The next day, Li Min finished writing the little girl's hospitalization record, and Su Ying also had surgery, and she was very happy to receive Li Min's consultation order as promised.But when she wanted to leave, she noticed Yan Hong, who was staring at the consultation list, and her eyes were almost saying to herself: Take me.So Su Ying brought Yan Hong with her."
Senior sister."
Su Ying greeted Li Min, took the CT film that Li Min pushed over and placed on the table.Li Min pulled out all the things in the medical record folder in his hand, left the ones he wanted to use, and handed the rest to Yan Hong and said, "You take a look first, I wrote the first journey." ”Su Ying asked while watching the film, "Didn't you write the first trip first and then write the complete medical record?"
What about your interns?
”"The intern wrote the first trip and also wrote the medical record.I thought you might need this case, so I'll write it again. ”Yan Hong smiled gratefully at Li Min.She understood that Li Min was preparing for her ability to use this case.Li Min went back to dinner yesterday and reminded Yan Hong to pay attention to this consultation list."
I can't say let Su Ying bring you over for a consultation, but I think if you keep an eye on the consultation list and stay with her, she will probably bring you over."
The abdominal CT scan is very clear, and it can be called a beautiful 100 points.Su Ying didn't find the uterus and ovaries on the CT film, so she frowned and went through other examinations.B-ultrasound suggested that this was a cystic cavity tissue, and as for what it was, B-ultrasound could not tell.This tangled mass of tissue is actually two masses: the large one is about 5 or 6 centimeters, and there is a small tangled solid mass of 3 centimeters on the dorsal side.Yan Hong waited for Li Min to finish writing the first trip, and rearranged the documents on the desktop in order and handed them to Li Min."
Minmin, she has accurate menstruation, heavy menstrual flow and dysmenorrhea, do you think this is the uterus?
The uterus was not found in the abdominal cavity. ”"That's what I thought, too.The discussion with Sister Su that day also tended to be a hernia composed of uterus and ovaries.But strangely where she had menstrual cramps was her lower abdomen. ”But there is no uterus in the lower abdomen!
Li Min waited for Su Ying and Yan Hong to read all the auxiliary examinations and then suggested, "Let's go see that little girl."
The kid was very lively and very organized in answering questions. ”She took Su Ying and Yan Hong to the small ward, but the child's mother looked more nervous than the little girl."
Dr.
Li.""
This is Director Su of the Department of Obstetrics and Gynecology, my senior sister.Dr.
Yan, my college classmate.I asked them to come and consult with your daughter. ”Li Min explained to the mother and daughter.This time, the intern led by Li Min was a boy, and the young man followed behind in a sneering manner, not daring to go forward.Su Ying asked about her medical history in detail, focusing on menstrual history and dysmenorrhea.There is no discrepancy with the information provided to her by Li Min in the medical record.Finally, Su Ying said: "Go to the dressing room of your department for a physical examination." ”Li Min saw that the little girl's mother and daughter were a little hesitant, so she sent her intern away.Anyway, this young man is not going to be an obstetrician and gynecologist, and the hernia part of the surgical internship is also a general teaching content.The young man left relieved, and the spirit of the mother and daughter relaxed at once."
Minmin, be careful if you do this, students complain about you."
Yan Hong reminded Li Min."
I'll find another case for him.There are many surgeries at the end of the year.will come up to the point where they don't want to go. ”After entering the dressing room, Li Min's action of locking the door and pulling the screen was done in one go, and Su Ying, Yan Hong and the child's mother couldn't help laughing."
What are you doing, be like a thief?"
Yan Hong laughed at Li Min."
Hehe, I'm just in case.There are many men and few women in the surgical ward, and there are many difficult men to accompany them.I do this for female patients to check and change dressings, otherwise it would be embarrassing if another man breaks in the middle. ”"You've been so cautious in surgery, beware of perverts.""
Be careful to sail the ship of ten thousand years."
Li Min waited for Su Ying to check on the little girl and asked, "Sister Su, I think she has menstruation, and I think about whether to arrange an iodine oil imaging for her?"
”"It should be done."
