Professor Liang carefully inquired about the medical history and examined the patient himself. He was relieved when he felt that there was nothing wrong.
This has been his habit for many years, and he must handle Corey's difficult cases personally.
For his surgery, you must take a medical history and perform a physical examination in person before the operation.
He couldn't do such a thing by going on stage to perform an operation without even seeing the patient's face based on just an image and picture.
After the physical examination, Professor Liang put the percussion hammer into the pocket of his white coat and said, "Mr. Jing, your surgical project is a bit big. We need to be well prepared and don't be in a hurry."
Jing Yunsong sat cross-legged on the hospital bed: "Don't worry, you can study slowly. I checked all the first-class hospitals in China. After much deliberation, it is more reliable to come here."
Professor Liang patted him on the shoulder: "Rest peacefully and we will notify you when the surgery is scheduled. Usually on Monday, we will do our best."
"It's hard work, I'm waiting for news from you." Jing Yunsong was relaxed throughout the whole process, not afraid of the big scene of dozens of doctors doing rounds.
Because there are so many doctors, some doctors cannot squeeze into the ward. They gather at the door of the ward and listen to the conversations inside.
After seeing the patients, dozens of doctors cheered and cheered from the ward to the doctor's office, which was very impressive.
In fact, as a professor-level doctor, the most glorious moments are two. One is leading the entire department to conduct ward rounds, and the other is giving a speech on stage during an academic meeting. This is also the life goal pursued by young doctors.
Back in the doctor's office, Professor Liang sat down and thought carefully about whether there were any loopholes in this operation.
The preoperative preparations have been very complete, and the 3D printed spinal prosthesis has been designed with no flaws. It is estimated that it can be printed out and sent for sterilization today. The support of the vascular surgery department has also been confirmed. If the aorta and inferior vena cava are found during the operation,
If the tumor is indeed invaded, the blood vessel wall is destroyed, and there is a lack of normal and complete blood vessel wall, artificial blood vessels should be placed in advance to avoid intraoperative or postoperative tearing of large blood vessels.
Professor Hu Guolin works steadily and tries his best to be as leak-free as possible. As the new generation director of Peking Union Medical College Orthopedics, he gives people a humble and low-key feeling. It seems that he has no dazzling achievements, but he can't find any faults at all.
"What are you going to do to stop the bleeding? If all three vertebrae are removed, there will be more bleeding."
Professor Liang suddenly asked.
Professor Hu Guolin must be well prepared for such basic work. He said calmly:
"We have fully estimated the bleeding during the operation. In addition to routine blood preparation, we have also made preparations from three aspects. With the tumor angiography image as a reference, we will ligate the blood supplying vessels of the tumor one by one; before the operation, we also
The interventional department has been asked to perform embolization of the main blood supply vessels of the tumor in advance; if necessary during the operation, the aorta or inferior vena cava will be temporarily blocked for a limited time."
Professor Liang asked: "Please ask the interventional department for embolization. Have you considered the possibility that the blood supply blood vessels of the tumor and the blood supply blood vessels of the spinal cord are shared. Once embolism occurs, it will cause ischemic damage to the spinal cord, leading to paraplegia and incontinence?"
Professor Hu also had some considerations: "During the preoperative tumor angiography, the blood supply vessels have been carefully screened."
After listening to Professor Hu's words, Professor Liang nodded with satisfaction. Professor Hu did indeed achieve a watertight operation in this operation.
Yang Ping also felt that Xiehe was rigorous and could not take care of any detail.
Professor Liang always felt that something was not done enough. He reviewed the surgical process in his mind and found that there was still one step that was not perfect: when using a wire saw to cut off the vertebral pedicle, because the tumor had embedded the pedicle, the wire saw was inserted into the pedicle.
It will inevitably damage the tumor, leading to the leakage of tumor cells and the risk of dissemination.
Professor Hu took the necessary precautions. He used a special guide instrument to perform bone puncture and guided the wire saw to insert it under the vertebral pedicle, thus minimizing the damage to the tumor body. This was considered the best solution.
Because even if there is a guide for bone-to-bone puncture, there is still a risk of tumor spread.
The most perfect level of puncture operation is to pass between the tumor pseudomembrane and the vertebral pedicle bone during puncture, and guide the wire saw to be inserted between the tumor pseudomembrane and the vertebral pedicle bone, but the tumor is close to the vertebral pedicle.
When the wire saw is pulled back and forth, it will inevitably damage the adjoining tumor pseudomembrane, causing tumor cells to leak out, contaminating the surgical area, and violating the tumor-free technical principle of tumor surgery.
