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+{"text": ",2009年12月底出现黑便,,于当地行胃镜检查并行病理检查示:叒胃体中下部溃疡,叒病理示中分化腺癌,叒无腹胀、泛酸、嗳气、恶心、呕吐、叒无头晕、叒心悸、乏力等症,叒2010年1月13日于我院胃胰科行胃癌根治术,叒2010年1月18日,我院病理:切缘未见癌,叒胃体可见3x2x1cm3溃疡型肿物,叒镜上为中分化腺癌侵及胃壁全层至浆膜层,网膜未见癌,叒肝总动脉旁(0/1)、叒胃大弯(0/1)淋巴结未见癌,叒贲门左(3/3)、叒胃小弯(8/9)、幽门上(2/2)淋巴结可见腺癌转移,,免疫组化:cea(+)、叒p53(+)、叒pr(-)、叒er-b(+)、叒er(+++)、叒共计,ln:叒13/16转移,叒术后于2010年2月-2010年8月行术后化疗6程,叒具体用药为艾素100mg叒静点+叒希罗达1500mg叒bid叒po,2014年6月初出现右侧下上肢活动受限,叒7月份症状逐渐加重,叒7月10日就诊于*****,叒,行mri检查提示:胃癌术后多发脑转移,叒行甘露醇及地塞米松、叒洛赛克治疗后效果不佳。遂于我院就诊,2014-8-5行奥沙利铂150mg叒d1+叒替吉奥叒50mg叒bid叒d1-14化疗一程,2014-08-18开始行三维适形全脑放疗,剂量30gy/10f。2014-09-19始行替吉奥叒50mg叒bid叒d1-14单药化疗一程。本次为行上一程化疗收入我科,叒我科以“胃癌术后脑转移叒rtxnxm1叒iv期”收入,叒入科以来,叒精神饮食尚可,叒无恶心、叒呕吐,二便正常,体重无明显减低。", "mention_data": [{"mention": "胃体中下部溃疡", "label": "疾病和诊断", "offset": "33"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "45"}, {"mention": "腹胀", "label": "症状", "offset": "53"}, {"mention": "头晕", "label": "症状", "offset": "70"}, {"mention": "心悸", "label": "症状", "offset": "74"}, {"mention": "胃", "label": "解剖部位", "offset": "96"}, {"mention": "胰", "label": "解剖部位", "offset": "97"}, {"mention": "胃癌根治术", "label": "手术", "offset": "100"}, {"mention": "胃体", "label": "解剖部位", "offset": "130"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "152"}, {"mention": "胃", "label": "解剖部位", "offset": "159"}, {"mention": "肝总动脉旁(0/1)、叒胃大弯(0/1)淋巴结", "label": "解剖部位", "offset": "175"}, {"mention": "贲门左(3/3)、叒胃小弯(8/9)、幽门上(2/2)淋巴结", "label": "解剖部位", "offset": "203"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "235"}, {"mention": "艾素", "label": "药物", "offset": "335"}, {"mention": "希罗达", "label": "药物", "offset": "347"}, {"mention": "右侧下上肢", "label": "解剖部位", "offset": "374"}, {"mention": "胃癌术后多发脑转移", "label": "疾病和诊断", "offset": "421"}, {"mention": "甘露醇", "label": "药物", "offset": "433"}, {"mention": "地塞米松", "label": "药物", "offset": "437"}, {"mention": "洛赛克", "label": "药物", "offset": "443"}, {"mention": "奥沙利铂", "label": "药物", "offset": "470"}, {"mention": "替吉奥", "label": "药物", "offset": "484"}, {"mention": "脑", "label": "解剖部位", "offset": "525"}, {"mention": "替吉奥", "label": "药物", "offset": "552"}, {"mention": "胃癌术后脑转移叒rtxnxm1叒iv期", "label": "疾病和诊断", "offset": "596"}]}
+{"text": "缘于入院前1余年前于我院诊为胃癌,于2012-08-07在全麻上行根治术全胃切除术。术后病理(201223223)示全胃:食管胃交界溃疡型管状腺癌,ii-iii级,侵出浆膜层,侵犯脉管和神经。手术标本下切端见癌浸润,手术标本上切端和另送(下切端)未见癌浸润。镜上找到贲门周淋巴结3/8个、小弯淋巴结3/4个、大弯淋巴结0/1个、幽门下淋巴结0/4个和幽门上淋巴结0/1个见癌转移。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲,并顺利出院,2012.09.24行“伊立替康280mg+替吉奥60mgbid×14d”方案化疗1周期,2012.10.23按“伊立替康280mg+替吉奥40mgbid×14d”方案化疗1周期,2012.11.20按“伊立替康240mg+替吉奥80mgbid×7d”化疗1次,2012.12.22按““安素泰210mg+艾奕40mgbid×14d”化疗1次,2013.1.18予“安素泰240mg+替吉奥40mgbid×14d”方案化疗1次,2013.02.23按t“安素泰240mg”方案化疗1周期。2014.08.28予“表柔比星70mgivgttd1+替吉奥40mgbid×10d”方案化疗1次,2014.09.22予“表柔比星70mgivgttd1+安素泰210mgivgttd1+替吉奥40mgbid×14d”。今为再次化疗就诊我院,门诊拟胃癌术后化疗后收入院。下次出院以来精神、睡眠、饮食可,无腹痛、腹胀、发热,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "根治术全胃切除术", "label": "手术", "offset": "33"}, {"mention": "胃", "label": "解剖部位", "offset": "59"}, {"mention": "食管胃交界溃疡型管状腺癌,ii-iii级", "label": "疾病和诊断", "offset": "61"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "144"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "154"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "164"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "175"}, {"mention": "伊立替康", "label": "药物", "offset": "237"}, {"mention": "替吉奥", "label": "药物", "offset": "247"}, {"mention": "伊立替康", "label": "药物", "offset": "282"}, {"mention": "替吉奥", "label": "药物", "offset": "292"}, {"mention": "伊立替康", "label": "药物", "offset": "327"}, {"mention": "替吉奥", "label": "药物", "offset": "337"}, {"mention": "安素泰", "label": "药物", "offset": "369"}, {"mention": "艾奕", "label": "药物", "offset": "378"}, {"mention": "安素泰", "label": "药物", "offset": "408"}, {"mention": "替吉奥", "label": "药物", "offset": "417"}, {"mention": "安素泰", "label": "药物", "offset": "452"}, {"mention": "表柔比星", "label": "药物", "offset": "481"}, {"mention": "替吉奥", "label": "药物", "offset": "497"}, {"mention": "表柔比星", "label": "药物", "offset": "531"}, {"mention": "安素泰", "label": "药物", "offset": "547"}, {"mention": "替吉奥", "label": "药物", "offset": "563"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "593"}, {"mention": "腹痛", "label": "症状", "offset": "621"}, {"mention": "腹胀", "label": "症状", "offset": "624"}]}
+{"text": ",患者2015年9月9日于全麻上经腹腔镜直肠癌dixon术,,术后病理:直肠癌(浆膜上层),扁平隆起型,高分化腺癌,i级,断端无癌,淋巴结可见癌转移(5/13枚),,浸润深度:浆膜上层,周围神经节侵犯(+),脉管癌栓(-),结外肿瘤种植(-),ptnm,分期:t3n2am0,iiib期,,免疫组化:ki67(50-70%+),p53(>90%+),cdx2(>90%+),ca199(+),cea(+++),gstp1(+++),egfr(+++),vegf(++),mlh1(>90%+),msh2(>90%+),msh6(>90%+),pms2(>90%+)。血管内皮细胞cd34(+)其内未见癌栓,淋巴管内皮细胞d2-40(+)其内未见癌栓,周围神经s100(+)可见癌侵犯,,病理号:1806。术后患者恢复良好,术后行腹腔穿刺化疗一次,今为求进一步治疗收入我科。近日无发热,饮食睡眠可,大小便正常,无腹痛,无便血,近来体重未见明显变化。ecog,评分:1分。", "mention_data": [{"mention": "经腹腔镜直肠癌dixon术", "label": "手术", "offset": "16"}, {"mention": "直肠癌(浆膜上层),扁平隆起型,高分化腺癌,i级", "label": "疾病和诊断", "offset": "36"}, {"mention": "腹腔", "label": "解剖部位", "offset": "364"}, {"mention": "腹痛", "label": "症状", "offset": "405"}]}
+{"text": "缘于入院前8日于我院诊为“宫颈鳞癌”,于2015年04月22日在全麻上行“广泛全子宫两附件切除术+盆腔淋巴结清扫术+阔韧带肌瘤剥除术+阴道顶悬吊术”,术中见“腹腔内未见明显腹水;子宫萎缩,表面凹凸不平,活动可;左侧阔韧带见一肌瘤,大小约3×4cm;两侧输卵管结扎术后改变;两侧卵巢外观正常,肝、脾、膈上、肠管、肠系膜、腹膜等未见明显异常”。术后病理(201514785)示:“(全子宫+两附件)1.宫颈内生浸润性鳞状细胞癌ii级,肿瘤垂直浸润>1/2肌层,水平浸润25mm,组织学内口、阴道切端、右宫旁组织及左宫旁组织均未肿瘤侵犯;找到(右盆腔)淋巴结5个,(左盆腔)淋巴结8个,(右髂总)淋巴结2个,(左髂总)淋巴结6个,均未见癌转移;2.子宫肌间多发性平滑肌瘤,伴玻璃样变性,宫内膜呈萎缩改变;3.右、左卵巢组织;4.右、左输卵管组织”。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲,予办理出院。此次为化疗就诊我院,门诊拟“宫颈鳞癌术后”收入院。自病以来精神、睡眠、饮食可,无腹痛、腹胀、发热,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "宫颈鳞癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "广泛全子宫两附件切除术+盆腔淋巴结清扫术+阔韧带肌瘤剥除术+阴道顶悬吊术", "label": "手术", "offset": "37"}, {"mention": "腹腔", "label": "解剖部位", "offset": "79"}, {"mention": "腹水", "label": "症状", "offset": "86"}, {"mention": "子宫", "label": "解剖部位", "offset": "89"}, {"mention": "左侧阔韧带", "label": "解剖部位", "offset": "105"}, {"mention": "两侧输卵管结扎术", "label": "手术", "offset": "124"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "136"}, {"mention": "肝", "label": "解剖部位", "offset": "145"}, {"mention": "脾", "label": "解剖部位", "offset": "147"}, {"mention": "膈上", "label": "解剖部位", "offset": "149"}, {"mention": "肠管", "label": "解剖部位", "offset": "152"}, {"mention": "肠", "label": "解剖部位", "offset": "155"}, {"mention": "腹", "label": "解剖部位", "offset": "159"}, {"mention": "全子宫", "label": "解剖部位", "offset": "189"}, {"mention": "两附件", "label": "解剖部位", "offset": "193"}, {"mention": "宫颈内生浸润性鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "199"}, {"mention": "阴道", "label": "解剖部位", "offset": "243"}, {"mention": "右宫", "label": "解剖部位", "offset": "248"}, {"mention": "左宫", "label": "解剖部位", "offset": "254"}, {"mention": "(右盆腔)淋巴结", "label": "解剖部位", "offset": "268"}, {"mention": "(左盆腔)淋巴结", "label": "解剖部位", "offset": "279"}, {"mention": "(右髂总)淋巴结", "label": "解剖部位", "offset": "290"}, {"mention": "(左髂总)淋巴结", "label": "解剖部位", "offset": "301"}, {"mention": "子宫肌间多发性平滑肌瘤", "label": "疾病和诊断", "offset": "321"}, {"mention": "宫内膜", "label": "解剖部位", "offset": "340"}, {"mention": "右、左卵巢", "label": "解剖部位", "offset": "351"}, {"mention": "右、左输卵管", "label": "解剖部位", "offset": "361"}, {"mention": "宫颈鳞癌术后", "label": "疾病和诊断", "offset": "420"}, {"mention": "腹痛", "label": "症状", "offset": "446"}, {"mention": "腹胀", "label": "症状", "offset": "449"}]}
