Mingjie Li: Debriefing report

In support of Application for Chief Surgeon

Since the resumption of professional journals and academic activities after the Cultural Revolution in 1979, I have published dozens of papers in journals such as Southern Anhui Medicine, Journal of Bengbu Medical College, Lectures of Provincial Medicine, Domestic Medicine (Surgery) and Jiaotong Medicine.  In 1979 and 1980, I participated in the preparation and re-founding of Anhui Orthopedic Society and Surgical Society respectively, and attended the annual meetings (1-6 sessions) of the two societies.  I also participated in many academic activities of surgery in China and the Ministry of Transportation.  

In 1994, I was involved in the planning and organization of a symposium on orthopedics in the Yangtze River Basin area, helping to compile a special issue of Orthopedic Clinic for Journal of Southern Anhui Medical College, Vol-13 supplement, 1994) under the guidance of Professor Jingbin Xu, editor of Chinese Journal of Orthopedics, carrying over 100 published papers, with participants and contributions from all over the country.

In September, 1995, I published two papers at the National Academic Conference on Acute and Severe Surgery (Guilin, 1995), among which "Problems in the Treatment of Liver Trauma" (0190) won the certificate of excellent papers.  I have also published papers in the First International Academic Conference of Chinese Naturopathy (Chengdu, 1991) and Naturopathy (published in Taiwan Province).

1 Professional path and deputy chief physician performance

(On evolution of several theoretical problems in surgery)

1.1 In the early 1960s, a large number of patients suffered from acute volvulus, ascaris lumbricoides intestinal obstruction and cholelithiasis.  Carrying out a large number of related operations for these cases consolidated my mastering  the basic surgical skills.  In addition, for the treatment of toxic shock in late cases, we practitioners underwent an arduous zigzag path from vasoconstriction and pressure increase to volume expansion and improvement of microcirculation, which proves to be an epoch-making change and progress both theoretically and clinically.

1.2  In Southern Anhui, there used to be a large number of patients with portal hypertension, hypersplenism and upper gastrointestinal bleeding in the early years of late-stage schistosomiasis and late hepatitis cirrhosis.  The medicine community has also experienced a process of repeated debate and re-understanding of the choice between shunt and devascularization.  In this regard, as early as in 1975, I performed splenectomy, splenorenal vein anastomosis and other various shunts. Due to the high rate of postoperative embolism, the blood supply to the liver was reduced and hepatic encephalopathy was easily induced.  Later on, I switched to various types of portal-azygous devascularization, and obtained many lessons and various experiences for improvements from the treatment of this difficult problem.

1.3 Biliary lithiasis still bothers the surgical community. With the development of hepatobiliary surgery and improvement of monitoring methods, surgical procedures for this challenging problem of intrahepatic calculi are constantly updated and improved.  I started the surgery of regular resection of the left lateral lobe of the liver for this disease in 1980 (the paper on five early cases was published in the Annual Meeting of the Provincial Surgery in 1980 and in Journal of Southern Anhui Medicine (80, 13; 51, “Regular resection of the left outer lobe of the liver for the treatment of intrahepatic stones”).  Also starting in 1980, various types of choledocho-intestinal drainage (Finster, Longmire, Roux-en-Y, etc.) were successively performed.  In 1992 and 1995, three cases were treated with intrahepatic bile duct incision, stone removal and plasty, and "basin" biliary and intestinal drainage (The first case was reported in “Communication Medicine”,  93,7; 91, “A case of hepatobiliary basin type biliary enteric drainage”). This work advanced the operation to the treatment of intrahepatic lesions, leading to improved  clinical efficacy.

1.4 In recent years, the incidence rate of acute pancreatitis has increased. All severe pancreatitis patients in my department were cured by measures such as focus removal, pancreatic bed drainage, intraperitoneal lavage, 5-Fu, somatostatin and other measures to inhibit exocrine, anti-shock and anti-infection. In recent years, one patient was rescued in my department despite the complicated stress ulcer bleeding after operation was performed in another external hospital.  

1.5 On the basis of treatment and operation for various thyroid diseases, hyperthyroidism operation was performed after 1980, and two cases of radical thyroidectomy (neck-mimicking surgery) were performed in 1994. One case was re-operated due to recurrence 3 years after the initial surgery was performed in an external hospital.  No further recurrence was observed during follow-up.  

