Come on, Dr. Wu

Chapter 265 Those who learn from me will live, those who imitate me will die (ask for monthly ticket)

Jinhu County Hospital.

The next day, Mr. Jiao was admitted to the hospital under Wu Xiaofu's arrangement.

Wu Xiaofu plans to perform surgery on Mr. Jiao on Saturday, one day in advance, just in time for preoperative preparation.

Wu Mingjie also learned the news that Wu Xiaofu was going to perform surgery on Mr. Jiao.

While I am excited, I am also looking forward to success.

Of course, Wu Xiaofu still had to go to the outpatient clinic as usual on Friday morning. The first patient was a patient who came in holding his stomach, looking pale and in pain. This was a patient transferred from the emergency room and did not register.

After Wu Xiaofu took the patient's pulse, he asked, "Do you usually have stomach bloating or stomach pain?"

Hearing this, the patient nodded quickly, "Yes, I often have stomach bloating and stomach pain. I have actually checked it out and even had a gastroscopy. They said it was gastric ulcer. I haven't used medication just once, but I have used medication repeatedly and it keeps coming back. It gets better and then comes back again. It's really troublesome no matter how much I take medicine when it comes back.

Just like last night, I woke up in pain again. I feel pain every day if I don’t eat, and it only feels better if I eat. Doctor, you tell me, I can’t take medicine for the rest of my life. Besides, I heard that this kind of condition is prone to stomach cancer.

Can you please see if you can cure it completely for me?"

Duodenal ulcer!

After hearing the patient's description, Wu Xiaofu determined the cause of the disease. After all, pain before meals, relief after meals, and pain at midnight are basically common symptoms of duodenal ulcer, and the pulse also shows gastrointestinal coldness.

Wu Xiaofu gave him a physical examination and found that he had gastrointestinal problems, and there was no problem with his liver and gallbladder. Well, this is also the process of outpatient medical treatment, and a differential diagnosis is required.

There are too many diseases that need to be identified when there is abdominal pain.

"You probably have a duodenal ulcer. We need to further investigate whether you have a stomach ulcer or not. You should be hospitalized first for an examination. If necessary, we will perform surgery. For people with recurrent ulcers like you, it is probably impossible to permanently solve the problem by just taking medicine."

Operation!

The patient and his family were both frustrated and happy. They were frustrated because they had to undergo surgery, but they were happy because Wu Xiaofu was indeed an expert and did have a solution.

The patient was only in his forties but very thin, obviously suffering from the disease. After hesitating for a while, he nodded and agreed to be hospitalized.

Seeing him nod, Wu Xiaofu asked Qu Tianqi to write a hospital admission order.

Wu Xiaofu mentioned duodenal ulcer, but if you really want to prepare for surgery, you have to do some tests and leave the test data. Not to mention blood tests, urine tests and stool tests, you also have to do gastrointestinal endoscopy and Helicobacter pylori screening.

Duodenal ulcer is one of the common and frequently occurring diseases among the Chinese population. Wu Xiaofu usually works in the hepatobiliary surgery clinic, so he seldom sees this disease. However, he sees it quite often in the gastrointestinal surgery and gastroenterology departments.

Basically, they first check for Helicobacter pylori and then do a gastroenteroscope. Jinhu County Hospital has gastroenteroscope equipment, but lacks good gastroenterologists to perform the operation and examination. When Wu Xiaofu came this time, there was a gastroenterologist with him who directly picked up the gastroenteroscope.

In the past two days, Wu Xiaofu asked him to help train doctors at Jinhu County Hospital. The effect was good. The examination results and efficiency were very satisfactory.

Duodenal ulcer is prone to occur in winter and spring when the climate changes greatly. Now is April, when the disease is most common. Patients with frequent ulcers like this must have such cases twice a year. Moreover, the incidence rate of duodenal ulcer in men is significantly higher than that in women, and men are more common in outpatient clinics.

