Back in 2002 as a doctor

So Director Jiang went to sterilize and lay the sterile sheets in person, and then became an assistant.

"Director Wen, what do you think is the problem?"

The operation starts inside, stepping on the line at any time.After the airtight lead door was slowly closed, Director Han asked.

"Han Chu, I don't know." Director Wen of Gastrointestinal Surgery did not brag, but confessed that he didn't understand.

"Tell me what you want, but Professor Zhou can't hear you." Director Han looked at the operation inside through the leaded glass, and continued to ask.

"Han Chu, I really don't understand it." Director Wen said, "The signs on the body surface are all negative, and the patient is vomiting blood... I think the color of the vomited blood should be below the duodenum. There was bleeding not far away. But my physical examination denied this."

Director Han asked the director of the Department of Gastroenterology and the director of the ICU the same question.

Everyone didn't know, so they looked at the screen curiously.

The guide wire catheter has been inserted, and Director Jiang presses the button of the high-pressure syringe sideways, and the radiography starts.

Everyone stared at the screen intently.

The dark contrast agent on the screen rushed forward, and after more than ten seconds, a position began to "smoke".

Here is the bleeding point.

But not only the three directors, but even Director Han was surprised, he asked in surprise, "Where is this?"

Chapter 1516 I don't know either

"Appendix! How could it be an appendix..." Director Wen said in surprise.

What everyone thought was upper gastrointestinal bleeding suddenly turned into lower gastrointestinal bleeding, and it turned out to be the appendix!

This little bit of useless tissue, which was innocuous when cut off, nearly killed a 15-year-old girl.

Everyone in the operating room didn't know how to describe this matter, they looked at each other in blank dismay.

"The equipment nurse came to the stage as soon as possible." Zhou Congwen's voice came from the intercom, "The patient is bleeding from the appendix, so he was operated on here."

"Okay!" Director Han responded, and began to urge the people in the operating room.

The interventional catheterization room had stopped stepping on the line, and the airtight lead door was opened. Director Jiang looked happily at the many directors and Director Han outside, "Look, I said that this matter has to be found in our blood vessels."

"..."

"Professor Zhou, what's the problem? Is appendicitis causing the rupture of the appendix artery?" Director Wen was startled by the angiographic image, and he walked in immediately and asked.

"Probably not." Zhou Congwen said.

"It's a ruptured aneurysm!" Director Jiang hurriedly replied.

"No." Zhou Congwen glanced at Director Jiang, but still denied his diagnosis.

"..." Director Jiang just wanted to continue to show off the advanced nature of the interventional discipline, brainwash the other directors, and remember to call himself when something happens, which can be regarded as opening up a part of the situation.

But unexpectedly, Professor Zhou Congwen Zhou denied his diagnosis without hesitation.

This is too embarrassing... Director Jiang scratched his head, not knowing what to say.

But he didn't dare to refute Zhou Congwen's diagnosis, it's no big deal, right?

For Zhou Congwen, Director Jiang of the Department of Vascular Surgery had already knelt down, when Zhou Congwen was still a junior doctor in the Third Hospital of Jianghai City.

"What's that?" the director of the gastroenterology department asked in confusion.

"This girl is so unlucky. Usually, this kind of disease occurs in the stomach." Zhou Congwen said, "Dieulafoy's disease, have you heard of it?"

"..."

"..."

"..."

Several directors were confused by the words thrown out of Zhou Congwen's mouth, and their eyes widened. From the eyes of the other party, it was clear that everyone knew nothing about it.

"Dieulafoy's disease is also called constant-diameter arteriolar malformation, which refers to the fact that the branches of the feeding artery do not gradually narrow to form capillaries, but maintain a constant diameter directly to the gastric mucosa, which causes the gastric mucosa to be damaged under the impact of high-pressure blood flow disease."

"It's not very common, but it's not rare. Many Dieulafoy's diseases are treated as other diseases in clinical practice, so it's normal that people don't know about it."

"I didn't expect it to happen in the appendix either."

"This is a preliminary diagnosis, and it's not certain yet. Let's cut it first."

After Zhou Congwen finished speaking, he turned around and stepped off the stage, tore off the sterile clothes and the lead clothes, and began to sterilize his hands again.

