godfather of surgery

Chapter 805 Is this like a department case discussion?
When girls say this, boys obviously have the upper hand. It seems like this is the case. Even normal healthy pigs can short-circuit like this.

Why did the great Dr. Fontan at that time not experiment with pigs, but directly use the new surgical method on patients? This question seems difficult to answer.

Since the girl was already 12 years old, it seemed that it was not an emergency life-saving operation and she had enough time to prepare.

"Because Dr. Fontan is a genius and cannot be guessed by our thinking, I still ask Professor Yang to answer this question."

"I?"

Yang Ping didn't expect Song Zimo Gao's sudden attack at all.

There was no time for Yang Ping to think about it, and the audience burst into applause. Professor Yang was an absolute genius in the eyes of everyone. Only geniuses can understand geniuses. Why didn't Dr. Fontan buy pigs for animal experiments at that time?
Yang Ping stood up, Song Zimo and everyone looked at him, waiting for his answer.

"Because he is very convinced of his plan and feels there is no need to waste time on it. In his eyes, every minute wasted, the little girl is in danger——"

Song Zimo immediately applauded: "Only a very few people have this kind of confidence. In fact, just thinking about the actions of these geniuses in the history of medicine, many of my questions have answers. Okay, let's continue -"

Yang Ping sat down again, this guy was just teasing me.

A PhD student raised his hand: "I just mentioned the pressure difference. There is a pressure difference between the systemic circulation and the pulmonary circulation. That is, the pressure of the systemic circulation is greater than the pressure of the pulmonary circulation. This can ensure that the blood returned from the superior and inferior vena cava can flow to the pulmonary artery under this pressure gradient. For the short circuit to be successful, I would love to know if - and I'm just saying if - there was high pressure in the pulmonary arteries so that this pressure difference didn't exist, would this surgery still be done?"

Song Zimo answered this question:
"Very good, the situation you mentioned is a contraindication to Fontan. The basis of Fontan surgery is here. If there is no skin, hair will be attached. If there is high pressure in the pulmonary artery, this pressure difference will not exist, and the blood will not be able to follow the schedule. If the flow is in the wrong direction, this kind of surgery will not be able to achieve its purpose, but we can solve this difficulty, how to solve it?"

Another graduate student raised his hand. He was a boy. He wanted to regain the dignity he had just lost in front of the girls.

"Generally, the cause of this situation is pulmonary stenosis or incomplete opening of the pulmonary valve. We expand the pulmonary artery or perform valve replacement. In this way, the pulmonary hypertension is relieved and the pressure gradient is formed. This operation has a basis for existence. If pulmonary hypertension is If it is caused by other reasons, we will solve these problems. If it cannot be solved, we can only give up this technique."

"That makes sense."

Song Zimo approved.

"The surgical method created by Dr. Fontan began with the treatment of tricuspid atresia, but it goes beyond that. It can treat many types of congenital heart disease and provide countless patients with congenital heart disease who have irreparable heart malformations and cannot wait for a heart transplant. It brings the last hope, but unfortunately, this method is only a palliative surgery and cannot cure the disease."

“The Fontan surgery we just talked about was just a prototype. Later, with the development, Fontan surgery formed a system of surgical procedures. It is a combination of many surgeries and is far more complicated than the prototype. However, these surgical procedures all follow Dr. Fontan’s original instructions. Principle: The heart is only responsible for the systemic circulation, and the pulmonary circulation is completed by the short connection between the upper and lower vena cava and the pulmonary artery; oxygen-rich arterial blood and oxygen-poor venous blood cannot mix and must be separated."

"Then how to perform the surgery in this case? Follow the standard surgical procedure and do it in three steps!"

Song Zimo wrote one, two, and three on the electronic blackboard. The Fontan surgery in this case was much more complicated than the prototype surgery performed by the founder back then, and there were many more factors to consider.

During the lecture, Song Zimo observed that people were coming in from time to time at the back door of the demonstration classroom. Because there were no seats, they just squeezed in and stood in the last row.

Because everyone was facing the podium, no one would pay attention to the audience who came after them. However, as a speaker, Song Zimo faced the entire demonstration classroom and could clearly see who was coming in from behind.

Li Zehui, who had just landed in the United States, saw this case from the WeChat group, and then decided to buy a ticket to return to China. If he had not held an academic exchange visa that allowed multiple trips to China, Li Zehui would never have been so convenient.

And his senior brother is still stuck in the visa. If his senior brother knew that there were still these cases, he would definitely cry and faint in the toilet.

Immediately afterwards, Song Zimo saw Xia Shu leading Academician Wang, Professor Chen, and Director Xin in, and they all returned to Sanbo Hospital. They also found out that the General Surgery Department was discussing this case today, so they hurried to Sanbo Hospital.

