Chapter 655 Are you still talking about cooperation?
The risk of patients developing aortic dissection is mainly in the abdominal aorta, because the tumor invades this section of the aorta, causing local lesions in the blood vessel wall, loss of normal anatomical structure, and inability to withstand normal blood pressure.
Therefore, this case is treated as type B dissection.
Aortic dissection is clinically divided into two categories based on the location of the dissection, called type A dissection and type B dissection.
Type A dissections accumulate to a section of the aorta connected to the heart. They are the most dangerous of aortic dissections because the aorta has the highest blood pressure and is very prone to rupture. The only treatment for this type of aortic dissection is
Emergency surgery replaces the section of the aorta connected to the heart with an artificial blood vessel, thus reducing the risk of aortic rupture.
The other type is called type B dissection. The aortic dissection does not accumulate to a section of blood vessels connected to the heart, but is limited to the aorta in the chest and abdomen. In this type of dissection, the blood vessel pressure will be lower, and there is a risk of aortic rupture.
Relatively small, generally an interventional stent can be considered.
So what Director Zuo wants to implant now cannot be said to be an artificial blood vessel to be precise, but a stent artificial blood vessel graft.
Normally, this type of surgery is minimally invasive. The stent is delivered to the predetermined position through a small incision in the iliofemoral artery. Today's case is special. First of all, the role of the stent is prevention, so it is difficult to judge the position through X-ray fluoroscopy. In the fluoroscopy image
Can't see any problem.
Special cases are treated specially. Director Zuo is very experienced. He directly inserts the stent from the abdominal aorta based on the actual situation of the patient. He then inserts the stent distal to the diseased blood vessel segment under direct vision and finger touch.
Combine to send the bracket to the predetermined position.
Director Zuo and his two assistants were familiar with the process, and they quickly moved the bracket to the predetermined position. After touching it gently with their hands, they did not rush to release the bracket.
"Professor Yang, come and take a look, is the location correct?" Director Zuo needed Yang Ping to make the final judgment.
Because as the chief surgeon, Yang Ping knew that the section of the abdominal aorta was adhering to adhesions and needed to peel off the blood vessel wall. He went on stage and reached in and touched it: "Yes, this is it, release it."
After being confirmed, Director Zuo immediately released the stent decisively and neatly. His technique was very skillful and the stent was released accurately without any displacement due to the influence of blood flow.
Therefore, the comprehensive level of a hospital is very important, and sometimes various departments need to collaborate with each other.
For example, if this patient is placed in another hospital, even if the orthopedics department has the ability to complete the operation, without the support of top macrovascular surgeons, the operation will be difficult to complete, or even if it can be completed, it will leave huge potential risks.
Of course, most patients do not need to perform total vertebra resection. Jing Yunsong’s situation is really special.
After completing the implantation of the stent-based artificial vascular graft, Director Zuo began to take off his surgical gown:
"Is this Professor Yang from the south?"
Just now, Director Zuo just asked Yang Ping to help determine the position of the bracket, and now he officially added hello.
"Hello, Director Zuo!" Yang Ping also greeted politely.
Director Zuo smiled and said: "Heroes come from young, are you the winner of this Orthopedic Golden Knife Award?"
Yang Ping nodded.
Song Yun immediately introduced Director Zuo in front of him: "Our Director Zuo was also the winner of the Golden Knife Award for Great Vascular Surgery that year."
Union Medical College has produced many Golden Knife Award champions, such as orthopedics, vascular surgery, general surgery, which is the basic surgery of Union Medical College, and has produced Golden Knife Award champions.
Although the Golden Sword Award cannot be said to be everywhere, it is not a rare thing.
It was very difficult for Director Zuo to win back the Golden Knife Award for the Department of Vascular Surgery from Anzhen Hospital and Fuwai Hospital, because the Golden Knife Award for Cardiac and Vascular Surgery usually takes turns between these two hospitals, especially for cardiac surgery.
It was these two hospitals that alternately took over, and it never fell into the hands of a third hospital.
The same goes for major vascular surgery, which is handled by these two hospitals. Only Director Zuo won the Golden Knife Award for major vascular surgery, breaking An Zhen and Fuwai's undefeated streak.
"It's not worth mentioning. I was forty-two years old when I won the award. You are not even thirty now, so you can't compare." Director Zuo waved his hand.
He also wanted to chat with Yang Ping for a few words. After all, it was the Golden Sword Award, heroes cherish each other, and there were many topics to talk about.
