Chapter 164 - 152: Wu Ting’s Strength and Dr. Wang’s Admiration

Chapter 164: Chapter 152: Wu Ting’s Strength and Dr. Wang’s Admiration

When Head Nurse Xiao Xixi came in to ask Director Qin for help, the team from Haijin Port wasn’t surprised. But her specific request for Wu Ting left them a little baffled.

’A little coward who doesn’t even dare to try the ERCP simulator—what could he possibly know about hepatic cystic echinococcosis?’

The teaching assistant from the training camp, annoyed at being overlooked by Xiao Xixi, chimed in:

"When it comes to hepatic cystic echinococcosis, our Haijin Port hepatobiliary surgery department is the best in all of Jin Province. Dr. Wang here has assisted our Director Shen on several of these procedures."

"Dr. Wang, you can perform this surgery?"

At a time like this, Qin Donglai had no time for institutional rivalries. The patient’s condition was what mattered most.

If it was confirmed to be hepatic cystic echinococcosis, the situation would be extremely dangerous. A ruptured hydatid cyst could trigger an allergic reaction. Milder reactions would just cause erythema, itching, hives, nausea, and chest tightness.

But a severe reaction could lead to anaphylactic shock, which was the leading cause of early death in patients with ruptured cysts.

Of course, spillage of the cystic fluid during the operation, or an accidental puncture causing the fluid to leak into the liver tissue, would be fatal.

So, Qin Donglai was under immense pressure. Director Huo was away on a business trip, and Director Jiang had gone to Qinghe City for advanced training. He was left to manage everything alone, and frankly, he was worried.

Hearing that the doctor from Haijin Port had performed surgical resections for hepatic cystic echinococcosis, he looked at Dr. Wang with a hopeful expression.

Wang Nanjin hesitated. Although he had participated in several liver cyst surgeries for patients with hydatid disease, they were all performed alongside Director Shen Xiaofei. He had never led one on his own.

"Well, Director Qin, I can only say I’ll do my best. If this were a routine liver cyst surgery, I could handle it as the lead surgeon, as long as it didn’t involve complex work on the common bile duct. But when it comes to hepatic cystic echinococcosis, I’ve never operated as the lead surgeon. I do have experience, though."

In truth, for someone his age, Wang Nanjin was already exceptionally skilled.

It was just that the risks and difficulty of a hepatic cystic echinococcosis surgery were extremely high.

"Alright, here’s the plan. Wu Ting, Dr. Wang, you’ll come with me for a consultation first. I’ll also call over Director Cai Qi from Hepatobiliary Surgery."

"After all, we only suspect it’s caused by hydatid disease for now. If it turns out to be a routine liver cyst surgery, then a joint operation between us will be no problem at all."

Qin Donglai ushered Dr. Wang and Wu Ting out the door.

Of course, Qin Donglai wasn’t planning on having Wu Ting perform the liver tumor resection. For one, having Wu Ting by his side was reassuring. For another, he wanted Wu Ting to gain more experience with different kinds of emergencies.

Of course, if the diagnosis determined it wasn’t hydatid disease but a routine liver tumor resection, Wu Ting’s perfect triple-assisted laparoscopy technique could be put to good use.

If it really was caused by hydatid disease, they would have to rely on Dr. Wang and Director Cai. If the two of them weren’t enough, they would have to transfer the patient to Jinggang University Affiliated First Hospital immediately.

A few moments later, they arrived at the resuscitation room.

The patient was in poor condition. The liver cyst was edematous and weakened, and the patient was suffering from severe upper abdominal pain that had quickly spread throughout the entire abdomen, including the stomach and duodenum...

Seeing Qin Donglai, Wu Ting, and Wang Nanjin, the expert from Haijin Port, Song Qi wasted no time and immediately began his briefing.

"We’ve already initiated symptomatic treatment, including anti-infectives and analgesics, and have begun monitoring the patient’s vitals..."

"Director Qin, Dr. Wang, Wu Ting, these are the patient’s CT and MRI images that just came in. Please, take a look..."

