MTL - Since 1981 Health School-Chapter 419 suspected neonatal lung cancer

  Chapter 419 Suspected Neonatal Lung Cancer

   With the assistance of a ventilator, after a week of internal medicine anti-infection treatment, the condition of this little baby less than 2 months old finally stabilized.

  But the operation could no longer be delayed, because the amount of chylothorax drained every day was still a lot, exceeding 100ml for 7 consecutive days, so Chen Qi had to take the risk to schedule the operation.

   Of course, Chen Qi is still sure about whether the operation will be successful.

   "Isn't it just to ligate the thoracic duct?"

  While watching the two assistants disinfecting, Chen Qi sat next to him and bragged to others: "Old Gai from the Second Hospital is too timid. In the future, he will have to see our Fourth Hospital if he is going to Ji County Surgery!"

  Hahaha, there was laughter in the operating room.

  Neonatal chylothorax surgery attracted the attention of all the surgeons in the fourth hospital. Chen Qi simply planned to make this surgery into a teaching operation, and even turned on the closed-circuit TV to broadcast live.

   This condition is the only one in Vietnam.

  Bianmeng finished disinfection, checked with the anesthesiologist again, and then shouted: "Tou Chen, you are ready for the operation."

  Chen Qi stood up suddenly, took his "chess knife" from the sterile tray, entered the chest with a standard posterolateral incision, and began the operation.

  The surgical director is the first assistant, Yan Shifan is the second assistant, and the border team is the third assistant.

  As soon as the chest cavity was opened, Director Bian skillfully sucked away the accumulated chylus in the pleural cavity, exposing a clean wound surface, and the first step of the operation went smoothly.

  Maybe I feel that the atmosphere in the operating room is relatively relaxed, and the words of the border alliance are a little more:

   "Tou Chen, where do you usually find this chest tube?"

  Facing several of his confidants, Chen Qi did not hesitate to teach:

"The thoracic duct is usually located between the azygos vein and the aorta. Its color is easy to distinguish. It is usually pearly white and translucent, about 5 mm in thickness. Later, our surgery will mainly involve the two ends of the damaged thoracic duct. Once ligated, it's OK, and I'm discharged from the hospital."

   Director Bian smiled and flattered:

   "That is to say, you said it so easily. For such a little baby, you would have gone crazy without seeing the anesthesiology department. The dosage of the general anesthesia drug formulated has been studied for several days."

  The anesthetist nodded desperately.

   "Hey, it's good to have this kind of energy. Not only our surgery needs to improve, but also the anesthesiology, internal medicine, and pediatrics. The anesthesiology department should be praised for being so careful and thoughtful."

   Hehehe~~~

  The atmosphere in the operating room was relaxed. Outside the operating room, other doctors watching the operation were chatting and watching the TV screen.

  The operation proceeded to the second step. At this time, Chen Qi was about to push the lungs aside, and then expose the mediastinum and aorta at the back for easy incision. Suddenly, Chen Qi stopped moving.

   Visible to the naked eye, his face swiped, and all the sweat flowed out.

   Director Bian and Yan Shifan next to Chen Qi glanced at each other, and they both saw the surprise in each other's eyes.

  Because I have been doing surgery with this Dean Chen for so many years, this is the first time that everyone has encountered him showing a nervous, even frightened expression during the operation.

  For a while, the operating room, which was still talking and laughing just now, became quiet, both the nurses and the little doctors closed their mouths.

  As we all know, there was an accident during the operation.

  And this accident is probably very fatal.

  Director Bian's voice trembled a little: "Tou Chen, why, what's wrong?"

  Chen Qi didn't make a sound, switched his left hand to his right hand, continued to gently touch the child's lungs, then gritted his teeth, and turned the inside of the lungs over.

   "Hiss~~~~"

  Everyone in the operating room was gasping for air. On the inner surface of the pink lung, a small black nodule suddenly appeared, with a diameter of less than 1cm. Under the shadowless light, it was particularly dazzling.

   Now, everyone's sweat is streaming down at the same time.

  Yan Shifan's voice also stuttered: "This, this, this is, this looks like a malignant tumor?"

  Chen Qi's face was ashen, and he said to himself: "The touch is hard, the boundary is not very clear, it's over, it's over, why is this kid so unlucky."

  Chen Qi knew in his heart that he might have encountered an unexpected situation before. Who would have thought that this 2-month-old infant would actually have a tumor in his lung? Is this chylothorax directly related?

  When thinking of this, Chen Qi was very annoyed.

