Chapter 526: Challenging the most difficult surgery, a glimmer of enlightenment
Opening the dura mater barrier basically means a straight advance.
First drain the blood accumulated in the brain.
Even though this was just the simplest step, Director Wu Yongming was still very careful. When aspirating the fluid in the cranial cavity, it is very easy to make mistakes and damage important brain tissue.
Deputy Director Lu's intracranial environment is extremely severe, and he is much more susceptible to accidents than ordinary patients.
Not to mention anything else, the serious aging, hardening and brittleness of blood vessels alone is enough to make surgeons tread on thin ice.
After the blood in the brain is almost completely drained, the intracranial pressure basically returns to normal, or in other words, is even lower than the normal level.
Because the original cranial cavity was closed, two holes are now opened, which is equivalent to a semi-open cavity.
In medicine, this is called fenestration.
The operation is going smoothly.
But soon they ran into trouble.
Simply sucking out the accumulated blood is definitely not enough. If the bleeding is not stopped, your cranial cavity will soon be filled with blood again.
Director Wu Yongming tried to repair the ruptured blood vessels, but he encountered problems even with the debridement, not to mention anastomosis.
"No, this blood vessel is too close to the brain stem. The operating space is even narrower. I am not sure about endoscopic hemostasis."
Beads of sweat the size of green beans appeared on his forehead and he shook his head repeatedly.
It was as if there was a terrifying beast blocking the way ahead.
In terms of surgical skills, everyone is actually about the same in terms of common surgeries. At least as long as you reach a normal level, you can complete the surgery smoothly.
To use the original words of a certain surgical master, surgery is all about cutting out lesions and mending gaps.
Of course, the surgical great said these words in the 1960s.
The development of surgical medical technology has gone beyond the simple process of mending and removing. Many new technologies have been applied, such as artificial blood vessels, vascular stents, artificial hearts, etc.
Even if it is just repairing blood vessels, organs or tissues, it is extremely challenging for the doctor's skills.
Needless to say, repairing blood vessels in a narrow cranial cavity, and doing endoscopic surgery, is simply hellishly difficult.
Next to it is the brain stem, and there are other important brain tissues around it. Doctors with poor psychological quality will tremble with fear when operating the endoscope arm.
It's not an exaggeration.
The psychological and mental pressure that doctors, especially surgeons, endure during operations is beyond imagination.
If anything happens to the patient, the surgeon must be responsible!
"The damaged area of this blood vessel is not particularly large, and its length is relatively short. It is indeed very close to the brain stem, making it extremely inconvenient to operate. Mr. Wu, why don't you try to repair it with a vascular stent?"
Director Gou Qiong was standing by and offering him advice and suggestions.
"If it's a small brain aneurysm, I can put a coil in and fix it. Even if it's a larger aneurysm, I can put a stent in and fix it. But there's no way I can use a stent in this blood vessel."
He shook his head repeatedly to reject the proposal.
The purpose of drilling holes and making windows in the skull is definitely to drain the intracranial fluid and relieve intracranial pressure.
The second purpose is to repair blood vessels and stop bleeding.
Not all vascular repairs are suitable for stent placement.
First, stents are expensive. Second, the operation is extremely difficult, especially when it comes to placing stents in intracranial arteries.
"How about... you help me move the brain tissue to the upper right of the bleeding point a little bit, and let me try!"
When Zhou Can saw the bleeding cerebral artery, a hint of excitement flashed in his eyes.
It was completely different from the fear in Director Wu Yongming's eyes. Director Wu was full of fear and had no confidence to challenge, and he was indeed unsure. Zhou Can was full of sharpness, like a fearless hero.
"Doctor Zhou, you must do what you can! Don't try to be stubborn. If it really doesn't work, we can have another joint consultation to discuss other surgical options."
Wu Yongming said this, but he actually knew in his heart that there was no other surgical option.
If there was a better surgical plan, the patient would not have been put off treatment.
If it is an internal medicine medication, sometimes there may be other alternatives. There are really not many options for this kind of intracranial artery rupture. There are only two or three.
"I'll be extra careful."
Zhou Can answered in a sonorous and powerful voice with a serious expression.
After he took over as the surgeon, he first instructed Director Wu to help move the brain tissue to the side. This operation required a certain amount of technical skills, and more of it was like a physical job like pulling a hook.
