godfather of surgery

Chapter 193 Out of the Box Surgery

For the whole day on Sunday, Yang Ping was in a trance.

Little Su!Professor Su's daughter, Su Nanchen's younger sister, this question has been lingering in Yang Ping's mind. She walked down the steps in a long dress, and the beautiful and moving picture is still imprinted in his mind. Several identities are linked together. It's still hard to get used to.

No matter whose daughter she is, no matter whose sister she is, Xiao Su is right, she is Xiao Su, so Yang Ping no longer thinks about it.

When I went to work on Monday, Sisi's [-]D reconstruction came out, especially the infrared scan reconstruction, which is the image to be used directly in the operation, and the other two, CT and MRI reconstructions are just supplementary.

Judging from the images, the primary tumor has spread to the surrounding area very seriously, and has spread to the entire hip joint, and the treatment method needs to be adjusted.

There are several ways for malignant tumors to metastasize. Tumor cells are like seeds, which can be transferred out in several ways: hematogenous metastasis, seeds are transported to another place through blood circulation, take root and germinate, and settle down; lymphatic metastasis is similar to hematogenous metastasis, but different It is transported through lymphatic circulation instead of blood circulation; planting spreads, the seeds fall to another place, begins to grow, and occupies the territory; there is also direct spread, the tumor grows continuously, grows directly, and invades other places.

For local resection, the scope is too large and too destructive, so it can only be combined with surgery and ultrasonic scalpel. First, the tumor in the bone tissue is removed, the prosthesis is removed, the femur is extended, and then the ultrasonic scalpel is used to treat other surrounding tumors and distant tumors. metastases.

At around seven o'clock in the morning, Yang Ping watched Sisi's film and roughly planned the operation plan.Entering the system space, there is one last task left in the progress of sports medicine. After completing this task, you can advance to bone disease training, but what this task is and when it will be released, I don’t know yet.

After finishing the shift, I took everyone to make a ward round, and then performed a morning operation, all of which were arthroscopic operations. Most of the patients living in the ward now have arthroscopic operations, and the turnover is also very fast. Generally, the surgery is completed within two days He will be discharged from the hospital in the next day.

Word-of-mouth spreads very quickly. Many patients are referred by patients who have undergone surgery, and the accumulation becomes more and more. Slowly, the wards are almost full.

At two o'clock in the afternoon, Yang Ping gave a small lecture to everyone in the demonstration classroom. Many doctors from the whole department of orthopedics came, including several directors, Director Han, Director Tan, Director Tian, ​​Director Bai, Director Ouyang, and Director Ding. After the meeting, we will discuss the affairs of the academic meeting.

The content of the lecture is to rescue the cases of penetrating tree injuries on the stone slope, and to perform out-of-the-box surgery under the blockage of great vessels.

This surgery is extremely difficult because large blood vessels and internal organs are often involved.Anyone who has watched "Grey's Anatomy" knows a scene where two people face each other and are pierced by a steel bar. The doctor is in a dilemma. The doctor wants to pull out the steel bar so that one can survive and the other can only die. How cruel!

Because the woman had damaged the aorta, the doctor decided that it was impossible to save her, so she had to sacrifice her to save another black man with less damage.

The aorta is the real dead artery. Once damaged, a lot of blood will be lost in a short period of time, and the fastest one can die instantly.

This dilemma segment of "Grey's Anatomy" was constantly shown on the screen, played repeatedly, and then frozen in a picture, two people facing each other, sitting in an ambulance, and being pierced by a steel bar.

Yang Ping pointed to the screen and said: "Everyone, don't be misled by the TV. On the TV, the two patients are both conscious and chatting happily, which means that the vital signs are stable, at least the blood pressure is temporarily stable. In this case, the other should be sacrificed. Why? ? Why can't you save two?"

"No way, the director arranged it!" Someone said, and everyone laughed.

Yang Ping also laughed, and continued after laughing: "In Anzhen and Fuwai in our country, aortic dissection rupture is much more dangerous than this, and the success rate of rescue is very high, not to mention that after this kind of aortic injury, you can still talk and laugh? Not to belittle others, but to think scientifically! The surgical method on TV is extremely backward, and they actually use the method of pulling out the steel bar, which is tantamount to gambling with their lives. In this case, the steel bar must not be pulled out. Steel bars, everything will get out of control, pulling out the steel bars is like dismantling a bomb, you don’t have to think about anything, just snap a few wires at will, is that okay? Of course not! So what shall we do?”

Everyone listened carefully, everyone who came to the class knew that Yang Ping’s class was full of dry stuff, especially when talking about surgery, it was definitely not based on the scriptures, but the refinement of his own experience. As for how his surgery was, needless to say, the miracle he created was not One or two.

Among the young doctors, some bowed their heads to take notes, some used tablets to record, and some simply used their mobile phones to directly watch the video, so as to save trouble and listen slowly when they went back.

"If we were to rescue these two patients, think about it, how can you pull out the steel bar for an operation? We are not evaluating TV today, but just using this case to elicit our thinking!" Yang Ping Ask questions to indicate the purpose of borrowing the TV.

The people in the audience were eager to try, someone raised their hand, and a young doctor from the Department of Traumatology and Orthopedics stood up: "I have always felt that this is not advisable, why not saw off the steel bar from the middle, so that the two people can be separated, and the operation can be performed in two groups? Cut off the steel bar When using continuous cooling and some shock-absorbing measures!"

