Human anatomy is very complex, with various potential gaps and abscesses far beyond what can be seen with the naked eye. Magnetic resonance imaging shows several nearby locations, making it difficult to observe all aspects with the naked eye during surgery.
Choledochoscope, flexible scope! Now it comes into use. This is usually an instrument used by general surgery to remove bile duct stones. Now Yang Ping uses it to observe the true extent of the abscess.
With the guidance of magnetic resonance images, the scope of the abscess is already known in the mind. The soft scope is inserted, up, down, left and right, to explore the entire scope of the abscess, and then guides the suction device to aspirate.
This equipment has never been used in previous surgeries. Surprisingly, Xiao Su knew how to use this step, and also knew that Yang Ping was going to use it now. Yang Ping stretched out his hand out of habit, and the lens was delivered to his hand in time. Various wire tubes had been connected in advance.
Su asked Zhou Can to turn on the display screen.
Rinse and suction, Yang Ping holds the lens in his left hand and operates the suction device in his right hand, flushing and suctioning in all directions without blind spots, and suctions out almost 3,000 ml. After excluding the 2,000 ml of rinsed saline, 1,000 ml is pus. "Can the choledochoscope still be used like this?" Song Zimo also wants to try it next time.
Yang Ping said while doing it: "The soft scope can change the direction of the lens, which is suitable for all-round exploration. Later, we can also use a thin soft scope, which is used for intrahepatic bile duct stone removal, to explore the scope of pus in the spinal canal and completely remove it.
, the hard scope is not good, it cannot enter the dead area, and it is easy to damage the spinal cord."
The entire vertebral body of the 9th thoracic vertebra was invaded by abscess and has collapsed. The bone fragments have moved backward and invaded the spinal canal.
Only the ninth thoracic vertebra could be removed. After Yang Ping processed the blood vessels around the vertebral body, he reminded the anesthesiologist: "Be prepared to remove the vertebral body, pay attention to your blood pressure."
The vertebral body is a layer of cortical bone wrapping cancellous bone. The cancellous bone has rich blood supply, so when the vertebral body is removed, the bleeding is much more than in other steps.
At this point in the operation, the aspirator that attracts blood is still relatively clean for the time being, and there is not much blood to aspirate. The suction head of the aspirator used to remove cheese has been changed several times, and more than 2,000 ml of cheese has been aspirated.
The bone knife cut through the vertebral root arches on both sides, cleared the upper and lower intervertebral discs, and then took out the vertebral body completely. It was still possible to operate like this. Song Zimo gained another insight.
In this step, a bird's-mouth rongeur is usually used to bite off the vertebral body one by one. Such a step will inevitably cause a lot of blood. Now Yang Ping directly takes out the vertebral body completely, and there is no bleeding at all.
The cross-section of the vertebral pedicle was sealed with bone wax, and the spinal canal was exposed, along with the touched spinal cord. Inside the spinal canal was a tofu-like substance mixed with dead bones, compressing the spinal cord.
No wonder the patient developed neurological symptoms, with muscle strength loss and sensory impairment in both lower limbs. If surgery was not performed, the muscle strength would slowly continue to deteriorate and eventually become zero-level, with both lower limbs completely paralyzed.
Use a curette and a nerve dissector in conjunction to remove the tofu-like material, leaving a portion for bacterial culture and pathological examination. This is a necessary step.
Following the spinal canal space upwards and downwards, Yang Ping was still uneasy about removing the compressing substances. After all, the upper and lower parts of the spinal canal were like narrow tunnels, and it was difficult to completely detect the true extent of these pathological substances with the naked eye.
The choledochoscope is used again. It is gently inserted into the spinal canal, almost against the wall of the spinal canal, and probes up and down. According to the instructions on the magnetic resonance imaging, there are some areas above and below that cannot be seen by the naked eye. There is an abscess, although it does not exist.
Oppression can become an obstacle to recovery.
Insert the peeler, and under the guidance of the soft lens, easily remove these residual substances, rinse and suction, and then remove again. Repeat several times, and finally it is completely removed.
"Microscopic instruments!"
Xiao Su is ready. He knows that Yang Ping will not let go of this step, nor will he let go of the exploration of the anterior spinal artery. Yang Ping will not lose any points he deserves for the operation.
Let's explore the anterior spinal artery. Yang Ping carefully exposed the anterior spinal artery, and gently clamped it with the microscopic forceps to feel the tension of the blood vessel wall.
