The Godfather of Surgery

Takahashi's three-month study period is about to end. He hopes to extend the study period and continue to stay in Sanbo.

There are still many cases that he needs to learn. During the time he followed Yang Ping, he not only learned advanced surgical methods, but also learned a new way of thinking. Whether it is anatomy or surgery, it has reached a new height.

Takahashi felt that three months was not enough. If he could stay, one year, three years—he would be willing.

It is a pity that it is impossible for him to stay in China for so much time, and there is still a lot of work waiting for him to do at the Affiliated Hospital of Tokyo University.

Takahashi's visa has a maximum stay of 180 days, and he hopes not to waste a day.

So he applied to Fujiwara Masao for a three-month extension, and Fujiwara Masao replied: Takahashi will continue to study in China, and Miyuki must return to Japan as scheduled.

Miyuki's arthroscopic technique has advanced so quickly that she can engrave a crooked letter on the olive pit.

She didn't care what Fujiwara Masao said. Although he was the director of the Department of Orthopedics at the University of Tokyo, he still had an identity, his own brother.

In fact, Miyuki has more time to stay than Takahashi. She is just a middle-level young doctor and does not have any position.

"You should listen to Mr. Fujiwara and go back as soon as possible." Takahashi didn't want her to go against Mr. Fujiwara's words.

Miyuki didn't care: "Why should I listen to him, I have my own life!"

In fact, Miyuki knew in her heart that her brother asked her to go back, just to let her meet with Yusuke Mitsui. The two families wanted to discuss their marriage arrangements. This was a marriage between the Fujiwara family and the Mitsui family, and it was a major event.

Although Yusuke Mitsui is also a top student at Dongda University, both in talent and appearance, she doesn't like that guy and has no feelings for him at all.

"My visa also has 180 days. I don't want to call him anymore. You tell Mr. Fujiwara that I have decided to stay in China and continue my studies." Fujiwara Miyuki was very firm.

Takahashi sighed helplessly, this is already the matter of the Fujiwara brothers and sisters, and he can't get involved.

——

After the fifth round of surgery, it was the final round of surgery in the regional competition: anterior surgery for thoracolumbar fractures, which, like surgery for pelvic and acetabular fractures, was very risky.

The surgical approach is an important part of the operation, and the risk of the approach is destined to be very risky.

In a large hospital, an anterior thoracic spine surgery patient died on the operating table, like a bird in shock. For a long time, it was forbidden to perform anterior spine surgery, which was a bit extreme.

After the sixth round of surgery, Song Zimo still maintained a full score, and his strong fighting ability made this first assistant attract a lot of attention.

With the end of the sixth round of surgery, the regional competition came to an end, and the hospital emblems of the qualifying hospitals in each competition area were arranged on the homepage of the website.

The photos of the main swordsmen of each team are also played on the website in a loop. Everyone is familiar with the other main swordsmen. Only Yang Ping is not familiar to everyone, because he did not show up in the regional competition at all.

In the Western Division, Li Ling from West China and the students of Professor Fu Shancheng advanced with perfect scores. The team from Xijing Hospital missed the perfect score by one point and advanced as the second place. The third advancing team was also from West China.

In the northern division, Ouyang Siming, Xiao Yi, Lu Qing, and Song Yuncheng came from the Third Hospital of Imperial Medicine, Jishuitan, 301, and Xiehe, and they all advanced with full marks.

In the Eastern Division, Wen Rentao and Yue Zhengming advanced with full marks, and Wang Kaisheng of Changzheng Hospital advanced as the second place.

In the central division, only Xiangya has a perfect team, Tongji is two points behind, and the Second Hospital of Xiangya's Brother Hospital is four points behind.

In the Southern Division, Song Zimo and Su Nanchen advanced with perfect scores. Lin Hao ligated the intercostal artery too hastily during anterior surgery for a thoracolumbar fracture and deducted one point.

There are three promotion places in each competition area, and there are no quotas for full marks.

For example, if there are more than three perfect scores, all of them will advance, and other teams with less than perfect scores will have no chance.

Two full-point teams, there is one place left to make up for the second place, and no matter how many second places are tied, they will use this place to advance together.

If a team with a full score, the other two places, the second and third places are filled, if the second place is tied for full, the third place has no chance, and so on.

A total of 16 teams have advanced to the national competition. After a two-week break, the national competition will be randomly matched by a computer, allowing these teams to combine.

The competition implements a knockout system. During the specified competition period, after completing the specified types of operations, points will be awarded. The laggards with total points will be eliminated, the leaders will advance, and those with the same points will play additional games.

Promoters enter the second round of elimination, the third round of elimination, and the final championship match.

According to the current situation, there are exactly 16 teams in the competition. The top eight will be determined in the first round, the top four will be determined in the second round, the top two will be determined in the third round, and the fourth round will be the championship match.

In the duel of masters, if you are weak in that link, you will lag behind your opponent.

The new stars of the younger generation in the medical field are all gearing up and eager to try.

In the national competition, the first round of orthopedic surgery was arthroscopic and foraminal surgery. It is difficult for doctors with incomplete skills to go very far.

Some hospitals are not large enough to find even the cases, let alone the competition.

So in the end, all the top hospitals that are familiar with the competition will be able to compete.

Knowing oneself and knowing the enemy, one hundred battles will not be lost. After the regional competition is over, everyone starts to sweep the list. Most people are familiar with it. Only Sanbo Hospital is not very familiar to everyone.

