Come on, Dr. Wu

Chapter 214 Pancreas Progression

During this period, Wu Xiaofu read a lot of relevant literature and videos. Last time, he also performed Lin Yuxiu's surgery, which gave Wu Xiaofu a lot more to think about.

Because the transplant was half a liver, Wu Xiaofu wondered whether the connection of these pipelines could be more scientific.

For example, in the case of blood vessels, in addition to the main blood vessels, other nutritional blood vessels can also be selectively reconstructed.

Lin Yuxiu's recovery speed did not satisfy Wu Xiaofu. It was only half a month after the operation. After color ultrasound, Lin Yuxiu's liver recovery rate had not reached one-seventh.

The degree of liver recovery is closely related to vascular nutrition.

The better the vascular nutrition, the faster the recovery.

Liver transplants currently performed basically only reconstruct the main blood vessels of the liver, including the hepatic artery and portal vein, which enter the liver, and the left hepatic vein, middle hepatic vein, and right hepatic vein, which exit the liver. Other blood vessels are basically abandoned.

For the liver, this is actually very unfriendly, because the nutritional blood vessels that the liver needs are not just these. It is like a tree. It is not enough to have a main trunk, but the branches must also grow.

Especially after surgery, there is still half a liver, which requires even more energy.

The reason why subsequent growth is very slow is because the liver not only needs to absorb nutrients to restore the normal size of the liver, but also needs to breed necessary nutritional blood vessels during recovery, including those small veins and small capillaries.

This consumes a lot of energy in the liver. If more blood vessels can be connected, this loss can be reduced. The reason why no one was willing to reconstruct these small blood vessels before is that on the one hand, it is difficult to reconstruct these small blood vessels and they are prone to reconstruction. Post-bleeding is time-consuming and labor-intensive.

The operation time of liver transplantation is inherently long. If the operation time is extended further due to the reconstruction of these small blood vessels, it will cause greater harm to the patient's body and even be life-threatening.

Therefore, the surgeon made a choice and gave up all blood vessels except the large blood vessels.

But Wu Xiaofu is different. He can clearly separate the blood vessels, and their functions are also clear. There is no need to worry about incomplete reconstruction and the risk of bleeding. The most important thing is that Wu Xiaofu is fast enough. It won't add too much time to the surgery.

Under such conditions, Wu Xiaofu felt that he could give it a try.

Wu Xiaofu felt that after such an operation, the patient's recovery speed would definitely be better than that of Lin Yuxiu. With Lin Yuxiu comparing it with the case in front of him, if the effect is really good, then it can be promoted.

It is not necessary to complete the reconstruction of all the blood vessels surrounding the liver, but also to partially reconstruct it. Various documents and various postoperative color ultrasounds allowed Wu Xiaofu to determine that a total of twelve small blood vessels will basically be repaired three months after the patient's surgery. Within a period of time, it was derived.

It was these twelve blood vessels that Wu Xiaofu wanted to reconstruct during the operation.

You must know that after the reconstruction of these blood vessels, it can bring more nutrients to the patient, allowing the patient's liver and body to recover quickly. These blood vessels may not only transport nutrients and blood, but also the patient's lifespan.

"Boss, do you want to reconstruct these small blood vessels?"

Seeing that Wu Xiaofu had completed the reconstruction of the large blood vessels, but it had not stopped yet. Looking at the small blood vessels that Wu Xiaofu deliberately left behind, Chen Zhendong and the others instantly understood something. Wu Xiaofu wanted to rebuild the small blood vessels as well.

In fact, it is not that no one has tried it, but it is too time-consuming.

Subconsciously, they wanted to persuade Wu Xiaofu, but looking at Wu Xiaofu's movements and thinking about how long it would take Wu Xiaofu to rebuild his large blood vessels, they all shut up. That was someone else, but this was Wu Xiaofu, their boss.

As many people as ever questioned Wu Xiaofu, they were slapped in the face, and they didn't want to be one of them.

In the time it took to speak, Wu Xiaofu had already completed the reconstruction of two blood vessels.

One or two minutes is really amazing. In other words, it takes less than half an hour to reconstruct these blood vessels. If it takes half the time for other people to reconstruct large blood vessels, they are probably not as fast as Wu Xiaofu.

That’s it!
Director Cai heard Yuna and the others' questions and came over to join in the fun. Watching Wu Xiaofu's operations, he felt as reassured as ever.

His eyes fell on Chen Zhendong, "Zhendong, aren't you bragging about how powerful you are abroad? Why don't you brag about it anymore?"

