Chapter 983 Discovery of the Anatomical Experimental Body (Leader 1010105 Plus 3)
Zheng Ren has experienced the intelligence and humanization of Big Pig's Trotter, and this is an operation with a mission. So after entering the system space, Zheng Ren had no doubts, so he clicked to buy surgery training time.
The system operating room rose from the ground, and the experimental body was lying on the operating table.
Zheng Ren started the operation.
For Zheng Ren, who was at the pinnacle of interventional surgery, renal artery stenting was just a very simple operation.
Compared with puncture, superselection, renal artery and fourth- and fifth-order arterioles, driving on an eight-row road is the same as bumping on a small road that does not exist in a tropical jungle.
The super selection is smooth, lower into the bracket, and open.
Surgery is as simple as that.
However, the completion of the operation did not even reach 50%, and words appeared on the system panel, saying that the experimental subject died 58 hours after the operation.
Zheng Ren was not surprised by this result.
Because the operation process of this operation is the same as the operation process performed by the Mayo Clinic doctor in the video, and all the operations are performed at the most basic level.
The operation was over, the test subject died, and Zheng Ren began to dissect it.
This is what Zheng Ren really wants to do.
The structure of the renal artery changed obviously, and there was a stenosis about 5cm from the initial segment. Narrowing of the renal arteries leads to increased blood pressure, known as renovascular hypertension.
Because of the reduction of intrarenal perfusion pressure, renal parenchymal disease, and renin-secreting cell tumors, the juxtaglomerular cells can release a large amount of renin, causing an increase in the activity of angiotensin Ⅱ, and contraction of the arteriole wall throughout the body, resulting in high blood pressure.
Renin and angiotensin Ⅱ can also promote the increase of aldosterone secretion, lead to sodium and water retention, increase blood volume and produce high blood pressure.
But after the renal artery is expanded, why is the blood pressure higher?
Zheng Ren knew that this involves an area that cannot be studied and understood by existing science. As a person who is particularly determined, Zheng Ren is not prepared to completely solve the problem of nephrogenic hypertension.
As long as he can complete a task and get time for surgery training, Zheng Ren is very satisfied.
After dissecting the renal artery, Zheng Ren found that the renal sympathetic preganglionic neuron cell bodies emanating from the mediolateral column of the spinal cord from the 12th thoracic segment to the 2nd lumbar segment were normal before entering the celiac ganglion and located in the aorta. .
However, when the aorta branched to form the renal artery, the renal sympathetic nerve that should have accompanied the renal artery fused with the renal artery in the narrow section.
That's why!
Because of the thermal stimulation of radiofrequency ablation, the local anatomical structure changes, resulting in renal artery stenosis, and at the same time, the renal sympathetic nerve is also fused with the renal artery because of the exudate material wrapping.
When the stent goes in and the renal artery in the stenosis is opened, it also stimulates the renal sympathetic nerve, so that irreversible high blood pressure occurs.
The transmitter released from the postganglionic fiber terminals of the renal sympathetic nerves is norepinephrine, which regulates renal blood flow, glomerular filtration rate, tubular reabsorption, and renin release.
When the renal artery and renal sympathetic nerve are stretched by the stent and the nerve is compressed, a series of physiological processes have changed.
Zheng Ren looked at the experimental subject on the operating table in the operating room of the system and began to meditate.
Now that the problem is found, what should I do?
He was not in a hurry to end the operation. Although it had become a scene of forensic autopsy, Zheng Ren still did not end the process.
First, the stent was used to measure the fusion site of the renal artery and the renal sympathetic nerve, and it was found that no matter how the angle was changed, it was absolutely impossible to avoid compressing the renal sympathetic nerve while the stent opened the renal artery.
Zheng Ren hesitated for a moment, changed his mind, and began to prepare to use surgical methods to solve such a problem.
Surgery, peeling off the renal artery and sympathetic nerve... Just thinking about it, Zheng Ren's head becomes two big.
The difficulty of this operation has soared to the sky!
Although his general surgery skills had reached the level of a master, Zheng Ren was still not sure.
But since you have found an idea, give it a try. The big trotter of the system did not give an S-level surgery classification, which proves the difficulty... The difficulty is still very high, Zheng Ren sighed.
Such a difficult task, but there are not many rewards. Is the big pig's hooves down? Zheng Ren slandered in his heart.
At the beginning of the second operation, the subject was placed in the lateral position, and the abdominal aorta, renal artery and renal vein were exposed along the retroperitoneal route through a longitudinal incision at the waist. The renal sympathetic nerve accompanying and fused with the renal artery and renal vein was carefully dissected under a dissecting microscope.
However, Zheng Ren discovered an advantage.
During normal dissection, it is also necessary to avoid fascia and other nerve tissues being mistaken for renal sympathetic nerves.
But for this patient, only retrograde dissection is enough.
This can reduce many surgical procedures and shorten surgical training time.
Zheng Ren has already made a plan. There are not a thousand or eight hundred surgeries for such a difficult operation, so he probably won't be able to do it.
The dissociation process was relatively smooth at the beginning.
However, under the microscope, there was a little bit of dissociation, less than 1cm away, and the blood pressure of the test subject suddenly rose, and then the system reminded Zheng Ren that the test subject had died due to the rupture of a cerebral blood vessel due to high blood pressure.
Zheng Ren was taken aback.
Is this all right? I have been very careful, I used a 20 times microscope, and the operation under the microscope did not seem to touch the renal sympathetic nerve.
But the death of the experimental subject is a fact, there must be something wrong.
Zheng Ren started the operation again.
The result remains the same.
And then... death again.
The experimental subjects died again and again, and the surgical training time was quickly consumed.
After Zheng Ren failed the 78th operation, he finally hesitated. Although he is still sure that the method he chose is correct, but the operation has repeatedly failed, and he always has to find the reason.
Definitely not a matter of technique.
He didn't continue the surgical training, and he didn't bother to look at the mocking expression of the little white fox, so he went straight out of the system space.
"Su Yun, are you asleep?" Zheng Ren asked.
"If you don't talk, I'm already dreaming."
"Dreams are a manifestation of poor rest. Being unable to enter a deep sleep will have a great impact on the body." Zheng Ren said.
"What's the matter?" Su Yun didn't argue with Zheng Ren, but got up and asked.
"I read the patient's case and surgical procedure, and I highly suspect that the renal sympathetic nerve fuses with the renal artery. After the implantation of the stent, the renal sympathetic nerve is stimulated, which leads to malignant and intractable hypertension." Zheng Ren said.
Su Yun frowned.
It's just the operation process, can you see the renal sympathetic nerve? Isn't this nonsense?
But he didn't ask Zheng Ren how he found out, because there was only one answer - insufficient technical level.
Su Yun rarely makes fun of himself.
"When you had a heart transplant, how did your nervous system work?" Zheng Ren asked.