There is a grading system for surgery. It's just that many ordinary people have never heard of this statement at all.

According to the corresponding laws and regulations, the difficulty of the surgery is classified as one to four. Newly recruited residents can preside over first-level surgery under the guidance of a senior physician and then work their way up the ladder. For fourth-level surgery, the chief surgeon is required to be at least the deputy chief physician. Moreover, the newly promoted deputy chief physician needs to work in the post of deputy chief physician for three years, and those with postdoctoral degree need to work in the post of deputy chief physician for two years before they can independently preside over the fourth-level surgery. However, the prerequisite is that the new technology is not applied in the fourth-level surgery presided over, or it does not belong to the new project surgery and scientific research project surgery.

PCI is special because it is a tertiary surgery and it is also a qualified surgical procedure. The senior attending physician must obtain the admission qualification for the procedure.

According to the analysis of the four people, if Yao Zhuangxian is to be given an ectopic repair operation, at least one senior attending physician with admission qualifications, two senior deputy chief physicians of cardiac surgery, and one junior deputy chief physician of general surgery need to be used, a total of five people can be used. For such a large-scale operation, the deputy director of the anesthesiology department must be present, and at the same time, the nursing department has to send a team of nurses who often cooperate with several doctors to participate in the operation, which means that there may be a team of more than 20 people in the operating room at the same time.

"Of course, such a major operation will certainly not be done in one go. Yuan Ping'an explained to Sun Lien, "For example, PCI should be ......done before off-site repair."

"The patient's heart is in the abdominal cavity, and this PCI is not something that ordinary doctors can do. Xu Yourong shook his head, "I don't know, I may have to separate the heart from the body before I can dredge it." ”

"Isn't it?" Zhou Ce frowned and asked, "After the heart is separated from the body, the blood vessels are deflated, how to intervene?"

That's why PCI surgery requires special access qualifications. If you are not a doctor who specializes in this, your understanding of this operation will be very limited, and everyone understands the principle, which is to use a guide wire to poke the artery all the way to the coronary artery of the heart, and then find the blocked or severely stenotic place, and choose to suck the thrombus according to the situation, crush the hardened plaque, or simply put a stent directly to dilate the narrowed blood vessel. The specific treatment method to be used needs to be judged by a doctor who has obtained PCI access qualifications.

"It's a big deal, it's a bypass outside the body. Sun Lien was bold and expressed his opinion in the discussion of a group of top students. Anyway, everyone knows each other, and they all know that they are a small rule train, even if they say something wrong, it seems that there will be no serious consequences.

"Don't say it, it's a really good idea. After everyone was silent for a while, Zhou Ce suddenly nodded and said, "It is definitely more beneficial for the heart to stop beating after leaving the body." And there is no need to worry about insufficient blood supply to the myocardium during bypass, the only problem may be whether the blood vessels can be sewn well - the proliferative blood vessels are very thin. ”

Yuan Ping'an thought for a while and added, "You should also pay attention to the medication in the future." Anticoagulation is required after bypass, but anticoagulation increases the risk of bleeding later on......"

Xu Yourong glanced at Yuan Ping'an, and then shook his head dissatisfiedly, "That's wrong, every patient's situation is different, you can't just copy the content of the book." ”

Looking at Yuan Ping'an's somewhat overwhelmed expression, Xu Yourong continued, "Short-term anticoagulation therapy is required after heart bypass surgery, which is the content of the textbook. But you are ignoring a very important premise. ”

After all, Yuan Ping'an was not an academic research doctor with no clinical experience, and he immediately understood what Xu Yourong meant. "You're right, this patient doesn't have the same etiology as other patients who need 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 a number of reasons for this. The largest proportion of these is arteriosclerotic plaques caused by hyperlipidemia or thrombosis caused by hypercoagulability. For coronary heart disease caused by these two causes, patients do need short-term anticoagulation therapy after bypass surgery. But the cause of Yao Zhuangxian's coronary heart disease is completely different - his blocked blood vessels should not have been there in the first place. The cause of the blockage is not the viscosity of the blood, but the compensatory diameter of the blood vessels is too thin and the blood vessels are too twisted.

The blood vessels in the human body can be regarded as natural rivers to some extent. The arteries, on the other hand, are like rivers in a state of flood discharge. A wide and straight river is ideal, but it is inevitable that there will be some twisted and narrow parts of the river, or where the slopes are fragile.

The fragile slope bank may be eroded little by little under long-term erosion, and the result of erosion is an aneurysm. If you rush to the slope of the bank, it is a ruptured aneurysm, which is a serious symptom that can kill people in minutes.

