Editor's note: Tian ye, member of Jiangsu medical aid team in Wuhan, deputy chief physician of geriatric digestive department of Jiangsu People's Hospital, is one of the most effective assistants of Professor Tang Qiyun, a famous endoscopist in China. Since the outbreak, he has been sticking to the front-line posts. On February 13, he rushed to Wuhan with the medical team of Jiangsu Provincial People's hospital. So far, he has fought for more than 50 days and nights in the front line of the war on epidemic diseases. He participated in the rescue of critical patients again and again. The anti epidemic story was reported by many media, such as Jiangsu TV, jiangsu.com, and the news of the intersection. During the epidemic, he solemnly applied to join China Zhigong party, saying that he would play his own role and actively participate in the practice of "working for the public and overseas Chinese to serve the country".
In this issue, wechat forwards the battle stories of the party joining activist Tian ye and his colleagues at the front line of the epidemic.
The novel coronavirus pneumonia (novel coronavirus pneumonia) was successfully treated in April 3rd by Jiangsu Province People's Hospital (the First Affiliated Hospital of Nanjing Medical University), supported by the Wuhan golden Yin Tan medical team. The first esophageal stent placement in Wuhan was performed in the first case of new crown pneumonia combined with esophageal and tracheal fistula.
Crisis: endoscopy found that the patient's esophagus and trachea were "broken"
The novel coronavirus pneumonia, a 61 year old woman, developed fever, cough and dyspnea in January 26th. He was admitted to Wuhan No.1 Hospital in February 1st after he was diagnosed with new crown pneumonia. After respiratory failure, she underwent tracheal intubation and ventilator assisted ventilation. On February 17, Ms. Li was transferred to Wuhan Jinyintan hospital. On March 6, doctors of the local hospital found that Ms. Li had an esophagotracheal fistula, so she had her tracheotomy on March 7.
On March 25, Jiangsu medical team member and the deputy chief physician of geriatric department of digestive medicine of Jiangsu People's Hospital made digestive endoscopy for the patients. It was found that there were two fistulas in the patient's esophagus. The upper position of the fistulas was close to the esophageal entrance, about 1.5x1.0cm and 1.2x0.8cm in size, respectively. The mucosa at the fistulas was congested and edematous. The most terrible thing was that the two fistulas were connected with the trachea. "This is a very common complication after long-term endotracheal intubation, as the saying goes, the patient's esophagus and trachea are 'broken'." According to the field introduction, this is due to the long-term compression of the cannula, which leads to the ischemia and necrosis of the tracheal mucosa, and then passes through the parallel esophagus at the back, forming a fistula. "This disease has a clinical mortality rate of 66%. If it is not blocked in time, the consequences will be unimaginable." According to the field introduction, esophagotracheal fistula means that the esophagus and trachea are connected. In addition, Ms. Li has gastroesophageal reflux. Under the effect of reflux, gastric acid and secretion will enter the trachea through the fistula mouth to cause lung lesions, and if there is solid food, it may enter the trachea to cause suffocation. In addition, Ms. Li still relies on ventilator to assist ventilation, and oxygen will also enter the stomach through the fistula mouth, Cause belching, acid reflux, and then cause reflux. "In front of the patient, there are anti-virus, anti infection, nutrition enhancement, muscle strength recovery and other checkpoints. Previously, the patient has generally improved under the support of ventilator, but if combined with an esophago tracheal fistula, it is difficult to say that the patient can survive." Under various crises, in order to save the patient's life, the medical team of Jiangsu People's Hospital hopes to give it a go. At this time, the idea of "placing esophageal stent for patients" comes to mind.
Before and after linkage: do not block esophagus, patients will have no chance!
The field immediately reported to Liu Yun, the leader of the medical team, the vice president of Jiangsu People's Hospital, and Chen Qun, the vice leader and the chief physician of orthopaedic department of Jiangsu People's Hospital, and sought the help of the expert team of the rear area Jiangsu People's hospital.
