Chapter 1079

Is perfect vascular anastomosis really perfect enough?

Chen Cang looked at his suture and began to ask himself such a question!

What is perfection?

Perfection is a threshold reached using current means.

However, the current means are limited.

There is room for improvement in both surgical techniques and surgical schemes.

This is a process that needs continuous research and improvement.

Perfect, not to mention master.

Chen Cang's aortic dissection and total aortic arch replacement at this time are masters.

It takes a long distance to break through to perfection.

"Line 4."

"Normal saline flushing!"

"Clamp!"

……

The operation is continuing.

Facing the repair of intercostal artery, Chen Cang began to calm down and observe carefully. The third rib... The fourth rib

Chen Cang suddenly asked Xu Ziming, "is there a big difference in the time limit of intercostal artery on spinal cord blood supply?"

Xu Ziming nodded: "well, according to the 2009 version of the guide, it can be completed within 60 minutes, but later research found that in fact, the ischemic and hypoxic response of spinal cord nerve tissue began to appear in about 45 minutes. Although there is no intuitive performance, there are some problems for later repair!"

Chen Cang looked at such a complex intercostal artery: "how long is the best time?"

He Chao blurted out: "Professor Wu of Ruijin hospital can repair all intercostal arteries in 35 minutes! That's... My teacher."

Xu Ziming nodded: "well, indeed, Professor Wu Nan has rich experience in Marfan syndrome and has been committed to it for a long time. He also keeps practicing the repair of intercostal artery."

Chen Cang nodded after hearing this!

More than 20 arteries, 30 minutes!

All the time is taken into account. A blood vessel takes only one and a half minutes. This also needs to deal with thread ends, knots, needles... And so on!

The most important thing to deal with intercostal vessels is to avoid injury of intercostal nerve.

It's a lot more trouble than the large blood vessels in the chest.

The limit time for Chen Cang to hold the abrasive tool is thirty or forty seconds, but how long does it take to put it in this situation?

Chen Cang decided to practice sometime.

……

After the operation, anesthesiologist Zhou he has been monitoring the vital signs of the patient. Because the operation takes a long time, appropriate brain protection needs to be selected.

In fact, if the patient does not have Marfan syndrome and is only an acute type I aortic dissection, only ascending aortic replacement or semi arch replacement can be performed.

However, under Marfan syndrome, the damaged ascending aorta and aortic arch have changed in the fibrous layer. If it is not controlled, it must be a problem!

The use of total arch replacement is certainly good, or the use of common "elephant trunk surgery" has a significant effect!

But this actually has high requirements for patients and surgeons.

It not only requires the master surgeon to be skilled, but also requires the patient to be in good general condition, so as to stabilize the smooth progress of the operation.

Tian Zhengkai, an athlete, has a good foundation, and Chen Cang is skilled enough, so at this time, total arch replacement surgery is actually the best choice!

The ascending aorta is processed!

The patient's vital signs are completely normal and ready for total arch replacement!

Chen Cang sighed and said, "cool down!"

Hypothermia, circulatory arrest and retrograde vena cava perfusion are effective brain protection strategies!

Everyone began to get busy!

"How many degrees Celsius?" Zhou he looked at Chen Cang and asked directly.

"Turn it to 20 degrees Celsius!" Chen Cang said decisively!

Zhou he was stunned!

Low temperature is directly related to cycle stop.

The lower the temperature, the longer the allowable time to stop the cycle. It can be maintained for 60-80 minutes at 15 ~ 18 ℃!

In this way, the operational time becomes sufficient.

If the temperature is high, the time is limited, but... The patient's injury may be slightly smaller.

But again, if you have plenty of time, the patient may need some price!

Why is medicine difficult?

Because the time we strive for is actually given by the patient, and the patient's time is swallowed by the God of death!

For every minute we consume and disease damage, death devours a little!

This is a tug of war. The chip is time.

Whoever grabs the patient first wins!

Perhaps at this moment, the feeling of competing for time with death will become more and more obvious!

Chen Cang chose 20 degrees Celsius, which suddenly increased the requirements for doctors, because the operable time became shorter, but similarly, the patient's injury became smaller.

Zhou he looked at Chen Cang's firm eyes and nodded!

Xu Ziming and he Chao also lamented one after another: Chen Cang, this is Chen Cang!

He Chao even had a little more expectation and excitement.

When the temperature drops to 20 ℃, the circulation is stopped or the retrograde perfusion of superior vena cava is completed at the same time!

Chen Cang began to separate the aortic arch!

Tension!

The feeling of low temperature in your hands!

Anxious time!

The sound from the monitor!

The doctors' breathing became clearer and clearer.

All the signs show that this is a difficult operation.

Free distal aortic arch is a precision operation.

The vagus nerve and recurrent laryngeal nerve should be carefully confirmed. The nerve should be dissociated first and then placed in a band for traction. Special attention should be paid to prevent injury to the recurrent laryngeal nerve when dissociating the distal end of the lower edge of the arch.

Dexterous and stable, Chen Cang carefully avoided danger.

It took less than 8 minutes to separate successfully!

Xu Ziming and he Chao looked at each other, full of surprises.

Such a fast and accurate free aortic arch saves too much time for replacement surgery.

Seemingly ordinary operations are full of details and invisible technology.

However, for the experienced Xu Ziming, it is also an opportunity to learn and exercise.

He Chao was a little excited.

Chen canggang's free time is not inferior to his teacher.

Then Chen Cang put down the separating forceps and began to trim the aortic arch!

Then select the appropriate artificial blood vessel and suture the descending active vein mouth with 4-0 polypropylene thread.

In this process, Chen Cang takes a shorter time. As the champion of the great blood vessel suture competition in the cardiac surgery skills competition, Chen Cang has little pressure to deal with these things.

Then, start to suture the posterior wall of the arch containing three branch blood vessel openings, which are the branches and directions of blood vessels. The suture needs to be tight to prevent blood leakage.

This is the aorta. The blood pressure is very high. If there is a crack or something, it will be a potential disaster for the patient!

Therefore, the anastomosis of artificial blood vessel and blood vessel is the key of operation!

Not only fast!

And keep it secret!

That's the tone of the whole operation!