The rest of the meeting process was proceeding normally, and there were no further incidents.
Cai Dongfan listened for a while, then called Luo Yun and asked Luo Yun what his plans were. Luo Yun replied that nothing happened. Then Cai Dongfan quickly took Zhou Chengxian to yo-yo.
The main reason is that the eyes of the people next to me are too fiery, always coming to find out the news, or they are surprised by Zhou Cheng's previous surgery and focus their attention here.
Even though Cai Dongfan was very thick-skinned, he couldn't stand the torture of such a fiery gaze: "Zhang Zhengquan, Yan Jun, you guys can take a taxi back later. I'm going out first, I have something to do."
"Okay!" Du Yanjun and Zhang Zhengquan both nodded.
I even felt that once Zhou Cheng and Cai Dongfan left, the pressure on them was reduced a lot. Before, their eyes kept wandering nearby, which made the two of them very stressed and very uncomfortable.
"Brother Quan, Brother Zhou Cheng is really awesome today." Du Yanjun breathed a sigh of relief.
Zhang Zhengquan also nodded: "Yes, Brother Zhou Cheng is really awesome. Everyone around here has blazing eyes, even more so than the doctors from the Shonan University Affiliated Hospital."
When Du Yanjun heard what Zhang Zhengquan said, he seemed to think it made sense.
It seems that Zhou Cheng's appearance has at least broken the theory of academic supremacy on a personal level!
…
Cai Dongfan originally planned to take Zhou Cheng to eat, preferably somewhere where he could have a drink, chat, and talk alone.
But as soon as he got in the car, he saw that the phone rang, and Zeng Yi actually called.
Cai Dongfan didn't answer the call the first time, but Zeng Yi called again.
Cai Dongfan hesitated for a moment. After taking it, he listened for a long time and then said: "Director Zeng, are we still here at the venue? It will take a certain amount of time to get to the operating room now."
Zeng Yi said: "Cai Dongfan, can you do me a favor and rush to the hospital? Director Zhang is in the operating room now, and Director Huang from the Vascular Surgery Department is also there."
"Okay!" Although Zeng Yi's call disrupted Cai Dongfan's arrangements.
But, as a member of the department, as a doctor, you can never imagine when the emergency will come and in what strange way it will come!
After hanging up the phone, Cai Dongfan said to Zhou Cheng: "We have an emergency call from the Department of Orthopedics. They need amputation. It's an acquaintance of Director Zhang. Director Zeng called us to help."
"It seems I can't drink this wine." Cai Dongfan was helpless.
Hearing this, Zhou Cheng moved in his heart and said, "Teacher Cai, we originally made an appointment with Teachers Luo Yun and Professor Liu to have dinner together and then send them back to the Magic City. If we don't have time, why don't we call them in advance?"
The arrival of an emergency will disrupt many plans, but doctors still have to focus on patients, although they don't have to go.
But when you hear the call, if you have time and ability, you still have to be there.
Cai Dongfan hurriedly said: "Oh, yes, you are here to drive. I have to make a few more calls. I have several appointments tonight!"
Cai Dongfan has a lot of friends and he likes to make friends. Therefore, he has made appointments with a lot of people today, and he just happened to deal with them all now.
Originally, the annual meeting on the weekend was a time for learning and building relationships...
But for work.
…
Zhou Cheng took his driver's license and drove to the downstairs of the Eighth Hospital. Then Cai Dongfan also put aside all the problems, and the two of them ran directly into the operating room.
Because of the sudden disappearance of Zhou Cheng and Cai Dongfan, Luo Yun was punished for drinking two more glasses of wine, four liang. In the end, Liu Yiping couldn't find anyone to send Luo Yun home, so he directly called Luo Yun in his address book.
The person who received the most calls said they couldn't deliver it in person because they had to catch a flight...
Zhou Cheng and Cai Dongfan saw it when they arrived in the operating room.
The instruments from the vascular surgery department had not yet been removed from the femoral artery. On the operating table, there were still many black cord-like traces of thrombus. Zhou Cheng estimated that it might be someone from the vascular surgery department who removed the thrombus from the femoral artery or femoral artery.
It was taken out from the popliteal artery, the branches of the popliteal artery, and the proximal ends of the anterior and posterior tibial arteries are also connected.
