Chapter 837 Am I not Isuke? Why am I in the audience?
The liver is very close to the pancreas, so pancreatic tumors have many ways to invade it. Nowadays, liver metastases are particularly complicated. They actually grow around the portal arteries and veins and various ducts.
If you want to remove the tumor, you must cut off the blood vessels and then reconstruct the blood vessels. Of course, this tricky tumor cannot be removed in the body, so there is such a surgical procedure as ex vivo resection.
Now Yang Ping regards the liver and the tumor as a whole, and does not want to separate them. The separation of the tumor is left to outside the body. What Yang Ping needs to do now is to separate the "organ tumor" as a whole from the surrounding normal tissue.
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But even so, it is not that easy, because the tumor eventually wraps around the blood vessels and crawls towards the inferior vena cava.
The sharp knife is the best sharp separation tool. Compared with the various "knives" nowadays, such as laser knife, ultrasonic knife, water jet - the power of the sharp knife in the hands of experts is still undiminished, and it is the easiest weapon to obtain.
, available in any hospital.
The anatomy of the liver and tumors in the video can no longer be described, and I have no idea what they are.
Yang Ping and his assistants have put on fluorescent navigation glasses. Through these glasses, tumors stained with indocyanine green emit a faint green fluorescence, but normal tissues do not emit this light. Therefore, the tumor tissue may be affected by the tumor.
The invaded tissue and the surrounding normal tissue are divided into two obvious camps. The sharp knife wanders between the two camps. In order to ensure the completeness of the resection, it must cross the dividing line and remove part of the surrounding normal tissue.
Resection first and reconstruction later is a helpless choice for surgery. Once important structures are violated, they will be killed without mercy and then these structures will be reconstructed afterwards.
Today's sharp knives are wandering in dangerous areas: the blood outflow outlet of the liver - this is the "intersection" where three hepatic veins merge into the inferior vena cava. All blood that has been "detoxified" by the liver must come out from here.
Back to the inferior vena cava.
These blood vessels have been severely violated, so they cannot be preserved. Of course, before the entire surgical target is taken out of the body, Yang Ping temporarily retains their existence to ensure that the blood circulation of the liver continues normally.
If the entire surgical target is taken out of the body, the blood vessels here will be cut off at a normal location, and then the blood vessels and the tumor will be cut out together. After the tumor is removed outside the body, these blood vessels must be rebuilt by grafting blood vessels.
Director Shi's heart is under tremendous pressure. If it weren't for those seven organs, if there was only this one organ, and only the liver and tumor seen so far, it would actually be a very major operation.
This surgery is called ex vivo liver resection and autologous liver transplantation.
What we usually call liver transplantation generally refers to allogeneic liver transplantation. The liver transplanted is someone else's liver. Now the transplant is your own liver. It seems that transplanting your own liver should be easy.
On the contrary, autologous liver transplantation is much more difficult than conventional allogeneic liver transplantation, and is called the Mount Everest of hepatobiliary surgery.
There are two difficulties in autologous liver transplantation. First, after the patient's liver is taken out, the patient will have a liver-free period. During this period of time when the patient has no liver, the surgical team must ensure that he lives well.
Secondly, after the liver is taken out and put back after careful repair, it is necessary to ensure that the liver repair is flawless. Once the liver is repaired and damaged, the patient lying on the operating table will definitely not be saved.
Allogeneic liver transplantation is different. Someone else's liver is used. The patient has his own liver. When preparing the allogeneic liver, the patient has a liver. Although this liver is not good, it is better than nothing. In case something goes wrong with the allogeneic liver.
It cannot be implanted, and the patient has no major problems for the time being.
Both situations are equivalent to changing the CPU on a running computer.
For autologous liver transplantation, the original CPU is taken out, repaired and then put back. During this process, it is necessary to ensure that the computer cannot be shut down and can still operate normally. Once the CPU is repaired and cannot be reinstalled, the computer can only be scrapped. Alien liver transplantation
Liver transplantation requires buying a new CPU to replace the original CPU. Although the computer is also required not to shut down, when dealing with the new CPU, doesn’t the computer still have its own CPU? Is it more difficult to keep the computer from shutting down with or without a CPU?
, Obviously, if the new CPU is accidentally broken at this time, it doesn't matter. At most, it will fail this time and it will be replaced next time. Isn't there still a piece inside that can be used.
