I can see health

Chapter 433
Lu Chen withdrew the guide wire, his mood was quite complicated.

In desperation, there was a trace of reluctance to admit defeat.

He has tried his best and tried many times, but in the end he still can't get the guide wire through the superior vena cava.

This was his first failed surgery experience since he set foot in the field of electrophysiology!

Xiao Shikang patted Lu Chen's shoulder, seeming to see his thoughts, "Lu Chen, it's okay, this is not your problem. No one would have thought that the patient's superior vena cava would be blocked."

Lu Chen took off his gloves and fixed his eyes on the screen on the operating table, "Ms. Xiao, I'm fine."

"Well, I will apply for a general consultation with the Department of Cardiology for this medical record." Xiao Shikang continued, "Is there any good way to see other doctors in the Department of Cardiology at that time."

Lu Chen nodded slightly, looked away, and silently arranged the equipment on the operating table.

……

"Doctor, is my surgery done?"

At this time, the old man on the hospital bed suddenly said.

Lu Chen moved his lips, wanting to say something, but he didn't say it.

Xiao Shikang walked slowly to the side of the patient, and said softly, "Master, not yet. If there is a problem, don't worry, we will take care of it."

In this case, in order to avoid the patient's emotional fluctuations, Xiao Shikang decided to communicate with the patient's family first, and then slowly explain to the patient himself.

"Lu Chen, please tidy up the equipment, and I will communicate with the patient's family about the patient's condition."

"it is good."

After Xiao Shikang said something, he left the cath lab.

……

catheter outside.

Lu Chen had already packed up the surgical equipment and asked Dr. Guipei to push the patient back to the ward.

He sits on the equipment outside the catheterization room and repeatedly watches the patient's X-ray angiography on the computer screen.

Before today, he was very confident, even a little conceited.

Although Lu Chen has only been exposed to electrophysiological surgery for a short year, with the help of the systematic surgery simulation room and the realistic simulated surgery room, the level of electrophysiological interventional surgery has improved rapidly.

Whether it is pacemaker implantation or arrhythmia ablation, he can do it with ease.

Even the difficult dry pericardiocentesis is not a problem.

His level of electrophysiological intervention has surpassed the absolute part of attending physicians and deputy chief physicians.

But today's failure made Lu Chen suddenly wake up.

His efforts are far from enough!
There are still many diseases that have not been completely overcome, and there are many, many things he has to do!

Thinking of this, the arrogant conceit in Lu Chen's heart is slowly disappearing.

Instead, it was an indomitable momentum!

……

In the afternoon, Lu Chen had dinner and returned to the hotel where he was staying.

Tonight, instead of continuing to train in the system simulated surgery space, he began to read relevant literature.

This patient is definitely not the first case of superior vena cava blockage.

He wants to look through the case reports of various countries, and wants to see what other people's handling measures are.

Doctors, only through this kind of learning can they continue to improve.

No doctor can survive by gnawing at his roots.

After looking through the domestic and foreign literature of the past five years, the time has come to ten o'clock in the evening.

"Ding ding..."

The familiar WeChat notification sounded, and Lu Chen took out his phone, and it was another message from Min Xiaobo.

"Lu Chen, it's been half a month, how many operations have you completed?"

Two weeks have passed since the second stage of assessment.

Lu Chen recalled the operations he had completed, and there were only six cases so far.

Among all the students, this is considered to be lower than the middle.

"Ah? You only have six?" Min Xiaobo was surprised. "I feel like I have very few, but I have already made eleven."

In two weeks, six surgeries were completed, and this volume of surgeries may be at the bottom.

Although the evaluation index is not completely calculated according to the amount of surgery, it is also an important index.

"No way." Lu Chen said helplessly.

In fact, there are not too few surgeries here, but three of them were canceled after Lu Chen reassessed that they were not necessary.

Then today this operation failed, and another one was reduced.

"There are still two weeks left in the assessment, come on!" Min Xiaobo said.

Both of them came from Jinghua, and their relationship is much better than others.

Min Xiaobo is still very optimistic about Lu Chen in his heart.

"Well, thank you Bo Ge for your concern." Lu Chen replied.

