Start From Emergency Doctor

Chapter 357

The anesthesia is general anesthesia with endotracheal intubation.

Because Xiaoding has congestive heart failure, the anesthesia process needs to be stable to prevent hypertensive crisis.

“Ninety degrees on the right side.” Zhou Yuan said.

Jiang Xiaoqi and the vascular surgeon immediately adjusted Xiao Ding’s position.

Zhou Yuan picked up the scalpel.

“The anesthesia is over,” the anesthesiologist said.

Zhou Yuan nodded, confirming once again that Xiaoding was completely anesthetized, and made an incision in the space behind the fourth rib on Xiaoding’s left side.

The scalpel entered the skin, exposing the descending aorta.

Zhou Yuan cut the surrounding mediastinal pleura longitudinally along the descending aorta, and then extended the incision upwards to the position of the left subclavian artery and the uppermost intercostal artery.

He stopped the scalpel, twisted his wrist, and the originally vertical scalpel suddenly turned into a parallel position.

Zhou Yuan increased his strength a little and made a horizontal incision.

Before the operation, the constriction of the descending aorta was confirmed. At this time, Zhou Yuan directly led the scalpel to free the descending arteries of the upper and lower ends of the constriction.

“Wrap around.”

“Free ligation of the catheter.”

Banding is to control bleeding in case of accidental damage to blood vessels.

After the vascular surgeon completed the winding of the descending aorta, Zhou Yuan began to freely ligate the arterial duct and arterial ligament.

His movements are very light, because there is the recurrent laryngeal nerve near the catheter. Once the recurrent laryngeal nerve that controls the laryngeal muscle is accidentally injured, it may cause hoarseness, and may even lead to poor breathing and suffocation.

In addition, nerve damage is difficult to recover, and nerve rupture must be avoided during the operation.

After completing the release of the arterial catheter, Zhou Yuan ligated the catheter exposed in the surgical field.

“Catheter clamp.”

Jiang Xiaoqi clamped both ends of the catheter with catheter clamps.

Zhou Yuan took the scalpel and cut the arterial catheter directly at the ligation site, and the arterial ligament was also cut after the ligation.

“5-0 suture.”

In order to prevent excessive blood loss, Zhou Yuan sutured the broken ends with 5-0 polypropylene thread.

The next step is to free the intercostal artery.

After the aorta narrows, the intercostal arteries will form collateral circulation to compensate the body for blood. Even if the constriction is completely closed, the collateral circulation can transport blood, temporarily ensuring that no accidents will occur.

However, the collateral circulation can never replace the original blood circulation.

When performing the constriction resection and end-to-end anastomosis, the intercostal artery must be ligated, otherwise after the aorta is blocked during the operation, all blood will flow through here, which will cause great pressure on the intercostal artery. It may even cause blood vessels to burst.(Read more @ wuxiax.com)

Under normal circumstances, the collateral circulation compensatory blood will naturally not happen this kind of situation, but at this time it is during the operation, there are many unexpected factors.

In patients with coarctation of the aorta, the intercostal artery is often thickened due to frequent collateral circulation, but because the surface area of ​​the vein is constant, the area increases, the wall becomes very fragile, and it may rupture if you are not careful. , And even showed tumor-like expansion.

Zhou Yuan performed the separation carefully. In order to fully expose the constriction of the aorta after the intercostal artery, Zhou Yuan ligated and severed two pairs of intercostal arteries.

“Starting to free the intercostal artery~” Zhou Yuan said.

Jiang Xiaoqi immediately concentrated and stared at Zhou Yuan’s movements.

She is still a little confused now, Zhou Yuan’s movements are extremely proficient, as if she has experienced countless times.

But… Zhou Yuan is only twenty-six years old, so it is impossible to have many operations!

I saw Zhou Yuan gently swim away from the intercostal artery far from the aortic wall, grasping the strength very well in the process.

The intercostal arteries have become extremely fragile due to the h collateral circulation all the year round. Many doctors have a slight improper force when freeing, which will cause the rupture of the blood vessels or the tear of the aorta, causing uncontrollable bleeding. However, Zhou Yuan restarted No mistakes to the end…

The doctor of vascular surgery has already looked at life with doubts.

“Don’t your hands shake when you peel it off?”

“It’s so much like a machine, it’s so precise…”

“Let me take a closer look… Damn, I haven’t seen that the separation is over yet?!”

The vascular surgeon looked shocked and looked up from the microscope, staring at Zhou Yuan blankly.

I’m so proficient!

The chief physician of vascular surgery is just like that, right? No, maybe the director can’t match it!

The vascular surgeon lowered his head, looked at Xiao Ding’s cut open chest, and fell silent.

He wanted to talk about it when the incision was made before.

Zhou Yuan’s incision technique is something he has never seen before.

Not to say how novel, but too precise.

Everyone’s body is slightly different from the standard anatomical human body. Although the difference is small, it is especially important during the operation. Because of this difference, it is possible that a scalpel that would otherwise have free blood vessels cut on the organ, or even directly Break the blood vessel.

Therefore, even the chief physician will be very cautious when scribing the line to confirm the location of the surgery, even confirming it several times, and performing the surgery very gently.

But what about Zhou Yuan.

Click.

It’s done.

laugh.

Cut open.

Then he stretched his hands into the incision and pulled a little to the side, and the perfect surgical field appeared in front of him.

“¨ˇNiubi…” The vascular surgeon combined a thousand words into these two words.

“Starting to build a temporary vascular bridge.” Zhou Yuan ignored the vascular surgeon and said.

Jiang Xiaoqi: “Good.”

With that said, she handed up the artificial vascular bridge that had already been prepared.

“Are you Zhou Yuan?” The vascular surgeon swallowed and asked.

Zhou Yuan nodded.

“I have heard of you. Our director had performed an operation with you before. During the meeting, he criticized an attending physician and then told us about your operation case.”

Zhou Yuan remembers this.

At that time, the Department of Vascular Surgery received a patient who needed a blood vessel transplantation (Wang Hao). As a result, the surgeon did not calculate the length of the blood vessel that needed to be transplanted. Finally, the great saphenous vein was cut short, which later caused a series of problems. The sequelae had to be transplanted again.

Seeing that Zhou Yuan did not speak, the vascular surgeon also calmed down and assisted Zhou Yuan in erecting the artificial vascular bridge.

This step is very simple, at least for Zhou Yuan.

It is nothing more than to make an incision in the upper descending aorta, and then put one end of the artificial blood vessel up and suture it.

Then the descending aorta is reopened at the lower end, and the other end of the artificial blood vessel is anastomosed again.

The constricted section of the aorta is in the middle of these two openings, and it is just bridged by a temporary blood vessel.

In the eyes of the vascular surgeon, everything has changed…

Fuck, after choosing an incision, don’t you need to consider the contraction of blood vessels and changes in tension?

Nima, is it all right again? Are you stitched up again? ! .