Su Ying supported Li Min's proposal."
I remember that her iodized oil imaging had to be filed with the medical office, and there was also the time for the imaging arrangement," Su Ying pondered for a while and said, "You give me the imaging list after the price, and I will arrange the imaging time."
You have to choose a time period when there are few people, and we will take the patient over.Xiao Yan, don't go over. ”"Good.Thank you, Sister Su. ”In private, Yan Hong also called Su Ying like this."
Xiao Li, you now start to prepare all the necessary signatures.Xiao Yan, do you have any templates there?
You look for one for Li Min. ”The two of them discussed the inspection method, and Yan Hong also popularized the purpose of iodized oil imaging and the meaning of having to sign for the mother and daughter.Iodine oil imaging is generally used to check for blockages in the fallopian tubes.During the test, iodized oil passes through the uterine cavity into the fallopian tubes.In this case at hand, it is possible to determine whether the substantial mass is the uterus and fallopian tubes.But this involves the gynecological examination of unmarried women, and in layman's terms, it is a □□ problem.The patient should be informed, and a signature of the patient's permission and understanding of how to do the examination should be obtained.Especially when she is still a 13-year-old girl who is underage, she needs her mother to take over this right.The child's mother said as the child said before she was hospitalized: I handed the child over to you, and you can see how to treat her.I agreed to do the imaging very cooperatively."
I should still have a template there, I'll send it to you later."
Yan Hong wanted to collect the documents that he needed for clinical use, and told Li Min with certainty."
I went with you to get it, so why didn't you run around
.
"* Li Min went to the obstetrics and gynecology department to get the template from Yan Hong, and after coming back to write it, he asked the child's mother to sign it, and then went to the medical department to find Director Qin to sign, and went to the hospital office to stamp the official seal.By the time she got back to Corey, it was already lunchtime.Then she rushed home to change her clothes like a war, turned on the washing machine, and then went to Yan Hong's house for dinner.Pan Zhi didn't come back to eat, only Yan Hong and Xiaoyan sat at the edge of the dining table, the pungent aroma and rising heat showed that the two had already started eating."
Why did you come back?
Director Qin is not difficult for you, right?
”Yan Hong held the rice bowl and said, "I'm hungry, so I won't wait for you." ”"Eat first when you're hungry, don't wait for me.The medical office has done it there, this is normal work, and Director Qin will not embarrass me for such a signature.I just went to change my clothes.Xiaoyan, you want to help me dry the clothes in the washing machine for a while. ”Li Min took the rice bowl and chopsticks handed to him by Xiaoyan and began to eat."
Hmm."
The little girl agreed, picked up her rice bowl and continued to eat.At the invitation of Pan Zhi and Yan Hong, Li Min's three meals have been arranged at their house.Li Min also told them that in addition to paying an average food fee, she would give Xiaoyan another 50 yuan every month.Xiaoyan is very happy.Li Min's house is not only cleaning but washing clothes, and the room where no one lives is easy to clean, and it is not difficult to wash clothes with a washing machine.Cooking is to add half a bowl of rice, and to cook is to cut an extra potato, not to mention the effort.The only thing that counts as "troublesome" is to send Li Min breakfast and dinner.But she's really happy to go out for a walk.Because Xiao Chen and Xiao Zhang chose to go home early and late in order to help their daughter-in-law pick up the child and go to the nursery.Li Min naturally had no objection to the two of them's choice.* "Don't go to see the child's iodized oil radiogram." ”Li Min said to Yan Hong while eating."
Well, I'm not going.Do you think the child is going to have a genetic test?
”"I told her mom and she agreed to do it.It's just that our provincial hospital can't do it, so we have to go to the medical university.But I think she's probably XX. ”"But her last operation was an ovotest.What if it's XXY?
”"I don't see any deformities in the genitalia.If she had □□ in her body, I don't think she would be in her current physical condition.You can see that her menarche time and menstrual history do not support the interference of male hormone secretion. ”"How can you explain the pathological diagnosis of her last ovo-testicle?"
Li Min thought for a moment and said, "Why don't we borrow her pathology film from last time and let Director Chai compare it with Dr.?"
