The head nurse of the operating room finally waited for Chen Wenqiang to finish the operation, and she asked anxiously: "Dean Chen, do you know that the whole hospital has changed the visitation system today?"
”She asked this because relatives and friends called and asked about the change in the visitation system of the provincial hospital.Chen Wenqiang shook his head tiredly: "I stayed overnight in the obstetrics and gynecology department last night, and I came directly without returning to the department today." ”What he said was true, yesterday he stayed overnight in the obstetrics and gynecology department.It's the second night.Although he didn't need to go to the bedside to see patients, he sat in the office of the obstetrics and gynecology department in order to ensure the convenience of the attending doctor from the respiratory department of the Affiliated Hospital of the Medical University.In the second half of the night, he was really sleepy, so he wrapped himself in the military coat on duty and took a nap on the table.Didn't even go to the radiator.He realized that the radiators in the obstetrics and gynecology department were not safe, and he also pondered how to overhaul the radiators in the whole hospital next year.I couldn't get a good rest for two nights in a row, but I just caught up with the unexpected thing in today's operation, which made him think he was going to get stuck on the operating table.This patient was referred by the neurology department and had to be treated with "moyamoya disease".Moyamoya disease is a disease of cerebral hemorrhage or ischemic caused by progressive stenosis and occlusion of the terminal of the primary internal carotid artery and abnormal vasodilation network at the base of the brain.The cause is unknown, and the disease was first mentioned in Japan ten years ago (1980).It took a lot of effort for Chen Wenqiang to get a little information about this.Surgical treatment is very simple to say, it is to solve the problem of blood supply.But there are also conditions, that is, the hemorrhagic type - to remove the hematoma and do external drainage; Hemorrhagic recovery and ischemic type – blood from the extracranial artery is supplied directly to the ischemic brain tissue, establishing collateral circulation.The establishment of the side branch cycle is quite simple, but it is not so easy to do.For example, Chen Wenqiang tried to start the surgery today, and the patient was also a case that he chose for two years before he started.It is ischemic moyamoya disease.The patient was in the prime of life, only 40 years old, but he was admitted to the hospital with intermittent dizziness for 2 years, weakness in the right limb, and slurred speech for a week.Whole cerebral angiography reveals bilateral occlusion of the ends of the internal carotid arteries and thinning of the anterior and middle cerebral arteries.Specifically, the left middle cerebral artery is occluded at the beginning and the right middle cerebral artery is narrowed.CT imaging findings are also consistent with clinical examination.Therefore, according to the patient's age and condition, Chen Wenqiang decided to try the left superficial temporal artery-middle cerebral artery anastomosis plus meningeal inversion and temporal muscle patching.For this reason, he also took Li Min to the laboratory for an afternoon to repeatedly practice vascular anastomosis under the microscope.The subject is a severed rat's tail after shaving.But he never expected that when the cases were well prepared and selected, and the previous cases were going very smoothly, at the most critical part of the operation, when the blood vessels were anastomosis, the 40-year-old man actually had arteriosclerosis in 5 or 60-year-olds.During the operation, a nylon thread with a diameter of 10-0 (22um) was used for vascular anastomosis, and a blood vessel tear occurred on the first needle.If there was any movement of the clock tweezers that fixed Li Min's blood vessels, Chen Wenqiang would mercilessly immediately oust her from the stage and replace her with Director Liang, who had been accompanying him all the time.However, he could clearly see from the eyepiece that the blood vessels clamped by Li Min did not move at all.He still knows how much strength his own hands have used."
Lao Liang," Chen Wenqiang didn't dare to move his head, lest he have to look for the surgical field again, he complained in his mouth: "This blood vessel is too brittle, it is not a 40-year-old man's blood vessel at all......"
Director Liang saw the torn blood vessel, and his heart was also difficult: after thinking about it repeatedly for a long time before the operation, it was easy to determine the approach, and the blood vessel with a diameter of 1.5mm was selected, did he give up like this?
The previous free is all for this blood vessel to be anastomosed."
Will it be the same as this one?"
Since it is a brittle blood vessel, it may be full brittle, and it may not have such a diameter if it is replaced by another one, and the range of blood supply should also be reconsidered......
This is simply a matter of Huashan's road, no matter how to change it, Director Liang didn't say it directly.Chen Wenqiang's brows were so furrowed that he could trap mosquitoes."
