The radiation-proof lead door was tightly closed, and Director Ji struggled hard inside, which was estimated to take about six hours.
After such an arduous struggle, it is possible that nothing can be achieved and nothing will be discovered.
The human body is complex and mysterious. Modern medicine, whether it is basic medicine or clinical medicine, is far from developed enough. It can be said that it has just begun.
For many diseases, textbooks say: the mechanism is unknown, symptomatic treatment is not available, there are no specific drugs, etc.
While there was nothing wrong, Yang Ping went to the system space to see if there was any interventional surgery training. There was no training for the moment. Currently, it was all training for bone diseases, mainly bone tumors. The next stage is orthopedic training.
The three major orthopedic surgeries of trauma, bone disease, and orthopedics should be advanced and completed before there can be training in side surgery, such as interventional surgery, robotic surgery, etc.
Yang Ping went inside and picked up some surgical training on thoracoscopy, laparoscopy, and foraminal endoscopy. Osteopathic surgeries often involve the spine. Minimally invasive spinal surgery requires the use of these laparoscopes and technical barrels. He must be down-to-earth and work step by step.
Complete.
"After all this effort, what do you think we should do if we can't find it?" Zhang Lin asked worriedly.
Xiaowu was also very worried: "I think Fang Xiaoyun's mother will most likely cause trouble. It's not easy to be a doctor. On one hand, you have to deal with these complex diseases, and on the other hand, you have to deal with the sinister human heart."
"This is how bold my senior brother is. If it were anyone else, he wouldn't dare to take risks in this situation."
"Zhang Lin, are you ready to have a baby? I'll help you with the surgery later, and you can take the photos."
"It's okay. I won't dare to ask for this for two or three years. At least I won't dare to ask for it until I am promoted to attending physician."
Yang Ping was resting his eyes with his eyes closed, and Song Zimo was thinking about this disease. Spinal dural arteriovenous fistula is such a rare disease. If it can be diagnosed in a single patient, it is considered very powerful. Now it is covered up by spinal tuberculosis, but Yang Ping discovered it.
This kind of diagnostic ability is too powerful.
Time is really hard, especially when we don’t know the outcome or how long we will have to wait. This kind of waiting is a torturous thing.
"Fifth Brother, would you like to go smoke a cigarette?" Zhang Lin suggested.
In fact, Zhang Lingang did not smoke when he was working. He worked late and night shifts. Sometimes he stayed up all night after emergency surgery. He smoked just to refresh himself and relieve fatigue.
"Smoke one, just smoke one."
Xiao Wu originally wanted to quit smoking. After all, he was going to be a father. The smell of cigarette smoke in the future would make him afraid that the little guy would dislike it.
There was no smoking room in the interventional operating room, and it was not easy for the two of them to look for a smoking room while wearing wash clothes, so they had to hide in the toilet and turn on the exhaust fan.
The electronic clock on the wall showed that it was past 22 o'clock, and there was no good news yet.
Even if the fistula is successfully found within six hours, surgery will still be required later, and the surgery will be done under a microscope.
Staying up late like this is very harmful to the body, but there is nothing you can do about it. It is said that the residency training in the United States is very cruel, regardless of day or night, and the sky is dark.
Physical strength alone can eliminate many people. Some people say that this is intentional to naturally eliminate people with poor physical fitness. A good doctor must have good physical fitness, be able to stay up late, be able to hold back urine, and be able to go hungry.
Xiao Wu and Zhang Lin smoked a cigarette and felt much better. The two of them went to the operating room door from time to time, but the door was still closed.
"Go inside and have a look, have you found it?" Song Zimo instructed Zhang Lin to go in and have a look.
"Don't panic. Let's all get some sleep. We have to go on stage for surgery later. With Director Ji's skill, he should be able to find the fistula. There is also Professor Zhang next to him. He has rich experience."
Yang Ping squinted his eyes. He came out of the system space and felt much more energetic. He suspected that the air inside had some special effect, such as increasing energy.
