The sudden sound drew everyone back to look.

Well?

When does a stranger come in the operating room!

Look at the surgical gown on the other party, it should be Renhe's medical staff.

But it seems like I've never seen it.

Huang Ping was puzzled, "Are you?" ”

The visitor ignored Huang Ping, and walked directly onto the operating table and said to Li Xiyang, "I am panda blood, you continue the operation, I will transfuse blood!" ”

Li Xiyang was stunned, this person seemed to have seen it somewhere.

However, the other party is wearing a surgical cap and mask at the moment, and his face is covered tightly, and he can't see his appearance clearly.

"Boy, what are you doing in a daze?"

The visitor frowned, looking a little impatient.

"Okay, thank you then!"

"Dr. Zheng, give him a blood transfusion!"

Zheng Xiaoyu hesitated a little, "Doctor Li, he..."

Give a blood transfusion to a patient, at least check the blood type first, in case the person is...

"It's too late, let's get started!"

Xiaoxiao's mother's blood pressure has dropped to a very dangerous level, and there is no time to delay.

Under the mask, Zheng Xiaoyu gritted his teeth, "Okay." ”

Soon the venous passage opened, and bright red blood slowly flowed from the man's body into the patient's body.

For a while, everyone was staring at the oximeter.

"Look, blood pressure is really starting to go up!"

Everyone was pleasantly surprised.

The anesthesiologist moved the stool in his corner to the man with an enthusiastic face.

But the man didn't look at it, his eyes swept over everyone, and he said unceremoniously, "What are you doing in a daze, hurry up and operate!" ”

Everyone looked at each other and said in their hearts, who is this person?

Between the gestures, it feels very majestic.

Li Xiyang glanced at him and nodded.

And then

"The operation begins!"

Like the previous plan, Li Xiyang chose sequential bilateral single lung transplantation.

In the past, double lung transplantation techniques were all whole double lung transplantation, which would cause patients to have obvious complications after surgery, especially tracheal anastomosis complications, which was very unfavorable to the postoperative recovery of patients, and the postoperative survival rate was only 30%.

In recent years, a new type of double lung transplantation has been carried out internationally, which is sequential bilateral single lung transplantation.

This type of surgery is characterized by the removal of one lung first, followed by transplantation of the other lung.

Compared with whole double lung transplantation, the utilization rate of intraoperative cardiopulmonary bypass is greatly reduced, and a series of complications caused by cardiopulmonary bypass are reduced.

At the same time, there are fewer complications of anastomosis and the survival rate of patients is higher.

The only disadvantage is that the two repeated actions make the cooling time of the post-transplanted single lung longer.

Fortunately, so far, no adverse consequences have been observed.

Patient under general anesthesia...

Supine position...

Chest padding...

Bilateral anterior external incisions, the fourth intercostal space simultaneously enters the chest...

Transect the sternum...

"Open the right ribcage and do a right lung transplant first!"

After Li Xiyang finished speaking, the stranger on the side asked, "Why did you do the right side first?" ”

Li Xiyang took the tissue scissors and said, "The condition of the right lung is better, it is easier to do." ”

The man wondered, "How do you tell?" ”

As far as he observes the bedside CT, the patient's left and right lungs can be said to be a collapse, where can I see which side is better?

Li Xiyang said, "Intuition! ”

Stranger, "......"

After speaking, Li Xiyang began the operation.

Tissue scissors...

Free right pulmonary artery...

Free right pulmonary vein...

Free bronchi...

Exposure of hilar structures...

As the operation progressed, the stranger's eyes slowly became serious.

Such a skillful operation is to start practicing in the womb, and he shouldn't be at his age.

What a good boy!

Huang Ping and the others were in admiration, although they had seen Dr. Li's lung removal surgery in the operating room next door just now, but when they saw it again, they were still shocked and envious.

And I don't know if it's an illusion, this time Dr. Li's movements seem to be faster.

Scalpel...

Dissect the atrial sulcus from the right side to reveal the 1~3cm wall of the left atrial wall proximal to the right pulmonary vein...

As Li Xiyang's scalpel paused, Huang Ping on the side hurriedly stepped forward to place an atrial clip.

With the previous surgical experience, several people are also more tacit at this moment.

Li Xiyang nodded with satisfaction, and the operation continued.

Transect ascending aorta at the point of aortic perfusion...

Transect of the pulmonary artery at the midpoint of the total pulmonary artery...

Cutting off the superior and inferior vena cava...

Soon, the operation had been going on for half an hour,

Li Xiyang suddenly stopped his movements and shouted, "Pulmonary artery floating catheter." ”

A pulmonary artery flotation catheter is a tool for measuring pulmonary artery pressure and pulmonary capillary blood pressure.

The total length is 110 scales, and the balloon is about 1mm from the top of the catheter.

Available0. 8~1ml of air or carbon dioxide gas is inflated, the diameter of the inflated air bag is about 13mm, and the tail of the catheter is connected to a 1ml syringe through a switch to inflate or deflate the air bag.

