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患者62岁,因左颈部鸡蛋大肿块1月余而入院。查体:于左耳垂下扪及1cm×1cm×1cm硬而固定的肿块,与皮肤无粘连,边界不清。左颈动脉三角区可扪及融合淋巴结团(4cm×6cm×5cm)不规则,活动差。左锁骨上扪及1cm×1cm×1cm质硬、光滑、活动差之肿块,左甲状腺区扪及0.5cm×0.6cm×0.6cm大肿块,随吞咽活动。ABC检查(细针穿刺活检)见肿瘤细胞,考虑来源于腮腺。CT扫描示左颈腮腺深叶区及左颈动脉鞘外侧有增强的结节状致密影,边界模糊,部分融合成团,示淋巴结转移。初诊为左腮腺癌并左颈淋巴转移。入院后在全麻下行左腮腺、甲状腺联合根治术。术中见腮腺深叶有-2.5cm×2.5cm×2cm质硬之肿块,边界不清,浸润面神经,遂行全腮腺切除。
The patient was 62 years old and was admitted to the hospital because of a large lump in the left neck for more than one month. Examination: The left ear lobe and the 1cm x 1cm x 1cm hard and fixed lump, with no adhesion to the skin, the border is unclear. The left carotid triangle can be irregular and fused lymph nodes (4cm × 6cm × 5cm) irregular, poor activity. Left clavicular tendon and 1cm × 1cm × 1cm mass, smooth, poorly moving mass, left thyroid area fistula and 0.5cm × 0.6cm × 0.6cm large mass, with swallowing activity. ABC examination (Fine needle biopsy) Sees tumor cells and is considered to be derived from the parotid gland. The CT scan showed enhanced nodular dense shadows in the deep areas of the left parotid gland and the left sheath of the left carotid artery. The borders were blurred and some of them merged into clusters, showing lymph node metastasis. Newly diagnosed left squamous cell carcinoma and left cervical lymph node metastasis. After admission, the left parotid gland and thyroid glands were treated with general anesthesia. During the operation, the deep parotid gland had a mass of -2.5cm × 2.5cm × 2cm hard mass, the border was unclear, and the facial nerve was infiltrated. The parotid gland was removed completely.