Director Cai is not used to Chen Zhendong. He is also the old director of the anesthesiology department. He has been with Yu Shifu all his life. Naturally, he will not care about Chen Zhendong's father. He should complain and talk. If this is normal, Chen Zhendong will have to give it to him at least. Director Cai talks about the good things abroad. After all, this is just the director of the anesthesiology department, not Yu Shifu, so he is not used to it.

But not today, the boss is here today.

He glanced at Director Cai and said slowly, "As a boss, he will have to develop abroad sooner or later. By then, he will still be powerful abroad."

Director Cai couldn't hold back his anger when he heard this.

"You fart, you think it's all you, so you go abroad every day. I'm afraid you won't even be able to find your home." After saying that, he looked at Wu Xiaofu, "Xiaofu, tell him that you won't go. We can study abroad, but we can’t act like this guy and rush to develop abroad as if everything is foreign.”

Wu Xiaofu couldn't help but laugh while watching the conversation between the two, "There are so many patients in China, and they are not enough for me to treat. How can I have time to go to a foreign country to see a doctor? Dr. Chen, don't be angry with Director Cai. This is ours." Director Cai will be so angry for a while, please give me anesthesia. "

While joking, all the blood vessels have been reconstructed, plus twelve small blood vessels. It took an extra fifteen minutes. For gallbladder removal, this may be considered a little time, but for this operation, it is really a waste of time.

Then there is the reconstruction of the biliary tract, which is directly anastomotic with the intestines.

The patient's gallbladder function has long since disappeared, and bile excretion has become a problem. Such patients usually have many signs before getting sick, such as digestive problems, typically diarrhea.

If a person has diarrhea for a long time, he should pay attention. If he excludes gastrointestinal problems, it must be a problem of bile excretion. Gallbladder disease should be considered, especially if the diarrhea suddenly disappears after a long period of time. , even more abnormal.

At this time, it may be that the gallbladder has deteriorated to a certain extent.

Some patients with cholecystitis had diarrhea before the operation but stopped after the operation. They said it was because the gallbladder was removed. In fact, it is not. It is just because the body has adapted.

However, the function of bile is still indispensable, so the reconstruction of the biliary tract must be done carefully.

"Boss, with your skills, you can do well in the gastroenterology department."

Seeing Wu Xiaofu's bold reconstruction, Chen Zhendong suddenly said, surprising everyone.

"Zhejiang, instead of bragging about foreign countries, brag about Xiaofu instead. By the way, I just noticed that you are called the boss very frequently."

Chen Zhendong curled his lips and said, "I'm willing to do it. That's how I am. Whoever forces me to brag about someone else, shouldn't I?"

Director Cai was really choked. It was fine. There was nothing wrong with him. He glared at Chen Zhendong and decisively left this angry guy.

"Three hours."

After Wu Xiaofu completed suturing the stoma, Wu Xiaofu didn't need to ask about the time. The patrol officer already said, "Three hours." Hearing this time, Yuna and others, who had performed this kind of surgery with Wu Xiaofu for the first time, were shocked.

It takes more than this time to change the liver.

As expected, he is the fastest man in the First Affiliated Hospital, and he lives up to his reputation.

The door of the operating room opened, and Feng Lingling also came in at this time. Looking at Yuna who had already started to apply dressings, Feng Lingling's face was full of frustration, "I hurriedly and slowly couldn't catch up?"

Yuna smiled even more happily, "Lingling, with the speed of our boss, you may be disappointed even if you come here a few times."

Aha!

When Wu Xiaofu heard what the two girls said, he felt strange, "What you'd better talk about is surgery."

At this time, everyone in the operating room started laughing. Yuna even flicked her hair out of habit. Although her hair couldn't be flung up, it was very stylish. "Boss, we haven't tried anything else."

Okay, Wu Xiaofu said that he indeed lost on this track.

Talk room.

"Don't worry, the operation went well. The follow-up depends on the recovery. I will stay in the intensive care unit for one night today. If there is no problem tomorrow, I can be transferred back."

Staying in the intensive care unit for a night after major surgery is basically a surgical routine.

One is that the risk factor after such a major surgery is indeed high. The nursing experience of nurses in general departments is definitely not as good as that of the intensive care unit. If something happens, the intensive care unit has the highest authority. What kind of medicine do you want to use? It can be used at any time, and the success rate of rescue is also high.

