The little girl, Sissi, now has hemiplegia on the left side of her limb, indicating a blockage of a blood vessel, which means that the brain tissue innervated by that blood vessel will infarct after a certain amount of time.

Emergency surgery to restore blood supply and reverse the condition before the infarction of the brain tissue, and the hemiplegia of the left limb will return to normal, so as to avoid lifelong disability.

Once there is a cerebral infarction, the condition is irreversible, and the left limb hemiplegia will be left for life.

The core of moyamoya disease surgery is the treatment of blood vessels, but the treatment of intracranial blood vessels, the most critical of which is vascular anastomosis.

Coronary artery bypass grafting of the heart is also vascular anastomosis, organ tube transplantation or vascular anastomosis, which shows how important vascular anastomosis is as a basic skill, and it can be seen in many cutting-edge surgeries.

Yang Ping tirelessly asked the doctors in the department to repeatedly train the basic skills, so that the basic skills could be mastered.

Even though Song Zimo and Xu Zhiliang were so powerful, he still asked them to train their basic skills regularly and achieve never-ending progress.

In fact, any complex surgery is a combination of basic surgical skills.

For example, in the case of moyamoya disease, after figuring out its pathogenesis, treatment is a combination of basic techniques.

This little girl is a symptom of ischemia, ischemia is caused by a blockage of blood vessels, and to solve the blockage, either unblock the blood vessels or re-establish new blood vessels, bypass the original blockage, and transfer the blood through. The former is not possible because of the congenital cause of moyamoya disease blood vessels, and the latter is the only option.

Both dressing and vascular bypass grafting are aimed at re-establishing new blood vessels, but in different ways and processes.

Zhang Lin and Xiao Wu had already gone to the emergency department for consultation, and Yang Ping was in the office facing the computer to ponder the little girl's surgery.

Consultation of these things, as long as it is not a very special case, Zhang Lin Xiaowu can deal with it independently.

There are three types of surgical methods for moyamoya disease: vascular bridging, that is, direct revascularization, which is difficult to operate and requires excellent vascular anastomosis technology, which can achieve immediate results, but the scope of bridging a blood vessel is limited.

The second method is patching, which is to apply tissues with abundant blood supply outside the brain to the brain, and the blood vessels of these tissues will slowly grow into the brain after the operation, so that the surface of the brain can establish a rich collateral circulation with the brain tissue that needs blood circulation, and after 3 to 6 months, the blood vessels of the attached tissue will spontaneously connect with the blood vessels in the cerebral cortex. This method is simple, and the onset of the surgery is slow, and it takes 3-6 months to show results.

The third method is to combine the first two methods and do both surgeries, so that you can learn from each other's strengths, avoid the disadvantages of both surgeries, and synthesize the advantages of both surgeries.

This two-year-old child has relatively thin blood vessels, so most doctors will choose the second method, but this little girl is now showing symptoms and is obviously not suitable for a method that takes 3 months or half a year to show results.

Yang Ping decided to use the third method, which is to do the vascular bypass and dressing together.

It is very difficult, but the effect is the best, here in Yang Ping, there is never a difference between high and low difficulty in surgery, only good or bad results.

In this patient, the bypass is not yet a one, and Yang Ping plans to build many roots.

Emergency Department.

The emergency doctor has done a preoperative examination for Sissi and is ready to be sent to the operating room for emergency surgery after signing the contract.

Sissi's father, Wang Chengpei, was very anxious at the time, and he made the six gods ownerless at once, and it took a while to come to his senses.

Because not long ago at home, Sissi did not fall, did not suffer any external injuries, was watching cartoons, and suddenly the left limb could not move, and the child cried without knowing what was going on.

Grandma hurriedly came over to coax, and found that one side of Sissi's limbs could not move at all, at first she thought that she had fallen and fractured, but obviously she didn't fall, and the whole family watched Sissi watch TV and watch it well, and suddenly something was wrong and she started crying.

If it is an old man, they will definitely be able to think of a stroke, but how can a child have a stroke, so the first thing they must think of is injury.

The family didn't dare to delay, because her mother had not yet gotten off work after overtime, and her father Wang Chengpei and grandparents immediately came to the hospital with Sissi.

Fortunately, the home is close to the hospital, so I arrived quickly.

The emergency doctor was very experienced, and after asking a few words casually, he felt that it was a cerebrovascular problem after a little examination, but in order to be safe, he shook Professor Chen Jianliang from the Institute of Surgery.

After the physical examination, Professor Chen said: "This must be a cerebrovascular problem, either cerebral hemorrhage or cerebral infarction, do an emergency cerebral angiography, right?"

