"Emergency?" Su Yun frowned when he heard that it was a TIPS surgery.
TIPS surgery was the most difficult surgery in the interventional department.
Of course, there were many new surgical methods that could not be performed with current medical conditions, such as prostate interventional embolization. However, these surgeries were only 'difficult'. In terms of technical level, most people would think that TIPS was the most difficult.
"In the gastroenterology department, there's a rather difficult patient. He's Chief Xia's classmate. We've already contacted him to go to Imperial Capital for TIPS surgery, but he suddenly vomited blood before he could leave. He's in shock. "Zheng Ren stood up, put on his white coat, and turned to Xie Yiren with an apologetic smile.
Xie Yiren waved her hand, indicating for Zheng Ren to get to work. She looked gentle and virtuous.
Zheng Ren calmed down and strode out of the on-call room.
"You know how to do it?" Su Yun asked.
"I can give it a try." Although he had never done it before, he still had time to perform surgeries. In order to save people, he should squander it.
The most difficult thing was that postoperative complications were more difficult to manage.
There were two treatments for hematemesis caused by decompensated cirrhosis, gastroesophageal varices, and splenomegaly. One was surgery, such as splenectomy and porto-azygos disconnection. The other was the TIPS surgery mentioned just now.
This surgery had been used in clinical practice for less than thirty years.
In 1988, German scholar Rihter and others first applied the jugular portal shunt technique to clinical practice. In 1991, they reported 16 successful cases of portal shunt technique via the jugular vein.
Zel (1991) and Rg (1992) subsequently reported the results of successful portal shunt technique via the jugular vein.
In 1999, portal shunt technique via the jugular vein was popularized in various countries.
In the 21st century, China Medical University's Professor Xu Ke pioneered the surgery in China.
Until now … it had not become a routine surgery.
Why?
Because it was difficult.
Especially difficult.
Even if the surgery was completed, the postoperative mortality rate was extremely high.
However, if the patient could survive, the postoperative quality of life would be greatly improved. It was a surgical method that benefited the patient greatly.
Su Yun had recently learned interventional surgery and naturally knew that TIPS surgery was the crown jewel of interventional surgery.
Was it going to start so soon? Did he have medical supplies? If not, what was Zheng Ren going to do?
"How about medical supplies?"
"I'll call Manager Feng," Zheng Ren said as he took out his phone.
"Manager Feng, it's me."
"I might need to perform TIPS surgery here. Send the relevant medical supplies over immediately."
"Yes, Old Chief Physician Pan will handle the procedures tomorrow. It'll probably be an ad hoc procedure."
"Hurry up! One hour!"
After saying that, he hung up the phone.
"Are you confident after the surgery?" Zheng Ren walked quickly but still asked Su Yun.
"Hepatic encephalopathy. If there's no way to prevent it, then it can only be controlled with amino acids and other drugs." Su Yun recalled the process of the TIPS surgery and the danger of hepatic encephalopathy. He did not dare to speak too confidently.
The key was that the clinical treatment for hepatic encephalopathy was still very limited.
With that in mind, he quickened his pace and arrived at the gastroenterology department.
Chief Xia was still smart and capable. There was a trace of embarrassment on her face when she saw Zheng Ren rushing over so quickly.
A floating gallbladder. In that case, Chief Xia could be considered to have embarrassed Zheng Ren in the emergency department.
It turned out that Zheng Ren was right. Therefore, Chief Xia really did not want to face this monster of a chief resident of the emergency department.
Even if there was an accident, she would still go through Old Chief Physician Pan … Well, this was also a normal procedure, a communication between department chiefs.
"Hello, Chief Xia. Which ward is the patient in?" Zheng Ren's expression did not change at all. There was no arrogance, no sarcasm. It was as if the previous incident had never happened.
"He's here." Department Chief Xia tossed those messy thoughts aside and rushed to the resuscitation room with Zheng Ren in tow.
It was a male patient in his fifties. His face was sallow and shrouded in a black aura. He was lying on the hospital bed with a basin under him. He kept vomiting black venous blood.
The scene was eerie and strange, like hell.
The thick smell of blood assaulted Zheng Ren's nostrils. He glanced at the System panel in the upper right corner of his vision.
A patch of red came into view.
The patient's diagnosis was: hemorrhagic shock, decompensated cirrhosis after hepatitis B, refractory ascites, pleural effusion, electrolyte metabolism disorder, splenectomy and periesophageal and cardiac vascular disconnection.
He had undergone splenectomy and portazygos disconnection …
Zheng Ren was originally hesitant between the two surgical methods, but there was no need to think about it now. He was ready for the TIPS surgery.
"He started vomiting blood three days ago. He had undergone splenectomy and portazygos disconnection, so he could only choose conservative treatment." Chief Xia explained the patient's condition in a low voice. "Three sets of intravenous hemostatic drugs and oral renal iced saline solution managed to control the bleeding. I was going to transfer him to Imperial Capital for the TIPS surgery, but I didn't expect him to vomit blood again when I contacted the ambulance. "
Three sets of hemostatic drugs and renal iced saline solution had been used, which was considered the maximum amount.
Even four or five sets of hemostatic drugs were not effective. It would be even more troublesome if complications such as cerebral infarction or myocardial infarction occurred.
