"Have you been having diarrhea a lot lately?" Yu Bing put down the stethoscope and asked quickly.

That Ma Baoguo pouted, "I have qigong to protect my body, how can I have diarrhea!" ”

"Heh, what happened when you fainted?"

"I... That's because I practiced too hard, I forgot to sleep and eat, and I was tired! ”

"Okay, since you're fine, I'll discharge you from the hospital now!"

When encountering such a strange patient, Yu Bing is enough.

Seeing that Yu Bing was really leaving, Ma Baoguo was in a hurry.

Hurriedly grabbed Yu Bing and smiled, "What, don't worry, I said, I said it can't be done." ”

Yu Bing glanced at Li Xiyang, and he had to scare him to deal with this kind of slippery head.

Li Xiyang nodded, indeed.

"Okay, then you can say it!"

"Doctor, don't worry, you come here first!"

Ma Baoguo beckoned and motioned for Yu Bing and Li Xiyang to come to the other side of the bed.

Then he sneakily closed the curtain in the middle of the hospital bed.

Looking at the latter's series of strange actions, Yu Bing frowned, "What are you doing?" ”

Ma Baoguo made sure that the curtains were tightened, and then turned back to the two of them and sneered, "I'm also the head of the same faction, and there are many people in the hospital, so you can't save me some face." ”

"Boss?"

Yu Bing and Li Xiyang glanced at each other, and said in their hearts, what did they say?

Did you fall and break your brain?

Unexpectedly, Ma Baoguo handed his mobile phone to the two of them, 'The 123rd generation of Ma Family Qigong, the contemporary head Ma Baoguo'.

Hey, there's such a school.

There's a picture on it, but it's not this old man.

Yu Bing was dumbfounded, "You really know qigong?" ”

The old man smiled, "That's natural, I told you that I have achieved great qigong and blood..."

Before he could finish speaking, he was interrupted by Li Xiyang, "Do you have diarrhea!" ”

Li Xiyang will not be fooled by him, he knows that this kind of web promotion, as long as you spend money, you can get on it.

And under his webpage is a link to sell courses.

This guy is just doing gimmicks and selling classes.

was interrupted by Li Xiyang, and Ma Baoguo also laughed, "Pull, pull it several times a day." ”

"Since when?"

"Probably... It's been two or three years! ”

Li Xiyang frowned, "So long?" ”

"Doctor Yu, arrange for him to have a urine check!"

"Good!"

……

Out of the ward, Yu Bing was still pondering the identity of the old man.

"Doctor Li, do you think this guy really knows qigong?"

Li Xiyang said with a smile, "I don't know if he can do qigong, I only know that as long as people eat whole grains, they will get sick!" ”

Yu Bing nodded, that's right.

What kind of qigong he has, and he is full of blood and blood, I think it is bragging.

But Dr. Li, you arranged for him to have a urine check, do you know what the disease is?

Li Xiyang nodded, "If I'm not mistaken, it should be carcinoid syndrome!" ”

Carcinoid syndrome?

Yu Bing thought about it for a while, and it seemed that it was really possible.

Carcinoid syndrome refers to neuroendocrine tumors, which are more common in some tumors of the digestive tract and respiratory tract, which can secrete some serotonin substances, causing skin flushing, itching, increased heart rate, and corresponding clinical symptoms.

Some people also develop changes in the heart called carcinoid heart disease.

Half of the occurrence of carcinoid is benign, and half may become malignant, and the digestive system is more common, and carcinoid syndrome can occur in the appendix, colon, transverse colon, and small intestine.

Surgery is given when such carcinoid lesions occur, and appropriate chemotherapy and radiotherapy are given if there are malignant lesions, which is mainly determined according to the method of radioimmune grouping.

Carcinoid syndrome is generally the first symptom of the syndrome, patients may have unexplained fatigue, palpitation, skin changes, etc., and then found to be carcinoid syndrome, carcinoid syndrome is generally more common in the digestive tract and lungs.

"Let's not talk about this for now, let's wait for the results to come out."

"Good!"

So the two went back to the office and worked separately.

After about 20 minutes, the results came in.

Judging from the information uploaded from the computer, it is indeed carcinoid syndrome.

The patient's duodenum is diseased.

"Dr. Li, that's amazing!"

The remaining soldiers were completely convinced.

Just by looking at him in the past, he was diagnosed with carcinoid syndrome.

He had long heard that Li Xiyang could often predict a patient's illness before the test results came out.

I had only heard about it before, and I still didn't believe it.

Now that I have seen it with my own eyes, I am really convinced.

