Start From Emergency Doctor

Chapter 211

Zhou Yuan feels very lucky.

Staying in such a hospital, Zhou Yuan can also focus on medical skills.

Soon, He Lili and He Lili’s mother came.

Everyone in the seminar has reached a consensus: surgery must be done, otherwise He Lili has no way to survive.

So next, I need to explain some specific surgical matters to He Lili, and I have to discuss and cooperate closely with the doctor in the anesthesiology department.

Pregnant women, especially pregnant women in this kind of labor period, are very difficult to anesthetize.

Anesthetics are generally prohibited in the first trimester, and anesthetics are not recommended in the second and third trimesters.

If pregnant women are given anesthetics, local anesthesia is best, as this will have less impact on the fetus.

In the early stages of pregnancy, especially the first three months of pregnancy, the embryo’s nervous system and various organs are in a critical period of development. If anesthesia is performed at this time, it may affect the development of the embryo.

At this time, anesthetics and drugs used after the operation, as well as the irritation and inflammation of the operation, may cause malformations in the fetus, and even stop the fetal development and abortion.

At 26 in the middle and late stages of pregnancy, the chances of miscarriage and premature delivery are the lowest during the entire pregnancy. Anesthesia at this time generally has little effect on the fetus, but at this time it is accompanied by the risk of premature delivery.

The anesthesiologist must balance the dosage to ensure that the pregnant woman is anesthetized, and not to allow too much anesthetic to avoid affecting the fetus. This requires an anesthesiologist to have a high level.

Therefore, in addition to caesarean section and normal delivery, pregnant women should avoid anaesthetics as much as possible. If they must be administered, they should also choose to be in the middle and late pregnancy when the fetus is relatively stable.

“Doctor Zhou, the results of the imaging department have come out.” The nurse ran over and reported.

Zhou Yuan is He Lili’s doctor in charge. He is in charge of all the examinations and so on. It is impossible to report to Dean Fang and others.

“Uterine fibroids combined with pregnancy…”

Zhou Yuan’s words silenced the entire conference room.

He Jianyi, Dean Fang and others were all taken aback.

It really is a uterine fibroids!

Uterine fibroids are the most common benign tumors in female reproductive organs and one of the most common tumors in the human body.(Read more @ wuxiax.com)

In fact, uterine fibroids are not considered dangerous tumors. Most patients don’t even have any symptoms when they suffer from uterine fibroids. Eighty percent of cases of uterine fibroids found in the hospital are during pelvic examinations or ultrasound examinations. Found it by accident.

The symptoms of uterine fibroids do not have much to do with the size and number of tumors. The various clinical manifestations are related to the location of the fibroids, growth rate, whether there is degeneration or complications, accompanying diseases, and so on.

If He Lili is not just in her pregnancy, and has reached the third trimester, she may not find this uterine fibroids…

Zhou Yuan took the CT results and said: “Now CT shows that the tumor has compressed the ureter and it is still developing. It will be very dangerous if it is delayed.”

The deputy director of gynecology oncology glanced at the film, hesitated, and said: “It is too difficult to perform a uterine tumor resection…”

If the uterine tumor is removed, it is likely that the endometrial layer is not clear during the resection, which will result in the inability to separate along the tumor capsule, resulting in bleeding.

Even, in some places, fibroids have adhesions to blood vessels and muscle layers. In this case, separation is more difficult!

Moreover, it may cause damage to nearby organs.

Uterine fibroids have reached twenty centimeters and are large tumors, which can cause positional variations in the bladder, rectum, ureter, etc., such as ureteral compression shown in CT reports. During the operation, the corresponding organ may be damaged. When the position of the ureter is not clear, it is very easy to cause accidental injury.

“My suggestion is… Caesarean section and uterus removal!” The deputy director of gynecological oncology was silent for a long time, and finally made this decision.

On the other side, the oncology doctor also nodded.

Uterine fibroids surgery can be performed through the abdomen, yin tract, hysteroscope and laparoscope.

Transabdominal surgery is performed from the open abdominal cavity, including myomectomy and hysterectomy. It is suitable for various types of uterine fibroids. There are three methods, myomectomy, hysterectomy and uterine artery embolization.

Trans-yin tract surgery is entered from the yin tract, including fibroids removal and trans-yin hysterectomy. It is suitable for mild or loose uterus, especially for patients with uterine prolapse.

Hysteroscopic surgery is to place an endoscope in the uterine cavity through the vagina to remove the fibroids that protrude in the uterine cavity. It is suitable for uterine submucosal fibroids and some intramural fibroids. This kind of operation is very difficult and requires higher surgical skills.

The last type, laparoscopic surgery, can perform hysteromyomectomy, laparoscopic-assisted trans-yin hysterectomy and laparoscopic total hysterectomy, suitable for small uterine fibroids or small single fibroids Fibroids.

The salient features of this type of surgery are that the patient has less injury, less pain, and quick recovery, but laparoscopic surgery also requires higher surgical skills for the doctor.

At present, because He Lili is a pregnant woman and there are huge fibroids in the uterus, it is not suitable for hysteroscopy, laparoscopy and other interventional treatments. Otherwise, the tumor may be touched, causing tumor cells to flow out and infect surrounding tissues and blood.

The only two remaining methods are: removal of the tumor, or removal of the uterus.

However, it is too difficult to remove the tumor, and there is a fetus in the uterus, the tumor is likely to oppress the fetus.

To put it awkwardly… This tumor is only a little smaller than the fetus. This situation is similar to that of a twin in He Lili’s womb.

Therefore, once the tumor is removed, it is very likely to cause damage to the fetus, and even cause tumor cells to enter the fetus through the mother’s blood…

The safest way is to perform a hysterectomy directly, take the child out, and separate the uterus from the human body along with the tumor growing on it.

He Lili was stunned: “Doctor, you want to remove my uterus?”

It took her a while to come back to her senses: “I can’t remove the uterus, I’m still young, I’m only 21 years old, I still have a baby…”

The two directors of the Obstetrics and Gynecology Oncology Department and Oncology Department bowed their heads.

Both of them can remove the tumor alone, but there is a fetus next to the tumor, and no one can guarantee that the fetus will not be accidentally injured.

Zhou Yuan did not participate in the discussion, he kept staring at the results of the angiography that he did later.

Uterine fibroids combined with pregnancy, the incidence of this disease accounts for about 1% of patients with fibroids and 0.3% of pregnancy.

Pregnant women with huge uterine fibroids are even rarer.

Just as Zhou Yuan frowned, a detail on the angiogram made Zhou Yuan happy. .