"Emergency?" Su Yun frowned when he heard that it was TIPS surgery (Note 1).

TIPS surgery is the most difficult surgery in interventional departments, no doubt.

Of course, there are many new procedures that cannot be performed in existing medical conditions, such as prostate interventional embolism. But these surgeries are only "difficult". From a technical perspective, everyone should think that TIPS is the most difficult.

"In the Department of Gastroenterology, there is a relatively difficult patient. The patient is Director Xia's classmate. He has contacted to go to the imperial capital for TIPS surgery, but before he even set off, he suddenly vomited blood and was in shock." Zheng Ren stood up, put on a white suit, and turned around and smiled apologetically at Xie Yiren.

Xie Yiren waved his hand and signaled Zheng Ren to go to work, with his eyebrows and eyes curved, gentle and virtuous.

Zheng Ren felt at ease and walked out of the duty room.

"How do you?" Su Yun followed and asked.

"You can give it a try." Zheng Ren thought to himself that although he had never done it, he still had time to do it. In order to save people, he should squander it.

The most difficult thing is that complications after TIPS surgery are more difficult to deal with.

There are two treatment methods for decompensated cirrhosis, gastric esophageal varicocele, and vomiting of hemorrhage caused by splenomegaly - one is surgical surgery, such as splenectomy and Menqi vein cessation; the other is the TIPS surgery just mentioned.

This kind of surgery has not been clinically available for less than thirty years.

In 1988, German scholar Richter and others applied transjugate intrahepatic stent portal shunt for the first time in clinical practice, and reported 16 successful transjugate intrahepatic stent portal shunt for the transjugate intrahepatic stent.

Later, Zemel (1991) and Ring (1992) reported the successful transjugural pathway intrahepatic stent shunt.

In 1993, the transjugate pathway of intrahepatic stents was promoted and applied in various countries.

The operation was initiated in China in the 21st century, and Tsui Hark from China Medical University took the lead in carrying out it.

Until now... it has not become a routine surgery.

Why?

Because it's hard to do.

It's particularly difficult to do.

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

However, if the patient can survive, the quality of life after surgery will be greatly improved, which is a surgical procedure that benefits a lot by patients.

Su Yun recently learned interventional surgery and naturally knew that TIPS surgery is known as the crown jewel of interventional surgery.

Is it going to be developed so soon? Are there consumables? There is nothing, Zheng Ren is going to make yarn?

"How about consumables?"

"I'll call Manager Feng." Zheng Ren said as he took out his cell phone.

"Manager Feng, it's me."

"I may have to undergo TIPS surgery on this side, and the related consumables will be sent here immediately."

"Well, in terms of procedures, Director Pan will handle it tomorrow, and it is probably the process of the preliminary registration."

"As soon as possible, 1 hour!"

After saying that, Zheng Ren hung up his phone.

"Are you confident after the operation?" Zheng Ren walked quickly, but still asked Su Yun.

"If hepatic encephalopathy is not preventable, it can only be controlled by amino acids and other drugs." Su Yun recalled the process of TIPS surgery and the sinisterness of hepatic encephalopathy, and dared not say too much.

The key is that the clinical method of treating hepatic encephalopathy is still very single.

Zheng Ren had a clear idea, and he accelerated his pace and came to the Department of Gastroenterology.

Director Xia was still smart and capable. Seeing Zheng Ren coming so quickly, there was a hint of embarrassment on his face.

The floating gallbladder, that patient, Director Xia, was considered to have Zheng Ren's face in the emergency department.

Afterwards, Zheng Ren was right. So Director Xia really didn't want to face this evil emergency department hospitalization director.

Even if an unexpected situation occurs, she still goes through Director Pan... Well, this is also a normal process, and communication between Directors.

"Hello, Director Xia, which ward is the patient in?" Zheng Ren did not change his expression at all, did not be arrogant, nor was hesitant, as if something had never happened before.

"On this side." Director Xia threw all the messy thoughts aside and rushed to the rescue room with Zheng Renfeng.

It was a male patient in his fifties, with a pale face and black air. He was lying on the hospital bed with a washbasin underneath. He kept vomiting black vein blood.

The picture is gloomy and weird, like hell.

A strong smell of blood came to my face, and Zheng Ren glanced at the system panel in the upper right corner of his field of view.

A piece of red came into view.

The patient's diagnosis was: hemorrhagic shock, decompensation period of posthepatitis B cirrhosis, stubborn ascites, pleural fluid, electrolyte metabolism disorder, splenectomy and vascular cessation of the esophageal cardia.

