Come on, Dr. Wu

Chapter 129 Liver Transplantation

Sunday.

After getting up, Wu Xiaofu looked at his blog and saw that the depression-related content he posted yesterday had received tens of millions of likes.

This surprised Wu Xiaofu. This was only one night.

After taking a closer look, I discovered that my blog had been forwarded by the official. No wonder the influence suddenly expanded so much. However, this was a good thing, and Wu Xiaofu was naturally happy to see it happen.

beep.

"Good morning, Teacher Duan."

"Xiao Fu, let's learn about liver transplantation in the operating room."

Liver Transplantation!
  Wu Xiaofu suddenly became energetic. Liver transplantation, general surgeons are probably proud of being able to complete liver transplantation operations.

After all, this is an operation beyond the fourth level. Anyone who can perform liver transplantation is basically a person who has been written in the history of medicine. Experts and professors have become famous and have left a strong mark on the history of medicine.

To say that liver transplantation is difficult, it is definitely difficult. Even if Wu Xiaofu feels that he is doing well now, when it comes to liver transplantation, it is unthinkable.

He wouldn't dare to go to Liangshan without three or three. Liver transplant surgery was not something he could handle at this stage.

That's why Wu Xiaofu was so excited when he heard that he had the opportunity to learn such surgery.

With his current learning ability, Wu Xiaofu dared to say that as long as he could learn a few machines, he would definitely be able to master 70% to 80% of them. He would take his time later. Will the day of doing the surgery himself be far away?
  Liver transplant surgery is not easy to develop in China. The first case was completed in the 1970s, also in Donghai and the First Affiliated Hospital.

Therefore, the First Affiliated Hospital can be said to be the origin of liver transplantation in China. Today, it is also the place with the highest success rate of liver transplantation and the highest number of completed cases.

But even so, the number of liver transplants performed in China each year only exceeds 10,000.

Don’t think this number is too high. Not to mention that there are cases that require liver transplantation repeatedly. According to statistics, the number of cases requiring liver transplantation at this time is no less than 10 million. Compared with this number, thousands of liver transplants are completed every year. Transplant surgery is simply not worth mentioning.

Wanting to do, needing to do, and being able to do are two different things.

Regardless of the difficulty of the operation, this is an issue that doctors and hospitals need to consider. Patients do not need to think too much. What patients need to consider are liver source issues and economic issues.

The first one is the liver source. Not to mention the world, there are millions of people in China waiting for liver sources. These people are all queuing up. People who need surgery are the kind of people who enter For people in the terminal stage of the disease, whose remaining life is less than a year, if they wait like this, most cases will die before the liver source is available.

Therefore, most people consider living donor liver transplantation, where people around them voluntarily give their liver to the patient.

Although the liver has the ability to repair itself, this ability is limited after all. Unless it is a close relative, there are really not many people who can do this. Maybe it is possible, but not everyone can have this ability. of.

In fact, the main reason why so many people in need of liver transplantation have not done so is not the source of the liver, but lack of financial capacity.

Poverty is the only original disease. This sentence may not be wrong.

operating room.

When Wu Xiaofu arrived, he realized that this operation was not performed by Duan Hao, but by Yu Shifu. Duan Hao was just an assistant. Not only Duan Hao, but also Che Liming, the chief physician of the General Surgery Department, had no choice but to perform the operation. Needless to say, this lineup is truly luxurious.

"Xiao Fu."

Seeing Wu Xiaofu, Che Liming immediately called out. The two had met before, and now he was even more familiar with Wu Xiaofu.

The hospital is so big, so the news that Wu Xiaofu was favored by Yu Shifu is no longer a secret.

"Teacher Che."

Che Liming was Duan Hao's contemporary, and he was also an expert in liver transplantation. He had performed many liver transplant surgeries himself, and Yu Shifu was able to get him to perform liver transplant surgeries at the First Affiliated Hospital.

Entering the operating room, the patient just came in.

According to medical classification, a man in his sixties is considered an old man. However, from the appearance, the patient does not look like he is only in his sixties. The long-term torture of the disease has already weakened the patient's spirit. and body, exhausted to the limit.

Alcoholic cirrhosis has reached the end stage, and the liver function is severely weakened. If surgery is not performed, it may be within this year.

End-stage alcoholic cirrhosis is a major indication for liver transplantation.

There are several main indications for liver transplantation. Surgery is, after all, the second choice to various treatment methods. No doctor is willing to operate on you without surgery, so this first one is the same as most of the indications for surgery. Basically, when various acute or chronic liver diseases cannot be cured by other medical and surgical methods, and death is expected to be unavoidable in the short term, liver transplantation is the best treatment.

