Path of Medicine With a System

"The patient's tumor has spread!"

"I didn't see it on CT!" Professor Li's hair stood on end in shock.

"The outer membrane of the liver tumor has ruptured!" Zhang Fan found a small opening in the ruptured outer membrane of the tumor when he cut it off. That's what makes a tumor hateful, and it can metastasize to other places with just a little bit of rupture. Moreover, the rupture is estimated to have occurred within a few days after the CT scan!

If it is really transferred, this operation is a typical perfect operation, and the patient will hang up!

"Clean the surrounding lymph?" Professor Li asked hesitantly. This is the horror of cancer. No one can determine whether it has metastasized or not. We can only remove all suspected tissues across the board. The advantage is that you don't have to worry about transferring! The disadvantage is that the basic circulation of the organs is almost cut off. Once an accident occurs, the cleaned organs do not even have a compensatory function, and the liver is a particularly complicated organ, with upper and lower blood vessels connected everywhere, and it is also an organ that secretes and detoxifies. . If there is a problem with the liver, there will be a problem with the brain if it is not done well!

Zhang Fan thought for a while, then gently put the tumor in the curved plate and said, "Let's clean it up!"

The observing doctors in the conference room were puzzled, because this kind of operation observation can only see the video and cannot hear the surgeon's conversation. Zhang Fan's operation in the early stage gave them too much surprise. After cutting such a large tumor, the patient His vital signs were surprisingly stable, and everyone was shocked when they saw the huge tumor being taken out.

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!

"Blood pressure and respiration?" Zhang Fan turned around and asked.

"Doctor Zhang, 90/70mmhg, breathing 20!" said the director of the anesthesiology department.

"Reduce the pressure! How much can it be reduced!" Zhang Fan said.

"it is good!"

The blood pressure drops, the bleeding decreases, and the disadvantages are also obvious. The major organs may fail at any time. So this is dancing on a tightrope. If you dance well, you will be beautiful, but if you dance poorly, you will die.

Continue the operation and start cleaning. Lao Li saw that Zhang Fan had started the operation, so he didn't worry about it anymore. After all, Zhang Fan was the chief surgeon in this operation, and Zhang Fan's decision was the safest.

Almost none of the doctors who watched in the conference room found out that something went wrong. After all, ordinary grassroots doctors might not be able to encounter one in this kind of surgery in their lifetime. Zhang Fan cleaned up all the lymph nodes around the hilum of the liver that could be cleaned.

Try to clean up this place to prevent tumor metastasis as much as possible. After the operation, Zhang Fan said to Professor Li, after the patient's wound healed, let's do radiotherapy!

After successful resection of liver cancer, there will still be a high probability of metastasis and recurrence within five years, and this kind of surgery with suspected metastasis has a greater chance of metastasis, and the five-year survival rate is estimated to be low. This is also the helplessness of doctors. No matter how high the level is, accidents will still happen. This is where the difficulty of medicine lies. There are many kinds of training, but the condition will change. This considers the overall quality of a doctor. In recent years, Huaguo has also discovered that this is a common problem among domestic doctors. Headaches can only be treated for the head, and foot pains can only be treated for the feet.

After the operation is completed, it is time to make an on-site report. Although the tumor was a little ulcerated, after the operation, the effect is definitely better than that of radiotherapy and chemotherapy, and it also has a huge advantage over liver transplantation! It's just not perfect.

On-site report, Zhang Fan's first time! It was impossible to say that he was not nervous. Originally, Zhang Fan wanted Professor Li to go up, but Professor Li didn't go up no matter what, he still had to lose face! The two doctors who came together looked at Zhang Fan enviously. Not to mention the high level of surgery, and the leaders of the hospital were willing to support him like this, I was really envious!

This kind of report can make a doctor famous. As long as this report is over, Chasu City, including the general surgery department of the affiliated county and township hospital, will regard Zhang Fan as the first person to perform liver surgery! The reputation of doctors was originally passed from one doctor to another.

"Leaders, teachers, colleagues, welcome to take time out of your busy schedule to come to our hospital to participate in the seminar on this surgery. Here I will talk about the specific ideas and surgical operations first!" Zhang Fan said modestly. The venue fell silent. Although the operation was shocking, few people really understood it. Now Zhang Fan wants to explain on the spot, and doctors in general surgery will not let it go. Although after listening to it, he can't perform this operation, but it will definitely have 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 except for the skin. The liver is almost completely protected by the ribs. Only the part below the sternum can be touched on the surface of the body." Zhang Fan After a brief introduction to the liver, we started to get down to business.

"The survival rate after surgery for liver tumors is not high, and the five-year mortality rate after surgery can be as high as 60%. Why is it so high? I need to mention a term, the small liver sinus!" Zhang Fan turned his head while speaking. I wanted to find a blackboard, but the meeting room was not prepared.

What does the regional manager of a competent appliance dealer do? She is a master at observing words and expressions. Zhang Fan turned her head slightly and hesitated for a moment, and she saw the problem, then went up quietly and asked, "Director Zhang, what do you have?" request?"

"Is there something like a blackboard? I want to write something." It's not that Zhang Fan is pretending, but that he really wants to write and talk, and he wants to share his experience and thoughts with everyone. In fact, he doesn't know, this is a kind of realm improvement! It is a truth that if you are poor, you will benefit yourself, and you will benefit 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 director of the hospital led a few people to lift up the big blackboard at the entrance of the hospital. How big is it? It's the kind of large blackboard with a length of seven or eight meters and a height of about two meters! This blackboard is still a product of its time!

