Chapter 648 Resection without leakage
When they heard that Professor Liang asked Yang Ping to perform the surgery, the young doctors became excited.
They have long wanted to see the level of the Golden Sword Award winner up close.
It's like an ordinary boxer who sees the world boxing champion and hopes to see the boxing champion show off his glory and see what's so great about him.
This surgery is expected to last up to twenty hours. It is very difficult and risky in terms of both surgical difficulty and risk. It will definitely be a feast for the eyes.
Director Hu was stunned for a moment when he heard Professor Liang's arrangement, but he immediately agreed. Director Hu once led a team to Sanbo Hospital and had the experience of operating on the same stage as Yang Ping. He knew Yang Ping's surgical skills very well.
"Do you have any objection to having Professor Yang perform this surgery?" Director Hu shouted loudly.
Asking knowingly!
"Agree!"
Everyone shouted in unison, and almost unanimously passed.
Especially those doctors who were familiar with Yang Ping were very excited. They had experienced Yang Ping's scientific research ability before, and now they wanted to experience his surgical ability. They couldn't wait for the operation to start now.
The tumor involves three vertebrae, and a total vertebrae resection of three vertebrae is required. Even at Peking Union Medical College, only Professor Liang and Director Hu can perform the surgery. The other professors and professors are very reluctant to perform the surgery, let alone their young doctors.
It is estimated that such a young doctor performed a total spondylectomy of three vertebrae, the only one in the country.
"Professor Yang, let's see how the time is arranged?" Professor Liang smiled. It was just a good opportunity for Yang Ping to establish his prestige in Xiehe Union through this operation, which would facilitate future work and also facilitate Professor Liang to help Yang Ping obtain some resources in the future.
Union Medical College is different from Nandu Medical University. Nandu Medical University has only a few academicians in the entire system, while Union Medical College has more than 20 academicians from the medical school to the hospital.
More than 20 academicians represent the strongest strength of Union Medical College, but they also said that it is not easy for young people like Yang Ping, who is still a doctor from an outside hospital, to secure some resources.
For example, Yang Ping's stem cell project can not only easily obtain cooperation from Nandu Medical University, but also occupy a dominant position in the cooperation.
But it is different in Xiehe. Whether cooperation can be obtained is still unknown. Professor Liang needs to work hard to win and lobby other big guys.
Of course, Yang Ping didn't care about this cooperation, just to repay Professor Liang's kindness.
Since Yang Ping said that he often performs this kind of surgery, he is very confident. However, out of caution, Professor Liang still asked a question.
"Are you sure?" Professor Liang asked Yang Ping in a low voice.
"Routine surgery, we're sure!" Yang Ping was extremely relaxed.
Fortunately, Professor Liang was familiar with Yang Ping, otherwise he would have been talking to death about what he just said.
For such a top-notch surgery, you can call it a routine surgery so easily.
But for Yang Ping, it is indeed a routine operation. Most of the surgeries performed by their comprehensive surgery department are difficult and high-risk surgeries that others are unwilling to do.
"I have a tight time schedule here. It will take three days at most. I have to go back to Sanbo Hospital on Monday afternoon. When can the surgery be arranged?" Yang Ping felt that the sooner the better.
"Director Hu, is it too late to arrange the surgery tomorrow?" Professor Liang believed that if the surgery is well prepared, it should be arranged earlier.
"No problem, I'll tell the operating room to add another surgery. Tomorrow is an exchange meeting with the Twin Cities Spine Center in the United States. The content of the surgical demonstration is spinal tumors. Because this operation takes too long, I don't plan to include it in the demonstration. Surgery.”
The preoperative preparation for this operation was very thorough. Director Hu originally planned to include it in the demonstration operation at the exchange meeting. However, because the operation time is expected to be as long as 20 hours, it is not suitable for demonstration, and the operation is too difficult, and he is worried about the operation during the operation. An uncontrollable accident occurred, so this surgery was removed from the list of demonstration surgeries.
Professor Liang felt that Director Hu's arrangement made sense: "Then we will take over the demonstration surgery tomorrow and do it after the meeting? How about that?"
Yang Ping believes that as long as the preparations for the operation are sufficient, it doesn't matter much as to when the surgery will be scheduled tomorrow.
"You can arrange it however you want. It's no problem if you arrange it as a demonstration surgery." Yang Ping said calmly.
Young people are very energetic. To demonstrate this kind of surgery, it would take 20 hours, so forget it. Director Hu shook his head.
"It doesn't matter, it won't take that long, it will only take a few hours, just enough for Americans to learn."
