Chapter 871 En-Caule Cesarean Section

The patient's tear started from above the left coronary artery and extended to the bifurcation of the bilateral internal and external iliac arteries.

Not only that, the left renal artery was also torn almost in half, and the other side was completely torn.

In addition, almost all of the inferior phrenic artery, celiac trunk, middle adrenal artery, lumbar artery, inferior mesenteric artery, etc. from top to bottom have tears to varying degrees.

In this case, it is no longer a matter of considering how to preserve the child's health and whether to have surgery.

But surgery is necessary no matter what, otherwise the mother will die at any time.

We really have to wait until it breaks down before taking measures. Even Xu Qiu has no way to save him.

"Prepare for surgery." Xu Qiu said immediately.

…

After leaving the conference room, he hurried to the conversation room on the other side.

At this time, Fang Jiajia's family members are already waiting here.

He quickly explained the situation.

Fang Jiajia's husband's expression suddenly changed, and he trembled on his lips and said, "Doctor Xu, please save my wife quickly. The child is not important, as long as we can save her!"

Seeing the family members signing without any hesitation, Xu Qiu nodded and said: "At present, we plan to perform a cesarean section first and then deal with the aortic dissection. The risk is very high, but we will try our best."

Fang Jiajia's husband has a medical background. He knows very well how terrifying Type A aortic dissection is. He has long stopped listening to anything and only hopes that Xu Qiu can have surgery quickly.

Xu Qiu didn't waste any time. After getting the informed consent form, she hurried to the operating room.

…

For the clinic's surgical team, aortic dissection is not difficult. The modified SUN surgery that Xu Qiu has mastered for a long time is aimed at this kind of complex dissection.

Let the director of cardiac surgery take the job, and the probability of success is very high.

Likewise, a cesarean section is not difficult.

But the two together represent a blind spot that neither department has ever touched.

This also makes the operation extremely difficult.

If dissection surgery is performed first, the fetus will be greatly affected. Coupled with the impact of premature birth, the chance of survival is very low, and it is very likely to die in the abdomen.

If you give birth by cesarean section first, the dissection may rupture at any time during the operation, which will kill two people.

The surgical team to assist in the cesarean section is already in place.

The preoperative color ultrasound results were also very clear: fetal head position, abdominal circumference 31.25cm, maximum depth of amniotic fluid on the femur 6.1cm, and low-lying placenta.

This was expected.

I knew this in advance when I was undergoing minimally invasive intrauterine intervention.

The difficulty lies in two points.

One is anesthesia.

The most troublesome part of this kind of combined surgery is the choice of anesthesia plan.

Conventional cardiac surgery for type A aortic dissection requires sedation and analgesia before surgery. After the patient's blood pressure and heart rate are controlled, systemic heparinization and deep anesthesia are performed.

In addition, ice caps, etc. must be used to reduce the oxygen consumption and perfusion damage of various organs on the basis of deep hypothermic extracorporeal circulation, so as to control the risk to a minimum.

But a cesarean section is different.

Since there is still a fetus in the belly, the anesthetic drugs will be transferred to the fetus through the placenta. The effects of drugs for adults entering the fetus can be imagined.

Therefore, in cesarean section, spinal anesthesia is commonly used clinically, and the anesthetic drugs used are also short-acting anesthetics such as propofol and remifentanil.

Two different levels of surgery require completely different methods of anesthesia.

And it's not over yet.

Fang Jiajia's blood pressure even reached 180mmHg at one point, breaking through the level three category of hypertension...

Such high blood pressure means that the blood is violently impacting the blood vessels, which may cause the dissection to rupture at any time!

Therefore, the anesthesia team must not only control hypertension and reduce the risk of aortic rupture.

It is also necessary to prevent hypotension so as not to affect the placental blood supply.

For a patient with severe aortic dissection, her blood pressure is already fluctuating violently, and it needs to be controlled within a reasonable range, neither too high nor too low, which raises the difficulty to another level...

Moreover, the effect and feedback of anesthetic drugs are not instantaneous.

Just like in ancient times, you could sit thousands of miles away and command the battlefield.

Compared with the real battlefield, the battle reports rushed from thousands of miles away from the front line have obviously lagged behind.

Maybe when the battle report was sent, it showed a great victory, but when the battle report was received thousands of miles away, the army was completely defeated. Then the strategy was adjusted according to the enemy's situation, and when the report was sent, the enemy was beaten away again...

…

The second difficulty lies in the fetus itself.

Needless to say, Fang Jiajia's life is at risk at any time.

The fetus itself is also at risk.

This is a common problem for all premature babies.

During premature birth, the lower uterine segment of pregnant women is often incompletely formed. When the uterine wall is incised and the membranes are artificially ruptured, the uterine muscles tend to contract rapidly due to stimulation.

At the same time, the uterine wall thickens and the uterine cavity volume decreases.

The difficulty of delivering the fetus will further increase, and as intrauterine pressure increases, the chance of the fetus experiencing amniotic fluid aspiration will also be much higher.

Moreover, a rapidly contracting uterus may also cause soft tissue damage, nerve damage, and traumatic intracranial hemorrhage to the fetus...

This places extremely high demands on practitioners.

…

"In terms of anesthesia, we will follow Dr. Xu's plan. We will first use nicardipine to control the patient's systolic blood pressure at around 130, and choose esketamine as an analgesic.

"Once the cesarean section begins, we will switch between propofol, esketamine, rocuronium and remifentanil, and use short-acting anesthetics to maintain the anesthesia state, while reducing the impact on the fetus..."

After careful consideration, the anesthesia director let out a long breath.

It has to be Dr. Xu.

The proposed anesthesia plan is simply impeccable.

The cesarean section team couldn't help but look at Xu Qiu.

Damage to premature babies is inevitable, and this is an ordeal that all premature babies who undergo cesarean sections have to go through.

Although Fang Jiajia's fetus is already miserable enough, premature damage is still unavoidable.

I just hope that Dr. Xu can use his superb surgical skills to keep the damage to a minimum.

The first knife fell.

Xu Qiu held the knife and cut the lower abdomen horizontally with the tip of the knife.

Chi Chi Chi——

The sharp blade entered the abdomen, cutting the skin surface, fat layer, rectus abdominis tendon sheath, abdominal muscle layer, peritoneum layer, uterine serosa layer, uterine muscle layer...

Just as everyone was waiting for Xu Qiu to cut the last amniotic membrane and see the fetus wrapped inside, Xu Qiu suddenly stopped.

At this moment, the cesarean section team showed puzzled expressions.

Why did it stop?

Then, they saw Xu Qiu flip his wrist, cut the muscle layer of the lower uterine segment, and then began to separate the amniotic sac around the uterine incision.

Xu Qiu freed his left hand and inserted his index and middle fingers into the protective amniotic sac while continuing to extend the uterine incision.

Two minutes later.

The thin membrane sac appeared in front of everyone.

And the fetus inside was curled up in the sac, moving irregularly.

Seeing this scene, Li Xue and Kong Huixia of the cesarean section team looked at each other and showed shocked eyes.

This is... En-Caule cesarean section!