Zhang Lin is arranging Fang Xiaoyun’s emergency surgery. The computer HIS system will issue medical orders, review the surgery, notify the operating room, and contact Huang Jiahui to prepare the instruments.
Huang Jiahui's company's main products are in the field of sports medicine, but in order to cooperate with Yang Ping's surgery, Huang Jiacai applied to be an agent for several trauma, spine and joint consumables to complete the product line.
Yang Ping told Zhang Lin to ask Su Yixuan to prepare a choledochoscope for general surgery and a flexible lens to be used during the operation. Zhang Lin didn't know what he needed the equipment for general surgery and didn't dare to ask.
Fang Xiaoyun needs to undergo anterior thoracic spine surgery, open a thoracotomy into the front of the 9th thoracic vertebra, remove the vertebral body of the 9th thoracic vertebra invaded by tuberculosis, and remove the compressed material in the spinal canal.
The 4th to 9th thoracic vertebrae are dangerous areas. The blood supply of the spinal cord is fragile and the blood supply is easily damaged. Once the blood supply is destroyed, it is easy to cause ischemic necrosis and degeneration of the spinal cord. Not only will the paraplegia not be recovered, but it will worsen and become permanent.
Sexual.
In the system space, Yang Ping has undergone a lot of anatomy training and a lot of spinal trauma surgery training, but has never performed spinal tuberculosis surgery.
With his experience in spinal trauma surgery, it was easy to perform this surgery. However, to be on the safe side, Yang Ping went to the system space and purchased 300 cases of spinal tuberculosis surgeries for special training, especially the surgeries on the 4th to 9th thoracic vertebrae.
, when removing the oppressive material, try not to interfere with the blood supply to the spinal cord.
Now I have hundreds of thousands of points in my hand. As long as I don't simulate surgeries every now and then, I can handle this for a long time with this amount of points.
To treat spinal tuberculosis, some hospitals use minimally invasive methods. For example, a professor from the 301 Hospital has accumulated rich experience in minimally invasive treatments.
He believes that spinal tuberculosis can be treated with internal medicine. The specific method is to use CT to locate and puncture, inject anti-tuberculosis drugs into the infected site, perform local anti-tuberculosis treatment, and then cooperate with systemic anti-tuberculosis treatment until cured.<
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This method has caused sharp discussions in academic conferences, but it is undeniable that this professor has opened up a new idea, which is very effective at least for some less serious cases.
Fang Xiaoyun cannot use this minimally invasive method and can only operate because she has been complicated by paraplegia. The cause of paraplegia is that the spinal cord is compressed by a mixture of pus, granulation tissue, caseous necrotic tissue and dead bone.
Open surgery is necessary to directly remove the compressed material in the spinal canal, completely relieve the compression of the spinal cord, and allow the spinal nerves to recover as soon as possible. This is in line with the three major principles of spinal surgery - decompression, stabilization, and correction!
Comprehensive Orthopedics has its own independent operating room, which makes surgical arrangements very convenient. As long as the patient's condition permits, surgery can be performed at any time.
In less than half an hour, everything was ready. Su Yixuan and Zhou Can prepared surgical instruments. Huang Jiahui's anterior spinal plate was in place, sterilized, and ready to be used. Any gaps should be filled after use.
Yang Ping's team is making rapid progress. The first assistant Song Zimo is extremely talented, full of passion for surgery, and unswervingly strives to be the best surgeon.
Now, as Yang Ping's assistant, he did not fail to challenge Takahashi Sasaki. In the academic society's surgery, when Takahashi was in trouble and could not proceed, he was able to handle ten blood vessels.
In terms of microsurgery, although there is a big gap between him and Yang Ping, compared to others, he is already an insurmountable peak. At his current level, he can cut the tail of a newborn mouse into countless sections and let Song Zimo anastomose the blood vessels.
The blood circulation is smooth, and the operation can be completed with both hands hanging in the air.
