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病例:男,60岁。因发热、咳嗽9个月,痰中带血7个月,于1990年2月27日入院,入院前X线胸片示左肺片状模糊阴影,考虑为肺炎、肺结核,间断的抗感染及对症治疗6周,抗痨治疗7个月,症状好转,但肺部阴影无变化。查体:T37.2.P84,R18。两肺叩诊清音,左下肺呼吸音减低,未闻及干、湿性啰音。心浊音界不大,心率84/分,律整。腹软,肝脾未触及。双踝部轻度浮肿。轻度杵状指。X线胸片示左肺中野有-5×5.5cm近似球形阴影。密度不均匀,边缘模糊。血常规、血沉、肝功能均正常。3次痰涂片及6次24小时痰浓缩集菌法查结核杆菌均阴性,3次查痰脱落细胞均未找见瘤细胞。初步诊断:①浸润型肺结核;②支气管肺癌待排。给予雷米封、利福平、乙胺丁醇治疗,一个月后肺部阴影仍无吸收。4月1日B
Case: Male, 60 years old. Due to fever, cough for 9 months, bloody sputum for 7 months, admitted to hospital on February 27, 1990, before admission X-ray showed left lung flaky fuzzy shadow, considered as pneumonia, tuberculosis, intermittent anti-infective and Symptomatic treatment for 6 weeks, anti-tuberculosis treatment for 7 months, the symptoms improved, but no change in the shadow of the lungs. Physical examination: T37.2.P84, R18. Pneumoconiosis percussion lungs, lower left lung breath sounds reduced, no smell and dry, wet rales. Heart dullness is not big, heart rate 84 / points, law and order. Abdomen soft, liver and spleen not touched. Double ankle mild edema. Mild clubbing. X-ray showed the left lung in the field have -5 × 5.5cm approximate spherical shadow. Uneven density, blurred edges. Blood, ESR, liver function are normal. 3 sputum smear and 6 24 hours of sputum concentration of Mycobacterium tuberculosis were negative, three sputum exfoliated cells found no tumor cells. Preliminary diagnosis: ① infiltrative pulmonary tuberculosis; ② bronchial lung cancer to be discharged. Give Remifentanil, rifampicin, ethambutol treatment, one month after the lung shadow still no absorption. April 1st