The Godfather of Surgery

After speaking, Teng Guihua realized that something was wrong with her, and immediately covered up: I'll just ask, ask.

There was a hint of unnoticeable joy on her face, which was caught in Yang Ping's eyes. Maybe the usual physical examination training in the system space made him more observant than ordinary people.

I read that right, my daughter, her condition is getting worse, shouldn't she be anxious and even cry? Why is she still a little happy.

I'll come! Teng Guihua also squeezed to the side of the bed to help Fang Xiaoyun massage his legs.

Fang Xiaoyun's colleague, Chang Juan, stepped aside a little bit, showing a look of disgust.

However, she is also Fang Xiaoyun's mother. This time, she didn't ask for money. She just came to see her daughter. As a colleague, she couldn't say anything.

This mom is quite fashionable, with heavy lipstick and pungent perfume, which can be smelled through the mask.

The rings and bracelets on her hands and the necklaces on her neck are all alike.

After watching Fang Xiaoyun, Professor Zhang urged Yang Ping to observe closely. He still had to go to the outpatient clinic. He said that a patient's test results came out. He was very anxious and had been waiting for him.

It was time for get off work, and the old man went to explain the patient's condition, which was really hard work.

The old man is 80 and still can't rest. The hospital arranged for him to have an outpatient clinic one day a week.

After Professor Zhang left, Yang Ping transferred all Fang Xiaoyun's case data for research.

Any abnormality must have an explanation, otherwise there will be a knot in my heart and I will be unhappy.

It's okay to put this abnormality in the eyes of others, but Yang Ping is not willing to let it go easily.

What? Still not getting off work? Xiao Su put her bag next to the computer, sat down with Yang Ping, and massaged Yang Ping's shoulders.

The two agreed to have dinner together, take a walk after dinner, and play tennis for a while.

This patient's spinal cord edema continues and does not subside, and the peak period lasts too long, which is very abnormal- Yang Ping explained to Xiao Su.

Look slowly, I'll accompany you. Xiao Su sat next to her, next to her, kneading and kneading Yang Ping's shoulders with both hands.

Doctor, it is very important to have an understanding partner.

Otherwise, a few days of continuous emergency surgery can make a mess at home.

You watch the movie seriously, don't worry about me, my father is a doctor, and my mother is a nurse, I've been used to it since I was a child. Xiao Su smiled slightly.

Yang Ping looked at it one by one, not letting go of any clues, and inspecting every part carefully.

It doesn't matter if you sacrifice a little rest time yourself, it's better if you don't find a problem. If you find a problem, you can deal with it in time. In case of delay, it will affect the patient's life.

The spinal cord compression has been completely relieved, the arteries supplying blood show no signs of embolism, and the dural veins are slightly thicker than normal.

While watching, Yang Ping told Xiao Su that Xiao Su was very interested, and he liked to hear Yang Ping talk about his illness.

The dural veins are slightly thickened, which is an intuitive feeling that Yang Ping has seen in the system space after seeing too many images and pictures.

Blood vessels, a little thicker or thinner, can't find anything at all, and a little difference can't explain the problem.

Yang Ping compared the MRI and CT films before surgery, on the first day after surgery, and 1 week after surgery.

The dural vein, at the same part, is actually a little thicker every time. Although this change is very subtle, it was still captured by Yang Ping.

Moreover, the changes of dural veins were positively correlated with spinal cord edema, and the thicker the veins, the more severe the spinal cord edema.

If it weren't for the devil-like training in the system space, how could this almost negligible change be seen.

Dural arteriovenous fistula?

No, there are less than 300 cases reported worldwide, such a rare disease, and the incidence of spinal tuberculosis complicated with paraplegia is also superimposed together. This is the probability of lightning strikes.

However, the more Yang Ping looked, the more he pointed to this disease, which was almost certain.

If so, a spinal arteriography must be done as soon as possible, which can be very long, several hours.

There are many blood vessels in the spinal cord, and the distribution is very complex. There are bilateral vertebral arteries, common carotid arteries, thyrocervical trunks, costocervical trunks, and 12 pairs of 24 intercostal arteries. These blood vessels may be where the fistula is formed.

During angiography, the X-ray irradiation time is long, which is a great test for the patient and the surgeon.

The most troublesome thing is that because of the complex structure of blood vessels around the spinal cord, it may be because the manipulation is not in place, all the above blood vessels have been angiography, and the problem blood vessels cannot be found.

Contrast media also increases the risk of spinal artery embolism, especially the anterior spinal artery that was anastomosed in the previous operation. The condition is complex and many conflicting risks are intertwined.

If there is no full understanding and cooperation of the patient, in this case, the next step of examination and treatment cannot be carried out at all.

Dural arteriovenous fistula? It is necessary to arrange DSA digital subtraction angiography immediately. Yang Ping told Xiao Su.

I couldn't eat dinner in the evening, and I lost my walk and tennis.

What do you eat? We order takeout! Xiao Su was not dissatisfied.

Looking at Yang Ping's posture, if a DSA diagnosis is made, emergency surgery is required, and surgery is performed together, which is very good!

No need to explain, the two had a tacit understanding, and Xiao Su immediately went to arrange a takeaway for dinner.

Everyone was about to pack up and leave for get off work. Song Zimo and Tang Fei greeted Yang Ping and were about to leave work.

Fang Xiaoyun, dural arteriovenous fistula!

Yang Ping responded to Song Zimo.

Song Zimo immediately stopped: Emergency DSA?

Well, after the diagnosis, immediately operate, contact the interventional operating room, and have an operating room that can do hybrid surgery.

