Chapter 687

Fang Ziye and Li Yongjun's hands rubbed against each other under the disinfectant, water carrying pale blue foam sliding down along their wrist bones.

The two turned and quickly crashed through the airtight door, their scrub suits flapping in the airflow. Li Yongjun's slender neck tilted slightly forward, the gaze behind his gold-rimmed glasses sharp as a scalpel:

"Two Professor Lins, what exactly is the situation here?"

At this moment, the surgeons operating in the OR were Professor Lin Qiaoshan of Hepatobiliary Surgery and Professor Lin Guoqiang of Fuwai Hospital!

Under the shadowless lamp, Hepatobiliary Surgery's Lin Qiaoshan's hand trembled slightly with the DSA: "Three minutes ago, the patient suffered ventricular fibrillation again!"

"Rapid cardioversion given, systemic multi-site vascular fibrillation, large amounts of thrombi entering solid organs from arteries, currently DSA imaging shows multiple emboli in both kidneys, liver, intestines, etc."

"Splenic artery embolism!"

"Bilateral lower limb arterial embolism, bilateral upper limb arterial embolism!"

"Venous return obstructed!"

Fuwai Hospital's Professor Lin Guoqiang's fingers rapidly zoomed on the DSA screen, the 3D vascular imaging like a dried river network: "Intracranial barrier intact, ECMO flow dropped below critical value."

He turned to look at Fang Ziye and the other, lead apron clanking dully at his waist, "Professor Fang, extremely troublesome!"

Hearing halfway through, Fang Ziye immediately switched to the DSA display screen, observing the blood flow signals inside, his brow instantly furrowing tightly.

"How are the intracranial vessels and cardiac blood flow?"

"Filter placed in advance, intracranial vessels show no obvious abnormality, cardiac blood supply patent, but ECMO blood flow plummeted!" Lin Guoqiang replied very professionally.

Fang Ziye thought of a saying at this moment: you can dodge the first day but not the fifteenth.

Protected the heart vessels and intracranial in advance, but cannot block all vessels, nor can filters be pre-placed on all vessels for embolic protection design.

Fang Ziye's gaze switched rapidly between DSA images, shadows of vascular occlusion lingering on his retina.

The third second after the screen dimmed, Fang Ziye decided on the spot: "Nie Mingxian, Professor Li, you two immediately take charge of bilateral upper limb arterial and venous flow severance surgery, reconstruct blood supply with limb microcirculation apparatus, local heparinization of blood."

"Wu Xuanqi, you immediately perform bilateral lower limb flow blockade with Professor Du Donglin!"

"Heparin concentration increased to 200 IU/kg!"

"Reconstruct ECMO arteriovenous circulation, ensure cardiac and intracranial vascular blood supply."

"Professors Lin, cooperate with me to perform organ intravascular thrombectomy."

"Chen Guangbai!" Fang Ziye spoke too fast, couldn't control his address for Chen Guangbai at this moment, only pausing slightly after calling out.

Although he reacted that calling Doctor Chen would be better, Fang Ziye also had no time to struggle: "Dean Chen's condition is extremely critical now, if handled improperly, very easy to develop multi-organ failure."

"We may have to activate the organ microcirculation apparatus that hasn't undergone animal trial verification."

"But this has risks, and the risks are extremely great!"

Chen Guangbai and Lin Qiaoshan were currently examining Chen Song with Traditional Chinese Medicine methods, especially Chen Guangbai, whose emotions were slightly excited at this moment.

According to modern medicine principles, currently both upper limb arteries are embolized, by common sense there should be no arterial pulse in both upper limbs, yet he felt a subtle "pulse" beating.

This proves that TCM meridian theory, one part may come from arterial pulsation, and another part of pulsation has no interference relationship with arterial pulsation.

This may be a major discovery in TCM meridian theory.

Of course, the pulse Chen Guangbai feels now is also not good, even using acupuncture to protect Chen Song's Qi mechanism cannot reverse the final outcome.

A must-die death pulse, can only leave it to fate!

"Go!"

"Professor Fang, you handle it at your own discretion! All rescue efforts follow your arrangement."

"Professor Wang Qishan, Professor Deng Huai, pause all pulse recording and acupuncture, TCM nasal feeding, pause formula derivation and use!" Chen Guangbai merely hesitated for nearly three seconds, then made a decisive decision.

