The Godfather of Surgery

After Yu Shuilian finished removing the sutures, her liver and kidney functions remained normal, and she successfully passed the dangerous period of organ dysfunction.

In this way, the reconstructive surgery of the urethra and anus was put on the agenda, and it was time to hand in the homework assigned by Yang Ping.

Yang Ping arranged homework for them and designed reconstructive surgery plans individually, hoping that Song Zimo, Xu Zhiliang and Gao Qiao could discuss together, and the others would also learn together.

Gao Qiao is a master of international trauma surgery. He masters the latest concepts and techniques, allowing Song Zimo and Xu Zhiliang to collide with Gao Qiao, generating sparks of thought.

Judging from the discussion information in the group, the three actually have their own advantages.

Gao Qiao has the most clinical experience, Song Zimo has the highest talent, he is obviously better than Gao Qiao and Xu Zhiliang in both thinking ability and hands-on ability. The difference between Song Zimo and Gao Qiao lies in clinical experience.

For Song Zimo, the experience that Yang Ping taught him is still a theory, a theory that cannot be found in books. He has not had as many surgeries as Takahashi, and naturally his clinical experience is worse than that of Takahashi.

Xu Zhiliang's thinking ability is no worse than Takahashi's, but his theoretical knowledge and clinical experience are still much worse than Takahashi's.

After all, Gaoqiao has studied in this major for a long time, communicated and studied everywhere, and has always been at the top international level, which is far behind Xu Zhiliang.

Xu Zhiliang graduated from Nandu Medical University from undergraduate to doctorate. The Chinese population is more than one billion. If he can be admitted to Nandu Medical University with an undergraduate degree, he is considered a top student among more than one billion people.

Takahashi is a top student among the 100 million Japanese. From this selection ratio, Takahashi is only a provincial top student in China.

Therefore, it is reasonable that Xu Zhiliang's IQ level is no worse than that of Takahashi.

However, the elite doctor training route accepted by Takahashi is far superior to Xu Zhiliang in terms of clinical and scientific research capabilities, which is also reasonable.

As long as Xu Zhiliang is cultivated, it is entirely possible to surpass Takahashi over time, at least Yang Ping thinks so.

He hoped that the two of them could get along with Takahashi and learn from his broad international vision. This is the most important thing.

The conference room was crowded with people, some sitting and some standing, all wearing clean white lab coats, and even the most sloppy people had their collars and buttons sorted.

These people include doctors of comprehensive orthopedics, graduate students, trainees, interns, and young doctors from other departments.

Those who sit are usually from the general orthopaedic department, and those around are usually from other surgeons.

There are also many stools around, but everyone is afraid that they will not be able to see or hear, so they simply stand up and have a better view.

Yu Shuilian's rescue operation has already caused a sensation in the hospital. Now the comprehensive orthopaedic department wants to reconstruct her urethra and anus. Everyone wants to know how to do this operation.

If the rectum is present, just anal sphincter damage, surgery to reconstruct the anus, a general surgeon or plastic surgeon will have many ways to reconstruct it.

However, reconstructing a functional anus at the end of the descending colon is beyond the scope of everyone's knowledge. Everyone is very interested in this, and what kind of top new surgery is being carried out.

In addition, a department that robs patients from death, a department that can attract international trauma surgeons, and a department that continues to create miracles.

Every focus is fascinating, and several doctors with high professional titles from plastic surgery, general surgery, urology, and anorectal surgery came here with the mentality of participating in the academic conference.

Although this discussion is a department-level surgical discussion, in everyone's eyes, it is no different from an international academic conference.

Yang Ping is almost a god in Sanbo Hospital; Song Zimo, a genius; Gao Qiao, an international trauma surgeon, this kind of conference must be very exciting.

The white lab coats were brushed on the floor, and the meeting was silent. The medical discussion was serious, and everyone was in awe.

Takahashi was the first to show the surgery plan. He arranged for him, and for nothing else. Except for Yang Ping, no one has more surgical experience than him. He is the leader of international trauma surgery today.

However, during the period of comprehensive orthopaedics, everyone forgot Takahashi's original identity, and only regarded him as the submissive Xiao Gao. Yang Ping wanted him to inspire everyone's enthusiasm.

Takahashi sorted out his white coat and turned his eyes to Yang Ping. With permission, he walked to the podium confidently. Perhaps at this time, he could find his true identity.

How many times he has swaggered to the podium at the international trauma surgery conference, and how many times he has given speeches, it is not as good as this podium, just because next to him, there is a god-like figure in his heart.

A pair of surgical spectrograms were recorded into the computer in advance and opened on a high-definition screen. This is the work of Takahashi using his life-long skills.

Not for anything else, but for the recognition of the young teacher.

Hello everyone, I'm Fumiya Takahashi, a trainee in the Department of Comprehensive Orthopedics. You can call me Xiao Gao. Below is my report on Yu Shuilian's surgical plan.