The diagnosis of a critical illness turned into an appendectomy, which no one expected.

Although Director Wen was inexplicably surprised, he followed Zhou Congwen to brush his hands immediately.

Zhou Congwen helped solve such a big problem, so why should he stand aside and watch others suffer from appendicitis?That's impossible!

Director Wen asked while brushing his hands, "Professor Zhou, the patient's symptom is upper gastrointestinal bleeding, how could it be in the appendix? If it's here, it should be lower gastrointestinal bleeding."

"I don't know either." Zhou Congwen shook his head.

Director Wen was taken aback.

"There are only two cases of Dieulafoy's disease in the appendix in all literature reports." Zhou Congwen explained, "I guess the incidence of Dieulafoy's disease is not so low, but most clinical doctors do not know about this disease. "

Director Wen felt that Zhou Congwen was in Yin and Yang himself, but even if it was Yin and Yang himself, what could he do.He lowered his head and brushed his hands, brushing the brush.

"It is known that two cases of Dieulafoy's disease occurred in the lesions of the appendix, and one case was accompanied by hematemesis, which almost did not lead to a misdiagnosis." Zhou Congwen continued to explain, "I heard about it from the boss, and the boss didn't know the specific reason, I guess The boss of this patient’s data will be very concerned.”

Director Wen didn't know what Zhou Congwen meant, so he continued to brush his hands.

Bleeding of the appendix, Dieulafoy's disease... Although Director Wen worked in general surgery when he was a young doctor, he specialized in gastrointestinal after division. It can be said that he has dealt with the intestinal tract all his life, and he did not know how many appendixes were cut.

But he had never seen this incident, this diagnosis before.

Curious in my heart, countless question marks could not be restrained from popping up in clusters, and Director Wen couldn't wait to brush them up.

After laying out the list, Director Wen stood directly on the assistant's seat, knowing who was the big king and who was the little king.

"Director Wen, come here." Zhou Congwen said.

"Professor Zhou, you should be the surgeon." Director Wen thought that Zhou Congwen was being polite to him, so he immediately refused.

"Oh, I cut off the appendix and I'll go down. It's uncomfortable for you to stand on the left side and close your abdomen."

Director Wen burst into tears.

It turned out that Zhou Congwen was not being polite to himself, but was planning to step down early.

he,

In my heart,

it turns out,

I really think of myself as a junior doctor.

With the knife in his hand, Zhou Congwen cut open the skin at the Mai's point in the lower right abdomen, applied electric heat to stop the bleeding, and separated layer by layer.

After the appendix is ​​covered for protection, the appendix artery is clamped and the appendix is ​​cut off smoothly.

This level of surgery is a small job for both Zhou Congwen and Director Wen. It is an exaggeration to say that it can be done with eyes closed, but it is only a slight exaggeration.The eyes still have to be opened, as for the rest, it's all muscle memory.

Holding the appendix, Zhou Congwen no longer cared about Director Wen who was standing in the operator's position, but asked the nurse to make room for himself on the instrument table, and began to dissect the appendix.

"Professor Zhou, are you looking for the location of Dieulafoy's disease?" Director Han asked standing behind Zhou Congwen.

"Well, look for it."

After cutting the appendix, a small ulcer appeared in front of my eyes.

The scab after blood coagulation can be seen on the ulcer surface, but the scab is only a thin layer, which seems to fall off at any time.

"Here, here it is." Zhou Congwen said, pointing at the scab.

"Is this an ulcer?" the director of Gastroenterology asked suspiciously.

"Ulcers are right or wrong. Dieulafoy's disease lesions are generally 2 to 5 mm in diameter, showing localized mucosal defects or erosions, or solitary conical polyps.

In the center of the defect, pulsatile arteries with a diameter of 1-3 mm can be seen protruding from the mucosa, and there may be clots or thrombus attached to the surface.Here, here it is, the pulsating artery..."

Director Wen is working very hard on the patient's incision. Although appendectomy is one of the most basic and simplest surgical operations, it still takes time to solve it.

No matter how fast you are, you can't finish it in 5 minutes.

