Chapter 265: Those who learn from me live, and those who resemble me die (please vote for me)
Jinhu County Hospital.
The next day, Mr. Jiao was directly hospitalized under Wu Xiaofu's arrangement.
Wu Xiaofu was going to operate on Mr. Jiao on Saturday, one day in advance, just in time to prepare for the operation.
Wu Mingjie also found out that Wu Xiaofu was going to perform an operation on Mr. Jiao.
While I was excited, I also had some expectations that I would succeed.
Of course, Wu Xiaofu still had to go out to the outpatient clinic on Friday morning as usual. The first patient was a patient who came in with his belly in his arms. His face was pale and painful. This was a patient who was transferred from the emergency department. No registration.
After Wu Xiaofu took the pulse, he asked, "Do you usually have stomach bloating and stomach pain?"
The patient nodded quickly when he heard this, "Yes, you usually have stomach pain. I actually had my gastric pain checked out and had a gastroscopy. It was said that it was a gastric ulcer, but it was not just a one-time medication, but repeated medication, recurring attacks, relapses, and no matter how good the medication was, it was really troublesome.
Just like last night, I woke up with pain again. It hurts every day if I don’t eat. I feel better if I eat. Doctor, you said, I can’t take medicine for the rest of my life. Besides, I heard Yes, this kind of people are prone to stomach cancer.
Take a look, can you give me a complete cure? ”
Duodenal ulcer!
After hearing the patient’s description, Wu Xiaofu determined the condition. After all, pain before meals, relief after meals, and pain at midnight, these are basically ten types of pain. Duodenal ulcer is a common symptom, and the pulse is also due to coldness in the intestines and stomach.
Wu Xiaofu performed a physical examination and found that there were gastrointestinal problems, liver and gallbladder, etc., and there were no problems. Well, This is also the process of outpatient treatment. There are too many diseases that need to be differentiated for abdominal pain.
"You should have a duodenal ulcer. Whether there is an ulcer in the stomach needs further investigation. Go to the hospital first and get checked. If necessary, we will perform an operation. For someone with frequent ulcers like you, I'm afraid you can only rely on food." Medicine, it is basically impossible to permanently solve the problem. ”
Surgery!
The patient and his family were really frustrated and happy at the same time. They were frustrated that surgery was needed, but they were happy that Wu Xiaofu was indeed an expert and indeed had a solution.
The patient was only in his forties, but his body was very thin. He was obviously suffering from it. After hesitation, he nodded and agreed to be hospitalized.
Seeing his nod, Wu Xiaofu asked Qu Tianqi to issue a hospitalization order.
Duodenal ulcer is what Wu Xiaofu said, but if you really want to prepare for surgery, you have to do some tests and leave the test data. Not to mention blood tests, urine tests, and stool tests, gastrointestinal endoscopy and Helicobacter pylori screening are all required. conduct.
Duodenal ulcer is a common and frequently-occurring disease among Chinese people. Wu Xiaofu usually attends the hepatobiliary surgery clinic, so he rarely sees it, but it is seen in both gastrointestinal surgery and gastroenterology departments. many.
Basically, Helicobacter pylori is checked first, and then gastrointestinal endoscopy is performed. Jinhu County Hospital has gastrointestinal endoscopy equipment, but there is a lack of good gastroenterologists to perform operations and examinations. This time when Wu Xiaofu came here , there was a gastroenterologist at the same time, and he just picked up the gastrointestinal scope.
In the past two days, Wu Xiaofu asked him to help train the doctors at Jinhu County Hospital, and the results were good. The inspection results and efficiency were still very satisfactory.
Duodenal ulcers tend to occur in winter and spring when the climate changes greatly. Now is April, a time when the disease is most common. Patients with ulcers like this must have it every year. This happened twice, and the incidence of duodenal ulcer in men is significantly higher than that in women, and it is more common in men in outpatient clinics.
