godfather of surgery

Modified abdominal organ cluster transplantation means that in addition to the liver, abdominal organs including the stomach, pancreas, duodenum and small intestine are transplanted as a series of organ clusters. This transplant operation is more complicated than a single organ transplant. , there are not many hospitals that can carry it out at present.

Therefore, everyone was highly motivated to observe. The general surgery department was full of people today, and doctors from other departments also came to visit. After all, such highly technical surgeries are rarely seen.

"Xiao Chen, the classroom is showing live broadcast. Is the picture clear?" Director Fang asked Dr. Chen in the audience.

Dr. Chen is Director Fang's graduate student and one of the few doctors allowed to observe in the operating room. However, he is responsible for maintaining the live broadcast in the classroom, so he also runs both directions.

"It's very clear. It's being broadcast right now. The scene is very heated. Everyone cranes their necks and stares at the screen, saying that the surgeon's skills are excellent." Dr. Chen did not forget to compliment his instructor.

Director Fang smiled and said: "Well, just keep an eye on it. If there is any problem with the video, go directly to the person on duty in the computer department. You're welcome. I'll also bring you some midnight snacks or something. Don't just sit here. I'll treat you." "

It shows that the classroom is not a sterile area. Just like the rest room and dining room in the operating room, you can take off your mask and eat.

Dr. Chen immediately took the order and went out to make arrangements. The tutor was happy today. Dr. Chen was also wondering if there was anything difficult that he needed help from the tutor, so he might as well raise it together later.

Director Fang continued the operation. It was indeed very difficult to remove Pan Doudou’s damaged organ. No wonder Director Luo had not removed anything for a long time. Due to the influence of chronic inflammation, there were adhesions everywhere and everything was blurred, and the anatomical structure could not be distinguished at all.

If Yang Ping hadn't guided Director Fang like this, it would have been difficult for Director Fang to do it himself.

The steps of allogeneic organ transplantation are actually three steps: donor organ removal, patient organ removal, and allogeneic organ transplantation.

Of these three steps, Director Fang has successfully completed the first step. The donor's pancreas, stomach, duodenum and small intestine have been successfully removed and are now soaked in a special liquid and stored, waiting for transplantation.

Director Fang is currently in the second step. The removal of any organ in the human body is to cut off the various connections between the organ and the human body, such as blood vessels, nerves, mesangium and other structures.

The most common organ removal is amputation. In the old barbaric medical era, the mortality rate of amputation was extremely high, because amputation at that time could be made into a horror movie. After amputating the patient's limb using a knife or saw, the stump of the amputated limb was directly pressed. Boiling oil or boiling water was believed to kill bacteria.

So at that time, amputation was simply the most terrifying and painful operation. After such a horrific operation, many patients after amputation died of infection.

Amputations are different now. Under anesthesia, drapes are sterilized and then the connection between the abandoned limb and the human body - blood vessels, nerves, ligaments, muscles and tendons - are cut off, and the blood vessels are also ligated.

Anesthesia, hemostasis, and asepsis are the three cornerstones of surgery. Since their emergence, modern surgery has begun.

In fact, in ancient times before the emergence of modern surgery, Chinese medicine was not only milder than European medicine, but more importantly, both in theory and therapeutic effect, it was far ahead of European medicine, not even in the same dimension.

Director Fang's surgical steps are very clear and pleasing to the eye. They are neither too fast nor too slow. In short, the operation is smooth and smooth. After all, Director Fang is passively following Yang Ping's guidance, so it is impossible to say that it is very fast. But this speed is now rarely matched.

Resection of the pancreas and duodenum is regarded as a difficult operation in general surgery because they have numerous blood supplying vessels and are complicated in steps. Vascular nerves are targets that must be faced seriously in any operation.

The pancreas is divided into the pancreatic head, pancreatic body and pancreatic tail. The blood supply vessels of the pancreatic head are the superior and inferior pancreaticoduodenal arteries anastomosing each other. The superior pancreaticoduodenal artery comes from the gastroduodenal artery, and the pancreaticoduodenal artery The inferior enteric artery arises from the superior mesenteric artery.

The blood supply to the body and tail of the pancreas comes from the splenic artery. In addition to the splenic artery, the blood supply to the body and tail of the pancreas also includes the dorsal pancreatic artery and transverse pancreatic artery from the celiac artery, and the branches of the splenic artery, the great pancreatic artery and the tail pancreatic artery.

In addition to arterial blood supply vessels, every organ also has veins that return blood. The veins of the pancreas eventually merge into the splenic vein, superior mesenteric vein, and portal vein.

