The Godfather of Surgery

Human anatomy is very complex, various potential gaps, and abscesses are far from the scope of the naked eye. Magnetic resonance imaging shows that there are several nearby places, and it is difficult to observe all directions with the naked eye during the operation.

Cholangioscopic, soft mirror! Now it's time to use it. Usually, this is a device used in general surgery to remove bile duct stones. Now Yang Ping uses it to observe the true extent of the abscess.

With the guidance of magnetic resonance images, the scope of the abscess is well known in the heart. The flexible mirror is placed, up and down, left and right, to explore the entire scope of the abscess, and then guide the suction device to attract.

This equipment has never been used in previous operations, but Xiao Su knew that this step was going to be used, and Yang Ping was going to use it now. Yang Ping habitually stretched out his hand, and the lens was delivered to his hand in a timely manner. Su asked Zhou Can to turn on the display too.

For flushing and suction, Yang Ping held the lens in his left hand, and operated the suction device with his right hand. He flushed and sucked in all directions without dead ends, and attracted almost 3,000 milliliters. After removing the 2,000 milliliters of saline that was rinsed, 1,000 milliliters were pus.

Can a choledochoscope still be used like this? Song Zimo wanted to try it next time.

Yang Ping said as he did it: The flexible scope can change the direction of the lens and is suitable for all-round exploration. Later, you can also use a thin flexible scope, a flexible scope for intrahepatic bile duct stone extraction, to explore the range of pus in the spinal canal and completely remove it. , the hard mirror is not good, can not enter the dead area, and it is easy to damage the spinal cord.

The entire vertebral body of the ninth thoracic vertebra was invaded by the abscess, which had collapsed, and the bone fragments moved backward and invaded the spinal canal.

Only the ninth thoracic vertebra could be removed. Yang Ping finished processing the blood vessels around the vertebral body and reminded the anesthesiologist: Prepare to remove the vertebral body, pay attention to blood pressure.

The vertebral body is a layer of cortical bone wrapping the cancellous bone, and the cancellous bone is rich in blood supply, so when the vertebral body is removed, the bleeding is much more than other steps.

At this point in the operation, the suction device for attracting blood is relatively clean for the time being, and there is not much blood to attract. The suction device used to remove cheese has been replaced several times, and the amount of cheese that has been sucked out has exceeded 2,000 ml.

The bone knife cut off the pedicle arches on both sides, removed the upper and lower intervertebral discs, and then took out the vertebral body completely. It was still possible to operate in this way. Song Zimo gained insight.

In this step, a bird's beak rongeur is usually used to bite off the vertebral body one by one. Such a step will inevitably lead to a lot of blood. Now Yang Ping directly took out the vertebral body completely and there was no bleeding at all.

The cross-section of the pedicle is sealed with bone wax, the spinal canal is exposed, and the spinal cord is exposed.

No wonder the patient developed neurological symptoms, muscle weakness and sensory disturbance in both lower extremities. If surgery is not performed, the muscle strength will gradually continue to deteriorate, and finally becomes zero, with complete paralysis of both lower extremities.

Curettes and nerve peels are used together to remove the bean curd residue-like substances, and leave a part for bacterial culture and pathological examination. This is a necessary step.

Going up and down along the spinal canal space, always remove the oppressive substances, Yang Ping is not at ease. After all, the upper and lower spinal canal is like a narrow tunnel, and it is difficult to completely discover the true scope of these pathological substances with the naked eye.

The choledochoscope was used again. It was gently inserted into the spinal canal, almost against the wall of the spinal canal, and probed up and down. According to the MRI tips, there were still some areas up and down that were invisible to the naked eye. There was an abscess, although it did not exist. oppression, but can be a hindrance to healing.

Reach into the peeler, and under the guidance of the soft mirror, easily remove these residual substances, rinse and suction, and then remove, repeat several times, and finally remove it.

Microscope!

Xiao Su is ready, it knows that Yang Ping will not let go of this step, will not let go of the exploration of the anterior spinal artery, Yang Ping will not lose any of the points he deserves for the operation.

Let's explore the anterior spinal artery. Yang Ping carefully exposed the anterior spinal artery, and then gently clamped it with the micro forceps to feel the tension of the blood vessel wall.

