The Godfather of Surgery

Teng Shaokui took his daughter and carried large and small luggage into the general surgery ward. The ward was a three-person room, which was quite spacious. The beds were separated by curtains.

The enthusiastic nurse measured Xinmei's heart rate, blood pressure, etc. It was the first time for the little girl to come to such a big hospital. She felt it was very novel. She looked around, but she felt uncomfortable just thinking about spending 100,000 yuan.

Do you need a companion bed? the nurse asked after finishing her work.

There are only beds in the ward. If family members accompany the patient, they can be given a companion bed. This companion bed is foldable and can be folded up during the day for centralized management. At night, it can be taken over and opened to create a bed.

Teng Shaokui asked the nurse: Is there a charge?

Thirty dollars a night, the nurse said.

Teng Shaokui scanned the room. There was a chair next to each bed. You can sit on the chair and sleep on it. Besides, the hospital has a garden and a hall. There are many long chairs in the garden and hall, and you can sleep on them. These thirty yuan can be saved. .

Teng Shaokui waved his hand: Forget it, no need.

But Teng Shaokui immediately felt something was wrong. He was afraid that his daughter would feel uncomfortable, so he immediately changed his mind and said, Here's one.

Teng Shaokui understands that if he behaves too frugally, the girl will be preoccupied, overthink, and feel uncomfortable.

As for the shortfall in surgery fees, Teng Shaokui was also worried and racked his brains to figure out where to make up the money. However, this anxiety could not be shown on his face, which would increase his daughter's mental burden.

After settling down, Teng Shaokui felt much more at ease. The hospital recommended by the provincial government security was definitely the right one.

The doctor in charge was Li Guodong, who was on duty that day. Li Guodong inquired about the medical history in detail, conducted a series of physical examinations, carefully read the outpatient examination report, and then made records.

There is no doubt that Teng Xinmei’s diagnosis is hypertrophic obstructive cardiomyopathy. He has had dyspnea and chest pain for more than ten years after exertion; an obvious systolic murmur can be heard in the auscultation area of ​​the aortic valve of the heart; the evidence from outpatient examination is also very sufficient. The main examination, echocardiogram, shows severe asymmetric hypertrophy of the left ventricle and interventricular septum.

The combination of chief complaint, physical examination and auxiliary examination makes the diagnosis very clear.

After asking about the medical history, Li Guodong told Teng Shaokui not to be anxious, but to complete the preoperative examination first, and then schedule the operation. After finishing his work, Li Guodong left the ward.

Teng Shaokui asked Xinmei to rest in the ward. He followed Li Guodong out of the ward and came to the doctor's office.

Doctor Li—— Teng Shaokui didn't know what to say.

Li Guodong said gently: If you have anything to say, just say it. I am your daughter's doctor in charge. If you have anything you don't understand, you can come to me at any time.

Teng Shaokui plucked up the courage and said, Dr. Li, the outpatient expert said that the surgery fee will be 100,000 yuan. Is this 100,000 yuan paid at once before the operation?

Li Guodong gestured to Teng Shaokui to sit down: This 100,000 yuan is just an approximate cost. It is not just the surgery fee, but the cost of the entire hospitalization. In principle, it must be paid in full before the operation.

That's it - Teng Shaokui's face turned a little red: Dr. Li, I won't hide it from you. I only prepared 10,000 yuan and I don't have medical insurance. I know it will not be enough. I mean, can I The operation is scheduled as normal and I will pay the money in installments. I am afraid that I will not be able to pay 100,000 yuan before the operation.

As he spoke, Teng Shaokui took out his ID card from his jacket pocket and showed it to Li Guodong: Doctor Li, this is my ID card. You can check it.

Also, Teng Fakui took out a house book: This is my house book in the countryside. I know it is not valuable, but it is also a guarantee.

While talking, Teng Shaokui glanced at the office door from time to time, fearing that his daughter would follow him.

That's it! You should put these things away first. Li Guodong was a little embarrassed.

