Source of this article: Selected from "Scientist Spirit Innovation"
Wu Mengchao (August 1922 - May 2021), hepatobiliary physician, medical educator and hospital management expert, academician of the Chinese Academy of Sciences. In the 1950s, he led a "three-person team" to start from the basic theoretical exploration of liver anatomy, and created and established a basic and clinical theoretical system of hepatobiliary disease. He personally wrote and edited 38 monographs such as " Huang Jiasi Surgery " and "Primary Liver Cancer". It has successively won more than 10 first-class awards at the national, provincial and ministerial levels, including , the highest national science and technology award. He has won more than 70 honors such as "Model Medical Expert" from the Central Military Commission, and has been awarded 10 military medals (including first-class merit ).
Beautiful Coral
and "Five Leaves and Four Sections"
In the 1950s, young military doctor Wu Mengchao would receive patients with liver cancer in the outpatient clinic from time to time. The patient's painful face and eyes looking for survival made him deeply sympathize but unable to do anything. At that time, for the treatment of liver cancer, the international medical community unanimously believed that for those with indications for surgery, the most ideal treatment option was surgical resection. To successfully remove liver tumors, an urgent issue is to understand the physiological anatomical structure of the liver and the distribution of blood vessels in the liver, so as to solve the major problem of bleeding during liver surgery. The surgical community has always recognized that the liver is a "forbidden area" for surgical operations. The knowledge about the anatomy of the liver that Wu Mengchao learned at the Tongji University School of Medicine in the late 1940s only provided superficial descriptions such as "there are four kinds of tubes in the liver, and the liver is divided into left and right lobes" and did not provide any information about the liver. Information such as the direction of each blood vessel or blood flow distribution pattern. In fact, there are not only thousands of blood vessels as dense as a spider web in the liver, but also bile ducts, lymphatic vessels, etc. that overlap and cross. The complex distribution and direction of the pipelines can lead to massive bleeding if you are not careful during surgery. Excessive bleeding or continued bleeding is the main cause of patient death during or after surgery.
The great love of benevolent doctors and the lag in knowledge made Wu Mengchao worried and anxious, and also gave birth to a stronger emotion of saving lives and the driving force for innovation.
Under the guidance of his mentor Professor Qiu Fazu, he took the initiative to form a "three-person team" for hepatobiliary research at the Second Military Medical University, dreaming of changing the current situation and dilemma of the inability to surgically treat liver cancer in my country as soon as possible.
The first step taken by the team led by Wu Mengchao was basic scientific research - mastering the anatomical structure of the liver. From the rare literature, they were excited to discover that in 1951, the Swiss expert Giorgi had first established a research method for liver duct corrosion specimens and bile duct modeling. This reminded them that an ideal liver specimen should Liquid plastics of different colors can be injected into the liver's hepatic artery, hepatic vein, portal vein and biliary tract. After the plastic solidifies, the liver tissue outside the pipes will be corroded to form a liver. A clear model of the distribution and direction of various pipelines in the project. But at that time, due to the Western blockade of my country's scientific and technological information, further analysis was difficult to find. Wu Mengchao could only make cast specimens of liver ducts by himself to thoroughly understand the anatomical structure of the liver.
It is precisely because Wu Mengchao started his career in hepatobiliary medicine from basic theoretical research and inherited the ideas and concepts of his predecessors. This gave him the confidence to succeed in a series of innovations in the future, and thus he took the step towards hepatobiliary medicine. Medical research must be combined with clinical practice.
Starting from 1958, the "three-person team" led by Wu Mengchao used the liver organs remaining after the unidentified corpses were dissected by the Forensic Medical Laboratory in a simple animal laboratory, and they were very involved in planning how to make liver duct cast specimens. Specific details.The first problem encountered was what kind of plastic should be poured. They used various methods to match various liquefied plastics with colors and poured them into the corresponding pipes of the liver. After the specimen was formed, acid was put in to try to corrode it. Problems arise when the liver tissue surrounds the duct. Although the liver tissue around the tube was corroded away, the plastic filling the tube also softened, and the entire specimen collapsed. Hundreds of failures have caused the three young military doctors who are engaged in amateur scientific research to lose more than ten pounds, but they don't care at all, they only hope to find a new way out of the predicament of repeated trials and failures. The laboratory is next to the experimental dog breeding room, and the dogs bark constantly, which makes them upset. In particular, the laboratory is filled with the unpleasant smell of dissolved plastic, which is even more uncomfortable in the sweltering Shanghai... If they hadn't all been curious and aggressive about scientific research, they would have given up long ago. Wu Mengchao, who was born with a stubborn streak, would never give up on anything he was determined to do, no matter how difficult it was. Pavlov once said: "Experimental failure may be the beginning of discovery." Wu Mengchao firmly believes: There is no perfect way, and there will always be a way!
