Chapter 191

"The patient's tumor has spread!"

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

"The outer membrane of the liver tumor has broken!" When Zhang Fan cut it down, he found a small opening in the ruptured tumor adventitia. The tumor is hateful at this point. As long as it breaks a little, it can transfer to other places. And this break is estimated to break in a few days after CT!

If it is transferred, this operation is a typical operation. It is perfect. The patient needs to hang up the operation!

"Clean the surrounding lymph?" Professor Li asked hesitantly. The horror of cancer is like this. No one can be sure whether there is metastasis or not. We can only eliminate all suspected tissues across the board. The advantage is that you don't have to worry about transfer! The disadvantage is that the basic circulation of the organ is almost cut away. Once there is an accident, the cleaned organ does not even have a compensatory function. Moreover, the liver is a particularly complex organ, with the upper and lower blood vessels connected everywhere. It is also an organ with the function of secretion and detoxification. If there is a problem with the liver, there will be a problem with the brain!

Zhang fanlue thought, then gently put the tumor in the bend and said, "clean it!" He is not at ease. No one can guarantee such a thing. Great damage is better than life!

The observation doctors in the conference room were wondering, because this kind of operation observation could only see the image and could not hear the surgeon's conversation. They were too surprised by Zhang Fan's operation in the early stage. After such a large tumor was cut, the patient's vital signs were particularly stable. Everyone was shocked when they saw that the huge tumor was taken out.

What they don't know is that Zhang Fan and Professor Li in the operating room are doing a difficult multiple-choice question! Finally, Zhang Fan made up his mind and continued!

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

"Dr. Zhang, 9070mmhg, breathe 20!" The director of Anesthesiology said.

"Step down! Drop as much as you can! " Zhang Fan said.

"Good!"

Blood pressure drops, bleeding decreases, and the disadvantages are obvious. Major organs may fail at any time. So this is dancing on the steel wire. If you dance well, it's beautiful. If you don't dance well, it's fatal.

Continue the operation and start cleaning. As soon as Lao Li saw that Zhang Fan had started the operation, he didn't tangle. After all, Zhang Fan was the main knife in this operation, and Zhang Fan's decision was the safest.

Few doctors in the meeting room found anything wrong. After all, ordinary grass-roots doctors may not meet one in their life. All the lymph nodes near the hepatic hilum can be cleaned by Zhang Fan. Try to clean this place and eliminate tumor metastasis as much as possible. After the operation, Zhang Fan told Professor Li that after the patient's wound healed, he'd better do radiotherapy!

After successful resection of liver cancer, there will still be a great chance of metastasis and recurrence within five years, and this operation with suspected metastasis has a greater chance of metastasis, and the five-year survival rate is not estimated to be high. This is also the doctor's helplessness. No matter how high the level is, there will still be accidents. The difficulty of medicine is here. There are many kinds of training, but the condition will change, which takes into account the comprehensive quality of a doctor. In recent years, China has also found that this is a common problem for domestic doctors. Headache can only cure the head and foot pain can only cure the foot.

After the operation, we're going to make an on-site report. Although the tumor is a little broken, after this operation, it is definitely better than what kind of radiotherapy and chemotherapy, and it also has great advantages over liver transplantation! It's just a little imperfect.

Field report, Zhang Fan for the first time! It's impossible not to be nervous. Originally, Zhang Fan wanted Professor Li to go up, but Professor Li didn't go up anyway. He still wanted face! The two doctors who came together looked at Zhang Fan with envy. They didn't say that the level of operation was high, and the leaders of the hospital were willing to take the stage like this. They really envy him!

This kind of report is the best way to make a doctor famous. As long as this report is over, the general surgery department of chasu City, including the affiliated county and township hospitals, will regard Zhang Fan as the first person for liver surgery! Doctors' fame was first passed on from doctors to doctors.

"Leaders, teachers and colleagues, welcome to take time out of your busy schedule to participate in the seminar of this operation in our hospital. Here I'll talk about specific ideas and operation! ~" Zhang Fan said modestly that the originally debated venue was quiet. Although the operation was very shocking, few people really understood it. Now Zhang Fan wants to explain on the spot that doctors engaged in general surgery will not let go. Although after listening, he can't do this operation, 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. Almost all the liver is protected by ribs, and only a part below the sternum can be touched on the surface of the body." Zhang Fan briefly introduced the liver, and then began to get to the point.

"The survival rate of liver tumor after operation is not high, and the five-year mortality rate can be as high as 60%. Why is it so high? It is necessary to mention a term, hepatic sinuses!" With that, Zhang Fan turned to find a blackboard, but the meeting room was not ready.

What does the regional manager of a competent instrument manufacturer do? He is an expert in observing words and expressions. Zhang Fan turned his head a little and hesitated a little. She saw the problem, then went up quietly and asked, "director Zhang, do you have any requirements?"

"Is there a blackboard or something? I want to write something." This is not Zhang Fan pretending to force, but he really wants to write and speak out. He wants to share his experience and ideas with you. In fact, he doesn't know that this is the promotion of a realm! It is a truth that if you are poor, you will be alone. If you reach the world, it is almost impossible to climb the peak in the field of technology without a broad mind.

When Zhang Fan said this, Ouyang also heard it. With a wave of her hand, the director of the hospital office took several people to lift the blackboard at the gate of the hospital. How big is it? It's the kind of large blackboard with a length of seven or eight meters and a height of about two meters! This blackboard is still a product of the age!

