Oncology Physician Life

Chapter 10 Chapter 09 Misdiagnosis
Surgical center.

Starting at [-] o'clock this morning, more than half of the operating rooms in the surgery center have been registered. The second-line doctors have basically been on the operating table, and even the first-line residents who have just passed the training have not had time to sleep after staying up all night. Make up, just follow the second-line doctor in the operating room platform.

In the preparation room, stainless steel sinks covered with white tiles are simply arranged in two rows, behind which are separate shower rooms for men and women.Potassium permanganate is pungent in the air.After Xu Youshu put on the sterile surgical gown, he stood in front of the infrared sensor and washed his nails with disinfectant.

Originally, the laparoscopic cholecystectomy was not his turn today, but fortunately, all the second-line doctors had entered the operating room, and most of the first-line residents, except those who were changing shifts, had no free time to perform this operation, so it was handed over to him. After him, Tan Tan, a resident doctor, assisted and guided him, which was regarded as a clinical teaching operation.

The door of the operation preparation room was opened, and Tan Tan, who had already changed into a sterile surgical gown, stood in front of the stainless steel sink with his strong forearms for preoperative aseptic treatment.He glanced at the younger Xu Youshu beside him, and smiled: "How does it feel to be the chief surgeon for the first time?"

Xu Youshu smiled shyly: "I've thought about doing the surgery for the first time before, but I didn't expect it to be so fast, so I'm still very nervous."

Tan Tan has been in the oncology department for five years. At first, he was an intern in BJ Concord. With his academic performance and practice performance, he can stay in Concord International Department, but his father thinks that BJ is far away from Shanghai. So I let my son come back and went to the first tumor hospital.

Different from Tan Tan, Xu Youshu graduated from Shanghai Second Medical University, and is an intern with a fixed specialty. As soon as he entered the hospital, he came to the Department of Oncology Surgery, and there was no need to rotate departments. Swelling outside.Tan Tan has heard him tell you more than once that he was applying for an oncology major in a major in medicine, and it can be seen that he is yearning for and full of enthusiasm for oncologists.

"I heard that you are the only child in your family?" Tan Tan chatted with him while cleaning his nails.

Xu Youshu nodded: "Yes, there is only one child in my family, and the senior brother also has a sister?"

"That's right, my sister is three years older than me, but my parents divorced when I was young. My sister went to the United States with my mother. She also received foreign education since she was a child. Unlike me, she also returned to Shanghai after her mother passed away. He is now a hepatobiliary surgeon." Tan Tan chatted casually.

Xu Youshu showed an envious expression on his face: "It must be very happy to have a sister, right?"

Tan Tan looked at him curiously: "What? Isn't the only child bad? No one quarrels with you, no one grabs a room with you, no one grabs snacks with you, don't tell me your only child is lonely?"

Xu Youshu smiled wryly: "It's not that I'm lonely, but sometimes the pressure is a bit high. If I have a sister or brother, I should help share it."

After Tan Tan finished cleaning, he put away the smile on his face: "Have you seen the case of this laparoscopic cholecystectomy patient?"

Xu Youshu immediately became serious and nodded.

"The patient was transferred from general surgery. It is different from ordinary cholecystectomy. The patient had a 3cm-square polyp in the gallbladder. The polyp was removed with a choledochoscope. If it was confirmed that it was cholesterol crystals, the gallbladder It is possible not to remove the gallbladder, but after Li Xiaojun communicated with the patient, he insisted on removing the gallbladder, so there is no need to open the gallbladder to remove the polyps, you just need to treat it as an ordinary laparoscopic cholecystectomy.”

Soon the two walked into the operating room next door, and the anesthetist had already performed anesthesia in advance.The patient is a woman in her 40s with childbirth experience.At the moment, she was lying on the operating table, her body was covered with a sterile drape, and only her yellow, round abdomen, which had been smeared with iodine, was exposed.

"The gallbladder is hidden behind the liver. It is a soft, finger-length bag containing bile, like a leaky green balloon. If the patient has gallstones, it will be accompanied by bursts of abdominal pain. After gallbladder removal , the pain will disappear.”