It seems that innovation does require a fighting spirit that is not afraid of hardships.
As the saying goes: Opportunity always favors those who are good at catching it. In the blink of an eye, in April 1959, an exciting piece of good news was broadcast on the campus in the cold spring: Chinese table tennis player Rong Guotuan won the men's singles championship in the 25th World Table Tennis Championships. This is the first time that China has won the glorious title of world champion since the World Table Tennis Championships was held in 1927. For this exciting event, all walks of life will produce colorful comments from their own perspectives. Wu Mengchao, a table tennis fan, is naturally particularly excited. While the good news has washed away the frustration of hundreds of failed tests, it also triggered This triggered a string that was always tight in his heart - isn't a table tennis ball also a kind of plastic? Why not experiment with it? The perspective is unique and the ideas are inevitable. Wu Mengchao's idea was a true flash of "innovative inspiration" that he thought about every day and dreamed about every night. As soon as he said it, Wu Mengchao led a "three-person team" and used liquid celluloid perfusion technology. After overcoming difficulties such as the thickness of the perfusion solution and the perfusion propulsion pressure, he finally successfully made a beautiful liver duct cast like coral. specimen.
▲ Figure 1 Coral-like beautiful liver cast specimen
(still kept in the display room of Oriental Hepatobiliary Hospital, provided by Wu Mengchao’s office)
Wu Mengchao gazed at this " coral flower " affectionately, looking through the refraction of tears. The three-dimensional structure of the liver ducts seems to be shining and jumping. Since four different colors have been pre-mixed into the celluloid and poured into the hepatic artery, hepatic vein, portal vein and bile duct respectively, the crisscrossing, climbing and entangled large and small pipes are presented differentially and clearly. The colorful colors make The direction of the clear pipeline is clear at a glance. The various ducts and veins inside the liver were now clearly displayed in front of the three young military doctors. This was the first step in opening the door to liver scientific research that Wu Mengchao dreamed of opening, and it was also his most critical innovation in hepatobiliary surgery.
By the end of 1959, as the experimental technology became increasingly sophisticated and sophisticated, the "coral flowers" they produced became more delicate and more beautiful. Wu Mengchao observed carefully from all angles, using the tip of his pen to follow the direction of the hepatic artery, hepatic vein, portal vein and bile duct, analyzing their respective diameter changes to infer their flow rate, and looking for their distribution patterns in the liver lobe . He carefully studied the liver structure of Chinese people of different ages, big and small, and used three views to draw the distribution of the corresponding ducts. From groping to knowing the direction and distribution of blood vessels in the liver, he has further reached the level of proficiency.On this basis, he uniquely proposed the innovative theory of "five leaves and four segments" in the anatomy of the liver in my country: the human liver is divided into five lobes: "left outer, left inner, right front, right back and caudate", and The left outer lobe and the right posterior lobe were each divided into two segments, totaling four segments.
At the Seventh National Surgery Academic Conference held in Zhengzhou in June 1960, Wu Mengchao's report on this innovative theory was generally recognized by the experts attending the meeting. After that, he and his team members successively published a series of Chinese and English treatises such as "Observation on intrahepatic anatomy of normal human liver" and "Observation on intrahepatic anatomy of normal human liver in my country", proposing a whole new set of new theories about human liver anatomy.
The clinical practice of the next 60 years has fully demonstrated that the "five leaves and four segments" theory has provided key anatomical markers for the success of liver surgery in my country and even the world, and Wu Mengchao proposed that there are venous anastomosis branches and caudate lobes inside the liver. The anatomical characteristics of blood vessels provide clear and safe theoretical guidance on the principles and methods of accurate treatment of blood vessels and bile ducts during liver surgery. This series of discussions has been included in many theoretical monographs and medical textbooks.
Under the guidance of his own new theory, on March 1, 1960, surgeon Wu Mengchao successfully removed a large liver cancer on a middle-aged female patient, becoming the first successful case since the establishment of the First Affiliated Hospital of the Second Military Medical University. Liver tumor resection surgery.
