This doctor has a system

Chapter 486 550. The patient who needs God's salvation

"H Nan?"

"To be exact, it's State Z," Director Fan said. "It's very complicated."

"How complicated is it?" Gao Feng instantly became interested.

"This is a world-class problem. All the vascular surgery doctors have been mobilized for several months, but they still dare not take action," said Director Fan.

In fact, when the patient was brought in by ambulance, almost everyone in the department was stunned.

His body was wrapped in thick bandages, but blood could still be seen seeping out.

From Zzhou to Beijing, a distance of nearly 700 kilometers, he could neither sit nor lie down, and could only lie prone in the ambulance with his hands and feet tied to his chest. The slightest movement could lead to fatal bleeding.

All of this stems from the fact that there is a huge time bomb buried in his hips and pelvis.

In fact, this patient is not unfamiliar to some veteran doctors in vascular surgery.

More than ten years ago, Xiao Liu came to Beijing Xhe Hospital for treatment.

"Wasn't it cured at that time?" Li Youliang asked, and he soon realized that his question was a bit stupid. If it was cured, the patient would not have to come.

"No, we had an operation at that time, but..." Director Fan shook his head.

"Let's go see the patient." Gao Feng was a little impatient. He was very curious about what kind of patient would make the country's top hospitals helpless.

Time bomb?

Gao Feng came to the vascular surgery department accompanied by Director Fan. As soon as they entered the ward, they smelled a pungent smell of disinfectant, mixed with a disgusting stench.

Looking up, I saw a patient in his 20s lying on the bed. His hips were wrapped in thick bandages covered in blood, and a disgusting smell was emanating from them.

Several doctors from the vascular surgery department were checking on the patient, and Director Fan greeted the leader.

The patient looked painful, and when he saw another person coming, he subconsciously looked up.

At this moment Gao Feng saw his eyes, which were a pair of gray eyes filled with frustration, despair and pain.

The patient is Liu Ping'an, 27 years old.

Xiao Liu has always been concerned about his name. When he was 17 years old, he was diagnosed with arteriovenous malformation in his buttocks and pelvis.

Arteriovenous malformation refers to the abnormal tangle of blood vessels connecting arteries and veins. Blood flows rapidly through the incorrectly connected tangled area, causing the blood vessels to dilate and the blood vessel walls to become thin and fragile, which may rupture and bleed at any time.

As Xiao Liu grew older, his arteriovenous malformation grew rapidly. Every bowel movement, every turn over, and even every sit down could cause massive bleeding in the lesion.

He left the campus very early, after all, he couldn't afford to bleed so often.

Later, he completely lost the ability to take care of himself and was bedridden. The deformed arteries and veins in his body were like a time bomb that could explode at any time.

As mentioned earlier, Xiao Liu had been treated at Xhe Hospital. He was treated by Dr. Hua Shanjun, the doctor who just greeted Director Fan.

In a blink of an eye, 10 years have passed, and the latter is now the director of the Department of Vascular Surgery.

Director Hua Shanjun recognized the patient at first sight.

Many times, people always remember and dwell on their failures, especially when success becomes a routine.

"At that time, the patient's condition was mainly on one side of the buttocks, and also involved part of the pelvic cavity." Director Hua recalled, "We tried to cut open part of it, but the bleeding was too severe. We wanted to do a radical resection, but it was difficult for us to achieve it even with the efforts of the entire hospital at that time."

In the following ten years, Xiao Liu went to many well-known hospitals, including surgery, interventional embolization, sclerosis, and almost all experts in the industry, trying all the current methods that can be used to treat arteriovenous malformations.

Nearly 10 million yuan was spent on treatment over the past few years, but the condition not only did not improve, but became more serious.

With nowhere else to go, Xiao Liu returned to Beijing Xhe again. He had only one request - to survive.

"When faced with this disease, doctors often start with good intentions but end up with helpless amputations." This was a description of arteriovenous malformations in the early book "Huang Jiasi's Surgery", which is enough to show how serious the disease is.

Now, in the past decade, X and the vascular surgery team have grown step by step, forming a mature MDT team and accumulating more abundant diagnosis and treatment experience.

However, everyone is still at a loss.

Over the past ten years, Xiao Liu's condition has gradually worsened and become more difficult to treat, and the situation inside the lesion is even more chaotic.

