There is no need to be too normal to be a doctor

Chapter 208: How did you think of it? !

Xu Shiming was obviously nervous at this time.

To be honest, he just felt relieved, but he was not stupid. He was also very grateful to Chen Gong for teaching him and solving his doubts.

only……

Things have already come to this point, so what's the use of talking more?

And seeing that Chen Gong had already asked the question, Xu Shiming was helpless.

I have to ask!

Simply, Xu Shiming said directly:

"Professor Chen, this is the case. The patient has periampullary cancer, and there is cancer in the pancreas. The stomach must be resected. Is there any good way to perform surgery?"

"If the stomach is completely removed, there will be post-gastrectomy dumping syndrome and a series of comprehensive reactions."

"Is there a way to optimize the surgery?"

Following Xu Shiming's question, the entire audience fell silent.

After all, this problem is obviously too difficult.

This is no longer just an “anatomy” category, it involves surgical optimization.

It even involves too much.

The optimization of an operation requires the patient to have a full understanding of the structure and organization of the human body, and the patient needs to have novel concepts about the operation and human anatomy.

And Xu Shiming's problem is definitely not his own problem.

This kind of surgery is a difficult problem in the field of general surgery, pancreaticoduodenum and digestive surgery!

Not to mention Xu Shiming, even doctors from large tertiary hospitals in the capital obviously cannot have such doubts. Only those experts who are proficient in major surgeries will encounter such problems.

Anyone who knows Xu Shiming well knows that Xu Shiming's father is the master of digestive surgery in the 301 Hospital.

This must be a problem his father encountered in clinical practice!

Time passes minute by minute.

Chen Gong stood on the stage, also lost in thought.

Chen Gong didn't know much about this kind of surgery.

Although Chen Gong has a research history in general surgery, he also has a clear understanding of general surgery operations.

But because of this, Chen Gong knew even more how difficult this operation was!

but!

Although Chen Gong could not solve the problem exactly, but... the anatomy foundation upgraded to level 6 gave him unparalleled strength in human structure and histology, whether it was anatomy, tissue anatomy, or regional anatomy.

He can guide practice through theoretical thinking!

This is why Chen Gong remained silent.

He is really thinking about countermeasures!

At this moment, many students in the audience were staring at Xu Shiming angrily.

Xu Shiming was staring at Chen Gong without saying a word.

Naturally, he was aware of his presumption.

I know I shouldn't ask such a question.

And the first one to speak was He Sen!

He Sen stood up directly and said, "Teacher Chen, I think this question has no meaning at all!"

"You are our teacher, what you need to do is to train and teach us!"

"You have no obligation to solve difficult cases like this!"

"And to be honest, shouldn't such an issue be put on the stage of a professional committee for discussion by a group of top experts from all over the country?"

"In other words, even if you solve this problem, what does it mean to us?"

"On the international stage, can their competition committee regard such questions as our test points?"

"This makes no sense!"

"At the same time, I am here now to apologize to Teacher Chen and all the students present!"

"Because the question I raised this morning also makes no sense!"

"Because this problem, this topic, is actually a topic that my father is currently researching!"

"My father is the chief of surgery at Union Medical College. He is currently conducting observations on wound healing through abdominal incisions."

"My father is He Yuanzhi, I believe many friends know about it."

"I shouldn't use my father's achievements to make things difficult for Teacher Chen. This is a sign of my narrow-mindedness. I apologize!"

"But, here I am, I still have something to say!"

"Teacher Chen's strength, my father personally admitted, is above him."

"Let's not talk about other things for now, let's talk about the incision. Teacher Chen's one-surgery technique. According to my father, this is definitely an incision surgery that cannot be copied in the world."

"At the same time, I can also say that my father's observation of 1309 surgeries has proven the conclusion of this project. Scalpel incisions, combined with electrosurgery, will accelerate skin healing."

"I believe that all the students present know this answer, because this is the answer from Teacher Chen. He said that after removing the manipulation, this is the best healing therapy."