"If we do not put in stent to block the esophageal fistula and restore the integrity of the esophagus, the patient will have no chance. What the medical staff have done before may fall short. We can't fail to live up to the trust of the patient and his family members!" Professor Tang Qiyun, director of geriatric digestive department of Jiangsu People's Hospital, Professor Fan Zhining, director of digestive endoscopy center, and Professor Zhang Guoxin, director of digestive department, all strongly supported this. Professor Tang Qiyun and field fully discussed and practiced before operation, and finally designed more than ten detailed operation steps. "This week, I discussed with field at least one hour every night, because For this operation is very difficult, we must be well prepared. " Tang Qiyun introduced that it's difficult to locate the fistula too high. "The top fistula is close to the esophageal entrance, which is equivalent to just under the throat, and the upper edge of the stent itself has a certain distance, which leads to our stent placement space is very limited, it must be placed accurately, which can't be covered by a millimeter." Said Tang Qiyun. In addition, Professor Li Xueliang, deputy director of gastroenterology department of Jiangsu Provincial People's Hospital, specially prepared alternative conservative treatment schemes such as gastrointestinal decompression and jejunal nutrition tube placement for unsuccessful placement.
Through discussion with the above-mentioned experts and experts of academician Zhong Nanshan's team, it finally became a scheme of endoscopic esophageal stent placement and closure for this patient. The operation is scheduled to start at 1:30 p.m. on April 3, with Tao Pengfei, the team leader of the medical team, Qi Xu, the chief physician of the respiratory and Critical Medicine Department of Jiangsu People's Hospital, Chen Xufeng, the group leader of Nanqi ward and the chief physician of the emergency medicine department of Jiangsu people's Hospital, Li Jinhai, and Jiang, the deputy chief physician of the critical medicine department of Jiangsu People's hospital More than 10 operation teams including Liu Shijiang, chief physician of anesthesia and perioperative medicine department of Jiangsu People's Hospital, and relevant medical staff of Wuhan Jinyintan hospital jointly operated.
Winning in danger: 3 minutes, equivalent to "closing eyes and piercing needle"
According to the field introduction, in addition to the high position of the fistula, the large area of the fistula, thin esophageal wall, inflexible endoscopy, and protective equipment hindering the operation are all obstacles, "let alone that we operate through ultra-fine endoscopy or direct vision under fluoroscopy, but there is a lack of these configurations, I can only rely on experience and hand feeling to" blind discharge ", which is equivalent to" closed eye puncture "
On the afternoon of the 3rd, the patients were ready before operation, and the operation group began to fight. With the successful delivery of a guide wire, the preparation for placing a 10 cm long and 2 cm diameter hollow cylindrical esophageal stent is ready. In operation, the field has already been close to the patient over a safe distance, holding one's breath - once in place! The esophageal stent was placed in one step, in an impartial position, just on the top edge of the fistula. After that, field endoscopy showed that the fistula was blocked successfully, and the hearts of all members of the operation group were finally released. "My feeling at that time was that the patient was saved!" Speaking of the success experience, field said that after long-term work training, the digestive endoscopist placement of stent can be said to be "eye to hand to heart", so he is very confident in the face of "blind wear", and there are experts from other departments in the medical team to escort the operation For the risk of novel coronavirus pneumonia, the field said: "at that time, we did not think so much, and our protection was in place, and the patients were the first to be treated." According to the field report, esophageal stents will expand completely 24 hours after implantation, "with the growth of the year, the fistula will grow well."
Vice president of novel coronavirus pneumonia was rejoined at the noon of April 4th at 11:30, at the remote medical consultation center of Jiangsu Province People's Hospital. The successful esophageal stent placement has great significance for the treatment of severe acute esophageal fistula with new crown pneumonia. The head of the medical team and vice president Liu Yun said: "the cause is" Qi ". Tracheoesophageal fistula caused by intubation is common, and there is no appropriate treatment method before. Through the successful treatment of this patient, we can summarize relevant experience to provide specific treatment measures for other similar patients. " In addition to this exception, the medical team of Jiangsu People's hospital has made remarkable achievements in the treatment of severe diseases in Jinyintan hospital. Qi Xu, chief physician of respiratory and Critical Medicine Department of Jiangsu People's Hospital, introduced that up to now, 48 patients have been admitted, including 11 discharged, 15 improved and 3 extubated. Behind the achievements, the treatment data are also very considerable: 1 ECMO support treatment, 20 fiberbronchoscope, 17 mechanical ventilation, 20 tracheotomy, 14 tracheal intubation, 9 high flow, 10 deep vein intubation, 1 PICC intubation, 10 CRRT (continuous renal replacement therapy), 5 prone position, 23 bedside ultrasound, 4 gastrointestinal endoscopy, etc.
Intersection reporter Shen Zhengrong correspondent he Yutian
Video source: Jiangsu Satellite TV Jiangsu new time and space
Some pictures are from jiangsu.com
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