godfather of surgery

After the inferior vena cava artificial blood vessel transplantation and the autologous transplantation of five organs, Yang Ping stopped the operation and observed the patient's condition for a while. Nie Shun'e's vital signs were stable, the transplanted organ was red in color, and no obvious bleeding was seen.

Yang Ping still did the final inspection carefully to prevent missing bleeding points. Confidence is a good thing, but confidence cannot replace rigorous work procedures. Necessary procedures should be walked through again.

The tumor that was removed was a large string, including parts of the liver, gallbladder, pancreas, spleen, stomach, inferior vena cava, the entire duodenum, left kidney, and accessory connective tissue. Such a large string was placed in a large metal sterile basin. Inside, they are quite heavy. These things are ready to be sent to the pathology department for pathological examination. The final gold standard for any tumor is pathological examination.

After observing for half an hour, there was no obvious bleeding and the vital signs were normal.

"Shut up!"

Yang Ping put the tweezers in his hand into the curved plate, and left the final work of closing the abdomen to Song Zimo and Xu Zhiliang.

"How about you guys take a rest and let me and Lao Fang close your belly?"

Director Shi has always wanted to go on stage to experience it, but the operation has ended and there is no chance now. This is the last chance to experience it. This kind of operation is probably the first in the world. It is different when he is on stage and not on stage.

On stage, you are a participant, and off stage, you are an observer. There is an essential difference in identity.

Director Fang immediately understood: "Professor Yang, we are here to close the abdomen. Thank you for your hard work."

Are they here to confine the belly?
  When these senior directors usually perform operations, lower-level doctors are usually responsible for closing the abdomen. If the senior director is really required to close the abdomen, he may be a handicap. Song Zimo is a little hesitant. If the abdomen is not closed properly, it may easily cause dehiscence of the surgical incision or long-term abdominal wall hernia. .

"Thank you, Director Shi and Director Fang, thank you for your hard work." Yang Ping had already sat on the stool next to him.

Yang Ping agreed and Song Zimo complied, but he and Xu Zhiliang still stayed on the operating table to help pull the hook and cut the thread, which actually played a supervisory role.

Director Shi and Director Fang immediately stepped onto the stage. In fact, Director Shi was very serious about surgery, unlike other big guys. He usually closed the abdomen himself for more complicated major surgeries.

Professor Yang is better, he has a high standard and he is not arrogant. I still remember that I have not experienced it, so give it a chance. Director Shi felt good about Professor Yang for the first time.

"Xiao Chen, help me take some photos. Take more photos to make them clearer."

Director Fang ordered his graduate students. In fact, the clever graduate students had already seized a favorable angle and had their mobile phones on standby at any time.

The idea of ​​a graduate student is very simple. If the tutor does well, he will benefit from it, so he defends the tutor at all times and is devoted to him.

This time, Director Fang took the initiative to stand in the position of the first assistant and gave up the position of chief surgeon to his senior brother. He had already experienced it, but his senior brother had not experienced it yet, so he should be allowed to experience it.

"Is it a continuous suture inside, or is it an interrupted suture?"

Director Shi asked Yang Ping, Director Shi was very serious even when it came to closing the abdomen, and he could not be careless during the operation.

The surgical incision is closed in layers, and is sutured layer by layer according to the anatomical levels. You cannot sew several layers together by grabbing your eyebrows and beard.

The skin of the abdominal cavity from the inner layer to the outer layer, including the peritoneum, fascia and muscle layers, whether to be sutured continuously or intermittently, each surgeon has different preferences. Continuous suturing saves trouble and moves quickly. You can sew the entire layer in one go. Good, but the disadvantage is also obvious. Once loose, the entire incision of this layer will loosen.

Intermittent suturing is more troublesome. Each stitch is independent and takes a long time. However, once the phenomenon of loose needles occurs, one stitch will be stitched and it will not have much impact on the entire incision.

"Intermittent sutures!" Yang Ping replied.

"Should I use leather staples or silk thread to sew the skin?"

"No damage to nylon thread!"

The leather stapler sews the skin quickly, and the tissue reaction to the metal is small, but the closure is rough; the silk thread manual suturing speed is slow, the tissue reaction is more obvious than the metal, but the suture is finer; the non-destructive nylon thread is used to sew the skin, and the suturing is relatively fine. The quality is high and the tissue reaction is small.

Director Shi understood the intention of the surgeon before he began to operate, but he guessed that Yang Ping did not like leather staples, because when he first performed organ autotransplantation, the gastrojejunostomy used traditional manual suturing instead of stapler anastomosis. Yang Ping The quality of manual anastomosis is significantly higher than that of staplers.

