Chapter 543 Taking out the needle is not that easy!
Baby Min Min was admitted to the ward and hospitalized. Even with Li Guodong's help, the two elderly people were still a little dizzy from the work.
No matter what you do now, many operations use mobile phones such as WeChat. It is inconvenient for the elderly to use mobile phones, so they waste some time.
When they arrived at the ward, the two old men could finally take a breath.
But the baby started crying again, and the grandfather hurriedly mixed the milk powder. The grandmother walked back and forth with the baby in her arms to comfort her.
When Nurse Cai saw this, she immediately took the baby over and coaxed her in her hands for a few minutes. The baby slowly calmed down.
Usually there are very few babies in the ward, so Head Nurse Cai asked the nurse to go to the pediatric department to borrow a crib, and arranged for a nurse who was married and had children and had childcare experience to take charge of Minmin.
After the doctor in charge, Li Guodong, asked about the medical history, the old man began to sort out the payment list, count the cash in the bag, record the details of the expenses in his notebook, and then click on the expenses twice with a calculator.
Fortunately, the couple has pensions, so they won't be left alone if something like this happens, but their pensions have been squeezed out by their son.
Thinking of this incident, the old man felt heartbroken. He had lived his whole life and was so angry that his son was so angry that he could not stop himself.
The couple did not give birth to their son until they were in their forties, so they were very doting on him when he was a child. He only opened his mouth when he had clothes to wear, and opened his mouth when he had food to eat.
My son's high school graduation grades were terrible. The old man paid for his son to go to a private university. But after graduation, this kid was too picky and did not even work for a few days. He spent most of his time at home unemployed and playing games, all relying on the support of the two old men.
Save money to live.
The old couple are working-class people with some savings and pensions. They are just an only child, so they can still survive. They think that their son may not grow up yet and will be sensible one day.
It was not easy for their son to find a wife, and the two old men scraped together to buy a house for their son.
After buying the house, my money was very tight and I didn’t buy a car.
For this reason, the son put a kitchen knife to his neck, made a show of committing suicide, knelt down and forced the old couple to say that everyone else had cars, but he alone had no car, and he couldn't live this life, so he might as well end it once and for all. p>
Alas, there is no way!
The old man gritted his teeth and used the last bit of his coffin to buy a car for his son.
My son is not ambiguous at all when buying a car. He will not look at anything other than Mercedes-Benz and BMW.
In the end, the old couple’s coffins were all spent.
This son has been like this since he was a child, giving him whatever he wants. If he doesn't achieve his goal, he will live or die.
Everything that has an effect has a cause. The old couple admit that they have no way to teach their children, but in this situation, what can they do? This is called reaping the consequences.
After finally calculating and recording the expenses clearly, the old man stopped and checked how much milk powder he had brought.
After checking the milk powder, they also checked whether the medicine the couple had brought with them was enough. They were all long-term medicines, for lowering blood pressure and lowering blood sugar. Each of them had several kinds.
The old lady said that she was worried that there were not enough diapers, so she asked the old man to go to the hospital store to buy some.
It took the old man a few minutes to stand up and go downstairs to buy diapers with the crutches he brought.
I happened to be seen by the head nurse Cai again. She felt soft and couldn't stand it anymore. She called a trainee nurse to help run errands to buy some diapers, and also to see what else was missing and bring them back.
Nurse Cai rarely sees elderly people bringing their children to the hospital alone, and the two old people don't seem to be in good health and can't stand the hardship.
So she still went the extra mile and arranged for a fairly flexible intern nurse to help the elderly.
The old man also took this into consideration and was very grateful.
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In the doctor's office, everyone hasn't gotten off work yet, and they don't plan to get off work on time.
Xiao Minmin's X-ray was hung on the reading lamp screen, and everyone spread out in a semicircle and gathered around the reading lamp.
Analyze each needle one by one, where it is, what are the adjacent anatomical structures, where it opens, what path it takes to take out, and what dangerous structures need to be avoided.
There is a thin needle in the 4/5 intervertebral space of the cervical spine. How this needle was inserted into the intervertebral space and how it appeared in the intervertebral space is no longer worthy of investigation.
Now we have to figure out how to remove this needle.
Incision and removal of fine needles is the preferred operation. If the intervertebral space is entered from the anterior approach of the cervical spine, many important blood vessels and nerves need to be bypassed.
Using the posterior cervical approach, you can bypass the blood vessels and nerves in the front, pass through the narrow gap between the cervical laminae, and enter the intervertebral space to remove the fine needle.
This operation is feasible, but it requires X-ray fluoroscopy, and the needle removal path needs to pass through the spinal canal, which is narrow. It is difficult to adjust the direction of the thin needle in the narrow space, and it is easy to get stuck in it.
Open surgery is also very difficult, but Yang Ping said that minimally invasive surgery can be used to remove needles using color ultrasound positioning.
Professor Zhang really wants to hear the specific details of Yang Ping's operation. Of course, others also want to hear it.
"Xiao Yang, can you talk about how to remove needles minimally invasively during color Doppler ultrasound positioning?" Professor Zhang asked.
No one has used this method in spinal surgery, especially cervical spine surgery. This is an innovation.
Yang Ping pressed his finger on the thin needle of the cervical spine in the
The direction of the needle is consistent, then the lens is inserted, and under the surveillance of the lens, the anterior longitudinal ligament and intervertebral disc are cut, and the fine needle is taken out."
The anterior approach needs to face many blood vessels and nerves. Once damaged, the consequences will be serious.
At this time, color ultrasound positioning plays a huge advantage. Color ultrasound can identify soft tissues, especially nerves and blood vessels, with a very high degree of recognition.
