Chapter 129 Liver Transplant
Sunday.
After getting up, Wu Xiaofu looked at his blog. The depression-related content he posted yesterday had received tens of millions of likes.
Wu Xiaofu was also surprised. This was only one night.
After taking a closer look, I discovered that my blog had been forwarded by the official. No wonder the influence suddenly expanded so much. However, this is a good thing, and Wu Xiaofu is naturally happy to see it happen.
Toot toot.
"Good morning, Teacher Duan."
"Xiao Fu, come and learn about liver transplantation in the operating room."
Liver transplantation!
Wu Xiaofu suddenly became energetic. Liver transplantation, general surgeons are probably proud of being able to complete liver transplantation operations.
After all, this is an operation beyond the fourth level. Anyone who can perform liver transplantation is basically a person who has been written in the history of medicine. Experts and professors have become famous and have left a strong mark on the history of medicine.
To say that liver transplantation is difficult, it is definitely difficult. Even if Wu Xiaofu feels that he is doing well now, when it comes to liver transplantation, it is unthinkable.
There are no twos and threes, and he dare not go to Liangshan. Liver transplant surgery is not something he can touch at this stage.
That’s why Wu Xiaofu was so excited when he heard that he had the opportunity to learn such surgery.
With his current learning ability, Wu Xiaofu dares to say that as long as he can learn a few machines, he will be able to master 70% to 80% of them. He will take his time later. Will the day when he performs the surgery himself be far away?
Liver transplant surgery is not easy to develop in China. The first case was completed in the 1970s, also in Donghai and the First Affiliated Hospital.
Therefore, the First Affiliated Hospital can be said to be the origin of liver transplantation in China. Today, it is also the place with the highest success rate of liver transplantation and the highest number of completed cases.
But even so, the number of liver transplants performed in China each year only exceeds 10,000.
Don’t think this number is too high. Not to mention that there are cases that require liver transplantation repeatedly. According to statistics, the number of cases requiring liver transplantation at this time is no less than ten million. Compared with this number, every year The thousands of liver transplants that have been performed are simply not worth mentioning.
Wanting to do, needing to do, and being able to do are two different things.
Regardless of the difficulty of the operation, this is an issue that doctors and hospitals need to consider. Patients don’t need to think too much. What patients need to consider are liver source issues and economic issues.
The first one is the liver source. Not to mention the world, there are millions of people in China waiting for liver sources. These people are all queuing up and need surgery. , are the kind of people who have entered the terminal stage of the disease and have no more than a year left. After waiting like this, most cases die before the liver source is available.
So, most people consider living donor liver transplantation, where people around them voluntarily give their liver to the patient.
Although the liver has the ability to repair itself, this ability is limited after all. Unless it is a close relative, there are really not many people who can do this. Maybe the ability can, but not anyone All have such abilities.
In fact, the main reason why so many people in need of liver transplantation have not done so is not the liver source, but lack of financial capacity.
Poverty is the only original disease. This sentence may not be wrong.
Operating room.
When Wu Xiaofu arrived, he realized that this operation was not performed by Duan Hao, but by Yu Shifu. Duan Hao was just an assistant. Not only Duan Hao, but also the general surgeon Chief physician Che Liming, I have to say that this lineup is truly luxurious.
"Xiaofu."
Seeing Wu Xiaofu, Che Liming immediately called out. The two had met before, and now he was even more familiar with Wu Xiaofu.
The hospital is so big, so the news that Wu Xiaofu was favored by Yu Shifu is no longer a secret.
"Teacher Che."
Che Liming is Duan Hao's contemporary and an expert in liver transplantation. He himself has performed many liver transplant surgeries and performed liver transplant surgeries. In the First Affiliated Hospital, Yu Shifu was able to get him to start.
Entering the operating room, the patient just came in.
A man in his sixties is considered an old man according to medical classification. However, from the appearance, the patient does not look like he is only in his sixties. He has been suffering from long-term diseases. It has exhausted the patient's spirit and body to the limit.
Alcoholic cirrhosis has reached the end stage, and the liver function is severely weakened. If surgery is not performed, it may be within this year.
The end stage of alcoholic cirrhosis is a major indication for liver transplantation.
There are several main indications for liver transplantation. Surgery is, after all, the second choice of various treatment methods. No doctor is willing to operate on you without surgery, so the first one is the same as the first one. Most surgical indications are similar. When various acute or chronic liver diseases cannot be cured by other medical and surgical methods, and death is expected to be unavoidable in the short term, liver transplantation is the best treatment.
