Oncology Physician Life

Chapter 51 Chapter 50 Surgery
Jiang Li and Ji Han have been in a state of cold war since the last time they broke up with Ji Han over the issue of Zhang Qianyi's surgery.

Jiang Li didn't go home at all, and spread out a folding bed in the lounge.When they got together with the group of four, the two of them spoke awkwardly and alienated.

Fortunately, the work in the oncology department is very busy, and Ji Han Yi San Wu is even more busy going out to the clinic, so the time the two of them can meet is very limited.

The next day, when Lu Jiajia's rotation was over, he walked into the doctor's lounge when he saw Jiang Li sleeping on a folding bed, and asked curiously, "Mr. Jiang, haven't you been home for the past two days?"

Jiang Li was startled by Lu Jiajia's sudden voice. She sat up from the bed, pretending to be calm: "I have two SCI papers to write in the past two days, so I will live in the department and stop tossing back and forth."

Lu Jiajia had no doubts, and put the breakfast he just bought on the table: "I just bought soy milk fritters. The soy milk in the breakfast cart at the side entrance of the hospital is very sweet. Teacher Jiang, try it."

Jiang Li said thank you, turned around and searched for the phone, except for the few greeting text messages sent by Gu Jun after dinner yesterday, there was no other news.

She opened Moments, and half of them were advertising products recommended by various micro-businesses.

Jiang Li threw down his mobile phone irritably, turned around and went to the bathroom, splashed a handful of cold water on his face, his skin shrank under the stimulation of the cold water, and he became more energetic.

She looked at herself in the square mirror, even though she was in her 30s, her skin didn't look old at all, and she was so busy on weekdays that she hardly had time to use any skin care products.

Slapping his face, Jiang Li became more and more angry, and decided to have a cold war with Ji Han.

On her way to the oncology ward, Xu Youshu, an intern in the oncology surgery department, was walking in the direction of the elevator in a hurry, and many interns ran upstairs one after another behind her.

Jiang Li was a little confused, looked at Head Nurse Sun who was coming out of the nurse's desk, and asked, "What happened? Where are these interns going in such a hurry?"

Head Nurse Sun glanced at the wristwatch and said, "Professor Ji agreed with Professor Zhao Zhiqiang from the Department of Thoracic Surgery to be Zhang Qianyi's first assistant in surgery. They should all go to the operating room to observe!"

"Ji Han agreed to help Zhao Zhiqiang?"

Jiang Li was taken aback, he didn't care to finish talking to head nurse Sun, turned around and trotted towards the elevator.

When we rushed to the observation room next to the No. 7 operating room, there were more than 20 residents and interns in the Department of Oncology Surgery, and more than [-] people, large and small, filled the small room. Director Qi Song was present.

Everyone looked at the screen hanging high above their heads. On the screen, the anesthetist had completed Zhang Qianyi's general anesthesia.

Looking at the picture in the operating room, Qi Song said to Tao Dayong: "When the MDT was first diagnosed, the operation plan given by the tumor surgery department was to remove the right laryngeal hemilaryngectomy, preserve the voice, and then adopt Resction of Carcinoma at the Upper Part of Esophagus ( upper esophagus cancer resection), remove the patient's neck lymph and chest lymph, remove the upper esophagus, and then adopt the method of cutting the rectum to transplant the patient's rectum to the upper esophagus. Zhao Zhiqiang is a thoracic surgeon and is good at chest surgery. This operation To simultaneously remove the esophagus, cut the rectum, and the most difficult thing, remove the recurrent laryngeal nerve in the right half of the larynx, and clear out the infiltrating cancer cells, Ji Han must preserve the patient's vocal part on the premise of minimizing the damage to the recurrent laryngeal nerve."

Tao Dayong also raised his heart: "If this operation is performed by Zhao Zhiqiang himself, I am really worried, but I never thought that Professor Ji would agree to help him."

Qi Song nodded: "I really didn't expect that. After all, what Zhao Zhiqiang did too much four years ago. In order to participate in an academic conference, he left Ji Han's patient on the operating table. If Zhao Zhiqiang could participate in that The prognosis of that little girl is not so bad, and the tumor relapsed and died not long after."

In the operating room, Zhao Zhiqiang changed into a sterile gown, put on white rubber gloves with the help of the itinerant nurse, and wore a binocularloupe (Kepler binocular magnifying glass) in front of his glasses. Ji Han who was also wearing rubber gloves on the opposite side.

Zhao Zhiqiang himself didn't expect that Ji Han would suddenly come to him this morning and ask him to let him be the first assistant in this operation.Zhao Zhiqiang was naturally happy, and with Ji Han's joining, his confidence in this operation was a bit greater.

