Since 1981 Health School

Chapter 545 Cardia too tight causing obstruction

No one interceded for Jiang Aiguo, and everyone watched Jiang Aiguo being taken away by the security department.

Jiang Aiguo was also the first employee taken away by the security department of the People's Hospital in the history of the People's Hospital. Now it is not a question of job security, but a possibility of criminal offense.

$500 is enough for Jiang Aiguo to drink a pot.

Even Lan Lijuan didn't raise her eyelids, and didn't plead for this old classmate.

When Chen Qi was assigned after graduation, he was assigned by Jiang's family to Huangtan Mountain, the most remote area in the city. He impersonated himself and went to the People's Hospital.

The Jiang family clearly wanted to put Chen Qi to death. This matter is not news at the upper levels of the health system.

Lan Lijuan watched Chen Qi buy building materials step by step, build a house and build an operating room by herself, and even begged her grandpa to tell her grandma to get a batch of second-hand surgical instruments, so that the surgery could be established.

Once Fan Chen Qi was a little disheartened in the middle, he must still be eating corned buns in Huangtan Mountain today.

It was impossible to say that Lan Lijuan was not angry when her husband suffered such unfair treatment.

So regardless of whether you are an old classmate or not, Chen Qi's enemy is her Lan Lijuan's enemy, so she has no intention of pleading for Jiang Aiguo at all.

Hong Tianxing saw that the atmosphere at the scene had cooled down, so he quickly smoothed things over:

"Everyone is gone, what's there to see, the dean is here to make a formal inspection today, and everyone has lifted their spirits."

Only then did everyone recover from the scene where Jiang Aiguo was taken away, and they all ran back to their jobs, terrified like chickens.

Can it not be scary? They directly sent an employee to the security department. This dean is too scary, even scarier than the original dean Guo.

Chen Qi has returned to smiling at Mimi.

"Yes, everyone, work hard, don't be half-hearted like Jiang Aiguo, I will still ask questions later, if you can't answer, then feel embarrassed."

As soon as Chen Qi said this, a group of young doctors were already trembling with fright.

Who would come to the radiology department if there is a really good academic doctor? Half of the medical school graduates majored in imaging, and the other half graduated from clinical majors.

Now that Chen Qi said that he would continue to ask questions, would he be called the security department if he couldn't answer?

Many little doctors are already calling Dad to save me in their hearts.

Chen Qi began to observe in the imaging department.

Lan Lijuan has already taken Lu Zhaodi, a minor patient, to start the examination.

By the time Chen Qi came to the X-ray room after walking around, the film had already been developed.

Before the film reader, Chen Qi saw that his previous guess was indeed correct, because a "bird's beak sign" clearly appeared on the film.

The so-called bird's beak sign is due to the dilation of the esophageal lumen after swallowing barium in the esophagus, which hinders the passage of barium.

If the bird's beak sign appears in the gastrointestinal area, it may be sigmoid colon volvulus, congenital hypertrophic pyloric stenosis and other diseases.

But if it occurs in the esophagus, the most likely disease is achalasia.

"Achalasia?"

Hearing Chen Qi's diagnosis, both the gastroenterology doctors and the radiology doctors found it strange, because they had never heard of this disease.

Chen Qi has already looked through the internal medicine book, and there is indeed no introduction of this disease in the book, so it is understandable for everyone not to know about it.

They don't understand, but Chen Qi understands, so he introduced:

"Achalasia of the cardia is called a chalasia of cardia in English, and it has already been described in foreign textbooks, and the principle is also very simple.

It is an esophageal dysfunction caused by neuromuscular dysfunction in the esophageal cardia, which causes the lower esophageal sphincter to relax, and food cannot pass smoothly and stays, thereby gradually reducing esophageal tension, peristalsis, and esophageal dilation.

Its main features are lack of esophageal peristalsis, lower esophageal sphincter hypertension and a weakened relaxation response to swallowing. Clinical manifestations include dysphagia, retrosternal pain, and regurgitation of food.

Gastroenterology comrades, do you think this disease is the same as gastroesophageal reflux disease? The clinical symptoms are the same, even the patients are exactly the same when they lose weight, and they all vomit whatever they eat.

The clinical symptoms are indeed similar, but the causes are completely different. One is that the cardia is too loose, and the other is too tight, so the treatment methods are completely different. "

Lan Lijuan watched the film thoughtfully:

"How should this situation be treated? The last gastroesophageal reflux disease was because the cardia was too loose, so you had a fundoplication to strengthen the pressure on the cardia.

