godfather of surgery

Chapter 340 Difficulty Reconstruction
After Yu Shuilian had the stitches removed, her liver and kidney functions remained normal, and she successfully passed the critical period of organ dysfunction.

In this way, the reconstructive surgery of the urethra and anus was put on the agenda, and it was time to hand in the homework assigned by Yang Ping.

Yang Ping assigned them homework and each designed a reconstruction surgery plan, hoping that Song Zimo, Xu Zhiliang and Gao Qiao could discuss together, and the others would follow suit.

Takahashi is a master of international trauma surgery, mastering the latest concepts and techniques, allowing Song Zimo, Xu Zhiliang and Takahashi to collide with each other to generate sparks of thought.

Judging from the discussion information in the group, the three actually have their own advantages.

Takahashi has the most clinical experience, and Song Zimo has the highest talent. Whether it is thinking ability or hands-on ability, he is obviously higher than Takahashi and Xu Zhiliang. The gap between Song Zimo and Takahashi lies in clinical experience.

The experience that Yang Ping taught him, to Song Zimo, was still a theory, a theory that was not available in books. He had not done as many surgeries as Takahashi, so naturally he had worse clinical experience than Takahashi.

Xu Zhiliang's thinking ability is not inferior to Gao Qiao's, but whether it is theoretical knowledge or clinical experience, it is still much worse than Gao Qiao's.

After all, Takahashi has studied this major for a long time, exchanged and learned everywhere, and has always been at the top international level, which is far behind Xu Zhiliang.

Xu Zhiliang graduated from Nandu Medical University from undergraduate to doctoral degree. There are more than one billion Chinese people, and those who can be admitted to Nandu Medical University with an undergraduate degree can be regarded as academic masters among more than one billion people.

Takahashi is a top student among the [-] million Japanese. From this selection ratio, Takahashi is only a provincial top student in China.

Therefore, it is reasonable that Xu Zhiliang's IQ level is no worse than Takahashi's.

However, the elite doctor training route that Takahashi received far surpasses Xu Zhiliang in terms of clinical and scientific research capabilities, which is also reasonable.

Xu Zhiliang, as long as he is cultivated, it is entirely possible to surpass Takahashi in time, at least Yang Ping thinks so.

He hopes that these two people can learn from his broad international vision when they get along with Takahashi, which is the most important thing.

The meeting room was full of people, some were sitting, some were standing, all of them were wearing clean white coats, and even the most sloppy ones had their collars and buttons tidied up.

These people include general orthopedic doctors, graduate students, training students, interns, and young doctors from other departments.

Those who are sitting are usually from the general orthopedics department, and those who are around are usually from other surgeries.

A lot of stools were added around, but everyone was afraid that they would not be able to see or hear them, so they simply stood up and had a better view.

Yu Shuilian's rescue operation has already caused a sensation in the whole hospital, and now the general orthopedics department is going to rebuild her urethra and anus, and everyone wants to know how this operation is done.

If the rectum is present, just an anal sphincter injury, surgery to reconstruct the anus, a general surgeon or plastic surgeon will have many ways to reconstruct it.

However, the reconstruction of a functional anus at the end of the descending colon is beyond the scope of everyone's knowledge. Everyone is very interested in this, and what kind of cutting-edge new surgery is carried out.

In addition, a department that grabs patients from death, a department that can attract international trauma surgery experts, and a department that continues to create miracles.

Every focus is fascinating. Several doctors with high professional titles in plastic surgery, general surgery, urology, and anorectal surgery came, with the mentality of participating in an academic meeting.

Although this discussion is a surgical discussion at the department level, in everyone's eyes, it is no different from an international academic conference.

Yang Ping is almost a god-like existence in Sanbo Hospital; Song Zimo is a genius; Gao Qiao is a master of international trauma surgery. This kind of meeting must be very exciting.

The white coats were neatly dressed, the venue was silent, and the medical discussion was serious, and everyone was in awe.

The first person to show the operation plan was Takahashi. He was arranged for no other reason. Except for Yang Ping, no one has more surgical experience than him. He is a leader in international trauma surgery today.

It's just that during the period of comprehensive orthopedics, everyone forgot Takahashi's original identity, and only regarded him as the submissive Xiao Gao. Yang Ping wanted him to stimulate everyone's enthusiasm.

Takahashi tidied up his white coat, turned his eyes to Yang Ping, and got permission, he walked confidently to the podium, maybe at this time, he found his true identity.

How many times he has strode to the podium at the International Trauma Surgery Conference, and those many speeches are not as good as this podium, just because there is a god-like figure in his heart sitting next to him.

A pair of surgical spectrum maps were entered into the computer in advance and opened on a high-definition screen. This is the work of Takahashi's life-long skills.

Not for anything else, just to get the young teacher's approval.

"Hi everyone, I am Takahashi Fumiya, a comprehensive orthopedics student. You can call me Xiao Gao. The following is my report on Yu Shuilian's operation plan."

