论文部分内容阅读
患者女,26岁,因进行性呼吸困难3个月,产后20天入院。患者于妊娠28周始感呼吸困难,自认为妊娠所致,20天前在外院顺产一健康男婴,呼吸困难仍不缓解,来我院就诊。查体:呼吸急促,眼睑轻度浮肿;右颈静脉怒张,气管左移;右胸饱满,叩实,呼吸音消失,左肺呼吸音增强,心界向左下移位,心率106次/分,心律齐,无杂音;腹软,肝脾未及移动性浊音阳性;血象及肝肾功能均正常;胸部CT示:右侧胸腔大量积液,右肺萎陷,肺内有大小约13cm×12cm×11cm,四周包膜完整的椭圆形肿物。腹部B超未见异常。拟诊为右肺内畸胎瘤伴大量胸腔积液:入院后经支持治疗,于1997年5月28日在全麻下行手术治疗,术中见:右侧胸膜腔广泛不规则增厚,可见大小不等鱼肉样肿瘤结节,右侧胸膜腔闭锁,巨大肿瘤位于前纵隔,类球形,大小约25cm×20cm×20cm,质地较韧,内有皮质样物、毛发及钙化点,肿瘤前及胸壁,后坐于心包,左界越过正中线3cm,右界旁开锁骨中线约5cm,全部肿瘤组织重约5kg,右肺被压迫而不张;行右前纵隔肿物切除及右侧胸膜剥脱术。术后病理示:恶性混合性生殖细胞肿瘤(内胚窦瘤合并未成熟畸胎瘤),肿瘤累及肺组织。术后行化疗(顺铂50mg,连续静点3天,足叶以甙
The patient, 26 years old, had difficulty breathing for 3 months and was hospitalized 20 days after delivery. The patient felt dyspnea at 28 weeks’ gestation and was considered to be due to pregnancy. He had a healthy baby boy in the outer hospital 20 days ago and his breathing difficulties were not relieved. He came to our hospital for treatment. Physical examination: shortness of breath, slight edema of the eyelids; right jugular vein engorgement, tracheal leftward shift; full chest right, sturdy, respiratory sounds disappear, left lung breath sounds enhanced, heart sector shifted to the lower left, heart rate 106 beats/min , Heart rhythm Qi, no noise; Abdominal soft, liver and spleen is not mobile voiced positive; blood and liver and kidney function were normal; chest CT showed: a large right pleural effusion, right lung collapse, the size of the lung about 13cm × 12cm × 11cm, surrounded by a complete oval tumor. There was no abnormality in the abdomen B ultrasound. To be diagnosed with right lung teratoma with massive pleural effusion: after supportive treatment after admission, he was treated surgically under general anesthesia on May 28, 1997. During the operation, the right pleural cavity was irregularly thickened. Fish and meat tumor nodules ranging in size, right pleural cavity atresia, giant tumor located in the anterior mediastinum, spherical shape, size of about 25cm × 20cm × 20cm, texture is tough, cortical material, hair and calcification, preneoplastic and Chest wall, sitting in the pericardium, the left border across the midline 3cm, right border next to the open clavicular midline about 5cm, all tumor tissue weighs about 5kg, the right lung is oppressed without tension; line right anterior mediastinal tumor resection and right pleural effusion. Postoperative pathology showed malignant mixed germ cell tumors (endodermal sinus tumors combined with immature teratoma), and tumors involving lung tissue. Postoperative chemotherapy (cisplatin 50mg, continuous 3 days, footbirth