The "safety line" of epidemic prevention and control, the "lifeline" of diagnosis and treatment. Since the outbreak of the epidemic in this city, the Obstetrics and Gynecology Hospital affiliated to Fudan University has adhered to the "two lines and tracks", taken many measures to adhere to the normal treatment of the whole hospital, and ensured the medical needs of female patients in layers to ensure the safety and health of women. In order to ensure the medical needs of the public during the epidemic, the hospital has never stopped carrying out critical care, chemotherapy, limited-term and emergency surgery, and gynecological elective surgery has also resumed.
Patients with malignant tumors who cannot afford to wait
Multidisciplinary collaboration and illness "grab" time
On April 19, when the epidemic prevention and control situation in Shanghai was grim, Zhu Zhiling, director and chief physician of the Department of Integrative Medicine of the Obstetrics and Gynecology Hospital affiliated to Fudan University, received news that a patient with "black spot polyposis syndrome" combined with cervical adenocarcinoma was on his way from other places to the emergency department of Red House Hospital.
"Dark spot polyp syndrome" is a genetic tumor syndrome caused by genetic variations, with an incidence of about 0.36-4/100,000, which is very rare. In addition to the manifestations of skin and mucosal pigmentation, gastrointestinal multiple hamartomatous polyps, and complications such as abdominal pain, obstruction, and bleeding caused by polyps, the risk of specific cancers is greatly increased. The "cervical adenocarcinoma" suffered by the patient Xiaoning (pseudonym) is one of the types of cervical cancer, and the prognosis is poor.
It is understood that Xiaoning has a history of 2 intussusception surgeries. Since being diagnosed with "dark spot polyps syndrome", she has undergone an average of gastrointestinal endoscopy every six months, and she has lost count of how many large and small polyps she has removed, just like leeks, cutting stubble after stubble. It wasn't until February this year that Xiaoning began to experience stinging pain in the lower abdomen, and it became more and more severe, so much so that she had to be relieved by daily oral painkillers. In March, the local hospital underwent a series of examinations and cervical biopsies and was considered "cervical cancer". Doctors recommend that patients go to large hospitals to find a big specialist to determine the treatment plan.
"Go to Shanghai! Go to the best obstetrics and gynecology hospital - Fudan University Affiliated Obstetrics and Gynecology Hospital! Xiao Ning's father made up his mind. But at this moment, the epidemic situation in Shanghai is at its most critical moment, how to go? Did you go to the hospital to collect it? Cure or not? "The treatment of tumor patients cannot wait!" With the help of the local hospital and the local health commission, the Shanghai Municipal Health Commission learned of Xiao Ning's condition and issued a pass to "rescue the emergency".
On April 19, a local 120 ambulance escorted Xiaoning and her father all the way to the emergency department of the Yangpu Branch of Red House Hospital. Rushing to 100 kilometers, when 120 drove into the Red House Hospital, Xiao Ning and his father's hearts settled. According to the requirements of epidemic prevention and control, the emergency medical team immediately improved a series of examinations for patients, accelerated the "green channel", admitted to the hospital, and then a series of diagnosis and treatment work was carried out in an orderly manner.
To clarify the diagnosis and treatment plan, there must be a clear diagnosis. For oncology patients, pathological diagnosis is the "gold standard". The pathology department of the hospital consulted the pathological slice again, and it was clearly defined as "cervical gastric adenocarcinoma". This is a less common subtype of cervical adenocarcinoma, uncorrelated with HPV infection, highly invasive, and less sensitive to adjuvant therapy. Based on the results of medical history, gynecological examination and imaging examination, Director Zhu Zhiling diagnosed Xiaoning as "gastric adenocarcinoma stage IIA2", that is to say, the patient's condition has developed to a local advanced stage, and if it is not treated in time, it will face disease progress at any time, affecting survival.
