Back in 2002 as a doctor

"..." Zhang You was speechless. Technical details are the most important thing. The devil is in the details. This sentence is correct.

After watching the operation, I thought I would know how to do it, but after the operation, I caught a lot of people who didn't know what to do.

This situation is very common in surgery.

"The balloons are all in, and the technical point of the next step is the balloon expansion time.

Because non-compliant balloons do not inflate well for periods shorter than 10 seconds, I would expect peak filling pressures to be maintained for at least 10-15 seconds during kiss-to-balloon inflation. "

"Then the next technical detail is the speed of balloon expansion. It can't be fast or slow, but... I think it's better to slow down.

When there are no special requirements for the technique, the pressure and filling speed of the balloon should be as slow as possible, especially when choosing a super-large caliber balloon, which can reduce the risk of vessel rupture. "

Director Miao's voice was dull, but Zhang You's heartbeat suddenly accelerated.

With such a fluffy word, I don’t know how many patients have intraoperative accidents of coronary artery rupture during the classic crush operation.

Once an accident occurs, emergency cardiac bypass is inevitable.

From this point of view, Director Miao may not have done the classic crush surgery, but it may be that he has wiped too much buttocks of circulatory internal medicine, which has created a psychological shadow.

After watching too much, even Director Miao of the Cardiac Surgery Department has his own experience.

To say that the director of the imperial capital is really not easy, you can figure out the way of it with just a few glances, amazing!

Zhang You sighed and admired in his heart.

"The most important thing is to try to inflate the balloon synchronously and decompress the balloon synchronously. Asynchronous decompression may cause the bifurcation ridge to shift, resulting in compression of the branch opening that was decompressed first."

"Synchronization, do you know how difficult this is?"

Director Miao's eyes were fixed on the operator's operation on the screen, his voice became smaller and smaller, and he watched more and more attentively.

Although he used interrogative sentences, he didn't expect to get an answer at all.

Although Zhang You is old, his memory has never been bad. In addition to yesterday's research, he has many doubts in his mind. Director Miao's words gave him a better understanding and understanding of crush technology.

The operator's operations on the screen confirmed Director Miao's words to a certain extent.

Whether it is the position of the balloon, the timing of the squeeze, the force of the squeeze, or the synchronization, it is all done very well.

Although Director Miao said that this step was difficult, Zhang You only watched the operation once and couldn't understand how difficult it was.

In the great hall, the sound of unconscious heavy breathing could be heard occasionally, and the participating doctors were all watching the operation of the surgeon intently.

Sure enough, as Director Miao introduced, the time-consuming operation of kissing is much longer than the time for the guide wire to penetrate the mesh of the stent.

The surgeon takes every step carefully, like walking on thin ice.

However, the surgeon's operation is really good. He operates the guide wire, catheter, balloon, and stent. Every step is clean and neat. Although each step is not fast, it is clear and clear.

The double balloons are pressed against each other, and the naked eye can see on the screen that the stent branching in the main trunk is crushed, trying to fit the blood vessel wall as much as possible.

Zhang You suddenly understood why Dr. Miyamoto joined forces with Abbott to make a drug-eluting stent.

No matter how perfect the kiss squeeze is, the bracket has its own volume.

The crushed and wall-attached stent itself is equivalent to a stenosis, coupled with the characteristics of the stent itself, it will definitely lead to hemodynamic changes in the blood vessel.

That is to say, this position is particularly prone to blockage, stent thrombosis, and restenosis of side branch vessels.

Drug-eluting stents, as the name suggests, are drugs that can be slowly released on the intima of the stent. Zhang You understands it this way.

Under the direct action of the drug, the occurrence of stent thrombosis and restenosis of side branch vessels can be delayed, and it will be delayed for several months no matter how bad it is.

When technology has been pursued to a certain level, it is extremely difficult to make further progress.

Presumably, Dr. Miyamoto has reached the pinnacle of crush technology, but he cannot avoid the emergence of these complications, so he can only seek another change—the support of material science.

Amazing!

Zhang You gradually understood the operation, and also understood why Director Miao and the circulatory physicians around him were so fanatical and nervous.

Four words gradually appeared in his mind—reaching the pinnacle.

