Takahashi’s speech received a round of warm applause, and those wonderful drawings also received constant praise.
"Dr. Takahashi, with your surgery, after the anus is reconstructed, the nerve reflexes controlled by the muscles are opposite to the natural anal sphincter. The anal sphincter usually contracts and closes, and relaxes and opens during defecation. The pectoralis minor muscle you used is usually in a relaxed state.
, it will shrink when you exert force." A graduate student asked.
People who can ask questions are those who study hard at ordinary times. Otherwise, their heads will be all mush at this time, and they will not ask questions.
"You lack basic knowledge of repair and reconstruction surgery -" As soon as the words came out, Takahashi immediately realized that his tone was wrong, and turned to look at Yang Ping. There was nothing strange on Yang Ping's face.
He confirmed that Yang Ping had not noticed his off-line tone just now. He paused and continued, but his tone was already lowered: "After surgery, we use biofeedback stimulation to rebuild the coordination of contraction of the transplanted muscles, which means we train the muscles.
, allowing it to contract and close normally, and relax and open when needed."
"The discharge of stool is not only the opening of the anus, but also the rhythmic contraction and peristalsis of the rectum, which pushes the stool down until it is discharged. This patient has a defect in the rectum and sigmoid colon. How to solve this problem?" A doctor asked a more pointed question.
In academic disputes, relatives are not recognized, and whoever has the right is the boss. These guys are usually immersed in technical research and do not have the tact and sophistication of social people.
"This problem does not exist. The entire intestine has peristaltic propulsion capabilities, and the descending colon is no exception. Although the descending colon does not have as strong a push as the lower rectum, in view of the principle of adaptation of human anatomy and function, as the number of times of reconstructed anus increases,
, the thrust of the descending colon will gradually increase to adapt to its working position."
"You just mentioned that the sphincter is made from the pectoralis minor muscle, but you didn't mention where the material for urethral reconstruction comes from? I would like to know what material you plan to use for urethral reconstruction? Is it the anterior wall or the posterior wall of the bladder?" Deputy Urology Department
the chief physician asked.
He has also had urethral reconstruction, so he is naturally concerned about this aspect. Yu Shuilian is missing almost the entire urethra. With such a long distance, what is the best material to use? If the bladder wall mucosa is used for reconstruction, it may not be enough.
"The colonic mucosa can be used to reconstruct the urethra, so that the material is sufficient and there is no limit to the length of the urethra. This method came from the Sixth Hospital of Shanghai, and I improved it."
Urethral reconstruction is the domain of urology, but Takahashi is a composite trauma surgeon, and his level in this area is not inferior to any urological expert in the world who is good at urethral reconstruction.
There were many questions, from graduate students who were just starting out to doctors with high professional titles in their profession. Takahashi relied on his extensive and profound knowledge to handle every question perfectly.
Takahashi is known for his aggressiveness at international academic conferences. He once singled out a few Americans at a trauma surgery conference in North America and left them speechless.
I was overly excited today and almost fell off the line. Fortunately, I stopped in time and it didn't cause serious consequences.
Of course, this serious consequence is also what Takahashi himself thinks is a serious consequence.
The contradictory emotions of nervousness and confidence are intertwined. Because Yang Ping is sitting under the podium, he is nervous. The student mentality makes him always take care of Yang Ping's expression for fear that he will not perform well.
Confidence is in front of the audience. He is used to talking loudly and confidently, and it is inevitable that he will lose touch when he is excited.
When it was Song Zimo's turn, the surgical atlas he displayed was even more beautiful than Takahashi's. Perhaps influenced by Professor Zhang and Yang Ping's guidance, his surgical atlas had a strong three-dimensional feel, which was better than Takahashi's flat graphic vision.
The effect is definitely better.
Takahashi's technique design has been very complete. Many things overlap and are the same. He just went through them briefly and focused on adding what Takahashi didn't talk about.
"The patient's ovaries, fallopian tubes and uterus have been preserved. We cannot focus only on the reconstruction of the urethra and anus. We should consider the reconstruction of YingDao to solve the problem of female patients' cyclic endometrial collapse and discharge accompanied by bleeding."
"The patient has given birth. In this special case, it is meaningless to retain the uterus. Why can't the uterus be removed? This way, there is no need to reconstruct the YD and it will reduce trouble." A newly recruited doctor from the Department of Traumatology and Orthopedics proposed a simpler method. p>
Why reconstruct when it can be resected? It’s unnecessary! The questioner’s logic is very clear.
"Hysterectomy will not only lead to the inability to get pregnant normally, but may also cause ovarian function decline, estrogen secretion disorders, abnormal blood lipid metabolism, etc. Endocrine abnormalities may affect mental and psychological aspects, and it is not ruled out that it may lead to depression."
“One step of trouble for us saves the life of the patient.”
Song Zimo's thinking is exactly the opposite. It can be reconstructed, so why remove it?
It could be ninety points, why should I only focus on sixty points?
Discussions among top academics naturally marginalize ordinary students. This is an unchangeable reality.
The discussion made Song Zimo and Gao Qiao the protagonists, and even Xu Zhiliang of the trio was under great pressure.
