Come on, Dr. Wu

Chapter 374 The wave behind pushes the wave ahead

night.

As soon as Wu Xiaofu returned home, he received a message from Liu Lin.

"Boss, I heard that your case has been confirmed. We agreed before that as long as I get a good score on the written test and my performance during this period satisfies you, I will be the first in line."

"I know, I know. You are the only one who is well-informed."

This Liu Lin really doesn't leave any room for error. However, even if Liu Lin doesn't say it, Wu Xiaofu will give priority to her. Liu Lin has been with him for some time. Liu Lin's ability is beyond doubt. She has potential and tenacity. Although surgeons prefer male doctors, they will basically not let go of such a female doctor when they meet one.

After all, female doctors are still capable of performing hepatobiliary surgery, and there are more and more female doctors engaged in hepatobiliary surgery.

Not only male doctors like surgery, female doctors like it too.

Many medical students feel that the sense of accomplishment that surgery can bring them is incomparable to that of internal medicine. They say that choosing internal medicine will make things easier. However, this idea is becoming less and less common, because they will find that neither internal medicine nor surgery is easy. In this case, it is better to choose a major that can better give full play to one's abilities and enhance personal achievements.

Besides, surgery makes a lot of money.

After all, this is the first time that Wu Xiaofu is a graduate student supervisor. He plans to talk to Yu Shifu tomorrow and learn from him. To be honest, it does feel a bit different to be a teacher.

time flies.

In the eyes of doctors, time is very valuable and important. In many cases, they have to race against time, but the thing they cannot grasp the most is also time.

Many times, it’s just a trance and the day is over.

However, seeing that it was already Thursday, these interns were getting a little nervous. Time passed too quickly, and they felt that they had not improved much. The day after tomorrow would be time for another assessment.

I have surgery this week, so Saturday can’t be the surgery assessment, right?
If it was last season, they definitely wouldn’t have thought this way, but this season, the assessment is really a little different.

Wu Xiaofu went to find Yu Shifu after checking the room.

"How about it? Let's decide. Let me tell you, there is no one who doesn't want to be a teacher. Teaching and answering questions is something that we Chinese people respect in our roots. In the eyes of each of us, being a teacher is the most noble thing. Who can resist the temptation of being a teacher?

At that time, I said that I felt it was troublesome, but when I really thought about becoming a teacher, I was so excited in my heart. I knew you wouldn't refuse. Even though you are young, the younger you are, the more you like this new feeling.

However, being a teacher is not an easy job. Not only do you have to teach knowledge, but you also have to teach people how to be human beings and be responsible for their future. It is very troublesome.”

Duan Hao was still in Yu Shifu's office. When he heard Yu Shifu talking, he rolled his eyes.

"Teacher, your words are quite suitable to describe me. Xiaofu is so worry-free. I think your teaching is quite easy."

"Are you itching for a fight? Why don't you feel uncomfortable if you don't get spanked for a day?"

Duan Hao quickly begged for mercy, and Wu Xiaofu also laughed. It must be said that the atmosphere in their sect was absolutely the best.

"That's great. Come with me for surgery later."

While chatting, Yu Shifu hadn't said anything yet when he dragged Wu Xiaofu to perform surgery, saying that it was an operation on an acquaintance and he hadn't performed surgery for a long time, so he asked him to do the operation and he just had to watch from the side.

Wu Xiaofu was also stunned when he heard this. What is this? If the teacher says so, should the disciple accept it?
However, Wu Xiaofu did not say anything. He was able to find Yu Shifu and get Yu Shifu to agree to the surgery. Even if he was a relative of Yu Shifu, the surgery would definitely not be small, because Yu Shifu would definitely be selective and would not do an ordinary gallbladder surgery. He would also take the time to do it.

Maybe it is an operation that he would not encounter normally. Wu Xiaofu cannot refuse such an operation. Wu Xiaofu never underestimates Yu Shifu's background. He has been working for decades, while he has only been working for a few years.

Not only was he going, he also brought everyone in his group who was willing to go.

Cheng Shi and Jiang Bei were naturally no exception. The disciple Liu Lin, who had already been basically confirmed, as well as Duan Hao's disciple You Zhiyi and Peng Xia were all there.

When we arrived at the operating room, we knew that since Yu Shifu was found, this would not be a simple operation.

Hilar cholangiocarcinoma.

Cholangiocarcinoma is also divided into types according to its location. Hilar cholangiocarcinoma is undoubtedly the most difficult to treat.

Currently in the medical community, hilar cholangiocarcinoma is recognized as one of the most complex operations in abdominal surgery, and the combined arterial and venous resection and reconstruction involved is the ceiling level of this type of operation.

