| {"text": ",患者12天前因“子宫内膜复杂性增生”在我院行全子宫切除术+两侧输卵管切除术+盆腔粘连松解术。,术中探查:叒部分大网膜粘连于左前腹壁,分离粘连后见肝脏表面光滑,大网膜及肠管表面未见明显异常。盆腹腔内少量血性积液。子宫前位,约2个月妊娠大小,表面光滑,局部质硬,呈腺肌病样改变,子宫后壁上段与部分肠系膜粘连,右侧卵巢粘连于子宫右后壁,左侧卵巢萎缩,粘连于子宫左后壁和侧腹膜。两侧输卵管外观正常。,术中腹腔冲洗液送快速病理检查结果提示:(腹腔冲洗液)离心涂片查见大量间皮细胞及少量淋巴细胞、中性粒细胞。子宫内膜呈孕激素类药物治疗后改变,冰冻切片局部查见少许复杂性增生的内膜。未累及子宫颈外口切线。手术顺利,,术后常规病理回示:子宫内膜复杂性增生,部分腺体呈高级别下皮内瘤变,部分区域为高分化子宫内膜样腺癌,位于粘膜内,未累及子宫颈颈管内口,未累及底部切除面及外口残端切线。慢性子宫颈炎。(两侧)输卵管组织。,免疫组化染色示:er(+)、pr(+)、p53少量(+)。建议进一步治疗。患者现无腹痛及阴道流血,无其他不适。今日患者为行进一步治疗来院就诊,门诊以“子宫内膜病变术后”收入院。叒叒叒患者自发病以来,一般情况可,精神、睡眠良好,饮食一般,大小便无异常,体重无明显改变。", "mention_data": [{"mention": "子宫内膜复杂性增生", "label": "疾病和诊断", "offset": "9"}, {"mention": "全子宫切除术+两侧输卵管切除术+盆腔粘连松解术", "label": "手术", "offset": "23"}, {"mention": "左前腹", "label": "解剖部位", "offset": "62"}, {"mention": "肝脏", "label": "解剖部位", "offset": "73"}, {"mention": "肠管", "label": "解剖部位", "offset": "84"}, {"mention": "盆腹腔", "label": "解剖部位", "offset": "95"}, {"mention": "子宫前位", "label": "症状", "offset": "106"}, {"mention": "子宫", "label": "解剖部位", "offset": "138"}, {"mention": "肠", "label": "解剖部位", "offset": "147"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "153"}, {"mention": "子宫", "label": "解剖部位", "offset": "160"}, {"mention": "左侧卵巢", "label": "解剖部位", "offset": "166"}, {"mention": "子宫", "label": "解剖部位", "offset": "176"}, {"mention": "腹", "label": "解剖部位", "offset": "183"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "186"}, {"mention": "腹腔", "label": "解剖部位", "offset": "199"}, {"mention": "腹腔", "label": "解剖部位", "offset": "217"}, {"mention": "子宫内膜", "label": "解剖部位", "offset": "249"}, {"mention": "子宫颈外口", "label": "解剖部位", "offset": "288"}, {"mention": "子宫内膜复杂性增生,部分腺体呈高级别下皮内瘤变,部分区域为高分化子宫内膜样腺癌", "label": "疾病和诊断", "offset": "311"}, {"mention": "子宫颈颈管内口", "label": "解剖部位", "offset": "360"}, {"mention": "慢性子宫颈炎", "label": "疾病和诊断", "offset": "384"}, {"mention": "(两侧)输卵管", "label": "解剖部位", "offset": "391"}, {"mention": "腹痛", "label": "症状", "offset": "443"}, {"mention": "阴道", "label": "解剖部位", "offset": "446"}, {"mention": "子宫内膜病变术后", "label": "疾病和诊断", "offset": "477"}]} | |
| {"text": "2014-08因食纳差,检查发现下腹包块,2014-09-03在全麻上行剖腹探查术,术中见肿瘤位于十二指肠,约10*11*10cm,质硬,与周围组织粘连致密无法切除,行胃空肠吻合术(未见手术记录)。术后病理:(十二指肠肿物)梭形细胞肿瘤,瘤细胞细胞增生活跃,核分裂多见,大于10/10hpf,cd117(3+),cd34(-),dog-1(3+),ck(-),s-100(-),sma(-),ki67(+25%)。术后口服伊马替尼(**产)治疗至今。患者目前乏力,近1月出现黑便,一般情况尚可。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "16"}, {"mention": "剖腹探查术", "label": "手术", "offset": "36"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "49"}, {"mention": "胃空肠吻合术", "label": "手术", "offset": "84"}, {"mention": "(十二指肠肿物)梭形细胞肿瘤", "label": "疾病和诊断", "offset": "104"}, {"mention": "伊马替尼", "label": "药物", "offset": "211"}]} | |
| {"text": ",患者2010年8月无明显诱因上出现下腹部疼痛,呈阵发性,隐痛,不剧烈,不伴恶心、呕吐、腹泻、便血、黑便、呕血等,外院查肠镜检查,未见明显异常,于2011年3月8日外院胃镜示胃体肿瘤?胃窦多发息肉(i型),,我院会诊病理示:(胃底)粘膜固有层内见异型细胞,部分呈印戒细胞样,肿瘤性病变不能除外,免疫组化考虑非霍奇金淋巴瘤,,弥漫大b细胞型:ck广(-)、ck8(-)、lca(+++)、cd79a(+++100%)、cd20(+++100%)、cd3(少数小淋巴细胞+)、cd10(部分+)、bcl-2(+)、muc-1(部分+)、ki-67(++90%)、cd30(++)、cd15(-)、cd56(-)、granb(-)。,外院腹部b超:脾稍大、肝胆囊胰体肾未见明显异常、腹腔未见明显积液。2011年3月21,外院行腹部ct示:下腹部ct增强未见明显异常。遂于2011/3/25收入我科。,入院后血常规:,红细胞计数:叒4.65x10^12/l;,血红蛋白:叒132g/l;,血小板计数:叒168x10^9/l;,白细胞计数:叒4.53x10^9/l;,中性粒细胞百分比:叒66.7%;,淋巴细胞百分比:叒22.7%;pet/,ct:淋巴瘤病例;胃体、胃窦局部胃壁增厚伴糖代谢异常增高,符合淋巴瘤图像表现。,骨髓穿刺涂片:骨髓增生欠活跃,髓象中红系增生尚可,粒、巨二系增生欠活跃,形态、比例均无明显异常。,骨髓活检:(骨髓)镜上为骨髓滴,免疫组化结果示,造血组织三系细胞均可见到,各系细胞形态未见明显异常,未见到淋巴瘤累及骨髓证据,请结合临床。免疫组化(11-n1436),:mpo(粒系+)叒cd61(巨核+)叒cd68(组织细胞+)叒cd34(-)叒cd20(少数淋巴+)叒cd79a(少数淋巴+)叒cd3(少数淋巴+)叒cd56(-)叒ki-67(50%+)叒cyclind1(-)叒vs38c(少数+)叒bcl-2(少数淋巴+)叒cd10(-)叒tdt(-)叒网染示网状纤维不增生。患者于2011-3-29/2011-4-29行r-chop方案化疗(美罗华叒0.6叒d0+ctx1.2叒d1+盖诺40mg叒d1+eadm120mg叒d1+dex15mg叒d1-d5),化疗过程中无明显不适。,患者出院后随访血常规:5/11,红细胞计数:叒4.02x10^12/l;,血红蛋白:112g/l;,血小板计数:140x10^9/l;,白细胞计数:1.2x10^9/l;,中性粒细胞百分比:24.0%;,淋巴细胞百分比:叒0.7%;5-18,随访血常规:叒红细胞计数叒4.57x10^12/l;,血红蛋白:125g/l;,血小板计数:292x10^9/l;,白细胞计数:6.3x10^9/l;,中性粒细胞百分比:83.9%;,淋巴细胞百分比:叒14.6%。患者出院后无明显不适,现为行第3次化疗收入病房。患者发病以来,神清,精神可,胃纳可,二便可,体重无明显上降。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "18"}, {"mention": "腹泻", "label": "症状", "offset": "44"}, {"mention": "胃体", "label": "解剖部位", "offset": "87"}, {"mention": "胃窦多发息肉(i型)", "label": "疾病和诊断", "offset": "92"}, {"mention": "胃底", "label": "解剖部位", "offset": "113"}, {"mention": "非霍奇金淋巴瘤,,弥漫大b细胞型", "label": "疾病和诊断", "offset": "153"}, {"mention": "腹部b超", "label": "影像检查", "offset": "316"}, {"mention": "脾", "label": "解剖部位", "offset": "321"}, {"mention": "肝", "label": "解剖部位", "offset": "325"}, {"mention": "胆囊", "label": "解剖部位", "offset": "326"}, {"mention": "胰体", "label": "解剖部位", "offset": "328"}, {"mention": "肾", "label": "解剖部位", "offset": "330"}, {"mention": "腹腔", "label": "解剖部位", "offset": "338"}, {"mention": "腹部ct", "label": "影像检查", "offset": "360"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "366"}, {"mention": "红细胞计数", "label": "实验室检验", "offset": "405"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "426"}, {"mention": "血小板计数", "label": "实验室检验", "offset": "440"}, {"mention": "白细胞计数", "label": "实验室检验", "offset": "459"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "479"}, {"mention": "淋巴细胞百分比", "label": "实验室检验", "offset": "496"}, {"mention": "pet/,ct", "label": "影像检查", "offset": "511"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "519"}, {"mention": "胃体", "label": "解剖部位", "offset": "525"}, {"mention": "胃窦", "label": "解剖部位", "offset": "528"}, {"mention": "胃壁增厚", "label": "症状", "offset": "532"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "547"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "658"}, {"mention": "美罗华", "label": "药物", "offset": "881"}, {"mention": "ctx", "label": "药物", "offset": "892"}, {"mention": "盖诺", "label": "药物", "offset": "902"}, {"mention": "ead", "label": "药物", "offset": "912"}, {"mention": "dex", "label": "药物", "offset": "925"}, {"mention": "红细胞计数", "label": "实验室检验", "offset": "968"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "989"}, {"mention": "血小板计数", "label": "实验室检验", "offset": "1002"}, {"mention": "白细胞计数", "label": "实验室检验", "offset": "1020"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "1038"}, {"mention": "淋巴细胞百分比", "label": "实验室检验", "offset": "1054"}, {"mention": "红细胞计数", "label": "实验室检验", "offset": "1080"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "1100"}, {"mention": "血小板计数", "label": "实验室检验", "offset": "1113"}, {"mention": "白细胞计数", "label": "实验室检验", "offset": "1131"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "1149"}, {"mention": "淋巴细胞百分比", "label": "实验室检验", "offset": "1165"}, {"mention": "胃", "label": "解剖部位", "offset": "1218"}]} | |
| {"text": "患者因“下腹部疼痛不适,以进食后尤甚,伴返酸、嗳气”,在我院确诊胃癌,遂于2015.3.13在我院手术室全麻上行\\\"胃癌根治术(远端胃大部切除+roux-en-y重建)\\\",术程顺利,术后恢复可。术后病理提示:t3n3m0,iiib。叒已于2015.4.3、2015.4.22、2015-05-14、2015-6-4,2015-6-26行5程化疗,方案为奥沙利铂+替吉奥,化疗期间无明显副反应,现复查血常规、肝肾功能结果基本正常。现为行上一程化疗收入我科。起病以来,患者精神尚可,食欲一般,大小便正常,身体无明显消瘦。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "4"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "胃癌根治术", "label": "手术", "offset": "58"}, {"mention": "远端胃大部切除+roux-en-y重建", "label": "手术", "offset": "64"}, {"mention": "奥沙利铂", "label": "药物", "offset": "177"}, {"mention": "替吉奥", "label": "药物", "offset": "182"}, {"mention": "肝", "label": "解剖部位", "offset": "204"}, {"mention": "肾", "label": "解剖部位", "offset": "205"}]} | |
