The little girl Sissi now has hemiplegia on the left side of her limbs, indicating that there is blood vessel blockage. Blood vessel blockage means that the brain tissue controlled by the blood vessel will infarct after a certain period of time.
Emergency surgery can restore the blood supply before brain tissue infarction and reverse the condition. The left hemiplegia will return to normal, thus avoiding lifelong disability.
Once brain tissue infarction occurs, the condition is irreversible and will leave him with lifelong hemiplegia of the left limb.
The core of surgery for moyamoya disease is still the treatment of blood vessels, which is just the treatment of intracranial blood vessels. The most critical one is the anastomosis of blood vessels.
Coronary artery bypass grafting of the heart is also a vascular anastomosis, and organ-tube transplantation is also a vascular anastomosis. It can be seen how important vascular anastomosis is as a basic skill, and it can be seen in many cutting-edge surgeries.
Yang Ping took the trouble to ask the doctors in the department to repeatedly train the basic skills to the point of mastering them.
Even though Song Zimo and Xu Zhiliang were so powerful, he still required them to practice basic skills regularly to achieve never-ending progress.
In fact, any complex surgery is a combination of basic surgical skills.
For example, in the operation of moyamoya disease, after the pathogenesis of the disease is understood, the treatment is a combination of basic techniques.
This little girl has symptoms of ischemia. Ischemia is caused by blood vessel blockage. To solve the blockage problem, one must either clear the blood vessels or re-establish new blood vessels to bypass the original blockage and connect the blood. The former is due to the congenital vascular disease of moyamoya disease.
The reason is impossible, the latter is the only option.
Both dressing surgery and vascular bypass surgery are used to rebuild new blood supply, but the methods and processes are different.
Zhang Lin and Xiao Wu had already gone to the emergency department for consultation, while Yang Ping was in the office in front of the computer contemplating the little girl's surgery.
As long as it is not a very special case, Zhang Lin Xiaowu can handle these matters independently.
Surgical methods for moyamoya disease are divided into three categories: vascular bridging, which is direct revascularization. This method is difficult to operate and requires excellent vascular anastomosis technology. It can achieve immediate results, but the scope of bridging a blood vessel is limited.
The second method is taping. This method is to stick extracranial tissues with rich blood supply to the brain. After the operation, the blood vessels of these tissues will slowly grow into the brain, allowing the surface of the brain to establish a rich connection with the brain tissue that needs blood supply.
With the collateral circulation, after 3 to 6 months, the blood vessels of the adhered tissue will spontaneously connect with the cerebral cortex blood vessels. This method is simple, but the operation is slow to take effect, and it takes 3 to 6 months to show the effect.
The third method is to combine the first two methods and perform both surgeries. This way, you can learn from each other's strengths, avoid the shortcomings of the two surgeries, and combine the advantages of the two surgeries.
This two-year-old child has relatively thin blood vessels, so most doctors would choose the second method. However, this little girl has now developed symptoms, and is obviously not suitable for a method that takes 3 months or half a year to show results.
Yang Ping decided to use the third method, which was to do blood vessel bypass and patching together.
It is very difficult, but the effect is the best. Here in Yangping, there is no difficulty level in surgery, only good or bad results.
For this patient, the bridge is not just one bridge. Yang Ping plans to build many bridges.
Emergency Department.
The emergency doctor has already done a preoperative examination for Sissi and is ready to send her to the operating room for emergency surgery after signing the signature.
Sissi's father, Wang Chengpei, was very anxious at the time, and it took him a while to calm down.
Because at home not long ago, Sissi did not fall or suffer any trauma. She was watching a cartoon. She was watching a cartoon and suddenly she could not move her left limb. The child burst into tears without knowing what was going on.
Grandma hurried over to comfort her and found that Sissi couldn't move one limb at all. At first she thought she had fallen and broken her body, but she clearly didn't fall. The whole family was watching Sissi watching TV, but something suddenly didn't feel right and they started crying.
If they are elderly, they will definitely think of a stroke, but if a child has a stroke, they will definitely think of injury first.
The family did not dare to delay because her mother had not finished get off work yet after working overtime. Her father, Wang Chengpei, and her grandparents immediately came to the hospital with Sissi in their arms.
Fortunately, my home is close to the hospital, so I got there quickly.
The emergency department doctor was very experienced. After asking a few questions, he felt that it was a cerebrovascular problem after a brief examination. But just to be sure, he called Professor Chen Jianliang from the Institute of Surgery.
After the physical examination, Professor Chen said: "This must be a cerebrovascular problem, either cerebral hemorrhage or cerebral infarction. Should we do an emergency cerebral angiography?"
