There is a grading system for surgery. However, many ordinary people have never heard of this term.
According to corresponding laws and regulations, the difficulty of surgery is divided into levels one to four. Newly hired residents can preside over level one surgeries under the guidance of superior physicians, and then move up the levels. To perform level four surgeries, the surgeon is required to be at least
Only the deputy chief physician can do it. And the newly promoted deputy chief physician needs to work in the deputy chief physician position for three years, and those with a postdoctoral degree need to work in the deputy chief physician position for two years before they can independently preside over level four surgeries. But the prerequisites are
, the level 4 surgeries performed did not use new technologies, or were not new project surgeries or scientific research project surgeries.
PCI is special. It is a third-level surgery, and it is also a qualified surgery. Senior attending physicians can only perform it after they have obtained the qualification for this surgery.
According to the analysis of the four people, if Yao Zhuangxian is to perform a heart ectopic repair surgery, at least one qualified senior attending physician, two senior deputy chief physicians of cardiac surgery, and one general physician will be required.
It takes a total of five junior deputy chief physicians of the Department of Surgery to complete the operation. For such a large-scale operation, the deputy director of the anesthesiology department must be present. At the same time, the nursing department must dispatch a team of nurses who often cooperate with several doctors to participate in the operation.
In other words, there may be a team of more than 20 people in the operating room at the same time.
"Of course, such a major operation will definitely not be completed in one go." Yuan Pingan explained to Sun Lien, "For example, PCI should be done before ectopic repair..."
"The patient's heart is in the abdominal cavity. This PCI is not something ordinary doctors can do." Xu Yourong shook his head, "Maybe the heart must be removed from the body before it can be unblocked."
"Isn't it?" Zhou Ce frowned and asked, "After the heart was removed from the body, the blood vessels were deflated. How can I intervene?"
This is why PCI surgery requires special qualifications. If you are not a doctor who specializes in this surgery, your understanding of this surgery will be very limited. Everyone knows the general principle, which is to use a guide wire to follow the artery to the coronary heart.
into the artery, and then find the blockage or severe stenosis. Depending on the situation, you can choose to suck out the thrombus, crush the hardened plaque, or simply put a stent directly to dilate the narrowed blood vessel. The specific treatment method requires a doctor who has obtained PCI admission qualification.
Make a judgment.
"The worst case scenario is to build a bridge outside the body." Sun Lien took courage and expressed his opinion in a discussion among a group of top students. Anyway, everyone is familiar with him, and they all know that he is a junior graduate, even if he said something wrong
It seems that there will be no serious consequences.
"Don't tell me, this is really a good idea." After everyone was silent for a while, Zhou Ce suddenly nodded and said, "It is definitely more beneficial for the bridge to be built after the heart is separated from the body and stops beating. And there is no need to worry about the myocardium during the bridge.
Regarding the problem of insufficient blood supply, the only problem may be whether the blood vessels can be sewn well because the proliferating blood vessels are very thin."
Yuan Ping'an thought for a while and added, "You must also be very careful with subsequent medication. Anticoagulant treatment is required after bypass, but anticoagulant treatment will increase the risk of bleeding later..."
Xu Yourong glanced at Yuan Pingan, then shook his head dissatisfied, "That's wrong. Every patient's situation is different. You can't just copy the contents of the book."
Looking at Yuan Pingan's somewhat overwhelmed expression, Xu Yourong continued, "Short-term anticoagulation treatment is required after heart bypass surgery. This is what is in the textbook. But you ignored a very important prerequisite."
After all, Yuan Pingan is not an academic research doctor without clinical experience. He immediately understood what Xu Yourong meant. "You are right. The cause of this patient is not consistent with other patients who need bypass surgery."
The actual manifestation of coronary heart disease is that the blood vessels that wrap around the heart are narrowed or blocked. But there are many reasons for this manifestation. Among them, the largest proportion is arteriosclerotic plaques caused by high blood lipids, or
Thrombus blockage caused by hypercoagulability. For coronary heart disease caused by these two causes, patients do need short-term anticoagulation treatment after bypass surgery. But the cause of Yao Zhuangxian's coronary heart disease is completely different from the original reason of his blocked blood vessel.
It shouldn't exist. The cause of the blockage is not the viscosity of the blood, but the excessive diameter of the compensated blood vessels and the excessive twisting of the blood vessels.
The blood vessels in the human body can be regarded as natural rivers to a certain extent. The arteries are like rivers in a flood discharge state. The most ideal situation is that the rivers are wide and straight, but it is inevitable to encounter some
Some river channels are twisted and narrow, or have fragile slopes.
If the slope is fragile, it may be eroded little by little under long-term erosion, and the result of erosion is an aneurysm. If the slope breaks out, it will be a ruptured aneurysm, which is a serious symptom that can kill people in minutes.
Compared with fragile slopes, sedimentation caused by twisted and narrow river channels progresses relatively slowly. Siltation will cause the river to gradually narrow, and when the river is completely blocked, it will cause coronary heart disease.