Checking for Helicobacter pylori infection seems to be a key factor in the onset of ulcers. Regardless of whether surgery is required or not, if Helicobacter pylori is found, it must be sterilized first. Otherwise, it is easy to relapse after surgery.

Of course, Helicobacter pylori infection is not the only cause of the disease. It is also closely related to abnormal gastric acid secretion, non-steroidal anti-inflammatory drugs (NSAIDs), irregular lifestyle and diet, work and external pressure, smoking, drinking, and mental and psychological factors.

In the afternoon, there was a similar patient in the gastrointestinal surgery department who was going to have surgery. He was admitted before Wu Xiaofu came. He was first admitted to the gastroenterology department and was transferred to the gastrointestinal surgery department two days ago. He also had peptic ulcer, and we thought he had Helicobacter pylori, so we planned to do some screening and then give him bactericidal treatment. Since he was also an emergency patient, we planned to hospitalize him for intravenous infusion.

Just then Wu Xiaofu and his team arrived, so they did a gastroscopy and found that it was a duodenal ulcer.

The gastroenterologist judged that it was probably a stubborn duodenal ulcer caused by vagus nerve excitement, so he recommended surgery.

The patient was not willing to go far away and immediately asked to be transferred to the gastrointestinal surgery department to let Wu Xiaofu help with the operation.

The surgery was scheduled for Friday afternoon, which was this afternoon.

The morning outpatient clinic was similar to that on Wednesday, except that there were more patients with extra appointments today compared to Wednesday morning, and Wu Xiaofu didn't finish seeing them until after 1:00 p.m.

After having dinner with Qu Tianqi at the same restaurant we visited on Wednesday, we returned to the operating room.

The first one was the patient with duodenal ulcer.

Wu Xiaofu was going to perform vagotomy on this patient.

The cause of ulcer disease is relatively complicated. It is generally believed to be a complex disease caused by the combined action of multiple factors. However, with the deepening of research, it has been found in recent years that mental and neurological factors still play a major role in ulcer disease.

Mental stress and stimulation caused by various reasons can make the brain over-excited or fatigued, resulting in coordination disorders between the cortical and subcortical centers, which in turn cause autonomic nervous system dysfunction, ultimately manifesting as vagus nerve dysfunction.

It is generally believed that the vagus nerve fibers in patients with gastric ulcers are dysfunctional, causing pyloric spasm, antral stagnation, and antral gastric acid secretion.

The vagus nerve function of patients with duodenal ulcers is often hyperactive, causing the release of acetylcholine, which directly stimulates the gastric wall cells to produce gastric acid.

At the same time, vagal nerve excitation also stimulates the antrum, causing the secretion of gastrin in the vagal-antral phase, indirectly producing gastric acid.

Therefore, patients with intractable ulcers basically have mental factors as the main cause. The most direct and simple way to treat ulcers caused by this cause is to cut off the vagus nerve, thereby reducing the patient's gastric acid secretion from the middle link.

The principle of reflex regulation is used here, which is a biology problem we learned in middle school.

Actually, Wu Xiaofu didn't perform many vagotomies. It seemed that he had only performed one case in the First Affiliated Hospital. The operation was not too difficult, but there were not many cases. After all, most people thought that it was just an ulcer and it could be cured by taking medicine. Why did he need surgery?

For most Chinese people, surgery is still a word that is difficult to accept.

There are two types of vagotomy: trunk vagotomy and selective vagotomy.

The former operation is simple, but symptoms such as abdominal distension and diarrhea often occur after the operation. It is suitable for more serious and critical patients. Patients with refractory ulcers generally do not choose this operation.

The latter, namely selective vagotomy, causes less disturbance to gastrointestinal function after surgery, but the surgical operation is relatively complicated. It is suitable for patients with good tolerance to surgery. After all, the operation time is relatively long.

However, neither the former nor the latter can be considered an independent operation in theory. Both must be supplemented with gastric drainage or partial gastrectomy to make the operation complete.

In recent years, the First Affiliated Hospital has developed a surgical procedure called "highly selective gastric vagotomy (also known as parietal cell vagotomy)".