Since his own team was weaker in this area, Qin Donglai handed the images to Dr. Wang from the Hepatobiliary Surgery department of Jinggang University Affiliated First Hospital first. After all, Dr. Wang had clinical experience with several such cases.

Wang Nanjin could only brace himself and accept the images, his mind racing as he tried to recall all the relevant information on hepatic cystic echinococcosis.

Wang Nanjin was certainly familiar with the condition, but he was far from mastering it. Participating in a surgery was one thing; making the definitive diagnosis was another.

Before, it had always been Director Shen who held the images and informed them of his analysis. This time, faced with having to make the diagnosis all by himself, Wang Nanjin felt an immense amount of pressure.

But Wang Nanjin had his pride. This kind of situation, paradoxically, ignited his potential. He began to work backward, combining what clinical experience he did have.

He actually managed to formulate a surprisingly coherent line of reasoning.

"Director Qin, hepatic cystic lesions are quite common in clinical practice, with an incidence rate as high as 20% in the general population. Cystic echinococcosis is an infectious lesion caused by the tapeworm *Echinococcus granulosus*, most often affecting the liver. The basic pathology is a space-occupying cystic lesion in the liver..."

"Looking at these images, we can see the cystic fluid and the cyst wall. And look here, you can also clearly see nodules on the wall..."

"Furthermore, based on these images, I’ve done a preliminary count, and there are at least seventeen distinct foci... This is definitely a case of complex cystic lesions..."

"Therefore, my diagnosis is hepatic cystic echinococcosis. The only thing that’s unclear right now is whether the hydatid cyst has ruptured."

"If the cyst has ruptured, the situation is extremely dangerous. A rupture into a blood vessel would compromise the entire circulatory system. A rupture into the thoracic cavity would irritate the diaphragmatic pleura. And a rupture into the biliary tract would perforate a hepatic duct. In short, it’s an incredibly perilous situation!"

"If this is an uncomplicated case of hepatic cystic echinococcosis, I can attempt the resection, as I have some experience. But if a rupture has occurred, the situation is far too complex. With my current level of experience, I don’t dare to take the lead on this surgery."

Listening to Dr. Wang’s analysis, the expressions of both Song Qi and Qin Donglai turned grim.

"So, can we determine from the images if there’s been a rupture?"

Wang Nanjin shook his head. "I’m not a radiologist; my skills aren’t at that level. I can only determine that intraoperatively. Once we start the surgery, if we confirm there’s no rupture, we can proceed. But if it has ruptured and an extreme complication arises, it will be too late to do anything."

Just as Dr. Wang was wavering, the director of the ultrasound department and the director of the radiology department hurried over.

Cai Qi was busy prepping an operating room and would come over as soon as it was arranged.

However, after reviewing the images, none of them could make a decision. Not one person was willing to make the final call.

What were they to do?

"The most important thing right now is to determine the patient’s exact condition. Is it hepatic cystic echinococcosis, and has the cyst ruptured? We can only proceed with surgery once that’s confirmed."

The director of the radiology department looked at Qin Donglai.

After all, it was up to the Emergency Department, as the department of first contact, to reach a conclusion.

A wave of panic washed over Qin Donglai. He looked toward Wu Ting, who had been silent until now. Just then, the two sets of images were passed into Wu Ting’s hands.

Possessing the (Purple) Imaging Differentiation Technique for Hepatic Cystic Lesions from Professor Liang Ang, Wu Ting studied the images seriously.

Because of its geographical location, Pinfan Hospital was at the forefront of hydatid disease treatment in Jin Country, and Liang Ang was one of its most distinguished experts.

Wu Ting scrutinized the images. ’No, this isn’t caused by hydatid disease.’

A flash of inspiration struck Wu Ting. He recalled another disease whose imaging findings also presented as complex cystic lesions, just like hepatic cystic echinococcosis.

"Director Qin, I suspect this might not be hepatic cystic echinococcosis. Can we run another contrast-enhanced CT scan?"

"I need to pay close attention to whether the density and signal of the cystic fluid are uniform, whether the cyst wall is calcified, whether the wall nodules show enhancement and spread, and whether there are any septations!"

