Release date: 2017-04-28
On April 27, Peking Union Medical College Hospital announced that the thoracic surgery of the hospital has successfully performed a thoracoscopic tumor resection for an elderly male patient with a "mirror person" with lung cancer. Radiology, cardiology, anesthesiology, operating room, etc. to protect the surgery, fully reflects the comprehensive advantages of Concord multidisciplinary.
On April 11, an elderly male patient was seen at the Thoracic Surgery Clinic of Union Hospital. After seeing the film, Associate Professor Cui Yushang of the hospital was surprised to find that this is a rare "mirror person" with lung cancer patients. The right lower lobe has a 2.3cm*3.0cm tumor, which is highly malignant. The patient was immediately admitted to hospital for treatment.
"Mirror man" is a common name for the complete visceral inversion (SIT). It is a rare congenital malformation. It is usually manifested as a complete left and right reversal of the thoracic cavity, abdominal organs and anatomy. SIT usually does not affect human health, but once it becomes ill, it can pose a huge obstacle to treatment, especially surgery. Because the anatomical variation will subvert the doctor's original medical knowledge, affecting the smooth operation of the surgical operation, thus seriously affecting the prognosis.
The incidence of SIT is between 1/8000 and 1/20,000, and SIT with lung cancer is even rarer. According to the pubmed literature, SIT has only 25 cases of lung cancer worldwide, 16 cases (64%) in the left lung and 9 cases (36%) in the right lung. Only 16 of the 25 patients underwent surgery, 12 (75%) left lung, and 4 (25%) right lung. Of the 16 procedures, 75% used conventional thoracotomy and only 25% underwent thoracoscopic surgery.
After the patient was admitted to the ward, the Department of Thoracic Surgery paid great attention to it. In the general ward rounds, the doctors at all levels discussed the surgical methods, the surgical approach and the difficulties that may be encountered during the operation. In order to avoid the risk of trauma and large amount of bleeding for thoracotomy, it was decided to adopt thoracoscopy. surgery. Director Li Danqing emphasized that "SIT patients with lung cancer have a particularly limited reference. The right thoracic cavity structure is usually more complicated than the left side. The patient admitted to our hospital happens to be right lung cancer. Therefore, the patient's lung must be carefully studied before surgery. The anatomical structure, the number of possible variations can be well-informed, careful observation during the operation, anatomy and separation layer by layer, in order to smoothly achieve the removal of the tumor and lymph node dissection." In order to visually and clearly present the left and right side of the patient's chest The bronchial structure of each level and its positional relationship with tumors and blood vessels, the radiology department of the hospital completed the three-dimensional reconstruction of thoracic CT.
On April 17, the operation proceeded as scheduled. Early in the morning, Dr. Fan Jingbo from the Department of Cardiology rushed from the clinic to the operating room, and carried out detailed examination and adjustment of the patient's pacemaker to ensure that the patient greeted the operation at the best condition. For the variation of the left main bronchus and the right main bronchus, pay attention to the appropriate position of the left main bronchus when selecting the double lumen endotracheal intubation, and pay close attention to the patient's blood pressure, heart rate, heart rate, and vigilance. Ventricular arrhythmia and unstable blood pressure caused by adjustment of pacemaker parameters.
Under thoracoscopy, the entire field is like looking at the left lower lobe in the mirror, which puts high demands on the surgeon's familiarity with the lung anatomy and spatial imagination. The patient's heart and aortic arch and esophagus are on the right side. There are only two leaves in the right lung and the leaf fissure is completely undeveloped. The blood supply to the bronchus and arteries and veins is similar to that in the normal left lung. Therefore, the operation can only be retrograde resection of the lung. When the lower lung bronchus was isolated, the doctor found that the patient's right lower lobe dorsal segment and basal segment of the bronchus were abnormally large and staggered, next to the posterior pulmonary artery. If the tough separation is made, it is highly likely that the blood vessel wall will be scratched, causing uncontrolled bleeding. The surgeon and the doctor took the initiative to set the red tube as a buffer and protection device and placed it on the tip of the nail chamber. With many years of surgical experience and superb surgical skills, the trachea and blood vessels were successfully separated, and the tracheal structure was disconnected. The entire operation was successful and the operating room sounded a warm applause on the spot.
Source: China Science and Technology Network - Technology Daily
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