medical road high rise

Chapter 249 Three breaches in the vascular intima

Chapter 249 Three breaches in the vascular intima

"Leave it to me, don't worry." Qin Feng said.

Qin Feng quickly entered the state and reached out to ask for surgical instruments such as blood vessel clamps.

"Surgical forceps!"

"Tissue scissors!"

As soon as the instrument was sent to Qin Feng, Qin Feng's speed was also very fast, and the instrument kept swimming in his hand.

The director of the thoracic surgery department and the assistant were a little dazed. Qin Feng's speed was really too fast, and there was no sense of disobedience in the use of the equipment.

It's not like they need to pause in the middle of the operation, worrying that the tip of the instrument or other parts of the instrument will cause damage to human tissue.

This kind of operation can be considered a high-end operation, and there are only a few surgeons in Ruijin Hospital who can do this.

The director of the Thoracic Surgery Department gradually put away his contempt and looked at Qin Feng's blood vessel suture seriously.

After 5 minutes, Qin Feng's hands stopped.

"What? Did you encounter any trouble?" The director of the thoracic surgery department was fascinated by the sight, and Qin Feng's pause made the director of the thoracic surgery department subconsciously think that Qin Feng had encountered some problems.

"No, it's just that the sutures are done and the extracorporeal circulation needs to be established." Qin Feng said.

"Is this done?" The director of thoracic surgery widened his eyes.

How long has it been since? 5 minutes? 10 minutes?

The blood vessels were sutured in such a short time. This blood vessel suturing technique was beyond his imagination.

Originally, in his heart, Qin Feng was a noun representative.

But now, the director of thoracic surgery has changed his opinion. He feels that Qin Feng can really carry out this operation.

"Don't be in a daze, help!" Qin Feng interrupted the thoughts of the director of the Thoracic Surgery Department.

The director of the Thoracic Surgery Department and Yisuke hurriedly chose the left side with good pulsation of the femoral artery for femoral artery intubation. Qin Feng commanded from the side, "For the venous drainage tube, choose to intubate the superior and inferior vena cava."

"Why not choose conventional venous drainage tube intubation?" The assistant asked.

Qin Feng glanced at it and continued to deal with the sternotomy. "How can the patient be routinely intubated in this situation? The only way is to use the superior and inferior vena cava cannula. You can use deep hypothermia and circulatory arrest at any time according to the patient's condition during the operation."

When Qin Feng performs surgery, he considers the factors of avoiding the risk of surgery as much as possible.

The director of the thoracic surgery department nodded after listening. He approved of Qin Feng's operation.

Soon, the director of thoracic surgery established extracorporeal circulation.

Qin Feng directly lowered the scalpel, cut the ascending aorta, etc., and then made an incision in the left and right coronary arteries.

"Perfuse cardioplegia." Qin Feng shouted.

The assistant was stunned for a moment. The director of thoracic surgery quickly took over the operation and gave the assistant a fierce look.

The infusion of cardioplegia solution also needs to be reminded by other surgeons. Generally, cardioplegia solution can effectively protect the myocardium during STANFORD-A aortic dissection surgery.

"Direct perfusion through the openings of the left and right coronary arteries, and then intermittently perfusing the openings of the left and right coronary arteries through the coronary sinuses," Qin Feng said.

"Perfusion is complete." The director of thoracic surgery said.

Qin Feng glanced at the instrument and saw that the patient's vital signs were a little bad. The heart rate was only about 40, and the blood pressure was sub-UN sub-UN within the normal range.

"Deep hypothermic circulatory arrest, superior vena cava retrograde perfusion." Qin Feng frowned.

As the deep hypothermic circulatory arrest progressed, Qin Feng stared at the thermometer in the nasopharynx. When the temperature dropped to [-] degrees Celsius, Qin Feng blocked the ascending aorta three centimeters away from the beginning of the innominate artery.

Holding the scalpel again, Qin Feng incised the arterial dissection, and then asked the director of thoracic surgery to refill the left and right coronary arteries with cardioplegia solution.

Qin Feng stared at it for a while, then began to trim the proximal dissection, extending to about 1.5 cm above the opening of the left and right coronary arteries.

When he saw the interlayer through the opening, Qin Feng was silent for a while.

"The dissection has affected the aortic valve junction!"

This is not a good thing. The wider the area affected by aortic dissection, the more dangerous Zhao Mingshi is, and the more difficult the operation will be.

"Needle pliers."

In order to prevent the harm caused by the interlayer, Qin Feng sutured and reinforced this junction, which can avoid the impact of blood impact. If the impact of blood is too strong, not to mention suture, even the blood vessel itself will not be able to hold it.

After the suture was completed, Qin Feng added felt strips on the intima and adventitia of the aorta.

The role of this gadget is mainly to seal and prevent blood from leaking.

"Doctor Xiao Qin, the temperature has reached [-] degrees." The director of thoracic surgery reminded.

Qin Feng nodded and said, "Stop extracorporeal circulation, adjust the patient's position, and lower the head thirty degrees."

Qin Feng bowed his head and continued to repair the blood vessels from the distal dissection to the proximal end of the innominate artery. He took the felt strip again and placed it on the intima and adventitia side of the aorta, and reinforced it with 4-0 polypropylene suture. The artificial vessel and the aortic root were continuously sutured.

Then, Qin Feng perfused and exhausted the femoral artery to prevent various problems after the blood supply was restored due to the presence of air in the blood vessel.

Soon, the exhaust was completed, and Qin Feng looked at the instrument next to him.

The patient's physical data are relatively stable, and Qin Feng can continue to lower his head and do it steadily with peace of mind.

The distal anastomosis was reinforced again to prevent bleeding, and then the remaining aortic adventitia was wrapped around the artificial blood vessel.

Wrapping the artificial blood vessel with the patient's own aortic adventitia can greatly reduce the body's rejection reaction, and at the same time protect the artificial blood vessel and strengthen the anastomosis.

After Qin Feng finished wrapping the artificial blood vessel, he glanced at the director of thoracic surgery, who was still seriously performing the reverse perfusion of the superior vena cava.

The replacement of the ascending aortic arch generally has to wait for the completion of this step by the director of the thoracic surgery department.Prevent minor problems.

But Qin Feng, what he pays attention to is a shortcut. Under the watchful eyes of the assistant of the director of thoracic surgery, he directly starts to check the ascending aortic arch, and then replaces it.

"Aren't you taking too much risk?" Reminded by the assistant, the chief of thoracic surgery raised his head.

He has no doubts about Qin Feng's surgical ability, but performing aortic arch replacement during superior vena cava retroperfusion requires extremely high technical requirements. Even the professors of Ruijin Hospital, no more than one person dares to do this. The number of palms.

Don't think that you can get a lot in one hand. Ruijin Hospital, the first hospital in Shanghai, has the best professors and chief physicians in the country.

Moreover, during the reverse perfusion period, the blood vessels themselves are pulsating due to the perfusate. At this time, the aortic arch is also replaced, which is equivalent to you holding a book while reciting books, and the difficulty of memorizing them is similar.

"It's not a big problem, it's just that the intima of the three branches of the aortic arch is ruptured, so it must be repaired during the perfusion period, otherwise it will not be repaired." Qin Feng said seriously.

This is also the most critical step in the operation, repairing the breach.

Usually there is only one breach, but this time there were three.

(End of this chapter)