"Isn't this a fracture or dislocation? How could a two-year-old child have cerebral hemorrhage and cerebral infarction? Please ask an orthopedic surgeon to help you take a look." Grandma Sissi doesn't agree to do cerebral angiography. It sounds like this thing is quite complicated, especially after hearing that
Grandma Sissi disagreed even more with the idea of putting a shadow agent into the body.
Professor Chen said confidently: "This is a cerebrovascular problem. It is most likely a cerebral infarction. Don't waste time. Just do a cerebral angiogram. Once the diagnosis is confirmed, treatment is a matter of time. If you delay, you will be semi-paralyzed for the rest of your life."
When Sissi's father Wang Chengpei heard this, he couldn't leave this matter to the old man's whim. The doctor was a professional, so he immediately made up his mind: "Doctor, I am the father of the child. We listen to you. I will sign when it's time to sign. I'll do what you want as soon as possible."
Make arrangements and race against time."
Grandma also wanted to stop her: "No, the child can't stand the torture. Let's wait until Li Ni comes over."
Li Ni is Xixi's mother, and she is on her way back.
"No, this matter cannot be delayed. Doctor, make arrangements quickly. Listen to me. I am the child's father and the child's legal guardian. Don't listen to the old man. The old man doesn't understand anything." Wang Chengpei said firmly.
Normally, Wang Chengpei would be obedient in front of his father-in-law and mother-in-law, as if he didn't have his own ideas about anything and would always listen to the old man's advice, but how could he be vague about such a big matter?
What kind of attitude is this? How do you say this?
What is your responsibility? Are you the legal guardian of the child?
The mother-in-law was immediately angry and wanted to go crazy. She planned to make the decision, but the father-in-law held her back and said, "Listen to the father of the child. What do you know? Don't mess around."
"Am I fooling around?" The mother-in-law felt that her father-in-law did not stand with her at this time and was ready to scold her.
The father-in-law forcefully pulled his mother-in-law out of the emergency department, as if determined to pull her away from the scene. Amidst the noise, the father-in-law finally pulled his mother-in-law out of the emergency department.
Wang Chengpei didn't have time to care about whether they were quarreling. He had to keep his head clear. A wrong decision now would affect the child's life.
Because the couple had some fertility deficiencies, it took several in vitro fertilizations for this girl, and the couple was already 45 years old, that is, they had a daughter at 43 years old.
Now that their daughter suddenly developed symptoms of hemiplegia, how could they not be anxious?
"Doctor, please help me, please, to save Sissy. I will listen to you and make arrangements as soon as possible." Wang Chengpei was very worried.
Her wife, Li Ni, is the head teacher of the senior high school graduating class and is very busy at work. She just learned the news and asked for leave and is rushing to the hospital.
"We will make arrangements immediately and take the green channel." Professor Chen immediately ordered the emergency doctor to arrange an examination. At the same time, he also told the doctor to perform emergency surgery and complete the preoperative examination together.
In this way, Sissi received a clear diagnosis in the shortest possible time.
At this time, Zhang Lin and Xiao Wu rushed to the emergency department, and Professor Chen handed over the next steps to Zhang Lin and Xiao Wu.
After understanding the situation, Zhang Lin stayed to communicate with the patient's family and arrange the operation. Xiao Wu went to the operating room to prepare for the operation.
"Don't worry, look, Wang Qianqian has moyamoya disease, which is a congenital cerebral vascular malformation. This disease exists since birth, but it's just getting worse now. Look, this is a malformed blood vessel, like a cloud of smoke.
Hence the name moyamoya disease.”
"These smoke are abnormal blood vessels. Because they are too thin, much thinner than normal blood vessels, they look like smoke. It is difficult for these very thin blood vessels to pass through the blood, so their downstream blood vessels are easily blocked. Now it is blood vessel blockage. Let me explain.
It’s a cerebral infarction.”
Wang Chengpei doesn’t know much about moyamoya disease, but he still understands cerebral infarction.
"Now we must take measures to restore the blood supply to the infarcted area through surgery. If the blood supply is restored in time, it is possible for the left hemiplegic limb to return to normal."
"If the blood supply cannot be restored in time, the infarcted area will become an infarcted area, and hemiplegia of the left limb will become permanent."
"So we're going to do emergency surgery."
Zhang Lin is like a great professor, full of momentum, speaking at a medium speed and articulating clearly.
Wang Chengpei now understood the general meaning of what Zhang Lin said.
In fact, there was a reason why Wang Chengpei bought a house near the hospital. His physical examination revealed that the electrocardiogram was abnormal, but the reason was never found, so he has been worried about his health.
He heard others say that buying a house around here is equivalent to buying a health insurance. He heard that a wealthy businessman from Southeast Asia bought an entire building for medical treatment. That's why he bought a house near Sanbo Hospital, and he had just moved in.
Unexpectedly, I did not use this "insurance", but my two-year-old daughter did.