Now Lu Zhaodi's disease is due to the inability of the lower esophageal sphincter to relax. Can the sphincter be intervened to relax the muscles and never relieve the obstruction of the cardia by muscle tension? "

Chen Qi clapped his hands:

"Fortunately, it's my family, Lijuan. When it comes to the point, the mainstream treatment methods in the world are endoscopic balloon dilatation and stent implantation, endoscopic injection of botulinum toxin type A, and endoscopic microwave incision. And sclerotherapy injection treatment three methods.

However, these three methods are all palliatives, not the root cause, and do not fundamentally solve the problem of muscle tension, so patients often do not recover, and relapse after a period of time.

There is also a more direct method, which is to use traditional surgery and perform a cardia myotomy, which is to cut off all the muscles, so that the problem of muscle tension is relieved, and cardia obstruction does not exist. up.

But this surgery has a very big side effect, that is, your cardia is too tight. After all the surgery, the muscle function of the cardia will be completely lost, causing the cardia to be too loose, which will aggravate the occurrence of esophageal reflux disease. . "

Ma Xiaona next to her muttered softly:

"Then what should we do? This won't work, that won't work, too tight won't work, too loose won't work, it's troublesome not to have surgery, and it's even more troublesome to have surgery. Could it be that there is no cure for Lu Zhaodi?"

Knowing husband Mo Ruo's wife, Lan Lijuan glanced at her complacent husband, smiled and said to Ma Xiaona:

"That's not necessarily true. Your old classmate doesn't know it yet. He must have come to teach us this lesson because he has a good idea. If he doesn't know how to treat this patient, he won't take over this patient at all. This guy is broken."

Ma Xiaona looked at Chen Qi suspiciously, then nodded firmly:

"Lijuan, I think what you said is right. Your Dean Chen almost had his legs crossed, with a cigarette in his mouth, and then he looked like everyone is coming to ask me."

Speaking of this, Ma Xiaona whispered to Lan Lijuan's ear: "I'm sorry!"

Lan Lijuan burst out laughing when she heard this.

Chen Qi was upset: "Hey, Ma Xiaona, I respect you for being a man, if you have the ability, you can say it in front of the dean, what kind of ability is whispering?"

Ma Xiaona snorted lightly: "I'm not a man in the first place."

As a result, Hong Tianxing next to him couldn't help it:

"Dean Chen, do you really have a way to treat this kind of achalasia? Since endoscopy and surgery are not enough, what other methods are there?"

It's so funny.

Dean Chen gave Section Chief Hong a thumbs up in his heart, and the next time he can be selected as the deputy dean, he can focus on this senior from the health school.

"No, no, if the side effects are small, the recovery time should be quick, and the curative effect must be definite, and the symptoms should be cured as well as the root cause. Of course, endoscopic surgery must be performed."

Ma Xiaona's eyes lit up: "Hey, Chen Qi... Dean, do you have a new technique?"

Just as Chen Qi was about to answer, director Liu Huichun from the hospital barged in:

"President Chen, you are here. The visiting group from Zhongshan Hospital has arrived, and Guo Shuji is already receiving him. Please hurry over."

"Okay, I'll go right away."

Other visiting groups usually come in the morning and leave in the afternoon, during which everyone worships for a meal and pick up some souvenirs before leaving.

The reason why Zhongshan Hospital did not arrive until the afternoon was because there were only two trains a day from Shanghai City to Yuezhong City, one slow train and one express train.

Express trains generally only stop at county-level and city-level railway stations. They depart from Shanghai in the morning, and the old locomotives burning media only travel at tens of kilometers per hour. They can reach Yuezhong in the afternoon, and the journey takes about 7 hours.

The slow train stops at every small train station in the town. It takes less than a few minutes to drive to a platform.

So starting from Shanghai in the morning, it takes 12 hours to get to Yuezhong City after dark at night.

Unlike later generations, the speed of the high-speed rail is more than 350 kilometers per hour, and it takes more than an hour to travel from Shanghai to Vietnam.

Seeing that Chen Qi was about to leave, Hong Tianxing grabbed him suddenly, and said with a smile:

"President Chen, look at this achalasia has not been included in the textbooks in China, and you also said that the barium meal X-ray film is a new auxiliary examination, so can our imaging department set up a research group on this disease ?”

"Hey, Brother Hong, you have a good vision. This proposal is good, but I think it can be expanded. Director Lan is also here. You two departments can work together on this achalasia project. I will treat it. Then the three of us can complete several international papers."

Chen Qi was more satisfied with Hong Tianxing now.

