Back in 2002 as a doctor

Finally, the guide wire at point [-] has been recognized as the best clinically used, and it has become a routine.

Although the mesh of the vascular stent net is much wider than that of the [-]-point guide wire, the guide wire can walk in the blood vessel. It is difficult to turn smoothly, overcome blood flow obstacles, and then pass through the mesh.

Whether the operation can be successful or not is only now the real start.

Sure enough, just as Director Miao said, the operation, which had been going smoothly, was paused for nearly a minute. Presumably, the surgeon was adjusting his state and was preparing to use the guide wire to pass through the mesh and enter the branch blood vessel.

After 1 minute, the image moved again.

The guide wire no longer moved freely like before, and began to become more cautious with a burst of confidence.

Zhang You's heart rose unknowingly.

Although Zhang You is willing to use power tactics to solve problems, he is a doctor after all, and the success of the operation has already formed a deep imprint. In the deepest part of his heart, he has influenced Zhang You all the time.

Director Miao was also average. He clenched his fists with somewhat tangled hands, subconsciously cheering up the surgeon.

The guide wire moves gently and delicately, and the operator is always stepping on the thread, instead of stepping on the thread intermittently as before, trying to avoid "eating the amount of thread".

The image was very continuous, and the guide wire turned slightly cautiously.

It's a pity that it just happened to touch the wall of the mesh, and the guide wire was discounted, so it didn't go in.

Failure × 1.

"It's so stupid." Director Miao said contemptuously, "I can't get through such a thick mesh!"

Zhang You breathed a sigh of relief, the performer's performance was indeed top-notch. Although he failed the first time, the performer should have found a position.

Just like shooting a cannon, in the heavy artillery naval era of the last century, the ironclad ship had to straddle first, and then it was bound to hit.

This is what the surgeon completes.

After failing once, the operator seemed to be adjusting his state, but he was obviously nervous and forgot to stop stepping on the line.

Zhang You noticed that Dr. Miyamoto, who was sitting in the front row, was talking and laughing with the assistant beside him, pointing at the screen, with his wrist slightly bent at a certain angle.

It's a pity that Dr. Miyamoto didn't want people to understand, the movements were fleeting, and Zhang You didn't understand at all.

After 32 seconds, the wire moved again.

Chapter 0671 the first step

Zhang You held his breath and concentrated, as if he was doing the surgery himself.

The guide wire began to move in the main coronary artery, and the mesh of the stent seemed so fine that even a .[-] guide wire... Zhang You felt that it could not penetrate.

Although the guide wire of [-] is very thin, it is like a water plant, and it is not stressed at all.What's more, what the operator has to do is not to walk in a straight line, but to make the guide wire turn a corner and pass through the mesh of the stent to enter the branch blood vessel.

There was no sound in the whole venue.

Everyone held their breath and concentrated, as if they were cheering up the surgeon.

Although this step is not the most difficult in the classic CRUSH procedure, it is the beginning of the real operation. The process just before is a prelude. What everyone wants to see is this step and the subsequent balloon extrusion.

It was really difficult, I only failed once, and Zhang You's palms were full of sweat.

He subconsciously wiped the sweat on his legs. At the same time, Director Miao was staring at the screen and wiping sweat on his pants.

Zhang You didn't notice Director Miao's actions, and his eyes didn't leave the screen for a second.

The guide wire advances, slightly sideways, and hits the mesh wall again.

"Snapped"

Zhang You seemed to hear the sound of the .[-] guide wire colliding with the titanium-nickel alloy metal mesh wall in the blood vessel.

Failed again.

"Ugh."

There was a sigh in the Great Hall.

"It failed again, I thought it would work."

"This step is very difficult. I failed 22 times at most, and finally had to give up the operation."

"I think this time I'm very close to success. I guess it will be done once or twice more. It will definitely work."

Zhang You heard the surrounding doctors whispering.

Their voices were very low, as if they were afraid that their words would disturb the surgeons in the catheterization lab.

Zhang You sighed, "Director Miao, how many times do you think you can do it?"