In this case, even if all the steps of isolated liver resection and autologous liver transplantation go smoothly, there will still be complicated pipeline reconstruction such as: hepatic artery, common bile duct, portal vein, suprahepatic inferior vena cava, infrahepatic inferior vena cava ---
If any step is not done well, if it is re-implanted into the human body, for example, if the blood vessels are not rebuilt properly, it will cause massive bleeding, which will be hopeless. If the common bile duct leaks, causing bile leakage, it will be life-threatening.
Director Shi Guosheng is one of several professors who perform this type of surgery in China. Currently, he has not accumulated many cases. Isolated liver resection and autologous liver transplantation basically take him about ten hours.
Not long ago, Pengcheng performed a case of isolated liver resection and autologous liver transplantation. It is said to be the first case in Pengcheng's medical history. The operation took more than 20 hours, which shows the difficulty of this kind of operation.
This is just an isolated liver resection, but autologous liver transplantation is so difficult. The operation Yang Ping is doing now involves eight organs. This difficulty is simply the Everest on Mount Everest, the Tower of Babel of general surgery.
This operation must take a long time. Director Shi counted it and couldn't help but shudder. How many days and nights should this operation be done?
An isolated liver resection and autologous liver transplantation can take more than ten hours. The removal of these eight organs and the autologous transplantation, as well as the dissection of various lymph nodes, do not count more than a hundred hours, not five or six days.
You have to work day and night to complete the operation. Even if some organs are not as difficult as the liver and pancreas, shorten the time to two or three days.
I didn't calculate the time before, I just rushed to see the operation. Now that I do the calculation, I feel like I'm going to collapse. What kind of operation is this? How many days and nights will it take?
Professor Shi had to turn his head to look at the few young people on the stand. Just these few guns, they could persist for days and nights, wouldn't they?
Look at the junior fellow students and other doctors. They are watching with great interest. Don't they realize the problem of time? Are they still in the dark? It is true that the ignorant are fearless.
For days and nights, even the people who were watching the surgery were now scared, let alone the doctors who were standing on the stage performing the surgery.
The surgery in the video is still going on. The surgery has always adhered to one principle: the arteries and veins are temporarily preserved, and all other connecting parts are gradually disconnected. The tumor is not decomposed. The tumor and these eight organs are treated as a whole, as a "big organ" as a whole.
Remove.
Do these people have no knowledge of this surgery and are looking at a peep show?
"They are just the same team? Is there a relay team?" Director Shi Guosheng asked Director Fang.
Usually this kind of super major surgery takes a long time and requires several teams to take over each other and engage in relay races or wheel battles.
Director Fang was suddenly asked and his brain was short-circuited: "Relay? What kind of force should be relayed? Professor Yang still needs to relay when performing surgery?"
Director Shi was speechless by the tone of his junior brother's words. This was obviously true, but it could easily be regarded as a "rebuke". If it weren't for the close senior brothers, Director Shi would have criticized him again. How could he have spoken like this?
Yes, but the other director, Director Shi, is used to it. He knew from when he was a student that this guy is like this. He talks straightforwardly. He was a second-rate guy when he was a student, and he still hasn't changed at all.
Speaking of the relay, Director Fang suddenly felt something was wrong in his mind, but he didn't know what was wrong for a moment. He looked at the operating table, then at the audience, then at other people, and finally at himself.
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Why did you think the scene was so weird just now? What's wrong?
"What’s wrong with you?"
Director Shi felt something was wrong in his junior brother's eyes and asked.
Director Fang didn't answer. He rolled his eyes back and forth. What's wrong?
Holy shit!
Am I not Ichisuke? Why am I in the audience? Why are they all on the stage?
Didn't I agree that I would be Ichisuke?
Why am I in the audience, why am I in the audience---
Song Zimo, Xu Zhiliang, you two are not authentic, why are you standing on the stage, that is my position, and I was promised to be Isuke, why didn't anyone remind me today.
As a result of this, I accompanied my senior brother to the point where I forgot that I was a first aid. Now that the operation has begun, what should I do?
Swallowing the front tooth that he lost by himself? No way.
Director Fang immediately walked to the operating table, first pretending to stick his head in to observe the operation, and then suddenly said: "Dr. Song, it's a bit hard, how about I come and help you?"
When Song Zimo heard Director Fang's voice, he didn't understand what he meant for a moment, so he said: "It's okay, it's just a joke, it's okay."
Director Fang circled around the operating table, feeling anxious. How could he let go of such a good opportunity? Not to mention that he could learn a lot of things. It was just an operation. Even though he was only an assistant, he would brag about it later.
, you can also start with "we", this surgery can last a lifetime.
