godfather of surgery

Chapter 437 Super Brain
Yang Ping is right, this case is unique, no one has done similar surgery, including dissection, it is also unique.

The anatomical relationship in the thorax and abdomen is in a mess. If you don't know the detailed medical history, you may think that the thorax and abdomen have undergone many surgeries.

The heart and great vessels are the problem, as is the liver, gallbladder and pancreas.

The patient's heart and great blood vessels were squeezed in the narrow and deformed space, and he couldn't last long, and eventually he would die of heart failure. It was not easy to survive.

This kind of deformity is not caused in a short period of time, but gradually evolved over a long period of time. The originally deformed heart and great blood vessels will seriously affect the function of the heart, coupled with the extrusion caused by spinal deformity, and the displacement caused by adhesions. The condition deteriorated, and now the large amount of ascites is the result of this deterioration.

Not only cause ascites, improper posture, but also shock.

The inferior vena cava return is blocked, the blood volume returned to the heart decreases, the right atrial pressure decreases, and the cardiac output decreases, which leads to a decrease in blood pressure. In severe cases, a series of manifestations of shock appear, and the symptoms of certain postures will be more obvious, such as supine position, Clinically, this syndrome is called inferior vena cava syndrome or orthostatic shock.

Clinically, pregnant women are prone to this special state. For example, pregnant women with abnormally enlarged uterus such as multiple pregnancy and polyhydramnios, the enlarged uterus compresses the inferior vena cava, causing reflux obstruction and causing the above symptoms.

In this patient now, there is no fetal oppression, nor tumor oppression, but the inferior vena cava wall is bent and flattened due to adhesion, spinal column and thoracic deformity, resulting in oppression, which also produces a similar syndrome.

If the fetus or tumor compresses the vena cava, the patient is prone to shock symptoms in the supine position.

Zheng Baosheng's situation is special. He will cause shock in several positions. Due to the human body's self-protection awareness, he has found these positions and consciously avoided them.

But it is dangerous to sleep at night. In case of a rapid drop in blood pressure, once you go into shock, your life will be in danger at any time.

Once in the shock position, once more than 5 minutes, shock symptoms will appear, manifested as dizziness, chest tightness, nausea, vomiting, frequent yawning, cold sweats all over the body, rapid pulse, blood pressure drop, systolic blood pressure drops below 80mmHg rapidly.

If the blood pressure doesn't drop too quickly, as with sleep apnea, he can wake up from sleep, adjust his posture, and get relief.

If the blood pressure drops very quickly and he loses consciousness very quickly, he will die in his sleep.

Since he had this symptom, his parents took turns watching over him at night to prevent him from going into a shock position.

Zheng Baosheng has survived many death threats since he was able to live till now.

"In addition to ascites, heart failure, and liver enlargement, there is not much hope of survival without surgery, and there is almost no hope of success with surgery."

Seeing that Yang Ping is so persistent, Professor Li now feels that taking risks is worthwhile.

If you don't have an operation and wait to die, you will die if you have an operation. It is better to be more active.

"What can I do?"

Originally, Professor Li thought that Yang Ping would ask him to be the chief surgeon, but Yang Ping said that he was the chief surgeon, so it was inconvenient for him to say anything more.

"If it's convenient, let's complete this operation together. I wonder if Professor Li is interested?"

Yang Ping felt that he could learn from the experience of an excellent cardiac surgeon.

Even with the system in hand, Yang Ping will never close himself. Only by keeping open academically can he go higher and further.

All of Yang Ping's medical knowledge comes from the reading of the system space and the practical training of a large number of experimental subjects. He still needs other people's empirical things.

As the older generation of professors often say, learn from teachers, learn from books, learn from practice, and learn from peers.

In this kind of case, Professor Li is willing to participate in the operation no matter out of interest or responsibility. He also wants to see where Yang Ping's confidence comes from and dare to do this kind of operation.

Later, Yang Ping and Professor Li began to discuss the details of the operation, because it was too difficult and every detail had to be handled well.

At the beginning, people around can still participate in chatting together.

While chatting, other people, including Professor Wu Yucheng, couldn't get in the conversation at all, because the discussion knowledge was constantly upgrading, and the knowledge reserve could not keep up.

"It's too narrow here, and the narrowness is irregular. The turning angle of the channel is too large, and it is difficult to implant the artificial blood vessel. Otherwise, the artificial blood vessel can be implanted by interventional methods in advance to improve the venous return and facilitate the separation of the vena cava during the operation. Even if the separation ruptures, it will not cause major bleeding."

"It's difficult, but you can try."

"These mesentery must be preserved. After the adhesion is successfully separated, if there is no such mesentery for suspension, the heart and great vessels will move a lot in the chest cavity, which is very dangerous."

"The envelope of the heart has to be completely stripped, and it is already showing signs of constriction."

"Temporary vascular bridging technology can be used before surgery to divert blood circulation and avoid the surgical area."

