The Godfather of Surgery

For the whole day on Sunday, Yang Ping was in a trance.

Xiao Su! Professor Su's daughter, Su Nanchen's younger sister, this question has been lingering in Yang Ping's mind. She walked down the steps in a long dress. The beautiful and moving picture is still imprinted in her mind. Several identities are linked together for a while. Still difficult to adapt.

No matter who she is, no matter who she is, no matter who she is, Xiao Su is right, she is Xiao Su, so Yang Ping doesn't think about it anymore.

At work on Monday, Sisi's three-dimensional reconstruction came out, especially the reconstruction of infrared scanning, which is the image to be used directly in the operation, and the other two, the reconstruction of CT and MRI are only supplements.

Judging from the image, the primary tumor has spread very seriously around the entire hip joint, and the treatment method needs to be adjusted.

There are several ways of metastasis of malignant tumors. Tumor cells are like seeds, which can be transferred out in several ways: hematogenous metastasis, the seeds are transported to another place through the blood circulation, take root and germinate, and settle down; lymphatic metastasis is similar to hematogenous metastasis, but different. It is transported through the lymphatic circulation, not the blood circulation; planted spread, the seed falls to another place, starts to grow, and takes over the territory; and direct spread, the tumor keeps growing, grows directly, and invades other places.

To do local excision, the scope is too large and the destructiveness is too large. Only surgery and ultrasonic scalpel can be combined. First, the tumor of the bone tissue is removed, the prosthesis is removed, the femur is lengthened, and then the ultrasonic scalpel is used to treat other surrounding tumors and distant places. of metastases.

At seven o'clock in the morning, Yang Ping watched Sisi's film and made a rough plan for the operation. Entering the system space, there is one last task left in the progress of sports medicine. After completing this task, you can advance to the training of bone disease, but what this task is and when it will be released, I don’t know yet.

After finishing the shift, I took everyone to the ward, and then I had an operation in the morning, all of which were arthroscopic surgery. Most of the patients in the ward now have arthroscopic surgery, and the turnover is also very fast. Generally, the second after the operation is completed. Discharged in a day.

Word-of-mouth spreads very quickly. Many patients are introduced by patients who have undergone surgery. Slowly, the ward is almost full.

At two o'clock in the afternoon, Yang Ping gave a small class to everyone in the classroom. Many doctors from the orthopaedics department came. Several directors, Director Han, Director Tan, Director Tian, ​​Director Bai, Director Ouyang, and Director Ding all attended. After the meeting, there will be discussions about the academic conference.

The content of the lecture is to rescue the case of tree penetrating injury in Shipo, and perform the open-box operation under the large-vessel occlusion operation.

This procedure is extremely difficult because large blood vessels and internal organs are often involved. Anyone who has watched Grey's Anatomy knows a scene in which two people face each other and are penetrated by a steel bar. The doctor is in a dilemma.

Because the woman had damaged the aorta, the doctor decided that it could not be rescued and had to sacrifice her to save another black man with less severe damage.

The aorta is the real artery of death. Once damaged, a lot of blood will be lost in a short period of time, and the fastest can die instantly.

This dilemma of Grey's Anatomy was continuously shown on the screen, played repeatedly, and then fixed in one picture, two people facing each other, sitting on an ambulance, and being penetrated by a steel bar.

Yang Ping pointed to the screen and said: Don't be misled by the TV. On the TV, the two patients are both conscious and laughing, which means that their vital signs are stable, and at least their blood pressure is temporarily stable. In this case, the other should be sacrificed. Why? Why can't you save two?

No way, the director arranged it! Someone said, and everyone laughed.

Yang Ping also laughed, and after laughing, he continued: In Anzhen and Fuwai in our country, aortic dissection rupture is much more dangerous than this, and the success rate of rescue is very high, what's more, you can still talk and laugh after this kind of aortic injury? It's not to belittle others, but to think with science! The surgical method on TV is extremely backward. They actually use the practice of pulling out the steel bars, which is equivalent to gambling with their lives. In this case, the steel bars must not be pulled out. Reinforcement, everything will get out of control. Pulling out the rebar is like when you defuse a bomb, you don't have to think about anything. Just tear off a few wires. Is this okay? Definitely not! What should we do?

Everyone listened carefully. Everyone who came to the class knew that Yang Ping's class was full of good stuff, especially when he talked about surgery. It was definitely not based on the script, but the refinement of his own experience. As for how his surgery was, needless to say, the miracle created was not One or two.

Among the young doctors, some people lowered their heads to take notes, some were recording with a tablet, and some simply took a mobile phone directly to the video, so that it would save trouble and go back and listen slowly.

If we were to rescue these two patients, let's think about how to do an operation. Are you pulling out this steel bar? We are not evaluating TV today, but just using this case to elicit our thinking! Yang Ping Ask questions to indicate your purpose for borrowing the TV.

The people in the audience were eager to try, some people raised their hands, and a young doctor from the Department of Traumatology stood up: I have always felt that this is not advisable, why not saw the steel bars from the middle, so that the two people are separated and divided into two groups for surgery? Saw the steel bars. use continuous cooling and certain shock absorption measures!”

