The Godfather of Surgery

"Dr. Yang!"

Yang Ping walked very fast, and Gao Qiao trotted along with him.

Soon, everyone entered the elevator.

"Mr. Takahashi, what do you think of this patient?"

Takahashi is an internationally renowned trauma surgeon. He is by no means a generalist. He must have his own unique insights in many places.

"I just saw that the professor wanted to use the resuscitative endovascular aortic occlusion balloon (REBOA) technology, but the femoral artery of the injured person was damaged and the balloon could not be successfully implanted. The current general REBOA technology has fallen behind. With intelligent REBOA technology, using portable equipment and ultrasound guidance, it can enter the aorta from any relatively thick artery in the human body, such as the subclavian artery, radial artery, brachial artery, femoral artery, popliteal artery, and even dorsal foot artery. It can find its way on its own, and even if it enters from an upper extremity artery, it can cross some dangerous bifurcations and enter the aorta to deliver the balloon to the intended location."

Everyone was in a hurry and spoke very fast. Although Gaoqiao's Chinese was a little unfamiliar, he could express his meaning clearly and there was no problem at all.

"If Dr. Yang is interested, I will send the complete set of materials to Dr. Yang, but the precise vascular occlusion technique that Dr. Yang has just used is already one level ahead of our simple aortic occlusion!"

Takahashi was surprised that Yang Ping actually asked for his opinion, and his attitude towards him was not condescending, but equal treatment.

And the last time I came to China, my arrogant attitude seemed so narrow, it was like a clown, and Dr. Yang was the real master.

Soon everyone rushed to the dressing room of the operating room, and the discussions on the road stopped, and there was no time for academic discussions.

Everyone hurry up to change clothes, the wounded has entered the operating room through another special channel.

Usually when I change clothes, the clothes I take off will be folded and put in their respective cabinets. Now I take off the clothes and throw them into a pile, and no one cares when they throw them on the ground by mistake.

"Senior brother, please, save her, okay?" Song Zimo lowered his head and put on his pants.

This kind of injury, who can guarantee to save it, can only strive for it with all its strength. Whether it can survive or not really depends on the sky.

Yang Ping didn't understand how Song Zimo, who was always rational, could suddenly say such sentimental and wishful words.

Song Zimo put on his pants and looked up, Yang Ping saw that his eyes actually contained tears.

Yang Ping understood immediately, and put his hand on his shoulder: "I will definitely bring her back to life!"

Yang Ping doesn't know if he can live or not, and Yang Ping doesn't know if he can survive the operation. This is a good wish.

The wounded was pushed into the operating room and transferred to the operating bed, where Fatty Liang was already waiting.

"I have blood pressure, 65/30mmHg!"

The blood pressure was finally measured, and the first nurse to find it was so surprised that she burst into tears.

In this kind of trauma, the main cause of death in the early stage is massive bleeding. If the bleeding can be successfully stopped, there is a glimmer of hope for blood transfusion and fluid replacement.

Yang Ping sent more than a dozen blood vessel clips, large and small, into the abdominal cavity, accurately blocking almost all possible bleeding.

This will continue to control the blood loss to a minimum, and there is still a glimmer of hope for success after blood transfusion and rehydration.

Because the feces contaminate the abdominal cavity, the autologous blood transfusion machine cannot be used, and only conventional allogeneic blood transfusion can be used.

Two blood transfusion sets with heating function continuously pressurize blood transfusion, and blood products are continuously injected into the body of the wounded from the bilateral subclavian veins, but blood transfusion is not unlimited, and to a certain extent, it will cause some complications disease.

Those blood vessels can not be blocked for too long, the safe time is 60 minutes, and the operation should be completed within 60 minutes from the time of blocking.

Fatty Liang's hands never stopped, dopamine, epinephrine, etc., all kinds of rescue drugs are pushed from the veins, blood pressure slowly rises, the anesthesia machine is connected to the tracheal tube that has been inserted, and various parameters can be adjusted easily.

Hearing the sound of the wheels of the carts rubbing against the ground outside, someone opened the induction door of the operating room in advance and blocked the induction area with their hands, so that the blood-sending cart could enter the operating room smoothly and without delay.

Another car of blood bags came in, with suspended red blood cells and plasma. The nurse was very skilled at changing the blood bags, pulling them out and inserting them into the suspension, all in one go.

Several instrument tables have been laid out, Xiao Su has put on the surgical gown, the instruments have been classified and divided, the first used has been picked out, the needles and threads are put on, and the sticky notes for the distinction of alcohol and saline are also pasted.

Their respective work is carried out at the same time, and there is no need for anyone to direct them, let alone shout loudly.

Those who are allowed to observe, suppress the sudden heartbeat, and consciously stand in the corner so as not to interfere with the operation.

Anesthesia was successful, blood pressure continued to rise, and it was as laborious as free rock climbing.