I have had splenectomy and Menqi vein cessation surgery...

Zheng Ren was hesitating between the two procedures, but now he doesn’t have to think about it anymore, just prepare for TIPS surgery.

"The bleeding occurred three days ago. Because of splenectomy and Menqi's venous cessation surgery, he could only choose conservative treatment." Director Xia introduced the condition in a deep voice. "Three groups of intravenous hemostatic drugs plus oral Zhengshenice saline were controlled. I was originally planning to transfer to the hospital to the Imperial Capital for TIPS surgery, but I didn't expect that when I contacted the ambulance, I vomited blood again."

Three groups of hemostatic drugs have been used, plus Zhengshenice Salted Water, which can be said to be considered extremely heavy.

Even if there are four or five groups of hemostatic drugs, there will be no effect. Once complications such as cerebral infarction and myocardial infarction appear, it will be even more difficult.

Zheng Ren pondered, considering whether the operation time he reserved was enough.

TIPS surgery is the most difficult surgery in an interventional subject after all, and Zheng Ren is not sure.

When Director Xia saw Zheng Ren pondering, he smiled bitterly and said, "In our hospital, you are the only one who is undergoing interventional surgery. There is nothing we can do about it, it's hard for you."

Her unexpected but reasonable attitude softened, which was very logical. Zheng Ren understood Director Xia’s thoughts.

"As long as you can be 10%, it's always right to give it a try." Director Xia said firmly: "The patient is my classmate, and his lover is also my classmate. Dr. Zheng, don't worry, even if you can't get off the table and die on the operating table, there will be no problem."

The last sentence is to give Zheng Ren a reassurance.

For nothing else, because emergency TIPS surgery is the only option at this time. If Zheng Ren said he would not do it, the patient could only vomit blood while waiting for the arrival of death.

Perhaps a few minutes later, a mouthful of venous blood was vomited out, sprayed onto the wall, sprayed onto the roof, and the person was gone.

However, the difficulty coefficient of TIPS surgery for normal slow diagnosis exceeds the limit threshold of 10 and reaches more than 11, not to mention emergency TIPS surgery.

"Director Xia, to be honest, I haven't done it." Zheng Ren pondered, "The patient is in a critical condition and has not many choices. Try an emergency surgery. I can't guarantee it, I can only do my best."

"Thank you." Director Xia sincerely thanked.

It is already considered a conceited to let the director of the University of Science and Technology say the word thank you in front of the patient's family.

Su Yun showed a victory smile on his lips.

Zheng Ren frowned.

"Do you have any consumables?" Director Xia immediately asked the most acute question.

"I've already contacted and I'll be sent to the emergency room in a few more minutes." Zheng Ren said, "Prepare to send the patient to the patient, sign the pre-operatively..."

"I can sign." Director Xia said.

It seems that she and the patient and his wife are indeed familiar to a certain extent.

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

At the same time, a "Ding Dong~~" mission prompt sound rang in Zheng Ren's ears.

[Main mission: The first stage of the crown.

Task content: The most difficult transjugate intrahepatic portal shunt surgery, known as the crown of the pearl.

Task reward: The average time to complete TIPS surgery is 4 hours and 23 minutes. If the host completes the task longer than the average time, there will be no special rewards. If the completion time is shorter than the average time, you will receive a generous reward.

The lucky value +2, two gold treasure chests, and the experience value is 200,000 points.

Mission time: 6 hours.]

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

Seeing a long list of numbers, a reward of +2 for luck, and the "rich reward" mentioned by the big pig's hoof in the system, Zheng Ren felt in a trance that he had returned to the imperial capital.

Is TIPS surgery also considered the main task?

Among the existing interventional surgery, TIPS surgery is indeed the most difficult one. If you climb a technology tree, it is indeed a procedure that must be completed to reach the top.

Main mission... OK.

I just don’t know what the main task of general surgery is.

I have never had TIPS surgery. Whether it is for the purpose of saving people or completing tasks, I have to think about it carefully.

There seems to be some time for surgery training, and it seems that you have to take a gamble.

Zheng Ren's brain was running at high speed and he began to figure out all the steps of TIPS surgery.

The procedure of the operation is very simple.

After successful puncture through the right jugular vein under local anesthesia, the hepatic vein and portal vein channels were opened by using a catheter guide wire and puncture needle, balloon dilated the portal vena cava puncture channel and accurately released the stent.

The difficulty of TIPS surgery is that the puncture needle opens the channels between the hepatic vein and the portal vein.

This is blind wear, only based on experience...and luck.
To be continued...