Regardless of whether it was a liver hydatid or a malignant tumor, once it invaded the portal vein, the high probability meant that the difficulty of the surgery would increase exponentially.
“The thoracic department has opened four operating theaters in the operating theater. They’ve gone crazy tonight and even the thoracic department’s experts can’t really help.” Dong Jia complained, “Professor Zhao said that he wanted me to look for you if there’s anything. If anything happens, he’ll be responsible. He hasn’t even called you and yet, you’re already here.”
As he spoke, a figure rushed in quickly, panting.
“Professor Yang!” Dong Jia quickly shouted.
“How’s the resuscitation?” The professor was still out of breath and had probably ran all the way there.
“It’s stable for now, but…”
“I’ll go change.” Professor Yang did not look at Zheng Ren and Su Yun. He probably thought that they were passersby.
“Do you have radiographic films?” Zheng Ren asked.
“Yes, I have CT scans done this afternoon. I have both chest and abdomen.” Dong Jia immediately turned around and took out a bag of radiographic films from under the patient’s bed and handed it to Su Yun.
“You guys take a look first. I’ll go take care of the patient. Don’t let anything happen later.” Dong Jia did not forget to be polite in the end.
Su Yun carried the bag of radiographic films and did not say anything. He turned around and went straight to the office.
When the radiographic films were inserted into the radiographic film viewer, Su Yun was stunned.
Two layers of CT images were directly reflected in his eyes. On one layer, a small snake appeared in his field of vision. The snake was not big, less than 10 cm, but its shape was realistic. On the other layer, it was a ball of gauze.
What the f*ck? Was this put in as an experiment?
Zheng Ren was still in his usual position. He rested his chin on his right hand and looked at the radiographic films seriously.
No matter how talented Su Yun was, he was not from the general surgery department. He did not know much about liver hydatidosis, which was a rare disease in the Imperial Capital.
Seeing that Zheng Ren was focused on the radiographic films, he took out a chest CT scan to take a look.
The imaging findings were shocking.
Liver hydatid disease was widespread, involving four abdominal and thoracic organs as well as important blood vessels.
Looking at the images, there were some similarities with cancer.
It was also appropriate to say that it was parasitic cancer.
Hydatid worms invaded about 65% of the liver and formed a huge and hard lump. They also invaded the right kidney and renal veins.
The hydatid worms invaded a large area of the diaphragm, then invaded the chest and right lower lung, and spread to the pericardium.
The hydatid worm went deep into the largest vein and its branches in the abdomen, causing a total occlusion of the vena cava, which was 17cm long, from the right renal vein to the right atrium. The four sets of blood vessels that entered and exited the liver at the same time, including the hepatic artery, the portal vein, the hepatic vein, and the bile duct, were all severely damaged.
It was similar to Budd-chiari syndrome, but the range of the portal vein erosion was simply too wide. It was impossible to treat it through interventional surgery.
Looking at the erosion of the chest cavity, the wall of the bubble was relatively thin. Zheng Ren estimated that the cyst on the right side of the chest had ruptured, resulting in septic shock.
However, this surgery…was a little too complicated.
If it was done, the chances of the patient leaving the hospital alive were not very high. At the very most, there was a 30% chance.
That was not even counting. Even if the patient left the hospital alive, the chance of surviving the critical period was not more than 20%.
After calculating, the probability of the patient being able to recover and leave the hospital after the surgery was only 5-6%.
This was practically dancing on the tip of a knife!
“Boss, this surgery can’t be done.” Su Yun looked at the radiographic films for two minutes and finally came to a conclusion.
Zheng Ren knew what Su Yun meant. In fact, he himself also thought the same.
For patients who did not do this surgery, they would die. If they did it, they would still have about 5% hope of surviving. Most doctors would choose to give up.
‘It has nothing to do with me if I don’t go on stage. If I go on stage, I’ll be affected.’
‘Who would be confident with tackling such a difficult surgery?’
‘What about the patient’s family members? The chances of success are so low. If it fails…’
In Sea City General Hospital, Zheng Ren performed a bleeding stop operation on a pregnant woman. The surgery was successful, but the patient’s family members still took the patient away and prepared to sue Zheng Ren and the doctors in the obstetrics department.
However, since the medical administration division had already filed the case, it meant that the hospital would take responsibility for the matter. Zheng Ren looked at the radiographic films, and his mind was already thinking about how to perform the operation.
To watch the patient die? Zheng Ren really could not do that.
It was fine if it was a disease like triple-negative breast cancer where even if Zheng Ren used up all the time for the operation, he would not be able to solve it.
However, even though this patient looked severe, there was still a slight possibility.
Although Zheng Ren had left Sea City General Hospital for a few months, he had first carried out a mission when he went for earthquake relief. He had not adapted to the situation of only performing interventional surgery.
The first thing he did was habitually was put himself in the position of chief resident of the emergency department.
He had to help with patient resuscitation no matter what, even if there would be endless trouble in the future.
He would give it a try. Even if he had the time to train for the surgery, Zheng Ren still did not have the confidence.
This kind of surgery was simply too damn difficult.
“You are…” Zheng Ren was pondering when Professor Yang’s voice came over. He had not recovered from his shock. He was panting heavily. He had just changed into his white clothes, his chest drenched in sweat.
“Hello, Professor Yang. I’m Zheng Ren from the interventional department.”
Professor Yang, who was leading the team, saw that Zheng Ren and Su Yun were looking at the radiographic films. But soon, professor Yang recalled what Zheng Ren had just said.
“Are you Zheng Ren from the interventional department?”
