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病人中年男性,因右肾透明细胞癌术后5个月.胸背胀痛10天于1998年11月11日入院。查体:一般情况可,心肺查体无异常,右肾区见一长约20cm手术疤痕。胃镜检查未见异常。胸部磁共振检查示:胸主动脉旁及气管、食管旁转移肿大淋巴结团块。诊断:肾癌纵隔淋巴结转移。入院后给予免疫制剂并纵隔淋巴结局部放疗.X刀治疗.放疗开始后病人即明显返酸、上腹烧灼样痛,予西米替丁、普瑞博思对症治疗.症状时轻时重。1999年1月16日放疗、X刀治疗完毕后复查胸部磁共振示:纵隔转移肿大淋巴结消失;病人返酸、恶心、上腹痛也明显减轻,1999年3月初出现吞咽阻挡感,
The patient’s middle-aged man was admitted to hospital on November 11, 1998 because of clear cell carcinoma of the right kidney after 5 months of operation. Physical examination: In general, there is no abnormality in cardiopulmonary examination. A 20-cm long surgical scar is seen in the right kidney area. No abnormal gastroscopy. Chest MRI showed thoracic aortic paralysis and paratracheal and paraesophageal masses of lymph nodes. Diagnosis: mediastinal lymph node metastasis. After admission, immunosuppressive agents and radiotherapy of mediastinal lymph nodes were performed. X-knife treatment. After the beginning of radiotherapy, the patient was significantly reverted to acid and epigastric burning pain. He was given cimetidine and Prebuth symptomatic treatment. Symptoms were light and heavy. After the radiotherapy and X-knife treatment was completed on January 16, 1999, the chest magnetic resonance was reexamined. The lymph nodes in the mediastinal metastasis disappeared; the patient’s acid reflux, nausea, and upper abdominal pain were also significantly relieved. In early March 1999, a swallowing sensation appeared.