"Emergency?" Su Yun frowned when he heard that it was a TIPS operation (Note 1).

TIPS surgery is one of the most difficult surgeries in interventional departments.

Of course, there are many new procedures that cannot be done with existing medical conditions, such as prostate interventional embolization. But these surgeries are only "difficult", and from a technical point of view, everyone should think that tips are the most difficult.

"In gastroenterology, there is a tricky patient. The patient is Director Xia's classmate, and he has been contacted to go to the imperial capital for TIPS surgery, but before he set off, he suddenly vomited blood, and the person was already in shock. Zheng Ren stood up, put on his white clothes, and turned back to Shay and smiled apologetically.

Shay waved his hand, signaling Zheng Ren to get busy, his eyebrows and eyes were crooked, gentle and virtuous.

Zheng Ren felt at ease and strode out of the duty room.

"Will you?" asked Su Yun.

"You can give it a try. Zheng Ren thought to himself, although he hadn't done it, he still had time for surgery, so in order to save people, he might as well squander it.

The most difficult thing is that the complications after TIPS surgery are more difficult to deal with.

There are two treatments for decompensated cirrhosis, gastric esophageal varices, and hematemesis caused by splenomegaly - one is surgery, such as splenectomy, Menchi vein devascularization, and the other is the TIPS surgery just mentioned.

This kind of surgery has not been in the clinic for 30 years.

In 1988, German scholar Rihter et al. first applied the transjugular intrahepatic stent portosystemic shunt to clinical practice, and reported 16 successful transjugular intrahepatic stent portosystemic shunts in 1991.

Subsequently, Zel (1991) and Rg (1992) successively reported the results of successful intrahepatic stent portosystemic shunt through the jugular route.

In 199, transjugular intrahepatic stent portosystemic shunt was widely used in various countries.

In the 21st century, Mr. Xu Ke of China Medical University took the lead in starting surgery in China.

Until now...... It has not yet become a routine procedure.

Why?

Because it's hard to do.

It's especially hard to do.

Even after surgery, the postoperative mortality rate is extremely high.

However, if the patient can get through it, the quality of life after surgery will be greatly improved, and it is a surgical procedure that greatly benefits patients.

Su Yun recently studied interventional surgery, and naturally knows that tips surgery is known as the crown jewel of interventional surgery.

Is it going to be carried out so soon? Are there any consumables? Nothing, Zheng Ren is going to make wool?

"How's the consumables?"

"I called Manager Feng. Zheng Ren said as he took out his phone.

"Manager Feng, it's me. ”

"I may have to do tips surgery on this side, and the related consumables will be sent over immediately. ”

"Well, in terms of procedures, Director Pan will do it tomorrow, and it is estimated that it is still a temporary procurement procedure. ”

"As soon as possible, 1 hour!"

After speaking, Zheng Ren hung up the phone.

"After the operation, are you confident?" Zheng Ren walked briskly, but still asked Su Yun.

"Hepatic encephalopathy, if there is no way to prevent it, can only be controlled by drugs such as amino acids. Su Yun recalled the process of TIPS surgery and the sinister nature of hepatic encephalopathy, and he didn't dare to say too much.

The key is that the clinical treatment of hepatic encephalopathy is still very simple.

Zheng Ren had a number in his heart, quickened his pace, and came to the Department of Gastroenterology.

Director Xia was still shrewd and capable, and there was a trace of embarrassment on his face when he saw Zheng Ren rushing over so quickly.

The floating gallbladder, that patient, Director Xia was in the emergency department to roll up Zheng Ren's face.

As it turned out later, Zheng Ren was right. So Director Xia really didn't want to face this evil emergency department inpatient general.

Even if there was an unexpected situation, she still ...... through Director Pan Well, this is also a normal process, it is a communication between the big directors.

"Director Xia, hello, which ward is the patient in? Zheng Ren didn't change his expression in the slightest, he didn't have arrogance, he didn't mean anything, as if what had never happened before.

"On this side. Director Xia put aside all those messy thoughts and rushed to the rescue room with Zheng Renfeng in a hurry.

It was a man in his fifties, with a sallow, black face, lying on the hospital bed, with a basin underneath, and he was constantly vomiting black venous blood one by one.

The picture is eerie, like hell.

The heavy smell of blood came to his face, and Zheng Ren glanced at the system panel in the upper right corner of his vision.

A patch of red comes into view.

The patient's diagnosis was hemorrhagic shock, decompensated post-hepatitis B cirrhosis, refractory ascites, pleural effusion, electrolyte metabolism disorders, splenectomy, and perivascular dissection of the esophageal cardia.

I've had splenectomy and Menci vein devascularization......

Zheng Ren was still hesitating between the two procedures, but now he doesn't have to think about it, and he is directly preparing for TIPS surgery.

"Three days ago, I had hematemesis, and because I had splenectomy and Menchi vein devascularization, I could only choose conservative treatment. Director Xia introduced the condition in a deep voice, "Three groups of intravenous hemostatic drugs plus oral positive kidney ice saline, the bleeding has been controlled. I was going to transfer to the imperial capital for TIPS surgery, but I didn't expect that when I contacted the ambulance, I had vomiting blood again. ”

Three groups of hemostatic drugs have been used, plus the ice saline for the kidney, which can be said to be extremely much.

Even if four or five groups of hemostatic drugs are added, it has no effect. At that time, complications such as cerebral infarction and myocardial infarction will be more difficult once they appear.

