The operation was completed when it was dark.Director Li is on the night shift tonight, so Chen Wenqiang said: "Lao Li, let's change it, you will work the night shift again tomorrow." ”Knowing that Chen Wenqiang was for his own good, Director Li accepted it with a smile.After standing for most of the day, he already felt very tired.The ten years he spent in prison not only interrupted his career development in the best years of a surgeon, but also greatly ruined his health.He's just an empty shelf now.Director Shi followed Chen Wenqiang to send the patient to the intensive care unit for placement, and then said, "Dean Chen, you and Dr.
Li have surgery tomorrow, I slept in the department on the night shift last night, and I will come to see this patient tonight." ”Chen Wenqiang happily agreed, anyway, Director Shi lived in a single dormitory, and he would be alone when he went back."
Then I'll be sorry for you tonight.What's the matter so busy that I can't call Xiao Li to help, she lives in Corey. ”Director Shi smiled and nodded in response.But this night was not as lucky as last night, and when the shift was handed over in the morning, Director Shi was still in the operating room and did not come back.
*Director Li asked, "Xiao Li, what kind of surgery is Lao Shi?"
”"Cirrhosis of the liver, vomiting blood.Transferred from the district hospital.called Director Liang to the stage. ”"Didn't have a three-lumen two-capsule tube?""
The first time I vomited blood four months ago was the third lumen and two cysts in the internal medicine department, and this is the second time.In the early hours of this morning, the Department of Internal Medicine asked for a consultation, Director Shi went, and then found Director Liang to decide on emergency surgery.The patient was sent to the operating room at about six o'clock. ”Li Min was itching for this operation, but she remembered that there was an important elective operation today, so she had to watch Director Shi go to the operating room."
It's a shift."
The head nurse has a good grasp of the time.The focus is on the patient from last night.Everyone has to admire the strength of its vitality.It's just one night, such a serious injury, and the speed with which his vital signs recover, so that everyone has clear expectations that he can recover.The patients who stabbed each other with watermelon knives last week have also improved significantly after supportive treatment."
Corey has two or three serious problems, and your classes are cheering up.Especially those who are on special care, don't be negligent.Dean Chen, is there anything wrong with you?
”"Nope.""
Adjournment."
*Today's elective surgery is a case of dural arteriovenous fistula.The patient complained of unprovoked distal weakness of both lower extremities six months ago, with a heavy right side.His legs were sore and he could walk, and he didn't feel like he was stepping on cotton, but he fell down the stairs several times.In the last three months, he has developed difficulty standing, requiring the assistance of crutches, and has developed a second bowel disorder, which is manifested by laborious urination and a feeling of incomplete urination, and stool 3-5 times a day.The patient had a lumbar CT scan in the local area, and the diagnosis was lumbar disc bulging and foraminal stenosis, and the treatment did not show any effect for more than three months and was transferred to the orthopedic ward of the provincial hospital.In China, lumbar disc bulge and intervertebral foraminal stenosis are orthopedic diseases.Fortunately, although Director Xiang is a domineering person, but his vision and clinical skills are not ambiguous, after the clinical doctor who has been treated gave the patient an MRI, he found that he could not discharge the spinal cord vascular malformation, and immediately sent a consultation order to Chen Wenqiang.Chen Wenqiang took Li Min to the consultation, and according to the MRI images, he was diagnosed with "spinal vascular malformation dural arteriovenous fistula SDAVF".Then, under the guidance of Chen Wenqiang and with the cooperation of Director Hu, Li Min first performed spinal angiography (MRA) examination for the patient.MRA is a test that does not require the injection of a contrast agent into the blood vessels, and uses the contrast between the blood flow and the resting blood vessel wall and surrounding tissues to directly visualize the blood vessels, which can basically show the arteries, fistulas, and veins that are draining.However, the results of this non-invasive examination did not satisfy Chen Wenqiang.Director Hu once suggested that Chen Wenqiang try a creative imaging examination.Chen Wenqiang hesitated for a long time but gave up."
Lao Hu, I have found several cases of paraplegia caused by contrast agent poisoning, even with water-soluble contrast agents, patients have a strong reaction when they are intolerant.I'm afraid that this patient can't bear it, so I want to do intraoperative imaging. ”Director Hu shook his head and objected: "If you go on stage so presumptuously, should the intraoperative imaging not be shown well?"
