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患者男性,66岁.因颈前肿块迅速增大,伴声音嘶哑3个月,于1992年4月26日入院.发病3年前曾行贲门癌根治术.查体:T36.8℃,R20次/min,P82次/min,BP20/12kPa.呼吸平稳,心肺无异常发现.两侧甲状腺不对称,右侧明显增大约6cm×5cm×4cm,质硬、不规则,基底固定,可随吞咽上下移动,无压痛及血管杂音,颈前静脉显露;右锁骨上和颈后三角区可触及肿大淋巴结(最大者为3cm×2cm),质硬、可活动,无压痛.B超提示右甲状腺增大为4.3cm×3.6cm实质回声,尚均匀.喉镜检查右侧声带固定于正中位.X线检查:右颈前肿瘤无钙化,气管、食管受压移位;吞钡检查示食管受压.胃镜检查提示贲门癌根治术后,吻合口炎症改变;病理报告慢性炎症,未见癌细胞.右颈部淋巴结活检为转移性腺癌(来自消化道).实验室检查:CEA 36ug/ml,T_30.7ug/ml, T_446ug/ml,血沉25mm/h.全麻下行右甲状腺全切除加同侧
The patient was male, 66 years old. He had a rapid enlargement of the anterior cervical mass with hoarseness for 3 months. He was admitted to hospital on April 26, 1992. He had undergone cardiac cancer radical surgery 3 years earlier. Physical examination: T36.8°C, R20 Times/min, P82 beats/min, BP20/12kPa. Respiratory stability, no abnormalities found in the heart and lungs. Both sides of the thyroid asymmetry, the right side significantly increased by about 6cm × 5cm × 4cm, hard, irregular, fixed base, can be swallowed Move up and down, no tenderness and vascular murmur, anterior cervical veins exposed; right supraclavicular and posterior cervical triangle can reach the enlarged lymph nodes (the largest is 3cm × 2cm), hard, movable, no tenderness. B ultrasound prompt right thyroid Increase to 4.3cm × 3.6cm real echo, still uniform. Laryngoscopy right vocal cords fixed in the median position. X-ray examination: the right front of the tumor without calcification, tracheal, esophageal pressure displacement; swallowing examination showed esophageal Pressure. Gastroscopy prompted cancer after radical gastrectomy, anastomotic inflammation changes; pathology reports chronic inflammation, no cancer cells. Right cervical lymph node biopsy for metastatic adenocarcinoma (from the digestive tract). Laboratory tests: CEA 36ug/ml, T_30.7ug/ml, T_446ug/ml, ESR 25mm/h. Total anesthesia with right thyroidectomy plus ipsilateral