Life is like a journey

"Patient Wu Xinyuan, 21 years old, has stage IV pancreatic cancer. After two courses of targeted therapy, the stage was pushed forward, but CT still showed that the tumor adhered to the abdominal aorta and duodenum, and there were secondary tumors in the stomach. Transfer, please actively discuss and speak freely.”

The CT scan results were magnified on the big screen, Lu Qingshi propped his chin in silence, and Wu Xinyuan's latest examination results were on hand.

The four blood coagulation items showed that her blood coagulation function was not good, and unpredictable bleeding and hemostasis may occur during the operation.

The operation plan that was written all night was passed. Everyone in the meeting room frowned. The gastroenterology doctor stood up and said, "Use the autologous blood recovery machine, so that there will be no problem of insufficient blood."

The deputy chief physician of the hematology department immediately retorted: "No, the problem of using blood with the autologous blood recycling machine has been solved. The key is that it is impossible to hang the jar without suturing all the time."

Dean Meng put on his glasses, picked up the IPad to look at it, and magnified the scan results of abdominal blood vessels with his fingertips.

"This location is really not good. You see, the tumor is just at the head of the pancreas, wraps the abdominal aorta, and is very tightly adhered to the lower part of the duodenum. What's worse, there is a shadow in the stomach, which means that the lymph nodes are in contact with the incision. The edge of the layer must be cleaned very cleanly and thoroughly before it can be cured, otherwise the prognosis will be too poor and it will be a dead end.”

Lu Qingshi stood up: "This is not the worst. The worst thing is that the patient's blood coagulation function is too poor, and the trauma of the open chest surgery is bleeding a lot. It is very likely that he will not be able to get off the operating table."

Yu Gui weakly raised his hand: "Well... you can use laparoscopic radical pancreatectomy."

The doctor in charge of the gastroenterology department let out a sneer: "I've thought about it a long time ago, and it's the plan proposed by your Director Lu. It's a pity that the bleeding is less in laparoscopy, but the lymph nodes may not be cleaned so clean."

The organs around the pancreas are dense, at least nine nerve plexuses have to be cleaned up to the superior mesenteric artery, and there are at least twenty lymph nodes. It is difficult to control bleeding even with laparoscopy for such a long-term major operation. Laparoscopic bleeding is more troublesome than thoracotomy. After all, you can press gauze on it immediately after thoracotomy. The laparoscope is only so big, and the hemostasis speed of monopolar electrosurgical surgery is not as fast as that of thoracotomy. The day lily was cold when it was converted into a thoracotomy.

Yu Gui shrank his neck and tightened his grip on the pen in his hand: "Then if we mark the nerve plexuses and lymph nodes that need to be cleaned in advance, can the operation speed be faster?"

Lu Qingshi nodded: "In theory, yes."

Yu Gui cast a grateful glance, but the other party turned a blind eye, and then she fell into the bottom of the valley with a sentence: "But it is only in theory, in order to prevent further spread and metastasis of the tumor, aortic artificial blood vessel replacement is needed, spv/pv has been involved The superior mesenteric artery cannot be reconstructed for a long time, and the common hepatic artery is also affected. Therefore, the only feasible plan at present is—pancreaticoduodenectomy, portal vein + superior mesenteric artery resection, and aortic artificial vascular replacement, and anastomosis of biliary tract to reconstruct the digestive tract "

The longer the medical term, the more difficult it is to operate. A series of nouns were thrown out, which made Yu Gui dizzy. Before the anesthesiologist said it, she knew that the operation was almost an impossible task.

Chen Yi stood up and handed the preoperative assessment to the dean: "After multiple assessments and consultations by the anesthesiology department, the patient's anesthesia tolerance time is within 7 hours, and life will be in danger if it exceeds this time."

In the silence of the room, Liu Changsheng took the lid off the tea foam in the porcelain cup, and finally put it on slowly.

"From the perspective of the patient's family situation, we are more inclined to offer chemotherapy and combined drug regimens. Please return the patient to the local hospital to continue treatment. We will guide and assist remotely, so that part of the medical insurance can be covered, and the burden on the patient's family can be lightened."

