The Godfather of Surgery

Zhang Lin is arranging Fang Xiaoyun's emergency operation, the doctor's order under the computer HIS system, the operation review, the operating room is notified, and Huang Jiahui is contacted to prepare the instruments.

Huang Jiahui's main products are in the field of sports medicine, but in order to cooperate with Yang Ping's surgery, Huang Jiacai applied for the agency of several trauma, spine and joint consumables to complement the product line.

Yang Ping instructed Zhang Lin to ask Su Yixuan to prepare a choledochoscope for general surgery, equipped with a flexible mirror, which should be used during the operation. Zhang Lin did not know what the equipment for general surgery was for, and did not dare to ask more.

Fang Xiaoyun needed an anterior thoracic vertebra surgery to open the chest and enter the front of the 9th thoracic vertebra, remove the 9th thoracic vertebral body invaded by tuberculosis, and remove the oppressive material in the spinal canal.

The 4th thoracic vertebrae to the 9th thoracic vertebrae are dangerous areas. The blood supply of the spinal cord is fragile and the blood supply is easily damaged. Once the blood supply is damaged, it is easy to cause ischemic necrosis and degeneration of the spinal cord. Not only will the paraplegia not recover, but it will also worsen, and it will be permanent. sexual.

In the system space, Yang Ping has undergone a lot of anatomical training and a lot of training in spinal trauma surgery, but he has never done surgery for spinal tuberculosis.

With the experience of spinal trauma surgery, it was easy to win this surgery, but for the sake of safety, Yang Ping went to the system space and purchased 300 cases of spinal tuberculosis surgery, and carried out special training, especially the operation of the 4th thoracic vertebrae to the 9th thoracic vertebrae. , When removing oppressive substances, try not to interfere with the blood supply to the spinal cord.

Now I hold hundreds of thousands of points in my hand. As long as I don't simulate surgery at every turn, this point can be dealt with for a long time.

For the treatment of spinal tuberculosis, some hospitals use minimally invasive methods. For example, a professor from 301 Hospital has accumulated rich experience in minimally invasive methods.

He believes that spinal tuberculosis can be treated with internal medicine. The specific method is to use CT to locate the puncture, inject anti-tuberculosis drugs into the infected site, carry out local anti-tuberculosis treatment, and then cooperate with systemic anti-tuberculosis treatment until cured.

This method has caused sharp discussions in academic conferences, but it is undeniable that the professor has opened up a new idea, at least for some cases that are not very serious.

Fang Xiaoyun could not use this minimally invasive method and could only perform surgery, because she had developed paraplegia, and the reason for the paraplegia was that the spinal cord was compressed by a mixture of pus, granulation tissue, caseous necrotic tissue and sequestrum.

Open surgery must be done to directly remove the compression material in the spinal canal, completely relieve the compression of the spinal cord, and allow the spinal cord to recover as soon as possible. This is in line with the three principles of spine surgery - decompression, stabilization, and correction!

Comprehensive Orthopedics has its own independent operating room, which makes the arrangement of surgery very convenient. As long as the patient's condition allows, surgery can be performed at any time.

In less than half an hour, everything was ready. Su Yixuan and Zhou Can prepared surgical instruments. Huang Jiahui's anterior spinal plate was in place, sterilized and ready to use.

Yang Ping's team has made rapid progress. The first assistant, Song Zimo, has a very high talent, is full of passion for surgery, and unswervingly strives to be the best surgeon.

Now, as Yang Ping's assistant, he did not fail to challenge Takahashi Sasaki. In the operation of the academic society, when Takahashi was in trouble and could not proceed, he could still handle ten blood vessels.

In terms of microsurgery, although there is a big gap with Yang Ping, he is already an unsurmountable peak compared to others. At the current level, he has cut the tail of a newborn mouse into countless pieces and let Song Zimo anastomos the blood vessels. The blood circulation is smooth, and it can also be done with both hands in the air.

