Chapter 846 How to use the knife in the nook and cranny
A few days later, Nie Shun'e was transferred from the ICU back to the general ward.
Her condition after the operation is very stable. She can already eat liquid diets such as rice soup. The original yellow color on her face has slowly faded away. The abdominal distension and pain are no longer there. The remaining pain in the surgical incision is treated with standard analgesia.
After the treatment, I basically didn’t feel much pain.
Theoretically, tumor recurrence is certain, but since the tumor is so cleanly removed, there shouldn't be any major problems in the short term.
For Nie Shun'e, she no longer cares about whether she relapses. She just needs to live day by day and live well every day.
The "charitable organization" sent someone to buy flower baskets and nutritional supplements to see Nie Shun'e. The representative sent said that they could help Nie Shun'e apply for a charitable aid fund, and the amount was relatively large, up to 100,000.
This matter was rejected by Nie Shun'e. She is now living a decent life and can support herself without needing help from others.
She has a soft mouth when eating people and short hands when taking others. Even if she receives charity funding, Nie Shun'e always feels that she owes others. She is used to solving her own problems by herself.
Yang Ping came to Xiehe, the imperial capital, where he was stationed. In his absence, the 45-bed department was managed by Song Yun, who was the de facto acting director.
The work I come to Xie Xie is nothing more than making rounds, giving lectures, and teaching surgeries.
You didn't know it by looking at it, but you were shocked when you saw it. After the ward rounds, Yang Ping counted the number of patients waiting for surgery. These guys admitted more than thirty new patients and were waiting for surgery.
I have only been here for a few days and have done so many surgeries. These guys are also crazy and work very hard. Song Yun chuckled: "Professor, I'm sorry!"
"How many channels are there?"
Yang Ping asked, knowing that these guys wanted to use their time in these few days to do more surgeries.
"There are two specialized stations, one for Kong Weiquan and I, and you, the professor, have to take turns giving guidance. There are also several surgeries that you have to do personally, and we can't handle them at all." Song Yun said with a smile.
With so many patients, the ward rounds and pre-operative discussions would take a whole day, and some lectures would be interspersed with the pre-operative discussions. Today, it would last until evening.
After the ward check, everyone gathered around the electronic reader to discuss the case.
Other cases were okay. There was a patient with a cervical spine tumor. The tumor almost crossed the spinal cord and he had to undergo two surgeries. It was very troublesome. Yang Ping asked to see this most special case first.
The electronic reader is turned on, and the doctor in charge of the bed calls up the case images.
"Professor, I admitted this patient from the outpatient clinic. He has undergone two operations. The first operation did not remove the tumor, but only fixed the cervical spine. The second operation the doctor planned to remove the tumor, but on the operating table
After opening it, it was found that it was impossible to remove it. I didn't know how to operate the knife, so the surgeon gave up the operation and just took some tumor tissue for pathological examination. Now the patient's main problem is pain. The pain in both upper limbs is severe and unbearable.
My strength has also decreased, with grade four on the left limb and grade three on the right limb. I have to rely on family members and crutches to support me when I stand. Currently, oral painkillers and methylcobalamin are completely useless."
Song Yun briefly introduced the ins and outs of this case.
My hands are numb on both sides, my left foot can't touch the ground, it feels like stepping on cotton, and the pain is excruciating.
"The tumor invades neck 4, 5, and 6, both inside and outside the marrow." Yang Ping said while looking at the images.
"Pathology was taken during both operations, and the postoperative pathological diagnosis was hemangioblastoma."
While everyone was discussing the case, Director Zuo from the Vascular Surgery Department and Director Wen from the Cardiac Surgery Department came over with two students carrying a basket of fruits. They heard that Yang Ping had arrived, so they took the time to come over and take a look.
Director Zuo knew Yang Ping. At that time, Yang Ping was performing a spinal tumor surgery at Union Medical College, demonstrating the leak-free en bloc resection of spinal tumors. Because the tumor aorta was adherent, the aortic vessel wall became thin after the tumor was separated, and an interventional implant was required during the operation.
The interventional surgery at that time was performed by Director Zuo, so the two of them knew each other once.
The medical circle is sometimes very small. The 13 CNS papers and Yang Ping's group cardiac bypass surgery in 301 were all spread in the cardiovascular surgery department in the imperial capital.
Director Wen has a special case in his hands. A little boy who is just over one month old was diagnosed with Kawasaki disease coronary artery disease and needs coronary artery bypass grafting. Coronary artery bypass grafting is inherently a high-precision surgery. There are very few hospitals in the country that can carry out it. Children
Coronary artery bypass grafting has been carried out even less nationwide, especially for such small cases, as there is currently no precedent.
