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If Mr.
Li (pseudonym) is given another chance, he will definitely adjust his eating habits-two months ago, shortly after he ate a moon cake at the age of 32, he experienced knife-like pain in his upper abdomen.
He was diagnosed with severe acute pancreatitis (SAP) by the local hospital
.
In the past two months, Mr.
Li has undergone multiple ultrasound-guided extracorporeal thoracic and abdominal puncture and drainage, and also underwent left thoracoscopic thoracoscopic exploration and thoracoscopic thoracoscopic hemostasis due to massive chest hemorrhage
.
However, although thoracic hemorrhage was controlled, the effect of conservative medical treatment was not satisfactory.
Mr.
Li's abdominal pancreatic pseudocyst gradually enlarged, and repeated fever due to co-infection, the highest body temperature reached 39℃
.
Abdominal pain and pain, unable to eat.
.
.
Mr.
Li, who was suffering from illness, came to the Gastroenterology Department of Hangzhou First People's Hospital for treatment.
The CT scan revealed that Mr.
Li had a huge encapsulated necrosis of the posterior peritoneal cavity with infection
.
After careful preoperative multidisciplinary (MDT) discussion, on December 2nd, Professor Zhang Xiaofeng, Deputy Dean of Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine, Dean of Hangzhou Digestive Disease Hospital, and Professor Yang Jianfeng, Deputy Director of Gastroenterology, led the team This large cyst was resolved with the latest endoscopic ultrasonography and drainage stent placement, which helped Mr.
Li to turn the crisis into peace
.
This is also the first such operation in Zhejiang Province
.
Professor Zhang Xiaofeng solves the dilemma of endoscopic drainage of pancreatic encapsulated necrosis (MSAP) and severe acute pancreatitis (SAP) category 3
.
Among them, MAP is mild, and patients usually recover within 5 to 7 days; MSAP does not have persistent (more than 48 hours) organ failure; and SAP accounts for about 15% to 20% of AP, with acute onset, critical illness, and course of disease.
It is relatively long, with a fatality rate of 20% to 30%, which is extremely dangerous and requires active cooperation from multiple disciplines to achieve high-level treatment
.
"SAP will cause a large amount of exudate and pancreatic juice to overflow, and the surrounding fibrous tissue will form a encapsulated effusion.
After more than 4 weeks, it can be called pseudocyst or encapsulated necrosis
.
" Zhang Xiaofeng said that early drainage can maximize Reduce the continuous stimulation of inflammatory effusion to the body
.
However, pancreatin will corrode the fat and organs in the abdominal cavity and cause tissue necrosis.
The cysts are "like a pool of mud", and adequate drainage is not easy
.
On November 30th, Mr.
Li’s preoperative CT re-examination of the image of the abdomen “Previously, doctors could only remove the decaying fat and necrotic tissue in the abdominal cavity through surgical operations.
However, with endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound With the development of endoscopy (EUS) technology, endoscopic stent drainage has become an important treatment option for pancreatic pseudocyst/encapsulated necrosis
.
" Zhang Xiaofeng introduced that in recent years, therapeutic endoscopy technology has been widely used in pancreatic diseases, endoscopic guidance A variety of treatment procedures including drainage debridement of infectious pancreatic necrosis and drainage of pancreatic pseudocyst can already be carried out.
It not only has better therapeutic effects than surgical procedures, but also has less trauma and fewer complications
.
Under ultrasound guidance, the doctor can choose the best site to puncture the pancreatic pseudocyst/encapsulated necrosis, and place a drainage stent or catheter between the digestive tract and the necrotic cavity
.
However, endoscopic ultrasound-guided drainage also has limitations: the traditional plastic stent has a small lumen diameter, which makes it difficult to adequately drain decaying fat and necrotic tissue
.
The use of metal stents for bile duct drainage is also difficult to completely solve this "dilemma"-although its diameter is larger than that of plastic stents, it is difficult for the endoscope to enter the necrotic cavity through the stent due to its longer length, so it can only do nothing for the surrounding decaying tissues.
Hu Naihe
.
The emergence of the electrocutting drainage stent has changed all of this
.
