As the three of them walked, Ruan Bin asked, "What is the condition of the patient?"

"At about 6 o'clock, this patient came to the emergency department to see a doctor, and this patient said that he had pain in his lower back, as well as gross hematuria, nausea, vomiting, etc. After some examination, it was found that it was a ruptured renal hamartoma and bleeding. At that time, I asked him to treat conservatively. I didn't expect that only a few hours had passed, and the conservative treatment had not made much difference. It had been in shock just ten minutes ago. So calling you to help with the operation. Guo Hui explained briefly.

"It looks like I'm going to have to have surgery right away. Ruan Bin nodded.

Renal hamartoma (RAML), also known as renal angiomyolipoma, is made up of mature adipose tissue, smooth muscle, and vascular components. There is no clear boundary between tumor tissue and kidney tissue, the size of the blood vessels is different, abnormally distorted, and the wall is irregularly thickened, among which the small and medium-sized blood vessels of the lesion lack elastic layer and muscle wall, which is easy to form extensive pseudoaneurysm-like dilation, resulting in rupture and bleeding of blood vessels in the tumor, and this spontaneous rupture and bleeding will become a fatal danger for patients!

Conservative treatment like this has no effect, and shock has occurred, and the situation is very urgent.

Outside the ward, Ruan Bin began to talk to the patient's family before the operation.

The patient is a man of about 37 years old, and his family is the wife of the other party.

"This lady, your husband's condition is more urgent, his renal hamartoma ruptured and bleeding is more serious, and he needs surgery to stop the bleeding. There are certain risks associated with surgery, and if you agree to it, sign it. Ruan Bin quickly explained.

"Is there a risk? What if the operation fails?" the woman suddenly tensed.

"Don't worry, we still have a lot of confidence in this operation. However, whether your husband's kidney can be saved in the end depends on the resection of the renal hamartoma after the hemostasis is stopped. ”

"Ah, the kidneys can't be saved, aren't you very sure of the operation just now?" the woman suddenly became anxious. She and her husband only had their first child, and if they couldn't save their kidneys, wouldn't it affect their normal life.

"I'm doing hemostasis surgery for your husband now, and it is estimated that he will be transferred to the urology department after the hemostasis is successful. At that time, it is estimated that your husband will be surgically removed from the kidney hamartoma! Whether you can save the kidney depends on the situation and the effect of the operation. Ruan Bin patiently explained.

Seeing that the woman wanted to speak and stopped, Ruan Bin said in a deep voice: "What you have to think about now is to save your husband's life first, stop the bleeding, and then consider the kidney problem when the bleeding is successfully stopped." If you think about it for a second, the more blood your husband will come out!"

"I'll sign, I'll sign!" the woman was awakened by Ruan Bin's words, and immediately signed with a brush.

"Don't worry, I'll do my best to do this surgery, it's very certain, don't worry. Ruan Bin comforted him and walked towards the operating room.

"System!"

[System Points]: 76000

"Hehe, I don't have to charge money this time. ”

The last time I recharged 100,000, there was 26,000 left, and the previous task rewarded 50,000 points.

[Transarterial and renal artery embolization]: Not initiated+

This is a second-level interventional procedure.

"Level up!"

"Ding-dong...... Deduct 800 points, [Transarterial and renal artery embolization]: Beginner+!"

"Ding-dong...... Deduct 1600 points, [Transarterial and renal artery embolization]: Proficiency level +!"

"Ding-dong...... Deduct 3200 points, [Transarterial and renal artery embolization]: Director level +!"

[System points]: 20,400.

The director level is completely sufficient.

If you can save it, you can save it.

In the operating room, Wei Haiyang was Ruan Bin's assistant.

Wei Haiyang came here as an attending physician of Jiangshi Hospital to train here, and he was accustomed to an attending physician being an assistant to Ruan Bin, a resident doctor.

"Ruan Bin, don't do the surgery too quickly later, I'll learn to learn. Wei Haiyang flattered. He has been studying interventional surgery frantically for the last month. At present, he can do first-level interventional surgery, and he can also do four or five second-level interventional surgery. He has also seen Director Liu do this renal artery embolization several times, but there are still some tricks that have not been thoroughly mastered.

He has also been an assistant to Ruan Bin many times, and this genius pursues speed every time he performs surgery, so he can't see many key points clearly and can't learn the essence, so he says so.

"Okay!"

The operation began, and I saw that Ruan Bin used the seldinger technique and first put 5F

Pigtail catheter at the level of the lumbar 1 vertebral body abdominal aortogram.

The location, number, and shape of the bilateral renal artery openings are displayed on the television screen.

The pararenal arteries and lumbar arteries or other systemic circulation are then searched for blood supply to the lesion.

After the judgment is completed, 5f is used

Yashiro's catheter is performed with bilateral renal arteriography.

"You see, the arterial stage is characterized by uneven thickness of blood vessels in the aneurysm area, tortuous and spiral-shaped, and small aneurysms overlapping each other like grape bunches!" Ruan Bin explained.

At this point, the lesion has been confirmed, and 3F is used

SP microcatheter, through the catheter injection of PVA particles, anhydrous alcohol embolization of the distal small branch of the bleeding artery, and then metal coil or microcoil embolization of the bleeding artery......

After 10 minutes after embolization, the catheter and catheter sheath are removed and the puncture point is compressed and bandaged after the imaging is confirmed to be completely occluded.

The surgery is complete!

Secondary interventional surgery is generally very simple.

Outside the operating room.

"Doctor, how is my husband?" the woman asked hurriedly when she saw Ruan Bin coming out.

"The operation was successful, the bleeding has been successfully stopped, and I believe that I will wake up in a few hours. Ruan Bin said.

"Thank you, doctor. ”

"No thanks~"

At this time, it was already past 11 o'clock in the evening.

The emergency department has finally become less patient and a little deserted.

Ruan Bin, who had nothing to do, ran to the front desk with another cup of coffee and chatted with a few nurses.

Suddenly, he saw a girl walking in hunched outside the entrance of the emergency department.

"Wang Lingfei?" Ruan Bin looked at the girl who walked over with her belly covered inside, but he didn't expect that it was Wang Lingfei who he had gone on a blind date with the other party before!

That is, the daughter of his mother's classmate.

Since the blind date, there has been no contact.

"Wang Lingfei, are you uncomfortable?" After all, everyone is from the same hometown, and the other party is also the daughter of his mother's classmate.

"Ruan Bin, are you working here?" Wang Lingfei was also slightly stunned when she saw Ruan Bin.

"Didn't I tell you I worked in this hospital?" Ruan Bin smiled. I secretly said in my heart that if a woman is not interested in you, people will not remember any information related to you.

"Oh, I forgot for too long. Wang Lingfei smiled awkwardly. She had indeed forgotten something, something that was inconsequential and of no interest to herself, of course, would not have been memorized.

：。 : I want to talk about "Krypton Doctor" with more like-minded people, pay attention to "excellent reading literature" on WeChat, talk about life, and find confidants~