Checking for Helicobacter pylori infection seems to be a key factor in the development of ulcers. Regardless of whether surgery is required, if Helicobacter pylori is found, it must be sterilized first. Otherwise, it will easily relapse after surgery.
Of course, Helicobacter pylori infection is not only a cause, but also related to abnormal gastric acid secretion, non-steroidal anti-inflammatory drugs (NSAIDs), irregular life and diet, work and external stress, smoking, drinking and Psychological factors are closely related.
In the afternoon at the Gastrointestinal Surgery Department, there was a similar patient who needed surgery. He was admitted before Wu Xiaofu came. He was admitted to the Department of Gastroenterology first, and was transferred to the Department of Gastrointestinal Surgery two days ago. He was also admitted to the Department of Gastroenterology two days ago. I thought the ulcer was caused by Helicobacter pylori, so I planned to investigate it and then treat it with sterilization. Since it was also an emergency, I planned to be hospitalized for infusion.
Just when Wu Xiaofu and others arrived, they did a gastrointestinal endoscopy and found that it was a duodenal ulcer.
The gastroenterology doctor judged that it was an intractable duodenal ulcer caused by vagus nerve excitement, and recommended surgery.
The patient was not prepared to abandon the near and far away, even if he asked to be transferred to the gastrointestinal surgery department and let Wu Xiaofu help with the operation.
The operation was scheduled for Friday afternoon, this afternoon.
The outpatient clinic in the morning was almost the same as Wednesday. However, compared with Wednesday morning, there were more plus-number patients today. Wu Xiaofu didn't finish it until after one o'clock at noon.
I and Qu Tianqi went to the same restaurant we went to on Wednesday, had dinner, and then returned to the operating room.
The first one was the patient with duodenal ulcer.
Wu Xiaofu was going to perform a vagotomy on this patient.
The cause of ulcer disease is still relatively complex. It is generally considered to be a complex disease caused by the combined effects of multiple factors. However, with the deepening of research, in recent years, it has been found that ulcer disease is still caused by mental and physical factors. Neurological factors play a major role.
Mental stress and stimulation caused by various reasons can overexcite or fatigue the brain, causing coordination disorders between the cortex and subcortical centers, causing autonomic nerve dysfunction, and ultimately manifesting as vagus nerve dysfunction.
It is generally believed that patients with gastric ulcers have low vagus nerve fiber function, causing pyloric spasm, sinus stagnation, and antral gastric acid secretion.
In patients with duodenal ulcer, the vagus nerve function is often hyperactive, causing the release of acetylcholine and directly stimulating the gastric parietal cells to produce gastric acid.
At the same time, vagus nerve excitement also stimulates the antrum, causing the secretion of gastrin in the vagus-antrum phase and indirectly producing gastric acid.
Therefore, patients with intractable ulcers basically have mental factors as the most important factor. The most direct and simple way to treat ulcers caused by this cause is to cut off the vagus nerve and reduce the patient's gastric acid secretion from the middle. .
The principle of reflex adjustment is used here, a biological problem that I learned in middle school.
In fact, Wu Xiaofu has not done much vagotomy. It seems that Wu Xiaofu has only done one in the First Affiliated Hospital. The difficulty of the operation is not too high, but there are not many cases. After all, most people don’t know That is, it is just an ulcer, and it can be cured by taking medicine, so why do we need surgery?
For most Chinese people, surgery is still a difficult word to accept.
There are two types of vagotomy: vagotomy and selective vagotomy.
The former surgery is simple, but symptoms such as abdominal distension and diarrhea are common after surgery. It is suitable for more serious patients and patients with stubborn ulcers. Generally, this surgery is not chosen.
The latter, that is, selective vagotomy, has less disruption to postoperative gastrointestinal function, but the surgical operation is more complicated. It is suitable for patients who have a good tolerance to surgery. After all, the operation time is relatively long.
However, neither the former nor the latter can be regarded as independent surgeries in theory. Both must be supplemented with gastric drainage or partial gastric resection to make the surgery complete.
