There are a lot of people, and everyone's enthusiasm for learning is very high.

Every time, Professor Liang was able to tell everyone a lot of things, so everyone enjoyed listening to Professor Liang's lectures.

Professor Liang's attainments in spine are very high, and his academic achievements are not only in a leading position in China, but also world-class, giving Concord Spine Surgery a place in the world.

Therefore, the supreme fame of Concord has been achieved by the efforts of generation after generation.

After Song Yun reported the medical records, everyone was thinking about it, and Professor Liang began to speak.

"Total spine resection, also known as total vertebral resection, is very complicated, and there are not many articles at home and abroad, only a dozen articles, and even fewer hospitals can do it."

"Due to the complex anatomy of the spine, adjacent to the spinal nerves, large blood vessels and important organs, surgical resection is very difficult, and the risk is also very high.

"In the nineties of the last century, Tomita, a professor at Kanazawa University in Japan, proposed posterior total spine resection, which is now total vertebral lumpectomy, with this technology, not only for such tumors, but also for all complex tumors of the spine, the surgical effect is improved. In this case, I want to ask everyone, total vertebrae resection, how to operate specifically, Song Yun, you will answer for me. ”

Professor Liang would like to use this case to tell you about the difficult and high-risk surgery of total vertebral bone resection, so that you can thoroughly grasp the relevant knowledge in combination with the case.

Song Yun used to be a graduate of the eight-year college entrance examination of Concord, both in basic knowledge and learning ability are outstanding, and the score line of the eight-year college entrance examination of Concord is at the same level as Tsinghua University, but because of the small enrollment scale, it is more difficult than Tsinghua University.

This kind of high starting point, high standards, high requirements to train talents, all of them are the elite of the industry.

Think about Su Nanchen's entry into the eight-year system of Concord, and his college entrance examination score that year was the top in the province of science.

Song Yun was not in a hurry, and replied in a clear manner:

"Dr. Tomita's surgical method, which is also the mainstream surgery now, is to operate from the back side, using a wire saw to cut the vertebrae from the pedicle, dividing the vertebrae into two parts, the vertebral body and the appendage, and then cutting the two parts separately, and of course, safely separating all the structures around the vertebrae."

"Combined with the specific situation of this patient, the tumor invaded the large blood vessels in front of it and adhered to it, and the problem could not be solved by simple posterior surgery, and the tumor could only be removed by combining anterior surgery."

"The choice of anterior approach should also take care of the growth mode of the tumor, and the lateral anterior approach cannot fully dissect the aorta and inferior vena cava, so it is best to choose the anterior approach, which is convenient for the treatment of the aorta and inferior vena cava, and at the same time, pay attention to the protection of the internal and external iliac veins."

"Segmental arteries should be treated carefully, the psoas muscle attaches to the vertebral body, and great care should be taken when separating to prevent damage to the nerve roots that are walking inside the psoas muscle."

Song Yun briefly explained the surgical process and precautions, indicating that he had a very thorough understanding of the operation in order to make such a summary.

"Excellent! Not only have I read papers in this area, but I also have some experience in surgery, and I have a good understanding of the precautions. Professor Liang praised.

Although Professor Liang is strict, he never hesitates to praise his students, and he believes that criticism is not enough, but also timely praise and encouragement should be given.

"So, when this operation is going to cut the vertebrae from the pedicle, it requires a special tool, and why is this tool special? What's so special? Raise your hand and answer. ”

Professor Leung continued to ask questions, and since the case had already been discussed, he wanted to check whether the young doctor had grasped it.

A lot of people raised their hands in the whole conference room, everyone was very positive, and the atmosphere was very lively.

Professor Liang casually ordered a young doctor, who had good looks and temperament, and replied very confidently and calmly: "The structure of the vertebrae is complex, so a special guide is needed to guide the wire saw under the pedicle, because the direction of the wire saw cannot follow the standard route like the usual long bones, so a special reverser is also needed to change the direction of the wire saw, so that it can go around the pedicle and form an effective cut." ”

"This particular instrument is very hard to come by in the market, and the hospitals that are able to perform this type of surgery will either bring back the tools from abroad when they study or use existing tools to adapt to the surgery."

"This patient's surgical tools, we need to redesign, we look at the three-dimensional reconstruction of the spine and tumor, the normal wire saw penetrates from between the lamina, through the intervertebral foramen, and then uses the wire saw reverser to cut off the pedicle, now there is a space-occupying lesion in the spinal canal, there is no gap to thread the wire saw, if it is forcibly penetrated, it is easy to cause tumor dissemination, causing tumor bleeding, and the instrument needs to make some personalized changes to adapt to this special situation."

