Chapter 471 You call this a stupid idea? (Please subscribe)
Author: A lancet
"Ah? Professor Chen?" Zhou Cheng went down to the operating room and met with Chen Tingye. Chen Tingye's words made Zhou Cheng's steps stiffen and his expression became complicated.
Finally he stopped and looked at Professor Chen Tingye with a bitter look on his face.
Chen Tingye is the ward director of the Department of Orthopedics, and is currently the leader of the Hand Surgery Department of the Affiliated Hospital of Hunan University. He is also the mentor and former superior physician of Associate Professor Ning Xihua——
Chen Tingye may also feel that what he said to Zhou Cheng face to face is a bit inappropriate, so he calmed down and said: "Xiao Zhou, I just explained this situation to you calmly, and I am not blaming you.
Right, you and I are an orthopedic family."
"I didn't tell you this because I thought you were an outsider. If you were an outsider, I could have kept it all hidden."
"It's not that when you were in Changshi, you brought a lot of pressure to Ning Xihua when you taught Wei Hong from the Second Affiliated Hospital of Xiangnan University." Chen Tingye's tone was serious and his explanation was very straightforward.
.
Amputating a limb to save life, and then replanting the amputated limb to restore the limb is a pioneering surgical concept. The first person to propose it was Zhou Cheng. At that time, Zhou Cheng did not have much experience with Shonan University Affiliated Hospital.
relation.
Although the creation of a surgical concept is far less difficult than subverting the foundation, as the founder, the one who has the deepest understanding is Zhou Cheng.
When he was in the Orthopedics Department of Changshi Traditional Chinese Medicine Hospital, Wei Hong, who was also the 'inheritor' of the Hand Surgery Department of the Second Affiliated Hospital of Shonan University, went down to work with Zhou Cheng for a while, and now he does this very well in the Second Affiliated Hospital of Xiangnan University.
It is equivalent to being brought by Zhou Cheng himself...
As for Ning Xihua, he was also an associate professor and was about the same age as Wei Hong. He saw that Wei Hong was doing so enthusiastically, and then a lower-level hospital called him to do a consultation operation, so Ning Xihua went.
He also didn’t want to fall behind others and disgrace Chen Tingye, so he was studying the replantation of amputated limbs after amputation.
But this thing——
Whether or not someone takes care of it are two different surgeries.
not to mention?
The person who led Wei Hong was still Zhou Cheng, so Wei Hong, as an associate professor, could now carry out the surgery. Ning Xihua felt that he would not be weaker than him, so after he understood the basic theories, he started to perform surgery.
The current result is that even if Chen Tingye went there, he could not reattach the severed limb. In fact, all the places that should be sutured have been sutured, but the sutures were not done particularly well. It may be that the affected limb, blood vessels, etc. have been lost.
active.
Moreover, the time has also exceeded...
The most difficult point in replanting a severed limb after amputation is not to deal with the proximal stump of the amputation, but the distal end of the amputation. There is a time limit required, which must not exceed twenty-four hours.
If it has been out of the body for too long, it will be difficult for gods and goddesses to revive it.
The problem now is that when the amputation was performed to save life, there was a lack of time. Then Ning Xihua worked on it for a while, and then Chen Tingye worked on it, and now he was transferred to Shonan University Affiliated Hospital.
Twenty-four hours have already passed.
"Professor Chen, that's not what I meant." Zhou Cheng calmed down his inner emotions.
How to put it, now it seems that the relationship between Ning Xihua and himself is naturally closer than that of Wei Hong, but when he and Wei Hong worked together, Zhou Chengdu couldn't figure out who Ning Xihua was.
How could he have thought of so much? He never imagined that he was just cooperating with others on a new topic at that time. At that time, Wei Hong took the initiative to come to him, and it would bring such a big impact to Ning Xihua, who he now knows and is familiar with.
pressure.
"Professor Chen, last year..." Zhou Cheng still wanted to explain a few words.
Chen Tingye didn't want to waste any more time: "What happened in the past has nothing to do with the present. Xiao Zhou, you must take a good look at it. If you can be saved, that's the best. If you can't be saved, then you can only go and fight with him."
The patient and his family discussed further amputation."
After amputation, the severed limb was replanted, and now it needs to be amputated again.
After all this trouble, what family member would be angry?
However, this kind of thing has been discussed before, so it's not Ning Xihua's fault.
