Reporter Zhang Xiaoguang Correspondent Liu Yan This is the evening of the summer of 2022, with the orange sunset intertwined with the sunset. Looking at the scenery outside the window, Liu Wenwen (pseudonym) in the hospital bed felt like she was reborn from a desperate situation.

Reporter Zhang Xiaoguang Correspondent Liu Yan

This is the evening of the summer of 2022, with the orange sunset intertwined with the sunset.

Looking at the scenery outside the window, Liu Wenwen (pseudonym) in the hospital bed felt like she was reborn from a desperate situation...

A month ago, choriocarcinoma was in the late stage and she suddenly developed respiratory failure and intra-abdominal bleeding, and was rushed to the ambulance. Enter Zibo Central Hospital .

HCG index exceeded one million, shock , difficulty breathing, rapid drop in blood pressure, increased abdominal bleeding... Within a few hours, Liu Wenwen's condition deteriorated sharply.

Critical illness notices came to her family members one after another.

After emergency consultation and multidisciplinary joint rescue between Zibo Central Hospital and provincial hospitals, on the 11th day in the intensive care unit (ICU), Liu Wenwen's vital signs tended to be good and her condition was stable...

Finally, she got through this. Tao "Gate of Life and Death".

Time goes back to a month ago -

Respiratory failure and massive bleeding, HCG broke one million

html On the evening of May 19, Yu Jia, a gynecologist at Zibo Central Hospital who was working the night shift, received an emergency call: "Is it gynecology? I am an emergency room, outside the hospital. We are sending a patient with intra-abdominal bleeding from choriocarcinoma, please come here quickly and prepare for rescue!”

html At 18:30, the patient Liu Wenwen was sent to the emergency rescue center of Zibo Central Hospital.

After Yu Jia arrived at the scene, she immediately handed over the situation with the accompanying doctors from other hospitals and got a preliminary understanding of the patient's condition.

It is reported that Liu Wenwen had an abortion 18 days ago and coughed for 12 days after the operation. After being diagnosed, he suffered from choriocarcinoma. This time, he suddenly developed lower abdominal pain on the first day of EMA-CO chemotherapy. The color ultrasound showed a huge mass in his pelvis and bleeding in his abdominal cavity.

At the same time, Liu Wenwen also suffered from respiratory failure and was urgently transferred from an external hospital to Zibo Central Hospital.

At this moment, Liu Wenwen's breathing difficulties in the emergency room further worsened. Under oxygen inhalation, his blood oxygen saturation was only 70%, and his blood pressure dropped sharply.

"Already close to shock." Seeing that the patient's condition was getting worse, Yu Jia immediately reported the situation to the on-duty doctors Su Shan and Dou Hongtao of the department, as well as the off-duty director Zhang Qinghua. At the same time, the patient was given oxygen and hemostasis. , capacity expansion and other emergency operations.

At the same time, the entire hospital immediately opened an emergency green channel and used a flat cart to push the patient to the CT room for a comprehensive scan.

Liu Wenwen’s examination results surprised the doctors present. The situation was far more serious than imagined. "The examination results at that time showed that the patient had severe pneumonia in both lungs, and there was large area of ​​lung consolidation, which does not rule out lung metastasis. Moreover, there was a huge mass in the pelvis, and the hemoperitoneum and bleeding were severe." Yu Jia said At this time, the patient's cancer cells have metastasized to the lungs, there is a huge pelvic mass, and the amount of abdominal bleeding increases, each of which may be fatal.

At this moment, a dilemma was placed in front of the doctors at Zibo Central Hospital.

If surgery is chosen to stop bleeding at this time, can patients with persistent respiratory failure tolerate the surgery? If surgery is not chosen, how can one reverse the shock caused by his continued intra-abdominal bleeding?

After thinking for a moment, Yu Jia reported the new inspection situation to the hospital's general duty officer and director Dou Hongtao again.

Subsequently, the hospital immediately convened the respiratory department, intensive care unit (ICU) and cardiovascular interventional department to initiate multidisciplinary consultation. After careful discussion and condition analysis, they finally decided to perform "transcatheter bilateral uterine artery + right ovarian artery embolization" for Liu Wenwen.

From 21:00 that night to 0:00 the next day, the above-mentioned embolization surgery was carried out for a full three hours. In the early hours of the morning, Huang Guangming, director of the interventional department, walked out of the operating room and said to Dou Hongtao, who had been waiting for a long time: "Our embolization operation was successful. The next step is left to you." After saying that, he patted Dou Hongtao on the shoulder and the two of them Nodding.

Although the embolization surgery was successfully completed, Liu Wenwen's several laboratory tests showed that her condition had not improved. HCG had exceeded the hospital's laboratory limit of 2.7 million, and respiratory failure continued to worsen...

"Normal HCG for pregnant women" The peak value was around 10,000, and her HCG was more than 200 times higher..." Dou Hongtao said.

This means that Liu Wenwen's life will turn on a "red light" at any time.

"It was still unknown at the time whether the patient could survive this 'life and death crisis'." Dou Hongtao said.

ICU, she fell seriously ill many times in the 11 days

20. At 6 a.m. on the 20th, Zhang Qinghua, director of the gynecology department of Zibo Central Hospital, discovered during an examination that although Liu Wenwen had been using high-flow oxygen inhalation, she still could not maintain normal oxygen saturation and developed asthma. Phenomenon of respiratory failure such as suffocation, cyanosis .