Arthroscopy, thoracoscopy, laparoscopy, and foramenoscopy are all extremely proficient, not to mention open surgery. Under the guidance of Yang Ping, the proficiency in anatomy is by no means comparable to that of ordinary people.

If someone wanted to challenge Yang Ping, they had to climb the mountain of Song Zimo first, but this mountain was very difficult to climb.

The status of Xiaowu Zhanglin's golden hook and silver hook has not been clearly distinguished. The two are comparable, and it is difficult to distinguish Zhongbo, but it is not denied that they are the best second and third assistants.

Anesthesiologist Liang Fatzi is as passionate about anesthesia as food, and he enjoys his role from beginning to end.

Needless to say, nurse Su Yixuan, Yang Ping's most tacit partner, Tiancheng's tacit understanding, makes the cooperation of every operation flawless.

Zhou Can is the best itinerant nurse, and if he takes office, he is also an excellent instrument nurse.

The most important thing is that they have gone through battle after battle, especially the operation that Takahashi did not win, and the confidence of the team has greatly increased. They firmly believe that they are the best team in the world.

Fang Xiaoyun's important imaging examination films are hung on the reading light, which is convenient for the surgeon to view at any time. There are also images and pictures on the electronic screen, which can be seen with a little head up.

Endotracheal intubation was performed under general anesthesia. The patient was placed in a 90-degree left lateral decubitus position. The right upper limb was lifted up and placed on the support frame.

Posture is very important for surgery. A good position can be fully revealed, and an improper or wrong position can make exposure difficult or even impossible.

Fang Xiaoyun had a tracheal tube inserted in her mouth, which was connected to the anesthesia machine. The head frame was placed on top of her head, her eyes were protected and fitted in the closed position, and various bony prominences in her body, such as the sacrococcygeal region, were protected by silicone protective pads. In order to avoid ischemic necrosis due to compression, a thin pillow is also placed on the right upper chest and axilla, so that the axillary artery, axillary vein and brachial plexus are well protected.

Zhou Can checked whether Fang Xiaoyun's upper limbs were colorless or purple, whether there was venous congestion, and whether the radial artery pulse was normal. It was confirmed that there was no problem. Song Zimo sterilized and laid out the sheets, and everything was ready. Yang Ping wore a surgical gown and gloves and came to the stage.

The sacred pre-operative check is not only to prevent mistakes in the surgical site and method, but more importantly, it is a ritual that expresses the seriousness and dedication of the surgical team.

"Name, gender, age, hospital number, body position, surgical site, surgical method, anesthesia method, surgical concerns, anesthesia concerns—"

Stop all the work at hand, check every item, and every member of the operation must participate. If there is any objection raised on the spot, if there is no objection, it will be announced: the operation begins! Only then can the knife be moved.

Through the transthoracic approach, along the superior border of the 8th rib, from the outer border of the erector spinae to the anterior axillary line, incise the skin, subcutaneous tissue, and deep fascia, and continue to incise the muscles: the latissimus dorsi of the first layer, the second layer The serratus anterior and the external oblique muscle originate from the outer edge of the erector spinae, and the third layer of the external intercostal muscle and the intercostal muscle is cut to protect the intercostal nerve and intercostal artery and vein on the lower edge of the rib.

The parietal layer of the pleura was exposed. Yang Ping used a knife to cut a small incision in the parietal layer of the pleura. The air immediately entered the chest cavity, the negative pressure disappeared immediately, and the lung on one side gradually collapsed.

There was adhesion between the lung and the pleura, and the tissue was cut over. Yang Ping cut the band-like and membranous adhesions, the lung was completely collapsed, and the saline gauze protected the chest wall.

The chest opener gradually opens the chest, the beating heart and a pair of contracted lungs are vividly presented in front of you, especially the beating heart, the thumping sound, the rhythmic pulsation, which represents the power of life, From birth until death, it beats at its own rhythm day and night.

