If we want to divide this operation into steps, then it is divided into four major parts, eight organs and the total resection of the tumor---resection of the tumor outside the body---reconstruction of blood vessels and some structures---artificial blood vessel transplantation of the inferior vena cava.
, autologous transplantation of six organs.
The patient's vital signs had been stable, and Yang Ping began to speed up the operation and try to shorten the operation time.
The "golden team" was in place. Xu Zhiliang took Zhang Lin to remove the great saphenous vein from the limb, and Yang Ping took Song Zimo and Xiao Wu to start reconstructing various blood vessels and some structures.
Fatty Liang crossed his legs and checked the data of the monitoring equipment from time to time, then recorded it and analyzed it in his mind.
Director Shi stood next to the sterile table and observed the operation. Director Fang switched back and forth between the LCD screen and the sterile table. Other doctors gathered in front of the LCD screen. This LCD screen hanging on the wall was far away from the operating table and interfered with the operating staff.
smallest,
Xu Zhiliang cut two long sections of the great saphenous vein as material for blood vessel transplantation. Following Yang Ping's requirements, he cut the blood vessels into various lengths, soaked them in physiological saline, took them out, and spread them neatly on the wet saline
Keep it on gauze for later use. The isolated human tissue needs to be moisturized, otherwise it will easily dry out and become necrotic.
Director Shi was very puzzled by Xu Zhiliang's operation. Professor Yang did not calculate the number of blood vessels needed, nor did he measure the length of the blood vessels. Why did he trim all the blood vessels to various lengths in advance?
What if it doesn't fit properly? Once it doesn't fit, all these blood vessels will be wasted.
Director Shi himself also performs ex vivo resection and autologous transplantation of pancreatic tumors. Although the number of cases he has accumulated is not very large, he ranks among the top in the country, so he has rich experience.
Not only him, but other experts will determine whether a blood vessel transplant is needed after the tumor is removed during the operation. If a transplant is needed, they will then calculate the number, caliber and length of the transplanted blood vessels. They will make an approximate estimate of these data and report it to the assistant, who will then follow these data.
To deal with blood vessels, there is no such thing. This assistant directly cuts the blood vessels into dozens of sections.
Could it be that Professor Yang had considered these factors and made precise calculations before the operation? How could this be possible?
With this question in mind, Director Shi couldn't help but ask Yang Ping: "Professor Yang, have you completed the measurement of the number and length of blood vessels through images before surgery?"
Yang Ping said while performing the operation: "It's like building a house. There must be design drawings before the operation. What materials to use and the specifications of the materials must be planned before the operation. And how much excess material is prepared must be left in
Within the calculation, I still refer to the engineering concept. Our surgery, especially this kind of super large surgery, must have the concept of engineering, so that the operation can be done well, otherwise it is easy to focus on one thing and lose the other, and it will be a mess."
Director Shi learned something new today about the application of engineering concepts in surgery. He thought about what Yang Ping said and it was indeed very meaningful. In the future, he will also apply engineering concepts to surgery, which will make the surgery more rigorous and precise.
accurate.
Director Shi remembers this knowledge point. This is the core technology. Without the guidance of this engineering concept, this complex operation can easily fail.
The left kidney has been removed and does not require transplantation; the cholecystectomy does not require transplantation; the inferior vena cava is transplanted using artificial blood vessels; Yang Ping has transplanted the remaining five organs and now needs to put them back into the body
, let them return to their respective places.
First, complete the artificial blood vessel transplantation of the inferior vena cava so that the subsequent surgery can be performed.
The artificial blood vessel transplantation of the inferior vena cava was completed, and the five organs were returned to their original positions.
After returning to position, their suspensory ligaments and mesentery should be anastomized first, so that the organs can be fixed in the body and avoid wandering around. Once torsion or herniation occurs, it will be very dangerous.
After the organs were fixed to a certain extent, Yang Ping began to anastomose their arteries and veins, as well as some necessary nerves that could be anastomosed.
First, a vascular anastomosis is performed on the pancreas to reconstruct the pancreatic duct, and then the blood vessels of the liver, including the hepatic artery and vein and portal vein, are anastomosed to reconstruct the bile duct.
These two steps of functional pipeline reconstruction are very important. Once the quality of reconstruction is not high, it can easily cause bile leakage and pancreatic leakage, cause chemical peritonitis, infection, etc., leading to serious complications.
