In the process of fighting against diseases, Ruijin has always moved forward bravely, creating countless miracles and accumulating many original experiences. It is precisely because of the successful treatment cases that Ruijin has become a hospital that today is trusted by patients, pride of employees, respected by peers, and satisfied with society.
Train tumor is rare in the field of thoracic surgery, hidden symptoms and special location, and the operation is extremely difficult. It can be described as the "pinpoint work" in the field of thoracic surgery. Recently, Grandma Wang (pseudonym), an 85-year-old man from Nantong, Jiangsu Province, experienced a "three-high surgery" of "high difficulty + advanced age + high complications" at Ruijin Hospital in . It is gratifying that this octogenarian was able to walk around independently and take care of himself 5 days after the operation, which made his family very happy.
1 "Grape-shaped" tumors "occupies" the tracheal "fortress"
A year ago, 85-year-old Grandma Wang started to have asthma after activity. Her family thought she was older and did not pay attention. In August this year, she began to intensify asthma and cough. Seeing that breathing was getting more and more difficult, her children quickly accompanied her to the local hospital for treatment. After examination, Grandma Wang had a "grape-shaped" tumor in her trachea, which occupied nearly 3/4 of the "ventilation fortress". biopsy confirmed it to be a malignant tracheal tumor. However, the operation was too difficult, further treatment was not possible.
After many twists and turns, Grandma Wang and his family came to the thoracic surgery clinic of Ruijin Hospital. After receiving the treatment, Zhang Yajie's attending physician immediately realized the seriousness of the problem - if the treatment is not done in time, it may be life-threatening! But such a "three-high" operation is indeed very difficult. He immediately reported the situation to Li Hecheng, director of thoracic surgery. "Add to treat her as soon as possible! We will find a way to save her!" Director Li Hecheng decided.
Dr. Zhang Yajie introduced that tracheal tumors generally grow slowly, with no specific symptoms or signs in the early stages, which are very easy to misdiagnose and misdiagnosis, and are often in the advanced or advanced stage when diagnosed. When the tumor body accounts for 2/3 to 3/4 of the lumen, it will cause severe respiratory obstruction and threaten life, and have a poor prognosis. Tracheal tumors are one of the most difficult surgeries in thoracic surgery at present. The surgical technology and anastomotic reconstruction methods are complex. They are prone to complications such as bleeding, anesthesia accidents, anastomotic fistulas, and respiratory failure during and after surgery. Not only does it have high requirements for surgical technology, but it has very high requirements for intraoperative anesthesia technology and perioperative management. Grandma Wang is an elderly patient, and the situation is even more serious. "When I got Director Li's affirmative answer, coupled with my trust in my brother departments such as anesthesia and critical illness, I had a clear idea at that time!" Zhang Yajie said.
2 The "grapes" in the thorny bush" of the thoracic surgery
After being admitted to the hospital, the doctor conducted a series of detailed examinations for Grandma Wang, conducted a more detailed assessment of the condition, and consulted with multiple disciplines such as thoracic surgery, respiratory department, anesthesia department , critical care medicine department , critical care medicine department , to improve the formulation of surgical plans, predict surgical risks and formulate relevant plans.
Soon, a robot hybrid surgery tracheal tumor resection and tracheal reconstruction surgery began. The surgery was performed by the team of Director Li Hecheng of the Department of Thoracic Surgery. First, we must split the sternum at the incision of the middle of the sternum, free the upper mediastinal thymic adipose tissue, dissect and free important and thick blood vessels such as the left unnamed vein, superior vena cava , and the right arm trunk, expose and free the deep trachea, and remove all the lesion of the trachea. Since there are important blood vessels and organs around the trachea, any damage may be very dangerous. The difficulty of the operation can be imagined. Fortunately, Director Li Hecheng has rich experience, "a set of knife techniques" is smooth and smooth, and the surgical area is clean and clear, and he successfully removed the tracheal segment where the patient's tumor tissue is located.
Subsequently, Li Hecheng's team innovatively used a robotic surgical system to perform tracheal reconstruction anastomosis on the patient. The trachea is the "main channel" for the human body's oxygen supply, and the anastomosis reconstruction method is also very complex. The robot surgical system has a high-resolution three-dimensional image processing system, which can make the field of vision clearer and has a simulated wrist with 7 degrees of freedom of movement. It is more flexible and slender than human hands, and can penetrate deep into the tracheal tissue for more precise anastomosis, improving the accuracy and stability of anastomosis. After
3 hours, the operation was successfully completed.Grandma Wang was sent to the intensive care unit for postoperative monitoring and treatment.
3 Multidisciplinary escort, and you can take care of yourself 5 days after surgery
"The pathology of the external hospital confirmed that tracheal malignant tumors account for 3/4 of the tracheal cavity. The texture is brittle and easy to bleed when touched. Therefore, for our challenge, 'oldering' is just the beginning." Dr. Shen Jie, who participated in the anesthesia, said, "We used repeated measurements and calculations through CT imaging data to accurately select the most suitable tracheal catheter and intubation depth that can pass through the tumor gap. Finally, anesthesia-induced intubation is in place in one step, and the artificial airway is quickly and effectively established without any airway bleeding."
" In order to ensure the effective oxygen supply of patients, ventilation on the operating table and ventilation under the operating table need no The sewing connection is particularly challenging the close cooperation between the anesthesiology department and the thoracic surgeon. "Luo Yan, director of the anesthesiology department, said, "At the same time, through careful evaluation, we removed the tracheal catheter in the operating room, allowing patients to breathe independently as soon as possible, reducing the bedtime and postoperative infection risk. For such airway tumors, we have mature preoperative evaluation and anesthesia plan, and complete airway evaluation methods to deal with it at any time."
In the intensive care unit , Director Liu Jialin believes that tracheal management, coughing and sputum after tracheal surgery and preventing lung infection is very important, and various measures need to be taken to reduce the incidence of complications. "We discussed several versions of the plan before the operation, such as whether the patient comes back after the extubation or brings the tracheal intubation, it depends on the actual situation of the operation, but our treatment plan must be complete. For Grandma Wang, the most important thing is how to find a balance point, which not only protects the anastomosis of the airway, but also does a good job of sputum drainage to prevent infection, and also provides nutritional support as soon as possible to make her overall condition better and better, and ultimately avoids the occurrence of anastomotic fistula."
Interestingly, because Grandma Wang does not understand Mandarin at all, in order to smooth communication and allow Grandma Wang to cooperate with treatment and rehabilitation, Dr. Zhang Yajie, who can call Nan, also acts as a "translator", traveling back and forth between the critical care medicine every day, which touched the family. Five days after the operation, Grandma Wang had already acted independently and took care of herself. A few days later, the children happily picked her up home!
"We are all ordinary farmers. After experiencing repeated rejections, the brother and sister felt that the sky was about to collapse. We were lucky to come to Ruijin and met a group of good medical staff who care about us. We must take good care of our mother. I hope she lives to 100 years old and live up to the hospital's treatment!" said Grandma Wang's son.
It is reported that the Department of Thoracic Surgery at Ruijin Hospital has established a subspecialty for mediastinal , trachea, and chest wall tumors and MDT clinics, which are specially designed to discuss complex and difficult trachea such as Grandma Wang and mediastinal , and formulate personalized treatment plans to solve fundamental problems for more such patients.
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A successful treatment is behind the result of a joint efforts of a team or a multi-disciplinary team. The belief of the Ruijin people to overcome difficulties and make everything for the patient will never change, and their pursuit of the peak of medicine will never stop.
Written and edited by | Tang Wenjia
illustration | Jiang Yan
