godfather of surgery

Just now, Yang Ping showed off his dual-purpose skills. While performing abdominal surgery, he could also take care of chest surgeries. Doctors both on and off the stage were all deeply impressed.

This level of surgery is no longer a simple high level, but has entered a more advanced realm.

All the short steel bars have been pulled out, and now Yang Ping begins to process the two long steel bars. The path of the two long steel bars is very long and passes through many parts, so the injury is very complicated.

One of the two long steel bars penetrated through the anus, pierced the rectum in the lower abdomen, then damaged the small intestine and pancreas, passed up through the diaphragm and entered the mediastinum of the chest, then penetrated into the pericardium, and exited through the left chest. He almost died. The heart was pierced. Fortunately, after entering the pericardium, it came out almost close to the heart. The heart was obviously squeezed by the steel bars, and the surface was scratched by the steel bars, but there were no fatal puncture wounds.

These are only the important organs along the path. In addition to these, countless blood vessels are damaged along the entire path.

The steel bar that penetrates from the anus not only has a long and complicated path, but also has the trouble of passing through the anus and rectum, causing stool from the rectum to leak out into the abdominal cavity.

Moreover, after the steel bars pass through feces and pass through so many places with feces, they will cause extremely widespread pollution. Feces is equivalent to a super bacterial reservoir, so everywhere it passes may be contaminated by a large number of bacteria, and the probability of postoperative infection is extremely high.

In order to minimize the scope of contamination, this steel bar was temporarily left for final treatment.

The other steel bar is not much better. It is inserted from the perineum, passes through the bladder and intestines, avoids the stomach from the side of the spleen, passes through the diaphragm, enters the chest, inserts into the lungs, then passes through the upper opening of the thorax, and then enters Neck, enters the skull through the neck steel bars, and finally passes through the top of the skull.

This steel bar was relatively clean, so Yang Ping thought it should be dealt with first.

In principle, if the threat to the human body is equal, clean targets should be treated first, and seriously contaminated targets should be dealt with later.

For example, the same is true for surgical disinfection. Clean areas are disinfected first, and contaminated areas are placed later. This is to prevent the target of contamination from spreading contamination to clean areas.

The neurosurgery department is exploring along the steel bars step by step, separating the injured parts and stopping bleeding, creating favorable conditions for removing the steel bars.

Unfortunately, the steel bars penetrated through the base of the skull by accident. The anatomy of the skull base is complicated. The skull base has uneven grooves, and various nerves and blood vessels pass in and out. It is also the base of the brain tissue, which makes the operation very difficult.

Yang Ping ignored the work of the neurosurgeon for the time being, and he began to deal with this relatively clean steel bar.

The entrance of this steel bar is in the perineal area, and now the entire perineal area has been crushed into a state of disrepair. It can be said that it is simply a mess.

Yang Ping didn't even know how to insert this steel bar, and even the scrotum was severely bruised. Everyone was dealing with more critical injuries just now, and they didn't pay attention to this place at all, because the bleeding here was simply negligible compared to those places just now. .

Yang Ping examined the perineal injury and found that it was very serious. Everything from the skin to the pelvic fascia and pelvic floor muscles were severely damaged. The tissue was severely bruised and a large number of blood clots were accumulated in all layers.

The testicles in the scrotum were almost shattered, and there was no possibility of repair, so they had to be completely removed.

The pubic branch of the pelvis was severely comminuted and fractured. This should be a serious straddling injury caused by some obstruction in the air when falling. From this point of view, the urethra should also be broken. It is almost certain that this place is a serious straddling injury. caused by injury.

Now that the bleeding is under control, we can proceed steadily and dissect along the steel bars, not only to explore and treat the injured area, but also to safely remove the steel bars.

Yang Ping had no hesitation about certain things on the operating table. Since the two testicles had been crushed, Yang Ping decisively removed them, debrided the scrotum, and then sutured them.

Song Yun persuaded Professor Liang to go back and rest, but Professor Liang was not sleepy at all at this time. He was also very interested and would take a closer look at the operating table from time to time.

"What, can't you keep it?"

Professor Liang was asking about the shattered testicles.

Yang Ping replied: "It has been completely shattered. This part should have been severely impacted when it fell."

After hearing this, Professor Liang let out a long sigh: "The price of enjoying the cool air on the balcony is really too high."

In order to warn the young people again, the old academician pointed to the crushed tissue that Yang Ping had cut out and emphasized again: "Look, you must take this as a warning. Never lean on the railing when enjoying the cool air on the balcony."

