"The patient's tumor has spread!"
"I didn't see it on the CT scan!" Professor Li's hair stood up in shock.
"The outer membrane of the liver tumor has ruptured!" When Zhang Fan cut it open, he found a small opening in the outer membrane of the ruptured tumor. That's what's so bad about tumors, as long as they break down a little bit, they can spread to other places. And this ulcer probably broke out within a few days after the CT scan!
If it is really metastasized, this operation is a typical operation that is perfect and the patient will die!
"Clean the surrounding lymph?" Professor Li asked hesitantly. The scary thing about cancer is that no one can be sure whether it has metastasized or not. All we can do is remove all suspected tissues in one go. The good thing is that you don’t have to worry about transferring! The disadvantage is that the basic circulation of the organ is almost cut off. Once an accident occurs, the organ that has been cleaned does not even have a compensatory function. Moreover, the liver is a very complex organ. The upper and lower blood vessels are connected to everywhere, and it is also an organ with secretion and detoxification functions. . If there is a problem with the liver, there will be a problem with the brain!
Zhang Fan thought for a moment, then gently placed the tumor on the curved plate and said, "Clean it up!" He was not at ease, no one could guarantee this kind of thing, it would be better to cause serious damage than to kill someone!
The observing doctors in the conference room were all puzzled because this kind of surgical observation could only see images but not hear the surgeon's conversation. Zhang Fan's surgery in the early stage surprised them too much. After cutting such a large tumor, the patient His vital signs were actually very stable. When they saw the huge tumor being taken out, everyone was shocked.
But what they didn't know was that Zhang Fan and Professor Li in the operating room were doing a difficult multiple-choice question! Finally Zhang Fan made up his mind to continue!
"What's your blood pressure and respiration?" Zhang Fan turned around and asked.
"Dr. Zhang, 90/70mmhg, breathing 20!" said the director of the anesthesiology department.
"Lower the blood pressure! Lower it as much as you can!" Zhang Fan said.
"good!"
Blood pressure drops, bleeding decreases, and the disadvantages are obvious. Major organs may fail at any time. So this is dancing on the tightrope. If you dance well, you will be beautiful, but if you dance poorly, you will be killed.
Continue with surgery and begin dissection. When Lao Li saw that Zhang Fan had started the operation, he stopped worrying. After all, Zhang Fan was the surgeon in charge of this operation, and Zhang Fan's decision was the safest.
Few of the doctors observing in the conference room noticed that something was wrong. After all, ordinary grassroots doctors may never encounter this kind of surgery in their lifetime. Zhang Fan, who could clean up all the lymph nodes near the liver portal, cleaned them all. Try to make this area as clean as possible to prevent tumor metastasis as much as possible. After the operation was completed, Zhang Fan said to Professor Li that after the patient's wound healed, it would be better to undergo radiotherapy!
After successful surgical resection of liver cancer, there will still be a high chance of metastasis and recurrence within five years. Moreover, such surgery for suspected metastasis has a greater chance of metastasis, and the five-year survival rate is not estimated to be high. This is also the helplessness of doctors. No matter how high their level of expertise is, accidents will still happen. This is where the difficulty of medicine lies. There are various trainings, but the condition can change. This takes into consideration the overall quality of a doctor. In recent years, China has also discovered that this is a common problem among domestic doctors. A headache can only be cured for the head, and a foot pain can only be cured for the feet.
After the operation is completed, it’s time to give an on-site report. Although the tumor is a little ulcerated, after this operation is completed, it is definitely more effective than radiotherapy and chemotherapy, and it also has huge advantages over liver transplantation! Just a little less than perfect.
On-site report, Zhang Fan’s first time! It's impossible to say he's not nervous. Originally, Zhang Fan wanted Professor Li to go up, but Professor Li didn't go up no matter what, so he still wanted to lose face! The two doctors who came together looked at Zhang Fan with envy. Not only his surgical skills were high, but also the hospital leaders were willing to support him like this. I was really envious!
This kind of report can make a doctor famous the most. As long as this report is over, the general surgery department in Chasu City, including the affiliated county and township hospitals, will regard Zhang Fan as the first person to perform liver surgery! The reputation of doctors was initially passed on from one doctor to another.
