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患者,男,58岁,因进行性吞咽困难4个月于1981年9月12日入院。无其他自觉症状。体检:一般情况良好,未触及腹块。食管造影示贲门明显狭窄,病变长2cm,粘膜尚光整,膈上食管虽球状扩张,胃底未见软组织肿块阴影(见图)。食管脱落细胞检查(一)。术前诊断贲门癌。在全麻下剖左胸探查,见左胸腔广泛粘连,左肺无肿块。膈肌中心部硬而厚,表面呈细小结节状,食管裂孔细小,仅勉强容纳一食指。切开左膈,松解食管裂孔,贲门和胃均正常,膈肌肿块向右侵,肿块大10×8×4cm。下腔静脉裂孔受累而细小,下腔静脉明显梗阻,主动脉裂孔正常大。肝胰未触及肿块。取膈肌肿块组织活检,关胸。病理诊断为转移性腺癌。
The patient, male, 58 years old, was admitted to hospital on September 12, 1981 for dysphagia 4 months. No other symptoms. Physical examination: Generally good, no palpable masses. The esophageal angiography showed that the cardia was obviously narrowed, the lesion was 2 cm long, the mucosa was still smooth, and although the esophageal spasm of the fistula was dilated, there was no shadow of the soft tissue mass on the fundus (see figure). Esophageal exfoliative cell examination (1). Preoperative diagnosis of cardiac cancer. Under general anesthesia, the left chest was dissected and left thoracic cavity was extensively adhered, and there was no lump in the left lung. The central part of the diaphragm is hard and thick, with a small nodule on the surface. The esophageal hiatus is small and only one index finger is barely accommodated. The left fistula was dissected, and the esophageal hiatus was resolved. The fontanelles and the stomach were normal. The iliac muscle mass was invaded to the right. The mass was 10×8×4 cm. The inferior vena cava is infiltrated with a small hole, the inferior vena cava is obstructed, and the aortic hiatus is normal. Liver pancreas did not touch the mass. Take a biopsy of the iliac muscle mass and close the chest. Pathological diagnosis of metastatic adenocarcinoma.