For gossipy people, the biggest news in the People's Hospital is that Jiang Aiguo was fired.

But for people who like to engage in clinical and technical activities, the biggest news of the People's Hospital should be that President Chen is going to start public classes and perform public surgeries again.

Moreover, because the professor from Fudan Zhongshan Hospital came to visit, this public operation has become more high-end and high-end.

Fudan Zhongshan, this is a well-known brand in China, and it was originally an unattainable existence of a local hospital of this level as the Yuezhong People's Hospital.

As a result, when people heard that their dean could do endoscopic surgery, they came all the way to visit, but in fact it was learning, because the professors in Fudan would not do this kind of endoscopic surgery.

This made all the staff of the People's Hospital have a lot of ringing in their throats when they speak in the past few days.

Therefore, when Chen Qi was preparing to open the operation after lunch, the doctors who sat in the auditorium on the second floor of the People's Hospital to watch the operation were no longer limited to the People's Hospital itself.

President Li of Haidong Medical University personally led the team, and doctors from five affiliated hospitals, as well as professors and associate professors in charge of teaching in the university, came a lot.

Of course, bigwigs like President Li, Dean Wang of the First Affiliated Hospital, and Xu Jinxing, Master Tutor Chen Qi, all entered the operating room to watch the operation with their own eyes, while other professors and directors could only watch the live broadcast in the Great Hall.

In today's operation, Chen Qi is the chief surgeon, and the assistant is naturally Professor Zhang Weizhong and Lan Lijuan.

Yi Zewen, Dean Chen's first intimate person, took the initiative to act as a photographer.

In the operating room, the little patient is still under general anesthesia, and in the office of the operating room, Chen Qi is writing and drawing on paper, explaining his operation ideas to everyone.

It must be explained, and this explanation is also live, otherwise others will not understand endoscopic surgery at all.

Different from traditional surgery, the endoscopic surgery that Chen Qi has to do is through the oral cavity gastroscope.

Gastroscopy is still a new thing in China, and non-gastroenterologists have no contact at all.

Moreover, there is still a lag in domestic textbooks that have not been covered, young people are fine, and older doctors can't understand the TV screen at all.

What you see is a small passage like the inside of the intestines, and there are pink or bright red flesh next to it.

And Chen Qi is still playing a kind of "tunnel punching" today, the clinical technique of POEM is not a new thing at all in his previous life, as long as he is an endoscopist, he can almost do it, but it is 1988.

So don't say that doctors in other departments can't understand it, I'm afraid doctors in the Department of Gastroenterology can't understand it either.

Professor Zhang Weizhong sat next to Chen Qi, watching him draw a schematic diagram while asking questions like a primary school student.

"Dean Chen, you mean we haven't heard of your achalasia, can you help explain?"

At this time, Chen Qi's voice sounded in the stereo in the auditorium:

"Okay, before the operation, I'll talk about what achalasia is, and remember to take notes.

We know that the place where the tube is connected to the stomach is called the cardiform, and the cardia is usually closed, but when it enters, the cardia will open so that the object can enter the stomach through the tube.

If the cardiax cannot be opened normally when swallowing, that is, it cannot be relaxed, it will produce dysphagia, a feeling of choking, and the retention of matter and saliva in the tube for a longer time, and it is easy to overflow when bending over and lying down, which will form a reaction.

Serious is like eating grass, a ruminative feeling, of course, not real rumination.

Some conditions have chest pain. Due to poor progress, many patients will lose weight and lose weight, which is what we call achalasia in clinical practice.

Of course, this disease needs to be differentiated, because esophageal tumors and even gastroesophageal reflux disease have similar symptoms, which requires our clinicians to do more endoscopy, barium swallow, and esophageal pressure measurement.

This disease has been found a lot abroad, and there is no such concept in China, but everyone should remember that in the future, achalasia will also be found in our domestic gastroenterology department, and the first to put forward this concept is our Viet Chung People's Hospital.

Then I'm going to do a new technique to treat this achalasia, and then we're going to form an expert consensus, and then we're going to upgrade this consensus to a clinical guideline, which is also developed by us at the Viet Chung People's Hospital. ”

In the auditorium, the doctors of the People's Hospital burst into laughter, followed by a round of applause.

