Chapter 374 The waves behind push the waves ahead
Night.
As soon as Wu Xiaofu returned home, he received a message from Liu Lin.
"Boss, I heard that your matter has been decided. We agreed before that as long as I do well in the written test and you are satisfied with my performance during this period, I will be the first in line."< br>
“I know, I know, you are the only one who is well-informed.”
This Liu Lin really doesn't leave any gaps. However, even if Liu Lin didn't say anything, Wu Xiaofu would choose her first. Liu Lin has been following him for a while. Liu Lin's abilities are beyond words. She has potential and has Tenacity, although surgeons like to choose male doctors, they will basically not let go of such a female doctor.
After all, female doctors are still competent in hepatobiliary surgery, and there are more and more female doctors engaged in hepatobiliary surgery.
Not only male doctors like surgery, but female doctors also like it.
Many medical students feel that the sense of accomplishment that surgery can bring them is unmatched by internal medicine. They say that it would be easier to choose internal medicine. Such thoughts are becoming less and less common. Because they will find that neither internal medicine nor surgery will be easy. In this case, it is better to choose a major that can better utilize their abilities and enhance personal achievements.
Besides, surgery can make a lot of money.
After all, this was his first time as a graduate tutor. Wu Xiaofu was going to talk to Yu Shifu tomorrow and learn from it. To be honest, it felt a little different if he really wanted to be a teacher.
Time passes quickly.
In the eyes of doctors, time is very valuable and important. In many cases, they have to race against time, but the last thing they can’t grasp is time.
Many times, it is just a dazed thing, and a day passes.
However, seeing that it is already Thursday again, these interns are somewhat nervous. This time has passed too fast. They feel that they have not improved much yet. The day after tomorrow , it’s time for the assessment again.
I'm having surgery this week, so Saturday can't be the surgery assessment, right?
If it was last season, they definitely wouldn't think so, but this season, the assessment is really different.
Wu Xiaofu went to see Yu Shifu after checking the house.
"How about it? It's settled, let me tell you, no one is willing to be a teacher. Preaching, accepting karma, solving doubts, and being a teacher are things that we Chinese people respect deeply. In the eyes of each of us, Being a teacher is the most noble thing. Who can resist the temptation of becoming a teacher?
At that time, I said I thought it was troublesome, but when I really thought about becoming a teacher, I didn’t know how much I wanted to do. Excited, I know you won’t refuse. Even if you are young, the younger you are, the more you like this fresh energy.
However, being a teacher is really not an easy task. You not only have to teach knowledge, but also teach people how to behave. You also have to be responsible for their future. It is very troublesome. "
Duan Hao was still in Yu Shifu's office. When he heard Yu Shifu's talk, he just rolled his eyes.
"Teacher, your words are quite suitable to describe me. Little rich man, you can worry less. I think your teaching is quite easy. "
"Is your skin itchy? Why, if you don't get beaten for a day, you feel uncomfortable! "
Duan Hao hurriedly begged for mercy, and Wu Xiaofu also laughed. Not to mention, the atmosphere in their school is definitely the best.
"Just in time, I'll do an operation with me later."
While chatting, Yu Shifu didn't say anything, so he first dragged Wu Xiaofu to do the operation, saying that it was an operation performed by an acquaintance, and it took him a long time Instead of doing the surgery, let him go up and do it, and he can just watch from the side.
Wu Xiaofu was also stunned when he heard this. What is this called? The teacher has something to do, do the disciples obey it?
But Wu Xiaofu didn’t say anything. If he could find Yu Shifu and get Yu Shifu to agree to the operation, even if it was a related party, the operation would definitely not be small, because Yu Shifu must have chosen it. He doesn't know how to perform ordinary gallbladder surgery, but he also takes the time to perform it.
Maybe it is an operation that he would never encounter in ordinary times. Wu Xiaofu cannot refuse such an operation. Regarding Yu Shifu’s background, Wu Xiaofu has never underestimated him. People with dozens of jobs have Years old, he is only a few years old.
Not only did he want to go there, he also brought everyone in his group who was willing to go there.
Cheng Shi and Jiang Bei are naturally no exception. Liu Lin, their already confirmed disciple, Duan Hao's disciple You Zhiyi, and Peng Xia are all here.
When I arrived at the operating room, I knew that it would not be a simple surgery to find Yu Shifu.
Hilar cholangiocarcinoma.
Chole duct cancer is also divided into different types according to its location. Hilar cholangiocarcinoma is undoubtedly the most difficult to treat among cholangiocarcinomas.
Currently, in the medical community, hilar cholangiocarcinoma is recognized as one of the most complex operations in abdominal surgery, and the combined arterial and venous resection and reconstruction involved is the ceiling level in this type of surgery.
