"I have a patient here and would like to invite you to come over to assist in the consultation."
Asking her, a medical student, to assist in the consultation? Assisting in the consultation usually means asking a lower-level doctor to come over and assist in the consultation if he is not satisfied with the consultation. Xie Wanying had every reason to think she had heard wrongly.
"This is a patient who developed anastomotic fistula after surgery for cardiac cancer." Wei Guoyuan first briefly introduced the case to her so that she could understand why he suddenly thought of asking her for help.
In China, people like to classify cardia cancer as gastric cancer. The incidence and mortality rates are calculated based on gastric cancer. In fact, it is a junctional cancer. According to the anatomical explanation, the cardia is located at the junction of the esophagus and the stomach. Tumors occurring here naturally have the characteristics of both gastric cancer and esophageal adenocarcinoma. In the future, it will be more accurately defined as esophageal-gastric junction cancer in medicine.
Regarding the treatment of this disease, the early tumor is small, just like other tumors such as colorectal cancer, and can be treated with a gastroscopy in the gastroenterology department. All tumors follow the principle of early treatment for a better prognosis. Unfortunately, Chinese people do not have the habit of physical examinations. The symptoms of early cardia cancer are similar to those of ordinary gastrointestinal inflammation, and cannot be distinguished without a gastroscopy. When domestic patients are discovered, they are often in the middle and late stages and can only undergo surgery.
Both general surgery and cardiothoracic surgery are departments that can perform surgical operations for cardiac cancer. The general surgery approach is to open the abdomen, without cutting the diaphragm, and partially remove the stomach and esophagus. Due to the limitations of surgery from the abdomen, the residual tumor at the end of the esophagus and the thoracic lymph nodes may not be completely removed, and are prone to recurrence. Therefore, more people choose to go to cardiothoracic surgery for this operation. The cardiothoracic surgery method is to enter the chest cavity and then enter the abdominal cavity, which can more thoroughly clear the patient's tumor than general surgery. However, there may be more serious complications, such as squeezing of organs such as the heart, and anastomotic fistulas in the chest cavity after surgery.
The patient's surgery was performed at Xuanwu's cardiothoracic surgery department. Xuanwu's cardiothoracic surgery department is not very famous, but it can certainly perform common tumor surgeries and has a certain level of technical skills. So Xuanwu's neurosurgery department is not incapable of treating all diseases, but can treat common diseases. It's just that for a serious sudden injury like Sister Xu's, the technical level is really limited and can only be so.
Postoperative anastomotic fistula is a very common postoperative complication in surgery. The cause of its occurrence is related to the skills of the surgeon, and is also closely related to the individual differences of the patient. 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 field. This does not mean that Xuanwu's cardiothoracic surgery skills are not good. Unless a surgical department has many cases of postoperative fistula that exceed the normal proportion, then something is wrong.
Wei Guoyuan's classmate, Dr. Shao Jialiang, worked in the cardiothoracic surgery department of the same hospital. When he encountered such a case, he wanted to ask Guozhi for a cardiothoracic consultation. When Wei Guoyuan heard this, he suggested asking Xie Wanying to come over and take a look.
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There are generally two ways to solve postoperative fistulas, either conservative treatment or surgical treatment. For surgical treatment, you can do another surgery and re-open the chest and abdomen. You can also use endoscopic minimally invasive surgery to block the fistula, which is usually done by a gastroenterologist.
Dr. Shao asked colleagues in the internal medicine department of the hospital for help. The gastroenterology department of Xuanwu is as well-known as the general surgery department of Xuanwu and has the technical strength to do this, but the conclusion reached was that it could not be done.
Why? The patient had anastomotic stenosis and the gastroscope could not be inserted.
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