Unfortunately, Director Zuo's assistant received a call and there was another emergency surgery. The emergency department admitted a pregnant woman with a torn aortic dissection. The blood vessels were now bulging like balloons and could rupture at any time, requiring emergency surgery.
Without even having time to say hello, Director Zuo left in a hurry with his assistant.
Yang Ping then continued the operation, and everyone rested for a while before getting into the mood again.
With the protection of artificial blood vessels, the weak points in the blood vessel wall caused by tumor separation are artificially strengthened.
Even if aortic dissection occurs in the future, there is no need to worry about the danger, as this mine has been eliminated in advance.
It is more difficult to complete this step in advance, but the effect is better. If you do this work again after separation during the operation, if dissection occurs immediately after separation, the damage to the blood vessel wall will be greater. But now that it is placed in advance, you don’t have to worry about this.
question.
Yang Ping began to separate the tumor. Although the separation on the back side did not reach 360 degrees, most of it was completed, leaving only the front side without separation.
Most of the blood supplying vessels to tumors come from the anterior approach, so the anterior approach poses a greater challenge to hemostasis.
Moreover, the tumor adheres to the abdominal aorta and inferior vena cava, making it very difficult to separate the blood vessels.
This step is very dangerous and tests the doctor's surgical operation.
The doctors in the entire conference room are looking forward to seeing how this top expert can separate the tumor here, whether he can break the large blood vessels, and whether he can break the pseudomembrane of the tumor, so that the separation of the tumor cannot be performed without leakage.
.
Because the pseudomembrane of the tumor here is part of the wall of the large blood vessel, successful separation is much more difficult than the posterior approach.
Cheney's bladder doesn't feel so obviously bulging now. It may be that the reabsorption of the bladder plays a role, and Cheney no longer drinks water.
This chapter is not over yet, please click on the next page to continue reading the exciting content! Director Hu ignored him throughout the whole process. He watched the operation by himself. Several other American doctors were also immersed in the observation, and from time to time they talked with the Chinese doctors next to him.
comminicate.
Cheney also wanted to communicate and ask about some details of the operation. He was very interested in this Chinese-style total vertebra removal, but Director Hu's answer made him dare not ask any more questions.
"After 360 degrees of separation, the last step is left. Now we need to complete the ligation of the tumor blood vessels. Only by ligating all the tumor blood vessels and keeping the surgical field absolutely clear can the subsequent separation be carried out calmly."
Yang Ping would tell Song Yun every critical step.
He ligated the segmental arteries around the 2, 3, and 4 lumbar vertebrae, and then began to ligate the blood vessels supplying the tumor one by one. He knew every blood vessel in advance, never missed it, never missed it, and the operation was still the same.
skilled.
Song Yun couldn't figure out why Yang Ping was so familiar with the anatomy of this tumor. If he relied on angiography images to remember these blood vessels, then Yang Ping's ability to apply image images to actual surgical operations was too strong.
Yang Ping kept asking the nurse for blood vessel clamps, and Song Yun kept tying the blood vessels and tying them!
The blood supplying blood vessels of the tumor were ligated one by one, without missing any one or finding the wrong one. This kind of cutting-edge hemostasis method is very effective.
The entire surgical field is very clean, almost unreal.
This kind of surgical field can only occur when tourniquets are used in extremity surgeries and preoperative hemorrhage is used.
The clean and clear surgical field makes the separation of the tumor very smooth. When the separation progresses to the area where it adheres to the large blood vessels, the laser knife performs very precise dissection.
"It's still the same principle, start with normal organization and go deeper step by step!"
Because at this time, to prevent tumor leakage, the outer membrane of the large blood vessels must be completely peeled off. The outer membrane of the large blood vessels is part of the tumor pseudomembrane.
The adventitia of the aorta is opened bit by bit under the separation of the laser knife, neither thick nor thin, and the adventitia is kept intact.
"So when doing this operation, it is very important to insert the artificial blood vessel in advance, otherwise it will cause massive bleeding once it is damaged. Blocking the aorta can only temporarily stop the bleeding in a short time and cannot prevent damage. Even if it is not damaged and the outer membrane is successfully peeled off,
The remaining blood vessel walls are also unhealthy and prone to dissection."
Soon, the tumor separated from the aorta, and then from the vena cava.
Yang Ping checked whether there were any tissue adhesions near the tumor and the vertebral body. It was very good. There was no connection at 360 degrees. Yang Ping carefully removed the entire tumor and three vertebrae from the front abdominal cavity, and then put them into the metal basin of the instrument nurse.
.
The removal of the tumor and three vertebrae is complete!
Now the operation has progressed to the third hour. These three hours include the time for the vascular surgery department to insert the artificial blood vessel.
