The thoracic combined anesthesia team accurately cleared the "three forks", and a 63 year old patient discovered a tumor | protuberance | trachea in the trachea

Tracheal protuberance tumor obstructs normal breathing, and ultra precision surgery is performed to clear the airway congestion at the triple junction of the trachea. Seeing that the patient has been transferred from the intensive care unit to the general ward and will soon recover and be discharged, the chief surgeon Zhao Xiaojing's heart finally relaxed. Recently, the team led by Zhao Xiaojing from the Department of Thoracic Surgery at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine once again broke through the technical limit and completed a trachea carina tumor resection and complex carina reconstruction surgery, with up to three tracheal anastomoses.

Two sets of plans to ensure patient safety during surgery

At the beginning of this year, 63 year old Aunt Wang discovered a tracheal tumor during her physical examination, which seriously affected her respiratory function. The patient was sent to Renji Hospital for treatment at the end of February. After consultation with the Director of Thoracic Surgery, Zhao Xiaojing, and his team, it was determined that adenoid cystic carcinoma of the tracheal carina affected both main bronchi and the opening of the right upper lobe bronchus. Complex carina reconstruction surgery should be performed as soon as possible.

"Based on the patient's CT and bronchoscopy examination results, we have developed a complete set of surgical procedures and plans for them." Zhao Xiaojing said, "The difficulty of this surgery lies in the extremely high technical requirements of the surgeon, who needs to perform" embroidery needle "style ultra fine operations in the respiratory system. At the same time, it also poses challenges to the formulation and implementation of anesthesia plans. How to maintain the patient's airway unobstructed and stable oxygen supply during the surgery is the key to the success or failure of the surgery."

Before the surgery, Zhao Xiaojing communicated and negotiated with the chief anesthesiologist Chen Jie and the deputy chief physician Liu Yaling multiple times, repeatedly designed and polished the surgical plan, and prepared multiple contingency plans. Finally, the intraoperative two route oxygen supply plan was determined, that is, in addition to oral tracheal intubation oxygen supply, tracheal incision intubation assisted oxygen supply.

At noon on the day of the surgery, with Zhao Xiaojing as the main surgeon and the assistance of the deputy chief physicians of thoracic surgery, Qian Xiaozhe, Tang Jian, and resident physician Zheng Jiajie, the anesthesia department's Chen Jie, Yaling, and resident physician Hu Xiaoting were responsible for anesthesia. A battle to protect the lifeline of tumor patients officially began.

The patient's condition is complex, and the difficulty of surgery is constantly increasing

Although the plan was well prepared, the team still encountered challenges during the surgical process. "During the surgery, we found that the area of the tracheal protrusion and main bronchus infected by tumor cells in the patient was longer than previously expected." Zhao Xiaojing said that the extraluminal lesions of the patient's bronchus far exceeded expectations, which cannot be detected during preoperative examinations and can only occur during the surgical process.

Liu Yaling revealed that according to the patient's intraoperative condition, there is a great risk of completing the resection and reconstruction of the left and right main bronchial masses and corresponding tracheal segments while preserving autonomous breathing, and mechanical assisted ventilation cannot be achieved according to the original plan. After rapid communication, the surgical team adopted a venous venous extracorporeal membrane oxygenation mode to maintain the patient's oxygen supply level. ECMO catheters were inserted through the internal jugular vein and femoral vein respectively, ensuring that the patient's oxygen saturation remained within the safe range during surgery.

In the end, Aunt Wang's right common bronchus and right middle bronchus were excised by 3.5 centimeters, the left common bronchus was excised by 2.5 centimeters, and the trachea was excised by 2 centimeters, forming four trachea resection ends: the trachea resection end, the left common bronchus resection end, the right middle bronchus resection end, and the right upper lobe bronchus resection end. This means that during the surgery, the chief surgeon needs to perform three anastomosis operations. Both the length of resection and the number of anastomoses have created the highest level of difficulty among the team, and the difficulty of this surgery is also very rare in China. After the surgery, Aunt Wang was sent to the intensive care unit for further observation.

"The entire surgery was smooth, but the monitoring, observation, and nursing treatment of the patients were crucial." Zhao Xiaojing explained, "Due to the patient's ECMO surgery under extracorporeal circulation during the surgery, although the anastomosis process was smooth, it was prone to tissue edema. Along with the occurrence of persistent anastomotic edema, how to maintain airway oxygen supply and prevent and treat lung infections posed great challenges to subsequent medical and nursing care." The persistent anastomotic edema also brought about softening of the cartilage ring and granulation proliferation in the later stage. The medical team cleverly and accurately calculated the reasonable tracheostomy, combined with the use of cryoablation surgery to remove granulation tissue at the anastomotic site, greatly improving the patient's breathing difficulties. In recent times, the tracheostomy was successfully closed. ". Now, Aunt Wang's physical condition is stable and she is about to be discharged from the hospital.