Photo: Professor Yang Guangshun's team operates on children Source/ The Third Affiliated Hospital of the Naval Military Medical University
Xinmin Evening News (reporter Gao Yang correspondent Cao Xi) reporter learned from the Third Affiliated Hospital of the Naval Military Medical University (Shanghai Dongfang Hepatobiliary Surgery Hospital) that the hospital lasted more than 20 days and successfully treated two 5-month-old children with giant hepatoblastoma who were admitted to the intensive care unit through surgery.
One night in November, the ICU phone rang and Yan Kai, a fifth surgeon in liver surgery, requested a consultation. However, the patients asked the experts to take a breath of cold air - the newly admitted five-month-old child ruptured a huge hepatoblastoma of 80 mm x 90 mm in the abdominal cavity due to crying, requiring emergency indwelling central venous catheterization, and may need emergency surgery at any time.
The child's name is Chong Chong (pseudonym), from the mriori resonance point of view, the tumor that occupies three-quarters of the liver is tightly surrounded by the main large blood vessels in the liver, and surgical treatment is the only way to give Chong Chong a second life. Previously, Chong Chong's parents had taken their children to many hospitals, but they were told that there was no chance of surgery because the child was too young and the operation was too difficult. In the face of his beloved parents and the innocent lives of young children, Professor Yang Guangshun of the Third Affiliated Hospital of the Naval Military Medical University decided to admit him to our hospital with his courage and rich experience to try to prepare for the removal of tumors before surgery.
"If you want to successfully carry out surgery, in addition to the surgeon's excellent skills, you must also have complete anesthesia, critical care, and nursing protection." We also invited the team of Professor Zhou Lin of the Department of Pediatrics of the First Affiliated Hospital of the Naval Military Medical University (Shanghai Changhai Hospital) to assist in the formulation of a detailed plan. Yang Guangshun introduced. The already difficult treatment was exacerbated by the unexpected rupture of rushing hepatoblastoma , when the hemoglobin had dropped to half of its normal level and its vital signs were unstable.
The hospital revealed that unlike the adult central venous catheter, the child is not only thin and difficult to puncture, but also unable to cooperate with the catheter operation, which needs to be carried out under anesthesia. Sun Yuming, director of the anesthesiology department of the hospital, immediately coordinated the operating room and the anesthesiologist, and the head nurse of the operating room arranged for the nurse to cooperate, and the surgeon quickly prepared for emergency surgery at the same time.
The central vein puncture, which is not complicated in normal days, has become a race against the god of death in the rush. The rescue was carried out in a tense and orderly manner under the cooperation of three departments: anesthesiologist Tao Yong inserted a tracheal catheter thinner than a pencil in the child's airway, and general anesthesia was successfully completed; Associate Professor Zhang Jinmin successfully placed an internal jugular venous catheter on the neck of a child with only one finger width through ultrasound guidance, and the child's vital signs were stable. After careful observation, there is no need for emergency surgery for the time being, leaving valuable preoperative preparation time for the child... Inside and outside the operating room, the heart of the medical staff hanging for the baby is temporarily put down.
Children with life-saving access are immediately transferred to the ICU for continued treatment. Examination, blood transfusion, rehydration, observation, all work is carried out in an orderly manner. The child's vital signs were further stabilized, and emergency surgery was improved to limited-time surgery, avoiding the risks that may be posed by emergency surgery. In order to get better care of the child by his parents, after the condition was stabilized, the child was smoothly transferred back to the ward. The head nurse of the ward led the nursing team to take over the care of the child, and the surgery, anesthesia, and critical care began to make the next perioperative plan for the child.
On the third day after returning to the ward, the operation officially began. Director Sun Yuming sat in anesthesia, Dr. Qiu Haibo carefully operated, smooth and stable; Zhang Haibin, director of the five departments of hepatic surgery, calmly raised the scalpel under the leadership of professor Yang Guangshun. Because of the size of the tumor, each step requires hemostatic forceps to tossing and turning between several important blood vessels.
During the operation, it was found that the actual situation of the rush was more serious than the preoperative MRI showed - only a quarter of the liver was able to retain; of the three important liver veins, two had been swallowed by the tumor, and the remaining one was also severely stressed. Fortunately, under the leadership of Yang Guangshun, the medical team finally successfully removed the tumor that was almost 1/8 of the child's weight, and the operation was successful!
Pictured: Chong Chong was carefully cared for in the intensive care unit
The operation ended smoothly, the child was transferred to the ICU again, and the trauma and pain of the operation caused the rushing heart rhythm to reach 200 beats per minute at one point. Guardianship assessment, rehydration transfusion, sedation and analgesia, medical staff carefully cared for the small life, and the vital signs of Chong Chong finally gradually returned to normal. In response to the crying of the children, in addition to the use of sedative and analgesic drugs, Dr. Wei Kai had a clever move, let the family buy a pacifier, and use as little drug intervention as possible to achieve a better soothing effect. Later, Chong Chong cried less and had more urine, and everyone continued to work hard; they could defecate, they didn't have a fever, and everyone didn't dare to relax. After staying in the ICU for 4 days, Chong Chong was successfully transferred back to the nursing ward of the five departments of hepatic surgery; after 9 days, the indicators gradually returned to normal.
On the day of discharge, the baby had an innocent smile on his face, as if the previous ordeal was just a nightmare. The paramedics and mom and dad who could send him off knew how hard his recovery was.