The endoscopic team of Zhongshan Hospital broke into the restricted area again
Cleverly used a small intestinal scope to remove huge polyps
Removal of the "zippered abdomen" patient intestinal insperpation bitterness
54-year-old Ms. Zhou has been tortured by multiple intestinal polyps for more than 30 years. Since she was 20 years old, she underwent four surgical open abdominal surgery to remove the intestinal segment caused by polyps, resulting in a zipper-like scar on her abdomen, commonly known as "zipper abdomen". Although the "zippered belly" is not beautiful, it is not bad. The most serious thing is that the patient's intestinal adhesion of intestinal caused by multiple surgeries, which poses huge risks to her next surgery. Not long ago, Ms. Zhou fell ill again. Due to huge polyps, intestinal insufficiency caused by intestinal obstruction, resulting in stomach pain and inability to eat and digest. She could only treat conservatively or have another surgery in the local area. With the last glimmer of hope, Ms. Zhou came from Heilongjiang to the endoscopic center of Zhongshan Hospital Affiliated to Fudan University for treatment.
The picture shows the patient's "zippered abdomen"
. After diagnosis, Ms. Zhou suffered from dark spot-polyp syndrome, an autosomal dominant genetic disease characterized by gastrointestinal multiple polyps, skin and mucosal pigmentation, and tendency to develop cancer. If the polyp grows more than 3cm, it can cause repeated intestinal obstruction and intussusception, or even cancer, and patients need to undergo surgical treatment multiple times. However, repeated open laparotomy surgery will not only cause great trauma to the patient, but also easily cause serious complications such as postoperative intestinal adhesions and short bowel syndrome , and also cause great psychological pressure on the patient.
The circle is drawn to the patient's hand pigmentation
. According to Ms. Zhou's situation, the CT image shows that there is a huge space at the end of the small intestine, with the diameter of the polyp being about 8*5cm. Since multiple surgeries have caused intestinal adhesions and accompanied by intussusception, conventional resection methods cannot solve the problem safely and effectively. According to the expert consensus on the diagnosis and treatment of Peutz-Jeghers syndrome in China (2022), for huge small intestinal polyps with a diameter of 5 cm, especially when small intestinal insubsequentially, the risk of serious complications such as bleeding and perforation under endoscopy is increased accordingly, and treatment methods should be carefully selected after fully weighing the pros and cons. Professor Zhou Pinghong, director of the Endoscopy Center, led the team to discuss Ms. Zhou's treatment plan. Although the operation is extremely difficult and there is little experience in related surgical procedures at home and abroad, with the support of many years of accumulated rich experience and advanced endoscopic resection technology, the endoscopy team decided to break into the restricted area again and perform a huge polyp resection under the entanglement of Ms. Zhou.
October 20th, the operation began at 3 pm. Due to the huge size of the polyp, the half-meter-long small intestine was pulled into the colon, like a goose egg wrapped in layers, embedded in it, and a dilemma. Block removal of tumors is the only option, but after 1/3 of the tumor is removed, the whole picture of the polyps is still not observed. The surgical team took turns to operate carefully. As the tumor gradually became smaller, the lesion was finally unstacked and retracted. Due to intestinal adhesion caused by multiple surgeries, the small intestine sperm requires an assistant to turn over and press the stomach whenever the entanglement is followed. After more than 6 hours of "tug-of-war", the operation finally succeeded!
According to the deputy chief physician of Ma Lili of the Endoscope Center, the small intestine is an area that is difficult to reach for ordinary gastroscopy and colonoscopy , and was once considered a "blind spot" of digestive tract examination. For doctors, it usually takes 5 to 15 minutes to do a gastroscopy, while it takes 2 to 4 hours or even more to do an intestinal scene. In addition, the small intestine wall is very thin and the blood supply is rich. Endoscopic treatment is a test for the doctor's physical strength and technology. Postoperative pathology suggests precancerous cancer. Although this "battle" was difficult, it not only solved the urgent problem for the patients, but also avoided the consequences of cancer. The success of this operation also marks another breakthrough in the minimally invasive resection of Zhongshan endoscopy and reaching a new level.
Since the diagnosis and treatment of double airbags in recent years, the endoscopic center of Zhongshan Hospital has completed more than 100 cases of minimally invasive surgery under small colonoscopy. Among them, the resection and flip diverticulum under small colonoscopy is another innovative approach for endoscopy, representing that endoscopic minimally invasive truly eliminates the last blind spot of endoscopic resection under endoscopy.In 2022, the endoscopy center of Zhongshan Hospital has gone through 30 years of ups and downs; under the leadership of several generations of directors, Zhongshan Endoscopy insists on practicing internal skills and building a solid foundation, while regarding pioneering as a responsibility and making innovation a happy life. Combining technology and the actual needs of the masses, we continue to explore and make progress, "As long as it can reach the scope of endoscopy, it is the base for endoscopy treatment." Professor Zhou Pinghong's team opened the door to the forbidden area for endoscopy surgery. The difficulty of the surgery has been continuously improved in the use of endoscopic technology to treat various gastrointestinal difficult and complicated diseases. From endoscopic submucosal dissection to full-layer resection technology, endoscopic submucosal tunneling technology, to endoscopic extragastric surgery, the difficulty of the surgery has continuously refreshed the world's height; it has led to super minimally invasive surgeries such as endoscopic appendectomy and endoscopic gallbladder stone removal, allowing new methods and new concepts to truly benefit patients. "Super minimally invasive" will bring better economic benefits, better quality of life after surgery, and longer postoperative survival.