Currently, there are very few hospitals and doctors that can perform such operations. It is natural that it will not be successful, but it will be a miracle if it is successful.
However, everyone still hopes to give it a try before finally losing hope.
"Professor Chen, I'll try my best!" Zhou Cheng could only respond, and his pace accelerated a bit.
Chen Tingye asked again: "Dr. Zhou, the out-of-body time is a little over twenty-four hours, so there shouldn't be much of a problem, right?"
"I don't know about this either. Let's take a look first and then evaluate." Zhou Cheng replied.
…
When he arrived at the operating room, Zhou Chengcheng saw that Ning Xihua was still operating on the patient seriously and assessing blood supply status and other things.
"Doctor Zhou." Ning Xihua called out when she saw Zhou Cheng enter the operating room, put on his work clothes and then go on stage.
I couldn't see his expression clearly, but his eyes seemed to have a hint of prayer and longing. I don't know if he was afraid that his skills would be insufficient, so he would be in trouble by the patient's family members.
Zhou Cheng didn't reply, but looked at the leg first.
It should be a girl's right leg. The girl is not too old, probably in her twenties. The skin above the broken end is still quite white and tender, but there is a little blood stain at the moment.
Then I saw that the severed end of the amputated leg had been sewn back together.
And below the broken end, the skin color is white, which must be due to a long period of ischemia.
"At the beginning, were the descending blood vessels treated with pan-heparinization?" Zhou Cheng asked after sorting out the previous steps.
"It's been dealt with. After I go there, this is the first step I will deal with." Ning Xihua nodded.
Chen Tingye hadn't come yet at that time, so he could only answer this question.
Zhou Cheng then looked at the connected hemodialysis machine and found that the blood inside was not moving at all. It should be a blockage at the far end, otherwise.
The blood purifier must have started working.
Immediately afterwards, Zhou Cheng removed the arterial and venous connecting ends of the connecting tubes and observed the blood supply respectively. At this time, Zhou Cheng discovered that there was liquid blood flowing at both the arterial end and the venous end.
Slowly seeping out.
This means that there is a certain amount of blood supply where the blood purifier is connected. However, after both ends are connected, there is no flow. This means that there must be stagnation in the lumen of the blood vessel.
Another better way to determine is that the arteries and veins have channels with the outside world. If the circulation is smooth, it is definitely not extravasation, but external spray.
"Do I need the instrument to remove the bolt?" Chen Tingye asked Zhou Cheng.
In this situation, everyone knows that there must be a blockage, and the most likely possibility is thrombotic blockage.
If there is a blood clot, it is natural to deal with the blood clot first and then cause recanalization.
"No. Let's not take it for now. This situation may no longer be suitable for interventional thrombectomy. It may be necessary to perform incision and thrombectomy." Zhou Cheng said with a solemn expression.
"Doctor Zhou, you make the decision." Chen Tingye did not push him because Zhou Cheng said maybe, but gave all the initiative to Zhou Cheng.
After Zhou Cheng finished doing this, he seemed to have remembered something, and then he tested the back of the affected leg's calf.
In such a situation, the priority is to consider whether there is compartment syndrome, which is a weak compression that compresses blood vessels, rather than thrombus.
"Dr. Zhou, I have checked and there is no increased pressure in the fascial chamber." Ning Xihua immediately realized Zhou Cheng's purpose and responded immediately.
The pressure in the bone fascia chamber can be measured with instruments, which is better than touching it with hands.
"Get a syringe!" Zhou Cheng quickly ordered the tour.
At this time, there is actually a simpler testing method.
That is to go along the route of the artery and poke it open one by one to see where the situation is not good.
It's just that such an operation requires very rigorous and proficient anatomical knowledge, and the shape of the blood vessels can be reshaped based on the patient's current posture.
"Syringe." The patrol immediately gave it to the instrument nurse, who handed it to Zhou Cheng without removing the safety cover of the syringe.
After Zhou Cheng took it, he took off the safety jacket and inserted it into the tibial artery, which was located about eight centimeters below the sutured end.
After feeling a slight breakthrough with this injection, Zhou Cheng immediately saw that there was nothing inside the syringe, as if it had been plunged into a vacuum!
At this time, Zhou Cheng chose to withdraw again.
During the withdrawal process, the withdrawal was very casual and effortless, and then I saw a small amount of blood entering the syringe.
This seems to mean that the blood flow here is smooth.
