In general, it is more gentle to make an incision from the intercostal space, or in all three directions: the neck, below the sternum, or abdomen.

However, when planning a surgical plan, the doctor will take all aspects into account.

The chest must be opened from the front, then it must be opened.

The risks and possible sequelae will be explained to family members and patients before surgery.

This patient's cardiac aneurysm is more than 5.5 cm in diameter and is an extremely dangerous type. Moreover, it has been severely compressed to the surrounding organs, causing great physical pain to the patient.

Opening the chest from the center is the most direct and quick way to deal with it.

Director Xue methodically commanded the three assistants to open the patient's chest, and the key high-risk parts were operated by her or instructed by a helper. The surgical team she led was quite strong.

Even Dr. Long could only barely mix up the position of three assistants.

Ichisuke seemed to be older than Director Yuki, with a large amount of gray hair on his temples, and the gray-white hair had spread to the top of his head. There are fewer wrinkles.

Doctors are a very stressful, high-risk profession, and premature aging has become almost universal.

Many people have gray hair after finishing clinical medicine.

In addition, the professional title of a doctor is never evaluated based on age. As long as the working years can meet the evaluation standards, and the academics, surgical volume, written examinations, scientific research achievements and other aspects can meet the evaluation requirements, they can be submitted for review.

Some doctors with good talent and special hard work can really be promoted to chief physician at the age of 42.

And some people, who may be stuck in one aspect or fail to meet the requirements in many aspects, are still in the main seat at the age of nearly 60.

This Ichisuke is at least five or six years older than Director Xueyan.

Watching him sawn open his sternum, it was a little wobbly, quite scary.

"You remember, because this aneurysm is right behind the sternum, you need to have a clever swing sternal saw when sawing the sternum to avoid tearing the aneurysm wall and causing massive bleeding."

Director Xue instructed Ichisuke to saw open the sternum while explaining the key points of operation to other junior doctors.

After Zhou Can heard this, he suddenly realized in his heart.

I thought Ichisuke was getting old and his hands were unsteady.

It turned out to be a deliberate and conscious swinging sternal saw.

can be a helper, and has a high degree of trust from Director Xue, and really has a lot of strength.

These valuable experiences are all summed up by the blood lessons of our predecessors.

After opening the chest cavity, the huge aneurysm was already visible.

It must be noted that an aortic aneurysm is a lesion of the blood vessel wall that causes damage to the normal structure of the aortic wall due to various reasons, and locally bulges outward to form aneurysm-like dilation.

It's not really a tumor.

The nature of the two is also completely different.

The biggest danger of an aneurysm is rupture, causing massive bleeding.

In addition, when it continues to grow and compress the surrounding organs and tissues, it will bring great pain to the patient. If it is an intracranial aneurysm, it is more dangerous, and any important nerve, blood vessel, or brain tissue that is pressed on it may cause serious problems.

Tumors, whether benign or malignant, are frantically self-replicating, destroying the body's immune mechanism and infringing on normal cells and organs throughout the body.

Tumors also have the problem of compressing surrounding organs.

The largest liver tumors can occupy more than half of the chest and abdomen.

"Director Xue, this aneurysm is located on the trunk of the head and brachi, very close to the ascending aorta, do you need to be prepared to establish extracorporeal blood circulation first?"

The anesthesiologist for this operation is also an official doctor.

He has the discipline of an anesthesiologist and generally remains silent and does not interfere with the operation of the chief surgeon.

This is only a reminder if there is a high risk associated with the procedure.

Ascending aneurysms are not suitable for interventional procedures.

The most common treatment method is to remove and replace the artificial blood vessel.

Director Xue's choice to clip the aneurysm rather than remove it may also be due to the huge risks involved in the process of replacing the blood vessels.

Even today, the technology for replacing the ascending artery is well established, and the mortality rate is still as high as more than 10%.

If you encounter a surgeon with a technical fistula, or if there is some accident during the operation, the mortality rate will only be higher.

After listening to Dr. Guan's reminder, Director Xue hesitated for a moment, and then said, "To establish extracorporeal blood circulation, systemic heparinization is required first, and the femoral artery and femoral vein cannulation are required, which will cause certain physical harm to the patient." Because it is only a clipping procedure, the risk is relatively small, so let's not prepare for this first! ”

She has her considerations.