"Why is the quality of this railing so poor? Are the current developers so irresponsible? Human lives are at stake. Can't we make it stronger?"

The old academician did not forget to criticize the developers.

Song Yun followed Professor Liang, not daring to answer casually, but just agreed with him.

Since the perineum is bruised like this, the wound can only be repaired temporarily if it can be repaired first. In the second stage, it can be dealt with flexibly according to the changes in the postoperative condition. The first principle at present is to save lives.

Continuing to explore the separation along the steel bar, Yang Ping found that the urethra had indeed been broken. Yang Ping marked it and waited until the steel bar was removed before going back to anastomose the urethra.

The bladder was also ruptured. Fortunately, the kidneys on both sides were bruised, but they were not serious. They were probably indirect bruises caused by the fall.

I blindly guessed the damage mechanism at that time. It should be that the shed on the first floor was built using construction steel bars. When it fell, it should have been buffered. The buffering part was on the roof of the shed. The posture at that time should be astride the roof of the shed. It was huge. While the energy was dispersed by the steel scaffolding, the steel bars also fell apart, and then the body continued to impact the many scattered steel bars, so several steel bars were inserted into the human body from different angles.

Yang Ping separated all the way, stopping the bleeding while separating, and then placed wet gauze with normal saline in the gap around the steel bar to protect it.

Yang Ping separated all the way to stop the bleeding, followed the steel bars upward, all the way from the abdominal cavity to the chest cavity. The diaphragm is separated between the chest cavity and the abdominal cavity. The diaphragm does not need to be completely incised. Yang Ping only expanded the wound to facilitate the removal of the steel bars later. Waiting for two After the steel bar is pulled out, the diaphragm is debrided and sutured.

Yang Ping explored the esophagus and found that the esophagus was also damaged. There were almost no organs that were not damaged, and almost all of them were damaged to some extent.

The damage to the chest was also extremely complicated. One lung was punctured. Just now, the two directors planned to perform a lobectomy and had already done so. However, after Yang Ping took action to stop the bleeding, the lobectomy was temporarily shelved.

Now Director Deng and Director Rong were waiting for Yang Ping to deal with the chest injury. They thought they could really breathe a sigh of relief, but they didn't expect that Yang Ping's separation of the steel bars had reached the chest so quickly.

The exploration, separation and hemostasis of the path through which the steel bar penetrates the abdomen have been completed. Now it is handed over to Director Xu for flushing. Yang Ping moves to the chest injury.

"Let's have the lungs repaired later!"

Yang Ping decided to cut open the lung for exploration and debridement first, then pull out the steel bars later and then repair the ruptured lung.

Lung tissue is very fragile and difficult to suture and stop bleeding. This is why the two directors just decided to perform a lobectomy on the lung.

Yang Ping carefully cut open the lung and stopped bleeding while cutting. The blood vessel clamps easily clamped the blood vessels in the fragile and elastic lung tissue.

After treating the lungs, Yang Ping did not rest at all. All the way up, within the scope of the existing incision, Yang Ping began to separate along the steel bars, all the way to the thoracic outlet, and after the thoracic outlet, he separated toward the neck. .

After the neck separation was completed, the skull base was located further up the mandible. The steel bars entered the skull cavity through the skull base. Fortunately, the steel bars did not damage important intracranial structures, such as the brain stem, otherwise there would be no rescue operation today. Yang Ping's work has been completed and he is waiting to be connected with the neurosurgeon. The neurosurgery is still slowly exploring the separation and hemostasis. Because the cranial cavity space is small and the anatomy is complicated, it cannot be done quickly.

You can't wait idle with your hands. Yang Ping took a look at the progress of the neurosurgeon. It turned out that he was separately exploring the base of the skull. This place is really complicated. If you are not careful, it may cause big trouble.

But we can't wait forever. We must either separate the second steel bar now or ask the neurosurgeon to help.

It's better to pull it. Yang Ping called the circulating nurse: "Give the assistant a head-mounted microscope!"

The neurosurgeon was stunned. What is he doing? He wants to help us. Do we have enough manpower? No, you can even perform neurosurgery.

Our neurosurgery, especially skull base surgery, has a very high threshold.

Yang Ping put on the microscope and looked inside: "It's difficult to operate like this. How about unplugging the steel bars and then operating?"

Unplug? What a trick, the neurosurgeon subconsciously refused.

"There is no damage here for the time being. Look, the blood vessels there have been damaged, but they are pressed by the steel bars. Slowly pull out the steel bars and stop the bleeding immediately." Yang Ping pointed inside and said.

