Start as an Emergency Physician

Seeing that Wei Lili's face was a little bad, Zhou Yuan's expression also became solemn, and he looked at the inspection results.

The MRI images showed that the brain tissue of the two conjoined children was not fused and shared, which means that as long as the separation is appropriate, the two children can develop like normal children.

This is a better situation, some conjoined children even share the brain, which cannot be separated at all, and some have two brains but some of the brains are missing, if you want to separate, only one person can save a relatively intact brain, and the other is a defective brain.

Fortunately, it is not the latter, otherwise, this choice is too cruel for parents.

There is nothing wrong with the MRI image, which is good news, but the other cerebral angiography is not so optimistic.

It can be seen that there is a cross-supply of cerebral arteriovenous blood vessels in conjoined children, and although some of the blood vessels are separated, they are glued together and become double-lumen parallel blood vessels.

Some blood vessels may even have cavity fusion.

In other words, once separated, the parallel adherent blood vessels will split, potentially causing the blood vessels to rupture.

Obviously, the two results suggest that the conjoined child is a conjoined malformation with high difficulty of separation.

"Is the 3D printed model coming out?" Zhou Yuan asked.

He needs to determine the superior sagittal sinus in the conjoined brain.

Once the superior sagittal sinus fusion is present, separation of the conjoined child becomes more difficult.

"I'm done scanning, and I'm still printing. He Jing said.

Zhou Yuan nodded, looked at the sleeping conjoined in the ward, and asked, "How are the two of them in physical condition now?"

Wei Lili said: "Don't worry, neonatal ICU students, specialist nurses, etc., are taking care of them carefully, paying close attention to the changes in their bodies, and there will be no problems." "

He Jing said: "We are also gradually improving the preoperative preparations of patients. "

Zhou Yuan breathed a sigh of relief, nodded, and looked at Xiao Xuebo, the director of brain surgery who was staring at the MRI image next to him: "Director Xiao, what do you think?"

Xiao Xuebo touched his chin, frowned, and asked rhetorically, "What do you think?"

"Soon after the birth of the conjoined child, although the blood vessels cross, the brains of each child are intact and can be separated. The sooner the separation surgery is done, the better it will be for the two of them, and if it is delayed, their brains may grow together, and it will be almost impossible to separate again. "

If the brains are really glued together, the knife may damage the functional areas of the brain and bring lifelong trauma, and at that time you can only give up if you want to separate.

Zhou Yuan continued: "While they haven't grown together yet, let's perform separation surgery as soon as possible. "

Xiao Xuebo nodded: "I also think it should be as soon as possible!"

Zhou Yuan: ...

The patient's father looked at Zhou Yuan with some uncertainty: "It's... You're going to do it?"

"We're a whole team going to get involved. Zhou Yuan told the truth.

"You're still participating in surgery at such a young age?!" the patient's father glared, not very reassured.

"I'm the main knife. "

There is no way to hide this kind of thing, and it can't be hidden.

The patient's parents' eyes widened immediately.

"I don't think you look like a great doctor, right? You're here to operate, can our children be saved?" the patient's father was a little angry.

He felt that the hospital was perfunctory to him.

Zhou Yuan patiently explained: "We have a whole team, and when the time comes, doctors from neurosurgery, plastic surgery, brain surgery, etc. will be involved, and there will be many directors. "

"We will choose the most suitable surgery for your child, and we will also choose the most suitable doctor!" Wei Lili said.

The father wanted to say something, but was stopped by his wife.

"I believe in your hospital...", the mother of the conjoined child glanced at the child in the ward, and her voice gradually became quieter.

"Let's take a look at the 3D printed model first. Zhou Yuan said helplessly.

He Jing and Wei Lili stayed for the time being, ready to explain to the patient's family, and Zhou Yuan, Xiao Xuebo, and Lu Chenxi were ready to make the next step.

In the end, what worried Zhou Yuan the most came - the 3D printed model clearly showed the fusion and sharing of the superior sagittal sinus of conjoined children.

This is a structure located within the sagittal sinus sulcus at the superior edge of the falx and the midline of the inner plate of the skull roof, and is a single dural venous sinus that contains blood from the upper meridians, dural veins, and skull veins of the brain, which is particularly important.

At the same time, it also contains cerebrospinal fluid, and there are 10~15 meridians connected to the brain here, and once the structure is damaged, it can cause paralysis and even death.

Therefore, it is very difficult to isolate the superior sagittal sinus of a conjoined child.

"I can't do it. Xiao Xuebo glanced at it, and directly shook his head to admit that he was not capable.

"To do a skull separation, it will be cut here, how to do it?" he sighed and looked at Zhou Yuan.

Zhou Yuan thought for a while and said, "Cut the middle and posterior third of the superior sagittal sinus, and then perform the repair operation." "

"It can be, but the blood vessels are too dense, once you can't grasp it well..."

"I'll come. Zhou Yuan said coldly.

Xiao Xuebo was stunned for a moment and nodded.

Soon, the doctors from the Department of Neurosurgery and Plastic Medicine also arrived.

Together with pediatricians, Wei Lili, He Jing, Lu Chenxi, nurses, anesthesiologists and others, the number of this team has reached fifteen.

In just three days, the team held five or six meetings to discuss the specific plans and steps of the operation.

Finally, Zhou Yuan finalized the final surgical plan, which is briefly summarized and includes a total of four steps:

First: Strip skull removal.

This step is to remove part of the skull where the conjoined child is fused.

Second: Perform soft tissue excision.

It is mainly to insert a soft tissue expander under the skin to make the fused skin loose and dilated, so as to ensure that the separated skull has more skin area, so as to facilitate the suturing of the separated skin.

Third: separation of the cerebral hemispheres.

With the help of computer navigation technology, the two cerebral hemispheres of the conjoined children were separated.

The last and most difficult step: the separation of the shared sagittal sinuses.

It was not only extremely difficult for Zhou Yuan's team, but also for parents.

Because...... The separation of the shared sagittal sinuses means that it is difficult to deal with, and only one baby can be selected to divide a little more, a baby to divide a little less, and the one with less is bound to be stunted.

Zhou Yuan is a doctor and can't make this decision.

Soon, the parents of the conjoined children were invited.

Zhou Yuan and the others introduced the entire operation process to them, and finally, asked in a deep voice: "Now, how are you going to distribute the superior sagittal sinus?"

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