Yang Ping hurriedly ran 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 have already taken the stage, which shows how tricky this operation is.
Director Guan is the surgeon, Director Ji is the assistant, and several young doctors are gathered around the operating table. They can only watch helplessly as they are unable to help.
Defibrillation!
The director immediately stopped. The patient suffered cardiac arrest, and intensive ventricular fibrillation waves appeared on the monitoring screen.
The anesthesiologist and nurse immediately performed electric defibrillation on the patient.
After several defibrillations, the patient's heartbeat recovered under strong electrical stimulation. Perhaps due to the influence of electrical stimulation, the patient screamed after recovery.
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, please explain this to the patient's family." Director Guan ordered his doctor, Dr. Yu.
Director Ji added: "Don't open the door, go out from the locker room."
These directors all have experience. Once the door is opened, family members who don't know what is going on rush in, make noises, and refuse to let go. The patient will definitely not be saved.
They didn't know the dangers of surgery. When they heard the patient's screams, they thought the doctor was abusing the patient.
The heartbeat recovered, and Director Guan and Director Ji continued the operation.
"Professor Yang came to power!" Director Ji felt relieved when he saw Yang Ping had arrived.
"Chronic total occlusion of the coronary arteries. The left main coronary artery is completely blocked. The two bifurcations of the anterior descending and circumflex branches are completely occluded. Severe calcification lesions. The right main coronary artery is 90% blocked. We are working on the obstruction.
After rotational atherectomy treatment, the calcification of the blocked mouth is as hard as a rock. The condition is too dangerous and complicated, so I ask you to come and take a look." Director Ji quickly and briefly introduced the condition.
Director Guan focuses on interventional treatment of the cardiovascular system, while Director Ji is a versatile person who is proficient in almost all interventional treatments, including intracranial, tumor, etc.
Relatively speaking, Director Guan has deeper attainments in cardiovascular intervention, after all, he only focuses on this aspect.
Therefore, this surgery was performed by Director Guan.
It was obvious that Director Guan's back was soaked. This severe coronary artery occlusion still had rock-hard calcification. Not only was the main trunk severely blocked, but the two bifurcations were also completely blocked. This kind of
Multiple complex occlusions are simply a devilish case.
The coronary arteries are the blood supply vessels of the heart. They run on the surface of the heart and spread like a tree crown. They have a trunk and branches. They are like the oil pipelines that provide gasoline to the car engine. Once blocked, the heart will lose power. p>
The coronary arteries, which serve as oil pipelines, are divided into left and right branches. When these two arteries and their branches develop atherosclerosis or vasospasm, it will lead to lumen stenosis or occlusion.
When the coronary artery lumen is narrowed by more than %, coronary circulation disorder will occur, resulting in insufficient blood supply to the myocardium, causing an imbalance in myocardial oxygen supply and demand, and causing obvious clinical symptoms such as angina pectoris. When the coronary artery lumen is completely blocked, myocardial ischemia and lack of blood will occur.
Oxygen, necrosis, causing myocardial infarction.
At this time, interventional treatment is often required to implant a stent to open the blood vessel.
This patient has severe blockage and severe calcification. The blockage is as hard as a rock. Ordinary instruments cannot open the blood vessels at all. Instead, special rotational atherectomy instruments must be used to grind away these "rocks" bit by bit to open the coronary arteries, and then insert
Stent expansion.
As for bifurcation lesions, one is the main branch and the other is the branch, both of which are blocked, and the blocked parts are close to each other and concentrated at the bifurcation.
Because the lesion affects the "fork in the road" of the cardiovascular blood vessels, the surgical technique is particularly complex, and the post-operative restenosis rate is particularly high. When multiple stents need to be implanted at the same time, if the "anastomosis" of both ends of the stent is not good, the patient is very prone to re-stenosis.
Stenosis and thrombosis.
In this case, if the stent is simply implanted in the main branch, the plaque will be displaced under the squeeze of the stent, and sometimes it will be squeezed into the branch blood vessels, forming new blockages, making things worse.
If a stent is implanted in both the main branch and the branch, due to the close distance between the blockage parts, the two stents will fight and interfere with each other. With current medical technology, it is impossible to trim the stent in advance enough to adapt to this bifurcation.
Cause a fight.
Therefore, for bifurcation lesions, it is necessary to implant stents to open the blood vessels and ensure that the implanted stents perform their duties without fighting or forming new blockages. This is the difficulty of treatment.
It not only solves the current problems, but also does not bring new problems. Interventional treatment of coronary artery bifurcation lesions is extremely difficult to operate.
It is as hard as rock and has complicated forks, doubling the difficulty.
"CCTV technology must be used!" Director Guan added.
This is a double-stent surgery, which can be summarized as "CCTV": C extrusion series stent surgery: classic-crush; C hakama series stent surgery: classic and improved hakama stent surgery; T series stent surgery: classic and improved
T stent, V series stent: classic and SKS stent.
This kind of patient has a complete blockage. In this situation, it is necessary to open the blood vessel as soon as possible to allow the ischemic myocardium to receive blood supply, so that there is a glimmer of hope. Otherwise, if the time is too long, large areas of myocardial necrosis will occur, and even if it is opened, it will not help. p>
Yang Ping quickly brushed his hands and put on a lead gown. Then with the help of the circulating nurse, he put on a surgical gown and sterile gloves.
"Professor Yang, Director Ji said that you are very skilled in your skills. Are you sure you can quickly clear these blockages?" Director Guan also said.
Yang Ping just took a look. Although he usually doesn't pay much attention to intervention, the training in the system space is a basic technology training.
When he was in the United States, Yang Ping used interventional technology to rescue astronauts, which was not a problem for him.
Once the surgery reaches a certain level, everything will be clear.
"It's not a big problem!" Yang Ping answered decisively.
According to Professor Yang, if the problem is not big, then there is no problem.
The patient's heartbeat stopped again!.
Defibrillation! Defibrillation! Defibrillation!
Director Guan has no idea whether this patient can come back today. This is the most difficult and dangerous patient he has ever encountered. The rotational atherectomy instrument does not dare to penetrate too aggressively for fear of breaking the blood vessels.
Bang bang bang!
Outside the operating room, the sounds of punching, kicking, and banging on the door kept coming and going.
However, since President Xia implemented the hospital's safety plan, the doors of these operating rooms have been replaced with blast-proof doors, allowing them to kick and beat them as they please.
The anesthesiologist and nurse started defibrillating the patient again, and Director Guan shouted: "Xiao Yu! What's going on?"
Dr. Yu went out and was still explaining to the family members, but it obviously had no effect.
"Don't open the door! Rescue first!" Director Ji was afraid that the doctor in the audience would accidentally open the door and the family members 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 closer.
I asked Yang Ping to come just because I wanted to speed things up.
"Should we use intravascular ultrasound to check again?" Director Guan reminded Yang Ping.
"No need!" Yang Ping felt that it would be a waste of time to watch anymore.
He took over the instrument and began to rotate the hard calcified lesions with the micro "diamond drill". Compared with Director Guan, he was obviously bolder and more exaggerated. Director Guan's heart skipped a beat when he saw Yang Ping's exaggerated operation. "It's okay, he's sure of it!" Director Ji stabilized Director Guan.
The rotational atherectomy head always targets the calcifications and does not come into contact with the blood vessel wall. Under bold and radical operations, the first blocked part is slowly opened through vigorous rotational atherectomy.
Immediately afterwards, Yang Ping began to overcome a blockage.
This kind of operation is undoubtedly like 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 break the blood vessel wall. Director Ji looked very calm and said: "People with high skills are bold, don't worry!"
