crazy scalpel

In the operating room, Professor Xu Wanjin, who had always been in the leading position, was lying unconscious on the operating table—he had been successfully anesthetized.

Shayk positioned his head in the best position, then scrubbed his nose and mouth with antiseptic.The pituitary gland is a brain organ that grows up during the embryonic period. It is located deep in the nasopharynx, and is adorned on the sphenoid bone like a jewel in a crown.Use a microscope and a tool with a rather long handle to penetrate the pituitary gland through the nostril. This method was proposed more than 100 years ago, and it was not until the past 30 to [-] years that a truly qualified instrument was developed.

Different from directly opening the head to expose the surgical area, since the nasal speculum needs to go deep into the sphenoid sinus through a long passage, and then cut open the front wall of the sphenoid sinus, it is a bit like a grave robber digging a hole and then passing through the long passage. The corridor, perhaps experienced some dangers, came to a huge door, the treasure behind this door is even more mysterious because of the hardships of the process.

The same is true for brain surgeons. The more difficult things are, the more they are likely to arouse their interest. However, the various difficulties in the operation seem a bit childish to Xie Ke today.

The operating room is staffed by colleagues that Xie Ke has always been familiar with, not only used to and understand, but also enough to repay his trust.

Under the focused eyes of these people, Xie Ke finished disinfecting, inserted the nasal dilator into the nostril for pre-stretching, passed through the middle meatus and reached the front wall of the sphenoid sinus.The nostrils of Chinese people are much smaller than those of Europeans and Americans, so although Xie Ke learned the technique from the California Medical University surgery video brought by Cai Tianqiao, he still made many changes.

Shayk not only chose a small expander, but also increased the pre-stretch time.For Xu Wanjin, who is a patient with Alzheimer's disease, the shorter the operation time, the better, but it is also very particular about where and how to shorten the operation time.

If in order to speed up the operation process, the nostrils and nasal mucosa were torn, the loss outweighed the gain, so Xie Ke proceeded very slowly at the beginning of the operation.

Generally speaking, the lower nasal passage is relatively wide. When Xie Ke inserts the dilator into the nasal cavity, it goes down first, and then slowly raises up along the anterior wall of the sphenoid sinus. In the process, the damage to the nasal septum is avoided. This first step is regarded as finished.

Finding the opening of the sphenoid sinus is the key to accurately locate the sphenoid sinus.It is located on the anterior wall of the sphenoid sinus, on both sides of the nasal septum, and on the medial side of the superior turbinate.For Xie Ke, it is the keyhole. If you want to open the door correctly, you must first find it.

Xie Ke intentionally let his fingers indicate the position of the sphenoid sinus ostium, so as to save the time of searching with dilators.But he couldn't stick his fingers into Professor Xu's nostrils. With a thought, he thought of what Li Shiguang had said to him.

It's just an organ that communicates perception and doesn't need to be deformed.

Xie Ke held the spreader and kept it still. He slowly closed his eyes, and the field of vision under the microscope suddenly disappeared.Xie Ke tried his best to find a way to convey his thoughts of "seeing" clearly to his fingertips.At the beginning, there was still darkness in my mind, but gradually, the real space centered on the fingertips suddenly appeared in Xie Ke's consciousness, and this space gradually became larger, clearer, and finally frozen.

Xie Ke clearly felt the existence of the sphenoid sinus mouth in his own consciousness, and this feeling was much more advanced than vision.Shayk opened his eyes, and moved his head back slightly, keeping his eyes away from the microscope.The feeling didn't disappear, but merged with the vision instead.

really can!Brother is great!If it wasn't for the operation, Xie Ke would have jumped up and punched a fist in the air to celebrate.

After feeling the position of the ostium of the sphenoid sinus, Xie Ke shook his head slightly, withdrawing the signal from the brain to the fingertips, so that the feeling would disappear first.After all, Xie Ke didn't dare to use the technique on Professor Xu without proficiency.Fortunately, he already knew where it was, so he went through the microscope again and used the dilator to move horizontally on the anterior wall of the sphenoid sinus, and finally stopped at a place slightly below the midline.

Under the microscope, a crescent-shaped concave mucosa can be clearly seen, which is the position of the ostium of the sphenoid sinus.

This is the position where the upper edge of the front end of the dilator is placed, and it is also the upper edge boundary of the sphenoid sinus fenestration.In order to make the opening position of the sphenoid sinus more suitable for tumor resection, Xie Ke had already thoroughly analyzed the preoperative imaging examination.The relationship between tumor and sella, sella and sphenoid sinus, sphenoid sinus cavity and sphenoid sinus walls, anterior inferior wall of sphenoid sinus and nasal cavity has been deeply imprinted in Xie Ke's mind, and now it is more in line with his special perception Ability to know the location of various organs and tissues in the operation area.

After placing the dilator in place and letting it stretch for a period of time, Shayk began to remove the mucous membrane at the junction of the anterior wall of the sphenoid sinus and the root of the nasal septum. These mucous membranes need to be separated sharply, otherwise it is easy to accidentally injure the nasal mucous membrane.Then he pushed the nasal septum together with the superficial mucosa to the opposite side, and separated the nasal mucosa on both sides of the bony septum to reach the bottom of the sphenoid sinus, exposing the bone.

