bookpower Chapter 378
Chapter 378
twin transfusion syndrome (TTTS),
This is a more serious complication of "single villi, double amniotic sac, monozygotic twins".
How is it a serious law?
In layman's terms, it is the maternal body - the main valve of the blood supply system, artery - the blood supply system branches to the two fetuses, arteries (in the umbilical cord) - two fetuses - the blood supply branch, vein (in the umbilical cord) - (confluence) the main valve of the blood supply system - the mother...
And now, something is wrong with the main valve ...
Originally, it was supposed to be two branches, each taking about 50%.
And now, the sister supplies 35%, the sister supplies 65% ...
In layman's terms: it is the sister who "snatched" the blood of the younger sister.
This situation is not beneficial to either the sister or the younger sister.
The younger sister develops anemia, decreased blood volume, resulting in insufficient renal perfusion, oligohydramnios, and even death due to malnutrition.
The older sister, on the other hand, has increased blood volume and can develop congestive heart failure, hydrops amnios, and polyhydramnios.
If left untreated, fetal mortality can be as high as 90%!
So what to do?
It's simple to say,
That is, through the fetal scope, guided by ultrasound, into the uterus, the laser burns the blood vessels connected between the two babies.
Directly turn the main valve into a branch!
This will prevent uneven distribution.
It's easy to explain, but it's hard to really operate.
Difficulty 1: Now the two babies are 22 weeks old, and the total weight is estimated to be less than 2 pounds, or a little more than 2 pounds, the size of a mouse. The smaller the target, the harder it is to operate.
Difficulty 2: This is not an operation on a pregnant woman, but through the pregnant woman entering the uterus, the operation on the baby is added another level.
Difficulty 3: The blood vessels at the main valve position are confluent and enriched, so the operation is difficult and it is easy to implicate other blood vessels.
The above difficulty,
It is decided that this operation is not something that ordinary people can do!
And the obstetrics and gynecology department happened to be short of manpower, so the director of the obstetrics and gynecology department found Lin Feng and wanted to see if Lin Feng could do it.
"How? Dr. Lin, is this operation sure? "
"This operation is no problem, I took it..."
Lin Feng readily agreed.
Director of the Department of Obstetrics and Gynecology: "Okay, Dr. Lin, because this operation was arranged by another doctor, the time is to wait until 11 o'clock, but there is something wrong at his home, so please come to the obstetrics and gynecology department at 10 o'clock to understand the situation, and start the operation at 11 o'clock..."
Lin Feng: "Good." "
Hang up the phone.
Lin Feng looked at the several emergency department doctors and nurses in front of him.
Shrugging,
"It seems that I am going to take a leave of absence this morning..."
The doctors were embarrassed ~~~
Cried ~~
I thought that Lin Feng would come back and relieve their pressure, but they were called away all of a sudden.
However, he was also shocked that Lin Feng could do fetal scopic surgery.
This is much more difficult than gastroscopy!
......
10:20 a.m. ...
Lin Feng came to the obstetrics and gynecology department, and then learned in detail about the situation of pregnant women and fetuses (various examination results).
Then I communicated with the pregnant woman and her family several times, and obtained the consent and signature of the family.
Then start taking antibiotics 30 minutes earlier to prevent postoperative uterine infections.
11 o'clock...
Pregnant women pushed into the operating room...
Strictly carry out sterilization, Lin Feng and others, strictly implement aseptic operations...
B-ultrasound machine, fetal scope, laser ready...
General anesthesia......
B ultrasound start, observation position...
Adjust the lying position of the pregnant woman and choose the appropriate angle.
Under ultrasound detection, determine the size and position of the fetus, understand the position of the placenta, the amount of amniotic fluid, and select the puncture point of the fetal scope...
Lin Feng's technique is still very powerful, and the direct one-time puncture is successful.
Flowing clouds and flowing water...
It's as if you've done it 10,000 times!
After successful puncture, Lin Feng inserted the puncture trocar needle into the amniotic cavity and exited the needle core, inserted the fetal scope through the cannula, and extracted 40ml of amniotic fluid for chromosomal karyotyping.
The 600um laser fiber is introduced into the amniotic cavity, and the semiconductor laser output power is conventionally set to 20W...
Choose a suitable position (1 cm from the vascular anastomosis (main valve))...
Started burning...
Soon, after the blood vessels were burned, they became "pale" under the display of B-ultrasound.
Block successfully!
Here, the operation was temporarily stopped.
Wait 10 minutes...
Lin Feng passed the B ultrasound and continued to observe the internal situation to see if there would be bleeding.
At last
Make sure there is no bleeding.
Lin Feng began to withdraw from the fetal mirror...
Then release the amniotic fluid of the blood-affected fetus (sister) ...
Why do this?
Because my sister has too much amniotic fluid, it is not conducive to growth.
When Lin Feng released almost 1500ml, stop.
Here we are,
The operation is over!
Lin Feng continued to observe for 10 minutes.
The patient's vital signs were stable during the operation, the twin babies were in good condition in utero, the puncture point did not touch the placenta, and there was no amniotic fluid overflow and bleeding...
At this point, the operation is officially over.
Lin Feng pulled out the puncture needle...
Suture puncture holes...
Wait for the pregnant woman to wake up.
Surgery time: 1 hour 04 minutes...
When Lin Feng pushed the pregnant woman out of the operating room, the family surrounded her worriedly.
......
I got this surgery.
In the evening, the obstetrics and gynecology department invited Lin Feng to a meal, and many young nurses ran away.
......
At the same time,
nighttime
Mizuki University basketball court.
A lively little game is underway.
"Pass..."
"Quick, quick..."
"Defend, cover him!"
"Be careful Zhang Chen..."
On the field, the game is very intense, and experienced players are fighting at a rapid pace.
On the sidelines, many onlookers were waving flags and shouting.
suddenly
"Ah~~~~"
Player Zhang Chen suddenly felt a burst of dizziness, weakness, and back pain, and the shooting action that was originally prepared suddenly froze, fell directly to the ground, and then was accidentally stepped on by his teammates.
"Zhang Chen!"
"Are you all right?"
"I fuck!"
The scene was chaotic.
The game stopped.
"It's okay, you guys go on, I'll take a break..."
Zhang Chen limped to the side of the court and sat down to rest.
His lower back began to ache again.
Since three months ago, he had this old problem, suddenly dizziness, and then sometimes low back pain. He used to play basketball very well, but now he has become commonplace.
"What's wrong? It hurts again? The girlfriend walked over quickly and asked with concern.
"Yes... I don't know what's going on..." Zhang Chen frowned.
"It's better to go to the hospital and check it, in case there is a problem, it will be troublesome." The girlfriend said.
"Hmm..." As a student of Mizuki University, I have a great future, and I naturally cherish my body.
"If you don't have classes on Saturday the day after tomorrow, I'll accompany you to the hospital for a check-up..." said my girlfriend.
"Good."
......