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例1:男 43岁。因咳嗽、吐痰十余年,发热、气促、腹胀7天入院。既往有“肺结核”及“血吸虫病”史。体查:体温38℃,消瘦,气促,颈静脉充盈,右下胸饱满实变,呼吸音减弱,左侧呼吸音增粗,无罗音。腹部膨隆,无腹壁静脉怒张,肝脾扪及不清,腹水征(+)。余体查无异常。白细胞13.4×10~9/L,中性95％,血沉50mm/h,肝功能:II6u,TTT8u,ZnTT18u,SGPT正常,TFT(++),凡登白试验(-)。胸透提示右侧胸膜炎、大量积液。A超提示肝脾大、腹水。入院拟诊:右侧结核性胸膜炎,肝硬化并腹水,结核性腹膜炎。给予抗炎、抗痨、保肝、利尿、胸腔穿刺抽液减压等治疗后,咳嗽、气促、腹胀稍有改善,但胸水生长迅速。第5天在抽胸水后摄胸片在中下肺野有大片密度增高圆形、均匀一致淡薄阴影,胸水中查到已分化腺癌细胞及间皮细胞,确诊为胸膜间皮瘤,转移性腹膜间皮瘤?给予长春新碱、环磷酰胺、丝裂霉素联合化疗,
Example 1: Male 43 years old. Due to cough, spit more than ten years, fever, shortness of breath, abdominal distension 7 days admission. Past history of “tuberculosis” and “schistosomiasis”. Physical examination: body temperature 38 ℃, weight loss, shortness of breath, filling the jugular vein, full right lower chest consolidation, weakened breath sounds, the left breath tone thickening, no rales. Abdominal bulge, no abdominal vein, liver and spleen palpable and ascites (+). No abnormal body check. White blood cells 13.4 × 10 ~ 9 / L, neutral 95%, erythrocyte sedimentation rate 50mm / h, liver function: II6u, TTT8u, ZnTT18u, SGPT normal, TFT (++) Thoracotomy prompted pleurisy on the right, a lot of fluid. A super prompt liver and spleen, ascites. Admission to be diagnosed: Right tuberculous pleurisy, cirrhosis and ascites, tuberculous peritonitis. Give cough, shortness of breath, bloating a slight improvement after anti-inflammatory, anti-tuberculosis, liver protection, diuretic, chest puncture pumping decompression and other treatment, but rapid growth of pleural effusion. On the 5th day after taking the pleural effusion, the chest radiograph had a large circular density in the middle and lower lung field, uniform and light shades. The differentiated adenocarcinoma cells and mesothelial cells were found in the pleural effusion. The pleural mesothelioma was confirmed as metastatic Peritoneal mesothelioma? Given vincristine, cyclophosphamide, mitomycin combined chemotherapy,