1.6 In addition, there are surgeries such as excision and anastomosis of cervical aneurysm, thymopharyngeal duct cyst, thyroglossal duct cyst and cystic hygroma resection, etc.

1.7 Over the past 30 years, more than 1,000 cases of breast cancer, gastric cancer, colon cancer and rectal cancer have been treated, and many of them have survived for a long time.  

1.8  The prevention and treatment of short bowel syndrome after large intestinal resection as a surgical method of interposition of distal reverse peristaltic bowel loops, the observation shows no diarrhea and malnutrition for 21 years. This paper was published in the Journal of Bengbu Medical College (82; 7: 214, PEUTZ Syndrome) and Traffic Medicine (91; 1: 41, “Surgical treatment of short bowel syndrome”).  

1.9 The management of duodenal injury has its particularity and complexity, and its retroperitoneal injury is especially prone to missed diagnosis and misdiagnosis.  The prognosis of patients who underwent surgery more than 24 hours after injury is grim.  In a case report from 1994, following the principle of "rest transformation" of duodenum, I performed a Berne-like operation 28 hours after injury, and the recovery was smooth. My paper was published in Communication Medicine (“Experience in Diagnosis and Treatment of Closed Retroperitoneal Duodenal Injury”, by Mingjie Li).

1.10  Subdiaphragmatic total gastrectomy, jejunostomy, supradiaphragmatic esophagectomy, thoracic esophagogastrostomy, lobectomy, mediastinal thymoma removal, diaphragmatic hernia repair, etc. which started years ago.

2. Work involving various medicine disciplines

The two hospitals I have served are both base-level primary hospitals. The "major surgery" department covers general surgery, orthopedics, urology, chest surgery, obstetrics and gynecology, ophthalmology and otorhinolaryngology,  anesthesia, radiation, laboratory test and other related work.  As professional subject leader, I have long been engaged in the work of all of the above areas, outlined below.

2.1 Orthopedics is one of my key areas, only second to general surgery.  I have performed all major surgeries in this area, and participated in academic activities at all levels, including publication of numerous papers, professional talks and compilation of a special issue on Orthopedics.  My representative operations treating bone injury and bone disease include closed nailing of femoral neck (for the paper, see Orthopedics Clinical 1994, 13:37, Closed nailing treatment of femoral neck fracture in 45 cases), surgical paraplegia (paper in Anhui Province Medical Lectures 1982;, 4:21, Surgical paraplegia analysis of 14 cases), spinal tuberculosis surgery (paper Spinal tuberculosis a surgical therapy in Proceedings of First Provincial Orthopedic Annual Conference, 1979), lumbar disc surgery, spinal cord tumor enucleation, bone tumor removal and orthopedic surgery, etc.    

2.2 Urological surgery: nephrectomy, stripping of renal pedicle lymph nodes, removal of various segments of ureteral calculi and Urethral trauma realignment repair, ureteral transplantation, vasovasostomy, spermatic vein–inferior epigastric vein anastomosis, hypospadias repair, radical resection of bladder cancer and penile cancer, etc.

2.3 Gynaecology and obstetrics: I founded the department of obstetrics and gynecology of our hospital, having operated Cesarean section (lower segment and extraperitoneal operation), hysterectomy (abdominal type and vaginal type), oophorectomy, repair of vesicovaginal fistula and cervical cancer resection, etc.

2.4 Ophthalmology and otorhinolaryngolog: parotid gland, tonsil, maxillary sinus, mastoid, cataract, artificial pupil, enucleation, nasolacrimal duct anastomosis, strabismus correction, etc.  

2.5 Anesthesiology: various segments of epidural block, cervical plexus block, brachial plexus block, intubation general anesthesia and intravenous compound anesthesia, etc.    

2.6 Radiology: I founded the department of radiology in 1960, and concurrently served as the head of the department for 2 years (1960-1962).  Very familiar with its routine work and related angiography.

Environment trains people.  A wide range of issues encountered in the long-term work of grass-roots hospitals enabled me to dabble in many subjects.  The knowledge and skills of these relevant areas complement each other, contributing to and deepening the improvement of my surgical expertise.  Various Level-4 and Level-5 surgeries have been performed to keep placing me at the forefront of contemporary surgery.

