Chapter 297： The crown of the pearl (1/4)
“Emergency?” Su Yunyi was a TIPS operation (Note 1), frowning.
TIPS surgery is the most difficult surgery in the interventional department, no one.
Of course, many new procedures are not available for existing medical conditions, such as prostate interventional embolization. But these operations are just "difficult". From a technical perspective, everyone should think that TIPS is the most difficult.
"In the Department of Gastroenterology, there is a more difficult patient. The patient is a classmate of Xia, who has contacted the Emperor to do TIPS surgery, but before he started, he suddenly vomited blood and people have already been shocked." Zheng Ren stood up and draped On the white suit, I turned back and thanked the Iraqi people for apologetic smile.
The Xie Yi waved and gestured to Zheng Ren to go to work, his eyebrows bent, gentle and gentle.
Zheng Ren’s heart was calm and strode out of the duty room.
"Will you?" Su Yun kept up and asked.
"You can give it a try." Zheng Ren thought, although he had not done it, but there is still surgery time, in order to save people, still squander it.
The hardest part is that the complications after TIPS surgery are more difficult to deal with.
There are two treatments for decompensated cirrhosis, gastric fundus esophageal varices, and hematemesis caused by splenomegaly—one is surgery, such as splenectomy, and portal venous devascularization; the other is Just said the TIPS surgery.
This kind of surgery has not been in clinical practice for 30 years.
In 1988, German scholar Richter et al first applied the transjugular intrahepatic stent shunt in clinical practice, and in 1991 reported 16 successful transjugular intrahepatic stent shunts.
Subsequently, Zemel (1991) and Ring (1992) reported success of transjugular intrahepatic stent shunts.
In 1993, transjugular intrahepatic stent shunt surgery was promoted in various countries.
The beginning of surgery in China was in the 21st century, and Xu Ke, a teacher at China Medical University, took the lead.
Until now...has not become a routine operation.
why?
Because it is difficult to do.
Especially difficult to do.
Even after the surgery is completed, the postoperative mortality rate is extremely high.
However, if the patient can survive, the quality of life after surgery will be greatly improved, which is a surgical procedure in which patients benefit greatly.
Su Yun recently studied interventional surgery, and naturally knows that TIPS surgery is known as the jewel in the crown of interventional surgery.
Is it going to be carried out so soon? Is there any consumables? Nothing, Zheng Ren is ready to engage in wool?
"How about consumables?"
"I called Mr. Feng." Zheng Ren said, taking out the phone.
"Manager Feng, it is me."
"I may have a TIPS operation on this side, and the related supplies will be sent immediately."
"Well, in terms of procedures, the director of the old Pan will do it tomorrow, and it is estimated that it will be the process of mining."
"As soon as possible, 1 hour!"
After that, Zheng Ren hung up the phone.
"After surgery, is there confidence?" Zheng Ren walked quickly, but still asked Su Yun.
"Hepatic encephalopathy, if there is no way to prevent it, it can only be controlled by drugs such as amino acids." Su Yun recalled the process of TIPS surgery and the sinisterness of hepatic encephalopathy, and did not dare to say too full.
The key is the clinical means of treating hepatic encephalopathy, which is still very simple.
Zheng Ren has a number in his heart, speeding up his footsteps and coming to the Department of Gastroenterology.
Director Xia was still smart and capable, and he saw Zheng Ren rushing over so quickly, and there was a trace of embarrassment on his face.
Floating gallbladder, the patient, Xia director in the emergency department is the face of Zheng Ren.
Afterwards, Zheng Ren was right. Therefore, Director Xia really does not want to face this enchanting emergency department.
Even if there was an unexpected situation, she passed the director of Lao Pan... Well, this is the normal process and the communication between the directors.
"Director Xia, hello, patient in which ward." Zheng Ren did not change his expression, no arrogance, no bitterness, as if the previous things never happened.
"On this side." Director Xia put aside all the messy thoughts, and rushed to the rescue room with Zheng Ren.
It was a man in his fifties, his face was sallow, his black air was covered, he was lying on the hospital bed, and there was a washbasin underneath. He was vomiting black venous blood in a constant bite.
The picture is gloomy and strange, like hell.
The thick **** taste rushed, and Zheng Ren glanced at the system panel in the upper right corner of the field of view.