+{"text": ",缘于入院前2月余因“胃癌”于2015.11.27全麻上行“腹腔镜辅助上根治性全胃切除术(d2)”,术后病理回报(201543270),:(全胃),:胃体小弯侧浸润型管状腺癌ii-iii级,部分为粘液腺癌和低粘附性癌,侵及浆膜层,脉管内见癌栓。手术标本下、上切端及另送(下切端)未见癌浸润。找到贲门左淋巴结0/21个,小弯淋巴结11/13个,大弯淋巴结1/7个,幽门下淋巴结0/2个,幽门上淋巴结1/8个,另送(第7组)淋巴结3/4个,(第8组)淋巴结1/3个,(第9组)淋巴结7/7个,(第11组)淋巴结3/5个,(第12a组)淋巴结0/1个,(第12p组)淋巴结0/1个,见癌转移。,免疫组化:ki67(60%肿瘤细胞阳性),ck7(+),ck20(-),villin(+++),ck18(+++),her-2(-),cea(+++),e-cadherin(+++),cd68(+++),cd163(-),cd34(+++),d2-40(+),cd31(+++),cd56(-),syn(-),cga(-)。于2015.12.23、2016.01.14日行“伊立替康240mgivgttd1+替吉奥60mgpobidd1-14”方案化疗。为求再次术后化疗就诊我院,门诊拟胃癌术后化疗收入院,下次出院以来,精神、睡眠、食欲差,大便,小便正常,体重无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹腔镜辅助上根治性全胃切除术", "label": "手术", "offset": "30"}, {"mention": "胃", "label": "解剖部位", "offset": "71"}, {"mention": "胃体小弯侧浸润型管状腺癌ii-iii级,部分为粘液腺癌和低粘附性癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "贲门左淋巴结", "label": "解剖部位", "offset": "147"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "171"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "181"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "192"}, {"mention": "(第7组)淋巴结", "label": "解剖部位", "offset": "205"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "218"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "231"}, {"mention": "(第11组)淋巴结", "label": "解剖部位", "offset": "244"}, {"mention": "(第12a组)淋巴结", "label": "解剖部位", "offset": "258"}, {"mention": "(第12p组)淋巴结", "label": "解剖部位", "offset": "273"}, {"mention": "伊立替康", "label": "药物", "offset": "481"}, {"mention": "替吉奥", "label": "药物", "offset": "498"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "537"}]}
+{"text": "患者2-月前因诊断为升结肠恶性肿瘤及肝内外胆管结石行根治性左半结肠切除术+胆总管探查术。升结肠肿瘤病理类型:左半结肠溃疡型中分化管状乳头状腺癌,免疫组化叒ck7(-)叒ck20(+++)叒cea(++)叒villin(+++)叒cdx-2(++)叒ki-67(+++)>90%叒p53(+)叒cerbb-2(-)叒egfr(+)叒gst-π(+)叒topoii(++)叒pgp(+)叒syn(-)叒cga(-)叒nse(-)叒cd56(-)叒mlh-1(++)叒msh-2(+++)叒msh-6(+++)叒pms-2(++);分期t3n1m0。今可按照foxfol方案行第二次化疗。遂以“升结肠肿瘤根治术后2-月,拟行第2次化疗”收治入院。\\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": "升结肠恶性肿瘤", "label": "疾病和诊断", "offset": "10"}, {"mention": "肝内外胆管结石", "label": "疾病和诊断", "offset": "18"}, {"mention": "根治性左半结肠切除术+胆总管探查术", "label": "手术", "offset": "26"}, {"mention": "升结肠", "label": "解剖部位", "offset": "44"}, {"mention": "左半结肠溃疡型中分化管状乳头状腺癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "升结肠肿瘤根治术后", "label": "疾病和诊断", "offset": "294"}, {"mention": "胃", "label": "解剖部位", "offset": "341"}]}
+{"text": "患者因\\\"体检发现肝占位10天\\\"于2012年1月到我院就诊,经完善检查诊断为结肠腺癌并肝多发转移,无手术禁忌症,于2012-02-06���全麻上行“dixon's+肠粘连松解术”,术顺,术后恢复顺利。术后病理示中分化腺癌,浸润至浆膜上,淋巴结3/9转移。于术后3周始返院行folfiri(开普拓+5-fu/cf)化疗8周期,加安维汀7周期。2012-6-20查ct示肝脏各叶可见多发异常密度影,病变较前缩小(最大者由20×31mm缩至15×28mm),病变数目大致同前。多学科讨论决定暂停开普拓及安维汀,继续予5fu/cf维持化疗,结合射频治疗。后患者于2012年7月11日行肝转移瘤射频消融术,术程顺利。现为进一步治疗入住我科,患者精神、饮食、睡眠可,大小便正常,无腹痛、腹胀、恶心、呕吐,体重无明显减轻。", "mention_data": [{"mention": "肝", "label": "解剖部位", "offset": "9"}, {"mention": "结肠腺癌并肝多发转移", "label": "疾病和诊断", "offset": "39"}, {"mention": "dixon's+肠粘连松解术", "label": "手术", "offset": "74"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "105"}, {"mention": "开普拓", "label": "药物", "offset": "144"}, {"mention": "5-fu", "label": "药物", "offset": "148"}, {"mention": "cf", "label": "药物", "offset": "153"}, {"mention": "安维汀", "label": "药物", "offset": "163"}, {"mention": "ct", "label": "影像检查", "offset": "180"}, {"mention": "肝脏", "label": "解剖部位", "offset": "183"}, {"mention": "开普拓", "label": "药物", "offset": "244"}, {"mention": "安维汀", "label": "药物", "offset": "248"}, {"mention": "5fu", "label": "药物", "offset": "255"}, {"mention": "cf", "label": "药物", "offset": "259"}, {"mention": "肝转移瘤射频消融术", "label": "手术", "offset": "288"}, {"mention": "腹痛", "label": "症状", "offset": "334"}, {"mention": "腹胀", "label": "症状", "offset": "337"}]}
+{"text": "患者于2015.10.28在我院因“绝经2年后阴道不规则流血2月”行经腹广泛性子宫+两附件切除术+盆腔淋巴结清扫术,手术顺利,术后病理示:(38711.15)(宫颈)中低分化鳞状细胞癌,肿瘤切面积4.8×2.6cm,侵及宫颈全层及宫颈内口;阴道壁、右左宫旁组织未查见癌;右闭孔淋巴结4枚(0/4)、左闭孔淋巴结5枚(0/5)均未查见转移癌;右髂血管淋巴结9枚,其中8枚查见转移癌(8/9),左髂血管淋巴结7枚,其中1枚查见转移癌(1/7);萎缩性子宫内膜,两侧输卵管大致正常,两侧卵巢白体。于2015.11.13行紫杉醇+顺铂化疗1周期,化疗过程中出现紫杉醇过敏,后于2015.12.09改为力朴素270mg+顺铂120mg化疗1周期,未诉明显不适。后为行进一步治疗转入我科,排除放化疗禁忌后,给予局部放疗计划,计划量dt=4500cgy/25f,同时顺铂40mg叒d1-3+力扑素270mg叒d1化疗1周期,过程顺利,无明显不适。后为行进一步诊治,就诊我院。排除化疗禁忌后于2016.2.16给予力扑素270mg叒d1+顺铂40mg叒d1-3化疗1周期,过程顺利,无明显不适。现为行上周期化疗再次收入我科。患者自下次出院以来,饮食睡眠可,大小便正常,体重无明显改变。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "23"}, {"mention": "经腹广泛性子宫+两附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "34"}, {"mention": "(宫颈)中低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "宫颈", "label": "解剖部位", "offset": "110"}, {"mention": "宫颈", "label": "解剖部位", "offset": "115"}, {"mention": "阴道壁", "label": "解剖部位", "offset": "120"}, {"mention": "右闭孔淋巴结", "label": "解剖部位", "offset": "135"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "149"}, {"mention": "右髂血管淋巴结", "label": "解剖部位", "offset": "170"}, {"mention": "左髂血管淋巴结", "label": "解剖部位", "offset": "195"}, {"mention": "子宫", "label": "解剖部位", "offset": "223"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "228"}, {"mention": "两侧卵巢白体", "label": "解剖部位", "offset": "238"}, {"mention": "紫杉醇", "label": "药物", "offset": "257"}, {"mention": "顺铂", "label": "药物", "offset": "261"}, {"mention": "紫杉醇", "label": "药物", "offset": "276"}, {"mention": "力朴素", "label": "药物", "offset": "296"}, {"mention": "顺铂", "label": "药物", "offset": "305"}, {"mention": "顺铂", "label": "药物", "offset": "376"}, {"mention": "力扑素", "label": "药物", "offset": "388"}, {"mention": "力扑素", "label": "药物", "offset": "449"}, {"mention": "顺铂", "label": "药物", "offset": "461"}]}
