godfather of surgery

Chapter 901 I can also do this surgery

Professor Chen Jianliang stood in front of the reading lamp and discussed with Yang Ping.

Although he has retired, he is most interested in his profession. After being a doctor all his life, he feels that he can only have a sense of existence when he treats diseases and saves people. He can never find a sense of existence when doing other things. Without a sense of existence, he feels confused and empty. I don’t know what the value of life is.

Now Professor Chen usually only goes out to outpatient clinics and basically does not participate in operations. He is still fighting on the front line while sitting in outpatient clinics. However, as a surgeon, how can he bear to sit in outpatient clinics all the time? After a long time, he naturally feels lonely inside.

Just like a sniper on the battlefield, although he still stays on the front line, his position is no longer to shoot enemies. Instead, he squats in the fortifications to look at the battlefield with binoculars and collect battlefield intelligence. It must be difficult to adapt to his mood.

In order to regain this sense of presence, Professor Chen can only try his best to find opportunities to interfere with the operation. Of course, he will not go on stage to cause trouble for the young people. He just feels the atmosphere in the operating room, participates in the discussion of the operation, says a few words, and then surrounds the operation. Just check it out.

This is how he is now, carefully choosing a place to stand, for fear of disturbing everyone's normal work.

"The blood vessels are probably very thin, so it would be difficult to bypass the graft. However, the current obstruction of the blood vessels cannot be relieved without bypass. It is difficult to ensure the quality of the anastomosis for such a thin vessel. What do you plan to do?" Professor Chen asked.

Yang Ping nodded and said: "The blood vessels are indeed very thin, but it doesn't matter. A blood vessel bypass with this diameter should not be a big problem. I often do blood vessel bypass that is thinner than this."

When the diameter of blood vessels is very thin, usually less than 1 mm, vascular bypass grafting is not chosen. Instead, the simpler surgical application is chosen, because the thinner the blood vessels, the higher the requirements for vascular anastomosis technology. Once the anastomosis technology is not up to standard, the surgery will be difficult. If the blood vessels are blocked later, the surgery will be in vain.

However, if the level of vascular anastomosis is very high and there is no problem of blood vessel blockage after anastomosis, then a bridge of less than 1 mm can still be bypassed.

Professor Chen knew Yang Ping's skills thoroughly. No matter what kind of vascular anastomosis, as long as the manpower is available, Yang Ping can definitely do it. At least from Professor Chen's experience, Yang Ping is the pinnacle of surgery.

"Are you going to do patching after the bypass?" Professor Chen knew that Yang Ping would definitely focus on the effectiveness of the surgery regardless of the difficulty of the surgery.

"A two-pronged approach, fighting both distant and near fires," Yang Ping said.

Professor Chen touched his chin and nodded slightly. There was nothing to say about this surgery. It should be the most perfect plan.

Sissi's surgical position was in the supine position, with her head fixed with a fixator and slightly elevated. The anesthesiologist, Fatty Liang, kept Sissi's blood pressure at a slightly higher level than usual.

Zhang Lin and Xiao Wu completed the disinfection and draping, Yang Ping brushed his hands on the stage, the circulating nurse brought the microscope for backup, and the operation officially began.

It seemed that no one was in a hurry, but the operation was not delayed at all.

Yang Ping didn't have time to explain the emergency surgery at the same time, so he just kept running all the way. If he still explained this kind of emergency surgery, his speaking speed would not match his hand speed.

If you want to learn, you can only watch the synchronous surgery video, and then ask Professor Yang after the surgery if you don’t understand anything.

Dr. Jin, Dr. Wen and Xia Shu envied Zhang Lin Xiaowu very much. When he could perform most surgeries like them, he would truly be able to keep up with the pace of the Institute of Surgery.

Now they are just the tail of the team. They used to be the elites of their own departments, but when they arrived at the Institute of Surgery, they discovered that they were no match for the two handymen Zhang Lin Xiaowu.

Knowing their shame and then being brave, the three of them secretly determined that they must work hard and surpass Zhang Linlin Xiaowu. Of course, it seems that these two people are the easiest to surpass. It is very difficult to surpass Song Zimo and Xu Zhiliang.

The three doctors are now watching the synchronized surgery videos on the screen very seriously. They are not willing to let go of every operation and every detail.

And they now understand how well the Institute of Surgery trains doctors. Based on their foundation and in this environment and this training method, as long as they work hard and over time, they will become great talents.

Whatever Zhang Lin and Xiao Wu can do, they can definitely do it, and they can far surpass them.

Dr. Jin used to feel that he was too old, already in his 40s, and felt that he had missed the best opportunity to train surgeons. Now he has no such thoughts at all. He is full of energy and full of ambition.

Dr. Li Min also understood from the sidelines why Professor Yang must be so persistent in letting him learn anatomy and practice basic skills in various ways.

