Surgical artist

Chapter 360 Flawless
"Everyone."

Zhao Peiru said: "I would like to ask everyone to clarify a premise first."

"The cause of the patient's cystic dilatation of the pancreatic segment was a choledochal cyst involving the extrahepatic bile duct."

"The size of the cyst, the preliminary detection is 6.9cmX4.2cmX5.1cm."

"With such a large cyst, no one can guarantee whether there are cancerous lesions inside, let alone whether these lesions have expanded to the entire bile duct of the pancreas."

"So, when making a treatment plan, the first thing to consider is to prevent recurrence of cancer and prevent 'second surgery'. Only after this is clarified can the plan continue to be discussed."

"The several plans I heard just now did not completely remove the cystic dilatation of the pancreatic segment, so..."

Zhao Peiru shook his head: "There is no need to continue the discussion."

As soon as he said this, everyone's expressions changed slightly.

The two masters, Professor Dong Yuanheng and Professor He Chuanying also looked at each other, and their hearts skipped a beat.

They really didn't emphasize such an important matter just now.

It can also be regarded as the dereliction of duty of the two.

Although there was such a red line vaguely in their hearts, since they did not clearly point it out, various plans emerged one after another.

To put it lightly, it will waste discussion time and delay the illness.To put it more seriously, it is possible to accidentally choose a plan that seems to be beautiful, but actually crosses the red line.

The leaders of the provinces and organizing committees who were listening at the main venue also frowned.

He looked at Professor Dong Yuanheng and Professor He Chuanying with some displeasure.

If this treatment did not cure the root cause due to negligence, and after a few months, cancerous lesions reappeared in Yan Lao's body, and he was forced to undergo a second operation. It is also extremely uncomfortable.

Several experts on the line turned pale in an instant.

The several sets of plans that Zhao Peiru pointed out just now are their "masterpieces".

At this moment, they were also a little scared. Several people had cold sweat on their foreheads.

If they really adopted their plan and caused old Yan to relapse in the later stage, then I'm afraid they will be turned over and their spines poked.

Fortunately, before everything happened, Zhao Peiru made this point clear and clear.From this point of view, they still feel a little grateful to Zhao Peiru in their hearts, at least they didn't make a big mistake.

Just when everyone was thinking about it.

Zhao Peiru continued: "After this point is ruled out, there are still five sets of plans that meet the requirements."

Of the eight sets of plans, nearly half of them disappeared immediately.

"Among the five sets, divided according to the basic idea, there are cyst internal drainage, external drainage, cyst resection, and total bile duct resection."

"At this time, we have to clarify another point."

"The purpose of the patient's surgical treatment is to radically cure the cyst, remove the diseased tissue, realize bile-pancreatic shunt, resolve bile stasis, biliary tract infection, and prevent canceration."

Everyone nodded one after another. What Zhao Peiru said directly pointed to the essence of the purpose of the operation.

Before they knew it, everyone was already following Zhao Peiru's train of thought.

Zhao Peiru: "Using this as the screening standard, external drainage and cystic cholangioenterostomy cannot achieve the above radical curative effect, and the long-term curative effect of surgery is poor, with high recurrence rate and high reoperation rate."

"Even, it will have a counterproductive effect and accelerate cancer."

Several experts also changed their expressions.

The "external drainage" and "cyst-biliary-enterostomy" mentioned by Zhao Peiru are their masterpieces.

And what Zhao Peiru said is indeed reasonable. If they continue to deduce according to their surgical methods, with the reconstruction of important blood vessels, there may indeed be cases where cancerous parts are nourished by blood supply and accelerated.

Zhao Peiru continued:

"These types of surgery are actually more suitable for excessive surgery, such as the treatment of concurrent acute cholangitis, acute pancreatitis, severe jaundice, liver failure, cyst rupture and other diseases."

"Therefore, these types of techniques are also excluded and will not be considered."

Everyone has different expressions.

Some had pensive eyes, some had heavy faces, and some had pale faces and tensed hearts.

In the main meeting room, the leaders were also a little anxious.

Because following Zhao Peiru's analysis...

Of the original eight plans, only three remained.

What if the last three sets are all rejected?
And Zhao Peiru's analysis is not over yet.

The last three sets of proposals were proposed by Professor Dong Yuanheng from Jiangsu Province, Professor He Chuanying from Fuzhou Province, and Zhao Peiru.

