medical simulator

Chapter 197 Beautiful Gift! (Please subscribe!)
The subsequent meeting process is going on normally, and nothing has changed.

Cai Dongfan listened for a while, then called Luo Yun and asked Luo Yun what his plans were, and Luo Yun replied that he had nothing to do.Then Cai Dongfan quickly took Zhou Chengxian to yo-yo.

The main reason is that the eyes of the people next to him are too hot, they always come to find out the news, or they are surprised by Zhou Cheng's previous operation and focus their eyes on this side.

Cai Dongfan had a thick skin, but he couldn't stand such fiery gazes: "Zhang Zhengquan, Yan Jun, you guys take a taxi back later, I'm going out first, I have something to do."

"Okay!" Du Yanjun and Zhang Zhengquan both nodded.

I even felt that once Zhou Cheng and Cai Dongfan left, the pressure on them was reduced a lot. Before, they had been wandering around non-stop, which put a lot of pressure on the two of them, and they were very uncomfortable.

"Brother Quan, Brother Zhou Cheng is really awesome today." Du Yanjun breathed a sigh of relief.

Zhang Zhengquan also nodded: "Yeah, Brother Zhou Cheng is really awesome. Everyone around here is looking at him with fiery eyes, even worse than seeing a doctor from the Affiliated Hospital of Shonan University."

When Du Yanjun heard what Zhang Zhengquan said, he seemed to think it made sense.

It seems that the appearance of Zhou Cheng broke the theory of academic supremacy at least on a personal level!

……

Originally, Cai Dongfan planned to take Zhou Cheng to eat, preferably the kind where he could find a place to have a drink, chat, and talk alone.

But as soon as he got in the car, he saw that the phone rang, and Zeng Yi actually called.

Cai Dongfan didn't answer the first time, but Zeng Yi called again.

Cai Dongfan hesitated a little, and after taking it, he listened for a while before saying, "Director Zeng, are we still at the venue? It will take a certain amount of time to come to the operating room now."

Zeng Yi said, "Cai Dongfan, can you do me a favor and rush to the hospital? Dean Zhang is in the operating room right now, and Director Huang of the vascular surgery department is also here."

"Okay!" Although he said, Zeng Yi's phone call disrupted Cai Dongfan's arrangement.

But, as a member of the department, as a doctor, you can never imagine when the emergency department will come, and in what strange way it will come!

After hanging up the phone, Cai Dongfan said to Zhou Cheng: "The Department of Orthopedics came to the emergency department and needed amputation. It is an acquaintance of Director Zhang. Director Zeng called us to help."

"This wine seems to be undrinkable." Cai Dongfan said helplessly.

Hearing this, Zhou Cheng moved his heart and said, "Teacher Cai, we originally made an appointment with Teacher Luo Yun and Professor Liu to have dinner together, and then send them back to Shanghai. If we don't have time, why don't we call them in advance?"

The arrival of the emergency department will disrupt many plans, but doctors still have to focus on patients, although they don't have to go.

But if you hear the call, if you have time and ability, you still have to be there.

Cai Dongfan hurriedly said: "Oh, yes, you are driving, I have to make a few phone calls, I have several appointments tonight!"

Cai Dongfan has a lot of friends, and he likes to make friends, so today he has a lot of appointments, and it just happens to be dealt with together now.

Originally, the weekend annual meeting was a time to learn and build relationships...

But for work.

……

Zhou Cheng took his driver's license and drove to the downstairs of the No. [-] Hospital. Then Cai Dongfan also pushed all the bureaus, and the two ran directly into the operating room together.

And because of Zhou Cheng and Cai Dongfan's sudden disappearance, Luo Yun drank two glasses of wine, four or two, and was fined. In the end, Liu Yiping really couldn't find anyone to send Luo Yun home, so he directly called Luo Yun's address book The person who made the most calls, because they had to catch a plane, they couldn't deliver it in person...

When Zhou Cheng and Cai Dongfan went to the operating room, they saw it.

The instruments from the femoral artery in the vascular surgery department had not been removed before, and there were still many traces of black thrombus in the form of cords on the operating table. Zhou Cheng estimated that the person in the vascular surgery department might have removed the thrombus from the femoral artery or It was taken from the popliteal artery, the branches of the popliteal artery, and the proximal ends of the anterior tibial and posterior tibial arteries were also connected.

