Since 1981 Health School

  Chapter 93 Serious Misdiagnosis

   Cholangiocarcinoma, surgery is very difficult.

  Choledochocarcinoma is located in the hepatic hilar area, and the tumor will grow along the common bile duct, hepatic duct, and pancreatic duct, and it is easy to invade the pancreas and 12-denocarcinoma. Therefore, it is necessary to remove the gallbladder, part of the bile duct, pancreatic head, duodenum and other organs.

  Some cancer cells may invade the transverse colon, and it is possible to resect an additional section of intestinal tube. In addition, as a radical surgical resection of cholangiocarcinoma, regional lymph node dissection must be performed.

  So Director Guo’s surgical incision is quite large, reaching tens of centimeters.

   This brings difficulty to the operation, and also increases the chance of postoperative infection and complications. In the words of ordinary people, it is very difficult for the body to recover.

  Zhang Jun didn't understand what Dean Guo said at all.

  If it’s just bile duct inflammation, no surgery is needed at all, and the surgical incision only needs to be a few centimeters.

  However, radical resection of cholangiocarcinoma not only requires a large surgical incision and improves the surgical grade, but also has a negative impact on the prognosis of the patient. If it is wrong at that time, it will be a big trouble.

Who is responsible?

  Zhang Jun thought that Dean Guo was encouraging him, so he was full of confidence. He felt that he had received the attention of the big boss and had a bright future.

  Dean Guo also sighed in his heart,

  Even as the "Mr. One Knife" of the Yuezhong People's Hospital, he was not sure whether the soft tissue shadow was a tumor or an inflammation, so even though he was inclined towards inflammation in his heart, he finally operated on cholangiocarcinoma based on the results of the department's discussion.

   You can't take a gamble with your own reputation, right?

  He is not an intern like Zhang Jun and Chen Qi. As the dean, he is under more pressure, needs to think more, and cherishes his feathers more.

   After all, it was still in 1982, there were too few advanced inspection instruments in hospitals, especially in Huaguo, there were very few instruments and equipment available for clinical diagnosis.

  Large open surgery, the operation process is very slow, everyone is holding their breath.

   When Dean Guo drove all the way to the common bile duct, he suddenly uttered involuntarily:

"what?"

  The people in the operating room were all professionals, and they immediately knew that the answer had been revealed. As the surgical assistants, Jin Peilin and Shen Zhemin had the advantage of being close to the water, so they immediately stretched their heads to take a look.

  The two of them glanced at each other and stepped aside. This made Li Jun, the third assistant, very anxious, but both the dean and the director were there. How could he be presumptuous as a little doctor?

  So while obediently preparing the surgical machinery, he was so anxious that his **** was getting oily.

  Dean Guo didn't raise his head, and said to the side: "Old Zhu, Lao Qi, come, you all have a look at this surgical field of vision."

  Zhu Huoyan and Qi Damin couldn't bear it for a long time, the nurse brought two benches, they stood on it and watched, and they also uttered:

"what?"

Zhang Jun stood on the outermost side with question marks in his head, and at the same time he was very anxious. He wanted to see but did not dare to move his position. Relatively speaking, Chen Qi was much calmer. He had a premonition that these "huh" meant that something unexpected happened during the operation. .

  What accident?

  The biggest surgical accident is that this is not cholangiocarcinoma at all, and the surgery script formulated according to the radical operation of cholangiocarcinoma is completely wrong!

  President Guo spoke again at this time:

   "Come on, Director Jin and Director Shen, you two get out of the way for a while, Xiao Zhang and Xiao Chen, you two come over and have a look by yourself, maybe my old eyes are dizzy and I can't find the tumor."

   Zhang Jun moved the fastest, he was the first to come to the operating table, and his eyes widened.

   At the confluence of the left and right hepatic ducts, the bile duct did have obvious stenosis, but no tumor was seen around, nothing at all.

  Zhang Jun was so surprised that the decibels of his voice increased:

   "Where did the soft tissue shadow shown in the B-ultrasound go? Where is the medical record? Where is the checklist? It shouldn't be."

  Dean Guo looked at the indifferent Chen Qi: "Xiao Chen, tell me where is the tumor?"

  Chen Qi wanted to laugh but didn't dare to, pretending to be serious and saying:

"I judged it wasn't a tumor before, so there is no tumor. Zhang Jun's misleading soft tissue shadow is basically this. Look, here, it is due to the fibrous hyperplasia of the bile duct due to scar contraction for some reasons. The B-ultrasound looks like It's like a malignant tumor."

  The onlookers and doctors in the office gasped.

  Qi Damin couldn't help but whispered: "This is troublesome, it was misdiagnosed."

  At this time, Zhu Huoyan looked at Chen Qi with eyes full of admiration, this kid is too amazing, too powerful.

  Zhang Jun almost went crazy when he heard that, "Impossible, how is it possible."

  Dean Guo didn't say anything, but asked Zhang Jun to be his assistant to conduct a comprehensive investigation of the biliary tract, but nothing was found.

   Now, the truth has come to light. Zhang Jun’s diagnosis was wrong, and the doctors who supported his diagnosis collectively made a misdiagnosis. The result of this misdiagnosis is that Director Zhu Bai suffered such a big knife.

   All the doctors in the operating room felt their scalps tingling. If Director Zhu knew the truth, there would be a commotion. In the future, the supply of ingredients in the cafeteria of the People's Hospital would be a problem.

   At the critical moment, Jiang was still old and hot, and Director Guo didn't criticize anyone, but just continued the operation silently.

   "Zhang Jun and Chen Qi, the two of you step back first, and Director Jin and Director Shen continue to take over. We will remove all the bile duct tissue in the stricture first, and send it to freeze immediately, so that the pathology department can issue a report as soon as possible.

  In addition, biliary stricture exists objectively, and sooner or later it will affect the patient’s future health. Therefore, we will perform cholecystectomy, remove the hilar bile duct stricture, and finally perform a cholangiojejunostomy. "

  As a physician, Qi Damin did not understand the meaning of these words for the time being. Just as he was about to ask a question, the director Zhu next to him explained:

"What the dean means is that we have resected the biliary tract stricture for him, so that there will be no systemic infection caused by cholestasis obstruction in the future, and the hidden danger has been completely resolved. As for whether it is cancer, it depends on the pathological examination report. Anyway, our operation is successful."

  Qi Damin immediately reacted:

   "Oh, yes, yes, the operation was successful, the problem of bile duct stenosis was resolved, and the lesion was resected. It is not the cancer that is best, but the cancer has also been eradicated."

  The tense atmosphere in the office just now eased up, and everyone began to laugh and talk softly.

  Chen Qi took a look at Dean Guo, thinking that it was indeed an old fox, so he avoided the serious ones and ignored the previous fault of enlarging the incision and the scope of surgery due to the misdiagnosis of cholangiocarcinoma.

  Anyway, the patient and his family members were confused, thinking that the operation should be done in this way, and the incision should be so large.

  Maybe they were scared out of their wits when they saw such a large incision, and they still want to thank Dean Guo for his skillful operation and help them completely cure the hidden danger.

  (end of this chapter)