This is not to save trouble, but to consider it from the patient's point of view.

It can save the patient the cost of surgery and also avoid causing harm to the patient's body.

Dr. Guan didn't say anything more, and the operation continued.

Zhou Can found that the aneurysm was in a very bad position, at the junction of the brachiocephalic trunk near the ascending aorta.

How to say it, the ascending artery and the aortic arch are like a round arch, and then three important branch arteries branch out from this arch. Brachiocephalic trunk, left common carotid artery, left subclavian artery.

These three branch arteries are interesting.

Both the left common carotid artery and the left subclavian artery branch directly from this round arch.

However, the right common carotid artery and the right subclavian artery branch off from this brachiocephalic trunk.

The right common carotid artery is slightly higher.

From here, it can be seen that the brachiocephalic trunk corresponds to the integrated trunk of the two branch arteries on the right. It has a very large blood supply.

It can be understood as half of the sum of the blood pumped by the heart.

Not to mention the ascending artery.

Equivalent to arterial assembly.

The location of the aneurysm is very specific, and it is extremely difficult to perform clipping surgery.

Some highly skilled doctors are particularly fond of challenging this type of surgery.

Zhou Can does not yet know the specific treatment plan of Dr. Xue.

Since it is a clipping operation, even three clips may not be able to clip the special aneurysm completely.

In addition, if such a large aneurysm appears, the hardening of the blood vessel wall and spots will definitely be accompanied.

The most appropriate treatment is to remove and replace the artificial blood vessel.

"This aneurysm is a bit special, but I've had successful aneurysm clipping surgery at the intersection of blood vessels before. Now that the surgical field is sufficient, the difficulty of the operation will be relatively reduced. If done well, two arterial clips are sufficient to complete this clipping procedure. Director Lu, you will use a temporary blocking clip to temporarily block this blood vessel. ”

As she made the arrangements, she repeatedly selected the appropriate aneurysm clips.

This clamp style is very rich in size and is sufficient to meet all the clamping needs of aneurysms.

It can be seen that Director Xueyan is very stable in doing things.

Not only were the two most suitable aneurysm clips selected, but three more were prepared, which were used to remediate the accident in the event of an accident.

"Let's get started!"

She gestured to Ichisuke.

"Doctor Guan, it's okay to block it for about a minute, right?"

She asked the anesthesiologist for her opinion.

"Absolutely. It is only a minute to complete the clamping operation, which is quite difficult. I didn't have an extracorporeal blood circulation pathway, so I was a little unsure. ”

Dr. Guan is still worried.

Experienced anesthesiologists often experience many surgical accidents.

There are many risks that are unpredictable, and accidents often happen in a split second.

He has seen too many surgeons who are confident before surgery, only to have an accident during the operation, leaving the patient in a state of extreme danger.

"It's okay, a minute passed quickly. Feel relieved! ”

Director Xue comforted him.

The chief surgeon had already said so, and Dr. Guan didn't say anything more.

Only the eyebrows were full of worry.

"Block it!"

She gestured to Ichisuke again.

is several years older than her, and was commanded by her during the operation, indicating that this Director Lu should be the deputy chief physician.

Deputy Director Lu controlled the temporary occlusion clip to accurately block the position where the ascending artery and the brachiocephalic trunk meet.

This operation is quite difficult and tests the doctor's skills.

He successfully completed the proximal blockade.

Next, the upper end of the head and arm trunk is also temporarily blocked.

At this point, it is equivalent to framing the aneurysm so that there is no effective blood flow in.

It is equivalent to completely cutting off the blood transfusion of this blood vessel to ensure that the process of clamping the aneurysm is safer for Director Xue.

The cooperation between the two sides is very tacit.

Director Xue's operation is also very precise.

It took less than ten seconds to close the first clamp. When the second aneurysm clip was placed, it didn't seem to go as smoothly as she expected.

The site itself is relatively special, and if the blood circulation of the entire aneurysm cannot be blocked, the therapeutic effect will not be achieved.

So, it's the second clip that is the hardest.

A minute is a very short time.

