can afford Leonardo da Vinci is a novice. Everyone is very good at fighting, and there is no need to call for foreign aid.However, hospitals that need surgical support cannot afford this set of equipment. For operations that require experts to operate, they must either transfer the patient to a high-level hospital, or invite experts to come to the hospital for surgery.Remote surgical support is a big selling point, but in reality it is not available at all.

Although now relying on 5G technology, large hospitals can achieve remote Da Vinci consultations and even surgery with each other, but such cases are still rare after all-the round-trip air ticket for experts is much cheaper than a Da Vinci and a bunch of follow-up support services. too much.

(End of this chapter)