Many doctors who participated in the Trauma Orthopaedic Symposium have memories, including Professor Fu Shancheng and Professor Meng Heng.

Lin Hao was extremely depressed. He originally wanted to get rid of Sanbo Hospital, but he was almost thrown away by Song Zimo.

He decided to play steadily in the national competition, even if he didn't meet Sanbo, he would go further than Sanbo.

If it is possible to meet Sanbo in the first round, it is best, however, arthroscopic multi-ligament reconstruction in the shoulder and knee is the most rewarding operation in this round.

Lin Hao can use the world's most advanced surgery taught by his mentor Robert to raise the score and eliminate Sanbo Hospital in one fell swoop.

During the two-week break, the computer random party results will be announced on the website before 6pm on Friday the second week.

——

In Director Han's office, a USB flash drive containing Professor Feng's images and pictures was inserted into the computer.

X-rays, CT and MRI of the cervical spine and skull, along with enhanced images, appear on electronic screens.

Chordoma, malignant, is relatively rare in the upper cervical spine, and it is even rarer when it penetrates from the upper cervical spine to the brain.

The tumor originates from the embryonic residual notochord tissue and generally grows slowly.

Therefore, if the surgery can be successfully removed, a certain survival period can be obtained.

However, the connection between the upper cervical spinal cord and the medulla oblongata is where the respiratory and circulation center is located, and it controls the heartbeat and breathing of a person. If this part is damaged, the direct breathing and the heartbeat will stop.

Professor Feng's chordoma, which invades the respiratory and circulatory centers, has a very poor prognosis and is life-threatening at any time.

In this case, the tumor and the respiratory and circulatory center are mixed together, and there is no way to operate at all.

"There is no distant metastasis for the time being, and radiotherapy has been done, but it is ineffective. I have been treated with the targeted therapy drug PDGFR inhibitor imatinib and MTOR inhibitor sirolimus, but the effect is not satisfactory. Combining rapamycin is still not good. ." Director Han called Yang Ping to the office, but he did not say that the patient was his teacher, Professor Feng, for the time being.

Yang Ping carefully analyzed the video images and the 3D printed models.

Director Han poured the image data into the 3D printer, and printed out the models of the upper cervical vertebra, the base of the skull and the tumor.

Yang Ping observed for a long time, this case is really difficult, involving three departments of neurosurgery, orthopedics and tumor surgery.

It is no exaggeration to say that this tumor should be out of surgery.

If you want to do this operation, there are four difficulties, the first to reveal is the difficulty.

Conventional exposure is not enough. It is necessary to completely open the back of the upper cervical vertebra and the back of the skull from the rear, and it must be able to be installed after opening.

Only in this way can the upper cervical spinal cord and medulla oblongata be exposed, and then the medulla oblongata and upper cervical spinal cord should be incised, and the tumor should be removed as completely as possible while protecting the vital functional area.

The other three difficulties are that the surgical operation must be very precise, which is the biggest test of surgical accuracy.

Robotic surgery would be precise, but not suitable for this high-risk surgery, the most reliable is the machine, the least reliable is the machine.

Robots have no human touch, and once a mistake is made, even a little bit will be fatal.

The precision of this kind of operation should be controlled at about 0.1mm. Ordinary metal scalpel, no matter how sharp it is, can’t achieve this precision, and the scalpel cannot squeeze the tissue. As long as the ordinary scalpel cuts, it must be squeezed.

So it is necessary to use advanced laser knife for surgery.

Third, the boundary of the tumor is determined, and the tumor is mixed with the medulla oblongata and upper cervical spinal cord. No matter what method is used, there is no way to identify the tumor and the functional area of ​​life that needs to be protected during the operation. It can only rely on the experience of the operator.

There are few cases in this case, and even fewer operations are performed. Most of the cases of operations are failures. How can successful experience be obtained?

The last step is hemostasis. The tumor is still very rich in blood supply, and hemostasis is not complete. The hematoma oppresses the respiratory and circulatory center, and the patient stops breathing and heartbeat.

Yang Ping was looking at the video and the 3D model again. Director Han felt the cup beside him, feeling uneasy.

It took a long time for Yang Ping to speak.

"Using the most advanced laser knife, the upper cervical vertebra and the base of the skull are opened posteriorly, and the upper cervical spinal cord and medulla oblongata are completely exposed, and then surgical operations with a precision of 0.1 mm are performed."

Is this surgery feasible? Director Han finally waited for Yang Ping's reply, and immediately asked, "What is the success rate of the operation?"

"Not high!" Yang Ping replied with a lack of confidence.

This was the first time Yang Ping gave a lack of confidence. Even in the case of Lu Gang, he was confident and said without hesitation: he was admitted to the hospital.

"How high is it estimated?" Old Han still asked.

"Eighty percent."

Yang Ping made an approximate estimate, there is no way, the operation is too difficult, how high the success rate of this kind of restricted area operation can be.

"Eighty percent?"

Lao Han thought that he had heard it wrong. The success rate of this kind of operation is currently reported to be less than 1%.

"Yes, there is no way, it is too difficult, at most 80%!" Yang Ping was very embarrassed.

After confirming that it was 80%, Lao Han calmed down.

"Where is the patient?" Yang Ping was very concerned, this case was very special.

Which case in his hands is not special and difficult?

"The patient is in the Sixth Hospital of Modu, and I don't know the arrangement there yet."

Old Han has a bottom line.