A piece of red came into view.
The patient's diagnosis was: hemorrhagic shock, decompensated cirrhosis after hepatitis B, refractory ascites, pleural effusion, electrolyte metabolism disorder, spleen resection and vascular dissection around the esophagus.
Have done splenectomy and portal venous devascularization...
Zheng Ren was still hesitating between the two types of surgery, now I don't have to think about it, I am going to do TIPS surgery directly.
"Three days ago, hematemesis occurred. Because he had undergone splenectomy and portal venous devascularization, he could only choose conservative treatment." Director Xia Sheng introduced the condition. "Three groups of intravenous hemostatic drugs plus oral Zhengshenbing saline, bleeding I got control. I was going to transfer to the Imperial Capital to do TIPS surgery, but I didn't expect to have a big vomiting when I contacted the ambulance."
Three groups of hemostatic drugs have been used, plus plus kidney ice water, it can be said that it is considered to be extremely large.
Even with four or five groups of hemostatic drugs, it has no effect. When cerebral infarction, myocardial infarction and other complications appear, it is even more difficult.
Zheng Ren Shen Shen, I figured that the surgery time reserved by myself was not enough.
TIPS surgery is, after all, the most difficult operation in the interventional discipline, and Zheng Ren is not sure.
Director Xia met with Zheng Ren, and he smiled a bit. He said: "Our hospital, only you are doing interventional surgery. This is no way, it is difficult for you."
Her unexpected, but irrational attitude softened, very logical, Zheng Ren understands the director Xia's mind.
"As long as you have 10% confidence, it is always right to try." Director Xia firmly said: "The patient is my classmate, and his lover is also my classmate. Dr. Zheng, you can rest assured that even if you can't get down, you will die in surgery. There will be no problems on the stage."
The last sentence is to give Zheng Ren a heart.
Nothing else, because emergency TIPS surgery is the only option. If Zheng Ren said that he would not do it, the patient could only vomit blood while waiting for the death to come.
Perhaps a few minutes later, a venous blood vomited, sprayed onto the wall, sprayed to the roof, and people were gone.
However, the difficulty rate of TIPS surgery usually slowed beyond the limit threshold of 10, reaching 11 or more, not to mention emergency TIPS surgery.
"Director Xia, to be honest, I have not done it." Zheng Ren Shen Yan, "The patient is critically ill and there are not many choices. Try emergency surgery. I can't guarantee it, I can only try my best."
"Thank you." Director Xia thanked him sincerely.
It is a good idea to let the director of a department head in front of the patient's family and say thank you two words.
Su Yun’s mouth showed a triumphant smile.
Zheng Ren is locked in his eyebrows.
“Is there any consumables?” Director Xia immediately asked the most acute question.
"I have already contacted, and then I can send it to the emergency operating room in a few minutes." Zheng Rendao, "Prepare to send the patient, sign before surgery..."
"I can sign." Xia director said.
It seems that she and the patient couple are indeed familiar with a certain degree.
"Good." Zheng Rendao: "Prepare for emergency surgery!"
At the same time, "叮咚~~" a task prompt sounded in Zheng Ren's ear.
[Main line mission: the first stage of the Pearl of the Crown.
Quest content: Complete the internal carotid endovascular shunt of the internal jugular vein, which is the most difficult and the crown of the pearl.
Mission reward: The average time to complete TIPS surgery is 4 hours and 23 minutes. If the host completes the task longer than the average time, there is no special reward. If the time to complete the surgery is shorter than the average time, you will receive a generous reward.
Another reward is the lucky value +2, two gold treasure chests, and the experience value is 200000 points.
Mission time: 6 hours. 】
Zheng Ren had wanted to ignore this task, but when he glanced at it, he stopped.
Seeing a long list of numbers, a lucky value of +2, and the "great reward" that the big pig hoof said, Zheng Renyi felt that he had returned to the Imperial Capital.
Is TIPS surgery a main task?
In the existing interventional surgery, TIPS surgery is indeed the most difficult one. If you climb the technology tree, it is indeed the surgery that must be completed when you climb to the top.
Main line task... well.
I just don't know what the main task of general surgery is.
I haven't done any TIPS surgery, whether it's for saving people or for the purpose of completing a task, I have to ponder it.