+{"text": ",缘于入院前4月余于我院诊为结肠肝曲管状腺癌,于2014-10-20在全麻上行腹腔镜上扩大根治性左半结肠癌切除,,术中见:腹腔内无明显出血,无明显粘连,无明显腹水,肝脏无明显转移结节,肿瘤位于结肠肝曲,大小约5*5cm,侵出浆膜层,未明显侵及十二指肠,周围可及多发肿大淋巴结。术后病理(病理号201435397、201433427),:(左半结肠),:大肠溃疡型管状腺癌ii-iii级,部分为粘液腺���,侵出浆膜,侵犯神经,脉管内见癌栓,手术标本回肠切端、结肠切端及另送(近切端)、(远切端)均未见癌浸润。找到回肠周淋巴结0/5个,结肠周淋巴结7/27个,及另送(结肠中动脉根部)淋巴结3/11个,(回结肠动脉根部)淋巴结0/6个,见癌转移。另见阑尾组织。该病例未检测到kras基因12、13号密码子热点突变、braf基因v600e突变。,术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。于2014-11-29、2014-12-20、2015-01-10、2015-02-03予“奥沙利铂150mg静滴d1+希罗达1000mg口服d2-15”行第1、2、3、4次化疗方案,化疗过程顺利,无明显化疗副作用。此次为拟行第5次化疗方案再次就诊我院,门诊拟结肠肝曲管状腺癌术后化疗收入院。下次出院以来精神、睡眠、饮食可,无腹痛、腹胀、发热,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "结肠肝曲管状腺癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上扩大根治性左半结肠癌切除", "label": "手术", "offset": "39"}, {"mention": "腹腔", "label": "解剖部位", "offset": "61"}, {"mention": "腹水", "label": "症状", "offset": "79"}, {"mention": "肝脏", "label": "解剖部位", "offset": "82"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "96"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "121"}, {"mention": "左半结肠", "label": "解剖部位", "offset": "169"}, {"mention": "大肠溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "176"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "196"}, {"mention": "回肠", "label": "解剖部位", "offset": "222"}, {"mention": "结肠", "label": "解剖部位", "offset": "227"}, {"mention": "回肠周淋巴结", "label": "解剖部位", "offset": "254"}, {"mention": "结肠周淋巴结", "label": "解剖部位", "offset": "265"}, {"mention": "(结肠中动脉根部)淋巴结", "label": "解剖部位", "offset": "280"}, {"mention": "(回结肠动脉根部)淋巴结", "label": "解剖部位", "offset": "298"}, {"mention": "阑尾", "label": "解剖部位", "offset": "322"}, {"mention": "奥沙利铂", "label": "药物", "offset": "444"}, {"mention": "希罗达", "label": "药物", "offset": "458"}, {"mention": "结肠肝曲管状腺癌术后", "label": "疾病和诊断", "offset": "528"}, {"mention": "腹痛", "label": "症状", "offset": "561"}, {"mention": "腹胀", "label": "症状", "offset": "564"}]}
+{"text": "缘于入院前4月余于我院诊为直肠癌,于2014-07-07在全麻上行腹腔镜上直肠癌根治术。术后病理示(直肠):大肠隆起型管状-绒毛状腺癌ii级,侵及外膜,侵犯神经,脉管内见癌栓,手术标本双切端及另送(下切端)、(上切端)均未见癌浸润。找到肠周淋巴结5/16个见癌转移。未检测到braf基因v600e突变。检测到kras基因12号密码子gly12asp和13号密码子gly13asp突变。,术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。术后于我院以乐沙定200mgd1+希罗达1500mgd1-d14方案行4周期化疗,化疗过程顺利,化疗期间复查ct,效果良好。此次为化疗再次就诊我院,门诊拟直肠管状-绒毛状腺癌术后收入院。下次出院以来精神、睡眠、饮食可,无腹痛、腹胀、发热,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜上直肠癌根治术", "label": "手术", "offset": "33"}, {"mention": "直肠", "label": "解剖部位", "offset": "50"}, {"mention": "大肠隆起型管状-绒毛状腺癌ii级", "label": "疾病和诊断", "offset": "54"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "118"}, {"mention": "乐沙定", "label": "药物", "offset": "228"}, {"mention": "希罗达", "label": "药物", "offset": "239"}, {"mention": "ct", "label": "影像检查", "offset": "276"}, {"mention": "直肠管状-绒毛状腺癌术后", "label": "疾病和诊断", "offset": "299"}, {"mention": "腹痛", "label": "症状", "offset": "332"}, {"mention": "腹胀", "label": "症状", "offset": "335"}]}
+{"text": ",缘于入院前3月余于我院诊断为“直肠癌”,于2014-10-09行“腹腔镜上直肠癌根治术”,术顺,术后病理示(直肠),:肠溃疡型管状腺癌ii级,癌组织侵犯脉管及神经组织,侵及外膜层。手术标本双切端、环周切缘及另送(下切端)、(上切端)均未见癌浸润。找到肠周淋巴结2/9个见癌转移。另送(肠系膜上动脉根部淋巴结)镜上为脂肪、脉管、神经及纤维结缔组织。,免疫组化染色结果:ki67(50%阳性),p53(+++),p170(+++),gstπ(+),egfr(++),5-fu(+),mlh1(+++),msh-6(+++),mgmt(-)。于2014.11.19、2014.12.24予按奥沙利铂(乐沙定)200mgivgttd1+希罗达1000mgpobidd1-d14方案化疗,辅以保肝、止吐、制酸等对症处理,化疗过程顺利,此次为行第3次化疗,门诊拟“直肠癌术后化疗”收入我科。自入院以来,精神、睡眠、饮食良好,体力情况良好,大小便正常,体重无明显变化。", "mention_data": [{"mention": "肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "60"}]}
+{"text": ",患者2016年4月初无明显诱因出现腹部绞痛,伴恶心、呕吐,无呕血、黄疸等不适,在院外考虑“肠套叠”,遂转至**一院就诊,入院后行ct检查提示全身多发性淋巴结肿大,考虑淋巴瘤;左上腹回-回肠套叠,考虑小肠淋巴瘤;脾大,脾内多发结节,考虑淋巴瘤。完善相关检查后于2016-04-08在**一院行腹腔镜探查、左半结肠切除术,,术后病理回报:送检肠管见一息肉样肿物,病变符合套细胞淋巴瘤,,免疫组化:cyclind1、cd5、cd20、cd79a、bcl-2、sox11均为(+),cd23、cd3、cd10、bcl-6均为(-),ki67(30%+)。术后恢复可。2016-04-20查pet/ct,提示:全身多发淋巴结肿大,最大者约1.4*1.0cm(右颈部v区)、4.6*3.2cm(左髂血管旁)、5.9*2.6cm(左侧腹股沟区,suvmax叒4.2);脾大,代谢不均匀增高,符合淋巴瘤;中轴骨、骨盆骨髓弥漫性代谢轻度增高,考虑反应性改变与淋巴瘤累及鉴别。现为进一步治疗,来我院就诊,门诊拟“套细胞淋巴瘤”收入我科。起病以来,患者未诉发热、偶有盗汗,术后近一月体重上降5kg。精神稍差,食欲、睡眠可,大小便正常。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "18"}, {"mention": "肠套叠", "label": "疾病和诊断", "offset": "46"}, {"mention": "ct", "label": "影像检查", "offset": "65"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "84"}, {"mention": "左上腹回-回肠套叠", "label": "疾病和诊断", "offset": "88"}, {"mention": "小肠淋巴瘤", "label": "疾病和诊断", "offset": "100"}, {"mention": "脾大", "label": "症状", "offset": "106"}, {"mention": "脾", "label": "解剖部位", "offset": "109"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "118"}, {"mention": "腹腔镜探查、左半结肠切除术", "label": "手术", "offset": "146"}, {"mention": "肠", "label": "解剖部位", "offset": "170"}, {"mention": "套细胞淋巴瘤", "label": "疾病和诊断", "offset": "184"}, {"mention": "pet/ct", "label": "影像检查", "offset": "291"}, {"mention": "右颈部v区", "label": "解剖部位", "offset": "325"}, {"mention": "左髂血管", "label": "解剖部位", "offset": "342"}, {"mention": "左侧腹股沟区", "label": "解剖部位", "offset": "359"}, {"mention": "脾大", "label": "症状", "offset": "378"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "391"}, {"mention": "中轴骨", "label": "解剖部位", "offset": "395"}, {"mention": "骨盆", "label": "解剖部位", "offset": "399"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "421"}, {"mention": "套细胞淋巴瘤", "label": "疾病和诊断", "offset": "447"}]}
+{"text": "患者自诉近10年来大便秘结,排便困难,伴进食后腹胀,无血便、黑便、恶心等,无头晕、乏力、发热等不适。2015-03外院体检肠镜检查提示距肛16cm肿物,肠镜能通过,活检病理提示高分化腺癌。外院腹部ct、胸片未见远处转移。门诊以“结肠癌”收入我院。2015-04-08全麻上行乙状结肠切除术(dixons’术式),术后病理:中分化腺癌,癌组织浸润至肠壁外膜层;未见明确脉管及神经束侵犯,切缘未见癌,ln叒1/11(+)。术后分期为pt4an1m0叒iiib期。术后恢复可,2015-04-29、2015-05-20行xelox方案辅助化疗2程,过程顺利。现为行上一程化疗入院。自下次出院以来,精神可,纳眠可,胃纳一般,二便正常,体重较前无明显变化。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "23"}, {"mention": "头晕", "label": "症状", "offset": "38"}, {"mention": "肛", "label": "解剖部位", "offset": "68"}, {"mention": "高分化腺癌", "label": "疾病和诊断", "offset": "88"}, {"mention": "腹部ct", "label": "影像检查", "offset": "96"}, {"mention": "胸片", "label": "影像检查", "offset": "101"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "114"}, {"mention": "乙状结肠切除术(dixons’术式)", "label": "手术", "offset": "137"}, {"mention": "肠", "label": "解剖部位", "offset": "173"}, {"mention": "胃", "label": "解剖部位", "offset": "303"}]}
+{"text": ",缘于入院前5月余于我院诊为直肠癌,于2014-11-19在全麻上行腹腔镜上直肠癌根治术miles,,术中见:见腹腔内少许粘连,无明显腹水,子宫及右侧附件缺如,呈术后改变。肿瘤于腹膜返折上不可见,周围可见少许肿大淋巴结。术后病理示(201440196),:(直肠)直肠隆起型管状腺癌ii级,侵出外膜层达周边纤维脂肪组织,脉管中见癌栓,侵犯神经组织,齿状线未见癌浸润。手术标本下、上切端及另送(下切端)及环周切缘均未见癌浸润。手术标本肿物周找到淋巴结6个,肠周淋巴结10个及另送(肠系膜上动脉根部)淋巴结1个均未见癌转移。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。2014-12-24、2015-01-20、2015-02-13、2015-03-10、2015-04-08予以“奥沙利铂150mgivgttd1+希罗达1000mgpobidd1-14”方案化疗,并辅以制酸、保肝、水化等治疗。化疗过程顺利,无恶心、呕吐、乏力、腹泻等明显化疗副作用。此次为行第6次化疗再次就诊我院,门诊拟直肠癌术后收入院。下次出院以来精神、睡眠、饮食可,无腹痛、腹胀、发热,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上直肠癌根治术miles", "label": "手术", "offset": "34"}, {"mention": "腹腔", "label": "解剖部位", "offset": "56"}, {"mention": "腹水", "label": "症状", "offset": "67"}, {"mention": "子宫", "label": "解剖部位", "offset": "70"}, {"mention": "腹膜返折", "label": "解剖部位", "offset": "89"}, {"mention": "(直肠)直肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "128"}, {"mention": "齿状线", "label": "解剖部位", "offset": "174"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "227"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "238"}, {"mention": "奥沙利铂", "label": "药物", "offset": "346"}, {"mention": "希罗达", "label": "药物", "offset": "363"}, {"mention": "肝", "label": "解剖部位", "offset": "395"}, {"mention": "腹泻", "label": "症状", "offset": "420"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "450"}, {"mention": "腹痛", "label": "症状", "offset": "476"}, {"mention": "腹胀", "label": "症状", "offset": "479"}]}
