boyutpedia Chapter 950 Climbing Mount Everest (Part )
Chapter 950 Climbing Mount Everest (Part )
In a small classroom at Kyoto University of Chinese Medicine, Wen Xiuping, Song Luojun, Chu Yiyun, Mo Xinzhi and several others were watching the operation.
"I didn't expect Xiao Chen to have such high attainments in hepatobiliary surgery?"
Chu Yiyun said in surprise.
Although they guessed that since Borg could invite Chen Yang, Chen Yang's level must be very high, they still couldn't help being shocked when they saw it with their own eyes.
There is no doubt that Chen Yang's level of traditional Chinese medicine is already top-notch at the moment. There are not many people who are better than Chen Yang. The level of hepatobiliary surgery demonstrated by Chen Yang is also top-notch at the moment.
"Mr. Wen, your grandson-in-law is really amazing." Song Luojun said with emotion.
"I knew Chen Yang was involved in surgery before, and because he was good at Chinese medicine, I didn't interfere. I didn't expect him to be so strong."
Wen Xiuping also said with emotion: "Chen Yang is really a natural born doctor."
Kang Xingchao and Mu Xuehai also nodded. They made a big profit by getting such a talented young doctor like Chen Yang to their school.
In the operating room of Kyoto Hospital, the atmosphere was so heavy that it seemed as if water might drip out of it.
When the adhesions between the tumor and the surrounding tissues were peeled off one by one, the Klatskin tumor, which had been strangling the liver portal like a malignant tumor, finally revealed its most hideous core - a dense infiltration area of 2.5 cm long with the main trunk of the left branch of the portal vein (PV-L).
On the screen, the blood vessel walls of the parts of PV-L that were wrapped, squeezed, and invaded by the tumor had become unevenly thick and pale in color, having lost their normal elasticity and luster, like a piece of dead wood that was about to break.
Chen Yang took a deep breath, and his eyes seemed to become extremely sharp, like a falcon locking onto a target, his entire mind focused on the "Devil's Fortress" in front of him.
He switched to more sophisticated microscopic instruments: jewelry tweezers, microscissors, and a microneedle holder.
With the help of a head-mounted magnifying glass, Chen Yang's hands were as steady as a rock, without the slightest tremor, as he began the "bomb disposal" operation, which is considered the pinnacle of surgical art.
"Intraoperative ultrasound!" Chen Yang's voice rang out.
The experienced ultrasound physician immediately placed the sterilized high-frequency ultrasound probe in the surgical field and, under the guidance of Chen Yang, accurately scanned and located the relatively safe areas of PV-L at the proximal end (point A, close to the portal vein bifurcation) and distal end (point B, close to the left intrahepatic branch) of the tumor.
The relatively complete layers of the blood vessel walls and blood flow signals in these two areas are clearly displayed on the screen.
Chen Yang used a fine electrocoagulation pen to gently make two almost invisible marks on the outer membrane of the blood vessel.
A huge surgical microscope was pushed above the surgical field, and the light was focused, magnifying that small area several times.
Under the microscope, the boundary between the tumor and the blood vessel wall becomes more blurred. The proliferating fibrous tissue and tumor cells are like countless tiny tentacles, taking root deeply and penetrating into the vascular adventitia and even the middle membrane.
Borg slightly turned sideways, giving the most core operating area to Chen Yang.
Chen Yang took a deep breath, adjusted his breathing, and stabilized his heart rate at around 60 beats per minute.
His eyes, looking through the eyepiece of the microscope, became extremely sharp and focused. Everything in the outside world seemed to be isolated, and only the diseased blood vessel and the surrounding intricate anatomical structure remained in his eyes.
"Attractor." Chen Yang stretched out his hand.
Emily accurately handed the fine suction device with suction tip to him.
Chen Yang held the suction device in his left hand and took the microstripper handed to him by Borg in his right hand, and began this "millimeter-level" battle - the ultimate "skeletonization" of the PV-L segment.
Chen Yang's movements were as light as picking up a flower. The tip of the dissector carefully explored and separated the potential gap between the tumor and the vascular adventitia.
Every touch is extremely precise, never going a bit deeper and never leaving any trace of adhesion.
"It's so delicate..." In the observation room, the old director of Union Hospital praised in a low voice, "This technique, this stability, is simply art!"
"Damn it, Doctor Chen has gotten stronger again."
At the Shanzhou Medical University Affiliated Hospital, Chen Xingwu had already stood up, staring at the screen without blinking.
Inside the observation room of Kyoto Hospital, Xun Jiahong narrowed his eyes slightly, his heart in turmoil.
Is this the gap between me and Chen Yang?
While I was still struggling in the field of traditional Chinese medicine, Chen Yang had already reached the top in the field of hepatobiliary surgery.
To be the best in all fields is simply not a human being.
Under the microscope, those tough fiber strands like steel wires were picked apart bit by bit, and the proliferating small blood vessels were precisely coagulated by Chen Yang using a special microscopic bipolar electrocoagulation forceps, making a slight "sizzling" sound and forming tiny eschars.
