The Godfather of Surgery

Director Long was relieved when he received a reply that his vital signs were stable. It was a false alarm, and he smiled at the ridiculous idea that had just passed through his mind.

However, this operation was quite strange. Even the small blood vessels were electrocoagulated in advance, and no blood vessels were passively stopped without foreseeing it in advance.

Although the pancreatic tumor has not caused too serious invasion of the liver, the blood supply vessels of the tumor have been intertwined with the blood vessels of the porta hepatis. Yang Ping is now dealing with this bunch of troublesome blood vessels.

The blood vessels and bile ducts of the liver are intricate. The first porta hepatis located in the transverse groove of the liver contains the hepatic artery, portal vein, bile duct, lymphatic vessels and nerve tissue; the second porta hepatis located behind and above the liver gathers a large number of veins, where the liver mainly contains The locations where blood flows out of the liver include the left hepatic vein, the middle hepatic vein, and the right hepatic vein. They gradually merge into the retrohepatic inferior vena cava, returning blood from the liver to the heart; the third hepatic portal is hidden between the retrohepatic and inferior vena cava. Between the veins, there are small blood vessels at this site that return the retrohepatic blood flow to the inferior vena cava.

The liver and pancreas, coupled with complex tumors, have dozens of large and countless small heterogeneous blood vessels. These blood vessels are intertwined with the blood vessels of the pancreas and porta hepatis, and it is simply a knotted mess.

Originally, this patient had traveled all over the country, and other hospitals recommended giving up the surgery. Because the patient was still young and the breadwinner of the family, he had no choice but to come to Xiehe Union Medical College. After seeing the patient in the outpatient department, Dr. Liao decided to take the risk and challenge this after some consideration. This difficult surgery gives the patient a glimmer of hope.

However, Dr. Liao was young and energetic after all, and was not well prepared for the operation. He did not prepare enough blood before the operation, so he failed to do this step properly. As a result, the operation now seems to be stuck in a quagmire, making every step difficult.

This surgery involves so much blood loss that it would be impossible to complete without adequate blood transfusions.

Looking at the pile of knotted mess in front of him, Director Long sighed. Even though he had experienced hundreds of battles, his scalp was numb and his back was chilling.

But in Yang Ping's hands, the sharp knives and tweezers moved like dragons and snakes. One blood vessel after another was freed from the entanglement without any damage, and was handed over to Director Long to clamp, tie, cut, suture or ligate. .

This ability of dissecting anatomy requires many operations to develop this skill. This also depends on how many operations on tumors, liver cancer and pancreatic cancer.

The doctors who were watching the surgery were close to the warning distance, and the circulating nurse had verbally reminded them many times. They continued to get closer by centimeters and millimeters, and the crowd was pushing and jostling.

In fact, the only ones who can really see clearly are the doctors on the stage, especially the first assistant, who has the best view. These bystanders under the stage can still get a general view from a distance, and can also watch the excitement from a distance.

Someone has moved the pedal and is standing on it, leaning forward, his eyes almost bulging out, and this posture seems to make him lose his center of gravity immediately.

There were still people who couldn't find a position, not even a position with the worst viewing angle, so they anxiously circled around, asking people who had already occupied a favorable position from time to time what steps to perform the surgery.

There is a camera on the operating light, but there is no connected LCD screen in the operating room. The supporting mobile LCD screen is in the classroom, but no one is going to discuss it at this time.

The circulating nurses only care about their own territory. As long as you don't mess with the rules of the operating room, they won't be able to drive everyone away with a straight face. They should look up but not look down every day, and they should do less things that offend others.

If the head nurse comes to make rounds, the traveling nurse will pretend to enforce the law with a straight face. But when the head nurse leaves, everyone will gather again, just reshuffling their respective positions.

Professor Liang was sitting alone in the corner, very bored. He circled around the operating table and couldn't see anything, but he knew that this operation was difficult and Yang Ping was very good now.

Not to mention a bunch of blood vessels, it is not easy to untie a bunch of tangled and knotted tangles.

Compared to Nie Feng'e's surgery, this surgery was still a little less difficult. Yang Ping continued to separate the blood vessels without panic. In the dangerous area surrounded by dangers, the sharp knife never retreated and still charged at the front line.

Mountain darkly, vista.

Every time Director Long felt that the operation was in dire straits, the instruments in Yang Ping's hands opened up a new world and steadily pushed the operation forward.

This patient is relatively good compared to Nie Feng'e, because the invasion of the liver by the tumor is not that exaggerated. That is to say, although traditional resection is insufficient in space and very difficult, it is not impossible to try. This may be why Dr. Liao feels that traditional resection is better. reason.