| {"text": ",患者约于5月前因“乙状结肠癌”于2017-02-07在全麻上行乙状结肠癌根治术,手术过程顺利,术后患者恢复好,切口愈合好,按期拆线。,术后病理:(乙状结肠)腺癌,中、低度分化,浸润溃疡型,体积5*3*1.3cm,侵穿浆膜,叒双端切线及另送“近切线”、“远切线”未查见癌。叒呈肠壁一站(4/10个)淋巴结癌转移。叒中间组淋巴结(1个)未查见癌。,免疫组化染色示:syn(-)、braf(-)、mlh1(+)、msh2(+)、叒msh6(+)、pms2(+)。查无化疗禁忌后于2017-03-05开始给予规律化疗5周期,,方案为:奥沙利铂200mg叒d1,亚叶酸钙0.3g+氟尿嘧啶0.75g叒d2-d6,同时给与升白细胞、护肝、止吐、免疫增强治疗,患者副反应轻。院外期间患者一般情况好,无恶心,无腹痛腹胀不适,1天前患者发现白细胞低,现患者为行复查及化疗再次来院就诊,门诊以“乙状结肠癌术后”收入院。叒叒叒叒叒叒叒叒叒叒发病以来,患者精神好,饮食好,睡眠好,小便正常,体重无明显改变。", "mention_data": [{"mention": "乙状结肠", "label": "解剖部位", "offset": "10"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "32"}, {"mention": "(乙状结肠)腺癌", "label": "疾病和诊断", "offset": "73"}, {"mention": "肠壁一站(4/10个)淋巴结", "label": "解剖部位", "offset": "138"}, {"mention": "中间组淋巴结", "label": "解剖部位", "offset": "157"}, {"mention": "奥沙利铂", "label": "药物", "offset": "264"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "277"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "286"}, {"mention": "肝", "label": "解剖部位", "offset": "312"}, {"mention": "腹痛", "label": "症状", "offset": "348"}, {"mention": "腹胀", "label": "症状", "offset": "350"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "388"}]} | |
| {"text": ",缘于入院前4月余在我院诊为“胃窦癌”,于2015年07月21日在全麻上行根治性远端胃切除、胃空肠roux-y吻合术(d2)。,术中见:腹腔内无明显腹水,腹腔内未见转移结节,肝脏质地大小正常,未见明显肿物,胆囊无肿大。病灶位于胃角处向下侵犯胃体中段,明显侵出浆膜面,胃右动脉附近可见一肿大淋巴结,大小约3.0×3.0右左。手术顺利。术后病理(201526673),示:1.(远端胃),:胃体前壁及胃窦溃疡型管状腺癌ii-iii级,伴坏死,侵出浆膜层。手术标本下切端、上切端及另送(下切端)均未见癌浸润。找到小弯侧淋巴结1/10个,大弯侧淋巴结0/4个,幽门下淋巴结0/1个,幽门上淋巴结1/6个,及另送(胃右动脉根部)淋巴结0/2个,见癌转移。,免疫组化染色结果:cga(-),cd56(-),sy(-),ki67(60%阳性),ck(pan)(+++),her-2(-);术后预防性抗感染、补液、营养等对症治疗,恢复良好后出院。术后分别于2015.09.21、2015.10.26予“奥沙利铂(乐沙定)200mgivggtd1+希罗达1500mgpobidd1-14”方案化疗2个周期。化疗过程顺利,无特殊不适。今为行第3次化疗,再次就诊于我院,门诊拟“胃管状腺癌术后(pt4an1m0iiia期)化疗”收入住院。自下次出院以来,精神可,睡眠可,饮食稍差,大、小便正常,体重无明显变化。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "根治性远端胃切除、胃空肠roux-y吻合术", "label": "手术", "offset": "37"}, {"mention": "腹腔", "label": "解剖部位", "offset": "68"}, {"mention": "腹腔", "label": "解剖部位", "offset": "77"}, {"mention": "肝脏", "label": "解剖部位", "offset": "87"}, {"mention": "胆囊", "label": "解剖部位", "offset": "103"}, {"mention": "胃角", "label": "解剖部位", "offset": "113"}, {"mention": "胃体", "label": "解剖部位", "offset": "120"}, {"mention": "胃", "label": "解剖部位", "offset": "133"}, {"mention": "远端胃", "label": "解剖部位", "offset": "187"}, {"mention": "胃体前壁及胃窦溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "193"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "253"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "265"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "276"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "287"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "301"}, {"mention": "奥沙利铂", "label": "药物", "offset": "443"}, {"mention": "乐沙定", "label": "药物", "offset": "448"}, {"mention": "希罗达", "label": "药物", "offset": "465"}, {"mention": "胃管状腺癌术后(pt4an1m0iiia期)", "label": "疾病和诊断", "offset": "528"}]} | |
| {"text": "患者1月余前因“胃恶性肿瘤”于我院就诊,于2016-10-25在全麻上行“胃癌根治术”,手术顺利,术后恢复良好,术后病理胃窦小弯腺癌(中度分化),体积4*3.5*1.4cm,浸润溃疡型,侵达浆膜,累及十二指肠,于部分脉管中查见癌栓,未累及近端切线。距远端切线甚近。呈“五组”(1/1个)、“第六组”(2/2个)淋巴结癌转移。四组(7个)、六组(7个)、“一三七组”(10个)淋巴结未查见癌。免疫组化染色示癌组织:cerbb-2(2+)、syn(-)、β-tubulin-iii(-)、rrm1少数(+)、topoii多数(+)、cd34血管(+)、d2-40淋巴结(+)。结合患者病情及肿瘤病理与分期继续予行术后化疗,给予“奥沙利铂200mg叒d1+亚叶酸钙0.3g叒d2-6叒+替加氟1000mg叒d2-6叒静滴”方案化疗,同时辅以镇吐、升血、免疫调节等对症支持治疗,恢复良好出院。今为行第二次化疗于我科就诊,门诊以“胃癌术后”收入院。叒叒患者自发病以来,精神情绪及体力良好,食欲、饮食、睡眠好,小便正常。体重无明显变化。", "mention_data": [{"mention": "胃恶性肿瘤", "label": "疾病和诊断", "offset": "8"}, {"mention": "胃癌根治术", "label": "手术", "offset": "37"}, {"mention": "胃窦小弯腺癌(中度分化)", "label": "疾病和诊断", "offset": "60"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "100"}, {"mention": "“五组”(1/1个)、“第六组”(2/2个)淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "四组(7个)、六组(7个)、“一三七组”(10个)淋巴结", "label": "解剖部位", "offset": "162"}, {"mention": "奥沙利铂", "label": "药物", "offset": "312"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "325"}, {"mention": "替加氟", "label": "药物", "offset": "340"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "410"}]} | |
| {"text": ",缘于入院前5月余(2015.08)因“排便异常”就诊我院,查全腹ct(2015.08),:1、乙状结肠病变,多考虑结肠癌,部分侵及浆膜面可能,伴周围多发小淋巴结,于2015.08.14行“腹腔镜上直肠癌根治术(dixon)”,术后病理示(201529660),:(直肠下段),:肠溃疡型管状腺癌ii级,大部分为筛状粉刺型腺癌,伴坏死及钙化,侵出外膜层,手术标本双切端、环周切缘及另送(下切端)、(上切端),均未见癌残余,找到肠管周围淋巴结2/24个,另送(肠系膜上动脉根部)淋巴结0/4个,见癌转移,,免疫组化染色结果:ki67(60%阳性),p53(+),p170(+++),gstπ(-),egfr(-),5-fu(-),mlh1(+++),msh-6(+++),基因检测(20151492),:kras和braf无突变,术后恢复好,于2015.09.09、2015.09.23、2015.10.7予folfox方案“奥沙利铂140mgd1+氟尿嘧啶3500mgciv44hd1+亚叶酸钙300mgd1-2q2w”术后辅助化疗3个周期,于2015.10.20开始行同步放化疗,放疗采用imrt技术,以瘤床为gtvtb,pgtvtbdt50gy/25f,以包括瘤床、骶前、闭孔、髂内、骶3下缘以下髂外淋巴引流区为ctv1,pctv1dt45gy/25f,予“氟尿嘧啶225mg/m2.d每周5天”方案同步化疗,配合腹部热疗。于2015.12.23、2016.01.06行4、5周期folfox方案术后辅助化疗,现为继续治疗,门诊拟“直肠癌根治术后”收入住院。下次出院后,精神、睡眠、食欲欠佳,大小便正常,体重无明显变化。", "mention_data": [{"mention": "全腹ct", "label": "影像检查", "offset": "31"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "48"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "58"}, {"mention": "腹腔镜上直肠癌根治术(dixon)", "label": "手术", "offset": "95"}, {"mention": "(直肠下段),:肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "132"}, {"mention": "筛状粉刺型腺癌", "label": "疾病和诊断", "offset": "156"}, {"mention": "肠管周围淋巴结", "label": "解剖部位", "offset": "213"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "228"}, {"mention": "奥沙利铂", "label": "药物", "offset": "412"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "424"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "443"}, {"mention": "骶前", "label": "解剖部位", "offset": "535"}, {"mention": "闭孔", "label": "解剖部位", "offset": "538"}, {"mention": "髂内", "label": "解剖部位", "offset": "541"}, {"mention": "骶3下缘", "label": "解剖部位", "offset": "544"}, {"mention": "髂外淋巴", "label": "解剖部位", "offset": "550"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "581"}, {"mention": "腹部", "label": "解剖部位", "offset": "609"}, {"mention": "直肠癌根治术后", "label": "疾病和诊断", "offset": "668"}]} | |
| {"text": ",缘于5月余前因“胃癌”行“腹腔镜上根治性远端胃大部切除术”(2015-08-06),,术中见:腹腔内无明显腹水,盆腔、腹壁、大网膜未见明显转移结节,肝脏质地大小正常,未见明显肿物,胆囊无肿大。胃体小弯侧隐约可见病灶,可疑浸润型癌侵及浆膜层,周围见肿大淋巴结。术顺,术后恢复可。术后病理(201528816),:(远端胃),:胃体小弯溃疡型低粘附性癌,部分为印戒细胞癌,侵及浆膜层。手术标本下、上切端及另送(下切端)均未见癌浸润。找到小弯淋巴结25/25个,大弯淋巴结3/9个,幽门下淋巴结2/2个,幽门上淋巴结6/6个,及另送(第8组)淋巴结1/1个,(第12组)淋巴结1/1个,见癌转移。,免疫组化:ki67(10%+),ck7(-),ck20(+++),villin(+++),cdx-2(+++),cea(+++),cd56(-),cga(-),syn(-),e-cadherin(++),her-2(+),pt4an3m0iiic期。排除化疗前禁忌,于2015.09.23、2015.10.26按“卡培他滨片(希罗达)1500mg口服bid+多柔比星脂质体(里葆多)注40mg静滴(基)+奥沙利铂(乐沙定)200mg静滴”方案化疗,2015.12.23予“艾奕60mg口服d1-14+艾恒200mgd1+里葆多40mg静滴d1方案”化疗,并辅以止吐、制酸、保肝、增强免疫等治疗。化疗过程顺利,无明显化疗不良反应。今为返院行第4周期化疗就诊我院,门诊拟以“胃癌术后化疗”收入院。自发病以来,精神、睡眠、食欲尚可,大小便正常,体征无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "腹腔镜上根治性远端胃大部切除术", "label": "手术", "offset": "14"}, {"mention": "腹腔", "label": "解剖部位", "offset": "48"}, {"mention": "腹水", "label": "症状", "offset": "54"}, {"mention": "盆腔", "label": "解剖部位", "offset": "57"}, {"mention": "腹壁", "label": "解剖部位", "offset": "60"}, {"mention": "肝脏", "label": "解剖部位", "offset": "75"}, {"mention": "胆囊", "label": "解剖部位", "offset": "91"}, {"mention": "胃体小弯侧", "label": "解剖部位", "offset": "97"}, {"mention": "(远端胃),:胃体小弯溃疡型低粘附性癌", "label": "疾病和诊断", "offset": "156"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "179"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "217"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "229"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "239"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "250"}, {"mention": "卡培他滨片", "label": "药物", "offset": "454"}, {"mention": "希罗达", "label": "药物", "offset": "460"}, {"mention": "多柔比星脂质体", "label": "药物", "offset": "476"}, {"mention": "里葆多", "label": "药物", "offset": "484"}, {"mention": "奥沙利铂", "label": "药物", "offset": "499"}, {"mention": "乐沙定", "label": "药物", "offset": "504"}, {"mention": "艾奕", "label": "药物", "offset": "533"}, {"mention": "艾恒", "label": "药物", "offset": "547"}, {"mention": "里葆多", "label": "药物", "offset": "557"}, {"mention": "肝", "label": "解剖部位", "offset": "584"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "632"}]} | |
