"Emergency?" Su Yun frowned when he heard it was a tip surgery (Note 1).
Tips surgery is the most difficult surgery in the interventional department, bar none.
Of course, this excludes many new surgeries that cannot be performed due to existing medical conditions, such as prostate interventional embolization. But these surgeries are only "difficult". From a technical level, everyone would think that tips are the most difficult.
"In the Department of Gastroenterology, there is a rather difficult patient. The patient is a classmate of Director Xia. He has been contacted to go to the Imperial Capital for tip surgery, but before departure, he suddenly vomited blood and went into shock." Zheng Ren stood up and put on his clothes Putting on the white clothes, he turned around and smiled apologetically at Xie Yiren.
Xie Yiren waved his hand and signaled Zheng Ren to go to work. His eyebrows were curved, gentle and virtuous.
Zheng Ren felt at ease and strode out of the duty room.
"You know how?" Su Yun followed and asked.
"You can give it a try." Zheng Ren thought to himself that although he had never had surgery, he still had time for surgery. In order to save people, he might as well splurge.
The most difficult thing is that post-surgery complications are difficult to deal with.
For decompensated liver cirrhosis, gastric esophageal varices, and hematemesis caused by splenomegaly, there are two treatment methods. One is surgical operation, such as splenectomy and portal azygos vein devascularization; the other is the just mentioned Tips for surgery.
This kind of surgery has not entered clinical practice for less than thirty years.
In 1988, German scholar Richter et al. first applied transjugular intrahepatic stent portosystemic shunting in clinical practice, and reported 16 successful cases of transjugular intrahepatic stent portosystemic shunting in 1991.
Later, Zemel (1991) and Ring (1992) successively reported the successful results of transjugular intrahepatic stent portosystemic shunt.
In 1993, transjugular intrahepatic stent portosystemic shunt surgery was promoted and applied in various countries.
Surgery began in China in the 21st century, pioneered by Mr. Xu Ke from China Medical University.
Until now... it has not become a routine surgery.
Why
Because it’s hard to do.
Extremely difficult to do.
Even after surgery, the postoperative mortality rate is extremely high.
But if the patient can survive it, the quality of life after surgery will be greatly improved, and it is a surgical procedure that benefits the patient greatly.
Su Yun recently learned interventional surgery, so he naturally knew that tip surgery is known as the crown jewel of interventional surgery.
Is it going to start so soon? Are there any consumables? There is nothing, Zheng Ren is going to start knitting
"How about the supplies?"
"I'll call Manager Feng." Zheng Ren said as he took out his cell phone.
"Manager Feng, it's me."
"I may need to undergo tip surgery. The related consumables will be sent over immediately."
"Well, as for the procedures, Director Pan will handle it tomorrow. It's probably still a temporary procurement procedure."
"As soon as possible, one hour!"
After saying that, Zheng Ren hung up the phone.
"After the operation, are you confident?" Zheng Ren walked quickly, but still asked Su Yun.
"If there is no way to prevent hepatic encephalopathy, it can only be controlled through drugs such as amino acids." Su Yun recalled the process of tips surgery and the dangers of hepatic encephalopathy, and he did not dare to speak too fully.
The key is that the clinical methods for treating hepatic encephalopathy are still very simple.
Zheng Ren had an idea in his mind, so he quickened his pace and came to the Department of Gastroenterology.
Director Xia was still smart and capable. Seeing Zheng Ren rushing over so quickly, there was a trace of embarrassment on his face.
The patient with the floating gallbladder, Director Xia, was able to gain face from Zheng Ren in the emergency department.
Later it was proved that Zheng Ren was right. So Director Xia really didn't want to face this evil resident of the emergency department.
Even if something unexpected happens, she still goes through Director Pan... Well, this is also a normal process, it is communication between the directors.
"Hello, Director Xia, which ward is the patient in?" Zheng Ren's expression did not change at all, he was not arrogant or sarcastic, as if what happened before had never happened.
"Over here." Director Xia put aside all the messy thoughts and rushed to the emergency room with Zheng Ren in a hurry.
It was a male patient in his fifties, with a sallow face and a black air. He was lying on the hospital bed with a washbasin underneath. He was constantly vomiting black venous blood.
The scene is eerie and eerie, like hell.
The strong smell of blood hit his face, and Zheng Ren glanced at the system panel in the upper right corner of his field of vision.
A flash of red came into view.
The patient's diagnosis was: hemorrhagic shock, decompensated stage of post-hepatitis B cirrhosis, refractory ascites, pleural effusion, electrolyte metabolism disorder, splenectomy and esophageal pericardial vascular disconnection.
I had splenectomy and portazygous vein devascularization...
Zheng Ren was originally hesitating between the two surgeries, but now he doesn't have to think about it anymore and just prepares for the tips surgery.
"I had hematemesis three days ago. Because I had undergone splenectomy and portal azygous vein devascularization, I could only choose conservative treatment." Director Xia introduced the condition in a deep voice, "Three groups of intravenous hemostatic drugs plus oral orthorenal ice saline, the bleeding It was under control. I was originally going to be transferred to the Imperial Capital for tip surgery, but I didn’t expect that when I called the ambulance, I would vomit blood again."
I have already used three sets of hemostatic drugs, plus Zhengshen ice salt water, which can be said to be an extreme amount.
Even if four or five groups of hemostatic drugs were added, there would be no effect. Once complications such as cerebral infarction and myocardial infarction occur, it will be even more difficult.
