Chapter 767： Late stage of worm (below)
Whether it is a liver hydatid or a malignant tumor, once the portal is invaded, a high probability means that the difficulty of surgery increases geometrically.
"The thoracic department opened four stations in the operating room. I am guilty tonight, and I can't find anyone in the thoracic family." Dong Jia complained, "Zhao Zong said, something makes me look for you, he is responsible for the accident. I haven't called you yet, you are here."
As he said, a figure rushed in quickly, panting. The scorpion is like pulling the wind scorpion, and the sound of the cymbal sounds like I feel that my breathing is not smooth.
"Professor Yang!" Dong Jia screamed.
"How is the rescue?" The man was out of breath, and it was estimated that he ran up.
"Susually stable, but..."
"I am going to change clothes." Professor Yang did not look at Zheng Ren and Su Yun, fearing that they were both passers-by.
"Is there a film?" Zheng Ren asked.
"Yes, in the afternoon, t, chest and abdomen have." Dong Jia immediately turned around, took out the film bag under the patient's bed, and handed it to Su Yun.
"Look first, I will take care of the patients, and I will have something to do again." Dong Jia did not forget his last politeness.
Su Yun squatted on the film bag, did not speak, turned and went straight to the doctor's office.
The film was inserted into the reader, and Su Yun was shocked.
Two levels of t-images are directly visible. On one level, a small snake appears in the field of vision, the snake is not big, less than 10, but the form is realistic. The other level is a gauze.
What's so special, is this a test put in?
Zheng Ren is still in the old position, holding his right hand and looking at the film seriously.
Su Yun is no more talented. After all, he is not a general practitioner. He does not know much about liver echinococcosis, a disease rarely seen by the emperor.
Seeing Zheng Ren's intent to watch the film, he took out his chest and looked at it.
Imaging shows that people are shocking.
Hepatic hydatid disease has a wide range of erosion, involving 4 abdominal and thoracic organs and important blood vessels.
Looking at the images, there are some similarities between cancer and cancer.
It is also appropriate to say that it is a worm.
The hydatid erodes the liver around 65 to form a large, hard mass that erodes the right kidney and the renal vein.
Erosion upwards penetrates a large area of the diaphragm, which invades the chest and the right lower lung and spreads to the vicinity of the pericardium.
The hydatid extensively invades the largest venous blood vessels and their branches in the abdomen, resulting from the right renal vein to the right atrial level. The long vena cava of 17 is completely occluded, and the four groups of vessels that enter and exit the liver include the hepatic artery, portal vein, and hepatic vein. Both the bile duct and the bile duct are severely damaged.
Similar to Budd-Chiari syndrome, the extent of portal erosion is simply too broad to be treated by interventional surgery.
Looking at the erosion of the chest, the wall is relatively thin, Zheng Ren estimated that the cyst in the right chest should be ruptured, leading to septic shock.
Just this surgery...
It’s too complicated.
If you do, the chances of the patient being able to step down alive are not great, and there is a possibility of zero on the top.
This is not a big deal. Even if you are alive, the chances of passing the dangerous period are no more than 20.
Calculated, the probability of patients recovering after surgery is 5-6.
This is simply dancing on the tip of the knife!
"Boss, this surgery can't do it." Su Yun watched the film for two minutes and finally came to a conclusion.
Zheng Ren knows what Su Yun means. In fact, he thinks so.
For this kind of not doing is death, there are still about 5 patients who hope to survive, most doctors will choose to give up.
Not on stage, it doesn't matter to me. When I came to power, I got it.
Who is sure of such a complicated operation?
And family members are not there? Successful surgery will definitely not happen. Once it failed... In the first hospital of Haicheng, Zheng Ren’s hemostasis surgery for maternal bleeding was successful. The patient’s family still took the patient away and then prepared to tell Zheng Ren and the obstetric doctor.
However, since the Medical Office has already filed a record, it means that something is wrong with the hospital. Zheng Ren looked at the film and thought about how to operate it.
