At present, the main treatment for Debakey type I dissecting aneurysms was surgical replacement of artificial blood vessels.
Because the cause of the patient's Marfan syndrome could not be eradicated, and the distal residual lesions still had the possibility of further development, there was a high possibility of recurrence after ascending aortic replacement.
Dr. Rudi probably had a premonition long ago and told his wife to go to the King's Hospital immediately if she felt unwell.
Therefore, the disease was discovered early this time. He should have started to control his blood pressure in the intensive care unit to prevent the condition from worsening further and wait for the next step of treatment.
The more troublesome thing about Marfan syndrome was that the large blood vessels in the body had the pathological manifestation of mid-level cystic necrosis. Even if the surgery was successful, no one could predict when the disease would occur again.
Dr. Rudi continued to talk about the results of various tests. He knew it like the back of his hand. Zheng Ren did not say anything and just pondered.
After getting into the car, Su Yun asked, "Boss, it's very difficult to split the sternum in the middle of the surgery."
Zheng Ren knew what he meant.
This was one of the main points of the surgery and one of the difficulties.
Generally speaking, the second surgery should use the same approach as the first surgery. This way, the patient's damage would be smaller.
Moreover, for aortic arch replacement surgery, splitting the sternum was almost the only way. The other incisions were limited.
However, the healthy sternum had a thick callus. It had to be split close to the side, and if the sternum saw slipped … then it would be a tragedy.
If it was a normal surgery, it would be fine to change the incision. However, if it was an aortic arch replacement surgery, it was completely impossible. They could only choose the incision with the largest field of view.
Zhao Yunlong was thinking about laparoscopic aortic arch catheterization surgery, but it was just an idea. He did not know when he would really be able to study it.
However, when the second surgery split the sternum, the heart, especially the right atrium, might have secondary bleeding or aneurysm rupture. The prognosis was very poor.
This was experience. It seemed that Su Yun had done similar surgery before and the effect was average.
Zheng Ren nodded and said, "I'll take care of the approach. It's not difficult. The difficulty lies in the back. I've thought about a few ways. Among them, I think heparinization and lowering the temperature first are more reliable. "
"Heparinization and lowering the temperature first?" Su Yun was stunned.
This train of thought was a little strange.
Moreover, to achieve this, the speed of the surgery was extremely high.
The body's blood undergoing heparinization would face many complications. The patient rescued in the EICU two days ago was one example.
"No, it's a little different from usual surgery."
"What should I do?"
"Preheparinization, intubation through the right subclavian artery or femoral artery or vein, parallel cardiopulmonary bypass, and cooling. Thoracotomy can reduce the chance of heart or blood vessel rupture, and at the same time, it's more conducive to the separation and exposure of mediastinal adhesions during the second surgery, "Zheng Ren said.
Uh …
Let's lower the temperature first …
After cooling down, all the organs in the body, including the heart, would receive a certain impact. In other words, the speed of breaking the sternum and opening the mediastinum had to be fast enough. Perhaps two to three minutes was the limit.
However, Zheng Ren's words seemed to be a line of thought. Su Yun followed Zheng Ren's words and continued thinking.
Unconventional surgeries were not for the sake of sensationalism.
Why did fixed tactics exist? This was because countless surgeons had been experimenting with clinical surgeries, and they had used countless surgical failures to prove that a certain path was correct.
Once an unconventional surgery was used, there would be a huge risk.
However, sometimes, the actual situation forced doctors to use unconventional methods to complete the surgery.
However, compared to directly cutting the sternum, the boss's words seemed to have fewer complications. No wonder he wanted Lao He and Yiren to come together. Only a team that had worked together many times could shorten this time to the limit.
"Marfan syndrome is very difficult to deal with." Su Yun sighed.
"Yes, I've thought about it. During the surgery … Damn, I forgot!" Zheng Ren suddenly slapped his thigh.
"What did you forget?" Su Yun asked in surprise.
Zheng Ren did not answer immediately. Instead, he focused and thought for a while. Finally, he sighed.
"What's wrong? Looking at how you're in so much pain that you want to die, is it because the surgery can't be done? "Su Yun asked.
"No," Zheng Ren said. "I think that a congenital disease like Marfan syndrome causes the pathological changes of the middle layer of the aorta to necrosis. We should use a stent during the surgery to prevent similar problems from happening again."
"…"
"A second thoracotomy is fine, but a third thoracotomy will probably be enough for the patient," Zheng Ren said bluntly.
"During the surgery? First, we do an aortic replacement, and then we have to get a stent? "Su Yun asked.
"Yes." Zheng Ren nodded. "Lil Fugui can't come. There's still surgery to be done at home. He and Old Liu can't be moved. "
So that was how it was.
"The standard of the King's Hospital isn't bad," Su Yun said. "We can use their doctors to get the stent."
"That's the only way," Zheng Ren said. "You should ask Old Zhao to come. If there's a problem during the surgery, you can get the stent. Old Zhao and I will do the surgery. "
Su Yun's face suddenly twisted.
"Boss, I'm a narrow-minded doctor!" Su Yun complained.
"Old Zhao doesn't know how to do the interventional surgery. If I do it, can you guarantee that Old Zhao and you can complete the surgery smoothly?" Zheng Ren asked.
"…" Su Yun recalled the surgery process. Could he do an unconventional surgery?
Forget it.
He would just do as the boss said.
Seeing that Su Yun was silent, Zheng Ren smiled and said, "It's okay. I'll see the situation when the time comes. I'll try not to delay your learning of the surgery."
"Learning?" Su Yun said disdainfully.
"You can't do it. If it's not learning, are you still going to teach me how to do surgery?" Zheng Ren casually retorted.
Su Yun had no chance of winning this kind of confrontation.
After all, he could not do the surgery himself. Zheng Ren's rebuttal was accurate.
"What about the anastomosis?" Su Yun stiffly changed the topic and talked about the main point of the next surgery.
"I think that in order to reduce the complications of the anastomosis, the lesion of the aorta that is removed during the surgery should be long enough.
The rupture must be removed to ensure that the blood vessel is anastomosed to the normal blood vessel wall tissue. At the same time, in order to increase the strength of the blood vessel anastomosis, we should use the method of using the full circumference of the aorta anastomosis to reinforce the inside and outside of the aorta anastomosis. Not only can it increase the strength of the anastomosis, but it can also ensure that the blood vessel dissection is completely sealed. "
"The full circumference of the aorta anastomosis to reinforce the inside and outside of the aorta anastomosis is very difficult," Su Yun said.
"It's okay. I'm here."
Su Yun did not say anything. He just glanced at Zheng Ren. His simple and honest face seemed to have a layer of luster, making people trust him.
"Alright, you seem to have thought about the surgery very thoroughly," Su Yun said after a long time.
"There's one more thing. Brain protection under hypothermia cardiopulmonary bypass," Zheng Ren said. "I have an idea, but I still want to ask Old He to see if he has any opinions."
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