原发性肺癌胃转移的临床特点浅析附1例报告并文献总结.docVIP

精品论文 参考文献 原发性肺癌胃转移的临床特点浅析附1例报告并文献总结 王佐佑 穆振斌 张洋 辛志勇 毕亚 丁明修 　　【摘 要】原发性肺癌胃转移临床罕见，随着消化内镜和其它影像学手段的应用，该病报告有增多的趋势，新近，我们发现一例，并回顾分析了近十四年来文献报道的另外6例，对该病的临床特点，包括胃转移病灶的发现、症状、诊断、治疗和预后进行总结，结果显示：胃转移病灶发现时距原发性肺癌诊断后2-14个月，平均6.6个月，上消化道出血是主要临床症状，胃镜及PET、CT检查有助于及时发现转移病灶，确诊有赖于活检病理检查和免疫组化分析，原发性肺癌发生胃转移，常伴有其它转移灶，缺乏有效治疗手段，预后不良。 　　【关键词】 肺肿瘤； 胃转移； 免疫组化； 消化内镜 　　Clinicai Features Of Primary Lung Cancer Metastases to the Stomach One Case Report and Literature Review Zuoyou Wang zhenbin Mu yang Zhang zhiyong Xin ya Bi mingxiu Ding 　　【Abstract】 Primary lung cancer metastases to the stomach are rare, with the application of the digestive endoscopy and other imaging methods, reports of the disease showing a rising trend. Recently, a case were discovered, analysing with other 6 cases recorded in nearly 14 years, we summarize the clinical features of the disease, including the lesions found, symptoms, diagnosis, treatment and prognosis of the metastases in the stomach. The results showed: the lesions of metastases in stomach often be found after diagnosed with primary lung cancer about 2-14 months, average of 6.6 months, the main clinical symptoms is upper gastrointestinal bleeding, examining with endoscopy and PET, CT can help to detect metastatic lesions, and its diagnosis relies on biopsy and immunohistochemical analysis. Metastases in stomach from primary lung cancer often accompanied by other metastases, however, its now still lack of effective treatment, and prognoses are poor. 　　【Key words】 Lung cancer, Gastric metastasis, Immunohistochemical analysis, Digestive endoscopy 　　原发性肺癌胃转移临床罕见，我们以“肺癌”和“胃转移”检索同方医学文献数据库，显示自2001年以来，国内共报告6例原发性肺癌胃转移临床病例〔1-6〕，结合我们新近发现的一例，拟对该病的临床特点进行总结，以加深对原发性肺癌胃转移的认识。 　　病例资料：患者男性，55岁，2014年2月27日行左肺癌左肺切除术，术后病理：左肺中—低分化鳞癌，术前、术中及术后未行化疗及放疗。吸烟史20年，每日20只，不嗜酒，无消化性溃疡病史。2014年5月发现左小指末节渐肿大，伴充血、疼痛，逐步加重，出现皮肤破溃，拍X线片示左小指末节指骨溶骨性损害，肝胆脾胰超声示轻度脂肪肝，查两次便潜血阳性，无上腹疼、烧心、泛酸等消化道症状，未行胃镜检查。6月25日行左小指截肢术，术后病理：左小指转移性鳞状细胞癌，指骨未见损害。7月12日拟行TP方案化疗，超声及增强ＣＴ检查示肝脏多发实性占位，改行GP（吉西他滨+顺铂）方案化疗，共４个周期，复查肝脏超