Surgical artist

Chapter 349 "Gold Standard" Diagnosis

"This is acute pancreatitis caused by incomplete pancreas divisum and abnormal biliopancreatic junction."

After just one glance, Zhao Peiru made a final diagnosis in his mind.

"The master-level level after symptomatic treatment, the ability to distinguish and vision are still excellent."

The moment after making the diagnosis, Zhao Peiru screened out several treatment options from his mind.

Choose one of them, the most suitable for this case of recurrent disease.

So far, Zhao Peiru's heart is completely settled.

This patient, who was difficult to diagnose, has become very simple in his eyes.

And in the small conference room at this moment.

All the experts still looked sad, and kept looking at the medical record, trying to find some clues from it, so as to help them judge and diagnose the disease.

But that medical record was about to be smashed by 8 experts back and forth.

Still can't figure it out.

Director Zhen Weichen of Los Angeles No. [-] People's Hospital sighed when he saw the expressions of the experts.

This picture is so similar to the one they had when Corey organized the discussion.

It was exactly the same, all of them were frowning and suffering without thoughts.

At this moment, Zhao Peiru said, "Director Zhen, let's go and see the patient."

Zhen Weichen nodded upon hearing this.

Zhen Weichen only thought that Zhao Peiru wanted to see the patient, and maybe he could get some inspiration for diagnosis.

How did he know that Zhao Peiru was not only diagnosed, but also had a treatment plan.This visit to the patient is just to make the final fine-tuning of the plan.

Leaving the experts, they are still discussing here.

In the expert group, the four experts from Jiangnan Province and the four experts from Los Angeles Province were all frowning.

They communicated with each other for a while, thinking that they could rely on the different medical opinions of the two provinces to collide with each other to spark some sparks, but in the end, it was still in vain and nothing was achieved.

Zhao Peiru and Director Zhen Weichen came to the ward.

In the ward, a 56-year-old female patient suddenly whispered, "Why don't I treat my disease."

The two family members beside the hospital bed, one is her husband and the other is her son, immediately jumped up when they heard the words.

"Mom, what did you say?"

The husband also gave the female patient a hard look: "What's wrong? You're only so young, and you'll have many more years to live!"

The female patient sighed weakly, and pressed one hand on the middle and upper part of her right abdomen, and her uncomfortable hand was trembling.

The constant pain and repeated attacks of the disease kept killing her hope.

Pain affects the quality of life the most, and it even makes her unable to sleep well every day. After a long time, people's spirits will really collapse, hopeless, helpless, and even want to die of the idea.

Especially for this kind of pain, the hospital has treated it several times, and every time I leave the hospital with hope, but I finally live in it with disappointment and pain.

This kind of repeated discomfort, and the subconscious that even the hospital can't help, make the patient most desperate and uncomfortable.

Moreover, the family has suffered for many years. The youngest granddaughter is only over one year old, and she needs someone to watch her. The son and daughter-in-law have to go to work and make money, and they need people everywhere. Adding chaos and tossing her family made her feel even more uncomfortable.

At this moment, Zhao Peiru and Zhen Weichen came in.

"Director Zhen."

Seeing the doctor come in, the two family members quickly stood up and asked, "How is my mother's illness? Is it acute pancreatitis again?"

The family is already familiar with the hospital and doctors because they have been hospitalized many times.

Zhen Weichen nodded: "It must be acute pancreatitis, but the specific root cause needs to be screened again."

As soon as he said this, he saw disappointment on the faces of the family members.

It seems to be saying: Doctor or this rhetoric?
Zhen Weichen said: "Everyone, we have invited experts to come over. This is the expert sent from above. In the future, there may be more experts involved."

"Especially the patient, your disease is not terminally ill, it can be cured and recovered, you have to have confidence in yourself."

The patient nodded slightly, and the whole family looked in Zhao Peiru's direction with some hope in their eyes.

Is this the new expert sent from above?
I don't know if it's reliable.

Zhao Peiru checked the patient's condition, asked some questions, and confirmed his train of thought.

……

After returning to the small meeting room.

Everyone's gazes converged on the door.

"President Zhao, Director Zhen and the others are back."

Zhao Peiru looked at everyone: "Everyone, do you have any ideas?"