The medicine is no longer able to awaken the function of the liver. It is so bad that it can only be replaced.
Then there is the requirement for quality of life. Some patients have severe liver disease, severe functional limitations, and severe symptoms, which have seriously affected the quality of life. Not to mention other things, they must at least be able to go to the ground. They cannot just Just be a vegetative person in bed. In order to seek a better life, liver transplantation is also necessary.
There is also liver cancer. As long as liver cancer has not metastasized, that is to say, in situ liver cancer, such as hepatocellular liver cancer and cholangiocarcinoma, is also one of the main indications for liver transplantation, accounting for about 1/3 of all liver transplant cases. -2/3.
Finally, there is the classification of indications for the patients in front of us. End-stage benign liver disease and alcoholic cirrhosis are still benign diseases after all. The surgical effect is much better than that of liver cancer. Therefore, gradually, end-stage benign liver disease Liver disease has also become the main indication for liver transplantation.
Just like the patient in front of me, as long as the doctor sees him, he will basically recommend a liver transplant.
Jaundice is so severe that it is not just a sallow complexion. This is basically the most typical sign of patients with end-stage liver disease. Then there is hepatic ascites. Even if the patient is covered with a quilt, he can see a bulging abdomen. It is actually no smaller than a woman's ten-month pregnancy, and this is much more uncomfortable than being pregnant with a child.
Pain.
Most of these patients can only rely on painkillers, which is similar to the late-stage cancer pain of cancer patients. If they don't take painkillers, they won't even have a few hours of peaceful sleep.
“This is a case of living donor liver transplantation. The patient’s daughter donated half of his liver to him.”
Hearing Che Liming’s words, Wu Xiaofu nodded. At this time, he could take the initiative to donate his liver. , that is, the patient's close relative. The patient is lucky, but not every relative can do this.
“The four daughters and one son in the patient’s family were all matched. The matching result was that the patient’s eldest daughter was the most suitable. I heard that after discussion, the other three daughters and one son were responsible for the medical expenses, and the eldest daughter was responsible for the medical expenses. Donate your liver.”
Is that so?
This is another benefit of having more children. Many patients’ children are actually willing to donate livers, but it does not mean that everyone’s liver can be used. The match must be successful. Even if it is a biological son or biological daughter, it is not possible. It is said that the liver can adapt 100%, but after all, parent-child parent-child has the highest chance.
If you have many children, this won’t work. You can try other methods, but the patient’s chance of survival will be different.
“The old man was unwilling to do anything before. After all, he is already so old and his illness would be a drag on his child. Now he has to ask his child to donate his liver because of him, which may even affect his daughter’s health for the rest of her life. Life is hard for an old man, but children are also extremely filial. The four daughters and one son jointly persuaded the patient for several days, and the patient agreed. "
On the operating bed.
Even wearing a mask, Wu Xiaofu could smell the strong stench.
However, they are all accustomed to it. This is also a common characteristic of many patients. As they age, coupled with systemic diseases and degeneration of the digestive system, bad breath and body odor will follow. Then there are personal reasons, even for children. They are filial, but they cannot change clothes and take a shower every day. Therefore, medical staff also need regular training and education guidance in this regard.
Sometimes patients not only need to be treated, but also need to be treated with due respect during the treatment process. A small disgusting gesture by a medical staff may mean that they themselves do not have much understanding. Feelings, but if the patient notices them, it will cause great psychological implications and frustration to the patient.
You must know that for such terminal patients, sometimes mental health is more important than drugs for physical recovery.
Living donor liver transplantation is more difficult than cardiac death donor liver transplantation.
After all, this is not just an operation, but also removing the liver from the living body, and then transplanting the patient's liver as soon as possible. The risks, operation time, and difficulty of the operation are all increased, but for the patient's later recovery, the living body The success rate of liver transplantation is naturally higher.
Donors for cardiac death donor liver transplantation are basically donated by people from the public. They have been preserved during this period. No matter how perfect the preservation is, the activity is not as good as that of a freshly delivered liver.
Nowadays, there is a very popular surgery on the anterior finger, which uses the organs of the second senior brother to provide donors for the human body.
There are many second senior brothers. If it can really succeed, then there is no need to worry about the donor. However, this kind of attempt is still difficult to succeed. Basically, it ends in failure. The rejection reaction is very serious. serious.
Moreover, there are many resistances. Not to mention technical and logical issues, many experts and professors are also opposed to it in terms of ethics.
