godfather of surgery

Chapter 318 Ambush from All Sides
"Dr. Yang!"

Yang Ping walked quickly, and Takahashi trotted along.

Soon, everyone entered the elevator.

"Mr. Takahashi, what do you think of this patient?"

Takahashi is an internationally renowned master of trauma surgery. He is by no means an ordinary person. He must have his own unique insights in many places.

"Just now I saw that the professor wanted to use resuscitative endovascular aortic occlusion balloon (REBOA) technology, but the femoral artery of the wounded has been damaged, and the catheter implantation of the balloon could not be successful. The current general REBOA technology has fallen behind. We With intelligent REBOA technology, using portable equipment and ultrasound guidance, it can enter the aorta from any relatively thick artery in the human body, such as the subclavian artery, radial artery, brachial artery, femoral artery, popliteal artery, and even the dorsalis pedis artery. It can find its way by itself, even if it enters from the upper limb artery, it can cross some dangerous bifurcations, enter the aorta, and deliver the balloon to the intended location."

Everyone was in a hurry and spoke very fast. Although Takahashi's Chinese was a little rusty, he could express himself clearly without any problem.

"If Dr. Yang is interested, I will send the full set of materials to Dr. Yang. However, the precise blood vessel blocking technique that Dr. Yang just used is already one level ahead of our simple aortic blocking technique!"

Takahashi was surprised that Yang Ping actually asked for his opinion, and his attitude towards him was not condescending, but treated as an equal.

And the last time I came to China, the arrogant attitude seemed so narrow, it was a clown, and Dr. Yang was the real master.

Soon everyone rushed to the locker room of the operating room, and the discussion on the way stopped, and there was no time for academic discussions.

Everyone took the time to change clothes. The wounded had already entered the operating room through another special passage.

Usually when I change clothes, the clothes I take off will be folded and placed in their respective cabinets. Now I take off the clothes and throw them in a pile. If I make mistakes and throw them on the ground, no one cares.

"Brother, please, save her, can you?" Song Zimo lowered his head and put on his pants.

This kind of injury, who can guarantee to save it, can only fight for it with all its strength. Whether it can survive or not really depends on the sky.

Yang Ping didn't understand why Song Zimo, who was always rational, would suddenly say such sentimental and wishful thinking.

Song Zimo put on his pants, looked up, and Yang Ping saw that his eyes actually contained tears.

Yang Ping understood immediately, and put his hand on his shoulder: "I will definitely bring her back to life!"

Yang Ping doesn't know whether he can live or not, and Yang Ping doesn't know whether he can survive the operation. This is a good wish.

The wounded were pushed into the operating room and transferred to the operating bed. Fatty Liang was already waiting.

"I have blood pressure, 65/30mmHg!"

Finally, the blood pressure can be measured, and the nurse who was the first to find out the blood pressure was so happy that she shed tears.

In this kind of trauma, the main cause of death in the early stage is heavy bleeding. If the bleeding can be successfully stopped, and blood transfusion and fluid replacement can keep up, there is a glimmer of hope.

Yang Ping sent more than a dozen blood vessel clips, large and small, into the abdominal cavity, precisely blocking almost all possible bleeding.

In this way, the blood loss will be kept to a minimum, and there is still a glimmer of hope for success if the blood transfusion and fluid replacement are followed up.

Because the feces polluted the abdominal cavity, the autologous blood transfusion machine could not be used, and only conventional allogeneic blood transfusion could be used.

Two blood transfusion sets with heating function continuously pressurized blood transfusion, and blood products were continuously injected into the wounded body from the bilateral subclavian veins, but the blood transfusion was not unlimited, and to a certain extent, it would cause some complications disease.

The time for those blood vessels to be blocked should not be too long. The safe time is 60 minutes. Calculated from the blockage, the operation must be completed within 60 minutes.

Fatty Liang's hands never stopped, dopamine, epinephrine, etc., and various rescue drugs were pushed in through the veins, blood pressure slowly climbed up, the anesthesia machine was connected to the tracheal tube that had been inserted, and various parameters were adjusted at his fingertips.

Hearing the sound of the cart wheels rubbing against the ground outside, someone opened the sensor door of the operating room in advance and blocked the sensing area with their hands, allowing the blood delivery cart to enter the operating room without delay.

Another cart of blood bags was pushed in, including suspended red blood cells and plasma. The nurses were very skilled in changing the blood bags, pulling them out and inserting them into the suspension, all in one go.

Several instrument tables have been laid out, Xiao Su has already put on the surgical gown, the instruments have been classified and partitioned, the first used ones have been picked out, the needles and threads have been threaded, and the alcohol and saline distinguishing notes have also been pasted.

Their respective work is carried out at the same time, and there is no need for someone to direct, let alone shout at the top of their throats.

Those who were allowed to observe, suppressed the sudden heartbeat, and consciously stood in the corner so as not to interfere with the operation.

The anesthesia was successful, and the blood pressure continued to rise, which was as strenuous as freehand rock climbing.

