godfather of surgery

Dr. Chen led Yang Ping and Director Fang to the ward. This was a 25-year-old young girl with a good face and a thin body, especially the collarbone area. She felt completely skinny. This is what is called skinny.

Selling weight loss products with a figure like her is really a living advertisement. This manufacturer is very good at finding people, and they actually found this patient to live stream the products.

The girl is lying on the bed with a large bag of nutrient solution hanging on the infusion pole. She currently relies on parenteral nutrition to maintain her life.

Parenteral nutrition is the ingestion of nutrients without passing through the gastrointestinal tract. Nutrient solution is directly injected into the blood vessels through intravenous infusion for the body to utilize.

As the name suggests, enteral nutrition means that no matter what the method is, whether it is eaten by oneself or injected into the stomach through a nasal catheter, the nutrients must pass through the intestines and be absorbed by the intestines.

Now the girl's intestines have almost lost their peristaltic function. No matter what they are, they will accumulate in the intestines, nutrients cannot be absorbed, and residues cannot be eliminated from the body.

Not to mention eating, just drinking a sip of water will cause abdominal distension and pain, so things cannot be transported to the intestines. Parenteral nutrition can only be used to supply nutrients to the body, but it is impossible to carry a bag of nutrients 24 hours a day for the rest of your life.

The bed doctor gave her a brief introduction. Yang Ping performed some simple abdominal examinations on her. It was obvious that a lot of gas was pressed in the abdominal intestines, so the abdomen was bulging like a balloon. It felt like a balloon when pressed. Auscultation of the intestines The chirping sound also disappeared.

After returning to the ward, the doctor in charge of the bed said that this girl was very pitiful. She had been ill for seven or eight years, but because her parents died in a car accident, she never had money for treatment. In addition, the symptoms were not that severe at that time, so she went to the hospital every once in a while to get enema. The laxative can be maintained, but the condition has worsened rapidly in the past few months. In the past two weeks, I can't even drink water.

"Is there a video of a colonoscopy?"

Yang Ping thought, various cases flashed through his mind. After comprehensive medical history and physical examination, he had a clue in his mind, and a mind map of deriving diagnosis from symptoms slowly unfolded in his mind.

"There must be a video archive in the endoscopy room. I'll ask someone to copy it over."

Seeing Yang Ping's expression, Dr. Chen felt that there was something interesting about him, so he was very active and immediately grabbed a trainee to go to the endoscopy room to copy the video.

Although Yang Ping is a surgeon, Yang Ping's speeches at several hospital-wide case discussion meetings were amazing. Several difficult cases were diagnosed by him. Therefore, Dr. Chen, who had always looked down on surgeons, changed his mind. view of surgeons.

Besides, who is Yang Ping? In Sanbo Hospital, the young doctor is called Yang Shen behind his back.

In the past, in Dr. Chen's eyes, surgeons were just surgeons.

"The mucosa of the small intestine was removed for pathological examination?"

Yang Ping asked, and Dr. Chen nodded. Not only did he take the mucous membrane, but he also took several specimens from different parts.

Yang Ping looked through the pathology diagnosis report again and saw that it was not Wen Ruzheng who was looking at the pathology slides. Yang Ping was a little disappointed because Wen Ruzheng from the pathology department was indeed very skilled, especially after streaking once, his level had improved a lot.

Wen Ruzheng was not born in nature, and Sanbo Pathology Department has regressed by three years. Wen Ruzheng who can say this is still capable.

His department director is quite open-minded, otherwise such an arrogant boy would have been kicked out long ago, and he would have been set back three years, and you would be just a living person as the director.

Unknowingly, Yang Ping was surrounded by doctors. Internal medicine is not like surgery. Surgeons hide in the operating room all day long. No one can be seen in the ward. In the surgical ward, except for the doctor on duty and his interns, , there was no one to be seen at all, and even those who were hospitalized always hid in the duty room and slept.

Physicians do not operate. Except for highly qualified doctors who make regular outpatient visits, most doctors are crowded in the ward, so the doctor's office is generally overcrowded, especially the young doctors who are all busy writing medical records, and the doctor's office is filled with the sound of typing on keyboards.

Everyone was interested in this difficult case. When they heard that Yang Shen had intervened, everyone gathered immediately.

"Are you all okay? You've finished writing the case, and you're just standing around watching the fun?" Dr. Chen scolded.

This group of guys immediately dispersed like birds and beasts, but when Dr. Chen lowered his head to communicate with Yang Ping, these guys immediately gathered back in twos and threes. Dead pigs are not afraid of boiling water, and Yang Shen's charm is still very great.

Gui Peisheng went to the endoscopy room to copy the video and came back. Yang Ping needed to see the appearance of the intestinal mucosa through the video. Although the report did not find any problems, it was better to watch the original video.

