Since 1981 Health School Chapter 271

  Chapter 271 Tumor markers are wrong

  After finishing the anesthesia, the anesthetist returns to his small bench.

  While writing down the anesthesia record, he quietly glanced at the little doctor in front of him who was looking around, who was said to be from a health center in the Yuezhong area, with a little contempt in his heart, thinking:

   "Heh, doctors from the countryside just don't know much about the equipment in the operating room."

   Actually wronged Chen Qi

   Still the same sentence, why haven't Chen Qi and Qi met before? The reason why he turned into a curious baby is to evaluate how far the medicine of this era has developed.

   To talk about advanced, he will know who is the real ignorant "country guy" when he takes out the equipment in the operating room in his space.

  This "exploratory laparotomy" is performed by Chen Qi, the first assistant is Zhao Chen, and the second assistant is two other small doctors from the third department of surgery.

   Xu Hongxing and Li Baotian have also completed hand disinfection, and are ready to go on stage in surgical gowns and gloves.

  Especially Xu Hongxing, although he agreed to Chen Qi's application for teaching surgery, he had no idea in his heart. In case of accidents during the operation, he was ready to take over from Chen Qi as the chief surgeon at any time.

  Zhao Chen had already finished laying the surgical towel, nodded and said, "President Chen, the preparations for the operation are complete, and we can begin."

  The anesthetist also said beside him: "The anesthesia is complete, the patient's vital signs are balanced, and the patient can start."

  Chen Qi nodded, and said in a low voice: "Okay, then I will start, scalpel..."

  Decades later, in addition to advanced CT and MR positioning for this huge abdominal tumor, the operation will generally adopt a "laparoscopic" approach.

  Laparoscopic surgery has good lighting, better field of vision than open surgery, safe and reliable, and more thorough tumor resection and dissection.

   At the same time, it has the advantages of less trauma, less bleeding, faster recovery, less impact on the body's immune system, and shorter hospital stay.

   But in 1983, traditional surgery was still the world. Even in hospitals that didn't even have CT machines, it would be nice to give you an electric knife.

  Chen Qi slandered in his heart, but still took a deep breath, and began to concentrate on preparing for the operation. A longitudinal incision of about 10cm was directly made on the left side of the patient below the navel.

  Zhao Chen glanced in surprise at Chen Qi, the chief surgeon, and at Director Xu behind Chen Qi.

  Actually, many people in the operating room looked as surprised as Zhao Chen, because compared to the huge tumor, the 10cm incision is too small, so small that there is no way to remove the huge tumor.

  Many doctors are directly shaking their heads, not to mention the level of surgery, just from the size of the incision, it can be seen that the level of grassroots doctors is not enough.

  Zhao Chen didn't have any bad intentions, and while assisting the operation, he asked doubtfully:

   "Dean Chen, according to the previous examination, it is estimated that the diameter of this huge tumor is at least 30cm. With such a small incision, how will you completely remove the tumor?"

  Chen Qi didn't look up, but he still answered:

   "Now we lack the necessary auxiliary examinations. Although the tumor indicators are high and there is fluid from unknown sources, we cannot easily conclude that the tumor is malignant. Otherwise, why do we need to do laparotomy?

  There are benign surgical methods for benign ones, and malignant surgical methods for malignant ones. If it is finally judged to be malignant, we can expand the incision. But if I make a large incision of 30cm at the beginning, and the tumor is benign in the end, the patient will suffer an extra cut and affect the prognosis. "

  Chen Qi's statement still made some sense, and several older doctors nodded slightly to express their agreement.

  The young doctors scoffed at each other, quite disapproving, the tumor index CA199 has reached 2043U/L, how could it not be ovarian cancer? Is this possible with benign cysts?

  Therefore, many doctors in the operating room once again questioned Chen Qi's level, thinking that he could not understand the tumor indicators, probably because Yuezhong did not carry out this latest examination?

  Chen Qi didn't know that he had already been despised N times, he was still advancing rapidly, and just as he opened the peritoneum and entered the abdominal cavity, a pale yellow liquid flowed out.

  Zhao Chen quickly sucked up the liquid with a suction device.

  Chen Qi still didn't look up, and ordered: "Take this liquid to the pathology department for exfoliative cytology examination immediately, and report the results as soon as possible."

At this time, inside the surgical incision, a huge multilocular cyst appeared in front of everyone. After several assistants measured it, it was in line with the prediction. It reached a size of 30cm*30cm*15cm, and the upper edge almost covered the spleen. to the side.

  Although the doctors behind were very anxious to see the huge tumor up close, there were rules in the operating room, no one could approach the operating table without the permission of the chief surgeon, otherwise it would cause pollution.

   Li Baotian and Xu Hongxing received preferential treatment. They stepped on the pedestal cabinet. Looking from the top to the bottom, the vision is quite clear.

  Chen Qi wrapped the incision with gauze and started the abdominal examination.

  Because this is a "teaching operation", Chen Qi can't be silent like before, and now he needs to explain every step and its meaning continuously.

