Chapter 766 Late Stage of Insect Cancer (Part 2)

Whether it is liver hydatid or malignant tumor, once the portal vein is invaded, the high probability means that the difficulty of surgery will increase geometrically.

"The thoracic department opened four tables in the operating room. There was something wrong tonight, and the thoracic department couldn't find anyone at home." Dong Jia complained, "Mr. Zhao said, let me call you if there is something wrong. You came here before I called you."

Just as he was talking, a figure rushed in quickly, panting. There was a wind box in his throat, and after hearing the roaring sound, he felt that his breathing was not smooth.

"Professor Yang!" Dong Jia called out hastily.

"How about rescue?" The man was out of breath, and he probably ran up.

"Temporarily stable, but..."

"I'm going to change clothes." Professor Yang didn't even look at Zheng Ren and Su Yun, probably thinking they were passers-by.

"Is there a movie?" Zheng Ren asked.

"Yes, the CT done in the afternoon covers both the chest and abdomen." Dong Jia immediately turned around, took out the scan bag from under the patient's bed, and handed it to Su Yun.

"Look first, I'll take care of the patient, don't have anything else to do later." Dong Jia didn't forget to be polite at the end.

Su Yun carried the film bag, turned around and went straight to the doctor's office without saying a word.

When the film was inserted into the film viewer, Su Yun was stunned.

The two-level CT images are directly in front of the eyes. In one layer, a small snake appeared in the field of vision meandering. The snake is not big, less than 10cm, but its shape is lifelike. Another level is a ball of gauze.

What the hell, is this put in for an experiment?

Zheng Ren was still in the old posture, resting his chin on his right hand, watching the film seriously.

No matter how talented Su Yun is, he is not from general surgery after all. He doesn't know much about hepatic echinococcosis, a rare disease in the imperial capital.

Seeing that Zheng Ren was concentrating on watching the film, he took out a chest CT scan.

The imaging display is shocking.

Hepatic echinococcosis had extensive erosions, involving 4 abdominal and thoracic viscera and important blood vessels.

Looking at the images, it is somewhat similar to cancer.

It is also very appropriate to say that it is worm cancer.

The echinococcosis eroded about 65% of the liver to form a huge and firm mass, and eroded the right kidney and renal vein downward.

The upward erosion penetrated a large area of ​​the diaphragm, and then invaded the chest cavity and right lower lung, and spread to the vicinity of the pericardium.

The hydatid infiltrates deeply into the largest vein and its branches in the abdomen, causing complete occlusion of the vena cava up to 17 cm from the right renal vein to the level of the right atrium. The four groups of vessels entering and exiting the liver at the same time include the hepatic artery, portal vein, and hepatic vein and bile ducts were severely damaged.

Similar to Budd-Chiari syndrome, except that the portal vein erosion is simply too extensive to be treated by interventional surgery.

Looking at the erosion of the thoracic cavity, the bubble wall is relatively thin. Zheng Ren estimated that the cyst on the right side of the thoracic cavity ruptured, leading to septic shock.

Just this surgery...

It's a little too complicated.

If it is done, the chance of the patient resigning alive is not great, at most there is a 30% possibility.

Not to mention, even if he stepped down alive, the chance of surviving the dangerous period was no more than 20%.

Calculated, the probability of the patient recovering and being discharged after the operation is only 5-6%.

It's literally dancing on the tip of a knife!

"Boss, this operation can't be done." Su Yun watched the film for two minutes and finally came to a conclusion.

Zheng Ren knew what Su Yun meant. In fact, he thought so too.

For this kind of patients who do not do it or die, and about 5% of patients hope to survive after doing it, most doctors will choose to give up.

It doesn't matter to me not to go on stage. When you get on stage, you get stuck.

Who is sure about such a complicated operation?

And the family members are not there? If the operation is successful, it will definitely not appear. If it fails... In Haicheng No. 1 Hospital, Zheng Ren performed a hemostatic operation on maternal hemorrhage. The operation was successful, but the patient's family still took the patient away, and then prepared to sue Zheng Ren and the obstetrician.

But since it is said that the medical office has filed a record, it means that the hospital will handle the matter. Looking at the film, Zheng Ren was already thinking about how to operate.

Watching patients die? Zheng Ren really couldn't do it.

Diseases such as triple-negative breast cancer can be ignored. Even if Zheng Ren exhausted all the operation time, there is no way to solve it.

However, although this patient looked heavy, there was still a possibility.

Although Zheng Ren left Haicheng No. 1 Hospital for a few months, he first went on missions and then went to the earthquake relief work, and he has not yet adapted to the situation of only doing interventional surgery.

Immediately, he habitually put himself in the general position of inpatients in the emergency department.

No matter what, he must be rescued, even if troubles continue in the future.

Let's try it, even if there is time for surgery training, Zheng Ren is still not sure.

This kind of surgery is simply too difficult.

"You are..." Zheng Ren was thinking about it when Professor Yang's voice came over. Before he could recover, he was out of breath, and his chest was wet with sweat in the white clothes he had just changed into.

"Professor Yang, hello, I'm Zheng Ren from the interventional department."

Professor Yang, who led the group, saw Zheng Ren and Su Yun watching a movie, so he asked casually. But soon, Professor Yang recalled what Zheng Ren had just said.