"No, it's better to have blood filling, which is more conducive to separation."

"Well, the heart can be taken out if necessary, so that the pericardium and the mediastinum can be disposed of, and a suitable bed for the heart can be prepared again."

"Some of these adhesions can be exploited and can't be completely removed."

"What about the liver, gallbladder and pancreas? Should I ask someone to help?"

"No, I can handle it."

"There is another big risk factor. This patient's blood type is RH negative, and the blood preparation work will be subject to many restrictions. Can you prepare enough blood products?"

"We will contact the blood bank in advance to prepare enough blood products, and we will also adopt a series of autologous blood transfusion techniques to assist."

"If necessary, low temperature technology can be used to reduce the oxygen consumption of tissue cells, which can prolong the application of blood vessel blocking technology."

"The vascular blocking technique is only a temporary application and does not need to be used during the operation. During the operation, the blood can circulate normally, and the filled blood vessels are more conducive to separation."
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The two discussed for two hours, and the people next to them just sat and listened to their chat.

From clinical chat to basic medicine, and then back to clinic from basic medicine, anatomy, physiology, biochemistry, tissue embryo, pathology, pathophysiology, etc. are all involved. The results of experts, cross fusion.

After the chat, Professor Li began to re-examine this young doctor. Dr. Yang has a super brain and an amazing amount of knowledge. The knowledge he has mastered has far exceeded the depth and breadth that a surgeon should have. It is very laborious.

He now somewhat believes that this young man still has some confidence in taking the risk of doing this kind of surgery, at least he is well prepared with theoretical knowledge.

Professor Li decided to stay and complete the operation with Yang Ping.

Yang Ping asked Xiao Wu to book rooms for Professor Li and Professor Wu at the Sanbo Hotel. Professor Qin said, "Don't bother, I'll make the reservation, and I will live in the room next to me. I see that the rooms next to me are empty."

Professor Qin also lives in the Sanbo Hotel, which is good, they are familiar with each other, and they can chat when they live together.

Yang Ping asked Song Zimo to call the doctor in the department to the demonstration classroom. He wanted to briefly explain the case to everyone. Everyone should have some knowledge in advance, which is conducive to the implementation of the patient's entire treatment plan.

Everyone is in the department, only Zhang Lin is missing.

Song Zimo smiled and said, "Zhang Lin is explaining the basic operation of arthroscopic surgery to some young doctors in the training room, and some young doctors from Xiehe are also listening."

He taught people about arthroscopic operation, and he made rapid progress.

"He and Xiaowu practiced for an hour or two every day, and they made rapid progress. They were just invited by the gynecology department to help, and they showed off an endoscopic operation in the operating room of the emergency department." Song Zimo reported the progress of the two people by the way. Yang Ping handed Zhang Lin Xiaowu to Song Zimo for training.

Yang Ping didn't understand: "You were asked by the gynecology department for help?"

"The emergency department admitted a patient with acute abdominal pain. He was checked according to the procedures for acute abdomen. Nothing else was found. The color ultrasound of the uterus and ovaries showed two strips of moving objects in the uterus. Then an X-ray was taken, and there were two similar vertebrae in the uterus. After inquiring about the medical history, the patient said that two eels had strayed into the body and were alive. The emergency department immediately requested a consultation with the gynecologist. The gynecologist needed to use a hysteroscope to remove the foreign body in the emergency operating room, but the thing was still alive and slippery. It is not easy to choose. The gynecologist is afraid of damaging the endometrium. I feel that the endoscopic operation is similar. Knowing that our arthroscopic operation technology is very good, please feel a little overqualified. I am sorry. It happens that Zhang Lin is free, so I invite Zhang Lin. Go help, this kid didn't embarrass us, grab the pliers one at a time, and solve the problem in less than 2 minutes, and now he is arrogant." Song Zimo explained the ins and outs clearly.

This is not a strange thing. When Yang Pinglun was in the emergency department, he often encountered this kind of foreign body extraction, rectal, urethral, ​​and so on.

Zhang Lin follows Yang Ping every day, and Song Zimo trains him strictly. As the tide rises, no matter in theory or practice, he naturally progresses faster than others, and his knowledge is wider than others.

"Zhang Lin and Xiao Wu, you should be strict with them. Basic knowledge, basic theory, basic skills, and knowledge points must be [-]% clear." Yang Ping instructed Song Zimo.

"Where's Little Five? How's it going?"

"Xiao Wu's hands-on ability is very strong, especially the endoscopic technology, which has progressed very fast, and the basic skills of hand-eye separation and triangulation are very good."

Song Zimo called Zhang Lin and asked him to go to the classroom for a meeting.

Soon, he came over, followed by several young doctors. He was still explaining the main points of endoscopic operation, and he seemed to be speaking well. The doctors listened carefully and looked admiring.

(End of this chapter)