Living donor liver transplantation wraps three main steps, the first liver arteriovenous reconstruction, the second hepatic tract reconstruction, and the third lymphatic reconstruction, all three are indispensable, the most difficult is arteriovenous reconstruction, followed by the liver tract, followed by lymph.

As we all know, if any organ of the human body wants to play a role, it is indispensable to provide blood, so blood is indispensable for every organ, and it is necessary to ensure sufficient blood supply in order to ensure the success of liver transplantation, but how to ensure it is a difficult point.

Take hepatic vein reconstruction as an example, if the reconstruction of the right hepatic vein (RHV) is chosen, this reconstruction usually adopts an end-to-end anastomosis with the recipient RHV stump, but because the regeneration of the right liver graft often leads the right liver to grow to the left, resulting in compression and distortion of the anastomosis, resulting in the narrowing or even obstruction of the hepatic venous outflow tract, if this situation cannot be solved, the transplanted liver will be blocked due to blood transportation, and eventually the liver will fail or even necrosis, but how to solve that?

The solution is very simple to solve the stenosis and obstruction of the hepatic venous outflow tract formed by the compression and distortion of the anastomosis, but this method is simple, but it is very difficult to solve, the space where the anastomosis is located is quite narrow, and it is impossible to change the compression and distortion of the situation, unless the space can be expanded, but the back of this place is the posterior peritoneum, and the front is the transplanted liver, and there is no way to expand the space.

In other words, when the right hemihepatic graft without the middle hepatic vein (MHV) is used, the closure of the middle hepatic vein of the right liver segments V and VIII will cause blood stasis in the V and VIII segments of the liver, which will cause this part of the liver tissue to lose its function and reduce the functional volume of the entire transplanted liver. Resulting in small liver graft and small liver syndrome, the recipient eventually dies due to insufficient liver function, so the reconstruction of the middle hepatic venous branch is very important, but it is not clear whether all the middle hepatic vein branches should be reconstructed, and whether there is collateral circulation between the middle hepatic vein and the right hepatic vein.

This is also a difficult point, it is difficult to reconstruct all the veins in the liver, not all of them are reconstructed and I am afraid that the blood circulation is not sufficient enough to cause a part of the liver tissue to lose function, and it is too difficult to rebuild. God knows how many middle hepatic venous branches there are in a piece of liver. If you want to figure it out, you can only dissect this liver thoroughly, but once you dissect this liver, it will be completely scrapped.

And now Su Hongwen has chosen to reconstruct all blood vessels and liver tracts, which is almost impossible, Fu Zhendong really can't believe it. Unless Su Hongwen dissects the liver thoroughly. But in this way, the operation was a complete failure. I couldn't figure out what Su Hongwen was going to do, Fu Zhendong could only watch from the side, and when the operation was here, he no longer wanted to go to the main operation. Unconsciously, he has already trusted Su Hongwen, and hopes that Su Hongwen can create another miracle, if he has a way to rebuild all blood vessels and liver tracts, it is equivalent to making Huaxia's liver transplant technology leap to the front of other countries in one fell swoop, and this gap is huge, at least 30 years to pull down other countries, Fu Zhendong was excited when he thought of these, but after the excitement, he was worried, what if Su Hongwen's method didn't work?

At this time, the liver that was removed from Hou Changlin's body had been delivered, Su Hongwen took the liver and looked at it, and then handed Qiming's liver to Fu Zhendong, and said in his mouth: "Teacher Fu, please help me continue to extract blood vessels and liver tubes, the longer the length, the better, by the way, try to find relatively thick blood vessels and liver tracts." ”

Fu Zhendong couldn't understand what Su Hongwen was going to do, but he did what Su Hongwen said, and he was expecting Su Hongwen to create another miracle.

At the same time, liver transplant experts from various countries in front of TV and computers are also speculating about what Su Hongwen is going to do, and some people think that Su Hongwen extracts the blood vessels and liver tract in the patient's liver to anastomosis all the blood vessels and liver tracts, and only if Su Hongwen wants to do this can it make sense why he needs so many blood vessels and liver tracts, but then they all feel that Su Hongwen cannot anastomosis all blood vessels and liver tracts, unless he dissects the liver thoroughly, but then the operation will be a complete failure, and what the patient needs is a functional liver. Instead of being destroyed after the liver loses its function.

Su Hongwen didn't have the heart to think about other people's thoughts, he continued the operation, the conventional liver transplantation had to anastomosis the main artery and vein at this time, first restore the blood supply for this liver, otherwise this liver will soon die completely, but Su Hongwen did not rush to anastomosis the main artery and vein, but used a hemostat to free the liver membrane in the lower layer of the liver, of course, not all of it was removed, and one end of this liver membrane was still connected with the liver.

It took less than a minute for Su Hongwen to operate this surgical step, and then he began to anastomosis the main arteries and veins, but Su Hongwen's anastomosis was different from conventional hepatic arteriovenous reconstruction, he neither chose right hepatic arteriovenous reconstruction, nor did he choose hepatic arteriovenous reconstruction, but used the two blood vessels he had just extracted from Qiming's body to do an anastomosis with the liver arteriovenous reconstruction.

