Professor Chen Jianliang stood in front of the reading lamp and discussed with Yang Ping.

Although he has retired, he is most interested in his profession, he has been a doctor all his life, and he feels that he can only have a sense of existence when he treats diseases and saves people, and he always can't find a sense of existence when he does other things, and he is very confused and empty without a sense of existence, and he doesn't know where the value of life is.

Now, Professor Chen usually only goes out of the outpatient clinic, basically does not participate in surgery, and he is still fighting on the front line when he sits in the outpatient clinic, but as a surgeon, how can he endure sitting in the outpatient clinic all the time, and he is naturally lonely and lonely after a long time.

Just like a sniper on the battlefield, although he still stays on the front line, his post is no longer to shoot and kill the enemy, but to squat in the fortifications and take a telescope to look at the battlefield and collect battlefield intelligence, and the mood must be difficult to adapt.

In order to regain this sense of existence, Professor Chen can only try to find opportunities to rub the operation, of course, he will not go on stage to cause chaos for young people, he just feels the atmosphere in the operating room, participates in the surgical discussion and says a few words, and then looks around the operating table.

He is like this now, carefully choosing a position to stand, for fear of interfering with everyone's normal work.

"The blood vessels are estimated to be very thin, and it is a little difficult to bypass, but without bypassing, the current vascular obstruction cannot be lifted, and it is difficult to ensure the quality of anastomosis with such thin blood vessels, what are you going to do?" Professor Chan asked.

Yang Ping nodded and said: "The blood vessels are indeed very thin, but it doesn't matter, this diameter of the vascular bypass should not be a big problem, and I often do it with a vascular bypass that is thinner than this."

When the diameter of the blood vessel is very small, generally less than 1 mm does not choose vascular bypass, but chooses the simpler the surgical application, because the thinner the blood vessel, the higher the requirements for vascular anastomosis technology.

However, if the level of vascular anastomosis is high and there is no problem of vascular blockage after anastomosis, then less than 1 mm can still be bypassed.

Professor Chen knows Yang Ping's level well, no matter what vascular anastomosis, as long as the manpower is within reach, then Yang Ping will definitely be able to do it, at least in Professor Chen's experience, Yang Ping is the pinnacle of surgery.

"Are you going to do a patch after the bridge?" Professor Chen knew that Yang Ping would definitely care about the effect of the operation, regardless of the difficulty of the operation.

"A two-pronged approach, save the fire from afar and the fire together." Yang Ping said.

Professor Chen touched his chin and bowed his head slightly, the operation was done, there was nothing to say, it should be the most perfect plan.

Sissi's surgical position was supine, her head was fixed with a fixator, slightly elevated, and anesthesiologist Liang Fatzi kept Sissi's blood pressure slightly higher than usual.

Zhang Lin and Xiao Wu completed the disinfection sheet, Yang Ping brushed his hands to the stage, the itinerant nurse pushed the microscope for backup, and the operation officially began.

It seems that everyone is not in a hurry, but the operation is not delayed at all.

Emergency surgery, Yang Ping didn't have time to explain while doing it, but he just buried his head and ran all the way, if this kind of emergency surgery is still explained, the speed of speech cannot match the speed of hands.

Everyone has to learn to only watch the synchronous operation video, and then ask Professor Yang after the operation if there is something they don't understand.

Dr. Jin, Dr. Wen and Xia Shu are very envious of Zhang Lin Xiaowu, when will they be able to win most of the surgeries like them, that is to really keep up with the rhythm of the Institute of Surgery.

Now they are just the tail of the team, they used to be the elites of their own departments, but when they arrived at the Institute of Surgery, they found that they were not as good as Zhang Lin Xiaowu.

Shameful and courageous, the three of them secretly decided that they must work hard and surpass Zhang Linlin Xiaowu, of course, it seems that these two people are the easiest to surpass, and it is very difficult to surpass Song Zimo and Xu Zhiliang.

The three doctors are now very serious about watching the synchronized surgery video on the screen, and they are not willing to let go of every operation and every detail.

And they now understand how powerful the training of doctors is in the Institute of Surgery, and with their foundation, in this environment, under this kind of training, as long as they work hard, over time, they will become great.

What Zhang Lin and Xiao Wu can do, they must be able to do, and they can far surpass them.

Dr. King used to feel that he was too old, in his 40s, and felt that he had missed the best opportunity to train as a surgeon, but now he has no such thoughts at all, and he is full of energy and ambition.

Dr. Li Min also understood why Professor Yang must be so persistent in letting him learn anatomy and practice basic skills in various ways.

