The aorta and inferior vena cava are separated to the diaphragm tear.
In addition to separating the main trunk, their countless branches must also be separated, and the branches must also be separated to a sufficient length. Otherwise, during spinal correction, the strong pulling force will tear off the blood vessels, causing the patient's chest to instantly fill with blood.
There are too many branches, and each branch has branches. Almost all major branches need to be separated in this way.
This is a meticulous job, and there is no way to do it quickly. Yang Ping's tip of the knife separates the old adhesions bit by bit.
This requires enough patience and not to be impatient, discouraged or relaxed.
In addition to the heart and great blood vessels, the chest also contains the thymus, lungs, trachea, and bronchi.
Now that the problems of the heart and great blood vessels have been solved, the thymus does not need special treatment, and the remaining problems are the lungs and trachea.
Under the blowing of the ventilator, the lungs open and contract. The lungs are currently in very good condition. They will not be affected during the subsequent spinal correction, and some adhesions can be easily handled by Yang Ping.
However, the trachea and bronchi are not so optimistic and must be properly separated like the great blood vessels.
The trachea and bronchi are behind the heart and great blood vessels. Yang Ping put in two rubber strips, bypassing the aorta and superior vena cava respectively, retracting them to both sides, and then clamped the two ends of the rubber strips with large curved forceps.
Leave it to the second and third assistants responsible for revealing.
The retracted aorta and superior vena cava reveal a window, and the trachea and bronchi hidden behind are exposed.
Without the previous separation of the aorta and superior vena cava, allowing them to form independently, there would be no way to retract the trachea and bronchi, and there would be no way to expose the trachea and bronchi. Without exposure, surgery would be impossible, and exposure is a necessary condition for surgery. p>
The exposure of the trachea is easier than the exposure of blood vessels because the annular fibrocartilage structure makes it easier to identify than blood vessels and surrounding adhesion tissues.
After freeing the trachea and bronchi, the organ processing in the chest is not over yet. The organs must be properly suspended and fixed in the human body, otherwise they will be stacked together due to gravity and movement.
Yang Ping has taken this into consideration. When dealing with adhesions, some adhesions suitable for hanging are retained, but such adhesions are rare.
In order to obtain good fixation of these organs, they must be resuspended at key nodes. This seems simple but is very complicated to do.
If there is no suspension and fixation, it is very simple. When running, the five to eight-meter-long intestines will either pile up together due to gravity, or become entangled and knotted with each other. But in fact, we do not. Let alone running, even if we turn a few somersaults,
The internal organs and intestines are still fixed in their original positions.
This is because our internal organs have a special structure to fix them. This fixed structure is some membranes, but the fixation should not be too rigid, and the internal organs should be given a certain space to pulsate or peristalsis.
The several large blood vessels from the heart extend in all directions and have a fixing effect, but this is far from enough. The main structure that fixes the heart is the pericardium, so after peeling off the pericardium, it is enough to stop it, rather than removing all the pericardium and turning the heart into light.
Fluffy eggs.
The organs in the abdominal cavity are fixed to the body wall by the omentum, mesentery, and ligaments.
The intestines are wrapped and fixed by the omentum and mesentery, and the liver, gallbladder, pancreas, spleen, etc. are also fixed by many ligaments.
Therefore, after the organs in the chest are separated, they need to be rearranged and restored to their normal state. The key step is to correct or rebuild their fixed structures so that they can stay in place and stick to their posts.
This is beyond the understanding and ability of general surgeons. Few surgeries require such thorough consideration. Except for joint ligament reconstruction in sports medicine, reconstruction of visceral ligaments is rarely considered.
Most of the ligament structures have been separated by Yang Ping, but they need to be lengthened due to contracture, a few need to be shortened due to laxity, and some ligaments need to be reconstructed.
Considering that it will take some time for the reconstructed ligament to heal, Zheng Baosheng will be restricted from activities after the operation. He will do gentle activities in bed within two weeks, start walking on the ground after two weeks, and will not be able to do sports for three months.
Yang Ping began to operate on these ligaments and mesentery again, lengthening, shortening, or reconstructing them. The removed pericardial tissue was put to use at this time, reusing waste and becoming a material supplier for reconstruction.
Each ligament has been carefully processed, and the organs in the chest have been processed. Now they still look like before, squeezed together, but this is only a superficial phenomenon. In fact, they have said goodbye to their previous adhesions. p>
It’s just that due to the small space, we still have to squeeze together.
If the spine suddenly returns to normal curvature and the entire thoracic volume expands, these organs will immediately be distributed in the chest and in the correct position close to that of a normal person.
The diaphragm slit, the space connecting the chest cavity and the abdominal cavity, the aorta, inferior vena cava, vagus nerve, and esophagus all enter the abdominal cavity from their respective spaces.
The diaphragm of the dome structure is now like a collapsed roof, losing its proper shape and full of wrinkles. If these wrinkles are not opened, once the spine is corrected and the volume of the chest cavity is restored, they will also be stretched and torn.
