"The patient's tumor has spread!"

"I didn't see it on the CT!" Professor Li's hair stood on end.

"The outer membrane of the liver tumor has been broken!" When Zhang Fan cut it with a knife, he found that there was a small opening in the outer membrane of the ruptured tumor. This is where the tumour is hateful, and it only takes a little bit of rupture to move it elsewhere. And this rupture is estimated to have broken within a few days after the CT scan!

If it is really transferred, this operation is a typical operation that is perfect and the patient wants to hang up!

"Clean up the surrounding lymph?" Professor Li asked hesitantly. The horror of cancer is like this, no one can determine whether it has metastasized or not, and it can only be a one-size-fits-all approach to remove all the suspected tissues. The advantage is that there is no need to worry about transferring! The disadvantage is that almost the basic circulation of the organs has been cut off, and once there is an accidental cleaning, the organs that have been cleaned do not even have a compensatory function, and the liver is a very complex organ, and the upper and lower blood vessels are connected everywhere, and it is still an organ with secretion and detoxification functions. If you have a problem with your liver, you will have a problem with your brain!

Zhang Fan thought for a while, then gently put the tumor in the curved plate and said, "Clean it up!" He didn't feel at ease, no one dared to guarantee this kind of thing, it was better to have a big damage than to kill someone!

The doctors in the conference room were wondering, because this kind of surgical observation could only see the image and not hear the conversation of the surgeon, Zhang Fan's operation in the early stage surprised them too much, after such a large tumor was cut, the patient's vital signs were still very stable, and everyone was shocked when they saw the huge tumor being taken out.

But what they didn't know was that Zhang Fan and Professor Li in the operating room were making a difficult multiple-choice question!

"How much blood pressure and breathing?" Zhang Fan asked back.

"Dr. Zhang, 90/70mmHg, breathing 20!" said the head of the anesthesiology department.

"Drop your blood pressure!"

"Good!"

Blood pressure drops, bleeding decreases, and the disadvantages are obvious, and major organs may fail at any time. So this is dancing on a tightrope, dancing well is beautiful, dancing badly is fatal.

Continue the surgery and begin the dissection. Lao Li saw that Zhang Fan had started the operation, and he didn't bother anymore, after all, Zhang Fan was the chief surgeon in this operation, and Zhang Fan's decision was the safest.

Almost no one in the conference room observed the problem, after all, this kind of surgery may not be encountered by grassroots doctors in their lifetime. The lymph near the liver gate was cleaned by Zhang Fan, who could be cleaned. Try to clean this place and prevent the metastasis of the tumor as much as possible. After the operation, Zhang Fan said to Professor Li that after the patient's wound healed, it would be better to do radiotherapy!

After successful resection of liver cancer surgery, there is still a high probability of metastasis recurrence within five years, and this kind of surgery with suspected metastasis has a greater chance of metastasis, and the five-year survival rate is not estimated to be high. This is also the doctor's helplessness, no matter how high the level is, there will still be accidents. The difficulty of medicine lies here, there are thousands of trainings, but the condition will change, which considers the comprehensive quality of a doctor. In recent years, Huaguo has also discovered that this is a common problem for domestic doctors, and headaches can only treat the head, and foot pain can only treat the disadvantages.

After the surgery, it is time to do the on-site report. Although the tumor is a little broken, after this operation, it is definitely better than any radiotherapy and chemotherapy, and it also has a huge advantage over liver transplantation!

It is impossible to say that he is not nervous, Zhang Fan originally wanted Professor Li to go up, but Professor Li didn't go up anyway, he still wanted to be faced! The two doctors who came together looked at Zhang Fan with envy, not to mention the high level of surgery, and the leaders of the hospital were willing to set up such a platform, they were really envious!

This kind of report can make a doctor famous the most, and as long as this report is over, the general surgery department of Chasu City, including the affiliated county and township hospitals, will regard Zhang Fan as the first person to perform liver surgery! The doctor's fame was passed on from the doctors to each other at the beginning.

