Opening the dura mater is basically a long drive.

Drain the blood in the skull first.

Even if this is only the simplest step, Director Wu Yongming is still cautious. When aspirating fluid in the cranial cavity, it is very easy to make mistakes and injure vital brain tissue.

Deputy Director Lu's intracranial environment is even more harsh, and the degree of accident is far greater than that of ordinary patients.

Not to mention anything else, just the serious aging of blood vessels, hardening, and brittleness is enough to make surgeons walk on thin ice.

After the intracranial blood has been suctioned almost completely, the intracranial pressure is almost normal. Or rather, it's a little lower than normal.

Because the original cranial cavity was closed, now two holes have been opened, which is equivalent to a semi-open one.

Medically, this is called fenestration.

The operation is progressing well.

It's just that it quickly ran into trouble.

Just sucking out the accumulated blood is definitely not enough, not only blood, but also a full skull cavity will soon be available for you.

Director Wu Yongming tried to repair the ruptured blood vessels, not to mention anastomosis, and even debridement was in trouble.

"No, this blood vessel is too close to the brainstem. The operating space was even narrower, and I was not sure that the endoscope would stop the bleeding. ”

Droplets of sweat the size of mung beans appeared on his forehead, and he shook his head repeatedly.

It was as if there was a terrible beast blocking the way.

The level of surgery is actually similar to that of ordinary surgery. At least as long as the normal level is reached, the surgery can be completed smoothly.

In the words of a certain surgical boss, surgery is about cutting out the lesion and repairing the stitches.

Of course, this surgical boss still said this sentence in the sixties.

With the development of surgical technology, it is no longer just about patching up and excision. There are already many new technologies being used, such as artificial blood vessels, vascular stents, artificial hearts, and so on.

Even the repair of blood vessels, organs and tissues is a great test of the doctor's skills.

Not to mention whether vascular repair is done in a narrow cranial cavity or endoscopic surgery. It's hellish level of difficulty.

Next to it is the brain stem, there are other important brain tissues around, and doctors with poor psychological quality will tremble with fear when they manipulate the endoscopic arm.

Not an exaggeration.

The psychological and mental pressure endured by the doctors, especially the chief surgeon, during the operation is beyond imagination.

Because if something happens to the patient, the surgeon has to be responsible!

"The damaged area of this blood vessel is not particularly large, the length is short, and it is indeed very close to the brainstem, which is extremely inconvenient to operate. Master Wu, why don't you try a vascular stent to repair it? ”

Director Gou Poor was on his side to give him advice.

"If it's a small aneurysm in the brain, I can put a coil on it and get it done. Even if the aneurysm is larger, it can be repaired by placing a stent. However, there is no way to use a stent for this vessel. ”

He shook his head and vetoed the proposal.

Drilling holes in the skull to open a window must first and foremost to drain the intracranial fluid and reduce intracranial pressure.

The second is to repair blood vessels and stop bleeding.

Not all vascular repairs are suitable for stent placement.

First of all, the bracket is expensive. Secondly, the difficulty of operation is also extremely high, especially if the intracranial artery wants to place a stent, the difficulty is frightening.

"Or ...... You can help me move the brain tissue on the upper right side of the bleeding point a little and let me try it! ”

Zhou Can saw the bleeding cerebral artery, and there was a trace of excitement in his eyes.

It is completely different from the fear in Director Wu Yongming's eyes. Director Wu was full of fear, and he didn't have any confidence to challenge at all, and he was really not sure. Zhou Can is full of sharpness, like a fearless brave.

"Doctor Zhou, you must do what you can! Don't be reckless, it's really not possible, we can also have a joint consultation again to discuss other surgical options. ”

Wu Yongming said so, but in fact, he also knew in his heart that there was no other surgical plan at all.

If there is a better surgical plan, it will not be delayed all the time.

In the case of medical medication, there may be other alternatives. There are really not many solutions for this rupture of intracranial arteries. Just two or three.

"I'll be extra careful."

Zhou Can replied sonorously and forcefully, with a serious expression.

After changing his main knife, he first instructed Director Wu to help move the brain tissue to the side. This operation has a certain technical content, and it is more like pulling the hook and other strenuous work.

Of course, with the help of the endoscopic arm, the actual physical exertion is not large.

Next, Zhou Can tried to operate in this extremely small and limited space.