Zhao Peiru continued: "Professor Dong Yuanheng's cyst resection and hepatic ductojejunostomy, generally speaking, the prognosis of this kind of surgery is relatively good, so it can be regarded as an excellent plan."

Many people listened and nodded secretly.

Especially many Fuzhou experts headed by Dong Yuanheng felt a little proud when they heard Dong Yuanheng being praised.Among them, many of them are Dong Yuanheng's students, and the rest have more or less attended Dong Yuanheng's class, and highly admire many of his ideas.

"but……"

Zhao Peiru changed the subject and said, "However, in terms of the scope and degree of resection, the industry has always been controversial about this idea. The amount of resection has its own advantages and disadvantages in terms of friendliness to patients, and it is impossible to find a perfect balance."

Having said this, many people who opposed Professor Dong Yuanheng's plan very much recognized it. It is precisely because of this consideration that they think that this plan is not good enough, especially because the patient's status is special, so it cannot be used.
So……

The eyes of everyone in the audience finally converged on the final two sets of proposals.

Zhao Peiru: "Professor He Chuanying's plan, partial cyst resection, is good in other aspects, but in order to achieve bile-pancreatic shunt, part of the cystic dilated bile duct of the pancreas is preserved..."

"In this way, even if biliopancreatic shunt is achieved, it will still lead to the retention of pancreatic juice in the residual bile duct and the formation of protein plugs, which will easily lead to complications such as stones and pancreatitis in the future."

"So, Professor Dong's and Professor He's plans also have their flaws."

After saying this, the audience fell silent.

Zhao Peiru is really outspoken!
Directly point out the shortcomings of Dong Yuanheng and He Chuanying, two top pancreas masters, and point it out thoroughly!

Even, the approval was worthless, and it was short of directly saying "it is not suitable for Yan Zhiming's patient".

So far, out of the eight plans, Zhao Peiru has ruled out seven, leaving only his "total resection" plan.

At this moment, not to mention other experts, even Dong Yuanheng and He Chuanying looked a little unhappy.

They wrote these plans, but also wasted a lot of energy, and took out what they had learned all their lives.

Although the plan is not perfect and has all the shortcomings mentioned by Zhao Peiru, it is already one of the best plans in the pancreas industry.

Even Dong Yuanheng and He Chuanying dared to say that even if they went out of the five southeastern provinces, taking these two plans to Kyoto, Haishi, and Xijing could be regarded as a good treatment plan.

Dong Yuanheng said: "President Zhao Peiru, you mean that only your plan is the most suitable for Mr. Yan?"

Although he was a little unhappy, he was more curious.

Since Zhao Peiru dared to refute other people's plans one by one, he left his own plan alone, which is too obvious.

But this is also equivalent to Zhao Peiru elevating himself to a high place.

Zhao Peiru just talked about all the shortcomings of those plans, and when he can talk about his own plans, he has to avoid all those shortcomings.

This difficulty can be high.

Professor He Chuanying and other experts also looked at Zhao Peiru curiously.

Since Zhao Peiru said that everyone's plan is not perfect, what does this imply?
In Zhao Peiru's tone, there was indifference and strong self-confidence: "My plan is indeed the most suitable for the patient."

"My plan uses the idea of ​​complete resection. The cystic dilated bile duct, including the pancreatic segment, is severed at the junction of the bile-pancreatic duct."

"In this way, without damaging the pancreatic duct, the goal of complete resection of the dilated bile duct in the pancreas can be achieved. At the same time, it can also prevent stones or even canceration caused by residual pancreatic cysts, and reduce complications such as postoperative pancreatitis."

Dong Yuanheng frowned: "How to achieve it?"

Zhao Peiru spoke eloquently and confidently: "First of all, we have to clarify the anatomy of cystic dilatation of the pancreas."

"The cystic dilated bile duct in the pancreas is composed of mucosal layer, lamina propria, and fibrous connective tissue layer from the inside to the outside."

"Its blood supply mainly comes from the branches of the superior duodenal artery, and the vascular plexus formed by these blood vessels is distributed between the connective tissue layer and the lamina propria, as well as between the lamina propria and the mucosal layer."

"When these anatomical premises are clarified, it is easy to realize the treatment plan."

