godfather of surgery

Chapter 807 The stunt of debut
After a free discussion, Professor Li Zehui talked about the latest progress in the treatment of congenital heart disease in children.

As a professor at the Cleveland Medical Center and a rising star in cardiac surgery in the world, Li Zehui’s classes naturally contain a lot of useful information. He talks about cutting-edge technologies, things that cannot be seen in textbooks.

A department’s case discussion involves both academicians and top international experts flying in to participate in the case discussion. This kind of meeting will undoubtedly increase students’ knowledge and confidence.

He Xiangjun, director of the Thoracic Surgery Department of Sanbo Hospital, has been silent. Probably because the longer he works, the less passionate and curious he becomes. He is not interested in what these young graduate students are discussing.

Yang Ping is about to serve as the chief surgeon for infant cases, so Academician Wang hopes that Yang Ping can make a concluding speech on the discussion just now.

As the head of the department, this is what he should do. Yang Ping slowly walked to the podium and said:

"I have thought a lot about this case. What I just said about burying a dilator in the hypoplastic left ventricle is not just a talk, but I really want to set up a topic to study specifically, hoping to find a way to treat left ventricular hypoplasia. The general direction of the radical cure method is already there, and what is left is to refine the topic. I hope that every doctor and student in the department will participate. How to design the dilator, how to bury it, how to lead out the pipe, and how to specifically expand it. We have achieved both It expands the space of the left ventricle and ensures the thickness and contraction strength of the myocardial wall, so that the left ventricle can beat normally and powerfully after completion of expansion."

"I'm signing up!" Li Guodong raised his hand excitedly.

Immediately many people at the venue followed suit and raised their hands to sign up. Everyone was highly motivated and felt that they could accomplish the task.

"Okay, after the meeting, Li Guodong will take the lead and build the team first."

"There are also two cases of failure that Mr. Wang just mentioned about his failure. Failure is the mother of success. Without Mr. Wang's pioneering work to provide experience and lessons for those who come after him, the latter would not be able to succeed."

"Mr. Wang didn't say anything just now. Let me add that this case not only requires high suturing technology, but also requires very fast suturing speed. Because the case is an infant, the infant cannot accept long-term extracorporeal circulation, and deep hypothermia must be used. Circulation arrest technology, deep hypothermic circulatory arrest technology generally takes 45 minutes, and with special brain protection technology, it can only be extended to 60 minutes, so all sutures must be completed within this time, which is actually very difficult."

Academician Wang deliberately did not say this just now. He just did not want to expose objective difficulties. Failure is failure and must be faced squarely.

In Yang Ping's summary, the case discussion ended. Everyone was looking forward to the arrival of this operation. I heard that the suturing of this operation was the ceiling of surgical suturing technology.
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Early the next morning, the baby was brought to Sanbo Hospital by his parents for hospitalization.

The little guy's lips are obviously cyanotic. Cyanosis is a symptom of hypoxia. Logically, the first stage of surgery should be completed within a month. Now it has been more than a few days a month. If the surgery is not carried out, the baby may not survive for a few days.

The baby's parents also tried their best to fight for it and did not want to give up, so they found Fuwai Hospital and Professor Chen. Professor Chen is a top expert in pediatric congenital heart disease. Except for Academician Wang, who has retreated to the second line, Professor Chen is known as China's first pediatrician. It is no exaggeration to say that it is the No. 1 cardiac surgery.

The baby's mother untied the baby's clothes, and Yang Ping checked the condition of his whole body, then auscultated the heart, and then went through various examinations brought from the outside hospital. The indications for surgery were clear and there were no contraindications to surgery, so there was nothing wrong with it. What’s more – surgery!

If you do it one day earlier, there will be less risk and more hope.

"I will complete the preoperative examination today and do the operation tomorrow." Yang Ping said after completing the examination.

Academician Wang admired Yang Ping's decisiveness very much. He did not hesitate and did what he said, and did not hesitate because of difficulties.

The baby's surgery needs to be done in three steps. If there are no problems in the first step, it means that the blood vessels Yang Ping sutured are qualified. Then the second and third steps generally have no problems, so the first-stage surgery is the most important.

Xia Shu got into the mood quickly. Perhaps he originally liked the working status of general surgery. As soon as he got to work, he used his professional advantages to assist the bedside doctor in the perioperative management of the baby.

The surgery started the next day.

Yang Ping was the surgeon, with Academician Wang and Professor Chen as assistants because they had experience in this kind of surgery.

Song Zimo and Xu Zhiliang also appeared on stage, but they were marginal characters.

As observers, Li Zehui, He Xiangjun, and Xia Shu sat in the corner of the operating room, preparing to use the operating room screen to observe the operation.

Professor Cao did not come this time. He felt that because he was older, it would be better to see less of Yang Ping's surgeries.

