godfather of surgery

Chapter 655 Are you still talking about cooperation?
The risk of patients with aortic dissection is mainly in the abdominal aorta, because the tumor invades this section of the aorta, causing local lesions on the vessel wall, losing its normal anatomical structure, and unable to withstand normal blood pressure.

Therefore, this case is treated according to type B dissection.

Aortic dissection, according to the location of the dissection, is clinically divided into two categories, called type A dissection and type B dissection.

Type A dissection will accumulate to a section of the aorta connected to the heart. It is the most dangerous type of aortic dissection, because the blood pressure of the aorta is the highest and it is very prone to rupture. For this type of aortic dissection, the only treatment is Emergency surgery replaces the section of the aorta connected to the heart with an artificial blood vessel, which can reduce the risk of aortic rupture.

The other type is called type B dissection. The aortic dissection does not accumulate to a section of blood vessels connected to the heart. It is limited to the aorta in the chest and abdomen. In this type of dissection, the blood vessel pressure will be lower and the risk of aortic rupture will occur. Relatively small, generally can be considered through interventional stents.

So what Director Zuo wants to insert now is not an artificial blood vessel, but a stent artificial blood vessel graft.

Usually this kind of operation is minimally invasive, and the stent is sent to the predetermined position through a small incision in the iliofemoral artery. Today's case is special. First, the role of the stent is prevention, so it is difficult to judge the position through X-ray fluoroscopy. Can't see any problem.

Special cases are treated specially. Director Zuo is very experienced. According to the actual situation of the patient, he directly inserts the stent from the abdominal aorta. He considers the distal end of the blood vessel segment with disease, and it is done under direct vision and finger touch. Combined to send the bracket to the predetermined position.

Director Zuo and two assistants were familiar with the road, and soon they sent the bracket to the predetermined position, and after gently touching it with their hands, they did not release the bracket in a hurry.

"Professor Yang, come and take a look, is the location right?" Director Zuo needed Yang Ping to make the final judgment.

Because as the chief surgeon, Yang Ping knew that the section of the abdominal aorta was stuck and needed to be stripped of the blood vessel wall, so he went up to the stage and reached in and touched it: "That's right, this is it, release it."

After being confirmed, Director Zuo decisively released the stent immediately. His technique was very skilled, and the stent was released accurately without any displacement due to the influence of blood flow.

Therefore, the comprehensive level of a hospital is very important, and sometimes the departments need to cooperate with each other.

For example, if this patient is placed in another hospital, even if the orthopedic department has the strength to complete the operation, without the support of top-notch great vessel surgeons, the operation will be difficult to complete, or even if it can be completed, there will be huge potential risks.

Of course, the vast majority of patients do not need to perform total vertebral resection. Jing Yunsong's situation is too special.

After the implantation of the stent artificial vascular graft was completed, the left director began to take off the surgical gown:
"This is Professor Yang from the south, right?"

Just now Director Zuo just asked Yang Ping to help determine the position of the bracket, and now it is a formal greeting.

"Hello, Director Zuo!" Yang Ping also greeted politely.

Director Zuo smiled and said, "Heroes come out of youth, are you the champion of this orthopedic Golden Knife Award?"

Yang Ping nodded.

Song Yun immediately introduced Director Zuo in front of him: "Our Director Zuo was also the winner of the Golden Knife Award in Great Vascular Surgery."

Xiehe has produced many Golden Knife Award champions, such as orthopedics, vascular surgery, and general surgery, that is, the basic surgery of Xiehe, all of which have won Golden Knife Award champions.

Although it can't be said that the Golden Knife Award goes everywhere, it is not uncommon.

It was very difficult for Director Zuo to win back the Golden Knife Award for Great Vascular Surgery from Anzhen Hospital and Fuwai Hospital, because the Golden Knife Award for Cardiac and Great Vessel Surgery is usually held by these two in turn, especially for Cardiac Surgery. It was the two hospitals that took over alternately, and never fell into the hands of the third hospital.

The same is true for the major vascular surgery, which was performed by these two hospitals. Only Director Zuo won the Golden Knife Award for major vascular surgery, breaking the unbeaten status of An Zhen and Fu Wai.

"It's not worth mentioning. I was 42 years old when I won the award. You are not even 30 years old now. There is no comparison." Director Zuo waved his hand.

He also wanted to chat with Yang Ping. After all, they are all Golden Knife Awards. Heroes cherish each other, and there are many topics to talk about.

