godfather of surgery

Chapter 251 Cheese
Zhang Lin is arranging Fang Xiaoyun's emergency surgery. The computerized HIS system issued a doctor's order, reviewed the surgery, notified the operating room, and contacted Huang Jiahui to prepare the equipment.

The main products of Huang Jiahui's company are in the field of sports medicine, but in order to cooperate with Yang Ping's surgery, Huang Jiacai applied for the agency of several trauma, spine and joint consumables to complete the product line.

Yang Ping told Zhang Lin to ask Su Yixuan to prepare general surgery choledochoscope and soft mirror for use during surgery. Zhang Lin didn't know what to do with general surgery equipment, so he didn't dare to ask more questions.

Fang Xiaoyun needs an anterior thoracic surgery, open the chest and enter the front of the 9th thoracic vertebra, resect the 9th thoracic vertebra invaded by tuberculosis, and remove the oppressive material in the spinal canal.

The 4th thoracic vertebra to the 9th thoracic vertebra are dangerous areas. The blood supply of the spinal cord is fragile, and the blood supply is easily damaged. Once the blood supply is destroyed, it is easy to cause ischemia and necrosis of the spinal cord. Not only will the paraplegia fail to recover, it will also worsen, and it will be permanent sexual.

In the system space, Yang Ping has undergone a lot of training in anatomy and spinal trauma surgery, but he has not done any surgery for spinal tuberculosis.

With his experience in spinal trauma surgery, it was very easy to get this surgery, but to be on the safe side, Yang Ping went to the system space and purchased 4 cases of spinal tuberculosis surgery for special training, especially the surgery of the 9th thoracic vertebra to the [-]th thoracic vertebra , When removing oppressive substances, try not to interfere with the blood supply of the spinal cord.

Now he holds hundreds of thousands of points in his hand, as long as he doesn't just simulate surgery every now and then, this amount of points can last for a long time.

For the treatment of spinal tuberculosis, some hospitals use minimally invasive methods. For example, a professor from the 301 Hospital has accumulated rich experience in minimally invasive methods.

He believes that spinal tuberculosis can be treated with the idea of ​​internal medicine. The specific method is to use CT positioning puncture, inject anti-tuberculosis drugs into the infected site, perform local anti-tuberculosis treatment, and then cooperate with systemic anti-tuberculosis treatment until cured.

This method has caused sharp discussions at academic conferences, but it is undeniable that this professor has opened up a new idea, at least for some not very serious cases, the effect is very good.

Fang Xiaoyun could not use this minimally invasive method, and had to undergo surgery because she had already developed paraplegia. The reason for paraplegia was that the spinal cord was compressed by a mixture of pus, granulation tissue, caseous necrotic tissue, and sequestrum.

Open surgery must be performed to directly remove the oppressive substances in the spinal canal, completely relieve the compression of the spinal cord, and allow the spinal nerves to recover as soon as possible.This is in line with the three principles of spinal surgery - decompression, stabilization, orthopedics!
The comprehensive orthopedics department has its own independent operating room, which makes the operation arrangement very convenient. As long as the patient's condition permits, the operation can be performed at any time.

In less than half an hour, everything was ready. Su Yixuan and Zhou Can prepared surgical instruments, and Huang Jiahui's anterior spinal plate was in place, sterilized and ready to use at any time.

Yang Ping's team has made rapid progress. The first assistant Song Zimo is extremely talented, full of passion for surgery, and will unswervingly strive to be the best surgeon.

Now, as Yang Ping's assistant, he did not lose out in challenging Sasaki Takahashi. In the operation at the academic society, when Takahashi was in trouble and unable to advance, he could still treat ten blood vessels.

In terms of microsurgery, although there is a big gap with Yang Ping, he is already an insurmountable peak compared to others. With his current level, he can cut the tail of a newborn mouse into countless sections and let Song Zimo anastomose the blood vessels. The blood flow is smooth, and it can be done with both hands in the air.