Furthermore, based on this situation, if the patient is admitted to the general ward, the director may have to work night shift to check the situation. It is really difficult to deal with other people's problems, so it is easiest to stay in the intensive care unit.

The hardest part is the intensive care unit. Otherwise, why do you think there is always a shortage of beds and so many people in the intensive care unit?

The patient's family members cried excitedly when they heard Wu Xiaofu's words.

"Thank you Dr. Wu. Thank you so much. We knew we were right to find you. You are really amazing. We..."

After hearing the words of thanks from the patient's family, Wu Xiaofu also said a few words of comfort and hurriedly left.

After returning to the ward, there is still a lot of work to do.

The examinations for patients with liver cancer are almost done. If there is no problem at a glance, they can be scheduled for Wednesday. There are also examinations for patients with pancreatic cancer. All of these need to be looked at. The surgery must be done as early as possible.

Even if the preoperative evaluation is not suitable for surgery, the patient must be informed as soon as possible so that the patient can quickly take other treatments. The patient's condition cannot be delayed just because he is busy. At least this is Wu Xiaofu's principle.

In the locker room.

"Linda, you don't know how fast hepatobiliary surgery is developing in China. The first laparoscopic extended radical resection for gallbladder cancer and the first laparoscopic extended radical resection for gallbladder cancer plus liver transplantation. These are all What we in China do, just now, I personally performed the surgery in Taiwan, it was amazing.

Hey, hey, how long do you think this operation will take? Three hours. Is it feasible in country M? It doesn’t work at all. I couldn’t find one that can treat liver and gallbladder disease in the ma clinic. Which hospital is good for liver and gallbladder surgery? It has to be the First Affiliated Hospital of Donghai, China.

Let me tell you, you should come and study, otherwise, you will easily become a frog in the well. Now that you are here, I will introduce you to our big boss, my new big brother, the most powerful one, you know It's definitely not a loss, if you study hard with him and learn the techniques, you will be able to take charge directly.

......"

As soon as he entered the locker room, Wu Xiaofu heard someone speaking in M ​​Mandarin. The more he listened, the more familiar he became. Isn't this Chen Zhendong? Everyone has ADHD, but Chen Zhendong's genes are imprinted on his mouth, and his mouth will not change for a while. Take some time off.

But it seems that this means that I am bragging about people from country M.

Good guy, both ends are taken care of, this guy is the most powerful, the attention is so full, Wu Xiaofu also figured out that when this child was a child, his parents were busy, so they basically took care of everything by themselves, because there were basically no parents to hold parent-teacher conferences. Therefore, he has been said to be an orphan, and his personality is becoming more and more withdrawn.

Because he couldn't get the attention of his parents, he thought of various ways to attract their attention. Because of his withdrawn personality and few friends later, Chen Zhendong's father gradually noticed Chen Zhendong's problem and hurriedly gave Chen Zhendong some advice. Psychological intervention is just a bit too much, and it even goes astray. Then there is the current Chen Zhendong. From a verbal point of view, he is not withdrawn. After all, who is an autistic patient who talks so much? However, this does not seem to be a psychological problem. After all, the desire for attention is not to this extent. Ah, so, he is still mentally defective.

They have all arrived in their own group, and Wu Xiaofu will definitely help them solve it.

Linda on the other side of the phone was helpless listening to Chen Zhendong's words. Do you think Chen Zhendong is unpopular in China? He is synonymous with unpopularity everywhere. Country M is now recognized as the Mount Everest of modern medical care. ah.

As a result, you keep advocating for China in country m, saying that country m is not good at this and that it is not as good as that. Aren't you making yourself uncomfortable? Even if Linda has a good personality, she can't stand it. The least you can do is It has to be reliable.

Is country M not as good as China? Who would believe this?
"Chen, tell me, who is this big boss? He can't even compare to David, right?"

"Hey, who is David? Ask him, does he dare to compete with our boss?"

hiss!
Linda only felt a toothache. Did Chen Zhendong drink too much?

"Tell me, tell me who I can't compete with?"

Over the phone, David's voice suddenly came, and Chen Zhendong was also panicked. Why are they still together? Even if Linda is David's assistant, it's almost midnight over there. They can't still be doing surgery, right? When did the two of them become so hardworking?

wrong!

"Wouldn't you be?"

"Humph, now do you know how inappropriate your call was? It's been more than half an hour. I've been listening to your chatter for half an hour. I don't think Linda is even interested anymore. Chen, China is so good, so don’t come here again.”