Obviously, after the vascular surgeons completed the thrombectomy of the relatively large blood vessels, they could no longer go further.
First, the distance from the femoral artery to the lower part of the knee joint is too far, and most of the space for operation has been lost. Moreover, without the assistance of any imaging, they cannot blindly guess where the artery should go next.
go!
Seeing this, Zhou Cheng immediately exited the operating room and washed his hands as quickly as possible.
This patient was special, so the roving nurse assigned three of them directly. Even the director, Zhang Hongsheng, was doing hemostasis on the surface of the liver on the operating table. Therefore, the roving nurse dressed Zhou Cheng without even asking which department he was from.
clothing.
…
After Zhou Cheng put on his clothes and gloves, he immediately came to the opening opened by Huang Shinan.
In fact, the most suitable thrombectomy for this patient is arteriotomy and thrombectomy from the popliteal fossa. However, the patient also has abdominal injuries, and the popliteal fossa is at the back, so he can only take the supine position!
Thrombosis will only harm the legs, but if the damage inside the abdomen is not treated, it can also be fatal!
Therefore, Huang Shinan could only resort to ultra-long-distance arterial balloon dilatation and thrombectomy from the femoral artery.
He also specially introduced it to Zhou Cheng: "Xiao Zhou, last time you said that the thrombectomy equipment was not good, we introduced this set of equipment."
"Yes!" Zhou Cheng nodded hurriedly and said, "Director Huang, if you have equipment, removing thrombus is less invasive and easier to remove than incision, right?"
Zhang Hongsheng glanced at Zhou Cheng who was doing the operation, but didn't say much. Instead, he chose to continue treating his abdomen with the general gastrointestinal surgeon.
After Zhou Cheng took over Huang Shinan's position, he immediately extended the balloon downward and then along the femoral artery to the popliteal artery. At this time.
Zhou Cheng turned slightly and drilled directly into the anterior tibial artery!
The anterior tibial artery is slightly simpler, unlike the posterior tibial artery which branches into the posterior tibial artery and the peroneal artery.
And the anterior tibial artery plays an important role as it can supply blood all the way to the dorsalis pedis artery!
However, even if the thrombus in the anterior tibial artery is removed, it is still useless because there is still a thrombus in the dorsalis pedis artery. Therefore, Zhou Cheng must perform at least two accurate thrombectomy operations before he can truly restore the health of his lower limbs.
Restore blood supply.
At this moment, Zhou Cheng's mental energy was highly concentrated throughout the whole process.
Intravascular catheterization has similarities with orthopedic arthroscopic surgery, but there are more differences. The catheter has been extended from the femoral artery to the anterior tibial artery. This is already an extra-long tube, which is no less than extending the catheter from the femoral artery to the anterior tibial artery.
The blood vessels in the neck extend into the cerebral blood vessels!
Moreover, this is done without the assistance of angiography, so there cannot be any mistakes.
Otherwise, if the blood vessel is punctured or the inner wall of the blood vessel is scratched, the intima of the artery will be torn, and the patient will not be able to withstand such torture.
Finally, the front end of Zhou Cheng's catheter was about to touch the front end of the thrombus. Zhou Cheng continued to move forward, which became slightly difficult.
The catheter is soft, but the thrombus is not soft, and it cannot penetrate deeply violently. The branch artery at this moment is almost only slightly larger than the catheter!
If it were larger, the balloon catheter would not be effective and would only push the thrombus further forward.
After Zhou Cheng used his hand to feel the feel of the thrombus, with a little force, the catheter passed through the thrombus. When it got inside, before it was halfway through, when he pushed forward, the catheter had already moved the anterior tibial artery.
The distal thrombus was pushed farther away.
Zhou Cheng tried again, but the catheter still could not pass through again, so he could only inflate the balloon and start to pull back the thrombus that had passed through.
But not too fast. If you pull it too fast, it will damage the blood vessel, and it will easily cause the thrombus to detach from the bifurcation of the anterior and posterior tibial artery into other blood vessel cavities. In addition, it may also push the blood vessel into the anterior recurrent artery of the knee joint.
go.
The recurrent knee artery and the anterior tibial artery are a bifurcation!
