The radiation-proof lead door was closed, and Director Ji worked hard inside, with an estimated time of about six hours.

After such a hard struggle, it is possible that the bamboo basket will be empty, but nothing will be found.

The human body is complex and mysterious, and modern medicine, whether it is basic medicine or clinical medicine, is far from being developed enough, and it can be said that it has just started.

Many diseases, textbooks say: the mechanism is unknown, symptomatic treatment, there is no specific drug, and so on.

While there is nothing to do, Yang Ping went to the system space to see if there was any training for interventional surgery, not for the time being, at present, it is all training for bone diseases, mainly bone tumors, and the next stage is orthopedic training.

The three major orthopedic surgeries of trauma, osteopathy, and orthopedics should be completed in an advanced manner, so that there will be surgical training of side branches, such as intervention, robotic surgery, etc.

Yang Ping went to the inside to pick up some thoracoscopy, laparoscopy, intervertebral foraminoscopy surgical training, bone surgery involves the spine, minimally invasive spine needs to use these laparoscopes, technical barrels, to rely on down-to-earth, piece by piece to make up.

"After so much effort, what if you can't find it?" Zhang Lin asked worriedly.

Xiao Wu was also very worried: "I think Fang Xiaoyun's mother, nine times out of ten, she will make trouble, it's not easy to be a doctor, on the one hand, you have to deal with these complex diseases, and on the other hand, you have to deal with sinister people's hearts." ”

"This is a senior brother who is bold, if it is someone else, in this case, where would he dare to take risks."

"Zhang Lin, are you ready to have a child? I'll help you with the surgery later, and you'll be in charge of taking pictures. ”

"It's okay, I don't dare to ask for this for two or three years, at least I don't dare to ask for it until I am promoted to the main director."

Yang Ping is closing his eyes and recuperating, Song Zimo is thinking about this disease, dural venous fistula, such a rare disease, put on a patient alone, can be diagnosed is very powerful, and now it is covered up by spinal tuberculosis, and it was actually discovered by Yang Ping, this diagnostic ability is too strong.

Time is really difficult, especially I don't know the result, I don't know how long to wait, this kind of waiting is a torturous thing.

"Fifth brother, are you going to smoke a cigarette?" Zhang Lin proposed.

In fact, Zhang Lingang will not smoke at work, but works night shifts, and sometimes the emergency surgery is done all night, and smoking is just to refresh and relieve fatigue.

"Smoke one, just smoke one."

Xiao Wu wanted to quit smoking, after all, he was going to be a father, and he was afraid that the little guy would dislike it when he took a sip of cigarettes in the future.

There was no smoking room in the interventional operating room, and it was difficult for the two of them to look for a smoking room in their hand clothes, so they had to hide in the toilet and turn on the exhaust fan.

The electronic clock on the wall showed that it was past 22 o'clock, and there was no good news inside.

Even if the fistula is successfully found in six hours, surgery will be performed later, and the operation will be done under the microscope.

It is said that the training of resident doctors in the United States is very cruel, some days and nights, and the sky is dark.

Some people say that this is deliberate, and a good doctor must have good physical fitness, be able to stay up late, be able to hold urine, and be able to go hungry.

Xiao Wu Zhang Lin smoked a cigarette and was in much better spirits, and the two went to the operating room from time to time, but the door was still closed.

"You go inside, did you find it?" Song Zimo instructed Zhang Lin to go in and have a look.

"Don't panic, everyone will sleep, and you will have to go on stage later, with Director Ji's level, you should be able to find this fistula, and there is Professor Zhang next to him, he is experienced."

Yang Ping squinted his eyes, he came out of the system space, and felt that the whole person was a lot more energetic, and he suspected that the air inside had some special effect, such as improving energy.

It was past twelve o'clock, and there was no movement.

Zhang Lin and Xiao Wu are like two hairy monkeys, they can't be quiet, and they are asked to sit on chairs and sleep, they can't sleep, they always walk around.

"No, I'll have to go in and have a look." Zhang Lin was restless.

Xiao Wu grabbed him: "I'll go in, you wait here." ”

Xiao Wu took a lead coat from the shelf where the lead coat was placed and put it on, went in, about ten minutes or so, and came out: "I haven't found it yet!" ”

Six hours and still haven't found it?

Do you really want a bamboo basket to fetch water?

If you really can't find it, it's okay for the patient to understand, but if you don't understand, you'll be anxious, toss for a night, and spend more money, and in the end there is no result.

Therefore, for some diseases, whether the patient understands and cooperates, the outcome is completely different.

Only if you understand and cooperate, doctors dare to take risks, and if you don't understand cooperation, doctors don't have the courage to work hard.

If you don't work hard, how can you get the best results.

I'm dying!

Zhang Lin patted his forehead by himself.

Xiao Wu comforted him: "Stabilize the point, or go smoke another one?" ”

It was almost one o'clock in the morning when the heavy lead door finally opened.

"Found it!"

The nurse who opened the door said excitedly.

It's like a midwife in the delivery room who opens the door and shouts to the husband of the mother who is waiting anxiously outside: "It's born!" ”

Everyone stood up like springs--- found it!

"A communication fistula was found in the left intercostal arterioven of thoracic 8-9, and in this place, the abnormal tortuous and thickened vein around the medullary area was clearly visible, and the operation can be performed?" Director Ji's voice was a little unspeakable.

It's really a dural arteriovenous fistula, and the probability of a lightning strike was stepped on by Fang Xiaoyun.

Fang Xiaoyun is like this, the two diseases overlap, it is the probability of two lightning strikes!

"In the prone position, don't pull out the catheter, and if you can't find a fistula during the operation, you have to trouble Director Ji to help inject Meilan into the catheter." Yang Ping asked Director Ji to take a break.

