Chapter 341 Surgery in Theory
Takahashi's speech received a round of warm applause, and his wonderful drawings also received constant praise.
"Dr. Takahashi, with your surgery, after the anus is reconstructed, the nerve reflexes controlled by the muscles are opposite to the natural anal sphincter. The anal sphincter usually contracts and closes, and relaxes and opens during defecation. The pectoralis minor muscle you used is usually in a relaxed state. ," a graduate student asked.
People who can ask questions are those who study hard at ordinary times. Otherwise, their heads will be all mush at this time, and they will not ask questions.
"You lack basic knowledge of repair and reconstruction surgery -" As soon as the words came out, Takahashi immediately realized that his tone was wrong, and turned to look at Yang Ping. There was nothing strange on Yang Ping's face.
He confirmed that Yang Ping had not noticed his off-line tone just now, paused, and continued, but his tone was already lowered: "After surgery, we use biofeedback stimulation to rebuild the coordination of contraction of the transplanted muscles, that is, we train the muscles. , allowing it to contract and close normally, and relax and open when needed.”
"The discharge of stool is not just the opening of the anus, but also the rhythmic contraction and peristalsis of the rectum, which pushes the stool down until it is discharged. This patient has a defect in the rectum and sigmoid colon. How to solve this problem?" A doctor asked a more pointed question.
In academic disputes, relatives are not recognized, and whoever has the right is the boss. These guys are usually immersed in technical research and do not have the tact and sophistication of social people.
"This problem does not exist. The entire intestine has peristaltic propulsion capabilities, and the descending colon is no exception. Although the descending colon does not have as strong a push as the lower rectum, in view of the principle of adaptation of human anatomy and function, as the number of times of reconstructed anus increases, , the thrust of the descending colon will gradually increase to adapt to its working position.”
"You just mentioned that the sphincter is made from the pectoralis minor muscle, but you didn't mention where the material for urethral reconstruction comes from? I would like to know what material you plan to use for urethral reconstruction? Is it the anterior wall or the posterior wall of the bladder?" Deputy Urology Department the chief physician asked.
He has also had urethral reconstruction, so he is naturally concerned about this aspect. Yu Shuilian is missing almost the entire urethra. With such a long distance, what is the best material to use? If the bladder wall mucosa is used for reconstruction, it may not be enough.
"You can use colonic mucosa to reconstruct the urethra. This way you can use enough material and there is no limit to the length of the urethra. This method came from the Sixth Hospital of Shanghai, and I improved it."
Urethral reconstruction is the domain of urology, but Takahashi is a composite trauma surgeon, and his level in this area is not inferior to any urological expert in the world who specializes in urethral reconstruction.
There were many questions, ranging from fresh graduate students to doctors with high professional titles. Takahashi relied on his extensive and profound knowledge to handle every question perfectly.
Takahashi is known for his aggressiveness at international academic conferences. He once singled out a few Americans at a trauma surgery conference in North America and left them speechless.
I got too excited today and almost fell off the line. Fortunately, I stopped in time to avoid serious consequences.
Of course, this serious consequence is also what Takahashi himself thought was a serious consequence.
The conflicting emotions of nervousness and confidence are intertwined. Yang Ping is nervous because he is sitting under the podium. The student mentality makes him always take care of Yang Ping's expression for fear that he will not perform well.
Confidence is in front of the audience. He is used to talking loudly and confidently, and it is inevitable that he will lose touch when he is excited.
When it was Song Zimo's turn, the surgical atlas he showed was even more beautiful than Takahashi's. Perhaps influenced by Professor Zhang and Yang Ping's guidance, his surgical atlas had a strong three-dimensional feel, which was better than Takahashi's flat graphic vision. The effect is definitely better.
Takahashi's technique design is already very complete. Many things overlap and are the same. He just goes over them briefly and focuses on what Takahashi didn't talk about.
"The patient's ovaries, fallopian tubes and uterus have been preserved. We cannot focus only on the reconstruction of the urethra and anus. We should consider reconstructing YingDao to solve the problem of female patients' cyclic endometrial collapse and discharge accompanied by bleeding."
"The patient has given birth. In this special case, it is meaningless to retain the uterus. Why can't the uterus be removed? This way, there is no need to reconstruct the YD and it will reduce trouble." A newly recruited doctor from the Department of Traumatology and Orthopedics proposed a simpler method.
Why reconstruct when it can be resected? It’s unnecessary! The questioner's logic is very clear.
"Hysterectomy will not only lead to the inability to get pregnant normally, but may also cause ovarian function decline, estrogen secretion disorders, abnormal blood lipid metabolism, etc. Endocrine abnormalities may affect mental and psychological aspects, and may lead to depression."
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"One step of trouble for us saves the patient a lifetime of convenience."
Song Zimo's thinking is just the opposite. Why remove it if it can be reconstructed?
It could be ninety points, why should I only focus on sixty points.
Discussions among top academics naturally marginalize ordinary students. This is an unchangeable reality.
The discussion made Song Zimo and Gao Qiao the protagonists, and even Xu Zhiliang of the trio was under great pressure.
If you think of clinical experience as poker prowess and personal IQ as poker skill, this discussion is like playing cards.