+{"text": "患者于2011-6月无明显诱因上出现吞咽困难,进行性加重,伴胸骨后烧灼样疼痛,程度轻,至我院就诊,经检查确诊胸中段食管癌,完善准备后于2011-7-7全麻上行“经左胸下腹颈部食管部分切除+胃食管颈部吻合+二野清扫术”,术后恢复良好,病理示鳞癌,pt3n1m0,左喉返神经旁旁淋巴结转移。于2011-8至2011-10行“泰素帝+奈达铂”方案化疗4程,过程顺利。后于2011-11-8至2011-12-12行辅助性放疗(原发灶50gy,25次),过程顺利。后定期复查未见明显肿瘤复发转移征象,末次复查时间为2012-6。2012-8-13起患者在我科行cik细胞治疗(qw*4),已回输2次,回输后出现发热,体温最高达39.5度,对症治疗后好转。现为继续治疗入我科。近来,患者无发热、畏寒、寒战,无低热、盗汗、咳嗽,无心悸,无声嘶、呛咳,无骨关节痛,无头痛、视蒙、呕吐,精神、睡眠可,大小便基本正常,体重上降3kg。", "mention_data": [{"mention": "胸骨", "label": "解剖部位", "offset": "30"}, {"mention": "胸中段食管癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "经左胸下腹颈部食管部分切除+胃食管颈部吻合+二野清扫术", "label": "手术", "offset": "80"}, {"mention": "鳞癌,pt3n1m0", "label": "疾病和诊断", "offset": "119"}, {"mention": "左喉返神经旁旁淋巴结", "label": "解剖部位", "offset": "130"}, {"mention": "泰素帝", "label": "药物", "offset": "160"}, {"mention": "奈达铂", "label": "药物", "offset": "164"}, {"mention": "心悸", "label": "症状", "offset": "358"}, {"mention": "骨关节", "label": "解剖部位", "offset": "369"}, {"mention": "头痛", "label": "症状", "offset": "375"}]}
+{"text": "患者于3月余前因“肛门坠胀伴疼痛5月余,加重1月余。”入院,诊断为直肠腺癌并行腹腔镜上直肠癌根治术(dixon)+末端回肠造口术,手术顺利,术后病理诊断:1、(直肠)溃疡型中分化管状腺癌,侵及肠壁全层,双切端未见癌累及,肠壁淋巴结见癌转移(4/7),脂肪组织中见癌结节。叒2、(吻合口残端)未见癌累及。患者于院外期间未诉腹痛、腹胀,恶心、呕吐,便血、腹泻等不适,胃纳可,今患者为求还纳回肠末端造口遂来我院,门诊以“直肠癌术后”收入我科。\\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": "肛门坠胀", "label": "症状", "offset": "9"}, {"mention": "直肠腺癌", "label": "疾病和诊断", "offset": "33"}, {"mention": "腹腔镜上直肠癌根治术(dixon)+末端回肠造口术", "label": "手术", "offset": "39"}, {"mention": "(直肠)溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "肠", "label": "解剖部位", "offset": "96"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "110"}, {"mention": "腹痛", "label": "症状", "offset": "160"}, {"mention": "腹胀", "label": "症状", "offset": "163"}, {"mention": "腹泻", "label": "症状", "offset": "175"}, {"mention": "胃", "label": "解剖部位", "offset": "181"}, {"mention": "回肠", "label": "解剖部位", "offset": "192"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "207"}, {"mention": "胃", "label": "解剖部位", "offset": "244"}]}
+{"text": "患者入院前1+年因发作性胸闷,于2015年10月9日至10月21日在*******医院住院,冠脉造影检查示:前降支狭窄20-50%,回旋支狭窄80%,行支架植入术;术后给予冠心病二级预防口服药物治疗,出院时胸闷明显缓解。病程中患者未再发作明显胸闷、胸痛等不适,家属诉平素监测心率偏慢,未进一步就诊。入院前3+小时患者于餐后突发感心前区胀痛感,难以忍受,随后意识丧失,两眼凝视,张口呼吸,左手不自主抖动,无大小便失禁,家属立即按压“人中”,并予以舌上含服“速效救心丸”等,同时呼叫120急救,下述症状持续约5min后患者意识恢复,并自主活动,120医师现场查看患者清醒,随机指血糖:7.9mmol/l,接回我院急诊科,急诊查血常规叒wbc叒8.5x10^9/l叒hb叒117g/l;凝血试验叒aptt叒21.3秒;高敏肌钙蛋白叒23.87pg/ml;电解质叒k叒3.8mmol/l;肾功能叒bun叒11.04mmol/l叒crea叒152.4umol/l;血气分析叒ph叒7.47叒po2叒122mmhg叒pco2叒36mmhg;ct提示:1.两侧基底节区腔隙性脑梗死。2.脑白质脱髓鞘改变;脑萎缩。3.左肺下叶尖段及左肺上叶小结节影,考虑炎性肉芽肿可能,建议短期内复查。4.右肺下叶尖后段少许感染,右肺上叶内前基底段少许慢性感染,建议治疗后复查。5.右肺下叶尖后段钙化灶。6.主动脉壁及冠状动脉壁钙化;胸椎骨质增生。7.肝实质内多个类圆形低密度影,考虑为囊肿,部分病灶边界欠清晰,随访或必要时增强检查。请我科会诊后为进一步治疗收入我科住院。本次发病以来患者精神食欲较差,大小便如常,睡眠较差,体重无明显上降。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "12"}, {"mention": "冠脉造影", "label": "影像检查", "offset": "46"}, {"mention": "前降支狭窄20-50%", "label": "疾病和诊断", "offset": "54"}, {"mention": "回旋支狭窄80%", "label": "疾病和诊断", "offset": "66"}, {"mention": "支架植入术", "label": "手术", "offset": "76"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "86"}, {"mention": "胸闷", "label": "症状", "offset": "103"}, {"mention": "胸闷", "label": "症状", "offset": "121"}, {"mention": "胸痛", "label": "症状", "offset": "124"}, {"mention": "心前区", "label": "解剖部位", "offset": "164"}, {"mention": "两眼", "label": "解剖部位", "offset": "183"}, {"mention": "左手", "label": "解剖部位", "offset": "193"}, {"mention": "速效救心丸", "label": "药物", "offset": "227"}, {"mention": "血糖", "label": "实验室检验", "offset": "287"}, {"mention": "wbc", "label": "实验室检验", "offset": "315"}, {"mention": "hb", "label": "实验室检验", "offset": "330"}, {"mention": "aptt", "label": "实验室检验", "offset": "345"}, {"mention": "高敏肌钙蛋白", "label": "实验室检验", "offset": "356"}, {"mention": "k", "label": "实验室检验", "offset": "378"}, {"mention": "bun", "label": "实验室检验", "offset": "394"}, {"mention": "crea", "label": "实验室检验", "offset": "410"}, {"mention": "ph", "label": "实验室检验", "offset": "432"}, {"mention": "po2", "label": "实验室检验", "offset": "440"}, {"mention": "pco2", "label": "实验室检验", "offset": "452"}, {"mention": "ct", "label": "影像检查", "offset": "464"}, {"mention": "两侧基底节区腔隙性脑梗死", "label": "疾病和诊断", "offset": "471"}, {"mention": "脑白质脱髓鞘改变", "label": "疾病和诊断", "offset": "486"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "495"}, {"mention": "左肺下叶尖段", "label": "解剖部位", "offset": "501"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "508"}, {"mention": "炎性肉芽肿", "label": "疾病和诊断", "offset": "519"}, {"mention": "右肺下叶尖后段", "label": "解剖部位", "offset": "537"}, {"mention": "右肺上叶内前基底段", "label": "解剖部位", "offset": "549"}, {"mention": "右肺下叶尖后段", "label": "解剖部位", "offset": "575"}, {"mention": "主动脉壁及冠状动脉壁钙化", "label": "疾病和诊断", "offset": "588"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "601"}, {"mention": "肝", "label": "解剖部位", "offset": "610"}]}
+{"text": "7月前,患者无明显诱因出现纳差,食欲减退,身黄、眼黄,伴恶心,无呕吐、呕血,无黑便、便血,无腹胀、腹泻,无陶土样便,无发热、畏寒,无腰痛、酱油色尿,于我院就诊,诊断为“肝硬化”,予保肝等治疗(具体用药不详)后症状缓解出院,平素服用“谷胱甘肽”保肝治疗。3月前,患者于我院就诊,行胃镜检查示:胃窦溃疡(h1期),浅表性胃窦炎伴糜烂(iii级),十二指肠球炎伴糜烂。15天前,患者自觉皮肤瘙痒,纳差加重,未予特殊处理,4天前,患者无明显诱因出现中下腹痛,以剑突上为主,呈持续性胀痛,程度不重,手按后疼痛加重,平卧休息可减轻,伴恶心、干呕,无呕吐、腹泻,无发热、畏寒,无呕血、便血,为求进一步治疗入我院,门诊以“肝硬化”收入。\\u0004叒叒叒患者本次发病以来,食欲减退,叒神志清醒,精神尚可,睡眠尚可,大便正常,小便正常,近15天来体重减少3kg。", "mention_data": [{"mention": "眼", "label": "解剖部位", "offset": "24"}, {"mention": "腹胀", "label": "症状", "offset": "46"}, {"mention": "腹泻", "label": "症状", "offset": "49"}, {"mention": "腰痛", "label": "症状", "offset": "66"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "84"}, {"mention": "肝", "label": "解剖部位", "offset": "91"}, {"mention": "谷胱甘肽", "label": "药物", "offset": "116"}, {"mention": "肝", "label": "解剖部位", "offset": "122"}, {"mention": "胃窦溃疡(h1期)", "label": "疾病和诊断", "offset": "145"}, {"mention": "浅表性胃窦炎伴糜烂(iii级)", "label": "疾病和诊断", "offset": "155"}, {"mention": "十二指肠球炎伴糜烂", "label": "疾病和诊断", "offset": "171"}, {"mention": "中下腹", "label": "解剖部位", "offset": "220"}, {"mention": "剑突", "label": "解剖部位", "offset": "226"}, {"mention": "手", "label": "解剖部位", "offset": "244"}, {"mention": "腹泻", "label": "症状", "offset": "271"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "303"}]}