Look at the time, it was more than six hours, twenty-four blood vessels, the lead clothes were not breathable, and Director Ji's back was all wet, but he didn't dare to take it off for the time being, Yang Ping still had to operate on it, and he might need his help during the operation, inject Meilan into the catheter and locate the fistula.

Yang Ping, Song Zimo, Zhang Lin and Su Yixuan washed their hands and took the stage.

"Director Ji, why don't you take a break?" Yang Ping said politely.

"It's okay, I'll just sit next to it." The nurse brought a stool, and Director Ji sat and rested.

Yang Ping's surgery was done quickly and well, which is well-known in the hospital, if Director Ji takes off the surgical gown now, it won't be long before he has to brush his hands and dress, which is troublesome.

"Xiao Zeng, help me make a call to my wife, the phone is on that countertop."

Lao Ji felt very guilty, and ate with his wife, but now he is on the operating table and hangs his wife aside.

He is going to make a phone call to his wife to report the good news, he encountered a rare case, there are only 300 cases in the world, he successfully found a fistula, as a doctor, just this mouthful, when he gets old, brag with the younger generation, what to brag?

It's not about blowing these, how rare cases were back then, only 300 cases were found in the world, and one of them had its own credit, one in 300 in the world, what a concept.

Now it's past one o'clock in the morning, and she is still calling at this point, and Nurse Xiao Zeng is a little hesitant: "Do you still call my sister-in-law at this point?" ”

"Hit! I haven't slept yet, let her rest early, don't wait for me, I won't be able to go back for a while, come here, I'll tell you the gesture password. ”

The nurse had to help call: "Hey, sister-in-law, Director Ji can't go back now, yes, I'm here tonight, no, I mean, he's with me tonight, no, sister-in-law, I mean ---"

This late-night operation has confused people, and their mouths are not good at speaking, and they have not made it clear after correcting a sentence several times.

You said this, with you, fortunately, Director Ji's wife is more familiar with the situation, otherwise this will stab the big basket.

The nurse hung up the phone and said to Director Ji in surprise, "Sister-in-law is outside the operating room?" ”

"Director Ji, is this a check?"

"Check what's the post, I haven't eaten yet, she brought food, let her wait, let's talk after the operation."

Good surgery, sprinkle what dog food. Yes, I haven't eaten yet, Xiao Su ordered a lot of takeout, but I forgot to eat it, and everyone was hungry at this point.

"It's okay not to say it, but when you say it, this stomach is gurgling!" Zhang Lin swallowed a mouthful of saliva.

"Hold on, brother, you're not alone in starving!" The grunting was so loud that Xiao Wu heard it.

Posterior approach, in order not to destroy the stability of the posterior column of the spine, Yang Ping used a technique similar to cervical spine opening, cutting off the vertebral plate into a rectangle on three sides, leaving one side to break off, protect the periosteum, and then open it like opening the door.

This technique requires a very delicate technique, otherwise it is easy to fail, open the lamina, the veins are indeed a little thickened and tortuous, because patients with spinal tuberculosis will not routinely do DSA angiography, so it is impossible to find this vascular malformation on magnetic resonance.

It's not a matter of level, it's a problem of the technology itself, just as a black and white photograph can't be found in color.

The fistula is in this vein, which is to find a point from one side to another, and to find it one by one, but it takes time to confirm whether it is a fistula or not.

Yang Ping stopped: "Director Ji, please help us inject Meilan into the arteriovenous fistula just now." ”

The catheter inserted from the femoral artery has not yet been pulled out, and Director Ji came to the stage to help inject Meilan: "It's too!" Then I'm drugged. ”

Meilan followed the catheter, and it didn't take long for a point in the venous plexus to appear blue, and then slowly expanded, Yang Ping found that point, there was only a fistula, the diameter of the blood vessel was about three millimeters, and the arteries and veins needed to be separated under a microscope, and then the break was sutured.

"Okay, it's okay, Director Ji, I found it, the catheter is still there, and I'll do a contrast after the operation to confirm it."

"Microscope!"

Zhou Can pushed the microscope in, which was already covered with a sterile protective sleeve, Yang Ping adjusted the focal interpupillary distance by himself, and began to separate the blood vessels under the microscope and repair the fistula.

"A small fistula has such a big impact on the human body? It can actually cause paraplegia, it seems that the evolution of the human body is not good, and the fault tolerance rate of the parts is too poor. Zhang Lin looked at this small fistula, but it was only a fistula on a 3 mm blood vessel.

Originally, the artery is an artery, the vein is a vein, the bridge is the bridge, the road is the road, the two systems circulate separately, the proximal end is connected in the heart, the distal end is connected by the capillaries, and the middle is isolated from each other, and now there is a channel connection between them, which is the arteriovenous fistula.

Just like the highway, the lane that comes and goes has a separation belt, and now the separation belt lacks an opening, and the cars coming and going are mixed together through the separation belt, and it will be chaotic.

People are the same, once there is an arteriovenous fistula, arterial blood flows into the vein, and venous blood flows into the artery, so that the arterial blood is mixed with venous blood, the blood oxygen content decreases, and the vein communicates with the artery, and the return pressure of the blood vessel increases, causing congestion.

It was precisely because of venous congestion that the spinal cord edema could not be relieved, and it continued to worsen, and he lost the parabolic direction of the postoperative spinal cord edema, which went uphill all the way up to the apex and became a platform.

Abscesses of spinal tuberculosis compress the spinal cord and can cause spinal cord edema and paraplegia; Dural arteriovenous fistulas cause venous congestion and can also cause spinal cord edema and paraplegia.

The intertwining of the two conditions, one masking the other, naturally increases the difficulty of diagnosis.

After the operation, the surgical area was rinsed and a drainage tube was placed.