For the whole day on Sunday, Yang Ping was in a bit of a trance.

Xiao Su! Professor Su's daughter, Su Nanchen's sister, this question has been lingering in Yang Ping's mind, she walked down the steps in a long skirt, the beautiful and moving picture is still imprinted in her mind, several identities are linked, and it is still difficult to adapt for a while.

No matter whose daughter she is, no matter whose sister she is, Xiao Su is right, she is Xiao Su, in this way, Yang Ping doesn't think about it anymore.

At work on Monday, Sisi's 3D reconstruction came out, especially the reconstruction of the infrared scan, which is the image to be used directly for the operation, and the other two, the reconstruction of CT and MRI are just supplements.

Judging from the imaging, the primary tumor has spread to the entire hip joint very severely, and the treatment method needs to be adjusted.

There are several ways of metastasis of malignant tumors, tumor cells are like seeds, which can be transferred out through several ways: hematogenous metastasis, where the seeds are transported to another place through the blood circulation, take root and sprout, and settle down; Lymphatic metastasis, similar to hematogenous metastasis, except that it is transported through the lymphatic circulation, not through the blood circulation; The planting spreads, the seed falls to another place, begins to grow, occupies the territory; There is also direct spread, where the tumor grows and grows out directly, invading other places.

Local excision is too large and too destructive, so surgery and ultrasound can only be combined, the tumor of bone tissue is removed first, the prosthesis is removed, the femur is lengthened, and then other surrounding tumors and distant metastases are treated with ultrasound.

At seven o'clock in the morning, Yang Ping finished watching Sisi's film and roughly planned the surgical plan. Entering the system space, there is still one last task left in the progress of sports medicine, and after completing this task, you can advance to the training of bone disease, but it is not known what this task is and when it will be released.

After the shift, I took everyone to round the ward, and then did a morning of surgery, all arthroscopic surgery, most of the patients in the ward are arthroscopic surgery, and the turnover is also very fast, and they are generally discharged the next day after the operation.

Word of mouth spreads very quickly, and many patients are introduced by patients who have undergone surgery, and it adds up, and slowly, the ward is almost full.

At two o'clock in the afternoon, Yang Ping gave a small lecture to everyone in the classroom, and a lot of doctors from the entire orthopedic department came, including several directors, Director Han, Director Tan, Director Tian, Director Bai, Director Ouyang, and Director Ding.

The content of the lecture is to rescue the case of penetrating injury of a tree on a rocky slope, and perform an open-box operation under large vessel occlusion.

This surgery is extremely difficult because it often involves large blood vessels and internal organs. Everyone who has seen it knows a scene, two people face to face and are pierced by a steel bar, the doctor is in a dilemma, the doctor has to pull out the steel bar, so that one person can survive, and the other can only die, how cruel!

Because the woman had injured the aorta, the doctor decided that she could not be saved, so he had to sacrifice her to save another black man with less serious injuries.

The aorta is the real dead artery, once damaged, a lot of blood will be lost in a short period of time, and the fastest can die instantly.

This dilemma, which is constantly shown on the screen, is played over and over again, and then freezes in a frame of two people facing each other, sitting in an ambulance, pierced by a steel bar.

Yang Ping pointed to the picture and said: "Don't be misled by TV, in TV, the two patients are conscious, talking and laughing, indicating that the vital signs are stable, at least the blood pressure is temporarily stable, in this case, you have to sacrifice the other, why?" Why can't you save two? ”

"No way, the director arranged it!" Some people say that everyone laughs.

Yang Ping also smiled, and continued after laughing: "In our country's Anzhen and Fuwai, aortic dissection rupture is much more dangerous than this, and the rescue success rate is very high, not to mention that you can still talk and laugh after this kind of aortic injury?" Not to belittle others, but to think in terms of science! The kind of surgical method on TV is extremely backward, they actually use the practice of pulling out the rebar, which is equivalent to gambling with life, this situation must not pull out the rebar, once the rebar is pulled, everything will be out of control, the practice of pulling out the rebar, just like defusing the bomb, don't think about anything, just tear off a few wires, is this okay? Definitely not! So what do we do? ”

Everyone listened carefully, and everyone who came to the lecture knew that Yang Ping's class was full of dry goods, especially about surgery, which was definitely not a script, but a refinement of his own experience, as for his surgery, needless to say, there were not one or two miracles created.

Among the young doctors, some people bow their heads to take notes, some people take tablets to record, and some people simply use their mobile phones to record the video, so as to save trouble, and listen slowly when they go back.

"If we were to rescue these two patients, think about it, how to do an operation, will you also pull out this steel bar? We are not evaluating TV today, but just using this case to elicit our thinking! Yang Ping asked, indicating his purpose for borrowing the TV.

