godfather of surgery

Chapter 292
When Yang Ping and Director Zhu were outside just now, they had already had a heated discussion.

Several international celebrities agreed that the blood supply of the spinal cord was damaged. If the blood supply of the spinal cord was really damaged, it would be impossible to restore the blood supply through surgery. We could only treat it conservatively and use some drugs to improve blood circulation. Its natural development cannot escape paralysis in the end.

Dural arterial fistula leads to insufficient arterial blood supply and increased venous pressure, which in turn causes spinal cord edema. These manifestations are similar to those of impaired spinal cord blood supply.

Moreover, judging that the blood supply of the spinal cord is damaged based on MRI and CT is not something that ordinary spine surgeons or radiologists can do. Only top spine surgery experts have this ability to judge.

Therefore, this in-game case can be regarded as a high-level case. Ordinary doctors have a way to enter the game, and senior doctors have a way to get into the game. This is the reason why many experts cannot solve the problem. Diseases are sometimes so wonderful.

Several big guys finally broke the game with their rich knowledge, but they didn't know that they entered the game when they broke the game. They thought they had broken the game, but they actually entered a new game, and this new game was even more difficult to break, because the entrants didn't know it. So there is no possibility of breaking the game at all.

"We can try to perform DSA digital subtraction angiography on the main blood vessels of the spinal cord to find damaged blood vessels, such as those caused by too much ligation of the intercostal artery during the operation, and we can try to repair them. The spinal cord has not yet undergone necrotic degeneration, and Opportunity.” August was more positive than Milton.

"This is a huge and complicated project, which is beyond your imagination. It can be tried as a scientific research project, but there are many obstacles to the implementation of immature ideas in clinical cases." Milton remained conservative.

"If it is transferred to our Suntendo Hospital, we have more advanced equipment than DSA to conduct inspections to clarify the location and degree of vascular damage to evaluate whether it is suitable for surgical repair. If surgical repair is required, our spinal surgery has experience in this regard." Kobayashi is very confident.

They really have a set of more advanced equipment than DSA, which was jointly developed by the University of Tokyo and its affiliated hospital, and Toshiba Corporation. Shun Tendo was fortunate to obtain an experimental machine.

"If we talk about inspection, our hospital also has better blood vessel inspection technology than DSA, computerized X-ray dynamic simulation imaging technology, which can perfectly reconstruct the whole human blood vessel image." Auguste did his part.

August comes from the Harlaching Orthopedic Hospital in Munich, Germany. The spine surgery of this hospital is at the top level in the world. He is a little unhappy that the Japanese say they are advanced in front of them.

This consultation invited several big names and a professor from the Twin Cities Spine Center in Minnesota, USA. It coincided with the convening of the spinal surgery academic meeting in the hospital and declined the consultation invitation.

The arrogance of the British was shattered by the Germans and Japanese. They each said that they have a set of more advanced inspection equipment. These equipment should be in the experimental research stage and have not yet been popularized on a large scale.

But Milton couldn't produce such equipment, and these guys almost monopolized cutting-edge equipment. Now in Milton's hospital, most of the cutting-edge medical equipment comes from these two countries.

To check the location and status of damaged blood vessels is not something that can be done with general equipment, and more sophisticated imaging equipment and technology are necessary.

Several doctors from other countries basically did not speak, and became the foil of several big names to make the scene grand.

"Dr. Yang from China hasn't spoken yet. Let's listen to Dr. Yang's opinion." Dr. Lin took the opportunity to push Yang Ping.

Yang Ping was seriously watching the images on the screen just now, when he suddenly heard Dr. Lin's introduction, he immediately withdrew his attention.

Everyone turned their attention to it, it was just a young doctor, maybe some insurance company made up the money and just found a doctor to deal with it.

Moreover, during the discussion just now, I didn't see this doctor at all, and I don't know when he entered the venue.

"I'm sorry, everyone, I still have at most half an hour to stay here." Milton was still a gentleman, reminding that the meeting would end within half an hour, or he would leave early.

Yang Ping looked around, very calm, and said: "Actually, this case is very simple, not very complicated. Everyone has seen it relatively rarely, so I am a little at a loss."

All speeches in the meeting were in English, and Yang Ping was no exception.

As soon as this statement came out, and it came out of Yang Ping's mouth, that kind of self-confidence and calmness that is unique to "men from the earth" can see through time and space at a glance.

Let all the experts in the audience be stunned at once, easy?
Such a complicated case was compressed into two easy words in his mouth - simple!
Milton, August, and Kobayashi are all experts in spinal surgery. Professor Milton shrugged his shoulders as a silly joke when someone said such a thing in front of him; August put his elbows on the table, Resting his chin with one hand, he listened carefully; Xiao Lin Du was a little disdainful, feeling that it was purely grandstanding and trying to find a sense of existence.

"Please help me to call up the patient's images, both CT and MRI are needed!"

Dr. Lin immediately ordered the doctor in charge of the computer operation to call out the patient's images.

Yang Ping walked to the screen directly opposite the oval table, and pointed to the pictures on the screen: "Slow down, just these few pictures, and MRI ones, yes, keep these few pictures."

After selecting the pictures, he pointed to the screen with an electronic pen: "This is a typical game-in-game case, where the white game covers the black game. You are stuck in the white game and cannot extricate yourself, but the patient cannot be rescued in the black game."

In the middle of the game, I don't understand. I have never heard of such a case in medicine. Everyone shook their heads and shrugged, looking helpless.

"On the surface, this case is that the spinal cord is compressed by a cyst, and then cystectomy in the spinal canal is performed. The operation accidentally damages the blood supply of the spinal cord. After the operation, the neurological symptoms are temporarily relieved due to the cyst removal, and the delayed onset of symptoms occurs due to the destruction of the spinal cord blood supply. The neurological symptoms worsen, everything is flawless, and the entire diagnosis and treatment process can be included in textbooks, and no one will question it even after many years." Yang Ping paused.

