godfather of surgery

Chapter 783 The ceiling of aortic dissection

Doctors specializing in emergency medicine are generally more impatient, and doctors engaged in major vascular surgery are particularly impatient.

Director Xiang of the Cardiac Surgery Department occasionally urged his doctors to check at the door to see if the ambulance was coming. Professor Cao also kept looking at his watch. Judging from the contrast images, the aorta in the patient's body was now like a balloon, and the blood vessel wall was very thin. , it may explode and cause bloodshed at any time.

Once the "vascular balloon" explodes, the patient will die immediately, and there is no second possibility.

But Yang Ping seemed very calm. He had been sitting in front of the electronic screen, even closing his eyes to relax, as if he was not anxious at all. In fact, the devilish training in the system space not only improved Yang Ping's medical skills, but also changed Yang Ping's temperament. .

After too much experience, you will get used to it. Whether you are anxious or not has no impact on the outcome of the matter.

"Should we prepare for such a long artificial blood vessel? This is the angiogram taken at the emergency department of the First Affiliated Hospital at that time. The iliac artery has been reached downward, and the brachiocephalic trunk and left carotid artery have been affected upward. It is estimated that it will continue to extend up and down. The artificial blood vessel will require Prepare to go up to the internal and external carotid arteries and down to the femoral arteries." Yang Ping pointed at the electronic screen and said calmly.

The cardiovascular surgeon nodded slightly to the director: "It's ready, the length is enough."

Yang Ping's extreme calmness can infect the people around him, and his calmness naturally cools down his mind. Some impatient doctors gradually calm down.

"As soon as the patient arrives, he goes directly to the operating table. No other examinations are required except blood drawing. He goes directly to the table to do a thoracotomy and open abdomen. First, he blocks the aorta from the root, and then immediately establishes extracorporeal circulation and stops the heart." Yang Ping began to talk to Yang Ping. Discuss the surgical plan together with everyone to become familiar with it in advance.

"Then how do you know the latest extent of blood vessel tears before surgery?" Director Xiang asked doubtfully.

Blood vessel tears are dynamic and may continue to worsen during transportation. If no angiography is performed, how can we know the latest extent of blood vessel tears?
Professor Cao also had such doubts, and he was also waiting for Yang Ping's answer.

"After opening the chest and blocking the aorta, the patient will be much safer. I am left to explore, following the tear of the blood vessel up and down until it is normal." Yang Ping sounded rational and confident.

According to common sense, to determine the scope of new blood vessel tears, interventional angiography is actually faster and more intuitive than exploration.

However, angiography takes time. In any case, it will be delayed for more than ten minutes. If the "vascular balloon" explodes within these ten minutes, there will be no chance for surgery later.

If the step of angiography is removed, the chest is opened directly, the aorta is blocked first, and the blood vessels are immediately explored while establishing extracorporeal circulation. This will increase the doctor's operational burden, but also take up the time of aortic blocking and the time after aortic blocking. Must be left to artificial blood vessel replacement.

Because the artificial blood vessel replacement surgery must be completed within 30 minutes.

Exploration is not only difficult, but also time-consuming, leaving less than 30 minutes for artificial blood vessel replacement.

"The blood vessel is too long. It is estimated to be more than 100 centimeters. Are you sure that the time for replacing the blood vessel is enough?"

Professor Cao asked. After all, his experience told him that it was far from enough.

"Don't worry about time, it's enough! Just do as I say." Yang Ping said in a firm tone.

If the operating time in the system space is added up, no one in the world can take more operating time than Yang Ping, so anyone in Yang Ping's eyes is considered "inexperienced".

Professor Cao stopped talking because he thought it was impossible to perform a minimally invasive myocardial rotation at the time, but Yang Ping not only did it, but also did it extremely skillfully, and the surgical effect far exceeded Professor Cao's expectations.

Having had the experience of the last operation, Professor Cao no longer doubted this young man's words. His confidence was real and not unfounded.

"Shall I be your assistant later?" Xiang Director volunteered.

