Doctor's Life Simulator

Chapter 83 The First Affiliated Hospital of Zijingang University
Hangzhou, First Affiliated Hospital of Zijingang University.

In the conference room of oral and maxillofacial surgery, a few experts who can shake the medical circle of Zhejiang Province if they are pulled out at random, are consulting on the treatment plan for a special patient.

Yang Tangjue, director of oral and maxillary surgery at the First Affiliated Hospital of Zijingang University, frowned:
"The only feasible plan now is this: the patient's left tongue border squamous cell carcinoma with ipsilateral cervical lymphatic metastasis, the cancer invaded the external carotid artery, in order to achieve tumor-free status after surgery and radical resection, the external carotid artery must be resected spontaneously. Ligate the initial segment and resect about 8cm upwards”

Hearing Director Yang's words, Yu Ping, the director of general surgery, looked at the following materials again:
"However, in this way, extended resection of the primary lesion + neck dissection + reconstruction and repair of the external carotid artery must be performed at the same time, and the superior thyroid artery in this case is above the origin of the external carotid artery, together with the superior thyroid artery, tongue The artery, the initial segment of the facial artery was ligated and cut off. This is very difficult to reconstruct the blood vessels in the recipient area of ​​the neck similar to the 'frozen neck'."

Director Yang gave a wry smile:
"Yes, this is also the biggest challenge of this operation. However, if the external carotid artery is not resected and the recurrence occurs again, the survival rate of the patient is less than 1%."

Yu Ping also nodded in approval:
"Since this is the case, then we have to find a way to solve this vascular reconstruction. Director Meng, your burn department is very experienced in this kind of wound repair and vascular repair. Do you have any good solutions to offer?"

Director Yang and Director Yu both looked at Director Meng Zhoutong, who is also the director of the Burn Center of the First Affiliated Hospital of Zijingang University.

Meng Zhoutong naturally has deep knowledge in wound repair and blood vessel repair. After thinking about it, he said:
"There is no solution, but it is very difficult. Similar to this case, we have tried to prepare an ultra-long vascular pedicle tissue flap to anastomose the contralateral neck blood vessel and transverse cervical blood vessel, and vascular bridging can also be used. Only the flap preparation requirements Very high, with disadvantages such as vascular anastomosis and additional trauma to open up the third surgical field of view. As a result, it is not very ideal, and we can only try our best."

Hearing Meng Zhoutong's plan, the two directors thought about it but did not give a better plan:
"Maybe, this is already the best solution. Then we will try to prepare ultra-long vascular pedicle tissue to repair the defect."

After the three chief directors initially drew up the plan, the man who had been silent in the meeting room finally spoke:
"Three directors, I don't care how difficult your plan is, but this operation must be successful. The status of this patient is very special. Let me reiterate to you. She is the aunt of our Dean Wen Yunqi. If we My dean's aunt can't be cured, so what face is there to call the strongest hospital in Zhejiang Province."

"We are the Bauhinia Port No. [-] Hospital! We have gathered the top medical talents in Zhejiang Province. No matter how difficult the operation is, there are doctors who can do it. As long as you ask, I can give you all the surgeons in the various departments of the Bauhinia Port No. [-] Hospital." Arrange to come over and assist you to complete this operation."

Lin Qi, the vice president of the Bauhinia Port No. [-] Academy, spoke loudly.

"We can guarantee the resection of the primary lesion and neck dissection, but because the patient's own condition is relatively poor, we are afraid that no suitable artery in the recipient area will be found. Perfectly resolved."

Regarding Vice President Lin's request, Director Meng finally expressed his judgment despite the pressure:

"In this way, the deputy director of our department, Shen Jiachen, is very accomplished in free flap transplantation, and he is also the doctor who has the deepest understanding of cutting-edge technologies in my department. I will contact him immediately and participate in the consultation together to see if there is anything more. Good solution for difficult vessels in the neck recipient area of ​​the 'frozen neck'."

Lin Qi's complexion is not very good-looking:
"I'll give you another half an hour. You must come up with the best treatment plan for me. I'll go visit Ms. Wen Xia now."