The same goes for pathology slides. Yang Ping, who specializes in pathology, likes to look at the slides himself.

Although pathological slides are true standards, they still rely on people to see them in the end, so there are differences between people. In rare cases, a malignant tumor is diagnosed in Hospital A, but the result is not a malignant tumor in Hospital B. This situation completely exists. , and finally the patient had a false alarm.

Yang Ping decided to see the pathology slides in person after watching the colonoscopy video.

The graduate student has played the video. Yang Ping carefully checked the video, almost not missing every detail, and took screenshots from time to time to zoom in and take a closer look.

After watching the video, Yang Ping discovered that the villi in the small intestine were slightly atrophied. If you didn't look carefully, you wouldn't be able to see it at all, or most doctors would think that this slight atrophy is nothing.

In fact, for difficult and complicated diseases, the doctor's diagnosis of the disease is a process of reverse logical reasoning, which is similar to the police's thinking in solving crimes. The doctor starts from the patient's clinical symptoms and continues to deduce the diagnosis, so reasoning also requires clues.

Yang Ping finally caught the clue, Dr. Chen said, "What have you found?"

Yang Ping pointed to a clearly enlarged shot on the video and said: "Look, the villi of the small intestine are slightly atrophied. There is no other reason. I suspect it is autoimmune intestinal smooth myositis, but I am not sure now. Let's go and take a look. Pathological slides, right?”

Autoimmune intestinal smooth myositis, Dr. Chen had never thought of this disease at all, and all examinations showed no major abnormalities.

After Yang Ping reminded him, Dr. Chen went back to watch the video of the colonoscopy. It was true that the villi of the small intestine were slightly atrophied, but this was nothing special and lacked specificity. This patient often had diarrhea and had poor absorption of nutrients in the small intestine. If it is not good, the absorptive function of the small intestine will deteriorate, so the villi of the small intestine will also degenerate, and there will be no directivity.

"When there are no clues, very weak clues must be amplified." Yang Ping said.

Normally, this kind of small intestinal villi would not be taken seriously, but now, when there is no clue, we must pay attention to this clue and magnify its value and significance.

After watching the video, Yang Ping suggested going to see the pathology slides, and Director Fang and Dr. Chen also went along.

When Yang Ping came to the pathology department, he happened to meet Director Guan, the director of the pathology department. He had been sitting for too long looking at pathological slides, so he took a break and stood in the corner doing cervical spine exercises. Yang Ping explained his purpose, and Director Guan said: "You have to do this. Find Xiao Wen, he is more powerful than me."

Then Director Guan called out Wen Ruzheng, and Wen Ruzheng's response came from the lounge.

"Here, you go in."

Director Guan valued Wen Ruzheng very much, so he loved him very much, and also intended to train him to take over as director. Originally, the pathology department was the Qingshui Department, and its talents were withering. It was rare to find a young man who loved this specialty.

Yang Ping opened the door, and Dr. Wen was using dumbbells to train his biceps. No wonder he still had a few muscles when he ran naked. “Professor Yang!”

Seeing Yang Ping coming in, Wen Ruzheng quickly put down the dumbbells.

"Your job is quite leisurely, and you still have time to exercise." Yang Ping, Dr. Chen, and Director Fang each found a place to sit down.

Wen Ruzheng said: "That is necessary. If you run naked next time, you can at least show off your toned figure. How come Professor Yang is free to inspect our remote areas today?"

"I'm looking for some work for you. There may be some minor problems with the pathological slides of a patient. Let's come down and take a look. Dr. Wen can help take a look at it?" Yang Ping explained his purpose.

Looking at pathological slides was Wen Ruzheng's favorite. After a flash of excitement in his eyes, he immediately turned to suspicion: "You're not making another bet, are you?"

"Aren't you building your muscles well now? Why are you afraid of betting? Now is just a chance for you to show off the results of your recent training." Yang Ping pretended to bet.

Wen Ruzheng quickly waved his hand: "I'm not in shape yet, Professor Yang, please give me some more time."

Director Fang and Dr. Chen were laughing on the sidelines. It was unexpected that Wen Ruzheng was sometimes afraid of people. He was usually a cool person. As long as it was about pathology, he had never been afraid of people. It is said that he once participated in a national pathology conference. As an unknown young doctor, he directly quarreled with the big boss at the conference, causing the big boss to lose face.

"Okay, then just let me know when you're ready. I happen to want to show off my muscles, so you have to give me a chance." Yang Ping said Wen Ruzheng lost his temper.

"Which patient?" Wen Ruzheng quickly got to the point.

Dr. Chen immediately handed over a small piece of paper with the patient's name, hospitalization number, department, and bed number written on it.

Wen Ruzheng put on his white coat and asked an intern to look for pathological slides. The intern brought a pile of pathological slides. Because this patient had multiple intestinal samples, and one sample was a slice, there was a stack of pathological slides.

