Since 1981 Health School Chapter 548

   For those who gossip, the biggest news in the People's Hospital is that Jiang Aiguo was fired.

  But for people who like to engage in clinical practice and technology, the biggest news of the People's Hospital should be that President Chen will start to give public lectures and perform public surgery again.

  Besides, this public surgery has become more high-end and upscale because of the visit of professors from Fudan Zhongshan Hospital.

  Fudan Zhongshan, this is a well-known brand in China. It was originally an unattainable existence for a local hospital of the level of Yuezhong People's Hospital.

   As a result, when he heard that his dean could perform endoscopic surgery, he came all the way here eagerly. He said it was a visit, but he was actually studying, because the professor at Fudan University did not know how to do this kind of endoscopic surgery.

  This has made all the staff of the People's Hospital have a lot of throats when they speak these days.

  So when Chen Qi was about to open the operation after lunch, the doctors sitting in the auditorium on the second floor of the People's Hospital watching the operation were not limited to the People's Hospital itself.

  Principal Li of Haidong Medical University personally led the team. Doctors from 5 affiliated hospitals, as well as professors and associate professors in charge of teaching in the university came.

  Of course, bigwigs like President Li, Dean Wang of the First Affiliated Hospital, and Xu Jinxing, Chen Qi's master tutor, all went into the operating room to watch the operation with their own eyes, while other professors and directors could only watch the live broadcast in the auditorium.

  Today's operation was performed by Chen Qi, and the assistants were naturally Professor Zhang Weizhong and Lan Lijuan.

  Yi Zewen, Dean Chen's first confidant, took the initiative to act as a photographer.

  In the operating room, the minor patient is still under general anesthesia, while in the operating room office, Chen Qi is writing and drawing on paper, explaining his operation ideas to everyone.

   It must be explained, and this explanation is also broadcast live, otherwise others will not understand endoscopic surgery at all.

  Different from traditional surgery, the endoscopic surgery Chen Qi is going to do is to poke the gastroscope through the mouth.

   Gastroscopy is still a new thing in China, and non-digestive physicians have never had contact with it.

   Moreover, the domestic textbooks are still lagging behind. Young people are fine, but older doctors can't understand the TV screen at all. Where is the anatomical part of the stabbed place.

   What I saw was a small passage like the inside of the intestine, with pink or bright red fleshy things beside it.

   Moreover, Chen Qi still wants to play a kind of "tunnel punching technique" today. The clinical technique of POEM was not a new thing in his previous life. Almost any endoscopist can do it, but it's 1988.

  So don't say that doctors in other departments can't understand it, I'm afraid doctors in gastroenterology can't understand it either.

  Professor Zhang Weizhong sat beside Chen Qi, watching him draw diagrams, and kept asking questions like a primary school student.

   "Dean Chen, you mean that we have never heard of your achalasia, can you help explain it?"

  At this time, Chen Qi's voice sounded from the stereo in the auditorium:

   "Okay, before the operation, let me talk about what achalasia is, please remember to take notes.

  We know that the place where the tube connects to the stomach is called the cardia, and the cardia is usually closed, but when it enters, the cardia will open, so that things can enter the stomach through the tube.

  If the cardia cannot be opened normally when swallowing, that is to say, it cannot be relaxed, it will cause dysphagia and choking sensation, and the retention time of food and saliva in the tube is longer, and it is easy to overflow when bending over or lying down, forming a reaction.

   Seriously, like eating grass, the feeling of rumination, of course not real rumination.

  Some diseases cause chest pain. Due to poor intake, many patients will experience weight loss and emaciation, which is what we call achalasia clinically.

  Of course, this disease must be identified, because esophageal tumors and even gastroesophageal reflux disease have similar symptoms, which requires our clinicians to do more endoscopy, barium meal, and esophageal manometry.

  This disease has been found many times in foreign countries, and there is no such concept in China, but everyone should remember that in the future, achalasia will also appear in our domestic gastroenterology department, and it was our Yuezhong People's Hospital who first proposed this concept.

   Next, I will implement a new technology to treat this achalasia, and then we will form an expert consensus, and then upgrade this consensus to a clinical guideline, which is also formulated by our Yuezhong People's Hospital. "

  In the auditorium, the doctors of the People's Hospital burst into laughter, followed by warm applause.

   Principal Li smiled and cursed at Lao Guo beside him:

   "This kid is a master at arousing the emotions of the masses. No wonder he was in charge of the work of the masses and women in the Fourth Academy."