Li Xiyang asked, "Now that the disease has been found, what are you going to do?" ”

Yu Bing said, "I'll contact the Department of General Surgery in a moment and transfer him to the ward." ”

Li Xiyang said strangely, "Are you going to do it yourself?" ”

Yu Bing smiled, "This operation is not so urgent, there is no need to do it in our emergency department." ”

"If that's the case, then give it to me!"

Li Xiyang took the initiative to ask for surgery.

Yu Bing was stunned for a moment, and then said with a wry smile, "You like surgery so much?" ”

This guy has at least six to seven surgeries a day, and is a notoriously surgical maniac in the emergency department.

But on second thought, it's right.

No wonder his surgical skills are so good, it seems that they have all been practiced in this way.

"Okay, I'll give you this patient, but I've never seen carcinoid syndrome surgery, so I'll go in and have a look later."

"Good!" Li Xiyang smiled and nodded.

Qian Min was still in the consultation room, so Li Xiyang called Lin Yue and asked her to help prepare the operating room.

Then he came to the ward again.

Outside the ward, Li Xiyang heard a burst of laughter inside.

Aunt No. 1 didn't have a good breath, "Master Ma, I heard that your love is cancerous, why are you so happy?" ”

Ma Baoguo sat on the bed and said with a nonchalant expression, "It's just carcinoid, it's not really cancer, even if I don't have surgery, my qigong can kill cancer cells." ”

Another young man questioned, "Master Ma, since your qigong is really so powerful, why are you still sick?" ”

Ma Baoguo smiled, "Young man, you don't understand this, I'm sick, that's because although I am a great qigong, I still eat whole grains after all, as long as I eat whole grains, I can't escape the disease, but, do you see if I have pain?" Is there anyone who has cancer who is as energetic and radiant as I am?

So, this is the difference between you and me, I have the Ma family qigong to protect the body, and the little cancer cells can't help me! ”

Everyone saw that Ma Baoguo's face was ruddy, and he looked healthier than normal people, and nodded one by one, Master Ma is amazing.

Ma Baoguo smiled, "This is my secretary's contact number, you send each other, if you want to learn my qigong, you can sign up for my class." ”

Li Xiyang stood at the door and pulled the corners of his mouth, how can this guy look like a pyramid scheme leader.

……

In the operating room, everything is ready.

Ma Baoguo was pressed on the operating table, and he chattered endlessly, promoting his Ma family qigong with the little nurses.

Li Xiyang was so annoyed that he waved his hand directly at the anesthesiologist.

Soon, the guy stopped.

At this time, Yu Bing also changed his clothes and walked in, wanting to see Li Xiyang's operation up close.

Everyone said that Li Xiyang's surgery was very good, but he really hadn't seen it with his own eyes.

This opportunity will not be missed.

"Operative time!"

"17:42 minutes!"

Li Xiyang stood on the main knife position and nodded, "The operation begins!" ”

For carcinoid tumors, surgical removal of the primary lesion is the most effective treatment.

Early surgery is particularly effective, but even if metastases occur, removal of the large primary lesion can reduce and eliminate symptoms.

In general, carcinoid in the small intestine has a high rate of malignant transformation, and radical resection should be performed aggressively.

Rectal carcinoid with a diameter of more than 1 cm is easy to spread to regional lymph nodes, while those with a diameter of less than 1 cm generally do not exceed the submucosa.

Gastric and duodenal carcinoid tumors, if the diameter is less than 1cm, can be locally resected.

If it is more than 1 cm, partial gastrectomy and omentectomy should be performed.

Pancreaticoduodenectomy may be required for duodenal carcinoid tumors, but the mortality rate of this procedure is very high and should be carefully controlled.

In addition, there are many complications associated with carcinoid tumor surgery, including anesthesia accidents, surgical exploration of tumors can promote carcinoid crisis, and surgical squeezing of tumors can often cause severe hypotension.

Therefore, preoperative preparation, high-dose antiserotonin drugs, and backup vasoactive drugs should be used to correct hypotension in a timely manner. Catecholamines should be avoided and thiophenyl sodium should be used with caution for induction.

Yu Bing made up for the operation of carcinoid tumors in the office just now.

In order to see how much gap there is between himself and Li Xiyang.

But when the operation began, it was just an incision operation, which shocked Yu Bing.

In the face of older patients with loose skin, Li Xiyang did not choose the conventional laparotomy scalpel gripping method, but chose the bow holding style.

Seeing Li Xiyang use the bow to open the patient's abdominal cavity, Yu Bing compared the pen holding style he used most often, and found that the wound of the bow holding style was more regular, and the loose skin did not appear to be displaced.

In this way, both the placement of the laparotomy and the postoperative suture will be more convenient.

Just an incision is enough to show Li Xiyang's skill and judgment.