For a while, everyone was silent, and a few people spoke sporadically, and what they said was nothing more than Director Zhen Weichen of the Second People's Hospital and the others had already said things over and over again.

In the end, everyone fell silent again.

Zhao Peiru opened the mouth and said: "I think that this patient should be acute pancreatitis caused by incomplete pancreas divisum and abnormal biliopancreatic confluence."

"Previously Director Zhen and the others, considering the abnormal biliopancreatic confluence, also performed laparoscopic cholecystectomy on the patient."

"But the incomplete pancreas divisum has never been cured. It has led to the patient's condition and repeated attacks."

After saying this, everyone felt a flash of inspiration in their minds, as if Zhao Peiru had opened a window for everyone in the darkness.It was as if there was a ray of light coming in from outside the house.

Incomplete pancreas divisum?

This etiology is relatively rare, but not impossible.

Director Zhen Weichen also had a flash of light in his mind, as if he had grasped something vaguely, but more doubts appeared in his mind:
How is incomplete pancreas divisum diagnosed?How can we be sure that the repeated attacks of this patient are caused by this cause?

"President Zhao, what do you think?" Zhen Weichen asked eagerly.

The experts in other groups also looked over curiously, and Zhen Weichen had asked their hearts out.

Zhao Peiru: "I noticed that when the patient was hospitalized for the first time four years ago, you performed magnetic resonance cholangiopancreatography on the patient."

Zhao Peiru picked up the video images at that time.

"Look, the communicating branches here are small, and the communicating branches of the main and auxiliary pancreatic ducts are small. There should be multiple considerations here, one of which should be incomplete pancreas divisum."

"But your doctor at the time only considered gallstone acute pancreatitis."

Director Zhen Weichen lowered his head a little ashamedly.Although Zhao Peiru didn't mention him directly, he also signed the operation at that time, and he was also responsible for it.

Zhao Peiru continued: "Later, when the patient was hospitalized for the second time, you performed surgery to relieve the biliary obstruction, but the patient still had recurrent attacks. After you ruled out the causes such as cholangiopancreatic and duodenal tumors, it became even more difficult." 'Incomplete pancreas divisum' should have been taken into account."

Zhao Peiru slowly elaborated his point of view.

The more Zhen Weichen listened, the more ashamed he became, and the brighter his eyes became!

Following Zhao Peiru's train of thought, he felt more and more that the possibility of this patient suffering from incomplete pancreas schizophrenia was indeed as Zhao Peiru said, the possibility was extremely high!
The 8 team experts in the room are all moved at this moment!
That's right, why didn't they consider this kind of illness before?
There are many specific conditions that cause acute pancreatitis.

But as Zhao Peiru said, when such small communication branches occur, and biliary tract obstruction and bile duct obstruction and duodenal tumors are ruled out, this disease should be included in their consideration, but they are not professional enough to be aware of it. arrive.

Zhao Peiru: "There is still a gold standard for the final diagnosis of 'incomplete pancreas divisum'."

As soon as this was said, everyone pricked up their ears.

Director Zhen Weichen of the Second People's Hospital also looked over expectantly.

"Endoscopic retrograde cholangiopancreatography."

"It's an invasive test, and it's done at the same time as the test."

"However, if other causes are excluded, and there are accompanying symptoms such as abdominal pain, and conservative medical treatment cannot be given, and good intervention is given, 'endoscopic retrograde cholangiopancreatography' is the best method for diagnosis and treatment."

After hearing this, everyone nodded.

Makes sense.

Zhen Weichen is sure too!
For this patient, he has been thinking about what other tests are needed to assist the diagnosis, as if he has been walking in a fog, unable to figure out the direction.

But now, after hearing Zhao Peiru's words, everything suddenly became clear.

"The experts from Jiangnan Province are so high-level!"

Zhen Weichen couldn't help sighing in his heart: "If it wasn't for him, I don't know how long I would have to think before I could think of the direction of 'incomplete pancreas schizophrenia'."

Not to mention him, none of the pancreas experts in the Second People's Hospital of Los Angeles could think of this direction these days.

A group of experts in the team carefully checked the patient's condition again, especially comparing the MRI cholangiopancreatography images of several hospitalizations, repeated multi-angle observations, and finally, they all nodded.