  In the quiet operating room, only Chen Qi made a voice:

   "The surface of the tumor is smooth without adhesion."

   "The tumor originates from the left ovary, and the lower edge of the cyst is densely adhered to the posterior wall of the uterus."

   "The uterus is often large, the right adnexa is normal, and the right ovary is 2*2*1cm."

   "The surface of the liver and spleen is smooth, the surface of the peritoneum and intestines are smooth, and there is no abnormality. There is no obvious enlarged lymph node in the pelvic cavity."

  According to Chen Qi's report, the doctors in the operating room are all thinking, and each doctor has his own judgment.

  After the abdomen test was over, Chen Qi gave the final conclusion decisively: "Ms. Li, Director Xu, I think this tumor is benign."

  Xu Hongxing only said one sentence: "Chen Qi, Zhao Chen, get out of the way first, and I will take a look with Director Li."

  Chen Qi and Zhao Chen put their hands in the air in front of their chests, turned back to back with the two teachers, and stepped out from the operating table.

  Xu Hongxing took the position of the chief surgeon, and immediately checked it again according to the procedure, then nodded to Li Baotian who was opposite:

   "Chen Qi, I support your judgment. The tumor does not seem to be malignant. Don't move it yet. Wait for the report from the pathology room before deciding on the next operation."

   At this time, a doctor who was watching couldn't help asking:

"Dr. Chen, in the patient's preoperative examination report, the tumor index was very high, and not a little bit high. Why do you insist that the tumor is benign now? When you chose the incision before, you said that it could not be ruled out as benign. Your confidence And what is the basis for the judgment?"

   "That's right, the tumor indicator detection reagent is still imported from abroad, and there should be no mistakes in foreign things."

   "If the tumor indicators don't count, why do we need to do this test? Didn't we waste the rich foreign exchange in vain?"

  The doctors in the operating room suddenly started talking.

  Chen Qi is a bit strange.

  Tumor indicators can only be used as a reference in clinical practice, or for dynamic observation, but they are by no means the basis for judging whether you have a malignant tumor.

  This is basic medical knowledge that any little doctor can understand. Why don't these doctors from the First Affiliated Hospital of the Province not understand it?

  Chen Qi asked Xu Hongxing next to him in puzzlement:

   "Director Xu, how long has your First Affiliated Hospital carried out this tumor index test?"

   "Oh, this is a new technology we introduced from abroad last year, and now the hospital attaches great importance to this inspection."

  Chen Qi thought it was no wonder, he was deceived by a foreigner, and some things were not clearly stated. There are also some young doctors who always think that the moon in foreign countries is rounder than that in China, so they think that the tumor index is the "gold standard".

   "Director Xu, fellow seniors, I have also learned about tumor indicators from some foreign journals. You have a small misunderstanding about this point, that is, tumor indicators are only a reference indicator and cannot be regarded as a diagnostic indicator.

For example, the carbohydrate antigen ca199 of this patient reached 2043U/L. Indeed, high ca199 syndrome will be formed in malignant tumors, but some benign lesions such as digestive tract inflammation and liver cirrhosis will also cause different degrees of increase in ca199 value .

  Therefore, an occasional high ca199 test has little clinical significance. If the index continues to rise in a diagnosed malignant tumor, it means that the disease is progressing, the disease has relapsed, or the curative effect after treatment is not good, which generally indicates that the prognosis is poor. "

  A little doctor was not convinced: "According to what you said, the tumor indicators are all inaccurate, so it is not caused, and it is necessary for clinical application?"

  Chen Qi shook his head:

  “That's not necessarily the case. Some tumor indicators are still very specific. For example, AFP and alphfetoprotein can reflect well-differentiated hepatocellular carcinoma, and their increase is often earlier than clinical symptoms such as liver pain.

It can significantly improve the surgical resection rate and one-year survival rate of liver cancer, but then again, not all elevated AFP is liver cancer. For example, acute and chronic hepatitis can also increase AFP, but most of them are within 300 μg, and often with elevated transaminases. "

  The little doctor was still dissatisfied, and asked again: "Dr. Chen, can you specifically talk about the clinical significance of tumor indicators?"

  "Yes, clinically, tumor markers are first used for the prognosis analysis of patients with known malignant tumors, such as the analysis of malignancy, invasiveness, spread, survival, etc.;

  Secondly, for those tumor markers that increase before treatment, they can be used to evaluate the efficacy during treatment, decide whether to change the treatment plan, diagnose whether there is residue, and use it to diagnose recurrence during follow-up;

  Thirdly, for patients with definite mass or metastasis, it can be used for auxiliary diagnosis and tumor classification of tumor origin. Only individual tumor markers can be used for screening and early diagnosis of corresponding tumors during physical examination. "

  Chen Qi paused again at this point, and smiled embarrassedly:

"Our grassroots hospitals have few inspection items, but your provincial hospitals are different. They offer more tumor indicators. This thing has high profits and can make money. It is much more than you earning a few cents for registration fees. The director likes to open inspections. A single doctor."

   Hehehe~~~~

  (end of this chapter)

Chapter end