The medicine is no longer able to awaken the function of the liver, and it is completely damaged, so it can only be replaced.

Then there is the requirement for quality of life. Some patients have severe liver disease, severe functional limitations, and severe symptoms, which have seriously affected the quality of life. Not to mention other things, they must at least be able to go to the ground, and they cannot just stay in bed like a vegetative state. People, in order to seek a better life, liver transplantation is also necessary.

There is also liver cancer. As long as liver cancer has not metastasized, that is to say, in situ liver cancer, such as hepatocellular liver cancer and cholangiocarcinoma, is also one of the main indications for liver transplantation, accounting for about 1/3 of all liver transplant cases. -2/3.

Finally, there is the classification of indications for the patients in front of us. End-stage benign liver disease and alcoholic cirrhosis are still benign diseases after all, and the surgical effect is much better than that of liver cancer. Therefore, gradually, end-stage benign liver disease has also become a candidate for liver transplantation. main indications.

Just like the patient in front of me, as long as the doctor sees him, he will basically recommend a liver transplant.

Jaundice is so severe that it is not just a sallow complexion. This is basically the most typical sign of patients with end-stage liver disease. Then there is hepatic ascites. Even if the patient is covered with a quilt, you can see the bulge in the abdomen, which is no bigger than that of a woman in October. Being pregnant is much more uncomfortable than having a baby.

pain.

Most of these patients can only rely on painkillers, which is similar to the late-stage cancer pain of cancer patients. If they don't take painkillers, they won't even have a few hours of peaceful sleep.

"This was a living donor liver transplant, and the patient's daughter donated half of his liver."

After hearing Che Liming's words, Wu Xiaofu nodded. At this time, those who can take the initiative to donate a liver are the patient's close relatives. The patient is lucky, but not every relative can do this.

"The four daughters and one son in the patient's family have all been matched. The matching result was that the patient's eldest daughter was the most suitable. I heard that after discussion, the other three daughters and one son were responsible for the medical expenses, while the eldest daughter was responsible for donating the liver."

Is that so?
  This is another benefit of having more children. Many patients’ children are actually willing to donate livers, but it does not mean that everyone’s liver can be used. The match must be successful. Even if it is a biological son or biological daughter, it is not possible. It is said that the liver can adapt 100%, but after all, parent-child parent-child has the highest chance.

If there are many children, this won't work, but other methods can be tried, but the patient's chance of survival will be different.

"The old man was unwilling to live or die before. After all, he is already so old. Even if he is sick and burdens his child, now he has to ask his child to donate his liver because of him, which will even affect his daughter's life for the rest of his life. What does the old man feel like? I must be patient, but my children are also the utmost filial piety. The four daughters and one son jointly persuaded the patient for several days, and the patient finally agreed."

On the operating bed.

Even wearing a mask, Wu Xiaofu could smell the strong stench.

However, they are all accustomed to it. This is also a common characteristic of many patients. As they age, coupled with systemic diseases and degeneration of the digestive system, bad breath and body odor will follow. Then there are personal reasons, even for children. They are filial, but they cannot change clothes and take a shower every day. Therefore, medical staff also need regular training and education guidance in this regard.

Sometimes patients not only need to be treated, but also need to be treated with due respect during the treatment process. A small disgusting gesture by a medical staff may not be felt by the patient himself, but if the patient notices it, it will cause The patient has great psychological implications and frustration.

You know, for such terminally ill patients, sometimes mental health is more important than medication for physical recovery.

Living donor liver transplantation is more difficult than cardiac death donor liver transplantation.

After all, this is not just an operation, but also removing the liver from the living body, and then transplanting the patient's liver as soon as possible. The risks, operation time, and difficulty of the operation are all increased, but for the patient's later recovery, the living body The success rate of liver transplantation is naturally higher.

The donors for cardiac death donor liver transplantation are basically donated by people from the public. They have been preserved during the period. No matter how perfect the preservation is, the activity is not as good as that of a freshly delivered liver.

Nowadays, there is a very popular surgical procedure that uses the organs of the second senior brother to provide donors for the human body.

There are many second brothers. If it can really succeed, then there is no need to worry about a donor. However, it is still difficult to succeed in this kind of attempt. Basically, it ends in failure, and the rejection reaction is very serious.

Moreover, there are many resistances. Not to mention technical and logical issues, many experts and professors are also opposed to it in terms of ethics.