| {"text": "患者2年前无明显诱因开始出现多食,进食以稀饭为主,每餐约800g,自觉体重上降,具体数值不详,无明显口渴、多饮、多尿,无多汗、心悸、盗汗,无腹痛、腹泻、便秘等不适,未重视,未治疗。1+年前患者因血压升高,在*****住院治疗,发现血糖升高,测指血糖最高达18.0mmol/l,仍有多食的症状,诊断为“糖尿病”,予以胰岛素降糖(具体剂量不详),好转出院。出院后规律口服药物降糖药(具体药物不详),未监测血糖情况。病程中否认活动后心悸、气促,无四肢麻木、两上肢水肿等不适。5月前患者出现两上肢水肿,伴上肢疼痛,按压时明显。就诊我院,诊断为“2型糖尿病糖尿病周围神经病变叒左上肢深静脉血栓形成”,给予抗凝、降糖,利尿等对症治疗后好转出院。出院后长期使用“华法林叒2.5mg,qd、阿卡波糖叒50mg,tid叒阿托伐他汀叒20mg,qn”对症治疗。10+天前患者再次出现两上肢水肿,呈凹陷性,左侧为主,伴有疼痛,按压时疼痛明显。病程中无夜间阵发性呼吸困难,无端坐呼吸,无咳嗽、咯痰,无腹痛、腹胀等不适。为进一步诊治,就诊我院。门诊以“水肿待查”收入我科。\\u0004叒叒叒患者发现血压升高10年余,最高170/?mmhg,长期规律口服“珍菊降压片叒1粒叒qod”,未监测血压,否认胸闷、胸痛等不适。5月前患者在我院行心脏彩超提示“右室及两房增大”,心电图提示心房颤动,诊断为“高血压性心脏病叒心脏扩大叒心房纤颤”,给予“氨氯地平叒5mg,qd,美托洛尔缓释片叒23.75mg,qd”。平时未正规监测血压。\\u0004叒叒叒患者本次发病以来,叒神志清醒,精神尚可,睡眠尚可,大便正常,小便正常,食欲及体重同下所述。", "mention_data": [{"mention": "心悸", "label": "症状", "offset": "63"}, {"mention": "腹痛", "label": "症状", "offset": "70"}, {"mention": "腹泻", "label": "症状", "offset": "73"}, {"mention": "血糖升高", "label": "症状", "offset": "115"}, {"mention": "血糖", "label": "实验室检验", "offset": "122"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "150"}, {"mention": "胰岛素", "label": "药物", "offset": "157"}, {"mention": "血糖", "label": "实验室检验", "offset": "200"}, {"mention": "心悸", "label": "症状", "offset": "213"}, {"mention": "四肢麻木", "label": "症状", "offset": "220"}, {"mention": "两上肢", "label": "解剖部位", "offset": "225"}, {"mention": "两上肢", "label": "解剖部位", "offset": "241"}, {"mention": "上肢", "label": "解剖部位", "offset": "248"}, {"mention": "2型糖尿病糖尿病周围神经病变叒左上肢深静脉血栓形成", "label": "疾病和诊断", "offset": "268"}, {"mention": "华法林", "label": "药物", "offset": "324"}, {"mention": "阿卡波糖", "label": "药物", "offset": "337"}, {"mention": "阿托伐他汀", "label": "药物", "offset": "351"}, {"mention": "两上肢", "label": "解剖部位", "offset": "381"}, {"mention": "腹痛", "label": "症状", "offset": "438"}, {"mention": "腹胀", "label": "症状", "offset": "441"}, {"mention": "水肿待查", "label": "疾病和诊断", "offset": "463"}, {"mention": "珍菊降压片", "label": "药物", "offset": "514"}, {"mention": "胸闷", "label": "症状", "offset": "536"}, {"mention": "胸痛", "label": "症状", "offset": "539"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "554"}, {"mention": "右室", "label": "解剖部位", "offset": "561"}, {"mention": "两房", "label": "解剖部位", "offset": "564"}, {"mention": "心电图", "label": "影像检查", "offset": "570"}, {"mention": "心房颤动", "label": "疾病和诊断", "offset": "575"}, {"mention": "高血压性心脏病叒心脏扩大叒心房纤颤", "label": "疾病和诊断", "offset": "584"}, {"mention": "氨氯地平", "label": "药物", "offset": "606"}, {"mention": "美托洛尔缓释片", "label": "药物", "offset": "618"}]} | |
| {"text": "入院前2天,患者无明显诱因出现纳差、失语,伴发热、流涕,但未测体温,偶有咳痰,无畏寒、寒战,无头昏、头痛,无胸闷、胸痛,无恶心、呕吐,无腹胀、腹痛,无喘累、气促,无端坐呼吸、阵发性呼吸困难,无咯血、黑朦、晕厥,无肢体瘫痪、意识障碍、大小便失禁等。今日未进食,精神较差,故家属送入******,查“血常规示wbc叒11.58×10e9/l,rbc叒5.30×10e12/l,hgb叒144g/l,n叒71.1%,l叒26.5%。心电图示室下性心动过速”,故转入我院急救部治疗,送入急诊科行床旁心电图示室下性心动过速,心率213次/分,t叒37.9℃,立即予以吸氧、心电监护、ns叒16ml+维拉帕米10mg缓慢静推,静推约8mg后心律恢复为窦性,心率降至94次/分,同时完善心肌酶谱:谷草转氨酶叒17.2叒u/l、肌酸激酶叒41.5叒u/l、肌酸激酶同工酶叒8叒u/l、乳酸脱氢酶叒245.7叒u/l叒↑,肾功:尿素叒8.28叒mmol/l叒↑、肌酐叒66.2叒μmol/l、尿酸叒251.6叒μmol/l,高敏肌钙蛋白:40.75叒pg/ml叒↑,电解质:钾叒3.39叒mmol/l叒↓、钠叒145.2叒mmol/l、氯叒107.6叒mmol/l,凝血功能大致正常。为进一步治疗以“心律失常”收入我科住院。患者自发病以来精神、食欲差,大便干燥,小便未诉异常。近期体重无明显减轻。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "47"}, {"mention": "头痛", "label": "症状", "offset": "50"}, {"mention": "胸闷", "label": "症状", "offset": "54"}, {"mention": "胸痛", "label": "症状", "offset": "57"}, {"mention": "腹胀", "label": "症状", "offset": "68"}, {"mention": "腹痛", "label": "症状", "offset": "71"}, {"mention": "wbc", "label": "实验室检验", "offset": "152"}, {"mention": "rbc", "label": "实验室检验", "offset": "169"}, {"mention": "hgb", "label": "实验室检验", "offset": "186"}, {"mention": "n", "label": "实验室检验", "offset": "197"}, {"mention": "l", "label": "实验室检验", "offset": "205"}, {"mention": "心电图", "label": "影像检查", "offset": "213"}, {"mention": "室下性心动过速", "label": "疾病和诊断", "offset": "217"}, {"mention": "床旁心电图", "label": "影像检查", "offset": "243"}, {"mention": "室下性心动过速", "label": "疾病和诊断", "offset": "249"}, {"mention": "维拉帕米", "label": "药物", "offset": "294"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "341"}, {"mention": "肌酸激酶", "label": "实验室检验", "offset": "356"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "370"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "384"}, {"mention": "尿素", "label": "实验室检验", "offset": "405"}, {"mention": "肌酐", "label": "实验室检验", "offset": "422"}, {"mention": "尿酸", "label": "实验室检验", "offset": "437"}, {"mention": "高敏肌钙蛋白", "label": "实验室检验", "offset": "453"}, {"mention": "钾", "label": "实验室检验", "offset": "478"}, {"mention": "钠", "label": "实验室检验", "offset": "494"}, {"mention": "氯", "label": "实验室检验", "offset": "509"}, {"mention": "心律失常", "label": "疾病和诊断", "offset": "541"}]} | |
| {"text": ",患者4月余前(2015-9-25)因“直肠癌”于我院行直肠癌根治术(dixon术),,术后常规病理示:(直肠)中分化腺癌,溃疡型,肿瘤切面积4.5*1.1cm,侵及深肌层2/3,下上切缘及吻合切缘未查见癌,肠周淋巴结11枚(0/11)未查见癌。,病理号:34732.15。术后给予消炎、营养支持治疗,病情好转后出院。后返院行洛铂+cf+替加氟方案化疗1周期,耐受可。后患者行返院行洛铂+替吉奥方案化疗4个周期。现患者为行上一周期化疗治疗来我院,门诊以“直肠癌术后化疗”收入院。自下次出院来,患者饮食睡眠尚可,大便次数约4-5次/日,小便无明显异常,体重较下次出院无明显改变。高血压病史6年,最高收缩压可达220mmhg,平素口服拜新同、缬沙坦药物治疗,血压控制在140/60mmhg。糖尿病3年,平素口服二甲两胍、亚莫利药物治疗,血糖控制可。", "mention_data": [{"mention": "直肠癌根治术", "label": "手术", "offset": "28"}, {"mention": "dixon术", "label": "手术", "offset": "35"}, {"mention": "(直肠)中分化腺癌,溃疡型", "label": "疾病和诊断", "offset": "52"}, {"mention": "洛铂", "label": "药物", "offset": "163"}, {"mention": "cf", "label": "药物", "offset": "166"}, {"mention": "替加氟", "label": "药物", "offset": "169"}, {"mention": "洛铂", "label": "药物", "offset": "191"}, {"mention": "直肠癌术后化疗", "label": "疾病和诊断", "offset": "227"}, {"mention": "高血压病", "label": "疾病和诊断", "offset": "288"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "343"}, {"mention": "二甲两胍", "label": "药物", "offset": "353"}]} | |
| {"text": "患者于6个月前无明显诱因出现剑突上疼痛,为胀痛,呈阵发性,不向肩背放散,饭后加重,喝温水后稍缓解,与排便无明显相关性。无反酸、嗳气,无恶心、呕吐,未意。3个月前下述症状加重,且发作频次较前增多,2013-12-27日患者于我院行胃镜检查提示:胃多发息肉;浅表性胃炎伴糜烂。现为行胃息肉电切术入住我院。患者病来精神状况可,偶有咳嗽、无咳痰,无发热,二便如常,饮食、睡眠可,体重未见明显变化。", "mention_data": [{"mention": "剑突", "label": "解剖部位", "offset": "14"}, {"mention": "肩背", "label": "解剖部位", "offset": "31"}, {"mention": "胃多发息肉", "label": "疾病和诊断", "offset": "121"}, {"mention": "浅表性胃炎伴糜烂", "label": "疾病和诊断", "offset": "127"}, {"mention": "胃息肉电切术", "label": "手术", "offset": "139"}]} | |
| {"text": "患者2月余前开始无明显诱因上出现右上肢足趾坏疽,伴右上肢肿胀疼痛,伴活动困难,追问病史,曾行左髂动脉支架术,2011-03-24行右股腘动脉旁路术,2011-8-11行右第i、ii趾截趾术。2013-05-27因右侧股股浅动脉闭塞旁路术后,旁路远端血管吻合处假性动脉瘤在局麻监护上行左侧股动脉穿刺,上肢动脉动脉造影,上肢动脉pta及stent术。术顺,恢复可。现患者来我院就诊,为求进一步治疗,收治入院发病以来,患者精神、食欲、睡眠尚好,二便如常。", "mention_data": [{"mention": "右上肢足趾坏疽", "label": "疾病和诊断", "offset": "16"}, {"mention": "右上肢", "label": "解剖部位", "offset": "25"}, {"mention": "左髂动脉支架术", "label": "手术", "offset": "46"}, {"mention": "右股腘动脉旁路术", "label": "手术", "offset": "65"}, {"mention": "右第i、ii趾截趾术", "label": "手术", "offset": "84"}, {"mention": "右侧股股浅动脉闭塞旁路术", "label": "手术", "offset": "106"}, {"mention": "血管", "label": "解剖部位", "offset": "124"}, {"mention": "假性动脉瘤", "label": "疾病和诊断", "offset": "129"}, {"mention": "左侧股动脉穿刺", "label": "手术", "offset": "141"}, {"mention": "上肢动脉动脉造影", "label": "影像检查", "offset": "149"}, {"mention": "上肢动脉pta", "label": "手术", "offset": "158"}, {"mention": "stent术", "label": "手术", "offset": "166"}]} | |
| {"text": ",患者9个月前(2014-9)无明显诱因出现排便次数增加,最多每日5-6次,便中带血,无脓液,无叒发热。2个月前(2015-4)于当地行肠镜检查病理为直肠腺癌叒。,后于我院行肠镜检查:距肛缘约6-12cm见不规则隆起性病变,表面结节状,充血、粗糙,触之易出血,约环3/4周。患者于2015-4-29全麻上行直肠癌根治术(dixon式),术后病理(z0499139),:(直肠)腺癌(高-中分化),浸润生长至外膜,a1(直肠旁淋巴结)淋巴结及癌结节(5/6)叒a2(直肠旁淋巴结)淋巴结淋巴组织增生(0/2)叒b1-b2(直肠下动脉旁淋巴结)淋巴结组织(0/8),术后分期pt3n2am0,iiib期。现患者术后恢复良好,为求进一步诊治入我科,患者病来饮食可,睡眠可,二便基本正常,周身无疼痛,ecog评分1分。", "mention_data": [{"mention": "直肠腺癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "肛缘", "label": "解剖部位", "offset": "93"}, {"mention": "直肠癌根治术(dixon式)", "label": "手术", "offset": "153"}, {"mention": "(直肠)腺癌(高-中分化)", "label": "疾病和诊断", "offset": "184"}, {"mention": "直肠旁淋巴结", "label": "解剖部位", "offset": "209"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "216"}, {"mention": "直肠旁淋巴结", "label": "解剖部位", "offset": "232"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "239"}, {"mention": "直肠下动脉旁淋巴结", "label": "解剖部位", "offset": "260"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "270"}]} | |
