When a doctor opened a plug-in

Is a perfect anastomosis of great vessels really perfect enough?

Looking at his stitching, Chen Cang began to ask himself such a question!

What is perfect?

Perfection is a threshold reached using current methods.

However, current methods are inherently limited.

There is room for improvement and improvement in both surgical techniques and surgical plans.

This is a process that requires continuous research and improvement.

Perfection is still so, not to mention the master class.

Chen Cang's aortic dissection surgery and total aortic arch replacement at this time are both masters.

It takes a long distance to break through to perfection.

"Line four."

"Flush with saline!"

"Clamp!"

...

The operation is continuing.

Facing the repair of the intercostal artery, Chen Cang began to calm down and observe carefully, the third rib...the fourth rib...

Chen Cang suddenly asked Xu Ziming: "Is there a big difference in the time limit of the intercostal artery to the spinal cord?"

Xu Ziming nodded: "Well, according to the 2009 version of the guidelines, it can be completed within 60 minutes, but later research found that in about 45 minutes, the ischemic and hypoxic response of the spinal cord nerve tissue began to appear, although there is no intuitive Performance, but there are some problems with post-fix!"

Chen Cang looked at such complicated intercostal arteries: "How long is the best time?"

He Chao blurted out: "Professor Wu from Ruijin Hospital can repair all intercostal arteries in 35 minutes! That's...my teacher."

Xu Ziming nodded: "Well, it is true. Professor Nan Wu has rich experience in Marfan syndrome and has been committed to it for a long time. He also constantly practices the repair of intercostal arteries."

After Chen Cang heard it, he nodded!

More than 20 arteries, 30 minutes!

All the time is counted. A blood vessel only takes one and a half minutes. This also needs to include the processing of thread knots, needle insertion... and so on!

The most important thing in the treatment of intercostal blood vessels is to avoid damage to the intercostal nerve.

It is a lot more troublesome than the large blood vessels in the chest.

The limit time of Chen Cang holding the abrasive tool is thirty or forty seconds, but how long does it take to put it in this situation?

Chen Cang decided to find some time to practice.

...

After the operation started, the anesthesiologist Zhou He has been monitoring the vital signs of the patient, because the operation time is long and appropriate brain protection needs to be selected.

In fact, if the patient does not have Marfan syndrome, but is only an acute type I aortic dissection, he can only undergo ascending aorta replacement or semi-arch replacement.

However, in Marfan syndrome, the originally damaged ascending aorta and aortic arch have already undergone fibrous layer changes. If it is not controlled, it will definitely be a problem!

It is definitely good to use total bow replacement surgery, or the common "elephant nose surgery" is also very effective!

But this actually places high demands on both the patient and the surgeon.

Not only is the surgeon required to be skilled, but the patient's overall condition is also required to stabilize the operation.

Tian Zhengkai, who was born as an athlete, has a good foundation and Chen Cang is skilled enough, so at this time, total bow replacement surgery is actually the best choice!

The ascending aorta is processed!

The patient's vital signs are completely normal and he is ready to undergo a total bow replacement operation!

Chen Cang sighed and said, "Cool down!"

Hypothermia, circulatory arrest, and retrograde perfusion of the superior vena cava are effective brain protection strategies!

Everyone is getting busy!

"How many degrees Celsius is adjusted?" Zhou He looked at Chen Cang and asked directly.

"Adjust to 20 degrees Celsius!" Chen Cang said decisively!

Zhou He was taken aback!

There is a direct correlation between low temperature and halted circulation.

The lower the temperature, the longer the allowable time to stop the cycle, which can be maintained for 60-80 minutes at 15-18 degrees Celsius!

In this way, the operational time becomes abundant.

If the temperature is high, time is limited, but... the patient's injury may be slightly less.

But again, if you have plenty of time, the patient may need some price!

Why is medicine difficult?

Because the time we buy is actually given by the patient, and the patient's time is swallowed by death!

Every additional minute we consume, one minute of disease damage, death swallows a little!

This is a tug-of-war game, and the chip is time.

Whoever snatches the patient over first will win!

Perhaps at this moment, this feeling of competing with death for time will become more and more obvious!

However, Chen Cang chose 20 degrees Celsius, and his requirements for doctors suddenly increased, because the operating time became shorter, but in the same way, the patient's injury was also reduced.

Zhou He glanced at Chen Cang's firm eyes and nodded!

And Xu Ziming and He Chao also sighed: Chen Cang, this is Chen Cang!

He Chao was even more expectant and excited.

When the temperature is lowered to 20℃, the circulation is stopped or the superior vena cava retrograde perfusion is completed at the same time!

Chen Cang began to separate the aortic arch!

Tense atmosphere!

The feeling of low temperature in the hand!

Worry time!

The sound of dripping from the monitor!

The breathing of several doctors became clearer.

All signs indicate that this is a difficult operation.

Freeing the distal end of the aortic arch is a precision operation.

The vagus and recurrent laryngeal nerves should be carefully confirmed, and the nerves should be freed first and then banded for traction. Pay special attention to preventing damage to the recurrent laryngeal nerve when freeing the distal end of the lower edge of the arch.

Chen Cang, who is dexterous and stable, is careful to avoid danger.

It took less than 8 minutes to separate successfully!

Xu Ziming and He Chao looked at each other, full of surprises.

Such a quick and accurate freeing of the aortic arch saves too much time for a short replacement operation.

The seemingly ordinary operation is full of details and invisible technology.

However, this is also an opportunity to learn and exercise for Xu Ziming, who is experienced.

He Chao became a little excited.

Chen Cang's free time just now was not inferior to his own teacher.

Then, Chen Cang put down the separating forceps and started trimming the aortic arch!

Then select a suitable artificial blood vessel, and suture the descending aorta with 4-0 polypropylene thread.

In this process, Chen Cang took even shorter time. As the champion of the Cardiac Surgery Skills Contest, Chen Cang had little pressure to deal with these things.

Then, begin to suture the back wall of the arch containing the openings of the three branch blood vessels. These are the branches and directions of the blood vessels. The suture needs to be tight to prevent blood leakage.

Here is the aorta, and the blood pressure is very high. If there is a crack or something, this is a potential disaster for the patient!

Therefore, the anastomosis of the artificial blood vessel and the blood vessel is the key to the operation!

Not only fast!

And keep it secret!

This is the tone of the entire operation!