[Heavy Medical Second Hospital , Focus pillar] Editor's Note:
Senior, experienced, skilled... In the Second Affiliated Hospital of Heavy Medicine, there is such a group of old experts, they have superb medical skills, in the 20, 30 years of clinical practice, accumulated a full of experience, and can be skillful in the race against the disease; they have a unique vision, good at using unique diagnosis and treatment methods, and the ability to turn the tide when dealing with difficult diseases; they delve into research, always master the latest technology, and can be apricot forest spring warmth when competing with complex diseases...
Upstream News opened a column entitled "Heavy Hospital II: Focusing on pillars" to lead everyone into this group of "mainstays" to see how they practiced their Hippocratic oaths with enthusiasm and lifelong faith.
"A good doctor must not only have superb medical skills, but also have noble medical ethics, be anxious about what patients are anxious about, and think what patients think..." This is the belief that Professor Li Yang has adhered to as a surgeon for 30 years, and it is also the original mission of party members. In order to treat patients with refractory gastroesophageal reflux disease, in order to allow patients with gastric cancer and colorectal cancer to receive more minimally invasive surgery than minimally invasive, in order to improve the quality of life of patients with low and ultra-low rectal cancer, he immersed himself in various new technologies to bring first-class surgery and intimate care to patients. He said that surgeons should "have a knife in their hands and love in their hearts."
[Mainstay of this issue] Li Yang
Deputy Director, Chief Physician, Doctor of Medicine, Master Supervisor, And CPC Member of the Second Hospital of Heavy Medical College
The pursuit of "more minimally invasive than minimally invasive"
Pioneered gastrointestinal NOSES surgery
In today's rapid development of medicine, minimally invasive surgery has become the preferred method of surgical treatment in the minds of patients. Under the premise of ensuring the quality of surgery, reducing surgical trauma is the goal that surgeon Professor Li Yang has been pursuing since practicing medicine, and it is also the mission of the pioneer party member to solve the patient's suffering with the original intention.
With the improvement of surgical requirements for patients with gastric cancer and colorectal cancer, in recent years, natural cavity specimen retrieval surgery (NOSES) has also become increasingly favored by patients. This procedure has many advantages such as no incision in the abdominal wall, small trauma, light pain, and fast postoperative recovery, and is called "minimally invasive in minimally invasive". Whether it is the physiological or psychological impact on the patient is very small, the previous minimally invasive surgery is generally in the laparoscopy of the lesion resection, in vitro to complete the reconstruction, while THESES surgery needs to complete the reconstruction in vivo, which is very difficult.
Therefore, NOSES surgery is very demanding for the surgeon. However, in order to meet the needs of patients, Professor Li, who has rich experience and skills in endoscopic minimally invasive surgery, took the lead in carrying out such surgeries in Chongqing with his own ability.
Ms. Tong, 42 years old, went to the doctor because of the change in stool habits, and the colonoscopy results found new rectal organisms, and the biopsy results suggested rectal adenocarcinoma. Due to Ms. Tong's obesity, diabetes mellitus and asthma, Professor Li decided to perform laparoscopic radical resection of rectal cancer (NOSES) for her after comprehensively evaluating her condition. The next day after the operation, Ms. Tong was able to get out of bed and move, the pain level was very mild, because there was no incision in the abdomen, avoiding complications such as fat liquefaction of the incision, delayed healing of the incision, incision infection, incision hernia, etc., and was cured and discharged from the hospital on the 6th day after the operation. "I didn't expect this surgery to be less painful than my appendix surgery." Ms. Tong was pleasantly surprised to tell Professor Li and expressed her gratitude.
According to statistics, at present, the team led by Professor Li has carried out more than 200 CASEs of NOSES and NOSES-like surgeries, and the response from patients is very good. "However, not every patient can undergo NOSES surgery, which has strict indications. For example, tumor circumference diameter greater than 5 cm, rectal lumen is thinner, mesangial hypertrophy, etc. are not suitable for NORTHES surgery. Professor Li, who is rigorous and careful, has repeatedly stressed that in order to ensure the safety of surgery, NOSES surgery must ensure the principle of "no tumor and no germ".