David muttered, Chen Zhendong didn't know that he was disturbing David's good things, but he was also thinking in his heart, Linda, he fell in love with her after she went there, and they have been in contact with each other ever since. See if you can deepen the relationship further.

That's good. David actually followed the unspoken rules of the workplace. Forget about being an assistant on the operating table, he now works directly on the bed. Damn it, bah, what kind of thing is he? No wonder he can't compare to our boss.

"By the way, you haven't said who you are talking about yet?"

"You also passed the video yesterday."

"Wu! Oh my god, yes, you and Wu are in the same hospital. He is so terrible. He accepts everyone. He will regret it."

Chen Zhendong hung up the phone decisively. He was very unhappy when he knew that the two were role-playing in the middle of the night, but David still belittled him like this. He could bear it, so he hung up the phone decisively. But when he turned around and saw Wu Xiaofu, his heart skipped a beat.

"Boss, you just came in, right?"

"No, I came in when you first started talking."

"Oh, no, boss, I swear, I never said anything bad about you."

"I know, otherwise, I would have given you a set of combo punches just now. Tell me, what happened to David?"

Chen Zhendong hurriedly told the gossip to Wu Xiaofu.

Linda!

Wu Xiaofu suddenly thought of the graceful female doctor who was David's assistant when David asked him to perform surgery. Good guy, this doctor is really stressed.

the other side.

"Chen is talking about Wu who saved us last time?"

"That guy dares to hang up on me. When I go to China, I have to let Wu put on his shoes."

It's already four o'clock when I get home.

A sip of the icy life source progress at 3.6 degrees Celsius will instantly make you feel refreshed.

The computer turns on.

Title: Genetic theory of pancreatic cancer.

As for rectal cancer, the basic theoretical research is almost complete, and clinical research will soon begin. To be honest, there are only a few places where Wu Xiaofu can get started. Research is not surgery, so it takes a lot of energy and time. What Wu Xiaofu lacks is time.

Professional matters should be left to those professional people. They have such a strong foundation. If these people can't produce results, they will be very sorry for their resume.

Now Wu Xiaofu is about to start theoretical research on the genetic basis of pancreatic cancer.

There are many ready-made theories in Wu Xiaofu's head, but they are all scattered. They are basically the memories of another Wu Xiaofu, formed articles and theoretical research results, various speculations and studies on existing results, etc. .

Compared with the theoretical research on rectal cancer, the current research on pancreatic cancer is much more complicated and more difficult than the previous theoretical research. There are some fragmented information about targeted drugs in the memory. Combining them is not what Wu Xiaofu expected. desired results.

Not to mention curing pancreatic cancer, Wu Xiaofu at least wanted to prevent patients after pancreatic cancer surgery from producing cancer cells.

Just like Zhou Lin, after Wu Xiaofu performed the operation, she was clean. If his results are supplemented, it can ensure that Zhou Lin's survival period is not just three to five years, but even longer.

Even reaching the life span of a normal human being.

Even for those who are in an advanced stage and really cannot undergo surgery, this kind of result can be better than the targeted drugs we see now.

It's a good idea, but the progress will definitely not be as ideal as imagined.

After all, compared with the mature theory, this one is much more difficult and involves more aspects. This stage of Wu Xiaofu's theory is destined not to be completed in three or two months.

Thinking from time to time, typing on the keyboard from time to time, checking information from time to time, time flies by quickly.

Wednesday.

The first operation was to remove pancreatic cancer, and the second operation was to remove liver cancer.

Pancreatic cancer was performed by Wu Xiaofu, and liver cancer resection was performed by Zhang Xuewen. However, this time he was not given the first one. A group, operating room arrangement, usually let people do it consecutively, like the situation yesterday, really It's great luck.

Pancreaticoduodenectomy.

Unlike Zhou Lin's surgery, the patient's cancer this time was in the tail of the pancreas, so the approach was also different.

Compared with pancreatic head cancer, pancreatic tail cancer is actually less malignant. The reason why this operation is more difficult is because there is gastric metastasis. It is a combination of two operations, so the treatment is much more difficult.

Coupled with the migration of the disease course, the patient's physical condition is not very good, so it is a big test for both the surgeon and the anesthesiologist. The anesthesiologist is still Director Cai. To be honest, if Wu Xiaofu was not the surgeon, Director Cai would It's really not that easy to make the decision to give anesthesia.

Drill holes, pneumoperitoneum, and place a microscope.