The neurosurgeon took a closer look and found that this seemed to be the case. If he kept tinkering with it, he didn't know when it would be done.

"Unplug it?"

"Unplug!"

"All right!"

"Then I pulled it out?"

"Pull it out?"

"The steel bars can be pulled out!"

Yang Ping told everyone to get ready. When pulling out the steel bar, the neurosurgeons, basic surgeons, and thoracic surgeons all stayed within their scope of responsibility. Yang Ping held the lower part of the steel bar and slowly pulled it down. The steel bar passed through the safe passage. Slowly pulling out, everyone breathed a sigh of relief.

But the neurosurgeon was busy. He pulled out the steel bars, and the base of his skull was covered in blood. He made a yarn, and suddenly he felt like he had been cheated.

"Let me see!"

Yang Ping held the suction device in one hand and the bipolar electrocoagulation device in the other hand. He was suctioning and coagulating at the same time.

Three times five times two times, the inside is clean, and there is no more bleeding at the base of the skull.

The neurosurgeon is dumbfounded. The labor and management have been busy for so long and can't stand you for a few minutes?

Yang Ping rinsed the dissected channel and then began to dissect the second long steel bar.

The second long steel bar was contaminated with feces because it passed through the anus and rectum, but I didn't care about that now and rinse it thoroughly later.

Just like the first long steel bar, Yang Ping was very fast and quickly completed the dissection of the second steel bar.

After taking out all the steel bars, Yang Ping began to explore these channels again and performed flushing and debridement. After repeated flushing with a large amount of physiological saline, Yang Ping felt relieved.

Several steel bars were removed, and the patient's blood pressure remained stable and did not drop again.

Director Xu thought the operation was about to end, but Yang Ping said: "Let's do a few big fractures. With so many fractures, it's not good to keep bleeding like this. It won't take much time."

In this way, Yang Ping began to deal with the fracture.

Pelvic fractures, acetabulum fractures, femoral shaft fractures, and multiple rib fractures, these orthopedic surgeons have seen what real speed is.

For closed intramedullary nail fixation of fracture shaft fractures, the skin is cut, the opening is opened, and the intramedullary nail is directly inserted, and the operation is completed in a few minutes.

For pelvic fractures, remove the packing gauze, reduce the pelvic fracture, and stop bleeding. After the gauze is removed, a few pieces of the fractured steel plate are placed in various places. For pelvic fractures, as long as the fracture is well fixed, the bleeding will be reduced by half, and then the pelvic cavity will be treated. Once the bleeding is stopped, pelvic bleeding is basically worry-free.

Multiple rib fractures occur more quickly. Titanium clips are used to fix the fractures. One titanium clip is used to treat one fracture site. More than twenty titanium clips are put in and the thorax is stably fixed.

In principle, this kind of surgery needs to be performed in stages, but that is compared to others. This theory is not suitable for Yang Ping because Yang Ping's speed is very fast and the amount of blood loss in Yang Ping's surgery is very small, which has a very small impact on the patient.

Weighing the benefits and consequences of the operation, it is obvious that the benefits outweigh the consequences, so it is not a big problem to extend the time and complete the entire operation.

For burst fractures of the thoracolumbar spine, Yang Ping used the anterior approach, entering from outside the peritoneum, to remove the vertebral body that burst and invaded the spinal canal, and used artificial vertebral body implantation and anterior plate fixation.

All surgeries were performed at once. Each of these surgeries was a major one, but it was very easy in Yang Ping's hands.

One person performed not only general surgery, but also orthopedic, thoracic and neurosurgery operations. Director Xu worked as an assistant at high speed throughout the process, sweating profusely.

Professor Liang didn't understand why the surgery could be so fast after not having any trauma surgery for so long.

Song Yun said: "If only Professor Yang could be faster at Sanbo Hospital."

''Why? "Professor Liang asked.

Song Yun said: "Sanbo's equipment nurse is the original partner, but today's equipment nurse is not the original partner."

In order to make it easy to understand, Song Yun used the inappropriate word "original match", but he immediately realized that he had used the wrong word, so he explained to Professor Liang: At Sanbo Hospital, Professor Yang's equipment nurses are matched for a long time, and the cooperation will be more tacit agreement.

Today’s device nurse is Qiu Nuo. Although she works with Professor Yang the most at Xiehe, Professor Yang only comes to Xiehe for a few days every month, and the number of times she cooperates is also limited, so it is not as good as at Sanbo Hospital. instrument nurse.

Professor Liang nodded slightly. This was more or less the same, almost causing misunderstanding.