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患者,黄某某,男,42岁。自幼左上臂外侧皮肤有黄豆大黑痣,突出皮肤。两年前增大到花生米大小,行病变皮肤清除术后痊愈出院,病理证实恶性黑色素瘤基底浸润。一年前发现左肩胛骨外侧、左腋下均各有拇指大包块一枚,伴腹胀、腹水。考虑是恶性黑色素瘤淋巴转移,虽经化疗,但疗效欠佳。入院前一月出现持续头痛,且进行性加重。喷射性呕吐,颈硬。无意识障碍,肢瘫及抽搐,亦无发烧及二便失禁,病前无感冒史。 既往体健:无风湿病及结核病史。 入院查体:血压18.6/12.0KPa,心率72次/分,左上臂外侧可见一约20cm手术疤痕,左肩胛骨外侧左腋窝均各可触及一约3×4cm~2及3×2cm~2包块,软质、活动、无压痛,心肺(一),腹水征(+)。 神经系统检查:神清,右瞳3.5mm>左瞳3mm,
Patient, Hwang, male, 42 years old. Since his childhood left upper arm outside the skin with soy mole, highlighting the skin. Two years ago increased to the size of peanuts, the lesion was cleared and discharged after surgery, pathologically confirmed malignant melanoma basilar infiltration. A year ago, the left shoulder blade outside the left axilla were found to have a thumb mass, with bloating, ascites. Considered to be lymphatic metastasis of malignant melanoma, although chemotherapy, but poor efficacy. One month prior to admission, persistent headache was present and was progressively worsened. Spitting vomiting, stiff neck. Unconsciousness, limb paralysis and convulsions, no fever and no incontinence, no history of cold before illness. Past physical health: no history of rheumatism and tuberculosis. Admission examination: blood pressure 18.6 / 12.0KPa, heart rate 72 beats / min, the left upper arm can be seen on the outside of a surgical scar of about 20cm, the left shoulder blade outside the left axilla may reach about 3 × 4cm ~ 2 and 3 × 2cm ~ 2 mass , Soft, activity, no tenderness, cardiopulmonary (a), signs of ascites (+). Nervous system examination: God clear, right pupil 3.5mm> left pupil 3mm,