"Uncle Yun? What do you mean? Fang was puzzled, but paused.

"In the operating room of the trauma center of the Shonan University Hospital where you used to work, there are many advanced operating equipment and supporting equipment that other hospitals do not have. Including the operating room of the trauma center of the First People's Hospital of Changshi, where we are now, there are no such instruments, what should we do? ”

"If you only think that in the Affiliated Hospital of Shonan University, there are only two celebrity effects, Professor Yang and Professor Zhou, then you are wrong!" Fang Yun continued to walk upstairs.

"Think about it carefully, don't frame theory and basic skills in particular."

"The theory is memorized more rigidly and more profoundly, in order to be more flexible when it is applied."

Fang Xian's brows furrowed.

What if you don't have something so good to use?

Is it difficult for a good woman to cook without rice?

This was Fang Xian's first reaction.

The second reaction was, is the Shonan University Affiliated Hospital so conservative and selfish, and the good things are not spread out?

No, the equipment is not exclusive to the hospital, so those easy-to-use equipment, if it is really very practical, would have been promoted all over the country and even the world to make money.

The more money Huaguo's medical device companies pay in taxes, the cheaper and more affordable the domestic medical price can be. If most of the medicines and equipment need to be imported from abroad, then the price will definitely remain high.

Apparently not.

But now is not the time to think about it.

There must be something that I don't think about comprehensively.

Abdominal aortic pseudoaneurysm belongs to three types of diseases, and the mortality rate of the target is equal to that of a part of the damage.

However, the degree of treatment and development of this disease is obviously more refined and mature than that of damage.

There are very few patients with pseudoaneurysms that heal on their own, and the traditional treatment is surgery!

In the initial stage, the surgical treatment of pseudoaneurysm includes ligation of the aneurysm artery, aneurysm resection end anastomosis and vascular grafting, and intracapsular vascular repair of the aneurysm.

This is the most traditional and initial treatment method, a relatively simple treatment method, there is no specialized corresponding surgical method, that is, the basic skills such as incision and suture are flexibly applied to correspond.

Let's save my life first-

First ligation to stop bleeding, finally aneurysm removal, and finally blood vessel grafting, suturing, vascular repair. All of them are basic skills, which are further combined with vascular surgery skills such as vascurectomy, vascular suture, and vascular repair and reconstruction.

The patient can survive and the postoperative recovery is barely okay, but this is obviously not refined enough, and the prognosis is not the best.

However, after further development.

Endovascular therapy can be done with deballoonization, tungsten wire spiral trap occlusion of the aneurysm cavity, aneurysm carrier artery, or spring trap occlusion of the aneurysm-bearing artery. This is the further specialty skill, the specialty skill for pseudoaneurysms.

However, if it is a giant pseudoaneurysm of the carotid artery adjacent to the subclavian artery, and it is difficult to treat it with surgery alone or endovascularly, the aneurysm artery is temporarily blocked through the vascular lumen with a balloon catheter, and then combined with open surgery......

For superficial external carotid artery pseudoaneurysm, the aneurysm is directly punctured with a puncture needle after diagnosis, and the aneurysm is blocked by a coil or tungsten microcoil through the puncture needle......

Of course, there is a bigger problem here.

Pseudoaneurysms of the abdominal aorta and true aneurysms are treated similarly.

All are stent graft endovascular repair.

Endovascular repair for the treatment of true aneurysms of the abdominal aorta has the advantages of less trauma, faster postoperative recovery and low incidence of complications, and has now become the preferred treatment for true aneurysms of the abdominal aorta.

By placing a stent graft across the lesion site, it is fixed on the distal and proximal normal artery wall to isolate the aneurysm from normal blood flow and promote thrombosis in the aneurysm, so as to prevent the aneurysm from enlarging and rupturing.

Of course, there are more advanced treatments that cannot be applied for the time being.