Yang Ping took the water from Xiao Su, Xiao Su said with a smile, It seems that everyone can't get off work, so I have ordered takeout.

Song Zimo Tang Fei immediately gave up get off work, Song Zimo handed the backpack to Tang Fei: Help me put the bag, I will call Zhang Lin Xiaowu and a few fat guys over, there is work to be done tonight, there are less than 300 cases worldwide, We stepped on it, true or false?

90% is true, prepare for DSA and surgery. Yang Ping stood up.

When the two diseases are superimposed together, they can both cause spinal cord edema and paraplegia. One disease covers the other, and the probability is very low.

Zhang Lin, Xiao Wu and Fatty saw that Yang Ping didn't get off work, and they didn't dare to get off work on time because they were afraid of something.

Several people were meeting in the duty room, and they all came out when they received a call from Song Zimo.

Dural arteriovenous fistula, they have no concept at all, have never heard of it.

At this time, Professor Zhang called in a hasty tone: Xiao Yang, where is it? In the emergency department, Fang Xiaoyun is given a DSA of the spinal artery. It is very likely that a dural arteriovenous fistula is involved!

I'm making arrangements!

I'll get to Corey right now!

The phone didn't hang up in time, and the old lady's voice came from inside: Hey——, I just came back, the food is ready, and then go after eating, it's okay to eat two or three mouthfuls to fill the stomach——

Professor Zhang is very experienced, and he also thought of this rare possibility.

Song Zimo is contacting the interventional operating room, and there are several operating rooms that can perform hybrid surgery.

But at night, I don't know if there are enough people to help with DSA. This requires the help of an interventional doctor with a very good technique.

Everyone worked separately. Xiao Su and Zhou Can had to prepare accurate instruments, prepare microscopes, and determine the interventional operating room, and send them over.

After DSA is done, the diagnosis is made, and the operation is performed directly in the interventional operating room. Sometimes angiography is needed to look for vascular fistula during the operation, and angiography is required after the operation to confirm whether the arteriovenous fistula has been handled well.

Yang Ping reported to Director Han, and Director Han also said that he came immediately. He was not worried about Yang Ping's technology, but gave Yang Ping a platform and took risks. After all, Yang Ping was the attending physician.

After checking Zhang Lin's informed consent form, making some modifications, and printing it out, Yang Ping took Zhang Lin to talk to Fang Xiaoyun to get her understanding and cooperation.

Teng Guihua is in the ward, and Fang Xiaoyun's colleague Chang Juan is there. She may be worried, worried that this mother will do something unfavorable to Xiaoyun.

Yang Ping felt that Fang Xiaoyun was fine. This mother may be the biggest obstacle to communication. Fang Xiaoyun is an adult. In order to save trouble, Yang Ping decided to bypass this wonderful mother.

I want to talk to the patient now, you go out, Zhang Lin, I called the nurse in and took them out. Yang Ping's words were beyond doubt.

I'm her mother, what can't you talk about in front of me. Teng Guihua noticed something unusual.

Yang Ping waved his hand: Go out, didn't you hear clearly? I don't want to waste time. Fang Xiaoyun is an adult and has the ability to act independently. You don't need to be present.

Although these words are rude and direct, at this time, entanglement with her is a waste of time.

Chang Juan is more aggressive: Just go out when the doctor says it, there is so much nonsense, Xiaoyun, let's go out, listen to the doctor, don't think too much.

The colleague pushed her mother out, and when the nurse came in, Zhang Lin closed the door to examine the female patient, or if she wanted to close the door for a private conversation, a third party such as a nurse or a female doctor must be present to avoid unnecessary disputes.

Doctor Yang, what happened? Fang Xiaoyun asked a little scared.

Yang Ping said calmly: Fang Xiaoyun, it's been a week since the operation, and the strength of your legs is getting weaker and weaker, which is not normal. We suspect that besides spinal tuberculosis, you also have a dural arteriovenous basket, which is a rare occurrence. There are only less than 300 cases of the disease reported in the world. It is very likely that it happened right after the operation and became the reason for the aggravation of your paralysis of the lower extremities. I am not 100% sure, but I am 90% sure. Now I need to do a spinal artery angiography , look for one blood vessel by one blood vessel. It may be found, or it may not be found. If you find it, operate immediately and deal with it. This time, the operation will be performed from the back. Are you willing to trust us and cooperate with us? If so This disease, if not detected and treated in time, will cause permanent paralysis.”

The disease is acute, has a poor prognosis, and causes venous stasis, resulting in irreversible spinal cord edema, followed by extensive arterial embolism.

Don't be afraid, you can decide your own affairs, your body is yours, you don't need to consider other factors. Yang Ping added, his tone was firm but gentle, and his words were clear.

Fang Xiaoyun is an ordinary rural girl. Before graduating from junior high school, she was scolded by her mother to work part-time. She worked as an ordinary worker in a factory.

All her money has been used to subsidize her family over the years, and all she has bought are cheap clothes. After using a Redmi phone for several years, she is reluctant to change it.

But at the critical moment, the girl's idea was very clear. She thought about it and nodded: Dr. Yang, I will listen to you. It's hard for you. It's time for inspection and surgery.

If you have this sentence, we will arrange it immediately. I will tell you the details of the operation--

After speaking and signing, Yang Ping got up and the nurse opened the door.

I thought it would take a lot of effort to convince Fang Xiaoyun, but I didn't expect it to be easy, this girl is very reasonable.

Perhaps, her decisiveness can save herself.