The Godfather of Surgery

The baby Minmin was admitted to the ward. Even with the help of Li Guodong, the two old people were still a little dizzy.

No matter what you do now, many operations use things like WeChat on your mobile phone. The elderly are mobile phones for the elderly, which is inconvenient, so it takes some time.

When they arrived at the ward, the two old men could finally catch their breath.

But the baby started crying again, the grandfather hurriedly adjusted the milk powder, and the grandmother walked back and forth holding the baby to coax her.

Seeing this, Head Nurse Cai immediately brought the baby over and coaxed the baby in her hands for a few minutes, and the baby gradually calmed down.

Usually there are very few babies in the ward, so the head nurse Cai ordered the nurses to borrow a crib from the pediatrics department, and arranged for a married nurse with childcare experience to be in charge of Minmin.

After Li Guodong, the doctor in charge, asked about the medical history, the grandfather began to sort out the payment list, count the cash in the bag, record the details of the expenses in the notebook, and then use the calculator to count the expenses twice.

Fortunately, the couple had pensions, so they would not be isolated and helpless when this happened, but the pension was squeezed out by the son and there was not much money left.

Thinking of this incident, the old man's heart ached. He lived his whole life and was so angry with his son.

The two couples gave birth to their son in their forties, so they were very spoiled when they were young. They opened their mouths for clothes and food.

His son's high school graduation grades were terrible, and the old man paid his son to go to a private university. But after graduation, this kid was picky and picky. He didn't go to work for a few days. Most of the time he stayed at home and played games. Save money to live.

The old couple are working-class, with some savings and pensions. They are just an only child, so they can survive, thinking that their son may not grow up yet, and one day he will be sensible.

After all, the son married a wife, and the two old people also pieced together to buy a house for the son.

After buying a house, money was very tight, so I didn't buy a car.

For this matter, the son put a kitchen knife on his neck, pretended to commit suicide, knelt down and forced the old couple to say that everyone else has a car, but he doesn't have a car. This day can't go on, so it's better to stop it.

Hey, no way!

The old man gritted his teeth and used the last coffin to buy a car for his son.

My son is not ambiguous at all when buying a car. He doesn't look at anything other than Mercedes-Benz and BMW.

In the end, the coffins of the old couple were all spent.

This son has been like this since he was a child, giving what he wants, and if he can't achieve his goal, he will die or live.

Where there is an effect, there is a cause. The old couple admit that they have no way to teach their children, but at this point, what can they do? This is called self-indulgence.

After finally calculating and recording the expenses clearly, the old man stopped to check how much milk powder he had brought.

After checking the milk powder, they also checked whether the old couple had brought enough medicines. They were all long-term medicines, blood pressure lowering and blood sugar lowering medicines, and each of them had several kinds.

The grandmother said that she was afraid that there would not be enough diapers, so she asked the old man to go to the hospital store to buy some.

It took the old man a few minutes to stand up and go downstairs to buy diapers with the crutches he brought.

Just happened to be seen by head nurse Cai again. She was soft-hearted and couldn't stand it anymore. She called an intern nurse to help her run errands to buy some diapers.

Head nurse Cai seldom sees elderly people bring children to the hospital alone, and the two elderly people don't seem to be in good health, and they can't stand the toss.

So she took extra care and arranged for a flexible trainee nurse to help the elderly.

The old man also saw it in his heart and was very grateful.

——

In the doctor's office, everyone hasn't left work yet, and they don't plan to leave work on time.

Xiao Minmin's X-ray was hung on the screen of the reading lamp, and everyone spread out in a semicircle, surrounding the screen in front of the reading lamp.

Analyze each needle one by one, where it is, what are the adjacent anatomical structures, where does it open, what path is taken out, and what dangerous structures need to be avoided.

There is a thin needle in the 4/5 intervertebral space of the cervical spine. How the needle penetrated and appeared in the intervertebral space is no longer worth investigating.

Now figure out how to get the needle out.

Incision and removal of fine needles is the preferred operation. If you enter the intervertebral space from the anterior approach of the cervical spine, many important blood vessels and nerves need to be bypassed.

Using the posterior cervical approach, you can bypass the blood vessels and nerves in the front, pass through the narrow gap between the cervical lamina, and enter the intervertebral space to take out the fine needle.

This operation is feasible, but X-ray fluoroscopy is required, and the needle removal path needs to pass through the spinal canal. The narrow spinal canal makes it difficult to adjust the direction of a thin needle in a narrow space, and it is easy to get stuck in it.

Open surgery is also very difficult, but Yang Ping said that minimally invasive surgery is used to remove needles under color ultrasound positioning.

Professor Zhang really wanted to hear the details of Yang Ping's specific operation, and of course, other people also wanted to hear.

"Xiao Yang, can you talk about how to take the needle minimally invasively under the positioning of color ultrasound?" Professor Zhang asked.

Spine surgery, especially cervical spine surgery, has not been used in this way, which is an innovation.

Yang Ping pressed his finger on the thin needle of the cervical spine on the X-ray, and said: "Take the anterior approach, perform puncture under the positioning of the color ultrasound, send the working sheath to the front of the cervical 4/5 intervertebral space, and connect it with the fine needle. The direction is the same, and then the lens is inserted, under the monitoring of the lens, the anterior longitudinal ligament and intervertebral disc are cut open, and the fine needle is taken out."

The anterior approach needs to face many blood vessels and nerves. Once damaged, the consequences will be serious.