The duodenum is a part of the small intestine. Its blood supply vessels are mainly the anterior superior pancreaticoduodenal artery, the posterior superior pancreaticoduodenal artery and the inferior pancreaticoduodenal artery. The blood supply of the entire small intestine is mainly the mesentery. Upper and lower arteries.

The pancreas is connected to the duodenum through the pancreatic duct. The pancreatic duct opens on the inner wall of the duodenum and inputs pancreatic juice produced by the pancreas into the duodenum. The main function of pancreatic juice is to digest and break down fat. Therefore, in addition to handling blood vessels, the pancreas also needs to Take care of the pancreatic duct.

The main arteries of the stomach are the left gastric artery, the left hepatic artery and the splenic artery.

So many blood vessels are densely distributed, and some of them anastomose with each other in a ring shape, making the circuit extremely complex. This is why the successful removal of the pancreas and duodenum marks the entry into the highest level of general surgery.

Faced with these complex blood vessels, Director Fang sat firmly on the Diaoyutai, unhurried and followed Yang Ping's rhythm attentively.

Soon, the blood vessels, nerves and mesentery of the pancreas, stomach, duodenum and small intestine were cut off one by one by Director Fang, and the entire organ cluster was detached and successfully cut out.

The second step is completed, and now the third step is to transplant the donor's organ into Pan Doudou. The most critical step in organ transplantation is the anastomosis of the blood vessels. Restoring the normal blood supply and allowing it to survive is the best way.

The blood vessels in the abdominal viscera are relatively thick, unlike the blood vessels that need to be anastomosed in finger replantation and coronary artery bypass grafting which are thinner. Moreover, if it is a coronary artery bypass grafting with a heart that keeps beating, the heartbeat will also interfere with the surgical operation. Now the abdominal organs Cluster transplantation does not have these problems. For this operation, Director Fang also made full preparations in advance. Che Lizi bought an unknown number of boxes for the doctors and nurses at the surgical institute so that he could train on vascular anastomosis in the training room. Later, he practiced several cases with pigs in the experimental building. times, so there is still something in the stomach, otherwise Yang Ping wouldn't be able to touch it.

The most difficult thing about abdominal organ cluster transplantation is not the pancreas, but the small intestine transplantation, because the small intestine is a highly immune organ and contains a large number of lymph nodes, which is prone to rejection. In addition, the small intestine is rich in various intestinal bacteria, which can easily cause infection. Therefore, the operation is very difficult and the risks are very high, otherwise today's operation would not attract so many people.

In fact, any allogeneic organ transplantation will face rejection problems, but the degree is different. Anti-rejection treatment is required after allogeneic organ transplantation, and anti-rejection drugs often cause hyperlipidemia, hypertension, high uric acid, and may also cause bone marrow transplantation, causing White blood cells and platelets decrease, suppressing the patient's immunity and leading to infection, but these complications are insignificant compared to saving lives.

Combined pancreaticoduodenectomy is a super major surgery in general surgery and a landmark surgery in general surgery. However, the removal and transplantation of the pancreas, stomach and duodenum are more difficult.

When anastomosing blood vessels, Director Fang was worried because as the chief surgeon, he had to do a lot of complicated operations independently. Yang Ping's help as an assistant was very limited. He could only help fix the blood vessels, but he couldn't help much. This Director Fang was a little unsure of the procedure, because he had to suture it himself in the end. Unlike the resection just now, he only had to cut and cut along the way, and then continuously ligated the blood vessels.

Director Fang calmed down and cheered himself up. It was not a severed finger and replantation, nor was it a coronary bypass. What was he afraid of? Such a thick blood vessel was afraid of a ball.

In fact, Director Fang is not afraid that he will not be able to handle the gentle blood vessels, but is worried that the contrast before and after the operation will be too great, which will seriously affect his image tonight.

After all, in front of everyone tonight, he was the one who successfully performed the abdominal organ cluster transplantation. It would be a shame if he looked like he was lame when the blood vessels were anastomosed.

Yang Ping saw that Director Fang was a little unsure, so he used fine toothless forceps to clamp the outer membrane of the blood vessel opening, gently lifted the blood vessel, and gave it to Director Fang to trim the outer membrane of the blood vessel. When the blood vessels were anastomosed, the port must be trimmed. The treatment ensures that the port is neat and the adventitia cannot be turned over and embedded in the vascular lumen, so trimming the adventitia is a necessary step.

The blood vessels raised by Yang Ping make it very convenient for Director Fang to trim the adventitia, because this angle is the best angle, and Director Fang can complete the trimming of the adventitia in the most comfortable and natural posture. Moreover, Director Fang's microscissors had just cut open the outer membrane that had just been lifted. Another pair of toothless forceps in Yang Ping's hand had already lifted the new outer membrane and brought it to his scissors. The two toothless forceps worked so well together that it actually allowed Director Fang can easily trim a complete circle of outer membrane in one go.