It's past twelve o'clock, but there's still no movement.
Zhang Lin and Xiao Wu were like two furry monkeys who couldn't calm down. I asked them to sit on a chair and sleep for a while, but they couldn't sleep and kept walking around.
"No, I have to go in and take a look." Zhang Lin was anxious.
Xiao Wu grabbed him: "I'll go in, you wait here."
Xiaowu took a piece of lead clothing from the shelf where the lead clothing was placed and put it on, went in, and after about ten minutes, he came out and said, "I haven't found it yet!"
Haven’t found it in six hours?
Is it really necessary to draw water from a bamboo basket but in vain?
If you really can't find it, it's okay if the patient understands. If you don't understand, you'll be in a hurry. You'll spend a whole night and spend more money, but in the end there will be no results.
Therefore, for some diseases, the outcome is completely different whether the patient understands and cooperates.
Only with understanding and cooperation can doctors dare to take risks. Without understanding and cooperation, doctors have no courage to work hard.
If you don’t work hard, how can you get the best results?
So anxious!
Zhang Lin patted his own forehead.
Xiaowu comforted him: "Be careful, why don't you go smoke another one?"
At almost one o'clock in the morning, the heavy lead door finally opened.
"Found it!"
The nurse who opened the door shouted excitedly.
Just like the midwife in the delivery room opening the door and shouting to the mother's husband waiting anxiously outside: "Give birth!"
Everyone stood up like springs---I found it!
"A communicating fistula was found in the left intercostal artery and vein of chest 8-9. In this place, the abnormal tortuous and thickened veins around the medullary area are clearly visible. Is it possible to operate?" Director Ji's voice was a little hard to pronounce.
It was really a spinal dural arteriovenous fistula, the probability of being struck by lightning was stepped on by Fang Xiaoyun.
For people like Fang Xiaoyun, the probability of two overlapping diseases is two lightning strikes!
"Lie prone. Don't pull out the catheter. If the fistula is not found during the operation, please ask Director Ji to help insert Meilan into the catheter." Yang Ping asked Director Ji to take a rest.
Look at the time, it's more than six hours, twenty-four blood vessels, the lead clothing is not breathable, Director Ji's back is all wet, but he doesn't dare to take it off yet, Yang Ping has to operate, and he may be needed during the operation.
Help, inject melanin into the catheter to locate the fistula.
Yang Ping, Song Zimo, Zhang Lin and Su Yixuan washed their hands and took the stage.
"Director Ji, how about you take a break?" Yang Ping said politely.
"It's okay, I'll just sit next to you." The nurse moved a stool and Director Ji sat down to rest.
Yang Ping is well-known in the hospital for performing surgeries quickly and well. If Director Ji takes off his surgical gown now, he will have to wash his hands and get dressed again soon, which will be troublesome.
"Xiao Zeng, help me call my wife. The phone is on that table."
Lao Ji felt quite guilty. He had eaten with his wife, but now he was on the operating table, leaving her alone.
He wanted to call his wife to report the good news. He had encountered a rare case. There were only 300 cases in the world. He had successfully found the fistula. As a doctor, this is the best thing. When he gets old, he will brag to the younger generation.
What are you blowing?
It’s not just bragging about such rare cases. Only 300 cases were found in the world, and one of them has its own contribution. It’s 1 in 300 in the world. What a concept.
It’s now past one o’clock in the morning, and I’m still calling at this hour. Nurse Xiao Zeng is a little hesitant: “You’re still calling my sister-in-law at this hour?”
"Hit! She's not asleep yet. Let her rest early. Don't wait for me. She won't be able to go back for a while. Come here and I'll tell you the gesture password."
The nurse had no choice but to make a phone call: "Hey, sister-in-law, Director Ji can't go back now. Yes, he is here with me tonight, no, I mean, he is with me tonight, no, sister-in-law, I mean--
-"
I stayed up all night and was so confused that I couldn't speak clearly. I revised a sentence several times and still couldn't make it clear.