Professor Lee has a deep knowledge and rich clinical experience in various total laparoscopic minimally invasive surgeries and endoscopic surgeries in the digestive tract, and he is trusted and recognized by patients. His superb medical skills benefit from the accumulation of 30 years of medical practice.
In 1992, Li Yang, who graduated from Chongqing Medical University with a bachelor's degree, came to work in the General Surgery Department of the Second Affiliated Hospital of Chongqing Medical University, and in 6 years of residency and 10 years of attending physicians, he was down-to-earth and conscientious, working hard to learn various new technologies to meet clinical needs, continuously improving his professional ability and diagnosis and treatment level, and actively moving closer to the party organization ideologically, and joined the Communist Party of China in 1998. In order to further his studies, he studied for a master's and doctoral degree at the University of Major Medical Sciences. In 2008, Li Yang, who is already the deputy chief physician of general surgery, in order to continuously strengthen the responsibilities and mission of party member doctors, is committed to the diagnosis and treatment of digestive system diseases, chooses gastrointestinal and anorectal surgery, and under the "troika" of medical education and research, he immerses himself in the study of new technologies in the professional field, and gradually rises to chief physician and associate professor, which has a certain influence inside and outside the industry.
Push the limits of conservation surgery
Treatment of patients with low and ultra-low rectal cancer
The surgery is first-class, breaking through the limit, in the hearts of low and ultra-low rectal cancer patients, Professor Li is the savior who makes them reborn. It is understood that in order to improve their quality of life, Professor Li also took the lead in Chongqing to carry out low-level and ultra-low-level rectal cancer preservation surgery.
Professor Li introduced that the incidence of low and ultra-low rectal cancer is getting higher and higher, with the local anatomy of the rectum, the pathological characteristics of rectal cancer, tumor infiltration, lymph node metastasis law cognition, as well as the anastomotic device, closed device widely used, more and more low and ultra-low rectal cancer patients can perform preservation surgery. "The key to the success of the operation lies in the strict grasp of the indications for the operation, the reasonable choice of the surgical method, the professional skills of the surgeon, and the personalized comprehensive intervention throughout the perioperative period." Professor Li made it clear.
Ms. Zhao, 68, was unfortunately diagnosed with ultra-low rectal cancer last year, and the lower edge of the tumor lesion was only 2.0cm from the edge. Since her husband underwent a combined transabdominal perineal resection (permanent colostomy) for rectal cancer two years ago, after witnessing the inconvenience caused by her husband's permanent abdominal wall stoma, she told Professor Li that if she had made a permanent diversion, she would rather die than have surgery.
Professor Li repeatedly enlightened Ms. Zhao, informed her of the pros and cons, and promised to do his best to preserve the anus. Due to the early stage of Ms. Zhao's tumor, Professor Li performed ultra-low rectal cancer extreme preservation surgery for her, which preserved her defecation and urination function to the greatest extent under the premise of achieving radical tumor cure.
"You gave me hope to live, and without you, my life would be over." After the operation, Ms. Zhao was grateful to Professor Li and lamented that if her husband had met Professor Li, he might be able to have a better quality of life now.
I'm as happy as they are to see patients successfully undergo conservation surgery. Professor Li said that he reminded gastrointestinal and anorectal surgeons to strictly comply with the indications for ultra-low rectal cancer radical resection, not to protect the anus for the sake of preserving the anus, nor to protect the anus in order to comply with the patient's wishes, and must be operated from the comprehensive consideration of many factors such as tumor radical treatment and retention of function.
Work on refractory gastroesophageal reflux disease
Immerse yourself in the study and application of new therapeutic technologies
"Professor Li, I have been tortured by gastroesophageal reflux for 4 years, and now there is obvious acid reflux, heartburn, epigastric pain and discomfort, and I have also taken a lot of drugs to suppress gastric acid secretion. A few days ago, Ms. Zhang, 48 years old, listened to the patient's introduction that Professor Li was good at diagnosing and treating difficult diseases in the gastrointestinal and anorectal areas, and immediately went to the Second Affiliated Hospital of The Heavy Medical Hospital to find him for diagnosis and treatment.
Professor Li patiently and carefully read the various examination lists and treatment lists brought by Ms. Zhang, inquired in detail about her medication history, and the treatment effect after using proton pump inhibitors, saying that "you are likely to be refractory gastroesophageal reflux, you need to do gastroscopy to clarify the lesions first" and admitted her to the hospital.