Efficient, convenient and rapid digestive endoscopy "point-and-shoot camera" "The electric resection drainage stent has three advantages: high efficiency, convenience, and speed
.
" Zhang Xiaofeng introduced that the electric resection drainage stent has two diameters of 1.
5cm and 2cm, which not only makes the drainage smoother, but also It can also make all kinds of endoscopes easily pass through the stent, enter the necrotic cavity from the stomach and intestines, and guide suction and flushing, so as to achieve a better drainage effect
.
"The second advantage of the resection and drainage stent is its convenience
.
" Zhang Xiaofeng said that in the past, doctors had to place a stent in five steps.
The first step is to determine the puncture point after identifying the lesion under the guidance of ultrasound endoscopy.
The operation channel beside the head is punctured; the second step is to insert the guide wire along the puncture needle path into the cyst; the third step is to cauterize between the stomach wall and the cyst through the electrocoagulation head; the fourth step is to guide the guide wire down Balloon expansion of the puncture tract; the fifth step is to place a stent
.
"Among them, the placement of the stent is the difficulty of the entire operation.
It can be said that the success or failure is only a few millimeters.
The entire operation process requires close cooperation with the surgeon.
The operation will fail and all previous efforts will be lost
.
" "In contrast, the operation of the resection and drainage stent is very convenient
.
" Zhang Xiaofeng introduced that when the resection and drainage stent is placed in the operation under ultrasound endoscopy, the doctor only needs to put the guide tube through the ultrasound system Put it into the patient’s stomach, the ceramic nose cone with the electric cutting function at the front of the stent can quickly cut the stomach wall, help the stent enter the sac cavity, and release the first flange
.
After pulling back, the second flange can be released in the stomach wall by the prompt on the handle, thus forming a dumbbell-shaped bracket
.
The entire operation is completed on the same conveyor, which not only minimizes radio frequency interference to images, helps doctors locate quickly and accurately, but also reduces the risk of equipment replacement for patients and greatly increases the success rate of surgery
.
"Even the first time doctors can successfully insert the stent as long as they follow the standard procedures.
It can be called a'point and shoot' camera in an endoscope
.
" The process of puncturing and releasing the stent took only 8 minutes.
If you are a skilled doctor, you can complete the stent placement in 3 minutes.
This not only saves a lot of time in the operation, but also reduces the risks related to anesthesia
.
" Zhang Xiaofeng introduced, the first in Zhejiang Province.
She has led the team to successfully carry out 5 such operations in just a dozen days after the implantation of the stent under the ultrasound endoscopic resection and drainage
.
"The effect of the operation is very good, and the patient can get out of bed on the day of the operation!" "Advance the pass" is the "pioneer" of popularizing medical science.
The responsibility of popular science
.
" Zhang Xiaofeng said that with the rapid development and popularization of the Internet, the Internet has become the main channel for people to obtain information, and some "pseudo-science popularization" has also taken advantage of it
.
"As the saying goes: spread rumors with one mouth and run off the legs, medical staff should'move the gate forward ', actively devote themselves to popular science, use easy-to-understand language, and be the'pioneer ' to pass on medical science knowledge
.
" Sharing experience in the application of electrosurgical drainage stents As early as the 1990s, Zhang Xiaofeng led team members and presided over the development of the "Digestive Through Train" project
.
For more than 20 years, she has traveled to secondary hospitals and community hospitals in almost all cities and counties in Zhejiang Province, and conducted hundreds of popular science lectures
.
As the science popularization position shifted from offline to online, she organized the members of the department to open a public account to plug the wings of the Internet for professional popular science knowledge
.
Just in the past October, "Hangzhou City Science Expert" Zhang Xiaofeng, Director of Gastroenterology Department Yang Jianfeng, and Doctor Zhou Haibin also became "novelists" and jointly wrote and published the medical science novel "Knowing the Intestines and Knowing the Stomach".
Language has popularized common sense of digestive diseases and has been widely welcomed by readers
.
The popular medical science novel "Knowing the Intestines and Knowing the Stomach" goes all the way, without fear of wind and rain
.
Zhang Xiaofeng also truly felt the "dividends" brought by popular science education
.
"In recent years, there have been more and more clinical patients with early gastrointestinal cancer, and fewer and fewer patients with advanced cancer.