Yang Ping refused without hesitation: "No, your movements are too slow. Let Song Zimo be the assistant. He is used to my rhythm. Xu Zhiliang is the second assistant, and Zhang Lin Xiaowu is the hook. 伱——You can watch it in the audience. ."

awkward!

Director Xiang stroked the hair on the back of his head and was speechless.

The rescue operation must not be done carelessly. As long as conditions permit, Yang Ping must have a "golden team" on stage.For elective surgeries, you can even take Director Xiang for a ride on stage.

"Listen to Professor Yang, this kind of surgery is too difficult. He needs to cooperate with a skilled assistant." Professor Cao Zhenshan helped smooth things over.

Professor Cao Zhenshan is a specially appointed expert of Sanbo Hospital. He is an expert in cardiovascular surgery and can be regarded as a member and instructor of cardiovascular surgery. He is naturally familiar with cardiac surgeons, so he is also very familiar with Director Xiang.

"That's--I'm in the reserve team. I can make arrangements at any time if necessary and come on stage at any time." Director Xiang pretended to be generous, but he still felt that he was losing face.

At this time, Director Zhao, who was on duty, came to this office and announced loudly:

"All-out rescue, green channel!"
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Finally, as the shrill siren sounded, an ambulance appeared at the door of the emergency department.

The back door of the ambulance opened, the stretcher carrying the patient was pulled out, and then it immediately turned into a flat car. Doctors and nurses pushed the flat car and rushed to the emergency department.

Among the doctors who pushed the cart was Director Ouyang Songhua. Because the patient's condition was too special, he personally sent the patient here.

"Enter the operating room, hurry up, enter the operating room." The emergency doctor who greeted the patient held the cart and guided the cart to the prepared operating room. The nurse immediately completed the blood drawing in the movement to cross-match the blood. .

If this kind of emergency was done in an inexperienced hospital, it would definitely turn into a mess, with no one knowing what to do. At most, some basic first aid measures would be given in a panic.

There are only a few hospitals that can perform aortic dissection surgery, and the only two hospitals that can perform such severe aortic dissection surgery are Anzhen and Fuwai Hospitals, which are the two leading hospitals in cardiovascular surgery in China.

Director Xin from Fuwai has more than [-] years of experience in major vascular surgery. Many patients who have undergone his surgery simply live and work in the place closest to Director Xin's hospital in order to receive timely rescue when they have a second attack. When an illness occurs, one can rely on Director Xin's skills to save one's life.

The flat car pushed the patient to the operating room, and Yang Ping and everyone were ready.

Transferring the bed, anesthesia, disinfection, and making sheets - without any delay for a second, Yang Ping immediately opened the chest, so fast that Professor Cao was speechless.

In my 50 years of medical practice, I have never seen such a speed of operation, fast but not chaotic, and rapid progress.

How many surgeries does it take to achieve this level of proficiency?
After thoracotomy and abdominal dissection, the thoracoabdominal aorta expanded by blood is automatically exposed like a huge balloon. The blood vessel wall is thin, and the blood vessel "balloon" beats with the beating of the heart, and is in danger of exploding at any time.

Yang Ping immediately blocked the aorta temporarily and worked with the extracorporeal circulation team to stop the heart and open extracorporeal circulation.

In order to save time and buy more time for rescue, Yang Ping went straight down to explore.

The long incision extends from the chest to the abdomen, up to the neck, and down to the roots of both thighs. The scope of the blood vessel tear has extended downwards to the femoral artery below the roots of the thighs, and upwards. The tear reaches the common carotid artery, which can be called the ceiling of aortic tear.

The extent of the blood vessel tear has exceeded that of the angiography pictures at that time, indicating that it was still torn during transportation.

Professor Cao, as an experienced expert, had never seen such extensive tearing before. He almost held his heart in his hands while watching the operation.

The movement was so fast that Professor Cao was dazzled. The aorta was cut open from top to bottom, and the artificial blood vessel was gently inserted, followed by hundreds or even thousands of stitches. No blood could leak from a single stitch.

Yang Ping's hand speed is very fast and very stable, like a machine, precise and stable.

