Chapter 303

"Emergency?" Su Yun frowned upon hearing it was a TIPS surgery (note 1).

TIPS surgery is the most difficult surgery in the Intervention Department, with no equal.

Of course, excluding new procedures that current medical conditions cannot perform, such as prostate interventional embolization surgery; but these surgeries are merely "difficult"—from a technical level, everyone would consider TIPS the most difficult.

"In the Xiao Hua Nei Ke, there's a rather tricky patient. The patient is Director Xia's classmate; they had already arranged to go to Di Du for a TIPS surgery, but before departure they suddenly vomited massive blood and went into shock." Zheng Ren stood up, put on his white coat, and gave Xie Yiren an apologetic smile.

Xie Yiren waved her hand, indicating Zheng Ren should get busy, her eyes curved, gentle and virtuous.

Zheng Ren felt at ease, striding out of Zhibanshi.

"Can you do it?" Su Yun caught up and asked.

"I can give it a try." Zheng Ren thought, although he had never done it, he still had surgery time; to save a life, he might as well splurge a bit.

The most difficult part is that postoperative complications of TIPS surgery are relatively hard to handle.

For hemorrhaging due to decompensated hepatic cirrhosis, gastric esophageal varices, and splenomegaly, there are two treatment methods—one is surgical, such as splenectomy and devascularization of the portal vein; the other is the TIPS surgery just mentioned.

This surgery has been in clinical use for less than thirty years.

In 1988, German scholars Richter et al. first applied the transjugular intrahepatic portosystemic shunt procedure clinically, and in 1991 reported 16 successful cases of the transjugular intrahepatic portosystemic shunt procedure.

Subsequently, Zemel (1991) and Ring (1992) successively reported successful outcomes of the transjugular intrahepatic portosystemic shunt procedure.

In 1993, the transjugular intrahepatic portosystemic shunt procedure began to be promoted and applied worldwide.

Domestic surgery began in the 21st century, when Professor Xu Ke of China Medical University pioneered it.

Even now…… it has not become a routine surgery.

Why?

Because it's difficult to perform.

Especially difficult to perform.

Even if the surgery is completed, the postoperative mortality rate is extremely high.

But if the patient can pull through, postoperative quality of life will greatly improve; it is a surgical procedure that greatly benefits patients.

Su Yun recently studied interventional surgery, naturally knowing that TIPS surgery is hailed as the pearl on the crown of interventional surgery.

Is it going to be launched this soon? Do we have the supplies? With nothing at all, Zheng Ren is preparing to mess around with yarn?

"How are the supplies?"

"I'll call Manager Feng." Zheng Ren said while pulling out his phone.

"Manager Feng, it's me."

"I might need to perform a TIPS surgery here; please send the related supplies immediately."

"Hmm, regarding the paperwork, Director Pan will handle it tomorrow; I suppose it's still the provisional procurement procedure."

"As soon as possible, within one hour!"

After saying that, Zheng Ren hung up the phone.

"Post-op, are you confident?" Zheng Ren walked briskly, but still asked Su Yun.

"Hepatic encephalopathy, if it cannot be prevented, can only be controlled with medications such as amino acids." Su Yun recalled the TIPS surgery process and the dangers of hepatic encephalopathy, not daring to speak too confidently.

The key is that clinical means of treating hepatic encephalopathy remain very limited.

Zheng Ren had a plan in mind, quickened his pace, and arrived at the Xiao Hua Nei Ke.

Director Xia remained sharp and capable; seeing Zheng Ren arrive so quickly, she felt a hint of embarrassment.

The floating gallbladder case—Director Xia, in the Emergency Department, had essentially saved face for Zheng Ren.

Afterwards it was proven that Zheng Ren was correct. Therefore Director Xia genuinely did not want to confront this monstrous Emergency Department Inpatient Chief.

Even if an unexpected situation arose, she would still go through Director Pan…… well, this is also the normal procedure, communication between senior directors.

"Director Xia, hello, which ward is the patient in?" Zheng Ren showed no change in expression, no arrogance, no sharp-tonguedness, as if the previous events had never happened.

"This way." Director Xia cast aside all her scattered thoughts and hurried Zheng Ren to the resuscitation room.

It was a male patient in his fifties, with a sallow complexion, darkened aura, lying prone on the bed, a basin placed beneath him, continuously vomiting black venous blood mouthful by mouthful.

The scene was gloomy and eerie, like hell.

A strong smell of blood assailed his nostrils; Zheng Ren glanced at the system panel in the upper right of his field of view.

A sheet of red filled his vision.

The patient's diagnosis: hemorrhagic shock, post-hepatitis B hepatic cirrhosis decompensation, refractory ascites, pleural effusion, electrolyte metabolism disorder, post-splenectomy and post-devascularization of the portal vein around the esophagogastric junction.

He had undergone splenectomy and devascularization of the portal vein……

Zheng Ren had been hesitating between the two procedures, but now there's no need to think—he should directly prepare for a TIPS surgery.

"Three days ago, hematemesis appeared; because he had undergone splenectomy and portal vein occlusion surgery, only conservative treatment could be chosen." Director Xia introduced the condition in a low voice: "Three groups of venous hemostatic drugs plus oral Zhengbing Ice Salt Water have controlled the bleeding. Originally we planned to transfer to Di Du for TIPS surgery, but unexpectedly, when contacting the ambulance, massive hematemesis occurred again."

"Three groups of hemostatic drugs have already been used, plus Zhengbing Ice Salt Water; it can be said that we have already reached the maximum dosage."

