The operation has been going on for nearly 5 hours, and I am in a highly concentrated state of mind. It is impossible to say that I am not exhausted.
Acute pulmonary embolism is still in the right pulmonary artery, and it is the highest risk direct thrombectomy.
But at this moment, there is no retreat, we must carry forward with a heavy load and fight with our last resort!
"Teacher, let me and Brother Mo Yan take over."
Seeing how tired Song Dong and Wang Ji were, Xia Xingran took a deep breath, tried her best to bloom a bright smile from her eyes, and took the initiative to take over the baton.
In an instant, the haze-filled operating room seemed to be flooded with sunlight again, becoming dazzling and warm.
Pulmonary artery thrombectomy is different from previous surgeries. It requires a constant temperature of 16 degrees Celsius for 6 to 7 hours.
The operating room cooled down rapidly, and Xia Xingran's body was already cold. This was a temperature she had never experienced before.
After the temperature was appropriate, Bai Moyan took over first and started extracorporeal circulation smoothly. Then handed it over to Xia Xingran.
To remove the thrombus in the pulmonary artery, the first step is to cut the pulmonary artery.
Xia Xingran chose to incise the right pulmonary artery longitudinally. After the incision, Bai Moyan immediately cooperated to dilate the blood vessel.
Everyone couldn't help but gasped when they saw it.
The patient's right pulmonary artery, its anterior segment, posterior segment, and basilar artery were filled with a large number of thrombi.
Xia Xingran observed carefully and found that these blood clots were huge, like small plugs, blocking the blood vessels tightly.
"Xia Xingran, separation and removal of blood clots is an extremely delicate job. You are a girl and have a natural advantage. Do it well!"
Song Dong and Wang Ji wanted to tap Xia Xingran's hidden potential, so they were willing to take huge risks and let Xia Xingran try it alone.
Xia Xingran said "Yeah" and began to carefully separate and completely remove the blood clot.
Just when everyone thought they were done, Xia Xingran made a decision that surprised everyone.
She did not stop the operation and chose to close her chest, but continued to go deeper to prepare for a new round of surgery.
"Xia Xingran, what are you doing?!" Song Dong and Wang Ji shouted. Read the book
"Teacher, after removing the blood clot, it won't have any effect if the distal blood vessels are not opened."
During the process of clearing the pulmonary artery thrombus, Xia Xingran carefully discovered that the patient still had severe multi-vessel embolism.
If you just follow the preoperative plan, it will simply treat the symptoms but not the root cause. It cannot completely solve the patient's problem.
So she and Bai Moyan exchanged glances and temporarily adjusted the surgical plan.
"The next thing I have to do is to peel off all the intima at the far end, like a vascular tree, to peel off all the intima that extends to the small blood vessels that extend to the lungs, and all the intima that blocks the blood vessels. come out."
Xia Xingran's calm tone sounded as if she was not performing an operation on the heart at this moment, but an appendix operation.
But everyone in the operating room exploded in an instant. This is equivalent to upgrading from pulmonary thrombectomy to pulmonary thromboendarterectomy.
Even though the change only added a few words, these few words were enough to suddenly increase the difficulty and risk factor of the entire operation several times!
"Xia Xingran, how dare you..."
Song Dong and Wang Ji were angry and shocked by Xia Xingran's attitude of "disobeying foreign military orders".
Zhou Wei hurriedly pulled the frustrated two people over and comforted them: "Little brother, don't panic when something happens, just take a look before talking. Take a step back and say, with the four of us here, even if something goes wrong with the children, nothing will happen." There’s nothing to be afraid of. Don’t you still believe in yourself?”
Song Dong and Wang Ji were helpless. After all, the operation had already begun and they could not stop it. They could only watch Xia Xingran and Bai Moyan's operations with their hearts hanging.
"Brother Mo Yan, enlarge the pulmonary artery and enlarge the heart." Xia Xingran was not affected at all and cooperated with Bai Moyan in an orderly manner.
There was a straight line on the monitor, and the heart had stopped beating.
Bai Moyan has quite a lot of
In a tacit understanding, the patient's right pulmonary artery was exposed to Xia Xingran.
"Xiao Ran, why don't you stop the circulation." Bai Moyan suggested after observing the status of the operation.
"Okay, then I'll count to one, two, and three and you stop it." With Bai Moyan by his side, Xia Xingran felt at ease and relaxed.
Song Dong and Wang Ji on the side were so shocked that they stretched their necks forward again and again. Even the two of them did not dare to make temporary adjustments to the operation and take the extremely risky operation of circulatory arrest.
However, Xia Xingran and Bai Moyan, two children who were less than one year old together, proposed the surgical plan of circulatory arrest in such an understatement.
