Chapter 856 S1+2aii Pulmonary segmentectomy
This is the core of lung segment resection.
3DCTA can provide fine individualized anatomical details. It is the most intuitive way to see the anatomical characteristics and structure of a patient besides autopsy.
Before Xu Qiu can find a way to autopsy the patient while he is still alive, 3DCTA is the most appropriate way clinically.
In addition, there are routine examination items such as lung function test, blood gas analysis, chest CT, etc.
Preoperative conversation.
Xu Qiu gave three surgical methods: wedge resection, segment resection and lobectomy.
Sitting across the conference room were Jiang Donger and Jiang Donger's parents, who were concentrating.
Moreover, the grandfather generation also came. The four elderly people of the two families sat obediently on one side and listened quietly.
"The patient's metastatic tumor is in the right upper lobe of the lung. At present, the surgical options available in the clinic are mainly lobectomy, wedge resection and segment resection...
"Lobectomy, that is, directly cutting off the right upper lobe of the lung, has a large range of damage and a great impact on lung function, but it almost never recurs.
"Compare the right upper lobe to a tree. The apex, posterior segment and anterior segment of the right upper lobe are three large bifurcations.
"Lobectomy means cutting off all three large bifurcations without leaving any possibility of residual tumors.
"Wedge resection means removing the entire crown of a tree.
"As for segmentectomy, it is a precise treatment of a certain area of bifurcation. After resection, various small bifurcations must be trimmed and the small bifurcations must be treated in detail."
The corresponding treatment is the treatment of arteries, veins and bronchi.
Jiang Dong'er and her family only understood half of it.
Although the description is very vivid, for people who have not received systematic medical education, even if they have previously made up for various surgical plans for lung metastases, they cannot understand it thoroughly.
After Xu Qiu finished speaking, Jiang Dong'er couldn't wait to say, "Doctor Xu, you decide!"
Jiang Dong'er's parents also nodded repeatedly and said in unison, "We trust you unconditionally, Doctor Xu! ”
Although the four old men behind did not eat, their expressions were similar to those of Jiang Donger's parents.
Xu Qiu did not shirk and said: "I would recommend lung segment resection. Although it is more difficult and requires more delicate operation, it will cause the least damage. And thanks to the analysis of anatomical structure by 3DCTA, the surgical plan will be very safe. ”
"Okay, that's it! "Jiang Dong'er said without hesitation.
Dad Jiang also nodded and signed his name on the informed consent form for the surgery.
...
It went so smoothly...
The surgery conversation only lasted seven or eight minutes and ended, which was unexpectedly smooth.
Xu Qiu didn't even need to do this popular science. For Jiang Dong'er's family, they believed in Xu Qiu, and it didn't matter whether they knew the details of the surgery.
But for Xu Qiu, every patient has the right to know... Even if they don't want to know, they must know something about their upcoming surgery.
On that day, Xu Qiu convened the emergency department, respiratory department, thoracic surgery department and oncology department for a pre-operative consultation and discussion.
The patient's detailed examination was also displayed on the screen.
Osteosarcoma metastasis in the right upper lobe of the lung, 3D CTA showed right S1+2aii 10 mm lung nodules, simulated surgery on 3D images, with operability conditions, sufficient margins for resection, and can undergo S1+2aii lung segmentectomy...
Half an hour later, the meeting ended.
Although it has been determined to do lung segmentectomy, the crowd debated for a while about the specific way to carry it out.
Clinically used are mainly ordinary thoracotomy lung segmentectomy, small incision thoracotomy, and thoracoscopic minimally invasive surgery.
The former is the simplest, using the traditional posterolateral incision approach, which can fully expose the surgical field of view. The doctor can remove the tumor lesions and clear the lymph nodes under direct vision.
Small incisions do not need to cut muscles and ribs, and recovery is relatively faster.
Direct thoracotomy has a large wound, good field of view, and slow recovery.
Small incisions have a better field of view, Small wound, fast recovery.
And finally, thoracoscopy, which has a poor field of view, small wound, and fast recovery.
However, there is also a fourth surgical method.
That is, robot-assisted thoracoscopic minimally invasive surgery, also commonly known as the "Da Vinci robot".
This procedure combines almost all of the above advantages, with small wounds, fast recovery, good field of view, and is not limited by the surgeon's ability. It has only one disadvantage - it is too expensive.
Moreover, this is not a question of whether the patient can afford it.
At present, Linyi has only one Da Vinci robot for liver resection. For lung segment resection, the relevant technology has not been introduced in China, and even if it wants to be carried out, it is powerless.
"Don't argue, with Dr. Xu here, why consider small incisions? It must be thoracoscopic minimally invasive surgery! "At this time, Director Hu of the Respiratory Department, who is good at flattering others, made the final decision.
After this, everyone was silent.
Yes, they were just here to join in the fun, and the operator was still Comrade Thigh...
After Director Hu raised his arm and called for action, the surgical plan was initially determined:
The patient underwent right S1+22 three-port thoracoscopic lung segmentectomy under unilateral ventilation and general anesthesia.
During the operation, the target pulmonary veins, arteries and bronchi were dissected in turn, and the sub-sub-segmental veins were retained.
The sub-sub-segmental plane was determined by the inflation collapse line, and then separated by electrocoagulation hook and cutting closure device...
During the operation, N1 and N2 lymph nodes were taken for frozen section analysis, and the relevant lung segments were removed...
"Another difficult operation!"
"If it is done by thoracotomy, the operation is not difficult, just cutting a lung, but if it is done under the premise of thoracoscopy, it requires delicate operation..."
"Is there anyone in the respiratory department who can be Dr. Xu's assistant?"
"Yes, there is. We have a specialist in thoracoscopic surgery, but this is the first time to do thoracoscopic resection of lung metastatic cancer. He needs to catch up for a few days before he can get started."
"Let Yang Yuen come."
"Yang Yuen? She is not a cardiologist, why is she joining the respiratory department?"
"Yang Yuen did a lot of thoracoscopy when she was at the Livland Clinic. She is very good at this kind of minimally invasive surgery and is most suitable to be an assistant!"
Hearing these suggestions, Xu Qiu was a little surprised.
I didn't expect that Yang Yuen had already made a name for herself in Linyi after I hadn't paid attention to her for only one or two years?
Even a bunch of directors are recommending her!
"Okay, let's go with Yang Yuen." Xu Qiu decided.
...
Three days later, the operation began.
In the operating room, everyone was ready.
Yang Yuen also quickly reviewed the key points of this operation.
There are three key links in thoracoscopic minimally invasive lung segmentectomy.
The first is anatomical lobectomy.
The second is the treatment of the anti-lobar fissure.
The last one is the treatment of the hilar blood vessels and bronchi, including the cutting and anastomosis of the trachea, bronchi and pulmonary blood vessels, which is also the key step that makes the operation more difficult.
Similarly, anastomosis and reconstruction are also related to the quality of the operation and the patient's prognosis.
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