"There seems to be no problem here, right?" Ning Xihua asked.
However, after Zhou Cheng took a closer look at the blood condition in the syringe, he immediately remembered something.
"No, Professor Ning, there is something wrong with this blood. This patient should have developed arterial dissection after reperfusion!"
"Look at this blood, its color looks more like venous blood than arterial blood, but our blood collection site is an artery, so the blood in it should flow back."
"This may be arterial dissection, and a vascular stent is needed. Does our hospital have this?" Zhou Cheng asked quickly.
Ning Xihua was stunned, but Chen Tingye chose to believe it: "I'll call and ask right away!"
The vascular stent is a device for vascular surgery. You need to contact the vascular surgery department to find the corresponding device manufacturer.
Moreover, the diameters of vascular stents are different, and the hospital may not even know whether they have them in stock.
Chen Tingye quickly dialed the number of the director of vascular surgery. After a while, the corresponding stent was brought into the operating room by the circulating nurse. At this time, Zhou Chengcheng had already prepared the arterial guide sheath...
The guide sheath is located further down.
Soon, Zhou Cheng pushed the vascular stent in with a smooth operation.
During this operation, one end of the blood purifier finally began to move. It seemed that blood was slowly flowing.
"It's done!" Ning Xihua shouted happily when he saw this.
However, Zhou Cheng was not happy about this.
Because he did not see the flow at the venous end, this means that even after the artery here is recanalized, there are still vascular obstructions in other locations, and the location is not yet clear.
So under such circumstances, it seems that he has to follow the current steps again, maybe even more than once. Blind testing like this is obviously not feasible...
Ning Xihua's smile appeared, but soon became stiff again.
He looked nervous, but didn't dare to say a word.
Chen Tingye also looked at Zhou Cheng, while his eyes were moving rapidly, thinking about ways and countermeasures.
The current case is estimated to have evolved into a special case. There is no previous treatment experience to draw from, and the current diagnosis is not clear.
It may be thrombus, or there may be other intimal avulsion dissections.
Although everyone said nothing, they all looked at Zhou Cheng, which made Zhou Cheng feel a certain amount of pressure. However, this pressure did not affect Zhou Cheng's thoughts. Zhou Cheng thought for a moment and said, "I don't know now.
Is it a case where dissection and thrombus coexist, if you still want to save the leg that has exceeded the time limit of being separated from the body."
"There is only one stupid way to do it. Let's just open up and do a full dissection of the blood vessels! Professor Chen."
Chen Tingye was stunned when he heard this, and immediately replied: "Xiao Zhou, there is no problem in doing the blood vessel exposure, but I'm just afraid that there is not enough time. After doing it, it still won't help."
Exposing blood vessels is actually a time-consuming and labor-intensive matter, let alone the whole process?
This kind of vascular anatomy exposure is not just like digging eels and loaches, just dig along the hole.
It took a lot of time, and in the end the limb must have become necrotic. Even if it is recanalized, there is no way to restore vitality.
"If after the full dissection and exposure, there is still necrosis in the end, it's just a matter of luck. We can only do this now!"
"Professor Chen, please call Yi Feng over and ask him to make arterial and venous circulation channels at any time. We have to do it bit by bit." At this time, stop trying to be clever and honestly follow the simplest method.
Find the cause.
This is not a simple theory or an accident. In special cases, the cause can be found.
"Okay!" Chen Tingye's suspicion was just to give a suggestion, not to refute Zhou Cheng's treatment plan.
He immediately arranged a tour and called Yang Yifeng.
Then when I looked back at the operating table, I realized that Zhou Cheng's scalpel seemed to have been opened. The knife went directly from the middle of the calf to the dorsum of the foot. The smooth incision curve was not sloppy at all.
And the depth of the cut is just right——
There wasn't much blood leaking out or even surging.
Is it because the blood supply is originally blocked, so there is no blood?
Zhou Cheng's operation was too fast. While Chen Tingye was still thinking, Zhou Cheng had already started blunt dissection. Before he could react, Zhou Cheng had already used blunt dissection to open up the muscle layer and cut the shin.
Part of the anterior artery was removed.
As skilled as poaching a bird...
Chen Tingye swallowed two mouthfuls of saliva and said silently, I take back what I just said. This kind of surgery is the same as what I thought, but the stupid method Zhou Cheng said may not be the stupid method he thought...