A case discussion in the Department of General Surgery unexpectedly turned into a meeting of top cardiac surgery experts.

"Actually, there is an old senior at our conference who has more say than me about the Fontan surgery to treat this case. He is the first doctor to perform Fontan surgery in my country and is an authoritative expert on pediatric congenital heart disease in my country." Song Zimo We decided to invite Academician Wang to give lectures on Fontan surgery and let everyone have a glimpse of the academician’s style.

Academician Wang was actually standing behind him. He heard that Song Zimo was talking about him and waved his hand quickly, feeling a little embarrassed.

If we were to judge the academician with the least pretensions last year, it would definitely be Academician Wang. He did not regard himself as an academician at all, but just as an ordinary doctor.

At this time, Yang Ping also looked behind and saw Academician Wang. He quickly called Xiao Wu over and asked him to arrange seats for the guests.

“I’d like to invite Professor Wang from Fuwai Hospital in our imperial capital!”

Song Zimo applauded and then walked down the podium to shake hands with Academician Wang.

No one reacted at all. Damn it, there were academicians inside listening to the lecture. Everyone followed Song Zimo's gaze and saw an old professor shaking hands with Song Zimo.

Some people know them, but most don’t.

In fact, the circle of doctors is very small. Even well-known experts in the country are only acquainted with doctors in the same major. After all, everyone holds academic conferences together and often sees experts on the podium. If doctors rarely attend academic conferences, even if they are in the same major, , still don’t know the big guys in the industry.

Academician Wang is approachable and has no academician pretensions at all. He holds a microphone and walks up to the podium like an ordinary teacher. Then Yang Ping steps forward to shake hands with him.

"Is this an academician?"

Why are there still academicians in the room to listen to the lecture? The meeting place was very excited. General surgery is really hard to understand. Isn't it just a case discussion in the department? Why are there still academicians participating?

"Everyone, please be quiet. Let me say a few words. In fact, I just got off the plane. Sorry, the plane was delayed, so I am late. I came here specially to participate in your case discussion. This case is my patient." Academician Wang pointed at the electronic screen Image pictures on.

"Dr. Song just said that I was the first person to perform Fontan surgery in China. This is true. Not only Fontan surgery, but also many pediatric congenital heart disease surgeries were the first. I was the editor-in-chief of several editions of guidelines in this area, and now the latest edition is The editor-in-chief is Professor Chen Yueliang. We actually visited Sanbo Hospital a few days ago. When we returned to the Imperial Capital, we heard that you wanted to discuss this case, so we flew back again."

"I've said too much off topic, let's get back to the point."

"Why was this case not done in our Fuwai hospital instead of being done in Sanbo Hospital? Many people have questions. In fact, it is very simple. Let us do this surgery, but the success rate is not high. Let Professor Yang do it, and the success rate is higher. A lot, it’s that simple.”

"Everyone sitting here is a doctor, even some interns are considered quasi-doctors. To be honest, there were two similar cases in the past, but I could not save them. The difficulty of this case is not only the Fontan operation itself, but also the difficulty of the case. The difficulty is that there are problems with blood vessel development. There is a lack of collagen fibers and elastic fibers in the blood vessel walls. We have not found the reason yet. We speculate that it is related to cardiac malformations, but in any case, it makes the operation more difficult, not more difficult. A little bit."

"In the two failed cases, one died on the operating table. After opening the chest and cutting off the blood vessels, he could not kiss during the anastomosis. He accidentally hooked the blood vessel wall. After the operation was finally completed, the extracorporeal circulation was removed and the heart was restarted. The bleeding started to stop after the jump, but it couldn't be stopped at all. Why, a patch here, but another break somewhere, and in the end we watched the child leave helplessly, and there was nothing we could do."

"You don't have this feeling when you are young. At our age, you have been a doctor for a long time, and you have this kind of memory. Really, at that time, you were really helpless, helpless, and desperate. As a surgeon, a cardiac surgeon Doctor, how do you feel when you see the blood pouring out everywhere and you can't stop it?"

"The second case was already 10 years later. We learned our lesson and added artificial blood vessel assistance during the operation. This case had no problems on the operating table, but died in the intensive care unit on the third day after the operation. At that time we We performed emergency rescue surgery and opened the chest, but it was full of blood and the blood spurted out because the suture between the large blood vessels and the artificial blood vessels was torn."

"Later, with the consent of the family, we performed an autopsy to find out the reason - the vascular anastomosis could not meet the requirements. In this case, it would have been impossible to perform surgery without the emergence of new basic theories. Why?"

"Because, if the operation is to be successful, your suturing must last for more than 5-7 days, but the reality is very difficult and basically impossible. Do you know why?"