The First Affiliated Hospital has developed another surgical procedure in recent years called "highly selective gastric vagotomy (also known as parietal cell vagotomy)".
Only the vagus nerve in the gastric parietal cell area is cut without additional gastric drainage or hemigastric or antral resection. It can be performed as an independent operation. This operation has great advantages in theory, but the surgical operation requirements are more stringent. , the requirements for operators are higher.
As a high-end technology, it is also difficult to pass it down.
However, Kang Jinwang has a good foundation and understanding, and there happen to be patients with relevant indications. Wu Xiaofu is ready to pass on this new technology. Isn't this a major significance of going to the countryside?
Moreover, the reason why many ulcer patients cannot undergo surgery is because this surgery is not a minor surgery in the traditional sense. Most of them are accompanied by partial gastrectomy.
Stomach surgery, this is not gastric cancer. Just a simple gastric cancer requires gastric surgery and vagus nerve cutting. Patients can understand it relatively well, but stomach surgery is not possible, especially for some young patients. accept.
Well, this is also the reason why highly selective gastric vagotomy can be developed. After all, this surgical operation is relatively less invasive. For patients with duodenal ulcer, it is understood to be the same as cutting the gallbladder and appendix.
In the patient's understanding, as long as the stomach or intestines are not cut, it is easy to accept.
The most important thing is that stubborn gastric ulcers are really annoying. If you only get them once or twice a year, you may be able to tolerate them, but as the condition progresses, they may occur once a month or even A more frequent rhythm.
This is unacceptable, especially if most of the sick people are boys. Good guys, the pain is more frequent than that of my aunt’s girlfriend. If the people around me are not sympathetic, then You have to tease them a few times.
Moreover, my body can’t stand it even if I keep taking medicine.
The most important thing is that in recent years, more and more cases have turned into cancer. Ulcers are actually a kind of irritation. If you really plan to ignore them for the rest of your life, it is really unrealistic to just bear it.
Wu Xiaofu was going to perform a highly selective gastric vagotomy on this patient this afternoon. Of course, the patient only agreed to the operation after hearing Wu Xiaofu’s words that there was no need for gastric incision.
A fifty-year-old patient has been suffering from ulcers for five and a half years. Now he is experiencing a lot of discomfort every month. His stomach is more difficult to maintain than his children. He dare not eat raw or cold foods. Order a meal and don't dare to delay. Keep medicine with you and take it at any time. You never know when you will be sent to the emergency room. This life is really a bit of torture and seriously affects the quality of life.
Since the root of the disease can be solved without stomach incision, many patients are still willing to grit their teeth and stamp their feet.
It was also on the basis of this group that highly selective gastric vagotomy was developed.
"Boss, this operation seems a bit difficult?"
Kang Jinwang stood next to Wu Xiaofu and said slowly. He has been studying highly selective gastric vagotomy in the past few days. , Wu Xiaofu recommended surgery-related information to him, and Kang Jinwang did a lot of research and felt that this surgery was too easy to operate, but it was also difficult, even more difficult than usual subtotal gastrectomy. .
The patient understands it as similar to removing the gallbladder and appendix, but the doctor does not dare to think so.
The dissemination of this new technology is much more difficult. Therefore, most tertiary hospitals have not yet mastered this technology.
Wu Xiaofu looked at Kang Jinwang rubbing his little hands and smiled. Over the past two days, Wu Xiaofu got to know Kang Jinwang better. In terms of obsession with surgery, Kang Jinwang was still very similar to him.
Although it sounds difficult, I am afraid that I can’t wait to learn this technology.
"With your background, it's not difficult to master. Just happened to be out of the clinic in the morning, and there was another similar patient. After the operation, you went to do some work, and maybe there was another operation. There were two such times, you "I can learn almost as much."
Kang Jinwang nodded quickly. He had already seen the patient in the morning. He knew Wu Xiaofu's habits. If he performed well in this operation, maybe he would do it in the next one. He would then be able to take charge of the operation and let Wu Xiaofu provide guidance.
