Sign In: Going Back to Being a Surgeon 10 Years Ago Chapter 211: This operation is not so difficult
"Chick!"
Chen Ning couldn't help laughing beside him.
Wu Yuan was also a little embarrassed.
Where did he expect that his name as a "blood-faced lunatic" really spread throughout Dongcheng Hospital.
No one seems to pay attention to how medical skills are. Instead, they only care about these small names and gimmicks, which is really confusing.
Shen Feichen said to Wu Yuan: "Okay, let's find a place to sit down. Doctor Wu just joined in. Let's take another look at the patient's condition and let him understand the situation."
Wu Yuan also appeared to be very low-key, sitting in the last seat, took out a small notebook and pen, and got ready to record.
Does Wu Yuan need to make records?
Obviously not needed.
For a surgeon of Wu Yuan's level, as long as it is a field that is relatively good at, there is no need to record it at all. After listening to it once, it will naturally be understood in place.
Of course, this operation also involves obstetrics and gynecology. In this regard, Wu Yuan's knowledge reserve is not enough.
Wu Yuan's heart moved, thinking that he hadn't clocked in today, why don't he check in in the meeting room of the obstetrics and gynecology department, and see if he can get something good?
After struggling for a while, Wu Yuan still gave up.
He really has no interest in the skills of doctors in obstetrics and gynecology.
Although it is a good thing to have relevant knowledge, it always feels weird.
At this time, Shen Feichen had already begun to explain the patient's condition information.
Wu Yuan quickly collected his mind and began to listen carefully.
The first is the basic information of the patient.
Liu Mengxue, 37 years old, female (nonsense).
Wu Yuan saw that this was an older woman.
This is a disadvantage. The body functions of older women are declining, and there are certain risks in childbirth, not to mention the need to pick tumors from the purple uterus.
Just thinking about it like this is very troublesome.
Of course, this is the beginning, and the troubles are yet to come.
Shen Feichen opened the data bag, took out the films that Liu Mengxue checked, and inserted them one by one on the backlight.
Shen Feichen interjected and said, "I'm already 22 weeks pregnant, and during the ultrasound at the 16th week, a tumor was found at the caudal vertebra of the embryo."
Those are some ultrasound films.
Of course it can also be called B-ultrasound.
There are also a few films of MRI.
All the films are plugged into the backlight board.
Shen Feichen looked at Wu Yuan and continued to explain: "Moreover, the pregnant woman has been suffering from antiphospholipid syndrome for several years."
Wu Yuan was stunned, realizing that the problem was serious.
Antiphospholipid syndrome, more common in women, is an autoimmune disease.
Having this disease will cause many consequences, such as the formation of blood clots, miscarriage, and thrombocytopenia, etc.
Moreover, they are not as simple as choosing one, and several complications may appear at the same time.
Shen Feichen added: "Because of antiphospholipid syndrome, the risk of pregnancy is very high. The pregnant woman has miscarried three times, and this is the fourth pregnancy."
Wu Yuan got a headache when he heard it, the condition is too complicated
Of course, antiphospholipid syndrome is not a fatal disease, but the problem is...
A tumor was also found.
This is fatal.
With antiphospholipid syndrome, not only the risk of pregnancy will increase, but also the risk of surgery will be extremely high, or it is not suitable for surgery.
Under such circumstances, remove the tumor in the purple uterus...
In a sense, it is not too difficult, it is extremely difficult, and the possibility of success is very low.
At this time, Shen Feichen said to Deng Caixia: "Director Deng, please explain."
Deng Caixia is the director of Obstetrics and Gynecology.
This surprised Wu Yuan, he seemed young.
If you can become a director, your level must be extraordinary.
Deng Caixia nodded, walked to the backlight panel, pointed to the first film and said: "You can see the embryo here, the length of the top arm is 21.5 cm, and it is developing very healthy."
Speaking of this, Deng Caixia looked at the others and said with a wry smile: "This may be good news."
Shen Feichen: "Don't worry, this is not the only good news."
Shen Feichen's words were more like cheering up the team and comforting himself.
Wu Yuan opened his mouth and closed it again.
Be careful and don't rush to ask questions.
Since Deng Caixia is an experienced director of obstetrics and gynecology, she will definitely explain all the problems clearly.
Sure enough, Deng Caixia immediately mentioned Wu Yuan's concern, which was the size and growth speed of the tumor.
