godfather of surgery

Chapter 645 What is the level of the Golden Knife Award?

Professor Liang really had a heart attack. After reading the materials brought by Yang Ping, his face was ruddy, he was full of energy, he didn't cough anymore, and he ate five bowls of rice for lunch, and almost half a roast duck.

Those present are all familiar juniors, and it's no secret that they can eat, and they don't pay much attention to refinement at home.

Professor Liang's appetite should be among the best among the elderly, and Yang Ping suspected that the previous hospitality for Professor Liang might not have given him enough to eat.

Didn't it mean viral acute upper respiratory infection?Is it so fast that the virus is killed?

Hu Guolin and Song Yun couldn't understand it at all. Professor Liang's wife knew her husband's temper, so she didn't find it strange.

After lunch, Professor Liang and Yang Ping discussed the application of stem cell technology in orthopedics, especially in the cultivation of cartilage.

If stem cells are used to grow real articular hyaline cartilage for transplantation, the post-transplantation process is like fracture healing, which is much simpler than other organ transplants.

And Yang Ping chose stem cells to grow muscles, because muscles have the basic characteristics of other organs. For example, after transplantation, they must rely on anastomotic blood vessels for blood supply. To exert their own contractile function, the quality of the function cannot be compromised. There is one more important point. After muscle transplantation, the nerve must be anastomosed to restore nerve function, otherwise it is meaningless.

Therefore, if all the problems of stem cell cultivation of muscles are solved, it is equivalent to solving the basic problems to be solved for all cloned organs.

Through the communication with Yang Ping, it is found that Yang Ping has read almost all the papers and monographs in the field of stem cells, and the breadth and depth of his knowledge is difficult to match.

No wonder he was able to conduct a thorough analysis of other people's research and finally came up with his own proposal.

How about the cooperation between Xiehe's stem cell laboratory and Yang Ping?Professor Liang came up with this idea.

Concorde's stem cell research has been going on for 30 years, while Yang Ping's stem cell research has just begun. It may take some time to convince the professors in the laboratory to cooperate with Yang Ping.

Moreover, it is difficult to coordinate the cooperation between the two. Yang Ping's project is so large that he must occupy the leading position, and it is impossible for Xiehe's laboratory to give up its leading position and join Yang Ping's project.

Xiehe has more than [-] academicians from medical school to hospital, and many national-level projects are the leaders. How could it be possible to give up the leadership at will and join the new projects of young people.

If we cooperate, many contradictions seem difficult to reconcile.

However, it doesn't matter whether we cooperate or not. As long as Yang Ping is in China and the subject is in China, Professor Liang will feel at ease.

Perhaps the older generation has a deep understanding of key technologies being stuck, so they always look at the research of these major technologies from the perspective of national strategy, and attach great importance to "independence and self-renewal".

"Xiao Yang, if you have any difficulties with the project, please tell me at any time, such as funds, manpower, etc." Professor Liang felt that he could still help, because after all, his position in the medical circle is here, and there are many scientific research resources available. mobilize.

"Okay, I will tell you anytime I have difficulties." Yang Ping was very grateful for Professor Liang's concern.

After talking with Yang Ping for a long time, Professor Liang said to his wife, "I will take my temperature later. If there is no problem, I will go to work in the hospital."

"Today, Saturday, don't you take a rest and recuperate?"

Teacher Luo was still a little worried.

Professor Liang said unconvinced: "Five bowls of rice, half a side of roast duck, have you ever seen such a patient who can eat?"

"Okay, you go, Guolin, just keep an eye on him." Teacher Luo had no choice but to agree, but he was still worried, and told Hu Guolin to pay attention to his body, after all, he had been lying down for three days.

"Is there any special patient these days?"

I have been bedridden for the past few days, and I just recovered today, so I naturally care about the patients in the department.

"There was a special patient with chordoma that invaded the 2nd, 3rd, and 4th vertebrae of the waist. During the case discussion, it was decided to perform surgery: posterior-anterior-posterior approach, total vertebral resection of three vertebrae, tumor resection, and 3D printing Titanium alloy artificial vertebra implantation, posterior pedicle screw system fixation, the operation is too big, the risk is too high, it is estimated to take more than 20 hours, we have not arranged the operation for the time being, waiting for your help to check.

Professor Liang has now handed over the position of department director to Professor Hu Guolin, but he still insists on rounds for surgery.

Professor Liang knew it immediately: "This is a world-class operation. At present, there are only a handful of total vertebral resections in the country. In addition to tumor removal and vertebral reconstruction, I am afraid that there are only three or four hospitals in the country that can do this. There are relatively few cases, Xiehe and Huaxi have done it, and at that time they were doing two vertebrae, and it took about [-] hours."