Compensatory hyperplasia of blood vessels has a characteristic. No matter which organ it appears in, the bending and narrowing of the blood vessels is inevitable. When this kind of compensation occurs in the brain, it is moyamoya disease, and when it occurs in the liver, it indicates late stage cirrhosis. In general,
Although it can ensure the normal operation of the human body in the short term, this is not a good thing.
Speaking of which, this discussion should be regarded as the first collective consultation and discussion of Sun Lien's medical team after the avian influenza. Although Dr. Pascal did not participate, it was not easy to gather such people. Although Zhou Ce is not the treatment team
member, but he has a close relationship with Xu Yourong and likes to chat with Sun Lien. He can basically be regarded as half a non-staff member.
"Speaking of which, didn't Dean Song ask Professor Liu to take over the treatment team?" When Song Wen made this decision, Yuan Pingan was at the scene. He was almost the most concerned about the treatment team's affairs among the four, "But so
I haven’t seen Professor Liu come to the group for a long time..."
"Don't speak ill of Dean Liu so blatantly!" Zhou Ce coughed twice and said seriously, "Be tactful, be tactful."
"For example, Dean Liu has recently become obsessed with a newly opened fried noodle shop." Xu Yourong said without changing his expression, "The old man has eaten fried noodles three times a day and almost turned into fried noodle."
The three of them were shocked, but they couldn't figure out what kind of disease the noodles looked like fried sauce.
"Isn't this joke funny?" Xu Yourong was stunned for a while, then shook his head, "I'm still not very good at telling jokes."
Sun Lien sighed, "Anyway, the treatment team is temporarily disbanded. Once Dr. Xu sorts out the paper, I guess Dean Liu will take some action."
The original intention of setting up the treatment team was to pave the way for Xu Yourong's promotion. Once this paper has a clue, Liu Pingchuan will most likely transfer Xu Yourong to neurosurgery. Even if there is a position in the diagnostic department in the future, he will have to wait until later.
Two years later.
"The outline of the thesis will probably be out in two days." Xu Yourong nodded and replied, "Chen Wen's surgical plan is probably already available. Teacher Liu means that it will be mainly interventional. Using the cerebral blood vessels as the operating channel, first remove the close proximity
That batch of cysts in the white matter of the brain.”
Complex operations, operations that cause great trauma to the human body, are best divided into several times. This is a very important conceptual advancement in modern medical surgery. Chen Wen's condition is so complicated and serious that not only Sun Lien has heard of it for the first time
, even Xu Yourong was seeing her for the first time. The Neurosurgery Department of the Fourth Central Hospital has not relaxed its design of Chen Wen’s surgical plan during this period. Liu Pingchuan even contacted his old friends from the association to help with the surgical plan. At the same time,
Liu Pingchuan ordered two sets of 3D printed models of Chen Wen's brain from Shenzhen, specifically for practicing surgical plans.
The real challenge is yet to come. For this operation, the Fourth Central Hospital decided to use the newly purchased rosa neurosurgery robot system.
This operation has many wounds and deep locations. It is obvious that the neurosurgeon's hands alone cannot achieve the required accuracy. Even if the first few worm cysts can be removed with Xu Yourong's steady hands, no one knows the strength of Xu Yourong's hands.
How long does it remain stable?
Once the operation time is too long and Xu Yourong's hands lose their stability, the sharp sampling needle will damage the normal brain tissue or puncture the intracerebral artery and cause severe bleeding. This kind of mistake must never occur.
"I've used the rosa system several times in the United States, but I'm not particularly skilled at it." Xu Yourong stretched and then tucked his loose hair back behind his ears. "I've been practicing these past few days, so it's okay.
Time to come to the emergency room.”
Sun Lien had never heard of rosa, but he had heard that there was a Da Vinci system in the courtyard. He asked curiously, "Isn't there a Da Vinci in the courtyard? Why not use that one?"
"The kind of thing used for thoracic and abdominal surgery is not accurate enough." Xu Yourong did not need to answer, Yuan Pingan answered directly, "And Da Vinci can't walk in the artery. If you need to do neurosurgery, that thing is
Scrap metal.”
Speaking of which, the positioning of the da Vinci surgical robot is really embarrassing. After being introduced into the country as an advanced equipment, the phenomenon of the da Vinci robot being acclimatized has become more serious than everyone initially expected. During thoracoabdominal surgery,
Although da Vinci can achieve advantages such as less trauma and faster recovery, da Vinci surgery has not yet been covered by medical insurance. Many commercial insurances will not cover this huge additional expense. And compared with ordinary
Compared with laparoscopic surgery, Da Vinci's advantages are not so great as to be "revolutionary."
Another huge advantage of the da Vinci system, remote surgical support, is even more meaningless. None of the hospitals that can afford da Vinci is a rookie. Everyone is very good at it, so there is no need to call in foreign aid. Instead, surgical support is needed.
Many hospitals cannot afford this equipment, so surgeries that require experts must either transfer the patient to a high-level hospital or invite experts to come to the hospital to perform the surgery. Although remote surgical support is a big selling point, in reality it is not used at all.
superior.
Although now relying on 5G technology, large hospitals can perform remote Da Vinci consultations and even operations with each other, but after all, this case still involves a small number of experts. A round-trip air ticket is much cheaper than a Da Vinci and a bunch of follow-up support services.