Tan Tan assisted, and Xu Youshu put on white rubber gloves, making sure that he could move his fingers flexibly, and then came to the laparoscopic operating instruments.

Ten years ago, for this type of cholecystectomy, a large 15-centimeter incision had to be made on the patient's stomach to remove the gallbladder, and then the patient would rest on the hospital bed for three or four days.

But in China 10 years later, with the development of medical research today, it is only necessary to use a mini-camera and some new instruments to perform gallbladder removal through a small incision in the abdomen—that is, laparoscopic cholecystectomy.

This kind of operation has been popularized in county hospitals across the country, and even some community hospitals in the suburbs also have the ability to perform this operation.

Xu Youshu carefully made a semicircular incision with a diameter of about 3 cm on the patient's navel, cut through the fat and fascia, and then entered the abdominal cavity.A 1 cm wide cannula is inserted to allow access for instruments.Then put in the inflatable tube and inject carbon dioxide. At this time, the patient's stomach slowly expands like a tire inflating a balloon.

He took the mini camera from Tan Tan’s hand. From the monitor on the operating table, he could clearly see the patient’s intestines. As the abdomen continued to expand, the camera had enough room to move in the patient’s abdomen and could be adjusted continuously. The position of the camera.

Xu Youshu then made three smaller incisions in the patient's abdomen as additional entrances for the operation.

And insert a slender clip into the cut on the other side.

While watching the monitor screen, he operated, and slowly extended the clip to the edge of the liver, clamped the gallbladder, and pulled it out of sight, and then the gallbladder could be removed.

"Cholecystectomy seems to be very simple. Cut off from the root, then stop the bleeding, and then pull out this small green bag from the abdominal incision. Then empty the carbon dioxide in the abdominal cavity, remove the cannula, suture the small incision, and stick the maker Post it, and you're done. But you have to pay special attention, if you accidentally remove the common bile duct during the operation, the bile will flow back, causing liver damage, and 10%-20% of the patients will die as a result, and the surviving patients may also be due to liver damage. The permanent damage of the liver must be replaced. Therefore, any team is very careful when performing laparoscopic cholecystectomy to avoid such mistakes. Remember that surgery is not divided into major and minor operations. As long as it is an operation, we must devote 100% to it No matter how small the operation is, as long as there is a mistake, it may lead to the death of the patient!"

Listening to Tan Tan's words, Xu Youshu tensed all the muscles, and his heart tensed up involuntarily. He carefully used an instrument to remove the white fibrous tissue and yellow fat covering the root of the gallbladder, and he could see the thick root of the gallbladder. And the more you extend inward, the thinner it becomes.

He inserts the clip placer, a V-shaped metal clip, and aligns it with the cystic duct in preparation for cutting.But at this moment, Tan Tan, who had been watching the monitor, suddenly called out: "Wait a minute!"

The action of the nail clip placer inserted by Xu Youshu also froze.He looked at Tan Tan suspiciously, and asked aloud, "What's the matter, brother, what's the problem?"

Tan Tan stared at the monitor, and found that there was something suspected of tumor tissue outside the gallbladder near the liver.His expression was much more serious, and he thought about things far deeper than Xu Youshu, an intern.

"Who asked you to perform this operation?" He couldn't wait to ask Xu Youshu.

"It's Li Xiaojun from our department who is in charge." Xu Youshu didn't know what went wrong, so he could only tell the truth.

"When Li Xiaojun asked you to perform this operation, he only said that the patient had polyps in the gallbladder and that the entire gallbladder was to be removed? Didn't he tell you anything else?" Tan Tan's face became more and more ugly.

"Yes, and isn't everything written in the medical record?" Xu Youshu became more curious, and also became nervous.

Tan Tan suddenly sighed. If he did not expect it, it should be Li Xiaojun who misdiagnosed gallbladder cancer as gallbladder polyps. The problem now is that this operation has become a clinical teaching operation by intern Xu Youshu, and halfway through the operation It was found that the gallbladder tumor had metastasized to the liver, and the seriousness of the matter was far worse than he thought.

"Stop the operation first, I'll go and make a call to the attending doctor Li Xiaojun."

