Start From Emergency Doctor

Chapter 77

“Zhou Yuan, can you still hold on…”

He Jian saw that Zhou Yuan’s face was not so good, and asked distressedly.

He knows Zhou Yuan’s inner struggle and pain.

but……

This is something that a doctor must experience when he grows up.

Only by handling these well can you become a good doctor!

“Begin to remove the right lung.”

After a few seconds, Zhou Yuan opened his eyes and said.

Because Zhou Yuan chose sequential bilateral single-lung transplantation, the surgical sequence is to first remove one lung, perform one lung transplant, and then remove the other side and transplant the other half of the lung.

“Why the right lung?”

As He Jian asked, he passed tissue scissors, vascular clamps, and so on.

He is not an expert in this area, so naturally he is not clear.

Zhou Yuan smiled and said: “The donor lungs are in better condition than the left lung. The right lung transplant must be performed first.”

“How did you tell?” He Jian was taken aback.

Zhou Yuan: “Intuition.”

He believes in his intuition for master-class double lung transplantation.

Zhou Yuan raised his head and glanced at 26. Another thoracic surgeon had already transferred to Operation Room No. 1 to continue processing the remains of Chuchu’s father.

The same group of people in the operating room.

“Prepare to separate the right lung.” Zhou Yuan said.

“Tissue shears.”

Zhou Yuan carefully trimmed the adhesive tissues of the right lung and chest wall, mediastinum, and diaphragm to expose the pulmonary arteries and veins in the surgical field.

He Jianyi and others have seen this kind of skillful operation much, but when they saw it again, they still couldn’t help wondering: even if they started practicing surgery in the mother’s womb, they weren’t so skillful…

“Knife.”

Zhou Yuan put down the tissue shears and said again.

Between receiving the knife, Zhou Yuan raised his head and glanced at the time.

It took half an hour for the removal of the donor lungs in Operating Room No. 1, and now it has been 17 minutes.

“Vascular clamp.”

Zhou Yuan took the scalpel steadily and slowly opened the ditch in the room.

“Left atrium clamp.”

He Jian had already been waiting by the side in the morning, placing the left atrium clip on the anatomical part of the inter-chamber sulcus.

“Swan-Ganz catheter.”

Swan-Ganz catheter, also known as pulmonary artery floating catheter, is a kind of expensive and difficult-to-source material. It is suitable for patients who need to perform complex breathing methods to support their life activities.

For example, double lung transplantation, myocardial infarction, cardiovascular surgery, etc.

Zhou Yuan took the Swan-Ganz catheter and pushed it into the left pulmonary artery to allow the left lung to perform one-lung ventilation and maintain the patient’s normal respiratory activity.

“Do you want to open the left pleural cavity?” Lu Chenxi asked.

Zhou Yuan shook his head: “No, keep the pressure difference so that the left lung can ventilate easily.”(Read more @ wuxiax.com)

Having said that, Zhou Yuan began to test the patient’s pulmonary artery systolic blood pressure and respiratory activity after the Swan-Ganz catheter was placed.

The result is not ideal. Even if the Swan-Ganz catheter is added to the left lung, it is difficult to ensure that the patient breathes normally.

“Establish an extracorporeal circulation system.” Zhou Yuan said immediately.

The extracorporeal membrane oxygenation system previously applied to the dean came in handy.

Soon, the patient’s extracorporeal blood circulation is completed.

The bright red blood flows in the transparent tube, and then it passes through the power pump equivalent to the artificial heart, passes through the oxygenator equivalent to the artificial lung, passes through the blood vessels of the patient’s body with sufficient oxygen, and then returns to it. Inside the hose.

Everyone in the operating room has long been used to this scene, and there is no surprise.

“Maintain pulmonary artery systolic pressure below 4kPa.”

Director Lin nodded: “Understood.”

Zhou Yuan: “Scalpel.”

He Jianyi stepped forward and freed the pulmonary artery with tissue forceps.

