Chapter 2972 ​​Too Cautious

Facing Zheng Ren's relaxed smile, everyone's tension was relieved a little.

At the beginning of the operation, after opening the chest, Zheng Ren cut open the mediastinal pleura around the root of the lung, and bluntly separated it to the side of the lung to expose the hilar blood vessels.

Then Lin Yuan and Gu Xiaoran retracted the upper and lower lobes of the lungs to expose the front edge of the hilum. First separate the superficial superior pulmonary vein, ligate and cut off the upper lobe vein and the middle lobe vein respectively.

Dr. Charles stood silently watching the operation, his pupils gradually narrowed.

The standard pneumonectomy procedure is completely a textbook-level operation. After 15 minutes of operation, the arteriovenous veins of the right lung have been exposed, and the ligation begins.

The doctor could see that Zheng Ren did not pursue speed on purpose, but performed an operation step by step. It's just that the operation was performed very smoothly. Not only the surgeon and the first assistant, but also the second and third assistants were very familiar with the surgical process, and the tacit cooperation was to an outrageous level.

What do surgeons want most?

The most hopeful thing is that the surgical field is clean, not only bleeding will block the line of sight, but it is also critical to use the retractor to pull other tissues apart and expose the surgical field.

When Zheng Ren bluntly dissected the right lung to expose the hilar blood vessels, the second assistant Lin Yuan and the third assistant Gu Xiaoran pulled away the tissues that should be pulled apart in advance, and the surgical field was fully exposed.

During the surgical practice, Dr. Charles did not notice the role of the assistant. At that time, he focused all his attention on the 3D-printed lung tissue donor; on Zheng Ren's microsurgical skills.

Today, when facing a real patient, Dr. Charles thought that the performance of the two young people was perfect when he looked at the operation from the beginning.

Surgery is not performed by one person. Today, the two assistants, the second assistant and the third assistant, perfectly explained this point.

"Liver function, alanine aminotransferase..."

"Blood gas analysis..."

At 15 minutes, Lao He began to report the test results. Liver and kidney function, blood gas analysis, several major indicators are clearly reported.

"Next time." Zheng Ren replied simply. Others sounded foolish, but Lao He nodded to show that he understood.

The assistant next to Dr. Charles interpreted for him behind him, and the doctor began to think about these numerical values.

Now the total bilirubin in liver function is 89 μmol/L, which is 4 times higher than the upper limit of normal value. However, according to the medical records, the total bilirubin of this small patient was high before the operation, which may be related to several liver embolization operations.

The kidney function is good, the blood gas analysis is also relatively satisfactory, and the ECMO is running quite smoothly. Dr. Charles smiled. Dr. Zheng was really cautious. He even limited the amount of low-molecular-weight heparin before the operation, and he continued to observe during the operation.

Although it is said that doctors should be cautious, Dr. Zheng was a little too cautious today.

After getting the first test report, Zheng Ren ligated and cut off the first branch of the pulmonary artery, which is the anterior segment of the artery.

Immediately, the right pulmonary artery trunk was completely exposed and blocked with a thick silk thread.

"Zheng, you're too cautious." Dr. Charles finally couldn't stand it anymore, and began to communicate with Zheng Ren.

Here is to wait, generally speaking, it is 10 minutes. However, the patient is already on ECMO, even if the blood pressure drops due to resection, there will be no major problems, as long as the fluid rehydration lasts for a long time.

"Doctor, because the patient's liver function is not good, I have to be careful." Zheng Ren explained to Dr. Charles why he was careful to observe the blood pressure with the assistance of ECMO.

Zheng Ren's voice in the operating room was mixed with the singing of Good Luck, and the others standing on the stage, including Su Yun, did not move, but seemed to be waiting for something.

"Dididi~~~" The alarm sounded from the monitor, and the arterial pressure displayed on it was constantly dropping.

Dr. Charles didn't think it was necessary, as long as the fluid was infused for a long time, could the operation be stopped because the blood pressure dropped after the right pulmonary artery was blocked?

It's impossible, so Zheng's waiting is meaningless.

But then Su Yun made a gesture without hesitation, and Gu Xiaoran, who was standing beside him, pulled up the sterile drape, leaving the sterile area and exposing the left groin.

What is this for? Dr. Charles froze.

The ICU doctor who had been prepared for a long time came in from the operating room immediately, and pushed over a set of strangely shaped machines. The Shay handed him a piercing kit, and after scrubbing and sanitizing his hands, he began to operate.

The machine...is patchwork, looks like it has been patched countless times, a bit shabby and dilapidated. And the alarm sound of the monitor resounding in the ears made people feel agitated. It seemed that the singing of Good Luck was not so melodious, and they also became irritable.

Dr. Charles did not comment on the machine, he narrowed his eyes to watch the ICU doctor's operation carefully.

The femoral vein was punctured to establish a circulatory pathway, and the ICU doctor started to turn on the machine and connect the tubing.

Adsorbed bilirubin, plasma exchange! Dr. Charles soon discovered the usefulness of this machine. Blood pressure drops, do you need liver dialysis? Is this operation a little overdone?

It is true that hypotension can lead to impaired renal and hepatic function, but it is generally considered that renal impairment is more serious. Intraoperative dialysis...seems unnecessary.

Could it be that Dr. Zheng practiced surgery for a long time and lost himself in the end? Dr. Charles wondered. But out of respect for the practitioner, he did not express his thoughts of questioning Zheng Ren.

After the liver dialysis channel was established, Zheng Ren immediately opened the blockage and continued the operation. Despite the alarm sound of the invasive arterial blood pressure monitoring, he started the methodical operation again.

Lin Yuan pulled the lower lobe forward, and Zheng Ren and Su Yun began to ligate and cut off the inferior pulmonary ligament.

Then the mediastinal pleura was pushed away, the inferior pulmonary vein was freed, ligated with suture and sutured, and then cut off.

Gu Xiaoran retracted the upper lobe of the lung downward, freed the right main bronchus below the azygos arch, cut it off at a distance of 0.5-0.8 cm from the tracheal carina, and sutured it.

No one spoke, the silent operation process was accompanied by harsh sirens, and even the tacit cooperation of the operation seemed not so clear and eye-catching, and became frizzy.

Can this work? Dr. Charles looked more at the monitor, watching the changes in blood pressure, feeling a little worried. He worried that the patient's low blood pressure would directly lead to cardiac arrest, which would lead to the failure of the operation.

Although the blood pressure is still within the tolerable range, it is impossible to justify it without rehydration.

"Give heparin 82U/kg, prostaglandin E1 860U/kg, Perferdex solution antegrade perfusion, perfusion pressure 52cm H2O, perfusion temperature 4 ℃." Zheng Ren said in a deep voice.

"Zheng, do you need rehydration?"

After holding back for a few minutes, Dr. Charles finally couldn't bear it when Zheng Ren was about to give the perfusion fluid before the lung transplant, and began to suggest in a low voice.