Moreover, most of these operations require technical support from liver transplant experts, otherwise any problems with the artery or portal vein after the operation would be catastrophic.

That is to say, when you perform this type of operation, either you have the ability to perform a liver transplant yourself, or you need someone with the ability to perform a liver transplant to watch you, so the learning threshold is very high.

Yu Shifu had originally planned to ask a doctor from Area A to come over and help Wu Xiaofu, but who would have thought that Wu Xiaofu would bring so many people with him. However, while the anesthesia was in effect, he still asked the doctor to report the patient's condition to Wu Xiaofu.

"A 39-year-old male presented with upper abdominal distension and pain. He was diagnosed with hilar cholangiocarcinoma at an external hospital. He was referred to our hospital after visiting several hospitals. Physical examination showed no obvious abnormality. The abnormal laboratory test results were: total bilirubin 52; CA199:>1200.

Imaging examinations showed that the patient's right hepatic artery was partially invaded, the distal end of the right hepatic artery was in good condition, the middle hepatic vein was normal, the main trunk of the portal vein was normal, and the beginning of the right branch of the portal vein was invaded. "

This is the reward of a professional doctor. Let me pick out the key points. The difficulty of hilar cholangiocarcinoma lies in the blood vessels. After all, the hilar region is rich in blood vessels. Once one of the blood vessels is invaded, it will be very difficult to treat. Therefore, during the examination, the focus of observation is also on the blood vessels.

With the doctor's report, Wu Xiaofu could quickly understand where the difficulty of the operation lay and how difficult it was.

However, this case is indeed very troublesome.

Both the right hepatic artery and portal vein were invaded. Although not the entire segment was invaded, two blood vessels had to be dealt with, so the difficulty naturally increased. This is completely different from ordinary hilar cholangiocarcinoma surgery.

By hanging the patient's CT on the developing machine, it can be seen that the patient's tumor is located in the left hepatic duct, invading the bile duct confluence, and the right hepatic duct is slightly dilated; the left hepatic artery and the left branch of the portal vein are invaded; the right hepatic artery segment is invaded, and the starting part of the right branch of the portal vein is invaded.

The doctor did a very detailed job and also performed a staining retention test, which is used for positioning, structural assessment, and quantitative evaluation.

Generally it is not done. However, if the patient has connections and needs to be meticulous, it can be done. It is very expensive and ordinary people will definitely not choose it. Of course, if it is done, it will make the doctor's operation easier.

The 15-minute retention rate of ICG is 11.3%. ICG is a staining material.

"Based on this level, if the left hemiliver + caudate lobe is removed, the remaining liver should account for 63.8% of the standard liver volume." After Wu Xiaofu finished speaking, the doctor nodded hurriedly. "It took me a long time to calculate the answer, but Director Wu said it all at once. I can't help but be convinced."

This is not a compliment to Wu Xiaofu, because it involves a conversion, which most people cannot do mental arithmetic, but Wu Xiaofu is obviously here to play the game of "Super Brain".

After hearing the ratio of the remaining liver to the standard liver volume, everyone seemed to be relieved.

After all, there is still so much liver left. This operation is relatively good both in terms of difficulty and prognosis.

"This is calculated, that is, you cut the best result, but can you do it just right? Generally, you have to cut more, so if you can keep 60% in the end, it's amazing."

Yu Shifu took the opportunity to remind him that surgery is never about data and it is impossible for it to remain unchanged based on data.

If you are superstitious about data and surgical results, you will only suffer great losses.

Those who perform surgery based on data will basically be deceived by the data in the end. There are too many lessons from this.

Everyone nodded subconsciously when they heard this. Yes, who could really cut it so perfectly? However, thinking of this, they looked at Wu Xiaofu again.

Others can't do it, but Wu Xiaofu can.

Upon seeing this, Yu Shifu rolled his eyes. He didn't count, and besides, it wasn't certain that he could not be less than 60%.

When Wu Xiaofu performed surgery normally, he would never cut more normal tissue than tumor tissue. Yu Shifu was also amazed. He thought, Wu Xiaofu's eyes were like a ruler. Not to mention, everyone in the pathology department said that Wu Xiaofu's eyes were like a ruler. He could always remove the tumor tissue perfectly, never too much or too little.

Once the first cut is made, there will never be a second cut.

Because of what these people have spread, Wu Xiaofu is now almost a living legend. When Yu Shifu said this, he was just speaking casually and was not thinking about Wu Xiaofu. Who could have thought that these people were so synchronized.

