The most enlightened doctor

Tuesday was also a busy day for Yu Zhiming.

As soon as he arrived at Zhizhen Building of the hospital, Yu Zhiming performed a full body and heart check-up on a five-year-old girl introduced by Yao Hui, director of the community property committee.

It must be said that this little girl's heart malformation is the most serious that Yu Zhiming has examined so far.

Affected by cardiac malformations, the little girl’s cardiac ejection index was only 30%, far below the lower limit of normal of 55%.

Yu Zhiming also discovered that the little girl's lungs, kidneys and other organs had been damaged due to insufficient heart pumping function.

If this continues, even if effective auxiliary treatment is obtained, as long as the cardiac malformation is not cured, it will only last for more than a year at most.

In view of the seriousness of the little girl's heart malformation, Yu Zhiming was quite vague about the little girl's parents. Whether there is any chance of surgery can only be determined after careful research...

It took Yu Zhiming more than two hours to complete the perspective drawing of the little girl's heart. He then took photos of the drawing and sent it to Dr. Luo Yu of the People's Liberation Army General Hospital.

Then he went to the soundproof examination room next door.

On the experimental console in the center of the room, there is a one-to-one scale bust model of a pregnant woman in labor.

This is a bionic prop used to train medical staff to deliver babies and perform caesarean sections.

Nowadays, medical teaching mannequins are made to be quite lifelike and high-end, almost replicating the real ones, which to a large extent make up for the shortcomings of general teachers.

In the corner of the operating table, there is a cage with three trembling little white rabbits in it.

Yu Zhiming looked at Duan Yi and Zhou Mo who were standing aside, and ordered: "Let's get started."

After hearing the instructions, Duan Yi reached into the cage with one hand, grabbed the back of a rabbit, pulled it out, and pressed it on the experimental table.

At the same time, she grabbed the anesthetic needle with her other hand and stabbed it directly into the little white rabbit's shoulder.

The anesthetic is administered in one push.

Duan Yi's movements were smooth and flowing. You could tell at a glance that he had done similar things before.

But Zhou Mo's heart twitched when he saw it, and he couldn't help but said: "Doctor Duan, please be gentle, rabbits also know how to feel pain."

Duan Yi grinned and said: "We used to do experiments on rabbits. After the experiment was completed, the last step was to inject air injection into the rabbit and euthanize it."

Zhou Mo hummed, "These three are the most beautiful rabbits I carefully selected at the Experimental Animal Center."

"Doctor Yu has already said that after the experiment, I can take them home and raise them."

"Doctor Duan, don't hurt them."

Yu Zhiming added: "The premise is that my surgical trial goes well and they survive."

As he spoke, Yu Zhiming had already opened the soft-feeling silicone belly of the pregnant woman, then the uterus, and took out the fetal model curled up inside.

Then, he took the anesthetized and unconscious little rabbit from Duan Yi and stuffed it into his womb.

Then, Yu Zhiming adjusted the little rabbit's position so that its chest was facing up and not covered by the rabbit's legs.

In a true intrauterine interventional surgery, the fetus is in a correct and appropriate position, which is the prerequisite for the smooth start of the surgery.

Adjusting the fetal position is not too simple for Yu Zhiming.

After covering the uterus and closing the belly of the pregnant model, Yu Zhiming pressed his hands on the belly of the model to simulate the first part of the surgery and confirm the precise position of the fetus and fetal heart rate.

Then, Yu Zhiming stretched out his hand.

Duan Yi, who had been prepared long ago, placed a slender puncture needle seventeen centimeters long in his hand.

Duan Yi picked up the interventional guidewire and dilation balloon that would be used next, and looked at Yu Zhiming again.

At this time, Yu Zhiming was holding the puncture needle in his hand and had not made any next move, but the whole person gave Duan Yi the feeling that he was no longer as casual as before.

Duan Yi believes that Yu Zhiming at this time is like a warrior, building up his strength for the upcoming duel, which is awe-inspiring.

Duan Yi unconsciously breathed lightly and did not dare to blink, for fear of affecting Yu Zhiming's performance.

At the next moment, Yu Zhiming moved.

I saw him raising and lowering the needle, and the puncture needle disappeared into the model's belly.

Because there is no ultrasound imaging equipment, Duan Yi cannot see whether the puncture needle has penetrated into the exact location.

However, Yu Zhiming could feel very clearly that the puncture needle had pierced the belly and uterus of the pregnant woman.

Immediately afterwards, the puncture needle passed through the fetal intercostal space and the fetal right ventricular wall without any obstruction, and successfully reached and passed through the pulmonary valve stenosis.

At this point, the important puncture step is completed.

Yu Zhiming took the interventional guidewire from Duan Yi without any delay, as well as the expansion balloon with a diameter of only 3.5 mm, and sent it into the pulmonary artery through the central channel of the puncture needle.

When the center of the balloon was straddling the pulmonary valve, Yu Zhiming used the pressure valve to pressurize and expand the balloon. After rapid expansion twice, he quickly withdrew the balloon.

The next step is to withdraw the guide wire and puncture needle.

At this point, the intrauterine interventional surgery is completed.

From the beginning of the puncture needle to the withdrawal of the puncture needle, the entire interventional surgery process did not take more than eight seconds.

After completing the operation, Yu Zhiming stood in front of the experimental table without making any further movements. He closed his eyes slightly and began to review the previous operation process.

