The Godfather of Surgery

Director Kong looked anxiously at the elevator entrance. As soon as Yang Ping came out, he immediately greeted him.

Doctor Yang, I'm sorry, I called you over this weekend! Director Kong looked embarrassed.

Yang Ping said humbly: Director Kong is serious, and Xiao Yang is always on call. Is there anything that needs me?

In an emergency, Director Kong was also unambiguous and straightforward: Mr. Ning suddenly suffered respiratory failure in the morning, and his blood oxygen has been unable to come up, hovering around 70. Director Jiang from the ICU saw it and decided to use ECMO. They puncture the device in the emergency ward. After the catheter was placed, ECMO was connected. Although the blood oxygen went up a little, it was still low, and it was only 78. They considered that the tumor squeezed and violated the right external iliac artery and vein, resulting in stenosis of the lumen, and the flow rate of the blood was not good. The unit time The amount of blood drawn out for oxygenation is too small to meet the demand, so Miss Ning offered to ask you to come.

ECMO, nicknamed magic lung, improved artificial heart-lung machine, also called extracorporeal membrane oxygenation, can replace the function of human lung or heart to a certain extent and for a certain period of time.

It draws the blood of the human body from the veins, oxygenates it through the machine, turns it into oxygen-rich blood, and then returns it to the human body through the veins or arteries.

If it is returned to the human body through a vein, it can replace the function of the lungs; if it is returned to the human body through an artery, it can replace the functions of both the heart and the lungs. The magic lung is called the last straw for saving lives by doctors!

However, the price of this kind of machine is very expensive, so the cost of using it is also very expensive, and it cannot be covered by medical insurance. It costs 60,000 to start up, and 10,000 to 20,000 per day in the follow-up. This is a sky-high price for ordinary people. For Mr. Ning, this does not need to be considered at all.

As the two walked towards the ward, Director Kong introduced the situation to Yang Ping, and when they reached the emergency ward, the situation was also briefed.

The emergency ward of the Overseas Chinese Building is equivalent to a small ICU. All kinds of emergency equipment are readily available, including expensive magic lungs. These equipment were not bought by the hospital itself, but were donated by patients who lived here or lived here.

Inside, Director Jiang of the ICU was putting in the tube with his assistant, but he had stopped, probably waiting for Yang Ping. Next to it, there are chief physicians or deputy chief physicians of vascular surgery, general surgery, tumor surgery, and color Doppler ultrasound.

You can't go in any more, hurry back a little, the blood vessels will be broken if you go in again! The deputy chief physician of the Vascular Surgery Department reminded Director Jiang.

Lower it down! See it clearly! Director Jiang directed the doctors in the color ultrasound room.

The ultrasound doctor's probe was slightly lowered, and the blood vessels on the ultrasound image became clearer.

Mr. Ning was lying on the bed, his face was yellow and his mind was a little unclear. He was covered with a blue sterile sheet. Director Jiang had just completed the catheterization of bilateral femoral veins. The catheterization of the left femoral vein went smoothly, but there was a Narrow, the catheter did not dare to go deep. Now the right side is the tube that draws the blood, and the left is the tube that takes the blood.

Because of the stenosis of the right external iliac vein, the blood drawn did not reach the expected flow. If you swap it, the right side is the input pipe and the left side is the output pipe, and the result will not make any difference. Even if the blood drawn from the left side for oxygenation is sufficient, the blood flow rate sent back is too slow to achieve the intended purpose.

Doctor Yang, I'm going to trouble you again! Miss Ning said.

She stayed by the side the whole time, squatted by the bed, grabbed her father's hand, and smiled: Dad, don't be afraid, Dr. Yang is here, he has a solution.

When Mr. Ning heard his daughter's words, he seemed to know clearly, but he couldn't speak, so he nodded with difficulty.

In fact, Yang Ping was also helpless as to what he could do for a patient with advanced liver cancer and systemic failure.

Doctors are to patients, just like the epitaph of Dr. Trudeau in New York, USA: sometimes cure, often help, always comfort.

With difficulty, Mr. Ning stretched out a hand tremblingly, and Yang Ping held his hand tightly, cold and thin.

His lips trembled, and he wanted to say something. Yang Ping's ear came close to his mouth and heard a few vague words.

