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患者女性,40岁,因发现颈部肿块5个月于1987年9月3日入院.5个月前患者无意中发现颈前一核桃大肿物,后渐增大,无疼痛,不发热,近半月来感颈前区有紧迫感,吞咽食物时有梗噎感;伴食欲下降、体重减轻.发病来无声音嘶哑、呼吸困难、腹泻、心悸等症状.体检:BP11.5/7.5kPa,P68次/分.体重41kg(病前50kg),皮肤巩膜无黄染,两眼裂对称,无突眼,甲状腺呈弥漫性Ⅱ度肿大、质硬,左甲状腺上极触及2.0×1.5cm质硬肿块,无压痛,随吞咽上下活动.左锁骨上窝未及肿大淋巴结、心、胸、腹部体检无异常发现.咽喉部检查无异常.颈部B超示双侧甲状腺中度增大,左叶上极1.3×3.1cm实质性肿块.甲状腺同位素扫描示左甲状腺叶冷结节.拟诊甲状腺癌.于1987年9月7日在全麻下行甲状腺癌根治术.术中见甲状腺与颈前肌群粘连,甲状腺弥漫性肿大,质硬,左腺叶上极有2.5×1.5cm实质性肿块,包膜完整,行左甲状腺次全切除加左侧颈淋巴结清扫术.病理诊断;甲状腺高分化鳞癌,左颈深淋巴结转移性高分化鳞癌.术后吞咽困难更加明显,行食道吞钡检查,示主动脉弓以下食管壁僵硬,管腔变狭,长达5cm,病变上方食管
The female patient, 40 years old, was found on the September 3, 1987 admission because she had found a neck mass for 5 months. Five months before the patient inadvertently found a large swollen mass in front of the neck, which gradually increased, no pain, and no fever. In the past half month, I felt a sense of urgency in the anterior cervical area, and there was a sensation of stenosis when I swallowed food; I had decreased appetite and weight loss. I had no symptoms such as hoarseness, dyspnea, diarrhea, heart palpitations, etc. Physical examination: BP11.5/7.5 kPa, P68 beats per minute. Weight 41 kg (50 kg before illness), no yellow staining of the skin sclera, two eyes split symmetry, no exophthalmos, diffuse thyroid diffused II degree, hard, left upper thyroid touch 2.0 × 1.5cm Hard mass, no tenderness, up and down with the activities of swallowing. Left upper clavicle follicular enlargement of lymph nodes, heart, chest, abdomen, no abnormal findings. No abnormal throat examination. Neck bilateral B ultrasound showed moderate increase, A 1.3×3.1cm solid mass on the left lobe. The thyroid isotope scan shows the cold nodules on the left thyroid gland. The thyroid cancer was diagnosed. On September 7, 1987, thyroid cancer was treated with general anesthesia. The thyroid gland and neck were seen during the operation. Adhesion to the anterior muscles, diffuse thyroid enlargement, hardened mass, 2.5 x 1.5 cm solid mass on the left lobe, complete capsule, left thyroid Subtotal resection combined with left cervical lymph node dissection. Pathological diagnosis; Thyroid well-differentiated squamous cell carcinoma, metastatic well-differentiated squamous cell carcinoma of the left deep cervical lymph node. Postoperative dysphagia is more pronounced, esophageal swallowing examination, showing the aortic arch below esophageal wall Stiff, narrowed lumen, up to 5cm, esophagus above lesion