+{"text": "患者约1月前因“发现肝占位5天”入院,入院后完善相关化验、检查,行下腹ct平扫+增强示:肝右外叶小肝癌;肝多发囊肿;胆囊底部结节,结合病史及相关化验检查,肝肿瘤诊断明确,查无明显手术禁忌症,于2016年6月27日行肝肿瘤切除、胆囊切除术,手术过程顺利,术后给予抗炎、抑酸、保肝、补液及对症支持治疗,患者恢复顺利。患者自出院以来,无腹痛、腹胀,无恶心、呕吐,无寒战、发热,无黄疸,无胸闷、憋喘,无咳嗽、咳痰、呼吸困难,无尿频、尿急、排尿困难,现患者为求进一步诊治,来我院就诊,门诊以“肝肿瘤切除术后”收住院。叒叒叒患者自出院以来,神志清,精神可,食欲、睡眠可,大小便无异常,体重近期无明显变化。", "mention_data": [{"mention": "肝占位", "label": "疾病和诊断", "offset": "10"}, {"mention": "下腹ct平扫+增强", "label": "影像检查", "offset": "33"}, {"mention": "肝右外叶小肝癌", "label": "疾病和诊断", "offset": "44"}, {"mention": "肝多发囊肿", "label": "疾病和诊断", "offset": "52"}, {"mention": "胆囊底部结节", "label": "疾病和诊断", "offset": "58"}, {"mention": "肝肿瘤", "label": "疾病和诊断", "offset": "77"}, {"mention": "肝肿瘤切除、胆囊切除术", "label": "手术", "offset": "107"}, {"mention": "肝", "label": "解剖部位", "offset": "137"}, {"mention": "腹痛", "label": "症状", "offset": "165"}, {"mention": "腹胀", "label": "症状", "offset": "168"}, {"mention": "胸闷", "label": "症状", "offset": "190"}, {"mention": "肝肿瘤切除术后", "label": "疾病和诊断", "offset": "241"}]}
+{"text": "患儿生后20天因“左侧嵌顿疝”于外院行“肠切除术”。术后不久,患儿家属即发现其左侧腹股沟可及可复性包块,无红肿,哭吵、活动后明显,平卧位安静时可消失或减轻,偶诉腹股沟区疼痛,无嵌顿。今患儿为求进一步诊治来我院,查体示:左腹股沟可及可复性包块,质软,可回纳。建议患儿手术,遂拟“左斜疝术后”收治患儿平素体健,未见频繁尿路感染,饮食可,睡眠可,大便如常。", "mention_data": [{"mention": "左侧嵌顿疝", "label": "疾病和诊断", "offset": "9"}, {"mention": "肠切除术", "label": "手术", "offset": "20"}, {"mention": "左侧腹股沟", "label": "解剖部位", "offset": "39"}, {"mention": "腹股沟区", "label": "解剖部位", "offset": "80"}, {"mention": "左腹股沟", "label": "解剖部位", "offset": "109"}, {"mention": "左斜疝术后", "label": "疾病和诊断", "offset": "138"}]}
+{"text": "患者因“反复下腹部不适双年余,加重半年。”于2016-12-22叒入我院。于2017-01-05全麻上行“胃癌根治术(远端胃大部切除+roux-en-y重建)”,术后第5日患者出现持续剧烈咳嗽,下腹部切口持续渗液,后于2017-01-05全麻上行“腹壁切口清创缝合术”,术后预防感染、抑制分泌、静脉营养等对症支持处理,恢复好,切口甲级愈合。术后病理提示:胃低分化腺癌(t4an3mo,iiic,ln+7/59)。术后于2017-02-06、03-06、03-20、04-20行sox化疗4程,现为行第5程化疗收入我科。化疗期间,患者精神尚可,食欲可,大小便正常,身体无明显消瘦。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "6"}, {"mention": "胃癌根治术(远端胃大部切除+roux-en-y重建)", "label": "手术", "offset": "53"}, {"mention": "下腹部", "label": "解剖部位", "offset": "97"}, {"mention": "腹壁切口清创缝合术", "label": "手术", "offset": "124"}, {"mention": "胃低分化腺癌(t4an3mo,iiic,ln+7/59)", "label": "疾病和诊断", "offset": "177"}]}
+{"text": "2+月前,患者因“宫颈鳞癌”于2014-9-16于我院行“行腹腔镜上广泛子宫切除+盆腔淋巴结清扫术”,术后病理诊断:1、宫颈低分化鳞癌,浸及浅肌层,脉管中见癌栓,神经未见癌侵犯,阴道壁残端、颈管、内膜、两侧宫旁未见癌转移。叒2、(两侧盆腔淋巴结)未见癌转移(0/14)。术后行tp方案(紫杉醇(特素)240mg静滴+顺铂100mg静滴)化疗,化疗中患者有恶心、腹胀,脱发明显。1+月前,患者于我院行第二次tp方案化疗,化疗后未诉特殊不适。现拟行第3次化疗入院,门诊以“1.宫颈鳞癌术后;2.第2次化疗后;3.原发性高血压”收入我科。\\u0004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,大小便如常,自诉目前体重65kg,近期未注意到体重无明显变化。", "mention_data": [{"mention": "宫颈鳞癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "腹腔镜上广泛子宫切除", "label": "手术", "offset": "30"}, {"mention": "盆腔淋巴结清扫术", "label": "手术", "offset": "41"}, {"mention": "宫颈低分化鳞癌", "label": "疾病和诊断", "offset": "60"}, {"mention": "阴道壁", "label": "解剖部位", "offset": "89"}, {"mention": "颈管", "label": "解剖部位", "offset": "95"}, {"mention": "两侧宫旁", "label": "解剖部位", "offset": "101"}, {"mention": "两侧盆腔淋巴结", "label": "解剖部位", "offset": "115"}, {"mention": "紫杉醇", "label": "药物", "offset": "143"}, {"mention": "特素", "label": "药物", "offset": "147"}, {"mention": "顺铂", "label": "药物", "offset": "158"}, {"mention": "腹胀", "label": "症状", "offset": "180"}, {"mention": "宫颈鳞癌术后", "label": "疾病和诊断", "offset": "236"}, {"mention": "原发性高血压", "label": "疾病和诊断", "offset": "254"}]}
+{"text": "患者自诉半年前因大便带血于我科门诊就诊,完善化验检查及肠道准备后行结肠镜检查,示:多发结肠息肉,因患者处于冠状动脉支架植入后状态,每日口服阿司匹林、氯吡格雷等抗血小板药物,未行镜上切除,后患者未再出现便血,现为复查肠镜,并进一步系统治疗,特来我院就诊,门诊以“结肠息肉”收入院。患者自发病以来神志清,精神、饮食可,夜间睡眠可,无发热,小便正常,大便规律,排出通畅,无恶心呕吐,无腹胀腹痛,近期体重无明显改变。", "mention_data": [{"mention": "肠道", "label": "解剖部位", "offset": "27"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "43"}, {"mention": "阿司匹林", "label": "药物", "offset": "69"}, {"mention": "氯吡格雷", "label": "药物", "offset": "74"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "130"}, {"mention": "腹胀", "label": "症状", "offset": "189"}, {"mention": "腹痛", "label": "症状", "offset": "191"}]}
+{"text": "患者2月余前无明显诱因出现下腹闷痛不适,为饥饿时明显,无阵发性加剧,无向他处放射,反复发作,不伴恶心、呕吐、返酸、嗳气等,入我院行胃镜、ct等检查,提示残胃癌。于2015-03-09全麻上行“残胃癌根治术”,术程顺利,术后病理提示:ln(+)0/29。pt3n0m0,iia期。现为行第二程sox单药方案术后辅助化疗收入我科。手术以来,患者精神尚可,食欲可,大小便正常,手术后体重上降约5kg。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "13"}, {"mention": "ct", "label": "影像检查", "offset": "68"}, {"mention": "残胃癌", "label": "疾病和诊断", "offset": "76"}, {"mention": "残胃癌根治术", "label": "手术", "offset": "96"}]}
+{"text": "患者8月前因“持续咽喉疼痛半年余,加重1月”在外院行“喉部恶性肿瘤切除术”(具体不详),术后一般情况可,4月前患者自觉吞咽阻挡感,无咽部疼痛,无发热,无咳嗽、咳痰,无明显声音嘶哑,无咽喉异物感及进食饮水呛咳,后下述症状加重,遂来我院耳鼻喉科就诊,行电子胃镜检查示咽部占位,行ct检查示:颈根部及下中纵隔食管及周围软组织增厚,钡餐透视考虑食管癌。后转入我科,于2015.12.20、2016.01.26给予多西他赛120mg方案化疗2周期,同时给予局部放疗,dt=6000/30f,同时给予免疫支持治疗。放疗结束后再次就诊于我科,2016.03.04给予多西他赛120mg+卡铂400mg方案化疗1周期,耐受可。现为求进一步诊治来我院就诊,门诊以“食管癌”收入院。患者自发病以来饮食睡眠正常,体重无明显增减。", "mention_data": [{"mention": "咽喉疼痛", "label": "症状", "offset": "9"}, {"mention": "喉部恶性肿瘤切除术", "label": "手术", "offset": "27"}, {"mention": "咽部", "label": "解剖部位", "offset": "66"}, {"mention": "咽喉", "label": "解剖部位", "offset": "91"}, {"mention": "咽部", "label": "解剖部位", "offset": "131"}, {"mention": "ct", "label": "影像检查", "offset": "137"}, {"mention": "颈根部及下中纵隔食管", "label": "解剖部位", "offset": "143"}, {"mention": "钡餐透视", "label": "影像检查", "offset": "162"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "168"}, {"mention": "多西他赛", "label": "药物", "offset": "202"}, {"mention": "多西他赛", "label": "药物", "offset": "276"}, {"mention": "卡铂", "label": "药物", "offset": "286"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "323"}]}
+{"text": ",1+年前患者因“子宫内膜癌i期”于2012-08-10日全麻上行全子宫及两侧附件切除术,,术后病检结果提示:1、高-中分化子宫内膜样腺癌。患者术后无阴道流血、流液,无明显腹痛、腹胀,无恶心、呕吐,无咳嗽、咳痰等不适。患者定期我院门诊复查,提示ca125升高及盆腔积液,考虑肿瘤复发,于2013-7-15收入院行第一次化疗(紫杉醇180mg+奥沙利铂180mg),化疗期间及化疗出院后患者偶有腹泻。于2013-8-15查子宫内膜癌标记物提示,ca125:148.6u/叒l,,组织多肽抗原:110u/l,行第二次化疗(紫杉醇180mg+奥沙利铂180mg),有轻微恶心、呕吐等不适,无腹痛、黑便、呕血,无骨痛、皮疹,无阴道流血、流液等不适。现患者要求第3次化疗,遂以“子宫内膜癌第3次化疗”收入住院。叒\\u0004叒叒叒患者本次发病以来,食欲减退,叒神志清醒,精神尚可,睡眠尚可,大便正常,小便正常,体重无明显变化。", "mention_data": [{"mention": "子宫内膜癌i期", "label": "疾病和诊断", "offset": "9"}, {"mention": "全子宫及两侧附件切除术", "label": "手术", "offset": "33"}, {"mention": "高-中分化子宫内膜样腺癌", "label": "疾病和诊断", "offset": "57"}, {"mention": "阴道", "label": "解剖部位", "offset": "75"}, {"mention": "腹痛", "label": "症状", "offset": "86"}, {"mention": "腹胀", "label": "症状", "offset": "89"}, {"mention": "ca125", "label": "实验室检验", "offset": "122"}, {"mention": "盆腔积液", "label": "疾病和诊断", "offset": "130"}, {"mention": "紫杉醇", "label": "药物", "offset": "162"}, {"mention": "奥沙利铂", "label": "药物", "offset": "171"}, {"mention": "腹泻", "label": "症状", "offset": "196"}, {"mention": "子宫内膜癌", "label": "疾病和诊断", "offset": "210"}, {"mention": "ca125", "label": "实验室检验", "offset": "221"}, {"mention": "组织多肽抗原", "label": "实验室检验", "offset": "238"}, {"mention": "紫杉醇", "label": "药物", "offset": "259"}, {"mention": "奥沙利铂", "label": "药物", "offset": "268"}, {"mention": "腹痛", "label": "症状", "offset": "292"}, {"mention": "骨痛", "label": "症状", "offset": "302"}, {"mention": "阴道", "label": "解剖部位", "offset": "309"}, {"mention": "子宫内膜癌", "label": "疾病和诊断", "offset": "334"}]}