"Isn't this a fracture or dislocation? How can a two-year-old child have a cerebral hemorrhage and cerebral infarction? You ask the orthopedic surgeon to take a look at it. "Grandma Sissi didn't agree to do a cerebral angiography, it sounds like it's quite complicated, especially when I heard that the contrast agent is put into the body, Sissi's grandmother disagrees even more.

Professor Chen said confidently: "This is a cerebrovascular problem, it is likely to be a cerebral infarction, don't waste time, just do cerebral angiography, once diagnosed, treatment is a race against time, if delayed, it will be a lifetime of semi-paralysis."

When Wang Chengpei, Qianqian's father, heard that this matter could not be determined by the old man's temperament, the doctor was professional, so he immediately made up his mind: "Doctor, I am the child's father, we listen to you, I will sign it, hurry up and arrange it according to your wishes, and race against time." ”

Grandma still wanted to stop: "No, the child can't stand the toss, wait for Li Ni to come over."

Li Ni is Sissi's mother and is on her way back.

"No, this matter can't be delayed, doctor, hurry up and arrange, listen to me, I am the child's father and the child's legal guardian, don't listen to the old man, the old man doesn't understand anything." Wang Chengpei said resolutely.

Usually Wang Chengpei is submissive in front of his father-in-law and mother-in-law, as if he doesn't have his own ideas about anything, and listens to the old man, but how can this kind of big thing be vague.

What is this attitude? How does this speak?

What listens to you? What are you the legal guardian of your child?

The mother-in-law immediately got angry and wanted to be mad, planning to make her call the shots about this, but the father-in-law grabbed the mother-in-law: "Listen to the child's father, what do you know, don't be foolish."

"Am I fooled?" The mother-in-law felt that her father-in-law was not on her side at this time, and was ready to scold.

The father-in-law pulled his mother-in-law to the outside of the emergency department, as if he was determined to pull her away from the scene, and in the noise, the father-in-law finally pulled the mother-in-law out of the emergency department.

Wang Chengpei has no time to care about whether they quarrel or not, he must keep a clear head, and now a wrong decision will affect the child for the rest of his life.

Because the couple was a little deficient in fertility, the girl was successful in several IVF sessions, and the couple was already 45 years old, that is, 43 years old before they got a daughter.

Now that their daughter suddenly has this symptom of hemiplegia, how can they not be in a hurry.

"Doctor, please help, save Sissi, it's all up to you, hurry up and arrange it." Wang Chengpei was anxious.

Her wife Li Ni is the head teacher of the senior high school graduating class, and she is very busy with work.

"We'll arrange it right away, take the green channel." Professor Chan immediately instructed the emergency doctor to arrange the examination, and at the same time instructed the doctor to probably perform the emergency surgery and complete the preoperative examination together.

In this way, Sissi was able to get a clear diagnosis in the shortest possible time.

At this time, Zhang Lin Xiaowu rushed to the emergency department, and Professor Chen handed over the next things to Zhang Lin and Xiaowu.

After understanding the situation, Zhang Lin stayed to communicate with the patient's family and arrange the operation, and Xiao Wu went to the operating room to prepare for the operation.

"Don't worry, you see, Wang Qianqian has moyamoya disease, which is a congenital cerebrovascular malformation, this disease has existed since birth, but it is just developing now, you see, this is a malformed blood vessel, like a cloud of smoke, so it is named moyamoya disease."

"These smoke are malformed blood vessels, because they are too thin, much thinner than normal blood vessels, so they are like smoke, these very thin blood vessels are difficult to pass through the blood, so their downstream blood vessels are very easy to block, and now it is blood vessel blockage, to put it bluntly, it is cerebral infarction."

Wang Chengpei doesn't understand moyamoya disease, but he still understands cerebral infarction very well.

"Now we have to take steps to restore the blood supply to this infarcted area with surgery, and if the blood supply is restored in time, it will be possible for the left hemiplegic limb to return to normal."

"If the blood supply is not restored in time, this infarcted area will become an infarct area, and the left limb hemiplegia will become permanent."

"So we're going to have emergency surgery."

Zhang Lin is like a big professor, full of momentum, medium speed of speech, and clear words.

Wang Chengpei now understands the general meaning of what Zhang Lin said.

In fact, Wang Chengpei bought the house near this hospital for a reason, because his physical examination found that the electrocardiogram was abnormal, but he never found the reason, so he has been worried about his health.

He had heard from others that buying a house around the area was equivalent to buying a health insurance, and he had heard that a wealthy businessman in Southeast Asia had bought an entire property for medical treatment. That's why I bought a house near Sanbo Hospital, and I just moved in.

I didn't expect that I didn't use this "insurance", but my two-year-old daughter did.