"Leaders, teachers, peers, welcome to take time out of your busy schedule to come to our hospital to participate in the seminar of this operation, here I will first talk about the specific ideas and surgical operations!~" Zhang Fan said modestly, the venue that had been discussed was quiet, although the operation was very shocking, few people really understood. Now Zhang Fan wants to explain on the spot, and the doctors who are engaged in general surgery will not let it go, although after listening to it, they can't do this surgery, but it can definitely have a huge improvement in liver surgery.

"The liver, the largest and most important digestive organ in the human body, weighs about a kilogram and is the largest internal organ of the human body besides the skin, and the liver is almost protected by ribs, and only a part below the sternum can be touched on the surface of the body. Zhang Fan briefly introduced the liver, and then began to get to the point.

"The survival rate of liver tumors after surgery is not high, and the mortality rate can be as high as 60% in five years after surgery, why is it so high, this is a noun, hepatic sinusus!" Zhang Fan turned his head to find a blackboard as he spoke, but the conference room was not prepared.

Zhang Fan turned her head slightly, hesitated slightly, she saw the problem, and then quietly went up and asked, "Director Zhang, do you have any requirements?"

"Is there a chalkboard or something, I want to write something. "It's not that Zhang Fan is pretending, but he really wants to write it out, talk about it, and he wants to share his experience and thoughts with everyone. In fact, he didn't know that this was a kind of realm improvement! It is the same principle that if you are poor, you will be good to yourself, and if you are poor, you will help the world at the same time, and it is almost impossible to climb to the top in the field of technology without a broad mind.

As soon as Zhang Fan said this, Ouyang also heard it, and with a wave of her hand, the director of the hospital office took a few people to lift up the big blackboard at the entrance of the hospital.

Zhang Fan took the chalk and began to draw. Medicine, sometimes when you don't understand it in words, you can use pictures to express it, this is the key to why Comrade Lao Lu can't study medicine well, he is busy writing and can't draw!

Zhang Fan drew a big liver lobule anatomy with red chalk and blue chalk, almost all of the surgeons present were a little qualified, Zhang Fan's liver lobule anatomy directly made the sitting blush, this hand drawing is really beautiful and intuitive.

Zhang Fan started with the central vein: "There are three lines of liver in the liver, which are the interlobular artery and the interlobular vein. The difficulty of liver cancer surgery lies in the fact that the internal blood vessels of the liver are extremely abundant and extend in all directions, and the tumor can enter the brain, intestines, stomach, and even the uterus with the blood. ”

Zhang Fan became more and more proficient in speaking, and the faster the pace became, and this systematic review also allowed him to begin to integrate the knowledge of the liver system, "Then the bile duct in the Gleason sheath is also a potential point to ignore, I have reviewed the evidence-based medical data of liver cancer in the past ten years, and this point is currently the easiest place for us to ignore." "This data comes from the system, Zhang Fan has it at his fingertips, but for everyone here, it is a pure crit, not to mention the ten-year data, it is very difficult to collect. And this evidence-based medicine is one of the subjects that Huaguo attaches the least importance to.

Step by step, it became more and more difficult, and when Zhang Fan talked about the method of tumor removal, he had already persuaded 80% of the doctors to quit. Although this explanation is very detailed, it is really difficult for doctors who have been out of the classroom for many years to understand, and doctors in grassroots hospitals pay more attention to clinical practice and despise the basics, so it is difficult for grassroots hospitals with a huge foundation in China to come out of any famous doctors. It is impossible to break away from the basics and make achievements in a higher field.

Professor Li and the two doctors listened to it with relish, although they also knew this knowledge, but no one had ever collected and refined it so systematically, this is the real essence!

"When the tumor invades the blood supply system of the hilum of the liver, our current treatment is to go to embolization and palliative treatment! I have an idea, why not reinvent it, although the damage is great, the survival rate is extremely high, after the removal of the portal vasculature, I think the five-year survival rate can be increased by 30%!"

