Auto chess in the operating room

Chapter 369 I will, don't you?

In order to prevent the previous embarrassment from repeating itself, Dr. Tian behaved this time: "Dr. Wang, the first stage is over, and the patient is out of danger for the time being. Go and invite Director Huang over for another valve replacement."

Dr. Wang nodded, "Okay."

Just as Dr. Tian was about to start repairing, he heard a suspicious voice from the side of Tang Lou: "Dr. Tian, ​​what are you asking Director Huang for? Could it be that you still don't know how to perform another valve replacement?"

Looking at Tang Lou who asked such an obvious question in a serious manner, Dr. Tian was stunned for a while, and the old man blushed and said: "No. Of course I won't do such a difficult operation. Why, you will?"

Dr. Tian looked at Tang Lou, who was almost overturned in the first stage, and asked back, the latter nodded slightly: "Yes!"

Doctor Tian: "."

After much difficulty, Dr. Wang who was about to walk out of the operating room also stopped, with black lines all over his face, he now seriously suspected that Tang Lou was just pretending.

"Doctor Tang, this is not a joke. Are you sure you can have surgery? The patient is out of danger now, and we have enough time to wait for Director Huang to come back."

Dr. Tian confirmed it again, a bit reluctant to admit that Tang Lou crushed him again!
Tanglou waved his hand and shouted directly to the instrument nurse: "Scalpel"

After receiving the scalpel, he said to Dr. Tian: "Next, cooperate with me to perform mitral valve replacement again. I will use the right atrium-atrial septal incision. You are all optimistic. If you don't know anything about this, just dare to do it." Into the operating room, the heart is really big."

Listening to Tang Lou's complaints, Dr. Tian and Dr. Wang were also suffocated and wanted to hit someone.

Dr. Tian glanced at Dr. Wang helplessly and shrugged: "Since Dr. Tang has spoken, we will cooperate."

"Oh."

Dr. Wang is like a duckweed in water, drifting with the current, wherever the wind blows from the superior doctor, he can only float there.

At this time, Tang Lou's scalpel had already made a longitudinal incision on the lateral wall of the right atrium, about 2cm away from the interventricular groove.

"This patient has a small right atrium. If you encounter this situation in the future, the incision will be extended to the position of the inferior vena cava cannula to expand the surgical field. However, remember not to injure the crista ligamentum, because it contains the internode The conduction bundle and the atrioventricular sulcus are unlikely to be injured, which contains the right coronary artery."

Hearing Tang Lou's instructions, Dr. Tian and Dr. Wang wanted to refute, but after thinking about it carefully, they really didn't dare to learn Tang Lou's small surgical field and dare to operate.

"What kind of eyes are these, and they are too powerful."

Doctor Tian sighed in his heart, and his confidence was hit again.

"seams"

Tang Lou continued the next step of the operation. Seeing Tang Lou using sutures, Dr. Tian didn't understand.

"Doctor Tang, what is this?"

"The cutting edge of the atria can be drawn with sutures to expose the atrial septum. After that, the incision is made at the center of the fossa ovalis, and then extends upward and downward. The upward incision can reach part of the upper border muscle bundle, and the downward incision must stop at the 1.5cm above the medial coronary sinus."

When Tang Lou's voice fell, it means that this step has been completed.

"So that's it, Dr. Tang, your excision is too powerful."

Tang Lou continued to operate. The right atrial septal margin was fixed to the parietal pericardium with sutures, and two traction sutures were sutured on the left margin together with the right atrial wall.

Dr. Wang, after Tang Lou's operation, suddenly found that his hook became very easy.

"Social experience has improved again!"

Dr. Wang's eyes lit up, watching Tang Lou's operation, it turned out that it was still like this, the hook that was a bit laborious to control at first, was gently pulled, and the mitral valve was exposed.

Oh Huo!

The mitral valve and the artificial valve appeared very clearly in the field of vision.

