Teng Shaokui took his daughter and carried a large bag of luggage into the ward of the general surgery, the ward was a triple room, quite spacious, and the beds were separated by curtains.

The enthusiastic nurse measured Xinmei's heart rate, blood pressure, etc., the little girl came to such a big hospital for the first time, she felt very novel, looked around, just remembered that it would cost 100,000 yuan, and felt uncomfortable.

"Do you need a bed with someone?" The nurse asked.

There are only beds in the ward, and if the family members accompany them, they can give a bed, which is folded, and can be folded up for centralized management during the day, and opened at night to be a bed.

Fuji Shaokui asked the nurse, "There is a charge, right?" ”

"Thirty dollars a night." The nurse said.

Teng Shaokui glanced at the room, there was a chair next to each bed, you can sit on the chair and sleep, and besides, the hospital has a garden, a hall, and there are many long chairs in the garden and hall, you can sleep, and these thirty yuan can be saved.

Teng Shaokui waved his hand: "Forget it, don't use it." ”

But Teng Shaokui immediately felt that something was wrong, and he was afraid that his daughter would feel uncomfortable, so he immediately changed his words: "Let's have one." ”

Teng Shaokui understands that if he behaves too thriftily, the girl will think too much, and she will feel uncomfortable.

As for the gap in the operation fee, Teng Shaokui was also anxious, racking his brains to find out where to make up, but this kind of anxiety could not be shown on his face, which increased the burden on his daughter's thoughts.

After settling down, Teng Shaokui felt a lot more at ease, and the hospital recommended by the provincial government security guard would definitely not be wrong.

The doctor in charge was Li Guodong, who was on duty that day, and Li Guodong asked about the medical history in detail, conducted a series of physical examinations, read the outpatient examination report carefully, and then made a record.

Teng Xinmei's diagnosis is no longer in doubt, it is hypertrophic obstructive cardiomyopathy. dyspnea and chest pain after exertion for more than 10 years; a significant systolic murmur can be heard on auscultation of the aortic valve; Evidence is also strong on the outpatient examination, which focuses on echocardiography showing severe asymmetric hypertrophy of the left ventricle and interventricular septum.

The combination of the chief complaint, physical examination, and ancillary tests makes the diagnosis very clear.

After asking about the medical history, Li Guodong told Teng Shaokui not to worry, to complete the preoperative examination first, and then arrange the operation, and leave the ward after being busy.

Teng Shaokui asked Xinmei to rest in the ward, and he followed Li Guodong out of the ward and came to the doctor's office.

"Doctor Li—" Teng Shaokui didn't know what to say.

Li Guodong said gently: "If you have anything to say, just say it, I am your daughter's doctor in charge, and you can come to me at any time if you don't understand anything." ”

Teng Shaokui plucked up the courage and said, "Doctor Li, the outpatient expert said that the operation fee will be 100,000 yuan, is this 100,000 yuan paid before the operation?" ”

Li Guodong motioned to Teng Shaokui to sit down: "This 100,000 yuan is only an approximate cost, not a simple operation fee, but the cost of the entire hospitalization, in principle, it must be paid before the operation." ”

"That's right-" Teng Shaokui's face turned a little red: "Doctor Li, I won't hide it from you, I only prepared 10,000 yuan, and I don't have medical insurance, I know it's definitely not enough, I mean, can the operation be arranged normally, I will pay the money in installments, I'm afraid I won't be able to pay 100,000 yuan before the operation." ”

Saying that, Teng Shaokui took out his ID card from his coat pocket and showed it to Li Guodong: "Doctor Li, this is my ID card, you can check it." ”

Also, Fuji Fakui took out a house book: "This is my country house book, I know it's not worth much, and it's also a guarantee." ”

While talking, Teng Shaokui glanced at the door of the office from time to time, for fear that his daughter would follow.

"That's it! You put these things away first. Li Guodong was a little embarrassed.

