godfather of surgery

Chapter 365 Eighty percent
Takahashi's three-month study period is coming to an end, and he hopes to extend the study period and stay in Sanbo.

There are still many cases that he needs to learn. During the time he followed Yang Ping, he not only learned advanced surgical methods, but also learned a new way of thinking. Both anatomy and surgery have reached a new height.

Takahashi felt that three months was not enough, if he could stay, one year, three years -- he would be willing.

It is a pity that it is impossible for him to stay in China with so much time. There is still a lot of work waiting for him to do at the University of Tokyo Hospital.

Takahashi's visa has a maximum stay of 180 days, and he hopes not to waste a day.

So he applied to Masao Fujiwara for a three-month extension. Masao Fujiwara replied: Takahashi will continue to study in China, and Miyuki must return to Japan as scheduled when the term expires.

Miyuki's arthroscopic technology has advanced rapidly, and can carve a crooked letter on the olive nucleus.

She didn't care about Masao Fujiwara's words. Although he was the director of the Department of Orthopedics at the University of Tokyo, he still had another identity, his brother.

In fact, Miyuki had more time to stay than Takahashi. She was just a mid-level young doctor without any position.

"You should listen to Mr. Fujiwara and go back as soon as possible." Takahashi didn't want her to go against Mr. Fujiwara's words.

Miyuki didn't care: "Why should I listen to him, I have my own life!"

In fact, Miyuki knew in her heart that her brother asked her to go back just to meet Mitsui Yusuke. The two families wanted to discuss their marriage arrangements. This was a marriage between the Fujiwara family and the Mitsui family, and it was a major event.

Although Mitsui Yusuke is also a top student at Tokyo University, both in talent and appearance, she doesn't like that guy and has no feeling for him at all.

"My visa also has 180 days. I don't want to call him anymore. You tell Mr. Fujiwara that I have decided to stay in China and continue my studies." Miyuki Fujiwara was very firm.

Takahashi sighed helplessly, this was already the matter of the Fujiwara brothers and sisters, and he couldn't intervene.
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After the fifth round of surgery, there will be the last round of surgery in the regional competition: anterior surgery for thoracolumbar fractures. Like pelvic and acetabular fractures, this surgery is very risky.

The surgical approach is an important part of the operation, and the risk of the approach is destined to be very risky.

In a large hospital, patients who had undergone anterior thoracic surgery died on the operating table like a frightened bird. Anterior spinal surgery was banned for a long time, which is a bit extreme.

After the sixth round of surgery, Song Zimo still maintained a full score, and his strong combat effectiveness attracted a lot of attention to this first assistant.

With the end of the sixth round of surgery, the regional competition came to an end, and the emblems of the qualified hospitals in each competition area were listed on the homepage of the website.

The photos of the chief surgeons of each team are also played in a loop on the website. Everyone is familiar with the other chief surgeons, but Yang Ping is not familiar with everyone, because he did not show up in the regional competition at all.

In the Western Division, Li Ling from Huaxi, a student of Professor Fu Shancheng, advanced with full marks. The team from Xijing Hospital missed the full mark by one point and advanced as No.2. The third promotion team was also from Huaxi.

In the northern division, Ouyang Siming, Xiao Yi, Lu Qing, and Song Yuncheng were from the Third Imperial Medical Hospital, Jishuitan, 301, and Xiehe, and they all advanced with full marks.

In the Eastern Division, Wen Rentao and Yue Zhengming advanced with full marks, and Wang Kaisheng of Changzheng Hospital advanced as No.2.

In the Central Division, only Xiangya has a perfect score team, Tongji is two points behind, and the Second Brother Hospital of Xiangya is four points behind.

In the Southern Division, Song Zimo and Sun Nanchen advanced with full marks. Lin Hao received a point deduction for his intercostal artery ligation too hastily during anterior surgery for thoracolumbar fractures.

There are three promotion places in each competition area, and there is no limit to the number of places for full marks, and those who are tied will advance with the excess places.

For example, if there are more than three perfect scores, all of them will be promoted, and other teams with less than perfect scores will have no chance.

For two full-scoring teams, there is one spot left to make up for No. 2. No matter how many No. 2s are tied, they will use this spot to advance together.

If a team with a perfect score, the other two places, the second and third places will make up. If No.2 is tied and occupied, No.3 has no chance, and so on.

A total of sixteen teams advanced to the national competition. After a two-week break, the national competition will be randomly matched by computer to allow these teams to combine.

The competition adopts an elimination system. Within the specified period of time, after completing the specified types of operations, points will be scored. Those who fall behind in total points will be eliminated, and those with the same score will be promoted to the next round.

Those who advance will enter the second round of elimination, the third round of elimination, and finally the championship.

According to the current situation, there are exactly sixteen teams in the competition. The top eight will be determined in the first round, the top four will be determined in the second round, the top two will be determined in the third round, and the fourth round will be the championship match.

In a duel between masters, if you are weak in that link, you will fall behind your opponent.

The rising stars of the younger generation in the medical field are all gearing up and eager to try.

In the national competition, the first round of orthopedic surgery is arthroscopy and transforaminal surgery. It is difficult for doctors with incomplete skills to go very far.

Some hospitals are so small that they can't even find all the cases, let alone participate in the competition.

So in the end, the only ones who can participate are the well-known top hospitals.

Know yourself and know your enemy, win a hundred battles, the regional competition is over, and everyone starts to sweep the rankings. Most people are familiar with it, but Sanbo Hospital is not very familiar to everyone.

