Chapter 2256

In the classroom of pediatric surgery in the imperial women's and children's Hospital, a simulated operation was carried out in a tense and orderly manner.

This is a pair of conjoined babies, combined chest and abdomen. Although there are two hearts, they share a pericardium, and the hearts are connected together.

The separation operation is quite difficult. The women's and children's hospital has joined hands with the Philadelphia children's Hospital, the world's top children's hospital. After a series of preparations, it has entered the perioperative period. As long as the simulation operation is successful, the operation can be started at any time.

The 3D printing model as like as two peas in real life.

Intraoperative navigation and two sets of customized external aids ensure that surgical simulation can be done.

If the simulated operation is successful, the conjoined babies can be separated at a low age to effectively protect their young heart regeneration ability.

This set of preliminary preparation costs too much. Women's and children's hospital is close to the world's advanced medical level at almost all costs, especially the application of 3D simulation printing and intraoperative navigation system.

Intraoperative navigation is a preoperative evaluation mode that accurately corresponds the patient's preoperative or intraoperative image data with the patient's anatomical structure on the operating table and is reconstructed by computer.

During the operation, the surgical instruments are tracked and the position of the surgical instruments is updated and displayed in real time in the form of virtual probe on the patient's image, so that the doctor can see the position of the surgical instruments relative to the patient's anatomical structure at a glance, making the surgical operation faster, more accurate and safer.

Its application mainly includes intraoperative application and preoperative simulated operation, etc.

Intraoperative navigation technology has existed for a long time, but the application of preoperative simulated surgery has not been fully spread in clinic because of its high price and imperfect computer-aided function.

Zheng Ren knew this for a long time, which is the same as the experimental body in system space. But the technology is not mature. It is not easy to use big pig hooves at all.

Now, doctors in women's and children's hospital are trying to carry out heart conjoined infant separation in the "system operating room" built with heavy money.

The surgical model is as like as two peas printed by 3D.

The operation was originally carried out by the medical team of Philadelphia children's Hospital, but in the preoperative simulation operation, the team of Philadelphia children's hospital found that the child's heart deformity was serious, and the success rate of the operation was less than 5%, so they directly refused.

Conjoined babies can withstand surgery with their vital signs under the careful care of the women's and children's Hospital, but with the passage of time, the symptoms of heart failure become more and more serious, and there is no way to delay it.

The hospital talked with the children's parents for many times, and finally reached a consensus that conjoined infants have the symptoms of heart failure. There is still a glimmer of life after surgery. If they don't have surgery, they won't even have a glimmer of life.

Then try it.

According to the plan, this is the last simulated operation.

The three-dimensional positioning of CT and MRI made yesterday produced a bitmap image, which stereoscopically showed the situation in the conjoined baby's body.

When the conjoined baby first came to Dadu women's and children's Hospital, it was found that there was a common pericardium and two hearts were connected in the atrium. The large blood vessels and atrium at the bottom of the heart are completely separated without traffic. The apex of the heart is connected near the diaphragm. The two hearts have a small tubular connection with a diameter of 3 mm. Most of the two hearts are membranous connection.

There are many parts connected to the liver, but that's not the point.

The most difficult operation for conjoined infants is to connect the brain, followed by the heart. The rest of the organs are not very important.

However, the reason why the expert team of Philadelphia children's hospital gave up was that as conjoined babies grew, they found that their hearts beat at different frequencies, and the operation could not go on at all.

After several simulated operations, no one can solve this problem.

Therefore, Philadelphia children's Hospital announced to give up the operation.

Chen, vice president of the women's and children's Hospital, was in charge and was ready to try again. If you give up the operation at this time, the child will die within one month, and all previous efforts will be in vain.

For the conjoined babies, only they know how much effort the women's and children's hospital has made.

Not to mention the top 3D printing simulation children, not to mention the introduction of surgical navigation system, countless small details are immersed in the painstaking efforts of medical staff.

Careful feeding is the first step.

In order to enhance the physique of conjoined infants and create conditions for surgery.

The two conjoined infants were 10 days old and weighed 3.93 kg, belonging to ⅱ ° malnutrition.

After admission, the feeding of high-quality neonatal formula has increased from 3 ml every time and once every 3 hours to 60-90 ml every 3 hours. And in the process of feeding, pay attention to the inclination of the bottle and the size of the milk hole, and pay attention to prevent choking, vomiting and even asphyxia.

During this period, children were supplemented with intravenous nutrition - children's compound amino acids, fat emulsion, multiple vitamins and trace elements, and intravenous administration of homotype plasma, human blood white egg, calcium, etc.

Every detail was not missed. The weight of the two infants had increased to 7.8 kg before operation.

This,

Just part of it.

In addition to feeding, we should strengthen basic nursing, control infection and place a single room for protective isolation.

The daily air sterilizer in the ward will disinfect automatically and regularly, and pay attention to ventilation to keep the air fresh. The room temperature is 20 ℃ - 24 ℃ and the relative humidity is 50% - 60%.

The children suffered from severe diaper rash and purulent herpes in the armpit, groin, both lower limbs and around the external genitalia. After bathing with 0.05% Bromogeramine water every day, they were smeared with Baiduobang Red Hip ointment 3-4 times a day.

And this is only part of the foundation.

Because conjoined children have a relatively large range of connections, there may be a large range of skin deficiency after separation. In order to ensure sufficient incision skin during operation and avoid skin grafting as much as possible, the body bridge must be lengthened and widened.

Body bridge is the "bridge" shared by conjoined infants.

At admission, the initial anterior umbilicus of conjoined infants was 16 cm long. A body bridge with a width of 4 cm and a circumference of 37. Because the body bridge tension is high, it is necessary to relax the thoracoabdominal wall and expand the thoracoabdominal cavity.

The pediatric director shall personally press the connecting parts of conjoined infants for 15 minutes three times a day.

The old director is nearly 60 years old. Every day, Vice President Chen feels very hard to watch her put one hand and four fingers together, put them flat under the body bridge, put her thumb above, and press them rhythmically from light to heavy.

When pressing, the reaction and complexion of the conjoined body shall also be observed. After pressing, a rice bag with a length of 16 cm, a diameter of 2 cm and a weight of 150 g shall be pressed above the body bridge.

The lower part is padded with a cotton bag of the same shape. During sleep at night, the lateral traction method is adopted, that is, a small pillow is padded between the two children, so that the two children can be pulled separately as far as possible in the lateral position, so as to achieve satisfactory preparation of the body bridge during the operation.

With joint efforts, the peripontine track of conjoined infants is 54 cm, 20 cm long and 7 cm wide.

But everything was ready, but the operation could not be completed.

……

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