China News Service, Guangzhou, April 21 (Cai Minjie, Zhang Lanxi, Jin Ting) 12-year-old girl Xiaoxiu (pseudonym) is in junior high school. She is optimistic and cheerful and never expected that a sudden illness is breaking her peaceful life. There is a "time bomb" quietly hidden in the left chest cavity - a huge tumor with a diameter of 20 cm.
Recently, the Department of Cardiac Surgery of Guangdong Provincial People's Hospital organized a multidisciplinary collaborative effort, which took several hours to complete the removal of a huge mediastinal teratoma in the left thoracic cavity, which was successfully "defused".
The child had no obvious intraoperative and postoperative complications, recovered well, and has been discharged from the hospital successfully.
A few months ago, Xiaoxiu found a huge tumor in the left thoracic cavity during the physical examination. From the CT imaging features, the tumor contained lipid components, bones and teeth and other ossification components. The preliminary clinical diagnosis was mediastinal teratoma.
According to reports, teratomas are embryonal tumors, and are more common in benign mature and differentiated properties. They are caused by partial mutations during the occurrence, migration and development of germ cells during embryonic development.
Mediastinal teratoma accounts for about 15% to 20% of primary mediastinal tumors. It is more common in young adults under the age of 30, and is more common in women than in men. It is more common in benign, and may also be poorly differentiated and malignant. Although the tumor grows slowly, it can reach After the huge volume, it will cause pressure on the surrounding organs.
According to Chen Jimei, director of the Institute of Cardiovascular Diseases and Director of Cardiac Surgery of Guangdong Provincial People's Hospital, after further detailed examination, it was found that Xiaoxiu's mediastinal teratoma was about 20 cm in diameter, located deep in the left posterior inferior mediastinum, and had been partially compressed Cardiac pericardium, left lower lung, left diaphragm and retroperitoneal organs, and the tumor is closely adhered to the descending aorta, with unclear demarcation, adjacent to the esophagus, thoracic duct and multiple nerves, and several feeding vessels are supplied by the descending aorta Tumor blood supply.
"These complex anatomies all bring multiple high-risk risks to the operation. How to completely remove the tumor while avoiding damage to the surrounding important organs and reducing the occurrence of complications is the biggest challenge for the surgeon." Chen Jimei said.
In order to formulate the best treatment plan, the Institute of Cardiovascular Diseases organized multidisciplinary consultations such as pediatric cardiac surgery, cardiac and major vascular surgery, thoracic surgery, cardiac anesthesiology, and extracardiac intensive care. The plan was discussed in detail and a surgical plan was developed.
At 9:50 on March 1, the expert team performed this difficult operation for Xiaoxiu.
"This is the largest mediastinal teratoma I've ever cut. If the aorta ruptures, it may cause massive hemorrhage at any time." said Sun Tucheng, director of the Cardiac and Great Vascular Surgery Department of the Cardiac Surgery Institute of the Heart Institute of Guangdong Provincial People's Hospital. In case of massive bleeding, extracorporeal circulation will be activated immediately, and the surgical team will immediately carry out vascular repair or artificial blood vessel replacement. If the tumor breaks through the diaphragm, the surgical team will optimize the plan at any time and remove the tumor under the premise of ensuring safety.”
Fortunately, after thoracotomy, the surgical team found that Xiaoxiu's mediastinal teratoma did not break through the diaphragm, and the operation went smoothly according to the preoperative plan.
The doctors first cut off the "supply" of the tumor, blocked and locally repaired the descending aorta.
After passing the highest risk level, the surgical team carefully dissected and dissociated the adjacent area around Xiaoxiu's tumor, released the adhesions of the pericardium and lung, and released the adhesion of the diaphragm, and dissociated the mediastinum at the base of the tumor layer by layer to remove the tumor. The pedicle feeding vessels were free ligated root by root.
At about 12 o'clock that day, the medical staff in the operating room held their breath, and a huge mediastinal teratoma was completely removed from the chest cavity.
Subsequently, the surgical team carefully inspected the adjacent areas around the original tumor, completed local repairs in turn, and successfully completed the "bomb disposal task".
According to reports, huge and complex mediastinal tumors, especially those closely related to cardiovascular anatomy, have always been a surgical intractable disease.
Mediastinal teratomas are generally relatively common in the abdominal cavity and thoracic cavity, and may originate from the mutation of a single embryonic germ cell, which is difficult to detect at an early stage.
There is currently no effective preventive measure for the disease. Regular physical examination or early medical treatment can ensure early diagnosis and early treatment, and most of them are benign in nature and can be cured by surgical resection.
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