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　　诊断容易排除难

To eliminate the diagnosis difficult

　　本报记者　王君平

Our reporter WangJunPing

　　时间：1月18日

time:1 month and day

　　地点：北京协和医院

site:Beijing union medical college hospital

　　13时30分，在门诊一楼第三十七诊室，记者跟随泌尿外科主任李汉忠出诊。第一位患者是84岁的赵姓老人，患有前列腺肿瘤。老人一进诊室，李汉忠请他先坐下，问老人什么情况。老人说是血尿。

13 when 30 points,On the first floor in outpatient clinic 37,Reporters followed urology director LiHanZhong home visit.The first patient is 84 - year - old ZhaoXing old man,With prostate cancer.The old man entered the clinic,LiHanZhong asked him to sit down first,Asked what the old man.The old man say hematuria.

　　李汉忠拿出化验单，仔细看着各项指标。他问老人，排尿好吗？一晚上起来几次？大便干燥吗？老人说，每晚2至3次，大便干。记好病历，李汉忠对老人说，效果还不错，指标高了1个点。年龄大了，就不考虑手术了。血尿可能和大便干燥有关，膳食多吃些水果和蔬菜。下个月再来一次。

LiHanZhong out of paper,Carefully look at each target.He asked the old man,Micturition??A night up several times?Defecate dry??The old man said,2 to 3 times a night,Defecate dry.Remember good medical records,LiHanZhong to the old man said,Effect is good,High index for a point.age,Will not consider surgery.Hematuria may move bowels dry and relevant,Dietary eat more fruit and vegetables.Next month once again.

　　在门诊的过程中，不断有患者推门进来要求加号。凡是复诊的，李汉忠都会为他们加号。随李主任出诊的两个博士生告诉患者，直接去护士站加号。

In the outpatient service process,There is growing patients pushed the door and come in requirements plus.Those who return visit of,LiHanZhong for them will be plus.With li, director of home visit two doctoral tell patients,Go directly to nurse station plus.

　　一对河南夫妇走进诊室。丈夫3个月前胃疼，当地诊断为胃幽门螺旋杆菌感染，在省城抗菌治疗。后来又做了胃镜，结果发现并不是胃部的问题，再做CT发现肾部有肿瘤。

A pair of henan couple walked into the clinic.Her husband 3 months ago stomach ache,The diagnosis of gastric helicobacter pylori infection,In the provincial capital antimicrobial therapy.Then do gastroscope,The results showed that the stomach is not the problem,To do CT renal tumors that have.

　　博士生王栋打开阅片灯，把几张片子插在阅片灯上。李汉忠发现，片子是残缺的，只照了上腹部，下腹部只有部分，片子连肿瘤都没照全。他告诉患者，这是一个巨大的肿瘤，生长非常快，压迫胃部，但您需要做PET/CT。这个检查一看肿瘤发展到什么程度，二看有没有骨转移，三是能够发现普通CT检查不到的范围。检查大约需要1万元，病人入院后可能还要做活检。李汉忠详细向患者做了说明，并给他开了住院条，安排他住院。

Doctoral WangDong open read a slice lamp,Put a few pieces of film stuck in reading piece of light.LiHanZhong found,The film is incomplete,Just as the midsection,Only part of the lower abdomen,The film didn't even tumors according to the whole.He told the patients,This is a huge tumor,Grow very fast,Oppression stomach,But you need to do PET/CT.This check a look tumor development and to what degree,2 look have bone metastasis,The third is to find common CT check less than range.Check about 10000 yuan,After admission patients may have to do a biopsy.LiHanZhong detailed patients to do that,And gave the hospital,Arranged for him in hospital.

　　将近17时，一位男青年陪着他的小舅舅来看病。舅舅体检时发现肾部有囊肿。打开阅片灯，李汉忠把片子仔细看了一遍，还把几张片子拿在手里，对着灯光辨认。他对患者说：“你的肾上有个东西在出血。一旦包在外面的膜破了，就会造成大出血，必须要住院治疗。但住院要排队预约，我帮你在节前安排，能帮你把肾保住。”

Nearly 17 when,A young man with his little uncle to see a doctor.Uncle found a medical renal cyst.Open read a slice light,The film LiHanZhong carefully watched it again,Also a few pieces of film hold it in hand,To identify the light.He says to patients:"Your kidney on something in bleeding.Once the package in the outside membrane is broken,Can cause massive haemorrhage,Must stay in the hospital treatment.But in hospital to line up an appointment,I help you arrange in advance,Can help you keep the kidney."

　　患者问：“现在上班可以吗？”李汉忠说：“上班还可以，不影响。你出去一下，我和你外甥说两句话。”

Patients ask:"Now go to work?"LiHanZhong said:"Work can also,Do not affect.You go out for a while,I and your nephew said the two words."

