Chapter 259 Hybrid Surgery
Teng Guihua wanted to come over and ask a few questions, but Chang Juan stopped her. Chang Juan didn't want this woman to interfere with the doctor's treatment.
Although she is Fang Xiaoyun's mother, this mother has no daughter at all in her heart. Her daughter is just a money-making tool that is being exploited.
If it could be sold, this mother wouldn't even blink an eye and would sell her daughter for money to pay for the down payment and decoration of her son's house.
"The doctor on duty in the interventional operating room is busy on the stage. A patient with spontaneous intracranial hemorrhage and interventional embolization needs several coils. I reported it to the general on-duty, who was coordinating and calling the backup person over."
Song Zimo contacted the interventional operating room. Spinal arteriography requires very high skills from interventional doctors. They need to super-select the interspinal arteries one by one, push contrast agents, and identify them one by one.
Moreover, one of the anterior spinal arteries was embolized at that time. During the operation, the thrombectomy was performed and the anastomosis was re-anastomized. Once the angiography was performed, the risk of embolization again increased significantly.
"How is Fang Xiaoyun's condition?" Professor Zhang rushed to the general orthopedic surgeon's office.
Yang Ping immediately reported his analysis and arrangements to Professor Zhang. Professor Zhang sat down and took a breath: "I have been thinking about it, it is too similar to a spinal dural arteriovenous fistula. I have encountered such a case before, but it appeared The symptoms did not come so quickly. At that time, the patient suffered from low back pain and numbness and weakness in his lower limbs. He went to another hospital for lumbar disc herniation and underwent surgery. However, the symptoms were not relieved after the operation and he became completely paraplegic. Later, I considered this disease and performed DSA. It took 6 hours of spinal arteriography to find the fistula. Later, surgery was performed to deal with the arteriovenous fistula. The patient recovered the feeling and muscle strength of the lower limbs. Fang Xiaoyun's condition was more complicated. Spinal tuberculosis and spinal dural arteriovenous fistula were mixed together. If it is true that it causes paraplegia at the same time, it is too rare to arrange DSA in the emergency department. If confirmed, perform surgery immediately and put the patient in the hybrid operating room of the interventional department.”
Hybrid operating room is a type of hybrid operating room, usually in a 100-level laminar flow operating room. It fully integrates DSA equipment and surgical equipment, and can complete interventional treatment, surgical operations and imaging examinations in one operating room, so that some complex operations do not need to be decomposed. It can be completed in one go, reducing surgical risks, reducing patient transportation, and saving surgical time.
"We have made arrangements. The doctor on duty in the interventional department is busy and there is no manpower. The general duty is making arrangements and has called the backup person to come over." Yang Ping introduced.
Director Han also hurriedly arrived: "Xiao Yang, I contacted Director Shi from the Interventional Department, and they arranged for Director Ji to come over. Director Ji is the best in the Interventional Department and has done the most spinal angiography."
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Great, at critical moments, Director Han can coordinate, create conditions for Yang Ping, and at the same time bear the risks for Yang Ping.
Although the general on-duty can also be scheduled, he will not be as attentive as Director Han. Once Director Han communicates with Director Shi, they will know who you need and immediately transfer Director Ji instead of just calling a doctor. cope.
"Have you communicated with the patient?" Director Han asked.
Yang Ping nodded: "We just communicated and signed. The patient herself communicates well. Her mother, I think, is not a good person. She is always evasive and suspicious of this and that."
Director Han hummed: "She is an adult. She only needs to agree. The family members don't need to worry about it. Xiao Zhang, bring over the medical records."
Zhang Lin immediately brought over the medical records. Director Han looked through the medical records and signed his name in front of Yang Ping's name on the informed consent form for the surgery.
"Do it according to your ideas. If there is anything, I will take care of it. As doctors, there is no way we do not take risks. As long as we consider the interests of the patients, be fully prepared and control the risks, I will have to make a call later. Tell Mr. Zhao from the Medical Office. If your family members have problems or potential disputes, please go to them to prepare a case in advance.”