There is nothing that can be changed in one surgical method, but the postoperative effect of clinical surgery is not very satisfactory. Countless doctors have continued to study and improve it.

If one direction does not work, switch to another. To some extent, there is no difference between Dr. Miyamoto and Mr. Huang.

Mr. Huang is directly improving the operation method, while Dr. Miyamoto is seeking to change the material science, but no matter whether it is successful or not, there is only one purpose - to make the effect of the operation more ideal and to prolong the postoperative survival time of the patient.

It is only one aspect of the public demonstration surgery at this annual meeting to let everyone learn the crush technology, and the more important thing is to demonstrate the drug-eluting stent.

Zhang You thought a lot, and cast his eyes on Dr. Miyamoto in the front row, seeing Dr. Miyamoto commenting on the surgeon's surgery with his assistant in a low voice.

Director Xue's operation did not attract Dr. Miyamoto's attention. He chatted with his assistant in a relaxed voice. Zhang You really wanted to go over to hear what Dr. Miyamoto was saying, and he became more and more curious.

But in a flash, Zhang You was taken aback.

Crush has been crowned with the word "classic" since its appearance until now, and the technique has been honed and perfected.

Some problems that cannot be solved are not the responsibility of the surgeon. They belong to the inherent shortcomings of the surgical method, which can only be made up by the technology of materials science.

It is extremely difficult to change one of the main points of this kind of technology that has been honed over thousands of years, just like the fixed formula in Go.

Each step of the formula has been practiced thousands of times, which shows that this is the most reasonable step and the optimal solution.

Huang Lao wants to change the formula? !

Anyway, Zhang You didn't think he would have such an idea. Mr. Huang...maybe he was confused and wishful thinking.

As for 912's successful operation these days, Zhang You also felt that it was a rumor.

Wanting to change the surgical method is like changing the routine of a Go player, it is impossible!

Unless there is a formula like a big avalanche.

But the classic crush technique is not difficult to understand when looking at the process. The difficulty lies in the operation and the retention of the stent in the main blood vessel.

Want to change?

impossible.

Zhang You suddenly sighed.

"Director Zhang, what's the matter?" Director Miao looked at the operation on the screen and asked absent-mindedly.

"Mr. Huang and Zhou Congwen will demonstrate the operation next time. I don't think it's necessary. Director Xue's operation... I don't think there is anything that can be changed. If there is anything, it's just some techniques and details." Zhang You said honestly.

"..." Director Miao was startled, his lips moved, but he didn't say anything and remained silent.

Yes.

The classic Crush technique is already close to perfection, how is Mr. Huang going to change this damn technique?

This is simply impossible.

Director Miao also put himself into it, but in the end he still felt that what Dr. Miyamoto did was right.

The technology has reached the extreme, so the next thing to do must be "outside the box", modifying the bracket, starting with materials science to reduce postoperative complications is the right way.

It is estimated that after this annual meeting, drug-eluting stents should really enter clinical trials and appear on the front line of clinical trials as soon as possible.

Alas, Mr. Huang is really old. He still wants to improve a perfect and impeccable surgical technique.It doesn't matter if you just think about it, but it's not good to have a demonstration operation in front of so many people, why bother to embarrass yourself.

Thinking of this, Director Miao was a little depressed.

No matter from which point of view, Mr. Huang can be regarded as Mr. Miao's teacher, and it is not too much to call him a master.

Watching Mr. Huang humiliated, this is the embarrassment of the Department of Cardiac Surgery... Director Miao already has the idea of ​​leaving.

"Why don't you take a second look, let's go." Zhang You also had the same idea, he suggested in a low voice.

Director Miao nodded, and then sighed deeply.

After 1 hour and 22 minutes, the kissing squeeze ended.

The level of the surgeon was indeed extremely high. The stent after the kiss was squeezed was smoothly attached to the intima of the blood vessel, and there was only a little bulge on the angiography. Presumably, it should not have too much impact on the prognosis of the patient.

At least it can hold out for 2-3 years!Zhang You has his own judgment.

If it is combined with drug-eluting stents, patients can be guaranteed to be disease-free for at least 3-5 years after surgery.

From being incurable to 5 years of survival, Zhang You felt a little lost.

The classic crush technique is indeed worthy of the word classic.