Zheng Ren groaned, wondering if the operation time he had reserved was enough.

TIPS surgery, after all, is the most difficult surgery in the interventional department, and Zheng Ren is not sure.

Seeing Zheng Ren groaning, Director Xia also smiled bitterly and said, "In our hospital, only you are doing interventional surgery." It's also no way, it's hard for you. ”

Her unexpected, but reasonable attitude softened, which was very logical, and Zheng Ren understood Director Xia's thoughts.

"As long as you can be 10 sure, it's always a good idea to give it a try. Director Xia said firmly: "The patient is my classmate, and his lover is also my classmate. Dr. Zheng, don't worry, even if you can't get off the stage and die on the operating table, there will be no problem. ”

The last sentence is to reassure Zheng Ren.

Not for anything else, because at this time emergency tips surgery is the only option. If Zheng Ren said that he would not do it, the patient could only vomit blood while waiting for death to come.

Maybe a few minutes later, a mouthful of venous blood vomited out, sprayed on the wall, sprayed onto the roof, and the person was gone.

However, the difficulty coefficient of the TIPS surgery for the usual slow diagnosis has exceeded the limit threshold of 10 and reached more than 11, not to mention the emergency TIPS surgery.

"Director Xia, to be honest, I haven't done it. Zheng Ren muttered, "The patient is in critical condition and doesn't have many options, so let's try emergency surgery." I can't guarantee it, I can only do my best. ”

"Thank you. "Director Xia's sincere thanks.

It is already a confession to let the director of a university of science and technology say thank you in front of the patient's family.

A smile of victory appeared on the corner of Su Yun's mouth.

Zheng Ren frowned.

"Are there any consumables?" Director Xia immediately asked the most pointed question.

"It's been contacted, and it will be sent to the emergency operating room in a few dozen minutes. Zheng Ren said, "Prepare to send the patient, sign ...... before the operation"

"I can sign it. Director Xia said.

It seems that she and the patient couple do know each other to a certain extent.

"Good. Zheng Ren said: "Prepare for emergency surgery!"

At the same time, a task prompt sound of "Ding Dong ~~" sounded in Zheng Ren's ears.

Main Quest: Crown Jewel Phase 1.

Task content: Complete the most difficult interventional operation, known as the crown jewel, transjugular intrahepatic portosystemic shunt.

Reward: The average time to complete the TIPS surgery is 4 hours and 2 minutes. If the host takes longer than average to complete the task, there is no special reward. If the time to complete the surgery is shorter than the average time, you will be rewarded handsomely.

In addition, you will be rewarded with +2 Luck Points, 2 Golden Chests, and 200,000 XP points.

Mission duration: 6 hours.

Zheng Ren originally wanted to ignore this task, but after a glance, he was stunned.

Seeing a long list of numbers, a reward of luck value +2, and the "rich reward" that the big pig's trotter in the system said, Zheng Ren felt like he was back in the imperial capital in a trance.

TIPS surgery, is it also considered a main quest?

Among the existing interventional surgeries, TIPS surgery is indeed the most difficult one, and if you climb the technology tree, it is indeed a surgical procedure that must be completed to reach the top.

Main quest ...... All right.

I just don't know what the main mission of general surgery is.

I haven't had tips surgery myself, whether it's to save people or to complete the task, I have to think about it.

There seems to be some time left for surgical training, and it seems that it will have to be desperate.

Zheng Ren's brain was running at high speed, and he pondered the steps of the TIPS operation.

The process of surgery is very simple to say.

After successful puncture through the right jugular vein under local anesthesia, the hepatic vein and portal vein channels were opened by catheter guidewire and puncture needle, and the portal cava puncture channel was dilated with balloon and the stent was accurately released.

The difficulty of TIPS surgery is to open the passage between the hepatic vein and the portal vein with a puncture needle.

This is blind wear and can only be done empirically...... And luck.

No matter how high the level is, if you are a little unlucky in the face of TIPS surgery, you will not be able to complete this surgery.

Therefore, it makes sense that TIPS surgery is claimed to be the most brilliant pearl in the crown of interventional surgery.

Zheng Ren thought about how to rely on luck as little as possible.

For Zheng Ren, who is unwilling to even open the system treasure chest and try his luck, trying his luck on the operating table is undoubtedly an extremely difficult thing to accept.

"Not sure?" Su Yun followed behind Zheng Ren, and seeing that his steps were not very fast, he seemed to be in deep thought, so he approached and asked.

"No one in the world is absolutely sure. Zheng Rendao.

"Professor Rudolf Wagner, sleeping in Shangri-La. Su Yun reminded.

"Uh......" Zheng Ren had forgotten about Professor Rudolf Wagner in the back of his head.

The professor is one of the world's top interventional surgeons, and since he stays, no matter what the purpose, he should always come and help.

Zheng Ren nodded and picked up the phone.

"Professor Rudolph, I'm Zheng Ren. The phone rang for nearly half a minute before the professor picked it up.

Zheng Ren directly ignored his slightly wake-up German and said things directly.

"There's a TIPS surgery on this side, please take a look. ”

After speaking, Zheng Ren hung up the phone.

……

Note 1: Transjugular intrahepatic portosystemic shunt, referred to as TIPS surgery. In the introduction of this chapter, I said it several times in order to deepen the impression. In the future, only the abbreviation will be said, not the number of words.

In addition, the four characters of tips should only be counted as one word, and I also heard people say ~~ ask for a recommendation vote, thank you.

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