During the Spring Festival, there is a lot of rain and snow
Everyone also minimized going out
You are not
Haven't sung K in a long time?
Is there a hint of nostalgia？
A feat of almost swallowing a "microphone" for soaring high notes?
Gossip is less, the book is back to the truth
Department of Gastroenterology, First Affiliated Hospital of Zhejiang University School of Medicine
Tingting, a 27-year-old Wenzhou girl (pseudonym)
Eating chest blockage
A few bites are full
The "initiator" turned out to be in the esophagus
A huge tumor
Chen Hongtan, Deputy Director of the Department of Gastroenterology, Chief Physician
With more than 20 years of exquisite endoscopic technology
Innovative minimally invasive concept of excellence
and a sincere and responsible attitude towards the patient
Cut out from the wall of Tingting's esophagus
A "microphone" 10 cm long and 3 cm wide
Images are raw, click carefully
How did the "microphone" grow on the wall of the patient's esophagus?
What is "sacred"?
Let's decrypt it!
panicky
Doctor, could it be that I have esophageal cancer?
Can you not open your chest?
Tingting, 27 years old this year, is a native of Pingyang, Wenzhou, 1.54 meters tall, and her weight hovers at 80 pounds all year round. She and her two-year-old sister are a pair of beautiful sister flowers, the sister behaves quietly, her face is like a silver plate, like the "Baochao" in the dream of the Red Chamber novel, there is a plump beauty, while the younger sister has a poor appetite and is sickly since childhood, like "Sister Lin", which makes her parents more worried.
After graduating from university, Tingting stayed in Hangzhou to do IT work. Long-term sedentary, plus like takeaway, milk tea, Tingting colleagues are increasingly "half a month", only how she eats is 80 pounds, which is envied.
But she also has her own "troubles" - that is, every time she eats, she will have a choking feeling and always feel that her stomach is very uncomfortable. Even if it is the most favorite to eat shallot oil noodles, at most you can only eat a small half bowl, eat a few bites to feel that "the stomach is topped", and eat a few more bites to vomit.
In 2019, Tingting found Helicobacter pylori-positive and chronic atrophic gastritis in the physical examination, and she felt that she had found the "culprit" with a bad appetite, and she was young and did not take this "small disease" to heart. "Who doesn't have a little problem?" It doesn't hurt or itch, what does it matter? She had been comforting herself that Helicobacter pylori also had a pair of treatments.
In November this year, when shooting X-ray chest x-ray chest x-ray in the unit physical examination, the examining doctor found that Tingting's esophagus was abnormal, with a shadow of about 3cm, prompting "mass lesions in the lower part of the esophagus", coupled with this year's busy work, every time she ate something, Tingting felt that there was something in her chest, which made her very panicked: Is it difficult to be esophageal cancer?
Tingting first went to the general chest surgery department of a third-class hospital in the province, the diagnosis results confirmed the physical examination report, the doctor said that it is necessary to "open the chest" to completely remove the benign and malignant behemoth in the esophagus, "I am not married, the thought of leaving a scar of more than ten centimeters in the chest, like a centipede, I feel very sad!" Tingting, who hesitated repeatedly, inquired in many ways, and learned that the Gastroenterology Department of the First Hospital of Zhejiang University had superb skills that could also remove esophageal tumors without opening the chest, and decided to seize the last straw and try it again in the First Hospital of Zhejiang University.
Huge tumors
Removal is not easy, and removal is even more difficult
Accompanied by her family, Tingting came to the expert clinic of Chen Hongtan, deputy director of the Department of Gastroenterology of the First Hospital of Zhejiang University. After a chest enhancement CT and ultrasonography, it was found that her lower esophagus and cardia, stomach base saw a huge dachshund-like submucosal bulge, because the tumor was too large, considering the "giant leiomyoma" that extended from the lower esophagus across the cardia to the stomach, and she was subsequently admitted to the hospital.
Chief Physician Chen Hongtan reassured Tingting not to be nervous, leiomyomas are the most common benign tumors in the esophagus, accounting for about 70% of all benign tumors of the esophagus. "But such a large lesion, the location is relatively deep!" He further patiently explained to Tingting that this huge submucosal tumor across the cardia in the lower part of the esophagus is close to the aorta and continues all the way to the bottom of the stomach, and the choice of traditional surgery is difficult and long, the patient's wound is large, the recovery is slow, the treatment cost is high, and even complications that are difficult to recover may occur. With endoscopic surgery, these challenges will be solved.