Therefore, this process must be done carefully. Zhou Cheng carefully controlled the direction of the closest end of the thrombus in the blood vessel, and then slowly adjusted it, and then, finally!
Zhou Cheng brought the thrombus out of the common artery before the branches of the anterior tibial artery and the anterior recurrent knee artery. Then he used the same principle to bring the thrombus back to the popliteal artery!
At this time, Zhou Chengcai breathed a sigh of relief. Perhaps in the eyes of others, Zhou Cheng was entering and recovering the intravascular balloon catheter like an apprentice, so he moved very slowly.
But don’t you know that Zhou Cheng’s balloon is carrying heavy blood clots at the moment!
Moreover, when it reaches the large blood vessels, be careful to continue to expand the balloon slightly. Otherwise, the lumen of the large blood vessels may be larger than the sum of the diameter of the thrombus and the expanded balloon in the small blood vessels, and then the thrombus will fall into the small blood vessels.
Unknown place!
Zhou Cheng slowly pulled back and then removed the first blood clot!
"Circulating teacher, can you get me another balloon catheter of the smallest size?" Zhou Cheng asked the circulating nurse.
The circulating nurse said yes immediately, without any hesitation, and quickly opened a thinner catheter and went to the stage.
Seeing Zhou Cheng remove the blood clots, Zhang Hongsheng and several other abdominal surgeries didn't think anything. Before Huang Shinan left, they said that the patient had many blood clots and they were widely distributed. Even if one or two were removed, there would be no point.
It's not very big either.
For this reason, when Zhou Cheng was operating here, even though he looked young, there was a high possibility that both lower limbs of this patient would be amputated, so there would be nothing wrong with letting Zhou Cheng practice his hands!
Zhou Cheng replaced the thin catheter, and when he felt it in his hand, he frowned fiercely.
The smaller the thing, the more unbearable the force will be in the longitudinal direction. The catheter must be wound at least several times from the femoral artery to the anterior tibial artery and even further to the dorsalis pedis artery and metatarsal artery!
This makes it more difficult to apply force longitudinally and break through the thrombus, which requires more precise force control!
…
When Huang Shinan stood next to Zhou Cheng, he interrupted Zhou Cheng: "Xiao Zhou, where did you get this blood clot?"
The catheter Zhou Cheng operated was very thin and long, so Huang Shinan estimated that it was at least taken out from the anterior tibial artery or posterior tibial artery, and it was also taken out from the distal end of the artery, because only the diameter there could be so thin.
.In normal times, Huang Yuanwu removes the thrombus strip from the popliteal fossa, or it can also be removed from the anterior and posterior tibial arteries!
However, it is indeed a bit difficult to cross so many forked roads from the femoral artery!
"Director Huang, this is the dorsal artery of the foot. The thrombus in the artery in this leg has basically been removed. There may be a thrombus in the dorsal metatarsal artery, but it can be left alone for the time being. The communicating branches in the foot are very developed."
Zhou Cheng said with some regret, and gave up his position: "Director Huang, it's up to you to verify whether there is any thrombus in the medial and lateral plantar arteries!"
Without arteriography, the specific location of the thrombus cannot be found, so Zhou Cheng said conservatively, and if the proximal thrombus is blocked, it cannot be visualized even with angiography, and the thrombectomy still needs to be performed diagnostically. Diagnosis and treatment are integrated.
change.
"Where? Where?" Huang Shinan thought he had heard wrongly.
The dorsalis pedis artery, as the name suggests, is the dorsum of the foot.
Brother, you inserted the catheter in the femoral artery, why don't you go and remove the blood clot on the moon?
Cai Dongfan also heard what Zhou Cheng said about the anatomy, and immediately looked at the position of the groin and the dorsalis pedis artery that he usually felt, and cursed Zhou Cheng in his heart for being an inappropriate person!
And it’s a real dog!
Usually they have more contact with Huang Shinan. The farthest end that Huang Shinan can reach for thrombectomy from the popliteal fossa is the distal end of the posterior tibial artery, peroneal artery and anterior tibial artery. Further down, there are
Vascular surgery is relatively a blind spot.
There are so many blood vessel branches that even anatomical incision and thrombectomy would take too much time!
When Zhou Cheng came up, he asked Huang Shinan to take out the branch of the peroneal artery. Wasn't this just to embarrass Huang Shinan?
