godfather of surgery

Chapter 647 Not in One Dimension

Professor Liang carefully asked about the medical history and performed a physical examination on the patient himself, so he was relieved when he felt that there was nothing wrong.

This has been his habit for many years. He has to personally handle Corey's difficult cases.

Before his operation, he had to ask about his medical history and check up in person.

He can't do this kind of thing with just a video picture, without even seeing the patient's face.

After the physical examination, Professor Liang put the percussion hammer into the pocket of his white coat, and said, "Mr. Jing, your operation is a bit complicated. We need to prepare well and don't worry."

Jing Yunsong sat cross-legged on the hospital bed: "Don't worry, you study slowly. I have checked all the first-class hospitals in the whole of China. After much deliberation, it is more reliable to come here."

Professor Liang patted him on the shoulder: "Rest at ease, we will notify you when the operation is scheduled, usually on Monday, and we will definitely do our best."

"It's been hard work, I'll wait for your news." Jing Yunsong relaxed the whole process, not afraid of the big scene of dozens of doctors making ward rounds.

Because there are too many doctors, some doctors can't squeeze into the ward at all, and gather at the door of the ward, listening to the conversation inside.

After seeing the patient, dozens of doctors went from the ward to the doctor's office again, very imposing.

In fact, as a professor-level doctor, there are two brightest moments. One is to lead the entire department to conduct a big round, and the other is to give a speech on stage during an academic conference. This is also the life goal pursued by young doctors.

Back in the doctor's office, Professor Liang sat down and thought about whether there were any loopholes in the operation.

The preoperative preparations have been sufficient, and the 3D printed spinal prosthesis has been designed with no defects. It is estimated that it can be printed today and sent for sterilization. The support for vascular surgery has also been confirmed. If the aorta and inferior vena cava are found during the operation If it is indeed invaded by the tumor, the vessel wall is destroyed, and lacks a normal and complete vessel wall, artificial blood vessels should be placed in advance to avoid tearing of large vessels during or after surgery.

Professor Hu Guolin works in a stable manner and tries his best to be as tight as possible. As the new director of Concord Orthopedics, he gives people a humble and low-key feeling, as if he has no dazzling achievements, but he can't find any faults at all.

"What are you going to do to stop the bleeding? Total vertebral resection of the three vertebrae will cause more bleeding."

Professor Liang asked suddenly.

Professor Hu Guolin must be well prepared for such a basic job, he said calmly:

"For intraoperative bleeding, we have a full estimate. In addition to routine blood preparation, we also make preparations from three aspects. With tumor angiography images as a reference, we will ligate the blood vessels of the tumor one by one; The interventional department has been asked to embolize the main blood supply vessels of the tumor in advance; if necessary, the aorta or inferior vena cava will be temporarily blocked for a limited time during the operation."

Professor Liang asked: "Please do embolization in the Department of Interventional Surgery. Have you considered the possibility that the blood vessels supplying the tumor and the spinal cord may share. Once embolized, it will cause spinal cord ischemic injury, leading to paraplegia and incontinence?"

Professor Hu also has considerations: "During the preoperative tumor angiography, the blood supply vessels have been carefully screened."

After listening to Professor Hu's words, Professor Liang nodded with satisfaction. Professor Hu has indeed done a leak-proof operation.

Yang Ping also felt the rigor of Xiehe, and he could not be careless about any detail.

Professor Liang always felt that there was still something that was not done enough. After sorting out the operation process in his heart, he found that there was still one step that was not perfect: when cutting the pedicle with a wire saw, because the tumor had embedded the pedicle, the wire saw was inserted into the pedicle. Sometimes it will inevitably damage the tumor, leading to the leakage of tumor cells and the risk of dissemination.

Professor Hu has taken necessary preventive measures here, using special guiding instruments for bone-bonding puncture, guiding the wire saw to insert the bone-bonding under the pedicle, so as to minimize the damage to the tumor body, which is already the best solution.

Because even if there is a guide for bone-bonding puncture, there is still a risk of tumor dissemination.

The puncture operation is the most perfect state, when the puncture passes between the tumor pseudomembrane and the pedicle bone, the guiding wire saw is inserted between the tumor pseudomembrane and the pedicle bone, but the tumor is close to the pedicle, When the wire saw is pulled back and forth, it will inevitably damage the tumor pseudomembrane that is close to it, causing tumor cells to leak out and pollute the operation area, which violates the principle of tumor-free technology in tumor surgery.

