Chapter 1326： 【1326】Consultation case

Chapter 1326 [1326] Consultation Cases

"I have a patient here and would like to invite you to assist in the consultation."

Let her, a medical student, assist in the consultation? Assisting the consultation is generally to ask the lower-level doctor to ask the higher-level doctor to come over and assist the consultation after the consultation is not satisfied. Xie Wanying had every reason to think that she had heard it wrong.

"This is a patient with anastomotic leakage after cardiac cancer surgery." Wei Guoyuan briefly introduced the case to her so that she could understand why she suddenly thought of asking her for help.

Cardia cancer, which is liked to be classified as gastric cancer in China. Morbidity and mortality were calculated in gastric cancer. In fact, it is a kind of junctional cancer. According to anatomical interpretation, the cardia is located at the junction of the esophagus and the stomach. The tumor that occurs here will naturally have the characteristics of both gastric cancer and esophageal adenocarcinoma. In the future, medicine will define it more accurately as esophagogastric junction cancer.

Regarding the treatment of this disease, the early stage tumor is small, and like other tumors such as colon cancer, it can be solved with a digestive endoscope in the gastroenterology department. All tumors follow the principle of early treatment and good prognosis. It is a pity that Chinese people do not have the habit of doing this kind of physical examination. The symptoms of early cardia cancer are similar to those of common digestive tract inflammation, which cannot be distinguished without endoscopy. When domestic patients are found, they are often in the middle and late stages and can only undergo surgery.

General surgery and cardiothoracic surgery are both departments that can perform cardiac cancer surgery. The general surgery method is to open the abdomen, without incising the diaphragm, and partially removing the stomach and esophagus. Due to the limitations of abdominal surgery, the residual tumor at the end of the esophagus and the lymph nodes in the thoracic cavity may not be removed cleanly, which may lead to recurrence. Therefore, more people choose to go to cardiothoracic surgery for this operation. The operation method of cardiothoracic surgery is to enter and re-enter the abdominal cavity from the thoracic cavity. Compared with general surgery, the tumor of the patient can be cleaned more thoroughly. However, there may be more serious complications, such as extrusion to the heart and other organs, postoperative anastomotic leakage of the thoracic cavity, etc.

This patient's surgery was performed at Xuanwu's Cardiothoracic Surgery Department. Xuanwu's cardiothoracic surgery does not seem to be well-known, but common tumor surgery can certainly be done, with a certain technical level. Therefore, Xuanwu's neurological disease is not incurable, common diseases can be cured, but a serious sudden injury like Sister Xu, the technical level is really limited and can only be so.

Postoperative anastomotic leakage is a very common postoperative complication in surgery. The reason for this has a certain relationship with the technique of the chief surgeon, and at the same time has a great relationship with the individual differences of patients. It can be seen in all surgical departments of the National Association. How to deal with anastomotic leakage has always been a major difficulty in the surgical field. Therefore, it must not be said that Xuanwu's skills outside his heart are not good. Unless there are many cases of postoperative fistula in a surgical department exceeding the normal ratio, it is not right.

Dr. Shao Jialiang, a classmate of Wei Guoyuan, works in the cardiothoracic department of the same hospital. When he encountered such a case, he wanted to go to Guozhi's cardiothoracic department for consultation. When Wei Guoyuan heard it, he said that it would be better to ask her Xie Wanying to come and have a look.

There are two general solutions for postoperative fistulas, either conservative treatment or surgical treatment. If surgical treatment is required, surgery can be performed again, and the chest and abdomen can be reopened. Endoscopic minimally invasive surgery can also be used to plug the fistula, which is usually done by a gastroenterologist.

Dr. Shao sought help from colleagues in the internal medicine department of our hospital. Xuanwu's gastroenterology department, like Xuanwu's general surgery department, is relatively famous and has this technical strength, and the conclusion is that it cannot be done.

why? The patient was complicated with anastomotic stenosis, and the gastroscope could not enter.

(end of this chapter)