Recently, the Department of Neurosurgery of Shantou Central Hospital successfully carried out a case of occlusion opening of the "right common carotid artery - internal carotid artery" in the compound operating room, and the surgical team skillfully combined a variety of means to make full use of the advantages of the "one-stop" medical equipment provided by the composite operating room to allow patients to be treated.
Xu Ke, deputy director of the second ward of neurosurgery of the main knife, introduced that the operation used both interventional surgical treatment and surgical treatment, which is the first case in eastern Guangdong, and there are not many hospitals in the country that can carry out such surgery.
Shantou Central Hospital's "one-stop" service of the compound operating room avoids the risk of patient transport. Courtesy of respondents
Make every effort to rescue patients with complicated conditions
According to Xu Ke, the patient Lin Bo's condition is more complicated. As early as December 2020, Limber was admitted to the hospital for aortic aneurysm mulching stent implantation, and his condition improved and he was discharged from the hospital after treatment. On July 15 this year, he was diagnosed with a sigmoid colon tumor, and doctors planned to perform tumor resection on him half a month later. After 10 days, Limber was re-admitted to the hospital due to weakness in his left limb, and a complete cerebral angiography suggested that his right common carotid artery to the internal carotid artery was occluded, and magnetic resonance scan showed multiple intracranial cerebral infarction.
"The patient's condition is contradictory." Xu Ke said that this contradiction is mainly embodied in two aspects. On the one hand, Lin Bo wants to undergo tumor resection, and the anti-platelet aggregation drug must be stopped for more than 7 days, otherwise it will cause serious consequences due to bleeding, but he also has a common carotid artery occlusion, and the drug can easily induce cerebral infarction. On the other hand, after the doctor gave two intensive antiplatelet aggregation drugs, the hemiplegia of Limber's limb slowly improved, but there was bloody stool, and once the double antibody was stopped, the weakness of the left limb was repeated again.
Lin Bo's situation can not be solved by interventional surgery alone, Xu Ke suggested to the patient's family, first through open surgery for carotid artery bifurcation reconstruction, the occluded artery is divided into two parts: proximal and distal - the distal end opens the blood vessel through intervention, and the proximal end opens the blood vessel through "surgery + intervention".
The risks of surgery are self-evident, and there are not many reports of related cases in China. After consultation, the family members decided to agree to the recommendations of the medical team. Xu Ke said that before the operation, by consulting relevant literature at home and abroad and consulting with hospital professors who have carried out such surgeries, he was fully prepared to treat Lin Bo.
The "small balloon" helps open occluded blood vessels
7 cm proximally and 4 cm distal, The occluded blood vessels that Limber needs to open are very long, and it is not difficult to open them completely. Xu Ke said that the more difficult part of the operation falls on the opening of the proximal blood vessel.
After the anesthesia is satisfactory, Xu Ke first uses the B ultrasound for precise localization, and performs carotid artery intimal detachment according to the positioning, and parallel internal carotid artery, that is, distal thrombosis removal. Faced with the proximal end, that is, the direction of the common carotid artery is not smooth, Xu Ke thought of a way: use the Foggy balloon to enter the common carotid artery, use the balloon to open the blood vessel, and then bring out a long thrombus.
After suturing the blood vessels, Xu Ke immediately performed a complete cerebral angiography on the patient, and he was ready to open the interventional means immediately if the internal carotid artery was still not smooth. Fortunately, the patient's right common carotid artery to the internal carotid artery and then to the intracranial blood vessels have been fully unblocked.
It is understood that after the patient successfully extubated, the limbs are well moved, and there is no longer a weakness in the left limb.
Xu Ke told the author that with the increasing improvement of living standards in recent years, more and more patients have carotid artery stenosis and carotid artery occlusion. In cases like Limber's, the common carotid artery is occluded, the intracranial blood vessels are infertile, and recurrent cerebral infarction can only be controlled by opening occluded blood vessels, providing conditions for the treatment of colorectal tumors in the future. However, such vascular occlusion cannot be treated by simple interventional means, and requires the seamless docking of B ultrasound, microscope and DSA machines before, during and after surgery.
Therefore, the hospital has a composite operating room is an important condition for the smooth operation of this operation. During the operation, B ultrasound, microscope, DSA machines take turns, these medical equipment originally needed to be completed in several different departments, can now be combined in the composite operating room to complete at once.
"The compound operating room avoids the risks of hypoxia and unstable vital signs that patients may bring during the transfer process, and the 'one-stop' service is truly patient-centered, disease treatment-centered, and medical equipment and medical staff can work around patients." Xu Ke said that in the future, combined with the advantages of equipment, complex cerebrovascular lesions will be better, safer and more economically treated.
[Reporter] Wang Hanqi
【Correspondent】 Huang Qing
Click on the picture, one click to report ↓↓↓
【Author】 Wang Hanqi
【Source】 Southern Press Media Group South + client
Source: South+ - Create more value