Back in 2002 as a doctor

At this moment, his state of mind was no longer a huge wave, but calm as water, so that he didn't even know what Shi Ping was thinking.

Change valve!

Immediate results!

The operation only took half an hour!

All kinds of fragmented information were mixed together, and Shi Ping, who had wanted to learn thoracoscopy before, had completely turned into a wooden chicken.

He claims to be an old doctor and the director of the chest department of a medium-sized hospital in a prefecture-level city. If Xiao Kai hadn't come to the provincial capital for further studies and met Zhou Congwen by "coincidence", he would have become the chest doctor of the largest hospital in the prefecture-level city. Director.

But for valve replacement surgery, I cannot guarantee a high probability of success.

The example before him tells Shi Ping that he is at least two geometric orders of magnitude away from Huang Lao and Zhou Congwen.

From the perspective of surgery, Shi Ping felt that he was extremely small, and he couldn't even do the most basic work well...

Worse than a junior freshman in Zhou Congwen's medical group.

Thinking of this, Shi Ping felt inexplicably sad.

Fortunately, he made the right choice, Shi Ping thought to himself.At least he didn't make any mistakes, and he kept competing with Xiao Kai.

……

……

Zhou Congwen returned to the office, sat on the bed with a smile and looked at his boss.

"Boss, awesome!" Zhou Congwen praised with a thumbs up.

"Minor surgery." Elder Huang said leisurely, "Is the patient okay?"

"Okay, no problem. I guess I can be discharged tomorrow or the day after tomorrow. Do you think it's okay?"

"Yes." Huang Lao stretched out his right hand, and rubbed his thumb on the index finger and middle finger.

"Line management disorder." Zhou Congwen said.

"Smoke a cigarette, you Bai Lingzhi and give me one." Mr. Huang knew that Zhou Congwen did it on purpose, but he didn't have any cigarettes around him, so he couldn't reprimand Zhou Congwen.

Zhou Congwen glanced at Deng Ming. Deng Ming didn't seem to hear it. He sat there with his eyes watching his nose, his nose watching his mouth, and his mouth watching his heart, like a Bodhisattva.

"Hey." Zhou Congwen took out a white ganoderma, handed one to his boss, lit it and opened the window, "Boss, you are really amazing."

"What's so great, tell me." Mr. Huang took a puff of the cigarette, feeling very good.

"Let's arrange the sequence of operations." Zhou Congwen said, "Can I still talk about surgery? Such a small operation is not difficult at all."

"Tell me." Huang Lao said.

"When you got out of the car, did you feel a little upset when you heard that the doctor's mother was going to have a thoracoscopy?"

"A little bit, but it doesn't matter what you do, it's the choice of the patient and the patient's family." Mr. Huang said something to save face.

"Hey, boss, the door is closed, tell the truth." Zhou Congwen approached his boss and asked with a smile.

Holding the thermos cup, Deng Ming looked at Zhou Congwen quietly. Deng Ming guessed what the boss meant, but he didn't know if it was right.

Because the boss has basically never done the sorting of operations, and the interventional surgery could have been done on the same day, but was postponed by the boss for a day.

These abnormal actions all point to one thing.

"Doctor Shi said that he is a chest doctor. If we do it together, I'm afraid he won't be impressed. Taking care of patients is busy and tiring, so there is no time to see others. When his mother recovers almost Focus on the patient in the next bed." Huang Lao said with a smile, holding a cigarette in his hand.

"Boss, you have this problem again." Zhou Congwen said with a smile, "Teaching people tirelessly, I don't know if they are willing to listen."

"Doctor Shi seems to have gone to Peking University for advanced studies. The director there is on the same level as Deng Ming and Liu Wuyan, so you are also his junior uncle." Mr. Huang squinted his eyes and looked at Zhou Congwen, "You can't just watch him fall into the river .”

Zhou Congwen didn't speak, just laughed.

"If we do it together, or if the interventional surgery is done first, the doctor will feel the difference, but the difference will not be too big. There will be harm if there is a comparison. Let them know how low-level the surgery they have been holding on to all the time, and let them see it. See what the world looks like now."

"If they're pretending to be dead, I'll lift their eyelids and let them take a good look at the situation."

"There is harm only when there is comparison, and this harm is not small." Zhou Congwen smiled, "Boss, the patient must be discharged tomorrow."

"It depends on the patient's condition." Huang Lao said, "Actually, I think it's better for the patient to stay for two more days. But a family of several people live in the provincial capital, and they have to earn a month in the countryside for one day's expenses. They can go back Just go back, this matter has nothing to do with Doctor Shi."

