Chapter 427: Poor parents in the world
A two-month-old baby has a liver tumor, no wonder he is called.
Today is New Year's Eve. The other wards are basically on second line duty, and the first line is no longer there. Of course, it is also because I know that Wu Xiaofu will be on duty this year, so I feel relieved to leave. Hepatobiliary Surgery is also a whole. , if there is really a need for surgery, it can be solved by asking Wu Xiaofu.
While listening to Zhu Yun's report on the infant's medical history, Wu Xiaofu went to the emergency room to check on the infant's condition.
Because the baby was in respiratory distress, the first thing Wu Xiaofu looked at was the baby’s blood oxygen. The blood oxygen saturation without oxygen was 88%. In fact, it was not bad. He was conscious and mentally responsive. , but the complexion is pale, but it is understandable. It has the effect of occupying the liver, and the baby can be in the current state because of the efforts of the mother and child.
The baby's development was considered normal, his nutrition was average, and his skin elasticity was OK. After Zhu Yun's diagnosis and treatment, the baby's breathing had stabilized, the three-sag sign was negative, and there was no cyanosis around the mouth.
There is no rash on the skin all over the body, there is no deformity of the skull, and the tension of the anterior fontanel is not high. It seems that there should be no problem with the skull.
On auscultation, the breath sounds in both lungs are thick, and wet rales can be heard, which is like signs after a cold.
The heart rhythm is regular, the heart sounds are strong, and no obvious murmurs are heard. It seems that the heart problem is not serious.
The abdomen was swollen. The baby was crying violently, perhaps because of discomfort. Wu Xiaofu took the opportunity to conduct an abdominal examination and found that the baby's umbilicus and bilateral groins could be seen without touching them. The package can be returned with a push.
After some inspections, Wu Xiaofu knew what he was doing. He took over the previous maternal and child inspection of the sick baby and asked while looking at it.
“Have you had your blood checked urgently?”
“Yes, the results have been transmitted. The white blood cells in the blood routine are 5.7×10^9/L, the lymphocyte ratio is 48%, and the neutrophil count Cell ratio 38%, hemoglobin 67g/L, platelets 139×10^9/L, C-reactive protein 82mg/L, respiratory pathogens: seven negative. "
This is not like an ordinary flu. !
Wu Xiaofu listened to these data and realized that the inflammation was actually not bad and should not cause respiratory distress to the infant. The mother and child were forced to send the infant over on New Year's Eve.
After coming to the hospital, Zhu Yun urgently checked the chest X-ray: the texture of both lungs was thick and the heart shadow was full.
No obvious abnormalities were found on ultrasound of the gastrointestinal tract and right lower quadrant.
Cranial color Doppler ultrasound: No signs of intracranial hemorrhage.
In fact, color ultrasound of the brain is rarely done, unless it is to look at the blood flow of the brain. The infant is not an adult and cannot describe the condition by himself, so we can only rule out one by one to make sure that the infant has no symptoms. In the case of intracranial hemorrhage, cranial color Doppler ultrasound is very suitable.
Abdominal examinations are carried out by women and children.
Ultrasound of liver, gallbladder, pancreas and spleen: the lesion in the right lobe of the liver is 12*8.0cm.
Enhanced CT: A huge round-like mass was seen in the right lobe of the liver. The CT value was about 23.1-40.1HU. Dotted and linear dense shadows were seen in the right lobe of the liver. After enhancement, the focus was unevenly enhanced and the range of enhancement was delayed over time. It was enlarged, with clear edges, and the size was about 106.9*80.4*119.5mm; multiple irregular dense shadows were seen in the liver; no clear abnormal enhancement was found in the left lobe of the remaining liver.
MR: There is a huge irregular space-occupying lesion in the right lobe of the liver, with a size of about 74×108x120mm (left and right×anterior×upper and lower). The boundary of the lesion is clear. T1WI shows uneven low signal, and T2WI shows high and low mixed signal. , the DWI sequence shows local high signal and the ADC value decreases.
Looking at it this way, the biggest problem for children is liver tumors.
"Director Wu, look."
At this time, the child developed symptoms again, with sudden shortness of breath and repeated episodes of bruising.
Respiratory distress again!
"Quickly, get on the non-invasive ventilator."
Seeing this, Zhu Yun did not dare to neglect, and hurriedly asked the nurse to get on the non-invasive ventilator to assist ventilation. However, after being put on the non-invasive ventilator, he seemed to be suffering from the disease. The child's breathing did not improve much.
Wu Xiaofu couldn't help but shook his head when he saw this. It was indeed not just a matter of breathing, but also a problem of the liver.
"Intubate the trachea directly, notify the interventional department, and prepare for surgery."
Ah!
