Chapter 816: Prohibited Ventriculoperitoneal Shunt
This is also the reason why Jing'an People's Hospital dare not perform surgery.
The director of the gastroenterology department said: "If there are fewer worms, the worms can be removed from the intestines, but judging from the CT scan, there are too many worms in the patient's body. If you want to treat it, I'm afraid the only way is to remove the intestines..."
Director Lin also said: "Lesions in the brain are much more complicated. Theoretically, as long as the brain abscess is incised and drained, the pus and internal parasites are removed, and the lesions are thoroughly cleaned, the problem can be solved... But the patient also And severe cerebral edema!”
This is a fatal problem.
There is a basis for cerebral edema. If you clean up the parasites rashly at this time, it will almost certainly lead to a severe allergic reaction and make the edema more serious.
In this case, the rapidly worsening edema will lead to an increase in intracranial pressure and a greatly increased incidence of cerebral herniation, which is the real fatal problem.
Xiaojie can at least survive for a while due to insect infection.
But if a brain herniation occurs, death is only a matter of minutes.
The director of the Hepatobiliary Department put forward a plan and said: "Our department has made a lot of plans. For Xiaojie's disease, we can rely on artificial livers to make the transition..."
Hearing this, Xu Qiu nodded slightly.
This method coincides with his idea.
Artificial liver is a commonly used clinical treatment method. It refers to the use of mechanical, physical, chemical or biological devices outside the body to remove various harmful substances, supplement necessary substances, and improve the internal environment, thereby temporarily replacing part of the functions of the failing liver.
Xiaojie's liver was affected by Angiostrongylus infection and was severely damaged, and his liver function was abnormal.
But his liver itself was fine.
Therefore, the transition to an artificial liver can create conditions for liver cell regeneration and liver function recovery. After Xu Qiu's liver cleansing operation, the liver will slowly recover its functions and return to a state close to normal, completing liver treatment.
The problem of abnormal liver function can be solved.
Next, there are only worm lesions in the brain and intestines.
After discussing for nearly half an hour, we finally stopped at the step of brain abscess removal and intestinal tube removal.
In fact, this is the only solution, but it is extremely difficult to implement.
"Dr. Xu, what do you think?" Director Lin asked for help skillfully.
Xu Qiu thought for a while and said: "Abscess removal is not a problem. What is bothering you about brain deworming now is cerebral edema?"
Director Lin said worriedly: "Yes, mannitol has basically reached its limit. It is basically impossible to rely on drugs to reduce blood pressure. In this case, if an allergy aggravates edema, the patient's life will be in danger..."
Xu Qiu smiled faintly and said, "Didn't you already tell me the solution?"
"Huh?" Director Lin was stunned for a moment, but he quickly came to his senses, "Dr. Xu, what you mean is... if medication fails to reduce blood pressure, surgery is required?"
There are five commonly used clinical treatments for intracranial hypertension.
The first, and most commonly used, is medication to lower blood pressure.
For example, 20% mannitol; or hydrochlorothiazide, acetazolamide, triamterene, etc. The drugs have different characteristics, different dosages, and are applicable to different situations.
But for cerebral edema caused by parasites like Xiaojie and eventually intracranial hypertension, 20% mannitol is commonly used to reduce blood pressure.
Now that it has failed, it is natural to rule out drug antihypertensive methods.
The second method of reducing blood pressure is hormones.
and hibernation hypothermia, external cerebrospinal fluid drainage, and assisted hyperventilation.
Each of these four methods has its own advantages and disadvantages.
Nowadays, the only thing that may be useful is probably external drainage of cerebrospinal fluid.
This is also the most effective method - since the intracranial pressure is too high, draining some of the fluid in the brain can naturally lower the pressure.
"Not enough." However, Xu Qiu rejected the cerebrospinal fluid drainage method.
Director Lin didn't react for a moment: "Not enough? The amount is too small?"
Xu Qiu nodded and said: "Based on Xiaojie's infection situation, once the operation is carried out, the allergic reaction will not be too mild, and the resulting cerebral edema will be severe. Just relying on the small amount of cerebrospinal fluid drained out will not be able to meet the need for blood pressure reduction. ”
"If you want to achieve a large amount of drainage... Doctor Xu, are you planning to do a ventriculoperitoneal shunt?!" Director Lin thought of a possibility and his mouth suddenly opened wide.
Ventriculoperitoneal shunting and cerebrospinal fluid drainage are not the same level of surgery.
The former is one of the most effective ways to treat hydrocephalus. It is a technology that has only emerged in recent years. It is very invasive and has very good curative effect, but it requires high technical skills from the surgeon.
The operation requires drilling a hole in the skull, then inserting a special ventricular drainage tube into the ventricle through the hole in the skull, and then passing the drainage tube through the subcutaneous channel into the abdominal cavity, and then absorbing blood through the omentum in the abdominal cavity!
Thinking of this, Director Lin quickly shook his head.
No, that's not right... The patient's cerebrospinal fluid is very likely to be infected with parasites. If the water from the cerebrospinal fluid is drained into the abdominal cavity, won't the abdominal cavity be filled with parasites?
This solution will never work!
"It really doesn't work." The director of the gastroenterology department also realized the problem.
He analyzed: "Although ventriculoperitoneal shunt can significantly reduce blood pressure, the shunt requires the placement of a drainage tube for a long time, and the tube itself must be strictly prevented from infection, blockage, etc. Once these two problems occur, the consequences will be catastrophic. of……
"The patient is infected with Angiostrongylus. The infection is likely to occur and may even spread throughout the abdomen.
"Another point is that larvae and adults may even enter the brain through the drainage tube in reverse, causing more serious disasters. Even if they cannot enter the brain, a bunch of worms blocking the tube will cause the drainage tube to be scrapped, and re-operation and re-tube placement will be necessary!"
Although Xiaojie's abdominal cavity is already full of traces of roundworms, but...if the infection can not be spread, it should be avoided as much as possible.
"Bad idea." The ophthalmologist said with a pout, insulting Director Lin.
Director Lin ignored him. He propped up his chin and repeatedly checked the patient's medical records like Xu Qiu, but he couldn't find a solution after thinking about it, and finally turned his eyes back to Xu Qiu.
Thigh, rely on you...
The directors present were a little embarrassed.
Although this patient himself has been sentenced to death, it is impossible to find a treatment method so easily.
Even the People's Hospital specializing in this field is helpless!
But, when they were really sent to the clinical doctor, they participated in the general consultation, and the suggestions and plans proposed by more than a dozen people were not as many as those proposed by Xu Qiu alone, which was really a bit regretful...
Director Lin glanced at the whole audience and laughed to himself.
This group of guys really have no sense of flattery...
He turned to look at Xu Qiu and asked: "Doctor Xu, if it is not a ventriculoperitoneal shunt, how do you plan to deal with it?"
——
Remember to vote for love power!