{"text": ",患者3月前因“直肠癌”于在我院于全麻上行直肠癌根治术(dixon术),手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好,切口愈合良好。,术后病理示:直肠腺癌(中低度分化),浸润溃疡型,面积3.5*2cm,侵达外膜。双端切线另送“近端”、“远端”及环周底部切除面未查见癌。肠壁一站(10个)、中间组(8个)淋巴结未查见癌。,免疫组化染色示:ercc1弥漫(+)、ts少部分弱(+)、syn(-)、cga(-)。术后查无化疗禁忌后给予3周期化疗,,方案为:奥沙利铂150mg叒d1,亚叶酸钙0.3g+替加氟1.0g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,无腹痛腹胀胀不适,无现患者为行复查及化疗再次来院就诊,门诊以“直肠癌术后”收入院。叒叒叒近期患者精神可,饮食可,大便正常,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "直肠癌根治术(dixon术)", "label": "手术", "offset": "21"}, {"mention": "直肠腺癌(中低度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "78"}, {"mention": "肠壁一站(10个)、中间组(8个)淋巴结", "label": "解剖部位", "offset": "139"}, {"mention": "奥沙利铂", "label": "药物", "offset": "230"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "243"}, {"mention": "替加氟", "label": "药物", "offset": "252"}, {"mention": "肝", "label": "解剖部位", "offset": "276"}, {"mention": "腹痛", "label": "症状", "offset": "312"}, {"mention": "腹胀", "label": "症状", "offset": "314"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "342"}]}
{"text": ",患者因罹患“胃癌”于2013-10-29在我院予行全麻上胃癌根治术,,术中见:腹腔内腹水,腹膜无转移,肝脏未触及明显转移性灶,肿瘤位于胃体、胃底部,小弯侧偏后壁,约5*4*2cm大小,肿瘤已侵达浆膜外,第1、3组淋巴结肿大,肿瘤尚能活动,经探查决定行全胃切除,空肠j字代胃术。手术顺利,术后积极予相关对症支持治疗;,后病理示:胃底、体小弯侧低分化腺癌,部分为印戒细胞癌图像,蕈伞型,面积5.2*3.5cm,局部侵达粘膜上层,并于少数腺管内查见癌栓。双端切线及另送“近端切线”未查见癌。呈三组(5/13个)淋巴结癌转移。一组(7个)、四组(13个)、五组(1个)、六组(4个)淋巴结未查见癌。,癌组织免疫组化染色示:ercc1(+)、β-tubulin-iii(+)、ts(-)、rrm1(-)、topoii阳性细胞数约20%、cerbb-2(2+)叒。依据患者病情及肿瘤病理与分期继续术后辅助性化疗指征存在,患者及家属拒绝化疗。自术后出院以来,患者一般情况保持良好;无发热,偶有恶心,无呕吐,无反酸、嗳气,无明显进食不适,偶有进食后轻微腹胀,无腹痛。现患者为行进一步复查并必要时适当处理而再来我院就诊,门诊依情以“胃恶性肿瘤术后”收入院。目前患者精神及情绪状态良好,食欲较术前明显减少,饮食可,夜间睡眠后;今8个月体重减轻18kg。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "胃癌根治术", "label": "手术", "offset": "29"}, {"mention": "腹腔", "label": "解剖部位", "offset": "40"}, {"mention": "腹水", "label": "症状", "offset": "43"}, {"mention": "腹", "label": "解剖部位", "offset": "46"}, {"mention": "肝脏", "label": "解剖部位", "offset": "52"}, {"mention": "胃体", "label": "解剖部位", "offset": "68"}, {"mention": "胃底部", "label": "解剖部位", "offset": "71"}, {"mention": "小弯侧", "label": "解剖部位", "offset": "75"}, {"mention": "全胃切除,空肠j字代胃术", "label": "手术", "offset": "126"}, {"mention": "胃底、体小弯侧低分化腺癌,部分为印戒细胞癌图像,蕈伞型", "label": "疾病和诊断", "offset": "164"}, {"mention": "三组(5/13个)淋巴结", "label": "解剖部位", "offset": "244"}, {"mention": "一组(7个)、四组(13个)、五组(1个)、六组(4个)淋巴结", "label": "解剖部位", "offset": "260"}, {"mention": "腹胀", "label": "症状", "offset": "469"}, {"mention": "腹痛", "label": "症状", "offset": "473"}, {"mention": "胃恶性肿瘤术后", "label": "疾病和诊断", "offset": "508"}]}
{"text": ",患者3月余前于我院诊断为“直肠癌”,于2015-10-26在全麻上行腹腔镜直肠癌根治术,,术后病理示:,201518502:(直肠)腺癌(中度分化),浸润溃疡型,体积2.7*2*0.8cm,侵达浆膜。叒双端切线及另送“近切线”、“远切线”未查见癌。叒肠壁一站(6个)、中间组(3个)、中央组(3个)淋巴结未查见癌。低级别腺管状腺瘤。,免疫组化染色示:ts部分(+)、syn(-)。,术后病理分期:pt3n0m0,ii期,dukes叒b。依情2015-11-08.2015-12-09给予奥沙利铂200mg叒d1+亚叶酸钙0.3g叒d2-6叒+替加氟1g叒d2-6叒静滴,同时辅以镇吐、升血、免疫调节等对症支持治疗。化疗过程总体顺利。现为复查化疗来我院,门诊以“直肠癌术后”收入院。目前患者精神好,食欲及饮食好,夜间睡眠良好,小便正常,大便4-5次/天,基本成形。否认近期明显体重变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜直肠癌根治术", "label": "手术", "offset": "35"}, {"mention": "(直肠)腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "63"}, {"mention": "肠壁一站(6个)、中间组(3个)、中央组(3个)淋巴结", "label": "解剖部位", "offset": "126"}, {"mention": "低级别腺管状腺瘤", "label": "疾病和诊断", "offset": "158"}, {"mention": "奥沙利铂", "label": "药物", "offset": "244"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "257"}, {"mention": "替加氟", "label": "药物", "offset": "272"}]}
{"text": ",患者因“结肠癌”于2012-12-13在我院于全麻上行右半结肠切15除术,手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好,切口愈合良好,,术后病理:13862.2012结肠腺癌(中度分化),溃疡型,面积6.5*3.5,侵达浆膜脂肪组织。双端切线未查见癌。结肠腺管状腺瘤。呈肠壁一站(1/5个)淋巴结癌转移。肠壁二站(3个)淋巴结未查见癌。,免疫组化染色示癌组织:ercc1(+)、ts少数细胞(+)。(pt4an1m0,iiia,ducks叒c)。后患者恢复好出院,术后给予化疗2周期。叒叒叒院外期间患者一般情况好,无恶心,无腹痛腹胀胀不适,现患者为行复查及化疗再次来院就诊,门诊以“结肠癌术后”收入院。叒叒叒近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "右半结肠切15除术", "label": "手术", "offset": "28"}, {"mention": "结肠腺癌(中度分化),溃疡型", "label": "疾病和诊断", "offset": "89"}, {"mention": "结肠腺管状腺瘤", "label": "疾病和诊断", "offset": "132"}, {"mention": "肠壁一站(1/5个)淋巴结", "label": "解剖部位", "offset": "141"}, {"mention": "肠壁二站(3个)淋巴结", "label": "解剖部位", "offset": "158"}, {"mention": "腹痛", "label": "症状", "offset": "268"}, {"mention": "腹胀", "label": "症状", "offset": "270"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "297"}]}
{"text": ",缘于入院前4月余因中下腹部闷痛不适伴排黑便于我院就诊,诊断为“胃癌”,于2014年06月06日在全麻上行“腹腔镜辅助上根治性远端胃大部切除术(roux-y吻合术d2)”手术顺利。术后病理(201417771),:“(远端胃)胃体小弯早期(iic型)低分化腺癌,部分为印戒细胞癌,侵及粘膜上层,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5个,大弯淋巴结5个,幽门下淋巴结18个,幽门上淋巴结3个,及另送(第8p组)淋巴结2个,均未见癌转移。另送(胃右动脉根部淋巴结)为脂肪、脉管及神经组织。,免疫组化结果:ck(l)(+++),cd68(组织细胞+),ki67(50%+)”,术后给予对症、抗感染治疗,恢复良好,伤口愈合良好。分别于2014.07.16、2014.08.13、2014.09.17、2014.10.29予“奥沙利铂(齐沙)150mgivgttd1+替吉奥胶囊(艾奕)40mgpobidd2-15”方案行术后第1、2、3、4周期化疗,化疗过程顺利。今为第5周期化疗再次入院。自下次出院后饮食、睡眠可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "11"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "腹腔镜辅助上根治性远端胃大部切除术", "label": "手术", "offset": "54"}, {"mention": "roux-y吻合术d2", "label": "手术", "offset": "72"}, {"mention": "(远端胃)胃体小弯早期(iic型)低分化腺癌,部分为印戒细胞癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "173"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "181"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "189"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "199"}, {"mention": "(第8p组)淋巴结", "label": "解剖部位", "offset": "211"}, {"mention": "胃右动脉根部淋巴结", "label": "解剖部位", "offset": "233"}, {"mention": "奥沙利铂", "label": "药物", "offset": "371"}, {"mention": "齐沙", "label": "药物", "offset": "376"}, {"mention": "替吉奥胶囊", "label": "药物", "offset": "392"}, {"mention": "艾奕", "label": "药物", "offset": "398"}, {"mention": "腹痛", "label": "症状", "offset": "468"}, {"mention": "腹胀", "label": "症状", "offset": "471"}]}
{"text": ",缘于入院前5月余因“反复返酸、嗳气7年”就诊我院,,行胃镜检查示:“1.胃窦癌2.慢性萎缩性胃炎”,,病理示:“胃管状腺癌ii-iii级”,下腹部平扫+,增强示:“胃肿瘤,伴腹腔、腹膜后多发淋巴结肿大”,考虑肿瘤局部较晚期,遂于2015.04.18、2015.05.11、2015.06.02、2015.06.29、2015.08.02予“安素泰210mgivgttd1+奥沙利铂(艾恒)150mgivgttd2+希罗达1000mgbidpod1-14”方案新辅助化疗,辅以止吐、制酸、保胃、保肝、营养支持等治疗。化疗后未见明显骨髓抑制,一般情况尚可。并于入院前1月余(2015.09.01)全麻上行“腹腔镜上根治性远端胃大部切除术”。术顺,术后恢复可,,术后病理:(远端胃),:胃体及胃窦小弯侧早期隆起型(0-i型)低黏附性癌,印戒细胞癌为主,部分为低分化腺癌及未分化癌,浸润脉管及神经组织,脉管内见癌栓,侵及黏膜上层。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0/13个,大弯侧淋巴结2/10个,幽门下淋巴结1/4个,幽门上淋巴结5/6个,另送(胃右动脉根部)淋巴结2/8个,(胃壁)淋巴结0/4个,见癌转移。,免疫组化染色结果:ck(pan)(+++),e-cadherin(+++),cdx-2(+++),cga(+),cd56(-),sy(-),her-2(-)。门诊拟“胃窦术后化疗”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": "胃窦癌", "label": "疾病和诊断", "offset": "37"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "42"}, {"mention": "胃管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "57"}, {"mention": "下腹部平扫", "label": "影像检查", "offset": "71"}, {"mention": "胃肿瘤", "label": "疾病和诊断", "offset": "83"}, {"mention": "腹腔", "label": "解剖部位", "offset": "88"}, {"mention": "腹膜后多发淋巴结", "label": "解剖部位", "offset": "91"}, {"mention": "安素泰", "label": "药物", "offset": "171"}, {"mention": "奥沙利铂", "label": "药物", "offset": "187"}, {"mention": "艾恒", "label": "药物", "offset": "192"}, {"mention": "希罗达", "label": "药物", "offset": "208"}, {"mention": "胃", "label": "解剖部位", "offset": "245"}, {"mention": "肝", "label": "解剖部位", "offset": "248"}, {"mention": "腹腔镜上根治性远端胃大部切除术", "label": "手术", "offset": "302"}, {"mention": "胃", "label": "解剖部位", "offset": "337"}, {"mention": "胃体及胃窦小弯侧早期隆起型(0-i型)低黏附性癌,印戒细胞癌为主,部分为低分化腺癌及未分化癌", "label": "疾病和诊断", "offset": "341"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "439"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "451"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "463"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "474"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "487"}, {"mention": "(胃壁)淋巴结", "label": "解剖部位", "offset": "503"}, {"mention": "胃窦术后化疗", "label": "疾病和诊断", "offset": "604"}]}
{"text": ",入院前1月余因“进行性吞咽困难1年”就诊我院,,查胃镜示:,食管占位伴狭窄:癌不能排除,,活检病理示:“鳞状下皮呈乳头状增生,部分鳞状下皮呈低级别下皮内瘤变”,完善颈胸腹部,ct:食管下段部分管壁不规则增厚,考虑为食管癌,伴右侧锁骨下窝、食管旁沟及纵膈内多发淋巴结转移;另病变下缘一食管憩室。考虑食管癌伴纵隔淋巴结转移,为提高手术切除率,建议行术前新辅助化疗,告知患者家属,其表示理解,遂于2016.12.26、2017.01.16按氟尿嘧啶3000mg微量泵泵入+洛铂50mgivgttd2+多西他赛(泰索帝)120mgivgttd2”第1、2周期化疗,辅以保肝、止吐、制酸、营养支持等治疗,疗程较为顺利,未见明显化疗副反应。现为求进一步治疗,遂再次就诊我科,门诊拟“食管癌术前化疗”收住院。末次出院以来,精神、睡眠一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管", "label": "解剖部位", "offset": "31"}, {"mention": "鳞状下皮呈乳头状增生,部分鳞状下皮呈低级别下皮内瘤变", "label": "疾病和诊断", "offset": "53"}, {"mention": "颈胸腹部,ct", "label": "影像检查", "offset": "83"}, {"mention": "食管下段", "label": "解剖部位", "offset": "91"}, {"mention": "食管癌,伴右侧锁骨下窝、食管旁沟及纵膈内多发淋巴结转移", "label": "疾病和诊断", "offset": "108"}, {"mention": "食管憩室", "label": "疾病和诊断", "offset": "142"}, {"mention": "食管癌伴纵隔淋巴结转移", "label": "疾病和诊断", "offset": "149"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "218"}, {"mention": "洛铂", "label": "药物", "offset": "234"}, {"mention": "多西他赛", "label": "药物", "offset": "248"}, {"mention": "泰索帝", "label": "药物", "offset": "253"}, {"mention": "肝", "label": "解剖部位", "offset": "282"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "336"}]}
{"text": "患者4月余前因“下腹疼痛不适,伴反酸、嗳气”在我院完善相关检查后确诊“胃体胃窦癌”,于2015-10-10在全麻上行“胃癌根治术(远端胃大部分切除)”,术程顺利,术后预防感染支持对症等处理,恢复好,切口甲级愈合。术后病理示:“胃体胃窦癌叒pt4an3am0叒iiic期。”于2015-11-05、2015-12-07、2016-01-14、2016-02-15、2016-03-18日在我院行sox(奥沙利铂叒100mg叒ivdrip+替吉奥叒60mg叒qn+替吉奥叒40mg叒qm)方案化疗,化疗期间患者未诉特殊不适,未见明显副反应。现在为上一步治疗来我院门诊就诊,拟“胃癌综合治疗后”收入我科。术后出院至今患者精神尚可,食欲为半流为主,大小便正常,体重增加约2kg。", "mention_data": [{"mention": "下腹疼痛", "label": "症状", "offset": "8"}, {"mention": "胃体胃窦癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "胃癌根治术(远端胃大部分切除)", "label": "手术", "offset": "59"}, {"mention": "胃体胃窦癌叒pt4an3am0叒iiic期", "label": "疾病和诊断", "offset": "113"}, {"mention": "奥沙利铂", "label": "药物", "offset": "200"}, {"mention": "替吉奥", "label": "药物", "offset": "218"}, {"mention": "替吉奥", "label": "药物", "offset": "230"}, {"mention": "胃癌综合治疗后", "label": "疾病和诊断", "offset": "286"}]}
{"text": ",患者因壶腹部占位于2016-07-22日在我科行胰十二指肠切除术+肝囊肿开窗引流+肝活检术,,术后病理示:壶腹部鳞状细胞癌(低度分化),体积4*2.8*2.5cm,侵达十二指肠粘膜层,侵及胰腺组织,于较多脉管内查见癌栓。胆总管、胃、十二指肠切线及胰腺切除面未查见癌;胆总管残端切线于少数脉管内查见癌栓。呈胰腺周围淋巴结(1/2个)癌转移。胃周围(2个)淋巴结未查见癌。慢性胆囊炎。(肝囊肿右、左)纤维性囊壁样结构,慢性发炎,局部衬覆单层立方下皮。(肝活检)肝组织一块,部分肝细胞淤胆,肝被膜及汇管区较多炎细胞浸润。,免疫组化染色示:ck5/6(+)、p63(+)、ck7(-)、ck20(-)、syn(-)。患者术后恢复良好,无特殊不适,2016.10.6入院行静脉化疗治疗,2016.12.5入院行介入及静脉化疗,2017.2.16入院行静脉化疗,治疗结束后出院。患者出院后,自觉全身乏力,无明显腹胀、腹痛,无恶心、呕吐,无心慌、胸闷等不适。今患者为术后综合治疗,来我院就诊,门诊以“胰十二指肠术后”收入院。叒叒叒患者自术后以来,神志清,精神好,饮食可,睡眠可,大小便无异常,体重略增加。", "mention_data": [{"mention": "壶腹部", "label": "解剖部位", "offset": "4"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "25"}, {"mention": "肝囊肿开窗引流", "label": "手术", "offset": "34"}, {"mention": "肝活检术", "label": "手术", "offset": "42"}, {"mention": "壶腹部鳞状细胞癌(低度分化)", "label": "疾病和诊断", "offset": "54"}, {"mention": "十二指肠粘膜", "label": "解剖部位", "offset": "85"}, {"mention": "胰腺", "label": "解剖部位", "offset": "95"}, {"mention": "胆总管", "label": "解剖部位", "offset": "111"}, {"mention": "胃", "label": "解剖部位", "offset": "115"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "117"}, {"mention": "胰腺", "label": "解剖部位", "offset": "124"}, {"mention": "胆总管", "label": "解剖部位", "offset": "134"}, {"mention": "胰腺周围淋巴结", "label": "解剖部位", "offset": "153"}, {"mention": "胃周围(2个)淋巴结", "label": "解剖部位", "offset": "170"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "185"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "192"}, {"mention": "肝活检", "label": "手术", "offset": "225"}, {"mention": "肝", "label": "解剖部位", "offset": "229"}, {"mention": "肝", "label": "解剖部位", "offset": "237"}, {"mention": "肝", "label": "解剖部位", "offset": "243"}, {"mention": "腹胀", "label": "症状", "offset": "400"}, {"mention": "腹痛", "label": "症状", "offset": "403"}, {"mention": "心慌", "label": "症状", "offset": "414"}, {"mention": "胸闷", "label": "症状", "offset": "417"}, {"mention": "胰十二指肠术后", "label": "疾病和诊断", "offset": "444"}]}
{"text": ",缘于入院前3年余于我院诊断为胃癌,于2012-04-11在全麻上行腹腔镜上根治性全胃切除术,术后病理示(201210103),:食管胃交界溃疡型管状腺癌ii-iii级,侵出浆膜层,手术标本下、上切端及另送(下切端)均未见癌浸润。找到贲门左淋巴结1/15个,小弯淋巴结0/2个,大弯淋巴结0/1个,幽门下淋巴结0/5个,幽门上淋巴结0/5个,及另送(第8组)淋巴结0/4个见癌转移。,免疫组化:ki67(30%+),p53(-),cd56(-),sy(-),cga(-),ck18(+++)。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。术后再入院行洛铂50mg+表柔比星100mgd1+希罗达1500mgbidd1-d14方案化疗6周期,未见明显化疗反应,2天前,自诉腹痛,脐周明显,呈阵发性,可自行缓解,伴肛门停止排气排便.现感症状加重,无明显缓解方式,为求进一步诊治遂来我院,门诊拟腹痛待查收入院。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": "15"}, {"mention": "腹腔镜上根治性全胃切除术", "label": "手术", "offset": "34"}, {"mention": "食管胃交界溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "65"}, {"mention": "贲门左淋巴结", "label": "解剖部位", "offset": "117"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "129"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "139"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "149"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "160"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "174"}, {"mention": "洛铂", "label": "药物", "offset": "281"}, {"mention": "表柔比星", "label": "药物", "offset": "288"}, {"mention": "希罗达", "label": "药物", "offset": "300"}, {"mention": "腹痛", "label": "症状", "offset": "341"}, {"mention": "脐", "label": "解剖部位", "offset": "344"}, {"mention": "肛门", "label": "解剖部位", "offset": "361"}, {"mention": "腹痛待查", "label": "疾病和诊断", "offset": "400"}, {"mention": "腹痛", "label": "症状", "offset": "425"}, {"mention": "腹胀", "label": "症状", "offset": "428"}]}
{"text": ",缘于入院前3月因“直肠癌”就诊我院,于2016年11月10日在全麻上行腹腔镜上直肠根治术(dixon手术),探查腹腔内无明显出血,没有明显粘连,无明显腹水,肿瘤位于腹膜返折下5cm对系膜侧,侵及浆膜层,未形成肠梗阻,近端无扩张,周围未见明显肿大淋巴结。术顺,术后予预防感染、制酸、补液、营养支持、增强免疫力等处理,术后恢复可。术后病理(201641027),:(直肠),:直肠隆起型中分化管状腺癌,小灶区为黏液腺癌,侵犯肠壁全层,脉管见癌侵犯,未见明确神经侵犯,手术标本下、上切端及另送(下切端)、(上切端)未见癌浸润。找到肠周淋巴结3/14枚及另送(肠系膜上动脉根部)淋巴结0/4枚,(中间组)淋巴结1/9枚,见癌转移。,免疫组化:肿瘤细胞示ck7(-),ck20(+++),ki67(60%+)。mlh-1(++),msh-2(+++),msh-6(+++),pms-2(+)提示该病例肿瘤微卫星稳定(mss),请结合临床。检测到kras基因存在g13d突变。未检测到nras基因热点突变。未检测到braf基因v600e突变。于2016-12-10予“奥沙利铂200mgivgttd1+卡培他滨1500mgbidd1-d14”方案化疗,此次为化疗再次就诊我院,门诊拟直肠癌术后化疗收入院。自下次出院以来精神、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": "10"}, {"mention": "腹腔镜上直肠根治术(dixon手术)", "label": "手术", "offset": "36"}, {"mention": "腹腔", "label": "解剖部位", "offset": "57"}, {"mention": "腹水", "label": "症状", "offset": "76"}, {"mention": "腹", "label": "解剖部位", "offset": "83"}, {"mention": "肠", "label": "解剖部位", "offset": "105"}, {"mention": "直肠", "label": "解剖部位", "offset": "182"}, {"mention": "直肠隆起型中分化管状腺癌,小灶区为黏液腺癌", "label": "疾病和诊断", "offset": "187"}, {"mention": "肠", "label": "解剖部位", "offset": "211"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "263"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "276"}, {"mention": "(中间组)淋巴结", "label": "解剖部位", "offset": "294"}, {"mention": "奥沙利铂", "label": "药物", "offset": "479"}, {"mention": "卡培他滨", "label": "药物", "offset": "496"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "536"}, {"mention": "腹痛", "label": "症状", "offset": "565"}, {"mention": "腹胀", "label": "症状", "offset": "568"}]}
{"text": ",缘于入院前20余日于我院诊为乙状结肠癌,于2015-10-21在全麻上行乙状结肠癌根治术,,术中见:腹腔内无明显腹水,腹腔、盆腔、大网膜无明显转移结节,肝脏质地大小正常,未触及肿物,胆囊未触及结石。肿瘤位于乙状结肠上段,约6×5㎝,未形成肠梗阻,近端肠管无扩张,周围可见少许肿大淋巴结。诊断“乙状结肠癌”,遂决定行“乙状结肠癌根治术。术后病理示.(乙状结肠),:肠溃疡型管状腺癌ii级,侵犯肠壁全层及肠周脂肪组织,侵犯神经组织,未见肯定脉管侵犯,手术标本下、上切端及另送(下切端)(上切端)均未见癌浸润;找到肠周淋巴结9个,未见癌转移。2.该病例检测到kras基因12号密码子gly12asp突变。3.该病例未检测到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。2015-11-21行第1周期化疗,具体方案为“沙利铂140mgd1ivgtt+氟尿嘧啶700mgd1ivgtt+氟尿嘧啶4200mgd1-d2微量泵泵人+亚叶酸650mgd1-d2ivgtt”,此次为术后第2次化疗再次就诊我院,门诊拟乙状结肠癌术后化疗收入院。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": "乙状结肠癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "37"}, {"mention": "腹腔", "label": "解剖部位", "offset": "51"}, {"mention": "腹水", "label": "症状", "offset": "57"}, {"mention": "腹腔", "label": "解剖部位", "offset": "60"}, {"mention": "盆腔", "label": "解剖部位", "offset": "63"}, {"mention": "肝脏", "label": "解剖部位", "offset": "77"}, {"mention": "胆囊", "label": "解剖部位", "offset": "92"}, {"mention": "乙状结肠上段", "label": "解剖部位", "offset": "104"}, {"mention": "肠", "label": "解剖部位", "offset": "120"}, {"mention": "肠管", "label": "解剖部位", "offset": "126"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "140"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "147"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "159"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "175"}, {"mention": "肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "182"}, {"mention": "肠壁", "label": "解剖部位", "offset": "196"}, {"mention": "肠", "label": "解剖部位", "offset": "201"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "255"}, {"mention": "沙利铂", "label": "药物", "offset": "377"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "393"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "410"}, {"mention": "亚叶酸", "label": "药物", "offset": "431"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "471"}, {"mention": "腹痛", "label": "症状", "offset": "501"}, {"mention": "腹胀", "label": "症状", "offset": "504"}]}
{"text": ",缘于入院前2个月因诊断为“胃癌”,于2014年12月09日在我院全麻上行“根治性远端胃大部切除术,roux-y吻合,d2,r0”,术顺,术后予以制酸、保肝、增强免疫力、抗肿瘤、抗感染、抑制消化液分泌及对症支持治疗。术后病理(201443329),:(远端胃),:胃角溃疡型粘液腺癌,部分为印戒细胞癌,侵出浆膜外,手术标本下、上切端均未见癌浸润,找到小弯淋巴结2/14个,大弯淋巴结0/7个,幽门上淋巴结2/15个,见癌转移。(201443369),:找到(第7组)淋巴结0/1个、(第8组)淋巴结2/2个、(第9组)淋巴结0/1个,见癌转移。2015.01.09按“奥沙利铂150mgd1多柔比星脂质体(里葆多)40mgd2希罗达1000mgd1-14”行第1周期术后辅助化疗,辅以护胃,保肝,止呕吐等对症处理。1天前无明显诱因出现发热,无寒战,无肢体抽搐,遂来我院就诊,门诊拟“胃角溃疡型粘液腺癌(pt4an2m0iiib期)术后化疗,发热待查”收住入院。自发病以来,患者精神、饮食、睡眠尚可,大小便正常,体重未见明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "根治性远端胃大部切除术", "label": "手术", "offset": "38"}, {"mention": "roux-y吻合", "label": "手术", "offset": "50"}, {"mention": "肝", "label": "解剖部位", "offset": "77"}, {"mention": "远端胃", "label": "解剖部位", "offset": "126"}, {"mention": "胃角溃疡型粘液腺癌,部分为印戒细胞癌", "label": "疾病和诊断", "offset": "132"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "175"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "186"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "196"}, {"mention": "(第7组)淋巴结", "label": "解剖部位", "offset": "228"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "241"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "254"}, {"mention": "奥沙利铂", "label": "药物", "offset": "284"}, {"mention": "多柔比星脂质体", "label": "药物", "offset": "295"}, {"mention": "里葆多", "label": "药物", "offset": "303"}, {"mention": "希罗达", "label": "药物", "offset": "313"}, {"mention": "胃", "label": "解剖部位", "offset": "343"}, {"mention": "肝", "label": "解剖部位", "offset": "346"}, {"mention": "胃角溃疡型粘液腺癌(pt4an2m0iiib期)术后", "label": "疾病和诊断", "offset": "391"}, {"mention": "发热待查", "label": "疾病和诊断", "offset": "420"}]}
{"text": ",入院前8天(2013.12.06)因“宫颈鳞癌ib1期”就诊我院全麻上行行腹腔粘连松解术+部分大网膜切除术+广泛全子宫+两侧卵巢移位术+盆腔淋巴结清扫术,术前查,ca125:18.42u/ml,术后病理回报(201338627),:1、(全子宫),:宫颈浸润型鳞状细胞癌ii级,侵及肌层(浸润深度<1/2宫颈全层),脉管内见癌栓,手术标本阴道切端及两侧宫旁组织均未见癌浸润。宫体肌间平滑肌瘤,宫内膜呈增生状态。2、找到(右髂总)淋巴结0/6个,(右盆腔)淋巴结2/40个,(右侧腹股沟)淋巴结0/2个,(左髂总)淋巴结0/9个,(左盆腔)淋巴结1/16个见癌转移。3、(大网膜),:送检网膜组织未见癌细胞种植转移。,免疫组化:ki67(40%+),ck5/6(+++),ck(h)(+++),p63(++++),cea(++),ck18(-),术后予补液、营养支持等治疗,恢复良好,伤口愈合ii/甲。今为行第1次化疗,再次就诊我院,门诊拟“宫颈鳞癌(ib1期,ii级)术后”收入院。下次出院以来,精神、睡眠、饮食好,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ib1期", "label": "疾病和诊断", "offset": "20"}, {"mention": "腹腔粘连松解术+部分大网膜切除术+广泛全子宫+两侧卵巢移位术+盆腔淋巴结清扫术", "label": "手术", "offset": "38"}, {"mention": "ca125", "label": "实验室检验", "offset": "82"}, {"mention": "子宫", "label": "解剖部位", "offset": "121"}, {"mention": "宫颈浸润型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "126"}, {"mention": "阴道", "label": "解剖部位", "offset": "170"}, {"mention": "两侧宫旁", "label": "解剖部位", "offset": "175"}, {"mention": "宫体肌间平滑肌瘤", "label": "疾病和诊断", "offset": "188"}, {"mention": "宫内膜", "label": "解剖部位", "offset": "197"}, {"mention": "(右髂总)淋巴结", "label": "解剖部位", "offset": "210"}, {"mention": "(右盆腔)淋巴结", "label": "解剖部位", "offset": "223"}, {"mention": "(右侧腹股沟)淋巴结", "label": "解剖部位", "offset": "237"}, {"mention": "(左髂总)淋巴结", "label": "解剖部位", "offset": "252"}, {"mention": "(左盆腔)淋巴结", "label": "解剖部位", "offset": "265"}, {"mention": "宫颈鳞癌(ib1期,ii级)术后", "label": "疾病和诊断", "offset": "421"}, {"mention": "腹痛", "label": "症状", "offset": "460"}, {"mention": "腹胀", "label": "症状", "offset": "463"}]}
{"text": ",患者7月前因“下腹腹胀伴反酸”至我院就诊,完善相关检查,诊断“胃体胃窦癌(ct4n2m0,iiib期)”,建议先行化疗,患者及家属表示理解同意,遂于2015-5-26、2015-06-19、2015-07-13分别予xelox(希罗达叒1250mg叒bid叒po叒d1-14+奥沙利铂150mg叒ivdrip叒q3w)化疗三程,过程顺利,无明显副反应,后于2015-08-24在全麻上行胃癌根治术(远端胃大切),术程顺利,术后预防感染支持对症等处理。,术后病理示:胃中至低分化管状腺癌(lauren,分型:肠型),浸润至胃壁浆膜上层,可见神经束侵犯,未见明确脉管内癌栓;肿瘤消退分级(mandard),:trg4;网膜组织未见癌;ln(-);ypt3n0m0,iia期。术后恢复可,于2015-10-10、开始采用xelox化疗方案化疗(奥沙利铂150mg叒q3w叒ivdrip+卡培他滨1250mgbid*14天)一程,过程顺利。现为行上程化疗来我院就诊,拟“胃癌综合治疗后”收入我科。自下次出院以来,患者精神可,食欲尚可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "8"}, {"mention": "腹胀", "label": "症状", "offset": "10"}, {"mention": "胃体胃窦癌(ct4n2m0,iiib期)", "label": "疾病和诊断", "offset": "32"}, {"mention": "希罗达", "label": "药物", "offset": "115"}, {"mention": "奥沙利铂", "label": "药物", "offset": "139"}, {"mention": "行胃癌根治术(远端胃大切)", "label": "手术", "offset": "193"}, {"mention": "胃中至低分化管状腺癌(lauren,分型:肠型)", "label": "疾病和诊断", "offset": "233"}, {"mention": "胃", "label": "解剖部位", "offset": "261"}, {"mention": "奥沙利铂", "label": "药物", "offset": "370"}, {"mention": "卡培他滨", "label": "药物", "offset": "391"}, {"mention": "胃癌综合治疗后", "label": "疾病和诊断", "offset": "432"}]}
{"text": ",患者因低位直肠癌于2014-08-27在全麻上行直肠癌根治术(dixon)。,术中探查见:腹腔内无腹水,腹膜无转移,肝脏未触及转移结节,肿瘤位于腹膜返折处,手术顺利,术后给予抑酸、抗感染、营养支持等治疗。术后病理(201413291),:(直肠)腺癌(中度分化),浸润溃疡型,体积7.5*4.5*2cm,部分侵穿纤维膜达脂肪组织,距底部切除面甚近,局部侵达浆膜,浆膜面未查见癌。叒双端切线及另送“近切线”、“远切线”未查见癌。叒呈一站(6/10个)淋巴结癌转移。叒中央组(7个)淋巴结未查见癌。叒,癌组织免疫组化染色示:ts(-)、syn(-)。术后给予3周期化疗,,方案为:奥沙利铂200mg叒d1,亚叶酸钙0.3g+替加氟1.0g叒d2-d6,同时给与升白细胞、护肝、止吐、免疫增强治疗,过程顺利,自下次出院以来,患者一般情况保持良好;无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适;未现明显腹痛、腹胀。现患者为行复查并辅助化疗而再来我院就诊,门诊以“直肠癌术后”收入院。叒叒叒患者精神好,食欲、饮食好,睡眠可;肛门排气排便存在。无体重变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "直肠癌根治术(dixon)", "label": "手术", "offset": "25"}, {"mention": "腹腔", "label": "解剖部位", "offset": "46"}, {"mention": "腹水", "label": "症状", "offset": "50"}, {"mention": "腹", "label": "解剖部位", "offset": "53"}, {"mention": "肝脏", "label": "解剖部位", "offset": "59"}, {"mention": "腹", "label": "解剖部位", "offset": "73"}, {"mention": "(直肠)腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "120"}, {"mention": "一站(6/10个)淋巴结癌", "label": "解剖部位", "offset": "216"}, {"mention": "中央组(7个)淋巴结", "label": "解剖部位", "offset": "233"}, {"mention": "奥沙利铂", "label": "药物", "offset": "289"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "302"}, {"mention": "替加氟", "label": "药物", "offset": "311"}, {"mention": "肝", "label": "解剖部位", "offset": "335"}, {"mention": "腹痛", "label": "症状", "offset": "401"}, {"mention": "腹胀", "label": "症状", "offset": "404"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "431"}]}
{"text": ",缘于入院前6月余于我院诊为胃窦癌,于2016年02月26日在全麻上行腹腔镜上根治性远端胃切除术,术顺,,病理:(远端胃),:胃窦溃疡型低黏附性癌(印戒细胞癌为主,部分为未分化癌及黏液腺癌),侵犯脉管及神经组织,脉管内见癌栓,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0/8个,幽门下淋巴结0/1个,幽门上淋巴结4/9个,另送(第1组)淋巴结0/1个,(第7组)淋巴结0/1个,(第8组)淋巴结0/6个,(第9组)淋巴结0/1个,见癌转移。另送(第12组淋巴结)镜上为脂肪、纤维及脉管组织。(小肠),:送检小肠组织,未见癌浸润。,免疫组化染色结果:ki67(70%阳性),p53(-),p170(+++),gstπ(-),egfr(+++),5-fu(+),her-2(-)。术后予制酸、营养支持等治疗好转后出院。术后予2016-04-12、2016.5.6、2016.5.30、2016.6.23、2016.8.9行“洛铂d150mgivgtt+卡培他滨d2-141500mgpobid”化疗6次,辅以保肝、保胃、止吐抗肿瘤治疗。此次入院前2天因无明显诱因出现中下腹绞痛,伴恶心,无呕吐,无畏冷、寒战,无腹胀、腹痛等其他不适,求诊我科,门诊拟胃窦癌术后化疗后,腹痛待查收入院。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": "胃窦癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上根治性远端胃切除术", "label": "手术", "offset": "35"}, {"mention": "远端胃", "label": "解剖部位", "offset": "57"}, {"mention": "胃窦溃疡型低黏附性癌(印戒细胞癌为主,部分为未分化癌及黏液腺癌)", "label": "疾病和诊断", "offset": "63"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "147"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "158"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "(第1组)淋巴结", "label": "解剖部位", "offset": "182"}, {"mention": "(第7组)淋巴结", "label": "解剖部位", "offset": "195"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "208"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "221"}, {"mention": "第12组淋巴结", "label": "解剖部位", "offset": "242"}, {"mention": "小肠", "label": "解剖部位", "offset": "265"}, {"mention": "小肠", "label": "解剖部位", "offset": "272"}, {"mention": "洛铂", "label": "药物", "offset": "429"}, {"mention": "卡培他滨", "label": "药物", "offset": "443"}, {"mention": "肝", "label": "解剖部位", "offset": "472"}, {"mention": "胃", "label": "解剖部位", "offset": "475"}, {"mention": "中下腹", "label": "解剖部位", "offset": "500"}, {"mention": "腹胀", "label": "症状", "offset": "522"}, {"mention": "腹痛", "label": "症状", "offset": "525"}, {"mention": "胃窦癌术后", "label": "疾病和诊断", "offset": "541"}, {"mention": "腹痛待查", "label": "疾病和诊断", "offset": "550"}, {"mention": "腹痛", "label": "症状", "offset": "575"}, {"mention": "腹胀", "label": "症状", "offset": "578"}]}
{"text": ",患者于2015年5月26日在我院行腹腔镜检查+卵巢肿瘤活检术。,术后病理学检查报告:(左卵巢)破碎卵巢组织见部分异型性腺体和分化较低的片巢状细胞,局灶伴鳞状下皮化生,符合恶性肿瘤,考虑为腺癌。于5月30日给予tp方案化疗(紫杉醇(特素)240mg静脉滴注,顺铂90mg腹腔灌注)。于7月3日在全麻上经腹行全子宫切除术+两侧附件切除术+大网膜部分切除术+阑尾切除术。,术后病检示:1、(左卵巢)中-低分化浆液性乳头状腺癌,同侧输卵管未见癌累及。右卵巢见癌转移,右输卵管、子宫未见癌转移。阑尾未见癌转移。大网膜见癌转移。2、子宫平滑肌瘤。于7月13日行紫杉醇(泰素)240mg静脉滴注+顺铂90mg灌腹,8月14日行紫杉醇(泰素)240mg+顺铂100mg静脉滴注化疗,9月19日、10月21日、11月19日、12月19日行紫杉醇(泰素)240mg+奥沙利铂200mg化疗。化疗过程中,患者有恶心、呕吐、脱发等症状,化疗结束后缓解。入院前20天,患者于我科门诊复查,门诊给予“华蟾素片”治疗,自诉用药后患者感腹痛、腹胀,尚能忍受,无腹泻、恶心、呕吐等。因腹痛持续,患者遂于今日来院。门诊以“第六次化疗后、卵巢浆液性乳头状腺癌iiic期”收住入院。\\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,体重无明显变化。", "mention_data": [{"mention": "腹腔镜检查+卵巢肿瘤活检术", "label": "手术", "offset": "18"}, {"mention": "左卵巢", "label": "解剖部位", "offset": "44"}, {"mention": "卵巢", "label": "解剖部位", "offset": "50"}, {"mention": "恶性肿瘤", "label": "疾病和诊断", "offset": "86"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "94"}, {"mention": "紫杉醇", "label": "药物", "offset": "112"}, {"mention": "特素", "label": "药物", "offset": "116"}, {"mention": "顺铂", "label": "药物", "offset": "129"}, {"mention": "腹腔", "label": "解剖部位", "offset": "135"}, {"mention": "经腹行全子宫切除术+两侧附件切除术+大网膜部分切除术+阑尾切除术", "label": "手术", "offset": "150"}, {"mention": "(左卵巢)中-低分化浆液性乳头状腺癌", "label": "疾病和诊断", "offset": "192"}, {"mention": "输卵管", "label": "解剖部位", "offset": "213"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "222"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "230"}, {"mention": "子宫", "label": "解剖部位", "offset": "235"}, {"mention": "阑尾", "label": "解剖部位", "offset": "243"}, {"mention": "子宫平滑肌瘤", "label": "疾病和诊断", "offset": "261"}, {"mention": "紫杉醇", "label": "药物", "offset": "275"}, {"mention": "泰素", "label": "药物", "offset": "279"}, {"mention": "顺铂", "label": "药物", "offset": "292"}, {"mention": "腹", "label": "解剖部位", "offset": "299"}, {"mention": "紫杉醇", "label": "药物", "offset": "307"}, {"mention": "泰素", "label": "药物", "offset": "311"}, {"mention": "顺铂", "label": "药物", "offset": "320"}, {"mention": "紫杉醇", "label": "药物", "offset": "361"}, {"mention": "泰素", "label": "药物", "offset": "365"}, {"mention": "奥沙利铂", "label": "药物", "offset": "374"}, {"mention": "华蟾素片", "label": "药物", "offset": "437"}, {"mention": "腹痛", "label": "症状", "offset": "453"}, {"mention": "腹胀", "label": "症状", "offset": "456"}, {"mention": "腹泻", "label": "症状", "offset": "465"}, {"mention": "腹痛", "label": "症状", "offset": "476"}, {"mention": "卵巢浆液性乳头状腺癌iiic期", "label": "疾病和诊断", "offset": "501"}]}
{"text": ",2016.1.29患者以“阴道不规则出血半年”为主诉首次入院,我院病理科会诊为浸润性低分化鳞状细胞癌,诊断宫颈鳞癌iib期,,术前予tp化疗2周期:紫杉醇480mg、顺铂220mg,检查无手术禁忌症,2016-03-18在全麻上行iii型全子宫及及两附件两附件切除及盆腔淋巴结清扫术及腹主动脉旁淋巴结活检术,术顺,,术后病理回报:盆腔及腹主动脉淋巴结未见转移癌。宫旁及子宫动脉未见癌。全子宫及两附件示宫颈及宫体上段肌层(均大于1/2肌层)中见异型细胞呈小巢团状排列,病变诊断为低分化癌,符合腺鳞癌,可见脉管癌栓,阴道穹窿可见个别散在的癌细胞,检查现为术后放疗入院。自起病以来,患者精神、睡眠可,食欲如常,大小便正常,体重无上降。", "mention_data": [{"mention": "阴道不规则出血", "label": "症状", "offset": "14"}, {"mention": "浸润性低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "宫颈鳞癌iib期", "label": "疾病和诊断", "offset": "54"}, {"mention": "紫杉醇", "label": "药物", "offset": "75"}, {"mention": "顺铂", "label": "药物", "offset": "84"}, {"mention": "iii型全子宫及及两附件两附件切除及盆腔淋巴结清扫术及腹主动脉旁淋巴结活检术", "label": "手术", "offset": "116"}, {"mention": "盆腔", "label": "解剖部位", "offset": "166"}, {"mention": "腹主动脉淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "宫旁", "label": "解剖部位", "offset": "182"}, {"mention": "子宫动脉", "label": "解剖部位", "offset": "185"}, {"mention": "子宫", "label": "解剖部位", "offset": "194"}, {"mention": "两附件", "label": "解剖部位", "offset": "197"}, {"mention": "宫颈", "label": "解剖部位", "offset": "201"}, {"mention": "宫体上段肌层", "label": "解剖部位", "offset": "204"}, {"mention": "低分化癌", "label": "疾病和诊断", "offset": "239"}, {"mention": "腺鳞癌", "label": "疾病和诊断", "offset": "246"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "257"}]}
{"text": ",者约于1个月前因“结肠恶性肿瘤”于2013-04-28日在全麻上行左半结肠切除术。手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好。,术后病理:4976.2013叒结肠腺癌(中低分化),浸润溃疡型,面积5.5*5.5cm,局部粘液腺癌图像,侵达浆膜脂肪组织。双端切线未查见癌,呈肠壁一站(2/8个)淋巴癌转移。肠壁二站(2个)、中间组(4个)淋巴结未查见癌。,免疫组化染色示癌组织:ercc1(+),ts(-)。术后分期叒pt4n1m0叒iii期,术后给予化疗治疗,,方案为:奥沙利铂200mg叒d1+右亚叶酸钙50叒mgd2-6叒+氟尿苷1000mg叒d2-6叒静滴。叒叒叒叒院外期间,患者无发热,无腹痛腹胀不适,大便通畅。现患者为行复查化疗来我科就诊,以“结肠癌术后”收入院。叒叒叒叒病人自下次出院以来,神志清,精神可,饮食可,大、小便正常,体重未见明显变化。", "mention_data": [{"mention": "结肠恶性肿瘤", "label": "疾病和诊断", "offset": "10"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "34"}, {"mention": "结肠腺癌(中低分化),浸润溃疡型", "label": "疾病和诊断", "offset": "86"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "肠", "label": "解剖部位", "offset": "143"}, {"mention": "肠壁二站(2个)、中间组(4个)淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "奥沙利铂", "label": "药物", "offset": "242"}, {"mention": "右亚叶酸钙", "label": "药物", "offset": "255"}, {"mention": "氟尿苷", "label": "药物", "offset": "271"}, {"mention": "腹痛", "label": "症状", "offset": "305"}, {"mention": "腹胀", "label": "症状", "offset": "307"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "334"}]}
{"text": ",患者2015-09-15因“腹痛伴大便性状习惯改变1月”就诊于我院结直肠科,外院肠镜检查提示结肠肝曲环周肿物,肠镜不能通过,活检病理提示腺癌,遂2015-09-18行全麻上“左半结肠切除术”,过程顺利,,术后病理示:镜检为中分化腺癌,癌组织浸润至肠壁浆膜上层;未见明确脉管内癌栓及神经束侵犯;各切缘未见癌;淋巴结2/10见腺癌转移,,免疫组化:er(-),ercc1(+),msh2(+),msh6(+),mlh1(+),pms2(+),ki67(40%+),,分期为:pt3n1bm0iiib期,术后恢复可。2015-10-15于我科行第1程xelox方案术后辅助化疗,过程顺利,现患者为行进一步治疗入我科。患者3周来,无发热,胃纳可,睡眠一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "15"}, {"mention": "结直肠", "label": "解剖部位", "offset": "34"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "47"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "88"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "112"}, {"mention": "肠", "label": "解剖部位", "offset": "124"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "162"}, {"mention": "胃", "label": "解剖部位", "offset": "316"}]}
{"text": ",缘于入院前半个月前我院行胃镜检查提示:食管炎(a级),贲门息肉样隆起,共双枚,大小分别为1.0cm、1.5cm,慢性萎缩性胃炎,十二指肠球部溃疡(s2期),十二指肠球部炎症。,胃镜病理:(十二指肠降部)间质中量慢性炎症细胞及少量急性炎症细胞浸润,灶性腺体呈腺瘤样增生。(贲门)腺下皮轻度肠化,其上见胃固有腺,间质大量急、慢性炎症细胞浸润。,肠镜检查示:结肠多发息肉,直径0.6cm-1cm。予内镜上切除部分小息肉。,病理:(肝曲)肠管状腺瘤,伴腺下皮低级别下皮内瘤变,(横结肠)肠管状腺瘤,伴腺下皮低级别下皮内瘤变(中度不典型增生)。无腹痛、腹胀、腹泻、呕血、排黑便、排血便、里急后重,无恶心、呕吐,无反酸、嗳气、胸骨后烧灼感,无消瘦、食欲减退等。今为求进一步诊治求诊我院,门诊拟“胃肠息肉”收住院。近半个月以来,精神、睡眠、食欲尚可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "食管炎(a级)", "label": "疾病和诊断", "offset": "20"}, {"mention": "贲门", "label": "解剖部位", "offset": "28"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "57"}, {"mention": "十二指肠球部溃疡(s2期)", "label": "疾病和诊断", "offset": "65"}, {"mention": "十二指肠球部炎症", "label": "疾病和诊断", "offset": "79"}, {"mention": "十二指肠降部", "label": "解剖部位", "offset": "95"}, {"mention": "贲门", "label": "解剖部位", "offset": "136"}, {"mention": "胃", "label": "解剖部位", "offset": "150"}, {"mention": "结肠", "label": "解剖部位", "offset": "177"}, {"mention": "(肝曲)肠管状腺瘤", "label": "疾病和诊断", "offset": "212"}, {"mention": "腺下皮低级别下皮内瘤变", "label": "疾病和诊断", "offset": "223"}, {"mention": "(横结肠)肠管状腺瘤", "label": "疾病和诊断", "offset": "235"}, {"mention": "腺下皮低级别下皮内瘤变(中度不典型增生)", "label": "疾病和诊断", "offset": "247"}, {"mention": "腹痛", "label": "症状", "offset": "269"}, {"mention": "腹胀", "label": "症状", "offset": "272"}, {"mention": "腹泻", "label": "症状", "offset": "275"}, {"mention": "胸骨后", "label": "解剖部位", "offset": "308"}, {"mention": "胃肠息肉", "label": "疾病和诊断", "offset": "342"}]}
{"text": ",缘于入院前39个月因反复左上腹痛于我院行腹部b超示:回盲部壁增厚,癌可能。并于2010.11.1于我院肿瘤外科在全麻上行左半结肠切除术,盲肠部可及一大约3cm*4cm肿物,侵及浆膜层。术后病理(201026573),示:(左半结肠)大肠回盲部结外粘膜相关淋巴组织边缘区b细胞淋巴瘤(malt),侵犯浆膜层,手术标本双切端未见肿瘤。找到肠周淋巴结1/19个见淋巴瘤细胞浸润。,免疫组化:cd3(-),cd5(-),cd10(-),cd20(+++),cd21(-),cd23(-),cd30(-),cyclind1(-),ki67(10%),bcl-2(+++),cd56(-)。术后恢复可,切口ii/甲愈合。术后进一步查胸部+全腹ct未见明显复发转移征象,术后先后予chop(环磷酰胺1100mgiv,d1+表柔比星90mgiv,d1+长春新碱2mg,iv,d1+泼尼松10mgtid,d1-d14)3周方案全身化疗4周期,辅以保肝、止吐、调节免疫力等处理,化疗过程较顺利。最后一次化疗2011年1月27日。此后定期(3个月)复查胸部+全腹ct增强未见复发转移征象,血清β2微球蛋白阴性。今无腹痛、腹胀、腹泻,无恶心、呕吐等不适,今为求复查再次就诊我院,门诊拟回盲部淋巴瘤术后收住院。本次发病以来,精神、睡眠、食欲可,大小便如常,体重无骤变。", "mention_data": [{"mention": "左上腹", "label": "解剖部位", "offset": "13"}, {"mention": "腹部b超", "label": "影像检查", "offset": "21"}, {"mention": "回盲部", "label": "解剖部位", "offset": "27"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "61"}, {"mention": "盲肠部", "label": "解剖部位", "offset": "69"}, {"mention": "(左半结肠)大肠回盲部结外粘膜相关淋巴组织边缘区b细胞淋巴瘤(malt)", "label": "疾病和诊断", "offset": "111"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "168"}, {"mention": "胸部+全腹ct", "label": "影像检查", "offset": "311"}, {"mention": "环磷酰胺", "label": "药物", "offset": "339"}, {"mention": "表柔比星", "label": "药物", "offset": "355"}, {"mention": "长春新碱", "label": "药物", "offset": "369"}, {"mention": "泼尼松", "label": "药物", "offset": "383"}, {"mention": "肝", "label": "解剖部位", "offset": "416"}, {"mention": "胸部+全腹ct", "label": "影像检查", "offset": "466"}, {"mention": "腹痛", "label": "症状", "offset": "497"}, {"mention": "腹胀", "label": "症状", "offset": "500"}, {"mention": "腹泻", "label": "症状", "offset": "503"}, {"mention": "回盲部淋巴瘤术后", "label": "疾病和诊断", "offset": "531"}]}
{"text": ",缘于入院前3月余前于我院诊为胃癌,于2014-12-12在全麻上行腹腔镜上根治性远端胃大部切除术,术顺。术后病理示(胃大部),:胃体大弯侧溃疡型低分化腺癌,侵及浆膜层,侵犯神经,手术标本下、上双切端及另送(下切端)、(上切端)均未见癌浸润。找到小弯淋巴结0/10个,大弯淋巴结2/8个,幽门下淋巴结0/2个,幽门上淋巴结0/2个,及另送的(第一组)淋巴结0/1个,(第七组)淋巴结0/5个,(第八组)淋巴结0/1个,(第十二组)淋巴结0/3个,见癌转移。(第九组),:送检脂肪、纤维及神经组织。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。患者于2015-01-05行“奥沙利铂(齐沙)200mgivgtt+替吉奥60mgpod1-14。”化疗方案治疗1周期,辅以止吐、制酸、保肝等对症支持治疗,患者口服替吉奥时出现皮肤瘙痒、皮疹等不适,2015-01-24行“替加氟3.6g泵入+奥沙利铂130mgivgtt+亚叶酸钙300mgivgtt”方案化疗,2015-02-11,2015-02-28予“替加氟3.6g泵入+奥沙利铂130mgivgtt+亚叶酸钙300mgivgtt”方案化疗辅以止吐、保肝、制酸等处理。今为行第5周期化疗治疗,再次就诊我院,门诊拟胃癌术后收入院。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": "胃癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "腹腔镜上根治性远端胃大部切除术", "label": "手术", "offset": "34"}, {"mention": "胃", "label": "解剖部位", "offset": "59"}, {"mention": "胃体大弯侧溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "65"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "123"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "134"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "144"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "155"}, {"mention": "(第一组)淋巴结", "label": "解剖部位", "offset": "170"}, {"mention": "(第七组)淋巴结", "label": "解剖部位", "offset": "183"}, {"mention": "(第八组)淋巴结", "label": "解剖部位", "offset": "196"}, {"mention": "(第十二组)淋巴结", "label": "解剖部位", "offset": "209"}, {"mention": "奥沙利铂", "label": "药物", "offset": "292"}, {"mention": "齐沙", "label": "药物", "offset": "297"}, {"mention": "替吉奥", "label": "药物", "offset": "311"}, {"mention": "替吉奥", "label": "药物", "offset": "359"}, {"mention": "皮疹", "label": "疾病和诊断", "offset": "370"}, {"mention": "替加氟", "label": "药物", "offset": "388"}, {"mention": "奥沙利铂", "label": "药物", "offset": "398"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "413"}, {"mention": "替加氟", "label": "药物", "offset": "456"}, {"mention": "奥沙利铂", "label": "药物", "offset": "466"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "481"}, {"mention": "肝", "label": "解剖部位", "offset": "506"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "536"}, {"mention": "腹痛", "label": "症状", "offset": "561"}, {"mention": "腹胀", "label": "症状", "offset": "564"}]}
{"text": ",患者2014年3月无明显诱因上出现中下腹疼痛,较剧烈,每次持续2-3分钟,不伴放射痛,有反酸嗳气,患者食欲欠佳,进食油腻食物后即感恶心,无腹胀腹泻,无呕血黑便。于2014-4-1行pet-ct考虑为胃窦部mt伴胃周淋巴结转移;脂肪肝;肝左后叶上段及两肾囊肿;左肾小结石;2014-04-02在我院全麻上行胃癌根治术,毕ii式远端胃。术中见腹腔无腹水,肝脏、腹盆腔大网膜无异常。胃窦部小弯侧直径2cm增厚区,未浸润浆膜,胃周围可见肝动脉旁3cm肿瘤结节,淋巴结明显肿大。,病理:(远端胃)下皮性恶性肿瘤,部分区为神经内分泌癌(g3,约占肿瘤体积40%);部分为肉瘤样癌(约占肿瘤体积40%);部分为管状腺癌,分化ii级(lauren分型肠型,约占肿瘤组织20%)。癌组织浸润胃壁肌层。双切缘未见癌累及。检出大弯侧淋巴结8枚,均未见癌转移(0/8);检出小弯侧淋巴结19枚,其中5枚见癌转移(5/19),另见癌结节1枚;检出幽门上淋巴结12枚,其中3枚见癌转移(3/12)。免疫组化(2014-n3491),:tp(60%+),ts(20%+),b-tubulin(30%+),ki67(60%+),topii-a(40%+),ercc-1(-),c-met(-),her-2(0),ck广(神经内分泌癌及肠型腺癌区域100%++,肉瘤样癌区域约10%+),syn(30%++),chg(30%++),cd56(部分+)。叒手术过程顺利。术后恢复良好。患者术后分期pt2n3m0叒iiia期,有术后辅助化疗指征,考虑患者术后病理提示部分神经内分泌癌、部分肉瘤样癌、部分管状腺癌,拟三药联合方案,于2014.5.12、2014.6.2、2014.6.23、2014.7.15行第1-4次eox方案术后辅助化疗,,计划用药:表柔比星叒50mg/m2,奥沙利铂叒130mg/m2,希罗达叒1000mg/m2叒bid叒d1-14,,计算用药:表柔比星叒76.605mg叒d1,奥沙利铂叒199.173mg叒d1,希罗达叒1532.1mg/m2叒bid叒d1-14,,实际用药:表柔比星100mg叒d1,奥沙利铂叒150mg叒d1,希罗达叒1500mg叒bid叒d1-14叒q3w,期间于2014.7.15复查腹部ct未见明确复发转移灶。患者化疗耐受可,今日为行第5次辅助化疗治疗入院。患者患病以来,精神可,夜眠可,二便无殊,近期体重稳定。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "18"}, {"mention": "腹胀", "label": "症状", "offset": "70"}, {"mention": "腹泻", "label": "症状", "offset": "72"}, {"mention": "pet-ct", "label": "影像检查", "offset": "91"}, {"mention": "胃窦部mt伴胃周淋巴结转移", "label": "疾病和诊断", "offset": "100"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "114"}, {"mention": "肝左后叶上段及两肾囊肿", "label": "疾病和诊断", "offset": "118"}, {"mention": "左肾小结石", "label": "疾病和诊断", "offset": "130"}, {"mention": "胃癌根治术,毕ii式远端胃", "label": "手术", "offset": "153"}, {"mention": "腹腔", "label": "解剖部位", "offset": "170"}, {"mention": "腹水", "label": "症状", "offset": "173"}, {"mention": "肝脏", "label": "解剖部位", "offset": "176"}, {"mention": "腹盆腔", "label": "解剖部位", "offset": "179"}, {"mention": "胃窦部小弯侧", "label": "解剖部位", "offset": "189"}, {"mention": "胃周", "label": "解剖部位", "offset": "210"}, {"mention": "肝动脉", "label": "解剖部位", "offset": "215"}, {"mention": "(远端胃)下皮性恶性肿瘤,部分区为神经内分泌癌(g3,约占肿瘤体积40%);部分为肉瘤样癌(约占肿瘤体积40%);部分为管状腺癌,分化ii级(lauren分型肠型,约占肿瘤组织20%)", "label": "疾病和诊断", "offset": "239"}, {"mention": "胃", "label": "解剖部位", "offset": "337"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "353"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "376"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "411"}, {"mention": "神经内分泌癌", "label": "疾病和诊断", "offset": "667"}, {"mention": "部分肉瘤样癌", "label": "疾病和诊断", "offset": "674"}, {"mention": "部分管状腺癌", "label": "疾病和诊断", "offset": "681"}, {"mention": "表柔比星", "label": "药物", "offset": "759"}, {"mention": "奥沙利铂", "label": "药物", "offset": "772"}, {"mention": "希罗达", "label": "药物", "offset": "786"}, {"mention": "表柔比星", "label": "药物", "offset": "816"}, {"mention": "奥沙利铂", "label": "药物", "offset": "833"}, {"mention": "希罗达", "label": "药物", "offset": "851"}, {"mention": "表柔比星", "label": "药物", "offset": "883"}, {"mention": "奥沙利铂", "label": "药物", "offset": "896"}, {"mention": "希罗达", "label": "药物", "offset": "910"}, {"mention": "腹部ct", "label": "影像检查", "offset": "949"}]}
{"text": ",缘于入院前6月余于我院诊为胃窦癌,于2016-6-14在全麻上行腹腔镜上根治性远端胃大部切除术。,术中见:腹腔镜探查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。胃窦幽门管可见病灶,侵及浆膜层,侵及部分肝脏,侵及部分胰腺及横结肠系膜,周围可见大量肿大淋巴结,最大约1.5×1㎝,考虑为“胃窦癌伴出血伴肝脏、胰腺受侵”。术后病理(201620266)示(远端胃),:胃窦浸润型管状腺癌ii-iii级,侵出浆膜层,侵犯肝被膜至肝实质。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0/7个,幽门下淋巴结1/4个,幽门上淋巴结2/8个,见癌转移。,免疫组化:ki67(50%+),ck8(++),ck7(-),ck20(++),cd56(-),her-2(-),术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。术后分别于2016-09-04、2016-10-12、2016-11-07行乐沙定150mgivgttd1+替吉奥40mgpobidd1-14方案化疗,此次为行第4次化疗就诊我院,门诊拟胃窦癌术后化疗收入院。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": "胃窦癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上根治性远端胃大部切除术", "label": "手术", "offset": "33"}, {"mention": "腹腔", "label": "解剖部位", "offset": "54"}, {"mention": "腹腔", "label": "解剖部位", "offset": "60"}, {"mention": "腹水", "label": "症状", "offset": "66"}, {"mention": "盆腔", "label": "解剖部位", "offset": "69"}, {"mention": "腹", "label": "解剖部位", "offset": "72"}, {"mention": "肝脏", "label": "解剖部位", "offset": "87"}, {"mention": "胆囊", "label": "解剖部位", "offset": "103"}, {"mention": "胃窦幽门管", "label": "解剖部位", "offset": "109"}, {"mention": "肝脏", "label": "解剖部位", "offset": "129"}, {"mention": "胰腺", "label": "解剖部位", "offset": "136"}, {"mention": "横结肠", "label": "解剖部位", "offset": "139"}, {"mention": "胃窦癌伴出血伴肝脏、胰腺受侵", "label": "疾病和诊断", "offset": "171"}, {"mention": "胃", "label": "解剖部位", "offset": "206"}, {"mention": "胃窦浸润型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "210"}, {"mention": "肝", "label": "解剖部位", "offset": "235"}, {"mention": "肝实质", "label": "解剖部位", "offset": "239"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "269"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "279"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "290"}, {"mention": "行乐沙定", "label": "药物", "offset": "430"}, {"mention": "替吉奥", "label": "药物", "offset": "447"}, {"mention": "胃窦癌术后", "label": "疾病和诊断", "offset": "486"}, {"mention": "腹痛", "label": "症状", "offset": "514"}, {"mention": "腹胀", "label": "症状", "offset": "517"}]}
{"text": ",患者于2016-10-12在全麻上行\\\"胃癌根治术\\\"(远端胃切除术),,术后病理回报:“(胃大体)镜检为胃低粘附性癌,符合低分化腺癌,lauren,分型:弥漫型,癌组织浸润至胃壁浆膜上层,可见脉管内癌栓及神经束侵犯;网膜组织未见癌。淋巴结46枚,4枚见癌。(远、近切缘)未见癌”。2016-11-11,2016-12-05,2016-12-28已行sox方案化疗3程,现为行上一程术后辅助化疗收入我科。患者目前无恶心、呕吐,无腹泻、腹胀,精神尚可,食欲一般,大小便正常,身体减轻4kg。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "21"}, {"mention": "远端胃切除术", "label": "手术", "offset": "29"}, {"mention": "胃", "label": "解剖部位", "offset": "47"}, {"mention": "胃低粘附性癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "胃", "label": "解剖部位", "offset": "89"}, {"mention": "腹泻", "label": "症状", "offset": "215"}, {"mention": "腹胀", "label": "症状", "offset": "218"}]}
{"text": ",患者于2015年初患者出现呕吐、呕吐血性胃内容物,,外院查胃镜示:胃窦癌伴胃潴留,考虑胃癌,于2015-02-09于外院行“胃癌根治术”,病理提示低分化腺癌,,术后病理诊断:pt4n1m0(我院会诊病理切片示(胃窦)镜检为低分化腺癌,浸润胃壁全层至浆膜外脂肪组织。送检双切缘未见癌。送检癌结节一枚,淋巴结4枚,1/4见癌转移。)。术后于我院复查ct示未见复发转移。于2015-03及04月、2015-5-4给予sox方案化疗3程顺利,无不适。今为求进一步诊治来我院。患者发病以来,有呕吐等症状。精神不佳,饮食睡眠佳,大小便正常,体重无减轻。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "21"}, {"mention": "胃窦癌伴胃潴留", "label": "疾病和诊断", "offset": "34"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "44"}, {"mention": "胃癌根治术", "label": "手术", "offset": "63"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "74"}, {"mention": "胃窦", "label": "解剖部位", "offset": "106"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "112"}, {"mention": "胃", "label": "解剖部位", "offset": "120"}, {"mention": "ct", "label": "影像检查", "offset": "173"}]}
{"text": ",缘于入院前1月余于我院诊为肝曲结肠粘液腺癌侵犯十二指肠及肝门区,于2016-08-03在全麻上行剖腹探查+胃空肠吻合+升结肠-横结肠侧侧吻合术,,术中见:腹腔内无明显腹水,肝脏表面光滑,盆腔、肠系膜、网膜表面未见明显结节,升结肠肠管略扩张,结肠肝曲可触及一大小约8*7cm肿物,质硬,侵出浆膜层,并向后侵犯包绕十二指肠降部、水平部,向下侵犯肝十二指肠韧带上方,肿物部分与后腹膜粘连致密固定无法分离。遂行下术,术顺,术后予补液、抗感染、营养支持等治疗。,术后病理:(左结肠动脉旁淋巴结),:送检淋巴结1个见粘液腺癌转移,结合免疫组化结果,考虑消化系统来源。,免疫组化结果:ck7(-),ck20(+++),pax-8(-),cdx2(+++)。并于2016-08-24予“乐沙定100mgivgttqdd1+卡培他滨1500mgpobid×14天”方案行第1周期化疗,辅以保胃、保护粘膜、止吐及营养支持处理。今为行上一周期化疗,就诊我院门诊,门诊拟“升结肠癌术后化疗”收住入院,病程中精神、饮食、睡眠尚可,大小便正常,体重较前上降2kg。", "mention_data": [{"mention": "肝曲结肠粘液腺癌侵犯十二指肠及肝门区", "label": "疾病和诊断", "offset": "14"}, {"mention": "剖腹探查+胃空肠吻合+升结肠-横结肠侧侧吻合术", "label": "手术", "offset": "49"}, {"mention": "腹腔", "label": "解剖部位", "offset": "78"}, {"mention": "肝脏", "label": "解剖部位", "offset": "87"}, {"mention": "盆腔", "label": "解剖部位", "offset": "94"}, {"mention": "肠", "label": "解剖部位", "offset": "97"}, {"mention": "升结肠肠管", "label": "解剖部位", "offset": "112"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "121"}, {"mention": "十二指肠降部、水平部", "label": "解剖部位", "offset": "156"}, {"mention": "肝十二指肠韧带", "label": "解剖部位", "offset": "171"}, {"mention": "腹", "label": "解剖部位", "offset": "187"}, {"mention": "左结肠动脉旁淋巴结", "label": "解剖部位", "offset": "233"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "255"}, {"mention": "乐沙定", "label": "药物", "offset": "336"}, {"mention": "卡培他滨", "label": "药物", "offset": "354"}, {"mention": "胃", "label": "解剖部位", "offset": "387"}, {"mention": "升结肠癌术后化疗", "label": "疾病和诊断", "offset": "425"}]}
