Yang Ping is right, this case is unique, no one has ever done similar surgery, including dissection, which is also unique.

The anatomical relationship in the thoracic and abdominal cavity is a mess, and if you don't know the detailed medical history, you will think that the thoracic and abdominal cavity have undergone multiple surgeries.

The heart and large blood vessels are the problem, as is the hepatobiliary pancreas.

This patient's heart and large blood vessels were squeezed into a small and deformed space, and he could not support it for long, and eventually he would die of heart failure, and it was not easy to live to the age of eighteen.

This malformation is not caused by a short period of time, but gradually evolved over a long period of time, the original malformed heart and large blood vessels will seriously affect the function of the heart, coupled with the squeezing caused by spinal deformity, the displacement caused by adhesions, and eventually this condition deteriorates, and now a large amount of ascites is the result of this deterioration.

Not only does it cause ascites, improper positioning, but it can also cause shock.

The inferior vena cava return is blocked, the amount of blood returning to the heart is reduced, the right atrial pressure drops, and the stroke volume decreases, which causes the blood pressure to drop, and in severe cases, a series of manifestations of shock appear, and a certain postural symptom will be more obvious, such as the supine position, which is clinically called inferior vena cava syndrome or orthostatic shock.

Clinically, pregnant women are prone to this special state, such as multiple pregnancy, polyhydramnios and other abnormal uterine enlargement of pregnant women, the enlarged uterus compresses the inferior vena cava, resulting in reflux disorders, causing the above symptoms.

Now this patient does not have fetal compression or tumor compression, but the inferior vena cava is compressed due to adhesions, the tube wall is bent and flattened, and the spine and thoracic deformity are compressed, which also produces a similar syndrome.

If the fetus or tumor compresses the vena cava, the patient is prone to shock symptoms in the supine position.

Zheng Baosheng's situation is special, he can cause shock in several positions, and due to the body's sense of self-protection, he has found these positions and consciously avoided them.

But sleeping at night is dangerous, in case the blood pressure drops rapidly, once shocked, life can be in danger at any time.

Once in the shock position, once it exceeds five minutes, the symptoms of shock appear, showing dizziness, chest tightness, nausea, vomiting, frequent yawning, cold sweat all over the body, rapid pulse, blood pressure drops, and systolic blood pressure drops rapidly below 80mmHg.

If the blood pressure does not drop very quickly, as in sleep apnea, he can wake up from sleep, adjust his position, and get relief.

If his blood pressure drops quickly and he loses consciousness quickly, he will die in his sleep.

Since he had this symptom, his parents have taken turns watching him at night to prevent him from going into shock position.

Zheng Baosheng has survived many death threats since he survived.

"In addition to ascites, heart failure, and the liver has also enlarged, there is not much hope of survival without surgery, and there is almost no hope of success at all."

Seeing that Yang Ping was so persistent, Professor Li now feels that taking risks is also valuable.

If you don't have surgery and wait for death, you will die if you do surgery, so it's better to be positive.

"What can I do?"

Originally, Professor Li thought that Yang Ping would ask him to be the main knife, but Yang Ping said that he was the main knife, so it was inconvenient for him to say anything.

"If it's convenient, let's complete this operation together, I wonder if Professor Li is interested?"

Yang Ping feels that the experience of an excellent cardiac surgeon can be used as a reference for himself.

Even if there is a system in his body, Yang Ping will never close himself off, and only by staying open academically can he go higher and further.

All of Yang Ping's medical knowledge comes from the reading of the system space, the practical training of a large number of experimental subjects, and he still needs other people's empirical things.

As the older generation of professors often said, learn from teachers, learn from books, learn from practice, and learn from peers.

In this case, Professor Li is willing to participate in the operation, whether out of interest or responsibility, and he also wants to see where Yang Ping's confidence comes from and dares to do this kind of surgery.

Subsequently, Yang Ping and Professor Li began to discuss the details of the operation, because it was too difficult and every detail had to be dealt with.

At the beginning, the people around me can still participate in the chat.

Chatting and chatting, others, including Professor Wu Yucheng, couldn't interject at all, because the discussion knowledge was constantly escalating, and the knowledge reserve couldn't keep up at all.

"It is too narrow here, and the stenosis is irregular, the turning angle of the channel is too large, and it is difficult to implant artificial blood vessels, otherwise interventional methods can be used to implant artificial blood vessels in advance to improve venous return, and it is also convenient to separate the vena cava during the operation, even if it is separated and ruptured, it will not cause major bleeding."

"It's difficult, but you can try."

"These mesangiums must be preserved, and after the adhesions are successfully separated, if there is no mesangium at all for hanging, the heart and large blood vessels will be very mobile in the chest cavity, which is very dangerous."

"The capsule of the heart is completely peeled off, and there is already a sign of coarctation."

"Temporary bridging of blood vessels can be used before surgery to divert blood circulation and avoid the surgical area."