Professor Liang can't think of a better alternative for the time being. Of course, it would be more perfect if the tumor could be peeled off from the vertebral pedicle along with the periosteum and then implanted with a wire saw.
However, this operation only exists in theory and is impossible to do in surgical practice, and it is easy to be damaged during separation, so the risk of dissemination is greater.
Professor Liang felt that Professor Hu's treatment had reached the limit, so he asked Yang Ping next to him: "What do you think of this case? Especially to prevent the spread of tumors, are there any good methods?"
Union Medical College handled this case very thoughtfully and meticulously. There are only a few hospitals in the country that can complete such a complex operation, which can remove three complete vertebrae and a complex chordoma at one time. This is the crown jewel level in spinal tumor surgery.
If any hospital completes such a surgery, it can write a big book about it and promote it on the hospital's official website for several years. Moreover, if you share this kind of case with your peers at every academic conference, you will definitely gain countless respects.
If there is still something that is not in place, it is the step of cutting off the vertebral pedicle. After a special guide is used to guide the bone, the tumor will still be penetrated, leading to the risk of dissemination.
Yang Pingping said candidly: "The surgical plan is very thorough and there are almost no loopholes. Even in the step of inserting the wire saw, I think it is best to completely peel off the tumor from the pedicle and intervertebral foramen. During the peeling, there will be no trace of the tumor."
The membrane and periosteum are peeled off together, and even a little cortical bone can be peeled off together, without breaking the membrane during the whole process."
“After the tumor is separated, the operating space is much wider, and then the wire saw is inserted, so that the pedicle can be cut boldly. The wire saw will not stick to the tumor, causing friction or cutting damage, and there is no need to worry about the risk of tumor spread.
"
Professor Liang also thought about separating the tumors at the vertebral pedicle and intervertebral foramen in advance with the periosteum, but the operation was too difficult and not feasible.
Professor Liang said to Song Yun: "Enlarge the three-dimensional reconstructed images of the lumbar spine and tumor a little more."
Professor Liang did not immediately agree or refute Yang Ping's words, but studied the images again.
After studying the images again, Professor Liang frowned even more.
This method is the best, as it can avoid tumor spread to the greatest extent, but the operation is the most difficult and impossible to achieve. Moreover, the intervertebral foramen formed by the upper and lower vertebral pedicles is the passage for the nerve roots to enter and exit. If you are not careful, the nerves will be damaged.
To separate tumors in such a narrow and complex space, the pseudomembrane cannot be broken, and the periosteum must be carried along, which is impossible.
If according to Yang Ping, it is best to wear a layer of cortex, then a fine bone knife will be used, making the operation even more impossible.
After thinking for a long time, Professor Liang shook his head: "Theoretically this is the best method, but in reality there is no way to do it."
"Furthermore, I think that the entire surgery is centered on the tumor, and pseudo-extramembranous operations are performed. Wherever bone is encountered, except for the pedicle, other parts should be cut off. The tumor will be removed along with the vertebrae, and the vertebrae will be removed.
When part of the tumor is removed, the entire tumor pseudomembrane is accompanied by a layer of surrounding normal tissue with a thickness of several millimeters, so that the tumor is removed most completely without worrying about the leakage of tumor cells." Yang Ping pointed to the three-dimensional image on the screen.
Tumor cells are like seeds. Once scattered, they will "take root and sprout" and become the source of recurrence.
Therefore, tumor surgery has an operating principle called "tumor-free technology". This technology emphasizes that the tumor should be isolated from normal tissue during the entire surgical process, and the tumor should not be allowed to contaminate surrounding normal tissue.
Professor Liang turned his head and glanced at Yang Ping, thinking that Yang Ping didn't hear what he said.
So I repeated it again: "What you said is very good, but it is unrealistic."
Now this tumor is extremely complex. It is impossible to achieve it just by operating on the pedicle according to your method. It is even more impossible to remove the entire tumor according to this idea.
"The ideal is full, but the reality is very skinny. How can it be possible to achieve such a precise operation? It would be fine if the operation area is flat and wide, but the anatomy here is very complex, especially the bony space is extremely narrow, and there are no corners."
Professor Liang is quite funny sometimes.
"It's very difficult, but it can be done. It's just a matter of practice makes perfect." Yang Ping said confidently.
The dozens of doctors nearby were all shocked when they heard clearly the conversation between Professor Liang and Yang Ping.
It’s not that everyone can’t think of doing this, but they dare not think of it because it simply can’t be done.
There are a few doctors who are always wondering about the level of the youngest Golden Knife Award winner in the country.