Although it was a job performed by a lower-level doctor like abdominal confinement, Director Shi was not perfunctory at all and took it seriously.

On the contrary, Director Fang has not done this for a long time, and the movements of his hands are a bit unfamiliar. However, he is an assistant and has little impact on the operation.

Director Shi has also come to Sanbo Hospital many times for surgery. If Director Fang encounters difficulties such as pancreatic cancer, he will ask Director Shi for help and invite Director Shi to perform the surgery. This not only solves the problem, but also gives the senior brother an opportunity to make money by performing acupoint surgery. Afterwards, the two brothers can sit down to have a meal and chat, so why not.

The brothers cooperated well and completed the abdominal closure quickly.

After the abdomen is closed, the patient is observed for half an hour and the patient's vital signs are stable before being sent to the ICU. This kind of major surgery is prone to various complications after surgery, so it is safer to put it in the ICU.

In the evening, Director Fang fulfilled his promise and invited the doctors and nurses who participated in the operation and observed the operation to have dinner at a random location. Several graduate students clamored to eat seafood.

But Director Fang’s graduate student was a clever guy. When he saw that there were quite a lot of people in the team, he was afraid that someone would kill the instructor, so he said first: "Second uncle grilled fish, just uncle grilled fish. The distance is close, the environment is good, and the food is good." tasty."

With just a few words, graduate student Xiao Chen helped his tutor decide on a location, and then called to book a private room. Although he had grilled fish at Ershu, several tables were set up, and the cost would not be small. Director Fang was happy today, so he spent some money. No matter what, he accidentally found a secret passage across the academic hierarchy, which was to be the permanent second child in the surgical institute.

While switching cups of apple cider vinegar, Director Fang finalized a strategic partnership with the Institute of Surgery.

These days, only by having a bigger picture and a higher vision can you achieve something famous. Choice is more important than hard work.

The so-called strategic partner is actually the Institute of Surgery's technical assistance to the general surgery department. Director Fang has clearly positioned himself to accept Yang Ping's assistance wholeheartedly.

Although it is the same hospital, different departments have autonomy. If the department director is not willing to accept help, Yang Ping cannot forcefully intervene. For people like Director Fang who have formalized the assistance relationship and are willing to accept assistance, Yang Ping will naturally go all out to help them improve their technology.

After dinner, Director Shi drove home by himself. Director Fang, Song Zimo and Xu Zhiliang followed Yang Ping to the ICU to see the patient. For such a major surgery, Yang Ping felt more at ease after seeing him twice.

The results of the post-operative blood test by the doctor on duty have come out. Mild anemia was present before the operation, but it has not worsened significantly now, indicating that there was very little bleeding during the operation.

Aspartate aminotransferase and bilirubin are relatively high, which is also present before surgery. Pancreatic cancer causes obstruction of the biliary system, causing an increase in bilirubin in the blood, and the tumor invades the liver, causing an increase in transaminases.

After the operation, the biliary obstruction has been relieved, so the effect is immediate. The bilirubin is already lower than before the operation, but the transaminase is still about the same, because even if the diseased liver is removed, the recovery of the transaminase will not be so fast, and the remaining liver will be needed. Return to normal only after you have fully adapted.

The liver is an organ with strong regenerative ability. After a part is removed, the remaining part can grow to normal size through regeneration and resume normal functions.

This is why liver transplantation can be performed as a living donor transplant. The donor only needs to cut off a part of the liver and give it to the recipient. The donor lives on the remaining part of the liver, and the recipient lives on the donated part of the liver. These two parts of the liver pass through the regeneration ability. It can continue to grow, probably to normal size.

Kidneys can also be transplanted from a living donor because a person has two kidneys and only needs one to survive.

The heart cannot be transplanted from a living donor because the human body cannot survive after the heart is removed, so it can only be donated by the deceased.

After part of the stomach is removed, the remaining part can slowly expand to its original size.

There was no abnormality in Nie Shun'e's kidney function. The function of a single kidney was good. Overall, the functions of several organs designed for the operation were stable and there were no major fluctuations.

The vital signs are also normal, and the blood oxygen saturation and other things are very good.

"Professor Yang, what should I pay attention to tonight?" The doctor on duty respected Yang Ping very much.

Yang Ping personally auscultated the heart and lungs, felt the fluctuation of the radial artery and the temperature of the limbs, observed the amount and color of urine drained from the urine bag, and told the doctor on duty to call him directly if anything happened.

The doctor's phone is open 24 hours a day, and it is a basic skill of a doctor to answer the phone at any time.

