godfather of surgery

Chapter 252 The Details Determine Success or Failure
The anatomy of the human body is very complex, and various potential gaps and abscesses are far beyond the scope of the naked eye. Magnetic resonance imaging shows that there are several nearby, and it is difficult to observe in all directions with the naked eye during the operation.

Choledochoscopy, soft mirror!Now it's time to use it. Normally, this is an instrument used by general surgery to remove bile duct stones. Now Yang Ping uses it to observe the true extent of the abscess.

Guided by magnetic resonance images, the range of the abscess is already well known in the heart, and the soft mirror is inserted, up and down, left and right, to explore the entire range of the abscess, and then guide the suction device to attract.

This equipment has never been used in previous operations, but Xiao Su knows that this step needs to be used, and Yang Ping also knows that Yang Ping needs to use it now. Yang Ping habitually reaches out, and the lens is delivered to his hand in good time. He has already connected various wires in advance. Su asked Zhou Can to turn on the display as well.

For flushing and suction, Yang Ping held the lens in his left hand and operated the suction device with his right hand. He flushed and sucked in various directions without any dead ends, and sucked out about [-] milliliters. After removing [-] milliliters of saline for flushing, [-] milliliters was pus.

"Can the choledochoscope be used in this way?" Song Zimo wanted to try it next time.

Yang Ping said while doing it: "The soft mirror can change the direction of the lens, which is suitable for all-round inspection. Later, you can also use the soft mirror, which is used for removing stones from the intrahepatic bile duct, to detect the pus in the spinal canal and completely remove it. , Hard mirrors are not good, they cannot enter the blind area, and it is easy to damage the spinal cord.”

The entire vertebral body of the 9th thoracic vertebra was invaded by abscess and collapsed, and the bone fragment moved backward and invaded the spinal canal.

Only the ninth thoracic vertebra could be removed. Yang Ping reminded the anesthetist after treating the blood vessels around the vertebral body: "Prepare to remove the vertebral body and pay attention to blood pressure."

The vertebral body is covered by a layer of cortical bone and the cancellous bone has rich blood supply, so when the vertebral body is removed, bleeding is much more than other steps.

At this point in the operation, the aspirator for sucking blood is still relatively clean for the time being, and there is not much blood to suck. The aspirator used to remove the cheese has changed its suction head several times, and the aspirator has sucked out more than 2000 ml of cheese.

The bone knife chiseled off the vertebral arches on both sides, cleared the upper and lower intervertebral discs, and then took out the vertebral body completely. Song Zimo has gained insight again because he can still do this operation.

In this step, a bird's-billed rongeur is usually used to bite off the vertebral body one by one. Such an operation will inevitably cause a lot of blood. Now Yang Ping directly took out the vertebral body completely without bleeding at all.

The cross-section of the pedicle was sealed with bone wax, and the spinal canal was exposed, along with the palpated spinal cord. Inside the spinal canal was a substance like bean curd, mixed with sequestrum, compressing the spinal cord.

No wonder the patient had neurological symptoms, muscle weakness and sensory disturbance in both lower limbs. If surgery was not performed, the muscle strength would gradually continue to deteriorate, and finally it would become level zero, with complete paralysis of both lower limbs.

Use curettes and nerve dissectors together to remove tofu-like substances and leave a part for bacterial culture and pathological examination. This is a necessary step.

Going up and down the spinal canal space to remove the oppressive substances, Yang Ping was not at ease. After all, the upper and lower parts of the spinal canal are like narrow tunnels, and it is difficult for the naked eye to thoroughly discover the true scope of these pathological substances.

The choledochoscope will be used again. Gently insert the spinal canal, almost sticking to the wall of the spinal canal, and probe up and down. According to the tips on the MRI, there are still some areas that cannot be seen by the naked eye. There are abscesses, although they do not exist. Oppression, but can become an obstacle to recovery.

Stretch into the stripper, under the guidance of the soft mirror, easily remove these residual substances, rinse and attract, then remove, repeat several times, and finally remove completely.

"Microscopic instruments!"

Xiaosu is ready, she knows that Yang Ping will not miss this step, he will not miss the detection of the anterior spinal artery, and Yang Ping will not lose any points he deserves for the operation.

Let's explore the anterior spinal artery. Yang Ping carefully exposed the anterior spinal artery. The microscopic forceps gently clamped it, feeling the tension of the vessel wall.