"I am shocked. Teacher Chen has obviously discovered this result, but has not published a paper or topic. What does this mean? I believe everyone knows it!"

"So, I once again hope and implore everyone not to make things difficult for Teacher Chen!"

"Teacher Chen is willing to teach us the unique incision technique in the world. What could be greater than such a teacher?"

"Xu Shiming is my good friend. I hope you can withdraw your question."

"This is unfair to Teacher Chen!"

In fact, there was one thing He Sen didn't say, and that was... Teacher Chen is only 21 years old, what is his future?

No matter what the future holds, his current surgical experience is obviously unable to answer this question!

After He Sen finished speaking, the entire audience fell silent.

They are very familiar with Professor He Yuanzhi in the field of hepatobiliary surgery. He studied under Mr. Wu Mengchao and is now a leader in the field of hepatobiliary surgery.

He also has extraordinary achievements in the field of liver cancer research in China.

Such a person, who admires Chen Gong so much, is there anything worth arguing about?

At the scene, more and more voices appeared.

"That's right, He Sen is right. I think this kind of deliberately making things difficult is meaningless!"

"This is a very unfair bet in itself."

"Teacher Chen, please start class!"

"Yes, Teacher Chen, please start class..."

……

More and more voices sounded, and the atmosphere at the scene gradually increased.

Everyone began to feel a little uncomfortable with how difficult the problem was and how difficult it was.

Xu Shiming also bowed his head in shame at this time.

He was extremely ashamed!

He knew he shouldn't ask this question.

Hey!

To be honest, it’s really too much to ask Teacher Chen to ride a tiger.

Xu Shiming gritted his teeth and stood up, just as he was speaking.

Suddenly, at this time, Chen Gong spoke.

"Haha, classmate Xu Shiming, do you have anything else to add?"

Xu Shiming immediately shook his head: "No... Teacher Chen... I don't want to add anything... I just think..."

Chen Gong smiled slightly and waved his hand: "Sit down first."

"I have something to say."

Xu Shiming heard the sound and sat down honestly.

But Chen Gong turned around at this time, took the chalk, and started drawing on the blackboard.

Not long after, after a moment of effort, Chen Gong clearly drew an anatomy diagram that looked like it was in a book.

The gastrointestinal tract tissue is clearly visible, as well as the liver, gallbladder, pancreas, spleen and kidney tissue.

Later, Chen Gong used chalks of other colors to draw the important blood vessels in their original shape.

This scene made everyone in the audience dumbfounded.

Everyone is a talented person in the field of surgery. They are all Ph.D.s, and they are also Ph.D.s from prestigious universities.

They have also given lessons to lower grade students under the organization of the school.

Therefore, everyone knows more clearly how difficult it is to draw such a "structural organization chart"?

Previously, there was a drawing competition on anatomy in China.

Many people have participated!

Therefore, everyone is very clear about the value of Chen Gong’s painting of a structural organization chart.

Distance, proportion, degree of restoration, blood vessel shape...

These things are almost exactly the same as in the textbook.

What kind of ability is this?

Chen Gong even clearly described the tumor in the patient's pancreas.

Suddenly, the applause from the audience was like boiling water, resounding throughout the entire professor.

Chen Gong waved his hand: "Okay, okay, be quiet!"

"These are all basic skills. Once you become proficient in them, you can do them."

"Okay, let me start my explanation."

"In this lesson, we will start analyzing and learning from this case. We will conduct an analysis of our understanding of anatomy and how anatomy guides surgical operations!"

"This class is more difficult."

"I hope everyone can concentrate and listen to me carefully."

As soon as the words fell, the entire audience was stunned.

Because no one expected that Teacher Chen would actually analyze Xu Shiming's problem.

What's more, I didn't expect that Teacher Chen would analyze such an operation as a case!

Use it to teach everyone!

What kind of strength is this?

What courage!

Time, at this moment, became a little stagnant.

Chen Gong started his lecture.

