Under the lens of the thoracoscope, a fist-sized red tumor looked like a giant egg lying in a bird's nest, silently looking at the doctor in front of the camera. The bird's nest is a bunch of large blood vessels in the patient's chest, such as the aorta, superior vena cava, etc.,

In late May 2019, Capital Medical UniversityBeijing Chest Hospital operating room.

Under the lens of the thoracoscope, a fist-sized red tumor looked like a giant egg lying in a bird's nest, silently looking at the doctor in front of the camera.

The bird's nest is a bunch of large blood vessels in the patient's chest, such as the aorta, superior vena cava, etc., surrounding the tumor. These blood vessels are like high-voltage wires that no one can touch. If it touches or breaks, the blood will spurt out and cannot be stopped at all.

The red tumor looked at the chief surgeon, Li Yunsong, seemingly provocatively.

Can you try to move me?

On March 10 this year, 24-year-old Xiaoyan and her lover entered the marriage hall hand in hand. Xiaoyan, who was still on her honeymoon, started to suffer from chest pain for no reason since April. When it hurts, I always want to press the painful area on my chest, but the pain does not relieve at all. This pain without trigger lasts for a month. Could it be gastric ulcer? Xiaoyan also had a stomach check, but there was nothing wrong with her stomach.

Xiaoyan is young and in good physical condition. She has never had any serious illness before, but she could only endure the chest pain for a month. However, during a physical examination organized by her work unit in May, Xiaoyan was unexpectedly told that she had a tumor in her chest. It looked quite small!

Xiaoyan quickly found the Thoracic Surgery Department of Beijing Chest Hospital. After the examination, Li Yunsong, MD, deputy chief physician of the Thoracic Surgery Department, told Xiaoyan that there was good news and bad news.

The good news is that Xiaoyan’s tumor is a benign teratoma . Benign teratomas generally grow slowly, but will grow rapidly once they develop into malignant tumors.

Teratoma is actually formed by another embryo during fetal development and does not belong to the patient's own tissue. It is generally benign. The chance of recurrence after benign teratoma is removed is very low. Teratomas generally grow in the sacrococcygeal area, , mediastinum, , retroperitoneum, and gonads. The proportion of women suffering from teratomas is relatively high.

Some people have teratomas but do not have any symptoms. It is possible that they will never know it unless they go to the hospital. But some people have symptoms, like Xiaoyan’s symptoms, which are persistent chest pain.

Although Xiaoyan’s teratoma is benign, the bad news is that the teratoma is in a dangerous location, right next to the heart blood vessels! The white part in the picture below is the cross-section of the cardiovascular system, and the gray shaded part is the teratoma. It can be seen that this teratoma is very close to the heart blood vessels and must be removed. If the teratoma causes cardiovascular rupture and bleeding, the consequences will be disastrous.

The scene at the beginning of the article happened.

Xiaoyan's tumor grew in the space between the aorta and superior vena cava, surrounded by large blood vessels. Like a giant egg lying in a nest of blood vessels.

Fortunately, this tumor is like a soup dumpling with a layer of skin on the outside. It has not directly invaded the surrounding blood vessels that are as dense as a bird's nest. Visual inspection shows only some adhesions. But the actual situation can only be determined after direct exploration with a scalpel. Just like a wig can fit perfectly with the scalp, it is difficult to completely figure it out with the naked eye. You can only really confirm it by pulling it up. Although

is a benign tumor, it also has its own way of survival. As it grows up and consumes more nutrients, it will induce the human body to grow small blood vessels specifically for it. It is like an oil rat stealing oil, constantly absorbing nutrients from fresh blood, and growing up day by day. .

The devil is as high as one foot, and the Tao is as high as one foot. Dr. Li Yunsong picked up the surgeon's ultrasonic scalpel and carefully removed the tumor along the gap between the tumor and the large blood vessels of the heart. This is a dance on the tip of a knife, like walking on a balance beam. Deviation in any direction will lead to failure of the operation. If the direction of the blade is biased towards the tumor, it will lead to tumor residue and recurrence. If it deviates toward the heart, it can lead to life-threatening bleeding.

After 30 minutes, the giant egg and the surrounding bird's nest-like blood vessels were completely separated. Finally it can be taken out safely.

The last problem is that this is a minimally invasive surgery, and the hole made in the chest is only 4 centimeters at most.But this tumor is six centimeters in diameter.

The peeled off tumor is like a thin-skinned soup dumpling with large filling. It must be taken out completely through this small hole without breaking or leaking. Once it leaks, the malignant tumor cells that may exist inside will be sown in the chest like seeds, which will be even more troublesome.

Why are surgeons awesome? To use a magician’s words: Now is the time to witness miracles.

comes out, it can be cut.

Be careful.

After the operation, Xiaoyan recovered well.

Li Yunsong, deputy chief physician of the Second Department of Thoracic Surgery, Beijing Chest Hospital Affiliated to Capital Medical University, doctor of surgery, master's tutor, youth committee member of the Thoracic Surgery Branch of the China Association for the Promotion of Medical Sciences, member of the American Society for Cancer Research, specializes in lung cancer, mediastinal tumors and the diagnosis and treatment of other benign thoracic tumors.

is out every Tuesday afternoon.

Pictures and text: Yuan Meng/Uncle Fixed Focus

Medical professional proofreading: Li Yunsong, deputy chief physician of the Department of Thoracic Surgery, Beijing Chest Hospital, Capital Medical University

Thanks to: Li Yun for his help