The Godfather of Surgery

Yang Ping is right, this case is unique, and no one has done similar operations, including autopsy, and it is also unique.

The anatomical relationship in the thoracic and abdominal cavity is a mess. If you don't know the detailed medical history, you will think that the thoracic and abdominal cavity has undergone many operations.

The heart and great blood vessels are the problem, as are the hepatobiliary and pancreas.

The patient's heart and large blood vessels were squeezed into the narrow and deformed space, and they would not be able to support it for a long time. In the end, he would die of heart failure. It was not easy to live to the age of eighteen.

This deformity is not caused in a short time, but gradually evolves over a long period of time. The originally deformed heart and large blood vessels will seriously affect the function of the heart, coupled with the extrusion caused by the deformity of the spine, and the displacement caused by adhesion. The condition deteriorated, and now the massive ascites is the result of this deterioration.

Not only cause ascites, improper posture, but also cause shock.

Inferior vena cava backflow is blocked, blood return to the heart decreases, right atrial pressure drops, and cardiac output decreases, resulting in a drop in blood pressure, a series of manifestations of shock in severe cases, and some postural symptoms will be more obvious, such as supine position, This syndrome is clinically called inferior vena cava syndrome or orthostatic shock.

Clinically, pregnant women are prone to this special state, such as multiple pregnancy, polyhydramnios and other pregnant women with abnormally enlarged uterus.

Now this patient has neither fetal compression nor tumor compression, but the inferior vena cava due to adhesion, bending and flattening of the wall, deformity of the spine and thorax, resulting in compression, which also produces a similar syndrome.

If the vena cava is compressed by the fetus or tumor, the patient is prone to shock symptoms in the supine position.

Zheng Baosheng's situation is special. He will cause shock in several positions. Due to the human body's self-protection awareness, he has found these positions and consciously avoids them.

But it is dangerous to sleep at night, in case of rapid blood pressure drop, once shock, life-threatening at any time.

Once in the shock position, once more than five minutes, there will be shock symptoms, such as dizziness, chest tightness, nausea, vomiting, frequent yawning, cold sweat, rapid pulse, drop in blood pressure, and rapid drop in systolic blood pressure below 80mmHg.

If the drop in blood pressure is not rapid, as with sleep apnea, he can wake up from sleep, adjust his posture, and get relief.

If the blood pressure drops rapidly and loses consciousness quickly, he will die in his sleep.

Since he had the symptoms, his parents have taken turns watching him at night to prevent him from going into shock.

Zheng Baosheng has survived many death threats until now.

In addition to ascites, heart failure, and the liver has also swelled, there is not much hope of survival without surgery, and there is almost no hope of successful surgery.

Seeing that Yang Ping was so persistent, Professor Li now felt that taking risks was worthwhile.

Waiting for death without surgery, surgery is also death, it is better to be active.

What can I do?

Originally, Professor Li thought that Yang Ping would invite him to be the chief knife, but Yang Ping said that he was the chief knife, and he was inconvenient to say anything.

If it is convenient, let's complete this operation together. I wonder if Professor Li is interested?

Yang Ping felt that the experience of an excellent cardiac surgeon can be used as a reference for himself.

Even if he has a system, Yang Ping will never close himself. Only by keeping academically open can he go higher and farther.

All of Yang Ping's medical knowledge comes from the reading of the system space, the practical training of a large number of experimental subjects, and he still needs the experience of others.

As the older generation of professors often say, learn from teachers, learn from books, learn from practice, and learn from peers.

In this case, whether out of interest or responsibility, Professor Li is willing to participate in the operation. He also wants to see where Yang Ping's confidence comes from and dare to perform such an operation.

Afterwards, Yang Ping and Professor Li began to discuss the details of the operation. Because it was too difficult, every detail had to be handled well.

At the beginning, people around you can still participate in the chat.

Chatting and chatting, other people, including Professor Wu Yucheng, couldn't get in at all, because the discussion knowledge was constantly upgraded, and the knowledge reserve could not keep up at all.

It is too narrow here, and the stenosis is irregular. The turning angle of the channel is too large, and the artificial blood vessel is difficult to implant. Otherwise, the artificial blood vessel can be implanted in advance using an interventional method to improve venous return, and it is also convenient to separate the vena cava during the operation. Even once the separation ruptures, it doesn't cause major bleeding.

It's difficult, but you can try.

These mesentery must be retained. After the adhesion is successfully separated, if there is no such mesangium for suspension at all, the heart and large blood vessels will move very much in the thoracic cavity, which is very dangerous.

The capsule of the heart has to be completely peeled off, and now there is a narrowing of the performance.

Temporary vascular bridging techniques can be used before surgery to divert blood circulation and avoid the surgical area.