"Firstly, before the bile duct resection, the gastroduodenum is ligated...Secondly, the blood supply of the cyst is blocked...Then, extramural separation is used...Finally, the residual pancreatic wound is treated intermittently..."

In front of everyone, Zhao Peiru gradually explained his point of view.

Gradually, the realization process of his entire plan was shown to everyone like a wonderful Qingming Riverside Scene.

Everyone followed his thoughts and gradually deepened.

Gradually... I became engrossed in listening, even stunned!
This kind of thinking is simply unbelievable!
Its thinking concept is completely different from the roots of everyone.

If we say that all of their plans start from the "superficial level" of the disease, and are a process of "from the outside to the inside", gradually exploring how to treat the disease and how to eradicate the disease.

It is a positive way of solving problems.

Then, Zhao Peiru's plan is triggered from the "root" of anatomy, and is conceived "from the inside out". It first considers the complete cure of the disease, and then explores how to solve the problems that arise during the process.

It is reverse thinking.

Until Zhao Peiru finished speaking...

The entire main conference room, including the online conference room, was quiet, and a needle could be heard.

If it wasn't for the fact that everyone was still blinking, they would have thought it was a network card, and the picture was still.

All the experts are brainstorming at this moment, running at high speed, considering and digesting everything that Zhao Peiru said just now.

In the end, Professor Dong Yuanheng, the top student in Jiangsu Province with the highest level and the fastest mind, broke the tranquility first.

He rolled his throat a few times, and said: "This kind of plan...if it can be implemented, it does have advantages."

He looked down at his notebook, which was the result of his brainstorming just now, and listed several deduction results on it.

"If the plan is really feasible, this type of operation will indeed make it easier to control the bleeding, help identify the opening of the pancreatic duct during the operation, and also help identify the end of the narrow bile duct, which is conducive to the operation during the operation."

At this time, Professor He Chuanying, the top professor in Fuzhou next to him, also took the lead and said:
"Chairman Zhao's implementation idea has indeed achieved the complete resection of cystic dilatation in the pancreatic segment without damaging the pancreatic duct, and also prevented protein clots."

"From this point of view, Chairman Zhao's plan... is indeed perfect."

"At least, all the flaws of our other seven plans have been bypassed."

The experts looked at each other.

They found that each other's eyes were full of surprise, shock, and admiration.

It's just a cystic dilatation of the pancreas, not too serious a disease.

Many surgeries can be used for treatment.

But all kinds of techniques have flaws.

But no one has ever been able to develop a plan to such a perfect and extreme level that Zhao Peiru can bypass all the flaws!

This is like a road full of thorns and pits.In order to pass through efficiently, others will inevitably have to step on some pits, and the stumbles will pass.

But Zhao Peiru was able to find the smoothest road among these potholes, and the efficiency of walking was as efficient and fast as a shortcut.

Such calculations and considerations not only require profound knowledge of pancreatic anatomy and rich experience in the treatment of pancreatic segmental dilatation, but also consume a lot of brain power to conceive the layout.

This is very powerful!
At this moment, every expert looked at Zhao Peiru with admiration!

In the main venue, the current chairman of the Joint Organizing Committee, Lin Jinsong, spoke.

Lin Jinsong was the highest leader present. As soon as he spoke, everyone fell silent.

"Professor Dong, Professor He, do you all think President Zhao Peiru's plan is feasible?"

Both of them nodded and said: "After preliminary deduction, it is feasible to a certain extent and has great advantages. The key is that it has no flaws and is highly patient-friendly. But it is not known whether it will be feasible in the end, and further deduction and simulation are required. "

Lin Jinsong nodded, "Okay, then President Zhao Peiru's plan will be included in the first consideration plan, and the plans of Professor Dong and Professor He will be the alternative plans."

He looked at Zhao Peiru in the video: "President Zhao, please come to Jiangsu Province in person to discuss further plans."

Everyone looked at Zhao Peiru enviously.

Zhao Peiru seized such a good opportunity!

Not only the patient Yan Zhiming has a special status, but also Director Lin Jinsong and so many leaders in the organizing committee and the leaders of the medical associations in various provinces are all staring at this matter...

Whoever can take action to treat them can gain the favor of these leaders.

However, they knew it was useless to be envious. Who told them not to come up with such a brilliant and flawless plan like Zhao Peiru?

(End of this chapter)