I am extremely skilled in arthroscopy, thoracoscopy, laparoscopy, and foraminoscopy, not to mention open surgery. Under Yang Ping's guidance, my proficiency in anatomy is beyond the ordinary people.
If someone wants to challenge Yang Ping, they must first climb the Song Zimo mountain, but this mountain is very difficult to climb.
The status of the fifth and fifth Zhang Lin's golden hook and silver hook has never been clearly distinguished. The two are on par with Uncle Zhong, but there is no denying that they are the best second and third assistants.
Anesthesiologist Fatty Liang is as passionate about anesthesia as he is about food. He enjoys his role from beginning to end.
Needless to say, nurse Su Yixuan is Yang Ping’s most tacit partner, and Tiancheng’s tacit understanding makes every operation flawless.
Zhou Can is the best circulating nurse, and if she takes the stage, she will also be an excellent equipment nurse.
The most important thing is that they have experienced battle after battle, especially the surgery that Takahashi failed to perform. The team's confidence has greatly increased, and they firmly believe that they are the best team in the world.
Fang Xiaoyun's important imaging examination films are hung on the reading lamp for the surgeon to view at any time. There are also images on the electronic screen, which can be seen by raising your head slightly.
Under general anesthesia with endotracheal intubation, take a 90-degree left lateral position, lift your right upper limb, place it on the armrest, and externally rotate the scapula on the chest wall to easily expose the 5th and 6th intercostal spaces.
Posture is very important for surgery. Good posture can fully expose the patient. Improper or wrong posture can make exposure difficult or even impossible.
Fang Xiaoyun has an endotracheal tube inserted in her mouth and connected to the anesthesia machine. The head frame is placed above her head. Her eyes are protected by protective patches in the closed position. Various bony protrusions throughout her body, such as the sacrococcyx, are protected by silicone protective pads.
, to avoid ischemic necrosis due to compression, the right upper chest axilla is also padded with a thin pillow, so that the axillary artery, axillary vein and brachial plexus are well protected.
Zhou Can checked whether Fang Xiaoyun's upper limbs were discolored or purple, whether there was venous congestion, whether the radial artery pulse was normal, and confirmed that there were no problems. Song Zimo disinfected and spread the drape, and everything was ready. Yang Ping put on surgical clothes and gloves and went on stage.<
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The sacred pre-operative check is not only to prevent mistakes in the surgical site and method, but more importantly, it is a ritual to show the seriousness and all-out efforts of the surgical team.
Stop all the work you are doing, check every item, and every operating member must participate. If there are any objections, raise them on the spot. If there are no objections, announce: The operation has begun! Only then can the knife be operated.
Through the thoracic approach, along the upper edge of the 8th rib, from the outer edge of the erector spinae muscle to the front axillary line, incise the skin, subcutaneous tissue and deep fascia, and continue to incise the muscles: the first layer of latissimus dorsi, the second layer
The serratus anterior muscle and the external oblique muscle originate from the outer edge of the erector spinae muscle. The third layer is incised into the external intercostal muscles and internal intercostal muscles to protect the intercostal nerves and intercostal arteries and veins at the lower edge of the ribs.
The parietal layer of the pleura was exposed. Yang Ping used a knife to make a small incision in the parietal layer of the pleura. The air immediately entered the chest cavity, the negative pressure disappeared immediately, and the lung on one side gradually collapsed.
There were adhesions between the lungs and the pleura, and the tissue was cut through. Yang Ping cut off the band-like and membranous adhesions. The lungs completely collapsed, and saline gauze protected the chest wall.
The thoracotomy gradually opens the chest, and the beating heart and a pair of contracting lungs are vividly presented in front of you, especially the powerful beating heart, the thumping sound, and the rhythmic beating, which represent the power of life.
From birth until death, it beats to its own rhythm day and night.
Sometimes, during chest heart compression, you need to hold the heart in your hands. At that time, you can feel the magic of life the most, because life is held in the palm of your hand.