{"text": ",患者因“反复餐后腹胀、恶心1月余”于2015-07-03入住我院,外院未经提示胃癌,于2015-07-16在全麻上行胃癌姑息切除术(远端胃大切),,术中探查见:小网膜囊可见少量硬结,盆底、横结肠、肝脏、胰腺、脾脏等未见种植转移结节,肿物位于胃窦,大小约6*8cm,突破浆膜,侵犯周围结缔组织,遂行胃癌姑息切除术,术后预防感染支持对症等处理,恢复好,切口甲级愈合。术后病理示1(胃大体)镜检为中至低分化腺癌,部分为粘液腺癌(lauren,分型:混合型),癌组织浸润至胃壁浆膜层;可见脉管内癌栓及神经束侵犯;网膜组织中见淋巴结2枚,2/2见腺癌转移。2(第1组淋巴结)5枚,4/5见腺癌转移。3(第3组淋巴结)4枚,3/4见腺癌转移。4(第4组淋巴结)11枚,7/11见腺癌转移。5(第5组淋巴结)3枚,3/3见腺癌转移。6(第6组淋巴结)镜上为脂肪结缔组织,未见癌。7(第7组淋巴结)3枚,3/3见腺癌转移。8(第8组淋巴结)2枚,2/2见腺癌转移。9(第12a组淋巴结)镜上为脂肪结缔组织,未见癌。10(近切缘)未见癌。11(远切缘)未见癌。,免疫组化:vegf(+),her-2(0)。,原位杂交:ebers(-)。术后于2015-09-17、2015-10-15、2015-11-12予以sox(s-1叒60mg,bid×d1-14+oxa190mg×d1)方案化疗3程。今为求进一步诊治来我院。患者发病以来,无腹痛、恶心、呕吐、反酸、嗳气。精神佳,饮食睡眠佳,大小便正常,体重无减轻。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "9"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "胃癌姑息切除术(远端胃大切)", "label": "手术", "offset": "59"}, {"mention": "盆底", "label": "解剖部位", "offset": "92"}, {"mention": "横结肠", "label": "解剖部位", "offset": "95"}, {"mention": "肝脏", "label": "解剖部位", "offset": "99"}, {"mention": "胰腺", "label": "解剖部位", "offset": "102"}, {"mention": "脾脏", "label": "解剖部位", "offset": "105"}, {"mention": "胃窦", "label": "解剖部位", "offset": "121"}, {"mention": "胃癌姑息切除术", "label": "手术", "offset": "149"}, {"mention": "胃", "label": "解剖部位", "offset": "189"}, {"mention": "中至低分化腺癌,部分为粘液腺癌(lauren,分型:混合型)", "label": "疾病和诊断", "offset": "196"}, {"mention": "胃", "label": "解剖部位", "offset": "233"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "269"}, {"mention": "第1组淋巴结", "label": "解剖部位", "offset": "276"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "290"}, {"mention": "第3组淋巴结", "label": "解剖部位", "offset": "297"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "311"}, {"mention": "第4组淋巴结", "label": "解剖部位", "offset": "318"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "334"}, {"mention": "第5组淋巴结", "label": "解剖部位", "offset": "341"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "355"}, {"mention": "第6组淋巴结", "label": "解剖部位", "offset": "362"}, {"mention": "第7组淋巴结", "label": "解剖部位", "offset": "385"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "399"}, {"mention": "第8组淋巴结", "label": "解剖部位", "offset": "406"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "420"}, {"mention": "第12a组淋巴结", "label": "解剖部位", "offset": "427"}, {"mention": "s-1", "label": "药物", "offset": "551"}, {"mention": "oxa", "label": "药物", "offset": "570"}, {"mention": "腹痛", "label": "症状", "offset": "609"}]}
{"text": ",缘于入院前20个月因“中下腹闷痛”就诊于我院,查胃镜提示胃窦溃疡,恶性待排,住胸外科于2012.05.21在全麻上行根治性远端胃大部切除+毕i式吻合术,术中探查未见腹水,盆底、肝脏表面无转移性结节,肿瘤位于胃窦小弯侧,呈溃疡型,范围约4cmx3cm,侵及浆膜,另见小弯侧胃壁3枚米粒大小结节,,切除结节送术中冰冻示:平滑肌和小淋巴结2个,送检淋巴结呈反应性增生。手术顺利,术后病理(201214740),:(胃),:胃窦小弯侧溃疡型管状腺癌ii级,侵及浆膜层,侵犯神经组织,脉管内见癌栓。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1/14个、大弯淋巴结1/18个、幽门下淋巴结1/2个、幽门上淋巴结1/9个及另送(贲门右)淋巴结0/3个、(胃右动脉旁)淋巴结0/7个、(脾动脉旁)淋巴结0/2个、(肝总动脉旁)淋巴结0/4个见癌转移,(201214606),:(胃壁结节)送检少量平滑肌组织及淋巴结二个,淋巴结反应性增生。术后予“5-fu7500mg泵入+cf300mg静滴d1-5+顺铂30mg静滴d1-5q3w”化疗3周期及口服希罗达化疗2周期(具体不详),末次化疗时间2012.10。术后定期复查未见肿瘤复发转移。12,周前复查腹部b超:肝左叶实质性占位性病变,大小约27mm×26mm,,下消化道钡餐:吻合口区钡剂通过顺畅,两肺纹理增多增粗。遂就诊我科,查下腹部,ct:1、肝右内叶占位性病变,与2012-05-15旧片对比为新增病灶,考虑肝转移瘤,另肝内数个小囊肿,2、两肾多发囊肿,两肾小结石或钙化;cea24.8ng/ml;ca199149.1u/ml。于2013.11.2、2013.11.16、2013.11.30予folfox两周方案“奥沙利铂(艾恒)120mg静滴d1+亚叶酸钙300mg静滴d1、2+替加氟3g持续泵入44hd1q2w”姑息性化疗3周期,过程顺利。后复查腹部ct平扫+,增强:1、胃大部切除术后,残胃充盈欠佳,吻合口区未见明显占位性病变。2、肝右内叶占位性病变,考虑肝转移瘤,与2013-10-31旧片对比较前明显减小,另肝内数个小囊肿。3、所摄入右侧肾下腺内侧肢增粗,部分略呈结节状,转移不能排除。4、两肾多发囊肿;两肾小结石或钙化。cer13.97ng/ml,ca12510.95u/ml。疗效评价为pr。于2013.12.16在基础麻醉上行超声引导上右肝肿块射频消融术,术顺,术后无腹痛、恶心、呕吐等不适。于2013.12.21、2013.01.04予原方案(folfox两周方案)化疗第4、第5周期。目前患者无腹痛、恶心、呕吐,无纳差、乏力,无眼黄、尿黄、皮肤黄,今为进一步诊治,门诊拟“胃癌术后肝转移”收入我科。术后精神、睡眠、食欲尚可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "12"}, {"mention": "胃窦溃疡", "label": "疾病和诊断", "offset": "29"}, {"mention": "胸", "label": "解剖部位", "offset": "40"}, {"mention": "根治性远端胃大部切除+毕i式吻合术", "label": "手术", "offset": "59"}, {"mention": "腹水", "label": "症状", "offset": "83"}, {"mention": "盆底", "label": "解剖部位", "offset": "86"}, {"mention": "肝脏", "label": "解剖部位", "offset": "89"}, {"mention": "胃窦小弯侧", "label": "解剖部位", "offset": "104"}, {"mention": "小弯侧胃", "label": "解剖部位", "offset": "133"}, {"mention": "胃", "label": "解剖部位", "offset": "205"}, {"mention": "胃窦小弯侧溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "209"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "271"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "282"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "293"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "304"}, {"mention": "(贲门右)淋巴结", "label": "解剖部位", "offset": "317"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "330"}, {"mention": "(脾动脉旁)淋巴结", "label": "解剖部位", "offset": "345"}, {"mention": "(肝总动脉旁)淋巴结", "label": "解剖部位", "offset": "359"}, {"mention": "胃", "label": "解剖部位", "offset": "392"}, {"mention": "5-fu", "label": "药物", "offset": "426"}, {"mention": "cf", "label": "药物", "offset": "439"}, {"mention": "顺铂", "label": "药物", "offset": "453"}, {"mention": "希罗达", "label": "药物", "offset": "477"}, {"mention": "腹部b超", "label": "影像检查", "offset": "528"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "533"}, {"mention": "下消化道钡餐", "label": "影像检查", "offset": "559"}, {"mention": "两肺", "label": "解剖部位", "offset": "577"}, {"mention": "下腹部,ct", "label": "影像检查", "offset": "593"}, {"mention": "肝右内叶", "label": "解剖部位", "offset": "602"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "635"}, {"mention": "两肾多发囊肿", "label": "疾病和诊断", "offset": "651"}, {"mention": "cea", "label": "实验室检验", "offset": "667"}, {"mention": "ca199", "label": "实验室检验", "offset": "680"}, {"mention": "奥沙利铂", "label": "药物", "offset": "739"}, {"mention": "艾恒", "label": "药物", "offset": "744"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "757"}, {"mention": "替加氟", "label": "药物", "offset": "773"}, {"mention": "腹部ct平扫+,增强", "label": "影像检查", "offset": "808"}, {"mention": "胃大部切除术后", "label": "疾病和诊断", "offset": "821"}, {"mention": "胃", "label": "解剖部位", "offset": "830"}, {"mention": "肝右内叶", "label": "解剖部位", "offset": "852"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "864"}, {"mention": "肝", "label": "解剖部位", "offset": "892"}, {"mention": "右侧肾下腺内侧肢", "label": "解剖部位", "offset": "905"}, {"mention": "两肾多发囊肿", "label": "疾病和诊断", "offset": "933"}, {"mention": "两肾小结石或钙化", "label": "疾病和诊断", "offset": "940"}, {"mention": "cer", "label": "实验室检验", "offset": "949"}, {"mention": "ca125", "label": "实验室检验", "offset": "963"}, {"mention": "超声引导上右肝肿块射频消融术", "label": "手术", "offset": "1004"}, {"mention": "腹痛", "label": "症状", "offset": "1025"}, {"mention": "腹痛", "label": "症状", "offset": "1090"}, {"mention": "眼", "label": "解剖部位", "offset": "1107"}, {"mention": "胃癌术后肝转移", "label": "疾病和诊断", "offset": "1129"}]}
{"text": ",患者因“进食阻挡感1月余”于2017.10.23第1次入住我院,入院后完善相关辅助检查,ct检查示“考虑食管上段贲门ca可能性大,请结合内镜检查;肝多发囊肿;肝内钙化灶”,给予抑酸、保护胃黏膜、抗氧化等对症支持治疗,结合患者病史、胃镜检查、活检病理,诊断贲门腺癌明确,为行手术治疗于2017.10.25由消化科转入胸外1科。转科后完善相关术前检查,排除手术禁忌后,于2017.10.27全麻上行贲门癌根治术,术后病理(2017.10.31,病理号201725281),示:贲门腺癌(中度分化),浸润溃疡型,体积4*3.5*0.6cm,侵达浆膜;双端切线未查见癌;一组(1个)、二组(1个)、三组(4个)、“上段食管旁”(3个)、“贲门周围”(4个)、“胃右动脉旁”(8个)淋巴结未查见癌。,免疫组化染色示:cerbb-2(3+)、syn(-)、β-tubulin-iii少数(+)、叒rrm1少数(+)、topoii多数(+)。术后给予雾化、化痰、抗感染、抑酸、止疼、补液、营养支持等治疗,患者术后恢复良好,经口进食未诉明显不适、病情平稳后出院。叒叒叒患者自出院以来半流质饮食,偶有进食哽噎感,伴胸骨后烧灼感,无进食疼痛,无嗳气、呃逆,无声音嘶哑、饮食呛咳,无咳嗽、咳痰,无咯血,无胸痛、胸闷,无心悸,无恶心、呕吐,无腹痛、腹泻,今患者为求进一步诊治,再次来我院就诊,拟行全身化疗为主的肿瘤综合治疗,门诊以“贲门癌”收入院。叒叒叒患者神志清,精神、睡眠好,半流质饮食,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "ct", "label": "影像检查", "offset": "45"}, {"mention": "食管上段贲门ca", "label": "疾病和诊断", "offset": "53"}, {"mention": "肝多发囊肿", "label": "疾病和诊断", "offset": "74"}, {"mention": "肝内钙化", "label": "症状", "offset": "80"}, {"mention": "胃", "label": "解剖部位", "offset": "94"}, {"mention": "贲门腺癌", "label": "疾病和诊断", "offset": "128"}, {"mention": "胸", "label": "解剖部位", "offset": "158"}, {"mention": "贲门癌根治术", "label": "手术", "offset": "198"}, {"mention": "贲门腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "237"}, {"mention": "“上段食管旁”(3个)、“贲门周围”(4个)、“胃右动脉旁”(8个)淋巴结", "label": "解剖部位", "offset": "303"}, {"mention": "胸骨", "label": "解剖部位", "offset": "499"}, {"mention": "胸痛", "label": "症状", "offset": "542"}, {"mention": "胸闷", "label": "症状", "offset": "545"}, {"mention": "心悸", "label": "症状", "offset": "549"}, {"mention": "腹痛", "label": "症状", "offset": "560"}, {"mention": "腹泻", "label": "症状", "offset": "563"}, {"mention": "贲门癌", "label": "疾病和诊断", "offset": "605"}]}
{"text": ",缘于1月余前因“进行性吞咽困难伴疼痛半年,加重半个月”就诊我院,查胃镜示“食管癌(距门齿22cm)”,病理(,病理号:201334934)示“食管鳞状细胞癌ii级”;,胸腹部ct示:1、食管下段管壁不规则增厚,符合食管癌改变,肿块与气管后壁分界不清,邻近食管下段周围多发肿大淋巴结,下腹部贲门周围一淋巴结轻度增大,2、两上肺少许慢性炎症;两侧胸腔少量积液,3、左侧甲状腺甲状腺占位性病变。考虑肿瘤较大,尚不适手术,予排除化疗禁忌症,于2013.11.15按“顺铂40mgd1-3+安素泰240mgd2”行新辅助化疗,辅以止吐、制酸、保胃、抗过敏等治疗,化疗过程顺利,无诉特殊不适。今为行化疗再次入院。近来,精神、睡眠、饮食一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "食管鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "72"}, {"mention": "胸腹部ct", "label": "影像检查", "offset": "85"}, {"mention": "食管下段", "label": "解剖部位", "offset": "94"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "气管", "label": "解剖部位", "offset": "117"}, {"mention": "食管下段周围多发肿大淋巴结", "label": "解剖部位", "offset": "128"}, {"mention": "下腹部贲门周围一淋巴结", "label": "解剖部位", "offset": "142"}, {"mention": "两上肺", "label": "解剖部位", "offset": "160"}, {"mention": "两侧胸腔", "label": "解剖部位", "offset": "170"}, {"mention": "左侧甲状腺", "label": "解剖部位", "offset": "181"}, {"mention": "甲状腺", "label": "解剖部位", "offset": "186"}, {"mention": "顺铂", "label": "药物", "offset": "230"}, {"mention": "安素泰", "label": "药物", "offset": "241"}, {"mention": "胃", "label": "解剖部位", "offset": "268"}]}
{"text": ",缘于入院前2月于我院查胃镜示:1.食管癌;2.慢性萎缩性胃炎;3.胃角溃疡(s2期),,胃镜病理:(门齿30cm),:送检食管粘膜,鳞状下皮高级别下皮内瘤变,部分癌变为鳞状。胸部ct平扫+,增强示:主动脉弓上缘水平至右上上肺静脉水平食管壁不规则明显增厚,考虑食管癌,侵犯外膜可能,伴纵膈及所摄入右锁骨窝区、肝胃间隙多发肿大淋巴结,遂门诊拟食管癌收入院,患者食管中上段鳞癌诊断明确,据其肿瘤分期需行术前新辅助化疗,2016-05-29、2016-06-25予以tp方案“紫杉醇(泰素)210mgivgttd2+顺铂40mgivgttd1-3”方案化疗,辅以保肝、保胃、抗肿瘤等治疗。发病以来,精神、睡眠可,食欲欠佳,大小便如常,体重减轻6公斤。", "mention_data": [{"mention": "食管癌", "label": "疾病和诊断", "offset": "18"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "24"}, {"mention": "胃角溃疡(s2期)", "label": "疾病和诊断", "offset": "34"}, {"mention": "门齿", "label": "解剖部位", "offset": "51"}, {"mention": "食管", "label": "解剖部位", "offset": "62"}, {"mention": "鳞状下皮高级别下皮内瘤变", "label": "疾病和诊断", "offset": "67"}, {"mention": "胸部ct平扫+,增强", "label": "影像检查", "offset": "88"}, {"mention": "主动脉弓", "label": "解剖部位", "offset": "100"}, {"mention": "右上上肺", "label": "解剖部位", "offset": "109"}, {"mention": "食管", "label": "解剖部位", "offset": "117"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "130"}, {"mention": "纵膈及所摄入右锁骨窝区、肝胃间隙多发肿大淋巴结", "label": "解剖部位", "offset": "142"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "170"}, {"mention": "食管中上段鳞癌", "label": "疾病和诊断", "offset": "179"}, {"mention": "紫杉醇", "label": "药物", "offset": "235"}, {"mention": "泰素", "label": "药物", "offset": "239"}, {"mention": "顺铂", "label": "药物", "offset": "255"}, {"mention": "肝", "label": "解剖部位", "offset": "279"}, {"mention": "胃", "label": "解剖部位", "offset": "282"}]}
{"text": ",缘于入院前4月余因胸闷、气促就诊我院,,查全腹部ct提示:1、胃体部大弯、小弯壁不规则增厚,伴肝胃间隙、腹膜后多发淋巴结肿大,网膜增厚,为胃ca侵出浆膜层并网膜种植转移。2、腹腔、盆腔见大量积液。3、脾内类圆形低密度影,可能为转移瘤。4、两附件区多发囊实性病灶,为种植转移可能性大。5、所摄入两肺少许炎症,两侧胸腔少量积液。6、所摄入右房、右室增大。,我院麻醉胃镜:胃体癌慢性萎缩性胃炎。,病理示:(胃体)送检炎性肉芽组织中见多灶粘液湖,其内漂浮个别印戒样细胞,高度可疑癌。2014.03.03行“腹腔置管引流术”,于2014.03.05、2014.04.10予“乐沙定100mg+里葆多40mg”方案化疗,辅以保肝、止吐、补液等处理。过程顺利,无诉不适。03.14予腹腔腔内注射替加氟1g*3天+肿瘤坏死因子200万iu。于2014.05.14按“奥沙利铂(艾恒)150mg静滴d1+里葆多40mgd2”方案化疗,05.19、05.22、05.26予腹腔内注射“肿瘤坏死因子300万iu”。2014.06.23按“紫杉醇(安素泰)180mg+替吉奥60mgbid*14d”方案化疗,辅予止吐、保肝、营养等治疗,于2014.06.25予肿瘤坏死因子300万iu腹腔滴注。此次为化疗再次就诊我院,门诊拟胃体癌伴腹腔种植转移收入院。下次出院以来精神、睡眠、饮食尚可,诉偶有下腹胀痛不适,无发热,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "10"}, {"mention": "全腹部ct", "label": "影像检查", "offset": "22"}, {"mention": "胃体部大弯、小弯壁", "label": "解剖部位", "offset": "32"}, {"mention": "肝胃间隙", "label": "解剖部位", "offset": "48"}, {"mention": "腹膜后", "label": "解剖部位", "offset": "53"}, {"mention": "淋巴结肿大", "label": "症状", "offset": "58"}, {"mention": "胃ca侵出浆膜层并网膜种植转移", "label": "疾病和诊断", "offset": "70"}, {"mention": "腹腔", "label": "解剖部位", "offset": "88"}, {"mention": "盆腔", "label": "解剖部位", "offset": "91"}, {"mention": "脾", "label": "解剖部位", "offset": "101"}, {"mention": "两附件区", "label": "解剖部位", "offset": "120"}, {"mention": "两肺", "label": "解剖部位", "offset": "147"}, {"mention": "两侧胸腔", "label": "解剖部位", "offset": "154"}, {"mention": "右房", "label": "解剖部位", "offset": "168"}, {"mention": "右室", "label": "解剖部位", "offset": "171"}, {"mention": "胃体癌慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "184"}, {"mention": "胃体", "label": "解剖部位", "offset": "201"}, {"mention": "腹腔置管引流术", "label": "手术", "offset": "250"}, {"mention": "乐沙定", "label": "药物", "offset": "283"}, {"mention": "里葆多", "label": "药物", "offset": "292"}, {"mention": "肝", "label": "解剖部位", "offset": "308"}, {"mention": "腹腔", "label": "解剖部位", "offset": "335"}, {"mention": "替加氟", "label": "药物", "offset": "341"}, {"mention": "肿瘤坏死因子", "label": "药物", "offset": "350"}, {"mention": "奥沙利铂", "label": "药物", "offset": "376"}, {"mention": "艾恒", "label": "药物", "offset": "381"}, {"mention": "里葆多", "label": "药物", "offset": "394"}, {"mention": "腹腔", "label": "解剖部位", "offset": "427"}, {"mention": "肿瘤坏死因子", "label": "药物", "offset": "433"}, {"mention": "紫杉醇", "label": "药物", "offset": "459"}, {"mention": "安素泰", "label": "药物", "offset": "463"}, {"mention": "替吉奥", "label": "药物", "offset": "473"}, {"mention": "肝", "label": "解剖部位", "offset": "499"}, {"mention": "肿瘤坏死因子", "label": "药物", "offset": "519"}, {"mention": "腹腔", "label": "解剖部位", "offset": "531"}, {"mention": "胃体癌伴腹腔种植转移", "label": "疾病和诊断", "offset": "551"}, {"mention": "下腹胀痛", "label": "症状", "offset": "585"}]}
{"text": ",患者因“下腹部隐痛不适3月”于2014年4月就诊我院门诊,行胃镜病理示低分化腺癌,后入住我院胃肠外科于2014年5月6日在全麻上予行根治性远端胃大部切除、毕ii式吻合术,术后病理(201406646),:胃窦部腺癌(中、低度分化),体积4.6*4.5*0.3cm,侵达粘膜上层。双端切线未查见癌。呈四组(2/5个)、五组(1/3个)淋巴结癌转移。六组(4个)、“1、3、7组”(10个)淋巴结未查见癌。(腹膜后)脂肪坏死结节。,免疫组化染色示:ercc1少量(+)、β-tubulin-iii少量(+)、ts少量(+)、rrm1(-)、topoii多量(+)、cerbb-2(-)、syn(-)、cga(-)叒。术后患者恢复顺利,并行辅助化疗5周期,,化疗方案为:奥沙利铂200mg叒d1,希罗达2.0g叒bid叒d1-d14;化疗期间患者无明显副反应。末次化疗时间2014年10月8日。患者为行复查于2014年12月入住我科复查,ct:胃贲门癌术后ct所见,建议结合临床,左肺结节灶,较前无明显变化。肝脏多发低密度,符合囊肿ct表现,较前无明显变化,建议复查。复查腹部彩超示;肝内钙化灶,肝囊肿,胆囊息肉,右上腹皮上脂肪层强回声团,考虑脂肪瘤。此次为行复查入院。叒叒叒叒叒目前患者精神及情绪状态可,饮食好,夜间睡眠可,大小便正常,近期无明显体重变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "5"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "36"}, {"mention": "胃", "label": "解剖部位", "offset": "47"}, {"mention": "肠", "label": "解剖部位", "offset": "48"}, {"mention": "根治性远端胃大部切除、毕ii式吻合术", "label": "手术", "offset": "67"}, {"mention": "胃窦部腺癌(中、低度分化)", "label": "疾病和诊断", "offset": "103"}, {"mention": "四组(2/5个)、五组(1/3个)淋巴结癌", "label": "解剖部位", "offset": "150"}, {"mention": "六组(4个)、“1、3、7组”(10个)淋巴结", "label": "解剖部位", "offset": "174"}, {"mention": "腹", "label": "解剖部位", "offset": "203"}, {"mention": "奥沙利铂", "label": "药物", "offset": "333"}, {"mention": "希罗达", "label": "药物", "offset": "346"}, {"mention": "ct", "label": "影像检查", "offset": "417"}, {"mention": "胃贲门癌术后", "label": "疾病和诊断", "offset": "420"}, {"mention": "左肺", "label": "解剖部位", "offset": "438"}, {"mention": "肝脏", "label": "解剖部位", "offset": "452"}, {"mention": "ct", "label": "影像检查", "offset": "464"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "484"}, {"mention": "肝内钙化", "label": "症状", "offset": "490"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "496"}, {"mention": "胆囊息肉", "label": "疾病和诊断", "offset": "500"}, {"mention": "右上腹", "label": "解剖部位", "offset": "505"}, {"mention": "脂肪瘤", "label": "疾病和诊断", "offset": "520"}]}
{"text": ",患者因患“胃癌”于2006-8-9于我院在全麻上予行“姑息性近端胃大部切除、幽门成形术”,,术后病理回示:贲门腺癌(中度分化),浸润溃疡型,面积6*3cm,侵穿浆膜,周围淋巴结未查见癌。术后行6周期化疗,化疗期间病人无明显不适,适应性良好。自出院后,患者每年复查1次,一般情况保持良好,近来感下腹部隐痛不适,无发热、腹泻、腹胀,无反酸、嗳气等不适。3月前患者再次来院复查,查cea明显增高,为83.96ng/ml,,行胃镜检查示:食管上端近原手术吻合口见菜花样病变,胃食管食管吻合口以远至胃体,见大面积的菜花样隆起,,病理示:(胃体)高级别下皮内瘤变(重度异型增生及原位癌)。考虑胃癌术后复发可能性大,已给予序贯化疗3次,方案为奥沙利铂200mg叒d1+亚叶酸钙0.3g叒d2-6叒+替加氟1000mg叒d2-6叒静滴。经化疗后cea指标呈上降趋势,最近1次cea为50.12ng/ml化疗期间患者消化道反应较重、白细胞降低,均给予对症处理。出院后一般情况良好,进食、大小便恢复正常。现患者为行进一步复查治疗就诊,门诊以“胃癌术后”收入院。叒叒叒目前患者精神及情绪状态可,食欲、饮食可,夜间睡眠正常,大小便正常,近期无明显体重变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "姑息性近端胃大部切除、幽门成形术", "label": "手术", "offset": "28"}, {"mention": "贲门腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "54"}, {"mention": "下腹部", "label": "解剖部位", "offset": "147"}, {"mention": "腹泻", "label": "症状", "offset": "159"}, {"mention": "腹胀", "label": "症状", "offset": "162"}, {"mention": "cea", "label": "实验室检验", "offset": "188"}, {"mention": "食管上端", "label": "解剖部位", "offset": "216"}, {"mention": "胃食管", "label": "解剖部位", "offset": "234"}, {"mention": "食管", "label": "解剖部位", "offset": "237"}, {"mention": "胃体", "label": "解剖部位", "offset": "245"}, {"mention": "(胃体)高级别下皮内瘤变(重度异型增生及原位癌)", "label": "疾病和诊断", "offset": "264"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "291"}, {"mention": "奥沙利铂", "label": "药物", "offset": "315"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "328"}, {"mention": "替加氟", "label": "药物", "offset": "343"}, {"mention": "cea", "label": "实验室检验", "offset": "365"}, {"mention": "cea", "label": "实验室检验", "offset": "380"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "462"}]}
{"text": ",缘于入院前1年余患者因“体检发现“血psa”升高1个月”为主诉入院,,入院后查免疫:t--psa5.05ng/ml、f--psa0.463ng/ml、f/t9.2。行“b超引导上经直肠前列腺穿刺活检”,恢复好,病理报告(201231203),:1.(右外侧中部),:前列腺癌gleanson分级iii级(评分2+3=5分)。,免疫组化染色:灶性ck(h)、p63示腺体基底细胞消失,p504s腺体阳性。2.(右、左外侧基底部)、(左外侧中部)、(右、左外侧尖部),:前列腺增生症,伴pini级。,免疫组化染色:ck(h)(基底细胞+),p63(基底细胞+),p504s(-)。,全身骨ect示:未见明显异常。当时予拟手术治疗,因患者暂不想手术并要求出院,故未经手术治疗,予口服‘氟他安’治疗,并嘱其出院后定期复查。1年患者定期复查psa均无异常。今为进一步诊疗求诊我院。门诊拟“前列腺癌”收入院。患者自发病来体重无明显变化,体力情况良好,小便如前所述,大便正常,睡眠良好,食欲一般,精神状态一般。", "mention_data": [{"mention": "t--psa", "label": "实验室检验", "offset": "43"}, {"mention": "f--psa", "label": "实验室检验", "offset": "59"}, {"mention": "f/t", "label": "实验室检验", "offset": "76"}, {"mention": "b超引导上经直肠前列腺穿刺活检", "label": "手术", "offset": "85"}, {"mention": "前列腺癌gleanson分级iii级", "label": "疾病和诊断", "offset": "134"}, {"mention": "前列腺增生症,伴pini级", "label": "疾病和诊断", "offset": "234"}, {"mention": "全身骨ect", "label": "影像检查", "offset": "290"}, {"mention": "psa", "label": "实验室检验", "offset": "366"}]}
{"text": "入院前2+月,因诊断结肠肿瘤于我科住院治疗,于2015年09月24日在全麻上行腹腔镜上腹腔探查术、中转开腹,右半结肠癌根治术、小肠系膜结节活检、开腹肿瘤特殊治疗、肠粘连松解术。术后病检示(病理号1508031):右半结肠粘液性腺癌(中分化),侵及浆膜层外脂肪组织、肠系膜及网膜癌转移、肠系膜淋巴结未见癌转移(0/14),两侧切缘未见癌累及。术后予以止血、镇痛、补液、抑酸、雾化祛痰、抗感染等对症治疗。目前患者无恶心、呕吐、腹痛、腹胀、便血等表现,今日前来我院,拟行第2次化疗,故以\\\"右半结肠癌术后叒第2次化疗\\\"收入我科住院治疗。叒叒叒近期患者精神、食欲、睡眠可,大小便正常,体重无明显改变。", "mention_data": [{"mention": "结肠肿瘤", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹腔镜上腹腔探查术、中转开腹,右半结肠癌根治术、小肠系膜结节活检、开腹肿瘤特殊治疗、肠粘连松解术", "label": "手术", "offset": "39"}, {"mention": "右半结肠粘液性腺癌(中分化)", "label": "疾病和诊断", "offset": "106"}, {"mention": "肠系膜及网膜癌转移", "label": "疾病和诊断", "offset": "132"}, {"mention": "肠系膜淋巴结", "label": "解剖部位", "offset": "142"}, {"mention": "腹痛", "label": "症状", "offset": "211"}, {"mention": "腹胀", "label": "症状", "offset": "214"}, {"mention": "右半结肠癌术后", "label": "疾病和诊断", "offset": "242"}]}
{"text": ",2016.2.17行“胃癌切除术”,具体术式不详,术后病理示(远端胃及大网膜),切除:溃疡型低分化腺癌,伴印戒细胞癌,lauren,分型:弥漫型;癌侵及浆膜;可见脉管癌栓及神经侵犯(免疫组化cd34、d2-40证实);十二指肠残端及胃残端未见癌;网膜组织未见癌;淋巴结可见癌转移(第1组6/12,第3组1/1,第4sb组0/0,第4d组0/1,第5组1/1,第6组6/8,第7组1/1,第8组1/3,第9组0/3,第11p组0/0,第12a组0/0,第14v组1/1);(第1组淋巴结)其中一枚淋巴结内见异位胰腺组织;-叒,肿瘤病理分期:pt4an3b。,免疫组化结果显示肿瘤:afp(-),cmet(1+),eber(-),egfr(2+),her2(0),ki-67(+25~50%),mlh1(+>75%),msh2(+>75%),msh6(+>75%),pdl-1(-),pms2(+>75%),sall4(-),ck(+)。,淋巴结转移癌:ck(+)。入组resolve叒a组叒已行xelox方案化疗3周期,末次化疗2016.04.11,化疗后出现恶心2度,影响进食,目前患者大小便基本正常,化疗后体重上降3kg。", "mention_data": [{"mention": "胃癌切除术", "label": "手术", "offset": "12"}, {"mention": "胃", "label": "解剖部位", "offset": "34"}, {"mention": "溃疡型低分化腺癌,伴印戒细胞癌,lauren,分型:弥漫型", "label": "疾病和诊断", "offset": "44"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "110"}, {"mention": "胃", "label": "解剖部位", "offset": "117"}, {"mention": "第1组淋巴结", "label": "解剖部位", "offset": "237"}, {"mention": "胰腺", "label": "解剖部位", "offset": "255"}]}
{"text": ",患者因卵巢癌于2016-04-12行“经腹筋膜外子宫+两附件切除+大网膜切除+阑尾切除+盆腔转移病灶清除+肿瘤细胞减灭术”,手术过程顺利,术后输液抗炎治疗。,常规病理结果示:(两侧附件)高级别浆液性乳头状癌,右卵巢肿物切面积2.8*1.5cm,左卵巢肿物切面积6*3.5cm,两侧输卵管查见癌。阑尾、“盆腔转移灶”查见癌,另送大网膜组织中查见癌。(子宫)萎缩的子宫内膜;慢性宫颈炎。右宫旁查见癌,左宫旁未查见癌。,免疫组化:er(2+,20%),pr(1+,2%),wt-1(+),p53(-),ki67阳性率约50%。于2016-01-22给予多西他赛(多帕菲)100mg+卡铂400mg方案化疗,患者住院期间化疗毒副反应轻。今日入院,拟行第2次化疗。患者自出院后,无发热,无咳嗽咳痰,恶心呕吐轻,无腹痛腹胀,无阴道流血及排液,饮食睡眠可,大小便无异常,体重增加1kg。", "mention_data": [{"mention": "卵巢癌", "label": "疾病和诊断", "offset": "4"}, {"mention": "经腹筋膜外子宫+两附件切除+大网膜切除+阑尾切除+盆腔转移病灶清除+肿瘤细胞减灭术", "label": "手术", "offset": "20"}, {"mention": "(两侧附件)高级别浆液性乳头状癌", "label": "疾病和诊断", "offset": "88"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "105"}, {"mention": "左卵巢", "label": "解剖部位", "offset": "123"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "139"}, {"mention": "阑尾", "label": "解剖部位", "offset": "148"}, {"mention": "盆腔", "label": "解剖部位", "offset": "152"}, {"mention": "子宫", "label": "解剖部位", "offset": "175"}, {"mention": "子宫内膜", "label": "解剖部位", "offset": "181"}, {"mention": "慢性宫颈炎", "label": "疾病和诊断", "offset": "186"}, {"mention": "右宫", "label": "解剖部位", "offset": "192"}, {"mention": "左宫", "label": "解剖部位", "offset": "199"}, {"mention": "多西他赛", "label": "药物", "offset": "274"}, {"mention": "多帕菲", "label": "药物", "offset": "279"}, {"mention": "卡铂", "label": "药物", "offset": "289"}, {"mention": "腹痛", "label": "症状", "offset": "352"}, {"mention": "腹胀", "label": "症状", "offset": "354"}, {"mention": "阴道", "label": "解剖部位", "offset": "358"}]}
{"text": "患者因“腹痛1月余”于2011-11-17入我院,查ca125为1349u/ml,ca153为189.7u/ml,nse为25.15ng/ml。b超提示“左侧卵巢实性占位伴中至大量腹水”,考虑“卵巢癌”,于2011-11-24行“肿瘤细胞减灭术(全子宫+两附件切除术+大网膜切除术+dixon术+回盲部切除术)”。术程顺利,减瘤满意,残存肿瘤直径小于1cm。术后病理示:两侧卵巢见低分化浆液性腺癌浸润,脉管内见癌栓;子宫底壁外膜层、右输卵管外膜层、直肠外膜层及肌层见浆液性腺癌浸润;回盲部肠管肠壁浆膜层、肌层、粘膜上层及粘膜层均见低分化浆液性腺癌浸润,脉管内见癌栓,另见2枚淋巴结有腺癌转移;余送检、大网膜、结肠表面肿物均见低分化腺癌浸润。术后诊断“卵巢浆液性腺癌iiic期”。术后出现肠瘘,保守治疗效果欠佳,遂于2011-12-09行“腹腔清创引流+回肠造瘘术”,术后予加强营养等治疗。一般情况恢复、腹壁切口愈合良好后于2012-01-18、2012-02-23、2012-5-17予tp(北华素180mg,波贝500mg)方案化疗3程,化疗后无明显恶心、呕吐反应,出现两脚底麻木感,予营养神经治疗后好转。今遵原主诊教授意见为行化疗入院。下次出院至今,患者精神、食欲、睡眠可,大便正常,小便顺畅,体重稍有增加。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "4"}, {"mention": "ca125", "label": "实验室检验", "offset": "26"}, {"mention": "ca153", "label": "实验室检验", "offset": "41"}, {"mention": "nse", "label": "实验室检验", "offset": "57"}, {"mention": "b超", "label": "影像检查", "offset": "72"}, {"mention": "左侧卵巢", "label": "解剖部位", "offset": "77"}, {"mention": "腹水", "label": "症状", "offset": "90"}, {"mention": "卵巢癌", "label": "疾病和诊断", "offset": "97"}, {"mention": "肿瘤细胞减灭术(全子宫+两附件切除术+大网膜切除术+dixon术+回盲部切除术)", "label": "手术", "offset": "115"}, {"mention": "两侧卵巢见低分化浆液性腺癌浸润", "label": "疾病和诊断", "offset": "185"}, {"mention": "子宫底", "label": "解剖部位", "offset": "208"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "216"}, {"mention": "直肠", "label": "解剖部位", "offset": "224"}, {"mention": "回盲部", "label": "解剖部位", "offset": "241"}, {"mention": "肠管", "label": "解剖部位", "offset": "244"}, {"mention": "肠", "label": "解剖部位", "offset": "246"}, {"mention": "低分化浆液性腺癌", "label": "疾病和诊断", "offset": "265"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "291"}, {"mention": "结肠", "label": "解剖部位", "offset": "304"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "312"}, {"mention": "卵巢浆液性腺癌iiic期", "label": "疾病和诊断", "offset": "325"}, {"mention": "肠瘘", "label": "疾病和诊断", "offset": "343"}, {"mention": "腹腔清创引流+回肠造瘘术", "label": "手术", "offset": "369"}, {"mention": "腹", "label": "解剖部位", "offset": "401"}, {"mention": "北华素", "label": "药物", "offset": "446"}, {"mention": "波贝", "label": "药物", "offset": "455"}, {"mention": "两脚底", "label": "解剖部位", "offset": "486"}]}
{"text": ",患者3余月前因“胃癌”于我院在全麻上行“胃大部切除术”。,术中探查:未见腹水,p0h0,肿瘤位于胃窦小弯明显浸透浆膜外,浆膜呈皱缩上凹状部分网膜覆盖其下。,术后病理:,病理诊断:,进行期胃窦癌:borrmann3型叒浸润深度(se)叒浸润溃疡型,低-中分化腺癌叒断端无癌叒,静脉癌栓:,无叒淋巴管癌栓:无叒伴淋巴结转移(1/38枚)叒。(,病理号:199546)。患者术后恢复良好。今为求进一步治疗,遂来我院。病来,患者饮食睡眠可,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "胃大部切除术", "label": "手术", "offset": "21"}, {"mention": "腹水", "label": "症状", "offset": "37"}, {"mention": "胃窦小弯", "label": "解剖部位", "offset": "49"}, {"mention": "胃窦癌:borrmann3型叒浸润深度(se)叒浸润溃疡型,低-中分化腺癌", "label": "疾病和诊断", "offset": "94"}]}
{"text": ",患者4年前因\\\"胸中段段食管中-低分化鳞癌\\\"于我院行“经右胸食管癌根治+胃食管主动脉弓下吻合术”,,术后复查:2015年2月25日,我院ct检查示:食道癌术后改变,纵隔胃代食管未见明显软组织肿物。气管右侧旁淋巴结转移。,超声检查示:右侧颈部vi区及iv区小淋巴结,其中vi区最大淋巴结较前次检查(2014-11-04)增大,考虑恶性可能性大。2015年02月27日,右颈肿大淋巴结穿刺活检病理考虑:增生的纤维组织中见高至中分化鳞状细胞癌浸润,考虑为食管癌转移。现患者出现声嘶20天,考虑右颈转移淋巴结侵犯喉返神经。今为进一步诊治收入我科。起病以来,患者无发热、咳嗽,无胸闷、胸痛,无恶心、呕吐,胃纳、睡眠、精神可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "胸中段段食管中-低分化鳞癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "经右胸食管癌根治+胃食管主动脉弓下吻合术", "label": "手术", "offset": "29"}, {"mention": "ct", "label": "影像检查", "offset": "70"}, {"mention": "食道癌术后", "label": "疾病和诊断", "offset": "76"}, {"mention": "纵隔", "label": "解剖部位", "offset": "84"}, {"mention": "胃", "label": "解剖部位", "offset": "86"}, {"mention": "食管", "label": "解剖部位", "offset": "88"}, {"mention": "气管右侧旁淋巴结", "label": "解剖部位", "offset": "100"}, {"mention": "右侧颈部vi区及iv区小淋巴结", "label": "解剖部位", "offset": "118"}, {"mention": "vi区最大淋巴结", "label": "解剖部位", "offset": "136"}, {"mention": "右颈肿大淋巴结", "label": "解剖部位", "offset": "185"}, {"mention": "高至中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "210"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "226"}, {"mention": "右颈转移淋巴结", "label": "解剖部位", "offset": "245"}, {"mention": "喉", "label": "解剖部位", "offset": "254"}, {"mention": "胸闷", "label": "症状", "offset": "286"}, {"mention": "胸痛", "label": "症状", "offset": "289"}, {"mention": "胃", "label": "解剖部位", "offset": "299"}]}
{"text": ",缘于4个月前因食管胃交界腺癌于我院行(2015.10.19)正中开腹根治性全胃切除+食管-空肠roux-en-y吻合+空肠造瘘+脾切除术,术后病理(201537413),:(全胃),:食管-胃交界处溃疡型混合型腺神经内分泌癌[腺癌为管状腺癌ii-iii级,神经内分泌肿瘤为g3型(神经内分泌癌)],浸润脉管及神经组织,脉管内见癌栓,侵出浆膜层。手术标本下切端、上切端,及另送(最下切端)均未见癌浸润。找到贲门周淋巴结1/4个,小弯侧淋巴结1/11个,大弯侧淋巴结0/6个,幽门上淋巴结0/2个。脾脏组织。,免疫组化染色结果:ki67(30%阳性),p53(++),mlh1(++),msh-6(+++),cga(+++),cd56(++),sy(++)。(mm2051901)该病例未检测到kras基因12、13号密码子热点突变。(mm20151902)该病例未检测到braf基因v600e突变。术后恢复良好,目前进食半流质膳食,无不适。分别于2015.11.25、2015.12.25、2016.01.21日行3周期化疗,“顺铂40mg静滴d1-3+紫杉醇180mg静滴d2”方案,今为求术后第4周期化疗再诊我院,门诊拟食管胃交界腺癌术后化疗收住我科。近来,精神、睡眠、饮食一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管胃交界腺癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "正中开腹根治性全胃切除+食管-空肠roux-en-y吻合+空肠造瘘+脾切除术", "label": "手术", "offset": "31"}, {"mention": "胃", "label": "解剖部位", "offset": "89"}, {"mention": "食管-胃交界处溃疡型混合型腺神经内分泌癌[腺癌为管状腺癌ii-iii级,神经内分泌肿瘤为g3型(神经内分泌癌)]", "label": "疾病和诊断", "offset": "93"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "203"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "214"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "226"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "237"}, {"mention": "脾脏", "label": "解剖部位", "offset": "248"}, {"mention": "顺铂", "label": "药物", "offset": "464"}, {"mention": "紫杉醇", "label": "药物", "offset": "477"}, {"mention": "食管胃交界腺癌术后", "label": "疾病和诊断", "offset": "512"}]}
{"text": ",患者5年余前因\\\"升结肠癌\\\"在外院手术治疗,术后规律完成辅助化疗(xelox方案化疗8程),但未规律复查。近1年偶有大便带血,量少,大便不成形,1-3次/天,无腹痛、腹胀,无黑便、恶心等,未予重视。于2015-01月至外院复查肠镜发现距肛40cm结肠肿物,肠镜不能通过,活检病理提示腺癌。叒于2015-01-22至我院全麻上行\\\"右半结肠切除术\\\",,术后病理示:(乙状结肠大体)镜检为肠低分化腺癌(印戒细胞癌),浸润至肠壁浆膜上层,未见脉管内癌栓及神经束侵犯;网膜组织未见癌。区域淋巴结15/22(+),,免疫组化:er(-),ercc1(+),mlh1(+),msh2(-),msh6(-),pms2(+),ki67(40%+),ck(+)。,术后分期:pt3n2bm0叒iiic期。于2015-03-25、2015-04-11、2015-04-28、2015-05-12及2015-05-26;2015-6-9、2015-06-23给予叒folfox叒方案化疗7程顺利,化疗耐受性可,今为进一步治疗入院。近期患者精神胃纳睡眠尚可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "升结肠癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹痛", "label": "症状", "offset": "82"}, {"mention": "腹胀", "label": "症状", "offset": "85"}, {"mention": "肛", "label": "解剖部位", "offset": "120"}, {"mention": "结肠", "label": "解剖部位", "offset": "125"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "143"}, {"mention": "右半结肠切除术", "label": "手术", "offset": "167"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "185"}, {"mention": "肠低分化腺癌(印戒细胞癌)", "label": "疾病和诊断", "offset": "195"}, {"mention": "肠", "label": "解剖部位", "offset": "212"}, {"mention": "胃", "label": "解剖部位", "offset": "463"}]}
{"text": "入院前1月,患者因确诊“食管下段鳞癌”于2016年04月11日在全麻+两腔上行经颈胸腹下段食管癌切除术、术后标本送病检(1603183):食管鳞状细胞癌侵及全层,远近切缘均未见癌累及,贲门上淋巴结见癌转移(1/1),胃右动脉旁、隆突上淋巴结未见癌转移,术后予以心电监护、禁食、水、胃肠减压、静脉高营养、抗感染、祛痰、解痉、护胃、止血、降血压等对症支持治疗后,好转出院。今患者为行第一次化疗来我院就诊,门诊以“食管癌”收入我科住院治疗。叒叒叒自患病以来,患者精神、食欲、睡眠尚可,二便正常,体征无明显上降。", "mention_data": [{"mention": "食管鳞状细胞癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "贲门上淋巴结", "label": "解剖部位", "offset": "92"}]}
{"text": ",患者于69天前于我院因“,盆腔包块:卵巢ca?”行“腹腔镜上腹膜活检术+右侧卵巢切除术”,术中切除右侧卵巢及2.0cm*1.0cm大小腹膜送冰冻病理切片,2013-4-27叒,冰冻切片报告单检查报告:1、(右卵巢)卵巢组织中见腺癌。2、(腹膜)纤维脂肪组织中见腺癌。检查无活动性出血后,手术顺利,麻醉满意,术中出血约50ml,术毕安返病房。2013-4-28叒,组织病理检查报告:1、(右卵巢)送检组织中见腺癌组织,待免疫组化进一步明确类型。2、(腹膜)送检纤维脂肪组织中可见少许腺癌组织。2013-05-03(右卵巢)中-低分化宫内膜样腺癌伴腹膜转移。,术后给予:补液、抗炎对症治疗。术后给予紫杉醇静滴+顺铂腹腔灌注化疗双次,化疗过程中病员有恶心、呕吐等不适。现患者来我院要求行第3次化疗。\\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": "盆腔包块", "label": "症状", "offset": "14"}, {"mention": "卵巢ca", "label": "疾病和诊断", "offset": "19"}, {"mention": "腹腔镜上腹膜活检术+右侧卵巢切除术", "label": "手术", "offset": "27"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "50"}, {"mention": "腹", "label": "解剖部位", "offset": "68"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "104"}, {"mention": "卵巢", "label": "解剖部位", "offset": "108"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "114"}, {"mention": "腹", "label": "解剖部位", "offset": "120"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "131"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "194"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "204"}, {"mention": "腹", "label": "解剖部位", "offset": "225"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "241"}, {"mention": "(右卵巢)中-低分化宫内膜样腺癌伴腹膜转移", "label": "疾病和诊断", "offset": "256"}, {"mention": "紫杉醇", "label": "药物", "offset": "298"}, {"mention": "顺铂", "label": "药物", "offset": "304"}, {"mention": "腹腔", "label": "解剖部位", "offset": "306"}]}
{"text": "缘于入院1年前于我院诊为“直肠癌伴肝转移”,于2015年12月07日在全麻上行“腹腔镜上直肠姑息性切除术+末段回肠造瘘术”,术顺,术后病理示:(直肠)大肠溃疡型管状腺癌ii级,部分为筛状粉刺型,侵出外膜层,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2/21个,及另送(肠系膜上动脉根部)淋巴结0/1个,见癌转移。术后恢复良好。于2015.12.30、2016.01.21、2016.02.13、2016.03.06、2016.03.30、2016.04.22、2016.05.12、2016.06.03、2016.06.27、2016.07.21、2016.08.11、2016.9.02、2016.10.27、2016.11.18、2016.12.23行“伊立替康240mgivgttd1+卡培他滨1500mgpobidd1-d14”化疗,辅以止吐、制酸、保肝、增强免疫等,化疗过程顺利,未见明显不适。出院后无头晕、乏力,无口腔溃疡、手足麻木无力等不适。此次为行第16次化疗就诊我院,门诊拟“直肠癌术后化疗”收入院。下次出院以来精神、睡眠、饮食可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "直肠癌伴肝转移", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜上直肠姑息性切除术+末段回肠造瘘术", "label": "手术", "offset": "40"}, {"mention": "直肠", "label": "解剖部位", "offset": "72"}, {"mention": "大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "75"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "132"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "146"}, {"mention": "伊立替康", "label": "药物", "offset": "342"}, {"mention": "卡培他滨", "label": "药物", "offset": "359"}, {"mention": "肝", "label": "解剖部位", "offset": "393"}, {"mention": "头晕", "label": "症状", "offset": "419"}, {"mention": "口腔溃疡", "label": "症状", "offset": "426"}, {"mention": "手足麻木", "label": "症状", "offset": "431"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "460"}]}
{"text": "缘于1个多月前因食管下段癌于我院行胸腹腔镜联合全胸段食管切除+食管-胃底右颈部吻合术。手术顺利。术后病理(病理号:201607041)示食管髓质型高分化鳞状细胞癌,侵及外膜层,手术标本双切端未见癌浸润,找到食管周淋巴结1个,未见癌转移。现患者一般情况尚可,无明显恶心、呕吐,无头晕、头痛,无咳嗽、咳痰,无胸闷、胸痛,无腹痛、腹胀,无周身骨骼疼痛等不适。今为求入院第1周期化疗再诊我院,门诊拟食管癌(t3n2m0iiib期)收住我科。近来,精神、睡眠、饮食一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管下段癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "胸腹腔镜联合全胸段食管切除+食管-胃底右颈部吻合术", "label": "手术", "offset": "17"}, {"mention": "食管髓质型高分化鳞状细胞癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "食管周淋巴结", "label": "解剖部位", "offset": "103"}, {"mention": "头晕", "label": "症状", "offset": "138"}, {"mention": "头痛", "label": "症状", "offset": "141"}, {"mention": "胸闷", "label": "症状", "offset": "152"}, {"mention": "胸痛", "label": "症状", "offset": "155"}, {"mention": "腹痛", "label": "症状", "offset": "159"}, {"mention": "腹胀", "label": "症状", "offset": "162"}, {"mention": "骨骼", "label": "解剖部位", "offset": "168"}, {"mention": "食管癌(t3n2m0iiib期)", "label": "疾病和诊断", "offset": "195"}]}
{"text": ",患者2月余前因“反复剑突上痛3年余,加重2月。”入院,入院完善辅助检查后于2015.12.09在or于全麻上行“远端胃切除+b-ii重建+空肠braun吻合”术,术后予以预防感染,对症支持治疗,恢复顺利,,术后病理:(胃大体)镜检为胃粘液腺癌,lauren,分型:肠型,浸润至胃壁浆膜层,可见脉管及神经束侵犯;网膜组织未见癌。切缘未见癌。淋巴结6/44见粘液腺癌转移。,免疫组化:癌细胞叒her-2(0),vegf(+)。,原位杂交:ebers(-)。术后于2016-01-20行sox(奥沙利铂叒150mg叒+叒替吉奥叒50mg叒bid)第1疗程化疗,无明显不良反应。现为行术后第二次化疗返院。自下次出院,患者无发热,无头痛、头晕,无咳嗽、咳痰,无心悸、胸闷、胸痛,无尿频、尿急。精神、睡眠可,胃纳一般,二便正常,患者体重上降2kg。", "mention_data": [{"mention": "剑突", "label": "解剖部位", "offset": "11"}, {"mention": "or", "label": "影像检查", "offset": "49"}, {"mention": "远端胃切除+b-ii重建+空肠braun吻合", "label": "手术", "offset": "57"}, {"mention": "胃", "label": "解剖部位", "offset": "110"}, {"mention": "胃粘液腺癌,lauren,分型:肠型", "label": "疾病和诊断", "offset": "117"}, {"mention": "胃", "label": "解剖部位", "offset": "139"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "178"}, {"mention": "奥沙利铂", "label": "药物", "offset": "245"}, {"mention": "替吉奥", "label": "药物", "offset": "258"}, {"mention": "头痛", "label": "症状", "offset": "312"}, {"mention": "头晕", "label": "症状", "offset": "315"}, {"mention": "心悸", "label": "症状", "offset": "326"}, {"mention": "胸闷", "label": "症状", "offset": "329"}, {"mention": "胸痛", "label": "症状", "offset": "332"}]}
{"text": ",缘于入院前28个月因结肠息肉行腹部ct示肝脏数个低、稍低密度灶,部分为小囊肿,部分转移瘤不能排除,并于2012.03.06行腹腔镜上乙状结肠病损切除术,术后病理(201206355),示:(降结肠肿瘤及肠管系膜),:肠溃疡型管状腺癌ii级,侵出外膜层。手术标本双切口及另送(下切端)、(上切端)均未见癌浸润。找到肿物周淋巴结4/10个,肠周淋巴结2/8个见癌转移,术后患者恢复顺利出院。于2012-4-25在b超引导上行“左肝转移灶射频消融术”,并于2012-5-8及2012-5-30行2次“艾恒150mg+希罗达1000mgbid*14天”化疗。于2012-06-22、2012-08-24、2012-10-11、2013-01-18、2013-03-11、2013-04-08行肝动脉置管(5-fu+亚叶酸钙+艾恒)化疗,此后不定期复查。今为进一步治疗就诊于我院,门诊拟结肠癌肝转移术后介入术后收入院。目前患者精神、睡眠、饮食尚可,大小便无明显异常,体重未见明显减轻。", "mention_data": [{"mention": "结肠息肉", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹部ct", "label": "影像检查", "offset": "16"}, {"mention": "肝脏", "label": "解剖部位", "offset": "21"}, {"mention": "腹腔镜上乙状结肠病损切除术", "label": "手术", "offset": "63"}, {"mention": "降结肠肿瘤", "label": "疾病和诊断", "offset": "96"}, {"mention": "肠管系膜", "label": "解剖部位", "offset": "102"}, {"mention": "肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "109"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "左肝转移灶射频消融术", "label": "手术", "offset": "212"}, {"mention": "艾恒", "label": "药物", "offset": "248"}, {"mention": "希罗达", "label": "药物", "offset": "256"}, {"mention": "肝", "label": "解剖部位", "offset": "343"}, {"mention": "5-fu", "label": "药物", "offset": "349"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "354"}, {"mention": "艾恒", "label": "药物", "offset": "359"}, {"mention": "结肠癌肝转移术后", "label": "疾病和诊断", "offset": "389"}]}
{"text": ",患者5月余前因“发作性胸闷、憋气半年余,加重1月余”入院,,行肠镜检查提示:结肠癌、结肠多发息肉。查无手术禁忌后于2016-11-03日在全身麻醉上行左半结肠切除术。,术后病理示:结肠腺癌(中-低度分化),浸润溃疡型,体积7.5*4*1.7cm,侵穿浆膜,未累及底部切除面及双端切线。叒“一站”(7个)、“二站”(5个)、“三站”(12个)淋巴结未查见癌。慢性阑尾炎,外膜有较多中性粒细胞浸润。,癌组织免疫组化染色示:syn(-)、braf(-)、mlh1(+)、msh2(+)、msh6(+)、pms2(±)。院外期间患者一般情况好,无恶心,无腹痛腹胀胀不适,现患者为行复查及化疗来院就诊,门诊以“结肠癌术后”收入院。叒叒叒近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "12"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "43"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "76"}, {"mention": "结肠腺癌(中-低度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "91"}, {"mention": "慢性阑尾炎", "label": "疾病和诊断", "offset": "179"}, {"mention": "腹痛", "label": "症状", "offset": "274"}, {"mention": "腹胀", "label": "症状", "offset": "276"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "301"}]}
{"text": ",患者2016年2月因“反复下腹痛4月余。”入院,入院完善辅助检查,,明确诊断:胃癌。后于2016-02-17在or于全麻上行“腹腔镜辅助胃癌根治术(远端胃切除+b-ii重建+空肠空肠braun吻合)”,术后予以预防感染,对症支持治疗,恢复顺利,,术后病理回报:(胃大体)镜检为中-低分化腺癌,部分为印戒细胞癌,lauren,分型:混合型,癌组织浸润至胃壁浆膜上层,可见脉管内癌栓及神经束侵犯。切缘未见癌。淋巴结)2/46见腺癌转移。,免疫组化:ck(+),vegf(+),her-2(-)。,原位杂交:ebers(-)。叒术后于2016-03-21、2016-04-11、2016-05-03、2016-05-23、2016-06-13、2016-07-05在我院行(奥沙利铂叒150mg叒q3w叒ivdrip叒d1叒+叒替吉奥叒60mg叒bid叒po叒d1-14)化疗6疗程,过程顺利。现为行术后第7疗程化疗返院治疗。自下次出院以来,患者体重无明显变化。", "mention_data": [{"mention": "下腹痛", "label": "症状", "offset": "14"}, {"mention": "胃", "label": "解剖部位", "offset": "40"}, {"mention": "腹腔镜辅助胃癌根治术", "label": "手术", "offset": "64"}, {"mention": "远端胃切除", "label": "手术", "offset": "75"}, {"mention": "b-ii重建", "label": "手术", "offset": "81"}, {"mention": "空肠空肠braun吻合", "label": "手术", "offset": "88"}, {"mention": "胃大体", "label": "解剖部位", "offset": "132"}, {"mention": "中-低分化腺癌,部分为印戒细胞癌,lauren,分型:混合型", "label": "疾病和诊断", "offset": "139"}, {"mention": "胃", "label": "解剖部位", "offset": "176"}, {"mention": "奥沙利铂", "label": "药物", "offset": "335"}, {"mention": "替吉奥", "label": "药物", "offset": "362"}]}
{"text": ",患者约于1个月前因“胃癌”于2014-10-23在全麻上行根治性胃大部切除、毕i式吻合术,手术顺利,术后给予输液、抗生素及营养支持等治疗。,术后病理示:(9302.2012)胃窦大弯侧腺癌(中度分化),浸润溃疡型,面积2.5*2cm,厚2.8cm,侵达浆膜。双端切线未查见癌。四组(5个)、六组(9个)、“1、3、7组”(8个)淋巴结,未查见癌。,术后病理分期:pt4an0m0,iib期。院外期间,患者无发热,无腹痛腹胀不适,大便通畅。现患者为行复查化疗来我科就诊,以“胃癌术后”收入院。叒叒叒叒病人自下次出院以来,神志清,精神可,饮食可,大、小便正常,体重未见明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "根治性胃大部切除、毕i式吻合术", "label": "手术", "offset": "30"}, {"mention": "胃窦大弯侧腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "88"}, {"mention": "四组(5个)、六组(9个)、“1、3、7组”(8个)淋巴结", "label": "解剖部位", "offset": "139"}, {"mention": "腹痛", "label": "症状", "offset": "208"}, {"mention": "腹胀", "label": "症状", "offset": "210"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "237"}]}
{"text": ",患者3月前因“下腹部疼痛不适半年余,加重伴进食后呕吐2月余”入院,于2016-9-7在全麻上行胃癌根治术(毕-ii式吻合),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:胃窦低分化腺癌,体积3.5*3.5*1.6cm,浸润溃疡型,侵穿浆膜。双端切线未查见癌。呈“第六组”(6/13个)、“胃第六组”(1/1)淋巴结癌转移。第三组(4个)、第四组(4个)、“胃第七组”(1个)淋巴结未查见癌。第五组查见癌结节一个。,癌组织免疫组化染色示:cerbb-2(1+)、syn(-)、β-tubulin-iii(-)、叒rrm1个别(+)、topoii(+)。根据患者病情具有化疗指征,于2016-09-25开始第一周期化疗,,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,患者化疗耐受可,无明显化疗副反应。现患者为求明确诊疗来我院就诊,门诊以“胃癌术后”收入我科。叒叒叒患者自发病以来,精神可,饮食欠佳,睡眠可,二便正常,体重减轻约14kg。体力无明显改变。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "8"}, {"mention": "胃癌根治术", "label": "手术", "offset": "48"}, {"mention": "毕-ii式吻合", "label": "手术", "offset": "54"}, {"mention": "胃窦低分化腺癌", "label": "疾病和诊断", "offset": "95"}, {"mention": "“胃第六组”(1/1)淋巴结", "label": "解剖部位", "offset": "153"}, {"mention": "第三组(4个)、第四组(4个)、“胃第七组”(1个)淋巴结", "label": "解剖部位", "offset": "171"}, {"mention": "奥沙利铂", "label": "药物", "offset": "323"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "336"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "345"}, {"mention": "肝", "label": "解剖部位", "offset": "371"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "419"}]}
{"text": ",患者4月前因“下腹部疼痛不适10余年,加重1月余”入院,2016-06-02在全麻上行胃癌根治+幽门成形术,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:(201611546),:胃体小弯腺癌(中度分化),局部伴神经内分泌分化,体积2*1*0.5cm,溃疡型,侵达浅肌层。双端切线及另送“近切线”未查见癌。叒呈“三组”淋巴结(8/13个)淋巴结癌转移。“四组”(5个)淋巴结未查见癌。叒,癌组织免疫组化染色示:ts部分(+)、topoii多数(+)、β-tubulin-iii少数(+)、叒rrm1(-)、syn部分(-)、cerbb-2(-)。术后给予辅助化疗,,方案为:奥沙利铂150mg叒d1+亚叶酸钙0.3g叒d2-6叒+氟尿嘧啶750mg叒d2-6叒静滴。现患者为求复查化疗来我院就诊,为行进一步治疗,门诊以\\\"胃癌术后\\\"收入我科。叒叒叒患者自发病以来,精神可,饮食可,睡眠可,二便正常,体重体力无明显改变。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "8"}, {"mention": "胃癌根治+幽门成形术", "label": "手术", "offset": "44"}, {"mention": "胃体小弯腺癌(中度分化)", "label": "疾病和诊断", "offset": "100"}, {"mention": "“三组”淋巴结", "label": "解剖部位", "offset": "165"}, {"mention": "“四组”(5个)淋巴结", "label": "解剖部位", "offset": "186"}, {"mention": "奥沙利铂", "label": "药物", "offset": "297"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "310"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "325"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "371"}]}
{"text": ",患者于1月前因“反复中下腹闷痛不适3月”入院,诊为胃癌,于2013年12月10日在全麻上行根治性全胃切除术+食管空肠roux-y吻合术(d2),手术顺利。术中见腹腔内无明显粘连,无明显腹水,盆腔、腹壁、大网膜无明显转移结节,肝脏表面光滑,未见明显转移灶,肿瘤位于贲门胃体下段小弯侧,侵出浆膜层,活动度可,周围可及明显肿大淋巴结,主要位于胃小弯侧及胃右动脉旁。术后病理(201339038),:(全胃),:食管胃交界溃疡型低分化腺癌,侵出浆膜层,侵犯神经,脉管内见癌栓,手术标本下、上切端及另送(下切端)均未见癌浸润,找到贲门左淋巴结1/2个,小弯淋巴结5/11个,大弯淋巴结0/1个,幽门上淋巴结0/3个,及另送的(胃右动脉根部)淋巴结2/5个见癌转移。另送(脾门淋巴结)为纤维、脂肪组织。术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。此次为术后第1次化疗入院。患者出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "11"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "26"}, {"mention": "根治性全胃切除术+食管空肠roux-y吻合术(d2)", "label": "手术", "offset": "46"}, {"mention": "腹腔", "label": "解剖部位", "offset": "81"}, {"mention": "腹水", "label": "症状", "offset": "93"}, {"mention": "盆腔", "label": "解剖部位", "offset": "96"}, {"mention": "腹", "label": "解剖部位", "offset": "99"}, {"mention": "肝脏", "label": "解剖部位", "offset": "113"}, {"mention": "贲门胃体下段小弯侧", "label": "解剖部位", "offset": "132"}, {"mention": "胃小弯侧", "label": "解剖部位", "offset": "169"}, {"mention": "胃", "label": "解剖部位", "offset": "174"}, {"mention": "胃", "label": "解剖部位", "offset": "199"}, {"mention": "食管胃交界溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "203"}, {"mention": "贲门左淋巴结", "label": "解剖部位", "offset": "261"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "272"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "283"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "293"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "308"}, {"mention": "脾门淋巴结", "label": "解剖部位", "offset": "331"}, {"mention": "腹痛", "label": "症状", "offset": "399"}, {"mention": "腹胀", "label": "症状", "offset": "402"}]}
{"text": ",患者6月余前因“直肠癌”在我院行直肠癌dixon手术,手术过程顺利,术后给予抗感染、营养支持并补液治疗,患者2017-02-15因“直肠癌术后吻合口瘘”行“横结肠造口术”,手术过程顺利,术后给予抗感染、营养支持、补液及对症治疗,,术后病理检查结果回示:(直肠)腺癌(中、低度分化,局部伴神经内分泌分化;部分为粘液腺癌,约占30%),叒隆起型,体积2*2*1.5cm,局部侵达深肌层,并肠壁外脂肪组织内查见癌转移叒灶(1处),长径约0.7cm,双端切线及另送“近切线”、“远切线”未查见癌。叒多发性增生性(锯齿状)息肉。叒一站淋巴结(8个)未查见癌。,癌组织免疫组化染色示:syn局部(+)、braf(-)、msh2(+)、msh6(+)、叒mlh1(+)、pms2(+)。病情稳定后出院.患者于2017-6-2、2017-7-2及2017-7-30来我院入住我科,排除化疗禁忌后给予奥沙利铂200mgd1+氟尿嘧啶0.75g叒d2-d6+亚叶酸钙0.3g叒d2-d6,辅以保肝、护胃、止吐等对症支持治疗,过程顺利,患者耐受可,化疗结束后出院。叒叒叒出院后患者病情稳定,无发热畏寒,无恶心呕吐,无咳嗽胸闷,无腹胀腹泻以及腹痛,精神好,饮食好,睡眠好,小便正常,体重无明显改变。现患者为求进一步治疗入院,门诊以“直肠癌术后”收入院。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "直肠癌dixon手术", "label": "手术", "offset": "17"}, {"mention": "直肠癌术后吻合口瘘", "label": "疾病和诊断", "offset": "67"}, {"mention": "横结肠造口术", "label": "手术", "offset": "79"}, {"mention": "(直肠)腺癌(中、低度分化,局部伴神经内分泌分化;部分为粘液腺癌,约占30%),叒隆起型", "label": "疾病和诊断", "offset": "127"}, {"mention": "肠", "label": "解剖部位", "offset": "193"}, {"mention": "多发性增生性(锯齿状)息肉", "label": "疾病和诊断", "offset": "246"}, {"mention": "一站淋巴结", "label": "解剖部位", "offset": "261"}, {"mention": "奥沙利铂", "label": "药物", "offset": "392"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "404"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "420"}, {"mention": "肝", "label": "解剖部位", "offset": "438"}, {"mention": "胃", "label": "解剖部位", "offset": "441"}, {"mention": "胸闷", "label": "症状", "offset": "500"}, {"mention": "腹胀", "label": "症状", "offset": "504"}, {"mention": "腹泻", "label": "症状", "offset": "506"}, {"mention": "腹痛", "label": "症状", "offset": "510"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "555"}]}
{"text": ",患者于2012-11无明显诱因出现下腹不适,轻度腹痛,与饮食无关,伴嗳气,无反酸、腹胀、恶心、呕吐及黑便。2012-11-9,就诊*********行电子胃镜检查:胃窦小弯侧见一巨大溃疡,大小约4.0x4.0cm,周围粘膜红肿,累及胃角,,胃窦活检病理为:粘膜慢性炎伴溃疡形成,局部腺体排列紊乱,不排外恶变可能.2012-11-22,入**三院行电子胃镜检查示:胃角结构破坏,可见一3x3cm巨大溃疡,底部凹凸不平,,胃角粘膜活检病理为:低分化腺癌。后转我院就诊,于2012-12-14日在全麻上行“胃癌根治术”术程顺利,术后病理为胃低分化腺癌,浸润至浆膜层,淋巴结7(+)/34,后遵原主诊医师意见2013-01-06、2013-01-25、2-25、3-15予多西他赛+s-1”化疗3程,过程顺利。现为上一程化疗入院,起病以来,精神、饮食、睡眠尚可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "18"}, {"mention": "腹痛", "label": "症状", "offset": "25"}, {"mention": "腹胀", "label": "症状", "offset": "42"}, {"mention": "胃窦小弯侧", "label": "解剖部位", "offset": "83"}, {"mention": "胃角", "label": "解剖部位", "offset": "117"}, {"mention": "胃窦", "label": "解剖部位", "offset": "121"}, {"mention": "胃角", "label": "解剖部位", "offset": "182"}, {"mention": "胃角", "label": "解剖部位", "offset": "210"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "220"}, {"mention": "胃癌根治术", "label": "手术", "offset": "251"}, {"mention": "胃低分化腺癌", "label": "疾病和诊断", "offset": "267"}, {"mention": "多西他赛", "label": "药物", "offset": "333"}, {"mention": "s-1", "label": "药物", "offset": "338"}]}
{"text": "患者3个多月前因“大便习性改变4个月。”到我院就诊,经肠镜、mr等检查考虑为直肠肿物,侵犯粘膜上层,经多次表面活检及穿刺病理均未见癌。2016-3-11全麻上行tem术,术中见肿物巨大,并与固有肌层粘连,予粘膜上层分离并分块切除。术中冰冻病理报告未见癌。术后石蜡病理提示腺癌,侵犯粘膜肌层并有中断。术后诊断为腺癌pt1n0m0。考虑肿物基底为下次肠镜息肉切除后疤痕,可能有残留,2016-5-21全麻上行腹腔镜dixon+回肠造瘘术,术后病理:肠壁及淋巴结未见癌残留。术后恢复较慢。出院后造口排液较稀,无腹痛、发热等其他不适。现为造口回纳收入院。自下次出院以来,患者无恶心、呕吐等,无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,体重上降月8kg。", "mention_data": [{"mention": "mr", "label": "影像检查", "offset": "30"}, {"mention": "直肠", "label": "解剖部位", "offset": "38"}, {"mention": "tem术", "label": "手术", "offset": "80"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "135"}, {"mention": "腺癌pt1n0m0", "label": "疾病和诊断", "offset": "154"}, {"mention": "腹腔镜dixon+回肠造瘘术", "label": "手术", "offset": "202"}, {"mention": "肠壁及淋巴结", "label": "解剖部位", "offset": "222"}, {"mention": "腹痛", "label": "症状", "offset": "252"}, {"mention": "骶部", "label": "解剖部位", "offset": "304"}]}
{"text": "缘于入院前9月于我院诊为胃癌,于2014-02-24在全麻上行腹腔镜上根治性远端胃大部切除术,术后病理示(远端胃)胃窦小弯侧溃疡型管状腺癌ii-iii级,侵出浆膜层,侵犯神经,脉管内见癌栓,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3/9个,大弯淋巴结4/6个,幽门下淋巴结0/5个,幽门上淋巴结0/3个,及另送(第8组)淋巴结1/2个,(第15组)淋巴结0/1个见癌转移。另送(第14v组淋巴结)为脂肪、纤维及脉管组织。免疫组化结果:ck7(+++),ck20(-),villin(+++),cea(+++),cdx-2(灶+),cga(-),cd56(-),sy(-),ki67(30%+),her-2(++)。术后恢复情况良好,术后已予“奥沙利铂200mgd1+多柔比星60mgd1+替吉奥60mgbidd1-d14”方案化疗6周期,过程顺利,效果良好,未见明显化疗副反应。此次为复查就诊我院,门诊拟胃癌术后化疗收入院。下次出院以来精神、睡眠、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": "12"}, {"mention": "腹腔镜上根治性远端胃大部切除术", "label": "手术", "offset": "31"}, {"mention": "远端胃", "label": "解剖部位", "offset": "53"}, {"mention": "胃窦小弯侧溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "57"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "121"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "131"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "141"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "152"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "166"}, {"mention": "(第15组)淋巴结", "label": "解剖部位", "offset": "179"}, {"mention": "第14v组淋巴结", "label": "解剖部位", "offset": "200"}, {"mention": "奥沙利铂", "label": "药物", "offset": "332"}, {"mention": "多柔比星", "label": "药物", "offset": "344"}, {"mention": "替吉奥", "label": "药物", "offset": "355"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "413"}, {"mention": "腹痛", "label": "症状", "offset": "440"}, {"mention": "腹胀", "label": "症状", "offset": "443"}]}