This has a lot to do with the promotion of early cancer screening
.
" As the head of the early gastric cancer collaboration network in Hangzhou Zhang Xiaofeng quoted her "idol"-Academician Li Zhaoshen: Lack of knowledge about gastric cancer prevention and treatment is the main factor affecting the participation rate of gastric cancer screening and compliance with gastroscopy.
Only by making full use of media such as TV stations, radio stations, newspapers, websites, WeChat, etc.
Only by increasing the publicity of knowledge related to gastric cancer screening and early diagnosis and treatment can the ideological worries of the screening population be eliminated and the initiative and compliance of gastric cancer screening can be improved
.
"In the past, many doctors resisted the media, but as practitioners of'Healthy China', medical staff in the new era should take the initiative to embrace the media, shoulder the important task of popularizing medical science, and contribute to improving people's health!" Zhang Xiaofeng said
.
Lifelong learning does not forget to be a life-innovating medical practitioner whose original intention "innovation" has always accompanied Zhang Xiaofeng's career
.
Since her exposure to endoscopic retrograde cholangiopancreatography (ERCP) in the 1990s, she not only performed ERCP operations on more than 13,000 patients, but also led a team to complete more than 40,000 ERCP treatments
.
Not only was she called the “ERCP Superwoman” by the patient, she also took the lead in developing a number of new endoscopic treatment technologies: she completed the world’s first radiofrequency ablation of pancreatic tumor under EUS, and was the first to carry out children’s ERCP in China (the smallest patient is only 100 days), depending endoscopic examination and treatment of bile duct, photodynamic therapy, biliary puncture and drainage EUS, EUS combined ESWL antegrade biliary stone and the like
.
The concept of "three mirrors in one" of endoscopy, duodenoscope and choledochoscopy that she put forward has profoundly promoted the development of ERCP technology
.
Zhang Xiaofeng gave a report at the 13th Hangzhou International Symposium on Diagnosis and Treatment of Biliary and Pancreatic Diseases in 2021, "Innovating for life is the original intention of doctors
.
" Zhang Xiaofeng said that advanced technology and equipment are the foundation for doctors to base themselves on clinics and serve patients
.
And continuous learning is the source of motivation to promote innovation
.
In December 2005, Zhang Xiaofeng went to the Faculty of Medicine of the University of Hamburg, Germany, to study under Professor Sohendra, a well-known international ERCP expert
.
During her study, she was surprised to find that there were not only specialist doctors from major hospitals but also community doctors with white temples
.
It was from that moment that she realized that continuous learning and continuous innovation are the mission of every medical practitioner
.
She said that doctors are a profession that requires lifelong learning: specialists in tertiary hospitals should focus on the frontiers of disciplines, solve difficult and complicated diseases, promote and even lead the development of a certain field; while general practitioners in basic hospitals should understand the frontiers of various specialties Dynamic, excellent completion of prevention, health care, rehabilitation, diagnosis and treatment of common diseases and referral of difficult and severe cases, to be the gatekeeper of the health of the people
.
This is also the original intention of the country to carry out hierarchical diagnosis and treatment
.
In 2020, Zhang Xiaofeng won the honorary title of "National Advanced Worker".
He has been commended and worked as a doctor in Beijing for more than 30 years.
Zhang Xiaofeng has forgotten how many critically ill patients referred from primary hospitals have been treated
.
But whenever a patient expresses her gratitude to her, she always remembers to say to the patient: "When you go home, remember to thank the doctor who sent you here, because they sent you here in time, so that we can use it.
.
"typesetting: Hu Haiyan editor: Yin Han audit: Hui-forward driving force of the industry! Honor registration for the 7th Medical Scientists Summit is in full swing.
.
.
2022 "Physician News" subscription has begun! ! ! Millions of doctors are watching.
.
.
For more content, please click: Hot Comment | Girls with mental disabilities are used for vulgar live broadcast, no matter if it doesn't work! In 2021, the medical field will hand over the remarkable "People's Livelihood Ledger" and "Physician's Daily".
Public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete it, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us
Li (pseudonym) is given another chance, he will definitely adjust his eating habits-two months ago, shortly after he ate a moon cake at the age of 32, he experienced knife-like pain in his upper abdomen.