Professor Liang can't think of a better alternative for the time being. Of course, if the tumor can be peeled off from the pedicle with the periosteum, and then implanted with a wire saw, that would be more perfect.

However, this kind of operation exists only in theory, and it is impossible to do it in practice, and it is easy to be damaged during separation, so the risk of dissemination is greater.

Professor Liang felt that Professor Hu's treatment was the limit, so he asked Yang Ping next to him: "What do you think of this case? Especially to prevent the spread of tumors, is there any good way?"

The treatment of this case by Xiehe was very thoughtful and meticulous. Originally, few hospitals in the country were able to perform this kind of complex operation, and removed three complete vertebrae and complex chordoma at one time, which is the crown jewel of spinal tumor surgery.

If any hospital completes such an operation, it can write a special book, and it will be no problem to publicize it on the hospital's official website for several years, and every academic conference, sharing this case with colleagues will definitely gain countless respects.

If there is still something that is not in place, it is the step of cutting off the pedicle. After bone-attached guidance with a special guide, it will still penetrate the tumor and cause the risk of dissemination.

Yang Ping said bluntly: "The operation plan is very careful, and there are almost no loopholes. It is the step of inserting the wire saw. I think it is best to completely peel off the tumor at the pedicle and intervertebral foramen. The membrane and periosteum are peeled off together, even with a little cortical bone, and the membrane cannot be broken during the whole process."

"After the tumor is separated, the operation space is much more generous, and then the wire saw can be placed, so that the pedicle can be boldly sawed off. The wire saw will not cling to the tumor, causing friction or cutting damage, and there is no need to worry about the risk of tumor dissemination. "

Professor Liang also thought about separating the tumors at the pedicle and intervertebral foramen in advance, with the periosteum, but the operation was too difficult to be feasible.

Professor Liang said to Song Yun: "Enlarge the [-]D reconstructed image of the lumbar spine and tumor a little more."

Professor Liang did not immediately agree or refute Yang Ping's words, but re-studied the images.

After re-studying the images, Professor Liang frowned even more.

This method is the best and can avoid tumor spread to the greatest extent. However, the operation is the most difficult and cannot be realized. Moreover, the intervertebral foramen surrounded by the upper and lower pedicles is the channel for the nerve root to enter and exit, and a little carelessness will damage the nerve.

It is impossible to separate the tumor in such a narrow and complicated space without breaking the pseudomembrane and carrying the periosteum.

According to Yang Ping, it is better to wear a layer of cortex, then it is necessary to use a fine bone knife, and the operation is even more impossible.

After thinking for a long time, Professor Liang shook his head: "In theory, this is the best way, but in reality there is no way to do it."

"Moreover, I think that the whole operation is centered on the tumor, and the pseudomembranous operation is performed. Wherever the bone is encountered, except for the pedicle, the other parts should be cut off, and the other parts should be ignored. The tumor is removed along with the vertebra, and the vertebra When a part of the tumor is removed, the entire tumor pseudomembrane will carry a layer of surrounding normal tissue with a thickness of several millimeters, so that the tumor is removed most completely and there is no need to worry about the leakage of tumor cells." Yang Ping pointed to the three-dimensional image on the screen.

Tumor cells are like seeds. Once scattered, they will "take root and sprout" later and become the source of recurrence.

Therefore, there is an operating principle called "tumor-free technique" in tumor surgery. This technique emphasizes that the tumor should be isolated from normal tissues during the entire operation, and that the tumor should not contaminate the surrounding normal tissues.

Professor Liang turned his head and looked at Yang Ping, thinking that Yang Ping hadn't heard what he said.

So I repeat: "You say it well, but it's not realistic."

Now the tumor is extremely complicated, and it is impossible to operate on the pedicle according to your method, and it is even more impossible to remove the entire tumor according to this idea.

"The ideal is very full, but the reality is very skinny. How can such a precise operation be possible? If it is in a flat and wide operation area, the anatomy here is very complicated, especially the bony space is extremely narrow, and it is full of corners and dead ends."

Professor Liang is very funny sometimes.

"It's very difficult, but it can be done, just a matter of practice makes perfect." Yang Ping said confidently.

As long as the dozens of doctors nearby heard what Professor Liang and Yang Ping were talking about, they were all shocked.

This kind of operation is not that everyone can't think of it, but that they dare not think about it, because it is impossible to do it.

There are a few doctors who are always struggling with the level of the youngest Golden Knife Award in the country.