No, the feeling under the tweezers is very hard, which is not what a normal pipe structure should feel. There should be an embolism.
"What? Embolism?" Song Zimo looked at the movements of the microforceps on Yang Ping's hand.
"It's embolism!" Yang Ping was sure.
The embolus is almost two centimeters long, which is the section that was just compressed. If the embolism is not removed, the spinal cord will undergo ischemic necrosis and degeneration. The paraplegia will not recover after the operation and will continue to worsen. All the work just now will be in vain. p>
"What should I do?" Song Zimo asked thoughtfully.
Fortunately, Yang Ping conducted an exploration. Otherwise, the feeling and muscle strength of both lower limbs would not be restored after the operation, or would gradually worsen. By then, it would be too late to conduct another exploration.
"The embolism should be imminent. If we can open the blood vessels now, it's still too late." Yang Ping judged from the hardness of the blood vessels under the forceps.
The perfect effect of an operation is the result of countless perfect details.
"Cut the blood vessels, remove the thrombus, and then anastomose the blood vessels?" Song Zimo guessed.
Yang Ping nodded: "Prepare the microscopic instruments to anastomose blood vessels!"
A careful investigation changed this patient's fate. Otherwise, she would probably spend the rest of her life in a wheelchair.
In spinal tuberculosis surgery, there is no step to explore the anterior spinal artery, because most spine surgeons do not have the thinking and experience of microsurgery.
Yang Ping decisively cut off the anterior spinal artery and used forceps to gently drive out the thrombus. The thrombus was like a tiny earthworm and was placed on the saline gauze in Xiao Su's hand.
"Take pictures!"
Yang Ping ordered that Zhou Can was fine in the audience for the time being and helped take photos. The purpose of taking photos was to leave complete information for the operation and to accumulate original data for future scientific research.
According to the microsurgical small blood vessel anastomosis process, heparin saline flushes the blood vessel pipes, trims the outer membrane of the blood vessels, anastomoses the needles and threads without damaging the blood vessels, and anastomoses the blood vessels, and checks whether the blood vessels are leaking and whether they are pulsing well.
After observing for a full two minutes, Yang Ping was relieved: "Okay, let's take out the iliac bone and perform intervertebral bone grafting."
Song Zimo began to remove the iliac bone. The removal of the iliac bone was very skillful. It was necessary to obtain a satisfactory volume without affecting the appearance and function of the donor site.
"I'm getting married before the Spring Festival. Brothers will definitely come over to have a fun time. I've already sent Director Han's invitations, and I've asked the head nurse to send out invitations for him. I'll hand them over to the brothers myself later."
Xiaowu said something unexpectedly.
"So fast?" The fat man arrived and was surprised. Brother, he is the fastest.
"If we don't hold a banquet, we will hold a banquet with my baby in my arms." Zhang Lin said lightly.
"What? You're going to be a father, are you just one step ahead?" The fat man didn't expect that he didn't have a girlfriend yet, and this guy was going to be a father.
"My father-in-law and mother-in-law are urging me so hard that I dare not disobey." Xiao Wu said helplessly.
"You're not going to quit being a doctor and become a charterer after you get married?" Zhang Lin teased him.
Xiao Wu’s parents-in-law are locals in G City. They traveled to and from Hong Kong and Mainland China in the 1980s reselling electrical appliances and made a fortune. They then invested in real estate and made a lot of money. I heard that there are several buildings in the CBD of G City.
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The old couple only has one daughter, and they are very cautious about their daughter's life-long affairs. After seeing Xiaowu, the old couple liked her very much. The young man is handsome, eloquent, and has a flexible mind. He is a graduate student, a doctor, and has a good education and career.
Now that Xiaoqing is pregnant, the old couple are so happy that they are going to be grandparents. They are urging them to get married every day, so that they don't have to worry about anything, and they two old people will take care of it.
"Fifth brother, do you have a sister-in-law? A sister-in-law is fine too!" Fatty felt that he was not a little behind.
"You didn't tell me earlier!" Xiao Wu said while pulling the hook.
The fat man was very surprised: "Why, then it's already there?"
"I told them earlier, I advised them to have another child, but I'm afraid it won't work now." Xiao Wu said with a smile.
While talking and laughing, Xiao Wu and Zhang Lin's retractors did not move, and the surgical area was well exposed.
Song Zimo's iliac bone block has been removed. It is square and very beautiful.
Yang Ping used a spreader to spread the upper and lower vertebral bodies, and implanted the iliac bone quickly and just right.
