godfather of surgery

Chapter 295 The Truth Comes Out
Dr. Zhou's operation is very standardized and skillful. Chinese people's hands are dexterous. Yang Ping's previous worries were a bit unnecessary.

Dr. Zhou super-selected the supply vessels of the thoracic marrow one by one, carefully and patiently.

Yang Ping guided him, when to stop, when to move forward, and when to push the medicine. There was a certain delay from instruction to operation, but Dr. Zhou's understanding ability was very good, and the cooperation did not appear blunt.

"Slow down, push, stop, push again, step over the bifurcation, go to the outside, yes, push two centimeters, stop—you can push the medicine." Every word of Yang Ping, Dr. Zhou can become a hand. precise movement.

"Dr. Yang has learned to intervene?" Dr. Zhou was surprised. Surgeons also know how to intervene.

Yang Ping thought for a while: "I am very familiar with the anatomy of this area, and I know the origin, direction and supply range of each blood vessel."

According to his guidance, Dr. Zhou completed the first set of vascular angiography safely and quickly. Dr. Yang is no longer familiar with anatomy, but is superb.

The facial expressions of the British are always so rich, such as surprise, doubt, admiration, all kinds of expressions on his face are exaggerated by the expressive muscles.

Milton took two steps towards the video screen, his cheeks were puffed up, his face was flushed, as if he was holding his breath, and he opened his eyes as wide as possible, as if to get a higher definition.

August glanced at this old friend, not to be outdone, and took two steps forward. As long as it is outside the yellow line on the ground, it meets the requirements of hospital infection management.

The image on the screen is very similar to a Chinese ink painting. The jet-black blood vessels twist and turn from thick to thin, and the branches become thinner.

Dr. Zhou is now quite used to following the navigation, he dare not speak any more, and concentrates on looking at the screen, the movements of his hands are extremely gentle and precise, and the blood vessels of the spinal cord are super-selected group by group.

Finally, the site of the arteriovenous fistula was found, and the contrast agent leaked out through the fistula and entered the vein, forming a clear communication between the arteriovenous.

"Dural arteriovenous fistula!" Milton exclaimed, as if holding his breath, just to shout this sentence.

Milton's voice was very soft, for fear of interfering with the operation of the operator, but he had to shout this sentence to show that he did not show any weakness in front of August, and August gave his old friend an unfriendly look.

"How many cases is this in the world? August?" Milton kept his eyes on the screen.

"Don't disturb me, now is not the time for academic discussions, I also need to concentrate." August was very angry.

All doubts of Atsushi Kobayashi were wiped out. This impromptu doctor turned out to be a real top expert. His proficiency in anatomy surpassed Atsushi Kobayashi's knowledge. Fumiya Takahashi and Jiro Sasaki, who are famous for trauma surgery at the Tokyo University Affiliated Hospital It is also difficult to beat him.

Takahashi Fumiya and Sasaki Jiro personally dissected more than 100 "general teachers". At that time, the University of Tokyo purchased hundreds of "general teachers" from Eastern Europe for a certain subject and used them for teaching. Takahashi and Sasaki were the chief surgeons. A full hundred.

However, why is such a doctor not well-known internationally? I have never even seen the papers written by him, nor have I seen him attend international academic conferences.

Under Yang Ping's guidance, Dr. Zhou saved a lot of time. The operation that was originally planned in seven or eight hours can now be completed in three to four hours.

Another arteriovenous fistula was found, and this patient has two arteriovenous fistulas. Yang Ping asked Dr. Zhou to relax a bit: "There are only two arteriovenous fistulas, and you can super-select the remaining groups and show them to them. Rest after finishing." In a few minutes, super-select a few mutated arteries."

"Ok!"

Dr. Zhou seemed a little tired because of his high concentration. He thought that if every operation was guided by Dr. Yang, no matter how difficult the operation was, he might be able to complete it smoothly. If Dr. Yang performed interventional surgery, he would probably be at the top level in the world.

After superselecting the remaining groups of blood vessels, there was no problem. Dr. Zhou took a short rest and began to superselect those mutated arteries.

The purpose of super-selecting these mutated arteries is to prove to everyone that these blood vessels are the main supply vessels of the spinal cord, and once damaged, they will cause spinal cord ischemia and necrosis.

At the same time, use this DSA image to make a virtual reality 3D imaging to help everyone understand the position of the blood vessel in the approach and how to protect it.

These blood vessels are not in the normal anatomical knowledge, and they are tortuous. The difficulty of angiography is much greater than that of those groups of blood vessels. Those groups do not have Yang Ping's navigation, and Dr. Zhou can complete them slowly. These blood vessels, Without navigation, Dr. Zhou could not complete the operation.

"Don't worry, slow down, the shape of these blood vessels is complicated, the curvature is large, it is difficult to over-select, accidentally damaged, easy to form bleeding or embolism, just like just now, listen to my navigation—— "

Doctor Zhou didn't dare to move the guide wire in his hand, waiting for Yang Ping's navigation to start.