　　患者走出诊室，李汉忠表情变得严肃起来，对他外甥说：“我是瞒他的，把他先稳住。这是典型的肾癌。不说出血，担心他不住院。但又不能说得很严重。去预约检查，准备住院手术吧。”

Patients out of the office,LiHanZhong expression got serious,To his nephew said:"I am from his,He first hold the.This is typical of kidney cancer.Not bleeding,Don't worry about him in hospital.But can't say very serious.Check to make an appointment,Preparation in hospital's operation."

　　随后，患者何先生进来了。他在北京一家医院检查，前列腺癌抗原特异性指标只有0.8，前列腺内膜只是饱满，但诊断报告却说有前列腺癌的可能。“癌”字让他感觉活着都没希望了，有的医院还让他做穿刺活检，这件事让他心理压力极大。

then,Patients with Mr. He came in.He is in a Beijing hospital inspection,Prostate cancer antigen specific indicators only 0.8,Prostate intima is full,But the report said a diagnosis of prostate cancer may be."carcinoma"Words made him feel alive didn't hope,Some hospitals also let him do biopsy,The thing that makes him great psychological pressure.

　　李汉忠平和地说，从检查结果来看，癌的可能性不高。没有必要做穿刺活检，这对身体有创伤。如果实在担心的话，就做个骨扫描，看看有无转移。何先生激动地说：“您去了我的心病！”

LiHanZhong peacefully said,From the test results to see,The possibility of cancer is not high.There is no need to do biopsy,The body has trauma.If there is worry about words,Do a bone scan,Look for transfer.Mr. He said excitedly:"Are you going to my heart!"

　　18时9分，夜幕降临。李汉忠看完第四十九号，这是门诊的最后一个病人。在4个半小时里，李主任只喝了3口水，上了一次厕所。他对记者说，在门诊看病时，诊断某种疾病相对难度不大，但是排除患者已在外院诊断的某种疾病却不是件容易事。因为需要准确的判断力和可靠的证据。

"Nine points,The night.LiHanZhong watching, 49,This is the end of the outpatient service a patient.In four and a half hour,Li, director of only had 3 saliva,A toilet.He told reporters,When a doctor in outpatient service,Some kind of disease diagnosis relative difficulty is not great,But exclude the outer court patients have some kind of disease diagnosis is not easy thing.Because of the need to accurate judgment and reliable evidence.

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　　永不停歇的手术 Neverending surgery

　　余易安

Tang more than

　　时间：1月18日

time:1 month and day

　　地点：北京儿童医院

site:Beijing children's hospital

　　上午10时20分，第二台手术开始了。这是一台食管裂孔紧缩术，由胸外科主任曾骐主刀。13时，手术顺利结束。2岁的小女孩醒了就要找妈妈。虽然过了饭点，但没人提一个“饭”字。

10 to points,The second table the operation started.This is a hiatus tightening operation,The director of the thoracic surgery CengQi operator.13 when,Surgery for a successful end.2 years old girl woke up to find mom.Although the rice point,But no one make a"rice"word.

　　排班表显示，曾骐今天共有6台手术。同台的助手们一边准备着下一台手术，一边预测下班时间：“又得做到晚上七八点了。”

Scheduling table shows the,Today CengQi six station operation.The same aides side ready to next station operation,Side prediction quitting time:"And to do the QiBaDian night."

　　13时20分，推进来的是一名7岁男孩，因患肿瘤，右腿已被截肢，后又转移到了肺部。曾骐要做的是肺转移瘤切除术。 　　

13 when twenty points,Advance to a seven year old boy,For a tumor,The right leg has been amputated,And then transferred to the lungs.CengQi to do is lung metastatic tumor resection.

　　麻醉、固定、插管，一切准备就绪，曾骐戴上手套又上台了。

anesthesia/fixed/intubation,Everything is ready,CengQi wear gloves and go on stage.

　　这一次，不开胸，用的是胸腔镜技术，两把像枪一样的手术器械进入体内。显示屏上，患者体内脏器组织清晰可见。两把“枪”好似两只手，一个、二个、三个……探、碰、剪，曾骐寻觅着埋藏在肺组织里黄豆粒大小的肿瘤，然后一手夹子，一手剪子，果断地拿下。 　　

This time,Don't open the chest,With thoracoscope technology,Two like gun as surgical instruments into the body.screen,In patients with visceral organization clearly visible.two"gun"Like two hands,a/two/Three......agent/touch/shear,CengQi look for buried in lung tissue HuangDouLi in the size of the tumor,Then a clip,Hand scissors,Decisively won.

