The images on the computer showed that MRI showed long T1 and short T2 signals in the liver with limited diffusion. The mass enhanced uniformly and emptied rapidly in the arterial phase, and showed cystic enhancement in the delayed phase.
Based on the enhancement characteristics, a preliminary diagnosis of hepatocellular carcinoma can be made.
The surgery is actually not difficult.
Whether it is hepatobiliary surgery to remove the right lobe of the liver or interventional embolization, these are the indications.
But the patient's condition was difficult because he drank a lot.
"The amount of ascites is too large and is not suitable for surgery." Zheng Ren said: "It must have been used for a long time to reduce the ascites."
"Yes." Professor Yang said, "Boss Zheng, can you see the patient?"
Zheng Ren nodded, stood up and followed Professor Yang out.
He seemed to have completely forgotten his purpose before coming - to work on a project with the hepatobiliary surgery department.
When I came to the ward, the first thing I saw was a swollen belly.
The weather has warmed up a bit, so it’s the time to dress casually.
The patient was wearing a black vest with her belly exposed.
Although the amount of ascites has dropped a lot, it is still very large. As a result, the belly is bulging high, and even the belly button is slightly protruding, which looks very weird.
"Lao Yang, you're here." The patient was lying on the bed in a semi-recumbent position, leaning against the quilt.
Seeing Professor Yang come in, he wanted to sit up. But because my stomach was so swollen, my abdominal muscles contracted, and the pressure increased, my body's natural protective response made me stop getting up and lie down again.
Professor Yang was helpless and sighed: "Lie down well, Boss Zheng, give me a slap."
The patient was a little surprised when he saw Professor Yang coming in with two young doctors, but out of politeness he did not speak.
Zheng Ren first took a look at the system panel, which was the same as his diagnosis just now, and there was no difference.
It's just that the patient's belly is much more distended than when the MRI was done.
Recalling it, the film was made 2 days ago.
Has it developed to this extent in only 2 days? Zheng Ren's first feeling was that the patient was hopeless.
Although he thought so in his heart, Zheng Ren still conducted a physical examination on the patient first.
Upon percussion, there was moving dullness all over the stomach. Zheng Ren estimated that there was about 2000ml of abdominal fluid.
With this amount of ascites, let alone liver resection, even minimally invasive surgery such as interventional surgery cannot be performed.
Zheng Ren looked at the patient's protruding belly button, feeling particularly helpless.
The same is true for Professor Yang, but he and the patient are classmates, which is completely different from other patients.
His face turned serious, with displeasure written all over it.
Zheng Ren nodded, looked into Professor Yang's eyes, and turned around to go out.
"Brother Yang, the patient's condition is not good and portal vein embolization cannot be performed." After leaving the hospital, Zheng Ren told Professor Yang bluntly.
Professor Yang naturally knew that. He sighed deeply and said, "I told him to stop drinking and talk about it again. If it doesn't work, then there's nothing I can do about it."
Hepatocyte growth factor mainly acts on the portal vein. Hepatocyte proliferation can occur after portal vein ligation, a phenomenon that has been discovered since 1920.
In the past, portal vein ligation was a major operation.
After interventional surgery, it is enough to directly embolize the portal vein branches.
The portal vein branches are embolized to proliferate the contralateral liver lobe, so that the remnant liver can compensate for the liver function after hepatic lobectomy.
After portal branch embolization, hepatocytes can undergo dedifferentiation and clonal proliferation.
If the remnant liver is normal, up to 75% of the liver can be removed while still keeping the patient alive. But the patient's alcoholic liver disease... cannot remove so much of the liver. However, the patient does not need to remove 75% of the liver, just the tumor.
However, portal vein embolization also has strict requirements. A large amount of ascites in a patient is one of the contraindications.
Theoretically, the benefit of ipsilateral portal branch embolization before partial hepatectomy is not only to enlarge the remnant liver, but also to avoid damage to the remnant liver caused by a sudden increase in portal pressure caused by partial hepatectomy.
There are many benefits, and this is also one of the projects that hepatobiliary surgery and interventional departments can cooperate on.
"Brother Yang." Su Yun said with a smile from behind: "I saw you sneaking around this morning. Is this the reason?"
Having said this, Professor Yang paused for a moment, then smiled and said, "No way, did Director Kong say that?"
Su Yun despised this chicken thief in his heart.
If you have something to talk about, first ask Director Kong if he has said it, then there will be a lot of little details in it.
Zheng Ren didn't think anything of it and said with a smile, "I told you."
"Boss Zheng, I'm not polite to you. What do you think of this matter?" Professor Yang asked immediately.
"Find a place, smoke a cigarette and talk in detail." Zheng Ren said.
Come to the duty room.
It was in the morning, everyone was going for surgery, and the duty room was empty, no one was there.
After closing the door, Su Yun smoked, and Zheng Ren asked directly: "Brother Yang, we are our own people, we are not hiding, do you need anything here?"
When he first started to visit the docks, Professor Yang and Director Luo from the Department of Gastroenterology were the first people to support him.
To reciprocate a favor, one should also ask this question.
Professor Yang was a little nervous, but seeing that Zheng Ren was very serious and serious, he thought about it and said, "This is not because Deputy Director Tian of the department is retiring. I am thinking about fighting for this position."
Zheng Ren was stunned for a moment, but he didn't expect this to be the reason.
However, scientific research has nothing to do with the deputy director. It does not mean that if the scientific research is done well, the deputy director will not run away.
"Other conditions are not bad, the level... you are definitely incomparable with Boss Zheng, but compared with other people in Corey, we are not afraid of anyone." Professor Yang said frankly: "Now we are missing someone to build momentum."
Zheng Ren and Su Yun said nothing, waiting quietly for Professor Yang to finish speaking.
"It's not that I've had smoother communication with the hospital since I met you recently... To be honest, I just want to get some glory from you, Boss Zheng." Professor Yang said frankly, staring directly into Zheng Ren's eyes. .
This was very true. Zheng Ren smiled and said, "Brother Yang, you were very supportive of me at the beginning. If you have difficulties, I will definitely help you."
Professor Yang knew there would be a but, so he listened attentively.
"The surgery should be broadcast live. Are you okay with this?" Zheng Ren asked.
"Okay." Professor Yang beamed, "Live broadcast is the best!"
To build momentum, Professor Yang probably had other Austrian aid, but that had nothing to do with him. Zheng Ren nodded.
"What do you think, Director Li?"
"Director Li supports me." Professor Yang said: "As long as you agree to the project, Boss Zheng, I will start accepting patients immediately. The interventional surgery will be done on my hospital bed, and the resection will be done after a period of time."
"OK."
The two of them had nothing to hide in this matter, and each took what they needed.
"Boss Zheng, I won't delay your Nobel Prize project, right?" Professor Yang finally asked anxiously.
This is what he is most worried about. After all, the weight of a director of 912 is far less than the Nobel Prize in Medicine.