"Lan Tianluo, call Jie Han, call Director Song Libo, have them hurry and transport microcirculation apparatus 3-6 from the backup room to the operating room."

"ECMO blood supply channel differentiation, start surgery immediately..." Fang Ziye did not make detailed arrangements further.

Nie Mingxian is one of the founders of microcirculation apparatus theory, he and Li Yongjun have profound understanding of microcirculation apparatus circulatory severance surgery, only Li Yongjun's operation may not be as smooth as Nie Mingxian's.

Similarly, Wu Xuanqi and Hand Surgery's Professor Du Donglin, both operate limb microcirculation apparatus circulatory severance surgery extremely proficiently.

After Fang Ziye finished instructing, the four each began taking the femoral artery sheaths and brachial plexus sites suitable for limb microcirculation apparatus severance, each beginning limb blood supply severance and limb preservation surgery.

At the same time, Fang Ziye, Lin Qiaoshan, Lin Guoqiang and the others gathered together after Fang Ziye put on the sterile surgical suit.

Lin Guoqiang asked: "Liver and kidney embolism most severe, extremely troublesome to handle! Prioritize handling?"

"I believe the spleen can be sacrificed."

"But the patient's condition is very poor right now, estimated electrolyte imbalance will occur soon, if liver and kidney thrombectomy and organ preservation are performed simultaneously now, patient estimated won't last until that time."

"My meaning is, even with ECMO intervention, patient may still die from ventricular tachycardia due to electrolyte imbalance."

Chen Song is currently no longer in a state a normal person would be in.

If it were just simple liver or kidney embolism, then with ECMO monitoring and assistance, there would still be plenty of time.

The human body needs metabolism, liver and kidneys are the largest metabolic factories in the body, almost all metabolic waste needs to be metabolized out through these two organs.

Fang Ziye quickly replied: "Professor Lin, the ECMO and dialysis machine in this OR are connected, dialysis parameters can be adjusted anytime, can short-term replace liver and kidney metabolic functions!"

"Splenic embolism we'll ignore for now, limb embolism we can also delay, but liver and kidney embolism, we prioritize."

"You and Professor Lin Qiaoshan perform liver local thrombolysis together! I will preemptively perform local reconstruction of liver blood supply!"

"Bilateral renal thrombi I will handle alone."

"Mesenteric artery multiple emboli and splenic artery multiple emboli, handle later!" Fang Ziye responded quickly.

"But?" Lin Guoqiang still wanted to voice his concerns.

Fang Ziye's light floating sentence, in the ears of him as a professional vascular surgeon, contained too many difficult points needing handling.

"No buts, Professor Lin!"

"I believe you are professional!" Fang Ziye at this moment still gave Professor Lin Guoqiang a bootlicking remark.

Expediency in emergency, current situation doesn't allow detailed explanation of local principles.

Time doesn't permit!

Chen Guangbai immediately understood, voice very decisive: "Professor Lin, trouble you to cooperate with Professor Fang's operation, all consequences, I will bear!"

Trust no one you doubt; employ no one you don't trust.

Fang Ziye had long since won over Chen Guangbai and Chen Song with his personal skill and level; in surgical resuscitation, Fang Ziye ranked among the three he trusted most.

Of the other two, one had already passed away from illness, the other had long since retired to enjoy his remaining years; neither could possibly appear in the operating room.

Professor Lin Qiaoshan also spoke up in a low voice at the right moment: "Professor Lin, the resuscitation brooks no dissent! ~"

Lin Guoqiang took a deep breath, swiftly suppressing all emotion in his heart: "Prepare for liver local contact thrombolysis! ~ Super-sensitive anticoagulation therapy."

With Chen Song's son bearing all liability, and Fang Ziye as the primary commander of the surgical resuscitation, the situation was urgent; more words would serve no purpose! ~

Moreover, Lin Guoqiang had already learned of the twists and turns that had befallen Chen Song; some of Fang Ziye's maneuvers, in his view, were also stunningly brilliant!

"Open the abdomen! ~"

Because the content to be operated on at once was somewhat extensive, simple interventional manipulation could hardly satisfy multiple operative fields simultaneously.

Now was a race against time; one could not continue operating through a small field for the sake of minimally invasive reduced local trauma! ~

Song Libo, Jie Han, and the others had long been standing by; in barely a minute and a half, they delivered the microcirculation apparatus that had not undergone clinical trials.