She kept adjusting, but never achieved satisfactory results.

At the moment, it is equivalent to getting the patient's whole body blood

There was no way, seeing that the time was up, she could only place the second aneurysm clip first.

"Let's try it first! If it doesn't work, adjust it again! ”

It takes too long to cut off the blood supply, which is very dangerous.

In any part of the world, as long as there is ischemia, there will be rapid cell death. Over a longer period of time, a large area of tissue will be irreversibly necrotic.

After the blood, everyone was nervously staring at the clamped hemangioma.

The blood pressure on the main road is very strong.

As soon as the blood is passed, the blood is running again at a very fast rate.

Most of the aneurysm was clipped, but it was missing.

Blood is forced to pour in, and the aneurysm appears to be enlarged.

After seeing this situation, Director Xue did not panic, but very calmly observed the gap in the clamping position and thought about the solution.

"Three clips may need to be used!"

She seemed to be talking to herself, and it was as if she was consulting with other doctors.

"It's really safer to use three clips, and it's a little easier to operate. Director Xue is sometimes too kind and considerate of patients. ”

Ichisuke agreed with her.

admires her character even more.

From what she did in this operation, it can indeed be seen that she is always thinking about the patient. Some of the risks are all at her own risk.

It is said that each other is born from the heart.

Her temperament is so good, and she is still very beautiful in her forties, which is enough to show how kind her heart is.

One less hemangioma clip can save a lot of money for the patient.

"This patient's family burden is relatively heavy, he himself runs food delivery for a living, and his wife is blind. It belongs to the disadvantaged group, and if you can, you can help. She said.

The poorer the family, the more likely it is to have some serious diseases.

Some diseases are saved, and some diseases are tired.

Poverty has made them sick and dragged on, and they are usually reluctant to go to the hospital for examination, and some food has spoiled, and they are still reluctant to throw it away. There are also all kinds of very bad working conditions, as well as hard work regardless of the body, which is easy for some malignant diseases to find them.

There is not only beauty in the world, but also suffering.

After a short rest, the vessel is blocked again and then clipped.

It is important to note that it is not necessary to block the blood vessel in order to clip it, but surgeons generally follow the procedure strictly for safety reasons.

"Didi......"

Not long after the blockade, the life monitor directly sent out an alarm.

The patient's heartbeat plummets with ventricular fibrillation.

The official doctor panicked.

"It must have been a continuous blockade of blood supply, which induced the occurrence of cataplexy in the center of surgery. This is a big problem. ”

It's the first time I've seen Dr. Guan panic like this.

The problem is extremely serious.

Director Xue's face turned pale, and there were obvious palpitations and panic in the depths of his eyes.

It happened so suddenly.

Women are not suitable to be surgeons, in addition to being physically inferior to men, their psychological quality is generally much worse.

When encountering emergencies, fear can easily make them lose their ability to think and judge.

Deputy Director Lu's brows were tightly knit and his face was solemn.

The other doctors and nurses looked nervous.

The most feared thing about surgery is some sudden accidents. Because the consequences are often death.

"Doctor Zhou, hurry up and help with the intubation of extracorporeal blood circulation."

Doctor Guan had to call Zhou Can for help again.

Cardiothoracic surgery is often carried out with high risks, and various dangers occur almost every day.

What can be prevented can only be prevented by the concerted efforts of doctors and nurses.

Therefore, it is very important to have a strong surgical team.

Deal with all the difficult parts of the operation, and cooperate well to help the patient get through the danger.

"Who is Dr. Zhou?"

Director Xue was a little dazed, and there was no doctor surnamed Zhou in his surgical team.

Then, she saw the trainee who had been punished by Dr. Zhao for cleaning in the operating room walked briskly onto the operating table, and quickly established an extracorporeal blood circulation channel for the patient with very professional and skillful movements.

Femoral movement and intravenous cannulation, in exchange for Director Xue's personal operation, can be completed in ten minutes, even if it is a very good performance.

But Zhou Can only took less than thirty seconds.

It's just amazing.

It was as if she had seen the legendary sweeping monk reappear.

