Uterine fibroids cause severe anemia
MDT fulfills the patient's wishes
Recently, a patient with severe anemia caused by chronic blood loss caused by uterine fibroids was treated at the Obstetrics and Gynecology Hospital affiliated to Fudan University. Under the emergency diagnosis and treatment mechanism of epidemic prevention and control, the hospital meets the necessary medical needs of patients, and multidisciplinary team collaboration removes fibroids and preserves the uterus for patients, successfully saving patients' lives and fulfilling patients' wishes.
Suffered from uterine fibroids for 8 years
Irregular follow-up triggers severe anemia
Ms. Wu (pseudonym), 49, was found 4 centimeters of uterine fibroids during a physical examination 8 years ago. At that time, Ms. Wu did not have any physical discomfort and did not attract attention. Until 9 months ago, ms. Wu's menstrual duration began to become longer, and the menstrual volume gradually increased, reaching 2 times the previous one. In December 2021, Ms. Wu visited a hospital near her home, and the ultrasound examination found that the uterine fibroids had enlarged to 9 centimeters in diameter, and it was recommended to undergo total hysterectomy. However, Ms. Wu believes that "the uterus is an important organ for women, and the uterine fibroids are only benign tumors, and the uterus cannot be removed unless it is absolutely necessary!" ”
Until the end of March 2022, Ms. Wu began to experience a series of uncomfortable symptoms such as dizziness, fatigue, and palpitation, and the hemoglobin had dropped to 48 g/L, which seriously affected her normal life.
She went to the Obstetrics and Gynecology Hospital affiliated to Fudan University to find Professor Hua Keqin, hoping to help her realize her wish of "cutting fibroids and protecting the uterus". After examination, it was found that Ms. Wu's uterus was as old as if it were more than 4 months pregnant, with irregular morphology, in addition to the fibroids that had enlarged to 11 centimeters, it was also found that there was a nearly 2 cm mass in the cervical canal, and the nature of the mass could not be judged. Severe hemorrhagic anemia would endanger her life.
The patient's condition is very dangerous and requires surgery as soon as possible. Professor Hua Keqin immediately arranged for Ms. Wu to be admitted through the emergency green channel and contacted the multidisciplinary team to jointly formulate a diagnosis and treatment plan.
Multidisciplinary collaboration for timely diagnosis and treatment
Save lives without regrets
After admission, Ms. Wu's severe anemia was corrected after blood transfusion treatment, and there was a significant increase in hemoglobin. Surgery can be put on the agenda.
To help patients realize the desire to "cut fibroids and protect the uterus", it is first necessary to clarify the nature of cervical canal masses. During the period of urban closure, the hospital ensured that medical services were not interrupted and ensured that sufficient human resources were available 24 hours a day. Wang Qing, deputy director of the Department of Gynecology and chief physician of the Department of Cervicology, performed hysteroscopic surgery for the patient as a left-behind member of the Department of Cervicology. However, unexpectedly, when Director Wang Qing placed the hysteroscopic lens into the patient's uterine cavity, it was found that the long-term compression of the uterine cavity by fibroids had caused the surface of the uterine lining to be covered with angry blood vessels, and there had been obvious bleeding visible to the naked eye before further operation. The amount of bleeding is increasing, and the hemostasis effect of drugs is not ideal, what to do?
After consulting with Director Wang Qing, Professor Hua Keqin immediately decided to perform "uterine artery embolization" for the patient while performing "uterine artery embolization" for interventional hemostasis. After receiving the call, radiologist Wang Tianping immediately took action and made all preparations in the shortest possible time. At the same time, the transfer work, the blood transfusion work... It's all going on in an orderly manner. The path from the outpatient operating room to the radiology department became the road of life. About 10 minutes later, the patient arrived at the radiology department, Dr. Wang quickly penetrated the artery, placed the catheter, pushed the contrast agent, and pushed the hemostatic material into the uterine artery, and the bleeding stopped!
Through the images on the display screen, Dr. Wang carefully studied the distribution of blood vessels in the patient's fibroids and endometrium, and found that the blood supply to Ms. Wu's endometrium and fibroids was extremely rich. This means that the slightest carelessness in the operation can have unimaginable consequences. The difficulties of surgery do not stop there. The normal uterus is only about the size of an egg, but Ms. Wu's uterine fibroids are already 11 centimeters large, occupying almost the entire uterus. Fibroids compress the uterine cavity, and in such a situation, laparoscopic surgery requires very limited space for doctors to operate.
Ms. Wu's condition seems to be much more complicated than expected, so can she still keep the uterus?
In order to try his best to meet the wishes of patients, Professor Hua Keqin, Professor Lu Xin, Director of the Department of Gynecology, Director Zhou Xianrong, Director of the Department of Pathology, and Director Wang Qing, Deputy Director of the Department of Gynecology, discussed again, believing that after the intervention of the Radiology Department, the patient's bleeding situation has completely improved, and it is now an ideal time for surgery. However, the benign or malignant nature of cervical tube masses has not yet been determined! Is it possible to perform a rapid pathological examination of freezing after intraoperative removal of fibroids and cervical canal massing? After consulting with Professor Zhou Xianrong, Director of the Department of Pathology, he consulted. After receiving a positive reply, under the escort of Dr. Chen Yingjie of the Department of Anesthesiology, Professor Hua Keqin's team and the Department of Cervication performed "hysteroscopic examination + hysteroscopic cervical lucidectomy + 3D laparoscopic fibroid excision + 3D laparoscopic intestinal adhesion for Ms. Wu". Wang Qing, deputy director of the Department of Gynecology and chief physician of the Department of Cervicology, first performed hysteroscopic surgery for the patient and removed the cervical canal. After the results of the intraoperative frozen pathological examination revealed that it was benign tissue, Professor Hua Keqin, Director Zhang Xuyan, Dr. Zhou Shan and Dr. Yang Shimin successfully removed the fibroids for Ms. Wu through laparoscopic surgery. Not only did it lift this life-threatening "time bomb", but it also successfully preserved the womb and fulfilled Ms. Wu's wish. After the operation, the patient recovered well and was successfully discharged from the hospital a few days ago.
At present, the epidemic situation in Shanghai is still running at a high level. Under the premise of standardizing epidemic prevention, the two hospitals of the Affiliated Obstetrics and Gynecology Hospital of Fudan University have opened up green channels for critically ill patients to seek medical treatment and made every effort to protect women's life and health.
Author: Li Min
Editor: Li Miaoran