Principal Li scolded Lao Guo next to him with a smile:

"This kid is a master at stirring up the emotions of the masses, no wonder he was in charge of the masses and women's work in the Fourth Yuan back then."

The bigwigs in the operating room also laughed softly.

Professor Zhang Weizhong is not familiar with several bigwigs, so he acts as a curious baby on the side, doing the work of complimenting:

"Then Dean Chen, how did the achalasia you mentioned happen? What is the idea of the new surgery? ”

While explaining, Chen Qi wrote and drew on a blank piece of paper, Yi Zewen pushed the camera in, and this simple schematic diagram appeared on the TV screen:

"The cause of achalasia is not very clear before, foreign experts have not studied it, doesn't this give us a chance, if anyone can study it and publish it in top international journals, I will directly give you a promotion and a salary increase."

There was another chuckle in the venue, this is the new rule after Chen Qi became the dean, and there will be different rewards for the publication of papers according to the level of the magazine.

If it is a foreign journal, especially the four major journals, it will directly reward 5,000 yuan and upgrade the title to one level, which is very tempting and of course very difficult.

Chen's explanation continues:

"But it's clear that it's the part of the ductal flexia propria that ultimately decides whether to close or open the cardia or open it, which can be called the cardia sphincter or the subductal sphincter.

It is this part of the muscle, for various reasons, that cannot relax, resulting in the continuous closure of the cardi, unable to respond to the temptation of various delicacies, from the appearance of dysphagia.

Therefore, if achalasia is treated, we can cut off this part of the muscle, which is equivalent to opening the dam of the obstruction, and the object can enter the stomach from the tube to relieve the symptoms of dysphagia. ”

With such an explanation, not only Professor Zhang Weizhong understood, but even everyone in the auditorium also understood the principle of treatment.

"In the past, when the lower sphincter was cut, it was necessary to enter thoracotomy and cut off the ribs, so I was afraid, and then went into mediastinum, which had great side effects, but the surgical effect was not very good, so today I will let you see what is the majesty of endoscopic surgery."

The anesthesiologist came running over at this time:

"Dean Chen, the child is under general anesthesia and can be operated on at any time."

Chen Qi stood up: "Let's go, let's go to the operating room, Professor Zhang and Director Lan will follow me to the preoperative disinfection." ”

The operation began, and everyone held their breath, both in the operating room and in the auditorium.

Especially those surgeons who are not convinced, they all want to see how endoscopy that can eliminate itself can show its majesty?

The previous fundoplication was only a chance success, and many surgeons were holding their breath.

During the operation, Chen Qi successfully got off the gastroscope tube, passed through the esophagus, and went all the way down to the junction of the cardia and the esophagus, which is also the place where the obstruction occurred.

At this time, Chen Qi's voice sounded again in the stereo:

"Did you see that? This is where the obstruction occurs, and the root cause is that the sphincter at the periphery of the esophagus has been kept tight, causing the lower end of the esophagus to be tightened and closed, and the upper end of the esophagus to become thicker. ”

The brains of all the doctors are spinning rapidly, including Professor Zhang Weizhong, President Li, Dean Wang and other famous doctors, they can't figure it out.

After all, the gastroscope is now inside the esophagus, and the sphincter is outside the esophagus, with a layer of esophageal wall in between, how do you deal with the muscles in this gastroscope?

Punching a hole in the esophagus?

This is obviously an invasive surgery, and it is not at all like the principle of safe, convenient, non-invasive and effective endoscopic surgery mentioned earlier.

The consequences of esophageal perforation are also very serious, and if the perforation site is close to a large blood vessel, such as the aorta, it is very risky.

If it is combined with mediastinal infection, chest infection, aortic infection or even rupture and other complications, it can completely cause the death of the patient.

If the harm far outweighs the benefit, then this endoscopic surgery is of little significance.

There were all professional doctors, everyone had a scale in their hearts, and everyone wanted to see how this miraculous dean dealt with this thorny problem.

Contrary to everyone's expectations, Chen Qi did not stay too much in the esophageal cardia department, and after showing everyone the obstruction site and leaving a few photos, the gastroscope went all the way backwards and slowly began to dial it out.

This move made one question mark after another appear above everyone's heads.

What's going on? Didn't have surgery? Then why did you Chen Qi brag so much before?

This is a live broadcast, how many big guys are watching, it is a rollover accident.

