godfather of surgery

Chapter 445 The Shadow of the Year

The aorta and inferior vena cava are separated up to the diaphragmatic hiatus.

In addition to separating the main trunk, it is also necessary to separate their countless branches. The branches must also be separated to a sufficient length. Otherwise, when the spine is corrected, the strong pulling force will tear off the blood vessels, causing the patient's chest to fill up with blood in an instant.

There are too many branches, and each branch has branches. Almost all major branches have to be separated in this way.

This is a meticulous job, there is no way to speed up, Yang Ping's knife tip bit by bit, parting those old adhesions.

This requires enough patience, not to be impatient, not to be discouraged, not to relax.

In addition to the heart and great vessels, the chest cavity also contains the thymus, lungs, trachea, and bronchi.

Now the problems of the heart and great blood vessels have been resolved, the thymus gland does not need special treatment, and the rest is the problem of the lungs and trachea.

Under the blowing of the ventilator, the lungs expanded and contracted. The current condition of the lungs is very good. They will not be involved in the next spinal correction, and some adhesions were easily handled by Yang Ping.

But the trachea and bronchi are not so optimistic and must be properly separated like the great vessels.

The trachea and bronchi are behind the heart and great blood vessels. Yang Ping puts in two rubber strips, bypassing the aorta and superior vena cava respectively, pulls them to the sides, and then clamps the two ends of the rubber strips with large curved forceps. Hand it over to the second and third assistants who are in charge of revealing.

The retracted aorta and superior vena cava reveal a window, revealing the trachea and bronchi hiding behind.

Without the previous separation of the aorta and the superior vena cava, allowing them to form independently, there is no way to retract it now, and there is no way to expose the trachea and bronchi. Without exposure, surgery cannot be performed. Exposure is a necessary condition for surgery.

The exposure of the trachea is easier than that of the blood vessels because of the cricoid fibrocartilage structure, which makes it easier to identify than the blood vessels and surrounding adhesions.

The trachea and bronchi are liberated, and the treatment of the organs in the chest cavity is not over yet. The organs must be properly suspended and fixed in the human body, otherwise they will be stacked together due to gravity and movement.

Yang Ping has considered this point. When dealing with adhesions, some adhesions suitable for hanging are kept, but such adhesions are very few.

In order to get a good fixation of these organs, it is necessary to rebuild their suspension at key nodes, which seems simple, but it is very complicated to do.

If there is no suspension and fixation, it is very simple. When running, the five to eight-meter-long intestines are either piled together by gravity, or entangled with each other, but in fact we don’t. The viscera and intestines are still fixed in their original positions.

This is because our viscera have a special structure to fix it. This fixed structure is some membranes, but the fixation should not be too dead, and the viscera must be given a certain space to pulsate or wriggle.

The several large blood vessels from the heart extend in all directions and have a fixed effect, but this is far from enough. The main structure that fixes the heart is the pericardium, so after peeling off the pericardium, enough is enough, instead of removing all the pericardium to make the heart become light. Slippery eggs.

The organs of the abdominal cavity are fixed to the body wall by the omentum, mesentery, and ligaments.

The intestinal tract is wrapped and fixed by the omentum and mesentery, and the liver, gallbladder, pancreas, and spleen are also fixed by many ligaments.

Therefore, after separating the organs of the chest cavity, it is necessary to rearrange them and restore them to their normal state. Another key link is to correct or rebuild their fixed structures so that they can be in place and stick to their posts.

This is beyond the understanding and operational ability of general surgeons. Few surgeries are considered so comprehensive. Except for joint ligament reconstruction in sports medicine, reconstruction of visceral ligaments is rarely considered.

Most of the ligament structures have been separated by Yang Ping, but they need to be lengthened due to contracture, very few need to be shortened due to laxity, and some ligaments need to be reconstructed.

Considering that it will take a certain amount of time for the reconstruction of the ligament to heal, Zheng Baosheng will be restricted in his activities after the operation. He will perform gentle activities on the bed within two weeks, and will start to walk on the ground after two weeks. He will not be able to perform sports within three months.

Yang Ping began to perform operations on these ligaments and mesentery again, lengthening, shortening, or reconstructing them. The excised pericardial tissue was then put to use for waste utilization and became a material supplier for reconstruction.

Every ligament has been finely processed, and the internal organs of the chest cavity are considered complete. Now it looks as if they are squeezed together as before, but this is only a superficial phenomenon. In fact, they have bid farewell to the previous adhesion.

Only limited by the small space, they had to still squeeze together.

If the spine suddenly returns to normal curvature and the volume of the entire thoracic cavity expands, these organs can immediately be distributed in the correct position in the thoracic cavity similar to that of a normal person.

The gap in the diaphragm, the space connecting the thoracic cavity and the abdominal cavity, the aorta, the inferior vena cava, the vagus nerve, and the esophagus all enter the abdominal cavity from their respective spaces.

The diaphragm of the dome structure is now like a collapsed roof. It loses its proper shape and is full of folds. If these folds are not opened, once the spine is corrected and the volume of the chest cavity is restored, they will also be pulled and torn .