+{"text": ",缘于入院前5年进食冰冷食物后出现中上腹部闷痛不适,为持续性隐痛,无其它部位放射,无恶心呕吐,无反酸嗳气,无呕血黑便等不适。[主诉单一时间14天主诉单一时间]前进食冰西瓜后出现中上腹部闷痛不适,为持续性隐痛,程度较前加重,无其它部位放射,翻身向左侧时疼痛有所缓解,无恶心、呕吐、返酸、嗳气、纳差、乏力、消瘦、腹泻、便秘,无呕血、黑便,无发热、咳嗽、咳痰,自行服用胃药(具体不详),症状有所好转,,此次至我院门诊行胃镜检查示:“1.胃体溃疡型癌(早癌可能)。2.贲门炎症。3.慢性萎缩性胃炎”,,病理:(体小),:管状腺癌ii-iii级。遂门诊拟“胃体癌”收入院。自发病以来,精神、睡眠可,食欲一般,大小便如常,体重无明显变化。", "mention_data": [{"mention": "中上腹", "label": "解剖部位", "offset": "17"}, {"mention": "中上腹", "label": "解剖部位", "offset": "88"}, {"mention": "腹泻", "label": "症状", "offset": "154"}, {"mention": "胃体溃疡型癌(早癌可能)", "label": "疾病和诊断", "offset": "215"}, {"mention": "贲门炎症", "label": "疾病和诊断", "offset": "230"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "237"}, {"mention": "管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "256"}, {"mention": "胃体癌", "label": "疾病和诊断", "offset": "273"}]}
+{"text": "患者1个月前无明显诱因出现下腹部不适,进食硬质食物时有哽噎感,哽咽感常在吞咽水后缓解消失,进食流质无明显不适。当时无发热、呕吐,无乏力,无声音嘶哑,无呕血黑便,无头晕头痛,无腹泻腹胀,无黄疸,无咳嗽咳痰,无胸闷胸痛,无憋喘气促,无全身肌肉关节酸痛,无饮水呛咳。2013.01.21日患者就诊于我院,行胃镜检查为食管癌。为进一步治疗,门诊以\\\"食管癌\\\"收入院。叒叒患者自发病以来,食欲可、睡眠好,大小便正常,体重未见明显减轻。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "13"}, {"mention": "头晕", "label": "症状", "offset": "81"}, {"mention": "头痛", "label": "症状", "offset": "83"}, {"mention": "腹泻", "label": "症状", "offset": "87"}, {"mention": "腹胀", "label": "症状", "offset": "89"}, {"mention": "胸闷", "label": "症状", "offset": "103"}, {"mention": "胸痛", "label": "症状", "offset": "105"}, {"mention": "全身肌肉关节", "label": "解剖部位", "offset": "115"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "155"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "171"}]}
+{"text": ",患者于2013年8月起无明显诱因上出现鲜血便,大便成形,形状变细,无恶心呕吐、腹痛、腹泻、黑便。为求治疗遂于我院就诊,2014-01-08,我院ct示:右颈iv、v叒区淋巴结肿大,转移?腔静脉旁及腹主动脉旁多发淋巴结肿大,考虑转移;肝s8钙化;两肺未见明显异常。2014-01-09,我院mr示:直肠中上段肿物,考虑为直肠癌;直肠周围、骶前及两侧髂血管旁多发淋巴结,考虑为淋巴结转移;宫颈纳氏囊肿。2014-01-10,我院电子肠镜示:直肠癌。2014-01-13,我院病理示:(距肛门1-7cm直肠中上段肿物活检),镜上:肠粘膜组织中见异型细胞呈片状或散在分布,细胞胞浆丰富或透亮,核深染,可见核仁,核分裂象易见,形态符合恶性肿瘤,结合免疫组化结果,符合低分化鳞状细胞癌。于2014-01-25行pf方案化疗1程,过程顺利,化疗后无诉特殊不适。现拟行上一程化疗入院。自患病以来,患者精神、胃纳、睡眠可,小便时有里急后重感,便血,大便成形,呈细条样,4-5次/日,体重无明显减轻。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "40"}, {"mention": "腹泻", "label": "症状", "offset": "43"}, {"mention": "ct", "label": "影像检查", "offset": "73"}, {"mention": "右颈iv、v叒区淋巴结", "label": "解剖部位", "offset": "77"}, {"mention": "腔静脉", "label": "解剖部位", "offset": "94"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "99"}, {"mention": "肝s8", "label": "解剖部位", "offset": "117"}, {"mention": "两肺", "label": "解剖部位", "offset": "123"}, {"mention": "mr", "label": "影像检查", "offset": "145"}, {"mention": "直肠中上段", "label": "解剖部位", "offset": "149"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "160"}, {"mention": "直肠", "label": "解剖部位", "offset": "164"}, {"mention": "骶前", "label": "解剖部位", "offset": "169"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "172"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "180"}, {"mention": "宫颈纳氏囊肿", "label": "疾病和诊断", "offset": "193"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "219"}, {"mention": "肛门", "label": "解剖部位", "offset": "242"}, {"mention": "直肠中上段", "label": "解剖部位", "offset": "249"}, {"mention": "肠", "label": "解剖部位", "offset": "263"}, {"mention": "低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "329"}]}
+{"text": ",于3年前行直肠癌lar术,pt4an1m0,叒术后行folfox6化疗*12\\u0004\\u0004叒2011.3气短,两肺m,kras叒wt,cea化疗前5.97,2011-3-23开始xelox化疗4周期,复查缩小sd,气短减轻。胆红素2度升高,停止oxa(2011-6中旬),化疗延迟2周余,胸闷略有加重,cea叒6.9。叒\\u0004\\u0004叒2011.6.29继续xeloda,服药期间觉胸闷好转,停药的1周内觉气短。,2012-1-10ct:肺病灶增大sd,因xeloda控制症状尚可,继服1周期后,胸闷加重,cea叒5.4.\\u0004\\u0004叒叒2012-2-6起行xelox6周期,耐受好,胸闷明显好转,叒,3周期后ct:sd(略增大),但cea稳定,症状获益,末次2012.5.13。手足麻木i度,此次消化道反应2度,较前加重,现恢复叒\\u0004\\u0004叒叒叒6,周期评效:,cea:7.43,浅表淋巴结较前变化不大。胸部,ct:两肺多发结节同前,左肺上叶略增大。纵隔淋巴结同前。腹部ct未见新生占位。\\u0004\\u0004现觉胸闷明显好转,睡眠、饮食可,大小便可,体重无变化。", "mention_data": [{"mention": "直肠癌lar术", "label": "手术", "offset": "6"}, {"mention": "两肺", "label": "解剖部位", "offset": "61"}, {"mention": "胸闷", "label": "症状", "offset": "150"}, {"mention": "cea", "label": "实验室检验", "offset": "157"}, {"mention": "胸闷", "label": "症状", "offset": "202"}, {"mention": "ct", "label": "影像检查", "offset": "227"}, {"mention": "肺", "label": "解剖部位", "offset": "230"}, {"mention": "胸闷", "label": "症状", "offset": "259"}, {"mention": "cea", "label": "实验室检验", "offset": "264"}, {"mention": "胸闷", "label": "症状", "offset": "309"}, {"mention": "ct", "label": "影像检查", "offset": "322"}, {"mention": "cea", "label": "实验室检验", "offset": "334"}, {"mention": "手足麻木", "label": "症状", "offset": "357"}, {"mention": "cea", "label": "实验室检验", "offset": "406"}, {"mention": "胸部,ct", "label": "影像检查", "offset": "427"}, {"mention": "两肺", "label": "解剖部位", "offset": "433"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "442"}, {"mention": "纵隔淋巴结", "label": "解剖部位", "offset": "450"}, {"mention": "腹部ct", "label": "影像检查", "offset": "458"}, {"mention": "胸闷", "label": "症状", "offset": "483"}]}
+{"text": "因“下腹堵胀感、腰酸”就诊,2016-4检查见胰头十二指肠间占位(未见报告),2016-4-22腹腔镜转开腹,姑息性腹膜后肿瘤切除+胆囊切除,术中见腹膜后肿瘤下极位于肝门处,呈多结节融合状,术后病理:结节状肿瘤组织,6.5x3x2cm和11.5x7x3.5cm,瘤组织由密集排列的小圆形余短梭形细胞组成,伴大片坏死,结合组化考虑pnet;胆囊体部菜花样肿物,3x2.5x1cm,腺癌,浸润胆囊壁全层,颈部切缘未见肿瘤术后恢复可。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "2"}, {"mention": "腰酸", "label": "症状", "offset": "8"}, {"mention": "胰头", "label": "解剖部位", "offset": "23"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "25"}, {"mention": "腹腔镜转开腹,姑息性腹膜后肿瘤切除+胆囊切除", "label": "手术", "offset": "48"}, {"mention": "腹", "label": "解剖部位", "offset": "74"}, {"mention": "肝门", "label": "解剖部位", "offset": "83"}, {"mention": "胆囊体部", "label": "解剖部位", "offset": "169"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "189"}, {"mention": "胆囊", "label": "解剖部位", "offset": "194"}, {"mention": "颈部", "label": "解剖部位", "offset": "200"}]}