The previous test didn't find that his blood vessels were like this.""
yes.Such blood vessels are not occluded, and it is easy to bleed even if you are slightly excited.Do you want to change Xiao Li to try?
Girls are light-handed. ”Li Min, who was sitting on the side and became a wooden man, was almost stupid, this is the middle cerebral artery!
Director Li, do you want to cheat me like this?
Chen Wenqiang immediately said: "Xiao Li, you try."
A full-thickness stitch is made on the opposite side of this stitch.Do it as you would anastomosis a colon-rectal stump. ”Director Li suggested that he subconsciously follow suit.Li Min had no choice but to ask the instrument nurse for a straight needle holder.Under the five-fold magnifying glass, the suture needle with a diameter of 75um is small but still visible.She slowly used a clock tweezer with a tip of only 1 mm to hand the back 1/3 of the suture needle to the 2 mm small opening of the needle holder and clamped it, and then she chose to ignore Chen Wenqiang's traction on the blood vessel wall, and adopted the method of pulling out the suture needle and thread through one end of the blood vessel wall, re-fixing the suture needle, and then piercing the blood vessel wall at the other end.When she completely pulled the nylon thread into the right position and completed the operation with knotted tweezers, Chen Wenqiang did the same action as her.If it is a blood vessel that is not well placed, Li Min's anastomosis is fine.But now that the blood vessels aligned at the broken ends are anastomosed like this, he will scold people at another time: I want to sew it until the Year of the Monkey and the month of the horse!
However, this needle was successful, and the blood vessel wall was not torn!
Director Liang praised Chen Wenqiang after cutting the thread: "Good!
Xiao Li was born to eat this bowl of rice. ”"Lao Chen, didn't you sleep well last night?"
Director Li stood behind him and asked in a "reminder" manner."
I didn't sleep much."
Chen Wenqiang was a little embarrassed.Today is the first time I have done such a new procedure.He shouldn't have been on the night shift last night, or he should have gone to sleep in the obstetrics and gynecology duty room.No, he shouldn't replace Shu Wenchen, he should let him spin without sleep for three days and three nights?!
But then Li Min raised his voice and shouted at him, so that he could come back to his senses from such and such undue situations.After stitching the stitch, Li Min handed the empty needle holder back to the instrument nurse: "Teacher, my finger ......
I can't get a second stitch. ”Sure enough, Li Min's right index finger was twitching slightly."
You're so nervous.Take it easy.It's just tearing again, and there's the stitch in front of me. ”Chen Wenqiang's mouth comforted Li Min like this, but he still took the needle holder himself and slowly and firmly stitched it down.One shot is successful!
He realized that it was not that the blood vessels were so brittle that they could not be matched, but that he was impetuous."
Xiao Li, trim this edge.""
Yes."
The total length of the straight scissors is also 8 cm, but the cutting edge of the scissors is only 5 mm long, and only half of the front can be used to trim the blood vessels.This means that it can only be opened by a maximum of 3 mm.The microscopic instruments, which are only 8 centimeters long and up to 10 centimeters long, look good for Li Min's fingers, but she also carefully opens only 2 millimeters in size and slowly trims the edges of the torn blood vessels.It was so slow that Chen Wenqiang was so anxious that he frowned.But after thinking about it, after a few stitches, he handed it to Li Min for further anastomosis."
You can do the same as you did just now, don't be afraid of slowness, just don't tear it.The length of the next stitch should be the same as the stitch in front of me. ”"Okay."
Li Min took the needle holder, and such a delicate instrument made her feel very handy.After a few stitches, she handed it back again.M's, so nervous.It's not about telling yourself when the colon-rectal stump is full-thickness anastomosis.The two of them anastomosed the blood vessels back and forth alternately, and Director Zhou sighed for Chen Wenqiang in his heart, it is really unforgiving, if Chen Wenqiang was young in the past, even if he didn't sleep all night, he would not let others stitch such an important place.No, Chen Wenqiang did not do neurosurgery at that time, and he changed his specialty to neurosurgery when he returned from the south for the first time.Hmph, this old boy is so lucky, if he changes someone else, he will have to be skinned if he doesn't die, but he goes back and forth to the north and south to avoid trouble - his own mouth is in trouble!