Watching the patient die? Zheng Ren really can't do it.
For example, the disease of Sanyin breast cancer is no problem. Zheng Ren even has exhausted all the operation time, and there is no way to solve it.
However, this patient looks at the weight, but there is still a possibility.
Although Zheng Ren left the hospital for a few months from Haicheng, he first carried out the task, then went to the earthquake relief, and did not adapt to the case of interventional surgery alone.
For the first time, he habitually put himself in the general position of the emergency department.
How to rescue, even if troubles continue in the future.
Give it a try, even if there is surgery time, Zheng Ren is still not sure.
This kind of surgery is simply too difficult.
"You are..." Zheng Ren is pondering, Professor Yang’s voice passed. He hasn't slowed down yet, panting, just changing the white suit, the chest is wet with sweat.
"Professor Yang, hello, I am Zheng Ren from the Interventional Department."
Professor Yang with the group saw Zheng Ren and Su Yun watching the film and asked for a mouthful. But soon, Professor Yang recalled what Zheng Ren had just said.
"You are Zheng Ren in the intervention department?"
"Yeah." Zheng Ren nodded, no smile, he was thinking about what to do.
Even if you go to the operating room for training, you still have ideas.
It’s just the surgery of this patient... a mess, where is the idea.
“Is it the boss who won the Nobel Prize nomination?” Professor Yang whispered.
"Yeah." Zheng Ren snorted again.
"Fortunately, I will be lucky." Professor Yang reached out and shook with Zheng Ren, and immediately asked: "Can intervention solve the problem of the portal?"
"If you wait for the liver source, you can try it. But now the patient is in the acute shock period, if the surgery is done, the vascular department should be reconstructed." Zheng Ren replied simply.
Professor Yang is obviously somewhat disappointed.
In the case of the patient, he knew early on that he wanted to delay as much as possible. After the hospital authorized the patient to perform a slow liver transplant operation, he did not expect the capsule to rupture at night.
I also thought that there would be any good means for the Nobel Prize winners... Although Zheng Ren said the truth, Professor Yang still could not help but sigh.
"Boss, what is this little snake?" Su Yun looked at the film and suddenly asked.
"It is the manifestation of the image of the liver hydatid, which is not true like the gauze below. Two articles published in the European Journal of Radiology in 1990 and 1991 have a classic description of this characteristic image: The snake-like sign and the spinning sign have a definite diagnosis of hepatic cyst rupture acute abdomen." Zheng Rendao.
"Hey..." Su Yun took a breath and was very embarrassed.
Determining gauze and small snakes is actually not important, important surgery.
“Hey.” Professor Yang sighed, picked up his mobile phone, and contacted Dong Jia while he was ready to send the patient to the stage.
This is a hot potato, but without surgery, the patient will die.
If you say it again, you should report it, then go on the stage and try it.
As for the troubles in the future... I will talk about it later.
"Boss, this surgery can't be done. You first came to pick up, don't let people catch the handle. Don't say Professor Zhao, the director of each department, the professor of the group, you can not show off." Su Yun shook his head, once again Zheng Zheng benevolence.
"Can you do it on the chest?" Zheng Ren suddenly asked.
"I can definitely do it in the chest, but the abdomen..." Sai said, Su Yun pointed his finger on the door vein and the right kidney, saying: "These, I am afraid you can't do it."
......
......
At this time, Professor Interventional Zhao was at home, sitting in the study room and looking at a foreign language journal.
“Who did you call now?” asked Professor Zhao’s lover.
"New arrival of Zheng Ren."
"Is that the little doctor who asked you for a bed?" Professor Zhao’s lover’s eyebrows erected, and after hearing the name of Zheng Ren, a murderous murder.
It’s justified to break people’s money, just like killing parents.
"What a small doctor, people are the treasure of Director Kong, is the candidate for the Nobel Prize." Professor Zhao said with a smile.
"Come on it, you have nothing to call him for?"
"This is not a hospital consultation in the afternoon. There is a patient with liver echinococcosis. All departments have gone to see it."
