novelraw Chapter 457 - 334: Super-Long Atresia, First Case in China
Chapter 457 - 334: Super-Long Atresia, First Case in China
Peking Union Medical College Hospital Neonatal Department,
Inside the operating room, Director Qian Hong from the Obstetrics Department and Director Chen Jiang from the Pediatrics Department had already begun preliminary preoperative preparations.
Since esophageal atresia surgery requires reconstruction of the stomach and esophagus, all imaging must be completed before surgery.
There is particular concern about whether there will be associated malformations, such as congenital heart disease, imperforate anus, congenital small intestine atresia, hydronephrosis, skeletal malformations, etc.
If associated malformations appear, surgery may not be possible.
"Director Qian, is Qin Feng really up to this?"
Pediatrics Director Chen Jiang looked at the infant on the operating table, feeling a bit worried.
"Since Old Dong recommended him, there shouldn’t be any problem."
Qian Hong sighed, comforting,
"Besides, Qin Feng’s surgical skills are unparalleled among the younger generation at Peking Union Medical College Hospital, and in many aspects, he has already surpassed us.
The intensive care specialists value him so highly; there must be a reason for that.
Rest assured."
After speaking, the two of them looked at the infant on the operating table, who was less than two hours old.
The sanitation worker who brought the baby had left, and only two police officers remained outside waiting.
Due to the special circumstances, she immediately called 110 and 120, and the police swiftly retrieved surveillance to investigate the pregnant girl who gave birth.
After all, she had just delivered in an environment with pathogens, and without timely medical treatment, any massive bleeding or infection could be life-threatening.
Of course, the child also needs someone to care for them. The hospital can provide medical assistance, but if the child becomes an orphan, that would be very troublesome.
This would also significantly harm the child.
Ding~
A while later, Qian Hong’s phone rang.
She moved aside, and the circulating nurse helped open it, seeing the message from Qin Feng.
"Qin Feng has arrived. We can begin."
"Okay."
Hearing this, Chen Jiang nodded and then looked at the anesthesiologist nearby,
"Begin anesthesia."
After speaking, the anesthesiologist began operating.
Because the infant is so small, intravenous and inhalation anesthesia are not suitable, and it’s best not to use a pressure mask to prevent anesthetic gases from entering the stomach through the tracheoesophageal fistula, causing gastric distension.
Therefore, they used endotracheal intubation anesthesia with multiple pressure adjustments this time.
Intubating anesthesia for an infant is extremely meticulous and challenging, demanding high skills from the anesthesiologist.
"Listen."
Soon, as the anesthesia doctor gently inserted the catheter into the trachea, they stopped once it could go no further, rotating the tube while applying cuff pressure to inflate the lungs.
"Secure it."
The nurse beside him placed a stethoscope to help him, and upon hearing the words, quickly secured the tube with tape,
At this point, the tube exceeded the tracheal and tubular fistula opening level, facilitating left lung single ventilation and preventing gas from entering the stomach through the fistula during pressurization.
If the tracheal insertion is not deep enough, causing both lungs to inflate, right lung expansion would hinder surgical operation.
Moreover, if gas enters the stomach, when re-pressurizing during lung inflation, gastric fluids refluxing into the lungs could easily cause postoperative pneumonia.
"Monitor the values."
Once anesthesia was complete, the physician moved aside to focus on the infant’s physiological indicators.
Whirr~
Just then,
The operating room door opened, and a figure in deep green surgical attire walked in, hands raised.
"Director Qin, you’ve arrived."
Seeing the person, a hint of delight appeared on Qian Hong’s face.
"Director Qian, Director Chen."
Qin Feng nodded, then glanced at the operating table,
"How is the situation?"
"The fistula is completed, and anesthesia has just finished; we can start the surgery at any time."
Qian Hong said, as the nurse brought the surgical gown for Qin Feng to wear and tie.
"Alright, give me a few minutes."
Qin Feng nodded slightly, walked directly to the operating table to examine each part of the imaging.
Since he was breaking down alcohol on his way and had no time to be distracted by the materials, he could only wait until he was on-site.
However, this didn’t make much difference to Qin Feng because he had in his mind details of over a thousand surgeries for ultra-long esophageal atresia.
In terms of surgical experience, he alone in the world could master the entire surgical process simultaneously!
Based on imaging, the esophageal atresia exceeded 5cm.
This completely meets the criteria for ultra-length because the infant’s esophagus is inherently short.
"Do the two directors have any surgical plans?"
Qin Feng asked as he examined.
"Generally, esophageal atresia surgery would choose to extend the child’s own esophagus and connect the two ends to form a new esophagus."
Chen Jiang replied upon hearing,
"But now the child’s esophagus is missing too much, making extension anastomosis impossible. I suggest esophagus replacement."
Esophagus replacement!