Director Miao shook his head, "The surgery is up to now, it's completely dependent on fate. Old Geng, who is doing intervention in our hospital, here, the one by the window in the fifth row in front. He once performed the classic crush operation, and this step It took three hours to get in, and I almost collapsed from exhaustion."

"Our hospital has not yet carried out the classic crush technique." Zhang You is learning and selling now. When he flew to the imperial capital the day before yesterday, he didn't know what the crush technique was.

But if Teng Fei could do the crush technique, she must know that she would not be able to bear the loneliness and show off to herself.

Failed twice in a row, this is not the most difficult step of the crush technique, Zhang You was immediately daunted by this difficult technique.

This is the world... No, the operations performed by the top surgeons in the country actually failed twice in a row.

Moreover, it is still an open operation, and the patient's condition is not complicated.In actual combat, various situations are complicated, what should I do if the guide wire is walking in the coronary artery, suddenly a coronary artery spasms, and the patient goes into shock.

In the document, there is only one sentence written on the .[-] guide wire passing through the mesh. Zhang You vaguely knew that it would be difficult, but he did not expect it to be so difficult.

This is what open surgery is all about.

Some details and some difficulties cannot be understood by looking at the information at all.

The more Zhang You thought about it, the more discouraged he became, and the more he thought about it, the more fearful he became.

How can this surgery be performed by humans?

Zhou Congwen must be fooling himself, wanting to do this kind of surgery by himself.

Although Zhang You understands that a considerable number of patients with coronary artery stenosis are accompanied by bifurcation lesions, so what, does it have anything to do with him?

Just do what you can, other things...why make things difficult for yourself.

Zhang You looked at the picture on the big projection screen with some pity.

The surgeon must be in a very complicated mood right now, a little anxious and a little irritable, for fear that the operation will fail, but the operation process is beyond his control.

Alas, the classic crush technique is really too difficult!

The operator finally stopped stepping on the line, and the operator could be seen communicating with his assistant on the screen of another camera.

Dr. Miyamoto, who was sitting in the front row, was also communicating with his assistant, but Dr. Miyamoto looked very relaxed, and Zhang You even guessed that he had a smile on his face.

This time, the time interval was very long, at least 5 minutes, before the operator started to step on the line again.

Failure × 3!

Fail × 4! !

Failure × 5! ! !

A series of failures made the atmosphere in the Great Hall tense.

Although everyone knows that the crush operation is extremely difficult, since Director Xue dared to perform a demonstration operation, he must have some confidence in it.

Judging from the initial steps, Director Xue's level is very high, very high.

But because of this, one failure after another makes it harder for everyone to accept.

Zhang You suddenly remembered the esophageal cancer surgery that took nine hours to complete in the first half of this year.

It is always inevitable to show your butt when you want to show your face, and who can do it.

Surgery sometimes depends on fate. The more operations you do, the more Zhang You believes in this.The operation, which seemed to be nothing to worry about, could not be performed for a long time, and even caused the operator to collapse emotionally.

I hope Director Xue can hold on.

Even Zhang You, who was discouraged, was secretly cheering for Director Xue.

At the sixth attempt, the guide wire seemed to become hesitant, not as smooth as the first and second attempts.

Do it all at once, second time tired, third time exhausted.

These words appeared in Zhang You's heart.

If it doesn't work, I don't know if Dr. Miyamoto will save Taiwan.

wrong!

Zhang You suddenly thought of his purpose of coming to "attend" the annual meeting—where is Zhou Congwen?If it was him who did it, would he take it all at once?

Impossible, just as soon as Zhang You thought about it, the thoracoscopic double cuff resection of the right upper lobe performed in his own facility appeared before his eyes.

What else is he unable to do?

Although Zhou Congwen is young, he can really be said to be as stable as an old dog.What's more, there is Huang Lao, that legendary figure.

If you are not sure, who will come here to make a fool of yourself.

If Mr. Huang and Zhou Congwen performed the surgery like this, it would really be a shame.

Thinking about it, Zhang You almost didn't cry.

