Chapter 1326 【1326】Consultation Case

"I have a patient here, and I want to invite you to come over to assist in the consultation."

Let her, a medical student, go over to assist in the consultation? Assisting in consultation is generally to ask a low-level doctor who is not satisfied after the consultation to call the superior doctor to come to assist in the consultation. Xie Wanying had every reason to think that she had heard wrong.

"It's 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 wanted to ask her for help.

Cardiac cancer, in China, likes to list it as gastric cancer. The calculated morbidity and mortality were all in gastric cancer. In fact, it is a junctional cancer. According to anatomical explanation, the cardia is located at the junction of the esophagus and the stomach. Tumors occurring here will naturally have the characteristics of both gastric cancer and esophageal adenocarcinoma. In the future, it will be more accurately defined as cancer of the esophagogastric junction in medicine.

Regarding the treatment of this disease, early tumors are small, and like other tumors such as intestinal cancer, they can be resolved with a digestive endoscope in the Department of Gastroenterology. All tumors follow the principle of early treatment and good prognosis. It's a pity that Chinese people don't have the habit of this physical examination. The symptoms of early gastric cardia cancer are similar to the symptoms of common gastrointestinal inflammation, which cannot be distinguished without a gastroscopy. When domestic patients are discovered, they are often in the middle and late stages and can only undergo surgery.

Both general surgery and cardiothoracic surgery are departments that can perform cardiac cancer surgery. The method adopted in general surgery is to open the abdomen without incision of the diaphragm, and to partially resect the stomach and esophagus. Due to the limitation of surgery from the abdomen, the residual tumor at the end of the esophagus and the lymph nodes in the thoracic cavity may not be removed cleanly and may recur easily. Therefore, more people choose to go to cardiothoracic surgery for this operation. The operation method of cardiothoracic surgery is to enter the abdominal cavity from the thoracic cavity. Compared with the operation of general surgery, the patient's tumor can be removed 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.

The operation on this patient was performed in the cardiothoracic surgery department of Xuanwu. Xuanwu's cardiothoracic surgery does not seem to be well-known, but he can certainly perform common tumor surgeries with a certain level of skill. Therefore, it is not that Xuan Wu's neurological diseases cannot be cured, and all common diseases can be cured. It's just that for a serious sudden injury like sister Xu's technical level is really limited.

Postoperative anastomotic leak is a common postoperative complication in surgery. The reason for its occurrence has a certain correlation with the technique of the surgeon, and has a lot to do with the individual differences of the patients. It can also be seen in various surgical departments of the National Association of China. How to deal with anastomotic leakage has always been a major difficulty in the surgical field. It must not be said here that Xuanwu's extra-psychic skills are not good. Unless there are many cases of postoperative fistula in a surgical department exceeding the normal ratio, something is wrong.

Dr. Shao Jialiang, Wei Guoyuan's classmate, works in the cardiothoracic clinic of the same hospital. When encountering such a case, he wanted to ask Guozhi's cardiothoracic clinic for consultation. When Wei Guoyuan heard this, he said that he might as well ask her, Xie Wanying, to come over and have a look.

There are generally two ways to solve postoperative fistula, either conservative treatment or surgical treatment. For surgical treatment, surgery can be performed again, and the chest and abdomen can be re-opened. It is also possible to use endoscopic minimally invasive surgery to block the fistula, which is usually done by a gastroenterologist.

Dr. Shao asked colleagues in the internal medicine department of this hospital for help. Xuanwu's Department of Gastroenterology, like Xuanwu's General Surgery, is relatively well-known for its technical strength, and the conclusion is that it cannot be done.

Why? The patient was complicated by anastomotic stenosis, and the gastroscope could not enter.