I heard that Yang Ping also did research in cardiac surgery, so Director Wen came over to talk to Yang Ping, but Director Wen didn't know Yang Ping, but Director Zuo did.
Cardiac surgery and great vascular surgery are originally one company, collectively called cardiovascular surgery. However, large hospitals like Union Medical College separate them in order to strive for excellence.
"Come here, don't bring anything else." Song Yun asked someone to take the fruit over and asked the two directors to take a seat.
"This is Director Wen of our cardiac surgery department, and this is our Professor Yang."
Director Zuo made connections and helped them make introductions.
"You are so young, it seems we are really old." Director Wen said humorously when he saw Yang Ping.
"Thank you two directors. If you have two directors here, please give me any advice." Yang Ping didn't beat around the bush. There must be a reason why people came here with fruits.
"I won't disturb you, will I?"
Director Zuo saw the images on the electronic reader and knew that they had just been discussing the case, so he was a little embarrassed for the sudden interruption.
"It's okay, we are discussing cases, we can discuss them anytime," Yang Ping said.
Song Yun and Kong Weiquan had already brought two glasses of water to the two directors. Other doctors were surrounding them, wanting to hear what the two directors were doing.
Director Wen also wasted time: "Well, I saw a child with Kawasaki disease in the outpatient clinic. He was only one month old. The opening of the left anterior descending coronary artery was completely occluded due to vasculitis. He currently relies on the collateral branches of the other two coronary arteries.
Blood vessel supply, in this case, myocardial infarction may occur at any time, so coronary artery bypass grafting is needed to save life. Considering that the child is relatively young and the height and weight are too small, the operation must be performed with a non-stop beating heart bypass, which lasts for one month
The coronary arteries of children are very thin, and it is very difficult to do it on a heart that is constantly beating. There has never been a precedent for this. The people in Shanghai who have done more surgeries in this area are in Shanghai. The youngest person they have done is 14 years old.
Months old, we heard that you are very good at anastomosis of small blood vessels, so we came over to see if there is anything we can do.''
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The diameter of the coronary arteries of a one-month-old infant is about 1 millimeter, and may be even thinner. It will be more troublesome in premature infants.
However, the operation of anastomosis of blood vessels requires only a suitable microscope and needle and thread. There are no blood vessels that Yang Ping cannot handle. This is a unique trick for his debut.
''should be no problem."
Yang Ping felt that it was not difficult as it was his old profession.
Director Wen was very happy to receive Yang Ping's reply, which meant that this operation could be performed. He had been worried that it would be too difficult to anastomose such a thin coronary artery.
"This child needs to keep jumping down for surgery." Director Wen reminded Yang Ping.
Because in Yang Ping's surgery such as replantation of severed fingers, the anastomotic blood vessels are fixed, which is different from the anastomosis on a beating heart.
It is more difficult to anastomose small blood vessels on a beating heart. Yang Ping must explain it clearly to avoid any misunderstanding.
"It's not a big problem. When will it be done? If you need help, just let me know." Yang Ping said simply.
"Well, the family members are waiting anxiously. The earlier the surgery, the better, otherwise there is a possibility of myocardial infarction at any time. Originally, we planned to ask our colleagues from Shanghai to do the surgery together, but they did not have experience in such a small case.
We are not sure enough. If Professor Yang can help provide technical support during the anastomosis of blood vessels, we will be much more sure of the success of the operation. Thank you Professor Yang."
Coronary artery bypass grafting was originally a surgical method to treat adults. In recent years, it has been used to treat children with Kawasaki disease and severe coronary artery disease. However, there are not many such surgeries performed in China. The most mature one is the Magic Children's Medical Center, which took the lead in domestic
Establish a pediatric cardiomyopathy and heart failure diagnosis and treatment center. This center has a dedicated Kawasaki disease diagnosis and treatment team composed of cardiology, cardiac surgery, anesthesiology, and radiology. So far, more than 10 cases of coronary artery bypass grafting have been successfully performed in children.
Several cases of interventional treatment have also been carried out.
"We will arrange the surgery as soon as possible in the next few days. Please don't disturb Professor Yang then."
Director Wen and Director Zuo were very polite and did not say anything unnecessary. They were busy discussing the case.
