Recently, there was a scene of supercombustion in the obstetric operating room of the Qunli Campus of the First Hospital of Harbin Medical University, and after a pregnant woman delivered a baby by cesarean section here, the baby began to examine before the umbilical cord was connected to the placenta, and after the examination and assessment, he was immediately carried to the operating table next to him to complete an operation. Multidisciplinary experts from the Department of Obstetrics, Neonatology, Department of Anesthesiology, Department of Blood Transfusion, Department of Ultrasound, and Operating Room of the First Hospital of Harbin Medical University jointly carried out difficult intrapartum delivery room surgery and successfully rescued fetuses with congenital umbilical hernia.
The woman was 5 months pregnant and found that the baby had "abnormalities" The small intestine "overflowed" the navel
When she was about 5 months pregnant, Ms. Wang found that there were some abnormalities in the baby during an examination. "Congenital omphalocele was found during the maternity examination of the Qunli Campus of the First Hospital of Harbin Medical University, and the family's heart mentioned the throat eye at that time." Ms. Wang's husband said that Ms. Wang's second half of pregnancy was even more worrisome.
The only thing that made Ms. Wang happy was that after other examinations, the baby did not have malformations of other organs such as the heart. Therefore, how to make the newborn baby operate more smoothly and safely has become a big stone in Ms. Wang's heart. After Ms. Wang came to the Qunli Campus of the First Hospital of Harbin Medical University, Huang Mingli, the director of obstetrics, formulated a plan for her intrapartum delivery room surgery and applied to the hospital for multidisciplinary team treatment. Work with multidisciplinary experts such as pediatric surgery, neonatology, anesthesiology, blood transfusion, ultrasound, and operating room to develop the rescue process of mother and child in advance.
In this way, with the joint efforts of everyone, Ms. Wang was in a state of anxiety and was close to her due date. "The fetus is 37 weeks + 2, and the mother has threatened labor and is ready for delivery." Director of Obstetrics Huang Mingli introduced. However, by full-term pregnancy, the fetal umbilical hernia gradually grows.
In order to protect the baby from transport infection, experts plan to operate on the child immediately after birth
"The so-called umbilical hernia is when the small intestine is turned out of the navel, and there will be a capsule on the outside of the small intestine." It is not uncommon for Director Huang Mingli, who has been practicing medicine for many years, to face this situation. However, many neonates with omphalocele often miss the best time to see a doctor. In addition, due to the newborn's crying, breastfeeding and excretion after birth, there is not enough space for the bulge to be stored back into the abdomen at one time, and a second operation is often required, which not only increases the difficulty of the operation and the pain of the newborn itself, but also leaves ugly scars that will accompany the newborn for a lifetime.
Director Huang Mingli introduced. "Many babies don't get treated the same day, and they usually take a few days or even a period of time apart." However, here's the problem. After the baby is delivered, it is easy to be contaminated with different degrees of bacteria in the process of transport, where the intestinal tube is exposed. "Of course, cleaning and disinfection are also carried out before surgery, but for newborns, postoperative infection is a challenge that must be challenged."
Without leaving the operating room, the child is not contaminated on the sterile operating table, so there is almost no risk of postoperative infection. Secondly, when the gastrointestinal tract of newborns enters less gas and there is no abdominal distention, it is very beneficial for surgical recovery.
Cattle! The surgery is performed at the same time As soon as the baby is born, the operation is performed next to the mother
"At that time, when the baby was born, the area of the exposed bowel of the baby's umbilocele reached 4-5cm in diameter." According to Huang Mingli, director of obstetrics. "We had studied and simulated many times before and decided to operate on the baby as soon as it was delivered."
Therefore, there was a very powerful scene in the operating room that day, where the mother had just given birth, and the baby was immediately moved to the bed next to it for "seamless connection" for surgery.
At 13 o'clock on March 6, obstetrics, neonatology, anesthesiology, blood transfusion, ultrasound, operating room team, and pediatric surgery staff were all in place, and all intraoperative equipment and neonatal incubators were also prepared in advance. Director Huang Mingli and Deputy Director Yuan Jing of the Department of Obstetrics led the obstetrics team to skillfully perform the operation.
