Pheochromocytomas arise from chromaffin tissue in the adrenal medulla, sympathetic ganglia, or elsewhere.

In 2004, the World Health Organization defined pheochromocytoma as a catecholamine-producing pheochromocytoma originating from the adrenal medulla.

The basic pathophysiological changes of pheochromocytoma are endogenous catecholamine hypersecretion, which causes paroxysmal or persistent hypertension, and in severe cases, hypertensive crisis, shock, intracranial hemorrhage, heart failure, ventricular fibrillation, and myocardial infarction and death.

Hypertension is the main and characteristic manifestation of the disease, which can be intermittent or persistent.

Typical paroxysmal seizures are often characterized by a sudden increase in blood pressure, as well as a surge in adrenaline, the former can reach up to 200~300/130~180mmHg, accompanied by severe headache, sweating profusely, cardiac seasons, and tachycardia.

Too much adrenaline will lead to neurological disorders.

Looking at the patient's blood sugar, blood pressure and heart rate, all of which are caused by hyperactive suicide.

With an inference in his heart, Li Xiyang said quickly, "Blood examination, urine catecholamine and its metabolite determination, adrenal CT scan, magnetic resonance imaging, and B-ultrasound." ”

Qian Min nodded and quickly pushed the patient to do an examination.

Li Xiyang glanced at the family member, but the latter still didn't speak.

Li Xiyang didn't waste any effort here, and went straight out of the rescue room.

But after a few steps, the man followed, "Doctor, that... Let's talk! ”

Li Xiyang smiled slightly, is he finally going to say it?

But when the two came to the office, the first thing the man said was, "I have a fear of marriage!" ”

Li Xiyang was stunned, not too understanding the meaning of the latter.

And what does this have to do with a woman's illness?

The man hesitated for a moment and continued, "I talked to her for three years, and she always wanted to get married, but I was a little scared, and this matter was delayed. ”

Li Xiyang raised his eyebrows, "So that means you're not husband and wife yet?" ”

The man nodded, and sighed, "If she is still like this, I don't think I can continue with him." ”

Li Xiyang's eyes suddenly became a little disgusted when he looked at the man.

Phobia of marriage?

Through Li Xiyang's previous observation of men, this guy is eighty percent disheartened and wants to play for a few more years.

Now that I see that the woman is in a bad situation, I want to break up again?

Li Xiyang didn't want to continue talking to him anymore, "You should know her parents' phone number, notify them to come over!" ”

"Huh?"

The man's expression was visibly unwilling.

Li Xiyang said in a deep voice, "She is not mentally ill or psychological, she is sick, a very rare disease, and she is likely to have surgery later, and she has to sign an operation agreement, you are not married, and her parents must come and sign it." ”

The man thought for a while, then picked up the pen and paper on the table and wrote a phone number, handed it to Li Xiyang and said, "This is her mother's phone, you also said it, I'm not a family member, then I'll leave first!" ”

With that, the man turned and left.

Li Xiyang looked at the man's back, shook his head and sighed.

"This is the so-called scumbag!"

Then he picked up his phone and called the number on the note.

The other party was a sick mother, and as soon as she heard that the child was in the hospital, she immediately rushed over.

It's clear who is really true at a glance.

"Child, why are you so stupid!"

"If there's anything you can't think of, you can tell your mother, why do you want to kill yourself!"

"Your father is gone, if you are gone, how can I live alone!"

The mother came to the bed and wept bitterly.

At this time, the patient slowly opened his eyes, and Qian Min and the others immediately became vigilant.

for fear that women will seek death again.

But this time, her state seemed to be much better, looking at her mother in front of the hospital bed, the woman said sadly, "Mom, I don't want to, I can't control it!" ”

As soon as Qian Min heard this, was he guessed by Dr. Li again.

It's not a psychological problem, it's really sick?

At this time, the inspection report came.

Ultrasonography showed a slightly more echoic mass in the right upper quadrant, and the right adrenal pheochromocytoma was considered first;

CT showed that peritoneal tumor was 3x4cm, pheochromocytoma was considered;

ECG report: left ventricular hypertrophy with strain.

Urine catecholamines were tested for 10 times higher than normal.

That's right, it's a pheochromocytoma.

Suicide, irritability, and hurting others are all related to the instantaneous secretion of adrenaline.

"Dr. Li, what now? Do I need surgery? ”

Li Xiyang nodded, "The only radical cure for pheochromocytoma is to surgically remove the tumor. ”

But

The biggest difficulty in this surgery is anesthesia.

Because pheochromocytoma patients release high adrenaline at any time, the patient is likely to wake up during surgery, which makes the operation extremely difficult.

Moreover, the sudden increase in blood pressure during the operation is also the most fatal.

"Xiao Qian, call the best anesthesiologist in the hospital, this surgical anesthesiologist is very important!"

"The best anesthesiologist..."

Qian Min thought for a moment, "That must be Dong Hua." ”

Dr. Lee, I'm going to contact Dr. Dong right now.

Qian Min left, and Li Xiyang chatted alone with the patient's mother for a while.

Hearing that her child was suffering from illness, the mother blamed herself and felt distressed.

Complaining about why I didn't find out earlier.

It turned out that the woman's grandfather also had pheochromocytoma and died.

Li Xiyang nodded, this is right.

According to modern medicine, pheochromocytoma is associated with familial inheritance.

My mother was no stranger to pheochromocytoma and knew the dangers of the disease, so she prepared for the best and the worst.

The surgical protocol naturally went very smoothly.

However, Li Xiyang also comforted his mother that although pheochromocytoma is rare, it is not so terrible.

