The whole day on Sunday, Yang Ping was in a trance.
Xiao Su! 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 his mind. Several identities are connected.
Together, it was still difficult to adapt to it.
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 came out, 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 areas and has spread to the entire hip joint. The treatment methods need to be adjusted.
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 instead of the blood circulation; by planting and spreading, the seeds fall to another place, start to grow and occupy the territory; and by direct spreading, the tumor continues to grow, grows directly, and invades other places. p>
Local resection is too extensive and destructive, so we can only combine surgery 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 metastases.
At around seven o'clock in the morning, Yang Ping watched Sisi's film and roughly planned the surgical plan. After entering the system space, there was only one last task left in the progress of sports medicine. After completing this task, you can advance to bone disease training.
, but we still 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.
I'll be discharged from the hospital today.
Word-of-mouth spreads very quickly. Many patients were introduced by patients who had undergone operations. 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 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 is 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.
In this way, one person can survive, but 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 severe damage.
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 person can die instantly.
This dilemma clip from "Grey's Anatomy" was continuously shown on the screen, played repeatedly, and then froze in a scene where two people were facing each other, sitting in an ambulance, and 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, 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 is much more dangerous than this, and the success rate of rescue is very high. What's more, 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. They actually use the method of pulling out steel bars. This is equivalent to gambling with your life. In this case, you must not pull out the steel bars. Once they are pulled out,
Steel bars, everything will be out of control. The practice of pulling out steel bars is like when defusing a bomb. You don't have to think about anything and just tear off a few wires. Is this okay? 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 are taking notes with their heads down, some are recording with tablets, and some simply point their mobile phones directly at the video. This saves trouble and can 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 a question and explain your purpose of borrowing the TV.
The people in the audience were eager to try, someone raised their hand, and a young doctor from the Department of Traumatology and Orthopedics stood up: "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 operate in two groups? Saw the steel bar.
When necessary, use continuous cooling and certain shock-absorbing measures!"
Yang Ping asked him to sit down: "Very good! This doctor is very correct. To deal with 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 craniocerebral injuries, can theoretically be saved. It depends on whether you are quick enough and can stop the bleeding and transfuse blood and fluids within an effective time. The first step is
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 rescued safely. On one side, the blood vessels are blocked to completely stop the bleeding, and on the other side, 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 this question.
"But, is this an extremely high-risk operation?" Some people are 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 blocked the large blood vessels, and we entered the fifth step, unboxing 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 highlight 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 entrance was constantly hemostatic and repaired, and finally it was taken out, 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, can have his aorta repaired in half an hour, and even if it's not that fast, large vessel bridging technology can be used to go from proximal to distal, across the injury site, and allow blood flow
Temporarily avoiding the injured part can not only ensure the blood supply of the lower body, but also allow you to slowly repair the damaged aorta. There is another way, which is commonly used by our thoracic surgery to treat aortic dissection, artificial blood vessel implantation, or even
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
Surgery for arterial dissection can be applied to trauma surgery, but why can't our usual laparotomy and thoracotomy be applied to steel bar penetration injuries, instead of pulling out steel bars, using such a stupid method?"
"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."
In this case, even this kind of thoracoabdominal penetrating injury, I can responsibly say that if the two patients on TV appeared in Moliu and Jishuitan, there is no need to sacrifice the other one, both of them can be saved, and the same can be saved in our three cases.
Bo, we can save both of them."
Director Han stood up and told everyone:
"Soon, we will have an academic conference, where we will broadcast live major trauma emergency surgeries. 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, what are the world’s top rescue procedures like, how the surgery is done, how the team collaborates, how everything is done, done well, and done to the extreme is a completely different realm for general surgery.
Everyone knows that the cure rate for gastric cancer in Japan is more than 80%. What is this concept? Ours is 30%, and the United States is 60%!"
Next, Yang Ping explained in detail the surgical details of the case of penetrating tree injuries on Shipo, how to block blood vessels, how to unpack, how to explore, and how to repair.