The inspiration of turning the faucet
and mid-hepatic lobe resection
Wu Mengchao's subsequent series of liver cancer resection surgeries were all successful, but he still strived to successfully seek further innovation in key theories and technologies. The first is the improvement of hemostasis methods during surgery, which is also a major issue that needs to be solved urgently in the international hepatobiliary medicine community. In the early 1960s, during major liver surgery, in order to reduce bleeding during the operation, the patient was soaked in ice water to lower his body temperature to below 32°C. The main basis is that short-term ischemia of the liver is only allowed for no more than 20 minutes. Only in a low temperature state can liver cells withstand a longer period of ischemia without necrosis. At that time, doctors in European and American countries all used this method of intraoperative hypothermia, and it was recognized as the "classic liver cutting method" in the world. Due to the backwardness of preoperative examination methods at that time, sometimes when the abdominal cavity was opened, it was discovered that the patient had advanced liver cancer that could not be resected, or that the patient had not developed cancer at all, and the original diagnosis was wrong. Therefore, if the suturing is done in a hurry, the patient will suffer a big sin.
How to face this cruel reality and innovate new humane surgical techniques?
Wu Mengchao is a soldier after all, and the basis for thinking about the problem is "My surgical method must not only be suitable for a peaceful environment, but also suitable for a wartime environment." Under field conditions, where can ice water or ice cubes be used to cool down the wounded? This "low-temperature anesthesia method" is simply impossible to use to rescue soldiers with liver trauma on the battlefield. Is it true that liver surgery cannot be performed safely at normal temperature?
This question was firmly entrenched in his mind, making him restless. All responsible innovators always have a sense of mission and motivation to contribute to society: they must find a good way to allow patients to undergo surgery at normal temperature. For this reason, he was thinking about it at work and after get off work. He even dreamed at night that he was blocking the liver hilus. "Whenever a great doctor treats a disease, he must calm his mind and calm his mind, have no desires or demands, and first express a heart of great compassion and compassion, vowing to save the suffering of souls." Sun Simiao 's sincere words of saving people always struck Wu Mengchao's soul.
Cheng can be said to have "a kind of character called tenacity", and God sometimes favors such persistent people. One morning, Wu Mengchao was washing his face under the faucet. He subconsciously opened and closed the faucet, opened it again, and closed it again... Looking at the water flowing out of the faucet, he smiled stupidly.After a while, he shouted excitedly: "I found it! I found it!" Just like when Archimedes entered the bathtub to take a bath, looked at the overflowing water, and shouted "Eureka! Eureka!" generally. Archimedes's cry at that time was because he suddenly discovered that he could use the overflowing water to measure the volume of the crown, calculate its specific gravity by weighing it, and determine whether the crown was pure gold.
His wife Wu Peiyu asked in surprise: "What did you find?"
"I found a good way to stop bleeding!"
Wu Mengchao hurriedly pulled Wu Peiyu to the faucet. He pressed the faucet with his left hand and gestured with his right hand: " During the operation, I only need to tie a rubber band at the patient's liver porta. When cutting the liver, tightening the band is equivalent to turning off the faucet, and the blood flow is blocked. After a period of time, loosening the band is equivalent to turning off the faucet. Open it and restore the blood supply to the liver. After a few minutes, tighten the band again and continue to cut the liver. After the cutting is completed, loosen the band... By switching on and off intermittently, the liver will not become necrotic, but the operation can proceed normally. , and the bleeding can be controlled, and the patient no longer has to be cruelly soaked in ice water..."
There is no place to look for after breaking through the iron shoes, and it (seemingly) takes no effort at all. The result of this sudden burst of innovative inspiration was the "Intermittent Portal Blocking Liver Cutting Method at Normal Temperature" that shocked the medical community.
Numerous clinical practices in the past 60 years have convincingly shown that this technological innovation has extremely important clinical significance for the safe performance of liver surgery, especially for the characteristic that 90% of liver cancer patients in my country have cirrhosis . Especially in the future, Wu Mengchao successively discovered the theory of postoperative metabolic rules, crossed the "mid-lobe resection" operation, "the forbidden area within the forbidden area" and many other innovations, and cooperated with the "intermittent hilar occlusion hepatectomy method at normal temperature", my country The high success rate of liver cancer surgery shocked the global liver surgery community.