No, the feeling under the tweezers is very hard, which is not what a normal pipeline structure should feel, and there should be an embolism.

"What? Embolism?" Song Zimo looked at the movements of the microscopic tweezers in Yang Ping's hand.

"Embolic!" Yang Ping was sure.

The embolus was about two centimeters long, and it was the section that was just compressed. If the embolism was not released, the spinal cord would be ischemic, necrotic and degenerated, and the paraplegia would not recover after the operation, and it would continue to worsen. All the work just now would be wasted.

"What should I do?" Song Zimo asked anxiously.

Fortunately, Yang Ping had done the inspection, otherwise the feeling and muscle strength of both lower limbs would not recover after the operation, or would gradually get worse, and it would be too late to come back for inspection at that time.

"The embolization should not be long. If the blood vessel is opened now, there is still time." Yang Ping judged from the hardness of the blood vessel under the tweezers.

The perfect effect of a surgery is the combination of countless perfect details.

"Cut off the blood vessel, take out the thrombus, and then anastomose the blood vessel?" Song Zimo guessed.

Yang Ping nodded: "Prepare the microscopic instruments for anastomosis!"

A careful investigation changed the fate of this patient, otherwise, she would probably spend the rest of her life in a wheelchair.

In spinal tuberculosis surgery, there is no step to explore the anterior spinal artery, because most spine surgeons do not have the thinking and experience of microsurgery.

Yang Ping decisively cut off the anterior spinal artery, and gently drove out the thrombus with tweezers. The thrombus was like a tiny earthworm, and it was placed on the saline gauze in Xiaosu's palm.

"Photograph!"

Yang Ping instructed Zhou Can to be fine in the audience for the time being, and to help take pictures. The purpose of taking pictures is to leave complete information for the operation and to accumulate original information for future scientific research.

According to the microsurgical small vessel anastomosis process, heparin saline flushes the blood vessel, trims the adventitia of the blood vessel, anastomoses the needle and thread without damaging the blood vessel, anastomoses the blood vessel, checks whether the blood vessel leaks blood, and checks whether the pulsation is good.

After observing for a full 2 ​​minutes, Yang Ping was relieved: "Okay, let's take the ilium for intervertebral bone grafting."

Song Zimo began to harvest the ilium, which was very skillful, and it was necessary to obtain a satisfactory volume without affecting the appearance and function of the donor site.

"I'm getting married before the Spring Festival. The brothers must come to be lively. I've already sent Director Han's invitation, and I've asked the head nurse to distribute the other invitations. For the brothers, I'll present them myself later." Xiao Wu suddenly said something.

"So fast?" The fat man was surprised when he arrived, brothers, he was the fastest.

"If we don't hold a banquet anymore, we will hold a banquet with the baby in our arms." Zhang Lin said lightly.

"What? I'm going to be a father, aren't you just one step faster?" The fat man didn't expect that he didn't have a girlfriend yet, and this kid was going to be a father.

"Father-in-law and mother-in-law are pressing so hard, I dare not disobey orders." Xiao Wu said helplessly.

"You won't stop being a doctor and become a charterer after you get married?" Zhang Lin teased him.

Xiao Wu's parents-in-law are locals in City G. In the 80s, they went back and forth to Hong Kong to resell electrical appliances and made a fortune. Then they invested in real estate and made a lot of money. I heard that there are several buildings in the CBD of City G.

The old couple has only one daughter, and they are very cautious about their daughter's lifelong affairs. After seeing Xiao Wu, the old couple likes him very much. The young man is handsome, eloquent, and flexible. He is a graduate student, doctor, and has a good education and career.

Now that Xiaoqing is pregnant, the old couple are so happy, they are going to be grandparents, and they are urged to get married every day, so that they don't have to worry about anything, and the two old people will take care of it.

"Fifth brother, do you have a sister-in-law? A sister-in-law is also fine!" Fatty felt that he was not a little behind.

"Say it sooner!" Xiao Wu said while pulling the hook.

The fat man was pleasantly surprised: "Why, is there?"

"I said it earlier, I advised them to have another one, I'm afraid it won't work now." Xiao Wu laughed.

While chatting and laughing, Xiao Wu and Zhang Lin's retractors did not move at all, and the operation area was well exposed.

Song Zimo's iliac bone was taken out, it was square and beautiful.

Yang Ping used a spreader to spread the upper and lower vertebral bodies, and the implantation of the iliac bone was fast and just right.

(End of this chapter)