The Godfather of Surgery

The aorta and inferior vena cava are separated all the way to the fissure of the diaphragm.

In addition to separating the main trunk, they must also separate their numerous branches. The branches must also be separated to a sufficient length. Otherwise, when the spine is corrected, the strong pulling force will tear off the blood vessels, causing the patient's chest to fill up with blood instantly.

There are too many branches, each root has branches, and almost all major branches are separated in this way.

This is a meticulous work, and there is no way to get up quickly. Little by little, Yang Ping's knife tip separates those old adhesions.

This requires enough patience, not impatient, not discouraged, not slack.

In addition to the heart and great blood vessels, the thoracic cavity also contains the thymus, lungs, trachea, and bronchi.

Now that the problems of the heart and great blood vessels have been resolved, the thymus does not need special treatment, and the rest is the problem of the lungs and trachea.

Under the blowing of the ventilator, the lungs shrank one by one, and the lungs are currently in very good condition. They will not be involved in the next spinal correction, and some adhesions are also easily handled by Yang Ping.

But the trachea and bronchi are not so optimistic and must be properly separated like the great vessels.

The trachea and bronchi are behind the heart and great blood vessels. Yang Ping placed two rubber strips, bypassing the aorta and superior vena cava respectively, pulling them to both sides, and then clamping the two ends of the rubber strips with large curved forceps. Give it to the second and third assistants responsible for revealing.

The retracted aorta and superior vena cava reveal a window, and the hidden trachea and bronchi are revealed.

If there is no separation of the aorta and superior vena cava before, so that they can be formed independently, there is no way to retract them, and the trachea and bronchi cannot be exposed. Without exposure, surgery cannot be performed, and exposure is a necessary condition for surgery.

The exposure of the trachea is easier than the exposure of the blood vessels, because the annular fibrocartilage structure makes it easier to identify than the blood vessels and the surrounding adhesion tissue.

The trachea and bronchi are freed, and the processing of the thoracic organs is not over yet. The organs must be properly suspended and fixed in the human body, otherwise they will be stacked together due to gravity and movement.

Yang Ping has taken this into account, and when dealing with adhesions, some adhesions suitable for hanging are retained, but such adhesions are very few.

In order for these organs to get good fixation, it is necessary to rebuild the suspension for them at key nodes, which seems simple, but is very complicated.

If there is no suspension and fixation, it is very simple. When running, the five- to eight-meter-long intestines are either piled together by gravity, or twisted and knotted with each other, but in fact we do not, let alone running, even if we turn a few somersaults, The internal organs and intestines are still fixed in their original positions.

This is because our viscera has a special structure to fix it. This fixed structure is some membrane, but the fixation should not be too dead, and the viscera must be given a certain space for pulsation or peristalsis.

Several large blood vessels from the heart extend in all directions and have a fixed role, but this is far from enough. The main structure of the fixed heart is the pericardium, so after the pericardium is peeled off, it is enough to stop, instead of removing all the pericardium and letting the heart become light Yogurt eggs.

The organs in the abdominal cavity are fixed to the body wall by the omentum, mesentery, and ligaments.

The intestine is wrapped and fixed by the omentum and mesentery, and the liver, gallbladder, pancreas and spleen are also fixed by many ligaments.

Therefore, after separating the organs of the chest cavity, it is necessary to rearrange the layout and return to a normal state. Another key part is to correct or rebuild their fixed structures, so that they can be in their respective positions and stick to their posts.

This is beyond the understanding and ability of general surgeons. Few surgeries need to be considered so comprehensively. Except for joint ligament reconstruction in sports medicine, visceral ligament reconstruction is rarely considered.

Most of the ligament structures have been separated by Yang Ping, but because of contractures, they need to be lengthened, very few need to be shortened because of laxity, and some ligaments need to be reconstructed.

Considering that the reconstruction of the ligament will take some time to heal, Zheng Baosheng will be restricted from activities after the operation. He will do moderate activities in bed within two weeks, and will start activities on the ground after two weeks. He will not be able to play sports for three months.

Yang Ping began to operate on these ligaments and mesangium again, lengthening, shortening, or reconstructing. At this time, the resected pericardial tissue was used for waste utilization and became a material supplier for reconstruction.

Every ligament has been carefully processed, and the organs in the chest cavity are not processed. It seems that they are still squeezed together as before, but this is only a superficial phenomenon. In fact, they have said goodbye to the previous adhesion.

It's just that the space is limited and I have to still squeeze together.

If the spine suddenly returns to its normal curvature, and the entire thoracic volume expands, these organs can immediately be distributed in the thoracic cavity and in the correct position as in a normal person.

Diaphragmatic hiatus, the space between the thoracic cavity and the abdominal cavity, the aorta, inferior vena cava, vagus nerve, and esophagus all enter the abdominal cavity from their respective spaces.

The diaphragm of the dome structure, now also like a collapsed roof, has lost its proper shape and is full of folds. If these folds are not opened, once the spine is orthopedic and the volume of the thoracic cavity is restored, they will also be pulled and torn. .

