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"Doctor, please give me a piece of cotton.……"

Zhou Yuan took a look and took a piece of cotton."Here, one."

"……"

Zhou Yuan:"Are you going to plug the left ear or the right ear?"

Soon, another circumcision was completed.

Several doctors in the urology department were itching to do it, and the next operations were divided among them.

Zhou Yuan, who was no longer of use, was sent back to the emergency department, and earned a commission from the operation.

A circumcision operation takes a very short time, about ten minutes, and Zhou Yuan can get one or two hundred yuan.

However, this kind of money is extra income for urology doctors. After all

, there are only so many birds, and circumcisions are only performed during the winter and summer vacations every year. Who would come to the hospital for a circumcision at other times?

After returning to the emergency department, Zhou Yuan rested for a while, and the sound of the ambulance sounded again.

Zhou Yuan hurriedly got up and was about to walk out when he saw the panicked Zhang Ling running over.

"Doctor Zhou, something bad has happened.……"Zhang Ling leaned against the wall and gasped.

He felt a little proud: It seems that Zhou Yuan and I have a telepathic connection! There is no need to call him now!

Zhou Yuan ran over with Zhang Ling and asked,"What's going on?"

"An old man got off the ambulance. He had severe abdominal pain and couldn't even walk, so they sent him here by ambulance."

Zhou Yuan nodded:"Where was he sent to?"

"In observation room No. 1, observing the situation now!"

Zhou Yuan immediately went to observation room No. 1.

He Jianyi was also in the observation room at this time, looking serious.

"Teacher, what's wrong?"

He Jianyi sighed:"The patient's condition is a bit complicated.……"

""It's complicated?"

He Jian handed the medical record to Zhou Yuan and said,"The family members who came with the car brought the old man's medical record. Take a look.……"

Zhou Yuan immediately opened it.

The old man's name was He Jianguo, he was 72 years old, and he had primary IgA disease.

The clinical symptoms of patients with primary IgA disease include abdominal pain, back pain, muscle pain or low fever. A few patients have persistent gross hematuria and varying degrees of proteinuria, which may be accompanied by edema and hypertension.

This disease is not easy to identify and is likely to be confused with lupus nephritis, purpuric nephritis, and latent nephritis. Severe primary IgA disease has similar symptoms to chronic glomerulonephritis.

"Past medical history: hypertension, gout……"

Like most elderly people, He Jianguo suffers from a variety of illnesses and can almost be called a medicine jar.

"Have you done hemodialysis before?"

Zhou Yuan carefully examined the hemodialysis case.

On July 7, 2017, a cuff dialysis catheter was implanted in the right internal jugular vein, and hemodialysis treatment was started at the same time.

On September 25, 2017, a laparoscopic peritoneal dialysis catheter was implanted, and peritoneal dialysis was started at the same time, and the cuff catheter placed two months ago was removed. On May 21, 2018

, an autologous arteriovenous fistula was performed in the left forearm, but during this examination, it was found that the patient's compliance with peritoneal dialysis was poor and the ultrafiltration was poor, so it was planned to switch to hemodialysis.

On September 8, 2018, acute peritonitis suddenly occurred, and it was decided to perform fistula surgery, and the peritoneal dialysis catheter was removed at the same time, and outpatient dialysis was performed regularly.

2018-11-24. Due to insufficient flow of the fistula, color Doppler ultrasound revealed venous outflow stenosis, and fistula balloon dilatation was performed. After three years of dialysis, there were various complications and physical illnesses.

There is no doubt that this is a critically ill patient, and an accident may happen if you are not careful.

Zhou Yuan walked forward and carefully checked the forearm cephalic vein, and found that the cephalic vein in the forearm was pulsating strongly, but the tremor became extremely weak.

"Teacher, do you want to do color Doppler ultrasound?"

He Jian nodded,"I have already done the color Doppler ultrasound, and the results will be out soon."

Soon, the color Doppler ultrasound results came out.

Zhou Yuan took a look and said,"The cephalic vein aneurysm in the upper forearm has expanded, accompanied by thrombosis. The blood returning to the heart has flowed into the side branches, forming a thrombus, and the venous return has been blocked."

"There are two venous thrombosis, cephalic vein thrombosis and perforating vein thrombosis."

"Teacher, I suspect that it is high venous pressure with pain from fistula."

He Jian nodded:"I also suspect that it is high venous pressure with pain from fistula, and the thrombosis is serious. It may need to be cleared. I just don't know how the thrombosis is."

""The vascular surgery doctor will be here soon." Haiyang said.

Soon, several doctors in white coats came in. After a careful examination, they said with a serious look,"The patient is very old and a high-risk patient. He also has multiple diseases, so the operation is very difficult."

"Doctor, please save my dad!"A middle-aged man said

"Didn't they say that hemodialysis can help you live for a long time? Why can't it work now?……"The other middle-aged woman was He Jianguo's daughter.

The vascular surgery doctor said solemnly:"The operation is too difficult. The blood clot is difficult to clear, and the patient's body function may not be able to support the entire operation.……"

"Why not perform great saphenous vein grafting?"

Zhou Yuan, who had been checking the results, suddenly said.

He Jianyi and others were stunned.

Zhou Yuan continued:"The patient's elbow vein has a thrombosis. Block the main blood vessel with thrombosis, and then establish a pathway back to the heart through collateral reflux."

"I have seen the color Doppler ultrasound. Although the blood clot is blocked here, the bypass blood vessels are unblocked. My idea is to block the blood vessels first, cut open the blood vessels to remove the clots, and open the perforating veins."

"Why not abandon the fistula and implant a cuff catheter for dialysis?"A vascular surgeon asked.

This is also a solution, of course, there are also huge risks.

"This method is indeed possible, but considering the patient's advanced age and many health problems, the success rate of abandoning the fistula and then implanting a cuff catheter for dialysis is almost zero. Even if it is successful, it will take a long time for the patient to recover."

"But... performing a vascular transplant is also very difficult.……"

Zhou Yuan didn't say anything. He picked up a marker and started to draw on the old man's arm, marking the thrombus positions of the upper end of the forearm cephalic vein, the anastomosis, the basilic vein of the upper arm, and the thrombus position on the superficial surface of the skin.

Zhou Yuan pointed to the thrombus position of the perforating vein and said,"There is a thrombus here, so we can do a vascular transplant here.……"

As he spoke, Zhou Yuan took a marker and connected the thrombus-bearing vein with the basilic vein on the outside of the upper arm:"In this way, the blood in the basilic vein of the upper arm can also enter the perforating vein, and blood circulation will be restored!"

Several doctors in the vascular surgery department were stunned. This idea... connecting the basilic vein next to the perforating vein to restore blood circulation and solve the thrombus problem was something they had never thought of.

"But... this operation is very difficult!" A vascular surgeon raised the biggest problem.

Zhou Yuan smiled and said,"If it can be solved with technology, it is not a problem."_

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