If you regard clinical experience as poker power and personal IQ as card skill, this discussion is like playing cards.
When the cards are evenly matched, technology can only come into play. If the cards are seriously tilted, no technology can affect the outcome.
Gao Qiao has the best poker hand, Song Zimo has the best poker skills, and Xu Zhiliang has no advantage. There is a gap between his poker skills and Song Zimo's, and there is a huge gap between his poker power and Gao Qiao's.
However, he did not lose heart because of this. Instead, he had high morale and was happy that he could join such a team. He was grateful to Yang Ping for not disdainful of his congenital defects and giving him a precious opportunity.
Gao Yuan, director of the Sports Medicine Center, is too busy. He has just finished handling the matters at hand and hurried over. He will definitely attend comprehensive orthopedic meetings, case discussions, preoperative discussions, and small lectures as long as he is free.
When Director Gao arrived, the conference room was already packed. There was a rectangular conference table with rounded corners in the middle, and a distance of one meter was maintained around the conference room. There were three floors inside and three floors outside. Even the door was packed with people. p>
How to get in here? Director Gao had to squeeze in regardless of his identity. He turned his body sideways and used all his strength to squeeze in. An intern was staring at the electronic screen with his eyes fixed and his ears erect, listening.
At this time, damn, people are always squeezing here and there.
In the moment of anger, the intern didn't even look, and moved his body in the direction of the squeezing force, bumping and shaking hard. Director Gao was knocked backwards and almost fell down.
"I'm squeezing you. The place is already full. If you didn't come earlier," the intern cursed in a low voice, but still stared at the screen.
Director Gao barely stood still and wiped his sweat. Everyone was listening intently to the speech inside, and no one paid any attention to him.
Lao Gao didn't care about the intern. There were two doors in the conference room. You couldn't squeeze in from one side. If you moved to the other side, the other side was almost the same, airtight.
There was no other way. Lao Gao asked the nurse for a chair in the ward, placed it at the door, put a piece of paper on it, and stood on the chair, so that he could see inside.
Fortunately, everyone is more disciplined. No one speaks except the speaker, even if he whispers a few words, you can hear clearly that it is Song Zimo who is speaking.
Yang Ping should not have spoken yet, he should speak last. Director Gao was glad that he was not too late.
When Gao Qiao heard Song Zimo proposed YD reconstruction, he couldn't help but feel ashamed. Indeed, he had not considered it so thoroughly.
Song Zimo was indeed Dr. Yang's assistant. He thought about this patient's surgery more deeply than he did.
Xu Zhiliang's surgical plan could no longer surpass Takahashi. After he stepped on the stage, Zhang Lin subconsciously trembled in his heart.
Seeing Xu Zhiliang speak, Zhang Lin became anxious, but Lao Xu really didn't stutter when discussing the case: "The surgical plan has been very complete. I only have one immature suggestion. After the patient loses his lower body, he loses his sexual characteristics. Is it right?"
The shape of the WaiYin can be reconstructed based on the patient's psychology, which is more acceptable than the appearance of the abrupt pores. At the same time, the natural WY structure of women can protect the urethral opening and reduce the possibility of urinary tract infection."
The suggestions put forward by Xu Zhiliang are not necessary, and even for most doctors, they would not consider this issue at all, but Xu Zhiliang considered it and bravely put it forward.
There was another discussion, with people around asking questions and people from the Department of Comprehensive Orthopedics arguing with each other. Finally, it was Yang Ping's turn to speak.
Everyone is looking forward to the stars and the moon, the climax of the meeting is now, especially Lao Gao, standing with his legs numb, just for this moment.
As Yang Ping stood on the podium, dozens of mobile phones were secretly pointed at him. His memory is not as good as recording on his mobile phone.
I went through more than a dozen pictures first. For any meeting, just looking at these pictures is enough. For those who don’t know, you might think that the photos of the human body taken by a black and white camera are not the key photos that have such a three-dimensional effect.
These pictures also borrow the split-shot technique from comics to clearly show the steps of the surgery, with close-up magnifying shots of key steps.
He briefly summarized everyone's plan, and then added his own opinion: "To reconstruct defecation function, in addition to rebuilding the sphincter, bladder mucosa transplantation is also required to move part of the bladder mucosa to the inner surface of the descending colon. There are pressure receptors in the bladder mucosa.
These pressure receptors are used to reconstruct the urge to defecate and establish a truly autonomous defecation function."
To transplant the bladder mucosa, it is necessary to connect the nerves. The anatomy of the unnamed small nerves is difficult to do, otherwise many surgeons will do it.
Mucosal transplantation, if the connection to nerves is not considered, the baroreceptors cannot transmit signals to the centers of the brain and spinal cord, as if they do not exist.
If we can find unnamed neural connections and then use biofeedback training, it is completely feasible to restore the ability to have bowel movements.
However, when looking for the innominate nerve in the bladder mucosa, one must have a length that can connect the pudendal nerve and its branches, which is something that surgery simply cannot do.
Takahashi once conducted research in this area but ended in failure.
Many top urological surgeons and reconstructive surgeons in the world have also tried this, but all ended in failure.
This is destined to be an impossible operation and can only exist in theory.