Obviously, after the vascular surgeon has completed the thrombectomy of a relatively large blood vessel, he has no way to go further.

One is that the distance from the femoral artery to the lower part of the knee joint is too far, and most of the space for manipulation has been lost, and without any imaging aids, they can't blindly guess where the artery should go next. go!

Seeing this, Zhou Cheng immediately exited the operating room, and then washed his hands as quickly as possible.

This patient is special, so the itinerant nurse assigned three directly. Even the dean Zhang Hongsheng was doing hemostasis on the surface of the liver on the operating table. Therefore, the itinerant nurse didn't even ask Zhou Cheng which department he was in, and just put it on for him. clothing.

……

After Zhou Cheng put on his clothes and gloves, he immediately came to the opening in Huangshi Nan.

In fact, the most suitable thrombectomy for this patient is incision and thrombectomy from the artery in the popliteal fossa. However, the patient also has an abdominal injury, and the popliteal fossa is behind, so he can only take the supine position!
Thrombosis will only harm the legs, and if the damage in the abdomen is not treated, it will also kill!

Therefore, Huang Shinan had no choice but to perform ultra-long-distance arterial balloon dilatation and thrombectomy from the femoral artery.

He also specially introduced to Zhou Cheng: "Xiao Zhou, last time you said that the equipment for thrombectomy is not good, we introduced this set of equipment."

"Yeah!" Zhou Cheng nodded hurriedly and said, "Director Huang, with equipment available, taking out the thrombus is less traumatic than incision and easier to take out, right?"

Zhang Hongsheng glanced at Zhou Cheng who was operating, but didn't say much, but chose to continue working on his abdomen with the general gastrointestinal surgeon.

After Zhou Cheng took Huang Shinan's position, he immediately extended the balloon down, and then followed the femoral artery to the popliteal artery.

Zhou Cheng turned a little bit in one direction, and then went straight into the anterior tibial artery!

The anterior tibial artery is somewhat simpler, unlike the branch of the posterior tibial artery that divides into the posterior tibial and peroneal arteries.

And the role of the anterior tibial artery is important, it can supply blood to the dorsalis pedis artery!
However, even taking out the thrombus in the anterior tibial artery is still useless, because there is still a thrombus in the dorsalis pedis artery, so Zhou Cheng has to do at least two accurate thrombus removal operations before he can truly let his lower limbs recover. Restore blood supply.

At this moment, Zhou Cheng's spiritual power was highly concentrated throughout the process.

Vascular endovascular catheterization has similarities with orthopedic arthroscopic surgery, but there are more differences. The catheter has been extended from the femoral artery to the anterior tibial artery. This is already a super long tube, no less than the catheter from The blood vessels in the neck extend into the blood vessels of the brain!

Moreover, this operation was performed without the assistance of angiography, so there cannot be a slight difference.

Otherwise, if the blood vessel is punctured, or the inner wall of the blood vessel is scraped, the intima of the artery will be torn again, and the patient cannot stand such a toss.

Finally, the front end of Zhou Cheng's catheter was about to touch the front end of the thrombus, and it became a little difficult for Zhou Cheng to move on.

The catheter is soft, but the thrombus is not soft, and it cannot penetrate violently. At this moment, the branch artery is almost only a little bigger than the catheter!
If it is larger, the balloon catheter will not be effective and will only push the thrombus further forward.

After Zhou Cheng felt the thrombus with his hands, with a little force, the catheter passed through the thrombus. When he got inside, he hadn’t gone halfway through, but when he pushed forward again, the anterior tibial artery was already pushed forward. The distal thrombus was pushed farther.

Zhou Cheng tried again, but the catheter still could not pass through again, so he could only inflate the balloon, and then began to pull back the thrombus that had passed through.

But not fast, if you pull too fast, it will damage the blood vessel, and it will easily cause the thrombus to separate from the bifurcation of the anterior and posterior tibial artery into other blood vessel cavities. In addition, it may push the blood vessel into the anterior recurrent artery of the knee joint go.

The recurrent artery of the knee joint and the anterior tibial artery are a bifurcation!