  He was not upset about his bad luck, but rather that he was reborn in the 1980s. He didn't have so many inspection equipment, not even a CT machine, and the preoperative preparation was too insufficient.

   Then Chen Qi thought about the anticipation on the faces of the mother, grandparents, and grandparents who had a child before entering the operating room. They trusted him and Chen Qi was transferred to the fourth hospital. He did not expect such a result in the end.

  Thinking of this, Chen Qi really wanted to slap himself hard.

  Everyone in the operating room looked at Chen Qi with pale and dark faces for a while, and everyone dared not even breathe.

  Suddenly, as if Chen Qi had come to his senses, he ordered loudly:

   "Shifan, take a slice immediately and send it to the pathology room for testing as quickly as possible."

"OK!"

   "Head nurse, you should immediately call the People's Hospital and ask Director Guo and Director Zhu Huoyan to come to the Fourth Hospital immediately, hurry up!"

   "Okay, I'll go right away."

   "Department of Anesthesiology, you immediately reorganize the operation plan, extend the time of general anesthesia, and pay close attention to the vital signs of the child."

  Director Bian looked down at the suspected malignant tumor, feeling a lot of emotion in his heart.

   "Tou Chen, what shall we do now? This thing looks very fierce, this child is going to be lost."

  Chen Qi's mind was a little confused: "Wait, wait until Director Guo and Director Zhu arrive. If we overturn the operation today, I really don't know how to explain it to the family."

   Outside the operating room.

  When Chen Qi told his family members about the unexpected situation in his hands, Shen Lifen suddenly fainted on the ground, and several relatives rushed to help him.

  The child's grandma and grandma immediately sat on the ground and began to howl, "My child~~~My miserable grandson~~~"

  The child's grandfather and grandfather are also considered calm, even if their hands are already trembling, it can be seen that their hearts are not calm.

   "Dean Chen, then, what should we do now?"

  Chen Qi felt sad when he saw this:

"The experts from People's Hospital are on their way now. The baby's chest cavity is still open. We need to re-discuss the operation plan. Also, don't worry. Whether this lump is benign or malignant is still unclear. Maybe things are not that bad. Woolen cloth."

  The grandpa of the child sat down on the wooden chair:

   "Yes, yes, it must not be so bad. My son beats devils in the south. Our family has never done anything bad. It shouldn't be good people who don't get rewarded."

  The grandma next to her squeezed out her snot: "Ah, my grandson, if you are dead, grandma won't be alive~~~"

  The family members were in a state of confusion at this time, and Chen Qi was also in a state of confusion. He looked at the entrance of the hospital helplessly, and finally, a jeep drove into the hospital quickly.

  President Guo and Director Zhu arrived first, got off the car and rushed towards the operating room.

  Dean Guo had a loud voice, and when he saw Chen Qi, he asked, "What's the situation? I'm in such a hurry to come, I'm still in a meeting."

  Director Zhu also asked: "Did there be an accident during the operation?"

  Chen Qi hurriedly reported while helping the two godfathers change their surgical gowns:

"I took over a child with chylothorax in the second hospital before, and it was less than two months old. My father is a fighting hero. The second hospital can't cure it, so I wanted to be sent to the fourth hospital for surgery and help them. When I wanted to do thoracic duct ligation today, I found a tumor in the lower lobe of the right lung of the child."

   "Tumor? A 2-month-old child?"

  Dean Guo and Director Zhu stopped dressing and looked at Chen Qi in surprise.

   "Yes, and according to my visual inspection, it should be more likely to be malignant."

   Hiss~~~

  The two little old men also gasped. The probability of infants and young children suffering from lung cancer is extremely low, less than one in a million, so low that no one has ever seen it before.

   Not to mention that Chen Qi, who has been a doctor for two lifetimes, is extremely surprised. Even two old doctors who have worked for decades are also unheard of. This is the first time I have heard of it.

   But after being surprised, Dean Guo's interest increased greatly. Doctors, the favorite is difficult and miscellaneous syndromes.

   "Hurry up and disinfect your hands."

  Zhu Huoyan nodded, not knowing what he was thinking about.

  The three of them quickly entered the operating room. Dean Guo didn't consider himself an outsider, and immediately stood in the position of the chief surgeon, and Director Zhu stood in the opposite position of the first assistant.

  Chen Qi, the "master", was immediately pushed aside.

   "Just here, this place, look, I don't think this is a tuberculosis, nor a lung abscess, nor a hamartoma or a fibroma."

  President Guo touched it with his hand, and then said: "The possibility of malignancy is 90%, have you done the pathological section?"

