Takahashi's three-month training period is coming to an end. He hopes to extend his training period and continue to stay at Sanbo.
There are still many cases that he needs to learn. During this time with Yang Ping, he not only learned advanced surgical methods, but also learned a new way of thinking. Both anatomy and surgery have reached a new height.<
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Takahashi felt that three months was not enough. If he could stay, he would do it for one year or three years.
Unfortunately, it is impossible for him to have so much time to stay in China. There is still a lot of work waiting for him to do at the University of Tokyo Hospital.
Takahashi's visa has a maximum stay of 180 days, and he hopes not to waste a day.
So I applied to Masao Fujiwara for a three-month extension, and Masao Fujiwara responded: Takahashi will continue to study in China, and Miyuki must return to Japan as scheduled when the term expires.
Miyuki's arthroscopy technology has advanced rapidly and can carve a crooked letter on the olive pit.
She didn't care about Masao Fujiwara's words. Although he was the director of the Orthopedics Department of the University of Tokyo, he also had another identity, his brother.
In fact, Miyuki has more time to stay than Takahashi. She is just a mid-level young doctor without any position.
"You should listen to Mr. Fujiwara and go back as soon as possible." Takahashi didn't want her to go against Mr. Fujiwara's words.
Miyuki didn't care: "Why should I listen to him? I have my own life!"
In fact, Miyuki knew in her heart that her brother asked her to go back just to let her meet Yusuke Mitsui. The two families wanted to discuss their marriage arrangements. This was a marriage between the Fujiwara family and the Mitsui family, and it was a major event.
Although Mitsui Yusuke is also a top student at Tokyo University, with outstanding talent and appearance, she doesn't like that guy and has no feelings for him at all.
"My visa is still valid for 180 days. I don't want to call him anymore. Tell Mr. Fujiwara that I have decided to stay in China and continue studying." Miyuki Fujiwara was very determined.
Takahashi sighed helplessly, this was already a matter between the Fujiwara brothers and he couldn't get involved.
---
After the fifth round of surgery, there is the last round of surgery in the regional competition: anterior surgery for thoracolumbar fractures. Like pelvic and acetabular fracture surgery, this surgery is very risky.
The surgical approach is an important part of the operation, and the risks of the approach make this operation very risky.
A large hospital banned anterior spinal surgery for a long time because a patient undergoing anterior thoracic spine surgery died on the operating table. This is a bit extreme.
After the sixth round of surgery, Song Zimo still maintained perfect scores, and his strong fighting ability attracted a lot of attention to this first assistant.
With the end of the sixth round of surgeries, the regional competition came to an end, and the emblems of the qualifying hospitals in each competition area were arranged on the homepage of the website.
Photos of the surgeons of each team are also played on the website. The other surgeons are familiar to everyone, but Yang Ping is not familiar to everyone because he did not show up at the regional competition.
In the Western Division, Li Ling from West China and a student of Professor Fu Shancheng advanced with perfect scores. The team from Xijing Hospital missed the perfect score by one point and advanced as second place. The third team that advanced was also from West China.
In the northern division, Ouyang Siming, Xiao Yi, Lu Qing, and Song Yuncheng came from Imperial Medical College Third Hospital, Jishuitan, 301, and Xiehe respectively, and all advanced with perfect scores.
In the Eastern Division, Wen Rentao and Yue Zhengming advanced with full scores, and Wang Kaisheng from Changzheng Hospital advanced as second place.
In the central division, there is only one perfect-scoring team from Xiangya, with Tongji lagging behind by two points and Xiangya’s sister hospital, the Second Hospital, lagging behind by four points.
In the Southern Division, Song Zimo and Su Nanchen advanced with full scores. Lin Hao had an intercostal artery ligation that was too hasty during the anterior surgery for a thoracolumbar fracture and was deducted one point.
There are three promotion places in each division, and there is no limit to the number of places with perfect scores. Those who are tied will advance as the quota exceeds the quota.
For example, if there are three or more perfect scores, all teams will be promoted, and other teams with non-perfect scores will have no chance.
For two teams with perfect scores, there is still one spot left for the second place to fill in. No matter how many second places are tied, they will use this place to advance together.
If a team has a perfect score, the other two places will be filled by the second and third places. If the second place is tied, the third place will have no chance, and so on.
A total of sixteen teams have advanced to the national competition. After a two-week break, the national competition will be randomly matched by computer to allow these teams to combine.
The competition implements an elimination system. Within the specified competition period, after completing the specified types of surgeries, points will be scored. The laggard in total points will be eliminated, the leader will advance, and those with the same score will advance to the next round.
Those who advance will advance to the second round of elimination, the third round of elimination, and the final championship match.
According to the current situation, there are exactly sixteen teams in the competition. The top eight will be determined in the first round, the top four will be determined in the second round, the top two will be determined in the third round, and the championship game will be determined in the fourth round.
In a duel between experts, if any link is weak, you will fall behind your opponent.
The younger generation of rising stars in the medical field are all gearing up and eager to try.
In the national competition, the first round of orthopedic surgery is arthroscopy and transforaminal surgery. It is difficult for doctors without comprehensive skills to go very far.
Some hospitals are small and cannot even find all the cases, let alone participate in the competition.
So in the end, all those who can participate are well-known top hospitals.
Know yourself and the enemy, and you will never be in danger. After the regional competition, everyone began to sweep the rankings. Most people are familiar with it, but Sanbo Hospital is not very familiar to everyone.
