godfather of surgery

Tang Shun is very efficient and can manage more than a dozen top students from Dongda University with his girlfriends at the same time. Yang Ping believes that his time management level must be top-notch.

No, the laboratory construction plan has been placed on Yang Ping's desk.

It is a thick plan with very detailed contents. From the decoration of the laboratory, the configuration of equipment, the structure of personnel, the budget of funds, the establishment of safety rules, etc., not a single thing is missed. This guy is a scientific researcher. All-rounder. If Yang Ping had to do these things himself, it would take a lot of time.

People who come up with ideas and use talents to do big things must be good at doing these two things.

The same goes for scientific research. The so-called coming up with ideas means that you can come up with good research topics and come up with specific research directions and methods. The so-called employing talents means that you must have a group of high-quality professionals under your command. These people must be both smart and demanding. diligent. In this way, scientific research projects can be carried out smoothly and achieve success.

Yang Ping is currently engaged in research with only one purpose, which is to overcome medical problems, and this is also his interest.

As for the Nobel Prize, Yang Ping actually doesn't have much interest. It's not that he's pretending, but he really doesn't have much interest. His interest in the Nobel Prize stems from the powerful supercomputer promised by the system.

The third-stage long-term task given by the system is to win the Nobel Prize. Although the goal is very secular and scientific research is not for winning awards, Yang Ping is still interested in this award for the sake of the computer in the system laboratory.

You know, even in a system laboratory, a computer with powerful computing power is simply a scientific research artifact.

The discovery of space-oriented genes, if some human subjective factors are not taken into account, the scientific research value of this topic can fully reach the level of the Nobel Prize.

Tang Shun handed over not only the construction plan of the tumor laboratory, but also the next experimental plan for the stem cell cultured organ project and the progress of the launch plan of the "Medicine" journal.

When Tang Shun was a Ph.D. student, Tang Shun's mentor, Professor Fukunaga, held the top medical journal in Japan. The mentor had no energy to do these things. In fact, it was Professor Fukunaga's disciple Tang Shun who led the work of the journal. Not only that. , Tang Shun has also studied the operations of several top medical journals in the world, and he is well versed in how medical journals operate.

Yang Ping can see from the information submitted by Tang Shun that the number of submissions received by the journal far exceeded previous expectations.

Everyone is very considerate, including Robert, August, Li Zehui, Johannesson, Woodhead, Griffin, Takahashi, etc. Almost every one of these guys has submitted a high-quality paper.

Surprisingly, German Maninstein also submitted his own manuscript, a paper on spinal cord injury research.

The quality of these papers written in Chinese is very high. Could it be that Professor Manenstein also learned Chinese and was able to write papers in Chinese so quickly?

Judging from the quality of the papers, this journal can be regarded as a top journal. Yang Ping is very confident, because in addition to these papers, his own heavyweight paper-the discovery of space-oriented genes will also be published in the first issue of the journal. This paper will cause a sensation in the world and open a new chapter in medicine.

Yang Ping is now focusing all his attention on overcoming medical problems. On the road to overcoming medical problems, every breakthrough will bring Yang Ping a great sense of accomplishment and satisfaction, which is greater than winning any award.

The review of the paper has been completed and a publisher has been found. The journal will be printed by Nandu People's Publishing House.

The launch of the journal "Medicine" will once again enhance the academic status of Sanbo Hospital. For a hospital to become a top hospital in the world, clinical practice is only one part, and only the most basic part. In addition to clinical practice, scientific research is also needed, and scientific research represents the quality of a hospital. Academic level, scientific research is reflected in the quantity and quality of papers.

On the other hand, if a hospital dominates a certain journal, if the journal is national, it means it has a place in the academic community across the country. If the journal is global, it means it has a place in the academic world around the world.

Dean Xia also attaches great importance to journals. Of course, he will not interfere with Yang Ping's academic activities and will never issue any guiding opinions. He positions himself to serve Yang Ping well.

For example, coordinating the relationship with the publishing house, etc., and doing a good job in these services allows Yang Ping's team to concentrate on developing the journal.

"Professor, the first issue of our journal has not yet been published. In the United States, Europe and Japan, academic organizations specializing in translating our journals have already appeared."

Tang Shun said with a smile.