That's amazing!

In fact, both incision methods are correct, and Yu Bing's suturing technique is enough to deal with any wound.

But this subtle difference can only be seen by an insider.

Yu Bing sighed that he really came to the right place.

In the past, it was inevitable that some people would sit in the well and watch the sky.

Li Xiyang didn't know Yu Bing's mental activities, and from the moment he picked up the scalpel, he focused on the operation.

In fact, the choice of incision method for this surgery can be completely determined by the operator's habits.

Li Xiyang chose a straight incision in the upper right abdomen.

The incision must be long enough to be fully exposed, so it is often necessary to extend to about 4 cm below the umbilicus.

Although there are more imaging diagnostic data before the operation, it is still necessary to re-diagnose during laparotomy to determine the surgical plan and steps.

Intraperitoneal exploration should pay attention to the presence of peritoneal, intrapelvic, omental, liver, hepatoduodenal ligament, peripancreas, periceliac artery, mesenteric root, and para-aortic lymph node metastases.

Although the route and extent of metastasis of tumors from different sources are slightly different, when there are the above distant metastases, it means that they are at an advanced stage.

In this case, radical surgical resection is no longer possible, and simpler palliative surgery should be used for tumors with a high degree of malignancy.

The incision is completed and the surgical field is fully exposed.

Li Xiyang first lifted the transverse colon and checked whether there were metastatic lymph nodes or direct metastases of tumors in the root of the transverse mesocolon, the root of the small mesentery, and the lower edge of the pancreas...

"No transfers found."

Next, Li Xiyang cut the lateral peritoneum of the duodenum, and the second segment of the duodenum, together with the head of the pancreas, was released from the retroperitoneum to further explore the posterior side of the pancreas...

"Everything works!"

Then, with his left index finger and middle finger behind the duodenum and his thumb in front of him, Li Xiyang touched the lower end of the common bile duct, the ampulla and the head of the pancreas...

"Lump found!"

Li Xiyang and Lin Yue glanced at each other, this was a sudden situation.

Yu Bing on the side was also stunned for a moment, but he didn't expect to encounter such an emergency during the operation.

It's hard!

Li Xiyang put down the scalpel and said quickly, "We must leave to investigate the nature of the tumor and determine whether it is a benign lesion or a malignant lesion."

"Kobayashi, No. 20 puncture needle!"

"Yes!"

After receiving the puncture needle, Li Xiyang first fixed the lump with his left index finger and thumb, and then directly punctured it with a 20-gauge puncture needle...

"The needle has touched a hard object, and there is a clear sense of blockage!"

Hearing Li Xiyang's words, everyone breathed a sigh of relief.

If there is a hard object, it means that it is a stone in the tube, not a malignant lesion of the tissue.

So Li Xiyang took out the stone for the patient by the way, and the exploration continued.

Free transverse colon hepatic flexure to free the duodenum 2nd and 3rd segments anteriorly for further examination of the mesangial intervascular condition

In general, vascular invasion is only possible when carcinoid tumors have progressed to an advanced stage, while pancreatic cancer can invade the portal vein at an early stage, and carcinoid cells can encircle mesenteric blood vessels.

"Xiaolin, B-ultra!"

"Yes!"

Intraoperative ultrasound exploration can help determine the relationship between the pancreatic head mass and the superior mesenteric blood vessels.

Whether portal vein wall infiltration is a contraindication to pancreaticoduodenectomy is a contraindication to pancreaticoduodenectomy is unanimous.

However, Li Xiyang believes that when there is only a partial invasion, it is possible to partially remove the portal vein wall and repair it again if it does not prevent the operation from proceeding.

Soon the results came in, and there was no organizational abuse.

Cut the omentum greater at the upper border of the transverse colon, open the lesser omentum sac, hook the stomach upward, expose the front of the entire pancreas, and check for changes in the pancreas...

"Everything works!"

Cut the peritoneal layer and fibroadipose tissue, ligate some small venous branches that drain pancreatic blood, and slightly separate, can reach the superior mesenteric vein...

Cut the loose tissue in front of the vein and continue to separate upwards...

Note that there is generally no vascular branch communication between the dorsal surface of the pancreatic neck and the portal vein, so it is easy to separate, and the fingers extend along the front of the portal vein to the upper edge of the pancreas.

If it can be reached smoothly without a sense of blockage, it means that the portal vein has not been invaded by the tumor.

"Doctor Li, no abnormalities found!"

Lin Yue cooperated with Li Xiyang to do the patient's intra-abdominal exploration, and everything went well.

At this point, the investigation is complete.

Li Xiyang nodded, "The carcinoid cells have not metastasized to their organs and can be operated." ”