Yang Ping is right, this case is unique, no one has ever done similar surgery, including dissection, it is also unique.
The anatomy of the thoracic and abdominal cavities is a mess. If you didn’t know the detailed medical history, you would have thought that the thoracic and abdominal cavities had undergone many surgeries.
The heart and large blood vessels are problems, as are the liver, gallbladder and pancreas.
This patient's heart and large blood vessels are squeezed into a small and malformed space and cannot support it for long. In the end, he will die of heart failure. It is not easy to live to the age of eighteen.
This deformity is not caused in a short time, but gradually evolves over a long period of time. The originally deformed heart and large blood vessels will seriously affect the function of the heart. In addition, the compression caused by the spinal deformity and the displacement caused by adhesion will eventually lead to this kind of malformation.
The condition has worsened, and the large amount of ascites now is the result of this deterioration.
Not only can it cause ascites and improper posture, it can also cause shock.
The inferior vena cava return is blocked, the amount of blood returned to the heart is reduced, the right atrial pressure decreases, and the stroke volume decreases accordingly, causing a decrease in blood pressure. In severe cases, a series of symptoms of shock may occur. Symptoms will be more obvious in certain postures, such as supine position.
Clinically, this syndrome is called inferior vena cava syndrome or postural shock.
Clinically, pregnant women are prone to this special state, such as multiple pregnancy, polyhydramnios and other abnormally enlarged uterus. The enlarged uterus compresses the inferior vena cava, causing reflux disorder and causing the above symptoms.
Now this patient does not have fetal compression or tumor compression, but the inferior vena cava wall is bent and flattened due to adhesions, causing spinal and thoracic deformity, resulting in compression, which also produces a similar syndrome.
If the fetus or tumor compresses the vena cava, the patient is prone to shock symptoms in the supine position.
Zheng Baosheng's situation is special. He has several postures that can cause shock. Due to the body's self-protection consciousness, he has found these postures and consciously avoided them.
But sleeping at night is dangerous. If your blood pressure drops rapidly and you go into shock, your life may be in danger at any time.
Once in the shock position, once it lasts for more than five minutes, shock symptoms will appear, including dizziness, chest tightness, nausea, vomiting, frequent yawning, cold sweats all over the body, accelerated pulse, drop in blood pressure, and systolic blood pressure rapidly dropped below 80mmHg.
If the blood pressure does not drop quickly, like sleep apnea syndrome, he can wake up from his sleep, adjust his posture, and get relief.
If the blood pressure drops quickly and he loses consciousness quickly, he will die in his sleep.
Since he developed this symptom, his parents have taken turns taking care of him at night to prevent him from entering a shock position.
Zheng Baosheng has survived many death threats by surviving until now.
"In addition to ascites, heart failure, and an enlarged liver, there is not much hope of survival without surgery. Surgery has almost no hope of success."
Seeing how persistent Yang Ping is, Professor Li now feels that taking risks is worthwhile.
If you don’t do surgery and wait to die, you will die if you do surgery. It’s better to be more active.
"What can I do?"
Professor Li originally thought that Yang Ping would ask him to perform the surgery, but Yang Ping said that he would do the surgery himself, so he couldn't say anything else.
"If it's convenient, let's complete this operation together. I wonder if Professor Li is interested?"
Yang Ping felt that the experience of an excellent cardiac surgery expert could serve as a reference for him.
Even with the system at his side, Yang Ping will never close himself off, and only by remaining open academically can he go higher and further.
All of Yang Ping's medical knowledge comes from the reading of system space and the practical training of a large number of experimental subjects. He still needs other people's empirical things.
As the older generation of professors often say, learn from teachers, learn from books, learn from practice, and learn from peers.
In this kind of case, Professor Li is willing to participate in the operation, whether out of interest or responsibility. He also wants to see where Yang Ping's confidence comes from and dares to perform this kind of operation.
Afterwards, Yang Ping and Professor Li began to discuss the details of the operation. Because it was too difficult, every detail must be handled well.
At the beginning, people around me could still participate in the chat.
While we were chatting, others, including Professor Wu Yucheng, could not get in the conversation at all, because the discussion knowledge was constantly upgrading and the knowledge reserve could not keep up.
"It is too narrow here, and the stenosis is irregular. The turning angle of the channel is too large, making it difficult to implant artificial blood vessels. Otherwise, interventional methods can be used to implant artificial blood vessels in advance to improve venous return and facilitate the separation of the vena cava during the operation.
Even if the separation ruptures, it will not cause major bleeding."
"It's difficult, but you can try."
"These mesangium must be preserved. After the adhesions are successfully separated, if there is no such mesangium for suspension at all, the heart and great blood vessels will move very much in the chest, which is very dangerous."
"The heart's capsule needs to be completely peeled off, and now it's showing signs of constriction."
"Temporary blood vessel bridging technology can be used before surgery to redirect blood circulation and avoid the surgical area."
"No, it's better to have blood filling, which is more conducive to separation."
