A male patient underwent varicose vein surgery at the local hospital 3 weeks ago, and the preoperative examination found that there was a 2 cm solid nodule in the lung, which was most likely a malignant tumor from the chest CT image at that time. As the patient has just undergone varicose vein surgery, the patient is still taking oral anticoagulant medication and needs to stop taking the medication for a period of time before undergoing the surgery.
According to the patient's lung condition and the need for anticoagulation, I provide a two-line parallel regimen for the patient. On the one hand, the oral anticoagulant drug is discontinued and the low molecular weight heparin for injection is changed, because if the anticoagulant drug is not stopped, it will lead to more blood in the operation, and it is easy to bleed again after surgery, but if the anticoagulant drug is stopped, it will affect the efficacy of the patient's varicose vein surgery that has just been done. Therefore, I chose to use injectable drugs with a short metabolic time instead of oral drugs with a long metabolic time. On the other hand, it is necessary to use the time of surgery such as stopping medication to evaluate the condition as soon as possible and arrange surgery as soon as possible.
The patient immediately underwent a whole-body PETCT examination, and the results of the examination showed that: 1. Hypermetabolic nodules in the anterior segment of the right upper lobe, malignant lesions were considered; 2. Multiple lymph nodes in the mediastinum (2R, 4R groups) and right hilum with increased metabolism and possible metastatic lesions; Left hilar metabolic hypermetabolism with lymph nodes with calcification, metastatic lesions to be discharged. It is to be expected that the right lung nodule is malignant, but it is surprising that so many lymph nodes may already have metastases. I immediately contacted the patient's family and said that the patient's lung nodule was only 2 cm, and the possibility of comprehensive metastasis in the early stage was relatively small, and it was recommended to confirm the nature of the lesion and the true condition of the lymph nodes by bronchoscopy and ultrasound biopsy. After full communication, the patient's family trusted me very much and expressed their understanding and support for my proposal for further examination.
After communicating with the director of the respiratory department, I immediately arranged a bronchial examination and a small probe ultrasound biopsy for the patient. The process of FOB+EBUS examination was smooth, and the postoperative pathology was "anterior segment lesion of the right upper lobe": non-small cell carcinoma, combined with immunohistochemical markers, consistent with lung adenocarcinoma. No malignant cell components were found in the lymph nodes.
At this point, the conditions for the patient's surgery have been fully satisfied, and before the Chinese New Year, I performed a minimally invasive single-port thoracoscopic lung cancer surgery for the patient, removing the upper lobe of the right lung and performing the corresponding lymph node dissection. The patient recovered quickly after surgery, got out of bed on the first day, had the drain removed on the second day, and was discharged on the third day. Accompanied by his family, he happily spent a peaceful Spring Festival at home.
At present, cardiovascular and cerebrovascular diseases are more common than before, and many patients have a history of placing vascular stents and oral anticoagulant drugs, and if they need to undergo surgery, they need to use low molecular weight heparin drugs to "bridging"**, so they need to fully communicate with medical staff in taking drugs to avoid delaying the timing of surgery. Although this patient used anticoagulant drugs and the preoperative examination results were also twists and turns, due to the trust between doctors and patients and sufficient communication, it took about 3 weeks from medical treatment to completion of surgery and smooth discharge. At the time of the follow-up examination after the year, the patients and their families sent the first pennant of 2024 to express their gratitude. Here, I would also like to thank the patients and their families for their trust and support, and your encouragement and recognition are the driving force for me to move forward.