godfather of surgery

Chapter 259 Hybrid Surgery
Teng Guihua wanted to come over to ask a few words, but was stopped by Chang Juan, who didn't want this woman to interfere with the doctor's treatment.

Although she is Fang Xiaoyun's mother, this mother has no daughter at all in her heart. The daughter is just a money-making tool to be squeezed.

If it can be sold, this mother will not even blink her eyes, and sell this daughter for money, and pay the down payment and decoration for her son's house.

"The doctor on duty in the interventional operating room is busy on the stage. A patient with spontaneous intracranial hemorrhage is involved in embolization and needs to apply several coils. I will report to the chief on duty. He is coordinating and calling the backup staff over."

Song Zimo contacted the interventional operating room for spinal angiography, which had very high requirements for interventional doctors. They had to super-select the interspinal arteries one by one, push contrast agents, and identify them one by one.

Moreover, an anterior spinal artery was embolized at the time, and the thrombus was cut and removed during the operation, and re-anastomized. After angiography, the risk of re-embolization increased a lot.

"How is it, Fang Xiaoyun's condition!" Professor Zhang rushed to the general orthopedic surgeon's office.

Yang Ping immediately reported his analysis and arrangement to Professor Zhang, and Professor Zhang sat down to take a breather: "I have been thinking about it too, it's too similar to spinal dural arteriovenous fistula, I have encountered such a case before, but it appeared The symptoms were not so fast. At that time, the patient had low back pain, numbness and weakness in the lower limbs, and went to another hospital for lumbar disc herniation. After surgery, the symptoms did not relieve after the operation, and he was completely paraplegic. Later, I thought about this disease and did DSA. It took 6 hours to do spinal arteriography to find the fistula. Later, surgery was performed to treat the arteriovenous fistula, and the patient recovered the sensation and muscle strength of the lower limbs. Fang Xiaoyun’s condition was more complicated. If it is true, it is too rare for the disease to cause paraplegia at the same time. The emergency department arranges DSA. If the diagnosis is confirmed, the operation should be performed immediately, and the patient should be placed in the hybrid operating room of the interventional department.”

Hybrid operating room is a kind of compound operating room, generally in the [-]-level laminar flow operating room, which fully integrates DSA equipment and surgical equipment, and can complete interventional treatment, surgical operation and imaging examination in one operating room, so that some complex operations do not need to be disassembled. Achieve one-time completion, reduce operation risk, reduce patient handling, and save operation time.

"We have already arranged that the doctor on duty in the interventional department is busy and there is no manpower. The chief on duty is dispatching, and the backup is called." Yang Ping introduced.

Director Han also rushed over: "Xiao Yang, I contacted Director Shi of the interventional department, and they arranged for Director Ji to come over. Director Ji is the best in the interventional department, and he has done the most spinal angiography."

That's great, at critical times, Director Han can coordinate in the middle, create conditions for Yang Ping, and at the same time take risks for Yang Ping.

Although the general on duty can also be dispatched, but he will not be as attentive as Director Han. Once Director Han communicates with Director Shi, he will know who you need, and he will transfer Director Ji over immediately, instead of calling a doctor casually. Handle.

"Have you communicated with the patient?" Director Han asked.

Yang Ping nodded: "Just now we have communicated and signed the contract. The patient himself communicates very well. Her mother, I think, is not very kind. She is always evasive, doubting this and that."

Director Han hummed: "She is an adult, as long as she agrees, the family members don't need to worry about it, Xiao Zhang, bring the medical records here."

Zhang Lin immediately brought over the medical records. Director Han looked through the medical records and signed his own name in front of Yang Ping's name on the informed consent form for the operation.

"According to your ideas, I will take care of things. As doctors, how can we not take risks? As long as we proceed from the interests of patients, make full preparations, and control the risks. I have to make a phone call later. To Lao Zhao from the medical office, this kind of family members have problems, potential dispute cases, and file a case with them in advance."

Director Han handed over the medical records to Zhang Lin. Professor Zhang beckoned and took the medical records, adding his own name: "Let's go and do it. This case is relatively rare. Remember to collect the information."

"Xiao Wu, you are in charge of collecting information. Song Zimo and Zhang Lin will come on stage with me, and Fatty will be anesthetized." Yang Ping made arrangements on the spot.

"The Intervention Department called and asked us to send patients. They came with two doctors and a nurse and opened a hybrid operating room for us." Song Zimo answered the phone and said.

Su Yixuan took Zhou Can and hurriedly pushed the surgical instruments and microscopes to the interventional operating room. Orthopedic surgery required a lot of specialized instruments. Spinal surgery had a complete set of spinal surgical instruments. The hybrid operating room of the interventional department only had some general-purpose instruments and no orthopedic specialized instruments.

"Let's go, send the patient!" Director Han mused.

Zhang Lin Xiaowu sent the patient, and pushed Fang Xiaoyun to the interventional operating room on a flat cart. The interventional operating room was located on the second floor of the emergency building, and the chest pain center was also located there.

The flat car of the comprehensive orthopedics department is newly bought, with inflatable wheels and shock absorbers, and there is no too much sound or vibration when pushing it. Fang Xiaoyun's mother followed behind: "Hey! Hey! Hey! What are you going to do—— "

"You talk so much nonsense!" Chang Juan blocked her, for fear that she would do something wrong and affect the doctor's work.

There are barrier-free passages between the buildings, and the flat car is hurriedly pushed to the interventional operating room. Director Ji is already waiting in the operating room with his assistants and nurses.

"Old Zhang! Director Han!" Director Ji greeted respectfully.

"Doctor Yang!" Director Ji also greeted politely, but the others ignored him.