At this time, color Doppler ultrasound positioning has a huge advantage. Color doppler ultrasound can identify soft tissues, especially neurovascular, with a very high degree of recognition.

"If it can be removed in this way, it will reduce the trauma of the patient, but it is very difficult. If you are not absolutely sure, it is recommended to open the operation as much as possible and not take risks." Professor Zhang reminded.

Song Zimo said on the side: "Professor Zhou Yue from the Xinqiao Hospital of the Third Military Medical University once said that minimally invasive surgery leaves the difficulties and risks to the doctors and brings beauty to the patients. Positioning can avoid blood vessels and nerves, but it is very difficult to find a fine needle, and if it fails, it can be converted to open surgery.”

The difficulty and risk of minimally invasive surgery lies in the transformation from traditional open-sight surgery to surgery under microscopes and endoscopes.

Performing complex operations under a tiny channel of more than ten millimeters or even only a few millimeters requires very high operating skills for doctors.

Spine surgery is full of risks. It contains the spinal cord and nerves. A mistake in the millimeter difference will have a lifelong impact on the patient.

Therefore, minimally invasive surgery is like dancing on the tip of a knife, and has higher requirements on doctors than open surgery.

This kind of operation with fine needles does not have the ultimate minimally invasive level, so I definitely dare not try it.

For surgery, you can writhe a few times in the operation area, but it is really impossible to extend the incision.

Minimally invasive surgery, the level is not at home, and there is no chance of tumbling.

"Color ultrasound—guidance at the right time, can the ultrasound department—the doctor—cooperate?" Xu Zhiliang asked.

Yang Ping said to Xu Zhiliang, "I will operate the ultrasound probe myself."

Xu Zhiliang forgot that Yang Ping can do color Doppler ultrasound by himself, and his level is still very high.

If two people cooperate, one will be guided by color ultrasound, and the other will complete the operation. This kind of separation makes the risk of complicated operations very high.

But Yang Ping operates the color ultrasound guidance himself, so the risk is lower.

"If I'm sure, I agree."

Professor Zhang affirmed Yang Ping's innovative move. Combined with color Doppler ultrasound and endoscope, color Doppler ultrasound was used to help the endoscope establish an accurate channel.

"Great grasp!"

Yang Ping is very confident.

Since Yang Ping said so, Professor Zhang also knew it in his heart, and said: "This needle, if there is no other opinion, it will be settled."

If there is no comment, let’s discuss the next needle: the needle in the thoracic pericardium.

"Is it feasible to combine thoracoscopy with color Doppler ultrasound? With color Doppler ultrasound for positioning, under the supervision of thoracoscopic surgery, cut the pericardium and take out this needle?" Professor Zhang still advocates the combination of laparoscopy and color Doppler ultrasound.

If the needle in the cervical spine can be removed minimally invasively under the guidance of color ultrasound, then this needle can also be tried.

"The X-ray showed that the contour of the needle was not smooth, which meant it had rusted."

Song Zimo has read the X-ray several times and can confirm that it is a rusty needle.

If it has been rusted, it will undoubtedly increase the difficulty of taking out the needle, and it is very likely that the needle will be broken accidentally.

"That's right, the needle is already rusted. The entry direction of the thoracoscope is very strict. It must be in a straight line with the planned removal path of the needle, otherwise the needle will easily break."

Yang Ping felt that Song Zimo's film reading technology had improved again.

Rust can be judged from the outline of the needle on the X-ray, which requires very high image-reading skills.

Xu Zhiliang looked at Song Zimo, then at the X-ray, and then moved closer to observe the needle carefully.

"Do you want to ask the thoracic surgeon for assistance?"

Professor Zhang speaks very straightforwardly.

These doctors are all orthopedic surgeons. Although the hospital gave them the authority to operate the entire surgery, it was for the convenience of the operation.

Yang Ping and Song Zimo have also demonstrated the ability of whole body trauma surgery, but after all, there is a specialization in the surgery industry.

"It is necessary in theory, but not in practice." Song Zimo's answer was very dialectical.

With Yang Ping's level, still using thoracic surgery to help? Thoracoscopy and laparoscopy are very good at playing.

Song Zimo's skills are all taught by Yang Ping. He knows exactly how good Yang Ping is. This person is so powerful. There seems to be no blind spot or ceiling in technology.

Anyway, so far, Song Zimo has never seen Yang Ping say that he can't get the operation that he is sure of.

Professor Zhang adjusted his glasses: "Well, if this is the case, then there is no need for multi-department coordination, you can do it alone."

In fact, it is not only a technical matter to ask the general surgery department of the thoracic department to cooperate, but also to share risks. If there is any problem, everyone will take responsibility together.

If someone else is doing the surgery, Professor Zhang will still invite other departments to cooperate to spread the risks for young people.

Now Yang Ping is the chief surgeon, so if you don't invite him, you won't invite him. Professor Zhang still has a plan in his mind.

The two most dangerous needle surgery plans are determined, and the rest is not all right.

Although the positions of the remaining needles are not as dangerous as these two, the operation difficulty is not lower than these two.

For example, it is difficult to find out where the needles are when the laparoscope goes in. As the intestines move, the needles may shift. X-rays show that they are in the abdominal cavity. Who knows where they are inserted, maybe on the intestinal wall. , perhaps on the peritoneum.

Even after incision, opening the abdominal cavity, and turning over and over, it is still difficult to find where the needle is.

What about minimally invasive surgery?

Don't look at the tiny needles, it's not that easy to take them out!