If this operation can be performed with traditional resection, it means that the level of traditional resection can reach the top. If it is really difficult to remove completely, the target can also be lowered, and only an extended resection can be performed instead of a complete radical cure.

Dr. Liao's plan was originally quite thorough, but he seriously underestimated the bleeding from the tumor. His previous surgical experience was not suitable for this case, which led to misjudgment before surgery.

On the liver side, mainly the blood vessels of the tumor are intertwined and grown. If these blood vessels are untied, the liver side is considered complete, and the liver does not need to be removed.

The tumor mainly invades the pancreas, so the pancreas is the big head. After the tumor blood vessels from the liver are unwrapped, it follows the clues and finally touches the pancreas. The duodenum is next to the pancreas, so the duodenum must be Most of it needs to be removed, part of the pancreas also needs to be removed, and part of the nearby stomach also needs to be removed. The operation is indeed quite large.

The relationship between the pancreas, duodenum, and stomach is intricate here, so combined pancreaticoduodenal resection is considered the top surgery in gastrointestinal surgery.

After cleaning up the surrounding area, especially around the liver, Yang Ping began to focus on the pancreas, duodenum and stomach. The blood vessels here were in chaos again.

The main blood vessels of the duodenum include the first segment of the superior duodenal artery, branches of the gastroduodenal artery, and branches of the posterior superior pancreaticoduodenal artery. The gastroduodenal artery is a branch of the common hepatic artery. , these blood vessels are intricately intertwined.

The blood supply to the remaining three segments of the duodenum comes from the anterior and posterior arterial arches. Branches from these arterial arches to the pancreas and duodenum. The branches supplying the duodenum are called peripheral arteries. They are sometimes embedded in in pancreatic tissue.

The blood supply of the pancreas itself is more complicated. The blood vessels come from the celiac artery and the superior mesenteric artery. These blood vessels are very atypical and often mutate. This is the most annoying thing for surgeons. The blood vessels look different from the textbooks and different from others. This makes people sometimes have to spend a lot of time groping for their positions, which is like fighting a war without a map, or the map they get is wrong, and they have to fumble around on the spot to advance.

"How's it going? Where did you do it?"

The peripheral doctors, graduate students, and training doctors were all anxious, so they could only ask the brothers who could see the operation.

"It seems to be separating the tumor blood vessels of the pancreas."

Brothers with good vision actually didn’t see anything. The surgery was too fast and they couldn’t see anything. They only saw the instruments coming in and out, and the instruments were constantly switching in their hands. But even if you don’t watch the operation, you can only see the use of these instruments. The operation is already very enjoyable. It is estimated that many people do not actually watch the operation, but just watch the operation of the equipment.

The pancreatic artery arch, dorsal pancreatic artery arch, transverse pancreatic artery, caudal pancreatic artery, splenic artery branches, and pancreatic veins are dissected out one by one, and then the tumor blood vessels are dissected out one by one, and all the tumor blood vessels are clamped. Clip severing and ligation.

All the major arteries of the pancreas are located behind the pancreas, so it is very difficult to deal with, which is why some surgeries must require excision to achieve the goal.

The pancreas has so many blood vessels, and the tumor has almost twenty blood vessels growing in this area. It is impossible to tell which are the blood vessels of the pancreas and which are the blood vessels of the tumor. It is necessary to understand their ins and outs.

The more Dr. Liao watched, the more he admired him. He was usually so conceited, but in front of Professor Yang, his three-legged cat skills were nothing.

Anyway, Director Long was watching with gusto. The blood vessels were separated one by one. What should be preserved was preserved and what should be processed was handled without any mistakes.

The most terrifying thing is that after doing it for so long, it is like having a gallbladder cut out, with almost no bleeding. This level is unique in the country.

After the pancreas is processed, the adjacent stomach and duodenum are processed.

Everyone has completely forgotten the time. This operation is expected to take place at night, and more than ten hours is the normal time. Director Long probably forgot that the operation will take so long, and he actually asked Dr. Lu to order food.

Large pieces of gauze were continuously laid around the surgical area, and many traction wires were tied to the tumor. A pair of vascular forceps was clamped at the end of each traction wire, and they were neatly placed around the abdominal cavity.

Dr. Lu did not go on stage, but was also playing guerrilla action in the audience. He also suddenly thought of this. Director Long was treating him to a treat, but the operation usually took more than ten hours. It was not easy to treat this guest.

But Director Long is busy on the stage and it's not easy to ask, so we'll wait and see, or ask again when Director Long is free.