| {"text": ",患者3个月余前因“下腹疼痛伴间断性黑便1月。”就诊我院我科,完善相关检查后诊断胃窦癌,排除手术禁忌症后于22016-4-27在全麻上行“胃癌根治术”,术程顺利,术后预防感染支持对症等处理。,术后病理示:“胃低分化腺癌,lauren,分型:弥漫型,浸润至胃壁浆膜层,可见神经束侵犯,未见明确脉管内癌栓;网膜组织,未见癌”;pt4n3m0,iiic期。术后于2016.5.27、2016-6-23行叒sox叒(奥沙利铂1500mg+替吉奥60mg叒bid)方案化疗双程,过程顺利,期间曾出现ii°骨髓抑制,口服升白药后可恢复。行出院后生活质量可,现为上一程化疗来我院门诊就诊,拟“胃癌综合治疗后”收入我科。起病以来,患者精神尚可,食欲尚可,大小便正常,体重稍减轻。", "mention_data": [{"mention": "下腹疼痛", "label": "症状", "offset": "10"}, {"mention": "胃窦癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "胃癌根治术", "label": "手术", "offset": "69"}, {"mention": "胃低分化腺癌", "label": "疾病和诊断", "offset": "103"}, {"mention": "胃壁浆膜层", "label": "解剖部位", "offset": "127"}, {"mention": "奥沙利铂", "label": "药物", "offset": "204"}, {"mention": "替吉奥", "label": "药物", "offset": "215"}, {"mention": "骨髓抑制", "label": "症状", "offset": "247"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "289"}]} | |
| {"text": "患者既往月经规律,5/28天,量中等,无痛经。6年前因“黏膜上子宫肌瘤”于我院行宫腔上子宫肌瘤切除术,术后定期查体,1年前行妇科b超检查提示“子宫肌瘤,多发,较大者直径约3cm”,未在意。半年前月经量增多,有血块,量约原经量的2倍,无腹痛、头晕等不适,3个月前检测血常规提示“重度贫血”,给予补铁药物治疗。3天前就诊于我院行妇科b超检查提示“子宫多发肌瘤,较大者直径约5cm”,建议行手术治疗。患者现无腹痛及异常阴道流血,为行手术治疗来我院,门诊以“子宫肌瘤”收入院。叒叒叒患者自发病以来,精神、饮食,睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "黏膜上子宫肌瘤", "label": "疾病和诊断", "offset": "28"}, {"mention": "宫腔上子宫肌瘤切除术", "label": "手术", "offset": "40"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "71"}, {"mention": "腹痛", "label": "症状", "offset": "117"}, {"mention": "头晕", "label": "症状", "offset": "120"}, {"mention": "b超", "label": "影像检查", "offset": "164"}, {"mention": "子宫多发肌瘤", "label": "疾病和诊断", "offset": "171"}, {"mention": "腹痛", "label": "症状", "offset": "201"}, {"mention": "阴道", "label": "解剖部位", "offset": "206"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "225"}]} | |
| {"text": "患者2个月前因胃痛,偶有恶心、呕吐行胃镜检查,取病理提示胃恶性肿瘤。予我院普外科行胃癌根治术,术中见腹腔大网膜等与腹壁广泛粘连,术后病理提示低分化腺癌及少量粘液腺癌。术后进食差,乏力、消瘦明显,出现呼吸困难,不能平卧,心肌酶、肌钙蛋白升高,诊断为非st段抬高型心梗,予对症处理后好转。出院后进食差,仍有恶心、呕吐。于****静脉予营养支持等治疗,乏力无好转,为求进一步诊治入我科。近1个月来,饮食差、睡眠可,周身无疼痛,精神状态欠佳。近1个月体重减轻10公斤。kps叒60分。", "mention_data": [{"mention": "胃痛", "label": "症状", "offset": "7"}, {"mention": "胃恶性肿瘤", "label": "疾病和诊断", "offset": "28"}, {"mention": "胃癌根治术", "label": "手术", "offset": "41"}, {"mention": "腹腔", "label": "解剖部位", "offset": "50"}, {"mention": "大网膜", "label": "解剖部位", "offset": "52"}, {"mention": "腹壁", "label": "解剖部位", "offset": "57"}, {"mention": "心肌", "label": "解剖部位", "offset": "109"}, {"mention": "非st段抬高型心梗", "label": "疾病和诊断", "offset": "123"}]} | |
| {"text": ",患者2月余前因“胃癌并幽门梗阻”就诊于我院,排除手术禁忌后于2015-11-26行手术治疗,,术中探查见:肿瘤位于胃窦幽门部,约5*4cm,阻塞幽门,胃腔扩张,胃壁充血、水肿,胃大小弯侧见多枚肿大淋巴结。打开胃结肠韧带,探查肿瘤侵及横结肠及其系膜,肿瘤跨过幽门侵及十二指肠球部及降段,向患者家属交代,肿瘤侵及十二指肠降段、横结肠及其系膜,无法行根治性切除,患者存在幽门梗阻,遂行胃肠吻合术,,术后大网膜常规病理示:(大网膜)脂肪结缔组织,未查见肿瘤(,病理号:42808.15),术后给予抗感染,补液及营养支持治疗,好转后出院。后再次入院,排除化疗禁忌,于2015-12-26开始行sox方案化疗2个周期,耐受可,现患者为行上一周期化疗治疗,今日就诊于我院,门诊以“胃癌术后化疗”收住入院,患者自发病以来,神志清,精神可,流质饮食,二便正常,体重较前无明显改变。", "mention_data": [{"mention": "胃癌并幽门梗阻", "label": "疾病和诊断", "offset": "9"}, {"mention": "胃窦幽门部", "label": "解剖部位", "offset": "58"}, {"mention": "幽门", "label": "解剖部位", "offset": "73"}, {"mention": "胃腔", "label": "解剖部位", "offset": "76"}, {"mention": "胃壁", "label": "解剖部位", "offset": "81"}, {"mention": "胃大小弯侧", "label": "解剖部位", "offset": "89"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "99"}, {"mention": "胃结肠韧带", "label": "解剖部位", "offset": "105"}, {"mention": "横结肠", "label": "解剖部位", "offset": "117"}, {"mention": "幽门", "label": "解剖部位", "offset": "129"}, {"mention": "十二指肠球部", "label": "解剖部位", "offset": "133"}, {"mention": "十二指肠降段", "label": "解剖部位", "offset": "155"}, {"mention": "横结肠", "label": "解剖部位", "offset": "162"}, {"mention": "幽门梗阻", "label": "疾病和诊断", "offset": "183"}, {"mention": "胃肠吻合术", "label": "手术", "offset": "190"}, {"mention": "大网膜", "label": "解剖部位", "offset": "199"}, {"mention": "大网膜", "label": "解剖部位", "offset": "209"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "334"}]} | |
| {"text": "患者约半月前因“皮肤巩膜黄染”来我院就诊,诊断肝门胆管癌、梗阻性黄疸,排除相关禁忌后于2015-02-12行内镜上胆管支架置入术,手术过程顺利,术后给予保肝、增强免疫等治疗,患者病情好转出院。近半月来患者皮肤、巩膜仍有明显黄染,小便色深黄,大便正常,无寒战、发热,无恶心、呕吐,无腹痛、腹胀、腹泻,无咳嗽、咳痰,无胸闷、喘憋,无四肢酸痛不适,现患者为求入院复查,来我院就诊,门诊以“梗阻性黄疸”收入我科治疗。叒叒叒叒叒患者自发病以来,神志清,精神可,饮食睡眠可,小便色深黄,大便正常,体重较前无明显减轻。", "mention_data": [{"mention": "皮肤", "label": "解剖部位", "offset": "8"}, {"mention": "巩膜", "label": "解剖部位", "offset": "10"}, {"mention": "肝门胆管癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "梗阻性黄疸", "label": "疾病和诊断", "offset": "29"}, {"mention": "内镜上胆管支架置入术", "label": "手术", "offset": "54"}, {"mention": "肝", "label": "解剖部位", "offset": "77"}, {"mention": "皮肤", "label": "解剖部位", "offset": "102"}, {"mention": "巩膜", "label": "解剖部位", "offset": "105"}, {"mention": "腹痛", "label": "症状", "offset": "140"}, {"mention": "腹胀", "label": "症状", "offset": "143"}, {"mention": "腹泻", "label": "症状", "offset": "146"}, {"mention": "胸闷", "label": "症状", "offset": "157"}, {"mention": "四肢", "label": "解剖部位", "offset": "164"}, {"mention": "梗阻性黄疸", "label": "疾病和诊断", "offset": "191"}]} | |
| {"text": ",患者于2009-09于我院经食道镜等候相关检查诊断“食道胸中段鳞癌”,于2009-09-27起行放疗(原发灶40gy/20次)及np方案化疗2程。于2012-12-09于我院行经左胸三切口部分食管切除+胃食管右颈吻合术,术顺,恢复好,,术后病理示:未见癌组织(pcr)。于2012-04发现左颈多个肿大淋巴结,行左颈淋巴结活检,,病理示:中分化鳞癌,病情复发,于2012-05-16至2012-07-06予tp方案化疗3程。今为求进一步诊治来我院。患者发病以来,无恶性、呕吐、腹痛、腹胀等不适。精神尚可,饮食睡眠尚可,大小便正常,体重无减轻。", "mention_data": [{"mention": "食道胸中段鳞癌", "label": "疾病和诊断", "offset": "27"}, {"mention": "左胸三切口部分食管切除+胃食管右颈吻合术", "label": "手术", "offset": "90"}, {"mention": "左颈", "label": "解剖部位", "offset": "146"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "152"}, {"mention": "左颈淋巴结", "label": "解剖部位", "offset": "157"}, {"mention": "腹痛", "label": "症状", "offset": "239"}, {"mention": "腹胀", "label": "症状", "offset": "242"}]} | |
| {"text": ",缘于入院前[主诉单一时间10天主诉单一时间]因“反复下腹部闷痛2个月。”就诊于我院中医科,,门诊查胃镜示:慢性萎缩性胃炎,,肠镜示:直肠多发息肉(宽基息肉,大小约1.0cm),无恶心、呕吐,无呕血,无排柏油样便,无食欲减退,无多汗、心悸、手抖,无多饮、多尿,无明显消瘦,无乏力,于2015.09.14在局麻上行“内镜上直肠息肉切除术”,术顺,,术后病理提示:大肠乳头状管状腺瘤,腺体高级别下皮内瘤变,伴癌变,癌变为管状腺癌ii级,灶性侵及粘膜上层。今为进一步诊疗就诊我院,遂门诊拟直肠癌收入院,发病以来,精神、睡眠、食欲尚可,大便如下述,小便如常,体重无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "27"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "54"}, {"mention": "直肠多发息肉", "label": "疾病和诊断", "offset": "67"}, {"mention": "心悸", "label": "症状", "offset": "117"}, {"mention": "内镜上直肠息肉切除术", "label": "手术", "offset": "157"}, {"mention": "大肠乳头状管状腺瘤", "label": "疾病和诊断", "offset": "180"}, {"mention": "管状腺癌ii级", "label": "疾病和诊断", "offset": "208"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "241"}]} | |
| {"text": "患者6月前于我科接受剖腹探查术+姑息性降结肠肿瘤切除术+降结远端封闭、近端造口术,手术顺利,并送病理活检提示乙状结肠溃疡型中-低分化管状腺癌(含粘液腺癌成份),侵及肠壁全层达肠周组织,脉管、神经未见癌侵犯,双切端未见癌累及,淋巴结未见癌转移(0/12)。明确诊断:乙状结肠管状腺癌(t4n0m0)。术后予以胃肠减压、营养支持等治疗,患者愈痊出院。已接受4次全身静脉化疗,化疗过程中患者食欲减退,恶心呕吐较明显,经对症处理后缓解,今为行第5次化疗收治入院。\\u0004叒叒叒患者发病以来,神志叒清晰,精神可,胃纳可,大便如常,小便如常,体重未见明显上降。", "mention_data": [{"mention": "剖腹探查术+姑息性降结肠肿瘤切除术+降结远端封闭、近端造口术", "label": "手术", "offset": "10"}, {"mention": "乙状结肠溃疡型中-低分化管状腺癌(含粘液腺癌成份)", "label": "疾病和诊断", "offset": "54"}, {"mention": "肠", "label": "解剖部位", "offset": "82"}, {"mention": "肠", "label": "解剖部位", "offset": "87"}, {"mention": "乙状结肠管状腺癌(t4n0m0)", "label": "疾病和诊断", "offset": "132"}, {"mention": "胃", "label": "解剖部位", "offset": "153"}, {"mention": "肠", "label": "解剖部位", "offset": "154"}, {"mention": "胃", "label": "解剖部位", "offset": "253"}]} | |