The diaphragm is like a folded lotus leaf, opening up the folds, allowing it to gain the ability to expand to adapt to the normal posture in the future.

After the diaphragm was processed, the abdomen was opened, and the abdomen was also made a median incision.

"And the liver and pancreas underneath?"

Professor Li was cautious and held his breath even when speaking.

Yang Ping nodded.

Crossing the diaphragm and entering the abdominal cavity is no longer Professor Li's field of expertise.

"Let Dr. Song come?" Yang Ping thought it would be more appropriate to let Song Zimo be his assistant in the next step.

In the training of compound trauma surgery, Song Zimo is already very proficient in the anatomy of the whole body. In terms of the heart and great vessels, Song Zimo is far inferior to Professor Li Zehui, but in the anatomy of the abdominal cavity, he must surpass Professor Li, which has nothing to do with fame.

Seeking truth from facts is the greatest conscience of doctors.

"After finishing the treatment of the diaphragm, Dr. Song will be the first assistant, and I will be the second assistant."

Professor Li obeyed the arrangement of the chief surgeon.

The organs in the abdominal cavity are much more optimistic than those in the chest cavity, and the extent of their transformation is much smaller.
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A group of big orthopedic experts were waiting to see scoliosis correction, but now they are also interested in thoracic surgery.

How can young people be so proficient in anatomy, especially heart and great vessel surgery, whether it is separation of adhesions or suspension fixation, it is simply a miracle.

With such anatomical skills, any operation in his hands would be much easier than others.

Professor Qin likes such a young talent more and more.

Even if it is not poached, Sanbo Hospital must be made into the medical center of 301 in the south.

With the support of the leaders and your own efforts, this matter can probably be successful.
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The abdominal viscera operation, Yang Ping finished it very quickly, almost all were separation of adhesions, no fixation was needed, and the original position and length of the ligaments did not need to be corrected.

After the internal organs of the chest and abdomen are treated, the anterior surgery is considered complete.

The almost impossible operation was successfully completed by Yang Ping in such an orderly manner.

In addition to admiration, Professor Li still worships in his heart.

If he hadn't seen it with his own eyes, he would not have believed that someone could perform this kind of operation, nor would he believe that someone could be so proficient in human anatomy.

"You rest for a while, I'll close your chest and abdomen." Professor Li said with a proper attitude.

Yang Ping really needed to take a break, and he handed over the rest of the work to Professor Li and Song Zimo.

They began to flush the surgical area, then placed a drainage tube, sutured in layers from inside to outside, closed the chest cavity and abdominal cavity, drilled holes in the split sternum, and fixed it with several pairs of steel wires.

Next, the scoliosis correction is performed in the prone position.

Remove all sterile drapes, turn the patient over into a prone position, and re-sterilize the drapes.

Changing positions across the bed is regulated.

Several people are required to operate, how each person stands, what job they are responsible for, and the posture of their hands, there are operating specifications.

A head nurse in the operating room of Xiehe Hospital wrote a book called "Safe Surgical Position Map".

This should be the only monograph in China that systematically introduces how to pose for surgery.

In European and American countries, there are special body positioners in the operating room, who specialize in helping patients to position themselves so that doctors can perform operations comfortably.

Don't underestimate the patient's surgical position, a good posture can make the operation more effective.Bad or wrong posture often increases the difficulty of the operation, and sometimes makes the operation impossible to complete, causing some complications.

This is the gap between a technology from rough to fine.

If Zhang Lin and Xiao Wu can make "Surgical Pull Hook" into a book, it will definitely fill the gap in China, and the pioneering work may also fill the gap in the world, because they have pushed the pull hook technology from rough to fine.

Apples fall from the tree, and when studied seriously as a science, the results are immeasurable.
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"Little Five, Zhang Lin, come on stage!"

Changing positions, Yang Ping took off his surgical gown and gloves, and took a rest. Song Zimo led them to disinfect the drape, cut open and expose, and fix the pedicle screws. Yang Ping went on stage to perform osteotomy and correction.

"Good!"

Zhang Lin dragged the urine bag and followed Song Zimo out to wash his hands.

Because I walked too fast, the urine bag dangled on my thigh.

Professor Li saw the urine bag hanging from Zhang Lin's trouser leg and immediately knew what was going on.

Recalling that when he himself was a junior resident doctor, he once drank a lot of beer with a senior resident doctor. When encountering an emergency operation, Professor Li had no choice but to secretly hang a urine bag on stage. At that time, Professor Li's role in the operation was the second assistant.

The senior doctor who drank with him didn't have this kind of cleverness. He was an assistant on the operating table and couldn't hold back his urine, so he had to apply to the instructor: urinate!
The instructor was very angry, and when the first assistant stepped down to urinate, he said to Professor Li: "I remember you, you will be the first assistant in the future."

A urine bag changed the status of Professor Li in the heart of the tutor.

Generally, anyone who can succeed is a person who can be cruel to himself.

This kid actually has the shadow of him back then.

(End of this chapter)