Doctors will also take less risk, which is not necessarily a bad thing for patients. Instead of being unable to get off the operating table, it is better to seize the time for radiotherapy and chemotherapy to live one day longer.

During the lunch break, everyone dispersed and went to the cafeteria to eat. Yu Gui walked into the simulated operating room, but someone was already there. Lu Qingshi was wearing a surgical gown, standing in front of the operating table with a laparoscope in hand.

"This is..." Yu Gui was stunned for a moment. There was a simulated organ on the operating table. Judging from the entanglement of the tumor, it was undoubtedly Wu Zhiyuan's digestive organ.

The "3D printed organ" Lu Qingshi didn't lift her head, she moved her fingertips slightly, and the beeping sound of the super knife sounded. She was staring at the computer screen, and suddenly her vision was blocked by a cloud of blood, and the monitoring equipment beeped beeping.

The bleeding exceeded 1000cc, and the operation failed.

Lu Qingshi put down the laparoscope, pursed the corners of his lips: "Do it again"

Yu Gui put on his surgical gown and came to help: "I'll come too"

"Pancreatoduodenectomy Completed"

"Next strip the portal vein"

"tweezers"

Lu Qing glanced at the screen while handing over the equipment: "attract"

She quickly connected the suction device, and her movements were much more agile than before.

"Okay, the stripping is complete, ready to be resected, and the aorta is ligated"

"Yes." Yu Gui held the laparoscope in his hand and neatly tied a knot.

"No, tie it tighter"

Thin sweat oozes from Yu Gui's forehead: "Okay, I see."

The intern watching at the side poked his companion and whispered, "Have you noticed that Yu Gui's speed is quite fast now?"

The other party rolled his eyes: "If you are trained by Director Lu's devil every day, you will also become faster."

The intern who had spoken before suddenly shuddered: "Forget it, I'd rather eat and wait to die"

While talking, Yu Gui couldn't keep up with Lu Qing's hand speed, and was scolded all over her head and face. Her temper was definitely not good on the operating table.

"The dog ate the brain? The portal vein was removed in the wrong way! Get off the stage and replace someone"

The intern who was watching next to him felt sorry for him and hurried up, but Yu Gui still stood motionless in the assistant's position.

"you……"

She looked up, staring at the big screen, correcting where she made a mistake: "She is my patient, I must cure her"

As soon as the voice fell, the timer rang, and 7 hours passed without knowing it. The critical point of anesthesia was reached, which meant that the operation was also unsuccessful, and everyone was lost.

Lu Qingshi took off his mask and threw it into the trash can: "Okay, let's go here first, Yu Gui will stay and continue"

Lu Qingshi's surgery team's rules, whoever made a mistake in the simulated operation, who is responsible for staying to deal with the aftermath and propose a solution, asked to be placed on her desk within 24 hours.

Everyone looked at her with sympathy, patted her on the shoulder and left. Yu Gui could only smile wryly, but he didn't seem to be as angry as when he was left behind for the first time.

"A serving of fried noodles, thank you." Lu Qingshi ordered food from the window and went to sit down in the corner of the cafeteria. The stool was not yet warm, and a person sat down on the opposite side.

She thought it was Qin Xuan, so she didn't raise her head: "Sit over there, don't touch me"

"It's been a long time since Director Lu is still so radiant, it's enviable."

It was a middle-aged male voice with a low voice. When Lu Qing raised his head, his eyes suddenly turned cold: "Get lost!"

The temporary pass on the man's chest reads: Zheng Bin, sales representative of Changsheng Biological Pharmaceutical Co., Ltd. in South China.

He leaned forward slightly, and was not embarrassed by her sarcastic remarks. He was obviously an old fritter who had been in various hospitals all year round.

"Don't be like this, Director Lu, I heard that you like to eat Poria biscuits. I brought them here from Beijing. It's the authentic restaurant in Qianmen. Try it."