Help me--a few more days-- Mr. Ning seemed to use all his strength to say these words.

Yang Ping nodded heavily and clenched his hand to show that he heard what he said. Trust, how precious this trust is, just a few words on the operating table, you can entrust your life to yourself.

Definitely, I will try my best to help you win! Yang Ping put down his hand.

Mr. Ning used to be hospitalized in Fuyi. For his condition, he invited all the top oncologists in the industry, and even overseas experts for consultation. Lost the opportunity for surgery, tumor resection, liver transplantation, lung transplantation can not be done. So after interventional therapy for liver cancer, lenvatinib was used as targeted therapy, and later drug resistance was changed to regorafenib.

Because the hospital conditions in Sanbo's Overseas Chinese Building can be said to be the best VIP ward in City G, so I transferred to Sanbo and planned to spend the last leg of my life in Sanbo's Overseas Chinese Building.

Both infraclavicular and internal and external jugular blood vessels were seriously invaded by the tumor, so I didn't dare to puncture the catheter, so I wanted to put two tubes in the bilateral femoral veins. The tumor pushes the external iliac vein away, causing squeezing. The tube cannot go in. Forcibly pushing it up may break the blood vessel and cause massive bleeding. If it stays here, the blood flow rate for the replacement will be too low, not up to the standard, and the blood oxygen will still be high. I can't go up, you see that the blood oxygen is only 80, this is not good--

Director Jiang didn't care about his face at this time. He was a real person. At the juncture of life and death, he would listen to anyone who had a solution, no matter if he was a young doctor or a great professor.

He is familiar with Yang Ping. He has also heard about the nerve root block last time. Needless to say, the five-stage replantation is not enough. The treasure that Director Han holds in his hand is not at the right level, and he is not qualified to stand at this time. At this.

You've worked hard, let me see!

There is a reading light in the emergency ward, and the film has been hung. Yang Ping went to the reading light to watch the film. Indeed, as Director Jiang said, the bilateral subclavian and internal and external jugular veins cannot be punctured, only bilateral femoral vein puncture. , The right femoral artery vein has been invaded and squeezed by the tumor, and the lumen is flat. If the puncture is forced, once the blood vessel is broken, it will cause massive bleeding.

In Mr. Ning's situation, if there is a massive abdominal hemorrhage, the whole body collapses immediately, and the multiple organs fail.

But now, if only the catheter of the magic lung is left in its current position, there is a narrow opening on it, the blood flow drawn out is too small, and the oxygenated blood per unit time is too small, which cannot meet the needs of important organs at all. If a stent is used to support it Open, but also to be able to pass to open.

No wonder the temperature of his right lower extremity was lower than his left lower extremity during the last physical examination, especially the peripheral circulation was particularly poor.

Using the knowledge gained from systematic anatomical training, combined with Mr. Ning's CT scan, Yang Ping began to compose pictures in the brain, superimposing sections one by one, and slowly, a three-dimensional anatomical map was presented in the brain.

This time, it was still very difficult, and several times of splicing were unsuccessful, but it was a little easier than last time, indicating that there was progress.

According to the blood flow rate of the human body, Yang Ping simulated the blood flow in his mind, added the dynamic image of the blood flow, and presented a dynamic three-dimensional anatomical image in his mind, which was quite clear.

It seems that brain composition is very important for the improvement of medical skills. The ability of the system to use anatomy to train itself is to lay a strong foundation for the improvement of medical skills in the future. Yang Ping understands the intention of the system.

To successfully puncture the catheter, it is necessary to construct the catheter of the devil lung. Yang Ping kept the image in his brain and turned to ask Director Jiang: Director Jiang, is there still a catheter for the devil lung? Let me take a look?

Little Li, open a tube and show it to Dr. Yang. Director Jiang instructed an ICU doctor next to him.

The cost of a tube is very expensive, tens of thousands, but this is not the time to care about it, and there is no need to care about it.

Xiao Li opened the sterile packaged tube, Yang Ping observed the complete catheter, copied a catheter like this in the brain, and then matched the graphics constructed in the brain to simulate puncture and catheterization, so that Yang Ping knew it. .

Okay! Yang Ping asked Xiao Li to put away the catheter.

I'll try!

Yang Ping put on sterile gloves and a disposable sterile gown and stood beside the bed.