"Is it related to you?"
"No. If you want to force it, you can stick it. Finally, when you do an autologous liver transplant, it will be faster to make a shadow."
"What do you call Zheng Ren?"
"I can't help, it doesn't mean that there is no way for Zheng boss." Professor Zhao leaned back in his chair and closed his eyes. He seemed to be thinking about something.
"he……"
"When I was doing research last time, I heard that he was a professional."
"Then let him go? You are the opportunity to show your face to others?" Professor Zhao did not understand the lover.
"Opportunity? I am afraid that he would not dare to go." Professor Zhao smiled and said: "Haicheng came, I don't know how to be spotted by Director Kong. He is the general hospital of the emergency department in Haicheng, I will I am looking forward to his surgery. You said, no matter who you are, can you let him go to the surgery, an interventionalian to do it? This is not a face."
"You have more thoughts."
"If he dares to ask for surgery, don't think about it at 912 in the future Professor Zhao smiled and said: "If that's the case, it would be really worrying." ”
"Director Kong is also a small doctor. As for grabbing a bed from your hands."
"People are candidates for the Nobel Prize. If I am Director Kong, I will do the same. Anyway, he has to retire. It doesn't matter. Unfortunately, if I was two years later, I would fight for the position of the director and meet him again. How good is that."
“So capable?” Professor Zhao’s lover is very different.
"I can't do surgery than him, especially the tips surgery, the way people do, it's called a slip. But what, young and energetic, this age has such a big skill, the heart is definitely high. I don't know what the situation is today, really If he didn't know the depth and wanted to go on stage, he would have fun."
"I won't really go to the main knife."
"How is it possible! Emergency rescue is a joke? Besides, Yang Rui, who stayed at home in hepatobiliary surgery, is a fuel-efficient lamp? For so many years, he has not seen who he served. A few years ago, it was not Lin Guodong’s troubles can’t be broken, and finally the hard-boiled student has squeezed Lin Guodong away. A small doctor who is less than 30 years old in the intervention department, why should he grab Yang Rui’s Taiwan? So, I really have some expectations.”
"The thoracic department opened four stations in the operating room. I am guilty tonight, and I can't find anyone in the thoracic family." Dong Jia complained, "Zhao Zong said, something makes me look for you, he is responsible for the accident. I haven't called you yet, you are here."
As he said, a figure rushed in quickly, panting. The scorpion is like pulling the wind scorpion, and the sound of the cymbal sounds like I feel that my breathing is not smooth.
"Professor Yang!" Dong Jia screamed.
"How is the rescue?" The man was out of breath, and it was estimated that he ran up.
"Susually stable, but..."
"I am going to change clothes." Professor Yang did not look at Zheng Ren and Su Yun, fearing that they were both passers-by.
"Is there a film?" Zheng Ren asked.
"Yes, in the afternoon, t, chest and abdomen have." Dong Jia immediately turned around, took out the film bag under the patient's bed, and handed it to Su Yun.
"Look first, I will take care of the patients, and I will have something to do again." Dong Jia did not forget his last politeness.
Su Yun squatted on the film bag, did not speak, turned and went straight to the doctor's office.
The film was inserted into the reader, and Su Yun was shocked.
Two levels of t-images are directly visible. On one level, a small snake appears in the field of vision, the snake is not big, less than 10, but the form is realistic. The other level is a gauze.
What's so special, is this a test put in?
Zheng Ren is still in the old position, holding his right hand and looking at the film seriously.
Su Yun is no more talented. After all, he is not a general practitioner. He does not know much about liver echinococcosis, a disease rarely seen by the emperor.
Seeing Zheng Ren's intent to watch the film, he took out his chest and looked at it.
Imaging shows that people are shocking.
Hepatic hydatid disease has a wide range of erosion, involving 4 abdominal and thoracic organs and important blood vessels.
Looking at the images, there are some similarities between cancer and cancer.
It is also appropriate to say that it is a worm.
