Under the epidemic
Cervical cancer mother gives birth
"At the moment when Omikejong is raging and Shanghai is under control, I can give birth smoothly and gradually recover, and my physical condition has improved significantly, and I am really grateful to the Red House Hospital." In a recent thank-you letter from the Obstetrics and Gynecology Hospital affiliated to Fudan University, Jiani (pseudonym), who described herself as "impatient to write down her heartfelt words", wrote so. Just three days ago, through the cooperation of multiple departments and teams, Jiani, a pregnant and cervical cancer patient, successfully gave birth to a healthy baby girl and successfully underwent radical surgery for cervical cancer.
01
Transient bleeding in the first trimester is a precursor to cervical cancer
The 41-year-old Jiani finally became pregnant with her second child after going through twists and turns. I thought that life would be sunny from then on, but when I built a card in the outer courtyard, I found hpV high-risk types 16 and 52 positive, and high-grade squamous intraepithelial lesions of the cervix, that is, the possibility of malignant tumors could not be ruled out, and the whole family was suddenly shrouded in dark clouds. But all this is not without warning, recalling a transient hemorrhage in the first trimester, Jiani did not dare to be careless this time, and came to the outpatient clinic of Director Wang Qing of the Cervical Department of the Red House Obstetrics and Gynecology Hospital. Director Wang suggested that she first conduct pathological consultation to define the benign and malignant nature of the lesion. However, Professor Zhou Xianrong, a gynecological pathologist, believed that the situation was not optimistic after consultation, and under his suggestion, Director Wang Qing performed another colposcopy for Jiani. This time, luck did not fall from the sky, and the pathology clearly showed that Jiani had cervical focal invasive squamous cell carcinoma, and there were lesions in the vaginal wall. For the Jani family, the blow was like a collapse.
In order to determine the follow-up treatment plan, LEEP cone should be done as soon as possible to determine the tumor stage, but for pregnant women, the cervix is in a state of congestion, which not only increases the difficulty of surgery, but also causes a series of adverse consequences such as bleeding and even miscarriage. Director Wang Qing, who has rich experience, successfully performed LEEP knife cone surgery for Jiani, and the postoperative pathology once again suggested that cervical squamous cell carcinoma, infiltration is less than 1mm, incision margin is affected by carcinoma in situ, vaginal vault squamous cell carcinoma in situ.
The contradiction is once again in front of us: the margin is positive, the period can not be clear, should it be chemotherapy or follow-up to the treatment after childbirth? Despite the threat of cancer, the stubbornness of motherhood still makes Jiani hope to find the best treatment solution in the almost desperate situation, and her desire to protect the fetus is very strong.
02
The advantage team has multidisciplinary consultation, and there is still a dawn in the misfortune
This time, Jiani pinned her hopes on Professor Hua Keqin, the leading expert of the hospital's cervical cancer and precancerous disease integration team. As a well-known expert in the field of gynecological oncology, the team led by Professor Hua Keqin has extremely rich experience in the treatment of gestational cervical cancer, as early as 2013, it completed the world's first case of minimally invasive technology to preserve the fetus and preserve the radical cervical surgery during pregnancy, and has established a complete set of gestational cervical cancer diagnosis and treatment procedures, and has accumulated rich experience in the treatment of various stages. Professor Hua has been committed to the care of cervical cancer patients and achieves the good wishes of motherhood for patients with a more humane goal.
After a detailed assessment of Jiani's specific situation, Professor Hua Keqin contacted obstetrics, cervical, pathology, chemotherapy and radiation-related experts, conducted a multidisciplinary consultation (MDT), and decided to undergo cervical LEEP cone surgery again to clarify the phase and decide on the follow-up treatment plan.
Two consecutive LEEP surgeries are a greater risk for the average woman, let alone pregnant women who are pregnant. With excellent technology, Director Wang Qing successfully completed the operation again. This time, Jiani's luck was not disconnected. Postoperative pathology confirmed a negative cone incision margin and was diagnosed with cervical squamous cell carcinoma stage IA1, that is, she could be followed up until delivery under close monitoring.
03
Integrated treatment process, improve the plan to ensure prognosis
In the Red House Hospital, the diagnosis and treatment of pregnancy and cervical cancer has formed a complete set of integrated treatment procedures and a multidisciplinary diagnosis and treatment team that integrates gynecology, cervicology, obstetrics, neonatology, pathology, anesthesiology and so on. When such pregnant women come to the clinic, the cervical department first improves the examination and makes a preliminary diagnosis, on this basis, the gynecological team will make an assessment of the patient's specific situation, and then choose specific options such as chemotherapy, surgery or follow-up during pregnancy, while obstetric intervention is closely monitored. Between the possibility of preterm birth in such pregnant women, the obstetrics department specially arranged for the preterm birth group to connect with the team. If the situation is stable at follow-up, the obstetric department prepares for delivery at 34 weeks' gestation, including advance treatment for fetal lung maturation, consultation with specialists from the gynaecological team, and neonatology to assess fetal prognosis.