{"text": ",患者因“直肠癌”于2017-02-17在全麻上行直肠癌根治术(dixon),术后给予抗感染、营养支持、抑酸治疗,患者恢复好,切口愈合良好。,术后病理:直肠腺癌(中、低度分化),部分呈粘液腺癌分化,隆起型,体积9*9*2.5cm,侵穿浆膜,于外膜脂肪组织内查见一处癌转移灶。双端切线及另送“近切线”、“远切线”未查见癌。呈“一站”(1/12个)淋巴结癌转移。叒“中央组”(2个)、“中间组”(1个)未查见癌。,免疫组化染色示:syn(-)、braf(-)、mlh1(+)、msh2(+)、msh6(+)、pms2(+)。叒2017-03-17开始化疗,方案为奥沙利铂200mgd1,亚叶酸钙300mg+氟尿嘧啶750mg叒d2-d6,化疗期间有恶心、无呕吐,院外期间患者一般情况好,无恶心,无腹痛腹胀不适,现患者为行复查及化疗再次来院就诊,门诊以“直肠癌术后”收入院。叒叒叒近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "直肠癌根治术(dixon)", "label": "手术", "offset": "25"}, {"mention": "直肠腺癌(中、低度分化),部分呈粘液腺癌分化,隆起型", "label": "疾病和诊断", "offset": "76"}, {"mention": "“一站”(1/12个)淋巴结", "label": "解剖部位", "offset": "161"}, {"mention": "奥沙利铂", "label": "药物", "offset": "279"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "291"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "301"}, {"mention": "腹痛", "label": "症状", "offset": "346"}, {"mention": "腹胀", "label": "症状", "offset": "348"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "374"}]}
{"text": "入院前3月,患者因直肠癌于本院行腹腔镜辅助上直肠癌根治术(miles),手术顺利。术后组织病理检查报告示直肠溃疡型中分化管状腺癌,浸及肠壁全层,可见神经侵犯及癌栓。切端未见癌累及。肠壁淋巴结可见癌转移(1/2)。术后患者恢复好,无畏寒发热,无恶心呕吐,无腹胀腹痛,造瘘口排便排气通畅,已行folfox方案化疗2次,为求术后第3次化疗于今日入院。\\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": "直肠癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "腹腔镜辅助上直肠癌根治术(miles)", "label": "手术", "offset": "16"}, {"mention": "直肠溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "52"}, {"mention": "肠", "label": "解剖部位", "offset": "67"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "90"}, {"mention": "腹胀", "label": "症状", "offset": "127"}, {"mention": "腹痛", "label": "症状", "offset": "129"}, {"mention": "胃", "label": "解剖部位", "offset": "193"}]}
{"text": ",2012-11-30行右乳癌根治术,术后病理示(右)乳腺浸润性导管癌,ii级,大小1.8×xxx1.7×xxx1.5cm,未见脉管癌栓;乳头及皮肤未见特殊。,肿瘤病理分期:pt1c。(右腋窝前哨)淋巴结未见癌转移(0/1);(右腋窝前哨及导丝定位)淋巴结未见癌转移(0/2)。,免疫组化染色结果:ck(-)。,免疫组化:er(+>75%),pr(+约20%),her-2(1+)。术后cef方案化疗6周期,现口服来曲唑(芙瑞)内分泌治疗。叒5-20本院胃镜检查提示慢性胃炎,hp(-)。现恶心未吐,进食少,大便可,睡眠差。", "mention_data": [{"mention": "右乳癌根治术", "label": "手术", "offset": "12"}, {"mention": "(右)乳腺浸润性导管癌,ii级", "label": "疾病和诊断", "offset": "24"}, {"mention": "(右腋窝前哨)淋巴结", "label": "解剖部位", "offset": "92"}, {"mention": "(右腋窝前哨及导丝定位)淋巴结", "label": "解剖部位", "offset": "113"}, {"mention": "来曲唑", "label": "药物", "offset": "207"}, {"mention": "芙瑞", "label": "药物", "offset": "211"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "233"}]}
{"text": "缘于入院前4年余因“乙状结肠癌”于我院行“腹腔镜辅助上乙状结肠癌根治术”,术后病理(201131862)回报“(乙状)结肠蕈伞型管状腺癌ii级,侵及浆膜层,手术标本下、上切端及另送(下、上切端)未见癌浸润,找到肠周淋巴结11个均未见癌转移,另送(肠系膜上动脉根部淋巴结)为脂肪脉管结缔组织”,术后恢复良好出院,出院后于门诊定期复查期间发现肝、肺、骨多发转移。3年前开始口服希罗达及中药治疗(具体不详),治疗期间未诉不适。入院前2天患者无明显诱因出现纳差,并逐渐出现乏力感,无恶心、呕吐,无腹痛、腹胀、腹泻,无发热、畏寒等不适,今为求进一步诊治,就诊我院,门诊拟“乙状结肠癌术后伴肝、骨、肺多发转移”收治入院,自发病以来,饮食较差,睡眠可,二便正常,体重较前无明显改变。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹腔镜辅助上乙状结肠癌根治术", "label": "手术", "offset": "21"}, {"mention": "(乙状)结肠蕈伞型管状腺癌ii级", "label": "疾病和诊断", "offset": "55"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "105"}, {"mention": "肠系膜上动脉根部淋巴结", "label": "解剖部位", "offset": "123"}, {"mention": "肝", "label": "解剖部位", "offset": "169"}, {"mention": "肺", "label": "解剖部位", "offset": "171"}, {"mention": "骨", "label": "解剖部位", "offset": "173"}, {"mention": "希罗达", "label": "药物", "offset": "186"}, {"mention": "腹痛", "label": "症状", "offset": "244"}, {"mention": "腹胀", "label": "症状", "offset": "247"}, {"mention": "腹泻", "label": "症状", "offset": "250"}, {"mention": "乙状结肠癌术后伴肝、骨、肺多发转移", "label": "疾病和诊断", "offset": "281"}]}
{"text": ",缘于入院前[主诉单一时间1年于我院诊断“降结肠癌”,查无禁忌后,于2014年04月28日在全麻上行腹腔镜上右半结肠切除术。,术中见:无腹水,肝表面光滑,胃及空肠未见明显病变。降结肠可见一大约2*3cm隆起型肿物,质硬,侵出浆膜层,肠系膜根部未见明显肿大淋巴结,术顺,术后予抗炎、制酸、补液等对症治疗,,术后病理示:(结肠),:肠隆起型管状腺癌ii级,侵及粘膜上层,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14个,及另送(肠系膜动脉根部)淋巴结2个,均未见癌转移。,免疫组化结果:ki67(40%阳性),p53(-),p170(+),gstπ(+),egfr(-),5-fu(++),mlh1(++),msh6(++),mgmt(++)。该病例未检测到braf基因v600e突变、未检测到kras基因12、13号密码子热点突变。术后恢复良好。1周前患者于我院行pet-ct提示肝转移,无寒战、发热,无恶心、呕吐,无反酸、嗳气、腹胀、消瘦、头晕、乏力、皮肤巩膜黄染再次。就诊于我院,遂门诊拟降结肠癌术后收入院。自发病以来,精神、睡眠、食欲尚可,大便如下述,小便正常,体重无明显变化。", "mention_data": [{"mention": "降结肠癌", "label": "疾病和诊断", "offset": "21"}, {"mention": "腹腔镜上右半结肠切除术", "label": "手术", "offset": "50"}, {"mention": "腹水", "label": "症状", "offset": "68"}, {"mention": "肝", "label": "解剖部位", "offset": "71"}, {"mention": "胃", "label": "解剖部位", "offset": "77"}, {"mention": "空肠", "label": "解剖部位", "offset": "79"}, {"mention": "降结肠", "label": "解剖部位", "offset": "88"}, {"mention": "肠", "label": "解剖部位", "offset": "116"}, {"mention": "结肠", "label": "解剖部位", "offset": "159"}, {"mention": "肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "164"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "213"}, {"mention": "(肠系膜动脉根部)淋巴结", "label": "解剖部位", "offset": "225"}, {"mention": "pet-ct", "label": "影像检查", "offset": "395"}, {"mention": "肝转移", "label": "症状", "offset": "403"}, {"mention": "腹胀", "label": "症状", "offset": "428"}, {"mention": "头晕", "label": "症状", "offset": "434"}, {"mention": "皮肤", "label": "解剖部位", "offset": "440"}, {"mention": "巩膜", "label": "解剖部位", "offset": "442"}, {"mention": "降结肠癌术后", "label": "疾病和诊断", "offset": "459"}]}
{"text": ",缘于入院前1+个月(2014.05.30)因“卵巢浆液性乳头状囊腺癌”就诊我科在全麻上行“全子宫+两附件切除+腹盆腔粘连松解术”,术前查,ca125:144.50u/ml(2014.05.27);,术中见:腹水300ml,色黄,子宫略小,子宫右前侧壁上段见结节状增生约0.8cm,右卵巢萎缩状,右输卵管未见占位病变,左附件区一囊实性包块约7*9*12cm,表面不规则,包膜尚完整,与肠管及左侧腹壁广泛粘连,松解粘连后见肠系膜及陶氏腔少许乳头状结节。术中满意减瘤(无肉眼残留)。术后恢复可,腹部切口愈合良好,术后病理回报(201416906),:左卵巢高级别浆液性乳头状囊腺癌,伴坏死;另见输卵管下皮呈中度不典型增生;(201416919),:送检(肠系膜结节)中见腺癌浸润;(c1401074)腹水涂片未见肿瘤细胞。入院前31天(2014.06.13)查ca12581.07u/ml,遂于入院前27天(2014.06.17)予以“‘紫杉醇240mgivgttd1+洛铂50mgipd1’”方案行术后第1次辅助化疗,化疗过程顺利,停药第5天出现骨髓抑制i度、药物性肝损害,予升白、保肝对症治疗后好转出院。出院后一般情况可,现拟行术后第2次化疗,就诊我院门诊,门诊拟“卵巢浆液性乳头状囊腺癌(iiib期,g1)术后”收住入院。自下次出院以来,饮食、睡眠可,二便正常,体重无明显减轻。", "mention_data": [{"mention": "卵巢浆液性乳头状囊腺癌", "label": "疾病和诊断", "offset": "24"}, {"mention": "全子宫+两附件切除+腹盆腔粘连松解术", "label": "手术", "offset": "46"}, {"mention": "ca125", "label": "实验室检验", "offset": "70"}, {"mention": "腹水", "label": "症状", "offset": "104"}, {"mention": "子宫", "label": "解剖部位", "offset": "115"}, {"mention": "子宫右前侧壁上段", "label": "解剖部位", "offset": "120"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "141"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "148"}, {"mention": "左附件区", "label": "解剖部位", "offset": "159"}, {"mention": "肠管", "label": "解剖部位", "offset": "192"}, {"mention": "腹", "label": "解剖部位", "offset": "197"}, {"mention": "肠", "label": "解剖部位", "offset": "210"}, {"mention": "陶氏腔", "label": "解剖部位", "offset": "214"}, {"mention": "乳头", "label": "解剖部位", "offset": "219"}, {"mention": "眼", "label": "解剖部位", "offset": "234"}, {"mention": "腹部", "label": "解剖部位", "offset": "245"}, {"mention": "左卵巢高级别浆液性乳头状囊腺癌", "label": "疾病和诊断", "offset": "273"}, {"mention": "输卵管", "label": "解剖部位", "offset": "295"}, {"mention": "肠", "label": "解剖部位", "offset": "325"}, {"mention": "腹水", "label": "症状", "offset": "348"}, {"mention": "紫杉醇", "label": "药物", "offset": "417"}, {"mention": "洛铂", "label": "药物", "offset": "433"}, {"mention": "骨髓抑制i度", "label": "疾病和诊断", "offset": "472"}, {"mention": "肝", "label": "解剖部位", "offset": "482"}, {"mention": "肝", "label": "解剖部位", "offset": "491"}, {"mention": "卵巢浆液性乳头状囊腺癌(iiib期,g1)术后", "label": "疾病和诊断", "offset": "533"}]}
{"text": ",患者1个月余前因“吞咽困难1月余。”就诊我院我科,完善相关检查后诊断残胃癌,排除手术禁忌症后于2016.5.23在全麻上行残胃癌切除术+复杂肠粘连松解术+roux-en-y吻合术,术程顺利,术后预防感染支持对症等处理,恢复好,切口甲级愈合。,术后病理示:中至低分化腺癌(lauren,分型:肠型),癌组织浸润至胃壁浆膜层并侵犯邻近的肝组织被膜,并累及食管壁深肌层,可见脉管内癌栓及神经束侵犯;pt4n3m0叒iiic期。患者术后恢复可,出院后生活质量可,于2016.6.24于我院经随机分组纳入capital临床试验行术后辅助化疗,签署知情同意书后行叒sox叒(奥沙利铂150mg+替吉奥60mg叒bid)方案化疗一程,化疗过程顺利,出现i°骨髓抑制,无其他明显不适。现为行上一程化疗来我院门诊就诊,拟“残胃癌综合治疗后”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": "残胃癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "残胃癌切除术+复杂肠粘连松解术+roux-en-y吻合术", "label": "手术", "offset": "62"}, {"mention": "中至低分化腺癌(lauren,分型:肠型)", "label": "疾病和诊断", "offset": "128"}, {"mention": "肝", "label": "解剖部位", "offset": "167"}, {"mention": "食管", "label": "解剖部位", "offset": "176"}, {"mention": "奥沙利铂", "label": "药物", "offset": "282"}, {"mention": "替吉奥", "label": "药物", "offset": "292"}, {"mention": "i°骨髓抑制", "label": "疾病和诊断", "offset": "320"}, {"mention": "残胃癌综合治疗后", "label": "疾病和诊断", "offset": "353"}]}
{"text": "入院前4+月,患者因“大便习惯改变伴大便带血6月,加重2月。”于我科住院治疗,完善相关检查,诊断为“直肠腺癌(pt2n0m0)”,于2016年2月6日在全麻上行腹腔镜上直肠癌根治术(dixon)。术后病理报告(1601061):(直肠)中分化腺癌,侵及深肌层。远、近端切缘及环周切缘未见癌累及。肠周淋巴结未见癌转移(0/11)。术后予以补液、止血、抗感染、对症支持、伤口换药等处理,恢复较好,无特殊不适,好转出院。术后分别于2016-02-27日、3月25日、4月19日,5月13日于我科行化疗4次,方案均为奥沙利铂+雷替曲塞,化疗后患者偶有肢体麻木,无明显恶心、呕吐、腹痛、腹胀、便血等表现,遵医嘱于今日至我院行直肠癌术后第5次化疗。故以\\\"直肠癌术后第5次化疗\\\"收入我科住院治疗。", "mention_data": [{"mention": "直肠腺癌(pt2n0m0)", "label": "疾病和诊断", "offset": "50"}, {"mention": "腹腔镜上直肠癌根治术(dixon)", "label": "手术", "offset": "80"}, {"mention": "(直肠)中分化腺癌", "label": "疾病和诊断", "offset": "114"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "147"}, {"mention": "奥沙利铂", "label": "药物", "offset": "254"}, {"mention": "雷替曲塞", "label": "药物", "offset": "259"}, {"mention": "腹痛", "label": "症状", "offset": "285"}, {"mention": "腹胀", "label": "症状", "offset": "288"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "307"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "322"}]}
{"text": ",缘于入院前1月于我院诊为小肠癌,于2015-11-09在全麻上行小肠癌根治术,,术中见:腹腔内无明显腹水,大网膜、盆腹腔未见转移结节,距treitz韧带约6cm处空肠可触及肿物,大小约7×5×4cm,侵出浆膜层,环周生长,系膜侧可触及多个肿大淋巴结,最大直径约0.8cm,近端肠管无明显扩张。术后病理(201540286)示(小肠),:溃疡型乳头状-管状腺癌ii级,侵及浆膜层,手术标本双切端及另送(近切端)(远切端)均未见癌浸润。找到肠周淋巴结19个及另送(系膜)淋巴结1个,(肠系膜根部)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。此次为化疗再次就诊我院,门诊拟小肠管状腺癌(pt4an0m0iib期)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": "小肠癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "小肠癌根治术", "label": "手术", "offset": "33"}, {"mention": "腹腔", "label": "解剖部位", "offset": "45"}, {"mention": "腹水", "label": "症状", "offset": "51"}, {"mention": "大网膜", "label": "解剖部位", "offset": "54"}, {"mention": "盆腹腔", "label": "解剖部位", "offset": "58"}, {"mention": "treitz韧带", "label": "解剖部位", "offset": "69"}, {"mention": "空肠", "label": "解剖部位", "offset": "82"}, {"mention": "肠管", "label": "解剖部位", "offset": "139"}, {"mention": "小肠", "label": "解剖部位", "offset": "164"}, {"mention": "溃疡型乳头状-管状腺癌ii级", "label": "疾病和诊断", "offset": "169"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "219"}, {"mention": "(系膜)淋巴结", "label": "解剖部位", "offset": "230"}, {"mention": "(肠系膜根部)淋巴结", "label": "解剖部位", "offset": "240"}, {"mention": "小肠管状腺癌(pt4an0m0iib期)术后", "label": "疾病和诊断", "offset": "304"}, {"mention": "腹痛", "label": "症状", "offset": "347"}, {"mention": "腹胀", "label": "症状", "offset": "350"}]}
{"text": ",患者因“便血伴便细近2月,加重5天”进一步确诊为直肠癌于2016-4-11在我院予行全麻上直肠肿瘤dixon切除术,,术中探查见:腹腔内无腹水,腹膜无转移,肝脏未触及转移病灶,肿瘤位于直肠上段,腹腔内无法触及,病人肥胖,系膜未触及肿大淋巴结。手术顺利,术后积极予相关对症支持治疗并恢复总体平稳;相关手术病理示直肠腺癌(中、低度分化),隆起型,体积3.5*3*0.8cm,侵达浅肌层,未累及底部切除面。双端切线及另送“近切线”、“远切线”未查见癌。肠壁一站(13个)、二站(10个)淋巴结未查见癌。,免疫组化染色示:syn(-)、ts较多(+)。患者于术后20天康复出院;依据患者病情及肿瘤病理与分期继续术后辅助性化疗指征存在,依情于2016-4-26给予术后首周期辅助化疗,,具体用药为: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,同时辅以镇吐、升血、免疫调节等对症支持治疗(化疗过程总体顺利)。其后给予原方案化疗3周期。自下次出院以来,患者一般情况保持良好;无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适;持续未现明显腹痛、腹胀。现患者为行复查并辅助化疗而再来我院就诊,门诊依情以“直肠癌术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;肛门排气排便存在(排便次数偏多)。述近期无明显体重变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "25"}, {"mention": "直肠肿瘤dixon切除术", "label": "手术", "offset": "46"}, {"mention": "腹腔", "label": "解剖部位", "offset": "66"}, {"mention": "腹水", "label": "症状", "offset": "70"}, {"mention": "腹", "label": "解剖部位", "offset": "73"}, {"mention": "肝脏", "label": "解剖部位", "offset": "79"}, {"mention": "直肠", "label": "解剖部位", "offset": "93"}, {"mention": "腹腔", "label": "解剖部位", "offset": "98"}, {"mention": "直肠腺癌(中、低度分化),隆起型", "label": "疾病和诊断", "offset": "155"}, {"mention": "肠壁一站(13个)、二站(10个)淋巴结", "label": "解剖部位", "offset": "224"}, {"mention": "奥沙利铂", "label": "药物", "offset": "345"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "358"}, {"mention": "替加氟", "label": "药物", "offset": "373"}, {"mention": "腹痛", "label": "症状", "offset": "487"}, {"mention": "腹胀", "label": "症状", "offset": "490"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "519"}, {"mention": "肛门", "label": "解剖部位", "offset": "556"}]}
{"text": ",患者2015-06因“无明显诱因出现大便带鲜血,量少,伴大便次数增加至2-3次/天5月”,外院肠镜检查提示乙状结肠距肛门18-20cm肿物,大小2×1cm,肠镜能通过,活检病理提示腺癌,大肠多发息肉。转诊我院2015-06-20在全麻上行dixon术,,术后病理示:(乙状结肠大体)镜检为结肠中分化腺癌,浸润至肠壁浆膜上层,癌组织侵犯神经束,脉管内见癌栓;经多取材另见淋巴结2枚,未见癌。2(近切缘)未见癌。3(远切缘)未见癌。4(中央组淋巴结)1枚,未见癌。5(中间组淋巴结)2枚,1/2见腺癌转移。6(肠旁淋巴结)2枚,未见癌。,免疫组化:er(-),ercc1(+),mlh1(+),msh2(+),msh6(+),pms2(+),ki67(70%+),分期pt3n1am0,iiib期。术顺,术后切口愈合佳。于2015-07-18、2015-08-07、2015-08-28行xelox方案辅助化疗3程,过程顺利。3程化疗后于2015-09-17行胸片及彩超复查未见肿瘤复发转移征象。现患者为行上程化疗入院。近3周来,患者精神睡眠可,胃纳可,二便正常,体重无明显上降。", "mention_data": [{"mention": "乙状结肠", "label": "解剖部位", "offset": "54"}, {"mention": "肛门", "label": "解剖部位", "offset": "59"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "91"}, {"mention": "大肠多发息肉", "label": "疾病和诊断", "offset": "94"}, {"mention": "dixon术", "label": "手术", "offset": "120"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "135"}, {"mention": "结肠中分化腺癌", "label": "疾病和诊断", "offset": "145"}, {"mention": "肠", "label": "解剖部位", "offset": "156"}, {"mention": "中央组淋巴结", "label": "解剖部位", "offset": "217"}, {"mention": "中间组淋巴结", "label": "解剖部位", "offset": "233"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "247"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "254"}, {"mention": "胸片", "label": "影像检查", "offset": "429"}, {"mention": "彩超", "label": "影像检查", "offset": "432"}, {"mention": "胃", "label": "解剖部位", "offset": "472"}]}
{"text": ",入院前5个月余诊断为“贲门-胃体癌”,于2013.12.25在我科行“腹腔镜辅助上根治性全胃切除(d2)+食管空肠roux-en-y吻合术”,术顺,术后病理(201341015),:(全胃),:食管胃交界溃疡型管状腺癌iii级,伴神经内分泌分化,侵出浆膜层,手术标本下、上切端和另送(下切端)均未见癌浸润。找到贲门周淋巴结11个,小弯淋巴结13个、大弯淋巴结11个、幽门下淋巴结4个、幽门上淋巴结14个和另送(胃右动脉根部)淋巴结4个、(脾门)淋巴结4个均未见癌转移。另送(脾动脉旁淋巴结)为纤维脉管脂肪组织。,免疫组化结果:ki67(60%),p53(+++),p170(++),gstπ(++),egfr(-),5-fu(++),her-2(-),sy(+)。术后予预防感染、补液、营养支持、调节免疫等治疗,恢复良好后出院。于2014.01.28,2014.02.21,2014.3.18,2014.04.16按“奥沙利铂100mgivgttd1+替吉奥40mgbidpod2-15”方案行术后化疗,辅以保肝、止吐、增强免疫等治疗,过程顺利。现为行术后第4周期化疗就诊我院,门诊拟“胃癌术后化疗”收入院。", "mention_data": [{"mention": "腹腔镜辅助上根治性全胃切除(d2)+食管空肠roux-en-y吻合术", "label": "手术", "offset": "36"}, {"mention": "食管胃交界溃疡型管状腺癌iii级,伴神经内分泌分化", "label": "疾病和诊断", "offset": "98"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "175"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "193"}]}
{"text": ",患者因“大便带血”并进一步确诊为直肠癌于2015-2-9在全麻上行腹会阴联合直肠癌根治术(miles手术)。,术中探查见:腹腔内无腹水,腹膜无转移,肝脏未触及转移结节,肿瘤位于直肠上段,腹腔内无法探及。直肠系膜内可触及肿大淋巴结。手术顺利,患者术后积极予相关对症支持治疗并恢复总体平稳。相关手术病理(201502427),回示:(直肠)腺癌(中度分化),浸润型,体积5*4.5*1cm,侵达外膜。叒双端切线未查见癌;叒一站(12个)、二站(4个)、中间组(5个)及中央组(1个)淋巴结未查见癌;,免疫组化染色示癌组织:ts少量(+)、syn(-)。患者术后于相关化疗治疗。现患者1月前出现阴道内流出少量液体,于2016-10-13日行腹盆部ct示盆腔内占位性病变,考虑局部复发并侵及局部阴道壁可能性大,门诊依情以“直肠癌术后复发”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠好;间断性结肠造口排气排便顺畅并性状良好。述近期无明显体重变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "17"}, {"mention": "腹会阴联合直肠癌根治术(miles手术)", "label": "手术", "offset": "34"}, {"mention": "腹腔", "label": "解剖部位", "offset": "62"}, {"mention": "腹水", "label": "症状", "offset": "66"}, {"mention": "腹", "label": "解剖部位", "offset": "69"}, {"mention": "肝脏", "label": "解剖部位", "offset": "75"}, {"mention": "直肠上段", "label": "解剖部位", "offset": "89"}, {"mention": "腹腔", "label": "解剖部位", "offset": "94"}, {"mention": "直肠", "label": "解剖部位", "offset": "102"}, {"mention": "直肠", "label": "解剖部位", "offset": "166"}, {"mention": "腺癌(中度分化),浸润型", "label": "疾病和诊断", "offset": "169"}, {"mention": "一站(12个)、二站(4个)、中间组(5个)及中央组(1个)淋巴结", "label": "解剖部位", "offset": "210"}, {"mention": "阴道", "label": "解剖部位", "offset": "295"}, {"mention": "腹盆部ct", "label": "影像检查", "offset": "318"}, {"mention": "盆腔", "label": "解剖部位", "offset": "324"}, {"mention": "阴道", "label": "解剖部位", "offset": "344"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "358"}, {"mention": "结肠", "label": "解剖部位", "offset": "400"}]}
{"text": ",因“进食后胸骨不适半年”,当地胃镜提示:胃窦溃疡型隆起性病变。诊断胃癌。体重较前稍有上降。我院行胃癌根治术,,术后病理:胃隆起型高分化腺癌,伴粘液分泌,大小10.5×xxx6.5cm,lauren,分型:肠型;癌侵及浆膜上纤维脂肪组织;可见脉管癌栓;胃残端、(十二指肠残端)及网膜组织均未见癌;淋巴结未见癌转移(第1组0/2、第3组0/0、第4sb组0/7、第4d组0/2、第5组0/3、第6组0/21、第7组0/11、第8a组0/4、第8p组0/1、第9组0/9、第11p组0/1、第12a组0/0、第12p组0/1);,肿瘤病理分期:pt3n0。,免疫组化结果显示:b-catenin(+),cd147(+),cd44(-),cmet(1+),egfr(3+),her2(0),ki67(+90%),mlh1(+<25%),msh2(+>75%),msh6(+>75%),p-cadherin(+>75%),pms2(+25~50%),ttf-1(-)。术后恢复可,拟行术后化疗。2015-6-11开始行sox术后辅助化疗,无明显不良反应。", "mention_data": [{"mention": "胸骨", "label": "解剖部位", "offset": "6"}, {"mention": "胃窦溃疡型隆起性病变", "label": "疾病和诊断", "offset": "21"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "34"}, {"mention": "胃癌根治术", "label": "手术", "offset": "49"}, {"mention": "胃隆起型高分化腺癌", "label": "疾病和诊断", "offset": "61"}, {"mention": "肠", "label": "解剖部位", "offset": "103"}, {"mention": "胃", "label": "解剖部位", "offset": "126"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "131"}]}
{"text": ",患者因“直肠癌”于2016-11-08于我院在全麻上予行直肠hartmann手术,术后病理(3766.2013),回示:病理诊断叒,:直肠腺癌(中度分化),浸润溃疡型,体积8*6*0.6cm,侵达外膜脂肪组织,未累及切除面。双端切线未查见癌。呈肠壁一站(1/22个)淋巴结癌转移。肠壁二站(2个)淋巴结未查见癌。低级别腺管状腺瘤。,免疫组化染色示癌组织:syn(-)、braf(-)、mlh1(+)、msh2(+)、msh6(+)、pms2(+)。患者术后恢复好。根据患者病情,除外化疗禁忌症,于2016-12-8、201-01-08给予化疗双周期,,方案为:奥沙利铂200mg叒dl+亚叶酸钙0.3gd2-6+替加氟1000mg叒d2-6静滴,同时给予升白细胞、护肝、止吐、免疫增强治疗,无明显化疗副反应。自下次出院后,患者一般情况保持良好,叒无乏力感,无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显叒腹痛、腹胀;大小便情况良好。现患者为行复查来我院就诊,门诊以“直肠癌术后”收入院。目前患者精神及情绪状态可,食欲、饮食好,夜间睡眠可,大便出现便秘,不规律,不成形,小便正常,近期无明显体重变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "直肠hartmann手术", "label": "手术", "offset": "29"}, {"mention": "直肠腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "68"}, {"mention": "肠壁一站(1/22个)淋巴结", "label": "解剖部位", "offset": "123"}, {"mention": "肠壁二站(2个)淋巴结", "label": "解剖部位", "offset": "141"}, {"mention": "低级别腺管状腺瘤", "label": "疾病和诊断", "offset": "157"}, {"mention": "奥沙利铂", "label": "药物", "offset": "281"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "294"}, {"mention": "替加氟", "label": "药物", "offset": "307"}, {"mention": "肝", "label": "解剖部位", "offset": "334"}, {"mention": "腹痛", "label": "症状", "offset": "410"}, {"mention": "腹胀", "label": "症状", "offset": "413"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "441"}]}
{"text": "缘于入院前9天(2013.12.24)因“卵巢癌”于我院行“全子宫+两附件切除术+阑尾+大网膜切除术+盆腔淋巴结清扫术”。术中见腹腔内淡黄色腹水约200ml,取腹水30ml送细胞学检查,子宫体前位,常大,右卵巢囊实性增大约10*10*10cm大小,色灰白,表面光滑,包膜完整,组织脆烂,与周围组织无粘连,内见淡黄色粘稠样液体流出,右输卵管及左附件外观正常,肝、脾、膈上、肠管、肠系膜、腹膜等未见明显异常。切除右附件送冰冻,病理回报(201340780):卵巢恶性下皮性肿瘤,考虑为粘液性囊腺癌,输卵管未见肿瘤细胞浸润。遂行下术,术顺,术后恢复好,术后病理(201340902)(左侧)卵巢及输卵管组织;盆腔淋巴结均未见癌转移;(大网膜)送检网膜组织未见癌细胞种植转移;(阑尾)阑尾组织未见癌细胞种植转移,呈阑尾周围炎改变。(c132334)腹水涂片未见肿瘤细胞。余病理未报。现患者无畏冷、发热,无咳嗽、咳痰,无腹痛、腹胀,无头晕、眼花,胸闷、心悸等不适,要求入院化疗,门诊拟“右卵巢粘液性囊腺癌ia期术后”收入院。发病以来,精神、睡眠、食欲一般,大小便正常,体重无明显增减。", "mention_data": [{"mention": "卵巢癌", "label": "疾病和诊断", "offset": "21"}, {"mention": "全子宫+两附件切除术+阑尾+大网膜切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "30"}, {"mention": "腹腔", "label": "解剖部位", "offset": "64"}, {"mention": "腹水", "label": "症状", "offset": "70"}, {"mention": "腹水", "label": "症状", "offset": "80"}, {"mention": "子宫体", "label": "解剖部位", "offset": "93"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "102"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "165"}, {"mention": "左附件", "label": "解剖部位", "offset": "170"}, {"mention": "肝", "label": "解剖部位", "offset": "178"}, {"mention": "脾", "label": "解剖部位", "offset": "180"}, {"mention": "膈上", "label": "解剖部位", "offset": "182"}, {"mention": "肠管", "label": "解剖部位", "offset": "185"}, {"mention": "肠", "label": "解剖部位", "offset": "188"}, {"mention": "腹", "label": "解剖部位", "offset": "192"}, {"mention": "右附件", "label": "解剖部位", "offset": "204"}, {"mention": "卵巢恶性下皮性肿瘤", "label": "疾病和诊断", "offset": "227"}, {"mention": "粘液性囊腺癌", "label": "疾病和诊断", "offset": "240"}, {"mention": "输卵管", "label": "解剖部位", "offset": "247"}, {"mention": "(左侧)卵巢", "label": "解剖部位", "offset": "288"}, {"mention": "输卵管", "label": "解剖部位", "offset": "295"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "301"}, {"mention": "阑尾", "label": "解剖部位", "offset": "335"}, {"mention": "阑尾", "label": "解剖部位", "offset": "338"}, {"mention": "阑尾", "label": "解剖部位", "offset": "353"}, {"mention": "腹水", "label": "症状", "offset": "370"}, {"mention": "腹痛", "label": "症状", "offset": "405"}, {"mention": "腹胀", "label": "症状", "offset": "408"}, {"mention": "头晕", "label": "症状", "offset": "412"}, {"mention": "眼花", "label": "症状", "offset": "415"}, {"mention": "胸闷", "label": "症状", "offset": "418"}, {"mention": "心悸", "label": "症状", "offset": "421"}, {"mention": "右卵巢粘液性囊腺癌ia期术后", "label": "疾病和诊断", "offset": "438"}]}
{"text": "患者于2014年7月7日因“卵巢癌”在全麻上行剖腹探查+卵巢癌细胞减灭术(全子宫、两侧附件、大网膜、阑尾、盆腔转移灶、直肠转移灶切除+盆腔淋巴结清扫术),术后病检结果为:左卵巢浆液性乳头状腺癌;叒(直肠表面转移灶、腹腔转移灶)见癌组织。(大网膜)未见癌累及。(右盆腔淋巴结、左盆腔淋巴结)未见癌转移(0/6、0/6)。于7月20日行术后第一次tp方案(紫杉醇静脉滴入+顺铂腹腔灌注)联合化疗,于2014年8月12日第二次行tp(紫杉醇静脉滴入+顺铂腹腔灌注)方案化疗,于2014年9月2日行第三次化疗,化疗方案为tp方案(紫杉醇+奈达铂)静脉化疗,于2014年9月22日行第四次化疗,化疗方案为tp方案(紫杉醇+奈达铂)静脉化疗,化疗后无明显毒副反应。于2014年10月13日行第五次化疗,化疗方案为tp方案(紫杉醇+奈达铂)静脉化疗,化疗后无明显毒副反应。于2014年11月04日第六次化疗,化疗方案为tp方案(紫杉醇+奈达铂)静脉化疗,化疗后无明显毒副反应,出院后定期复查电解质及血常规。今患者为行第7次化疗再入院,门诊拟以“卵巢浆液性乳头状腺癌iiic期术后,拟行第7次化疗”收治入院。叒叒叒患者自患病以来,精神、食欲尚可,睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "卵巢癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "剖腹探查+卵巢癌细胞减灭术(全子宫、两侧附件、大网膜、阑尾、盆腔转移灶、直肠转移灶切除+盆腔淋巴结清扫术)", "label": "手术", "offset": "23"}, {"mention": "左卵巢浆液性乳头状腺癌", "label": "疾病和诊断", "offset": "85"}, {"mention": "直肠", "label": "解剖部位", "offset": "99"}, {"mention": "腹腔", "label": "解剖部位", "offset": "107"}, {"mention": "右盆腔淋巴结", "label": "解剖部位", "offset": "130"}, {"mention": "左盆腔淋巴结", "label": "解剖部位", "offset": "137"}, {"mention": "紫杉醇", "label": "药物", "offset": "176"}, {"mention": "顺铂", "label": "药物", "offset": "184"}, {"mention": "腹腔", "label": "解剖部位", "offset": "186"}, {"mention": "紫杉醇", "label": "药物", "offset": "214"}, {"mention": "顺铂", "label": "药物", "offset": "222"}, {"mention": "腹腔", "label": "解剖部位", "offset": "224"}, {"mention": "紫杉醇", "label": "药物", "offset": "261"}, {"mention": "奈达铂", "label": "药物", "offset": "265"}, {"mention": "紫杉醇", "label": "药物", "offset": "302"}, {"mention": "奈达铂", "label": "药物", "offset": "306"}, {"mention": "紫杉醇", "label": "药物", "offset": "355"}, {"mention": "奈达铂", "label": "药物", "offset": "359"}, {"mention": "紫杉醇", "label": "药物", "offset": "407"}, {"mention": "奈达铂", "label": "药物", "offset": "411"}, {"mention": "卵巢浆液性乳头状腺癌iiic期术后", "label": "疾病和诊断", "offset": "465"}]}
{"text": ",缘于入院前6个月“进行性眼黄、尿黄、皮肤黄染30天”为主诉入我科住院,考虑十二指肠乳头占位,并于全麻上行“胰十二指肠切除术”,术中见腹腔内无腹水,腹壁及盆底未触及种植结节。肝脏表面张力高,呈淤胆改变,形态、大小正常,未触及肿物,胆囊约8×5×4cm3,表面张力高,无充血、水肿,未触及结石,肝脏及胆囊与大网膜粘连明显,予松解。胆总管扩张,直径约1.5cm。十二指肠降部触及一肿物,质硬。,术后病理回报:1、(胰十二指肠),:十二指肠乳头部浸润型管状腺癌ii-iii级,侵犯神经,侵及深肌层,未侵犯胆总管及胰腺,手术标本胃切端、小肠切端、胰腺切端及胆总管切端均未见癌浸润。找到胃周淋巴结1个、胰腺周淋巴结2个,及另送(肝十二指肠韧带)淋巴结1个和(肝总动脉旁)淋巴结4个均未见癌转移。2、,胆囊:慢性胆囊炎,胆石症。术后患者恢复好,皮肤黄染逐渐消退,无发热、呕吐、腹泻、血便等。近1个月患者偶有下腹部闷痛,行走时明显,无发热、呕吐、腹胀、黑便、皮肤黄染等不适。为进一步复查,再次求诊我院,门诊拟“十二指肠癌术后”收住入院。本病以来患者精神睡眠食欲大致可,二便无明显异常,体重无明显改变。", "mention_data": [{"mention": "眼", "label": "解剖部位", "offset": "13"}, {"mention": "十二指肠乳头", "label": "解剖部位", "offset": "38"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "54"}, {"mention": "腹腔", "label": "解剖部位", "offset": "67"}, {"mention": "腹水", "label": "症状", "offset": "71"}, {"mention": "腹", "label": "解剖部位", "offset": "74"}, {"mention": "盆底", "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": "115"}, {"mention": "肝脏", "label": "解剖部位", "offset": "146"}, {"mention": "胆囊", "label": "解剖部位", "offset": "149"}, {"mention": "胆总管", "label": "解剖部位", "offset": "164"}, {"mention": "十二指肠降部", "label": "解剖部位", "offset": "179"}, {"mention": "胰十二指肠", "label": "解剖部位", "offset": "205"}, {"mention": "十二指肠乳头部浸润型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "213"}, {"mention": "胆总管", "label": "解剖部位", "offset": "249"}, {"mention": "胰腺", "label": "解剖部位", "offset": "253"}, {"mention": "胃", "label": "解剖部位", "offset": "260"}, {"mention": "小肠", "label": "解剖部位", "offset": "264"}, {"mention": "胰腺", "label": "解剖部位", "offset": "269"}, {"mention": "胆总管", "label": "解剖部位", "offset": "274"}, {"mention": "胃周淋巴结", "label": "解剖部位", "offset": "288"}, {"mention": "胰腺周淋巴结", "label": "解剖部位", "offset": "296"}, {"mention": "(肝十二指肠韧带)淋巴结", "label": "解剖部位", "offset": "308"}, {"mention": "(肝总动脉旁)淋巴结", "label": "解剖部位", "offset": "323"}, {"mention": "胆囊", "label": "解剖部位", "offset": "345"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "348"}, {"mention": "腹泻", "label": "症状", "offset": "382"}, {"mention": "下腹部", "label": "解剖部位", "offset": "397"}, {"mention": "腹胀", "label": "症状", "offset": "416"}, {"mention": "十二指肠癌术后", "label": "疾病和诊断", "offset": "448"}]}
{"text": "缘于入院前1+月,于我院诊断“子宫内膜癌”,在全麻上行“全子宫切除术+两侧附件切除术+肿瘤细胞减灭术+骶韧带悬吊术+大网膜肿物切除术”,术后予以预防感染、补液、营养支持等治疗,术后病理(201340184)(全子宫):恶性苗勒氏管混合瘤,侵及宫体浆膜层(浸润深度&gt;1/2肌层),宫颈组织学内口见肿瘤浸润。宫体肌间多发平滑肌瘤。慢性宫颈炎。术后诊断“子宫恶性苗勒氏管混合瘤iiia期”,于2013.12.30及2014.01.21行化疗,化疗方案为“异环磷酰胺2g静滴d1-3+洛铂40mg腹腔注射”,并辅以止吐、保肝、抗过敏、补液等支持治疗,2次化疗过程中均出现骨髓抑制ii度,予“惠尔血”升白处理。今为化疗再次就诊我院,门诊拟“子宫恶性苗勒氏管混合瘤iiia期”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": "子宫内膜癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "全子宫切除术+两侧附件切除术+肿瘤细胞减灭术+骶韧带悬吊术+大网膜肿物切除术", "label": "手术", "offset": "28"}, {"mention": "全子宫", "label": "解剖部位", "offset": "104"}, {"mention": "恶性苗勒氏管混合瘤", "label": "疾病和诊断", "offset": "109"}, {"mention": "宫体", "label": "解剖部位", "offset": "121"}, {"mention": "宫颈", "label": "解剖部位", "offset": "142"}, {"mention": "宫体", "label": "解剖部位", "offset": "155"}, {"mention": "慢性宫颈炎", "label": "疾病和诊断", "offset": "166"}, {"mention": "子宫恶性苗勒氏管混合瘤iiia期", "label": "疾病和诊断", "offset": "177"}, {"mention": "异环磷酰胺", "label": "药物", "offset": "227"}, {"mention": "洛铂", "label": "药物", "offset": "241"}, {"mention": "腹腔", "label": "解剖部位", "offset": "247"}, {"mention": "肝", "label": "解剖部位", "offset": "260"}, {"mention": "骨髓抑制ii度", "label": "疾病和诊断", "offset": "284"}, {"mention": "惠尔血", "label": "药物", "offset": "294"}, {"mention": "子宫恶性苗勒氏管混合瘤iiia期", "label": "疾病和诊断", "offset": "318"}, {"mention": "腹痛", "label": "症状", "offset": "356"}, {"mention": "腹胀", "label": "症状", "offset": "359"}]}
{"text": "术前化疗xelox方案2周期,行根治性远端胃大部切除,术后病理:胃窦小弯侧溃疡型中-低分化腺癌,大小1.6×1.6cm,侵至胃壁深肌层(约4/5固有肌层),部分肿瘤细胞变性坏死(30%),未见脉管癌栓,淋巴结未见癌转移(第3组0/4、4d组0/2、第6组0/5、第7+9组0/6、第8组0/2、第11p组0/1、第12a、第1组0/0、第4sb组0/0、第5组0/0、第8p组0/0),胃断端及十二指肠断端未见癌,网膜组织未见特殊。目前进食可。", "mention_data": [{"mention": "胃窦小弯侧溃疡型中-低分化腺癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "胃", "label": "解剖部位", "offset": "193"}]}
{"text": ",患者于2017-5-22在全麻上行3d腹腔镜上直肠癌根治术(dixon)。手术过程顺利,术后患者恢复良好。术后病理(201711714),:直肠管状粘液腺癌(低分化),浸润溃疡型,体积3*2.5*1cm,浸润浆膜上层。未侵犯切线(近切线12cm、远切线甚近)。叒呈一站(11/11个)、二站(3/3个)淋巴结癌转移。,免疫组化染色示癌组织:syn(-)、braf(-)、mlh1(+)、msh2(+)、msh6(+)、pms2(+)。术后恢复顺利,先后给予2次辅助化疗(具体用药为),今日为行术后复查及再次化疗治疗来院,门诊以“直肠癌术后”收入。患者无发热,无头痛、头晕,无胸闷、心慌,无恶心、呕吐,无腹胀、腹痛,无黑便、便血;自下次出院以来病情稳定,精神可,食欲及饮食正常,夜间睡眠好,大便约2次/日,质软成形,小便次数有所增多,量及性状无明显异常,体重无明显改变。", "mention_data": [{"mention": "直肠癌根治术(dixon)", "label": "手术", "offset": "24"}, {"mention": "直肠管状粘液腺癌(低分化),浸润溃疡型", "label": "疾病和诊断", "offset": "71"}, {"mention": "一站(11/11个)、二站(3/3个)淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "265"}, {"mention": "头痛", "label": "症状", "offset": "281"}, {"mention": "头晕", "label": "症状", "offset": "284"}, {"mention": "胸闷", "label": "症状", "offset": "288"}, {"mention": "腹胀", "label": "症状", "offset": "302"}, {"mention": "腹痛", "label": "症状", "offset": "305"}]}
{"text": ",缘于入院前3个月于我院诊为胃癌,于2015-12-29在全麻上行根治性全胃切除术(食管空肠roux-y吻合、d2+、r0),术后病理(201547566),示:(全胃),:胃体-胃窦溃疡型管状腺癌ii级,侵及浆膜层,侵犯神经及脉管组织。手术标本下切端、上切端及另送(下切端)均未见癌浸润。找到贲门周淋巴结2/14个,小弯侧淋巴结0/1个,大弯侧淋巴结0/1个,幽门下淋巴结0/1个,幽门上淋巴结0/5个及另送(第8组)淋巴结0/1个、(第9组)淋巴结0/4个、(第11d组)淋巴结0/2个、(第11p组)淋巴结0/6个、(第14v组)淋巴结0/2个见癌转移。另送(第12组淋巴结)镜上为纤维脂肪组织。,免疫组化结果:肿瘤细胞示ck7(+),ck20(+),villin(+),cdx-2(+),cea(+),her-2(2+),ki67(40%+)。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。于2016.01.27、2016.02.17、2016.03.07予“奥沙利铂(艾恒)200mg静滴d1+氟尿嘧啶4000mg持续48h泵入”方案化疗,辅以止吐、保胃、护肝等支持治疗,化疗过程顺利,未见明显化疗副反应。此次为第4次化疗再次就诊我院,门诊拟胃癌术后化疗收入院。下次出院以来精神、睡眠、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": "根治性全胃切除术(食管空肠roux-y吻合、d2+、r0)", "label": "手术", "offset": "33"}, {"mention": "胃", "label": "解剖部位", "offset": "83"}, {"mention": "胃体-胃窦溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "87"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "147"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "170"}, {"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8组)淋巴结", "label": "解剖部位", "offset": "205"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "218"}, {"mention": "(第11d组)淋巴结", "label": "解剖部位", "offset": "231"}, {"mention": "(第11p组)淋巴结", "label": "解剖部位", "offset": "246"}, {"mention": "(第14v组)淋巴结", "label": "解剖部位", "offset": "261"}, {"mention": "第12组淋巴结", "label": "解剖部位", "offset": "283"}, {"mention": "奥沙利铂", "label": "药物", "offset": "440"}, {"mention": "艾恒", "label": "药物", "offset": "445"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "458"}, {"mention": "胃", "label": "解剖部位", "offset": "487"}, {"mention": "肝", "label": "解剖部位", "offset": "490"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "532"}, {"mention": "腹痛", "label": "症状", "offset": "559"}, {"mention": "腹胀", "label": "症状", "offset": "562"}]}
{"text": ",缘于入院前1月于我院诊为“胃窦癌”,于2016年10月27日在全麻上行腹腔镜上根治性远端胃大部切除术(d2,roux-en-y吻合)。,手术经过如上:腹腔镜探查见腹腔内无明显腹水,盆腔、腹壁、大网膜无转移结节,肝脏质地大小正常,未见明显转移病灶。腹腔镜上探查肿瘤位于胃窦小弯侧,未侵及浆膜层,周围未及明显肿大淋巴结,遂决定行“腹腔镜辅助上根治性远端胃大部切除+残胃空肠roux-y吻合术(d2)”。术后予预防性抗感染、制酸、免疫调节及营养支持等治疗,恢复良好,伤口愈合ii/甲。,术后病理:1、(远端胃),:胃体胃窦交界前壁早期(0-i型)管状腺癌ii级,部分为黏液腺癌,侵及黏膜上层。手术标本下、上切端及另送(下切端)均未见癌浸润。找到另送(第1组)淋巴结0/4个,(第3组)淋巴结0/2个,(第4sb组)淋巴结0/4个,(第4d组)淋巴结0/4个,(第6组)淋巴结0/5个,(第7组)淋巴结0/8个,(第8a组)淋巴结0/1个,(第9组)淋巴结0/1个,(第11p组)淋巴结0/1个,(第12a组)淋巴结1/1个,见癌转移。2、(第5组淋巴结),:送检为纤维、脂肪和脉管组织。,免疫组化:ki67(50%+),ck7(+++),ck20(个别细胞阳性),villin(+++),cd56(-)。此次为化疗再次就诊我院,门诊拟“胃窦癌术后”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": "胃窦癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上根治性远端胃大部切除术(d2,roux-en-y吻合)", "label": "手术", "offset": "36"}, {"mention": "腹腔", "label": "解剖部位", "offset": "76"}, {"mention": "腹腔", "label": "解剖部位", "offset": "82"}, {"mention": "腹水", "label": "症状", "offset": "88"}, {"mention": "盆腔", "label": "解剖部位", "offset": "91"}, {"mention": "腹壁", "label": "解剖部位", "offset": "94"}, {"mention": "肝脏", "label": "解剖部位", "offset": "106"}, {"mention": "胃窦小弯侧", "label": "解剖部位", "offset": "134"}, {"mention": "腹腔镜辅助上根治性远端胃大部切除+残胃空肠roux-y吻合术(d2)", "label": "手术", "offset": "164"}, {"mention": "胃", "label": "解剖部位", "offset": "251"}, {"mention": "胃体胃窦交界前壁早期(0-i型)管状腺癌ii级,部分为黏液腺癌", "label": "疾病和诊断", "offset": "255"}, {"mention": "(第1组)淋巴结", "label": "解剖部位", "offset": "322"}, {"mention": "(第3组)淋巴结", "label": "解剖部位", "offset": "335"}, {"mention": "(第4sb组)淋巴结", "label": "解剖部位", "offset": "348"}, {"mention": "(第4d组)淋巴结", "label": "解剖部位", "offset": "363"}, {"mention": "(第6组)淋巴结", "label": "解剖部位", "offset": "377"}, {"mention": "(第7组)淋巴结", "label": "解剖部位", "offset": "390"}, {"mention": "(第8a组)淋巴结", "label": "解剖部位", "offset": "403"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "417"}, {"mention": "(第11p组)淋巴结", "label": "解剖部位", "offset": "430"}, {"mention": "(第12a组)淋巴结", "label": "解剖部位", "offset": "445"}, {"mention": "第5组淋巴结", "label": "解剖部位", "offset": "468"}, {"mention": "胃窦癌术后", "label": "疾病和诊断", "offset": "566"}, {"mention": "腹痛", "label": "症状", "offset": "593"}, {"mention": "腹胀", "label": "症状", "offset": "596"}]}
{"text": ",患者3月余前因“便血1年加重1天”入住我院,入院后完善相关检查,,结肠镜结果示:直肠癌,取病理送检。,病理示:(直肠)腺癌(201709974)。查无手术禁忌,于2017-05-15日行“直肠miles术”,手术顺利,术后恢复可,,术后病理:(,病理号:201710980)(直肠)腺癌(中度分化),浸润溃疡型,体积5*3.5*0.8cm,浸润非腹膜覆盖的结直肠周围组织,双端切线未查见癌。呈“中间组”(2/10个)淋巴结转移。一站(4个)淋巴结未查见癌。,免疫组化染色示癌组织:syn(-)、braf(-)、mlh1(+)、msh2(+)、msh6(+)、pms2(+)。术后给予3程化疗,,具体用药为:奥沙利铂200mgd1+亚叶酸钙0.3g叒d2-6叒+替加氟(方克)1g叒d2-6叒静脉滴注;同时予镇吐、升血及免疫调节等对症支持治疗。过程顺利,患者出院。出院后病情稳定,现为求进一步复查治疗入院,门诊以“直肠癌术后”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,大小便正常,体重无明显改变。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "41"}, {"mention": "(直肠)腺癌", "label": "疾病和诊断", "offset": "56"}, {"mention": "直肠miles术", "label": "手术", "offset": "95"}, {"mention": "(直肠)腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "138"}, {"mention": "腹", "label": "解剖部位", "offset": "174"}, {"mention": "结直肠", "label": "解剖部位", "offset": "179"}, {"mention": "“中间组”(2/10个)淋巴结", "label": "解剖部位", "offset": "197"}, {"mention": "一站(4个)淋巴结", "label": "解剖部位", "offset": "215"}, {"mention": "奥沙利铂", "label": "药物", "offset": "304"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "316"}, {"mention": "替加氟", "label": "药物", "offset": "331"}, {"mention": "方克", "label": "药物", "offset": "335"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "407"}]}
{"text": ",患者4个月前因“便秘2月余”入住我院消化内科,行胸、腹、,盆腔ct示:两肺上叶纤维灶,肝多发囊肿、肾囊肿,直肠壁增厚、符合直肠ca表现。为行手术治疗,转我科。完善相关术前检查后,于2016-02-15行直肠癌根治术,,术后病理:直肠腺癌(中低度分化),部分呈粘液腺癌图像,浸润溃疡型,体积6.5*5*0.6cm。叒侵达被膜。叒双端切线及另送“直肠近切线”、“直肠远切线”未查见癌。叒呈肠壁一站(2/11个)淋巴结癌转移。叒符合炎性增生性息肉。叒,免疫组化染色示:ts部分(+)、syn(-)。术后给予补液,换药及对症支持治疗并口服希罗达行化学治疗。叒叒叒院外期间患者一般情况可,无发热,无腹痛腹胀胀不适,现患者为行复查及本周期化疗再次来我院就诊,门诊以“直肠术后”收住入院。叒叒叒患者自下次出院来,神志清,精神可,饮食尚可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "胸、腹、,盆腔ct", "label": "影像检查", "offset": "25"}, {"mention": "两肺上叶", "label": "解剖部位", "offset": "36"}, {"mention": "肝多发囊肿", "label": "疾病和诊断", "offset": "44"}, {"mention": "肾囊肿", "label": "疾病和诊断", "offset": "50"}, {"mention": "直肠壁", "label": "解剖部位", "offset": "54"}, {"mention": "直肠ca", "label": "疾病和诊断", "offset": "62"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "102"}, {"mention": "直肠腺癌(中低度分化),部分呈粘液腺癌图像,浸润溃疡型", "label": "疾病和诊断", "offset": "115"}, {"mention": "直肠", "label": "解剖部位", "offset": "172"}, {"mention": "直肠", "label": "解剖部位", "offset": "180"}, {"mention": "肠", "label": "解剖部位", "offset": "193"}, {"mention": "炎性增生性息肉", "label": "疾病和诊断", "offset": "214"}, {"mention": "希罗达", "label": "药物", "offset": "266"}, {"mention": "腹痛", "label": "症状", "offset": "295"}, {"mention": "腹胀", "label": "症状", "offset": "297"}, {"mention": "直肠术后", "label": "疾病和诊断", "offset": "328"}]}
{"text": ",患者入院完善相关检查,诊断\\\"乙状结肠癌叒右肾下腺转移?叒\\\",未见手术禁忌,2015-07-31全麻上行乙状结肠切除+右肾下腺切除术,术中见肿瘤侵犯浆膜,近端结肠不全梗阻,,术后病理回报:1(乙状结肠大体)镜检为中分化腺癌,浸润至肠壁浆膜上层,未见明确脉管及神经束侵犯,并可见脓肿形成。2(近切缘)未见癌。3(远切缘)未见癌。4(中央淋巴结)镜上为脂肪结缔组织,未见癌。5(中间淋巴结)5枚,未见癌。6(肠旁淋巴结)10枚,未见癌。7(右肾下腺肿物)镜上为肾下腺组织,未见癌。,免疫组化:er(-),ercc1(+),msh2(-),msh6(+),pms2(+),mlh1(+),ki67(60%+)。患者术后恢复可。并于今日来诊入院行术后辅助治疗。患者发病以来,精神饮食睡眠一般,大小便正常,体重无减轻。", "mention_data": [{"mention": "乙状结肠癌叒右肾下腺转移", "label": "疾病和诊断", "offset": "16"}, {"mention": "乙状结肠切除+右肾下腺切除术", "label": "手术", "offset": "54"}, {"mention": "结肠", "label": "解剖部位", "offset": "81"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "98"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "肠", "label": "解剖部位", "offset": "117"}, {"mention": "中央淋巴结", "label": "解剖部位", "offset": "167"}, {"mention": "中间淋巴结", "label": "解剖部位", "offset": "189"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "204"}, {"mention": "右肾下腺", "label": "解剖部位", "offset": "220"}, {"mention": "肾下腺", "label": "解剖部位", "offset": "230"}]}
{"text": ",患者2012年底开始出现接触性出血,2013年4月曾行宫颈细胞学检查及hpv检查未发现异常(未见单),2014年8月我院门诊就诊,,tct:镜上见异型腺细胞,考虑为腺癌。遂行(宫颈肿物)活检术,,术后病理:镜检为低分化癌。妇科检查可见宫颈下唇可见结节状肿物约3x2.5cm,考虑“宫颈癌ib1期”,于2014-09-16在行“宫颈癌根治术(ii型子宫切除+两侧附件切除+盆腔淋巴结清扫术+腹主动脉旁淋巴结活检术)”。,术后病检结果示:(全子宫+两附件)镜检为宫颈低分化癌,结合免疫组化结果,符合低分化腺鳞癌,浸润宫颈及宫颈管浅肌层(&lt;1/2肌层),未累及阴道穹窿及子宫体上段;未见明确脉管内癌栓及神经束侵犯。淋巴结未见肿瘤转移。术后于2014-09-25、2014-10-21予tp方案(紫杉醇+顺铂)化疗2程,下次化疗结束后白细胞最低达2.1×109/l,予瑞白升白治疗后血常规恢复正常。今再次返院化疗入院。患者起病以来,精神可,无呕吐,入睡好,阴道无流血,二便正常,体重无明显改变。", "mention_data": [{"mention": "hpv", "label": "实验室检验", "offset": "36"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "83"}, {"mention": "(宫颈肿物)活检术", "label": "手术", "offset": "88"}, {"mention": "低分化癌", "label": "疾病和诊断", "offset": "107"}, {"mention": "宫颈下唇", "label": "解剖部位", "offset": "118"}, {"mention": "宫颈癌ib1期", "label": "疾病和诊断", "offset": "141"}, {"mention": "宫颈癌根治术(ii型子宫切除+两侧附件切除+盆腔淋巴结清扫术+腹主动脉旁淋巴结活检术)", "label": "手术", "offset": "164"}, {"mention": "全子宫", "label": "解剖部位", "offset": "219"}, {"mention": "两附件", "label": "解剖部位", "offset": "223"}, {"mention": "宫颈低分化癌", "label": "疾病和诊断", "offset": "230"}, {"mention": "低分化腺鳞癌", "label": "疾病和诊断", "offset": "248"}, {"mention": "宫颈", "label": "解剖部位", "offset": "257"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "260"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "281"}, {"mention": "子宫体", "label": "解剖部位", "offset": "286"}, {"mention": "紫杉醇", "label": "药物", "offset": "348"}, {"mention": "顺铂", "label": "药物", "offset": "352"}, {"mention": "瑞白", "label": "药物", "offset": "384"}, {"mention": "阴道", "label": "解剖部位", "offset": "428"}]}
{"text": ",缘于入院前1月因门诊胃镜检查示:“贲门溃疡型胃癌”,,病理:腺癌,门诊拟“贲门癌”收住入院,入院后完善相关检查未见明显手术禁忌症,2014年07月07日在全麻上行“根治性全胃切除术(食道空肠roux-y吻合、d2、r0)”,术顺,术后予换药、止血、补液、营养心肌、维持电解质平衡等治疗。,术后病理结果:1、,全胃:食管胃交界溃疡型管状腺癌ii,侵出浆膜层,侵犯神经,脉管内见癌栓,手术标本上切端未见癌浸润。找到贲门周淋巴结1/7个,小弯淋巴结2/6个,大弯淋巴结0/4个,幽门下淋巴结0/1个,幽门上淋巴结0/4个,及另送的(第8组)淋巴结0/3个,(第9组)淋巴结0/5个,(第十一组)淋巴结0/1个,(腹主动脉旁)淋巴结0/1个,(空肠系膜)淋巴结0/1个见癌转移。2、(食管上段旁)、(第十组),:送检脉管、纤维及脂肪组织。3、(大网膜结节),:送检纤维脂肪组织中见癌浸润。此次为化疗再次就诊我院,门诊拟胃癌术后化疗收入院。下次出院以来精神、睡眠、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": "贲门溃疡型胃癌", "label": "疾病和诊断", "offset": "18"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "31"}, {"mention": "贲门癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "根治性全胃切除术(食道空肠roux-y吻合、d2、r0)", "label": "手术", "offset": "83"}, {"mention": "心", "label": "解剖部位", "offset": "130"}, {"mention": "胃", "label": "解剖部位", "offset": "156"}, {"mention": "食管胃交界溃疡型管状腺癌ii", "label": "疾病和诊断", "offset": "158"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "206"}, {"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": "227"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "237"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "248"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "263"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "276"}, {"mention": "(第十一组)淋巴结", "label": "解剖部位", "offset": "289"}, {"mention": "(腹主动脉旁)淋巴结", "label": "解剖部位", "offset": "303"}, {"mention": "(空肠系膜)淋巴结", "label": "解剖部位", "offset": "318"}, {"mention": "食管上段", "label": "解剖部位", "offset": "339"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "406"}, {"mention": "腹痛", "label": "症状", "offset": "433"}, {"mention": "腹胀", "label": "症状", "offset": "436"}]}
{"text": "患者于约4月前无明显诱因上开始出现阴道出血,于******健院行宫颈活检提示中分化鳞癌,后至我院行病理会诊提示低分化癌,考虑为低分化鳞状细胞癌。临床考虑宫颈癌iia2期。2016-01-18、2016-2-15于我院行力朴素+顺铂方案2程。2016-03-15全麻上行iii型子宫切除、两附件切除、盆腔淋巴结清扫。术后病理:(子宫)镜检为宫颈低分化鳞状细胞癌,浸润宫颈及宫颈管深肌层;累及阴道穹窿;可见脉管内癌栓,未见明确神经束侵犯;萎缩性子宫内膜;平滑肌瘤。送检(左髂内淋巴结)1枚,见癌转移,其余多组淋巴结送检均未见癌。术后恢复好,现患者按主诊教授意见入院行术后辅助化疗,2016-04-07给予tc(力扑素240mgd1+顺铂50mgd1)方案化疗1程顺利,无不适。查体无特殊。患者发病以来,精神、饮食、睡眠尚可,大小便无明显异常。体重无明显减轻。", "mention_data": [{"mention": "阴道出血", "label": "症状", "offset": "17"}, {"mention": "宫颈", "label": "解剖部位", "offset": "32"}, {"mention": "中分化鳞癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "低分化癌", "label": "疾病和诊断", "offset": "55"}, {"mention": "低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "宫颈癌iia2期", "label": "疾病和诊断", "offset": "76"}, {"mention": "力朴素", "label": "药物", "offset": "109"}, {"mention": "顺铂", "label": "药物", "offset": "113"}, {"mention": "iii型子宫切除、两附件切除、盆腔淋巴结清扫", "label": "手术", "offset": "134"}, {"mention": "宫颈低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "169"}, {"mention": "宫颈", "label": "解剖部位", "offset": "182"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "185"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "194"}, {"mention": "子宫内膜", "label": "解剖部位", "offset": "220"}, {"mention": "左髂内淋巴结", "label": "解剖部位", "offset": "233"}, {"mention": "力扑素", "label": "药物", "offset": "303"}, {"mention": "顺铂", "label": "药物", "offset": "314"}]}
{"text": ",患者2个月前因下腹部不适于我院就诊,,入院后行胃镜检查示:于胃体上部、胃角后壁处可见较深凹陷性病变,占胃腔1/2周,中央可见巨大溃疡,表面覆污苔,周围粘膜不规则,有明显浸润并周边呈堤形隆起;病变部位胃腔狭小,内镜尚能通过;贲门部未受侵犯。胃镜病理(201600649),示:(胃角、胃体后壁)低分化腺癌。于2016-01-14在全麻上行根治性胃癌根治术+毕i式吻合,,术后病理示:(201600925)胃体、胃窦低分化腺癌,浸润溃疡型,体积14*9*1.6cm,侵穿浆膜,并于部分脉管内查见癌栓。累及近端切线,远端切线及另送“远端切线”未查见癌。呈三组(3/3个)、四组(11/17个)、六组(9/11个)、“胃1、3、7组”(2/5个)淋巴结癌转移。叒“胃第六组”(1个)淋巴结未查见癌。,癌组织免疫组化染色示:rrm1(-)、ts局灶(+)、topoii部分(+)、叒β-tubulin-iii(-)、syn(-)、cerbb-2(-)。术后给予静脉营养、抑酸、补液、补充白蛋白、抗感染等对症治疗。患者恢复良好出院,现患者为进一步行化疗来我院,门诊以“胃癌术后”收入我科。叒叒叒患者自发病以来,精神可,饮食欠佳,睡眠可,二便正常,体重体力无明显改变。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "8"}, {"mention": "胃", "label": "解剖部位", "offset": "31"}, {"mention": "胃", "label": "解剖部位", "offset": "36"}, {"mention": "胃", "label": "解剖部位", "offset": "52"}, {"mention": "胃", "label": "解剖部位", "offset": "100"}, {"mention": "贲门", "label": "解剖部位", "offset": "112"}, {"mention": "(胃角、胃体后壁)低分化腺癌", "label": "疾病和诊断", "offset": "138"}, {"mention": "根治性胃癌根治术+毕i式吻合", "label": "手术", "offset": "169"}, {"mention": "胃体、胃窦低分化腺癌", "label": "疾病和诊断", "offset": "202"}, {"mention": "三组(3/3个)、四组(11/17个)、六组(9/11个)、“胃1、3、7组”(2/5个)淋巴结", "label": "解剖部位", "offset": "275"}, {"mention": "“胃第六组”(1个)淋巴结", "label": "解剖部位", "offset": "328"}, {"mention": "白蛋白", "label": "实验室检验", "offset": "439"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "479"}]}
{"text": "入院前3月,患者因结肠镜发现左半结肠肿瘤就诊于我院我科,于2015-09-23我院在全麻上行“剖腹探查、结肠癌根治术、肠粘连松解术”,手术顺利,术后予止血、预防性抗感染、补液、对症等治疗。术后病检(1508028):(升结肠)粘液性腺癌,侵及全层,远、近切缘未见癌累及,肠周脂肪组织中淋巴结未见癌转移(0/8),(肠系膜结节)见癌组织(2枚),(腹膜结节)未见癌组织。术后恢复可,病情好转出院。于2015-10-20及2015-11-10在我科行化疗,目前患者无畏寒、发热,无咳嗽、咳痰,无恶心、呕吐,无腹痛、腹泻,无胸闷、胸痛、心悸等不适。患者为求第三次化疗,以“左半结肠癌术后3月,拟行第四次化疗”收入我科住院治疗。", "mention_data": [{"mention": "左半结肠肿瘤", "label": "疾病和诊断", "offset": "14"}, {"mention": "剖腹探查、结肠癌根治术、肠粘连松解术", "label": "手术", "offset": "47"}, {"mention": "(升结肠)粘液性腺癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "肠", "label": "解剖部位", "offset": "135"}, {"mention": "肠", "label": "解剖部位", "offset": "157"}, {"mention": "腹", "label": "解剖部位", "offset": "173"}, {"mention": "腹痛", "label": "症状", "offset": "252"}, {"mention": "腹泻", "label": "症状", "offset": "255"}, {"mention": "胸闷", "label": "症状", "offset": "259"}, {"mention": "胸痛", "label": "症状", "offset": "262"}, {"mention": "心悸", "label": "症状", "offset": "265"}, {"mention": "左半结肠癌术后", "label": "疾病和诊断", "offset": "283"}]}
{"text": "患者7月前于我院行剖腹探查+胃癌根治(d2,r1)+放射性粒子植入术,手术顺利,术后安返病房,术后给予补液、消肿、营养支持等对症处理,术后患者恢复顺利,术后病理检查结果:(胃窦)低分化腺癌。胃第八组淋巴结)可见癌转移(1/1)。(胃窦)溃疡型低分化腺癌,浸及胃壁全层,神经见癌侵犯,脉管中见癌栓,上切端见癌累及,下切端食管复鳞下皮轻度不典型增生,胃小弯、大弯淋巴结见癌转移(各为7/8、7/8),网膜中未见癌转移,患者出院后无特处不适。1周前无明显诱因出现全身乏力,且食欲减退,无畏寒、发热,无腹痛,无恶心呕吐等症状,为弄清病情并及时治疗,今入我院我科。\\u0004叒叒叒患者自起病以来,精神略差,胃纳较差,大便如常,小便如常,体重未见明显上降。", "mention_data": [{"mention": "剖腹探查+胃癌根治(d2,r1)+放射性粒子植入术", "label": "手术", "offset": "9"}, {"mention": "(胃窦)低分化腺癌", "label": "疾病和诊断", "offset": "85"}, {"mention": "胃第八组淋巴结", "label": "解剖部位", "offset": "95"}, {"mention": "(胃窦)溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "114"}, {"mention": "胃", "label": "解剖部位", "offset": "129"}, {"mention": "食管", "label": "解剖部位", "offset": "159"}, {"mention": "胃小弯、大弯淋巴结", "label": "解剖部位", "offset": "173"}, {"mention": "腹痛", "label": "症状", "offset": "247"}]}
{"text": "患者6月余前(2015-7-16)因结肠癌于我院行左半结肠切除术+淋巴结清扫术,术后常规病理示:(25232.15)(左半结肠)中低分化腺癌,溃疡型,切面积6*4.5cm,侵达外膜,下上切缘、阑尾及另送吻合器切缘均未查见癌。肠周淋巴结14枚,其中7枚查见转移(7/14);另送肠系膜根部淋巴结1枚,未查见转移癌(0/1)。术后给予消炎营养支持治疗,病情好转后出院。后患者因“术后肠梗阻”再次入院,行保守治疗好转后出院。后患者再次返院行奥沙利铂+cf+替加氟方案化疗5周期,耐受好。现患者为行上一周期化疗治疗再次来我院,门诊以“结肠癌术后化疗”收入院。自发病来,患者饮食睡眠尚可,二便无明显异常,体重较前无明显改变。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "18"}, {"mention": "左半结肠切除术+淋巴结清扫术", "label": "手术", "offset": "25"}, {"mention": "(左半结肠)中低分化腺癌", "label": "疾病和诊断", "offset": "58"}, {"mention": "阑尾", "label": "解剖部位", "offset": "96"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "112"}, {"mention": "肠系膜根部淋巴结", "label": "解剖部位", "offset": "138"}, {"mention": "术后肠梗阻", "label": "疾病和诊断", "offset": "187"}, {"mention": "奥沙利铂", "label": "药物", "offset": "217"}, {"mention": "cf", "label": "药物", "offset": "222"}, {"mention": "替加氟", "label": "药物", "offset": "225"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "263"}]}
{"text": ",缘于入院前4月余于我院诊断为直肠癌,于2016-01-21在全麻上行腹腔镜上直肠癌姑息性切除术dixon,,术后病理:(201602459)1、(直肠),:肠溃疡型管状腺癌ii级,侵及外膜层。手术标本下、上切端及另送(下切端)、(上切端)均未见癌浸润。找到肠周淋巴结0/6个,未见癌转移。肠周脂肪组织中找到12枚癌结节。2、(肠系膜上动脉根部淋巴结),:送检为纤维、脂肪及脉管组织。3、(盆壁结节),:送检为癌结节。,免疫组化:ki67(50%+),ck7(-),ck20(+++),villin(++++),cdx-2(+++),cd56(-),mlh1(+),msh2(+),pms2(-),msh-6(+)。,微卫星稳定性:msi-l。,病理:(mm20160170)该病例检测到kras基因12号密码子g12d突变。,病理:(mm20160171)该病例未检测到braf基因v600e突变。术后给予对症、营养支持等治疗,恢复可。于2016.03.19,2016.5.4予“伊立替康240mgd1+卡培他滨片1500mgbidd1-14”方案化疗,辅以保胃、保肝、增强免疫等,未见明显化疗副反应。出院后无腹痛、腹胀,无呕血、黑便,无发热、寒战等。此次为行上一周期化疗再次就诊我院,门诊拟直肠癌术后化疗收入院。下次出院以来精神、睡眠、饮食可,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": "15"}, {"mention": "腹腔镜上直肠癌姑息性切除术dixon", "label": "手术", "offset": "35"}, {"mention": "直肠", "label": "解剖部位", "offset": "74"}, {"mention": "肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "79"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "129"}, {"mention": "肠", "label": "解剖部位", "offset": "145"}, {"mention": "肠系膜上动脉根部淋巴结", "label": "解剖部位", "offset": "164"}, {"mention": "伊立替康", "label": "药物", "offset": "441"}, {"mention": "卡培他滨片", "label": "药物", "offset": "453"}, {"mention": "胃", "label": "解剖部位", "offset": "481"}, {"mention": "肝", "label": "解剖部位", "offset": "484"}, {"mention": "腹痛", "label": "症状", "offset": "506"}, {"mention": "腹胀", "label": "症状", "offset": "509"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "547"}]}