It was not fun for Professor Liang to be alone in the operating room. Yang Ping was busy here, so he wandered over to the orthopedics department to take charge.

The anesthesiologist is also a well-informed person. He also hangs around the operating table from time to time. Although he cannot see the specific operations of the operation, he pays attention to the large tailed gauze currently used. If the gauze is full of blood, the amount A lot means there is a lot of bleeding.

But now that he has turned around a few times, in addition to the gauze that was already there, there are only a few new pieces in the basin for collecting gauze, and they are still the same ones with some blood stains on them.

Looking at the patient's blood pressure, it has been stable since Professor Yang took over. Due to fluid replenishment, the blood pressure is now on the rise.

This is an extremely skilled person, the anesthetist judged.

The anesthesiologist is relatively old, about fifty years old, and has very rich experience in the operating room. Even if he does not understand the details of the operation, he can tell at a glance what the level of the surgeon is. This is the basic skill of all senior anesthesiologists.

The operation is at a critical moment, and the sharp knife is wandering in the most dangerous area. Director Long, as the latest witness, now feels that he is not performing an operation, but participating in some kind of extreme sports, or that this kind of operation can be used The method is named extreme surgery.

Because this kind of surgery conveys a different atmosphere all the time - extreme, high-risk and no mistakes, Director Long devoted all his knowledge to participate in the surgery and became a qualified experiencer.

With the separation and ligation of blood vessels, the operation progressed in an orderly manner. If this state was maintained, even if the blood transfusion department could not support more blood, Director Long believed that the operation could be completed safely, and he felt instantly at ease.

The tumor not only invades the duodenum, but also invades the stomach, left gastric artery, right gastric artery, left gastroepiploic artery, right gastroepiploic artery, short gastric artery, posterior gastric artery, a large number of blood supply arteries, left gastric, Right vein, left and right gastroepiploic veins, and short gastric vein. The first two directly drain into the portal vein, and the latter three drain into the portal vein indirectly through the superior mesenteric vein and splenic vein respectively.

It is really an intricate vascular network system. The sharp knife is as powerful as a bamboo and irresistible, but it always wanders in various gaps. Even if there is no gap, he will open up the gap by himself.

Dr. Liao is the second assistant. He is completely fascinated. His understanding of this sharp knife is no longer a scalpel, but some kind of weapon with super powers.

How he can quickly judge the location of blood vessels, and how he can quickly distinguish which are normal blood vessels and which are tumor blood vessels, because every time he cuts and ligates blood vessels, he does not hesitate, which shows that his judgment is extremely confident and accurate. How is it done.

Dr. Liao had to think about this simple question.

In these complex anatomical gaps, Yang Ping didn't know how many blood vessels he had processed. Anyway, he kept wandering between blood vessels, tumors, and organs. It seemed impossible to deal with the blood vessels on the back of the pancreas and the blood vessels at the porta hepatis. , Yang Ping completed it in extremely reluctant operating space.

There were even several blood vessels. Director Long saw with his own eyes that he picked them out directly from the back side of the organs with curved forceps, which meant that they were not processed under direct vision at all.

Because those blood vessels cannot be treated under direct vision and are blocked by the liver and pancreas, it is impossible to cut off the blood vessels unless the liver and pancreas are cut off.

The surgery was very enjoyable, but it was too hard for the person doing the surgery, whether it was Director Long or Dr. Liao, to feel it was very hard, because it required a high degree of concentration, and the nerves in the entire brain were tense.

"That's it!"

Yang Ping finished processing the last blood vessel.

As long as the blood vessels are taken care of, the subsequent surgery will be easy, and Director Long feels more at ease.

At this time, Yang Ping, holding several vascular forceps holding the tumor traction wire, actually pulled the tumor out directly from the abdominal cavity. It was a complete tumor.

Didn’t you just deal with blood vessels? Why was the tumor removed?

Director Long had just seen Yang Ping separating blood vessels, but didn't see him separating tumors at all. He thought he was just dealing with blood vessels.

But Yang Ping worked hand in hand. The bright line was to separate the blood vessels, and the dark line was to separate the tumors. While separating the blood vessels, he also separated the tumors. Just now, no one paid attention, thinking that he was only dealing with the blood vessels. A large part of the tumors were hidden in the organs. Later, Yang Ping stirred up the blood vessels just now, but it was not possible to separate all the tumors.

"Director Long, look, I helped you take out the tumor by the way."

Director Long immediately went inside to take a look and spent ten minutes feeling inside with his hands. All the tumors had been removed.

Is the operation over? Are you going to close your abdomen?

By the way, help me remove the tumor?