During Jiani's follow-up visit, Professor Hua Keqin's team specially set up a WeChat group to closely monitor Jiani's condition. The good news is that everything is within the control range, after completing the 32 weeks of regular review, after Professor Hua Keqin's assessment, it is recommended that Jiani be admitted to the hospital for 34 weeks.
Things are always unpredictable, the epidemic situation in Shanghai is becoming more and more severe, and Jiani cannot be admitted to the hospital smoothly. In order to alleviate Jiani's anxiety, the doctors in Professor Walkerqin's team sent the latest hospital policies in real time and encouraged her to actively wait for delivery at home. At the same time, in order to deal with possible emergencies at any time, the team made a plan in advance.
In the early morning of the day when she had just turned 35 weeks old, Jiani suddenly had an early rupture of membranes, although it was expected, but at this time, Jiani could not provide a valid nucleic acid test report. Admission to the hospital is imminent! In line with the principle of exhaustion, the hospital emergency department immediately started the green channel, according to the process for Jiani to carry out emergency nucleic acid sampling and antigen, immediately put her into the isolation ward, while waiting for the nucleic acid report, the obstetric department began to make preparations for promoting fetal lung maturation before delivery.
But accidents always come unexpectedly. That afternoon, just after lunch, the contractions came unexpectedly. Considering that Jiani was a menstrual woman with a faster delivery and a scarred uterus, the obstetrics department decided to perform a caesarean section immediately and urgently contacted the gynecology department to perform radical cervical cancer resection at the same time. However, due to the suddenness of the incident, Professor Sun Hong, deputy director of the Gynecology Department of the hospital who was on standby in the sealing ring, took over the baton.
04
Seamless, reborn after two surgeries
In view of having eaten lunch, in order to reduce the risk of inhalation, Hu Jianying, deputy chief physician of the Department of Anesthesiology, decided to take a semi-anesthesia method after evaluation to ensure the safety of mothers and babies, but this is a greater test for the doctor's skills. When everything was ready, the surgery began. Peng Ting, chief physician of the Maternal Pathology obstetrics Department, and Li Ruixia, deputy chief physician, took the lead, and the Neonatology Department also made emergency rescue preparations. Peeling, abdomen, delivery, a loud cry resounded throughout the operating room, female treasure, 3120g, Apgar scored 9 points, beautiful report card made all the medical workers involved in this treatment extremely pleased.
The scene of the birth of life is also the battlefield of the hand blade tumor. As soon as the caesarean section was over, the director of gynecology Sun Hong, who was waiting on the side, immediately took the stage and fought for her mother's safety. The uterus after delivery is several times larger than normal, and the blood supply is very rich, and the slightest carelessness during the operation will cause heavy bleeding and endanger the life of the mother. And The pelvic organs after Jiani's birth were obviously congested; in addition, she had undergone two PREVIOUS LEEP surgeries, and the cervix was wide, stubby and brittle, which was very easy to cause bleeding.
With rich surgical experience, Director Sun successfully performed whole uterine and bilateral salpingectomy for Jiani, and considered that there were lesions in the preoperative vaginal vault, and part of the vagina was removed at the same time. The intraoperative specimen was sent for rapid freezing examination to further clarify the degree of cervical lesion involvement and vaginal margin involvement, and the pathology department quickly replied to the results, and there was no obvious invasive lesion residue in the cervix, which meant that Jiani temporarily did not need to expand the scope of surgery for extensive surgery and pelvic lymph node dissection, and could preserve the ovaries; however, freezing suggested that there was still a high-level precancerous lesion on the vaginal margin, so Director Sun resected part of the vaginal wall again to ensure that the lesion was completely removed without residue.
On the third day after the successful operation, Jiani, who was recovering, could not suppress her gratitude and wrote a thank-you letter to the doctors and nurses of the Red House. "The symptoms of pregnancy must not be ignored, and as for the pregnancy test, even in the epidemic period, the perfect test cannot be missed." Professor Hua said, "Finding clues to tumors as early as possible can help improve prognosis and open up two green channels for mother and fetus." ”
For patients with cervical cancer, preserving fertility and endocrine function not only makes motherhood possible, but also greatly improves the quality of life in the future. Up to now, under the multidisciplinary cooperation of Red House Hospital, more than 1,000 cases of cervical cancer fertility preservation surgery have been completed, the recurrence rate is only 0.1%, and more than 340 cases of birth have been completed, and the live birth rate has reached 33%.
Text: Shen Yan
Editor: Li Miaoran