| {"text": ",缘于入院前[主诉单一时间半年主诉单一时间]前无明显诱因出现中下腹部胀痛不适,为持续性隐痛,无其它部位放射,与进食无关,伴返酸、嗳气,无恶心、呕吐、纳差、乏力、消瘦、腹痛、腹泻、便秘,无发热、咳嗽、咳痰,未予特殊治。2月前于我院门诊行数字胃肠造影,,结果示:1.胃小弯侧明显缩短,考虑胃溃疡愈合所致,胃窦部扩缩欠佳,十二指肠-胃窦部间距可疑增宽,多考虑胃窦炎,建议胃镜检查;予制酸、保胃等治疗,症状无明显好转。2周前出现恶心、呕吐,伴乏力、纳差,进食后加重,呕吐为胃内容物,至我院门诊行腹部ct检查(2014.08.21),:1.胃窦部胃壁不规则增厚,考虑胃ca,累积浆膜及邻近胰腺、肝右叶,病变周围、邻近肝胃间隙、肝门区及腹膜后多个淋巴结,部分稍增大。遂门诊拟“胃窦癌?”收入院。自发病以来,精神、睡眠可,食欲差,大小便如常,体重减轻约10kg。", "mention_data": [{"mention": "中下腹部", "label": "解剖部位", "offset": "30"}, {"mention": "腹痛", "label": "症状", "offset": "83"}, {"mention": "腹泻", "label": "症状", "offset": "86"}, {"mention": "数字胃肠造影", "label": "影像检查", "offset": "117"}, {"mention": "胃小弯侧", "label": "解剖部位", "offset": "131"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "142"}, {"mention": "胃窦部", "label": "解剖部位", "offset": "150"}, {"mention": "十二指肠-胃窦部", "label": "解剖部位", "offset": "158"}, {"mention": "胃窦炎", "label": "疾病和诊断", "offset": "176"}, {"mention": "胃", "label": "解剖部位", "offset": "192"}, {"mention": "胃", "label": "解剖部位", "offset": "232"}, {"mention": "腹部ct", "label": "影像检查", "offset": "243"}, {"mention": "胃窦部", "label": "解剖部位", "offset": "265"}, {"mention": "胃", "label": "解剖部位", "offset": "268"}, {"mention": "胃ca", "label": "疾病和诊断", "offset": "278"}, {"mention": "胰腺", "label": "解剖部位", "offset": "289"}, {"mention": "肝右叶", "label": "解剖部位", "offset": "292"}, {"mention": "肝胃间隙", "label": "解剖部位", "offset": "303"}, {"mention": "肝门区", "label": "解剖部位", "offset": "308"}, {"mention": "胃窦癌", "label": "疾病和诊断", "offset": "332"}]} | |
| {"text": ",患者2014年9月因\\\"体检发现肝占位\\\"于本院诊断为肝癌,2014年9月24日行肝癌切除术+胆囊切除术,术中发现肝s6有子瘤,予行肝肿物微波固化术,术后病理中至低分化肝细胞肝癌。患者术前afp193.8ng/ml,术后降至正常。术后无行其它抗肿瘤治疗。,2015-01-04再次入院复查ct:肝s4、s5/8交界区斑片灶,考虑术后改变,未见明显复发征象;肝s2、3、5、8多发结节,多考虑肝硬化结节,较前相仿。后患者规律于我院门诊复查。,2015-04-03我院下腹部mri:肝s4叒呈术后改变,其右缘动脉期斑片强化灶,较前新见,考虑有肿瘤活性可能大。遂于我科就诊,2015-04-17日行肝肿瘤微波消融,术程顺利,术后患者恢复尚可。现患者一般情况可,无不适,未发现明显复发,后出院。下次治疗至今患者无明显腹痛、腹胀,无恶心、呕吐,无畏寒、发热,患者精神尚可,食欲如常。大小便正常,体重无明显上降。", "mention_data": [{"mention": "肝", "label": "解剖部位", "offset": "17"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "28"}, {"mention": "肝癌切除术+胆囊切除术", "label": "手术", "offset": "42"}, {"mention": "肝s6", "label": "解剖部位", "offset": "58"}, {"mention": "肝肿物微波固化术", "label": "手术", "offset": "67"}, {"mention": "中至低分化肝细胞肝癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "afp", "label": "实验室检验", "offset": "95"}, {"mention": "ct", "label": "影像检查", "offset": "145"}, {"mention": "肝s4、s5/8", "label": "解剖部位", "offset": "148"}, {"mention": "肝s2、3、5、8", "label": "解剖部位", "offset": "179"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "196"}, {"mention": "下腹部mri", "label": "影像检查", "offset": "233"}, {"mention": "肝s4", "label": "解剖部位", "offset": "240"}, {"mention": "肝肿瘤微波消融", "label": "手术", "offset": "297"}, {"mention": "腹痛", "label": "症状", "offset": "355"}, {"mention": "腹胀", "label": "症状", "offset": "358"}]} | |
| {"text": ",入院前8年余无明显诱因出现下腹部闷痛不适,呈间歇性,空腹明显,无反酸、嗳气,无进食后呕吐,无发热、眼黄、皮肤黄,不伴胸痛、背痛及咳嗽,无声音嘶哑、呛咳,无呕血、黑便,无吞咽困难、呼吸困难,,于外院查胃镜示:胃体溃疡型腺癌。未治疗,转诊我院,完善相关检查,未见明显手术禁忌症,并于2005.09.20于全麻上行“根治性全胃大部切除术”,,术中见:无腹水、右肝脏面见多个米粒大小囊肿,盆腔无种植结节。大网膜粘连、纤维化明显,胃体部后壁可见一溃疡状肿物,大小2.5cmx2.5cmx1.5cm,未侵出浆膜。,术后病理回报:胃体小弯溃疡浸润型管状腺癌,侵及深肌层,下上切端未见癌浸润,小弯淋巴结1/3个,大弯淋巴结0/1个,幽门上淋巴结0/1个,贲门周未找到淋巴结。8年来,无规律复查,具体不详。今为复查,就诊我科,门诊拟“胃癌术后”收住入院,发病以来,精神一般,食欲尚可,睡眠可,大小便如常,体重无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "14"}, {"mention": "空腹", "label": "症状", "offset": "27"}, {"mention": "胸痛", "label": "症状", "offset": "59"}, {"mention": "背痛", "label": "症状", "offset": "62"}, {"mention": "胃体溃疡型腺癌", "label": "疾病和诊断", "offset": "104"}, {"mention": "根治性全胃大部切除术", "label": "手术", "offset": "156"}, {"mention": "腹水", "label": "症状", "offset": "174"}, {"mention": "右肝", "label": "解剖部位", "offset": "177"}, {"mention": "盆腔", "label": "解剖部位", "offset": "191"}, {"mention": "胃体部", "label": "解剖部位", "offset": "211"}, {"mention": "胃体小弯溃疡浸润型管状腺癌", "label": "疾病和诊断", "offset": "259"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "289"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "299"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "309"}, {"mention": "贲门", "label": "解剖部位", "offset": "320"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "359"}]} | |
| {"text": ",患者入院2年余前(2013-6-13)因\\\"结肠占位\\\"于我院行\\\"结肠癌根治术+放射性粒子置入术\\\",,术后病检提示:乙状结肠溃疡型中分化管状乳头状腺癌,浸及肠壁全层,脉管、神经未见癌侵犯,双切端未见癌累及,淋巴结见癌转移(1/5),,肿瘤分期:t3nxm1叒。术后予以预防感染、抗肿瘤等对症支持治疗,恢复良好。已分别于2013.7.15、2013.8.7、2013.8.29、2013.9.20、2013.10.11、2013.11.7、2013.12.4按期入院行folfori方案化疗7次,化疗期间,化疗副反应较轻,化疗后患者无畏寒、发热,无恶心、呕吐,无头昏、乏力等不适。后长期于我院复查。10余月前(2016年6月)患者无明显诱因出现乏力,无恶心、厌油、纳差、畏寒、发热等不适,伴体重上降,1月内体重减轻约10kg。期间未予重视,自行口服中药调理(具体不详),症状未见明显缓解。现患者为求进一步诊治入我院。\\u0004叒叒叒患者本次发病以来,食欲正常,叒神志清醒,精神尚可,睡眠尚可,大便正常,小便正常,体重减少。", "mention_data": [{"mention": "结肠", "label": "解剖部位", "offset": "23"}, {"mention": "结肠癌根治术+放射性粒子置入术", "label": "手术", "offset": "35"}, {"mention": "乙状结肠溃疡型中分化管状乳头状腺癌", "label": "疾病和诊断", "offset": "61"}, {"mention": "肠", "label": "解剖部位", "offset": "81"}, {"mention": "头昏", "label": "症状", "offset": "283"}]} | |
| {"text": ",患者6月前因“剑突上隐痛不适伴腹胀1月余”入院,,入院完善辅助检查:2016-4-21叒,*****院胃镜检查:胃癌叒取胃角活检4块,,病理诊断:印戒细胞癌。2016-4-26叒,*****病理诊断:(胃角)印戒细胞癌。,全腹部增强ct提示:1.胃体壁局部稍增厚并明显强化,考虑胃癌。2.子宫颈体积增大并增强后密度不均,子宫后壁可疑小结节,子宫肌瘤?3.腹膜后多发小淋巴结显示。完善术前检查,明确无手术禁忌症后,于2016-05-03全麻上行腹腔镜上远端胃大部切除术+放射性粒子植入术,手术顺利,,术后病理报告:胃印戒细胞癌,浸及胃壁全层,未见明确脉管及神经侵犯,双切端未见癌累及。胃大、小弯淋巴结均未见癌转移(分别为0/8、0/5)。大网膜未见癌转移。另送(第3、6组)淋巴结均未见癌转移(均为0/1)。,病理分期:t3n0m0。院外期间患者术后恢复良好,已行5次化疗(xelox方案),未诉发热、畏寒、恶心、呕吐、腹泻等不适。本次拟行第6化疗(xelox方案)入院,门诊以“胃癌术后”收入我科。\\u0004叒叒叒患者自起病以来,精神可,胃纳可,大便如常,小便如常,体重未见明显上降。", "mention_data": [{"mention": "剑突上", "label": "解剖部位", "offset": "8"}, {"mention": "腹胀", "label": "症状", "offset": "16"}, {"mention": "胃", "label": "解剖部位", "offset": "57"}, {"mention": "胃角", "label": "解剖部位", "offset": "61"}, {"mention": "印戒细胞", "label": "疾病和诊断", "offset": "74"}, {"mention": "(胃角)印戒细胞癌", "label": "疾病和诊断", "offset": "101"}, {"mention": "全腹部增强ct", "label": "影像检查", "offset": "112"}, {"mention": "胃", "label": "解剖部位", "offset": "124"}, {"mention": "虑胃", "label": "影像检查", "offset": "139"}, {"mention": "子宫", "label": "解剖部位", "offset": "145"}, {"mention": "子宫", "label": "解剖部位", "offset": "161"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "171"}, {"mention": "腹膜后多发小淋巴", "label": "解剖部位", "offset": "178"}, {"mention": "行腹腔镜上远端胃大部切除术+放射性粒子植入", "label": "手术", "offset": "221"}, {"mention": "胃印戒细胞癌", "label": "疾病和诊断", "offset": "257"}, {"mention": "胃", "label": "解剖部位", "offset": "266"}, {"mention": "胃大、小弯淋巴", "label": "解剖部位", "offset": "292"}, {"mention": "送(第3、6组)淋巴", "label": "解剖部位", "offset": "329"}, {"mention": "腹泻", "label": "疾病和诊断", "offset": "410"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "440"}, {"mention": "胃", "label": "解剖部位", "offset": "471"}]} | |
| {"text": "入院20+年前,患者无明显诱因出现月经紊乱,无痛经、恶心、呕吐、腹泻等症状。遂于****就诊,确诊为宫颈癌,并行手术切除,术后予以化疗(具体方案不详),化疗过程顺利,之后定期复查未见复发及转移。10+年前患者因粘连性肠梗阻于我院手术治疗,术后因伤口破裂造成腹部切口疝,此后因反复腹痛及腹泻,每年数次到我院外科及我科住院治疗,诊断不全性肠梗阻,经禁食、胃肠减压及抗感染等对症处理后腹痛能够缓解。2015年3月10日患者因外伤在我科行头颅ct提示右侧额部占位性病变,请结合头颅mri增强检查。头部mri(2015-03-10):右侧额顶叶占位性病变,考虑脑膜瘤可能性大,请结合临床。请相关科室会诊评估行颅脑手术风险。建议患者行陀螺刀放疗。患者拒绝后出院。2小时前患者无明显诱因出现间断腹部隐痛,无恶心呕吐,无腹泻,肛门未见排气。为求进一步诊治来我院门诊就诊,门诊以“宫颈癌术后,肠梗阻”收入我科。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "32"}, {"mention": "宫颈癌", "label": "疾病和诊断", "offset": "50"}, {"mention": "粘连性肠梗阻", "label": "疾病和诊断", "offset": "105"}, {"mention": "腹部切口疝", "label": "疾病和诊断", "offset": "128"}, {"mention": "腹痛", "label": "症状", "offset": "139"}, {"mention": "腹泻", "label": "症状", "offset": "142"}, {"mention": "不全性肠梗阻", "label": "疾病和诊断", "offset": "164"}, {"mention": "胃肠", "label": "解剖部位", "offset": "175"}, {"mention": "腹痛", "label": "症状", "offset": "189"}, {"mention": "头颅ct", "label": "影像检查", "offset": "215"}, {"mention": "右侧额部占位", "label": "疾病和诊断", "offset": "221"}, {"mention": "头颅mri", "label": "影像检查", "offset": "234"}, {"mention": "头部mri", "label": "影像检查", "offset": "244"}, {"mention": "右侧额顶叶", "label": "解剖部位", "offset": "262"}, {"mention": "脑膜瘤", "label": "疾病和诊断", "offset": "275"}, {"mention": "颅脑", "label": "解剖部位", "offset": "299"}, {"mention": "腹部", "label": "解剖部位", "offset": "340"}, {"mention": "腹泻", "label": "症状", "offset": "352"}, {"mention": "肛门", "label": "解剖部位", "offset": "355"}, {"mention": "宫颈癌术后", "label": "疾病和诊断", "offset": "381"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "387"}]} | |