No, it's better to have blood filling, which is more conducive to separation.

Well, if necessary, the heart can be taken out, so that the pericardium and mediastinum can be handled, and a suitable accommodation bed can be re-prepared for the heart.

Some of these adhesive bands can be used, but they cannot be completely removed.

What about the liver, gallbladder and pancreas? Do you want me to ask someone to help?

No, I can handle it.

There is also a big risk factor. This patient's blood type is RH negative. There will be many restrictions on blood preparation. Can you prepare enough blood products?

We will contact the blood bank in advance, prepare enough blood products, and adopt a series of autologous blood transfusion techniques to assist.

If necessary, hypothermia can be used to reduce the oxygen consumption of tissue cells, which can prolong the application of vascular blocking technology.

The vascular occlusion technique is only a temporary application and does not need to be used during the operation. During the operation, the blood circulates normally, and the filled blood vessels are more conducive to separation.

——

The two discussed for a full two hours, and the people next to them sat silly and listened to their chat.

From clinical chat to basic medicine, and then from basic medicine back to clinical, anatomy, physiology, biochemistry, tissue embryos, pathology, pathophysiology, etc., all involve, the latest articles in various journals are constantly cited, and cardiovascular The results of experts, cross-integrated.

After the chat, Professor Li began to re-examine the young doctor. Dr. Yang has a super brain and an amazing amount of knowledge. His knowledge has far exceeded the depth and breadth that a surgeon should have. All are laborious.

He now somewhat believes that this young man still has some confidence in taking such a risk, at least the theoretical knowledge is fully prepared.

Professor Li decided to stay and complete the operation with Yang Ping.

Yang Ping asked Xiao Wu to book a room for Professor Li and Professor Wu at the Sanbo Hotel. Professor Qin said, Don't be too troublesome, I'll make the reservation. Just stay in the room next to me. I think the rooms next to me are empty.

Professor Qin also lives in the Sanbo Hotel, so that's fine. They are familiar with each other and can chat when they live together.

Yang Ping asked Song Zimo to call Keli's doctor to the classroom. He wanted to briefly explain the case to everyone, so that everyone could acquire some knowledge in advance, which would be beneficial to the implementation of the patient's entire treatment plan.

Everyone is in the department, only one Zhang Lin is missing.

Song Zimo smiled and said, Zhang Lin is explaining the basic operation of arthroscopic surgery to several young doctors in the training room, and several young doctors from Xiehe are also listening.

He told people about arthroscopy, and the progress was very fast.

He and Xiao Wu practice for one or two hours a day, and they are making great progress. They were just asked by the gynecology department to help out and showed an endoscopy operation in the operating room of the emergency department. Song Zimo reported the progress of the two people's learning by the way. Yang Ping gave Zhang Linxiaowu to Song Zimo for training.

Yang Ping didn't understand: Ask the gynecology department to help?

The emergency department admitted a patient with acute abdominal pain. According to the procedure of acute abdomen, nothing else was found. The color Doppler ultrasound of the uterus and ovary showed two strip-shaped moving objects in the uterus, and then an X-ray was taken. After asking about the medical history, the patient said that the two yellow eels had entered the body by mistake, and they were alive. The emergency department immediately called for a gynecological consultation. It is not very easy to take. The gynecologist is afraid of damaging the endometrium. I feel that the endoscopic operation is similar. I know that our arthroscopy operation technology is very good. Please let us feel that it is a bit overkill. Go and help, this kid didn't embarrass us, grab the pliers one at a time, and solve the problem in less than two minutes, and now he's in high spirits. Song Zimo will explain the origin of the dragon in the future.

This is not a strange thing. In the past, when Yang Pinglun was in the emergency department, he often encountered this kind of foreign body removal, rectal, urethral, ​​etc. There were also various foreign bodies, and they frequently broke through the ceiling of imagination.

Zhang Lin follows Yang Ping every day, and Song Zimo trains him strictly, and the tide rises. Whether in theory or practice, he naturally progresses faster than others, and his knowledge is wider than others.

Zhang Lin and Xiao Wu, you must be strict with them. Basic knowledge, basic theory, basic skills, and knowledge points must be 100% clear. Yang Ping instructed Song Zimo.

Where's Xiao Wu? How's it going?

Xiao Wu's hands-on ability is very strong, especially the endoscopic technology, which has improved very quickly. The basic skills of hand-eye separation and triangulation are very well mastered.

Song Zimo called Zhang Lin and asked him to go to the classroom for a meeting.

Soon, he came over, followed by a few young doctors. He was still explaining the main points of endoscopic operation, and it seemed that he was doing a good job. The doctors listened carefully and looked admired.