"No, we have to move a little bit to the side, about 0.5CM should be enough."

"Okay, I'll try."

Director Wu gritted his teeth, his eyes were extremely focused, and he squeezed and moved the brain tissue little by little, so as to make more room for Zhou Can to operate the operation.

"You can't move anymore, that's the limit. If you move again, you may seriously injure the brain tissue. ”

Director Wu didn't dare to move his eyelids off the screen, and he was trying to control the volume of his speech, for fear that the strength of his hands would increase and damage the brain tissue.

Whether it is in the abdominal cavity or cranial cavity, moving the surrounding tissues during surgery is itself a kind of injury to the body.

The abdominal cavity and thoracic cavity that have undergone surgery often have serious adhesions between various tissues and organs, which will bring a series of negative long-term effects to the patient. It can be called a postoperative complication, or sequelae.

For example, after chest surgery, some people often feel chest tightness and shortness of breath, which is the sequelae of surgery.

There is no way to treat it, and it will basically stay with you for life.

Experienced and skilled doctors often try to avoid other tissues and organs when performing thoracic and abdominal surgery. Only the lesions are treated.

Of course, the idea is beautiful, but in practice, doctors have no choice.

For example, when you have an intra-abdominal appendectomy, how can you do it if you don't bring out the intestines?

Just looking for the appendix is a long toss.

"Keeping this surgical space the size should be enough."

After Zhou Can made a comparison, he showed a satisfied expression this time.

"It is stated in advance that when this blood vessel is repaired, it will definitely cause some damage to part of the tissue in the upper left side. But I think it should be worthwhile to damage these less lethal and non-disabling brain tissues in exchange for the smooth repair of blood vessels. The human body's ability to heal itself is very strong, and I believe that as long as ten days and half a month pass, these injuries can basically return to normal. ”

In order to avoid frightening Director Wu, Director Mingxin and others, Zhou Can gave them preventive shots in advance.

The way of thinking in surgery needs to be ever-changing.

Surgical repair of arteries in such a small space is an almost impossible challenge in itself. It is equivalent to driving a car onto a narrow dead-end road and then making a U-turn on this dead-end road that is only two meters wide.

It is simply impossible for an ordinary driver to accomplish this task.

If you have superb driving skills, it is possible to complete this impossible task.

The challenge for Zhou Can now is to successfully complete the almost impossible task of vascular repair in a very limited space.

"Is the risk manageable?"

After listening to this, Director Wu still didn't dare to turn his head or move his gaze.

"It's hard to say about the other unknown risks, but at least I'm sure that some damage to the brain tissue in this range is not fatal or disabling."

Zhou Can replied truthfully.

No one dares to make any promises and guarantees.

Even first-level surgery is risky. Not to mention this kind of cranial endoscopic surgery.

"Dr. Zhou's plan is highly feasible!"

Director Mingxin actually supported Zhou Can in his adventure at this time.

Her words carry a lot of weight.

After getting her support, Director Wu Yongming did not hesitate any longer, and directly agreed, "You can start the operation!" You don't have to have too much mental burden, just be bold and careful. ”

"Understood! Thank you! ”

While nodding in agreement, Zhou Can thanked the two chief physicians.

Without their strong support, he would not have had this chance of surgery.

He tried to manipulate the endoscopic arm to begin debridement and then anastomosis the ruptured blood vessel. The whole process is extremely slow, revealing not only stability, but also a strong concentration that only top doctors have.

This kind of concentration is quite similar to commanding thousands of troops to fight on the battlefield, facing a powerful enemy army and a complex battlefield environment, and always sitting firmly in the big tent of the Chinese army.

[Suture XP Reward +100, Ligation XP Reward +100......]

His XP bonus is soft.

And it's a reward of one hundred and one hundred every time.

When the anastomosis is almost complete, it is necessary to drain the air and blood that may be present inside. Because Director Wu wants to fix that part of the brain tissue and let Zhou Can operate it, it is actually quite difficult.

After all, a person only has one pair of hands, and it is difficult to complete the work of four hands or even six hands.

"No, if there is air in the blood vessels that are anastomosed like this, it will be troublesome."

Zhou Canke knows that there is air in the blood vessels, especially the intracranial blood vessels, which are very easy to form blood clots. It's a ticking time bomb.

