godfather of surgery

Chapter 967: Is the World's First Case So Easy?
Intestinal necrosis is a very urgent disease and cannot be delayed for too long. If it is delayed for too long, complications such as intestinal necrosis may easily occur. Therefore, Yang Ping asked the Overseas Chinese Building to arrange an emergency surgery for him.

The operation was performed by Director Ji from the Interventional Department. The Interventional Department is also very strong, especially the two directors, Director Guan and Director Ji. Director Guan specializes in cardiovascular interventional treatment, while Director Ji is an all-round master who is very skilled in all interventional surgeries such as cardiovascular, cerebrovascular, and tumor surgeries.

Although enema treatment for intussusception is not an interventional surgery, it requires the use of the interventional department's X-ray equipment. The interventional department's X-ray equipment is easier to use than the gastrointestinal X-ray machine and can monitor more clearly. As for enema under X-ray monitoring, it is very simple for Director Ji. As a generalist in the interventional department, he has also helped the gastroenterology department do a lot of such things.

"It was originally just acute pancreatitis, but I didn't expect it to turn into intussusception."

Niu Zhixuan sighed.

Dr. Feng, who was in charge of the patient, comforted him, "You are lucky. Severe cases of acute pancreatitis can be fatal. You only have the mildest type of edema. As for the intussusception, if Professor Yang hadn't come to see you that day, it wouldn't have been discovered so quickly. If it had been discovered later, you might have had to undergo surgery."

Niu Zhixuan is a doctor and he knows very well that intussusception in adults is very rare. If it weren't for Yang Ping's rich experience, most doctors would have considered the abdominal pain to be a recurrence of pancreatitis. If they treated it for a few days and then went for a CT scan, it would easily delay the best time for treatment.

"What about the tumor marker results? Aren't they out yet?"

Niu Zhixuan was still worried. It was impossible for him to be completely reassured without seeing the final result.

When he was a pediatrician, he worked day and night shifts and made very little money, which really ruined his health. In the past two years, he made a lot of money selling health products and had been planning to enjoy life, but now that this has happened, Niu Zhixuan prays that he will not have any health problems.

Dr. Feng refreshed the tablet in his hand again, and the results of Niu Zhixuan's tumor marker test came out.

"CEA is elevated! 190μg/L!" Dr. Feng slid his finger and displayed the latest test results.

This news was like a bolt from the blue for Niu Zhixuan. An elevated CEA level meant that it might be a tumor, and it was so high, it really was true.

"Come back to the ward after the enema. We will conduct further examinations. Don't worry too much." Doctor Feng comforted Niu Zhixuan.

Niu Zhixuan's mind was blank at this time, and he was anxious, but he still knew the priorities of the matter. The most urgent task now was to cure the intussusception, otherwise it would be very troublesome once intestinal necrosis occurred. After curing the intussusception, he could slowly check the elevated CEA.

If I had known earlier, I would not have had this midnight snack. If I had not had this midnight snack, I would not have had acute pancreatitis. If I had not had acute pancreatitis, I would not have come to the hospital. If I had not come to the hospital, I would not have been checked. If I had not had the check, there would not have been so much trouble. What's the point of checking?

"Old Cow, why are you shivering all over for an enema? You are a pediatrician after all."

Xiaowu found that Niu Zhixuan's whole body was stiff and he was shaking all the time.

Yang Ping naturally had no time to follow the show, so as a friend, Xiao Wu took some time to come and follow Niu Zhixuan's show. Just now, when he was passing the bed with the nurse, he found that Niu Zhixuan was in a stiff state and was still shaking.

"Where are you shivering? Your air conditioner is too cold."

Niu Zhixuan made excuses.

Xiaowu looked at the control panel on the wall and saw that the air-conditioning temperature was just 25 degrees. Isn't this the most comfortable room temperature?
"Let him rest for a while. If that doesn't work, give him a sedative." Director Ji said that Niu Zhixuan was not only trembling, but his heart rate was also very fast, which was obviously caused by nervousness.