When the cards are evenly matched, technology can only come into play. If the cards are seriously tilted, no technology can affect the outcome.
Gao Qiao has the best poker hand, Song Zimo has the best poker skills, and Xu Zhiliang has no advantage. There is a gap between his poker skills and Song Zimo's, and there is a huge gap between his poker power and Gao Qiao's. But he was not discouraged. Instead, he was very motivated and happy that he could join such a team. He was grateful to Yang Ping for not disdainful of his congenital defects and giving him a valuable opportunity.
Gao Yuan, director of the Sports Medicine Center, was too busy. He had just finished handling the matters at hand and came in a hurry. He would definitely attend comprehensive orthopedic meetings, case discussions, preoperative discussions, and small lectures whenever he was free.
When Director Gao arrived, the conference room was already packed. There was a rectangular conference table with rounded corners in the middle, and a distance of one meter was maintained around the conference room. There were three floors inside and three floors outside. Even the door was crowded with people.
How to get in here? Regardless of his identity, Director Gao had to squeeze in. He turned his body sideways and used all his strength to squeeze in. An intern was staring at the electronic screen with his eyes fixed on the electronic screen and his ears erect. At this time, he Damn, people are always squeezing here and there.
In the moment of anger, the intern didn't even look. He moved his body in the direction where the squeezing force came from, bumping and shaking hard. Director Gao was knocked backwards and almost fell down.
"I'm squeezing you. It's already full. If you didn't come earlier," the intern cursed in a low voice, but still stared at the screen.
Director Gao barely stood still and wiped his sweat. Everyone was listening intently to the speech inside, and no one paid any attention to him.
Lao Gao didn't care about the intern. There were two doors in the conference room. You couldn't squeeze in from one side. If you moved to the other side, the other side was almost the same, airtight.
There was no other way. Lao Gao asked the nurse for a chair in the ward, placed it at the door, put a piece of paper on it, stood on the chair, and then he could see inside.
Fortunately, everyone was more disciplined. Except for the speaker, no one else spoke, not even a few words in a low voice. You could hear clearly that it was Song Zimo who was speaking.
Yang Ping should not have spoken yet, he should speak last. Director Gao was glad that he was not late.
When Gao Qiao heard Song Zimo proposed YD reconstruction, he couldn't help but feel ashamed. Indeed, he had not considered it so thoroughly.
Song Zimo was indeed Dr. Yang's assistant. He thought about this patient's surgery more deeply than he did.
Xu Zhiliang's surgical plan could no longer surpass Takahashi. After he walked on stage, Zhang Lin subconsciously trembled in his heart.
Seeing Xu Zhiliang speak, Zhang Lin became anxious, but Lao Xu really didn't stutter when discussing the case: "The surgical plan has been very complete. I only have one immature suggestion. After the patient loses his lower body, he loses his sexual characteristics. Is it right?" The shape of WaiYin can be reconstructed based on the patient's psychology, which is more acceptable than the abrupt pore appearance. At the same time, the natural WY structure of women can protect the urethral opening and reduce the possibility of urinary tract infection. ”
The suggestion made by Xu Zhiliang is not necessary, and even for most doctors, they would not consider this issue at all, but Xu Zhiliang considered it and bravely put it forward.
There was another discussion, with people around asking questions and people from the Department of Comprehensive Orthopedics arguing with each other. Finally, it was Yang Ping's turn to speak.
Everyone is looking forward to the stars and the moon. The climax of the meeting is now, especially Lao Gao, who stood with his legs numb just for this moment.
Yang Ping stood on the podium, and dozens of mobile phones were secretly pointed at him. His memory was not as good as recording on his mobile phone.
I went through more than a dozen pictures first. For any meeting, just looking at these pictures is enough. Those who don’t know better would think that the photos of the human body taken by a black and white camera would not have such a three-dimensional effect in the key photos.
These pictures also borrowed the split-shot technique from comics to clearly show the steps of the surgery, with close-up magnifying shots of key steps.
He briefly summarized everyone's plan, and then added his own opinion: "To reconstruct defecation function, in addition to rebuilding the sphincter, bladder mucosal transplantation is also required to move part of the bladder mucosa to the inner surface of the descending colon. There are pressure receptors in the bladder mucosa, which can be used to transplant the bladder mucosa." These pressure receptors are used to reconstruct the urge to defecate and establish true autonomous defecation function.”
To transplant the bladder mucosa, it is necessary to connect the nerves. It is difficult to dissect the unnamed small nerves, otherwise many surgeons will do it.
Mucosal transplantation, if the connection to nerves is not considered, the baroreceptors cannot transmit signals to the centers of the brain and spinal cord, as if they did not exist.
If we can find unnamed neural connections and then use biofeedback training, it is entirely feasible to restore the urge to defecate.
However, to find the innominate nerve in the bladder mucosa, one must have a length that can connect the pudendal nerve and its branches, which is something that surgery simply cannot do.
Takahashi once conducted research in this area but ended in failure.
Many top urological surgeons and reconstructive surgeons in the world have also tried, but all ended in failure.
This is destined to be an impossible operation and can only exist in theory.
(End of chapter)