godfather of surgery

Dr. Wen of the pathology department is still very efficient. Nong Tiesheng's postoperative pathology report was quickly sent out. A total of twelve tissues were taken from the surgical areas on both sides of the neck for pathological examination. No findings were found in any of the twelve specimens. tumor tissue.

This pathological examination is only to guide postoperative treatment and cannot affect the diagnosis at that time.

From this point of view, there is no need to treat the tumor after surgery. The imaging examinations performed during Nong Tiesheng's entire treatment process, including PETCT, did not show any signs of tumor metastasis. It can be considered that Nong Tiesheng's tumor has been cured.

Yang Ping recalled Nong Tiesheng's medical records again. In the entire medical record, there was only one color ultrasound of the thyroid gland, which suggested that thyroid adenocarcinoma was considered. However, in Appendix 4, no more color ultrasounds were performed. Instead, CT, CT-enhanced, PETCT and other examinations were performed. In the end, The important color ultrasound was missing, and the most important pathology report was missing. It was really strange.

This color ultrasound that considered thyroid adenocarcinoma was not taken in Appendix 4, but was taken by Nong Tiesheng at the county hospital. But when he saw that it was cancer, he immediately came to the provincial capital to see a doctor.

Yang Ping asked Li Guodong to go to the general surgery department to get all the imaging examination materials from Nong Tiesheng. Yang Ping slowly read the films again in the office, one by one.

Because some images were seriously dissolved and blurred, Yang Ping ordered Nong Zhiwen to go to Attachment 4 to copy all the image examinations into a CD. Although it was more troublesome, treating the disease was inherently troublesome. In order to take this matter seriously Done well, a little trouble is nothing.

Nong Zhiwen cooperated actively and immediately followed Yang Ping's instructions to Attachment 4 and copied all the image data into a CD and brought it over. Originally, a USB flash drive was much more convenient, but the USB flash drive sockets in many hospitals are closed. In order to avoid computer viruses, once the hospital system is infected, it is not a trivial matter.

Yang Ping knew that many patients' imaging data were on CD-ROMs, so his computer was not only connected to a dedicated imaging display screen, but also had a CD-ROM drive.

After looking at the pictures one by one, Yang Ping took a long breath. From the original pre-operative pictures, to the pictures after the two operations, to the latest pictures, Yang Ping judged from the images that this thyroid gland The tumor should be a benign tumor, and Yang Ping was very confident based on his own experience in film reading.

However, pathological diagnosis is the gold standard for tumors. Without the original pathology report, what the tumor ultimately is can only be a mystery.

Even if Yang Ping was absolutely sure, he could not say that the tumor was definitely benign. Yang Ping read the medical records again and again. Judging from the two admission records, discharge records, and operation records, the diagnosis was always thyroid cancer, but after all There is no mention of the classification, grading and staging. It is thyroid cancer from beginning to end, which is very contradictory.

It stands to reason that as a tertiary A teaching hospital, such medical records are unqualified, especially for a large tertiary A teaching hospital like Appendix IV. Is it that the medical records of Appendix IV are so rough now? Management is so loose?

If it is a benign tumor, a radical thyroidectomy is performed, and then various radiotherapy, chemotherapy and targeted therapy are performed around the tumor?

Yang Ping didn't dare to think so, but he had to think so.

It shouldn't be possible, there must be some misunderstanding, Yang Ping told himself.

Because from the time I graduated from college to the present, among all the doctors I have come into contact with during these years of work, although there are some doctors with evil intentions, these very few doctors with evil intentions are only trying to make profits on the sidelines. The vast majority of doctors have principles and bottom lines. Professional ethics will never do anything that violates basic principles.

At least in my own impression, no doctor would treat a patient with a benign tumor so exaggeratedly as malignant and then provide a lot of treatments.

At most, benign tumors should be completely removed for active treatment, which is completely in line with medical principles.

For example, there is a lot of controversy over the treatment of pulmonary nodules. Some doctors believe that they should be surgically removed to prevent future problems. Some doctors think that we should not be so aggressive. In cases where many evidences prove that they are benign, they can be observed and reviewed regularly, because Most lung nodules are benign.

Even around pulmonary nodules, there are some doctors who specialize in pulmonary nodules, and some hospitals have specialized pulmonary nodule clinics.

This is an academic dispute and there is no final conclusion. It is completely normal for everyone to have different opinions and different ways of handling it.

However, for the treatment of malignant tumors, two surgeries have been performed. No matter what the judgment was at the time, it should be a rigid rule to perform pathological examination after surgery. It is also the consensus of the world and there is no dispute.

