Now that the family members have arrived, Director Fang is more cautious, and really talks to the family members again in the case of real-time video, explains every detail of the informed consent of the operation clearly, confirms that the other party has understood, and then asks Jiang Li's family representative ---to sign and press her brother on behalf of her brother.

Moreover, let the other siblings sign a formal power of attorney, which means that all siblings will hand over all the decision-making power of Jiang Li during Jiang Li's treatment in the hospital to Jiang Li's eldest brother, so that they are legally ready, even if the family members turn their faces and do not recognize people after surgery, they will not be limited to passivity.

There's no way, doctors are not careful now, it's easy to fall into the pit, and this society is so complicated by rat.

After signing before the operation, Director Fang checked whether there were any loopholes in his mind, and carefully sailed the ship of ten thousand years, which means that the operation should be careful, and the process of the operation should be careful.

After confirming that there were no loopholes, Director Fang asked the doctor in charge of the ICU to arrange the operation.

The doctor in charge began to contact the nurse on duty in the operating room to inform the operation, and the nurse in the ICU ward also began to prepare for the operation and send the patient to the operating room.

Parasites are generally divided into helminths and protozoa, and hepatic echinococcus belongs to the category of helminths.

Hepatic echinococcosis is relatively rare in the south, and the northwest of China is the high-incidence area, such as Xinjiang, Qinghai, Ningxia, Gansu, Inner Mongolia and Tibet, among which Nagqu in Tibet is the place with the highest incidence.

The treatment process is roughly as follows: the canine tapeworm as a worm is parasitic in the small intestine of dogs, and the eggs excreted with the feces often adhere to the hair of dogs, sheep and other animals, and people can be infected if they swallow food contaminated with eggs.

The eggs enter the digestive tract through the mouth, and under the action of intestinal digestive juices, the larvae will shed their shells and pass through the intestinal mucosa, enter the portal venous system, and enter the liver through the portal vein, and most of these larvae are left in the liver.

The larvae develop into hydatid cysts in the body after 3 weeks, and the hydatid cysts gradually grow in the liver, and the long-grown hydatid cysts cause compression symptoms of adjacent organs, and complications such as obstruction, infection, rupture and spread of hollow organs can occur.

Judging from the medical history, Jiang Li has been to the pastoral area of Nagqu, Tibet, where she may have been infected by hepatic hydatids, but Jiang Li went a year ago, if you calculate it this way, the onset of the disease is only one year, but now it has eroded most of the liver, and has also invaded the abdominal cavity and chest cavity, which is a little too fast.

This is only an epidemiological speculation, some animals are now more mobile, urban stray animals are increasing, and there will be some sporadic cases in non-high-incidence areas.

Hepatic echinococcosis: Once the cyst ruptures into the abdominal cavity, the cyst fluid contains a large amount of xenoproteins, which can cause a strong allergic reaction, resulting in peritonitis and anaphylactic shock.

CT is the most common imaging test to confirm the diagnosis of this disease, and the CT imaging findings that are conclusive to the acute abdomen of hepatic cyst rupture are the "snake sign" and the "spinning sign", which are characteristic image descriptions made by European doctors in 1990 and 1991.

Now Jiang Li is in a state of shock, there are two reasons for shock, septic shock and anaphylactic shock are mixed together, it is very difficult to treat, it is almost impossible to rely on drugs alone, emergency surgery must be carried out to remove the liver hydatid in the body, the liver tissue eroded by the liver hydatid, the ruptured cyst and the sac fluid that is scattered everywhere, only in this way can the pathogen be completely removed, and the anti-shock treatment during and after the operation can be used to save Jiang Li's life.

It is impossible to go home for dinner on time, Yang Ping called Xiao Su to explain the situation, so that the family did not have to wait for him to eat.

Everything was arranged, Yang Ping and Director Fang hurried to the operating room, Director Fang got some dry food, the two of them filled their stomachs in the locker room, and immediately changed their clothes.

Because there is a separate operating room at the Institute of Surgery, Yang Ping rarely performs surgery here, but when he heard that Yang Ping came here for surgery, everyone was very happy, and god-like figures would be worshiped wherever they went.

Besides, whether it is an anesthesiologist or an operating room nurse, no matter who wants to work in the surgical institute, not only the income is high, but the experience of working in the surgical institute is very valuable.

Not to mention anything else, anesthesiologist Liang Fatzi's girlfriend recently found is a flight attendant, which everyone knows, and the anesthesiologist circle of Sanbo Hospital is crazy, saying that Liang Fatzi is now developing with Yang Ping, not only earning money, but also having so many resources, and the future is immeasurable. If you don't have a lot of money, you can fall in love with a flight attendant.

