论文部分内容阅读
病历摘要:患者,男56岁.1993年10月因颈部肿块伴疼痛,声音嘶哑临床诊断为甲状腺肿瘤而行甲状腺腺右叶切除.术后经病理诊断:甲状腺低分化滤泡癌(病理号9331066),并接受放疗、化疗.1994年3月始上腹不适;纳差、消瘦,经药物治疗不见好转且发现上腹肿块.查体示明显消瘦,原手术区域无异常.腹部平坦,偶可见肠型.左右上腹均可们及拳头大肿块,表面不平,质硬、触痛、活动度差.腹部B超示:脐上可及低回声肿物外型不规则,向左右两侧分布.与强回声的肠腔气体关系密切.全消化道钡餐检查发现空肠第2、3组均呈局限性充盈缺损,粘膜破坏有龛影,肠管僵硬,不能扩张.术前诊断:甲状腺低分化滤泡状癌腹腔转移伴不全性肠梗阻.手术所见:肝胆胰脾未见异常,肿块位于肠系膜,从左向右呈亚铃状,左右两肿块均如成人拳头
Medical record summary: Patient, male, 56 years old. In October 1993, a thyroid gland was diagnosed as a thyroid tumor due to pain in the neck mass with pain in the neck. Right thyroid gland right lobectomy was performed. Postoperative pathological diagnosis: thyroid poorly differentiated follicular carcinoma (pathological number 9331066), and receive radiotherapy, chemotherapy. In March 1994 began abdominal discomfort; anorexia, weight loss, after drug treatment and improved abdominal mass was found. Check the body showed significant weight loss, the original surgical area without abnormal abdominal flat, even Visible intestine type. Left and right upper abdomen can be large fists and fists, the surface is uneven, hard, tender, poor activity. Abdominal B-show: umbilical can be low echo echo irregular shape, to the left and right sides Distribution and strong echo of the intestinal cavity gas closely related to the whole gastrointestinal barium meal examination found that the jejunum in the second and third group showed a local filling defect, mucosal damage has a shadow, intestine stiffness, can not be expanded. Preoperative diagnosis: thyroid poor differentiation Follicular carcinoma abdominal cavity metastasis with incomplete intestinal obstruction. Surgical findings: no abnormalities in hepatobiliary and pancreatic spleen, mass located in the mesentery, subclavian from left to right, left and right masses are as adult fists