What's wrong with this, Mr. Huang, you are so old, you can't afford to stay at home to take care of yourself honestly, you insist on coming to embarrass your heart, and make the cardiothoracic surgery worse.

But impossible!

Zhang You continued to struggle. In the eighth attempt, the guide wire finally penetrated the mesh and came into the branch artery.

There was scattered applause in the great hall. They seemed to have forgotten that the most difficult point of the operation is not that the .[-] guide wire penetrates the vascular stent and enters the branch artery. The subsequent balloon extrusion is the key point of the crush operation. .

Why did Dr. Miyamoto join hands with Abbott to make a new drug-eluting stent?Isn't it because there will be some stents in the main coronary artery after the balloon is squeezed?

And this part of the stent is the key to subsequent complications.

But no matter how you say it, it finally passed a level!

Chapter 0672 is worthy of the word classic

"You're so weak!" Director Miao said contemptuously while wiping the sweat from his palms on his trousers.

Zhang You saw Director Miao's movement of wiping his sweat accurately, and thought in his heart, you are still very nervous.

"The most difficult part of the classic Crush technique is the expansion of the kiss. This step determines the patient's postoperative recovery." Director Miao seemed to have not noticed his small movements at all, and continued to talk, "I have seen how many circulatory interventions have been done. Classic Crush surgery, Kiss expansion here is really uneven."

"Director Miao, I don't understand." Zhang You first said that he didn't understand, and admitted that he was talking nonsense, so as not to misunderstand Director Miao.

"what happened?"

"Our hospital's circulatory interventional surgery has not yet carried out the classic Crush technique. I studied it for a day yesterday and felt that the guide wire penetrated into the mesh of the stent. I dare not think about how this operation is done."

Zhang You smiled embarrassingly, with his big teeth bared, a little dazzling.

At that time, he didn't think it was difficult for the .[-] guide wire to penetrate the mesh of the stent, but he didn't expect it to be so difficult. This is what he just felt.

"But the last step of kissing and dilating doesn't seem to be that difficult. The branch blood vessels and the two balloons in the main trunk are expanded together, and the titanium-nickel alloy stent is crushed to stick to the main blood vessel wall as much as possible. This...seems very simple. "

After hesitating for a while, Zhang You still asked the question in his heart.

"Precise wire guide technique, this is just one of the key points, and it's the first one." Director Miao explained to Zhang You in a low voice while the operator was slowing down.

"The side branch balloon is usually difficult to enter, so it should be sent into the side branch balloon first; sometimes in order to increase support, it can also be sent into the main branch balloon first, and even pressurized properly after the main branch balloon is in place to increase support and then Push the side branch balloon.

However, care should be taken to avoid deforming and destroying the bracket by forcing it forward.When pushing the balloon, if resistance is encountered, the most common cause is wire entanglement..."

When it came to technical details, Zhang You suddenly found that Director Miao seemed to have studied this technology very deeply, unlike what he said he had never dabbled in.

For example, forced pushing causes deformation and damage to the bracket, which is difficult to mention in textbooks and peer exchanges.

And once the bracket is deformed and damaged, it will be very difficult to take it out again.

These are all bloody clinical experiences and lessons. Could it be that Director Miao has done classic crush surgery?Or is it that their hospital has carried out crush surgery, and when it happened, Director Miao went to save the fire.

"This is just the beginning, isn't it difficult?" Director Miao asked in a low voice, watching the operator's movements on the screen.

"Uh..." Zhang You was taken aback.

Something so complicated or just getting started?

"When the balloons are finally inflated kissingly, the proximal markers of the two balloons are aligned, and the overlapping part should be shorter, located above the vascular crest, facing the "iliac part" of the vascular bifurcation, or equivalent to the POC area.

If the diameter of the two branch vessels is significantly smaller than that of the mother vessel, the position of the kissing expansion balloon can be moved to a higher position, and the double balloon kissing can be used to make the stent of the mother vessel segment fully adhere to the wall. "

"The technical details here are too difficult, and I don't know what to do." Director Miao sighed, "The doctors involved in our hospital are of average level, and they plan to go to the United States to study next year."