After speaking, Teng Guihua found out that something was wrong, and immediately covered it up: "I'll ask, ask." ”

There was a trace of imperceptible joy on her face, which was caught in Yang Ping's eyes, maybe the physical examination training in the usual system space made his observation stronger than ordinary people.

That's right, my daughter's condition is getting worse, shouldn't she be in a hurry, or even crying? How can I still be a little happy.

"I'll do it!" Teng Guihua also squeezed to the side of the bed to help Fang Xiaoyun massage his legs.

Fang Xiaoyun's colleague Chang Juan, let go of the position a little bit, showing a disgusted expression, the weasel gave the chicken a New Year's greeting, and he didn't have a good heart.

But it's also Fang Xiaoyun's mother, this time she didn't force money, she just came to see her daughter, as a colleague, it's hard to say anything.

This mom is dressed quite fashionably, the lipstick is very heavy, the perfume is pungent, and you can smell it through the mask.

The rings and bracelets on her hands and the necklace around her neck are all the same.

After reading Fang Xiaoyun, Professor Zhang told Yang Ping to observe closely, and he still had to go to the outpatient clinic, saying that a patient had come out with the test results, and he was very anxious, and he had been waiting for him, so he went to explain to the patient.

It's past work time, and the old man also went to explain the condition to the patient, which is really hard work.

The old man is eighty years old, and he can't be idle, so the hospital arranges outpatient clinics for him one day a week, but he doesn't do it, he has to go out five days a week.

After Professor Zhang left, Yang Ping retrieved all the case data of Fang Xiaoyun for research.

Any abnormality must have an explanation, otherwise there will be a knot in the heart, and it will not be happy.

This kind of abnormality is put in the eyes of others, and it is okay, but Yang Ping is unwilling to let it go easily.

"What? Still off work? Xiao Su put the bag next to the computer, sat down to accompany Yang Ping, and helped Yang Ping massage his shoulders.

The two agreed to have dinner together, take a walk after the meal, and play tennis for a while.

"This patient's spinal cord edema continues to not subside, and the peak lasts too long, which is very abnormal—" Yang Ping explained to Xiao Su.

"You take your time, I'll accompany you." Xiao Su sat next to her, next to her, and helped Yang Ping's shoulders knead with both hands.

Doctor, it is very important to have a partner who understands.

Otherwise, a few days of continuous emergency surgery can make the family a chicken.

"You watch the film carefully, don't worry about me, my dad is a doctor, my mom is a nurse, and I've been used to it since I was a child." Xiao Su smiled slightly.

Yang Ping looked at them one by one, not letting go of any clues, and carefully inspected every part.

It doesn't matter if you sacrifice a little rest time, it's better if you don't find a problem, if you find a problem, you can deal with it in time, in case of delay, it will affect the patient's life.

"The spinal cord compression has been completely relieved, there is no sign of embolism in the arteries supplying the blood, and the dural veins are slightly thicker than normal."

Yang Ping said to Xiao Su while watching that Xiao Su was very interested, and he liked to listen to Yang Ping talk about his condition.

The dural veins are slightly thickened, which is the intuitive feeling that Yang Ping got from looking at too many image pictures in the system space.

The blood vessels, a little thicker or thinner, can't be found at all, and the slightest difference doesn't explain the problem.

Yang Ping compared the MRI and CT films before the operation, on the first day after the operation, and one week after the operation.

The dural veins, the same part, are actually a little thicker than the previous one, although this change is very subtle, but it was still captured by Yang Ping.

Moreover, changes in the dural veins are positively correlated with spinal cord edema, with thicker veins and more severe spinal cord edema.

If it weren't for the devilish training in the system space, how could this almost negligible change be seen.

Dural arteriovenous fistula?

No, there are less than 300 cases reported in the world, such a rare disease, and spinal tuberculosis complicated by paraplegia at the same time, and superimposed together, this is the probability of lightning strikes.

However, the more Yang Ping looked, the more he pointed to this disease, almost certainly.

If so, a spinal arteriography must be done as soon as possible, and it can take a very long time, several hours.

There are many blood vessels in the spinal cord, and the distribution is very complex, including bilateral vertebral arteries, common carotid arteries, thyroid neck trunk, costocervical trunk, and 12 pairs of 24 intercostal arteries, all of which may be fistula formations.

During imaging, X-rays are irradiated for a long time, which is a great test for both patients and surgeons.

The most troublesome thing is that because of the complex structure of the blood vessels around the spinal cord, it may be that the technique is not in place, and all the above blood vessels are impaired once, but the blood vessels in question can still not be found.

Contrast agents also increase the risk of embolism of the spinal arteries, especially the anterior spinal artery that was anastomosed during the previous surgery, and the condition is complex and multiple conflicting risks are intertwined.

Without the patient's full understanding and cooperation, the next step of examination and treatment cannot be carried out at all.

"Dural arteriovenous fistula? DSA digital subtraction angiography should be ordered immediately. Yang Ping told Xiao Su.

I couldn't eat in the evening, and I didn't have to go for a walk or a tennis ball.

"What do you eat? We order takeaway! Xiao Su was not dissatisfied.

Looking at Yang Ping's posture, if you are diagnosed with DSA, you will have emergency surgery, and you will have surgery together, which is good!

There is no need to explain, the two have a very tacit understanding, and Xiao Su immediately went to arrange takeout for dinner.

Everyone was about to pack up their things and get off work, Song Zimo Tang Fei greeted Yang Ping and was about to get off work.

"Fang Xiaoyun, dural arteriovenous fistula!"

Yang Ping responded to Song Zimo.

Song Zimo immediately stopped: "Emergency DSA?"