"Are you Zheng Ren from the interventional department?"

"Yeah." Zheng Ren nodded, without a smile, he was thinking about how to do the surgery.

Even if you go to the system operating room to train surgery, you still need to have ideas.

It's just that this patient's operation...is a mess, where there is no way of thinking.

"Boss Zheng, who was nominated for the Nobel Prize?" Professor Yang asked in a low voice.

"En." Zheng Ren hummed again.

"It's a pleasure to meet you." Professor Yang stretched out his hand, shook Zheng Ren, and then asked, "Can intervention solve the door vein problem?"

"If you're waiting for a liver source, you can try it. But now the patient is in acute shock. If surgery is performed, the Department of Vascular Surgery will be required to perform reconstruction surgery." Zheng Ren replied bluntly.

Professor Yang was obviously disappointed.

He knew the patient's condition early in the morning, and originally wanted to delay as much as possible, and performed the chronic liver transplant operation after authorization from the hospital, but he did not expect the cyst to rupture at night.

I thought the Nobel Prize candidates would have some good means... Although Zheng Ren was telling the truth, Professor Yang still couldn't help but sigh.

"Boss, what's the matter with this little snake?" Su Yun looked at the film and suddenly asked.

"Is a representation of a hepatic hydatid image, like the underlying gauze, not real. Two papers published in the European Journal of Radiology in 1990 and 1991 give a classic description of this characteristic image: Snake sign and spinning sign are diagnostic for acute abdomen with hepatic cyst rupture." Zheng Ren said.

"Hiss..." Su Yun took a breath, feeling very embarrassed.

It is not important to determine the gauze and the small snake, but the important surgery.

"Alas." Professor Yang sighed, picked up his mobile phone, contacted Dong Jia and asked Dong Jia to send the patient to the stage.

This is a hot potato, but without surgery, the patient will die.

No matter how you say it, you have to report it, and then go on stage and try it out.

As for the troubles in the future... let's talk about it later.

"Boss, this operation can't be done. You are new here, so don't let anyone catch you. Not to mention Professor Zhao, the chief directors and professors of each department are here, so don't show off." Su Yun shook his head and told Zheng Zheng again Benevolence.

"Can you do breasts?" Zheng Ren asked suddenly.

"I can definitely do the breasts, but the abdomen..." Su Yun pointed the door vein and the right kidney on the film with his fingers, and said, "I'm afraid you can't do these things."

...

...

At this time, Professor Zhao from the Department of Intervention was at home, sitting in the study and reading a foreign periodical.

"Who did you call just now?" Professor Zhao's lover asked.

"The new Zheng Ren."

"It's the little doctor who asked for your bed?" Professor Zhao's lover raised his eyebrows, and when he heard Zheng Ren's name, his murderous aura surged into the sky.

Cutting off people's wealth is like killing their parents. This is really reasonable.

"What little doctor, he is Director Kong's treasure and a candidate for the Nobel Prize." Professor Zhao said with a smile.

"Just pretend and you're fine, what are you doing calling him when you have nothing to do?"

"This is not an afternoon consultation with the whole hospital. There is a patient with hepatic echinococcosis, and all departments have gone to see it."

"Is it related to you?"

"No. I can barely say yes, and I can post it. When I finally do autologous liver transplantation, it will be faster to take a picture."

"Then why are you calling Zheng Ren?"

"I can't help it, but it doesn't mean Boss Zheng can't help it either." Professor Zhao leaned back on the chair, closed his eyes, and seemed to be thinking about something.

"he……"

"When I was doing scientific research last time, I heard that he had a background in general surgery."

"Then you let him go? Are you giving others a chance to show their face?" Professor Zhao's lover didn't understand.

"Opportunity? I'm afraid he won't dare to go up." Professor Zhao smiled and said, "He came from Haicheng, and somehow he was spotted by Director Kong. He is the chief resident of the emergency department in Haicheng. Looking forward to his surgery. You said, no matter who it is, let him do it? What kind of surgery needs an interventional doctor to do it? This is not showing your face. "

"It's just your thoughts."

"If he dares to ask for surgery, he won't be able to gain a foothold in 912 in the future." Professor Zhao said with a smile: "If that's the case, it will really save my worries."

"Director Kong is also, a little doctor, as for grabbing the bed from you."

"He is a candidate for the Nobel Prize. If I were Director Kong, I would do the same thing. Anyway, he is going to retire, so it doesn't matter. It's a pity, if two years later, I will fight for the position of chief director and meet him again. How nice that would be."

"So capable?" Professor Zhao's lover was surprised.

"I can't compare to him in surgery, especially the TIPS surgery. His technique is a slippery one. But, young and energetic, with such a great ability at this age, he must have a high spirit. I don't know what's going on there today, really. If he doesn't know how to go on stage, it will be fun to watch."

"I won't really go up to the knife."

"How is it possible! The emergency rescue is just a joke? Besides, Yang Rui, who stayed at home in the hepatobiliary surgery department, is that a fuel-efficient lamp? I haven't seen him serve anyone for so many years. A few years ago, if he didn't return the medicine Lin Guodong made a big fuss, and finally pushed Lin Guodong away abruptly. How can a young doctor in the interventional department, who is less than 30 years old, take Yang Rui's place? So, I really look forward to it."