Director Han handed the medical record to Zhang Lin. Professor Zhang waved, took the medical record and added his name: "Go ahead and do it. This case is relatively rare. Remember to collect information."
"Xiaowu, you are responsible for collecting information. Song Zimo and Zhang Lin will come on stage with me, and Fatty will anesthetize you." Yang Ping made arrangements on the spot.
"The interventional department called and asked us to send the patient. They came with two doctors and a nurse and opened a hybrid operating room for us to use." Song Zimo answered the phone and said.
Su Yixuan and Zhou Can quickly pushed the surgical instruments and microscope to the interventional operating room. Orthopedic surgery requires many specialized instruments. Spinal surgery has a complete set of spinal surgical instruments. The interventional hybrid operating room only has some general instruments and no orthopedic specialist instruments.
"Let's go and send the patient!" Director Han said in a deep voice.
Zhang Lin Xiaowu sent the patient and pushed Fang Xiaoyun on a transfer cart to the interventional operating room. The interventional operating room is located on the second floor of the emergency building, where the chest pain center is also located.
The comprehensive orthopedic department's flat cart is a new one, with pneumatic wheels and shock absorption. It makes no big noise or vibration when pushed. Fang Xiaoyun's mother followed behind: "Hey! Hey! Hey! What are you going to do?" ”
"Why are you talking so much nonsense!" Chang Juan blocked her, fearing that she would cause trouble and affect the doctor's work.
There are barrier-free passages between each building. The flat car was hurriedly pushed to the interventional operating room. Director Ji, his assistants and nurses were already waiting in the operating room.
"Mr. Zhang! Director Han!" Director Ji greeted respectfully.
"Doctor Yang!" Director Ji also greeted politely, but others ignored him.
Now Yang Ping is also a celebrity in the hospital, and everyone knows his abilities. The hospital is a place where technology is king. If the technology is good, everyone respects it in their hearts. If the technology is not good, it will be useless even if there is support from the backstage. Everyone does not say it in words, but in their hearts Definitely look down on it.
"Is this patient considering spinal dural arteriovenous fistula? The operation will take a long time. Each blood vessel has to be superselected and tested. There is a possibility of failure. I will try my best."
Director Ji said it very honestly, but he was very happy. He had never encountered this rare case before. When he was studying in Fuwai, he heard the teacher talk about it. Now that he has encountered it clinically, he is naturally happy.
Professor Zhang encouraged him and said: "Don't worry, I have done DSA on this kind of patient. You do it and I will watch it for you in the audience."
That would be best. The older generation of doctors are not like now, and can only guard their own one-third of an acre. At that time, it was normal for them to dabble in some cross-technologies. Many old doctors could take X-rays themselves.
"A week ago, this patient had an embolism in the anterior spinal artery of thoracic 9. During the operation, the thrombectomy was performed and the anastomosis was re-anastomized." Yang Ping introduced, and then Zhang Lin introduced the patient in detail.
Director Ji said: "The amount of contrast agent during the operation must be strictly controlled, otherwise it will easily cause reinbolism." After the handover of the condition was completed, the young doctor under Director Ji signed the DSA informed consent and the informed consent for iodinated contrast agent with the patient.
The fat man underwent anesthesia and was under general anesthesia with tracheal intubation. The people on Yang Ping's team were different. The fat man's anesthesia was fast and good. He was still talking here, but the anesthesia was over there and he could brush his hands.
Director Ji admires this young team with excellent professional quality. This fat anesthesiologist is much better than his anesthesiologist, who is afraid of this and that.
"Then let's go ahead and do a DSA of the spinal arteries. We'll do a puncture of the femoral arteries and find them one by one. It'll probably take five or six hours. Why don't you go out and take a rest first."