In the past, Li Min did not know much about moyamoya disease, a rare neurosurgical disease, let alone how to perform the specific surgery.

Now he is not only very familiar with this disease, but also understands the operation, because now he has a wealth of anatomical knowledge, and also has complete knowledge of pathology, pathophysiology and other aspects.

As long as Yang Ping mentioned it a little bit, he could understand the principles and methods of surgery for this disease without Yang Ping even needing to say anything.

Even if he faced this kind of case, he would dare to perform a relatively simple patching operation.

Once you have a solid foundation, subsequent learning will naturally become easier.

Yang Ping didn't speak, he focused on the operation, and Xiao Wu Zhang Lin was his assistant.

The first is blood vessel bypass. Yang Ping plans to bridge the superficial temporal artery and the middle cerebral artery first, which is the most important bridge.

Some bridges can be built directly, and some bridges must be connected with blood vessels.

The blood vessels to be bridged are usually cut directly from the scalp. Yang Ping moved quickly and removed several arteries of suitable diameter and length for use.

After the bypass blood vessel was taken, Yang Ping separated the superficial temporal artery.

The superficial temporal artery is the terminal branch of the external carotid artery. It passes between the temporomandibular joint and the ear on the side of the face, and then runs upward to the scalp.

If you are particular about this surgery, it is best to use intraoperative color ultrasound to locate the superficial temporal artery, use color ultrasound to find its shape, and then mark it.

The superficial temporal artery was separated according to the markings.

Yang Ping is too familiar with human anatomy, so he doesn't need color ultrasound positioning at all, which can save more operation time, but this is only limited to him.

In order not to mislead other doctors, every time he performs this kind of omission operation that is exclusive to him, he will remind everyone: "When you perform this operation, you must use color ultrasound to locate the superficial temporal artery. You must not imitate me and do omissions." operate."

Xia Shu has not been here long and is not very familiar with some things, but he is very serious. He likes to get to the bottom of problems that he does not understand. He must find out clearly, so he asked curiously: "Why can't we do this?" Do it? Isn’t that great? It saves one step and saves operation time, especially in emergencies, it’s faster and better.”

"The level is not good enough. If you omit color ultrasound positioning, it is easy to damage the blood vessels during the removal of blood vessels. If you want to pursue surgical quality, you must locate the superficial temporal artery so that you can more accurately grasp its walking route. Before cutting the blood vessels When doing this, try to protect the blood vessels to the maximum extent and avoid damage." Professor Chen answered Xia Shu.

It turned out to be due to the level of surgery, Xia Shu finally figured it out.

After isolating the superficial temporal artery, Yang Ping selected the appropriate location for the vascular anastomosis in the area where the superficial temporal artery travels based on the path of the superficial temporal artery on the scalp, preoperative images and the anatomical characteristics of a two-year-old child's head. point so that it is in the center of the cranial bone window to be dug.

The surgical incision is designed to be approximately 0.5cm distal and proximal to the vascular anastomosis point, which means the incision is approximately 1cm.

This is a minimally invasive method. If it is an adult, the distance between the anastomosis point is only about 2-2.5 cm, and the incision is about 5 cm, which is much smaller than the traditional surgical incision.

"This is not a traditional method?" Professor Chen saw it.

"Minimally invasive!" Yang Ping said while doing it. The first condition for this minimally invasive method is to accurately determine the anastomosis point, which must be the closest distance between the superficial temporal artery and the middle cerebral artery.

If you want to find this best location, you generally have to rely on the help of a CTA-based navigator, but Yang Ping can accurately locate it just with the help of images.

After making an incision, Yang Ping made a bone window with a diameter of about 0.5 cm in the center of the anastomosis point, entered the skull through the bone window, and then opened the dura mater.

The circulating nurse immediately brought over a microscope, and Yang Ping looked for a suitable recipient artery to isolate under the microscope.

The temporalis muscle is incised, and then a window with a diameter of 1 cm is opened, the dura mater is opened, and the receptor blood vessels of less than 1 cm are freed from this window, and temporarily clamped with the finest microvascular clips.

"Please be careful not to twist the blood vessels in this step. Once twisted, it can easily lead to blood vessel blockage." Yang Ping reminded everyone.

"Knock on the blackboard, a great trick!" Zhang Lin reminded everyone.

Li Min immediately took out a small notebook. Almost at the same time, several other doctors also took out notebooks. It seemed that everyone had the same routine.

Yang Ping carefully cut the recipient blood vessel with microscopic forceps, and performed an end-to-side anastomosis between the superficial temporal artery and the recipient artery. After the anastomosis was completed, he injected indocyanine green and then confirmed the smooth blood flow under a microscope.

Indocyanine green is a fluorescent imaging agent, and the microscope Yang Ping is currently using has a fluorescence imaging function.

In this way, under a microscope, the blood flow in the blood vessels can be observed through fluorescence.