However, the patient's family is very honest and took the initiative to explain that there is a gap in the cost, and as a doctor, he is also very sympathetic to the patient, but after all, this is money, and he can't make his own decisions.

"Uncle Teng, don't worry about it, I'll try to help you arrange the operation, I will report your situation to the leader, and you will actively think of ways to get it together as soon as possible, how about it." Li Guodong could only reply to Teng Shaokui like this first.

"Okay, that-Dr. Li, don't tell the girl about the cost, the girl is old and sensible early, I'm afraid she will have a burden in her heart." Fuji Shaokui said embarrassedly.

Li Guodong nodded: "Don't worry, she is still a minor, and I will only tell you about the cost." ”

"Thank you, Dr. Li, I'm going back."

Teng Shaokui is very grateful to the doctor.

——

13 CNS caused a strong earthquake, and now there is no sign of subsiding, no matter what corner of Sanbo Hospital is, it is hotly discussed, and now even the aunt and uncle who sweep the floor know what is going on with CNS.

The Internet is also lively, a certain garden is full of posts about this matter in the past few days, if there is a hot search for the medical version, this matter must be ranked first.

But Yang Ping doesn't care so much, he calms down and works with peace of mind, as usual.

If you add the time spent in the system space, Yang Ping's experience is estimated to be many times that of others, and this thing can still be seen through.

As the head of the department, Yang Ping will pay attention to the newly admitted patients in the department every day, and before leaving work every afternoon, he will browse the computer, copy down the bed numbers of the newly admitted patients, and then go to the room alone according to the list.

More contact with patients is the basic working principle of Yang Ping.

Only by having more contact can we obtain first-hand information about the condition, and many things cannot be reflected by instrument examination.

After the round, Yang Ping paid special attention to Teng Xinmei's case, not only because Professor Cao had shown her the medical records in advance, but also because this case was really tricky.

The left ventricular and ventricular septum are hypertrophied, the left ventricular outflow tract is obstructed, and left ventricular compliance is reduced.

The heart can be seen as a four-cylinder pump, these four cylinders are the left ventricle, the right ventricle, the left atrium, and the right atrium, and they are connected to several pipes.

The pump and the pipeline form two sets of circulating routes, which are equivalent to the "irrigation" system of the human body.

The left ventricle is connected to the aorta, the right atrium is connected to the vena cava, the right ventricle is connected to the pulmonary artery, and the left atrium is connected to the pulmonary vein.

Blood is pumped out by the right ventricle through the pulmonary artery to the lungs, where oxygen is sucked in and the blood returns to the left atrium, which is the small circulation, also called the pulmonary circulation.

The small circulation allows the blood to get oxygen, and the blood that receives oxygen flows from the left atrium to the left ventricle.

It is then pumped from the left ventricle to the aorta, where it flows through the artery throughout the body for irrigation, transporting oxygen to cells throughout the body, and after completing the irrigation task, the blood collects through the veins to the vena cava and finally returns to the right atrium.

At this time, the blood is short of oxygen, because the oxygen has been handed over to the cells for use, so the blood flows from the right atrium to the right ventricle, and the small circulation of oxygen begins again.

——

And so on and so forth, and life goes on and on.

The power of these two cycles is that the heart has a rhythmic contraction and relaxation, pumping and receiving blood, and achieving a cycle of cycles.

Between each cylinder of the heart, the entrance and exit of the connection between the cylinder and the pipeline, there is a one-way open movable valve, which can ensure the one-way flow of blood without backflow and mixing.

Hypertrophic obstructive cardiomyopathy can be understood as the heart becoming obese, especially the valve between the two ventricles is the most prone to obesity, cardiac obesity will bring a series of problems, such as leading to the narrowing of the chamber duct space, especially during systole, the obese ventricular septum protrudes into the left ventricle, and the mitral valve moves forward close to the herniated ventricular septum, which aggravates the outflow tract obstruction.

Because the heart pump is blocked, it cannot pump enough blood smoothly, so the symptoms of ischemia and blood oxygen appear.