Xie Ke used the sphenoid crest, a bony raised structure at the junction of the nasal septum and the anterior wall of the sphenoid sinus, as the surgical midline.The vomer is constant on the midline, which is the main anatomical landmark to determine the midline to avoid left-right deviation, while the single nostril direct approach needs to push the bony septum to the opposite side, so the positioning landmark is not obvious, so the main basis for determining the surgical midline The upper end of the remnant sphenoid crest.This is why Xie Ke placed the sphenoid crest in the middle of the surgical field.

When opening the sphenoid crest, Xie Ke entered along the midline, and used the rongeur to bite open the anterior wall in three directions: downward, external, and internal, downward to the bottom of the sphenoid sinus, outward to the sphenoid ethmoid recess, and internal to remove the sphenoid bone Mouth, sphenoid septum, and part of the vomer.

After entering the sphenoid sinus, Xie Ke identified the bone of the cavernous sinus and the bottom of the sella, and opened the bone window of the bottom of the sella.Due to the relatively large height of the tumor, Xie Ke opened the bone window as close as possible to the sella tubercle to facilitate resection.

After receiving the puncture needle handed over by the nurse, Xie Ke performed an intrasellar puncture through the dura mater to confirm that there was no cerebrospinal fluid and arterial blood drawn out, and cross-cut the dura mater.In this way, the tumor can be completely removed under direct vision.

Xie Ke followed the bottom-up principle, first resecting the tumors developed in the sellar, cavernous sinus, and parasinus, and then resecting the tumor in the suprasellar part.

The assistant next to him could see Xie Ke's flexible movements on the display, using curettes of various specifications to scrape the tumor from various incredible angles.The texture of the pituitary tumor is soft, and Xie Ke will have obvious resistance prompts when he scrapes the tumor border, so he let go even more. In addition, he himself has a perception talent that others can't imagine, this speed is quite impressive. look sideways.

After the tumor was resected, Xie Ke placed a suction device in the tumor cavity and rinsed it repeatedly with normal saline to further remove the residual tumor tissue.After all this was done, Xie Ke found no residue under the mirror, but to be on the safe side, he used his perception ability again to reveal the operation area in his consciousness.

This time, he really caught a little fish that slipped through the net.After verification, Xie Ke was quite confident in his perception, so he did not open the C-arm again, but directly used the tumor removal forceps and the suction device to remove the hard and stubborn tumor under the perception.

Looking at the cleaned operation area through the monitor, the assistant's admiration was beyond words, but when he saw Xie Ke take out another piece of light yellow tough tumor tissue from nowhere , I simply shouted evildoer in my heart.

After the tumor was resected, Xie Ke used bio-protein glue to fill the residual cavity. There was no cerebrospinal fluid leakage during the operation, and there was no need for saddle bottom repair, which was perfect.And it takes only half an hour.

The first thing after the operation, Xie Ke looked at the anesthetist Feng Daqiang.Xie Ke breathed a sigh of relief when Feng Da gave him an ok gesture.

Coming out of the operating room, I heard Feng Dada catching up from behind, "Xie Ke!"

Shayk turned to wait for him.Feng Daqiang put his shoulder lightly on him, "Don't worry, you can wake up within an hour."

"I know," Xie Ke rubbed his fingers and said, "Of course you and I can rest assured."

"Let's go together. Just in time, I have something to tell you." Feng Daqiang's voice was a little heavy.

Hearing this, Xie Ke cheered up and looked at the other party.

Although the operation went well, he was under a lot of pressure. He had been suppressed because of his full concentration just now, but now that the operation was over, he was exhausted and broke out like a flood.After the operation, he would always relax completely, which is what most surgeons do, closing their eyes and resting their minds or other specific habits.

As for Xie Ke, his favorite thing to do is to go to the small garden downstairs to rest.

Feng Daqiang used to go to the small garden downstairs with Xie Ke after the operation before, but they usually talked about gossip or boring things in tacit understanding. They had never passed by so seriously like this time. Most people don’t feel tired when they feel tired. Like to talk about business.So this is a bit strange.

Amidst the singing of birds and the fragrance of flowers, Xie Ke looked at Feng Daqiang who was a little silent, and asked, "Don't you have something to say? What is so important?" He will have other operations later, what exactly does Feng Daqiang want to tell him?

Feng Daqiang clenched his fists on his knees, then loosened them, and finally sighed and said to Xie Ke: "Xie Ke, I'm afraid that operation just now will be the last time we cooperate, and I really don't want to part with it. To be honest, you are the most powerful surgeon I have ever seen, and Cai Tianqiao can't compare to you."

"What?" Xie Ke only felt that there was a bolt from the blue. Feng Daqiang was his favorite anesthesiologist. This was one of the reasons why he would stay in the No. [-] Hospital in the city. "Are you going to change jobs? Where are you going?"

Feng Daqiang looked at him and said, "I'm going abroad."

Xie Ke's mouth moved, but what he finally asked was not why but: "When?"

"I knew you wouldn't persuade me," Feng Daqiang pretended to be wronged: "Actually, you are quite indifferent. I can't even bear you, so can't you express it?"

Xie Ke: "..."

Feng Daqiang suddenly smiled again: "Forget it, even if you beg me to stay by your side, I can't agree. After all, it's all arranged. I'll leave next week, and you can come see me off when the time comes."

Xie Ke: "..." Can you still say no?