It was pushed into the patient's left pulmonary artery to facilitate Li Xiyang's resection of the patient's right lung, and the left lung was first ventilated with a single lung to maintain the patient's normal breathing activity.

Soon the catheter arrived, and the left pulmonary artery was successfully advanced.

However, the patient's pulmonary artery systolic blood pressure and respiratory activity are not ideal.

This means that even if a catheter is attached to the left lung, it is still difficult to maintain the patient's breathing.

Never mind

"Let's push extracorporeal membrane oxygenation!"

Originally, in order to avoid the occurrence of multiple complications after surgery, Li Xiyang planned to use the cardiopulmonary bypass system less.

But the patient's pulmonary fibrosis is too severe.

Such a single lung simply does not guarantee that the patient can breathe normally.

Extracorporeal membrane oxygenation can only be used to help patients establish cardiopulmonary bypass.

The stranger was also slightly surprised when he saw the extracorporeal membrane oxygenation system pushed by Zhao Hai.

He secretly said in his heart, "It is worthy of being the imperial capital, and there is extracorporeal membrane oxygenation." ”

Extracorporeal membrane oxygenation is known as the 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 extracorporeal membrane oxygenation includes: intravascular cannula, connecting tube, power pump (artificial heart), oxygenator (artificial lung), oxygen supply tube, and monitoring system.

Among them, the oxygenator, its function is to synthesize non-oxygenated blood oxygen into oxygenated blood, also known as artificial lungs.

Among them, the power pump, known as the artificial heart, is used to form a power to drive blood to flow to one side of the pipe, similar to the function of the heart.

Extracorporeal membrane oxygenation, also known as an emergency life-saving device, is significantly different from the traditional cardiopulmonary bypass.

Extracorporeal membrane oxygenation is a blood storage bottle device in the process of closed pipeline without cardiopulmonary bypass, and extracorporeal circulation has a blood storage bottle as an exhaust device, which is an open pipeline;

Greatly reduces the complications of bleeding in patients,

And prolonged life support provides enough recovery time to damaged organs and increases the cure rate.

soon

The bright red blood flows through the transparent flexible tube, then passes through a power pump equivalent to an artificial heart, passes through an oxygenator equivalent to an artificial lung, and carries sufficient nutrients through the blood vessels throughout the patient's body before returning to the flexible tube.

This is also the first time Li Xiyang has used the extracorporeal membrane oxygenation system, and he can't help but nod with satisfaction.

The simple and fast operation method can set up the cycle at a very fast time in rudimentary conditions, and the skilled team can reduce the time to less than 10 minutes.

It's no wonder that extracorporeal membrane oxygenation is known as an emergency lifesaver.

"Dr. Huang, pay attention to maintaining the systolic blood pressure of the pulmonary arteries below 4KPa."

Huang Ping nodded, "Understood." ”

Then Li Xiyang took the scalpel again and cut off the first branch and descending branch of the pulmonary artery.

At this point, the removal of the diseased right lung is basically completed.

"Take out the right lung!"

Zheng Xiaoyu and Zhang Jie stood on both sides of the operating table on both sides of the operating table, carefully taking out the patient's diseased right lung.

Zhao Hai, who had already prepared on the side, quickly opened the portable refrigerator, took out the donor's right lung with Li Xiyang and slowly put it into the patient's chest.

"Needle pliers!"

"4# absorbable monofilament thread!"

Li Xiyang opened his mouth, and Huang Ping hurriedly handed it over.

The bronchial anastomosis was started first, and Li Xiyang used the continuous suture method.

A thread is sewn to the end, and it is done in the blink of an eye.

"4-0 Vicryl Line!"

Quickly change the sutures and start suturing the bronchocartilage part.

Because there was no continuity here, Li Xiyang switched to intermittent sutures.

When the pulmonary artery was reached, Li Xiyang changed the sutures again,

"5-0 Prolene Line!"

This time intermittent sutures were used.

With this method of suturing, even if one silk thread slips off after the surgery, there are still more silk threads to protect the wound.

And once there is fluid or fat liquefaction under the incision, two silk threads can be used to stretch and drain, which not only achieves a good drainage effect, but also avoids the full-thickness cracking of the incition.

Three types of sutures were replaced in a row, corresponding to three types of sutures.

And it's so fast that it's dizzying.

For a moment, everyone stared at each other.

The stranger next to him looked at him in shock, but he saw it differently than the others.

This kid's suture was wonderful, but the most incredible thing for him was that the pulmonary artery anastomosis was not bad at all.

It is important to know that in lung transplant surgery, the caliber of the anastomosis orifice is often compared, and if the size does not match, it needs to be trimmed.

It is often this process that is the most time-consuming.

And what did he see just now?

This is true not only for pulmonary artery anastomosis, but also for bronchial anastomosis.

