晚期不可切除非小细胞肺癌病例分享一例（腺癌）
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病例介绍</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"> <span style="color: black;">病人</span> 男 65岁 抽烟30余年，近期因“咳嗽、咯血伴<span style="color: black;">呼气</span>困难1月余”入院；<span style="color: black;">病人</span>自诉，活动后<span style="color: black;">显著</span><span style="color: black;">呼气</span>困难，偶有咯血；查体：右肺<span style="color: black;">呼气</span>音<span style="color: black;">显著</span>减弱；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">影像学<span style="color: black;">检测</span></p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-6086ab0db87c4d0246f982103de336de_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-09a0b0c1f646f159ccbf9fa51d54454b_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">病人</span>入院后行胸部CT<span style="color: black;">检测</span><span style="color: black;">发掘</span>：双肺占位，右侧<span style="color: black;">位置于</span>肺门处，肿块<span style="color: black;">很强</span>，包绕血管。从CT片<span style="color: black;">能够</span>看到阻塞性肺炎。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病情分析</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">影像学表现如上两张<span style="color: black;">照片</span>所示；患者症状与影像学表现一致；专业<span style="color: black;">大夫</span>一看便知；<span style="color: black;">思虑</span>肿瘤；且分期较晚，<span style="color: black;">病人</span>已失去手术机会。好在<span style="color: black;">病人</span>经经查未<span style="color: black;">发掘</span>远处转移<span style="color: black;">状况</span>；只能<span style="color: black;">选取</span>内科保守治疗，<span style="color: black;">因此呢</span><span style="color: black;">日前</span>首要任务是<span style="color: black;">知道</span>诊断。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗经过</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">争取<span style="color: black;">病人</span>意见后于当天给<span style="color: black;">病人</span>进行纤维支气管镜<span style="color: black;">检测</span>及取材活检，于右肺下叶支气管开口处见到简润生长肿瘤，已突破气管壁，肿瘤呈菜<span style="color: black;">花招</span>生长，表面触之易<span style="color: black;">流血</span>，气管内<span style="color: black;">海量</span>粘稠痰液；于肿块表面取组织活检；当时未留下照片及图像资料；只能文字描述向<span style="color: black;">大众</span>介绍。经过2天等待以后，病理科给<span style="color: black;">报答</span>的结果是：查见恶性肿瘤细胞；<span style="color: black;">思虑</span>腺癌；当时看到此报告，我内心是纠结的；这是一个不完善的病理报告，但好在证明了恶性肿瘤，<span style="color: black;">意见</span><span style="color: black;">病人</span>再次取材活检；<span style="color: black;">病人</span>因<span style="color: black;">保持</span>难受拒绝再次活检；只能按肺恶性肿瘤给出治疗<span style="color: black;">方法</span>；当时<span style="color: black;">思虑</span>的治疗<span style="color: black;">方法</span>两种；一种多西他赛+铂；一种培美曲塞二钠+铂化疗；此处我与上级医师治疗上产生了<span style="color: black;">歧义</span>；上级医师认为，<span style="color: black;">病人</span>肺恶性肿瘤诊断<span style="color: black;">知道</span>，但腺癌诊断不<span style="color: black;">知道</span>，<span style="color: black;">意见</span>多西他赛+铂化疗；观察治疗效果；<span style="color: black;">大众</span>懂的，只能按上级<span style="color: black;">大夫</span>的治疗<span style="color: black;">方法</span>执行；<span style="color: black;">病人</span>多西他赛+铂治疗<span style="color: black;">1星期</span>期；<span style="color: black;">时期</span>给予抗感染等治疗；<span style="color: black;">病人</span>肿瘤得到<span style="color: black;">必定</span><span style="color: black;">掌控</span>；阻塞性肺炎较前<span style="color: black;">显著</span><span style="color: black;">掌控</span>；<span style="color: black;">病人</span>症状<span style="color: black;">显著</span>缓解；但肿瘤并未缩小（影像学表现未见肿瘤缩小，当时<span style="color: black;">无</span>留取影像学资料；CT片只能看到阻塞性肺炎吸收；肿瘤未见缩小）；在治疗过程中经常和<span style="color: black;">病人</span>及<span style="color: black;">病人</span>家属沟通<span style="color: black;">创立</span>了<span style="color: black;">必定</span>的信任关系，再次<span style="color: black;">意见</span><span style="color: black;">病人</span>取材活检；<span style="color: black;">病人</span>接受<span style="color: black;">意见</span>以后再次取材活检；病理诊断<span style="color: black;">最终</span><span style="color: black;">知道</span>诊断：肺泡型腺癌；立即给<span style="color: black;">病人</span>更换化疗<span style="color: black;">方法</span>；<span style="color: black;">而后</span>给<span style="color: black;">病人</span>抽血做了基因检测（<span style="color: black;">由于</span>气管镜取材组织太少，没办法用组织去做基因检测，<span style="color: black;">否则</span>准确率更高<span style="color: black;">有些</span>，基因检测10基因，<span style="color: black;">好似</span>5000多完全自费；专科<span style="color: black;">大夫</span>一看就<span style="color: black;">晓得</span><span style="color: black;">为何</span>要做这个）；给予培美曲塞二钠+铂化疗；化疗后<span style="color: black;">病人</span><span style="color: black;">显著</span>自觉症状好转；再次返院复查胸部CT：如下图</p>
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