The results did not predict Professor Li,and gastroscopy suggested: reflux esophagitis, atrophic gastritis, and hernia with hiatal hernia. Combined with Ms. Zhang's 8-week history of standard-dose proton pump inhibitor treatment, Professor Li clearly diagnosed refractory gastroesophageal reflux and formulated a detailed diagnosis and treatment plan.
After sufficient preoperative preparation, Professor Li performed laparoscopic fundoplication + esophageal hiatal hernia tension repair for Ms. Zhang. On the second day after the operation, her acid reflux and heartburn symptoms completely disappeared; she was discharged from the hospital 5 days after the operation; returned to the hospital for follow-up consultation 2 weeks after the operation, and the symptoms of hidden pain and discomfort in the epigastric abdomen also disappeared; and at 6 months after the operation, the gastroscopy was reviewed, and the results were no abnormalities.
"In addition to clinical symptoms such as acid reflux and heartburn, patients with gastroesophageal reflux disease are often accompanied by hiatal hernia, and the risk of esophageal cancer is also high, which needs to be paid great attention to by patients and doctors." Professor Li introduced that patients with clinical manifestations of gastroesophageal reflux in China account for about 2.5% to 7.8% of the population, and 38.6% of patients have hiatal hernia at the same time. Multiple studies have shown that patients with gastroesophageal reflux with hiatal hernia have more pronounced acid exposure and are more susceptible to esophageal cancer. In order to treat refractory gastroesophageal reflux disease, Professor Li took the lead in carrying out surgical anti-reflux surgery in Chongqing for gastroesophageal reflux combined with hiatal hernia.
"Laparoscopic fundoplication and tension-free repair of esophageal hiatal hernias have developed rapidly since they were proposed in the 1990s, and have become the most popular laparoscopic anti-reflux surgery due to their small trauma and rapid recovery." Professor Li further explained that fundoplication is to strengthen the anti-reflux barrier of the gastroesophageal junction by reconstruction; esophageal hiatal hernia repair is to eliminate mechanical events that cause reflux by repairing. From the perspective of pathophysiological mechanism, the treatment of gastroesophageal reflux combined with hiatal hernia has a good and stable long-term clinical effect.
Uncle Li, 72, is also the beneficiary of Professor Li's surgery. In the past 10 years, he has repeatedly appeared in the upper abdomen swelling pain and discomfort, the diagnosis found esophageal hiatal hernia, further examination found that the gastroesophageal reflux, Professor Li resolutely performed laparoscopic fundoplication + esophageal hiatal hernia tension repair, and the symptoms disappeared on the 3rd day after the operation. When he was discharged from the hospital, Uncle Li always held Professor Li's hand and said, "Thank you, thank you, you have freed me from 10 years of illness." ”
At present, Professor Li's team has completed more than 100 laparoscopic fundoplication + esophageal hiatal hernia tension repair, and the treatment effect is remarkable, which has been unanimously praised by patients.
Exquisite medical skills + sincere care
Anxious patients, think what patients think
In addition to patients with difficult and critical diseases in the gastrointestinal and anorectal fields, Professor Li's patients also have some patients with serious and repetitive common diseases. From the detailed diagnosis and treatment plan formulated for them, professor Li's benevolence and benevolence were revealed.
Mr. Chen, a hemorrhoid patient, has the most serious degree of his condition than Professor Li has seen since practicing medicine. Mr. Chen has visited many hospitals and received the answer that multiple surgeries are needed to alleviate the current symptoms, and the risk of stenosis after surgery is extremely high. Because of family difficulties, Mr. Chen even planned to give up treatment until he saw Professor Li's interview program on TV and came to the Second Hospital of Zhongyi Hospital to find him with the attitude of trying it out.
Professor Li made a detailed examination for Mr. Chen and told him that the purpose of hemorrhoid treatment is to alleviate clinical symptoms, and according to his current condition, there is a chance to achieve the purpose of treatment with one-time surgery. Mr. Chen will be suspicious, after the operation, Professor Li's superb medical skills made him praise, not only solved the pain at one time, but also did not affect the postoperative bowel function. Not only that, due to the poor economic situation, Professor Li helped to apply for a reduction in part of his medical expenses when he was discharged from the hospital.
