There are many people, and everyone is very motivated to learn.
Professor Liang can tell everyone a lot every time, so everyone likes to listen to Professor Liang’s class.
Professor Liang has very high attainments in the field of spinal surgery. His academic achievements are not only leading in the country, but also world-class, giving XCMG spine surgery a place in the world.
Therefore, Xiehe’s supreme reputation is the result of the hard work of generations of people.
After Song Yun finished reporting the medical records, everyone was almost done thinking, and Professor Liang started to speak.
"En bloc resection of the whole spine, also called total vertebra resection, is a very complicated operation. There are not many articles at home and abroad, only about a dozen, and there are even fewer hospitals that can do it."
"Due to the complex anatomy of the crest column, which is adjacent to the spinal cord nerves, large blood vessels and important organs, surgical resection is very difficult and the risk is very high. In the past, subtotal resection was used to treat such cases, which resulted in ineffective tumor resection.
It is very easy to relapse, and the recurrent tumors are difficult to treat. In the end, the treatment effect of this type of tumor is very poor."
"In the 1990s, Professor Tomita from Kanazawa University in Japan proposed posterior total vertebral en bloc resection, which is now called total vertebral en bloc resection. With this technology, not only can this type of tumors be treated
, for all complex vertebral tumors, the surgical effect has been improved. In this case, I want to ask you how to perform total vertebra resection. Song Yun, please answer me."
Professor Liang would like to use this case to teach you about total vertebra resection, a highly difficult and high-risk operation, so that everyone can thoroughly master the relevant knowledge based on the case.
Song Yun once graduated from the Concordia Eight-Year Program, and was outstanding in both basic knowledge and learning ability. The college entrance examination scores of the Concordia Eight-year Program are at the same level as those of Tsinghua University, but because of the small enrollment, it is more difficult to take the exam than Tsinghua University. Talents cultivated with such a high starting point, high standards and high requirements are all elites in the industry.
Think about it when Su Nanchen entered the Xiehe Eight-Year School, and his college entrance examination score was the top scorer in the province of science.
Song Yun was calm and answered clearly:
"Dr. Tomita's surgical method is also the current mainstream surgical method. He performs the surgery from the posterior approach, uses a wire saw to cut off the vertebrae from the pedicle, divides the vertebrae into two parts: the vertebral body and the appendage, and then cuts the two parts separately. Of course, it is necessary to
Safely separate all structures surrounding the vertebrae."
"Based on the specific situation of this patient, the tumor invades the large blood vessels in front and adheres to them. Simple posterior surgery cannot solve the problem. It must be combined with anterior surgery to remove the tumor."
"The choice of the anterior approach should also take into account the growth pattern of the tumor. The lateral-anterior approach cannot fully dissect the aorta and inferior vena cava, so it is best to choose the anterior approach, which facilitates the treatment of the aorta and inferior vena cava. At the same time, pay attention to the iliac
Protection of internal and external veins."
"The segmental arteries must be handled carefully. The psoas major muscle is attached to the vertebral body. Be very careful when separating to prevent damage to the nerve roots that deform inside the psoas major muscle."
Song Yun briefly explained the surgical process and precautions, which showed that he had a very thorough understanding of the surgery and was able to make such a summary.
"Very good! Not only have I read papers in this field, but I also have some surgical experience and have a good understanding of the precautions." Professor Liang praised.
Although Professor Liang has strict requirements, he never hesitates to praise his students. He believes that criticism alone is not enough, and students should also be praised and encouraged in a timely manner.
"So, this operation requires special tools when cutting the vertebrae from the pedicles. Why is this tool special? What is so special? Raise your hand to answer."
Professor Liang continued to ask questions. Since this case has been discussed, he wanted to check whether the young doctor had mastered it.
Many people raised their hands in the entire conference room. Everyone was very positive and the atmosphere was very lively.
Professor Liang randomly selected a young doctor. This young doctor had good looks and temperament. He answered very confidently and calmly: "The structure of the vertebrae is complex, so a special guide is needed to guide the wire saw under the pedicle. Because of the direction of the wire saw,
It cannot follow the standard route like normal long bones, so a special redirector is needed to change the direction of the wire saw so that it can go around the pedicle and form an effective cut."
"This special instrument is difficult to buy on the market. Hospitals that can perform this type of surgery must either bring back tools from abroad when studying, or use existing tools to improve them to adapt to this type of surgery."
"We need to redesign the surgical tools for this patient. Look at the three-dimensional reconstruction of the spine and tumor. The normal wire saw penetrates between the lamina and exits through the intervertebral foramen. Then the wire saw redirector is used to remove the vertebrae.
