Chapter 191： Unclear

Chapter 191: Unknown

"The patient's tumor has spread!"

"I didn't see it on CT!" Professor Li's hair straightened in surprise.

"The outer membrane of the liver tumor has been ruptured!" When Zhang Fan cut it off, he found a small opening in the outer membrane of the ruptured tumor. The tumor is awful at this point, as long as it ruptures it can metastasize elsewhere. And this rupture is estimated to be ruptured within a few days after CT!

If it is really transferred, this operation is perfect for typical surgery, and the patient has to hang!

"Clean up the surrounding lymph?" Professor Li hesitated. This is how terrible cancer is. No one can be sure whether it is metastatic or not. It can only be done across the board and all suspected tissues can be removed. The advantage is that you don't have to worry about transferring! The disadvantage is that the basic circulation of the organ is almost cut off. Once the organ that has been accidentally cleaned has no compensation function, and the organ is particularly complicated, the upper and lower blood vessels are connected everywhere, and it is still an organ with secretion and detoxification function. . Liver problems, brain problems!

Zhang Fan thought for a moment, then gently put the tumor in the curved plate and said, "Clean it up!" He didn't rest assured that no one could guarantee such a thing. Damage is better than death!

The observation doctors in the conference room are wondering, because this kind of surgery observation can only see the image and can not hear the surgeon's conversation. Zhang Fan's surgery in the early stage surprised them too much. After such a large tumor was cut, the patient His vital signs were so smooth that everyone was shocked when they saw huge tumors being taken out.

What they didn't know was that Zhang Fan and Professor Li in the operating room were doing a difficult multiple choice question! At last Zhang Fan made up his mind and continued!

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

"Dr. Zhang, 90 / 70mmhg, breath 20!" Said the director of the anesthesia department.

"Buck down! How much can you drop?" Zhang Fan said.

"it is good!"

Blood pressure drops, bleeding decreases, the disadvantages are also obvious, and major organs may fail at any time. So this is dancing on the wire. It's beautiful if you jump well.

Continue the operation and start cleaning. Lao Li saw that Zhang Fan had started the operation, and he was not entangled. After all, Zhang Fan was the main surgeon, and Zhang Fan's decision was the safest.

Few doctors observed in the meeting room found that there was a problem. After all, this kind of surgery generally may not meet a doctor in a lifetime. The lymph near the hilum was cleaned up by Zhang Fan who could clean it. Try to make this place as clean as possible to prevent tumor metastasis. After the operation was completed, Zhang Fan told Professor Li that after the patient's wound healed, let's do radiotherapy!

After successful resection of liver cancer surgery, there is still a great chance of metastasis recurrence within five years, and this operation 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 the doctor. No matter how high the level is, there will still be accidents. The difficulty of medicine is here, the training is varied, but the condition can change, which considers the comprehensive quality of a doctor. In recent years, China has also noticed that this is a common problem among domestic doctors. Headaches can only treat heads, and foot pains can only cure feet.

After the operation is completed, we must go to the site to report. Although the tumor is a little ulcerated, after this operation is completed, it is definitely better than any chemoradiation, and it also has a huge advantage over liver transplantation! Just a little less perfect.

On-site report, Zhang Fan for the first time! It is impossible to say that you are not nervous. Originally, Zhang Fan wanted Professor Li to go up, but Professor Li did not go up, he still had a face! The two doctors who came together looked at Zhang Fan enviously, the level of surgery was high, and the hospital's leaders were so willing to take the stage to carry, really envious!

This kind of report can make a doctor famous. As long as the report is over, the general surgery of the Chasu City, including the county and township hospitals, will treat Zhang Fan as the first person for liver surgery! The fame of doctors was originally passed from doctor to doctor.

"Dear leaders, teachers, colleagues, welcome to take the time out of your busy schedule to come to our hospital to participate in this surgery seminar. Here I will talk about specific ideas and surgical operations! ~" Zhang Fan said modestly, originally talking about it The venue of the conference was quiet. Although the operation was shocking, few people really understood it. Now Zhang Fan wants to explain on the spot that doctors outside the country will not let it go. Although this operation can't be done after listening, it can definitely improve liver surgery.

"The liver, the largest and most important digestive organ of the human body, weighs about one kilogram. It is the largest internal organ of the human body except the skin. The liver is almost protected by the ribs, and only the part below the sternum can be touched on the body surface." Zhang Fan Briefly introduced the liver, and then began to enter the topic.

"The survival rate of liver tumors after surgery is not high. The five-year mortality rate after surgery can be as high as 60%. Why is it so high? This requires mentioning a noun, hepatic sinus!" Zhang Fan turned his head while talking. Looking for a blackboard, the conference room was not prepared.

The district manager of a competent equipment maker is what he is doing. He is a master who observes and observes the color. Zhang Fan turned his head slightly, hesitated a little, then she saw the problem, and then went up quietly and asked, "Director Zhang, what do you have? Is it required? "

"Is there something like a blackboard, I want to write something." This is not Zhang Fan pretending to be forced, but he really wants to write it and tell it, and he wants to share his experience and thoughts with everyone. In fact, he didn't know that this was an ascension of state! It is a principle for He Po to stand alone and to help the world. It is almost impossible to climb the peak in the technical field without a broad mind.

