Chapter 1824

At present, the treatment of DeBakey type I dissecting aneurysm is mainly surgical replacement of artificial blood vessels.

Because the cause of Marfan syndrome can not be eradicated, and the distal residual lesions still have the possibility of further development, there is a great possibility of recurrence after ascending aortic replacement.

It is estimated that Dr. Rudy had a hunch about this and told his wife to go to King's hospital immediately in case of discomfort.

Therefore, the onset of the disease was found very early. We should have started to control blood pressure in the intensive care unit to avoid further deterioration of the disease and wait for the next treatment.

The trouble of Marfan syndrome is that there are pathological manifestations of cystic necrosis of the middle layer in the large blood vessels of the whole body. Even if the operation is successful, no one can predict when to get sick again next time.

Dr Rudy went on to talk about the results of various tests, which he knew like the back of his hand. Zheng Ren didn't speak, just meditated.

On the bus, Su Yun asked, "boss, it's very difficult to split the sternum in the middle of the operation."

Zheng Ren knows what he means.

This is one of the key points and difficulties of surgery.

Generally speaking, for the second operation, the original approach of the first operation should be taken, so that the patient's injury is relatively small.

Moreover, for aortic arch replacement, sternotomy is almost the only approach, and the field of other incisions is limited.

But the long sternum has a thick callus. It needs to be cleaved next to it. The sternum saws and slides... And then it's a tragedy.

If it's an ordinary operation, just change an incision. However, if you want to do aortic arch replacement, you can't make do with it at all. You can only choose the hole with the largest field of vision.

Zhao Yunlong's endoscopic aortic arch catheterization is just an idea. I really can study it. I don't know when.

However, when the sternum is split longitudinally in the second operation, the heart, especially the right atrium, may have secondary injury and bleeding or aneurysm rupture, and the prognosis is very poor.

This is from experience. It seems that Su Yun has had similar surgery, and the surgical effect is general.

Zheng Ren nodded and said, "I'll take care of it. It's not difficult. The difficulty lies in the back. I've figured out several ways. Among them, I think the way of heparinization and cooling first is more stable."

"Heparinization, cool down first?" Su Yun was stunned.

This idea is a little strange.

And to do this, the operation speed is very high.

Heparinization of the body's blood will face a variety of complications. The patient rescued in EICU two days ago is one example.

"No, there are some differences in peacetime surgery."

"How?"

"Heparinization first, intubation through the right subclavian artery or femoral artery and vein, parallel cardiopulmonary bypass and cooling. At this time, thoracotomy can reduce the chance of heart or vascular rupture, and is more conducive to the separation and exposure of mediastinal adhesion during secondary surgery." Zheng Rendao.

Uh

Cool down first

After cooling, all organs of the whole body, including the heart, will be impacted to a certain extent. In other words, the speed of splitting sternum and opening mediastinum must be fast enough. It is estimated that 2-3 minutes is the limit.

However, Zheng Ren's statement seems to be a train of thought. Su Yun thought along with Zheng Ren's statement.

Unconventional surgery, not to impress.

Why does fixation exist? It is because countless surgeons are constantly groping for clinical surgery and have proved that a certain path is correct with countless surgical failures.

Once unconventional surgery is used, it will face great risks.

But sometimes, the actual situation forces doctors to choose unconventional means to complete the operation.

But compared with splitting the sternum directly, the boss's statement seems to have fewer complications. No wonder he wants Lao he to come with Yi. Only the team who has cooperated with him many times can shorten this time to the limit.

"Marfan syndrome is difficult to deal with." Su Yun sighed.

"Well, I've thought about it. During the operation... I'll go and forget!" Zheng Ren suddenly patted his thigh.

"What have you forgotten?" Su Yun asked in surprise.

Zheng Ren didn't answer immediately, but concentrated on thinking, and finally sighed.

"What's the matter? It looks like you're in pain. Can't you get it down?" Su Yun asked.

"No." Zheng Ren said: "I think the pathological changes of middle-layer necrosis of great arteries caused by Marfan syndrome, a congenital disease, should be supported by stents during surgery to avoid similar problems."

“……”

"It's OK to open the chest twice and open it three times. The patient is estimated to be choking." Zheng Ren said bluntly.

"During the operation? Do aortic replacement first, and then remove the stent?" Su Yun asked.

"Yes." Zheng Ren nodded, "rich son can't come. There are still operations to be done on the other side of the house. Neither he nor Lao Liu can move."

i see.

"The level of King's hospital is not bad." Su Yun said, "you can use their doctor to remove the stent."

"That's the only way." Zheng Ren said, "you should find Lao Zhao. If there is a problem during the operation, you go to the stent and Lao Zhao and I will have an operation."

Su Yun's face suddenly twisted.

"Boss, I'm a thoughtful doctor!" Su Yun complained.

"Lao Zhao won't intervene. If I do it, can you guarantee the smooth completion of the operation with Lao Zhao?" Zheng Ren asked.

"..." Su Yun recalled the operation process, unconventional operation, can he do it?

forget it.

It's done as the boss said.

Seeing Su Yun's silence, Zheng Ren smiled and said, "it's all right. I'll see the situation at that time and try not to delay you from learning surgery."

"Learn?" Su Yun said contemptuously.

"You can't do it. You're not learning. Do you still want to teach me surgery?" Zheng Ren went back at random.

For this confrontation, Su Yun has no chance of winning at all.

After all, the operation can't be taken down by himself. Zheng Ren is a good candidate.

"What about the anastomosis?" Su Yun stiffly reversed the topic and talked about the key points of the next operation.

"I think in order to reduce the complications of anastomosis, the diseased aortic aneurysm removed during operation should be long enough.

The rupture must be removed to ensure that the blood vessel is anastomosed to the normal blood vessel wall tissue. At the same time, in order to increase the strength of vascular anastomosis, the whole circumference dense felt at the end of aortic anastomosis should be strengthened inside and outside. It can not only increase the strength of the anastomosis, but also ensure the complete closure of the vascular dissection. "

"It is difficult to strengthen the aortic anastomotic end with dense felt inside and outside the whole circumference." Su yundao.

"It's all right. There's me."

Su Yun didn't speak, just glanced at Zheng Ren. His simple and honest face seems to have a layer of luster, which makes people trust.

"Well, in terms of surgery, you seem to think very well." Su Yun said after a long time.

"One more thing, brain protection under hypothermic cardiopulmonary bypass." Zheng Ren said, "I have an idea, but I also want to ask Lao he if he has any opinions."