After receiving a smooth reply from his vital signs, Director Long was relieved, and he had a false alarm, and he also smiled at the absurd thoughts that he had just flashed.

However, this operation is also quite strange, even the small blood vessels are electrocoagulated in advance, and none of the blood vessels are passively stopped bleeding without foresight.

Although the pancreatic tumor did not cause too serious invasion of the liver, the blood vessels supplying the tumor have been intertwined with the blood vessels of the hepatic hila, and Yang Ping is now dealing with this pile of troublesome blood vessels.

The blood vessels and bile ducts of the liver are intricate, and the first hepatic hilum located in the transverse groove of the liver has hepatic artery, portal vein, bile duct, lymphatic vessels and nerve tissue; The second hepatic portal located at the back and top of the liver gathers a large number of veins, which are mainly the location where the liver blood flows out of the liver, including the left hepatic vein, the middle hepatic vein, and the right hepatic vein, which gradually merge into the posthepatic inferior vena cava and return the blood flow from the liver to the heart; The third hepatic portal is located between the posthepatic and inferior vena cava, where small blood vessels flow backward blood to the inferior vena cava.

The liver and pancreas, plus complex tumors, have dozens of large tumor metaphytic blood vessels, and countless small ones, which are intertwined with the blood vessels of the pancreas and the hilum of the liver, which is simply a mess with dead knots.

Originally, the patient had traveled all over the country, and other hospitals recommended giving up the operation, because the patient was still young and the pillar of the family, so he had no choice but to come to Xiehe.

However, Dr. Liao was young and vigorous after all, and his preparation for the operation was insufficient, and the preoperative blood preparation was not sufficient, so he did not do this step in place, resulting in the current operation being like falling into a quagmire, and it was difficult to move step by step.

This surgery has lost so much blood that it is simply impossible to complete without enough blood transfusions.

Looking at the pile of countless knots in front of him, Director Long sighed, even if he was experienced in a hundred battles, his scalp was numb and his back was cold.

But the mess was in Yang Ping's hands, the sharp knife and tweezers were like dragons and snakes, and one after another blood vessels were unscathed from the entanglement and intertwined, and handed over to Director Long to clamp knots, cut off, sew or ligate.

This ability to separate and dissect, how many surgeries have been done to practice this body of kung fu, and how many tumor surgeries have been done, how many surgeries have been performed for liver cancer and pancreatic cancer.

The doctors who watched the operation around, even though they were infinitely close to the warning distance, and the itinerant nurses had verbally reminded them many times, they still continued to approach at a pace of centimeters and millimeters, and the crowd pushed and pushed, crowded and bumpered.

In fact, only the doctors on the stage can really see clearly, especially the first assistant has the best vision, these onlookers in the audience, those who are close can also see a rough idea, and those who are far away can also watch a lively.

Someone had already moved his foot and stood on it, leaning forward, his eyes almost bulging, and the posture seemed to immediately lose his center of gravity.

There are also people who have not found a position, not even the worst viewing angle, so they are so anxious to go around in circles on the side, and from time to time ask the person who has occupied the advantageous position what step the operation has taken.

There is a camera on the operating lamp, but there is no connected LCD screen in the operating room, and the supporting mobile LCD screen is showing the classroom, but no one goes to Zhang Luo at this time.

As long as you don't mess up the rules of the operating room, it's not easy for them to keep a straight face to disperse everyone, and they don't look up and look down every day, and they still don't do less things that offend people.

If the head nurse comes to make rounds, the roving nurses will pretend to be and enforce the law with a straight face, but when the head nurse is gone, everyone will reassemble, just reshuffle the cards in their respective positions.

Professor Liang sat alone in the corner, very boring, he circled around the operating table, and couldn't see anything, but he knew that this operation was difficult, and Yang Ping was very good now.

Not to mention a bunch of blood vessels, it is not easy to untie a bunch of tangled and knotted messes.

Compared with Nie Feng'e's operation, the difficulty of this operation is still a little worse, Yang Ping is not in a hurry, continues to separate the blood vessels, in the dangerous area, the sharp knife has never retreated, and is still charging on the front line.

There is no way out of the mountains and rivers, and the willows and flowers are bright and another village.

Every time Director Long felt that the operation had fallen into a desperate situation, the instruments in Yang Ping's hand opened up a new world and steadily pushed the operation forward.

This patient is not bad compared to Nie Feng'e, because the invasion of the tumor to the liver is not so exaggerated, that is, although the traditional resection is not enough space and is very difficult, it is not impossible to try, which may be the reason why Dr. Liao thinks that traditional resection is used.

