Department of Thoracic Surgery at Shanghai General Hospital Removed Huge Mediastinal Tumors for A 3-year-old Child with Multiple Disciplinary Team

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https://mp.weixin.qq.com/s/WHVR0R5NZEs2dfx4xdUXqw

A 3-year-old girl weighing only 15kg had a huge mediastinal tumor with a diameter of 20 cm and a weight of nearly 1.5kg. This tumor, which is close to one tenth of the child's weight, has severely squeezed her thoracic organs, threatening her life at all times.

The teams of thoracic surgery, cardiac and large vessel surgery, pediatrics, anesthesiology, blood transfusion department, intensive care unit, nursing group of operating room and other disciplines of Shanghai General hospital worked closely to overcome many difficulties and successfully implemented the "complex mediastinal tumor + right total lung resection" for the girl, removing the huge tumor in the chest. At present, she has recovered and was discharged on August 25.

Xiangxiang, a 3-year-old girl, comes from other cities. One month ago, he developed fever and asthma. After chest CT examination in the local hospital, it was found that the right thoracic cavity was a huge space occupying tumor, which was considered as pulmonary blastoma. The huge chest tumor constantly oppresses Xiangxiang's normal lung tissue and heart, making it difficult for her to even breathe and eat normally. Seeing that their lively and lovely daughter had become so angry that she could only live on oxygen in the ICU, Xiangxiang's parents were burning with anxiety. After making inquiries, they came to the thoracic surgery department of Shanghai General Hospital for help.

When he came to the hospital, Xiangxiang had already suffered from severe respiratory failure. Her lips were dark, her mind was indifferent, her right lung completely lost its function, and his carbon dioxide index exceeded 80. Jiang Fan, director of thoracic surgery department, immediately admitted her to the ward and contacted the medical ultrasound department to place a new chest tube for her under the guidance of ultrasound to temporarily relieve the symptoms and buy time for the formulation of the operation plan.

The operation is urgent, but the difficulty is obvious. Can the baby's weak body withstand the trauma of thoracotomy? How can anesthesia maintain hemodynamic stability as much as possible while establishing a safe airway? How to deal with the collapse of internal circulation that may be caused by the removal of a huge tumor? How to protect the nerves and blood vessels closely adhered to the tumor during the operation? In order to ensure that the operation is safe, after completing a series of examinations, the thoracic surgery department, with cooperation of the cardiac and macrovascular surgery department, pediatrics department, anesthesiology department and blood transfusion department, carried out a large-scale consultation, fully discussed and formulated a detailed operation plan, alternative plan and emergency plan in case of accidents, and tried to reduce the operation risk as much as possible.

On the day of the operation, the multidisciplinary team worked cooperatively. The operation was performed by Liang Wu, deputy director of thoracic surgery (North), and Wei Huang, deputy chief surgeon of thoracic surgery, Jinbao Li, director of the department of anesthesiology, Junyan Yao , deputy director (North) of the department of anesthesiology, and Long Guo, anesthesiologist, implemented anesthesia management. When intubation and venous access were established for the girl, they also played cartoons to ease her anxiety; Limin Wang, deputy chief physician of cardiac and large vessel surgery department, has prepared cardiopulmonary bypass equipment and can establish cardiopulmonary bypass at any time. The blood transfusion department also prepared a large amount of plasma and albumin. Before the operation, Xiangxiang held the arm of Dr.Junyan Yao and said in an inaudible voice: "Auntie, I want to drink milk." This extremely small and eager request for survival made all medical staff in the operating room more determined to save this young life.

Because the tumor is too large, in order to fully expose the surgical field, the surgical team adopted the clam shell incision, which is generally used for double lung transplantation. After opening the thoracic cavity, a huge tumor appeared. The tumor with a diameter of 20 cm occupied the entire thoracic cavity of Xiangxiang, severely compressed the vena cava, mediastinum, heart and left lung, and closely adhered to the surrounding nerves, blood vessels and other tissues. The surgical team carefully dissociated the tumor and surrounding tissues to protect the nerve function from loss. The anesthesiology team closely monitors the patient's blood pressure and coordinates tumor removal by adjusting intravenous infusion. After 3 hours of cooperation, the operation was successfully completed and the mediastinal tumor weighing 1.35 kg was completely removed. The patient's blood pressure was stable during the operation and was sent to the intensive care unit for close observation. In the evening of the same day, Xiangxiang successfully pulled out the tube. The heart and left lung that had been oppressed for a long time were relieved, and the blue and purple lips before the operation also had blood color.

On the second day after the operation, Xiangxiang was smoothly transferred from the intensive care unit to the general ward for further rehabilitation. She finally realized her dream to drink milk smoothly and forcefully. In the next few days, the medical team in the thoracic surgery ward gave her meticulous care. As the child was too young, the nursing team led by head nurse Wenjie Wang had to closely observe the vital signs of Xiangxiang all day long, patting her back and expectorating. Under the careful care of the medical staff, Xiangxiang quickly recovered its vitality and was able to walk on her own.

Prof. Jiang Fan introduced that mediastinal tumors are one of the common diseases in thoracic surgery, but giant mediastinal tumors are rare. Generally speaking, mediastinal tumors with a diameter of more than 10 cm can be called giant mediastinal tumors, and giant mediastinal tumors with a diameter of 20 cm occurring in children as young as 3 years old are even more rare. Because the mediastinal tumors are generally located deep and easily adjacent to important organs, the operation is very difficult. The thoracic surgery team of the Shanghai General Hospital has rich experience in mediastinal tumors, especially giant mediastinal tumors, and has successfully performed surgery for dozens of patients this year.

Correspondent: Jingyu Mao, Liang Wu, Xing Wang, Department of Thoracic Surgery 

Editor: Yang Hu, Shishi Cai, Department of Publicity