The diameters of the two broken ends are exactly matched, and there is no need to do any trimming at all.

That's why this kid's surgery gives people a smooth flow without the slightest sense of stagnation.

But what's behind that?

It means that this kid has already calculated it when he did the donor lung removal.

When the recipient's lung was then removed, the same incision was made, and there was an undifferentiated anastomosis.

Wrong

The size and length of organs vary from person to person.

Men and women, as well as height, age, etc. are different.

Not every person's lungs are the same shape, size, or weight.

In this case, this kid was able to accurately make the cuts on both sides.

Is this a coincidence??

But not only the pulmonary artery and bronchi, but also the upper and lower vena cava, as well as the anastomosis of the right atrial sleeve, are all the same.

！

！

This kid is really a natural sorcerer!

"Scissors."

When the atrial cuff is gentle, the right lung transplant is complete.

Everyone looked at the time, and it was only one and a half hours later.

However, it was too late to be surprised, and I saw Li Xiyang directly push the pulmonary artery floating catheter into the transplanted right pulmonary artery, and then removed the cardiopulmonary bypass.

Everyone was shocked, "Dr. Li, don't you want to use the newly transplanted lung to breathe independently, but you can't mess around!" ”

Li Xiyang asked rhetorically, "Isn't the new lung transplant just to make it breathe?" ”

Huang Ping nodded, that's right.

But this is just a successful transplant!

The heart-lung blood vessels have just been anastomosed, don't you wait for them to heal?

Li Xiyang smiled lightly and pointed to the electrocardiogram next to him.

At this point, cardiopulmonary bypass has been withdrawn, and the patient's breathing is unexpectedly stable.

Looking at the evenly undulating right lung, everyone's eyes widened in disbelief.

The new lung has just been transplanted and can breathe?!

This...

Huang Ping said excitedly, "Doctor Li, how did you do it?!" ”

The new lung has just been transplanted and is able to breathe.

That's amazing, isn't it?

"Amazing indeed!"

Li Xiyang opened his mouth surgingly, making everyone stunned.

Then I saw Li Xiyang staring at the evenly undulating right lung, his eyes full of complicated colors.

In an instant, everyone seemed to understand.

In the dark, maybe the man is guarding his wife in another way...

"Wipe the sweat!"

Li Xiyang turned his head sideways, and the little nurse hurriedly stepped forward.

Now is not the time for sentimental remembrance, and all surgeries must be done as soon as possible.

When wiping his sweat, Li Xiyang noticed that the person next to him was in a state that was not right.

His face was pale, and a lot of cold sweat oozed from his forehead.

For an hour and a half, at least more than 800 ml has been lost.

"You can't lose anymore, stop!"

Li Xiyang spoke, but the person opposite glared.

"The operation is only half done, let me withdraw now, in case the patient is gone, won't Lao Tzu's 800cc panda blood be lost in vain?!"

"But you..."

"Less nonsense, hurry up and operate!"

The man's attitude is resolute and unquestionable.

Li Xiyang glanced at the man seriously and nodded, "Okay, I will complete the operation as soon as possible!" ”

After a pause, he said, "I have two candies in my pocket, you eat them first!" ”

The man rolled his eyes, looking unangry.

was about to open his mouth to complain, but he heard Li Xiyang say, "This is the candy given by Xiaoxiao." ”

The man was stunned, that kid...

Sigh softly, and don't refute anymore.

Reached out and took out two candies from Li Xiyang's pocket.

"Alright, let's do the surgery quickly!"

Li Xiyang nodded, took a deep breath and said, "Start the left lung transplant." ”

There is essentially no difference between a left lung transplant and a right lung transplant, so no matter Li Xiyang's operation or everyone's cooperation, it is obviously faster.

Finally, in the 50th minute, the left lung transplant was successful.

Blunt separation of the retrosternal tunnel, descending against the xiphoid process, taking the omentum into the thoracic cavity...

Use two omental pedicles to completely wrap around the bronchial anastomosis on both sides from the posterior hilar anteriorly...

2 chest drains on each side of the chest...

Fix the sternal end with 3 sternal wires, and suture the thoracic incision in layers...

When the last stitch is dropped,

Behind Li Xiyang, the man fell to the ground with a thud.

Li Xiyang hurriedly shouted, "Stop the blood transfusion, hurry!" ”

Zheng Xiaoyu stepped forward and quickly pulled out the needle on the other party's arm.

Li Xiyang handed over the final bandaging work to Zhao Hai and walked to the man in two or three steps.

Anxiously asked, "How is it, is it okay?" ”

The man waved his hand, "It's just a little anemic, I can't die!" ”

At this time, Li Xiyang noticed that the latter was still holding two candies in his palm, and suddenly said a little angrily, "Why don't you eat it?" ”

Quickly pick up a candy and peel it off, then pull off the other person's mask.

But when he saw the other party's appearance clearly, Li Xiyang was stupid, "Section Chief Wei??? ”