Director Ji, assistants and nurses put on lead clothes. Everyone looked for lead clothes to wear. Professor Zhang also wanted a lead clothes. The lead clothes were not breathable and heavy, weighing dozens of kilograms. Wearing them for several hours, eight It would be very difficult for a ten-year-old person.
"We will perform DSA in the supine position now, find the fistula, and then switch to the prone position for you to perform the surgery, is that okay?"
Director Ji came back after brushing his hands, disinfecting the sheets, and putting on gloves.
"Thank you, Director Ji!"
"It's okay, they're all doctors. This kind of thing happens all the time. It's my wife's birthday today and I asked her to have a meal with her. As soon as I sat down, I got a call. There's nothing I can do. Who asked us to be doctors?"
Can it be replaced by someone else?
It’s not necessarily possible. This kind of case requires a doctor with good skills to have a high success rate.
Director Ji is in his forties, with gray hair and a lean build. He is one of the directors of the interventional department.
The interventional department is divided into several wards, including the neurointerventional group, the cardiovascular interventional group, and the tumor interventional group. Lao Ji is in the cardiovascular interventional group, and the cardiovascular interventional group is also an important part of the chest pain center.
Lao Ji came from the Department of Cardiovascular Medicine. After getting married and having children, he started to engage in interventional medicine. Generally, those who engage in interventional medicine are often exposed to X-rays. Those who are not married and have children are not willing to engage in this profession. The hospital will not select people who are unmarried. Pick inside.
The femoral artery was punctured and a catheter guidewire was inserted. Lao Ji performed skillfully and successfully superselected the first interspinal artery.
We can only check them one by one. Too much contrast agent will not work, and too little will not work. The dose must be accurately controlled, and the technique of super-selection of blood vessels must be gentle and precise.
"Push the contrast agent, Onipex!"
Onipex is a non-ionic iodine contrast agent, which is a safe intraspinal contrast agent. For spinal arteriography, it is necessary to select a contrast agent that can enter the spinal canal.
"Okay, that's enough. You want a little less, right? Mr. Zhang!" Lao Ji asked Professor Zhang.
"Yes, too much can easily cause embolism." Professor Zhang has comprehensive knowledge and experience.
"Yes! When I went to Fuwai for further study, a colleague said that their hospital had a spinal artery angiography. After the angiography, it caused spinal artery embolism, causing blood supply disorder to the spinal cord, spinal cord ischemia and necrosis, paralysis, and a lawsuit. For several years, it is better to have fewer people with high-risk factors.”
But too little will not play a developing role, so you have to be very careful about the amount.
"No, next one!"
There are twenty-four intercostal arteries alone. This is just the beginning. One blood vessel cannot be repaired in more than ten minutes.
"Teacher Zhang, would you like to go out and take a rest? I'll be fine here."
Director Han was afraid that he wouldn't be able to bear it, staying up late and wearing such heavy lead clothes.
Professor Zhang waved his hand: "It's okay. I have experience in this kind of case and have done this kind of DSA. I can give them some advice. You go out and take a rest outside. A few young men have to undergo surgery later."< br>
Professor Zhang's tone was stern, more like an order. He wanted to protect young people. After all, everyone was not married yet and had children, so they should try to reduce their exposure to X-rays.
"It's okay. I'm inside and want to see how the imaging is going." Yang Ping also wore lead clothing, and everyone else wore lead clothing.
Professor Zhang lost his temper: "Why are you disobedient? Just go out when told to do so. There are so many people watching the fun!"
Director Han immediately ordered Yang Ping: "As long as Professor Zhang and I stay inside, you all can get out, do you hear me?"
Five or six hours of X-ray exposure, even with lead clothing, cannot fully protect the patient. Surgery will be required later. Orthopedic surgeons often deal with X-rays and try to avoid unnecessary exposure.
Okay, Yang Ping takes everyone out and goes to the locker room to rest.
Let's take a nap. If Director Ji finds the fistula, he will call everyone.
(End of chapter)