The postoperative observation of this patient is very complex. In addition to observing the functional status of these organs, it is also necessary to dynamically observe blood pressure and hemoglobin concentration. There are so many blood vessels anastomosed in the abdominal cavity, and the inferior vena cava has undergone artificial blood vessel transplantation. As long as one blood vessel ruptures, it will cause massive bleeding. , this kind of internal bleeding can easily be fatal.

"How much blood have you prepared?" Yang Ping asked, not missing any detail.

The doctor on duty thought for a while: "It's still the blood that was prepared before the operation. This patient has a lot of blood prepared, including six units of suspended red blood cells and 1200 ml of plasma."

Well, when Yang Ping heard this number, he felt much relieved. In case of massive abdominal bleeding, emergency blood transfusion would be needed to buy time for rescue surgery.

This blood was prepared before the operation. It was not used during the operation. Now it is used to prepare blood after the operation. The blood transfusion department sometimes cancels the blood preparation because it is not used during the operation, so Yang Ping had better confirm it.

"Professor Yang, your patient must be honest in the blood transfusion department. We usually ask grandpa and grandma for blood." The doctor on duty looked envious.

Because of this patient's preoperative blood preparation, the blood transfusion department actually called and said it would keep it for a few days. Normally, the blood transfusion department would not be so proactive. In fact, the blood transfusion department is also a department that suffers from both sides. When the blood bank resources are relatively tight, this department needs blood and that department needs blood. They cannot change the bleeding and can only make use of the existing resources.

Yang Ping glanced at the ward, and the doctor on duty said: "The artificial liver, bedside dialysis machine, and ECMO are all ready, don't worry! Our director personally told us."

At critical moments, we rely on these high-tech equipment to save lives. Many of the essence of modern medicine's life-saving equipment are in the ICU. These equipment are usually not seen in ordinary wards.

After seeing the patients, Yang Ping, Song Zimo, Xu Zhiliang and Director Fang sat in the ICU for a while. The main thing was to sit down and calm down and think about whether there was anything they missed.

When I got home, it was already past eleven o'clock in the evening, and Xiao Su and Mrs. Su were still awake. Xiao Su was reading in the study, and Mrs. Su was talking on the phone with Professor Su in the living room.

Professor Su will soon attend the annual spine surgery conference in Europe. Annual academic conferences in North America and Europe are generally very large and equivalent to world-wide academic conferences, and spine surgeons from all over the world will attend.

In recent years, with the advancement of my country's medical technology, Chinese doctors have more and more opportunities to appear at these international academic conferences. For example, Professor Su defeated Japan and became the president of the Asia-Pacific Orthopedic Academic Association, marking a milestone in the international academic community. The right to speak is strengthened.

When Yang Ping came back, Xiao Su also stopped reading. In addition to reading some professional books, she also started reading various parenting books to systematically learn some theoretical knowledge in advance.

Mrs. Su has prepared some late-night snacks for Yang Ping. Because of the hard work during the day, Yang Ping's appetite is quite large. Mrs. Su is always worried that her son-in-law will not have enough to eat, so she adds extra meals. Mrs. Su's cooking skills are very good. All kinds of southern dishes and snacks are made very exquisitely.

Professor Su and Mrs. Su loved this son-in-law very much and treated him completely like a son.

Therefore, the multinational company's ruthless attack on Yang Ping's new equipment angered the always gentle Professor Su. Professor Su used his influence to quickly organize a counterattack and helped Ruixing Company defeat the multinational company.

The counterattack at that time was massive. Almost all hospitals in China removed equipment from multinational companies. How powerful this was.

Yang Ping nodded and smiled at his mother-in-law who was on the phone, and then started eating supper, with Xiao Su accompanying him.

"Xiao Yang just got off work. Don't worry, I'll follow you. I'll take good care of myself. I'll have late-night snacks. They'll be hot and fresh. The surgery I did today was general surgery. It involved extracorporeal tumor resection + autologous transplantation of eight organs. I heard that this is the first case in the world. I don’t know the specific situation. You can talk to Xiao Yang.”

Mrs. Su chatted with Professor Su, and then handed the phone to Yang Ping: "Where's your dad? You talk to him."

Since everyone is a surgeon, there are naturally many topics to talk about. Yang Ping chatted with Professor Su for a long time, and Professor Su usually communicated with Yang Ping like friends, which made Yang Ping feel very comfortable.

Professor Su is going to Europe to attend the annual spine meeting. Yang Ping will not go this time. He does not have time to attend these meetings now. The scientific research project is at a critical moment.

Originally, Yang Ping wanted to say hello to August and take care of his father-in-law there during the meeting, but after thinking about it, he decided not to do it. It was not good and seemed unnecessary.