"Does menstruation affect pneumothorax? Or is pneumothorax related to menstruation?" Su Yun looked at Zheng Ren in confusion.
Zheng Ren was also in a daze.
This is true for menstrual pneumothorax, but it is mostly related to endometriosis. But if it’s endometriosis…
Zheng Ren was stunned for a moment, could it be menstrual pneumothorax? !
This disease is so rare that Zheng Ren didn't even think about it.
"Boss, if you have endometriosis, pneumothorax will be mainly on the right side and occur during menstruation, but... Lao Shao, the patient has had 7 surgeries, how many times have he had both left and right sides?" Su Yun asked.
"Four times on the left side and three times on the right side." Shao Jinghe immediately replied.
"That shouldn't be the case." Su Yun frowned and spoke very quietly.
He was unsure, and subconsciously he was not sure that it was a spontaneous pneumothorax caused by endometriosis.
Zheng Ren stood up suddenly and came to the reader again, looking at the image.
Shao Jinghe was dumbfounded. He looked at Fang Lin blankly, at a loss.
Fang Lin has never encountered this kind of disease. Although he knows about menstrual pneumothorax, he can't even take the exam.
If any examiner asked this question, he would probably be punched in the chest.
"The endometrium migrates to the pleura and the lung surface, and then falls off when menstruation begins. Because the pleura is very thin, it is prone to damage, causing air to enter the pleural cavity from the lungs, forming a pneumothorax and causing symptoms." Zheng Ren said , while thinking.
It seemed like he was talking to himself, or like he was having a conversation with someone somewhere in the dark.
"The diaphragm is fine."
"Well, it's not like a diaphragm problem." Zheng Ren looked at the video, "Generally, menstrual pneumothorax is accompanied by diaphragm damage..."
After saying that, he held his chin and asked: "Old Shao, if I understand correctly, what you just said is that every time the patient has a pneumothorax, it is a menstrual period, and then the menstrual period is very long and the amount is relatively heavy, right? .”
Shao Jinghe nodded repeatedly.
Although he had no idea what little boss Zheng was thinking, he could still answer the most basic questions.
"Uh..." Fang Lin didn't watch the movie, but looked at Boss Zheng, a little speechless.
"Diagnosis of menstrual pneumothorax." Zheng Ren said with certainty, "There are four diagnostic criteria."
"..." Fang Lin looked at Boss Zheng in shock. Did he hear what he just said wrong
"First, spontaneous rupture of bullae."
"Second, uneven uterine contractions during the menstrual period prompt gas to enter the uterine cavity and enter the abdominal cavity through the fallopian tube. At this time, the ectopic endometrium that blocks the micropores of the diaphragm falls off, the diaphragm channel opens, and the gas enters the chest cavity and causes the disease."
“Third, the ectopic endometrium on the visceral pleura is shed, causing lung air leakage.”
“Fourth, alveolar rupture due to prostaglandin-induced bronchiolar constriction or one-way valve mechanism due to bronchiolar endometriosis.”
Zheng Ren started talking again, and not only Shao Jinghe, but also Fang Lin was confused.
"I have endometriosis and am diagnosed as menstrual pneumothorax, which meets criteria 1 and 3." Zheng Rendao.
"But..." Shao Jinghe wanted to say something, but in the end he remained silent.
"There is a problem with the diaphragm." Su Yun added, "A very small tear. Only when the abdominal pressure increases will there be a small gap, causing the endometrium to ectopic again."
"again… "
"It goes further and falls directly on the lungs. Finally, it erodes the visceral pleura during the menstrual period, leading to the continuous occurrence of spontaneous pneumothorax."
"Yes." Zheng Ren nodded, "Old Shao, have you ever observed the diaphragm during surgery?"
"without… "
Shao Jinghe was at a loss. During pneumothorax surgery, who was watching the diaphragm for nothing
"Well, during the operation, single-chamber ventilation was used. Carefully look for the position of the diaphragm. I guess there is a small tear. Forget it, let's use laparoscopy to pressurize. If the pressure is too high, you can see air entering the chest cavity."
"Boss Zheng, Brother Yun, can we go up and have a look together?" Fang Lin was unsure.
"It sounds like you don't have any second-tier professors," Su Yun said casually.
That's what he said, but it's absolutely impossible to prevent him from taking the stage. Such a rare menstrual pneumothorax, Su Yun had to fight Fang Lin desperately if he didn't go up and take a look.
There was no problem with the patient's fasting and drinking time, and the order was submitted for surgery. There was still half an hour of preparation time before the operation, so Zheng Ren and Su Yun went directly to the operating room.
"Boss, it is said that the muscles of the diaphragm are very well developed and problems rarely occur. Is it a congenital problem?" Su Yun asked.
"It's possible. We'll find out when we go up and take a look." Zheng Ren said, "Repair the diaphragm and take chorionic releasing hormone treatment after the operation. It should be cured soon."
Su Yun suddenly remembered something. He looked at Shao Jinghe and asked, "Were all the postoperative pathology done in the previous surgery?"
“…”
In one sentence, Shao Jinghe was dumbfounded.
It is said that all the things that are removed must be sent for pathological examination. For example, appendices, 1-2 out of 1,000 may be malignant.
Because pathological diagnosis takes a long time and the cost is too expensive for some families, many people refuse to undergo pathological examination.
Doctors, especially those in lower-level hospitals, rarely force patients to undergo pathological examinations. Patients who came to 912 did not tell the patient's family about this matter at all, and it was only natural for them to undergo pathological examination after surgery.
This is the difference between small local hospitals and top tertiary hospitals in the imperial capital.
This patient had a spontaneous pneumothorax, and the diagnosis was clear. There were basically no problems with the pulmonary bullae removed during the operation.
At least Su Yun has never seen it.
I guess Shao Jing and Dr. Shao thought the same way. Judging from his appearance, he probably didn't undergo a pathological examination.
Sure enough, Shao Jinghe said sarcastically: "I didn't do it."
"Old Shao, your work is too meticulous." Su Yun said disdainfully, "If you do it once, even just once, this situation will never happen. You..."
"Brother Yun, it's not like that." Shao Jinghe was about to cry and said quickly: "The patient's family is not very wealthy, so I didn't dare to use titanium clips during the operation. They were all sutured by hand. The pathology report was - It’s consistent with bullous changes, but I don’t think it makes sense.”
Zheng Ren sighed and shook his head slightly.
The inspection is what it is, and the likelihood of something going wrong is unlikely. But once a problem occurs, such as the current situation, it may lead to misdiagnosis or missed diagnosis.
This is standard good intentions leading to bad deeds.
But having said that, even if Shao Jinghe did a pathological examination and sent the specimen to the pathology department, the doctor there would probably go crazy.
The pathological examination of pulmonary bullae was consistent with the microscopic condition of the endometrium, but no one in the local hospital dared to diagnose it.
When the time comes to take the pathological slides to a higher-level hospital for diagnosis, it will still be a hassle.
Grassroots hospitals are considered very good if they can correctly diagnose and treat common diseases.
As for rare diseases, there has not been one case in ten or twenty years. Even if you learn a dragon-slaying skill, it will be useless.
…
…
(Please give me some sympathy and monthly votes.)