论文部分内容阅读
张×,女,18岁,住院号843769,临胸县人。两月前患者生气后进凉食,不久感上腹钝痛,伴反酸、恶心,吐出少量食物后疼痛缓解。以后,上述症状食后即发,进硬食多不呕吐,当地医院行上消化道钡透和食管镜检查,见局部狭窄,镜筒通过困难,粘膜呈炎性改变,诊断为贲门失驰缓症和返流性食管炎,对症处理后稍好转。近十天食后腹痛加重,吐后则止,汤水不进,靠输液维持。神志清,脱水貌,营养欠佳。锁骨上淋巴结无肿大。入院后上消化道钡餐摄片食管下端呈鸟嘴样,近端食管扩张,诊断为贲门失驰缓症。挣脉复合麻醉下开左胸,贲门有16×10×3cm包块,病变侵及大部分胃小弯及部分胃大弯,与脾粘连,脾门胰尾有肿大淋巴结。诊断为贲门癌。即行贲门癌切除、胃食管弓下吻合术。术后恢复顺利,第5天进流汁,第10天普食,咽下无阻挡感,12天出院。病理报告为贲门低分化腺癌,侵及浆膜层。讨论贲门失驰缓症又称贲门痉挛、贲门不张、巨食
Zhang X, female, 18 years old, hospital number 843769, people from the county. Two months ago, the patient ran into cold food and soon felt dull on the abdomen, with acid reflux, nausea, and pain relief after spit out a small amount of food. After that, the above symptoms occur immediately after eating, and hard food does not vomit. Local hospitals performed upper digestive tract spasm and esophagoscopy. See local stenosis. The lens tube passed through difficulty and the mucous membranes became inflammatory. Diagnosis was achalasia. Symptoms and reflux esophagitis were slightly improved after symptomatic treatment. In the past ten days, abdominal pain worsened after eating, but it stopped after vomiting. The soup did not enter and was maintained by infusion. Clear mind, dehydration appearance, poor nutrition. No supraclavicular lymph node enlargement. After admission, the upper digestive tract was burrowed at the lower end of the esophagus. The proximal esophageal dilate was diagnosed as achalasia. Under the combined anesthesia, the left chest was opened and the fontanelle had a mass of 16×10×3 cm. The lesion invaded most of the small curvature of the stomach and part of the greater curvature of the stomach, and it adhered to the spleen, and there were enlarged lymph nodes in the tail of the spleen, pancreas and tail. Diagnosis is cardiac cancer. That is, cardia cancer resection and gastroesophageal anastomosis. After surgery, it recovered smoothly. The first 5 days of ingestion of juice, the first 10 days of general food, swallowing without blocking, 12 days discharged. The pathology report was a poorly differentiated adenocarcinoma of the cardia that invaded the serosal layer. Discussion of achalasia is also known as phlegm, arrogance, and giant food