As for Song Zimo, Xu Zhiliang, Zhang Lin, and Xiao Wu, who are the envy of the whole academy, Yang Ping's current preparation for the academician and the Nobel Prize is public, according to this trend, Song Zimo and Xu Zhiliang will be academicians sooner or later, and the newcomer Tang Shun will also be academicians sooner or later.

"Professor Yang!"

Whether it was the anesthesiologist or the nurse in the operating room who greeted Yang Ping politely, one after another, many people gathered in the operating room, and most of these doctors from general surgery came to observe Yang Ping's operation, because there are not many opportunities to observe Yang Ping's surgery at close range.

The itinerant nurses were not easy to catch up with Yang Ping's face, so they acquiesced to these guys gathering in the operating room, but fortunately, these doctors were more knowledgeable, and they paid attention to the concept of sterility and tried not to add chaos to the operating room.

Yang Ping just came in, and everyone was about to move a stool for Yang Ping to sit on, but the sharp-eyed itinerant nurse rushed to give the stool to him.

"My blood pressure is not very stable, and I can't go up." The anesthesiologist was worried.

Now he is a dead horse and a live horse doctor, severe shock, no surgery to remove the lesion, and blood pressure can't rise.

"The blood pressure is unstable, so we have to do it as fast as possible." Yang Ping nodded.

Director Fang has self-knowledge in his heart, this kind of operation is extremely difficult, if he comes to the main surgery and Yang Ping guides him to do it, it will definitely not be as fast as Yang Ping's main surgery, and when people's lives are at stake, it is not the time for them to study, and Director Fang still has this awareness.

"Professor, you're the main knife!"

As long as the operation time is not too outrageous, the quality of the operation can be guaranteed, and the effect of the operation will not be affected, but emergency surgery is racing against time, how can you let yourself take your time, a minute faster and a minute slower may be the difference between life and death.

"I'll do it! The patient's blood pressure does not rise, and if this hypoperfusion state is maintained, multi-organ failure will soon occur. ”

Yang Ping decided to take charge of the knife himself and make a quick decision.

Xiao Chen, a graduate student led by Director Fang, and another young doctor had already brushed their hands, and they began to disinfect the sheets.

Yang Ping has been maintaining a variety of surgical training in the operating room of the system space on a regular basis, so the operation has not been delayed because of scientific research, and the level of surgery has been rising, and now the case training in the system operating room is becoming more and more difficult.

For such a complex and difficult operation as Jiang Li, Yang Ping used to need to use the simulation function of the system space, but now there is no need for the simulation function at all, and the so-called difficult cases in reality are just simple operations for Yang Ping.

The preparations for the operation were almost done, and Yang Ping and Director Fang went to brush their hands and dress on stage.

"Doctor Luo, please help keep an eye on your blood pressure." Yang Ping told the anesthesiologist, Dr. Luo.

"Don't worry!"

Dr. Luo, an anesthesiologist, said that he was relieved, but his heart was empty.

Dr. Luo is about the same age as Liang Fatzi, he is under a lot of pressure now, he originally wanted to behave in front of Yang Ping, maybe he was selected by Professor Yang and picked up to the Institute of Surgery, and his life has been rising step by step since then, but this is the first operation with Professor Yang to match the table, this is not very good to play the level, what if there is some danger to life during the operation.

Yang Ping made an incision of the right upper rectus abdominis muscle, which was cut layer by layer and directly reached the abdominal cavity.

"I heard that she has been to Naqu in Tibet? It is the place with the highest incidence of hepatic echinococcosis in the world. ”

"There is an anesthesiologist in our department who just went to Tibet this year, and it seems that he is in that song."

"In fact, some parasitic diseases do not go to high-incidence areas, but are caused by liking to eat raw animal meat."

"The last time I anesthetized neurocysticercosis, I saw this kind of patient once, and I never dared to eat sashimi again."

"It's not a lot of people yet."

The anesthesiologist and the itinerant nurse were chatting, and Professor Yang's operation was fast and stable, which made people feel very relieved.

The liver was exposed, and the huge deformed liver filled the entire surgical field, squeezing the surrounding organs to the side.

Yang Ping used a straw to remove the sac fluid that flowed into the abdominal cavity, and it was the influx of these cysts that caused peritonitis, which in turn led to anaphylactic shock.

The ruptured naan is only a part, and there are the remaining unruptured pouches, Yang Ping continued to separate, these white large and small squeezed together pouches bulged out, dense, looking at people scalp numb, of course Yang Ping will not have a numb scalp.

This is the liver, this is a nest of worms.

Director Fang is an old fritter, and the two young doctors who are assistants are the first time to see this kind of scene, and they feel extremely uncomfortable.

Xiao Zhou, the young doctor who was the assistant, had already turned over his stomach and intestines, as if he had a feeling of acid water constantly bubbling out, and his forehead didn't know how to start sweating, but he was embarrassed to say it.