However, the patient's family was very honest and took the initiative to explain the shortfall in the cost. As a doctor, he also sympathized with the patient, but after all, it was money and he could not make the decision.

Uncle Teng, do you think this will work? Don't worry. I will try my best to help you arrange the surgery. I will report your situation to the leader. You should also actively think of ways to get it together as soon as possible. We will keep in communication at all times. , how about it. Li Guodong could only reply to Teng Shaokui like this first.

Okay, um - Dr. Li, don't tell the girl about the fee. The girl is old and sensible early. I'm afraid she will feel burdened. Teng Shaokui said embarrassedly.

Li Guodong nodded: Don't worry, she is still a minor. I will only tell you about the expenses.

Thank you Dr. Li, I'm going back.

Teng Shaokui was very grateful to the doctor.

——

13 CNS caused a strong earthquake, and there is no sign of subside yet. No matter where in the Sanbo Hospital, everyone is hotly discussing this matter. Now even the aunts and uncles sweeping the floor know what is going on with CNS.

The Internet is also abuzz. There are all posts about this matter on a certain park in the past few days. If there is a hot search on the medical page, this matter will definitely be ranked first.

But Yang Ping no longer cares about so much. He calms down and works as usual.

If you add in the time spent in the system space, Yang Ping's experience is estimated to be many times that of others. This matter can still be taken lightly.

As the director of the department, Yang Ping pays attention to the new patients admitted to the department every day. Before getting off work every afternoon, he will browse the computer, copy down the bed numbers of the newly admitted patients, and then go around the rooms alone according to the list.

It is Yang Ping's basic working principle to have more contact with patients.

Only through frequent contacts can we obtain first-hand information about the condition. There are many things that cannot be reflected by instrument examination.

After the ward rounds, Yang Ping paid special attention to Teng Xinmei's case, not only because Professor Cao had shown her the medical records in advance, but also because this case was really difficult.

The left ventricle and interventricular septum are both very hypertrophic, the left ventricular outflow tract is obstructed, and the left ventricular compliance is also reduced.

The heart can be seen as a four-cylinder pump. These four cylinders are the left ventricle, the right ventricle, the left atrium, and the right atrium. They are connected by several pipes.

The pump and pipes form two sets of circulation routes, which are equivalent to the human body's irrigation system.

The left ventricle is connected to the aorta, the right atrium is connected to the vena cava, the right ventricle is connected to the pulmonary artery, and the left atrium is connected to the pulmonary veins, thus forming two circulations, large and small.

Blood is pumped out by the right ventricle through the pulmonary artery to the lungs. After absorbing oxygen in the lungs, the blood returns to the left atrium. This is a small circulation, also called pulmonary circulation.

Small circulation allows the blood to obtain oxygen, and the oxygenated blood flows from the left atrium to the left ventricle.

It is then pumped from the left ventricle to the aorta, flows through the arteries throughout the body for irrigation, and transports oxygen to cells throughout the body for use. After completing the irrigation task, the blood is collected through the veins into the vena cava, and finally returns to the right atrium.

The blood at this time lacks oxygen, because the oxygen has been given to the cells for use, so the blood flows from the right atrium to the right ventricle, and the small cycle of obtaining oxygen begins again.

——

This cycle goes on and on, life never ends.

The driving force of these two sets of cycles is the rhythmic contraction and relaxation of the heart, pumping out and receiving blood, and completing the cycle over and over again.

There are one-way open movable valves between each cylinder of the heart and at the entrance and exit of the connection between the cylinder and the pipeline. This one-way valve can ensure one-way flow of blood without backflow and mixing.

Hypertrophic obstructive cardiomyopathy can be understood as the heart becoming obese, especially the valve between the two ventricles. Cardiac obesity will cause a series of problems, such as narrowing the chamber tube space, especially during systole. , the obese ventricular septum protrudes into the left ventricle, and the mitral valve moves forward close to the protruding ventricular septum, which further aggravates the outflow tract obstruction.