Many times people are frightened by the manifestations of this disease, but according to big data, pheochromocytomas are mostly benign tumors, and less than 10% are malignant.

Fortunately, the patient's cell tumor was benign.

Moreover, the position is on the peritoneum, so it is not difficult to cut.

The only caveat is that pheochromocytoma patients, because of the prolonged stimulation of a large amount of adrenaline.

After surgery, various psychological problems will occur, and the sequelae of these can be said to be very difficult to solve with current medicine.

In any case, it is imperative that the tumor is removed first.

In this way, the patient will no longer engage in suicidal behavior.

As for the psychological sequelae, I can only rely on the help of my family in the future.

……

In the operating room,

Li Xiyang met the anesthesiologist Dong that Qian Min said.

It's completely different from what I expected.,I thought the other party would be an experienced elder.,But I didn't expect it to be a young man about the same age as himself.。

Noticing Li Xiyang's suspicious gaze, Qian Min hurriedly said, "Doctor Li, Dong Hua is the vice president of our Imperial Capital Anesthesia Association!" ”

"Oh?"

Li Xiyang's eyes were surprised.

That's not a small story.

Dong Hua was very satisfied with Li Xiyang's surprise, he was a family of doctors, and his parents and grandfather were both anesthesiologists.

He was nurtured from an early age and showed a talent far beyond the average person.

So at a young age, he sat in the position of vice president of the Imperial Capital Anesthesia Association.

"In that case, I'm relieved!"

After being surprised, Li Xiyang was even more happy.

Because as he said earlier, anesthesia is the key to the success or failure of this operation.

Then Li Xiyang told Dong Hua about the general situation of the patient.

Dong Hua was also surprised after hearing this, pheochromocytoma?!

He had heard of this disease, which was quite rare.

And for their anesthesiologists, it's even trickier.

For the first time, Dong Hua seriously looked at the doctor in front of him who was about the same age as himself, and said, "Can you really do surgery for pheochromocytoma?" ”

Li Xiyang was happy, and this time it was his turn to be questioned.

Qian Min on the side poked Dong Hua and said angrily, "Our Doctor Li can do a double lung transplant, put away your little eyes." ”

Looking at the intimate movements of the two, Li Xiyang instantly understood.

The relationship between these two co-authors is not simple.

Dong Hua was shocked when he heard this, he could actually have a double lung transplant?

That's a top-notch surgery!

Suddenly he remembered that Renhe had a double lung transplant some time ago, and even his grandfather had mentioned it at home.

Could it be him?

Dong Hua immediately put away his contemptuous eyes.

He asked seriously, "Then Dr. Li, how do you want me to cooperate with you for a while?" ”

Li Xiyang said, "Before the operation, I have asked the patient to give 5mg of diazepam orally and 5mg of morphine intramuscularly!" ”

Dong Hua thought for a moment and said, "So you are planning to undergo laparoscopic pheochromocytoma resection under general anesthesia combined epidural anesthesia?" ”

Li Xiyang nodded, not bad.

"So I need you to give the patient T9-10 epidural puncture catheterization, as well as the left radial artery and right internal jugular vein puncture catheterization,

At the same time, the monitor continuously monitors ECG, SPO2, IBP, CVP, T, P, R, BIS, arterial pressure waveform, cardiac output and stroke volume variability.

In addition, 5ml of 2% lidocaine was injected epidurally before induction, and after 5 minutes of testing with a clear anesthetic plane, endotracheal intubation was induced with imidazolam, fentanyl, etomidate, and vecurodoride.

After intubation, 10ml of 0.5% Nelax was injected into the epidural space in fractions.

Most importantly, the depth of anesthesia was assessed according to blood pressure, heart rate, and BIS value during the operation, and the anesthesia was maintained with propofol, remifentanil, and intermittent inhaled sevoflurane.

Moderate expansion according to central venous pressure, blood pressure and SVV (maintained at about 13~15).

When the tumor was explored, the blood pressure rose suddenly, and the blood pressure was controlled by riqidine 27mg, esmolol 180mg, and peldipine 5mg, and the antihypertensive drugs were stopped 30 seconds before renal vein occlusion and the capacity was rapidly expanded.

After renal vein occlusion, blood pressure dropped suddenly, and epinephrine 30ug was injected intravenously in fractions, and norepinephrine 10ug/min micropump injection was used at the same time to maintain blood pressure stability.

The dose of norepinephrine is adjusted according to changes in blood pressure, and norepinephrine is discontinued until the abdomen is closed. ”

When Li Xiyang finished speaking, Qian Min and the little nurse on the side opened their mouths in surprise.

Such a complex anesthetic work, they are all heard for the first time.

That's an exaggeration, isn't it?

And this is not simply anesthesia, but also to cooperate with the operation of the main surgeon and the patient's vital signs during the operation.

"How? Can it be done? ”

Li Xiyang smiled at Dong Hua.

Dong Hua glanced at Li Xiyang and snorted coldly, "You don't care about anesthesia, since I'm here, there is no unfinished anesthesia, you still have to care more about how your tumor is removed!" ”

You dare to play laparoscopy in tumor surgery, I want to see if you are really that capable?

Everyone looked at each other, this operation has not started yet, how can the chief surgeon and the anesthesiologist get on the bar first!

Li Xiyang smiled and didn't care, turned his head to Qian Min and asked, "Operation time!" ”

Qian Min hurriedly said, "Fifteen forty o'clock!" ”

Li Xiyang nodded, "The operation begins!" ”

82 Chinese Net