Fang Xian stopped talking nonsense: "Uncle Yun, if a stent graft is used for endovascular repair, will it be appropriate?" ”

"Take this surgery apart." Fang Yun replied without hesitation.

Fang Xian was a little caught off guard: "Uncle Yun, wait a minute, I didn't know enough about vascular surgery skills before, I." ”

With such a level of surgical operation, the difficulty of operation is at least level 4 or above, and Fang Xian is a person who does basic medical skills, how can he deal with such a major disease?

On the contrary, because the basic theory of vascular surgery was promoted to level 5 by Fang Xian, he knew that such a thing existed, so it took a certain amount of time to extract.

"Don't worry, you look at it first today, don't be in a hurry to operate. Such a difficult technique cannot be achieved overnight, you need to go deeper from a more basic operation layer by layer——"

"It's the first time you've followed me, and I'll help you quickly disassemble this operation and this disease."

"First of all, it must be percutaneous under ultrasound guidance or direct puncture into the left common femoral artery. This is the approach and incision of the operation. Imagine that! ”

Fang Xian nodded, he could also disassemble this.

For any operation, there must be access and operation space before subsequent operations can be performed.

Of course, although Uncle Fang Yun said it simply, in addition to puncture, the follow-up must also require experience in the operation of surgical-related instruments to be more comfortable and handy.

"And insert the left common femoral artery sheath, which can be 6-French or domestic, this is not important, this arterial sheath has existed many years ago, but if you want to promote the treatment of this disease, in fact, the model of the arterial sheath is corrected, and it is also a way to advance the treatment effect."

"At the same time, we also need to expose the right common femoral artery through an inguinal incision for device placement."

"Do you know why you want to continue to open the right common femoral artery?"

"One side does the vision, the other side does the operation." Fang Xian replied without hesitation.

Fang Yun's dismantling of the operation was very clear, and Fang Xian's own theory was not bad, so he dealt with it immediately.

"The sheath is inserted into the right common femoral artery and an inclined guidewire with a catheter is pushed into the abdominal aorta. The pigtail catheter is then advanced through the left common femoral artery sheath. ”

"The pig's tail catheter is named because the end is curled and the end is shaped like a pig's tail!"

"Time is running out! If you can understand it, you can digest it yourself, and if you can't understand it, we will make a retrospective analysis later. As he approached the operating room, Fang Yun sped up the speed of his elaboration:

"Use multiple dilators to dilate the right CFA on a single hard wire and place a 24-French sheath."

"Intrathecal implantation of the ascending aortic stent graft was advanced through a 25-French sheath and the stent was deployed in the usual manner. The stent graft was deployed 15 mm proximal to the bifurcation of the left and right common iliac arteries and proximal to the beginning of the innominate artery. The stent graft is fully deployed. In this way, the pseudoaneurysm is completely covered. Balloon dilation was not required, and angiography after completion showed a ...... device location"

In order to speed up, Fang Yun replaced it with an English abbreviation.

CFA is the common femoral artery, and Fang Xian knows it......

After the two entered the operating room, the other surgeons had already completed the preliminary preparations for the corresponding operation, including the placement of the left and right common femoral artery sheaths.

The surgery is over.

Fang Yun instructed: "Now that I have filled the gap, the procoagulation, excision, and debridement of the peripheral hematoma, I don't need to do it myself, right?" ”

"No, Director Fang. Thank you for your hard work. "The director of the chief knife can't cry or laugh.

He had also tried this kind of operation before, but in the process of operation, how to move was not smooth, and he didn't dare to operate further, but Fang Yun was good, and after he came in, he divided three by five.

I got rid of this operation with a difficulty of up to level 4.

Fang Xian also looked stunned.

However, Fang Yun had already stepped down, looking at Fang Xian's confused eyes, he also knew that Fang Xian hadn't paid much attention to it just now.