"Every leader, teacher, and colleague, you are welcome to take time out of your busy schedule to come to our hospital to participate in this surgery seminar. Here I will first talk about the specific ideas and surgical procedures!~" Zhang Fan said modestly. There was originally a lot of discussion. The venue fell silent. Although the surgery was shocking, few people really understood it. Now Zhang Fan wants to explain on the spot, and doctors who perform general surgery will not let it go. Although after hearing this, he cannot perform this operation, but it will definitely make a huge improvement in liver surgery.
"The liver is the largest and most important digestive organ in the human body. It weighs about one kilogram. It is the largest internal organ in the human body besides the skin. The liver is almost entirely protected by the ribs. Only the part below the sternum can be touched on the surface of the body." Zhang Fan I briefly introduced the liver and then got to the point.
"The survival rate of liver tumors after surgery is not high, and the mortality rate five years after surgery can be as high as 60%. Why is it so high? This brings up a term, hepatic sinusoids!" Zhang Fan turned around as he spoke. I wanted to find a blackboard, but the conference room was not prepared.
What does the regional manager of a capable equipment dealer do? He is a master of observing people's actions. Zhang Fan turned her head slightly and hesitated for a moment. She saw the problem, then quietly went up and asked: "Director Zhang, what do you have? Do you want it?"
"Is there a blackboard or something like that? I want to write something." This is not Zhang Fan's pretense, but that he really wants to write it out and speak it out. He wants to share his experience and thoughts with everyone. In fact, he doesn't know that this is an improvement in realm! It is the same truth that if you are poor, you can work alone and help the world. Without a broad mind, it is almost impossible to climb to the top in the technical field.
When Zhang Fan said this, Ouyang also heard it. With a wave of her hand, the hospital office clerk and several people carried up the big blackboard at the entrance of the hospital. How big is it? It's the kind of large blackboard that's seven or eight meters long and about two meters high! This blackboard is still a product of its time!
Zhang Fan took the chalk and started drawing. Medicine, sometimes when you don't understand it with words, you can use pictures to express it. This is the key to why Comrade Lao Lu couldn't learn medicine well. He was too busy writing and couldn't draw!
Zhang Fan used red chalk and blue chalk to draw a large anatomical diagram of the liver lobules. Almost all of the people present here were surgeons with some qualifications. Zhang Fan's anatomical diagram of the liver lobules made everyone blush. The drawing was so realistic. Beautiful and intuitive.
Zhang Fan started from the central vein: "The three connected ducts of the liver are the interlobular arteries and interlobular veins. The interlobular bile ducts and the interlobular liver veins branch off the hepatic blood sinusoids and enter the inferior vena cava. The difficulty of liver cancer surgery is that, The liver is extremely rich in blood vessels and extends in all directions, and tumors can follow the blood into the brain, intestines, stomach, and even metastasize to the uterus."
Zhang Fan became more proficient as he spoke, and the pace became faster and faster. This systematic review also allowed him to begin to integrate the knowledge of the liver system. "Then the bile duct within the Gleason sheath is also a potential neglect point. I have read through it for nearly ten years. "Evidence-based medicine data on liver cancer, this point is currently the most overlooked point." This data comes from the system, Zhang Fan picked it up at his fingertips, but it is a pure blow to everyone here, let alone the ten years of data, Even collecting is a very difficult thing. And this evidence-based medicine is a subject that China attaches least importance to.
Step by step, it became more and more difficult. When Zhang Fan talked about the method of tumor resection, he had already persuaded 80% of the doctors to quit. Although this explanation is very detailed, it is really difficult for doctors who have been away from the classroom for many years to understand it. Doctors in primary hospitals pay more attention to clinical practice and despise the basics. Therefore, it is difficult for China's primary hospitals with a huge foundation to produce famous doctors. It is impossible to achieve success in higher fields without basic knowledge.
Professor Li and the two doctors listened with gusto. Although they also knew this knowledge, no one had ever collected, summarized and refined it in such a systematic way. This is the real essence!