"Because it's like sewing on a soap bubble, and you have to keep the soap bubble from bursting. Once the brittle blood vessels are cut and re-sutured, the suturing requirements are difficult to achieve manually. It's like a very thin paper bag. When it's When it is complete, it can lift water without leaking, and it can also lift very heavy water because the stress is evenly distributed."

"When you cut a paper bag in half, you sew it up with a needle and thread, and then lift the water, it's very difficult to keep it from leaking. And then let it lift heavy water, it's even more difficult. Why, the stress will be concentrated on the stitching It is impossible to distribute the stress evenly at any place, especially at any sewing position. Once one stitch carries too much stress, the paper bag will start to tear from here.”

"I wonder if you understand what I said?"

Academician Wang stopped.

"Professor Wang, what do you mean, how can someone achieve a theoretically perfect suture, so that all the stress on the anastomosis is evenly distributed on each needle according to theory, so that the operation is likely to be successful?" asked a student.

"Yes! This student listened very carefully. That's what I mean. Although this cannot guarantee a [-]% success in the operation, it can guarantee the highest probability of success."

"Why is it safe after five to seven days?"

Graduate students, graduate students, and interns were afraid to speak just now, but when they saw someone taking the lead, their thinking became active and they became bolder to speak.

"Think about it for yourselves, why does this problem become much less severe after the five to seven day danger period has passed?"

A graduate student raised his hand.

"Because the anastomosis at the broken end of the blood vessel has healed and is no longer a weak point, stress will not be concentrated here."

"That's what it means. The students at Sanbo Hospital are very bold in asking questions. This is how we study. Dare to ask questions and be good at asking questions. How can you make progress if you don't even dare to ask questions? I like this academic atmosphere very much. You see so many young doctors. , and students, discussing with each other. Our hospital is a bit rigid, and the people who speak are all senior doctors, and what they say is professional. As soon as I speak, everyone loses the ability to question, and they all agree. "

"I'm telling you, there is no authority in academia. Don't think that I am an academician. There are still many things I don't understand. I don't admit that I am an authority. There is no authority in academia. The Fontan surgery I just mentioned was invented by Dr. Fontan. He was only in his 30s at the time, and he was a junior doctor. The authorities at the time said that this would never work for you, you were just working behind closed doors and thinking wildly."

"If there is authority in academia, and it's over, Dr. Fontan will obey the authority. If the authority says no, then it can't be done. What kind of surgery is there? Then is there still the Fontan surgery we are discussing today? The further advancement of academics starts from questioning the so-called authority. start."

"Every time I revise a thesis for a doctor, after the revision is completed, the doctor says - OK, teacher, I will revise it according to your instructions."

"I thought to myself, it's over. My students don't have the ability to question. This is a problem with my teaching. I want to revise your paper. Why don't you even debate or refute? Where is your opinion?"

"I just saw a few boys and girls arguing about the pig issue. The sound was very loud, but it was all academic debate. This is good. Academic debate requires debate. The more you debate, the clearer you will be. Don't be afraid of arguing. The right thing It is gradually recognized in the debate, and the incorrect things naturally die out in the debate.”

After Academician Wang stopped speaking, Yang Ping was the first to applaud. Academician Wang is so simple and has no airs of an academician at all.

Among the academicians Yang Ping knows, Academician Wang is the least arrogant, while Academician Liang from the Union Medical College is the most upright, speaking and acting with integrity.My father-in-law, Academician Su, always seems to have a noble air, and he is personable at all times. How should I put it, to use an unpopular word, he has an aristocratic temperament about him.

How well it is said, science must first have the ability to question, and science progresses through questioning.

Therefore, science has no authority, and the existence of authority is an obstacle to progress.

"Influenced by this atmosphere, I want to talk a little more. Now I will tell you about the three steps of Fontan surgery. I will try to be as simple as possible. After I finish speaking, it is best for Professor Li Zehui to supplement it and add some information about Fontan surgery in the world. Some cutting-edge research on surgery, by the way, Professor Li Zehui is a top cardiac surgeon at Cleveland Medical Center in the United States, and has made great achievements in congenital heart disease, coronary artery bypass grafting, valve treatment, heart transplantation, etc."

"Wow!"

Everyone in the audience turned to look behind. This world-famous figure was shyly waving to everyone. He was also standing in the back and had just listened to the class with everyone.

These young students are very excited, and all of them are experts. Is this like a case discussion in the department?

PS: There will be another chapter later. Today I went to the "Editor-in-Chief Recommendation" of the Qidian client. I haven't recommended it for a long time. This is a reward for the recent return to normal updates. Thank you for your continued support.If you still have monthly passes or recommendation tickets, please help with them.Thanks!
(End of this chapter)