But now Song Zimo is a supporter and does a good job on stage. If I forcefully pull him down, I will look very unqualified as a person.
At that time, it was not that others were rushing to perform the surgery, but that I foolishly did not brush my hands and stayed with my senior brother in the audience. It is possible that the young man misunderstood that he wanted to accompany the guests, so he gave up the opportunity to go on stage. He was so confused that he was actually in the audience.
, just discovered it.
If the operation hasn't started yet, Lao Fang will definitely go straight. Can you please do me a favor? I will help. But now that people are on the stage, due to human emotions and reasons, we should not pull them off the stage, nor can we always disturb them. In this way
I still have some awareness of the impact on surgical safety.
What to do?
Director Fang was like an ant on a hot pot, anxious.
"Professor! Is the situation worse than imagined?"
Song Zimo saw that the anatomy inside was a mess, and all the anatomy in the textbook was invalid here.
"Calm down!"
Yang Ping reminded that the work at hand has not stopped.
Song Zimo raised his head and glanced at the professor. His confident look was that of a god. No wonder August said the professor was "a man from the earth."
"I'm calm."
Song Zimo cheered up and followed the professor's rhythm. However, this was not anatomy, it was clearly a mess of dough. This was hell at the beginning, and there were many steps that were far more difficult than this.
"Dr. Song, do you want to take a rest? It's okay. You come down and rest. I will help you for a while."
Director Fang finally seized the opportunity.
"It's okay. What's going on here? The operation has just started and I'm very energetic." Song Zimo replied.
Director Fang sighed inwardly and walked around a few more times. After just a short delay, the liver has been almost separated. Except for a few arteries and veins, the liver is almost free. Now it is separating the inferior vena cava. This is the separation step.
The most difficult one can cause massive bleeding if you are not careful.
"I'm sorry, brothers, you said that today's incident caused me to forget that I was Issuke in a hurry, and I asked you to help replace me. I'm really sorry."
This guy from Lao Fang is really straightforward and candid.
But at this time, no one heard it, especially Song Zimo, because everyone was focused on the operation. They didn't pretend not to hear it, they really didn't hear it.
What a tragedy, everyone didn’t hear what I said, so I can’t keep repeating this sentence, which is obviously disturbing other people’s surgeries.
Lao Fang has no choice but to stay by the operating table and watch, waiting for opportunities.
Cut the peritoneum and loose tissue in front of the common hepatic artery, separate the common hepatic artery, proper hepatic artery, and gastroduodenal artery above the head of the pancreas, and separate the gastroduodenal artery as well, and use silk thread to pull it distally.
Continue the separation until a satisfactory length is achieved, and then separate upward along the common hepatic artery until it joins the celiac artery. Along this direction, begin to separate the inferior vena cava.
This chapter is not finished yet, please click on the next page to continue reading the exciting content! The lymph nodes at the upper edge of the pancreatic head have been invaded by metastases, and they have been separated as part of the "big whole", waiting for the final uprooting.
The lymphatic tissue and connective tissue on the right side of the gallbladder were cut in normal locations.
Yang Ping's hands sometimes cooperated and sometimes operated independently. One hand was separating a blood vessel, and the instrument in the other hand was actually separating another part. The two hands were separated and operated independently.
What kind of irritating operation is this? If you don’t look carefully, you won’t know. If you look carefully, you will be shocked. You would think that two people’s hands are operating separately. One person can operate it completely independently with two hands.
This is really a magical operation, it is equivalent to two independent people doing the surgery, and the speed is doubled all of a sudden.
You have to be reasonable in doing things. This is completely unreasonable. How can a person operate his two hands independently and do their own work? But this is obviously the case now.
Now Director Shi Guosheng finally understood that there were two first assistants on the stage, and he said why the work of these two people, first assistant and second assistant, was so unclear.
There are two assistants, one to coordinate with his left hand and one with his right hand.
There are also these retractors, which are really good at pulling. They are exposed all the way down along the steps of the operation, so that the two hands during the operation do not have to worry about other things and can only do the work of the surgeon.
Let me go, I can still do this surgery, am I still a human being?
Director Shi Guosheng really couldn't figure it out. He really couldn't figure it out. He was considered a master in oncology surgery, but now he felt like he had never seen anything before and would be shocked by everything.
"Fighting left and right?"
There is a general surgeon who is a fan of Yang Ping. When he saw the current operation, he immediately called out the name of the technique.
It's a sword flow, it's a fight between left and right, it's a serious operation, but it looks like a martial arts novel.