Yang Ping asked them to touch and feel, letting them feel the tactile texture of the teratoma. Unexpectedly, this guy has a rich imagination.
Tumors in the pelvic cavity and tumors in the sacral canal form a dumbbell shape, except that one end is larger and the other end is smaller.
In order to completely remove the tumor, Yang Ping planned to divide the tumor into two parts and remove the large pelvic tumor first. In this way, without the obstruction of the large tumor, he could open the sacral canal in an open space and slowly remove the small ones in the sacral canal.
Tumor.
One blood vessel after another was tied and cut off, and after these ties were released.
Yang Ping ligated and cut off the connection between the tumor and the sacral canal, then removed the entire tumor from the pelvic cavity, handed it to Xiao Su, and placed it on a special sterile table.
The structure of the sacrum is complex, with a sacral canal, a sacral foramen, and nerves extending from both sides of the sacral foramen.
Yang Ping sorted out the anatomical structures here, which ones are normal tissues and which ones are teratoma structures. The knife is ruthless. If the cut is wrong and nerves are injured, neurological symptoms will occur.
After combing through it, Yang Ping marked the tumor connecting zones that had just been cut off one by one. These tissues were all the same as the tumors in the sacral canal. It is not clear whether the tumor originally originated outside the sacrum or in the sacral canal.
If the tumor is in the spinal canal or sacral canal, the bony canal must be opened, otherwise the tumor cannot be exposed.
Yang Ping used an ultrasonic osteotome to open the sacrum from the front, and formed the cross section of the cut bone into a trapezoid, so that the separated bone fragment would be larger on the outside and smaller on the inside.
The reason for cutting like this is to cover the bone piece back later without sinking and compressing the nerves in the sacral canal.
The front side of the sacrum is much thicker than the back side, so opening the window from the front side makes it easier to make bone blocks based on the manhole cover principle.
Besides, opening the window from the front can also reduce the occurrence of postoperative sacrococcygeal pain.
The bone block looks curved and square as a whole, with a trapezoidal cross-section. A total of three such bone blocks were cut out.
The bone fragment was uncovered, and the tumor hidden in the sacral canal was fully exposed.
This way of revealing is completely different from the textbook.
Song Zimo and Xu Zhiliang witnessed Yang Ping's method of entering the sacral canal and remembered the whole process in their hearts. Next time, they can also use this method.
The advantages of this method are obvious. It is not only practical, but also beautiful. After surgery, the bone fragments can be fixed back to their original position with plates and screws.
Moreover, every operation performed by Yang Ping has clear steps and clear anatomy, making it naturally educational.
I have been doing surgery with Yang Ping for a long time, and I have made rapid progress in both anatomy knowledge and surgical methods, many of which cannot be learned from textbooks.
** and Xiao Wu, while pulling the hook, occasionally poked their heads in to see what was going on inside when they had a field of vision.
Most of the time, the hook puller has no vision and cannot see what is going on inside. Naturally, it is easy to become sleepy and doze off after pulling the hook for a long time.
Therefore, one of the most basic qualities of a hook-up man is that he cannot doze off.
** and Xiaowu are not ordinary hook-up men, but great ones. Naturally, they will not take naps. In the near future, a monograph on hook-up jointly written by the two will be released.
"Xiao Wu, the hospital basketball game is about to start. I will draw lots after get off work in the afternoon. Are you going, or am I going?"
"I'll take care of your bad luck."
"Brother, let me go. I've been very lucky recently. If I buy Wong Lao Ji, I'll get another bottle every now and then."
This kind of thing represents the most promising department and participates in the lottery with the image of a young talent. As a generation king, how can you miss it?
The basketball game has been prepared for a long time and will start soon.
In the preliminary round, the teams that were least willing to encounter were the emergency department and the administrative department. Xiong Shihai from the emergency department had basically no opponents on the court.
The administrative department, a group of deans, vice deans, directors of medical offices and other elders are not very skilled at displaying their skills, especially dean Xia, who is simply the king of foul play.
