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  The doctors in the outer hospital are like the martial arts masters who show their faces and speak up and down when they talk about problems. The teachers in their own hospital do not give lectures. The medical students who came to the lecture for the first time were going to be confused, like the trainee Fan Yunyun, who felt that her head was about to be confused.

   It's not easy to learn from Senior Sister Xie. Senior Sister Xie can enter such an important operation to help show her face in front of her colleagues across the country, but she still hasn't figured out how this operation is done.

  Senior Sister Xie told her that it is necessary to chew on hard bones. The teacher said that it is better to explore with more energy. Only with a thorough understanding of anatomy can you understand all surgical problems.

  Fan Yunyun hurriedly lowered her head, took out a thick anatomy map from her schoolbag and opened the relevant pages.

   Geng Lingfei, who was sitting next to her, glanced at the large textbook in her hand in surprise, and only then did she finally realize and realize why she had to bring a large schoolbag when she came to the lecture. It is a school self-study class when people give lectures.

   Looking at her movements, Geng Lingfei frowned and turned his head back: Well, all the movements of this trainee seem to be intentionally or unintentionally robbing him of the teacher.

   "You said they were talking about where the liver is." Fan Yunyun seemed to be asking herself.

   Geng Lingfei didn't even look at her, and didn't discuss with someone like her who robbed her teacher.

   If Dai Nanhui is interested, look at the different expressions on their faces. I always thought it was strange that these two were studying with an intern.

Turning it over, Fan Yunyun whispered to the book the key points of knowledge in her heart: The hepatic vein is formed by the portal venous system of the liver and the hepatic arterial system through the central vein and the sublobular vein, mostly in the second and third hepatic portals. It drains into the inferior vena cava.

When the patient has Budd-Chiari syndrome, the outflow of the hepatic vein is blocked, so between the unobstructed hepatic vein and the blocked hepatic vein, the subcapsular arch of the liver and the sinusoidal space of the liver parenchyma, the phrenic vein and the hepatic vein between each other, the liver Between the veins and the short hepatic veins, between the interlobular and the perihepatic adhesions, between the ligaments around the liver, etc., the collateral circulation that the doctor in the outside hospital just said can be widely formed.

   Then there is the third porta hepatis, which has a large number of small and medium veins called short hepatic veins, with as many as thirty or fifty branches. The above elements constitute a huge risk of uncontrollable bleeding if the doctor does not handle it properly during the operation, resulting in the death of the patient on the operating table.

   The point of needing to establish cardiopulmonary bypass in this surgery is here. The inferior vena cava is a large channel for blood to flow back to the heart. Once blocked, venous congestion in the following segments may occur. How serious this problem is, sometimes it can cause kidney failure in the lower segment. In addition to this, most of the collateral circulation formed in patients with Budd-Chiari syndrome during the disease process are small blood vessels. Once the large channel is blocked, these small blood vessels will be detonated like a large minefield. At that time, the blood will flood into the sea, and the doctor has only a few hands, how can he deal with such a large minefield bursting blood vessels.

  Bleeding is uncontrollable is this horrific consequence.

   Got it, got it. Fan Yunyun nodded, Senior Sister Xie was amazing, it really was the most important thing to read and understand anatomy well.

  In this case, why do doctors hesitate to use this cardiopulmonary bypass?

   The reason is very simple. It is definitely not a good thing to do deep hypothermic anesthesia and circulatory arrest to the patient when it is not necessary.

   (end of this chapter)