The surgical area was flushed, and there were no missed bleeding points. If there were no problems, a drainage tube was inserted, and Song Yun was responsible for suturing the anterior surgical incision in layers.
In this way, the entire operation has been completed in two steps, leaving only the last step - posterior fixation, using the pedicle screw system and the truss structure of the artificial spinal prosthesis to support the spine.
After the patient's anterior surgical incision is sutured, a sterile dressing is applied, and the patient has to return to the prone position for posterior fixation.
Posterior surgery is relatively simple. An artificial spine is inserted and then connected and fixed with a pedicle system. The entire artificial truss structure replaces the three removed vertebrae and continues to function as a support for the central axis of the human body.
Four hours later, the operation was over.
The surgery, which was originally planned to take twenty hours, was completed in four hours.
All the doctors in the conference room were not only shocked, but also shocked.
Everyone was mentally prepared to observe the operation for more than ten hours, so no one felt how long the four-hour operation was, and there were many things that were left unfinished.
Professor Lu was so frightened that he couldn't believe it. The director of the medical department, who had seen big storms, was regretting it all the time. He should have been more active in signing the contract instead of pushing it left and right. This would also show that he had extraordinary vision.
Xiehe left behind a beautiful story.
Professor Liang had a slight smile on his face. The damage caused to him by the Zhang Chunquan incident had been completely healed by Yang Ping.
The east is not bright and the west is bright. Everyone has his own ambitions. Professor Liang no longer cares so much. Once the psychological hurdle is passed, there is no more entanglement.
Director Hu was still immersed in thinking about surgery. His understanding of Yang Ping began with the Golden Knife Award. Before that, Director Hu had never heard of Yang Ping’s name. It was not until the Golden Knife Award competition that a machine that shocked the entire orthopedics department.
Scoliosis correction appeared, and Concorde's strongest player Song Yun was killed instantly.
Only then did Director Hu and the entire Xiehe Orthopedics Department wake up to the fact that there was such a master.
Later, under the supervision of Professor Liang, everyone organized a group to go to Sanbo Hospital to learn scoliosis surgery, and later saw Yang Ping's masterpiece surgery in Japan.
Director Hu was completely impressed by Yang Ping. Today's surgery was much duller than the surgeries he had seen before.
The impact on Cheney was not ordinary. Now he feels that his self-esteem has been thrown to the ground and has been crushed into a pancake.
"Cheney, what did you just say?"
Professor Hu knew that Cheney had been restless and wanted to ask questions.
"Where's the bathroom?" Cheney summoned the courage to ask.
Director Hu pointed: "Go out the back door and turn left!"
Finally, the doctors of Union Medical College saw the level of the Golden Knife Award, the first in the country.
Four hours, a perfect operation, said it all.
"Can Professor Yang's team increase the number of seats now?" A chief physician leading the team came to Director Hu and asked quietly.
Director Hu shook his head: "His team is staffed by doctors under the age of forty, most of whom are under the age of thirty-five, and the number is sufficient."
The chief physician sat back in his seat disappointed.
"Professor Hu, is the second operation still a demonstration of Chinese-style total spondylectomy? Can I enter the operating room and observe on stage?"
After Cheney emptied his bladder, he felt much more relaxed and more courageous.
"I'm sorry, there is only one demonstration surgery today, and according to our operating room management rules, you can't enter the operating room now." Director Hu apologized.
Cheney was very disappointed and continued: "We can exchange doctors for further training. Are there any total spondylectomy surgeries in the next few days? Can I stay here and see?"
Director Hu still expressed his apology: "Our training will be carried out in stages, with priority given to Chinese doctors and foreign doctors will not be accepted for the time being."
Cheney blushed in embarrassment: "How long do we have to wait?"
"There are so many Chinese people. It's hard for me to determine the specific time now. If you have this request, just wait for our notification." Director Hu felt so good all over, he had never felt so good.
Cheney nodded helplessly: "Okay."
"Let's continue talking about cooperation when we have time?" Director Hu reminded Cheney.
Cheney hesitated: "This--the matter of cooperation--we are a little hasty and there are still many problems that have not been resolved."
Compared with Chinese-style total spondylectomy, Cheney's surgery seems a bit backward and rough.
He secretly called his assistant and took down his equipment box from the podium. He had no intention of continuing to explain after the meeting.
Cheney was very unhappy, but did not dare to show it.
He complained in his heart: Medical skills should have no borders. These Chinese people are so narrow-minded that they actually have to wait for the Chinese to finish their studies before arranging for foreigners to study. How long will it take?