Many doctors who participated in the Traumatology Orthopedics Academic Conference have memories, including Professors Fu Shancheng and Meng Heng.
Lin Hao was extremely depressed. He originally wanted to get rid of Sanbo Hospital, but he was almost dumped by Song Zimo.
He decided to play it safe in the national competition. Even if he didn't meet Sanbo, he would go further than Sanbo.
If we can meet Sanbo in the first round, it would be best. Arthroscopic shoulder and knee multi-ligament reconstruction is the surgery with the highest score in this round.
Lin Hao can use the world's most advanced techniques taught by his mentor Robert to raise the score and eliminate Sanbo Hospital in one fell swoop.
During the two-week break, the results of the computer random party will be announced on the website before 6 pm on Friday of the second week.
---
In Director Han's office, a USB flash drive containing Professor Feng's images was inserted into the computer.
X-rays of the cervical spine and head, CT and MRI, as well as enhanced images, appear on the electronic screen.
Chordoma, malignant, is relatively rare when it occurs in the upper cervical spine, and it is even rarer when it penetrates from the upper cervical spine into the skull.
This tumor originates from the residual notochord tissue of the embryo and generally grows slowly.
Therefore, if the surgery can be successfully removed, you can still get a certain survival period.
However, the connection between the upper cervical spinal cord and the medulla oblongata is where the respiratory and circulatory center is located, which is in charge of people's heartbeat and breathing. If this part is damaged, breathing and heartbeat will stop directly.
Chordoma like Professor Feng invades the respiratory and circulatory centers. The prognosis is very poor and life is in danger at any time.
In this case, the tumor and the respiratory and circulatory center are mixed together, and there is no way to operate.
"There is no distant metastasis for the time being. I have undergone radiotherapy, but it was ineffective. I have been treated with the targeted therapy drug PDGFR inhibitor imatinib and MTOR inhibitor sirolimus, but the effect is not satisfactory. I combined it with rapamycin, but it still doesn't work.
." Director Han called Yang Ping to the office, but he did not say that the patient was his mentor Professor Feng for the time being.
Yang Ping carefully analyzed the images and 3D printed models.
Director Han poured the image data into a 3D printer and printed out models of the upper cervical vertebrae, skull base and tumors. The tumors grew staggered, shaped like dumbbells, antlers, and grew in a complex way.
Yang Ping has been observing for a long time. This case is indeed difficult and involves three departments: neurosurgery, orthopedics and oncology surgery.
It is no exaggeration to say that this kind of tumor should be a restricted area for surgery.
If you want to do this surgery, there are four difficulties. The first difficulty is exposure.
Conventional exposure is not enough. It is necessary to completely open the back of the upper cervical spine and the back of the skull from the posterior approach. After opening, it must be able to be installed.
Only in this way can the upper cervical spinal cord and medulla oblongata be exposed, and then the medulla oblongata and upper cervical spinal cord should be incised to completely remove the tumor while protecting the vital functional areas.
The other three difficulties are that the surgical operation must be very precise, which is the biggest test of surgical accuracy.
Robotic surgery will be very precise, but it is not suitable for this kind of high-risk surgery. The most reliable is the machine, and the least reliable is also the machine.
Robots have no human touch. Once they make a mistake, even a little bit, it will be fatal.
The accuracy of this kind of surgery must be controlled at about 0.1mm. Ordinary metal scalpels, no matter how sharp they are, cannot achieve this accuracy, and the scalpels cannot cause squeezing of tissues. As long as ordinary scalpels cut, they must cause squeezing. Therefore, advanced laser scalpels must be used for surgery.
Third, the boundary of the tumor is determined, and the tumor is mixed with the medulla oblongata and upper cervical spinal cord. No matter what method is used, there is no way to identify the tumor and the vital functional areas that need to be protected during the operation. It can only rely on the experience of the surgeon.
There are only a few cases of this kind, and there are even fewer surgeries. Most of the surgeries are failures. How can we get any successful experience?
The last step is to stop the bleeding. This tumor still has a rich blood supply. If the bleeding is not complete, the hematoma will compress the respiratory and circulatory center, causing the patient to stop breathing and heartbeat.
Yang Ping looked at images and 3D models, while Director Han touched the cup and felt uneasy.
It took a long time before Yang Ping spoke.
"Using the most advanced laser knife, the upper cervical spine and skull base are opened posteriorly, completely exposing the upper cervical spinal cord and medulla oblongata, and then a surgical operation with a precision of 0.1 mm is performed."
Is the operation feasible? Director Han finally waited for Yang Ping's reply and immediately asked: "What is the success rate of the operation?"
"Not high!" Yang Ping replied without confidence.
This was Yang Ping's first lack of confidence in his answer. Even in cases like Lu Gang's, he was still confident and said without hesitation: Admit him to the hospital.
"How high is it estimated to be?" Lao Han still asked.
"Eighty percent."
Yang Ping made a rough estimate. There was no way. The operation was too difficult. How high could the success rate of this kind of restricted area operation be?
"Eighty percent?"
Old Han thought he had heard wrongly. According to current reports, the success rate of this kind of surgery does not exceed one percent.
"Yes, there is no way, it's too difficult, 80% at most!" Yang Ping was very embarrassed.
After confirming that it was 80%, Old Han calmed down.
"Where is the patient?" Yang Ping was very concerned. This case is very special.
Which case in his hands is not special or difficult?
"The patient is in the Sixth Hospital of Shanghai, and we don't know the arrangements there yet."