{"text": "缘于入院前4月余于我院诊为“胃癌、直肠癌”,于2016.6.11在全麻上行“全腹腔镜上根治性远端胃大部切除术+直肠癌根治术”。术后病理示“(远端胃)胃角溃疡型低黏附性癌(低分化腺癌,部分为印戒细胞癌),侵出浆膜层,侵犯神经及脉管组织,手术标本下、上切端及另送(胃下切端)均未见癌浸润;找到胃小弯淋巴结0/18个,大弯及网膜淋巴结0/9个,幽门下淋巴结1/1个,幽门上淋巴结0/8个,见癌转移。小弯侧脂肪组织见少量胰腺组织”,术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。术后分别于2016.7.13、2016.8.3、2016.8.23予“乐沙定200mgivgttqdd1+卡培他滨片1500mgpobidd1-14”方案化疗。于2016.09.21行回肠造口还纳术,术后恢复可,此次为行再次化疗就诊我院,门诊拟胃癌、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": "胃癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "17"}, {"mention": "全腹腔镜上根治性远端胃大部切除术+直肠癌根治术", "label": "手术", "offset": "38"}, {"mention": "胃", "label": "解剖部位", "offset": "72"}, {"mention": "胃角溃疡型低黏附性癌(低分化腺癌,部分为印戒细胞癌)", "label": "疾病和诊断", "offset": "74"}, {"mention": "胃", "label": "解剖部位", "offset": "130"}, {"mention": "胃小弯淋巴结", "label": "解剖部位", "offset": "144"}, {"mention": "大弯及网膜淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "180"}, {"mention": "小弯", "label": "解剖部位", "offset": "196"}, {"mention": "胰腺", "label": "解剖部位", "offset": "206"}, {"mention": "乐沙定", "label": "药物", "offset": "276"}, {"mention": "卡培他滨", "label": "药物", "offset": "294"}, {"mention": "回肠造口还纳术", "label": "手术", "offset": "333"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "363"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "366"}, {"mention": "腹痛", "label": "症状", "offset": "392"}, {"mention": "腹胀", "label": "症状", "offset": "395"}]}
{"text": "缘于入院前4年因“乙状结肠癌”就诊我院,于我院行“腹腔镜辅助上乙状结肠癌根治术”,术中见“肿瘤位于乙状结肠中段,约3*2.5cm,对系膜侧侵出浆膜层,未侵犯周围组织,周围无明显肿大淋巴结”,术后病理(201131862)回报“(乙状)结肠蕈伞型管状腺癌ii级,侵及浆膜层,手术标本下、上切端及另送(下、上切端)未见癌浸润,找到肠周淋巴结11个均未见癌转移,另送(肠系膜上动脉根部淋巴结)为脂肪脉管结缔组织”,术后病情恢复良好出院,后门诊定期复查发现肝、肺、骨多发转移。入院前2年前开始给予口服希罗达及中药治疗,无诉腹痛、腹胀,无畏冷、发热等不适。今为再次治疗,门诊拟“乙状结肠癌术后伴肝、肺骨多发转移”收治入院,自发病以来,饮食较差,睡眠可,二便正常,无消瘦乏力,体重较前无明显改变。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "腹腔镜辅助上乙状结肠癌根治术", "label": "手术", "offset": "25"}, {"mention": "乙状结肠中段", "label": "解剖部位", "offset": "49"}, {"mention": "(乙状)结肠蕈伞型管状腺癌ii级", "label": "疾病和诊断", "offset": "113"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "163"}, {"mention": "肠系膜上动脉根部淋巴结", "label": "解剖部位", "offset": "181"}, {"mention": "肝、肺、骨多发转移", "label": "疾病和诊断", "offset": "224"}, {"mention": "希罗达", "label": "药物", "offset": "246"}, {"mention": "腹痛", "label": "症状", "offset": "257"}, {"mention": "腹胀", "label": "症状", "offset": "260"}, {"mention": "乙状结肠癌术后伴肝、肺骨多发转移", "label": "疾病和诊断", "offset": "284"}]}
{"text": ",缘于入院前4月余诊为直肠癌,于2014年11月19日在全麻上行“腹腔镜上直肠癌根治术(miles)”,手术顺利。术后病理(201440195),:“(直肠)直肠溃疡型管状腺癌ii级并坏死,侵出外膜层,未侵及齿状线,侵犯神经组织,下、上切端及环周切缘均未见癌浸润。肿物周围淋巴结6个、肠周淋巴结14个未见癌转移。,病理分期:pt4an0m0,iib期。”术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。于2015年1月7日、2015年2月4日、2015年3月4日行“奥沙利铂(齐沙)250mgivgttd1+希罗达1500mgpobidd1-14”方案3次化疗,未见明显化疗副反应,今返院行第4周期化疗,门诊拟“直肠癌术后化疗”收入院。出院后饮食、睡眠可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹腔镜上直肠癌根治术(miles)", "label": "手术", "offset": "33"}, {"mention": "直肠", "label": "解剖部位", "offset": "76"}, {"mention": "直肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "79"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "142"}, {"mention": "奥沙利铂", "label": "药物", "offset": "236"}, {"mention": "齐沙", "label": "药物", "offset": "241"}, {"mention": "希罗达", "label": "药物", "offset": "257"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "309"}, {"mention": "腹痛", "label": "症状", "offset": "332"}, {"mention": "腹胀", "label": "症状", "offset": "335"}]}
{"text": ",缘于入院前5月余,以“排便次数增多伴血便1个月。”为主诉入院,诊断直肠癌,遂于2013-5-7在全麻上行腹腔镜上直肠癌根治术+预防性回肠造瘘,术顺,术后予防感染、补液等治疗。,病理示:1、大肠溃疡型管状腺癌ii级,侵及深肌层,手术标本吻合切端见少量癌浸润,手术标本另一切端及另送(下切端)、(上切端)均未见癌浸润。找到肿物周淋巴结6个,肠周淋巴结9个均未见癌转移。另送(肠系膜上动脉根部淋巴结)为脂肪、脉管及神经组织。2、大肠管状腺瘤,伴低级别下皮内瘤变。,免疫组化结果:ck7(-),ck20(++),villin(+++),cea(+++),cdx-2(+++),cd56(-),ki67(50%+)。今患者再次入院,要求关闭造瘘口,门诊拟“直肠癌术后,回肠造瘘术后”收入院,自发病以来,精神、睡眠、食欲尚可,大便经造瘘口排出可,小便正常,体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "34"}, {"mention": "腹腔镜上直肠癌根治术+预防性回肠造瘘", "label": "手术", "offset": "53"}, {"mention": "大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "95"}, {"mention": "肿物周淋巴结", "label": "解剖部位", "offset": "160"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "肠系膜上动脉根部淋巴结", "label": "解剖部位", "offset": "186"}, {"mention": "大肠管状腺瘤", "label": "疾病和诊断", "offset": "212"}, {"mention": "直肠癌术后,回肠造瘘术后", "label": "疾病和诊断", "offset": "324"}]}
{"text": "患者于1月余前因“直肠癌”在我科行“腹腔镜上直肠癌根治术(miles)+放射性粒子植入术”,手术顺利,术后病理结果为:(直肠)溃疡型中分化管状腺癌浸及肠壁深肌层,双切端未见癌累及,肠壁淋巴结见癌转移(1/10)。术后患者恢复较好,出院后患者无腹痛、腹胀,无畏寒发热,会阴部切口逐步愈合,现已明显变浅变小,肉芽组织生长良好,今患者为求术后第1次全身静脉化疗来我院就诊,门诊以“直肠癌(miles)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": "直肠癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "腹腔镜上直肠癌根治术(miles)+放射性粒子植入术", "label": "手术", "offset": "18"}, {"mention": "(直肠)溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "59"}, {"mention": "肠", "label": "解剖部位", "offset": "75"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "90"}, {"mention": "腹痛", "label": "症状", "offset": "121"}, {"mention": "腹胀", "label": "症状", "offset": "124"}, {"mention": "会阴部", "label": "解剖部位", "offset": "133"}, {"mention": "直肠癌(miles)术后", "label": "疾病和诊断", "offset": "187"}]}
{"text": ",患者于4月前(2015-09-07)因“1.盆腔包块(卵巢ca?);2.糖尿病”在全麻上行剖腹探查+全子宫两附件切除+大网膜切除+阑尾切除+放射性粒子置入术。,术中见:右侧附件失去正常形态,大小约10x9x8cm,实性,表面充血水肿,呈紫蓝色,可见烂鱼肉样组织,质脆,易触血,侵及后盆壁,与宫底、乙状结肠形成粘连。钝性分离粘连后,见子宫常大,子宫底、前壁见转移癌灶。左侧输卵管见少量转移灶,左卵巢形态正常。大网膜增厚、盆腔腹膜见散状结节病灶,最大约3cm。术中切除右附件交家属过目后送病理行冰冻切片示“(右附件)卵巢浆液性乳头状囊腺癌浸及输卵管”,遂行子宫、左侧附件、大网膜、阑尾切除术后标本送病检,,术后病检示:1、(肿瘤组织)送检物为浆液性乳头状囊腺癌。2、子宫表面见癌组织累及,宫腔、宫颈及右附件均未见癌累及。3、大网膜及阑尾均未见癌转移。并于09-11行顺铂100mg腹腔灌注、09-15行紫杉醇210mg静滴第一次化疗。分别于2015-10-20、2015-12-01予患者行紫杉醇(特素)210mg+奥沙利铂180mg化疗2个疗程,化疗过程较为顺利,患者恶心、呕吐等不适症状较轻。现患者无特殊不适,要求行第四次化疗。\\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,体重无明显变化。", "mention_data": [{"mention": "盆腔包块", "label": "症状", "offset": "23"}, {"mention": "卵巢ca", "label": "疾病和诊断", "offset": "28"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "37"}, {"mention": "剖腹探查+全子宫两附件切除+大网膜切除+阑尾切除+放射性粒子置入术", "label": "手术", "offset": "46"}, {"mention": "右侧附件", "label": "解剖部位", "offset": "85"}, {"mention": "宫底", "label": "解剖部位", "offset": "146"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "149"}, {"mention": "子宫", "label": "解剖部位", "offset": "167"}, {"mention": "子宫底、前壁", "label": "解剖部位", "offset": "172"}, {"mention": "左侧输卵管", "label": "解剖部位", "offset": "184"}, {"mention": "左卵巢", "label": "解剖部位", "offset": "196"}, {"mention": "盆腔", "label": "解剖部位", "offset": "210"}, {"mention": "腹", "label": "解剖部位", "offset": "212"}, {"mention": "右附件", "label": "解剖部位", "offset": "233"}, {"mention": "(右附件)卵巢浆液性乳头状囊腺癌", "label": "疾病和诊断", "offset": "252"}, {"mention": "输卵管", "label": "解剖部位", "offset": "270"}, {"mention": "子宫", "label": "解剖部位", "offset": "277"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "280"}, {"mention": "大网膜", "label": "解剖部位", "offset": "285"}, {"mention": "阑尾切除术", "label": "手术", "offset": "289"}, {"mention": "浆液性乳头状囊腺癌", "label": "疾病和诊断", "offset": "320"}, {"mention": "子宫", "label": "解剖部位", "offset": "332"}, {"mention": "宫腔", "label": "解剖部位", "offset": "343"}, {"mention": "宫颈", "label": "解剖部位", "offset": "346"}, {"mention": "右附件", "label": "解剖部位", "offset": "349"}, {"mention": "阑尾", "label": "解剖部位", "offset": "365"}, {"mention": "顺铂", "label": "药物", "offset": "382"}, {"mention": "腹腔", "label": "解剖部位", "offset": "389"}, {"mention": "紫杉醇", "label": "药物", "offset": "400"}, {"mention": "紫杉醇", "label": "药物", "offset": "444"}, {"mention": "特素", "label": "药物", "offset": "448"}, {"mention": "奥沙利铂", "label": "药物", "offset": "457"}]}
{"text": ",患者3月前因“反复腹痛、腹泻10余天,加重3天”入院,于2016-03-18在全麻上行乙状结肠部分切除+乙状结肠单腔造瘘术,手术过程顺利。,术后病理:结肠腺癌(中度分化),浸润溃疡型,体积5*4*0.9cm,侵达浆膜脂肪组织。双端切线及环周底部切除面未查见癌。肠壁一站(8/14个)淋巴结癌转移。符合结肠炎性息肉。,免疫组化染色示癌组织:syn(-)、ts弱(+)。2月前患者造口旁出现可复性肿物,站立和用力后增大,平卧后可以回纳消失,伴造口脱垂及肠粘膜渗血,现患者为求进一步诊治,门诊以“造口旁疝”收入我科。叒叒叒患者精神欠佳,普通饮食,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "10"}, {"mention": "腹泻", "label": "症状", "offset": "13"}, {"mention": "乙状结肠部分切除+乙状结肠单腔造瘘术", "label": "手术", "offset": "44"}, {"mention": "结肠腺癌(中度分化)", "label": "疾病和诊断", "offset": "76"}, {"mention": "肠壁一站(8/14个)淋巴结", "label": "解剖部位", "offset": "131"}, {"mention": "结肠炎性息肉", "label": "疾病和诊断", "offset": "151"}, {"mention": "肠", "label": "解剖部位", "offset": "225"}, {"mention": "造口旁疝", "label": "疾病和诊断", "offset": "246"}]}
{"text": ",缘于入院前1月余于我院诊为回盲部肿瘤,于2013-12-10在全麻上行根治性左半结肠切除术,术后病理(201339034)示回盲部浸润型粘液腺癌,侵犯浆膜外,手术标本回肠切端、结肠切端均未见癌浸润,送检淋巴结未见癌转移,术后给予对症、营养支持等治疗,术后恢复良好,伤口愈合ii/甲,术后于2014.01.02,行化疗治疗:folfox,方案:替加氟3.4持续泵入/cf0.3d1-2+奥沙利铂200mgd1,辅以保肝、制酸、止吐、提高免疫力,化疗过程顺利,无明显化疗不良反应,今为再次化疗入院,门诊拟回盲部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": "回盲部肿瘤", "label": "疾病和诊断", "offset": "14"}, {"mention": "根治性左半结肠切除术", "label": "手术", "offset": "36"}, {"mention": "回盲部浸润型粘液腺癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "回肠", "label": "解剖部位", "offset": "84"}, {"mention": "结肠", "label": "解剖部位", "offset": "89"}, {"mention": "替加氟", "label": "药物", "offset": "172"}, {"mention": "cf", "label": "药物", "offset": "183"}, {"mention": "奥沙利铂", "label": "药物", "offset": "193"}, {"mention": "肝", "label": "解剖部位", "offset": "208"}, {"mention": "回盲部腺癌术后", "label": "疾病和诊断", "offset": "251"}, {"mention": "腹痛", "label": "症状", "offset": "281"}, {"mention": "腹胀", "label": "症状", "offset": "284"}]}
{"text": ",患者因患“乙状结肠癌”于2014-02-25于我院在全麻上予行乙状结肠癌根治术;术后病理(201402452),示:(乙状结肠)腺癌(中、低度分化),隆起型,面积3.5*2cm,侵达浆膜脂肪组织,双端切线及另送“近端切线”、“远端切线”未查见癌。一站(13个)、中间组(3个)、中央组(5个)淋巴结未查见癌。,免疫组化染色示癌组织:ercc1少数(+)、ts(-)。,病理分期为:pt3n0m0叒iia期叒dukesb。依情行术后辅助化疗指证存在,排除化疗禁忌后,先后给予6个周期辅助化疗,,具体化疗方案为:奥沙利铂150mg叒d1,亚叶酸钙0.3g+替加氟1.0g叒d2-d6,同时给予升白细胞、保肝、护胃、止吐、免疫增强治疗。自下次出院后,患者一般情况保持良好,无乏力感,无发热,无恶心、呕吐,无胸闷、心慌,无头晕、头痛,无反酸、嗳气,无明显进食不适,未现明显腹痛、腹胀;大小便情况良好。现患者为行复查来我院就诊,门诊以“乙状结肠癌术后”收入院。目前患者精神及情绪状态可,食欲、饮食好,夜间睡眠可,大小便正常,近期无明显体重变化。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "32"}, {"mention": "(乙状结肠)腺癌(中、低度分化)", "label": "疾病和诊断", "offset": "59"}, {"mention": "一站(13个)、中间组(3个)、中央组(5个)淋巴结", "label": "解剖部位", "offset": "124"}, {"mention": "奥沙利铂", "label": "药物", "offset": "255"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "268"}, {"mention": "替加氟", "label": "药物", "offset": "277"}, {"mention": "肝", "label": "解剖部位", "offset": "301"}, {"mention": "胃", "label": "解剖部位", "offset": "304"}, {"mention": "胸闷", "label": "症状", "offset": "351"}, {"mention": "头晕", "label": "症状", "offset": "358"}, {"mention": "头痛", "label": "症状", "offset": "361"}, {"mention": "腹痛", "label": "症状", "offset": "383"}, {"mention": "腹胀", "label": "症状", "offset": "386"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "414"}]}
{"text": "缘于3月前因残胃癌在我院于2014年01月02日在全麻上行根治性残胃癌切除术手术顺利。术后病理示(残胃)胃近贲门处溃疡型管状腺癌ii-iii级,部分为粘液腺癌,侵及浆膜层,侵犯神经,脉管内见癌栓,未见侵犯食管胃交界区。手术标本下切端、吻合肠管双切端及另送(下切端)均未见癌浸润,找到贲门**/8个,小弯侧淋巴结0/6个,大弯侧淋巴结0/2个,见癌转移。术后恢复良好,顺利出院。出院后于术后2周出现“腹痛伴肛门停止排气、排便”再次就诊我院,考虑“粘连性小肠梗阻”予禁食、胃肠减压、灌肠、抑制消化液分泌、营养支持等积极保守治疗后,患者腹痛一度好转后再次呈持续性腹痛伴阵发性加剧,遂于2014.1.25全麻上行“剖腹探查+小肠粘连松解术”,术顺,术后恢复良好,出院后无腹痛、腹胀、恶心、呕吐等不适,2014.02.17、2014.3.3、2014.4.1于我院行“奥沙利铂100mgd1ivgtt+亚叶酸钙200mgd1-2ivgtt+替加氟3.0gciv”方案术后3周期化疗,化疗过程顺利,无特殊不适,此次为化疗再次入院。患者出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "残胃癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "根治性残胃癌切除术", "label": "手术", "offset": "29"}, {"mention": "(残胃)胃近贲门处溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "48"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "食管", "label": "解剖部位", "offset": "102"}, {"mention": "胃", "label": "解剖部位", "offset": "104"}, {"mention": "肠", "label": "解剖部位", "offset": "119"}, {"mention": "贲门", "label": "解剖部位", "offset": "141"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "149"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "160"}, {"mention": "腹痛", "label": "症状", "offset": "199"}, {"mention": "肛门", "label": "解剖部位", "offset": "202"}, {"mention": "粘连性小肠梗阻", "label": "疾病和诊断", "offset": "222"}, {"mention": "胃", "label": "解剖部位", "offset": "234"}, {"mention": "肠", "label": "解剖部位", "offset": "235"}, {"mention": "肠", "label": "解剖部位", "offset": "240"}, {"mention": "腹痛", "label": "症状", "offset": "265"}, {"mention": "腹痛", "label": "症状", "offset": "278"}, {"mention": "剖腹探查+小肠粘连松解术", "label": "手术", "offset": "303"}, {"mention": "腹痛", "label": "症状", "offset": "331"}, {"mention": "腹胀", "label": "症状", "offset": "334"}, {"mention": "奥沙利铂", "label": "药物", "offset": "379"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "396"}, {"mention": "替加氟", "label": "药物", "offset": "415"}, {"mention": "腹痛", "label": "症状", "offset": "472"}, {"mention": "腹胀", "label": "症状", "offset": "475"}]}
{"text": ",缘于入院前1月于我院诊为胃角癌,2015年09月07日在全麻上行腹腔镜辅助上根治性远端胃大部切除术(毕ii式,d2),术后予预防性抗感染、制酸、补液支持等治疗。术后病理(201532192),:(远端胃大部分),:胃角溃疡型管状腺癌ii级,侵及浆膜层,手术标本双切端及另送(下切端)均未见癌浸润。找到小弯淋巴结2/21个、大弯淋巴结0/2个、幽门下淋巴结0/2个、幽门上淋巴结1/11个,及另送(胃右a根部)淋巴结0/3个、(第8p)淋巴结1/6个,见癌转移。术后恢复良好,伤口愈合ii/甲。此次为化疗再次就诊我院,门诊拟胃角癌术后收入院。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": "胃角癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜辅助上根治性远端胃大部切除术(毕ii式,d2)", "label": "手术", "offset": "33"}, {"mention": "胃", "label": "解剖部位", "offset": "101"}, {"mention": "胃角溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "108"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "151"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "162"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "172"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "183"}, {"mention": "(胃右a根部)淋巴结", "label": "解剖部位", "offset": "198"}, {"mention": "(第8p)淋巴结", "label": "解剖部位", "offset": "213"}, {"mention": "胃角癌术后", "label": "疾病和诊断", "offset": "262"}, {"mention": "腹痛", "label": "症状", "offset": "288"}, {"mention": "腹胀", "label": "症状", "offset": "291"}]}
{"text": ",缘于入院前5月余于我院诊断为“直肠癌伴两肺多发转移瘤”,予2016-07-08行“腹腔镜上直肠部分切除术(姑息性)+乙状结肠造瘘术”,,术中见:腹腔内无明显出血,没有明显粘连,无腹水,肿瘤下缘位于腹膜反折下2cm右左,明显累及浆膜面,侵犯左侧盆壁,肿瘤上缘于腹腔内不可探及,术中诊断“直肠癌伴肺转移”,考虑肿瘤晚期,外侵明显,遂决定行“腹腔镜上姑息性直肠癌切除术(hartmann)+乙状结肠造瘘术”。术顺,术后予止血、止痛,抑酸保胃、保肝,增强免疫,加强营养支持等治疗,恢复良好。,术后病理示:(直肠),:肠溃疡型管状腺癌ii级,部分为筛状粉刺型,伴坏死,侵犯神经及脉管,见脉管内癌栓,侵及浆膜层。手术标本下、上切端均未见癌浸润。找到肠周淋巴结2/12个,见癌转移,找到癌结节3个。另送(肠系膜上动脉根部淋巴结)镜上为脂肪、血管及纤维结缔组织。,免疫组化染色结果:ki67(80%阳性),egfr(+),p53(+),p16(+)。于2016.07.30、2016.8.20、2016.09.10、2016.10.14行“伊立替康240mgivgttd1+卡培他滨1500mgpobidd1-14+洛铂40mg腹腔灌注d1”方案化疗。于2016.11.12予“伊立替康240mgivgttd1+卡培他滨1500mgpobidd1-14”方案化疗,今为第6次化疗,就诊我院,门诊拟“直肠癌术后化疗”收入院。自下次发病以来,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": "直肠癌伴两肺多发转移瘤", "label": "疾病和诊断", "offset": "16"}, {"mention": "腹腔镜上直肠部分切除术(姑息性)+乙状结肠造瘘术", "label": "手术", "offset": "42"}, {"mention": "腹腔", "label": "解剖部位", "offset": "73"}, {"mention": "腹水", "label": "症状", "offset": "90"}, {"mention": "腹", "label": "解剖部位", "offset": "99"}, {"mention": "腹腔", "label": "解剖部位", "offset": "130"}, {"mention": "直肠癌伴肺转移", "label": "疾病和诊断", "offset": "143"}, {"mention": "腹腔镜上姑息性直肠癌切除术(hartmann)+乙状结肠造瘘术", "label": "手术", "offset": "169"}, {"mention": "胃", "label": "解剖部位", "offset": "217"}, {"mention": "肝", "label": "解剖部位", "offset": "220"}, {"mention": "直肠", "label": "解剖部位", "offset": "250"}, {"mention": "肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "255"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "319"}, {"mention": "肠系膜上动脉根部淋巴结", "label": "解剖部位", "offset": "346"}, {"mention": "伊立替康", "label": "药物", "offset": "463"}, {"mention": "卡培他滨", "label": "药物", "offset": "480"}, {"mention": "洛铂", "label": "药物", "offset": "501"}, {"mention": "腹腔", "label": "解剖部位", "offset": "507"}, {"mention": "伊立替康", "label": "药物", "offset": "532"}, {"mention": "卡培他滨", "label": "药物", "offset": "549"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "592"}]}
{"text": ",患者5个半月前(2014-12-23)因“直肠癌”,在我院全麻上上行直肠高位前切除术。术中探查h0p0,病灶大小约3*2.5*1.0cm,位于直肠下段,左前壁,浆膜为脂肪遮盖。余腹膜内未见异常。,术后病理:,进展期直肠癌:隆起型叒中分化管状腺癌叒断端无癌。淋巴结见转移癌(1/15枚)dukes分期c期(,病理号:178036),术后3周(4个半月前)因胆囊炎、胆囊结石,在我院普外科行急诊胆囊切除术。恢复顺利,2015-5-4于我科行希罗达、艾恒化疗一次,现为再次行化疗而入我科,患者病来食欲佳,睡眠良好,大便不成形,小便正常,近半年自觉体重上降。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "直肠高位前切除术", "label": "手术", "offset": "35"}, {"mention": "直肠下段", "label": "解剖部位", "offset": "72"}, {"mention": "腹", "label": "解剖部位", "offset": "90"}, {"mention": "直肠癌:隆起型叒中分化管状腺癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "胆囊炎、胆囊结石", "label": "疾病和诊断", "offset": "178"}, {"mention": "胆囊切除术", "label": "手术", "offset": "196"}, {"mention": "希罗达", "label": "药物", "offset": "219"}, {"mention": "艾恒", "label": "药物", "offset": "223"}]}
{"text": ",罹患残胃癌于2013-9-6在我院予行全麻上全胃切除术(空肠j字代胃);,术中探查见:腹腔内严重粘连,腹腔内无腹水,肝脏无法探查,盆底腹膜无异常;肿瘤位于残胃后壁,溃疡性肿块,约10叒x叒8cm。肿瘤侵出浆膜层。患者术后积极予相关对症支持治疗并恢复顺利良好。相关手术病理(2013叒11248),示:残胃低分化腺癌,体积7.5*7*3.2cm,蕈伞型,侵达浆膜。双端切线及另送“胃远端切线”未查见癌。贲门周围(10个)淋巴结未查见癌。,免疫组化染色示癌组织:ercc1(+)、β-tubulin-iii(+)、ts(-)、rrm1(-)、topoii(阳性数60%)、cerbb-2(-)。合患者病情及肿瘤病理与分期继续予行术后化疗相关辅助治疗指征存在;依情先后予2013-9、2013-10予行术后辅助化疗2周期,,具体用药为: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,同时辅以镇吐、升血、免疫调节等对症支持治疗(化疗期间患者总体耐受性良好;复查血像示外周血白细胞减少,予瑞白升血处理)。自下次出院(2013-10-23)以来,患者一般情况保持良好;无发热,无恶心、呕吐,无明显反酸、嗳气,无明显进食不适,未现明显腹痛、腹胀。现患者为行规律性复查并完善相关后续辅助治疗而再至我科就诊,遂依情以“胃恶性肿瘤术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;近期无明显体重变化。", "mention_data": [{"mention": "残胃癌", "label": "疾病和诊断", "offset": "3"}, {"mention": "全胃切除术(空肠j字代胃)", "label": "手术", "offset": "23"}, {"mention": "腹腔", "label": "解剖部位", "offset": "44"}, {"mention": "腹腔", "label": "解剖部位", "offset": "52"}, {"mention": "腹水", "label": "症状", "offset": "56"}, {"mention": "肝脏", "label": "解剖部位", "offset": "59"}, {"mention": "盆底", "label": "解剖部位", "offset": "66"}, {"mention": "腹", "label": "解剖部位", "offset": "68"}, {"mention": "胃", "label": "解剖部位", "offset": "79"}, {"mention": "残胃低分化腺癌", "label": "疾病和诊断", "offset": "151"}, {"mention": "胃", "label": "解剖部位", "offset": "190"}, {"mention": "贲门周围(10个)淋巴结", "label": "解剖部位", "offset": "201"}, {"mention": "奥沙利铂", "label": "药物", "offset": "366"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "379"}, {"mention": "替加氟", "label": "药物", "offset": "394"}, {"mention": "外周血白细胞", "label": "实验室检验", "offset": "453"}, {"mention": "瑞白", "label": "药物", "offset": "463"}, {"mention": "腹痛", "label": "症状", "offset": "534"}, {"mention": "腹胀", "label": "症状", "offset": "537"}, {"mention": "胃恶性肿瘤术后", "label": "疾病和诊断", "offset": "574"}]}
{"text": ",患者于2016-11-04在全麻上行\\\"胃癌根治术(全胃)\\\",,术后病理回报:“(胃大体)镜检为中至低分化腺癌,lauren,分型:肠型,癌组织侵犯至胃壁浆膜上层,并累及食管壁外膜层;未见明确脉管内癌栓,可见神经束侵犯;网膜组织未见癌。淋巴结41枚,2枚见癌。(远、近切缘)未见癌”。术后预防感染、抑制分泌、静脉营养等对症支持处理,恢复好,2016-12-05已予行一程术后辅助化疗,以现为行上一程化疗收住我科,起病以来,患者精神尚可,食欲欠佳,大小便正常,体重上降3kg。", "mention_data": [{"mention": "胃癌根治术(全胃)", "label": "手术", "offset": "21"}, {"mention": "胃", "label": "解剖部位", "offset": "43"}, {"mention": "中至低分化腺癌,lauren", "label": "疾病和诊断", "offset": "50"}, {"mention": "胃", "label": "解剖部位", "offset": "77"}, {"mention": "食管", "label": "解剖部位", "offset": "87"}]}
{"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。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": "胃癌术后", "label": "疾病和诊断", "offset": "533"}, {"mention": "腹痛", "label": "症状", "offset": "561"}, {"mention": "腹胀", "label": "症状", "offset": "564"}]}
{"text": ",缘于入院前1月于我院诊为直肠癌,于2014-03-03在全麻上行腹腔镜上直肠癌根治术dixon,,术中见:腹腔网膜及盆底光滑无结节,无腹水,肝表面光滑,胃及空肠未见明显病变。直肠腹膜返折距离肛门约10cm可触及一肿物,大小约3cm*2cm,质硬,未侵犯浆膜层,肠系膜上动脉根部可触及多枚肿大,与腹壁明显粘连,予分离,见肠管周围数个肿大淋巴结,大者直径约1cm,决定行“腹腔镜直肠癌根治切除术”。。术后病理(201405649)示1.大肠溃疡型管状腺癌ii级,侵犯浅肌层。周围肠管粘膜及粘膜上层淋巴组织增生活跃。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1/18个,及另送(肠系膜上血管旁)淋巴结0/7个见癌转移。,免疫组化结果:ck7(-),ck20(+),villin(+++),cea(+++),cdx-2(+++),cga(-),cd56(-),sy(-),ki67(60%+)。2.大肠管状腺瘤,伴低级别下皮内瘤变。,术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。于2014.3.25、2014.4.9、2014.4.24、2014.5.14予“奥沙利铂150mgivgttd1+替加氟3.6gcivd1+亚叶酸钙300mgivgttd1-2”方案行4次化疗,此次为术后第5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": "13"}, {"mention": "腹腔镜上直肠癌根治术dixon", "label": "手术", "offset": "33"}, {"mention": "腹", "label": "解剖部位", "offset": "54"}, {"mention": "盆底", "label": "解剖部位", "offset": "59"}, {"mention": "腹水", "label": "症状", "offset": "68"}, {"mention": "肝", "label": "解剖部位", "offset": "71"}, {"mention": "胃", "label": "解剖部位", "offset": "77"}, {"mention": "空肠", "label": "解剖部位", "offset": "79"}, {"mention": "直肠", "label": "解剖部位", "offset": "88"}, {"mention": "腹", "label": "解剖部位", "offset": "90"}, {"mention": "肛门", "label": "解剖部位", "offset": "96"}, {"mention": "肠", "label": "解剖部位", "offset": "131"}, {"mention": "腹", "label": "解剖部位", "offset": "148"}, {"mention": "肠", "label": "解剖部位", "offset": "160"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "168"}, {"mention": "腹腔镜直肠癌根治切除术", "label": "手术", "offset": "185"}, {"mention": "大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "217"}, {"mention": "肠", "label": "解剖部位", "offset": "238"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "286"}, {"mention": "(肠系膜上血管旁)淋巴结", "label": "解剖部位", "offset": "300"}, {"mention": "大肠管状腺瘤", "label": "疾病和诊断", "offset": "410"}, {"mention": "奥沙利铂", "label": "药物", "offset": "498"}, {"mention": "替加氟", "label": "药物", "offset": "515"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "528"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "575"}, {"mention": "腹痛", "label": "症状", "offset": "601"}, {"mention": "腹胀", "label": "症状", "offset": "604"}]}
{"text": ",患者20余天月前行姑息性乙状结肠部分切除术,术后病理(201413928),:乙状结肠粘液腺癌,体积10*8*2.5cm,浸润溃疡型,侵达浆膜并侵穿纤维膜达脂肪组织。双端切线及另送“近切线”、“远切线”未查见癌。肠壁一站(7个)、中间组(6个)淋巴结未查见癌。,免疫组化染色示癌组织:ts大部分(+)、syn(-)。患者于1天前开始出现腹胀、呕吐胃内容物,未排气、排便。急来我院门诊就诊,为行进一步诊治门诊依情以“结肠术后”收入院。患者自发病以来,无反复发热、畏寒,未现尿频、尿急、尿痛及排尿困难。目前精神差,不能进饮食。否认近期明显体重改变。", "mention_data": [{"mention": "姑息性乙状结肠部分切除术", "label": "手术", "offset": "10"}, {"mention": "乙状结肠粘液腺癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "肠壁一站(7个)、中间组(6个)淋巴结", "label": "解剖部位", "offset": "107"}, {"mention": "腹胀", "label": "症状", "offset": "169"}, {"mention": "胃", "label": "解剖部位", "offset": "174"}, {"mention": "结肠术后", "label": "疾病和诊断", "offset": "208"}]}
{"text": ",缘于入院前5月余于我院诊断为“贲门癌”,于2015-12-21在全麻上行腹腔镜上根治性全胃切除术+胆囊切除术。术后病理示1、(全胃),:食管胃交界溃疡型管状腺癌ii-iii级,侵出浆膜层,侵犯神经组织。手术标本下切端见癌浸润。手术标本上切端及另送(下切端)均未见癌浸润。找到贲门左淋巴结4/9个,贲门右淋巴结0/1个,小弯淋巴结1/1个,大弯淋巴结0/0个,幽门下淋巴结0/3个,幽门上淋巴结0/1个,及另送(第7组)淋巴结1/1个,(第8组)淋巴结0/1个,(第11组)淋巴结2/3个,(第12组)淋巴结0/6个,见癌转移。,免疫组化:ki67(80%肿瘤细胞阳性),ck7(++),ck20(-),villin(+++),cea(+++),cd56(-),cga(-),syn(-),her-2(-)。2、(第9组淋巴结),:送检脂肪及脉管组织。3、(胆囊),:胆囊组织。术后恢复可,于2016.01.21、2016.02.14、2016.03.08、2016.04.01、2016.04.28予“伊立替康240mgivgttd1+替吉奥40mgpobidd1-14”方案化疗,辅以止吐、增强免疫、营养支持等治疗,化疗过程顺利,无化疗副反应。今为行第6周期化疗,求诊于我院门诊,门诊拟“贲门腺癌(pt4an3m0,iiic期)术后化疗”收入院。自下次出院以来精神、睡眠、饮食可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "贲门癌", "label": "疾病和诊断", "offset": "16"}, {"mention": "腹腔镜上根治性全胃切除术+胆囊切除术", "label": "手术", "offset": "37"}, {"mention": "胃", "label": "解剖部位", "offset": "65"}, {"mention": "食管胃交界溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "69"}, {"mention": "贲门左淋巴结", "label": "解剖部位", "offset": "138"}, {"mention": "贲门右淋巴结", "label": "解剖部位", "offset": "149"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "160"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "170"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "180"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "191"}, {"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11组)淋巴结", "label": "解剖部位", "offset": "231"}, {"mention": "(第12组)淋巴结", "label": "解剖部位", "offset": "245"}, {"mention": "(第9组淋巴结)", "label": "解剖部位", "offset": "356"}, {"mention": "胆囊", "label": "解剖部位", "offset": "379"}, {"mention": "胆囊", "label": "解剖部位", "offset": "384"}, {"mention": "伊立替康", "label": "药物", "offset": "452"}, {"mention": "替吉奥", "label": "药物", "offset": "469"}, {"mention": "贲门腺癌", "label": "疾病和诊断", "offset": "546"}]}
{"text": ",患者约于3年前因“乙状结肠癌”于2014-02-19日在全麻上行乙状结肠部分切除、乙状结肠单腔造瘘,阑尾切除术。手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好。,术后病理:结肠腺癌(中低度分化),浸润溃疡型,面积2.2*1.2cm,侵达浆膜,少数脉管内查见癌栓。双端切线未查见癌。结肠肠壁部分坏死、穿孔,肠系膜及肠壁周围脂肪组织化脓、坏死。肠壁一站(3个)淋巴结未查见癌。慢性阑尾炎。,免疫组化染色示癌组织:ercc1(+)、ts(+)。术后给予患者化疗4周期,,方案为: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,同时给与升白细胞、护肝、止吐、免疫增强治疗,患者化疗过程平稳。后患者拒绝继续化疗,未规律复查。院外期间,患者无发热,无腹痛腹胀不适,大便通畅。现患者为行复查来我科就诊,以“乙状结肠癌术后、乙状结肠造瘘术后”收入院。叒叒叒病人自下次出院以来,神志清,精神可,饮食可,大、小便正常,体重未见明显变化。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "乙状结肠部分切除、乙状结肠单腔造瘘,阑尾切除术", "label": "手术", "offset": "33"}, {"mention": "结肠腺癌(中低度分化)", "label": "疾病和诊断", "offset": "91"}, {"mention": "结肠", "label": "解剖部位", "offset": "145"}, {"mention": "肠", "label": "解剖部位", "offset": "147"}, {"mention": "肠", "label": "解剖部位", "offset": "157"}, {"mention": "肠", "label": "解剖部位", "offset": "161"}, {"mention": "肠壁一站(3个)淋巴结", "label": "解剖部位", "offset": "175"}, {"mention": "慢性阑尾炎", "label": "疾病和诊断", "offset": "191"}, {"mention": "奥沙利铂", "label": "药物", "offset": "241"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "254"}, {"mention": "替加氟", "label": "药物", "offset": "269"}, {"mention": "肝", "label": "解剖部位", "offset": "297"}, {"mention": "腹痛", "label": "症状", "offset": "346"}, {"mention": "腹胀", "label": "症状", "offset": "348"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "373"}, {"mention": "乙状结肠造瘘术后", "label": "疾病和诊断", "offset": "381"}]}
{"text": ",患者1月前因“腹部不适伴黑便1月余”入院,,腰骶部平扫示:腰1压缩性骨折,,腰椎退行性变:腰2/3、3/4、4/5椎间盘突出并腰4/5水平双侧隐窝狭窄,骶1-3水平椎管局限性膨大,不除外骶管囊肿。,腹部ct示:胆囊结石,胃腔扩张、幽门部周围壁厚。,行胃镜示:胃癌伴幽门梗阻;,病理示:(胃窦、幽门)腺癌。叒,幽门螺旋杆菌染色示:阳性(1+)。于2016-04-12全麻上行根治性胃大部切除+毕i式吻合术。,术后病理示:(201607470)胃窦腺癌(中低度分化),浸润溃疡型,体积4*4*2cm,侵达浆膜脂肪组织,部分侵穿浆膜。双端切线及另送“远端”切线未查见癌。呈六组(2/9个)淋巴结癌转移。三组(2个)、四组(3个)、另送“1、3、7组”(6个)淋巴结未查见癌。,免疫组化染色示癌组织:cerbb-2(-)、syn(-)、β-tubulin-iii部分(+)、ts部分弱(+)、rrm1部分(+)、topoii部分(+)。患者为求进一步诊治,来我院就诊,门诊以“胃癌术后”收入院。叒叒叒发病以来,食欲差,睡眠可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "腹部不适", "label": "症状", "offset": "8"}, {"mention": "腰骶部平扫", "label": "影像检查", "offset": "23"}, {"mention": "腰1压缩性骨折", "label": "疾病和诊断", "offset": "30"}, {"mention": "腰椎退行性变", "label": "疾病和诊断", "offset": "39"}, {"mention": "腰2/3、3/4、4/5椎间盘突出", "label": "疾病和诊断", "offset": "46"}, {"mention": "腰4/5水平双侧隐窝狭窄", "label": "疾病和诊断", "offset": "64"}, {"mention": "骶1-3水平椎管局限性膨大", "label": "疾病和诊断", "offset": "77"}, {"mention": "不除外骶管囊肿", "label": "疾病和诊断", "offset": "91"}, {"mention": "腹部ct", "label": "影像检查", "offset": "100"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "106"}, {"mention": "胃", "label": "解剖部位", "offset": "111"}, {"mention": "幽门", "label": "解剖部位", "offset": "116"}, {"mention": "胃癌伴幽门梗阻", "label": "疾病和诊断", "offset": "130"}, {"mention": "(胃窦、幽门)腺癌", "label": "疾病和诊断", "offset": "143"}, {"mention": "幽门螺旋杆菌染色", "label": "实验室检验", "offset": "155"}, {"mention": "根治性胃大部切除+毕i式吻合术", "label": "手术", "offset": "187"}, {"mention": "胃窦腺癌(中低度分化)", "label": "疾病和诊断", "offset": "221"}, {"mention": "六组(2/9个)淋巴结", "label": "解剖部位", "offset": "284"}, {"mention": "三组(2个)、四组(3个)、另送“1、3、7组”(6个)淋巴结", "label": "解剖部位", "offset": "299"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "435"}]}
{"text": "患者6周前因“血便伴大便习惯改变1月余”,确诊为“1、乙状结肠腺癌并肝转移2、两肺结节叒转移瘤?”后,完善检查,无手术禁忌症,于2013-12-27全麻上行姑息性“乙状结肠切除”,术顺,术后恢复可,术后病理结果回示:1(乙状结肠)叒镜检为结肠中至低分化管状腺癌,癌组织浸润至肠壁浆膜层外脂肪结缔组织,可见神经束侵犯及脉管内癌栓。2(近切缘)未见癌。3(远切缘)未见癌。4(中央组淋巴结)4枚,未见癌。5(中间组淋巴结)2枚,未见癌,另见2枚肿瘤种植结节。6(肠周淋巴结)6枚,1/6见腺癌转移。术后预防感染、对症、支持治疗,术后诊断1.乙状结肠腺癌并肝转移叒pt4an1m1叒iv期;2.两肺结节叒转移瘤?3.子宫肌瘤4.慢性胆囊炎叒5.左肾囊肿。现术后第6周,今为进一步治疗遂入我科。患者现无发热、乏力、咳嗽、气促、身目黄染等,精神睡眠可,胃纳一般,大小便可,体重无明显上降。", "mention_data": [{"mention": "乙状结肠腺癌并肝转移", "label": "疾病和诊断", "offset": "27"}, {"mention": "两肺结节叒转移瘤", "label": "疾病和诊断", "offset": "39"}, {"mention": "行姑息性“乙状结肠切除", "label": "手术", "offset": "77"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "110"}, {"mention": "结肠中至低分化管状腺癌", "label": "疾病和诊断", "offset": "119"}, {"mention": "肠", "label": "解剖部位", "offset": "137"}, {"mention": "中央组淋巴结", "label": "解剖部位", "offset": "186"}, {"mention": "中间组淋巴结", "label": "解剖部位", "offset": "202"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "229"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "242"}, {"mention": "乙状结肠腺癌并肝转移", "label": "疾病和诊断", "offset": "268"}, {"mention": "两肺结节叒转移瘤", "label": "疾病和诊断", "offset": "294"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "305"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "311"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "319"}, {"mention": "胃", "label": "解剖部位", "offset": "371"}]}
{"text": ",缘于3月前因“反复进食受阻2月余。”为主诉入院,诊断食管占位,排除手术禁忌症后于2016-01-20在全麻上行胸腔镜上全胸段食管切除+食管-胃底右颈部吻合术,术顺,术后恢复可,术后病理(201602316),:(食管及胃底),:食管溃疡型鳞状细胞癌ii级,侵及外膜层,手术标本下、上切端均未见癌浸润,找到胃周淋巴结1/17个,另送(隆突上)淋巴结0/2个、(右喉返喉返神经旁)淋巴结0/8个、(左喉返喉返神经旁)淋巴结个0/5、(右锁骨下)淋巴结0/4个、(下段食管旁)淋巴结0/1个、(颈段食管旁)淋巴结0/2个、(上段食管旁)个淋巴结0/1个,见癌转移。排除化疗禁忌症后于2016.02.19、2016.03.13、2016.04.08以“顺铂40mgd1-2,紫杉醇(泰素)180mgd2”行化疗,辅以保肝、护胃、提高免疫力等处理,未见明显化疗副反应,现为求第4期化疗,就诊我院,门诊拟“食管癌术后化疗后”收住入院,自出院以来,精神、睡眠、饮食一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管", "label": "解剖部位", "offset": "107"}, {"mention": "胃底", "label": "解剖部位", "offset": "110"}, {"mention": "食管溃疡型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "115"}, {"mention": "胃周淋巴结", "label": "解剖部位", "offset": "153"}, {"mention": "(隆突上)淋巴结", "label": "解剖部位", "offset": "166"}, {"mention": "(右喉返喉返神经旁)淋巴结", "label": "解剖部位", "offset": "179"}, {"mention": "(左喉返喉返神经旁)淋巴结", "label": "解剖部位", "offset": "197"}, {"mention": "(颈段食管旁)淋巴结", "label": "解剖部位", "offset": "244"}, {"mention": "(上段食管旁)个淋巴结", "label": "解剖部位", "offset": "259"}, {"mention": "顺铂", "label": "药物", "offset": "323"}, {"mention": "紫杉醇", "label": "药物", "offset": "334"}, {"mention": "泰素", "label": "药物", "offset": "338"}, {"mention": "肝", "label": "解剖部位", "offset": "356"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "398"}]}
{"text": "入院前5+月,患者因胃癌于2014.5.21全麻上行腹腔镜胃癌根治术中转开腹全胃切除空肠食管roux-eny吻合术+横结肠部分切除术。术后抗感染补液及营养支持治疗。术后病检:(1404047)&lt;胃&gt;低分化腺癌,部分为印戒细胞癌,侵及全层,双侧切缘未见癌累及,大弯淋巴结未见癌转移(0/3),小弯淋巴结见癌转移(10/15),&lt;7、8、9组&gt;淋巴结见癌转移(8/9),大网膜组织未见癌累及,经科内讨论于6月2日行奥沙利铂+氟尿嘧啶化疗及对症治疗。2014年07月03日患者行术后第二次化疗,2014年08月18日患者行术后第三次化疗,2014年09月25日患者行术后四次化疗,患者化疗副反应较轻,化疗后精神、食欲、睡眠尚可,未有发热,未明显见脱发,无咳嗽、咳痰,今日患者为拟行第5次化疗,到我院门诊就诊,门诊以“胃癌术后第5次化疗”收入我科住院治疗。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹腔镜胃癌根治术中转开腹全胃切除空肠食管roux-eny吻合术+横结肠部分切除术", "label": "手术", "offset": "26"}, {"mention": "低分化腺癌,部分为印戒细胞癌", "label": "疾病和诊断", "offset": "105"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "135"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "151"}, {"mention": "7、8、9组&gt;淋巴结", "label": "解剖部位", "offset": "172"}, {"mention": "奥沙利铂", "label": "药物", "offset": "217"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "222"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "367"}]}
{"text": ",缘于3个月前于我院查腹部ct示:1、横结肠近脾区肠壁增厚,伴邻近脂肪间隙内数个淋巴结,考虑新生物可能,建议进一步肠镜检查。2、肝内多发占位性病变,考虑多发转移瘤。,行肠镜示:结肠癌,病理回报为(降结肠)大肠管状腺癌ii级。于2013年11月21日在全麻上行“腹腔镜辅助上姑息性右半结肠切除术”,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。术后病理示“(右半结肠)大肠隆起型管状腺癌ii级,侵出浆膜层,浆膜面见癌结节形成,脉管内见癌栓,手术标本双切端均未见癌浸润。找到肠周淋巴结4/18个见癌转移。,免疫组化结果:ck20(++),ck7(-),villin(+++),cea(+++),cdx-2(+++),cga(-),sy(-),cd56(-),ki67(40%+)。”根据术后病理,肿瘤分期为pt4bn2am1iv期。据其肿瘤分期有化疗指征,于2013-12-06以“伊立替康280mgivgttd1+替吉奥60mgpobidd1-14”方案化疗,化疗过程顺利,无明显化疗副作用。此次为化疗再次入院。自出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "腹部ct", "label": "影像检查", "offset": "11"}, {"mention": "横结肠近脾区肠壁", "label": "解剖部位", "offset": "19"}, {"mention": "肝", "label": "解剖部位", "offset": "64"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "88"}, {"mention": "(降结肠)大肠管状腺癌ii级", "label": "疾病和诊断", "offset": "97"}, {"mention": "腹腔镜辅助上姑息性右半结肠切除术", "label": "手术", "offset": "130"}, {"mention": "(右半结肠)大肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "186"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "244"}, {"mention": "伊立替康", "label": "药物", "offset": "398"}, {"mention": "替吉奥", "label": "药物", "offset": "415"}, {"mention": "腹痛", "label": "症状", "offset": "476"}, {"mention": "腹胀", "label": "症状", "offset": "479"}]}
{"text": "胃癌术后2年,外院检查提示左上腹包块,肾积水外院2014-4-17胃镜提示胃底体粘膜水肿,僵硬(borrmanniv)。活检病理为低分化腺癌,部分印戒。2014.4.30行胃癌根治术,术中不详,术后病理:胃小弯弥漫浸润性低分化腺癌,部分为印戒,3x3cm,侵润胃壁全层,切缘、大网膜无癌累及,小弯侧大弯侧淋巴结10枚无癌转移。her-2(叒0)叒。现术后恢复可,可进少量半流食,进食后无明显不适,体重较术前上降约5kg近期检查发现左上腹肿块,左肾积水。", "mention_data": [{"mention": "胃癌术后", "label": "疾病和诊断", "offset": "0"}, {"mention": "左上腹", "label": "解剖部位", "offset": "13"}, {"mention": "肾积水", "label": "疾病和诊断", "offset": "19"}, {"mention": "胃底", "label": "解剖部位", "offset": "37"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "65"}, {"mention": "胃癌根治术", "label": "手术", "offset": "86"}, {"mention": "胃小弯弥漫浸润性低分化腺癌", "label": "疾病和诊断", "offset": "102"}, {"mention": "胃", "label": "解剖部位", "offset": "130"}, {"mention": "小弯侧大弯侧淋巴结", "label": "解剖部位", "offset": "146"}, {"mention": "左上腹", "label": "解剖部位", "offset": "215"}, {"mention": "左肾积水", "label": "疾病和诊断", "offset": "221"}]}
{"text": ",患者于4年余前在我科行剖腹探查+乙状结肠肿瘤切除+近端造口、远端封闭+结肠减压,3年余前行乙状结肠造口还纳术,已于2012年8月完成folfri化疗方案五次,2014年3月入院复查发现卵巢转移,遂行经腹全子宫+两附件切除术+阑尾切除术+大网膜切除+左侧淋巴结清扫术+盆腔粘连松解,术中冰冻病理结果示左卵巢腺癌;手术顺利,术后患者恢复可,半年前*****行ct检查后发现发现网膜及系膜多发肿瘤转移,遂行规范xelox化疗4次。1月前,患者因“乙状结肠癌术后3年余,肛门停止排气排便7天”入院。,入院后全腹部增强ct提示:结肠ca伴卵巢转移术后改变,小肠梗阻,考虑末端回肠粘连狭窄所致可能。遂于2015-12-03在全麻上行剖腹探查+肠粘连松解+左半结肠切除术,手术顺利,,术中冰冻切片提示:(左半结肠)腺癌,双切端未见癌累及。,术后病理诊断:左半结肠中分化管状腺癌,浸及肠壁全层,脉管内见癌栓。双切端未见癌累及。肠壁下淋巴结未见癌转移(0/10)。患者入院前无发热、寒战,无恶心、呕吐,无反酸、嗳气,今为行第5次化疗前来我院,门诊拟“乙状结肠癌、卵巢转移”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": "剖腹探查+乙状结肠肿瘤切除+近端造口、远端封闭+结肠减压", "label": "手术", "offset": "12"}, {"mention": "乙状结肠造口还纳术", "label": "手术", "offset": "46"}, {"mention": "卵巢转移", "label": "疾病和诊断", "offset": "93"}, {"mention": "经腹全子宫+两附件切除术+阑尾切除术+大网膜切除+左侧淋巴结清扫术+盆腔粘连松解", "label": "手术", "offset": "100"}, {"mention": "左卵巢腺癌", "label": "疾病和诊断", "offset": "150"}, {"mention": "ct", "label": "影像检查", "offset": "178"}, {"mention": "网膜及系膜多发肿瘤转移", "label": "疾病和诊断", "offset": "187"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "221"}, {"mention": "肛门", "label": "解剖部位", "offset": "232"}, {"mention": "全腹部增强ct", "label": "影像检查", "offset": "250"}, {"mention": "结肠ca伴卵巢转移术后", "label": "疾病和诊断", "offset": "260"}, {"mention": "小肠梗阻", "label": "疾病和诊断", "offset": "274"}, {"mention": "末端回肠", "label": "解剖部位", "offset": "281"}, {"mention": "剖腹探查+肠粘连松解+左半结肠切除术", "label": "手术", "offset": "311"}, {"mention": "(左半结肠)腺癌", "label": "疾病和诊断", "offset": "345"}, {"mention": "左半结肠中分化管状腺癌", "label": "疾病和诊断", "offset": "371"}, {"mention": "肠", "label": "解剖部位", "offset": "385"}, {"mention": "肠壁下淋巴结", "label": "解剖部位", "offset": "406"}, {"mention": "乙状结肠癌、卵巢转移", "label": "疾病和诊断", "offset": "467"}, {"mention": "胃", "label": "解剖部位", "offset": "504"}]}
{"text": ",缘于入院前1月于我院诊为回盲部癌,于2015-06-23在全麻上行腹腔镜上左半结肠切除术,,术中见:腹腔内无明显出血,无明显腹水,于回盲部见肿瘤,大小约6×5×4cm,累及回肠末端约3.0cm,侵出浆膜层,与周围组织无明显粘连,未形成梗阻,近端肠管无扩张,周围及肠系膜根部未见明显肿大淋巴结。术后病理(201523144)示(左半结肠),:肠浸润性管状腺癌ii级,侵犯回盲瓣及回肠,侵及浆膜层,见神经侵犯,手术标本双切端及另送(下切端)(上切端)均未见癌浸润,找到阑尾根部淋巴结3个,回肠周淋巴结7个,结肠周围淋巴结26个,另送(回结肠动脉根部)淋巴结4个,(结肠中动脉根部)淋巴结4个,均未见癌转移;慢性阑尾炎。该病例未检测到kras基因12、13号密码子热点突变。该病例未检测到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。此次为行第1次化疗再次就诊我院,门诊拟回盲部癌术后收入院。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": "回盲部癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜上左半结肠切除术", "label": "手术", "offset": "34"}, {"mention": "腹腔", "label": "解剖部位", "offset": "51"}, {"mention": "回盲部", "label": "解剖部位", "offset": "67"}, {"mention": "回肠末端", "label": "解剖部位", "offset": "87"}, {"mention": "肠管", "label": "解剖部位", "offset": "123"}, {"mention": "肠系膜根部", "label": "解剖部位", "offset": "132"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "143"}, {"mention": "左半结肠", "label": "解剖部位", "offset": "164"}, {"mention": "肠浸润性管状腺癌ii级", "label": "疾病和诊断", "offset": "171"}, {"mention": "回盲瓣", "label": "解剖部位", "offset": "185"}, {"mention": "回肠", "label": "解剖部位", "offset": "189"}, {"mention": "阑尾根部淋巴结", "label": "解剖部位", "offset": "233"}, {"mention": "回肠周淋巴结", "label": "解剖部位", "offset": "243"}, {"mention": "结肠周围淋巴结", "label": "解剖部位", "offset": "252"}, {"mention": "(回结肠动脉根部)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": "慢性阑尾炎", "label": "疾病和诊断", "offset": "302"}, {"mention": "回盲部癌术后", "label": "疾病和诊断", "offset": "405"}, {"mention": "腹痛", "label": "症状", "offset": "432"}, {"mention": "腹胀", "label": "症状", "offset": "435"}]}
{"text": ",患者4月前因“胃癌”于2017-05-04在我院于全麻上行胃癌癌根治术(远端胃大部切除+毕i式吻合术),手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好,切口愈合良好,病愈出院。,术后病理示:(201710017)胃窦前壁腺癌(低分化)粘液性印戒,面积5*4.5cm,厚1.2cm,侵达浆膜。双端切线未查见癌。三组(5个)、四组(4个)、七组(1个)、“1、3、7组”(12个)淋巴结,未查见癌。,免疫组化染色示:cerb-2(-)、syn少量(+)、β-tubulin-iii部分(+)、rrm1(-)、topo叒ii少量(+),于我院行化疗,,化疗方案为:奥沙利铂200mg叒d1+亚叶酸钙0.3d2-6叒+氟尿嘧啶750mg叒d2-6叒静滴,同时予以升白细胞、止吐、抑酸、保肝、免疫增强治疗。叒叒叒院外期间患者一般情况好,无恶心,无腹痛腹胀胀不适,现患者为行复查及化疗再次来院就诊,门诊以“胃癌术后”收入院。叒叒叒近期患者一般情况良好,神志清,精神良好,饮食、睡眠良好,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "胃癌癌根治术(远端胃大部切除+毕i式吻合术)", "label": "手术", "offset": "30"}, {"mention": "胃窦前壁腺癌(低分化)粘液性印戒", "label": "疾病和诊断", "offset": "111"}, {"mention": "三组(5个)、四组(4个)、七组(1个)、“1、3、7组”(12个)淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "奥沙利铂", "label": "药物", "offset": "284"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "297"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "310"}, {"mention": "肝", "label": "解剖部位", "offset": "344"}, {"mention": "腹痛", "label": "症状", "offset": "373"}, {"mention": "腹胀", "label": "症状", "offset": "375"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "402"}]}
{"text": ",患者3月余前无明显诱因出现下腹部疼隐痛,程度轻微,可自行忍受,予抑酸等处理后疼痛可缓解,腹痛无向腰背部放射,无腹胀、腹泻,无恶心、呕吐,无便血、黑便。遂就诊于我院,,查胃镜示:胃窦幽门前见一溃疡型肿物,胃窦腔变形,狭窄。,活检提示:(胃窦幽门前溃疡型肿物活检)镜检为中至低分化腺癌,lauren,分型:考虑混合型。入院后完善相关检查,未见明显手术禁忌,有手术适应症,于2017-04-07在我院行“腹腔镜胃癌根治术”,术程顺利,术后恢复良好。,病理检查:(胃大体)镜检为胃中至低分化腺癌,lauren,分型:混合型,癌组织浸润至胃壁浆膜层,可见脉管内癌栓及神经束侵犯;网膜组织未见癌。(近切缘)(远切缘),镜上:粘膜慢性炎,局灶腺体伴轻度不典型增生及肠下皮化生。(淋巴结)6/52见腺癌转移;,免疫组化:vegf(局灶弱+),her-2(0),ck(+)。,原位杂交:ebers(-)。术后分期为t4n2m0叒iiib期,术后恢复可,双便正常,体重上降20+斤。术后于2017-05-04行xelox方案化疗1程,现按主诊教授意见收入我科。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "14"}, {"mention": "腹痛", "label": "症状", "offset": "45"}, {"mention": "腰", "label": "解剖部位", "offset": "49"}, {"mention": "背", "label": "解剖部位", "offset": "50"}, {"mention": "腹胀", "label": "症状", "offset": "56"}, {"mention": "腹泻", "label": "症状", "offset": "59"}, {"mention": "胃窦", "label": "解剖部位", "offset": "89"}, {"mention": "幽门", "label": "解剖部位", "offset": "91"}, {"mention": "胃窦", "label": "解剖部位", "offset": "102"}, {"mention": "胃窦", "label": "解剖部位", "offset": "118"}, {"mention": "幽门", "label": "解剖部位", "offset": "120"}, {"mention": "中至低分化腺癌", "label": "疾病和诊断", "offset": "134"}, {"mention": "腹腔镜胃癌根治术", "label": "手术", "offset": "200"}, {"mention": "胃", "label": "解剖部位", "offset": "229"}, {"mention": "胃中至低分化腺癌,lauren", "label": "疾病和诊断", "offset": "236"}, {"mention": "胃", "label": "解剖部位", "offset": "265"}, {"mention": "肠", "label": "解剖部位", "offset": "326"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "342"}]}
{"text": ",患者因“胃癌”于2015-5-19于我院行“胃癌根治术”,术后恢复良好,,术后病理示:胃窦腺癌,中度分化,浸润溃疡型,体积8*5*2.2cm,侵穿浆膜,部分脉管内查见癌栓,并大弯侧、小弯侧脂肪组织内及大网膜内多灶性癌转移,双端切线未查见癌。呈四组(3/9个)、六组(1/6个)淋巴结癌转移及“肝圆韧带”癌转移。三组(2个)、五组(1个)、“1、3、7组”(13个)淋巴结未查见癌。,癌组织免疫组化染色示:β-tubulin-iii局灶(+)、ts(-)、rrm1局灶(+)、topoii少数(+)、cerbb-2(-)、syn(-)。,依情予行术后2疗程化疗:奥沙利铂150mg叒d1+亚叶酸钙0.3g叒d2-6+替加氟1gd2-6,化疗过程顺利,无明显不适,现为进一步治疗至我科就诊,遂依情以“胃恶性肿瘤术后”收入院。发病来,患者目前患者精神好,食欲一般,夜间睡眠可,小便正常,大便未诉异常,近期体重无明显上降。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "胃癌根治术", "label": "手术", "offset": "23"}, {"mention": "胃窦腺癌", "label": "疾病和诊断", "offset": "44"}, {"mention": "大弯", "label": "解剖部位", "offset": "88"}, {"mention": "小弯", "label": "解剖部位", "offset": "92"}, {"mention": "四组(3/9个)、六组(1/6个)淋巴结", "label": "解剖部位", "offset": "122"}, {"mention": "肝圆韧带", "label": "解剖部位", "offset": "147"}, {"mention": "三组(2个)、五组(1个)、“1、3、7组”(13个)淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "奥沙利铂", "label": "药物", "offset": "281"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "294"}, {"mention": "替加氟", "label": "药物", "offset": "308"}, {"mention": "胃恶性肿瘤术后", "label": "疾病和诊断", "offset": "349"}]}
{"text": ",患者因“乙状结肠癌”于2012-11-30在我院于全麻上行乙状结肠癌根治术,手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好,切口愈合良好。,术后病理示:(13304.2012)(乙状结肠)腺癌(中度分化,部分为粘液腺癌图像),符合绒毛状管状腺瘤癌变,面积为4*3.5cm,侵穿浆膜,双侧切线及另送“近端”、“远端”切线未查见癌。一站淋巴结(9个)、中间组淋巴结(7个)未查见癌。查无化疗禁忌后,分别于2012-12-20、2013-1-21、2013-2-16行3次化疗治疗,,化疗方案为:奥沙利铂150mg叒d1,亚叶酸钙0.3g+替加氟1.0g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。叒叒叒院外期间患者一般情况好,无恶心,无腹痛腹胀胀不适,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。叒叒叒近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "30"}, {"mention": "(乙状结肠)腺癌(中度分化,部分为粘液腺癌图像),符合绒毛状管状腺瘤癌变", "label": "疾病和诊断", "offset": "93"}, {"mention": "一站淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "中间组淋巴结", "label": "解剖部位", "offset": "179"}, {"mention": "奥沙利铂", "label": "药物", "offset": "250"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "263"}, {"mention": "替加氟", "label": "药物", "offset": "272"}, {"mention": "肝", "label": "解剖部位", "offset": "296"}, {"mention": "腹痛", "label": "症状", "offset": "335"}, {"mention": "腹胀", "label": "症状", "offset": "337"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "364"}]}
{"text": ",缘于入院1月余前于我院诊为降结肠中分化管状腺癌,于2016年03月04日在全麻上行“腹腔镜上根治性右半结肠切除术”,术后病理(n201601905),:(右半结肠),:结肠溃疡型中分化管状腺癌,侵犯肠壁全层及肠周脂肪组织,侵犯神经、脉管组织,手术标本双切端及另送(上切端)均未见癌浸润,另送(下切端)浆膜外纤维脂肪组织中见癌浸润。找到肠周淋巴结5/15个见癌转移。另送(右结肠根部淋巴结)、(结肠中血管右支根部淋巴结)镜上为纤维、血管、脂肪组织。(mn20160037),:该病例未检测到braf基因v600e突变。(mn20160037),:该病例检测到kras基因12号密码子g12s突变。术顺安返,予预防性抗感染、制酸、提高免疫力、营养支持等治疗好转后出院。于2016.04.12予“安维汀200mgivgttd1+奥沙利铂120mgivgttd2+氟尿嘧啶3400mgciv48h+亚叶酸钙300mgivgttd1-2”方案化疗1个周期,化疗过程顺利,化疗后未见明显不良反应。此次为化疗再次就诊我院,门诊拟结肠癌术后收入院。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": "降结肠中分化管状腺癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上根治性右半结肠切除术", "label": "手术", "offset": "43"}, {"mention": "右半结肠", "label": "解剖部位", "offset": "78"}, {"mention": "结肠溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "85"}, {"mention": "肠", "label": "解剖部位", "offset": "100"}, {"mention": "肠", "label": "解剖部位", "offset": "105"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "168"}, {"mention": "右结肠根部淋巴结", "label": "解剖部位", "offset": "186"}, {"mention": "结肠中血管右支根部淋巴结", "label": "解剖部位", "offset": "197"}, {"mention": "安维汀", "label": "药物", "offset": "346"}, {"mention": "奥沙利铂", "label": "药物", "offset": "362"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "379"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "396"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "458"}, {"mention": "腹痛", "label": "症状", "offset": "484"}, {"mention": "腹胀", "label": "症状", "offset": "487"}]}
{"text": ",2017年02月17日在全麻上行腹腔镜探查,根治性全胃切除术。,术后病理:(全胃和大网膜),切除:叒-叒溃疡型低分化腺癌,lauren,分型:混合型;叒-叒位于粘膜层;叒-叒未见脉管癌栓;叒-叒(食管断端)、(十二指肠残端)未见癌;叒-叒大网膜未见癌;叒-叒淋巴结未见癌转移(第1组0/3、第2组0/2、第3组0/0、第4d组0/1、第4sa组0/0、第5组0/2、第7组0/3、第8a组0/1、第8p组0/2、第9组0/2、第11d组0/3、第12a组0/0、第6组0/3、第11p组0/4、第4sb组0/0);叒-叒,肿瘤病理分期:pt1an0。,免疫组化结果显示:cd56(-),cga(-),ck(+),ki-67(+40%),syn(-)。术后恢复可。,术后基线:胸ct(-),腹盆,ct:盆腔少量积液,较前增多。2017-3-15叒c125叒76.84。", "mention_data": [{"mention": "腹腔镜探查,根治性全胃切除术", "label": "解剖部位", "offset": "17"}, {"mention": "胃", "label": "解剖部位", "offset": "40"}, {"mention": "溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "53"}, {"mention": "食管", "label": "解剖部位", "offset": "99"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "106"}, {"mention": "胸ct", "label": "影像检查", "offset": "338"}, {"mention": "腹盆,ct", "label": "影像检查", "offset": "345"}, {"mention": "盆腔", "label": "解剖部位", "offset": "351"}]}
{"text": ",缘于入院前44天因“盲肠癌”于2016.05.30在全麻上行“腹腔镜上左半结肠根治性切除术”,,术中见:腹腔内无明显出血,无明显腹水,肿瘤位于盲肠,肿瘤侵犯左外侧腹壁,未形成梗阻,近端肠管无扩张,周围可见数个肿大淋巴结。术后病理(201618360),示:(左半结肠),:结肠溃疡型管状腺癌ii级,伴坏死,侵出外膜层;回肠末端淋巴组织增生。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1/5个、结肠周淋巴结3/10个,及另送(回结肠动脉根部)淋巴结2/2,见癌转移。,免疫组化:13号ki67(60%+),ck8(+++),cea(+++),p53(-);22号ki67(生发中心80%+,滤泡间区2%+),cd3(t细胞+++),cd20(b细胞+++),bcl-2(+++)。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。并于2016.06.23予“奥沙利铂150mgivgttd1+卡培他滨片1000mgpobidd1-14”方案化疗1周期,辅以制酸、保肝、止吐等预处理,化疗过程顺利,无明显不适。此次为化疗再次就诊我院,门诊拟“盲肠癌术后化疗”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": "盲肠癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹腔镜上左半结肠根治性切除术", "label": "手术", "offset": "32"}, {"mention": "腹腔", "label": "解剖部位", "offset": "53"}, {"mention": "腹水", "label": "症状", "offset": "65"}, {"mention": "盲肠", "label": "解剖部位", "offset": "72"}, {"mention": "腹", "label": "解剖部位", "offset": "82"}, {"mention": "肠", "label": "解剖部位", "offset": "93"}, {"mention": "左半结肠", "label": "解剖部位", "offset": "130"}, {"mention": "结肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "137"}, {"mention": "回肠", "label": "解剖部位", "offset": "160"}, {"mention": "回肠", "label": "解剖部位", "offset": "175"}, {"mention": "结肠", "label": "解剖部位", "offset": "180"}, {"mention": "回肠周淋巴结", "label": "解剖部位", "offset": "207"}, {"mention": "结肠周淋巴结", "label": "解剖部位", "offset": "218"}, {"mention": "(回结肠动脉根部)淋巴结", "label": "解剖部位", "offset": "233"}, {"mention": "奥沙利铂", "label": "药物", "offset": "404"}, {"mention": "卡培他滨", "label": "药物", "offset": "421"}, {"mention": "肝", "label": "解剖部位", "offset": "457"}, {"mention": "盲肠癌术后", "label": "疾病和诊断", "offset": "495"}, {"mention": "腹痛", "label": "症状", "offset": "524"}, {"mention": "腹胀", "label": "症状", "offset": "527"}]}