In this interval, Fang Ziye and Professor Lin Guoqiang the two of them very fiercely directly opened the abdominal cavity.

The instant the scalpel incised the peritoneum, Fang Ziye's and Lin Guoqiang's wrists crossed in midair. The coordination of two top-tier surgeons was like precision gears — the scorched smell of electrocautery burning fat had not yet dissipated, and vascular clamps had already precisely clamped off the portal vein...

The two spoke not a word yet coordinated seamlessly; in a mutual glance, each saw in the other's eyes the four characters "kindred spirits."

Two lead surgeons who both knew the anatomical structures like the back of their hands, and whose incision techniques had both reached the realm of transformation (Level 5), when coordinating, seemed like one person grown four unobstructed hands.

"Abdominal retractor! ~" Lin Guoqiang instructed Lin Qiaoshan, without any psychological burden.

He had led many surgeries, instructed professors like Lin Qiaoshan not one thousand but three or four hundred times; as one of the most awesome figures in the nation's vascular surgery, his jianghu status was even a notch above Li Yongjun's.

Even Li Yongjun, upon seeing Lin Guoqiang, would obediently call out "Teacher Lin."

A 'National Treasure Doctor' is such that they can comprehensively crush the other party in strength, temperament, and many other aspects, making them utterly convinced.

Lin Qiaoshan could only comply with Lin Guoqiang's orders, honest and obedient, just as in his attending period when he set up the tray for the Old Director.

Jie Han, very sensibly, after entering the operating room, stood against the wall.

First, to continue observing this super-high-difficulty resuscitation; second, to avoid his presence blocking the positioning and flow of positions in the operating room.

Standing against the wall, though he couldn't see details, at least he could see the scene control, avoid being cleared out — this was a rare opportunity...

At this moment, Lan Tianluo spoke very sensibly: "My senior brother has arrived; I need him to help me process data."

Lan Tianluo, this Data Processing Master, was the absolute thigh in the operating room, exclusively occupying a corner; no one dared vie for position with him, not even the anesthesiologists could casually move his zone architecture.

Chen Guangbai and Group Leader Wang, understanding at once, immediately beckoned to Jie Han.

Jie Han, who had been eagerly anticipating this, finally approached within a two-and-a-half-meter radius of the operating table...

"Sterile catheters are on the table." Circulating Nurse No. 4 and Instrument Nurse No. 5 coordinated seamlessly to bring up the organ microcirculation apparatus catheters.

This organ microcirculation apparatus is similar in architecture to the limb microcirculation apparatus, and its operating principle is also similar.

Everyone's words were talking to themselves, merely to indicate what they were doing, to avoid being thought troublemakers; fundamentally, no one waited for an answer.

Fang Ziye rapidly performed separation of the liver's arteries and veins, at an oddly fast speed.

After completing the temporary occlusion of arterial and venous blood flow, he turned his head, picking up two pairs of catheters while saying: "Catheters aren't enough, keep opening! ~"

"At least ten pairs! ~"

Circulating Nurse No. 4 repeated: "Ten pairs of catheters! ~ On the table immediately."

Lin Guoqiang watched very meticulously as Fang Ziye connected the catheters to the liver's arterial and venous inlets and outlets; his brows instantly knitted tight.

"After local blood supply cutoff, what about blood oxygen levels?" Lin Guoqiang still found it somewhat incredible.

In truth, his inner doubt was even greater — could this be the liver microcirculation apparatus that the international community is currently racing to develop?

It hasn't even had a product officially launched internationally, yet in this tiny Enshi sanatorium, there's already a model applicable for clinical use?

Lin Guoqiang's question still got no answer; Fang Ziye only instructed him: "Liver blood flow occlusion complete, arterial and venous anastomosis suture! ~"

"Can it be done?"

Lin Guoqiang stiffly nodded.

Fang Ziye continued: "After single-organ microcirculation processing is complete, immediately conduct local contact thrombolysis treatment; safe thrombolytic dose unknown! ~"

This last sentence, Fang Ziye said to Lin Guoqiang, and also to Chen Guangbai.

This isn't Fang Ziye being unreliable; no animal trials — that was the 'background' he had pointed out early on!

Without trials, where would objective data come from?

Pure theoretical speculation? Pure conjecture?