All the games were watched on video, and now they wanted to see Yang Ping's operation up close.

It's like watching a Tyson match, watching TV and standing next to the boxing ring, the visual experience is completely different.

Yang Ping’s cooperation with Xiehe this time will definitely do a lot of operations, but most of the operations are external fixation surgery for scoliosis. This kind of operation contains many innovations and has a high technical content. In order to facilitate popularization, the difficulty of operation has been reduced. , certainly not this kind of three total vertebrectomy stimulus.

When these doctors heard Yang Ping's different opinions, they all leaned forward.

The level of the youngest Golden Knife Award in the country, is it possible to do such a fairy operation?

Professor Liang repeated his own words, and Yang Ping not only did not correct his own words, but also gave a more affirmative answer, which showed that Yang Ping was not talking to himself.

"Have you ever used this method in spinal tumors? How is the effect?" Professor Liang did not dare to question Yang Ping's words now, so he asked tentatively.

After all, this young man cannot be treated as a normal person.

So when communicating with him, you have to adjust your thinking, and you have to be a little imaginative. In other words, you need to open your brain. If your brain is too small, it needs to be bigger, otherwise it will be easy to talk to death.

It's true that people are talking about things that can be done, and when you open your mouth, it's something that can't be achieved with such super difficulty.

"I often use it for spinal tumor surgery. I basically use this method."

This is the truth. When Yang Ping has a spinal tumor, no matter what the dead corner is, it will be separated along the pseudomembrane with a few millimeters of normal tissue around it. There will never be a small incision. This is the best surgical effect and the postoperative recurrence rate lowest.

At that time, Academician Feng Tiancheng had a skull base tumor in the upper cervical spine, which was a high-risk place, and the tumor was completely removed in this way.

The lumbar spine is also very difficult and risky, but it is better than the upper cervical skull base, where the upper cervical spinal cord and medulla oblongata are located.

use frequently?

Professor Liang was speechless for a while, and the throats of all the doctors in the audience were blocked for a while.

Young man, I'm sorry, you've completely chatted the world to death.

Immediately, Yang Ping's words had a feeling of "why not eat minced meat".

Professor Liang couldn't answer for a moment, paused for a long time, and squeezed out a few words: "Use often? The intervertebral foramen and pedicles are everywhere, and the nerve roots are also buried. How to operate?"

"Using a laser knife to cut, but you must be extremely proficient in the anatomy of this part, and you must be very skilled in distinguishing tumors, tumor pseudomembranes, and normal tissues. You also need a strong spatial positioning ability, and you must remember these pictures on the screen. "Yang Ping likes this kind of direct communication, only talking about academics, without taking care of each other's emotions.

"If the anatomical space is larger, we can use navigation equipment to do it, but in such a narrow and complicated space, navigation equipment cannot be used, and it cannot be seen or operated." Professor Hu Guolin was very helpless.

"Navigation required!"

Yang Ping said firmly.

This time it was Professor Hu Guolin's turn to choke.

"Are there many cases where you do this?"

The doctor who was very critical just now asked.

"I operate every spinal tumor like this." Yang Ping answered him.

The critic was also choked and speechless.

Whoever opened his mouth was choked and speechless.

The atmosphere is a bit awkward!

It's a bit embarrassing indeed!

Everyone, look at me and I look at you!
Professor Liang touched his chin, frowned, and waved his hand to signal that everyone should not ask questions for the time being, and asked him to think about where the problem is and why the communication is so difficult and difficult to continue.

"During the Golden Knife Award competition, I don't know if you still remember that this method was used in my cervical spine and skull base tumor surgery." Yang Ping had to give an example that everyone is familiar with.

Oh!
Professor Liang remembered the operation and finally found the crux of the problem.

Obviously, this guy is not in the same dimension as everyone else. Professor Liang still understands the concept of reducing dimensionality.

Professor Liang raised his head, closed his eyes slightly, and said with a sigh of relief: "Why don't you teach this method to everyone, if it's convenient, you'd better perform this operation and demonstrate it to everyone."

It is useless to chase after Yang Ping and ask so many questions. One side often does it as a routine operation, while the other side has never done it and thinks it is impossible.

Communication is meaningless, how about Yang Ping to demonstrate his magic operation.

Professor Liang must have believed in Yang Ping, and Academician Feng Tiancheng's operation is a vivid example.

"Yes you can!"

Yang Ping answered straightforwardly, since Professor Liang trusted him so much, it would be pointless for him to be lenient.

(End of this chapter)