"Good boss." Zhou Congwen said seriously this time, "I think the patient's condition should be fine. In the afternoon, evening and tomorrow morning, I will personally perform an echocardiogram on her to see the situation. If the ejection fraction is satisfactory, I will test the patient tomorrow. Get them out."

Huang Lao happily smoked the white ganoderma lucidum in his mouth, noncommittal to Zhou Congwen's words.

"Boss, I have something to report to you."

"You said."

"The CD, Manager Wang has already engraved it, how much do you want?" Zhou Congwen asked.

Elder Huang stretched out a finger.

"Ten or a hundred?" Zhou Congwen asked.

"How can I ask for so much? I'm still not very satisfied with the operation method. Show it to a chest doctor you are familiar with and give me some advice." Huang Lao said lightly.

"Okay!" Zhou Congwen said, "When Manager Wang comes back, I'll show the patient's family members a look. If they are satisfied, I can use it as a teaching operation video."

"Teaching? It's not enough." Huang Lao said leisurely.

"Boss, your requirements are too strict. The operation itself is not difficult, and you can't ask for it to be flawless." Zhou Congwen argued, "Do it step by step. If it goes well, there will be hundreds of thousands of similar operations in the next 20 years. Big data screening The problem is always better than we ponder over it a little bit."

Huang Lao nodded slightly, he seemed to be immersed in the smell of Bai Lingzhi and couldn't extricate himself.

But Zhou Congwen knew that his boss was not lying, he really did not approve of this operation.

The surgery is awesome, it's true.But it is too complicated, and the number of people who can do it in the whole country can be counted on the palm of one hand.

After a while, Wang Xueteng came back with the DVD.

Zhou Congwen went to the ward to find the patient's family and told him to watch the video.If there is no objection, the video will be used as a teaching video.

The patient's family members were a little confused. He is an ordinary person, and what he cares about is absolutely different from what Zhou Congwen cares about.

But Shi Ping's eyes lit up, and he silently followed Zhou Congwen and the patient's family members out the door.

Chapter 1368 I have listened and read it, but I just don’t understand

"Director Shi." Seeing Shi Ping following behind, Zhou Congwen smiled slightly, and asked sideways, "Do you want to go and see too?"

Shi Ping nodded, and swallowed hard.

But his throat was sore and painful, as if he had xerosis, so that he couldn't even secrete saliva.

He cheekily followed behind Zhou Congwen, looking like he was not going to go back after saying anything.

People, sometimes you have to be thick-skinned.

Besides, Shiping is a cardiothoracic surgeon, and a half-hour heart valve replacement operation is inconceivable to Shiping.

"Director Shi, have you ever had an interventional operation?" Zhou Congwen did not refuse, but asked instead.

"No." Shi Ping shook his head.

"That's a pity, you may not be able to understand it." Zhou Congwen said, "But it's okay, let's take a look, and I will briefly explain it to you."

When he came to the office, Zhou Congwen took a CD and put it in the computer's CD drive.

Click start, and what appears on the computer screen is the screen in the interventional operating room.

A guide wire was walking, and Zhou Congwen explained, "Director Shi, the patient's transesophageal echocardiogram showed severe mitral regurgitation, annular dilation of the mitral valve, restricted movement of the posterior leaflet, enlarged left ventricle, and ejection fraction. 40%.

Because the length of the intervalvular suture during mitral valve systole was too large, and the STS score was only 31.9%, thoracotomy or laparoscopic surgery was difficult. "

Zhou Congwen briefly talked about the patient's situation first, and Shi Ping nodded, because he had a certain understanding of the patient's situation in the next bed.

The patient's condition can be said to be critical, and in Shi Ping's eyes, this operation is simply impossible.

but……

His eyes were full of images of interventional operations.

"The surgical device includes a nickel-titanium alloy stent system and three small pieces of bovine pericardium sewn together. The outer layer of the stent is covered with a polytetrafluoroethylene membrane to reduce paravalvular leakage." Zhou Congwen continued to explain in a low voice.

Shi Ping understands about titanium-nickel alloy, but Shi Ping really doesn't understand why three pieces of bovine pericardium suture are needed, the stent needs to be covered with Teflon membrane, and the principle of reducing paravalvular leakage.

"During the operation, the patient is under general anesthesia, and two puncture points are made in the groin via the femoral vein: the highest point is used to deliver instruments, and the lowest point is used to manipulate the operation.