If this operation is taken down by traditional excision, it marks that the level of traditional excision can be reached, and if it is really difficult to remove it cleanly, the target can also be lowered, and only enlarged excision can be done without complete radical cure.

Originally, Dr. Liao's plan was quite thorough, but he seriously underestimated the bleeding of the tumor, and his previous surgical experience was not suitable for this case, so it led to a misjudgment before the operation.

On the liver side, the blood vessels of the tumor are intertwined and grow, and if these blood vessels are untied, the liver side is considered complete, and the liver does not need to be removed.

The tumor mainly invades the pancreas, so the pancreas is the big head, and the tumor blood vessels that come from the liver side are dissolved, and finally the pancreas is touched, and the twelve intestines and the pancreas are next to each other, so most of the twelve intestines must be removed, the pancreas also needs to be removed, and the nearby stomach also needs to be removed.

The pancreas, duogut and stomach are intricately intertwined in this place, so the pancreatic duodenectomy is considered to be the top surgery in digestive tract surgery.

After cleaning the surroundings, especially the liver, Yang Ping began to focus on the pancreas, duodenum and stomach, and the blood vessels here were chaotic.

The main blood vessels of the duodenum are the superior duodenal artery of the first segment, the branch of the gastroduodenal artery, the superior posterior branch of the pancreaticoduodenal artery, and the gastroduodenal artery is a branch of the common hepatic artery, and these vessels are intertwined.

The blood supply to the remaining three segments of the duodenum comes from the anterior and posterior arterial arches, from which it flows to the branches of the pancreas and duodenum, which are called peripheral arteries, which are sometimes embedded in the pancreatic tissue.

And the blood supply of the pancreas itself is more complicated, the blood vessels come from the celiac artery and the superior mesenteric artery, these blood vessels are very atypical, often mutated, this is the most annoying thing for the surgeon, the blood vessels look different from textbooks, different from others, which makes people sometimes have to spend a lot of time to find out where they are, which is the same as fighting a war without a map, or the map obtained is wrong, and it must be groped for progress on the spot.

"How? Where did it go. ”

Doctors, graduate students, and advanced doctors in the periphery were so anxious that they could only ask the brothers who could see the operation.

"It's like separating tumor blood vessels from the pancreas."

The brother with a good vision actually didn't see anything, the operation was too fast, and he couldn't see anything, he only saw the instruments in and out, and the instruments kept changing in his hands, but even if he didn't look at the operation, just looking at the operation of this instrument was already very cool, and it was estimated that many people didn't actually see the operation, just looking at the operation of the instrument.

The pancreatic artery arch, the dorsal pancreatic artery arch, the transverse pancreatic artery, the caudal pancreatic artery, the splenic artery branch, and the veins of the pancreas are dissected one by one, and then the blood vessels of the tumor are dissected one by one, and all the blood vessels of the tumor are clamped and cut off and ligated.

All the major arteries of the pancreas are located behind the pancreas, making them tricky to manage, which is why some surgeries require ex vivo resection to achieve the goal.

There are so many blood vessels in the pancreas, and there are almost 20 blood vessels in the tumor, so it is impossible to distinguish where the blood vessels of the pancreas are and where are the blood vessels of the tumor, and we must figure out their ins and outs.

The more Dr. Liao looked at it, the more he admired, he was usually so conceited, in front of this Professor Yang, his little three-legged cat kung fu was nothing, it was really a heaven outside the world, and there were people outside the world.

Director Long is watching it with relish now anyway, these blood vessels are separated one by one, the retention that should be retained, and the treatment that should be treated, there is not a single mistake.

The most terrifying thing is that after doing it for so long, it is like cutting a gallbladder, almost no bleeding, and this level is the only one in the country.

After the pancreas is processed, the adjacent stomach and duodenum are treated.

Everyone has completely forgotten the time, this operation is estimated to be done at night, more than ten hours is the normal time, Director Long probably forgot that the operation will take so long, and actually asked Dr. Lu to order food.

Large gauze blocks are constantly spread around the surgical area, and many traction wires are tied to the tumor, and a vascular forceps are clamped at the end of each traction wire, which are neatly placed around the abdominal surgical opening.

Dr. Lu didn't come to the stage, and he was also fighting guerrillas off the stage, and he suddenly thought of this, Director Long had a treat, but this operation would take more than ten hours according to the regular time, and it was not easy to invite this guest.

But Director Long is busy on stage, and it's not easy to ask, so wait and see, or wait for Director Long to ask when he is free.