If it is really not thyroid cancer and a benign tumor is misdiagnosed as thyroid cancer, what impact will this have on the patient?

No matter how much experience Yang Ping has in reading pictures, he cannot replace the pathology report. Therefore, out of rigor, Yang Ping hopes to find the pathology report. Since Appendix 4 cannot be found, does the county hospital where Nong Tiesheng was first diagnosed have performed a puncture biopsy at that time?

Following this line of thought, Yang Ping told Director Fang his thoughts and asked Director Fang to find a way to find the patient and find out. It would be best if he could contact the relevant doctor at the county hospital at that time. He could help check the medical records. Is it true at that time? Have you had a needle biopsy or something like that? If so, bring over the pathology report and pathology slides.

In addition, Yang Ping told Director Fang to contact his acquaintances at Annex 4 to help them find out whether the pathological examination was not performed or whether the report was lost. These are completely two different things.

Yang Ping planned to get a clear picture of this case.

Regarding what Yang Ping explained, Director Fang acted vigorously and resolutely. He called Annex 4 to ask. A friend checked it with him and said that there was indeed no pathology report in the medical record, and there was no pathology report for this patient in the computer database of the pathology department. Report.

Two surgeries and no pathology report? Combined with Director Qian's famous reputation, Director Fang began to have an ominous premonition.

Since there is no pathology report in Appendix 4, he went to the county hospital to find it. Director Fang had a good relationship with colleagues in the province. After all, Sanbo Hospital is also a provincial hospital and there are many doctors training every year. He found the hospital where Nong Tiesheng first diagnosed him. Dr. Gu from the General Surgery Department of Zhongqiao County People's Hospital used to study in Director Fang's department, and Director Fang was often invited by him to perform surgeries.

Dr. Gu helped search the hospital's computer system, and then borrowed the patient's electronic medical records. This patient had previously had a thyroid ultrasound and a thyroid biopsy. Director Fang immediately asked Dr. Gu to copy the pathology report and then slice the pathology report. Help take out these two things and find a way to send them to Sanbo Hospital.

Dr. Gu was very helpful. Not only did he get the pathology report and the pathology slides at that time, he also made a copy of the entire medical record and immediately drove it to the provincial capital and handed it over to Director Fang.

Yang Ping was very happy to get the pathology slices, pathology report and the entire medical record, because there were too many contradictions in the medical record, which made Yang Ping have to doubt some things that he shouldn't doubt.

After reading the entire medical records of Zhongqiao County People's Hospital, Yang Ping roughly understood Nong Tiesheng's medical history.

At that time, the color ultrasound report of the county hospital concluded that thyroid adenocarcinoma was considered, and it was recommended to combine clinical and pathological factors. The color ultrasound doctor’s reasons were very good: the thyroid nodule was taller than wide, and had the characteristics of microcalcification and low blood supply.

The pathology report from Zhongqiao County People's Hospital said: Thyroid adenocarcinoma was considered. Because the specimen was not satisfactory and a large amount of blood and serous components were found, it was recommended to retake the specimen. These two examination reports are described in the medical record in Appendix 4. The admission record, current history and auxiliary examinations all have relevant descriptions, including the time of examination, results and the number of the examination order. This is very standard.

In this way, the diagnosis of thyroid cancer in Annex 4 was based on these two reports. However, as a superior hospital, shouldn't it be necessary to re-take specimens for review? Moreover, after two operations, shouldn't the tumor removed during the operation be sent to the hospital? Medical examination? Could it be that they diagnosed thyroid cancer based on this report and finally performed surgery and extensive treatment as thyroid cancer?

"I'll go see the pathology slides myself."

Yang Ping told Director Fang and immediately called Wen Ruzheng from the pathology department, so he brought Director Fang, Dr. Gu and the pathology slides to the pathology department.

Dr. Gu also followed because he was waiting to take the pathology slides back.

After borrowing the pathology department's microscope to read the pathological slides, Yang Ping thought for a while. The pathological slides were indeed unqualified and did not meet the requirements for judgment. However, there were still a small number of cells on the slides that could be observed, which might be difficult for other doctors to do. It was difficult to make a judgment, but for Yang Ping, these were enough to make a judgment. This was not thyroid adenocarcinoma, but a rare thyroid zombie nodule that was easily confused with thyroid cancer.

We don’t have the original color ultrasound images at hand now. If we had the original color ultrasound images, Yang Ping could make a very definite judgment. I don’t know if the color ultrasound doctor at the county hospital at that time had any images.