According to the pre-customized surgical plan, Zhang Qianyi's esophageal cancer tumor had diffusely metastasized to the thoracic lymph and lymph around the neck, infiltrating part of the recurrent laryngeal nerve, and was diagnosed as upper esophageal cancer.

He will adopt thoracoscopic esophageal cancer resection, and at the same time use "three-field dissection and extended radical resection of esophageal cancer" to completely clear the patient's chest and neck lymph nodes.

At the same time, the most difficult part, the right hemilaryngotomy, was handed over to Ji Han. The other party had to try to clear the tumor cells on the vocal cords within the same time period, minimize the damage to the recurrent laryngeal nerve, and preserve the patient's site of occurrence.

Afterwards, Zhao Zhiqiang will perform rectal resection simultaneously, and then construct rectoesophagus transplantation and anastomosis.

It was Zhao Zhiqiang who had considered it carefully!

Even if the operation was completed, Zhang Qianyi's vocal cords were severely damaged and he lost the ability to speak, and it had nothing to do with him.

This responsibility can be pushed to Ji Han in front of the media, so that he can retire.

In the operating room, the nurse confirmed the patient's condition, and told the chief surgeon and the first assistant that the operation was OK, and the interns in the observation room stopped talking.

Zhao Zhiqiang and Ji Han stood on both sides of the operating table.

Ji Han took advantage of the glare of the shadowless lamp to look up at Zhao Zhiqiang, who was also looking at him from the opposite side. The tense atmosphere between the two could be felt in the observation room separated by a wall.

Zhang Qianyi has been deeply anesthetized, and a central venous catheter was placed before the operation.

The purpose of doing this is to facilitate the nurse to observe the patient's central venous pressure during the operation and monitor whether the patient's vital signs are stable. The other is to facilitate the doctor's rapid fluid rehydration operation in case of emergency.

Zhao Zhiqiang glanced at the digital clock on the wall and said coldly, "Start the operation."

On the right side of the operating table, the second assistant began to adjust the shadowless lamp. Above the patient, the supporting instruments and monitors of the thoracoscope had been placed in advance.

In the observation room, Qi Song frowned: "Zhao Zhiqiang didn't choose to open the chest? The esophagus removal was completely performed under a thoracoscopic operation, including rectal transplantation. Increased the difficulty of the operation? Didn’t you propose a thoracotomy at the beginning?”

Tao Dayong's face was not very good-looking: "I didn't expect him to choose this method. In this way, Ji Han had to open his neck, which is equivalent to Zhao Zhiqiang completely dividing one operation into two operations. He and Ji Han Do not interfere."

Qi Song sneered: "It was divided into two operations, and the responsibilities were also separated. If Zhang Qian's art is not ideal, or even loses the function of vocalization, then it has nothing to do with him, Zhao Zhiqiang, and it will all be Ji Han's responsibility! "

Under the operation of the second assistant, Zhang Qianyi had made a thoracoscopic incision on the sixth ribbed on the posterolateral side of the chest. As the probe of the azygos vein continued to penetrate, the mediastinal pleura was cut longitudinally from the medial side of the azygos vein, and the probe was inserted Free a segment of the upper esophagus with traction.

The lens of the thoracoscope carefully avoided the surrounding organs of the patient.

On the monitor in front of the operating table, I finally saw irregular lobulated tumor cells located in the upper part of the esophagus.

Ji Han turned his head and glanced at the monitor, his brows retracted, the tumor spread on Zhang Qianyi's esophagus was a bit worse than he expected, and it had already moved to the side of the thoracic diaphragm.

He glanced at Zhao Zhiqiang, who was struggling a bit. In the past few years, the other team of doctors did not perform operations frequently, and his patients were all handed over to the attending doctors under him. It is inevitable that the skills in his hands will become rusty after a long time.

Even though the temperature in the operating room is suitable for a constant temperature, at this moment, Zhao Zhiqiang's forehead is still covered with a lot of sweat, his voice sounds a little tired, and he is struggling to operate the two pipe forceps in his hand: "The tumor grows along the upper part of the esophagus, determine the excised part, and start Separate the azygos vein bow!"

Following Zhao Zhiqiang's order, the second assistant hurriedly cooperated on the other side.

"The upper part of the esophagus has been resected and is ready to be ligated!"

Ji Han's hands didn't stop moving, the scalpel cut open Zhang Qianyi's trachea, revealing the field of vision of the operation, and glanced at the second assistant who was a little flustered from the corner of his eye.