"Don't be afraid, it's just an enema, but it will be done under the monitoring of an X-ray machine." The nurse also gave Niu Zhixuan courage.

I'm not afraid of enema, I'm afraid of elevated CEA levels.

The principle of using contrast liquid enema to treat intussusception is actually very simple. If you regard the intestine as a long balloon, because the balloon can be folded and nested when it is deflated, now fill the balloon with water or blow air into it, the balloon will immediately expand and there will be no more folds or nesting.

It is easy to inflate a balloon, but it is not so easy to inflate the intestines, and there is also a certain failure rate. If enema cannot solve the intussusception, it can only be solved by surgery, cutting open the abdomen, manually straightening the intestines, and then suturing the abdomen.
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Because Yang Ping had been on vacation a few days ago, Director Liao had been waiting for Yang Ping to do a lung nodule puncture. The diameter of the lung nodule was less than 0.5 cm, which was very small. The puncture was extremely difficult. It was feasible in theory, but impossible to do in practice. However, the characterization of this matter was of great significance to Director Liao, as it was a critical time for promotion, and his promotion could not be affected by this matter.

Don't underestimate this as just a nodule. It can be a big deal or a small deal. If you don't take it seriously, it's fine. But you can also take it seriously. An uncharacterized nodule can be benign or malignant, half and half. It's hard to say. If it's half and half, then it's a health hazard.

Although Director Liao is already fifty years old, he is still relatively young in his circle. His future is not limitless, but at least it is bright. He was also very nervous as he lay on the operating table. Although Yang Ping had said that the possibility of malignancy was extremely small, this was only a statistical concept of the doctor. For the patient, it was only the difference between 0 and 100.

In fact, Director Liao pays special attention to his health. He takes all kinds of health products and takes Cordyceps sinensis all year round. He either makes soup or soaks it in water. However, social events are inevitable. He has no choice but to quit drinking until retirement. Otherwise, the stock price of Moutai would not be so strong. In fact, Director Liao has made some contribution to this.

"Professor Yang, what if the pathological examination shows something bad?" Director Liao asked cautiously.

Yang Ping could only comfort him: "It's okay, don't be nervous. Whatever the examination shows is what it is. If it's benign, just observe it. If it's malignant, then surgery is required. Early surgery usually has a very good effect."

"'Didn't you say that the possibility of malignancy is extremely small?"

After hearing Yang Ping's 50-50 statement, Director Liao became nervous again.

Local anesthesia is generally used for lung puncture anesthesia. The patient is awake, and the surgeon can chat with the patient while performing the operation. Song Zimo assisted Yang Ping and began to disinfect and lay the sheets.

No doctor would choose to puncture such a small lung nodule, but Yang Ping cannot be treated as a normal person. Song Zimo has become accustomed to the fact that Yang Ping can do things that others cannot do. This is not the first time this has happened, it happens every day.

The disinfectant mixed with alcohol was applied to Director Liao's body. The cooling caused by the evaporation of alcohol made Director Liao feel a chill on his chest. "Professor Yang, you must help me puncture a benign one."

What you said is true. If I could do it on my own and make a benign tumor for you, then the Nobel Prize I would apply for now would not be for the complicated "Space-guided Gene Theory", but for "The mechanism by which biopsy can transform tumors into benign ones."

"Try your best!" Yang Ping replied.

The puncture must be monitored by imaging equipment. This kind of nodule puncture must use a navigation device. The navigation device is actually a CT with special functions. Song Zimo finished his preparation work and said, "Professor, go put on the lead suit."

Yang Ping looked at Director Liao's CT images and said, "No need. Just flash once. No need to monitor the whole process."

In this way, everyone goes out, and the navigation operator uses a remote control to control the machine to scan the lungs. After the scan is completed, everyone re-enters the operating room, which can avoid X-ray exposure.

Yang Ping put on his clothes and gloves, took a look at the CT image left on the navigation screen, held up the puncture needle in his hand, and slowly inserted it between the ribs. Then he ordered everyone to go out and scan again. Sure enough, the puncture needle had entered the center of the small nodule.