Many doctors who participated in the Trauma Orthopedics Symposium have memories, including Fu Shancheng and Professor Meng Heng.

Lin Hao was extremely depressed. He wanted to get rid of Sanbo Hospital, but Song Zimo almost got rid of him.

He decided to play steadily in the national competition, even if he didn't meet Sanbo, he would go further than Sanbo.

It would be best if he could meet Sanbo in the first round. Arthroscopic multi-ligament reconstruction of the shoulder and knee is the surgery with the highest score in this round.

Lin Hao can rely on the world's most advanced technique taught by his mentor Robert to increase the score and eliminate Sanbo Hospital in one fell swoop.

During the two-week break, the computer random party results will be announced on the website before [-]:[-] pm on Friday of the second week.
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In Director Han's office, a USB flash drive containing Professor Feng's images was inserted into the computer.

X-rays, CT and MRI of the cervical spine and head, as well as enhanced images, appear on electronic screens.

Chordoma, malignant, is relatively rare in the upper cervical spine, and it is even rarer from the upper cervical spine to the intracranial.

The tumor originates from the embryonic remnant notochord tissue and generally grows slowly.

Therefore, if the operation can be successfully removed, it can also obtain a certain survival period.

However, the connection between the upper cervical spinal cord and the medulla oblongata is the center of the respiratory cycle, which is in charge of the heartbeat and breathing. If this part is damaged, the breathing and heartbeat will stop immediately.

Professor Feng's chordoma invades the respiratory and circulatory centers. The prognosis is very poor and life-threatening at any time.

In this case, the tumor and the respiratory and circulatory center are mixed together, and there is no way to operate.

"There is no distant metastasis for the time being. I have undergone radiation therapy, but it is ineffective. I have used the targeted therapy drug PDGFR inhibitor imatinib and the MTOR inhibitor sirolimus, but the effect is not satisfactory. Combined with rapamycin, it still does not work. .” Director Han called Yang Ping to the office, but he did not say that the patient was his mentor, Professor Feng.

Yang Ping carefully analyzed the images and the 3D printed models.

Director Han poured the image data into the 3D printer, and printed out models of the upper cervical spine, skull base, and tumors. The tumors grew in a staggered manner, showing dumbbells, antlers, and winding complex growth.

Yang Ping observed for a long time that this case was really difficult, involving three departments of neurosurgery, orthopedics and tumor surgery.

It is no exaggeration to say that this kind of tumor should be a forbidden area for surgery.

If this operation is to be performed, there are four difficulties, the first to be revealed is the difficulty.

Conventional exposure is not enough, the back of the upper cervical spine and the back of the skull must be completely opened from the posterior approach, and it must be able to be installed after opening.

Only in this way can the upper cervical cord and medulla oblongata be exposed, and then the medulla oblongata and upper cervical cord should be incised, and the tumor should be removed as completely as possible while protecting the vital functional area.

The other three difficulties are that the surgical operation must be very precise, which is the biggest test of surgical accuracy.

Robotic surgery will be very precise, but it is not suitable for such high-risk surgery. The most reliable is the machine, and the least reliable is also the machine.

Robots don't have the touch of a human, and once they make a mistake, even a little bit, it will be fatal.

The accuracy of this kind of surgery should be controlled at about 0.1mm. Ordinary metal scalpels, no matter how sharp they are, cannot achieve this kind of accuracy. Moreover, the scalpels cannot squeeze the tissue. Ordinary scalpels only need to cut and squeeze.

So it is necessary to use advanced laser knife for surgery.

Third, the boundary of the tumor is determined, and the tumor is mixed with the medulla oblongata and the upper cervical cord. No matter what method is used, there is no way to identify the tumor and the life function area that needs to be protected during the operation. It can only rely on the experience of the surgeon.

There are few cases in this case, and even fewer operations are performed, and most of the operations are failures. How can there be successful experience?
The last is hemostasis. The blood supply of this tumor is still very rich, and the hemostasis is not complete. The hematoma oppresses the respiratory and circulatory center, and the patient stops breathing and heartbeat.

Yang Ping was looking at video pictures and 3D models, while Director Han was touching the cup, feeling uneasy.

It was a long time before Yang Ping spoke.

"Using the most advanced laser knife, the upper cervical spine and skull base are opened posteriorly, the upper cervical spinal cord and medulla oblongata are fully exposed, and then the surgical operation with 0.1mm precision is performed."

Is this surgery feasible?Director Han finally waited for Yang Ping's reply, and immediately asked, "What is the success rate of the operation?"

"Not high!" Yang Ping replied without confidence.

This was the first time Yang Ping answered without confidence. Even with Lu Gang's case, he said confidently and without hesitation: Admit to the hospital.

"How high is it estimated?" Lao Han still asked.

"Eighty percent."

Yang Ping made a rough estimate, there is no way, the operation is too difficult, how high the success rate of this kind of restricted area operation can be.

"Eighty percent?"

Old Han thought he had heard wrongly, the success rate of this kind of operation, according to current reports, did not exceed [-]%.

"Yes, there is no way, it's too difficult, up to [-]%!" Yang Ping was very embarrassed.

After confirming that it was [-]%, Old Han calmed down.

"Where is the patient?" Yang Ping was very concerned. This case was very special.

Now which case in his hands is not special and difficult?

"The patient is in the Sixth Hospital of Shanghai, and we don't know the arrangements there yet."

Lao Han has a bottom line in his heart.

(End of this chapter)