{"text": ",患者于入院前4个月因“反复血便6个月”住我院查腹部,ct:1、乙状结肠管壁不规则增厚,符合乙状结肠ca(浸润型)改变,侵犯浆膜层,伴周围少许淋巴结。2、阑尾切除术后改变。遂于2013.11.14全麻上“腹腔镜上乙状结肠癌根治术”,术顺,术后予预防感染、营养支持、补液等治疗。,术后病理:(乙状结肠),:肠溃疡型管状腺癌ii级,侵及深肌层,侵犯神经组织,手术标本下、上切端及另送(下切端)、(上切端)均未见癌浸润,找到肠周淋巴结17个,及另送(直肠下动脉旁染色淋巴结1)淋巴结1个,(直肠下动脉旁染色淋巴结2)淋巴结1个,(肠系膜上动脉)淋巴结2个均未见癌浸润。术后恢复可,进食半流质饮食无腹痛、腹胀等不适,创口愈合良好,于2013.12.23、2014.01.12、2014.02.05、2014.02.27予以“奥沙利铂200mgivgttd1+希罗达1500mgpobidd1-14”方案化疗,化疗期间辅以预防性制酸、止吐等治疗,化疗期间未见明显不适。今为第5次化疗就诊我院,门诊拟“结肠癌术后”收住入院,自患病以来患者精神、睡眠、饮食一般,大小便正常,体重无明显改变。", "mention_data": [{"mention": "腹部,ct", "label": "影像检查", "offset": "24"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "32"}, {"mention": "乙状结肠ca(浸润型)", "label": "疾病和诊断", "offset": "46"}, {"mention": "阑尾切除术", "label": "手术", "offset": "77"}, {"mention": "腹腔镜上乙状结肠癌根治术", "label": "手术", "offset": "102"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "145"}, {"mention": "肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "152"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "209"}, {"mention": "直肠下动脉旁染色淋巴结1", "label": "解剖部位", "offset": "222"}, {"mention": "直肠下动脉旁染色淋巴结2", "label": "解剖部位", "offset": "242"}, {"mention": "(肠系膜上动脉)淋巴结", "label": "解剖部位", "offset": "261"}, {"mention": "腹痛", "label": "症状", "offset": "295"}, {"mention": "腹胀", "label": "症状", "offset": "298"}, {"mention": "奥沙利铂", "label": "药物", "offset": "358"}, {"mention": "希罗达", "label": "药物", "offset": "375"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "445"}]}
{"text": ",缘于入院前4个月因“乙转结肠癌”于2014年01月09日行“腹腔镜上乙状结肠癌根治术”。术后病理(201400845),:1、(乙状结肠),:大肠溃疡型乳头状-管状腺癌ii级,侵及浆膜,手术标本双切端及另送(下切端)、(上切端)均未见癌浸润。找到肿物周淋巴结9个,肠周淋巴结8个,均未见癌转移。2、(肠系膜上动脉根部)送检脉管、纤维及脂肪组织。,术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。于2014.02.04、2014.02.24、2014.03.17、2014.04.10、2014.4.30予“奥沙利铂(艾恒)200mg静滴d1+卡培他滨片(希罗达)1500mg口服bidd1-14”方案化疗5周期,化疗过程顺利,辅以制酸、止吐等处理。此次为化疗再次入院。患者出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "腹腔镜上乙状结肠癌根治术", "label": "手术", "offset": "31"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "65"}, {"mention": "大肠溃疡型乳头状-管状腺癌ii级", "label": "疾病和诊断", "offset": "72"}, {"mention": "肿物周淋巴结", "label": "解剖部位", "offset": "124"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "肠", "label": "解剖部位", "offset": "151"}, {"mention": "奥沙利铂", "label": "药物", "offset": "257"}, {"mention": "艾恒", "label": "药物", "offset": "262"}, {"mention": "卡培他滨", "label": "药物", "offset": "275"}, {"mention": "希罗达", "label": "药物", "offset": "281"}, {"mention": "腹痛", "label": "症状", "offset": "351"}, {"mention": "腹胀", "label": "症状", "offset": "354"}]}
{"text": ",患者因“,盆腔包块:卵巢癌?”于2013-12-30我可行肿瘤细胞减灭术(全子宫切除+两附件切除+盆腔淋巴结切除+腹主动脉淋巴结切除+大网膜切除+肠粘连松解术),术程顺利,术后恢复良好。,术后病理提示:两侧卵巢见低分化腺癌浸润,形态较符合高级别浆液性腺癌,子宫体后壁外膜层及肌层见腺癌浸润,宫颈管后壁外膜层见腺癌浸润,大网膜纤维组织中见低分化腺癌浸润,两侧输卵管、宫颈及盆腔淋巴结均未见癌。结合术后病理诊断为“卵巢低分化腺癌iiic期”,今为术后辅助化疗收入院,患者近1月以来精神可,大小便无异常,体重无明显减轻。", "mention_data": [{"mention": "盆腔包块", "label": "症状", "offset": "6"}, {"mention": "卵巢癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "全子宫切除+两附件切除+盆腔淋巴结切除+腹主动脉淋巴结切除+大网膜切除+肠粘连松解术", "label": "手术", "offset": "38"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "102"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "107"}, {"mention": "高级别浆液性腺癌", "label": "疾病和诊断", "offset": "120"}, {"mention": "子宫体", "label": "解剖部位", "offset": "129"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "141"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "146"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "155"}, {"mention": "中见低分化腺癌", "label": "疾病和诊断", "offset": "167"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "177"}, {"mention": "宫颈", "label": "解剖部位", "offset": "183"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "186"}, {"mention": "卵巢低分化腺癌iiic期", "label": "疾病和诊断", "offset": "206"}]}
{"text": ",患者于3月余前因胰腺肿物于我科行胰十二指肠切除、联合胰腺体颈部切除、胃造瘘、空肠造瘘术”,,术后病理示:胰腺导管内乳头状粘连性肿瘤伴下皮重度不典型增生.术后予保肝、制酸、输白蛋白、对症等治疗。术后恢复可,予带t管、胃、空肠造瘘管、左腹腔引流管出院。2月余前t管管周出现明显渗液,呈浓稠状,,入院查下腹部ct示:腹腔积液.予行b超引导上腹腔穿刺置管引流后予抗感染、补液、保肝等处理后腹腔管、胃空肠造瘘管、t管均拔除后出院,现患者无腹痛、腹胀,无畏寒、发热,无眼黄、尿黄、皮肤黄等不适,今为进一步复查,来我院,门诊以胰十二指肠切除术后收入院。患者自发病以来饮食少,大小便无异常,体重无明显增减。", "mention_data": [{"mention": "胰腺", "label": "解剖部位", "offset": "9"}, {"mention": "胰十二指肠切除、联合胰腺体颈部切除、胃造瘘、空肠造瘘术", "label": "手术", "offset": "17"}, {"mention": "胰腺", "label": "解剖部位", "offset": "53"}, {"mention": "乳头状粘连性肿瘤伴下皮重度不典型增生", "label": "疾病和诊断", "offset": "58"}, {"mention": "肝", "label": "解剖部位", "offset": "81"}, {"mention": "胃", "label": "解剖部位", "offset": "108"}, {"mention": "空肠", "label": "解剖部位", "offset": "110"}, {"mention": "左腹腔", "label": "解剖部位", "offset": "116"}, {"mention": "腹部ct", "label": "影像检查", "offset": "150"}, {"mention": "腹腔积液", "label": "疾病和诊断", "offset": "156"}, {"mention": "b超引导上腹腔穿刺置管引流", "label": "手术", "offset": "163"}, {"mention": "肝", "label": "解剖部位", "offset": "186"}, {"mention": "腹腔", "label": "解剖部位", "offset": "191"}, {"mention": "胃空肠", "label": "解剖部位", "offset": "195"}, {"mention": "腹痛", "label": "症状", "offset": "215"}, {"mention": "腹胀", "label": "症状", "offset": "218"}, {"mention": "眼", "label": "解剖部位", "offset": "229"}, {"mention": "皮肤", "label": "解剖部位", "offset": "235"}, {"mention": "胰十二指肠切除术后", "label": "疾病和诊断", "offset": "257"}]}
{"text": ",缘于入院前1年余因“食管中段癌(pt2n0m0)ii期”就诊我院2013.08.12在全麻上行食管中段癌切除+食管-胃底弓下吻合术,,术中探查:胸腔无粘连,无淡黄色积液;肿物位于主动脉弓后,局部增厚约2.5cm,未累及外膜,食管旁多发淋巴结肿大。,术后病理示:(201324854)(食管),:食管溃疡型鳞状细胞癌ii级,侵及深肌层(1/2肌层),手术标本下上切端均未见癌浸润,找到食管周淋巴结3个及另送(中段食管旁)淋巴结11个,(胃右动脉旁)淋巴结14个,均未见癌转移,(贲门旁淋巴结)为血管、脂肪、纤维结缔组织及横纹肌组织。,免疫组化结果:ki67(50%),p53(+++),p170(-),gstπ(+++),egfr(+++)。现为术后复查再次就诊我院。下次出院至今患者无胸闷、憋气;无胸背痛;无腹痛、腹胀;无呕血、黑便;偶有返酸。饮食睡眠较好。大小便正常。体重无明显变化。", "mention_data": [{"mention": "食管中段癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "食管中段癌切除+食管-胃底弓下吻合术", "label": "手术", "offset": "48"}, {"mention": "胸腔", "label": "解剖部位", "offset": "73"}, {"mention": "主动脉弓", "label": "解剖部位", "offset": "90"}, {"mention": "食管旁多发淋巴结", "label": "解剖部位", "offset": "113"}, {"mention": "食管", "label": "解剖部位", "offset": "143"}, {"mention": "食管溃疡型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "148"}, {"mention": "食管周淋巴结", "label": "解剖部位", "offset": "192"}, {"mention": "(中段食管旁)淋巴结", "label": "解剖部位", "offset": "203"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "217"}, {"mention": "贲门旁淋巴结", "label": "解剖部位", "offset": "239"}, {"mention": "胸闷", "label": "症状", "offset": "343"}, {"mention": "胸背痛", "label": "症状", "offset": "350"}, {"mention": "腹痛", "label": "症状", "offset": "355"}, {"mention": "腹胀", "label": "症状", "offset": "358"}]}
{"text": "患者因\\\"子宫肌瘤\\\"于2013年9月10日行全子宫切除术+右侧附件切除术,术后外院病理结果示子宫内膜样腺癌(中-低分化),浸润深肌层,累及宫颈管,诊断为子宫内膜癌。术后恢复可。2013-10-30、2013-11-22行tp方案化疗(多帕菲、伯尔定)2程。2013-12-12行“力朴素+伯尔定”化疗1程。现按主诊教授意见入院行上一程化疗。患者近期精神、睡眠、胃纳可,大小便无异常,体重未见明显减轻。", "mention_data": [{"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "5"}, {"mention": "全子宫切除术+右侧附件切除术", "label": "手术", "offset": "23"}, {"mention": "子宫内膜样腺癌(中-低分化)", "label": "疾病和诊断", "offset": "47"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "70"}, {"mention": "子宫内膜癌", "label": "疾病和诊断", "offset": "77"}, {"mention": "多帕菲", "label": "药物", "offset": "118"}, {"mention": "伯尔定", "label": "药物", "offset": "122"}, {"mention": "力朴素", "label": "药物", "offset": "141"}, {"mention": "伯尔定", "label": "药物", "offset": "145"}, {"mention": "胃", "label": "解剖部位", "offset": "181"}]}
{"text": ",患者约于6个月前因“乙状结肠癌”于2017-01-23在全麻上行“乙状结肠根治术”,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(叒201701617),:乙状结肠粘液腺癌,浸润溃疡型,体积6.5*4*1.3cm,局部侵穿浆膜。双端切线及另送“近切线”、“远切线”未查见癌。呈一站(3/8个)、中间组(1/8个)淋巴结癌转移。,免疫组化染色示癌组织:syn(-)、braf(-)、mlh1(+)、msh2(+)、msh6(+)、pms2(+)。患者术后出现发热,尿培养+药敏(20170204),:叒铜绿假单胞菌,给予抗炎、退热等药物治疗后,症状逐渐缓解后出院。患者出院后规律至我院复查,给予6周期化疗,,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。叒叒叒院外期间,患者无发热,无腹痛腹胀不适,大便通畅。现患者为行复查化疗来我科就诊,以“乙状结肠癌术后”收入院。叒叒叒病人自下次出院以来,神志清,精神可,饮食可,大、小便正常,体重未见明显变化。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "乙状结肠根治术", "label": "手术", "offset": "34"}, {"mention": "乙状结肠粘液腺癌", "label": "疾病和诊断", "offset": "87"}, {"mention": "一站(3/8个)、中间组(1/8个)淋巴结", "label": "解剖部位", "offset": "147"}, {"mention": "尿培养", "label": "实验室检验", "offset": "240"}, {"mention": "药敏", "label": "实验室检验", "offset": "244"}, {"mention": "奥沙利铂", "label": "药物", "offset": "316"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "329"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "338"}, {"mention": "肝", "label": "解剖部位", "offset": "364"}, {"mention": "腹痛", "label": "症状", "offset": "398"}, {"mention": "腹胀", "label": "症状", "offset": "400"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "427"}]}
{"text": ",患者因患“胃癌”于2017-07-10日在全麻上行全胃切除术+空肠j字代胃术,手术顺利,术后给予抗炎、抑酸、营养支持及对症支持治疗,术后病理示术后病理(201715979),示:胃体腺癌(低分化),浸润溃疡型,体积2.5*1*1.3cm,侵达浆膜。双端切线及另送“食管切线”未查见癌。一组(7个)、三组(2个)、四组(4个)、五组(1个)及六组(2个)淋巴结未查见癌。,免疫组化染色示:cerbb-2(-)、syn(-)、β-tubulin-iii少数(+)、rrm1(-)、topoii部分(+)。术后给予化疗1疗程,,方案: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,现患者为行复查化疗来我院就诊,门诊以“胃癌术后”收入院。自下次出院后,患者一般情况保持良好,叒无乏力感,无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显叒腹痛、腹胀;大小便情况良好。目前患者精神及情绪状态可,食欲、饮食好,夜间睡眠可,大小便正常,近期无明显体重变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "全胃切除术+空肠j字代胃术", "label": "手术", "offset": "26"}, {"mention": "胃体腺癌(低分化)", "label": "疾病和诊断", "offset": "90"}, {"mention": "食管", "label": "解剖部位", "offset": "133"}, {"mention": "一组(7个)、三组(2个)、四组(4个)、五组(1个)及六组(2个)淋巴结", "label": "解剖部位", "offset": "143"}, {"mention": "奥沙利铂", "label": "药物", "offset": "265"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "278"}, {"mention": "替加氟", "label": "药物", "offset": "293"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "330"}, {"mention": "腹痛", "label": "症状", "offset": "394"}, {"mention": "腹胀", "label": "症状", "offset": "397"}]}
{"text": "患者1年余前(2014-9-30)因“胃癌”于我院行胃癌根治术(毕i),术后给予消炎营养支持治疗,患者出现肠梗阻症状,于2014-10-15在全麻上行肠粘连松解术+空肠造瘘术,术后给予消炎、营养支持治疗,病情好转后出院。术中常规病理示:(胃)中分化腺癌,溃疡型,肿物切面积4.5*1cm,侵达浆膜脂肪组织,双端切缘及吻合器切缘未查见癌。小弯侧淋巴结22枚,其中2枚(2/22)查见转移;大弯侧淋巴结12枚,其中4枚(4/12)查见转移。另送网膜组织内未查见癌。后患者再次入院行奥沙利铂+cf+替加氟方案化疗8个周期,耐受良好。后患者反复腹痛,给予对症后症状均可缓解。现患者为进一步诊疗,再次来我院,门诊以“胃癌术后肠粘连”收入院。自发病以来,患者神志清,精神可,睡眠尚可,昨日排便一次,小便无明显异常,体重较下次入院无明显改变。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "19"}, {"mention": "胃癌根治术(毕i)", "label": "手术", "offset": "26"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "53"}, {"mention": "肠粘连松解术+空肠造瘘术", "label": "手术", "offset": "75"}, {"mention": "(胃)中分化腺癌", "label": "疾病和诊断", "offset": "118"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "168"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "193"}, {"mention": "奥沙利铂", "label": "药物", "offset": "238"}, {"mention": "cf", "label": "药物", "offset": "243"}, {"mention": "替加氟", "label": "药物", "offset": "246"}, {"mention": "腹痛", "label": "症状", "offset": "268"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "303"}, {"mention": "肠粘连", "label": "疾病和诊断", "offset": "307"}]}
{"text": ",缘于入院3月余前我院诊断为贲门癌,于2015.11.06在气管插管全麻上行“腹腔镜辅助上根治性全胃切除术”,,术中见:腹腔内无腹水,腹腔内未见明显转移结节,肿瘤位于贲门,大小约5.0×5.0cm,呈浸润溃疡型,侵及浆膜层,周围有肿大淋巴结.术中诊断“贲门癌”。,术后病理示:食管胃交界处溃疡型中-低分化腺癌,侵犯浆膜层,侵犯脉管及神经组织,间质见多量淋巴细胞浸润。手术标本下切端粘膜上层可见脉管癌栓,标本上切端均未见癌浸润。找到贲门周淋巴结9/20个,小弯淋巴结0/29个,大弯淋巴结0/8个,幽门下淋巴结0/3个,幽门上淋巴结0/4个,网膜淋巴结0/1个及另送(胃右动脉根部)淋巴结1/9个见癌转移。(胃右动脉根部)淋巴结见多发下皮样结节,呈肉芽肿性炎改变。术后给予对症、营养支持等处理,恢复良好,切口愈合为ii/甲。术后于2015.12.5、2015.12.27、2016.01.23予以“伊立替康240mgivgttd1+替吉奥60mgpobidd1-d14”方案化疗,辅以保胃、保肝、增强免疫、营养补液治疗。今为术后4次化疗,再次入院,门诊拟“贲门癌术后化疗”收入住院,自下次出院以来饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "贲门癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "气管", "label": "解剖部位", "offset": "30"}, {"mention": "腹腔镜辅助上根治性全胃切除术", "label": "手术", "offset": "39"}, {"mention": "腹腔", "label": "解剖部位", "offset": "60"}, {"mention": "腹水", "label": "症状", "offset": "64"}, {"mention": "腹腔", "label": "解剖部位", "offset": "67"}, {"mention": "贲门", "label": "解剖部位", "offset": "83"}, {"mention": "贲门癌", "label": "疾病和诊断", "offset": "126"}, {"mention": "食管胃交界处溃疡型中-低分化腺癌", "label": "疾病和诊断", "offset": "138"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "215"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "227"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "238"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "248"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "259"}, {"mention": "网膜淋巴结", "label": "解剖部位", "offset": "270"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "282"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "302"}, {"mention": "伊立替康", "label": "药物", "offset": "398"}, {"mention": "替吉奥", "label": "药物", "offset": "415"}, {"mention": "胃", "label": "解剖部位", "offset": "442"}, {"mention": "肝", "label": "解剖部位", "offset": "445"}, {"mention": "贲门癌术后", "label": "疾病和诊断", "offset": "477"}, {"mention": "腹痛", "label": "症状", "offset": "505"}, {"mention": "腹胀", "label": "症状", "offset": "508"}]}
{"text": ",患者因“直肠癌”于2015-06-16在我院在全麻上行根治性dixon手术,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:(直肠)腺癌(中度分化),隆起型,体积8.5*7*1.5cm,侵达深肌层,底部切除面叒未查见癌。叒双端切线及另送“近切线”、“远切线”未查见癌。叒一站(5个)、中央组(11个)、中间组(1个)淋巴结未查见癌。叒,免疫组化染色示:ts少量(+)、syn(-)。后患者出现发热及左下腹痛,行ct检查示胆总管结石并以下水平胆系扩张,请肝胆外科会诊后给予抗生素及保肝治疗,患者症状明显好转。叒叒叒院外期间患者一般情况好,无恶心,无腹痛腹胀不适,2015年9月21日门诊行结肠镜检查发现结肠多发息肉,并行内镜上结肠息肉电切术,术后恢复好,现患者为行复查再次来院就诊,为行进一步治疗,门诊以“直肠癌术后、结肠多发息肉”收入院。叒叒叒近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "根治性dixon手术", "label": "手术", "offset": "28"}, {"mention": "(直肠)腺癌(中度分化)", "label": "疾病和诊断", "offset": "71"}, {"mention": "一站(5个)、中央组(11个)、中间组(1个)淋巴结", "label": "解剖部位", "offset": "144"}, {"mention": "左下腹", "label": "解剖部位", "offset": "208"}, {"mention": "ct", "label": "影像检查", "offset": "214"}, {"mention": "胆总管结石", "label": "疾病和诊断", "offset": "219"}, {"mention": "肝", "label": "解剖部位", "offset": "249"}, {"mention": "腹痛", "label": "症状", "offset": "282"}, {"mention": "腹胀", "label": "症状", "offset": "284"}, {"mention": "结肠", "label": "解剖部位", "offset": "309"}, {"mention": "内镜上结肠息肉电切术", "label": "手术", "offset": "318"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "361"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "367"}]}
{"text": ",缘于入院前2个月在我院诊为“降结肠癌”,并于2014.04.28在全麻上行“腹腔镜辅助上根治性右半结肠切除术+小肠肿物切除术”,术顺,术后病理(201412664),:(右半结肠),:1.肠隆起型绒毛状-管状腺癌ii级,癌组织侵犯脉管组织,侵及浅肌层。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23个,均未见癌转移。肠周见癌结节1个。2.肠绒毛状-管状腺瘤,伴腺下皮低级别下皮内瘤变。(小肠),:送检组织镜上为梭形细胞增生结节(最大径0.5cm),细胞核呈短梭形,可见核仁,胞浆嗜碱性,排列呈束状,核分裂像少见(&lt;2个/50hpf),结合免疫组化结果,考虑危险度低的胃肠道间质瘤,因送检组织均为肿瘤组织,未见肠粘膜,无法判断切缘情况,请结合临床诊断。建议随访。,免疫组化结果:ck(pan)(-),cd117(+++),cd34(++),dog1(+++),desmin(-),h-caldesmon(-),actin(sm)(-),s100(个别细胞阳性),nf(pan)(-),cd57(-),ki67(2%阳性)。术后予营养支持治疗,恢复良好。术后按“奥沙利铂(齐沙)150mgivgttd1+希罗达1000.00mgpobidd2-15”方案化疗,于2014-05-28行第1周期化疗。今入院行术后第2周期化疗,门诊拟“降结肠癌术后化疗”收住入院。自术后出院以来,精神、睡眠、食欲尚可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "降结肠癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "腹腔镜辅助上根治性右半结肠切除术+小肠肿物切除术", "label": "手术", "offset": "39"}, {"mention": "右半结肠", "label": "解剖部位", "offset": "86"}, {"mention": "肠隆起型绒毛状-管状腺癌ii级", "label": "疾病和诊断", "offset": "95"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "157"}, {"mention": "肠", "label": "解剖部位", "offset": "173"}, {"mention": "肠绒毛状-管状腺瘤", "label": "疾病和诊断", "offset": "184"}, {"mention": "小肠", "label": "解剖部位", "offset": "208"}, {"mention": "胃肠道间质瘤", "label": "疾病和诊断", "offset": "301"}, {"mention": "肠", "label": "解剖部位", "offset": "322"}, {"mention": "奥沙利铂", "label": "药物", "offset": "497"}, {"mention": "齐沙", "label": "药物", "offset": "502"}, {"mention": "希罗达", "label": "药物", "offset": "518"}, {"mention": "降结肠癌术后", "label": "疾病和诊断", "offset": "582"}]}
{"text": ",缘于入院前1月于我院诊为乙状结肠癌,于2015-05-03在全麻上行腹腔镜上乙状结肠根治性切除术,术后病理(201614352),示:“乙状结肠浸润性管状腺癌i-ii级,侵及浆膜上层。手术标本下、上切端及另送(下切端)、(上切端)均未见癌浸润。找到肠周淋巴结10个,及另送的(直肠下动脉根部)淋巴结3个,均未见癌转移。,免疫组化:ki-67(20%+),ck7(+),ck20(+++),villin(++++),cdx2(+++),β-catenin(膜+++)。该病例未检测到kras基因12、13号密码子热点突变。,病理:该病例未检测到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。2016.06.03予“奥沙利铂200mgivgttd1+卡培他滨1500mgpobidd2-14”方案化疗1个疗程,辅以止吐、保肝、制酸、增强免疫等治疗,无明显化疗毒副反应。此次为行上一周期化疗,门诊拟乙状结肠癌术后化疗收入院。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": "乙状结肠癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜上乙状结肠根治性切除术", "label": "手术", "offset": "35"}, {"mention": "乙状结肠浸润性管状腺癌i-ii级", "label": "疾病和诊断", "offset": "69"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "125"}, {"mention": "(直肠下动脉根部)淋巴结", "label": "解剖部位", "offset": "138"}, {"mention": "奥沙利铂", "label": "药物", "offset": "328"}, {"mention": "卡培他滨", "label": "药物", "offset": "345"}, {"mention": "肝", "label": "解剖部位", "offset": "381"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "418"}, {"mention": "腹痛", "label": "症状", "offset": "448"}, {"mention": "腹胀", "label": "症状", "offset": "451"}]}
{"text": ",缘于入院前25天因胃体癌于2015年11月24日在我院全麻上行“腹腔镜辅助上根治性全胃切除术”,,术中探查见:腹腔内无明显腹水,盆腔、腹壁、大网膜无转移结节,肝脏质地大小正常,胆囊无肿大。胃体病灶不能探及,周围无明显肿大淋巴结,手术顺利,术后予抗感染、营养支持、免疫等治疗,术后恢复良好,术后病理(201541588),:(全胃),:胃窦小弯侧溃疡型管状腺癌ii级,侵犯肌层。手术标本下、上切端及另送(下切端)均未见癌浸润。找到贲门周淋巴结0/7个,幽门上淋巴结0/13个,及另送(第1组)淋巴结0/1个、(第7组)淋巴结1/7个、(第8组)淋巴结2/9个、(第9组)淋巴结0/2个,见癌转移。另送(第11组淋巴结)、(第12组淋巴结)镜上为纤维、血管、脂肪组织。小弯侧、幽门下、大弯侧脂肪组织未找见淋巴结;,免疫组化:肿瘤细胞示ki67(20%阳性),p53(-),p170(++),gstπ(-),egfr(-),5-fu(+),her-2(+),ck(l)(++)。此次为术后第1周期化疗再次入院。患者出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃体癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹腔镜辅助上根治性全胃切除术", "label": "手术", "offset": "33"}, {"mention": "腹腔", "label": "解剖部位", "offset": "56"}, {"mention": "腹水", "label": "症状", "offset": "62"}, {"mention": "盆腔", "label": "解剖部位", "offset": "65"}, {"mention": "腹", "label": "解剖部位", "offset": "68"}, {"mention": "肝脏", "label": "解剖部位", "offset": "80"}, {"mention": "胆囊", "label": "解剖部位", "offset": "89"}, {"mention": "胃体", "label": "解剖部位", "offset": "95"}, {"mention": "胃", "label": "解剖部位", "offset": "164"}, {"mention": "胃窦小弯侧溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "168"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "215"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "226"}, {"mention": "(第1组)淋巴结", "label": "解剖部位", "offset": "241"}, {"mention": "(第7组)淋巴结", "label": "解剖部位", "offset": "254"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "267"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "280"}, {"mention": "(第11组淋巴结)、(第12组淋巴结)", "label": "解剖部位", "offset": "300"}, {"mention": "小弯", "label": "解剖部位", "offset": "333"}, {"mention": "幽门", "label": "解剖部位", "offset": "337"}, {"mention": "大弯", "label": "解剖部位", "offset": "341"}, {"mention": "5-fu", "label": "药物", "offset": "410"}, {"mention": "腹痛", "label": "症状", "offset": "466"}, {"mention": "腹胀", "label": "症状", "offset": "469"}]}
{"text": ",缘于入院前2月余于我院诊为“直肠癌”,于2015-10-12在全麻上行腹腔镜上直肠根治术(dixon手术)中转开腹+膀胱病损修补术,,术中见:腹腔内无明显出血,肿瘤位于直乙交界处,与膀胱分界不清,形成肠梗阻,近端稍扩张,周围见数个明显肿大淋巴结。,术后病理:(201541031)(直肠),:肠外生型管状腺癌ii级,侵犯肠壁全层及肠周脂肪组织,间质见多量急慢性炎症细胞及组织细胞浸润。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68个未见癌转移。于2015.12.18予“奥沙利铂(艾恒)200mg静滴d1+卡培他滨片(希罗达)1500mg口服bidd1-14方案”化疗,辅予止吐、保胃、护肝等相关治疗。化疗过程顺利,无化疗副反应。此次为第2次化疗,再次就诊我院,门诊拟“直肠癌术后化疗”收入我科。自下次出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "腹腔镜上直肠根治术(dixon手术)中转开腹+膀胱病损修补术", "label": "手术", "offset": "36"}, {"mention": "腹腔", "label": "解剖部位", "offset": "72"}, {"mention": "直乙交界处", "label": "解剖部位", "offset": "85"}, {"mention": "膀胱", "label": "解剖部位", "offset": "92"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "101"}, {"mention": "直肠", "label": "解剖部位", "offset": "142"}, {"mention": "肠外生型管状腺癌ii级", "label": "疾病和诊断", "offset": "147"}, {"mention": "肠", "label": "解剖部位", "offset": "161"}, {"mention": "肠", "label": "解剖部位", "offset": "166"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "223"}, {"mention": "奥沙利铂", "label": "药物", "offset": "250"}, {"mention": "艾恒", "label": "药物", "offset": "255"}, {"mention": "卡培他滨", "label": "药物", "offset": "268"}, {"mention": "希罗达", "label": "药物", "offset": "274"}, {"mention": "胃", "label": "解剖部位", "offset": "306"}, {"mention": "肝", "label": "解剖部位", "offset": "309"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "350"}, {"mention": "腹痛", "label": "症状", "offset": "377"}, {"mention": "腹胀", "label": "症状", "offset": "380"}]}
{"text": "患者8个月前因“进行性吞咽困难1个月”就诊于我院,完善术前准备后,于2013-10-08行“胸段段食管食管切除+食管-胃左胸顶吻合术+左侧第5肋骨固定术”,术顺,术后恢复良好后出院。术后病理示:胸段食管多中心鳞状下皮癌,其一为溃疡性鳞状细胞癌i-ii级,侵犯神经,侵出外膜,其二为浸润型鳞状细胞癌i-ii级,侵犯神经及齿状线。找到贲门淋巴结1/7,左喉返神经旁淋巴结1/3,见癌转移。于2013.12.01、2013.12.26按“洛铂50mgd1+多帕菲120mgivgtt”方案化疗2个周期,并于2014.01.19、2014.02.13按“洛铂50mgd1+安素泰180mgd2ivgtt”方案化疗第3、4周期,辅以制酸、保胃、保肝、止吐等治疗,化疗过程顺利,现为化疗4周期后复查就诊我院,门诊拟“食管癌术后化疗后”收住入院。下次出院至今无胸闷、憋气、胸背痛,无腹痛、腹胀,无呕血、黑便。精神、睡眠、饮食较好,大小便正常,体重无明显变化。", "mention_data": [{"mention": "胸段段食管食管切除+食管-胃左胸顶吻合术+左侧第5肋骨固定术", "label": "手术", "offset": "46"}, {"mention": "胸段食管多中心鳞状下皮癌", "label": "疾病和诊断", "offset": "97"}, {"mention": "溃疡性鳞状细胞癌i-ii级", "label": "疾病和诊断", "offset": "113"}, {"mention": "浸润型鳞状细胞癌i-ii级", "label": "疾病和诊断", "offset": "140"}, {"mention": "贲门淋巴结", "label": "解剖部位", "offset": "165"}, {"mention": "左喉返神经旁淋巴结", "label": "解剖部位", "offset": "174"}, {"mention": "洛铂", "label": "药物", "offset": "216"}, {"mention": "多帕菲", "label": "药物", "offset": "225"}, {"mention": "洛铂", "label": "药物", "offset": "273"}, {"mention": "安素泰", "label": "药物", "offset": "282"}, {"mention": "胃", "label": "解剖部位", "offset": "315"}, {"mention": "肝", "label": "解剖部位", "offset": "318"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "352"}, {"mention": "胸闷", "label": "症状", "offset": "373"}, {"mention": "胸背痛", "label": "症状", "offset": "379"}, {"mention": "腹痛", "label": "症状", "offset": "384"}, {"mention": "腹胀", "label": "症状", "offset": "387"}]}
{"text": "患者2008.2.1因“大便性状改变,发现结肠肿块10天”入我院全科,2.5行乙状结肠癌根治术(应用吻合器),术中探查:腹腔及其他脏器未及异常,乙状结肠近直肠处可及4×4cm肿块,术中病理“溃疡性腺癌,分化ii-iii级,侵及全层,切缘未见癌累及,肠旁淋巴结19枚,均未及癌转移”。分别1.28(乐沙定,君瑞清),2.23(乐沙定,替加氟)行介入化疗。今为再次行介入化疗入院。病程中,患者精神可,胃纳差,睡眠可,双便正常。", "mention_data": [{"mention": "结肠", "label": "解剖部位", "offset": "21"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "39"}, {"mention": "腹腔", "label": "解剖部位", "offset": "60"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "72"}, {"mention": "直肠", "label": "解剖部位", "offset": "77"}, {"mention": "溃疡性腺癌", "label": "疾病和诊断", "offset": "95"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "124"}, {"mention": "乐沙定", "label": "药物", "offset": "148"}, {"mention": "君瑞清", "label": "药物", "offset": "152"}, {"mention": "乐沙定", "label": "药物", "offset": "162"}, {"mention": "替加氟", "label": "药物", "offset": "166"}, {"mention": "胃", "label": "解剖部位", "offset": "198"}]}
{"text": ",缘于入院前1月于我院诊断为结肠肝曲癌,于2014-10-20在全麻上行腹腔镜上扩大根治性左半结肠切除术,,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*3cm,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201435395)示(左半结肠),:大肠隆起型管状腺癌ii级,侵及浆膜,侵犯神经,手术标本双切端及另送(近切端)、(远切端)均未见癌浸润。找到回肠周淋巴结1个,结肠周淋巴结50个,另送(回结肠动脉根部)淋巴结5个,(结肠中动脉根部)淋巴结5个均未见癌转移。另见阑尾组织,术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲,出院后无发热、畏冷,无咳嗽、咳痰,无胸闷、心悸,无腹痛、腹胀、腹泻等不适,今为行术后第1次化疗就诊我院,门诊拟结肠肝曲癌术后收入院。下次出院以来,精神、睡眠、饮食可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "结肠肝曲癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上扩大根治性左半结肠切除术", "label": "手术", "offset": "36"}, {"mention": "腹腔", "label": "解剖部位", "offset": "58"}, {"mention": "腹水", "label": "症状", "offset": "76"}, {"mention": "肝脏", "label": "解剖部位", "offset": "79"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "93"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "118"}, {"mention": "左半结肠", "label": "解剖部位", "offset": "155"}, {"mention": "大肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "162"}, {"mention": "回肠周淋巴结", "label": "解剖部位", "offset": "215"}, {"mention": "结肠周淋巴结", "label": "解剖部位", "offset": "224"}, {"mention": "(回结肠动脉根部)淋巴结", "label": "解剖部位", "offset": "236"}, {"mention": "(结肠中动脉根部)淋巴结", "label": "解剖部位", "offset": "251"}, {"mention": "阑尾", "label": "解剖部位", "offset": "274"}, {"mention": "胸闷", "label": "症状", "offset": "326"}, {"mention": "心悸", "label": "症状", "offset": "329"}, {"mention": "腹痛", "label": "症状", "offset": "333"}, {"mention": "腹胀", "label": "症状", "offset": "336"}, {"mention": "腹泻", "label": "症状", "offset": "339"}, {"mention": "结肠肝曲癌术后", "label": "疾病和诊断", "offset": "363"}]}
{"text": ",患者2月前于我院在全麻上行手术,探查腹腔内无腹水,腹膜无转移,肝脏未触及转移结节,肿瘤位于结肠肝曲,约5×4×4cm,已侵出浆膜,侵犯十二指肠和胰头,并造成肿瘤与盲肠之间闭袢性梗阻,梗阻肠腔明显扩张,肠腔内大量稀薄粪便,结肠系膜未见明显肿大淋巴结,探查后决定行姑息性左半结肠切除术。手术过程顺利。,术后病理结果示:(左半结肠)腺癌(中度分化),结合免疫组化考虑来自结肠,部分细胞伴神经内分泌分化。浸润溃疡型,体积4.5*3.5*1.2cm,侵穿浆膜及纤维膜。,术后病理结果示:(左半结肠)腺癌(中度分化),结合免疫组化考虑来自结肠,部分细胞伴神经内分泌分化。浸润溃疡型,体积4.5*3.5*1.2cm,侵穿浆膜及纤维膜。叒双端切线及底部切除面未查见癌。叒肠壁一站(8个)、二站(4个)、三站(3个)、中间组(5个)淋巴结未查见癌。叒,免疫组化染色示:ck7(-)、ck20(+)、villin(+)、cdx-2(+)、ts部分(+)、叒syn(少数细胞阳性)。现患者为行进一步诊治,门诊以“结肠癌术后”收入我科。患者术后精神、饮食可,小便正常,大便排便费力,体重无明显变化。", "mention_data": [{"mention": "腹腔", "label": "解剖部位", "offset": "19"}, {"mention": "腹水", "label": "症状", "offset": "23"}, {"mention": "腹", "label": "解剖部位", "offset": "26"}, {"mention": "肝脏", "label": "解剖部位", "offset": "32"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "46"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "68"}, {"mention": "胰头", "label": "解剖部位", "offset": "73"}, {"mention": "盲肠", "label": "解剖部位", "offset": "82"}, {"mention": "肠", "label": "解剖部位", "offset": "94"}, {"mention": "肠", "label": "解剖部位", "offset": "101"}, {"mention": "结肠", "label": "解剖部位", "offset": "111"}, {"mention": "姑息性左半结肠切除术", "label": "手术", "offset": "131"}, {"mention": "(左半结肠)腺癌", "label": "疾病和诊断", "offset": "158"}, {"mention": "结肠", "label": "解剖部位", "offset": "183"}, {"mention": "(左半结肠)腺癌", "label": "疾病和诊断", "offset": "239"}, {"mention": "结肠", "label": "解剖部位", "offset": "264"}, {"mention": "肠壁一站(8个)、二站(4个)、三站(3个)、中间组(5个)淋巴结", "label": "解剖部位", "offset": "328"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "446"}]}
{"text": ",患者因“宫颈癌”于2015-09-02在我院于全麻上行腹腔镜上盆腔淋巴结清扫+腹主动脉旁淋巴结取样+广泛子宫+两侧输卵管切除术+左侧卵巢切除+右侧卵巢悬吊术。,术后病理检查示:宫颈腺癌,符合中肾管癌,侵犯宫颈壁全层及宫颈管内口。右盆腔淋巴结12枚,其中一枚查见转移癌(31622.15)。,免疫组化:er(-)叒pr(-)叒cr(-)叒ck(-)叒p16(-)叒napsina(-)pax-8个别腺体弱阳性,p53(-)叒cea(+)叒wt-1(-)ki-67阳性率50%。术后一般情况可,2015-09-14给予紫杉醇240mg+顺铂110mg化疗,化疗过程顺利,副反应不重。2015-10-9予紫杉醇240mg+顺铂110mg方案化疗,予心电监护,水极化,化疗过程顺利,无明显化疗反应。2015-11-9叒在我院放疗二科予紫杉醇240mg叒d1叒+顺铂40mg叒d1-3方案化疗,盆腔适形放疗中,放化疗过程顺利,情况好转出院。于2015-12-25日、2016-1-17日给予紫杉醇240mg+顺铂110mg药物化疗2次。现患者无腹痛,无发热,无腰骶疼痛。为求第6次化疗,门诊以“宫颈癌术后化疗”收入院。患者一般情况可,睡眠饮食可,大小便无明显异常,体重无明显减轻。", "mention_data": [{"mention": "宫颈癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "腹腔镜上盆腔淋巴结清扫+腹主动脉旁淋巴结取样+广泛子宫+两侧输卵管切除术+左侧卵巢切除+右侧卵巢悬吊术", "label": "手术", "offset": "28"}, {"mention": "宫颈腺癌", "label": "疾病和诊断", "offset": "89"}, {"mention": "中肾管癌", "label": "疾病和诊断", "offset": "96"}, {"mention": "宫颈", "label": "解剖部位", "offset": "103"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "109"}, {"mention": "右盆腔淋巴结", "label": "解剖部位", "offset": "115"}, {"mention": "紫杉醇", "label": "药物", "offset": "258"}, {"mention": "顺铂", "label": "药物", "offset": "267"}, {"mention": "紫杉醇", "label": "药物", "offset": "300"}, {"mention": "顺铂", "label": "药物", "offset": "309"}, {"mention": "紫杉醇", "label": "药物", "offset": "364"}, {"mention": "顺铂", "label": "药物", "offset": "377"}, {"mention": "盆腔", "label": "解剖部位", "offset": "393"}, {"mention": "紫杉醇", "label": "药物", "offset": "441"}, {"mention": "顺铂", "label": "药物", "offset": "450"}, {"mention": "腹痛", "label": "症状", "offset": "468"}, {"mention": "腰骶疼痛", "label": "症状", "offset": "476"}, {"mention": "宫颈癌术后", "label": "疾病和诊断", "offset": "493"}]}
{"text": ",患者于2015年11月26日因“宫颈癌iai”在全麻上行腹腔镜上广泛子宫+两附件切除术+盆腔淋巴结清扫术。,术中见:子宫表面光滑,正常大小,两侧输卵管、卵巢均未见明显异常。两侧骶、主韧带无明显增厚。两侧盆腔未见明显肿大淋巴结。窥器扩开宫颈口,宫颈后唇可见活检创面,阴道壁粘膜光滑,无异常,术毕安返病房。,术后常规病理回示:(942790.15)(子宫)低分化鳞状细胞癌,4处癌灶,,切面积分别是:0.8*0.3cm、0.4*0.2cm、0.3*0.2cm、0.2*0.1cm,侵及宫颈管深度小于1/3,并查见鳞状下皮高级别下皮内瘤变累及腺体。右、左宫宫旁组织及阴道断端未查见癌。萎缩的子宫内膜。(两侧)输卵管组织。(两侧卵巢)白体。另送检右盆腔淋巴结4枚,均未查见转移癌(0/4),另送检“左盆腔淋巴结”为脂肪结缔组织,未查见癌。。今为术后第1次化疗就诊我院,门诊以“宫颈癌术后化疗”收入院,患者自发病以来,饮食睡眠可,体重无明显变化。", "mention_data": [{"mention": "宫颈癌iai", "label": "疾病和诊断", "offset": "17"}, {"mention": "腹腔镜上广泛子宫+两附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "29"}, {"mention": "子宫", "label": "解剖部位", "offset": "59"}, {"mention": "两侧输卵管、卵巢均", "label": "解剖部位", "offset": "71"}, {"mention": "两侧骶、主韧带", "label": "解剖部位", "offset": "87"}, {"mention": "两侧盆腔", "label": "解剖部位", "offset": "100"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "110"}, {"mention": "宫颈口", "label": "解剖部位", "offset": "118"}, {"mention": "宫颈后唇", "label": "解剖部位", "offset": "122"}, {"mention": "阴道", "label": "解剖部位", "offset": "133"}, {"mention": "(子宫)低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "173"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "241"}, {"mention": "状下皮高级别下皮内瘤变", "label": "疾病和诊断", "offset": "256"}, {"mention": "右、左宫", "label": "解剖部位", "offset": "272"}, {"mention": "阴道", "label": "解剖部位", "offset": "281"}, {"mention": "子宫", "label": "解剖部位", "offset": "293"}, {"mention": "(两侧)输卵管", "label": "解剖部位", "offset": "298"}, {"mention": "(两侧卵巢)白体", "label": "解剖部位", "offset": "308"}, {"mention": "右盆腔淋巴结", "label": "解剖部位", "offset": "320"}, {"mention": "左盆腔淋巴结", "label": "解剖部位", "offset": "346"}, {"mention": "宫颈癌术后", "label": "疾病和诊断", "offset": "385"}]}
{"text": ",患者6个月前(2014-5)无明显诱因出现排便习惯改变,大便2-4次/日,呈稀糊状,伴里急后重感,无脓血,无腹痛腹胀,无恶心呕吐,无发热,自诉口服中药(具体不详)效果不明显。遂就诊于我院消化内科,2014年7月9日,行肠镜检查示:,直肠:肛缘至距肛缘约7cm见约环2/3管腔不规则隆起病变,表面糜烂结节状。,诊断意见:直肠carcinoma。2014年7月16日于我院胃肠外科在全麻上行腹会阴直肠癌根治术(miles手术),术中见肿瘤位于腹膜返折上方,巨大充满小骨盆腔,,术后病理示:距肛门侧切缘4cm处,肠粘膜面见8*7*2.5cm灰白溃疡型肿物,,诊断意见:a(直肠肿瘤),:黏液腺癌(中低分化),侵及外膜;l251(14/14)、l252(3/8),:淋巴结转移癌;l253(0/1),:淋巴结淋巴组织增生(,病理号:z0480550)。,免疫组化:,a2:c-erbb-2(1+)叒d2-40(-)叒cea(+)叒ck20(+)叒ck7(-)叒ki-67(约50%+)叒cd34(-)。术后恢复可,于我科行xelox方案化疗3周期,,具体用药:艾恒叒200mg叒d1叒静点,希罗达叒1500mg叒日二次口服。末次化疗后出现i°粒细胞上降,未治疗。现为行进一步治疗收入我科。患者目前一般状况可,无发热,无腹痛、腹泻及便血,饮食睡眠可,二便正常,周身无疼痛,病来体重无明显减轻,ecog评分1分。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "55"}, {"mention": "腹胀", "label": "症状", "offset": "57"}, {"mention": "直肠", "label": "解剖部位", "offset": "117"}, {"mention": "肛缘", "label": "解剖部位", "offset": "120"}, {"mention": "肛缘", "label": "解剖部位", "offset": "124"}, {"mention": "直肠carcinoma", "label": "疾病和诊断", "offset": "160"}, {"mention": "腹会阴直肠癌根治术(miles手术)", "label": "手术", "offset": "194"}, {"mention": "腹", "label": "解剖部位", "offset": "220"}, {"mention": "小骨盆腔", "label": "解剖部位", "offset": "231"}, {"mention": "肛门", "label": "解剖部位", "offset": "244"}, {"mention": "肠", "label": "解剖部位", "offset": "254"}, {"mention": "直肠肿瘤", "label": "疾病和诊断", "offset": "284"}, {"mention": "黏液腺癌", "label": "疾病和诊断", "offset": "291"}, {"mention": "艾恒", "label": "药物", "offset": "477"}, {"mention": "希罗达", "label": "药物", "offset": "492"}, {"mention": "腹痛", "label": "症状", "offset": "556"}, {"mention": "腹泻", "label": "症状", "offset": "559"}]}
{"text": "2年前,患者因“反复腹胀1年”入我院,考虑“胃底贲门恶性肿瘤可能”,2014-09-19在我院于全麻上行“剖腹探查、根治性全胃切除术、食管-空肠roux-en-y吻合术”,手术顺利,术后病理诊断示“(胃)中分化腺癌,侵及肠壁全层至浆膜外,双切端未见癌累及,胃大、小弯淋巴结未见癌转移(分别为0/5、0/9),网膜未见癌累及”。术后积极予以抗感染、营养支持、对症和支持治疗,患者好转出院。术后已行6次全身静脉化疗(folfox方案)。现嘱医嘱,为例行术后复查收入我科。\\u0004叒叒叒患者起病以来,精神尚可,胃纳可,睡眠可,大小便正常,体重未见明显改变。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "10"}, {"mention": "胃底贲门恶性肿瘤", "label": "疾病和诊断", "offset": "22"}, {"mention": "剖腹探查、根治性全胃切除术、食管-空肠roux-en-y吻合术", "label": "手术", "offset": "53"}, {"mention": "(胃)中分化腺癌", "label": "疾病和诊断", "offset": "99"}, {"mention": "肠", "label": "解剖部位", "offset": "110"}, {"mention": "胃大、小弯淋巴结", "label": "解剖部位", "offset": "128"}, {"mention": "胃", "label": "解剖部位", "offset": "254"}]}
{"text": "患者2016年8月因“发现上腹包块4个月”就诊我院,考虑卵巢恶性肿瘤,于2016-09-13于全麻上行肿瘤细胞减灭术(i型全子宫切除+两侧附件切除+大网膜切除+盆腔及腹主动脉旁淋巴结清扫+肠修补术),术中冰冻提示为高级别浆液性癌,手术为满意减灭术。因患者术前贫血,术中输注红细胞400ml及新鲜冰冻血浆400ml,无明显输血反应,手术过程顺利,术后予心电监护、吸氧、抗炎、补液等对症支持治疗。并于2016-09-20行tc方案(进口紫杉醇210mg叒d1,伯尔定550mg叒d1)化疗第一程、2016-10-12行tc方案(紫杉醇210mg叒d1+卡铂700mg叒d1)化疗第二程、2016-11-07行tc方案(紫杉醇210mg叒d1+卡铂700mg叒d1)化疗第三程,现为行上一程化疗入院。患者近期精神、睡眠稍差,食欲欠佳,二便如常,体重近期无明显改变。既往化疗及肿瘤标志物情况:。", "mention_data": [{"mention": "上腹", "label": "解剖部位", "offset": "13"}, {"mention": "卵巢恶性肿瘤", "label": "疾病和诊断", "offset": "28"}, {"mention": "肿瘤细胞减灭术(i型全子宫切除+两侧附件切除+大网膜切除+盆腔及腹主动脉旁淋巴结清扫+肠修补术)", "label": "手术", "offset": "51"}, {"mention": "高级别浆液性癌", "label": "疾病和诊断", "offset": "107"}, {"mention": "紫杉醇", "label": "药物", "offset": "216"}, {"mention": "伯尔定", "label": "药物", "offset": "228"}, {"mention": "紫杉醇", "label": "药物", "offset": "262"}, {"mention": "卡铂", "label": "药物", "offset": "274"}, {"mention": "紫杉醇", "label": "药物", "offset": "307"}, {"mention": "卡铂", "label": "药物", "offset": "319"}]}
{"text": ",根治性全胃切除术后2月余复查。,术后病理:胃体小弯侧溃疡型低分化腺癌(lauren,分型:弥漫型),大小5×3.5cm;侵至浆膜层,见神经侵犯,免疫组化cd34(+),d2-40(+)示脉管癌栓;食道残端及十二指肠残端均未见癌;淋巴结见癌转移[共44枚,21,枚转移:第1组0/5、第2组0/0、第3组8/13、第4sa组0/2、第4sb组0/0、第4d组5/7、第5组1/1、第6组5/5、(第7、9组)0/6、第8组1/1、第11p组0/1、12a组0/2、叒14v1/1];,肿瘤病理学分期:pt4n3b。,免疫组化结果显示:cd34(+),cd44(+),cmet(+),d2-40(+),egfr(+),her2(-),ki-67(+25~50%),p170(+),p27(+25~50%),p53(+25~50%),topoii(+<25%)。术后化疗1周期sox(2013-8-8,乐沙定200mg叒d1,爱斯万叒60mg叒bid1-14,q3wks),骨髓毒性ii度,升白治疗,胃肠道反应0度,外周神经毒性i度。", "mention_data": [{"mention": "根治性全胃切除术后", "label": "疾病和诊断", "offset": "1"}, {"mention": "胃体小弯侧溃疡型低分化腺癌(lauren,分型:弥漫型)", "label": "疾病和诊断", "offset": "22"}, {"mention": "爱斯万", "label": "药物", "offset": "411"}]}
{"text": "缘于1年前因左肝原发性肝癌于我院行左半肝切除术+胆囊切除术,术顺,术后病理(201237164)示:左半肝肝脏原发性巨块型中分化肝癌,侵及肝被膜,脉管内见癌栓,周边组织呈空泡性及脂肪性变.术后恢复可。无腹胀、腹痛。无恶心、呕吐,无发热、寒战及黄疸。无畏冷、寒战、发热。现患者返院复查,门诊拟“肝癌术后”收住入院,自发病以来,患者食欲尚可,精神可,体重无明显上降,大、小便正常。", "mention_data": [{"mention": "左肝原发性肝癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "左半肝切除术+胆囊切除术", "label": "手术", "offset": "17"}, {"mention": "左半肝肝脏原发性巨块型中分化肝癌", "label": "疾病和诊断", "offset": "50"}, {"mention": "肝", "label": "解剖部位", "offset": "69"}, {"mention": "腹胀", "label": "症状", "offset": "101"}, {"mention": "腹痛", "label": "症状", "offset": "104"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "146"}]}
{"text": ",缘于2个月余前入院,诊断为直肠隆起型管状腺癌,于2014.01.16在我科行“腹腔镜上直肠癌根治术(dixon)”。术后病理示(201401611),:(直肠),:肠隆起型绒毛状-管状腺癌ii级,侵犯脉管组织,脉管内见癌栓,侵及深肌层(&gt;1/2肌层),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2/18个,见癌转移。另送(肠系膜上动脉根部)镜上为脂肪、脉管及纤维结缔组织。,免疫组化结果:ki67(80%阳性),p53(+++),p170(++),gstπ(个别细胞阳性),egfr(-),5-fu(-),mlh1(+++),msh6(个别细胞阳性),mgmt(++)。术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。并于2014.02.16开始予“奥沙利铂150mgivgttd1+希罗达1000mgpobidd2-15”方案行术后第1周期化疗,患者耐受良好,此次为第2次化疗再次入院。出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "直肠隆起型管状腺癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上直肠癌根治术(dixon)", "label": "手术", "offset": "40"}, {"mention": "直肠", "label": "解剖部位", "offset": "78"}, {"mention": "肠隆起型绒毛状-管状腺癌ii级", "label": "疾病和诊断", "offset": "83"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "165"}, {"mention": "肠系膜上动脉根部", "label": "解剖部位", "offset": "184"}, {"mention": "5-fu", "label": "药物", "offset": "268"}, {"mention": "奥沙利铂", "label": "药物", "offset": "351"}, {"mention": "希罗达", "label": "药物", "offset": "368"}, {"mention": "腹痛", "label": "症状", "offset": "431"}, {"mention": "腹胀", "label": "症状", "offset": "434"}]}
{"text": ",外院肠镜示:乙状结肠距肛门20cm可见环周样结节状粘膜不规则隆起。,病理:乙状结肠高分化腺癌。2017-8-22行乙状结肠癌手术,(直肠下段),切除:-叒中分化腺癌,伴钙化,最大径4.5cm;-叒可见脉管癌栓及神经侵犯;-叒癌组织侵达浆膜上,浆膜上另见癌结节;-叒(近端)及(远端)切缘未见癌;-叒淋巴结可见癌转移(肠周1/13,直肠下动脉旁0/1),未侵犯淋巴结被膜外;-叒,肿瘤病理分期:pt3n1a。,免疫组化结果显示:braf(-),cmet(2+),egfr(3+),her2(1+),ki-67(70%),mlh1(+),msh2(+),msh6(+),pms2(+)。", "mention_data": [{"mention": "乙状结肠", "label": "解剖部位", "offset": "7"}, {"mention": "肛门", "label": "解剖部位", "offset": "12"}, {"mention": "乙状结肠高分化腺癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "乙状结肠癌手术", "label": "手术", "offset": "58"}, {"mention": "直肠下段", "label": "解剖部位", "offset": "67"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "78"}, {"mention": "淋巴结可见癌转移(肠周1/13,直肠下动脉旁0/1)", "label": "解剖部位", "offset": "150"}]}
{"text": ",患者2016.1.28因左下腹疼痛4天入我院普外科。当时无恶心、呕吐,无反酸、嗳气,无呕血,腹部ct示结肠肝曲占位,考虑结肠癌并腹腔淋巴结转移,腹部b超示左侧腹部包块,考虑占位性病变,肠系膜及腹膜后淋巴结肿大。入院后给予完善各项检查,于2016-1-30在全麻上行腹腔镜扩大根治性左半结肠切除术,,术后病理:(结肠)中分化腺癌,部分为粘液腺癌(后者约占60%),溃疡型,肿瘤切面积9*2.5cm,侵透浆膜,回肠切缘、结肠切缘、阑尾及网膜组织未查见癌,肠周淋巴结36枚,其中1枚查见转移癌。患者术后恢复可,入我科后复查ct未见肿瘤复发及转移征象,2016-2-18起给予mfolfox6方案化疗5周期,,具体为:奥沙利铂130mg叒d1+右亚叶酸钙300mg叒d1+氟尿嘧啶0.625g叒d1,3.75g叒输液泵维持46小时,耐受可。今为行上一周期化疗再次入院。患者自下次出院以来,神志清,精神可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "13"}, {"mention": "腹部ct", "label": "影像检查", "offset": "47"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "52"}, {"mention": "结肠癌并腹腔淋巴结转移", "label": "疾病和诊断", "offset": "61"}, {"mention": "左侧腹部", "label": "解剖部位", "offset": "78"}, {"mention": "肠系膜及腹膜后淋巴结", "label": "解剖部位", "offset": "93"}, {"mention": "腹腔镜扩大根治性左半结肠切除术", "label": "手术", "offset": "133"}, {"mention": "(结肠)中分化腺癌", "label": "疾病和诊断", "offset": "155"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "168"}, {"mention": "回肠", "label": "解剖部位", "offset": "204"}, {"mention": "结肠", "label": "解剖部位", "offset": "209"}, {"mention": "阑尾", "label": "解剖部位", "offset": "214"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "226"}, {"mention": "ct", "label": "影像检查", "offset": "259"}, {"mention": "奥沙利铂", "label": "药物", "offset": "306"}, {"mention": "右亚叶酸钙", "label": "药物", "offset": "319"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "333"}]}
{"text": ",患者于2014-6外院检查发现afp升高。2014-6-22,六院行ct检查:肝左叶巨大占位,肝癌可能大。2014-7-1来我院就诊,,行mri检查示:肝左叶巨块型mt,大小约8.4x11.5cm。7/,15查afp:叒6428.0ng/ml;7/18行特殊肝段切除术(v、vi、viii段)+胆囊切除术。,术后病理:(肝左叶)肝细胞肝癌,iii级,伴出血、坏死,脉管内见癌栓。肝切缘未见癌组织累及。周围肝组织汇管区淋巴细胞浸润伴纤维组织增生(g1s2),部分区肝细胞大细胞变。(胆囊)慢性炎。检出胆囊旁淋巴结1枚,慢性炎。免疫组化(2014-n8731)2,号蜡块:afp(++),hepa(++),ck7(-),ck19(-),cd34(血窦丰富),ki67(50%阳性),gs(++),hsp70(++),gpc3(-),opn(-)。术后手术区积液,予以置管引流。7/,25出院前查afp:叒1362.0ng/ml;出院后,随访腹部,ct:肝mt术后改变,术区积液、积气,随访;肝脏囊肿,8/,18随访afp:113ng/ml。现为进一步介入治疗收入院。患者发病以来,胃纳可、夜寐可、二便正常、体重无明显减轻。", "mention_data": [{"mention": "afp", "label": "实验室检验", "offset": "16"}, {"mention": "ct", "label": "影像检查", "offset": "35"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "40"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "48"}, {"mention": "mri", "label": "影像检查", "offset": "70"}, {"mention": "肝左叶巨块型mt", "label": "疾病和诊断", "offset": "77"}, {"mention": "特殊肝段切除术(v、vi、viii段)+胆囊切除术", "label": "手术", "offset": "128"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "161"}, {"mention": "肝细胞肝癌,iii级", "label": "疾病和诊断", "offset": "165"}, {"mention": "肝", "label": "解剖部位", "offset": "190"}, {"mention": "肝", "label": "解剖部位", "offset": "203"}, {"mention": "肝", "label": "解剖部位", "offset": "232"}, {"mention": "(胆囊)慢性炎", "label": "疾病和诊断", "offset": "240"}, {"mention": "胆囊旁淋巴结", "label": "解剖部位", "offset": "250"}, {"mention": "afp", "label": "实验室检验", "offset": "396"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "419"}, {"mention": "肝mt术后", "label": "疾病和诊断", "offset": "425"}, {"mention": "肝脏囊肿", "label": "疾病和诊断", "offset": "444"}, {"mention": "afp", "label": "实验室检验", "offset": "456"}, {"mention": "胃", "label": "解剖部位", "offset": "489"}]}
{"text": "患者于2016-01-08因“结肠癌”于我院行左半结肠切除+淋巴结清扫术,术后病理示:(01083.16)结合986.16(结肠)中分化腺癌,隆起型,肿瘤切面积8*5.5cm,侵达浆膜,下、上切线均未查见癌,肠周查见淋巴结17枚,其中2枚查见癌(2/17)。(膀胱)结缔组织急慢性炎,其内查见少许异型下皮,考虑为腺癌累及。术后给予抗炎、补液、营养及对症治疗,术后恢复可。现患者无恶心、呕吐,无腹痛、腹胀,大便通畅,为行化疗治疗,今日就诊于我院,门诊以“结肠癌术后化疗”收住入院。患者自发病以来,神志清,精神可,食欲、睡眠可,小便正常,体重变化不明显。高血压病史30余年,未规律服药,现血压正常。患乙型病毒性肝炎20年。尿频、排尿困难1年余,未行治疗。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "左半结肠切除+淋巴结清扫术", "label": "手术", "offset": "23"}, {"mention": "(结肠)中分化腺癌", "label": "疾病和诊断", "offset": "61"}, {"mention": "肠周查见淋巴结", "label": "解剖部位", "offset": "104"}, {"mention": "膀胱", "label": "解剖部位", "offset": "130"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "156"}, {"mention": "腹痛", "label": "症状", "offset": "196"}, {"mention": "腹胀", "label": "症状", "offset": "199"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "226"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "275"}, {"mention": "乙型病毒性肝炎", "label": "疾病和诊断", "offset": "298"}]}
{"text": "患者1月前因\\\"间断下腹痛1年,发现结肠占位2天\\\"于我院行左半结肠切除术,手术顺利,病理回报为(左半结肠)结肠隆起型高中分化腺癌,部分为粘液腺癌,大小10×5×4cm,癌侵及浆膜上纤维脂肪组织,距环周切缘约3mm,未见脉管癌栓,淋巴结未见癌转移(肠周0/13,结肠中血管旁0/2),(近端)及(远端)切缘未见特殊。免疫组化结果显示叒cd44(+),cmet(+),cox2(+),egfr(),her2(1+),ki-67(+20%),mlh1(+50~75%),mmp7(弱+),msh2(+25~50%),msh6(),p170(),p27(+25~50%),p53(+50~75%),topoii(+<10%)。现患者为求进一步治疗,以“结肠癌术后”收入院。患者自发病以来,精神饮食可,睡眠可,二便正常,体重无明显减轻。", "mention_data": [{"mention": "结肠", "label": "解剖部位", "offset": "18"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "30"}, {"mention": "(左半结肠)结肠隆起型高中分化腺癌", "label": "疾病和诊断", "offset": "48"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "淋巴结未见癌转移(肠周0/13,结肠中血管旁0/2)", "label": "解剖部位", "offset": "115"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "323"}]}
{"text": "缘于入院前5月因诊为降结肠癌伴肝转移,于2016.01.15、2016.02.05在我院予“奥沙利铂200mgivgttd1+卡培他滨片(希罗达)1500mgbidpod1-14”方案行术前新辅助化疗,未见明显化疗后不良反应,于2016年02月29日于我院行腹腔镜上右半结肠切除术(姑息性),术顺,术后病理回报(201605763):结肠隆起型黏液腺癌,侵及浆膜上层,侵犯脉管组织,未见肯定神经侵犯。手术标本远、近切端均未见癌浸润。找到肠周淋巴结4/22个,见癌转移。肠周脂肪中找到4枚癌结节。肠粘膜溃疡。另送(右结肠动脉根部)、(肠系膜上静脉根部)镜上为纤维、血管及脂肪组织。术后恢复可,无腹痛、腹胀,无恶心、呕吐等不适,术后予“盐酸伊立替康240mg静滴d1+卡培他滨片1500mgbidpod1-14”“盐酸伊立替康240mg静滴d1+安维汀400mg(自备)d1+替吉奥60mgbidpod1-14”方案化疗3次,化疗期间予制酸、补液、营养支持等对症处理。为进一步治疗,门诊拟“降结肠癌伴肝转移(pt1n2am1aiva期)”收入院,自下次出院以来,精神、睡眠、饮食可,大小便如常,体重未见明显减轻。", "mention_data": [{"mention": "降结肠癌伴肝转移", "label": "疾病和诊断", "offset": "10"}, {"mention": "奥沙利铂", "label": "药物", "offset": "46"}, {"mention": "卡培他滨片", "label": "药物", "offset": "63"}, {"mention": "希罗达", "label": "药物", "offset": "69"}, {"mention": "腹腔镜上右半结肠切除术", "label": "手术", "offset": "129"}, {"mention": "结肠隆起型黏液腺癌", "label": "疾病和诊断", "offset": "167"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "218"}, {"mention": "肠", "label": "解剖部位", "offset": "234"}, {"mention": "肠", "label": "解剖部位", "offset": "247"}, {"mention": "右结肠", "label": "解剖部位", "offset": "256"}, {"mention": "肠", "label": "解剖部位", "offset": "266"}, {"mention": "腹痛", "label": "症状", "offset": "296"}, {"mention": "腹胀", "label": "症状", "offset": "299"}, {"mention": "盐酸伊立替康", "label": "药物", "offset": "316"}, {"mention": "卡培他滨片", "label": "药物", "offset": "332"}, {"mention": "盐酸伊立替康", "label": "药物", "offset": "355"}, {"mention": "安维汀", "label": "药物", "offset": "371"}, {"mention": "替吉奥", "label": "药物", "offset": "386"}, {"mention": "降结肠癌伴肝转移", "label": "疾病和诊断", "offset": "443"}]}
{"text": ",患者2014年上半年无明显诱因出现大便带鲜血,量少,伴大便次数增加至8-10次/天,稀烂,偶有里急后重,2014年11他也前出现间歇性脐周隐痛,大便后可缓解。无恶心、发热等不适。到外院对症处理,便血症状无明显缓解。2015-1-9,外院肠镜检查提示:距肛门17-19cm乙状结肠肿物,肠镜能通过。活检病理提示高分化腺癌。后至我院就诊,完善检查后于2015年1月22日全麻上行腹腔镜上dixon术,术程顺利,,术后病理结果回报:(乙状结肠大体)镜检为肠中分化腺癌,浸润至肠壁浆膜上层,未见明确脉管内癌栓及神经束侵犯。(中央淋巴结)1枚,未见癌。(中间淋巴结)2枚,未见癌。(肠旁淋巴结)6枚,未见癌。(系膜根部淋巴结)1枚,未见癌。,分期为:pt3n0m0叒iia期。,免疫组化:mlh1(+),msh2(+),msh6(+),pms2(+)。于2015-03-23开始至今行希罗达7程口服化疗顺利,化疗后未出现明显副反应。现患者为进一步诊治入院遵主诊教授意见行本周期化疗。目前患者一般情况可,无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,手术至今体重约上降15kg。", "mention_data": [{"mention": "脐周", "label": "解剖部位", "offset": "68"}, {"mention": "高分化腺癌", "label": "疾病和诊断", "offset": "155"}, {"mention": "腹腔镜上dixon术", "label": "手术", "offset": "188"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "215"}, {"mention": "肠中分化腺癌", "label": "疾病和诊断", "offset": "225"}, {"mention": "肠", "label": "解剖部位", "offset": "235"}, {"mention": "中央淋巴结", "label": "解剖部位", "offset": "259"}, {"mention": "中间淋巴结", "label": "解剖部位", "offset": "273"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "287"}, {"mention": "系膜根部淋巴结", "label": "解剖部位", "offset": "301"}, {"mention": "希罗达", "label": "药物", "offset": "388"}, {"mention": "骶部", "label": "解剖部位", "offset": "460"}]}
{"text": "患者因胃mt于2010年1月14日在我科行腹腔镜根治性全胃切除术,术后病理示:(全胃)平坦型低分化腺癌,侵及全层及周围脂肪组织,呈弥漫浸润性生长,侵及神经束,部分脉管可见癌栓,双切缘未见肿瘤累及.叒检出小弯淋巴结13枚,其中9枚见癌转移;叒检出大弯淋巴结3枚,均可见癌转移;叒检出幽门下淋巴结2枚,均未见癌转移;叒检出幽门上淋巴结13枚,均见癌转移;叒另送14组淋巴结2枚,均可见癌转移;叒另送切缘未见癌累及。患者术少量多餐,偶有腹泻,无发热、恶心、呕吐等。已行2次化疗,现为化疗收住入院。", "mention_data": [{"mention": "胃mt", "label": "疾病和诊断", "offset": "3"}, {"mention": "腹腔镜根治性全胃切除术", "label": "手术", "offset": "21"}, {"mention": "(全胃)平坦型低分化腺癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "101"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "122"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "140"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "腹泻", "label": "症状", "offset": "215"}]}
{"text": ",患者近1月前(2016-02-23)前因“胃癌”于我院行胃癌姑息性切除术(远端胃大部切除+毕i式吻合),,术中探查见:肿瘤位于胃窦小弯侧,大小约5*4*3cm,侵透浆膜并侵及胰腺,胃周可见多组肿大淋巴结,其中7、8、9组淋巴结融合成团,并与胰腺浸润。,术后常规病理示:(胃)低分化腺癌,局灶伴印戒细胞癌分化,弥漫浸润型,肿瘤切面积5.5*0.8cm,侵及胃壁深肌层。双端切缘、吻合器切缘及网膜组织未查见癌。大弯侧淋巴结11枚,其中3枚(3/11)查见转移;第7、8组淋巴结9枚,其中1枚(1/9)查见转移;小弯侧淋巴结8枚,均未查见转移(0/8)。,免疫组化:ck(+)、her-2(2+)、syn(-)、e-cad(+)。术后给予消炎、营养支持治疗,病情好转后出院。现患者无恶心、呕吐,无腹痛、腹胀,半流质饮食,二便正常。现为求进一步治疗,门诊以“胃癌术后”收入院。自下次出院来,神志清,精神可,饮食可,体重较前无明显改变。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "胃癌姑息性切除术(远端胃大部切除+毕i式吻合)", "label": "手术", "offset": "29"}, {"mention": "胃窦小弯", "label": "解剖部位", "offset": "64"}, {"mention": "胰腺", "label": "解剖部位", "offset": "88"}, {"mention": "胃", "label": "解剖部位", "offset": "91"}, {"mention": "7、8、9组淋巴结", "label": "解剖部位", "offset": "105"}, {"mention": "胰腺", "label": "解剖部位", "offset": "121"}, {"mention": "(胃)低分化腺癌", "label": "疾病和诊断", "offset": "135"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "147"}, {"mention": "胃壁深肌层", "label": "解剖部位", "offset": "178"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "204"}, {"mention": "第7、8组淋巴结", "label": "解剖部位", "offset": "229"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "254"}, {"mention": "腹痛", "label": "症状", "offset": "346"}, {"mention": "腹胀", "label": "症状", "offset": "349"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "376"}]}