Hearing Wu Xiaofu's words, Zhu Yun couldn't help but be stunned. Whether it was tracheal intubation or surgery, Zhu Yun thought it was a bit difficult to accept. The baby was only two months old, and tracheal intubation was dangerous. It's too big, and as for the surgery, Zhu Yun still can't figure out what's going on with the child.
To be honest, normal people rarely experience respiratory distress due to liver problems.
However, this is a sick baby. If other possibilities are eliminated, there is only one possibility.
After being stunned for a moment, Zhu Yun directly notified the interventional department and the anesthesiology department. The interventional department was preparing for the operation, and the anesthesiology department was responsible for tracheal intubation. Zhu Yun was naturally capable of tracheal intubation, but he had previously intubated adults. For children, even Zhu Yun has never been here, so it’s too uncertain.
“It’s too late, let me do it.”
Wu Xiaofu said and took the tracheal intubation tool directly from the nurse. The current situation of the infant obviously does not allow him to wait for anesthesia. Ke is coming.
Zhu Yun originally wanted to stop him, but seeing that Wu Xiaofu had already started, he could only step forward to help.
There are specialties in the surgery. Tracheal intubation may not seem difficult, but it depends on the situation. The physiological structure of children is very different from that of adults, and they are also more fragile.
However, it turned out that he still thought too much. Wu Xiaofu moved very quickly and finished it in a few strokes.
With endotracheal intubation and invasive ventilator-assisted ventilation, the child is getting better.
"Are the family members here?"
"Yes, just outside the rescue room."
Zhu Yun took Wu Xiaofu to the rescue room. At this time, the parents of the infant , were hugging each other and crying. Both of them looked not very good. I'm afraid they hadn't had a good night's sleep since the baby was born.
"I suspect that the child is in the current condition because of liver problems, so I want to perform interventional surgery on the child. If it is really a liver problem, it must be solved quickly. Otherwise, given the child's condition, I am afraid that I can’t survive tonight.”
Hearing Wu Xiaofu’s words, the mother of the infant cried even more. It's amazing. The father of the sick baby also looked paler. However, he was still rational in the end. He nodded quickly, "Director, I listen to you. You must save my baby..."
Meeting the sick baby When his father agreed, Wu Xiaofu stopped delaying and asked Zhu Yun to sign quickly. He took the affected infant directly to the interventional department.
The most important thing now is to see what happens when babies suffer from liver tumors. In fact, the babies are only two months old and their internal organs are not fully developed yet. The boundaries are not so clear. If one has a problem, the others will be affected. Organs are likely to be affected. Especially after the formation of liver tumors, liver function will be affected. One of the major functions of the liver itself is to detoxify. If liver tumors form and liver function is damaged, toxins will accumulate in the baby's body, affecting the heart, lungs and other functions.
After ruling out other possibilities, the infant's respiratory distress is most likely caused by liver tumors.
As for whether it is true or not, it is simple.
Stepping into the room, the two nurses looked at Wu Xiaofu with resentment. They were called here temporarily. On New Year's Eve, they were all ready to eat dumplings, so they were summoned, but they were just a little resentful. I won’t say anything.
After working for so many years, I have long been accustomed to the nature of my work. Let alone New Year's Eve, even if I am intimate with my husband in the middle of the night and get a phone call at a critical moment, I have to go to work.
"I'll try to solve it as quickly as possible."
Wu Xiaofu smiled at everyone and said that although it was fine for him and his assistant to enter the interventional room, other tasks still required a lot of cooperation from doctors and nurses. They could not leave until the operation was over.
After hearing Wu Xiaofu's words, everyone nodded. They still agreed with Wu Xiaofu's hurry. After all, who doesn't know that Wu Xiaofu is a fast shooter in the operating room.
The main purpose of this operation is to clarify the status of the infant's liver tumor and then check the condition of the blood vessels around the tumor. It would be best if the tumor could be cut off through interventional surgery.
As for the operation, the baby was only two months old, so it was not an easy task.
To create a contrast agent, the guide wire passes through the blood vessels and reaches the liver. According to the results of CT and MRI, the baby's liver has occupied a distance of seven to ten centimeters. You must know that the baby's liver It wasn't very big in itself, but the tumor of this size already occupied almost half of the baby's liver.
Under the imaging, Wu Xiaofu was a little frightened when he judged the condition of the tumor. This tumor was undoubtedly growing. It may have started when the fetus was conceived. It has already taken more than a year to grow to such a big size. In fact, this tumor The growth rate is already amazing.
Fortunately, except for the liver, there is no infiltration in other parts of the body. However, with such a fast growth rate, it is very likely to be considered a malignant tumor. As for what kind of tumor it is, there is a question mark at this time. .