And if not only the ventricular septum is obese, but also the left ventricle, there will be a lack of postdiastolic space, and the lack of space leads to insufficient volume of blood to be received.

In this way, the amount of blood collected is not enough, and now it cannot be sent out because of blockage, which makes it even more ischemic and oxygen-ising.

The surgery is to lose weight for the obese heart, open the chest cavity, cut the part of the aorta close to the heart, enter through the aortic incision, and cut off a layer of flesh from the thickened heart to make it thinner and thinner, so as to unblock the blocked passage and expand the narrow space.

In this case, the left ventricular and ventricular septum are severely hypertrophied, and it is likely that there will be insufficient resection during the operation, and once the resection is insufficient, the surgical effect will be poor, and even if the symptoms are temporarily relieved, it will recur after a few years, and then another operation will be required.

Too much incision is easy to cause complications such as conduction block, ventricular septal perforation, etc., and it is very likely that a permanent pacemaker may need to be inserted, and the normal beating of the heart depends on machine assistance for life.

It's like a person who loses weight, doesn't lose enough, and is still fat; It's so much reduced, it's skinny, I can't walk, and I rely on people to push me in a wheelchair.

In this case, the traditional surgical method will definitely not work well, and the risk is high.

Therefore, Yang Ping does not want to follow the traditional way of surgery, since he has the conditions, why not try a better method, he should make full use of the system space, actively explore, and create some new methods.

So Yang Ping began to do a lot of review of papers and monographs in this area, although he had read a lot of papers and monographs before, but this time it was a targeted review, and the effect would be different.

Hypertrophic obstructive cardiomyopathy is estimated to have more than 2 million people in the country according to the incidence of this disease, but less than 1,000 patients undergo surgery every year, because the operation is difficult and risky, there are few doctors who can perform surgery, and there are few patients who are willing to do surgery, and many patients cannot be effectively treated.

The reason why traditional surgery is difficult and high risk is because traditional surgery is to open the thoracic cavity, enter from the aorta, and go from the aorta incision to the ventricle, like a leopard in the tube, and cannot see the panorama of the hypertrophic area, so the surgical field and operation space are seriously insufficient.

Yang Ping thought that if an excision instrument was invented, it would not enter from the aorta, but directly from the apex of the heart to the heart.

In this way, under the ultrasound surveillance, the entire left ventricle can be seen at a glance, and there is no restriction on the surgical field of vision.

At the same time, the instrument can access the entire left ventricle, so that it can be cut arbitrarily, and there is no limitation of operating space.

Judging from the papers and monographs, there are people who have done this, and some doctors have invented apical puncture ablation, puncture from the apex, and perform ablation.

If you enter from a small incision in the apical puncture to perform minimally invasive surgery, there are several questions to consider: how to design the excision instrument? How is the hypertrophic heart muscle removed? How do I remove the removed heart muscle after resection? Otherwise, these myocardial tissues will run around with the bloodflow and become embolic embolism, which will cause cerebral infarction when it reaches the brain.

There is also a very important question, what about the material of the instrument?

Because the operation must be monitored by color ultrasound guidance, metal instruments will cause color ultrasound images to appear artifacts, and a large number of artifacts will cause the image to be unclear, and the operation cannot be done.

The heart is different from other cavity organs, such as the gastrointestinal tract can be used to assist in vision with an endoscope, but the inside of the heart is not good, the heart is filled with red blood, and the lens is just a piece of red in the blood, and nothing can be seen.

For example, the vascular endoscope only uses a balloon to temporarily block blood flow and create a bloodless cavity for the lens.

If it is an ordinary person who wants to solve these problems, it will not work at all in a few years, but Yang Ping has the system space to support it, he can do experiments at any time, and this kind of small experiment, for the current Yang Ping, there is no burden at all in terms of points.

Under the monitoring of color ultrasound, it enters from the apex of the heart, excises the hypertrophic myocardium and takes it out of the body intact, and studies according to this idea.