The danger is too high. ”"The lesser of two evils.He was only in his early fifties, so it was a shame that he was paraplegic. ”* "Xiao Li, you push the patient to the operating room. ”Chen Wenqiang takes this patient very seriously.After transferring the medical records from this patient, Chen Wenqiang did not let the intern touch a word.He had to read every preoperative preparation and every medical order that Li Min wrote down.I put a lot of energy into this patient, and the teachers and students put a lot of energy into it.All the clinical manifestations, physical examination results, and differential diagnoses, etc., Li Min used a notebook to record.Because the case of dural arteriovenous fistula (SDAVF) has only come into Chen's sight in recent years.Since 1977, when Kendall and Logue first reported 10 cases of SDAVF, they have searched through several journals in the field of neurosurgery in China in the last decade, and have not found any cases reported in China.This microsurgery, which belongs to neurosurgery, is not complicated and is much better than the "moyamoya disease" they did last time.The first surgical option is fistulectomy (blockage): only the fistula needs to be removed and then the dura is repaired accordingly, but it involves removing part of the dura through which the nerve root between T4 and T6 of the thoracic spine is removed, and the nerve root cannot be damaged.Another option is to directly remove the draining vein.This is the surgical approach that is used when the previous regimen is not available.Because the removal or closure of the fistula in the first option may cause ischemia and necrosis of the corresponding spinal cord segments, and then the most terrible complication after surgery - paraplegia.What bothered Chen Wenqiang and Li Min the most before the operation was the artery between T4 and T6 of the thoracic spine and the spinal cord segment that was donated.The arteries that supply the spinal cord come from a complex source, and the cervical, thoracic, and lumbar vertebrae are different.Although these arteries that supply the spinal cord are not single, direct to a certain spinal cord segment, and there is anastomosis between arterial branches, there are usually anastomosis weaknesses between two root arteries at the T4 level of the thoracic vertebrae; And once a branch is completely truncated and ischemia occurs, these anastomoses cannot establish an effective collateral circulation, which is neither enough to be trusted nor relied on.The uncertainty and complexity of the arterial anatomy, as well as the slenderness of the structure, are the greatest dangers of surgery.For this reason, before the operation, Chen Wenqiang asked Li Min to talk to him.
*"For this surgery, I am going to have a local arteriography during the operation.In this way, the amount of contrast agent that needs to be injected is much smaller, and the possibility of a contrast agent accident is very small.And I'm also prepared to draw blood immediately at the proximal end of the shunt vein to minimize the amount of contrast remaining in the blood vessels.Do you understand what I mean?
”Li Min nodded and said, "I understand."
Teacher, you say. ”Chen Wenqiang took a deep breath and said, "But intraoperative imaging and spotting cannot avoid receiving lines."
Even if we both wore lead suits, the damage to our bodies was still incalculable.I don't have anything to do, my sons and daughters are so old, and I don't have to worry about childbirth.However, this requires that you should not get pregnant for at least half a year, so as not to cause abnormal egg abnormalities and malformations due to ovarian threading. ”If she explained these to the patient, Li Min would not have abnormal heart fluctuations, but when it came to herself, as an unmarried girl, she was still a little shy."
Well, I see.I have no plans to get married in half a year. ”With such a surgical plan, the two of them have to go on stage in lead clothes.Xu Li, the instrument nurse, and Sister Feng, the patrol nurse, made a switch.After trying the weight of the lead suit, Director Liu directly gave up following the stage."
Senior sister, are you okay?
That's a few dozen pounds. ”"It should work."
No, the microsurgery of neurosurgery can only be done by himself and Chen Wenqiang, and Li Min has no way out, so he must survive this operation.Director Shi also knew that their operation today was important, so he proposed to be on duty for Chen Wenqiang.He vaguely felt that Chen Wenqiang wanted to use this case to go a little further academically.It didn't hurt him, and he naturally supported it strongly.The result of the support is that Li Min and the others are ready to open the stage, and they are still fighting bloodily.* After the opening of the stage, Li Min and Chen Wenqiang's movements were very fast, and one of them was fifty years old and had already passed the peak of physical strength; The other is not a strong guy with a big waist and a round waist, and the only way to save physical strength is to speed up the operation.Director Hu personally came to do intraoperative imaging and spotting.The contrast agent is injected distal to the artery at the identified T4 stage of the thoracic spine, and immediately on the screen is to show its course and branches, as well as the spinal cord segments it feeds.Director Hu didn't wait for Chen Wenqiang to speak, and immediately ordered two films."