  All the bosses in the operating room also laughed softly.

  Professor Zhang Weizhong is not familiar with the big guys, so he acts as a curious baby on the side, doing the work of making fans:

   "Then Dean Chen, how did the achalasia you mentioned happen? What is the new surgical idea?"

  Chen Qi was explaining, while writing and drawing on the white paper, Yi Zewen pushed the camera lens forward, and this simple schematic diagram appeared on the TV screen:

   "The etiology of achalasia was not very clear before. Foreign experts have not researched it. This gives us a chance. If anyone can research it and publish it in a top international journal, I will directly give you a promotion and a salary increase."

   There was another chuckle in the venue. This is the new rule after Chen Qi became the dean. When the paper is published, there will be different rewards according to the level of the journal.

  If it is a foreign journal, especially the four major journals, it will directly reward 5,000 yuan, and the title will be promoted to a higher level. This is very tempting, but of course it is also very difficult.

   Chen Qi's explanation continues:

  “However, it is clear that the ultimate decision to close or open the cardia is the proper muscle part of the cardia, which can be called the cardia sphincter or the inferior tube sphincter.

  It is this part of the muscle that cannot relax due to various reasons, resulting in the continuous closure of the cardia, unable to respond to the temptation of various delicacies, and resulting in difficulty swallowing.

   Therefore, if we treat achalasia, we can cut off this part of the muscle, which is equivalent to opening the dam of the barrier, so that the object can enter the stomach through the tube, so as to relieve the symptoms of dysphagia. "

   With such an explanation, not only Professor Zhang Weizhong understood, but everyone in the auditorium also understood the principle of treatment.

"In the past, incision of the inferior sphincter required a thoracotomy and amputation of the ribs. It was scary, and then a mediastinectomy had many side effects, but the effect of the operation was not very good. So today I will let you see what it means. The majesty of endoscopic surgery."

  The anesthesiologist ran over at this time:

   "Dean Chen, the child is under general anesthesia and can undergo surgery at any time."

  Chen Qi stood up: "Let's go, let's go to the operating room. Professor Zhang and Director Lan will come with me for preoperative disinfection."

  The operation started, and everyone held their breath no matter whether it was in the operating room or the auditorium.

  Especially those unconvinced surgeons, all of them want to see how the endoscope, which can eliminate themselves, can show its prestige?

  The previous fundoplication was only an accidental success, and many surgeons were suffocated.

  The operation was underway, and Chen Qi successfully inserted the gastroscope tube, passed through the esophagus, all the way down, until reaching the junction of the cardia and the esophagus, where the obstruction occurred.

  At this time, Chen Qi's voice sounded again in the stereo:

"Have you seen it? This is where the obstruction occurs. The root cause is that the sphincter around the esophagus has been kept tight, causing the lower end of the esophagus to be tightened and closed, and the upper end of the esophagus to become thicker. So how to relieve the lower esophageal sphincter? How about locking the machine?"

  All the doctors' minds were spinning rapidly, including Professor Zhang Weizhong, President Li, President Wang and other famous doctors, they couldn't figure it out.

   After all, the gastroscope is now inside the esophagus, and the sphincter is outside the esophagus, separated by a layer of esophageal wall. How does your gastroscope deal with the muscles?

   Make a hole in the esophagus?

   This is obviously an invasive operation, and it is not like the safe, convenient, non-invasive and effective endoscopic surgery principle mentioned earlier.

  And the consequences of esophageal perforation are also very serious. If the perforation is close to a large blood vessel, such as the aorta, it is a very dangerous behavior.

   If complications such as mediastinal infection, thoracic infection, aortic infection or even rupture occur, it can completely cause the death of the patient.

  If the harm is far greater than the benefit, then this endoscopic surgery is of little significance.

  All the doctors present are professional doctors, everyone has a steelyard in their hearts, and everyone wants to see how this amazing dean handles this difficult problem.

   Contrary to everyone's expectations, Chen Qi did not stay too much in the esophagus and cardia. After showing everyone the obstructed area and leaving a few photos, the gastroscope went backwards all the way and slowly began to be pulled out.

  This action caused question marks to appear on everyone's heads.

What's going on here? Didn't do the surgery? Then why did you boast so much, Chen Qi, before?

   This is a live broadcast, so many bigwigs are watching, it is a big car rollover accident.

