In the interventional operating room, the patient is positioned prone. The open appendix incision will definitely be affected to some extent, but it's not a major problem.
It’s just that the patient doesn’t understand what’s going on and keeps asking.
On the DSA machine, Zheng Ren first did a simple CT. The technical level here is average, but the DSA machine is newly purchased and has CT function.
Vertebral body CT showed: A strip-like slightly high-density shadow was seen on the right side of the spinal canal at the 7th to 12th thoracic level. The abnormal density shadow seemed to extend out of the body at the 12th thoracic level, and the soft tissue at the posterior edge of the spinous process of the 12th thoracic process was swollen.
"Boss, do you think the catheter that fell in is only about 6cm? It must be at least 10cm!" Su Yun looked at the image and said with disdain.
"It shouldn't be. It looks like it's at least 13cm." Zheng Ren pointed at the CT image and said.
Su Yun said no more, but directly drove the operator away, and he sat in front of the operating table.
"You can't work after drinking," Zheng Ren said.
"I haven't thought about it. You can do it in there alone, as if there is no one outside. I'm just curious about how you plan to take out the broken catheter." Su Yun smiled and said in a nonchalant manner.
"Just think of it as a thicker blood vessel." Zheng Ren smiled and took Gao Shaojie to brush his hands and go on stage.
"Boss Zheng, how to do the surgery?" Gao Shaojie asked while brushing his hands.
"First do an epidural angiogram, then puncture the original puncture point, remove the trap, and just catch the broken catheter." Zheng Rendao.
Gao Shaojie didn't really want to understand. Although the whole process was probably like this, he had never heard of a similar operation.
cheer up! Gao Shaojie encouraged himself in his heart to take a closer look.
He sped up his movements, finished brushing his hands and went to lay out the sterile drape.
Because angiography was required, Gao Shaojie reserved two different surgical areas. One at the sacrococcygeal region and one at the site of the serial epidural puncture.
Xiang Heping watched in silence, he couldn't understand anything here. Between the two surgical areas, it feels like the traumatic surface is larger than the surgical operation!
"Lao Gao, have you done epidural angiography?" Zheng Ren asked.
"No, Boss Zheng." Gao Shaojie replied honestly.
"Then let me do it." Zheng Ren stood on the operating table wearing sterile clothes and gloves.
He glanced at the various instruments, then stared at Xiang Heping. 1.25 seconds later, Zheng Ren's eyes became serious.
Boss Zheng's eyes made Xiang Heping look bad. Until now, no one has talked to him about money. Coupled with Director Zhang's persuasion, I also saw extremely professional judgment and operation, and the technicians were driven away.
Xiang Heping himself doesn't even believe that they are liars.
Why is Boss Zheng looking at me like this? Are you going to yell out loud? It is not uncommon for professors to change into a different person when they get on the operating table.
In an instant, Xiang Heping had countless more psychological dramas, and even sketched out many scenes of himself being bullied in the operating room.
"Director Xiang, do you want to watch the operation in the operating room?" Zheng Ren asked.
Xiang Heping nodded blankly.
My old man, can’t he perform the surgery himself? It shouldn't be.
"Go put on some lead clothes." Zheng Ren sighed. It’s understandable that the technical level of rural hospitals is low, but why don’t they even know how to put on a lead gown in an interventional operating room
At this level...it's really hard to describe.
Director Zhang of the Department of Orthopedics, who was also in the operating room and prepared to watch the entire operation, almost stuffed his head into his crotch.
It's really embarrassing. Now in Boss Zheng's mind, Langshan County Hospital cannot do its job properly.
This old Xiang is really embarrassing to the extreme.
After Zheng Ren finished speaking, he saw Xiang Heping hurriedly put on his lead clothes and ignored him, and started to puncture.
After local anesthesia, a No. 16 epidural puncture needle was used to pierce the sacrococcygeal ligament at an angle of 45° to the trunk. Then Zheng Ren's hand changed the angle to 25° and slowly penetrated into the sacral canal.
"Lao Gao, we should pay attention here." Zheng Ren said, "Since the subarachnoid space ends at the second sacral vertebra level, the puncture needle should not exceed the second sacral vertebra level to ensure that it does not penetrate into the subarachnoid space."
Gao Shaojie nodded and took note of this important point.
Zheng Ren then pulled out the needle core, checked for cerebrospinal fluid overflow, inserted the epidural anesthesia catheter into the lumbosacral epidural space, and then withdrew the puncture needle.
"Anesthetic." Zheng Ren said.
After injecting the anesthetic, Zheng Ren observed the patient for 5-10 minutes to confirm that there was no spinal anesthesia in the patient and to rule out penetrating dural injury before proceeding to the next step.
The airtight lead door slowly closed, and Zheng Ren began to take pictures.
Because the epidural anesthesia catheter is almost invisible under X-rays, even with contrast agent, it is still quite difficult to find a catheter with a thickness of a few tenths of a centimeter.
"Lao Gao, combined with the CT images just now, you can find abnormal images at chest 7-12." Zheng Ren explained to Gao Shaojie softly, "Looking at the position of the catheter not close to the wall, there should be no need to pump air into it."
"Well, Boss Zheng, I can probably find a position." Gao Shaojie said.
"I won't let you do it this time." Zheng Ren walked to the thoracolumbar surgery area and started to puncture.
Gao Shaojie knew that this should be the first time that Boss Zheng had encountered a similar patient. He has a good understanding of Boss Zheng. However, this young boss is still young and has shortcomings in clinical practice.
Although with the combination of deep enough theoretical knowledge and virtual operation, I often have fairy-like thoughts, such as the surgery in front of me.
But for the first operation, he must do it himself, trying to avoid any unexpected situations.
With Boss Zheng's guidance, Gao Shaojie already had a rough idea of the operation process. Whether you can do it depends on your technique.
Gao Shaojie still has some confidence in this. At least he should have accumulated more experience after seeing Boss Zheng do it once.
The guidewire is advanced and subsequently the catcher is advanced into the epidural space. Gao Shaojie concentrated, holding the end of the guide wire in his hand, staring at the screen opposite.
He should adjust the direction and turn on the trap, Gao Shaojie thought in his mind. This step is the most difficult. If it were you, you might have to do it more than ten times before you can successfully capture the broken catheter.
It is easy to say that it is easy to firmly grasp the 3mm diameter catheter, but it is difficult to do.
Just as the trap was lowered, the intercom rang.
"Director Xiang, we are looking for you." The operating room nurse's voice came from the intercom.
Gao Shaojie was a little angry. He had just reached full energy and was almost in full condition. He firmly believed that Boss Zheng had successfully captured it in one go and he would definitely be able to see more details clearly.
The annoying thing about surgery is being interrupted, which makes even the elegant Gao Shaojie feel disgusted.
He glanced at Xiang Heping, the "patient's family member" with dissatisfaction, and was speechless.