Zheng Ren thought about whether he had enough time left for the surgery.
After all, TIPS surgery was the most difficult surgery in interventional surgery. Zheng Ren was not confident.
Chief Xia saw Zheng Ren's hesitation and smiled bitterly. "You're the only interventional surgery in our hospital. It can't be helped. It's been hard on you. "
Her unexpected but reasonable softening of attitude was very logical. Zheng Ren understood Chief Xia's thoughts.
"As long as there's a 10% chance of success, there's no harm in trying," Chief Xia said firmly. "The patient is my classmate, and so is his wife. Don't worry, Doctor Zheng. Even if he dies on the operating table, it won't be a problem. "
The last sentence was to reassure Zheng Ren.
It was for no other reason than that emergency TIPS surgery was the only option. If Zheng Ren said he could not do it, the patient could only vomit blood and wait for death.
Perhaps a few minutes later, he would vomit venous blood, spray it on the wall, or even the ceiling, and he would be gone.
However, the difficulty of normal TIPS surgeries exceeded the threshold of 10, reaching 11, let alone emergency TIPS surgery.
"Chief Xia, to be honest, I've never done it before." Zheng Ren pondered. "The patient's condition is critical and there aren't many options. Let's try emergency surgery. I can't guarantee anything, but I'll try my best. "
"Thank you," Chief Xia said sincerely.
The fact that a department chief thanked the patient in front of the patient's family was already an admission of defeat.
A victorious smile appeared on Su Yun's face.
Zheng Ren's brows furrowed.
"Do you have the medical supplies?" Chief Xia immediately asked the most pointed question.
"I've already contacted them. They'll be sent to the emergency operating theater in a few minutes," Zheng Ren said. "Prepare to send the patient. Sign the preoperative documents …"
"I can sign them," Chief Xia said.
It seemed that she was indeed familiar with the patient and his wife.
"Okay," Zheng Ren said. "Prepare for emergency surgery!"
At the same time, a mission notification rang in Zheng Ren's ears.
[Main Mission: First phase of the Crown Jewel]
[Mission Details: Complete the most difficult interventional surgery, known as the Crown Jewel, intrahepatic portosystemic shunt via the internal jugular vein.
[Mission Reward: The average time taken to complete the TIPS surgery is 4 hours and 2 minutes. If the host takes longer than the average time to complete the mission, there will be no special reward. If the host takes less than the average time to complete the mission, there will be a generous reward.
In addition, there will be a reward of + 2 luck points, two golden chests, and 200,000 experience points.
[Mission Time: 6 hours.]
Zheng Ren originally wanted to ignore this mission, but after glancing at it, he was stunned.
Looking at the long list of numbers, the + 2 luck points, and the "generous reward" mentioned by the System, Zheng Ren felt like he was back in Imperial Capital.
Was TIPS surgery considered a main mission?
Among the current interventional surgeries, TIPS surgery was indeed the most difficult. If he wanted to climb the skill tree, it was a necessary procedure to reach the top.
Main mission … Fine.
However, he did not know what the main mission of general surgery was.
He had never performed TIPS surgery before. Whether it was to save a life or to complete the mission, he had to think about it carefully.
There was still some time left for surgery training. It seemed like he had to stake it all on this one throw.
Zheng Ren's mind raced as he pondered the steps of TIPS surgery.
The process of the surgery was simple.
After a successful puncture through the right jugular vein under local anesthesia, the guide wire and needle were used to open up the hepatic vein and portal vein. The portal vena cava puncture channel was then expanded with a balloon and the stent was accurately released.
The difficulty of TIPS surgery was to open up the hepatic vein and portal vein with the needle.
It was a blind puncture and could only rely on experience … and luck.
No matter how skilled the surgeon was, they would not be able to complete the surgery if they were unlucky.
Therefore, there was a reason why TIPS surgery was known as the brightest pearl in the crown of interventional surgery.
Zheng Ren was thinking about how he could minimize the need to rely on luck.
For someone who did not even want to open the System's Treasure Chest, trying his luck on the operating table was undoubtedly a difficult task.
"No confidence?" Su Yun, who was following behind Zheng Ren, noticed that he was walking slowly and seemed to be deep in thought.
"No one in this world has absolute confidence," Zheng Ren said.
"Professor Rudolf Wagner is sleeping in Shangri-La," Su Yun reminded him.
"Uh …" Zheng Ren had already forgotten about Professor Rudolf Wagner.
The professor was one of the world's top interventional surgeons. Since he was staying, it was only right for him to lend a hand.
Zheng Ren nodded and picked up the phone.
"Professor Rudolf, it's Zheng Ren." The phone rang for nearly half a minute before the professor picked up.
Zheng Ren ignored the professor's slightly grumpy German and got straight to the point.
"There's a TIPS surgery over here. Please come and take a look."
After saying that, Zheng Ren hung up the phone.
…
Note 1: Intrahepatic portosystemic shunt through the internal jugular vein, abbreviated as TIPS surgery. This chapter was introduced a few times to deepen the impression. In the future, only the abbreviation would be used.
Also, the four characters in TIPS should only count as one word. I also heard about it from others ~ Please recommend it, thank you.
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