However, the medical community has not given up.
According to different liver transplantation methods, liver transplantation is divided into classic, piggyback, reduced-volume, split, domino, and auxiliary.
As for the patient undergoing transplantation today, he chose the splitting method because of a related donor transplant.
"Teacher, senior brother."
Yu Shifu and Duan Hao have arrived. Wu Xiaofu greeted them. Yu Shifu looked at Wu Xiaofu and was very satisfied.
"Okay, the patient has come in, prepare to wash your hands and disinfect."
Hmm!
Wu Xiaofu was pleasantly surprised when he heard this. Not only could he observe, but he could also be a three-person assistant!
"Okay!"
Wu Xiaofu did not dare to neglect and hurriedly prepared. The opportunity was rare. Wu Xiaofu was afraid that if he was half a minute slower, others would take the opportunity away.
To be honest, Wu Xiaofu never dared to think that he would actually have such an opportunity to undergo a liver transplant before he became the doctor.
"Why, are you excited?"
Che Liming and Wu Xiaofu washed their hands together. Seeing Wu Xiaofu's excitement, he couldn't help but joke.
"Teacher Che, when was your first liver transplant?"
Che Liming's smile froze.
"Why don't you laugh? Did you freeze?"
After the anesthesiologist Liu Wengui passed by, he laughed when he heard the words, and his smile immediately shifted.
“He, I remember it was when he was the deputy director.”
Liu Wengui and Che Liming were at the same time and had a very good relationship, so they directly took advantage of Che Liming.
Che Liming had a look of resentment on his face, "If you hadn't told me, I still couldn't remember it, Xiaofu, you must be so lucky."
Envy began to permeate the air. At that time, he also coveted liver transplantation, but this was not something he could get just by coveting.
In the operating room, the patient's daughter has also been pushed in.
As we talked with the patient, we could see that both the patient and his daughter were very nervous at this time, but the patient’s daughter was still comforting her father. She could feel that her father was hesitating. She was afraid that her father would regret it at this time. After all the hard work, not only the doctor but also the patient's daughter was unwilling to give up.
Perhaps the father thinks that he is already like this and it doesn’t matter what happens, but for the children, he is the only one who has a home.
A drop of tears flowed. If there was no other way, who would be willing to lie on this cold operating bed.
"Let's anesthetize."
Yu Shifu explained, and Liu Wengui started anesthesia directly. The anesthesia method was general anesthesia. In fact, no matter what kind of abdominal surgery, as long as the body can tolerate it, general anesthesia is the best. , both for the surgeon and the patient.
The patient sleeps and the operation is completed.
The surgeon does not have to worry about interference from the patient or consider pain.
"Come on, open your mouth, breathe, hey, good..."
For general anesthesia, intubation and induction of anesthesia, this process only requires the patient to be in a supine position. There are not many position requirements, unlike spinal anesthesia, which also requires posture coordination. In fact, the anesthesia efficiency is higher.
Of course, with this kind of anesthesia, the anesthesiologist is under greater pressure during the operation. After all, the patient is unconscious and cannot express discomfort. The anesthesiologist can only look at a series of cold numbers.
"Xiao Duan, it will take me about an hour and a half here, please pay attention to the time."
Yu Shifu explained that he was preparing to collect the donor liver.
Liver transplant surgery requires the removal of the donor liver and the operation of the recipient at the same time. According to Yu Shifu's assignment, Duan Hao and Wu Xiaofu were the ones to remove the liver. He and Che Liming were responsible for removing the donor liver completely and performing cooling and lavage. , cryopreserved, and make necessary rest before implantation.
This time should be synchronized. During this period, Hao happened to remove the diseased liver, then implant the rested donor liver, anastomose blood vessels and reconstruct the bile duct.
As for the donor liver resection, there are more procedures, including resection and rest. It will definitely be slower than the recipient surgery group.
If Duan Hao does it too quickly, the patient will be in an anhepatic state for a long time, and the blood supply will stop, which is likely to cause inferior vena artery and vein infarction, thus endangering the patient's life.
But this is just an explanation. This is not the first time Duan Hao has performed a liver transplant with him. It is very stable. This sentence may be more of a reminder, and it is also said to Wu Xiaofu. .
"Teacher, don't worry."
Wu Xiaofu had basically completed the disinfection and started laying out towels.
However, what he didn't know was that in the observation room, a bunch of attending directors were envious of him.
(End of this chapter)