Recently, a 10 cm long silica gel covered stent was successfully implanted into a lung cancer patient with tracheoesophageal fistula under the guidance of X-ray in our hospital, which provided a channel for the patient's life.
Patient fan Mou, male, 65 years old. Two years ago, it was diagnosed as "squamous cell carcinoma of the left lung". After sleeve resection of the upper lobe of the left lung, there was hoarseness caused by injury of the recurrent laryngeal nerve, followed by intermittent chemotherapy for many times. There were cough, expectoration and blood in the sputum before September, and short of breath in daily activities. The reexamination of chest CT showed the recurrence of left lung cancer after operation. Two weeks ago, cough, expectoration, shortness of breath aggravated, accompanied by drinking water, eating and choking cough, the patient was very painful. Chest CT showed that: left hilar space occupying, two lung multiple exudative lesions, after anti infection and symptomatic treatment, the condition did not improve, and then lived in four departments of our hospital.
After admission, Yao Gang, deputy chief physician of the four departments, inquired about the medical history in detail and checked the auxiliary examination data, and carefully judged the condition: the choking cough of the patient did not occur immediately after drinking water and eating, but 2-3 seconds after drinking water and eating, which did not conform to the choking cough characteristics caused by bulbar paralysis and recurrent laryngeal nerve paralysis; and there was a small amount of food residue mixed in the sputum with fetid odor The CT findings of the chest are consistent with the characteristics of aspiration pneumonia, so it is possible to consider the possibility of tracheoesophageal fistula caused by lung cancer. After giving Methylthioninium Chloride Injection oral administration, the blue foam like sputum was continuously coughed, and tracheoesophageal fistula was confirmed. The esophagus iodine angiography was performed and the tracheoesophageal fistula was diagnosed, and the location of the fistula was determined. Further gastroscopic examination revealed esophageal metastases, tracheoesophageal fistula, and fistula from the incisor 29cm.
The patient is in the late stage of lung cancer and should not be treated by surgery. In order to reduce the sufferings of patients, improve the quality of life, avoid the risk of aspiration and infection caused by coughing, and solve the problem of patients unable to drink and eat normally, the medical team of the four departments of internal medicine decided to seal the fistula with esophageal covered stent implantation under the guidance of X-ray after comprehensive and accurate assessment of the condition and full communication with patients and their families. In order to ensure the safety of patients and achieve the best treatment effect, the hospital twice organized the consultation of multi-disciplinary experts such as respiration, digestion, intracardiac, shennei, emergency, surgery, imaging, anesthesia and so on. After repeated discussion, the perfect operation plan and detailed emergency plan were formulated. After sufficient preoperative preparation, careful organization of the medical education department and close cooperation of all departments, the first x-ray-guided esophageal silicone covered stent implantation was successfully completed by the cooperation of the four departments, radiology department and experts of the superior hospital. The cough, expectoration and shortness of breath were relieved and the effect was satisfactory. It is reported that the treatment of tracheoesophageal fistula with silica gel covered stent is the first in our county. The successful development of this technology in our hospital has filled in the blank of this technology field in our county and brought good news for such patients.
Esophageal covered stent implantation is mainly used for the treatment of esophageal stenosis and esophageal fistula caused by various reasons, because esophageal fistula is relatively rare in clinical, so esophageal covered stent implantation is mainly used for the treatment of esophageal stenosis. Tracheoesophageal fistula can be seen in advanced lung cancer, esophageal cancer and other diseases. Once it occurs, it will lead to choking cough, aspiration pneumonia, mediastinal infection and so on, which will seriously affect the quality of life and even endanger life. Placement of covered stent in the esophagus can block the fistula, expand the narrow esophagus, relieve the obstruction, let the patients return to normal eating function, and win more treatment opportunities and survival time. Compared with the surgical operation, the esophageal covered stent implantation has the advantages of less risk, no trauma, definite curative effect, high safety and low cost, which is suitable for the basic hospital.
Multidisciplinary expert consultation before operation
Operation in progress
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Before setting the bracket
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After setting the bracket
Section introduction
The four departments in our hospital are the key respiratory specialty alliance units of Shaanxi Province. The ward is located on the 12th floor of the inpatient building, with 45 beds. There are more than 20 medical staff, including 8 personnel with middle and senior professional titles.
Department director Yao Gang, deputy chief physician
Graduated from Yan'an Medical College, master of internal medicine, vice president of Fengxiang gerontology society. He has been engaged in the clinical work of internal medicine for more than 20 years, and has studied in Xijing Hospital and Beijing Armed Police General Hospital. He is good at the diagnosis and treatment of common and frequently occurring diseases of respiratory system, and has accumulated certain experience in the diagnosis and treatment of difficult and critical diseases of respiratory system. He has published more than 20 papers in medical journals at or above the provincial level and obtained one national invention patent. In 2017, it was rated as the "second best doctor pacesetter" of Fengxiang County, and in 2019, it was rated as the "top ten doctors with outstanding contributions" of the second Chinese doctor festival of Fengxiang county.
Deputy director Chen Fangli attending physician
Graduated from Shaanxi College of traditional Chinese medicine, bachelor degree. He has been engaged in clinical work for more than 10 years and has studied in respiratory and Critical Medicine Department of the First Affiliated Hospital of Xi'an Jiaotong University for one year. We have accumulated rich experience in the diagnosis and treatment of chronic obstructive pulmonary disease, bronchial asthma, severe pneumonia, cor pulmonale, bronchiectasis and other diseases.
Diagnosis and treatment scope: chronic obstructive pulmonary disease, bronchial asthma, pneumonia, lung cancer, interstitial lung disease, respiratory failure, heart failure, pulmonary thromboembolism, cor pulmonale, pleural effusion, pneumothorax, bronchiectasis, cough, hemoptysis caused by various reasons, respiratory sleep disorders, etc.
Technical features: percutaneous lung biopsy, minimally invasive thoracic closed drainage, pleural biopsy, tracheoesophageal stent implantation, pericardiocentesis and drainage, pulmonary function examination, bronchodilation test and other examination and treatment. Using the theory of syndrome differentiation and treatment of traditional Chinese medicine, using acupoint application of traditional Chinese medicine, ear acupuncture, "winter disease and summer treatment" three volt patch and other characteristic therapies to treat respiratory system diseases, the curative effect is significant.
Medical equipment: more than 30 sets of medical equipment, such as central monitoring system, Philips V60 non-invasive ventilator, Mir pulmonary function instrument, gy-6620 respiratory sleep monitor, abl80 blood gas analyzer, five rapid bedside detection instruments of heart and lung, cardiac defibrillator, micro injection pump, infusion pump, air compression atomizer, warm and hot direct current introduction therapy instrument, medium frequency therapy instrument, far-infrared physiotherapy instrument, etc.
We always adhere to the tenet of "taking patients as the center and attaching equal importance to traditional Chinese and Western medicine". We are willing to serve every patient with full enthusiasm and excellent technology. Your health is our greatest wish!
Department Hotline: 0917-7214591