Zheng Ren pondered, thinking about whether he had reserved enough time for the operation.
Tips surgery is, after all, the most difficult surgery in the interventional disciplines, and Zheng Ren was not sure.
Seeing Zheng Ren pondering, Director Xia also smiled bitterly and said, "In our hospital, you are the only one doing interventional surgery. There is nothing we can do about it, it's hard for you."
Her unexpected but reasonable softening of attitude was very logical. Zheng Ren understood Director Xia's thoughts.
"As long as you can be 10% sure, it's always right to give it a try." Director Xia said firmly: "The patient is my classmate, and his lover is also my classmate. Doctor Zheng, don't worry, even if you can't get off the stage, you will die during the operation. There will be no problem on stage."
The last sentence was to give Zheng Ren reassurance.
For no other reason than emergency tip surgery is the only option at this time. If Zheng Ren says he won't do it, the patient can only vomit blood while waiting for death.
Perhaps a few minutes later, a mouthful of venous blood would be vomited out, spraying onto the wall or onto the roof, and the person would be gone.
However, the difficulty coefficient of tip surgeries in ordinary chronic cases exceeds the limit threshold of 10 and reaches over 11, let alone emergency tip surgeries.
"Director Xia, to be honest, I have never done it." Zheng Ren muttered, "The patient is in critical condition and there are not many options. Let's try emergency surgery. I can't guarantee it, so I can only do my best."
"Thank you." Director Xia expressed his sincere thanks.
To be able to have the director of the First University of Science and Technology say thank you in front of the patient's family is considered giving in.
A victorious smile appeared on Su Yun's lips.
Zheng Ren frowned.
"Are there any consumables?" Director Xia immediately asked the most pointed question.
"We've been contacted, and it will take a few minutes to be sent to the emergency operating room." Zheng Rendao, "Get ready to send the patient, sign before the operation..."
"I can sign it," Director Xia said.
It seemed that she and the patient and his wife were indeed familiar to a certain extent.
"Okay." Zheng Ren said, "Prepare for emergency surgery!"
At the same time, a "ding dong~~" mission prompt sounded in Zheng Ren's ears.
Main Mission: Crown Jewel Phase 1.
Task content: Complete the most difficult interventional surgery, the transjugular intrahepatic portosystemic shunt, known as the crown jewel.
Task reward: The current average time to complete tips surgery is 4 hours and 23 minutes. If the host takes longer to complete the task than average, there will be no special reward. If the operation time is shorter than the average time, you will receive generous rewards.
In addition, you will be rewarded with +2 lucky points, two gold treasure chests, and 200,000 experience points.
Mission time: 6 hours.
Zheng Ren originally wanted to ignore this task, but as soon as he glanced at it, he was stunned.
Seeing a long list of numbers, a reward of +2 luck points, and the "rich rewards" mentioned by the big pig in the system, Zheng Ren felt like he was back in the imperial capital.
Tips surgery, is it also considered the main task
Among the existing interventional surgeries, tips surgery is indeed the most difficult one. If you climb the technology tree, it is indeed a must-have surgery to reach the top.
Main quest... Okay.
I just don’t know what the main mission of general surgery is.
I have never had tips surgery, so whether it is for the purpose of saving people or completing a mission, I have to think carefully about it.
There seems to be some time left for surgical training, and it looks like he has to make a desperate move.
Zheng Ren's mind was running at high speed, thinking about all the steps of tips surgery.
The surgical process is simple to say the least.
After the puncture was successfully performed through the right jugular vein under local anesthesia, the hepatic vein and portal vein channel were opened using the catheter guidewire and puncture needle, and the portacaval puncture channel was balloon-dilated and the stent was accurately released.
The difficulty of tips surgery is that the puncture needle opens the channel between the hepatic vein and the portal vein.
This is a blind penetration, you can only rely on experience... and luck.
No matter how high your level is, if you are slightly unlucky when it comes to tips surgery, you will not be able to complete this kind of surgery.
Therefore, it makes sense that tips surgery is known as the brightest pearl in the crown of interventional surgery.
What Zheng Ren was thinking about was how to rely on luck as little as possible.
For Zheng Ren, who was unwilling to even open the system treasure chest and try his luck, trying his luck on the operating table was undoubtedly an extremely unacceptable thing.
"Not sure?" Su Yun followed Zheng Ren. Seeing that he was not walking very fast and seemed to be deep in thought, he asked closer.
"No one in the world is absolutely sure." Zheng Ren said.
"Professor Rudolf Wagner is sleeping in Shangri-La." Su Yun reminded.
"Uh..." Zheng Ren had already forgotten Professor Rudolf Wagner.
The professor is the world's top interventional surgeon. Since he is staying, no matter what the purpose is, he should come and help.
Zheng Ren nodded and picked up the phone.
"Professor Rudolf, this is Zheng Ren." The phone rang for nearly half a minute before the professor picked up the phone.
Zheng Ren directly ignored his slightly irritated German and talked about the matter directly.
"There is a tips surgery here, please take a look."
After saying that, Zheng Ren hung up the phone.
…
Note 1: Transjugular intrahepatic portosystemic shunt, referred to as tips surgery. When introducing this chapter, I said it several times to deepen the impression. From now on, we will only talk about the abbreviation, not the number of words.
In addition, the four characters of tips should only count as one word. I have also heard people say it~~ Please give me a recommendation vote, thank you.
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