There seems to be some time for surgery training, and it seems that I have to be desperate.
Zheng Ren's brain is running at high speed, and he has to consider all the steps of TIPS surgery.
The process of surgery is simple to say.
After successful perforation of the right jugular vein under local anesthesia, the hepatic vein and portal vein were opened by the catheter guide wire and the puncture needle, and the balloon was dilated and the stent was accurately released.
The difficulty in TIPS surgery is that the needle penetrates the passage of the hepatic vein and the portal vein.
This is blind wear, only by experience... and luck.
No matter how high the level is, in the face of TIPS surgery, if the luck is a little bit worse, this surgery cannot be completed.
Therefore, TIPS surgery is said to be the most embarrassing pearl in the crown of interventional surgery, it makes sense.
What Zheng Ren thinks is how to rely on luck as little as possible.
For Zheng Ren, who is not willing to open even the system treasure chest, it is undoubtedly an unacceptable thing to take chances on the operating table.
"I'm not sure?" Su Yun followed behind Zheng Ren. Seeing his footsteps was not very fast. He seemed to be immersed in contemplation and asked for it.
"There is no absolute certainty in the world." Zheng Rendao.
"Professor Rudolf Wagner, sleeping in Shangri-La." Su Yun reminded.
"Hey..." Zheng Ren has forgotten Professor Rudolf Wagner behind his headProfessor is the world's top interventionalist. Since he stays, for whatever purpose, always take the handle It should be.
Zheng Ren nodded and picked up the phone.
"Professor Rudolf, I am Zheng Ren." The phone ringing for nearly half a minute, the professor picked up the phone.
Zheng Ren directly ignored the German language that he got up slightly, and said something directly.
"There is a TIPS operation on this side, so you can take a look."
After that, Zheng Ren hangs up the phone.
......
Note 1: Transjugular intrahepatic portosystemic shunt, referred to as TIPS surgery. When I introduced this chapter, I said it a few times in order to deepen my impression. In the future, only the abbreviation is mentioned, and the number of words is not water.
In addition, the four characters of TIPS should only be counted as one word. I also heard people say ~~ Ask for a recommendation ticket, thank you.
TIPS surgery is the most difficult surgery in the interventional department, no one.
Of course, many new procedures are not available for existing medical conditions, such as prostate interventional embolization. But these operations are just "difficult". From a technical perspective, everyone should think that TIPS is the most difficult.
"In the Department of Gastroenterology, there is a more difficult patient. The patient is a classmate of Xia, who has contacted the Emperor to do TIPS surgery, but before he started, he suddenly vomited blood and people have already been shocked." Zheng Ren stood up and draped On the white suit, I turned back and thanked the Iraqi people for apologetic smile.
The Xie Yi waved and gestured to Zheng Ren to go to work, his eyebrows bent, gentle and gentle.
Zheng Ren’s heart was calm and strode out of the duty room.
"Will you?" Su Yun kept up and asked.
"You can give it a try." Zheng Ren thought, although he had not done it, but there is still surgery time, in order to save people, still squander it.
The hardest part is that the complications after TIPS surgery are more difficult to deal with.
There are two treatments for decompensated cirrhosis, gastric fundus esophageal varices, and hematemesis caused by splenomegaly—one is surgery, such as splenectomy, and portal venous devascularization; the other is Just said the TIPS surgery.
This kind of surgery has not been in clinical practice for 30 years.
In 1988, German scholar Richter et al first applied the transjugular intrahepatic stent shunt in clinical practice, and in 1991 reported 16 successful transjugular intrahepatic stent shunts.
Subsequently, Zemel (1991) and Ring (1992) reported success of transjugular intrahepatic stent shunts.
In 1993, transjugular intrahepatic stent shunt surgery was promoted in various countries.
The beginning of surgery in China was in the 21st century, and Xu Ke, a teacher at China Medical University, took the lead.
Until now...has not become a routine operation.
why?
Because it is difficult to do.
Especially difficult to do.
Even after the surgery is completed, the postoperative mortality rate is extremely high.
However, if the patient can survive, the quality of life after surgery will be greatly improved, which is a surgical procedure in which patients benefit greatly.