Various past treatments have resulted in fragile and irregular tissue structures. Multiple unsuccessful operations have caused the blood vessels to be extremely dilated and very thin. Repeated ligation and embolization have increased the difficulty of interventional treatments. There are also large amounts of embolic materials such as spring coils left over from previous treatments. The slightest touch could result in fatal bleeding, not to mention going on the operating table.

At the same time, as repeated treatments failed to cure the disease, the scope of the lesion expanded further, from the original unilateral buttocks to gradually occupy the entire buttocks and pelvic cavity, while affecting multiple important tissue structures.

If you want to remove it all, the damage to the patient will be very serious and difficult to repair.

At this point, simple surgical resection was almost impossible. During the few months of hospitalization, Director Hua's team chose to first use palliative anhydrous ethanol interventional embolization treatment to control the massive bleeding.

There are countless fistulas in arteriovenous malformations. Before the emergence of anhydrous ethanol technology, traditional embolization treatments such as spring coils had very limited effects.

Director Hua's team reported the first SCI case in China using anhydrous ethanol intervention to treat arteriovenous malformations, and has accumulated a lot of experience in the past few years.

Gao Feng had heard a little about this treatment, but how should I put it, anhydrous ethanol is more effective, but the risk is also greater. If you are not careful, it may accidentally damage normal blood vessels, or even stimulate further progression of the disease. The more it is treated, the larger the lesion will be.

The precision required for this technique is comparable to licking blood from the tip of a knife, which is impossible for ordinary doctors to accomplish.

In the 7 months after admission to the hospital, Director Professor Hua's team performed 12 anhydrous ethanol interventional treatments on some of Xiao Liu's lesions. With the most precise attack possible, they significantly reduced the lesions in some areas that could not be surgically removed and effectively controlled the heavy bleeding.

Awesome! Gao Feng praised in his heart that Director Hua's skills were absolutely perfect, and what was even more rare was that he had thick black hair.

As we all know, the balder you are, the stronger you are. As a professor, it is not easy to gain the trust of your patients with so much hair.

"Let's go to the conference room. We will have a multidisciplinary consultation soon." Director Fan said to Gao Feng, "Director Hua has also invited foreign experts."

After waiting for more than 20 minutes, people finally arrived one after another.

Since Xiao Liu had been hospitalized for a long time, almost all departments that were slightly related to his condition knew about this person. Two multidisciplinary consultations had been conducted before, but the results were not satisfactory.

Many directors came in and shook their heads, obviously having no hope for today's discussion.

"I will report the patient's condition to you in detail." The attending physician opened the PPT. "The patient, Xiao Liu, is currently diagnosed with arteriovenous malformations in the buttocks and pelvis."

"We have undergone several interventional treatments with anhydrous ethanol and it is somewhat effective. The lesions in the surgically resectable area have shrunk significantly."

"The purpose of today's discussion is how to proceed with the next step of treatment."

As the attending physician finished speaking, the directors present began to communicate with each other in low voices.

"Gao Feng, what do you think we should do?" Director Fan asked, "I feel like this is the patient's condition."

"It is indeed very tricky." Gao Feng held his chin and fell into deep thought. To be honest, he had never imagined that there would be such a wide range of arteriovenous malformations. After watching the introduction to imaging just now, he felt shocked.

What sin did this patient commit in his previous life?
"I think it's better to suffer a short pain than a long one. Talk to the patient and decide to remove it." A director of the general surgery department was the first to speak up. "This way he can live."

Li Youliang, who was sitting next to Gao Feng, was confused. Intercept? "How?"

"Half-body amputation." Director Fan whispered, "It means cutting off the lower half of the body from the abdomen."

Li Youliang was shocked. What the hell?
He was a bystander and felt this way, let alone a patient. Xiao Liu strongly rejected this treatment. He was only 27 years old, and for him, this was another kind of life worse than death.

"I think we should still try surgical resection of the lesion," said a director of an interventional department. "It is definitely not enough to rely solely on interventional treatment."

His opinion was shared by many people, including Professor Wayne Yakes, an internationally renowned expert in arteriovenous malformation intervention, president of the International Society for Hemangioma and Vascular Malformation (ISSVA), and inventor of anhydrous ethanol interventional embolization therapy.

Professor Yakes believes that this is a rare and difficult case of arterial malformation in the world. If it is to be cured through anhydrous ethanol interventional embolization, it will require more than a hundred times.

“It’s only a theoretical possibility.”

Now everyone understood that surgery was necessary to solve the problem.

Then everyone discussed the surgical method.

