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患者华某,男性,32岁,诊断降结肠癌伴不全梗阻而于1985年5月21入院(住院号174963)。剖腹见降结肠近脾曲处4.5×4×3.5cm肿块,已浸出浆膜层,并见肿块部位浆膜面上有一灰白色黄豆大结节,质硬与肿块相连。肿块以上肠管扩张,肠系膜下动脉及腹主动脉旁有多个蚕豆、黄豆大、质中淋巴结可及。施行左半结肠切除,横结肠、直肠端端吻合术。术后病理切片报告:结肠粘液腺癌Ⅱ级,侵及浆膜层,转移至系膜上一个淋巴结。术后拟行COF方案化疗,后因毒副反应不能耐受,改FD_1口服,一周后也因消化道反应较重而停药。出院后十个月,门诊复查,发现脐左下可及3×3cm质硬,结节状肿块,活动。肛门指诊触到直肠膀胱陷凹内4×3.5cm菜花状肿块。于1986年3月第二次剖腹,术中
The patient Hua, male, 32 years old, was diagnosed with colon cancer and incomplete obstruction and was hospitalized on May 21, 1985 (Hospital No. 174963). The caesarean section showed a mass of 4.5 x 4 x 3.5 cm in the proximal descending segment of the descending colon, which had been leached out of the serosal layer and showed a large nodule of pale soy beans on the serosal surface of the mass. Hardness was associated with the mass. Expansion of the intestine above the mass, multiple inferior broad mesenterica and inferior abdominal aorta, broad beans, large lymph nodes in the mass. Left colon resection, transverse colon, rectal end-to-end anastomosis were performed. Postoperative pathological section reports: Colonic mucinous adenocarcinoma grade II, invasion of the serosal layer, and metastasis to a lymph node on the mesangium. After the proposed COF regimen chemotherapy, due to toxic side effects can not be tolerated, change FD_1 oral, one week later due to heavier digestive tract and withdrawal. Ten months after discharge, the clinic was reviewed and it was found that the umbilicus was inferior and 3×3cm hard, nodular mass, and activity. The anal finger touched a 4×3.5 cm cauliflower-like mass in the rectal bladder depression. The second abdominal laparotomy was performed in March 1986.