Only the vagus nerve in the gastric parietal cell area is cut off without additional gastric drainage or hemigastrectomy or antral resection. This procedure can be performed as an independent operation. This procedure has great advantages in theory, but the surgical operation is more stringent and has higher requirements for the operator.

As a high-end technology, it is difficult to pass it on to lower levels.

However, Kang Jinwang has a good foundation and understanding, and he happens to have patients with relevant indications. Wu Xiaofu plans to pass on this new technology. After all, isn't this one of the main purposes of going to the countryside?

Moreover, the reason why many ulcer patients cannot undergo surgery is that this surgery is not a minor surgery in the traditional sense, and most of them require partial gastrectomy.

Gastric resection, this is not gastric cancer, it is just a simple gastric cancer, and it requires gastric resection and vagus nerve resection. Patients can relatively understand this, but gastric resection is not acceptable, especially for some young patients, who simply cannot accept it.

Well, this is also the reason why highly selective gastric vagotomy has been developed. After all, this type of surgery is relatively less invasive. For patients with duodenal ulcers, it is understood in the same way as removing the gallbladder and appendix.

From the patients' perspective, as long as the stomach or intestines are not removed, it is acceptable.

The most important thing is that stubborn gastric ulcer is really annoying. If it happens once or twice a year, you may be able to accept it, but after the disease progresses, it may occur once a month or even more frequently.

This is unacceptable, especially since most of the patients are boys. The pain is more frequent than that of a girlfriend during her period. If the people around them are not sympathetic enough, they will tease them.

Moreover, my body cannot bear taking medicine all the time.

The most important thing is that in recent years, more and more cases have developed into cancer. Ulcers are actually a kind of irritation. If you are really prepared to ignore it for the rest of your life and just endure it, it is really unrealistic.

In the afternoon, Wu Xiaofu was going to perform a highly selective gastric vagotomy on this patient. Of course, the patient agreed to the operation only after Wu Xiaofu told him that there was no need to undergo gastric vagotomy.

A 50-year-old patient has had ulcers for five and a half years. He is now at the stage where he feels uncomfortable many times a month. His stomach is harder to take care of than his children. He dares not eat raw, cold or hard food. He has to eat on time and does not dare to delay. He carries medicine with him and takes it at any time. He never knows when he will have to go to the emergency room. This life is really a bit torturous and seriously affects the quality of life.

Since the root cause of the disease can be solved without gastric resection, many patients are willing to do it without any hesitation.

It was also based on this population that highly selective gastric vagotomy was developed.

"Boss, this operation seems a bit difficult?"

Kang Jinwang stood beside Wu Xiaofu and said slowly that he had been studying highly selective gastric vagotomy in the past few days. Wu Xiaofu recommended him some information related to the surgery. Kang Jinwang studied a lot and felt that this surgery was very difficult to operate, but it was also not easy, even more difficult than the usual subtotal gastrectomy.

The patient understands it as similar to removing the gallbladder and appendix, but the doctor does not dare to think so.

The dissemination of this new technology is much more difficult, so most of the tertiary hospitals still do not have this technology.

Wu Xiaofu looked at Kang Jinwang rubbing his hands and smiled. After these two days, Wu Xiaofu got to know Kang Jinwang better and better. In terms of his obsession with surgery, Kang Jinwang was very similar to him.

Although it sounds difficult, I am probably eager to learn this technique in my heart.

"With your foundation, it won't be difficult to master it. I happened to be in the outpatient clinic this morning and there was another similar patient. After the operation, you can do some work and maybe you can perform another operation. With two times like this, you can learn almost everything."

Kang Jinwang nodded quickly. He had already seen the patient in the morning and he knew Wu Xiaofu's habits. If he performed well in this operation, perhaps he would be able to perform the surgery in the next one and let Wu Xiaofu give him guidance.

"Okay, let's get started."

For surgical anesthesia, epidural anesthesia is used instead of general anesthesia. If the patient is older, local anesthesia can be strengthened.

