"Does menstruation affect pneumothorax? Or is it related to menstruation? "Su Yun looked at Zheng Ren in confusion.
Zheng Ren was also in a daze.
Menstrual pneumothorax was common, but it was mostly related to endometriosis. However, if it was endometriosis …
Zheng Ren was stunned. Could it be menstrual pneumothorax?!
The disease was so rare that Zheng Ren had not thought about it at all.
"Boss, if it's endometriosis, the pneumothorax on the right side will mainly occur during menstruation, but … Old Shao, the patient had seven surgeries. How many times did she have on both sides?" Su Yun asked.
"Four times on the left side and three times on the right side," Shao Jinghe answered immediately.
"I don't think so," Su Yun said softly with a frown.
He was unsure and subconsciously did not dare to say that it was spontaneous pneumothorax caused by endometriosis.
Zheng Ren suddenly stood up and went to the radiographic film viewer to look at the image.
Shao Jinghe was dumbfounded. He looked at Fang Lin blankly, not knowing what to do.
Fang Lin had never encountered such a disease. Although he knew about menstrual pneumothorax, he did not even know how to take the exam.
If an examiner were to take this test, he would probably be beaten until he had a pneumothorax.
"The endometrium migrates to the surface of the pleura and lungs to grow, and it falls off during menstruation. Because the pleura is very thin, it is easy to damage, causing air to enter the pleural cavity from the lungs, forming pneumothorax and causing symptoms, "Zheng Ren said as he thought.
It was as if he was talking to himself, but also like he was talking to someone in the unseen world.
"The diaphragm is fine."
"Well, it doesn't seem to be a problem with the diaphragm." Zheng Ren looked at the radiographic film. "Usually, menstrual pneumothorax is accompanied by diaphragm damage …"
After that, he held his chin and asked, "Old Shao, if I understand correctly, you just said that the patient has a menstrual period every time she has a pneumothorax, and the menstrual period is also very long and relatively large. Is that right?"
Shao Jinghe nodded repeatedly.
Although he had no idea what Little Zheng was thinking, he could still answer the most basic questions.
"Uh …" Fang Lin did not look at the radiographic film but looked at Boss Zheng, a little speechless.
"The diagnosis is menstrual pneumothorax," Zheng Ren said with certainty. "There are four diagnostic criteria."
"…" Fang Lin looked at Boss Zheng in astonishment. Did he hear wrongly just now?
"First, spontaneous rupture of the alveoli."
"Secondly, uneven uterine contractions during menstruation promote gas into the uterine cavity, through the fallopian tube into the abdominal cavity. At this time, the ectopic endometrium that occludes the diaphragm pore falls off, the diaphragm passage is opened, and gas enters the thoracic cavity and causes the disease."
"Third, the ectopic endometrium on the visceral pleura falls off, causing the lungs to leak."
"Fourth, the bronchiole rupture caused by prostaglandins or the one-way valve mechanism caused by bronchiole endometriosis."
Shao Jinghe was not the only one who was confused. Even Fang Lin was puzzled by his explanation.
"She has endometriosis and is diagnosed with menstrual pneumothorax, which meets criteria 1 and 3," Zheng Ren said.
"But …" Shao Jinghe wanted to say something, but he didn't.
"There's a problem with the diaphragm." Su Yun added, "It's a very small crack. Only when the abdominal pressure increases will there be a small crack, causing the endometrium to appear ectopic again."
"Again …"
"It traveled even further and landed directly on the lungs. Finally, it eroded the visceral pleura during menstruation, causing spontaneous pneumothorax. "
"Yes." Zheng Ren nodded. "Old Shao, did you observe the diaphragm during surgery?"
"No …"
Shao Jinghe was confused. Why would anyone observe the diaphragm during a pneumothorax surgery?
"Yes, during surgery, we used single-lumen ventilation and carefully looked for the diaphragm. I think there's a small crack. Forget it, we'll use a laparoscope to apply pressure. If the pressure is too high, we can see gas entering the thoracic cavity. "
"Boss Zheng, Brother Yun, shall we go and take a look?" Fang Lin was uncertain.
"You speak as if you don't have a second-rate professor," Su Yun said casually.
That being said, it was absolutely impossible for him not to go on stage. It was rare for menstrual pneumothorax. Su Yun would fight Fang Lin to the death if he did not take a look.
There was no problem with the patient's fasting time, so they went for the surgery. There was still half an hour to prepare, so they went straight to the operating room.
"Boss, the diaphragm muscles are very developed and rarely have problems. Is it a congenital problem? "Su Yun asked.
"It's possible. We'll know when we go up and take a look," Zheng Ren said. "After repairing the diaphragm, we'll still have to take chorionic releasing hormone treatment after the surgery. It should be fine soon."
Su Yun suddenly thought of something. He looked at Shao Jinghe and asked, "Have you done all the postoperative pathology for the previous surgeries?"
"…"
Shao Jinghe was dumbfounded by the question.
Normally, all the things that were cut off had to be sent for pathological examination. For example, the appendix. Out of a thousand, one to two might have malignant changes.
Because the period of pathological diagnosis was long and the cost was expensive for some families, there were many who refused to do pathological examinations.
Doctors, especially doctors from lower-level hospitals, rarely forced patients to do pathological examinations. As for the patients who came to the 912, they did not even tell the patient's family about this matter. It was only natural for them to do pathological examinations after the surgery.
This was one of the differences between a small local hospital and a top Class Three Grade A hospital in the Imperial Capital.
This patient had spontaneous pneumothorax. The diagnosis was very clear. There were basically no problems with the bullae of the lung that was cut off during the surgery.
At least, Su Yun had never seen it before.
Shao Jing and Doctor Shao probably had the same thought. From the looks of it, he had not done a pathological examination.
Sure enough, Shao Jinghe said embarrassedly, "I didn't do it."
"Old Shao, your work is too careless," Su Yun said disdainfully. "If you did it once, even if it was only once, such a situation wouldn't have happened. You … "
"Brother Yun, it's not like that." Shao Jinghe was about to cry. He quickly said, "The patient's family isn't very rich. I didn't even dare to use titanium clips during the surgery. I sutured it manually. The pathology report is also one — it's consistent with the changes in the bullae of the lung. I don't think it's meaningful. "
Zheng Ren sighed and shook his head slightly.
The examination was like this. The possibility of a problem occurring was not high. However, once a problem occurred, such as the current situation, it could lead to a misdiagnosis or missed diagnosis.
This was the standard example of good intentions doing bad things.
But then again, 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 the bullae of the lung matched the endometrium's microscopic condition. No one in the local hospital dared to diagnose it.
When the time came, they would take the pathological section to a higher-level hospital for a diagnosis. It would still be a hassle.
It was already considered very good for a primary hospital to be able to correctly diagnose and treat common diseases.
As for rare diseases, they would not encounter a single case in ten or twenty years. Even if they learned a set of dragon slaying skills, it would be useless.
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