Professor Cao didn't dare to breathe even when he was nearby. The speed of this kind of surgery is simply the ceiling of great vascular surgery. Not only is the surgery fast, but the hemostasis is also very thorough. Most hemostasis is done proactively rather than passively. Wait until the bleeding is stopped at the end of the surgery. , no need to stop bleeding. "Marfan Syndrome!"

Yang Ping gently placed the needle holder in the nurse's bent tray and said.

"Vascular calcification is serious," Yang Ping added.

"Is it done?" Professor Cao looked at the electronic clock on the wall.

Yang Ping nodded: "You can close your chest and belly."

It still takes less than two hours. This kind of surgery takes at least six hours. Even when Xin Weicong is in the best condition, it takes six hours.

Director Ouyang Songhua was observing the entire operation. His thoughts were closely following the operation and he did not dare to speak. Now that the operation is over, he still does not dare to speak.

"It seems that the prices of properties around the hospital are going to increase!" Professor Cao said with a smile.

Zhang Lin didn't understand what Professor Cao meant. Why did the surgery suddenly involve real estate? The veteran expert's thinking was too fast.

"When he wakes up, let him rent or buy a house near the hospital. The best place to work is also near Sanbo Hospital."

Song Zimo looked at Zhang Lin's confused look: "In a few years, there is a possibility that he will get sick again. In South China, only professors can save him. Living near Sanbo Hospital is equivalent to buying life insurance."

That's it!

"No wonder Wang Changxin bought another apartment near the hospital. He wants to live in a community with the professor. This is a personal genius."

"How is he now? Has he received follow-up calls, and has his X-rays been reviewed regularly?"

"Still in Africa, it's been very busy recently, with more and more gold mines being produced."

"Didn't you say that they sold him the unwanted waste ore after mining?"

"Others didn't want it. The previous detection was inaccurate. The original boss asked the Japanese to explore the mine. After the exploration, they found very little gold. The mining cost was high and it was worthless. The original boss deceived Wang Changxin and said it was a rich mine, and he moved to other places to invest. So the mine was sold to him, and Lao Wang bought it. After digging for a long time, nothing was found. Later, he invited an old expert from China University of Geosciences. The old expert took his team to help him explore. After the investigation, the old expert said , this is a rich ore. Dig 400 meters in this direction, which is the rich ore area. Wang Changxin kept digging, and as the experts said, he dug out high-quality gold mines. The original boss was so angry that he vomited blood because he was afraid that Wang Changxin would not want it. After coaxing and deceiving, I sold it to Wang Changxin at half price."

"Lao Wang is making a comeback. He used to sing on the bridge, and his song "Broad Sea and Sky" was really tear-jerking."

"I heard that some of the beggars who sang with him are now in Africa, working for him."

"Is there such a thing?"

"Someone came back not long ago and asked me to help arrange a physical examination. He said he was Wang Changxin's brother and the former guitarist in the Tianqiao band. I asked him what he was doing now. He said he was following Wang Changxin to open gold mines in Africa and now he has made a fortune."

Yang Ping had already stepped aside to rest, and Song Zimo and Xu Zhiliang were relaxing. The atmosphere instantly became relaxed, and everyone chatted.

Professor Cao couldn't help but smile. These young people are really talented and bold. The scene just now was really scary. They actually had a leisurely chat.

Director Ouyang Songhua was also stunned for a moment.

"How's your blood pressure? Fatty!"

"95/64mmHg."

"Send to CCU after surgery!"

"We have already contacted the bed and are waiting outside the door of the operating room."

After the operation, Guo Peihua was sent to CCU for monitoring and treatment. Because the cardiac surgery department in Sanbo Hospital has not yet developed and there is no cardiac surgical intensive care unit, he could only be sent to coronary heart disease intensive care. At least the doctors in CCU are better than those in ordinary ICU and trauma hospitals. ICU is much more professional.
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Guo Peihua's cell phone automatically turned on in the morning, and his parents kept calling him because today is his birthday.

And he was lying in the CCU of Sanbo Hospital, connected to a ventilator and various tubes throughout his body.

Mobile phones and other items were packed in a plastic bag and were temporarily kept by the nurse.