He was diagnosed with severe acute pancreatitis (SAP) by the local hospital
.
In the past two months, Mr.
Li has undergone multiple ultrasound-guided extracorporeal thoracic and abdominal puncture and drainage, and also underwent left thoracoscopic thoracoscopic exploration and thoracoscopic thoracoscopic hemostasis due to massive chest hemorrhage
.
However, although thoracic hemorrhage was controlled, the effect of conservative medical treatment was not satisfactory.
Mr.
Li's abdominal pancreatic pseudocyst gradually enlarged, and repeated fever due to co-infection, the highest body temperature reached 39℃
.
Abdominal pain and pain, unable to eat.
.
.
Mr.
Li, who was suffering from illness, came to the Gastroenterology Department of Hangzhou First People's Hospital for treatment.
The CT scan revealed that Mr.
Li had a huge encapsulated necrosis of the posterior peritoneal cavity with infection
.
After careful preoperative multidisciplinary (MDT) discussion, on December 2nd, Professor Zhang Xiaofeng, Deputy Dean of Hangzhou First People's Hospital Affiliated to Zhejiang University School of Medicine, Dean of Hangzhou Digestive Disease Hospital, and Professor Yang Jianfeng, Deputy Director of Gastroenterology, led the team This large cyst was resolved with the latest endoscopic ultrasonography and drainage stent placement, which helped Mr.
Li to turn the crisis into peace
.
This is also the first such operation in Zhejiang Province
.
Professor Zhang Xiaofeng solves the dilemma of endoscopic drainage of pancreatic encapsulated necrosis (MSAP) and severe acute pancreatitis (SAP) category 3
.
Among them, MAP is mild, and patients usually recover within 5 to 7 days; MSAP does not have persistent (more than 48 hours) organ failure; and SAP accounts for about 15% to 20% of AP, with acute onset, critical illness, and course of disease.
It is relatively long, with a fatality rate of 20% to 30%, which is extremely dangerous and requires active cooperation from multiple disciplines to achieve high-level treatment
.
"SAP will cause a large amount of exudate and pancreatic juice to overflow, and the surrounding fibrous tissue will form a encapsulated effusion.
After more than 4 weeks, it can be called pseudocyst or encapsulated necrosis
.
" Zhang Xiaofeng said that early drainage can maximize Reduce the continuous stimulation of inflammatory effusion to the body
.
However, pancreatin will corrode the fat and organs in the abdominal cavity and cause tissue necrosis.
The cysts are "like a pool of mud", and adequate drainage is not easy
.
On November 30th, Mr.
Li’s preoperative CT re-examination of the image of the abdomen “Previously, doctors could only remove the decaying fat and necrotic tissue in the abdominal cavity through surgical operations.
However, with endoscopic retrograde cholangiopancreatography (ERCP) and ultrasound With the development of endoscopy (EUS) technology, endoscopic stent drainage has become an important treatment option for pancreatic pseudocyst/encapsulated necrosis
.
" Zhang Xiaofeng introduced that in recent years, therapeutic endoscopy technology has been widely used in pancreatic diseases, endoscopic guidance A variety of treatment procedures including drainage debridement of infectious pancreatic necrosis and drainage of pancreatic pseudocyst can already be carried out.
It not only has better therapeutic effects than surgical procedures, but also has less trauma and fewer complications
.
Under ultrasound guidance, the doctor can choose the best site to puncture the pancreatic pseudocyst/encapsulated necrosis, and place a drainage stent or catheter between the digestive tract and the necrotic cavity
.
However, endoscopic ultrasound-guided drainage also has limitations: the traditional plastic stent has a small lumen diameter, which makes it difficult to adequately drain decaying fat and necrotic tissue
.
The use of metal stents for bile duct drainage is also difficult to completely solve this "dilemma"-although its diameter is larger than that of plastic stents, it is difficult for the endoscope to enter the necrotic cavity through the stent due to its longer length, so it can only do nothing for the surrounding decaying tissues.
Hu Naihe
.
The emergence of the electrocutting drainage stent has changed all of this
.