This thing is very strange. It has never appeared in academia before. Before the journal was released, various auxiliary organizations surrounding the journal actually appeared in advance, and not just one, but now there are many.

Several Tangshuns already know the background, including Robert, August and Takahashi, but some academic organizations have no idea who is behind it and why they are so active.

''This is a good thing. Even if we are a Chinese journal, we have people to help us translate it into various languages ​​to expand our influence. This is what a world-class journal should be like. "

How could Yang Ping have the time to pay attention to these things.

''I just feel strange, how can these people be so active? How do they know how influential our journal will be in the future and invest so much human and financial resources in advance to help us? Not logical. "Tang Shun said to himself.

Tang Shun didn't think too much. Professor Yang's matter could not be explained by logic at all. Let's just talk about scientific research. Before one topic ended, another started.

It would be easy to understand some water topics, but all of his topics are world-class, and any one of them could win the Nobel Prize.

Now Tang Shun feels that all this is a bit unreal, because it is too fast and too smooth. Slowly adapt to it, maybe this is the real genius.
-

Nong Zhiwen once again came to Director Fang with medical records. Because the opinions given by the two doctors were so different, Nong Zhiwen still wanted to listen to the advice of other doctors.

Before Nong Zhiwen came to Sanbo Hospital, he visited several hospitals. Their estimated costs were similar to what Director Fang said. They didn't mention anything about targeted therapy or liver cysts. However, doctors from other hospitals looked at medical records. When I was reading it, I changed my tone and said that the operation was too difficult and I could only go to the original hospital or a better hospital, such as Nandu Affiliated No. 1 and Sanbo Hospital.

Director Qian said that Sanbo Hospital was not good and was not ranked high in the province. However, several doctors ranked Sanbo Hospital with Nandu Affiliated One as the best hospital in the province.

If it were in the past, when money was relatively loose, Nong Zhiwen would definitely follow Director Qian's advice, because Director Qian was right. Sometimes we can't just think about saving money, treatment is the most important thing, but Nong Zhiwen Wen really couldn't get hundreds of thousands of yuan on hand now, so he had to consider the second option. The situation was stronger than the people, and there was no way around it.

This time, although Nong Zhiwen did not bring a pathology report, he did bring copies of the two surgical records as instructed by Director Fang.

With the surgical records, Director Fang will be able to judge the condition more accurately.

Director Fang carefully read the two operation records and couldn't help frowning. Although this operation was to repair the recurrent laryngeal nerve, it was indeed difficult to perform. If it was before, he would have just followed the traditional operation. Is the operation effective? Okay, it's not within the scope of his consideration. Everyone does it anyway, so let's try our luck.

It is obviously different now. He must go all out for every operation and strive for the best surgical effect.

According to the surgical records, the segmental resection of the right recurrent laryngeal nerve actually reached 8 cm. It was impossible to close and suture such a long defect.

If nerve bridging is done, the bridging effect will be very poor over such a long distance.

Using nerve transfer technology, according to the description of the surgical record, the phrenic nerve and hypoglossal nerve loop were also invaded by the tumor at that time, and a large section had been removed. This left very little room for selection of the transferred nerve, and it was difficult to find a suitable transfer. nerve.

No wonder Director Qian himself is unwilling to accept his patients for recurrent laryngeal nerve repair. In this case, surgery is simply impossible.

It's really strange how this tumor invaded so many nerves. Director Fang has never encountered this situation before, and he can't draw any conclusions.

Director Fang is a little confused now, and he is confused at all. He is not panic at all. Doesn't he still have a plug-in? The plug-in is Professor Yang. If you have any questions, please ask Professor Yang.

So Director Fang went to Yang Ping again with Nong Zhiwen's medical records. Yang Ping was busy these days, but he always remembered this case, and wanted to ask Director Fang if the patient had brought the pathology report.

This time the patient still didn't come with the pathology report. If he didn't bring it, he didn't bring it. Anyway, the recurrent laryngeal nerve must be repaired, so no matter what the result of the pathology report is? The goal of this surgery is to repair the recurrent laryngeal nerve.

The purpose of seeing the pathology report is to make a clear diagnosis. In terms of rigorous procedures, if surgery has been performed, pathological examination must be done after surgery, so that the nature, staging and grading of the tumor can be more clearly defined.