Of course, Zhou Cheng didn't mean it either. As long as everyone doesn't explain it clearly and thoroughly, it will still be fine.
"It's from the dorsalis pedis artery." Zhou Cheng was very convinced, and then he saw Director Chen wink at him again.
Zhou Cheng immediately understood: "Director Huang, how about I continue to operate, and you can guide me next to me? This way I will feel more at ease."
So Huang Shinan petrified for nearly four or five seconds without any thought. Then he was interrupted by Zhou Cheng's speech, but he didn't dare to lose his temper at all. He nodded and said: "Learn from each other, learn from each other!"
Huang Shinan immediately understood that Zhou Cheng was trying to give him face and was polite to him.
Previously, Zhou Cheng had experience in incisional thrombectomy, but that was due to equipment limitations, not because Zhou Cheng was incompetent.
Huang Shinan didn't know about the others, but even Professor Zhang from the Department of Vascular Surgery at the Second Affiliated Hospital of Shonan University certainly couldn't guarantee that it would be 100% safe from the groin to the dorsalis pedis artery.
Although he didn't know how Zhou Cheng did it, Huang Shinan didn't dare to ask. He couldn't do it even if he asked, and he might not even understand. Why bother?
At this time, Cai Dongfan also intervened: "Director Huang, you still have to work hard to do some popular science for Xiao Zhou, our orthopedics department. Dean Zeng, don't you think so?"
Cai Dongfan knew that he was asked to support Zhou Cheng at this moment. Everyone could say anything if everything went well with the patient, but if there were any problems, Zhang Hongsheng would need authorization in the name of the hospital to avoid danger.
"Is it possible to save these two legs?" Zhang Hongsheng asked Huang Shinan and Cai Dongfan.
He still understands the anatomy of the lower limbs, and he also knows what the dorsalis pedis artery is, but it sounds mysterious and useless. He wants to get a practical answer.
Huang Shinan said conservatively: "If the thrombus in the dorsal artery of the foot and the medial and lateral plantar artery can be removed, the possibility of limb salvage will be increased by at least 50%. In the end, there will be no need to be hospitalized and go to the orthopedics department. Transfer to us
Just vascular surgery!”
If Zhou Cheng could remove the arterial thrombus during the operation, then he would dare to put a filter in the vein and perform thrombolysis without restraint!
In this case, the chances of giving it a try are still very high!
It's quite okay for patients to stay in the vascular surgery department.
After all, even if bleeding occurs after surgery, surgery can still be performed to stop the bleeding! Coupled with anticoagulation, everything will be fine.
Zhou Cheng didn't talk nonsense. This was not the time to talk nonsense. He immediately inserted the catheter into the blood vessel. No one could see anything. But Huang Shinan, as the director of vascular surgery, saw that Zhou Cheng had turned around at least four or five times.
sub-azimuth, this means that Zhou Cheng passed through at least three or four forks!
Oh my God, little brother, you really came here to cause trouble. You did the vascular catheter so casually, as if you were walking on the road and turning four or five times.
Do you know that if you show off, you will be struck by lightning?
Immediately afterwards, Huang Shinan saw that Zhou Cheng pulled the small thrombus strip out of the blood vessel twice, and during the process of pulling it back, he turned four times again. It seemed that he was
My scalp is numb!
These operations may seem ordinary to Cai Dongfan and others, but at this moment Zhou Cheng is creating miracles!
After completing the thrombectomy, Zhou Cheng and Huang Shinan started suturing together. After the suturing was completed, let go of the proximal end of the femoral artery!
Huang Shinan immediately and nervously asked the circulating nurse to put on a syringe needle!
At this moment, the blood vessel has been connected from the femoral artery. If Zhou Cheng takes out all the thrombus, it means that the terminal blood circulation has been opened!
Hold the needle and poke it from your thigh down!
After being pierced, traces of blood slowly flowed out one after another, which was a dazzling bright red color.
The bright red color that looks bloody may not necessarily represent terror and nightmare, but it may also be the miracle of life.
For the lower limbs that have been embolized, especially the feet, isn't the drop of blood seeping out at this moment a miracle of life?
I just rushed it and will change it tomorrow, I really don’t have time.