Time seemed to freeze at this moment.
Every millimeter of separation feels like crossing a chasm.
Sweat slid down Chen Yang's forehead, and the circulating nurse helped Chen Yang wipe the sweat off in time.
Suddenly, Chen Yang stopped moving.
Under the microscope, a tumor tissue was found to be abnormally tightly adhered to the blood vessel wall. With a slight force from the dissector, a needle-tip-sized hole appeared in the blood vessel wall, and a trace of bright red blood instantly oozed out!
"Bleeding!" someone whispered in the observation room.
"Fuck, it's bleeding!"
Everyone watching the operation couldn't help but feel a pang of grief.
Most of the people watching the operation were hepatobiliary experts, and they knew very well what every bit of bleeding meant in this difficult operation.
It means risk, which means the operation may fail at any time.
Borg's heart suddenly tightened and he subconsciously stepped forward.
"Don't move." Chen Yang's voice was calm without a trace of emotion.
He put down the dissipator, aimed the suction device in his left hand precisely at the bleeding point, and gently sucked away the oozing blood. He quickly replaced the micro needle holder with his right hand and picked up a 7-0 prolene suture that was thinner than a hair.
Under the microscope, Chen Yang's hands were as steady as a rock. He held the needle holder with the suture and inserted the needle 0.5 mm away from the rupture at an extremely tricky angle, passing through the adventitia and media of the blood vessel, and then pulled out the needle from a symmetrical point on the opposite side, completing a perfect "8" suture.
Tying and tightening, the movements are done in one go, so fast that it is dazzling, but as precise as a textbook.
The needle-tip-sized bleeding spot was firmly blocked!
"Beautiful!" Borg couldn't help but give a low compliment, and his heart was finally at ease.
Chen Yang's skill in emergency hemostasis has reached perfection.
"Fuck!"
Someone in the observation room exclaimed.
"That's awesome."
"Dr. Chen's skills are absolutely world-class."
Chen Yang didn't pause at all, as if the previous incident had never happened, and continued to wander around with concentration.
Another full forty minutes passed, and under Chen Yang's almost harsh and delicate operation, the two ends of the PV-L segment invaded by the tumor - point A and point B, were finally "liberated" to the maximum extent!
The two healthy blood vessels, each about 1 cm long, are still a little pale, but the vascular wall structure is intact and the edges are neat, creating the most favorable conditions for subsequent anastomosis.
"Measure the distance." Chen Yang said.
A specially made microscopic ruler was carefully placed into the surgical field.
"After resection, the estimated anastomosis distance is about 1.8 centimeters." Zhong Dongyang reported the precise data.
Chen Yang and Borg looked at each other and saw confidence in each other's eyes.
1.8 cm, after careful freeing and sufficient relaxation, is completely within the operable range of end-to-end anastomosis!
"Execute Plan A!" Borg ordered decisively.
"Block the blood flow in the left branch of the portal vein." Chen Yang added.
Zhong Dongyang quickly tightened the vascular blocking bands pre-placed at the proximal end of the liver portal (proximal to point A) and the distal end of the liver (distal to point B) of PV-L.
The PV-L segment, which originally had a weak pulsation, turned pale in an instant, and the blood flow was completely blocked.
"resection!"
Borg took the microscissors handed to him by Chen Yang and cut the PV-L precisely and cleanly along the predetermined resection line - at least 1 cm away from the edge of the tumor in healthy tissue.
The section of blood vessel that was invaded by the tumor and looked like rotten wood was completely removed!
In the surgical field, two neat portal vein ends (points A and B) about 1.8 cm apart appeared. A small amount of blood slowly oozed out from the ends and was promptly sucked away by the suction device.
"Prepare for matching!" Borg's voice was filled with excitement, which was the excitement after overcoming difficulties.
Emily quickly handed over a brand new set of microstomy instruments and several packages of 7-0 prolene sutures.
Chen Yang picked up two sutures and sewed a positioning line at the "3 o'clock" and "9 o'clock" positions of the blood vessel ends at points A and B respectively. He tied knots to fix them, preliminarily aligned the two ends, and adjusted the tension.
"Start matching!"
Chen Yang supported the blood vessel wall steadily with his left hand and held the microneedle holder with his right hand, and began the most core and technically challenging part of the operation - end-to-end anastomosis of the portal vein.
He adopted the "continuous-interrupted mixed suture method" proposed at the previous meeting.
Start from the back wall, and perform continuous horizontal mattress sutures. The needle holder is like a living being, carrying the suture under the vascular intima. The needle distance and margin of each stitch are accurate to 0.2 mm, ensuring that the intima is flat and without any wrinkles.
At the moment the needle and thread pass through the blood vessel wall, there is almost no obvious bleeding, which proves that the tissue damage is minimal.
“Too stable…”
Dr. David from Mayo murmured to himself, his eyes full of shock.