The heart pump cannot pump enough blood smoothly due to blocked channels, so symptoms of ischemic blood oxygenation occur.

And if not only the ventricular septum is obese, but also the left ventricle is obese, there will be insufficient post-diastolic space, and the lack of space will lead to insufficient blood volume received.

In this way, the amount of blood collected was not enough, and now it cannot be sent out due to blockage, which makes the blood oxygen deprived even more.

The operation is to lose weight for the obese heart, open the chest, incise the aorta close to the heart, enter through the aorta incision, and cut off a layer of flesh from the thickened heart to make it thinner and thinner to clear the obstruction. Channels, enlarging narrow spaces.

In this case, both the left ventricle and the interventricular septum are severely hypertrophic, and it is very likely that the resection will be insufficient during the operation. Once the resection is insufficient, the surgical effect will be poor. Even if the symptoms are temporarily relieved, the symptoms will relapse a few years later, and another operation will be required.

Not enough resection is not enough, nor is too much resection. Too much resection can easily cause complications such as conduction block and ventricular septal perforation. It is very likely that a permanent pacemaker will need to be inserted, and the normal beating of the heart will depend on machine assistance for life.

It’s like a person who loses weight but doesn’t lose enough weight and is still fat; if he loses too much weight, he is skinny and bones, has no strength to walk, and relies on people to push him in a wheelchair.

In this case, traditional surgical methods are definitely not very effective and the risks are still high.

Therefore, Yang Ping no longer wants to perform surgery along the traditional path. Since he has the conditions, why not try a better method? He should make full use of the system space, actively explore and create some new methods.

So Yang Ping began to review a lot of papers and monographs in this field. Although he had read many papers and monographs before, this time it was a targeted review, and the effect would be different.

According to the incidence rate of hypertrophic obstructive cardiomyopathy, it is estimated that more than 2 million people in the country suffer from this disease, but less than 1,000 patients undergo surgery every year. Because the surgery is difficult and risky, there are few doctors who can perform the surgery and are willing to do it. There are also few patients undergoing surgery, and many patients do not receive effective treatment.

Why is traditional surgery so difficult and risky? Because traditional surgery involves opening the chest, entering from the aorta, and going from the aorta incision to the ventricle, it is like peering through a tube. The panoramic view of the hypertrophic area cannot be seen, so the surgical field of view and operating space are seriously insufficient.

Yang Ping thought about inventing a resection instrument that would not enter the aorta but directly enter the heart from the apex.

In this way, under color ultrasound monitoring, the entire left ventricle can be seen at a glance, without any restrictions on the surgical field of view.

At the same time, the instrument can access the entire interior of the left ventricle, enabling arbitrary cutting without any operating space limitations.

Judging from papers and monographs, some people have actually done this. Some doctors have invented apical puncture ablation, which involves puncturing the heart from the apex and performing ablation.

If minimally invasive surgery is performed through a small apical incision, several issues need to be considered. How should the resection instrument be designed? How to remove hypertrophic myocardium? How to remove the severed myocardium after resection? Otherwise, these myocardial tissues will travel everywhere with the blood flow and become embolism. When they reach the brain, they will cause cerebral infarction.

There is another very important question, what about the material of the equipment?

Because the surgery must be guided and monitored by color ultrasound, metal instruments will cause artifacts in the color ultrasound image. A large number of artifacts will make the image unclear and the surgery cannot be performed.

The heart is different from other hollow organs. For example, the gastrointestinal tract can be visualized with an endoscope, but the inside of the heart cannot. The inside of the heart is filled with red blood. The lens only sees a patch of red in the blood, and nothing can be seen.

For example, an angioscope only uses a balloon to temporarily block blood flow and create a bloodless cavity for the lens.

If an ordinary person wants to solve these problems, it will not be possible within a few years. However, Yang Ping has system space to support him. He can conduct experiments at any time, and such small experiments have no burden on Yang Ping in terms of points now.

