Start as an Emergency Physician

Anesthesia is performed with endotracheal intubation and general anesthesia.

Because Ding has congestive heart failure, the anesthetic process needs to be smooth to prevent hypertensive crisis.

"Ninety degrees on the right side. Zhou Yuan said.

Jiang Xiaoqi and the vascular surgeon immediately adjusted Xiao Ding's position.

Zhou Yuan picked up the scalpel.

"The anesthesia is done. The anesthesiologist said.

Zhou Yuan nodded, and after confirming that Xiao Ding had been completely anesthetized, he made an incision in the posterior position between the fourth ribs on Xiao Ding's left side.

The scalpel enters the skin and exposes the descending aorta.

Zhou Yuan made a longitudinal incision along the descending aorta to the surrounding mediastinal pleura, and then the incision extended upward to the left subclavian artery and the uppermost intercostal artery.

He stopped the scalpel and twisted his wrist, and the scalpel, which had been vertical, suddenly turned into a parallel position.

Zhou Yuan increased the strength of his hand a little and made a horizontal incision.

Before the operation, the coarctation of the descending aorta had been confirmed, and Zhou Yuan directly drove the scalpel to free the upper and lower descending arteries of the coarctation segment.

"Wrap around. "

"Free ligation of the catheter. "

Band wrapping is done to control bleeding in case of inadvertent damage to blood vessels.

After the vascular surgeon completed the banding of the descending aorta, Zhou Yuan began to ligate the ductus arteriosus and ligaments freely.

His movements are very light because there is a recurrent laryngeal nerve near the catheter, and if he accidentally injures the recurrent laryngeal nerve that controls the laryngeal muscles, it may cause hoarseness, and may even lead to poor breathing and suffocation.

In addition, nerve damage is difficult to recover, and nerve rupture must be avoided during surgery.

After the dissociation of the ductus arteriosus was completed, Zhou Yuan ligated the catheter exposed in the surgical field.

"Catheter wrench. "

Jiang Xiaoqi clamped both ends of the catheter with a catheter wrench.

Zhou Yuan picked up a scalpel and directly cut the ductus arteriosus at the ligation site, and the arterial ligament was also cut after ligation.

"5-0 stitches. "

In order to prevent excessive blood loss, Zhou Yuan sutured the broken ends with 5-0 polypropylene threads.

Next is the free intercostal artery.

When the aorta narrows, the intercostal arteries form collateral circulation to compensate the body for blood. Even if the coarctation is completely closed, the collateral circulation can transport blood, ensuring that there are no accidents for the time being.

However, collateral circulation is never a substitute for the original blood circulation.

The intercostal arteries must be ligated during the coarctation resection end-to-end anastomosis, otherwise the aora will be blocked during the operation, and all the blood will flow through it, which will cause great pressure on the intercostal arteries and may even lead to the bursting of the blood vessels.

This does not happen with the normal collateral circulatory compensatory blood, but at this time, during the procedure, there are many unexpected factors.

In patients with coarctation of the aorta, the intercostal arteries are often thickened due to the branching circulation, but because the surface area of the vein is certain, the area increases, and the wall of the tube will be very fragile, rupture and even aneurysm-like dilation.

Zhou Yuan carefully separated the aortic segment behind the intercostal artery, and in order to fully expose the coarctation of the aorta behind the intercostal artery, Zhou Yuan ligated and severed two pairs of intercostal arteries.

"Initiation of intercostal artery dissociation. Zhou Yuan said.

Jiang Xiaoqi immediately became focused, staring at Zhou Yuan's movements.

She is still a little confused, and Zhou Yuan's movements are extremely skillful, as if she has experienced it countless times.

But...... Zhou Yuan is only twenty-six years old, and it is impossible to have many surgeries!

I saw Zhou Yuan gently swim away the intercostal artery far from the aortic wall, and the strength was in place in the process.

The intercostal artery has become extremely fragile because of the perennial H collateral circulation, and many doctors have a little inappropriate strength when they are free, which will cause the rupture of the blood vessel or the tear of the aorta, so as to cause uncontrollable bleeding, but Zhou Yuan did not make any mistakes from beginning to end...

The vascular surgeon was already suspicious at the moment.

"Don't you shake your hands when you peel them off?"

"It's like a machine, it's so precise..."

"I'll take a closer look... it, you haven't seen it yet?!"

The vascular surgeon looked shocked, raised his head from the microscope, and looked at Zhou Yuan blankly.

It's too proficient!

The chief physician of vascular surgery is nothing more than that, right? No, maybe the director can't compare!

The vascular surgeon looked down at Xiao Ding's dissected chest cavity and was silent.

He wanted to say it when he made the incision before.

Zhou Yuan's incision technique was something he had never seen before.

Not that it's novel, but it's too precise.

Everyone's body has subtle differences from the standard anatomical human body, and although the differences are small, they are especially important during surgery, because this difference can be cut into the organ with a scalpel that would otherwise be used to free the blood vessel, or even directly break the blood vessel.

Therefore, even the chief physician will be cautious when marking to confirm the position of the surgery, and even confirm it several times, and the operation is very gentle.

But what about Zhou Yuan.

Click.

It's done.

Laugh at.

Cut open.

Then put both hands into the incision and pull it slightly to the side, and the incomparably perfect jutsuno appeared in front of him.

"Awesome...," the vascular surgeon summed up these two words in a thousand words.

"The construction of temporary vascular bridges began. Zhou Yuan ignored the vascular surgeon and said.

Jiang Xiaoqi: "Okay. "

As she spoke, she handed over the artificial vascular bridge that had been prepared long ago.

"You're Zhou Yuan, right?" the vascular surgeon asked, swallowing his saliva.

Zhou Yuan nodded.

"I've heard about you, our director had an operation with you before, and at that time he criticized an attending physician during a meeting, and then told us about your surgery case. "

Zhou Yuan remembered this incident.

At that time, the vascular surgery department took a patient who needed a vascular transplant, but the surgeon did not calculate the length of the blood vessel that needed to be transplanted, and the saphenous vein was finally intercepted so short that it later caused a series of sequelae and had to be re-transplanted.

Seeing that Zhou Yuan didn't speak, the vascular surgeon also quieted down and assisted Zhou Yuan in erecting an artificial vascular bridge.

This step is simple, at least for Zhou Yuan.

It is nothing more than making an incision in the upper descending aorta, and then putting one end of the artificial blood vessel on it and suturing it.

The lower descending aorta is then re-opened, and the other end of the artificial vessel is anastomosed again.

The coarctation of the aorta is located between the two openings, which are bridged by a temporary blood vessel.

And in the eyes of vascular surgeons, everything has changed...

Groove, this is the incision, do you not need to consider the constriction of blood vessels, tension changes?

Nima, it's okay again?!_

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