After taking off his clothes, he patted Fang Xian's shoulder and motioned him to go out, while saying: "The real operation of this operation is not difficult, because the stent graft has already packed some important difficult operations, and the most important thing is to locate and put the stent in the right position." ”

"This is actually the positioning of the vascular sheath and the technique of instrument operation, which is not particularly difficult."

"Now, we can go on to understand this case a little more. As well as its current treatment status and prospects, you see whether the development of medicine in the end is embarrassing. ”

Fang Xian is also helpless, but there are also forced numbers.

Maybe after reading all the operation processes of Uncle Yun, what I have learned is still limited, and what I need is to add points, not real teaching opportunities.

Slightly greedy, watching the others there for piercing and debridement preparations, Fang Xian walked outside.

Fang continued: "Aortic pseudoaneurysms are associated with high morbidity and mortality, mainly due to the higher risk of rupture. ”

"In traditional surgery, pseudoaneurysm complicated by surgery after vascular surgery is a common postoperative risk. Mainly due to factors such as insufficient suture quality, surgical technical problems, or infection. ”

"Now, some patients who have been treated in the past have become a new round of topics that need to be cared about."

"If this patient is re-incised, then he may have a secondary pseudoaneurysm after surgery, after all, no one can absolutely guarantee the problem of surgical technology and risk."

"But fortunately, the aneurysm of the aorta, with an abdominal aortic endoluminal stent."

"Unfortunately, endovascular stents for the ascending aorta are not readily available, for example, so surgeons can only use thoracic and abdominal aortic stents to treat thoracic aortic pseudoaneurysms or other vascular aneurysms."

"Did you find any problems?"

Fang Xian nodded: "Make do?" ”

"That's right! ~”

Fang Yun also nodded, and sighed: "The more you move forward, the more you will find that the essence of medicine seems to be to make do everywhere, make do all the time, make do all the time, make do all the time, make do with it, and only occasionally appear one or two, relatively suitable or absolutely adaptable treatment methods......"

"The development of the operation is like this, first with basic medical skills, then with specialist basic skills, and then with specialist skills, until, a one-to-one correspondence, standard, mature, absolutely favorable surgery appears."

"Even so, you have to wait for the right drugs, the right equipment, the right placements, the right operating equipment, etc., then you have to look forward to the treatment effect of this disease."

"For the time being, in the entire medical field, the best prognosis is a normal pregnancy, and the mortality rate can be hit to 1 in 10,000 or even less than 1 in 100,000, and there is still room for improvement in the rest."

"But even one in 100,000, hundreds of people die every year, one corpse and two lives, it may be one alive, but either it is a short mother, or there are fewer children, this is still the best ......" Fang Yun sighed, quite a little compassionate.

Fang Xian didn't let go of the problem directly, but asked, "Uncle Yun, if the stent of the abdominal aorta and thoracic aorta is used in the ascending aorta, what is the prognosis of the patient?" What is the difficulty of operation? ”

"TEVAR (thoracic aortic stent) and EVAR (abdominal aortic stent) stents need to be manually adjusted before each use to get the best results."

"But in most cases, even if the length of the bracket is adjusted; But you know, the ascending aorta is curved, and its curvature and all sorts of other key structures are very difficult for you to adjust. ”

"In addition to the use of thoracic aorta and abdominal aorta stents, other endovascular treatments for ascending aorta pseudoaneurysms that have been tried include the Amplatzer occluder device. The results of its use have been documented in case reports and in some case series – mixed. ”

"If you make do, you can only have mixed blessings and sorrows, and you can't be perfect."

"So, you don't have to worry about not being able to make achievements in diseases like destruction and injury, everyone has such a time, in fact, the most painful is Professor Zhou." Fang Yun suddenly sighed with emotion, but halfway through, he stopped abruptly.

"Professor Zhou?" Fang Xian turned his head away curiously.

Professor Zhou is so awesome, perfect doctor, what else does he have to worry about?