Just when everyone thought that Chen Qi was going to admit defeat and stop continuing the operation, suddenly Chen Qi stopped the gastroscope about 10cm away from the cardia and did not move.

"Professor Zhang, give me an electric knife."

Zhang Weizhong came back to his senses: "Oh good, electric knife, electric knife......"

Lan Lijuan quietly handed a tube with an electric knife at the front to Professor Zhang, no way, Professor Zhang had never done endoscopic surgery and was not familiar with the equipment.

Moreover, the gastroscope tubes of each manufacturer are different, mixed in a large box, and people who are not skilled cannot find it at a glance.

I saw Chen Qi take the electrosurgical tube and insert it into the empty groove along the gastroscope, and everyone could clearly see that the electric knife was exposed on the screen, and then Chen Qi slowly cut on the esophageal mucosa and made a small incision directly.

When, when, when~~~~

There are more and more question marks above everyone's heads, and I can't see why this Dr. Chen made a small incision in the esophageal mucosa, but it didn't penetrate the esophageal wall, the problem is that your gastroscope still can't go out of the esophagus.

Can you fetch things from the air?

Chen Qi gave an order to himself: "Give me the injection needle and prepare normal saline." ”

Zhang Curious Baby Wei Zhongzhong couldn't help but ask, "Dean Chen, why are you making such a fuss?" And why do you want saline? ”

Again, this is a common question for all doctors.

Chen Qi continued to explain to everyone while operating, after all, this is a public teaching surgery class, and the main purpose is to make people understand.

"Before answering this question, everyone recalls the anatomy of the tube wall, how many layers are there?"

As soon as Chen Qi asked this question, just like a teacher asking a student, everyone was quiet in an instant, and even bigwigs like Principal Li and Dean Wang were in a hurry trying to remember.

Jia Liangcai, director of the Department of Internal Medicine, was sitting in the auditorium at this time and sneered at several directors of surgery next to him:

"Hi, who is that, Lao Jin, Lao Liu, Lao Shen, come on, come on, you come and answer, don't you want to compare with our internal medicine, now the dean is asking questions, don't be a turtle with a shrunken head."

"Damn, you know it's amazing, you can memorize a few anatomical structures and die interestingly, come on, come on, this patient is for you, do you have the ability to use a knife to do surgery, I guess you fainted directly when you saw the blood flowing out, right?"

As soon as Director Jin Peilin's words fell, there was a burst of applause from the surgical crowd.

Because of Chen Qi's question, the surgeons and surgeons scolded each other again, and the big hall was as lively as the Spring Festival Gala.

In the operating room, Professor Zhang was like an intern at this time, and answered honestly:

"The normal wall of the digestive canal consists of four layers, including the mucosal layer, the submucosal layer, the muscularis propria, and the serous layer. It's also a four-story structure. ”

Chen Qi chuckled: "Sure enough, he is a professor from Fudan, which is worth learning from all of us, and such a basic question was answered casually." ”

As soon as these words came out, President Li, Dean Wang, Director Xu, Guo Shuji, Director Zhu and other bigwigs, one of them counted one, and they all blushed.

This is the biggest difference between academic experts and clinical experts, people are using their brains, rather than blindly holding a knife to cut and cut and do it.

Professor Zhang, this is an away battle, or here to learn, hurry up and be modest:

"Whereever, there is no Dean Chen's unbridled thinking."

Formal teaching surgery, Chen Qi is not convenient for too many commercial blowguns, so he continued the previous topic:

"We all know, ahem, some of our doctors know that the submucosa of the esophagus is made up of loose connective tissue, and if you look carefully at the steps I'm doing now, which is to inject normal saline into the submucosa, which can make the submucosa bulge and separate from the muscularis propria.

Then I use an electric knife to reach into this incision and cut off or melt all the tissues under the mucosal layer, you see, does this form a "tunnel hole"? It's equivalent to making a hole in the pipe wall.

If you like to watch spy dramas and suspense dramas, there is a mezzanine on the wall, where you can hide silver, hide and so on.

Then inside this tunnel is a mezzanine of the pipe wall, so as to create a space. After my gastroscope enters this dissection tunnel, the gastroscope can smoothly reach the ground of the cardia sphincter. ”

"Oh~~~ So that's what happened!"