Yang Ping stopped what he was doing: "Come and take a look!"
The observing trainees and interns lifted their pedals, one meter away from the operating bed, and looked into the chest to see that the heart and lungs were vividly displayed in front of them.
Seeing this scene, it is easy for people to involuntarily have a sense of holiness, nobility and responsibility.
Revere life, respect life! The impact on your heart is stronger than swearing a thousand medical student oaths.
Life is displayed in front of you as a pulsating picture. When it stops, the whole life disappears and has no connection with this world; while it is still beating, you can laugh, cry, love, hate, and experience the world.
Everything is ups and downs.
The dissection has entered a state of perfection and perfection. The lung tissue is covered with saline gauze and gently pulled toward the midline. The lateral front and posterior mediastinum of the thoracic vertebrae are exposed.
The whole process was carried out silently. There was no need to remind the assistant what to do at each step, the position, direction and strength of the retractor. The instrument nurse already had a very detailed and in-depth understanding of the surgical steps.
The knife, without even looking at it, the nurse has handed over the instrument, and the timing is right. The feeling of doing this operation is very wonderful, it is a heart-to-heart communication.
The mediastinal pleura was incised longitudinally, and the left thoracic aorta, hemiazygos vein, right azygos vein, and intercostal arteries and veins were all exposed.
These blood vessels need to be cut off and ligated partially to obtain full exposure. However, the intercostal arteries are one of the main blood supply arteries to the spinal cord. The number of cuts cannot exceed 3, otherwise the blood supply to the spinal cord will be compromised.
A true master adheres to the concept of minimally invasive surgery throughout the entire operation, and does everything possible to protect blood supply and tissue. Yang Ping does not intend to cut off or ligate these blood vessels, he wants to protect every blood supply blood vessel in the spinal cord.
Entering through the gaps between blood vessels, the gaps between blood vessels will form several operating windows, making the operation very difficult, but for Yang Ping, this is not a problem.
Enter through the blood vessel gap, use a periosteal dissector, push the extrapleural aorta away from the front of the vertebral body, protect it with saline gauze, and gently insert the retractor.
Saline gauze protects the surrounding area, and the operating space is revealed. The front of the thoracic vertebral body, the intervertebral disc and the anterior longitudinal ligament are about to appear in the field of vision, but what is revealed is a sac-like object with a fluctuating feeling.
This is an abscess. Xiao Su handed over a 50ml syringe. Yang Ping stabbed a small opening with a sharp knife. The sticky white-yellow "cheese" followed the small opening at the front of the syringe and eagerly entered the syringe tube. The syringe was quickly filled.
, change the syringe and continue to inhale.
The aspirated specimens were reserved for bacterial culture and pathological examination. Five tubes were aspirated in succession, aerobic bacterial culture, anaerobic bacterial culture, tuberculosis culture, smear for acid-fast bacilli, and pathological examination.
At this time, the assistant's suction device came in and gently inserted it from the small opening to remove the remaining "cheese". This suction device was specially designed to attract "cheese". The circulating nurse began to calculate the volume of "cheese", which was 1,000
Milliliters.
Yang Ping completely opened the abscess wall and repeatedly flushed and suctioned it with normal saline until the surgical area was clean, and the operation continued.
"It's quite beautiful!" Zhang Lin said.
Xiao Wu looked up at him: "Indeed, it's a pity that I can't smell it."
"Will it smell sweet?"
"I heard it's sour."
I didn't expect that the cheese-like substance of cold abscess could have such a good visual effect. Zhang Lin Xiaowu sighed at the same time, but the hook in his hand did not move, the strength was appropriate, and the exposure was sufficient.
The golden hook and silver hook are not just for free, they are earned through the excellent performance of countless surgeries.
"Congratulations, you are one step closer to becoming an excellent surgeon."
Yang Ping has exposed the front side of the ninth thoracic vertebra and started to ligate the surrounding blood vessels.