Arthroscopy, thoracoscopy, laparoscopy, and intervertebral foraminoscopy are all extremely proficient, not to mention open surgery. Under Yang Ping's guidance, the proficiency in anatomy is by no means comparable to that of ordinary people.

If someone wants to challenge Yang Ping, they must first climb over the mountain of Song Zimo, but this mountain is very difficult to climb.

Xiao Wu Zhang Lin's status as the golden hook and the silver hook has not been clearly distinguished.

Fatty Liang, an anesthesiologist, has the same passion for anesthesia as food, and he enjoys his role from beginning to end.

Needless to say, nurse Su Yixuan, Yang Ping's most tacit partner, Tian Cheng's tacit understanding makes every operation perfect.

Zhou Can is the best itinerant nurse, and if she is on stage, she is also an excellent equipment nurse.

The most important thing is that they have experienced one battle after another, especially the surgery that Takahashi failed to win, and the team's confidence has greatly increased. They firmly believe that they are the best team in the world.

Fang Xiaoyun's important image examination films are hung on the film reading light, which is convenient for the surgeon to view at any time. There are also images on the electronic screen, which can be seen by raising the head slightly.

Under general anesthesia with endotracheal intubation, take a 90-degree left decubitus position, lift the right upper limb, place it on a hand rest, and rotate the scapula outward on the chest wall, so that the 5th and 6th intercostal spaces can be easily exposed.

Posture is very important to the operation. A good posture can fully reveal, while inappropriate or wrong posture can make it difficult or even impossible to reveal.

Fang Xiaoyun has a tracheal tube inserted in her mouth, which is connected to the anesthesia machine. The head frame is placed above her head, her eyes are closed by protective stickers, and the bony protruding parts of her body, such as the sacrum, are protected by silicone protective pads. To avoid ischemic necrosis caused by compression, a thin pillow was placed on the right upper chest armpit, so that the axillary artery, axillary vein and brachial plexus were well protected.

Zhou Can checked whether Fang Xiaoyun's upper limbs were colorless or purple, whether there was venous congestion, whether the radial artery pulse was normal, and confirmed that there was no problem. Song Zimo disinfected and spread the sheets, and everything was ready. Yang Ping put on surgical gowns and gloves and went on stage.

The sacred pre-operative check is not only to prevent mistakes in the surgical site and method, but more importantly, it is a ceremony that expresses the seriousness and dedication of the surgical team.

"Name, gender, age, hospital number, body position, surgical site, surgical method, anesthesia method, surgical focus, anesthesia focus—"

Stop all the work at hand, check everything, and every member of the operation must participate. If there is any objection, it will be raised on the spot. If there is no objection, it will be announced: the operation has begun!Only then can the knife be used.

Through the thoracic approach, along the upper edge of the eighth rib, from the outer edge of the erector spinae to the anterior axillary line, incise the skin, subcutaneous tissue and deep fascia, and continue to incise the muscles: the latissimus dorsi of the first layer, the latissimus dorsi of the second layer The starting point of the serratus anterior and the external oblique muscle is close to the outer edge of the erector spinae, and the external intercostal muscles and internal intercostal muscles are cut in the third layer to protect the intercostal nerves and intercostal arteries and veins at the lower edge of the ribs.

The parietal layer of the pleura was exposed, and Yang Ping used a knife to make a small incision in the parietal layer of the pleura. The air immediately entered the chest cavity, the negative pressure disappeared immediately, and one lung gradually collapsed.

There were adhesions between the lungs and the pleura. The tissue scissors were handed over. Yang Ping cut off the band-shaped and membranous adhesions. The lungs collapsed completely, and saline gauze protected the chest wall.

The chest opener gradually opened the chest, and the beating heart and a pair of contracted lungs were vividly presented in front of the eyes, especially the beating and powerful heart, the sound of thumping, rhythmic pulsation, which represented the power of life, From birth to death, it beats according to its own rhythm day and night.