Of course, with the help of the endoscope arm, the actual physical exertion is not great.
Next, Zhou Can tried to operate in this extremely small and limited space.
"No, you have to move it a little further to the side. About 0.5cm should be enough."
"Okay, I'll try."
Director Wu gritted his teeth, his eyes extremely focused, squeezing and moving the brain tissue bit by bit to make more space for Zhou Can's surgery.
"You can't move it anymore. This is the limit. If you move it any further, you might seriously damage your brain tissue."
Director Wu didn't dare to move his eyes away from the screen, and he was trying to control the volume of his voice, for fear that the force of his hands would increase and damage the brain tissue.
Whether it is within the abdominal cavity or the cranial cavity, moving the surrounding tissues during surgery is itself a form of harm to the body.
The abdominal and thoracic cavities that have been operated on often have serious adhesions of tissues and organs, which will bring a series of adverse long-term effects to the patient. These can be called postoperative complications or sequelae.
For example, after a chest surgery, some people may often feel chest tightness and shortness of breath, which are the sequelae of the operation.
There is no cure and it basically lasts a lifetime.
Experienced and skilled doctors will usually try to avoid touching other tissues and organs when performing chest and abdominal surgery, and only treat the lesion.
Of course, the idea is good, but in practice, doctors have no choice at all.
For example, when performing an appendectomy within the abdominal cavity, how can you perform the surgery without taking out the intestines?
Just finding the appendix is a lot of work.
"It should be enough to keep the surgical space at this size."
After demonstrating, Zhou Can showed a fairly satisfied expression this time.
"I'd like to state in advance that repairing this blood vessel will definitely cause some damage to some tissues on the upper left side. But I think it's worthwhile to damage these brain tissues that are not fatal or disabling in exchange for the successful repair of the blood vessels. The human body has a strong ability to heal itself. I believe that after ten days or half a month, these injuries will basically return to normal."
In order to avoid scaring Director Wu, Director Ming Xin and others, Zhou Can gave them a shot of prevention in advance.
The ideas during surgery need to be ever-changing.
Repairing an artery surgically in such a small space is an almost impossible challenge in itself, which is equivalent to driving a car into a narrow dead-end road and then turning around on this dead-end road that is only two meters wide.
It is simply impossible for an ordinary driver to complete this task.
If you have superb driving skills, it is possible to complete this impossible task.
Zhou Can’s challenge now is to successfully complete the almost impossible vascular repair task within an extremely limited space.
“Is the risk controllable?”
After hearing this, Director Wu still didn't dare to turn his head or move his gaze.
"It's hard to say about other unknown risks, but at least I can be sure that some damage to the brain tissue within this range will not be fatal or disabling."
Zhou Can answered truthfully.
No one dares to make any promises or guarantees.
Even a primary surgery has risks, not to mention this type of endoscopic cranial surgery.
"Dr. Zhou's plan is highly feasible!"
Director Ming Xin actually supported Zhou Can to take the risk at this time.
Her words carry a lot of weight.
After getting her support, Director Wu Yongming did not hesitate any longer and directly agreed, "You can start the operation! Don't worry too much, just be bold and careful."
"Understood! Thank you!"
Zhou Can nodded in agreement and thanked the two chief physicians.
Without their strong support, he would not have had this surgery opportunity.
He tried to manipulate the endoscope arm to start cleaning the wound, and then anastomosed the broken blood vessels. The whole process was extremely slow, and he showed not only stability, but also a strong concentration that only top doctors have.
This kind of concentration is somewhat similar to commanding thousands of troops to fight on the battlefield. Facing powerful enemy forces and complex battlefield environment, one can always sit firmly in the central military tent.
[Suture skill experience bonus +100, Ligation skill experience bonus +100...]
He received a lot of experience points as rewards.
And each time the reward is one hundred.
When the anastomosis is almost complete, it is necessary to expel the air and blood that may be inside. Because Director Wu wants to fix that part of the brain tissue, and let Zhou Can do it, it is actually quite difficult.
After all, a person only has a pair of hands. It is easy to imagine how difficult it would be to complete the work of four or even six hands.
"No, it would be troublesome if there is air in the blood vessels that are anastomosed this way."
