Department of Neonatology, Xiehe Hospital,
In the operating room, Director Qian Hong of the Obstetrics and Gynecology Department and Director Chen Jiang of the Pediatric Department have already started preliminary preoperative preparations.
Because the operation of esophageal atresia requires reconstruction of the stomach and esophagus, angiography must be completed before the operation.
Especially worried about whether there will be combined deformities, such as congenital heart disease, anus, congenital atresia of the small intestine, hydronephrosis, bone deformities and other problems.
If combined deformities are present, surgery is likely to be inoperable.
"Director Qian, is Qin Feng really good?"
Chen Jiang, the director of pediatrics, looked at the baby on the operating table and said worriedly.
"Since Director Dong recommends it, there shouldn't be any problem."
Qian Hong sighed and comforted,
"Besides, Qin Feng's surgical ability is unique among the younger generation in the hospital, and even surpassed us in many aspects of technology.
There must be a reason why even intensive care medicine has taken such a fancy to him.
Do not worry. "
After speaking, both of them looked at the baby who was born less than two hours ago on the operating table.
The sanitation aunt who brought the baby had already left, and only two policemen were left waiting outside.
Because of the special situation, the aunt immediately called 110 and 120. After the police learned about it, they quickly called the surveillance to investigate the girl who was pregnant and gave birth.
After all, she has just given birth in a sterile environment. If she does not receive timely treatment, she may die if she suffers from bleeding or infection.
Of course, the child has to be taken care of, and the hospital can save it, but it will be very troublesome if it is really an abandoned baby.
This is also very harmful to children.
Ding!
After a while, Qian Hong's phone rang.
She walked aside, and the itinerant nurse helped to open it, and saw the message from Qin Feng.
"Qin Feng is here, we can start."
"OK."
Chen Jiang nodded when he heard the words, then looked at the anesthetist beside him,
"Start the anesthesia."
After speaking, the anesthesiologist began to operate.
Because the baby is too small, neither intravenous anesthesia nor respiratory anesthesia is suitable. It is best not to use a pressurized mask to prevent the anesthesia gas from entering the stomach from the esophagotracheal fistula and causing gastric dilation.
So, this time, endotracheal intubation was used for anesthesia, and the pressure was divided into multiple times.
Intubation anesthesia for infants is also an extremely delicate and difficult operation, which puts a great test on the skills of anesthesiologists.
"Listen."
Soon, the anesthesiologist slowly inserted the catheter into the trachea, and stopped when he felt that he could no longer go in. He rotated the catheter and inflated the lungs while pressurizing the skin bag.
"Fix it."
The nurse next to him put the stethoscope in place for him, and quickly fixed the catheter with adhesive tape after hearing the words.
At this time, the catheter exceeds the level of the fistula opening of the trachea and test tube, which is conducive to unilateral ventilation of the left lung and prevents gas from entering the stomach through the fistula when it is pressurized.
If the trachea is not inserted deep enough, both lungs will be inflated, and the expansion of the right lung will not be conducive to the operation.
Moreover, the gas enters the stomach, and the gastric juice reverses into the lungs when the lungs are pressurized for the second time, which can easily cause postoperative pneumonia.
"Monitoring value."
After the anesthesia was completed, the doctor stepped aside and began to pay attention to all the physiological indicators of the baby.
Wow~
At this moment, the door of the operating room opened, and a figure in a dark green surgical gown walked in with his hands raised.
"Director Qin, you are here."
Seeing the person coming, Qian Hong's face showed a touch of joy.
"Director Qian, Director Chen."
Qin Feng nodded, then looked at the operating table,
"How is it going?"
"The fistula has been completed, the anesthesia has just been completed, and the operation can begin at any time."
Qian Hong said, the nurse also brought the surgical gown and Qin Feng put it on and tied it.
"Okay, give me a few minutes."
Qin Feng nodded slightly, walked straight to the opposite side of the handstand and began to check the images of various parts.
Because the alcohol had been decomposing on the way when he came, he didn't have time to distract himself from looking at the materials, so he could only wait until the scene.
However, this does not make much difference to Qin Feng, because there are more than a thousand detailed operations on super-long esophageal atresia stored in his mind.
In terms of surgical experience, he is the only one in the world who can master the entire surgical process at the same time!
Judging by the angiography, the reading of esophageal atresia has exceeded 5cm.
This fits perfectly with the criteria for being super-long, as babies naturally have very short esophagus.
"Do the two directors have any surgical plans?"
Qin Feng asked while watching.
"Generally speaking, esophageal atresia usually chooses to extend the child's own esophagus and connect the two ends to form a new esophagus."
Chen Jiang heard the words and said,
"But now the child's esophagus is too long to be anastomosed. My suggestion is to replace the esophagus."