"It's out!" At 14:20, a baby boy with more than 6 pounds was taken out of the mother's body. There was a very powerful scene in the operating room, without cutting the short umbilical cord to continue to maintain the placental circulation, obstetric surgeons used drugs to strongly suppress uterine contractions, maintain uterine cavity tension, and try to extend the time window to maintain placental circulation as much as possible, while strictly controlling bleeding. During this time window, the team of Yang Xiuhua, director of the ultrasound department, quickly scanned the abdomen and brain of the newborn under the condition of continuous umbilical cord, constantly made diagnoses, and gradually confirmed that the baby had no other major deformities. "Normal brain!" "The abdomen is normal!" Due to the wide umbilocele position of the newborn, and the possibility of other abnormalities of the intestinal tube, after comprehensive evaluation, Professor Yu Youyou, Department of Pediatrics of the Sixth Hospital of Harbin Medical University, decided to perform post-umbilical hernia repair surgery, and the obstetrician specially reserved a 20-degree umbilical cord for him for subsequent surgery. At this time, the head nurse of the on-call delivery room, the neonatologist and the head nurse of the neonatal department immediately worked together to treat the airway and skin wounds for the baby. The baby is immediately moved to the operating table next to it "seamlessly" for the operation. At 14:25, the team of Shi Jinghui, director of the anesthesiology department, began to perform surgical anesthesia for the baby who had just been cut off his umbilical cord.
At the same time, because the contractions had just been strongly suppressed, the placental circulation was preserved for a long time, the contractions were not good, and the uterine bleeding tendency, the obstetrician team on the cesarean section operating table quickly controlled the bleeding, carried out uterine contractions and compression sutures, and the mother quickly turned into a safe place.
At 14:30, Professor Yu Youyou, a pediatric surgeon, and Dr. Fan Wei began mystocele reduction. The bulge is a bulging capsule more than 4 cm in diameter, the base is about 2.5 cm wide, and the bulge is the intestine of the newborn. Then they designed surgical incisions, incisions in the abdominal wall, finding and removing abnormal parts, anastomosis, and intestinal tubes... Everything is in order.
At 16:10, the entire operation was completed. The baby is immediately taken to the neonatology ward.
The wound cannot be seen from the outside
Little "Six Six" is recovering well and is expected to be discharged next week
"After this incident, the baby's nickname will be called six six in the future, and everything will be six or six in the future." At present, the mother and child are safe, and the newborn is recovering well after surgery.
Because the intraoperative uterine bleeding was well controlled, the mother's condition was stable after the operation and she was transferred back to the general maternity ward. After the operation, Ms. Wang couldn't wait to see the child, and Professor Yu You explained the operation process to Ms. Wang. "Won't I need surgery anymore?" Does it look no different from other children? Receiving Professor Yu Youyou's affirmative reply, Ms. Wang was relieved and smiled on her face. Ms. Wang was successfully discharged from the hospital on the fourth day after surgery. The baby continues to be treated in the hospital.
"The baby is recovering very well now. From the outside, there is no wound, which will not affect the baby's future appearance, and the child's swimming will not be affected. In the neonatal department, Deputy Chief Physician Han Gang said that the baby's condition is recovering well and is expected to recover and be discharged from the hospital today.
Wang Liang, director of the comprehensive office of Qunli Campus, introduced that the Qunli Campus of the First Hospital of Harbin Medical University adheres to the development concept of "three highs and one refinement", gives full play to the multidisciplinary advantages of large general hospitals, realizes the coordinated operation of multiple "diseases", and provides higher level and higher quality medical and health services for the people of Longjiang.
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Umphalocele is the most common congenital abdominal wall developmental malformation, which is due to congenital abdominal wall hypoplasia, forming abdominal wall defects around the umbilical cord, resulting in abdominal visceral prolapse neonatal malformations, often combined with patent yolk duct, patent umbilical ureter, bladder exstrophy, intestinal malrotation and other malformations. The disease is a critical disease, most of which require surgical treatment, and most deaths are related to serious infections, or associated cardiopulmonary malformations and chromosomal abnormalities. (Wu Di, Zou Shuangshuang)