“Yes.” Zheng Ren nodded. He did not smile. He was thinking about how to perform the surgery.
Even if he went to the operating theater to train for the surgery, he still had to have some ideas.
However, this patient’s surgery…was a mess. How could he have any ideas?
“Are you the same Boss Zheng who was nominated for the Nobel Prize?” Professor Yang asked in a low voice.
“Yes.” Zheng Ren grunted again.
“Nice to meet you.” Professor Yang extended his hand and shook Zheng Ren’s hand. Then, he asked, “Can intervention solve the problem of the portal vein?”
“If we wait for the liver source, we can try it. But the patient is currently in an acute shock stage. If we operate on him, the vascular department will need to carry out reconstruction surgery,” Zheng Ren answered straightforwardly.
Professor Yang was obviously a little disappointed.
He had known about the patient’s condition since a long time ago. Initially, he wanted to delay as much as possible and carry out the slow-motion liver transplant surgery with the authorization of the hospital. He did not expect that there would be a ruptured cyst at night.
He thought that the Nobel Prize candidate would have some good methods… Although Zheng Ren was telling the truth, Professor Yang could not help but sigh.
“Boss, what’s with this small snake?” Su Yun looked at the radiographic films and suddenly asked.
“It’s the performance of the liver hydatid image. It’s the same as the gauze below. It’s not real. The two documents published in the European Journal of Radiology in 1990 and 1991 had a classic description of this characteristic image: the snake-like sign and the spinning sign that has diagnostic significance for acute abdomen due to rupture of the liver hydatid,” Zheng Ren said.
Su Yun took a deep breath, feeling very troubled.
Confirming the gauze and the small snake was actually not important made all the difference.
Professor Yang sighed and picked up his phone. While contacting the people, he asked Dong Jia to prepare to send the patient to the stage.
This was a hot potato but if the surgery was not performed, the patient would die.
No matter what, he had to report it and then go on stage to give it a try. As for the troublesome matters in the future… They could talk about it in the future.
“Boss, this surgery can’t be done. You’re new here, so don’t let others catch you. Not to mention Professor Zhao, the chiefs of each department and the leading professors are here. Don’t show off.” Su Yun shook his head and reminded Zheng Ren again.
“Can you do the chest?” Zheng Ren suddenly asked.
“I can definitely do the chest, but the abdomen…” As he spoke, Su Yun pointed at the portal vein and right kidney on the radiographic films and said, “I’m afraid you can’t do these, either.”
..
..
At this moment, Professor Zhao of the intervention department was at home. He was sitting in the study and reading a foreign language journal.
“Who did you call just now?” Professor Zhao’s wife asked.
“The new Zheng Ren.”
“The junior doctor who asked for a bed from you?” Professor Zhao’s wife raised her eyebrows. When she heard Zheng Ren’s name, she became unhappy.
Cutting off one’s income was like killing one’s parents.
“What junior doctor? He’s Department Chief Kong’s treasure and a candidate for the Nobel Prize,” Professor Zhao said with a smile.
“Just pretend. Why did you call him when you had nothing to do?”
“This is not the afternoon consultation for the whole hospital. There is a patient with liver hydatid disease. All the departments have gone to see him.”
“Does it have anything to do with you?”
“No, but this is something that needs everyone’s help. When we do the autogenous liver transplantation in the end, the imaging will be faster.”
“Then why did you call Zheng Ren?”
“I can’t do anything. It doesn’t mean that Boss Zheng Can’t do anything either.” Professor Zhao leaned against the chair and closed his eyes as if he was deep in thought.
“He…”
“The last time I did scientific research, I heard that he graduated from the General Surgery Department.”
“Then you’re letting him go? Are you giving him a chance to show his face in front of others?” Professor Zhao’s wife did not understand.
“A chance? I’m just afraid that he won’t dare to do it.” Professor Zhao smiled and said, “He’s from Sea City. I don’t know why Department Chief Kong has taken a fancy to him. He’s the chief resident of the emergency department in Sea City. I’m hoping that he will perform the surgery. Tell me, no matter who it is, can he be allowed to perform the surgery? I’m not giving him a bed for free.”
“You’re the only one with a lot of thoughts.”
“If he dares to request to perform the surgery, then he won’t be able to stand on his feet in the Imperial Capital Hospital anymore.” Professor Zhao smiled and said, “If that’s the case, then it would really save us a lot of trouble.”
“It’s the same for Department Chief Kong. He’s just a junior doctor. Is there a need for him to snatch the bed from you guys?”
“He’s a candidate for the Nobel Prize. If I were Department Chief Kong, I would do the same. Anyway, he’s going to retire soon. It doesn’t matter. It’s a pity. If I had fought for the position of chief director two years later and met him again, how great would that have been?”
“He’s so capable?” Professor Zhao’s wife was surprised.
“I can’t compete with him in surgery, especially in TIPS surgery. His technique is so smooth. However, he’s young and impetuous. He’s so capable at such a young age, so he must be very ambitious. I don’t know what’s going on over there today. If he really doesn’t know his limits and wants to go on stage, it’ll be fun to watch.”
“He won’t really go on stage to be the chief surgeon, will he?”
“How is that possible? Is the emergency department’s reputation just a joke? Besides, was Yang Rui, who had stayed at home in the Department of Hepatobiliary and Pancreatic Surgery, someone who was easy to deal with? In all these years, he has never submitted to anyone. A few years ago, he was still in a heated argument with Lin Guodong. In the end, Lin Guodong was forced to leave. What right does a junior doctor who isn’t even thirty years old in the interventional department, have to steal Yang Rui’s spotlight? In that case, I’m really looking forward to it.”
