Start as an Emergency Physician

Zhou Yuan felt very lucky.

Staying in such a hospital, Zhou Yuan was also able to focus on medical skills in a new way.

After a while, He Lili and He Lili's mother came.

The discussion group has reached a consensus: the operation must be done, otherwise He Lili will not survive.

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

Pregnant women, especially those in this type of prenatal period, are quite difficult to anesthetize.

Anesthetics are generally prohibited in the first trimester, and anesthetics are not recommended in the second trimester and late pregnancy.

If a pregnant woman is given anesthetic, it is best to use local anesthesia, which will have less impact on the fetus.

In the early stages of pregnancy, especially in the first trimester of pregnancy, the nervous system of the embryo and various organs are at a critical stage of development. If anesthesia is performed at this time, the development of the embryo may be affected.

At this time, anesthetic drugs and drugs used after surgery, as well as the stimulation and inflammation of the operation, may cause fetal malformations and even lead to the cessation of fetal development and miscarriage.

In the middle and late stages of pregnancy, the chances of miscarriage and preterm birth are the lowest in the entire pregnancy. Anaesthesia at this time usually has little effect on the fetus, however, it carries the risk of premature birth.

The anesthesiologist must balance the dosage to ensure that the pregnant woman is anesthetized without too much anesthetic to avoid affecting the fetus. This requires an anesthesiologist to be highly competent.

Therefore, in addition to caesarean section and spontaneous episiotomy, pregnant women should try to avoid anesthetics, and if they must be injected, they should also choose to wait in the middle and evening of pregnancy when the fetus is relatively stable.

"Doctor Zhou, the results of the examination from the imaging department are out. The nurse ran over and reported.

Zhou Yuan is He Lili's doctor in charge, and he is in charge of the examination and so on, and it is impossible to report it to Dean Fang and others.

"Uterine fibroids combined with pregnancy..."

Zhou Yuan's words made the entire conference room quiet.

He Jianyi, Dean Fang and others were all stunned.

Sure enough, it's uterine fibroids!

Uterine fibroids are one of the most common benign tumors in the reproductive organs of women and one of the most common tumors in the human body.

In fact, uterine fibroids are not considered dangerous tumors, most patients do not even have any symptoms when they have uterine fibroids, and 80% of the cases of uterine fibroids found in hospitals are discovered incidentally during pelvic examination or ultrasound.

The symptoms of uterine fibroids are not much related to the size and number of tumors, and the reason for the various clinical manifestations is related to the location of fibroid growth, growth rate, whether there is degeneration or complications, accompanying diseases, etc.

If He Lili is not in pregnancy, when it comes to the late pregnancy, this uterine fibroid may not be found...

Zhou Yuan took out the CT results and said, "In the CT reality, the tumor has compressed the ureter, and it is still developing, and it will be dangerous if it is delayed any longer." "

The deputy director of gynecological oncology looked at it, hesitated, and said, "It's too difficult to simply remove uterine tumors..."

If uterine tumor resection is performed, it is likely that the endometrial layer is not clear at the time of resection, resulting in inability to separate along the tumor capsule and cause bleeding.

Even, in some parts, fibroids are adhesion with blood vessels and muscle layers, and it is more difficult to separate in this case!

In addition, it may cause damage to nearby organs.

Uterine fibroids have reached 20 centimeters, which are large tumors, which can cause changes in the position of the bladder, rectum, ureters, etc., such as ureteral compression shown in the CT report. During surgery, the corresponding organs may be damaged, and when the position of the ureter is not clear, it is easy to cause accidental injury.

"My advice is... C-section, removal of the uterus!" The deputy director of the gynecologic oncology department was silent for a long time, and finally made this decision.

On the other side, the oncology doctor also nodded.

Uterine fibroid surgery can be performed through the abdomen, yin, hysteroscopy, and laparoscopy.

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

Trans-Yin surgery is performed from the YIN area, including fibroid removal and transYIN hysterectomy, and is suitable for uterus with mild prolapse or flaccid uterus, especially for those with uterine prolapse.

Transhysteroscopic surgery is to place an endoscope in the uterine cavity through the vagina to remove fibroids protruding in the uterine cavity, which is suitable for uterine submucosal fibroids and some intermural fibroids. This type of surgery is very difficult and requires high surgical skills.

Finally, laparoscopic surgery, myomectomy, laparoscopic-assisted transhysterectomy and laparoscopic total hysterectomy can be performed, which is suitable for fibroids with small uterus or fibroids with small single fibroids.

The outstanding characteristics of this type of surgery are that the patient has less damage, less pain, and faster recovery, but laparoscopic surgery also requires high surgical skills of doctors.

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, resulting in the outflow of tumor cells and infecting the surrounding tissues and blood.

The only two options left are to remove the tumor, or to remove the uterus.

However, the difficulty of removing the tumor, coupled with the presence of a fetus in the uterus, is likely to compress the fetus.

To put it mildly... The tumour is only slightly smaller than the fetus, similar to the twins 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 option is to have a hysterectomy to remove the child and separate the uterus from the body along with the tumor growing on it.

He Lili was directly 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 twenty-one years old, I still have to have a baby..."

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

Removing the tumor alone can be done by both of them, but there is a fetus next to the tumor, and no one is sure that the fetus will not be accidentally injured.

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

Uterine fibroids combined with pregnancy, the incidence of this disease accounts for about 1 percent of fibroid patients, accounting for 0.3 percent of pregnancies.

Pregnant women with large uterine fibroids are even rarer.

Just as Zhou Yuan's brows were furrowed, a detail on the angiography made Zhou Yuan happy. _

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