Start as an Emergency Physician

Zhou Yuan glanced at the marked place again and said, "Use saphenous vein transplantation to bridging, secondly, reconstruct the outflow tract of the arteriovenous fistula, and finally remove the thrombus." "

The saphenous vein is a superficial subcutaneous fascia that is very long, starting from the anterior of the medial malleolus and extending to the thigh, and it is inherently suitable for transplantation: the lumen is of the right thickness, the length can be flexibly controlled, it is long enough, and the short one can be intercepted.

Moreover, the way to obtain it is very simple, cut open the skin, and it can be found under the skin. In addition, there are few lateral branches, so there are fewer blood vessels to deal with during transplantation.

"Is it really possible?" several vascular surgeons hesitated.

He Jian glanced at Zhou Yuan, and Zhou Yuan nodded.

"Okay, let him do it. He Jianyi said.

Seeing He Jian nodded, several vascular surgeons didn't say much.

"Vascular grafting is only a tertiary operation, but ... Combined with the patient's current physical condition, the surgery is very risky. "

Zhou Yuan stepped forward, looked at He Jianguo's pupils, and said, "The operation must be performed immediately, and I will be responsible for the problem!"

He Jianyi: "I'm responsible." What is your responsibility as a trainee!"

Speaking of this, He Jian was stunned again and again.

Dean Fang only told him this morning that he might have to give Zhou Yuan an exceptional promotion recently.

Originally, Dean Fang planned to upgrade Zhou Yuan after completing the finger regeneration surgery.

However, when the time comes, if the people who write the paper see that Zhou Yuan is just an intern, I am afraid that they will directly type the paper without even reading the title.

Besides, if he really appeared in The Lancet, the doctor who could write the Lancet magazine would be just a small intern at Yenching International Hospital... This will make the medical community think that Yenching International Hospital does not pay attention to talents, etc.

In any case, Zhou Yuan's intern hat had to be pulled off, and at least some people's mouths had to be silenced.

"Let's do the surgery quickly! The old man can't hold on!" Zhang Ling was a little anxious.

The heart rate and blood pressure are already a little unstable, and it is very dangerous for He Jianguo not to carry out blood vessel transplantation as soon as possible to dredge the blood clot.

He Jianyi became serious: "Push it to the operating room!"

He Jianguo's son and daughter hurriedly got out of the way, while Zhou Yuan and others held on to the handle and pushed the operating table into the operating room quickly.

in the operating room.

Under the shadowless lamp, He Jianguo was already unconscious.

After Zhou Yuan and others gave simple first aid and stabilized their heart rate and blood pressure, they began anesthesia.

Epidural block anesthesia used for surgery.

He Jianguo lay on the bed in a supine position, and the right limb that underwent the operation was spread out on the operating table.

"Anesthesia complete!" the anesthesiologist said quickly.

Zhou Yuan nodded, glanced at the time, and said, "The operation begins." "

The personnel of the operation.

Main knife: Zhou Yuan

One help: He Jianyi

Second assistant: a vascular surgeon

Sansuke: A vascular surgeon

Instrument nurses, anesthesiologists, etc.

"Scalpel. Zhou Yuandao.

The first step is to isolate the important vein of the upper arm and the cephalic vein near the elbow to estimate the length of the vessel that needs to be transplanted.

Zhou Yuan skillfully cut the outer skin, then separated the subcutaneous tissue, muscle tissue, etc., found the important vein, and measured the length of the blood vessel that needed to be transplanted.

"49.01mm," Zhou Yuan said.

In the second step, the saphenous vein is isolated, and then the blood vessel is removed from the saphenous vein for vascular grafting.

Zhou Yuan put down the scalpel.

He Jianyi and a vascular surgeon have done a good job of disinfection of the lower abdomen, the vocal department, and the femoral part of both lower limbs.

"Lay out the towel. "

He Jianyi exposed the femoral artery, and Zhou Yuan took the knife down with his hand, and sat down on the inside of the femoral artery, a longitudinal incision, about six centimeters long.

"Separate the saphenous vein. Zhou Yuan said.

"Scalpel. "

After making the incision on the medial side of the femoral artery, Zhou Yuan made an incision of the skin and subcutaneous tissue, and made an incision of the superficial fascia at the incision of the femoral artery, exposing the fossa ovale.

Once the fossa ovale is found, it is not difficult to find the saphenous vein. The confluence of the great saphenous vein and the femoral vein is located here, and the great saphenous vein is easily visible.

"Bend the hemostat. "

Zhou Yuan used a curved hemostat to isolate the main trunk of the saphenous vein.

"Cut off the branches of the saphenous vein. "

This step is important.

If there is a mistake or a rupture of a blood vessel, it may be fatal if the blood vessel graft is performed and cannot be sutured or bleed.

"Vascular clamps. "

Blocking the blood vessels, Zhou Yuan began to separate along the venous trunk of the saphenous vein.

The great saphenous vein has branches such as the superficial circumflex iliac, the superficial abdominal wall, the superficial lateral sound, the ventrolateral and medial femoral veins, and after these branches are found, ligated and cut one by one, the branches of the great saphenous vein are cut.

"Begin to intercept the saphenous vein segment. "

Zhou Yuan picked up the scalpel and peeled off the great saphenous vein, which had severed its branches.

"Wait... Why did you peel it off directly?" He Jianyi and the vascular surgeon were both stunned.

In general, stripping a blood vessel requires the removal of various connective tissues from the outside and separate the blood vessels.

But Zhou Yuan got started directly, this is to cut off all the blood vessels and tissues stuck to the blood vessels...

"Wait, you're no-touching?" the second vascular surgeon was a little surprised.

"No-touch?"

"Yes, it's a technology proposed by country M, but it's not used much... Moreover, it is quite difficult, because it is necessary to make precise cuts to tissues and blood vessels, and if you are not careful, you will damage other tissues and blood vessels... This is harder than simply stripping off the blood vessels!"

He Jian was stunned for a moment, he had a little impression.

"This... It seems that it can reduce the incidence of blood vessel stenosis?" He Jianyi said uncertainly.

"51.40mm is fine. Zhou Yuan removed a piece of blood vessel connected to connective tissue and said.

"It is indeed the No-touch procedure, which is used to intercept the saphenous vein, which can greatly reduce the incidence of vascular stenosis and increase the success rate of vascular grafting. Zhou Yuan explained.

The blood vessels in Zhou Yuan's hands were similar to the mutton of mutton skewers, but the color was more bright red and they were strip-shaped.

"Wait, why did you amputate 20mm more," the young, vegetative vascular surgeon asked.

While testing the isolated saphenous vein, Zhou Yuan explained: "You haven't been exposed to this technology, you don't understand. The saphenous vein retracts after being removed from the body, so it is best to be 2~4cm longer than the expected length."

"Heparin saline. Zhou Yuandao.

The next step is to infuse heparin saline into the saphenous vein.

This is to test whether this section of the saphenous vein has penetrated.

After injecting heparin saline into the blood vessels, Zhou Yuan carefully ligated the saphenous vein and examined it carefully.

——

Recommend a friend's book "Datang: Salted Fish Son-in-law", super hot-blooded, you can go and see it!_

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