Doctor’s Life Simulator

Hangzhou, the First Affiliated Hospital of Zijingang University.

In the oral and maxillofacial surgery conference room, a few experts who can pull out any one can shock the medical community in Zhejiang Province are consulting on the treatment plan for a special patient.

Yang Tangjue, director of oral and maxillofacial surgery at the First Affiliated Hospital of Zijingang University, frowned:

"The only feasible plan is this: the patient's left lingual border squamous cell carcinoma with ipsilateral cervical lymph node metastasis, the cancer invades the external carotid artery, in order to achieve a tumor-free state and radical resection, the external carotid artery must be spontaneously removed. The initial segment is ligated and excised upwards about 8cm..."

Hearing Director Yang's words, Yu Ping, the director of general surgery, looked at the following materials:

"However, in this case, extended resection of the primary tumor + neck dissection + reconstruction and repair of the external carotid artery should be performed at the same time, and the superior thyroid artery in this case starts above the external carotid artery, together with the superior thyroid artery, tongue The artery, the initial segment of the facial artery, is ligated and cut off. It is very difficult to revascularize the neck recipient area, which is similar to the 'frozen neck'."

Director Yang smiled bitterly:

"Yes, this is also the biggest challenge of this operation. However, if the external carotid artery is not removed and recurrence occurs again, the patient's survival rate is less than 1%."

Yu Ping also nodded in approval:

"In this case, the only way to solve this vascular reconstruction is to find a solution. Director Meng, your burn department has a lot of experience in dealing with this kind of wound repair and vascular repair. Do you have any good solutions?"

Director Yang and Director Yu both looked at Director Meng Zhoutong, who is also the director of the Burn Center of the First Affiliated Hospital of Zijingang University.

Meng Zhoutong naturally has deep knowledge in wound repair and blood vessel repair. After thinking about it, he said:

"The plan is not without it, but it is very difficult. Similar to this case, we have tried to prepare an ultra-long vascular pedicle tissue flap to anastomose the contralateral neck blood vessels, transverse cervical blood vessels, and vascular bridging can also be used. It is only required for flap preparation. Very high, shortcoming of vascular anastomosis and additional trauma to open up a third surgical field ... the result, not very ideal, can only try."

Hearing Meng Zhoutong's plan, the two directors thought about it and didn't give a better plan:

"Probably, this is already the best solution. Then we will try to prepare ultra-long vascular pedicle tissue to repair the defect."

After the three chief directors initially formulated the plan, the man who had been silent in the conference room finally spoke:

"Three directors, I don't care how difficult your plan is, but this time the operation must be successful. The identity of this patient is very special. I will reiterate it to you again. She is the aunt of our director Wen Yunqi. My aunt's own aunt can't be cured, and what face is called the strongest hospital in Zhejiang Province."

"We are the No. 1 Hospital of Zijing Port! We have gathered the top medical talents in Zhejiang Province. No matter how difficult the operation is, there are doctors who can do it. As long as you speak up, I can give you the surgeons from all departments of the No. 1 Hospital of Zijing Port. Arrange to assist you in completing this operation."

Lin Qi, the vice president of the First Hospital of Bauhinia Harbor, spoke loudly.

"We can guarantee the resection of the primary tumor and neck lymph node dissection, but because the patient's own condition is relatively bad, they are afraid that a suitable recipient artery will not be found. This is a defect of the plan, not the operator's skill. Perfectly resolved."

Regarding Vice President Lin's request, Director Meng finally expressed his judgment despite the pressure:

"In this way, the deputy director of our department, Shen Jiamo, is very accomplished in free flap transplantation, and he is also the physician who has the deepest knowledge of cutting-edge technologies in our department. I immediately contacted him and participated in the consultation to see if there was any more change. A good solution to the difficult vessels in the neck recipient area of ​​the 'frozen neck'."

Lin Qi's face was not very good-looking:

"I'll give you another half an hour, and I must make the best treatment plan for me. I'll visit Ms. Wenxia now."