But listening to Zhou Congwen's explanation of Dieulafoy's disease and other pulsating arterioles, Director Wen's heart itched unbearably.

Chapter 1517

"Here, Director Wen, take a look." Zhou Congwen was still very particular. He didn't step down after dissecting the appendix on his own. By the director's eyes.

Zhou Congwen held his appendix in his hand and was not close to the sterile area. Zhou Congwen was very careful and serious about the aseptic operation.

A 3mm spot can be seen in the appendix cavity, and there is no active bleeding, but there is a moderately large artery underneath.

Because the appendix artery has been severed, it has no blood supply, so it appears white, as if it were a piece of connective tissue.

"Blood?" Director Wen carefully identified it.

The hemostatic pliers in Zhou Congwen's hand rested on the "connective tissue" and picked it lightly.

The tips of the forceps are blunt so as not to cause damage during the operation.

But Zhou Congwen's hands are very steady, even with blunt forceps, he can pick up the small artery with a diameter of 3mm at once.

Director Wen's eyelids twitched.

Not to mention Zhou Congwen's diagnosis, he alone is enough to top the Second Hospital of Medical University.

In the past, when there was no deep vein puncture, when patients with massive bleeding were sent for rescue, nurses could not find blood vessels at all and could not establish venous access.

At this time, the most important thing is to cut the femoral vein and send the infusion tube to the patient's inferior vena cava.

Director Wen has seen many similar operations and patients, and he is very clear about the difficulty.

Because blood vessels collapsed in hemorrhagic shock and mixed with the surrounding connective tissue, no matter how skilled the surgeon was, it was difficult to find the femoral vein in the first place.

In many cases, it is necessary to follow the femoral artery, which is still a little in diameter, to "mask" according to the anatomical structure.

But in front of this...

The difficulty is definitely more difficult than femoral vein incision.

Hemorrhagic shock is just that the blood pressure is not enough, and there will be some blood flow, but the appendix in Zhou Congwen's hand has been cut off, and there is no blood flow at all.

Furthermore, the diameter of the femoral vein is more than twice the diameter of the abnormally proliferating vessel in front of it.

No matter from which angle you look at it, Director Wen was surprised that Zhou Congwen "inadvertently" picked up the hyperplastic blood vessels with blunt-tipped pliers.

No wonder it is number one in the world,

It really deserves to be number one in the world.

Director Wen knelt before he knew it, admiring Zhou Congwen's way of lifting weights with ease.

Zhou Congwen showed the demeanor of a world-class master with just a casual movement.

"Director Wen, what are you looking at?" Zhou Congwen said.

"Uh……"

"Here, here, the abnormally proliferating blood vessels, the ulcers are also very clear. Generally speaking, Dieulafoy's disease can be seen in all age groups, but it is more common in the elderly with high blood pressure."

"During the Chinese New Year, I met a 15-year-old patient with Dieulafoy's disease, the bleeding point was still in the appendix, what a fate."

Zhou Congwen shook his head and said with emotion.

"Professor Zhou, Dieulafoy's disease...is it called this?" asked the director of the Department of Gastroenterology.

"Yes."

"It looks so dangerous. We have a lot of gastric ulcer bleeding in our department of gastroenterology. It seems to be Dieulafoy's disease."

"This disease has several characteristics. The first is sudden onset - no obvious aura symptoms. Smoking and alcohol, high blood pressure and stress may be its triggers. There is no history of cirrhosis, peptic ulcer or family genetic disease in the past."

"Secondly, it is manifested as sudden fatal gastrointestinal hemorrhage - 54.0% of the patients had shock at the time of treatment, and only 33.0% of the patients complained of vomiting blood. Failure to rescue in time often leads to death, which is the cause of high fatality rate. reason."

"Third, Dieulafoy's disease is intermittent and refractory.

After the constant diameter artery ruptures and bleeds, a blood scab is formed, which temporarily stops the bleeding, but with the increase of blood pressure or irritation after the infusion and blood transfusion, the blood scab falls off, causing massive bleeding again, and it is characterized by recurrent attacks. "

"But it's really rare to happen in the appendix cavity." Zhou Congwen said with emotion, "Director Han."