Dr. Zhou's operations are very standardized and skillful. Chinese hands are dexterous. Yang Ping's previous worries were a bit unnecessary.
Dr. Zhou superselects the feeding blood vessels of the thoracic cord one by one, carefully and patiently.
Yang Ping helped him navigate, when to stop, when to move forward, and when to push medicine. There was a certain delay from instruction to operation, but Dr. Zhou's understanding was very good, and his cooperation did not appear stiff.
"Slow down, push, stop, push again, cross the bifurcation, go to the outside, yes, push two centimeters, stop---you can push the medicine." Every word of Yang Ping, Dr. Zhou can turn it into a hand.
precise movements.
"Dr. Yang, have you learned interventional medicine?" Dr. Zhou was surprised. Surgeons also know how to intervene.
Yang Ping thought for a while: "I am very familiar with the anatomy of this area. I know the origin, direction and supply range of each blood vessel."
Dr. Zhou followed his navigation and completed the angiography of the first group of blood vessels safely and quickly. Dr. Yang was no longer familiar with anatomy, but was fascinated by it.
The British face is always so rich in expressions, including surprise, doubt, and admiration. The various expressions on his face are exaggerated by the expressive muscles.
Milton took two steps toward the video screen, his cheeks bulging and his face flushed, as if he was holding his breath. He opened his eyes as wide as possible, as if opening them wider would lead to higher definition.
August glanced at this old friend, not to be outdone, and took two steps forward. As long as it was outside the yellow line on the ground, it complied with the requirements for hospital infection management.
The image on the screen is very similar to a Chinese ink painting. The dark blood vessels are twisting and turning, from thick to thin, and the more they branch, the thinner they are. The colors are also thick and light. The color that has just been selected is darker, and the color that has been selected is lighter.<
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Dr. Zhou is now very accustomed to following the navigation. He doesn't dare to speak anymore and looks at the screen with all his attention. The movements of his hands are extremely gentle and precise, and the blood vessels of the spinal cord are super selected one by one.
Finally, the site of the arteriovenous fistula was found. The contrast agent leaked out through the fistula opening and entered the vein, forming a clear communication between the arteries and veins.
"Dural arteriovenous fistula!" Milton exclaimed, as if he was holding his breath just to shout this sentence.
Milton's voice was very soft, for fear of disturbing the operator's operation, but he had to shout this sentence to show that he would not show weakness in front of August. August glared at his old friend unkindly. "How many cases is this in the world? August?" Milton kept his eyes on the screen.
"Don't disturb me. Now is not the time for academic discussions. I also need to concentrate." August was very angry.
All of Atsushi Kobayashi's doubts were swept away. This doctor who made up the numbers turned out to be a real top expert. His proficiency in anatomy exceeded Atsushi Kobayashi's knowledge. Fumiya Takahashi and Jiro Sasaki, both famous for their trauma surgery at the University of Tokyo Hospital,
It’s hard to beat him.
Fumiya Takahashi and Jiro Sasaki have personally dissected more than a hundred "gross teachers". At that time, the University of Tokyo purchased hundreds of "gross teachers" from Eastern Europe for a certain topic and used them for teaching. Takahashi and Sasaki were the surgeons.
A hundred were dissected.
However, how come such a doctor has no international reputation? I have never even seen the papers he wrote, nor have I seen him attend international academic conferences.
Under Yang Ping's guidance, Dr. Zhou saved a lot of time. The surgery that was originally planned to take seven or eight hours can now be completed in three or four hours.
Another arteriovenous fistula was found. This patient had two arteriovenous fistulas. Yang Ping asked Dr. Zhou to relax a little: "There are only two arteriovenous fistulas. You can also show them the remaining groups and rest after completion."
After a few minutes, super-select a few mutated arteries."
"Hmm!"
Dr. Zhou seemed a little tired due to his high concentration. He thought that if Dr. Yang guided every operation, no matter how difficult the operation was, he would be able to complete it successfully. If Dr. Yang performed interventional surgery, he would probably be at the top level in the world. After super-selecting the remaining groups of blood vessels, there were no problems. Dr. Zhou took a short break and began to super-select the several mutated arteries.
The purpose of super-selecting these abnormal arteries is to confirm to everyone that these blood vessels are the main supply blood vessels of the spinal cord. Once damaged, they will cause ischemic necrosis of the spinal cord.
At the same time, we will use this DSA image to create a virtual reality 3D imaging to help everyone understand the location of the blood vessel in the approach and how to protect it.
These blood vessels are not found in normal anatomy knowledge, and they are tortuous. The difficulty of angiography is much greater than that of those groups of blood vessels. Those groups did not have Yang Ping's navigation, so Dr. Zhou could slowly complete it by himself. These blood vessels,
Without navigation, Dr. Zhou could not complete the operation.
"Don't be anxious. Slow down. These blood vessels have complex shapes and large curvatures. It is difficult to super-select. If you accidentally damage them, it is easy to cause bleeding or embolism. Just like just now, listen to my navigation---
”
Dr. Zhou did not dare to move the guidewire in his hand, waiting for Yang Ping's navigation to begin.
