Chapter 1790

Back in the ward, Su Yun stood beside the patient and watched the ECG monitor with his eyes.

"How's it going?"

"Not optimistic." Su Yun said, "IABP can't let the heart get enough rest."

Zhao Yunlong put the signature sheet in the medical record folder. Su Yun caught a glimpse and breathed a sigh.

"Director Lin will arrive soon. Boss, what are you going to do?" Su Yun asked.

"I'll think about it." Zheng Ren did not directly answer Su Yun's questions, but inserted the patient's MRI film into the film reader.

Moyamoya disease is a cerebrovascular disease with unknown etiology, characterized by chronic progressive stenosis or occlusion at the ends of bilateral internal carotid arteries, anterior cerebral arteries and the beginning of middle cerebral arteries, and secondary to the formation of abnormal vascular network at the skull base.

Because this abnormal vascular network of skull base looks like "smoke" on cerebral angiography images, it is called "smoke disease".

MRI clearly showed the pathological changes of cerebral vessels in patients: old cerebral infarction and localized brain atrophy were most obvious in the bottom of frontal lobe and temporal lobe, and the abnormal vascular network in skull base showed honeycomb or reticular low signal vascular images due to flow void effect.

The more obvious smoke disease, Zheng Ren looked at the mass of proliferative blood vessels like the smoke spit out after smoking, and was a little worried.

Forget it, no matter how the patient's family chooses, go to the system operating room.

Although there is little hope of saving the patient, Zheng Ren doesn't want to give up as long as there is a glimmer of hope.

If the patient can be saved in the system operating room, Zheng Ren also wants to try at a great risk.

Big pig hooves are so hateful. Don't you issue a task for such a serious disease?

Zheng Ren habitually put his left hand under his right armpit and his right hand on his cheek, looking at the patient's MRI.

After making his judgment, he directly enters the system space.

Zheng Ren hesitated when he clicked to buy the operation training time.

If the patient's family disagrees with the operation, the operation training time purchased by themselves will be wasted. The key is not general surgery, but neurosurgery that I have never done!

At least "waste" a master level skill book.

When I did the task a while ago, I accumulated three skill books at the master level. At that time, Zheng Ren thought he would use it for a long time, but he didn't expect to use the last one so soon.

I'm going to Europe soon to face the ancient and mysterious vampire family

But what if the patient's family agrees, but they can't solve this problem with surgery?

After hesitating for less than a second, Zheng Ren made a judgment.

Click to buy operation training time, and click the last master level skill book to use.

Neurosurgery is the most sophisticated of all surgical operations.

When Zheng Ren went to school, he heard from his teacher that when the conditions were bad, he left a drainage strip after drilling and drainage. When the drainage strip is not unobstructed, it is generally used to apply negative pressure to discharge the redundant drainage.

However, such a process of applying negative pressure may lead to several milliliters of brain tissue being sucked out.

As a result, the patients can not speak, hemiplegia, walking weakness and other symptoms after operation because of the lack of these brain tissues.

Therefore, Zheng Ren has always avoided neurosurgery. For him, this is a very difficult operation.

But I can't help it today. I have to try it anyway.

After all, it's a master level skill. It should be no problem, Zheng Ren thought.

Yasargil first successfully anastomosed the superficial temporal artery to the middle cerebral artery in 1967 to treat cerebral ischemic diseases. Since then, such operations have been carried out in many countries.

Zheng Ren doesn't believe that his surgical techniques can't compare with the surgical level in the 1960s and 1970s.

After entering the system operating room, Zheng Ren saw the experimental body lying on the operating table.

He was not in a hurry for the operation, but first observed the position of the experimental body. After all, it is a strange neurosurgery. No matter how cautious, it is necessary.

The system adopts the general anesthesia method of endotracheal intubation and intravenous medication in the patient's supine position, and uses radial artery puncture to connect invasive arterial pressure monitoring, so as to timely observe the dynamic changes of intraoperative blood pressure and provide a reliable basis for controlling and regulating blood pressure.

It can monitor arterial pressure anytime and anywhere. It seems that big pig hooves are also very cautious. Zheng Ren makes a judgment.

The head of the subject was biased to the healthy side, and a microscope was placed in the operation area.

Zheng Ren glanced. It's Zeiss's! He was a little excited.

According to Su Yun's description, Zeiss's microscope can try to avoid the trouble of underdeveloped vestibular nerve.

Otherwise, every time I finish a microsurgery, I feel like taking a roller coaster.

Zheng Ren hates roller coasters!

It should be OK. Let's start the operation. Thinking of this, Zheng Ren noticed that the experimental body had prepared its skin.

The skin preparation of neurosurgery is to shave your head. Experienced nurses shave their head quickly and stably. Inexperienced nurses either leave some hair or cut their scalp.

Zheng Ren took a look. Big pig hoof is an experienced nurse. The skin preparation is almost perfect.

Routine brain surgery disinfection, covering sterile dressing, subcutaneous injection of local anesthetics around the cutting edge, pterional approach, incision of scalp and subcutaneous tissue and bipolar hemostasis.

The blood supply of the scalp is too rich. Although Zheng Ren is a master of surgical skills, he is encouraged by the system and is not skilled. A long time has been wasted in this step.

Then Zheng Ren began to free the superficial temporal artery, unipolar incision of the reverse top of the temporal muscle and covered it with normal saline gauze.

The cranial bone flap was removed with AO power system and milling cutter, the dura mater was cut, and the middle cerebral artery and its branches were separated from the downstream of the microscope.

The microscope is good, 40 times. Zheng Ren is very cautious in every step.

But after all, it was the first time. He failed 12 times in this step.

The operation failed and the experimental body died

The operation failed and the experimental body was paralyzed

Zheng Ren was almost numb to such tips.

But after all, he had the experience of microsurgery. The scope of neurosurgery was narrow and the movement under the microscope was as gentle as possible. He soon fully mastered it.

The 13th operation training, Zheng Ren finally finished the free step perfectly.

Select the appropriate receptor, anastomose the broken end of the superficial temporal artery with the middle cerebral artery end-to-side, and suture with 10 / 0 ploene suture. During the suture process, use soft needle head with heparin saline to repeatedly flush the operation field and lumen to prevent thrombosis.

After anastomosis, rinse the operation field thoroughly, turn over the dura mater, count the surgical materials, apply the inner layer of temporal muscle to the meningeal surface and fix it with the dura mater at the bone margin.

Put back the bone flap, suture the scalp with 3 / 0 absorbable thread, and cover the iodine yarn Baotou.

Operation completion, 50%!