Just when the second assistant was about to perform the ligation according to Zhao Zhiqiang's order, Ji Han suddenly interrupted.

His voice was full of unquestionable majesty: "Don't panic, first ligate all the tissues around the esophagus, and then suture and cut it to avoid damage to the thoracic duct!"

The second assistant's movements froze, and under Ji Han's gaze, his hands trembled a little, and sweat dripped from his slender eyelashes.

He looked up at Zhao Zhiqiang, who was silent. The other party did not object to Ji Han's order. The second assistant and the first gritted their teeth and continued to operate according to Ji Han's order.

On this end, Ji Han stretched out his hand to the equipment nurse: "Give me the pointed scalpel."

The equipment nurse immediately took the pointed scalpel from the stainless steel tray and handed it up.

While clarifying the lymph around Zhang Qianyi's recurrent laryngeal nerve, Ji Han instructed the second assistant to cut the upper esophagus: "Prepare to cut the cardia, close the distal end with two layers of suture, and ligate the proximal end."

Following Ji Han's order, the upper esophagus was cut off, and the upper esophagus growing cancer cells was pulled out from the sternal incision channel and thrown on the stainless steel tray.

Ji Han looked at the second assistant coldly, and continued to order: "Open the diaphragm and esophagus by 3 cm, and prepare to suture to stop the bleeding."

The second assistant immediately took the esophageal hiatus device to open the hole, and then sutured to stop the bleeding.

"Scalpel."

Listening to Ji Han's order, the equipment nurse didn't dare to delay at all, and immediately handed over a scalpel. Following his continuous orders, the operation was carried out step by step and in a clear manner.

Zhao Zhiqiang glanced at Ji Han, who had completely replaced him as the chief surgeon.

This made Zhao Zhiqiang look anxious, but he didn't say anything, but the movement of his hands froze, and the whole person was obviously stunned.

The nurse monitoring the patient's vital signs saw the siren sounding suddenly, and hurriedly turned around and shouted at Zhao Zhiqiang: "Professor! The patient's thoracic blood vessels ruptured, and the amount of pleural bleeding was huge!"

Zhao Zhiqiang loosened the surgical clamp. Just now he just shook, but accidentally cut off the blood vessels in the patient's chest cavity, causing massive bleeding in the chest cavity.

At this time, listening to the constant warning sounds from the nurse, I just felt a buzzing in my head, and I didn't react for a long time.

"Professor Zhao, Professor Zhao! What should we do now?!"

It wasn't until he heard the second assistant constantly calling himself anxiously that Zhao Zhiqiang finally realized that when he was about to speak, Ji Han grabbed his wrist.

Zhao Zhiqiang looked up at Ji Han's cold gaze, and couldn't help swallowing.

Ji Han took his position as chief surgeon, and said, "Professor Zhao has already completed the esophagus cutting operation, and the rest are trivial matters, so leave it to me to deal with the aftermath!"

The second assistant was terrified when he heard it, the operation was less than half done, and a blood vessel in the chest ruptured and hemorrhaged. Professor Ji cares about the rest, calling them trivial things?

Zhao Zhiqiang reacted and pretended to be calm: "Then leave the rest to Professor Ji to deal with the aftermath."

After finishing speaking, Zhao Zhiqiang turned around and hurried out of the operating room, as if there was a terrifying beast trying to devour him.

Ji Han glanced at the medical staff around the operating table, and calmly said, "Wipe your sweat!"

The itinerant nurse immediately picked up the gauze and came over to wipe the cold sweat off Ji Han's forehead, only to find that the white shirt inside his surgical gown was soaked with sweat.

Ji Han looked at the blood continuously pouring out from the incision, and decisively gave up the thoracoscope, and said to the second assistant: "Remove the thoracoscope, adjust the operating table, change to supine, and open the abdominal cavity!"

"a!"

After receiving the electric knife from the equipment nurse, Ji Han put away the knife, and a smell of burnt flesh came out. Zhang Qianyi's abdominal cavity was quickly opened, and the second assistant immediately fixed the fascia with a tendon hook.

Looking at the blood gushing out of the abdominal cavity, Ji Han put his rubber-gloved hand directly into the blood-filled abdominal cavity, found the stomach body that had been separated from the upper esophagus, and ordered the second assistant to "attract" and empty it out. Hemoperitoneum.

"At 1 cm from the inner wall of the chest cavity, three-needle traction sutures were sutured!"

Ji Han found the bleeding point, and the second assistant hurriedly took the traction thread and sewed it up.

"Connect the esophageal ligature to the fundus traction."