He had performed vascular anastomosis countless times, but had never seen such a precise, smooth and stable operation.
After the continuous suture of the posterior wall was completed, Chen Yang began to deal with the anterior wall.
Chen Yang first sutured a key interrupted horizontal mattress suture at the "6 o'clock" position of the anterior wall (where the greatest tension is expected). After tying the knot, it effectively shared most of the longitudinal tension.
Then, a simple interrupted suture is sutured between "6 o'clock" and "3 o'clock", and between "6 o'clock" and "9 o'clock" as an "anchor point" to ensure precise alignment of the vascular wall.
Finally, starting from the "3 o'clock" anchor point, perform short-distance continuous sutures in the "6 o'clock" direction; then perform continuous sutures from the "9 o'clock" anchor point in the "6 o'clock" direction.
The entire matching process is like carving patterns on rice grains, and every movement requires extreme precision and stability.
More sweat oozed from Chen Yang's forehead, and his goggles seemed to be covered with a layer of mist, but his hands remained as steady as a rock, without the slightest tremor.
Time passes by minute by minute, and every stitch is like a race against death.
When the last stitch was through, Chen Yang tied a secure surgical knot and cut the thread short.
The entire portal vein anastomosis is like an exquisite necklace, perfectly connecting the two broken ends of the blood vessels!
"Release the blocking belt!" Chen Yang ordered.
Zhong Dongyang first loosened the blocking band at the far end of point B, and then slowly loosened the blocking band at the near end of point A.
Everyone held their breath, staring at the anastomosis.
A few seconds later, as the blood flow resumed, the originally pale anastomosis and its distal blood vessels were quickly filled with bright red blood, regaining their plump shape and weak pulsation!
"It's connected!" An uncontrollable low cry broke out in the observation room.
Under the microscope, the anastomosis is smooth and flat, there is no obvious leakage, and the blood flows smoothly without turbulence!
Chen Yang let out a long sigh, and his tense shoulders finally relaxed.
This step is done!
The success of the portal vein anastomosis is like opening a key tunnel on a rugged mountain road, laying the most solid foundation for the success of the entire operation. But the journey to climb the "Mount Everest" is not over yet, and greater challenges are coming one after another.
"Next, we'll deal with the hepatic artery and bile duct." Borg's voice was firm with relief.
The tumor not only invaded the portal vein, but also severely compressed and infiltrated the left hepatic artery (LHA). Preoperative evaluation showed that the right hepatic artery (RHA) was well compensated and sufficient to supply blood to the right liver and some residual tissues of the left liver.
"Cut off the left branch of the hepatic artery." Borg made the decision after careful examination.
Chen Yang assisted in exposing the surgical field, and Zhong Dongyang accurately separated the LHA, double-ligated it, and then severed it. The whole process was clean and neat, without causing any additional damage.
After dealing with the blood vessels, the focus of the operation turned to the bile duct system, which was also severely damaged.
The tumor invaded the confluence of the left and right hepatic ducts and extended approximately 0.5 cm proximal to the right hepatic duct (RHD).
"We need to perform right hepatic duct shaping + hepatic duct-jejunostomy." Borg pointed to the bile duct stump. "The right hepatic duct opening is narrow. We must perform shaping to ensure smooth bile drainage after surgery."
This is another delicate job.
Chen Yang and Borg worked together to carefully trim the scar tissue and the invaded edge of the right hepatic duct to form a relatively wide and neat opening. Then, they used 5-0 absorbable sutures to properly suture the anterior and posterior walls of the right hepatic duct longitudinally to expand the diameter of the duct and complete the "choledochoplasty".
The diameter of the right hepatic duct opening after formation is about 1 cm, which is sufficient to ensure smooth outflow of bile.
“Prepare for a Roux-en-Y hepaticojejunostomy,” Borg said.
This is a classic surgical procedure for treating complex bile duct injuries or resections. It requires freeing a section of the jejunum, leaving the duodenum unattended, and anastomosing it to the severed end of the hepatic duct to reconstruct the bile drainage channel.
Zhong Dongyang is experienced and is responsible for freeing the jejunum and constructing the Roux loop (intestinal loop). His operations are skillful and efficient.
The anastomosis between the bile duct and the jejunum was performed by Borg, assisted by Chen Yang.
They used the "single-layer continuous suture" technique, using 4-0 absorbable sutures, starting from the posterior wall of the bile duct, to accurately align the jejunal mucosa with the bile duct mucosa to ensure that the anastomosis was tension-free and free of twisting.
"Check whether the anastomosis is open and whether there is any leakage." Chen Yang suggested.
A thin silicone tube was carefully inserted into the jejunum distal to the anastomosis and a small amount of normal saline was injected.
"No leakage!" Zhong Dongyang reported after careful observation.
At this point, the three core steps of tumor resection, vascular reconstruction, and bile duct reconstruction have all been successfully completed!
I won't post the two-in-one chapter separately.