As soon as he said and did, Yang Ping entered the system space, and he began to design a dynamic rotary cutting system, using a rotary cutting blade to cut the heart muscle, and then take it out of the body.

Yang Ping drew the drawings well, but in reality, he needed to find a factory for production, which took a lot of time. In the system space, only need to input the drawings into the system panel, the universal system will replace the factory, directly output the instrument, of course, it is completely in accordance with Yang Ping's drawings production, if the drawings are problematic, can not be produced, the system will also output obstacles.

With the instruments, Yang Ping used the experimental body to start simulating the surgery.

At first, it was completely impossible, and the metal instruments seriously interfered with the color ultrasound image, and the operation could not be completed at all.

Therefore, Yang Ping improved the material of the instrument, used an anti-interference coating, and solved the problem of color ultrasound artifacts, but found that the rotary cutting was completely inaccurate, and it could not achieve the purpose of cutting as much as he wanted.

Yang Ping improved the blade again, and improved the blade until he was satisfied, and found new problems.

There are debris in the removed heart muscle that leaks and mixes into the blood in the ventricles, and as the blood circulates throughout the body, these emboli are potentially dangerous molecules that do not know where embolism will form.

Yang Ping did not have a gas properly, he continued to improve the instruments, surgery--improvement--reoperation--re-improvement-——

Until the surgical instruments were satisfied, in a severe hypertrophic obstructive cardiomyopathy subject, 30g of myocardium was cut off and all of it was taken out of the body, without causing any debris, and the subject recovered well after surgery.

It's a pity that there is no way to bring out the physical object of the system space, otherwise he will directly bring out how good it is to use the finished product, in order to solve this problem, Yang Ping recorded the last complete set of drawings in his brain.

Out of the system space, and then hand-drawn out, handed over to Ruixing Company to manufacture.

Realize his ideas as quickly as possible, which is why Yang Ping needs his own medical device company.

——

Professor Cao had doubts about whether Yang Ping could perform "myocardial bariatric" surgery, so he paid special attention to Teng Xinmei's treatment plan, which was a patient he had brought in, and nothing could go wrong.

Clinical medicine is a completely practical science, especially surgery, which must be tempered to master high-precision technology, and a young man like Yang Ping, who has not undergone professional training in this area, has nothing to do with this operation even if he publishes a hundred CNS.

However, Professor Zhang Zongshun said that Yang Ping must be able to do it, and Sanbo Hospital also unconditionally supports Yang Ping's interprofessional behavior.

Therefore, Professor Cao did not dare to say anything casually, but it was necessary to secretly track this case, and once there were any signs, he would take action in time to stop the loss.

"Professor Yang, how is it, how is this myocardial bariatric surgery planned? It's not too easy to do. ”

Professor Cao found Yang Ping, sat down to chat, and he came to the ward every day to pay attention to the treatment dynamics.

Yang Ping knew in his heart that Professor Cao was an expert in Fuwai, the imperial capital, and represented the top level in China, and it was reasonable for him to have doubts about some things.

"Open surgery is really not easy to do, and I am ready to use a minimally invasive method to solve it."

Yang Ping replied truthfully that it was impossible for him to ignore the old professor's doubts.

"Minimally invasive? Radiofrequency ablation or chemical ablation? I'm afraid not, right? ”

Professor Cao is a top expert and knows very well that whether it is radiofrequency ablation or chemical ablation, this kind of serious case will definitely not work, and if these two methods are used to deal with it, it will be completely perfunctory for the patient.

When the money was spent, the illness was not cured, and Professor Cao could not explain.

If this is the case, he still pushes the patient to the Imperial Capital Fuwai Hospital, so as not to delay the child.

Radiofrequency ablation and chemical ablation are relatively new methods at present, radiofrequency ablation, in a few hospitals can be done, under the guidance of electrocardiogram monitoring, the use of electrophysiological methods through radiofrequency ablation, the hypertrophic myocardium is ablated, and strive to restore to normal myocardial thickness.