Moreover, most of these surgeries require the technical support of liver transplant experts. Otherwise, if there is any problem with the arteries or portal veins after the operation, it will be catastrophic.
In other words, when you do this kind of surgery, you either have to have the ability to perform liver transplantation yourself, or you have to have someone with the ability to perform liver transplantation to watch over you. So, learn The threshold is also very high.
Yu Shifu originally planned to ask a doctor from Area A to come and help Wu Xiaofu. Who would have thought that Wu Xiaofu would bring so many people with him, but while he was under anesthesia, he still asked this doctor to help Wu Xiaofu. Reported on the patient's condition.
“A 39-year-old male suffered from upper abdominal distension and pain. Hepatobiliary cholangiocarcinoma was found during examination at an outside hospital. He was referred to our hospital after consulting several hospitals. There were no obvious abnormalities in the physical examination. The abnormal laboratory test results were: total Bilirubin 52; CA199: >1200.
Imaging examination showed that the patient's right hepatic artery was partially invaded, the distal end of the right hepatic artery was good, the middle hepatic vein was normal, the trunk of the portal vein was normal, and the origin of the right branch of the portal vein was invaded. ”
This is the reward of a professional doctor. Let’s take a look at the key points. The difficulty of hilar cholangiocarcinoma lies in the blood vessels. After all, the hilar region is rich in blood vessels. Once the blood vessels are invaded, it will be very difficult to deal with. It was difficult, so during the examination, the focus of observation was also on the blood vessels.
With this report from the doctor, Wu Xiaofu would soon know what the difficulty of this operation was and how difficult it was. >
However, this case is indeed very troublesome
Both the right hepatic artery and the hepatic portal vein are invaded. Although not the entire segment is invaded, two blood vessels still have to be treated, which naturally makes it difficult. Come on, this is completely different from ordinary hilar cholangiocarcinoma surgery
Hanging the patient's CT on the imaging machine, it can be seen that the patient's tumor is located in the left hepatic duct, invading the confluence of the bile ducts, and the right hepatic duct is slightly dilated; the left hepatic artery and the left branch of the portal vein are invaded; the right hepatic artery segment is invaded, The origin of the right branch of the portal vein was invaded.
This doctor did a very detailed job and also performed a dye retention test, which is used for positioning, structural evaluation, and quantitative evaluation.
Generally, it won’t be done. However, if it is a related household and it must be meticulous, it can be done. It is very expensive and ordinary people will definitely not choose it. Of course, if it is done , which will make the doctor’s surgery easier.
The 15-minute retention rate of ICG is 11.3%. ICG is a dyeing material.
“At this level, if the left hemihepatectomy + caudate lobe is resected, the remaining liver should account for 63.8% of the standard liver volume.” Wu Xiaofu’s voice fell, and the doctor nodded quickly, “Let me calculate It took me a while to get the answer, but Director Wu said it right away. I’m really not convinced.”
This is not a compliment to Wu Xiaofu, because it involves a conversion, and most of the verbal calculations cannot be done, but Wu Xiaofu obviously has the strongest brain when it comes to playing.
After hearing the standard liver volume ratio of the remaining liver, everyone felt a little relaxed.
After all, there is still so much liver left. This operation is still relatively good in terms of difficulty and prognosis.
"This is calculated, that is to say, you can cut the best result, but can you do it so well? Generally, you have to cut more, so in the end, you can leave a percentage Sixty is awesome.”
Yu Shifu took advantage of the situation and reminded that surgery is never data, and it cannot be set in stone based on data.
If you are superstitious about data, the results of the surgery will only make you suffer a big loss.
Those who perform surgeries based on data will basically be deceived by the data in the end. This has too many lessons.
Everyone nodded subconsciously when they heard this. Yes, who can really cut it so well? However, thinking of this, they looked at Wu Xiaofu again.
Others can’t, but Wu Xiaofu can.
When Yu Shifu saw this, he rolled his eyes. He didn't count, and he didn't necessarily get less than 60%.
Wu Xiaofu usually performs surgeries, cutting out tumor tissue and not much normal tissue at all. Yu Shifu was also surprised. Wu Xiaofu’s eyes are like rulers. Don’t say that, now everyone in the pathology department is surprised. It is said that Wu Xiaofu's eyes are like rulers, and they are perfectly removed every time, with nothing more and nothing less.
After the first cut, there will never be a second cut.
Because these people passed it on, Wu Xiaofu is now almost a living legend. When Yu Shifu said this, he was just talking about it in ordinary terms and did not think about Wu Xiaofu. Who would have thought that these people were so in sync with each other? .
