godfather of surgery

Chapter 258 Less than [-] cases worldwide

After finishing speaking, Teng Guihua realized that she was wrong, and immediately covered it up: "I'll just ask, ask."

The subtle joy on her face was captured by Yang Ping's eyes. Perhaps the usual physical examination training in the systematic space made him more observant than ordinary people.

I read it right, my daughter's condition worsened, shouldn't she be anxious, even crying? Why is she still a little happy.

"Let me come!" Teng Guihua also squeezed to the side of the bed to help Fang Xiaoyun massage her legs.

Fang Xiaoyun's colleague, Chang Juan, stepped aside a little bit, showing a disgusted expression, and the weasel had no good intentions in wishing the chicken a new year.

But anyway, she is also Fang Xiaoyun's mother. She didn't force money this time, but just came to see her daughter. As a colleague, she couldn't say anything.

This mother is dressed in fashion, with heavy lipstick and pungent perfume, which can be smelled through a mask.

There are many rings and bracelets on her hands, and necklaces on her neck.

After watching Fang Xiaoyun, Professor Zhang told Yang Ping to observe closely, and he still had to go to the outpatient clinic, saying that a patient's test results came out, and he was very anxious, and he had been waiting for him, so he went to explain to the patient.

It's past get off work time, and the old man went to explain the condition to the patients, which was really exhausting.

The old man is in his eighties and still can't take time off. The hospital arranged for him to have an outpatient clinic one day a week, but he quit and insisted on going out five days a week.

After Professor Zhang left, Yang Ping pulled out all of Fang Xiaoyun's case materials for research.

Any abnormality must have an explanation, otherwise there will be a knot in my heart and I will be unhappy.

It's okay to put this abnormality in the eyes of others, but Yang Ping is unwilling to let it go easily.

"What? Still not off work?" Xiao Su put her bag next to the computer, sat down with Yang Ping, and helped Yang Ping massage his shoulders.

The two made an appointment to have dinner together, take a walk after dinner, and play tennis for a while.

"This patient's spinal cord edema persists, and the peak period lasts too long, which is very abnormal—" Yang Ping explained to Xiao Su.

"Look slowly, I'll accompany you." Xiao Su sat beside her, next to her, kneading Yang Ping's shoulders with both hands.

Doctor, it is very important to have an understanding partner.

Otherwise, a few days of consecutive emergency operations can ruin the family.

"You watch the film carefully and don't worry about me. My father is a doctor and my mother is a nurse. I have been used to it since I was a child." Xiao Su smiled slightly.

Yang Ping looked at each part carefully, not missing any clues.

It doesn't matter if you sacrifice a little rest time, it's better if you don't find any problem, if you find a problem, you can deal with it in time, if it is delayed, it will affect the patient's life.

"The compression of the spinal cord has been completely relieved, the arteries supplying blood have no signs of embolism, and the dural veins are slightly thicker than normal."

While watching, Yang Ping told Xiao Su that Xiao Su was very interested, and he liked to hear Yang Ping talk about his condition.

The dural veins are slightly thickened, this is Yang Ping's intuitive feeling after watching too many images in the system space.

As for blood vessels, if they are a little thicker or thinner, nothing can be found at all, and even a little difference can't explain the problem.

Yang Ping compared the MRI and CT images taken before the operation, on the first day after the operation, and one week after the operation.

The dural vein, in the same part, is unexpectedly thicker every time. Although this change is very subtle, it is still captured by Yang Ping.

Moreover, changes in the dural veins are positively correlated with spinal cord edema, the thicker the veins, the more severe the spinal cord edema.

If it weren't for his devilish training in the system space, how could such an almost negligible change be seen.

Spinal arteriovenous fistula?
No way, there are less than [-] cases reported in the world, such a rare disease, with spinal tuberculosis and paraplegia occurring at the same time, and superimposed together, this is the probability of lightning strikes.

However, the more Yang Ping looked at it, the more he pointed to this disease, which was almost certain.

If yes, spinal arteriography must be performed as soon as possible. The time required for angiography is very long, several hours.

There are many blood vessels in the spinal cord, and the distribution is very complicated. There are bilateral vertebral arteries, common carotid arteries, thyroid neck trunk, costocervical trunk, and 12 pairs of 24 intercostal arteries. These blood vessels may be the site of fistula formation.

During radiography, X-ray exposure takes a long time, which is a great test for both the patient and the surgeon.

The most troublesome thing is that because the structure of blood vessels around the spinal cord is complex, perhaps because the technique is not in place, all the above blood vessels have been angiographyed, but still no problematic blood vessels can be found.

Contrast agents can also increase the risk of spinal artery embolism, especially the anterior spinal artery that was anastomosed in the previous surgery. The condition is complicated, and multiple conflicting risks are intertwined.

Without the full understanding and cooperation of the patient, in this case, the next step of examination and treatment cannot be carried out at all.

"Spinal dural arteriovenous fistula? Immediate emergency call for DSA digital subtraction angiography." Yang Ping told Xiaosu.

There was no dinner to eat in the evening, and walks and tennis were in vain.

"What do you eat? We order takeaway!" Xiao Su was not dissatisfied.

Looking at Yang Ping's posture, if he is diagnosed with DSA and needs emergency surgery, it would be great to have the surgery together!

There was no need to explain, the two had a good understanding, and Xiao Su immediately went to arrange takeaway for dinner.

Everyone was getting ready to pack up and get off work. Song Zimo and Tang Fei greeted Yang Ping, saying that it was time to get off work.

"Fang Xiaoyun, dural arteriovenous fistula!"

Yang Ping responded to Song Zimo.

Song Zimo stopped immediately: "Emergency DSA?"