3  Continuous innovations and some experience to share

Over the past 40 years, with high technological development, diagnosis and monitoring methods are constantly updated.  With the change of social life, diseases are also changing. In an aging society, geriatrics takes a prominent position.  Many factors make the clinical work evolve too.  This requires physicians to constantly hunt for scientific and technological information, learn from the experience of others, study hard and embrace the courage for innovation, in order to improve the service quality for our patients.

3.1 Improvement and innovation

3.1.1 The key to the control of traumatic infection is complete debridement at the first diagnosis, rather than relying on drainage and antibiotics.  Techniques involve a large quantity of water washing, elimination of foreign objects and inactivating tissues, disinfection, and no suture.  When postoperative inflammatory reaction occurs, apply local wet compress with alcohol, supplemented with with or without antibiotics.  Following this strategy, surgery within 6 hours of trauma is almost completely free from infection.

3.1.2 Over the past 30 years, based on the experience of over 1,000 cases of gastrectomy I have performed, the preset gastric tube has basically been abandoned except for special needs, and there were no cases of failure.  This requires excellent anastomosis, perfect hemostasis, intraoperative emptying of the residual stomach, and attentive postoperative monitoring.

3.1.3 For extensive peritonitis, after the nidus and infectious substances are removed, abdominal cavity drainage can be abandoned to reduce postoperative adhesion.  The key for this to work is to wash it thoroughly during the operation.  As the drainage is quickly blocked by fibrin glue in the abdominal cavity and soon stops working, it only increases the pain of the patient. To be sure, however, in cases such as pancreatitis, abdominal abscess, etc., if continuous overflow is expected, double-cannula negative pressure drainage is still required.  

3.1.4  For any surgery, regardless of scale, its success or failure makes a big difference to the health and safety of patients.  As a surgery practitioner, I attach importance to the technical improvement of each and every "small" surgery.  Some of my technical innovations and experience are outlined below.

For inguinal hernia repair, the focus is the transverse abdominal fascia, the traditional Bassini method should be replaced by the modified Madden procedure, which greatly reduces the pain of postoperative tension suture for patients, and is also conducive to healing, with the recurrence rate greatly reduced.

For circumcision, the conventional routine procedure has plagued both doctors and patients with the poor alignment of the inner and outer plates, hematoma, edema, as well as difficulty in stitches removal.  I modified the procedure, using local venous anesthesia to support neat cutting under a tourniquet, with perfect hemostasis, accompanied by careful sutures with human hair or absorbable thread.  The benefits include no pains during the operation, good alignment, fast healing, and avoiding stitches. (see my paper published in Jiaotong Medicine 90; 43)66,  Several improvements of circumcision

Anal fistula seton therapy or open resection both make patients suffer from postoperative pains with a long recovery period. I used long-acting anesthesia (with local injection of diluted methylene blue) to ensure the primary resection and suture. Most cases receiving this treatment result in primary healing, with the course of treatment greatly shortened.

3.2 Some General Experiences

Based on what I have learned from my 40 years of hands-on surgical practice, I feel that in order to be a qualified surgeon, we need not only consolidate the basic knowledge with continuous updating, but also exercise meticulous working methods with a high sense of responsibility, supported by logical thinking and practical orderly working style.  It is very difficult to just follow a unified norm or standard procedure when the real-world surgery scenario involves so many moving parts to be weighed and considered, factors like the ever-changing condition, physical differences, positive and negative effects of drugs, advantages and disadvantages of the techniques in consideration, the reserve function of body organs, the length of the course of the disease, and even the natural environment, mental and material conditions, and so on.  One must be equipped with high adaptation wisdom.  It is not an exaggeration to say that the adaptation ability determines a surgeon’s diagnosis and treatment level and the clinical effects.  

3.2.1 The entire process on the operating table involves struggles between personal fame and the interests of patients.  The so-called following "safety first, and draw the line accordingly” principle is often not a feasible practice.  A competent physician must have the courage to take risks for his patients.  It is often the case to be placed in the position in fighting for patients' good chances of rescue that can be missed because of a small mistake in one's thinking.  I have countless memories of such incidents in the past, one of which is as follows.  In the fifth operation of the biliary tract, cavernous blood vessels caused by portal hypertension due to biliary cirrhosis were distributed all over the hepatic hilus, and in addition, the inflammation was thickened.  After struggling for 8 full hours of operation, I finally managed to open the biliary duct and save the life of the patient.  This was a victory of perseverance.