However, with this kind of surgery, Wu Xiaofu may not be able to cut it perfectly. There must be a one percent error.
I guess so.
"Okay, let's start the operation. Everyone is done with anesthesia. Dr. Li, you will be an assistant. Peng Xia, wash your hands and disinfect."
Wu Xiaofu smiled and started directly. This operation Not too fast, start early and finish early.
“Okay.”
Dr. Li originally thought that he was just here to make soy sauce, but he didn’t expect Wu Xiaofu to let him be a helper. If he didn’t get rid of him, it would really be considered a blessing. To be honest, he was originally an assistant. Being an assistant to Yu Shifu was no different from being an assistant to Wu Xiaofu.
Moreover, he had never cooperated with Wu Xiaofu. To be honest, he was also very curious after hearing Wu Xiaofu's legend, which was really exciting.
Disinfect, lay down towels, and make preparations.
It is better to do it laparoscopically, as long as more than half of the liver is not cut, now Wu Xiaofu basically does it laparoscopically. Although it is more difficult, it is obviously better for the patient.
When the mirror went in, Wu Xiaofu directly started tissue separation. The first difficulty of this operation was to dissect the first porta hepatis. First, he had to explore the violation of the vascular structure to see if it was consistent with the preoperative image. , it’s easy to agree and just follow the plan made in advance. Once there are changes, it will be very troublesome.
But many times, it is really different. After all, the examination is done through the body surface. No one knows what is going on in the body cavity. Many times, some things cannot be photographed, and The illnesses are also all kinds of strange, and you might encounter a mutated one, which is commonly known as thunder.
This is inevitable, and whoever encounters it should just consider himself unlucky.
Fortunately, this case is still very reasonable. The field of view after opening is basically the same as the pre-operative image.
The next step is to follow the preoperative plan. The affected parts are mainly the right hepatic artery and the beginning of the right branch of the hepatic portal vein.
Therefore, these two parts of blood vessels need to be reconstructed.
This is also the second difficulty of the operation, which is to reconstruct the main portal vein - the right branch of the portal vein; to reconstruct the proper hepatic artery - the right hepatic artery.
Although there are only a few words, seniors in the medical field have done decades of attempts and scientific research on this work. To achieve this step, it basically requires years of skill from transplant experts. Ordinary doctors simply cannot I don't dare to touch these things. After all, rebuilding blood vessels is a bad thing. It is a failure of the operation and a life-threatening result.
Wu Xiaofu did it with ease, Peng Xia and the others took it for granted. After following Wu Xiaofu for a long time, they felt that whatever Wu Xiaofu did should be in this state, and it was not surprising. If he stumbled, then it would be It's a problem, but Dr. Li is different.
According to normal circumstances, this blood vessel reconstruction work would take more than two or three hours. Wu Xiaofu completed it in half an hour, which is too unusual!
At this time, Dr. Li only knew the weight of the three words Wu Xiaofu.
This surgical ability, he has made a circle in his head, it seems that it is not even comparable to the longitude and latitude.
hiss!
It’s so scary. If you don’t set up a stage with Wu Xiaofu, you don’t know how powerful Wu Xiaofu is.
The vascular reconstruction was completed, and Wu Xiaofu had begun liver resection.
After the vascular reconstruction, it seems that the next work will be easier. According to the ischemic line, en-block resection of the left half of the liver + caudate lobe is completed, including the dissection of groups 12, 13, and 8 lymph nodes. .
En-block resection is en bloc resection. It is now very popular in medicine, especially in orthopedic spine surgery.
As for the lymph nodes, these are all grouped before surgery. Groups 12, 13 and 8 are all lymph node tissues surrounding the left hemi-liver + caudate lobe.
These are the tissues involved in cholangiocarcinoma and must be removed.
The right anterior ventral branch, right anterior dorsal branch, and right posterior branch hepatic duct openings can be seen in the cross section of the right liver.
Next, Wu Xiaofu reshaped the three openings of the right hepatic duct into a common opening, and performed a bile-enteric anastomosis in the space between the dorsal side of the hepatic artery and the ventral side of the portal vein. At this point, the operation was nearing completion.
Yu Shifu originally had something to do, so he asked Wu Xiaofu to come so that he could leave at any time without delaying the matter.
But watching Wu Xiaofu's operation, Yu Shifu was actually fascinated. You must know that this operation is already at the ceiling level of abdominal surgery. No matter which professor comes, he must be careful and the operation time must be whatever. Guaranteed to be at a level of four to five hours, and doing it for seven to eight hours, or ten or so hours, is normal.
But Wu Xiaofu looked at the time and saw that it had only been two hours.
Why does it feel like being slapped on the beach by the back wave!
(End of this chapter)