Photo: Chen Tongyu, director of the Department of Cardiothoracic Surgery of Shanghai Yueyang Hospital, performed the operation zuo Yan, chief reporter of Xinmin Evening News( the same below)
"Wu Fanghua (pseudonym), can wake up." On the operating table, Wu Fanghua, a 65-year-old Aunt in Shanghai, heard a soft cry, slowly opened her eyes, and looked around. Confirming that she was still in the operating room, she asked, "My knife has been prescribed?" After receiving a positive answer, she was a bit surprised, she had just undergone lung cancer surgery and did not expect to wake up so soon.
The day before yesterday, the reporter witnessed Aunt Wu's operation in the operating room of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine. Receiving needle and drug compound anesthesia, she was operated by Chen Tongyu, director of the cardiothoracic surgery department of the hospital, and was intubated without trachea throughout the whole process, and when she woke up, she was in a normal state, and soon sat up, and even chatted with reporters.
Immediately after the operation, the patient wakes up and "really does not hurt"
Aunt Wu has curly hair, a slight figure, and a fashionable dress. She found a ground glass nodule in her left lung with a diameter of 2 cm, which was assessed to be highly likely to be malignant and met the indications for surgery. However, when the reporter saw her, she was lying on her side on the operating table, and her left arm was temporarily fixed to the shelf to facilitate surgery.
Pictured: Aunt Wu's left arm was temporarily fixed to a shelf to facilitate surgery
The operating room of Yueyang Hospital has a word-of-mouth team for anesthesia - acupuncture anesthesia multidisciplinary team, which is composed of acupuncture department, anesthesiology department, surgeon and so on. The acupuncture doctor first found 4 acupuncture points on Aunt Wu's hand and arm to acupuncture anesthesia, including Houxi, Zhigou, Neiguan, and Hegu Acupoint; Shen Hua, deputy director of the Department of Anesthesiology, "relayed" to the field and administered drugs from the side of the spine under the guidance of B ultrasound for nerve block. Unlike conventional general anesthesia, the dosage is only one-third of that of general anesthesia. This method of anesthesia is different from the ancient pure acupuncture anesthesia and is known as the modern acupuncture anesthesia technique.
After 30 minutes of induction by electro-acupuncture stimulation, Chen Tongyu operated on her, first making a small incision under her chest and performing a single-hole thoracoscope for her to perform a resection of the lamina propria of the upper lobe of her left lung. At this moment, Aunt Wu is "asleep", there is no endotracheal intubation, completely spontaneous breathing, and her slight snoring can still be heard in the quiet operating room.
Pictured: Chen Tongyu (first from right) team in surgery
During the operation, Chen Tongyu focused his eyes on the screen, observed the situation in the chest cavity, and cooperated with both hands to quickly separate the intubated segment of the left upper lung. "It really doesn't hurt, I want to drink water." After waking up, Aunt Wu took the straw handed by the nurse and took a few sips. As Chen Tongyu expected, a rapid frozen biopsy during surgery suggested adenocarcinoma.
Single-hole thoracoscopic lung segment resection is a major step forward in thoracic surgery. For a considerable number of ground glass nodule lesions, lung segment surgery can not only remove the lesion but also preserve normal lung tissue and lung function as much as possible, and the operation is more minimally invasive, accurate, and more conducive to the patient's postoperative recovery. The operation was not too difficult for the experienced Chen Tongyu. The only "inconvenience" is that the patient breathes spontaneously during the operation, which causes the lungs to expand and contract, which interferes with the operation. It is equivalent to playing a "moving target", which requires the doctor to operate more accurately and quickly, and also has the close cooperation of the anesthesiologist.
Modern acupuncture techniques are also constantly improving
The magical acupuncture anesthesia made Aunt Wu, who had experienced it for the first time, praise, in fact, this anesthesia method is not new in Yueyang Hospital. Just last month, Mr. Yu, 38, was also in the same operating room, underwent modern acupuncture anesthesia techniques, and Chen Tongyu performed a single-hole thoracoscopic right lower lobectomy without endotracheal intubation. Mr. Yu is young, has good physical strength, recovers faster, walks back to the ward after surgery, eats and drinks on the water toilet with ease, and is discharged from the hospital two days later.
However, acupuncture has its indications and is not suitable for every patient. Aunt Wu is very large, the BMI index is at the critical point, and she can hardly do acupuncture anesthesia. She underwent an anesthesia evaluation before surgery to determine pain thresholds and pain tolerance thresholds. She was very well adapted to acupuncture anesthesia and trusted the doctors. Chen Tongyu said that it was with the full cooperation of patients that the operation was carried out smoothly.
Chen Tongyu's modern acupuncture anesthesia thoracoscopic lung surgery has been carried out in more than 500 cases. Since May this year, the team has continuously improved the technology and drug regimen. "For example, in the past, in addition to acupuncture, we also had to implement epidural anesthesia, but now we have changed to paravertebral block anesthesia in the relevant ganglia under the guidance of B ultrasound; silicone nasopharyngeal airway is added to ensure oxygen supply when patients breathe lightly; intrathoracic vagus nerve block is used in conjunction with intercostal nerve block to play a better analgesic effect; at the same time, we also pay attention to the infiltration effect of anesthetic drugs on the surface of the lungs, which can reduce the amount of intravenous drugs and be more accurate." Chen Tongyu said. In addition, according to Shen Hua, deputy director of the Department of Anesthesiology, in terms of the compatibility of drugs, a set of better schemes has also been explored, so that the use of drugs and the state of patients' breathing can achieve the best balance, which is more conducive to doctors' surgical operations.
Constantly innovating, surgeons embark on the road of promoting acupuncture and hemp
How could a Cardiothoracic surgeon with a Western background deal with acupuncture? He said that he was influenced by Zhou Jia, the president of Yueyang Hospital, in his early years. 10 years ago, Chen Tongyu encountered a student who was about to take the college entrance examination, pneumothorax, lung compression chest pain, drainage for several days did not improve the condition, must be operated on. After communicating with the parents and determining the plan with the anesthesiologist, Chen Tongyu and Zhou Jia performed thoracoscopic surgery without endotracheal intubation. Before the operation, only epidural partial anesthesia was given, a small amount of sedatives were used, the operation was successful, and the child soon went to school. After doing this kind of surgery, he added acupuncture techniques that he had been studying, so that there were fewer anesthesia drugs.
In recent years, Zhou Jia's team has continued to promote modern acupuncture anesthesia technology, and the relevant research results have won the first prize of Shanghai Integrated Traditional Chinese and Western Medicine Science and Technology In 2020. In addition, the new concept of "accelerating the rehabilitation of perioperative period based on modern acupuncture anesthesia technology applied to pneumectomy" has also been promoted in more than 20 hospitals across the country.
Chen Tongyu admitted that although he was not good at acupuncture, the effect of acupuncture was obvious to all and had been clinically demonstrated. Combined with modern acupuncture, surgery without endotracheal intubation, the dosage of anesthesia analgesic drugs is only 20%-30% of similar surgeries for tracheal intubation, and the complete non-use of muscle relaxants can not only avoid the pain and injury caused by intubation of patients, improve intraoperative organ protection, reduce complications, but also accelerate patient recovery, he hopes that more surgeons will use this technique.
Zuo Yan, chief reporter of Xinmin Evening News