Lin Qi left several directors to visit Wen Xia alone, the aunt of Wen Yunqi, the principal of the first hospital in Zijingang.

In addition, Wen Xia also has an identity, which very few people know. Due to the low profile of President Wen and Ms. Wen Xia, only a few core figures in the entire Zijingang First Hospital know that Wen Xia's eldest son is the current Huaguo Academician of the Academy of Engineering.

If his own hospital really can't come up with the best treatment plan, then for the safety of Ms. Wen Xia, he can only suggest that Ms. Wen Xia be transferred to the hospital in the magic capital or the imperial capital.

However, at that time, it would be a huge loss to the reputation of their hospital, a disgrace to him personally, and a disgrace to the entire Zijingang First Hospital.

At this moment, in the conference room, several directors continued to discuss better plans. After a while, Deputy Director Shen Jiamo hurried to the conference room of Oral and Maxillofacial Surgery.

As soon as he entered the conference room, Meng Zhoutong beckoned and called Shen Jiamo to him in a friendly tone:

"Jia Mo, I know that you are very experienced in free flap transplantation and vascular reconstruction, and it is also your area of ​​expertise. Let's take a look at the patient's condition. Is there a better solution that can reduce the difficulty of flap preparation? A more convenient and safe solution for external carotid artery repair.”

Several directors waited quietly for Shen Jiamo's conclusion. They did not mention their plan too much, but showed him all the information.

After taking the CT, MRI, PET-CT and other imaging data of the patient's tongue squamous cell carcinoma recurrence after neck dissection, Shen Jiamo looked at it carefully.

"The patient's cancer metastases are very serious. Unconventional lymph nodes such as parapharyngeal, surrounding carotid, floor of mouth, base of external maxillary artery, paralingual lymph node, parapharyngeal lymph node, and deep lymph node in the upper carotid artery... Extended resection of the primary tumor + neck dissection and repair of the external carotid artery were performed."

Basically, Shen Jiamo's judgment is similar to Meng Zhoutong's, but he has a bold new plan for the repair of the external carotid artery.

This is also the biggest gain of his trip to the first hospital in Tahecheng this time.

However, Shen Jiamo has only just accepted the retrograde blood supply mode proposed by Qin Lang, and he still lacks clinical experience in the specific operation and degree of manipulation.

Although he has excellent clinical talent, he still needs surgery to practice mastering, just like sharpshooters are fed with bullets, and top clinical surgeons ~www.readwn.com~ also rely on patients to practice one knife at a time.

When Shen Jiaqi was thinking, sometimes excited, sometimes hesitant, Meng Zhoutong asked:

"Jia Mo, do you have any new plans? Don't worry, we have the best equipment and doctors to cooperate with you!"

Shen Jiamo took a deep breath and said truthfully:

"To be honest with the directors, I do have a brand new idea, but I have just observed this technique once. I can deduce the whole idea and treatment plan, but the specific details of the operation are still lacking in practice verification."

Shen Jiamo directly took a pen and started to design the surgical plan on the small whiteboard in the conference room:

"Directors, the plan I proposed this time is a brand new model, but I can guarantee that it is feasible after clinical verification."

I saw that Shen Jiamo drew the patient's "frozen neck" on the small whiteboard, and then instead of using conventional ultra-long vascular pedicle tissue anastomosis, a completely different local distal stump vessel retrograde blood supply was used. model.

While drawing, marking and explaining the principle, several directors also felt a sense of enlightenment, especially Director Meng Zhoutong:

"Jia Mo, your retrograde blood supply model is simply amazing. Is this the latest technique created by a professor abroad or domestic?"

Director Yang and Director Yu are also brilliance in their eyes:

"Wonderful, using the retrograde blood supply mode, the blood vessels in the recipient area are solved, and the position of the blood vessels in the recipient area is completely freed!"

After several directors understood the genius idea proposed by Shen Jiaqi, Vice President Lin Qi walked in with a solemn expression.

"Everyone, there are five minutes left, the plan I want!"