Efficient, convenient and rapid digestive endoscopy "point-and-shoot camera" "The electric resection drainage stent has three advantages: high efficiency, convenience, and speed
.
" Zhang Xiaofeng introduced that the electric resection drainage stent has two diameters of 1.
5cm and 2cm, which not only makes the drainage smoother, but also It can also make all kinds of endoscopes easily pass through the stent, enter the necrotic cavity from the stomach and intestines, and guide suction and flushing, so as to achieve a better drainage effect
.
"The second advantage of the resection and drainage stent is its convenience
.
" Zhang Xiaofeng said that in the past, doctors had to place a stent in five steps.
The first step is to determine the puncture point after identifying the lesion under the guidance of ultrasound endoscopy.
The operation channel beside the head is punctured; the second step is to insert the guide wire along the puncture needle path into the cyst; the third step is to cauterize between the stomach wall and the cyst through the electrocoagulation head; the fourth step is to guide the guide wire down Balloon expansion of the puncture tract; the fifth step is to place a stent
.
"Among them, the placement of the stent is the difficulty of the entire operation.
It can be said that the success or failure is only a few millimeters.
The entire operation process requires close cooperation with the surgeon.
The operation will fail and all previous efforts will be lost
.
" "In contrast, the operation of the resection and drainage stent is very convenient
.
" Zhang Xiaofeng introduced that when the resection and drainage stent is placed in the operation under ultrasound endoscopy, the doctor only needs to put the guide tube through the ultrasound system Put it into the patient’s stomach, the ceramic nose cone with the electric cutting function at the front of the stent can quickly cut the stomach wall, help the stent enter the sac cavity, and release the first flange
.
After pulling back, the second flange can be released in the stomach wall by the prompt on the handle, thus forming a dumbbell-shaped bracket
.
The entire operation is completed on the same conveyor, which not only minimizes radio frequency interference to images, helps doctors locate quickly and accurately, but also reduces the risk of equipment replacement for patients and greatly increases the success rate of surgery
.
"Even the first time doctors can successfully insert the stent as long as they follow the standard procedures.
It can be called a'point and shoot' camera in an endoscope
.
" The process of puncturing and releasing the stent took only 8 minutes.
If you are a skilled doctor, you can complete the stent placement in 3 minutes.
This not only saves a lot of time in the operation, but also reduces the risks related to anesthesia
.
" Zhang Xiaofeng introduced, the first in Zhejiang Province.
She has led the team to successfully carry out 5 such operations in just a dozen days after the implantation of the stent under the ultrasound endoscopic resection and drainage
.
"The effect of the operation is very good, and the patient can get out of bed on the day of the operation!" "Advance the pass" is the "pioneer" of popularizing medical science.
The responsibility of popular science
.
" Zhang Xiaofeng said that with the rapid development and popularization of the Internet, the Internet has become the main channel for people to obtain information, and some "pseudo-science popularization" has also taken advantage of it
.
"As the saying goes: spread rumors with one mouth and run off the legs, medical staff should'move the gate forward ', actively devote themselves to popular science, use easy-to-understand language, and be the'pioneer ' to pass on medical science knowledge
.
" Sharing experience in the application of electrosurgical drainage stents As early as the 1990s, Zhang Xiaofeng led team members and presided over the development of the "Digestive Through Train" project
.
For more than 20 years, she has traveled to secondary hospitals and community hospitals in almost all cities and counties in Zhejiang Province, and conducted hundreds of popular science lectures
.
As the science popularization position shifted from offline to online, she organized the members of the department to open a public account to plug the wings of the Internet for professional popular science knowledge
.
Just in the past October, "Hangzhou City Science Expert" Zhang Xiaofeng, Director of Gastroenterology Department Yang Jianfeng, and Doctor Zhou Haibin also became "novelists" and jointly wrote and published the medical science novel "Knowing the Intestines and Knowing the Stomach".
Language has popularized common sense of digestive diseases and has been widely welcomed by readers
.
The popular medical science novel "Knowing the Intestines and Knowing the Stomach" goes all the way, without fear of wind and rain
.
Zhang Xiaofeng also truly felt the "dividends" brought by popular science education
.
"In recent years, there have been more and more clinical patients with early gastrointestinal cancer, and fewer and fewer patients with advanced cancer.
