胸外科病例讨论英文版PPT课件.ppt

Casereport 2014 3 15孙嘉阳 ChiefComplaint Intermittentcoughfor1year withbloodysputum20days Historyofpresentillness Patienthasbeencoughsputumforabout1yearwithnoobviousIncentives HissputumwasWhitefoamysputumandwhenpatientwalkingfast coughwasobviouslyincreasedwhileasalittlerestcanbebebefitforcoughcutting Thesesymptomsappearintermittentlywithnoformaldiagnosis Patientcoughedbloodysputum20daysagoandachestCTatlocalhoapitalreported Leftlowerlobemass considerlungcancer Pastmedicalhistory previouslyhealthy nohistoryoftuberculosisandnohistoryofchronicbronchitis nofood drugallergies nohistoryoftrauma surgery Personalhistory smoking20cigarettesperdaywith40yearshistory drinkingIrregular Obstetricalhistory married sterileason Familyhistory familyhealth nohepatitis tuberculosispatientswithouthypertension diabetes non hereditarydisease CTexamination CTexamination CTexamination CTexamination CTexamination CTexamination Electronicbronchoscopyexamination 左肺下叶可见腔内肿物 累及左主支气管直至距隆突4个软骨环处 管腔部分堵塞 Pathologicaldiagnosis Adenocarcinoma EGFRgenemutationdetection EGFRgenemutationdetection Thetreatmentprinciples Icotinib125mgTidpo CTexaminationaftertwomonths CTexaminationaftertwomonths 2020 1 9 17 CTexaminationaftertwomonths CTexaminationaftertwomonths CTexaminationaftertwomonths CTexaminationaftertwomonths Contrast BeforetreatmentAftertreatment Contrast Electronicbronchoscopyexamination 左肺下叶可见腔内肿物 累及左主支气管直至距隆突7个软骨环处 管腔部分堵塞 Contrast Thetreatmentprinciples 2 SurgicaloperationThesurgicalindicationswereperformedLeftpneumonectomysurgery 2013 08 06 Removalpartofesophagealmuscularisandpartofthepericardium3 LocalchemotherapyRefused4 ContinueIcotinibtreatment Pathologicaldiagnosis Moderatelydifferentiatedadenocarcinoma2 1 5 1 5Bronchialstump 4L 0 2 5 0 2 6 0 2 7 2 10 8 0 1 10 1 4 pT3N2M0 A Follow up ContinuousadministrationIcotinibandreviewingmonthlyWithoutlocalrecurrenceandmetastasis Conclusion Theadvancedadministrationoftargetedmedicinecanreducetheriskanddifficultyofsurgery Discussion 1 Targetedmedicinemainlybeusedforpatientswithlocallyadvancedlungcancerwhohasbeenreceivedpriorchemotherapyormetastaticnon smallcelllungcancerpatientsTargetedmedicinecanbeanotheroption