No, the feeling under the tweezers is very hard, not the normal pipe structure should feel, there should be embolism.

What? It's embolized? Song Zimo watched the movement of the micro-tweezers on Yang Ping's hand.

It's embolized! Yang Ping was sure.

The embolus is about two centimeters long, which is the segment that has just been compressed. If the embolization is not removed, the spinal cord will be ischemic necrosis and degeneration, and the paraplegia will not recover after the operation, and it will continue to worsen. All the work just now will be in vain.

What should I do? Song Zimo asked cautiously.

Fortunately, Yang Ping carried out the exploration. Otherwise, the sensation and muscle strength of the lower limbs would not recover after the operation, or would gradually increase. At that time, it would be too late to explore again.

The embolization should not be long, if it is too late to open the blood vessel now. Yang Ping judged from the hardness of the blood vessel under the forceps.

A single operation, the perfect effect is the combination of countless perfect details.

Cut the blood vessel, remove the thrombus, and then anastomos the blood vessel? Song Zimo guessed.

Yang Ping nodded: Prepare microscopic instruments for anastomotic blood vessels!

A careful exploration changed the patient's fate, otherwise, she would probably spend the rest of her life in a wheelchair.

In spinal tuberculosis surgery, there is no step to explore the anterior spinal artery, because most spine surgeons do not have the thinking and experience of microsurgery.

Yang Ping decisively cut off the anterior spinal artery, and used forceps to gently dislodge the thrombus. The thrombus was like a tiny earthworm and placed on the saline gauze in Xiao Su's palm.

Photograph!

Yang Ping instructed that Zhou Can was fine for the time being under the stage, and he helped to take pictures. The purpose of taking pictures was to leave complete data for the operation and to accumulate original data for future scientific research.

According to the procedure of microsurgical small vessel anastomosis, heparin saline was used to flush the vascular pipeline, trim the adventitia of the blood vessel, anastomosis needle and thread without damage to the blood vessel, anastomosed the blood vessel, and check whether the blood vessel leaks and whether the pulsation is good.

After observing for two minutes, Yang Ping was relieved: Okay, let's take the iliac bone for intervertebral bone grafting.

Song Zimo began to take the iliac bone, which was very skillful. It was necessary to obtain a satisfactory volume without affecting the appearance and function of the donor site.

I got married before the Spring Festival, and the brothers must come here to be lively and lively. I have sent Director Han's invitation, and I have asked the head nurse to help send the invitation. For the brothers, I will submit them in person later. Xiao Wu said abruptly.

So fast? Fatty rushed to the surprise, brothers, he was the fastest.

If we don't have a banquet, we will hold a banquet with the baby. Zhang Lin said lightly.

What? You're going to be a father, you're not just one step ahead? Fatty didn't expect that he didn't have a girlfriend yet, and this kid was going to be a father.

Father-in-law and mother-in-law are pressing too hard, don't dare to disobey. Xiao Wu said helplessly.

You don't want to be a doctor after you get married and become a charterer? Zhang Lin teased him.

Xiao Wu’s parents-in-law are locals in City G. In the 1980s, they sold electrical appliances to and from the mainland of Hong Kong. .

The old couple has only one daughter, and they are very cautious about her daughter's life-long affairs. After seeing Xiaowu, the old couple likes it very much. The young man is handsome, eloquent, and his brain is flexible.

Now Xiaoqing is pregnant, and the old couple is happy. They want to be grandparents and grandparents. They urge them to get married every day, so that they don't have to worry about anything. The two old people will take care of it.

Fifth brother, do you have a sister-in-law? A sister-in-law is fine too! Fatty felt that he was not a little behind.

Don't tell me sooner! Xiao Wu said while pulling the hook.

Fatty was very surprised: Why, that's it?

I said earlier, I persuaded them to have another one, but now I'm afraid it won't work. Xiao Wu smiled.

While chatting and laughing, Xiao Wu and Zhang Lin's retractors did not move, and the surgical area was well exposed.

Song Zimo's iliac bone block was taken, it was square and beautiful.

Yang Ping used a spreader to open the upper and lower vertebral bodies, and the implantation of the iliac bone was quick and just right.