Zhou Mo on the side looked a little stunned.

She pulled Duan Yi a few steps away from Yu Zhiming, lowered her voice and asked, "Is the operation over?"

"So fast?"

Duan Yi also explained in a low voice: "The requirement for this operation is to be fast and to achieve a quick result."

"The fetus will not remain motionless in the belly of a pregnant woman, especially when it is stimulated."

"If the fetus suddenly becomes alarmed, the consequences will be disastrous."

"Also, this is an operation performed on the extremely delicate heart of the fetus. When the balloon is inflated, it also blocks the pulmonary artery. In order to avoid triggering an overreaction of the heart and minimize stimulation, it must be done quickly."

Zhou Mo said half-understood, then glanced at Yu Zhiming, who was thinking about something, and said: "The operation took just a few seconds. Doctor Yu seemed to have completed it quite easily."

Duan Yi cast a sidelong glance at this ignorant and fearless guy.

"Does it look easy?"

"Let me tell you, there are no more than five teams in the country that can perform this kind of intrauterine interventional surgery."

"I also tell you that even if a mature team in the world performs this intrauterine interventional surgery, various fetal complications will occur in 50% of cases."

"10-20% of them are intrauterine deaths..."

Duan Yi wanted to give some data, but saw Yu Zhiming open his eyes and ran over quickly.

"Dr. Yu, continue?"

Yu Zhiming shook his head and said: "No need, one test is enough. I have got the data I want."

"You don't have to let the little rabbit suffer anymore."

This statement made Zhou Mo smile happily. He pointed to the belly of the pregnant model and asked, "The one inside?"

Yu Zhiming replied: "It's okay."

As he spoke, he took out the rabbit from the model's belly and handed it to Zhou Mo.

"When the anesthesia wears off, it will still be a lively little white rabbit."

Zhou Mo held the motionless little rabbit in his arms and asked: "Doctor Yu, after this operation, will the fetus recover and be fine?"

Yu Zhiming smiled and said: "It's not that simple and easy. This is not a radical surgery."

"After this intrauterine dilation and intervention, we hope that the fetus will be able to compensate for the hypoplastic right ventricle caused by severe pulmonary artery stenosis in subsequent development."

After a pause, Yu Zhiming added: "If the corrective development of the heart is not in place, surgery to correct cardiac malformations will be required after the fetus is born."

Zhou Mo let out a light sigh and said, "I'm taking such a big risk to do this intrauterine surgery, but the result is still uncertain."

"Hey, what is the final effect of this operation?"

Yu Zhiming replied: "According to current statistics, the success rate of intervention is about 60%."

Zhou Mo was a little puzzled and asked: "With such a big risk and only half the success rate of intervention, why not just wait until the child is born and have the surgery to correct the heart malformation?"

Yu Zhiming rolled his eyelids and ignored this guy.

Duan Yi patiently explained: "Zhou Mo, if we don't do this intrauterine interventional surgery, a large number of fetuses will lose the chance of surgery after birth."

"Even if surgery is possible, the risk is extremely high and the cost of treatment is staggering."

Yu Zhiming spoke again: "Just like the little girl with a heart malformation in the morning, if it could be discovered in the fetus, intrauterine intervention could be actively carried out..."

"As long as there are some effects, the risk of correcting cardiac malformations will not be so high now, so no cardiac specialists dare to do the surgery."

Zhou Mo understood these words clearly.

"In other words, even fetal heart malformations can be intervened in utero?"

"And is it simpler and easier to perform surgical intervention in utero than to perform corrective surgery after birth?"

Yu Zhiming explained: "Not all, but most of the cardiac malformations can be treated with intrauterine intervention."

"The advantage of intrauterine intervention is that it can induce the fetal heart to correct through development."

Zhou Mo thought of something and said enthusiastically: "Doctor Yu, since you have completed this operation, does it mean that the fetus has a heart malformation and you can perform intrauterine intervention?"

"Just like cancer, you can deal with it in the early stage, and there are ways to deal with it in the late stage."

"For this heart malformation, you can cooperate with experts such as Luo Yu in the late stage, and you can also treat early-stage fetuses."

Yu Zhiming chuckled and sighed softly.

"In this so-called early stage, given that the risks of intrauterine intervention are also very high and the success rate of intervention cannot be guaranteed, I personally think that the best decision is to terminate the pregnancy."

These words made Zhou Mo hesitate and struggle for a moment, but finally he spoke and said, "Does the doctor become a little cold-blooded after working for a long time?"

"Dr. Yu, why do I feel that you are so lighthearted when it comes to your decision to terminate the pregnancy?"

"After six or seven months of development, a baby can respond to its mother in the womb and is already a baby with flesh and blood and emotions."

Yu Zhiming didn't want to talk to Zhou Mo anymore.

Duan Yi explained again: "In our country, a fetus is not a complete natural person until it is born."

After a pause, she continued: "Zhou Mo, have you ever seen someone give up treatment just because of a mere 20,000 to 30,000 yuan in medical expenses?"

"I've seen it, more than once."

"This intrauterine interventional surgery costs one to two hundred thousand yuan. Surgery to correct cardiac malformations after birth usually costs hundreds of thousands, or even millions."

"Zhou Mo, are there even 1% of families in our country who can afford so much money?"

"Even if the corrective surgery is successful, many children will have some deficiencies in their heart function, which will have a considerable impact on their future growth and development..."

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