   "It's done, head nurse Qiu, has the result come out? Go and remind."

   After a while, Niu Meizhen from the pathology room of the laboratory came in panting: "Dean, the report is out, it is malignant, squamous cell carcinoma."

   There was a burst of regret in the operating room, and the doctors outside the operating room hurriedly searched for relevant materials and textbooks.

  Confirmed the guess. Not only was Chen Qi not happy or satisfied, but he was a little confused. He really didn't know how to face his family.

   Looking at the little patient on the operating bed, everyone felt a sense of powerlessness.

   After all, he is still young. How can an old Jianghu like Dean Guo have time to be sad at this time? Instead, he was calmly thinking about the problem:

   "Old Zhu, do you remember any books or magazines that recorded neonatal lung cancer?"

   Zhu Huoyan thought about it for a long time, then shook his head:

   "I haven't heard of it, nor have I seen it. There were several suspected cases of lung cancer in our hospital, but the family members of the children refused to do an autopsy, so the final death was unclear."

  Even the People’s Hospital doesn’t have a CT machine. Ordinary X-rays are still old-fashioned CR machines. Small nodules or tumors can’t be seen at all.

   Like this small patient, the X-ray of the Second Hospital did not show the tumor, so he missed the preoperative examination.

   This problem exists both at home and abroad.

  Even hospitals that have CT scans rarely do CT scans for infants and young children. One is that the child does not cooperate, and the other is that the doctor will not think of the diagnosis of lung cancer even if he kills him.

  Children have symptoms such as coughing and fever for a long time. The most common pneumonia must be the first thing doctors think of, followed by tuberculosis. They can't even think of chylothorax, let alone lung cancer.

  President Guo was thinking again:

   "How did you say such a small child got lung cancer? Is it the cause of itself, or is it brought out from the mother's womb?"

  This question made Chen Qi start to think deeply.

   As we all know, lung cancer mainly occurs in smokers over 40 years old, people who have been exposed to second-hand smoke for a long time, people living in areas with serious air pollution, people who are often exposed to carcinogens that can cause lung cancer, and people with chronic respiratory diseases.

  Then what is the reason for this newborn who has just been born for 2 months?

   Even if you stay in the environment of second-hand smoke every day, it is impossible to get lung cancer immediately, unless you put it in the Fudao nuclear power plant.

   Director Zhu said at this time:

   "This should be related to the child's own problems, and it is more likely to be brought out of the mother's womb."

  Chen Qi thought of another possibility. There are papers on this aspect in relevant journals.

   "Do you think cancer is contagious or genetic?"

  Dean Guo gave Chen Qi a blank look: "No one said that cancer is contagious, even if it is, have the child's parents got cancer?"

  Chen Qi was at a loss for words. The child's father was still fighting at the front line, so he was obviously not sick. The child's mother...

  Chen Qi suddenly thought of Shen Lifen, his face was a little yellow, and he looked a little weak, looking like anemia or malnutrition.

  Before, I always thought that she was caused by taking care of the child for a long time, but now I think about it, did Shen Lifen suffer from some chronic wasting disease? For example, how can there be cancer?

  Chen Qi had such an idea in his mind, and he couldn't let it go.

  The head nurse Qiu next to him saw that the three big doctors were all lost in thought, and couldn't help feeling a little anxious:

   "Dean Guo, Director Zhu, Dean Chen, what should the child do now? Should the operation continue or should the chest be closed?"

  President Guo shouted at the border alliance: "Go, bring the pathology report."

   "Hey, come on!"

  Bianmeng obediently brought the pathology report in front of Dean Guo and Director Zhu, holding his hands up and not daring to show it. These two are "teacher-level" bosses and cannot be offended.

  Dean Guo and Director Zhu discussed it, and carefully observed the condition of the right lung. They both nodded.

  President Guo first spoke:

"The operation should continue, not only to continue, but also to expand it. Taking advantage of this thoracotomy, not only will the thoracic duct that caused the chyle fluid be ligated, but the right lower lobe of the child's lung will be removed together with the malignant tumor. "

   Director Zhu added:

   "The pathology report shows that the lung cancer is still relatively in situ, and there is no sign of metastasis at present, so I took this opportunity to remove it together. Maybe the newborn's lung cancer will be cured in this way, and it is possible that it will not recur."

  Everyone in the operating room swallowed their saliva, thinking that this operation might not last for half a day.

   Moreover, part of the lungs will be removed for such a young child. It is unknown whether lung cancer can be cured and whether the operation will affect survival.

   This is already an extremely difficult operation.

  (end of this chapter)