Takahashi judged based on his rich professional knowledge that if he performed the whole operation, it would take at least four hours. If the multidisciplinary joint model was used, each surgical injury site would be performed by doctors of different specialties, and the operation time might take eight. Hour.

Experts from general surgery, urology, and obstetrics and gynecology rushed to the operating room one after another. The trauma emergency center was originally a multidisciplinary model, but it was dominated by trauma orthopedics.

Seeing that Yang Ping is here and is about to take the stage, everyone has no plans to take the stage. Yang Ping's surgery authority can do trauma to the whole body. This is licensed by the hospital, and he does it better than everyone else.

This operating room is very spacious. Since everyone is here, they will stay to observe and study. This kind of trauma is too rare.

Rinse, repeatedly rinse with a large amount of normal saline, hydrogen peroxide, normal saline, type III iodine, normal saline, regardless of the quantity, alternately rinse a lot.

A large amount of feces contaminates the abdominal cavity, and the possibility of infection is very high. Many open fractures of the pelvis are contaminated by feces, and finally patients die of serious infections.

Rinse, keep rinsing, keep diluting the bacteria, that's the best thing to do.

Yang Ping flushed almost paranoidly, and the mixture of blood clots mixed with stool was constantly diluted and flushed.

His sterile gloved hands were tumbling in the abdominal cavity, allowing the pulse jets in Song Zimo's hands to be flushed without dead ends.

The three-liter bag of physiological saline is suspended, passed through the pulse flushing machine, connected to the flushing tube, and the water flow is sprayed from the flushing head.

The normal saline was consumed very quickly, and the itinerant nurses kept changing it. There were already more than 20 bags in the bucket with empty bags.

And the barrels that collect the liquid, the water level keeps rising, and it contains a lot of dirt.

Yang Ping and Song Zimo did not go to wash their hands until the rinsing liquid was clear.

Zhang Linxiaowu, who has already brushed his hands, began to disinfect and lay out the sheets, which were seamlessly connected.

In order to save time, Yang Ping brushed his hands much faster than usual, and the movements were simplified.

Electrocautery, double-click electrocoagulation, suction tube, and irrigation tube have been connected.

Yang Ping put on a surgical gown and gloves, and started the operation, and the usual pre-operative verification procedures were naturally omitted.

The knife extends the abdominal wound to expose the entire abdominal cavity as much as possible.

The two big S pull hooks were gently placed, and the small five Zhang Lin was in place.

A full set of new pipes, continue to be responsible for flushing, after flushing, everyone changes gloves.

Yang Ping put his hands in, and carefully probed the abdominal organs one by one to determine which ones were worth repairing and which ones needed to be decisively removed.

The spleen has been shattered, and Yang usually ligates blood vessels, sometimes separates his fingers, and sometimes separates tissue scissors. The switching of different instruments is dazzling.

The action was so fast that I couldn't see the steps at all. Very quickly, it was like a smashed spleen was successfully removed and thrown into a metal basin.

He didn't stop for a moment, and he began to remove the broken right lobe of the liver. The removal of the right lobe of the liver was originally a difficult operation, but in his hands, some steps did not even need to be revealed, and were completed by touch.

Those who ligated blood vessels, removed the gallbladder, and separated the right lobe of the liver. I couldn't see the steps at all. The vascular forceps went in with the silk thread, tied the knot, and then the tissue was cut in and separated. After a few rounds, the gallbladder was taken out, followed by the broken right lobe of the liver. also taken out.

The pancreas is from the head of the pancreas to the tail of the pancreas, and the hand is gently touched, turned over, and quickly explored.

The hand immediately changes the target, starting from the stomach, from top to bottom, to explore the entire digestive tract of the abdominal cavity, there is a contusion in the stomach, no need to deal with it, the small intestine is turned over while touching the hand, so that the eyes can see the circumference of the intestinal tube and the mesangial blood vessels , the information collected by touch and vision is integrated in the brain and converted into accurate and unmistakable judgments.

Yang Ping's proficiency in anatomy has reached the realm of freedom at will, and he can accurately identify the anatomical structure without even looking at it.

The hand stretched out, the handle of the knife was slapped in the hand, and before everyone could breathe, the small intestine was cut to decompress, the hand continued to go down, the smooth and slippery intestinal tube could be adjusted arbitrarily in the hand, and even the cecum and appendix were not spared. , Then, the ascending colon, transverse colon and descending colon were preserved, and the entire sigmoid colon and rectum were completely resected and taken out.

The large metal basins for excised tissue were placed on a special sterile instrument cart, in a neat row, and a few were already full.

Both kidneys and adrenal glands were probed, and both hands were probed at the same time. After the kidneys were probed, they went down the ureter, to the bladder, and then to the urethra.

With the exploration, Yang Ping reported the location and extent of the injury, as well as the surgical plan to be implemented soon.

"No obvious damage to the kidneys, adrenal glands, bilateral ureteral rupture, bladder rupture, urethral damage—"

The voice was loud and clear, but it seemed extremely calm, without roaring or urging.

