The Godfather of Surgery

Teng Guihua wanted to come over and ask a few questions, but was stopped by Chang Juan, who didn't want this woman to interfere with the doctor's treatment.

Although it is Fang Xiaoyun's mother, this mother does not have a daughter at all, and her daughter is just a money-making tool that is being squeezed.

If it could be sold, the mother would not even blink an eye, she sold her daughter for money, and paid the down payment and decoration for her son's house.

The doctor on duty in the interventional operating room is busy on the stage. A patient with spontaneous intracranial hemorrhage, interventional embolization, needs a few spring coils. I report it to the duty officer. He is coordinating and called the preparer over.

Song Zimo contacted the interventional operating room, and the spinal artery angiography had very high requirements on the interventional doctor's technique. It was necessary to superselect the interspinal arteries one by one, push the contrast agent, and identify them one by one.

In addition, an anterior spinal artery was embolized at the time. During the operation, the thrombectomy was cut and the thrombectomy was performed again. Once the angiography was performed, the risk of re-embolization was greatly increased.

How is it, Fang Xiaoyun's condition! Professor Zhang rushed to the general orthopaedic doctor's office.

Yang Ping immediately reported his analysis and arrangements to Professor Zhang. Professor Zhang sat down and took a breath: I have been thinking about it, too much like a dural arteriovenous fistula. I have encountered a case like this before, but it appeared. The symptoms were not so fast. At that time, the patient had low back pain, numbness and weakness in the lower limbs, and went to another hospital as a lumbar disc herniation. It took 6 hours for spinal artery angiography to find the fistula. Later, surgery was performed to treat the arteriovenous fistula. The patient recovered lower limb sensation and muscle strength. Fang Xiaoyun’s condition was more complicated. Spinal tuberculosis and dural arteriovenous fistula were mixed together. If it is true, it is too rare to have paraplegia at the same time. DSA will be arranged in the emergency department. If the diagnosis is confirmed, it will not be too late.

Hybrid operating room is a kind of hybrid operating room. Generally, it is a 100-level laminar flow operating room, which fully integrates DSA equipment and surgical equipment. It can complete interventional treatment, surgery and imaging examination in one operating room, so that some complex operations do not need to be decomposed. Achieve one-time completion, reduce surgical risks, reduce patient handling, and save operation time.

We have already arranged that the doctor on duty in the interventional department is busy and has no manpower. The chief on-duty is dispatching, and we have called the preparer to come over. Yang Ping introduced.

Director Han also hurriedly arrived: Xiao Yang, I contacted Director Shi of the Interventional Department, and they arranged for Director Ji to come over. Director Ji is the best in the interventional department and has done the most spinal artery angiography.

Great, at a critical time, Director Han can coordinate in the center, create conditions for Yang Ping, and at the same time take risks for Yang Ping.

Although the main shift can also be dispatched, it will not be as diligent as Director Han. As soon as Director Han communicates with Director Shi, people will know who you need, and will immediately transfer Director Ji instead of calling a doctor casually. Handle.

Have you communicated with the patient? Director Han asked.

Yang Ping nodded: We just communicated and signed the signature. The patient himself communicates very well. Her mother, in my opinion, is not good. She always hides and doubts this and that.

Director Han snorted: She is an adult, she can agree to it, the family members don't need to worry about it, Xiao Zhang, bring the medical records.

Zhang Lin immediately brought over the medical records. Director Han read the medical records. On the informed consent form for the operation, Yang Ping's name was signed in front of his name.

According to your ideas, I have something to take care of. As doctors, there is no way we don't take risks. We only need to proceed from the interests of the patient, be fully prepared, and control the risks. I have to make a phone call later. To Lao Zhao of the Medical Department, if this kind of family members have problems and potential disputes, go to them in advance to prepare the case.

Director Han handed over the medical records to Zhang Lin, and Professor Zhang waved, took the medical records, and added his name: Let's do it, this case is relatively rare, remember to collect information.

Xiao Wu, you are in charge of collecting information. Song Zimo and Zhang Lin will come to power with me, and Fatty will be anesthetized. Yang Ping made arrangements on the spot.

The Interventional Department called and asked us to send the patient. They brought two doctors and a nurse and opened a hybrid operating room for us to use. Song Zimo answered the phone and said.

Su Yixuan and Zhou Can quickly pushed the surgical instruments and microscopes to the interventional operating room. Orthopedic surgery requires a lot of specialized instruments. Spinal surgery has a complete set of spinal surgical instruments. The interventional hybrid operating room has only some general instruments and no orthopedic specialized instruments.

Let's go, send the patient! Director Han pondered.

Zhang Linxiaowu sent the patient and pushed Fang Xiaoyun to the operating room of the interventional department with a transport flat cart. The interventional operating room is located on the second floor of the emergency building, and the chest pain center is also located there.

The flat car of the comprehensive orthopaedic department was newly purchased. It has inflatable wheels and shock absorption. There is not much noise and vibration when pushed. Fang Xiaoyun's mother followed behind: Hey! Hey! Hey! What are you going to do————

What nonsense are you! Chang Juan blocked her, for fear that she would make a fool of herself and affect the doctor's work.

There are barrier-free operation passages between the buildings, and the flat car is hurriedly pushed to the interventional operating room. Director Ji and his assistants and nurses are already waiting in the operating room.

Old Zhang! Director Han! Director Ji greeted respectfully.

Doctor Yang! Director Ji also greeted politely, and others ignored it.

