MTL - Doctor’s Life Simulator-Chapter 83 crisis! Intraoperative vagus nerve variation

Soon Wei Guoqiang brought Qin Lang to the first hospital of Zijingang.

After the two parked the car, they rushed to the bottom of the ward building. Deputy Director Shen Jiaqi and one of his lower-level doctors were already waiting early.

The girl beside Shen Jiamo was tall, 1.7 meters tall, with straight and slender legs, wearing a white coat, and a delicate and beautiful face.

The girl is twenty-seven years old this year. She is Shen Jiamo's graduate student, and is considered his proud disciple.

"Director Wei, Doctor Qin, you've worked hard."

Shen Jiayang thanked Wei Guoqiang and Qin Lang, and then introduced the little attendant beside him.

"This is my student Tang Yue, my graduate student. She is also doing an internship at my burn and plastic surgery center. This time, let her observe the operation together and learn from Director Wei and Dr. Qin."

Tang Yue folded her smooth hair in her right hand, and nodded towards Wei Guoqiang and Qin Lang with a delicate and cute face:

"Director Wei, Dr. Qin is good. I will learn more from you next time."

As a graduate student of Zijingang First Academy, Tang Yue is also a top doctor such as Deputy Director Shen Jiaqi, so she has no air or arrogance.

In the tone, Qin Lang and Wei Guoqiang are very respectful and curious.

In particular, looking at Qin Lang, who is just like her and has perfect appearance, he added:

"Dr. Qin, Director Shen asked me to learn more about the basic skills of surgery from you. In return, if you need to revise your paper or submit to a foreign journal in the future, you can come to me. And this is also my best field, and I can help you at that time. Modify it together."

Speaking of her scientific research ability and foreign language attainments, Tang Yue's back is straight, full of confidence and pride.

Shen Jiaqi also added a sentence like an old father:

"Doctor Qin, your clinical talent is overflowing, and Tang Yue's scientific research talent is not bad. In the future, you should communicate more and promote each other."

Hearing Director Shen's praise of Qin Lang, Tang Yue became more and more curious about the length of this young man who was three years younger than himself.

Qin Lang is also observing the depth of Tang Yue. It may be that he has been in Shuguang Beautiful Hospital for a long time today, so he instinctively starts from the forehead, eyebrow arch, orbicularis muscle, eyelid, nose bridge, nose wing, nose tip, lips, chin, neck , collarbone... all the way down.

This ratio is simply a template for plastic surgery, especially the facial features, the symmetry of the body, even if the bears are separated by clothes, they can be accurately distinguished. Just right pelvis, golden ratio upper and lower body.

Seeing Qin Lang's focused and meticulous eye scan, Tang Yue was a little puzzled, but Qin Lang's appearance was just like her, so it should just be the sympathy of girls with the same level of beauty, right?

Tang Yue was not at all embarrassed, and responded with a generous look. After all, appearance is justice!

When the two little doctors met each other's eyes for the first time, Deputy Director Shen Jiamo had already led Wei Guoqiang to open the way.

"Okay, that's a lot of trouble for Doctor Tang."

Qin Lang really didn't know anything about writing papers. Although there was a free labor force from Cheng Yunfeng in the city's first hospital, Qin Lang really didn't believe in his level.

And now the slim Tang Yue stood in front of him, whether it was out of politeness or instinct to appreciate her perfect plastic template figure, he had no reason to refuse.

"This time, our Zijingang No. 1 hospital is considered to be the top lineup. Our two little doctors are really lucky."

Tang Yue and Qin Lang communicated, and when they talked about the surgery that was going to be carried out, they were looking forward to it.

She naturally thought that Qin Lang was a proud disciple of Wei Guoqiang like her, and brought him to see the world.

After all, this opportunity is a rare opportunity!

Of course, this arrangement is also the attention of Deputy Director Shen Jiamo. After a while, he will let Tang Yue and Qin Lang Wei Guoqiang enter the operating room together. After all, in the operating room, they are wearing surgical clothes. It's not clear who is who.

Shen Jiayang had seen Qin Lang's operations and techniques with his own eyes, so he was sure of it, but the other directors didn't necessarily think so.