{"text": ",缘于入院前1月余于我院诊为直肠癌,于2016.01.12在全麻上行腹腔镜上直肠癌根治术dixon,,术中见:上腹部粘连,腹腔内无明显出血,无明显腹水,盆腔、腹壁、大网膜、肝脏未见明显转移结节,腹腔位于直肠下段,大小约3*2.5cm,可疑侵及浆膜层。术后病理(201601067),:(直肠),:肠隆起型绒毛状-管状腺癌ii级,局灶性浸润深肌层(&gt;1/2肌层),并见淋巴管内癌栓。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9个(经本组下级医师复核淋巴结),另送(肠系膜上动脉根部)淋巴结1个,均未见癌转移。,免疫组化染色结果:ki67(60%阳性),p53(+++),p170(+++),5-fu(++),mlh1(+++),msh2(+++),pms2(+++),msh-6(+++)。dna错配修复的mmr蛋白(pms2、msh6、mlh1和msh2)免疫组化染色提示本例肿瘤微卫星稳定(mss)。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲出院。于2016.01.30行“奥沙利铂(乐沙定)150mgivgttd1+卡培他滨片(希罗达)1000mgpobidd1-14”方案化疗,辅以保胃、保肝、止吐等治疗,未见明显化疗副反应。今为行第2次化疗再次就诊我院,门诊拟“直肠癌术后化疗”收住入院。自下次出院以来,。", "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dixon", "label": "手术", "offset": "34"}, {"mention": "上腹部", "label": "解剖部位", "offset": "55"}, {"mention": "腹腔", "label": "解剖部位", "offset": "61"}, {"mention": "腹水", "label": "症状", "offset": "73"}, {"mention": "盆腔", "label": "解剖部位", "offset": "76"}, {"mention": "腹", "label": "解剖部位", "offset": "79"}, {"mention": "肝脏", "label": "解剖部位", "offset": "86"}, {"mention": "腹腔", "label": "解剖部位", "offset": "97"}, {"mention": "直肠下段", "label": "解剖部位", "offset": "101"}, {"mention": "直肠", "label": "解剖部位", "offset": "143"}, {"mention": "肠隆起型绒毛状-管状腺癌ii级", "label": "疾病和诊断", "offset": "148"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "223"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "247"}, {"mention": "5-fu", "label": "药物", "offset": "311"}, {"mention": "奥沙利铂", "label": "药物", "offset": "462"}, {"mention": "乐沙定", "label": "药物", "offset": "467"}, {"mention": "卡培他滨片", "label": "药物", "offset": "484"}, {"mention": "希罗达", "label": "药物", "offset": "490"}, {"mention": "胃", "label": "解剖部位", "offset": "519"}, {"mention": "肝", "label": "解剖部位", "offset": "522"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "559"}]}
{"text": ",缘于4月前因反复进食阻塞3个月就诊于我院,完善术前准备后,于20160106行胸腹腔镜联合全胸段食管切除+食管-胃底右颈部吻合+右甲状腺结节切除术。手术顺利,术后恢复良好后出院,,术后病理示:(食管及胃底)食管多中心性蕈伞型鳞状细胞癌ii级,侵及外膜层,侵犯神经及脉管组织,手术标本下、上切端及另送(最下切端)均未见癌浸润。找到食管周淋巴结0/2个,胃周淋巴结0/5个,及另送(右喉返喉返神经旁)淋巴结0/16个,(左喉返喉返神经神经旁)淋巴结0/5个,(颈部右喉返喉返神经旁)淋巴结1/1个,(隆突上)淋巴结0/2个,(上段食管旁)淋巴结0/5个,(贲门旁)淋巴结0/4个见癌转移。,免疫组化:肿瘤细胞示ki67(60%阳性),ck(h)(+),p63(+),p53(个别细胞阳性),p170(++),gstπ(-),egfr(++)。排除化疗禁忌症后于2016-02-03,2016-02-28,2016-03-22以“顺铂40mgd1-3,紫杉醇210mgd2”方案行3周期次化疗,辅以保肝,护胃,提高免疫力等处理,未见明显化疗副反应。现为求第4次化疗,就诊我科,拟“食管癌术后”入我科。下次出院至今无胸闷、憋气;无胸背痛;无腹痛、腹胀;无呕血、黑便;偶有返酸。饮食睡眠较好。大小便正常。体重无明显变化。", "mention_data": [{"mention": "胸腹腔镜联合全胸段食管切除+食管-胃底右颈部吻合+右甲状腺结节切除术", "label": "手术", "offset": "40"}, {"mention": "(食管及胃底)食管多中心性蕈伞型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "97"}, {"mention": "食管周淋巴结", "label": "解剖部位", "offset": "165"}, {"mention": "胃周淋巴结", "label": "解剖部位", "offset": "176"}, {"mention": "(右喉返喉返神经旁)淋巴结", "label": "解剖部位", "offset": "189"}, {"mention": "(左喉返喉返神经神经旁)淋巴结", "label": "解剖部位", "offset": "208"}, {"mention": "(颈部右喉返喉返神经旁)淋巴结", "label": "解剖部位", "offset": "228"}, {"mention": "(隆突上)淋巴结", "label": "解剖部位", "offset": "248"}, {"mention": "(上段食管旁)淋巴结", "label": "解剖部位", "offset": "261"}, {"mention": "(贲门旁)淋巴结", "label": "解剖部位", "offset": "276"}, {"mention": "顺铂", "label": "药物", "offset": "413"}, {"mention": "紫杉醇", "label": "药物", "offset": "424"}, {"mention": "肝", "label": "解剖部位", "offset": "448"}, {"mention": "胃", "label": "解剖部位", "offset": "451"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "488"}, {"mention": "胸闷", "label": "症状", "offset": "505"}, {"mention": "胸背痛", "label": "症状", "offset": "512"}, {"mention": "腹痛", "label": "症状", "offset": "517"}, {"mention": "腹胀", "label": "症状", "offset": "520"}]}
{"text": ",缘于入院前1月于我院诊为胃癌,于2013-11-29在全麻上行根治性远端胃大部切除术,,术中见:腹腔内无明显腹水,盆腔、腹壁、大网膜无转移结节,肝脏质地大小正常,未及明显转移结节。胃腔扩张明显,胃壁水肿增厚,肿瘤位于幽门管大弯侧偏前壁,活动度可,侵出浆膜层,未侵犯胰腺,周围可及肿大淋巴结。术后病理示(201337693)(远端胃),:胃窦溃疡型管状腺癌ii-iii级,少部分为低粘附性癌(主要为印戒细胞癌),脉管内见癌栓,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。找到大弯侧淋巴结0/1个,小弯侧淋巴结4/6个,幽门下淋巴结4/6个,幽门上淋巴结4/7个另送(胃右动脉根部)淋巴结1/9个,见癌转移。找到小弯侧癌结节1个,幽门下癌结节1个,幽门上癌结节1个,另送(第14v组淋巴结)镜上为脉管、脂肪、纤维结缔组织。,免疫组化结果:ki67(75%阳性),p53(+++),p170(-),gstπ(+),egfr(-),5-fu(++),her-2(-)。术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。此次为化疗就诊我院,门诊拟胃癌术后收入院。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": "胃癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "根治性远端胃大部切除术", "label": "手术", "offset": "32"}, {"mention": "腹腔", "label": "解剖部位", "offset": "49"}, {"mention": "腹水", "label": "症状", "offset": "55"}, {"mention": "盆腔", "label": "解剖部位", "offset": "58"}, {"mention": "腹", "label": "解剖部位", "offset": "61"}, {"mention": "肝脏", "label": "解剖部位", "offset": "73"}, {"mention": "胃腔", "label": "解剖部位", "offset": "91"}, {"mention": "胃壁", "label": "解剖部位", "offset": "98"}, {"mention": "幽门管大弯", "label": "解剖部位", "offset": "109"}, {"mention": "胰腺", "label": "解剖部位", "offset": "133"}, {"mention": "胃", "label": "解剖部位", "offset": "165"}, {"mention": "胃窦溃疡型管状腺癌ii-iii级,少部分为低粘附性癌(主要为印戒细胞癌)", "label": "疾病和诊断", "offset": "169"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "247"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "258"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "269"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "280"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "292"}, {"mention": "小弯", "label": "解剖部位", "offset": "315"}, {"mention": "幽门", "label": "解剖部位", "offset": "324"}, {"mention": "幽门", "label": "解剖部位", "offset": "333"}, {"mention": "第14v组淋巴结", "label": "解剖部位", "offset": "345"}, {"mention": "5-fu", "label": "药物", "offset": "423"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "483"}, {"mention": "腹痛", "label": "症状", "offset": "508"}, {"mention": "腹胀", "label": "症状", "offset": "511"}]}
{"text": "患者于2014年05月因“子宫内膜癌”于******健院行“腹腔镜上广泛切除术+两附件切除术+盆腔ln及腹主动脉旁淋巴结清扫术”术后病理为“子宫内膜样腺鳞癌ii级伴鳞状生化”。2014年5月至7月行tc方案化疗3程。2015年11月复查ct提示“盆腔以及两侧髂血管旁多发肿大淋巴结,考虑m”。2015年12月pet/ct示“两髂及两闭孔多个淋巴结代谢活跃,考虑m”。遂至我院就诊,当时因患者拒绝化疗未及时治疗。现患者诉阴道口瘙痒严重,里急后重感,于2016-03-07给予tc(进口)方案化疗1程。今再次来我院就诊。患者发病以来,精神一般,饮食睡眠不佳,大小便不正常:里急后重感,体重有减轻。", "mention_data": [{"mention": "子宫内膜癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜上广泛切除术+两附件切除术+盆腔ln及腹主动脉旁淋巴结清扫术", "label": "手术", "offset": "30"}, {"mention": "子宫内膜样腺鳞癌ii级伴鳞状生化", "label": "疾病和诊断", "offset": "70"}, {"mention": "ct", "label": "影像检查", "offset": "118"}, {"mention": "盆腔", "label": "解剖部位", "offset": "123"}, {"mention": "两侧髂", "label": "解剖部位", "offset": "127"}, {"mention": "pet/ct", "label": "影像检查", "offset": "154"}, {"mention": "两髂", "label": "解剖部位", "offset": "162"}, {"mention": "两闭孔", "label": "解剖部位", "offset": "165"}, {"mention": "阴道口", "label": "解剖部位", "offset": "209"}]}
{"text": ",患者约于7年前因“结肠癌”于2009-09-08日在全麻上行左半结肠切除术。手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好。,术后病理:(7282.2009)结肠腺癌(中低度分化),浸润溃疡型,面积4*3cm,侵达浆膜脂肪组织。累及阑尾浆膜面。双端切线未查见癌。呈一站(1/22)个淋巴结癌转移。术后给予患者化疗6周期,,方案为:奥沙利铂200mg叒d1(1-3期)奥沙利铂150mg叒d1(4-6期),亚叶酸钙0.3g+替加氟1.0g叒d2-d6。现患者腹胀,食欲差,就诊于我院门诊。叒叒叒叒患者院外就诊期间,神志清,精神可,大、小便正常,体重未见明显变化。门诊以“左半结肠切除术后7年余”收入我院。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "31"}, {"mention": "结肠腺癌(中低度分化)", "label": "疾病和诊断", "offset": "84"}, {"mention": "阑尾", "label": "解剖部位", "offset": "121"}, {"mention": "一站(1/22)个淋巴结", "label": "解剖部位", "offset": "137"}, {"mention": "奥沙利铂", "label": "药物", "offset": "170"}, {"mention": "奥沙利铂", "label": "药物", "offset": "188"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "207"}, {"mention": "替加氟", "label": "药物", "offset": "216"}, {"mention": "腹胀", "label": "症状", "offset": "233"}, {"mention": "左半结肠切除术后", "label": "疾病和诊断", "offset": "289"}]}
{"text": ",缘于4月前因“下腹部闷痛不适”腹部ct提示肝占位,进一步于我院行“腹腔镜上右肝肿物切除术+胆囊切除术”。,术后病理报告示:1.(右肝脏肿物),:肝脏原发性中分化肝细胞-胆管细胞混合型癌,伴坏死,侵及肝被膜及周边肝组织。癌周肝脏组织,肝细胞水肿变性,汇管区小胆管增生,伴中量慢性炎症细胞浸润。2(胆囊),:慢性胆囊炎。,免疫组化:ck7(-),ck20(+++),villin(+++),cdx-2(-),ck19(+++),ca19-9(-),glypican-3(+),cea(-),ki67(70%),ttf-1(-),nse(-),sy(-),pas(灶性区域少量阳性),ab染色(-)。术后患者无不适。无畏寒、寒战、发热,无恶心、呕吐、纳差,无皮肤黄、眼黄、尿黄。无腹痛、腹胀、腹泻,无返酸,嗳气。定期我院门诊随访,评估病情稳定。今为复查来我院,门诊拟“肝癌术后”收入院。自发病以来,食欲正常,睡眠、精神可,体重无明显上降,大、小便正常。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "8"}, {"mention": "腹部ct", "label": "影像检查", "offset": "16"}, {"mention": "肝", "label": "解剖部位", "offset": "22"}, {"mention": "腹腔镜上右肝肿物切除术+胆囊切除术", "label": "手术", "offset": "34"}, {"mention": "右肝脏", "label": "解剖部位", "offset": "65"}, {"mention": "肝脏原发性中分化肝细胞-胆管细胞混合型癌", "label": "疾病和诊断", "offset": "73"}, {"mention": "肝", "label": "解剖部位", "offset": "100"}, {"mention": "肝", "label": "解剖部位", "offset": "106"}, {"mention": "肝脏", "label": "解剖部位", "offset": "112"}, {"mention": "肝", "label": "解剖部位", "offset": "117"}, {"mention": "汇管区小胆管", "label": "解剖部位", "offset": "125"}, {"mention": "胆囊", "label": "解剖部位", "offset": "148"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "153"}, {"mention": "腹痛", "label": "症状", "offset": "338"}, {"mention": "腹胀", "label": "症状", "offset": "341"}, {"mention": "腹泻", "label": "症状", "offset": "344"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "382"}]}
{"text": "患者于2011.8.3在全麻上行剖腹探查+肠减压+根治性左半结肠切除术,术后恢复可,病理类型为结肠溃疡型中分化管状腺癌,浸及肠壁全层,脉管内见癌栓。双切端及阑尾均未见癌累及。肠壁下淋巴结未见癌转移(0/12),另送(系膜)组织未见癌转移,分期(t4n0m0)叒。术后已行6次folfox方案全身化疗,化疗期间患者无恶心、呕吐、腹泻等不适,化疗过程顺利,本次为术后复查入院。\\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,体重无明显变化。", "mention_data": [{"mention": "剖腹探查+肠减压+根治性左半结肠切除术", "label": "手术", "offset": "16"}, {"mention": "结肠溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "47"}, {"mention": "阑尾", "label": "解剖部位", "offset": "78"}, {"mention": "肠壁下淋巴结", "label": "解剖部位", "offset": "87"}, {"mention": "腹泻", "label": "症状", "offset": "163"}]}
{"text": ",入院前3个月余于我院诊为胃癌,于2015年04月06日在全麻上行“腔镜上根治性全胃切除术+食管空肠roux-y吻合术(d2)+脾切除术”。术后病理(201512223),:(全胃),:食管胃交界溃疡型管状腺癌ii-iii级,侵及浆膜层,累及神经。手术标本下、上切端及另送(下切端)均未见癌浸润。找到贲门周淋巴结1/3个,小弯淋巴结1/11个,大弯淋巴结1/1个,幽门上0/5个,另送(第7组)淋巴结0/1个,(第8组)淋巴结0/1个,(第9组)淋巴结1/4个,(第10组)淋巴结1/3个,(第11组)淋巴结1/2个,(第15组)淋巴结0/1个,见癌转移。幽门下淋巴结及另送(第12组淋巴结)未查见淋巴结。另送脾脏组织,未见癌浸润。术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。于2015.05.04、2015.06.23、2015.06.13行“奥沙利铂200mgivgttd1+替吉奥60mgpobidd1-14”方案化疗3次,辅予保胃、制酸、止吐、补液等,无明显药物毒性反应。今为术后第4次辅助化疗,门诊以“胃贲门管状腺癌(pt4an2m0iiib期)术后”收入院。自出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腔镜上根治性全胃切除术+食管空肠roux-y吻合术(d2)+脾切除术", "label": "手术", "offset": "34"}, {"mention": "胃", "label": "解剖部位", "offset": "89"}, {"mention": "食管胃交界溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "93"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "150"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "161"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "172"}, {"mention": "幽门", "label": "解剖部位", "offset": "182"}, {"mention": "(第7组)淋巴结", "label": "解剖部位", "offset": "192"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "205"}, {"mention": "(第9组)淋巴结", "label": "解剖部位", "offset": "218"}, {"mention": "(第10组)淋巴结", "label": "解剖部位", "offset": "231"}, {"mention": "(第11组)淋巴结", "label": "解剖部位", "offset": "245"}, {"mention": "(第15组)淋巴结", "label": "解剖部位", "offset": "259"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "278"}, {"mention": "脾脏", "label": "解剖部位", "offset": "305"}, {"mention": "奥沙利铂", "label": "药物", "offset": "378"}, {"mention": "替吉奥", "label": "药物", "offset": "395"}, {"mention": "胃", "label": "解剖部位", "offset": "423"}, {"mention": "胃贲门管状腺癌(pt4an2m0iiib期)", "label": "疾病和诊断", "offset": "461"}, {"mention": "腹痛", "label": "症状", "offset": "502"}, {"mention": "腹胀", "label": "症状", "offset": "505"}]}
{"text": ",缘于入院前2月余前于我院确诊为“直肠癌”,2015.07.11日行腹腔镜上直肠部分切除术,术后予以制酸,抗炎,护胃等对症处理,术后病理示(201525467),:,:(直肠),:肠隆起型管状腺癌ii级,伴坏死,侵及外膜层,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13个均未见癌转移。(mm20151216),:该病例未检测到kras基因12、13号密码子热点突变。该病例未检测到braf基因v600e突变,术后于2015.07.29、2015.08.25予以“卡培他滨1500mgpobidd1-d14+奥沙利铂200mgd1ivgtt”方案化疗,期间辅以保胃,保肝止呕吐等对症处理。此次为行第3周期化疗再次就诊我院,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": "17"}, {"mention": "腹腔镜上直肠部分切除术", "label": "手术", "offset": "34"}, {"mention": "胃", "label": "解剖部位", "offset": "57"}, {"mention": "直肠", "label": "解剖部位", "offset": "85"}, {"mention": "肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "90"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "142"}, {"mention": "卡培他滨", "label": "药物", "offset": "246"}, {"mention": "奥沙利铂", "label": "药物", "offset": "268"}, {"mention": "胃", "label": "解剖部位", "offset": "295"}, {"mention": "肝", "label": "解剖部位", "offset": "298"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "328"}, {"mention": "腹痛", "label": "症状", "offset": "354"}, {"mention": "腹胀", "label": "症状", "offset": "357"}]}
{"text": ",其于1月前因结肠占位性病变于2013.06.13下午在全麻上行遂行结肠癌根治术+放射性粒子置入术,术中冰冻提示乙状结肠腺癌,侵及肠壁深肌层,双切缘阴性。手术顺利,,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,并于2013.06.24治愈出院。出院后食欲较好,体重增加约6kg,未诉特殊不适,今患者为行第1次全身静脉化疗入院。\\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": "结肠", "label": "解剖部位", "offset": "7"}, {"mention": "结肠癌根治术+放射性粒子置入术", "label": "手术", "offset": "34"}, {"mention": "乙状结肠腺癌", "label": "疾病和诊断", "offset": "56"}, {"mention": "肠", "label": "解剖部位", "offset": "65"}, {"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": "90"}, {"mention": "肠", "label": "解剖部位", "offset": "110"}, {"mention": "胃", "label": "解剖部位", "offset": "271"}]}
{"text": ",缘于5月余前因“直肠癌”就诊我院,于2016.06.29行“腔镜上直肠根治术(dixon手术)”,探查腹腔内无明显出血,无明显腹水,无明显粘连,无明显腹腔肿瘤种植转移,肿瘤位于腹膜返折下7cm,侵出前壁浆膜层,未形成肠梗阻,近端无扩张,周围少许肿大淋巴结。术顺,术后予预防感染、制酸、补液、营养支持等治疗,,术后病理示:(直肠)大肠溃疡型管状腺癌ii级,侵出外膜层,可见脉管内癌栓,未见明确神经侵犯。,病理:手术标本双切端及另送(下切端)、(上切端)均未见癌浸润,另送(上切端)灶性腺下皮呈低级别下皮内瘤变。找到肠周淋巴结1/24个,及另送(肠系膜上动脉根部)淋巴结0/1个,见癌转移。,免疫组化:ki67(60%+),p53(+++),ck7(-),ck20(+++),cea(++)。术后恢复可,无恶心、呕吐、腹痛、腹胀、发热、畏寒等不适。术后于2016.07.26、2016.08.17、2016.09.12、2016.10.08、2016.10.30、2016.11.21予以“奥沙利铂150mgivgttd1+卡培他滨1500mgbidd1-d14”方案化疗,为行上一周期化疗,就诊我院,门诊拟直肠癌术后化疗收治入院。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": "9"}, {"mention": "腔镜上直肠根治术(dixon手术)", "label": "手术", "offset": "31"}, {"mention": "腹腔", "label": "解剖部位", "offset": "52"}, {"mention": "腹水", "label": "症状", "offset": "64"}, {"mention": "腹腔", "label": "解剖部位", "offset": "76"}, {"mention": "腹", "label": "解剖部位", "offset": "89"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "109"}, {"mention": "(直肠)大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "161"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "257"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "271"}, {"mention": "腹痛", "label": "症状", "offset": "358"}, {"mention": "腹胀", "label": "症状", "offset": "361"}, {"mention": "奥沙利铂", "label": "药物", "offset": "444"}, {"mention": "卡培他滨", "label": "药物", "offset": "461"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "503"}, {"mention": "腹痛", "label": "症状", "offset": "532"}, {"mention": "腹胀", "label": "症状", "offset": "535"}]}
{"text": ",患者因直肠癌于2014年12月05日行直肠前切除术,,术后病理:直肠(切除),:溃疡型中分化腺癌,肿物最大径6cm;侵及周围脂肪组织及浆膜上层;可见脉管癌栓;叒淋巴结可见癌转移(19/24);叒-叒环周切缘、(近端)及(远端)均未见癌;另送肠管未见癌;叒,肿瘤病理分期:pt3n2b。现为行术后辅助化疗入院,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": "直肠癌", "label": "疾病和诊断", "offset": "4"}, {"mention": "直肠前切除术", "label": "手术", "offset": "20"}, {"mention": "直肠", "label": "解剖部位", "offset": "33"}, {"mention": "溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "41"}, {"mention": "肠", "label": "解剖部位", "offset": "121"}]}
{"text": "患者1月余前于我院诊断为“乙状结肠肿物,恶性待排”完善术前检查,排除手术禁忌症后于2013-01-31行乙状结肠切除术,术后恢复可,有排气排便,术后病理示:乙状结肠中分化腺癌,浸润至肠壁粘膜上层,未见神经束侵犯,未见脉管内癌栓,中间淋巴结转移一枚(1/7),中央淋巴结(0/5),肠旁淋巴结(0/2),患者术后于2013年2月26日开始行xelox方案化疗5程,过程顺利,现为进一步治疗入住本科。患者自下次出院以来,食欲、睡眠及精神良好,小便正常,体力无上降,体重无明显上降。", "mention_data": [{"mention": "乙状结肠肿物,恶性待排", "label": "疾病和诊断", "offset": "13"}, {"mention": "乙状结肠切除术", "label": "手术", "offset": "52"}, {"mention": "乙状结肠中分化腺癌", "label": "疾病和诊断", "offset": "78"}, {"mention": "肠", "label": "解剖部位", "offset": "91"}, {"mention": "中间淋巴结", "label": "解剖部位", "offset": "114"}, {"mention": "中央淋巴结", "label": "解剖部位", "offset": "129"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "140"}]}
{"text": ",缘于入院前4个月(2015-09-14),于我院查肠镜:升结肠肠乳头状管状腺癌ii级,遂于3个月前(2015年09月21日)全麻上行腹腔镜上左半结肠根治性切除术,,术中探查见:探查腹腔内无明显出血,无明显腹水,升结肠可见肿瘤,近端几达回盲部,远端近肝曲,明显侵出浆膜层,与周围组织稍明显粘连,未形成梗阻,近端肠管无扩张,周围及肠系膜根部可见数个肿大淋巴结;术后病理(n201503896),:左半结肠回盲部隆起型管状腺癌ii级,伴神经内分泌分化及坏死,侵及浆膜层,脉管内见癌栓,手术标本结肠切端、回肠切端及另送(下切端)、(上切端)均未见癌浸润。找到回肠周淋巴结2个,结肠周淋巴结29个均未见癌转移。术顺,术后分别于2015-10-22、2015-11-13、2015-12-05、2015-12-27行“奥沙利铂d1200mgivgtt+希罗达d2-141500mgpobid”方案化疗4次,化疗过程顺利,今为进一步化疗,门诊拟“结肠癌术后”收住入院。自下次出院以来,精神、食欲、睡眠尚可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "升结肠肠乳头状管状腺癌ii级", "label": "疾病和诊断", "offset": "29"}, {"mention": "腹腔镜上左半结肠根治性切除术", "label": "手术", "offset": "67"}, {"mention": "腹腔", "label": "解剖部位", "offset": "91"}, {"mention": "腹水", "label": "症状", "offset": "103"}, {"mention": "升结肠", "label": "解剖部位", "offset": "106"}, {"mention": "回盲部", "label": "解剖部位", "offset": "118"}, {"mention": "肝曲", "label": "解剖部位", "offset": "125"}, {"mention": "近端肠管", "label": "解剖部位", "offset": "153"}, {"mention": "肠", "label": "解剖部位", "offset": "164"}, {"mention": "左半结肠回盲部隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "197"}, {"mention": "结肠", "label": "解剖部位", "offset": "244"}, {"mention": "回肠", "label": "解剖部位", "offset": "249"}, {"mention": "回肠周淋巴结", "label": "解剖部位", "offset": "276"}, {"mention": "结肠周淋巴结", "label": "解剖部位", "offset": "285"}, {"mention": "奥沙利铂", "label": "药物", "offset": "354"}, {"mention": "希罗达", "label": "药物", "offset": "371"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "417"}]}
{"text": ",患者2015.11.27因“卵巢癌”于我院全麻上行经腹子宫+两侧附件切除+大网膜切除+部分肠壁转移病灶切除术。,术中探查见:盆腹腔可见淡黄色腹水,量约500ml,子宫前位,萎缩,前壁可见菜花样结节,右侧卵巢约3*2cm大小,表面不规则菜花状突起,质脆,左侧卵巢约2*2cm大小,形态似右侧卵巢,大网膜挛缩呈厚饼状,质硬,与肠管形成致密粘连,结肠、升结肠、横结肠、直肠前前壁肿物与肠管致密粘连,直肠前壁、结肠肝区及肝上极均可见不规则菜花样突起,腹盆壁、小肠表面可见大量结节样突起,质脆,易脱落。,术中切除右侧附件送快速病理回示:(右附件)图像符合高级别浆液性乳头状癌。,术后常规病理示:(两附件区)卵巢高级别浆液性乳头状癌,两侧输卵管查见癌,肿瘤自子宫浆膜面侵达宫壁肌层,送检(肠壁转移灶)和大网膜组织均查见癌;右、左宫宫旁组织未查见癌。(子宫)萎缩状态子宫内膜。慢性宫颈炎。,免疫组化:er(80%+),pr(-),wt-1(+),p53(+)。术后恢复可,根据术后病理,于2015.12.06、2015.12.30、2016.01.21、2016.2.14、2016.3.10给予顺铂120mg+多帕菲120mg方案化疗5疗程,现患者欲行第6次化疗来院就诊,门诊以“卵巢癌术后化疗”收入院,患者者饮食睡眠正常,大小便无异常,体重无明显增减。", "mention_data": [{"mention": "卵巢癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "经腹子宫+两侧附件切除+大网膜切除+部分肠壁转移病灶切除术", "label": "手术", "offset": "26"}, {"mention": "盆腹腔", "label": "解剖部位", "offset": "63"}, {"mention": "腹水", "label": "症状", "offset": "71"}, {"mention": "子宫前位", "label": "症状", "offset": "82"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "100"}, {"mention": "左侧卵巢", "label": "解剖部位", "offset": "127"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "143"}, {"mention": "肠", "label": "解剖部位", "offset": "162"}, {"mention": "结肠", "label": "解剖部位", "offset": "171"}, {"mention": "升结肠", "label": "解剖部位", "offset": "174"}, {"mention": "横结肠", "label": "解剖部位", "offset": "178"}, {"mention": "直肠前前壁", "label": "解剖部位", "offset": "182"}, {"mention": "肠", "label": "解剖部位", "offset": "190"}, {"mention": "直肠前壁", "label": "解剖部位", "offset": "197"}, {"mention": "结肠肝区", "label": "解剖部位", "offset": "202"}, {"mention": "肝上极", "label": "解剖部位", "offset": "207"}, {"mention": "腹盆壁", "label": "解剖部位", "offset": "222"}, {"mention": "小肠", "label": "解剖部位", "offset": "226"}, {"mention": "右侧附件", "label": "解剖部位", "offset": "252"}, {"mention": "右附件", "label": "解剖部位", "offset": "265"}, {"mention": "高级别浆液性乳头状癌", "label": "疾病和诊断", "offset": "273"}, {"mention": "(两附件区)卵巢高级别浆液性乳头状癌", "label": "疾病和诊断", "offset": "293"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "312"}, {"mention": "子宫浆膜", "label": "解剖部位", "offset": "324"}, {"mention": "宫壁肌层", "label": "解剖部位", "offset": "331"}, {"mention": "肠", "label": "解剖部位", "offset": "339"}, {"mention": "右、左宫宫旁组织", "label": "解剖部位", "offset": "356"}, {"mention": "子宫", "label": "解剖部位", "offset": "370"}, {"mention": "子宫内膜", "label": "解剖部位", "offset": "377"}, {"mention": "慢性宫颈炎", "label": "疾病和诊断", "offset": "382"}, {"mention": "顺铂", "label": "药物", "offset": "492"}, {"mention": "多帕菲", "label": "药物", "offset": "500"}, {"mention": "卵巢癌术后", "label": "疾病和诊断", "offset": "535"}]}
{"text": "患者入院3-月前,因直肠癌于2015-11-17行腹腔镜上直肠癌根治术,术后病检:(直肠)印戒细胞癌,侵及肠周脂肪组织,两侧切缘未见癌累及,肠周围脂肪组织中淋巴结见癌转移(9/13)。术后恢复良好,好转后出院。院外未诉特殊不适,无畏寒、发热、腹痛、腹泻、腹胀、恶心、呕吐等不适。于2015-12-19遵医嘱行第一次化疗,方案为folfox4(奥沙利铂+5-氟尿嘧啶),化疗期间无化疗副反应,复查血常规未见明显异常后出院。院外无特殊不适,无腹痛、腹胀、腹泻、恶心、呕吐等不适。今为行第二次化疗就诊我院,门诊以“直肠癌术后,拟行第二次化疗”收入我科住院治疗。。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹腔镜上直肠癌根治术", "label": "手术", "offset": "25"}, {"mention": "(直肠)印戒细胞癌", "label": "疾病和诊断", "offset": "41"}, {"mention": "肠", "label": "解剖部位", "offset": "53"}, {"mention": "肠", "label": "解剖部位", "offset": "70"}, {"mention": "腹痛", "label": "症状", "offset": "121"}, {"mention": "腹泻", "label": "症状", "offset": "124"}, {"mention": "腹胀", "label": "症状", "offset": "127"}, {"mention": "奥沙利铂", "label": "药物", "offset": "171"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "178"}, {"mention": "腹痛", "label": "症状", "offset": "219"}, {"mention": "腹胀", "label": "症状", "offset": "222"}, {"mention": "腹泻", "label": "症状", "offset": "225"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "254"}]}
{"text": ",缘于入院前23天因“反复中下腹闷痛2周于外院”,行胃镜检查示:糜烂性胃炎(ii级),胃角溃疡性质待定。病理(s201439361),:(胃角,活检)粘膜腺癌。遂于2014.11.28于我院行在全麻上行根治性远端胃大部切除术(毕ii式,d2)。术顺,术后恢复良好,,术后病理:(201441656),:(远端胃大部),:胃角溃疡癌变,为管状腺癌ii级,其中部分为黏液腺癌,侵及肌层,间质纤维母细胞增生,并多量嗜酸性粒细胞浸浸润,未见明确的脉管内癌栓及神经侵犯,标本双切端均未见癌浸润。找到小弯侧淋巴结12个,大弯侧淋巴结1个,幽门上淋巴结3个,及另送(幽门下)淋巴结1个,(肝总动脉旁)淋巴结3个,(腹腔动脉旁)淋巴结4个,均未见癌转移。,免疫组化:肿瘤细胞示ki67(70%+),p53(+),p170(++),gstπ(+),egfr(+),5-fu(+),her-2(-)。下次出院至今,进食流质膳食可,无恶心、呕吐,无腹痛、腹胀、腹泻,无呕血、黑便等不适,今为进一步复查就诊我院,门诊拟“胃癌术后”收住入院。自发病以来,患者精神、饮食、睡眠可,大小便正常,体重无明显增减。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "13"}, {"mention": "糜烂性胃炎(ii级)", "label": "疾病和诊断", "offset": "32"}, {"mention": "胃角", "label": "解剖部位", "offset": "43"}, {"mention": "胃角", "label": "解剖部位", "offset": "69"}, {"mention": "粘膜腺癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "根治性远端胃大部切除术(毕ii式,d2)", "label": "手术", "offset": "101"}, {"mention": "远端胃大部", "label": "解剖部位", "offset": "152"}, {"mention": "胃角", "label": "解剖部位", "offset": "160"}, {"mention": "黏液腺癌", "label": "疾病和诊断", "offset": "181"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "244"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "254"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "263"}, {"mention": "(幽门下)淋巴结", "label": "解剖部位", "offset": "275"}, {"mention": "(肝总动脉旁)淋巴结", "label": "解剖部位", "offset": "286"}, {"mention": "(腹腔动脉旁)淋巴结", "label": "解剖部位", "offset": "299"}, {"mention": "腹痛", "label": "症状", "offset": "413"}, {"mention": "腹胀", "label": "症状", "offset": "416"}, {"mention": "腹泻", "label": "症状", "offset": "419"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "448"}]}
{"text": ",缘于入院1年半前无明显诱因感下腹闷痛不适,就诊我院查腹部ct示“,胰头占位:考虑假乳头状”,于2013.04.11在全麻上行“胰头肿物切除、肝肿物切除、小肠憩室切除、胰肠吻合、空肠造瘘术”,术顺,术后病理(201310448),示:肝转移胰腺实性-假乳头状瘤。1.(胰头肿物)胰腺实性-假乳头状瘤,伴出血坏死,侵犯胰腺被摸。另送(肝结节)组织见肿瘤细胞浸润;2.(小肠)送检小肠组织,小肠全层见异位胰腺组织;3.(肝结节)肝转移性胰腺实性-假乳头状瘤。,免疫组化结果:ck(pan)(++),ki67(6%),sy(+),cd56(+++),cga(-),cd10(++),cd99(-),e-cadherin(-)。今为复查就诊我院,门诊拟胰腺实性假乳头状瘤伴肝转移术后收入院。自发病以来,精神、饮食、睡眠尚可,大小便正常,体重无明显改变。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "15"}, {"mention": "腹部ct", "label": "影像检查", "offset": "27"}, {"mention": "胰头", "label": "解剖部位", "offset": "34"}, {"mention": "乳头", "label": "解剖部位", "offset": "42"}, {"mention": "胰头肿物切除、肝肿物切除、小肠憩室切除、胰肠吻合、空肠造瘘术", "label": "手术", "offset": "64"}, {"mention": "肝转移胰腺实性-假乳头状瘤", "label": "疾病和诊断", "offset": "117"}, {"mention": "(胰头肿物)胰腺实性-假乳头状瘤", "label": "疾病和诊断", "offset": "133"}, {"mention": "胰腺", "label": "解剖部位", "offset": "158"}, {"mention": "肝结节", "label": "症状", "offset": "166"}, {"mention": "小肠", "label": "解剖部位", "offset": "183"}, {"mention": "小肠", "label": "解剖部位", "offset": "188"}, {"mention": "小肠", "label": "解剖部位", "offset": "193"}, {"mention": "胰腺", "label": "解剖部位", "offset": "200"}, {"mention": "(肝结节)肝转移性胰腺实性-假乳头状瘤", "label": "疾病和诊断", "offset": "207"}, {"mention": "胰腺实性假乳头状瘤", "label": "疾病和诊断", "offset": "322"}, {"mention": "肝转移术后", "label": "疾病和诊断", "offset": "332"}]}
{"text": ",患者2016.1.26因“腹水原因待查”于我院在全麻上行经腹腹膜外子宫切除+两附件切除+全盆腹膜切除+盆腔淋巴结清扫+腹主动脉旁淋巴结清扫+阑尾切除术,,术后常规病理回示:(两侧卵巢)高级别浆液性乳头状癌,,右侧肿瘤体积:12*9.5*5cm,左侧肿瘤体积11*10*5.5cm,肿瘤侵及两侧输卵管壁外膜,右侧输卵管粘膜查见癌。子宫浆膜面、腹膜、大网膜、阑尾浆膜面均查见癌。右髂血管淋巴结4枚,其中1枚(1/4)查见转移;左髂血骨淋巴结3枚,其中1枚(1/3)查见转移;右闭孔淋巴结2枚,其中1枚(1/2)查见转移,左闭孔淋巴结3枚,其中2枚(2/3)查见转移;上腔静脉旁淋巴结1枚,其内(1/1)查见转移;髂前淋巴结1枚,其内(1/1)查见转移;腹主动脉旁淋巴结3枚,均(3/3)查见转移;“腹膜外肿瘤”内查见淋巴结1枚,其内(1/1)查见转移癌。另送“右髂血管淋巴结”3枚及“左髂血管淋巴结”1枚,均未查见转移。,免疫组化:ck(+)、ck7(+)、p53(+)、ki67阳性率约60%,er(约30%,+)、pr(约90%,++)、wt-1(+)、cr局灶(+)。(,病理号:03351.16)。今日拟行卵巢癌术后第一次化疗入院,门诊以“卵巢癌术后化疗叒”收入院。患者自下次出院后,食欲欠佳,睡眠好,大小便正常,无明显恶心、呕吐,体重无明显变化。", "mention_data": [{"mention": "腹水原因待查", "label": "疾病和诊断", "offset": "14"}, {"mention": "经腹腹膜外子宫切除+两附件切除+全盆腹膜切除+盆腔淋巴结清扫+腹主动脉旁淋巴结清扫+阑尾切除术", "label": "手术", "offset": "29"}, {"mention": "(两侧卵巢)高级别浆液性乳头状癌", "label": "疾病和诊断", "offset": "87"}, {"mention": "两侧输卵管壁外膜", "label": "解剖部位", "offset": "145"}, {"mention": "右侧输卵管粘膜", "label": "解剖部位", "offset": "154"}, {"mention": "子宫浆膜", "label": "解剖部位", "offset": "165"}, {"mention": "腹", "label": "解剖部位", "offset": "171"}, {"mention": "阑尾浆膜面", "label": "解剖部位", "offset": "178"}, {"mention": "右髂血管淋巴结", "label": "解剖部位", "offset": "188"}, {"mention": "左髂血骨淋巴结", "label": "解剖部位", "offset": "212"}, {"mention": "右闭孔淋巴结", "label": "解剖部位", "offset": "236"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "259"}, {"mention": "上腔静脉旁淋巴结", "label": "解剖部位", "offset": "282"}, {"mention": "髂前淋巴结", "label": "解剖部位", "offset": "305"}, {"mention": "腹主动脉旁淋巴结", "label": "解剖部位", "offset": "325"}, {"mention": "腹膜外肿瘤", "label": "疾病和诊断", "offset": "348"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "357"}, {"mention": "右髂血管淋巴结", "label": "解剖部位", "offset": "379"}, {"mention": "左髂血管淋巴结", "label": "解剖部位", "offset": "391"}, {"mention": "卵巢癌术后", "label": "疾病和诊断", "offset": "506"}, {"mention": "卵巢癌术后", "label": "疾病和诊断", "offset": "523"}]}
{"text": ",患者半个月前无明显诱因出现阵发性腹部绞痛,脐周为主,伴腹胀,恶心、呕吐,停止排气排便。无头晕、乏力、发热等不适。就诊外院,予胃肠减压、抑制消化液、抗炎、补液、灌肠等治疗,现腹痛缓解,今晨排不成形大便1次。2014-12-01外院肠镜检查提示结肠肝曲肿物,肠镜不能通过,活检病理提示腺癌。2014-12-16日于全麻上行“左半结肠切除+开腹恶性肿瘤特殊治疗”术,,术后病理:1(结肠大体)镜检为中分化腺癌,部分为黏液腺癌,浸润至浆膜上层,可见脉管内癌栓,未见神经束侵犯;阑尾粘膜慢性炎;另送检16枚淋巴结均未见癌。2(近切缘)未见癌。3(远切缘)未见癌。4(中央淋巴结)镜上为脂肪结缔组织,未见癌。5(中间淋巴结)镜上为脂肪结缔组织,未见癌。6(肠旁淋巴结)4枚,未见癌。7(阑尾)镜上为粘膜慢性炎。,免疫组化:er(-),ercc1(+),pms2(+),mlh1(+),msh2(+),msh6(+),ki67(70%+)。叒术后恢复顺利。起病以来无发热,睡眠一般,小便正常,体重上降8kg。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "17"}, {"mention": "脐周", "label": "解剖部位", "offset": "22"}, {"mention": "腹胀", "label": "症状", "offset": "28"}, {"mention": "头晕", "label": "症状", "offset": "45"}, {"mention": "胃肠", "label": "解剖部位", "offset": "63"}, {"mention": "肠", "label": "解剖部位", "offset": "81"}, {"mention": "腹痛", "label": "症状", "offset": "87"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "121"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "141"}, {"mention": "左半结肠切除+开腹恶性肿瘤特殊治疗", "label": "手术", "offset": "161"}, {"mention": "(结肠大体)镜检为中分化腺癌", "label": "疾病和诊断", "offset": "188"}, {"mention": "黏液腺癌", "label": "疾病和诊断", "offset": "206"}, {"mention": "阑尾粘膜慢性炎", "label": "疾病和诊断", "offset": "235"}, {"mention": "中央淋巴结", "label": "解剖部位", "offset": "279"}, {"mention": "中间淋巴结", "label": "解剖部位", "offset": "301"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "323"}, {"mention": "阑尾", "label": "解剖部位", "offset": "338"}, {"mention": "粘膜慢性炎", "label": "疾病和诊断", "offset": "344"}]}
{"text": ",患者因“胃恶性肿瘤”于2017-07-04在全麻上予行胃空肠吻合+空肠侧侧吻合术;,术中探查见:腹腔内少量腹水,肝脏正常,肿瘤位于胃窦小弯侧为主,远端绕胃近1周,已累及十二指肠第1段,约8*7*5cm大小,造成幽门梗阻,近端胃腔明显扩张,胃壁水肿增厚。肿瘤已侵出浆膜,与胰腺被膜及胰头浸润粘连,第3、4、5、6、7、8及12组淋巴结明显肿大,其中5、8、12组淋巴结与胰腺融合成团,探查发现原发肿瘤无法切除。术中遂行胃空肠吻合+空肠侧侧吻合术。病理学检查回示(201715397),:(大网膜)纤维脂肪组织内浸润的低分化腺癌。叒胃型粘膜充血、水肿,轻度急慢性发炎。结合患者病情及肿瘤病理与分期继续予行术后化疗相关辅助治疗指征存在;依情于2017-7-19开始予行术后首周期辅助化疗,同时辅以镇吐、升血、免疫调节等对症支持治疗(化疗期间患者总体耐受性良好),患者现为求进一步治疗来院就诊,门诊依情以“胃恶性肿瘤术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;近期无明显体重变化。", "mention_data": [{"mention": "胃恶性肿瘤", "label": "疾病和诊断", "offset": "5"}, {"mention": "胃空肠吻合+空肠侧侧吻合术", "label": "手术", "offset": "28"}, {"mention": "腹腔", "label": "解剖部位", "offset": "49"}, {"mention": "腹水", "label": "症状", "offset": "54"}, {"mention": "肝脏", "label": "解剖部位", "offset": "57"}, {"mention": "胃窦小弯侧", "label": "解剖部位", "offset": "66"}, {"mention": "胃", "label": "解剖部位", "offset": "77"}, {"mention": "十二指肠第1段", "label": "解剖部位", "offset": "85"}, {"mention": "幽门梗阻", "label": "疾病和诊断", "offset": "106"}, {"mention": "近端胃腔", "label": "解剖部位", "offset": "111"}, {"mention": "胃", "label": "解剖部位", "offset": "120"}, {"mention": "胰腺被膜", "label": "解剖部位", "offset": "136"}, {"mention": "胰头", "label": "解剖部位", "offset": "141"}, {"mention": "5、8、12组淋巴结", "label": "解剖部位", "offset": "174"}, {"mention": "胰腺", "label": "解剖部位", "offset": "185"}, {"mention": "胃空肠吻合+空肠侧侧吻合术", "label": "手术", "offset": "209"}, {"mention": "(大网膜)纤维脂肪组织内浸润的低分化腺癌", "label": "疾病和诊断", "offset": "243"}, {"mention": "胃型粘膜", "label": "解剖部位", "offset": "265"}, {"mention": "胃恶性肿瘤术后", "label": "疾病和诊断", "offset": "400"}]}
{"text": ",缘于入院前7月余因“食管胃交界区癌”于我科行根治性全胃及食管上段切除+食管-空肠roux-en-y吻合术(2015-09-17),术后病理(201533702)示“(食管上段+全胃),:食管胃交界浸润型管状腺癌ii级,侵及浆膜层,侵犯神经,手术标本下、上切端均未见癌浸润,找到大弯淋巴结6个,幽门下淋巴结3个,幽门上淋巴结6个均未见癌转移。,201534030:1.(下切端),:送检切端组织未见癌浸润。2.找到(贲门旁)淋巴结4/9个,(胃右动脉旁)淋巴结1/12个,(腹腔动脉旁)淋巴结0/1个,(肝总动脉旁)淋巴结0/1个,见癌转移”。术后恢复良好,并按“安素泰210mgd1+顺铂40mgd1-3”方案行术后辅助化疗1周期(2015-10-21),因第1次化疗消化道反应剧烈,故于2015.11.13、2015.12.05、2015-12-28以“洛铂50mg静滴d1+紫杉醇注射液(安素泰)210mg静滴d1”方案行第2、3、4周期化疗,辅以保肝、止吐、制酸、营养支持等治疗,疗程较为顺利。今为行术后复查再诊我院,门诊拟“食管胃交界区癌术后化疗后”收住入院。近来,精神、饮食、睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "根治性全胃及食管上段切除+食管-空肠roux-en-y吻合术", "label": "手术", "offset": "23"}, {"mention": "(食管上段+全胃),:食管胃交界浸润型管状腺癌ii级", "label": "疾病和诊断", "offset": "83"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "139"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "(贲门旁)淋巴结", "label": "解剖部位", "offset": "207"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "220"}, {"mention": "(腹腔动脉旁)淋巴结", "label": "解剖部位", "offset": "236"}, {"mention": "安素泰", "label": "药物", "offset": "282"}, {"mention": "顺铂", "label": "药物", "offset": "293"}, {"mention": "消化道", "label": "解剖部位", "offset": "335"}, {"mention": "洛铂", "label": "药物", "offset": "379"}, {"mention": "安素泰", "label": "药物", "offset": "397"}, {"mention": "肝", "label": "解剖部位", "offset": "428"}]}
{"text": ",缘于1月前因进行性吞咽困难1个月就诊于我院,完善术前准备后于2014-08-07在全麻上行经左胸三切口食管下段癌切除+食管胃底左颈部吻合+左侧第5肋骨固定术,,术中所见:全胸腔少量粘连,探查肿瘤位于食管下段,奇静脉弓上,局部增厚长约6cm,累及外膜,局部侵出外膜,下段食管旁及纵隔多发淋巴结肿大。切除全胸段食管,并将胃底引线送至颈部,行食管-胃底手工吻合。术顺,术后安返病房,术后给予预防感染、营养支持、制酸、雾化祛痰等治疗,患者恢复良好。术后病理(201425956),:(食管),:食管溃疡型鳞状细胞癌ii级,侵出外膜层,手术标本双切端及另送(上切端)均未见癌转移。找到食管周淋巴结1/2个,另送(上切端)周淋巴结0/2个,(颈部食管旁)淋巴结0/2个,(下段食管旁)淋巴结0/1个,(胸部入口处)淋巴结1/1个,(胃右动脉旁)淋巴结0/5个,(肝总动脉旁)淋巴结0/2个见癌转移。今为入院化疗,遂就诊我院。门诊拟“食管癌术后”收入我科,下次出院至今患者无胸闷、憋气;无胸背痛;无腹痛、腹胀;无呕血、黑便;偶有返酸。饮食睡眠较好。大小便正常,体重无明显变化。", "mention_data": [{"mention": "经左胸三切口食管下段癌切除+食管胃底左颈部吻合+左侧第5肋骨固定术", "label": "手术", "offset": "46"}, {"mention": "胸腔", "label": "解剖部位", "offset": "87"}, {"mention": "食管下段", "label": "解剖部位", "offset": "100"}, {"mention": "奇静脉弓", "label": "解剖部位", "offset": "105"}, {"mention": "下段食管", "label": "解剖部位", "offset": "133"}, {"mention": "纵隔", "label": "解剖部位", "offset": "139"}, {"mention": "胸段食管", "label": "解剖部位", "offset": "152"}, {"mention": "胃底", "label": "解剖部位", "offset": "159"}, {"mention": "颈部", "label": "解剖部位", "offset": "165"}, {"mention": "食管-胃底手工吻合", "label": "手术", "offset": "169"}, {"mention": "(食管),:食管溃疡型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "238"}, {"mention": "食管周淋巴结", "label": "解剖部位", "offset": "288"}, {"mention": "(颈部食管旁)淋巴结", "label": "解剖部位", "offset": "315"}, {"mention": "(下段食管旁)淋巴结", "label": "解剖部位", "offset": "330"}, {"mention": "(胸部入口处)淋巴结", "label": "解剖部位", "offset": "345"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "360"}, {"mention": "(肝总动脉旁)淋巴结", "label": "解剖部位", "offset": "375"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "411"}, {"mention": "胸闷", "label": "症状", "offset": "431"}, {"mention": "胸背痛", "label": "症状", "offset": "438"}, {"mention": "腹痛", "label": "症状", "offset": "443"}, {"mention": "腹胀", "label": "症状", "offset": "446"}]}
{"text": ",缘于3月前(2014-11-18)因食管癌于我院行“胸腹腔镜联合翻身三切口全胸段食管切除+食管-胃底右颈吻合+空肠造瘘术”。手术顺利,术后恢复良好后出院。术后病理(201441090),:(食管及胃底),:食管隆起型鳞状细胞癌ii级,伴坏死,癌组织侵犯脉管及神经组织,脉管内见癌栓,侵及外膜层。手术标本下切端、上切端均未见癌浸润。找到食管周淋巴结1/2个,胃周淋巴结0/2个,及另送(下段食管旁)淋巴结0/1个,(上段食管旁)淋巴结0/3个,(左喉返旁神经)淋巴结0/4个,(第7组)淋巴结0/8个,(第8组)淋巴结0/2个见癌转移。,免疫组化染色结果:ki67(40%阳性),p53(++),p170(-),gstπ(++),egfr(+++)。于2014.12.24、2015.01.14按“洛铂50mgd1+氟尿嘧啶4000mgciv44h”方案行术后2周期化疗,并辅予保肝、止呕、制酸、增强免疫等辅助治疗。现为求化疗求诊我科,门诊拟“食管上段鳞癌术后”收入院。术后至今偶有返酸,进食半流质尚顺畅。饮食睡眠较好。大小便正常。体重无明显变化。", "mention_data": [{"mention": "(食管及胃底),:食管隆起型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "95"}, {"mention": "(第7组)淋巴结", "label": "解剖部位", "offset": "238"}, {"mention": "(第8组)淋巴结", "label": "解剖部位", "offset": "251"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "358"}, {"mention": "肝", "label": "解剖部位", "offset": "390"}]}
{"text": "1+月前,患者因“大便习惯改变、便血”于我院胃肠外科住院治疗,行钡剂灌肠提示乙状结肠占位性病变;上腹部ct提示乙状结肠壁占位性病变;于2015.08.21在全麻上行腹腔镜上腹腔探查术+中转开腹+术中冰冻活检+乙状结肠癌根治术+小肠部分切除术、肠吻合术,术中见肿瘤位于右上腹,与右侧盆壁粘连紧密,同时与部分小肠、膀胱壁粘连,腹腔少量清亮腹水,肿瘤与盆壁粘连分离困难,升结肠、横结肠未见异常,于乙状结肠靠近降结肠处扪及一直径约5x4cm质硬肿块,肿瘤浸透肠壁,与右侧盆壁广泛粘连且紧密,与右侧膀胱壁部分粘连,小肠距回盲部约180cm处与肿瘤粘连,乙状结肠系膜间及根部可扪及肿大淋巴结。手术过程顺利,术后伤口出现感染,予以头孢替安抗感染等治疗,伤口逐渐愈合。术后病检:乙状结肠低分化腺癌侵及浆膜层,肠系膜淋巴结见癌转移(5/6),送检右侧盆壁见癌累及;于2015.09.04予以folfox4(奥沙利铂150mg叒d1+亚叶酸钙0.3g叒d1~2+5-fu叒0.625g叒d1~2静脉注射+5-fu叒1g叒d1~2静脉滴入)、2015.09.23予以folfox4(奥沙利铂150mg叒d1+亚叶酸钙0.3g叒d1~2+5-fu叒0.7g叒d1~2静脉注射+5-fu叒1g叒d1~2静脉滴入)化疗,化疗过程中无恶心、呕吐等不适,化疗结束后复查血常规未见骨髓抑制;患者今为行进一步治疗于我科住院治疗。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "22"}, {"mention": "肠", "label": "解剖部位", "offset": "23"}, {"mention": "肠", "label": "解剖部位", "offset": "35"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "38"}, {"mention": "上腹部ct", "label": "影像检查", "offset": "48"}, {"mention": "乙状结肠壁", "label": "解剖部位", "offset": "55"}, {"mention": "腹腔镜上腹腔探查术+中转开腹+术中冰冻活检+乙状结肠癌根治术+小肠部分切除术、肠吻合术", "label": "手术", "offset": "82"}, {"mention": "右上腹", "label": "解剖部位", "offset": "133"}, {"mention": "右侧盆壁", "label": "解剖部位", "offset": "138"}, {"mention": "小肠", "label": "解剖部位", "offset": "152"}, {"mention": "膀胱壁", "label": "解剖部位", "offset": "155"}, {"mention": "腹", "label": "解剖部位", "offset": "161"}, {"mention": "腹水", "label": "症状", "offset": "167"}, {"mention": "盆壁", "label": "解剖部位", "offset": "173"}, {"mention": "升结肠", "label": "解剖部位", "offset": "182"}, {"mention": "横结肠", "label": "解剖部位", "offset": "186"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "195"}, {"mention": "降结肠", "label": "解剖部位", "offset": "201"}, {"mention": "肠", "label": "解剖部位", "offset": "225"}, {"mention": "右侧盆壁", "label": "解剖部位", "offset": "229"}, {"mention": "右侧膀胱壁", "label": "解剖部位", "offset": "242"}, {"mention": "小肠", "label": "解剖部位", "offset": "252"}, {"mention": "回盲部", "label": "解剖部位", "offset": "255"}, {"mention": "乙状结肠系膜间及根部", "label": "解剖部位", "offset": "271"}, {"mention": "头孢替安", "label": "药物", "offset": "308"}, {"mention": "乙状结肠低分化腺癌", "label": "疾病和诊断", "offset": "331"}, {"mention": "肠系膜淋巴结", "label": "解剖部位", "offset": "346"}, {"mention": "右侧盆壁", "label": "解剖部位", "offset": "364"}, {"mention": "奥沙利铂", "label": "药物", "offset": "394"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "407"}, {"mention": "5-fu", "label": "药物", "offset": "421"}, {"mention": "5-fu", "label": "药物", "offset": "442"}, {"mention": "奥沙利铂", "label": "药物", "offset": "480"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "493"}, {"mention": "5-fu", "label": "药物", "offset": "507"}, {"mention": "5-fu", "label": "药物", "offset": "526"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "573"}]}
{"text": ",患者2015-03无明显诱因出现大便带暗红血,量少,伴大便次数增加至2-3次/天,稀烂,偶有里急后重,外院肠镜检查提示升结肠近肝曲环形肿物,肠镜能通过,活检病理提示腺癌;升结肠、乙状结肠、直肠多发小息肉。后就诊我院,完善检查后诊断为升结肠癌,未见远处转移,遂于2015-07-06全麻上行“左半结肠切除术”,,术后病理结果回示:1(近切缘)未见癌。2(远切缘)未见癌。3(根部淋巴结)5枚,未见癌。4(中间组淋巴结)4枚,未见癌。5(肠旁淋巴结)15枚,未见癌;另见癌结节一枚。6(肠大体)镜检为中至低分化腺癌,浸润至肠壁浆膜上层,未见明确脉管及神经束侵犯;阑尾及小肠粘膜慢性炎。,免疫组化:msh2(+),msh6(+),pms2(+),mlh1(+),er(-),ercc1(+),ki67(60%+)。诊断分期pt3n1cm0iiib期。患者术后恢复良好,现为进一步治疗收入我科。自下次出院以来,胃纳可,睡眠一般,小便正常,体重无上降。", "mention_data": [{"mention": "升结肠近肝曲", "label": "解剖部位", "offset": "60"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "83"}, {"mention": "升结肠", "label": "解剖部位", "offset": "86"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "90"}, {"mention": "直肠", "label": "解剖部位", "offset": "95"}, {"mention": "升结肠癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "146"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "218"}, {"mention": "肠", "label": "解剖部位", "offset": "242"}, {"mention": "中至低分化腺癌", "label": "疾病和诊断", "offset": "249"}, {"mention": "肠", "label": "解剖部位", "offset": "260"}, {"mention": "阑尾及小肠粘膜慢性炎", "label": "疾病和诊断", "offset": "280"}, {"mention": "胃", "label": "解剖部位", "offset": "402"}]}
{"text": "患者1月余前因“大便带血3月余。”入院,诊断为“直肠癌”,患者入院后完善相关辅助检查,排除禁忌后于2016-01-17日在全麻上行腹腔镜直肠癌根治术,术后病理检查结果:(直肠)中分化腺癌,溃疡型,肿物切面积3.5*0.5cm,侵透外膜达周围脂肪组织,手术下上切线及环周切线均未查见癌,肠周淋巴结13枚中均未查见转移。现患者为求化疗治疗再次就诊于我科。患者近日来饮食、睡眠可,小便正常,大便同下,体重正常。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "24"}, {"mention": "腹腔镜直肠癌根治术", "label": "手术", "offset": "65"}, {"mention": "(直肠)中分化腺癌,溃疡型", "label": "疾病和诊断", "offset": "84"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "142"}]}
{"text": ",患者2013年8月16日于我科全麻上行乙状结肠癌根治术,,术后病理:进展期乙状结肠癌,溃疡浸润型,中分化腺癌,,浸润深度:透浆膜,,生长方式:浸润型生长,肌间神经节侵犯(+),ii级,断端无癌,淋巴结未见癌转移(0/19枚),dukes,分期:b2期。,免疫组化结果:ki67>80%,p53>70%,cdx2叒>50%,ca199(+),nm23(+),mlh1>70%,msh2>70%,msh6>60%,,病理号:517。患者术后行腹腔化疗2次,xelox辅助化疗4次,无明显不良反应,今为求进一步辅助化疗收入我科。患者近日无发热,饮食睡眠可,小便正常,大便日一次,无腹泻,无便血,近来体重未见明显减轻。ecog,评分:1分。", "mention_data": [{"mention": "乙状结肠癌根治术", "label": "手术", "offset": "20"}, {"mention": "进展期乙状结肠癌,溃疡浸润型,中分化腺癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "腹", "label": "解剖部位", "offset": "220"}, {"mention": "腹泻", "label": "症状", "offset": "288"}]}
{"text": "患者1月余前因“嗳气、剑突上隐痛5月余。”于我院就诊后,完善辅助检查后于2015.04.29行“胃癌根治术(d2全胃+roux-en-y重建)”,术后病理提示:胃食管结合部腺癌ii型,pt3n3am0,iiib期。术后恢复可,无腹痛、腹胀、恶心、呕吐等不适。于2015.05.27行sox方案(奥沙利铂150mg叒ivdrip叒d1+s-1叒60mg叒po叒bid叒d1-14)化疗。现按主诊教授建议来我院住院化疗。患者起病以来,食欲可,睡眠、精神可,大小便无明显异常,体重无明显变化。", "mention_data": [{"mention": "剑突", "label": "解剖部位", "offset": "11"}, {"mention": "胃癌根治术(d2全胃+roux-en-y重建)", "label": "手术", "offset": "48"}, {"mention": "胃食管结合部腺癌ii型,pt3n3am0,iiib期", "label": "疾病和诊断", "offset": "80"}, {"mention": "腹痛", "label": "症状", "offset": "114"}, {"mention": "腹胀", "label": "症状", "offset": "117"}, {"mention": "奥沙利铂", "label": "药物", "offset": "147"}, {"mention": "s-1", "label": "药物", "offset": "167"}]}
{"text": "患者因“胃窦癌”于2015-7-8在我院全麻上行\\\"远端胃癌姑息切除癌姑息切除术\\\",术程顺利,术后病理提示胃窦癌(pt4an3bm1,iv期)。患者术后恢复可,于2015-8-12行sox(维康达40mg叒bid叒po叒d1-14+奥沙利铂叒150mg叒ivdrip叒q3w)方案一程,过程顺利,偶感疲乏,余无恶心、呕吐、发热等不适,今为行上程术后辅助化疗收入我科。自下次出院以来,患者精神、睡眠可,食欲可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "4"}, {"mention": "远端胃癌姑息切除癌姑息切除术", "label": "手术", "offset": "26"}, {"mention": "胃窦癌(pt4an3bm1,iv期)", "label": "疾病和诊断", "offset": "54"}, {"mention": "维康达", "label": "药物", "offset": "96"}, {"mention": "奥沙利铂", "label": "药物", "offset": "117"}]}
{"text": ",患者因“胃窦癌”入我院于2014-12-24在全麻上行\\\"(远端)胃癌根治术\\\",术程顺利,,术后病理回报:“(胃肿物大体)镜检为胃中至低分化腺癌,lauren,分型:肠型,浸润胃壁浆膜层,可见脉管内癌栓及神经束侵犯;网膜组织未见癌。淋巴结4/61枚见腺癌转移。(近、远切缘)未见癌。,免疫组化:vegf(+),her-2(1+)。pt4an2m0,iiib期。”患者术后恢复可,现为行术后辅助化疗来我院就诊,拟“胃窦癌术后”入我科。自下次出院以来,患者一般情况可,大小便正常,进食量一般,睡眠正常,体重无明显上降。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "(远端)胃癌根治术", "label": "手术", "offset": "30"}, {"mention": "胃", "label": "解剖部位", "offset": "57"}, {"mention": "胃中至低分化腺癌", "label": "疾病和诊断", "offset": "66"}, {"mention": "肠", "label": "解剖部位", "offset": "85"}, {"mention": "胃", "label": "解剖部位", "offset": "90"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "127"}, {"mention": "胃窦癌术后", "label": "疾病和诊断", "offset": "208"}]}
{"text": ",患者约于4个月前因“胃恶性肿瘤”在我院全麻上行姑息性胃大部切除术+毕ii式吻合,手术过程顺利,术后患者恢复好,切口愈合好,,术后病理:胃窦部低分化腺癌,局部呈粘液腺癌图像,浸润溃疡型,体积7.5*3.7*2.2cm,侵穿浆膜,累及底部切除面。双端切线未查见癌。呈三组(3/3个)、五组(2/4个)、六组(5/7个)淋巴结癌转移。四组(2个)淋巴结未查见癌。,免疫组化染色示:cerbb-2(1+)、syn(-)、ercc1弥漫(+)、β-tubulin-iii少量(+)、ts较多(+)、rrm1少量(+)、topoii少量(+)。根据患者病情具有化疗指征,于2014-08-06开始第一周期化疗,,方案为: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,同时给与升白细胞、护肝、止吐、免疫增强治疗,注意观察患者病情变化,给予升白、止吐等药物,患者化疗耐受可,无明显化疗副反应。", "mention_data": [{"mention": "胃恶性肿瘤", "label": "疾病和诊断", "offset": "11"}, {"mention": "姑息性胃大部切除术+毕ii式吻合", "label": "手术", "offset": "24"}, {"mention": "胃窦部低分化腺癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "奥沙利铂", "label": "药物", "offset": "305"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "318"}, {"mention": "替加氟", "label": "药物", "offset": "333"}, {"mention": "肝", "label": "解剖部位", "offset": "361"}]}
{"text": "缘于入院前3个月月于我院诊为“卵巢癌”,于2013-10-16在我科行“全麻上行盆腔粘连松解+阔韧带肿物切除术+全子宫切除术”,术后病理回报示:卵巢子宫内膜样腺癌i级,术后恢复良好,伤口愈合ii/甲。术后于2013-11-03及2013-11-27予“多西他赛70mg/m2ivgttd1+洛铂30mg/m2ivgttd1”方案化疗2次,化疗过程顺利,第2次化疗出现ii度骨髓抑制,予升白治疗后好转出院。2013-12-26予“紫杉醇240mgivgttd1+洛铂50mgivgttd1”方案第3次化疗,化疗过程顺利,化疗后出现ii度骨髓抑制,予升白治疗后好转出院。现化疗间期已满,患者无畏冷、发热,无恶心、呕吐,无腹痛、腹泻等不适,今为求进一步诊治,门诊拟“卵巢子宫内膜样腺癌(ii期,i级)术后”收入院。下次出院以来,精神、睡眠、饮食可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "卵巢癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "全麻上行盆腔粘连松解+阔韧带肿物切除术+全子宫切除术", "label": "手术", "offset": "36"}, {"mention": "卵巢子宫内膜样腺癌i级", "label": "疾病和诊断", "offset": "72"}, {"mention": "多西他赛", "label": "药物", "offset": "126"}, {"mention": "洛铂", "label": "药物", "offset": "145"}, {"mention": "ii度骨髓抑制", "label": "疾病和诊断", "offset": "183"}, {"mention": "紫杉醇", "label": "药物", "offset": "214"}, {"mention": "洛铂", "label": "药物", "offset": "230"}, {"mention": "ii度骨髓抑制", "label": "疾病和诊断", "offset": "264"}, {"mention": "腹痛", "label": "症状", "offset": "308"}, {"mention": "腹泻", "label": "症状", "offset": "311"}, {"mention": "卵巢子宫内膜样腺癌(ii期,i级)术后", "label": "疾病和诊断", "offset": "330"}]}
{"text": ",患者3月前“结肠癌”于2015-10-14叒在全麻上行姑息性乙状结肠癌切除+横结肠造瘘术,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:201517712(乙状结肠)粘液腺癌,浸润溃疡型,体积12*6*3cm,侵穿浆膜。叒双端切线未查见癌。叒肠壁一站(10个)淋巴结未查见癌。,免疫组化染色示癌组织:syn(-)、ts(-)、braf(-)、mlh1(+)、叒msh2(+)、msh6(+)、pms2(+)。根据患者病情具有化疗指征,于2015-10-27、2015-11-24、2015-12-20行化疗3次,,方案为:奥沙利铂150mg叒d1,亚叶酸钙0.3g+替加氟0.8g叒d2-d6,同时给与升白细胞、护肝、止吐、免疫增强治疗,为进一步治疗,门诊以“乙状结肠癌术后”收入院。患者自发病以来,精神、睡眠可,体重近2月上降5千克。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "姑息性乙状结肠癌切除+横结肠造瘘术", "label": "手术", "offset": "28"}, {"mention": "(乙状结肠)粘液腺癌,浸润溃疡型", "label": "疾病和诊断", "offset": "87"}, {"mention": "肠壁一站(10个)淋巴结", "label": "解剖部位", "offset": "131"}, {"mention": "奥沙利铂", "label": "药物", "offset": "271"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "284"}, {"mention": "替加氟", "label": "药物", "offset": "293"}, {"mention": "肝", "label": "解剖部位", "offset": "317"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "340"}]}
{"text": "患者因家族性结肠息肉病于2010-9-8在我院于全麻上行全结肠切除术+远端直肠息肉电切术,手术过程顺利,术后给予抗感染、营养支持及对症治疗,恢复好,好转出院。病理回示:结肠多发绒毛状管状腺瘤,部分腺体呈轻-中度不典型增生;双端切线未见明显病变;肠壁一站(19个)、二站(13个)、三站(69个);“结肠中动脉”(1个)淋巴结,呈反应性增生;慢性阑尾炎。叒叒叒院外期间患者坚持口服易蒙停等药物治疗,大便成型,约5-6次/日,定期入院复查并行肠镜检查及直肠息肉电切治疗。现患者为行复查及进一步诊疗再次来我院就诊,门诊以\\\"结肠全切除术后、肠息肉\\\"收入院。叒叒叒患者自下次出院后一般情况可,精神可,饮食、睡眠可,小便正常,体重无明显变化。", "mention_data": [{"mention": "结肠息肉", "label": "疾病和诊断", "offset": "6"}, {"mention": "全结肠切除术+远端直肠息肉电切术", "label": "手术", "offset": "28"}, {"mention": "结肠多发绒毛状管状腺瘤", "label": "疾病和诊断", "offset": "84"}, {"mention": "肠壁一站(19个)、二站(13个)、三站(69个);“结肠中动脉”(1个)淋巴结", "label": "解剖部位", "offset": "122"}, {"mention": "慢性阑尾炎", "label": "疾病和诊断", "offset": "170"}, {"mention": "易蒙停", "label": "药物", "offset": "189"}, {"mention": "直肠息肉电切", "label": "手术", "offset": "224"}, {"mention": "结肠全切除术后", "label": "疾病和诊断", "offset": "259"}, {"mention": "肠息肉", "label": "疾病和诊断", "offset": "267"}]}
{"text": ",患者2015.11.03在我院于全麻上行“经腹子宫切除+两附件切除+大网膜切除+肠壁转移瘤切除术”。2015.11.09,术后常规病理回示:(右附件)高级别浆液性乳头状癌,肿瘤体积约4*2.5*2cm。子宫内膜及肌层、宫颈、左附件及大网膜均未查见癌。另送“肠壁转移瘤”组织内查见癌。,免疫组化:er(约60%)pr(约10%)p53(+)wt-1(+),napsina(-),ki67阳性率约50%;分泌状态子宫内膜;慢性宫颈炎;左卵巢黄体囊肿。评估患者病情后,于2015.11.12、2015.12.12、2016.1.6给予紫杉醇(力朴素)270mg+卡铂(波贝)600mg方案静脉化疗3周期,并给予止吐、补液等对症治疗。化疗过程顺利,副反应轻,好转出院,现患者为行第4次化疗来我院就诊,门诊以“恶性肿瘤术后化疗”收入院。患者自发病以来,饮食及睡眠可,大小便正常,阴道无流血流液,体重无明显变化。", "mention_data": [{"mention": "子宫内膜", "label": "解剖部位", "offset": "205"}, {"mention": "慢性宫颈炎", "label": "疾病和诊断", "offset": "210"}, {"mention": "左卵巢黄体囊肿", "label": "疾病和诊断", "offset": "216"}, {"mention": "力朴素", "label": "药物", "offset": "269"}, {"mention": "卡铂", "label": "药物", "offset": "279"}]}
