Chapter 193 Unpacking Surgery
Yang Ping was in a daze all day Sunday.
Xiaosu! Professor Su's daughter, Su Nanchen's sister, this question has been lingering in Yang Ping's mind. She walked down the steps in a long skirt. The beautiful and moving picture is still imprinted in her mind. Several identities are connected together, and for a moment Still hard to adapt.
No matter whose daughter she is, no matter whose sister she is, Xiao Su is right, she is Xiao Su, so Yang Ping doesn't think about it anymore.
At work on Monday, Sisi's three-dimensional reconstruction was completed, especially the reconstruction of the infrared scan, which is the image directly used in the surgery. The other two, CT and MRI reconstruction, are just supplementary.
Judging from the images, the primary tumor has spread very severely to the surrounding area and has spread to the entire hip joint. The treatment method needs some adjustments.
There are several ways for malignant tumors to metastasize. Tumor cells are like seeds and can be transferred out through several ways: hematogenous metastasis, where the seeds are transported to another place through blood circulation, take root, sprout, and settle down; lymphatic metastasis, which is similar to hematogenous metastasis, but different It is transported through the lymphatic circulation, not the blood circulation; planting and spreading, the seeds fall to another place, start to grow and occupy the territory; and there is direct spreading, the tumor continues to grow, grows directly, and invades other places.
Local resection is too extensive and destructive, so surgery can only be combined with ultrasonic scalpel. First, remove the tumor in the bone tissue, remove the prosthesis, lengthen the femur, and then use ultrasonic scalpel to treat other surrounding tumors and distant tumors. of metastatic tumors.
At around seven o'clock in the morning, Yang Ping watched Sisi's film and roughly planned the operation plan. Entering the system space, there is still one last task left in the progress of sports medicine. After completing this task, you can advance to bone disease training. However, we don’t know what this task is and when it will be released.
After the shift was over, I led everyone around the ward, and then performed surgeries all morning, all of which were arthroscopic surgeries. Most of the patients in the ward now have arthroscopic surgeries, and the turnover is also very fast. Generally, the second surgery is done after the surgery. He was discharged from the hospital today.
Word-of-mouth spreads very quickly. Many patients were introduced by patients who had undergone surgeries. Little by little added up, and slowly, the ward was almost full.
At two o'clock in the afternoon, Yang Ping gave a small lecture to everyone in the demonstration classroom. Many doctors from the entire orthopedics department came, including several directors, Director Han, Director Tan, Director Tian, Director Bai, Director Ouyang, and Director Ding. After the meeting, we will discuss the academic affairs.
The content of the lecture was to rescue cases of penetrating tree injuries on Shipo and perform unpacking surgery under large vessel occlusion.
This kind of surgery is extremely difficult because it often involves large blood vessels and internal organs. Anyone who has watched "Grey's Anatomy" knows a scene where two people are facing each other and are penetrated by a steel bar. The doctor is in a dilemma. The doctor has to pull out the steel bar so that one person can survive and the other can only die. How cruel!
Because the woman had damaged her aorta, the doctor determined that she could not be saved and could only sacrifice her to save another black man with less serious injuries.
The aorta is the real artery of death. Once damaged, a lot of blood will be lost in a short period of time, and the fastest death can occur instantly.
This dilemma clip from "Grey's Anatomy" was constantly shown on the screen, played over and over again, and then froze in a scene where two people were facing each other, sitting in an ambulance, being penetrated by a steel bar.
Yang Ping pointed at the picture and said: "Don't be misled by the TV. On the TV, both patients are conscious and chatting and laughing, which means that the vital signs are stable, and at least the blood pressure is temporarily stable. In this case, the other one has to be sacrificed. Why? ? Why can’t we save two?”
"No way, the director arranged it!" someone said, making everyone laugh.
Yang Ping also laughed, and continued: "In Anzhen and Fuwai in our country, aortic dissection rupture is much more dangerous than this, and the success rate of rescue is very high. Not to mention that you can still talk and laugh after such aortic injury? Not to belittle others, but to think scientifically! The surgical method on TV is extremely backward, and they actually use extraction. The method of pulling out the steel bars is equivalent to gambling with your life. In this case, you must not pull out the steel bars. Once the steel bars are pulled out, everything will be out of control. The method of pulling out the steel bars is like when you are defusing a bomb. You don’t have to think about anything and just tear it off. A few wires, will this work? Definitely not! What should we do?”
Everyone listened carefully. Everyone who came to attend the class knew that Yang Ping’s class was full of useful information, especially when it came to surgery. He was definitely not following a textbook, but was refining his own experience. As for how his surgery was, needless to say, the miracle he created was not One or two. Among the young doctors, some were taking notes with their heads down, some were recording with tablets, and some simply pointed their mobile phones directly at the video. This saves time and allows them to listen to it slowly when they get back.
"If we are asked to rescue these two patients, think about it, how do you perform an operation? Will you also pull out this steel bar? We are not commenting on TV today, we are just using this case to elicit our thinking!" Yang Ping Ask questions and explain your purpose for borrowing the TV.
The people in the audience were eager to try. Someone raised their hand. A young doctor from the Department of Traumatology and Orthopedics stood up and said, "I have always felt that this is not advisable. Why not saw the steel bar in the middle so that the two people can be separated and perform the surgery in two groups? Saw the steel bar. When using continuous cooling and certain shock-absorbing measures ”
Yang Ping asked him to sit down: "Very good! This doctor is very correct. To handle this case, he did not pull out the steel bars, but sawed off the steel bars, separated the two people, and let two groups of doctors complete the operation. This is completely achievable and accurate. Frankly speaking, this is already the third step. Before that, there are two more steps?”
