godfather of surgery

Chapter 260 Found it

The anti-radiation lead door was closed tightly, and Director Ji struggled hard inside, and the estimated time was about six hours.

After such an arduous struggle, it is possible that the bamboo basket fetches water in vain, and nothing is found in the end.

The human body is complex and mysterious. Modern medicine, whether it is basic medicine or clinical medicine, is far from developed enough, it can be said that it has just started.

Many diseases are written in textbooks: the mechanism is unknown, symptomatic treatment, no specific drugs and so on.

While he was free, Yang Ping went to the system space to see if there was any training for interventional surgery. Currently, there was no training for bone diseases, mainly bone tumors. The next stage is orthopedic training.

The three major orthopedic surgeries of trauma, bone disease, and orthopedics should be advanced, so that there will be side surgery training, such as interventional surgery, robotic surgery, etc.

Yang Ping went there to pick up some surgical training for thoracoscopy, laparoscopy, and intervertebral foramenoscopy. Many bone disease operations involve the spine. Minimally invasive spinal surgery requires the use of these laparoscopic and technical wooden barrels. make up.

"After so much effort, what do you say if you can't find it?" Zhang Lin asked worriedly.

Xiao Wu is also very worried: "I think that Fang Xiaoyun's mother is likely to cause trouble. It is not easy to be a doctor. On the one hand, I have to deal with these complicated diseases, and on the other hand, I have to deal with sinister people."

"This is the boldness of my senior brother Yigao. If it were someone else, how would I dare to take risks in this situation."

"Zhang Lin, are you ready to have a baby? I'll help you after the surgery, and you'll be responsible for taking pictures."

"It's okay, I don't dare to take it for two or three years, at least I dare not take it until I'm promoted to attending."

Yang Ping was resting his eyes with his eyes closed, and Song Zimo was thinking about this disease. Dural arteriovenous fistula, such a rare disease, can be diagnosed even if it is placed on a patient alone. Now it is covered by spinal tuberculosis, but it was discovered by Yang Ping. This kind of diagnostic ability is too powerful.

Time is really hard, especially if you don't know the result and don't know how long to wait. This kind of waiting is a torment.

"Fifth brother, do you want to smoke a cigarette?" Zhang Lin suggested.

In fact, Zhang Lingang did not smoke when he was working, and he worked late night shifts. Sometimes when he had an emergency operation, he would stay overnight. He smoked only to refresh himself and relieve fatigue.

"Pick one, just one."

Xiao Wu originally wanted to quit smoking. After all, he was going to be a father. In the future, if he took a sip of cigarettes, he was afraid that the little guy would dislike him.

There was no smoking room in the interventional operating room, and it was hard for the two of them to look for a smoking room in their hand sanitizers, so they had to hide in the toilet and turn on the exhaust fan.

The electronic clock on the wall showed that it was past 22 o'clock, and there was no good news yet.

Even if the fistula is successfully found within six hours, surgery will be required later, and the surgery will be performed under a microscope.

Staying up late like this hurts the body, but there is no way to do it. It is said that the residency training in the United States is very cruel, regardless of day and night, and the sky is dark.

Physical strength alone eliminated many people. Some people said that this was intentional, and people with poor physical fitness were naturally eliminated. A good doctor must have good physical fitness, be able to stay up late, be able to hold back urine, and be able to be hungry.

Xiao Wu Zhang Lin smoked a cigarette, and his energy improved a lot. The two went to the door of the operating room to check from time to time, but the door was still closed.

"Go inside and have a look, did you find it?" Song Zimo instructed Zhang Lin to go in and have a look.

"Don't panic, everyone will sleep for a while, and you will have to perform surgery later. With Director Ji's level, you should be able to find this fistula. There is also Professor Zhang next to him. He has rich experience."

Yang Ping squinted his eyes. When he came out of the system space, he felt much more energetic. He suspected that the air inside had some special effect, such as boosting energy.

After twelve o'clock, there was still no movement.

Zhang Lin and Xiao Wu were like two hairy monkeys, unable to calm down, they were asked to sit on chairs to sleep for a while, but they couldn't sleep, they kept walking back and forth.

"No, I have to go in and take a look." Zhang Lin was restless.

Xiao Wu grabbed him: "I'll go in, you wait here."

Xiao Wu took a lead coat from the shelf where the lead coat was placed, put it on, went in, and after about 10 minutes, came out: "I haven't found it yet!"

Haven't found it for six hours?

Is it really necessary to fetch water from a bamboo basket in vain?

If you really can't find it, the patient understands it well, but if you don't understand it, you are in a hurry. After a whole night of tossing and spending more money, there is nothing in the end.

Therefore, for some diseases, whether the patient understands and cooperates, the outcome is completely different.

Doctors dare to take risks if they understand and cooperate. Doctors don't have the guts to work hard if they don't understand and cooperate.

If you don't work hard, how can you have the best results.

Terrified!

Zhang Lin patted himself on the forehead.

Xiao Wu comforted him: "Take it easy, why don't you smoke another one?"

At nearly one o'clock in the morning, the heavy leaden door finally opened.

"found it!"

The nurse who opened the door shouted excitedly.

It was like the midwife in the delivery room opened the door and yelled to the husband of the pregnant woman who was waiting anxiously outside: "I gave birth!"

Everyone stood up like a spring - found it!
"A traffic fistula was found in the intercostal arteries and veins on the left side of chest 8-9. In this place, abnormal tortuous and thickened veins around the medullary area can be clearly seen. Is it possible to operate?" Director Ji's voice was a bit speechless.

It was really a dural arteriovenous fistula, the probability of a lightning strike was stepped on by Fang Xiaoyun.

For Fang Xiaoyun, the two diseases overlap, which is the probability of two lightning strikes!