Compared with the fragility of the slope bank, the sediment accumulation caused by the twisting and narrowing of the river channel is relatively slower. 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 is characterized by the fact that no matter which organ it appears in, it is inevitable that the blood vessels will be curved and narrowed. This compensation occurs in the brain and is moyamoya disease, which occurs in the liver and indicates the middle and advanced stages of cirrhosis. In general, although it can ensure 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 the first collective consultation and discussion of Sun Lien's medical team after the avian flu. Although Dr. Pascal was not involved, it was not easy to get together such a group of 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 Lien. It can basically be regarded as half a supernumerary.

"Speaking of which, didn't Dean Song let Professor Liu take over the treatment team?" When Song Wen made this decision, Yuan Ping'an was on the scene. He is almost the most concerned about the affairs of the treatment group among the four, "But for such a long time, 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 jajanjanjan noodle restaurant. Xu Yourong said without changing his face, "The old man has eaten fried noodles three times a day recently, and he is almost making fried sauce when he eats them." ”

The three of them were shocked, but they couldn't think of what kind of disease the noodles were like fried sauce.

"Isn't this joke fun?" Xu Yourong was stunned for a moment and shook his head, "I'm still not very good at telling jokes." ”

Sun Lien sighed, "Anyway, the treatment team is temporarily disbanded now, and when Dr. Xu sorts out the papers, I guess there will be some moves on Dean Liu's side." ”

The original intention of setting up the treatment team was to pave the way for Xu Yourong's promotion. When this paper probably has a clue, Liu Pingchuan will most likely still transfer Xu Yourong to neurosurgery. Even if there is a position in the diagnostics department later, it will have to wait until a year or two later.

"The outline of the dissertation is estimated to be available in two days. Xu Yourong nodded and replied, "Chen Wen's surgical plan is probably already there." What Mr. Liu means is to intervene. Using the cerebral blood vessels as the operation channel, the batch of cysts close to the white matter of the brain is removed first. ”

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Complex surgeries, which are highly traumatic to the human body, are best divided into several times. This is a very important conceptual advancement in modern medical surgery. Chen Wen's condition is so complicated and the situation is so serious, not only Sun Lien has heard of it for the first time, but even Xu Yourong has seen it for the first time. The Department of Neurosurgery of the Fourth Central Hospital has not relaxed the design of Chen Wen's surgical plan during this time, and Liu Pingchuan even contacted old friends from the association to help grasp the surgical plan. At the same time, Liu Pingchuan ordered two sets of 3D printed models of Chen Wen's cranial brain from Shenzhen, which were specially used to practice the surgical plan.

For this operation, the Fourth Central Hospital decided to use the newly purchased ROSA neurosurgical robot system.

This operation has many wounds and deep positions, and it is obvious that the required accuracy cannot be achieved with the hands of the neurosurgeon alone - even if the first few cysts can be removed with Xu Yourong's stable hands, no one knows how long Xu Yourong's hands can be stable.

Once Xu Yourong's hands lose stability due to the long operation time, the sharp sampling needle will injure normal brain tissue or puncture the arteries in the brain and cause serious bleeding. This kind of mistake must never happen.

"I've used the ROSA system a few times in the U.S., but I'm not particularly proficient. Xu Yourong stretched, and then pulled his loose hair back behind his ears. "I've been practicing for the past few days, so I don't have much time to go to the emergency room. ”

Sun Lien had never heard of ROSA, but he had heard that there was a da Vinci system in the hospital. He asked curiously, "Isn't there a Leonardo da Vinci in the courtyard? Why not that?"

"The kind of thing that is used to do thoracic and abdominal surgery, is not precise enough. There was no need for Xu Yourong to answer, Yuan Ping'an replied directly, "And Da Vinci can't walk in the arteries, and if he wants to do neurosurgery, that lump of things is scrap iron." ”

Speaking of which, the positioning of the da Vinci surgical robot is really awkward. After being introduced into China as an advanced equipment, the phenomenon of da Vinci robot adapting to water and soil is more serious than everyone estimated at the beginning. In the case of thoracic and abdominal surgery, da Vinci has the advantages of less trauma and faster recovery, but the da Vinci surgery has not yet been covered by medical insurance. Many commercial insurance plans will not cover this huge additional expense. Compared with general laparoscopic surgery, Leonardo da Vinci's advantages are not so great as "revolutionary subversion".

Another great advantage of the da Vinci system, remote surgical support, is even less meaningful. None of the hospitals that can afford da Vinci are rookies, everyone is very good at fighting, and there is no need to call for foreign aid at all. However, hospitals that need surgical support cannot afford this equipment, and they need to perform surgeries performed by specialists, either by transferring patients to high-level hospitals or by inviting specialists to come to our hospital for surgery. Remote surgical support is a big selling point, but in reality it is not used at all.

Although 5G technology now allows large hospitals to remotely consult with each other and even perform surgeries, there are still a few such cases - a round-trip ticket from an expert is much cheaper than a Da Vinci and a bunch of follow-up support services.

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