Under the surveillance of color ultrasound, the patient enters from the apex of the heart, removes the hypertrophic myocardium and takes it out of the body completely, and conducts research according to this idea.

Just do what he said, Yang Ping entered the system space, and he began to design a power rotary cutting system, using the rotary cutting blade to cut out the myocardium, and then take it out of the body.

Yang Ping drew the drawings, but in reality he needed to find a factory for production, which took a lot of time. In the system space, you only need to input the drawings into the system panel, and the universal system will replace the factory and directly output the equipment. Of course, it will be produced exactly according to Yang Ping's drawings. If there is a problem with the drawings and it cannot be produced, the system will also output obstacles.

With the equipment in hand, Yang Ping used the experimental body to start simulating surgery.

It didn't work at all at first. The metal instruments seriously interfered with the color ultrasound images, making it impossible to complete the operation.

So Yang Ping improved the material of the instrument and used an anti-interference coating to solve the problem of color ultrasound artifacts. He found that the rotational cutting was not accurate enough and could not achieve the purpose of cutting as much as he wanted.

Yang Ping improved the blade again, until he was satisfied with it, but found new problems.

There are debris in the resected myocardium. The debris will leak and mix into the ventricular blood. As the blood circulates throughout the body, these emboli are potentially dangerous molecules. It is unknown where an embolism will form.

Yang Ping didn't have enough energy, so he continued to improve the instruments, operated - improved - operated again - improved again - -

Until the surgical equipment was satisfactory, a full 30g of myocardium was cut off from an experimental subject with severe hypertrophic obstructive cardiomyopathy and all was taken out of the body without causing any debris. The experimental subject also recovered well after the operation.

It's a pity that there is no way to bring out the actual system space, otherwise he would just bring out the finished product and use it. In order to solve this problem, Yang Ping memorized the last complete set of drawings in his brain.

After leaving the system space, draw it by hand and hand it over to Ruixing Company for manufacturing.

Realize your ideas as quickly as possible, which is why Yang Ping needs his own medical device company.

——

Professor Cao had doubts about whether Yang Ping could perform myocardial weight loss surgery, so he paid special attention to Teng Xinmei's treatment plan. This was a patient he handled and nothing could go wrong.

Clinical medicine is completely a practical science, especially surgery, which must be practiced to master high-precision technology. A young man like Yang Ping, without professional training in this area, will not be able to publish a hundred CNS articles. It has nothing to do with this surgery.

But Professor Zhang Zongshun said that Yang Ping would definitely do it, and Sanbo Hospital also unconditionally supported Yang Ping's interprofessional behavior.

Therefore, Professor Cao did not dare to say anything casually, but it was necessary to follow this case secretly. If there were any signs, he could take action to stop the loss in time.

Professor Yang, how about this myocardial weight loss surgery? It's not easy to do.

Professor Cao found Yang Ping and sat down to chat. He visits the ward every day and always pays attention to the treatment trends.

Yang Ping understood in his heart that Professor Cao used to be an expert outside the imperial capital and represented the top level in the country. It was reasonable to have doubts about some things.

Open surgery is really not easy to do. I plan to use minimally invasive methods to solve the problem.

Yang Ping answered truthfully, it was impossible for him to ignore the old professor's doubts.

Minimally invasive? Radiofrequency ablation or chemical ablation? I'm afraid not?

Professor Cao is a top expert and knows very well that whether it is radiofrequency ablation or chemical ablation, it will definitely not work in such serious cases. If these two methods are used to deal with it, it will be completely perfunctory for the patient.

When the money is spent and the illness is not cured, Professor Cao will have no way to explain.

If this was the case, he would still push the patient to Fuwai Hospital in the imperial capital to avoid delaying the child.

Radiofrequency ablation and chemical ablation are relatively new methods at present. Radiofrequency ablation can be performed in a few hospitals. Under the guidance of ECG monitoring, electrophysiological methods are used to ablate the hypertrophic myocardium through radiofrequency ablation, and strive to restore it to normal. Normal myocardial thickness.