"Professor Yang, how about this? Let's read it separately. After reading it, each of us will write down the pathological manifestations and diagnosis on paper, and then make a comparison. Let's make it clear first that there is no bet this time. This is a completely normal academic exchange." Wen Ruzheng was the first to sit in front of the microscope and made a gesture for Yang Ping to sit down as well.

Yang Ping chose a seat a few seats away from him and sat down, and the two began to take turns looking at the pathological slides. The intern was responsible for helping to exchange the slides in the middle.

After the two read it, they wrote down what they saw under the mirror and their diagnosis on a piece of paper.

Wen Ruzheng had a slight smile on his face. Damn it, this slice should have been a gamble with Professor Yang just now. Not many people in the country can see such a difficult pathological slice. Professor Yang will definitely fail. After all, he is not a pathology major.

When I was studying for my doctorate, there were relatively few pathological slides for some diseases, and one hospital could not accumulate enough. Therefore, in order to increase the number of cases for review, Wen Ruzheng often traveled around. In order to understand the pathological slides of some special diseases, Dr. Wen used various connections to travel around the country, including Xiehe Hospital, Huaxi Hospital, etc., and became brothers with the doctors in the pathology departments of these hospitals, just to see more. Zhang slices.

Back then, Wen Ruzheng spent a lot of thought on the pathology of this disease, and in the end he was even better than his mentor.

"So, what's the gain? It's just an ordinary slice of small intestinal mucosa, nothing special, right?" Wen Ruzheng had a smirk on his face.

Yang Ping didn't say anything and exchanged the paper he wrote with Wen Ruzheng.

"Small intestinal villi are blunted and atrophic; mononuclear cells in the lamina propria of the mucosa are increased; lymphocytes are increased in the deep crypt epithelium; intraepithelial lymphocytes are decreased; apoptotic bodies are increased in the crypt epithelium. Diagnosis: Consider autoimmune intestinal smooth myositis. Please combine it with clinical practice."

Good guy, he saw all this, Wen Ru is a real person.

As for Wen Ruzheng, after reading Yang Ping's report, he was almost the same as himself, even more detailed, and said "fuck" again. Immediately, a chill ran down his spine. It happened that he didn't make a bet with him, otherwise he would end up running naked again.

How can a surgeon have such a deep knowledge of pathology? What kind of logic is this? It is completely illogical.

This kind of special pathological biopsy, and you bring people to the door to see it, is this considered to be a challenge?

Even if we are playing against each other, I and you are still tied today.

Wen Ru is raising his arrogant head. As long as I, Wen Ru, are here, no one else can come to the pathology department to play.

"The pathological manifestations are relatively typical. It seems that there is no doubt about the diagnosis. It should be autoimmune intestinal smooth myositis." Yang Ping said.

Wen Ruzheng nodded. There may not be many pathologists who can identify the pathological manifestations of autoimmune intestinal smooth myositis.

"treat?"

Dr. Chen understands that if the disease is at its current level, any conservative treatment is useless. Conservative treatment can only treat symptoms and rely on parenteral nutrition to maintain life.

"Improved intraperitoneal multi-organ family transplantation!"

Yang Ping believes that under the current medical conditions, this is the only treatment method. Otherwise, he will have to lie in bed and rely on parenteral nutrition to maintain his life.

Modified abdominal organ cluster transplantation - In addition to the liver, abdominal organs including the stomach, pancreas, duodenum and small intestine are transplanted in a string of organ clusters, compared with small intestinal transplantation performed separately.

Because it requires the transplantation of several large organs of the digestive system, it has a great impact on the patient's systemic pathophysiology and poses greater challenges to the surgical and anesthesia teams. It is recognized as the technical pinnacle and difficult problem of digestive surgery.

Upon hearing this surgical method, Dr. Chen from the Department of Gastroenterology fell silent. Although he is a physician, he also knows how difficult this surgery is.

But Director Fang thought that autologous transplantation of the five organs including the liver could be easily handled, while allogeneic transplantation of these organs was considered trivial.

"Director Chen, transfer to our general surgery department as soon as possible! We will arrange the surgery." Director Fang said immediately.

This old man is really prosperous. He had just completed the ex vivo removal of eight organs and the autologous transplantation of five organs for pancreatic cancer. Now he has encountered such a strange case.

Director Fang was so excited that before Director Chen could say anything, he started calling the doctors and nurses in the department to arrange bed docking.

"Let's go, Director Chen, transfer him immediately. Since the diagnosis has been confirmed and the treatment plan is clear, surgery is required. If the patient stays in your Department of Gastroenterology, it will be a time bomb. An accident can easily happen. People's lives are at stake. Please transfer him as soon as possible. "

Director Fang pulled Dr. Chen.