"Doctor, you must do your best to help, can you ask Professor Yang Ping to perform the surgery, we bought the house here, we came to Professor Yang Ping, Guo Peihua, what you know, is the life you saved, I am his former colleague."

At that time, Wang Chengpei decided to buy a house here when he heard about Guo Peihua.

"My name is Zhang Lin, and I am the attending doctor of Professor Yang Ping's team."

Zhang Lin said confidently, and then handed over an informed consent for the operation, and Wang Chengpei signed his name with a brush.

Anesthesiologist Liang Fatzi heard Zhang Lin's call and rushed back, the fat man was preparing to go out to eat and watch a movie with the stewardess Liao Yiyi, and when he heard the emergency surgery, he had to rush back, and the stewardess Liao Yiyi also followed the fat man.

She saw the scene of the doctor saving the wounded, and felt that her boyfriend was a doctor, and she was very proud and secure.

The fat man immediately printed out the anesthesia informed consent and signed it for Wang Chengpei, but he didn't even look at it, and signed it immediately.

Sissi's preoperative examination has been done and she will be pushed to the operating room soon.

Wang Chengpei breathed a sigh of relief after signing, he didn't think much about it, in order to save time, he just signed the informed consent form at a glance, and he couldn't understand it anyway, he believed that the doctor here, handing over the child to the doctor was the best choice, and if he was indecisive, he would only delay the treatment.

His wife was still on the way back, and when she heard that the child was hemiplegic on the left side, his wife was so anxious that she couldn't speak clearly, and the logic of her phone call was confused.

The fat man's movements were very quick, and he had already given sedatives to Sissi when he was in the emergency department, so that Sissi was sent to the operating room without crying or making trouble.

Because the child is young and the blood vessels are thin, this operation is more difficult.

If it is just a patch application, Zhang Lin Xiaowu can complete it independently.

However, the application technique does not save the near fire from far water, and it cannot solve Sissi's current problem.

Therefore, it is necessary to do vascular bypass, and one vascular bridge has very limited improvement in blood supply, and in order to increase the amplitude of blood supply improvement, several bridges need to be built.

Each bridge must not only ensure the quality of vascular anastomosis, but also the location selection of the bridge must be very accurate, which Zhang Lin and Xiao Wu can't do.

If Yang Ping had guided them throughout the process and told them where they should have bridged, they should have been able to complete the operation.

Now this kind of surgery has to race against time, and it is necessary to shorten the operation time to the shortest possible time, open the blood supply in the shortest possible time, and save the brain tissue that is on the verge of necrosis.

Even if Zhang Lin and Xiao Wu could take down the operation, their speed would definitely not be fast, so Yang Ping decided to take charge of the operation himself.

Hearing that there was an emergency operation, Xia Shu, Dr. Jin, and Dr. Wen hurriedly finished dinner and immediately rushed to the operating room to help.

When they heard that Professor Yang was in charge, they wanted to learn even more.

Professor Chen Jianliang, who was in charge of the consultation at the beginning, also went to the canteen to have dinner in a hurry and rushed to the operating room to observe.

He also wanted to see how Yang Ping did this surgery, because in Professor Chen's cognition, Yang Ping can do the operation better than others every time, even if it is an ordinary operation, Yang Ping can also make a higher realm, not to mention this difficult moyamoya disease.

The fat man arranged Liao Yiyi to read in the anesthesiologist's office and concentrate on anesthesia.

The fat man's movements were very fast, and he quickly completed Sissi's tracheal intubation under general anesthesia.

When they were in the emergency department, the nurse had already shaved the head of the child and put them in a position, Zhang Lin and Xiao Wu began to brush their hands and disinfect the patient.

They knew in their hearts that this kind of operation was difficult and pursued the ultimate speed, which was not something that their brothers could play, and Professor Yang would personally take the stage.

Yang Ping came into the operating room and stood in front of the reading light to look at the pictures of Sissi's cerebral angiography.

At this time, he is already confident that he will complete the operation in two steps, first do vascular bypass grafting, because vascular bypass grafting can play an immediate role, once the bypass is successful, the ischemic area can immediately obtain blood supply, so as to prevent the death of local brain tissue to the greatest extent.

And Yang Ping doesn't plan to build just one bridge, he plans to build several bridges to form a blood supply system.

The second step is to do the dressing, which can increase blood circulation in the long term and further ensure the effectiveness of the surgery.

Such a two-pronged strategy can solve the problems of the near and far at once.

The surgery has begun, and Sissi's mother is still on her way.

And Sissi's grandparents quarreled in the parking lot outside the emergency department, of course, grandma kept scolding, and grandpa coaxed hard.

PS: I'm sorry.,Copy this chapter in the draft sent out.,A lot of it is garbled.,It's all corrected just now.,Thank you!

The first is the latest.