The patient lies supine and a midline incision is made in the upper abdomen from the xiphoid process to the umbilicus.

This operation can actually be done with a mirror, but the cost is relatively high. If the patient wants to save more, then surgery will be performed. In fact, surgery is performed most often in major hospitals.

The first step is laparotomy. Only after confirming that it is a duodenal ulcer can surgery be continued.

Some ulcers may also reveal tiny holes when cut out, and those that do may be cancer.

But you can't spend half a day doing nothing and not only end up with no results, but also create hidden dangers. So this first step must not be skipped. First, you need to determine the patient's condition, which is duodenal ulcer.

In fact, this is the case for most surgeries. Your first step must be to make sure that the symptoms are the same as the preoperative diagnosis.

Sometimes, something will happen in the hospital. The patient is clearly suffering from the disease on the left side, but during the operation they were able to open the entire right side, only to find out it was wrong after the operation was completed.

Symptoms such as left eye problems, left knee ligament rupture, etc. are actually very outrageous. The first step is to determine the cause of the disease. If you do it even if you are not sick, are you doing a routine surgery?
There have been similar lessons before. For a duodenal ulcer, the patient underwent vagotomy and partial gastrectomy. However, a follow-up examination after the operation revealed a tumor. Was it not there before the operation, was not seen during the operation, and appeared after the operation? Or was it there before the operation and you missed it?
As a doctor, you should not test and torture your inner self when a patient or a judge asks you a question. It is outrageous if you are still not sure whether the problem exists or not. Wu Xiaofu will never allow such a thing to happen.

Whenever there is a question involving technical issues, Wu Xiaofu dares to say: There is no problem with the process.

As long as you don't be lazy, this guarantee will ensure you will always be confident.

After confirming that it was a duodenal ulcer, the operation officially began. The left lateral lobe of the liver was exposed, and Qu Tianqi used a retractor to pull it open and cut the left triangular ligament and coronary ligament of the liver.

At this time, we should pay attention to ligating the small blood vessels from the diaphragm to the liver and the accessory hepatic vein on the surface of the diaphragm. After covering them with gauze pads, use the retractor to pull the left lobe of the liver to the right to expose the cardia and esophageal hiatus, and then cut the esophageal hiatus peritoneum in sequence.

This step is to expose the vagus nerve.

The anterior trunk of the vagus nerve, which is the left branch, usually lies close to the anterior wall of the esophagus and runs slightly to the left. It can usually be seen after the peritoneum is incised and the esophagus is exposed. After the esophagus is pulled open, the posterior trunk of the vagus nerve, which is the right branch, can also be found in the loose connective tissue on the right rear side of the esophagus.

"If you are doing a vagotomy, you can just cut off the anterior and posterior trunks. If you do not do a vagotomy and want to do a more complicated selective vagotomy, you need to fully judge the process affected by the vagus nerve and selectively remove it.

The highly selective gastric vagotomy that we are going to perform now is actually developed on the basis of selective vagotomy, which is to remove the vagus nerve wall cells.

This is a greater test of skills and judgment.”

Parietal cells, also known as acid-secreting cells, are the acid-secreting glands in the stomach. With this explanation, you can actually understand the significance of this operation. What is an ulcer? It is just excessive secretion of gastric acid that causes burns. As long as the excessive secretion of gastric acid is inhibited, the disease will actually be basically cured.

After all the parietal cells are removed, no matter whether it is mental factors or any other factors that stimulate the vagus nerve and make it excited, and want to further transmit information to the parietal cells, it is found that the operator is gone and it is impossible to continue to convey the next step of instructions.

That’s what highly selective vagotomy is all about.

However, this is also where the difficulty lies.

It is easy to cut the front trunk and the right trunk, but it is difficult to cut the vagus nerve, and many people make mistakes.

If the cut is made incorrectly, the postoperative effect will not be as ideal and other complications may occur.

This is the difficulty of highly selective vagotomy.

