Chapter 677 Multiple choice question, too difficult!
A lot of preparation has been made for this operation. Although everything is planned, everyone will be nervous when the operation actually begins.
Jia Xiuzhang glanced at Zhao Yuan and said, "Are you going to do a pneumonectomy?"
Jia Xiuzhang plans to increase the workload for Zhao Yuan.
At the beginning, Zhao Yuan was only asked to assist, and the important work would be done by himself.
But after some things, Jia Xiuzhang gained a full understanding of Zhao Yuan and gained more trust.
He wanted to test Zhao Yuan's level more deeply.
After all, it is not difficult for a surgeon who can perform pulmonary artery dissection surgery to perform a pneumonectomy.
Pneumonectomy only requires removal of the lung organs and external blood vessels, while pulmonary artery dissection surgery requires the use of means to repair internal lesions, which is not at the same level of difficulty.
Zhao Yuan nodded, "Okay!"
No hesitation, clean and decisive.
Jia Xiuzhang and the anesthesiologist ordered, "Inject imidazole, etomidate, sufentanil, atracurium besylate..."
The anesthesiologist is the chief physician of the Department of Anesthesiology of the Municipal People's Hospital. He did not hesitate in the face of Jia Xiuzhang's instructions.
The dosage of the drug is a conclusion Jia Xiuzhang reached through countless actual battles.
In this difficult operation, the surgeon needs to be familiar with the dosage of anesthesia.
Zhao Yuan secretly observed every detail, and it was a rare experience to be able to perform surgery with the "Banbu Academician".
Although Jia Xiuzhang is kind to others in private, he is completely different in the operating room, and he is stern and unsmiling.
The atmosphere was extremely dull.
The anesthesiologist started administering medication, muscle relaxation, endotracheal intubation, connection to the ventilator, and mechanical ventilation...
The endotracheal tube is a left-sided double-lumen endobronchial tube.
Zhao Yuan has been paying attention to the values of the ventilator. Each value is Jia Xiuzhang's valuable experience, or a private secret book.
Zhao Yuan was also thinking about what he would do if he had to handle it himself, and even began to speculate in advance about the next steps.
Confirm one by one with Jia Xiuzhang's ideas and analyze which method is more appropriate.
"Intravenous infusion of propofol, vecuronium bromide, and intermittent intravenous infusion of sufentanil."
Zhao Yuan and Jia Xiuzhang had the same idea, but there were some deviations in the dosage of medicine.
Although there is only a slight difference, it also shows that the two have different styles.
Zhao Yuan's dosage of medicine will be more than that of Jia Xiuzhang.
The main reason is that Zhao Yuan has a background in emergency medicine, while Jia Xiuzhang has a background in chest care.
One is radical and the other is conservative.
Anesthesia takes effect.
Zhao Yuan and Chen Xie looked at each other, and the two began to cooperate in operating the ecmo (artificial lung).
The artificial lung has been successfully installed and the patient's condition is stable. The next step is the first key point.
Lung transplant surgery, to put it simply, is to remove the patient's damaged lung organ and then install a brand new lung organ. The human lungs are divided into left lung and right lung. Sometimes only one lung needs to be transplanted, and sometimes two lungs need to be transplanted.
Two lungs are transplanted together. When both lungs need to be transplanted, a pneumonectomy is required.
Zhao Yuan studied the equipment, including the electric knife and suction device, and then glanced at Bai Lu.
Bai Xiaohu pressed the iodophor gauze on his hand.
Zhao Yuan performed disinfection and then started incision.
Jia Xiuzhang's eyes were focused, showing a thoughtful look.
Zhao Yuan's incision method is very classic and familiar.
He cuts from the anterolateral side of the thorax on both sides, passes through the fourth intercostal space, then enters the sternum edge at the mid-axillary line, and transects the sternum.
The advantage of this kind of incision is that it can fully expose the whole lung, making it easy to mobilize the whole lung.
In recent years, small incisions have been advocated during surgery, but Zhao Yuan used a large incision this time.