After cutting off the pedicle, there are space-occupying lesions in the spinal canal, and there is no gap to thread the saw. If the thread is forced through, it will easily cause tumor dissemination and cause tumor bleeding. The instrument needs to make some personalized changes to adapt to this special situation.
."
The ceiling of Chinese hospitals is well-deserved. Any one you pick is the elite of the elite, and these doctors all have a temperament: calm and confident.
Yang Ping has been listening to their speeches quietly, thinking about the uniqueness and shortcomings of these speeches.
"Very good! Every case should be treated as a classic. This is a responsibility to the patient and to ourselves. We can learn a lot from one case. Who is responsible for 3D printing?" Professor Liang was full of enthusiasm. p>
"Me!" A young doctor raised his hand.
The doctor immediately walked to the computer and put the 3D artificial spine model on the screen.
Because of the importance of 3D printing technology, almost every doctor at Xiehe Orthopedics is proficient in this technology, and they train this technology as a basic skill.
The 3D printed artificial ridge prosthesis is placed on the screen and rotates 360 degrees.
"This is a 3D artificial ridge prosthesis designed by us to replace the three vertebrae that will be removed during the operation. In order to achieve effective reconstruction of the vertebral body, we carry out personalized design based on the patient's anatomical structure and biomechanical characteristics. This is the top priority of the prosthesis.
Below, it perfectly fits the connecting surface of the upper and lower normal vertebral bodies. This is a screw implantation hole specially designed by us. It can connect the artificial vertebral body with the screw rod system at the rear to form a unique truss structure. The truss structure is combined with the titanium alloy we use.
The porous design allows the artificial vertebral body to have sufficient biomechanical strength. After surgery, patients can get out of bed as early as possible for rehabilitation training and achieve life and work like normal people."
Yang Ping feels that the design of this artificial vertebral body is very good and meets the requirements of biology and biomechanics. The designer must have received relevant systematic training.
After sorting it out in this way, the preparation for the entire operation has been very sufficient, and there are no mistakes.
"I have a question!"
Among the crowd without seats, a young doctor raised his hand to ask a question.
Because there are too many people, some people have seats, and many young doctors are standing.
"Say!"
Professor Hu Guolin asked him to stand up.
The doctor in his early thirties said loudly: "The preparations for the surgery just mentioned are assuming that everything goes well. If it does not go well and an extremely bad situation occurs, such as the aorta or inferior vena cava ruptures during dissection, what should we do?
?Especially in the case of large-scale tears."
The doctor walked up to the podium with his chest raised and continued confidently:
"As you can see, the adhesion range between tumors and large blood vessels is up to 10 centimeters. In this case, it is very easy to tear the aorta and inferior vena cava. Even if no tear occurs, the tumor and large blood vessels can be successfully separated. Such large blood vessels
Can it still be used? Is there any safety hazard? Like aortic dissection, it is like a time bomb. I saw an article mentioning a case of a patient who specializes in abdominal tumors. The tumor adhered to the large blood vessels in the abdominal cavity. The doctor successfully removed it.
The tumor was separated from the large blood vessels, and the operation went smoothly. However, the patient died suddenly on the fifth day after the operation. Later, an autopsy found the cause, which was that the aorta was invaded by the tumor and the blood vessel wall had changed. There was a basis for the onset of aortic aneurysm.
Later, the patient suffered from an aortic aneurysm and a large-scale tear in the aorta. The patient died due to internal bleeding and shock. Have we ever thought about what we would do if we encountered the worst case scenario? Do we need blood transfusions?"
This young doctor is like a critic, with a sharp tone, as if he is questioning his colleagues, Professor Liang and Director Hu in the front row.
Yang Ping found that among the doctors at Xiehe, almost none of them had a hunched back with their chests in their chests. They all held their heads high and their chests held high, with their backs straight.
Even Professor Liang, the oldest, always holds his head high, his back straight, and is full of energy whether he is sitting, standing or walking.
“Very good!”
Professor Liang applauded the questioner, and everyone followed suit.
"This is what I often tell you, what should we do as doctors?"
Everyone answered in unison: "Make the best effort and prepare for the worst!"
"Yes! We are working hard towards the best goal, but we must prepare for the worst. Who will answer the doctor's question?" Professor Liang was very satisfied with the doctor's question.
Academic people must have a questioning spirit and not follow what others say, lacking the ability to think independently.
Director Hu stood up: "Let me answer. We have considered this situation and measured the blood vessel wall on the images. Indeed, the blood vessel wall has this risk, and the risk is very high. We have prepared for this
For the artificial blood vessel, we invited vascular surgery to assist, and the blood vessel condition was explored during the operation. If necessary, the artificial blood vessel was implanted in advance to prevent the worst case scenario mentioned by the doctor."
