七年制醫(yī)學(xué)課件肺科10lungcancer—7年制(參考版)
2024-10-06 22:53本頁(yè)面
【正文】 ?afebrile (bloody) pleural effusion. Differential diagnosis: 1. Tuberculosis ⑴ Tuberculoma結(jié)核球 : ⑵ Hilar lymph node tuberculosis: ⑶ Miliary tuberculosis 粟粒型肺結(jié)核 : 2. Pneumonia: 肺炎 3. Lung abscess:肺膿腫 4. Tuberculous pleural effusion 結(jié)核性胸腔積液 Staging of cancer 分期 TNM system Occult carcinoma 隱性肺癌 Tx N 0 M 0 Stage 0 carcinoma in situ原位癌 T is Stage Ⅰ T1N0M0 T2N0M0 Stage Ⅱ T1N1M0 T2N1M0 Stage Ⅲ a T3N0M0 T3N1M0 T13N2M0 Stage Ⅲ b T N3M0 T4 NM0 Stage Ⅳ T NM1 Distant metastasis present T= tumor T1: 3 cm T2: 3cm, or to carina 2cm T3:involve mediastinum縱隔 T4 : involve heart and carina隆凸 N = lymph node N1: regional, N2: mediastinal N3: to contralateral or exathoraxic M= matastasis P119 Treatment : ? 1. Surgery: ? 2. Chemotherapy化療 : ? 3. Radiation therapy放療 : 4. Other local applied treatments: 5. Biological therapy: 6. Chinese traditional medicine中醫(yī)治療 : classification helpful in guiding treatment ? SCLC small cell lung cancer ： choice chemotherapy first, plementary with operation or radiotherapy if possible ? NSCLC squamous cell carcinoma, large cell carcinoma,adenocarcinoma : choice operation (if operable) + bine therapy ? 1. Surgery stageⅠ and Ⅱ NSCLC should be treated with surgical resection aimed at cure. Lobectomy 肺葉切除 is remended. Overall 5year survival rate is about 10~ 35%. ? 2. Chemotherapy 化學(xué)療法 : SCLC highly responsive to chemotherapy. The effective drugs are: etoposide (VP16) 足葉乙甙 cyclophosphamide (CTX) 環(huán)磷酰胺 adriamycin (ADM) 阿霉素 vincristine (VCR) 長(zhǎng)春新堿 methotrexate (MTX) 氨甲蝶呤 Capsulation (DDP) 順鉑 ,etc. Most regimens produce a 50～ 90% response rate. VP16 +DDP Regimens方案 was adviced. ? 3. Radiation therapy 放射治療 : The effective order is as follow : SCLC squamous cell carcinoma adenocarcinoma It is proven benefit in controlling bone pain, spinal pression, superior vena cava syndrome, bronchial obstruction, hemoptysis, as a palliative姑息 treatment. 4. Other local applied treatments局部治療 : transbronchial (intercostal) artery infiltration and thrombosis支氣管動(dòng)脈（或）肋間動(dòng)脈灌注加 栓塞治療 , transbronchoscopical laser 經(jīng) 支氣管 激光 or radiotherapy. 5. Biological therapy生物學(xué)治療 : interferon 干擾素 , transfer factor 轉(zhuǎn)移因子 , levamisole 左旋咪唑 etc., useful in promoting the immune condition of the patient. 6. Chinese traditional medicine中醫(yī)治療 : impro
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