Deng Caixia pointed to another picture, and took a ruler to draw there: "The diameter of the tumor is... everyone, it's 10.6 centimeters."
Wu Yuan was a little confused, and said, "...it's half the size of an embryo."
This is too large.
The tumor that was discovered at the 16th week is now the 22nd week, which is 6 weeks, and has grown to 10.6 cm.
What does this mean?
It shows that the growth rate of the tumor is not usually fast, extremely fast!
Wu Yuan: "Director Deng, have you done a pathological analysis? Is it benign or malignant?"
Deng Caixia nodded: "This is the second good news. After pathological analysis, the tumor is benign."
Wu Yuan fell into silence.
This is only half good news.
Although this is not a malignant tumor, it grows too fast and is too big, and it will gradually monopolize the blood supply. In that case...
The fetus does not get enough blood supply, which will affect the growth of the fetal heart, resulting in weakening of the embryonic heart.
Deng Caixia sighed; "If this continues, the embryo will not be able to survive to the stage where it can be fertile."
Based on the current condition, the best way is to terminate the pregnancy, get the fetus, and then judge whether to remove the benign tumor according to the situation.
Because it is a benign tumor, if the growth rate of the tumor starts to slow down or even stagnate, conservative treatment can be performed to slowly reduce the swelling.
Of course, it is also possible to remove the tumor if necessary.
But no matter what, the fetus must be removed.
For a woman who has had three miscarriages, this is tantamount to a bolt from the blue.
Wu Yuan does not think that pregnant women, or patients, are willing to get their fetuses in this way to concentrate on treating tumors and antiphospholipid syndrome.
In fact, when Wu Yuan and Chen Ning communicated yesterday, Chen Ning also said it.
Pregnant women want to keep the fetus, no matter how much others persuade them, it will not work.
Since she is pregnant for the fourth time, it means that she desperately wants a child.
To be honest, the pregnant woman is already thirty-seven years old, even if the antiphospholipid syndrome can be cured, the possibility of getting pregnant for the fifth time should be very low.
Wu Yuan: "So... the pregnant woman intends to take risks and insist on keeping the fetus?"
Deng Caixia: "Yes, so we need to respect the opinions of pregnant women. We need to perform an operation to remove the tumor and ensure the normal survival of the fetus."
Wu Yuan was speechless for a while.
This operation is extremely difficult just by considering all aspects of the situation.
It is likely to encounter various emergencies during the operation, which will increase the difficulty.
In Wu Yuan's imagination, the surgery that would make Shen Feichen worry must be very difficult, but he never thought that it would be this difficult.
At this time, Shen Feichen looked at the crowd, and his eyes stopped on Wu Yuan: "Because the pregnant woman suffers from antiphospholipid syndrome, if the operation takes a long time, the pregnant woman will be very dangerous, and there is a high possibility of blood clots."
Shen Feichen: "So our problem is to keep the fetus on the one hand, and pay attention to the vital signs of the pregnant woman at all times on the other hand. Even so, there is still a high possibility that the pregnant woman's life will be in danger during the operation."
It's not just big.
What Shen Feichen said was still too conservative.
Pregnant women with antiphospholipid syndrome are about 80 percent more likely to develop blood clots during surgery.
Once a thrombus occurs, it will be very troublesome to rescue.
Who would bet on the twenty percent chance?
Wu Yuan sighed: "If the pregnant woman dies during the operation, there is no point in saving the fetus. Don't the pregnant women understand that the possibility of successful operation is very low?"
At this time, Wang Jiangxue said: "I have talked with the pregnant woman several times, and she said...she has had three miscarriages, and if she has another miscarriage, she would rather die."
Chen Ning: "Even if the family members persuade her, she insists on protecting the fetus."
Wu Yuan: "Director Shen, Director Deng, is the current operation plan confirmed?"
Shen Feichen and Deng Caixia looked at each other, with a little helplessness on their expressions.
It can be seen that the surgical plan has indeed been determined, but it is far from perfect, and the risk is still very high.
Shen Feichen: "Because the tumor is too big, if the embryo is in the purple palace, the tumor cannot be removed smoothly, so now I plan to take out the embryo first, remove the tumor, and then put the embryo back into the purple palace."
This is a three-step process.
The first step is to remove the embryo.
The second step is to remove the tumor.
The third step is to put the embryo back.
Hey guys, that sounds easy, but it's much harder to do.
This can really be called shocking every step of the way.
