Medical road

"The patient's tumor has spread!"

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

"The outer membrane of the liver tumor has been ruptured!" When Zhang Fan cut it down, he found a small opening in the outer membrane of the ruptured tumor.Tumors are hateful at this point, as long as they rupture a little bit, they can spread to other places.And this rupture is estimated to be ruptured within a few days after the completion of CT!

If it is really transferred, this operation is a typical operation perfect, the operation that the patient wants to hang!

"Clean up the surrounding lymph?" Professor Li asked hesitantly.This is how scary cancer is. No one can be sure whether it has metastasized or not. It can only remove all suspected tissues across the board.The advantage is that there is no need to worry about transfer!The disadvantage is that almost all the basic circulation of the organs is cut off. Once accidentally cleaned, the organs will not even have a compensatory function, and the liver is particularly complicated. The upper and lower blood vessels are connected everywhere, and it is still 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 while, then gently placed the tumor in the curved plate and said, "Clean it up!" He was not relieved. No one can guarantee this kind of thing. It's better to damage than to kill!

The observation doctors in the conference room are all wondering, because this kind of operation observation can only see the image but cannot hear the surgeon’s conversation. Zhang Fan’s earlier operation gave them too much surprise. After such a large tumor was cut, the patient His vital signs were still particularly stable. When the huge tumor was 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, continue!

"How much blood pressure and breathing?" Zhang Fan asked back.

"Doctor Zhang, 9070mmhg, breathing 20!" said the director of the anesthesiology department.

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

"it is good!"

Blood pressure drops, bleeding decreases, and the disadvantages are obvious. All major organs may fail at any time.So this is to dance on a tightrope. If you jump well, you will be beautiful, if you don't jump well, you will die.

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

Few doctors in the conference room found out that there was a problem. After all, this type of operation might not be met by a doctor in a lifetime.Zhang Fan, who can clean all the lymph near the hepatic portal, cleaned it all.Try to make this place as clean as possible to prevent tumor metastasis as much as possible.After the operation, Zhang Fan said to Professor Li that after the patient's wound healed, let's do radiotherapy!

After successful resection of liver cancer, there is still a high probability of metastasis and recurrence within five years, and this type of suspected metastasis surgery has a greater probability 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, there will still be accidents.The difficulty of medicine is here. Training is in a variety of ways, but the condition can change. This considers the overall quality of a doctor.In recent years, Hua Guo has also discovered that this is a common problem among domestic doctors. Headaches can only cure the head, and feet pain can only cure the disadvantages of the feet.

After the operation is completed, we must go to the scene to report.Although the tumor is a bit ulcerated, after the operation is completed, 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 is impossible to say that it is impossible not to be nervous. Originally Zhang Fan wanted Professor Li to go up, but Professor Li didn't go up anyway, he still wanted face!The two doctors who came together looked at Zhang Fan enviously, not to mention the high level of surgery, and the hospital leader was willing to set up such a support, really envious!

This kind of report can best make a doctor famous. As long as the report is over, the general surgery department of 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 first passed from doctors to each other.

"Dear leaders, teachers, and colleagues, please take time out of your busy schedule to come to our hospital to participate in this surgical seminar. Here I will first talk about the specific ideas and surgical procedures!~" Zhang Fan said modestly, and there were a lot of discussions. The venue was quiet. Although the operation was shocking, few people really understood it.Now Zhang Fan wants to explain on the spot that doctors who do general surgery will not let it go. Although he can't perform this operation after listening to it, it can definitely make a huge improvement in liver surgery.

"The liver, the human body's largest and most important digestive organ, weighs about one kilogram. It is the largest internal organ of the human body except the skin. Almost all of the liver is protected by ribs. Only the part below the breastbone can be touched on the surface of the body." Zhang Fan A brief introduction to the liver, and then began to enter the topic.

"The survival rate of liver tumors after surgery is not high, and the five-year mortality rate can be as high as 60%. Why is it so high? This requires a term, hepatic sinusoids!" Zhang Fan turned his head. I wanted to find a blackboard, but the meeting room was not prepared.

What does the regional manager of a capable equipment dealer do? He is a master of words and expressions. Zhang Fan turned her head and hesitated a little, then she saw the problem, then quietly went up and asked: "Director Zhang, what do you have? Is it required?"

"Is there anything like a blackboard? I want to write something." It's not that Zhang Fan is pretending to be forced, but that he really wants to write and speak out. He wants to share his experience and thoughts with everyone.In fact, he didn't know that this was an improvement in realm!It is the same truth that it is the same as the poor to be independent, and to benefit the world. It is almost impossible to climb to the top in the technical field without a broad mind.

Ouyang also heard what Zhang Fan said. With a wave of her hand, the secretary of the hospital office led several people to lift the large blackboard at the entrance of the hospital. How big was it?It is the kind of large blackboard that is seven or eight meters long and two meters high!This blackboard is still a product of the age!

Zhang Fan took the chalk and started to draw.Sometimes when you don’t understand medicine in words, you can show it by drawing pictures. This is the key to why Old Comrade Lu can’t learn medicine well. He is busy writing and can’t draw pictures!

Zhang Fan drew a big liver lobule anatomy with red chalk and blue chalk. Almost all the surgeons present here are somewhat qualified surgeons. Zhang Fan’s hand on the liver lobule anatomy made the sitting blush directly. This hand drawing is really true. Beautiful and intuitive.