It's not that I don't believe in the pathology of the children's hospital, it's that the clinical signs and the diagnosis don't match at all.In fact, for us, it may be that the frozen section during the operation is more meaningful.You say, don't you?
”"Naturally.If it is XX, we will definitely have to reset the ovaries and uterus.Minmin, how do I think and think that her dysmenorrhea is wrong. ”"Do you think it's possible that she was misled by her classmates, or misled by physiology class?"
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Yan Hong thought for a moment and said, "It's also possible."
Otherwise, her uterus is not in the normal position, how can there be pain in the normal position.And her menstrual cycle, I can't say if it was affected. ”"That may have an effect, but she doesn't live on campus.No, she may have been influenced by her mother.Therefore, I really have to go to the pathology room in the afternoon to see if Director Chai can come forward to find her pathology film from thirteen years ago.I guess Director Chai and Dr.
Chai will be interested.But if you can't do it, you have to come forward to borrow the film, and I heard that the children's hospital is not easy to talk to. ”"That's not something that a little doctor like us can manage.You've completed all the tests and scheduled the surgery as soon as possible. ”"Well, it's going to see the results of the iodized oil angiogram, and I'll schedule the operation as soon as possible
.
"* Li Min went to the obstetrics and gynecology department again when she went to work in the afternoon, and showed Su Ying the consent form for the special examination that had been completed, and at the same time handed her the iodine oil imaging application form that Lu Qing handed over to her and had completed the bargaining procedures.As for the pathological examination, Su Ying said that she contacted Director Chai.Li Min suddenly felt a lot more relaxed.That is, she now directly manages relatively few neurosurgical patients, so she has such free time to run for a single patient.Another reason is that the interns who came this time are much better than the previous two sessions, probably because they have been interning for three months and have listened to many big lectures intermittently.When she returned to the department, Lu Qing told her: "Director Su called and said that she had contacted the imaging and asked you to take the patient to the radiology department at 6:15 p.m." ”"Uh-huh, thank you, Sister Lu."
Li Min went to the small ward to inform the mother and daughter non-stop."
Can I eat in the evening?"
The child's mother asked."
It's better not to eat it yet, I'm afraid that she will be nervous at that time, and it won't be good if she vomits again."
Li Min touched the little girl's fluffy hair and gave her a vaccination first: "I'll accompany you for the evening check-up."
That Director Su is my senior sister, she is a careful person, and she will check on you carefully.But this test will be a little uncomfortable, well, it will be much lighter than menstrual cramps, similar to the gas pain before menstruation, you will have to hold on to it then.Can you endure it?
”"Yes, I can."
The little girl agreed very simply.Li Min looked at the child's mother and told her: "You can go too, you won't be too nervous with your child, you must use a speculum for this examination." ”"Okay."
The child's mother hugged her daughter lovingly.My daughter is still so young......
But she understands that this test is for the good of the child.* In the evening, Li Min took the mother and daughter to the radiology department."
Is that Dr.
Yan pregnant?"
The child's mother held her daughter's hand and nervously found a topic to distract herself."
yes.She didn't show her affection, how can you tell?
”"Being pregnant is naturally different.So did she also go on stage for surgery?
”"AhhWe're going to have to wait seven months before we don't work the night shift.As for going to the operating table, I didn't say that I could definitely not go on it for a long time, and it was up to Corey and the individual. ”"Doctor Li, when are you going to get married?"
Li Min replied with a smile: "My boyfriend is a soldier, and I have to wait for him to approve the marriage report." ”"Now the marriage of military personnel still needs to be approved?"
The child's mother was surprised."
Generally, not.He is an officer, and he always has to go through a process.How can you tell I'm not married?
”Li Min is so strange that this woman can not only see that Yan Hong is pregnant, but also that she is not married."
The girl's eyebrows are not scattered, so naturally she is not married.I see that you have a good relationship with Dr.
Yan, think about whether there has been a significant change in her appearance before and after marriage. ”The woman reminded Li Min with a smile.Li Min thought about Yan Hong's appearance after returning from a trip to get married, and asked suspiciously: "I just think she has become beautiful."