Wu Yuan: "The prerequisite is that the risk of blood clots needs to be controlled."
Shen Feichen gave a "hmm"; "That's right, so now I plan to inject ordinary heparin before the operation to reduce the risk of blood clots in pregnant women during the operation."
Wu Yuan nodded.
It is indeed the method that the elite doctors of Dongcheng Hospital came up with.
Unfractionated heparin is a non-oral anticoagulant drug, which is a mixture of amino dextran sulfate extracted and refined from pig intestinal mucosa or bovine lung.
It is mainly used to prevent and treat thrombosis or embolism diseases, such as myocardial infarction, cerebral infarction, thrombophlebitis, pulmonary embolism, etc. It is also used in operations such as hemodialysis, extracorporeal circulation, catheterization, and microvascular surgery.
However, this so-called heparin is not widely used at this time, and it is still a new type of blood coagulation drug.
The price is also very high, and it can even be said to be expensive.
Unfractionated heparin is an imported drug and cannot be reimbursed, so not many people can afford it.
Of course, Wu Yuan can be sure that this pregnant woman and her family are not ordinary people, and they must be able to afford unfractionated heparin.
Wu Yuan fell into deep thought, and said to himself: "...Even with the use of unfractionated heparin, there is no guarantee that there will be no blood clots, especially if the patient's heart may have problems. How to know in advance that there will be heart problems and intervene in advance is a big problem..."
When Wu Yuan said this, he felt that the atmosphere was not right.
Wu Yuan looked up and found that other eyes were on him.
Wu Yuan waved his hand immediately: "I'm sorry, I'm talking nonsense, the teacher is too good."
Shen Feichen chuckled; "Doctor Wu, you don't have to be modest, what you said is indeed a big problem, and we are all stumped."
It is true that today's monitors can only know that the patient's heart is having problems, but they cannot predict that the heart will go wrong.
For such an operation, if the patient has a heart problem, it will be too late to deal with it. Even if he is rescued, the chance of becoming a vegetative state will be very high.
So how to do it effectively?
It is when the thrombus is forming, is about to form, and has not yet affected the heart of the pregnant woman, only by performing intravenous intervention can the danger be saved.
It can not only avoid the complete formation of thrombus and the impact on the heart, but also ensure that the tumor removal operation will not be interrupted.
This can be said to be a prerequisite for the success of the operation.
But how do you know if a blood clot is forming? Existing instruments can't detect it at all.
It is impossible for a surgeon to make a prediction based on experience. If something goes wrong, it will be the doctor's fault.
Wu Yuan's eyes suddenly lit up. If there is anyone who can make an accurate prediction, it can only be Wu Yuan!
Yes! Wu Yuan has the talent of "key lock".
When the thrombus is forming, you can detect the abnormality at the first time, and then you can notify the anesthetist for venous intervention!
It seems that Shen Feichen will not be able to enter the operating room without Wu Yuan.
At this time, Deng Caixia pointed to another film and said: "The length of the umbilical cord is 48 cm, so we can take out the embryo by laparotomy ~IndoMTL.com~ and let it lie on the pregnant woman's lap when I remove the tumor."
Deng Caixia coughed lightly again: "But the difficult thing is to put the embryo back into the mother's body after removing the tumor. We can't stretch the uterine wall too much, and we have to ensure that every stitch is tightly sealed without any flaws, so that the uterus can survive the blows and kicks of the embryo in the next four months."
Deng Caixia: "Everyone should understand that this is an extremely difficult job. Our obstetrics and gynecology doctors are unable to do it. The surgeons can only be responsible."
In fact, in this operation, the obstetrics and gynecology department can't do much, and the key indicators are the main work.
Shen Feichen looked at Wu Yuan, although he didn't make a sound, he seemed to be saying, "The stitching job belongs to you."
Of course Wu Yuan did his part.
If there is one person who can perfect the suture technique, or say that it is infinitely close to perfection, then it really can only be Wu Yuan, Shen Feichen will not be able to do it.
When Deng Caixia said this, the two most difficult parts of this operation were finished. Although the other parts were also dangerous, for a boss like Shen Feichen, the level was not high and they could be easily dealt with.
At this time, Shen Feichen asked: "Doctor Wu, what are you thinking?"
The eyes of several other people also focused on Wu Yuan.
Wu Yuan pondered for a while, and replied: "Director Shen, although it is a bit arrogant to say that, but... I think I should be able to help."
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