Chapter 2970

Facing Zheng Ren's relaxed smile, everyone's tension has also been relieved.

At the beginning of the operation, after opening the chest, Zheng renhuan cut the mediastinal pleura around the root of the lung, and blunt separated to the lung side to expose the hilar vessels.

Then Lin Yuan and Gu Xiaoran pulled the upper and lower lobe lungs backward to expose the front edge of the hilar. First, the superficial superior pulmonary vein was separated, and the superior lobe vein and middle lobe vein were ligated and cut off respectively.

Dr. Charles stood silently watching the operation, and his pupils gradually narrowed.

The standard procedure of pneumonectomy is a textbook operation. After opening for 15 minutes, the arteries and veins of the right lung had been exposed and ligation began.

The doctor can see that Zheng Ren did not deliberately pursue speed, but did an operation step by step. But the operation was particularly smooth. Not only the operator and the first assistant, but also the second and third assistants had a good understanding of the operation process, and the tacit understanding reached an appalling level.

What does the surgeon want most?

The best hope is that the operation field is clean, not only the bleeding will block the line of sight, but also the exposure of the operation field by pulling away other tissues with a retractor.

When Zheng Ren bluntly separated on the right lung side and revealed the hilar vessels, the second assistant Lin Yuan and the third assistant Gu Xiaoran opened the opened tissues in advance, and the operation field was fully exposed.

Dr. Charles did not notice the role of the assistant during the surgical practice. At that time, he focused all his attention on the 3D printed lung tissue donor; Put it on Zheng Ren's microsurgical skills.

Today, when facing real patients and looking at the operation from the beginning, Dr. Charles thought that the performance of the two young people was perfect.

The operation was not done by one person. Today, two and three assistants have perfectly explained this for a long time.

"Liver function, alanine aminotransferase..."

"Blood gas analysis..."

15 minutes later, Lao he began to report the test results. Liver and kidney function, blood gas analysis, several main indicators were reported clearly.

"Next time." Zheng Ren's simple answer sounded that others had no head, but Lao he nodded and signaled that he understood.

The assistant beside Dr. Charles translated for him behind him, and the doctor began to ponder over these values.

Now look at the total bilirubin of liver function 89 μ Mol / L, 4 times higher than the upper limit of the normal value. However, according to the medical records, the total bilirubin of this small patient was high before operation, which was considered to be related to several liver interventional embolization operations.

Renal function is good, blood gas analysis is also ideal, and ECMO runs quite smoothly. Dr. Charles smiled. Dr. Zheng was really cautious. He limited the dosage of low molecular weight heparin before operation, and he was still observing during operation.

Although doctors should be cautious, Dr. Zheng is a little too cautious today.

After receiving the first test report, Zheng Ren ligated and cut off the first branch of the pulmonary trunk, that is, the anterior apical artery.

Then, the right pulmonary trunk was completely exposed and blocked with thick silk thread.

"Zheng, it's too cautious." Dr. Charles finally couldn't stand it and began to communicate with Zheng Ren.

Here is to wait, usually 10 minutes. However, the patient has been on ECMO. Even if the blood pressure drops due to resection, there will not be much problem. Just pay attention to rehydration for a long time.

"Doctor, because the patient's liver function is not good, I must be careful." Zheng Ren explained to Dr. Charles why he observed blood pressure carefully with the help of ECMO.

In the operating room, Zheng Ren's voice was mixed with the song of good luck. The others standing on the stage, including Su Yun, didn't move, but seemed to be waiting for something.

"Didi ~ ~ ~" the alarm sound of the monitor sounded, and the arterial pressure displayed on it was declining.

Dr. Charles doesn't think it is necessary. As long as the fluid is replenished for a long time, can the operation be stopped because the blood pressure drops after blocking the right pulmonary artery?

It's impossible, so Zheng's waiting is meaningless.

But then Su Yun made a gesture without hesitation. Gu Xiaoran, standing beside him, pulled up the sterile area one way, kept the sterile area and exposed the left groin.

What is this? Dr. Charles was stunned.

The long prepared ICU doctor immediately came in from the operation room and pushed a set of strange machines. Shea handed him a puncture kit. After brushing and disinfecting his hands, he began to operate.

The machine... Is patched up. It looks like it has been patched countless times. It's a little shabby and shabby. The alarm sound of the monitor that rang through my ears made people feel irritable. It seemed that the songs of good luck were not so pleasant, and they became impatient together.

Dr. Charles did not comment on the machine. He narrowed his eyes and looked carefully at the operation of the ICU doctor.

Femoral vein puncture and catheterization established a circulatory pathway, and ICU doctors began to turn on the machine and connect the pipeline.

Adsorbed bilirubin, plasma exchange! Dr. Charles soon discovered the usefulness of the machine. Blood pressure drops. Do you want to do liver dialysis? Is this operation too much.

Indeed, hypotension can lead to impairment of renal and liver functions, but it is generally considered that kidney damage will be more serious. For intraoperative dialysis... It doesn't seem necessary.

Did Dr. Zheng practice surgery for a long time and finally lose himself? Dr. Charles wondered. However, out of respect for the practitioners, he did not speak out his doubts about Zheng Ren.

After establishing the liver dialysis channel, Zheng Ren immediately opened the block and continued the operation. Despite the alarm of invasive arterial blood pressure monitoring, he began the orderly operation again.

Lin Yuan pulled the lower lobe forward. Zheng Ren and Su Yun began to ligate and cut off the inferior pulmonary ligament.

Then the mediastinal pleura was pushed open, the inferior pulmonary vein was dissociated, ligated and sutured, and then cut off.

Gu Xiaoran pulled down the upper lobe lung, dissociated the right main bronchus under the azygos vein arch, cut it 0.5 ~ 0.8cm away from the tracheal ridge and sutured it.

No one spoke. The silent operation process was accompanied by a harsh alarm. Even the tacit operation cooperation seemed not so clear and eye-catching, and became irritable.

Will this work? Dr. Charles paid more attention to the monitor and looked at the change of blood pressure with some anxiety. He worried that the patient's lower blood pressure would directly lead to cardiac arrest, which would lead to the failure of the operation.

Although the blood pressure is still within the tolerable range, it can't make sense without rehydration.

"Heparin 82u / kg, prostaglandin E1 860u / kg, perferdex solution, perfusion pressure 52cm H2O, perfusion temperature 4 ℃." Zheng Ren said in a deep voice.

"Zheng, do you need rehydration?"

After a few minutes, Dr. Charles finally couldn't bear it when Zheng Ren was preparing to give perfusion fluid before lung transplantation and began to whisper his suggestions.