15-year-old girl
Flower the same age
I was supposed to enjoy the beauty of youth on campus
But it was repeated high fever for inexplicable reasons
Coughing up phlegm and tormenting
Recently, the Department of Thoracic Surgery, Zhongda Hospital, Southeast University
A young patient with pulmonary sequestration and lung abscess was treated
A team of experts
In the most minimally invasive way
Successfully relieved the patient's pain
The quality of life in the future is guaranteed
Let's walk into today's day
"Clinical Frontline Treatment Story"
The girl coughed up phlegm and had a high fever
Suffering from pulmonary sequestration with lung abscess
Xiao Wang (pseudonym), a 15-year-old high school student, has had recurrent pain in his right lower back since November last year without obvious causes. Xiao Wang endured the pain and lived normally and went to school every day, and after persevering like this for 3 months, the pain in his lower back not only did not improve, but also had repeated high fever, coughing up yellow sputum, and the highest fever reached 39 °C. The family hurriedly took Xiao Wang to the local hospital for treatment, and Xiao Wang's condition still did not improve after 3 days of hanging water. The local hospital further examined Xiao Wang's chest CT and found that the patient had an abscess in the lower lobe of the right lung and a small amount of fluid in the right pleural cavity, and he needed to go to a higher-level hospital with treatment ability and experience for further treatment as soon as possible.
When he suffered from a lung abscess at a young age, his family did not dare to delay for a moment, and took the child to the Department of Thoracic Surgery of CUHKMC for medical treatment. In order to further clarify the patient's condition, Li Hongyan, deputy chief physician of the Department of Thoracic Surgery of the hospital, arranged for Xiao Wang to undergo a chest CT with contrast.
The results of this enhanced CT scan made the expert team feel the pressure: the patient's lung abscess had a maximum diameter of 12 cm, covering almost the entire lower part of the chest cavity, and in addition, an abnormal artery with a diameter of about 1 cm was seen entering the lungs from the descending thoracic aorta!
"This is a typical lung sequestration, combined with lung abscess!" Deputy Chief Physician Li Hongyan immediately made a clear diagnosis.
It is reported that pulmonary sequestration refers to a rare congenital malformation of lung development, which forms a cystic mass from part of the lung tissue supplied by abnormal systemic arteries, resulting in recurrent localized infections, and is clinically characterized by the presence of abnormal arterial blood supply, such as fever, cough, purulent sputum, and hemoptysis. If left unchecked, the disease can progress rapidly and endanger the patient's life.
The team of experts is confronted with a huge lesion
Patiently search for the best surgical plan
Preoperative images
"For such a huge lesion, according to the conventional protocol, it must be a large thoracotomy, an incision of more than 30 centimeters, cutting off all layers of muscles, and even cutting off the ribs in order to fully expose the surgical field. Deputy Chief Physician Li Hongyan said that foreign doctors said that this kind of incision is to cut all the patient in half (cut in half), which is traumatic and has a lot of blood loss, and is a typical operation of "the patient's flesh ache and the doctor's heartache".
What's worse is that the patient is currently in the acute infection stage, with obvious vascular hyperplasia, and it is difficult to stop bleeding during surgery, and even life-threatening. In addition to the loss of lung function, the risk of bronchial stump fistula is significantly increased in an infected environment, resulting in serious consequences of either death or disability.
Looking at the 15-year-old girl, the team of experts fell into deep thought: if the preparation for thoracotomy is not adequate, if the bleeding during the operation is done lobectomy, the patient will not only lose 20% of lung function, but also leave a huge scar on the chest, which will accompany the girl for the rest of her life.
Is there a surgical method that is neither teratogenic nor disabling at the same time, and can keep the flower girl in the flower season like a flower? To this end, the team of deputy chief physician Li Hongyan put forward two requirements for themselves: one is to minimally invasive the patient as much as possible, and the other is to preserve all normal lung function as much as possible.
Successfully overcome many difficulties
Difficult surgeries were carried out smoothly
With a clear goal in mind, the next step is to put the skills of the expert team to the test. Deputy Chief Physician Li Hongyan said that to be minimally invasive, it is necessary to first control the patient's inflammatory response, and to control the inflammatory response, it is necessary to drain the abscess. The abscess shrinks after drainage, and surgery is much safer, but it is more difficult to operate because of pleural adhesions.
As a result, the team of experts joined hands to start the "breakthrough mode". On February 20, Dr. Pu Zhen, the chief physician of the Department of Thoracic Surgery, successfully completed the closed drainage of the abscess cavity for the patient under the guidance of local anesthesia CT. After drainage, Xiao Wang's abscess cavity was significantly reduced, and after 4 days, the blood routine white blood cells decreased to normal, and the drainage volume was less than 10ml/d, and the toxicity symptoms were significantly improved.
After 30 days, Xiao Wang's inflammatory response subsided, and the first hurdle was successful. On March 20, Li Hongyan, deputy chief physician of the Department of Thoracic Surgery, led the team of "elite soldiers" to jointly "shoot" and perform minimally invasive surgery for Xiao Wang as originally planned, and the medical care of anesthesia surgery and pain management department was fully guaranteed, and the "battle for life" began.
On this day, tension was in the hospital's operating room, and the operation was even more difficult than the experts had expected. After exploration, the surgical team found that even after drainage treatment, the abscess was still 6cm in diameter, the patient's pleural cavity was densely adhesed due to previous infection, and the two blood vessels of the abnormal artery and the lower pulmonary vein were "ambushed" like two "time bombs". Among them, the abnormal artery has the thickness of a little finger, is in the deepest and farthest part of the surgical field, affected by infection, the tissue is very fragile, and poor treatment will lead to fatal hemorrhage, and the inferior pulmonary vein has become the "key object of protection", because the uppermost edge of the isolated lung abscess cavity is adjacent to the inferior pulmonary vein, and the complete resection of the isolated lung abscess must ensure that the lower pulmonary vein is not injured or deformed, otherwise it will cause pulmonary congestion and even lead to lung function impairment.
Time passed quietly, and the operation was carried out in the expected difficulties. During the operation, the expert team avoided one risk after another, lasted more than 4 hours, completed the single-port thoracoscopic surgery, completely resected the isolated lung tissue, and preserved the normal function of the right lower lung, and the operation was finally successfully completed. After waking up, the patient was transferred to the ward, and under the careful care of the medical team such as Zhou Lingzhen, the head nurse of the thoracic surgery department, Xiao Wang completely removed the chest tube after 4 days, and the isolated lung was completely resected by chest CT reexamination, the right lower pulmonary vein was intact, and there was no congestion in the right lower lung. A week later, he was discharged from the hospital "full of energy".
Before being discharged from the hospital, Xiao Wang and his family presented a pennant to the team of Deputy Chief Physician Li Hongyan of the Department of Thoracic Surgery.
"Looking at the youthful look on the patient's face, we felt that all the hard work was worth it. Deputy Chief Physician Li Hongyan said that surgery is never a simple technical problem, and perfect preoperative planning is a prerequisite for the success of surgery, which is the so-called "thinking determines the way out". When doctors put the interests of their patients first, we can always find a better way.
Source: Zhongda Hospital Affiliated to Southeast University
Correspondents: Cui Yuyan, Cai Yiqiu
Editor: Huang Menglin
Reviewer: Xie Tao
Issued: Daley Red
Picture: Some of the pictures in this article are from the Internet, the copyright belongs to the original author, if there is any infringement, please contact us to delete.