He put the wrapped gift on the table and pushed it over, a sneer appeared on the corner of Lu Qingshi's lips, he put down his chopsticks, got up and left, the short word "scroll" had exhausted all her patience, she really didn't want to be with her The hypocrisy and hypocrisy of longevity creatures.

The man stood up: "Director Lu, don't you want to know about our company's latest product, the nanoknife? It can directly ablate tumors without damaging normal organs and tissues for pancreatic cancer..."

Lu Qingshi turned around, put his hands in the pockets of his white coat, his eyes were a little frosty, and there was a trace of contempt, but the words he spit out were full of confidence, or in other words, conceit, of a senior surgeon.

"is this necessary?"

"I only trust the scalpel in my hand"

"No. 40 Five Marking Points" Yu Gui rubbed his eyes, yawned, and circled a small red dot on the paper with a pen.

Hand-drawing anatomical diagrams of human organs is the basic skill of every surgeon. Yu Gui's drawing skills are good. Went to pick up a half espresso to perk up.

"Xiang Team, the autopsy results are out, the deceased died of drug poisoning"

The forensic doctor opened the autopsy report and handed it to her: "The neurotoxin in the body of the deceased in the case in Yunnan is exactly the same. There are pinholes in the veins. The initial confirmation is undoubtedly a new type of drug."

"Okay." Xiang Nanke looked at it carefully: "Have the people from the anti-drug brigade of the Yunnan Provincial Department arrived?"

Cross-provincial case handling is the most cumbersome. In Yunnan, the deceased was identified as a Jinzhou citizen because of a drug overdose, and because the police in both places attach great importance to drug-related issues, the case was also handed over to the Jinzhou Public Security Bureau, vowing to find out the source of the drugs.

Xiang Nanke's delay in taking any action was also to avoid alarming others. She always felt that Bao Fengnian was just one of the links, and there was someone above him.

"It's almost here." The subordinate glanced at his watch: "Our people are waiting at the train station."

Before he could finish his sentence, another criminal policeman pushed the door and entered with a bad expression: "Captain Xiang, the chief is looking for you."

Xiang Nanke closed the autopsy report, stood up, and his colleague quickly followed him and said in a low voice: "The director's face is very bad, he must be dissatisfied with our delay in closing the Internet, please be careful."

Xiang Nanke paused: "I know."

Sure enough, as soon as he knocked on the office door, a thick case file flew towards him. Xiang Nanke took it firmly in his hand, bowed slightly, and placed it on the desk of the half-hundred old man in front of him.

"What did Director Li want me for?"

Director Li has been promoted step by step from the grassroots level to a department-level cadre. His temper is notoriously violent, and he slaps the table loudly.

"How long has this case been handed over from the Yunnan Provincial Public Security Bureau to the Jinzhou City Bureau!!! It's so big that it can't be found out! Xiang Nanke, what are you doing! Let me tell you that I have already issued a military order with the Provincial Bureau If we can’t solve the case and find the source of the drugs within a month, let’s get out together!”

When Xiang Nanke first arrived at the Criminal Investigation Detachment of the Municipal Bureau, he actually didn't like her very much. As a woman, she just needs to find a support post and be a vase honestly. The criminal police, fighting wits and courage with criminals, has made outstanding achievements many times. Every step she has taken until today is bought by herself with scars and sweat. She cherishes it as much as it is hard won.

Xiang Nanke's throat moved, but he didn't say anything: "I see."

When she was about to turn around and leave, someone stopped her again: "I understand that you are afraid of bludgeoning, but you can start with the suspect's close relatives. Bao Fengnian's wife can't ask anything, so the lover is not necessarily the case, you know I mean?"

Director Li lit a cigarette, and sighed heavily in the smoke: "Nan Ke, you are my most valued detective, don't let me down."

Xiang Nanke's nails dug deep into his flesh, and he said in a hoarse voice: "I know this, don't worry, if I can't produce strong evidence within a month, I'll wring my head off and make an apology to the Provincial Public Security Bureau."