Because the small intestine has been resected, the pancreatic duct needs to be connected to the jejunum. Yang Ping uses Blumgart anastomosis, which is a modified pancreatojejunal mucosal anastomosis. That is, this anastomosis requires the operator to have a high level of anastomosis of small ducts. For those who are good at anastomosis of small ducts,
For Yang Ping, who has blood vessels, this is nothing.
The reconstruction of the biliary tract of the liver is also very difficult. This patient's biliary reconstruction was close to the porta hepatis, which required the shaping of multiple bile duct openings and then a biliary-enteric Roux-en-Y anastomosis.
Among the autologous transplantations of these organs, autologous transplantation of pancreas and liver is the most difficult because it requires complex reconstruction of blood vessels and functional conduits.
Director Shi watched it with gusto, because any step of this is a top-notch operation in hepatobiliary surgery and pancreatic surgery. Now it is combined in one operation, and such complicated reconstruction is usually not seen at all.
"Professor Yang's level of general surgery is generally high, isn't he?" Director Shi said to himself, the difference is not just a little bit.
In particular, the engineering concept of this kind of major surgery is already far ahead of him in terms of concept. He is still at the level of making a rough and vague plan before the operation and doing it step by step during the operation. He has no such detailed engineering concept at all.
A major surgery includes many minor surgeries. Of course, any one of these so-called minor surgeries is considered a major surgery.
These surgeries are not only independent and form a module, but they also need to coordinate with other surgeries so that each module forms an organic whole.
For this kind of complex surgery, doctors must have basic knowledge of engineering, treat the entire surgery as a large project, and treat each step as a component module. The Fontan surgery, a masterpiece in the history of human surgery, embodies this kind of operation.
Engineering thinking, in order to achieve the goal, needs to closely consider many factors, rather than thinking about problems empirically in a scattered and disorderly manner.
This chapter is not over yet, please click on the next page to continue reading! "What else? I'll tell you that Professor Yang does all the magic surgeries, but you won't believe it."
Director Fang said proudly, after all, this kind of god is his brother in the hospital, and he has to follow him no matter what.
Director Shi said unhappily: "How can I not believe it?"
The liver and pancreas have already completed autologous transplantation. Now we need to perform autologous transplantation on the spleen. The spleen only needs to reconstruct the arterial and venous blood vessels, and does not need to reconstruct functional ducts, so it is much easier than the liver and pancreas.
But the spleen is a bit strange. Its implantation can be limited to any position within the cavity or within solid organs, such as the liver, pelvic cavity, chest cavity, pericardium, subcutaneous tissue, etc.
That is to say, if a bit of spleen tissue is accidentally scattered to these parts due to trauma or surgery, it can survive like seeds.
Therefore, in order to prevent this kind of accidental spleen implantation, Yang Ping was very careful, just like treating tumors, and protected the surgical periphery very tightly to prevent the tiny spleen tissue from falling off and causing accidental implantation.
Director Shi was sweating profusely. He held a tissue in his hand and pressed it on his forehead several times from time to time.
Director Fang is thinking about whether he should try an autologous liver transplant next time. It would be good if autologous liver transplantation can be done well. After all, it is also a difficult operation. There are not many hospitals in the country that can carry out autologous liver transplantation.
, eat the food one bite at a time, and perform the operations one by one.
And if he performed an ischemia-free autologous liver transplant, it would be the second in the world.
In a surgical institute, being ranked number one in the world is worthless, but to the director, being ranked number 10 in the world, let alone number two, is a dream.
Thinking of this, Director Fang's mind was aroused. At the Institute of Surgery, the world's first case was performed every three days. Wasn't the myocardial minimally invasive rotational cutting technology not long ago also the world's first?
A bold idea came to Director Fang's mind. From now on, he would follow the lead of the Institute of Surgery and focus exclusively on his general surgery. As long as they did the first case, he would do the second one. For such a super-large operation, he would do it himself.
If you can't lift it at all, it doesn't matter. Just do the reduction surgery as small as possible.
For example, Professor Yang performed ex vivo excision and autologous transplantation of eight organs, and he performed ex vivo excision and autologous transplantation of one organ.
In this way, he will be second in the world every time, second in the world!
Director Fang was excited just thinking about it and felt happy for his own enlightenment. From now on, he would stick to this concept and complete the "academic class leap" in his life.
"Copy the surgery video back later!"
Director Fang told his graduate students in a dignified tone that in the future, all the general surgery videos from the Institute of Surgery should be copied back and studied slowly, and then he would ask Professor Yang to "lead" him to perform the surgery. If he is pulled a few times, he will become familiar with it naturally.
