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患者,男,53岁,以咳嗽、胸闷、气短1年,左侧胸痛3日入院。查体:T37℃,P80次/min、R22次/min、BP14/9kPa,全身淋巴结不肿大,口唇无发绀。气管轻度左移,左侧胸壁稍塌陷,肋间隙变窄,语颤减弱,叩诊实音,呼吸音消失。右肺呼吸音增强。心、腹部未见异常。X线摄片示:气管左移,左肺大片模糊阴影。纤支镜所见:左主支气管开口处可见2.5cm菜花样肿物,管腔被肿物完全阻塞。隆突嵴部可见肿物,右主支气管已被肿物堵塞约三分之一,经病检诊断为左主支气管乳头状腺癌,左肺阻塞性肺不张。给予吸氧、抗感染、对症治疗,并开始用纤支镜微波灼烧治疗。因瘤体较大,疗效甚微,后改用逐步部分钳割治疗,以活检钳钳割过程有出血时给局部点滴麻黄素稀释液止血。经8次纤支镜微波结合钳夹切割治疗。
The patient, male, 53 years old, had cough, chest tightness, shortness of breath for 1 year, and left chest pain on the 3rd. Physical examination: T37°C, P80 beats/min, R22 beats/min, BP14/9kPa, systemic lymph nodes are not swollen, lips have no cyanosis. The trachea moved slightly to the left, the left chest wall collapsed slightly, the intercostal space narrowed, the lingual trespass weakened, the palpation sounded, and the breath sounds disappeared. Right lung breath sounds increased. No abnormalities were found in the heart and abdomen. An X-ray film showed that the trachea was left-shifted and the left lung mass was blurred. The bronchoscope seen: A 2.5 cm cauliflower-like mass was seen at the opening of the left main bronchus, and the lumen was completely blocked by the tumor. The tumor was seen in the lumbosacral ridge, and the right main bronchus was blocked by about one-third of the tumor. The diagnosis of the right main bronchus was papillary adenocarcinoma and left lung obstructive atelectasis. Give oxygen, anti-infection, symptomatic treatment, and start bronchoscopy microwave burning treatment. Due to the large size of the tumor, the efficacy was minimal. Afterwards, a gradual partial clamp was used to stop the bleeding with a local drip ephedrine diluent during hemorrhaging with a biopsy forceps. After 8 times of fiber bronchoscopes microwave combined clamp cutting treatment.