This has a lot to do with the promotion of early cancer screening
.
" As the head of the early gastric cancer collaboration network in Hangzhou Zhang Xiaofeng quoted her "idol"-Academician Li Zhaoshen: Lack of knowledge about gastric cancer prevention and treatment is the main factor affecting the participation rate of gastric cancer screening and compliance with gastroscopy.
Only by making full use of media such as TV stations, radio stations, newspapers, websites, WeChat, etc.
Only by increasing the publicity of knowledge related to gastric cancer screening and early diagnosis and treatment can the ideological worries of the screening population be eliminated and the initiative and compliance of gastric cancer screening can be improved
.
"In the past, many doctors resisted the media, but as practitioners of'Healthy China', medical staff in the new era should take the initiative to embrace the media, shoulder the important task of popularizing medical science, and contribute to improving people's health!" Zhang Xiaofeng said
.
Lifelong learning does not forget to be a life-innovating medical practitioner whose original intention "innovation" has always accompanied Zhang Xiaofeng's career
.
Since her exposure to endoscopic retrograde cholangiopancreatography (ERCP) in the 1990s, she not only performed ERCP operations on more than 13,000 patients, but also led a team to complete more than 40,000 ERCP treatments
.
Not only was she called the “ERCP Superwoman” by the patient, she also took the lead in developing a number of new endoscopic treatment technologies: she completed the world’s first radiofrequency ablation of pancreatic tumor under EUS, and was the first to carry out children’s ERCP in China (the smallest patient is only 100 days), depending endoscopic examination and treatment of bile duct, photodynamic therapy, biliary puncture and drainage EUS, EUS combined ESWL antegrade biliary stone and the like
.
The concept of "three mirrors in one" of endoscopy, duodenoscope and choledochoscopy that she put forward has profoundly promoted the development of ERCP technology
.
Zhang Xiaofeng gave a report at the 13th Hangzhou International Symposium on Diagnosis and Treatment of Biliary and Pancreatic Diseases in 2021, "Innovating for life is the original intention of doctors
.
" Zhang Xiaofeng said that advanced technology and equipment are the foundation for doctors to base themselves on clinics and serve patients
.
And continuous learning is the source of motivation to promote innovation
.
In December 2005, Zhang Xiaofeng went to the Faculty of Medicine of the University of Hamburg, Germany, to study under Professor Sohendra, a well-known international ERCP expert
.
During her study, she was surprised to find that there were not only specialist doctors from major hospitals but also community doctors with white temples
.
It was from that moment that she realized that continuous learning and continuous innovation are the mission of every medical practitioner
.
She said that doctors are a profession that requires lifelong learning: specialists in tertiary hospitals should focus on the frontiers of disciplines, solve difficult and complicated diseases, promote and even lead the development of a certain field; while general practitioners in basic hospitals should understand the frontiers of various specialties Dynamic, excellent completion of prevention, health care, rehabilitation, diagnosis and treatment of common diseases and referral of difficult and severe cases, to be the gatekeeper of the health of the people
.
This is also the original intention of the country to carry out hierarchical diagnosis and treatment
.
In 2020, Zhang Xiaofeng won the honorary title of "National Advanced Worker".
He has been commended and worked as a doctor in Beijing for more than 30 years.
Zhang Xiaofeng has forgotten how many critically ill patients referred from primary hospitals have been treated
.
But whenever a patient expresses her gratitude to her, she always remembers to say to the patient: "When you go home, remember to thank the doctor who sent you here, because they sent you here in time, so that we can use it.
.
"typesetting: Hu Haiyan editor: Yin Han audit: Hui-forward driving force of the industry! Honor registration for the 7th Medical Scientists Summit is in full swing.
.
.
2022 "Physician News" subscription has begun! ! ! Millions of doctors are watching.
.
.
For more content, please click: Hot Comment | Girls with mental disabilities are used for vulgar live broadcast, no matter if it doesn't work! In 2021, the medical field will hand over the remarkable "People's Livelihood Ledger" and "Physician's Daily".
Public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments.
If there is any infringement, please contact to delete it, thank you! Tel: 010-58302828-6808 Currently 1130000+ doctors have been following to join us