“Okay, let’s get started.”
For surgical anesthesia, epidural anesthesia is used instead of general anesthesia. If you are older, local anesthesia can also be strengthened.
In the supine position, make a midline incision on the upper abdomen from the xiphoid process to the umbilicus.
This operation can actually be done using a mirror, but the cost is relatively high. If the patient wants to save more, then surgery is performed. In fact, in major hospitals, surgery is often performed.
The first step is to perform an exploratory laparotomy. Only after it is confirmed that it is a duodenal ulcer can the operation continue.
Some ulcers can be cut out, and they may turn out to be cancer.
You can't do it for a long time without saying it's a waste of effort and laying a hidden secret, so this first step must not be skipped. You must first determine the patient's condition, which is duodenal ulcer.
In fact, this is true for most surgeries. Your first step must be to confirm that the disease is the same as the preoperative judgment.
Sometimes, the hospital will reveal something. It is clear that the left side has symptoms, but the right side was able to be operated on during the operation. After the operation was completed, it was discovered that the mistake was made.
Symptoms such as left eye problems, left knee ligament rupture, etc. are actually very outrageous. The first step is to determine the location of the disease. You can do it even if you are not sick. Is this a routine surgery?
I have experienced a similar lesson before. I had a duodenal ulcer and had a vagotomy and partial gastric resection. However, it was only after the postoperative review that I discovered that there was a tumor. Then you didn’t have it before the operation, and you didn’t have it during the operation. See, it was born after the surgery, or was it there before the surgery? Did you miss it?
Doctors, don't test your heart when a patient or judge asks you. If you are not sure whether the problem exists, it is outrageous. Wu Xiaofu will never allow such a thing to happen.
Whenever he was asked about technical issues, Wu Xiaofu dared to say: there was no problem in the process.
As long as you are not lazy, you will always be confident with this guarantee.
After it was determined that it was a duodenal ulcer, the operation officially began. The left outer lobe of the liver was exposed, and Qu Tianqi used a retractor to pull it open and cut the left triangular ligament and coronary ligament of the liver.
At this time, attention should be paid to ligating the small blood vessels from the diaphragm to the liver and the accessory hepatic vein on the surface of the diaphragm. After covering it with a gauze pad, use the retractor to pull the left lobe of the liver to the right to expose the cardia and esophageal hiatus. Sequentially cut the peritoneum of the esophageal hiatus.
This step is to expose the vagus nerve.
The anterior trunk of the vagus nerve, the left branch, is usually close to the front wall of the esophagus and descends slightly to the left. It can usually be seen after incising the peritoneum and exposing the esophagus. The posterior trunk of the vagus nerve, which is the right branch, can also be found in the loose connective tissue.
“If you are doing a truncal vagotomy, just cut off the anterior and posterior trunks directly. If you don’t do a truncal vagotomy, you have to perform a more complicated selective vagotomy. , you have to fully judge the process of vagus nerve influence and perform selective resection
The highly selective gastric vagotomy we are going to perform now is actually developed on the basis of selective vagotomy. To remove the vagus nerve wall cells
This requires more skill and judgment. ”
Parietal cells are also called oxyntic cells, which are acid oxyntic glands in the stomach. With this explanation, you can actually understand the significance of this surgery. What is an ulcer? Isn’t it just a burn due to excessive gastric acid secretion? It suppresses the excessive secretion of gastric acid, and the symptoms are actually basically cured.
After all the parietal cells were removed, whether it was mental factors or other factors, the vagus nerve was stimulated and excited, and I wanted to further transmit information to the parietal cells, but I found that the operator was gone. Next step It is impossible to continue to convey instructions.
This is what highly selective vagotomy is all about.
However, this is also where the difficulty lies.
It is easier to cut the front stem and the right stem, but it is difficult to cut the vagus nerve. There are many people who make the wrong cut.
Once the wrong cut is made, the postoperative results will not be so ideal, and other complications may occur.
This is the difficulty of highly selective vagotomy.