It's a pity that Director Zuo's assistant received a call, and there was another emergency operation. The emergency department admitted a pregnant woman with a torn aortic dissection. Now the blood vessel is bulging like a balloon and may rupture at any time, requiring emergency surgery.

Before he even had time to say hello, Director Zuo left in a hurry with his assistant.

Yang Ping went on to continue the operation, everyone rested for a while, and then re-entered the state.

With the protection of artificial blood vessels, the weak part of the blood vessel wall caused by tumor separation is artificially strengthened.

Even if aortic dissection occurs in the future, there is no need to worry about the danger, which means that the mine has been discharged in advance.

This step is more difficult to complete in advance, but the effect is better. If you do this work again after the separation during the operation, if dissection occurs immediately after the separation, the damage to the vessel wall will be greater. Now, if you place it in advance, you don’t have to worry about this. question.

Yang Ping began to separate the tumor. Although the separation of the rear side did not achieve 360 ​​degrees, most of it had been completed, leaving only the front side unseparated.

Most blood vessels for tumors come from the anterior approach, so the anterior approach poses a greater challenge to hemostasis.

Moreover, the tumor adheres to the abdominal aorta and inferior vena cava, so it is very difficult to separate the blood vessels.

This step is very dangerous, and it is a test of the doctor's surgical operation.

The doctors in the entire conference room are very much looking forward to seeing how this top expert will separate the tumor here, whether it will break the large blood vessels, and whether it will break the pseudomembrane of the tumor, so that the separation of the tumor cannot be performed without leakage. .

Because the pseudomembrane of the tumor here is part of the wall of the large vessel, it is much more difficult to successfully dissect it than the posterior approach.

Cheney's bladder doesn't feel so bloated now, probably the reabsorption of the bladder has played a role, and Cheney no longer drinks water.

Director Hu ignored him throughout the whole process. He watched the operation by himself, and several other American doctors were also immersed in the observation, communicating with the Chinese doctors beside him from time to time.

Cheney also wanted to communicate and ask a few details about the operation. He was very interested in this Chinese-style total vertebral resection, but Director Hu's answer made him afraid to ask any more.

"For the [-]-degree separation, the last step is now left. Now, the ligation of the tumor blood vessels must be completed. Only when all the tumor blood vessels are ligated and the surgical field is kept absolutely clear can the subsequent separation be carried out calmly."

Yang Ping would tell Song Yun every critical step.

He ligated the segmental arteries around the lumbar 2, 3, and 4 vertebral body, and then began to ligate the blood vessels supplying the tumor one by one. He knew every blood vessel in advance, never missed it, never missed it, and the operation was still the same. skilled.

Song Yun couldn't figure out why Yang Ping was so familiar with the anatomy of this tumor. If he relied on angiography images to memorize these blood vessels, then Yang Ping's ability to apply the images to actual surgical operations was too strong.

Yang Ping kept asking the equipment nurse for vascular clamps, and Song Yun followed him to ligate the blood vessels, tying knots non-stop!
The blood vessels supplying the tumor were ligated one by one, without missing one or finding the wrong one. This method of hemostasis is very useful.

The entire surgical field is very clean, so clean that it is a bit unreal.

This kind of surgical field can only be achieved by using a tourniquet and preoperative exsanguination in extremity surgery.

The clean and clear surgical field allows the tumor to be separated very smoothly. When the separation progresses to the part that adheres to the large blood vessel, the laser knife dissects very finely.

"It's still the same principle, starting from the normal organization, and going deeper step by step!"

Because at this time, to prevent the tumor from leaking, the adventitia of the large blood vessels must be completely stripped off, and the adventitia of the large vessels is a part of the tumor pseudomembrane.

Under the separation of the laser knife, the adventitia of the aorta is lifted bit by bit, neither thick nor thin, and the adventitia remains intact.

"So when doing this operation, it is very important to place the artificial blood vessel in advance, otherwise, once it is damaged, it will cause massive bleeding. The occlusion of the aorta can only temporarily stop the bleeding for a short time, and cannot prevent the damage. Even if it is not damaged, the adventitia can be successfully peeled off. The remaining vessel walls are also unhealthy and prone to dissection."

Soon, the tumor was separated from the aorta, followed by the vena cava.

Yang Ping checked whether there was any tissue adhesion near the tumor and the vertebral body. It was very good, and there was no connection at [-] degrees. Yang Ping carefully took out the entire tumor and three vertebrae from the front abdominal cavity, and then put them into the metal basin of the equipment nurse. .

The resection of the tumor and three vertebrae is complete!

