Chapter 756 This knife is the result of decades of hard work
In the next two days, there was still no new change in Lu Ruping's condition.
There was no improvement in her blindness.
But what surprised Xu Qiu and the ophthalmologist was that even after four consecutive days of blindness, Lu Ruping's eye tissue, optic nerve conduction pathway, and the final cranial CT scan did not show any abnormalities.
In other words, Lu Ruping was a completely healthy person.
But she was blind!
This made everyone feel incredible.
On the morning of the third day, Xiang Kai's surgery finally began.
Sympathectomy!
Specifically, it was lumbar sympathetic nerve resection.
Xiang Kai's problem was his ankle, which was also a vascular motor dysfunction in the area. Complex regional pain syndrome occurred, causing hyperalgesia, and the sympathetic preganglionic fibers that control the vascular movement of the lower limbs originated from the lateral horn cells from T10 to L2 and L3.
The postganglionic fibers enter the lumbar plexus and sacral plexus through the gray communicating branches, and then distribute to the branches beyond the femoral artery of the lower limbs through the femoral nerve, obturator nerve, and sciatic nerve...
The purpose of removing the lumbar sympathetic nerves is to remove the sympathetic nerve control of the diseased segment, relax the vascular smooth muscle, dilate the blood vessels, improve local hemodynamics, and thus control the phenomenon of hyperalgesia.
Of course, since the sympathetic nerves are related to a variety of human functions, once a mistake is made during the removal, it may lead to a large number of lifelong sequelae.
For example, the sympathetic ganglion of L1 contains preganglionic fibers emitted from the lateral horn cells of T12 and L1, which are related to the function of male snake sperm. Once damaged, the patient basically loses normal sexual function...
The only doctor who dares to say that the risk is not high is a doctor of Xu Qiu's level.
...
The operation began around ten o'clock in the morning.
The patient was in a supine position, the waist on the side of the operation was raised, and it was tilted 30 degrees to the opposite side, with the hip and knee joints bent, and general anesthesia...
As the anesthesiologist nodded, Xu Qiu also picked up the scalpel at the same time.
"The operation begins."
The voice fell, and the atmosphere in the operating room, which was still joking a moment ago, immediately became serious.
The operation was not risky only for Xu Qiu. Most people present did not dare to underestimate this sympathectomy...
Swish!
Under the shadowless lamp, Xu Qiu's hand pressed down lightly, and the sharp scalpel fell on Xiang Kai's skin.
The next moment, a cut of about seven centimeters in length appeared between the iliac crest and the rib margin, and the height was just controlled at the level of the second lumbar vertebra.
As soon as the fine blood line appeared, it was immediately wiped away by the assistant.
Xu Qiu's movements were not affected at all, and then he cut the skin and subcutaneous tissue. After a while, the external oblique muscle was exposed to everyone's gaze.
The tip of the knife fell again, and the trajectory was smooth. Soon, it followed the direction of the muscle fibers, separating the external oblique muscle from the tip of the twelfth rib, and finally cutting the fascia.
The internal oblique muscle was separated next.
Going deeper, it was the transverse abdominal fascia.
Unlike before, the transverse abdominal fascia is separated by blunt method. After the peritoneum and the internal organs of the abdomen are pushed to the midline together with the ureter, it is separated from the quadratus lumborum and the psoas major.
Then the peritoneum is separated by blunt method and pushed to the front edge of the vertebral body.
Hiss——
The inner edge of the psoas major and the fascia beside the spine are neatly cut by Xu Qiu.
In the slightly thin fat tissue, the yellow-white nodular tissue is picked out by Xu Qiu.
This is the lumbar sympathetic ganglion.
…
At this point, everyone's attention is highly focused.
The next cut is related to the success or failure of the operation, and it is also a moment that directly affects the patient's second half of life.
Many doctors are very skilled in using high-end equipment such as electrosurgery. The operation is even more beautiful, and there is almost no bleeding during the operation. They can immediately attract countless laymen to worship.
But this kind of doctor is just a show-off. Behind all kinds of gorgeous operations, there is a high probability of fistula and accidental injury to surrounding tissues.
But these complications often occur several years after the operation.
No one would associate it with the seemingly perfect operation at the beginning.
But Xu Qiu is just the opposite.
His operation does not have too many fancy things, but just uses various mature technologies to the extreme, and shows them in the simplest and most simple manner.
Every time the knife falls, it seems ordinary.
But only experts know that the selection of the position of each knife, the control of the force, the control of the precision, etc., cannot be done without decades of hard work.
The so-called good fighters have no glorious achievements, which is just right for Xu Qiu.
No matter how serious the condition of the patients cured by Xu Qiu is before the operation, the complications and sequelae after the operation are very few, and the prognosis is far beyond the average standard in the industry...
This makes many people think that the patients selected by Xu Qiu are very mild.
Only the internal staff of Linyi and the doctors familiar with Xu Qiu understand that most of his patients, if placed in other hospitals, can hold several hospital-wide consultations, and the successful operation can be posted on the hospital homepage for several days to show off...
...
The operation continues.
The upper part is free to the diaphragm, and the lower part reaches the bifurcation of the abdominal aorta...
The sympathetic nerve branches, the sympathetic ganglia of L2 and L3 were cut off one by one.
Xu Qiu then pushed aside the fat and accurately picked out the ureter and genital femoral nerve, saying:
"You should know these two nerves, which are easy to be damaged during the operation.
"Just remember the anatomical position. The sympathetic ganglion is on the medial edge of the psoas major muscle, but the ureter and genital femoral nerve are distributed in front of the psoas major muscle, and the former is a yellow-white nodule, while the latter two are regular nerve fibers wrapped in a reticular loose connective tissue endoneurium..."
"..."
The assistants and other doctors and nurses were sweating.
"I know, I know..."
"Doctor Xu, put it down quickly, don't pull it off!"
Everyone was relieved when Xu Qiu put the two nerves back.
Other doctors dared not touch these two nerves at all, and only Xu Qiu was so sure that he could control the strength that would never damage the nerves.
"Also, there are common variations of lumbar sympathetic nerves, which may exist from two to eight, and up to a dozen. Carefully identify them and do not miss any.
"The third and fourth lumbar veins on the right side will cross the right sympathetic ganglion. Do not accidentally injure the lumbar veins when removing them..."
While Xu Qiu was operating, he did not forget to impart his experience.
Everyone was fascinated... They were so happy to be taught by a surgical god. A few casual words may be valuable wealth that can only be summarized after hundreds of surgeries, which can save them several years of detours!
...
An hour later, the operation ended perfectly.
If nothing unexpected happens, Xiang Kai's problem will be completely solved, and he will not have hyperalgesia again. After that, he will slowly recuperate his nerves, which will be not much different from normal people, and he can participate in various sports activities.
"Next, we will do our best to treat Lu Ruping." Xu Qiu returned to the office and opened the other party's medical records.