As Kang Jinwang and others watched, um, it’s really difficult, um, Dr. Wu has found it, um, Dr. Wu has already cut it.
Wu Xiaofu explained to them how to find and determine the anatomical structure where the parietal cells are located while performing the operation. He had an impression and believed that they should at least not mess around during future operations.
Especially Kang Jinwang, "How is it?"
Kang Jinwang nodded quickly when he heard the words, "It should be fine, but it seems that I can do it. I don't know if it can be done during the operation. Boss, you also know that your operation is different from us."
In just a day or two, Kang Jinwang actually changed his name to "boss", which made Wu Xiaofu sigh that his charm was too great.
As for Kang Jinwang’s statement, Wu Xiaofu was noncommittal. Can we still expect Kang Jinwang to learn it after watching it once?
The talent is really good, but now that Kang Jinwang is almost forty, he is a bit old to take the postgraduate entrance examination. As for the postgraduate step, you cannot do it selfishly. You must take a standardized examination. No For example, for a doctorate, you can apply directly and meet the requirements.
Then there are on-the-job graduate students, but Wu Xiaofu doesn’t know what the policies are like in various places. Anyway, the top tertiary hospitals that Wu Xiaofu saw basically didn’t recognize this when evaluating professional titles. This makes Kang Jinwang very embarrassed now.
Anyone who is five years younger should be advised to take the postgraduate entrance examination again.
Kang Jinwang doesn’t know Wu Xiaofu’s thoughts. He is now fully devoted to the operation. This is not the first time he has performed surgery with Wu Xiaofu. He has long understood that the surgery performed by Wu Xiaofu is similar to what he learned. Surgery is actually not the same thing.
It's like the surgical procedure written in the textbook. People write it like that, but you can really do it. An operation can take several hours. The textbook only writes one main part. If you really remember that , if you dare to take action, you will definitely hang on the stage.
But Wu Xiaofu’s surgery was almost a textbook one. After opening the abdomen to confirm the condition, without any unnecessary movements, he directly found the vagus nerve with three strokes, five divisions and two divisions, and then it was like fishing out meat from porridge. , you can get it accurately.
However, it was Wu Xiaofu who caught it, and Kang Jinwang did not dare to say that if he went on stage to perform surgery, he could do it so lightly. I am afraid it would be difficult to find the vagus nerve, let alone the parietal cells.
Therefore, he had to expand from Wu Xiaofu's simple surgical operation and imagine what he would look like during the operation. It was absurd to say that Kang Jinwang had seen many simplified operations, which seemed to be difficult for him to understand before. He was considered unique. One portion.
Wu Xiaofu seems to have really used such a difficult and highly selective vagotomy to perform appendectomy and gallbladder removal.
Suddenly he remembered the conversation he had with Fan Xin when he had dinner yesterday. He deliberately approached Fan Xin and wanted to ask Fan Xin about Wu Xiaofu's habits, and Fan Xin said the same thing.
"Everyone who has worked with Dr. Wu knows that in Dr. Wu's eyes, even cutting out cancer lesions is the same as digging out acne. If you follow Dr. Wu's surgery, it will be really amazing. It’s time to hang on the stage. What’s the saying?
He who learns from me will live, and he who resembles me will die. Yes, that’s the saying.”
Those who imitate me will live, and those who resemble me will die. In just two days, Kang Jinwang had a deep understanding of this. If he really imitated Wu Xiaofu blindly, he would never learn any of Wu Xiaofu's skills.
Because it is difficult to find another person who dares to do surgery like Wu Xiaofu. It seems that it is not only based on rich technical experience and basic knowledge, but also something else that is more important. .
Kang Jinwang can't understand this thing. Maybe it's talent, but this talent must be something Kang Jinwang doesn't have. Therefore, he can only learn the ideas and then work hard on this basis.
When Kang Jinwang expressed his understanding to Fan Xin, Fan Xin gave him a thumbs up.
“Brother, you are ready.”
(End of this chapter)