Now Yang Ping is also a celebrity in the hospital. Everyone knows his ability. The hospital is a place where technology is king. If the technology is good, everyone respects it in their hearts; Definitely look down upon.

"This patient is considering spinal dural arteriovenous fistula? The operation time will be longer, and it is necessary to super-select blood vessels one by one, to conduct experiments, and there is a possibility of failure. I will try my best."

Director Ji spoke very truthfully, but he was very happy. He had never encountered such a rare case before. When he was studying in Fuwai, he heard from the teacher. Now that he has encountered it in the clinic, he is naturally happy.

Professor Zhang encouraged him and said, "Don't worry, I've done DSA for this kind of patient. If you do it, I'll watch it for you in the audience."

That would be the best, the older generation of doctors are not like now, they can only guard their own one-third of an acre of land.At that time, it was normal for them to dabble in some crossover techniques, and many old doctors could take X-rays themselves.

"A week ago, this patient had an embolism in the anterior spinal artery of chest 9. During the operation, the thrombus was cut off and re-anastomized." Yang Ping introduced, and then Zhang Lin introduced the patient in detail.

Director Ji said: "The amount of contrast agent during the operation must be strictly controlled, otherwise re-embolization may easily occur."

After the handover of the condition was completed, the young doctor under Director Ji signed the informed consent of DSA and the informed consent of iodine contrast agent to the patient.

Fatty was given anesthesia, endotracheal intubation and general anesthesia. The people in Yangping’s team were different. Fatty’s anesthesia was fast and good. He was still talking here, but he was numb there and could brush his hands.

Director Ji admired this young team with excellent professional quality. This fat anesthetist is much better than his anesthetist. His anesthetist is afraid of this and that.

"Then let's do the DSA of the spinal artery first, and we'll do the puncture of the femoral artery one by one. It's estimated to take five or six hours. Why don't you go out and have a rest first."

Director Ji, assistants, and nurses put on lead clothes. Everyone found lead clothes to wear. Professor Zhang also wanted a lead clothes. Older people will be very uncomfortable.

"We are now doing DSA in the supine position to find the fistula, and then change to the prone position for you to perform the operation, is that okay?"

Director Ji returned after brushing his hands, sanitized the shop sheets, put on his clothes and put on gloves.

"Thank you, Director Ji!"

"It's okay, they are all doctors. This kind of thing happens often. Today is my wife's birthday. I said to have a meal with her. I just sat down and a call came. There is no way. Who made us doctors."

Can I change someone?
It's not necessarily possible. For this kind of case, you must have a doctor with good skills, so the success rate is high.

Director Ji is in his 40s, with gray hair and a thin body. He is one of the directors of the Intervention Department.

The interventional department is divided into several wards, neurological interventional group, cardiovascular interventional group, and tumor interventional group. Old Ji belongs to the cardiovascular interventional group, which is an important part of the chest pain center.

Lao Ji came from the Department of Cardiovascular Medicine. After he got married and had children, he started to engage in interventions. Generally, those who engage in interventions are often exposed to X-rays. Those who are not married and have children are not willing to do it. The hospital will not pick people who are unmarried. Pick inside.

The femoral artery was punctured, and the catheter guide wire was inserted. Lao Ji was proficient in his movements, and the first interspinal artery was successfully super-selected.

It can only be checked one by one. Too much contrast agent will not work, nor will it be too little. The dose must be accurately controlled, and the technique of blood vessel superselection must be gentle and precise.

"Push the contrast agent, Omnipac!"

Omnipaque is a non-ionic iodine contrast agent, which is a safe intraspinal contrast agent. For spinal angiography, a contrast agent that can enter the spinal canal must be selected.

"Okay, that's enough, less, right? Mr. Zhang!" Old Ji asked Professor Zhang.

"Yes, too much, it is easy to cause embolism." Professor Zhang has comprehensive knowledge and experience.

"Yes! When I went to Fuwai for advanced training, a colleague said that there was a spinal arteriography in their hospital. After the angiography, the spinal cord artery was embolized, causing spinal cord blood supply disorder, spinal cord ischemia and necrosis, paralyzed, and the lawsuit was filed. For several years, it is better to have fewer high-risk factors."

But too little can not play a developing role, so the grasp of the amount must be very sophisticated.

"No, the next one!"

There are 24 intercostal arteries alone, and this is just the beginning, and one blood vessel cannot be fixed within ten minutes.

"Mr. Zhang, why don't you go out and rest for a while? I'll just stay here."

Director Han was afraid that he would not be able to bear it, so he stayed up late and wore such a heavy lead suit.

Professor Zhang waved his hand: "It's okay. I have experience in this kind of cases and have done this kind of DSA. I can give them some advice. Go out and have a rest outside. A few boys will have surgery later."

Professor Zhang's tone was stern, more like an order. He was out of the idea of ​​protecting young people. After all, everyone is not married and has children, so as to minimize X-ray exposure.

"It's okay, I'm inside, I want to see how the radiography is going." Yang Ping also wore lead clothes, and everyone wore lead clothes.

Professor Zhang lost his temper: "Why are you so disobedient, you go out as soon as you are told, there are so many people watching the fun!"

Director Han immediately ordered Yang Ping: "As long as Professor Zhang and I stay inside, you all go out, do you hear me?"

Five or six hours of X-ray exposure cannot be completely protected by lead clothing, and surgery will be required later. Orthopedic surgeons often deal with X-rays and try to avoid unnecessary exposure.

Well, Yang Ping took everyone out to rest in the locker room.

Relying on taking a nap, if Director Ji finds a fistula, he will call everyone.

(End of this chapter)