Struggling patient breathes easier after critical surgery

Xu Chengzhi, a physician from the Eye and ENT Hospital of Fudan University, guides a local surgeon through a procedure in Wenshan in October. WANG XIAOYU/CHINA DAILY

Madelung's disease is a rare condition characterized by uncontrolled growth of benign tumors in the neck and back, causing pain and respiratory distress. While the exact cause is unknown, heavy alcohol consumption is considered a major risk factor.

CT scans revealed Zha's tumor had grown markedly in just one month. The Shanghai experts estimated he might not have survived another two or three weeks without immediate surgery to remove the mass.

"We initially considered transferring him to Shanghai for the operation, but his condition was too frail. We eventually determined that performing the operation locally was the quickest and safest approach," said Xu, whose hospital specializes in the treatment of conditions of the ear, nose and throat.

With over 18 years of experience, Xu had encountered only one case comparable to Zha's complexity. "This was among the most challenging procedures of my career. Any surgeon, even from top-tier hospitals in Beijing or Shanghai, would find it difficult," he said.

One of the high-risk steps was the intubation, which involves inserting a breathing tube into the trachea after anesthesia. If standard methods failed, doctors would need to swiftly perform an emergency tracheotomy, a procedure to create an opening in the windpipe to place a tube directly.

"While some Madelung's patients have a thin, 1-to-2-centimeter layer of fat around the trachea, Zha's was encased in roughly 8 cm of tissue riddled with blood vessels, making an emergency incision extremely hazardous," said Xu.

"We assessed that successful intubation was highly probable, but the consequences of even a slim chance of failure would be fatal. Our goal, after extensive consultation, was to make the procedure as fail-safe as possible," he added.

To resolve the issue, Xu said that the expert team had decided to adopt a technique called awake tracheal intubation, meaning placing the breathing tube while the patient was still conscious and breathing independently.

"The process causes discomfort, but the advantage is that if conventional intubation failed, the patient would still be able to breathe on his own. This would give us time to resort to an extracorporeal membrane oxygenation (ECMO) machine," Xu said.