Sometimes, you need to hold the heart in your hands for chest compressions. At that time, you can feel the magic of life the most, because life is held in your hands.

Yang Ping stopped what he was doing: "Come and have a look!"

The trainees who were watching the training, lifted up the pedals, and looked into the chest cavity with a probe one meter away from the operating bed. The heart and lungs were vividly presented in front of them.

Seeing this scene, it is easy for people to involuntarily have a sense of holiness, nobility and responsibility.

Revere life, respect life!The impact on the heart is stronger than swearing the oath of medical students a thousand times.

Life is displayed in front of you with a pulsating picture. When it stops, the whole life will disappear, and there is no connection with this world; if it is still beating, you can laugh, cry, love, hate, and experience the world. Everything is sweet and bitter.

The dissection has entered the realm of free will and perfection. The lung tissue is covered with saline gauze and gently pulled toward the midline, revealing the lateral anterior and posterior mediastinum of the thoracic vertebrae.

The whole process is carried out silently. There is no need to remind the assistant what to do in each step, the position, direction and strength of the retractor. The equipment nurse has a very detailed and in-depth understanding of the operation steps.

You don't even need to look at the knife, the equipment nurse has already handed it over, and the timing is right.The feeling of doing this surgery is very wonderful, and it is a heart-to-heart communication.

The mediastinal pleura was cut longitudinally, and the left thoracic aorta, semiazygos vein, right azygos vein, intercostal artery and vein were all exposed.

Part of these blood vessels needs to be cut and ligated in order to obtain full exposure, but the intercostal artery is one of the main blood supply arteries of the spinal cord, and the number of cut off should not exceed 3, otherwise it will cause blood supply to the spinal cord.

A real master, adheres to the concept of minimally invasive surgery throughout the operation, and does everything possible to protect blood supply and tissues.Yang Ping did not intend to cut off and ligate these blood vessels, he wanted to protect every blood supply blood vessel of the spinal cord.

Entering from the gap between the blood vessels, several operation windows will be formed in the gap between the blood vessels, so the operation will be very difficult, but for Yang Ping, this is not a problem.

Enter from the gap of the blood vessel, use a periosteal stripper, push the extrapleural aorta away from the front of the vertebral body, protect it with saline gauze, and gently put it into the retractor.

Saline gauze protects the surrounding area, and the operation space is presented. The front of the thoracic vertebral body, intervertebral disc, and anterior longitudinal ligament are about to appear in the field of vision, but what is revealed is a fluctuating sac.

This is an abscess, Xiao Su handed over a 50ml syringe, Yang Ping stabbed a small hole with a sharp knife, the sticky white-yellow "cheese", along the small opening at the front of the syringe, couldn't wait to enter the syringe tube, the syringe filled up quickly , Change the syringe and continue to suck.

The collected specimens were reserved for bacterial culture and pathological examination. Five tubes were drawn in a row, aerobic bacteria culture, anaerobic bacteria culture, tuberculosis culture, smear for acid-fast bacilli, and pathological examination.

At this time, the assistant's aspirator came into play, gently inserted it through the small opening, and removed the remaining "cheese". This aspirator was specially used to attract the "cheese". ml.

Yang Ping completely opened the cyst wall of the abscess, and repeatedly flushed and sucked it with saline until the operation area was clean, and the operation continued.

"Very beautiful!" Zhang Lin said.

Xiao Wu looked up at him: "Indeed, it's a pity that I can't smell it."

"Would it be a sweet smell?"

"I heard it's sour."

I didn't expect the cheese-like substance of the cold abscess to have such a good sense of image. Zhang Linxiaowu sighed at the same time, but the hook in his hand didn't move at all, and the strength was appropriate and fully revealed.

The golden hook and the silver hook are not just for bragging, they are won by the excellent hook performance of countless operations.

"Congratulations, you are one step closer to being an excellent surgeon."

Yang Ping has exposed the front side of the ninth thoracic vertebra, and has started to ligate the surrounding blood vessels.

(End of this chapter)