Yang Ping asked him to sit down: Very good! This doctor is very correct. In dealing with this case, instead of pulling out the steel bar, he sawed the steel bar, separated the two people, and completed the operation by two groups of doctors. This is completely achievable and accurate. Speaking of which, this is already the third step, and before that, there are two more steps?

Everyone was silent and couldn't remember for a while. A trauma ICU doctor raised his hand and said uncertainly, Blood transfusion?

Yes! It's just such a simple step, this is the first step, blood transfusion and rehydration! This is the most common, and the most effective, and indispensable step. Everyone can understand that trauma, if the only thing that threatens life is blood loss, without causing Fatal damage to vital organs, such as severe craniocerebral injury, can theoretically be rescued, depending on whether you are fast enough to stop the bleeding and keep up with blood transfusion and fluid replacement within an effective time. Blood transfusion and rehydration to maintain blood pressure; the second step is to judge the injury and make a basic judgment on the injury. If you have the conditions, you can perform a quick CT scan. If you have no conditions, you can go directly to the operating table for exploration. The third step is to separate the steel bars, What about the fourth step? Yang Ping activated everyone's thinking.

The fourth step is our preoperative large-vessel occlusion operation, which directly blocks the large blood vessels. Just like this patient, it has been confirmed that the aorta is injured. Judging from the location, we can perform high abdominal surgery on the injury site. Arterial blockage, which is equivalent to closing the main gate and controlling all bleeding from the wound, but this blockade is time-limited, abdominal aorta blockage, 30 minutes is safe, we end the fight within 30 minutes, The patient can be rescued safely. On one side, the blood vessels are blocked to completely stop the bleeding, and the other side is blood transfusion to replenish the lost blood, so as to temporarily obtain a balance of capacity and strive for a safe operation time. Song Zimo participated in this operation, he answered this question.

But, is this a very high-risk operation? Some people worry.

Yang Ping said to everyone: Every operation we have is high risk. Our operation is like flying a fighter jet. Nothing is absolutely safe. It is the essential feature of surgery to complete all operations at risk. With the knowledge, skillful operation, calm mind, and blocking the great blood vessels, we have entered the fifth step, out-of-the-box surgery!

There was an uproar in the audience, I had never heard the word out-of-the-box surgery!

Yang Ping stood in the middle of the classroom, waiting for everyone to be quiet, and said, This is the essence of today. The unpacking operation is a word that I have thought about for a long time and selected. It is very simple. , How to open the box, according to the location of the CT scan, or the location that is simply judged, the abdominal cavity is opened; in the thoracic cavity, the chest is opened, along the steel bar, fully opened, and the entire steel bar is exposed. The entry way is constantly hemostasis and repair, and finally it is taken out, not pulling out, but taking out the steel bar!

This process is like defuse the bomb, opening the shell of the bomb, exposing the various parts and wires inside, and then removing the danger step by step with precision.

The patient in the picture, even the most severe one, can have the aorta repaired in half an hour, even if it's not that fast, can use a large vessel bridging technique, from proximal to distal, across the injury site, allowing blood Temporarily avoid the injury site, which can not only ensure the blood supply to the lower body, but also allow you to slowly repair the injured aorta. There is also a method that we commonly use in thoracic surgery to deal with aortic dissection, artificial blood vessel implantation, and even implantation of artificial blood vessels. It can also be implanted minimally. There are many methods. Why should you give up? You can see a few interventional procedures for aortic dissection. It is not difficult. If you are skilled in anything, it is not difficult. The operation of arterial dissection can be applied to trauma surgery, but why can't our laparotomy be applied to penetrating injuries of steel bars, and it is such a stupid practice to pull out the steel bars.

Theoretically speaking, it is very difficult to do! Someone whispered, after all, no one has encountered this kind of thing.

The screen immediately switched to the rescue photo of Shipo Hospital: Look, this is a living and successful example, the application of theory, theory guides practice, practice improves theory, don't separate theory from practice!

This case is much more serious than the one on TV, and they were all rescued. Yang Ping said: I am not the only one who successfully rescued a patient like Mo Liu, Jishuitan, and many hospitals across the country, all of which have been successfully rescued from very serious trauma. In this case, even this kind of penetrating injury to the chest and abdomen, I can say responsibly that if the two patients on TV appear in Mo Liu and Jishuitan, they don’t need to sacrifice the other, and both can be rescued. Bo, you can save them both.

Director Han stood up and said to everyone:

Soon, we are going to hold an academic conference. The conference will be broadcast live on major trauma emergency operations. At the same time as me, there is the Affiliated Hospital of the University of Tokyo. Director Tan has already obtained some of their major trauma rescue operations. Video, wait everyone. Let's take a look, what is the world's top rescue process, how the surgery is done, how the team works together, everything is done, done well, and done to the extreme, it is a completely different realm. We all know that the Japanese cure rate of gastric cancer is more than 80%, what is the concept? We are 30%, the United States is 60%!

Next, Yang Ping explained in detail the surgical details of Shipo tree penetrating injury cases, how to block blood vessels, how to open the box, how to probe, and how to repair.

Finally, three chapters have been published, with more than 10,000 words!

The TV with the steel bar penetrating injury is Grey's Anatomy. It's been too long and confusing. It is hereby corrected! Apologies!