In order to cope with possible emergencies, Yang Ping used the median sternal approach, which is the most open and open approach.

Open the chest and reveal the heart. This small heart is no bigger than a walnut, and the large blood vessels are even smaller.

Anastomizing blood vessels is Yang Ping's special skill and a unique skill when he debuted. When he came to Sanbo Hospital, he relied on replanting amputated limbs to dominate the world. He fought monsters and upgraded along the way. What is the core technology of replanting amputated limbs? It is vascular anastomosis. , is there anything thinner than the blood vessels in a baby’s finger?

The aorta, pulmonary artery and the connection parts with the heart were also exposed. Yang Ping gently touched the small blood vessels with his fingers, and at first he felt that the blood vessels had very poor elasticity.

"Prepare for cardiopulmonary bypass and cardiac arrest!"

Turn on the extracorporeal circulation and inject cardioplegia solution to stop the heart.

During the extracorporeal circulation process, the baby's body temperature is gradually lowered. When the core body temperature drops to 15C, the extracorporeal circulation machine is turned off and all blood circulation is stopped. This is DHCA - deep hypothermic circulatory arrest technology.

This technique must be used because infants cannot undergo prolonged cardiopulmonary bypass.

When a baby is in a state of deep hypothermic circulatory arrest, the heart stops and the blood stops flowing, so it is similar to "death", except that this is a human-controlled "death" that is reversible under certain conditions and can be "resurrected."

This condition is that this state cannot exceed 45 minutes, and it can be "resurrected" within 45 minutes. It cannot be "resurrected" after the time, so the operation must be completed within 45 minutes.

"Is it necessary to combine antegrade perfusion through the brachiocephalic artery and retrograde perfusion through the superior vena cava for brain protection?" Academician Wang suggested.

Adding this step to protect the brain can extend the deep hypothermic circulatory arrest time to 60 minutes, creating more sufficient time for surgery.

"No, I'll try to complete the operation in 20 minutes." Yang Ping said without hesitation.

20 minutes, what a joke, but Academician Wang has no doubts now, and he must not use ordinary thinking towards this young man.

Yang Ping began to quickly examine the heart and the blood vessels connected to the heart. The aorta was very thin and had severe stenosis. Now Yang Ping wanted to cut off the aorta and widen it to restore its normal diameter.

When the aorta was severed and the broken end of the blood vessel was exposed, Academician Wang took a deep breath.

This is exactly the same as the two failed cases back then. The blood vessel walls are like paper, thin and inelastic. Even if the suturing is perfect, every stitch cannot be even. If it is not even, there will be weak points, and the stress will be concentrated on it. The weak point directly causes the blood pressure to hit the weak link and tear the blood vessel from here.

In the first case that year, Academician Wang was heartbroken when he saw such a blood vessel. It was impossible to suture it. Although he tried his best to suture it, he still could not achieve the ideal uniform state.

"Do you want an artificial blood vessel?"

Academician Wang asked.

Artificial blood vessels are a good solution. Artificial blood vessels can withstand stress and protect the suture site, but there is a fatal weakness: babies will grow up over time, and the diameter of artificial blood vessels does not change, so it is not suitable for minors. , especially babies.The existence of this weakness leads to the removal of artificial blood vessels within a certain period of time after surgery. "Need not!"

Yang Ping decided to use his superb suturing skills to solve the problem. Since the blood vessels can withstand the impact of blood before being cut off, there is still hope for success as long as the suturing reaches an ideal uniform state.

Not only must the stitches be evenly stitched, but the stitch length and margins must also be carefully designed. They must not be designed according to normal blood vessels. Once the stitch lengths and margins are wrong, the bearing capacity of each stitch will be too small, and it will be useless no matter how perfect the stitching is.

In principle, the denser the suture, the better, so that the stress dispersed by each needle is the smallest. However, the denser the suture, the more pinholes. The more pinholes, the lower the strength of the blood vessel, so find a balance between the two.

This kind of suturing is not just a matter of suturing technique, but also a lot of factors to consider.

Academician Wang's two failed experiences left him with lingering fears. This kind of surgery was really painful and he couldn't make a single mistake while walking on the tip of a knife.

Yang Ping's movements are very careful, but they are also very fast. In fact, when you are proficient to a certain level, fast and slow are just relative.

First, the arterial duct between the pulmonary artery and the aorta is ligated and cut with a thread, then the pulmonary artery is cut above the pulmonary valve, and then the fracture on the pulmonary artery side is closed with a patch.

Taking a section of vein, Yang Ping cut open the vein and used it as a patch to expand the diameter of the aorta. Every needle entry and exit was carefully calculated and every action was completed at once. They are all 90 degrees perpendicular to the suture surface, and then use the sudden force of the wrist to quickly pierce the blood vessel wall with the needle tip. In this way, if the needle hole in the blood vessel wall is magnified, its edges will be the most aligned and the damage will be minimal.

