After Yu Shuilian had her sutures removed, her liver and kidney functions have remained normal, and she has successfully passed through the dangerous period of organ dysfunction.
In this way, the reconstruction surgery of the urethra and anus was put on the agenda, and it was time to hand in the homework assigned by Yang Ping.
Yang Ping gave them homework and each designed a reconstructive surgery plan. He hoped that Song Zimo, Xu Zhiliang and Gao Qiao could discuss it together and others would follow suit.
Gao Qiao is an international master of trauma surgery, mastering the latest concepts and technologies, allowing Song Zimo, Xu Zhiliang and Gao Qiao to collide and spark ideas.
Judging from the discussion information in the group, the three of them actually have their own advantages.
Gao Qiao has the richest clinical experience, and Song Zimo has the highest talent. Whether it is thinking ability or practical ability, he is obviously superior to Gao Qiao and Xu Zhiliang. The gap between Song Zimo and Gao Qiao lies in clinical experience.
The experience Yang Ping taught him was still theory to Song Zimo, a theory that could not be found in books. He had not done as many surgeries as Takahashi, so his clinical experience was naturally worse than Takahashi's.
Xu Zhiliang's thinking ability is no worse than Takahashi's, but whether it is theoretical knowledge or clinical experience, it is still much worse than Takahashi's.
After all, Gao Qiao has studied this major for a long time, exchanged and studied everywhere, and has always been at the top international level, which Xu Zhiliang is far behind.
Xu Zhiliang graduated from Nandu Medical University from bachelor's degree to doctorate. China has a population of more than one billion, and those who can get into Nandu Medical University for their bachelor's degree are considered top academics among more than a billion people.
Takahashi is a top student among 100 million Japanese. Based on this selection ratio, Takahashi is only a provincial-level top student in China.
Therefore, it is reasonable that Xu Zhiliang’s IQ level is no worse than Takahashi’s.
However, the elite doctor training route that Takahashi accepted far surpassed Xu Zhiliang in terms of clinical and scientific research capabilities, which is also reasonable.
Xu Zhiliang, as long as he is cultivated and given time, it is entirely possible to surpass Gao Qiao, at least that is what Yang Ping thinks.
He hoped that the two of them could get along with Takahashi and learn from his broad international perspective. This was the most important thing.
The conference room was packed with people, some sitting and some standing, all wearing clean white coats. Even the sloppiest people had their collars and buttons neatened up.
These people include comprehensive orthopedic doctors, graduate students, regular trainees, interns, and young doctors from other departments.
Those sitting are usually people from the general orthopedics department, and those around are usually people from other surgeries.
There are also a lot of stools added around, but everyone is afraid that they can't see or hear, so they just stand up and have a better view.
Yu Shuilian's rescue operation has already caused a sensation in the whole hospital. Now the Comprehensive Orthopedics Department is going to reconstruct her urethra and anus. Everyone wants to know how to perform this operation.
If the rectum is present and only the anal sphincter is damaged, a general surgeon or plastic surgeon will have many methods to reconstruct the anus.
However, it is beyond everyone's knowledge to reconstruct a functional anus at the end of the descending colon. Everyone is very interested in this and what cutting-edge new surgery is being carried out.
In addition, a department that snatches patients from the hands of death, a department that can attract international trauma surgery experts, and a department that continues to create miracles.
Every focus is fascinating. Several doctors with high professional titles from plastic surgery, general surgery, urology, and anorectal surgery came, with the mentality of participating in academic conferences.
Although this discussion is a department-level surgical discussion, in everyone's eyes, it is no different from an international academic conference.
Yang Ping is an almost god-like existence in Sanbo Hospital; Song Zimo is a genius; Gao Qiao is a master of international trauma surgery. This kind of meeting must be exciting.
There were all white coats on the floor, and the meeting was elegant and silent. The medical discussion was serious, and everyone was in awe.
The first person to present the surgical plan was Takahashi. He was arranged for nothing else. Except for Yang Ping, no one had as much surgical experience as him. He is a leader in international trauma surgery today.
However, during this period of time in the General Orthopedics Department, everyone forgot Gao Qiao’s original identity and only regarded him as the submissive Xiao Gao. Yang Ping wanted him to stimulate everyone’s enthusiasm.
Takahashi straightened his white coat and looked at Yang Ping. After receiving permission, he confidently walked to the podium. Perhaps at this time, he found his true identity.
How many times has he walked up to the podium at international trauma surgery conferences with his head held high, but no matter how many speeches he gave, they could not compare to this podium, just because sitting next to him was a person who was like a god in his heart.
A pair of surgical charts were entered into the computer in advance and opened on a high-definition screen. This is the work of Takahashi who has used his lifelong skills.
Not for anything else, just to be recognized by that young teacher.
"Hello everyone, I am Fumiya Takahashi, a trainee in the Department of General Orthopedics. You can call me Xiao Gao. The following is my report on Yu Shuilian's surgical plan."
