Reporter Sun Shuyu Correspondent Luan Xiuling Zhang Guojie
Want to cure back pain but unexpectedly encountered difficulty breathing. When the man was in critical condition, Yantai Mountain Hospital cooperated with many disciplines to escort him. The Department of Critical Care Medicine successfully completed the electrocautery, cryotherapy and balloon dilation of the stenotic main trachea under bronchoscopy. On April 27, the reporter learned from Yantaishan Hospital that the successful operation of this operation marks that the respiratory intervention technology of Yantaishan Hospital has reached a new level.
According to reports, half a year ago, the patient underwent tracheotomy in a local hospital. Later, due to tracheal scar hyperplasia and tracheomalacia, he underwent repeated tracheal interventional treatments for many times, but his breathing state was good and bad.
The patient suffers from lumbar tuberculosis. A few days ago, due to unbearable lumbar pain, he went to the Department of Spine Surgery, East Branch of Yantaishan Hospital for surgical treatment. During the hospitalization, the patient had difficulty breathing and the three concave signs were obvious. The doctor in the department invited the experts from the department of respiratory and critical care medicine to consult. Fei Jianwen, director of the Department of Respiratory and Critical Care Medicine, indicated that the patient had difficulty breathing or was caused by hyperplasia of scar and granulation tissue after the main airway tracheotomy, and instructed an urgent lung CT examination. Examination showed that the trachea was significantly narrowed at about 2 cm below the glottis, with a narrowed segment of about 1.5 cm and only 4 mm at the narrowest point. This means that the patient may suffocate with a mouthful of sputum, and the situation is critical, and endoscopic interventional treatment should be performed immediately.
In view of the high risk and difficulty of the operation, the department urgently applied for hospital-level case discussion. Director Du Wei, director of the Department of Anesthesiology Wei Fujiang and experts from the Department of Critical Care Medicine participated in the discussion in a timely manner, and agreed that the patient had severe main tracheal stenosis caused by benign lesions and needed bronchoscopy for interventional treatment. However, because the stenosis is too close to the glottis, endotracheal intubation cannot be performed, so the surgical risk is very high. However, permanent tracheotomy with high safety is difficult for patients and their families to accept. After discussing the case and communicating with the patient and their family members, the doctor decided to perform electrocautery, cryotherapy and balloon dilation under the bronchoscope under local anesthesia and intravenous anesthesia.
Before the operation, Director Fei Jianwen explained the purpose of treatment, surgical risks and emergency treatment plan to the patient’s family again, and fully evaluated the preoperative condition. The team of head nurse Wang Zili in the minimally invasive operating room prepared emergency surgical equipment overnight to prepare for the risks of massive bleeding and suffocation. During routine bronchoscopy, Deputy Chief Physician Han Jin found that the tracheal annular membranous scar was stenosis about 2.8 cm away from the patient’s glottis, and the narrowest point was about 4 mm. The treatment mirror could not pass through, which was consistent with the preoperative assessment. After assessing the risk of bleeding and airway wall damage, Director Fei Jianwen instructed to perform fan-shaped incision with electrocautery and repeated carbon dioxide cryotherapy at the stenosis of the lumen scar. Then, a suitable type of balloon catheter is sent into the working channel of the bronchoscope biopsy forceps, and the balloon catheter is sent to the airway stenosis for dilation treatment under direct vision. During the operation, Director Wei Fujiang of the Department of Anesthesiology and Dr. Zhang Wenhong performed intravenous compound anesthesia to reduce the patient’s intraoperative reaction as much as possible, and monitor the whole process to ensure the safety of the operation. Zhao Jing, the chief physician of the Department of Critical Care Medicine of the East Hospital, is also monitoring the whole process and is fully prepared. Once the patient suffers from bronchospasm and suffocation during the operation, an emergency minimally invasive tracheotomy is immediately performed.
With the efforts of Director Fei Jianwen, Deputy Chief Physician Han Jin and Chief Physician Zhang Xuefeng, within 40 minutes, the patient’s stenotic bronchi dilatation returned to 70% of normal, and the symptoms of dyspnea were relieved. Good preparation for later spinal surgery. After the operation, the patient was transferred to the surgical intensive care unit of the East Hospital to ensure a smooth passage of the postoperative edema period.
It is also understood that on April 14, the patient successfully completed the spinal surgery under the condition of tracheal intubation and invasive mechanical ventilation to ensure ventilation, and returned to the surgical intensive care unit of the East Hospital again. Director Fei Jianwen and Deputy Chief Physician Han Jin performed bronchoscopy again on the patient under tracheal intubation. Under the microscope, it was found that the trachea in the stenotic segment had recovered to 90% of normal, and a little necrotic tissue was visible. Carbon dioxide cryo-freeze-thaw treatment was performed at the stenosis of the lumen scar. The treatment effect was remarkable, and the airway lumen basically returned to normal. Finally, under the premise of ensuring safety, the doctor pulled out the tracheal intubation under the guidance of a bronchoscope.
Respiratory intervention, as an important subspecialty in the department of respiratory medicine, has shown an increasingly important position in recent years. Interventional therapy under respiratory endoscopy has saved the lives of many cancer patients. The Department of Respiratory and Critical Care Medicine of Yantaishan Hospital attaches great importance to discipline construction and sub-professional development, especially talent training and talent echelon construction, and has successively arranged a number of physicians to go to Shanghai Changhai Hospital, Emergency General Hospital, and Shandong Provincial Hospital to study and study respiratory intervention. technology. At present, the department can carry out bronchoscopy for benign and malignant airway tumor resection, pulmonary infection, diagnosis and treatment of interstitial lung disease, ultrasound bronchoscopy, foreign body removal, transbronchial lymph node biopsy, intratracheal coagulation, snare, carbon dioxide freezing, APC, airway stent implantation, drug injection, medical thoracoscopy and other interventional treatments.