   Just when everyone thought that Chen Qi was going to admit defeat and stop continuing the operation, Chen Qi suddenly stopped the gastroscope at a place about 10cm away from the cardia and did not move.

   "Professor Zhang, give me the electric knife."

  Zhang Weizhong came back to his senses: "Oh good, electric knife, electric knife..."

  Lan Lijuan quietly handed a tube with an electric knife on the front end to Professor Zhang. There was no way, Professor Zhang had never done endoscopic surgery and was not familiar with the equipment.

  Besides, the gastroscope tubes of each manufacturer are different, and they are mixed in a big box. It is impossible for unskilled people to find them at a glance.

   Chen Qi took the electric knife tube and inserted it into the empty slot along the gastroscope. Everyone could clearly see the electric knife exposed on the screen, and then Chen Qi slowly cut the esophageal mucosa, making a small incision directly.

  When, when, when~~~~

There are more and more question marks on everyone's head. I can't understand why Dr. Chen made a small opening on the esophageal mucosa, but it didn't penetrate the esophageal wall. The problem is that your gastroscope still can't stick out of the esophagus. .

   Could it be that you can fetch things from a distance?

  Chen Qi gave the order on his own: "Give me a needle and prepare saline."

  Zhang Curious Baby Wei Zhong couldn't help asking: "Dean Chen, why did you make such an incision? And why do you want saline?"

   This is also a common problem for all doctors.

  Chen Qi continued to explain to everyone while operating. After all, this is a public teaching surgery class, and the main purpose is to let people understand.

  "Before answering this question, everyone recalls the anatomical structure of the tube wall. How many layers are there?"

  When Chen Qi asked this question, it was like a teacher asking a student. Everyone was quiet in an instant, and even big bosses like President Li and President Wang were in a hurry and tried to remember.

  Director Jia Liangcai of the Department of Internal Medicine sat in the auditorium at this time, mocking the several directors of surgery next to him:

"Hey, so who, Lao Jin, Lao Liu, Lao Shen, come here, come and answer, don't you just want to compare with our internal medicine, now the dean is asking questions, don't be a coward .”

   "Fuck, you know it's amazing, you can memorize a few anatomical structures, it's so interesting, come on, come on, this patient is for you, do you have the ability to perform surgery with a knife, you probably fainted when you saw the blood flow out?"

  As soon as Director Jin Peilin of the Department of Surgery said this, a burst of booing burst out from the surgical crowd.

  Because of a question from Chen Qi, the surgeons and surgeons fell in love with each other again, and Ruoda's auditorium was as lively as the Spring Festival Gala.

  In the operating room, Professor Zhang answered honestly like an intern at this time:

"The normal digestive canal wall generally consists of four layers, including mucosa, submucosa, muscularis propria, and serosa. The tube does not have a serosa layer, but has an outer membrane, which is composed of some connective tissue. It is also a four-layer structure. "

  Chen Qi smiled lightly: "Sure enough, he is a professor of Fudan University. He is worth learning for all of us. He answered such a basic question casually."

  As soon as these words came out, Principal Li, Dean Wang, Director Xu, Guo Shuji, Director Zhu and other big bosses all blushed.

   This is the biggest difference between academic experts and clinical experts. They are using their brains, rather than blindly holding a knife and doing everything recklessly.

  Professor Zhang, this is an away game, and he is still here to study, so hurry up and say a few words of humility:

   "Where there is, there is no dean Chen's unconstrained thinking."

   Officially teaching surgery, Chen Qi is not convenient for too much commercial bragging, so he continues the previous topic:

"We all know, ahem, some of our doctors know that the submucosa of the esophagus is composed of loose connective tissue. Look carefully at the steps I am doing now, which is to inject normal saline into the submucosa, which can make the submucosa bulge, and The muscularis propria separates.

   Then I used an electric knife to penetrate into this incision, and cut off or melted away the tissue under the mucosal layer. You see, does this form a "tunnel hole"? It is equivalent to punching a hole in the pipe wall.

   If the family likes to watch spy dramas and suspense dramas, there is a mezzanine on the wall, where you can hide silver, hide, etc.

  Then the inside of the tunnel is an interlayer of the pipe wall, which creates a space. After my gastroscope enters this dissection tunnel, the gastroscope can reach the cardiac sphincter smoothly. "

   "Oh~~~So that's what happened!"

Chapter end