godfather of surgery

Chapter 341 Surgery in Theory
Takahashi's speech received a round of warm applause, and those wonderful drawings were constantly praised.

"Dr. Takahashi, with your surgery, after the reconstruction of the anus, the nerve reflex controlled by the muscles is opposite to the natural anal sphincter. The anal sphincter usually contracts and closes, and only relaxes and opens when defecating. The pectoralis minor muscle you sampled is usually in a relaxed state. , will only shrink when exerting force." A graduate student asked.

Those who can ask questions are those who study hard at ordinary times. Otherwise, their heads are all muddled at this time, and they would not ask questions.

"You lack basic knowledge of prosthetic and reconstructive surgery—" As soon as the words came out, Takahashi immediately realized that his tone was wrong, and turned to look at Yang Ping. There was no abnormality on Yang Ping's face.

He confirmed that Yang Ping did not notice the tone of his off-line just now, paused, and continued, but his tone has been suppressed: "Biofeedback stimulation is used after the operation to rebuild the coordination of the contraction of the transplanted muscles, that is, we train the muscles. , keep it contracted and closed at ordinary times, and relax and open when needed."

"The discharge of stool is not only the opening of the anus, but also the rhythmic contraction and peristalsis of the rectum, which pushes the stool down until it is discharged. The patient's rectum and sigmoid colon are both defective. How to solve this problem?" Some doctors asked more acute questions.

Academic debates, disapproval of relatives, and whoever is reasonable is the boss. These guys are usually immersed in technical research and do not have the tact and sophistication of social people.

"This problem does not exist. The entire intestinal tract has peristaltic propulsion capabilities, and the descending colon is no exception. Although the descending colon does not have the strong thrust of the lower rectum, in view of the principle of adaptability between human anatomy and function, with the increase in the number of times the reconstructed anus is used , the thrust of the descending colon will gradually increase to suit its working position."

"You just mentioned that the sphincter muscle comes from the pectoralis minor muscle, but you didn't mention where the material for urethral reconstruction comes from? I'd like to know what material you plan to use for urethral reconstruction? Is it the front wall or the back wall of the bladder?" Deputy Director of Urology Department asked the chief physician.

He has also done urethral reconstruction, so he is naturally concerned about this aspect. Yu Shuilian is missing almost the entire urethra. For such a long distance, what material is the best to use? If the bladder wall mucosa is used for reconstruction, it may not be enough.

"The colonic mucosa can be used to reconstruct the urethra, which is enough material, and there is no limit to the length of the urethra. This method comes from the Sixth Hospital of Modu, and I have improved it."

Urethral reconstruction is the field of urology, but Takahashi is a compound trauma surgeon, and his level in this area is no lower than that of any urology expert who is good at urethral reconstruction in the world.

There were a lot of questions, including graduate students who had just debuted, and doctors with high professional titles in their majors. Relying on his extensive and profound knowledge, Takahashi handled every question perfectly.

Takahashi is known for being aggressive at international academic conferences. He once singled out a few Yankees at a trauma surgery conference in North America, leaving them speechless.

I was too excited today and almost went offline, but fortunately I stopped in time so that no serious consequences were caused.

Of course, this serious consequence is also the serious consequence that Takahashi himself thought.

Nervousness and self-confidence are intertwined. Because Yang Ping is sitting under the podium, he is nervous. The student mentality makes him always take care of Yang Ping's expression, for fear that he will not perform well.

Confidence is in front of the audience. He is used to high-spirited speech, so confident that he will inevitably go offline when he is excited.

When it was Song Zimo's turn, the surgical atlas he showed was even more beautiful than Takahashi's. Perhaps influenced by Professor Zhang and Yang Ping's guidance, his surgical atlas had a strong sense of three-dimensionality, which was more visual than Takahashi's flat graphics The effect is definitely better.

Takahashi's surgical design is already very perfect, many things overlap, and he just went through the same place briefly, and mainly added what Takahashi didn't talk about.

"The patient's ovaries, fallopian tubes and uterus have been preserved. We can't just focus on the reconstruction of the urethra and anus. We should consider reconstructing YingDao to solve the female patient's periodic endometrial collapse and discharge problems associated with bleeding."

"The patient has given birth. In this special case, it is meaningless to preserve the uterus. Why can't the uterus be removed? In this way, there is no need to reconstruct the YD, which reduces trouble." A newly recruited doctor in the Department of Traumatology and Orthopedics proposed a simpler method.

Can be excised, why rebuild? No need!The questioner's logic is clear.

"Hysterectomy not only leads to the failure of normal pregnancy, but also may cause ovarian function decline, estrogen secretion disorders, abnormal blood lipid metabolism, etc. Endocrine abnormalities may affect the spirit and psychology, and it is not ruled out that it will lead to depression."

"One step of trouble for us, the convenience of the patient for a lifetime."

Song Zimo's thinking is just the opposite, it can be rebuilt, why cut it off.

It can be ninety points, why am I only staring at sixty points.

Discussions among top students naturally marginalize ordinary students, which is an unchangeable reality.

The discussion made Song Zimo and Gao Qiao the protagonists, and even Xu Zhiliang of the trio was under great pressure.