Familiar road.
Thinking of this, Director Fang couldn't help but recall the pleasure of being led for the surgery just now. It was really great. When can I be led again?
At this time, Director Shi was also planning to become the second best person in the world. As a senior brother, he thought of going together. Director Shi saw an opportunity: "Professor Yang, if you have time, go to our cancer hospital to guide the surgery. Over there."
There are many patients."
Director Shi and Director Fang's students also said, "Make a copy of it for me."
"Can I copy a copy of the surgery video and take it back?" After all, Director Shi is from another hospital. If you copy someone else's stuff, you still need to seek the owner's opinion.
Yang Ping has no objection to these. As long as you are willing to learn, you can copy it as you like. The more people copy it, the better.
"Attention! Look at the prompts next to the host computer and do not use your own USB flash drive. The drawer next to it is full of new USB flash drives. They are free. You can take them as you like. You must not use your own USB flash drive to copy them. Once discovered, you will not be allowed to enter the operating room."
Zhang Lin reminds people who want to copy surgery videos.
If these messy USB flash drives contain viruses and damage the computer host in the operating room, it will be a big problem.
Autologous liver transplantation is known as the ceiling of hepatobiliary surgery, but now autologous transplantation of five organs is required, so for a five-story house, the original ceiling was only the ceiling on the first and second floors.
Abdominal multi-organ transplantation began with abdominal multi-organ cluster transplantation, which was first pioneered in 1960 by Professor Starzl, known as the father of modern organ transplantation.
Abdominal multi-organ cluster transplantation refers to the transplantation of three or more anatomically and functionally related organs in the abdominal cavity or extraperitoneum as an en-bloc and in a string of organ clusters.
The basic principle of surgery is that the transplanted multiple organs in the abdominal cavity as a whole need to have a common arterial blood supply and venous outflow.
But Yang Ping's surgery today is obviously larger than an abdominal multi-organ cluster transplant surgery, because the organs involved do not share the same blood supply arteries and veins, nor are they fully functionally related.
The operation continued, steadily and meticulously, the entire sequence was carefully arranged, and engineering ideas penetrated into every detail of this large-scale operation.
Finally, even the remaining part of the stomach was transplanted. The entire operation was completed in one go, just like an old dilapidated house being completely demolished. The dismantled materials were sorted, throwing away the unusable ones and keeping the usable ones.
Then use the remaining materials to rebuild and build a strong new house.
Now that the new house has been completed, everyone is extremely excited.
Whether they were participating in the surgery on the stage or observing the surgery off the stage, everyone was excited.
All blood vessels are open, and there is no blood leakage at the anastomosis points. The transplanted organ is red in color, indicating that the blood vessels are unobstructed and the operation is complete.
The circulating nurse drew blood to test blood routine, biochemistry, liver and kidney function, and there were no obvious changes, indicating that the functions of each organ were functioning well.
Director Fang said on a whim: "Let's all take a photo later to commemorate this historical moment. I'll treat you to dinner tonight. You can choose any place, and everyone who meets you will be invited to participate."
"Oh, by the way, Professor Yang, I have a patient with liver cancer over there. The tumor has invaded the bile duct, hepatic artery, vein and portal vein, and is also growing entangled. It seems that ex vivo resection and autologous liver transplantation are necessary. Please help me.
I'll do it---oh, help guide me in doing it."
Director Fang was a little excited. Whatever he was thinking, he said it out loud at once.
That's what I mean, but I can't say it in front of so many doctors and make it so ugly that I'm being asked to do the surgery.
"I have a patient with pancreatic cancer over there who has invaded several organs. He must undergo ex vivo excision and autologous transplantation. Please give me Professor Yang's guidance."
Director Shi did not miss such a good opportunity. Although he was already well-known throughout the country, there was still a lot of room for improvement.
After seeing Professor Yang's surgery today, Director Shi and Director Fang have completely opened their minds. The surgery that they thought was very difficult now seems to be nothing.
And once you master Professor Yang's ex vivo resection surgery, many abdominal tumor surgeries that would otherwise have been impossible can be safely performed.
PS: Regarding the details of the operation, I don’t know if it is appropriate to write it like this. I feel that writing it is too deep and detailed, but it will easily lead to boredom because I cannot understand it. Regarding the details of the operation, I think it can be restored in a simple and general way. Everyone can read it.
I understand it and find it interesting. I don’t know what everyone’s opinions are. Thank you all!