Yang Ping continued to discuss the case with everyone. Should this patient with a spinal tumor undergo surgery or not? The risk of surgery is very high. No hospital will accept him now. If he does not have surgery, he can still move his limbs, but after the surgery, he is likely to be in a high position.
He is paraplegic and cannot move his limbs at all. If complications such as lung infection occur, he may not live long.
"If the tumor is removed, the spinal cord will also be transected, right?"
Kong Weiquan said worriedly.
This kind of case is thankless. Very few doctors are willing to poke this hornet's nest. It is almost certain that the probability of high paraplegia after surgery is very high. If surgery will make the condition worse, why do we need surgery? Therefore, surgery is completely meaningless and not worth it.
Risky, in other words--no cure!
"Yes, you see, the neck 4 section has already crossed the spinal cord. If the tumor is removed, it will easily cause high paraplegia, and hemangioblastoma is easy to relapse. If it is removed this time, it will easily relapse soon after the operation, but we are doctors
I can only say that we should try our best. It is impossible to completely cure him, but we should see if we can find a way to reduce his pain through surgery, at least relieve the pain and improve the patient's quality of life."
Yang Ping was thinking about how to perform surgery on this patient.
Song Yun said with embarrassment: "I am the one who caused you trouble. When I was in the outpatient clinic, I saw that the patient was in a lot of pain. Other hospitals did not accept him, so he wanted to admit him. Even if he did not perform the operation, I would help him.
Treat symptoms and relieve some pain.”
Yang Ping comforted Song Yun: "How can you say it's causing trouble? Aren't we all facing trouble? If Xiehe doesn't accept it, where will this patient go? Is there no place to go? Let me think about it."
"Some doctors recommend radiotherapy?" Song Yun added information.
Yang Ping shook his head and immediately denied: "Don't do radiotherapy. Once radiotherapy is given, the local spinal cord exposed to radiotherapy will be edematous. This edema will aggravate the condition, cause more severe neurological symptoms, and cause the severe high paraplegia just mentioned. If the edema can spontaneously
It's okay to subside, and the spinal cord function can slowly return to before radiotherapy. If the edema cannot subside on its own, it will cause permanent high paraplegia, so radiotherapy of the spinal cord must be done with caution."
"I was wondering if the tumor around the nerve root could be cut away, which would alleviate the patient's pain. His pain was caused by the tumor irritating the nerve root."
"The purpose of surgery is not necessarily a radical cure, but can be to relieve symptoms, prolong life, improve quality of life, etc."
Song Yun understood what Yang Ping meant: "Let's do a more detailed and precise positioning of the source of the pain?"
"Yes, this is of great significance for surgery."
"But---look, these nerve roots are all invaded by tumors. How do you remove the tumors? There are no corners."
"So what? We are Xiehe, and we are the last place for patients. No matter whether you can do it or not, you have to do it. There is no way out." Song Yun said firmly.
"Do I need to remove the internal fixation from the original surgery?"
"Don't dismantle it, keep it! Once dismantled, the cervical spine will be unstable, and we have to re-fix it. Don't do repeated work. Look at the cervical cone 4, there are already signs of pathological compression fractures."
"If the internal fixation is not removed, it will block the surgical operation. The exit of the nerve root is a dead end, and there is still internal fixation, so the surgery cannot be performed." Kong Weiquan has always been worried about this, and he gets a headache when he sees the tumors in these locations.
While everyone was discussing the case, a gust of fragrance blew in, and a beautiful figure appeared at the door of the doctor's office. It was Qiu Ruo, a flower in the operating room. She was dressed particularly beautifully today, and she had obviously been carefully groomed.
"The beauty from our operating room is treating us to dinner today." Song Yun said to Yang Ping.
Yang Ping was thinking about the method of surgery and didn't pay much attention to Qiu Ruo at the door. He just said "Oh."
"Then let's eat first. We'll discuss it after dinner. This patient will definitely need surgery. If not, the pain caused by the nerve root will be very uncomfortable. He will probably roll on the bed in pain."
Qiu Ruo, the nurse in the operating room, would wait for Yang Ping to come to Xiehe every month. She really fell in love with Yang Ping. From the first time they met, she couldn't help but love him.
She told her best friend Xiao Su about this matter. Before Xiao Su could speak, she told Xiao Su that no matter what, she would bravely pursue Yang Ping. Yang Ping was her prince charming and she was satisfied.
All her fantasies about her boyfriend, if Xiao Su dares to stop him, she will use Xiao Su’s trick,
Xiao Su could only say: You will die in society.
Qiu Ruo said: Just wait and see, I will definitely be able to capture him.