Lin Qi left several directors behind and went to visit Wen Xia alone, who is now the aunt of Wen Yunqi, the chief dean of Zijingang First Hospital.

In addition, Wen Xia has an identity that very few people know about. Due to the low profile of Dean Wen and Ms. Wen Xia, only a few core figures in the entire Zijingang No. [-] Hospital know that Wen Xia's eldest son is now Hua Guo Academician of the Academy of Engineering.

If his own hospital really can't come up with the best treatment plan, then for Ms. Wen Xia's safety, he can only suggest that Ms. Wen Xia be transferred to a hospital in Shanghai or the capital.

However, when that time really came, it would be a great loss to the reputation of their hospital, a shame to him personally, and a shame to the entire Zijingang First Hospital.

At this moment, in the meeting room, several directors continued to discuss better plans, and after a while, Deputy Director Shen Jiachen rushed to the meeting room of Oral and Maxillary Surgery.

As soon as he entered the meeting room, Meng Zhoutong beckoned and called Shen Jiachen to him with a friendly tone:
"Jia Chi, I know that you are very experienced in free flap transplantation and vascular reconstruction, which is also your field of expertise. Come and see the patient's condition, is there a better plan that can reduce the difficulty of flap preparation, It is more convenient and safer to solve the external carotid artery repair."

Several directors were quietly waiting for Shen Jiachen's conclusion. They didn't mention their plan too much, but showed him all the materials.

After taking the patient's CT, MRI, PET-CT and other imaging data of tongue squamous cell carcinoma recurrence after neck dissection, Shen Jiachen looked at it carefully.

"The patient's cancer metastasis is very serious. Unconventional lymph nodes such as parapharyngeal, carotid artery, mouth floor lymph nodes, external maxillary artery base lymph nodes, paralingual artery lymph nodes, parapharyngeal lymph nodes, and upper deep carotid artery lymph nodes can only be primary Extended resection of the lesion + neck dissection, and repair of the external carotid artery."

Basically, Shen Jiachen's judgment was similar to that of Meng Zhoutong, except that he had a bold new plan for repairing the external carotid artery.

This is also the biggest gain from his trip to the first hospital in Hecheng City this time.

However, Shen Jiachen has just accepted the retrograde blood supply model proposed by Qin Lang, and he still lacks clinical experience in the specific operation and degree of manipulation.

Although he has excellent clinical talent, after all, he still needs surgery to practice and master it, just like sharpshooters are fed by bullets, and top clinical surgeons are also trained by patients one by one.

When Shen Jiachen fell into thinking, sometimes excited and sometimes hesitant, Meng Zhoutong asked:
"Jia, do you have any new plans? Don't worry, we have the best equipment and doctors to cooperate with you!"

Shen Jiachen took a deep breath and said truthfully:

"To tell the truth, directors, I do have a brand new idea, but I have just observed this surgical technique once. I can deduce the whole idea and treatment plan, but the specific details of the operation are still lacking in practice verification."

Shen Jiachen directly took a pen, and began to design the operation plan on the small whiteboard in the conference room:
"Directors, the plan I proposed this time is a brand new model, but I can assure you that it is feasible after clinical verification."

I saw that Shen Jiachen drew the patient's "frozen neck" on the small whiteboard, and then did not use the conventional ultra-long vascular pedicle tissue anastomosis, but adopted a completely different local distal stump blood supply. model.

While drawing, annotating, and explaining the principles, several directors also felt a sense of enlightenment, especially Director Meng Zhoutong:
"Jia, your retrograde blood supply mode is simply admirable. Is this the latest technique created by a foreign or domestic professor?"

Director Yang and Director Yu also had sparkles in their eyes:
"Wonderful, using the retrograde blood supply mode, the blood vessels in the recipient area can be solved at a low level, and the constraints on the location of the blood vessels in the recipient area can be completely eliminated!"

And after several directors understood Shen Jiachen's genius idea, Vice President Lin Qi also walked in with a serious expression.

"Everyone, there are still 5 minutes, and the plan I want is here!"

(End of this chapter)