Chapter 211： This operation is not so difficult

"laugh!"

Chen Ning couldn't help laughing beside him.

Wu Yuan was also a little embarrassed.

Where did he think that his name "Blood-faced Madman" had really spread throughout the entire Dongcheng Hospital.

No one seems to be paying attention to how medical skills are, instead, they care about these little names and gimmicks, which are really annoying.

Shen Feichen said to Wu Yuan: "Okay, find a place to sit down. Dr. Wu has just joined in. Let's take a look at the patient's condition again and let him understand the situation."

Wu Yuan also seemed very low-key, sitting in the last position, took out a small notebook and a ballpoint pen, and prepared to record.

Does Wu Yuan need to make a record?

Obviously not needed.

For a surgeon of advanced level like Wu Yuan, as long as it is a field he is good at, there is no need to record it. After listening to it once, he will naturally understand it in his mind.

Of course, this operation also involves the related content of obstetrics and gynecology. In this regard, Wu Yuan's knowledge reserve is not enough.

Wu Yuan's heart moved, thinking that he hasn't punched in today, should he punch in the meeting room of the obstetrics and gynecology department to see if he can get something good?

After struggling for a while, Wu Yuan gave up.

He really has no interest in the skills of a doctor in obstetrics and gynecology.

Although it is good to have relevant knowledge, it always feels strange.

At this time, Shen Feichen had already begun to explain the patient's condition information.

Wu Yuan quickly regained 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 she was still an older mother.

This is an unfavorable condition. The physical function of older women is declining, and there is a certain danger in childbirth, not to mention the need to remove tumors from the purple palace.

Just thinking about it like this is troublesome.

Of course, this is the beginning, and trouble is yet to come.

Shen Feichen opened the information bag, took out the films that Liu Mengxue checked, and inserted them on the backlight board one by one.

Shen Feichen said while inserting: "It's been 22 weeks of pregnancy. During the ultrasound at the 16th week, a tumor was found in the coccyx of the embryo."

That's a few ultrasound pictures.

Of course, it can also be called B-ultrasound.

There are also a few MRI pictures.

All the chips are inserted into the backlight board.

Shen Feichen looked at Wu Yuan and continued to explain: "Also, pregnant women have had antiphospholipid syndrome for several years."

Wu Yuan was stunned, realizing that the problem was serious.

Antiphospholipid syndrome, more common in female surnames, is an autoimmune disease.

Having this condition can cause many consequences, such as thrombosis, miscarriage, and thrombocytopenia.

And they are not as simple as choosing one or the other, and it is very likely that several complications will appear at the same time.

Shen Feichen added: "Because of the antiphospholipid syndrome, the risk of pregnancy is very high. The pregnant woman has had three miscarriages, and this is the fourth pregnancy."

As soon as Wu Yuan heard this, he had a headache. This condition is too complicated.

Sure, Antiphospholipid Syndrome isn't a deadly condition, but the problem is...

Tumors were also found.

This is fatal.

With antiphospholipid syndrome, not only will the risk of pregnancy increase, but the risk of surgery will also be extremely high, or it is not suitable for surgery itself.

Under such circumstances, the tumor in the purple palace is removed...

In a sense, it is not too difficult, it is extremely difficult, and the probability 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 didn't look very old.

To be a director, that level is definitely not ordinary.

Deng Caixia nodded, walked to the back panel, pointed to the first film, and said, "Here you can see the embryo, the top arm is 21.5 cm long, and it is developing very healthy."

Having said that, Deng Caixia looked at the others and said with a wry smile, "This may be considered 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.

Just keep calm and don't rush to ask questions.

Since Deng Caixia is an experienced director of obstetrics and gynecology, she will definitely clarify all the problems.

Sure enough, Deng Caixia immediately mentioned Wu Yuan's concern, that is, the size and growth rate of the tumor.

Deng Caixia pointed to another film, took a ruler and gestured there: "The diameter of the tumor is... Let's see, it is 10.6 centimeters."

Wu Yuan was a little stunned and said, "...about half the size of an embryo."

It's also too big.

The tumor found at week 16, now at week 22, or 6 weeks, has grown to 10.6 cm.

What does this mean?

It shows that the growth rate of the tumor is not ordinary fast, extremely fast!

Wu Yuan: "Director Deng, have you done any pathological analysis? 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...

If the fetus does not get enough blood supply, it will affect the growth of the fetal heart, resulting in the weakening of the embryonic heart.

Deng Caixia sighed; "If this goes on, the embryo will not survive to the stage of fertility."

With the current condition, the best way is to terminate the pregnancy, get the fetus, and then judge whether the benign tumor should be removed according to the situation.

Because it is a benign tumor, if the growth of the tumor begins to slow down or even stagnate, conservative treatment can be performed to gradually reduce the swelling.

Of course, it is also possible to remove the tumor if necessary.

But in any case, the fetus must be removed.

For a woman who had three miscarriages, it was a bolt from the blue.

Wu Yuan does not think that pregnant women, or patients, are willing to get the fetus in this way to concentrate on the treatment of tumors and antiphospholipid syndrome.

In fact, when Wu Yuan communicated with Chen Ning yesterday, Chen Ning also said it.

Pregnant women want to keep their fetuses, no one else can persuade them.

Now that she is pregnant for the fourth time, it means she desperately wants a child.

To tell the truth, the pregnant woman is already thirty-seven years old. Even if the antiphospholipid syndrome can be cured, the possibility of a fifth pregnancy should be very low.

Wu Yuan: "So...the pregnant woman plans to take risks and insist on keeping the fetus?"

Deng Caixia: "Yes, so we need to respect the opinions of pregnant women, and we need to perform an operation to remove the tumor to ensure the normal survival of the fetus."

Wu Yuan was speechless for a while.