"Well, if necessary, the heart can be taken out, so that the pericardium and mediastinum can be easily disposed of, and a suitable accommodation bed can be prepared for the heart."
"Some of these adhesion bands can be used, but they cannot be completely removed."
"What should I do about the liver, gallbladder and pancreas? Do you want me to ask someone to come over and help?"
"No, I can handle it."
"There is another big risk factor. This patient's blood type is RH negative, and the blood preparation work will be subject to many restrictions. Can we prepare enough blood products?"
"We will contact the blood bank in advance to prepare sufficient blood products, and will also adopt a series of autologous blood transfusion techniques to assist."
"If necessary, low-temperature technology can be used to reduce the oxygen consumption of tissue cells, which can extend the application time of blood vessel blocking technology."
"The blood vessel occlusion technology is only a temporary application and does not need to be used during the operation. It allows normal blood circulation during the operation and the filled blood vessels are more conducive to separation."
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The two of them discussed for two hours, and the people next to them just sat there stupidly, listening to their chat.
From clinical talk to basic medicine, and then from basic medicine back to clinical, anatomy, physiology, biochemistry, tissue embryology, pathology, pathophysiology, etc., all involved, the latest articles in various journals are constantly cited, and various cardiovascular diseases in the world
The results of experts, cross-fusion.
After the chat, Professor Li began to re-examine the young doctor. Dr. Yang simply had a super brain and an amazing amount of knowledge. The knowledge he possessed far exceeded the depth and breadth that a surgeon should have. Many times, Professor Li had to follow
It’s very difficult to go up.
He now somewhat believes that this young man still has some confidence in risking such an operation, and at least he is well prepared with theoretical knowledge.
Professor Li decided to stay and complete the operation with Yang Ping.
Yang Ping asked Xiao Wu to book a room for Professor Li and Professor Wu at the Sanbo Hotel. Professor Qin said, "Don't bother me. I'll make the reservation. I'll stay in the room next to mine. I see that the rooms next to me are all empty."
Professor Qin also lives in the Sanbo Hotel, so that’s good. They are familiar with each other and can chat while living together.
Yang Ping asked Song Zimo to call the doctors in the department to the demonstration classroom. He wanted to briefly talk about the case with everyone, so that everyone could master some knowledge in advance, which would be beneficial to the implementation of the patient's entire treatment plan.
Everyone is in the department, only Zhang Lin is missing.
Song Zimo smiled and said: "Zhang Lin is explaining the basic operations of arthroscopic surgery to several young doctors in the training room, and several young doctors from Xiehe University are also listening."
He taught people about arthroscopic surgery and made rapid progress.
"He and Xiao Wu practiced for one or two hours every day and made rapid progress. They were just asked to help by the gynecology department and showed off an endoscopic operation in the emergency department's operating room." Song Zimo reported on the two people's learning progress.
Yang Ping handed Zhang Lin Xiaowu to Song Zimo for training.
Yang Ping didn't understand: "Asked by the gynecology department to help?"
"The emergency department admitted a patient with acute abdominal pain. We followed the acute abdomen procedure and found nothing else. The color ultrasound of the uterus and ovaries showed two strip-shaped moving objects in the uterus. Then an X-ray was taken. Two vertebra-like bones were found in the uterus.
After asking about the medical history, the patient said that two eels accidentally entered the body and were alive. Emergency gynecology consultation was immediately requested. The gynecology department used hysteroscopy to remove the foreign body in the emergency operating room, but the thing was still alive and slippery.
It’s not easy to choose. The department of gynecology is afraid of damaging the endometrium and feels that all endoscopic operations are similar. Knowing that our arthroscopic operation skills are very good, we feel that it is a bit overkill and we are sorry. Zhang Lin happened to be free, so he invited Zhang Lin.
Go help, this guy didn't embarrass us. He picked up the forceps one at a time and solved the problem in less than two minutes. He is looking very proud now." Song Zimo explained clearly the whole story.
This is not a strange thing. When Yang Ping was in the emergency department, he often encountered this kind of foreign bodies, from the rectum, urethra, etc. The foreign bodies were also various and varied, frequently breaking through the ceiling of imagination.<
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Zhang Lin followed Yang Ping every day, and Song Zimo trained him very strictly. As the tide rose, all boats rose. In both theory and practice, he naturally made faster progress than others and gained wider knowledge than others.
"Zhang Lin and Xiaowu, you should be more strict with them. Basic knowledge, basic theories, basic skills, and knowledge points must be 100% passed." Yang Ping ordered Song Zimo.
"Where's Xiaowu? How is it?"
"Xiaowu's hands-on skills are very strong, especially endoscopic technology, which has improved very quickly. He has mastered the basic skills of hand-eye separation and triangulation very well."
Song Zimo called Zhang Lin and asked him to go to the classroom for a meeting.
Soon, he came over, followed by several young doctors. He was still explaining the key points of endoscopic surgery. He seemed to be speaking well. The doctors listened attentively and looked impressed.
