Successful diagnosis and surgery of rare diseases

*Through paraclinical results, doctors of the Department of Thoracic Surgery discovered an image of a lesion next to the left spine of patient N.D.D. Photo: LH*

With high expertise and the application of modern techniques, especially endoscopic surgery, doctors have helped patients recover quickly and avoid dangerous complications.

Nerve sheath tumor resection

Doctors of the Department of Thoracic Surgery have just successfully performed endoscopic surgery to completely remove a rare hourglass-shaped nerve sheath tumor (more than 6cm in size), located in the left lung apex, a location where many important blood vessels and nerves are concentrated.

Patient N.D.D (born in 1991, residing in Phu Ninh commune) had a slight drooping of the left eyelid but subjectively did not go to the doctor. During a routine health check at the company, a chest X-ray discovered an abnormal tumor in the left lung apex, so the patient was admitted to the Thoracic Surgery Department for treatment.

Through chest CT scan, doctors discovered the image of a lesion next to the left spine, with clear edges, continuous with the left D1-D2 intervertebral foramen located close behind the left subclavian artery, left vertebral artery, and left common carotid artery.

Doctor CKII. Than Trong Vu, Head of the Department of Thoracic Surgery, who directly performed the surgery on the patient, said that the location of the tumor was near important structures: behind the subclavian artery, subclavian vein, left common carotid artery, X nerve, phrenic nerve, thoracic duct, cervical-thoracic sympathetic ganglion, making the surgery very difficult.

Many complications can occur such as bleeding, hoarseness, cerebrospinal fluid leakage, thoracic duct damage, cervical sympathetic chain damage, making ptosis worse.

However, with the high concentration and absolute precision of the Thoracic Surgery team in coordination with anesthesia and resuscitation, the doctors succeeded in completely removing the tumor using thoracic endoscopic surgery. After 2 hours and 30 minutes, the surgery was successful, the patient recovered well, without complications and was discharged after 1 week of treatment.

According to Dr. Than Trong Vu, schwannoma is the most common type of nerve tumor in the posterior mediastinum, accounting for more than 75% of nerve tumors in this location. Usually, these tumors grow slowly, have few symptoms, and many cases are discovered by chance.

However, when the tumor is large, it can compress and cause chest pain, difficulty breathing, hoarseness or Horner syndrome (ptosis, miosis). In particular, the hourglass-shaped tumor is very rare and surgery is difficult because it involves both the spinal canal and the pleural cavity.

“Regular health check-ups and timely examination when there are unusual signs are extremely important. People need to go to specialized medical facilities for early diagnosis and timely treatment to avoid unpredictable complications,” Dr. Vu advised.

Removal of isolated lung

Previously, the Department of Thoracic Surgery also successfully performed an endoscopic surgery to remove an isolated part of the lung for patient NTK (born in 1968, residing in Cam Le ward). This is a rare congenital disease, rarely diagnosed in adults.

*The team of thoracic surgeons and anesthesiologists performed complete removal of the tumor for patient N.D.D using thoracic endoscopic surgery. Photo: LH*

Doctors performed surgery to remove the isolated lung using a two-port thoracoscopic technique to minimize chest wall trauma for the patient. After 2 hours, the doctors successfully removed the isolated lung mass along with a part of the left lung lobe parenchyma, preserving as much of the remaining lung parenchyma of the lower lobe as possible instead of removing an entire lobe.

According to doctors, patient K.'s case is quite challenging because the isolated pulmonary artery is large. The patient is also old, has a risk of brittle artery walls, and is at increased risk of bleeding, so absolute caution is required.

Doctor Than Trong Vu said that pulmonary sequestration is a rare congenital disease, accounting for 0.1% of congenital lung lesions. The disease is diagnosed in childhood. In adults, the diagnosis of pulmonary sequestration is rarely recorded.

The progression of pulmonary sequestration can lead to recurrent pneumonia, lung abscess, cancer, severe bleeding that threatens the patient's life, heart failure due to increased cardiac output...

Source: https://baodanang.vn/chan-doan-phau-thuat-thanh-cong-cac-benh-ly-hiem-gap-3304943.html