Department of Urology, City No. 3 Central Hospital: One life, two surgeries

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Ms. Zhang, a 26-year-old newly married woman, discovered she had high blood pressure two years ago. Her blood pressure rose to about 270/130mmHg with a little activity, accompanied by obvious dizziness, palpitations and other discomforts. “It seriously affected her work and life. If it goes too high, it may break the cerebral blood vessels and even kill you,” Ms. Zhang said when she saw the doctor. After taking a variety of antihypertensive drugs in many hospitals, my blood pressure was still uncontrollable, and the cause of the disease was not found. I visited the cardiology department of Tianjin Third Central Hospital 3 months ago. After completing the abdominal CT examination, I found a mass of about 6cm in the retroperitoneum. It was considered to be ectopic pheochromocytoma (or paraganglioma), so I was referred to the hospital. Director of the Department of Urology Chen Fangmin visited the outpatient clinic. After understanding the condition, Director Chen considered it to be hypertension caused by ectopic pheochromocytoma and admitted him to the hospital. Upon completion of relevant examinations after admission, the patient’s methoxynorepinephrine level was nearly 10 times higher than normal, and a 4cm mass was found in the left pelvis. Ectopic pheochromocytoma is the culprit of this disease, and the diagnosis is relatively clear.

Ectopic pheochromocytoma (paraganglioma) is a relatively dangerous disease. Patients can suffer severe heart, brain, and kidney damage due to long-term high blood pressure, or may suffer from life-threatening crises due to sudden severe high blood pressure. However, if it can be diagnosed and treated in time and early, it is a curable secondary hypertension. It commonly occurs in the retroperitoneum, pelvis and retromediastinum, and is often closely related to surrounding important blood vessels, tissues and organs, and the risk of surgery is extremely high.

From the imaging data, the patient’s retroperitoneal mass was close to the pancreas and splenic artery on the upper side, the abdominal aorta on the right side, the kidney on the left side, and the renal arteries and veins on the lower side. The operation is extremely difficult, and the risk of massive bleeding, damage to the pancreas, kidneys, and abdominal aorta during the operation is extremely high. For the sake of surgical safety, Director Chen Fangmin led the team to invite the anesthesiology department, vascular surgery department, endocrinology department, general surgery department, imaging department, pathology department, etc. to conduct a multidisciplinary consultation (MDT) and finally formulate a strategy for divided operations.

　　With the help of the operating room and anesthesia team, and after sufficient preoperative preparations such as blood pressure reduction, heart rate reduction, and volume expansion, Chief Physician Chen Fangmin and attending physicians Ma Zhen and Li Song formed a surgical team to perform robot-assisted laparoscopic retroperitoneal surgery on the patient. During the surgery, it can be seen that there are a large number of vasa vasorum around the tumor, which is very easy to bleed. However, with superb skills, the tumor was completely removed and the kidney on that side was preserved without damaging the surrounding large blood vessels and organs. .During this period, deputy chief physician Yu Dahai and chief physician Li Kai were ready to provide support at any time.After the first operation, thanks to the efforts of the urological care team, the patient recovered smoothly and was discharged from the hospital one week after the operation.Six weeks later, the patient went to the hospital as scheduled. Considering the patient’s financial pressure, Professor Chen Fangmin of the urology team once again led the same team to overcome the difficulties and performed laparoscopic resection of the left pelvic tumor (pheochromocytoma). Although the tumor was closely related to the surrounding Organs and blood vessels are also tightly adherent, and the patient’s reproductive needs must also be considered.The team used superb techniques and precise separation to overcome difficulties and avoid damage to the iliac blood vessels, intestines, uterine appendages, etc. during the operation. The patient recovered well after the operation and was successfully discharged from the hospital a week later.At present, the patient’s blood pressure and heart rate have remained normal after surgery, and he has completely got rid of the trouble of long-term medication, and can devote himself to normal life and work.The patients and their families sincerely lamented that “the medical team of the urology department of the three centers saved our lives through two surgeries with superb skills that we will never forget.”

In recent years, the Department of Urology of Tianjin Third Central Hospital, under the leadership of the hospital’s party committee and administration, and with the support of the hospital’s functional departments and brother departments, has implemented thematic education and the concept of “Healthy China” into practical actions, and has long-term carried out the “Three Ones Project” “-Cure a patient, make a friend, and build a reputation. With the trust and support of the leaders and colleagues of the Urology Branch of the Tianjin Medical Association, Professor Chen Fangmin of this department was recently awarded the title of “Leader of the Minimally Invasive Group of the Ninth Urology Branch of the Tianjin Medical Association”, shouldering heavier responsibilities. He will lead the medical team to provide high-quality medical services to patients in Tianjin and even across the country.

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