Many doctors who have had experience agree with this doctor's words.
Doctors from other hospitals are like martial arts masters who talk about problems and speak clearly and clearly, while teachers from their own hospital do not give lectures. Medical students who come to listen to the lecture for the first time will be confused. For example, trainee Fan Yunyun feels that his head is spinning.
Qing Dynasty, southeast, northwest.
It is not easy to learn from Senior Sister Xie. Senior Sister Xie is able to enter such an important operation and help to show her face in front of colleagues all over the country, but she has not yet figured out how to perform this operation.
Senior Sister Xie told her that she had to gnaw on hard bones. The teacher said that it was better to put more energy into exploring on her own. Only by having a thorough understanding of anatomy can she understand all surgical issues.
Fan Yunyun quickly lowered her head, took out a thick anatomy atlas from her schoolbag and opened the relevant pages.
Geng Lingfei, who was sitting next to her, looked at the big textbook in her hand in surprise. Only then did he finally discover and realize why she brought a big school bag to attend the lecture. People thought the lecture was a self-study class at school.
Looking at her actions, Geng Lingfei frowned and turned back: Well, all the actions of this trainee seemed to be to compete with him for the teacher, intentionally or unintentionally.
"You said they were talking about the liver hilus." Fan Yunyun seemed to be asking and answering herself.
Geng Lingfei didn't even look at her and didn't discuss it with someone like her who was robbing the teacher.
If Dai Nanhui was interested, he looked at the different expressions on their faces. He always felt that it was really strange that these two people were studying with an intern.
After turning the page, Fan Yunyun whispered to the book and recited the key points of knowledge in her heart: The hepatic vein is formed by the convergence of the portal vein system and the hepatic artery system of the liver through the central vein and sublobular veins. It is mostly located in the second and third hepatic portals.
It joins the inferior vena cava.
When a patient has Budd-Chiari syndrome, the outflow part of the hepatic vein is blocked. Therefore, between the unobstructed hepatic vein and the obstructed hepatic vein, the sinusoidal space between the subcapsular arch of the liver and the liver parenchyma, the phrenic vein and the hepatic vein are between each other.
The collateral circulation that the doctor from the foreign hospital just mentioned can be widely formed between veins and short hepatic veins, between lobules and perihepatic adhesion bands, perihepatic ligaments, etc.
There is also the third porta hepatis, which has a large number of small and medium-sized veins called short hepatic veins, with as many as 30 to 50 branches. The above factors constitute the problem that if the doctor does not handle it properly during the operation, the bleeding will be difficult to control, causing the patient to be on the operating table.
Huge risk of death.
Here is the significance of establishing extracorporeal circulation in this kind of surgery. The inferior vena cava is a large channel for blood to return to the heart. Once blocked, venous congestion in the following segments may occur. How serious is this problem? Sometimes
Causes renal failure in the lower segment. In addition to this, most of the collateral circulation formed during the disease process in patients with Budd-Chiari syndrome are small blood vessels. Once the large channels are blocked, these small blood vessels will be detonated like large minefields.
There was a sea of blood at that time, and the doctor only had a few hands. How could he deal with such a large minefield bursting blood vessels.
Uncontrollable bleeding is the horrific consequence.
Got it, got it. Fan Yunyun nodded, Senior Sister Xie is great, it is indeed the most important thing to read and understand anatomy well.
In this case, why do doctors hesitate to use this extracorporeal circulation?
The reason is very simple. It is definitely not a good thing to do things like deep hypothermic anesthesia and circulatory arrest to patients when it is not necessary.