The puncture needle was pulled out, and the removed tissue was kept as a specimen and sent to the pathology department for examination. Although Song Zimo had been shocked by Yang Ping countless times, he was still very surprised now.

Song Zimo felt that he would never be immune to Yang Ping's various shocking actions in his lifetime.

A lung nodule less than 0.5 cm in size was punctured in just a few minutes. The needle went in and out, and the job was done! What a level of skill! A small nodule less than 0.5 cm in size was fixed just like that.

While cleaning up the mess, Song Zimo asked, "How did you do it?"

"It's just a matter of practice!" Yang Ping replied.

"Professor Yang, is it benign?"

Director Liao, who was lying under a sterile sheet, asked worriedly.

"Try to be as benign as possible!" Yang Ping replied.

"How can it be so fast? The specimen hasn't been sent yet. The pathological examination will take 3 to 5 working days to get the results. Don't be in a hurry and don't talk. Talking can easily cause pneumothorax." Song Zimo warned the anxious leader.
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Ou Lianfeng wandered around the hospital, trying to find a part-time job. Although he received some compensation, he calculated that after using it to treat his lungs, he had very little money left. Later, he received a fund subsidy from Sanbo Hospital, so he had a considerable amount of money in his hands.

This money is life-threatening money, and Ou Lianfeng dare not relax at all. He knows that it is impossible for him to do physical work after the lung transplant, and he basically cannot generate income on his own. He has to take subsequent immunosuppressants all the time, and various follow-up examinations also cost money. If any trouble comes, his one million yuan will not be able to withstand the tossing.

The family of the patient lying in the ICU relying on ECMO to survive is still hesitating whether to give up treatment or fight for it. The family is arguing outside the ICU. The patient's parents insist on rescuing him, but they have no money. His brothers and sisters also want to rescue him, but they can't afford it. His wife also wants to rescue him, but she still has no money. Next, they have to sell the house, but after selling the house, they will have nothing. What if they end up losing both their money and their lives? The doctor said that even if they spend money, there is little hope.

Ou Lianfeng had been waiting for his lungs. When he thought about it, he felt that it was very immoral for him to be thinking about someone else's lungs, although he didn't know who the other person was or where the other person was. Whenever he thought of this, Ou Lianfeng felt a strong sense of guilt.

After wandering around for a few days, he couldn't find a suitable job. A person like him who has no diploma, no skills and relies on physical labor to earn money now doesn't even have the last bit of physical strength to find a job. There is no place for him, sweeping the floor, washing dishes, or working as a security guard.

He wanted to be a security guard, the kind that guards the factory gate, so he went to ask an uncle in a factory. The security guard, who looked to be in his fifties, was a relative of the factory director. Not everyone can do this job of sitting there and operating the remote control to open and close the door every day, you have to be a relative of the factory director.

Someone suggested that he drive for Didi. But how could he drive for Didi if he didn’t even have a car? He could use an electric car?
When delivering food, he is a person who is out of breath when walking. Even if he doesn't leave on the way, he will still be fined for being late.

Ou Lianfeng browsed his phone, wanting to hear the opinions of experts. After all, experts are educated, knowledgeable, and well-informed. He found a professor who was giving advice to people in financial difficulties.

The professor said that the financial difficulties faced by Ou Lianfeng were actually very simple. He just needed to rent out the house he no longer lived in. The rent was enough to guarantee his basic living and help him get through the difficult period.

Oh my god, if it wasn’t for the phone screen, Ou Lianfeng would have wanted to spit in his face. He spoke without thinking.

In fact, Ou Lianfeng has already put life and death aside. He has a sum of money in his hand now. If Sanbo Hospital had not offered him a free lung transplant, he would not have wanted to spend the money on treatment. How long he can survive depends on his life. He wants to give the money to his wife and let her raise the child. He can find a job and earn as much as he can. If things don't work out, at least he will leave behind more than one million in cash. If he uses the more than one million in cash on the lung transplant surgery, if it is successful, it will be difficult for him, who relies on physical labor, to make money in the future. If the surgery fails, he will lose both his money and his life. In the end, he will get nothing.

