Chapter 1508: 1461 The Bulging Navel

The image on the computer showed that MRI revealed long T1 and short T2 signals within the liver, with diffuse restriction. In the arterial phase, the mass enhanced homogeneously and washed out quickly; in the delayed phase, it showed cystic enhancement.

Based on the enhancement characteristics, a preliminary diagnosis of hepatocellular carcinoma can be made.

Surgery, actually, is not difficult.

Whether it is hepatobiliary surgery resecting the right liver lobe, or interventional embolization therapy, both are indications.

But the patient's condition is complicated by his heavy drinking.

"The ascites volume is too large, unsuitable for surgery." Zheng Ren said: "Reducing the ascites has already taken a long time, right?"

"Hmm." Professor Yang said: "Zheng Lao Ban, shall we take a look at the patient?"

Zheng Ren nodded, stood up, and followed Professor Yang out.

He seemed to have completely forgotten the purpose of his coming—to collaborate with the hepatobiliary surgery department on a project.

Upon entering the ward, the first thing that caught the eye was a bulging abdomen.

The weather had already warmed up a bit, exactly the season for throwing on clothes haphazardly.

The patient wore a black vest, exposing his belly.

Although the ascites volume had decreased considerably, it was still large. This caused the abdomen to bulge prominently, even the navel slightly protruding, looking particularly odd.

"Old Yang, you've come." The patient was in a semi-reclining position, leaning against the blanket, lying on the bed.

Seeing Professor Yang enter, he wanted to sit up. But because his abdomen was severely distended, the abdominal muscles contracted, pressure increased, and the body's natural protective reflex prevented him from rising; he immediately lay back down.

Professor Yang felt helpless, sighed, and said: "Just lie still, Zheng Lao Ban, help me take a look."

The patient saw Professor Yang bringing in two young doctors, felt somewhat surprised, but out of politeness did not speak.

Zheng Renxian glanced at the system panel; it matched his earlier diagnosis exactly, with no discrepancy.

Only the degree of abdominal distension was far more severe than when the MRI was taken.

Recalling, the scan was done two days ago.

In just two days, it had progressed to this extent? Zheng Ren's first impression was that this patient was beyond saving.

Although he thought so, Zheng Ren still first performed a physical examination on the patient.

On percussion, there was a shifting dullness across the abdomen; Zheng Ren estimated about 2000 ml of intraperitoneal fluid.

With this amount of ascites, not to mention liver resection, even this minimally invasive interventional procedure cannot be performed.

Zheng Ren looked at the patient's protruding navel, feeling especially helpless.

Professor Yang felt the same, but he and the patient were classmates, making it completely different from facing other patients.

His face fell, full of displeasure.

Zheng Ren nodded, exchanged a glance with Professor Yang, then turned and left.

"Professor Yang, the patient's condition is poor; even portal vein embolization cannot be performed." After leaving, Zheng Ren frankly told Professor Yang.

Professor Yang naturally knew; he let out a long sigh and said: "I've told him to quit drinking and we'll discuss again. If it doesn't work, there's nothing I can do."

Hepatocyte growth factor mainly acts on the portal vein. After portal vein ligation, it can cause hepatocyte proliferation; this phenomenon has been known since 1920.

In the past, performing portal vein ligation was a major surgery.

After the advent of interventional surgery, it suffices to directly embolize the portal vein branches.

Embolizing the portal vein branches induces hypertrophy of the contralateral liver lobe, enabling the remnant liver to compensate for liver function after lobectomy.

After the portal vein branches are embolized, hepatocytes can undergo dedifferentiation and clonal proliferation.

If the remnant liver is normal, up to 75% of the liver can be resected while still keeping the patient alive. However, the patient's alcoholic liver … cannot tolerate that much resection. Nevertheless, the patient does not need to have 75% removed; removing the tumor alone suffices.

However, portal vein embolization also has strict requirements; massive ascites in the patient is one of the contraindications.

Theoretically, preoperative embolization of the ipsilateral portal vein branch before partial hepatectomy offers benefits not only by causing hypertrophy of the remnant liver but also by preventing the sudden rise in portal pressure due to partial liver resection that would damage the remnant liver.

There are many benefits; this is also one of the projects that hepatobiliary surgery and interventional departments can collaborate on.

"Professor Yang." Su Yun said from behind with a smile: "I saw you sneaking around this morning—is this about that?"

Having said that, Professor Yang's steps paused, then he laughed: "How could it be? Did Director Kong say anything?"

This sly fellow, Su Yun felt contempt in his heart.

Speak of things as they are; first ask Director Kong whether he said it, and the little thoughts inside multiply a bit.

Zheng Ren, however, felt nothing; he smiled and said: "He said it."

"Zheng Lao Ban, no pleasantries—what do you think of this matter?" Professor Yang immediately asked.

"Find a place, have a smoke, and we'll talk in detail." Zheng Ren said.

They arrived at the duty room.

It was morning; everyone had gone to surgery, leaving the duty room empty and deserted.

After closing the door, Su Yun lit a cigarette; Zheng Ren directly asked: "Professor Yang, we're our own people—no hiding—do you need anything in here?"

At the outset, when we paid respects everywhere, Professor Yang and Director Luo of the Department of Gastroenterology were the earliest supporters.

Returning the favor, we should also ask this question.

Professor Yang was somewhat hesitant, but seeing Zheng Ren earnest and solemn, he thought and said: "It's not that Deputy Chief Tian of the department is retiring; I'm considering vying for that position."

Zheng Ren stared, not expecting that to be the reason.

However, research and the deputy chief position have hardly any connection; doing well in research doesn't guarantee one won't lose the deputy chief role.

"Other conditions are not lacking; ability…… you definitely can't compare with Zheng Lao Ban, but compared to others in the department, we fear no one." Professor Yang candidly said: "Now we lack a publicity push."

Zheng Ren and Su Yun said nothing, silently waiting for Professor Yang to finish speaking.

"It's not that your recent dealings with the hospital have been going smoothly…… To be frank, I just want to bask in your glory, Zheng Lao Ban." Professor Yang said very candidly, his eyes fixed on Zheng Ren's.

That was very down-to-earth; Zheng Ren smiled and said: "Professor Yang, at the beginning you gave me strong support on this side; if you have difficulties, I will definitely help."

Professor Yang knew there would be a 'however,' and he listened attentively.

"Surgery should be live‑streamed; can you accept that on your end?" Zheng Ren asked.

"Okay." Professor Yang beamed with delight, "Live streaming is the best!"

Building hype, Professor Yang probably has other backup, but that has nothing to do with me, Zheng Ren nodded.

"What does Li Zhu ren think?"

"Li Zhu ren supports me." Professor Yang said: "As long as Zheng Lao Ban you agree, I will immediately start admitting patients. Interventional surgery, on my hospital bed, will be removed after a period of time post-operation."

"Alright."

There's nothing to hide about this matter between the two of them; each takes what they need.

"Zheng Lao Ban, this won't delay your Nobel Prize project, will it?" Professor Yang asked anxiously at the end.

This is what he worries about most, after all, the weight of a director at 912 pales in comparison to the Nobel Prize in Medicine.