"Gao Feng, do you think the operation will be successful?" asked Director Fan.

"I don't know." Gao Feng didn't say anything. Such a large-scale arteriovenous malformation contained a large number of embolic substances such as spring coils. It would bleed madly if touched.

Gao Feng couldn't even imagine how risky the surgery would be. The bleeding alone would probably be more than 10000 milliliters, right? !

Can surgery be performed in this case?

Besides, does the hospital have so much blood in reserve?

Don't tell me, there really are!
"As expected of Xhe, he's really awesome!" Li Youliang smacked his lips in amazement. Even an idle person like him was looking forward to the upcoming operation.

The team performed surgery on Xiao Liu for the first time. Despite adequate preparation, the intraoperative bleeding exceeded everyone's expectations.

During the preoperative discussion, the team estimated that, in the best-case scenario, the amount of blood loss from the operation would be at least 12000 mL - the equivalent of replacing all the blood in the body three times.

However, during the actual operation, only the left third of the lesion to be removed was severed, and Gao Feng, who was watching, frowned.

"The amount of bleeding has reached the safe limit!" he couldn't help but remind.

In fact, the commander-in-chief, Director Hua, had been worried for a long time. When he heard someone speak, he stopped hesitating and quickly called for a stop: "Let's stop here today!"

Gao Feng left the operating room early. He pondered for a moment and entered the system space.

"System, help me search for literature related to the treatment of arteriovenous malformations."

Soon, hundreds of documents were retrieved by the system, but most of them were useless at this time.

For arteriovenous malformations, the most commonly used treatment method is intervention, but the lesion in this patient is too extensive and interventional treatment has no effect at all.

Gao Feng read through the articles one after another and came up with some new ideas, but none of them could be used on this patient.

Before he knew it, several hours had passed. Feeling exhausted, he quickly exited the system space, feeling a little depressed.

Some diseases cannot be cured, Gao Feng said to himself, there is nothing we can do.

However, the patient Xiao Liu still wanted to try it again. At his strong request, the second operation began 10 days later.

This time the operation was closer to the center of the lesion, but it was also accompanied by more severe bleeding. Every step forward was extremely difficult, and the right part of the lesion that was originally planned to be removed was ultimately not successfully severed.

In fact, Director Hua’s team often performs major radical resections of arteriovenous malformations and is very familiar with how to minimize local ongoing bleeding.

This time, the situation was much more complicated than before. The entire lesion was filled with thin-walled large blood sinuses - the result of compensatory expansion after a long period of unsuccessful surgery - and although the operation was extremely cautious and quick, the blood still gushed out like a fountain at the slightest pressure.

This made the scalps of the onlookers tingle, not to mention the surgeon in charge! The anesthesiologist was almost pissed with fear.

This time, Director Hua stopped on his own without waiting for anyone else to speak.

"There's nothing we can do, the patient is just like this!" he said while washing his hands.

Director Hua decided to talk to the patient about amputation. Losing half of the body is painful, but at least he can survive, and if he survives, there is hope.
But Xiao Liu firmly rejected his proposal, saying that even if he died on the operating table, he would rather not have his lower half of his body amputated.

Just when everyone was feeling discouraged, a director of the interventional department proposed a treatment method.

“Can we try radiofrequency ablation?”

Radiofrequency ablation is a mature treatment technology currently used for solid tumors. A special ablation needle is used to penetrate the lesion through the skin, connect to an energy platform, burn the lesion, and completely disconnect the lesion from the systemic circulation before surgical removal.

However, some people say that this is not very realistic. In arteriovenous malformation lesions like Xiao Liu's, the blood flow rate is extremely fast, and important structures such as the anus, sciatic nerve, and sacral plexus are involved around the pelvic cavity.

Even the most skilled doctors would have to think twice before using radiofrequency ablation in such a dangerous area.

If it is not done properly, it is very likely that the next time you cut it, you will find that there are still countless connections under the lesion, and the risk of bleeding is uncontrollable;
However, if you overdo it, it may damage important nerves such as the sciatic nerve, and the function of your lower limbs will be greatly affected.

New questions arise: who can do it? Who dares to do it?
"Director Ge, are you able to do it?" Director Hua asked. Director Ge is the best doctor in the hospital who performs radiofrequency ablation.

"I can try 3-5 parts." Director Ge frowned and said, "There are so many places that need to be ablated. How can I possibly do it all?"

"Unless God takes charge," said Professor Yakes on the side.

(End of this chapter)