The spleen can produce lymphocytes and monocytes. Macrophages in the spleen engulf senescent red blood cells, platelets, and degenerated white blood cells. It can also engulf bacteria, protozoa, and foreign bodies in the blood. The spleen is rich in blood sinuses, which can store a certain amount (about 200 ml) of blood, and when the body exercises vigorously or climbs a mountain or suddenly loses blood, the smooth muscles of the spleen contract and release blood to replenish the body's needs. The lymphocytes in the spleen also make antibodies.

It is not a big problem to have the spleen removed at an old age, but this patient has had his spleen removed at such a young age, which is full of unknowns for a long life!

Originally, Ding Xuezhi came over to ask if Li Ning could save his spleen in person! After all, he was going to be sent to the city hospital later, and it happened that the doctor from the city hospital was here, so he asked in advance.

The main thing is that the family members also want to know!

But when he heard Li Ning say that it could only be completely removed, he was stunned.

"In this way, I personally went to see the patient's condition and saw if I could remove part of it and keep part of it. Li Ning also had compassion. He also has children, and he understands why his family wants to save his spleen so much.

"Let's go check it out too?"

"Anyway, I'm done with class, so I'll go back tomorrow to have a look. ”

Many doctors outside the hospital wanted to go and see it.

In fact, this is also a rare opportunity for case discussion and exchange.

After all, surgeons from more than a dozen city and county hospitals are here.

So, a group of people rushed to the emergency department.

When he came over there, Li Ning and a bunch of others looked at the test results, and went to check the child's condition in person.

Consultation room.

Full of friends.

After reading the examination results, Li Ning shook his head helplessly and said, "The cyst with 6.5cm on the upper pole of the spleen is too big! ”

Ruan Bin also sighed after seeing it, this situation was more tricky than the spleen repair surgery he had done last time in the First Affiliated Hospital of Modu.

Last time it was a 2 cm penetrating wound, and there was a save.

This is a 6 cm cyst!

It is necessary to know that the thickness of the human spleen is no more than 4 cm, the length is cm, and the width is 6~8 cm.

The 6-centimeter-large cyst occupies almost the entire width of the child's spleen.

If the cyst is removed alone, the entire spleen is equivalent to being cut in two!

"Can I treat it conservatively with medication?" asked one doctor.

"The estimate is not ideal, the cyst is too big, I am afraid that the effect of conservative treatment will not be good, and if conservative treatment does not do surgery, it is equivalent to the risk of rupture and bleeding in the spleen at any time, which is tantamount to a time bomb in the body!" said a doctor from another city hospital.

"Is it really that risky to remove the cyst?" asked a deputy chief doctor at the county hospital next door.

The main reason is that spleen surgery lacks effective methods to control bleeding, and the spleen is easy to break, and the difficulty of stopping bleeding is far greater than that of the liver. This is one of the reasons why it is difficult to operate. Therefore, the general spleen rupture or cysts and tumors that exceed 3cm are almost all completely resected. ”

In fact, there are constant debates about "protecting the spleen" and "cutting cards" in the development of medicine, but with the understanding of spleen function, especially immune function, the spleen is no longer the dispensable organ. How to remove the lesion and preserve the function of the spleen at the same time seems to be an incompatible!" another doctor sighed.

"Do the family really want to save their spleen?"

"Yes!" Ding Xuezhi nodded solemnly.

After all, the child is so young, of course, I hope to keep it.

"I remember that last year, a hospital in Beijing once did a patient with a splenic cyst of more than 6cm, and the operation was very successful! It is said that it is a new operation to cut the lesion and preserve the spleen - the best of both worlds! At that time, it also won the second prize of the 23rd 'Good Doctor'!"

I also remembered that I had read a report on the Doctors' Forum. It is said that the upper lobe where the cyst is located was removed through laparoscopic minimally invasive methods, and the remaining spleen was preserved, and the operation took only 92 minutes, and the bleeding was only 50ml. The patient was discharged from the hospital five days after surgery, and there was no explosive infection caused by immune function changes, no significant increase in platelets, and no recurrence of cysts during the whole postoperative follow-up period. Later, it seems that this hospital has done dozens of such new procedures! It seems that the success rate is very high. One doctor recalled.

"New technique?"

The doctors who had not heard of them were all looking shocked and staring.

"No, no, no, I don't really agree that this is a new technique!" Li Ning shook his head and said.

"Why not?" everyone looked at Li Ning in unison.

"I guess there is still no effective way to control bleeding in this innovative operation, so it can't be called a new operation, it can only be regarded as a pseudo-new operation!" Ruan Bin said.

"Haha...... Dr. Nguyen is right, I have seen this operation video, and I have also seen related papers and interviews, and from beginning to end, there is no mention of a new and effective method of hemostasis, only a slight improvement. Using the superb surgical skills of their group of doctors, they were able to reduce splenic bleeding and thus make this operation a success. This improved version can't be popularized on a large scale at all! Because not every doctor has the level of the chief surgeon in that Beijing hospital! So, I don't think it's a new technique!" Li Ning agreed.

"No wonder, no wonder it's just the second prize. ”

"But it's also very strong, you mean to suggest that patients go to the capital for treatment?" Ding Xuezhi looked at the doctor.

"Yes, it is estimated that all the hospitals in Jiang City cannot have such a superb level of surgery, and since the hospital in the capital has done a lot of similar surgeries, I think it is very safe to go there for treatment. It is very likely that this spleen will be saved. ”

"Then advise the patient's family to go to the capital, the sooner the better, this can not be delayed. Li Ning also agreed.

"But...... However, this family is only a farmer, and the economic conditions are not very good. He currently only has more than 10,000 yuan on hand! If he goes to the capital, the operation fee will definitely be about 20,000 yuan, plus hospitalization, medication, food, housing, and transportation for his family, and he will not be able to get down at all without 40,000 or 50,000 yuan. And if you go to the capital, the medical insurance reimbursement in other places is definitely not as much as in this province!" Ding Xuezhi brought up another problem.

Generally, the cost of splenectomy or splenic repair surgery is 10,000 to 15,000, but in a top hospital like Beijing, the fee must be higher!

Let's talk about medical insurance reimbursement, because most of the remote medical treatment will appear in cities with relatively developed medical resources, most of these cities belong to the "pay more than pay" in the medical insurance policy, if the remote medical personnel are allowed to enjoy the same reimbursement ratio in their own cities with a lower level of medical insurance payment standards in their own cities, it is a bit unfair.

Besides, the kind of big hospital beds are very scarce, you may not be able to wait for a bed when you go, if you wait for half a month to have a bed, your expenses in the capital for half a month are not small!