In fact, Qin Lang was too young. In order to avoid some unnecessary disputes, he and Qin Lang stood at the end during the operation for a while, waiting for Director Yu and Director Yang to complete the enlarged primary tumor resection and neck dissection. After that, directly take over the repair of the external carotid artery.

Deputy Director Shen Jiamo took Wei Guoqiang, Qin Lang, and Tang Yue to prepare for the operation. After learning about the patient's condition and the subsequent operation plan again, they entered the operating room.

In the operating room, Director Yu and Director Yang were already ready to go.

The director of the anesthesiology department personally administered general anesthesia to the patient.

"Director Wei, Doctor Qin, you've worked hard."

In the operating room, the focus was on the patients, and everyone was fully armed, so Director Yang turned their heads, unable to distinguish who was who, and greeted them.

"Since the staff has arrived, I will start first."

Director Yang was the first to start neck lymph node dissection.

Radical neck dissection, also known as total neck dissection, requires the removal of cervical lymphoid tissue in areas I to V in front of the prevertebral fascia on one side. It's a catch.

Director Yang is worthy of being the head of the Oral and Maxillofacial Surgery Department of Zijingang First Hospital.

Even Qin Lang couldn't pick out any flaws.

Soon Director Yang completed the incision of the skin and separated the skin flap from the superficial surface of the deep cervical fascia under the platysma.

The entire exposure position is controlled very precisely, from the upper border to the edge of the mandible, the lower border to the upper border of the clavicle, and the posterior border to the anterior border of the trapezius muscle.

The action is clean and neat, and the speed is also very fast.

Wei Guoqiang and Qin Lang on the side were eye-opening.

"It is the top hospital in Zhejiang Province."

Qin Lang also has a yearning in his heart. It is really a place where the crouching tiger hides the dragon. Director Yang's cutting and separation skills have reached 90% of his own skills, which is really amazing.

Next, Director Yang dealt with the lower end of the internal jugular vein, directly cut off the sternocleidomastoid muscle and the clavicle end with an electric knife, found the internal jugular vein, and began to separate the common carotid artery and vagus nerve.

The vagus nerve is the tenth pair of cranial nerves, and it is a mixed nerve.

Under normal circumstances, the vagus nerve in the neck is relatively constant, but this patient had a rare mutation.

Director Yang is very familiar with the normal vagus nerve branch, but during this neck dissection, he found that the left vagus nerve is about 3cm above the carotid artery branch. The internal artery descended anterolaterally and deviated.

It is very important to protect the vagus nerve when separating and ligating the internal jugular vein during neck dissection. Generally, the vagus nerve runs behind the common carotid artery and the internal jugular vein. The deep surface of the internal jugular vein is easy to protect.

However, this variation of vagus nerve walking, even if carefully identified, may still damage the nerve by ligating the vagus nerve and the internal jugular vein together.

With such a serious condition as the patient is now, if there is more damage to the vagus nerve and repair, it will undoubtedly make things worse.

Director Yang's previous fast rhythm came to an abrupt end, and cold sweat broke out on his forehead and back.

After all, this kind of vagus nerve mutation is too rare, and the extent to which it has mutated can only be known by incision, but once it is damaged, it is irreversible.

If it was an ordinary patient, Director Yang would have made a bold attempt. If it is really damaged, it would take more time to repair it, but this patient's identity is special, and in the observation room, Vice President Lin is eyeing him.

Director Yang's heart thumped, and he was in a dilemma.

"What happened to Director Yang?"

Director Yu, who was the closest, saw Director Yang's abnormality and asked nervously.

Director Yang's mouth was bitter, and he said helplessly:

"The patient's vagus nerve has a variation in the course of the cervical segment. Conventional experience is no longer effective. It is very likely that mistakes will occur in the operation. To achieve non-destructive separation, the surgeon needs to be very familiar with the neck anatomy, which is far more careful and precise than ordinary people. separation technology."

Director Yang didn't say a word in his heart. This is still after the incision and autopsy, to find out the trend, and after the fact, Zhuge Liang's situation.

How to do!