Back in 2002 as a doctor
Page 442
Director Jiang watched Zhou Congwen's movements, wanted to speak several times but stopped talking.The guide wire has gone in too much, and it may be discounted in the blood vessel. Now it is time to check the position of the guide wire with angiography.
Zhou Congwen's expression also looked a little wrong. It is estimated that it was his first time to receive interventional thrombolytic therapy after liver transplantation.
It seems that this time I have more experience than Zhou Congwen, Director Jiang thought to himself.
"Professor Zhou." Director Jiang felt that Zhou Congwen had entered too much into the guide wire, so he reminded him after holding back for a long time.
"Huh?" Zhou Congwen replied while performing the operation.
"Should I take an imaging scan now?"
"Need not."
No need... Director Jiang was startled for a moment.
Although he felt that what Zhou Congwen did was wrong, Director Jiang didn't point it out directly on the operating table.
After all, the cooperation with Zhou Congwen was very good before, and he has some problems today, so he will not question the operation.Or wait, there will always be imaging, and then we will talk about it.
Director Jiang's eyes widened, and he was about to remind Zhou Congwen immediately when he saw something wrong after stepping on the line.
"Han Chu, go out first." Zhou Congwen reminded after less than 2 minutes.
"Are you in position? So fast?" Director Han asked in surprise.
"Well, it's here." Zhou Congwen nodded.
People without lead suits left the operating room, leaving only the surgeon, assistant, and anesthetist, and Zhou Congwen didn't even leave the equipment nurse.
What about radiography? It’s not a surgical operation. Why do you need to keep the equipment nurse inside to eat the thread together?
If Liu Wei hadn't put on the lead suit early in the morning, Zhou Congwen would have wanted the anesthesiologist out too.
The airtight lead door was closed, and Zhou Congwen stepped on the line.
Director Jiang looked at the image on the screen of the DSA machine and was in a daze, feeling a river of sadness in his heart.
If he had an operation, the guide wire would still be at the iliac artery when he stepped on the thread.There are branch vessels there, such as superselection by naked eye.
But Zhou Congwen had just screwed the guide wire into the blood vessel. Director Jiang saw that the guide wire had gone in too much, and thought it was because the guide wire had been discounted in the blood vessel. He never expected that Zhou Congwen, who was illiterate, had already reached the position of the hepatic artery.
How did he do that?
How the hell did he do it!
"Xiao Zhou, why are you so accurate in blind exercises?" Director Jiang asked in amazement.
"Hand feeling." Zhou Congwen replied as he started to insert the catheter to prepare for angiography, "The blood flow velocity is different at the bifurcation of the iliac artery. There is no way to say this kind of thing. You will know it after doing too much."
Director Jiang cried very sadly.
Where can I go to reason when a brat despises the amount of surgery?
Although a little stunned and distracted, Director Jiang has long been used to Zhou Congwen's various miracles. He did what an assistant should do and connected the high-pressure injector as soon as possible.
Following Zhou Congwen's gesture, the contrast medium was injected.
Intraoperative abdominal aortic angiography showed hepatic artery filling defect from the beginning, no blood flow through, and thrombus formed.
really!
The hepatic artery was blocked, and it was completely blocked.
The current situation is not the same as thrombolytic therapy for coronary vessels.
The blood vessels anastomoticed in liver transplantation are still in the edema stage 3 days after the operation, and a little rough movement will cause serious problems. This is not a problem of technical level, but a problem of principle.
If there is no way to remove the thrombus, then only thrombolytic therapy can be performed.
Hepatic artery ostium disposal tube, 50 u of urokinase was injected pulse-style through the catheter.
Director Jiang could see that the position of Zhou Congwen's catheter was very precise, and the distance from the anastomosis of the hepatic artery was less than 1cm.
The thrombolytic catheter is almost pushing the thrombolytic drug on the embolus, and Director Jiang dare not do this kind of operation.
If there is a little carelessness, the hepatic artery anastomosis will be touched, causing unpredictable consequences.
This is also the reason why he dare not operate.
If one is not careful, the operation will have to be bared. After the emergency laparotomy, the patient may die on the operating table.