The hydatid erodes the liver around 65 to form a large, hard mass that erodes the right kidney and the renal vein.
Erosion upwards penetrates a large area of the diaphragm, which invades the chest and the right lower lung and spreads to the vicinity of the pericardium.
The hydatid extensively invades the largest venous blood vessels and their branches in the abdomen, resulting from the right renal vein to the right atrial level. The long vena cava of 17 is completely occluded, and the four groups of vessels that enter and exit the liver include the hepatic artery, portal vein, and hepatic vein. Both the bile duct and the bile duct are severely damaged.
Similar to Budd-Chiari syndrome, the extent of portal erosion is simply too broad to be treated by interventional surgery.
Looking at the erosion of the chest, the wall is relatively thin, Zheng Ren estimated that the cyst in the right chest should be ruptured, leading to septic shock.
Just this surgery...
It’s too complicated.
If you do, the chances of the patient being able to step down alive are not great, and there is a possibility of zero on the top.
This is not a big deal. Even if you are alive, the chances of passing the dangerous period are no more than 20.
Calculated, the probability of patients recovering after surgery is 5-6.
This is simply dancing on the tip of the knife!
"Boss, this surgery can't do it." Su Yun watched the film for two minutes and finally came to a conclusion.
Zheng Ren knows what Su Yun means. In fact, he thinks so.
For this kind of not doing is death, there are still about 5 patients who hope to survive, most doctors will choose to give up.
Not on stage, it doesn't matter to me. When I came to power, I got it.
Who is sure of such a complicated operation?
And family members are not there? Successful surgery will definitely not happen. Once it failed... In the first hospital of Haicheng, Zheng Ren’s hemostasis surgery for maternal bleeding was successful. The patient’s family still took the patient away and then prepared to tell Zheng Ren and the obstetric doctor.
However, since the Medical Office has already filed a record, it means that something is wrong with the hospital. Zheng Ren looked at the film and thought about how to operate it.
Watching the patient die? Zheng Ren really can't do it.
For example, the disease of Sanyin breast cancer is no problem. Zheng Ren even has exhausted all the operation time, and there is no way to solve it.
However, this patient looks at the weight, but there is still a possibility.
Although Zheng Ren left the hospital for a few months from Haicheng, he first carried out the task, then went to the earthquake relief, and did not adapt to the case of interventional surgery alone.
For the first time, he habitually put himself in the general position of the emergency department.
How to rescue, even if troubles continue in the future.
Give it a try, even if there is surgery time, Zheng Ren is still not sure.
This kind of surgery is simply too difficult.
"You are..." Zheng Ren is pondering, Professor Yang’s voice passed. He hasn't slowed down yet, panting, just changing the white suit, the chest is wet with sweat.
"Professor Yang, hello, I am Zheng Ren from the Interventional Department."
Professor Yang with the group saw Zheng Ren and Su Yun watching the film and asked for a mouthful. But soon, Professor Yang recalled what Zheng Ren had just said.
"You are Zheng Ren in the intervention department?"
"Yeah." Zheng Ren nodded, no smile, he was thinking about what to do.
Even if you go to the operating room for training, you still have ideas.
It’s just the surgery of this patient... a mess, where is the idea.
“Is it the boss who won the Nobel Prize nomination?” Professor Yang whispered.
"Yeah." Zheng Ren snorted again.
"Fortunately, I will be lucky." Professor Yang reached out and shook with Zheng Ren, and immediately asked: "Can intervention solve the problem of the portal?"
"If you wait for the liver source, you can try it. But now the patient is in the acute shock period, if the surgery is done, the vascular department should be reconstructed." Zheng Ren replied simply.
Professor Yang is obviously somewhat disappointed.
In the case of the patient, he knew early on that he wanted to delay as much as possible. After the hospital authorized the patient to perform a slow liver transplant operation, he did not expect the capsule to rupture at night.
I also thought that there would be any good means for the Nobel Prize winners... Although Zheng Ren said the truth, Professor Yang still could not help but sigh.
