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患者女,41岁。胸闷、憋气半年,加重伴咳嗽、有胸部疼痛2周;胸片发现纵隔巨大块影,于1994年11月22日以纵隔肿瘤收住院。检查:贫血貌,气管左偏,右侧肋间隙饱满,第4肋以下叩诊呈浊音,语颤及呼吸音减低。肝、脾未触及。X线胸片(图1,2)示,中纵隔向右胸腔内突出一巨大肿块影(约15cm×13cm),边缘光滑,密度均匀,心影左移,两肋间膈角清晰。B型超声波探查示,右前纵隔探得一个巨大(约10.5cm×10.0cm)弱回声光团,类圆形,边界清,其内为均质的细小光点。患者于同年12月3日晚突发行胸剧痛,胸部透视示右胸腔大量积液,原块影轮廓不清,考虑为肿瘤溃破所致。于次日晨在全麻下行右侧剖胸探查术。术中见瘤体已破溃,胸内有血性及胶冻样液2200ml;肿瘤表面不光滑,包膜不完整;瘤体为大量脂肪样组织,其内尚存较多胶冻样物。肿瘤与胸壁、心包及右肺中、下叶浸润性连,瘤蒂位于腔与左无名静脉间,瘤蒂直径2cm。分离粘连,将肿瘤全部清除,瘤蒂根部予以缝扎。切除肿瘤组重2100g。病理诊断:纵隔粘液型脂肪肉瘤(图3)。手术后右肺复张,症状消失,2周出院。术后6个月X线胸片见右肺上叶前段近胸壁处有约6cm×5cm密度增高影。经皮穿刺活检证实为转移性脂肪肉瘤,虽然给予了放疗和化疗,但终因衰竭而死亡,术后仅存活10个月。
Female patient, 41 years old. Chest tightness, belching for six months, aggravated with cough, chest pain for 2 weeks; a large block of the mediastinum was found on the chest radiograph and was admitted to the mediastinum tumor on November 22, 1994. Check: anemia appearance, left trachea deviation, full right intercostal space, the fourth rib below the percussion was dull, speech fibrillation and breath sounds reduced. Liver and spleen are not touched. X-rays (Fig. 1, 2) show that the mediastinum protrudes into the right thoracic cavity with a massive mass (approximately 15 cm x 13 cm), with a smooth edge, a uniform density, a left heart shadow, and a clear inter-rib angle. B-mode ultrasound exploration revealed that the right anterior mediastinum had a large (about 10.5cm×10.0cm) weak echogenic light mass, a round shape, clear borders, and homogeneous light spots. On the evening of December 3 of the same year, the patient developed sudden chest pain. A chest fluoroscopy showed a large amount of effusion in the right thoracic cavity. The original block shadow was unclear and was considered to be due to tumor collapse. On the morning of the next morning, the right thoracotomy was performed under general anesthesia. During the operation, the tumor had collapsed, and there was bloody and jelly fluid 2200ml in the chest; the tumor surface was not smooth and the capsule was incomplete; the tumor body was a lot of fat-like tissue, and there were many jelly-like substances in it. The tumor and the chest wall, the pericardium, and the right lung were infiltrated in the lower lobe. The pedicle was located between the cavity and the left innominate vein. The pedicle was 2 cm in diameter. The adhesions were separated and the tumors were completely removed. The roots of the pedicles were sutured. The tumor was excised and weighed 2100 g. Pathological diagnosis: mediastinal mucinous liposarcoma (Figure 3). After the operation, the right lung was replanted and her symptoms disappeared. She was discharged 2 weeks later. At 6 months after the operation, the chest X-ray showed an increase of about 6 cm x 5 cm at the chest wall near the right upper lobe. Percutaneous biopsy confirmed metastatic liposarcoma. Although radiotherapy and chemotherapy were given, it eventually died due to failure, and only survived for 10 months after surgery.