| {"text": "左半结肠切除+胰十二指肠切除术后4年,pt4bn0m0。术后病理提示:(左半)结肠溃疡型低分化腺癌,大小7.0×xxx6.0cm,侵透肠壁全层并侵及胰腺外脂肪组织及十二指肠肠壁浆膜层,未见脉管癌栓,淋巴结未见癌转移(结肠**/13,十二指肠**/1,胰腺周0/4,肝十二指肠韧带0/1,13组0/1),(近端)、(远端)、胃断端、十二指肠断端及胰腺断端未见癌;阑尾慢性炎;网膜组织未见特殊。本次定期复查提示肝右外叶偏强回声结节,直径1.3cm,较前稍有增大,余检查未见肿瘤转移及复发征象。腹部ct肝脏未见结节。本次定期复查,未见肿瘤转移及复发征象。", "mention_data": [{"mention": "左半结肠切除+胰十二指肠切除术后", "label": "疾病和诊断", "offset": "0"}, {"mention": "(左半)结肠溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "肠", "label": "解剖部位", "offset": "67"}, {"mention": "胰腺", "label": "解剖部位", "offset": "74"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "82"}, {"mention": "结肠", "label": "解剖部位", "offset": "108"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "116"}, {"mention": "胰腺", "label": "解剖部位", "offset": "125"}, {"mention": "肝十二指肠韧带", "label": "解剖部位", "offset": "132"}, {"mention": "胃", "label": "解剖部位", "offset": "161"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "165"}, {"mention": "胰腺", "label": "解剖部位", "offset": "172"}, {"mention": "阑尾慢性炎", "label": "疾病和诊断", "offset": "180"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "203"}, {"mention": "腹部ct", "label": "影像检查", "offset": "244"}, {"mention": "肝脏", "label": "解剖部位", "offset": "248"}]} | |
| {"text": ",因“呕吐1天”就诊,,2016-8-10ct:肠套叠,2016-08-15行左半结肠切除术,术中见升结肠中段约6*6cm肿物,侵透浆膜,与十二指肠降部紧密粘连,,术后病理:叒溃疡型低分化腺癌(大部分为粘液腺癌,6.5*4.7*2cm)伴灶性坏死,达浆膜外,侵犯间质神经纤维束,间质脉管内查见癌栓,网膜组织查见转移癌灶,断端阴性,淋巴结2/33,(十二指肠肠壁)送检平滑肌及脂肪组织内见低分化腺癌(大部分胃粘液腺癌)。术前cea正常,余肿标未查。kras/braf野生型,未测nras术后行伊立替康+氟尿嘧啶+爱必妥化疗2周期,伊立替康+卡培他滨+爱必妥2周期,伊立替康+爱必妥2周期,期间间断爱必妥单药3周期,末次化疗2017-04-06。2017-3出现不全肠梗阻,2017-3-28当地肠梗阻导管置入,,2017-04-14ct:腹膜网膜肠系膜转移,2017-04-20、2017-05-15行奥沙利铂+吉西他滨行肠系膜下动脉灌注介入化疗。进展,2017-05-12开始瑞戈非尼治疗。现纳差,消瘦,排便困难。", "mention_data": [{"mention": "ct", "label": "影像检查", "offset": "21"}, {"mention": "肠套叠", "label": "疾病和诊断", "offset": "24"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "39"}, {"mention": "升结肠", "label": "解剖部位", "offset": "50"}, {"mention": "十二指肠降部", "label": "解剖部位", "offset": "70"}, {"mention": "溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "88"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "101"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "174"}, {"mention": "低分化腺癌(大部分胃粘液腺癌)", "label": "疾病和诊断", "offset": "193"}, {"mention": "cea", "label": "实验室检验", "offset": "211"}, {"mention": "伊立替康", "label": "药物", "offset": "245"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "250"}, {"mention": "爱必妥", "label": "药物", "offset": "255"}, {"mention": "伊立替康", "label": "药物", "offset": "264"}, {"mention": "卡培他滨", "label": "药物", "offset": "269"}, {"mention": "爱必妥", "label": "药物", "offset": "274"}, {"mention": "伊立替康", "label": "药物", "offset": "281"}, {"mention": "爱必妥", "label": "药物", "offset": "286"}, {"mention": "爱必妥", "label": "药物", "offset": "297"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "331"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "346"}, {"mention": "ct", "label": "影像检查", "offset": "365"}, {"mention": "腹膜网膜肠系膜转移", "label": "疾病和诊断", "offset": "368"}, {"mention": "奥沙利铂", "label": "药物", "offset": "400"}, {"mention": "吉西他滨", "label": "药物", "offset": "405"}, {"mention": "肠系膜下动脉", "label": "解剖部位", "offset": "410"}, {"mention": "瑞戈非尼", "label": "药物", "offset": "438"}]} | |
| {"text": ",2009-1于(右乳癌)行改良根治术,2011-1行左乳癌手术。复查门脉与上腔静脉之间可见低回声淋巴结2.8*1.4cm,全面复查,*左肩x片,胸椎正侧位,建议患者拿病,腹部mri检查。已行卵巢切除。2013-6-3,查腹部增强mri示:肝s6、s7多发结节,考虑转移可能大,门腔间隙肿大淋巴结,考虑转移,腰椎及骨盆骨转移可能,建议骨扫描。患者入组帕妥珠单抗临床试验,2013.7.18开始第一周期治疗。患者化疗后出现感冒样症状,昨日出现头痛,今日查血常规提示ii度骨髓抑制,白细胞2.57,中性粒细胞1.29.无腹痛、腹泻及其他不适。患者已行三周期化疗,行评效检查,今日查血常规结果提示iii度骨髓抑制,ne1.0,升白治疗中。2013.9.19行第四周期化疗,化疗后骨髓抑制i度,经升白治疗后好转,2013.10.10行第五周期化疗,化疗后无特殊不适,2013.11.1给予第6周期化疗,后评效检查维持pr,2013.11.22给予第七周期化疗,化疗后无特殊不适。2013.12.13给予第8周期化疗。患者手足综合征ii度。2014.1.24给予第10周期化疗。2014.3.7第12周期化疗,化疗后患者脸肿,其他好,评效和继续靶向治疗.2014.4.2就诊,化疗减量240mg。继续靶向。,患者化疗18周期后评效检查:,心脏超声:二、三尖瓣少量返流;,2014-7-30腹部ct:较前相仿;2014.9.17完成第21周期治疗,评效检查。2014.11.21完成24周期治疗,预约评效。2015.1.26完成第28周期化疗。2015.8.25叒c37治疗,c39评效维持pr,2015-12-10叒c42治疗,c42评效维持pr,c48评效维持pr,2016-5-11行c49,6-23行c51,7-14行c52.10-8行c55。", "mention_data": [{"mention": "右乳癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "改良根治术", "label": "手术", "offset": "14"}, {"mention": "左乳癌", "label": "疾病和诊断", "offset": "27"}, {"mention": "门脉", "label": "解剖部位", "offset": "35"}, {"mention": "上腔静脉", "label": "解剖部位", "offset": "38"}, {"mention": "左肩x片", "label": "影像检查", "offset": "68"}, {"mention": "胸椎正侧位", "label": "影像检查", "offset": "73"}, {"mention": "腹部mri", "label": "影像检查", "offset": "86"}, {"mention": "卵巢切除", "label": "手术", "offset": "96"}, {"mention": "腹部增强mri", "label": "影像检查", "offset": "111"}, {"mention": "肝s6、s7", "label": "解剖部位", "offset": "120"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "139"}, {"mention": "腰椎及骨盆骨转移", "label": "疾病和诊断", "offset": "154"}, {"mention": "帕妥珠单抗", "label": "药物", "offset": "175"}, {"mention": "头痛", "label": "症状", "offset": "220"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "234"}, {"mention": "白细胞", "label": "实验室检验", "offset": "239"}, {"mention": "中性粒细胞", "label": "实验室检验", "offset": "247"}, {"mention": "腹痛", "label": "症状", "offset": "258"}, {"mention": "腹泻", "label": "症状", "offset": "261"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "299"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "336"}, {"mention": "手足综合征", "label": "疾病和诊断", "offset": "456"}, {"mention": "二、三尖瓣", "label": "解剖部位", "offset": "569"}, {"mention": "腹部ct", "label": "影像检查", "offset": "589"}]} | |
| {"text": ",患者2013年3月因“纳差,皮肤黄染”,外院行pet/ct,示:胆总管上段近胰头恶性肿瘤;胃小弯、胰头周围多发淋巴结转移灶。后至**一院,于2013-04-02全麻上行“胰十二指肠切除、门静脉节段切除、人工血管原位移植术、上腔静脉部分切除、修补术”,术程顺利,术中见病灶位于胰头部,大小约4cm×5cm,瘤体叒侵犯门静脉壁和上降静脉壁前壁。,术后病理:胰腺导管低分化腺癌,可见癌组织侵犯神经束并累及十二指肠粘膜上层,肠系膜淋巴结内可见转移癌(2/3)。术后恢复可。2013-04-08,复查ct示:残余胰腺未见异常。后转诊我院,于2013-04-27~8-6行健择1.6g叒d1,8+白蛋白紫杉醇200mg叒d1,8方案化疗5程。后定期复查未见明显异常,现为行复查入院。患者精神、睡眠可,胃纳一般,大小便正常,近期体重无明显上降。", "mention_data": [{"mention": "pet/ct", "label": "影像检查", "offset": "24"}, {"mention": "胆总管上段近胰头恶性肿瘤;胃小弯、胰头周围多发淋巴结转移", "label": "疾病和诊断", "offset": "33"}, {"mention": "胰十二指肠切除、门静脉节段切除、人工血管原位移植术、上腔静脉部分切除、修补术", "label": "手术", "offset": "86"}, {"mention": "胰头", "label": "解剖部位", "offset": "138"}, {"mention": "门静脉壁", "label": "解剖部位", "offset": "158"}, {"mention": "上降静脉壁", "label": "解剖部位", "offset": "163"}, {"mention": "胰腺导管低分化腺癌", "label": "疾病和诊断", "offset": "177"}, {"mention": "十二指肠粘膜上层", "label": "解剖部位", "offset": "200"}, {"mention": "肠系膜淋巴结", "label": "解剖部位", "offset": "209"}, {"mention": "ct", "label": "影像检查", "offset": "246"}, {"mention": "胰腺", "label": "解剖部位", "offset": "252"}, {"mention": "健择", "label": "药物", "offset": "281"}, {"mention": "白蛋白紫杉醇", "label": "药物", "offset": "293"}, {"mention": "胃", "label": "解剖部位", "offset": "345"}]} | |
| {"text": ",2009.2前因便血查肠镜示距肛门5cm叒直肠腺癌,行术前放疗50.6gy,同时口服希罗达增敏,于2009-5行直肠癌切除术,分期t1n0m0,术后行folfox叒化疗8周期,末次化疗2009-11,神经毒性iii度。此后定期复查,2010-12发现左肺占位,3cm,肿标正常,于2011-1-26行胸腔镜上左肺转移切除术。术后恢复可,2011-2-24开始口服希罗达单药治疗4周期,2011-6停药。2012.2复查cea叒6.34ng/ml,腹部超声示肝小囊肿(2011.1pet-ct见肝内多发低密度,囊肿?),胸/盆ct未见明显异常。2012.2.29,肿标:ca72-4叒9.46叒,cea正常。\\u0004\\u0004叒2012-09-25腹部ct、胸部正位片未见肿瘤复发转移。,肿标:ca724叒12.65.叒10-16胸部ct未见明显占位病变。\\u0004\\u0004叒,2013-3腹盆ct:骶前间隙软组织增厚同前相仿,较厚仍约19mm。肝内多发低密度灶同前,倾向囊肿。叒原肝s4及s5动脉期斑片状强化灶显示欠清。叒左上腹肠系膜多发小淋巴结同前。胸,ct:左肺上叶不规则索条影同前。叒肿标正常。血常规、生化基本正常。患者近期无不适,足底麻木缓解,进食可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "16"}, {"mention": "直肠腺癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "希罗达", "label": "药物", "offset": "43"}, {"mention": "直肠癌切除术,分期t1n0m0", "label": "疾病和诊断", "offset": "57"}, {"mention": "胸腔镜上左肺转移切除术", "label": "手术", "offset": "151"}, {"mention": "希罗达", "label": "药物", "offset": "182"}, {"mention": "cea", "label": "实验室检验", "offset": "210"}, {"mention": "腹部超声", "label": "影像检查", "offset": "224"}, {"mention": "肝小囊肿", "label": "疾病和诊断", "offset": "229"}, {"mention": "pet-ct", "label": "影像检查", "offset": "240"}, {"mention": "肝", "label": "解剖部位", "offset": "247"}, {"mention": "囊肿", "label": "疾病和诊断", "offset": "255"}, {"mention": "胸/盆ct", "label": "影像检查", "offset": "260"}, {"mention": "ca72-4", "label": "实验室检验", "offset": "285"}, {"mention": "cea", "label": "实验室检验", "offset": "298"}, {"mention": "腹部ct", "label": "影像检查", "offset": "327"}, {"mention": "胸部正位片", "label": "影像检查", "offset": "332"}, {"mention": "ca724", "label": "实验室检验", "offset": "350"}, {"mention": "胸部ct", "label": "影像检查", "offset": "368"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "401"}, {"mention": "骶前间隙", "label": "解剖部位", "offset": "406"}, {"mention": "肝", "label": "解剖部位", "offset": "429"}, {"mention": "囊肿", "label": "疾病和诊断", "offset": "442"}, {"mention": "肝s4", "label": "解剖部位", "offset": "447"}, {"mention": "s5", "label": "解剖部位", "offset": "451"}, {"mention": "左上腹", "label": "解剖部位", "offset": "468"}, {"mention": "肠系膜", "label": "解剖部位", "offset": "471"}, {"mention": "胸,ct", "label": "影像检查", "offset": "483"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "488"}, {"mention": "足底", "label": "解剖部位", "offset": "526"}]} | |