3.2.2  Adjust measures to real-world conditions, and keep an open mind to break the routine to save a patient.  The key to life-saving in case of liver and spleen trauma and massive hemorrhage of ectopic pregnancy in the countryside lies in the rigorous transfusion of the abdominal blood.  To wait for the blood supply in these scenarios means to wait for death.  I remember a case of liver trauma in which 1700ml of liver blood was transfused locally to support the successful operation.  (See paper Related issues in the treatment of liver trauma (review), in Proceedings of the National Academic Conference on Acute and Major Surgery, 95; 190 

3.2.3 For difficult surgery and new surgery, one must accumulate the relevant knowledge and operation skills, by reviewing the literature, consulting experienced experts for guidance, and visiting and studying surgery scenes, before embarking on the operation, to minimize potential misses or accidents.  In my first case of hepatobiliary-pelvic internal drainage operation, I asked for direct guidance from a professor of surgery. The subsequent two cases were successfully completed all by myself.  

Looking back on my 40 years of career in surgery, I deeply feel that clinical surgery is a combination of science, perseverance, determination, and a sense of responsibility.  It is like a small boat that ups and downs in the forefront of the waves.  Walking on thin ice, one can hit hidden rocks at any time.  The hardships and risks of our career are among the highest in all trades.  Fortunately, I have not failed the society.   Along the journey, there have been countless joys of success, together with many sleepless nights and panic moments.  For the rest of my career years, I am determined to maintain the service spirit of "healing the wounded and rescuing the dying", to complete the journey to the end.  

Appendix 1, Publications
Appendix 2, Relevant Materials and Records of Level III and Level IV surgeries


In Commemoration of Mingjie Li’s 66 Years of Medical Practice



Mingjie Li: My career as surgeon

I:  Career memoirs 

Before writing my debriefing report in support of my application for Chief Surgeon, let me start with three unforgettable orthopedic cases that I experienced in my medical practice. 

In 1970, my old schoolmate and close friend from junior high school, Mr. Gui from Fanchang No.1 Middle School at that time, brought his son’s case to my attention.  His son, aged 16 then, suffered from cervical vertebra 5 tuberculosis with cold abscess, which severely oppressed esophagus and trachea.  He was unable to eat, and had difficulty breathing, with hoarseness, dehydration and hypoxia, in a critical condition.  

They had visited Yijishan Hospital, the largest hospital in Wuhu, but the director there Dr. Chen of the Department of Orthopaedics could not admit this case, saying that a few days before, a similar case, died during the operation.  He made the suggestion for the patient to be sent to the provincial Hospital of Hefei, which required 800 yuan then.   However, Mr. Gui’s monthly salary was only 52 yuan, and he had to support a family of six with this income.  How could he afford it?  Besides, nobody knows whether the chief hospital in Hefei could treat him.  In a hurry, Mr. Gui turned to the No. 127 Army’s Hospital located in the suburb of my town Nanling, to try their luck there.  The corresponding department of the hospital was administered by Dr. Xu Jingbin, the nation-wide orthopedic authority, and this military hospital located in a small place long had a tradition of helping the poor.  Unfortunately, Dr. Xu was on a business trip to Nanjing, and several of his subordinates there were too afraid to accept this high-risk patient.  

Feeling helpless, Mr. Gui came to me in Nanling County Hospital (the two hospitals are only 5 miles apart) to discuss possible rescue plans with me.  I was not sure about how best to treat this condition either.  However, I had studied in No. 127 Hospital, with Dr. Xu as my supervisor, familiar with the personnel there.  I immediately called an ambulance. We went back to No.127 Hospital, found doctors in orthopedics and surgery, and asked them to work together for the treatment of this urgent case.  Mr. Gui as patient’s family and I jointly signed the required paper for willing to take the risk of the operation, and discussed the detailed rules.  However, this plan was still not approved by the hospital.  Instead, the hospital asked me to help them out of this embarrassing predicament, and promised a free car to be used for transferring the patient to big city hospitals in Hefei or Nanjing.  The patient's life was in danger at any time. Far water cannot put out the near fire, so it's not advisable to transfer to hospital far away. 