Next, Zhou Yuan cut off the patient’s first branch of the pulmonary artery and the descending limb, and cut off the pulmonary vein at the distal end.

“The bronchus is left.”

Zhou Yuan picked up the tissue forceps and the scalpel again, and cut the main bronchus at the proximal end of the upper lobe of the right lung.

At this point, the removal of the right lung has basically been completed.

“Start taking out the right lung.”

As Zhou Yuan said, he slowly lifted his right lung out and handed it to the nurse who had already prepared the equipment next to him.

“Now, start separating the right lung from the donor lung.”

Because the donor lung is already free from the human body, there is no need to process the surrounding blood vessels, and the operation is much simpler.

“Start right lung transplantation.” Zhou Yuan gritted his teeth and said weakly.

The right lung was inserted into the patient’s right chest.

“Bronchial anastomosis.” Zhou Yuan said.

“4-0 can absorb monofilament thread.”

Zhou Yuan took the needle-holding forceps from Lu Chenxi and started the bronchial anastomosis.

Continuous suture was used here. Zhou Yuan sutured one thread to the end. In the bronchial cartilage part, Zhou Yuan changed to a 4-0 suture with needle. Because this is not continuous, Zhou Yuan used intermittent suture.

“Anastomosis of the pulmonary artery.”

He Jianyi and others recovered from the suture, and Lu Chenxi immediately clamped the patient’s right pulmonary artery on the proximal side with a vascular clamp.

Zhou Yuan exposed the pulmonary artery of the donor lung, preparing to perform an anastomosis with the pulmonary artery of the recipient’s lung.

Generally speaking, the donor lung and the recipient’s pulmonary artery need to be trimmed before anastomosis, so that the caliber, the shape of the vascular gap, etc. correspond.

However, since the pulmonary arteries of the donor lung and recipient lung are both handled by Zhou Yuan, Zhou Yuan has already considered this before cutting the pulmonary artery.

So, after a simple repair of the caliber, Zhou Yuan directly started stitching.

This step made He Jianyi, Lu Chenxi, and Director Lin feel incredible.

A cut in the pulmonary arteries of two people was able to achieve a basic anastomosis…

This is too accurate!

“5-0 Prolene suture.”

Zhou Yuan quickly sutured the pulmonary arteries of the donor and recipient lungs.

“The next step is to fit the atrial sleeve.” Zhou Yuan said.

Director Lin was taken aback: “So fast?!”

He glanced at the time, it was only four hours…

After Zhou Yuan asked the instrument nurse to wipe the sweat, he clamped a vascular clamp on the left atrium near the pulmonary vein of the recipient to block the blood flow, and then removed the pulmonary vein stump that had been ligated during the previous operation.

“Connect the upper and lower pulmonary vein openings.” This step is to form the left atrial sleeve to protect the atria and blood vessels.

Zhou Yuan then anastomosed the corresponding blood vessel of the right lung with the blood vessel of the recipient’s lung. After proper trimming, he began to suture.

After a long time, Zhou Yuan put down the needle holder and breathed a sigh of relief.

“The right lung transplantation is complete.”

Zhou Yuan glanced at the time, 4 hours and 51 minutes.

Faster than expected.

“Are you okay?” He Jian asked as soon as Zhou Yuan’s face became paler.

Zhou Yuan clicked: “It’s okay, teacher, I can hold on.”

Although the vitality medicine does not have the function of replenishing physical strength, the incomparable mental fullness will be fed back to the body, which makes Zhou Yuan’s body feel much better.

“Let’s go ahead, there is a left lung transplant.”

After Zhou Yuan finished speaking, he placed the Swan-Ganz catheter in the transplanted right pulmonary artery and said: “Remove the extracorporeal circulation system.”

Director Lin in charge of cardiopulmonary bypass was taken aback.

“Zhou Yuan, do you want to… ventilate with newly transplanted lungs to support life activities?”

The right lung has just been successfully transplanted, and the blood vessels have only been dredged soon. Is it really possible to do it…….