#1467 Witness

"It would be nice to watch more films and have more clinical experience." Zheng Ren had to leave an illogical statement.

Zhou Chunyong burst into tears.

I have been engaged in clinical practice for decades, but I am not experienced enough?

He sighed, and when he saw Zheng Ren going to change his clothes, he followed.

"Boss Zheng, how many courses of treatment should be done before surgery?" Zhou Chunyong no longer mentioned the branch of the phrenic artery, but asked about the surgery with a smile.

"How many courses of treatment?" Zheng Ren was a little surprised.

"Yeah, isn't your surgery divided into several courses of treatment?" Zhou Chunyong felt that he must have misunderstood with Boss Zheng.

Generally speaking, interventional embolization therapy for liver cancer does not end with a single operation.

At least, once every 28 days, 3 courses of treatment can be done to determine whether the tumor has been completely embolized.

Because of the presence of the tumor supporting trunk, there are some abnormally proliferated and very thin arteries that cannot guarantee the filling state.

After the main trunk is embolized, the collateral vessels begin to take on the "important task" of feeding the tumor tissue.

Like a river channel, if the main trunk is blocked, the river will definitely flood. Formerly dry or inconspicuous tributaries become new channels.

The 3 times interventional embolization that Zhou Chunyong said is an ideal situation.

Generally speaking, interventional embolization is the most common procedure performed about 5 times in a row.

That's why Zhou Chunyong asked this question.

Zheng Ren thought for a while, put himself in the position of Dao Zhou Chunyong, and immediately understood what he meant.

"Director Zhou, that's not the case." Zheng Ren smiled and said, "A week or so after the operation, surgery can be done."

"So soon?" Zhou Chunyong found that he had thought wrong from the beginning.

"Uh... how do you say it?" Zheng Ren hesitated for a while, and said, "Radiofrequency ablation, have you done it?"

Zhou Chunyong was taken aback by this question.

"Liver?"

"Um."

"I did, about 2,000 cases a year." Zhou Chunyong immediately stated his proud data.

"Similar to radiofrequency ablation, surgery can be performed as long as the embolization is supported." Zheng Ren said: "I think radiofrequency ablation can be solved for those below 5cm. For those above 5cm, radiofrequency ablation cannot be solved at one time. The effect of surgery is Better."

Zhou Chunyong immediately understood what Boss Zheng meant.

They are the foundation of the operation, and the large blood vessels that support the tumor have been embolized. Once the edema period is over, surgery can be done.

but……

Seeing Zhou Chunyong's hesitant expression, Zheng Ren asked, "Director Zhou, do you have any questions? It doesn't seem to matter, just ask directly."

"Radiofrequency ablation can be done right away, why don't you do surgery right away?" Zhou Chunyong asked.

Vascular interventional embolization combined with radiofrequency ablation, there are two approaches.

Both are embolization and labeling first, and lipiodol is used to display the image of the patient's lesion under CT, and then radiofrequency ablation is performed using CT positioning.

But sometimes ablation is done directly after embolization, and sometimes it is ablated 1 week after embolization.

The difference... Zhou Chunyong didn't notice any big difference.

"Oh, that's right." Zheng Ren smiled, "First of all, I said that because the tumor is too big, radiofrequency ablation can't be solved at one time. Second... TIPS surgery, liver anatomy, does it greatly improve you? "

"Big!" Zhou Chunyong blurted out immediately.

Zhou Chunyong couldn't help being a little excited when he thought of the anatomy of an animal's liver, which looked like a handicraft.

"That's it." Zheng Ren smiled and said, "Organ intervention is basically done by doctors in the radiology department."

"..." Zhou Chunyong hesitated for a while, he didn't understand what Zheng Ren meant by saying this.

Zheng Ren saw Zhou Chunyong's confused expression, and knew that he was going a little far.

He changed his clothes and went out with Zhou Chunyong, explaining to him as he walked, "Director Zhou, the organ intervention did not go well."

Zhou Chunyong nodded.

This, he also admitted.

Circulatory intervention has crowded out cardiothoracic surgery. Cardiothoracic surgery in major hospitals now exists in name only.

Without coronary bypass surgery, they are almost half-employed.

And neurological intervention, with the participation of neurosurgeons, also "abolished" aneurysm surgery, which has a watershed significance in neurosurgery.

Interventional embolization, minimally invasive, less side effects after surgery, who still does surgical craniotomy?

You must know that a dozen or twenty years ago, whether or not an intracranial aneurysm could be operated was the most important way to determine whether a neurosurgeon was mature.

And now, these large-scale spells have been blown away by the rain and the wind.

In another 20 years, it is estimated that we can only find traces of the existence of these techniques and how important and brilliant they were back then.

However, visceral intervention, especially for the treatment of liver cancer, has been slow to progress.

Zhou Chunyong knew this.

Driven by his own efforts and that of other interventional physicians, some progress has been made in the past ten years.

The progress is weak and slow, but Zhou Chunyong has no good ideas.

Zhou Chunyong thought quickly and immediately realized what Zheng Ren might mean. Like his own thoughts, although Boss Zheng is a doctor from the general field, his mind is still more involved.

Thinking of this, Zhou Chunyong smiled.

"Interventional surgery for liver cancer is different from other departments. It is not performed by doctors in gastroenterology, but by doctors in radiology. This is due to historical reasons." Zheng Rendao.

Zhou Chunyong nodded frequently.

"Radiologists, you have no status." Zheng Ren smiled.

Radiologists... In the medical field, they are at the bottom of the chain of contempt, and they are in the same position as pathology, traditional Chinese medicine, acupuncture and physiotherapy.

Why does general surgery for liver cancer still exist?

General Surgery is the largest department. Since the founding of the People's Republic of China, talented people have come out in large numbers! The status in the medical world is the highest level of existence.

There are academic disputes, whether liver cancer should be treated with embolization or surgical resection, and the right to speak is in the hands of general surgery.

Secondly, because liver cancer is a malignant disease, it will be cured after removal, which is a common perception. In interventional embolization, the tumor tissue is still there, which is not reassuring.

The combination of the two has led to the present bizarre situation.

"Since there is no status in the arena and no right to speak, then perform relevant operations and use anatomy to tell all doctors the actual effect of interventional embolization on liver cancer." Zheng Ren smiled.

"Isn't it going to be surgery?"

"Director Zhou, you don't really want to find a patient for human autopsy. It's impossible."

Zheng Ren spoke earnestly.

Zhou Chunyong was sweating profusely.

"So, surgery is the best way to witness the effect of interventional embolization in liver cancer."

"But don't the surgeons have any opinions?" Zhou Chunyong asked cautiously.

"Director Zhou, I am a general surgery major." Zheng Ren smiled and said lightly.