v3 Chapter 2970： Too cautious

In the face of Zheng Ren's relaxed smile, everyone's nervousness was relieved a little.

开始 The operation started. After opening the chest, Zheng Ren cut the mediastinal pleura around the root of the lungs, and bluntly separated to the lung side, exposing the hilar vessels.

Then Lin Yuan and Gu Xiaoran pulled the upper and lower lobe lungs backward, exposing the leading edge of the hilum. First divide the superficial superior pulmonary veins, ligate and cut off the superior and middle lobe veins, respectively.

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

The standard pneumonectomy procedure is completely textbook-level surgery. 15 minutes after opening the platform, the arteries and veins of the right lung had been exposed, and ligation began.

Dr. Yun can see that Zheng Ren did not deliberately pursue fast, but performed an operation step by step. It's just that the operation is very smooth. Not only the operator and the first assistant, but also the second and third assistants have a good understanding of the surgical process, and the tacit understanding has reached an outrageous level.

What do the magicians want most?

What I hope most is that the surgical field is clean. It is not only that the bleeding will block the line of sight. Using hooks to pull other tissues apart, it is also critical to expose the surgical field.

When Zheng Ren bluntly separated on the right lung side and revealed hilar blood vessels, Erzhu Lin Yuan and Sanzhu Gu Xiaoran pulled the tissue apart in advance, and the surgical field was fully exposed.

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

While facing the real patient today, when looking at the operation from the beginning, Dr. Charles thought that the performance of the two young people was perfect.

Surgery is not performed by one person. Today, the two assistants and the three assistants have perfectly explained this point.

"Liver function, alanine aminotransferase ..."

"Blood gas analysis ..."

At 15 minutes, Lao He began to report the test results. Liver and kidney function, blood gas analysis, several major indicators reported clearly.

"Next time." Zheng Ren simply answered, others sounded headless, but Lao He nodded and motioned to understand.

Dr. Charles's assistant was translating behind him, and the doctor began to ponder these numerical questions.

Total liver bilirubin is 89 μmol / L, which is 4 times higher than the upper limit of normal value. However, according to the medical records, the total bilirubin of this small patient was high before surgery, which is considered to be related to several liver interventional embolizations.

Kidney function is good, blood gas analysis is also ideal, and ECMO runs quite smoothly. Dr. Charles smiled. Dr. Zheng was really cautious. He even restricted the amount of low-molecular-weight heparin before the operation.

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

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

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

"Zheng, be very cautious." Dr. Charles finally stopped watching and began to communicate with Zheng Ren.

Here you have to wait. Generally speaking, it is 10 minutes. However, the patient has already been on ECMO, even if the blood pressure is reduced due to resection, there will not be much problem, as long as you pay attention to rehydration.

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

仁 In the operating room, Zheng Ren's voice was mixed with good luck songs. The others on the stage, including Su Yun, did not move, but seemed to be waiting for something.

"Dididi ~~~" The alarm sounded, and the arterial pressure shown above was continuously decreasing.

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

Is it impossible at all, so Zheng's waiting is meaningless.

But then Su Yun made a gesture without hesitation, and Gu Xiaoran, who was standing next to him, pulled up the sterile sheet, keeping the sterile area, and exposed the left groin.

做 什么 What is this to do? Dr. Charles froze.

Dr. Icu, who had been prepared a long time ago, came in from the operating room and pushed over a strange set of machines. The Shayren handed him a puncture kit. After brushing his hands for disinfection, he began to operate.

The machine ... in pieces, looks like it has been patched in countless ways, a bit shabby and shabby. The alarm sound of the monitor that rang through my ears made my heart irritable. It seemed that the songs of good luck were not so pleasant, and they became irritable together.

Dr. Charles did not comment on the machine, he narrowed his eyes and watched Dr. Icu's operation carefully.

The iliofemoral vein was inserted into the cannula to establish a circulation path, and ICU's doctor began to open the machine and connect the tube.

Adsorb bilirubin, plasma exchange! Dr. Charles quickly discovered the usefulness of the machine. Blood pressure drops, do liver dialysis? Is this operation a bit overdone?

It is true that hypotension can lead to impaired renal and liver function, but it is generally considered that renal damage will be more severe. Intraoperative dialysis ... seems not necessary. UU reading books

是 Is it that Dr. Zheng has been practicing surgery for a long time, and finally lost himself? Dr. Charles wondered. However, out of respect for the surgeon, he did not speak out to question Zheng Ren's thoughts.

建立 After establishing the liver dialysis channel, Zheng Ren immediately opened the block and continued the operation. Following the alarm sound of invasive arterial blood pressure monitoring, he started the methodical operation again.

Qi Linyuan pulled the lower lobe forward, Zheng Ren and Su Yun began to ligate and cut the inferior lung ligament.

The mediastinal pleura was then pushed open, freeing the inferior pulmonary veins, the ligature was ligated and sutured, and then cut off.

Gu Xiaoran pulled the upper lobe downward and freed the right main bronchus below the sphenoid vein arch, cut off 0.5 ~ 0.8cm from the tracheal prosthesis, and sutured.

No one spoke, and the silent operation was accompanied by harsh alarm sounds, and even the tacit operation cooperation seemed not so clear and eye-catching, and became frizzy.

Can this be done? Dr. Charles looked more at the monitor and watched the change in blood pressure with some anxiety in his heart. He was concerned that the lower blood pressure of the patient would directly lead to cardiac arrest, which in turn would lead to surgical failure.

Although the blood pressure is still within the range that can be tolerated, it is impossible to justify it without rehydration.

"Give heparin 82U / kg, prostaglandin E1860U / kg, Perferdex solution perfusion, perfusion pressure 52cmH2O, perfusion temperature 4 ℃." Zheng Ren Shensheng said.

"Zheng, do you need fluid replacement?"

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