The games were all watched on video, and now they really want to see Yang Ping's surgery up close.
It's like watching a Tyson match. Watching TV and standing next to the boxing ring are completely different experiences.
Yang Ping will definitely perform a lot of surgeries this time when he cooperates with Xiehe, but most of the surgeries are external fixation surgeries for scoliosis. This kind of surgery contains many innovations and is extremely technical. In order to facilitate popularization, it has reduced the difficulty of the surgery.
, there is definitely no stimulation from three total vertebrae resections of this kind.
When these doctors heard Yang Ping's different opinions, they all leaned forward.
Is it possible for the youngest person in the country to win the Golden Sword Award to perform such a magical operation?
Professor Liang repeated what he said, and Yang Ping not only did not correct his words, but also answered more affirmatively, which shows that Yang Ping was not talking to himself.
"Have you ever used this method in spinal tumors? How was the effect?" Professor Liang did not dare to question Yang Ping's words, so he asked tentatively.
After all, this young man cannot be treated as a normal person.
Therefore, when communicating with him, you need to adjust your thinking and be a little bit unconstrained. In other words, you need to open up your imagination. If your imagination is too small, it won't work. You need to make it bigger, otherwise it will be easy to chat to death.
It is true that people are talking about things that can be done, but as soon as you start talking, it is something that is super difficult and cannot be achieved.
"I often use this method for spinal tumor surgery."
This is the truth. When Yang Ping performs spinal tumors, no matter what corners they are, they will be separated along the pseudomembrane with a few millimeters of normal tissue around them. There will never be a small opening. This way, the surgical effect will be the best and the probability of recurrence after surgery will be the best.
lowest.
At that time, Academician Feng Tiancheng had a tumor at the skull base of the upper cervical vertebrae, which was a high-risk area, and the tumor was completely removed in this way.
The lumbar spine is also very difficult and risky, but it is better than the skull base of the upper cervical spine, where the upper cervical spinal cord and medulla oblongata are located.
frequently used?
Professor Liang choked for a moment, and all the doctors in the room had their throats blocked.
Boy, I'm sorry, you've completely ruined the conversation.
Yang Ping's words suddenly sounded like "why not eat minced meat".
Professor Liang couldn't answer the question for a while. He paused for a long time and squeezed out a few words: "Used frequently? There are dead spots everywhere in the intervertebral foramen and pedicles, and the nerve roots are also embedded. How to operate?"
"Using a laser knife to cut, but you need to be very skilled in the anatomy of this part, and you need to be very skilled in distinguishing tumors, tumor pseudomembranes, and normal tissues. You also need strong spatial positioning capabilities, and you need to remember the pictures on the screen.
"Yang Ping likes this kind of direct communication. He only talks about academics and doesn't need to take care of the other person's emotions.
"If the anatomical space is larger, we can use navigation equipment to do it, but in such a small and complex space, navigation equipment cannot be used. It can be seen and operated." Professor Hu Guolin was helpless.
“No navigation required!”
Yang Ping said categorically.
This time it was Professor Hu Guolin's turn to choke.
"Do you have many cases where you do this?"
The doctor who was very critical just now asked.
"This is how I operate every spinal tumor." Yang Ping answered him.
This critic was also choked and had nothing to say.
Whoever opened his mouth was choked and speechless.
The atmosphere is a bit awkward!
It’s a bit embarrassing indeed!
Everyone, look at me and I look at you!
Professor Liang touched his chin, frowned, and waved his hands to signal everyone not to ask questions for the time being, asking him to think carefully about what the problem was and why the communication was so difficult to continue at this point.
"During the Golden Knife Award competition, I don't know if you still remember that I used this method in my cervical spine and skull base tumor surgery." Yang Ping had to give a familiar example.
oh!
Professor Liang thought of this operation and finally found the crux of the problem.
Obviously this young man is not in the same dimension as everyone else. Professor Liang still understands this concept of dimensionality reduction.
Professor Liang raised his head, closed his eyes slightly, and then exhaled and said: "How about you teach this method to everyone. If it is convenient, it is best for you to perform this operation and demonstrate it to everyone."
It is useless to ask so many questions after Yang Ping. One side often does it and regards it as a routine operation, while the other side has never done it and thinks it is impossible to achieve.
There is no point in communicating anymore, why not show Yang Ping his magical skills.
Professor Liang must have believed in Yang Ping. Academician Feng Tiancheng's surgery is a vivid example.
"all right!"
Yang Ping answered readily that since Professor Liang trusted him so much, there was no point in giving him mercy.
