The road from Jinling to Fengxian is not far or near, hundreds of kilometers long. Even if there was no traffic jam on the road early in the morning, it was already close to noon when Director Xia arrived at the Central Hospital.
Director Xia had a quick bite of hamburger in the car. When he arrived, surrounded by the patient's family members, he took a look at the patient's films and the patient himself.
As imagined, the patient was in the advanced stage of cancer and was terminally ill.
I once again explained the condition to the patient’s family. The risk of surgical failure was very high, and even if it was successful, it would only be able to maintain life for about 1 year.
This is the key point. If the patient's family members have illusions and want to be cured, Director Xia will turn around and leave without saying a word.
The patient's family members expressed their attitude. They just wanted the old man to receive the highest level of medical treatment they could, and the family knew that his life and death would depend on him.
In this case, let's have surgery.
Director Li curled his lips when he heard this. He thought to himself, the best medical treatment is in front of you, but you don't know how to cherish it.
But this has nothing to do with him anymore. Boss Zheng has completed several TIPS operations. He should be eating at this time, and then return to the imperial capital by high-speed train or plane.
It is really a pity to pass by Boss Zheng. Whether it is the patient or himself, this is life.
After sending the patient to the stage, Director Li accompanied Director Xia from Jinling Cancer Hospital and chatted while they were on stage.
Director Li was shocked when he learned that Director Xia was going to perform this surgery under endoscopic surgery.
No wonder people dare to undergo this operation. Director Xia is really capable.
Anesthetize, brush your hands, put on clothes and go on stage.
After pneumoperitoneum was established, Director Xia fiddled with it twice with the endoscopic forceps, and then he just stood there in shock.
Director Li saw very clearly that the adhesions in the abdominal cavity were very serious and could not be removed by laparoscopic surgery.
There is no surgical field, so what kind of laparoscopy is there? (Note)
Then switch to laparotomy. You can't just give up the surgery if you can't do it through laparoscopic surgery.
Director Xia has nothing to be embarrassed about. His condition is here, and if he insists on doing it with force, he is setting himself up for trouble.
Make an incision about 20cm long in the midline of the abdomen and cut into the abdomen layer by layer.
The liver surface, small intestine, and pelvic cavity were re-explored and no metastatic nodules were found; the gallbladder was approximately 8×3, and the gallbladder was resected retrogradely.
The surgery was done quite well, and I didn't see any laparoscopic surgery, but the surgical operation proved that Director Xia was very skilled.
Director Li's anxiety calmed down slightly.
Director Xia opened the gastrocolic ligament along the edge of the colon, opened the peritoneum on the duodenal side, and lifted up the duodenum for bimanual diagnosis. Exploration revealed that the mass in the uncinate process of the pancreas was 4 cm in diameter, hard in texture, unclear in boundary, and had fairly good mobility.
But as the operation progressed, Director Xia's face became more and more solemn.
Watching a movie is one thing, but actually watching it is another thing.
The current surgery is definitely more difficult than what I have done before. The patient had severe intra-abdominal adhesions and it was too difficult to successfully remove them for surgery.
After reaching this point, Director Xia tried hard not to think about the failure of the operation.
Continue to dissociate the head of the pancreas and the posterior part of the duodenum, and explore the inferior vena cava without involvement. The root of the transverse mesocolon was explored and no contracture was found to be invaded.
But when the superior mesenteric vein was isolated, Director Xia was confused.
He opened the retroperitoneum at the root of the transverse mesocolon and dissected it along the direction of the superior mesenteric vein to find the blood vessel.
Then the branch vessels that merge into the superior mesenteric vein are skillfully separated, the blocking band is suspended, and the main trunk of the superior mesenteric vein is separated upward along the vessel.
The macroscopically visible mass is closely related to the superior mesenteric vein, and the confluence of the superior mesenteric vein's downward bifurcation is involved.
All... affected...
Looking at the adhering tumor and superior mesenteric vein, Director Xia took a deep breath and prepared to start dissection.
Of course, he knew that it would be too difficult to escape smoothly from this kind of adhesion. At this time, he had already begun to regret why he was so obsessed with running over to have the knife changed last night that he underwent this operation.
What a fuck!
Director Xia carefully tried to dissociate. Subconsciously, he realized that he had made a wrong choice. A large amount of adrenaline and dopamine are secreted in the body, the parasympathetic nerves are inhibited, and the sympathetic nerves are excited, directly entering a state of stress.
The sweat glands secrete a large amount of sweat, and the sterile cap is penetrated within 2′22″.
Director Xia turned his head, but this was not his own hospital, and there was no tacit understanding at all. No one understood the intention of his every move, and he felt that his actions were stupid.
"Wipe the sweat." Director Xia said helplessly in a deep voice.
The circulating nurse took a piece of gauze, wiped his sweat and asked in a low voice, "Director Xia, can I tie a piece of gauze for you?"
"Okay." Director Xia took this opportunity to ease his already tense sympathetic nerves.
He recalled the adhering tumors and superior mesenteric veins in the surgical area and felt helpless.
I'm so confused, why am I rushing to talk to Boss Zheng? The result was not good. Boss Zheng escaped, but he was put on the fire rack to be roasted.
What the hell!
Director Xia has a good temper and seldom curses. But the complicated situation made him irritable. Perhaps it was a side effect of the parasympathetic nerves going dormant and the sympathetic nerves starting to get excited.
A piece of gauze was tied outside the sterile cap on the head, and Director Xia concentrated on continuing the operation.
I hope I can do it,
Hopefully, the adhesion between the tumor and the superior mesenteric vein is not as tight as it appears to the eye.
hope…
Director Xia has too many hopes in his heart.
However, after 3 minutes and 12″, all hope was lost.
The tumor was tightly adherent to the superior mesenteric vein, making it impossible to proceed with surgery.
"Do you have a vascular surgery department?" Director Xia asked in a deep voice.
"Uh..." Director Li hesitated, feeling a sense of pleasure that shouldn't have occurred in his heart.
But this emotion was suppressed by him. The patient could not get off the stage, and he had to take the blame. Although the family members of the patients have brought this blame upon themselves, it is better not to bear the blame.
"Director Xia, we have a vascular surgery department, but its technical level is average." Director Li said bluntly.
Director Xia stopped the operation and looked helplessly at the operating area. The internal organs and blood stains were so dazzling under the shadowless lamp. His hands and feet were a little numb, and he was wondering how to explain to the patient's family.
The operating room was quiet. Director Li secretly looked at the electronic timer next to him. He waited for 3 minutes. Seeing that Director Xia still didn't speak, he quietly suggested, "Director Xia, Mr. Zheng from Imperial Capital hasn't left yet." , do you want to..."
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Note 1: This operation is taken from a real operation in a top tertiary hospital in China, which was converted from laparoscopy to laparotomy. Not all preoperative assessments can correctly determine the surgical method. This point will be discussed separately.