Finally, Xiao Zhou couldn't help it: "Director, I'm a little uncomfortable!" ”

Director Fang saw that he was sweating slightly on his forehead, and knew that this was disgusting to the disgusting picture of the operation area: "It's not a shame, I'm still engaged in surgery, I don't have any immunity at all, go to the side to rest, and then get on the hook." ”

Director Fang said impatiently that he was most annoyed by this kind of squeamish student, and he couldn't hold a disgusting scene.

Xiao Zhou couldn't help it, he really couldn't stand it, and it wouldn't be good if he couldn't help but vomit on the operating table, so he hurried down, and another graduate student immediately went to brush his hands to fill the gap.

Hepatic echinococcosis is not as scary as cysticercosis, if a person with dense phobia sees the X-ray of cysticercosis, he will faint directly, because on the X-ray, the patient's limb muscles are densely packed with white cyst calcification images, this kind of X-ray, as long as you see it once, you will never forget it.

As the dissection deepened, the liver and surrounding tissues eroded by hydatid were soon exposed, and there were white follicle-like hydatid cysts in the liver, which were crowded together and looked extremely terrifying.

Where is this liver, this is a bunch of bugs and cysts, countless white things, I don't know if it's bugs or cysts crowded together.

"When I was a kid in the countryside, I went to the toilet and saw piles of maggots piling up and rolling in the toilet, and now I feel like this, and I think now, some people still eat maggots as vegetables."

Director Fang's graduate student Xiao Chen said calmly.

When Xiao Zhou heard Dr. Chen say this, the stomach and intestines that had been slightly calmed down were now tumbling again, and he couldn't help but start retching in the corner, Director Fang looked up and said: "Which of you accompanies him out to rest, those who are engaged in surgery must be immune to these, not only to see no reaction, but it is best to eat a bowl of pork liver after surgery, then it is qualified." ”

Turning his head, Director Fang scolded Dr. Chen again: "Can you say a few words, especially to pick and choose disgusting, when the dish is eaten meat maggots, people specially cultivated under sanitary conditions, are they the same as maggots in your toilet poop, your brain follows up maggots." ”

"Director, don't I feel this way?" Xiao Chen hurriedly explained.

"Please, you two please don't say that, I feel like throwing up right now."

The itinerant nurse immediately stopped Director Fang's disgusting topic.

There are many blood vessels in the liver, and many places are eroded by hydatids, which is easy to injure the blood vessels and cause massive bleeding if you are not careful, and the three hepatic hilar vascular nerves are complex and intertwined.

But Yang Ping's dissection is too skilled, and he has encountered all kinds of pathological dissections, so this operation is also very easy.

In order to catch up with the speed, Yang Ping's movements were very fast, and when Director Fang couldn't keep up with the rhythm, Yang Ping had to operate it by himself.

Soon, before Director Fang could react, Yang Ping had already dissected the entire liver, and after the liver was removed, his field of vision immediately widened, and the hydatid tissue around the liver was also easily removed.

Yang Ping asked Director Fang to go to another sterile table to process the isolated liver, cut off all the liver lobes eroded by hydatids, and left the healthy liver lobes for autologous transplantation. He took Dr. Chan with him to treat the hydatid-infested tissues of the abdominal cavity and thoracic cavity.

In order not to contaminate normal organs and tissues, Yang Ping used gauze to isolate the surgical area from the surrounding area.

Why is this girl's condition so serious, how many years has it taken to develop like this, he went to Tibet only a year ago, how can the disease develop so quickly.

Yang Ping opened the diaphragm upwards and entered the chest cavity, which could facilitate the cleaning of all the hydatids, vesicles and hydatid invasion tissues around the liver, and then rinse them repeatedly with normal saline.

Then Yang Ping and Director Fang worked together on the liver, Director Fang is no stranger to autologous liver transplantation, celiac organ cluster transplantation includes autologous liver transplantation, if you are not in a hurry, this operation Director Fang really wants to be the main surgeon, but following Yang Ping in this way, in fact, Director Fang can also learn a lot of things.

Autologous liver transplantation is a very difficult operation for others, but for Yang Ping, it is very simple, but it is a matter of anastomosis of several tubes, including several blood vessels and a bile duct, whether it is allogeneic liver transplantation or autologous liver transplantation, Yang Ping in order to reduce the possibility of cholestasis, not only anastomosis of the bile duct, but also the capillary bile duct is seriously anastomosed.

This allows for the most unobstructed biliary system and minimizes the complications of cholestasis.

Yang Ping is also very particular about the hepatic arteriovenous anastomosis, not only considering the number of arteriovenous anastomosis, but also trying to maintain the pressure of the original hepatic arteriovenous circulation.

On the sterile table, Yang Ping and Director Fang quickly completed the resection of the liver, and only two of the five lobes of the liver are now healthy, and now they have to replant these two lobes back into the patient's body to continue to function.

The first is the latest.