The person who asked the question was very satisfied. It seems that the director has considered it very carefully.
"Are you satisfied with my answer? During the case discussion, you must have left early, and finally I mentioned this issue." Director Hu did not mean to blame, but just told the questioner gently.
Indeed, the doctor's medical team was on duty at that time, and he left temporarily due to emergency surgery.
Yang Ping was sitting in the front row, and the enhanced three-dimensional reconstruction of the tumor was displayed on the screen. He saw the extent of the tumor's invasion. The spinal canal was already crowded, it invaded the spinal cord and nerve roots, and the front side was adherent to the aorta and inferior vena cava.
The difficulty of resection is indeed very high, especially because the wall of the vena cava is thin, and if the separation is even slightly difficult, the blood vessel wall will rupture.
The tumor is intertwined with the spinal cord nerves in the spinal canal, and it is easy to damage the nerves. This surgery is well-deserved world-class.
Implanting artificial blood vessels in advance is a very clever move that minimizes the risk of large blood vessel rupture during and after surgery.
There is another problem, although it is not fatal, but if it is not handled well, it can easily cause the spread of tumors. That is, the tumors in Lumbar 2 and Lumbar 3 have invaded the vertebral pedicles covering both sides. In this case, use a wire saw to cut off the vertebral pedicles.
In any case, the tumor body will be damaged and the tumor cells will spread.
In order to reduce the possibility of spread, careful operation can only be done.
This problem can be avoided if the vertebrae are not divided into two, but are cut off in one piece.
However, such a complete removal of vertebrae is unprecedented in the world. It is very difficult and can be said to be impossible to achieve.
Yang Ping thought about this problem in his mind and tried to handle every step perfectly.
"Does anyone else have any questions?"
Director Hu asked everyone, because the discussion cannot continue indefinitely, and it will not end in three days and three nights.
"I just mentioned that the tumor is intertwined with the vertebral pedicle. How to insert a wire saw to avoid damaging the tumor body and reduce the spread of the tumor." A doctor was also thinking about this issue and raised it.
"To remove the vertebra, it must be divided into two parts and cannot be cut in one piece, so this problem cannot be avoided. We can only perform circumferential pedicle dissection for tumors in the pedicle, and then insert a wire saw after dissection. Moreover, we have strict requirements on the instrument.
Make improvements and add a protective cover during insertion, which can minimize the risk of dissemination." Director Hu introduced the solution.
The questioner nodded, very satisfied. This is the best way. It is impossible to take out the entire vertebrae at once.
"Do you still have any questions? Time is limited. If you still have any questions, you can discuss them privately."
No one was asking questions. Director Hu said to Professor Liang: "Shall we go see the patient?"
Professor Liang nodded, turned to Yang Ping and said, "Let's go see the patient together."
Professor Liang did not let Yang Ping speak. After all, it was Yang Ping’s first time to come to Union Medical College. Professor Liang treated him not as a student, but as a professor, and this meeting was of a learning nature.
Under the leadership of President Song Yun, everyone came to the ward. Jing Yunsong was obese, especially his abdominal distension was very obvious. He was chatting with the patients in the same ward. When he saw the professor coming to check the ward, he immediately sat back on his bed.
When encountering this kind of ward round, most patients are a little confused and confused about the situation, but Jing Yunsong is very relaxed. He should be a patient who has been to many hospitals and seen big scenes.
"Hello, Professor Liang, I finally meet you." Jing Jingyunsong recognized Professor Liang.
Before coming to Xiehe, Jing Yunsong had already searched all the orthopedic surgeons on Xiehe’s official website online.
"We are going to perform an operation on you. This operation is very complicated and the risks are high, so we will come to see you again." Professor Liang was very kind.
Jing Yunsong said with a smile: "If it wasn't complicated and difficult, I wouldn't come to Xiehe. I heard that when hospitals in Peking University encounter difficult and complicated diseases, they will recommend that patients be transferred to higher-level hospitals. Only Xiehe does not have this saying. Xiehe is a comprehensive hospital.
Higher-level hospitals in China, if you don’t perform surgery, I will have no choice but to travel around the world.”
It's rare for a patient to be so relaxed. Whether he is really relaxed or just pretending, at least he can still face it optimistically.
"Professor Liang, I heard that this kind of surgery has been performed the most in China Union Medical College. I came here because of its reputation. Whether it works or not, I will be here and there will be nowhere to go. There is a saying in the legend that the King of Hell wants people at the third watch, and Union Medical College can stay until
Five o'clock." The patient is very interesting.
It is very rare for cancer patients to be so optimistic.