The picture printed on the current color ultrasound report is extremely blurry. This picture has no practical meaning and is just a symbol.

"Can you find the color ultrasound pictures from Zhongqiao County at that time?" Yang Ping asked Director Fang next to him.

Without complete certainty and sufficient evidence, it is difficult for Yang Ping to speak now, because his speech will overturn all previous diagnosis and treatment. This is an extremely serious matter and must be cautious.

"I can ask." Dr. Gu, who sent the information, said.

However, Dr. Gu looked at the signature on the color ultrasound report and found that the color ultrasound doctor had resigned long ago and had come to work in a private hospital in the provincial capital. Dr. Gu had to ask another doctor in the color ultrasound department to help check the patient's color ultrasound image at that time.

Fortunately, soon, another doctor found Nong Tiesheng's color ultrasound image and agreed to find a way to transmit it.

Because the hospital does not allow the insertion of USB flash drives, color Doppler ultrasound doctors can only engrave a CD, then find a place to process the images on the CD, and then upload them to the network disk.

Director Fang didn't go into surgery either, so he came here specifically to handle this matter. He took Dr. Gu to have lunch near the hospital, and while eating, he waited for the other party to transmit the image. The whole process was very troublesome, but it must be done clearly, as it affects the patient's life. .

If it weren’t for cancer, you can imagine that you would be burdened with cancer for the rest of your life.

Around three o'clock in the afternoon, the color ultrasound doctor finally asked a young doctor to help complete the conversion and transmission of the image format. He saved the image in a network disk and gave Dr. Gu a username and password so that Dr. Gu could see it himself.

At this time, Yang Ping happened to have finished another operation. He didn't even take off his washing clothes. He put on a white coat and went straight out of the operating room.

At the Institute of Surgery, Yang Ping's office has two computers, one connected to the external network and one not connected to the external network.

Using the computer connected to the external network, Yang Ping called up the color ultrasound images that he had worked so hard to obtain. After carefully viewing each frame of the image, Yang Ping breathed a sigh of relief.

But he did not express his opinion on the spot, because Dr. Gu from Zhongqiao County was present. This matter was very trivial. No matter how powerful he was, after all, it was a family affair. He did not want his remarks to spread for the time being, because there were still many things that were not clear. For example, there was no pathological examination at Appendix IV.

Dr. Gu's task was completed and he had to go to work tomorrow, so he hurried back with the pathology slides. Director Fang returned the pathology slides to him and asked him to take them back for filing. Before leaving, Dr. Gu realized that he had brought the pathology slides with him today. He was so lucky that the young doctor who looked at the color ultrasound images was the famous doctor Yang Ping.

The halo shrouded in more than a dozen CNS articles made Yang Ping truly like a god in the minds of these doctors.

After Dr. Gu left, there were only two people in Yang Ping's office, himself and Director Fang. Yang Ping said seriously.

"This is not thyroid adenocarcinoma. There is a bilateral sign on the color ultrasound image, which is a low-echoic ring outside the high-echoic mass. This is a typical manifestation of zombie nodules. Based on the descriptions of several medical records, Nongtie Throughout the course of the disease, thyroid nodules undergo a process of being unchanged, suddenly getting bigger, and suddenly getting smaller. This change is often seen in cystic degeneration or bleeding of thyroid nodules. The glandular tissue of the thyroid is generally loose. If it is inside When cystic degeneration or bleeding occurs, after a period of time, the cyst wall or solid tissue is prone to collapse. The internal fluid is absorbed by the glands, and the solid tissue collapses, eventually forming an irregular, hypoechoic, solid nodule. , some nodules are taller than wide, and the concentrated colloid inside can easily be misdiagnosed as microcalcifications. In this way, the absorbed color ultrasound image can easily be confused with papillary thyroid cancer."

''So the color ultrasound at that time considered papillary thyroid cancer! "

"This kind of thyroid zombie nodule is relatively rare and can easily be misdiagnosed."

This is the most original data. Based on these original objective examination data, the truth is now revealed. This patient is not a thyroid cancer, but a zombie nodule.

In this way, it is reasonable to connect these original data with all the tests done in Appendix 4 later, why all the tests in Appendix 4 did not point to thyroid cancer.

''So that's the case! "

Director Fang took a deep breath.

But why didn't the doctors at that time review it? Why didn't there be a pathology report after the surgery? Or did they just rely on this diagnosis to diagnose thyroid adenocarcinoma and then perform radical surgery, followed by radiotherapy, chemotherapy, and targeted therapy?

This isn't like higher-level hospital-style procedures, unless—

What the hell!

Director Fang cursed when he thought of this.