You said this, and I'm with you. Fortunately, Director Ji's wife is more familiar with the situation, otherwise this would be a big mistake.
The nurse hung up the phone and said to Director Ji in surprise: "Sister-in-law is outside the operating room?"
"Director Ji, is this a post inspection?"
"What is the check post? I haven't eaten yet. She has brought food. Let her wait until the operation is completed."
A good surgery, what a waste of dog food.
Yes, we haven’t eaten yet. Xiao Su ordered a lot of takeout and actually forgot to eat. Everyone is hungry at this point.
"It's okay if I don't say it, but when I say it, my stomach growls!" Zhang Lin swallowed.
"Hold on, brother, you're not hungry alone!" The grunting was so loud that even Xiao Wu heard it.
Through the posterior approach, in order not to destroy the stability of the posterior column of the spine, Yang Ping used a technique similar to the cervical vertebra door opening, cutting off three sides of the lamina in a rectangular shape, leaving one side broken to protect the periosteum, and then opened it like a door. In this way, the operation was completed.
The lamina can be closed to prevent posterior column damage and instability.
This technique requires very delicate techniques, otherwise it is easy to fail. When the lamina is opened, the veins are indeed thickened and tortuous. Because patients with spinal tuberculosis do not routinely undergo DSA angiography, this vascular malformation must be found on magnetic resonance imaging.
Unlikely.
This is not a problem of level, but a problem of the technology itself, just like the inability to detect color in a black and white photo.
The fistula is in this vein. If you search for one point from one surface or one blood vessel, you can still find it, but it will take time and you cannot confirm whether it is a fistula.
Yang Ping stopped: "Director Ji, please help us inject Meilan into the arteriovenous fistula just now."
The catheter inserted from the femoral artery had not yet been pulled out. Director Ji came on stage to help inject Meilan: "Then I will inject the medicine!"
Meilan followed the catheter, and not long after, a blue point appeared in the venous plexus, and then slowly expanded. Yang Ping found that point, and there was only a fistula. The diameter of the blood vessel was about three millimeters. The arteries and veins needed to be separated under a microscope, and then
Suture the tear.
"Okay, that's all. Director Ji, I found it. The catheter is still there. I'll do an angiogram to confirm after the operation."
"Microscope!"
Zhou Can pushed the microscope in, which had been covered with a sterile protective cover. Yang Ping adjusted the focus and interpupillary distance by himself, and began to separate blood vessels under the microscope and repair the fistula.
"A small fistula has such a big impact on the human body? It can actually cause paraplegia. It seems that human body evolution is not good enough. The fault tolerance rate of parts is too poor." Zhang Lin looked at this small fistula, which was only 3 mm.
Fistula on blood vessels.
Originally, arteries are arteries and veins are veins. Bridges are bridges and roads are roads. The two systems circulate independently. The proximal end is connected in the heart and the distal end is connected by capillaries. The middle is isolated from each other and is not connected. Now they appear.
A channel is connected, which is an arteriovenous fistula.
Just like a highway, there is a median for the lanes coming and going. Now there is a gap in the median, and the cars coming and going are mixed together through the median, and it will be chaotic.
The same goes for people. Once an arteriovenous fistula occurs, arterial blood flows into the veins, and venous blood flows into the arteries. In this way, because the arterial blood is mixed with venous blood, the blood oxygen content decreases, and because the veins are connected to the arteries, the return pressure of the blood vessels increases.
Cause congestion.
It was precisely because of venous congestion that Fang Xiaoyun's spinal cord edema could not be relieved and continued to worsen. He lost the parabolic trend of postoperative spinal edema. This trend has been uphill, reaching the top and becoming a platform.
The abscess of spinal tuberculosis compresses the spinal cord, causing spinal cord edema and paraplegia; spinal dural arteriovenous fistula causes venous congestion, which can also cause spinal cord edema and paraplegia.
The two conditions are intertwined, with one covering up the other, which naturally increases the difficulty of diagnosis.
After the operation is completed, the surgical area is rinsed clean and a drainage tube is placed.