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罕见!高龄孕妇不知自己怀孕8个月 还患宫颈癌

2017-10-20 07:57:55   中国青年网

每月来“例假”,怀孕34周不知自己要当妈

罕见!大意孕妈妈竟有宫颈癌

肚子日渐大了,但35岁的资阳妇女刘萍(化名)却不相信自己怀孕了:每个月都来例假,怎么会怀孕呢?

但超声检查确认她怀孕。在10月11日那天,刘萍走亲戚路过成都市妇女儿童中心医院时,“顺便”进去检查一下究竟是否真怀孕,这一查,竟查出生死攸关的问题:罕见的晚孕合并宫颈癌!

10月13日,市妇儿中心医院采用多学科联动模式,为刘萍实施了该院首例足月孕合并宫颈癌手术,让她的生命化险为夷。

是怀孕?怎么可能?

肚子大了就是怀孕?这种说法当然站不住脚,对家住资阳市雁江区老君镇的刘萍来说,这更站不住脚。首先,她没打算过再要孩子,其次,她每个月都来例假。因此,当同村的熟人看着她一天天大起来的肚子向她道喜时,她却嗤之以鼻:“我每个月都来月经,也没害喜,怎么就怀孕了呢?”

不过,见自己的肚子一日比一日隆起得厉害,她还是去了当地卫生院做超声检查,结果显示,她已怀孕8个多月!

面对这样的结果,她依然有些不相信。9月5日,她到成都走亲戚,正好路过成都市妇女儿童中心医院,听说这是很权威的妇儿医院,就打算去确认一下,看自己是否真的怀孕。然而,这里的超声检查仍提示,她怀孕34周零3天!她终于相信,自己确实怀孕了。

由于当日她仅仅选择了个超声检查,因而不会知道,危险正一步步向她靠近。幸好,她去了第二次!

有危险!强行安排病人入院!

刘萍第二次去市妇儿中心医院,是10月11日,她去的目的,是“想去问问医生好久生宝宝”。她拿着仅有的零星检查单,走进危小庆医生的诊断室。在这里,刘萍对自己“离奇”的怀孕过程谈笑风生,但危小庆听着听着,却从笑谈中听出了让她不安的多重危险:孕期非正常阴道出血、贫血、高龄、高血压、甲状腺功能异常……

之前的超声检查虽然没有提示刘萍胎盘位置异常,但患者有非正常阴道出血,危小庆凭着医生的敏锐判断力和高度责任心,她要求刘萍一定要做一次宫颈检查,通过检查判断出血原因。但她的要求被刘萍断然回绝,她说:“我不检查了,只需要晓得我好久生娃儿!”

危小庆医生有些急了,她不放刘萍走,耐心地解释后,她坚定地说:“你随时可能出现意外状况,我要马上安排你入院,你真的不能走!”尽管医院床位非常紧张,但危小庆依然通过绿色通道,火速把刘萍收入病区。

好可怕!是晚孕合并宫颈癌

刘萍是当日17:30进入母婴一区病房的,正逢市妇儿中心医院产科主任罗丹加班查房。在了解到病人孕期经过后,经验丰富的罗丹立即意识到问题严重,她也坚持让刘萍作详细检查。

通过查体,罗丹发现,刘萍宫颈处有大量脓性分泌物,且有接触性出血,能扪及凹凸不平的鸡蛋大小的结节,而且质地很脆,“我基本确定这个病人合并有宫颈癌!”罗丹说,刘萍之前顺产过两次,是标准的经产妇,鉴于她的病灶易出血,经阴道分娩可能导致大出血,还可能导致癌灶播散,就建议患者剖宫产终止妊娠,并安排输血纠正贫血,完善所有术前准备。

为了病人安全,罗丹主任专门为患者安排了该院著名妇产科专家、业务副院长林永红教授为她会诊。林永红教授紧急赶来,他的检查进一步判断:基本确认宫颈癌、分期IB2期,有手术机会,可在剖宫产手术的同时行广泛子宫切除术+盆腔淋巴结清扫术。

这是不幸中的万幸,像刘萍这样的宫颈癌患者还有手术机会,但这样开创性的手术,风险也极高,稍有不慎便会大出血,甚至危及母子生命。林永红教授推掉第二天满满的日程安排,他命令:多科室联动,共同攻克这个难题!

多科协作,产妇成功脱险

10月13日9:00,市妇儿中心医院首例足月孕合并宫颈癌手术拉开序幕。手术在林永红的指挥和医务部、护理部的协调下有条不紊地开展:

麻醉医师实施腰硬联合麻醉后,林永红为病人取宫颈组织送快速冰冻检查,与此同时,产科杜彧华主任医师和助手实施经腹子宫下段剖宫产术。该名患者顺利生下一个体重3450克的女婴,新生儿评分满分。此时,病理科冰冻报告回示:宫颈细胞癌!

一切都在总指挥林永红的掌握之中。剖宫产同时进行广泛子宫切除术+盆腔淋巴结清扫术势在必行。

为了尽力把患者出血的风险降到最低,该院介入科及超声科到场,赵虎副主任医师在B超引导下为患者实施了腹主动脉球囊置入术+暂时封堵术。此时,麻醉医师改麻醉方式为全麻,与此同时,检验科为此例特殊手术病人待命备战,绿色通道输送血源,以最快速度监测患者各项体液指标改变。

在多科协助配合下,由林永红主刀,在罗丹主任、杜彧华主任医师及魏艳主治医师等配合下,实施广泛子宫切除术+双侧输卵管切除术+盆腔淋巴结清扫术+腹主动脉淋巴结取样。

手术历时2个多小时,尽管难度大,但得益于对出血的预防性控制和林永红等专家的技术、手术一气呵成。

手术结束,患者被送往妇产科重症医学科(ICU)进一步监测治疗,这名大意的妈妈,终于彻底脱离生命危险。

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