"Doctor Guan, hurry up and do pericardial compressions! Otherwise, the patient's brain will soon die of ischemia and necrosis. On the contrary, Zhou Can urged the official doctor to come.

He studied various rescue knowledge and techniques from a number of chief physicians in the intensive care department.

In such an emergency, there is an immediate place to come in.

"Okay!"

Dr. Guan had actually asked the nurse to put on gloves and prepare to perform pericardial compressions.

Cardiac arrest and ventricular fibrillation during thoracotomy are extremely dangerous.

If effective and precise rescue measures are not implemented immediately, the patient will die quickly.

Zhou Can next, regardless of the extremely shocked expressions of others, calmly began to carry out the upper and inferior vena cava cannulation and other work.

Only Doctor Long, who has seen Zhou Can's skills, is quite calm.

Because he already knew that Zhou Can's skills were extraordinary.

The most shocking was Dr. Zhao.

He really never dreamed that this Gui Peisheng, who he looked down on, would explode. All kinds of intubation operations completely refreshed his cognition.

"W-who is this?"

Deputy Director Lu was shocked and asked the doctors around him.

His gaze first looked at Dr. Zhao.

Because when he came in, Dr. Zhao said that he was the one who punished Zhou Can for cleaning here.

Dr. Zhao, who is also a resident at the bottom of the cardiothoracic surgery department, really doesn't know much about it. How does he know where Zhou Can comes from? He was also confused.

Some stammered, "He, he's a trainee who just transferred to our cardiothoracic surgery today." ”

"How can a regular trainee be so powerful?"

Deputy Director Lu didn't believe it at all.

"What's his name?"

"It seems to be called...... Zhou Can, yes, it's called Zhou Can! ”

Dr. Zhao only remembered Zhou Can's surname Zhou, and thought about it for a long time before he remembered Zhou Can's name.

"Ah...... It turned out to be him, no wonder he was so good! ”

Deputy Director Lu is much better informed than Dr. Zhao.

Gui Peisheng Zhou Can's name, he has heard of it for a long time.

It is said that every time this trainee enters a new department, he will set off a huge wave, and his strength and talent are so strong that even the existence of Vice President Ye is shocked.

Director Xie of the Department of General Surgery heard that he wanted to dig Zhou Can several times, and promised all kinds of super high treatment, but Zhou Can refused.

In the department where Zhou Can stayed, the chief doctors were full of praise for him.

Such a powerful trainee, on the first day of his rotation to cardiothoracic surgery, he was punished to clean in the operating room. This Dr. Zhao is so ignorant.

When Director Xueyan heard Zhou Can's name, she also subconsciously took her eyes off the patient's pericardium and looked at Zhou Can.

"Doctor Guan, let's establish extracorporeal blood circulation now, right?"

"Of course!"

Dr. Guan replied while pressing on the pericardium.

He didn't dare to look up, he didn't dare to look away.

Chest compressions during CPR protect the entire rib cage of the rib cage. During thoracotomy surgery, the pericardium can only be compressed urgently.

It is equivalent to pressing directly on the heart.

The danger is self-evident.

"I think vasoactive drugs should be given to patients right away!"

Zhou Can made suggestions while operating to establish cardiopulmonary bypass for patients.

"Yes, yes, I almost forgot about it. Director Xue, you can arrange this matter immediately, I can't get out here. ”

The official doctor was as good as a stream, and accepted Zhou Can's suggestions in full.

No matter how stupid Director Xue is, he can see that Zhou Can's status in the eyes of the official doctor is very unusual. And it's extremely powerful. In a very short time, the preparation for the establishment of cardiopulmonary bypass is already ready.

And every suggestion is very precise and in place.

What is reflected is Zhou Can's comprehensive rescue strength.

"Fortunately, today there is this Dr. Zhou to help, otherwise it may be difficult for the patient to be rescued." Director Xue's evaluation of Zhou Can in his heart rose to an extremely high height.

can be regarded as seeing Zhou Can's true skills.

Seeing is believing, hearing is false.

Seeing Zhou Can's series of cardiopulmonary bypass establishment operations with her own eyes, she felt that Zhou Can was even more powerful than the rumors.

Thank you for your support! I wish all readers a happy Mid-Autumn Festival!

(End of chapter)