Rare diseases combined with dangerous cervical cancer, Xiaoning's treatment process is full of unknowns and dangers, especially her tumor lesions involve a wide range, and there have been two abdominal surgery history, pelvic tissue adhesions are serious, anatomical relationship is unclear, which is a huge challenge for surgeons. "Surgical or conservative treatment?" The hospital gathered the advantages of each department, and the Gynecology Department immediately convened experts from gynecology, pathology, imaging, cervical and other departments to conduct online MDT multidisciplinary consultations for the specific situation of Xiaoning to discuss and formulate the best diagnosis and treatment plan. On April 22, Zhu Zhiling, director of the Department of Integrative Traditional Chinese and Western Medicine, with the assistance of general surgery experts of Huashan Hospital, jointly performed surgery for Xiaoning, which lasted nearly 6 hours and was successfully completed. At present, Xiaoning is recovering well after surgery, and the attending physician formulates a follow-up adjuvant treatment plan according to the pathology.
It is understood that since the beginning of April, the Obstetrics and Gynecology Hospital affiliated to Fudan University has treated more than 50 cases of malignant tumor patients and operated on them, including cervical cancer, ovarian cancer, fallopian tube cancer, etc. Every gynecological malignant tumor patient who cannot afford to wait has received timely and effective treatment here.
Chemotherapy patients who can't be delayed
"Escalation management" guarantees safe treatment during special periods
Since the implementation of global static management in Shanghai, for patients who are receiving anti-tumor treatment, chemotherapy in special periods has become a big problem.
Chemotherapy for malignant tumors is a cyclical, coherent treatment. In order to ensure the medical needs of cancer chemotherapy patients, to ensure that all patients should be diagnosed and treated, since the beginning of the epidemic, the gynecological diagnosis and treatment groups have regularly screened all patients who intend to be hospitalized for chemotherapy. "Put safety issues ahead of patients." According to Lu Xin, director of the gynecological department of the hospital, the hospital's information on chemotherapy patients is very specific, including how many patients are receiving chemotherapy, or will receive chemotherapy, and what is the chemotherapy cycle? Are you an out-of-town patient? Can I come to the hospital for chemotherapy? Do I need inpatient chemotherapy or chemotherapy in a day ward? Have not been banned and so on.
Ms. Zhao (pseudonym) is a cervical cancer patient in the Yangtze River Delta region. In 2021, she came to The Red House Hospital for surgery, and then came to the chemotherapy regularly according to the prescribed plan. In early April, the time for the next chemotherapy was approaching, but the epidemic in Shanghai was in a state of anxiety. Just when she was anxious and helpless, she received a call from the chemotherapy ward. It turned out that the hospital found many foreign patients like Ms. Zhao after investigation. During the special period, what should I do if I follow up with chemotherapy patients from other places and chemotherapy? The hospital recommends that patients first choose a professional regular hospital near the local area to receive chemotherapy on time. As for the chemotherapy plan, the hospital also gathers the strength of chemotherapy specialists to connect with the local hospital receiving doctors by phone, and ensures that the patients continue to treat according to the optimal treatment plan as much as possible under the premise of fully understanding that the patient has no contraindications to chemotherapy.
Lu Xin, director of the gynecological department of the hospital, told us that patients who receive intravenous chemotherapy drugs generally need to be hospitalized for 1-5 days, and some patients even need longer. In the context of epidemic prevention and control, the epidemic risk caused by stranded hospitals is not only a concern for patients, but also an important agenda for hospital management.
In the special period, in order to avoid cross-infection in the hospital, the hospital has specially opened a buffer chemotherapy ward and an isolation chemotherapy ward on the basis of retaining the previous daytime chemotherapy ward and inpatient chemotherapy ward. In accordance with the requirements of epidemic prevention and control, bed allocation is carried out in accordance with the priority of the patient's condition. For hospitalized chemotherapy patients with complex conditions and high risk factors, a one-to-one responsibility system is implemented. During the epidemic period, the static management mode of ward partitioning has established a safe and smooth green channel for patient chemotherapy.
