Chapter 1080 Persistence of 22°

Is the perfect anastomosis of large vessels really perfect enough?

Chen Cang looked at his stitches and began to ask himself such a question!

What is perfect?

Perfection is a threshold reached using current means.

But the current means are inherently limited.

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

This is a process that requires constant research and improvement.

Perfection is still the case, not to mention the master level.

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."

"Saline flush!"

"Clamp!"

...

Surgery continues.

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 blood supply to the spinal cord from the intercostal artery?"

Xu Ziming nodded: "Well, according to the 2009 version of the guide, it can be completed within 60 minutes, but later studies found that in fact, at about 45 minutes, the ischemia and hypoxia response of the spinal cord nerve tissue has already begun, although there is no intuitive performance, but there are some problems with post-fix!"

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

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

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

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, which also needs to include dealing with thread knots, needle insertion... and so on!

The most important treatment of intercostal blood vessels also involves a problem of avoiding damage to the intercostal nerves.

It is much more troublesome than the large blood vessels in the chest cavity.

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

Chen Cang decided to find a time to practice.

...

After the operation, Zhou He, an anesthesiologist, has been monitoring the patient's vital signs. Because of the long operation time, appropriate brain protection needs to be selected.

In fact, if the patient does not have Marfan syndrome and is just an acute type I aortic dissection, only ascending aortic replacement or hemiarch replacement can be performed.

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

It is definitely good to use total arch replacement, or the effect of using the common "elephant trunk surgery" is also very significant!

However, this actually places high demands on both the patient and the chief surgeon.

Not only the surgeon is required to be skilled in the technique, but also the patient's general condition is required to be in good condition, so that the operation can be carried out smoothly.

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

The ascending aorta is done!

The patient's vital signs are completely normal and ready for total arch replacement surgery!

Chen Cang took a breath 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 it adjusted to?" Zhou He looked at Chen Cang and asked directly.

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

Zhou He was taken aback!

Low temperature and cessation of circulation are directly related.

The lower the temperature, the longer the time allowed to stop the cycle. When the temperature is 15-18 degrees Celsius, it can be maintained for 60-80 minutes!

In this way, the operational time becomes abundant.

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

But again, you have plenty of time, and patients may need some price!

Why is medicine difficult?

Because the time we buy is actually given by the patient, and the time of the patient is swallowed by the god of death!

For every extra minute we consume, a minute of disease damage, death devours a little!

This is a tug-of-war, and the chips are time.

Whoever grabs the patient first wins!

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

However, Chen Cang chose 20 degrees Celsius, which suddenly increased the requirements for doctors, because the operation time was shortened, but at the same time, the patient's damage 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 even had a little more anticipation and excitement.

When the temperature is lowered to 20 °C, the circulation is stopped or the retrograde perfusion of the superior vena cava is added at the same time!

Chen Cang began to separate the aortic arch!

Tense atmosphere!

The feeling of low temperature in the hand!

Anxious time!

The beeping sound from the monitor!

The breathing of several doctors became clearer.

All indications are that this is a difficult operation.

Freeing the distal aortic arch is a delicate procedure.

The vagus and recurrent laryngeal nerves should be carefully identified, and the nerves should be freed first and then placed with a band for traction. Special attention should be paid to preventing damage to the recurrent laryngeal nerve when freeing the distal end of the lower edge of the arch.

With his dexterity and stability, Chen Cang carefully avoided danger.

It took less than 8 minutes to separate successfully!

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

Such a fast and accurate free aortic arch saves too much time for the replacement surgery in a while.

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

However, for the experienced Xu Ziming, it is also an opportunity to learn and exercise.

He Chao was a little excited.

Chen Cang's free time just now was no less than that of his teacher.

Immediately afterwards, Chen Cang put down the separation 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 a shorter time. As the champion of the large blood vessel suture competition in the Cardiac Surgery Skills Competition, Chen Cang has little pressure to deal with these things.

Then, start to suture the posterior wall of the arch containing 3 branch blood vessel openings, these are the branches and directions of the blood vessels, and the suture needs to be strictly prevented from bleeding.

This 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 artificial blood vessels and blood vessels is the key to the operation!

Not only fast!

And keep it secret!

That's the tone of the whole operation!