"Modern surgery really kicked off when it began to conquer bleeding, pain, and infection. Today, surgery has solved many ailments for people. No matter what kind of surgery, there are three realms that cannot escape: resection, repair, and reconstruction."<
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"Excision, such as the treatment of appendicitis, discards the diseased tissue or organ and removes it from our body; repair, such as surgery for skin cracks, fractures, and tendon ruptures, we try to repair it and try to restore the original anatomy and
Function; and reconstruction is currently the highest level in the field of surgery. Disease or damage to an organ leads to loss of function. In order to restore its working ability, we have exhausted all means and created substitutes to perform its functions, such as artificial joint replacement."<
/p>
"Today, Yu Shuilian's surgery is a reconstructive surgery, because her original natural anus and urethra no longer exist. In order to restore her excretory function and live a clean and tidy life like a normal person, we need to reconstruct her anus and urethra.
That is to create a substitute."
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"To reconstruct an organ, our ultimate goal is to simulate function. This patient had two reconstructive surgeries to reconstruct the urethra and anus. The muscles that control urination are in the bladder neck. Fortunately, they were not damaged, so the reconstruction of the urethra only requires the function of a urinary conduit.
, this operation is a routine plastic surgery, it is not difficult. It uses the bladder wall to reconstruct the urethra. Any urology expert who is good at plastic surgery can do it. I have published many papers on this type of surgery in "The Lancet" and other journals, among which the curved
Reconstruction was the first theory I proposed."
"The most difficult thing is anal reconstruction. If you want to reconstruct an anus that can control defecation, under current medical technology, you must have a preserved rectum and a complete nerve pathway. Unfortunately, this patient's anus, rectum and sigmoid colon were removed.
, the terminal receptors of human defecation reflex---baroreceptors are distributed in the mucous membrane of the rectum. The descending colon lacks such receptors. In the absence of terminal nerve reflex arcs, it is almost impossible to establish an anus that has the intention to defecate and can control bowel movements independently!
”
"Is it possible to use artificial anus to achieve the purpose? Unfortunately, no! Whether it is shape memory alloy, medical silicone rubber, or polyether polyurethane and other materials to artificially synthesize the anal sphincter, it has been developed to this day and is still imperfect. The sphincter cuff has long-term
Implantation, repeated movement of the kit, frequent stimulation of the tissue, will inevitably produce an inflammatory reaction, coupled with the high-pressure activity of the cuff, leading to corrosion of the tissue, pain, infection and wound dehiscence, a series of complications have made the application of artificial anus linger.
Before."
"So, I recommend choosing autologous tissue to reconstruct the anus, electrical stimulation of the gracilis muscle or gluteus maximus muscle musculoplasty for in situ anal reconstruction. I have done it a lot to restore spontaneous defecation and reconstruct sphincter contraction. The fluid closure rate exceeds 95%. This data
I have always been a leader in the world, but I really lack experience in Yu Shuilian's ectopic reconstruction."
"With Dr. Yang's encouragement, I still came up with my own surgical plan, referring to the in situ reconstruction technology, and still using muscle flaps to reconstruct the anus. However, we must carefully choose the site where we take the muscle flaps. We must abandon the upper limbs and around the shoulder joints.
Muscles, because patients have to use their upper limbs to complete many alternative movements, so we can use them on the chest or back to reduce the negative impact of muscle weakness."
"To harvest the sphincter, I recommend using a free pectoralis minor muscle flap, with the thoracoacromial artery and the anterior medial pectoral nerve. The muscle flap is drilled in the center, buried in the end of the descending colon, surrounded by the colon, and implanted in the muscle layer. The blood vessels can be connected to the muscle layer.
The branches of the blood supply vessels near the colon are anastomosed, and the nerves can be anastomosed with the remaining pudendal nerve to establish a nerve conduction arc controlled by the muscles. But---I have no good way to deal with the urge to defecate."
Explaining his own surgery based on the atlas brought Takahashi back to the state of a trauma surgeon. He turned to Yang Ping from time to time for encouragement, became more energetic and talked endlessly.
This technique was designed by Takahashi based on his rich experience, and it is very suitable for Yu Shuilian's current situation. However, the biggest problem currently is that it cannot reconstruct the reflex of defecation.
His surgery can end Yu Shuilian's embarrassment of using an abdominal fistula to defecate. Even if there is no urge to defecate, regular defecation strategies can be used to solve the problem of defecation.
Anal reconstruction can seal the stool, allowing it to stay in the intestines when it shouldn't come out, and pass it out smoothly when it should come out.
It is more difficult to reconstruct anal seal with liquid than with solid, so liquid seal is the measure of high-quality anal reconstruction.
If the surgical effect can achieve a liquid closure rate of 95%, it will indeed be the world's top level.
