I Can See Health

   Chapter 433 Take a Different Path

  Lu Chen withdrew the guide wire, his mood was quite complicated.

   In desperation, there was a trace of unwillingness to admit defeat.

   He has tried his best and tried many times, but he still can't get the guide wire through the superior vena cava.

   This is his first failed surgical experience since he set foot in the field of electrophysiology!

  Xiao Shikang patted Lu Chen on the shoulder and seemed to see what he was thinking, "Lu Chen, it's okay, it's not your problem. No one would have thought that the patient's superior vena cava would be blocked."

  Lu Chen took off his gloves and stared at the screen of the operating table, "Mr. Xiao, I'm fine."

   "Well, I will apply for the General Cardiology Consultation for this medical record." Xiao Shikang continued, "I will see other cardiologists at that time. Is there any good way?"

  Lu Chen nodded slightly, looked away, and silently sorted out the equipment on the operating table.

  …

   "Doctor, my surgery is done?"

   At this time, the old man on the hospital bed suddenly said.

  Lu Chen moved his lips and wanted to say something, but he didn't say it.

  Xiao Shikang walked slowly to the patient's side and said softly: "Master, not yet. If you encounter a little problem, don't worry, we will handle it."

   In this case, in order to avoid the patient's mood swings, Xiao Shikang decided to communicate with the patient's family first, and then slowly explain to the patient himself.

   "Lu Chen, arrange the equipment, I will communicate with the patient's family about the patient's condition."

"it is good."

  Xiao Shikang left the catheterization room after saying a word.

  …

  Conduit outdoor.

  Lu Chen had packed up the surgical equipment and asked Dr. Gui Pei to push the patient back to the ward.

   He sat on the instrument outside the catheter room and repeatedly watched the patient's X-ray angiography on the computer screen.

  Before today, he was very confident, even a little conceited.

  Although Lu Chen has only been exposed to electrophysiological surgery for a short period of one year, with the help of the system surgery simulation room and the realistic simulation surgery room, the level of electrophysiological interventional surgery is rapidly improving.

  Whether it is pacemaker implantation or arrhythmia ablation, he can do it with ease.

   Even the difficult dry pericardiocentesis is not a problem.

   His electrophysiological intervention level has surpassed the absolute part of the attending physician and the deputy chief physician.

   But today's failure made Lu Chen wake up suddenly.

   His efforts are far from enough!

   There are still many diseases that have not been completely overcome, and there are still many things he has to do!

  Thinking of this, the arrogant conceit in Lu Chen's heart is slowly disappearing.

   was replaced by an indomitable momentum!

  …

  After the afternoon, Lu Chen ate dinner and returned to the hotel.

  Tonight, instead of continuing to train in the system to simulate surgical space, he began to read relevant literature.

   The superior vena cava is blocked, this patient is definitely not the first case.

   He was going to look at the case reports from various countries and wanted to see what other people's measures were.

   Doctor, and only through this kind of learning, can we continue to improve.

   There is no doctor who can survive by chewing on the old books.

   After looking through the domestic and foreign literature for the past five years, it is already ten o'clock in the evening.

   "ding ding..."

   The familiar WeChat alert sounded, Lu Chen took out his phone, and it was another message from Min Xiaobo.

   "Lu Chen, it's been half a month, how many surgeries have you completed?"

   The second stage of the assessment has passed for two weeks.

  Lu Chen recalled the surgeries he had completed. There are only six cases so far.

   This is considered to be lower than average among all the students.

   "Ah? You only have six?" Min Xiaobo said in surprise, "I feel like I'm already very few, but I have already made eleven."

   In two weeks, six operations were completed. This amount of operations may be at the bottom.

  Although the assessment index is not entirely based on the amount of surgery, it is also an important index.

   "No way." Lu Chen said helplessly.

   In fact, there are not too many surgeries here, but three of them were cancelled after Lu Chen's re-evaluation and they didn't need to be done.

   Then today the operation failed, and another one was reduced.

   "There are still two weeks left for the assessment, come on!" Min Xiaobo said.

   Both of them came from Jinghua, and their relationship is much better than others.

  Min Xiaobo was very optimistic about Lu Chen in his heart.