Considering the size and location of Tingting's esophageal tumor and other factors, Chief Physician Chen Hongtan suggested using "transoral endoscopic submucosal tunnel tumor resection" (STER) to remove her tumor.
"For general esophageal leiomyomas, we can directly remove them with a gastroscope. However, Tingting's tumor is huge, has compressed the esophagus, the lumen is narrow, leaving less room for maneuvering, which is a great test of the doctor's flexibility and stability. This is not the main one, most of the tumor is located in the mediastinum, where blood vessels and nerves are abundant, and a slight accident may also injure the large blood vessels outside the esophagus, increasing the risk of surgery. Before the operation, Chen Hongtan's chief physician team conducted an in-depth discussion on Tingting's condition, and the huge tumor also put forward higher technical requirements and challenges for experts.
At the end of December, under the general anesthesia of tracheal intubation, Tingting was guided by Chief Physician Chen Hongtan, just like the "mole drilling the ground to make holes", under the guidance of endoscopy, with a special knife to inject epinephrine-Meilan liquid at 5 cm above the tumor body to fully elevate the mucous membrane layer, cut the mucous membrane, and then open the submucosal tunnel for full separation and excision of the tumor, cut the mucous membrane through the metal clip, and then remove the tumor body in stages with a snare, the tumor body size is about 3.5 * 10cm, like a "microphone" shape. The operation went for about 3 hours and went very smoothly!
"The tunnel opening is endoscopically sutured, and the mucous membrane on the surface of the original lesion remains intact." Chief physician Chen Hongtan explained to Tingting that this endoscopic surgery for the peeling of the mass can maintain the integrity of the digestive tract and avoid secondary infection of the gastrointestinal fistula and the mediastinal chest cavity after surgery; but it needs to skillfully use the space between the mucous membrane and the muscle layer for precise operation, which is a super difficult surgical technique, and at present, only a few top three hospitals such as the First Hospital of Zhejiang University can carry out it.
On the third day after the operation, Tingting resumed her semi-liquid diet, and her foreign body sensation and stomach distension when swallowing were significantly alleviated, and she was quickly discharged from the hospital under the careful care of medical staff. Postoperative specimens were confirmed by pathological examination as leiomyomas.
When the patient was discharged from the hospital, he was very excited and said: "Thank you so much, such a large tumor, I thought I had to open a big mouth in the chest, but I didn't expect that there were no surgical scars on the surface of the body!" Kudos to your superb technology! ”
Esophageal leiomyomas
The same is not to be underestimated
According to experts, esophageal leiomyomas are mostly found in middle-aged men, and the incidence ratio between men and women is about 2:1. The exact cause and mechanism of the disease is not known, and it has little to do with diet.
Esophageal leiomyomas grow slowly and are often ignored in the early stages until symptoms such as choking on food or posterior sternal pain do not appear. In recent years, with the popularity of gastroscopic screening, the disease is more and more common clinically, but the etiology lesion is located under the mucosa, ordinary gastroscopy is difficult to distinguish from other submucosal lesions, easy to misdiagnose, ultrasound endoscopy provides the most reliable method for the accurate diagnosis and treatment of the disease.
Many people have the impression that benign tumors can ignore it, but esophageal leiomyomas are different.
Although most of the clinical symptoms of esophageal leiomyomas are mild and grow slowly, if the tumor is allowed to grow, it may have the effects of gastrointestinal bleeding and esophageal obstruction, and will also compress the surrounding vital organs, even if the probability of malignancy is extremely low. Therefore, patients with symptoms (eg, swallowing obstruction, dull pain in the retrosternal bone, etc.) must undergo surgery if the tumor gradually enlarges.
Experts particularly emphasized
When food is difficult to swallow, there is always a feeling of choking
Feeling swollen and painful behind the sternum
Or always a full stomach, discomfort
Aggressive visits to the gastroenterology department should be made
ATTENTION
Department of Gastroenterology, First Hospital of Zhejiang University
Every year, the "transoral endoscopic submucosal tunnel tumor resection" (STER) is used to remove nearly 100 cases of esophageal tumors for patients, endoscopy can not only remove early cancer, precancerous lesions, but also remove most of the submucosal tumors (mainly including stromal tumors, leiomyomas, lipomas, hemangiomas, granulocytomas, etc.), for different lesions, trap resection, submucosal dissection, intra-tunnel tumor resection and full layer resection and other methods to ensure the safety and effectiveness of surgery. At present, the first hospital of Zhejiang University carries out this type of surgery to recover quickly, without scarring, the cost is low, and the technical level is in the international leading position.