"If it can be taken out in this way, it will reduce the patient's trauma, but it will be very difficult. If there is no absolute certainty, it is recommended to do an open surgery as much as possible and not take risks." Professor Zhang reminded.
Song Zimo said on the side: "Professor Zhou Yue from Xinqiao Hospital of the Third Military Medical University once said that minimally invasive leaves the difficulties and risks to doctors and brings beauty to patients. If it can be minimally invasive, I support trying it, with skilled color ultrasound
Positioning can avoid blood vessels and nerves, but it is difficult to find the fine needle. If it fails, it can be converted to open surgery."
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The difficulty and risk of minimally invasive surgery lies in the change from traditional open direct surgery to surgery under microscopes and endoscopes.
Performing complex operations in a tiny channel of more than ten millimeters or even just a few millimeters requires very high operating skills for doctors.
Spine surgery is full of risks, as it involves the spinal cord and nerves. A mistake of just a few millimeters can have lifelong consequences for the patient.
Therefore, minimally invasive surgery is like dancing on the tip of a knife, and the requirements for doctors are higher than open surgery.
This kind of surgery using fine needles does not have the ultimate minimally invasive level, so I would definitely not dare to try it.
During surgery, you can roll around the surgical area a few times, but it is impossible to extend the incision.
Minimally invasive surgery is of inferior quality, and there is no chance of even turning.
"Color Doppler ultrasound - timely guidance, can the ultrasound department - doctors - cooperate?" Xu Zhiliang asked.
Yang Ping said to Xu Zhiliang: "I will operate the ultrasound probe myself."
Xu Zhiliang forgot that Yang Ping could do color Doppler ultrasound by himself, and his level was quite high.
If two people cooperate, one will guide the color ultrasound and the other will complete the surgery. This separation makes this complex operation very risky.
But Yang Ping operates the color Doppler ultrasound guidance himself, so the risk is lower.
"If I am sure, I agree."
Professor Zhang affirmed Yang Ping's innovative move. Color Doppler ultrasound is combined with endoscopy, and color Doppler ultrasound is used for positioning to help the endoscope establish an accurate channel. The channel reaches the position of the intervertebral space, and then under the guidance of color Doppler ultrasound, the fine needle is taken out.
“It’s a great certainty!”
Yang Ping is very confident.
Since Yang Ping said this, Professor Zhang knew what was going on and said, "This needle will be decided as long as there are no other opinions."
If there are no comments, let’s move on to the next needle: the needle in the chest and pericardium.
"Is it feasible to combine thoracoscopy with color ultrasound? Position the color ultrasound, cut the pericardium and take out the needle under the supervision of thoracoscope?" Professor Zhang still recommends the combination of thoracoscopy and color ultrasound.
If the needle in the cervical spine can be removed minimally invasively under the guidance of color ultrasound, then this needle can also be tried.
"The X-ray shows that the outline of the needle is not smooth, which means it has rusted."
Song Zimo has watched the X-ray several times and can confirm that it is a rusty needle.
If it is rusty, it will undoubtedly increase the difficulty of removing the needle, and the needle may be broken accidentally.
"Yes, this needle is rusty. The entry direction of the thoracoscope is very strict. It must be in a straight line with the planned removal path of the needle, otherwise the needle will easily break."
Yang Ping felt that Song Zimo's film reading technology had improved again.
Judging rust from the outline of the needle on the X-ray requires very high reading skills.
Xu Zhiliang looked at Song Zimo, then at the X-ray, then moved closer to observe the needle carefully.
"Should we ask a thoracic surgeon for assistance?"
Professor Zhang speaks very straightforwardly.
These doctors are all orthopedic surgeons. Although the hospital has given them full surgical authority, it is for the convenience of surgery.
Yang Ping and Song Zimo have also demonstrated their ability to perform systemic trauma surgery, but after all, they have specializations in the surgery.
"It is necessary in theory, but not necessary in practice." Song Zimo's answer was dialectical.
With Yang Ping's level, he still needs help from thoracic surgery? He is very good at thoracoscopy and laparoscopy.
Song Zimo's skills were all taught step by step by Yang Ping. He knows best how powerful Yang Ping is. This person is so powerful. There seems to be no blind spots or ceiling in technology.
Anyway, so far, Song Zimo has never seen anyone who Yang Ping said was confident that the operation could not be performed.
Professor Zhang adjusted his glasses: "Well, in that case, there is no need for multi-department collaboration, you can just do it alone."
In fact, asking thoracic and general surgery to collaborate is not only a technical matter, but also a way to share risks. If there is any problem, everyone must bear the responsibility.
If someone else is the surgeon, Professor Zhang will still ask other departments to collaborate to spread the risk among young people.
Yang Ping is the surgeon now. If you don’t want to be invited, you won’t be invited. Professor Zhang still knows how much Yang Ping weighs.
The surgical plan for these two most dangerous needles has been determined, but not everything else is going to be alright.
Although the location of the remaining needles is not as dangerous as these two, the difficulty of the operation is no less difficult than these two.
For example, if there are several needles in the abdominal cavity, it is difficult to find where the needle is when inserted laparoscopically. With the peristalsis of the intestines, the needle may shift. It can be seen in the abdominal cavity on the X-ray. Who knows where exactly it is inserted, maybe on the intestinal wall.
, maybe on the peritoneum.
Even if you perform an incision, open the abdominal cavity, and turn over and over, it is still difficult to find where the needle is?
What about minimally invasive surgery?
Don't look at the tiny needle, taking it out is not that easy!