Entering deep hypothermic circulatory arrest, the patient is equivalent to entering a "death" state, with blood stagnating throughout the body.
At first, they wanted to avoid this plan as much as possible, but the blood clot situation in the patient's body was far more complicated than they initially expected.
As a doctor, it is a basic skill to flexibly change the most suitable surgical plan.
Circulatory arrest creates a clear surgical field. However, for every circulatory arrest, as many blood clots as possible in the patient's blood vessels must be removed within 20 minutes to dismantle these life-threatening bombs.
What kind of confidence and confidence do you have in your medical skills to dare to do this!
Bai Moyan had already put an ice cap on the patient in advance to protect his brain tissue activity to the maximum extent.
Four experienced doctors sat in front of the extracorporeal circulation machine, staring at the timer to protect them. Once it exceeds 20 minutes, even if the operation is successful, the patient will suffer brain death and irreversible damage to multiple organs.
The first circulatory arrest occurred at 19 minutes and 38 seconds. Zhou Wei immediately reminded the two of them. After getting the response, he resumed extracorporeal circulation.
It should circulate for at least ten minutes to restore blood supply to the brain and organs first. After recovery, perform the second circulatory arrest.
Circulation arrest is to completely remove blood clots, and circulation restoration is to protect organs. This is Xia Xingran's second set-up process plan for this surgery.
The patient's body was severely clogged with thrombus. During the first circulatory arrest, only a small piece of thrombus was removed. It’s still too early to fully divest. Everyone knows that with every circulatory arrest, the risk of surgery increases.
This requires that Xia Xingran's speed and efficiency must be improved at the same time.
A quarter of an hour later, the second cycle stop began.
Bai Moyan blocked the proximal end first, and then Xia Xingran began to peel off the thrombus.
"Long thick forceps. Main pulmonary artery intima."
"Long, thin pliers. Quick."
"Another long, thick pliers."
Xia Xingran and Bai Moyan cooperated so well that the four old guys couldn't help but want to applaud for them.
Zhou Wei glanced at the time and reminded again: "There's still one minute left, kids."
But Xia Xingran was peeling off the largest thrombus at the moment. She hurriedly said to Zhou Wei: "Director Zhou, don't open it yet, there is still time!"
"There's only a little bit of blood clot left, just give me a minute or two! Brother Mo Yan, give me another long, thick forceps, quick!"
Xia Xingran speeded up the movements of his hands visibly. She wanted to reduce the number of circulatory arrests as much as possible, so that the damage to the patient would be as little as possible.
While closely monitoring cerebral oxygen and various vital signs, Zhou Wei extended the circulatory arrest time by one minute.
And in this snatched minute, Xia Xingran cut off the largest thrombus in the patient's pulmonary artery.
Zhou Wei and the other four people immediately got up to take a look and couldn't help but sigh: "Don't talk about you, this is the first time for us to see such a large blood clot, blocking it so hard, completely blocking the blood vessel."
The third circulatory arrest is to peel off the intimal hyperplasia in the small blood vessels.
This step is the most difficult and critical step of this surgery. It not only tests the doctor's endurance, but also tests the precision of the doctor's operation.
Once the tiny blood vessels bleed due to stripping, there is no chance of remediation. The operation will be terminated and declared a failure.
Bai Moyan checked in advance and reminded: "Xiaoran, be careful, this person's blood vessel intima is very
very thin. Old thrombi and intimal adhesions are very tight. The layer that is peeled off is the gap between the intima and media. "
"I understand Brother Mo Yan." Xia Xingran took a long breath and put out 120 points of energy.
Most of these blood vessels are only a few millimeters and very thin, and Xia Xingran has to peel them to a very far distance and then peel them off completely.
First, make sure to peel it off fully, and second, make sure it is peeled off safely.
While Xia Xingran was peeling off the blood clots, Bai Moyan was observing her aftermath, constantly assisting her in checking for leaks and filling in the gaps, and telling her where there were still unpeeled blood clots.
"Water, long thin pliers." No matter what Xia Xingran needed, Bai Moyan would react faster than others and hand it to her.
Finally, after nearly 6 hours and three circulatory arrests, the patient's blood clots were finally cleared!
The room began to heat up, and the four old doctors began to splice the removed tissues and examine the specimens to see if there were any problems.
The patient's body temperature slowly began to recover, and Xia Xingran and other doctors began to gradually remove the extracorporeal circulation to allow the patient's heartbeat to resume beating.
Just when Xia Xingran was stopping the patient's bleeding, closing the sternum, and threading the wire to prepare to end the operation, the most worrying thing happened. ..
"The patient's heart is suffering from ventricular fibrillation!"
"Defibrillation was performed quickly, but there was no significant improvement!"
The atmosphere in the operating room instantly became tense again.
