The system takes me for surgery

Lu Chenhao said: "Do not infuse cardioplegia directly through the aortic root, because the existence of false lumen will make cardiac arrest difficult."

"Okay, I've seen it, but I forgot it again." Zhang Jiayue said awkwardly.

There are three basic surgical methods for type A thoracic aortic dissection: one is ascending aorta replacement, including simultaneous aortic valve replacement or coronary artery transplantation, or aortic valvuloplasty; the other is ascending aorta and aortic arch replacement; the third is At the same time, the "elephant trunk" operation was performed.

Liang Yi chose the third option and performed the "elephant trunk" operation at the same time.

Moderate hypothermic extracorporeal circulation was used. After reaching the ideal temperature, Liang Yi chose to block the ascending aorta at a point 3.0 cm away from the origin of the innominate artery.

After incision of the arterial dissection, cardioplegia is perfused through the left and right coronary arteries. After cardiac arrest, the reverse perfusion can continue to protect the myocardium and avoid damage to the myocardium.

All this is a very unfamiliar operation for the obstetrics and gynecology department, and they watched intently from the side.It seems very complicated for such a young doctor to be able to manage it.It looks a little dreamy in front of them.

About 1.5 cm above the opening of the left and right coronary arteries, the proximal dissection was trimmed, and the operation on the heart was like carving the intima of an egg.Must be highly concentrated.A small mistake can cause a serious hemorrhage.

Liang Yi frowned and found that Lin Yiyi's aortic dissection had involved the aortic valve junction. A mattress suture had to be made at the junction to reinforce the junction, and a felt strip was added to the intima and adventitia of the aorta,

Aortic dissection is accompanied by a large number of thrombi in the dissection, which undoubtedly greatly increases the difficulty of the entire operation, and also seriously prolongs the entire operation time. Lu Chenhao: Do ​​you want me to help?
Liang Yi raised his head and glanced at him and said, "No, I can do it myself.

The thrombus must be removed in order to avoid future troubles and prevent the rupture of the fragile intima and the loss of thrombus in the dissection caused by blocking the ascending aorta, resulting in severe systemic arterial embolism.

Liang Yi took an artificial blood vessel of appropriate size, and continuously sutured the artificial blood vessel and the aortic root with 3-0 polypropylene thread, paying attention to the position of the opening of the left and right coronary arteries to avoid affecting the blood supply to the opening.

The "elephant trunk" operation is used when replacing the ascending aorta and aortic arch, but for those whose intimal rupture is located in the descending aorta, the "elephant trunk" operation is used in chronic descending aortic dissection to prevent the opening into the false lumen after closing the entrance Insufficient blood supply to the left renal artery, causing acute renal failure.

The treatment of the anastomotic stoma is the key to ensure the success of the operation. Proper treatment methods must be adopted. Otherwise, one will easily cause postoperative anastomotic bleeding, and the other is secondary arterial intima tear at the anastomotic site, resulting in a new false lumen entrance.The currently used "sandwich" technique is a more appropriate and effective method.

Lu Chenhao told Zhang Jiayue: "During aortic arch replacement, after the distal anastomosis is completed and the gas is fully exhausted, the arterial perfusion tube must be transferred from the femoral artery to the artificial blood vessel to prevent further femoral artery perfusion. The false lumen continues to expand, even tears and bleeds, and the blood flow in the true lumen is insufficient, resulting in poor tissue perfusion.

Now that the most difficult step has been done, everyone is a little relieved.Lu Chenhao held the medical polypropylene thread and said, "Why can't we make your stuff?"

Liang Yi said: "It seems easy to hear that the technical barriers are quite high."

Due to the high technical barriers of the medical polypropylene industry, the number of domestic enterprises is small, the output is limited, and the products are mainly concentrated in the low-end field, so my country needs to import a large amount of medical polypropylene products from abroad every year to meet the needs of the domestic market.

Lu Chenhao said: "Other fields want to break the standards of Europe and the United States relatively quickly, but in the medical field, it takes a relatively long process to form these basic things into a level of trust."

Liang Yi nodded and said, "That's right, because when it's used on people, most of them will choose more conservatively what they have experience or have confidence in."

"This requires a complete medical product ecology to be able to innovate and continuously strengthen our own product standards."

"These basic medical products still have a long way to go. But with your generation, we should be completely independent in the near future."

"The future is bright, but the road is tortuous."

Liang Yi raised his head and said, "The extracorporeal circulation can be turned off."

Lin Yiyi had stopped cardiopulmonary bypass, lowered her head by 30 degrees, opened the aortic clamp, trimmed the distal dissection to the proximal end of the innominate artery, and placed felt strips on the intima and adventitia side of the aorta.

Then use 4-0 polypropylene suture for reinforcement, and 3-0 polypropylene suture to continuously suture the artificial blood vessel and the distal end of the ascending aorta. Before tying the knot, perform retrograde perfusion and exhaust through the femoral artery or the superior cavity. After sufficient exhaust, gradually recover Systemic cardiopulmonary bypass and rewarming.

Liang Yi sighed: "I hope that one day our own medical industry can set standards, and we won't always be subject to people being accused that our medical products are inferior."

"Why do you say that?" Lu Chenhao asked.

Liang Yi said: "When the Jh's medical equipment and scalpels you saw before were sold abroad, they were sent back because they did not meet a certain standard of theirs. And some domestic manufacturers only recognize foreign ones. Only certain certifications are reassuring."

"Our own people are too unconfident. I have indeed used JH's medical equipment, and the quality is very good."

"That's right, those devices did not meet their so-called international standards abroad. There are also many manufacturers in China who use this excuse to refuse to use this type of medical device."

"This is cultural lack of self-confidence? Why do we have to let foreign devils prove that we can do every standard? As long as we have a standard organization and a trustworthy testing process, we can do it too."

"So sometimes scientific research is not just a technical issue. In the final analysis, it is also a question of cultural self-confidence. But I am relatively optimistic, and the answer is not far from the problem."

"You kid is also very optimistic."

When it came to the crucial step of processing, Liang Yi didn't speak any more.

To reinforce the distal anastomotic stoma and prevent bleeding from the anastomotic stoma, Liang Yi surrounded the distal anastomotic stoma with an artificial blood vessel.Finally, the graft is wrapped with the remaining aortic adventitia.

The entire operation came to an end in a tense and fast-paced atmosphere. Liang Yi's brows were covered with sweat droplets. The sweat droplets were cold, and when they landed on the eyes, they were irritating.

Shen Weiwei was amazed in his heart, this is unbelievable, during such a tense operation, Liang Yi could talk to Lu Chenhao about domestic hard power and soft power after the operation?