Do you know what the omentum is? The large omentum is an integral part of the peritoneum, which connects the large bend of the stomach to the transverse colon, covering the surface of the small intestine like an apron, providing protection for the small intestine.

Do you know what the omentum is? The large omentum is an integral part of the peritoneum, which connects the large bend of the stomach to the transverse colon, covering the surface of the small intestine like an apron, providing protection for the small intestine.

The large omentum has an important physiological function. When bacteria or foreign objects invade the abdominal cavity, the large omentum plays a protective role, and eliminates or confines these foreign harmful substances by wrapping, phagocytosis and absorption; when the organs in the abdominal cavity undergo inflammation or gastrointestinal perforation, some of the large omentum will immediately "roam" around the lesion or block the perforation to prevent diffuse peritonitis and sepsis.

Ye Liang, director of the Department of Thoracic Surgery of Shanghai Seventh People's Hospital, has a "unique skill" and cleverly uses the protective effect of the large omentum to "block the fistula" when there is a fistula that is difficult to heal. Recently, Ye Liang's team successfully completed a complex bronchial pleural fistula repair surgery.

bronchial pleural fistula , the terrible world problem

bronchial pleural fistula, is a condition that causes headaches for all thoracic surgeons around the world. Most of them occur after pulmonary resection. Although the incidence is not high, once it occurs, the consequences are very terrible.

After the pulmonary resection, for some reasons, the stump of the bronchial does not heal, resulting in a fistula, and the fistula is broken into the chest cavity. Because there is sputum and bacteria in the bronchial, there cannot be any bacterial contamination in the chest cavity, which inevitably leads to empyema. The chest cavity is filled with pus, which will flow backward into other lungs through the bronchial. In mild cases, long-term lung infection in , and in severe cases, it will cause suffocation. Due to the consumption of infection, patients experience chronic failure and may lose the treatment conditions such as follow-up tumor radiotherapy and chemotherapy, resulting in death.

Traditional surgical treatment of bronchial pleural fistula, using chest wall fenestration and thoracic shaping. The former is to open a large hole in the chest wall, and change the dressing the next day, put the disinfected cotton yarn into the chest cavity for filling it. It is very painful for patients who change the dressing for a long time. The latter removes the ribs of the chest area on a large scale, causing the chest wall to completely collapse, thereby blocking the abscess cavity and completely collapses on one side, which has severe functional disability.

now has the minimally invasive interventional method. Although the trauma is not great, the success rate is limited only for patients with small fistulas.

Lao Dong's nightmare was finally cured.

Lao Dong (pseudonym) found lung cancer more than two years ago after physical examination and underwent a total left lung surgery. One month after the operation, bronchial pleural fistula occurred. In the following two years, Lao Dong sought medical treatment everywhere and underwent a total of 6 interventional surgery , using a one-way valve and an occluder to seal the fistula, but all failed.

The last time the occluder fell off from the bronchial fistula and was pushed onto the esophagus. The long-term friction caused the esophagus to perforate, and one end of the occluder penetrated the esophagus. In this way, the abscess cavity originally had only sputum from the bronchial fistula, and now there were food residues, saliva and reflux digestive fluid from the esophageal fistula, which made the infection more and more serious.

When he found Ye Liang's team, 200ml of pus flowed out of Lao Dong's chest cavity every day. The serious consumption made Lao Dong look thin and his weight dropped from 65 kg two years ago to 49 kg.

Dr. Ye’s “unique skill” is not complicated in principle. The large omentum is a natural anti-infective tissue in the human body, and has very strong anti-infective ability. Ye Liang said that simply put it, it is to use laparoscopy to escape the omentum with minimally invasiveness and borrow it to the chest cavity to seal the fistula and fill the abscess cavity.

has two benefits: First, the large omentum is large in size and has a very strong anti-infection ability. This "rescue" brought from the abdominal cavity can make the treatment of infection in the chest cavity less painful; second, the large omentum can heal if filled in the abscess cavity, and no longer need to open the chest wall, nor do large-scale thoracic collapses. The appearance after the operation is no different from that of normal people. Since there is no need to cut muscle tamponade and will not cause postoperative dysfunction, the patient's postoperative motor ability is completely normal.

However, Lao Dong's condition is complicated, and there is almost never a record of successful cure in the professional literature.Considering that Lao Dong was extremely weak and could no longer withstand any disturbances, the Seventh Hospital mobilized the cooperation of multiple disciplines such as critical care medicine, imaging department, anesthesia department, digestive endoscopy, interventional department, and operating room. In the end, two fistulas were blocked at one time. Lao Dong fed normally one week after the operation, and his appearance and function were completely normal.

Editor in charge Yang Linyu

Text Zhang Qi

Source Pudong release