Dr. Lin took the opportunity to deliver a bottle of mineral water, and Yang Ping took a sip.

Continue: "But in fact, it is absolutely not the case. We opened this case, and there is a rare case hidden in it—"

Yang Ping's eloquence has also improved, and a case explanation is like telling a story.

"This rare case is --- dural arteriovenous fistula. You solved the white case, but did not find the black case. The black case continued to do evil, and gradually worsened, so the neurological symptoms in both lower limbs worsened. The white case covered up the black case. Surgical damage to the blood supply of the spinal cord has become its scapegoat, blocking everyone's bright eyes, and everyone has been led into a trap by it without knowing it."

"It's so exciting, God, are you sure you're talking seriously?" August exclaimed, he had never heard of such a strange opinion, it was simply too fresh.

"There is no basis! Spinal arteriovenous fistula must be diagnosed with DSA or more advanced vascular imaging technology. CT and MRI cannot be diagnosed at all. This patient has no such examination. How do you diagnose it?" Xiao Lindu sneered, the world There are currently no papers or monographs on the use of CT and MRI to diagnose spinal dural arteriovenous fistula.

Milton shook his head: "No, no, no, less than [-] cases of spinal dural arteriovenous fistula have been reported worldwide, CT and MRI are completely incapable of diagnosis, DSA is required, and a comprehensive superselective angiography of spinal cord arteries is required, even then there is still a diagnosis The possibility of failure, I think your speech should be at least professional and prudent."

"Whether right or wrong, we have heard different voices. It is very important. The truth is mostly in the hands of a few people. Go on, I am very interested." The old German hated the arrogance of the British.

"That's right, the fistula can't be seen directly from these pictures, but when you look at these MRI and CT films, there are several pictures that are very clear. This is the blood vessel image of CT, and this is the image obtained by MRI using the vascular flow void effect. Both There is one thing in common, which I call the truncation effect: From a certain point as the boundary, there is a discontinuous caliber expansion at the proximal end of the vein, but there is no such phenomenon in the artery. This is the characteristic of an arteriovenous fistula, suggesting a certain point. There is a fistula connection between the arteries and veins, the arteriovenous communication, and the veins are congested. This congestion causes the veins to expand, and the expansion loses its smooth transition. The venous congestion causes spinal cord edema. The two conditions are superimposed, causing the diagnosis to fall into a maze. .” Yang Ping pointed to several pictures.

From the perspective of medical knowledge, everyone lacks this knowledge, and they cannot support or refute Yang Ping's words.

"Then, if we do a DSA for the patient and perform superselective angiography of the spinal cord vessels, wouldn't this doctor Yang's diagnosis be confirmed?" August has always been very interested in this case.

The British are still conservative: "The superselective angiography takes a long time, and there is a possibility of failure. Do you believe what he said?"

"We have more advanced technology than DSA, which can verify this diagnosis." Atsushi Kobayashi has always advised patients to transfer to Japan.

"Actually, there is no problem with this patient's diagnosis, but to make the diagnosis clear in a familiar way, you can do another DSA, which requires a high level of doctor's skill, and there is a more critical issue - surgery, this The arteriovenous fistula is located in a relatively hidden location, and the requirements for the treatment of blood vessels are very high, and the operation must be very delicate. This patient is best left to my team for treatment, and it is difficult for others to have this surgical experience.”

Yang Ping is telling the truth that the treatment of this arteriovenous fistula can neither ligate the blood vessel nor repair the fistula after separating the blood vessel like ordinary fistula. For the safety of the patient, I am afraid that he really has to do it himself.

"The doctor's words lack basic evidence support, and there are operations that only you can perform. May I ask which hospital you are from? What kind of research do you do? What research results have you obtained?" Xiao Lindu was not polite.

"I am Yang Ping from Sanbo Hospital in China. You will be able to see my thesis soon. I have no intention to say that this operation is really difficult. It is very likely that there will be real damage to the blood supply of the spinal cord after the operation. It's catastrophic, irreversible, and I don't want to see that."

Yang Ping was very calm, he had said all he needed to say, he stepped off the podium and took a sip of water.

For every patient, he will go all out to strive for the best result for the patient.

This patient is actually a three-tier game. Yang Ping only talked about the two-tier game. Let them accept the two-tier game first, and then explain the third game later. Those who have not fully understood the two-tier game, rashly talk about the third Bureau, too brain-burning.

Why Yang Ping insisted on doing surgery by himself, because when dealing with arteriovenous fistula, several arteries blocking the approach must be ligated or electrocoagulated.

However, these arteries are routinely regarded as useless arteries that can be ligated or electrocoagulated in the surgical approach. In fact, these arteries are the main blood vessels for a certain segment of the spinal cord.

Mutation, KitKat's mutation, made this case weird and startling every step of the way!
If it weren't for Yang Ping's powerful ability in the system space, no one would be able to unravel this triple game. Like most intractable diseases in the world, there will never be a day of truth.

Everyone started whispering and discussing in low voices, not knowing what to do next.

　Spinal dural arteriovenous fistula, less than [-] cases have been reported worldwide, a rare case!Fang Xiaoyun's case comes from a real case of a friend, which is very classic.Guo Jingyao's case was formed by combining two similar intractable diseases in reality.Hereby explain!Brother Wolf, sorry!Allow me to prepare for a few days, and the two changes will start on Monday.Some book friends mentioned building a group. Do you think it is necessary to build a group?There are also book friends who mentioned the management of speeches in the comment area.I don't have time to pay attention to the comments, and I have to give you more updates during the limited break time!
　　
　
(End of this chapter)