Everyone was silent and couldn't think of anything for a moment. A doctor from the trauma ICU raised his hand and said uncertainly: "How about blood transfusion and fluid replenishment?"
"Yes! It's such a simple step. This is the first step, blood transfusion and rehydration! This is the most common, most effective, and indispensable step. You can understand it this way. Trauma, if the life-threatening thing is only blood loss, not caused by Fatal injuries to vital organs, such as severe brain injuries, can theoretically be saved. It depends on whether you are quick enough to stop the bleeding and transfuse blood and fluids within an effective time. The first step. Transfuse blood and fluids to maintain blood pressure; the second step is to judge the injury and make a basic judgment on the injury. If you have conditions, you can do a quick CT scan. If you have no conditions, you can go directly to the operating table for exploration. The third step is to separate the steel bars. What about the fourth step?" Yang Ping activated everyone's thinking.
"The fourth step is our preoperative large vessel occlusion surgery, which directly blocks the large blood vessels. Just like this patient, it has been confirmed that the aorta is injured. Judging from the location, we can perform a high abdominal aorta on top of the injured area. Arterial occlusion is equivalent to closing the main gate and controlling all bleeding from the wound. However, this occlusion has a time limit. Abdominal aorta occlusion is safe for 30 minutes. We will end the battle within 30 minutes. The patient can be saved safely. On the one hand, the blood vessels are blocked and the bleeding is completely stopped, and on the other hand, blood and fluid are transfused to replenish the lost blood, so as to temporarily achieve a volume balance and strive for a safe operation time." Song Zimo participated in this operation. answered the question.
"But, is this an extremely high-risk operation?" someone worried.
Yang Ping told everyone: "Every one of our operations is high risk. Our surgery is like flying a fighter jet. Nothing is absolutely safe. Completing all operations under risk is the essential characteristic of surgery, so everyone must have rich experience." With knowledge, skillful operation, and a calm mind, we block the large blood vessels, and we enter the fifth step, unpacking surgery! ”
The audience was in an uproar. They had never heard of the term open-box surgery!
Yang Ping stood in the middle of the demonstration classroom, waited for everyone to be quiet, and said: "This is the essence of today. Unboxing surgery is a word I have thought about for a long time and chose. It is very simple. It is to open the box, go inside to find the problem, and eliminate the problem. , how to open the box, according to the location of the CT scan, or simply judge the location, open the abdomen if it is in the abdominal cavity; open the chest if it is in the chest, open it completely along the steel bar, expose the entrance of the entire steel bar, and then follow the The access point is constantly hemorrhaged and repaired, and finally it is removed, not out, but out of the steel bar! ”
"This process is like defusing a bomb, opening the shell of the bomb, exposing the various components and wires inside, and then removing the danger step by step with precision."
"The patient in the picture, even the most severe one, could have his aorta repaired in half an hour, even if it wasn't that fast, using large vessel bridging technology, from proximal to distal, across the injury site, allowing blood flow Temporarily avoid the injured area, which can not only ensure the blood supply of the lower body, but also allow you to slowly repair the damaged aorta. There is another method that we commonly use in thoracic surgery to treat aortic dissection, artificial blood vessel implantation, or even implantation of artificial blood vessels. Minimally invasive implantation is also possible. There are many methods. Why give up? Just watch a few interventional surgeries for aortic dissection. It is not difficult. Once you are proficient in anything, it is not difficult. So we must understand everything and treat the main problem. Arterial dissection surgery can be applied to trauma surgery, but why can’t our usual laparotomy and thoracotomy be applied to steel bar penetrating injuries, instead of using such a stupid method to pull out steel bars? ”
"That's the theory, but it's very difficult to do!" someone said in a low voice. After all, some people have never encountered this kind of thing.
The screen immediately switched to the rescue photos of Shipo Hospital: "Look, this is a living example of success, the application of theory, theory guiding practice, practice improving theory, don't separate theory and practice!"
This case was much more serious than the cases on TV, and they were all rescued. Yang Ping said: "I am not the only one who has successfully rescued such patients. Moliu, Jishuitan, and many hospitals across the country have successfully rescued very serious trauma patients." I can responsibly say that if the two patients on TV appeared in Moliu or Jishuitan, there is no need to sacrifice the other one, and both of them can be saved. Bo, we can save both of them.”
Director Han stood up and said to everyone:
"Soon, we will have an academic conference where major trauma emergency surgeries will be broadcast live. The University of Tokyo Hospital will be broadcasting live at the same time as me. Director Tan has already obtained the full videos of some of their major trauma rescue surgeries. Please wait. Let’s take a look at what the world’s top rescue procedures are like and how surgery is done. How to do it, how the team collaborates, how to do everything, do it well, and do it to the extreme are completely different realms. Anyone who works in general surgery knows that the cure rate of gastric cancer in Japan is more than 80%. What is this concept? We are 30%, and the United States is 60%!”
Next, Yang Ping explained in detail the surgical details of the case of penetrating tree injuries in Shipo, how to block blood vessels, how to unpack, how to explore, and how to repair.
Finally, three chapters have been published, which is over 10,000 words!
The TV show that caused the steel bar penetrating injury is "Grey's Anatomy". I watched it for too long and got confused. I would like to correct it! Apologize!
(End of chapter)