"Well, after the diagnosis, immediately operate, contact the interventional operating room, and the operating room that can do hybrid surgery."

Yang Ping took the water brought by Xiao Su, and Xiao Su said with a smile: "It seems that everyone can get off work, and I have ordered all the takeouts." ”

Song Zimo Tang Fei immediately gave up getting off work, Song Zimo handed the backpack to Tang Fei: "Help me put the bag, I will call Zhang Lin Xiaowu and the fat people over, there is work to be done tonight, there are less than 300 cases in the world, we have stepped on it, is it really fake?"

"Ninety percent of the time it's true, preparing for DSA and surgery." Yang Ping stood up.

How low is the probability that two diseases are superimposed together, and the disease occurs at the same time, and one disease covers the other.

Zhang Lin, Xiao Wu and the fat man saw that Yang Ping didn't get off work, and they didn't dare to get off work on time, for fear that something would tell them.

Several people had a "meeting" in the duty room, and when they received a call from Song Zimo, they dared to delay and all came out.

At this time, Professor Zhang called, and his tone was urgent: "Xiao Yang, where, the emergency department will give Fang Xiaoyun a DSA of the spinal artery, it is likely that the dural arteriovenous fistula!" ”

"I'm arranging!"

"I'll be to Corey right away!"

The phone didn't hang up in time, and an old lady's voice came from inside: "Alas, ——, the rice is ready, let's go after eating, it's good to eat two or three bites to fill my stomach——"

Professor Zhang is very experienced, and he also thinks of this rare possibility.

Song Zimo is contacting the interventional operating room, and there are several operating rooms that can do hybrid surgery.

But at night, I don't know if there are enough people to help with DSA, so I need the help of an interventional doctor with very good skills.

Everyone acted separately, Xiao Su and Zhou Can wanted accurate instruments, prepared a microscope, determined the interventional operating room, and sent all of these over.

After DSA, the diagnosis is confirmed, the operation is directly carried out in the interventional operating room, and sometimes angiography is required to find the vascular fistula during the operation, and the arteriovenous fistula needs to be confirmed by angiography after the operation.

Yang Ping reported to Director Han, and Director Han also said that he would come immediately, he was not worried about Yang Ping's skills, but to give Yang Ping a platform and take risks, after all, Yang Ping was the attending physician.

After checking Zhang Lin's informed consent form, modifying it slightly, and printing it out, Yang Ping took Zhang Lin to talk to Fang Xiaoyun and obtain her understanding and cooperation.

Teng Guihua is in the ward, and Fang Xiaoyun's colleague Chang Juan is also there, so she may not be at ease, worried that this mother will do something unfavorable to the other party Xiaoyun.

Yang Ping felt that Fang Xiaoyun was fine, this mother may be the biggest obstacle to communication, Fang Xiaoyun is an adult, Yang Ping decided to bypass this wonderful mother in order to save trouble.

"I'm going to talk to the patients now, you guys go out, Zhang Lin, I've called the nurses in and take them out." Yang Ping's words are beyond doubt.

"I'm her mother, what can't be talked about in front of me." Teng Guihua noticed something unusual.

Yang Ping waved his hand: "Go out, you didn't hear clearly, I don't want to delay time, Fang Xiaoyun is an adult and has the ability to act independently, so he doesn't need you to be there." ”

Although these words are rough and direct, at this time, entangled with her is a waste of time.

Chang Juan was more spicy: "The doctor said that he would go out, what so much nonsense, Xiaoyun, let's go out, listen to the doctor, don't think too much." ”

The colleague pushed her mother out, and when the nurse came in, Zhang Lin closed the door to examine the female patient, or to close the door and talk alone, a third party such as a nurse or female doctor must be present to avoid some unnecessary disputes.

"Dr. Yang, what's going on?" Fang Xiaoyun asked a little scared.

Yang Ping said calmly: "Fang Xiaoyun, you have been operating for a week, and the strength of your legs is getting smaller and smaller, this is not normal. We suspect that in addition to spinal tuberculosis, you also have a dural arteriovenous cage, which is a rare disease with less than 300 cases reported worldwide, and it is likely that it happened to occur after surgery and became the cause of your paralysis of both lower limbs. I'm not 100% sure, but I'm 90% sure. Now you need to do a myeloid arteriography, one blood vessel at a time to find, it is possible to find it, it may not be found, if it is found, it will be operated on immediately, it will be dealt with, this time it will be operated on from behind, are you willing to believe us and cooperate with us? If this disease is not detected and treated in time, it will cause permanent paralysis. ”

The disease is acute, has a poor prognosis, and venous bruising can cause unrelieved spinal cord edema, followed by extensive arterial embolism.

"Don't be afraid, you can decide your own business, your body is your own, you don't have to think about other factors." Yang Ping added, his tone was firm but gentle, and his words were clear.

Fang Xiaoyun is the kind of ordinary rural girl, before graduating from junior high school, she was scolded by her mother to go to work, worked as a general worker in a factory, and was later introduced to a foot bath shop to engage in foot massage acupressure.

All the money she has spent all these years has subsidized her family, and she has bought cheap clothes, and she is reluctant to change a Redmi mobile phone after several years.

But at the critical time, this girl's idea was very clear, she thought about it and nodded: "Doctor Yang, I listen to you everything, hard work for you, it should be examined, it should be operated." ”

"If you have this sentence, we will arrange it immediately, and I will tell you the details of the operation——。"

After speaking, he signed, Yang Ping got up, and the nurse opened the door.

I thought it would take a lot of effort to convince Fang Xiaoyun, but I didn't expect it to be very easy, this girl is very reasonable.

Perhaps, her decisiveness can save herself.