"The patient has a periampullary carcinoma of Vute. This area is really interesting to talk about."

"Periampullary cancer refers to the general term for cancer that grows in the ampulla of Vater, the duodenal papilla, the lower end of the common bile duct, and the medial wall of the duodenum.

Their common feature is that when the cancer is small, it can cause obstruction of the common bile duct and main pancreatic duct.

The course of the disease progresses slowly, jaundice appears early, the surgical resection rate is about 60%, and the five-year cure rate is 35% to 40%. "

"And the patient also had lesions on the head of the pancreas."

"So, such an operation is actually very difficult." "Experts who can perform such an operation are all top surgical experts in the country."

"Such a disease did not need to be considered before. There is no doubt that there is no problem in choosing pancreaticoduodenectomy combined with total tail resection."

"But!"

"The patient's requirements are obviously relatively high. He doesn't want to undergo this kind of surgery. It is obvious that he has undergone sufficient examination and found that there is no infiltration or cancer cell metastasis in the stomach area, and he wants to pursue a better quality of life."

"This is good!"

"Actually, many times, what we pursue in surgery is not just as simple as removing the lesion."

“Many of us call surgeons craftsmen, but that’s actually wrong!”

"Because we are doctors!"

"What is the purpose of a doctor? What is the meaning of pursuit?"

“While removing the pain, we must also pursue the patient’s quality of life and survival.”

"So, we must reduce the sequelae of surgery as much as possible!"

“And that’s what anatomy is all about!”

“Anatomy must guide surgical operations, we must fully understand the oppositional relationship between health and disease, we must understand the difference between pathology and physiology, and we must fully and clearly understand the functions and efficacy of human body structures...”

"So, for this lifting surgery, I will think about the surgery from the perspective of anatomical optimization!"

"Therefore, in this class, I called him: The role of anatomy in optimizing surgery!"

"Start now and follow my thinking and start analyzing!"

"First of all, there are a few questions. After understanding these questions, it will be easy to analyze next!"

"The first question is, how do cancer cells metastasize? Through what media?"

"The second question is, in this area, where is the risk factor and where is not!"

“The third question is, what is the biggest improvement in patients’ quality of life?”

"The fourth question is, in the resection area, which blood vessels are not needed?"

……

Soon, as Chen Gong asked questions one by one, everyone in the audience fell into deep thought.

Everyone's eyebrows tightened at this time, trying hard to think about Chen Gong's problem.

And at this time, outside the window!

Ma Yanfu was standing outside the window with a middle-aged man. After hearing Chen Gong's question, both of them were stunned.

The two of them have been here for a while!

The man is He Yuanzhi.

He Yuanzhi felt a little uneasy when he went to work after noon today. Chen Gong's blow to him at noon was really hard.

Therefore, I secretly followed He Sen here in the afternoon.

Also met Ma Yanfu.

The two of them were actually a little surprised at first.

Ma Yanfu said with a smile: "To be honest, I have never worried about whether Chen Gong can convince the public. I think he can definitely do it, but... in terms of time, I didn't think it would be so fast!"

"In just half a day, so many students supported him!"

"hehe!"

"Xu Shiming, this kid, is also a little guilty. I really didn't expect that these second and third generation doctors would be convinced by Chen Gong so quickly."

"There is also this problem, it is obviously Xu Jialin's surgery!"

He Yuanzhi said: "Yes! It must be!"

"Xu Jialin and I discussed this issue. He said that he would perform this operation on a special big shot."

"The other party is 81 years old and his body cannot withstand the torture of major surgery."

"This is indeed a bit embarrassing for Chen Gong."

"After all, this issue has been discussed by the professional committee here in the capital, and there is no definite answer!"

"Chen Gongzhen flies so fast, how is it possible?"

but!

soon……

At this moment, along with the questions, the two people outside were also lost in thought.

even!

Faintly, Ma Yanfu actually felt that... it seemed that it was not impossible.

He Yuanzhi squinted his eyes and seemed to find some inspiration.