{"text": ",缘于入院前1月于我院诊为结肠癌,于2016年10月20日在全麻上行腹腔镜辅助上乙状结肠癌根治术。,手术经过如上:探查腹腔内无明显粘连,无明显出血,无明显腹水,未及种植结节,肝脏未见明显转移灶,乙状结肠上段可探及肿瘤,侵出浆膜层,活动度可,周围未及明显肿大淋巴结,术后予预防性抗感染、制酸、免疫调节及营养支持等治疗。术后恢复可,病理回报(,病理号:20163776),:(乙状结肠),:大肠溃疡型管状腺癌ii级,侵出外膜层,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1/17个,及另送(中间组)淋巴结0/6个、(肠系膜上动脉根部)淋巴结0/3个,见癌转移。此次为化疗再次就诊我院,门诊拟结肠癌术后化疗收入院。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": "结肠癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜辅助上乙状结肠癌根治术", "label": "手术", "offset": "34"}, {"mention": "腹", "label": "解剖部位", "offset": "59"}, {"mention": "腹水", "label": "症状", "offset": "77"}, {"mention": "肝脏", "label": "解剖部位", "offset": "87"}, {"mention": "乙状结肠上段", "label": "解剖部位", "offset": "97"}, {"mention": "(乙状结肠),:大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "185"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "242"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "269"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "307"}, {"mention": "腹痛", "label": "症状", "offset": "335"}, {"mention": "腹胀", "label": "症状", "offset": "338"}]}
{"text": ",缘于入院前16月于我院诊断为直肠癌,于2014年12月01日在全麻上行“腹腔镜上根治性直肠癌切除术+回肠造瘘术”,术中见腹腔内无明显出血,小肠与小肠多节段肠间粘连,盆腔少量黄色腹水,肿瘤位于腹膜返折下3cm,侵出浆膜,周围可探及多发肿大淋巴结,肿瘤左侧盆腔可疑种植结节。手术顺利。术后病理回报(201441985),:(直乙交界),:大肠溃疡型管状腺癌ii级,伴坏死,部分为筛状粉刺型,侵出浆膜层,癌组织侵犯脉管及神经组织,脉管内见癌栓;手术标本下切端、上切端及另送(下切端)、(上切端)均未见癌浸润。找到肠周淋巴结1/14个及另送(肠系膜上动脉根部)淋巴结0/4个见癌转移。(腹壁结节)送检纤维、脂肪组织中见腺癌组织浸润。于2015.01.21,2015.02.13,2015.03.25,2015.04.29行“奥沙利铂(齐沙)200mg静滴d1+希罗达1000mg口服bidd1-14”方案化疗,辅以增强免疫、保胃、营养等处理,化疗过程中无肝肾功能损害、骨髓抑制等不良反应。入院1月前无明显诱因出现肛门疼痛,呈阵发性隐痛,无腹痛、腹胀,无发热、寒战等,无便血、腹泻,今为进一步诊治再次入院。门诊拟“直肠癌术后化疗后(pt4an1m1iv期)”收入我院我科。下次出院后饮食、睡眠可,无腹痛、腹胀、发热,二便正常,体重较前无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "腹腔镜上根治性直肠癌切除术+回肠造瘘术", "label": "手术", "offset": "37"}, {"mention": "腹", "label": "解剖部位", "offset": "61"}, {"mention": "小肠", "label": "解剖部位", "offset": "70"}, {"mention": "小肠", "label": "解剖部位", "offset": "73"}, {"mention": "肠", "label": "解剖部位", "offset": "78"}, {"mention": "盆腔", "label": "解剖部位", "offset": "83"}, {"mention": "腹水", "label": "症状", "offset": "89"}, {"mention": "腹膜返折", "label": "解剖部位", "offset": "96"}, {"mention": "左侧盆腔", "label": "解剖部位", "offset": "125"}, {"mention": "(直乙交界),:大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "160"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "254"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "267"}, {"mention": "腹", "label": "解剖部位", "offset": "290"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "306"}, {"mention": "奥沙利铂", "label": "药物", "offset": "359"}, {"mention": "齐沙", "label": "药物", "offset": "364"}, {"mention": "希罗达", "label": "药物", "offset": "377"}, {"mention": "胃", "label": "解剖部位", "offset": "410"}, {"mention": "肝肾功能损害", "label": "疾病和诊断", "offset": "424"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "431"}, {"mention": "肛门疼痛", "label": "症状", "offset": "453"}, {"mention": "腹痛", "label": "症状", "offset": "466"}, {"mention": "腹胀", "label": "症状", "offset": "469"}, {"mention": "腹泻", "label": "症状", "offset": "484"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "503"}, {"mention": "腹痛", "label": "症状", "offset": "545"}, {"mention": "腹胀", "label": "症状", "offset": "548"}]}
{"text": ",患者近1个月前(2015-11-6)因“胃癌”于我科行胃癌根治术(毕i式吻合),手术过程顺利,,术后常规病理示:(胃)中分化腺癌伴粘液腺癌(后者约占15%),溃疡型,切面积4*1.0cm,侵透浆膜达周围脂肪组织。下上切线及吻合器切线均未查见癌。小弯侧淋巴结27枚,其中7枚查见转移癌(7/27);大弯侧淋巴结10枚(0/10)及网膜组织未查见转移癌。,免疫组化:ck(+),e-cad(+),her-2(2+)。40092.15,术后给予抗炎补液营养支持治疗,好转后出院,现为求化疗治疗,门诊以“胃癌术后化疗”收入院。患者自下次出院以来,饮食睡眠可,二便无明显异常,体重较下次入院无明显改变。高血压病史1年余,最高达150/90mmhg,未治疗。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "21"}, {"mention": "胃癌根治术(毕i式吻合)", "label": "手术", "offset": "28"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "123"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "149"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "249"}]}
{"text": ",患者3个月余前因“反复嗳气半年余,解黑便3周。”就诊我院,完善相关检查后诊断胃窦癌,排除手术禁忌症后于2015-09-06在全麻上行胃癌根治术(远端胃大切),术程顺利,术后预防感染支持对症等处理,恢复好。,术后病理示:中-低分化腺癌,lauren,分型:混合型,浸润至胃壁浆膜层,脉管内见癌栓,可见神经束侵犯,ln叒16/64(+);pt4n3m0,iiic期。出院后生活质量可,已于2015.10.8、2015-10-29、2015-11-25行sox方案(奥沙利铂叒150mg+替吉奥叒60mg叒bid)化疗,化疗期间无明显毒副反应,有恶心感,耐受度尚可。现为行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,体重无明显变化。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "胃癌根治术(远端胃大切)", "label": "手术", "offset": "67"}, {"mention": "中-低分化腺癌,lauren", "label": "疾病和诊断", "offset": "110"}, {"mention": "胃壁浆膜层", "label": "解剖部位", "offset": "135"}, {"mention": "奥沙利铂", "label": "药物", "offset": "231"}, {"mention": "替吉奥", "label": "药物", "offset": "242"}, {"mention": "胃癌综合治疗后", "label": "疾病和诊断", "offset": "299"}]}
{"text": ",入院前20+天,患者无明显原因出现大便干结,次数增多,平均每天3-4次,量少,不成形,伴大便中带血,伴肛门坠胀、里急后重,无腹胀、腹痛,无呕血、黑便,无头晕、头痛、发热等症状。遂于我院门诊就诊,,行乙状结肠镜并取活检提示:,电子乙状结肠镜:直肠新生物(性质?);,病理活检:&lt;直肠&gt;腺癌。以“直肠癌”收入我科。于2016-02-24日在全麻上行腹腔镜上直肠癌根治术(miles术式)。术中送病检(,病理号:1601483),:直肠中等分化腺癌侵及全层,远近切端均未见癌累及,肠系膜淋巴结未见癌转移(0/7)。术后予以抗感染,止血、抑酸护胃等对症支持治疗,术后恢复良好,造瘘口通畅,今日前来我院,拟行第一次化疗,故以“直肠癌术后第一次化疗”收入我科。", "mention_data": [{"mention": "肛门坠胀", "label": "症状", "offset": "52"}, {"mention": "腹胀", "label": "症状", "offset": "63"}, {"mention": "腹痛", "label": "症状", "offset": "66"}, {"mention": "头晕", "label": "症状", "offset": "77"}, {"mention": "头痛", "label": "症状", "offset": "80"}, {"mention": "直肠", "label": "解剖部位", "offset": "121"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "153"}, {"mention": "直肠癌根治术(miles术式)", "label": "手术", "offset": "183"}, {"mention": "直肠中等分化腺癌", "label": "疾病和诊断", "offset": "220"}, {"mention": "肠系膜淋巴结", "label": "解剖部位", "offset": "244"}, {"mention": "胃", "label": "解剖部位", "offset": "275"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "315"}]}
{"text": ",缘于入院前1月,我院诊为“胃癌,于2013年11月07日在全麻上行“腹腔镜上胃癌根治术”,手术顺利。,术后病理:(远端胃大部),:胃体小弯浸润型印戒细胞癌,侵及浆膜层,侵犯神经。手术标本下端、上端及另送(胃下端切口)均为浸润。找到小弯淋巴结1个吗,大弯淋巴结7个,幽门上淋巴结3个,及另送(第1组淋巴结1个),(第7组)淋巴结5个,(第8组)淋巴结1个,(第9组)淋巴结3个,(第12组)淋巴结1个均未见癌转移。,免疫组化:ki67(30%+),p53(个别细胞阳性),ck7(+++),ck20(-),villin(++++),cdx-2(++),cea(++),cd56(-),syn(-),cga(-),her-2(-),e-cadherin(+)。术后给予制酸、抑酶、提高免疫力、营养、补液等支持对症治疗,恢复良好,伤口愈合ii/甲。今为化疗再次入院。门诊拟“胃印戒细胞癌”收入院。下次出院以来精神、睡眠、饮食可,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": "腹腔镜上胃癌根治术", "label": "手术", "offset": "35"}, {"mention": "(远端胃大部),:胃体小弯浸润型印戒细胞癌", "label": "疾病和诊断", "offset": "57"}, {"mention": "胃", "label": "解剖部位", "offset": "103"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "116"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "125"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "胃印戒细胞癌", "label": "疾病和诊断", "offset": "385"}]}
{"text": ",缘于入院前1月余,于我院诊为结肠脾曲癌,于2016-04-11在全麻上行腹腔镜辅助右半结肠根治性切除术、胃部分切除术,,术中见:探查肿物位于结肠脾曲,大小约10x5x5cm,侵出肠管前壁浆膜层,与前腹膜明显粘连,侵犯胃大弯后壁,未侵及胰腺、脾脏、肾脏。术后病理示(右半结肠+部分胃壁),:结肠溃疡型中分化腺癌,大部分为筛状粉刺型腺癌,侵出浆膜层,未见肯定脉管及神经侵犯,侵及胃浆膜层及浆膜上层,手术标本近切端、远切端及另送(近切端)、(远切端)均未见癌浸润;找到肠周淋巴结31个,均未见癌转移。送检胃体粘膜,呈中度慢性浅表性胃炎改变,术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。于2015.05.06在我院按“奥沙利铂250mgd1+卡培他滨1750mgd1-14”方案化疗一周期。此次为化疗再次就诊我院,门诊拟结肠癌术后收入院。下次出院以来精神、睡眠、饮食可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "结肠脾曲癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "腹腔镜辅助右半结肠根治性切除术、胃部分切除术", "label": "手术", "offset": "37"}, {"mention": "结肠脾曲", "label": "解剖部位", "offset": "71"}, {"mention": "腹", "label": "解剖部位", "offset": "100"}, {"mention": "胃大弯后壁", "label": "解剖部位", "offset": "109"}, {"mention": "胰腺", "label": "解剖部位", "offset": "118"}, {"mention": "脾脏", "label": "解剖部位", "offset": "121"}, {"mention": "肾脏", "label": "解剖部位", "offset": "124"}, {"mention": "(右半结肠+部分胃壁),:结肠溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "132"}, {"mention": "筛状粉刺型腺癌", "label": "疾病和诊断", "offset": "160"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "232"}, {"mention": "胃体", "label": "解剖部位", "offset": "250"}, {"mention": "中度慢性浅表性胃炎", "label": "疾病和诊断", "offset": "256"}, {"mention": "奥沙利铂", "label": "药物", "offset": "313"}, {"mention": "卡培他滨", "label": "药物", "offset": "325"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "364"}]}
{"text": ",患者3月前主因“腹痛3月”入院,入院后完善相关检查,排除手术禁忌症,于2016.04.26在全麻上行胃癌根治术(全胃切除+叒roux-en-y重建),术程顺利,术后安返病房,术后经抗感染、抑酸、止血、化痰、静脉营养支持等治疗,,术后病理示:(胃大体)镜检为胃中至低分化腺癌,lauren,分型:混合型,浸润至胃壁浆膜层,并累及食管壁至外膜层;可见脉管内癌栓及神经束侵犯;网膜组织未见癌。远近切缘未见癌。15/31ln(+)。分期pt4an3mo,iiic期。叒现患者术后恢复良好,为术后行第7程xelox辅助化疗来我院就诊。起病以来,患者无头晕、头痛,无发热、咳嗽、咳痰、胸闷、胸痛,精神体力一般,食欲上降,睡眠一般,小便正常,体重较前上降2kg。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "9"}, {"mention": "胃癌根治术(全胃切除+叒roux-en-y重建)", "label": "手术", "offset": "51"}, {"mention": "(胃大体)镜检为胃中至低分化腺癌,lauren", "label": "疾病和诊断", "offset": "121"}, {"mention": "食管", "label": "解剖部位", "offset": "164"}, {"mention": "头晕", "label": "症状", "offset": "271"}, {"mention": "头痛", "label": "症状", "offset": "274"}, {"mention": "胸闷", "label": "症状", "offset": "287"}, {"mention": "胸痛", "label": "症状", "offset": "290"}]}
{"text": ",缘于入院前2+个月于我院诊为“宫颈腺癌”,于2013年11月27日于我院在全麻上行广泛全子宫切除+两附件切除术+盆腔淋巴结清扫术。,术中见:盆腔无腹水,子宫增大如孕2个月大,表面光滑,右侧卵巢一囊肿,大小约3*3cm,与子宫及盆底粘连,分离过程见巧克力样液体流产,两侧骶韧带增粗,子宫后壁见紫蓝色结节,直肠子宫陷凹变浅,左侧附件及右输卵管未见明显异常。术后病理回报(201337408),示:(全子宫+两附件)子宫颈内生浸润型中分化粘液腺癌(宫颈管亚型),侵犯肌层(浸润最深处深度约1.0cm),未侵及宫内膜组织,(右、左)宫旁组织及手术标本阴道残端未见癌浸润。盆腔淋巴结未见癌转移,宫体肌间多发性平滑肌瘤,宫内膜呈增生状态,两侧输卵管及卵巢未见癌转移。术后恢复良好,伤口愈合ii/甲。术后于2013.12.10及2014.1.8予pt方案“紫杉醇注射液(安素泰)210mgivgttd1+注射用洛铂43mgivgttd1”行第1,2次化疗。化疗后出现i度骨髓抑制,予特尔津升白治疗后出院。现患者无畏冷、发热,无腹痛、腹泻,无恶心、呕吐,无头晕、头痛等不适,遂就诊我院,门诊拟“宫颈腺癌(ib1期,ii级)术后”收入院。下次出院以来,精神、睡眠、饮食可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "宫颈腺癌", "label": "疾病和诊断", "offset": "16"}, {"mention": "广泛全子宫切除+两附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "42"}, {"mention": "盆腔", "label": "解剖部位", "offset": "71"}, {"mention": "腹水", "label": "症状", "offset": "74"}, {"mention": "子宫", "label": "解剖部位", "offset": "77"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "93"}, {"mention": "子宫", "label": "解剖部位", "offset": "111"}, {"mention": "盆底", "label": "解剖部位", "offset": "114"}, {"mention": "两侧骶韧带", "label": "解剖部位", "offset": "133"}, {"mention": "子宫后壁", "label": "解剖部位", "offset": "141"}, {"mention": "直肠子宫陷凹", "label": "解剖部位", "offset": "152"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "161"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "166"}, {"mention": "(全子宫+两附件)子宫颈内生浸润型中分化粘液腺癌(宫颈管亚型)", "label": "疾病和诊断", "offset": "197"}, {"mention": "宫内膜", "label": "解剖部位", "offset": "252"}, {"mention": "阴道", "label": "解剖部位", "offset": "272"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "282"}, {"mention": "宫体", "label": "解剖部位", "offset": "293"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "314"}, {"mention": "卵巢", "label": "解剖部位", "offset": "320"}, {"mention": "紫杉醇", "label": "药物", "offset": "372"}, {"mention": "安素泰", "label": "药物", "offset": "379"}, {"mention": "洛铂", "label": "药物", "offset": "399"}, {"mention": "i度骨髓抑制", "label": "疾病和诊断", "offset": "427"}, {"mention": "腹痛", "label": "症状", "offset": "457"}, {"mention": "腹泻", "label": "症状", "offset": "460"}, {"mention": "头晕", "label": "症状", "offset": "471"}, {"mention": "头痛", "label": "症状", "offset": "474"}, {"mention": "宫颈腺癌(ib1期,ii级)术后", "label": "疾病和诊断", "offset": "490"}]}
{"text": ",缘于入院前2月余因“下腹部闷痛2月”入院,于2016年12月09日在全麻上行“腹腔镜上根治性全胃切除术”,术顺,术后予制酸、保肝、营养支持、补液等处理,,术后病理示:(全胃),:胃体小弯溃疡型低粘附性癌(低分化腺癌),侵犯浆膜层,侵犯脉管及神经组织,手术标本下、上切端及另送(下切端)均未见癌浸润;找到贲门周淋巴结3/13枚,小弯淋巴结9/9枚,大弯淋巴结0/3枚,幽门下淋巴结0/2枚,幽门上淋巴结0/3枚及另送(11d)淋巴结0/2枚,见癌转移。另送(第6组淋巴结)、(第10组淋巴结)为纤维脂肪及脉管组织。诊断为“胃低分化腺癌”,于2017.01.07行“乐沙定200mgivgttqdd1+希罗达1500mgpobidd1-14”方案化疗,感耳鸣、恶心、呕吐,予对症处理后好转出院。此次为行第2周期化疗再次入院,门诊拟“胃低分化腺癌术后化疗”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": "下腹部", "label": "解剖部位", "offset": "11"}, {"mention": "腹腔镜上根治性全胃切除术", "label": "手术", "offset": "40"}, {"mention": "肝", "label": "解剖部位", "offset": "64"}, {"mention": "(全胃),:胃体小弯溃疡型低粘附性癌(低分化腺癌)", "label": "疾病和诊断", "offset": "84"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "152"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "164"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "174"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "184"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "195"}, {"mention": "胃低分化腺癌", "label": "疾病和诊断", "offset": "261"}, {"mention": "乐沙定", "label": "药物", "offset": "282"}, {"mention": "希罗达", "label": "药物", "offset": "300"}, {"mention": "胃低分化腺癌术后", "label": "疾病和诊断", "offset": "365"}, {"mention": "腹痛", "label": "症状", "offset": "397"}, {"mention": "腹胀", "label": "症状", "offset": "400"}]}
{"text": ",患者因诊为直肠癌2013-12-12就诊于我院,行放化疗,查无手术禁忌症,于2014-3-20全麻上行直肠癌低位前切除术,术后第六天出现吻合口瘘、腹膜炎,于2014-3-26急诊行剖腹探查术、腹盆腔冲洗、回肠造瘘术、腹盆腔置管引流术,术后予抗炎、营养支持治疗叒,恢复可。,术后病理:(近端18cm,直径3cm,距一断端2cm,距另一断端叒12cm,可见一溃疡型肿物,大小3.5×xxx3cm,叒溃疡深0.6cm,切面灰白、实性、质硬。直肠放化疗后(切除),:叒肠溃疡型中分化腺癌伴粘液形成,大小3.5×xxx3×xxx0.6cm;叒-叒侵至固有肌层;叒-叒肿瘤缓解率约50%;叒未见脉管癌栓;叒双端切缘及环周切缘未见癌;叒淋巴结未见癌转移0/21;叒-叒,肿瘤病理分期:ypt2n0。,-免疫组化结果显示肿瘤细胞:cd44(-),cmet(-),cox2(局灶+),egfr(+),hep(-),her2(1+),ki-67(+60%),mlh1(+>75%),msh2(+50~75%),msh6(+>75%),p170(+),p27(+),p53(-),topoii(+15%),ttf-1(-)。于2014-05-05日行术后第1周期化疗,化疗方案为“xelox”,,具体为:奥沙利铂(乐沙定)240mg叒d1+卡陪他滨片3片叒2/日叒d1-14。2014-5-26、2014-6-16,2014-07-10,2014-7-30,2014-08-25,2014-9-19行第2、3、4、5、6、7周期化疗。目前恢复良好。为行造口还纳再次入院。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": "直肠癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "直肠癌低位前切除术", "label": "手术", "offset": "52"}, {"mention": "吻合口瘘", "label": "疾病和诊断", "offset": "69"}, {"mention": "腹膜炎", "label": "疾病和诊断", "offset": "74"}, {"mention": "剖腹探查术、腹盆腔冲洗、回肠造瘘术、腹盆腔置管引流术", "label": "手术", "offset": "91"}, {"mention": "直肠", "label": "解剖部位", "offset": "218"}, {"mention": "肠溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "231"}, {"mention": "奥沙利铂", "label": "药物", "offset": "542"}, {"mention": "乐沙定", "label": "药物", "offset": "547"}, {"mention": "卡陪他滨片", "label": "药物", "offset": "560"}]}
{"text": ",患者因罹患“胃窦小弯侧低分化腺癌”于2013-10-15在我院予行全麻上根治性胃大部切除,毕i式吻合。术后病理(叒201312957),示:胃窦小弯侧低分化腺癌,溃疡型,面积3*3cm,侵达外膜脂肪组织。双端切线及另送“远切线”未查见癌。三组(4个)、四组(4个)、五组(1个)、“1、3、7组”(11个)淋巴结未查见癌。,癌组织免疫组化染色示癌组织:β-tubulin-iii(-)、ts(-)、rrm1(-)、topoii阳性细胞数约50%、cerbb-2(-)。,术后病理分期:pt4n0m0,iiia期。依据患者病情及肿瘤病理与分期继续术后辅助性化疗指征存在。自下次手术出院(2013-10-25)以来,患者一般情况保持良好;无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显腹痛、腹胀。现患者为行进一步复查并必要时适当处理而再来我院就诊,门诊依情以“胃术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;近期无明显体重变化。", "mention_data": [{"mention": "胃窦小弯侧低分化腺癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "根治性胃大部切除,毕i式吻合", "label": "疾病和诊断", "offset": "37"}, {"mention": "胃窦小弯侧低分化腺癌,溃疡型", "label": "疾病和诊断", "offset": "71"}, {"mention": "腹痛", "label": "症状", "offset": "348"}, {"mention": "腹胀", "label": "症状", "offset": "351"}, {"mention": "胃术后", "label": "疾病和诊断", "offset": "386"}]}
{"text": ",缘于入院前2年因食管髓质型鳞状细胞癌iiia期(pt3n1m0)在全麻上行食管中段癌切除+食管-胃底弓下吻合术,术后予抗感染、抑酸、营养支持等治疗。,术后病理回报:食管髓质型鳞状细胞癌ii级,侵及外膜层,手术标本下、上切端及另送(下切端)均未见癌浸润。找到(下段食管旁)淋巴结1/1个,(中段食管旁)淋巴结0/1个,(贲门旁)淋巴结0/3个,(胃右动脉旁)淋巴结0/1个,(降主动脉旁)淋巴结1/1个,(隆突上)淋巴结0/3个,(上肺韧带旁)淋巴结0/3个见癌转移。,免疫组化:ki67(40%+),p53(+++),p63(+++),ck5/6(++++),ck18(++),cd117(-)。术后予顺铂40mgd1-3+安素泰240mgd1方案化疗3周期,辅以保肝、止吐、制酸等治疗,患者疗程较为顺利。近2月来出现右胸肋骨疼痛,无胸闷、气促,无咳嗽、咳痰,无畏冷、发热等不适,今为求进一步诊治,求诊我院门诊,拟食管癌术后收入院。此次发病以来,精神、睡眠尚可,食欲如下述,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "食管髓质型鳞状细胞癌iiia期(pt3n1m0)", "label": "疾病和诊断", "offset": "9"}, {"mention": "食管中段癌切除+食管-胃底弓下吻合术", "label": "手术", "offset": "38"}, {"mention": "食管髓质型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "83"}, {"mention": "(下段食管旁)淋巴结", "label": "解剖部位", "offset": "129"}, {"mention": "(中段食管旁)淋巴结", "label": "解剖部位", "offset": "144"}, {"mention": "(贲门旁)淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "172"}, {"mention": "(降主动脉旁)淋巴结", "label": "解剖部位", "offset": "187"}, {"mention": "(隆突上)淋巴结", "label": "解剖部位", "offset": "202"}, {"mention": "(上肺韧带旁)淋巴结", "label": "解剖部位", "offset": "215"}, {"mention": "顺铂", "label": "药物", "offset": "302"}, {"mention": "安素泰", "label": "药物", "offset": "313"}, {"mention": "肝", "label": "解剖部位", "offset": "334"}, {"mention": "右胸肋骨", "label": "解剖部位", "offset": "360"}, {"mention": "胸闷", "label": "症状", "offset": "368"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "408"}]}
{"text": ",患者缘于入院前1年余于我院诊断为“胃间质瘤”,于2012.09.13在全麻上行腹腔镜辅助上胃体间质瘤楔形切除术。,术中见:肿物位于胃体前壁偏小弯侧,内生型,浆膜光滑无明显隆起,与周围组织无明显粘连,手术顺利。术后病理(291227160),:(胃间质瘤),:胃间质瘤,危险程度低。术后予抗感染、补液、制酸、营养支持等治疗。恢复良好,伤口愈合ii/甲。于1年余前开始口服“格列卫”治疗,服用后无诉不适。目前患者为复查,再次就诊我院,门诊拟“胃间质瘤术后”收入院。自下次出院以来饮食、睡眠正常,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃间质瘤", "label": "疾病和诊断", "offset": "18"}, {"mention": "腹腔镜辅助上胃体间质瘤楔形切除术", "label": "手术", "offset": "40"}, {"mention": "胃体前壁偏小弯侧", "label": "解剖部位", "offset": "66"}, {"mention": "胃间质瘤", "label": "疾病和诊断", "offset": "130"}, {"mention": "格列卫", "label": "药物", "offset": "186"}, {"mention": "胃间质瘤术后", "label": "疾病和诊断", "offset": "220"}, {"mention": "腹痛", "label": "症状", "offset": "247"}, {"mention": "腹胀", "label": "症状", "offset": "250"}]}
{"text": ",患者因罹患“结肠癌”于2013-08-06在我院予行全麻上姑息性右半结肠切除术,术后病理(9750.2013),:(横结肠)腺癌(中度分化),部分呈粘液腺癌图像,浸润溃疡型,面积7*6cm,侵穿浆膜,于肠壁脂肪组织内查见转移灶3处。呈肠壁一站(2/6个)、二站(1/1个)、“肠系膜根部”(1/1个)、“肠系膜中动脉根部”(2/2个)淋巴结癌转移。中间组(1个)淋巴结未查见癌。,术后病理分期:t4n2m0,iiic期。术后已行6周期化疗,,化疗方案为: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,同时给予止吐、升血、增强免疫等治疗,因肿瘤指标仍有升高,依情于2014-03-31开始更改化疗方案,,具体用药为:伊利替康200mg叒d1、d8+亚叶酸钙0.3g叒d2-6叒+替加氟1000mg叒d2-6叒静滴,同时辅以镇吐、升血、免疫调节等对症支持治疗。化疗期间耐受良好。自下次出院以来,患者一般情况保持良好;无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显腹痛、腹胀。现患者为行复查并辅助化疗而再来我院就诊,门诊依情以“结肠术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠可;肛门排气排便好。近期无明显体重变化。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "姑息性右半结肠切除术", "label": "手术", "offset": "30"}, {"mention": "(横结肠)腺癌(中度分化)", "label": "疾病和诊断", "offset": "58"}, {"mention": "肠", "label": "解剖部位", "offset": "102"}, {"mention": "肠壁一站(2/6个)、二站(1/1个)、“肠系膜根部”(1/1个)、“肠系膜中动脉根部”(2/2个)淋巴结", "label": "解剖部位", "offset": "118"}, {"mention": "中间组(1个)淋巴结", "label": "解剖部位", "offset": "175"}, {"mention": "奥沙利铂", "label": "药物", "offset": "228"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "241"}, {"mention": "替加氟", "label": "药物", "offset": "256"}, {"mention": "伊利替康", "label": "药物", "offset": "331"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "347"}, {"mention": "替加氟", "label": "药物", "offset": "362"}, {"mention": "腹痛", "label": "症状", "offset": "460"}, {"mention": "腹胀", "label": "症状", "offset": "463"}, {"mention": "结肠术后", "label": "疾病和诊断", "offset": "492"}, {"mention": "肛门", "label": "解剖部位", "offset": "528"}]}
{"text": ",缘于入院前3月余于我院诊为直肠癌,于2015-01-23在全麻上行直肠癌根治术(dixon手术),术顺,术后病理示(201503026),:(直肠),:直肠溃疡型管状腺癌ii级,侵出外膜层,侵犯神经组织,脉管内见癌栓,肠周纤维脂肪组织中见癌结节。手术标本下、上切端及另送(下切端)、(上切端)均未见癌浸润。找到肠周淋巴结1/12个,见癌转移。恢复良好,术后于2015.03.03予“替加氟2.5gciv(46h)d1+奥沙利铂(艾恒)150mgivgttd1+替加氟2.5gciv(46h)d3+亚叶酸钙300mgivgttd1-d5”方案化疗1次,2015.03.26予“替加氟2.5gciv(46h)d1+奥沙利铂(艾恒)150mgivgttd2+亚叶酸钙300mgivgttd1-d3”化疗1次,过程顺利,此次为化疗再次就诊我院,门诊拟直肠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": "直肠癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "直肠癌根治术(dixon手术)", "label": "手术", "offset": "34"}, {"mention": "(直肠),:直肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "71"}, {"mention": "肠周纤维脂肪", "label": "解剖部位", "offset": "110"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "替加氟", "label": "药物", "offset": "192"}, {"mention": "奥沙利铂", "label": "药物", "offset": "210"}, {"mention": "艾恒", "label": "药物", "offset": "215"}, {"mention": "替加氟", "label": "药物", "offset": "231"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "249"}, {"mention": "替加氟", "label": "药物", "offset": "288"}, {"mention": "奥沙利铂", "label": "药物", "offset": "306"}, {"mention": "艾恒", "label": "药物", "offset": "311"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "327"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "372"}, {"mention": "腹痛", "label": "症状", "offset": "401"}, {"mention": "腹胀", "label": "症状", "offset": "404"}]}
{"text": ",患者6月前因诊断为食管胸中段癌于我院行腹左胸食管癌切除术,术后患者出现左侧胸腔积液,留置胸腔穿刺引流可引出略浑浊液体,,术后病理提示:浸润性高分化鳞状细胞癌,大小3×xxx2×xxx1cm;癌侵透固有肌层达外膜层;淋巴结未见癌转移。,免疫组化结果显示:cd44(+++),cmet(+++),cox2(+),egfr(+++),ercc-1(+50~75%),her2(-),ki-67(+25~50%),p170(+),p27(+<25%),p53(-),topoii(+<5%)。术后患者出现吻合口瘘,胸腔感染,给予通畅胸腔引流、胸腔冲洗、抗生素治疗、营养支持等治疗,复查造影以及胃镜,提示吻合口瘘愈合,患者胸腔感染治愈,患者可经口进食,主诉进食后返流呕吐,进食量少。今为进一步治疗而入我科。自发病以来,精神睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "食管胸中段癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹左胸食管癌切除术", "label": "手术", "offset": "20"}, {"mention": "左侧胸腔积液", "label": "疾病和诊断", "offset": "36"}, {"mention": "胸腔", "label": "解剖部位", "offset": "45"}, {"mention": "浸润性高分化鳞状细胞癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "胸腔", "label": "解剖部位", "offset": "254"}, {"mention": "胸腔引流、胸腔冲洗", "label": "手术", "offset": "263"}, {"mention": "胸腔感染", "label": "疾病和诊断", "offset": "307"}]}
{"text": "患者2012年6月因“进行性吞咽困难”于外院确诊“贲门癌”,于2012年7月2日行贲门癌根治性近端胃切除+胃食管膈上吻合术,术中见贲门肿物约7*5大小,第1、2、3组淋巴结肿大,术后病理示贲门腺癌ii级,浸润全层,ln叒8/30叒(+),术后恢复可。遵主诊教授意见于2012-08-07至11-13行xelox方案辅助化疗5程,现返院行上一程治疗。起病以来,患者精神睡眠一般,胃纳尚可,二便正常,近3周体重上降3kg。", "mention_data": [{"mention": "贲门癌", "label": "疾病和诊断", "offset": "25"}, {"mention": "贲门癌根治性近端胃切除+胃食管膈上吻合术", "label": "手术", "offset": "41"}, {"mention": "贲门", "label": "解剖部位", "offset": "65"}, {"mention": "贲门腺癌ii级", "label": "疾病和诊断", "offset": "94"}, {"mention": "胃", "label": "解剖部位", "offset": "188"}]}
{"text": ",患者因“升结肠恶性肿瘤”于2014-09-12在我院予行全麻上行根治性左半结肠切除术。(201414180),:回盲部腺癌(中、低度分化),部分呈粘液腺癌图像,隆起型,体积7*6.5*4.5cm,侵达纤维膜,未累及浆膜。双端切线未查见癌。呈肠壁一站(1/17个)淋巴结癌转移。二站(4个)、三站(3个)、中间组(15个)、中央组(2个)淋巴结未查见癌。,免疫组化染色示癌组织:ts大部分(+)、syn(-)。,术后病理分期:t3n1m0叒iiib期。依据患者病情及肿瘤病理与分期继续术后辅助性化疗指征存在,,查无化疗禁忌后术后行辅助化疗具体用药为:奥沙利铂200mgd1叒+亚叶酸钙0.3g叒d2-6叒+替加氟1g叒d2-6叒静脉滴注;同时予镇吐、升血、免疫调节等对症支持治疗。患者化疗期间总体耐受性好。自下次化疗结束以来,患者一般情况保持良好;无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显腹痛、腹胀。现患者为行进一步复查并必要时适当处理而再来我院就诊,门诊依情以“升结肠恶性肿瘤术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;近期无明显体重变化。", "mention_data": [{"mention": "升结肠恶性肿瘤", "label": "疾病和诊断", "offset": "5"}, {"mention": "根治性左半结肠切除术", "label": "手术", "offset": "33"}, {"mention": "回盲部腺癌(中、低度分化)", "label": "疾病和诊断", "offset": "57"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "74"}, {"mention": "肠壁一站(1/17个)淋巴结", "label": "解剖部位", "offset": "121"}, {"mention": "奥沙利铂", "label": "药物", "offset": "275"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "288"}, {"mention": "替加氟", "label": "药物", "offset": "303"}, {"mention": "腹痛", "label": "症状", "offset": "404"}, {"mention": "腹胀", "label": "症状", "offset": "407"}, {"mention": "升结肠恶性肿瘤术后", "label": "疾病和诊断", "offset": "442"}]}
{"text": "患者于2012年6月因“下腹不适2个月住我院”于2012年6月26日于我院行“根治性左半结肠切除术”。术程顺利,术后病理结果回报:升结肠镜检为结肠中至低分化腺癌,浸润至浆膜上层,肠周淋巴结(1/40)见腺癌转移。术后恢复可,术后诊断升结肠中-低分化腺癌术后叒pt3n1m0iiib期。术后恢复可,后于2012-7-23和2012-8-13行xelox方案化疗2程,耐受可,现患者如期行上程化疗,患者一般情况可,饮食、睡眠正常,大小便如常,体重无明显减轻。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "12"}, {"mention": "根治性左半结肠切除术", "label": "手术", "offset": "39"}, {"mention": "结肠中至低分化腺癌", "label": "疾病和诊断", "offset": "71"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "89"}, {"mention": "升结肠中-低分化腺癌术后叒pt3n1m0iiib期", "label": "疾病和诊断", "offset": "116"}]}
{"text": ",缘于入院3个月前因胃癌就诊我院,于2015.4.17全麻上行“腹腔镜中转-根治性全胃切除术”,,术中见:腹腔内无腹水,脾脏呈切除术后改变,腹腔、盆地、网膜未见结节,肿瘤位于胃体下段至胃底贲门部,浸润溃疡型,大小约7*5cm,侵出浆膜层,侵犯后壁胰体尾并与粘连,中转开腹再探查,胰体尾后方多发大小约1*1.5cm肿大腹膜后淋巴结,贲门右一1.5cm大小淋巴结,胃右动脉及肝总动脉、肝固有动脉表面见数个1cm大小淋巴结。术后病理(201514107),回报示:食管胃交界处溃疡型低分化腺癌,侵及将磨层,脉管内见瘤栓,手术下上切端均未见癌转移。术后于2015.5.13、2015.6.5、2015.6.29予奥沙利铂(齐沙200mg)ivgttd1+希罗达1500mgpobidd1-14方案行术后3次化疗,辅助以制酸保肝补液等对症治疗。今为求术后第4次化疗,求诊我科,门诊拟“胃癌术后化疗”收住院。患者出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹腔镜中转-根治性全胃切除术", "label": "手术", "offset": "32"}, {"mention": "腹腔", "label": "解剖部位", "offset": "53"}, {"mention": "腹水", "label": "症状", "offset": "57"}, {"mention": "脾脏", "label": "解剖部位", "offset": "60"}, {"mention": "腹腔", "label": "解剖部位", "offset": "70"}, {"mention": "胃体下段至胃底贲门部", "label": "解剖部位", "offset": "87"}, {"mention": "胰体尾", "label": "解剖部位", "offset": "123"}, {"mention": "胰体尾", "label": "解剖部位", "offset": "139"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "158"}, {"mention": "贲门", "label": "解剖部位", "offset": "165"}, {"mention": "胃右动脉", "label": "解剖部位", "offset": "180"}, {"mention": "肝总动脉", "label": "解剖部位", "offset": "185"}, {"mention": "肝固有动脉", "label": "解剖部位", "offset": "190"}, {"mention": "食管胃交界处溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "229"}, {"mention": "奥沙利铂", "label": "药物", "offset": "302"}, {"mention": "齐沙", "label": "药物", "offset": "307"}, {"mention": "希罗达", "label": "药物", "offset": "323"}, {"mention": "肝", "label": "解剖部位", "offset": "358"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "387"}, {"mention": "腹痛", "label": "症状", "offset": "411"}, {"mention": "腹胀", "label": "症状", "offset": "414"}]}
{"text": "缘于入院前5月余前因食管腹段癌于我科行“右进胸食管腹段癌切除+食管-胃底弓上吻合术”(2014-06-25),术后病理(201420098)示“(腹段食管及近端胃)食管蕈伞型鳞状细胞癌ii-iii级,侵及外膜层,手术标本下、上切端及另送(下切端)均未见癌浸润。找到食管周淋巴结2个,及另送(右上肺门)淋巴结2个,(隆突上)淋巴结6个,(胃右动脉旁)淋巴结4个,(贲门旁)淋巴结2个,均未见癌转移。胃呈轻度慢性浅表性胃炎”。2个多月前因反复进食阻塞,考虑为“吻合口狭窄”并入院行“胃镜上吻合口狭窄扩张术”,按“顺铂40mgd1-3+安素泰240mgd1”方案行术后辅助化疗3周期(2014.09.17,2014.10.07,2014.11.06)。疗程较为顺利,无明显恶心、呕吐,无头痛、头痛,无呕血、黑便,无胸闷、胸痛,无气促、心悸,无腹痛、腹胀等不适。今为求术后第4周期辅助化疗再诊我院,门诊拟“食管上段癌”收住我科。近来,精神、睡眠、饮食一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管腹段癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "右进胸食管腹段癌切除+食管-胃底弓上吻合术", "label": "手术", "offset": "20"}, {"mention": "(腹段食管及近端胃)食管蕈伞型鳞状细胞癌ii-iii级", "label": "疾病和诊断", "offset": "72"}, {"mention": "食管周淋巴结", "label": "解剖部位", "offset": "132"}, {"mention": "(右上肺门)淋巴结", "label": "解剖部位", "offset": "144"}, {"mention": "(隆突上)淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "167"}, {"mention": "(贲门旁)淋巴结", "label": "解剖部位", "offset": "180"}, {"mention": "胃", "label": "解剖部位", "offset": "198"}, {"mention": "轻度慢性浅表性胃炎", "label": "疾病和诊断", "offset": "200"}, {"mention": "吻合口狭窄", "label": "疾病和诊断", "offset": "228"}, {"mention": "胃镜上吻合口狭窄扩张术", "label": "手术", "offset": "239"}, {"mention": "顺铂", "label": "药物", "offset": "254"}, {"mention": "安素泰", "label": "药物", "offset": "265"}, {"mention": "头痛", "label": "症状", "offset": "340"}, {"mention": "头痛", "label": "症状", "offset": "343"}, {"mention": "胸闷", "label": "症状", "offset": "354"}, {"mention": "胸痛", "label": "症状", "offset": "357"}, {"mention": "心悸", "label": "症状", "offset": "364"}, {"mention": "腹痛", "label": "症状", "offset": "368"}, {"mention": "腹胀", "label": "症状", "offset": "371"}, {"mention": "食管上段癌", "label": "疾病和诊断", "offset": "399"}]}
{"text": ",缘于半月余前因食管下段鳞癌于我院行(2014-2-14)翻身三切口食管下段癌切除+食管-胃底右颈部吻合+第6后肋内固定+空肠造瘘术,术后病理(201403696),:食管溃疡型鳞状细胞癌ii级,侵出外膜层,手术标本下切端、上切端及另送(食管下切端)均未见癌浸润;找到食管周淋巴结7个及另送(喉返旁)淋巴结6个、(上段食管旁)淋巴结7个、(隆突上)淋巴结8个、(胃右动脉旁)淋巴结19个、(贲门旁)淋巴结7个、(胃大弯)淋巴结1个,均未见癌转移。,免疫组化结果:ki67(65%阳性),p53(-),p170(-),gstπ(++),egfr(-)。(201403588),:(颈段食管(缝线处为下切端)),:送检食管切端组织,未见癌浸润。术后给予抗感染、营养支持、制酸、雾化祛痰等治疗,病情恢复顺利,已进食半流质,无明显恶心、呕吐,无头晕、头痛,无咳嗽、咳痰,无胸闷、胸痛,无腹痛、腹胀,无周身骨骼疼痛等不适。今为求入院术后第1周期化疗再诊我院,门诊拟食管下段癌术后化疗收住我科。近来,精神、睡眠、饮食一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管下段鳞癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "翻身三切口食管下段癌切除+食管-胃底右颈部吻合+第6后肋内固定+空肠造瘘术", "label": "手术", "offset": "29"}, {"mention": "食管溃疡型鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "84"}, {"mention": "食管", "label": "解剖部位", "offset": "119"}, {"mention": "食管周淋巴结", "label": "解剖部位", "offset": "134"}, {"mention": "(喉返旁)淋巴结", "label": "解剖部位", "offset": "145"}, {"mention": "(上段食管旁)淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "(隆突上)淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "180"}, {"mention": "(贲门旁)淋巴结", "label": "解剖部位", "offset": "194"}, {"mention": "(胃大弯)淋巴结", "label": "解剖部位", "offset": "205"}, {"mention": "颈段食管", "label": "解剖部位", "offset": "289"}, {"mention": "食管", "label": "解剖部位", "offset": "307"}, {"mention": "头晕", "label": "症状", "offset": "368"}, {"mention": "头痛", "label": "症状", "offset": "371"}, {"mention": "胸闷", "label": "症状", "offset": "382"}, {"mention": "胸痛", "label": "症状", "offset": "385"}, {"mention": "腹痛", "label": "症状", "offset": "389"}, {"mention": "腹胀", "label": "症状", "offset": "392"}, {"mention": "周身骨骼", "label": "解剖部位", "offset": "396"}, {"mention": "食管下段癌术后", "label": "疾病和诊断", "offset": "427"}]}
{"text": "患者1周余前在我院诊断为胃癌,于2013-3-20在全麻上行腹腔镜辅助远端胃癌根治术,手术过程顺利,术后病理结果回报远端胃局部残留粘膜内低分化腺癌(lauren分型:混合型;大小1毫米),未见脉管癌栓,淋巴结0/11未见癌转移,胃残端及十二指肠残端未见癌。术后患者出现胃排空障碍,为求进一步治疗入院。患者自发病以来精神、睡眠、食欲尚好,大小便正常,体重无明显改变。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "腹腔镜辅助远端胃癌根治术", "label": "手术", "offset": "30"}, {"mention": "胃", "label": "解剖部位", "offset": "114"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "118"}, {"mention": "胃", "label": "解剖部位", "offset": "134"}]}
{"text": ",缘于入院前1月余诊断“直乙交界处结肠癌”,于2013.11.11在我科行“腹腔镜上直乙交界处结肠癌根治术”,术中见腹腔内无明显腹水,未见明显转移结节,乙状结肠稍迂曲,肿瘤位于直肠-乙状结肠交界处,上缘距腹膜返折约7cm,约5×4cm,侵及浆膜层,未侵犯周围组织,未形成明显梗阻,周围未见明显肿大淋巴结。术顺,术毕安返病房,予补液及营养对症支持等治疗。术后病理(20335111),示:(直肠)大肠隆起型管状腺癌ii级,侵犯外膜层,手术标本下、上切端及另送(下切端)、(上切端)均未见癌浸润。找到肿物周围淋巴结11个,肠周淋巴结21个,及另送(肠系膜上动脉根部)淋巴结5个,均未见癌转移。,免疫组化结果:ck20(+),ck7(-),villin(+++),cea(++),cdx-2(++),cd56(-),cga(个别+),sy(个别+),ki67(85%+)。术后恢复出院,后于2013.12.05开始予“奥沙利铂150mgivgttd1+希罗达1000mgpobidd2-15”方案行术后第1周期化疗,辅以保胃、保肝、止吐等治疗,过程顺利。现为求术后第2周期化疗再次就诊我院,门诊拟“直乙交界处结肠癌术后”收入院。自下次出院以来精神、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": "直乙交界处结肠癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "腹腔镜上直乙交界处结肠癌根治术", "label": "手术", "offset": "38"}, {"mention": "腹腔", "label": "解剖部位", "offset": "58"}, {"mention": "腹水", "label": "症状", "offset": "64"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "76"}, {"mention": "直肠-乙状结肠交界处", "label": "解剖部位", "offset": "88"}, {"mention": "腹膜返折", "label": "解剖部位", "offset": "102"}, {"mention": "(直肠)大肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "193"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "259"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "271"}, {"mention": "奥沙利铂", "label": "药物", "offset": "406"}, {"mention": "希罗达", "label": "药物", "offset": "423"}, {"mention": "胃", "label": "解剖部位", "offset": "458"}, {"mention": "肝", "label": "解剖部位", "offset": "461"}, {"mention": "直乙交界处结肠癌术后", "label": "疾病和诊断", "offset": "496"}, {"mention": "腹痛", "label": "症状", "offset": "529"}, {"mention": "腹胀", "label": "症状", "offset": "532"}]}
{"text": "患者于2011年6月起前无明显诱因出现下腹部胀痛不适、纳差,无伴发热、黄疸、呕吐、黑便等,无处理,2011年9月再次出现右下腹痛,遂到**六院查ct示\\\"胰腺囊腺癌\\\",9-30在气管麻上行“胰体尾切除+空肠近端切除+脾切除+结肠脾区切除+roux-en-y吻合术”,术程顺利,术后病理示胰腺粘液性囊腺癌;12月ct复查未见复发或转移征象。半月前患者突觉右下腹酸痛,伴腹胀,遂到外院复查肿瘤标记物ca199叒164.1叒u/l,ca125叒49.6叒u/l。2012-4-17**六院pet/ct示:胰腺提残端高代谢灶,考虑肿瘤复发;腹盆腔、肠旁、肠系膜、大网膜,肝周围膜、子宫子宫直肠窝多发高代谢病灶,考虑腹,盆腔广泛种植性转移。为进一步诊治至我院就诊,于2012-4-25/2012-5-24行健择方案(d1,d8,d15)化疗2程,过程顺利,化疗后ii度白细胞上降。入院以来,无头晕头痛,无咳嗽咳痰,右下腹有按压痛,无腹胀,无呕吐、黑便,精神、胃纳、睡眠一般,体重无明显减轻。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "19"}, {"mention": "右下腹痛", "label": "症状", "offset": "60"}, {"mention": "ct", "label": "影像检查", "offset": "72"}, {"mention": "胰腺囊腺癌", "label": "疾病和诊断", "offset": "77"}, {"mention": "气管", "label": "解剖部位", "offset": "90"}, {"mention": "胰体尾切除+空肠近端切除+脾切除+结肠脾区切除+roux-en-y吻合术", "label": "手术", "offset": "96"}, {"mention": "胰腺粘液性囊腺癌", "label": "疾病和诊断", "offset": "144"}, {"mention": "ct", "label": "影像检查", "offset": "156"}, {"mention": "右下腹", "label": "解剖部位", "offset": "177"}, {"mention": "腹胀", "label": "症状", "offset": "184"}, {"mention": "ca199", "label": "实验室检验", "offset": "198"}, {"mention": "ca125", "label": "实验室检验", "offset": "214"}, {"mention": "pet/ct", "label": "影像检查", "offset": "242"}, {"mention": "胰腺", "label": "解剖部位", "offset": "250"}, {"mention": "腹盆腔", "label": "解剖部位", "offset": "267"}, {"mention": "肠", "label": "解剖部位", "offset": "271"}, {"mention": "肠", "label": "解剖部位", "offset": "274"}, {"mention": "肝", "label": "解剖部位", "offset": "282"}, {"mention": "子宫", "label": "解剖部位", "offset": "287"}, {"mention": "子宫直肠窝", "label": "解剖部位", "offset": "289"}, {"mention": "腹", "label": "解剖部位", "offset": "304"}, {"mention": "盆腔", "label": "解剖部位", "offset": "306"}, {"mention": "健择", "label": "药物", "offset": "349"}, {"mention": "头晕", "label": "症状", "offset": "392"}, {"mention": "头痛", "label": "症状", "offset": "394"}, {"mention": "右下腹", "label": "解剖部位", "offset": "403"}, {"mention": "腹胀", "label": "症状", "offset": "412"}, {"mention": "胃", "label": "解剖部位", "offset": "425"}]}
{"text": ",缘于入院前2个月周于我院诊断为乙状结肠癌,于2014.01.03全麻上行“乙状结肠癌姑息切除+近端乙状结肠造瘘+小肠部分切除吻合术”,,术中见:乙状结肠一菜花样肿物,大约7.0*4.0*3.0cm,质硬,侵出浆膜,侵犯部分回肠及小肠系膜,侵及右髂部盆壁并与其粘连固定,右髂血管及右性腺血管受侵并被包绕,肠系膜上血管根部可见肿大淋巴结,肿物近端乙状结肠稍扩张,肠壁明显水肿增厚。术后予保肝、保胃、营养等治疗。术后病理(201400261),:1、(结肠),:大肠隆起型管状腺癌ii级,伴坏死,侵及浆膜层,侵犯神经,手术标本下切端、上切端均未见癌浸润。找到肿物周淋巴结16个和肠周淋巴结7个均未见癌转移。2、(小肠),:送检小肠组织,肠壁全层急慢性炎症细胞浸润,病变以浆膜层最重,可见组织炎性坏死,伴大量急、慢性炎症细胞浸润,肉芽组织增生。该病例未检测到kras基因12、13号密码子热点突变。该病例未检测到braf基因v600e突变。术后恢复可,于2014.2.7、2014.2.21按“奥沙利铂150mgivgttd1+替加氟3.4gciv+亚叶酸钙300mgivgttd1-2”方案予术后2期化疗,今为术后第3次化疗求诊我院,门诊拟“乙状结肠癌术后”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": "乙状结肠癌", "label": "疾病和诊断", "offset": "16"}, {"mention": "乙状结肠癌姑息切除+近端乙状结肠造瘘+小肠部分切除吻合术", "label": "手术", "offset": "38"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "73"}, {"mention": "回肠", "label": "解剖部位", "offset": "112"}, {"mention": "小肠系膜", "label": "解剖部位", "offset": "115"}, {"mention": "右髂部盆壁", "label": "解剖部位", "offset": "122"}, {"mention": "右髂血管", "label": "解剖部位", "offset": "135"}, {"mention": "右性腺血管", "label": "解剖部位", "offset": "140"}, {"mention": "肠", "label": "解剖部位", "offset": "152"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "172"}, {"mention": "肠", "label": "解剖部位", "offset": "180"}, {"mention": "肝", "label": "解剖部位", "offset": "193"}, {"mention": "胃", "label": "解剖部位", "offset": "196"}, {"mention": "(结肠),:大肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "223"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "287"}, {"mention": "小肠", "label": "解剖部位", "offset": "304"}, {"mention": "小肠", "label": "解剖部位", "offset": "311"}, {"mention": "肠", "label": "解剖部位", "offset": "316"}, {"mention": "奥沙利铂", "label": "药物", "offset": "444"}, {"mention": "替加氟", "label": "药物", "offset": "461"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "472"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "519"}, {"mention": "腹痛", "label": "症状", "offset": "548"}, {"mention": "腹胀", "label": "症状", "offset": "551"}]}
{"text": "缘于入院前3个月于我院诊为“横结肠癌”,于2015.12.02在全麻上行“腹腔镜上横结肠癌根治性切除术”,术中见“探查腹腔内无明显出血、粘连、腹水,肿物位于横结肠中段偏左,可疑侵及浆膜层,未形成梗阻,周围可见数个肿大淋巴结”,术后病理(201543775):“大肠隆起型管状腺癌ii级,侵出浆膜层,手术标本下、上切端及另送(下切端)均未见癌浸润。找到肠周淋巴结14/42个,另送(结肠中动脉根部)淋巴结0/8个,见癌转移”,术后予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲出院。于2015.12.29、2016.01.19行“奥沙利铂(乐沙定)150mgivgttqdd1+希罗达1000mgpobidd1-14”方案化疗,未见明显化疗不良反应。今为行上一周期化疗就诊我院,门诊拟“横结肠癌术后化疗”收入院。自下次出院以来,精神、睡眠、饮食可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "横结肠癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上横结肠癌根治性切除术", "label": "手术", "offset": "37"}, {"mention": "腹腔", "label": "解剖部位", "offset": "59"}, {"mention": "腹水", "label": "症状", "offset": "71"}, {"mention": "横结肠中段偏左", "label": "解剖部位", "offset": "78"}, {"mention": "大肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "130"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "175"}, {"mention": "(结肠中动脉根部)淋巴结", "label": "解剖部位", "offset": "189"}, {"mention": "奥沙利铂", "label": "药物", "offset": "266"}, {"mention": "乐沙定", "label": "药物", "offset": "271"}, {"mention": "希罗达", "label": "药物", "offset": "290"}, {"mention": "横结肠癌术后", "label": "疾病和诊断", "offset": "344"}]}
{"text": "患者于2年前因“直肠吻合口漏”在我院于2012年09月04日在全麻上行剖腹探查+肠粘连松解术+回肠单腔造瘘术,手术过程顺利,术后给予抗感染及营养支持治疗。术后切口愈合较好。现患者一般情况可,造瘘口排气排便通畅,无腹胀、腹痛,无恶心、呕吐,无发热不适,为行小肠造口还纳术来我院就诊,门诊,以“小肠造漏术后”收入院。叒叒叒叒发病以来,患者精神好,饮食可,睡眠尚可,小便正常,体重无明显改变。", "mention_data": [{"mention": "直肠吻合口漏", "label": "疾病和诊断", "offset": "8"}, {"mention": "剖腹探查+肠粘连松解术+回肠单腔造瘘术", "label": "手术", "offset": "35"}, {"mention": "腹胀", "label": "症状", "offset": "106"}, {"mention": "腹痛", "label": "症状", "offset": "109"}, {"mention": "小肠造口还纳术", "label": "手术", "offset": "127"}, {"mention": "小肠造漏术后", "label": "疾病和诊断", "offset": "145"}]}
{"text": ",缘于入院前2月余因“反复返酸、嗳气7年”就诊我院,,行胃镜检查示:“1.胃窦癌2.慢性萎缩性胃炎”,,病理示:“胃管状腺癌ii-iii级”,下腹部平扫+,增强示:“胃肿瘤,伴腹腔、腹膜后多发淋巴结肿大”,考虑肿瘤局部较晚期,遂于2015.04.18、2015.05.11、2015.06.02予“安素泰210mgivgttd1+奥沙利铂(艾恒)150mgivgttd2+希罗达1000mgpobidd1-14”方案新辅助化疗,辅以止吐、制酸、保胃、保肝、营养支持等治疗。化疗后未见明显骨髓抑制,一般情况尚可。今为求第4次化疗就诊我院,门诊拟“胃窦癌”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": "胃窦癌", "label": "疾病和诊断", "offset": "37"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "42"}, {"mention": "胃管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "57"}, {"mention": "下腹部平扫", "label": "影像检查", "offset": "71"}, {"mention": "胃", "label": "解剖部位", "offset": "83"}, {"mention": "腹腔", "label": "解剖部位", "offset": "88"}, {"mention": "腹", "label": "解剖部位", "offset": "91"}, {"mention": "安素泰", "label": "药物", "offset": "149"}, {"mention": "奥沙利铂", "label": "药物", "offset": "165"}, {"mention": "艾恒", "label": "药物", "offset": "170"}, {"mention": "希罗达", "label": "药物", "offset": "186"}, {"mention": "胃", "label": "解剖部位", "offset": "223"}, {"mention": "肝", "label": "解剖部位", "offset": "226"}, {"mention": "胃窦癌", "label": "疾病和诊断", "offset": "272"}]}
{"text": ",患者2012年5月出现吞咽困难,伴下腹部不适,为隐痛,无明显放射,疼痛间断发作,患者无恶心、呕吐,无明显黑便,,患者行胃镜检查示:食管上段、贲门处占位,,病理示:低分化腺癌;,免疫组化结果显示:ck5/6(-),p63(-),ck8/18(+),ck7(+)。后行2次术前新辅助化疗,方案为奥沙利铂+替吉奥。患者于2012年11月29日在全麻上行经腹食管胃交界腺癌根治术,,术后病理回报:(食管胃交界腺癌化疗后)食管及胃交界部低分化腺癌,癌灶散在分布,直径0.2-0.5cm,侵及深肌层,癌细胞变性显著(约70%),肿瘤退缩分级(trg),:1级,未见脉管癌栓;淋巴结未见癌转移(胃周0/2、胃小弯侧0/0、食管胃交界处0/3、大弯侧0/1),食管和胃断端未见癌,网膜组织未见特殊;,肿瘤病理分期:ypt2nom0g3叒iia期。患者自发病以来,饮食睡眠好,体重无减轻;患者体重无明显减轻。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "18"}, {"mention": "食管上段", "label": "解剖部位", "offset": "66"}, {"mention": "贲门", "label": "解剖部位", "offset": "71"}, {"mention": "奥沙利铂", "label": "药物", "offset": "146"}, {"mention": "替吉奥", "label": "药物", "offset": "151"}, {"mention": "经腹食管胃交界腺癌根治术", "label": "手术", "offset": "174"}, {"mention": "(食管胃交界腺癌化疗后)食管及胃交界部低分化腺癌", "label": "疾病和诊断", "offset": "195"}, {"mention": "胃", "label": "解剖部位", "offset": "291"}, {"mention": "胃小弯侧", "label": "解剖部位", "offset": "297"}, {"mention": "食管胃交界", "label": "解剖部位", "offset": "305"}, {"mention": "大弯侧", "label": "解剖部位", "offset": "315"}, {"mention": "食管", "label": "解剖部位", "offset": "323"}, {"mention": "胃", "label": "解剖部位", "offset": "326"}]}
{"text": ",缘于入7月余于我院诊断为胃窦癌,于2016年04月08日在全麻上行腹腔镜辅助上根治性远端胃大部切除术,手术顺利,术后病理(201611241),:(远端胃),:胃窦溃疡型黏液腺癌,部分为低黏附性癌(印戒细胞癌及未分化癌为主),侵犯脉管及神经组织,脉管内见癌栓,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10/19个,大弯侧淋巴结12/13个,幽门下淋巴结5/8个,幽门上淋巴结6/8个,及另送(胃右动脉根部)淋巴结1/6个,见癌转移。网膜结节为副脾组织。胃壁见异位胰腺组织,胰岛细胞增生。,免疫组化染色结果示:ck(pan)(+++),her-2(-),ki67(50%阳性),cd56(-),sy(-),cga(-),e-cadherin(++)。术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。分别于2016.05.05、2016.05.25、2016.06.17、2016.07.11、2016.08.07、2016.09.05、2016.10.04行“伊利替康200mgivgttd1+替吉奥60mgpobidd1-14”方案化疗,现为行第8次化疗再次就诊我院,门诊拟“胃窦癌(pt4an3bm0iiic期)术后化疗”收入院。自下次出院后饮食、睡眠可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜辅助上根治性远端胃大部切除术", "label": "手术", "offset": "34"}, {"mention": "(远端胃),:胃窦溃疡型黏液腺癌", "label": "疾病和诊断", "offset": "74"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "165"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "178"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "191"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "202"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "216"}, {"mention": "副脾", "label": "疾病和诊断", "offset": "242"}, {"mention": "胃壁", "label": "解剖部位", "offset": "247"}, {"mention": "胰腺", "label": "解剖部位", "offset": "252"}, {"mention": "胰岛", "label": "解剖部位", "offset": "257"}, {"mention": "伊利替康", "label": "药物", "offset": "453"}, {"mention": "替吉奥", "label": "药物", "offset": "470"}, {"mention": "胃窦癌(pt4an3bm0iiic期)术后", "label": "疾病和诊断", "offset": "512"}, {"mention": "腹痛", "label": "症状", "offset": "554"}, {"mention": "腹胀", "label": "症状", "offset": "557"}]}
{"text": "入院前2+月,患者因“乙状结肠肿瘤”于我科住院治疗,完善相关检查于2014年7月10日在全麻上行腹腔镜上乙状结肠癌根治术,术后病理诊断:乙状结肠粘液性腺癌(中分化)侵及粘膜上浅肌层,双侧切缘未见癌累及,肠系膜淋巴结见癌累及(1/7),术后给予止血、补液、抗感染、营养支持、护胃等治疗,术后恢复可,复查血常规、肝肾功、电解质未见明显异常。患者病情恢复顺利,无特殊不适,切口甲级愈合,好转出院。目前患者无恶心、呕吐、腹痛、腹胀、便血等表现,遵医嘱今日入我院,拟行第3次化疗,故以\\\"乙状结肠癌术后第3次化疗\\\"收入我科住院治疗。", "mention_data": [{"mention": "乙状结肠肿瘤", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹腔镜上乙状结肠癌根治术", "label": "手术", "offset": "48"}, {"mention": "乙状结肠粘液性腺癌(中分化)", "label": "疾病和诊断", "offset": "68"}, {"mention": "肠系膜淋巴结", "label": "解剖部位", "offset": "101"}, {"mention": "胃", "label": "解剖部位", "offset": "137"}, {"mention": "肝", "label": "解剖部位", "offset": "154"}, {"mention": "肾", "label": "解剖部位", "offset": "155"}, {"mention": "腹痛", "label": "症状", "offset": "206"}, {"mention": "腹胀", "label": "症状", "offset": "209"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "239"}]}
{"text": ",2017-10-25在手术室行开腹根治性乙状结肠切除术。,术后病理:(乙状结肠血管根部淋巴结乙状结肠)?xxxxxx结肠隆起型中分化腺癌,大小3×xxx2.5cm?xxxxxx侵及浆膜上纤维脂肪组织?xxxxxx未见脉管癌栓及神经侵犯?xxxxxx双断端未见癌?xxxxxx淋巴结可见癌转移(肠周1/14、乙状结肠血管根部0/0)叒,肿瘤病理分期:pt3n1a;叒-叒,免疫组化结果显示:braf(-),cmet(1+),egfr(2+),her2(0),ki-67(+>75%),mlh1(+),msh2(+),msh6(+),pms2(+)。", "mention_data": [{"mention": "开腹根治性乙状结肠切除术", "label": "手术", "offset": "16"}, {"mention": "肠", "label": "解剖部位", "offset": "147"}, {"mention": "乙状结肠血管根部", "label": "解剖部位", "offset": "154"}]}
{"text": ",患者因“结肠癌并肺转移”于2014-07-17在我院行姑息性左半结肠切除术,术中输血2u,切除标本送病理,输液、预防感染及静脉营养等对症支持治疗。病理诊断(201410878),:左半结肠腺癌(中度分化),浸润溃疡型,体积2.7*2.6*0.6cm,侵达外膜脂肪组织。双端切线未查见癌。肠壁一站(8个)、二站(7个)、中央组(1个)、中间组(11个)淋巴结未查见癌。,免疫组化染色示:ercc1弥漫(+)、ts(-)。根据肿瘤病理分期(t3n0m1叒iv期)。现患者为行进一步复查并必要时适当处理而再来我院就诊,门诊依情以“结肠术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;近期无明显体重变化。", "mention_data": [{"mention": "结肠癌并肺转移", "label": "疾病和诊断", "offset": "5"}, {"mention": "姑息性左半结肠切除术", "label": "手术", "offset": "28"}, {"mention": "左半结肠腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "91"}, {"mention": "结肠术后", "label": "疾病和诊断", "offset": "263"}]}
{"text": "缘于入院前1月于我院诊为“直肠癌”,于2013.12.11在我科行“腹腔镜上直肠癌根治术dixon”,术中见腹腔内无明显腹水,肿物位于腹膜反折处,大小约2.5×2cm,可疑侵及浆膜层,周围见少许肿大淋巴结。术顺,术毕安返病房,予以预防感染、补液、营养支持、调节免疫等治疗。术后病理(201336679)示:(直肠)大肠溃疡型管状腺癌ii级,部分为粘液腺癌,侵出外膜层,外膜面见癌结节形成,手术标本双切端及另送(下切端)、(上切端)均未见癌浸润。找到肿物周淋巴结1/7个,肠周淋巴结2/7个见癌转移。另送(肠系膜上动脉根部淋巴结)为脂肪、脉管及神经组织。术后恢复良好出院。此次为化疗再次就诊我院,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": "13"}, {"mention": "腹腔镜上直肠癌根治术dixon", "label": "手术", "offset": "34"}, {"mention": "腹腔", "label": "解剖部位", "offset": "54"}, {"mention": "腹水", "label": "症状", "offset": "60"}, {"mention": "腹膜反折", "label": "解剖部位", "offset": "67"}, {"mention": "(直肠)大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "153"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "235"}, {"mention": "肠系膜上动脉根部淋巴结", "label": "解剖部位", "offset": "252"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "301"}, {"mention": "腹痛", "label": "症状", "offset": "328"}, {"mention": "腹胀", "label": "症状", "offset": "331"}]}
{"text": ",患者于患者于2月前于我院诊断为:结肠腺癌,在腹腔镜上结肠肿瘤切除术。,术后病理提示:左半结肠)溃疡型中分化腺癌,侵及肠壁全层,双切端未见癌累及,脉管内见癌栓,肠壁淋巴结见癌转移(2/15)。阑尾未见癌转移。1月前行第一次化疗,化疗后无发热,无恶心呕吐,无腹痛腹泻等不适。拟入院行第2次静脉化疗。\\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": "结肠腺癌", "label": "疾病和诊断", "offset": "17"}, {"mention": "腹腔镜上结肠肿瘤切除术", "label": "手术", "offset": "23"}, {"mention": ":左半结肠)溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "42"}, {"mention": "肠", "label": "解剖部位", "offset": "59"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "80"}, {"mention": "阑尾", "label": "解剖部位", "offset": "96"}, {"mention": "腹痛", "label": "症状", "offset": "128"}, {"mention": "腹泻", "label": "症状", "offset": "130"}, {"mention": "胃", "label": "解剖部位", "offset": "174"}]}
{"text": "患者于2004年4月份在本院行右乳癌改良根治术,术后病理诊为:右乳腺浸润性导管癌,淋巴结10/11(+),pt3n3m0,iiic期,er(+),pr(-),her-2(-),ki67(+++).术后以fec方案化疗4程,之后行放疗.2004年9月份开始行tam治疗,2004年12月加用雷诺得,2007年9月行卵巢去势手术,改瑞宁得治疗.2010年4月份发现骨转移(右股骨代谢活跃)行右股骨姑息性放疗.2011年初发现肺肝淋巴结等转移,行多西他赛化疗程4程后评价pd,改gx2程,肝病灶pd,行np方案化疗6程,评价sd.后于2012年5月始使用替加氟治疗.复查ct示肝转移灶进展(2012年5月11日肝脏数个低密度灶4×4mm-9×9mm,2012年9月21肝数个低密度灶最大33×24mm).于2012-10-22以“泰素+顺铂”方案化疗一程。为进一步治疗入院.精神,睡眠,食欲欠佳,大小便正常.体重无明显变化.。", "mention_data": [{"mention": "右乳癌改良根治术", "label": "手术", "offset": "15"}, {"mention": "右乳腺浸润性导管癌", "label": "疾病和诊断", "offset": "31"}, {"mention": "雷诺得", "label": "药物", "offset": "144"}, {"mention": "卵巢去势手术", "label": "手术", "offset": "156"}, {"mention": "瑞宁得", "label": "药物", "offset": "164"}, {"mention": "骨转移", "label": "疾病和诊断", "offset": "180"}, {"mention": "右股骨", "label": "解剖部位", "offset": "184"}, {"mention": "右股骨", "label": "解剖部位", "offset": "193"}, {"mention": "肺", "label": "解剖部位", "offset": "210"}, {"mention": "肝", "label": "解剖部位", "offset": "211"}, {"mention": "多西他赛", "label": "药物", "offset": "220"}, {"mention": "肝", "label": "解剖部位", "offset": "241"}, {"mention": "替加氟", "label": "药物", "offset": "274"}, {"mention": "ct", "label": "影像检查", "offset": "282"}, {"mention": "肝转移", "label": "症状", "offset": "285"}, {"mention": "肝脏", "label": "解剖部位", "offset": "302"}, {"mention": "肝", "label": "解剖部位", "offset": "331"}, {"mention": "泰素", "label": "药物", "offset": "362"}, {"mention": "顺铂", "label": "药物", "offset": "365"}]}