"In every game Dean Xia plays, I personally blow the whistle and I can't keep an eye on him!"
"Old Zhang!"
Professor Zhang stood behind him with his hands behind his back. Sometimes Director Han also helped out with the clinic, which made Professor Zhang's time quite free.
If there is any special surgery, the old man comes up to look around. An eighty-year-old man, who has not been around the operating room for several days, feels very panicked and feels like he has no clue.
As long as you go around in a circle and do nothing, you will feel at ease.
Surgeons actually spend more time operating during the day than at home, so it becomes a natural habit.
"Old Zhang is mighty!"
Others call him Lao Zhang, but these bastards call him Lao Zhang, and Professor Zhang is not angry.
The brothers who often eat chicken together behind closed doors are used to calling each other "Lao Zhang Lao Zhang".
"Fat brother, I heard that you have been in a bad mood recently. What's going on? The swan has flown away?" Professor Zhang detoured to Fatty Liang's side.
The intern quickly moved a stool for Mr. Zhang to sit on.
The fat man lowered his head and hesitated.
The shape of the sacrum is very irregular, with many nooks and crannies. Tumors in these nooks and crannies are difficult to remove, and there are blood vessels and nerves everywhere in these places.
This kind of surgery is as difficult as fighting a street fight in the city.
The basis of surgery is anatomy. If you are familiar with anatomy, the operation will be easier.
The irregular teratoma in the sacral canal was completely removed by Yang Ping while talking and laughing.
Two tumors, one large and one small, one spherical and one irregular, were placed on the sterile table.
"Send it to a frozen slice!"
Rapid frozen sections during surgery can quickly make pathological diagnosis.
The doctor can wait for the results of the pathological section on the operating table. If it is benign, just remove the tumor; if it is malignant, then the surgery must be expanded based on the grade and staging. Radical surgery is often performed, which not only removes the tumor, but also performs surrounding surgery.
Lymph nodes are dissected.
In European and American countries, the operating room is equipped with a pathology room specially used by surgeons. The chief surgeon removes the tumor specimen, takes off his surgical gown, goes to the pathology room to see the frozen sections in person, confirms the nature of the tumor, makes grading and staging, and then re-
Brush your hands and go on stage and continue the surgery.
But in our country, surgeons do not have the tradition of looking at pathological slides.
"I have to cut it open anyway, let's take a look?"
Song Zimo is very interested in the structure inside this teratoma.
Anyway, you need to get the specimens, and after incision, you can take multiple specimens based on different tissues, and then send them to the pathology department separately.
The meat balls were placed on the sterile table. Song Zimo and Xu Zhiliang, one fixed the meat balls and the other performed the task of cutting.
The swelling of the meat ball indicates that there is still a certain amount of tension inside.
In order to prevent incision liquid from splashing,
Song Zimo asked everyone to stay away from the sterile table.
The capsule was incised, and a pile of fat bulged out, followed by a thick oily liquid overflowing, mixed with a messy black stuff. Song Zimo took out a little fat and kept it as a specimen, and then continued the dissection.
The black, messy thing turned out to be hair like hair. Song Zimo used a blood vessel forceps to grasp a handful and gently pulled it out, pulling out a handful of one-meter-long jet-black hair.
This scene is a bit eye-catching. What is the concept of having a bunch of hair growing in your belly?
It's not just a bit of hair, but a lot of it. These hairs are no less than the long hair of an adult woman. No wonder the meat ball is so bulging. For better diagnosis, Song Zimo took a part of the hair and left it as a standard.<
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The tissue inside the meat ball is very complex. In order to make a clear diagnosis, multiple specimens must be taken.
Except for bone tissue, which cannot be frozen sectioned, other soft tissues can be frozen sectioned.
In addition to hair, there are also teeth-like structures inside, one by one.
The ridge vertebrae shown in the image pictures are not actually complete ridge columns, but neatly arranged ridge-like vertebrae-like bone blocks.
There are irregular muscle tissues around, and even skin tissue and nerve tissue were found.