However, everyone tried their best to keep up with his speed, especially Song Zimo, who was highly focused and did not dare to relax at all.

Everyone understood that at this time, it was the god of death who was competing with Dr. Yang, and with a slight negligence, the god of death took life from his hands.

There is no problem with the ovaries, the fallopian tubes are stretched, and even the uterus has contusions.

While exploring and repairing these organs, sutures, ligations or coagulation of blood vessels are interspersed.

The bilateral internal and external iliac arteriovenous, left lumbar arteriovenous, and bilateral inferior epigastric arteries and veins were ligated; the presacral venous plexus was sometimes sutured and sometimes coagulated.

The various operations are uninterrupted, seemingly chaotic, but in an optimal order.

When all explorations were completed, the entire omentum was lifted from the abdominal cavity and dropped into a metal basin.

It turned out that the surgeon was excising the greater omentum while exploring and repairing the organ. With the completion of the exploration, the greater omentum was naturally and completely removed.

"microscope!"

Zhou Can had long been ready to advance to the surgery area, Yang Ping and Song Zimo adjusted the focal length and pupillary distance.

Completed bilateral ureteral anastomosis under the microscope, bilateral ureteral catheter stent renal pelvis drainage; bladder rupture repair.

Continuing, using the cystic duct stump to insert a T-shaped tube, a choledochostomy was performed; the original spleen was also placed in a drainage tube.

Cystostomy; descending colostomy, a series of fistulas.

If there is no urethra, cystostomy is performed temporarily, and there is no rectum and anus, and descending colostomy is performed temporarily to preserve the temporary function of urination and defecation after surgery.

A beautiful flap transfer was also used at the end to repair the stump wound.

Three drainage tubes were placed on the wound surface for drainage, and together with various tubes placed in the abdominal cavity, a total of more than ten drainage tubes extended from the body.

Intraoperative blood transfusion has been 20,000 ml, barely maintaining blood pressure.

In the end, the entire lower body was separated, and a pile of muddy lower body left the body of the wounded.

A person more than 1.6 meters in height has become a half-sized person of about 70 centimeters, like a half-length ceramic doll.

The operating room was surprisingly quiet. Takahashi stared at the screen. After watching the entire operation, he accurately calculated the time. It only took thirty-five minutes from the time he washed his hands on the stage.

And every step, without any pause, without any hesitation, as if every step has been clear, where needs to be dealt with, consciousness arrives before the hand, consciousness leads the start, and completes every action accurately and accurately.

Countless surgeries are not simply followed step by step, but are intertwined and spliced ​​together flexibly without any sense of disobedience.

This kind of splicing is not done one by one. In order to save time, the surgeon has coordinated all the steps of independent operations, disrupted these steps, mixed them together, interspersed operations, and matched operations with operations.

Just like a DJ DJing, pull it fast here, insert it there, suddenly stop this section, connect to the other section, with both hands in the abdominal cavity, cooperate if you want, if you want to operate independently, you can operate independently, and the coordination is seamless.

The entire operation was completed under the pressure of death, which was urgent, thrilling and exciting.

A powerful force rushed towards him like a tsunami, causing Takahashi to feel a huge pressure, and the pressure of being unable to fight back, his knees almost softened and he knelt down directly.

The needle holder was gently placed in the turning plate of the sharps, and Yang Ping raised his head: "Vital signs?"

"Blood pressure 102/60mmHg, heart rate 102 beats per serving, low-flow oxygen inhalation, mechanical ventilation, and oxygen saturation 100%."

"After the first ghost gate, there are many ghost gates waiting for her." Yang Ping breathed a sigh of relief.

"I'll take care of this patient." Song Zimo stared at the monitor screen.

"You are responsible for the formation of the medical team, including Takahashi. I will tell the head nurse that a nursing team needs to be formed. If this patient wants to survive, a special team must be responsible. Any small mistakes may lead to the failure of previous achievements. , Death will come in at any time."

"In addition to this, there are currently only two cases of this kind of high-ranking half in China. One case was reported in Modu, who died six days after the operation—"

Takahashi is very familiar with these cases.

The prototype of this case is Peng Shuilin, a half-person rescued in Shenzhen Buji People's Hospital in 2004, and some modifications have been made to the patient and condition in the book. This kind of surgery is the pinnacle of surgical challenges, both in terms of surgical difficulty and post-operative care. An untimely change of sheets after surgery may lead to infection and eventually death. They have created a world miracle, perfect surgery, plus perfect postoperative care, to create this world miracle. It can be imagined that there are more than 20 doctors and nurses, and the operation takes more than six hours. After the operation, the dressing is changed more than ten times a day. One dressing change requires three or four nurses to work for an hour. I was a student at the time, and I learned about this case from my teacher when I was a graduate student. Salute to Director Fan Debiao, Director Yuan Taizhen and all medical staff who participated in the rescue at that time!