So this process must be careful, Zhou Cheng carefully controlled the direction of the proximal end of the thrombus in the blood vessel, and then slowly adjusted it, and then, finally!
Zhou Cheng brought the thrombus out of the common artery before the branches of the anterior tibial artery and the anterior recurrent artery of the knee joint.Then use the same principle to bring the thrombus back to the popliteal artery!

At this time, Zhou Cheng breathed a sigh of relief. Perhaps in the eyes of others, Zhou Cheng was entering and recovering the intravascular balloon catheter like an apprentice, so his movements were very slow.

But didn't they know that Zhou Cheng's balloon was carrying a heavy thrombus at the moment!
Moreover, when it is in a large blood vessel, pay attention to continuing to expand the balloon a little bit, otherwise, the lumen of the large blood vessel may be larger than the sum of the diameter of the thrombus and the expanded balloon in the small blood vessel, and then the thrombus will fall into the Unknown place!
Zhou Cheng dragged back slowly, and then took out the first thrombus!

"Itinerant teacher, can you get me another balloon catheter with the smallest size?" Zhou Cheng asked the itinerant nurse.

The itinerant nurse immediately agreed, without any hesitation, and quickly opened a thinner catheter and came to the stage.

Seeing Zhou Cheng take out the thrombus, Zhang Hongsheng and the other people who performed abdominal surgery didn't think much of it. Before Huang Shinan went out, he said that the patient had a lot of thrombus and it was widely distributed. It's not very big either.

That's why, when Zhou Cheng was operating here, even though he looked young, the patient's lower limbs were likely to be amputated, so there would be nothing wrong with letting Zhou Cheng practice his hands!
Zhou Cheng changed to a thin catheter, and when he felt it in his hand, he frowned fiercely.

The smaller the thing, the more uncomfortable the force in the longitudinal direction. The catheter must be wound at least several times from the femoral artery to the anterior tibial artery and even the farther dorsalis pedis artery and metatarsal artery!

In this way, it will be more difficult to bear longitudinal force and break through the thrombus, which requires more precise force control!
……

When Huang Shinan stood next to Zhou Cheng, he interrupted Zhou Cheng: "Xiao Zhou, where did you get this blood clot from?"

The catheter Zhou Cheng operated was very thin and long, so Huang Shinan estimated that it was at least taken out from the anterior tibial artery or the posterior tibial artery, and it was also taken from the distal end of the artery, because only the diameter there could be so thin. .Usually, Huang Yuanwu takes thrombus strips from the popliteal fossa, and can also take them into the anterior and posterior tibial arteries!
However, from the femoral artery, it is indeed a bit difficult to cross so many forks!

"Director Huang, this is the dorsalis pedis artery. The thrombus in the artery of this leg has basically been taken out, and there may be a thrombus in the dorsal metatarsal artery, but it can be ignored for the time being. The communicating branches of the foot are well developed." Zhou Cheng said with some regret, and gave up his seat: "Director Huang, it's up to you to verify whether there are blood clots in the inner and outer plantar arteries!"

Without arteriography, the specific location of the thrombus cannot be found, so Zhou Cheng said conservatively, and if the proximal thrombus is blocked, it cannot be visualized even with angiography, and a diagnostic thrombectomy is still required, integrating diagnosis and treatment change.

"Where? Where?" Huang Shinan thought he had heard it wrong.

The dorsalis pedis artery, as the name suggests, is the dorsum of the foot.

Brother, you are using the catheter in the femoral artery, why don't you go to get the thrombus on the moon?

Cai Dongfan also heard Zhou Cheng's anatomical structure, and immediately looked at the position of the groin and the dorsalis pedis artery that he usually touched, and scolded Zhou Cheng in his heart for being inappropriate!
And it's a real dog!
Usually they have more contact with Huangshinan. Huangshinan can reach the farthest end of the thrombus removal from the popliteal fossa, which is the distal end of the posterior tibial artery, peroneal artery and anterior tibial artery. Vascular surgery is relatively a blind spot.

There are too many blood vessel branches, even anatomical incision and thrombectomy will take too much time!
Zhou Cheng came up and called Huang Shinan to take the branch of the peroneal artery. Isn't this embarrassing Huang Shinan?
Of course, Zhou Cheng didn't mean it either. As long as everyone doesn't explain it clearly, it's fine.