Now the operation has progressed to the third hour, and these three hours include the time for vascular surgery to place artificial blood vessels.

Flush the surgical area, check if there are any missing bleeding points, and if there is no problem, a drainage tube is placed, and Song Yun is responsible for suturing the anterior surgical incision layer by layer.

In this way, two steps have been completed in the whole operation, and only the last step is needed—posterior fixation, using the pedicle screw system and the truss structure of the artificial spinal prosthesis to support the spine.

After the anterior surgical incision has been sutured, the patient is put on a sterile dressing, and then placed back in the prone position for posterior fixation.

Posterior surgery is relatively simple. The artificial spine is placed and then connected and fixed with the pedicle system. The entire artificial truss structure replaces the three excised vertebrae and continues to play the supporting function of the human body's central axis.

Four hours later, the operation was over.

The surgery, which was originally planned to take [-] hours, was completed in four hours.

All the doctors in the conference room were not only shocked, but still shocked.

Everyone was mentally prepared to observe for more than ten hours, so the four-hour operation did not feel how long it was at all, and there were many things that were still unsatisfactory.

Professor Lu was so frightened that he couldn't believe it. The director of the medical department, who had seen the big wind and waves, was still regretting it. He should have been more active in signing the signature, instead of pushing left and right. This would also make him appear to have extraordinary vision. Concord left a good talk.

Professor Liang had a slight smile on his face. The damage caused by the Zhang Chunquan incident had been completely healed by Yang Ping.

The east is not bright and the west is bright, everyone has their own ambitions, Professor Liang no longer cares so much, once the psychological hurdle is over, there is no entanglement.

Director Hu is still immersed in thinking about surgery. His understanding of Yang Ping started from the Golden Knife Award. Before that, Director Hu had never heard of Yang Ping’s name. The scoliosis correction appeared, and Song Yun, the strongest player of Xiehe, was killed in seconds.

Director Hu and the entire Xiehe Orthopedics Department woke up to the fact that there is such a master.

Later, under the urging of Professor Liang, everyone organized a group to go to Sanbo Hospital to learn scoliosis surgery, and then saw Yang Ping's amazing surgery in Japan.

Director Hu was completely overwhelmed by Yang Ping. Compared with the operations he had seen before, today's surgery seemed a lot more ordinary.

Cheney was hit hard, and now he feels that his self-esteem has been thrown to the ground and has been crushed into pancakes.

"Cheney, what did you just say?"

Professor Hu knew that Cheney had been fidgeting and wanted to ask questions.

"Where's the bathroom?" Cheney asked bravely.

Director Hu pointed: "Go out the back door, go forward and turn left!"

Finally, the doctors of Xiehe have seen the level of the Golden Knife Award, the first level in the country.

Four hours, a perfect surgery, says it all.

"Professor Yang's team, can we increase the quota now?" A chief physician leading the team came to Director Hu and asked quietly.

Director Hu shook his head: "His team is staffed with doctors under the age of 40, most of whom are under the age of 35, and the number is sufficient."

The chief physician sat back in his seat disappointed.

"Professor Hu, is the second operation still a demonstration of Chinese total vertebral resection? Can I enter the operating room to observe it?"

Cheney emptied his bladder, much more relaxed and courageous.

"Sorry, there is only one demonstration operation today, and according to our operating room management rules, you are not allowed to enter the operating room now." Director Hu expressed his apology.

Cheney was very disappointed, and then said: "We can exchange doctors for further training. Is there still a total vertebral resection these days? Can I stay here and see."

Director Hu still expressed his apology: "Our training will be carried out in stages, with Chinese doctors given priority, and foreign doctors will not be accepted for the time being."

Cheney blushed in embarrassment: "How long will I have to wait?"

"We have a lot of Chinese people, so it is difficult for me to determine the exact time. If you have this request, please wait for our notice." Director Hu felt refreshed all over his body, never feeling so sour.

Cheney nodded helplessly: "Okay."

"When you're free, let's continue talking about cooperation?" Director Hu reminded Cheney.

Cheney faltered: "This -- the cooperation thing -- we are a bit hasty, and there are still many problems that have not been resolved."

Compared with the Chinese style of total vertebral resection, Cheney's operation method is a bit backward and rough.

He secretly called his assistant and took his equipment box off the podium. He didn't plan to continue explaining after the meeting.

Cheney was very upset, but he dared not show it.

He complained in his heart: medical skills should have no borders, these Chinese people are narrow-minded, and they actually have to wait for the Chinese to finish their studies before arranging for foreigners to study, when will this wait.

(End of this chapter)