"President Zhao, it is indeed very similar to the disease you mentioned. Then... shall we perform 'endoscopic retrograde cholangiopancreatography' on the patient? And treat him while making a final diagnosis?"

Zhao Peiru shook his head slightly: "No."

"Don't worry, I haven't finished talking yet."

"The current 'endoscopic retrograde cholangiopancreatography' is relatively invasive and can easily cause serious complications such as bleeding, and it has extremely high requirements on the operation of the surgeon. Even for doctors with rich experience in endoscopy, 3% -10% chance of secondary cannula puncture failure."

"I plan to improve it."

"Increase the success rate of the puncture, simplify the operation steps, reduce the income of the operation, and improve the safety by improving the method and method."

Zhao Peiru slowly spread out the direction of his surgical thinking.

It was like a beautiful scroll, slowly unfolding in front of everyone, covering everyone's eyes with a layer of light.

Everyone was completely dumbfounded when they heard these words.

Chairman Zhao even proposed a new method of endoscopic retrograde radiography!This method uses different medical principles than traditional methods.

In comparison, this new method sounds more clear and intuitive to observe the pancreatic duct structure.And the surgical trauma is less!

The only problem is that this method is only an "imagination", and its feasibility is still unknown.

Director Zhen Weichen of the Second People's Hospital of Los Angeles was completely dumbfounded at the moment.

This President Zhao from Jiangnan Province is too terrifying!In this way, they not only diagnosed the patients who had been struggling for several days, but also proposed an improved 'endoscopic retrograde contrast' technique!
Not to mention whether this new technology can be successful, it is very rare to be able to propose this new idea.

At this level, the experts in the field of pancreas in the entire Los Angeles Province may not be enough together!

He also knew that it was Chairman Xiang Xinrong from Los Angeles Province who was "pk" with Zhao Peiru now.

Zhen Weichen admired Xiang Xinrong very much, but he vaguely felt that even if Xiang Xinrong had the bonus of "advanced sea market experience", he couldn't compare to Zhao Peiru in front of him.

……

On the other side, a team led by Xiang Xinrong is also at the Affiliated Hospital of Los Angeles Medical University, analyzing the patient's condition and formulating a treatment plan.

Suddenly, his cell phone rang.

"You guys discuss first, I'll answer the phone."

Xiang Xinrong came to the corner and answered the phone: "Is there something wrong with Zhao Peiru? How is their progress?"

Xiang Xinrong has been asking people to pay attention to Zhao Peiru's progress.

Since the failure of the first subject, he felt a little more anxious in his heart, fearing that he would lose the second subject again.

So this time, he not only had to do it fast, but also kept an eye on Zhao Peiru's progress.

The person on the other end of the phone reported the situation of Zhao Peiru's team.

"Has Zhao Peiru been diagnosed?"

Xiang Xinrong frowned when he heard the confirmed cause, and snorted.

"The selection of his patient was really complicated. It turned out to be such a rare cause of incomplete pancreas divisum."

This is more difficult than what he chose.

At the same time, treatment is more difficult.

The industry usually can only intervene with a kind of "endoscopic retrograde cholangiopancreatography", but this method is costly, highly traumatic to the patient, and has a high probability of failure.Even a specialized endoscopist cannot avoid puncture failure.

"Ask yourself."

Xiang Xinrong shook his head.

I just feel that my winning rate has suddenly increased.

The other party chose a difficult field, most likely because he wanted to quit and choose a new case. After going back and forth, time was consumed, and his chances of winning were even greater.

He was about to hang up the phone, but the phone said quickly: "Mr. Xiang, I heard that Zhao Peiru also proposed an improved endoscopic retrograde radiography method."

"This method, I only inquired about the general direction, and did not disclose the specifics."

Xiang Xinrong frowned, "What direction?"

Wait for the other end of the phone, and repeat the general content of the inquiry one by one.

Xiang Xinrong's mind was spinning rapidly, and finally, he shook his head slowly: "No, this direction is difficult to operate, and the operation time is long. Although it solves some of the complicated points of the traditional method, it is a 'tear down the east wall to make up for the west wall'. One approach will definitely lead to mistakes from other places.”

"Continue to inquire with me, and let me know in time if you have any new news."

After hanging up the phone, a long-lost smile appeared on Xiang Xinrong's face.

(End of this chapter)