Director Fang told Yang Ping: "The defect of the recurrent laryngeal nerve is too large, with a full 8 centimeters missing. It is impossible to suture it directly, even if we try to fully free the nerve to both ends."

Not to mention it's impossible, even if you can pull the sutures together, it's useless. There must be no tension after the nerves are sutured, because once the tension is too high, no matter how good the anastomosis is, it is impossible for the nerves to recover.

After hearing what Director Fang said, Yang Ping did not express an opinion for the time being, but carefully read the operation records. After reading it, he said: "Not only is the suturing impossible, but nerve transplantation and nerve transfer are also unrealistic. If nerve transplantation and nerve bridging are done, The distance is too long, so the postoperative recovery will definitely be very poor. If nerve transposition is performed, there seems to be no suitable transposed nerve to choose from. Judging from the surgical records, the tumor invaded a very wide range at that time? More than this nerve was removed root."

What should I do?

If none of the three methods worked, there was no way out. Director Fang was very helpless.

Yang Ping frowned and said, "Let me think about it again. This patient will definitely need surgery. The question now is how to do the surgery."

At this time, Nong Zhiwen took the opportunity to ask: "Professor Yang, do you still need targeted therapy after surgery?"

Yang Ping said: "Judging from the routine, it is not necessary, but I have to see the pathology report. Only with the pathology report can I know the specific classification and stage of the tumor, so that we can accurately judge the condition and formulate treatment plans accurately. There is no pathology report now, and we have no way to judge the condition, so you'd better get the pathology report." "Professor Yang, could you please help us take a look. Do the cysts on the liver need surgical treatment?" Nong Zhiwen seized the opportunity and raised all the questions.

Liver cyst?

When Yang Ping first looked at the medical records, it was true that there was a cyst on the liver, but such cysts generally did not cause major problems, so he did not focus on it.

"Did you bring the video?" Yang Ping asked.

"Bring it, bring it all!"

Nong Zhiwen immediately took out a large and thick bag, which contained many films, including all the imaging examinations his father had done in the past few years.

Nong Zhiwen didn't understand so many films, so he put them all together and showed them to the doctor every time he saw a doctor.

"It's okay, I'll take my time."

Yang Ping asked Nong Zhiwen to take the film to the reading light, and then put all the images on the reading light one by one, sorting them according to the type of examination and date. Some films have been dissolved and blurred due to their age. .

It took Yang Ping about ten minutes to sort out these films. After finishing, he began to read the films one by one in chronological order.

Not only color ultrasound was performed on the liver, but also CT and contrast-enhanced CT were performed. PET-CT of the whole body also had images of this part.

Starting from the first picture showing the liver, there was a mass on the liver. At that time, it was suggested that it was a space-occupying lesion. It was considered that the liver cyst was organized. In the subsequent series of pictures about the liver, the mass has not changed.

Although I am not 100% sure, I can basically confirm from the images that this is a cyst, and it is an organized cyst. There is no need for surgical treatment at all. It only requires a review of color ultrasound every six months to one year.

Yang Ping told Nong Zhiwen his opinion.

"No need for surgery? What if it's a malignant tumor?" Nong Zhiwen was very straightforward.

Yang Ping also communicates directly with patients, which can reduce unnecessary waste of time.

"The possibility of it being a malignant tumor is extremely slim, close to zero!"

Yang Ping's answer is very affirmative.

"I understand what you mean, Professor Yang. If you want active treatment, shouldn't you do surgery?"

Nong Zhiwen wanted to know more.

Yang Ping's opinion is very clear: "This liver cyst has no indication for surgery at all. Surgery is a tool for our doctors to treat diseases. It is a double-edged sword. We cannot abuse it. Some diseases require surgery, and some diseases can be operated on or not. Some diseases do not require surgery at all. Medically speaking, your father’s liver cyst does not require surgery at all.”

This statement is completely different from Director Qian's statement. Director Qian not only recommended surgery, but also recommended robotic surgery. He said: Robotic surgery can more accurately and completely remove tumors, which provides the best postoperative results and is the most reassuring. Ordinary surgery cannot accurately and completely remove the tumor, and there may be residual tumor. Once it is something bad, the residue will be very troublesome. If the grass is removed without eradicating the root, it will definitely grow again in the future.