There is nothing wrong with Yang Ping's words. He really wants Americans to learn this leak-free resection and return to the United States to promote it, so as to save him the trouble of talking.
Let Americans also learn?
The young man is a little crazy!
Director Hu was a little hung up on Yang Ping's words.
"Yes, add surgery and let Americans learn from it." Professor Liang supported Yang Ping.
Director Hu immediately ordered Song Yun to make arrangements.
"Xiao Yang, what is the leak-free resection you just proposed?" Professor Liang was very interested.
"This is a concept I put forward for tumor surgery. Around this concept, I established a surgical system." Yang Ping felt that he could take this opportunity to promote his own skills.
Sharing good things with everyone can heal more patients. Why does this guy have so many new things? It's like he has a magic pocket on his body. Just take it out and you'll find a treasure.
If he hadn't happened to meet this patient with a spinal tumor, who would have known what non-leakage resection techniques he had.
Professor Liang looked at Yang Ping beside him and felt very pleased. He carefully thought about what Yang Ping meant by leak-free resection.
Enblocresection, the surgical method currently has two schools: Japanese and European and American.
The posterior en bloc spinal resection technique represented by Tomita in Japan: through the posterior midline incision of the thoracolumbar spine, 360° dissection from back to front to expose the entire spine at the segment where the tumor is located, and then use a wire saw to remove the vertebrae on both sides. The pedicle and the adjacent intervertebral discs above and below the diseased vertebra are sawed off, so that the vertebral body in front and the attachment structure in the rear are completely separated. Finally, the vertebrae are divided into two parts: the vertebral body and the attachment, and are removed to complete the so-called "total spondylectomy".
The current spinal resection in Europe and the United States is different from the Tomita surgery in Japan. The method in Europe and the United States is to resect the normal bone tissue or soft tissue surrounding the tumor, try not to expose the tumor, and remove the dura mater together when necessary. , and the normal bone in the same segment of the spine that is not affected by the tumor does not necessarily require en bloc resection.
Relatively speaking, European and American methods are better. The resected tumor is completely surrounded by normal tissue structures. Although this sometimes increases the scope of resection of normal tissues or structures around the tumor, it does reduce the surgical process to a certain extent. the possibility of tumor contamination.
And what does Yang Ping’s leak-free resection mean?
"Xiao Yang, can you explain it to me in detail? Be more specific. I don't understand the concept you are talking about." Professor Liang was very open-minded.
Yang Ping briefly introduced his method to Professor Liang: "My method is different from the Japanese, European and American methods. The Japanese only emphasize the complete removal of vertebrae and do not propose a complete removal method for tumors, while the European and American methods emphasize the removal of tumors. Complete resection, but did not propose how to completely remove the tumor. It just generally said complete resection, and did not emphasize the complete resection of the vertebrae. In the end, it sounds good, but the effect is not good in practice. When I really encounter a case like Jing Yunsong , most of the vertebrae are violated and there is nothing you can do.”
"My leak-free resection is not only a concept, but also a specific method. I have done in-depth research on these tumors, starting from their properties and growth patterns, finding their boundaries, and starting from their invasion of the vertebral body. Find the way they invade the vertebral body, and find a way to interrupt the annular structure of the vertebrae. By combining the two, you can remove the entire tumor and vertebrae. It sounds beautiful, but it is also beautiful to do. For example, this patient's 3rd lumbar vertebrae , the entire 360 degrees of the vertebrae were wrapped by the tumor. No matter the Japanese method or the American method, they were unable to do anything, but my method can. My method can remove the tumor, leave a gap, and perform pedicle osteotomy. .”
Professor Liang thought for a long time and nodded approvingly: "It makes sense. You are making the whole vertebra resection method form a third school: the Chinese school! It just so happens that everyone is getting together now. You can tell everyone about your leak-free resection technology. Come on, take your pick of places to eat at night: Fengzeyuan, Quanjude, or Donglaishun.”
"Then why are you so embarrassed - you don't have to be so polite - then it's settled! I'm a good meat eater." Yang Ping was more respectful than obeying orders.
"Don't worry, I'm treating you tonight, and Director Hu will pay for it. It won't be a problem if you can't finish the meal and pack it away." Professor Liang smiled slightly.
"Go up to the podium and talk to everyone. Try to be as detailed as possible." Professor Liang encouraged Yang Ping.
Yang Ping walked up to the podium. Dozens of doctors in the audience applauded enthusiastically, and then eagerly waited for Yang Ping to speak. Yang Ping glanced at the audience. These are the elite among the elite. Once their own methods are in their hands, they are powerful in curing diseases and saving lives. arms.