　　紧盯屏幕，紧握“手枪”，整台手术下来，曾骐几乎保持同一个姿势近两个小时。 　　

Close watch screen,hold"pistol",The whole table operation down,CengQi almost keep the same posture nearly two hours.

　　在助手们缝合伤口、清理手术台的间隙，曾骐并未休息。他拿起一把镊子，把切肿瘤时残留在肉块里的小钩子一个一个挑出来。 　　

In the aides suture wounds/Clean up the table space,CengQi did not rest.He picked up a pair of tweezers,When the resection of the tumor residue in meat block the small hook one pick out.

　　时间到了15时，依然没人提“吃饭”两字，也没人喝水、去洗手间。　

Time and,Still nobody mention"eat"Two words,No one drink/To go to the bathroom.

　　笔者也戴着口罩，一直站着，滴水未进。心慌、胸闷、出汗，典型的饥饿型低血糖症状出现了，不得不拉一把椅子坐下来。忍不住问：“你们不饿吗？”

The author also wearing a mask,Standing all the,Drop not into.dismayed/Bosom frowsty/sweating,Typical symptoms of low hunger type appeared,Have to pull a chair to sit down.Cannot help but ask:"Don't you hungry??"

　　“咳，早习惯了！”曾骐答。 　　

"cough,Early accustomed to!"CengQi a.

　　一会儿，助手们交替去休息室吃东西。一个汉堡、一碗泡面，扒拉几下就吃完了。也不喝水，就怕上厕所。

For a while,Aides alternate to room to eat.A hamburger/A bowl of instant noodles,A pull-out is finished.Nor drink water,He was afraid the toilet.

　　曾骐仍不动，坐到手术台旁电脑前，劈里啪啦敲起了手术日志。　

CengQi still don't move,Sit on the table beside the computer,The split on the marble the operation log.

　　15时16分，给1岁的男孩做纵膈肿瘤切除术，又是两个小时。

The 16 points,For 1 year old boy do mediastinum tumor resection,Is two hours.

　　接下来是胸腔镜膈肌折叠术。其间，曾骐只喝了一次水、上了一趟厕所，依然没去吃饭。两台手术间隙，依然不休息，不是写手术日志，就是将患者信息录入数据库。

Followed by thoracoscope diaphragm folding technique.meanwhile,CengQi only drink a water/On a trip to the toilet,Still not to have a meal.2 sets of surgical clearance,Still don't rest,Not write operation log,Is the patient information recorded database.

　　20时，肺叶切除术。一助、二助、三助，围站手术台前，为给主刀大夫最好的视野，她们紧握腔镜，上身不动，可两脚累得左右倒换。 　　

And when,Lung lobe resection.A help/2 to help/Three help,Wai station operation stage,To operate the doctor for the best view,They hold cavity mirror,Upper body did not move,But two feet around too tired to rotate.

　　曾骐却一直保持那个姿势，直立，腰微弯，略低头，手臂往前，手指不停。 没人说话，生命监护仪里传出“滴滴滴”的心跳声，显得越来越大。　

CengQi but keep the posture,upright,Waist microbend,Slightly lower the head,Arm forward,Fingers kept. No one to speak,Life monitor coming out"DDD"Heartbeat of,Appears more and more.

　　21时23分，手术顺利结束。摘掉手套的曾骐，只是揉了揉右手指，又坐回到电脑前写手术日志。　　

When the 21st 23 points,Surgery for a successful end.Take off CengQi gloves,Just rubbed his right hand refers to,And sat back to the front of the computer to write operation log.

　　22时许，曾骐吃过夜班饭，又到病房查看当天所有手术患者的术后情况。一切忙完已近零点，他的后半夜就睡在医院的办公室。

At about 22,CengQi eaten dinner the night shift,And to view the same day ward all surgical patients postoperative situation.All busy nearly zero,His after midnight sleep in hospital office.

　

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　　从早9点到晚9点

From 9 am to 9 PM

　　田博夫

TianBoFu

　　时间：1月18日

time:1 month and day

　　地点：卫生部中日友好医院

site:The ministry of health the sino-japanese friendship hospital

　　8时50分，笔者跟随口腔科主任医师徐宝华来到诊室。他的专业是口腔正畸。

Eight at,The author with department of stomatology chief physician XuBaoHua came to clinic.His specialty is oral orthodontics.

　　9时整，一位中年妇女走进诊室，护士安排她躺在治疗椅上，徐宝华戴上口罩和橡胶手套。“牙齿长得不错，今天重新做一下。”

9 when the whole,A middle-aged woman walked into the clinic,The nurse arranged for her to lie down on the chair,XuBaoHua wear masks and rubber gloves."Teeth long well,Today to do it."