"Intermittent hilar occlusion and liver resection at normal temperature" is a complete technology. More strictly speaking, it is an innovation and breakthrough in basic theoretical research on liver medicine. It is still considered to be the simplest and most reliable in hepatobiliary surgery. And the safe hemostasis method has been widely used and promoted around the world. Wu Mengchao said eloquently: "All my technologies belong to human beings, and I, Wu Mengchao, have no patents!"
Wu Mengchao, who has an "altruistic" feeling, is so honest.
Continuous innovation and multi-faceted innovation
As the founder and academic leader of hepatobiliary medicine in my country, Mr. Wu must continue to learn, continue to question, and keep moving forward. While solving problems, he often achieves innovation. After successive innovations, Mr. Wu's scientific research pace has also taken greater steps. Theory and technological innovation have become the joy of his life, because he must work hard to "carry patients across the river one by one" and "conquer cancer" as soon as possible. , to realize this sacred mission and responsibility does require him to continue to innovate.
In 1964, he pioneered the resection of postoperative recurrence of liver cancer and achieved success. Later, a series of innovations in thinking and technology were proposed, including indications for surgical exploration, radiotherapy, reoperation for liver cancer, hepatic artery ligation or embolization.
In 1975, he miraculously cut out a miracle in the history of human medicine - the largest liver cavernous hemangioma reported at home and abroad so far. The tumor weighed 18 kilograms. Even the "Wu's knife method" Innovation has also reached a state of perfection. In 1976, he took the lead in conducting a liver cancer census in Shanghai on 180,000 people. He conducted research on the early diagnosis and treatment of liver cancer in the form of a public health incident. He also invested in innovative topics such as deciphering the codes related to liver cancer and hepatitis, and how to deal with the recurrence of liver cancer after surgery. of research. In 1978, my country also successfully performed the first allogeneic liver transplantation of primary liver cancer .
Since the 1980s, Wu Mengchao has successfully removed hepatoblastomas that were larger than their heads for more than a dozen Chinese and foreign infants (the youngest was only 4 months old), pioneering infant hepatobiliary surgery in the world. A series of theories and technologies... Later, new discoveries and technologies were continuously made in liver cancer markers, liver cancer cell chemotherapeutic drug sensitivity testing, establishment of liver transplantation models, semi-isolated liver resection, search for liver cancer genes, and cellular immunotherapy of cancer. innovative results.
The old man said sincerely: "Even if I, Wu Mengchao, am the Thousand-Hand Guanyin, working in front of the operating table every day, how many patients can I help? Besides, the final victory over cancer will not rely on surgeons, but on breakthroughs in basic medical theories... "Since 1978, he has personally taught hundreds of masters and doctors, and also trained a large number of training doctors from all over the country, passing on and spreading innovative ideas and achievements. For decades, he has worked tirelessly to build a stage for students to display their talents. From the Department of Hepatobiliary Surgery established within the Department of Surgery of Changhai Hospital (commonly known as the "Department within the Department") to the "Army Hepatobiliary Surgery Research Institute" established within the hospital (commonly known as the "Hospital within the Hospital"), to the establishment of the completely independent " Oriental Hepatobiliary Surgery Institute" "Hospital " and "Oriental Institute of Hepatobiliary Surgery" innovative platform for "hospital integration". In 2015, the elderly established the Anting New Hospital and the National Liver Cancer Scientific Center with 1,500 beds. What supports his continuous innovation is the support of innovative ideas. For example, in 2006, he proposed the concept of "living with disease" and in 2012, he proposed the concept of "precision medicine"...
No wonder Tianjin Nankai Hospital Wu Xianzhong The Academician Association said: “In the mid-to-late 1950s, some surgeons in China began to enter the field of liver surgery at the same time, but many of them gave it a try at the beginning, and some gave up halfway. Academician Wu Mengchao was the only one who persevered, led a team, and eventually formed a new discipline and a new hospital. "
After all, Mr. Wu is a person who "bravely ventures into restricted areas, is brave in innovation, and is never satisfied. "Always strive for the first" (these 16 words have become the motto of Oriental Hepatobiliary Surgery Hospital) is an innovator and a true warrior! At the age of 60, his innovative ideas have become more advanced and "fashionable"...
Written by: Shanghai Education Press Fang Honghui
