doctor
The eyes are sick
The heart is filled with people
A consultation telephone 2000 km away
At 16:00 on June 2, Professor Chen Bing, director of the Department of Vascular Surgery of the Second Hospital of Zhejiang University, received a phone call from 2,000 kilometers away, and the other end of the phone was Chen Chun, vice president of the People's Hospital of Xingyi City, Guizhou Province, with an urgent voice: "Director Chen Bing, we have received a patient and need your consultation support..."
Chen Bing learned about the patient's situation through the phone, is a nearly 80-year-old man, recently felt bloated abdominal pain, went to the hospital to check and found a huge abdominal aortic aneurysm, urgently transferred to Xingyi People's Hospital for treatment. Professor Chen Chun realized that the patient's condition was critical, and urgently contacted Dr. Chen Bing for remote consultation, and arranged for the patient to conduct relevant examinations.
Looking at the CT image that came over, Chen Bing frowned, this is a huge abdominal aortic aneurysm, 150mm long, more than 100mm in diameter, eccentric growth, local cystic protrusions, bilateral common iliac aneurysm, bilateral internal iliac aneurysm.
Abdominal aortic aneurysms are not tumors, but due to arteriosclerosis and other reasons, the strength of the blood vessel wall is reduced, and it is gradually impacted by blood flow, and the blood vessel caliber is thickened, "blowing up like a balloon".
Aneurysms with a diameter of more than 55 mm, if the morphology is biased to one side or have a special shape, abdominal pain symptoms are considered to be precursors to rupture and require surgical treatment as soon as possible. All kinds of clues point to a "bomb" of abdominal aortic aneurysms that can potentially rupture fatally at any time.
A severe irritating cough in a patient may induce rupture, which is life-threatening at any time, and the situation is very urgent. Surgery must be performed as soon as possible!
Problems ensued, Xingyi People's Hospital is already the best hospital in the local area, and there is no vascular surgery specialty.
Where and how are patients best treated?
Because aneurysms have an extremely high risk of rupture, patients lose the opportunity for long-distance transport, and any bumps and changes in barometric pressure can have disastrous consequences.
The remote and inaccessible location of Xingyi City in Guizhou Province has denied the choice of sending patients to a medical center with the ability to independently manage this difficult aneurysm.
Soon, Chen Bing and Chen Chun two experts jointly decided that the patient stayed in the local area for surgery, in view of the fact that Xingyi has the basic conditions for the implementation of DSA vascular luminal intervention, The Department of Vascular Surgery of Zhejiang University Second Hospital Chen provided technical support and help to save the patient together!
The results of the inspection add to the ripples
The two sides cooperated closely, and at 18:30, the CTA image data was transmitted to the hands of experts from both places.
At 21:30, the professionals reported the measurement results: the patient not only had a huge tumor, multiple ulcers of the thoracic aorta, potholes in the thoracic and abdominal aortic junction area twisted to the left at ninety degrees, the bilateral iliac artery was thinner, 360 degrees twisted, bilateral intraesiliac aneurysm, and more seriously, the aneurysm tumor carotid suitable for endovascular intervention was basically absent, it was flared horizontally, and the left renal artery was located at a corner, but less than 4 mm in diameter, and the right renal artery with a slightly higher position was equally slender.
Experts are even more nervous, according to such a situation, the conventional minimally invasive interventional treatment conditions are not met, to consider open surgery. Kexingyi People's Hospital has no vascular surgery, no related surgical instruments and related equipment, and no clinical experience, the surgical trauma is large, the risk is high, such as abdominal aortic aneurysm open surgery must have sufficient medical resources and technical support.
At 2:00 a.m. on June 3, Chen Bing had a telephone exchange with Professor Wang Zhong'an, Secretary of the Party Committee and President of Xingyi People's Hospital. Secretary Wang Zhong'an expressed his determination to treat patients at all costs, whether it is open surgery or intravascular interventional treatment, he will use the strength of the whole hospital to support and guarantee.