Song Yun helped adjust the microphone, and Yang Ping didn't even need to introduce himself. He just went on stage and showed off his skills:
"Enblocresection, the surgical method currently has two schools: Japanese and European and American. Today I will teach you the third method. I gave this technology a name, called non-leakage resection, which is actually a tumor-free technology. The upgraded version has a fancy name. For complex tumors of the spine, it is very difficult to perform a truly extra-tumor operation to completely remove the tumor without leaking tumor cells. ”
"Because the vertebrae are annular structures, with the spinal cord and cauda equina nerve in the middle of the annular ring. To cut off the entire vertebra, the annular structure must be broken and the vertebrae must be unhooked from the spinal cord or cauda equina. For complex tumors, the tumor has wrapped around the vertebral arch. Roots, breaking the annular structure, and cutting off the pedicles often cannot avoid entering the tumor body.”
“But we know that there are natural barriers to tumor spread, such as the natural barriers for spinal tumors: anterior and posterior longitudinal ligaments, periosteum around the spinal canal, ligamentum flavum, lamina, spinous process periosteum, supraspinal and interspinous ligaments, and cartilage endplates. , annulus fibrosus, we must be very familiar with these natural barriers and make good use of them during surgery.”
"Each vertebrae represents a compartment surrounded by several barriers, which appears to facilitate extensive surgical resection."
"However, the vertebrae are ring-shaped structures with the spinal cord in the middle. They are close to the important blood vessels and internal organs of the spine, and the complex anatomical relationships that exist between the spine, spinal cord, important blood vessels, and internal organs hinder wide surgical resection, such as the previous It has been mentioned repeatedly that pedicle osteotomy is difficult to perform outside the tumor. We can change our thinking. ”
"Breaking the annular structure is not necessarily at the pedicle. Wherever the bone quality is normal and has not been invaded by the tumor, we will break it. For example, in this patient's waist 2, all the pedicles are invaded. What should we do? The posterior lamina is damaged. Part of it is good. Isn't it better to cut the bone from here? The diameter of the spinal cord is only 1.2 centimeters. We only need a 1.5 centimeter breach to untie the ring. "
"Osteotomy can be done from the pedicle, but the surgical requirements are higher. The tumor should be separated first, and then the osteotomy should be performed. Those with poor operating skills should not try it easily."
"How to remove tumors without leakage? We must be very particular about the order of tumor removal. We must study the tumor thoroughly before surgery, where it starts, where it passes, and where it ends. It's like wrestling. If you want to fall someone, you have to catch it first. Which part of the body is caught, which part is trapped, and finally the center of gravity is destroyed, and the person is thrown out.”
"I have just studied this patient. According to the principle of non-leakage resection, I divided the operation into 21 steps. By performing the operation in sequence according to these 21 steps, complete resection can be achieved."
Yang Ping explained the 3D image on the screen and told everyone how to remove it.
Everyone was listening and thinking, simulating the process of the operation in their minds. Professor Liang and Director Hu, especially, have rich surgical experience. Once they simulated it in their minds, they could immediately understand the mystery.
Indeed, it is much easier to cut it off like this and it can be completely removed.
"He updated his ideas, and then innovated the technology under the new ideas, instead of simply honing his skills repeatedly." After hearing this, Professor Hu Guolin felt that he had gained a lot.
"Yes, let him perform the surgery tomorrow. Indeed, to completely remove the tumor, the order is very important." Professor Liang admired Yang Ping's leak-free resection very much.
"Not only is the sequence important, but we also need to understand the boundaries of the tumor, including natural boundaries, pseudomembranes, etc. When combined, these are the isolation zones of the entire tumor. Around the isolation zone, the tumor is removed step by step."
"It's like demolishing a house. You can't demolish it blindly. If you have a method, demolish it first and then demolish it. Since safety is guaranteed, the house can be demolished quickly."
"Tomorrow, this surgery will be added to the demonstration surgery so that Americans can see leak-free resection. What is the name of the leader?"
"Cheney!"
"Yes, doesn't he have eyeballs on the top of his head? Tomorrow let Yang Ping help him reset his two eyeballs."
"Twenty hours of surgery?"
"It's up to you to do it. Xiao Yang shouldn't do it for so long. Don't worry, even if it takes twenty hours, the Americans won't have any objections. They did a few cases of three full vertebrae last time, and they seem to be amazing."
Professor Liang and Director Hu talked in low voices.
PS: Today is the day before the holiday. There are a lot of surgeries. I will post them first and then change them. I wish everyone a happy Mid-Autumn Festival!
(End of chapter)