Based on his rich professional knowledge, Takahashi judged that this kind of operation would take at least four hours if he performed the entire operation. If a multi-disciplinary joint model was used, each surgical injury site would be performed by doctors of different specialties, and the operation time might take eight hours. Hour.

Specialists from general surgery, urology, and obstetrics and gynecology rushed to the operating room one after another. The trauma emergency center is originally a multidisciplinary model, but it is dominated by trauma orthopedics.

Seeing that Yang Ping was here and was about to go on stage, everyone had no plans to go on stage. Yang Ping's surgical authority can do whole body trauma, which is authorized by the hospital, and he did it better than everyone else.

This operating room is very spacious. Since everyone is here, they stay to observe and study. This kind of trauma is too rare.

Flushing, repeated flushing with a large amount of normal saline, hydrogen peroxide, normal saline, type III anal iodine, and normal saline, regardless of the amount, alternately flushing in large quantities.

A large amount of feces pollutes the abdominal cavity, and the possibility of infection is very high. Many open fractures of the pelvis are caused by the contamination of feces, and finally the patient dies of severe infection.

Rinse, rinse constantly, dilute the bacteria, this is the best way.

Yang Ping flushed almost paranoidly, the mixture of blood clots mixed with stool was continuously diluted and flushed.

His hands in sterile gloves writhed in the abdominal cavity, allowing the pulse nozzle in Song Zimo's hand to rinse without dead ends.

The three-liter bag of saline is suspended, passed through the pulse flushing machine, connected to the flushing tube, and the water stream is sprayed from the flushing head.

The normal saline was consumed very quickly, and the roving nurses kept changing it, and there were already more than [-] bags in the bucket of empty bags.

As for the barrels that collect the liquid, the water level keeps rising and contains a lot of dirt.

Yang Ping and Song Zimo didn't go to wash their hands to disinfect until the rinse solution was clear.

Zhang Linxiaowu, who had already brushed his hands, began to disinfect and spread the sheets, seamlessly.

In order to save time, Yang Ping brushed his hands much faster than usual, and his movements were simplified.

The electric knife, double-click electrocoagulation, suction tube, and flushing tube have been connected.

Yang Ping put on the surgical gown and gloves, and started the operation. The usual pre-operative check procedures were naturally omitted.

The knife extended the abdominal wound to expose the entire abdominal cavity as much as possible.

Gently put in the two big S pull hooks, and the little Wu Zhanglin is in place.

A full set of new pipelines will continue to be responsible for flushing. After flushing, everyone changes gloves.

Yang Ping stretched his hands in, carefully inspecting the abdominal organs one by one, judging which ones are worth repairing and which ones need to be resolutely removed.

The spleen has been shattered, and Yang usually ligates blood vessels, sometimes separates his fingers, and sometimes separates tissue scissors, switching between different instruments is dazzling.

The movement was too fast, and the steps could not be seen clearly. Soon, like a smashed spleen, it was successfully removed and thrown into the metal basin.

Without stopping for a moment, he began to resect the broken right lobe of the liver. The resection of the right lobe of the liver was originally a difficult operation, but in his hands, even some steps did not need to be revealed, and it was completed with the help of touch.

Those things ligate the blood vessels, remove the gallbladder, and separate the right lobe of the liver. I can’t see the steps at all. The blood vessel forceps go in with silk thread, tie a knot, and then cut the tissue in and separate. After a few rounds, the gallbladder is taken out, and the broken right lobe of the liver follows Also took it out.

From the head to the tail of the pancreas, gently touch, flip, and quickly explore the pancreas. The pancreas is mildly contused. After surgery, traumatic pancreatitis should be paid attention to.

Immediately change the target of the hand, start from the stomach, from top to bottom, explore the entire digestive tract of the abdominal cavity, the stomach is contused, no need to deal with it, the small intestine is turned over while touching in the hand, so that the eyes can see the circumference of the intestine and the mesangial blood vessels , The information collected by touch and vision is fused in the brain and converted into accurate and unmistakable judgments.

Yang Ping's proficiency in anatomy has reached the level of freedom to do whatever he wants, and he can accurately identify the anatomical structure with the feeling of his hands without even looking.

Stretching out the hand, the handle of the knife was clapped in the hand. Before everyone was relieved, the small intestine was incised and decompressed, and the hand continued to go down. The smooth and slippery intestinal tube could be adjusted freely in the hand, even the cecum and appendix were not spared. , Then, the ascending colon, transverse colon, and descending colon were preserved, and the entire sigmoid colon and rectum were completely resected and removed.

The large metal basins for the excised tissues were placed in a neat row on a special sterile instrument cart, and some of them were already full.

The bilateral kidneys and adrenal glands are explored, and both hands are explored at the same time. After the kidneys are explored, they go down along the ureter, to the bladder, and then to the urethra.

Following the investigation, Yang Ping reported the location and extent of the injury, as well as the operation plan to be implemented soon.

"No obvious damage to the kidneys and adrenal glands, ruptured bilateral ureters, ruptured bladder, damaged urethra—"

The voice was loud and clear, but extremely calm, without growling or urging.