"Yes, so we have to be fully prepared before we dare to do it. Patients also come for our ceiling status." Professor Hu is also very rigorous, and can only arrange surgery after full preparation.

When Yang Ping heard about the operation, he immediately became excited. This kind of operation is only interesting.

The anatomical structure of the vertebrae is extremely complex, and the invasion of the tumor makes the anatomy more complicated. There are spinal nerves inside, various criss-crossing blood vessels outside, and the aorta and vena cava in front. Three whole vertebrae and tumors are cut off at one time , and then rebuild.

This operation is a very large project.

"Let's go, let's go to the ward to have a look." When Professor Liang heard about this kind of case, he seemed to be on stimulants, and he didn't even need to rest after meals.
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Professor Liang, Professor Hu, Song Yun and Yang Ping came to Union Medical College Hospital on foot.

Professor Liang's home is not far from Xiehe, so walking is like taking a walk after dinner.

Any acute upper respiratory infection is a floating cloud.

Everyone came to the orthopedic ward of Xiehe Hospital and saw Professor Liang who was full of energy. Everyone was very puzzled, didn't they mean sick?Doesn't look sick?

The doctors in the department have just finished their professional studies. There are many people in the office, and a lot of doctors gather together, and they are all very busy.

Seeing Professor Liang and Director Hu, everyone greeted them respectfully.

Several doctors knew Yang Ping. After recognizing Yang Ping, they were very excited and ran over to talk to Yang Ping.

These doctors have all participated in the animal experiment in Guilin, and their names are all signed by Yang Ping's thesis. They are all Yang Ping's admirers.

They knew that Yang Ping was coming to Xiehe, and Xiehe had prepared ten beds for clinical trials on scoliosis patients, but they did not expect Yang Ping to arrive so soon.

"Director Hu, take a look at the medical records of the patient you mentioned, let's discuss in a small group." Professor Liang sat down and instructed Professor Hu Guolin.

Song Yun immediately went to get the medical records, then turned on the computer and put the medical records on the screen.

Everyone saw that Professor Liang wanted to see this case, so they put down their work and prepared to listen to the class seriously. The young people all held notebooks in their hands, and the learning atmosphere of Xiehe is good.

Doctors came one after another, including some chief doctors and deputy chief physicians.

There are more than 60 doctors in Xiehe Orthopedics, plus the number of doctors and masters who are studying, the number is very large.

Many young doctors heard that Yang Ping was coming, so they rushed to see him as much as possible. The winner of the Golden Knife Award has a great reputation in the orthopedic field, especially in the hearts of young doctors. He is an idol.

Seeing that the office could not be crowded, Director Hu suggested that it would be better to go to the meeting room.

Everyone moved into the conference room, ready to discuss this case.

Professor Liang, Director Hu, Yang Ping, and the director leading the group all sat in the first row, and other doctors started from the second row and were automatically sorted.

Song Yun also has to sit in the back, because he is not qualified enough to sit in the first row, but now he and several other doctors are in charge of multimedia control.

Originally, Professor Liang just wanted to discuss with a few people in a small group, but he didn't expect to gather so many people spontaneously, so he had to expand the scale of the discussion.

After reading through the paper medical records, Professor Liang handed them to Yang Ping: "Look at this medical record."

Yang Ping took the medical records, flipped through them quickly, and grasped the key information of the medical records.

Jing Yunsong, male, 48 years old, was admitted to the hospital for 7 months with low back pain and anterolateral numbness and pain in the right thigh. Physical examination: there was percussion pain in the lumbar 2, 3, and 4 spinous processes, and the bilateral psoas muscles were obviously tense. Cutaneous hypoesthesia, decreased anal reflex, and hypoesthesia on the lateral side of the right thigh.Auxiliary examination: lumbar anteroposterior and lateral grades and lumbar MRI showed: space-occupying lesions of the 2nd, 3rd, and 4th lumbar vertebrae, considered to be chordoma.

The tumor of the lumbar 2 vertebra grows into the spinal canal, which has obviously compressed the spinal cord and nerve roots in the spinal canal, resulting in damage to the conus cauda equina; the tumor of the lumbar 3 vertebra grows into the abdominal cavity, forming a huge soft tissue mass, which adheres to the aorta and vena cava in front ; The range of lumbar 4 vertebral tumor invasion is much smaller.

"Everyone has already discussed this case. We are just interested, so we took it out for research. It is not considered a formal discussion, and everyone treats it as learning." Professor Liang expressed his attitude so as not to cause procedural confusion.

