"Who is in charge of this patient?" Ahead, Xu Qiu stopped and asked in an unhurried tone. "It's Dr. Chen Jia." “Tell her to turn the patient over. Ma Pingchuan, I'll take over. " After leaving these words, Xu Qiu left without looking back. Only people with shocked faces were left. "Doctor Xu...can actually handle severe acute pancreatitis?!" "This is the most critical acute abdomen in gastroenterology, with a mortality rate as high as 40% and a high chance of various complications..." …
Soon, news spread throughout the hospital that a patient with severe acute pancreatitis was admitted to the emergency department. This is a serious disease that can easily kill people! therefore, The hospital urgently notified the whole hospital to hold a general consultation in half an hour! In the Department of Gastroenterology, many doctors felt their hearts skip a beat after seeing another case of severe acute pancreatitis. "Ah...why are you here again?" "Last week, we admitted a patient with severe acute pancreatitis. The director personally took action, but the patient still died in the end..." "I heard that Academician Chen's student is performing a surgery in our city? Can you invite him to come over and perform an operation?" "Yes, Academician Chen is a top expert in the field of pancreas and intestines. His 'Chen's Pancreaticoenterostomy' has created a new technique for pancreatic surgery. His students' words... may be able to save this man. !” After receiving the news of the hospital-wide consultation, Director Xiao from the Department of Gastroenterology immediately thought of Academician Chen's students. He quickly asked the medical department to contact him. Soon after, the medical department responded. "Professor Gao Pei'an said that he specializes in robotic duodenum and total resection of large liver cancer. Severe acute pancreatitis is not his area of expertise... However, he can come and participate in post-operative suturing." Gao Pei'an is Academician Chen's favorite student. I am fifty-two years old this year, and I am either flying knives or on the road to flying knives. This time, he had just completed a large liver cancer resection at the Municipal People's Hospital, and Linhai No. 1 Hospital happened to catch up with him when he was free. Director Xiao slapped his thigh: "Okay, how much does it cost there?" "Three thousand." Director Xiao felt a little itchy after hearing the quotation.
Just from the flying knife surgery, the other party had probably made ten thousand or twenty thousand. To make extra money after finishing the work, drop by and spend 20 minutes doing a "Chen's Pancreaticojejunostomy", and I'll quote you 3,000! But by chance, the other party has the qualifications of a lion to open his mouth! Chen's pancreaticojejunostomy is the best anastomotic method in the industry. Currently, doctors specializing in hepatobiliary, pancreatic and other fields are studying this suture technique. only-- Nowadays, the only people who can really master this technique are the doctors from Academician Chen's hospital. There are no experts in this technique like Linhai Hospital! Therefore, they can only practice on quality surgical videos. Chen's pancreaticojejunostomy is naturally difficult to achieve. Spending 3,000 yuan to hire an on-site teacher so that all doctors in the general practice have the opportunity to learn is quite cost-effective! Director Xiao thought about it for a while, and finally nodded: "Who said we don't have an expert on Chen's pancreaticojejunostomy here... Prepare a car and pick up Professor Gao!" … On the other side, Ma Pingchuan has been transferred to ICU for monitoring, and a dedicated person is closely observing changes in his condition. Includes general condition; Vital signs and abdominal conditions, etc.; In addition, there are dynamic analysis laboratory test results, Such as white blood cell count, hematocrit, blood and urine amylase, electrolytes, blood sugar, BUN and creatinine, carbon dioxide binding capacity... After urgently obtaining various examination data, Director Jiang took the results and prepared to participate in the joint consultation in ten minutes. … The consultation was finally scheduled in the emergency department. Medical record display, Report on inspection results... After a series of processes, the most intense discussion session entered. Director Xiao of the Department of Gastroenterology frowned and said: "The patient underwent endoscopic ultrasound and no common bile duct stones were found. This is good news. However, the patient’s TG level is too high and lipid-lowering treatment must be performed as soon as possible! If conditions permit, blood purification should be done first. " The director of the hepatobiliary department said: "First use gastrointestinal decompression, proton pump inhibitors and pancreatic enzyme inhibitors! The patient is in so much pain that we must also pay attention to the patient's subjective feelings!"
Director Jiang from the ICU said: "Now the patient has signs of respiratory failure. In addition, the patient also has intra-abdominal hypertension and is rated as a high-risk disease. Putting aside everything else, intra-abdominal pressure monitoring must be done before treatment... I I’m afraid he will develop abdominal compartment syndrome!” “It’s really not possible to try non-invasive ventilation for a short period of time!” "Otherwise, we have to go to ECMO..." The discussion became more intense, and eventually, a surgical plan was discussed. Director Xiao, who is still from the Department of Gastroenterology, spoke, He said: "We have invited Professor Gao Pei'an, a student of Academician Chen, to come over. He also agreed with the surgical plan proposed by our department: percutaneous puncture drainage, visual endoscopic assisted debridement and drainage, and a step-up treatment plan until the final surgical debridement and drainage! " After saying this, the conference room became quiet. Everyone said they had no objection. on the one hand, Professor Gao Pei'an's name is well-known in the Department of Hepatobiliary and Pancreatic Surgery, and "Academician Chen's student" has given him a layer of gold. on the other hand, Director Xiao proposed a widely used surgical plan in clinical practice. First, percutaneous puncture. If it doesn't work, do endoscopy. If it doesn't work, the last option is to open the abdomen and perform debridement directly. Severe acute pancreatitis means that the pancreas is completely necrotic, causing complications including organ failure and severe infection. The treatment method is naturally to clean up the necrotic tissue. The three-stage step-up therapy is impeccable. At this moment, a young voice broke the silence in the conference room. Xu Qiu stood up, and his face remained unchanged in the face of the stares of many directors. He said slowly: "ECMO is not used." The ECMO startup fee is 100,000 yuan, and the subsequent daily cost is also around 10,000 yuan. The patient's family really can't afford such a luxury. "Step-up therapy is also not advisable." Percutaneous puncture is definitely not feasible. Endoscopic debridement and drainage treatment does have the advantages of "minimally invasive, complications, and low mortality." However, this operation requires repeated debridement! The fatal problem it brings is - increasing the number of hospital stays and costs. Although the risk of surgery via the abdominal route is high,
but as long as the surgery is effective, the patient can be out of danger and transferred to a general ward after staying for about a month. But minimally invasive endoscopy requires repeated puncture and cleaning to gradually expand the sinus tract. The number of days in the ICU will soar to more than two months, and the cost of surgery will also rise... The people present were all experts, and they could hear what Xu Qiu meant from his two sentences. But at this time, Director Xiao stood up again and asked: "Xu Qiu, you have overlooked the most important issue..."