At the same time, there are two puncture points in the puncture of the femoral artery: the highest point is used to enter the three-ring snare, and the lowest point is used to insert the braided cigarette for left ventricular angiography. "

Zhou Congwen's explanation was countless times more detailed than Shen Lang's, and Shi Ping looked at the picture in astonishment.

He did not expect that there are puncture points in the femoral artery and vein during the operation, and each blood vessel has two puncture points.

This is too...

It's more complicated.

I have also seen circulatory surgery in the past. They either puncture the femoral artery or the radial artery, and then complete the operation.

However, the surgical arteries and veins in front of the eyes have punctures, and each has two puncture points.Although I usually don't understand surgery, I can feel the complexity of surgery just from Zhou Congwen's introduction.

Double arteriovenous puncture, this alone is enough to make Shiping horrified.

"Here, here, a manipulation snare is placed at the lowest puncture point of the femoral vein at the lowest point. The snare can be used to control the delivery sheath at the left atrium, and after crossing the interatrial septum, the guidewire is passed into the mitral valve ring and left ventricular cavity, to the descending aorta.

At the same time, a three-loop snare was placed in the femoral artery and the guidewire was captured to establish an arteriovenous loop. "

"Now is the process of catching the guide wire. It's not too difficult for me, but if you want to try it, or the doctors involved in the circulation in your hospital want to try it, there are more things to pay attention to here."

Zhou Congwen didn't go on to talk about the technical details, and now he just gave Shiping a brief description of the operation process.

In the words of the boss, there is harm only when there is comparison.

Shi Ping suffered [-] points of critical damage, and even the boss who defended the level at the end probably had bottomed out.

The next step is to ask him to watch the operation, explain it himself, and try to see if he can impress Shiping with his ideological stamp.

"A 14mm Tyshak balloon was dilated and placed over the left atrium and LV outflow tract to prevent the guidewire from getting caught in the mitral valve.

After ensuring free movement of the balloon, the guidewire was replaced with a Teflon-coated Nitinol guidewire and the arteriovenous ring was reconstructed. "

"What follows is the standard transseptal puncture procedure."

"Inflate the 14mm balloon to ensure that the guide wire is not crimped and does not injure the mitral valve device. This step must be very careful. You can see that the boss operates the balloon very slowly, just to avoid secondary damage."

I usually hear it in a cloud of fog.

In the interventional image, the heart is beating continuously, and devices such as guide wires and balloons are doing atrial septal puncture in the beating heart...

Atrial septum, puncture... Shi Ping tasted these words carefully.

Although he also knew that it was not difficult to get a needle through the interatrial septum, but the interatrial septum moved, moving with the blood flow and the beating of the heart.

It is conceivable that it is very difficult to accurately puncture on this.

"After dilation at the highest puncture point of the femoral vein, the venous catheter sheath was placed and the steering snare was placed in the middle of the nose cone of the delivery sheath.

After delivering the delivery sheath to the atrial septum, the snare is steered into the mitral valve.After entering the LV, release the snare from the nose cone. "

"Esophageal ultrasound is needed at this time, Director Shi, is there a doctor in your hospital who can do esophageal ultrasound?" Zhou Congwen asked.

Shi Ping was taken aback for a moment, then slowly shook his head.

"Sigh." Zhou Congwen sighed, "The barriers to surgery have been continuously lowered, making everything as simple as possible. However, the step of esophageal ultrasound cannot be avoided, but it is easy to say."

"During the operation, Director Deng performed the ultrasound of the esophagus, and it was really difficult to conform to the surgical habits of the surgeon and assistants."

Zhou Congwen sighed as he spoke.

He was reborn and underwent a similar operation again, thinking more than in his previous life.

In his last life, Zhou Congwen focused all his attention on system tasks.It was not until after the boss passed away that he carefully pondered what the boss had said these years.

Lowering the threshold and allowing more doctors with average talents to learn is what the boss has been pursuing all his life.

As for tricks like showing off skills, the boss doesn't even think about it.

If the operation is made beautiful, it is actually very simple.But in that case, there will be some - Huang Lao is awesome, this operation will not gain anything except Huang Lao's praise that no one in the world can do.

Let more people learn to operate and solve the pain of patients. The only purpose of the boss's work is this.

It is not too much to say what you want in your life.

"Now Director Deng has ordered an esophageal ultrasound, and determined the plane between the mitral annulus and the tip of the papillary muscle through transesophageal echocardiography and left ventriculography.

The CardiAQ valve can be placed perpendicular to the mitral annulus by manipulation of the arteriovenous annulus and delivery sheath.