No, that's worse than not saying it; just directly reference clinical specific thrombolytic dose standards and adjust up or down.

Data without trials is just data, fundamentally not theory.

Fang Ziye dispatched the liver region, then quickly summoned Professor Tang Meng of Vascular Surgery, standing opposite him, to handle the bilateral renal arteries together.

Fang Ziye said: "Professor Tang, you're responsible for left renal artery and vein blood flow stasis; subsequently I'll connect both sides' renal arteries and veins simultaneously with the microcirculation apparatus, forming a bilateral renal linkage system."

"Anesthesia teachers, watch the urine bag output; local renal perfusion volume will increase, but won't increase the kidneys' burden! ~"

"Received! ~" One of the anesthesiologists responded quickly.

The current team is neither Tan Mengbai nor Luo Tingzhu, but Fang Ziye knew these few could also be absolutely trusted.

Dark red blood surged through silicone tubes into the microcirculation apparatus; the LCD screen suddenly flashed a glaring red warning.

"Oxygenation index dropped below 300!" The anesthesiologist's voice carried a metallic tremor.

Fang Ziye's voice immediately delivered: "Activate biomimetic pulsation mode, pulse frequency match patient's baseline heart rate."

"Jie Han, Lan Tianluo! ~" Fang Ziye's voice was almost a roar; he never turned his head!

Lan Tianluo couldn't leave the data recording, but Jie Han arrived at the microcirculation apparatus in the first instant. Parameters cascaded like a waterfall; with the mechanical pump emitting a deep-sea whale-song-like hum, the dark red blood suddenly bloomed with oxygenation's characteristic bright brilliance.

Lin Guoqiang's pupils contracted slightly. He saw Fang Ziye's movements suturing the blood vessels carried a certain rhythmic beauty; the Level 5 Suturing Technique's needle spacing was precise as a Swiss movement...

Five minutes later, Fang Ziye actually finished the bilateral kidney microcirculation severance linkage with the Microcirculation Instrument before Lin Guoqiang did.

No other reason: although Fang Ziye's Suturing Technique was not as good as his Incision Technique, only Level 5, not every National Treasure Doctor's Suturing Technique is Level 5!

The operation speed and effective extent of Level 5 Suturing Technique cannot be compared to a Level 4 Skill!

After Fang Ziye finished connecting the Microcirculation Instrument, he did not explain to anyone again; the Catheter Gun in his hand suddenly emitted a bee-like buzz, and sixteen Microfilters bloomed simultaneously at the renal artery bifurcation.

"rt-pa pulse ready, dosage calculated by body surface area." His fingers pushing the drug were steady as a rock.

"Bilateral kidney contact thrombolysis." As his words fell.

The image of dark red thrombi disintegrating under X-ray was like ice crystals melting in slow motion. When the first drop of urine fell into the collection bag, the creatinine value on the Monitor began a cliff-like drop.

"ACT 140 seconds! Reduce thrombolytic dose to one-fifth, Microcirculation Instrument activate preset parameters, listen to my commands for fine-tuning..."

"Received!" Circulating Nurse No. 6 watched over the 'Kidney Microcirculation Apparatus' connected by Fang Ziye at all times!

When the thrombolytic agent entered the bilateral kidney linkage system, the blood inside both kidneys began to flow normally with the Microcirculation Instrument.

Roughly at ninety seconds, the Microcirculation Instrument lit up a Green Light, a slight beeping sound flashing non-stop!

At one hundred ten seconds, Fang Ziye said: "Bilateral kidney vessels restored rhythm, adjust Microcirculation Instrument heart rate index bpm 90! Blood oxygen saturation 95%!"

"Adjust filtration parameter 3!"

Five seconds later, the quick-eyed, quick-handed Circulating Nurse reported: "Adjustment complete! Flow parameters all normal."

"Ten minutes later adjust filtration parameter 2, half hour later adjust filtration parameter 1, three hours later adjust to parameter 2, three and a half hours later continue adjusting to filtration parameter 1, I will remind at any time!"

"ECMO parameters report!" After Fang Ziye asked the Circulating Nurse, he asked the Anesthesiologist for data at the First Time.

"Oxygenation level normal, blood pressure 98/66!" The Anesthesiologist spoke not a word of nonsense, not even referencing Luo Tingzhu's more precise report from before.