Zhang Fan began to draw with chalk. Medicine can sometimes be expressed in words. When you don't understand, you can use drawing. This is the key to why Lao Lu can't learn medicine well. He is busy writing and can't draw!

Zhang Fan drew a large anatomical map of hepatic lobules with red chalk and blue chalk. Almost all the surgeons present here are a little qualified. Zhang Fan's first-hand anatomical map of hepatic lobules directly makes the sitting blush. This picture is really beautiful and intuitive.

Zhang Fan said from the central vein: "the three connecting tubes of the liver are interlobular artery and interlobular vein. The interlobular bile duct and interlobular hepatic vein divide the hepatic sinuses into the inferior vena cava. The difficulty of liver cancer surgery is that the blood vessels in the liver are extremely rich and extend in all directions. The tumor can enter the brain, intestine, stomach and even transfer to the uterus with the blood. "

Zhang Fan spoke more skillfully and faster. This systematic review also made him start to integrate the knowledge of the liver system. "Then the bile duct in Gleason's sheath is also a potential neglect point. I read the evidence-based medical data of liver cancer in recent ten years, which is the most easily ignored place at present." This data comes from the system. Zhang Fan has it at his fingertips, but it is a pure critical blow to all of you here. It is very difficult to collect the data in the past ten years. And evidence-based medicine is one of the subjects that China does not attach importance to.

Gradually, it became more and more difficult. When Zhang Fan talked about the method of tumor resection, he had persuaded 80% of the doctors to retreat. Although this explanation is particularly detailed, it is really difficult for doctors who have been away from the classroom for many years to understand. Doctors in grass-roots hospitals pay more attention to clinical practice and despise the foundation. Therefore, it is difficult for grass-roots hospitals with a large foundation in China to get out of any famous doctors. It is impossible to make achievements in higher fields without basic knowledge.

Professor Li and two doctors listened with relish. Although they knew this knowledge, no one had ever collected and summarized such a system. This is the real essence.

"When the tumor invades the blood supply system of the hilar, our current treatment is to go to embolization and palliative treatment! I have an idea. Why not rebuild it? Although the damage is great, the survival rate is very high. After cleaning the portal vessels, I think the five-year survival rate can be increased by 30%

At this point, Professor Li raised his hand. In the municipal hospitals of prefectures and counties, like primary school students, he raised his questioning hand in a disciplined manner, which is the respect for knowledge and the desire for knowledge, because Zhang Fan never thought about this way and dared not think about it. It's too difficult!

"Mr. Zhang, then I have a question. How can such a huge vessel protect the organs 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 following doctors and equipment manufacturers have noticed that if Professor Li can call a teacher, it is estimated that Zhang Fan will be in the frontier! Cow! awesome!

"First embolization, large-area embolization, and then quickly select the radial artery to replace the portal vessel, suture under the microscope, and dredge after ensuring sound function."

"Do you have test data? And how to ensure fast suture? If the fiber suture time is too long, how long will the embolic liver fail? " Professor Li asked, the key point of this topic.

Zhang Fan also considered this question for a long time. After a lot of systematic training, combined with self-study, Zhang Fan had some ideas of his own.

"No data, but I can do it quickly!" Although there is no data, Zhang Fan is very confident, which is the performance of strength. One word shocked Lao Li“ I can do it! "

"A general practitioner can suture blood vessels with fibers, and can ensure a fast speed." Lao Li sat down and thought, Zhang Fan has such a high level of liver surgery, and at his age, he should spend all his time on the liver, so where does the rapid fiber surgery technology come from!

Zhang Fan continued his speech and became more and more excited. The regional manager of the equipment manufacturer began to call her boss: "Mr. Yun, today's observation meeting was very successful, and I found a young doctor with excellent technology. Today, he is not only the main surgeon, but also he is lecturing. Although I can't understand it, I can also feel that Professor Li has been convinced by him! I want you to communicate with him yourself. 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, twenty-five at most. I'll inquire about the details and implement them! "

"Are you sure he has convinced Lao Li?"

"Sure, if you don't feel at ease, you can ask Professor Li about it."

"OK, I see!" After hanging up the phone, a young woman in the capital was meditating. She entered the frontier market for the first time.

Foreign profiteers also have a good set of medical devices. If you don't have the strength, no matter how much money you have, you won't be represented. If you have the strength, even if you don't want the agency fee, you can be represented in a large region. Moreover, the regional division is very clear. It will change every few years. Many old people leave, and many new people enter. If you pay attention to the business scope of a top device manufacturer, you may see a little political things.

No matter how good the device manufacturer is, someone has to use it, and there are only a few top doctors in a province. If you want to fully enter the medical market of a province, there is no doubt that officials are the first and experts are the second.

It's over. It's over. Zhang Fan took a long sip of the climate and said, "this is my humble opinion on liver cancer. Please give me your advice."

When I said this, it was cold! Yes, can we not be cold? This is not a research institute or a provincial affiliated hospital. Most of the doctors working here are county and township doctors. Most doctors can't understand what Zhang Fan said. It's not that they don't work hard, but that they have no conditions.

For about twenty seconds, Professor Li stood up and took the lead in clapping! Ouyang quickly stood up and applauded, although she couldn't understand it after she was in the meeting! But this doesn't affect her pride at all!

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

At the end of the meeting, the equipment manufacturer was busy entertaining the doctors of the county and township to attend the banquet, while Professor Li took Zhang Fan to a teahouse, and the two sat opposite each other and talked!