Lung transplantation is currently the best at Zhejiang University Second Hospital. In the field of organ transplantation, heart transplantation and lung transplantation represent the highest level. If these two transplants can be done well, it means that the level of organ transplantation in this hospital has reached the top. Liver transplantation and kidney transplantation have been developed for so many years that many hospitals can do them very well. They are considered the threshold operations for organ transplantation.

For the development of a profession, we must have what others do not, be specialized in what others have, and be excellent in what others specialize in. Otherwise, it will be difficult to stand out from many hospitals. The Sports Medicine Center has taken this path, directly performing the most difficult surgeries in the field of sports medicine, and step by step becoming a national and world leader.

The Organ Transplant Center is now also going down this path. They plan to do a good job in heart transplantation and lung transplantation. Director He Xiangjun is still ambitious, mainly because he has a strong backing, so he is not afraid of taking too big a step and getting hurt.

The Organ Transplant Center is actually a patchwork department, which is made up of personnel drawn from many departments. For example, liver transplantation is performed by general surgery or hepatobiliary surgery, while kidney transplantation is performed by urologists. Director Li, who does liver transplantation, and Director Liu, who does kidney transplantation, were both transferred from their original departments.

Currently, Director He Xiangjun of the Department of Thoracic Surgery has begun to expand into heart transplantation and lung transplantation. With the help of Yang Ping, they have accumulated a certain number of cases, and the postoperative follow-up results are currently very good.

At this time, in the doctor's office of the Surgical Research Institute, Yang Ping, Director He of the Thoracic Surgery Department, and a group of doctors gathered around the reading light.

"Let's do it with a thoracoscopic approach. A fully thoracoscopic allogeneic lung sequential transplant. This will cause less trauma and allow for faster recovery."

Yang Ping told Director He.

As a thoracic surgery expert, Director He now reads widely. How come I have never heard of the allogeneic bilateral lung sequential transplantation surgery under full thoracoscopic surgery? I haven't even seen it in the papers?
"Professor, why haven't I heard of this operation?" Director He was very surprised and asked in a matter-of-fact manner.

Yang Ping stared at the CT scan and said, "Of course you haven't seen the name of the surgery I just came up with."

"Oh!" He Xiangjun said.

I just thought of this. I think no one in the world has done this yet. If I can really do it, wouldn’t it be the first case in the world?
"I'm afraid I can't do it?"

Director He knew that using thoracoscopic lung transplantation was extremely difficult and there were no precedents to refer to. He had to redesign everything from the approach to the procedure.

"What's so difficult about it? Isn't it just converting an open surgery into a minimally invasive surgery under a microscope? Now that the source of the lungs has not been determined, we can do it several times on experimental pigs to accumulate experience. I'll guide you to do it." Yang Ping felt that this was not difficult at all.

When Director He heard that Yang Ping would personally take care of him, he immediately nodded: "Okay, okay!"

The most classic surgical incision for lung transplantation requires transverse sternum section. After transverse sternum section, the process of opening the chest cavity is similar to opening the two halves of a clam shell, so it is vividly called "Clam-Shell". This incision causes greater damage to the patient's chest wall and the postoperative recovery period is also very long.

If a thoracoscope is used for this operation, only a few holes would be needed. The incision for sending the lung in would be slightly larger, and the other incisions would be very small. Most importantly, there is no need to transverse the sternum, and all the holes are made through the intercostal spaces.

Is it so easy to get the world's first case? Director He Xiangjun was very excited.

Director Gao sent cherries, and Director Fang from the general surgery department also sent cherries. But Director He decided to do something different and sent durian.

A durian, a world first, it’s really worth it.

"Director He!"

Head Nurse Cai came over.

"You're welcome, it's just a few durians." Director He waved his hand and said generously.

Head Nurse Cai said, "Director He, can you bring something else next time? The smell of this durian is too strong and it is not suitable to be eaten in the department."

"Oh!"

Director He said "oh" again.