I Can See Health

   Chapter 434 The Dean's Order

   "Percutaneous hepatic vein puncture implantation?" Everyone was shocked.

   Compared with other paths, this should be the most partial implantation path.

   On the podium, Xiao Shikang said, "Dr. Lu is the surgeon for this patient. We both performed the operation together for the first time."

   Everyone's attention shifted to Lu Chen.

   Most of the doctors present knew him.

  Although Lu Chen is just an outside doctor, his performance in the catheterization lab during this period is obvious to all.

   He not only successfully completed dry pericardiocentesis, but also went to Kyoto Central Hospital to assist in the operation as a representative of the hospital.

  This is talked about by many people as a talk after dinner.

   Qin Sifeng frowned after hearing Lu Chen's speech.

   "Percutaneous hepatic vein puncture implantation, we rarely choose this route." Qin Sifeng glanced at Lu Chen, "I remember that Western Sichuan Medical College used this puncture route, and they were the first in the world at that time."

"Well." Lu Chen nodded, "After I went back, I looked through the literature and found a case report published by Western Sichuan Hospital two years ago. They used this percutaneous hepatic vein puncture implantation to treat a patient with upper respiratory tract. patients with vena cava obstruction."

"I know the case you mentioned. Western Sichuan asked me for a remote consultation at that time." Qin Sifeng frowned, "But Lu Chen, do you know that the method you mentioned is theoretically feasible, but practically it is difficult to operate. Very high!"

   After hearing Qin Sifeng's words, everyone began to discuss.

  Fang Ruzhang frowned deeply: "Subclavian and superior vena cava puncture, this path is short and only needs to go through one curved arc, but implanted through the hepatic vein, not only the path is longer, but three consecutive arcs are required!"

  Three-turn arc, the difficulty of this operation is multiplied compared to one arc!

Another doctor said: "I think it's better to have more arcs. Try a few more times, and you should be able to pass. But the most difficult operation in the operation through the hepatic vein is that the entire path requires backhand operation. This kind of backhand operation Skills, everyone should have no experience, right?"

   There are few opportunities for surgical training in ordinary times, and this situation is almost never encountered. Who would deliberately train the backhand operation?

At this time, Qin Sifeng added fuel to the fire, "Actually, there is another problem. You may not have noticed that this operation involves not only the implantation of a pacemaker, but also the implantation of an ICD. The implantation is carried out through the hepatic vein. ICD? I haven't seen a case like this..."

  Everyone talked a lot, and Lu Chen's proposal of "implantation through hepatic vein puncture" was quickly rejected.

  It is theoretically feasible, but the actual operation is extremely difficult!

  Lu Chen moved his lips and wanted to say something, but gave up.

   He really wanted to shout, "I want to try transhepatic venipuncture."

   But the doctors present are much richer than him in terms of clinical diagnosis and treatment experience or interventional surgery experience.

   When he shouted out like this, he was a little over his head.

  …

   After half an hour, the General Cardiology Consultation is over.

   The crowd did not discuss a very good conclusion, so they could only temporarily postpone the operation and carry out conservative drug treatment.

  Lu Chen also had no choice. He read through the literature for a night and finally came up with a solution, but it was not recognized by everyone.

   However, Lu Chen was not discouraged.

   Since it is possible to use this "percutaneous hepatic vein puncture implantation" skill, he can just train in the virtual space of the system.

   In the virtual space of the system, Lu Chen set the surgical simulator to be similar to reality.

   The superior vena cava was blocked, and transhepatic puncture was performed instead.

  …

   In the blink of an eye, two days have passed.

   Three areas in the heart.

  Fang Ruzhang looked at the patient in front of him, feeling anxious.

   This old man's heart failure just committed again!

   This is also his fourth episode of acute heart failure in three days.

   "Doctor, how is my father?" The patient's family member, a middle-aged man, came to the office and asked actively.

  Fang Ruzhang shook his head slightly: "The old man's condition is not very good, as you can see, just came to the hospital a few days ago, at least once a day for small rescue."

   "Why is this so?" The middle-aged man's face was full of worry and confusion.

"If the heartbeat is slower than 40 beats per minute, there is a risk of sudden death." Fang Ruzhang explained, "Your dad's heartbeat has stopped beating for a long time because of his pacing dependence. At the same time, his heart still has potential cardiac arrhythmias. In the case of fast speed, the cardiac ejection function of a normal person is more than 50%, and he is already lower than 25%."

   The middle-aged man sighed deeply, then raised his head and stared at Fang Ruzhang, and said, "You are one of the top cardiology departments in the country. After so many days of discussion, can't you come up with a feasible plan?"

   Fang Ruzhang heard the words, and his heart was also bitter: "Don't worry, our Cardiology Department has a general consultation."

   "What's the use of just a general consultation?" The middle-aged man frowned, "What we need is a treatment plan!"

   "Don't worry, we will do it as soon as possible." Fang Ruzhang talked to the patient's family, and managed to calm him down.

  Fang Ruzhang also understands very well that whoever's father lies in bed sickly will only be in a worse mood than him!

   "Hey, the operation can't be delayed any longer!" Fang Ruzhang thought.

  Thinking of this, he immediately started calling Qin Sifeng.

   "Professor Qin, about the patient with blocked superior vena cava..."

   Before Fang Ruzhang could finish his words, Qin Sifeng said, "I know, the dean called me just now. It should be the patient's family who found a relationship and talked to him. The dean asked us to come up with a solution as soon as possible."

   "Hey, the leaders above are the real ones." Fang Ruzhang felt helpless, "If they move their lips, we will suffer. This plan is not so easy to come up with!"

On the other end of the phone, Qin Sifeng was a little silent.

  Fang Ruzhang thought he had hung up, and was about to hang up when Qin Sifeng's voice came again: "Xiao Fang, go and apply for a remote joint consultation of Western Sichuan Medical College, Zhongshan Medical College, and Modu Medical College for the patient."

   Fang Ruzhang was taken aback, "Professor Qin, joint consultation? Are you preparing for surgery?"

Qin Sifeng sighed, "Whether the dean says it or not, I have already thought about it. We can't just sit still and drag on because of the risk. We must put the safety of patients' lives as the first principle! After the consultation, come up with a specific surgical plan, and we will start implementing it!"

   "Good!" Fang Ruzhang said.

   hung up the phone, and he immediately started contacting the medical department of the hospital.

   Let the medical department come forward, notify other hospitals, and conduct a multi-hospital remote joint consultation.

  …

  Because of the director's order, this joint consultation will soon end.

   In the afternoon of the same day, the joint diagnosis and treatment plan of major hospitals was introduced.

  After intense discussions, major hospitals headed by Western Sichuan Medical College unanimously recommended the use of the "transhepatic vein puncture and implantation" plan!

   This is exactly the plan proposed by Lu Chen, and it is also the most compromised surgical plan at present.

   Since no other route can be used, only "hepatic vein puncture" is available.

  The only disadvantage of this surgery is that it is difficult!

  Therefore, Qin Sifeng came up with an idea.

   Before the formal operation, a small-scale simulated operation evaluation will be held in the catheterization room.

   The person with the highest surgical proficiency will have the opportunity to become the first assistant of the operation and participate in this operation.

   As soon as this notice came out, all the electrophysiological intervention doctors in the Cardiology Department began to gear up.

   This kind of difficult surgery, it may not be feasible for them to be the main surgeon.

   But if they were an assistant, then they could.

   If you can succeed, you can also get a name.

  This may be the world's first implantation of an ICD and a pacemaker through the hepatic vein at the same time!

   (end of this chapter)