Whether it is liver hydatid or malignant tumor, once it invades the portal vein, it will most likely mean that the difficulty of surgery will increase exponentially.
"The Department of Chest has opened four stations in the operating room. Something went wrong tonight. No one from the Department of Chest can be found." Dong Jia complained, "Mr. Zhao said, if anything happens, let me come to you. He will be responsible for anything that happens." .You’re here before I even call you.”
Just as he was talking, a figure rushed in quickly, panting. It felt like there was a wind box in my throat, and when I heard the roaring sound, I felt that my breathing was not smooth.
"Professor Yang!" Dong Jia shouted quickly.
"How about rescue?" The man was out of breath and probably ran up.
"It's stable for the time being, but..."
"I'm going to change clothes." Professor Yang didn't even look at Zheng Ren and Su Yun, fearing that he thought they were passers-by.
"Are there any movies?" Zheng Ren asked.
"Yes, the CT scan done in the afternoon was on the chest and abdomen." Dong Jia immediately turned around, took out the film bag under the patient's bed, and handed it to Su Yun.
"You guys watch first, I'll take care of the patient and don't worry about anything else later." Dong Jia didn't forget to be polite at the end.
Su Yun carried the film bag without saying anything, turned around and went straight to the doctor's office.
When the film was inserted into the reader, Su Yun was stunned.
CT images from two levels come into view directly. On one level, a small snake appeared in the field of view. The snake was not big, less than 10cm, but its shape was lifelike. On another level, it is a ball of gauze.
What the hell, was this put in for testing
Zheng Ren was still in the same posture, holding his chin with his right hand, watching the film seriously.
No matter how talented Su Yun is, he is not a general surgeon after all. He doesn't know much about hepatic hydatid disease, a disease that is rare in the imperial capital.
Seeing that Zheng Ren was concentrating on watching the film, he took out the chest CT scan.
The imaging results are shocking.
Hepatic hydatid disease has a wide range of erosions, involving 4 abdominal and thoracic organs and important blood vessels.
Looking at the images, there are some similarities with cancer.
It's quite appropriate to say it's insect cancer.
Hydatid worms eroded about 65% of the liver, forming a huge and hard mass, and eroded downwards the right kidney and renal vein.
The upward erosion penetrates a large area of the diaphragm, then invades the chest and right lower lung, and spreads to the vicinity of the pericardium.
Hydatid extensively invades the largest abdominal veins and their branches deep into the abdomen, causing complete occlusion of the 17cm-long vena cava from the right renal vein to the level of the right atrium. At the same time, four groups of vessels entering and exiting the liver include the hepatic artery, portal vein, and hepatic vein. and bile ducts were severely damaged.
Similar to Budd-Chiari syndrome, except that the extent of portal vein erosion is simply too extensive to be treated by interventional surgery.
Looking at the erosion of the chest cavity, the wall of the bubble was relatively thin. Zheng Ren estimated that the cyst on the right side of the chest had ruptured, causing septic shock.
It’s just this surgery…
It's a little too complicated.
If this is done, the chance that the patient will survive is not great, with a 30% chance.
Not to mention, even if he steps down alive, the chance of surviving the dangerous period is no more than 20%.
Calculated, the chance that the patient can recover and be discharged from the hospital after surgery is only 5-6%.
This is literally dancing on the edge of a knife!
"Boss, this operation cannot be performed." Su Yun watched the film for two minutes and finally came to a conclusion.
Zheng Ren knew what Su Yun meant, and he actually thought so too.
Most doctors would choose to give up on patients who would die if they don't do it, and there is still about 5% chance of survival if they do it.
Not going on stage has nothing to do with me. When you get on stage, you're hooked.
Who is sure about such a complicated surgery
And the family members are not here? If the operation is successful, it will definitely not happen. Once it failed... At Haicheng City No. 1 Hospital, Zheng Ren performed a hemostatic operation for maternal hemorrhage. The operation was successful, but the patient's family still took the patient away and prepared to sue Zheng Ren and the obstetrician doctor.
But since it is said that the medical office has registered it, it means that the hospital will take care of any problems. Zheng Ren looked at the film and was already thinking about how to perform the operation.
Watching patients die? Zheng Ren really can't do it.
Forget about diseases like triple-negative breast cancer, Zheng Ren couldn't solve it even if he used up all the time for surgery.
However, although this patient looked serious, there was still a glimmer of possibility.
Although Zheng Ren had been away from Haicheng No. 1 Hospital for several months, he first performed a mission and then went to earthquake relief. He had not yet adapted to the situation of only doing interventional surgery.
He immediately placed himself in the emergency department's general position out of habit.
We must rescue him no matter what, even if there will be constant trouble in the future.
Let's give it a try. Even if there is time for surgical training, Zheng Ren is still not sure.
This kind of surgery is simply too difficult.
"Are you..." Zheng Ren was thinking about it when Professor Yang's voice came over. Before he could recover, he was panting. The white clothes he had just changed into were wet with sweat on his chest.
"Hello, Professor Yang, I am Zheng Ren from the Interventional Department."
Professor Yang, who was leading the team, saw Zheng Ren and Su Yun watching a movie and asked casually. But soon, Professor Yang recalled what Zheng Ren had just said.
"Are you Zheng Ren from the interventional department?"