.
The diaphragm is like a folded lotus leaf, opening the folds so that it can gain the ability to expand to adapt to the normal posture in the future.
After treating the diaphragm, we started to open the abdomen, and the abdomen was also incised in the middle.
"The liver and pancreas below?"
Professor Li was careful and held his breath even when he spoke.
Yang Ping nodded.
Crossing the diaphragm and entering the abdominal cavity is no longer Professor Li's area of expertise.
"Let Dr. Song come?" Yang Ping felt that it would be more appropriate for Song Zimo to be his assistant next.
In the training of compound trauma surgery, Song Zimo has become very proficient in the anatomy of the whole body. In terms of the heart and great blood vessels, Song Zimo is far inferior to Professor Li Zehui, but in the anatomy of the abdominal cavity, he definitely surpasses Professor Li, regardless of his fame. p>
Seeking truth from facts is the greatest conscience of a doctor.
"After the diaphragm treatment is completed, Dr. Song will be the first assistant and I will be the second assistant."
Professor Li abides by the surgeon’s arrangements.
The organs in the abdominal cavity are much more optimistic than those in the chest, and they have been modified to a much smaller extent.
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A group of orthopedic experts, waiting to see scoliosis correction, are now interested in thoracic surgery.
How come young people are so proficient in anatomy, especially cardiac and major vascular surgery, whether it is separation of adhesions or suspension fixation, they are simply miraculous.
If he has such anatomical skills, any operation will be much easier for him than others.
Professor Qin likes such a young talent more and more.
Even if they are not poached, Sanbo Hospital must become 301’s medical center in the south.
With the support of the leader and your own efforts, this thing will probably succeed.
---
Yang Ping completed the surgery on abdominal organs quickly. Almost all adhesions were separated and no fixation was required. The original position and length of the ligaments did not need to be corrected.
After the organs in the thoracoabdominal cavity are processed, the anterior surgery is completed.
The almost impossible operation was successfully completed by Yang Ping in such an orderly manner.
At this time, Professor Li felt more than admiration in his heart.
If he hadn't seen it with his own eyes, he wouldn't have believed that someone could perform this kind of surgery, nor would he believe that someone could be so skilled in human anatomy.
"You take a rest for a while, and I'll close your chest and abdomen." Professor Li used the attitude he should have.
Yang Ping really needed a break, so he left the rest of the work to Professor Li and Song Zimo.
They began to flush the surgical area, then placed drainage tubes, sutured in layers from the inside to the outside, closed the chest and abdominal cavities, drilled holes in the split sternum, and fixed it with several pairs of steel wires.
Next, perform scoliosis correction in the prone position.
Remove all sterile drapes, turn the patient over into the prone position, and re-sterilize the drapes.
There are rules for changing positions when crossing the bed.
It requires several people to operate. There are operating specifications for how each person should stand, what work they are responsible for, and the posture of their hands.
A head nurse in the operating room of Union Hospital wrote a book called "Atlas of Safe Surgical Positions".
This should be the only monograph in China that systematically introduces how to position for surgery.
In European and American countries, there are specialized positionists in operating rooms, who specialize in helping patients position themselves so that doctors can perform operations comfortably.
Don't underestimate the patient's surgical position. A good position can make the operation twice the result with half the effort. Poor or wrong position often increases the difficulty of the operation, sometimes making the operation impossible to complete and causing some complications.
This is the difference between a skill from rough to fine.
If Zhang Lin and Xiao Wu can write "Surgical Retraction Science" into a book, it will definitely fill a gap in the country and be a pioneering work. Maybe it will also fill a gap in the world, because they have promoted the retraction technology from rough to refined.<
/p>
The apple falls from the tree. When a subject is studied seriously, the results are immeasurable.
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"Xiaowu, Zhang Lin, come on stage!"
After changing positions, Yang Ping took off his surgical gown and gloves and rested for a while. Song Zimo led them to disinfect and spread the drapes, make incisions and expose them, and secure the pedicle screws before Yang Ping went on the stage to perform osteotomy and correction.
"Okay!"
Zhang Lin dragged his urine bag and followed Song Zimo out to wash his hands.
Because I walked too fast, the urine bag swayed on my thigh.
Professor Li saw the urine bag hanging from Zhang Lin's trouser leg and immediately knew what was going on.
He recalled that when he was a junior resident, he once drank a lot of beer with a senior resident and encountered an emergency surgery. Professor Li had no choice but to secretly go on stage with a urine bag hanging on.
At that time, Professor Li's role in the operation was that of the second assistant.
The senior doctor who drank with him was not as smart as he was. He worked as an assistant on the operating table and couldn't hold back his urine, so he had to ask his instructor to urinate!
The instructor was very angry. When Ichisuke came off the stage to urinate, he said to Professor Li: "I remember you, and you will be Ichisuke from now on."
A urine bag changed Professor Li's status in the heart of his mentor.
Generally speaking, those who can achieve success are those who can be cruel to themselves.
This kid actually has the shadow of his former self.