And time passed by minute by second.

With Chen Gong’s guidance!

Suddenly everyone in the audience looked a little excited.

At this time, Ma Yanfu's eyes widened even more.

At this moment, he suddenly understood how terrifying Chen Gong's understanding of anatomy, understanding of surgery, and his understanding of all of this was!

Just then!

Chen Gong clapped his hands directly!

Suddenly, everyone in the audience was shocked.

Chen Gong said with a smile at this time:

"So, here's the surgery."

"Actually, the pylorus can be preserved."

"You don't need me to explain the importance of the pylorus, right?"

"Those who have studied anatomy should know very well that the pylorus is the part that connects the stomach and the small intestine. It is a small hole made of muscle tissue. Since it is muscle tissue, it is the most difficult for cancer cells to invade!"

"We need to be clear. In fact, human tissues have many natural barriers, and muscles are one of them!"

"For cancer cells to spread, it's very difficult for muscles to invade."

This sentence made everyone at the scene excited.

At this time, Chen Gong continued: "What is the function of pylorus?"

"First, the muscle layer can coordinate contraction and relaxation to control the function of the stomach. Second, it transports food for further digestion, prevents gastric reflux, and regulates gastric emptying..."

"You don't need me to tell you how important these effects are in the digestive tract, right?"

"Preserving these functions will greatly improve the patient's quality of life!"

"The first point is that we found the best area for preservation, which is also a core point to improve the patient's quality of life after surgery."

"Next, what I want to talk about is how to preserve and perform surgery!"

"The key steps in pylorus-preserving pancreaticoduodenectomy are to preserve the innervation of the antrum and pyloric sphincter and to maintain blood supply to the first segment of the duodenum.

Everyone, look at the picture!

It's this blood vessel.

Therefore, there is no need to dissect and remove lymph nodes around the hepatic artery, and the right gastric artery should be preserved and the nerve fibers accompanying the right gastric artery should be preserved. "

"The gastroduodenal artery is cut off and properly ligated after it is separated from the hepatic artery, and the right gastroepiploic artery is ligated and cut at the pylorus to preserve the branches of the right gastroepiploic artery to the stomach and the vascular arch on the greater omentum."

“There is no need to dissect the lymph nodes above the hepatoduodenal ligament and cut off the common bile duct at the upper edge of the duodenum!

The upper end is temporarily clamped with "pug" pliers!

Don't laugh, it's the kind of pliers you're talking about. Doesn't it look like a pug?

The duodenum is cut 2 to 3 cm away from the pylorus, and the steps for pancreatic resection are the same as those for typical pancreaticoduodenectomy. "

Suddenly, everyone in the audience laughed.

quickly!

With Chen Gong’s explanation completed.

The audience once again burst into the warmest applause.

And outside!

Ma Yanfu and He Yuanzhi left the scene with horrified expressions.

They were really frightened by Chen Gong.

And here!

At seven o'clock in the evening, Xu Shiming hurried home after class.

At this time, my father has returned.

Xu Jialin was sitting on the chair with a sad look on his face. The wife opposite him looked at her husband and sighed helplessly.

“These leaders are really difficult to maintain!”

"If we don't do surgery quickly, by the time the cancer cells spread, it will be too late!"

My wife consoled me.

Xu Jialin smiled: "I don't talk about work at home."

"Upset."

"Eat well."

"By the way, son, how was your study today?"

At this time, the couple's focus was on Xu Shiming.

Xu Shiming looked at his father and suddenly said: "Dad, how about keeping the pylorus? Can we perform surgery?"

"That is, during the operation, the pylorus area of ​​the stomach should be preserved, and then a conventional operation can be performed. What do you think?"

"Is it effective?"

One sentence made Xu Jialin's eyes widen immediately!

Immediately afterwards, Xu Jialin closed his eyes and started thinking crazily.

ten minutes later!

He stood up excitedly.

He looked at Xu Shiming with a horrified expression: "You...how did you think of it?"

...

……

(End of this chapter)