medical road high rise

Chapter 435 Total Laparoscopic Anatomic Liver Resection
Chapter 437 Total Laparoscopic Anatomic Liver Resection
Serum creatinine is a small molecular substance produced by human muscle metabolism, which can usually be excreted through the kidneys with urine.

And the patient's serum creatinine is so high, it must be related to the liver, and there is a high probability that there is a problem with the liver.

And the patient also has high blood pressure. If the high blood pressure is not treated regularly for a long time, the kidneys will be damaged and chronic renal insufficiency will appear, which is medically known as hypertensive nephropathy.

As kidney disease becomes more and more serious, it will slowly evolve into renal failure, and renal failure will lead to the inability to excrete water and toxins from the body, which will cause heart and brain dysfunction, and the most important manifestations are headache, coma, convulsions and so on.

These performances are in line with the patient, Qin Feng still asks the hospital chief to push a B-ultrasound machine over to make the diagnosis more accurate.

Qin Feng used B-ultrasound to check the kidneys first. Sure enough, the patient's right kidney was about one-third smaller than the normal kidney, indicating renal atrophy, which is one of the manifestations of renal failure.

Looking at the left kidney again, it was similar to the patient's right kidney, which meant that the patient was likely to be in the end stage of renal failure.

The end stage of renal failure has a terrifying name called uremia!

Therefore, the patient's condition should be uremic encephalopathy.

This disease is caused by the inability to excrete toxins in time, and the concentration of creatinine and urea nitrogen in the blood is very high, which leads to abnormal retention of metabolites, which can cause metabolic disorders in brain tissue and edema in brain cells.

Once uremic encephalopathy occurs, the patient will experience severe conditions such as limb convulsions and coma.

I continued to check the abdominal cavity and found no problem, but when I reached the bladder, no urine was found. This was consistent with uremia.

"The patient has uremia and was sent directly to the Nephrology Department for dialysis." Qin Feng said.

At present, the only treatment for uremia is dialysis and kidney replacement. Dialysis is to simulate the kidney to remove toxin molecules, and then let clean blood enter the patient's body.

Qin Feng also told patients these two methods.

"Thank you doctor." The patient said gratefully.

Qin Feng can only give suggestions, and the final decision still needs to be made by the patient himself, and kidney transplantation is also very difficult.

There are too many uremia patients in China, and it is even more difficult to match them while having a kidney source.

After the nephrologist came over, Qin Feng finished his explanation and left the emergency room.

After Qin Feng completed the consultation, he directly arranged the surgery for the liver cancer patient.

It's just that Qin Feng planned to use interventional methods for this operation, so he naturally went to the interventional department to apply for an operating room and corresponding surgical equipment.

Mr. He happened to be in the hospital, and he was also very curious about Qin Feng's liver cancer operation, so he said he wanted to help Qin Feng, but Qin Feng couldn't refuse, so he had to agree.

As soon as he helped, he became Mr. He. As soon as he heard that Mr. He was involved in this operation, some interventional doctors who were fine entered the viewing team one after another.

There were even doctors from other departments who heard the news, but in the end the operating room couldn't stand anymore. Mr. He only allowed five people from the oncology department and the interventional department to come in respectively.

He Lao said that even the dean of Ruijin Hospital must be obedient, and the doctors in other departments can only leave in despair.

"Xiao Qin, what type of operation are you going to use for this operation? I remember that there are not many interventional operations for liver cancer." Elder He asked.

"I want to use laparoscopic extrahepatic GLISSON intrathecal anatomical liver resection." Qin Feng said a brand new operation method.

"Is this a technique you developed yourself? Are there any successful cases?" Elder He asked doubtfully.

"Uh..." Qin Feng didn't know how to answer Mr. He. He couldn't say that all his techniques were trained in the system.

The reason why he chose this operation was that the patient’s condition was serious. Qin Feng was worried about long curves, bleeding, and bile leakage, so he tried a variety of methods, and finally found that the laparoscopic operation was the most suitable for the patient.

Compared with laparoscopy, total laparoscopy can accurately ligate the hepatic artery and portal vein under direct vision, block the blood flow of the pre-resected liver, and so on.

Qin Feng told Mr. He the idea of ​​the operation, and Mr. He nodded after listening.

"However, you are still a little risky, but with me here, you can give it a go. If it succeeds, we would like to thank you for bringing a new technique to the intervention discipline." He Lao said.

"Don't worry." Qin Feng tried more than 50 operations in the training room, and the success rate was as high as 90.00%. The last ten operations were as high as 100%.

The patient was pushed up, and Qin Feng re-read the patient's film, because laparoscopic surgery is different from surgery, it can only be solved part by part, and it is more difficult than surgery in terms of surgical field and operation, but for Patient injury is minimal.

He Lao stood aside without speaking, but quietly handed Qin Feng the equipment.

秦风将观察孔放置在患者平脐孔上缘中线右侧约2cm1的地方，12,mm主操作孔位于右锁骨中线肋缘下约2cm，右腋前线肋缘下置入5mm trocar（套管针）。

Continue to place a 10mm trocar on the lower left side of the xiphoid process, and place a 5mm trocar on the flat umbilicus and xiphoid process as an auxiliary operation hole. on both sides of the patient.

Qin Feng performed conventional laparoscopic cholecystectomy, dissected the Glisson sheath on the right side of the common bile duct, and dissected the right hepatic artery along the cystic artery. Mr. He ligated and cut off the right hepatic duct.

Qin Feng continued to dissect the surrounding connective and lymphatic tissues, and completely separated the right branch of the portal vein. After seeing the obvious demarcation line in the liver, Qin Feng quickly cut off the round ligament, falciform ligament, right coronary ligament, right Lateral deltoid ligament, hepatorenal ligament.

"Don't cut the naked liver area?" Mr. He asked while watching Qin Feng's operation.

"If you don't cut it, I'm afraid it will squeeze the tumor." Qin Feng said.

Soon, Qin Feng cut off the veins and arteries connecting the right liver to the tumor, and then continued to turn around to re-place the TROCAR to operate on the left hemi-liver.

Like the right hemi-liver, Qin Feng completed the resection, then took out the tumor, checked for bleeding or tumor residue, and then directly sutured to end the operation.

"Xiao Qin, this technique of yours is interesting. It's not very difficult, but it's very practical." As a person who has experienced it, He quickly discovered the advantages of this technique. "Go to my office later, let's have a good chat."

Qin Feng agreed, and after talking to his family members, he changed into the surgical gown and went to Mr. He's office.

"Xiao Qin, I'm just curious. You seem to have used two different methods of blocking blood flow into the liver in the operation of your right hemi-liver and left hemi-liver?" He Lao asked.

"Yes, two are used. In fact, I found three in total. These three methods can be changed at any time according to the patient's liver condition." Qin Feng said.

(End of this chapter)