Start with the emergency physician

Zhou Yuan glanced at the marked place again and said, “Use saphenous vein transplantation to bridge, secondly, carry out arteriovenous fistula outflow tract reconstruction, and finally remove the thrombus.” ”

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

Moreover, the way to obtain it is very simple, cut the skin, and you can find it under the skin. In addition, there are few lateral branches, so there are fewer blood vessels that need to be treated during transplantation.

“Is it really possible…” several vascular surgeons hesitated.

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

“Yes, let him do it.” He Jianyi said.

Seeing He Jian nodding, several vascular surgeons didn’t have much to say.

“Vascular grafting is only a tertiary operation, but … Combined with the patient’s current physical condition, 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 am responsible.” What is your responsibility as an intern! ”

Speaking of this, He Jianyi was stunned again.

Dean Fang only told him this morning that he might want to give Zhou Yuan a break in his promotion recently.

Originally, Dean Fang planned to promote Zhou Yuan to his title after completing the operation of finger regeneration.

However, at that time, if the person who wrote the thesis saw that Zhou Yuan was just an intern, I am afraid that he would directly type the thesis without even reading the title.

Moreover, if he really appeared in The Lancet, the doctor who could write the Lancet magazine was actually just a small intern doctor in Yanjing International Hospital… This will make the medical community think that Yanjing International Hospital does not value talents and so on.

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

“Let’s have surgery! The old man couldn’t hold on! Zhang Ling was a little anxious.

Heart rate and blood pressure are already somewhat unstable, and if you do not carry out blood vessel transplantation as soon as possible to unblock blood clots, He Jianguo is very dangerous.

He Jianyi became serious: “Hurry up and go to the operating room!” ”

He Jianguo’s son and daughter quickly got out of the way, while Zhou Yuan and the others quickly entered the operating room with their hands and pushing the operating table.

In the operating room.

Under the shadowless light, He Jianguo was already unconscious.

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

Epidural block anesthesia is used for surgery.

He Jianguo lay on the bed in a supine position, and the right limb that underwent surgery was unfolded 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 this operation.

Main knife: Zhou Yuan

Kazuke: He Jianyi

Nisuke: A vascular surgeon

Sansuke: A vascular surgeon

Instrument nurses, anesthetists, etc.

“Scalpel.” Zhou Yuandao.

The first step is to separate the valuable vein in the upper arm and the cephalic vein near the elbow to estimate the length of the blood vessel that needs to be transplanted.

Zhou Yuan skillfully cut the outer skin, and then separated the subcutaneous tissue, muscle tissue, etc. in turn, found the precious 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 separated, and then the blood vessel is taken 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 disinfecting the lower abdomen, the vocal part and both lower limb thighs.

“Spread the towel.”

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

“Separation of the great saphenous vein.” Zhou Yuan said.

“Scalpel.”

After making an incision on the inside of the femoral artery, Zhou Yuan incised the skin and subcutaneous tissue here, and cut the superficial fascia at the femoral artery incision, exposing the oval fossa.

If you find the fossa of the ovale, it is not difficult to find the saphenous vein. The confluence of the great saphenous vein and the femoral vein is located here, and it is easy to see the great saphenous vein.

“Bend the hemostatic forceps.”

Zhou Yuan used curved hemostatic forceps to separate the main trunk of the great saphenous vein.

“Cut off the branches of the saphenous vein.”

This step is important.

Once a mistake occurs, or the blood vessel is ruptured, there will be fatal conditions such as inability to suture and bleeding during vascular grafting.

“Vascular forceps.”

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

The saphenous vein has branches such as superficial iliac spiral, superficial abdominal wall, superficial voice, ventrolateral and medial femoral vein, and after finding these branches, and ligating and cutting them one by one, the branches of the saphenous vein are cut.

“Start amputating the saphenous vein segment.”

Zhou Yuan picked up the scalpel and peeled off the saphenous vein that had cut off the branch.

“Wait… Why did you strip straight away? He Jianyi and the vascular surgeon were stunned.

In general, the removal of blood vessels requires the various connective tissues outside to be cleared and the blood vessels separated.

But Zhou Yuan directly started, this is to cut off all the blood vessels and the tissue stuck to the blood vessels…

“Wait, you used No-touch?” The second vascular surgeon was a little surprised.

“No-touch?”

“Yes, it is a technology proposed by country M, but it is 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 blood vessels! ”

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

“This… It seems to reduce the incidence of narrowing of blood vessels? He Jianyi said uncertainly.

“51.40mm intercepted.” Zhou Yuan removed a section of blood vessels connected to connective tissue and said.

“It is indeed No-touch surgery, which is used to amputate the great saphenous vein, which can greatly reduce the incidence of vascular stenosis, and the success rate of vascular transplantation will also increase.” Zhou Yuan explained.

The blood vessels in Zhou Yuan’s hand were similar to the lamb of the lamb kebab, but the color was more bright red and it was strip-shaped.

“Wait, why did you cut 20mm more?” asked the young and vegetable vascular surgeon.

While testing the separated saphenous vein, Zhou Yuan explained: “You have not been exposed to this technology, I don’t understand. The saphenous vein will retract after it is 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 the saphenous vein with heparin saline.

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 “Da Tang: Salted Fish Son-in-law”, super hot-blooded, you can go and see! _

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