Zhou Can knew that the presence of air in blood vessels, especially in the brain, was very prone to blood clots. This was a time bomb.
Director Wu can't move. Should we drill another hole and insert another endoscope arm?
Not only does it cause huge harm to patients, but there are not enough instruments and equipment.
It was originally just a small problem in the matching process, but it stumped Zhou Can.
"Poor air exhaust is indeed a huge hidden danger."
Wu Yongming looked at the operation that was about to succeed, feeling unwilling.
It is definitely not okay to complete the operation carelessly.
They are all top experts in the field of surgery and they all pay great attention to some surgical details.
Everyone is racking their brains to think of a solution.
"Maybe there is a way we can try. I will leave the last stitch and not tie the knot yet. Director Wu won't have to worry about the right brain tissue at that time. He can just free up his hands to help me expel the air from the blood vessels. Then I will tie the knot and complete the final anastomosis of the blood vessel wall."
Zhou Can proposed a solution.
Suturing blood vessels requires a larger operating space, and he is confident that he can complete the final knotting within the limited space.
At most, it would damage some brain tissue on the left side.
This is also a last resort.
The brain tissue on the left side has already been damaged. It's no big deal to have some new injuries.
“Good idea.”
After listening to this, Wu Yongming nodded happily in agreement.
Next, follow the surgical ideas designed by Zhou Can to complete the final step.
The final knot was a little more difficult than expected .
But for Zhou Can, who had a sixth-level ligation, it was finally completed successfully.
[Ligation experience +1, bonus experience 1000. Anastomosis experience +1, bonus experience 10000. Pathology diagnosis experience +10000.]
Zhou Can was stunned when he saw the huge reward after the operation was completed.
Then, a flash of enlightenment came into his mind.
It seems that innovation in surgery, or the conception of some completely new surgical plans under extremely harsh conditions, have been successfully implemented.
They can all obtain huge pathology diagnosis experience points as rewards.
Last time, Zhou Can found a way to innovate a surgical plan for the patient with aortic dissection that did not require aortic replacement, and he also received a very considerable amount of pathological diagnosis experience points as a reward.
This also made him understand a truth: no matter internal medicine or surgery, they all end up in the same place.
They can all improve Zhou Can's pathological diagnosis skills.
To put it bluntly, pathological diagnosis is equivalent to a doctor's diagnostic level and treatment ideas.
Pharmacological differentiation and various surgical techniques are equivalent to two sharp swords of treatment.
It is a weapon to eliminate disease.
There is no doubt that no matter how powerful a weapon is, it will not be able to exert its power if you don't know how to use it.
Can a sharp knife in the hands of a three-year-old child kill a chicken or a duck?
If you don’t even know how to use it, you might end up hurting yourself.
If it falls into the hands of a strong man, it would be enough to kill ordinary beasts.
If it falls into the hands of a martial arts master, it will be a disaster. It can directly kill a tiger or even a dragon.
Therefore, improving the level of pathological diagnosis is more important than pharmacological differentiation and surgical skills.
One is the level of thinking, the other is weapons.
After Zhou Can's pathological diagnosis was upgraded to level six, it became incredibly difficult for him to advance further.
One million experience points is almost impossible to reach in a lifetime.
But with this kind of increase of ten thousand at a time, it is not easy to make up one million.
In addition, he has proved the usefulness of pathological diagnosis through countless clinical experiments. Level 6 is completely different from level 5. He is now at level 6, which is the director level. Whether in consultation, consultation, or surgery, his level is already on par with those powerful chief physicians.
This shows that improving medical skills with the help of the medical experience value system is not the so-called false obesity.
If one day he improves his pathological diagnosis to level seven, he will probably be one of the top few experts in the country.
Now it is only equivalent to the level of an ordinary director.
Can barely be called an expert.
After the final anastomosis of the blood vessels was completed, the blood flow test was performed and everything was normal.
"Good! The patient's vital signs have stabilized significantly. If there are no problems, we can end the operation and send him to the recovery room for observation."
Director Ming Xin said.
Wait until the endoscope is removed, and the wound is sutured to close the cranial cavity.
At this time, good news came again.
" The patient's brain waves have changed significantly, and they are changing for the better."
Director Ming Xin said with some surprise.
For comatose patients, brain awakening is the key.
