godfather of surgery

Chapter 673 Devil Level
Yang Ping hurriedly rushed to the operating room of the interventional department, changed into hand-washing clothes, put on a sterile cap and mask, and rushed into the operating room.

The operation is in progress. Director Ji and Director Guan of the Interventional Department, the two chief directors have already taken office, which shows how difficult the operation is.

Director Guan was the chief surgeon, Director Ji was his assistant, and several young doctors were around the operating table, unable to help, so they could only watch.

Defibrillation!

Director Guan immediately stopped, the patient suffered cardiac arrest, and the monitoring screen showed dense ventricular fibrillation waves.

The anesthesiologist and nurse immediately defibrillated the patient.

After several defibrillations, under strong electrical stimulation, the patient's heartbeat recovered, and the patient screamed after recovery, possibly due to the influence of electrical stimulation.

Outside the operating room, someone was knocking and kicking the door frantically. It could be heard that several people were punching and kicking at the door at the same time.

"Xiao Yu, explain to the patient's family." Director Guan instructed his doctor, Dr. Yu.

Director Ji added: "Don't open the door, you go out from the locker room."

These directors all have experience. Once the door is opened, family members who are not aware of it will rush in, making noise and quarrels, and will not give up. This patient will definitely not be able to be rescued.

They don't know the danger of the operation, and when they hear the patient's cry, they think the doctor is abusing the patient.

The heartbeat recovered, and Director Guan and Director Ji continued the operation.

"Professor Yang takes the stage!" Director Ji felt at ease when he saw that Yang Ping had arrived.

"Chronic total occlusion of the coronary artery, the left main coronary artery is completely blocked, the two bifurcations of the anterior descending and circumflex branches are completely occluded + severe calcification, and the right main coronary artery is 90.00% blocked. Grinding treatment, the calcification of the blockage is as hard as a rock, and the condition is too dangerous and complicated, so please come and take a look." Director Ji quickly and briefly introduced the condition.

Director Guan focuses on interventional therapy of the cardiovascular system, while Director Ji is an all-rounder, proficient in almost all interventional therapy, including intracranial, tumor, etc.

Relatively speaking, Director Guan has deeper attainments in cardiovascular intervention, after all, he only focuses on this aspect.

Therefore, this operation is performed by Director Guan.

Obviously, Director Guan's back was soaked wet. This severe coronary artery occlusion still has rock-solid calcification. Not only the main trunk is severely occluded, but the two bifurcations are also completely occluded. Multiple complex occlusions are simply devil-level cases.

Coronary arteries are the blood vessels supplying the heart. They run on the surface of the heart and spread like a tree crown. They have trunks and branches. They are like oil pipelines that supply gasoline to automobile engines. Once blocked, the heart will lose power.

The coronary artery, which is an oil pipeline, is divided into left and right branches. When these two arteries and their branches develop atherosclerosis or vasospasm, the lumen will be narrowed or occluded.

When the coronary lumen stenosis exceeds 50%-70%, coronary circulation disorder will occur, resulting in insufficient myocardial blood supply, resulting in an imbalance of myocardial oxygen supply and demand, and obvious clinical symptoms such as angina pectoris. When the coronary lumen is completely blocked, the myocardial ischemia, hypoxia, necrosis, causing myocardial infarction.

At this time, interventional therapy is often required, and stents are implanted to open up the blood vessels.

This patient has severe blockage and severe calcification. The blockage is as hard as a rock. Ordinary instruments cannot open up the blood vessels at all. Instead, special rotational atherectomy instruments are used to grind away these "rocks" little by little to open up the coronary arteries. Stent expansion.

For bifurcation lesions, one is the main branch and the other is a branch, both of which are blocked, and the blockage is close to the bifurcation.

Because the diseased part affects the "fork" of the cardiovascular blood vessels, the surgical technique is particularly complicated, and the postoperative restenosis rate is particularly high. When multiple stents need to be implanted at the same time, if the two ends of the stents are not "anastomosed" well, the patient is very prone to relapse. Stenosis and thrombosis.