Yang Ping asked him to sit down: "Very good! This doctor is very correct. To deal with this case, instead of pulling out the steel bar, he sawed off the steel bar, separated the two, and two groups of doctors completed the operation. This is completely achievable and accurate. To be honest, this is already the third step, before that, there are two more steps?"

Everyone was silent, unable to remember for a while, a doctor in the trauma ICU raised his hand and said uncertainly: "Should you transfuse blood?"

"Yes! It's such a simple step. This is the first step. Blood transfusion! This is the most common, most effective, and indispensable step. You can understand it in this way. If trauma is life-threatening, it is only blood loss, without causing trauma. Fatal injuries to vital organs, such as severe craniocerebral injuries, can be saved theoretically, it depends on whether you can stop the bleeding and follow up with blood transfusion within the effective time. The first step Blood transfusion and rehydration to maintain blood pressure; the second step is to judge the injury and make a basic judgment on the injury. If conditions permit, a quick CT scan can be performed; What about the fourth step?" Yang Ping activated everyone's thinking.

"The fourth step is our preoperative great vessel occlusion, which directly blocks the great vessels. Just like this patient, it has been confirmed that the aorta is injured. Judging from the location, we can perform high abdominal aortic surgery on the injured part. The artery is blocked, which is equivalent to closing the main valve and controlling all the bleeding of the wound, but this blocking is time-limited. The abdominal aorta is blocked for 30 minutes. It is safe. We will end the battle within 30 minutes. The patient can be rescued safely. On the one hand, the blood vessel is blocked to completely stop the bleeding, and on the other hand, blood and fluid are transfused to replenish the lost blood, so as to temporarily obtain a volume balance and strive for a safe operation time." Song Zimo participated in this operation, he answered the question.

"But, is this an extremely risky operation?" Someone worried.

Yang Ping said to everyone: "Every operation of ours is high-risk. Our surgery is like flying a fighter jet. Nothing is absolutely safe. It is an essential feature of surgery to complete all operations at risk, so everyone should have rich experience. With advanced knowledge, skillful operation, calm mind, blocking the large blood vessels, we have entered the fifth step, out-of-the-box surgery!"

There was an uproar in the audience, I had never heard the word out-of-the-box surgery!
Yang Ping stood in the middle of the demonstration classroom, waiting for everyone to be quiet, and said: "This is the essence of today. I have thought about opening the box for a long time. I chose a word. It is very simple. It is to open the box, find problems in it, and eliminate problems. , how to open the box, according to the location of the CT scan, or the location of simple judgment, open the abdomen in the abdominal cavity; The approach continues to stop bleeding and repair, and finally take it out, not to pull out, but to take out the steel bar!"

"This process is like dismantling a bomb, opening the shell of the bomb, exposing various components and wires inside, and then removing the danger step by step with precision."

"The patient in the picture, even the most severe one, could have repaired the aorta in half an hour, if not as quickly, using a large vessel bridging technique, from proximal to distal, across the injury, allowing blood Temporarily avoid the damaged part, which can not only ensure the blood supply of the lower body, but also allow you to slowly repair the damaged aorta. There is another method, which is commonly used in thoracic surgery to deal with aortic dissection, artificial blood vessel implantation, or even Minimally invasive implantation is also possible. There are many methods, why give up? You will know after watching a few interventional operations for aortic dissection. It is not difficult. If you are proficient in anything, it is not difficult. The arterial dissection operation can be applied to trauma surgery, but why can’t our usual laparotomy and thoracotomy be applied to steel penetrating injuries, and it is so stupid to pull out the steel bar.”

"That's the theory, but it's very difficult to implement!" Someone said in a low voice, after all, some people have never encountered such a thing.

The picture on the screen immediately switched to the rescue photos of Shipo Hospital: "Look, this is a living example of success, the application of theory, theory guiding practice, practice improving theory, don't separate theory and practice!"

This case is much more serious than the ones on TV, and they were all rescued. Yang Ping said: "I am not the only one who successfully rescued such patients. Many hospitals in Moliu, Jishuitan, and many hospitals across the country have successfully rescued very serious trauma. I can say responsibly that if these two patients appear on TV in Magic Six and Jishuitan, both of them can be saved without sacrificing the other. Bo, two of them can also be rescued."

Director Han stood up and said to everyone:
"Soon, we will hold an academic conference. The large-scale trauma emergency surgery will be broadcast live at the conference. The Affiliated Hospital of the University of Tokyo will be broadcast live at the same time as me. Director Tan has already obtained the full-process video of some of their large-scale trauma emergency operations. Wait for everyone Let’s take a look, what is the world’s top rescue process, how is the operation done, how is the team coordinated, everything is done, done well, and done to the extreme, all of which are in a completely different realm. We all know that the cure rate of gastric cancer in Japan is more than 80.00%, what kind of concept is this? Ours is 30.00%, and the United States is 60.00%!"

Next, Yang Ping explained in detail the surgical details of the case of penetrating tree injuries in Shipo, how to block the blood vessels, how to open the box, how to explore, and how to repair.

　Finally published three chapters, more than [-] words!
　　The TV with the steel bar penetrating injury is "Grey's Anatomy". I have watched it for too long and it is confusing. I hereby correct it!sorry!

　　
　
(End of this chapter)