In the past, Li Min did not have much knowledge of moyamoya disease, a rare neurosurgical disease, and he did not know how to do specific surgery.

Now he is not only very familiar with this disease, but also knows the operation by heart, because he now has a wealth of anatomical knowledge, as well as a complete knowledge of pathology and pathophysiology.

As long as Yang Ping mentions it slightly, or even without Yang Ping saying it, he can understand the principle and method of surgery for this disease.

Even if he was faced with such a case, he would dare to do a relatively simple patch surgery.

After the foundation is solid, the subsequent learning will naturally be easy.

Yang Ping didn't speak, he focused on the operation, and Xiao Wu Zhang Lin was the assistant.

The first is vascular bypass, and Yang Ping intends to bridge the superficial temporal artery with the middle cerebral artery first, which is the most important bridge.

Some bridges can be built directly, and some bridges must be bridged using blood vessels.

The bridging blood vessels are generally cut directly from the scalp, and Yang Ping's action is very fast, and several arteries of suitable diameter and length are removed for backup.

The bypass blood vessels were taken, and Yang Ping separated the superficial temporal artery.

The superficial temporal artery is the terminal branch of the external carotid artery, which runs from the lateral temporomandibular joint between the ear and travels up to the scalp.

If this surgery is exquisite, it is best to use intraoperative color ultrasound to locate the superficial temporal artery, use color ultrasound to look for its shape, and then mark it.

The superficial temporal artery is separated according to the marker.

Yang Ping is too familiar with human anatomy, so he doesn't need color ultrasound positioning at all, which can save more operation time, but this is only limited to him.

In order not to mislead other doctors, every time he does this kind of omitted operation, he will remind everyone: "When you do this surgery, you must use color ultrasound to locate the superficial temporal artery, and you must not learn from me to omit the operation."

Xia Shu has not been here for a long time, and he is not very familiar with some things, but he is very serious, and he likes to get to the bottom of the problems he doesn't understand, and he must be clear, so he asked curiously: "Why can't we do this?" Wouldn't that be nice? Skip a step to save surgery time, especially in the case of emergency medicine. ”

If you want to pursue the quality of surgery, you must locate the superficial temporal artery, so that you can more accurately grasp its walking route, and protect the blood vessels to the greatest extent and avoid damage when cutting blood vessels." Professor Chen replied to Xia Shu.

It turned out to be the reason for the level of surgery, and Xia Shu finally figured it out.

After separating the superficial temporal artery, Yang Ping selected a suitable position in the superficial temporal artery walking area as the vascular anastomosis point according to the movement of the superficial temporal artery in the scalp and the preoperative image pictures and the anatomical characteristics of the head of the two-year-old child, so that it was located in the center of the skull bone window that was about to be excavated.

The surgical incision is designed to be approximately 0.5 cm distal and proximal to the vascular anastomosis, i.e., approximately 1 cm of incision.

This is a minimally invasive method, and in the case of an adult, the anastomosis is only about 2-2.5 cm and the incision is about 5 cm, which is much smaller than the incision of traditional surgery.

"This is not the traditional method?" Professor Chan could tell.

"Minimally invasive!" Yang Ping said as he did it.

The first condition for this minimally invasive approach is to be precise in the determination of the anastomosis point, which must be the closest point between the superficial temporal artery and the middle cerebral artery.

If you want to find this optimal position, you usually rely on the help of a CTA-based navigator, but Yang Ping can accurately locate it with the help of images alone.

After making an incision, Yang Ping made a bony window with a diameter of about 0.5 cm in the center of the anastomosis, entered the skull through the bony window, and then opened the dura mater.

The itinerant nurse immediately pushed the microscope, and Yang Ping looked for a suitable recipient artery to isolate under the microscope.

The temporal muscle is incised, and then a window with a diameter of 1 cm is opened, and the dura mater is opened, from which less than 1 cm of the recipient vessel is freed, and the thinnest microvascular clip is temporarily clamped.

"In this step, everyone should pay attention to not distorting the blood vessels, once twisted, it is easy to cause blood vessel blockage." Yang Ping reminded everyone.

"Knock on the blackboard, trick!" Zhang Lin reminded everyone.

Li Min immediately took out a small notebook, and almost at the same time, several other doctors also took out their notebooks, and it seemed that everyone had similar routines.

Yang Ping carefully cut the recipient blood vessel with microscopic forceps, and performed an end-to-side anastomosis between the superficial temporal artery and the recipient artery.

Indocyanine green is a fluorescent imaging agent, while Yang Ping's current microscope has a fluorescence imaging function.

In this way, under the microscope, blood flow in the blood vessels can be observed by fluorescence.