"Doctor, please do your best to help. Can you please ask Professor Yang Ping to perform the surgery? We bought the house here because of Professor Yang Ping. Guo Peihua, whom you know, is the one who saved your life. I am his former colleague."
At that time, Wang Chengpei decided to buy the house here only after hearing about Guo Peihua.
"My name is Zhang Lin, and I am the attending physician of Professor Yang Ping's team."
Zhang Lin said confidently, and then handed over an informed consent for surgery, and Wang Chengpei signed his name.
Anesthesiologist Fatty Liang had already rushed back when he heard Zhang Lin's call. Fatty and stewardess Liao Yiyi were preparing to go out for dinner and a movie. When they heard about the emergency surgery, they had to rush back. Stewardess Liao Yiyi also followed Fatty.
She saw the scene of doctors saving lives and healing the wounded, and felt that her boyfriend was very proud and safe as a doctor.
The fat man immediately printed out the informed consent for anesthesia and gave it to Wang Chengpei to sign. He also signed it immediately without even looking at it.
Sissi's preoperative examination has been completed and she will be pushed to the operating room soon.
Wang Chengpei breathed a sigh of relief after signing. He didn't think much about it. In order to save time, he just glanced at the informed consent forms and signed them. He couldn't understand them anyway. He believed in the doctors here and it was best to hand the child over to the doctors.
If you are indecisive about your choice, you will only delay your treatment.
His wife was still on her way back. She heard that the child had left hemiplegia. His wife was so anxious that she couldn't speak clearly, and her logic on the phone was confusing.
Fatty's movements were very quick, and he had given Sissy a sedative when he was in the emergency department, so that Sissi could be sent to the operating room without crying or fussing.
Because the child is young and has thin blood vessels, this surgery is relatively difficult.
If it is just a patching technique, Zhang Lin Xiaowu can complete it independently.
However, the patching technique could not solve Sissi's current problem.
Therefore, blood vessel bypass grafting is necessary. One blood vessel bridge can only rarely improve blood supply. In order to increase the improvement in blood supply, several bridges need to be built.
Each bridge must not only ensure the quality of the vascular anastomosis, but also select the location of the bridge very accurately, which Zhang Lin and Xiao Wu cannot do.
If Yang Ping guides them throughout the process and tells them where to build a bridge, they should be able to complete the operation.
Nowadays, this kind of surgery is a race against time. The operation time must be shortened to the shortest possible time, the blood supply must be opened in the shortest possible time, and the brain tissue on the verge of necrosis can be saved.
Even if Zhang Lin and Xiao Wu could perform the surgery, they would never be able to do it quickly, so Yang Ping decided to perform the surgery himself.
Hearing that there was an emergency operation, Xia Shu, Dr. Jin, and Dr. Wen hurriedly finished their dinner and rushed to the operating room to help.
After hearing that Professor Yang was the surgeon, they wanted to learn even more.
Professor Chen Jianliang, who was initially in charge of the consultation, also went to the dining hall to have a quick dinner and rushed to the operating room to observe.
He also wanted to see how Yang Ping performed this operation, because in Professor Chen's opinion, Yang Ping could perform the operation better than others every time. Even if it was an ordinary operation, Yang Ping could do it.
To reach a higher realm, not to mention this difficult smoke disease.
Fatty arranged for Liao Yiyi to read in the anesthetist's office while he concentrated on giving anesthesia.
The fat man moved quickly and quickly completed Sissi's tracheal intubation and general anesthesia.
When they were in the emergency department, the nurse had already shaved Xixi's head and arranged her body position. Zhang Lin and Xiao Wu began to wash their hands and disinfect the patient's bed.
They knew in their hearts that this kind of surgery was difficult and required extreme speed, which was not something their brothers could handle. Professor Yang would personally perform it.
Yang Ping came into the operating room and stood in front of the reading light to look at Sissi's cerebral angiography pictures.
At this time, he was confident that he would complete the operation in two steps. He would first perform a vascular bypass surgery, because the vascular bypass surgery can have an immediate effect. Once the bypass is successful, the ischemic area will immediately receive blood supply, thus maximizing the
to prevent local brain tissue death.
Moreover, Yang Ping does not plan to build just one bridge, he plans to build several bridges to form a blood supply system.
In the second step, taping is performed, which can increase blood supply in the long term and further ensure the effectiveness of the surgery.
This two-pronged strategy can solve both distant and immediate worries at once.
The operation has begun and Sissi's mother is still on the way.
Sissi's grandparents were arguing in the parking lot outside the emergency department. Of course, her grandmother kept scolding her and her grandfather kept coaxing her.
PS: Sorry, I copied this chapter from the draft and sent it out. Many of the characters were garbled. They have all been corrected just now. Thank you everyone!