"Push forward, continue, continue, about 0.5 centimeters forward, which is 5 millimeters!" In order to prevent Dr. Zhou from misunderstanding, Yang Ping expressed it in two units.

"Stop! Now go over the bifurcation, rotate the guide wire, stop! Push forward 5 mm, stop! The curvature is too big, advance no more than 5 mm each time, stop every time you push, think clearly before moving forward."

"Okay, go ahead, stop, push the contrast agent!"

The branch-like ink painting is spread out, really, this is a main blood vessel for the spinal cord.

Dr. Zhou's palms were full of sweat and sticky through the gloves. Looking at the image on the screen, he couldn't believe that he succeeded in super-selecting this kind of blood vessels.

Dr. Lin and Dr. Huang looked at the screen without speaking.

Continuing, the blood vessels were tortuous, and the operation progressed very slowly. Dr. Zhou kept his hands steady and carefully, concentrating all his energy on every small movement.

If you are not careful, the guide wire will puncture the blood vessel, causing bleeding, or damage the endothelium of the blood vessel, leading to embolism. The consequences of each mistake are extremely serious.

Now, Dr. Zhou is like driving a car on a winding mountain road at night, and there is an abyss beside the road.

Every time I move forward, I follow some kind of navigation, turning the steering wheel a few degrees to the left and a few degrees to the right.

Push forward a little more, stop, and finally cross a few forks, succeed in super-selection again, push the contrast agent, and continue to the next one.

The second and third blood vessels were contrasted smoothly, and the contrast agent image on the screen drew a thick and tortuous line along the blood vessels.

The three mutated arteries were successfully super-selected, and Dr. Zhou put down his hanging heart gently, as if putting down a priceless and fragile antique.

What he feels now is that it is dawn, the car is on the top of the mountain, the driver looks down, the mountain road is along the cliff, and there is an abyss under the cliff, and he has actually gone up the mountain. I am afraid!
Doctor Zhou shuddered involuntarily, which may be a sign of fear.

Finally finished, everyone can take a big breath and talk.

The truth is revealed!

The diagnosis made by Chinese doctors based on CT and MRI was correct. This patient had dural arteriovenous fistula, and there were three mutated spinal supply arteries.

"Can virtual reality 3D reconstruction be done? It will be more intuitive to make three-dimensional blood vessel images in virtual reality." Auguste suggested.

"Our central hospital has it, and we can transfer data to it." Dr. Lin also felt it was necessary.

"Yes, it's more direct to use virtual reality technology to reconstruct the spinal cord and blood vessels. I understand everything." Milton finally saw through the triple game.

It's a pity that DSA didn't understand it before, and he was a bit behind August. I'm afraid he will lack confidence in front of August for a long time to come.

This DSA took nearly four hours, which is relatively fast, and no time wasted in the middle.

Now, it is not Yang Ping's own feeling, but in the eyes of others, he has become the "man from the earth".

Such a complicated case seemed so easy in his hands. His confidence in analyzing the disease and his proficiency in anatomy when doing DSA seemed to be simple and clear in his heart.

Milton reminisced about Yang Ping's words: "Actually, this case is very simple, not very complicated. You have seen it less, so you are a little at a loss."

Dr. Yang was so calm, calm, and relaxed, but everyone was so confused, confused, and helpless. Even after he had fully explained his illness, no one understood him except that old ghost of August, and Milton felt ashamed.

Dr. Zhou pulled out the catheter and pressed the puncture site with sterile gauze to stop the bleeding. Dr. Lin is arranging for the doctor to collect pictures and transmit them to Singapore for virtual reality 3D imaging.

Yang Ping went to the locker room to take off his lead clothes. August and Milton both chased after him and rushed to help Yang Ping take off his lead clothes.

"Can you explain more clearly when you have time, how to make an accurate judgment on this kind of vascular disease from CT and MRI?" Milton held one side of the lead coat.

"There is also hand-painted reconstruction of the image, how can it be done?" Auguste held the other side of the lead coat.

The two pulled back, and the lead clothes were taken off. The two pulled each other a few times, and they hung the lead clothes on the shelf together.

"This is not something that can be explained clearly in a few words." Yang Ping said flatly.

If you don't have extremely proficient knowledge of anatomy, you can't explain it clearly for the time being. When you sum up your experience in the future and turn it into some knowledge that can be popularized and applied, then it will be easy to understand.

For example, multi-ligament reconstruction of the knee joint is an example. When a set of standard procedures for reconstruction is summarized, everyone follows the procedure, so that surgery can be popularized.

"Dr. Yang, I finally figured out that this case has three nested traps of diagnosis and treatment. If you jump out of one trap, you must fall into another trap? This forms a series of traps that are difficult to solve? Such a classic case should become the medical science of Cambridge University. The teaching case of the college.” Milton realized later.

"It should be Charité Medical College!" Auguste showed no sign of weakness.

　Two chapters will start tomorrow. Sorry, the evolution has been slow for two days. I have worked hard.

　　
　
(End of this chapter)