After some discussion, everyone finally came up with the preliminary steps of the surgical plan.

That is, the complete and integral resection of the huge recurrent thyroid tumor of the cervical mediastinum, the thymus invaded by the tumor, the left internal jugular vein, the left subclavian vein, the left and right innominate veins, and the superior vena cava, the above-mentioned large blood vessels, the left intracranial vein, and the huge cancer thrombus in the right atrium were completely removed, and the superior circulation was reconstructed with artificial vascular replacement: including the vascular access of the high left internal jugular vein-right atrium, right innominate vein-right atrium.

Then it's time to tackle the puzzle at each of these steps.

"The first and most difficult problem we are facing now is that we need to completely remove and reconstruct the left internal jugular vein, the left subclavian vein, the left and right innominate veins, and the superior vena cava. We have to establish an extracorporeal venous vascular circulatory system for Liu Jitang during the operation!" Liu Bin, director of vascular surgery, said solemnly.

When you remove these blood vessels and reconstruct them, you will definitely bleed heavily and cause the venous blood circulation to be blocked. The procedure is estimated to take at least ** hours or even longer. You can't always have veins and blood vessels that can't circulate, right? The consequence of not being able to circulate is to cause many organs to die, and finally burp.

"Isn't it okay to use ECMO cardiopulmonary bypass?" Dai Yaowen asked suspiciously.

ECMO is the English abbreviation of extracorporeal membrane oxygenation, which is a technology that represents the critical care level of a hospital, or even a region or a country!

During cardiac surgery, cardiopulmonary bypass can completely replace the heart and lungs for a short period of time, and open-heart surgery can be performed. At the same time, the success rate of rescue after cardiopulmonary bypass, which is quickly established in the cardiac operating room, is very high.

ECMO is a cardiopulmonary bypass technique that comes out of the cardiac operating room. Its principle is to draw venous blood out of the body, and inject it into the patient's artery or venous system after oxygenation by artificial heart-lung bypass with special materials, which plays a part of the heart-lung replacement role and maintains the oxygenated blood supply of human organs and tissues.

The basic structure of ECMO: intravascular cannula, connecting tube, power pump (artificial heart), oxygenator (artificial lung), oxygen supply tube, monitoring system. Clinically, the disposable part is often composed of a package, and the non-disposable part is bound and stored, and is designed to be movable to improve emergency response capabilities.

For example, at present, Liu Jitang needs to remove most of the veins and blood vessels in the upper body and then reconstruct it, but the blood circulation of the human body must be maintained, so this cardiopulmonary bypass technique is needed!

At present, this kind of technology is basically only available in large hospitals, and large hospitals like the First Affiliated Hospital of Modu must have it.

The "incomplete, V-V diversion of ECMO" approach is suitable for cases with isolated impaired lung function and no risk of cardiac arrest. For example, Liu Jitang needs to remove the left internal jugular vein, which is more restrictive. Liu Bin, a vascular surgeon, shook his head. V-V diversion is a method in which venous blood is drawn out through a vein, oxygenated through an oxygenator, and carbon dioxide is removed before being pumped into another vein. Femoral vein elimination, internal jugular vein pumping, or bilateral femoral veins can be selected depending on the patient's condition. The principle is that the venous blood is partially exchanged with gas before it flows through the lungs, making up for the lack of lung function.

"What about the V-A diversion method of ECMO, will it work?" asked Director Qian. There are two main conversion methods for ECMO, which are V-V and V-A.

"It is also less ideal, V-A diversion is to draw venous blood through the vein, oxygenator oxygenation and carbon dioxide removal, and then pump it into the artery. Femoral arteriovenous options are usually the choice for adults; Neonates and young children choose jugular arteries and veins due to thin femoral arteries; Thoracotomy can also be performed with arteriovenous catheterization. V-A diversion is a connection that supports both cardiopulmonary function. V-A diversion is indicated for cases of heart failure, severe pulmonary failure, and the possibility of cardiac arrest. ”

"To be honest, if we want to establish an extracorporeal circulation system for the veins of the upper body, it is estimated that we have to create a new surgical method on the basis of ECMO to be relatively safe and effective!" Liu Bin said in a deep voice.

"Do you mean that we are going to create an external diversion system suitable for Liu Jitang's independent innovation based on this actual situation?" asked Dai Yaowen.

That's what it means. Liu Bin nodded.

"Director Liu, do you have any ideas now?" asked Director Qian.

"I didn't have any innovative ideas yet, the main reason was that the time was too short and I couldn't come up with a suitable way to improve it so quickly. Liu Bin spread his hands and said that he was helpless.

It didn't occur to them that the first problem would stump them.

"Why don't you start a relationship and ask those master professors you know to see if they have a way to solve this problem?"

Almost everyone here is a graduate of a famous medical school, and everyone must know a lot of old professors and experts. Or the instructors who teach them during further study and training must be famous doctors.

If you can get these people to help you figure it out, maybe a miracle will happen!

"At present, I can only look at it like this, I know a vice president of a hospital in Beijing, who used to be an old expert in vascular surgery. The existence of Taishan Beidou in the country is definitely vascular surgery, maybe he has something to do!" Liu Bin said. He was also a student of the other party back then.

"I'll ask too. ”

Ruan Bin didn't expect that the difficulty of this operation was beyond everyone's imagination, as well as his imagination!

"Ding-dong...... System Temporary Mission: It's Time to Show Your Bull Breaking Bolas! Save the patient Liu Jitang, and the reward for mission success - three lottery chances!

"Shhh...... Three lottery chances?" Ruan Bin's saliva flowed when he saw it. Three chances, maybe you can draw a billion points plus a Ferrari 488?

"System!"

[System points]: 104,400.

[Radical thyroidectomy]: Not started+

As for why Ruan Bin chose [radical thyroidectomy], because Liu Jitang had to use this surgery as the main stent for treatment.

In addition, it is necessary to solve the problem in line with Liu Jitang's actual situation, so Ruan Bin feels that if he goes down this operation, he may be able to find what he wants!

"Level up!"

"Ding-dong...... Deduct 6000 points, [Radical thyroidectomy] - Beginner+!"

"Ding-dong...... Deduct 9000 points, [Radical Thyroid Cancer Resection] - Proficiency Level +!"

"Ding-dong...... Deduct 12,000 points, [Radical thyroidectomy] - Director level +!"

"Ding-dong...... Deduct 15,000 points, [Radical thyroidectomy] - expert level +!"

"Ding-dong...... Deduct 18,000 points, [Radical thyroidectomy] - world-class +!"

"Huh?" When countless surgical experiences and patient examples poured into his mind, he searched and was shocked to find that he had never encountered a patient like Liu Jitang, who was rare in history!

Not to mention having experience in surgical treatment!

"It seems that Krypton Gold has reached the innovation level!" Ruan Bin gritted his teeth. 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~