Skillful hands defuse mines! Xiangya Hospital successfully performs complex thyroid tumor surgery on a 76-year-old high-risk patient

Recently, Professor Li Xinying's team from the Department of Thyroid Surgery at Xiangya Hospital of Central South University successfully performed a complex thyroid tumor surgery on Mr. Zhang, a 76-year-old man who suffered from multiple underlying diseases .

The operation consisted of "complete bilateral thyroidectomy + parathyroidoma resection + bilateral central neck and right II-V zone neck lymph node dissection + mediastinal lymph node resection". The patient recovered well after the operation and has been discharged smoothly.

Mr. Zhang discovered a thyroid nodule two months ago. After seeking medical treatment in many hospitals without success, he came to Xiangya Hospital. After admission and relevant examinations, it was found that Mr. Zhang's right thyroid nodule was medullary thyroid carcinoma, with the primary lesion larger than 6 cm and a fixed mass. There was right lateral cervical lymph node metastasis, with the largest metastatic lymph node exceeding 5 cm, fused with each other, invading the internal jugular vein, sternocleidomastoid muscle and closely related to the subclavian vein. At the same time, multiple lymph node metastases in the upper mediastinum were combined.

Considering Mr. Zhang's advanced age and his underlying diseases such as hypertension, diabetes, and severe pulmonary ventilation dysfunction, the tumor may have invaded the trachea, esophagus, recurrent laryngeal nerve, and right subclavian vein, and the mediastinal lymph nodes may require thoracotomy, which is a high-risk operation. Therefore, Professor Li Xinying's team invited experts from the Department of Cardiovascular Surgery, Department of Respiratory Medicine, and Department of Anesthesiology to conduct a multidisciplinary consultation .

Experts conducted a comprehensive assessment of the patient and suggested that special attention should be paid to airway management, improvement of lung function and perioperative respiratory risks before surgery. During surgery, multiple departments may need to perform surgery together. Under the guidance of the respiratory department, Mr. Zhang received combined nebulizer therapy before surgery to improve lung function and reduce the risk of intraoperative dyspnea and postoperative pneumonia.

On January 16, the operation went smoothly. Professor Li Xinying's team first completed the complete removal of the patient's bilateral thyroid glands. The intraoperative pathology report showed that the right thyroid gland was medullary carcinoma, and the central lymph nodes also showed cancer metastasis, which was consistent with the metastatic characteristics of malignant tumors. At the same time, because the patient's right superior parathyroid gland met the characteristics of parathyroid adenoma, the team also removed it. In order to completely remove the tumor and reduce the possibility of recurrence, Professor Li Xinying decided to perform lymph node dissection in the bilateral central neck area and right II-V zones, and at the same time expanded the removal of the invading sternocleidomastoid muscle and internal jugular vein.

After completing the above operations, Professor Li Xinying completely removed the patient's superior mediastinal lymph nodes through fine neck dissection, avoiding thoracotomy and greatly reducing the patient's trauma. With the cooperation of the anesthesiologist, the patient's airway management was effectively guaranteed during the operation, and the operation was successfully completed.

In order to promote the early recovery of Mr. Zhang's lung function after surgery, head nurse Hu Yuanping instructed the patient to perform lung rehabilitation breathing exercises. Under the careful care of the team, Mr. Zhang did not have any complications, recovered smoothly, and was discharged from the hospital on January 20. On January 24, the ward telephone follow-up learned that the patient recovered well and had no special discomfort.

Professor Li Xinying, director of the Department of Thyroid Surgery at Xiangya Hospital of Central South University , said that the successful completion of this operation provided valuable experience for the future treatment of similar locally advanced thyroid cancer with large vessel invasion and mediastinal lymph node metastasis.

Hunan Medical Chat Special Author: Luo Yan, Hu Yuanping, Xia Xiuzhi, Xia Fadada, Xiangya Hospital of Central South University

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(Edited by YT)