Patient, female, 81,Chief complaint: ovarian cancer reduced 11 months out postoperative abdominal distention for 10 daysIn March 2014 due to
Patient, female, 81,
Chief complaint: ovarian cancer reduced 11 months out postoperative abdominal distention for 10 days
In March 2014 due to abdominal pain in our hospital diagnosed with ovarian cancer in March 21st, underwent cytoreductive surgery (hysterectomy + double + + + accessory omental appendix resection + abdominal adhesions decomposition), pathological examination showed: (right) poorly differentiated serous papillary carcinoma, involving the uterus (the rectum and sigmoid fossa surface and omentum), left ovary and left fallopian tube showed no obvious abnormalities. Immunohistochemistry: CK20-, CK3+, ER weak +, PR +, Vimentin+, WT-1 + +, p53+. Postoperative chemotherapy. Abdominal distension, 10 days before admission, loss of appetite, for the next treatment in our department. Now in grade 4: abdominal distension, abdominal, fatigue 3, dry mouth and do not want to drink, the food not hing, sleep, stool 1-2 times / day, is still forming, urinate can.
3 past: history of hypertension for more than 10 years, has been taking nitrendipine and losartan, nearly 4 months of withdrawal, blood pressure control is still good, denied diabetes, coronary heart disease and cerebrovascular disease history.
4 physical examination 36.5 C T P R 20 BP 135/85mmHg 96 / min / min.
Height 140cm weight 40kg body surface area 1.28m2 KPS:70
Normal development, nutrition, into the ward, check the body cooperation. Systemic skin and mucous membrane without yellow, superficial lymph nodes did not touch the swelling. Head no facial deformity, palpebral conjunctiva pale, no sclera yellow dye, eye movements flexible, double pupil big round ears and nose without abnormal secretions. No lips cyanosis, pharynx, no swelling, no double tonsil enlargement. Neck soft without resistance, the trachea is centered, the thyroid gland is not big, the jugular vein does not have anger. The chest is roughly symmetrical, the anterior part of the spine. Lungs are clear, and at the end of dry and wet rales. The heart rate of 96 beats per minute, heart size, area of each valve auscultation without murmur. Abdominal distention, abdominal surgery can see scar healing, no tenderness and rebound tenderness, and rib before, shifting dullness (+), the kidney area without percussion pain, lower limb swelling. The normal physiological reflex, pathological reflex was not elicited by dark red tongue, yellow moss, pulse string slide.
5 auxiliary examination:
Blood routine, urine routine, stool routine, coagulation showed no obvious abnormalities,
Biochemical albumin (ALB) 28.80 (g/L) glucose (GLU) - (mmol/L) - liver and kidney function and electrolytes were normal,
Serum collagen was swollen standard (CYFRA) 8.61 (ng/mL) neuron specific enolase (NSE) 16.59 (ug/L) and carbohydrate antigen CA-125 (CA-125) 203.70 (U/mL) and carbohydrate antigen CA-153 (CA-153) 38.18 (U/mL)
Glycosylated hemoglobin: 6.60%, 2h blood glucose after lunch 9.8mmol/L,
Abdominal ultrasound: normal liver morphology, size, parenchyma echo heterogeneous, portal vein width, the left lobe of the liver to see a number of beaded 0.6cm strong echo, sound shadow, no expansion of the proximal bile duct. The size of the gallbladder is normal, 0.33cm thick, coarse, no definite abnormality internal echo, extrahepatic bile duct dilation. The gastrointestinal tract is more gas, and the pancreas and retroperitoneal lymph nodes are not clear. The thickness of spleen was normal and the echo was homogeneous. The portal vein is not wide. The shape and size of both kidneys were normal, the medulla was clear, and the renal pelvis was not dilated. There was no clear space occupying lesion in both kidneys. Color flow showed no obvious abnormality. The clearance to see a large number of free peritoneal fluid, deep about 11cm deep, liquid echo not clear, see a lot of star like echo. Conclusions 1. The calcification of liver or bile duct stones was 2, the wall of gallbladder was slightly thickened and ascites was high (3)
Echocardiography: 1, three tricuspid regurgitation (a small amount) of 2, left ventricular diastolic dysfunction
Pelvic MRI + enhancement: uterus and bilateral ovaries showed No. In the sacrum, there were multiple nodules with a slightly longer T1 and a longer T2 signal, and some of them were fused, the longest diameter was about 5.4cm, and the median was more uniform. The bladder was filled with no significant thickening of the wall. A large number of water samples can be seen in the abdominal cavity. Conclusion 1 of the presacral lymph node enlargement, part of the fusion, in line with the performance of the transfer of the uterus and bilateral ovaries showed no 2, in line with the performance of a large number of abdominal cavity after the operation of 3
Western medicine diagnosis: after ovarian serous papillary carcinoma (T3cN1MX IIIc)
Pelvic lymph node metastasis
Abdominal pelvic effusion
Impaired glucose tolerance
Treatment: diuretic, supplement of albumin, antitumor, and Addie Fufangbanmao Kanglaite injection, topical four Miao powder and water swelling,
1) oral Decoction of soothing liver and invigorating spleen, removing blood stasis and phlegm:
30 Astragalus Angelica 10 Banzhilian 15 Fuling 15
15 15 6 Taxus Codonopsis Atractylodes Zhigancao 6
10 of the 6 chelidonic Corydalis 15 fried Sanxian 30
Coke areca 10 fried rice sprout 10 or 10
Day one agent, water decoction
2) chemotherapy first Zhou Fang
From 30 10 10 6 fried Atractylodes Zhigancao poria
Jiang Banxia 10 10 6 6 Amomum Pericarpium Citri Reticulatae Fructus Mume
10 woody jiaosanxian 30 gold 10 Su stem 10
6 ginger fried Coptis 10 astragalus root 30 bamboo shavings
The top 4 agents, thick fried 100ml, one day a dose.
3) chemotherapy (March 5th)
Paclitaxel 80mg IVGTT D1 815
100mg D1 815 IVGTT carboplatin
After 2 cycles of ascites disappeared, blood glucose fluctuation, instead of albumin paclitaxel carboplatin, the evaluation of the efficacy of PR after 4 cycles, no obvious adverse reactions.