The people in the audience were eager to try, someone raised their hands, and a young doctor from the trauma orthopedic department stood up: "I have always felt that this is not advisable, why not cut the steel bar from the middle, so that the two people are separated and divided into two groups for surgery?" When sawing rebar, use continuous cooling and some shock absorption! ”

Yang Ping asked him to sit down: "Very good!" This doctor is very correct, to deal with this case, not to pull out the rebar, but to saw the rebar, separate the two people, and have two groups of doctors complete the operation, this is completely doable, to be precise, this is already the third step, and before that, there are two more steps? ”

Everyone was silent, and they couldn't remember for a while, a doctor in the trauma ICU raised his hand and said uncertainly: "Blood transfusion, rehydration, right?" ”

"That's right! It's such a simple step, and this is the first step, blood transfusion and rehydration! This is the most ordinary, but also the most effective, indispensable step, we can understand that trauma, if the life-threatening is only blood loss, does not cause fatal damage to the vital organs, such as severe head injury, in theory can be saved, it depends on whether you are fast enough, whether you can stop the blood and transfusion in an effective time. The first step is blood transfusion and fluid rehydration to maintain blood pressure; The second step is to judge the injury and make a basic judgment on the injury, if there is a condition, you can quickly scan it, and if you don't have the conditions, you can go directly to the operating table for exploration. The third step is to separate the rebars, and what about the fourth step? Yang Ping activated everyone's thinking.

"The fourth step is our preoperative large vessel blockade, directly blocking the large blood vessels, just like this patient, it has been clear that it is an aortic injury, judging from the location, we can perform high abdominal aortic blockade on the top of the injury site, which is equivalent to closing the main gate and controlling all the bleeding of the wound, but this blockade is time-limited, abdominal aorta blockade, 30 minutes is safe, we end the battle within 30 minutes, and the patient can be safely saved. On the one hand, the blood vessels are blocked to stop the bleeding completely, and on the other hand, blood is transfused and fluids are given to replenish the lost blood, so as to temporarily obtain a volume balance and strive for a safe operation time. Song Zimo was involved in the operation, and he answered the question.

"But this is a very high-risk operation?" Someone is worried.

Yang Ping said to everyone: "Every one of our operations is high-risk, our surgery is like flying a fighter jet, nothing is absolutely safe, and completing all operations in the risk is the essential feature of surgery, so we must have rich knowledge, skillful operation, cool mind, block large blood vessels, we have entered the fifth step, unboxing surgery!" ”

The audience was in an uproar, I had never heard the word unboxing surgery!

Yang Ping stood in the middle of the classroom, waiting for everyone to be quiet, and said: "This is the essence of today, unboxing surgery is a word that I have thought about for a long time and selected, which is very simple, that is, open the box, go inside to find the problem, eliminate the problem, how to open the box, according to the CT scan site, or the part that is simply judged, in the abdominal cavity to open the abdomen; In the thoracic cavity, open the chest, along the rebar, completely open, expose the approach of the entire rebar, and then continue to stop bleeding and repair along the approach, and finally take it out, not to pull it out, but to take out the rebar! ”

"The process is like defusing a bomb, opening the shell of the bomb, exposing the various parts and wires inside, and then removing the danger step by step."

"The patient on the screen, even the most severe, can repair the aorta in half an hour, even if the speed is not so fast, you can use the large vessel bridging technique, from the proximal end to the distal end, across the injured site, so that the blood temporarily avoids the injured site, which can not only ensure the blood supply to the lower body, but also allow you to slowly repair the damaged aorta. There is another way, which is commonly used in thoracic surgery to deal with aortic dissection, artificial vascular implantation, and even minimally invasive implantation, many methods, why give up? Let's go to observe a few interventional surgeries for aortic dissection, you will know, this is not a difficult thing, you are skilled in anything, it is not a difficult thing, so we have to integrate the surgery, the treatment of aortic dissection, can be applied to trauma surgery, and usually our laparotomy and thoracotomy exploration why can't we apply to the steel bar penetrating injury, and to pull out the steel bar, using such a stupid practice. ”

"In theory, it's hard to do!" Someone whispered that after all, someone had not encountered such a thing.

The screen immediately switched to the rescue photo of Shipo Hospital: "You see, this is a living successful example, the application of theory, theory guides practice, practice improves theory, don't separate theory from practice!" ”

Yang Ping said: "I am not the only one who has successfully rescued such a patient, Moliu, Jishuitan, many hospitals across the country, there are very serious cases of trauma rescue, and even this kind of chest and abdomen penetrating injury, I can say responsibly that if these two patients appear in Moliu and Jishuitan on TV, they don't need to sacrifice the other, both can be saved, and they can also be rescued if they also appear in our Sanbo, and they can also be rescued by bo." ”

Director Han stood up and said to everyone:

"Soon, we are going to have an academic meeting, at which we will broadcast a large-scale trauma emergency surgery, and I will broadcast live at the same time as the University of Tokyo Affiliated Hospital, Director Tan has already got the full video of some of their large-scale trauma rescue operations, wait a look, what is the world's top rescue process, how the operation is done, how the team is coordinated, everything is done, done well, and done to the extreme, it is a completely different realm, and everyone who is engaged in it knows that the cure rate of stomach cancer in Japan is more than 80%. What is this concept? We are 30 percent, the United States is 60 percent! ”

Next, Yang Ping explained in detail the details of the operation of the penetrating injury case of the stone slope tree, how to block the blood vessels, how to open the box, how to explore, and how to repair.

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