When he saw a circle of outer membrane cut off, Director Fang couldn't believe how his craftsmanship could be so good.

The outer membranes of both ends of the donor organ and the patient's blood vessels were repaired. Director Fang began to anastomose the blood vessels. The anastomosis of the blood vessels was much easier than he thought. Just like trimming the outer membrane, Yang Ping lifted the severed ends of the blood vessels and laid them out as best as possible. The optimal angle allows Director Fang to only insert and withdraw the needle from a natural angle, without having to worry about anything. Even if the angle of insertion of the needle is not good for any needle, Yang Ping will make adaptive adjustments to the broken end of the blood vessel to directly cater to it. Director Fang’s stitches are not about the needle looking for the blood vessel, but the blood vessel looking for the needle. The needle becomes the passive party and the blood vessel becomes the active party.

In an instant, Director Fang completed one stitch of suturing with standard and smooth movements, with almost no pressure.

The surgeon and assistant came and went with perfect coordination. When the doctors observing the operation saw this rhythmic suturing, they all admired Director Fang's progress.

In fact, it's like playing table tennis. Each opponent's ball is delivered to you in the most comfortable position to catch the ball. It's impeccable in height, distance, and distance. You just need to stand still, gently reach out to block the ball, and the ball passes.

After a few back and forths, Director Fang's confidence immediately increased and he could actually operate like this. He was very smart and immediately saw Yang Ping's feeding routine, so he took the initiative to sew the ones that were easy to sew, and simply removed the needle if he was not so good at sewing. The posture was set, and Yang Ping took the blood vessel to find the needle.

According to this pattern, with Yang Ping's cooperation, Director Fang continued to suture the blood vessels. The further back he went, the more Director Fang found his rhythm.

There are dozens of large and small blood vessels supplying the pancreas, stomach, duodenum and small intestine. Suturing them is also a big job. Originally, Director Fang was afraid that he would not perform well, but in front of so many people, he did a very good job in the first half of the operation. It's beautiful, but it would be very embarrassing if the second half of it were to fall off.

Now it seems that with Professor Yang on the other side, there is no way to lose control. Director Fang decided to follow Professor Yang's pace and stride toward the pinnacle of academics.

Not to mention blood vessels, even the reconstruction of the pancreatic duct, Director Fang is very confident.

The same goes for the suturing of some nerves, which seemed very easy with Yang Ping's help.

The demonstration classroom was very lively at this time. Dr. Chen followed the instructor's instructions and ordered a lot of late-night takeaway snacks. Everyone was eating late-night snacks while observing the surgery, and they felt very comfortable.

When these general surgeons saw the smooth operation on the screen, the young doctors paid homage to the director Fang. Why was the director so awesome today? The abdominal organ cluster transplant was performed so smoothly. It seems that they usually don’t have the chance to perform. Today, they have fully performed. own surgical level. Several directors with high professional titles saw something more and more wrong. There was something wrong with this operation. It was different from how they usually felt about the operation, but they couldn't tell where the problem lay.

It's like watching someone else play table tennis, all you know is that you and I are playing inextricably, and I feel that there is something wrong, but I can't say it out for a while.

oh! Several directors finally figured out the secret. The assistant was too active. Sometimes the assistant would take the blood vessel to thimble the needle. It turned out that this was Professor Yang using the mass feeding technique.

Several general surgeons with high professional titles took a closer look, and now they can see clearly. It is indeed the case. With Professor Yang's strong cooperation, Director Fang is now sweating profusely. This is comparable to when Dean Xia played basketball. In the hospital's basketball games every year, Dean Xia was extremely powerful. He could always score in the midst of thousands of troops and frequently won applause from the audience, even like Xiong Sihai in the emergency department. Even such a strong man could not block Dean Xia's three-step layup, because at this time Xiong Sihai seemed to be guarding Dean Xia tightly, but he was always just a little bit close, allowing Dean Xia to break through frequently, and by some strange combination of circumstances, Xia Yuan Chang can always get the ball in the best scoring position, and the opponent is always a little bit worse at this time. It wasn't until Professor Zhang Zongshun became the chief referee that the myth of Dean Xia was destroyed. Dean Xia barely scored a few points during the entire schedule and was almost sent off. The best player and scoring champion who belongs to Dean Xia every year was also forced to Change of ownership.

Until now, when Dean Xia plays basketball and sees Professor Zhang Zongshun, his legs tremble and he can't even touch the ball.

I saw Director Fang's surgery today, and it was so similar. It was like opening your mouth to eat, and just popping it into your mouth with a spoon.

PS: I caught a cold today and didn’t save my manuscript. I can only post so much. Thank you everyone!