"The visiting delegation from the Twin Cities Spine Surgery Center in Minnesota, USA will arrive tomorrow. I will temporarily add this case to the academic exchange case." Director Hu reported to Professor Liang.

A teaching hospital with a strong academic atmosphere like Xiehe has academic activities almost every Saturday and Sunday, some of which are limited to domestic exchanges, while others are international exchanges, which is almost the norm.

"Yes, this kind of operation is relatively rare. The operation is very large and the risk is very high. We should communicate with them." Professor Liang agreed with Director Hu's approach.

The Twin Cities Spine Center is a world-class spine center that has contributed significantly to the development of spine surgery.

Song Yun began to report the medical records, and everyone listened and thought.

Chordoma is a rare malignant tumor that occurs in the skull base, vertebrae, and sacrum. The incidence rate is very low, about 0.8 per 100 million people per year. Without effective treatment, the 5-year survival rate is only about 30%. This The survival rate is also very low.

The 5-year survival rate is a statistical concept, and it is generally used clinically to evaluate the treatment effect or prognosis of malignant tumors.

It is not the outcome of a specific patient, it does not mean that it can only survive for 5 years, but it refers to the proportion of patients with malignant tumors who survive 5 years after diagnosis.

That is, out of [-] confirmed patients, how many people are still alive after five years.

The higher the 5-year survival rate, the better the treatment effect of this tumor and the better the prognosis, otherwise the poor treatment effect and poor prognosis.

Chordoma is not sensitive to traditional radiotherapy and chemotherapy, and there are three methods for treating tumors—surgery, radiotherapy, and chemotherapy, and only surgery remains. Therefore, surgical treatment is the main treatment method for chordoma.

Chordoma is very easy to relapse after surgery. Once it recurs, it will often damage the spinal cord nerves, leading to incontinence, paralysis of lower limbs and even death.

Therefore, whether the tumor can be completely removed by the first operation is the key to the treatment of chordoma.

For Jing Yunsong, 5 of the 3 lumbar vertebrae were involved by the tumor, which is equivalent to the tumor having invaded three-fifths of the entire lumbar vertebrae. To completely remove the tumor, all 3 vertebrae must be removed, and there is no other choice .

The anatomical structure of the lumbar spine is very complex, with the spinal cord inside, the celiac aorta and vena cava in front, and a large number of blood vessels around it, and the vertebrae are deep and irregularly shaped.

To completely remove the vertebrae, all normal structures around the vertebrae must be preserved and then safely separated from the vertebrae so that the vertebrae can be removed.

Therefore, en bloc resection of the entire vertebra is also the most difficult and technically demanding operation in the field of spinal surgery.

The requirements for the surgeon's anatomical knowledge and anatomical practice are very high.

Jing Yunsong's tumor involved a long segment of the lumbar spine and a wide range. The tumor grew aggressively towards the surroundings and formed a mixed state of interpenetration and interweaving with the surrounding tissues. The spinal nerves are damaged, which makes the operation more difficult.

After the vertebrae and tumors are removed, the spine, which is the central axis of the human body, will lose three sections, just like a building without load-bearing walls and columns, so it can’t be done after removal, and the resected vertebrae must be reconstructed to rebuild the human body’s central bearing heavy column.

Traditional titanium mesh and other supports cannot replace the load-bearing of the three vertebral complexes at all. 3D printing technology must be used to manufacture personalized three-segmented vertebral complexes in order to rebuild the "load-bearing column" of the human body.

Jing Yunsong has traveled all over the country's top hospitals, and this time he came to Xiehe, hoping to get the best treatment.

"Surgery is the only treatment method. Everyone agrees on this point, and there is no doubt about the surgical method. The three vertebral bodies and tumors are all removed, and then 3D printed artificial vertebral bodies are implanted. Finally, pedicle screws are used to connect the upper and lower normal vertebral bodies. Fixing them together, the operation is very difficult, we had a similar operation not long ago, I don’t know if you have any impression, it took [-] hours for two vertebral bodies, West China Hospital also did a case, and the time was about the same.” Professor Hu sorted out the medical records and recounted the results of everyone's discussions.

Xiehe is the ceiling of Chinese hospitals. When patients come here, they have no intention of transferring or going to other hospitals.

This is the last stop for medical treatment.

Many patients think that Xiehe is not good, so they have to go back to eat and drink well.

Those doctors who were acquainted with Yang Ping had an idea in their minds: If Yang Ping were to perform this operation, would he be able to win it?Need more time?

What is the level of the Golden Knife Award?
What is the level of the top surgeons in the country?
(End of this chapter)