In the pediatric surgery demonstration room of Imperial Capital Women's and Children's Hospital, a simulated surgery was being carried out in an orderly manner.
It was a pair of conjoined twins with a united chest and abdomen. Although they had two hearts, they shared the same pericardium and their hearts were also connected.
Separation surgery was quite difficult. Women's and Children's Hospital had cooperated with Philadelphia Children's Hospital, which was the world's best in pediatric surgery. After a series of preparations, they had entered the perioperative period. As long as the simulated surgery was successful, the surgery could be carried out at any time.
The computer-aided 3D printed model was identical to a real person.
Intraoperative navigation and two sets of custom-made external auxiliary devices ensured that the simulation surgery could be carried out.
If the simulation surgery was successful, the conjoined twins could be separated at a young age, effectively protecting the regenerative ability of their young hearts.
This set of preparations was extremely expensive. Women's and Children's Hospital spared no expense in approaching the world's advanced medical standards, especially in the application of 3D simulation printing and intraoperative navigation systems.
Intraoperative navigation was a preoperative evaluation method that accurately corresponded the patient's preoperative or intraoperative imaging data to the patient's anatomical structure on the operating table and was reconstructed by computer.
During the surgery, the surgical instruments were tracked and their positions were updated in real-time on the patient's image in the form of a virtual probe. This allowed doctors to know the position of the surgical instruments relative to the patient's anatomical structure at a glance, making the surgery faster, more accurate, and safer.
Its main applications were intraoperative application and preoperative simulation surgery.
Intraoperative navigation technology had existed for a long time, but due to its high price and imperfect computer-aided functions, preoperative simulation surgery had not been fully applied in clinical practice.
Zheng Ren had known this for a long time. It was the same as the experimental subjects in the System. However, the technology was not mature enough and was not as useful as the System.
Doctors in Women's and Children's Hospital were attempting to separate conjoined twins in the System's "operating theater".
The surgical model was a 3D printed replica of the conjoined twins.
Originally, the surgery was to be carried out by the medical team from Philadelphia Children's Hospital. However, during the preoperative simulation surgery, the team from Philadelphia Children's Hospital had discovered that the infant's heart malformation was severe and the surgery success rate was less than 5%.
Under the careful care of Women's and Children's Hospital, the conjoined twins' vital signs were able to withstand the surgery. However, as time passed, the symptoms of heart failure worsened and could not be delayed.
The hospital and the infant's parents had discussed many times and finally reached a consensus. The conjoined twins had shown symptoms of heart failure. There was still a chance of survival through surgery, but without surgery, there was no chance of survival at all.
They would give it a try.
According to the plan, this was the last simulated surgery.
The CT and MRI 3D localization done yesterday produced a bitmap image that displayed the situation inside the conjoined twins' bodies in a stereoscopic manner.
When the conjoined twins first arrived at the Women and Children's Hospital in the Imperial Capital, they were found to share a common pericardium. The two hearts were connected in the atrium. The large blood vessels at the bottom of the heart and the atrium are completely separated without communication. The apex of the heart is connected to the diaphragm.
Most of the two hearts are membranous.
There were more parts connected to the liver, but that was not the main point.
The most difficult part of the conjoined twins' surgery was the connection of the brain, followed by the heart. The other organs were not very important.
However, the reason why the team of specialists from the Children's Hospital of Philadelphia gave up was that as the conjoined twins grew, they discovered that their heart beat at a different frequency. There was no way to proceed with the surgery.
After a few simulated surgeries, no one was able to solve this problem.
So, the Children's Hospital of Philadelphia announced that they were giving up on the surgery.
Vice Director Chen of the Women's and Children's Hospital was in charge, and he was ready to try a few more times. If they gave up the operation now, the child would die within a month, and all their previous efforts would be in vain.
Only the Women and Children's Hospital knew how much effort they had put into this pair of conjoined twins.
Not to mention the top-notch 3D printing and the introduction of the surgical navigation system, countless small details were immersed in the blood and sweat of the medical staff.
Meticulous feeding was the first step.
In order to strengthen the conjoined twins' physique, they had to create conditions for the surgery.
When the conjoined twins were in the hospital, their age was 10
Days, and their total weight was 3.93
Kg, which was classified as grade II malnutrition.
After admission, they were fed with high-quality neonatal formula milk.
ML, per 3
H feeding once, and now increased to 60 to 90
ML, per 3
H feeding once. During the feeding process, they had to pay attention to the tilt of the bottle, the size of the nipple hole, and pay attention to prevent choking, vomiting, and even suffocation.
During this period, they were supplemented with intravenous nutrition — pediatric compound amino acids, fat emulsion, various vitamins, trace elements, and intravenous plasma, human blood albumen, calcium, etc.
Not a single detail was missed. The preoperative weight of the two babies had increased to 7.8
kg。
This …
Only a part of it.
Apart from feeding, they also had to strengthen basic care, control infection, and set up a single room for protection.
The air sterilizer in the ward was automatically sterilized every day, and ventilation was paid attention to to keep the air fresh. The room temperature was 20 ℃ -24 ℃, and the relative humidity was 50% -60%.
The children suffered from serious diaper rash and impetigo in the armpit, groin, lower limbs, and around the anus and genitals. After being admitted to the hospital, they were bathed with 0.05% neomycin water every day and applied Baiduobang Red Butt Ointment to the affected areas.
3 to 4 times.
And this was only part of the basic care.
Because the conjoined twins were relatively large, there might be a large lack of skin after separation. To ensure that the incision skin was sufficient during the operation and avoid skin grafting as much as possible, the body bridge must be lengthened and widened.
The body bridge was the "bridge" shared by the conjoined twins.
At the time of admission, the conjoined twins initially had an umbilical length of 16
cm。 Width 4
Cm, and the circumference was 37 cm. Because the tension of the body bridge was relatively high, it was necessary to relax the thoracic and abdominal walls and expand the thoracic and abdominal cavity.
The director of pediatrics personally pressed the connecting part of the conjoined twins three times a day for 15 minutes each time.
The old director was almost 60 years old. Every day, Deputy Director Chen felt that it was very hard to watch her put four fingers together under the body bridge and her thumb on the top of the body bridge. She pressed from light to heavy rhythmically.
When pressing, the reaction and complexion of the conjoined twins were also observed. After pressing, a length of 16 cm, diameter 2
Cm, diameter 2
Cm, weight 150
G of rice bag was pressed above the body bridge.
A cotton bag of the same shape was used to pad the bottom. When sleeping at night, side lying was used to pull, that is, a small pillow was placed between the two children, so that the two children were as far apart as possible when lying on the side, so that the body bridge was prepared to the satisfaction of the operation.
Under the joint efforts, the circumference of the body bridge of the conjoined twins had reached 54
Cm, length 20
Cm, width 7
cm。
However, everything was ready, but the operation could not be completed.
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