But what is the reason for it to grow so fast? If we consider this aspect, Wu Xiaofu can almost certainly determine its origin.
In addition to blood vessel supply, the tumor certainly cannot grow so fast, and it is also limited to the liver, which shows that the liver tumor is likely to grow attached to the liver blood vessels.
So Wu Xiaofu’s biggest purpose for this operation was actually to inhibit the growth of the tumor through blood vessel embolization.
Liver Tumor Angiography Looking at the tumors attached to the liver arteries and veins, Wu Xiaofu also frowned.
Hepatic hemangioendothelioma?
Wu Xiaofu looked at the tumor situation, and an idea flashed in his mind. It was precisely because the infant's tumor might be hepatic vascular endothelial flow that Wu Xiaofu frowned.
Hepatic hemangioendothelioma, also known as angiosarcoma, is a highly malignant liver tumor. It is relatively rare and mostly congenital. It is most common in babies. As for the cause, if it is a baby who has already been born , may be related to the use of contrast agent thorium dioxide or ingestion of arsenic, and recently it is also believed to be related to vinyl chloride.
But if the unborn fetus suffers from hepatic hemangioendothelioma, it may be related to the fact that the mother of the baby had such an examination and ingested harmful substances when she was pregnant.
Unlike pregnant women in the last century, pregnant women in this century may be exposed to too many harmful substances, such as harmful gases and substances in the work environment, electromagnetic radiation in daily life, etc.
This is also the reason why hospitals do not recommend that pregnant women undergo x-rays, CT and other radiation-containing examinations. Data proves that pregnant women who eat too many threads can easily give birth to children with congenital diseases.
If the infant is really hepatic hemangioendothelioma, some of the symptoms and signs of the infant can be easily explained.
Under angiography, the baby's liver was significantly larger than that of children of the same month. Previously, the maternal and child medical records of the baby also mentioned that the baby had abdominal distension, abdominal pain, anorexia and anemia, but now they are all Right.
The risk of hepatic hemangioendothelioma is very high. Not to mention the malignancy of the tumor itself, if the tumor ruptures and hemoperitoneum appears, it is very dangerous. If not treated in time, it may cause death in a short time. Let the sick baby lose his life.
Moreover, hepatic hemangioendothelioma has the potential to form thrombosis.
If this is the case, you must know that there is a high possibility of respiratory distress, which is pulmonary embolism, which is the most dangerous.
While thinking about it, Wu Xiaofu had already started the operation. The blood vessels around the liver mass were very complicated, but the nutritional blood vessels of the mass were clearly visible to Wu Xiaofu. At this time, Wu Xiaofu had to do everything he could to save the swollen liver. The nutrient blood vessels of the tumor are embolized to inhibit the growth of the tumor.
As for the tumor itself, if it is really hepatic hemangioendothelioma, the lesion is now limited to the liver, and the most ideal treatment method is actually surgery.
But the current physical condition of the infant is obviously not suitable.
The best time is to resolve the child's crisis first, stabilize the child's condition, and then perform elective surgery later.
The interventional surgery went smoothly, but for Wu Xiaofu, if it was just a blood vessel embolism, it couldn't be easier. The baby was back in the ward safely in half an hour, but the baby itself was anemic. During the operation, some blood vessels are embolized, and the infant needs to be given symptomatic infusion of suspended red blood cells, fresh frozen plasma and other blood products after the operation.
There are also symptomatic potassium and calcium supplements, as well as some hormones and anti-inflammatory drugs.
Wu Xiaofu gave the doctor's orders, and then told the nurse some specific conditions. Babies are definitely not suitable for medication, let alone hormones and anti-inflammatory drugs, but there is no way. It's all like this. Between harming the body and saving life, life-saving must be the priority.
Methylprednisolone, sirolimus, and compound sulfamethoxazole were taken orally to prevent stuck lungs. Doctors’ orders were issued directly to Wu Xiaofu.
"Thank you, Director Wu, thank you, you saved our child's life, thank you."
Seeing that the child's condition had improved, the parents of the child thanked Wu Xiaofu profusely, and Wu Xiaofu also felt the same in his heart. It's a bit sad and pity the hearts of parents in the world. Nowadays, when children have such a situation, the parents are actually the ones who suffer the most.
However, there are some things that they should face, and they still have to face them.
“I suspect that the child is suffering from hepatic hemangioendothelioma, which is a highly malignant tumor. During this interventional surgery, I just stabilized the child’s condition first so that the child’s life is not in danger for the time being. , I recommended that the child undergo surgery to remove the tumor
Fortunately, the child’s tumor was only limited to the liver at this time, and the prognosis after surgery should be good.”
Need surgery!
(End of this chapter)