"A good doctor must not only have superb medical skills, but also noble medical ethics, be anxious about what patients are anxious about, think of what patients think, adhere to the principle of 'the heart of the doctor's parents', treat patients equally, regardless of poverty, wealth, status, and always put the patient's life safety and disease treatment first." As a surgical party member doctor who has been practicing medicine for 30 years, Professor Li has always taken the original intention as the rudder and the technology as the sail, and the wind has moved forward on the road of treating diseases and saving people.
In order to help more patients solve their pain, Professor Li has a clear goal for the next work arrangement. First of all, to do a good job in counterpart assistance and clinical technology promotion, Professor Li has been approved by the Chongqing Municipal Health Commission for two consecutive years of appropriate technology promotion project "laparoscopic rectal cancer radical resection", and will continue to promote technology in district and county hospitals in the next few years, and then improve the diagnosis and treatment level of grass-roots hospitals while reducing patient expenses. Second, strengthen scientific research work, so that scientific research can be combined with clinical practice, and constantly pioneering and innovating. Finally, strengthen the clinical teaching work, do a good job in passing on the help, and cultivate more excellent clinicians.
Doctor's Business Card》
Li Yang: Deputy Director, Chief Physician, Doctor, Master Supervisor, and CPC Member of the Second Affiliated Hospital of Heavy Medical College
Areas of expertise: Diagnosis and treatment of gastrointestinal benign and malignant diseases (gastric cancer, colon cancer, rectal cancer, gastrointestinal stromal tumor, gastrointestinal neuroendocrine tumor), obesity metabolic disease, hiatal hernia, gastroesophageal reflux disease (GERD), intra-abdominal and retroperitoneal mass lesions, intestinal infections, rectal prolapse and incontinence. He has a deep understanding of various total laparoscopic minimally invasive surgeries and endoscopic surgeries of the digestive tract, and has rich clinical experience. It was the first in Chongqing to carry out natural cavity specimen retrieval surgery (NOSES surgery or NOSES surgery) without incision in the abdomen of total laparoscopic gastric cancer and colorectal cancer, tension-free repair of gastric floor esophageal hernia and gastric floor folding (Nissen, Toupet, Dor), full laparoscopic obesity, type II diabetes surgery (Sleeve, By-pass surgery), ultra-low rectal cancer extreme preservation surgery (TaTME), refractory constipation surgery (Jinling surgery).
Outpatient hours: Yuzhong Campus Tuesday morning, Jiangnan Branch Wednesday morning.
Academic appointments: Vice Chairman of the Mucosal Repair Committee of the Chinese Association of Traditional Chinese Medicine, Member of the Hiatal Hernia Group of the Clinical Practical Technology Branch of the Chinese Medical Promotion Association, Member of the China NOSES Alliance, Vice Chairman of the Chongqing Branch of the China NOSES Alliance, Vice Chairman of the MDT Committee of gastrointestinal tumor of the Chongqing Medical Association, Standing Committee Member and Secretary of the Colorectal Cancer Committee of the Chongqing Anti-Cancer Association, Member of the Chongqing Municipal Committee of Integrated Traditional Chinese and Western Medicine, Member of the Weight Loss and Metabolic Surgery Group of the Minimally Invasive Surgery Committee of the Chongqing Medical Association, He is a member of the Parenteral Nutrition Committee of Chongqing Medical Association and an expert of the Chongqing Forensic Expert Committee.
Scientific research achievements: He has presided over 1 project of Chongqing Natural Science Foundation, 1 project of Chongqing Municipal Science and Technology Commission, 2 projects of Chongqing Municipal Health Bureau, 2 projects of appropriate technology promotion project of Chongqing Municipal Health Commission, and 1 third prize of Chongqing Yuzhong District Science and Technology Progress Award. He is a contributing reviewer for journals such as Diestarive Diseases and Sciences. He has published more than 40 papers in CSCD core journals such as Am J Surg, ACTA CIRURGIA BRASILEIRA, and Chinese Journal of Organ Transplantation.
Source: Upstream News Bring together the upward forces