"Well, after the diagnosis, the operation should be performed immediately. Contact the interventional operation room, and ask for a room that can perform hybrid surgery."

Yang Ping took the water brought by Xiao Su, and Xiao Su smiled and said: "It seems that everyone can't get off work, I've ordered takeaway."

Song Zimo and Tang Fei immediately gave up getting off work. Song Zimo handed the backpack to Tang Fei: "Put the bag away for me. I'll call Zhang Lin Xiaowu and the others over. I have work to do tonight. There are less than [-] cases in the world. Was stepped on by us, is it true or not?"

"[-]% is true, prepare for DSA and surgery." Yang Ping stood up.

The two diseases are superimposed together, and they can both cause spinal cord edema and paraplegia at the same time. How low is the probability that one disease will cover up the other?

Zhang Lin, Xiao Wu and Fatty saw that Yang Ping hadn't left work, so they didn't dare to leave work on time, for fear of having something to order.

Several people "had a meeting" in the duty room, and when they received a call from Song Zimo, they all came out without daring to delay.

Spinal dural arteriovenous fistula, they have no idea at all, and have never heard of it.

At this time, Professor Zhang called with a hasty tone: "Xiao Yang, where is it? The emergency department gave Fang Xiaoyun a DSA of the spinal artery. It is very likely that there is a dural arteriovenous fistula!"

"I'm making arrangements!"

"I'll be in Corey right away!"

The phone didn't hang up in time, and the old lady's voice came from inside: "Oh——, I just came back, and the food is all ready, let's go after eating, two or three bites to fill your stomach—"

Professor Zhang has rich experience, and he also thought of this rare possibility.

Song Zimo is contacting the interventional operating room, and there are several operating rooms that can perform hybrid surgery.

But at night, I don't know if there are enough people to help with DSA. This requires the help of a very good interventional doctor.

Everyone split up. Xiao Su and Zhou Can needed accurate instruments, prepared microscopes, decided to intervene in the operating room, and sent them all over.

After the DSA is done, the diagnosis is confirmed, and surgery is performed directly in the interventional operating room. Sometimes angiography is required to find vascular fistula during the operation, and angiography is required after the operation to confirm whether the arteriovenous fistula has been properly treated.

Yang Ping reported to Director Han, and Director Han also said that he would come immediately. He was not worried about Yang Ping's technology, but to give Yang Ping a platform and take risks. After all, Yang Ping is the attending physician.

After checking Zhang Lin's informed consent form, making some revisions, and printing it out, Yang Ping took Zhang Lin to talk to Fang Xiaoyun and obtained her understanding and cooperation.

Teng Guihua is in the ward, and Fang Xiaoyun's colleague Chang Juan is also there. She may be worried, worried that this mother will do something that is not good for Fang Xiaoyun.

Yang Ping thinks that Fang Xiaoyun is fine, this mother may be the biggest obstacle to communication, Fang Xiaoyun is an adult, Yang Ping decided to bypass this strange mother in order to save trouble.

"I want to talk to the patients now, you go out, Zhang Lin, I called the nurses to come in and take them out." Yang Ping's words were beyond doubt.

"I'm her mother, so don't talk about it in front of me." Teng Guihua noticed something unusual.

Yang Ping waved his hand: "Go out, didn't you hear clearly? I don't want to waste time. Fang Xiaoyun is an adult and has the ability to act independently. You don't need to be present."

Although these words were rude and direct, it was a waste of time to entangle with her at this time.

Chang Juan was more pungent: "Go out as soon as the doctor says so, so much nonsense, Xiaoyun, let's go out, listen to the doctor, don't think too much."

Colleagues pushed her mother out, and when the nurse came in, Zhang Lin closed the door to examine the female patient, or to close the door for a private conversation, a third party, such as a nurse or female doctor, must be present to avoid unnecessary disputes.

"Doctor Yang, what happened?" Fang Xiaoyun asked a little scared.

Yang Ping said calmly: "Fang Xiaoyun, you have been operating for a week, and the strength of your legs is getting weaker and weaker. This is not normal. We suspect that in addition to spinal tuberculosis, you also have spinal dural arteriovenous baskets. This is a rare condition. Disease, there are only less than [-] cases reported in the world. It is very likely that it happened just after the operation and became the cause of your lower limb paralysis. I am not [-]% sure, but I am [-]% sure. Now I need to do a spinal angiography , look for one blood vessel one by one, it is possible to find it, or it may not be found. If it is found, it will be operated immediately to deal with it. This time, the operation will be performed from the back. Will you trust us and cooperate with us? If so If this disease is not detected and treated in time, the time delay will cause permanent paralysis."

The disease is acute and has a poor prognosis. Venous stasis can cause irreversible spinal cord edema, followed by extensive arterial embolism.

"Don't be afraid, you can decide your own affairs, your body is your own, and you don't need to consider other factors." Yang Ping added, his tone was firm but gentle, and he spoke clearly.

Fang Xiaoyun is that kind of ordinary rural girl. She was scolded by her mother to work part-time before she graduated from junior high school. She worked as a general worker in a factory. Later, she was introduced to a foot bath shop for acupoint massage.

All the money she has spent these years has been used to subsidize her family, and all she buys are cheap clothes. She has used a Redmi phone for several years and is reluctant to change it.

But at the critical moment, the girl had a very clear idea. She thought about it and nodded: "Dr. Yang, I'll listen to you. Thank you for your hard work. It's time for an examination and surgery."

"As long as you have this sentence, we will arrange it immediately. I will tell you the details of the operation—"

After speaking and signing, Yang Ping got up and the nurse opened the door.

I thought it would take a lot of effort to convince Fang Xiaoyun, but I didn't expect it to be easy. This girl understands the truth very well.

Perhaps, her decisiveness can save herself.

(End of this chapter)