"Even if we add four or five more groups of hemostatic drugs, there will be little effect. Once complications such as cerebral infarction and myocardial infarction appear, it will become even more difficult."

"Zheng Ren pondered, calculating whether his reserved surgery time would be enough."

"TIPS surgery, after all, is the most difficult surgery in the Interventional Medicine Discipline; Zheng Ren also lacks confidence."

"Director Xia saw Zheng Ren pondering, also gave a wry smile, and said: 'Our Hospital only has you performing interventional surgery. This is also unavoidable; I feel sorry for you.'"

"Her attitude softened, unexpected yet reasonable, which made perfect sense; Zheng Ren understood Director Xia's thoughts."

"'As long as there is a 10% chance, trying is never wrong.' Director Xia said firmly: 'The patient is my classmate, and his spouse is also my classmate. Doctor Zheng, rest assured; even if you cannot get off the table, dying on the operating table would not be a problem.'"

"The last sentence was a reassurance for Zheng Ren."

"It's not for any other reason; at this moment, emergency TIPS surgery is the only option. If Zheng Ren says he cannot do it, the patient can only vomit blood while waiting for death to descend."

"Perhaps a few minutes later, a mouthful of venous blood would be vomited out, spraying onto the wall, spraying onto the ceiling, and the person would be gone."

"But even the TIPS surgery performed in ordinary outpatient clinics has a difficulty coefficient exceeding the limit threshold of 10, reaching 11 or higher, let alone emergency TIPS surgery."

"'Director Xia, to be honest, I have never done it.' Zheng Ren pondered: 'The patient's condition is critical, and there are not many options; let's try emergency surgery. I cannot guarantee anything, I can only do my best.'"

"Thank you." Director Xia sincerely thanked.

Being able to let a department chief say the two words "thank you" in front of the patient's family already counts as giving in.

Su Yun's mouth corner revealed a hint of a victorious smile.

Zheng Ren, however, furrowed his brows tightly.

"Any supplies?" Director Xia immediately asked the sharpest question.

"Already contacted, it will be able to be sent to the Emergency Operating Room in a few dozen minutes." Zheng Ren said, "Prepare to send the patient, preoperative signature……"

"I can sign." Director Xia said.

It seems she and the patient's couple have indeed become quite familiar.

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

At the same time, a "ding-dong~~" task prompt sound rang in Zheng Ren's ear.

【Main Line Quest: First Stage of the Pearl on the Crown.】

Quest content: Complete an interventional surgery with the highest difficulty, known as the Pearl on the Crown, the transjugular intrahepatic portosystemic shunt procedure.

Quest reward: The current average time to complete a TIPS Surgery is 4 hours 23 Minutes. If the host completes the quest time longer than the average, there is no special reward. If the surgery completion time is shorter than the average, then a generous reward will be obtained.

Additionally reward Luck Value +2, two golden treasure chests, 200000 Experience Points.

Quest time: 6 hours.】

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

Seeing a long string of numbers, the reward of Luck Value +2, and the system's Big Pig Trotter saying "generous reward," Zheng Ren dazedly felt he had returned to Di Du.

Is TIPS Surgery also considered a Main Line Quest?

Among existing interventional surgeries, TIPS Surgery is indeed the most difficult; if climbing the tech tree, it is indeed a procedure that must be completed to reach the summit.

Main Line Quest……Alright.

I just don't know what the Main Line Quest of the General Surgery Department is.

I have never performed a TIPS Surgery; whether for saving lives or for completing the quest, I need to think it over carefully.

Surgical Training Time seems to remain somewhat; it looks like we must go all in.

Zheng Ren's brain raced, pondering all the steps of TIPS Surgery.

The process of Shou Bing, simply put, is quite simple.

After successful puncture under local anesthesia via the right jugular Vein, using the Catheter guidewire and Puncture Needle to open the hepatic Vein and portal Vein channel, performing balloon dilation on the portal Vein puncture channel and precisely releasing a stent.

The difficulty of TIPS Surgery lies in the Puncture Needle breaking through the hepatic Vein and portal Vein channel.

This is a blind puncture, relying only on experience……and luck.

No matter how high the skill level, when facing TIPS Surgery, if luck is slightly lacking, one cannot complete this surgery.

Therefore, TIPS Surgery being called the most brilliant pearl on the crown of interventional surgery is justified.

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

For Zheng Ren, who is unwilling to even open the system's treasure chest and goes to test luck, to test luck on the Operating table is undoubtedly an extremely hard-to-accept thing.

"Not confident?" Su Yun followed behind Zheng Ren, seeing his steps not quick, seeming to be lost in thought, she stepped closer and asked.

"In the world, no one has absolute confidence." Zheng Ren said.

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

"Um……" Zheng Ren had already forgotten Professor Rudolf Wagner to the back of his mind.

The professor is a world-top interventional surgeon; since he stayed, regardless of purpose, lending a hand should be appropriate.

Zheng Ren nodded and picked up the phone.

"Professor Rudolf, I am Zheng Ren." The phone on that end rang for nearly half a Minute, before the professor answered.

Zheng Ren directly ignored his slightly groggy German and got straight to the point.

"There is a TIPS Surgery here, please come take a look."

After saying that, Zheng Ren hung up the phone.

……

Note 1: Transjugular intrahepatic portosystemic shunt procedure, abbreviated as TIPS Surgery. When this chapter was introduced, it was mentioned several times to deepen the impression. From now on, only the abbreviation will be used, no filler.

Additionally, the four characters of TIPS should count as only one character; I also heard that from others~~Please recommend a ticket, thank you.