Turning off the phone, Lu Chen continued to read the literature.

From this point of view, it was a whole night.

……

The next day.

For this failed case, Xiao Shikang quickly organized a cardiology conference.

The First Affiliated Hospital of Kyoto University, Cardiology Department Demonstration Classroom.

The small classroom was full of people.

At least one doctor with a deputy senior title came to each ward of the Cardiology Department.

A team of doctors of this level is considered a top-level "luxury group" even if viewed nationwide.

Xiao Shikang was standing on the podium, introducing the patient's condition to everyone.

"The battery of the patient's pacemaker is exhausted and needs to be replaced. At the same time, the patient has severe symptoms of heart failure and malignant arrhythmia. We are going to implant an ICD."

"But during the operation, we found that the patient's superior vena cava was blocked."

While Xiao Shikang was speaking, the live broadcast of yesterday's operation was also played on the projector screen on the podium.

"My surgical assistant and I tried many times, but the guide wire still couldn't pass, so we had to give up the operation."

After introducing the illness, everyone in the audience began to discuss with each other.

Qin Sifeng took the lead in saying: "The current diagnosis of the patient is severe and refractory heart failure. If the pacemaker and ICD are not implanted, the symptoms of heart failure will become more and more severe, which will not only affect the quality of life, but also affect the safety of life."

After Qin Sifeng, a heavyweight, spoke, everyone echoed.

"Professor Qin is right." Fang Ruzhang said, "This patient is from our ward. I went to see him personally as soon as possible. The symptoms of heart failure were obvious. He was tired from walking and eating, and he was completely lying on the bed. I can’t move at all. At night, I basically can’t sleep on my back. At present, we can maintain it with drugs, but if things go on like this, the effect will definitely not be good. We still need to implant a pacemaker and ICD as soon as possible.”

After some discussions, everyone's opinions were very unified, and pacemakers and ICDs must be done.

The question now is how to do it?

The superior vena cava is blocked, and the guide wire cannot pass through, and the superior vena cava is the only way for conventional pacemaker lead implantation.

On the podium, Xiao Shikang continued: "I don't know, teachers, do you have any good opinions on the next diagnosis and treatment plan?"

As soon as the words fell, everyone started talking again.

Fang Ruzhang took the lead and said: "The superior vena cava is blocked, we may choose other venous access, how about puncturing through the jugular vein?"

The early installation of cardiac pacemakers was performed through chest opening, which caused a lot of trauma.

Since the invention of endocardial electrodes in 1965, transvenous endocardial catheters have been used to install pacemakers.

There are 4 conventional access veins for the insertion of electrode leads, 2 on the left and right sides, which are the cephalic vein and the subclavian vein, and 6 unconventional access veins, 3 on the left and right sides, respectively, the external jugular vein , internal jugular and axillary veins.

The most common is of course the subclavian vein - the route of insertion of the superior vena cava.

This is the shortest and most mature path.

Qin Sifeng shook his head, rejecting the idea: "The patient is old, thin, has few muscles, and thin skin. If the electrode is implanted through the jugular vein route, the skin may be worn out and the electrode may be damaged in the future."

"Professor Qin, what if we use a leadless pacemaker?" Another deputy chief physician suggested.

Qin Sifeng was taken aback for a moment, thought for a moment, and then looked at Xiao Shikang on the stage.

Hearing this, Xiao Shikang also said helplessly: "In addition to the slow heart rate, the patient also has third-degree atrioventricular block and junctional escape rhythm. He needs to use a dual-chamber pacemaker, and a leadless pacemaker is not suitable for this name." patient."

For a while, most of the ideas were not established.

This doesn't work, that doesn't work, everyone is a little discouraged.

Could it be that he has been treated with drugs?

The patient's survival period will be shortened rapidly, and may even require long-term hospitalization.

Just like this, Lu Chen, who had been sitting in the corner, suddenly stood up.

He looked around at everyone, and said slowly: "Teachers, if the hepatic vein is implanted percutaneously, what is the route?"

As soon as Lu Chen's words came out, everyone present was taken aback.

(End of this chapter)