This indeed is a reasonable surgical plan and is the safest preoperative method with the least surgical risk.
However, ultra-long esophageal atresia has a significant issue with postoperative healing.
Especially esophageal strictures!
The recurrence rate exceeds 90% post-surgery!
This currently constitutes the biggest difficulty for this type of surgery.
"Alright."
Qin Feng responded softly.
At this moment, various different surgical plans had already appeared in his mind.
Esophageal replacement, as the first option, was directly dismissed by him.
To ensure the child’s postoperative recovery and future health, this method was definitely not the best.
The second method, stomach for esophagus.
Remove and open the atretic part of the esophagus, lift the stomach upwards a certain distance, reconnect it, and shorten the esophageal length.
However, this easily increases problems such as reflux, esophagitis, or other various stomach issues post-surgery.
Moreover, this method is also commonly used in esophageal cancer resection surgery.
...
About 5 minutes later,
Qin Feng withdrew his gaze, having already determined the final surgical plan in his mind.
Small intestine esophageal replacement!
Use a portion of the child’s small intestine to replace the atretic esophagus!
This method is very complex and takes a long time, and at least for now, a complete surgery cannot be performed.
Because the excised small intestine needs to undergo cultivation inside the body.
Only then can surgical anastomosis be performed to form a new esophagus.
The difficulty is high, but postoperatively, it has the least impact on the child’s future life.
After all, the child is still very young, with a long road ahead.
"Director Qin, what do you think?"
Qin Feng walked back to the operating table, Qian Hong asked.
"Here’s the plan, Director Chen will first perform gastrostomy, while I will strip the small intestine for in vivo cultivation. We will then perform surgery in two months, using the small intestine to replace the esophagus."
Qin Feng looked up at the two, speaking seriously.
"Small intestine replacement for esophagus?"
Hearing this, Chen Jiang was taken aback then slightly frowned.
As a pediatric director with considerable expertise in neonatal congenital malformations, he immediately felt a bit heavy-hearted.
He was well aware of the difficulty of this surgery, and of course, the benefits as well.
But he was surprised by Qin Feng’s method, directly performing in vivo small intestine cultivation, which was undoubtedly a domestic first.
And the difficulty, much higher!
This means selecting a section of the small intestine directly within the child’s abdominal cavity, freeing it from most of its vascular stalk without removal or damage, leaving only the lower part to maintain basic supply.
This section of the small intestine would simulate and adapt to a low perfusion circulation, similar to the esophagus, increasing the success rate for later transplantation and recovery.
"You want to cultivate the jejunum?"
Chen Jiang asked in a deep voice.
"Director Chen is correct."
Qin Feng said with a gentle smile.
As he spoke, Chen Jiang couldn’t help but feel a shiver down his spine, looking at him in shock.
Damn! This young man!
The courage is astounding!
Jejunum cultivation is rare not only domestically but even internationally, and it’s not guaranteed to succeed every time.
Most importantly, no lead surgeon can perfectly free vascular stalks every time, ensuring low perfusion circulation success.
This level of difficulty in surgery is absolutely unprecedented domestically!
And now Qin Feng wants to do it, which seemed somewhat daring to him.
"If Director Chen believes in it, you can try it with me."
Qin Feng looked at him with a smile, his tone resolute and calm.
"Are you confident?"
Chen Jiang frowned deeper.
"Yes."
Qin Feng nodded.
Beep~~~Beep~~~~Beep~~~~~
The operating room fell silent, leaving only the sound of the monitor.
"Alright, let’s give it a try."
A few seconds later, Chen Jiang finally made up his mind.
He wasn’t believing Qin Feng blindly but was rather excited that someone could devise and be willing to execute such an imaginative and bold surgical method.
He admitted that if it were him, he might think of it but would never do it.
Because there’s risk involved!
But seeing Qin Feng’s confident eyes, he couldn’t help but feel some restlessness and heat in his heart.
As if rediscovering the tension and excitement of every surgery in his youth, the pride between saving lives and confronting life and death!
Thirty years, he’d saved more and more people, but his courage had diminished.
Sometimes, for safety’s sake, people sacrifice certain things when attaining fame and fortune.
The word ’expert’ carries a lot of weight~~~
"Shall we begin?"
Qin Feng smiled at the two, asking.
Qian Hong and Chen Jiang exchanged glances, then silently nodded.
"Surgery start time, October 21, 2022, patient newborn, esophagotracheal fistula and jejunum cultivation."
Qin Feng stood at the lead surgeon’s position, looked up at the time, and said in a deep voice,
"Scalpel!"
Meanwhile, Qian Hong and Chen Jiang also started the minor gastrostomy.
Outside, the night cloaked, the cold wind blew, chilling the heart.
Several police cars sped through the night, endlessly searching for the missing girl who had given birth according to the surveillance direction....