Zhang Fan took the chalk and began to draw. Sometimes in medicine, when you don’t understand it in words, you can use pictures to express it. This is the key to why Comrade Lu can’t learn medicine well. He is too busy writing and can’t draw!

Zhang Fan used red chalk and blue chalk to draw a large anatomical diagram of the liver lobule. Almost all the surgeons present are experienced surgeons. Zhang Fan’s drawing of the liver lobule directly made everyone blush. beautiful and intuitive.

Zhang Fan started from the central vein: "The three tubes of the liver are the interlobular artery and the interlobular vein. The interlobular bile duct and the interlobular hepatic vein branch off from the hepatic sinusoids and enter the inferior vena cava. The difficulty of liver cancer surgery is that, The blood vessels inside the liver are extremely rich and extend in all directions, and tumors can enter the brain, intestines, stomach, and even transfer to the uterus along with the blood."

The more Zhang Fan speaks, the more proficient he becomes, and the more he speaks, the faster the rhythm. This systematic review also allowed him to integrate the knowledge of the liver system, "Then the bile duct in Gleason's sheath is also a potential neglect point. Evidence-based medical data on liver cancer, this is the point that we are most likely to ignore at present.” This data comes from the system, and Zhang Fan has it at his fingertips, but it is a pure blow to everyone here, so let’s not talk about the ten-year data. Even collecting is a very difficult thing. And this evidence-based medicine is a subject that Huaguo pays the least attention to.

Step by step, more and more difficult. When Zhang Fan talked about the tumor resection technique, he had persuaded 80% of the doctors to dismiss. Although this explanation is very detailed, it is really difficult for doctors who have been away from the classroom for many years to understand. Doctors in grassroots hospitals pay more attention to clinical practice and despise fundamentals. Therefore, it is difficult for Huaguo's grassroots hospitals with a huge foundation to produce famous doctors. It is impossible to make achievements in higher fields without basic knowledge.

However, Professor Li and the two doctors listened with great interest. Although they also knew this knowledge, no one had ever collected and refined it systematically. This is the real essence!

"When the tumor invades the blood supply system of the hepatic portal, our current treatment is embolization and palliative treatment! I have an idea, why not reconstruct it, although the damage is huge, the survival rate is very high, and the liver portal vein is cleaned. After the management, I think the five-year survival rate can be increased by 30%!"

When talking about this, Professor Li raised his hand. In the municipal hospitals in prefectures and counties, like a primary school student, he raised his questioning hand in a polite manner. This is the respect for knowledge and the desire for knowledge, because he never thought of the way Zhang Fan said. I don't dare to think about it, it's too difficult!

"Mr. Zhang, I have a question. How can such a huge vessel ensure that the organ does not fail? And how can the liver tumor cells not metastasize." Professor Li asked very politely.

Zhang Fan had already entered a state of thinking, and he didn't pay attention to Professor Li's attitude, but the doctors and equipment dealers below noticed, and if Professor Li could be called a teacher, Zhang Fan would probably be the only one in the frontier! cow! That's awesome!

"Embolize first, large-scale embolization, and then quickly select the radial artery to replace the hepatic portal vessel, suture it under a microscope, and then dredge it after ensuring that the function is sound."

"Is there any experimental 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 the key point.

Zhang Fan also thought about this question for a long time, combined with self-study after a lot of systematic training, Zhang Fan had some ideas of his own.

"I don't have the data, but I can do quick stitching!" Although there is no data, Zhang Fan speaks confidently, which is a manifestation of strength. One sentence shocked Lao Li! "I can do it!"

"A doctor in general surgery can suture blood vessels with fiber, and he can also guarantee a very fast speed." After sitting down, Lao Li thought inconceivably that Zhang Fan has 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 did the fast fiber surgery technology come from!

Zhang Fan continued his speech, getting more and more excited as he spoke. The regional manager of the equipment manufacturer started to call her boss: "Mr. Yun, today's observation will be very successful, and I found a young doctor with excellent skills. Not only is he the chief surgeon today, but he is also lecturing now. , although I don’t understand, but I can feel that Professor Li has been convinced by him! I want you to come and communicate with him in person, after all, he is still very young.”

"How old is it?" A very young voice came from the other end of the phone.

"In your twenties, at most twenty-five years old. I'll inquire about the specifics in detail!"

"Are you sure, he has convinced Lao Li?"

"Sure, if you are worried, you can ask Professor Li sideways."

"Okay, I see!" After hanging up the phone, a young woman far away in the capital was meditating. The frontier executives changed, and she entered the frontier market for the first time.

This medical device is just a few things. Foreign profiteers are also very good at it. If you have no strength, no matter how much money you have, they will not give you an agent. acting. Moreover, the division of this area is very clear, and it will be changed every few years. As many old people leave, so many newcomers will enter. If you pay attention to the business scope of a top equipment manufacturer, you may be able to see a little bit of political things.

No matter how good the device manufacturer is, someone needs to use it, and there are only a few top doctors in a province. If you want to fully enter the medical market in a province, the official 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 your advice."

As soon as I said this, the scene became cold! Yes, can you not stand aside, this is not a research institute, not a provincial affiliated hospital, most of the doctors working in the county and township, most of the doctors can't understand what Zhang Fan said, it's not that they don't work hard, But there are no conditions.

After about twenty seconds, Professor Li stood up and took the lead in applauding! Ouyang also quickly stood up and applauded, although she couldn't understand after the middle of the meeting! But this doesn't affect her pride at all!

The audience stood up and applauded. Although everyone was confused, what was the talk about today?

After the meeting was over, the equipment dealer was busy entertaining the doctors from the county and township to attend the banquet, while Professor Li took Zhang Fan to find a teahouse, and the two sat down and talked!