A boy aged 3 years was admitted to the hospital with bronchitis due to cough and tachypnea. The radiologist accidentally found cysts in his neck and chest cavity. After MDT consultation, experts of multiple department in Wuhan Children's Hospital specially designed a "hybrid minimally invasive surgery" for the child, "removing" the cysts at two sites in one surgery. Today (August 1), the family is very happy to leave the hospital with their recovering baby.
Jiajia (pseudonym) was a bouncing boy aged 3 years in Yichang. Four days ago, Jiajia began to suffer from fever, cough and even dyspnea, and he was diagnosed with bronchitis at a local hospital. During the plain chest CT scan, the doctor unexpectedly found a egg-sized mass in the right neck area, and significant tracheal stenosis due to compression. It was this mass that caused dyspnea in the child.
Due to the complex and critical condition, the doctor suggested referral to the superior hospital for treatment. In order to seek further treatment, Jiajia was transferred to Wuhan Children's Hospital through the "green channel" of the Hubei Pediatric Medical Alliance. Further examination revealed that in addition to the head and neck cysts, Jiajia also had a mediastinal cyst in her chest.
Neck is an important "traffic artery", which gathers many important nerves and blood vessels, especially trachea, an important life channel. In order to ensure the safety of the child's life while removing the cyst, after the expert consultation of Pediatric Cardiothoracic Surgery Department, Radiology Intervention Department, Plastic Surgery Department, Respiratory Internal Medicine Department of Wuhan Children's Hospital, doctors decided to perform a "hybrid surgery" to solve the two problems.
The cysts in Jiajia's neck area were treated with "cyst injection" by interventional radiologists. The cyst in the chest was removed by a Da Vinci robot operated by surgeons of Pediatric Cardiothoracic Surgery Department.
On July 25, Jiajia was wheeled into the operating room. Under the guidance of DSA and ultrasound, Huang Sui, director of the Radiology Department of Wuhan Children's Hospital, punctured the mass in the right neck area of Jiajia accurately, and the white sticky cyst fluid like yogurt was slowly extracted, which quickly relieved the compression of the cyst on the nerves and blood vessels in the neck.
Subsequently, the radiography revealed two cystic cavities of irregular size and shape. The disease, known as branchial cyst, is a congenital condition caused by incomplete absorption of embryonic structures after birth. Then, doctors performed intracystic drug irrigation and sclerotherapy to make the cells of cyst wall necrotic, and the cyst cavity closed, and this was an advanced minimally invasive technique, which could achieve the effect of traditional surgical resection.
Pi Ming'an, director of Cardiothoracic Surgery Department served as the surgeon of the next operation, and Wang Li, Yu Shuai doctors served as the assistants. Intraoperative findings: There was a ping-pong ball-sized cystic mass in Jia Jia's chest (right upper mediastinum), which was located in a "vital" position -- between the arch of azygos vein and the superior vena cava, and close to the phrenic nerve and the superior vena cava.
All of these were "extremely important blood vessels" of the human body, so it should be very cautious to perform surgery to remove the cyst without damaging blood vessels and tissues. "Skilled and bold", director Pi Ming'an quickly and accurately stripped the cyst with the assistance of a robot. Intraoperative findings: The cyst base was connected with the esophagus, and stuck to the main trachea. The experts were careful to separate the adhesion, and performed excision of the cyst.
The pathological results showed that the mediastinal cyst was an esophageal cyst. One week after surgery, Jiajia recovered and was discharged from hospital. "It was surprising that our child recovered so quickly after two problems were solved in one surgery", Jiajia's parents said gratefully.
Expert Pi Ming'an of Cardiothoracic Surgery Department of Wuhan Children's Hospital said: "Jiajia have two kinds of cysts, both of which are malformation in the process of congenital embryo development. The early symptoms of this disease are not apparent, but inflammatory response will occur as the cysts grow and secretions are gradually increased. Jiajia's fever was associated with this condition to a certain extent. In fact, the mass in the neck was palpable when the doctor performed physical examination." He also reminded that, when bathing the children, parents should observe carefully and seek medical treatment in time when finding any suspicious lumps.