I decided to take on the challenge myself.  At that time, I thought, at least I could give pus discharge for saving life first, relieving the oppression of esophagus and trachea, and making it possible for hime to eat and breathe.  So the patient was brought back to the county hospital where I worked.  Without even getting off the stretcher, I ordered to first give fluid replacement and antituberculosis.  At this point in the evening, Mr. Gui didn't get any food for a whole day, so he was given dinner at my home.  I could not afford the time to have a dinner.  I took the time to review the related literature and anatomy.  Half an hour later, the patient was sent to the operating room under local anesthesia. After my careful dissection, the patient’s pus cavity was cut to release a large amount of pus.  The patient immediately started making sounds, could sip the water, and breath smoothly, indicating him finally put out of immediate danger. 

The operation continued, exposing the focus of cervical vertebra 5 by anterior approach, I removed the dead bone, scraped off the granulation of tuberculosis, flushed the pus cavity, inserted streptomycin and isoniazid, put the drainage piece in, with suture.  The operation was smooth and very effective.  The fever came down 3 days after operation.  The patient went to get a haircut, ate normally and recovered well. 12 days after the operation, he was discharged from hospital, and his medical expenses were 32 yuan.  He continued anti-tuberculosis treatment for half a year and recovered well.  For more than 40 years now, the patient has been working and living normally, now enjoying a family of his numerous children and grandchildren. 

In addition to the complicated anatomy of the neck, such as dense blood vessels, nerves, thyroid gland, trachea, esophagus, etc., this type of cervical tuberculosis debridement operation is of high difficulty also due to the fragility of the cervical spine and the destruction of tuberculosis.  If there is a slight mistake in the cervical spinal cord, it will lead to being paraplegic at a high level or even death.  It's an orthopedic high risk level 4 operation.  Even in big hospitals, the directors are extremely cautious in treating such cases.  I was still a newcomer in orthopaedics then, but I needed to save lives, knowing that transferring to another hospital at that time was basically a dead end.  The patient was on the verge of an abyss.  But I also had some of my own strength and preparedness for this success.  I had had many years of experience in neck thyroid surgery, familiar with anatomy, and had accumulated specialized knowledge in orthopedics.  This solid foundation finally enabled me successfully complete this rare problem in a grass-roots hospital.  Life threatening symptoms were treated by relieving oppression immediately.  And the disease was cured, with the lesion eradicated.  It proved to be a cure for life.  

Another case, at the end of 1980s, named Xiao Wei, a 14-year-old junior student in Wuhu No.1 Middle School, suffered from right humeral neck tumor.  He had undergone two operations in Yijishan Hospital and Shanghai Zhongshan Hospital respectively.  Now, the disease struck at the right scapula.  The director of orthopaedics in a hospital of our city said, it is malignant tumor recurring and metastasizing, amputation is necessary, and it is challenging to save his life!   The family was in a desperate situation.  The patient’s grandfather, Mr. Wu, was my junior middle school teacher.    Mr.  Wu knew about the case of cervical tuberculosis treated  well by me on Mr. Gui’s son, so he came to me for consultation.  I carefully examined the medical records and the X-ray films before and after, and diagnosed it as a new critical tumor, neither a recurrence nor a metastasis of the original disease.  I personally performed a half-excision of the right scapula in my own hospital, resulting in his full recovery.   More than 20 years have passed, and Xiao Wei has enjoyed good health ever since.  He has become a Dr. Yang in the west later on, and is now a high-end international talent in his field.  From time to time, he and his father still come to visit me with appreciation. 

The third case, in the fall of 1975, a 35-year-old female patient, who had lost 40 kilograms, was admitted to our hospital for tuberculosis of thoracic vertebrae 6 and 7 with paraplegia.  Under general anesthesia, through the chest, the focus was cleared, and the dead bone and the necrotic intervertebral disc were removed.  The tubercle granulation in the spinal canal was 8cm long, which pressed the thoracic spinal cord, resulting in spinal canal obstruction and paraplegia.  After curettage, it could be seen that this segment of spinal cord was throbbing again.  The focus area was thoroughly washed, with antituberculosis drugs added in.     The ribs cut during thoracotomy were trimmed and embedded in the intervertebral defect area, and the anterior bone graft was completed in one stage. After operation, the patient recovered well and was cured.  The patient’s husband was a blacksmith, who gifted me with  a stainless steel kitchen knife and a spatula of his own craftsmanship, which are still in use in my home today.  In orthopedic surgery, this belongs to the top level-four category.  With thoracic tuberculosis complicated with paraplegia, the cure was one-time lesion clearance and bone grafting through the anterior thoracic approach, definitely having reached the peak in county-level hospitals. 

