Deep cultivation and taking the road of specialized development are the development trends of tertiary hospitals. After more than ten years of development, the Thyroid Center of General Surgery of Tongji Hospital Affiliated to Tongji University has gradually established the brand characteristics of "Tongji Thyroid Gland". Towards the end of the year, Li Xinping, deputy director of the Department of General Surgery, led Wu Shehua, deputy chief physician, and other thyroid center physicians to successfully carry out a number of difficult tumor surgeries, polishing the professional brand with solid technology and excellent service.
A doctor doesn't want to encounter surgery again
Xiao Wang, a student who has just entered high school, when his voice changes, his family thinks it is due to puberty and does not pay attention to it. Later, the school's physical examination found clues, so he went to the hospital for treatment, and the subsequent examination results completely shocked the family: bilateral thyroid malignancy with extensive cervical lymph node metastasis, unilateral vocal cord paralysis. It turned out that Xiao Wang's voice change was caused by the tumor invading the recurrent laryngeal nerve. The family hurriedly put down everything in their hands and brought their children to Shanghai for medical treatment. The professor from the outer hospital also felt troubled by this case, and seriously explained some serious complications that may occur during the perioperative period, and the family members felt unacceptable at once, and finally came to Tongji Hospital affiliated to Tongji University**.
The same case, of course, the same tricky, Li Xinping decided to lead the thyroid center team to meet this challenge after carefully reading the patient's information and communicating with the family in detail. Due to the large size of the tumor, which has invaded the trachea, esophagus, and large blood vessels in the neck, and multiple lymph nodes in both necks are swollen into clumps, the complexity of the operation can be imagined. More importantly, if one recurrent laryngeal nerve has been affected and has lost function, has the contralateral recurrent laryngeal nerve been affected, and can it maintain its function?If it doesn't work, you may face the harsh reality of tracheotomy. Faced with this young patient, who had not yet undergone surgery, the pressure was already coming in.
The difficulty, which lasted four and a half hours, was also reflected: the anterior neck muscles were involved and removed;Tracheal involvement, split and excision of part of the tracheal wall tissue;Esophageal involvement, removal of part of the muscles;Internal jugular vein involvement, lymph nodes are removed to repair the vessel wall;Even the highest submandibular swollen lymph nodes were removed by additional incisionsHowever, the most critical contralateral recurrent laryngeal nerve was also encased by the tumor, and although the nerve was finally stripped out after careful separation, no one knows how it functions.
Although it was past the end of work, several doctors were sitting in the office and did not leave, they were all waiting for one of the ICUs. Until the ** end said: "The endotracheal tube has been removed, the patient is breathing well!."There was no particular excitement in the office, but everyone rushed to the custody room, leaving their exhaustion far behind.
There's a reason why I like to wear silk scarves
Ms. Yang has worked abroad for many years, and friends who are familiar with her know that Ms. Yang likes to wear silk scarves very much, so many friends also praise her for her tasteful dressing. In fact, Ms. Yang wears a silk scarf for another reason. When she was young, she had a relatively large lump on her neck, and because it was not painful or itchy, she did not pay much attention to it. After all, it's not good-looking, so she often uses a silk scarf to cover it up.
As she grew older and became more knowledgeable, she realized that there might be a thyroid problem, so she decided to go to Tongji Hospital**. However, her mass was not an ordinary thyroid nodule: it was large, hard and fixed. When the CT examination came out, Wu Shehua realized the seriousness of the problem and communicated with Ms. Yang - she has been suffering from thyroid cancer for many years, the tumor has grown relatively large, the local invasion is obvious, and the lymph nodes in the side and neck are also swollen, which is relatively advanced, so the operation is relatively complicated and the incision will be relatively large.
During the operation, Li Xinping and Wu Shehua found that Ms. Yang's tumor had invaded the Adam's apple and part of the tracheal wall, densely encapsulated the recurrent laryngeal nerve, and enclosed the swollen lymph nodes and even the carotid artery sheath. The thyroid center team was also fully prepared and calmly responded to the total thyroidectomy + bilateral neck dissection in three and a half hours. Perhaps because of Ms. Yang's natural optimism, the postoperative recovery went smoothly, and none of the complications she had worried about occurred before.