This operation is a combination of all aspects of the situation, and after thinking about it, it is extremely difficult.

During the operation, various emergencies are likely to be encountered, which will increase the difficulty.

In Wu Yuan's imagination, the operation that can make Shen Feichen worry must be difficult, but he didn't expect it to be so difficult.

At this time, Shen Feichen looked at everyone, and stopped at Wu Yuan: "Because pregnant women suffer from antiphospholipid syndrome, if they operate for a long time, pregnant women will be very dangerous, and there is a high possibility of thrombosis."

Shen Feichen: "So our problem is that on the one hand, we must protect the fetus, and on the other hand, we must pay attention to the vital signs of pregnant women at all times. Even so, pregnant women are still very likely to be life-threatening during the operation."

More than a big one.

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 blood clot occurs, it will be very troublesome to rescue.

Who would bet on that twenty percent chance?

Wu Yuan sighed: "If a pregnant woman dies during the operation, there is no point in saving the fetus. Don't the pregnant woman understand that the probability of a successful operation will be very low?"

At this time, Wang Jiangxue said: "I have talked to the pregnant woman several times, and she said... She has had three miscarriages. If she has another miscarriage, she would rather die."

Chen Ning: "Even if her family persuaded her, she insisted on protecting the fetus."

Wu Yuan: "Director Shen, Director Deng, is the current surgical plan determined?"

Shen Feichen and Deng Caixia looked at each other with a little helplessness in their expressions.

It can be seen that the surgical plan has indeed been determined, but it is far from perfect, and the risks are 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 remove the embryo first, remove the tumor, and then put the embryo back into the purple palace."

It's three steps.

The first step is to remove the embryos.

The second step is to remove the tumor.

The third step is to put the embryo back.

Man, it sounds so easy, it's even harder to do.

This can really be called step by step startling ah.

Wu Yuan: "The prerequisite is that the risk of thrombosis needs to be controlled."

Shen Feichen gave an "um"; "Yes, 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.

As expected of the method that the elite doctors of Dongcheng Hospital came up with.

Unfractionated heparin is a non-oral anticoagulant drug, a mixture of aminodextran sulfate extracted and refined from porcine intestinal mucosa or bovine lung.

It is mainly used for the prevention and treatment of thrombosis or embolic diseases, such as myocardial infarction, cerebral infarction, thrombophlebitis, pulmonary embolism, etc. It is also used in hemodialysis, extracorporeal circulation, catheterization, microvascular surgery and other operations.

However, this so-called heparin is not widely used at this time, and it is still a new type of coagulation drug.

The price is also very high, it can even be said to be expensive.

Unfractionated heparin is an imported drug and cannot be reimbursed yet, and not many people use it.

Of course, Wu Yuan can be sure that this pregnant woman and the pregnant woman's 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 unfractionated heparin, there is no guarantee that blood clots will not occur, especially if the patient's heart may have problems, how do you know in advance that the heart will problem, intervene in advance, this 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 falling on him.

Wu Yuan immediately waved his hand: "I'm sorry, I'm talking nonsense, the teacher is too much."

Shen Feichen laughed; "Doctor Wu, you don't have to be humble, what you said is indeed a big problem, and we are all stumped."

This is indeed the case. Today's monitors can only know that there is a problem with the patient's heart, but they cannot predict that the heart will fail.

In an operation like this, if there is a problem with the patient's heart, it will be too late to deal with it.

So how does it work?

It is when the thrombus is forming, about to form, and has not affected the heart of the pregnant woman, intravenous intervention can save the risk.

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 successful surgery.

But how do you know that a blood clot is forming? Existing instruments simply cannot detect it.

It is impossible for surgeons to make predictions based on experience. If something goes wrong, it will be the doctor's fault.

Wu Yuan's eyes suddenly lit up, if there is one person who can make accurate predictions, it can only be Wu Yuan!

Yes indeed! Wu Yuan has the talent of "key lock".

When the thrombus is forming, the abnormality can be detected at the first time, and then the anesthesiologist can be notified for intravenous intervention!

It seemed that Shen Feichen would not be able to bring Wu Yuan into the operating room.

At this time, Deng Caixia pointed to another piece of film and said, "The length of the umbilical cord is 48 cm, so we can open the laparotomy to take out the embryo and let it lie on the pregnant woman's lap while I remove the tumor."

Deng Caixia coughed again: "But the difficulty is that after the tumor is removed, to put the embryo back into the mother's body, we can't stretch the uterine wall too much, and we have to make sure that every stitch is tight. Together, there must be no flaws, so as to ensure that the uterus can survive the punching and kicking of the embryo for more than four months."

Deng Caixia: "Everyone should understand that this is an extremely difficult job. Our obstetrics and gynecology doctors are unable to do the job, so the surgeons can only take care of it."

In fact, in this operation, the obstetrics and gynecology department can do not much, and the key indicators are the main work.

Shen Feichen looked at Wu Yuan, and although he didn't say anything, he seemed to be saying, "The stitching work is yours."

Of course, Wu Yuan also did his part.

If there is one person who can perform suture to perfection, or to say that it is infinitely close to perfection, it really can only be Wu Yuan, and it is not easy to change Shen Feichen.

Deng Caixia said here, the two most difficult parts of this operation are finished. Although the other parts are also dangerous, for a big man like Shen Feichen, the level is not high and can 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 moment and replied, "Director Shen, although it's a bit arrogant to say that, but... I think I should be able to help."

The error-free chapters of "Check-in at the beginning: Back to being a surgeon ten years ago" will continue to be updated on Novel.com. There are no advertisements on the site. Please collect and recommend it!

I like opening check-in: Back to being a surgeon ten years ago, please collect it: () Opening check-in: Go back to being a surgeon ten years ago and update the fastest.