"It's from the dorsalis pedis artery." Zhou Cheng was very sure, and then he saw Director Chen and winked at himself.

Zhou Cheng immediately understood: "Director Huang, why don't I continue to operate, and you can guide me from the side? This way I will feel more at ease."

So Huangshi Nanpei didn't have any thoughts for nearly four or five seconds, and then was interrupted by Zhou Cheng's speech, but he didn't dare to have the slightest temper, nodded and said: "Learn from each other, learn from each other!"

Huang Shinan immediately understood that Zhou Cheng was trying to save face and treated him politely.

Before, Zhou Cheng had experience in incision and thrombectomy. That was a limitation of the equipment, not that Zhou Cheng could not do it.

The others, Huang Shinan, don't know, but even Professor Zhang from the Department of Vascular Surgery at the Second Affiliated Hospital of Shonan University can't guarantee 100% access to the dorsalis pedis artery from the groin.

Although he didn't know how Zhou Cheng did it, Huang Shinan didn't dare to ask. He couldn't do it even if he asked, and he might not even understand it.Why bother?

At this time, Cai Dongfan also interjected: "Director Huang, you still have to work hard for Xiao Zhou, our orthopedic department. Dean Zeng, what do you think?"

Cai Dongfan knew that he wanted him to support Zhou Cheng at this moment. Everyone can say anything about the patient's success, but if there is any problem, Zhang Hongsheng needs to authorize him in the name of the hospital to avoid danger.

"Is it possible to keep these two legs?" Zhang Hongsheng asked Huang Shinan and Cai Dongfan.

He still has an understanding of the anatomy of the lower limbs, and he also knows what's going on with the dorsalis pedis artery, but it sounds futile, and he wants to get a solid answer.

Huang Shinan said conservatively: "If the thrombus in the dorsalis pedis artery and the medial and lateral plantar arteries can be removed, the possibility of limb salvage will increase by at least 50.00%. In the end, you don't need to be hospitalized to go to the orthopedics department. Just transfer to our vascular surgery department." !"

If Zhou Cheng could remove the arterial thrombus during the operation, then he would dare to dissolve the thrombosis after putting the filter in the vein!

In this case, the chances of giving it a go are still very high!
The patient lives in the vascular surgery department, which is still very good.

After all, even if you bleed after surgery, you can have another operation to stop the bleeding!With anticoagulation, everything will be fine.

Zhou Cheng didn't talk nonsense, and it wasn't time for nonsense at this time, he immediately inserted the catheter into the blood vessel again, and everyone couldn't see anything, but Huang Shinan, as the director of vascular surgery, saw that Zhou Cheng had turned at least four or five times. This means that Zhou Cheng has gone through at least three or four crossroads!

Oh my god, little brother, you really came here to mess with me, you did it so casually with the vascular catheter, it's like walking on the main road and turning four or five times.

If you pretend to be aggressive, you will be struck by lightning, don't you know?
Immediately afterwards, Huang Shinan saw that Zhou Cheng pulled the small thrombus out of the blood vessel twice, and in the process of pulling it back, he turned four times again, and it was obvious that he was Scalp numb!
These operations may seem ordinary to Cai Dongfan and others, but at this moment, Zhou Chengcheng is creating a miracle!
After the thrombectomy, Zhou Cheng and Huang Shinan started suturing together. After the suturing was completed!Free the proximal end of the femoral artery!

Huang Shinan immediately ordered the roving nurse very nervously to come up with a syringe needle!

At this moment, the blood vessel has penetrated from the femoral artery. If Zhou Cheng takes out all the thrombus, it means that the blood circulation at the end has been opened!

Hold the needle and poke it down from the thigh!

After piercing, traces of blood slowly flowed out one after another, it was dazzling bright red.

The bright red that looks bloody may not necessarily represent horror and nightmares sometimes, it may also be the miracle of life.

For the embolized lower limbs, especially the feet, isn't the blood dripping out at this moment a miracle of life?
　I rushed it temporarily, and I will change it tomorrow. I really don't have time.

　　
　
(End of this chapter)