"Boss, what is this little snake?" Su Yun looked at the film and suddenly asked.
"It is the manifestation of the image of the liver hydatid, which is not true like the gauze below. Two articles published in the European Journal of Radiology in 1990 and 1991 have a classic description of this characteristic image: The snake-like sign and the spinning sign have a definite diagnosis of hepatic cyst rupture acute abdomen." Zheng Rendao.
"Hey..." Su Yun took a breath and was very embarrassed.
Determining gauze and small snakes is actually not important, important surgery.
“Hey.” Professor Yang sighed, picked up his mobile phone, and contacted Dong Jia while he was ready to send the patient to the stage.
This is a hot potato, but without surgery, the patient will die.
If you say it again, you should report it, then go on the stage and try it.
As for the troubles in the future... I will talk about it later.
"Boss, this surgery can't be done. You first came to pick up, don't let people catch the handle. Don't say Professor Zhao, the director of each department, the professor of the group, you can not show off." Su Yun shook his head, once again Zheng Zheng benevolence.
"Can you do it on the chest?" Zheng Ren suddenly asked.
"I can definitely do it in the chest, but the abdomen..." Sai said, Su Yun pointed his finger on the door vein and the right kidney, saying: "These, I am afraid you can't do it."
......
......
At this time, Professor Interventional Zhao was at home, sitting in the study room and looking at a foreign language journal.
“Who did you call now?” asked Professor Zhao’s lover.
"New arrival of Zheng Ren."
"Is that the little doctor who asked you for a bed?" Professor Zhao’s lover’s eyebrows erected, and after hearing the name of Zheng Ren, a murderous murder.
It’s justified to break people’s money, just like killing parents.
"What a small doctor, people are the treasure of Director Kong, is the candidate for the Nobel Prize." Professor Zhao said with a smile.
"Come on it, you have nothing to call him for?"
"This is not a hospital consultation in the afternoon. There is a patient with liver echinococcosis. All departments have gone to see it."
"Is it related to you?"
"No. If you want to force it, you can stick it. Finally, when you do an autologous liver transplant, it will be faster to make a shadow."
"What do you call Zheng Ren?"
"I can't help, it doesn't mean that there is no way for Zheng boss." Professor Zhao leaned back in his chair and closed his eyes. He seemed to be thinking about something.
"he……"
"When I was doing research last time, I heard that he was a professional."
"Then let him go? You are the opportunity to show your face to others?" Professor Zhao did not understand the lover.
"Opportunity? I am afraid that he would not dare to go." Professor Zhao smiled and said: "Haicheng came, I don't know how to be spotted by Director Kong. He is the general hospital of the emergency department in Haicheng, I will I am looking forward to his surgery. You said, no matter who you are, can you let him go to the surgery, an interventionalian to do it? This is not a face."
"You have more thoughts."
"If he dares to ask for surgery, don't think about it at 912 in the future Professor Zhao smiled and said: "If that's the case, it would be really worrying." ”
"Director Kong is also a small doctor. As for grabbing a bed from your hands."
"People are candidates for the Nobel Prize. If I am Director Kong, I will do the same. Anyway, he has to retire. It doesn't matter. Unfortunately, if I was two years later, I would fight for the position of the director and meet him again. How good is that."
“So capable?” Professor Zhao’s lover is very different.
"I can't do surgery than him, especially the tips surgery, the way people do, it's called a slip. But what, young and energetic, this age has such a big skill, the heart is definitely high. I don't know what the situation is today, really If he didn't know the depth and wanted to go on stage, he would have fun."
"I won't really go to the main knife."
"How is it possible! Emergency rescue is a joke? Besides, Yang Rui, who stayed at home in hepatobiliary surgery, is a fuel-efficient lamp? For so many years, he has not seen who he served. A few years ago, it was not Lin Guodong’s troubles can’t be broken, and finally the hard-boiled student has squeezed Lin Guodong away. A small doctor who is less than 30 years old in the intervention department, why should he grab Yang Rui’s Taiwan? So, I really have some expectations.”
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