But the meaning was precise all the same.

Fang Ziye did not Struggle!

"Professor Tang Meng, you continue separating the splenic artery and vein vessels, five minutes later, I will come help you!" Fang Ziye finished speaking, and saw Professor Lin Guoqiang's side had just completed the liver artery and vein connection with the Microcirculation Instrument.

He wanted to speak but stopped!

Lin Guoqiang felt as miserable as a dog in his heart, but at this moment he could only respect the facts before him, stepping back half a step: "Lead Surgeon handover, Professor Fang, you operate!"

"Microcatheter!"

"Thrombolytic dosage ready." Fang Ziye had not a trace of politeness.

The current him was the core of the entire rescue; he had already prepared this positioning, so at this moment whether it was Lin Guoqiang or anyone else.

Even if a Hepatobiliary Surgery Academician came, or an Orthopedics Department Academician came, Fang Ziye could only make them become Assistants!

Because Fang Ziye knew he was worth it, he had this grasp, he had also completed the preoperative Accumulation and reserves; if explanation was needed, he would explain after the operation was done.

Even if Accountability, please postpone it.

"Set volume parameter 2, half hour later change to volume parameter 3, one hour later change volume parameter 4, two hours later change volume parameter 1, liver volume parameter set separately, please record in Detail."

"If any questions, raise them on the spot!" After Fang Ziye finished the thrombolysis operation, he interrogated the Circulating Nurse.

"Recording complete. Half hour later 3, one hour later 4, two hours later 1, current 2." The Circulating Nurse answered even more concisely, confirming she had finished recording.

"ECMO data report." Fang Ziye continued asking the Anesthesiologist for parameters.

"All normal, blood K level has already reversed." The Anesthesiologist again used the simplest words to explain what he was doing.

They were not playing; they just did not speak out everything that Occurred like Fang Ziye did.

But Fang Ziye had to speak it out.

"Sample the blood flow inside the bilateral kidney and liver microcirculation for testing, pay attention to necrosis and metabolites! Report at any time." After Fang Ziye gave one more order, he began to take over Professor Tang Meng's responsible splenic artery and vein microcirculation severance operation.

Lin Guoqiang, having experienced Witnessing Fang Ziye's two operational miracles, also knew Fang Ziye wanted to rescue all the embolized organs, so he actively suggested: "Professor Fang, is there a need to reconstruct the blood flow of the Mesentery artery and vein?"

Fang Ziye lowered his head but shook it: "The Mesentery artery and vein blood supply comes and goes in different systems; with thrombus volume not large, in Systemic Heparinization blood supply circulation, it will naturally circulate."

"Human intestinal tract capacity surplus exceeds two hundred percent; even if there is segmental necrosis, just resect it, no need to increase operation Burden!"

"Pay attention to heart and intracranial vessel shunting. Observe Filter and Occluder situation at any time!" Fang Ziye's voice was not loud, but in the operating room it was the only one, and resounding.

To forcefully push back the Ghost Gate, there cannot be two minds; no one is allowed to question!

"Professor Fang, you created the first full-body embolism rescue in medical history." Lin Guoqiang's voice was like myocardial fibrillation, powerless and thirsty: "These equipment."

Fang Ziye's eyelids drooped slightly, his Mood instantly suppressing all excited Emotion, voice like an old monk in meditation: "Professor Lin, you saw wrong."

"There are only common equipment and Instruments in the operating room; they are only Instruments assisting Surgery, not equipment!"

Surgical Instruments are objects assisting Surgery; the Lead Surgeon can carry them on stage for surgical assistance, and they may not be listed in the Surgical Record.

But equipment is different; in Principle, all equipment applications during Surgery need to be reflected in the Surgical Record.

The attempt of treating a dead horse as a living horse also needs to Maintain Cautious.

Even though Fang Ziye knew Chen Guangbai would not Whistleblow on him.

Lin Guoqiang's Mouth opened and closed a few times under the Mask, he stared blankly for a moment, and did not continue speaking.

As a Mature Surgeon, or say as a Mature Adult, learning appropriate Hypocrisy is a Skill everyone must have.

Fang Ziye had previously emphasized these things had not undergone Clinical Trial; then they are Instruments.

Asking Further would be picking a fight.

Fang Ziye being so Cautious for self-protection is not wrong!

(Chapter End)