Chapter 428: Finding a Different Way

Remember [New] in one second!     Lu Chen pulled out the guidewire, and his mood was quite complicated.

Helpless, but with a hint of unwillingness to admit defeat.

He had tried his best and tried many times, but in the end he still couldn't get the guidewire through the superior vena cava.

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

Xiao Shikang patted Lu Chen's shoulder, as if he saw his thoughts, "Lu Chen, it's okay, this is 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 on the operating table, "Teacher Xiao, I'm fine."

"Well, I will apply for a cardiology consultation for this medical record." Xiao Shikang continued, "Then see other cardiology doctors to see if there is any good solution."

Lu Chen nodded slightly, retracted his gaze, and silently sorted out the equipment on the operating table.

...

"Doctor, is my operation done?"

At this time, the old man on the bed suddenly spoke.

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

Xiao Shikang slowly walked to the patient's side and whispered, "Uncle, not yet. There is a problem. Don't worry, we will handle it."

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

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

"Okay."

After Xiao Shikang said this, he left the catheter room.

...

Outside the catheter room.

Lu Chen has packed up the surgical equipment and asked the resident doctor to push the patient back to the ward.

He sat on the instrument outside the catheter room and kept watching the patient's x-ray vascular imaging 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 year, his electrophysiological interventional surgery level is rapidly improving with the help of the system surgery simulation room and the real simulation surgery room.

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

Even the difficult dry pericardiocentesis is no problem.

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

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

His efforts are far from enough!

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

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

Instead, it is replaced by an unstoppable momentum!

...

After the afternoon, Lu Chen had dinner and returned to the hotel where he was staying.

Tonight, he did not continue to train in the system simulation surgery space, but began to read relevant literature.

This patient with superior vena cava obstruction is definitely not the first case.

He wants to look through case reports from various countries to see what other people's treatment measures are.

Doctors can only improve through this kind of learning.

No doctor can survive by relying on his old capital.

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

"Ding Ding..."

The familiar WeChat notification sounded, and Lu Chen took out his mobile phone. It was another message from Min Xiaobo.

"Lu Chen, it's been half a month. How many operations have you completed?"

Two weeks have passed since the second stage of the assessment.

Lu Chen recalled that he had only completed six operations so far.

This is considered to be below average among all the students.

"Ah? You only have six?" Min Xiaobo said in surprise, "I feel that I have done very few, but I have also done eleven."

Six operations completed in two weeks, this amount of operations may be the bottom.

Although the assessment indicators are not completely calculated according to the number of operations, it is also an important indicator.

"No way." Lu Chen said helplessly.

In fact, he has not had a small number of operations here, but three of them were not necessary after Lu Chen re-evaluated, so they were cancelled.

Then today's operation failed, and one more operation was reduced.

"There are only 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 still very optimistic about Lu Chen.

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

Turning off his phone, Lu Chen continued to read the literature.

This reading took a whole night.

...

The next day.

In response to this failed case, Xiao Shikang quickly organized a cardiology consultation.

Kyoto University First Affiliated Hospital, Cardiology Demonstration Room.

The small classroom was full of people.

Each ward of the cardiology department had at least one doctor with a deputy senior professional title.

This level of doctor team, even if placed on a national scale, is a top "luxury group".

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

"The patient's pacemaker battery is exhausted and needs to be replaced. At the same time, the patient has severe heart failure symptoms and malignant arrhythmias. 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 speaking, the live broadcast of yesterday's surgery was also played on the projector screen on the podium.

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

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

Qin Sifeng was the first to say: "The patient's current diagnosis is severe refractory heart failure. If a pacemaker and ICD are not implanted, the symptoms of heart failure will become more and more severe, which will not only affect the quality of life, but also affect life safety."

After Qin Sifeng, a heavyweight, spoke, everyone agreed.

"Professor Qin is right." Fang Ruzhang said on the side, "This patient is from 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 lay completely in bed and could not move. I can't move at all. At night, I basically can't sleep on my back. We can currently use medicine, but the effect will definitely not be good in the long run. We still need to implant a pacemaker and ICD as soon as possible. "

After some discussion, everyone agreed that a pacemaker and ICD must be done.

The question now is how to do it?

The superior vena cava was blocked and the guidewire could not pass through it, and the superior vena cava was the only way for conventional pacemaker lead implantation.

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

As soon as he finished speaking, everyone started talking again.

Fang Ruzhang was the first to say: "The superior vena cava is blocked. We may be able to choose other venous access. How about puncturing the jugular vein?"

In the early days, pacemakers were installed through thoracotomy, which was very invasive.

Since the invention of the endocardial electrode in 1965, transvenous endocardial cannulation has been used to install pacemakers.

There are 4 conventional access veins for electrode lead insertion, 2 on each side of the left and right sides, namely the cephalic vein and the subclavian vein, and 6 non-conventional access veins, 3 on each side of the left and right sides, namely the external jugular vein. , internal jugular vein and axillary vein.

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

This is the shortest and most established path.

Qin Sifeng shook his head and rejected the idea: "The patient is old, thin, has few muscles, and has thin skin. If the electrode is implanted through the jugular vein, UU Reading www.uukanshu.net may wear the skin and damage the electrode in the future."

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

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

Xiao Shikang heard this and said helplessly: "In addition to a slow heart rate, the patient also has III-degree atrioventricular block and junctional escape rhythm. He needs to use a dual-chamber pacemaker. A leadless pacemaker is not suitable for this name." patient."

For a while, most of the ideas didn’t hold up.

This doesn't work, that doesn't work either, everyone is a little discouraged.

Could it be that we should always use medication?

The patient's survival period will be rapidly reduced, and he may even need to be hospitalized for a long time.

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

He looked around at everyone and said slowly: "Teachers, if percutaneous hepatic vein puncture is implanted, what is this route?"

As soon as Lu Chen's words came out, everyone present was stunned.