*The most important blood vessels have a good anastomosis, and although the meningeal inversion and temporal muscle application are difficult, the pressure is much smaller.However, it is also necessary to monitor whether the blood vessels after anastomosis, blood flow after anastomosis, blood flow direction, and brain waves should be monitored during the operation.At the end of the operation, Li Min subconsciously looked at the time, and five hours had passed."
Fitting takes the most time.This technique is a new technique, and if you do more, you will get faster. ”Chen Wenqiang comforted Li Min."
It's that I don't dare to penetrate the walls of the blood vessels with a single needle.I'm so afraid of tearing my blood vessels. ”Li Min regretted that he had slowed down the operation process."
It's better to be scared like this."
Chen Wenqiang now feels that Li Min's caution should be.If she had torn her blood vessel after herself, she would have had to abandon the preoperative preparations and be forced to choose a second option."
If we do neurosurgery, we are afraid of being stupid and bold, and we dare to start with anything anywhere, which is absolutely not okay.Next time, let's try to anastomoses the intracranial and extracranial blood vessels directly, and I always feel that it is a problem in case there is scalp necrosis in the original supply area of the superficial temporal artery. ”Chen Wenqiang bandaged the patient by himself, and put the dressing extremely gently, like treating his heart and liver baby carefully, but he nagged about the operation.Director Li knew Chen Wenqiang's temperament, and when he saw him like this, he knew that he had not yet come out of this operation.It was enough for Director Liang to accompany him to answer.He turned his head and asked Li Min: "Xiao Li is very comfortable with the instruments of microsurgery." ”Li Min took off her gloves and handed something to Chen Wenqiang, and she answered Director Li's question with a smile: "In the past, when I did an arterial cannulation test, I used tweezers, scissors and needle holders eliminated from microsurgery.A while ago, Dean Chen helped me borrow microscopic instruments to practice my hands. ”Another change is that today the instrument nurse prepared binocular glasses for Li Min.Regarding the eyepiece, Chen Wenqiang is used to using a monocular, but Li Min emphasized: "When I was studying, I was used to using Olympus binoculars, and I always felt that I couldn't judge the distance quickly. ”This is not a big deal, Chen Wenqiang readily allowed Li Min to use binoculars."
This is our Dean Chen's treasure.The whole hospital is like this, and no one is allowed to touch it.The day before yesterday, when he was disinfecting, he chose the equipment, like a thief.Hey, Dean Chen, have you counted what you lost?
”Chen Wenqiang ignored the head nurse's ridicule and said to the instrument nurse: "I've cleaned up my things, don't lose anything."
This set was brought back from Germany by a trustee and was paid on credit.Our provincial hospital hasn't paid for it yet. ”Is this okay?
Li Min was surprised.The head nurse pouted: "Dean Shu can find you whatever you want, you don't need to treat these as family heirlooms." ”"It's still a family heirloom, my son didn't study medicine, and my daughter doesn't want to be a doctor.Who do I preach?
”"Oh, you call you a teacher.That's our old Li family's aunt and grandmother, and she uses this set of things quite easily. ”When Chen Wenqiang heard this, he said happily: "When I retire in ten years, this set of things will be eliminated long ago."
Xiao Li, in less than three or five years, there will be a better one. ”Chen Wenqiang stared at the instrument nurse while wiping and collecting the instrument.The blood stains on the instrument should be wiped off in time, and it should be scrubbed again after surgery before it can be sent for disinfection.I'm going to have to use this set of instruments for the aneurysm surgery tomorrow.※※※※※※※※※※※※※※※※※※※※* There is an ophthalmology big brother whose second career is to repair watches.Only tweezers, screwdrivers, etc., half the size of his palm, are very well-behaved in his hands.
**At present, there are various surgical methods for moyamoya disease, which are roughly divided into direct vascular bypass surgery, indirect vascular bypass surgery and combined vascular bypass surgery.The effective treatment for moyamoya disease is combined vascular bypass grafting.To find a suitable blood vessel from the surface of the brain for anastomosis, this part is done with neurosurgical microscopic instruments.- Exquisite, ridiculously expensive, and ruined if you fall.The risks of moyamoya disease surgery include intraoperative and postoperative blood pressure management, anesthesia induction and awakening.The difficulty lies in the selection, judgment and anastomosis of blood vessels before surgery.() The distance is a bit far