Such cases have brought me a great sense of pride and accomplishment, and they form the motivation for my lifelong dedication to saving lives and relieving pains for my countless patients.


In Commemoration of Mingjie Li’s 66 Years of Medical Practice



In Commemoration of Mingjie Li’s 66 Years of Medical Practice

Collected Works in Commemoration of Mingjie Li’s 66 Years of Medical Practice


© Mingjie Li

Dr. Mingjie Li has been practicing medicine for over 60 years. This collection, compiled to commemorate his amazing career, includes three sections: (i) career memoirs, (ii) medicine papers, and (iii) medicine education. The publication of his medicine papers is the culmination of his extensive experience and expertise in the field. His work has been recognized by his peers for its professional value and rigorous style. In addition to surgery, orthopedics, obstetrics, and gynecology, his work at times also incorporates elements of traditional Chinese medicine. The "Operation Records" section in the appendix provides detailed descriptions of operation procedures and emergency measures, making it a valuable reference for professionals in the field. The "Education Section" highlights Dr. Li's practical experiences and medical training materials he compiled, providing valuable insights into a range of clinical topics. Overall, this collection serves as a testament to Dr. Li's impressive career and contributions to the field of medicine.

August 2023, Wuhu, Anhui, China



Table of content

I:  Career memoirs

My career as surgeon

Debriefing report

Service beyond my hospital

Career Path and self review

Dad's medical career

II:  medicine papers

Regular resection of left lateral lobe of liver for intrahepatic calculi

PEUTZ syndrome

Surgical management study of hepatic injury

Surgical treatment of acute gastroduodenal perforation

Diagnosis and treatment of closed retroperitoneal duodenal injury

Surgical treatment of short bowel syndrome

Hepatobiliary basin type biliary-enteric drainage

Biliary enteric drainage

Several special problems in diagnosis and treatment of biliary tract surgery

Diagnosis and treatment of close duodenal retroperitoneal injury

Misdiagnosis of subacute perforated peritonitis in gastric malignant lymphoma

Adult retroperitoneal teratoma infection complicated with chronic purulent fistula

Lighter foreign body in stomach

Primary repair of congenital omphalocele

Recurrent stones in common bile duct with suture as core

A case of plastic tube foreign body in bladder

Abdominal trauma

Subcutaneous heterotopic pancreas of abdominal wall

Several improvement measures of circumcision

Clinical observation of a new minimally invasive circumcision

A surgical treatment of spinal tuberculosis

Transpedicular tuberculosis complicated with paraplegia

Surgical analysis of surgical paraplegia

Lipoma under soft spinal membrane complicated with high paraplegia

Treatment of femoral neck fracture with closed nailing

Fifth metatarsal fracture caused by varus sprain

Intervertebral disc excision in community health centers

In commemoration of the 50th anniversary of Dr. Xu Jingbin' s medical career

Intrauterine abortion combined with tubal pregnancy rupture

Rivanol induction of labour by amnion cavity injection

Extraperitoneal cesarean section

Prevention and treatment of trichomonas vaginalis and mold infection

Non-operative treatment of senile cholelithiasis with integrated traditional chinese medicine

Treatment of acute soft tissue injury with moxibustion

Treatment of scapulohumeral periarthritis with acupuncture combined with warm moxibustion

IV:  medicine education

Level 4 Surgery

New concept of modern surgical blood transfusion

Extrahepatic biliary injuries

Surgical treatment of thyroid cancer

Indications of splenectomy  and effects on body after splenectomy

Treatment of carcinoma of pancreas head  and carcinoma of ampulla

Treatment of cardiac cancer

Treatment of recurrent ulcer after subtotal gastrectomy

Treatment points of radical resection of colon cancer

Medicine Lecture Notes

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