"We must not skip this step. No matter how confident we are, we can't skip it. You see, even I didn't skip this step."

Yang Ping once again reminded everyone of the key steps.

After completing the bypass between the superficial temporal artery and the middle cerebral artery, only one blood vessel was anastomosed. Yang Ping was worried, so he then bridged and anastomosed the other two blood vessels.

At this point, the first step of the operation has been completed.

The second step is to complete the temporalis muscle taping and dura mater inversion. This step of the surgery is much simpler.

The temporalis muscle and dura mater have rich blood supply. If it is attached to the surface of the brain tissue, because the cortex of the brain tissue is ischemic, a special substance will be secreted. Under the stimulation of this special substance, the temporalis muscle or dura mater will move toward the surface of the brain tissue. The cortex grows blood vessels to improve blood supply to ischemic brain tissue.

In this way, the original malformed blood vessels are replaced by new blood vessels.

The entire operation actually took half an hour to complete, and the steps didn't seem complicated.

Li Min, who was watching from the side, felt that he could do this surgery himself and it seemed very simple.

In fact, this is an illusion. It mainly depends on Yang Ping's surgery. No matter what kind of surgery it is, it gives people an intuitive feeling that it is very simple, so simple that even an intern can be eager to try it.

-

Sissi's mother finally arrived at the hospital. Outside the operating room, she anxiously asked Sissi's father: "How is Sissi now?"

"Are you undergoing emergency surgery?" Sissi's father said.

"Do I have to have surgery? What's going on? Is it going to be nothing serious?" Sissi's mother was very worried.

"We're in there. We just went in. Don't worry. Professor Yang will do the surgery himself. It will be fine." Sissi's father comforted Sissi's mother.

"Where are my parents? Didn't they come together?"

"Here they are, they're probably having a quarrel downstairs. Mom didn't allow the doctor to examine Sissy, saying it would hurt her body, and she wasn't allowed to perform surgery. The doctor said this matter couldn't be delayed, so I ignored them and forced her to take it. When we were still in the emergency department, my father pulled my mother out, and they are probably still quarreling now."

"You definitely can't listen to them on this matter. That's what you have to do. Small things usually don't matter. You can't let them mess around with big things like this. Don't worry about them. I don't know about my own parents." Li Ni didn't blame her husband at all. , I feel that my husband did the right thing.

It's just that his daughter is undergoing surgery now, and he is really worried.

While the two were chatting, the door to the operating room opened. If the doctor hadn't called the family and said the operation was complete, Sissi's parents would have thought there was something wrong with the operation.

The entire operation took less than an hour from entry to exit.

-

After the operation, the child Xixi was sent back to the ward and back to the doctor's office. Yang Ping explained the operation to Wang Chengpei and his wife, telling them that the operation was successful. They could drink water and eat six hours after the operation, and they could be discharged from the hospital in a few days. Drink some water to keep your blood from being too concentrated.

Wang Chengpei thought that thanks to his former colleague Guo Peihua, Guo Peihua had a profound enlightenment after that accident. He never stayed up late or worked overtime again. He sold his original house and bought a house near Sanbo Hospital. He also quit his original job and started working in Sanbo Hospital. I found a job near Bo Hospital.

When Wang Chengpei and Guo Peihua had dinner one time, they talked about the problem of his electrocardiogram during the physical examination. Guo Peihua advised Wang Chengpei as a person who had experienced it.

When Wang Chengpei thought that this was really the case, he became a little scared and immediately discussed it with his wife. His wife was more supportive of him in everything, so he sold his house and bought a new house near Sanbo Hospital. Not long after he moved in, his daughter left the house. kind of thing.

The couple was waiting by their daughter's bedside. At this time, the old man and the old lady had stopped arguing and came to the ward.

"I told you where to move. It's unlucky. If you don't listen to me, is something wrong?" the mother-in-law babbled.

Being a son-in-law is not a matter of principle and I will definitely not talk back to him.

But the daughter is different. Li Ni is not afraid of his mother.

"The doctor said that this disease is congenital and is present at birth. What does it have to do with moving? I just didn't find it before. If it weren't for the fact that the hospital is so close now, I don't know what to do."

"The doctor said yes, can you have any brains? Nowadays, doctors are making money, just to scare you. I haven't seen it reported in the news." The mother-in-law said plausibly.

"That's a small probability event. There are scoundrels in every industry. There are reports in the news that bank deposits have disappeared. Your bank deposits are missing? Have you taken the customer's deposits again?"

Li Ni refuted her mother, who worked in a bank before retiring.

Her mother was speechless by Li Ni's retort. Li Ni knew that her husband always gave way to her mother, but she was not used to it. She always stood by her husband to defend her husband.

"How did you talk?"

"I'm just making a metaphor. Don't think that everything is like this when you hear reports of low-probability incidents."

(End of this chapter)