In addition, in order to enable chemotherapy patients to receive treatment in an orderly manner during the epidemic, the hospital has also set up an "online special line" to facilitate chemotherapy patient consultation. Online hotlines are available 24 hours a day, 7 days a week. For patients who have been assessed as not suitable for postponement, they will be admitted to the hospital in time to ensure effective treatment; for patients who can appropriately postpone chemotherapy or are undergoing oral drug treatment, they will be guided to do a good job of self-health management during the stay at home; dynamic adjustment and feedback according to the actual situation of patients to minimize the frequency of their visits to the hospital. In the past month or so, the "online special line" has received more than 200 patients and solved their urgent needs.
It is understood that since the outbreak of the epidemic, the hospital's malignant tumor chemotherapy outpatient clinic and ward chemotherapy treatment work has never stopped. Since April 1, the hospital has treated nearly 400 chemotherapy patients. Static partition management, active doctor-patient communication, smooth chemotherapy process... In the special period, it is not easy to do this, but it is precisely because of this that every chemotherapy patient who cannot be delayed has been treated safely and safely here.
Resuming elective surgery
Effectively solve the needs of patients for medical treatment
During the epidemic prevention and control period, the medical treatment of pregnant women, tumor patients and emergency patients in Red House Hospital has never stopped. Recently, with the initial results of urban epidemic prevention and control, in order to effectively meet the needs of patients for medical treatment, the hospital has now resumed elective surgery.
On April 28, Aunt Liu (pseudonym), 52, underwent laparoscopic total hysterectomy at the Yangpu branch of the hospital. "After waiting for almost a month, the stone in my heart has finally fallen."
At the beginning of February this year, Aunt Liu was treated in the outer courtyard for "irregular vaginal bleeding after menopause" and found that the endometrium was abnormal. In order to seek further diagnosis and treatment, in mid-March, Aunt Liu came to the outpatient clinic of Luo Xuezhen, chief physician of the endometrial lesion team of The Red House Hospital. After a series of examinations, the doctor found that Aunt Liu's symptoms were due to "atypical hyperplasia of the endometrium", which is what we often call the precancerous lesions of endometrial cancer. In addition, Aunt Liu was also diagnosed with a high-risk type of HPV positive with high-grade squamous intraepithelial lesions of the cervix. On the same day, Aunt Liu underwent cervical LEEP. Fortunately, the postoperative pathological results showed that "no lesions were involved in the incision margin", and Aunt Liu went home at ease and waited for the operation to schedule the treatment of her own endometrial lesions.
I don't want the epidemic to come, surgery like Aunt Liu had to be temporarily postponed according to the prevention and control needs of the epidemic at that time, giving priority to ensuring the diagnosis and treatment of critically ill patients. Recently, with the gradual stabilization of the epidemic trend, the hospital has effectively solved the medical needs of patients under the premise of strictly implementing various measures for epidemic prevention and control, and is gradually resuming elective surgery to open up medical channels for patients. According to Hua Keqin, secretary of the party committee of the hospital, the diagnosis and treatment teams of the gynecological department of the hospital are evaluating and scheduling patients who have been waiting for inpatient surgery before the epidemic and have scheduled surgery one by one. "Many patients, even if they have benign tumors, can't wait too long."
It is understood that during the epidemic period, the hospital's general outpatient clinics, emergency departments, and Internet hospitals have always been open, and expert outpatient clinics have recently resumed. At present, the epidemic prevention vigilance has not been relaxed, the hospital in the premise of epidemic prevention and control, in order to effectively solve the needs of the masses for medical treatment, various diagnosis and treatment services are gradually and comprehensively restored, during the May Day period, the hospital outpatient emergency and Internet hospitals will continue to open, to ensure the orderly development of medical services.
Author: Li Min
Editor: Li Miaoran