It was a long and sleepless night, and Chen Bing was constantly thinking about treatment methods, because the local hospital conditions and experience constraints may be more risky to open surgery. At the same time, he forwarded the patient's image to the Beijing experts, hoping to get the opinions of his peer experts. Immediately afterward, Chen Bing called Wang Jian'an, secretary of the Party Committee of the Second Hospital of Zhejiang University, to report on the critical situation, and Secretary Wang Jian'an immediately expressed his full support for and cooperation with the requirements of the Xingyi People's Hospital, and asked Wang Liangjing, assistant to the president of the Second Hospital of Zhejiang University and director of the Medical Department, to coordinate.
At the same time, communication with Beijing experts also reached a consensus. Comprehensive consideration, interventional surgery to achieve more reliable treatment, you can consider the unconventional abdominal aortic mulching stent combined with the thoracic aortic mulching stent method to try, but the technical requirements are extremely high, any negligence or mistake in the operation, will cause aneurysm rupture or treatment failure.
The road to rescue is difficult
At 8 o'clock on June 3, Chen Bing selected the stent with the best compliance according to the surgical plan, and contacted the instrument company to prepare the model and ensure that it could be delivered to Xingyi on time to ensure the smooth implementation of the operation.
At 10 o'clock on June 3, the two sides communicated the surgical plan and personnel division of labor: Chen Bing, director of the Department of Vascular Surgery of Zhejiang University Second Hospital, organized the technical team and surgical plan design; Chen Chun, vice president of Xingyi People's Hospital, arranged for patients to complete preoperative examinations, and organized anesthesia, surgery department and intervention center to cooperate.
At this time, another difficult problem emerged. From Hangzhou, take a 9-hour high-speed train, and then turn to 1 hour of road traffic to reach Xingyi. Although Xingyi has Wanfenglin Airport, there are fewer flights and are greatly affected by the weather. On June 3, there was a large area of cloud and rain changes in the south of China, and the alternative transportation plan was to fly directly to Guiyang Airport in Guizhou, and then the road traffic turned to Xingyi in 3 hours.
After understanding the weather changes and inquiring about the air condition control of Xingyi Wansongling Airport, it was finally decided that Chen Bing and his assistant Dr. Pan Yifeng would fly directly from Ningbo to Xingyi. While communicating with all parties, Chen Bing and Pan Yifeng drove from Hangzhou to Ningbo Lishe Airport, nearly 200 kilometers away, and carried with them the thoracic aortic mulching stent and balloon expansion stent to prevent accidents in Hangzhou.
At 14:40 on June 3, when the rescue team arrived at Lishe Airport, it was only 40 minutes before the boarding time, and there was a problem when passing through the security check, because the length of the bracket exceeded 150 cm, it was an extra-long baggage, and it should be checked in by air or declared to the airline in advance. However, the declaration time is too late, and due to the safety considerations of medical devices, the risk of consignment without outer packaging protection is greater, and it can only be carried on the plane. When Chen Bing explained to the security personnel that the equipment was used to rescue patients in Xingyi, the airport immediately sent special personnel to inspect the stent and send it directly to the plane, and at the same time, the news came from the front that the air situation in the Xingyi area was stable at present, and Dr. Chen Bing and Dr. Pan Yifeng finally set off smoothly.
The multi-team collaboration was a success
The orders of the healer, like a general raising troops, will be determined and then the battle will be fought.
On the plane, Chen Bing, who could not rest, had been calculating and thinking about comparing the patient's images and measurement data, and the surgical plan was gradually formed with increasing clarity.
At 19:00 on June 3, the plane landed smoothly at Xingyi Wanfenglin Airport. At this time, Chen Chun was already anxiously waiting at the airport. Subsequently, Chen Bing briefed him on the surgical plan and the deployment of consumables in many places across the country. After listening to Director Chen Bing's description of the treatment plan, Vice President Chen Chun felt that he was much more down-to-earth.
At 2:00 a.m. on June 4, the last piece of equipment landed in Guiyang, and the special car transported Xingyi overnight, and the operation could be carried out early the next morning, at which time the experts were able to take a short rest.