"When the tumor invades the blood supply system of the liver portal, our current treatment is to remove embolization and palliative care! I have an idea, why not do reconstruction. Although the damage is huge, the survival rate is extremely high, and the liver portal vein can be dissected After treatment, I think the five-year survival rate can be increased by 30%!”
When talking about this, Professor Li raised his hand. At the municipal hospital in the county, like a primary school student, he raised his hand in question politely. This was his respect for knowledge and his desire for knowledge, because he had never thought of what Zhang Fan said in this way. I don’t dare to think about it, it’s too difficult!
"Teacher Zhang, then I have a question, how can such a huge blood vessel prevent organ failure? And how can we ensure that liver tumor cells do not metastasize." Professor Li asked very politely.
Zhang Fan had already entered a state of thinking and did not pay attention to Professor Li's attitude. However, the doctors and equipment dealers below noticed it. It is estimated that Zhang Fan is the only one in the frontier who can call Professor Li a teacher! Bull! So cool!
"First embolize, large-area embolization, and then quickly use the radial artery to replace the hepatic portal vessel, suture it under a microscope to ensure that the function is intact, and then unblock it."
"Is there any test data? And how to ensure fast suturing? If the fiber suturing time is too long, how long will it take for the embolized liver to fail?" Professor Li asked, and this topic asked a key point.
Zhang Fan also considered this question for a long time. After a lot of systematic training and self-study, Zhang Fan had some ideas of his own.
"There is no data, but I can do it quickly!" Although there is no data, Zhang Fan is very confident. This is a sign of strength. One sentence shocked Lao Li! "I can do it!"
"A general surgeon can actually suture blood vessels with fiber and do it very quickly." After sitting down, Lao Li thought incredulously that Zhang Fan had such a high level of liver surgery, and at his age, he should have all the time It’s all spent on the liver, so where does the rapid fiber surgery technology come from?
Zhang Fan continued his speech, becoming more and more excited as he spoke. The regional manager of the equipment manufacturer started calling her boss: "Mr. Yun, today's observation meeting was very successful, and I found a young doctor with excellent skills. Not only was he the surgeon in charge of the surgery today, but he is also giving lectures. , although I don’t understand, I can feel that Professor Li is impressed by him! I want you to come and communicate with him in person, after all, he is still very young."
"How old?" A very young voice came from the other end of the phone.
"More than 20 years old, at most 25 years old. I'll find out more details and implement it!"
"Are you sure that he has impressed Lao Li?"
"Sure, if you're worried, you can ask Professor Li sideways."
"Okay, I get it!" After hanging up the phone, a young woman in the capital was deep in thought. There was a change of leadership in Borderland, and she had entered the Borderland market for the first time.
There are only a few things in this medical device. Foreign profiteers are also very clever. If you don’t have the strength, no matter how much money you have, they will not give you an agent. If you are very powerful, they can give you a large area even if the agency fee is not required. acting. Moreover, the division of this area is very clear. It changes every few years. As many old people leave, so many new people enter. If you pay attention to the business scope of a top equipment manufacturer, you may be able to see a little bit of politics.
No matter how good a device manufacturer is, someone has to use it, and there are only a few top doctors in a province. If you want to fully penetrate the medical market of a province, the officials should be first and the experts second. There is no doubt about this.
It's over, it's finally over. Zhang Fan took a long breath and said, "This is my humble opinion on liver cancer. Please give me some advice from all the experts and teachers."
As soon as he said this, he suddenly became silent! Yes, can we not be silent? This is not a research institute or a hospital affiliated to the province. Most of the people doing the work are doctors from counties and townships. Most doctors can’t understand what Zhang Fan said. It’s not that they don’t work hard. But there are no conditions.
For about twenty seconds, Professor Li stood up and took the lead in applauding! Ouyang also quickly stood up and applauded, although she could no longer understand it after the meeting was over! But this does not affect her pride at all!
The audience stood up and applauded. Although everyone was confused, what exactly was talked about today?
After the meeting, the equipment dealer was busy entertaining doctors from the county and township for a banquet, and Professor Li took Zhang Fan to a teahouse, and the two sat down and talked!