Again."......
"Xiao Li, do you remember?"
”"Remembered."
Although Sister Feng is older, her movements are still very accurate, she looked at the images displayed on the screen, and used the thinnest scalp needle in pediatrics to pierce the distal drainage veins, and most of the injected contrast agent was withdrawn.......
"Sure enough, the first option doesn't work completely. ”Chen Wenqiang muttered and took off his surgical gown.Director Hu pushed the machine out, beckoned the nurses waiting outside to come in, and helped Chen Wenqiang, Li Min, and Sister Feng take off their lead gowns and put on sterile surgical gowns.With a clear flow of blood to the artery supplying the spinal cord, the rest of the operation, whether it is to remove the fistula or cut the vein that drains, is not difficult for Chen Wenqiang and Li Min.The surgery was perfect.* Xu Li came over to clean the microscopic instruments, and she quietly asked Li Min: "Doctor Li, were you afraid when you took the picture just now?"
”Li Min smiled and shook his head: "Don't be afraid."
I won't get married in half a year. ”"Then when are you going to get married?
I see that the girls who are separated from you are almost going to get married this year. ”"I'll get married when he comes back."
Li Min said it very easily, as if the person she was waiting for was just a short business trip.Sister Feng walked over and grabbed Xu Li, signaling her not to ask again.Waiting for Li Min to leave the sink, Sister Feng scolded Xu Li with a straight face: "She is fighting on the front line, I don't know when she will be able to come back or whether she can come back."
Didn't the stupid thing you ask make people feel uneasy and sad?
”Xu Li was blushing by Sister Feng's words, and said, "I'll go and apologize to her." ”"Forget it, if you can't speak, say a word, no one will sell you as a dumb person."
Xu Li has been taken by Sister Feng since her internship, and the relationship between the two has been very deep in the past three years.Sister Feng is usually generous and generous, and it is rare to see her talk loudly and stingily to anyone.Xu Li's tears fell one by one on the used instrument in front of her."
Are you still wronged?""
Nope.Teacher Feng, I was reckless.I'm also worried about Dr.
Li's line. ”"Dean Chen must have thought about it, Dr.
Li graduated from the Medical University, and she will know this in her heart
.
"* "Lao Chen, go to X-ray to watch the video?"
”"Okay.Let someone shout Xiao Li and let her hurry up. ”The video they're going to see is the surgery they just did.Director Zhou deliberately used his personal connections for this operation to borrow a video camera from a TV station, which is said to be the best camera in the provincial capital at present.Early yesterday morning, under the murderous gaze of the head nurse in the operating room, he asked someone to prepare the placement of the camera in the operating room and carefully adjust the shooting angle.In the end, the head nurse gritted her teeth and threatened Director Zhou: "If there is anything wrong with the shadowless lamp tomorrow, I will hang you up." ”"I'm also here for our provincial hospital.There is no report on such an operation in China, and with this operation video, it will be shown to students in the future, and it will seem that the provincial hospital is no worse than the affiliated hospital of the Medical University. ”"Hmph.That's a nice thing to say. ”After Director Zhou waited for the head nurse to leave, he muttered to the photographer: "This tigress, do you want to hang me on the top of the shadowless lamp?"
”※※※※※※※※※※※※※※※※※※※※* Cirrhosis of the liver with hematemesis and hematemesis with three lumens and two cysts, on the first day of the internship in the Department of Gastroenterology, I saw this on the night shift.Every first night shift kills people......
Rescue, Death Summary, Death Discussion......
The arteries that supply the cervical spinal cord originate from the branches of the subclavian artery, vertebral artery, deep carotid artery, and ascending carotid artery.The thoracolumbar spinal cord is supplied by branches of the thoracic aorta, the intercostal artery of the abdominal aorta, and occasionally the internal iliac artery.The spinal cord has two nearly independent arterial systems, or longitudinal anastomotic chains: one anterior artery and two posterior arteries.The thinner anterior and posterior arteries at the back are too specialized, slightly.() The distance is a bit far