The main reason is that in addition to pneumonectomy, he also needs to solve the problem of thoracic aortic aneurysm at once.
Of course, Jia Xiuzhang still remains skeptical about whether the patient has a thoracic aortic aneurysm.
Conclusions based solely on physical examination and experience are obviously untenable.
Zhao Yuan opened the chest in a very short time.
The situation inside also comes into view.
The patient's lungs were obviously different from normal lungs, appearing dark black.
Zhao Yuan groped in the cavity for a while, and then started to puncture.
As the catheter entered, the thoracic aorta soon appeared on the screen.
Jia Xiuzhang's eyes became solemn. As a doctor trained in thoracic and cardiac surgery, he knew what the picture in front of him meant.
Just like the concerns raised by Zhao Yuan during the pre-operative communication.
The patient had a thoracic aortic aneurysm.
Normally, this kind of aneurysm can be left alone.
However, the patient is now receiving a lung organ transplant, and during the later treatment, the aneurysm will turn into a bomb with an extremely high risk factor.
Although there is a ninety percent chance that this bomb will not explode.
If it explodes, the patient will fall into a passive situation.
Jia Xiuzhang took a breath and said, "Dr. Zhao's judgment is correct. He is indeed a top expert in this field."
Zhao Yuan glanced at Jia Xiuzhang and asked for instructions, "Do you want to dismantle the bomb?"
Jia Xiuzhang nodded, "Do what you think!"
With Jia Xiuzhang's permission, Zhao Yuan began to perform thoracic aortic aneurysm surgery using interventional methods.
The difficulty of the operation soared instantly.
The piercing siren sounded, causing everyone to be highly focused.
Although the interventional method does little harm to the patient, the patient's situation is special at this moment, and slight changes may cause a chain reaction.
Especially when dealing with lesions in the thoracic aorta, it is very easy to cause cardiac arrest.
Just when everyone thought the operation might fail, Zhao Yuan suddenly breathed a sigh of relief, "The stent implantation is completed."
Zhao Yuan then carefully cut open the mediastinal pleura along the roots of the lungs, and then used blunt dissection to expose all the blood vessels in the hilus.
"Hold away!"
Zhao Yuan gently reminded Chen Xie, Populus euphratica.
Two people manipulated the instrument to expose the front edge of the lung hilum.
Without any pause, Zhao Yuan quickly separated the superior pulmonary vein, then ligated it, and then cut off the upper lobe vein and middle lobe vein.
Chen Xie's eyes showed surprise.
It is hard to imagine that Zhao Yuan completed the right pneumonectomy so quickly.
This is a very classic and standard surgery.
He didn't deliberately pursue speed, but it was obviously above Chen Xie's usual level.
Because there were no mistakes or flaws in the surgery, no blood vessels were touched, and no remedial measures were required, the process was smooth and smooth.
Of course, the instrumental nurses play a huge role.
Although it was her first time to participate in an organ transplant operation, she had a tacit understanding with Zhao Yuan.
With one look from Zhao Yuan, Bai Lu knew what he needed.
The most commendable thing is the technique field, the "rolled noodles" are so beautiful.
Afterwards, Zhao Yuan placed the completely cut out bad lung in a physiological basin.
Jia Xiuzhang paid attention to the time, and it was less than fifty minutes before the operation.
He actually completed two surgeries.
This also includes endovascular isolation of thoracic aortic aneurysm!
Although Zhao Yuan is young, he is too steady.
He is like a truck driver who has been driving for decades. He does not need navigation and knows how to avoid traffic jams, transport goods to the destination in the shortest time and burn the least fuel.
Jia Xiuzhang frowned and thought, if it were him, he would probably avoid the problem of thoracic aortic aneurysm.
The key is that he can't figure out why Zhao Yuan made this judgment.
Maybe this is talent!
No wonder junior brother Jiang Qiang has been emphasizing to himself that Zhao Yuan's style is very similar to his master.
The same thing happened when Academician Jiang was doing surgery!
He often displays incredible pre-operative predictions and exquisite on-stage skills.