"Push forward, continue, continue, go forward about 0.5 centimeters, which is 5 millimeters!" In order to prevent Dr. Zhou from mishearing, Yang Ping expressed it in two units.
"Stop! Now we have to cross the bifurcation, rotate the guide wire, stop! Push forward 5 millimeters, stop! The curvature is too big, do not advance more than 5 millimeters each time, stop every time you push further, think clearly before moving forward."<
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"Okay, continue forward, stop, push the contrast agent!"
The branch-like ink painting spreads out. Really, this is a major blood vessel supplying the spinal cord.
Dr. Zhou's palms were all sweaty and a little sticky through his gloves. Looking at the images on the screen, he couldn't believe that he had succeeded in super-selecting this kind of blood vessel.
Dr. Lin and Dr. Huang looked at the screen and remained silent.
Continuing, the blood vessels were twisting and turning, and the operation progressed very slowly. Dr. Zhou's hands remained steady and careful, and every small movement concentrated all his energy.
If you are not careful, the guidewire may puncture the blood vessel, causing bleeding, or damage the endothelium of the blood vessel, resulting in embolism. The consequences of each mistake are extremely serious.
Now, Dr. Zhou is like driving a car on a winding mountain road at night, with an abyss on the side of the road.
Every time you move forward, you follow a certain kind of navigation. Turn the steering wheel a few degrees to the left and a few degrees to the right.
Push a little further, stop, finally cross a few forks, super-select successfully again, push the contrast agent, and continue to the next one.
The second and third blood vessels were successfully imaged, and the contrast agent image on the screen drew a thick and curved line along the blood vessels.
The super-selection of three mutated arteries was successful, and Dr. Zhou's heart was gently relieved, as if he were letting go of a priceless and fragile antique.
What he feels now is that at dawn, the car reaches the top of the mountain, and the driver looks down. The mountain road runs along the cliff, and under the cliff is an abyss. He is actually going up the mountain, and he is scared!
Dr. Zhou shuddered involuntarily, which may be a sign of fear.
It's finally finished, everyone can take a deep breath and talk.
The truth is revealed!
The diagnosis made by Chinese doctors based on CT and MRI was correct. This patient had a spinal dural arteriovenous fistula and three mutated spinal cord feeding arteries.
"Can we do virtual reality 3D reconstruction? It would be more intuitive to make virtual reality three-dimensional blood vessel images." August suggested.
"We have it at the Central Hospital and can transfer data there." Dr. Lin also felt it was necessary.
"Yes, use virtual reality technology to reconstruct the spinal cord and blood vessels. This is more direct. I understand everything." Milton finally saw through the triple scheming.
It's a pity that DSA didn't understand it before and was a little behind August. I'm afraid he will not have enough confidence in front of August for a long time in the future.
This DSA took nearly four hours, which is relatively fast, and no time was wasted in the process.
Now, not in Yang Ping's own feelings, but in the eyes of others, he has become that "man from the earth."
Such a complicated case seemed so relaxed in his hands, his confidence in analyzing the condition, and his proficiency in anatomy when doing DSA, as if everything was simple and clear in his heart.
Milton recalled Yang Ping's words: "Actually, this case is very simple, not very complicated. Everyone has seen it relatively rarely, so it is a bit at a loss."
Dr. Yang was so calm, calm and relaxed, but everyone was so confused, confused and helpless. Even though he had fully explained his condition, no one understood except that old ghost August. Milton was embarrassed. Dr. Zhou pulled out the catheter and pressed sterile gauze on the puncture site to stop the bleeding. Dr. Lin is arranging for doctors to collect pictures and transmit them to Singapore for virtual reality 3D imaging.
Yang Ping went to the locker room to take off his lead clothes. August and Milton both caught up and rushed to help Yang Ping take off his lead clothes.
"If you have time, can you explain more clearly how to accurately judge this type of vascular disease from CT and MRI?" Milton pulled one side of the lead jacket.
"There is also a hand-painted reconstruction of the image. How can we do it?" August pulled the other side of the lead suit.
The two of them pulled back and took off the lead clothes. They pulled each other a few times and hung up the shelf where the lead clothes were placed.
"This cannot be explained clearly in a few words." Yang Ping said calmly.
If you don’t have extremely sophisticated knowledge of anatomy, you won’t be able to explain it clearly for the time being. It will be easier to understand it when you summarize your experience and turn it into some knowledge that can be widely used.
For example, multi-ligament reconstruction of the knee joint is an example. When a set of standard reconstruction procedures is summarized, everyone follows the procedures, so that the surgery can be popularized.
"Dr. Yang, I finally figured out that this case has three nested diagnosis and treatment traps. If you jump out of one trap, you will inevitably fall into another trap? This forms a series of traps that are difficult to escape? Such a classic case should be the center of Cambridge University Medicine
"Teaching Cases of the Academy." Milton's hindsight.
"It should be Charité Medical College!" Auguste showed no sign of weakness.