"Line on your stomach, don't pull out the catheter, and if you can't find a fistula during the operation, please ask Director Ji to help inject Meilan into the catheter." Yang Ping asked Director Ji to take a rest.

Looking at the time, for more than six hours, there were 24 blood vessels, and the lead clothing was airtight. Director Ji's back was all wet, but he didn't dare to take it off for the time being. Yang Ping still needed surgery, and his help might be needed during the operation. Inject melanin into the catheter to locate the fistula.

Yang Ping, Song Zimo, Zhang Lin and Su Yixuan washed their hands and went to the stage.

"Director Ji, why don't you take a break?" Yang Ping said politely.

"It's okay, I'll just sit next to you." The nurse moved a stool, and Director Ji sat and rested.

Yang Ping's surgery was done quickly and well, which is well-known in the hospital. If Director Ji took off his surgical gown now, he would have to brush his hands and get dressed again after a short wait, which would be troublesome.

"Xiao Zeng, call my wife for me. The phone is on the table."

Lao Ji felt very guilty, he had dinner with his wife, and now he was on the operating table, leaving his wife aside.

He wanted to make a phone call to announce the good news to his wife. He encountered a rare case. There are only [-] cases in the world. What are you blowing?
It’s not just bragging about what a rare case it was back then, only [-] cases were found in the world, and one of them had its own credit, [-] in [-] of the world, what a concept.

It's past one o'clock in the morning, and still calling at this time, Nurse Xiao Zeng hesitated: "Sister-in-law at this time?"

"Hit! She hasn't slept yet, let her go to bed early, don't wait for me, she won't be able to go back in a while, come here, I will tell you the gesture code."

The nurse had to help to make a phone call: "Hey, sister-in-law, Director Ji can't go back now, yes, he is with me tonight, no, I mean, he is with me tonight, no, sister-in-law, I mean—— "

I stayed up all night and confused people. I couldn't speak fluently. I corrected a sentence several times and didn't make it clear.

You said this, and we are with you. Fortunately, Director Ji's wife is more familiar with the situation, otherwise this would cause a big mess.

The nurse hung up the phone and said to Director Ji in surprise: "Sister-in-law is outside the operating room?"

"Director Ji, is this a post check?"

"What's the post? I haven't eaten yet. She has brought food. Let her wait until after the operation."

Good surgery, what kind of dog food to sprinkle.

That's right, I haven't eaten yet. Xiao Su ordered a lot of takeaways and forgot to eat them. Everyone is hungry at this point.

"It's okay if you don't say it, but once you say it, my stomach growls!" Zhang Lin swallowed.

"Hold on, bro, you're not alone!" The grunt was so loud that Xiao Wu could hear it.

For the posterior approach, in order not to damage the stability of the posterior column of the spine, Yang Ping used a technique similar to the opening of the cervical spine, cutting the lamina into a rectangle on three sides, leaving one side broken to protect the periosteum, and then opening it like opening a door. The lamina can be closed to prevent instability caused by the destruction of the posterior column.

This technique requires a very delicate technique, otherwise it is easy to fail. When the lamina is opened, the veins are indeed thickened and tortuous. Because patients with spinal tuberculosis do not routinely undergo DSA angiography, this kind of vascular malformation must be found on MRI. Not too possible.

This is not a problem of level, but a problem of technology itself, just like black and white photos cannot find color.

The fistula is in this piece of vein. It can be found by looking for a point from one surface, one by one, but it takes time to confirm whether it is a fistula or not.

Yang Ping stopped: "Director Ji, please help us inject Meilan into the arteriovenous fistula just now."

Before the catheter inserted from the femoral artery was pulled out, Director Ji came to the stage to help inject Meilan: "Then I will administer the medicine!"

Meilan followed the catheter, and not long after, a point in the venous plexus appeared blue, and then slowly expanded. Yang Ping found that point, and there was only one fistula, and the diameter of the blood vessel was about [-] millimeters. Suture the tear.

"Okay, it's ok, Director Ji, I found it, and the catheter is still there. I'll do an angiography after the surgery to confirm."

"microscope!"

Zhou Can pushed the microscope in, covered with a sterile protective cover, and Yang Ping adjusted the focus and pupillary distance by himself, and began to separate the blood vessels under the microscope and repair the fistula.

"A small fistula has such a big impact on the human body? It can actually cause paraplegia. It seems that human evolution is not enough, and the fault tolerance rate of parts is too poor." Zhang Lin looked at the small fistula, only 3mm A fistula in a blood vessel.

Originally arteries are arteries, veins are veins, bridges return to bridges, roads return to roads, the two systems circulate separately, the proximal end connects with the heart, and the distal end is connected by capillaries, and the middle is isolated from each other. Connected by a channel, this is an arteriovenous fistula.

Just like a highway, there is a barrier between the coming and going lanes. Now that the barrier has a gap, the cars coming and going will be mixed together through the barrier, and it will be a mess.

The same is true for humans. Once an arteriovenous fistula occurs, the arterial blood flows into the vein, and the venous blood flows into the artery. In this way, the arterial blood is mixed with venous blood, and the oxygen content in the blood decreases, while the vein is connected to the artery, and the return pressure of the blood vessel increases. cause congestion.

Fang Xiaoyun's spinal cord edema could not be relieved and continued to worsen because of venous congestion. He lost the parabolic direction of postoperative spinal cord edema.

The abscess of spinal tuberculosis compresses the spinal cord, causing spinal cord edema and paraplegia; dural arteriovenous fistula leads to venous congestion, which can also cause spinal cord edema and paraplegia.

The intertwining of two conditions, one covering the other, naturally increases the difficulty of diagnosis.

After the operation, the operation area was rinsed clean and a drainage tube was placed.

(End of this chapter)