Guo Peihua is a homebody with few friends. The high school classmate who helped him call 120 came to the hospital to see him early in the morning, but he did not see Guo Peihua himself. He chatted with the doctor in charge, Dr. Ruan, for a while to understand his condition, and then he breathed a sigh of relief.

Sure enough, this fellow doctor's judgment was correct. It was indeed a torn aortic dissection. Fortunately, he was able to get to the operating table in time.

If this fellow doctor had not been professionally sensitive and helped dial 120, Guo Peihua would have been in trouble now. He was sweating in pain and almost fainted. The 120 emergency personnel came to his door and knocked on the door but there was no response, so he had to ask for help from the on-duty staff. The security guard, who was also a warm-hearted Shandong man, smashed the door open because he felt that since he was trying to save lives, it was too late to call a locksmith or firefighter.

The nurse found that the phone kept vibrating. According to convention, patients without family members should contact their families by phone.

Because he had just been admitted to the CCU and had no time to contact his family, a call came at this time. The nurse immediately called Dr. Ruan. Dr. Ruan answered the phone, identified himself, and then told him about Guo Peihua's condition.

After hearing this, the other party cursed: "Liar! How come the phone fell into the hands of a liar."

Dr. Ruan shook his head helplessly. He dialed the number again, but the other party hung up immediately. After dialing a few times, the other party answered again and said, "Please stop doing such immoral things. What can a young man do wrong at such a young age?" I want to be a liar, and I also deceive the elderly. Not long ago, there was a call saying that my son had a car accident, and we were asked to transfer money. We were almost fooled. When we were transferring money, we were stopped by the salesperson. Now they said that the blood vessel was torn. I was lying in bed just after surgery. The intensive care unit will never end."

"This kid is the same. He must have been drunk last night and lost his cell phone."

The conversation between the old couple came from the mobile phone.

Guo Peihua is drunk and sometimes sleeps all day long without answering any phone calls. This does not happen once or twice, and sometimes he cannot be contacted for many days, so his parents are also familiar with their son's living habits. Decided this was a liar.

As for the work unit, Guo Peihua never clocks in at work. He rarely shows up at the company a few times a month. He works from home most of the time, so no one cares whether he goes to work or not.

As a high school classmate, he came to the hospital for a trip and never thought of calling Guo Peihua's family members.

This classmate knew that Guo Peihua was a homebody and lived alone, so he helped him call 120, but he never thought about subsequent help such as calling his family members.

Therefore, if Guo Peihua was murdered, it would probably take a month before he was discovered.

Dr. Ruan had no choice but to ask the head of the department for instructions. The head of the department, Director Kang, also had a doctorate. He was a nerd and couldn't handle the matter even if he made a phone call. He personally called back, but all the signals were busy. He was probably blocked. .

So Director Kang used the department's landline to dial, pressed the speakerphone, and the other party connected. Director Kang glanced at Dr. Ruan - look, isn't it connected?
When the call was connected, Director Kang immediately identified himself and explained the situation. He used a national curse in the conversation and was immediately blocked.

Doctors and nurses surrounded Director Kang. He blushed and put down the phone: "Go to work, you are quite free."

PS: For the content of this chapter, I have to mention Professor Sun Lizhong of Anzhen Hospital—the person with the best aortic dissection surgery results in the world.Professor Sun used to work in Fuwai and was later transferred to Anzhen.At a world-class academic conference, the host introduced Professor Sun like this - the person with the best aortic dissection surgery results in the world!Notice!It’s the whole world!Back then, Professor Sun led a delegation to Japan to attend an academic conference. For a Chinese team of more than 20 people, the Japanese only arranged lunch time for him to give lectures, which was obviously a look down on people.So Professor Sun temporarily changed the topic of his lecture and only talked about two cases - a total aortic arch replacement with a non-stop beating heart and a total aortic replacement.The Japanese were silent after hearing this, and did not even dare to ask questions, because there were no doctors in Japan who could perform these two surgeries, and their level was simply not up to par.After finishing the lecture, Professor Sun's conference treatment was rocket-likely upgraded from "passer-by" to "super VIP", a real person!

(End of this chapter)