After a day off, I went to work as usual the next day.

The first thing I do when I come to the hospital is, of course, to make rounds.

During the ward rounds, Jiang Yurong and Ruan Bin made rounds together.

The first person to check was Wang Deming, an old man in his 80s, because he had done liver and gallbladder puncture and catheter drainage for the other party the night before yesterday, and now he has to observe how the situation is. If stable, preparations can be made for percutaneous puncture drainage of abdominal pus. Even the last cholecystectomy was done.

"The situation has stabilized, it seems that abdominal drainage can be done in the afternoon!" After Jiang Yurong checked it, she found that this old man was in a good state. It proved that the liver and gallbladder puncture catheter drainage operation the night before was very appropriate, and it has greatly alleviated the other party's condition.

Just after the ward check, Nurse Xiaoli hurriedly walked over.

"Deputy Director Jiang, just now the gynecology department sent an emergency pregnant woman, and the gynecology director over there is waiting for you in the consultation room to discuss how to treat this pregnant woman!" Nurse Xiaoli hurriedly said. Today, since it is Sunday, Director Qian is resting, and Deputy Director Liu is currently undergoing surgery. So I can only call Deputy Director Jiang over.

"What's the situation?" Jiang Yurong asked as she walked, "By the way, Ruan Bin, you also come along." ”

"Hmm. Ruan Bin nodded.

"A pregnant woman who was 9 months pregnant had acute cholecystitis and heard that her condition was more serious. Nurse Xiaoli said.

"Nine months?" Hearing this, Jiang Yurong's brows furrowed.

Ruan Bin frowned when he heard this, generally speaking, there is a relatively large risk for pregnant women to have surgery, no matter what kind of surgery it is.

In particular, this pregnant woman is 9 months pregnant, and she is about to give birth. At this time, I had acute cholecystitis, and to be honest, the situation was not optimistic.

When the two came to the consultation room, they saw that Director Du Xiujuan of the gynecology department had been waiting for a long time again.

After a polite exchange between the two parties, they began to discuss the condition of the pregnant woman.

Jiang Yurong took a series of examination reports and looked at them, and said with a slight frown: "9-month-old woman, acute cholecystitis, accompanied by stones, gallbladder accumulation and hydrostagnancy. ”

Thankfully, there was no gallbladder perforation!

It's a blessing in misfortune.

"This pregnant woman was transferred from a lower level hospital, where she had tried conservative medication, but the results were not good. So I had to be transferred to the hospital for surgery!" explained Director Du.

"So this operation must be done?" Ruan Bin couldn't help but say. Truth be told, it's a lot of risk!

"Well, she's in a very unstable condition at the moment, and I'm worried that if she doesn't have another operation, the consequences will be serious. Since the cholecystectomy is done by your general surgery, I immediately sent this pregnant woman to our hospital. I just want to know now, how sure are you?" said Director Du.

"If it is an ordinary person, there is naturally no problem with surgery in this situation. But she was 9 months pregnant, and the anesthesia for the operation was there, and the length of the operation. It may cause contractions, processes, and even death in the pregnant woman. I can't say how sure I am. Jiang Yurong told the truth. After all, she is not a god, and there is an unknown existence in this operation, and she really can't guarantee it.

She had also performed cholecystitis resection for pregnant women in the hospital in the United States, but only for 6 or 7 months old women and 4 or 5 months old women. She really hasn't done anything like this 9-month-old pregnant woman. If this surgery is done for a six- or seven-month-old pregnant woman, she has a 90% success rate!

Ruan Bin also has a director-level cholecystitis resection, so he also knows that if this surgery is done for a 9-month-old woman, it is indeed very risky.

Even the surgeons in many hospitals are reluctant to take this risk!

"Director Du, can you tell us about the detailed risks of surgery for 9-month-old women? I think we have to fully understand it before we make a plan. Ruan Bin said.

"Okay. ”

"The miscarriage rate of cholecystitis surgery is 12% in early pregnancy, 5% and 0% in the second and third trimesters, and 0% in the second and third trimesters, and the chance of contractions in the second trimester is 0%! The chance of cholecystectomy in the third trimester rises to 40%! Therefore, the best time to remove cholecystectomy is in the second trimester! The chance of miscarriage and contractions in the second trimester is the lowest. Director Du explained. She is the director of the gynecology department, and of course she knows more about this miscarriage and contractions of pregnant women than Ruan Bin.

"In other words, if a pregnant woman who is 9 months pregnant has a cholecystectomy, the chance of uterine contractions is more than 40%?" said Ruan Bin. After all, when you are 9 months pregnant, there will be no more miscarriages, and some will only be born prematurely.

But the 40% chance of contractions is really fatal.

At that time, once the contractions occur during the operation, it will lead to premature birth or fetal death or even maternal death.

So the risk is not ordinarily large.

"40%? is a lot of risk. Jiang Yurong also said with a solemn face.

"But there is no way at the moment, conservative medical treatment does not work, only surgery. Director Du sighed and said.

"It seems that only surgery can be done, and my recommendation is to do laparoscopic cholecystectomy, which is less invasive and takes quickly. Jiang Yurong said.

"Yes, but we still think about how to reduce the contractions during the operation, I don't know what you can do, Deputy Director Jiang?" said Director Du to the point.

That's the most important thing.

"Continuous epidural anesthesia, according to statistics, laparoscopic removal of the gallbladder during pregnancy is a safe and effective treatment, but requires high surgical skill. Preferably, the shorter the operation time, the lower the chance of causing contractions!" Jiang Yurong said confidently.

"I used to do 28 early-to-mid-to-mid cholecystitis resections at Hopkins Hospital, all using laparoscopy, and I was usually able to do it in 30 minutes. The chance of contractions can be reduced to about 20%. However, now this patient is in the third trimester of pregnancy, or 9 months old, and it is also the most dangerous period to choose surgery. I don't know if I can reduce it. Unless, unless the surgery can be done in 20 minutes, if it can be done in 20 minutes, then I don't think it's a big problem. Jiang Yurong said.

However, she felt that it was a bit too difficult to complete a cholecystitis resection in 20 minutes. Generally, the operation time of laparoscopic cholecystectomy is half an hour to one and a half hours.

It depends on the severity of the patient's condition and, of course, the level of the surgeon.

Pregnant women like this are the more difficult types to do, and she can complete it in about 30 minutes at the earliest, not to mention the level. But to do this surgery for this 9-month-old pregnant woman for 20 minutes, she thought it would be almost impossible to do!