Tracheal tumor is called the "pinning work" in the field of thoracic surgery because of its rare disease, hidden symptoms, and special location, and extremely difficult surgery. Recently, Grandma Wang, an 85-year-old man from Nantong, Jiangsu Province, experienced a "three-high surgery" of "high difficulty + advanced age + high complications" at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine. It is gratifying that this octogenarian was able to walk around independently within 5 days after the operation and took care of himself, which made his family very happy.
"Grape-shaped" tumors occupy the "fortress" of the trachea
A year ago, Grandma Wang started to have asthma after she started to have activities. Her family thought she was older and did not pay attention to it. In August this year, her asthma intensified and accompanied by a cough. Seeing that her 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 has occupied nearly three-quarters 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, the attending physician Zhang Yajie immediately realized the seriousness of the problem - if the treatment is not done in time, it may be life-threatening! But such a "three highs" surgery 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!" Li Hecheng decided.
Zhang Yajie introduced that tracheal tumors generally grow slowly, with no specific symptoms or signs in the early stage, which is very easy to misdiagnose and misdiagnosis, and are often in the advanced or advanced stage when diagnosed. When the tumor body accounts for two-thirds to three-quarters of the lumen, it will cause severe respiratory obstruction and threaten life, and have a poor prognosis. Tracheal tumor is one of the most difficult surgeries in thoracic surgery at present. Its surgical technology and anastomotic reconstruction methods are complex. It is prone to complications such as bleeding, anesthesia accidents, anastomotic fistula, 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. Moreover, 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," said Zhang Yajie.
Thoracic surgery "in the thorn bush" "clearly picking "grapes"
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 multiple disciplines such as thoracic surgery, respiratory department, anesthesia department , critical care medicine department , critical care medicine department , etc., 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 operation was performed by Li Hecheng's team. 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. Just like "picking grapes from thorns", the difficulty of the operation can be imagined. Fortunately, Li Hecheng is experienced and has a set of "sword techniques" that flows smoothly. The surgery 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 view clearer and simulated wrists 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 and improve stability.
3 hours later, the operation was successfully completed, and Grandma Wang was sent to the intensive care unit for postoperative monitoring and treatment.
Multi-disciplinary escort, and he has taken care of himself for 5 days after surgery
" Pathology of the outer hospital confirmed that malignant tracheal tumors account for three-quarters of the tracheal lumen, have a relatively brittle texture and are prone to bleeding when touched, so for our challenge, 'oldering' is just the beginning."We used CT imaging data to measure and calculate it repeatedly 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, quickly and effectively establishing a safe artificial airway 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 to be seamlessly connected, which especially tests the close cooperation between anesthesiologists and thoracic surgeons. "Luo Yan, director of the Department of Anesthesiology, said, "At the same time, through careful assessment, we removed the tracheal catheter in the operating room, allowing patients to breathe independently as soon as possible, reducing the bedtime and risk of postoperative infection. For such airway tumors, we have mature preoperative evaluation and anesthesia plans, as well as complete airway evaluation methods, and we can deal with them at any time in daily training. "
In the intensive care unit of , Director Liu Jialin believes that tracheal management, coughing and sputum prevention after tracheal surgery, and lung infection, are very important, and various measures are needed to reduce the incidence of complications. "We discussed several versions of the plan before the operation, such as whether the patient comes back after extubation or comes back with intubation, which 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 couldn't understand Mandarin at all, in order to communicate smoothly and let Grandma Wang cooperate with treatment and recovery smoothly, Zhang Yajie, who can say Nankong , also acted as a "translator" and went to the critical care medicine department every day, which moved the family very much. Five days after the operation, Grandma Wang was able to act independently and take care of herself. A few days later, the children happily picked her up home. "We are all ordinary farmers. After being rejected again and again, our brother and sister felt that the sky was about to collapse. I was lucky enough to come to Ruijin Hospital and met a group of good medical staff who care about us very much. We must take good care of our mother, and hope that she will live to 100 years old and live up to the hospital's treatment! "Grandma Wang's son said.
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 discussed in multiple disciplines for complex and difficult trachea such as Grandma Wang, mediastinal tumors , etc., and formulate personalized treatment plans to better solve the fundamental problems for such patients. Editor-in-chief of
column: Gu Yong
Illustration drawing: Jiang Yan
Source: Author: Huang Yangzi Tang Wenjia
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