"The next step is to first remove any blood clots that may be present, and at the same time check for valve failure."

While operating, Tang Lou passed on his experience to Dr. Tian and Dr. Wang.

"Okay, Doctor Tang."

Dr. Tian began to carry out examinations according to Tang Lou's instructions. After a while, the whole person was not well.

"Doctor Tang, this situation is dangerous. The suture ring has been covered by new endocardial growth. How to do it?"

If Tang Lou was not on the side, Dr. Tian would have panicked in this extreme situation.

"Round blade."

Tang Lou glanced at it, and took a scalpel directly from the equipment nurse, and began to cut open with a round-headed blade at the part of the sewing ring close to the host's sewing ring.

"So direct?"

Doctor Tian's heart jumped when he saw it: "Doctor Tang, slow down, slow down."

Tang Lou ignored it, and extended directly to both sides. After a while, he cut a full 3cm in the seam ring.

"Doctor Tang, just dig like this! How do you determine the depth and length of the incision?"

Tang Lou's mind is full of various cases. The three-star level is equivalent to decades of skill of an ordinary chief physician.

Doctor Tian slandered inwardly: "I believe in you!"

Then, watching Tang Lou very easily peel off the tissue embedded in the sewing ring to the ventricle wall, is it so barbaric?

"pliers."

After a while, the whole seam ring was caught by Tang Lou and thrown on the iron plate. It was very clean and there was no trace of adhesion.

Looking at the stitching ring that Tang Lou processed, Dr. Tian was envious and puzzled. How did this technique come about?

"Scalpel"

Tang Lou didn't give Dr. Tian any time to recuperate, and went directly to the next step, which was the most critical removal of the artificial valve.

"You two, remember, next time you remove the artificial valve, you must find the suture ring from the annulus and remove it at this part, otherwise it may damage the mitral valve annulus and important tissues around it, and even cause atrioventricular annulus. ventricular perforation."

"It's good, but, Dr. Tang, can you slow down the operation a little bit, I can't keep up."

Doctor Tian's old face turned red.

"Oh."

Tang Lou responded casually, and then the operation still did not change: "A large amount of saline is used to flush the ventricles."

Doctor Tian: "."

Dr. Wang grinned from the side, as if seeing himself when he was helping Dr. Tian again.

It turned out that in front of Dr. Tang, Dr. Tian looked like a not-so-intelligent sub.

The next step is to replace the artificial valve. Since the previous steps are very clean and perfect, Tang Lou's subsequent valve sewing method is exactly the same as the first operation.

The only difference is that Tang Lou inserts the needle on the atrial surface and exits from the endocardium on the atrium and ventricular surface, so as to avoid leaving a rough surface and affecting the activity of the disc.

Ten minutes later, Tang Lou completed the entire operation.

"The treatment after valve replacement surgery is basically the same as the first surgery, but you need to pay attention to the following points:
The first point is hemodynamic monitoring. The Swan-Ganz catheter can be used to measure the pulmonary intrusion pressure and cardiac output, and monitor the central venous pressure and arterial pressure at the same time, so as to accurately judge the important functions of the heart, blood volume, vascular resistance, etc. The abnormal situation of the indicator can be dealt with in a timely manner. "

After listening to the speech, Dr. Tian's brain processor was not enough, so he looked at Dr. Wang opposite.

Dr. Wang said softly: "Don't worry, Dr. Tian, ​​we still have video, isn't he good at [-]x speed?"

Doctor Tian, ​​now I feel relieved.

Tang Lou continued: "The second point is cardiac function support, the third is respiratory support, and the last is close observation and treatment of bleeding. If a blood clot in the mediastinum blocks the drainage tube and causes cardiac tamponade, trypsin can reduce the non-surgical Sexual bleeding."

After Tang Lou gave his orders, he walked out of the operating room.

The two doctors were left in shock.

The ultra-difficult secondary valve replacement surgery was a complete success!

(End of this chapter)