She immediately contacted the intensive care unit (ICU) with gynecologist Zhang Zhe again, transferred Liu Wenwen to the ICU, immediately performed endotracheal intubation, and connected him to a ventilator to assist his breathing.

With intravenous lines and drug infusions all the way, Liu Wenwen's vital signs were temporarily stabilized under the rescue efforts of ICU physician Li Changjun's team.

However, because the patient is currently in stage III choriocarcinoma (high risk), his respiratory failure is still worsening and his condition is critical. The

ICU team consulted again with Dou Hongtao, director of the gynecology department, and Yuan Jing, director of the respiratory department, and finally concluded that the patient had allergic inflammation caused by tumor metastasis to the lungs.

The condition in this case deteriorates rapidly enough to be beyond imagination.

“Because of her severe pulmonary complications, we cannot continue to rescue her according to past experience and guidelines, but fortunately, the patient’s brain, liver, kidney and other other locations have not metastasized cancer cells, so currently, chemotherapy is the top priority for the patient. "After the consultation, all disciplines in the hospital unified the treatment plan, giving the patient chemotherapy first.

But now, new problems arise again.

Liu Wenwen, who has stage III cancer, is already an "ultra-high-risk choriocarcinoma patient", and the lung metastasis of cancer cells has caused severe lung symptoms. "If treated according to the conventional chemotherapy regimen, it may cause massive necrosis of the tumor in a short period of time, collapse of the lung tissue, and ultimately respiratory failure and life-threatening consequences." After careful consideration and discussion with the team, Dou Hongtao decided to give Liu Wenwen a small dose of EP first. Protocol induction chemotherapy.

During this period, Dou Hongtao and his team must, on the one hand, evaluate and consider the patient's tolerance, and on the other hand, pay close attention to the progression of the disease to lay the foundation for more effective chemotherapy in the future.

Under this treatment plan, one day, two days, one week, ten days... As time goes by, under the joint treatment of various departments, Liu Wenwen's condition is gradually controlled, the diffuse lesions in his lungs are gradually absorbed, and the blood HCG index drops significantly. , and in the next few days, the tracheal intubation was gradually removed, and the vasopressor medication was also reduced.

On the 11th day of Liu Wenwen’s treatment in the ICU, the ICU contacted Dou Hongtao. Liu Wenwen’s indicators were improving and he could be transferred back to the general ward to continue treatment.

In 11 days, Liu Wenwen experienced life and death difficulties in the ICU.

The family members who have been waiting outside the ICU are also living like a year.

He said that when his wife Liu Wenwen was in the ICU, he felt very scared listening to her condition reports every day, and the doctor also issued multiple critical illness notifications...

"I would like to thank the medical staff here for taking good care of my wife. Thank you for their patience in accompanying me through such a painful moment," Liu Wenwen's husband said in an interview with reporters.

On June 1, when Liu Wenwen was transferred out of the ICU and returned to the gynecological ward, her husband held her hand tightly with tears in his eyes and said tremblingly: "It's great that you are alive."

Hearing such words, Not only Liu Wenwen, but also the medical staff on the side couldn't help but have red eyes.

Reporters learned that Liu Wenwen is currently recovering well and is undergoing further gynecological treatment.

Multidisciplinary combination demonstrates the treatment level of general hospitals

Zhang Qinghua, director of the gynecology department of Zibo Central Hospital, introduced that the "choriocarcinoma" Liu Wenwen suffered from is a highly malignant gynecological tumor that originates in the uterus and mostly occurs in molar pregnancy, miscarriage or pregnancy. After full-term delivery, the disease is highly invasive and can be transferred to the body through the blood in the early stages to become a systemic disease.

Zhang Qinghua said that, therefore, they faced high-risk situations such as lung cancer metastasis, respiratory failure, and abdominal bleeding when Liu Wenwen was admitted to the hospital. They responded urgently, chose a suitable rescue plan as soon as possible, and started a race against time.

It is worth noting that during the rescue process of "high-risk choriocarcinoma patients", Zibo Central Hospital also contacted Qilu Hospital and Peking Union Medical College Hospital to discuss the treatment plan.

The professional guidance of provincial hospitals, coupled with the full efforts of our rescue team composed of high-level talents, and the full and sophisticated medical technology support, the successful treatment of patients is guaranteed.

In fact, during the rescue of Liu Wenwen, the hard-core rescue of Zibo Central Hospital, a comprehensive tertiary hospital, with multi-disciplinary joint diagnosis and treatment plans such as gynecology, ICU, and respiratory departments, provided the patient with life.

"This also reflects Zibo Central Hospital's emergency response capabilities and strong comprehensive treatment capabilities for critically ill patients as a general hospital, building a real bridge to save patients' lives." said an industry insider in Shandong's medical community.

During the interview, the reporter learned that, as the largest tertiary general hospital in Zibo , Zibo Central Hospital has always adhered to the common development of multiple disciplines over the years and established a regional medical highland centered on "people-benefiting medical care". Its comprehensive treatment The strength of the "hard-core" rescue team composed of highly capable and highly sophisticated talents cannot be underestimated.

Regarding the future, the hospital stated that they will continue to improve their comprehensive treatment capabilities and emergency rescue levels to bring hope to more high-risk emergency patients.