Zheng Ren has experience with the intelligence and humanization of Big Pig's Hoof, and this is an operation with a assigned mission. So after entering the system space, Zheng Ren had no doubts and clicked to purchase surgical training time.
The system operating room rose from the ground, and the experimental subject was lying on the operating table.
Zheng Ren started the operation.
For Zheng Ren, who is at the peak of his interventional surgery skills, renal artery stent is just a very simple operation.
Puncture, super-selection, renal artery and fourth- and fifth-grade arterioles are the same as driving on an eight-lane highway and bumpy roads in the tropical jungle that do not exist at all.
The super selection went smoothly, put the bracket in and opened it.
The surgery is that simple.
However, the completion degree of the operation did not even reach 50%. The words appeared on the system panel, and the experimental subject died 58 hours after the operation.
Zheng Ren was not surprised by this result.
Because the process of this operation is exactly the same as the one performed by the doctors at the Mayo Clinic in the video, and all the operations were performed.
After the operation was over and the experimental subject died, Zheng Ren began to dissect.
This is what Zheng Ren really wants to do.
The structure of the renal artery has undergone significant changes, with a stenosis of about 5cm from the initial segment. Narrowing of the renal arteries causes an increase in blood pressure and is called renovascular hypertension.
Because reduced intrarenal perfusion pressure, renal parenchymal disease, and renin-secreting cell tumors can cause juxtaglomerular cells to release a large amount of renin, causing an increase in angiotensin 2 activity, contraction of the walls of small arteries throughout the body, and hypertension.
Renin and angiotensin 2 can also promote increased secretion of aldosterone, leading to sodium and water retention, increasing blood volume and producing hypertension.
But after the renal artery is dilated, why does the blood pressure become higher
Zheng Ren knew that this involved areas that existing science could not understand. As a very stubborn person, Zheng Ren was not prepared to completely solve the problem of nephrogenic hypertension.
As long as he can complete a task and gain surgical training time, Zheng Ren will be satisfied.
After dissecting the renal arteries, Zheng Ren found that the cell bodies of the preganglionic neurons of the renal sympathetic ganglia emanating from the mediolateral columns of the spinal cord from the 12th thoracic segment to the 2nd lumbar segment were normal and had no mutations before entering the celiac ganglia and being located in the aorta. .
However, when the aorta branches and forms the renal artery, the renal sympathetic nerve that should accompany the renal artery actually merges with the renal artery in the stenotic segment.
That's why!
Because the thermal stimulation of radiofrequency ablation causes local anatomical structural changes, renal artery stenosis occurs, and at the same time, the renal sympathetic nerves are wrapped with the exuded material and fuse with the renal artery.
When the stent is inserted under the stent, it opens the narrowed segment of the renal artery and at the same time stimulates the renal sympathetic nerves, leading to irreversible hypertension.
The transmitter released by the postganglionic fiber terminals of the renal sympathetic ganglia is norepinephrine, which can regulate renal blood flow, glomerular filtration rate, renal tubular reabsorption and renin release.
When the renal artery and renal sympathetic nerve are opened by the stent and the nerve is compressed, this series of physiological processes are changed.
Zheng Ren looked at the experimental subjects on the operating table in the system operating room and began to think deeply.
The problem has been found, what should we do
He was not in a hurry to end the operation. Although it had now become the scene of forensic autopsy, Zheng Ren still did not end the process.
First, the stent was used to measure the fusion site between the renal artery and the renal sympathetic nerve. It was found that no matter how the angle was changed, the stent could never open the renal artery while avoiding compression of the renal sympathetic nerve.
Zheng Ren hesitated for a moment, changed his mind, and began to prepare to use surgical means to solve this problem.
Surgery, stripping off the renal arteries and sympathetic nerves... Just thinking about it, Zheng Ren's head turned into two.
The difficulty of this kind of surgery has skyrocketed!
Although his general surgical skills have reached the level of a master, Zheng Ren is still not sure.
But now that you’ve found an idea, let’s give it a try. The big pig's hooves of the system did not give an S-level surgical classification, which proves that the difficulty... is still very difficult, Zheng Ren sighed.
Such a difficult task, but the reward is not much. Is Big Pig Hoof down? Zheng Ren cursed in his heart.
At the beginning of the second operation, the subject was placed in the lateral decubitus position, and the abdominal aorta, renal artery, and renal vein were exposed through a longitudinal incision on the waist along the retroperitoneal path. The accompanying and fused renal sympathetic nerves were carefully dissociated near the renal artery and renal vein under a dissecting microscope.
However, Zheng Ren discovered a benefit.
During normal dissection, it is also important to avoid fascia and other nerve tissues being mistaken for renal sympathetic nerves.
For this patient, only retrograde dissection was enough.
This can reduce many surgical procedures and shorten surgical training time.
Zheng Ren had already made plans. There were not even 1,800 surgeries of this difficulty, so he probably wouldn't be able to do it.
The process of dissociation was relatively smooth at first.
However, under the microscope, there was a little dissociation, less than 1cm away, and the test subject's blood pressure suddenly increased. Then the system reminded Zheng Ren that the test subject had died due to high blood pressure, which caused cerebral blood vessels to rupture.
Zheng Ren was stunned for a moment.
Doesn't this work? I have been very careful. I used a 20x microscope. During the surgery, it seemed that the renal sympathetic nerves were not touched.
But the death of the experimental subject is a fact, and something must have gone wrong.
Zheng Ren started the operation again.
The result remains the same.
Then again... death again.
Experimental subjects died again and again, and surgical training time was consumed quickly.
Zheng Ren finally hesitated after his 78th operation failed. Although he was still sure that the method he chose was correct, he always had to find reasons for repeated failures in surgery.
It's definitely not a matter of technique.
He did not continue with the surgical training, and did not bother to look at the sneer expression of the little white fox, so he left the system space directly.
"Su Yun, are you asleep?" Zheng Ren asked.
"If you hadn't spoken, I would have started dreaming."
"Dreams are a sign of poor rest. Being unable to enter deep sleep has a great impact on the body." Zheng Rendao.
"What's going on?" Su Yun didn't argue with Zheng Ren, but got up and asked.
"I have read the patient's medical history and the surgical procedure, and I highly suspect that the renal sympathetic nerves are fused with the renal artery. After the stent is inserted, the renal sympathetic nerves are stimulated, which leads to malignant and refractory hypertension." Zheng Rendao.
Su Yun frowned.
Can renal sympathetic nerves be seen just during surgery? Isn’t this nonsense
But he didn't ask Zheng Ren how he discovered it, because the answer was just one technical level that was not enough.
Su Yun rarely asks for trouble.
"What happened to the nervous system when you had a heart transplant?" Zheng Ren asked.