In this case, if the stent is simply implanted in the main branch, the plaque will be displaced under the extrusion of the stent, and sometimes it will be squeezed into the branch blood vessel, forming a new blockage, which will make things worse.

If stents are implanted in both the main branch and the branch, due to the close distance between the blocked parts, the two stents will fight and interfere with each other. With the current medical technology, it is impossible to cut the stents to fit the bifurcation in advance. cause a fight.

Therefore, for bifurcation lesions, it is necessary to implant stents to open up the blood vessels, but also to ensure that the implanted stents perform their duties without fighting and forming new blockages. This is the difficulty of treatment.

It not only solves the current problems, but also does not bring new problems, the interventional treatment of coronary bifurcation lesions is extremely difficult to operate.

The rock-hardness, combined with the intricate splits, doubles the difficulty.

"CCTV technology must be used!" Director Guan added.

This is a double-stent procedure, which can be summarized as "CCTV": C-crushing series stenting: classic crush, DK-crush, mini-crush, step-crush; C hakama series stenting: classic and modified hakama Stenting; T series stenting: classic and modified T stenting, V series stenting: classic and SKS stenting.

This kind of patient is completely blocked. In this situation, the blood vessels must be opened as soon as possible, so that the ischemic myocardium can obtain blood supply.

Yang Ping quickly brushed his hands, put on a lead coat, and then, with the help of the roving nurse, put on a surgical gown and sterile gloves.

"Professor Yang, Director Ji said that you have done a lot of work. Are you sure you can get through these blockages quickly?" Director Guan was also unequivocal.

Yang Ping just glanced at it. Although he usually doesn't pay much attention to intervention, the training in the system space is training as a basic technology.

When in the United States, Yang Ping used interventional technology to rescue astronauts, which was not a problem for him.

After the operation reaches a certain level, it will be all-in-one.

"It's not a big problem!" Yang Ping answered decisively.

In Professor Yang's mouth, the problem is not big, that is, there is no problem.

The patient's heart stopped again! .

Defibrillation!Defibrillation!Defibrillation!

Today, whether this patient can come back, Director Guan has no idea at all. This is the most difficult and dangerous patient he has ever encountered. The rotational atherectomy device does not dare to be too aggressive, for fear of breaking the blood vessels.

Bang bang bang!
The sound of punching and kicking outside the operating room kept coming and going.

However, since President Xia implemented the hospital's safety plan, the doors of these operating rooms have been replaced with explosion-proof doors, and they can kick and beat them at will.

The anesthesiologist and nurse started to defibrillate the patient again. Director Guan shouted, "Xiao Yu! What's going on?"

Dr. Yu went out and was still explaining to his family, but apparently it didn't work.

"Don't open the door! Rescue first!" Director Ji was afraid that the doctor under the stage would accidentally open the door and the family would rush in, and everything would be over.

After several defibrillations, the patient's electrocardiogram showed normal QRS complexes again. Director Guan immediately gave up his position and Yang Ping came up.

Let Yang Ping come, just hoping to be quick.

"Do you want to use intravascular ultrasound again?" Director Guan reminded Yang Ping.

"No need!" Yang Ping felt that it was a waste of time to look again.

He took over the equipment, and the miniature "diamond drill" began to perform rotary grinding on the hard calcified stove. Compared with Director Guan, he was obviously bolder and more exaggerated. Director Guan saw Yang Ping's exaggerated operation, and his heart thumped.

"It's okay, he's sure!" Director Ji stabilized Director Guan.

The rotational atherectomy head is always aimed at the calcified foci and will not contact the vessel wall. Under the bold and aggressive operation, the rotational atherectomy head is vigorously performed, and the first blockage is slowly opened up.

Immediately afterwards, Yang Ping began to overcome a blockage.

This kind of operation is undoubtedly racing in the downtown area, which is Yang Ping's consistent style.

Director Guan's throat was dry and he kept swallowing saliva. He was afraid that Yang Ping would wear out the walls of the blood vessels. Director Ji looked very calm and said, "Yi Gaoren is bold, don't worry!"

(End of this chapter)