Since 1981 Health School

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

But for those 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.

Moreover, this public surgery has become more high-end and elegant 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 they heard that their dean could perform endoscopic surgery, they rushed here eagerly from thousands of miles away. They said it was a visit, but in fact they were studying, because the professors in Fudan University did not know how to do this kind of endoscopic surgery.

This made all the employees of the People's Hospital have their throats ringing a lot 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 no longer limited to the People's Hospital itself.

President Li of Haidong Medical University personally led the team. Doctors from five 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 hall.

In today's surgery, Chen Qi was the chief surgeon, and of course Professor Zhang Weizhong and Lan Lijuan were the assistants.

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

In the operating room, the minor patients are 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 any contact with it.

Moreover, the domestic textbooks are still lagging behind and did not cover it. 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 next to Chen Qi, watching him draw a schematic diagram, 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 audio system in the auditorium:

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

We know that the place where the tube is connected 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, which will cause dysphagia and a sense of choking. The retention time of objects and saliva in the tube is longer, and it is easy to overflow when bending over or lying down, forming a reaction.

Seriously, it feels like eating grass, regurgitating the cud, and of course it's not real rumination.

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

Then 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 scolded Lao Guo beside him:

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

All the bosses in the operating room also laughed softly.

Because Professor Zhang Weizhong is not familiar with several bigwigs, he acts as a curious baby on the side, doing the work of flattering:

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

While Chen Qi was explaining, he was 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 did not research it. This is an opportunity for us. 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. The publication of papers will have different rewards according to the level of the journal.

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

Chen Qi's explanation continued:

"But one thing is clear, that is, 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 heart, 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 food 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 follow me to disinfect before surgery."

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

Especially those unconvinced surgeons, each of them wanted to see how the endoscope, which could eliminate themselves, could show its prestige?

The previous fundoplication was only successful in one case, and many surgeons were suffocated.

During the operation, Chen Qi successfully lowered the gastroscope tube, passed through the esophagus, and went all the way down to 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 surgery, and it is not like the safe, convenient, non-invasive and effective endoscopic surgery principle mentioned earlier.

Moreover, 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 combined with mediastinal infection, thoracic infection, aortic infection or even rupture and other complications, it can completely cause the death of the patient.

If the harm far outweighs the benefits, then this endoscopic surgery is of little significance.

All the doctors present are professional doctors, and everyone has a steelyard in their hearts. 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 move 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, how many bosses are watching, it is a big car rollover accident.

Just when everyone thought that Chen Qi was about to admit defeat and stop the operation, Chen Qi suddenly stopped the gastroscope 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 at the front to Professor Zhang. There was no way, Professor Zhang had never done endoscopic surgery and was not familiar with the equipment.

Moreover, the gastroscope tubes of each manufacturer are different, and they are mixed in a big box, and 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. Then Chen Qi slowly cut the esophageal mucosa, directly making a small incision.

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 Weizhong 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.

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

"Before answering this question, let's recall 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 was sitting in the auditorium at this time, mocking the 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 department, now the dean is asking questions, don't be a coward .”

"Damn, 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, there was a burst of booing from the surgical crowd.

Because of Chen Qi's question, 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 tissues. It is also a four-layer structure. "

Chen Qi smiled slightly: "Sure enough, he is a professor of Fudan University, worthy of all of us to learn from, and 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.

This is an away game for Professor Zhang, and he is still here to study. Hurry up and say a few words of humility:

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

It is not convenient for Chen Qi to give too much commercial bragging for the formal teaching of surgery, so he continued 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 to cut off or melt away all the tissues under the mucosal layer. You see, did 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 money, 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!"