Esophagus Replacement!
This is indeed a reasonable surgical plan, and it is also a safe method with the least risk of preoperative surgery.
But one thing that is very troublesome for super-long esophageal atresia is the postoperative healing.
Especially esophagus stricture!
The recurrence rate after surgery is more than 90%!
This is also the biggest difficulty for this operation at present.
"OK."
Qin Feng replied in a low voice.
At this moment, various surgical plans have appeared in his mind.
And the esophageal replacement, which was the first option, was directly killed by him.
In order to ensure the postoperative recovery effect of the child and the future body, this method is definitely not the best.
The second type, the stomach replaces the esophagus.
Part of the atresia esophagus is excised and stretched, the stomach is lifted up for a certain distance, and the length of the esophagus is shortened.
However, this can easily increase nausea, esophagitis, or various other stomach problems in the later stage.
And this method is also commonly used in esophageal cancer resection.
…
After about 5 minutes,
Qin Feng withdrew his gaze, and the final operation plan had been determined in his mind.
Small intestine replacement esophagus!
Use part of the small intestine of the child to replace the position of the atresia esophagus!
This method is very difficult and takes a long time. At least for now, a complete operation cannot be performed.
Because the excised small intestine jejunum needs to be cultured in vivo.
Surgical anastomosis can then be performed to form a new esophagus.
It is difficult, but postoperative has the least impact on the child's future life.
After all, it is still very young, and there is still a long way to go in the future.
"Director Qin, what do you think?"
Qin Feng walked back to the operating table, Qian Hong asked.
"In this way, Director Chen, you perform the fistula first, and I will peel off the small intestine for in vivo culture. After two months, I will perform the operation and replace the esophagus with the small intestine."
Qin Feng looked up at the two of them and said seriously.
"The small intestine replaces the esophagus?"
Hearing this, Chen Jiang also froze for a moment, then frowned slightly.
As the director of pediatrics, he is also quite accomplished in the field of congenital deformities of newborns, and he felt a little heavy in his heart.
He is well aware of the difficulty of this operation, and of course he also knows the benefits.
But he was a little surprised by Qin Feng's method. It is definitely a precedent to directly cultivate the small intestine in vivo.
And the difficulty is even higher!
That is to say, a section of small intestine is directly selected in the abdominal cavity of the child, and most of the vascular pedicle tissue of the small intestine is freed without taking it out or destroying it, leaving only the lower part to maintain basic supply.
Let this section of small intestine adapt to the same low blood circulation as the esophagus in vivo, so as to improve the success rate for later transplantation and recovery.
"You want to culture the jejunum?"
Chen Jiang asked in a deep voice.
"Director Chen is right."
Qin Feng smiled lightly.
As soon as the words fell, Chen Jiang couldn't help his scalp numb, and looked at him in shock.
Fuck!
This young man!
How dare you!
Jejunum cultivation is extremely rare even in the world, not to mention domestic, and it is not 100% successful.
The most important thing is that no surgeon can perfectly free blood pedicle tissue every time to ensure the success of low blood circulation.
This kind of difficult operation is definitely the first case!
And Qin Feng wants to do this now, in his opinion, it is undoubtedly a bit risky.
"If Director Chen believes it, you can try it with me."
Qin Feng looked at him with a smile, his tone firm and calm.
"Are you sure?"
Chen Jiang frowned even deeper.
"Yes, I have."
Qin Feng nodded.
Drip~~~Drip~~~~Drip!
The operating room fell silent, save for the sound of the monitor.
"Okay, let's try."
After a few seconds, Chen Jiang finally made up his mind.
He didn't believe in Qin Feng, but he was a little excited that the other party could perform such an operation method full of imagination and willingness to act.
He admitted that if it was him, he might think about it, but he would never do it.
Because it's risky!
But when Chen Jiang saw Qin Feng's confident eyes, he couldn't help feeling restless and hot.
It seems that he has regained the nervousness and excitement he faced every operation when he was young, and the pride between saving lives and life and death!
For thirty years, he has saved more and more people, but his courage has also become less and less.
Sometimes while gaining fame and wealth, people always sacrifice something for safety.
The word "expert" is very heavy~~~
"Shall we begin then?"
Qin Feng looked at the two with a smile and asked.
Qian Hong and Chen Jiang looked at each other, then nodded silently.
"The operation started on October 21, 2022. The patient was a newborn with esophagotracheostomy and jejunum culture."
Qin Feng stood on the main knife position, looked up at the time and said in a deep voice,
"Scalpel!"
At the same time, Qian Hong and Chen Jiang also started micro creating fistula.
The night outside was shrouded in cold wind, which made people feel chilly.
Several police cars were galloping through the night, following the direction of surveillance, searching for the girl who had given birth and disappeared...