胸外科casereport.ppt

胸外科胸外科casereportcasereportName：guangbo sun Age：61 years oldSex：male Chief complaint：chest pain for 15 daysHistory of present illnessv We present is a 61-years-old male patient。During the last half month,he experienced intermittent chest pain on the right side without any other symptom.In the last half month,the patient chest pain daily so he decided to get a CT scan of the chest.The chest CT showed a placeholder located in the lower lobe of right lung.Past history He have underwent Interventional surgery of left coronary artery at our hospital in 2015,now oral aspirin intestinal solution 100milligram qd,atorvastatin 20milligram qd,metopolol 25milligram qd.OthervPersonal history,marital history and family history：No specialvPhysical examination was normal.The chest CT 2017.10.17The chest CT 2017.10.17Imaging diagnosisv The chest CT scan shows the basal segment bronchial obstruction and a mass high density shadow,about 3.2cm in diameter and some burr on the edge of the lower lobe of right lung.vThe head and abdomen CT scan showed no any signs of metastasis.vThe Imaging diagnosis is considered as malignant tumor of the lower lobe of right lung.Bone scan 2017.10.23vIt found have no any especially signs of bone metastasis in whole body bone imaging。Bronchoscope 2017.10.18The examination of the bronchi through a bronchoscope shows:The submucosal infiltration and hyperplasia of bronchial tube mouth in the lower lobe of right lung was stenosis。Pathological results 2017.10.23 Conventional staining combined with immunochemical staining considered was squamous cell carcinoma。Immunohistochemical results：CK5/6(+),CK7(-),ki-67(40%+),NapsinA(-),P40(+),page1;TTF-1(-)page2.Other Supplementary Examination vPulmonary function test showed(2017.10.17)：vForced expiratory volume in one Forced expiratory volume in one second(FEV1):2.85Lsecond(FEV1):2.85LvForced vital capacity(FVC):3.66LForced vital capacity(FVC):3.66LvForced Expiratory Flow Forced Expiratory Flow RateRate(FEF):6.59L/S(FEF):6.59L/SvMaximum Ventilatory Volume(MVVMaximum Ventilatory Volume(MVV）：）：110.8L/min110.8L/minvForced vital capacity as a Forced vital capacity as a percentage of predicted value(percentage of predicted value(FVCPP)FVCPP)：88.9%88.9%Other Supplementary Examination Colour Sonography（2017.10.17）：）：1.Ejection fraction（EF）：）：61%2.Left ventricular diastolic dysfunction Preliminary Diagnosis 1.malignant tumor of the lower lobe of right lung.cT2N1M0 IIB 2.Interventional surgery of left coronary arteryTreatmentv1.We decided to have surgical treatment was that underwent complete video-thocitscopic(VATS)resection of malignant tumors in the right lower lobe of lung in October 25,2017。v2.we aslo had a hyperthermic perfusion chemotherapy postoperation because of we discoverd there have many suspicious lymph nodes in the operation。The drug used for hyperthermic perfusion was 40 milligram cisplatin and had been successfully treated two times。Up to now，The patient feels good！