| {"text": ",患者1年前无明显诱因开始出现上腹疼痛,阵发性,无向其他部位放射,患者未引起重视,自行服药(具体不详),效果不明显,病情反复。,后于外院行肠镜检查示:结肠肝曲肿物,病理符合高分化腺癌。2011.1.10pet/ct,示:结肠癌并肝内多发转移,遂来我院就诊。于2011.1.26在我院行左半结肠切除术,术程顺利,,术后病理示:中分化腺癌。,分期为:pt3n1m1。术后于2011.2.17至2011.9.7行folfiri方案化疗9程。末次化疗后2011.9.16,复查ct示:升结肠癌术后改变。肝脏多发转移瘤,较前未见明显变化,后于2011-9-30行肝转移瘤微波消融术。现为进一步治疗入院,自起病以来,患者一般情况好,胃纳睡眠可,二便正常,体重无明显改变。", "mention_data": [{"mention": "上腹", "label": "解剖部位", "offset": "15"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "75"}, {"mention": "高分化腺癌", "label": "疾病和诊断", "offset": "86"}, {"mention": "pet/ct", "label": "影像检查", "offset": "101"}, {"mention": "结肠癌并肝内多发转移", "label": "疾病和诊断", "offset": "110"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "142"}, {"mention": "中分化腺癌。,分期为:pt3n1m1", "label": "疾病和诊断", "offset": "162"}, {"mention": "ct", "label": "影像检查", "offset": "234"}, {"mention": "升结肠癌术后", "label": "疾病和诊断", "offset": "238"}, {"mention": "肝脏多发转移瘤", "label": "疾病和诊断", "offset": "247"}, {"mention": "肝转移瘤微波消融术", "label": "手术", "offset": "276"}, {"mention": "胃", "label": "解剖部位", "offset": "310"}]} | |
| {"text": "因腹盆腔肿物,于2015-5-20行卵巢癌减瘤术,术后恢复可。术后于力朴素+伯尔定化疗7程,末次化疗2015-11-6。无不适。2015.10.27mri提示较前好转。2015.12.9行肿瘤细胞减灭术,术中粘连重,行右侧输尿管支架置入,术后盆腔引流600ml,12.22出院,23日盆腔引流1580,24日盆腔引流2970,2015.12.29膀胱镜检查+右输尿管支架调整+左输尿管支架置入。术后无阴道流液,近期自觉尿痛。憋气。后于2016-3取出dj管。术后化疗后半年。患者甲状腺功能异常。", "mention_data": [{"mention": "腹盆腔", "label": "解剖部位", "offset": "1"}, {"mention": "卵巢癌减瘤术", "label": "手术", "offset": "18"}, {"mention": "力朴素", "label": "药物", "offset": "34"}, {"mention": "伯尔定", "label": "药物", "offset": "38"}, {"mention": "mri", "label": "影像检查", "offset": "74"}, {"mention": "肿瘤细胞减灭术", "label": "手术", "offset": "94"}, {"mention": "右侧输尿管支架置入", "label": "手术", "offset": "109"}, {"mention": "膀胱镜检查+右输尿管支架调整+左输尿管支架置入", "label": "手术", "offset": "173"}, {"mention": "阴道", "label": "解剖部位", "offset": "200"}, {"mention": "甲状腺", "label": "解剖部位", "offset": "239"}]} | |
| {"text": ",患者因“进食后腹胀20余天”于2015.11.4来我院就诊,,胃镜检查:慢性非萎缩性胃炎,胃角溃疡(性质待定),幽门管隆起(性质待定),,取病理示:(胃窦)腺癌,(胃角)高级别下皮内瘤变(重度异型增生)。2015.11.4患者入院后完善辅助检查,经积极术前准备,于2015-11-07在全麻上行胃癌根治术(毕i式)。手术顺利,术后经抗感染及营养支持治疗,患者恢复良好,无腹痛、腹胀、发热等不适,已进流质饮食,引流管已拔除并拆除全部缝线,出院。院外未行其他治疗,定期复查。2016.4.21来我院复查,,ct:胃癌术后,胃壁厚,肝脏多发低密度影,考虑转移瘤,请结合临床,肝脏小囊肿,胆囊炎。现为进一步治疗,门诊以“胃癌”收入我科,发病以来患者精神可,饮食睡眠可,二便较前无明显异常。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "8"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "37"}, {"mention": "胃角溃疡", "label": "疾病和诊断", "offset": "46"}, {"mention": "幽门管", "label": "解剖部位", "offset": "57"}, {"mention": "(胃窦)腺癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "(胃角)高级别下皮内瘤变(重度异型增生)", "label": "疾病和诊断", "offset": "82"}, {"mention": "胃癌根治术(毕i式)", "label": "手术", "offset": "148"}, {"mention": "腹痛", "label": "症状", "offset": "186"}, {"mention": "腹胀", "label": "症状", "offset": "189"}, {"mention": "ct", "label": "影像检查", "offset": "252"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "255"}, {"mention": "胃", "label": "解剖部位", "offset": "260"}, {"mention": "肝脏", "label": "解剖部位", "offset": "264"}, {"mention": "肝脏小囊肿", "label": "疾病和诊断", "offset": "285"}, {"mention": "胆囊炎", "label": "疾病和诊断", "offset": "291"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "307"}]} | |
| {"text": "2014-8因便血查胃镜示贲门占位,病理示中分化腺癌。当地行贲门癌根治术。术后给予吉西他滨+奈达铂*1,folfox*6,末次化疗2015-2.间断中药治疗。2015-3发现肿标增高。2015-9-17ct示纵膈、残胃周围及腹膜后多发肿大淋巴结,肝内多发低密度密度灶,均考虑转移。两肺多发结节,考虑转移,盆腔积液。胃镜吻合口粘膜充血水肿,周围见结节样增生。距门齿25cm食管中段见1.5cm隆起型病变。病理示吻合口慢性炎,食管中段腺癌。目前患者进食欠佳,大小便正常,无黑便。体重稳定。", "mention_data": [{"mention": "贲门", "label": "解剖部位", "offset": "13"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "21"}, {"mention": "贲门癌根治术", "label": "手术", "offset": "30"}, {"mention": "吉西他滨", "label": "药物", "offset": "41"}, {"mention": "奈达铂", "label": "药物", "offset": "46"}, {"mention": "ct", "label": "影像检查", "offset": "101"}, {"mention": "纵膈", "label": "解剖部位", "offset": "104"}, {"mention": "胃", "label": "解剖部位", "offset": "108"}, {"mention": "腹", "label": "解剖部位", "offset": "112"}, {"mention": "肝", "label": "解剖部位", "offset": "123"}, {"mention": "两肺", "label": "解剖部位", "offset": "140"}, {"mention": "盆腔积液", "label": "疾病和诊断", "offset": "152"}, {"mention": "门齿", "label": "解剖部位", "offset": "179"}, {"mention": "食管中段", "label": "解剖部位", "offset": "185"}, {"mention": "食管中段腺癌", "label": "疾病和诊断", "offset": "211"}]} | |
| {"text": ",患者于2016-11-15主因“确诊乙肝肝硬化4年余,末次内镜治疗后一年余”就诊于我院消化科,,全面复查:2016-11-16,行胃镜检查:食管胃底静脉曲张治疗后改变,胃潴留,未行内镜上治疗。,核磁回报:肝iv、viii段交界处及右叶ii段占位,建议普美显,2016-11-28,于我院行普美显核磁检查:肝mt综合治疗后,肝内多发斑片状、结节状异常信号影,呈t1wi稍低信号,t2wi稍高信号,dwi高信号,大者约20x14mm,增强后动脉期明显强化,门脉期及延迟期强化减退,后期呈相对低信号;肝左后叶切缘见片状异常信号,t1wi呈稍低信号,t2wi呈混杂信号,约3.0×3.8cm,动态增强早期见病灶轻度异常强化,门脉期及延迟期呈相对高信号(考虑术后改变);肝右外叶术区见类圆形异常信号,直径约3.4cm,t1wi呈低信号为主伴周围稍高信号,t2wi呈高信号,增强后边缘强化;肝左前叶另见一直径1.6cm结节灶,t1wi呈低信号,t2wi呈高信号,增强后见边缘结节状轻度强化,静脉及延时期强化范围向病灶中心充填;脾脏增大,信号尚均匀;胰腺及所见右肾无异常;左肾见囊性无强化灶,大小约2.3×3.0cm;腹腔内无积液。肝胃间隙及胰头前缘可见肿大淋巴结,较大直径约35mm,环形强化。现患者为进一步治疗入住我科。", "mention_data": [{"mention": "乙肝肝硬化", "label": "疾病和诊断", "offset": "19"}, {"mention": "食管胃底静脉曲张", "label": "疾病和诊断", "offset": "71"}, {"mention": "胃潴留", "label": "疾病和诊断", "offset": "85"}, {"mention": "核磁", "label": "影像检查", "offset": "98"}, {"mention": "肝iv、viii段交界处及右叶ii段", "label": "解剖部位", "offset": "103"}, {"mention": "普美显", "label": "药物", "offset": "126"}, {"mention": "普美显", "label": "药物", "offset": "145"}, {"mention": "核磁", "label": "影像检查", "offset": "148"}, {"mention": "肝mt综合治疗后", "label": "疾病和诊断", "offset": "153"}, {"mention": "肝", "label": "解剖部位", "offset": "162"}, {"mention": "门脉", "label": "解剖部位", "offset": "227"}, {"mention": "肝左后叶", "label": "解剖部位", "offset": "248"}, {"mention": "门脉", "label": "解剖部位", "offset": "309"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "331"}, {"mention": "肝左前叶", "label": "解剖部位", "offset": "390"}, {"mention": "脾脏", "label": "解剖部位", "offset": "458"}, {"mention": "胰腺", "label": "解剖部位", "offset": "469"}, {"mention": "右肾", "label": "解剖部位", "offset": "474"}, {"mention": "左肾", "label": "解剖部位", "offset": "480"}, {"mention": "腹", "label": "解剖部位", "offset": "503"}, {"mention": "肝胃间隙", "label": "解剖部位", "offset": "510"}, {"mention": "胰头", "label": "解剖部位", "offset": "515"}]} | |