Su Yun recently studied interventional surgery, and naturally knows that TIPS surgery is known as the jewel in the crown of interventional surgery.
Is it going to be carried out so soon? Is there any consumables? Nothing, Zheng Ren is ready to engage in wool?
"How about consumables?"
"I called Mr. Feng." Zheng Ren said, taking out the phone.
"Manager Feng, it is me."
"I may have a TIPS operation on this side, and the related supplies will be sent immediately."
"Well, in terms of procedures, the director of the old Pan will do it tomorrow, and it is estimated that it will be the process of mining."
"As soon as possible, 1 hour!"
After that, Zheng Ren hung up the phone.
"After surgery, is there confidence?" Zheng Ren walked quickly, but still asked Su Yun.
"Hepatic encephalopathy, if there is no way to prevent it, it can only be controlled by drugs such as amino acids." Su Yun recalled the process of TIPS surgery and the sinisterness of hepatic encephalopathy, and did not dare to say too full.
The key is the clinical means of treating hepatic encephalopathy, which is still very simple.
Zheng Ren has a number in his heart, speeding up his footsteps and coming to the Department of Gastroenterology.
Director Xia was still smart and capable, and he saw Zheng Ren rushing over so quickly, and there was a trace of embarrassment on his face.
Floating gallbladder, the patient, Xia director in the emergency department is the face of Zheng Ren.
Afterwards, Zheng Ren was right. Therefore, Director Xia really does not want to face this enchanting emergency department.
Even if there was an unexpected situation, she passed the director of Lao Pan... Well, this is the normal process and the communication between the directors.
"Director Xia, hello, patient in which ward." Zheng Ren did not change his expression, no arrogance, no bitterness, as if the previous things never happened.
"On this side." Director Xia put aside all the messy thoughts, and rushed to the rescue room with Zheng Ren.
It was a man in his fifties, his face was sallow, his black air was covered, he was lying on the hospital bed, and there was a washbasin underneath. He was vomiting black venous blood in a constant bite.
The picture is gloomy and strange, like hell.
The thick **** taste rushed, and Zheng Ren glanced at the system panel in the upper right corner of the field of view.
A piece of red came into view.
The patient's diagnosis was: hemorrhagic shock, decompensated cirrhosis after hepatitis B, refractory ascites, pleural effusion, electrolyte metabolism disorder, spleen resection and vascular dissection around the esophagus.
Have done splenectomy and portal venous devascularization...
Zheng Ren was still hesitating between the two types of surgery, now I don't have to think about it, I am going to do TIPS surgery directly.
"Three days ago, hematemesis occurred. Because he had undergone splenectomy and portal venous devascularization, he could only choose conservative treatment." Director Xia Sheng introduced the condition. "Three groups of intravenous hemostatic drugs plus oral Zhengshenbing saline, bleeding I got control. I was going to transfer to the Imperial Capital to do TIPS surgery, but I didn't expect to have a big vomiting when I contacted the ambulance."
Three groups of hemostatic drugs have been used, plus plus kidney ice water, it can be said that it is considered to be extremely large.
Even with four or five groups of hemostatic drugs, it has no effect. When cerebral infarction, myocardial infarction and other complications appear, it is even more difficult.
Zheng Ren Shen Shen, I figured that the surgery time reserved by myself was not enough.
TIPS surgery is, after all, the most difficult operation in the interventional discipline, and Zheng Ren is not sure.
Director Xia met with Zheng Ren, and he smiled a bit. He said: "Our hospital, only you are doing interventional surgery. This is no way, it is difficult for you."
Her unexpected, but irrational attitude softened, very logical, Zheng Ren understands the director Xia's mind.
"As long as you have 10% confidence, it is always right to try." Director Xia firmly said: "The patient is my classmate, and his lover is also my classmate. Dr. Zheng, you can rest assured that even if you can't get down, you will die in surgery. There will be no problems on the stage."
The last sentence is to give Zheng Ren a heart.
Nothing else, because emergency TIPS surgery is the only option. If Zheng Ren said that he would not do it, the patient could only vomit blood while waiting for the death to come.
Perhaps a few minutes later, a venous blood vomited, sprayed onto the wall, sprayed to the roof, and people were gone.