The complexion is also very good, as if I have just finished a mask. ”"The little daughter-in-law and the big girl are naturally different."
The child's mother was hindered that Li Min was not married, so she smiled and stopped talking.The servant walked slightly dullly to the radiology department.
*The day shift is gone, and the patients on the night shift have not come up at this time, so it is the easiest time of the day for the radiology department.Li Min didn't know how Su Ying made sense of Director Hu, but it was Director Hu who operated the X-ray machine himself.Su Ying saw Li Min's doubts, and explained while unfolding the instrument package she brought: "A normal salpingogram, Director Hu naturally won't care.Because this is a congenital abnormality, I agreed as soon as I said Director Hu. ”Li Min assisted Su Ying in laying out the list, and the child's mother was more nervous than her daughter.Su Ying comforted her and said, "I have prepared the smallest speculum, don't worry, I will try to be as gentle as possible." ”The child was affected by the tension flowing between the adults and her mother's trembling body, and she grabbed Li Min's hand and refused to let go, hiding her head in her mother's arms, clamping her legs and not cooperating with the examination.Su Ying sighed, what she was most afraid of was encountering such a situation.Li Min stroked the little girl's hair and motioned for her mother to comfort the child."
Coco is good, let's do all the examinations, just do the surgery, and you can go back to school after that.""
Can't I have surgery without a check-up?"
The little girl was obviously terrified of the stainless steel speculum that Su Ying was holding in her hand."
This test is a must to decide whether to remove your mass or put it back in its rightful place.If the uterus and ovaries are cut off like this, you are not a girl, and you can't have menstruation like other classmates.If I didn't do this test, I wouldn't dare to operate on you casually, and I wouldn't be able to give you back if I cut it wrong.Come, be obedient.Yes. ”Li Min gently patted the back of the little girl's hand to comfort her.After thousands of coaxes, the little girl who resisted made Li Min feel guilty, so she coaxed the little girl to start cooperating."
Mom, it hurts."
The little girl screamed and began to struggle.Su Ying immediately said, "Press the leg, I've given the medicine." ”Li Min and the child's mother hurriedly hugged their waists and held one leg each."
Director Hu.You're on.Leave us alone. ”Su Ying immediately took out the speculum and shouted out the door.The 800 milliamp X-ray machine began to turn silently.Su Ying threw the equipment in her hand into the disposal car behind her, and stepped forward to replace Li Min, "Senior sister, you go out."
I'll leave it to me. ”Su Ying knew that Li Min had plans to get married, and she couldn't be allowed to be threaded again at this time.Li Min obediently pushed open the lead door and walked out, she watched through the glass window as Su Ying posed, rotated, and fixed the pelvis for the child under the instructions of Director Hu."
Xiao Su, this position is fixed, you and the child's mother let me, I'll order a film."
Director Hu ordered a few films one after another, and then said, "It's okay." ”The little girl was crying so much that she couldn't breathe, and her mother was crying bitterly when she hugged her daughter.This scene made Li Min wonder if the decision of iodized oil imaging was correct and too cruel.Director Hu instructed people to wash the film, and he showed the video of the machine just now to a few of them, and explained it himself: "You see that iodized oil passes from here, this ectopic tissue is the uterus, this thin and tortuous is the fallopian tube, and this mass is undoubtedly the ovaries." ”"Okay, thank you, Director Hu.Can you keep this video?
”"Okay, you find a video to bring, and I'll make a copy of it for you."
Director Hu readily agreed to Su Ying.Li Min called Corey and asked for a flat car.Waiting for the flat car, the child's mother cautiously asked, "Director Su, Dr.
Li, do you need to do other examinations?"
”"No need.I'll schedule your surgery tomorrow. ”Su Ying replied to the child's mother."
That junior sister, you can see if the surgery in your department can be lined up to the bed, if not, squeeze from my side."
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Li Min replied to her: "I'll call Dean Chen in a while, and if you can't get in line the day after tomorrow, I'll call you." ”"Okay, I'll wait for your call.""
