Looking at the preoperative radiographic films, the patient's diagnosis was very clear. It was primary liver cancer.
There was a 3 × 4 cm lesion on the liver, but the gallbladder was intact. Not to mention stones, there was not even a bit of roughness on the gallbladder wall.
Moreover, Zhao Yunlong did not insert one preoperative radiographic film, but two.
The first was a preoperative radiographic film. There was no iodine oil in the lesion. The second radiographic film was after the embolization. Looking at the date, it should have been a few days ago.
The most recent radiographic film showed that the inside of the tumor was already necrotic, and the image of the needle channel could still be seen. It should have been a radiofrequency ablation after the embolization.
"It shouldn't be gallstones," Zheng Ren said with certainty.
After looking at the radiographic films, he knew what Zhao Yunlong was conflicted about.
Zhao Yunlong nodded repeatedly. "Boss Zheng, there were no gallstones before the surgery. It's only been a few days, so it's impossible for a large number of silt-like gallstones to appear. This is a conventional logical judgment, but from the imaging point of view, there is one. "
As he said that, he sighed helplessly.
Sometimes, there would be errors in the imaging and logical judgment. Most doctors would use the objective imaging judgment as the final basis.
After all, the imaging was objective. Otherwise, what was the point of doing imaging examinations for patients? In many cases, the logic of thinking was limited by the quality and level of the doctor himself.
However, at Zhao Yunlong's level, the objective image could only be used as one of the criteria for reference. He would not believe in any objective image.
The higher the level of the doctor, the more problems he would consider.
Every problem that could not be solved logically could have a very rare situation that would cause the patient's condition to worsen further and even lead to the patient's death.
Even if there was a very typical imaging diagnosis on the radiographic films, he had to think it through.
This was also the reason why Zhao Yunlong was stunned when he looked at the CT radiographic films that had a very "clear" diagnosis.
This was because he could only feel that there was a problem, but he could not overturn the diagnosis of gallstones. The two contradicted each other, making it impossible for people to follow.
"What about the other tests?" Zheng Ren asked.
Lin Yuan sat at the side and was writing the medical record. She was a little sleepy, but when she heard Boss Zheng say that, she became energetic.
This was the tone of a senior doctor. As the lowest-level junior doctor in Boss Zheng's medical team, she definitely had to run over and hand over the other tests he needed.
It was like this when she was at Harvard, and it was the same when she returned to the 912.
However, the next second, Lin Yuan was stunned.
She saw Zhao Yunlong, one of the professors in charge of the 912's Intervention Department, bend his back slightly. He ran to the computer and quickly printed out all the patient's examination reports.
The printer buzzed as it spat out pages after pages of A4 paper.
Lin Yuan looked at Zhao Yunlong in surprise and saw his anxious face. Every time the printer spat out a report, he would directly take it into his hands.
Was there a need for that?
Although Boss Zheng was usually not willing to joke, and hitting the radial styloid process with hemostatic forceps on the operating table was also very painful, he was usually very kind.
Lin Yuan did not understand why Professor Zhao Yunlong's attitude was so humble. He's simply … more like a junior doctor than me.
"Boss Zheng, look." Zhao Yunlong immediately held the problematic test sheet in his hand and blew on it to lower the temperature left by the printer on the A4 paper.
Sure enough, the patient's white blood cells, blood and urine amylase, and serum lipase were high.
Low blood calcium, high blood sugar …
Zhao Yunlong was experienced. He had done all the necessary examinations, so Zheng Ren had nothing to be picky about.
"Does the patient have a history of diabetes?" he asked.
"No," Zhao Yunlong answered immediately.
There was no history of diabetes, but the blood sugar was elevated and the blood calcium was low. This was one of the typical clinical tests for acute pancreatitis.
Could it be a postoperative stress reaction that led to cholecystitis and acute pancreatitis? Zheng Ren flipped through the test sheet and thought to himself.
Although he thought so, he did not come to a simple and crude conclusion.
The patient's test sheet and imaging examination were very clear — acute gallstone and acute pancreatitis.
But!
There was still no way to explain how so many silt-like stones came about.
If it was the kind of cholecystitis with a rough wall of the gallbladder, Zheng Ren would probably give up thinking about it at this time. However, the gallbladder had grown from nothing to a large number of silt-like stones in a few days. No matter how he thought about it, something was wrong.
Moreover, it was a postoperative patient. Even if his diet was irregular, his family would still take good care of him at this time. If he could eat, he would eat.
Strange.
Zhao Yunlong looked at Zheng Ren with great anticipation in his heart.
"Tell me about the patient's condition." Zheng Ren stood at the position of reading the radiographic films. He crossed his arms and rested his chin on his hands. He looked at the radiographic films seriously and said lightly.
The junior doctor in Zhao Yunlong's group was about to speak when he was interrupted by Zhao Yunlong.
"It's like this, Boss Zheng." Zhao Yunlong began to report the medical history like a junior doctor.
"The patient came to our hospital for treatment a week ago. The initial diagnosis was liver cancer. When I went out of the outpatient clinic, I took the patient in. Three days ago, the liver cancer was treated with interventional embolization and radiofrequency ablation. There is a radiographic film that was left after the interventional embolization. "
Zheng Ren nodded, indicating that he knew.
"The patient's recovery after the surgery was not bad. In the early hours of this morning, he suddenly complained of severe abdominal pain. An urgent CT scan found gallstones and pancreatitis. After asking for a consultation, the Department of Hepatobiliary and Pancreatic Surgery's diagnosis was also the same. It was recommended that the patient be treated according to the symptoms. "
"But I looked at the radiographic films and thought there was a problem." Zhao Yunlong was very cautious. "The patient's current condition is not very good. The pain has not been relieved."
"Did you give him analgesics?"
"I didn't give it to him. There are some things that I haven't figured out yet."
Zheng Ren nodded.
Giving analgesics if he did not understand would be courting death.
That was not right! Just now, when he looked at the test results, there seemed to be something wrong. He passed by it in a flash and did not pay much attention to it.
Zheng Ren picked up the test results again in confusion and looked at them one by one.
Very soon, he found the problem. The patient's blood routine had high white blood cells. This could be used as one of the auxiliary diagnostic evidence for cholecystitis and acute pancreatitis.
However, the patient's hemoglobin had already dropped to 76 g/L, while the hemoglobin before the surgery was normal.
"Anemia? Professor Zhao, what do you think? "Zheng Ren asked.
Zhao Yunlong shook his head in a daze.
Whether it was radiofrequency ablation or interventional embolization, they would not cause anemia.
There was no need to talk about interventional embolization. There was a needle hole in the femoral artery of the thigh. Then, the guide wire and catheter entered and embolized the blood vessel. There were very few bleeding complications because the embolization itself was one of the treatments to stop bleeding.
If it was radiofrequency ablation, the radiofrequency needle was not thick. When it pierced into the liver, the radiofrequency needle had to be heated when it was pulled out after the ablation in order to prevent the needle from transferring.
While killing the tumor cells, the puncture needle would also be 'scalded'. Even if there were capillaries bleeding, it would be as if they had been burned by electricity and the bleeding would stop.
There was no anemia before the surgery, and there was no anemia during the first follow-up after the surgery. It was only in the early hours of this morning that progressive anemia began to appear.
This was a particularly suspicious point.
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