For this operation, Wu Xiaofu's assistant was Zhang Xuewen. Wu Xiaofu wanted to train Zhang Xuewen. Well, this is very arrogant, but when it comes to technology, especially in pancreatic surgery, there is still a gap between Zhang Xuewen and Wu Xiaofu.

If Wu Xiaofu leaves for something later, Zhang Xuewen will still be the one to take the lead in the group, and then Chen Zhendong, even if Chen Zhendong's skills may be really better than Zhang Xuewen.

Under the mirror, Wu Xiaofu quickly completed the free work. When Zhang Xuewen moved the mirror, his vision quickly became clear.

"Next, I'm going to open the omental sac."

Wu Xiaofu said to Director Zhang. Director Zhang also hurriedly followed the mirror, and the lens completely came to the tail area of ​​the pancreas. Wu Xiaofu's movements were not as cautious as others, and Zhang Xuewen frowned when he looked at it.

The frown is subconscious. After all, it is not an exaggeration to say that the pancreas is the most fragile organ in the body. He is really afraid that if he is not careful, greater damage will occur, which will increase the difficulty of the operation and cause unnecessary danger. But it was Wu Xiaofu who performed the operation. Everyone close to him knew that this was the rhythm of Wu Xiaofu's operation.

After opening the lesser omental sac, the tail of the pancreas was fully exposed. The original redness of the pancreas had disappeared. The entire tail of the pancreas began to turn white, and it looked dusty, looking lifeless.

The part of the cancerous lesion is not small. In the eyes of most doctors, this is enough to scare people away. After all, this is only the part that can be seen with the naked eye. When it is actually cut, the size of the cancerous lesion is not just that. .

However, at this time, in Wu Xiaofu's field of vision, the cancerous lesions and normal tissue were clearly visible.

Before resection, the blood flow must first be blocked.

The gastrocolic ligament is separated along the greater curvature of the stomach, and the blood vessels are ligated. At this time, the gastrocolic ligament is separated downward to the bottom of the stomach.

The next step is to deal with the spleen. The pancreas and spleen are connected and have rich blood supply. Therefore, before dealing with the pancreas, the spleen must be separated first, the spleen must be pulled inward, and then deep into the diaphragmatic surface of the spleen to separate the adhesions between the spleen and the retroperitoneum. .

At this time, the spleen can be completely cut off, the incision is expanded, and the spleen can be pulled out.

Once the spleen is completely freed, the tail of the pancreas can be folded ventrally, separated from the retroperitoneum using blunt or sharp techniques, and the small blood vessels leading to the colon can be ligated and separated.

"If you are a patient with pancreatic head cancer or a pancreatic tail cancer patient who is absolutely confident in your ability, it is actually possible to consider preserving the spleen, but this patient cannot do it because there is also gastric metastasis, so the risk of preserving the spleen is high."

Zhang Xuewen and the others all nodded, but they had no intention of preserving the spleen, especially for pancreatic tail cancer. They didn't have the confidence, they had the confidence, and they didn't want to take the risk. Not everyone belonged to Wu Xiaofu.

Because the splenic vein runs close to the spleen parenchyma, pancreatic tail resection basically requires removal of the spleen. Therefore, during the operation, the short gastric blood vessels are required to be separated and cut along the greater curvature of the stomach.

Relying on the precise positioning of the pancreatic tail resection, Wu Xiaofu separated the splenic artery directly from its root.

The electric knife came to the left side of the superior mesenteric vein, and the smell of meat filled the air, getting stronger and richer. Their mouths and noses fluttered, which stimulated their sense of taste. Swallowing saliva is a normal reaction, but it is definitely not fragrant. The reason is just a subconscious reaction.

The arteries and veins were freed and cut between the two ligatures. After the splenic vein was safely ligated, the pancreas was cut off with an electric knife between the ligatures. The pulsating blood vessels were clamped and sutured separately.

If it is a simple pancreatic tail cancer, at this time, the pancreatic duct can be directly tied with sutures, and the pancreatic parenchyma can be closed with tapered or interrupted fish mouth sutures. However, if it is also combined with gastric metastasis, another method must be performed at this time. , a Roux-en-Y pancreatojejunostomy is required.

This can ensure drainage and also reduce the burden on the duodenum a lot. After all, subtotal gastrectomy and gastroduodenal anastomosis will be required soon. Therefore, even the subsequent subtotal gastrectomy can be performed. It is also more difficult than ordinary subtotal gastrectomy.

"It's been an hour and a half."

(End of this chapter)