However, Zhou Cong, a master of literature and art, was so bold that he dared to place the thrombolytic catheter so close to the anastomosis and operate it on his face. Director Jiang admired it very much.
"Xiao Zhou, you did the interventional surgery. I was amazed once I saw it. To be honest, I didn't believe in talent before. Surgery, carpentry, even a stupid person can do it."
Taking advantage of the gap between thrombolysis, Director Jiang said to Zhou Congwen with emotion.
"Oh, that's true." Zhou Congwen was not polite, and said lightly, "Your generation has not caught up with the good times."
"..." When Director Jiang heard what Zhou Congwen said, he was not angry, but let out a long sigh.
The reason is very simple. Interventional surgery entered the country, and hospitals can afford dsa machines and have related consumables, all after joining the WTO.Before that, the hospital was so poor that no one dared to think about the dsa machine.
Not to mention dsa machines, even more than ten years later, CT has not yet become popular.
Director Jiang waited for the hospital to enter the DSA machine to start learning the interventional surgery, which can be regarded as rushing the ducks to the shelves.But he is very clear that he is old and has passed the best learning period.
What Zhou Congwen said was the truth, and he still had worse and more truthful things to say.
"But it's okay, it will get better if you do too much." Zhou Congwen reassured me.
"Xiao Zhou, do you think the thrombus can dissolve?" Director Jiang asked.
Zhou Congwen shook his head, "It's hard."
A sense of despair rose in Director Jiang's heart.
If it cannot be dissolved, what should the patient do?
"Director Jiang, what kind of surgery did our vascular surgery perform?"
"..." Director Jiang blushed.
If someone asked this question, Director Jiang must be very proud to say the technique he has mastered.
Director Jiang's level is one of the few in the province.
But in front of Zhou Congwen, Director Jiang didn't dare to say anything more.Wan Zhou asked himself from the text, how is the carotid endarterectomy performed?How is aortic torsion reduction surgery performed?
How do you answer yourself?
Some surgical procedures overlapped with cardiothoracic surgery, so Director Jiang wouldn't bother with it.
"Xiao Zhou, what if you can't dissolve it?" Director Jiang smiled sheepishly and asked in a low voice.
"Just do it and see."
Intubation of thrombolysis for 20 minutes and another imaging showed that the hepatic artery thrombus was indeed dissolved a little under the action of urokinase, but it did not help.
Director Jiang let out a long sigh.
"We're going to open the stage together, Director Jiang, it can be done by taking the radial artery."
Zhou Congwen was not disappointed, but looked at Director Jiang and asked.
Chapter 0758 Apologize before opening
"Investigate!" Director Zhao was taken aback, and hurried into the operating room, not even caring whether he stepped on the line or not.
"Professor Zhou, you can't investigate!" Director Zhao said in a panic.
"What should I do?"
"Thrombolysis!"
"It can't be dissolved." Zhou Congwen shook his head, "If the dose is increased, the patient will experience complications such as massive bleeding. Even if the thrombus is gone, the person will not survive."
"But……"
"Director Zhao, come on stage with your hand." Director Han said coldly.
Director Zhao looked at Zhou Congwen helplessly.
Because director Han had spoken, he didn't dare to say anything more, but the pitiful pleading in his eyes couldn't be more obvious.
Director Zhao was not sure about the operation, and he pinned all his hopes on thrombolytic therapy in the Department of Vascular Surgery.
"Don't worry." Zhou Congwen knew what Director Zhao was thinking. He said calmly, "I will be the surgeon. The chance of failure is not high."
Director Zhao's nose was sore when he heard Zhou Congwen like this, and he almost didn't cry.
Not moved, but enraged by Zhou Congwen.
Zhou Congwen was hired for the operation because he has a high level of intervention and can do things that Director Jiang cannot.
But Zhou Congwen's thrombolysis also failed. Director Zhao knew that the patient was in danger, and he was doomed.
Speaking of organ transplantation, the Second Hospital of Medical University is top-notch in the province. The first heart transplant in the country was the crab that the Second Hospital of Medical University first ate.