Actively requesting to do research projects and actively want to participate in medical papers, this meets the requirements of Chen Qi's "teaching hospital".

His constant requirement is that doctors should not only be able to see a doctor, but also be able to do scientific research. Not only do you need to know how to treat, but you also need to know why you treat like this? Is it possible to draw inferences from one instance?

In this way, individual doctors can improve, and hospitals can also improve rapidly.

Lan Lijuan was under a lot of pressure after hearing this, because Chen Qi had already given him several new projects,

For example, "refractory gastroesophageal reflux disease research group", "fundoplication in the treatment of reflux disease and esophageal hiatal hernia", and now "achalasia", plus the original Helicobacter pylori research group Not quite finished.

With so many research groups entrusted to her, Lan Lijuan felt that the task was too arduous even if she had three heads and six arms.

Other doctors are troubled by not being able to find good subjects, but Lan Lijuan is troubled by too many subjects. How can this be justified?

But fortunately, she belongs to the Iron Lady, and she probably has to work overtime to do research, let alone take care of her family.

But it’s not okay to do it like this. If you don’t study it, the research results will belong to doctors from other countries, and you are not the only one who is doing the research. That would be a pity.

Coming out of the imaging department, Chen Qi followed Liu Huichun directly into the small conference room on the third floor.

In the meeting room, Lao Guo was talking with a group of Zhongshan Hospital with a "kind" face.

There is a middle-aged man in a Chinese tunic suit in the middle

, Judging from the posture, it should be the leader of Zhongshan Hospital, smoking a cigarette with an indifferent expression, ignoring Lao Guo Aidai.

Instead, there was a middle-aged man with glasses and a refined temperament who kept asking questions, looking very eager.

In addition, everyone in Zhongshan Hospital stood at the window looking at the scenery outside the window, pointing from time to time.

There are not many high-rise buildings in Yuezhong City at this time, most of them are Ming and Qing buildings, which are antique. Standing on the third floor of the People’s Hospital, you can see more than half of Yuezhong City. This is a famous historical and cultural city, and it is the best place to travel.

In fact, except for Zhang Weizhong, the entire group of Zhongshan Hospital came here for tourism.

Even Vice President Ni, who led the team, hadn't reported to travel around Vietnam, such as Lu Shuren's hometown, Lanting, Dayu Mausoleum, and ancient city.

By the way, come here to show off in front of his peers, otherwise he would definitely not have come to a rural place like Yuezhong.

Not to mention anything else, as soon as you enter Yuezhong People's Hospital, the dilapidated two-story outpatient building is full of one-story inpatient departments.

This gave people who came from Shanghai a sense of status superiority.

At the same time, as a doctor, or hospital leader, Vice President Ni understands how difficult it is to establish an endoscopy center. You can't get it without millions of dollars.

Even Zhongshan Hospital can't afford so much money, so how can Yuezhong People's Hospital provide it?

If the cost of equipment is second, the key is where do you get a doctor who can do endoscopy? Where did you learn your skills? Anyway, there is definitely no such thing in China, how about studying abroad?

Don't be kidding, even Zhongshan Hospital only has one or two places for study abroad every year. How could the small Yuezhong People's Hospital get such an opportunity?

Therefore, Vice President Ni has basically decided in his heart that Yuezhong's ability to perform endoscopic surgery is a scam.

Of course, it is not a low EQ person who can become the vice president. Anyway, it is enough to walk around the process, pretend to visit, and just say a few nice words to save face.

It mainly depends on whether Vietnam and China are sensible or not, whether they will arrange a few more tours and provide high-standard board and lodging for free.

Thinking of this, Vice President Ni glanced at Zhang Weizhong, who was having an enthusiastic conversation with Shu Ji of Yuezhong People's Hospital, and thought to himself, why is this guy so simple-minded?

Sure enough, they are from the ivory tower, how naive would they think that this kind of country hospital can do endoscopic surgery?

In this weird atmosphere, Chen Qi walked into the conference room.

Lao Guo was also depressed. He was enthusiastic, but Zhongshan Hospital was neither cold nor cold, which was a bit embarrassing.

But there is no way, Zhongshan Hospital is an affiliated hospital of Fudan University, and the dean is concurrently held by the vice president.

In this way, the deputy dean will either be a high-ranking deputy director, or a real-time director, and Guo Yuanhang only enjoys the treatment of the director, and he is a head shorter than others, so he can only bear it.

Seeing Chen Qi come in, Lao Guo was overjoyed, and the person who dumped the blame came:

"Come, come, let me introduce you. This is the director of our hospital, Comrade Chen Qi."

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