"Yeah." Zheng Ren nodded without smiling. He was thinking about how to perform the operation.
Even if you go to the system operating room to train for surgery, you still need to have an idea.
It's just that this patient's surgery... it's a mess, there's no clue.
"Is it Boss Zheng who was nominated for the Nobel Prize?" Professor Yang asked in a low voice.
"Yeah." Zheng Ren hummed again.
"Nice to meet you." Professor Yang stretched out his hand, shook Zheng Ren's hand, and then asked: "Can intervention solve the problem of portal veins?"
"If we wait for a liver source, we can give it a try. But now the patient is in the acute shock stage. If surgery is needed, the vascular department will need to perform reconstructive surgery." Zheng Ren replied simply.
Professor Yang was obviously disappointed.
He knew the patient's condition early on. He originally wanted to delay it as long as possible and perform a chronic liver transplant with the hospital's authorization. Unexpectedly, the cyst ruptured at night.
I thought the Nobel Prize candidate would have some good tricks... Although Zheng Ren was telling the truth, Professor Yang still couldn't help but sigh.
"Boss, what's going on with this little snake?" Su Yun asked suddenly while watching the film.
"It is an image representation of liver hydatid, and like the gauze below, it is not real. Two documents published in the European Journal of Radiology in 1990 and 1991 gave a classic description of this characteristic image: The snake-like sign and spinning sign are diagnostic of acute abdomen due to ruptured hepatic cyst." Zheng Rendao.
"Hiss..." Su Yun took a breath, feeling very embarrassed.
Determining the gauze and small snake is actually not important, it is important surgery.
"Alas." Professor Yang sighed, picked up the phone, and while contacting people, asked Dong Jia to prepare to send the patient to the stage.
This is a hot potato, but without surgery, the patient will die.
No matter what you say, you must report it and then go on stage to give it a try.
As for the troubles in the future... let's talk about it later.
"Boss, this operation can't be done. You're new here, so don't let others catch you. Not to mention Professor Zhao, the chief directors and leading professors of each department are here, so don't show off." Su Yun shook his head and told Zheng again. Benevolence.
"Can you do something about your breasts?" Zheng Ren suddenly asked.
"I can definitely do the chest, but the abdomen..." As he said that, Su Yun pointed at the portal vein and right kidney on the film with his finger, and said, "I'm afraid you can't do these either."
…
…
At this time, Professor Zhao from the Intervention Department was at home, sitting in his study reading a foreign language journal.
"Who did you call just now?" Professor Zhao's lover asked.
"New Zheng Ren."
"Is that the little doctor who asked for your bed?" Professor Zhao's lover raised his eyebrows. After hearing Zheng Ren's name, murderous intent rose into the sky.
Cutting off someone's wealth is like killing one's parents. This statement really makes sense.
"What a little doctor, he is Director Kong's treasure and a candidate for the Nobel Prize." Professor Zhao said with a smile.
"Just pretend, why are you calling him when you have nothing to do?"
"This is not a hospital-wide consultation in the afternoon. There is a patient with liver echinococcosis, and all departments have gone to see him."
"Is it related to you?"
"No. I have to force myself to say yes, and it can still be attached. When I finally do an autologous liver transplant, it will be faster to take an image."
"Then why are you calling Zheng Ren?"
"I can't do anything, which doesn't mean Boss Zheng can't do anything either." Professor Zhao leaned back on his chair, closed his eyes, and seemed to be meditating on something.
"he… "
"The last time I did scientific research, I heard that he was majoring in general surgery."
"Then you let him go? Are you giving others a chance to show your face?" Professor Zhao's wife didn't understand.
"Opportunity? I'm afraid he won't dare to take it." Professor Zhao smiled and said: "He's from Haicheng, and I don't know why he was spotted by Director Kong. He was the chief resident of the emergency department in Haicheng, so I I'm looking forward to him having an operation. You said, no matter who it is, he can get it? Which surgery should be performed by an interventional surgeon? This is not showing off."
"You are the only one who thinks a lot."
"If he dares to ask for surgery, he will never be able to gain a foothold in 912 in the future." Professor Zhao said with a smile: "If that is the case, it will really save worry."
"The same goes for Director Kong. He's just a little doctor, but he's trying to steal the bed from you."
"He is a candidate for the Nobel Prize. If I were Director Kong, I would do the same thing. He is going to retire anyway, so it doesn't matter. It's a pity. If it were two years later, I would compete for the position of director and meet him again. That would be great.”
"So capable?" Professor Zhao's lover was surprised.
"I can't compare to him in surgery, especially tip surgery. His technique is just a slip-up. But he is young and energetic. He has such great abilities at this age, so he must be very ambitious. I don't know what's going on there today, really. It would be fun to watch if he didn't know how to do it and wanted to go on stage."
"I'm not really going to do the surgery, right?"
"How is it possible! Emergency rescue is a joke? Besides, is Yang Rui, who has left the hepatobiliary surgery department at home, a fuel-saving lamp? I haven't seen him serve anyone in so many years. A few years ago, he didn't return the favor Lin Guodong made a big fuss, and finally squeezed Lin Guodong away. Why should a young doctor who is less than 30 years old in the interventional department try to steal Yang Rui's stage? That said, I am really looking forward to it."