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¡¾1326¡¿Consultation cases

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    "I have a patient here, and I would like to invite you to come over to assist in the consultation."

    Let her, a medical student, go over to assist in the consultation?  To assist in consultation, you usually ask a lower-level doctor to consult. If you are not satisfied with the consultation, you will ask a higher-level doctor to come over and assist in the consultation.  Xie Wanying had every reason to think that she had heard wrongly.

    "This is a patient who developed anastomotic leakage after cardiac cancer surgery." Wei Guoyuan briefly introduced the case to her so that she could understand why she suddenly thought of asking her for help.

    Cardia cancer is classified as gastric cancer in China.  Calculation of morbidity and mortality were in gastric cancer.  In fact, it is a type of junctional cancer. According to anatomical explanation, the cardia is located at the junction of the esophagus and the stomach. Tumors occurring here will naturally have the characteristics of gastric cancer and esophageal adenocarcinoma.  In the future, it will be more accurately defined medically as esophagogastric junction cancer.

    Regarding the treatment of this disease, early-stage tumors are small and, like other tumors such as intestinal cancer, can be treated with a digestive endoscope in the Department of Gastroenterology.  Tumors all follow the principle that early treatment has a better prognosis.  It¡¯s a pity that Chinese people don¡¯t have this habit of physical examination.  The symptoms of early stage cardia cancer are very similar to the symptoms of ordinary gastrointestinal inflammation and cannot be distinguished without a gastroscopy.  Domestic patients are often in the middle and late stages when they are diagnosed, and can only undergo surgery.

    General surgery and cardiothoracic surgery are both departments that can perform cardiac cancer surgery.  The method adopted by general surgery is to open the abdomen without incising the diaphragm and partially remove the stomach and esophagus.  Due to the limitations of operating from the abdomen, residual tumors in the esophagus and thoracic lymph nodes may not be completely removed and may relapse easily.  Therefore, more and more people choose to go to cardiothoracic surgery for this surgery.  The surgical method of cardiothoracic surgery is to enter the chest and then into the abdominal cavity. Compared with general surgery, the patient's tumor can be more thoroughly removed.  However, there may be serious complications, such as squeezing the heart and other organs, anastomotic fistula in the chest after surgery, etc.

    This patient¡¯s surgery was performed at Xuanwu¡¯s Cardiothoracic Surgery Department.  Xuanwu's cardiothoracic surgery department seems not to be well-known, but it can definitely perform common tumor surgeries and has a certain technical level.  Therefore, it is not that Xuanwu¡¯s neurological diseases cannot be cured, and common diseases can be cured. However, for severe sudden injuries like Sister Xu¡¯s, the technical level is really limited and can only be treated like this.

    Postoperative anastomotic leakage is a very common postoperative complication in surgery.  The reason for its occurrence has a certain correlation with the skill of the surgeon, and also has a great relationship with the individual differences of the patients.  It can be seen in all surgical departments of the National Association.  How to deal with anastomotic fistula has always been a major difficulty in the surgical community.  It cannot be said here that Xuanwu's out-of-mind skills are not good.  Unless there are more cases of postoperative fistulas in a surgical department than is normal, something is wrong.

    Wei Guoyuan¡¯s classmate Dr. Shao Jialiang works in the cardiothoracic department of the same hospital. When he encountered such a case, he wanted to ask Guozhi for cardiothoracic consultation.  When Wei Guoyuan heard this, he said it would be better to ask Xie Wanying to come over and have a look.

    There are generally two ways to solve postoperative fistulas, either conservative treatment or surgical treatment.  For surgical treatment, surgery can be performed again and the abdomen can be re-opened.  Endoscopic minimally invasive surgery can also be used to plug the fistula. This is usually done by a gastroenterologist.

    Dr. Shao asked colleagues from the internal medicine department of our hospital for help.  Xuanwu's Department of Gastroenterology and Xuanwu's General Surgery are relatively well-known and have this technical strength. The conclusion is that it cannot be done.

    Why?  The patient was complicated by anastomotic stenosis and the gastroscope could not enter.  (Remember the website address: www.hlnovel.com
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