However, the difficulty rate of TIPS surgery usually slowed beyond the limit threshold of 10, reaching 11 or more, not to mention emergency TIPS surgery.
"Director Xia, to be honest, I have not done it." Zheng Ren Shen Yan, "The patient is critically ill and there are not many choices. Try emergency surgery. I can't guarantee it, I can only try my best."
"Thank you." Director Xia thanked him sincerely.
It is a good idea to let the director of a department head in front of the patient's family and say thank you two words.
Su Yun’s mouth showed a triumphant smile.
Zheng Ren is locked in his eyebrows.
“Is there any consumables?” Director Xia immediately asked the most acute question.
"I have already contacted, and then I can send it to the emergency operating room in a few minutes." Zheng Rendao, "Prepare to send the patient, sign before surgery..."
"I can sign." Xia director said.
It seems that she and the patient couple are indeed familiar with a certain degree.
"Good." Zheng Rendao: "Prepare for emergency surgery!"
At the same time, "叮咚~~" a task prompt sounded in Zheng Ren's ear.
[Main line mission: the first stage of the Pearl of the Crown.
Quest content: Complete the internal carotid endovascular shunt of the internal jugular vein, which is the most difficult and the crown of the pearl.
Mission reward: The average time to complete TIPS surgery is 4 hours and 23 minutes. If the host completes the task longer than the average time, there is no special reward. If the time to complete the surgery is shorter than the average time, you will receive a generous reward.
Another reward is the lucky value +2, two gold treasure chests, and the experience value is 200000 points.
Mission time: 6 hours. 】
Zheng Ren had wanted to ignore this task, but when he glanced at it, he stopped.
Seeing a long list of numbers, a lucky value of +2, and the "great reward" that the big pig hoof said, Zheng Renyi felt that he had returned to the Imperial Capital.
Is TIPS surgery a main task?
In the existing interventional surgery, TIPS surgery is indeed the most difficult one. If you climb the technology tree, it is indeed the surgery that must be completed when you climb to the top.
Main line task... well.
I just don't know what the main task of general surgery is.
I haven't done any TIPS surgery, whether it's for saving people or for the purpose of completing a task, I have to ponder it.
There seems to be some time for surgery training, and it seems that I have to be desperate.
Zheng Ren's brain is running at high speed, and he has to consider all the steps of TIPS surgery.
The process of surgery is simple to say.
After successful perforation of the right jugular vein under local anesthesia, the hepatic vein and portal vein were opened by the catheter guide wire and the puncture needle, and the balloon was dilated and the stent was accurately released.
The difficulty in TIPS surgery is that the needle penetrates the passage of the hepatic vein and the portal vein.
This is blind wear, only by experience... and luck.
No matter how high the level is, in the face of TIPS surgery, if the luck is a little bit worse, this surgery cannot be completed.
Therefore, TIPS surgery is said to be the most embarrassing pearl in the crown of interventional surgery, it makes sense.
What Zheng Ren thinks is how to rely on luck as little as possible.
For Zheng Ren, who is not willing to open even the system treasure chest, it is undoubtedly an unacceptable thing to take chances on the operating table.
"I'm not sure?" Su Yun followed behind Zheng Ren. Seeing his footsteps was not very fast. He seemed to be immersed in contemplation and asked for it.
"There is no absolute certainty in the world." Zheng Rendao.
"Professor Rudolf Wagner, sleeping in Shangri-La." Su Yun reminded.
"Hey..." Zheng Ren has forgotten Professor Rudolf Wagner behind his headProfessor is the world's top interventionalist. Since he stays, for whatever purpose, always take the handle It should be.
Zheng Ren nodded and picked up the phone.
"Professor Rudolf, I am Zheng Ren." The phone ringing for nearly half a minute, the professor picked up the phone.
Zheng Ren directly ignored the German language that he got up slightly, and said something directly.
"There is a TIPS operation on this side, so you can take a look."
After that, Zheng Ren hangs up the phone.
......
Note 1: Transjugular intrahepatic portosystemic shunt, referred to as TIPS surgery. When I introduced this chapter, I said it a few times in order to deepen my impression. In the future, only the abbreviation is mentioned, and the number of words is not water.
In addition, the four characters of TIPS should only be counted as one word. I also heard people say ~~ Ask for a recommendation ticket, thank you.
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