Seeing Tanglou speechless for a moment, Doctor Tian suddenly lost his temper: "Doctor Tang, you don't know how to do it, right?"

Faced with Dr. Tian's doubts, Tanglou felt embarrassed. He was just a doctor from the No. 1 City Hospital who came for further training. Wouldn't it be natural? Besides, at his prime age, wouldn't it be reasonable?

.

Doctor Tian seemed to understand the matter-of-factness in Tang Lou's eyes, swallowed his saliva, and looked at Doctor Wang aside. Doctor Wang moved to the side, lowered his head, and did his own trick.

Doctor Tian coughed lightly: "Doctor Tang, should I go find Director Huang to save the situation now?"

[Ding, new mission: temporary rescue, help colleagues fight lightning. Mission reward: 5 gold coins, the card library is refreshed once.]

Tang Lou directly redeemed it for a three-star valve replacement surgery (three stars, 27), and countless information and cases entered Tang Lou's mind.

Seeing that Tanglou was still silent and did not say a word, Dr. Tian also made a decisive decision: "Doctor Wang, please contact Director Huang immediately to come to the rescue."

"No, I'll take over."

Tanglou withdrew from the system space, looked at Dr. Tian and said.

"Doctor Tang, you!"

"Oh, I just recalled it again and deduced it in my mind. It's almost OK."

Tanglou said casually.

"Dr. Tang, this is no joke. If the mediastinal pericardial adhesion is separated and not done properly, it may cause a medical accident."

"Get out of the way! Instrument nurse, scalpel...scissors..."

Tanglou stood forcefully at the position of the surgeon. Under the aura of the surgeon, Dr. Tian stood aside and swallowed the words he wanted to persuade.

Doctor Wang was a little at a loss: "Go, or not!"

"Let's take a look first."

Doctor Tian, ​​after thinking about it, Doctor Tang's reputation is still there. If it were a young doctor, he would have been sprayed to death by him long ago.

"The extent of pericardial adhesion separation during revalvular replacement surgery should vary based on the number of reoperations, the severity of pericardial adhesions, and the type of surgery."

Tanglou started to operate and explained at the same time.

"Huh?" Dr. Tian was confused on the spot. He still looked unfamiliar just now, but now he suddenly started teaching. Although he had some doubts in his heart, he still nodded instinctively.

It’s indeed the internal flavor you’re talking about!

“Keep in mind that when performing pericardial separation in the future, you must not be able to separate all the pericardium. Although extensive separation can overcome surgical difficulties, it increases the chance of damaging the myocardium, and often leads to extensive bleeding that is difficult to control after surgery. It can also cause

The increase in operation time also increases the risk of surgery."

At this moment, under the three-star spell, Tanglou was speaking out really good advice, which was the experience summed up from countless cases.

Dr. Tian on the side was still a little nervous before. When he heard this, he seemed to have returned to the demonstration surgery yesterday. He chewed and savored the explanations of Tanglou, and then he felt like he had found a treasure!

"Then Doctor Tang, how should we separate better?"

Dr. Tian asked for advice seriously.

"The so-called limited separation is to separate the operating area to meet the operating requirements of the main surgeon. Of course, you cannot imitate my current degree of separation. After all, the operating area I need is relatively limited.

"

Tanglou was naturally afraid that these two mediocre men would try to imitate others. After all, not everyone had his solid basic skills and superb talent in martial arts.

"Understand."

Dr. Tian and Dr. Wang nodded. They still had some self-awareness, but they were a little angry.

"Electric knife..."

Tanglou issued an order, and the equipment nurse immediately cooperated.

With the electric knife in hand, Tang Lou quickly operated and taught: "The principle of separating adhesions is to use the electric knife or scissors to separate sharply without damaging the epicardium. Generally, the pericardium is cut longitudinally at the interventricular groove first.

, gradually expand toward the right atrium and both sides of the right ventricle to expose the right atrium and part of the right ventricle."

Tanglou explained the tips and quickly completed the operation.

"Furthermore, when separating pericardial adhesions, you can use electrosurgical cutting or sharp scissors to separate them closely to the parietal pericardium to avoid damage to the myocardium and coronary blood vessels. The operation should be gentle to prevent heart compression, which may cause cardiac rhythm disorders or cardiac arrest.

Patients with poor myocardial function must first intubate the vena cava and aorta, connect them to the extracorporeal circulation machine, and prepare for bypass before separation. When separation of the ventricular and diaphragmatic surfaces is difficult, it can be performed after bypass to avoid separation during pulsation.

Causing myocardial tear."

"Doctor Tang, you are so amazing!"

After Dr. Tian listened to Tanglou's explanation, he seemed to understand but suddenly became enlightened.

Doctor Wang listened attentively and looked at Tang Lou with admiration in his eyes. After all, he was a few years older than Tang Lou.

"Oh, this is talent."

After completing the separation of mediastinal pericardial adhesions, it is time to start establishing extracorporeal circulation.

"Because the patient has heart failure and pulmonary edema, an ultrafiltration device must be used... to expose and separate the common femoral artery and femoral vein. If necessary, intubate to prepare for femoral-femoral diversion to prevent pericardial adhesions during separation.

Bleeding occurs; prepare enough blood and prepare three aspirators connected to the extracorporeal circulation. Once bleeding occurs, ensure that it is returned to the circulating blood circuit device in time..."

Tanglou continued to operate, and at the same time introduced the treatment plans for various situations in detail one by one.

"Dr. Tang, your knowledge is too broad. If I hadn't known that you could learn the surgery at a glance, I would have thought you had performed hundreds of re-valve replacement surgeries."

Doctor Tian looked at the tenement building and was filled with emotion.

Under Tanglou's steady operation, the establishment of extracorporeal circulation was quickly completed.

"The next step is myocardial protection. Since the patient's preoperative cardiac function was poor, and it was an emergency operation, there was insufficient blood supply to the myocardium. Moreover, the entire operation was complicated, the aorta blocking time was too long, and the patient's left ventricular adhesions,

There are ice chips on the surface of the heart to cool down, so before valve replacement again, you must pay attention to strict protection of the myocardium. This is also an important part of the success of the operation."

Dr. Tian and Dr. Wang naturally nodded obediently to Tang Lou's very serious education. They did not feel disgusted at all because of Tang Lou's age. Instead, they were filled with gratitude. Following Tang Lou's surgery, they really learned a lot.

A lot of things.

Especially for a doctor like Dr. Tian who seems to be confused but only needs this last step. With the high-level leadership of Tanglou, he will be confident that he can perform the surgery independently next time.

"Cool the whole body by 26°C...cold-blood cardioplegia..."

Tanglou continued to issue instructions. Since the next operation was more complicated, Tanglou focused less on explanations and more on operations.

Dr. Tian watched Tanglou’s operation with full attention: “Antegrade perfusion is used for mitral and tricuspid valve surgeries; antegrade perfusion is used for aortic and double valve surgeries for the first time, and retrograde coronary sinus perfusion is used later.

...What a precise operation, amazing!”

"Use ice chips to cool the surface of the heart, and perfuse 4°C ice saline into the heart chamber to cool down."

Doctor Wang also memorized it seriously, and ten minutes later, the first stage was completed.
Chapter completed!