"No, it's better to have a blood fill, which is more conducive to separation."

"Well, if necessary, the heart can be removed so that the pericardium and mediastinum can be processed and a suitable bed can be rebuilt for the heart."

"Some of these adhesions can be utilized and cannot be completely removed."

"What about the liver and gallbladder pancreas? Do you want me to ask someone to come and help? ”

"No, I can handle it."

"There is also a big risk factor, this patient's blood type is RH negative, there will be many restrictions on blood preparation, can I prepare enough blood products?"

"We will contact the blood bank in advance to prepare enough blood products, and we will also use a series of autologous blood transfusion techniques to assist."

"If necessary, cryogenic techniques can be used to reduce oxygen consumption in tissue cells, which can extend the time of application of vascular occlusion techniques."

"The vascular occlusion technique is only a temporary application, and there is no need to use it during the operation, and the blood circulation and filled blood vessels are more conducive to separation."

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The two of them discussed for two hours, and the person next to them sat stupidly and listened to their chat.

From clinical talk to basic medicine, and then from basic medicine back to clinical, anatomy, physiology, biochemistry, tissue embryology, pathology, pathophysiology, etc., all involved, the latest articles in various journals are constantly cited, and the achievements of various cardiovascular experts in the world are cross-integrated.

After the conversation, Professor Li began to re-examine the young doctor, Dr. Yang simply had a super brain, and the amount of knowledge he had was amazing, and his knowledge was far beyond the depth and breadth that a surgeon should have, and in many cases, Professor Li had to struggle to keep up.

He now somewhat believes that this young man still has some confidence to take the risk of doing this kind of surgery, at least the theoretical knowledge is fully prepared.

Professor Li decided to stay and complete the surgery with Yang Ping.

Yang Ping asked Xiao Wu to book a room for Professor Li and Professor Wu at the Sanbo Hotel, and Professor Qin said: "Don't bother too much, I'll make a decision, just stay in the room next to me, I see that the rooms next to me are empty." ”

Professor Qin also lives in the Sanbo Hotel, so it's okay, they are familiar with each other, and they can chat together when they live.

Yang Ping asked Song Zimo to call the doctor to the classroom, and he wanted to briefly talk to everyone about this case, so that everyone could grasp some knowledge in advance, which would be conducive to the implementation of the patient's entire treatment plan.

Everyone is in the department, just one Zhang Lin is missing.

Song Zimo said with a smile: "Zhang Lin is explaining the basic operation of arthroscopic surgery to several young doctors in the training room, and several young doctors from Concord are also listening. ”

He taught people arthroscopic operations, and he made rapid progress.

"He and Xiao Wu practiced for an hour or two every day, and they made rapid progress, and they were just asked to help by the gynecology department and showed off an endoscopic operation in the operating room of the emergency department." Song Zimo reported the learning progress of these two people by the way, and Yang Ping usually handed over Zhang Lin Xiaowu to Song Zimo for training.

Yang Ping didn't understand: "Asked to help by the gynecology department?" ”

"The emergency department admitted a patient, acute abdominal pain, according to the process of acute abdomen, nothing else was found, utero-ovarian appendage color ultrasound showed two strip-like moving objects, and then a X-ray, two images similar to vertebrae in the uterus, asked about the medical history, the patient said that two yellow eels entered the body by mistake and were alive. The emergency department immediately asked for gynecological consultation, the gynecology department should use the hysteroscopy to take the foreign body in the emergency operating room, but this thing is still alive, slippery, not necessarily easy to take, the endoscopic operation is almost the same, the gynecology knows that our arthroscopic operation technology is very powerful, please we feel a little overkill, not very embarrassed, just Zhang Lin is free, so Zhang Lin asked Zhang Lin to help, this kid did not embarrass us, grab the forceps one at a time, solve the problem in less than two minutes, and now he is angry. "Song Zimo will explain the ins and outs of the future.

This is not a strange thing, in the past, when Yang Pinglun was in the emergency department, he often encountered this kind of foreign body, rectum, urethra, etc., and foreign bodies are also various.

Zhang Lin follows Yang Ping every day, Song Zimo trains him strictly, and the tide rises, whether in theory or practice, he naturally makes progress faster than others, and his knowledge is wider than others.

"Zhang Lin and Xiao Wu, you are strict with them, basic knowledge, basic theories, basic skills, and knowledge points must be 100% passed." Yang Ping instructed Song Zimo.

"What about Little Five? What do you think? ”

"Xiao Wu's hands-on ability is very strong, especially the endoscopic technique, which has made very rapid progress, and the hand-eye separation and triangulation techniques have mastered these basic skills very well."

Song Zimo made a phone call to Zhang Lin and asked him to go to the classroom for a meeting.

Soon, he came over, followed by several young doctors, who were still explaining the key points of endoscopic operation, and seemed to be speaking well, and several doctors listened very carefully and looked admiring.