Chapter 0673 or, let's go

"Director Xue's level is still high!"

"It's really good at kissing and squeezing. This is the real technique. Before the guide wire went through the mesh of the stent, no matter who got it, it was luck. Director Xue just didn't have very good luck."

"I finally understand the operation. There are a few technical details that I have never understood before. My hands are itchy. I really want to have the operation right away!"

There was a flood of noise in the Great Hall.

Listening to the whispers of the doctors around him, and their generous praise after the operation was successful, this made Zhang You feel sad.

But what he thought was not interventional surgery, but thoracoscopy.

From Zhang You's point of view, thoracoscopic surgery is already a new technology, and the classic crush surgery has nothing to do with him.

In his own hospital, Zhou Congwen had just performed an operation that broke the technical barriers of general thoracic surgery. After reading it, why didn't he want to try double-sleeve resection with thoracoscopic surgery according to Zhou Congwen's thinking?

Even if double sleeve cutting is too difficult, it is good to be able to do sleeve cutting.

If you can't do sleeve surgery, you can also do esophageal cancer!

hateful! !

Zhang You clenched his fists with both hands, and the flames of anger appeared in his eyes.

Chen Houkun is really hateful, he even took away the thoracoscope!This restless professor led the group to occupy the pit of the thoracoscope in advance, he must know something!

Zhang You has completely forgotten that he forcibly ordered Chen Houkun to perform thoracoscopic surgery and could only do thoracoscopic surgery. Everything is Chen Houkun's fault!

Alas, I also want to do thoracoscopy.

Thinking about it, Zhang You's nose was a little sour, and he almost shed tears.

"It should be the limit to achieve this level of surgery. Even Dr. Miyamoto will not be able to surpass it technically."

"I think so too."

"Even if Dr. Miyamoto's luck is slightly better in the step of passing the wire through the mesh, it is definitely not a technical matter. Maybe his luck is even worse, and it takes an hour to wear it."

"Dr. Miyamoto is here to demonstrate a new drug-eluting stent, but it will take at least a few months to see the effect."

"Who knows...that's right, Dr. Miyamoto didn't perform the surgery, but Mr. Huang brought his new apprentice Zhou...what's the matter?"

"Zhou Congwen, from Jianghai City, is now in charge of the work of the academician workstation in the provincial capital. Mr. Huang is going to take Zhou Congwen to do surgery, what kind of crush surgery."

"Is Mr. Huang suffering from Alzheimer's disease? The classic Crush operation has been practiced for many years, and every step has undergone hundreds of clinical tests before being improved. Mr. Huang...cough cough, Mr. Huang..."

Even if the doctor was behind him, surrounded by circulatory physicians, he didn't dare to say anything wrong with Mr. Huang.

He even regretted it a little, he should never have said something about Alzheimer.

"I also think Huang Lao is joking about the improved version of the crush technique. Just wait, maybe you can directly pierce the coronary artery and open the chest."

"Why is the cardiology department here to join in the fun?"

"You don't know? Mr. Huang has always believed that interventional cardiac surgery can be done in the circulatory department, and so can the cardiac surgery department."

"Hahaha, the cardiac surgeons in our hospital are like gray grandchildren, standing obediently at the door of the interventional catheterization room every day waiting to receive patients. If I don't give it to you, they have to eat dirt every day."

"..."

Zhang You felt quite uncomfortable when he heard the circulatory doctor say this.

Director Miao snorted, but couldn't refute.

What they said is correct, and they have nothing to refute.

Saying it out is nothing but self-inflicted humiliation.

The noise in the Great Hall was like the tide beating against the rocks on the coast, and it never stopped.Zhang You felt like sitting on pins and needles, he was depressed and wanted to leave now.

As for the purpose of traveling thousands of miles to the imperial capital, it doesn't matter now.

Although the operation performed by the surgeon just now had some twists and turns, all the steps were reasonable. Zhang You couldn't think of what Huang Lao and Zhou Congwen would do to find some changes.

It is meaningless to forcefully find changes. The biggest possibility is to turn yourself into a joke.

I can realize it, and the doctors in the peripheral circulatory department also realize that the classic crush technique has been honed for so many years. Although it cannot be said to be perfect, it is extremely difficult to change a certain point.