Sometimes, in chest compression, you need to hold the heart in your hand. At that time, you can feel the magic of life, because life is in your palm.

Yang Ping stopped what he was doing: "Come and see!"

The observing Pearson and the intern lifted their pedals and looked into the chest cavity with a probe one meter away from the operating bed. The heart and lungs were presented alive in front of them.

Seeing this scene, it is easy for people to involuntarily develop a sense of holiness, sublime and responsibility.

Respect life, respect life! The impact on the heart is stronger than taking the oath of a medical student a thousand times.

Life is displayed in front of you in a pulsating picture. When it stops, the whole life disappears and has no connection with this world. It is still beating, you can laugh, cry, love, hate, and experience the world. All sweet and sour.

The dissection has entered the realm of freewheeling and perfection. The lung tissue is covered with saline gauze and gently pulled to the midline. The lateral anterior and posterior mediastinum of the thoracic vertebrae are exposed.

The whole process of cooperation is carried out silently. What should the assistant do at each step, the position, direction and strength of the retractor do not need to be reminded. The equipment nurse has a very detailed understanding of the surgical steps.

The knife, without even looking at it, the equipment nurse has already handed it over, and the timing is right. The feeling of doing this surgery is very wonderful, it is heart-to-heart communication.

Longitudinal incision of the mediastinal pleura revealed the left thoracic aorta and hemizygos vein, right azygos vein, and intercostal artery and vein.

These blood vessels need to be cut and ligated to obtain adequate exposure, but the intercostal artery is one of the main blood supply arteries of the spinal cord, and the number of cut off cannot exceed 3, otherwise it will cause blood supply to the spinal cord.

A true expert, he adheres to the concept of minimally invasive surgery throughout the operation, and does everything possible to protect blood supply and tissues. Yang Ping did not intend to cut and ligate these blood vessels, he wanted to protect every blood vessel supplying the spinal cord.

Entering from the gap between the blood vessels, the gap between the blood vessels will form several operation windows, so the operation will be very difficult, but for Yang Ping, this is not a problem.

Enter from the space of blood vessels, use a periosteal peeler, push the extrapleural aorta away from the front of the vertebral body, protect it with saline gauze, and gently put it into the retractor.

The surrounding area is protected by saline gauze, and the operating space is presented. The front of the thoracic vertebral body, the intervertebral disc and the anterior longitudinal ligament will soon appear in the field of vision. However, it is a volatile cyst.

This is an abscess, Xiao Su handed a 50ml syringe, Yang Ping stabbed a small hole with a sharp knife, the sticky white-yellow "cheese", along the small hole at the front of the syringe, can't wait to enter the syringe barrel, the syringe is quickly filled , change the syringe and continue to suck.

The collected specimens were reserved for bacterial culture and pathological examination. Five tubes were drawn in a row, aerobic bacteria culture, anaerobic bacteria culture, tuberculosis culture, smear for acid-fast bacilli, and pathological examination.

At this time, the assistant's suction device entered the field, and it was gently inserted from a small mouth to remove the remaining "cheese". This suction device was specially used to attract "cheese". The itinerant nurse began to calculate the volume of "cheese", a full 1000 ml.

Yang Ping completely opened the cyst wall of the abscess, and repeated saline irrigation and suction until the operation area was clean, and the operation continued.

"It's pretty!" Zhang Lin said.

Xiao Wu looked up at him: "Indeed, it's a pity that I can't smell the smell."

"Will it be a sweet smell?"

"I heard it's sour."

Unexpectedly, the cheese-like substance of the cold abscess still has such a good sense of picture. Zhang Lin Xiaowu sighed at the same time, but the wire pattern of the hook in his hand did not move, the strength was appropriate, and it was fully revealed.

The gold hook and the silver hook are not blown, but are won by the excellent retractor performance of countless operations.

"Congratulations, you are one step closer to a good surgeon."

Yang Ping has exposed the anterior side of the ninth thoracic vertebra and began to ligate the surrounding blood vessels.