Chemical ablation, commonly known as alcohol ablation, mainly uses anhydrous alcohol, finds the blood vessels supplying the hypertrophic myocardium through coronary angiography, and injects anhydrous alcohol into the blood vessels supplying the hypertrophic myocardium, so that the hypertrophic myocardium is ablated, necrosis, and the surrounding myocardium slowly thins and returns to a normal state. This method is to "diet" the hypertrophic myocardium to achieve the purpose of "weight loss".

Both methods have common drawbacks, the effect is uncertain, and the amount of weight loss cannot be precisely controlled.

"Professor Yang, you should be cautious, this case is so serious, I am afraid that the two minimally invasive methods will not work, the left ventricle and ventricular septum are thickened, which is several times that of normal people, you see, the pressure gradient of the left ventricular outflow tract is as high as 190mmHg, which is very dangerous, and there is a possibility of sudden death at any time, it is not easy for this child to stumble to the present."

Professor Cao solemnly reminded that in the face of professional technology, there is nothing polite to say, and as an elder, it is the responsibility to remind the juniors.

Yang Ping knew what Professor Cao was worried about, so he explained to him: "The new method I am going to adopt is not radiofrequency ablation, nor chemical ablation, but transapical myocardial aspiration technology, which belongs to mechanical excision, which enters from the apex of the heart, directly excises the hypertrophic myocardium from the inside, and then takes it out of the body, so as to achieve the purpose of thinning the myocardium." ”

"Transapical myocardial aspiration technique? Why haven't I heard of it? Which country's technology? ”

The first time Professor Cao heard of this technology, he was a big man in Fuwai, and the doctors he brought with him are now the leaders of cardiac surgery in the country.

"Mr. Cao, let's be honest, this is a technology I created myself." Yang Ping told him frankly.

Professor Cao's heart trembled after hearing this: "The new technology you created yourself? Has it been clinically tested? ”

"This is not available yet, but we can use animal experiments before the operation, and then Professor Cao will evaluate it together, and if the conditions are met, we will perform human surgery." Yang Ping hopes to convince Professor Cao.

Professor Cao disagreed with Yang Ping's behavior: "Professor Yang, this is not appropriate, you and I are both surgeons, we should know that a clinical technique, especially surgery, must go through a lot of experiments before it can enter the clinic, and after entering the clinic, it will have to go through a large number of cases to mature before it can mature, this case is still heart surgery, how can it be so rash and let a new surgical method directly enter the clinic?" ”

In fact, from a normal point of view, there is no problem with Professor Cao's statement at all.

"Professor Cao, this technique is actually not without clinical testing, first from the apex of the heart, no problem at all, radiofrequency ablation has related technology is from the apex of the heart, as for the rotary resection technology, nothing more than two problems, control the amount of resection, can not let the heart perforate, under the monitoring of color ultrasound, this problem can be avoided, and then the removed myocardial tissue must be completely taken out of the body, do not leave debris, the formation of emboli, if these are solved, is it an excellent technology?"

Professor Cao was thoughtful, theoretically this is the case, but practice is practice, theory is theory, and if everything in theory can be done, then it will be worth it.

"If it's really the first case, before you do the surgery, you have to test it on animals, and then call me to see it."

Professor Cao decided that he had to check the operation.

"Don't worry, Professor Cao, the equipment will be delivered in a few days, I am going to use pigs for experiments, after you nod, I will apply it to the clinic, and the ethics committee still needs you to nod."

"Hmm!" Professor Cao kind of agreed to do so.

For the sake of safety, Professor Cao decided to call his own student from Fuwai Hospital, a chief physician of cardiac surgery and an excellent cardiac surgeon, who is not only familiar with myocardial hypertrophy surgery, but also in the field of vascular surgery, which is the top presence in the country.

Nominally, he came to see Yang Ping's new technology, but in fact, Professor Cao left behind.

(End of chapter)