Fang Yun turned his head and looked at Fang Xian: "You are Professor Gui's student, but you don't have to avoid suspicion." ”

"In fact, Professor Gui Yuanping was able to drive the crane west many years ago, and he was quite peaceful. But it's not bad, Professor Zhou's skills are very high, and he pulled him back half of the way from the Ghost Gate......"

Speaking of this, Fang Yun's voice also trembled slightly, as if it was that operation, which still shocked Fang Yun today.

But then, Fang Yun said: "But it is this half that makes Professor Zhou regret it for at least four or five years, maybe even longer, even longer, or even for life." ”

"You don't have to wonder, you just want to think about the state that Professor Gui Yuanping was in in the end, whether there is any quality of life, right?"

Fang Xianyan was silent when he heard this.

"If you can save it but you don't? Isn't it? I can't get over this hurdle in my heart, and before it happens, no one knows if I can recover better. ”

"yes, no one knows ......"

"But Professor Zhou just can't get out." Fang Yun shook his head, slightly embarrassed.

"Could it be that Professor Zhou knew in advance that it was impossible? If he had known in advance, he would definitely not have had surgery. Fang Xian asked.

"Of course I won't know, forget it, I don't want to do so much."

Fang Yun looked at the time, and then said, "Fang Qi'an will be out of school for a while, let's continue to disassemble this case just now, you can use it as an analogy to move forward." ”

"The treatment and development process of pseudoaneurysm is actually a reference for the progress and advancement of treatment methods for all diseases, it is not the first reference, but it is also one of the classic diseases."

"The current difficulty lies in the fact that there are no breakthrough new devices and breakthrough new technological advances, but the treatment of single diseases has already developed quite maturely, and the postoperative recovery rate and prognosis are very worth looking forward to. If you want to go further, it is a high-level exploration of medical treatment, and it is not of great significance in the treatment of diseases. ”

"It's just about improving the quality of life."

"The improvement of life and death, treatment, survival, and quality of life are some of the problems that cannot be avoided in the medical community, and they are also the purpose of every technological development."

"The instruments of the abdominal aorta and thoracic aorta, and the appropriation of the aortic arch, are actually not the most suitable and perfect."

"Therefore, the more professional the content, the narrower its scope of application, and the more basic the content, the wider the scope of its application."

"But if the scope of application is wide, it will definitely sacrifice some of the healing effect. At present, the medical community has not found a suitable solution to this point, but you probably need to have such a framework in mind. ”

Fang Xianyan nodded, he had also been popularized before, the reason why basic medical skills are particularly valued is because it is very malleable and has a wide range of use, because basic medical skills are life-saving techniques many times.

Simple and crude, refined only to save lives. If each of them is played well, it can save people's lives at critical times.

But what about healing?

It depends on how you define healing: "Uncle Yun, I have a question. ”

"Isn't it possible to use other technologies or other instruments to deal with all kinds of diseases?"

"I don't think it's appropriate to define it like this?"

Fang Yun tilted his head and looked at Fang Xian: "You can have such doubts, it proves that you are thinking very seriously-"

"In fact, whether you can borrow other technical concepts and operation forms to make do with the disease depends on how you recognize the disease, and how you treat the sequelae of the disease!"

"I'll give you a very simple example."

"Vitiligo in dermatology, a stubborn disease, right? There is no absolutely effective treatment at this time. ”

"But it itself does not cause much harm to the patient's body, and you borrow other dermatological treatment drugs to try it, which may or may not be useful, and it is a question worth exploring."

"However, if it is a disease like aortic dissection, if you don't go to specialized research and development, do you dare to borrow the instruments and operation procedures of lower extremity arterial dissection to deal with aortic dissection?"

"That's definitely not going to work."

"Oh!" Fang Xian suddenly realized.

Whether to find the most suitable treatment method and treatment plan, in fact, the most important thing is to see the severity of the disease to the patient's body, whether it causes damage to life and function.

(End of chapter)