Chapter 502 Three years and three years, I am almost the boss of clinical medicine!
Under the shadowless lamp, Xu Qiu's hand speed became faster and faster, and in the end, there was almost an afterimage.
His voice was still neither slow nor hurried.
"The elephant trunk stent can stabilize the descending aorta around the stent graft, so that the false lumen can be quickly closed.
In the past, clinicians chose the model of artificial blood vessels based on the diameter of the true lumen.
However, the problem was later discovered. This could easily lead to distal endoleak or patency of the false lumen, so that doctors could only hope that thrombus formation would occur in the false lumen during the follow-up period, leading to the closure of the false lumen...
If it still did not close during the follow-up period, endovascular repair would have to be performed.
Therefore, in the future, the surgeon will choose the size of the stent graft based on the total diameter of the aorta at the level of the left atrium. The best auxiliary examination before surgery...
What is it?"
When the last question came out, everyone's heart tightened suddenly.
Many eyes fell on Yang Yuen.
After all, in the operating room, it was either a famous doctor like Joseph or Director Zheng, and only Yang Yuen had the lowest title.
"Yes... yes, CT angiography?" Yang Yuen blurted out.
Xu Qiu nodded slightly: "Not entirely correct. To estimate the size of the covered stent, the best imaging method is to do multi-dimensional reconstruction along the center line of the curved blood vessel around ECG gating to CT angiography."
In short, it is multi-dimensional reconstruction.
This is not much different from the examination method relied on by the complete cranial fusion and separation surgery at the beginning of the year. Reconstruction is basically the killer of various top surgeries. By completely reconstructing the patient's anatomy and presenting it to the doctor, a more personalized and detailed surgical plan can be formulated.
Xu Qiu added: "In an emergency, reconstruction cannot be done. Generally, it depends on intraoperative esophageal ultrasound measurement, or CT angiography + intraoperative esophageal ultrasound."
For example, now.
This patient with dissection rupture is very dangerous. On the way to the hospital, he had lost nearly 1,200 ml of blood and was on the verge of death.
Therefore, there is no way to perform detailed imaging examinations, and everything can only be moved to the operation simultaneously.
"In addition to size, the length and depth of the implanted stent are also important.
The longest, distal anchoring area cannot exceed the T10 segment.
In fact, as long as it exceeds T7, the incidence of spinal cord injury will increase significantly.
Therefore, the seventh thoracic vertebra should be used as the boundary in clinical work, and the stent cannot cover the celiac trunk..."
The difficult modified SUN-style surgery was performed by Xu Qiu as if it was done with ease, and he could even teach while performing the surgery.
The details were mentioned from time to time, which made the eyes of the observers brighten.
Finally, as the surgery progressed, it came to the elephant trunk stent surgery!
"Next, I will do the advanced modified version.
There is another version, which is easier to operate and tends to be tricky, suitable for most doctors to learn. I will also make it public in cardiac surgery later.
What I want to do is a modified version with a higher threshold, but after mastering it, the speed is faster than tricks."
After that, Xu Qiu's knife moved.
The elephant trunk stent surgery, scientifically known as "aortic replacement hybrid surgery".
Its surgical method is simple to say, that is, to replace the diseased aorta and aortic arch with artificial blood vessels, and to close and block the rupture of the inner membrane of the blood vessels and expand the vacuum cavity by introducing artificial blood vessels with stents.
Xu Qiu made many improvements on the original basis.
In addition to the double-stack three-layer method, Xu Qiu also introduced a three-branch stent in aortic replacement.
…
The improved elephant trunk stent surgery started soon.
The right axillary artery and femoral artery were cannulated and perfused;
The left subclavian artery and left femoral artery were punctured and guide wires were inserted;
The aortic arch was cut off between the innominate artery and the left carotid artery;
Then, the guide wires punctured by the left subclavian artery and left femoral artery were pulled out and inserted into the main trunk and branches of the stent blood vessels;
Then, the stent blood vessels were extended into the descending aorta and the corresponding brachiocephalic artery...
"Huh."
Everyone held their breath and stared at the surgical area nervously.
Xu Qiu also calmed down, and after concentrating again, he gently released the branches of the left common carotid artery and the left subclavian artery.
Everyone's heart was hanging.
Released successfully!
Xu Qiu did not stop and released the main trunk of the stent in the descending aorta.
"Balloon."
Director Zheng, the first assistant, understood and immediately began to use the balloon to confirm whether the stent was fully released. Soon, Director Zheng's surprised voice rang out, "Success!"
A low celebration sounded in the operating room.
Joseph, Saito and others were also extremely happy. When they came to their senses, they realized that their palms were sweating.
It really succeeded!
Double stack three-layer technique...
Three-branch stent...
There are also short elephant trunk technology, a design of about one centimeter of bare area without stent, etc., one by one innovative surgical procedures, which makes people dazzled.
"I want to learn!" Joseph swallowed saliva frantically, his eyes almost dried up.
Yang Yuen in the corner couldn't help but smile.
Professor, professor, you said you would return to the Cleveland Medical Center in three months?
Three months and three months, if you don't leave, you will become the chief physician of Linyi!
Xu Qiu finally sutured the incisions at the proximal end of the trunk and the distal end of the aortic arch, and ended the whole operation.
Director Zheng and other people in the clinic were shocked, but also relieved.
Finally, Joseph was kept...
These famous doctors seemed to be taking advantage of the clinic for free.
In fact, just by staying in Linyi, they can bring great benefits to the hospital.
For some people, as long as they are alive, their significance is greater than anything else.
Joseph is obviously a person with such qualifications. As a contemporary authority in cardiac surgery, wherever he is, he will get the attention and respect of cardiac surgeons around the world!
"Strive to push Linyi's cardiac surgery to the top three in the country during this period!" Director Zheng and others are full of confidence.
With Xu Qiu's surgery and Joseph, a living fossil, the development and construction of Linyi's cardiac surgery is simply bright!
……
In the next few days, Xu Qiu used his free time to compile two versions of the elephant trunk stent.
One is for cardiac surgery, a systematic and technically improved version.
Similarly, Xu Qiu does not intend to keep this technology privately, and plans to publish the details of the operation to the whole country and the world in the next issue of "Linhai Great Doctor"!
As a surgery closely related to lesions such as aortic dissection, the importance of elephant trunk stent is greater than imagined.
Xu Qiu does not intend to monopolize it, and only by promoting it can it benefit more patients.
After all, aortic dissection is an emergency, and the patient can die within half an hour after the tear, so they can only choose the nearest hospital for treatment.
Even if the clinical doctor keeps the improved method secret, it will not bring more patients to the hospital... Only by making it public for free and allowing more hospitals and more doctors to master it can patients truly benefit.
Of course, the advanced improved version that Xu Qiu improved twice has a different treatment method.