Everything is ready and ready to go.
At 8:30 a.m. on 4 June, the patient entered the operating room to prepare.
At 9 o'clock, the measurement data and surgical equipment were finally checked before the operation, and the surgical method was determined.
Wang Zhong'an, Chen Chun and Liu Quanyi of Xingyi People's Hospital formed a logistics support team, Chen Bing and Pan Yifeng of the Second Hospital of Zhejiang University, and Chen Ming, Xu Yingming and Xiong Tianping of Xingyi People's Hospital formed a treatment team. The joint team of the first operation has not the slightest barrier to cooperation, because before the operation, the various experts have fully discussed and run-in, and the goal is firm: to go all out and treat patients!
The patient's diseased abdominal aorta occupies almost half of the volume of the abdominal cavity and may rupture at any time. Several doctors had a string in their hearts.
At 10 o'clock, the operation begins.
Disinfection, laying, smooth puncture, preset sutures, the first difficulty of surgery is that the bilateral external iliac artery is slender and extremely twisted, and the embolization of the bilateral dilated internal iliac artery is difficult to operate, due to the incompatibility of some instruments, the difficulty of operation is even heavier. Time slipped by minute by minute, the surgery continued in the difficult, the embolism was successfully completed, the work guide wire was in place, the angiogram, the huge aneurysm showed a hideous face.
Without any hesitation, according to the surgical plan, the abdominal aortic stent is in place, and after the stent is released, the stent is gradually sunk in its entirety with the assistance of the balloon, and the stent rides across the twisted iliac artery, branches into the common iliac artery, picks up the leg, fixes, and the operation has been successful by one-third.
More challenging operations began, the thoracic aortic stent passed through the inside of the abdominal aortic stent, through a series of technical operations, the stent was fixed close to the wall of the abdominal aortic aneurysm, the proximal end was accurately positioned 1 mm below the left renal artery, the distal end overlapped well with the abdominal aortic overlay stent, the stent was released rapidly, the visual morphology was good, angiography showed that the abdominal aortic aneurysm was well isolated, there was no contrast leakage, the bilateral iliac artery branch was patency, the bilateral renal artery was well patency, and the operation was successfully completed, fully achieving the expected goal! It was 14:20 on June 4.
Taking off the 15-kilogram lead coat, Chen Bing's surgical gown has long been soaked with sweat, his left arm trembled slightly, a huge soreness struck, more than 20 days ago, Chen Bing's left arm just underwent fracture reduction surgery, at this moment, this hand is getting more and more swollen, he rubbed his arm, gasped: "Success, it's good!" "All the medical staff involved in the rescue were relieved.
Life is supreme, and it is worth running around
"We have to hurry back to Hangzhou, and there are still many patients waiting for me." After the operation, there was no stop, and at 15:40, Director Chen Bing and Dr. Pan Yifeng hurried to the airport. On the way, there was good news, the patient was anesthetized and soberly extubated, and he was smoothly transferred back to the ward.
At 22:30, the good news came again, the patient was fully awake, could eat, and his vital signs were stable.
Is it worth running so far to save a patient? Faced with this question, Chen Bing replied without hesitation: "Life is priceless. People first, life first! No matter how hard you run, no matter how hard you work, it is worth it. ”
Lasting nearly 48 hours and spanning 2,000 kilometers, the two hospitals and instrument supply units worked together to race against the clock, go all out, race against time, compete with the disease, and walk with life, successfully rescue critically ill patients, and create many miracles - not only innovated surgical methods, solved cases that are difficult to treat by conventional surgery, and ensured the perfect realization of surgical solutions with exquisite technology. This is a great achievement in the rapid development of China's medical undertakings to escort the health of the people, and the medical staff have interpreted the benevolence of the doctors and the great love of the world with practical actions and professionalism.
Text, figure | Vascular Surgery Chen Bing
Audit | Vascular Surgery Chen Bing
Editor-in-charge | Zhu Junjun