Professor Liang is not fun in the operating room alone, Yang Ping is busy here, and he sneaks to the orthopedic department to sit down.

The anesthesiologist is also a well-informed person, and he also walks around the operating table from time to time, although he can't see the specific operation of the operation, but he pays attention to the large gauze with tails that is now used, if the gauze is full of blood, and there is a lot of it, it means that there is a lot of bleeding.

But now he turned around a few times, and in addition to the gauze already in front of him, there were only a few new pieces in the basin where the gauze was collected, and it was still the kind with some blood stains on it.

Looking at the patient's blood pressure, since Professor Yang took over, the blood pressure has been stable, and because of rehydration, the blood pressure is now on a rising trend.

This is a master, the anesthesiologist judges.

The anesthesiologist is relatively old, about 50 years old, and the experience in the operating room is very rich, even if he does not understand the details of the operation, he can know at a glance what the level of the surgeon is, which is the basic skill of all senior anesthesiologists.

The operation is at a critical moment, the sharp knife is wandering in the most dangerous area, Director Long, as the nearest witness, he now feels that he is not doing an operation, but participating in some kind of extreme sports, or this way of doing surgery can be named extreme surgery.

Because this kind of surgery conveys a different atmosphere all the time - limit, high risk and no mistakes, Director Long devoted all his knowledge to participate in the operation and became a qualified experiencer.

With the separation and ligation of the blood vessels, the operation proceeded in an orderly manner, and if this state was maintained, even if the blood transfusion department could not support more blood, Director Long believed that the operation could be completed safely, and he was instantly very relieved.

The tumor not only invades the duodenum, but also invades the stomach, the left gastric artery, the right gastric artery, the left gastric omentum artery, the right gastric omentum artery, the short gastric artery, the posterior gastric artery, a large number of blood supply arteries, the left and right gastric veins, the left and right gastric omentum veins and the short gastric veins, the first two directly merge into the portal vein, and the latter three indirectly merge into the portal vein through the superior mesenteric vein and splenic vein respectively.

It's really an intricate system of vascular networks, the sharp knife is like a bamboo, and it is irresistible, but it always swims in various gaps, and even if there are no gaps, he will carve out the gaps on his own.

Dr. Liao is the second assistant, he has become completely obsessed, and his understanding of this sharp knife is no longer a scalpel, but some kind of weapon with superpowers.

How did he quickly determine the location of blood vessels, and how did he quickly distinguish which were normal blood vessels and which were tumor blood vessels, because every time he cut off and ligated blood vessels, he did not hesitate, which shows that his judgment is extremely confident and accurate, and how he did it.

Dr. Liao had to think about this simple question.

In these complex anatomical gaps, Yang Ping didn't know how many blood vessels he had treated, anyway, he had been swimming between blood vessels, tumors, and organs, and it seemed impossible to deal with the blood vessels behind the pancreas and the blood vessels at the hepatic hilum position, which Yang Ping had completed in an extremely reluctant operation space.

There were even several blood vessels, which Director Long had seen with his own eyes, and he had picked them out directly from the back of the organs with curved forceps, that is, he was not treated directly at all.

Because those blood vessels cannot be treated directly at all, they are blocked by the liver and pancreas, and it is impossible to cut the blood vessels unless the liver and pancreas are cut off.

The operation was very cool, but it was too hard with the people who operated on it, whether it was Director Long or Dr. Liao, they felt very hard, because they had to concentrate a lot, and the nerves of the whole brain were tight.

"That's it!"

Yang Ping finished dealing with the last blood vessel.

As long as the blood vessels are dealt with, the subsequent surgery will be easy to handle, and Director Long is relieved.

At this time, Yang Ping, holding several vascular forceps clamping the tumor traction line, actually pulled the tumor out directly from the abdominal cavity, which was a complete tumor.

Didn't you just deal with blood vessels? Why did the tumor also cut out?

Director Long just saw Yang Ping separating blood vessels, but he didn't see that he was still separating tumors, and thought he was just dealing with blood vessels.

But Yang Ping is going hand in hand, the bright line is to separate the blood vessels, the dark line is to separate the tumor, and the tumor is also separated while separating the blood vessels, just now everyone didn't care, thinking that he was just dealing with blood vessels, and a large part of the tumor was hidden behind the organs.

"Director Long, take a look, I'll help you get the tumor out by the way."

Director Long immediately went inside to inspect it, and after touching it with both hands for ten minutes, all the tumors had been cut out.

Is this surgery over? Are you going to close your stomach?

By the way, help me cut out the tumor?

(End of chapter)