But everyone tried their best to keep up with his speed, especially Song Zimo, who was highly concentrated and did not dare to relax at all.

Everyone understood that at this time, it was the god of death who was fighting with Dr. Yang, and if he was negligent, the god of death would take his life from his hands.

There is no problem with the ovaries, the fallopian tubes are stretched, and even the uterus is contused.

While probing and repairing these organs, suture, ligation or electrocoagulation of blood vessels are interspersed.

The bilateral internal and external iliac arteries and veins, left lumbar arteries and veins, and double inferior epigastric arteries and veins were ligated; the presacral venous plexus was sometimes ligated and electrocoagulated.

Various operations without interruption, seemingly disorganized, but in the most optimized order.

When all the explorations were completed, the entire omentum was lifted out of the abdominal cavity and thrown into the metal basin.

It turned out that while the surgeon was inspecting and repairing the viscera, he was actually removing the omentum. After the inspection was completed, the omentum was naturally completely removed.

"microscope!"

Zhou Can had already prepared and advanced the operation area, while Yang Ping and Song Zimo adjusted the focal length and interpupillary distance.

Complete bilateral ureteral anastomosis under the microscope, bilateral ureteral catheter stent renal pelvis drainage; bladder rupture repair.

Continuing, use the stump of the cystic duct to insert a T-shaped tube for choledochostomy; the original location of the spleen is also placed in the drainage tube.

Cystostomy; descending colostomy, a series of stomas.

If there is no urethra, cystostomy is temporarily performed, and if there is no rectum and anus, descending colostomy is temporarily performed to preserve the temporary function of urination and defecation after surgery.

A beautiful flap transfer was also used at the end to repair the wound on the stump.

Three drainage tubes were inserted into the wound for drainage. In addition to various tubes placed in the abdominal cavity, a total of more than ten drainage tubes extended from the body.

During the operation, the blood transfusion was already [-] milliliters, and the blood pressure was barely maintained.

In the end, the entire lower body was detached, and a pile of muddy lower body left the wounded body.

A 1.6-meter-long person turned into a half-length person of about [-] centimeters, like a half-length ceramic doll.

The operating room was surprisingly quiet. Takahashi stared at the screen. After watching the entire operation, he accurately calculated the time. It only took 35 minutes from the moment he washed his hands and went on stage.

And every step, without any pause, without any hesitation, as if every step has been clearly understood, where needs to be dealt with, the consciousness arrives before the hand, the consciousness leads the hand, and completes every movement accurately.

Numerous operations are not simply performed step by step, but intertwined and spliced ​​together flexibly without any sense of disobedience.

This kind of splicing is not done one by one. In order to save time, the surgeon coordinates the steps of all independent operations, disrupts and mixes these steps, intersperses operations, and combines operations with operations.

Just like a DJ playing discs, pull fast here, insert there, suddenly stop this section, and insert another section, with both hands in the abdominal cavity, cooperate if you want to cooperate, and operate independently if you want to operate independently, the coordination and connection are seamless.

The entire operation process was completed under the pressure of death, which was urgent, thrilling and exciting.

A powerful force rushed towards his face like a tsunami, making Takahashi feel tremendous oppression, oppression that he could not fight back, his knees almost went limp, and he knelt down directly.

The needle holder was gently placed in the turning plate of the sharp instrument, and Yang Ping raised his head: "Vital signs?"

"Blood pressure 102/60mmHg, heart rate 102 beats/part, low-flow oxygen inhalation, mechanical ventilation, blood oxygen saturation 100%."

"After passing the first ghost gate, there are still many ghost gates waiting for her." Yang Ping breathed a sigh of relief.

"I'll take care of this patient." Song Zimo stared at the monitor screen.

"You are in charge of setting up the medical team, including Takahashi. Let me tell the head nurse that a nursing team needs to be formed. If this patient wants to survive, a dedicated team must be responsible. Any small mistakes may lead to wasted efforts. , the god of death will take advantage of it at any time."

"In addition to this, there are currently only two cases of such a high-ranking half person in China, and one case has been reported in Shanghai, who died six days after the operation—"

Takahashi is very familiar with these cases.

　The prototype of this case is Peng Shuilin, a half-body rescued by Shenzhen Buji People's Hospital in 2004. Some revisions have been made to the patient and condition in the book.This kind of operation, no matter in terms of the difficulty of the operation or postoperative care, is a challenge at the pinnacle of surgery.An untimely change of bed sheets after the operation may cause infection and eventually lead to death.They have created a world miracle, perfect surgery, coupled with perfect post-operative care, to create this world miracle.It can be imagined that more than [-] doctors and nurses operated for more than six hours, and the dressing was changed more than ten times a day after the operation. One dressing change required three or four nurses to work for an hour.I was still a student at that time, and I learned about this case from my teacher when I was in graduate school.Pay tribute to Director Fan Debiao and Director Yuan Taizhen who participated in the rescue at that time, as well as all medical staff!
　　
　
(End of this chapter)