At this point, Professor Li raised his hand. In the municipal hospital of the prefecture and county, he raised his hand of doubt in a proper manner, like a primary school student, this is the respect for knowledge and the desire for knowledge, because Zhang Fan said this way he has never thought about it, and he doesn't dare to think about it, it's too difficult!

"Teacher Zhang, then I have a question, how can such a huge vasculature ensure that the organ does not fail, and how can liver tumor cells not metastasize. Professor Li asked very politely.

Zhang Fan had already entered a state of thinking, and he didn't pay attention to Professor Li's attitude, but the doctors and equipment dealers below noticed that if they could call Professor Li teacher, it was estimated that Zhang Fan would be in the frontier!

"Embolization first, large-area embolization, and then the radial artery should be quickly selected to replace the hepatic portal vasculature, sutured under the microscope to ensure that the function is sound, and then dredged. ”

"Is there any trial data? And how can I ensure that the sutures can be fast? If the fiber sutures take too long, how long will the embolized liver fail? Professor Li asked, and the topic asked the key point.

Zhang Fan also thought about this question for a long, long time, and after a lot of systematic training combined with self-study, Zhang Fan had a little idea of his own.

"I don't have data, but I can do it quickly!" Although there is no data, Zhang Fan is very confident, this is the performance of strength. One sentence shocked Lao Li!"I can do it!"

"A general surgeon can suture blood vessels with fibers, and it can also ensure a very fast speed. After Lao Li sat down, he thought incredibly, Zhang Fan has such a high level of liver surgery, and at his age, he should spend all his time on the liver, so where did the rapid fiber surgery technology come from!

Zhang Fan continued his speech, and the more he spoke, the more excited he became. The regional manager of the instrument manufacturer began to call her boss: "Mr. Yun, today's observation will be very successful, and I have found a young doctor with excellent skills, today is not only him, but now he is lecturing, although I can't understand, but I can also feel that Professor Li has been impressed by him! I want you to communicate with him in person, after all, he is still very young." ”

"How big?" On the other end of the line, a very young voice came out.

"Twenty years old, twenty-five years at most. I'll inquire about the details and implement it in detail!"

"Are you sure that he has already convinced Lao Li?"

"Sure, if you're not at ease, you can ask Professor Li about it. ”

"Okay, I see!" hung up the phone, a young woman in the capital was pondering, the frontier high-level has changed, and she has also entered the frontier market for the first time.

This medical device is a few things, foreign profiteers are also very set, you don't have the strength is no matter how much money will not give you an agent, if you are very powerful, even if you don't want to pay the agency fee, you can also give you a regional agent. And this area is very clear, it will change every few years, there are a lot of old people leaving, and there are many new people entering, if you pay attention to the business scope of a top equipment manufacturer, you may be able to see a little bit of politics.

No matter how good the equipment manufacturer is, someone has to use it, and there are only a few top doctors in a province, and if you want to fully enter the medical market of a province, the official is the first, and the expert is the second, there is no doubt about this.

It's over, it's finally over. Zhang Fan took a long breath of the climate and said: "This is my little bit of opinion on liver cancer, please give advice to all experts and teachers." ”

As soon as he said this, it turned out to be cold! Yes, can it not be cold, this is not a research institute, not an affiliated hospital in the province, most of the doctors who are doing it are county and township doctors, what Zhang Fan said, most doctors do not understand, it is not that they do not work hard, but there are no conditions.

For about 20 seconds, Professor Li stood up and took the lead in applauding! Ouyang also quickly stood up and applauded, although she couldn't understand it after the middle of the meeting! But this did not affect her pride at all!

The audience gave a standing ovation, although everyone was confused, what did you talk about today?

At the end of the meeting, the equipment dealer was busy entertaining the county and township doctors to attend the banquet, and Professor Li pulled Zhang Fan to find a teahouse, and the two sat opposite each other and talked!