   "Well, thank you for your concern." Lu Chen replied.

   Turned off the phone, Lu Chen continued to read the literature.

   From this look, it is a whole night.

  …

   The next day.

   In response to this failed case, Xiao Shikang quickly organized a general meeting of the Department of Cardiology.

  Kyoto University First Affiliated Hospital, Cardiology Department Showroom.

  The small classroom was full of people.

   Each ward of the Cardiology Department has at least one doctor with a deputy senior title.

   A team of doctors of this level, even if viewed nationwide, is a top-level "luxury group".

  Xiao Shikang is standing on the podium, introducing the patient's condition to everyone.

   "The battery of the patient's pacemaker is exhausted, and the battery needs to be replaced. At the same time, the patient has severe symptoms of heart failure and malignant arrhythmia. We are going to implant an ICD."

   "But during the operation, we found that the patient's superior vena cava was blocked."

  While Xiao Shikang was talking, the projector screen on the podium also played the live broadcast of yesterday's surgery.

   "I tried many times with the surgical assistant, but the guide wire still couldn't pass, and finally we had to give up the operation."

   After introducing the condition, everyone in the audience began to discuss with each other.

   Qin Sifeng took the lead in saying: "The patient's current diagnosis is severe and refractory heart failure. If a pacemaker and ICD are not implanted, the symptoms of heart failure will become more and more severe, which not only affects the quality of life, but also affects life safety."

   After the heavyweight Qin Sifeng spoke, everyone agreed.

"Professor Qin is right." Fang Ruzhang said, "This patient belongs to our ward. I went to see him in person as soon as possible. The symptoms of heart failure were obvious. He was tired from walking and eating. He was completely lying in bed, moving. I can't move at all. At night, I basically can't sleep on my back. At present, we can use drugs to maintain it, but if it goes on like this, the effect will definitely not be good, and it is still necessary to implant a pacemaker and ICD as soon as possible."

   After some discussion, everyone's opinions are very unified. Pacemakers and ICDs must be done.

   Now the question is how to do it?

   The superior vena cava is blocked, and the guide wire cannot pass through, and the superior vena cava is the only route for conventional pacemaker lead implantation.

   On the podium, Xiao Shikang continued: "I wonder if you teachers have any good opinions on the next diagnosis and treatment plan?"

As soon as the    voice fell, everyone began to discuss again.

  Fang Ruzhang took the lead: "The superior vena cava is blocked, we may choose other venous access, how about entering from the jugular vein?"

  Early installation of cardiac pacemakers was done by opening the chest, which caused great trauma.

   Since the invention of the endocardial electrode in 1965, the pacemaker has been installed by transvenous endocardial cannula.

There are 4 conventional access veins for the insertion of electrode leads, 2 on the left and right sides, followed by the cephalic vein and subclavian vein, 6 unconventional access veins, 3 on the left and right sides, respectively, the external jugular vein , internal jugular and axillary veins.

   The most common is of course the subclavian vein - the implantation route of the superior vena cava.

   This is the shortest and most mature path.

   Qin Sifeng shook his head and rejected the idea: "The patient is old, thin, has few muscles, and thin skin. If the electrode is implanted through the jugular vein, the skin may be damaged and the electrode may be damaged in the future."

   "Professor Qin, what if you use a leadless pacemaker?" Another deputy chief physician suggested.

   Qin Sifeng was stunned for a moment, pondered for a moment, and then looked at Xiao Shikang on the stage.

When Xiao Shikang heard the words, he said helplessly: "In addition to the slow heart rate, the patient also has third-degree atrioventricular block and junctional escape rhythm, which requires the use of a dual-chamber pacemaker, and a leadless pacemaker is not suitable for this name. patient."

   For a time, most of the ideas did not hold.

   This is not good, that is not good, everyone is a little discouraged.

   Does it mean that he has been treated with drugs?

  The patient's survival will be drastically reduced, and may even require long-term hospitalization.

   Just like this, Lu Chen, who had been sitting in the corner, suddenly stood up.

   He looked around the crowd and said slowly: "Teachers, if percutaneous hepatic vein puncture is implanted, what is the path like?"

   When Lu Chen's words came out, everyone present was stunned.

   (end of this chapter)