The ceiling of Chinese hospitals, worthy of its name, any one picked out, is the elite of the elite, and these doctors all have a temperament: calm and confident.

Yang Ping has been listening quietly to their speeches, thinking about the uniqueness and shortcomings of these speeches.

"Excellent! Every case should be treated as a classic, which is responsible for the patient and for oneself, a case can learn a lot, who is responsible for 3D printing? Professor Leung was full of energy.

"Me!" A young doctor raised his hand.

The doctor immediately walked to the computer and projected a 3D model of the artificial spine onto the screen.

Because of the importance of 3D printing technology, almost every doctor in Peking Union Orthopedics is proficient in this technology, and they train this technology as a basic skill.

The 3D-printed artificial spinal prosthesis is projected onto the screen and rotated 360 degrees.

"This is the 3D artificial spinal prosthesis we designed, instead of the three vertebrae that will be removed during the operation, in order to achieve effective reconstruction of the vertebral body, we carry out personalized design according to the patient's anatomy and biomechanical characteristics, this is the upper and lower part of the prosthesis, which perfectly fits the upper and lower normal vertebral body connection surface, this is our specially designed screw implant hole, which can connect the artificial vertebral body with the nail rod system at the rear to form a unique truss structure, the truss structure combines the titanium alloy porous design we use, With sufficient biomechanical strength, patients can get out of bed as soon as possible for rehabilitation training after surgery, so as to live and work like a normal person. ”

Yang Ping felt that the design of this artificial vertebral body was very good, which met the requirements of biology and biomechanics, and the designer must have received relevant systematic training.

After combing through it like this, the preparation for the whole operation is very sufficient, and there are no mistakes.

"I have a question!"

In the crowd without seats, a young doctor raised his hand to ask questions.

Because there were so many people, some people had seats, and many young doctors were standing.

"You say!"

Professor Hu Guolin asked him to stand up.

The doctor, who is in his early thirties, said aloud: "The preparation for the surgery just mentioned is based on the assumption that everything is going well, if it doesn't go well, what if there is an extremely bad situation, such as the rupture of the aorta or inferior vena cava in the case of dissection? Especially in the case of extensive tears. ”

The doctor walked up to the podium with his chest puffed out and continued very confidently:

"You see, the range of adhesion between the tumor and the large blood vessels is as long as 10 centimeters, in this case, it is very easy to tear the aorta and inferior vena cava, even if there is no tear, the tumor and the large blood vessels are successfully separated, can such large blood vessels still be used? Whether there are potential safety hazards, like aortic dissection is like a time bomb, I saw an article mentioning a case, belonging to the abdominal tumor specialty, the tumor and the abdominal cavity large blood vessel adhesion, the doctor successfully separated the tumor from the large blood vessels, the operation process went smoothly, but the patient died suddenly on the fifth day after surgery, and later the autopsy found the cause, that is, the aorta was invaded by the tumor, the blood vessel wall has changed, there is a basis for the pathogenesis of the aortic aneurysm, the patient is complicated by aortic aneurysm after surgery, and the aorta is torn extensively, The patient died of internal hemorrhagic shock, have we ever thought about what to do if the worst happens? Blood transfusions? ”

The young doctor spoke sharply like a critic, as if questioning his colleagues, Professor Liang and Director Hu in the front row.

Yang Ping found that the doctors in Xiehe almost had almost no hunchbacks and chests, all of them held their heads high and their backs straight.

Even the eldest Professor Liang, whether sitting, standing or walking, is full of spirit and spirit.

"Very good!"

Professor Leung applauded the questioners, and everyone applauded.

"That's what I always tell you, how are we going to be doctors?"

Everyone replied in unison: "Do your best, prepare for the worst!" ”

"That's right! We strive for the best, but prepare for the worst, who will answer this doctor's question? Professor Liang was very satisfied with the doctor's question.

Academics should have the spirit of questioning, not follow the crowd and lack the ability to think independently.

Director Hu stood up: "Let me answer, we have taken this situation into account, and we have measured the blood vessel wall on the imaging picture, indeed, there is this risk in the blood vessel wall, and the risk is very high, for which we have prepared artificial blood vessels, invited vascular surgery to assist, explore the blood vessel during the operation, and if necessary, implant artificial blood vessels in advance to prevent the worst situation mentioned by this doctor." ”

The questioners were very satisfied, and it seemed that the Director had been very thoughtful.