Modern surgery really kicked off when it conquered bleeding, pain, and infection. Today, surgery has solved a lot of pain for people. No matter what kind of surgery, there are three realms that cannot escape: excision, repair, and reconstruction.

Excision, such as the treatment of appendicitis, discards the diseased tissue or organ so that it is separated from our body; repair, such as the operation of skin splits, fractures, tendon ruptures, we try to repair it, try to restore the original anatomy and Reconstruction is the highest state in the field of surgery at present, the disease or damage of the organ leads to the loss of function, in order to restore its working ability, we have exhausted the means to create alternatives to perform its function, such as artificial joint replacement.”

Today, Yu Shuilian's surgery is a reconstructive surgery, because her original natural anus and urethra no longer exist. In order to restore her excretory function and live as clean and tidy as a normal person, we will reconstruct her anus and urethra. That is to create an alternative.

Reconstructing an organ, our ultimate goal is to simulate the function, this patient has two reconstructive operations, reconstruction of the urethra and anus, the muscles that control urination are in the bladder neck, fortunately not damaged, so the reconstruction of the urethra only needs to achieve the function of the urination pipe , this surgery is a routine plastic surgery, not difficult, use the bladder wall to reconstruct the urethra, any urologist who is good at plastic surgery can be competent, this kind of surgery, I have many papers in The Lancet and other journals, in which bending Reconstruction was my first theory.

The most difficult thing is the reconstruction of the anus. If you want to reconstruct an anus that can control defecation, under the current medical technology, you must have a preserved rectum and a complete neural pathway. Unfortunately, the patient's anorectum and sigmoid colon have been removed. , The terminal receptors of the defecation reflex of the human body - baroreceptors are distributed in the mucosa of the rectum. The descending colon lacks such receptors. In the absence of the terminal of the nerve reflex arc, it is almost impossible to establish an anus that is intentional and can autonomously control defecation!

Is it possible to use artificial anus to achieve the purpose, unfortunately, no! Whether it is shape memory alloy, medical silicone rubber, or polyether polyurethane and other materials, the anal sphincter is still not perfect, and the sphincter cuff is long-term. Implantation, repeated movement of the kit, frequent stimulation to the tissue, is bound to produce an inflammatory response, coupled with the high-pressure activity of the cuff, leading to corrosion of the tissue, causing pain, infection and wound dehiscence, a series of complications make the artificial anus application lingering. forward.

So, I recommend choosing autologous tissue to reconstruct the anus, electrical stimulation of the gracilis or gluteus maximus for in situ anal reconstruction. I have done a lot of it, restoring autonomy and reconstructing sphincter contraction, and the fluid closure rate exceeds 95%. This data I have always been the leader in the world, but I really lack experience with Yu Shuilian's ectopic reconstruction.

Under the encouragement of Dr. Yang, I still came up with my own surgical plan. Referring to the in situ reconstruction technique, I still used the muscle flap to reconstruct the anus. However, we must carefully choose the location of the muscle flap, and we must give up the surgery around the upper limbs and shoulder joints. Muscles, because the patient uses the upper body to perform many alternative movements, we can take material from the chest or back to reduce the negative impact of muscle weakening.

For the sphincter, I recommend using a free muscle flap of the pectoralis minor, with thoracoacromial artery and anterior medial thoracic nerve, punched in the center of the muscle flap, embedded in the end of the descending colon, encircling the colon, and implanted in the muscle layer. The branches of the blood supply vessels near the colon anastomosed, and the nerves can be anastomosed with the residual pudendal nerve to establish a nerve conduction arc controlled by muscles, but——I have no good way for the generation of constipation.”

Explaining his own surgery in combination with Tutu has brought Takahashi back to the state of a trauma surgeon. He now turns to Yang Ping from time to time, gets encouragement, and becomes more energetic and eloquent.

This technique was designed by Takahashi based on his own rich experience, and it is very suitable for Yu Shuilian's current situation, but the biggest problem at present is that he can't reconstruct the reflection of convenience.

His operation can end Yu Shuilian's embarrassment of using abdominal fistula to defecate. Even if there is no desire to defecate, he can use the strategy of regular defecation to solve the problem of fecal excretion.

Anal reconstruction can seal the stool, allowing it to stay in the intestine when it should not come out, and to pass it smoothly when it should come out.

Reconstructing an anal seal is more difficult with liquids than solids, so liquid seals are a measure of high-quality reconstructed anus.

If the surgical effect achieves a liquid closure rate of 95%, it is indeed the world's top level.

Feel sorry! The chapter I sent out today seems to be a bit wrong again. I don't know what the problem is. Maybe the draft and the text to be sent are mixed up, so I made a mistake. It has just been republished. I also marked all the drafts, and this should not happen in the future.