Sister Su, do you want to prepare microscopic instruments and eyepieces?""
Microscope and eyepieces?
I'm not familiar with that.What do you mean?
”"I'm afraid I'll need to do a vascular anastomosis when I get back to my ovaries and uterus."
One of the purposes of the surgery is to solve the inconvenience of the little girl's current life, and more importantly, to ensure her quality of life in the future.The main thing for the uterus and ovaries to be accepted is that the ovaries can get enough blood supply and develop normally.Otherwise, for decades to come, she would have to rely on oral hormones to maintain her female physical characteristics."
Then be prepared.You tell Dean Chen about it, and let him come over and have a look when he has time. ”Su Ying had never done vascular anastomosis under the microscope, so she asked Chen Wenqiang to let them do it when the time came.The flat car came quickly, Su Ying carried the package used in the imaging and said: "Then I'll go back to the ward first, this ointment contains analgesic ingredients, if the child is still in pain at night, you can give the child a little." ”Li Min nodded and took it.The child's mother hurriedly thanked her again.After listening to Li Min's report, Chen Wenqiang said: "Tomorrow, I will invite Director Li from the Department of Obstetrics and Gynecology to come for a consultation, this congenital malformation, they should not have done it in the Department of Obstetrics and Gynecology."
I'll arrange the operation time. ”"Teacher, the child's parents have been divorced for many years.I don't think the economy of her mother and daughter is too good. ”"Hmm.Then I'll go to work tomorrow to read her medical records first, and if you are ready, you will arrange it for the first station the morning after tomorrow.You tell Su Ying that I will go over when the time comes. ”* The little girl after general anesthesia was fixed on a slender high operating table, and after disinfection, Li Min and Su Ying each stood in the position of a helper and a surgeon.Director Li of the Department of Obstetrics and Gynecology stood behind Su Ying.Chen Wenqiang stood between Li Min and Yan Hong and watched Li Min make the first move.The first part of this surgery is a general surgery.It is necessary to start from the groin, open the anterior wall of the groin, and pull the uterus, ovaries, and fallopian tubes that are still included in the inguinal canal out of the incut in the abdomen.This part is operated by Li Min, which is discussed and discussed before the operation.Li Min didn't care about her left and right hands, so she chose to stand in Ichisuke's position.In addition to determining whether the ovaries have □□ components, returning the uterus and ovaries to the normal anatomical position, and considering whether to reshape the mutated deformed cervix.This part was done by Su Ying, and Li Min also gave up his position to help Yan Hong.Anyway, I don't do obstetrics and gynecology anymore, and giving it to Yan Hong is the best choice.Because Yan Hong, she needs this case to write a paper.As for the elongated, twisted, mutated fallopian tube, this one doesn't need to be dealt with first.Li Min asked for a piece of saline gauze and carefully wrapped the fallopian tubes.Now to distinguish the seemingly normal ovaries, is it an ovotesticle or not?
If it is an ovone, it will be reabsorbed into the abdominal cavity, which will greatly increase the likelihood of malignant transformation.Dr.
Yang was already ready, and when it was his turn to identify whether there was □□ tissue, he immediately came to the stage and carefully performed dozens of fine-needle biopsies on this suspicious ovary.Li Min was surprised by such a serious Dr.
Yang, who had not undergone surgery with Dr.
Yang for more than a year.Is this man still like this?
She didn't know how much work Dr.
Yang had put into the Department of Urology, and of course she didn't know that Dr.
Yang had repeated the fine needle puncture test in the laboratory after yesterday's consultation.It wasn't until his eyes were so tired that his vision was blurry that he stopped and followed Director Luo home.The rest is waiting for the pathological results provided by Director Chai and Dr.
Chai.Yesterday, Director Chai also attended the consultation, and then he came forward through the medical department of the provincial hospital, and borrowed the pathology film from the children's hospital in time, and the doctor hurriedly came from the medical university to assist.However, to his and Dr. regret, the pathological film was not well preserved, and did not provide absolute, convincing, microscopic histological support for the original ovotestic diagnosis.() The distance is a bit far