On the day she was discharged from the hospital, she tied a beautiful silk scarf again and joked: "I can't live without a silk scarf in my life!."”
Your recurrent laryngeal nerve is the thinnest I've ever seen
Ms. Zhu came to Tongji Hospital from other places because of a thyroid tumor, and what makes her special is that there are multiple lesions in both thyroid glands, and of course, this kind of multifocal cancer itself has a higher probability of metastasis. According to the results of the imaging examination, Li Xinping decided to give her a total thyroidectomy + bilateral neck dissection.
The first element of thyroid surgery is to protect the recurrent laryngeal nerve, and to protect the nerve, it must be found first. With years of clinical experience, finding the recurrent laryngeal nerve is not difficult for the Thyroid Center team, but Ms. Zhu's surgery is indeed a bit different because her recurrent laryngeal nerve is so thin!So much so that after finding her recurrent laryngeal nerve during surgery, several doctors felt that it should be a nerve branch, not the main trunk of the recurrent laryngeal nerve, because it was only 1 3 thick as the main trunk of the recurrent laryngeal nerve of an ordinary person.
However, after careful searching, the doctors could not find another nerve trunk, and finally confirmed that this slender nerve was the trunk. Such a thin nerve was damaged without paying attention, so Li Xinping and Wu Shehua worked hard and operated carefully, and when they opened the contralateral thyroid gland, they were also very careful, and found that the contralateral nerve was also very slender. Although it took a lot of trouble to find the nerve, the operation went very smoothly overall.
A few days before the operation, Ms. Yang was prone to choking when drinking water and was very worried, Li Xinping comforted her during the ward rounds: "Your recurrent laryngeal nerve is the smallest I have ever seen, and it is normal to react a little, and the most important thing is that during the operation, we found it and protected it, fortunately there was no damage." ”
Within a few days, Ms. Yang's cough symptoms improved significantly, and her face showed the smile of the past, and she also became a volunteer propagandist of the thyroid center, often saying to new patients in the corridor: "You can come to Tongji to open the thyroid gland, you see how well I am recovering!".”
Coincidentally, these three complex surgeries were carried out consecutively over a period of about a week, which was indeed a psychological and physical test for the doctors. During the flu season, more than half of the doctors at the thyroid center had a fever and cough and hung with saline. But everyone worked hard to persevere, because everyone has a common belief: to polish the professional brand of Tongji thyroid with their own efforts.
Expert presentation
Li Xinping
Deputy Director of General Surgery
Deputy Chief Physician of the Thyroid Center of General Surgery
Specialist Clinic: Wednesday morning, Thursday afternoon
Doctor of Medicine from Tongji University, he has been engaged in clinical surgery for 26 years, and has studied oncology surgery at Peking University and Ruhr University in Germany. He specializes in thyroid surgery and has accumulated rich experience in the identification of thyroid nodules, thyroid tumor surgery, hyperthyroidism and hyperparathyroid surgery. He specializes in the diagnosis, identification and surgery of thyroid nodules**, especially thyroid malignant tumor modification** and cervical lymphatic dissection. He has been awarded the titles of "Shanghai Outstanding Volunteer", "Outstanding Foreign Aid Medical Team Member", "Top Ten Doctors of Tongji Hospital", "Young Post Technical Expert" and "Quality Service Star".
Wu Shehua
Deputy Chief Physician of the Department of General Surgery
He graduated from Shanghai Medical University with a master's degree in clinical medicine. He has been engaged in general abdominal surgery for more than 20 years, and has accumulated rich experience in the operation and comprehensive treatment of benign and malignant thyroid tumors and middle and advanced gastrointestinal tumors, especially in the cervical lymph node dissection surgery of thyroid cancer. Main research directions: research on surgical methods for thyroid tumors and middle and advanced gastrointestinal malignant tumors.
Author: Li Xinping, Tongji Hospital, Tongji University.
Editor: Jiani Lu.
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