　　细丝钳、丝剪……护士小夏默契地给徐大夫传递着治疗工具。病人闭着眼睛平躺在治疗台上。整个诊室只听见工具的声音。

Filaments forceps/Wire cut...The nurse XiaoXia tacit understanding to xu doctor transfer the treatment tool.Patients with eyes closed and lie low is on the treatment table.The clinic only hear the voice of the tool.

　　这位患者做的是牙齿矫正治疗。徐大夫拆下患者牙齿上的旧结扎丝，用细丝钳修正新的结扎丝。其间，不时询问患者是否舒适。

The patients do is teeth orthodontic treatment.Dr Xu removed on patients with tooth old ligature wire,With QianXiu filaments are new ligature wire.meanwhile,From time to time to ask whether the patient comfort.

　　50分钟后结束治疗。患者坐了起来，伸伸胳膊，扭扭腰，对徐大夫说了声“谢谢”。

Fifty minutes after the end of treatment.Patients sat up,Stretch your arms,Twist twist waist,The doctor said that the sound of xu"thank you".

　　“不用，上次说的治疗，今天准备做吗？”

"Don't,The last time said treatment,Going to do today?"

　　“今天没时间了，要去上班。”

"Today don't have time,To go to work."

　　“那行，你有时间给我们打电话吧，有啥情况及时跟护士联系。”

"The line,Do you have time to call us,Have what timely contact with the nurse."

　　护士迅速转移“阵地”，为下一位患者做治疗前的准备。10时50分，第二位患者也走出了诊室。

The nurse quickly transfer"position",For the next patients do preparation before treatment.10 at,The second patient also out of the clinic.

　　11时20分，盒饭送来了。可是还有两位患者躺在治疗椅上。直到12时，徐大夫才送走了上午最后一位患者。

11 to points,Bento brought.But there are two patients lie in the treatment of chair.When until 12,Xu doctor just off the morning last patients.

　　护士把午餐摆在办公桌上，然后开始收拾诊室，徐宝华在一旁书写上午6位患者的病历。20分钟后，他站起来，用力捶了捶腰。整个上午，没上一次厕所，也没喝一口水。

The nurse brought a lunch in the desk,Then began to pick up clinic,XuBaoHua aside writing at six the patient's chart.Twenty minutes later,He stood up,The pound thump on the waist.The whole morning,Not the last time the toilet,Don't drink water.

　　中午是徐大夫唯一能放松的时间。吃完盒饭，他和护士们聊了会儿，回到自己的休息室。

Noon is the only doctor xu can relax time.Finish eating lunch box,He and the nurses chatted for a while,Back to his room.

　　14时30分，徐大夫继续开始工作。因16时预约的病人有事不能来，护士小赵匆忙联系其他患者进行调配。打了几通电话，终于约好了另一位患者。

The 30 points,Xu doctor continue to begin to work.For 16 patients have not to make an appointment,The nurse little zhao4 zi3 hurry contact with other patients for deployment.A few on the phone,Finally an appointment another patient.

　　17时，护士小夏订了晚上的盒饭。而这时，夜门诊的患者提前来了，徐大夫没时间吃饭直接进入夜门诊。

And when,The nurse XiaoXia booked at night, lunch box.And then,Night clinic patients come in advance,Dr Xu didn't have time to eat directly into night outpatient service.

　　18时45分，躺在治疗椅上的患者刘某对徐宝华说：“不好意思，耽误你们吃饭了。”

And 45 points when,Lying in the treatment of patients LiuMou chair to XuBaoHua said:"embarrassed,Delay you for dinner."

　　“没事儿。你不也没吃吗，都一样。我们已经习惯了。”徐宝华笑了笑，然后拿起气枪清理患者口腔。

"That's all right.You don't also didn't eat,Are all the same.We have become accustomed to."XuBaoHua smiled,Then took the gun cleaning the patient's mouth.

　　20时30分，他送走了最后一位患者。护士们开始打扫“战场”，他继续写病历。10分钟后，和护士们一起吃晚餐。

And 30 points,He sent away the last patients.The nurses began to clean"battlefield",He continued to write medical records.Ten minutes later,And nurses eat dinner together.

　　21时10分，徐宝华结束了一天的工作，离开诊室。

And ten points when,XuBaoHua after a day's work,Leave office.

　　据悉，中日友好医院从2011年8月22日起，全面启动了夜间门诊和夜间医技检查。截至今年1月15日，夜门诊达11.3万人次。

It is reported,The sino-japanese friendship hospital from August 22, 2011 up,Comprehensive started the night and night outpatient medical check.So far this year on January 15,,Night outpatient service to 113000 people.