Now Yang Ping is also a celebrity in the hospital. Everyone knows his ability. The hospital is where technology is king. If the technology is good, everyone respects it. Despised for sure.

This patient is considering a dural arteriovenous fistula? The operation time will be relatively long, and it will take a blood vessel to superselection, to test, and there is a possibility of failure. I will try my best.

Director Ji is very honest, but he is very happy. He has never encountered such a rare case before. When he was studying in Fuwai, he heard the teacher talk about it. Now that he has encountered it clinically, he is naturally happy.

Professor Zhang encouraged him and said, Don't worry, I have done DSA for this kind of patient. You do it, and I will watch it for you in the audience.

That's the best, the older generation of doctors are not like now, they can only guard their own one-third of an acre. At that time, it was normal for them to dabble in some crossover techniques, and many old doctors would take X-rays themselves.

A week ago, the patient's thoracic 9 anterior spinal artery had an embolism. During the operation, the thrombectomy was cut and the thrombectomy was performed again. Yang Ping introduced, and then Zhang Lin introduced the patient in detail.

Director Ji said: The amount of contrast agent in the operation should be strictly controlled, otherwise it will easily cause re-embolization.

After the handover of the disease was completed, the young doctor under Director Ji signed the informed consent of DSA and the informed consent of iodine contrast agent for the patient.

Fatty was anesthetized and intubated for general anesthesia. The people in Yang Ping's team were different. Fatty's anesthesia was fast and good. He was still talking here, and he was numb over there, and he could brush his hands.

Director Ji admires this young team with excellent professional quality. This fat anesthetist is much better than his anesthesiologist, and his anesthesiologist is afraid of this and that.

Then let's go first, do the DSA of the spinal artery, we will do the femoral artery puncture, and we will come one by one. It is estimated that it will take five or six hours, or you will go out to rest first.

Director Ji, assistants, and nurses put on lead coats. Everyone looked for lead coats to wear. Professor Zhang also wanted a lead coat. The lead coat was airtight, heavy, and weighed dozens of pounds. Ten-year-olds will be miserable.

We are doing DSA in the supine position, find the fistula, and then change to the prone position for you to do the surgery, okay?

Director Ji came back after brushing his hands, disinfecting the sheets, and wearing gloves.

It's hard work, Director Ji!

It's alright, it's all doctors. This kind of thing happens often. Today, on my wife's birthday, I said I would have a meal with her. I just sat down and called. I can't help it. Who made us doctors?

Can you change someone?

It’s not necessarily true. In this case, a doctor with a good technique is required, and the success rate is high.

Director Ji is in his 40s, with gray hair and a lean body. He is one of several leaders of the Interventional Department.

The interventional department is divided into several wards, neurointervention group, cardiovascular intervention group, tumor intervention group, Lao Ji is the cardiovascular intervention group, and the cardiovascular intervention group is also an important part of the chest pain center.

Lao Ji came from the Department of Cardiovascular Medicine. After getting married and having children, he began to engage in interventional interventions. Generally, those involved in interventional interventions are often exposed to X-rays. Those who are not married and have children are unwilling to engage in it. Pick inside.

From the femoral artery puncture, the catheter guide wire was inserted, the old season was skilled, and the superselection of the first interspinal artery was successful.

It can only be checked one by one. Too much contrast agent is not enough, and too little is not enough. The dose must be accurate, and the method of superselection of blood vessels should be gentle and precise.

Push the contrast agent, Omnipac!

Omnipac is a non-ionic iodine contrast agent, which is a safe intraspinal contrast agent. For spinal artery angiography, a contrast agent that can enter the spinal canal must be selected.

Okay, enough, a little less, right? Mr. Zhang! Lao Ji asked Professor Zhang.

Yes, too much, it is easy to cause embolism. Professor Zhang has comprehensive knowledge and experience.

Yeah! When I went to study outside Fuwai, a colleague said that their hospital had a spinal artery angiography. After the angiography, the spinal artery was embolized, causing blood supply disorder to the spinal cord, ischemic necrosis of the spinal cord, paralysis, and a lawsuit was filed. For several years, it is better to have fewer high-risk factors.

But too little can not play a role in developing, so the amount of grasp should be very sophisticated.

No, the next one!

There are twenty-four intercostal arteries alone, and this is just the beginning, and one blood vessel can’t be fixed within ten minutes.

Mr. Zhang, are you going to rest for a while? I'll do it right here.

Director Han was afraid that he would not be able to bear it, so he stayed up late and wore such a heavy lead coat.

Professor Zhang waved his hand: It's okay, I have experience in this kind of case, and I have done this kind of DSA. I can give them some advice. Go out and take a rest outside. A few young men will have surgery later.

Professor Zhang's tone is stern, more like an order. He is out of the idea of ​​protecting young people. After all, everyone is not married and has children, so try to reduce X-ray exposure.

It's okay, I'm inside, I want to see the situation of the angiography. Yang Ping also wore lead clothes, and everyone wore lead clothes.

Professor Zhang lost his temper: Why are you disobedient? If you are asked to go out, go out, so many people are watching the fun!

Director Han immediately ordered Yang Ping: Professor Zhang and I are in there, you all go out, did you hear me!

After five or six hours of X-ray exposure, lead clothing cannot be completely protected, and surgery will be required later. Orthopedic surgeons often deal with X-rays and try to avoid unnecessary exposure.

Well, Yang Ping took everyone out and went to the locker room to rest.

By taking a nap, if Director Ji finds a fistula, he will call everyone.