As Tan Tan walked out of the operating room, he took out his mobile phone and dialed the number of the second-line doctor Li Xiaojun.At this time, in the business center of the outpatient building, Li Xiaojun was discussing with Zhang Xiaoyun, the sales general manager of Saman Technology Company, about the introduction of new anti-cancer drugs.Looking at the ringtone of his mobile phone, he remembered that it was Tan Tan, a resident doctor from the Department of Tumor Surgery, frowned, and hung up the phone casually.

Li Xiaojun looked at Zhang Xiaoyun and laughed: "Don't worry, Manager Zhang, I have already strongly promoted these newly released anti-cancer drugs represented by Saman Technology Company to Director Bi, so it should not be a big problem."

Zhang Xiaoyun showed a smile on his face: "Dr. Li, don't worry, as long as the matter is successful, our company will definitely not treat you badly!"

Tan Tan listened to the blind tone coming from the phone, and dialed again, but was hung up mercilessly.The matter is beyond his control. According to the hospital procedures, he can only contact the second-line doctor Li Xiaojun first, but now Li Xiaojun is not answering the phone. There is no other way. Tan Tan can only skip the second line and call the third-line deputy chief physician Ji Han went to the phone.

Ji Han was on a ward round in area C outside the tumor. He felt the vibration of his mobile phone in his pocket. Just as he was about to answer the call, Wei Chen, the chief resident, rushed over: "Professor Ji, the gastric cancer patient in bed 28 vomits blood, suspected to be bleeding from gastric varices." , The bleeding has been stopped with a three-lumen two-capsule tube (Senbuer's tube), and the amount of bleeding has decreased, but it continues."

Ji Han responded immediately: "Always pay attention to the patient's vital signs, and then perform an emergency gastroscopy on the patient, and call the deputy director Yu of the Gastroenterology Department. Intravenous stent bypass."

Wei Chen nodded and said, "The athlete who was transferred last night was suspected of having tendinitis. Doctor Zuo prescribed anti-inflammatory treatment, which was effective, but found that the patient's T4 was seriously lowered. It was suspected that there was a problem with the thyroid gland that caused the tendinitis. Doctor Zuo prescribed Thyroid treatment, the patient is very sensitive to pain, the calcium content in the body exceeds the standard, suspected thyroid tumor, MRI examination is normal, but osteosarcoma was found in the hind leg, the situation is not good."

Ji Han immediately put down his phone and followed Wei Chen over there: "Take me there to have a look first! How is the patient's nerve reflex?"

Wei Chen said while walking: "The patient's leg nerve reflexes disappeared and hematuria was present. The initial diagnosis was muscle necrosis and infarcted aneurysm."

At this moment, outside the operating room, seeing that Ji Han didn't answer the phone, Tan Tan couldn't help becoming anxious and thinking about countermeasures. The patient was still lying in the operating room, and he couldn't do half of the operation, so he canceled the operation, right?
Outside the surgery center, Jiang Li had just finished his induction surgery. Standing on the promenade of the surgery center, he could just see the gurgling waves of the artificial lake not far away, and even flocks of white pigeons passing by in the distance.

When Tan Tan was in a daze, he happened to see Jiang Li on the corridor, hurried over, and briefly explained the details of the patient to her.

Jiang Li frowned, knowing the seriousness of the matter, and immediately walked towards the operating room. Tan Tan picked up the sterile surgical gown and acted as an assistant.Jiang Li skillfully performed the preoperative aseptic operation, and told Tan Tan: "This kind of situation is a temporary emergency during the operation. You should immediately contact the patient's family members. Don't say anything unnecessary. Tell the family members that the gallbladder was found during the operation. The tumor has metastasized to the liver, and the situation is relatively critical. Now I have changed the resident doctor for a temporary operation. I, the director of the Children's Oncology Department, will perform the operation and ask the family members to sign the operation notice. In addition, suspend all medical work of intern Xu Youshu and you, and wait. After the operation is completed, the hospital's intervention investigation will follow the medical procedures, do you understand?"

Tan Tan hesitated to speak: "Professor Jiang, Xu Youshu is still an intern, and he really loves the profession of oncologist, can you help him?"

Hearing Tan Tan's request, Jiang Li looked back at him before entering the operating room, without saying anything.

(End of this chapter)