Zhang Fan started from the central vein and said: "The three connecting tubes of the liver are the interlobular artery and the interlobular vein. The interlobular bile duct and the interlobular hepatic vein divide the hepatic sinusoid into the inferior vena cava. The difficulty of liver cancer surgery lies in The blood vessels inside the liver are extremely rich and extend in all directions. Tumors can enter the brain, intestines, stomach, and even transfer to the uterus with the blood."

Zhang Fan is more proficient in speaking, and the more he speaks, the faster the pace. This systematic review also allows him to start to integrate the knowledge of the liver system. "Then the bile duct in Gleason's sheath is also a potential point of negligence. I have read it for nearly ten years. The data of evidence-based medicine for liver cancer in China is currently the most easily overlooked point.” This data comes from the system, and Zhang Fan took it in his hand, but for everyone here, it is a pure crit. Just collecting is a very difficult thing.And this evidence-based medicine is a subject that China does not value most.

Step by step, it became more and more difficult. When Zhang Fan talked about the technique of tumor resection, he had already dissuaded 80% of the doctors.Although this explanation is very detailed, it is really difficult for doctors who have been out of the classroom for many years to understand. The doctors in the basic hospitals pay more attention to the clinic and despise the basics. Therefore, it is difficult for the basic hospitals with a large foundation in China to get out of famous doctors.It is impossible to make achievements in higher fields without basic knowledge.

However, Professor Li and the two Ph.Ds listened with gusto. Although they also knew this knowledge, no one had ever collected and refined it systematically. This is the true essence!

"When the tumor invades the blood supply system of the hepatic portal, our current treatment is to embolize and go to palliative treatment! I have an idea, why not regenerate? Although the damage is great, the survival rate is extremely high. 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 city-level hospitals of prefectures and counties, like a pupil, he raised his questioning hand in a regular manner. This is the respect for knowledge, the desire for knowledge, because Zhang Fan said this way he never thought about it I dare not think about it, it's too difficult!

"Teacher Zhang, then I have a question, how can such a huge vessel prevent organ failure? And how to protect liver tumor cells from metastasis." Professor Li asked very politely.

Zhang Fan has already entered a state of thinking and has not paid attention to Professor Li's attitude, but the doctors and equipment dealers below have noticed. If Professor Li can be called a teacher, it is estimated that Zhang Fan will be in the frontier!Bull?That's awesome!

"First embolize, embolize a large area, and then quickly select the radial artery to replace the hepatic portal vessel, suture it under a microscope to ensure that the function is sound, and then go to dredge."

"Are there test data? And how to ensure rapid suture? The fiber suture time is too long, how long will the embolized liver fail." Professor Li asked, this topic asked the key point.

Zhang Fan also considered this question for a long, long time. After a lot of system training combined with self-study, Zhang Fan had a little idea of ​​his own.

"There is no data, but I can do it quickly!" Although there is no data, Zhang Fan said that he was very confident.One sentence shocked Lao Li!"I can do it!"

"A general surgeon can suture blood vessels with fibers, and it can guarantee a very fast speed." After sitting down, Lao Li thought incredulously, Zhang Fan has such a high level of liver surgery, and his age should have all the time. It is all spent on the liver, so where does the rapid fiber surgery technique come from!

Zhang Fan continued his speech, getting more excited as he spoke.The regional manager of the equipment manufacturer began to call her boss: "Mr Yun, today’s observation will be very successful, and I found a young doctor with superb skills. Not only is he in charge of the surgery today, but he is now giving lectures. Although I don’t understand, I can feel that Professor Li has been convinced by him! I want you to come and communicate with him personally, after all, he is still very young."

"How old?" A very young voice came out on the other end of the phone.

"How old are you in your twenties? Twenty-five years old at most. I will find out more about the specifics!

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

"OK, if you are not at ease, you can ask Professor Li from the side."

"Okay, I get it!" Hanging up the phone, a young woman in the capital was meditating, and the frontier senior management changed her term. She also entered the border market for the first time.

This medical device is just a few things. Foreign profiteers also have a very good set. If you don’t have the strength, no matter how much money you have, you won’t be able to act as an agent. If you are very capable, the agency fee can be given to you even if you don’t need it. proxy.Moreover, the division of this area is very clear. It will change every few years. When many old people leave, how 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 big the equipment manufacturer is, someone has to use it. There are only a few top doctors in a province. If you want to fully penetrate the medical market of a province, the official first, the expert second, there is no doubt about this.

It's over, it's finally over.Zhang Fan took a long sip of the weather and said, "This is my little bit of my opinion on liver cancer. Please give me your advice."

When I said this, it turned out to be cold!Yeah, can’t it be cold? This is not a research institute or an affiliated hospital in the province. Most of the doctors who are doing it are doctors from the county and township. Most doctors don’t understand what Zhang Fan says, and it’s not that they don’t work hard. But there are no conditions.

In 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 it anymore after the middle of the meeting!But this does not affect her pride at all!

The audience stood up and applauded. Although everyone was confused, what did they say today?

At the end of the meeting, the equipment dealer was busy to entertain doctors from the county and township to attend the banquet, while Professor Li took Zhang Fan to find a restaurant, and the two sat down and talked!