"I'm satisfied with my answer, right? When the case is discussed, you must have left the room early, and I mentioned this issue at the end. Director Hu didn't mean to blame, just told the questioner gently.

Indeed, the medical team of the doctor, who was on duty at the time, was temporarily away for emergency surgery.

Yang Ping sat in the first row, the screen showed the enhanced three-dimensional reconstruction of the tumor, seeing the extent of the tumor invasion, the spinal canal has been crowded, the spinal cord and nerve roots have been invaded, the anterior side and the inferior aorta vena cava adhesions, the difficulty of resection is indeed very high, especially the vena cava blood vessel wall is thin, the separation effort is slightly worse, and the blood vessel wall will rupture.

The tumor is intertwined with the spinal nerves in the spinal canal, which can easily damage the nerves, and this surgery is well-deserved and world-class.

Implanting artificial blood vessels in advance is a clever trick that minimizes the risk of rupture of large vessels during and after surgery.

There is another problem, although it is not fatal, but it is easy to cause tumor spread if it is not treated well, that is, the lumbar 2 and lumb 3 tumors have invaded the pedicle that wraps both sides, in this case, the pedicle is sawed off with a wire saw, which will damage the tumor body anyway and lead to the spread of tumor cells.

In order to reduce the possibility of dissemination, it can only be done with careful operation.

If the tumor can be carefully peeled away to expose a part of the pedicle, this problem can be solved, but it is very difficult.

Yang Ping thought about this problem in his heart and tried to handle every step perfectly.

"Who else has any questions?"

Director Hu asked everyone, because the discussion could not be carried out indefinitely, so there was no way to end it for three days and three nights.

"I just mentioned that the tumor and the pedicle are intertwined, how to insert a wire saw to avoid damage to the tumor and reduce the spread of the tumor." There is a doctor who is also thinking about this question and raising it.

"To remove the vertebrae, it has to be split in two, and it is impossible to cut it whole, so this problem cannot be avoided, so we can only perform a ring pedicle strip on the pedicle tumor, and then insert a wire saw after peeling, and we have improved the instrument to add a protective sleeve when it is inserted, so that the risk of dissemination can be minimized." Director Hu introduced the solution.

The questioner nodded, very satisfied, this is already the best way, it is impossible to take out the whole vertebrae at once, it can't be done.

"Still have questions? Time is limited, and there are questions that can be communicated privately. ”

No one was asking, and Director Hu said to Professor Liang, "Shall we go see the patient?" ”

Professor Liang nodded, turned to Yang Ping and said, "Let's go see the patient together." ”

Professor Liang did not let Yang Ping speak, after all, it was the first time Yang Ping came to Xiehe, and Professor Liang did not treat him as a student, or as a professor, and this meeting was of a learning nature.

Under the leadership of the general Song Yun, everyone came to the ward, Jing Yunsong was obese, especially the abdominal distension was very obvious, he was chatting with the patients in the same ward, and when he saw the professor coming to check the ward, he immediately sat back in his bed.

When encountering this kind of ward round, the average patient is a little confused and can't figure out the situation, but Jing Yunsong is very relaxed, he should be a patient who has walked through many hospitals and seen a big scene.

"Hello, Professor Liang, I finally met you." Jing Yunsong recognized Professor Liang.

Before coming to Xiehe, Jing Yunsong had searched all the orthopedic surgeons on the official website of Xiehe on the Internet.

"We're going to have surgery on you, it's complicated and risky, so we're going to see you again." Professor Leung is very kind.

Jing Yunsong said with a smile: "If it's not complicated, it's not difficult, I won't come to Xiehe, I heard that the hospital that doesn't move will be advised to transfer the patient to a higher-level hospital when it encounters incurable diseases, only Xiehe doesn't have this sentence, Xiehe is a high-level hospital in China, if you don't do surgery, I can only travel around the world." ”

It's rare for a patient to be so relaxed, no matter if it's really relaxed or pretended, at least he can be optimistic.

"Professor Liang, I heard that this kind of operation has done the most in the whole of China, I came here, okay or not, anyway, when I get here, there is no place to go, there is a legend, the third more important person in Hades, and the concord can stay until the fifth watch." The patient was very funny.

It is very rare for cancer patients to be so optimistic.