| {"text": ",2010-2-4行直肠癌根治术(距肛缘2cm),中分化腺癌,侵及肠壁全层,未透外膜层,脉管癌栓(+),淋巴结5/22,绒毛状管状腺瘤i级,切缘(-)。oxa+fu*12,末次2010-11。未行放疗。定期复查。术前,cea:2.7,但2012-9叒cea叒10ng/ml,2012-11ct及pet-ct示左盆底肌肉增厚伴弥漫性轻度代谢增高,炎性?刀口处疼痛?2013-5查cea升至60,ct示左盆底异常组织影略增大,同左侧臀肌分界不清,2次b超上穿刺(-),2013.5始希罗达*1,,2013-7-3:cea升至87ng/ml,刀口疼痛略加重,影响睡眠,体重无变化。后cea升至80ng/ml,肛周流液,盆腔ct及petct提示左盆底肌肉增厚,轻度代谢增高,临床考虑复发,曾双次活检均为阴性,但petct提示左盆底肌肉增厚代谢增高,临床考虑复发。建议再行活检明确诊,超声科拒行穿刺,患者本人及家属认同直肠癌术后复发,并同意放疗。经mdt讨论后,认为直肠癌术后盆腔复发诊断基本明确,建议放疗,同时完善全身检查。2013.8.7叒cea叒94.1ng/ml,腹胸部ct未见明显异常。已行放疗,剂量方案为gtv叒60gy/30f。无其他特殊不适。末次放疗2013-9-18。放疗期间同时口服希罗达(6片/日)。已于12月初停服希罗达。2013-12-18叒,肿标:癌胚抗原叒38.28ng/ml,癌抗原72.4叒12.06u/ml,癌抗原242叒23.3u/ml2014-02-21开始行3周期folfiri化疗。过程顺利。复查pd,近期腹胀,间断腹泻,左上肢水肿,体重减轻。腹平片小肠不全梗阻可能大,建议治疗后复查。", "mention_data": [{"mention": "直肠癌根治术", "label": "手术", "offset": "10"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "25"}, {"mention": "肠", "label": "解剖部位", "offset": "33"}, {"mention": "绒毛状管状腺瘤", "label": "疾病和诊断", "offset": "60"}, {"mention": "oxa", "label": "药物", "offset": "76"}, {"mention": "fu", "label": "药物", "offset": "80"}, {"mention": "cea", "label": "实验室检验", "offset": "109"}, {"mention": "cea", "label": "实验室检验", "offset": "125"}, {"mention": "ct", "label": "影像检查", "offset": "144"}, {"mention": "pet-ct", "label": "影像检查", "offset": "147"}, {"mention": "cea", "label": "实验室检验", "offset": "188"}, {"mention": "ct", "label": "影像检查", "offset": "196"}, {"mention": "左侧臀肌", "label": "解剖部位", "offset": "212"}, {"mention": "b超", "label": "影像检查", "offset": "223"}, {"mention": "始希罗达", "label": "药物", "offset": "238"}, {"mention": "cea", "label": "实验室检验", "offset": "255"}, {"mention": "cea", "label": "实验室检验", "offset": "288"}, {"mention": "盆腔ct及petct", "label": "影像检查", "offset": "306"}, {"mention": "petct", "label": "影像检查", "offset": "351"}, {"mention": "直肠癌术后复发", "label": "疾病和诊断", "offset": "404"}, {"mention": "直肠癌术后盆腔复发", "label": "疾病和诊断", "offset": "428"}, {"mention": "cea", "label": "实验室检验", "offset": "467"}, {"mention": "腹胸部ct", "label": "影像检查", "offset": "481"}, {"mention": "希罗达", "label": "药物", "offset": "546"}, {"mention": "希罗达", "label": "药物", "offset": "564"}, {"mention": "癌胚抗原", "label": "实验室检验", "offset": "583"}, {"mention": "癌抗原72.4", "label": "实验室检验", "offset": "599"}, {"mention": "癌抗原242", "label": "实验室检验", "offset": "617"}, {"mention": "腹胀", "label": "症状", "offset": "670"}, {"mention": "腹泻", "label": "症状", "offset": "675"}, {"mention": "左上肢", "label": "解剖部位", "offset": "678"}, {"mention": "腹平片", "label": "影像检查", "offset": "689"}, {"mention": "小肠不全梗阻", "label": "疾病和诊断", "offset": "692"}]} | |
| {"text": "缘于3年前诊为胃癌,在我院全麻上行根治性全胃切除术,手术顺利。术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。此后患者定期复查。2月余前因感中下腹闷痛不适,自服药物治疗症状仍反复就诊我院,查全腹ct+增强:1、胃大部切除术后改变,吻合口区管壁无明显增厚,吻合口周围未见明显肿大淋巴结,下腹部腹膜后少许淋巴结增大,建议隔期复查。2、胰腺尾部及脾门部脂肪间隙模糊伴斑片状密度增高影,增强扫描轻度强化,多考虑术后改变,建议隔期复查。3、肝内少许小囊肿,脾脏明显增大。考虑“胃癌术后腹腔转移”,遂于2014.09.15予“伊立替康280mg静滴d1,替吉奥胶囊(艾奕)80mg口服d1-14”方案,化疗顺利,化疗后无恶心、呕吐,无腹痛、腹泻等不适,今为行上一疗程化疗再次就诊我院,门诊查体后拟“胃癌术后腹腔转移”收住我科。自发病以来,精神睡眠食欲如常,大小便正常,体重无明显改变。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "根治性全胃切除术", "label": "手术", "offset": "17"}, {"mention": "中下腹", "label": "解剖部位", "offset": "73"}, {"mention": "全腹ct+增强", "label": "影像检查", "offset": "98"}, {"mention": "胃大部切除术后", "label": "疾病和诊断", "offset": "108"}, {"mention": "下腹", "label": "解剖部位", "offset": "145"}, {"mention": "胰腺尾部", "label": "解剖部位", "offset": "168"}, {"mention": "脾门", "label": "解剖部位", "offset": "173"}, {"mention": "肝", "label": "解剖部位", "offset": "218"}, {"mention": "脾脏", "label": "解剖部位", "offset": "226"}, {"mention": "胃癌术后腹腔转移", "label": "疾病和诊断", "offset": "236"}, {"mention": "伊立替康", "label": "药物", "offset": "260"}, {"mention": "替吉奥胶囊(艾奕)", "label": "药物", "offset": "274"}, {"mention": "腹痛", "label": "症状", "offset": "314"}, {"mention": "腹泻", "label": "症状", "offset": "317"}, {"mention": "胃癌术后腹腔转移", "label": "疾病和诊断", "offset": "346"}]} | |
| {"text": ",患者3年前行胰十二指肠切除术,病理示低分化腺癌。一年前行4次静脉化疗,具体用药不详,化疗后复查ct发现肝门区转移,在外院行伽玛刀治疗。随后在08-02及08-03行介入治疗,术中使用奥铂150mg、氟尿苷1g、砝码新50mg,2008年12月在我科行第四次介入治疗,术中用药fudr0.75g、艾恒150mg、thp50mg灌注化疗,<?,xml:namespace叒prefix叒=叒o叒ns叒=叒\\\",urn:,schemas-microsoft-com:,office:office\\\"叒/>术后患者恢复良好,2009年1月初在我科行第五次介入治疗,注入奥铂150mg,fudr(氟脲苷)1.0mg,thp50mg灌注化疗,术后患者恢复好。为进一步治疗入住我科。目前患者无畏寒发热,无恶心呕吐,无腹胀腹痛,食纳尚可,二便正常,夜眠尚可。", "mention_data": [{"mention": "胰十二指肠切除术", "label": "手术", "offset": "7"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "19"}, {"mention": "ct", "label": "影像检查", "offset": "48"}, {"mention": "肝门区转移", "label": "疾病和诊断", "offset": "52"}, {"mention": "伽玛刀治疗", "label": "手术", "offset": "62"}, {"mention": "奥铂", "label": "药物", "offset": "92"}, {"mention": "氟尿苷", "label": "药物", "offset": "100"}, {"mention": "砝码新", "label": "药物", "offset": "106"}, {"mention": "fudr", "label": "药物", "offset": "138"}, {"mention": "艾恒", "label": "药物", "offset": "148"}, {"mention": "thp", "label": "药物", "offset": "156"}, {"mention": "奥铂", "label": "药物", "offset": "281"}, {"mention": "fudr(氟脲苷)", "label": "药物", "offset": "289"}, {"mention": "thp", "label": "药物", "offset": "304"}, {"mention": "腹胀", "label": "症状", "offset": "352"}, {"mention": "腹痛", "label": "症状", "offset": "354"}]} | |
| {"text": "入院9+年前无明显诱因患者感活动后乏力、气促,无头昏、头痛、胸闷,无心悸、胸痛,无晕厥、黑曚,无呃逆、反酸、嗳气,无烧心、恶心、呕吐,无腹痛、腹胀,无腹泻、黑便。于*****医院诊断“溶血性贫血”,给予输血等处理后病情缓解。病程中下述症状反复发生,多次给予输血治疗后病情好转。2013年4月*****检查:间接coomb’s试验(+)p,阳性对照(+++),p。骨髓象:增生性骨髓象,红系增生旺盛。2014-4-24(******医院)分钟遗传学检验报告单:未检测到送检样本中g6pd基因g1388a,g1376t,a95g三个常见突变位点,结合临床;新生儿疾病筛查报告单:新生儿g6pd活性试验1.56(正常),肝功能提示异常(具体不详),诊断“溶血性贫血,g-6-pd酶缺乏症,贫血性心脏病,肝功能不全”明确,经输洗涤红细胞后病情好转。出院后患者反复出现乏力、气促,多次在我院住院,反复经输注洗涤红细胞后缓解。入院前7天患者再次出现乏力、气促、精神差,伴心悸,无腹痛、腹泻、血便。为求进一步治疗今日入我院门诊,门诊以“溶血性贫血”收入我科。病程中精神较差,饮食尚可,大便小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "24"}, {"mention": "头痛", "label": "症状", "offset": "27"}, {"mention": "胸闷", "label": "症状", "offset": "30"}, {"mention": "心悸", "label": "症状", "offset": "34"}, {"mention": "胸痛", "label": "症状", "offset": "37"}, {"mention": "腹痛", "label": "症状", "offset": "68"}, {"mention": "腹胀", "label": "症状", "offset": "71"}, {"mention": "腹泻", "label": "症状", "offset": "75"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "92"}, {"mention": "间接coomb’s试验", "label": "实验室检验", "offset": "153"}, {"mention": "新生儿g6pd活性试验", "label": "实验室检验", "offset": "287"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "324"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "330"}, {"mention": "贫血性心脏病", "label": "疾病和诊断", "offset": "341"}, {"mention": "肝功能不全", "label": "疾病和诊断", "offset": "348"}, {"mention": "心悸", "label": "症状", "offset": "429"}, {"mention": "腹痛", "label": "症状", "offset": "433"}, {"mention": "腹泻", "label": "症状", "offset": "436"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "461"}]} | |
| {"text": "入院前10+年患者反复出现咳嗽、咳痰,多于冬春季及受凉后发作,抗感染治疗有效,每年发作超过3个月。入院前6+年开始出现咳嗽咳痰时伴喘累,逐渐出现活动后心累,病情稳定期可耐受短距离平地慢步活动。反复多次于我院住院治疗,2017-12-08再次加重于我科住院,诊断“1.慢性阻塞性肺疾病叒叒急性加重期叒叒肺源性心脏病叒ii型呼吸衰竭,呼吸性酸中毒合并代谢性碱中毒叒代偿期,肺性脑病;2.支气管扩张伴感染;3.胸腔积液;4、肺大泡;5、冠状动脉粥样硬化性心脏病叒叒缺血性心肌病型叒叒心房纤颤叒心包积液叒心力衰竭叒心功能iii级;6.前列腺增生症;7、尿路感染。”,给予抗感染、平喘、化痰等治疗后好转出院。入院前1天,患者气喘加重,进食及穿衣感明显喘累,不能耐受平地一般活动,夜间需高枕卧位休息,无畏寒、发热,无明显咳嗽咳痰,无潮热、盗汗,无胸痛、咯血,无心慌、胸闷,无恶心、呕吐,无腹胀、腹痛,无颜面四肢浮肿等不适,今为求进一步治疗来我院就诊,门诊以“慢性阻塞性肺疾病叒肺源性心脏病”收入我科。本次发病以来患者精神食欲较差,大便如常,小便色黄,睡眠一般,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "75"}, {"mention": "慢性阻塞性肺疾病", "label": "疾病和诊断", "offset": "133"}, {"mention": "急性加重期", "label": "疾病和诊断", "offset": "143"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "150"}, {"mention": "ii型呼吸衰竭", "label": "疾病和诊断", "offset": "157"}, {"mention": "呼吸性酸中毒合并代谢性碱中毒叒代偿期", "label": "疾病和诊断", "offset": "165"}, {"mention": "肺性脑病", "label": "疾病和诊断", "offset": "184"}, {"mention": "支气管扩张伴感染", "label": "疾病和诊断", "offset": "191"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "202"}, {"mention": "肺大泡", "label": "疾病和诊断", "offset": "209"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "215"}, {"mention": "缺血性心肌病型", "label": "疾病和诊断", "offset": "229"}, {"mention": "心房纤颤", "label": "疾病和诊断", "offset": "238"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "243"}, {"mention": "心力衰竭", "label": "疾病和诊断", "offset": "248"}, {"mention": "心功能iii级", "label": "疾病和诊断", "offset": "253"}, {"mention": "前列腺增生症", "label": "疾病和诊断", "offset": "263"}, {"mention": "尿路感染", "label": "疾病和诊断", "offset": "272"}, {"mention": "胸痛", "label": "症状", "offset": "367"}, {"mention": "胸闷", "label": "症状", "offset": "377"}, {"mention": "腹胀", "label": "症状", "offset": "388"}, {"mention": "腹痛", "label": "症状", "offset": "391"}, {"mention": "颜面", "label": "解剖部位", "offset": "395"}, {"mention": "四肢", "label": "解剖部位", "offset": "397"}, {"mention": "慢性阻塞性肺疾病", "label": "疾病和诊断", "offset": "423"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "432"}]} | |