Hearing Wu Ting’s clear, purposeful instructions for the new scan, Qin Donglai immediately made the arrangements. He was all too familiar with Wu Ting’s habits; this meant he was onto something.

Only then did Wang Nanjin notice. The moment Wu Ting spoke, the entire consultation team transformed from a leaderless group into an orderly unit taking his commands. Even Director Qin, who was supposed to be in charge, seemed both compliant and relieved, as if he had just received an order from a higher-ranking director.

Wang Nanjin frowned. He couldn’t figure out what Wu Ting was thinking. But as an outsider, it wasn’t his place to comment, so he waited quietly on the sidelines.

He, too, wanted to see what was so special about this young man that Director Shen praised so highly.

The results came back quickly.

Wu Ting took one look at the new scan and immediately called everyone to gather around.

"Dr. Wang, you too."

Wu Ting motioned for Wang Nanjin to join them. After all, he couldn’t perform a liver tumor resection himself. He could only complete the diagnosis and assist during the operation; the lead surgeon would still need to be Qin Donglai, Wang Nanjin, or Cai Qi.

Although he wasn’t yet sure of Wang Nanjin’s skill level, the man had been personally selected by Shen Xiaofei as the group leader and representative for the first expert exchange week. He was the face of the Hepatobiliary Surgery department at Jinggang University Affiliated First Hospital.

"Dr. Wang, the patient’s condition is quite unusual, and the surgery will be very difficult. We’re going to need your help."

Wu Ting’s words were a compliment, and Wang Nanjin immediately moved closer to listen intently.

"Based on these enhanced scan results, you can clearly see the patient’s cystic fluid is uniform, there’s significant enhancement in the cyst wall, there are wall nodules, and the septa also show clear enhancement... If this were hydatid disease, there wouldn’t be wall nodules, the cyst wall would be calcified, and the cystic fluid would most likely be non-uniform... But most importantly, the lesion is lobulated and irregularly shaped!"

As Wang Nanjin listened to Wu Ting’s meticulous, step-by-step analysis, everything clicked into place for him. He had already grasped the basics, but now it all became crystal clear.

"Ah, that was my oversight. Dr. Wu, I see what you’re getting at now."

Wang Nanjin now saw the truth. His fundamental knowledge was solid; what he lacked was experience in independently diagnosing such difficult and complex cases. But he had been present for many of these operations.

With Wu Ting’s prompting, he was able to connect the disparate pieces of his own hands-on experience into a coherent whole. An answer, ready to burst forth, surfaced in his mind!

"Dr. Wu, a lesion caused by hydatid disease would be round or ovoid. It couldn’t possibly be lobulated or irregular."

"And because a hydatid cyst contains the actual parasite, it’s like an egg with a yolk and white—how could the fluid possibly be uniform?"

"So the patient’s true condition is a complex cystic lesion that’s very similar to a hydatid cyst..."

"It’s an extremely rare hepatic mucinous cystic neoplasm!"

"This type of tumor is rarer, but our hepatobiliary surgery department at Jinggang University has experience treating it. I’ve actually been involved in a case before. And even though it’s rarer, the surgery is less difficult, since we don’t have to worry about the unpredictable risk of a cyst rupture."

"Director Qin, Dr. Wu, contact Director Cai immediately. We can proceed with the surgery!"

"Impressive, Dr. Wang!"

Wu Ting hadn’t expected Dr. Wang to be so erudite and have such rich clinical experience.

Hearing Wu Ting’s praise, Dr. Wang felt an indescribable surge of joy and pride, along with the sense of accomplishment that came from being acknowledged by a fellow genius.

"I couldn’t have done it without your guidance, Dr. Wu! I’m truly impressed!"

Watching this intellectual exchange between the two young men, and how Dr. Wang proved the prowess of Haijin Port under Wu Ting’s perfect guidance, a group of senior doctors were reduced to mere spectators, part of the scenery. They couldn’t help but feel a mix of envy and admiration for the two young men’s brilliance.

Qin Donglai marveled to himself, ’Wu Ting, Wang Nanjin... this new generation is already starting to take the reins!’

’A powerful alliance. Now *this* is what a true expert exchange week is all about!’