At this time, due to the use of thoracoscopic esophagectomy, the remaining esophagus could not be extracted from the abdominal cavity, and the subsequent anastomosis of rectal transplantation and esophagus-gastric body could only be sutured at the opening of the patient's neck.

He had seen the distribution of Zhang Qianyi's mesorectal blood vessels in advance, according to the previous plan, quickly judged the current situation, and immediately made a revision of the surgical plan.

Ordered: "Make an incision at the anterior edge of the sternocleidomastoid muscle in the patient's left neck, raise the esophagus behind the trachea, and prepare for blunt dissection of the retrosternal tunnel. Perform colon-gastric end-to-side anastomosis, and simultaneously start the colon- End-to-end colon anastomosis!"

The anastomosis must be completed before the patient's blood oxygen drops, otherwise it is easy to cause insufficient blood supply to the patient's heart due to long-term surgery, causing sudden arrest.

After finishing speaking, Ji Han looked at the second assistant with a more serious expression: "Be careful not to touch the patient's left recurrent laryngeal nerve when lifting the esophagus from the neck!"

The second assistant didn't dare to breathe, nodded hurriedly, and carefully pulled out the half-finished esophagus and traction line from the incision on the neck.

Taking advantage of the moment, Ji Han turned around and cut the rectum ready for esophageal transplantation, then immediately switched to the second assistant's position, pushed the esophageal bed toward the chest cavity, stretched the stomach fundus to the position of the incision on the patient's neck, and performed rectal transplantation. The graft was anastomosed end-to-side with the gastric fundus.

"Stapler!"

Ji Han took the stapler from the equipment nurse, and fixed the anterior stomach wall to the patient's neck with a few stitches.

A series of operations caused everyone in the observation room to remain silent, all staring at the monitor above their heads.

"Anastomotic transplantation of the rectum and gastric fundus from the neck incision? Is it still possible to do this?"

In the observation room, the interns all showed shocked expressions.

In the operating room, Ji Han glanced at the time on the wall, kept counting in his mind, and ordered to the second assistant: "Prepare to suture the abdominal incision."

After finishing speaking, Ji Han quickly completed the anastomosis transplantation of the rectum and the fundus of the stomach, and sent it back to the chest cavity. He stared at Zhang Qianyi's recurrent laryngeal nerve, took the scalpel from the nurse's hand, and quickly and ruthlessly removed the tumor cells. Adam's Apple, divided into two.

…………

The difficulty and time of this operation exceeded everyone's prior estimate. It was not until two o'clock in the afternoon that the operation could be completed.

Ji Han put down the electric knife in his hand, heaved a sigh of relief, looked at the people around him, and said, "Start flushing the neck incision, place a rubber drainage strip, and sew up the neck incision."

In the observation room, everyone held their breath, watching the blood pump re-transfuse after the operation was completed, awakening the patient's sleeping heart.Suddenly, in the crowd behind him, someone shouted: "Heart rate, heart rate, there is a peak on the heart monitor!"

The big stone that Tao Dayong was pressing on his heart finally fell to the ground, and he couldn't help laughing: "A knife in our tumor surgery is a knife. This operation can be regarded as a teaching case!"

Qi Song followed with a smile: "Professor Ji is Professor Ji, he is capable!"

When Ji Han came out of the operating room, his sterile gown was completely drenched in sweat, and he couldn't help feeling bitingly cold when he was blown by the wind outside.

He looked up and saw Jiang Li walking in the corridor, so he got up to meet him.

Jiang Li gave Ji Han a thumbs up: "I just said that I saw the right person. Old Ji, you have a knife mouth and a bean curd heart, and you will definitely not die!"

The corners of Ji Han's thin lips were pursed, and his voice was still unhurried: "I don't know who it was, who scolded me so much yesterday? You also said that I am a heartless, cold-blooded animal, who will die without saving me?"

"Who am I? I didn't say that!" Jiang Li blushed.

Song Qin, Zhang Qianyi's manager, walked over with tears in her eyes, and bowed deeply to Ji Han: "Thank you, Professor Ji, I really appreciate it!"

Ji Han shook his head and signaled to the other party that you are welcome: "This is the doctor's duty. If there is nothing else, I have something to do here, so I will leave first."

Jiang Li hurriedly chased after him and asked, "By the way, how long will it take for Zhang Qianyi to recover his voice after the operation?"

Ji Han thought for a while: "It depends on the follow-up chemotherapy and rehabilitation training, but if the problem is not too big, there should be no problem with vocalization, but the voice and sound quality must have changed significantly from before. If you want to restore the previous The sound quality is almost impossible."

(End of this chapter)