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 Yan and Hou Quanhai made rounds together.

The first person to check was Wang Xinhua, an old man in his 80s, because he had done liver and gallbladder puncture and catheter drainage for the other party the night before, and now I have 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, and it seems that abdominal drainage can be done in the afternoon!" After Jiang Yan checked it, he found that this old man's state was okay. 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 inspection, Nurse Xiaojing hurriedly walked over.

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

"What's the situation?" Jiang Yan asked as he walked, "By the way, Hou Quanhai, you also come along." ”

"Hmm." Hou Quanhai nodded.

"A pregnant woman who is 9 months pregnant has acute cholecystitis, and I heard that the condition is more serious." Nurse Xiao Jing said.

"Nine months?" Hearing this, Jiang Yan frowned.

Hou Quanhai 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 Director Li Guiying of the gynecology department 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 Yan 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 hydropreservation. ”

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 transfer to the hospital for surgery! Director Li explained.

"So this surgery must be done?" Hou Quanhai 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? Director Li said.

"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 Yan 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!

Hou Quanhai also has a director-level cholecystitis resection, so he also knows that if this operation is done for a 9-month-old pregnant woman, it is indeed very risky.

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

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

"Okay."

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

"In other words, if a pregnant woman who is 9 months pregnant has a cholecystectomy, the chance of uterine contractions is more than 40%?" Hou Quanhai said solemnly. 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%？ The risk is relatively large. Jiang Yan also said with a solemn face.

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

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

"Yes, but let's think about how to reduce the contractions during the operation, I don't know what you can do, Deputy Director Jiang?" Director Li hit the nail on the head.

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. Ideally, the shorter the operation time, the lower the chance of causing contractions! Jiang Yan 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 should be a big problem. Jiang Yan 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!