If clinical experience is regarded as card strength and personal IQ is regarded as card skill, this kind of discussion is like playing cards.

When the card strength is evenly matched, the technique can only be used. If the card strength is seriously skewed, any technique will not affect the ending.

Takahashi had the best hand, Song Zimo had the best poker skills, Xu Zhiliang didn't have the upper hand, there was a gap between Song Zimo's poker skills and Takahashi's poker strength.

But he was not discouraged because of this, instead he was high-spirited, happy that he was able to join such a team, and grateful to Yang Ping for not despising his birth defect and giving him a precious opportunity.

Gao Yuan, the director of the Sports Medicine Center, is too busy. He has just finished dealing with the matter at hand and hastily rushed here. He will definitely attend the general orthopedics meeting, case discussion, preoperative discussion, and small lectures as long as he is free.

When Director Gao arrived, the conference room was already crowded. There was a rounded rectangular conference table in the middle, surrounding the conference room with a distance of one meter. There were three floors inside and three floors outside. Even the entrance was crowded with people.

How does this get in?Regardless of his identity, Director Gao had to squeeze in. He turned his body sideways and exerted brute strength to squeeze in. An intern was staring at the electronic screen with his ears upright listening. At this moment, he Damn, a person is always pushing around.

In a moment of anger, the intern didn't even look at it. He slammed his body in the direction of the squeezing force, and shook violently. Director Gao staggered backwards and almost fell down.

"Squeeze your head, the inside is full, don't come earlier." The intern cursed in a low voice, but his eyes were still fixed on the screen.

Director Gao managed to stand still and wiped off his sweat. Everyone concentrated on listening to the speech inside, but no one paid any attention to him.

Lao Gao didn't bother with the intern either. There were two doors in the conference room, and one side couldn't be squeezed in. If he moved to the other side, the other side was almost the same, airtight.

There was no way, Lao Gao asked the nurse for a chair in the ward, put it at the door, found a piece of paper to support it, stood on the chair, and only then could he see the inside.

Fortunately, everyone was more disciplined. Except for the speaker, no one else spoke, not even a few words in a low voice, but they could be heard clearly. Song Zimo was already speaking.

Yang Ping should not have spoken yet, he should be the last to speak, Director Gao is glad that he is not too late.

When Gao Qiao heard Song Zimo's proposed YD reconstruction, he couldn't help but feel ashamed. Indeed, he didn't think so thoroughly.

Song Zimo really deserved to be Dr. Yang's assistant, and his consideration for this patient's operation was even deeper than his own.

It was impossible for Xu Zhiliang's surgical plan to surpass Takahashi's. After he stepped onto the stage, Zhang Lin trembled subconsciously.

Seeing Xu Zhiliang open his mouth, Zhang Lin became anxious, but Lao Xu did not stammer when discussing the case: "The operation plan has been perfected before, and I only have one immature suggestion. After the patient loses his lower half, he loses his sexual characteristics. From the patient's psychological considerations, the shape of WaiYin can be reconstructed, which is more acceptable than the abrupt appearance of pores, and at the same time, the natural WY structure of women can protect the urethral opening and reduce the possibility of urinary tract infection."

Xu Zhiliang's suggestion is not necessary, and most doctors would not even consider this issue, but Xu Zhiliang considered it and bravely raised it.

There was another round of discussion, people around asked questions, and members of the general orthopedics department argued with each other. Finally, it was Yang Ping's turn to speak.

Everyone looks forward to the stars and the moon. The climax of the meeting is now, especially Lao Gao, whose legs are numb because of this moment.

Yang Ping stood on the podium, and dozens of mobile phones secretly pointed at him, and his memory was not as good as the mobile phone video.

Let’s go through a dozen or so pictures first. For any meeting, just looking at these pictures is enough. If you don’t know, you may think that the photos of the human body are taken by a black and white camera, and the key photos will not have such a three-dimensional effect.

These pictures also borrowed the split-shot expression method of comics to clearly show the steps of the operation, and there are close-up zoom-in shots for key steps.

He briefly summarized everyone’s plans, and then added his own opinion: “In addition to rebuilding the sphincter, bladder mucosal transplantation is also required to reconstruct the defecation function. Part of the bladder mucosa is moved to the inner surface of the descending colon. There are pressure receptors in the bladder mucosa. These baroreceptors are used to recreate the urge to defecate and establish true voluntary bowel function."

To transplant the bladder mucosa, it is necessary to connect the nerves, and the dissection of the small unnamed nerves is difficult, otherwise many surgeons will do it.

Mucosal transplantation, without taking into account the connecting nerves, the baroreceptors cannot transmit signals to the centers of the brain and spinal cord as if they were not present.

If you can find anonymous neural connections, and then use biofeedback training, recovery is entirely possible.

However, to find the innominate nerve of the bladder mucosa, there must also be a length that can connect the pudendal nerve and its branches, which is something that surgery cannot do at all.

Takahashi has done research in this area, but ended in failure.

Many top urologists and reconstructive surgeons in the world have also tried, but all ended in failure.

This is destined to be an unrealizable operation that can only exist in theory.

(End of this chapter)