The diaphragm is like a folded lotus leaf, opening the folds, allowing it to acquire the ability to open to accommodate the normal posture in the future.

After the diaphragm is processed, the abdomen is opened, and the abdomen is also a midline incision.

Below are the liver and pancreas?

Professor Li was cautious, holding his breath even when he spoke.

Yang Ping nodded.

Crossing the diaphragm and entering the abdominal cavity is no longer Professor Li's specialty.

Let Dr. Song come? Yang Ping felt that it would be more appropriate for Song Zimo to be his assistant next.

In the training of compound trauma surgery, Song Zimo is very proficient in the anatomy of the whole body. In terms of the heart and great blood vessels, Song Zimo is far inferior to Professor Li Zehui, but in the anatomy of the abdominal cavity, he must surpass Professor Li, regardless of his fame.

Seeking truth from facts is the doctor's greatest conscience.

After the treatment of the diaphragm, Dr. Song will be the first assistant, and I will be the second assistant.

Professor Li abides by the arrangements of the chief surgeon.

The organs in the abdominal cavity are much more optimistic than the thoracic cavity, and the extent of their transformation is much smaller.

——

A group of orthopedic bigwigs, waiting to see scoliosis correction, are now looking at thoracic surgery with great interest.

How can young people be so proficient in anatomy, especially heart and major vascular surgery, whether it is adhesion separation or suspension fixation, it is simply amazing.

If he has such anatomical skills, any operation in his hands will be much easier than others.

Such young talents, Professor Qin likes more and more.

Even if we don't poach it, we must make Sanbo Hospital the medical center of 301 in the south.

With the support of the leader and your own efforts, 80% of this can be successful.

——

The operation of abdominal organs, Yang Ping completed quickly, almost all adhesions were separated, no fixation was required, and the original ligament position and length did not need to be corrected.

After the organs in the thoracic and abdominal cavity are processed, the operation on the front route is completed.

The almost impossible operation was successfully completed in such an orderly manner by Yang Ping.

At this time, Professor Li's heart was not only worship, but also worship.

If he hadn't seen it with his own eyes, he wouldn't have believed that someone could perform such an operation, or that someone could be so proficient in human anatomy.

You rest for a while, I'll close your chest and abdomen. Professor Li used the attitude of a help.

Yang Ping really needed a break, and he handed over the rest of the work to Professor Li and Song Zimo.

They began to irrigate the surgical area, then placed a drainage tube, sutured in layers from the inside to the outside, closed the thoracic and abdominal cavities, drilled the split sternum, and fixed it with several pairs of wires.

Next, do the scoliosis correction in the prone position.

Remove all sterile sheets, turn the patient over to the prone position, and re-sterilize the sheets.

Change of body position after bed is standardized.

It requires several people to operate, how each person stands, what work is responsible for, and the posture of the hand, there are operating specifications.

A head nurse in the operating room of Union Medical College has written a book called Asana for Safe Surgery.

This should be the only monograph in China that systematically introduces how to set the surgical position.

In European and American countries, the operating room has a special body therapist, who specializes in helping the patient to set the body position, so that the doctor can perform the surgery comfortably.

Don't underestimate the patient's surgical posture, a good posture can make the operation more effective. Poor or wrong posture often increases the difficulty of surgery, sometimes makes it impossible to complete the surgery, and causes some complications.

This is the gap between a technology from rough to fine.

If Zhang Lin and Xiao Wu can write Surgical Retraction Science into a book, it will definitely fill the domestic gap, and the pioneering work may also fill the gap in the world, because they have pushed the pulling hook technology from rough to fine.

The apple falls from the tree, and when it is studied carefully as a science, the result is immeasurable.

——

Little Wu, Zhang Lin, come on stage!

After changing the ten thousand position, Yang Ping took off his surgical gown and gloves and rested for a while. Song Zimo led them to sterilize and lay out the sheets first, incised to expose, and screwed the pedicle screws.

Good!

Zhang Lin dragged the urine bag and followed Song Zimo out to brush his hands.

Because of walking too fast, the urine bag swayed on his thigh.

Professor Li saw the urine bag hanging from Zhang Lin's trousers and immediately knew what was going on.

Thinking back to when he was still a junior resident doctor, he once drank a lot of beer with a senior resident doctor and encountered an emergency operation. Professor Li had no choice but to sneak up on stage with a urine bag hanging on it. At that time, Professor Li's role in the operation was the second assistant.

The senior doctor who drank with him was not as smart as he was. He was an assistant on the operating table and couldn't hold back his urine, so he had to apply to the instructor: urinate!

The tutor was very angry, and when the assistant got off the stage to urinate, he said to Professor Li, I remember you, and you will be the assistant in the future.

A urine bag changed Professor Li's position in the mind of his mentor.

Those who can achieve success are those who can be cruel to themselves.

This kid actually has the shadow of his past.