"Modern surgery really kicked off when it conquered bleeding, pain, and infection. Today, surgery has solved many ailments for people. No matter what kind of surgery, there are three realms that cannot be escaped: resection, repair, and reconstruction."

"Excision, such as the treatment of appendicitis, discards the diseased tissue or organ and lets it out of our body; repair, such as surgery for skin cracks, fractures, and tendon ruptures, we try to repair it and try to restore the original anatomy and Function; and reconstruction is the highest state in the field of surgery at present, the diseased or damaged organ leads to the loss of function, in order to restore its working ability, we exhaust all means and create substitutes to perform its function, such as artificial joint replacement.”

"Today, Yu Shuilian's operation is a reconstruction operation, because her original natural anus and urethra no longer exist. In order to restore her excretory function and live clean and tidy like a normal person, we will rebuild her anus and urethra. That is to create a substitute."

"Reconstructing an organ, our ultimate goal is to simulate the function. There are two reconstruction operations for this patient, the urethra and anus are reconstructed. The muscles that control urination are in the neck of the bladder. Fortunately, they are not damaged, so the reconstruction of the urethra only needs to realize the pipeline function of urination. , this operation is a routine plastic surgery, there is no difficulty, using the bladder wall to reconstruct the urethra, any urologist who is good at plastic surgery can be competent, this type of surgery, I have many papers in the "Lancet" and other journals, in which the curved Reconstruction was my first theory."

"The most difficult thing is anal reconstruction. If you want to rebuild an anus that can control defecation, under the current medical technology, you must have a preserved rectum and a complete nerve pathway. Unfortunately, the anorectum and sigmoid colon of this patient were resected. , the terminal receptors of the human body's defecation reflex --- baroreceptors are distributed in the rectal mucosa, and the descending colon lacks such receptors. Under the condition of lacking the terminal of the nerve reflex arc, it is almost impossible to establish an anus that has the desire to defecate and can independently control defecation! "

"Is it possible to use an artificial anus to achieve the goal? Unfortunately, no! Whether it is shape memory alloy, medical silicone rubber, or polyether polyurethane and other materials, the anal sphincter is still incomplete. Implantation, the repeated movement of the kit, the frequent stimulation of the tissue, is bound to produce an inflammatory response, coupled with the high-pressure activity of the cuff, which leads to the corrosion of the tissue, causing pain, infection and wound dehiscence. A series of complications make the application of artificial anus linger. forward."

"So, I suggest choosing autologous tissue for anal reconstruction, electrical stimulation of the gracilis or gluteus maximus for in-situ anal reconstruction. I have done a lot of them to restore the voluntary defecation and rebuild the contraction of the sphincter. The fluid closure rate exceeds 95%. This data I have always maintained a leading position in the world, but Yu Shuilian's heterotopic reconstruction, I really lack experience."

"Under the encouragement of Dr. Yang, I still came up with my own operation plan, referring to the in situ reconstruction technique, and still using the muscle flap to reconstruct the anus, but we must carefully choose the location of the muscle flap, and we must give up the upper limbs and shoulder joints. Muscles, because patients use their upper limbs to perform a lot of alternative movements, so we can take samples from the chest or back to reduce the negative impact of weakening shadows.”

"For the sphincter, I recommend using a free muscle flap of the pectoralis minor, with the thoracoacromial artery and the medial thoracic nerve, with a hole in the center of the muscle flap, embedded in the end of the descending colon, surrounding the colon, and implanted in the muscular layer. The blood vessels can communicate with the The branches of the blood vessels near the colon are anastomosed, and the nerves can be anastomosed with the remaining pudendal nerves to establish a nerve conduction arc controlled by muscles, but --- I have no good way to produce the desire to defecate for the time being."

Combining with the map to explain his operation, Takahashi returned to the state of a master of trauma surgery. He turned to Yang Ping from time to time, and was encouraged, and became more energetic and eloquent.

This technique was designed by Takahashi based on his own rich experience, and it is very suitable for Yu Shuilian's current situation, but the biggest problem at present is that he cannot reconstruct the reflection of defecation.

His operation can end Yu Shuilian's embarrassment of defecation through abdominal fistula. Even if she doesn't feel like defecation, she can use the strategy of regular defecation to solve the problem of defecation.

Anal reconstruction seals off stool so it stays in the bowel when it shouldn't and passes when it should.

Reconstructing an anal closure is more difficult with liquid than solid, so a liquid seal is the measure of a high-quality reconstructed anus.

If the surgical effect achieves a fluid closure rate of 95%, it is indeed at the top level in the world.

　Feel sorry!The chapter published today seems to be a bit wrong again. I don’t know where the problem lies. Maybe the draft and the text to be published are mixed together, so I made a mistake. It has just been reposted.I also marked all the drafts, and this should not happen in the future.

　　
　
(End of this chapter)