Academician Wang noticed that when Yang Ping was suturing, each needle was very smooth from entry to exit, and the blood vessel wall seemed to be motionless without any pulling.

The diameter of the aorta was enlarged, and Yang Ping connected the aorta to the remaining part of the pulmonary artery where the right ventricle had just been cut off, that is, the aorta was connected to the right ventricle.

At this step, Academician Wang discovered that the diameter of the aorta was exactly the same as the diameter of the base of the remaining pulmonary artery in the right ventricle. That is to say, when Yang Ping expanded the diameter of the aorta, he had considered connecting the aorta to the base of the pulmonary artery. diameter remains consistent.

This is such a meticulous thought, it is almost watertight.

The same applies to the diameter of the anastomosis tube. One needle and one line. Each needle is placed in place at one time. No needle needs to be repeated or the quality is reduced.

After the suturing is completed, the diameter of the tubes just matches and the seal is very tight.

The interatrial septum is removed, and the left and right atria are opened to form one large room.

Next is the most difficult step, which is to bridge the pulmonary artery and the aorta. The so-called bridge does not mean to connect them, because the aorta is already connected to the right ventricle, but to use a blood vessel to temporarily connect the pulmonary artery and the aorta.

For this temporary bridge of blood vessels, Yang Ping chose the innominate artery, a branch of the aorta. This blood vessel does not have a name, but its name is the innominate artery.

The heart is not as big as a walnut, and the aorta is also very small. It is conceivable that its branch innominate artery must be very small, but no matter how small it is, it is still thicker than the blood vessels of a baby's finger. It is not a problem at all for Yang Ping.

The anastomosis of small blood vessels tests the stability of the hand, especially the operation with both arms hanging in the air, but for Yang Ping, this is not a problem. This is the stunt for which he is famous.

This stunt drove the doctors crazy during the surgery at the Mayo Clinic.

As assistants, Academician Wang and Professor Chen tried to breathe as evenly as possible. During key operations, they even held their breath. After relaxing their breathing, they had to work hard to control it and try not to inhale and exhale in large gulps, so as not to disturb Yang Ping's operation.

The bridge was completed with extremely skilled vascular anastomosis technology. There were still 20 minutes left before 5 minutes, that is, it only took 15 minutes. Yang Ping completed the entire suture just now, thanks to his unparalleled vascular anastomosis technology.

Academician Wang didn't know what to say at this time, he was completely shocked by the speed of this operation.

"Restore body temperature!"

Rewarming needs to be carried out gradually and slowly, not too quickly. After reset, the extracorporeal circulation specialist turns on the extracorporeal circulation to allow the blood to flow again in the baby's body.

Then the extracorporeal circulation is removed and the heart is allowed to beat again. After the heart beats again, the true autologous circulation with the heart as the core begins.

This step is the most thrilling. The scene from that year is still engraved in Academician Wang's mind - the heart started to beat, and soon, bleeding points appeared one by one, then the blood gushed, and finally the blood spurted out, and the entire chest was covered with blood. , it was a mess, and in the desperate situation, there was no way to stop the bleeding. The more injections were applied, the worse the blood vessels became. In the end, the only way to stop the bleeding was to block the large blood vessels, but this was in vain, and it was impossible to rely on temporary blocking forever.

"I'm going to start beating my heart again to see how the stitching works?" Yang Ping announced.

Academician Wang and Professor Chen stared at the heart and held their breath. The heart began to beat. They were worried whether blood would spurt everywhere like before, and eventually all the sutures would collapse.

1 minute, 2 minutes, 3 minutes, 4 minutes, 5 minutes - still no blood leakage, not even a bleeding point, let alone blood gushing or spurting.

"Observe for another 10 minutes. If there is no problem, close the chest."

Yang Ping put down the equipment in his hand.

"Song Zimo, finish!"

"Good!"

Song Zimo and Xu Zhiliang, who had been marginalized, immediately cheered up. Just now, they were watching the screen in the operating room, which also broadcast live operations.

"Professor, it seems that the special skill of replanting a severed finger of a baby has not deteriorated yet." Song Zimo said with a smile.

then?It's only been a long time, but it seems like it has a long history.

"This is my secret trick for debut, can I just throw it away?"

Yang Ping gave up his position as the surgeon and let his assistant do the finishing work.

Li Zehui, who had just sat next to the screen in the operating room, was also in shock. He completed the main steps of the operation in only 15 minutes without any problems with the needle. This unique skill is truly unique in the world and no one else has.

"Back then, Professor Yang was replanting amputated fingers of babies who were still premature babies. The technique of anastomosing blood vessels was simply superb. I was so impressed."

"I - I was - in the emergency department -"

"Professor Yang has done replantation of severed fingers before?"

"Of course - the ability to start a business."

(End of this chapter)