Director Wu can't move, drill another hole and insert another endoscope arm?

Not to mention the huge harm to patients, there are not so many instruments and equipment.

Originally, it was just a small problem in the anastomosis process, but Zhou Can was stumped.

"The air is not clean, which is indeed a huge hidden danger."

Wu Yongming looked at the upcoming successful operation, and his heart was full of unwillingness.

Sloppy completion of the operation, certainly not.

Everyone is a top expert in the field of surgery, and they pay great attention to some surgical details.

Everyone is racking their brains to think of a solution.

"Maybe there's a way to try, I'll leave the last stitch of the knot undone first. Director Wu didn't have to worry about the right brain tissue at that time, and directly freed his hand to help me drain the air in the blood vessels, and then I tied the knot to complete the final blood vessel wall anastomosis. ”

Zhou Can proposed a solution.

Suturing blood vessels requires more space to operate, and he is sure that the final knot can be completed in a limited space.

At most, it will damage a little bit of the tissue in the left side of the brain.

It's also an unavoidable solution.

The tissue in the left side of the brain itself has already been damaged, and it doesn't hurt to add some new injuries if you have a lot of debt.

"Good idea."

After listening to this, Wu Yongming nodded happily in agreement.

Next, follow the surgical ideas designed by Zhou Can to complete the final step.

The final knot is a little more difficult than you think.

But for Zhou Can, who had a sixth-level ligation, he was finally able to complete it successfully.

[Ligation XP +1, bonus XP 1000.] Anastomosis XP +1 and rewards XP 10,000. Pathology experience points reward +10000. 】

Looking at the huge reward after the completion of the operation, Zhou Can was stunned.

Immediately, there was a glimmer of realization in his heart.

It seems that some completely new surgical options have been conceived and successfully implemented under extremely demanding conditions.

can get a huge amount of experience points for pathological diagnosis.

Last time, he tried to innovate a surgical plan for the aortic dissection patient that did not have to replace the aorta, and Zhou Can also received a very considerable reward for pathological diagnosis experience points.

This also made him understand a truth, whether it is internal medicine or surgery, in the end, they will all end up in the same way.

All of them can improve the level of pathological diagnosis of Zhou Can.

To put it bluntly, pathological diagnosis is equivalent to a doctor's diagnosis level and treatment idea level.

Pharmacological syndrome differentiation and various surgical techniques are equivalent to the two sharp swords of treatment.

It is a weapon to destroy the disease.

There is no doubt that no matter how powerful the weapon is, it will definitely be difficult to exert its power if it cannot be used.

Can a sharp knife, held in the hands of a three-year-old child, kill a chicken or a duck?

I don't even know how to use it, but I might hurt myself.

If it falls into the hands of a strong man, it will be enough to kill ordinary beasts.

If it falls into the hands of a martial arts master, it will be terrible. It can directly slay tigers and even dragons.

Therefore, the improvement of pathological diagnosis is more important than pharmacological syndrome differentiation and surgical skills.

One is the level of thinking, and the other is the weapon.

After Zhou Can's pathological diagnosis was upgraded to level six, it was frighteningly difficult to advance again.

One million experience points is hard to reach in almost a lifetime.

But with an increase of 11,000 like this, it's not too easy to make up 1 million.

In addition, he has proven the usefulness of pathological diagnosis through countless clinical experiments. The sixth level and the fifth level are completely two grades. He is now at the sixth-level level, that is, the director level, whether it is in the consultation, consultation, or surgery, the level can already be equal to those powerful chief physicians.

This shows that improving medical skills with the help of the medical experience value system is not the so-called fatness.

If one day, he raises the pathological diagnosis to level seven, it is estimated that he will be the top group of experts in China.

At present, it is only equivalent to the level of ordinary directors.

Barely an expert.

After the final anastomosis of the blood vessels was completed, the blood flow test was normal.

"Good! The patient's physical signs have stabilized significantly, and if there are no problems, the operation can be ended and sent to the recovery room for observation. ”

Director Mingxin said.

Wait until the endoscope is withdrawn and the wound is sutured to close the cranial cavity.

Then there was good news.

"The patient's brain waves have changed significantly, and they are changing in a good direction."

Director Mingxin said with some surprise.

In comatose patients, brain resuscitation is key.

(End of chapter)