Under the gaze of Kang Jinwang and others, well, it was really difficult, well, Doctor Wu had already found it, well, Doctor Wu had already cut it off.

While performing the operation, Wu Xiaofu explained to them the anatomical structure of the parietal cells and how to find and identify them. Now that they have a deep impression of the structure, they believe that they will not mess around when performing surgery in the future.

Especially Kang Jinwang, "How is it?"

Kang Jinwang nodded hurriedly upon hearing this, "It should be fine, but it looks like he can do it, but I don't know if he can do it during the operation. Boss, you know that your operation is different from ours."

After just one or two days, Kang Jinwang actually changed his way of addressing Wu Xiaofu and started calling him "Boss", which made Wu Xiaofu sigh at his own charm.

Wu Xiaofu had no comment on Kang Jinwang's statement. Could he really expect Kang Jinwang to learn it just by watching it once? He would have to teach him how to make one or two sets at least. To be honest, Kang Jinwang really suffered from his lack of education.

His talent is really good, but Kang Jinwang is almost 40 years old now. He is a bit too old to take the postgraduate entrance examination. And for postgraduate study, one cannot be selfish and must take standardized examinations. It is not like a doctorate, where one can just apply and be accepted if they meet the requirements.

The next option is in-service graduate students, but Wu Xiaofu doesn't know what the policies are in different places. Anyway, the tertiary hospitals that Wu Xiaofu has visited basically do not recognize this when evaluating professional titles, which makes Kang Jinwang very embarrassed.

If he were five years younger, he should be advised to take the postgraduate entrance examination again.

Kang Jinwang had no idea what Wu Xiaofu was thinking. He was completely devoted to the operation. This was not the first time he had performed surgery on Wu Xiaofu. He had long realized that the surgery Wu Xiaofu performed was not the same as the surgery he had learned.

It's just like the surgical process written in the textbook. It's written that way, so can you really do it? An operation can take several hours. What's written in the textbook is just a main point. If you really remember that and dare to try it, you will definitely be able to perform well on the stage.

But Wu Xiaofu's operation was almost a textbook one. After opening the abdomen and confirming the patient's condition, he did not make any unnecessary movements and directly found the vagus nerve in no time. And then he got it out accurately, just like scooping meat out of porridge.

However, Wu Xiaofu got what he wanted, but Kang Jinwang dared not say that if he were to perform the operation on stage, he could do it so easily. It would be difficult for him to even find the vagus nerve, let alone the parietal cells.

Therefore, he had to expand upon Wu Xiaofu's simple surgical operation and imagine what he would look like when performing the operation. It was ridiculous to say, Kang Jinwang had seen many simplified surgeries, and it was difficult for him to understand. This was unique for him.

It seems that Wu Xiaofu really turned such a difficult and highly selective vagotomy into an appendectomy and gallbladder removal.

Suddenly he remembered the conversation he had with Fan Xin during dinner yesterday. He deliberately approached Fan Xin and wanted to ask Fan Xin about Wu Xiaofu's habits and so on, and Fan Xin said the same thing.

"Everyone who has worked with Dr. Wu knows that in Dr. Wu's eyes, even removing cancerous lesions is just like removing acne. If you follow Dr. Wu's surgery, you will really be ready to die. What's the saying?

Those who learn from me will live, those who imitate me will die. Yes, that’s it.”

Those who learn from me will live, and those who imitate me will die. In just two days, Kang Jinwang has a deep understanding of this. If he really just imitates Wu Xiaofu, he will never be able to learn any of Wu Xiaofu's skills.

Because it would be hard to find another person who dares to perform surgery like Wu Xiaofu. It seems that it is not only based on rich technical experience and basic knowledge, but also on something else more important.

Kang Jinwang could not understand this thing. Maybe it was a talent, but this talent was definitely something Kang Jinwang did not have. So, he could only learn the ideas and then work hard on this basis.

When Kang Jinwang told Fan Xin his understanding, Fan Xin gave him a thumbs up.

"Brother, you've got the hang of it."

(End of this chapter)