Chemical ablation, commonly known as alcohol ablation, mainly uses absolute alcohol. The blood vessels supplying the hypertrophic myocardium are found through coronary angiography. Absolute alcohol is injected into the blood vessels supplying the hypertrophic myocardium, causing the hypertrophic myocardium to ablate and become necrotic, and the surrounding myocardium slowly changes. Thin and return to normal state. This method is to diet the hypertrophic myocardium to achieve the purpose of weight loss.

Both methods have common shortcomings, the effect is uncertain, and the amount of weight loss cannot be accurately controlled.

Professor Yang, you should be more cautious. This case is so serious that the two minimally invasive methods may not be feasible. The left ventricle and interventricular septum are both thickened, several times that of normal people. You see, the pressure gradient in the left ventricular outflow tract is as high as 190mmHg. , very dangerous, there is a possibility of sudden death at any time, it is not easy for this child to stumble to this point.

Professor Cao seriously reminded that there is no politeness in the face of professional technology, and as an elder, he has the responsibility to remind the younger generation.

Yang Ping knew what Professor Cao was worried about, so he explained to him: The new method I plan to use is not radiofrequency ablation, nor chemical ablation, but transapical myocardial rotation. It is a mechanical resection. It enters from the apex of the heart and cuts it from the inside. The hypertrophic myocardium is directly removed and then taken out of the body to achieve the purpose of thinning the myocardium.

Transapical myocardial rotation technology? How come I haven't heard of it? Which country has this technology?

This is the first time Professor Cao has heard of this technology. He is a big boss in Fuwai, and the doctors he leads are now leading cardiac surgeons in the country.

Teacher Cao, to be honest, this is a technology I created myself. Yang Ping told him frankly.

Professor Cao's heart trembled after hearing this: Did you create a new technology yourself? Has it been clinically tested?

This is not available yet, but we can use animal experiments before surgery. Professor Cao will evaluate it together. If the conditions are met, we will perform human surgery. Yang Ping hopes to persuade Professor Cao.

Professor Cao disapproved of Yang Ping's behavior: Professor Yang, this is inappropriate. You and I are both surgeons. We should know a clinical technology, especially surgical procedures. It must go through a lot of experiments before entering the clinic. Later, it will take a lot of case practice to mature. This case is still a heart surgery. How can we be so rash and let a brand-new surgical method directly enter the clinic?

In fact, from a normal perspective, Professor Cao's statement is completely correct.

Professor Cao, this technology has not been clinically tested. First, it enters from the apex of the heart. There is no problem at all. Radiofrequency ablation already has related technology, which is to enter from the apex of the heart. As for the rotational cutting technology, there are only two problems. Control the amount of resection. The heart cannot be perforated and is performed under color ultrasound monitoring. This problem can be avoided. Furthermore, the resected myocardial tissue must be completely taken out of the body without leaving debris or forming emboli. If these are solved, will it be an excellent project? Technology?

Professor Cao thought thoughtfully. This is true in theory, but practice is practice and theory is theory. If all theoretical things can be done, then it will be okay.

If this is really the first case, you must test it on animals before performing the operation. Let me take a look at it then.

Professor Cao decided that he must check this operation.

Don't worry, Professor Cao, the equipment will be delivered in a few days. I'm going to do experiments on pigs. I won't use it in clinical practice until you nod. The ethics committee still wants your nod.

Yes! Professor Cao agreed to do this.

After coming out of general surgery, Professor Cao didn't want to offend anyone. To be on the safe side, he decided to call his student from Fuwai Hospital, a chief physician of cardiac surgery and an excellent cardiac surgery expert. He was not only familiar with myocardial hypertrophy surgery, but also Especially in the field of vascular surgery, it is the best in the country.

In name, I came here to see Yang Ping's new technology, but in fact, it was Professor Cao's backup.