Although very little was done after that, the Second Hospital of Medical University was the first in the country, and with all kinds of qualifications, it can be said that everything was ready, and the Department of Hepatobiliary Surgery took advantage of the opportunity to start liver transplantation.
Why did Zhou Congdi say that he was the chief surgeon?
Not to mention organ transplantation, Zhou Congwen probably never saw it.No matter how good his other surgeries are, he is still a rookie in the field of organ transplantation.
The daring Director Zhao has mixed feelings in his heart.
It is neither a cardiothoracic surgery nor an interventional operation, and it is easy to destroy, but extremely difficult to construct. The most difficult thing in the second palace is repairing.
Thrombectomy, then what?Anastomosis... Thinking of the donor hepatic artery that had been anastomosed once, Director Zhao's head turned into two big ones.
The difficulty of the operation is far higher than that of a liver transplant.
The daring director Zhao knew it well, so he resolutely refused to operate.
"Director Jiang, you take the radial artery." Zhou Congwen didn't have time to pay attention to Director Zhao's psychological changes. He immediately turned around and stepped off the stage, taking off the lead clothes. Go now if you tell me."
"Confession... I have confessed." Professor Wen Yuanwen's sterile cap was already wet with sweat, he stammered.
"Brush your hands and re-lay the sheet." Director Han said standing in the corner.
Director Zhao had no choice but to brush his hands with Wen Yuan, the brush was on his hands, and it hurt a little.
"Professor Wen, what are you talking about?" Director Zhao grumbled in a low voice, "If it's cardiothoracic or general thoracic surgery, I'll admit it. If it's interventional surgery, I'll admit it too. Zhou Congwen did a good job of surgery, It is a crime to disobey an expert. But this is a liver transplant!"
Wen Yuan sighed, and he was speechless, not knowing where Director Han's trust in Zhou Congwen came from.
What the director said is correct. Director Zhao has done the most cases of liver transplantation in the province and has the richest experience.Even on a national scale, Director Zhao can still be said to be above average.
Director Zhao was not sure at all, but Zhou Congwen was very firm. Who gave Zhou Congwen confidence.
"You have a lot of contact with Zhou Congwen. He learned about liver transplantation on 912?" Director Zhao asked while brushing his hands.
"You can't. A few days ago, I heard Zhang You gossip, saying that Zhou Congwen was still in Jianghai City half a year ago."
"Besides, there are not many liver transplants performed on 912."
Wen Yuan glanced at Director Zhao with a strange look, "Director, you're almost scratching your skin."
The hard-bristled brush in Director Zhao's hand left red marks on his forearm. Usually, he would not brush his hands so hard. Wen Yuan knew that Director Zhao did not escape the operation by self-harm.It was too much surprise, too much force, and no pain at all.
"Ah!" Director Zhao hurriedly stretched his forearm under the tap to rinse the disinfectant.
After brushing their hands, there were two "dong dong" sounds. Director Zhao and Wen Yuan bumped their knees against the device under the hand washing pool. The water tap was turned off, and they returned to the operating room with their hands raised.
At this time, Zhou Congwen and Director Jiang had removed the sterile drape placed on the radiography, arranged the title, and stretched their right arms.
"Director Jiang, Director Zhao, the operation is difficult." Zhou Congwen said seriously when he saw Director Zhao coming back, "If I have a bad temper during the operation, please take care of me. Professor Wen, please take care of me too."
Wen Yuan felt a chill in his heart.
When was Zhou Congwen so polite?
The most recent contact with him was mesenteric arteriovenous thrombosis caused by establishing pneumoperitoneum.
The patient is urgent enough, the condition is serious enough!
However, Zhou Congwen still spoke as gently as spring, as if he didn't care at all, and explained the origin of the blood clot to himself during the operation.
Facts have proved that people really don't care.
Zhou Congwen succeeded in lysing the thrombosis for a patient whom he could not even diagnose clearly, which saved the patient's life and allowed him to explain better.
Zhou Congwen finished such a heavy operation talking and laughing, and even exchanged experience in interventional thrombolysis with Director Jiang.
But this surgery...
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