What both sides say makes sense, but what should we do? Nong Zhiwen was very confused now.

The opinions of Sanbo Hospital were very clear, without any ambiguity, and Nong Zhiwen judged from his intuition that Professor Yang was very confident, completely different from ordinary doctors.

Director Qian's opinion seems to make sense. What if it's really something bad? What if? If the 100,000 yuan delays his illness, it will be too late to regret it. As Director Qian said, my father is only in his fifties.

Every patient has an instinctive desire to survive, which is also accompanied by fear, desire and fantasy. Popular scammers also seize the patient's psychology to defraud.

"Go back and think about it. Don't worry about it anymore. You can ask about the reputation of our hospital and Professor Yang." Director Fang told Nong Zhiwen.

Nong Zhiwen also left Sanbo Hospital with a large bag of information full of doubts. His trip was worth it, at least he heard different opinions.

After Nong Zhiwen left, Director Fang asked Yang Ping: "Is there any good method for this operation?"

In Director Fang's impression, Yang Ping is omnipotent.

Yang Ping has been thinking about this problem just now. How to solve the problem of repairing the recurrent laryngeal nerve? My thoughts just now also have some implications:

"We can directly dissect the severed end of the recurrent laryngeal nerve retrogradely from the brachiocephalic trunk to the vagus nerve, and anastomose it with the recurrent laryngeal nerve in the larynx behind the carotid artery."

Director Fang was a little confused after hearing this. He didn't understand it very well.

Yang Ping explained to him while drawing a picture: "Actually, the reason is very simple. It is to solve the distance problem by changing the route. The starting point of the nerve is a, the point where the nerve passes through the subclavian artery is b, and the end point of the nerve is C. The normal path It starts from a, goes around to point b of the subclavian artery, and then to point c of the throat. The abc segment often needs segmental resection due to tumor invasion. After the nerve is removed, a defect will appear. The defect is too long. The traditional method is Find other nerves to bridge, or do a nerve transposition, like a wire bridge, or run another wire from another room."

"These methods will not work for this patient. The bridge distance is too far. If a wire is connected from other rooms, the wires in other rooms are also very tight now, and a suitable one cannot be found at the moment.

"How to do?"

"We will no longer wrap the existing wire around point b, but reroute it directly to point c to complete the power supply between two points a. I have just calculated the distance. According to the speed of nerve growth and recovery, if the patient uses this With this method, significant recovery can be achieved in about half a year.”

As Yang Ping spoke, he drew pictures on A4 paper. He drew the anatomy of the neck.

Pictures are the best way to express anatomy and surgery, and language expressions will be pale and feeble.

"Between two points, a straight line is the shortest!"

With the help of the pictures drawn by Yang Ping, Director Fang instantly understood what Yang Ping just said. When it was just a verbal description, Director Fang still had a vague understanding, but now he fully understands.

"Smart! To be precise, the line segment between two points is the shortest!" Yang Ping praised.

Damn it, isn’t this a primary school math problem? You still praise me, does it mean that in Professor Yang’s eyes, I am only at the elementary school level?

However, when this simple mathematical axiom is used here, it actually works, giving birth to a new technique for solving problems.

"Can you draw anatomy diagrams?" Yang Ping asked Director Fang, who was still staring at the drawings.

Director Fang shook his head.

"That won't work. You have to learn to draw."

Drawing is a basic skill for doctors in surgical institutes. As a grassroots doctor, Dr. Li Min has also mastered medical drawing technology.

Director Fang blushed: "I can learn. I will learn right away. I will learn it soon."

"Well, it took you three months to learn medical drawing, including systemic anatomy, regional anatomy, transverse anatomy, and surgical approach anatomy. Is there no problem?"

Yang Ping felt that if Director Fang really wanted to improve, he must study systematically.

"Promise to do it!"

Director Fang was very excited. Is this official joining the team?

PS: Description of the new surgical technique for recurrent laryngeal nerve repair in this chapter: This surgical technique is the masterpiece of Professor Ji Qinghai and Professor Wang Yulong from the Department of Head and Neck Surgery, Fudan University Cancer Hospital. The paper was published in "Head & Neck". This surgical technique is at the international leading level. It has improved the academic status of my country's head and neck surgery in the world. I pay tribute to the two professors!