However, the medical community has not given up.

According to different liver transplantation methods, liver transplantation is divided into classic, piggyback, reduced-volume, split, domino, and assisted liver transplantation.

As for the patient undergoing transplantation today, he chose the split transplant method because of a related donor transplant.

"Teacher, senior brother."

Yu Shifu and Duan Hao had already arrived, Wu Xiaofu said hello, and Yu Shifu looked at Wu Xiaofu, also very satisfied.

"Okay, the patient has come in, prepare to wash your hands and disinfect."

Ah!
  Wu Xiaofu was pleasantly surprised when he heard this. Not only could he observe, but he could also become a third assistant!
  "it is good!"

Wu Xiaofu did not dare to neglect and hurriedly prepared. The opportunity was rare. Wu Xiaofu was afraid that if he was even half a minute slower, the opportunity would be taken away by others.

To be honest, Wu Xiaofu never dared to think that he would actually have such an opportunity to undergo a liver transplant before he became a doctor.

"What, are you excited?"

Che Liming and Wu Xiaofu washed their hands together. Seeing Wu Xiaofu's excitement, he couldn't help but joke.

"Teacher Che, when was your first liver transplant surgery?"

Che Liming's smile froze.

"Why aren't you smiling? Is your smile frozen?"

After the anesthesiologist Liu Wengui passed by, he laughed when he heard the words, and his smile immediately shifted.

"He, I remember it was when he was the deputy director."

Liu Wengui and Che Liming were at the same time and had a very good relationship, so they directly took advantage of Che Liming's old ways.

Che Liming had a look of resentment on his face, "I still can't remember it, Xiao Fu, you must be so lucky."

Envy began to permeate the air. At that time, he also coveted liver transplantation, but this was not something he could get just by coveting.

In the operating room, the patient's daughter has also been pushed in.

Looking to the left and right of the patient, it can be seen that both the patient and the daughter are very nervous at this time, but the patient's daughter is still comforting her father. She can feel that her father is hesitant. She is afraid that her father will... He regretted it again. After so much effort, not only the doctor but also the patient’s daughter was unwilling to give up.

Maybe the father thinks that he is already like this and it doesn't matter anymore, but for the children, they only have a home because of him.

A drop of tears flowed. If there was no other way, who would be willing to lie on this cold operating bed.

"Give it anesthesia."

Yu Shifu explained, and Liu Wengui started anesthesia directly. The anesthesia method was general anesthesia. In fact, no matter what kind of abdominal surgery, as long as the body can tolerate it, general anesthesia is the best, both for the surgeon and the patient. ,all good.

The patient sleeps and the surgery is completed.

The surgeon does not have to worry about interference from the patient or pain issues.

"Come on, open your mouth, breathe, hey, good..."

For general anesthesia, intubation and induction of anesthesia, this process only requires the patient to be in a supine position. There are not many position requirements, unlike spinal anesthesia, which also requires posture coordination. In fact, the anesthesia efficiency is higher.

Of course, with this kind of anesthesia, the anesthesiologist is under greater pressure during the operation. After all, the patient is unconscious and cannot express discomfort. The anesthesiologist can only look at a series of cold numbers.

"Xiao Duan, it will take me about an hour and a half, please pay attention to the time."

Yu Shifu confessed that he was preparing to collect the donor liver.

In liver transplantation, the donor liver removal and the recipient surgery must be performed simultaneously. According to Yu Shifu's assignment, Duan Hao and Wu Xiaofu were the ones to remove the liver. He and Che Liming were responsible for completely removing the donor liver, performing cooling lavage, cryogenic preservation, and storing it at low temperature. Take necessary rest before implantation.

This time should be synchronized. During this period, Hao happened to remove the diseased liver, then implant the rested donor liver, anastomose blood vessels and reconstruct the bile duct.

There are more procedures involved in resecting the donor liver, including resection and rest, so it will definitely be slower than the recipient surgery group.

If Duan Hao had done it too quickly, the patient would have been in an anhepatic state for a long time, and the blood supply would have stopped, possibly leading to inferior vena artery and vein infarction, thus endangering the patient's life.

However, it was just an explanation that this was not the first time Duan Hao had performed a liver transplant with him, and it was very stable. This sentence may be more of a reminder, and it was also said to Wu Xiaofu.

"Teacher, don't worry."

Wu Xiaofu had basically completed the disinfection and started laying out towels.

However, what he didn't know was that in the observation room, a bunch of attending directors were envious of him.

(End of this chapter)