Fan Fan said this, Ouyang heard it. She waved her hand, and the office's officer brought a few people to the big blackboard at the entrance of the hospital. How big? It's 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 started drawing with chalk. Medicine, sometimes when you do n’t understand it in words, you can use drawings to express it. This is why Comrade Lao Lu is not good at studying medicine. He is busy writing and ca n’t draw!

Fan Fan used red chalk and blue chalk to draw a large anatomy diagram of the hepatic lobule. Almost all of the doctors who are present here are a little qualified surgeon. Zhang Fan's anatomy of the hepatic lobule directly makes the sitting blush. This hand drawing is really true. Beautiful and intuitive.

Zhang Fan started from the central vein and said, "The triple liver tubes are the interlobular artery and the interlobular vein. The interlobular bile duct and the interlobular liver vein divide the hepatic sinus into the inferior vena cava. The difficulty of liver cancer surgery is that, The blood vessels inside the liver are extremely abundant, extending in all directions, and tumors can enter the brain, intestines, stomach, and even metastasize with the blood. "

Fan Fan became more and more proficient, and the faster the pace, the more systematic review led him to begin to integrate the knowledge of the liver system. "The bile duct in Gleason's sheath is also a potential neglect. I read it for nearly ten years. This is the point of evidence-based medicine for liver cancer, which is the easiest place for us to ignore at the moment. ”This data comes from the system. Zhang Fanxin came by hand, but for all of you here is pure crit. Let ’s take a look at the data for ten years. It's just that collecting is a difficult thing. And this evidence-based medicine is the subject that China pays least attention to.

Step by step, it is getting more and more difficult. When Zhang Fan talked about the method of tumor resection, he had already dismissed 80% of doctors. Although this explanation is particularly meticulous, doctors who can leave the classroom for many years are really hard to understand. Doctors in primary-level hospitals pay more attention to the clinic and despise the foundation. Therefore, it is difficult for a basic-level hospital with a large base in China to find a famous doctor. It is impossible to break away from the basics and achieve success in higher fields.

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

"When tumors invade the hepatic portal blood supply system, our current treatment is to go for embolization and palliative treatment! I have an idea, why not recreate it, although the damage is great, the survival rate is very high, and the portal vein of the liver is cleaned. After management, I think the five-year survival rate can increase by 30%! "

At this point, Professor Li raised his hand. At the city-level hospital in the county, he raised his doubtful hand like a primary school student. This is the respect for knowledge and the thirst for knowledge, because Zhang Fan said this way he never thought about it. I dare not think, it's too difficult!

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

Zhang Fan has entered a state of thinking and has not paid attention to Professor Li's attitude, but the doctors and equipment vendors below have noticed that Professor Li can be called a teacher. It is estimated that Zhang Fan will be in the frontier! Cow? Too great!

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

"Are there any experimental data? And how to ensure fast sutures? The fiber suture is too long and how long the embolized liver will fail." Professor Li asked, the key point of this topic.

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

"There is no data, but I can do fast stitching!" Although there is no data, Zhang Fan said very confidently, this is the performance of strength. In a word, shocked old Li! "I can do it!"

"A doctor outside the ordinary can suture blood vessels with fibers, and it can guarantee a very fast speed." Lao Li wondered after sitting down, Zhang Fan had such a high level of liver surgery, and his age should be all time It ’s all spent on the liver, so where does the fast fiber surgery come from!

Fan Zhang continued his speech, the more excited he became. The regional manager of the equipment manufacturer began to call and gave her boss: "General Manager Yun, today ’s observation will be very successful, and I found a young doctor with super technical skills. Today, not only is he the main surgeon, but he is now giving a lecture. Although I don't understand, I can still feel that Professor Li has been impressed by him! I want you to come and talk to him in person, after all, he is still very young. "

"How old?" At the other end of the phone, a very young voice came out.

"Twenty years old, up to twenty-five years old. I'll ask for more details."

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

"OK, if you are not assured, you can ask Professor Li on the side."

"Okay, I know!" I hung up the phone, and a young woman in the capital was thinking, and the frontiers of the frontiers were changing. She also entered the frontier market for the first time.

There are just a few things about this medical device. Foreign traitors also have a very good set. If you do n’t have the strength, you wo n’t be given an agent if you have more money. If you are very capable, you can give you a large area even if you do n’t have the agency fee proxy. And this area is very clear. It will change every few years. Many old people leave and there are many new people entering. If you pay attention to the business scope of a top-level equipment manufacturer, you may see a little political things.

There is also a need to use equipment vendors, and there are only a few top doctors in a province. If they want to enter the medical market of a province, the official is the first and the experts are the second. There is no doubt about this.

It's over, it's over at last. Zhang Fan took a long sip of the climate and said, "This is my little opinion on liver cancer. Please give us your advice."

With that said, it turned out to be cold! Is n’t it cold? This place is not a research institute or a provincial affiliated hospital. Most of the doctors are doing county and township doctors. Most of the doctors do n’t understand, it ’s not they do n’t work hard. There is no condition.

For about twenty seconds, Professor Li stood up and took the lead in applauding! Ouyang also quickly stood up and applauded, although after the middle of the meeting, she could not understand! But this did not affect her pride at all!

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

At the end of the meeting, the equipment vendors were busy hosting doctors from the county and townships to attend the banquet, and Professor Li took Zhang Fan to find a tea house, and the two sat down talking!

Hey!

No patience!

Still young!

Real envy!

I want to trade with you!

I want to be ten years younger too!

(End of this chapter)