Heilongjiang Economic Network News (Li Huahong Yang Jia'an) Recently, the first ward of the Obstetrics and Gynecology Department of the Second Hospital of Harbin Medical University admitted a special patient, 59-year-old Ms. Huang (pseudonym) is less than 1 meter 6 in height, but the weight has reached 164 pounds, the abdomen is defecated, when the physical examination is carried out for her, the doctors present are surprised, the belly is transparent, the abdominal wall veins are clearly visible, such as multiple fetal terms will soon burst the stomach, even Professor Li Peiling, director of the Department of Obstetrics and Gynecology of the Second Hospital of Harbin Medical University who has been practicing medicine for nearly 40 years, has directly called "never seen such a large belly patient." ”。
Prof. Peiling Li (1st from left) and Deputy Chief Physician Jiang Jing (2nd from right) perform surgery on patients
Women who avoid medical treatment for two years "raise" large lumps
59-year-old Ms. Huang from Shuangyashan City, according to her family, Ms. Huang is usually more anxious and willing to sulk, in the past two years, the family found that her stomach is getting bigger and bigger, every time she said to take her to the hospital for examination, she was rejected, Ms. Huang often said to her family, "You are less angry with me on the line", until the big belly pressure made her breathless, could not eat, and even lying flat became difficult to go to the local hospital for examination accompanied by her family. The ultrasound examination results showed that Ms. Huang's pelvic cavity had a diameter that could not accurately measure the huge mass, from the pelvic cavity to the abdominal cavity, and squeezed the surrounding organs, resulting in hepatobiliary pancreas, spleen and kidneys can not be developed. Due to the high risk of anesthesia and surgery, Ms. Huang's family took her to various hospitals and went to the first ward of the Department of Obstetrics and Gynecology of the Second Hospital of Harbin Medical University to find Professor Li Peiling for help.
Picture of the patient's abdomen before surgery
When Professor Li Peiling and Deputy Chief Physician Jiang Jing received the consultation, the patient had mobility problems and could not lie flat, and the results of the three-dimensional negative ultrasound examination made the doctors take a breath, "The pelvic cavity is a huge mixed mass, up to the sword process, the left and right sides to the mid-armpit line, down to the side of the uterus, the left ovarian mucus tumor is more likely, and the uterine fibroids and cysts in the right adnexal area were also found." If the operation is not performed in time, as the mass continues to increase and compress the surrounding important organs and cause the failure of the important organs of the whole body, even if it is surgery, the risk is very large, and it is very likely that there will be unresectable conditions during surgery, and even heavy bleeding will occur. Looking at the pleading eyes of the family members and the patients' hope for survival, Professor Li Peiling decided to give it a go.
Layer by layer, the total weight of the mass and sac fluid is about 70 pounds
Anesthesia is the first hurdle of surgery. According to Zhang Xueyong, deputy chief physician of the Department of Anesthesiology of the Second Hospital of Harbin Medical University, the compression of the mass makes the patient's diaphragm move up and have difficulty breathing, and at the same time, during the operation, the influence of the pressure drop in the abdominal cavity is very easy to cause a sudden drop in blood pressure, breathing, cardiac arrest and so on. In order to ensure the safety of the patient's life during surgery in the lying position, the anesthesiologist rehydrates the patient with an appropriate amount of fluids before the operation, gives vasoactive drugs, cardiotonic drugs, etc., and performs intravenous puncture catheters before the operation to prepare for unforeseen needs; at the same time, the patient's breathing is controlled by a combination of "small tidal volume + expansion lung + PEEP (end-expiratory positive pressure ventilation)".
Fluid drained from the cavity of the mass cyst
After opening the abdomen, the second difficulty was placed in front of the doctors, the diameter of the tumor in the patient's body has occupied almost all the space of the pelvic abdominal cavity, due to long-term compression, the sac wall and the peritoneal adhesion is serious, Professor Li Peiling decided to first slowly withdraw the fluid in the tumor cyst cavity, and then remove the tumor. After the cystic fluid was withdrawn, Professor Li Peiling and her assistant Jiang Jing carefully peeled off the peritoneum of the sac wall, free tissue blood vessels, and stopped the bleeding in time, quickly and accurately removing the mass. According to statistics, the total effluence of the tumor cystic cavity is nearly 33,000ml, equivalent to 66 pounds, the excised mass is about 4 pounds, and the intraoperative pathological return result is the mucinous cystic tumor of the left adnexal appendage, although the immunohistochemical test results have not yet been released, we expect Ms. Huang to harvest good news.
The whole surgical process lasted about 1 and a half hours, and the patient woke up smoothly after the operation, but the third difficulty immediately appeared. The patient had hypokalemia, hypocalcemia and hypotension, the doctor quickly corrected the ion disorder for his rehydration fluid, and gave vasopressor drugs, the patient gradually got out of danger, after 24 hours of intensive care, the condition was smoothly transferred to the general ward, Ms. Huang excitedly held the hand of Professor Li Peiling and Deputy Chief Physician Jiang Jing and said, "Thank you for giving me a second life."
Ovarian cystic adenoma is the most common benign tumor in the pelvic cavity of women, but there is still a possibility of potential malignancy, most common in the pelvic abdomen of a large cystic mass, can occur at all ages, there are no obvious self-conscious symptoms in the early stages, and there are symptoms of discomfort when the mass gradually grows and squeezes the surrounding organs. It can be divided into serous cystic adenoma and mucinous cystic adenoma, of which mucinous cystic adenoma is mostly single, multi-chambered and of different sizes, the sac wall is thin and uneven, and the cystic fluid is viscous. Professor Li Peiling reminded the general public that it is normal for middle-aged people to be blessed, but women should be wary of the sharp increase in abdominal circumference and abnormal bulge in the abdomen in the short term. Women of childbearing age are best able to carry out gynecological physical examination once a year, menopausal women should pay more attention to gynecological physical examination, many gynecological diseases can be found early, early diagnosis and treatment, early treatment in the harvest of better treatment effect.