"This step must not be saved, no matter how confident you are, you see, even I have not saved this step."

Yang Ping once again reminded everyone of the key steps.

After completing the bypass between the superficial temporal artery and the middle cerebral artery, only one blood vessel was anastomosed, Yang Ping was not at ease, and then he bridged and anastomosed the other two blood vessels.

At this point, the first step of the operation has been completed.

In the second step, the temporal muscle patch and dural inversion are completed, which is much simpler.

The temporal muscle and dura mater are rich in blood circulation, and it is attached to the surface of the brain tissue, because the cortex of the brain tissue is ischemia, it will secrete a special substance, and under the stimulation of this special substance, the temporal muscle or dura mater will grow blood vessels towards the cortex, improving the blood supply to the ischemic brain tissue.

In this way, the original malformed blood vessel is replaced by a new blood vessel.

The whole operation actually took half an hour to solve, and it seems that the surgical steps are not complicated.

Li Min, who was watching from the side, felt that he could do this operation by himself, and it seemed to be very simple.

In fact, this is an illusion, mainly looking at Yang Ping's surgery, no matter what kind of surgery it is, it gives people an intuitive feeling that it is very simple, so simple that interns can also be eager to try.

——

Sissi's mother finally arrived at the hospital, and outside the operating room, she anxiously asked Sissi's father, "How is Sissi now?"

"Emergency surgery?" Sissi's father said.

"Do I have to have surgery? What's the situation, it won't be a big deal, right? Sissi's mother was very anxious.

"It's inside, it's not long after I went in, don't worry, Professor Yang is in charge of the surgery, it's definitely fine." Sissi's father comforts Sissi's mother.

"What about my parents? Didn't they come along? ”

"Here, I guess I'm arguing downstairs, my mother didn't allow the doctor to examine Sissi, saying that it hurt her body, and she didn't allow surgery, and the doctor said that this matter couldn't be delayed, so I didn't care about them, and forcibly gave me the idea, and when I was still in the emergency department, my father pulled my mother out of the room, and now I guess it's still quarreling."

"You must not listen to them in this matter, you just have to be like this, usually small things are fine, this kind of big things must not let them mess around, don't care about them, I don't know my own parents yet." Li Ni didn't blame her husband at all, she felt that her husband did the right thing.

It's just that his daughter is now undergoing surgery, and he is really worried.

The two were chatting when the door of the operating room opened, and if the doctor hadn't called the family and said that the operation was done, Sissi's parents would have thought that there was something wrong with the operation.

The whole procedure took less than an hour from entering to coming out.

——

Yang Ping explained the operation to Wang Chengpei and his wife, telling them that the operation was very successful, and they could drink and eat six hours after the operation, and they could be discharged from the hospital after a few days.

Wang Chengpei thought that thanks to his former colleague Guo Peihua, Guo Peihua had a great understanding since that accident, and he never stayed up late or worked overtime in the future, sold his original house, bought a house near Sanbo Hospital, and quit his original job to find a job near Sanbo Hospital.

When Wang Chengpei once had dinner with Guo Peihua, he talked about the problem of his physical examination electrocardiogram, Guo Peihua suggested that Wang Chengpei must not be careless, once something goes wrong, it is a big deal, Guo Peihua is a person who has been closed for a while.

Wang Chengpei pondered that this was really the case, so he was a little afraid, and immediately discussed with his wife, his wife was more supportive of him in everything, so he sold the house and bought a new house near Sanbo Hospital.

The couple waited by their daughter's bedside, and by this time the old man and the old lady had stopped arguing and found the ward.

"I just said what to move, it's unlucky, don't listen to me, no, something happened, right?" Mother-in-law chattering.

As a son-in-law, it is not a matter of principle, and he will definitely not talk back.

But daughters are different, Li Ni is not afraid of his mother.

"The doctor said that this disease is congenital and is born with it, so what does it have to do with moving a house? I just didn't find it before, but if it weren't for the proximity to the hospital now, I wouldn't know what to do. ”

"The doctor said yes, can you have some brains? Now the doctors are making money and scaring you, and I haven't seen it in the news. "Mother-in-law is full of words.

"That's a small probability event, there are scum in any industry, and the news also reports that bank deposits are missing, and your bank deposits are gone? Have you taken a client's deposit again? ”

Li Ni retorted to her mother, who worked in a bank before she retired.

The mother was speechless by Li Ni's rebuttal, Li Ni knew that her husband usually let her mother, she was not used to it, and every time she stood by her husband's side to defend her husband.

"How do you speak?"

"I'm just using an analogy, don't hear those reports of small probability events and think that everything is like this."

(End of chapter)