However, Wu Xiaofu may not be able to cut the tissue perfectly in this kind of surgery. There will always be a one percent chance of error.

probably.

"Okay, let's start the operation. The anesthesia is over. Doctor Li, you assist. Peng Xia, wash your hands and disinfect them."

Wu Xiaofu smiled and started right away. The operation would not be too fast, so the sooner it was done, the sooner it would be over.

"okay."

Doctor Li originally thought that he was just here to make up the numbers, but he didn't expect Wu Xiaofu to let him be his assistant and not abandon him. It was really kind of him. He was originally an assistant, and there was no difference between being an assistant to Yu Shifu and being an assistant to Wu Xiaofu.

Moreover, he had never worked with Wu Xiaofu before. To be honest, after listening to the legend of Wu Xiaofu, he was also very curious and quite excited.

Disinfect, lay towels, and do preparation work.

It is still done laparoscopically. As long as more than half of the liver is not removed, Wu Xiaofu now basically does it laparoscopically. Although it is more difficult, it is obviously better for patients.

After inserting the mirror, Wu Xiaofu started to separate the tissues directly. The first difficulty of this operation was to dissect the first liver portal. First, he had to explore the invasion of the vascular structure to see if it was consistent with the preoperative imaging. If it was consistent, it would be easy to do according to the plan made in advance. Once there was a change, it would be very troublesome.

But many times, it is really different. After all, the examination is done through the body surface, and no one knows what is going on inside the body cavity. Many times, some things cannot be photographed, and the diseases are also strange. You may encounter a mutated one, which is commonly known as a thunder.

This is inevitable. If you encounter it, just consider yourself unlucky.

Fortunately, the case in front of us is still very reasonable. The field of vision after opening is basically consistent with the pre-operative image.

Next, just follow the preoperative plan. The affected areas are mainly the right hepatic artery and the starting part of the right branch of the portal vein.

Therefore, both parts of the blood vessels need to be reconstructed.

This is also the second difficulty of the operation, reconstructing the main trunk of the portal vein - the right branch of the portal vein; reconstructing the proper hepatic artery - the right hepatic artery.

Although there are only a few words, this work has been attempted and researched by predecessors in the medical field for decades. To achieve this step, it basically requires years of skills of transplant experts. Ordinary doctors dare not even touch these things. After all, when reconstructing blood vessels, if something goes wrong, the operation may fail and the patient's life may be in danger.

Wu Xiaofu did it with ease, and Peng Xia and the others took it for granted. After following Wu Xiaofu for a long time, they felt that whatever Wu Xiaofu did should be in this state and nothing was surprising. If he stumbled, that would be a problem. But it was different for Dr. Li.

Under normal circumstances, this vascular reconstruction work would take at least two to three hours. Wu Xiaofu finished it in half an hour, which was too much!
Only at this moment did Dr. Li realize the weight of the three words "Wu Xiaofu".

He thought about this surgical ability and it seemed that it was not even as good as Jingwei.

hiss!
It's so terrifying. If you don't compete with Wu Xiaofu, you won't know how powerful Wu Xiaofu is.

After completing the vascular reconstruction, Wu Xiaofu has started liver resection.

After vascular reconstruction, the next task seemed to be easier. According to the ischemic line, the en-block resection of the left half liver + caudate lobe was completed, including the clearance of 12, 13, and 8 lymph nodes.

En-block resection means the removal of the entire mass. It is now very popular in medicine, especially in orthopedic spine surgery.

As for the lymph nodes, they were grouped before the operation. Groups 12, 13 and 8 were all lymph node tissues surrounding the left half of the liver + caudate lobe.

These are tissues affected by bile duct cancer and must be cleared away.

The right liver section shows the openings of the right anterior ventral branch, right anterior dorsal branch, and right posterior branch hepatic ducts.

Next, Wu Xiaofu reshaped the three openings of the right hepatic duct into a common opening and performed cholechojejunostomy in the space between the dorsal hepatic artery and the ventral portal vein. At this point, the operation was almost over.

Yu Shifu originally had something to do, so he asked Wu Xiaofu to go so that he could leave at any time without delaying anything.

But watching Wu Xiaofu's operation, Yu Shifu was actually fascinated. You know, this operation is already the ceiling level of abdominal surgery. No matter which professor comes, he has to be very careful. The operation time must be guaranteed to be around four to five hours. Seven to eight hours, or even ten hours is also normal.

But Wu Xiaofu looked at the time and found that it had only been two hours.

Why do I feel like I'm being hit on the beach by the waves behind me?
(End of this chapter)