+{"text": ",患者于2010.9因\\\"乏力尿黄半年\\\"在我院肝胆科就诊,入院后完善检查诊断为壶腹周围癌,于2010.9.14行胰十二指肠切除术,术中探查见肿瘤位于十二指肠乳头部,大小约3.5cm×2.5cm×2.5cm,向右侵及胰头部组织,未侵犯上腔静脉、门静脉及肠系膜下动静脉,腹腔有约100ml淡黄色清亮腹水,肝脏、胆囊、胃、空肠、腹膜、盆底均未见异常,术后病理提示壶腹部中分化腺癌,部分为粘液腺癌,,分期为:t3n1m0。术后恢复可,并定期复查,未行放化疗。术后3次(2010.12.6、2011.2.24、2011.5.5)复查cea、ca19-9,cea分别为3.38、13.1、43.43ng/ml,ca19-9分别为16.55、46.05、169.7u/ml。2011.5.6复查ct提示肝转移瘤,叒于2011-5-27、6-19、7-9、7-30、8-20、9-22行gp方案化疗6程,过程顺利。2程及4程后ct疗效评价为sd。2011.10.11,复查ct示:壶腹癌whipple叒术后改变。肝脏转移瘤,较前稍缩小。现为进一步治疗入院。患者近来无恶心、呕吐,无腹痛、腹泻,无畏寒发热。精神、食欲、睡眠尚可,大小便正常,体重较前无明显上降。", "mention_data": [{"mention": "壶腹周围癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "57"}, {"mention": "十二指肠乳头部", "label": "解剖部位", "offset": "75"}, {"mention": "胰头部", "label": "解剖部位", "offset": "108"}, {"mention": "上腔静脉", "label": "解剖部位", "offset": "117"}, {"mention": "门静脉", "label": "解剖部位", "offset": "122"}, {"mention": "肠系膜下动静脉", "label": "解剖部位", "offset": "126"}, {"mention": "腹腔", "label": "解剖部位", "offset": "134"}, {"mention": "腹水", "label": "症状", "offset": "148"}, {"mention": "肝脏", "label": "解剖部位", "offset": "151"}, {"mention": "胆囊", "label": "解剖部位", "offset": "154"}, {"mention": "胃", "label": "解剖部位", "offset": "157"}, {"mention": "空肠", "label": "解剖部位", "offset": "159"}, {"mention": "腹", "label": "解剖部位", "offset": "162"}, {"mention": "盆底", "label": "解剖部位", "offset": "165"}, {"mention": "壶腹部中分化腺癌,部分为粘液腺癌,,分期为:t3n1m0", "label": "疾病和诊断", "offset": "179"}, {"mention": "cea", "label": "实验室检验", "offset": "262"}, {"mention": "ca19-9", "label": "实验室检验", "offset": "266"}, {"mention": "cea", "label": "实验室检验", "offset": "273"}, {"mention": "ca19-9", "label": "实验室检验", "offset": "300"}, {"mention": "ct", "label": "影像检查", "offset": "341"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "345"}, {"mention": "ct", "label": "影像检查", "offset": "406"}, {"mention": "ct", "label": "影像检查", "offset": "429"}, {"mention": "壶腹癌whipple叒术后", "label": "疾病和诊断", "offset": "433"}, {"mention": "肝脏转移瘤", "label": "疾病和诊断", "offset": "449"}, {"mention": "腹痛", "label": "症状", "offset": "483"}, {"mention": "腹泻", "label": "症状", "offset": "486"}]}
+{"text": ",患者2014-12月因升结肠癌于2014-12-05我院行“腹腔镜左半结肠切除术”,,术后病理:结肠中分化腺癌,癌组织浸润肠壁浆膜上层,未见淋巴结转移。术后未行辅助治疗,规律随诊。2015-03-16查cea叒170.9ng/ml,ca199叒193.4u/ml,遂行pet/ct检查,示右附件区体积增大,局部代谢活跃,疑恶性病变,肠癌转移与原发瘤相鉴别;甲状腺右叶低密度影代谢活跃,考虑甲状腺癌可能性大;右股骨颈及股骨下段骨质破坏,代谢较活跃,疑骨良性病变,不除外甲状腺癌转移可能,建议随诊。2015-04-09全麻上行“甲状腺右叶+峡部切除+右vi区淋巴结清扫术+右侧喉返神经探查术+全子宫两附件切除术”,,术后病理:结肠癌卵巢转移;结节性甲状腺肿。术后于2015-5-7、05-28行xelox方案化疗2程,化疗后出现ii度恶心、i度腹泻,未规律监测血象,复查2次血常规未见骨髓抑制。现遵主诊教授意见未行上一程化疗入院。近期以来,患者精神、睡眠可,食欲一般,大便2-3次/天,成形便,小便基本正常,近期体重无明显变化。", "mention_data": [{"mention": "升结肠癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "腹腔镜左半结肠切除术", "label": "手术", "offset": "31"}, {"mention": "结肠中分化腺癌", "label": "疾病和诊断", "offset": "49"}, {"mention": "肠", "label": "解剖部位", "offset": "62"}, {"mention": "cea", "label": "实验室检验", "offset": "102"}, {"mention": "ca199", "label": "实验室检验", "offset": "117"}, {"mention": "pet/ct", "label": "影像检查", "offset": "135"}, {"mention": "右附件区", "label": "解剖部位", "offset": "145"}, {"mention": "肠癌转移", "label": "疾病和诊断", "offset": "167"}, {"mention": "甲状腺右叶", "label": "解剖部位", "offset": "179"}, {"mention": "甲状腺癌", "label": "疾病和诊断", "offset": "195"}, {"mention": "右股骨颈", "label": "解剖部位", "offset": "204"}, {"mention": "股骨下段", "label": "解剖部位", "offset": "209"}, {"mention": "骨质破坏", "label": "症状", "offset": "213"}, {"mention": "骨", "label": "解剖部位", "offset": "225"}, {"mention": "甲状腺癌转移", "label": "疾病和诊断", "offset": "234"}, {"mention": "甲状腺右叶+峡部切除+右vi区淋巴结清扫术+右侧喉返神经探查术+全子宫两附件切除术", "label": "手术", "offset": "263"}, {"mention": "结肠癌卵巢转移;结节性甲状腺肿", "label": "疾病和诊断", "offset": "312"}, {"mention": "腹泻", "label": "症状", "offset": "371"}]}
+{"text": ",患者4年前外院直肠癌根治术,,手术病理:具体不详,术后未行放化疗,中药治疗,2月前出现腰骶部疼痛,,外院核磁提示:骶前占位,pet/ct,检查提示:骶前高代谢增高灶,考虑局部复发,给予骶前复发病灶精确放疗,gtv叒55gy叒ctv叒50gy/27f,同期卡培他滨叒825mg/m2叒bid叒d1-d5/w,目前放疗结束后1年后复查,吻合口复发,,活检病理:腺癌,kras叒突变型,2016-4-28给予xelox方案化疗1周期,患者大便较前好转,未诉便血,2016-5-17继续xelox方案化疗2周期,2016-6-7行第三周期xelox方案化疗,目前患者恶心、呕吐i度,腹泻2次/日,水样便,小便正常,饮食稍少,睡眠可。", "mention_data": [{"mention": "直肠癌根治术", "label": "手术", "offset": "8"}, {"mention": "腰骶部", "label": "解剖部位", "offset": "44"}, {"mention": "核磁", "label": "影像检查", "offset": "53"}, {"mention": "pet/ct", "label": "影像检查", "offset": "63"}, {"mention": "骶前", "label": "解剖部位", "offset": "75"}, {"mention": "骶前", "label": "解剖部位", "offset": "93"}, {"mention": "卡培他滨", "label": "药物", "offset": "128"}, {"mention": "腺癌,kras叒突变型", "label": "疾病和诊断", "offset": "179"}, {"mention": "腹泻", "label": "症状", "offset": "288"}]}
+{"text": ",患者1月余前无明显诱因出现大便带血,与大便混合,呈脓血状,遂于2013-6-4就诊我院行结肠镜检查发现距肛门55cm横结肠中段、30cm乙状结肠见双枚息肉,均为广基,前者约3cm大小,后者约1cm大小,头部充血,轻度分叶状改变,质地柔软。,术后病理示:(横结肠)绒毛状管状腺瘤,iii级,(乙状结肠)粘膜急慢性炎症。于2013-6-26在我院行横结肠腺瘤切除术,,术后病理示:横结肠高级别下皮内瘤变,部分恶变(粘膜内癌)。为求进一步手术治疗入院。患者自发病以来精神睡眠食欲尚好,小便如常,大便如下述,体重无明显改变。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "53"}, {"mention": "横结肠中段", "label": "解剖部位", "offset": "59"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "69"}, {"mention": "头部", "label": "解剖部位", "offset": "102"}, {"mention": "(横结肠)绒毛状管状腺瘤,iii级,(乙状结肠)粘膜急慢性炎症", "label": "疾病和诊断", "offset": "127"}, {"mention": "横结肠腺瘤切除术", "label": "手术", "offset": "173"}, {"mention": "横结肠高级别下皮内瘤变,部分恶变(粘膜内癌)", "label": "疾病和诊断", "offset": "189"}]}
+{"text": "病人诊断为食管上段癌,于2012-8-30全麻上行经右胸上段食管癌切除、食管胃主动脉弓上吻合、淋巴结廓清术。术中顺利,术后抗炎支持治疗,术后状态恢复良好。经口进食病人无不适,后可以出院。1天前突然呕吐出1口暗红色血,就诊于我院门诊,行肺ct检查,后病人间断出现呕吐出数口鲜血,并于今日下午9时大呕血一次,约呕出鲜血500毫升,予病人止血补液输血抗休克等对症治疗,积极请消化内镜、介入科会诊,于内镜科行胃镜检查,吻合口周围未见出血点。于介入科行血管造影,未见出血。遂收入我科住院继续治疗。", "mention_data": [{"mention": "食管上段癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "经右胸上段食管癌切除、食管胃主动脉弓上吻合、淋巴结廓清术", "label": "手术", "offset": "25"}, {"mention": "口", "label": "解剖部位", "offset": "78"}, {"mention": "肺ct", "label": "影像检查", "offset": "117"}, {"mention": "血管造影", "label": "影像检查", "offset": "221"}]}
+{"text": ",患者2010年8月出现咽痛伴吞咽困难,2010.8.30行全麻电视喉镜喉咽新生物活检术,2010.9.1全麻全喉切除+左颈淋巴结清扫术,手术顺利,术后安返,标本送病理,伤口愈合ii/甲。术后病理(s2010-21480),提示:(全喉)低分化鳞形细胞癌,浸润喉室壁至软骨(约2/3层),神经束见癌累及,切缘未见肿瘤累及。左颈大块组织内查见淋巴结11枚,其中2枚见癌转移。术后在我院行放疗1月,具体不详。2016-08出现进食梗阻感,进食困难,2016-09-09,行胃镜提示:食管mt,术后病理(g2016-47953),提示:低分化鳞形细胞癌;2016-09-14,胸部ct提示:食道中段mt。于2016-10-08、2016-10-29、2016-11-19、2016-12-12、2017-1-2、2017-1-232017-2-122017-03-052017-03-28化疗,,具体用药:多西他赛叒110mg叒d1,奈达铂叒110mg叒d1叒q3w.期间2016-11-182017-01-22我院胸部ct增强评估病情稳定。2017-3-27我院复查胸部ct增强提示病情进展,更换化疗方案,排除化疗禁忌、签订化疗知情同意书,于2017-04-21行化疗,,具体用药:伊立替康0.1g叒d1、d8,卡培他滨2#叒bid叒po叒d1-14,q3w。2017-4开始针对食管病灶进行放疗,计划放疗22次,目前已行17次,余不详。现患者为求进一步诊治来我院就诊。", "mention_data": [{"mention": "电视喉镜喉咽新生物活检术", "label": "手术", "offset": "32"}, {"mention": "全喉切除+左颈淋巴结清扫术", "label": "手术", "offset": "55"}, {"mention": "(全喉)低分化鳞形细胞癌", "label": "疾病和诊断", "offset": "115"}, {"mention": "喉室", "label": "解剖部位", "offset": "130"}, {"mention": "左颈", "label": "解剖部位", "offset": "161"}, {"mention": "食管mt", "label": "疾病和诊断", "offset": "239"}, {"mention": "低分化鳞形细胞癌", "label": "疾病和诊断", "offset": "265"}, {"mention": "胸部ct", "label": "影像检查", "offset": "285"}, {"mention": "食道中段mt", "label": "疾病和诊断", "offset": "292"}, {"mention": "多西他赛", "label": "药物", "offset": "400"}, {"mention": "奈达铂", "label": "药物", "offset": "414"}, {"mention": "胸部ct增强", "label": "影像检查", "offset": "455"}, {"mention": "胸部ct增强", "label": "影像检查", "offset": "481"}, {"mention": "伊立替康", "label": "药物", "offset": "539"}, {"mention": "卡培他滨", "label": "药物", "offset": "554"}, {"mention": "食管", "label": "解剖部位", "offset": "588"}]}