As soon as the anastomosis is completed, the length of the liver arteriovenous vein can increase a lot, Su Hongwen put this blood vessel directly to the lower end of the liver, and then used a hemostat to gently free the lower edge of the liver, and immediately a relatively thick blood vessel appeared, and then Su Hongwen freed out a section of this blood vessel and cut it in the middle, and finally anastomosed this blood vessel with the vein to form a "Ya" shape.

Cao Jingzhang was completely confused when he saw this scene, and couldn't help but say, "Xiao Su, what's the use of you anastomosizing this blood vessel?" The right hepatic vein is on top. ”

Su Hongwen shook his head and said: "If the anastomosis in that place is too small, once the hepatic venous outflow tract is narrowed or even obstructed due to the compression and distortion of the anastomosis, it will be troublesome." ”

"You can remove the right hepatic vein stump on the IVC to form an opening on the root IVC and enlarge it, and then anastomosis with the lateral end of the RHV of the right liver graft, which not only forms a larger anastomosis, but also avoids the compression and distortion caused by liver regeneration," Cao Jingzhang said. ”

From this sentence, it can be heard that Cao Jingzhang's medical knowledge is quite solid, and other people may not necessarily open their mouths like him to say a solution to the stenosis or obstruction of the hepatic vein outflow tract that is prone to right hepatic vein reconstruction.

Su Hongwen shook his head again and said: "This method is good, but to remove the stump of the right hepatic vein and make an opening on its root IVC and enlarge, it is inevitable to use hemostats to be free, the donated liver is so big, once it is free, it will cause damage to the liver, and the liver function is likely to recover after surgery, which is troublesome." ”

Cao Jingzhang naturally understood what Su Hongwen said, but Su Hongwen now anastomoses the liver vein with an unknown blood vessel to ensure that the liver function is fully restored after surgery. He didn't believe it, let alone he didn't believe it, even those liver transplant experts in developed countries didn't believe it.

A Japanese liver transplant specialist couldn't help but say, "What is this Chinese man going to do?" What is the point of revascularization at the lower edge of the liver? ”

Questions like this are everywhere, as long as anyone knows about liver transplantation, but now no one can answer their questions, all they have to do is wait.

An Zinan was also confused, although she had never had a liver transplant, but because Su Hongwen had to do this operation, she checked the information on liver transplantation, you must know that An Zinan is at Harvard Medical School in the United States, which is one of the best medical schools in the world, since it is the best medical school, the information on liver transplantation is quite comprehensive, and there is not so much information in Huaxia, with the help of these materials, An Zinan also has a certain understanding of liver transplantation, I dare not say that I am proficient, but it is not bad, However, An Zinan, who had read so much information, didn't know what Su Hongwen was going to do, because the technique he was doing now didn't exist in the world.

Could it be that this guy has thought of a whole new way of surgery? Thinking of this An Zinan's face was happy, but then he felt that it was unlikely, the last time Su Hongwen only had a general idea of the split surgery in the obstetrics, and then did a lot of practical work to perfect, and the difficulty was best known to her except Su Hongwen.

But recently, Su Hongwen has not done any real yàn, how can he create a new surgical method without real yàn?

This will not say that An Zinan doesn't believe it, everyone doesn't believe it, no one believes that Su Hongwen has created a new surgical method, this kind of thing is not to pick up mushrooms and find it, it is too difficult to create a new surgical method in contemporary times, is it hard to imagine, just with Su Hongwen, a young man in his twenties, he has not had a liver transplant, how can he create a new surgical method?

Su Hongwen's Fu Zhendong and Cao Jingzhang were shocked at this time, because Su Hongwen began to punch holes at the lower edge of the liver after anastomosis of the arteries and veins, which can cause great damage to the liver, in case of liver failure, it will be troublesome, but fortunately, Su Hongwen's "punching" is not deep, and they all find a blood vessel stored in the surface layer as soon as the hemostat goes down, and then it is still blocked, anastomosed, and anastomosed to the two arteries and veins just now.

What the hell is he going to do? What is the use of anastomosis in this way? Fu Zhendong didn't know, Cao Jingzhang didn't know, Ouyang Yuqin still didn't know, and no one except Su Hongwen knew at this time.

Su Hongwen's strange surgical method continued, time passed little by little, an hour, two hours, three hours Su Hongwen was still anastomosis blood vessels, and the blood vessels found were getting smaller and smaller, and Su Hongwen had to wear special glasses for microsurgery.

Four hours later, Su Hongwen no longer anastomosed the blood vessels, but began to anastomosis the liver canal, the same as anastomosis blood vessels, and after another four hours, Su Hongwen finally stopped, and at this time he was sweating.

Fu Zhendong looked down, and the scene in front of him almost made him pop out his eyes again. (To be continued......)

PS: Send the three watches, kneel and beg for a monthly pass!