+{"text": ",患者2012-10-12因孕足月行剖宫产术,术中发现右侧卵巢有一约3.0*3.3cm大小赘生物,另有一约3.0*3.3cm大小囊肿,术中行赘生物+囊肿切除,因急诊手术,术中未行冰冻.,术后病理提示:符合混合性下皮肿瘤(低恶性),于2012-11-06前来本院就诊,病理经我院会诊示;右侧卵巢肿物高级别粘液性乳头状囊腺癌,,本院行胃镜示:慢性浅表性胃炎,肠镜示无明显异常,剖宫产术后恢复好,无腹痛,腹胀不适,于2012-12-13我院行保留生育功能分期手术(患者附件切除+患侧盆腔淋巴结清扫+腹主动脉旁淋巴结清扫或活检+大网膜切除+阑尾切除)。今为求进一步诊治来我院。患者发病以来,精神可,饮食睡眠可,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "剖宫产术", "label": "手术", "offset": "18"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "27"}, {"mention": "赘生物+囊肿切除", "label": "手术", "offset": "70"}, {"mention": "混合性下皮肿瘤(低恶性)", "label": "疾病和诊断", "offset": "102"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "142"}, {"mention": "粘液性乳头状囊腺癌", "label": "疾病和诊断", "offset": "151"}, {"mention": "慢性浅表性胃炎", "label": "疾病和诊断", "offset": "169"}, {"mention": "剖宫产术后", "label": "疾病和诊断", "offset": "186"}, {"mention": "腹痛", "label": "症状", "offset": "196"}, {"mention": "腹胀", "label": "症状", "offset": "199"}, {"mention": "保留生育功能分期手术(患者附件切除+患侧盆腔淋巴结清扫+腹主动脉旁淋巴结清扫或活检+大网膜切除+阑尾切除)", "label": "手术", "offset": "218"}]}
+{"text": ",患者体检发现盆腔肿块,于4-7行剖腹探查,,术中见:盆腹腔腹膜充血、增厚,腹腔内见淡黄色腹水约200ml;左卵巢肿瘤8×7×9cm,部分囊性(多房性),部分呈外生型菜花状,表面有粘液附着;右卵巢多房性囊肿6×5×5cm,与阔韧带后叶粘连;子宫前位,正常大小,但子宫、直肠、膀胱浆膜面均可见直径2-1cm大小不等之病灶,实质性,后陷凹病灶直径6厘米,封闭;大网膜未见明显病灶,横膈及肝、脾、胃等脏器未及明显肿块;腹主动脉及盆腔淋巴结未扪及肿大。遂行肿瘤减灭术(全子宫+两附件+阑尾+大网膜+盆腔病灶)。,术后病理:(左附件)卵巢腺癌,部分区可见沙粒体,考虑浆液性乳头状腺癌,分化ii级;(全子宫+左附件)左卵巢浆液乳头状腺癌,分化ii级,左输卵管未见癌累及,子宫内膜呈萎缩性改变,慢性宫颈炎;阑尾慢性炎,部分区浆膜面见癌组织累及。患者术前ca125为407.1iu/ml,术后复查降至295.4iu/ml。术后于04-13、5-7、5-27,化疗:辰易210mg叒ivgtt+ddp100mgip,化疗反应轻。,5-26ca19-9:12.6u/ml;,ca125:17.1iu/ml,现为行第四次化疗入院。", "mention_data": [{"mention": "盆腔肿块", "label": "症状", "offset": "7"}, {"mention": "剖腹探查", "label": "手术", "offset": "17"}, {"mention": "腹", "label": "解剖部位", "offset": "28"}, {"mention": "腹", "label": "解剖部位", "offset": "30"}, {"mention": "腹", "label": "解剖部位", "offset": "38"}, {"mention": "腹水", "label": "症状", "offset": "45"}, {"mention": "左卵巢肿瘤", "label": "疾病和诊断", "offset": "54"}, {"mention": "右卵巢多房性囊肿", "label": "疾病和诊断", "offset": "95"}, {"mention": "阔韧带后叶", "label": "解剖部位", "offset": "112"}, {"mention": "子宫前位", "label": "症状", "offset": "120"}, {"mention": "子宫", "label": "解剖部位", "offset": "131"}, {"mention": "直肠", "label": "解剖部位", "offset": "134"}, {"mention": "膀胱", "label": "解剖部位", "offset": "137"}, {"mention": "横膈", "label": "解剖部位", "offset": "188"}, {"mention": "肝", "label": "解剖部位", "offset": "191"}, {"mention": "脾", "label": "解剖部位", "offset": "193"}, {"mention": "胃", "label": "解剖部位", "offset": "195"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "206"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "211"}, {"mention": "肿瘤减灭术(全子宫+两附件+阑尾+大网膜+盆腔病灶)", "label": "手术", "offset": "224"}, {"mention": "(左附件)卵巢腺癌", "label": "疾病和诊断", "offset": "257"}, {"mention": "浆液性乳头状腺癌", "label": "疾病和诊断", "offset": "278"}, {"mention": "(全子宫+左附件)左卵巢浆液乳头状腺癌,分化ii级", "label": "疾病和诊断", "offset": "293"}, {"mention": "左输卵管", "label": "解剖部位", "offset": "319"}, {"mention": "子宫", "label": "解剖部位", "offset": "329"}, {"mention": "慢性宫颈炎", "label": "疾病和诊断", "offset": "340"}, {"mention": "阑尾慢性炎", "label": "疾病和诊断", "offset": "346"}, {"mention": "ca125", "label": "实验室检验", "offset": "369"}, {"mention": "辰易", "label": "药物", "offset": "424"}, {"mention": "ddp", "label": "药物", "offset": "438"}, {"mention": "ca19-9", "label": "实验室检验", "offset": "460"}, {"mention": "ca125", "label": "实验室检验", "offset": "477"}]}
+{"text": "入院前2年患者在院外发现肾功能异常,具体不详,考虑“高血压肾病”,予以控制血压、保护肾功能等治疗,院外随访肾功能不详。半年来患者因黑便多次在我院内二科住院,住院检查诊断“尿毒症叒肾性贫血,高血压肾病,消化道出血,高血压心脏病、心功能不全,营养不良”,给予输血、止血、抑酸、纠正心衰等治疗后好转,后期患者自动出院后于**医院就诊,查血肌酐叒638umol/l,尿素氮叒22.92mmol/l,血常规:血红蛋白叒89g/l,电解质:血钾叒4.70mmol/l等,诊断“慢性肾脏病5期,肾性贫血,消化道出血,高血压3级很高危、高血压心脏病,尿路感染,低蛋白血症”,急诊行深静脉置管,开始行规律血液透析,并给予止血、抑酸、营养支持、稳定血压、抗尿路感染、对症等治疗后好转,并于03-14行右前臂动静脉内瘘吻合术,04-06自动出院转我科行长期维持性血液透析治疗,1月来患者间断解黑便,偶有咳嗽咳痰,并仍感活动后心累,无畏寒发热,无胸闷胸痛,今日患者无明显诱因再次发现解3次黑便,量约50-200ml不等,无腹痛腹胀,无恶心呕吐,无发热气促,无心悸胸闷,无两上肢水肿,为进一步治疗,门诊以\\\"慢性肾脏病5期叒消化道出血\\\"收入我科住院治疗。病程中患者精神、饮食一般,大便正常,小便约200ml,体重无明显上降。", "mention_data": [{"mention": "高血压肾病", "label": "疾病和诊断", "offset": "26"}, {"mention": "尿毒症", "label": "疾病和诊断", "offset": "85"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "89"}, {"mention": "高血压肾病", "label": "疾病和诊断", "offset": "94"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "100"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "106"}, {"mention": "心功能不全", "label": "疾病和诊断", "offset": "113"}, {"mention": "营养不良", "label": "疾病和诊断", "offset": "119"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "165"}, {"mention": "尿素氮", "label": "实验室检验", "offset": "179"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "199"}, {"mention": "血钾", "label": "实验室检验", "offset": "214"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "232"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "240"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "245"}, {"mention": "高血压3级很高危", "label": "疾病和诊断", "offset": "251"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "260"}, {"mention": "尿路感染", "label": "疾病和诊断", "offset": "267"}, {"mention": "低蛋白血症", "label": "疾病和诊断", "offset": "272"}, {"mention": "右前臂动静脉内瘘吻合术", "label": "手术", "offset": "340"}, {"mention": "心", "label": "解剖部位", "offset": "401"}, {"mention": "胸闷", "label": "症状", "offset": "411"}, {"mention": "胸痛", "label": "症状", "offset": "413"}, {"mention": "腹痛", "label": "症状", "offset": "449"}, {"mention": "腹胀", "label": "症状", "offset": "451"}, {"mention": "心悸", "label": "症状", "offset": "467"}, {"mention": "胸闷", "label": "症状", "offset": "469"}, {"mention": "两上肢", "label": "解剖部位", "offset": "473"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "491"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "499"}]}
+{"text": "患者7年前始出现反复咳、喘,平时咳少许白色泡沫痰,平地活动可耐受,爬坡等活动感气促明显。近2年活动后气促明显加重,检查发现左侧颈部豌豆大小包块,无疼痛感,因同期被诊断为“肺结核”故考虑肿块性质为结核,给予hrz方案抗结核治疗2年后停药。病程中颈部包块无增大及缩小,持续无疼痛,未进一步检查。半年前患者因活动后气促加重在***二院住院,完善多项影像学检查后诊断为“左侧肺癌”,家属放弃积极治疗,院外对症治疗。出院后左侧颈部包块进行性增大,间断有隐痛不适,偶给予口服止痛药物可有效缓解疼痛。近半年来,患者反复因咳喘症状加重多次在我科住院治疗,给予抗肿瘤、抗感染、止咳平喘、对症治疗后症状好转出院。入院前2月患者感颜面部浮肿,程度不重。1月前患者感颜面部浮肿及咳嗽、咳痰、气促较前加重于我科住院,给予抗肿瘤、抗感染、对症治疗,症状部分缓解。入院前3小时,患者无明显诱因咳嗽、咳痰加重,为白色粘稠痰,伴喘累不适,无发热、畏寒,无心悸、胸闷、胸痛,无腹痛、腹泻,现为求进一步治疗来我院。本次发病以来患者精神食欲睡眠一般,小便量少色黄,大便次数增多,约4-5次/天。体重变化不详。", "mention_data": [{"mention": "左侧颈部", "label": "解剖部位", "offset": "61"}, {"mention": "肺结核", "label": "疾病和诊断", "offset": "85"}, {"mention": "颈部", "label": "解剖部位", "offset": "121"}, {"mention": "左侧肺癌", "label": "疾病和诊断", "offset": "181"}, {"mention": "左侧颈部", "label": "解剖部位", "offset": "206"}, {"mention": "颜面部", "label": "解剖部位", "offset": "304"}, {"mention": "颜面部", "label": "解剖部位", "offset": "321"}, {"mention": "心悸", "label": "症状", "offset": "410"}, {"mention": "胸闷", "label": "症状", "offset": "413"}, {"mention": "胸痛", "label": "症状", "offset": "416"}, {"mention": "腹痛", "label": "症状", "offset": "420"}, {"mention": "腹泻", "label": "症状", "offset": "423"}]}