{"text": ",缘于入院前2月(2013.08.16)因“子宫内膜混合型腺癌”就诊我科行“盆腔粘连松解+筋膜外全子宫+两附件切除+盆腔淋巴结清扫术”。术顺,,术后病理回报:宫体混合型腺癌(80%为ii型透明细胞腺癌,20%为i型子宫内膜样腺癌),侵及浅肌层,未侵犯宫颈组织学内口;余未示明显异常。,免疫组化表达:ki67(40%+),er(-),pr(-)。术后恢复可,腹部切口ii/甲愈合。术后于2013.8.29,2013.09.22予以“多西他赛140mgivgttdl+洛铂50mgivgttdl”方案行术后辅助化疗2次,化疗过程顺利,化疗后复查血常规、肝肾功能均未示明显异常,好转出院。出院期间未定期复查血常规、肝肾功能。现为进一步化疗,就诊我院,门诊拟“子宫内膜腺癌ia期术后”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": "子宫内膜混合型腺癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "盆腔粘连松解+筋膜外全子宫+两附件切除+盆腔淋巴结清扫术", "label": "手术", "offset": "38"}, {"mention": "宫体混合型腺癌(80%为ii型透明细胞腺癌,20%为i型子宫内膜样腺癌)", "label": "疾病和诊断", "offset": "79"}, {"mention": "宫颈", "label": "解剖部位", "offset": "125"}, {"mention": "腹部", "label": "解剖部位", "offset": "178"}, {"mention": "多西他赛", "label": "药物", "offset": "215"}, {"mention": "洛铂", "label": "药物", "offset": "232"}, {"mention": "肝", "label": "解剖部位", "offset": "274"}, {"mention": "肾", "label": "解剖部位", "offset": "275"}, {"mention": "肝", "label": "解剖部位", "offset": "304"}, {"mention": "肾", "label": "解剖部位", "offset": "305"}, {"mention": "子宫内膜腺癌ia期术后", "label": "疾病和诊断", "offset": "326"}, {"mention": "腹痛", "label": "症状", "offset": "359"}, {"mention": "腹胀", "label": "症状", "offset": "362"}]}
{"text": ",患者因罹患“直肠腺癌”于2016-09-13在我院予行全麻上直肠肿瘤切除术,,术中见:腹腔内无腹水,腹膜无转移,肝脏正常。肿物位于腹膜返折下方,直肠与乙状结肠交界处,约2.5*2.5*1cm大小,肿瘤未侵出浆膜,直肠系膜根部未触及明显肿大淋巴结,肿瘤尚活动。决定行dixon手术。手术病理(0400.2013),示:直肠腺癌(中度分化),浸润溃疡型,体积约5×4×1.2cm,侵达外膜。双端切线未查见癌。肠壁二站(4个)、中央组(2个)淋巴结未查见癌。免疫组化染色示ercc(-)、ts(-)。术后行3周期辅助化疗,同时辅以镇吐、升血、免疫调节等对症支持治疗。化疗过程总体顺利,病情稳定出院。现患者为行复查并辅助化疗而再来我院就诊,门诊依情以“直肠癌术后”收入院。自下次出院以来,患者一般情况保持良好;无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显腹痛、腹胀。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;近期无明显体重变化。", "mention_data": [{"mention": "直肠腺癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "全麻上直肠肿瘤切除术", "label": "手术", "offset": "28"}, {"mention": "腹腔", "label": "解剖部位", "offset": "44"}, {"mention": "腹水", "label": "症状", "offset": "48"}, {"mention": "腹", "label": "解剖部位", "offset": "51"}, {"mention": "肝脏", "label": "解剖部位", "offset": "57"}, {"mention": "腹膜返折", "label": "解剖部位", "offset": "66"}, {"mention": "直肠", "label": "解剖部位", "offset": "73"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "76"}, {"mention": "直肠系膜根部", "label": "解剖部位", "offset": "107"}, {"mention": "dixon手术", "label": "手术", "offset": "133"}, {"mention": "直肠腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "159"}, {"mention": "肠壁二站(4个)、中央组(2个)淋巴结", "label": "解剖部位", "offset": "203"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "323"}, {"mention": "腹痛", "label": "症状", "offset": "382"}, {"mention": "腹胀", "label": "症状", "offset": "385"}]}
{"text": ",患者于今年8月初开始无明显诱因出现呕吐,伴嗳气,于外院行胃镜检查示“中段距门齿26-29㎝处后壁见一菜花状新生物,胃角见一3×2.5㎝溃疡”。病理“食管中段鳞状细胞癌;胃角低分化腺癌”。为进一步诊治来我院就诊。2016年8月25日行“贲门癌根治(全胃切除)+胰腺体尾部切除+脾切除术”,术中探查“肿瘤位于胃体小弯侧部,大小约8*7cm,向下侵犯胃底贲门及食管上段2cm,向后侵犯胰腺体部及尾部,脾门淋巴结多发肿大”。术后病理示“(胃大体)镜检为低分化腺癌,部分为印戒细胞癌,伴较多粘液分泌,lauren,分型:弥漫型,癌组织侵犯至胃壁浆膜层及食管外膜层,可见多量脉管内癌栓及神经束侵犯;另可见3枚淋巴结,其中2枚见腺癌转移,另1枚见鳞状细胞癌转移。(近切缘),镜上:食管粘膜组织中见一小团核异型的细胞,核偏位,胞浆有粘液,符合腺癌细胞浸润,经重新切片观察已未能找到该团细胞。56/69ln(+)”。分期pt4bn3bm0叒iiic期。然后转至我科,排除化疗禁忌症,于2016-09-30按“奥沙利铂200mg叒d1+替吉奥60mgbid叒d1-14”方案行第1程化疗,过程顺利。今患者按约回院继续化疗。入院时患者无呕吐、嗳气,睡眠、精神、食欲可,大小便正常,体重上降约1kg。", "mention_data": [{"mention": "门齿", "label": "解剖部位", "offset": "38"}, {"mention": "胃角", "label": "解剖部位", "offset": "58"}, {"mention": "食管中段鳞状细胞癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "胃角低分化腺癌", "label": "疾病和诊断", "offset": "85"}, {"mention": "贲门癌根治(全胃切除)+胰腺体尾部切除+脾切除术", "label": "手术", "offset": "118"}, {"mention": "胃体小弯侧", "label": "解剖部位", "offset": "153"}, {"mention": "胃底贲门", "label": "解剖部位", "offset": "173"}, {"mention": "食管上段", "label": "解剖部位", "offset": "178"}, {"mention": "胰腺体部及尾部", "label": "解剖部位", "offset": "190"}, {"mention": "脾门淋巴结", "label": "解剖部位", "offset": "198"}, {"mention": "胃", "label": "解剖部位", "offset": "216"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "223"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "232"}, {"mention": "胃壁浆膜层", "label": "解剖部位", "offset": "266"}, {"mention": "食管", "label": "解剖部位", "offset": "272"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "308"}, {"mention": "鳞状细胞癌", "label": "疾病和诊断", "offset": "317"}, {"mention": "食管粘膜", "label": "解剖部位", "offset": "334"}, {"mention": "奥沙利铂", "label": "药物", "offset": "446"}, {"mention": "替吉奥", "label": "药物", "offset": "459"}]}
{"text": ",患者因左侧结肠癌于2013-8-9在全麻上予行左半结肠切除术;相关手术病理(9929.2013),已回:结肠腺癌(中低度分化),部分呈粘液腺癌图像,侵润溃疡型,面积8*7cm,侵穿浆膜。少数脉管内查见癌栓,局部侵犯神经。双端切线未查见癌。呈肠壁一站(7/8个)、二站(1/3个)、中间组(1/2个)淋巴结癌转移。肠壁三站(2个)淋巴结未查见癌。,免疫组化染色示癌组织:ercc1(+)、ts(-)。结合患者病情及肿瘤病理与分期继续予行术后化疗相关辅助治疗指征存在;依情已行4周期化疗,,具体用药为: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,同时辅以镇吐、升血、免疫调节等对症支持治疗(化疗期间患者总体耐受性良好)。自第下次化疗结束出院以来,患者未诉明显不适,一般情况保持良好;无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显腹痛、腹胀。为行进一步复查并必要时适当处理而再来我院就诊,门诊依情以“结肠术后”收入院。目前患者精神及情绪状态良好,食欲、饮食好,夜间睡眠后;近期无明显体重变化。", "mention_data": [{"mention": "左侧结肠癌", "label": "疾病和诊断", "offset": "4"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "24"}, {"mention": "结肠腺癌(中低度分化)", "label": "疾病和诊断", "offset": "53"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "肠壁一站(7/8个)、二站(1/3个)、中间组(1/2个)淋巴结", "label": "解剖部位", "offset": "121"}, {"mention": "肠壁三站(2个)淋巴结", "label": "解剖部位", "offset": "157"}, {"mention": "奥沙利铂", "label": "药物", "offset": "250"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "263"}, {"mention": "替加氟", "label": "药物", "offset": "278"}, {"mention": "腹痛", "label": "症状", "offset": "394"}, {"mention": "腹胀", "label": "症状", "offset": "397"}, {"mention": "结肠术后", "label": "疾病和诊断", "offset": "429"}]}
{"text": ",缘于入院前2月在我院确诊为胃癌,于2014年06月18日在全麻上行“剖腹探查+胃窦肿物活检术+胃空肠吻合术”,术顺,术后病理(201419201),提示:1、(胃壁)间质瘤,肿瘤最大径约0.8cm,镜上为梭形细胞为主型,未见显著异型性,核分裂像4/50hpf,危险程度极低。,免疫组化结果:cd34(+++),dog1(+++),cd117(+++),p53(++),actin(sm)(-),desmin(-),s100(-),ki67(8%+)。(瘤结周边仅见少量平滑肌组织,无法判断肿瘤浸润范围及切缘情况,请结合术中所见)2、(胃窦体)胃浸润型低分化腺癌,部分向神经内分泌方向分化,侵及浆膜层。,免疫组合结果:ck(l)(+++),cd68(-),cga(-),cd56(+),sy(++),ki67(40%+)。术后给予对症、补液治疗,恢复良好,伤口愈合ii/甲。2014-07-28以“奥沙利铂150mgd1+紫杉醇150mgd2+替吉奥胶囊(艾奕)40.00mgbid*7d”方案化疗1次,并辅以止吐、制酸、保胃保肝等对症处理,化疗过程顺利。此次为化疗再次入院。门诊拟“胃癌、胃空肠吻合术后”收入院。自下次出院后精神、饮食、睡眠可,无腹痛、腹胀、发热,二便正常,体重较前无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "剖腹探查+胃窦肿物活检术+胃空肠吻合术", "label": "手术", "offset": "35"}, {"mention": "(胃壁)间质瘤", "label": "疾病和诊断", "offset": "80"}, {"mention": "(胃窦体)胃浸润型低分化腺癌", "label": "疾病和诊断", "offset": "267"}, {"mention": "奥沙利铂", "label": "药物", "offset": "399"}, {"mention": "紫杉醇", "label": "药物", "offset": "411"}, {"mention": "替吉奥胶囊", "label": "药物", "offset": "422"}, {"mention": "艾奕", "label": "药物", "offset": "428"}, {"mention": "胃", "label": "解剖部位", "offset": "462"}, {"mention": "肝", "label": "解剖部位", "offset": "464"}, {"mention": "胃癌、胃空肠吻合术后", "label": "疾病和诊断", "offset": "492"}, {"mention": "腹痛", "label": "症状", "offset": "524"}, {"mention": "腹胀", "label": "症状", "offset": "527"}]}
{"text": ",缘于入院前5个月余因胃癌,于2015年02月15日在我院行“腹腔镜辅助上根治性远端胃大部切除术(d2)”,手术顺利。,术后病理:(远端胃),:胃窦隆起型粘液腺癌,侵及深肌层,脉管内见癌栓,手术标本下切端、上切端及另送(下切端)均未见癌浸润;找到小弯淋巴结1/22个,大弯淋巴结0/20个,幽门下淋巴结4/7个,幽门上淋巴结1/8个,及另送(胃右动脉根部)淋巴结0/10个见癌转移。于2015.05.15、2015.06.07行“奥沙利铂200mg静滴d1+卡培他滨片(希罗达)1500mg口服bidd1-14”方案化疗第1、2周期,化疗过程顺利,此次为行第3周期化疗再次入院。患者出院后饮食、睡眠可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹腔镜辅助上根治性远端胃大部切除术(d2)", "label": "手术", "offset": "31"}, {"mention": "(远端胃),:胃窦隆起型粘液腺癌", "label": "疾病和诊断", "offset": "65"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "123"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "134"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "145"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "156"}, {"mention": "(胃右动脉根部)淋巴结", "label": "解剖部位", "offset": "170"}, {"mention": "奥沙利铂", "label": "药物", "offset": "215"}, {"mention": "卡培他滨片", "label": "药物", "offset": "229"}, {"mention": "希罗达", "label": "药物", "offset": "235"}, {"mention": "腹痛", "label": "症状", "offset": "302"}, {"mention": "腹胀", "label": "症状", "offset": "305"}]}
{"text": ",患者于4月余前入院,诊为结肠癌,于2015-08-11在全麻上行腹腔镜上左半结肠姑息性切除术,,术中见:腹腔内有淡黄色腹水约200ml,肿瘤位于升结肠中段,明显侵出浆膜面,形成不完全梗阻,近端肠管明显增厚扩张,周围可见数个肿大淋巴结,盆腔内可见多个绿豆大小的种植转移病灶,遂行下术,术顺。术后病理示(左半结肠),:结肠溃疡型管状腺癌ii级,侵出外膜层,侵犯神经组织,手术标本双切端及另送(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5/22个,及另送(回结肠动脉根部)淋巴结0/3个,见癌转移。阑尾组织。,免疫组化:ck18(+++),cga(-),cd56(-),sy(-),ki67(60%)。该病例未检测到kras基因12、13号密码子热点突变。该病例未检测到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。2015.08.28、2015.09.23、2015.10.21、2015.11.12、2015.12.06行“奥沙利铂200mgivggtd1+希罗达1500mgpobidd1-14”方案化疗,辅以保胃、保肝、止吐、增强免疫、营养补液等治疗。过程顺利,未见明显化疗副反应。此次为化疗再次入院。门诊拟以“升结肠癌伴腹腔种植(pt4bn2am1iv期)术后化疗”收入院,患者出院后饮食、夜休可,无腹痛、腹胀、发热,体重无明显改变。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "腹腔镜上左半结肠姑息性切除术", "label": "手术", "offset": "33"}, {"mention": "腹腔", "label": "解剖部位", "offset": "53"}, {"mention": "腹水", "label": "症状", "offset": "60"}, {"mention": "升结肠中段", "label": "解剖部位", "offset": "73"}, {"mention": "近端肠管", "label": "解剖部位", "offset": "95"}, {"mention": "盆腔内", "label": "解剖部位", "offset": "118"}, {"mention": "(左半结肠),:结肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "150"}, {"mention": "回肠周淋巴结", "label": "解剖部位", "offset": "214"}, {"mention": "结肠周淋巴结", "label": "解剖部位", "offset": "225"}, {"mention": "(回结肠动脉根部)淋巴结", "label": "解剖部位", "offset": "240"}, {"mention": "阑尾", "label": "解剖部位", "offset": "262"}, {"mention": "奥沙利铂", "label": "药物", "offset": "447"}, {"mention": "希罗达", "label": "药物", "offset": "464"}, {"mention": "胃", "label": "解剖部位", "offset": "492"}, {"mention": "肝", "label": "解剖部位", "offset": "495"}, {"mention": "升结肠癌伴腹腔种植(pt4bn2am1iv期)术后", "label": "疾病和诊断", "offset": "543"}, {"mention": "腹痛", "label": "症状", "offset": "588"}, {"mention": "腹胀", "label": "症状", "offset": "591"}]}
{"text": ",患者因\\\"阴道不规则流血持续1月余,外院诊刮病理示宫颈癌10天\\\"入院,入院完善各项检查,无明显手术禁忌症,于2012.5.31在在全麻上行“ii广泛性全子宫两附件切除术+盆腔淋巴结清扫术+腹主动脉旁淋巴结取样术”,,术中探查:无明显腹水。肝膈面、肝表面、胰、脾、胃、两肾、大小肠、大网膜未扪及明显异常,盆腔及腹主动脉旁可触及增大淋巴结,子宫增大,约10*8*7cm大小,水肿,宫颈膨大,约5*4*4cm大小,两附件外观正常。术后予以抗炎、对症等处理,患者恢复好。,术后病理结果示:中分化鳞状细胞癌,癌组织浸润宫颈至深肌层,并累及宫体上段至浅肌层,脉管内见癌栓,左闭孔淋巴结见鳞癌。有放化指征,经患者及家属充分知情同意,已入组5010计划,经随机抽签为序贯放化疗组(c组)。2012-06-08予以tp方案(紫杉醇240mg+ddp50mgd1-2)化疗一疗程。后于2012-7-24至2012-8-28行原发灶和转移灶放疗,45gy。今遵主诊教授意见前来化疗。患者发病以来饮食睡眠不佳,大小便正常,体重无减轻。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "6"}, {"mention": "宫颈", "label": "解剖部位", "offset": "26"}, {"mention": "ii广泛性全子宫两附件切除术", "label": "手术", "offset": "72"}, {"mention": "盆腔淋巴结清扫术", "label": "手术", "offset": "87"}, {"mention": "腹主动脉旁淋巴结取样术", "label": "手术", "offset": "96"}, {"mention": "腹水", "label": "症状", "offset": "118"}, {"mention": "肝膈面", "label": "解剖部位", "offset": "121"}, {"mention": "肝表面", "label": "解剖部位", "offset": "125"}, {"mention": "胰", "label": "解剖部位", "offset": "129"}, {"mention": "脾", "label": "解剖部位", "offset": "131"}, {"mention": "胃", "label": "解剖部位", "offset": "133"}, {"mention": "两肾", "label": "解剖部位", "offset": "135"}, {"mention": "大小肠", "label": "解剖部位", "offset": "138"}, {"mention": "大网膜", "label": "解剖部位", "offset": "142"}, {"mention": "盆腔", "label": "解剖部位", "offset": "153"}, {"mention": "腹主动脉旁", "label": "解剖部位", "offset": "156"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "166"}, {"mention": "子宫", "label": "解剖部位", "offset": "170"}, {"mention": "宫颈", "label": "解剖部位", "offset": "190"}, {"mention": "两附件", "label": "解剖部位", "offset": "206"}, {"mention": "宫颈", "label": "解剖部位", "offset": "256"}, {"mention": "宫体", "label": "解剖部位", "offset": "266"}, {"mention": "脉管", "label": "解剖部位", "offset": "275"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "282"}, {"mention": "紫杉醇", "label": "药物", "offset": "355"}, {"mention": "ddp", "label": "药物", "offset": "364"}]}
{"text": "患者近双月前因“右下腹疼痛3日”入院,肠镜检查示结肠脾曲癌,胸部ct考虑肺部转移,于2010.09.15在联合麻醉上行姑息性右半结肠切除术,术后病理示“(结肠)溃疡型腺癌,分化ii级,浸润全层及周围脂肪组织,双切缘未见癌累及。检出肠旁淋巴结14枚,均未见癌转移”。患者术后恢复可,10-6、11-3行双次化疗,方案为:乐沙定叒200mg,同澳200mg,替加氟1g,d1;5%叒gw叒140ml+替加氟叒3.0,化疗泵,无特殊不适。现为行第三次化疗收治入院。发病以来患者神清精神可,胃纳二便睡眠正常,体重无明显改变。", "mention_data": [{"mention": "右下腹", "label": "解剖部位", "offset": "8"}, {"mention": "结肠脾曲癌", "label": "疾病和诊断", "offset": "24"}, {"mention": "胸部ct", "label": "影像检查", "offset": "30"}, {"mention": "肺部转移", "label": "疾病和诊断", "offset": "36"}, {"mention": "姑息性右半结肠切除术", "label": "手术", "offset": "59"}, {"mention": "(结肠)溃疡型腺癌,分化ii级", "label": "疾病和诊断", "offset": "76"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "115"}, {"mention": "乐沙定", "label": "药物", "offset": "159"}, {"mention": "同澳", "label": "药物", "offset": "169"}, {"mention": "替加氟", "label": "药物", "offset": "177"}, {"mention": "5%叒gw", "label": "药物", "offset": "186"}, {"mention": "替加氟", "label": "药物", "offset": "198"}, {"mention": "胃", "label": "解剖部位", "offset": "241"}]}
{"text": ",缘于入院前2月因确诊为胃癌,于2014年04月28日在全麻上行腹腔镜辅助上姑息性全胃切除术(d2)。手术顺利。术后病理(病理号201412821),:(全胃)胃-食管交界溃疡型腺神经内分泌癌(g3),累及齿状线,脉管内见癌栓,侵出浆膜外,浆膜外见癌结节,手术标本下切端、上切端及另送(下切端)均未见癌浸润。找到手术标本小弯淋巴结8个,幽门上淋巴结6个,(第7组)淋巴结9个,(第8组)淋巴结1个,(第11组)淋巴结3个及(第12组)淋巴结1个均未见癌转移。手术标本贲门右、贲门左、大弯侧、幽门下均未查见淋巴结。送检(第9组淋巴结)镜上为脉管组织、纤维组织、平滑肌组织、神经组织、脂肪组织及脉管组织。,免疫组化:cd56(+),sy(++),cga(+),ck18(+++),ki67(35%+),cdx-2(+)。术顺,术后恢复良好,排除化疗禁忌后,于2014.06.01予“奥沙利铂(艾恒)150mgd1+里葆多40mgd2+替吉奥40mgbidd1-14_”方案化疗1次,过程中患者稍有恶心、呕吐,尚可耐受,予对症处理后症状明显好转出院,此次为化疗再次入院。门诊拟“胃癌术后化疗后”收住入院,出院后饮食、夜休可,大小便如常,体重较前无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "腹腔镜辅助上姑息性全胃切除术(d2)", "label": "手术", "offset": "32"}, {"mention": "(全胃)胃-食管交界溃疡型腺神经内分泌癌(g3)", "label": "疾病和诊断", "offset": "76"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "160"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "168"}, {"mention": "贲门右", "label": "解剖部位", "offset": "233"}, {"mention": "贲门左", "label": "解剖部位", "offset": "237"}, {"mention": "大弯侧", "label": "解剖部位", "offset": "241"}, {"mention": "幽门", "label": "解剖部位", "offset": "245"}, {"mention": "奥沙利铂", "label": "药物", "offset": "389"}, {"mention": "艾恒", "label": "药物", "offset": "394"}, {"mention": "里葆多", "label": "药物", "offset": "405"}, {"mention": "替吉奥", "label": "药物", "offset": "415"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "486"}]}
{"text": ",缘于入院前2年因“右肝内肝内胆管癌”于我院行“右半肝联合尾状叶切除+胆总管切除+左前、左后胆肠吻合+腹腔淋巴结清扫+腹腔粘连松解+腹壁肿物切除术”,术中输悬浮红细胞4u,血浆400ml,术后恢复尚可,定期复查腹部ct,,术后病理示:1.(右半肝),:肝中分化胆管细胞癌。2.(右门ⅴ)送检脂肪、纤维组织中见胆管细胞癌浸润。,免疫组化:ck19(+++)、ck7(+++)、ck20(-)、cdx-2(++)、villin(+++)。出院后无纳差、腹胀、腹泻,无返酸,嗳气,无恶心、呕吐,无发热、寒战及黄疸。20,余天前于我院门诊复查mri示:肝左叶近膈面浸润性病变伴肝内胆管扩张,考虑为肝内胆管癌。13天前于我院行tace,共灌注碘化油8ml+表柔吡星40mg+洛铂30mg+栓塞微球(300-500um)1支,术后出现发热,体温最高达38.9℃,伴畏冷、腹痛,考虑介入术后反应剧烈,治疗好转后出院。今为进一步治疗,门诊拟“右肝内肝内胆管癌术后复发”收住入院。自下次出院以来,精神、睡眠、食欲欠佳,大、小便正常,体重无明显变化。", "mention_data": [{"mention": "右肝内肝内胆管癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "右半肝联合尾状叶切除+胆总管切除+左前、左后胆肠吻合+腹腔淋巴结清扫+腹腔粘连松解+腹壁肿物切除术", "label": "手术", "offset": "24"}, {"mention": "腹部ct", "label": "影像检查", "offset": "105"}, {"mention": "(右半肝),:肝中分化胆管细胞癌", "label": "疾病和诊断", "offset": "119"}, {"mention": "右门ⅴ", "label": "解剖部位", "offset": "139"}, {"mention": "胆管细胞癌", "label": "疾病和诊断", "offset": "154"}, {"mention": "腹胀", "label": "症状", "offset": "224"}, {"mention": "腹泻", "label": "症状", "offset": "227"}, {"mention": "mri", "label": "影像检查", "offset": "267"}, {"mention": "肝左叶近膈面", "label": "解剖部位", "offset": "272"}, {"mention": "肝内胆管扩张", "label": "疾病和诊断", "offset": "284"}, {"mention": "肝内胆管癌", "label": "疾病和诊断", "offset": "294"}, {"mention": "tace", "label": "手术", "offset": "308"}, {"mention": "碘化油", "label": "药物", "offset": "316"}, {"mention": "表柔吡星", "label": "药物", "offset": "323"}, {"mention": "洛铂", "label": "药物", "offset": "332"}, {"mention": "栓塞微球", "label": "药物", "offset": "339"}, {"mention": "腹痛", "label": "症状", "offset": "379"}, {"mention": "介入术", "label": "手术", "offset": "384"}, {"mention": "右肝内肝内胆管癌术后", "label": "疾病和诊断", "offset": "413"}]}
{"text": "患者因“直肠癌”于2014-06-05叒在我院于全麻上行直肠癌根治术(dixon术),手术过程顺利,术后给予抗感染及营养支持治疗,患者恢复好,切口愈合良好。现患者为术后复查来我院就诊。院外期间患者一般情况好,无恶心,无腹痛腹胀胀不适,现患者为行复查及化疗再次来院就诊,门诊以“直肠癌术后”收入院。近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "4"}, {"mention": "直肠癌根治术(dixon术)", "label": "手术", "offset": "28"}, {"mention": "腹痛", "label": "症状", "offset": "109"}, {"mention": "腹胀", "label": "症状", "offset": "111"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "138"}]}
{"text": "患者23天前因“乙状结肠癌”在我院住院行开腹探查乙状结肠癌切除术,术中见腹膜及大网膜多发转移,手术顺利,术后恢复可,术后病检回示乙状结肠隆起型中分化腺癌,大小3.5×3.0cm,浸润肠壁全层,达周围纤维脂肪组织,可见脉管癌栓,肠周淋巴结可见癌转移(4/15),伴多个肠外癌结节,近肿物断端及远肿物断端未见癌;(肠系膜结节)纤维脂肪组织中可见中分化腺癌转移;(腹壁结节)中分化腺癌转移结节,大小0.5×0.5×0.3cm,病情平稳出院,为求第一次化疗,今来我院,门诊以“乙状结肠癌术后”收入院,患者自发病以来食欲可,食量稍少,精神、睡眠可,二便正常,体重近期无明显变化。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "开腹探查乙状结肠癌切除术", "label": "手术", "offset": "20"}, {"mention": "腹", "label": "解剖部位", "offset": "36"}, {"mention": "乙状结肠隆起型中分化腺癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "肠", "label": "解剖部位", "offset": "91"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "113"}, {"mention": "肠", "label": "解剖部位", "offset": "133"}, {"mention": "肠", "label": "解剖部位", "offset": "155"}, {"mention": "腹壁", "label": "解剖部位", "offset": "179"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "234"}]}
{"text": "缘于入院前4月余于我院诊断“胃体癌”,遂于2015.03.05在全麻上行“腹腔镜上根治性全胃切除术”,术顺,术后病理(201507470):胃体小弯溃疡型低分化腺癌,侵犯神经组织,侵出浆膜层,手术标本下切端、上切端及另送(下切端)均未见癌侵润。找到大弯侧淋巴结2/6个,小弯侧淋巴结6/7个,幽门上淋巴结9/15个,及另送(第7组)淋巴结0/8个,(第8组)淋巴结2/2个,(第9组)淋巴结0/3个,(第10组)淋巴结0/4个,(第11组)淋巴结2/3个,(第12组)淋巴结4/8个见癌转移。术后予抗感染、补液、营养支持等治疗,恢复可,切口ii/甲愈合。于2015-03-31、2015-04-20予“伊立替康240mgivgttd1替吉奥胶囊(艾奕)60mgpobidd1-14”化疗2次,辅以止吐、制酸、保胃、营养支持等治疗,化疗过程顺利。今为第3次化疗就诊我院,门诊拟“胃癌术后化疗”收住入院,自下次出院以来,精神、食欲、睡眠尚可,大小便正常,体重无明显增减。", "mention_data": [{"mention": "胃体癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上根治性全胃切除术", "label": "手术", "offset": "37"}, {"mention": "胃体小弯溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "70"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "124"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "135"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "146"}, {"mention": "伊立替康", "label": "药物", "offset": "301"}, {"mention": "替吉奥胶囊", "label": "药物", "offset": "317"}, {"mention": "艾奕", "label": "药物", "offset": "323"}, {"mention": "胃", "label": "解剖部位", "offset": "355"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "388"}]}
{"text": "患者2015-04-21因“无明显诱因出现腹胀,伴便秘、里急后重,大便成形,偶有便血7月”,外院肠镜示距肛40cm息肉,0.8×1.2cm,活检病理腺瘤;2015-04-30行乙状结肠息肉电切术,病理腺癌,浸润深度达粘膜上层,无法评估蒂部情况。2015-06-03于我院结直肠科行乙状结肠切除术,术后病理:肠粘膜慢性炎,局灶粘膜缺损,可见炎性肉芽组织生长及炎性坏死物渗出,结合病史,符合治疗后改变,未见癌残留。切缘未见癌,ln叒1/10(+)见癌转移。出院诊断为乙状结肠中分化腺癌术后ypt0n1m0叒iiia期。术后9天开始发现腹部伤口渗出暗红色液体,量较多,遂就诊于我院结直肠科,予负压吸引、抗生素抗感染等对症治疗,伤口愈合较前明显改善,排除化疗禁忌症后于2015-07-02、2015-07-28、2015-08-20、2015-09-14、2015-10-12行术后xelox辅助化疗5程,过程顺利。2程化疗后出现ii度转氨酶升高,予护肝治疗后好转。3程化疗后复查未见肿瘤复发、转移征象。现为行第6程xelox方案辅助化疗入我科。自下次治疗以来,患者无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,体重无上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "21"}, {"mention": "肛", "label": "解剖部位", "offset": "52"}, {"mention": "乙状结肠息肉电切术", "label": "手术", "offset": "88"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "结直肠", "label": "解剖部位", "offset": "135"}, {"mention": "乙状结肠切除术", "label": "手术", "offset": "140"}, {"mention": "肠粘膜慢性炎", "label": "疾病和诊断", "offset": "153"}, {"mention": "乙状结肠中分化腺癌术后ypt0n1m0叒iiia期", "label": "疾病和诊断", "offset": "231"}, {"mention": "腹部", "label": "解剖部位", "offset": "265"}, {"mention": "结直肠", "label": "解剖部位", "offset": "287"}, {"mention": "肝", "label": "解剖部位", "offset": "422"}, {"mention": "骶部", "label": "解剖部位", "offset": "492"}]}
{"text": ",患者2015-12-29于我院在全麻上行\\\"(远端)胃癌根治术\\\",术程顺利,,术后病理:“(胃大体)镜检为胃中至低分化腺癌(lauren分型为混合型),癌组织浸润至胃壁浆膜上层,可见脉管内癌栓及神经束侵犯;送检网膜组织未见癌。淋巴结55枚,8枚见腺癌转移。(近切缘)未见癌。(远切缘)未见癌。,免疫组化:ck(+),her2(0),vegf(+)。”,术后病理提示:胃窦癌(pt3n3m0,iiib期)。现为行术后第四程sox方案辅助化疗收入我科。起病以来,患者精神尚可,食欲欠佳,大小便正常,无明显变化。", "mention_data": [{"mention": "(远端)胃癌根治术", "label": "手术", "offset": "23"}, {"mention": "胃中至低分化腺癌(lauren分型为混合型)", "label": "疾病和诊断", "offset": "55"}, {"mention": "胃壁浆膜上层", "label": "解剖部位", "offset": "84"}, {"mention": "胃窦癌(pt3n3m0,iiib期)", "label": "疾病和诊断", "offset": "185"}]}
{"text": ",缘于入院前4月余于我院诊断为直肠癌,于2016-06-22在全麻上行腹腔镜上探查+中转开腹姑息性直肠癌切除+乙状结肠造瘘术。术后病理(201621457),:1、(直肠),:直肠溃疡型黏液腺癌,部分为中分化绒毛状-管状腺癌,侵犯肠壁全层及肠周纤维脂肪组织,未及明确侵犯脉管及神经组织,手术标本双切端均未见癌浸润;找到肠周淋巴结23个均未见癌转移。,免疫组化结果:肿瘤细胞ck20(+),cea(+),p53(+,野生型),ck7(-),egfr(+),ki67(40%阳性)。2、(盆壁组织),:送检为增生的纤维及脂肪组织,表面见纤维素样坏死,间质见多量急、慢性炎症细胞浸润。,病理:该病例检测到kras基因12号密码子g12d突变。,病理:该病例未检测到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ii/甲愈合。2016.07.20、2016.08.10、2016.09.02、2016.09.22、2016.10.14予“奥沙利铂200mgivgttd1+卡培他滨1500mgpobidd1-14”方案化疗,辅以制酸、保肝、营养支持、增强免疫力等处理。此次为第6次化疗就诊我院,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,造瘘口排便通畅,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": "15"}, {"mention": "腹腔镜上探查+中转开腹姑息性直肠癌切除+乙状结肠造瘘术", "label": "手术", "offset": "35"}, {"mention": "(直肠),:直肠溃疡型黏液腺癌", "label": "疾病和诊断", "offset": "82"}, {"mention": "肠", "label": "解剖部位", "offset": "115"}, {"mention": "肠周纤维脂肪", "label": "解剖部位", "offset": "120"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "盆壁", "label": "解剖部位", "offset": "242"}, {"mention": "奥沙利铂", "label": "药物", "offset": "428"}, {"mention": "卡培他滨", "label": "药物", "offset": "445"}, {"mention": "肝", "label": "解剖部位", "offset": "477"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "509"}, {"mention": "腹痛", "label": "症状", "offset": "535"}, {"mention": "腹胀", "label": "症状", "offset": "538"}]}
{"text": "患者于6月前,因“直肠癌”于2015-12-30在我院行“腹腔镜上直肠癌根治术”,术后病理:(直肠)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,肠壁脂肪中淋巴结未见癌转移(0/11)。术后患者恢复可,腹泻,不能控制,进食少,无腹痛腹胀,无发热等,为进一步治疗,拟行第2次化疗,门诊以“直肠癌术后”收入院。\\u0004叒叒叒患者自起病以来,精神可,胃纳略差,大便次数增多,小便如常,体重未见明显上降。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "腹腔镜上直肠癌根治术", "label": "手术", "offset": "29"}, {"mention": "(直肠)溃疡型中分化管状乳头状腺癌", "label": "疾病和诊断", "offset": "46"}, {"mention": "肠", "label": "解剖部位", "offset": "66"}, {"mention": "肠壁脂肪中淋巴结", "label": "解剖部位", "offset": "91"}, {"mention": "腹泻", "label": "症状", "offset": "119"}, {"mention": "腹痛", "label": "症状", "offset": "132"}, {"mention": "腹胀", "label": "症状", "offset": "134"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "161"}]}
{"text": ",患者因患“结肠癌并肠梗阻”于2015-11-25在全麻上行右半结肠切除术+横结肠两腔造瘘术,术后给予营养补液、抑酸、抗菌等治疗。,术后病理示:(结肠)腺癌(中度分化),浸润溃疡型,体积4*3.5*0.6cm,部分侵穿浆膜。叒双端切线未查见癌。叒呈肠壁一站(2/7个)、中间组(1/1个)淋巴结癌转移。叒中央组(3个)淋巴结及大网膜组织内未查见癌。,免疫组化染色示:syn(-)、ts较多(+)。于术后行化疗xelox方案(奥沙利铂200mg叒d1+希罗达2g叒bid叒d1-14叒)5次。后肿瘤标志物持续下升,改为洛铂50mg叒d1+亚叶酸钙0.3g叒d2-6+替加氟1g叒d2-6。现患者为行复查来我院就诊,门诊以“结肠癌术后”收入院。自下次出院后,患者一般情况保持良好,叒无乏力感,无发热,无恶心、呕吐,无反酸、嗳气,无明显进食不适,未现明显叒腹痛、腹胀;大小便情况良好。目前患者精神及情绪状态可,食欲、饮食好,夜间睡眠可,大小便正常,近期无明显体重变化。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "10"}, {"mention": "右半结肠切除术+横结肠两腔造瘘术", "label": "手术", "offset": "30"}, {"mention": "(结肠)腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "72"}, {"mention": "奥沙利铂", "label": "药物", "offset": "212"}, {"mention": "希罗达", "label": "药物", "offset": "225"}, {"mention": "洛铂", "label": "药物", "offset": "258"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "268"}, {"mention": "替加氟", "label": "药物", "offset": "282"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "310"}, {"mention": "腹痛", "label": "症状", "offset": "375"}, {"mention": "腹胀", "label": "症状", "offset": "378"}]}
{"text": ",缘于入院前3月余因“直肠癌”于2016.08.25在我科行“腹腔镜上直肠根治性切除术+预防性回肠造瘘术”,术顺,恢复良好,术后病理(201630447),:(直肠),:肠隆起型中分化管状腺癌,侵及深肌层,未见明确侵犯脉管及神经组织,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13个,及另送(肠系膜上动脉根部)淋巴结3个均未见癌转移。,免疫组化结果:肿瘤细胞示ki67(30%+),p53(30%+),cea(+),ck7(-),ck20(+),cdx2(+)。因患者要求化疗,后于2016.10.24、2016.11.15予“奥沙利铂(乐沙定)200mgivgttd1+卡培他滨1000mgpobidd1-d14”方案化疗,辅以水化、保肝、止吐、增强免疫力等处理,未出现明显化疗副反应。此后今为第3次化疗再次就诊我院,门诊拟“直肠癌术后化疗”收入院。自下次出院以来精神、睡眠、饮食可,无腹痛、腹胀、发热,小便正常,造口排便正常,体重较前无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹腔镜上直肠根治性切除术+预防性回肠造瘘术", "label": "手术", "offset": "31"}, {"mention": "(直肠),:肠隆起型中分化管状腺癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "147"}, {"mention": "(肠系膜上动脉根部)淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "奥沙利铂", "label": "药物", "offset": "278"}, {"mention": "乐沙定", "label": "药物", "offset": "283"}, {"mention": "卡培他滨", "label": "药物", "offset": "300"}, {"mention": "肝", "label": "解剖部位", "offset": "333"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "378"}, {"mention": "腹痛", "label": "症状", "offset": "408"}, {"mention": "腹胀", "label": "症状", "offset": "411"}]}
{"text": ",患者2008年1月因粘液血便在*****诊断为直肠癌,于2008.1.17行直肠癌切除术,,术后病理:直肠中-高分化腺癌侵及肠壁全层,肠系膜淋巴结3/6见癌转移,分期pt4n1m0.术后于2008.2.13-2008.4.26行folfox方案化疗4程。200.9.10.,19复查ct:直肠壁局部不规则增厚。2009.10.26放疗40gy。2009.12.5、2009.12.25再次行folfox方案化疗2程。2010.8.26行直肠癌根治术,9.21二期缝合,,术后病理:直肠高分化腺癌侵及肠壁全层,肛门切缘及切端均为见癌,肠周淋巴结0/2见癌转移。术后folfiri方案化疗3程,末次化疗时间2010.10.26.2010.11.23出现会阴部脓肿,行脓肿切开引流术,考虑肠穿孔。2011.2.9行回肠末端(穿孔部分)切除端侧吻合术。2011.3.,7复查ct:盆底少许软组织影,局部复发待排,两侧髂血管旁、两侧腹股沟淋巴结,两侧肾盂扩张、积液,考虑输尿管上端受压,肝s4、8转移瘤。2011.3.30,我院会诊病理:直肠中分化腺癌,肌层受侵犯,脉管内见癌栓,k-ras基因野生型。于2011.3.20-2011.7.20行xelox+bev方案化疗6程。2、4程化疗后评价疗效sd。于2011.8.16开始予xeloda单药维持化疗,至今已化疗5程。2程化疗后评价疗效sd,出现轻度手足麻木。现为进一步治疗入院。患者近期精神食欲可,大小便正常,体力体重无上降。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "24"}, {"mention": "直肠癌切除术", "label": "手术", "offset": "39"}, {"mention": "直肠中-高分化腺癌", "label": "疾病和诊断", "offset": "52"}, {"mention": "肠", "label": "解剖部位", "offset": "63"}, {"mention": "肠系膜淋巴结", "label": "解剖部位", "offset": "68"}, {"mention": "ct", "label": "影像检查", "offset": "142"}, {"mention": "直肠壁", "label": "解剖部位", "offset": "145"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "219"}, {"mention": "直肠高分化腺癌", "label": "疾病和诊断", "offset": "241"}, {"mention": "肠", "label": "解剖部位", "offset": "250"}, {"mention": "肛门", "label": "解剖部位", "offset": "255"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "267"}, {"mention": "会阴部", "label": "解剖部位", "offset": "325"}, {"mention": "脓肿切开引流术", "label": "手术", "offset": "332"}, {"mention": "肠穿孔", "label": "疾病和诊断", "offset": "342"}, {"mention": "回肠末端(穿孔部分)切除端侧吻合术", "label": "手术", "offset": "355"}, {"mention": "ct", "label": "影像检查", "offset": "384"}, {"mention": "盆底", "label": "解剖部位", "offset": "387"}, {"mention": "两侧髂血管旁", "label": "解剖部位", "offset": "403"}, {"mention": "两侧腹股沟淋巴结", "label": "解剖部位", "offset": "410"}, {"mention": "两侧肾盂", "label": "解剖部位", "offset": "419"}, {"mention": "输尿管上端", "label": "解剖部位", "offset": "431"}, {"mention": "肝s4、8转移瘤", "label": "疾病和诊断", "offset": "439"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "465"}, {"mention": "bev", "label": "药物", "offset": "524"}, {"mention": "xeloda", "label": "药物", "offset": "561"}, {"mention": "手足麻木", "label": "症状", "offset": "598"}]}
{"text": ",缘于1个月前入院,诊为胃体管状腺癌,于2014年02月07日在全麻上行“腹腔镜辅助上根治性全胃切除术+食管空肠roux-y吻合术(d2)”。手术顺利。,术后病理示:(全胃),:胃体溃疡型管状腺癌(ii-iii级),浸润深肌层,侵犯神经,手术标本下、上切端及另送(下切端)均未见癌浸润。找到贲门旁淋巴结5个,小弯淋巴结3个,幽门下淋巴结1个,幽门上淋巴结2个,及另送(第7组)淋巴结2个,(第8组)淋巴结4个,(第9组)淋巴结3个,(第12组)淋巴结1个均未见癌转移。,免疫组化:ki67(65%阳性),p53(+),p170(+++),gstπ(+),egfr(-),5-fu(+),her-2(+),cd56(-),cga(-),sy(-)。术后给予对症、抗感染治疗,恢复良好,伤口愈合ii/甲。此次为行术后第1次化疗入院,门诊拟“胃癌术后”收入院,自出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃体管状腺癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "腹腔镜辅助上根治性全胃切除术+食管空肠roux-y吻合术(d2)", "label": "手术", "offset": "37"}, {"mention": "(全胃),:胃体溃疡型管状腺癌(ii-iii级)", "label": "疾病和诊断", "offset": "83"}, {"mention": "贲门旁淋巴结", "label": "解剖部位", "offset": "145"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "154"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "162"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "171"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "368"}, {"mention": "腹痛", "label": "症状", "offset": "389"}, {"mention": "腹胀", "label": "症状", "offset": "392"}]}
{"text": ",患者2015-03-31因“黑便半年”就诊于我院结直肠科,2015-03-31,腹盆mr示:升结肠肿物,考虑为升结肠癌;升结肠系膜多发淋巴结,考虑转移,遂2015-04-09行全麻上“腹腔镜左半结肠切除术”,过程顺利,,术后病理示:符合中分化腺癌,浸润至肠壁浆膜上层,可见脉管内癌栓,未见明确神经束侵犯;淋巴结(2/23)可见癌转移,,分期为:pt3n1bm0叒iiib期,术后恢复可。2015-05-13、2015-06-03、2015-06-28起行xelox方案化疗3程,过程顺利。现为行第4程辅助化疗入我科。患者3周来,无发热,胃纳可,睡眠一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "结直肠", "label": "解剖部位", "offset": "25"}, {"mention": "腹盆mr", "label": "影像检查", "offset": "41"}, {"mention": "升结肠", "label": "解剖部位", "offset": "47"}, {"mention": "升结肠癌", "label": "疾病和诊断", "offset": "56"}, {"mention": "升结肠系膜", "label": "解剖部位", "offset": "61"}, {"mention": "腹腔镜左半结肠切除术", "label": "手术", "offset": "93"}, {"mention": "肠", "label": "解剖部位", "offset": "128"}, {"mention": "胃", "label": "解剖部位", "offset": "269"}]}
{"text": ",患者因“胃窦癌”于2015-6-24在我院全麻上行\\\"(远端)胃癌根治术\\\",术程顺利,,术后病理回报:“(胃大体)镜检为低分化腺癌,部分为印戒细胞癌(lauren,分型:弥漫型),癌组织浸润至胃壁浆膜上层;未见明确脉管内癌栓及神经束侵犯;网膜组织未见癌。淋巴结103枚,10枚见癌。(近、远切缘)未见癌。,免疫组化:ck(+),vegf(+),her2(0)叒”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。2015.8.6,2015.9.8行术后辅助化疗(替吉奥叒60mg叒bid+奥沙利铂叒150mg)双程,化疗耐受可,拟\\\"胃窦癌综合治疗后\\\"收入我科。从下次出院以来,患者精神尚可,食欲一般,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "(远端)胃癌根治术", "label": "手术", "offset": "28"}, {"mention": "(胃大体)镜检为低分化腺癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "印戒细胞癌(lauren,分型:弥漫型)", "label": "疾病和诊断", "offset": "71"}, {"mention": "胃", "label": "解剖部位", "offset": "98"}, {"mention": "替吉奥", "label": "药物", "offset": "243"}, {"mention": "奥沙利铂", "label": "药物", "offset": "256"}, {"mention": "胃窦癌综合治疗后", "label": "疾病和诊断", "offset": "279"}]}
{"text": ",缘于入院前4月余于我院诊断为胃窦癌,于2015年08月25日在全麻上行“腹腔镜辅助上根治性远端胃大部切除+残胃空肠roux-y吻合术(d2)+阑尾切除术”,手术顺利。,术后病理:1、(远端胃),:胃窦小弯侧溃疡型管状腺癌ii-iii级,少数为肝样腺癌,侵犯神经,脉管内见癌栓,侵及浆膜层。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0/7个,大弯侧淋巴结0/3个,幽门下淋巴结1/1个,幽门上淋巴结1/5个,及另送的(第7组)淋巴结0/1个,(第8组)淋巴结0/3个,(第9组)淋巴结0/4个,(第11组)淋巴结0/2个,(第12a组)淋巴结1/2个,(第12p组)淋巴结0/2个,见癌转移。另送(第10组淋巴结)镜上为脉管、纤维及脂肪组织。急性单纯性阑尾炎。,免疫组化染色结果:ck(pan)(+++),ki67(60%阳性),cdx-2(+++),cd56(-),cga(-),sy(-),her-2(-),hepacocyte(-),glypican-3(+)。术后予对症、抗感染治疗,恢复良好,伤口愈合ii/甲,遂出院。2015.10.10、2015.11.27行“伊立替康240mgivgttd1+替吉奥胶囊(艾奕)40mgpobidd1-14”方案化疗,现为行术后第3次化疗再入院。门诊拟“胃癌术后化疗”收住入院。自此次发病以来,精神、睡眠、食欲可,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "(远端胃),:胃窦小弯侧溃疡型管状腺癌ii-iii级", "label": "疾病和诊断", "offset": "92"}, {"mention": "肝样腺癌", "label": "疾病和诊断", "offset": "122"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "184"}, {"mention": "伊立替康", "label": "药物", "offset": "500"}, {"mention": "替吉奥胶囊", "label": "药物", "offset": "517"}, {"mention": "艾奕", "label": "药物", "offset": "523"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "564"}]}
{"text": ",患者3月余前(2015-12-24)因“直肠癌”于我院行腹腔镜直肠癌根治术(dixon术),,术后常规病理示:(直肠)粘液腺癌伴印戒细胞癌成分(40%),肿瘤切面积8.5*1.7cm,侵透浆膜达周围脂肪组织。下上切缘、环周切缘、吻合器切缘均未查见癌,肠周淋巴结21枚,均未查见转移癌(0/21),,病理号:46920.15。术后给予消炎、营养支持治疗,病情好转后出院。后再次入院行xelox方案化疗3周期,现患者为行化疗治疗来我院,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,大小便无明显异常,体重较前无明显改变。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "21"}, {"mention": "腹腔镜直肠癌根治术(dixon术)", "label": "手术", "offset": "29"}, {"mention": "(直肠)粘液腺癌伴印戒细胞癌成分(40%)", "label": "疾病和诊断", "offset": "56"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "126"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "221"}]}
{"text": "缘于入院前3月于我院诊为直肠癌,于2015-07-31在全麻上行腹腔镜上直肠全系膜切除术(tme)预防性回肠造口术。术后病理示肠溃疡型管状腺癌ii级,侵及深肌层。手术标本下、上切端及另送(下切端)、(上切端)均未见癌浸润。找到肠周淋巴结21个,未见癌转移。免疫组化结果:ki67(80%+),ck7(-),ck20(+),villin(+++),cdx-2(+++),cea(++),cd56(-),术后给予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。术后未定期复查化疗,此次入院为造口还纳就诊我院。门诊拟“直肠癌术后回肠造口状态”收入院。下次出院以来精神、睡眠、饮食可,无腹痛、腹胀、发热,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": "12"}, {"mention": "腹腔镜上直肠全系膜切除术(tme)预防性回肠造口术", "label": "手术", "offset": "32"}, {"mention": "肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "63"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "113"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "257"}, {"mention": "腹痛", "label": "症状", "offset": "290"}, {"mention": "腹胀", "label": "症状", "offset": "293"}]}
{"text": ",患者1月前因“进食梗阻感伴下腹部隐痛不适2月余”于2016.3.25在全麻上行全胃切除术+淋巴结清扫术,手术顺利,术后患者恢复良好,术后常规病理示(胃)低分化腺癌,弥漫浸润型,肿瘤切面积14*1.8cm,侵及浆膜脂肪组织,吻合器切缘及大网膜均未查见癌。小弯侧淋巴结7枚,其中5枚(5/7)查见转移;贲门周围淋巴结11枚,其中7枚(7/11)查见转移;大弯侧淋巴结2枚(0/2),均未查见转移。,免疫组化:ck(+)、e-cad(+)、her-2(0)。,病理号:10987.16。现患者为行进一步治疗来我院就诊,门诊以“胃癌术后”收入院。患者近期饮食睡眠可,大小便无明显异常,体重较前略有减轻。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "14"}, {"mention": "全胃切除术+淋巴结清扫术", "label": "手术", "offset": "40"}, {"mention": "(胃)低分化腺癌,弥漫浸润型", "label": "疾病和诊断", "offset": "74"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "127"}, {"mention": "贲门周围淋巴结", "label": "解剖部位", "offset": "150"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "176"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "261"}]}
{"text": ",缘于入院前9天(2016.12.15)因“右卵巢囊肿破裂”急诊于我院全麻上行“腹腔镜上右卵巢囊肿剥除术+盆腔粘连松解术”,,术中见:腹腔内见暗红色血液及凝血块约400ml,右卵巢见一大小约90×70mm的囊肿,表面有破口,可见活动性出血,囊肿内可见大量暗红色凝血块,右卵巢与右侧盆壁膜状粘连,子宫及左侧附件外观未见明显异常。术顺,术后病理(201646465),示:(右卵巢肿物),:符合卵巢卵黄囊瘤,伴大片出血坏死。期间监测,afp:(12.14)14235ng/ml、(12.16)9635ng/ml、(12.22)4986ng/ml。术后无特殊不适,切口愈合好。现无腹痛、腹胀、腹泻,无阴道流血、流液,无尿频、尿急、尿急,无胸闷、心悸等不适。为行化疗再次就诊我院,门诊遂拟“右卵巢卵黄囊瘤术后”收入院。下次出院以来,患者精神、睡眠、食欲尚可,大小便正常,体重无明显改变。", "mention_data": [{"mention": "右卵巢囊肿", "label": "疾病和诊断", "offset": "22"}, {"mention": "腹腔镜上右卵巢囊肿剥除术+盆腔粘连松解术", "label": "手术", "offset": "40"}, {"mention": "腹腔", "label": "解剖部位", "offset": "67"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "87"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "134"}, {"mention": "右侧盆壁", "label": "解剖部位", "offset": "138"}, {"mention": "子宫", "label": "解剖部位", "offset": "147"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "185"}, {"mention": "卵巢卵黄囊瘤", "label": "疾病和诊断", "offset": "195"}, {"mention": "afp", "label": "实验室检验", "offset": "215"}, {"mention": "腹痛", "label": "症状", "offset": "287"}, {"mention": "腹胀", "label": "症状", "offset": "290"}, {"mention": "腹泻", "label": "症状", "offset": "293"}, {"mention": "阴道", "label": "解剖部位", "offset": "297"}, {"mention": "胸闷", "label": "症状", "offset": "316"}, {"mention": "心悸", "label": "症状", "offset": "319"}, {"mention": "右卵巢卵黄囊瘤术后", "label": "疾病和诊断", "offset": "341"}]}
{"text": ",患儿2015年12月16日无明显诱因出现左下腹胀痛,无呕吐、腹泻等症状,家长自行查体可触及左下腹巨大包块,质硬,活动度可,遂于我院就诊,,完善b超发现:腹腔内巨大实性占位(150*90*140mm),肝母细胞瘤可能(侵犯肝右、左叶)。12-25于****行“肝肿瘤切除+胆囊切除术”,术后病理确诊肝母细胞瘤,下皮型(胎儿及胚胎型)。2016.1.9入住我科,评估全身检查后诊断为肝母细胞瘤i期,并入“肝母-scmc-2011”方案化疗。2016.1.10、2.2、2.25、3.21起予cddp+vcr+5-fu方案*4次化疗。此次化疗间期已满,拟收治入院按序化疗。叒叒叒近期患儿无发热,无咳嗽、喘憋,无吐泻,胃纳精神可,二便正常。,初始资料:,诊断日期:2016.1.11,进入方案:肝母(scmc-2011),初发影像学检查及特殊检查:b,超发现:腹腔内巨大实性占位(150*90*140mm),肝母细胞瘤可能(侵犯肝右、左叶)。,术后病理:肝母细胞瘤,下皮型(胎儿及胚胎型)。,末次化疗时间及方案:2016.3.21予以cddp+vcr+5-fu,方案化疗末次影像检查:头颅(mri平扫+增强)(2016-01-11)叒脑部mri平扫+增强未见明显异常。腹部(ct平扫+增强)(2016-01-07)叒肝母细胞瘤术后改变,请结合临床。--胸部(ct平扫)(2016-01-07)叒左肺尖条索影,请结合临床。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "21"}, {"mention": "腹泻", "label": "症状", "offset": "31"}, {"mention": "左下腹", "label": "解剖部位", "offset": "46"}, {"mention": "b超", "label": "影像检查", "offset": "72"}, {"mention": "腹腔", "label": "解剖部位", "offset": "77"}, {"mention": "肝母细胞瘤", "label": "疾病和诊断", "offset": "101"}, {"mention": "肝右、左叶", "label": "解剖部位", "offset": "111"}, {"mention": "肝肿瘤切除+胆囊切除术", "label": "手术", "offset": "130"}, {"mention": "肝母细胞瘤,下皮型(胎儿及胚胎型)", "label": "疾病和诊断", "offset": "149"}, {"mention": "肝母细胞瘤i期", "label": "疾病和诊断", "offset": "190"}, {"mention": "肝母-scmc-2011", "label": "疾病和诊断", "offset": "201"}, {"mention": "cddp", "label": "药物", "offset": "244"}, {"mention": "vcr", "label": "药物", "offset": "249"}, {"mention": "5-fu", "label": "药物", "offset": "253"}, {"mention": "胃", "label": "解剖部位", "offset": "306"}, {"mention": "肝母(scmc-2011)", "label": "疾病和诊断", "offset": "344"}, {"mention": "b,超", "label": "影像检查", "offset": "371"}, {"mention": "腹腔", "label": "解剖部位", "offset": "377"}, {"mention": "肝母细胞瘤", "label": "疾病和诊断", "offset": "401"}, {"mention": "肝右、左叶", "label": "解剖部位", "offset": "411"}, {"mention": "肝母细胞瘤,下皮型(胎儿及胚胎型)", "label": "疾病和诊断", "offset": "424"}, {"mention": "vcr", "label": "药物", "offset": "469"}, {"mention": "5-fu", "label": "药物", "offset": "473"}, {"mention": "头颅(mri平扫+增强)", "label": "影像检查", "offset": "489"}, {"mention": "脑部mri", "label": "影像检查", "offset": "514"}, {"mention": "腹部(ct平扫+增强)", "label": "影像检查", "offset": "531"}, {"mention": "肝母细胞瘤术后", "label": "疾病和诊断", "offset": "555"}, {"mention": "胸部(ct平扫)", "label": "影像检查", "offset": "573"}, {"mention": "左肺尖", "label": "解剖部位", "offset": "594"}]}
{"text": ",患者2015年5月开始无明显诱因出现腹泻、稀烂便为主,1-2次/日,后出现便血,量不多,无黑便、恶心、腹痛、腹胀等,无头晕、乏力、发热等不适。外院肠镜检查提示距肛22-25cm环周肿物,肠镜能通过,活检病理提示粘液腺癌;直肠多发息肉。2015-11-11在我院结直肠科全麻上行“dixon's”术,,术后病理回报:1(肠大体)镜检为中至低分化腺癌,部分为粘液腺癌,癌组织侵犯肠壁浆膜上层,未见明确脉管内癌栓及神经束侵犯。2(近切缘)未见癌。3(远切缘)未见癌。4(中央淋巴结)6枚,未见癌。5(中间淋巴结)5枚,未见癌。6(肠旁淋巴结)7枚,1/7见腺癌转移,并浸润至结外脂肪结缔组织。,免疫组化:er(-),ercc1(+),ki67(70%+),msh2(+),msh6(+),mlh1(+),pms2(+)。患者术后恢复良好,于2015-12-08、2015-12-30给予xelox方案(奥沙利铂200mg,d1+希罗达叒早2000mg晚1500mg,d1-d14)化疗2程。2016.1.21因考虑患者化疗反应较大,暂停乐沙定化疗,先予希罗达单药化疗1程。现为求上一程化疗入院,患者近来食欲、睡眠及精神尚可,二便正常,体力、体重无明显上降。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "52"}, {"mention": "腹胀", "label": "症状", "offset": "55"}, {"mention": "头晕", "label": "症状", "offset": "60"}, {"mention": "肛", "label": "解剖部位", "offset": "81"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "106"}, {"mention": "直肠", "label": "解剖部位", "offset": "111"}, {"mention": "结直肠", "label": "解剖部位", "offset": "131"}, {"mention": "“dixon's”术", "label": "手术", "offset": "139"}, {"mention": "肠", "label": "解剖部位", "offset": "160"}, {"mention": "中至低分化腺癌", "label": "疾病和诊断", "offset": "167"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "178"}, {"mention": "肠", "label": "解剖部位", "offset": "188"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "263"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "276"}, {"mention": "奥沙利铂", "label": "药物", "offset": "399"}, {"mention": "希罗达", "label": "药物", "offset": "412"}, {"mention": "乐沙定", "label": "药物", "offset": "466"}, {"mention": "希罗达", "label": "药物", "offset": "474"}]}
{"text": ",缘于入院前2月患者因“升结肠癌”,于2015.1.23全麻上行“腹腔镜上左半结肠根治性切除术”,,术中见:无腹水,肝表面光滑,胃及空肠未见明显病变。升结肠近肝曲可见一大约5*3*3cm菜花型肿物,质硬,可疑侵出浆膜层,肠系膜根部未见肿大淋巴结。术后恢复可,术后病理(201503027),:(左半结肠),:结肠隆起型管状腺癌ii级,部分为粘液腺癌,侵及浆膜层,侵犯神经组织,脉管中见癌栓,手术标本回肠切端、结肠切端及另送(下切端)、(上切端)均未见癌浸润;找到回肠周淋巴结2/6个、结肠周围淋巴结1/10个,及另送(左结肠系膜根根部)淋巴结0/3个,(回结结肠系膜肠系膜根部)淋巴结0/4个,见癌转移。另见阑尾组织。该病例未检测到braf基因v600e突变。该病例未检测到kras基因12、13号密码子热点突变。于2015.02.26予“奥沙利铂d1150mgivgtt+卡培他滨1000mgpod2-15”方案化疗,辅以止吐、制酸保胃、保肝等治疗,无明显化疗反应。此次为第2次化疗再次入院。自下次出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "升结肠癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "腹腔镜上左半结肠根治性切除术", "label": "手术", "offset": "33"}, {"mention": "腹水", "label": "症状", "offset": "55"}, {"mention": "肝", "label": "解剖部位", "offset": "58"}, {"mention": "胃", "label": "解剖部位", "offset": "64"}, {"mention": "空肠", "label": "解剖部位", "offset": "66"}, {"mention": "升结肠近肝曲", "label": "解剖部位", "offset": "75"}, {"mention": "肠", "label": "解剖部位", "offset": "110"}, {"mention": "(左半结肠),:结肠隆起型管状腺癌ii级", "label": "疾病和诊断", "offset": "146"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "170"}, {"mention": "回肠", "label": "解剖部位", "offset": "199"}, {"mention": "结肠", "label": "解剖部位", "offset": "204"}, {"mention": "回肠周淋巴结", "label": "解剖部位", "offset": "231"}, {"mention": "结肠周围淋巴结", "label": "解剖部位", "offset": "242"}, {"mention": "(左结肠系膜根根部)淋巴结", "label": "解剖部位", "offset": "258"}, {"mention": "(回结结肠系膜肠系膜根部)淋巴结", "label": "解剖部位", "offset": "276"}, {"mention": "阑尾", "label": "解剖部位", "offset": "304"}, {"mention": "奥沙利铂", "label": "药物", "offset": "370"}, {"mention": "卡培他滨", "label": "药物", "offset": "387"}, {"mention": "胃", "label": "解剖部位", "offset": "418"}, {"mention": "肝", "label": "解剖部位", "offset": "421"}, {"mention": "腹痛", "label": "症状", "offset": "461"}, {"mention": "腹胀", "label": "症状", "offset": "464"}]}
{"text": ",患者于2016-6-30在全麻上行\\\"(远端)腹腔镜辅助胃癌根治术\\\",,术后病理回报:“(胃大体)(肿物)镜检为低分化腺癌,lauren,分型:混合型,癌组织累及胃壁浅肌层,可见神经束侵犯,未见明确脉管内癌栓;(溃疡病灶)镜检为低分化腺癌,溃疡病灶浸润情况及免疫组化待待补充报告;网膜组织未见癌。淋巴结81枚,3枚见癌。(远、近切缘)未见癌”。于2016-08-04开始行s-1单药化疗,现为进一步术后辅助化疗收入我科。起病以来,患者精神尚可,食欲欠佳,大小便正常,身体无明显消瘦。", "mention_data": [{"mention": "(远端)腹腔镜辅助胃癌根治术", "label": "手术", "offset": "20"}, {"mention": "胃", "label": "解剖部位", "offset": "47"}, {"mention": "胃", "label": "解剖部位", "offset": "83"}, {"mention": "s-1", "label": "药物", "offset": "188"}]}
{"text": ",患者因“直肠癌”于2015-11-24在腰硬联合麻醉上行tem术,手术过程顺利,,术后病理示:(直肠)腺癌(中度分化),隆起型,体积2.3*2.1*1cm,侵达粘膜上层。未累及周边及另送“底部”切除面。术后给予抗感染及营养支持治疗,患者恢复好。6个月前患者返院复查行结肠镜检查,见手术部位愈合良好,直肠未见明显异常。2016-3-8,腹盆腔强化ct示:胆囊管结石,直肠壁厚,前列腺增生。于2016-3-9开始行直肠局部放疗,共行25次,dt叒5000cgy,同时给予局部灌肠及激素、维生素、改善微循环治疗,院外期间患者一般情况好,未再出现便血情况,无恶心,无腹痛腹胀不适,1月前患者查体发现胆囊息肉,直径约6mm,现患者为行手术治疗来院就诊,门诊以“tem术后、胆囊息肉”收入院。叒叒叒近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "腰硬联合麻醉上行tem术", "label": "手术", "offset": "21"}, {"mention": "(直肠)腺癌(中度分化),隆起型", "label": "疾病和诊断", "offset": "48"}, {"mention": "直肠", "label": "解剖部位", "offset": "150"}, {"mention": "腹盆腔强化ct", "label": "影像检查", "offset": "168"}, {"mention": "胆囊管结石", "label": "疾病和诊断", "offset": "177"}, {"mention": "直肠", "label": "解剖部位", "offset": "183"}, {"mention": "前列腺增生", "label": "疾病和诊断", "offset": "188"}, {"mention": "直肠", "label": "解剖部位", "offset": "206"}, {"mention": "肠", "label": "解剖部位", "offset": "237"}, {"mention": "腹痛", "label": "症状", "offset": "280"}, {"mention": "腹胀", "label": "症状", "offset": "282"}, {"mention": "胆囊息肉", "label": "疾病和诊断", "offset": "296"}, {"mention": "tem术后", "label": "疾病和诊断", "offset": "326"}, {"mention": "胆囊息肉", "label": "疾病和诊断", "offset": "332"}]}
{"text": "患者于2014.6.23因“下腹部胀痛不适并黑便”来我院胃肠外科就诊,入院后完善必要的化验检查,于2014-6-25行胃镜检查,于贲门部小弯处可见菜花样隆起,大小约5*4cm,周边粘膜不规则,呈结节状,质地脆,易出血。侵犯食道上段约3cm。综合患者病情,转胸外科后于2014.7.1日行贲门癌根治术,术后给予抗生素预防感染、化痰、止酸等治疗。术后病理:胃贲门小弯侧腺癌(中度分化),浸润溃疡型,体积5*5*1.2cm,累及上段食管。侵穿浆膜达脂肪组织。双端切线及底部切除面未查见癌。患者术后恢复顺利,于2014.7.14出院。叒叒叒患者于2014.8.6第2次入院,入院后完善检查,给予奥沙利铂+多西他赛方案化疗,同时给予保肝、升白细胞、止吐等对症治疗,化疗结束后患者顺利出院。叒叒叒患者现为求进一步治疗第3次来我院就诊,门诊以“胃底贲门癌术后”收入院。患者自下次出院以来无恶心呕吐,无腹胀腹泻,无胸闷憋气,无咳嗽咳痰等症状,饮食及睡眠可,大小便正常,体重未见明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "14"}, {"mention": "胃", "label": "解剖部位", "offset": "28"}, {"mention": "肠", "label": "解剖部位", "offset": "29"}, {"mention": "贲门部小弯处", "label": "解剖部位", "offset": "65"}, {"mention": "食道上段", "label": "解剖部位", "offset": "111"}, {"mention": "胸", "label": "解剖部位", "offset": "128"}, {"mention": "贲门癌根治术", "label": "手术", "offset": "143"}, {"mention": "胃贲门小弯侧腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "176"}, {"mention": "上段食管", "label": "解剖部位", "offset": "211"}, {"mention": "奥沙利铂", "label": "药物", "offset": "293"}, {"mention": "多西他赛", "label": "药物", "offset": "298"}, {"mention": "肝", "label": "解剖部位", "offset": "312"}, {"mention": "胃底贲门癌术后", "label": "疾病和诊断", "offset": "365"}, {"mention": "腹胀", "label": "症状", "offset": "393"}, {"mention": "腹泻", "label": "症状", "offset": "395"}, {"mention": "胸闷憋气", "label": "症状", "offset": "399"}]}
{"text": ",患者2014年12月22日于我科全麻上行扩大左半结肠切除术,,术中探查:肿瘤前壁与大网膜粘连,肿瘤后壁与胃后壁侵润粘连,病变位于横结肠中段,透浆膜,,术后病理:结肠癌(浆膜上层),溃疡型,中分化腺癌,ii级,断端无癌,淋巴结可见癌转移(1/23枚),,浸润深度:浆膜上层,肌间神经节侵犯(+),脉管癌栓(+),结外肿瘤种植(1+),ptnm,分期:t4bn1m0,iiic期,,免疫组化:ki67(50-70%+),p53(70-90%+),ca199(+),cea(++),cdx2(>90%+),gstp1(+),egfr(++),vegf(+++)。血管内皮细胞cd34(+)其内可见癌栓,淋巴管内皮细胞d2-40(+)其内未见癌栓。,病理号:1446。患者术后恢复良好,已行xelox方案4次,现为求进一步辅助化疗收入我科,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": "扩大左半结肠切除术", "label": "手术", "offset": "21"}, {"mention": "胃", "label": "解剖部位", "offset": "53"}, {"mention": "横结肠中段", "label": "解剖部位", "offset": "65"}, {"mention": "结肠癌(浆膜上层),溃疡型,中分化腺癌,ii级", "label": "疾病和诊断", "offset": "81"}, {"mention": "腹痛", "label": "症状", "offset": "386"}]}
{"text": "缘于入院前3月余于我院诊为“胃癌”,于2014.01.02全麻上行“腹腔镜上根治性全胃切除+食管空肠roux-y吻合术(d2)”,术中见:腹腔内无明显腹水,盆腔、腹壁、大网膜无转移结节,肝脏质地大小正常,未及明显转移病灶。术后病理(201400136)示“(全胃)胃体下段小弯侧溃疡型管状腺癌i级,侵出浆膜层,手术标本下、上切端及另送(下切端)均未见癌浸润,找到贲门右淋巴结3个,小弯淋巴结8个,大弯淋巴结12个,幽门下淋巴结6个,幽门上淋巴结15个,及另送(胃右动脉旁)淋巴结13个,(肝总动脉旁)淋巴结2个,均未见癌转移”,术后予对症、营养支持等治疗,恢复良好,伤口愈合ii/甲。于2014.2.11、2014.3.4、2014.3.27于我院予行“奥沙利铂200mgigvttd1+卡培他滨1000mgpobidd1-14”方案化疗3次,化疗后未见明显化疗副反应,此次为入院再次化疗求诊我院,门诊拟“胃癌术后”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": "胃癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上根治性全胃切除+食管空肠roux-y吻合术(d2)", "label": "手术", "offset": "34"}, {"mention": "腹腔", "label": "解剖部位", "offset": "69"}, {"mention": "腹水", "label": "症状", "offset": "75"}, {"mention": "盆腔", "label": "解剖部位", "offset": "78"}, {"mention": "腹壁", "label": "解剖部位", "offset": "81"}, {"mention": "大网膜", "label": "解剖部位", "offset": "84"}, {"mention": "肝脏", "label": "解剖部位", "offset": "93"}, {"mention": "(全胃)胃体下段小弯侧溃疡型管状腺癌i级", "label": "疾病和诊断", "offset": "128"}, {"mention": "贲门右淋巴结", "label": "解剖部位", "offset": "181"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "190"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "198"}, {"mention": "幽门下淋巴结", "label": "解剖部位", "offset": "207"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "216"}, {"mention": "(胃右动脉旁)淋巴结", "label": "解剖部位", "offset": "229"}, {"mention": "(肝总动脉旁)淋巴结", "label": "解剖部位", "offset": "243"}, {"mention": "奥沙利铂", "label": "药物", "offset": "327"}, {"mention": "卡培他滨", "label": "药物", "offset": "344"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "403"}, {"mention": "腹痛", "label": "症状", "offset": "429"}, {"mention": "腹胀", "label": "症状", "offset": "432"}]}
{"text": "患者因“宫颈癌”于2015-11-30在我院行经腹广泛子宫+两附件切除+盆腔淋巴清扫术,术后病理检查示:宫颈低分化鳞状细胞癌,内生浸润型,肿物切面积9.3*1.8cm,侵达深肌层,(约占宫壁全层3/4处),阴道壁断端及右左宫旁组织均未查见癌,送检右闭孔淋巴结4枚(0/4),左闭孔淋巴结12枚(0/12),右髂血管淋巴结9枚(0/9),左髂血管淋巴结5枚(0/5),均未查见转移癌。(宫腔)子宫内膜息肉,萎缩状态子宫内膜。(两侧)输卵管、卵巢大致正常。术后于2015-12-09应用力朴素+顺铂化疗一次,化疗过程顺利,副反应不重。现患者进食较差,轻度恶心,无呕吐,无腹胀、腹痛,现为求二次化疗入院,门诊以“宫颈癌术后化疗”收住妇科病房。现一般情况可,睡眠可,进食量少,大小便无异常,体重无明显变化。", "mention_data": [{"mention": "宫颈癌", "label": "疾病和诊断", "offset": "4"}, {"mention": "经腹广泛子宫+两附件切除+盆腔淋巴清扫术", "label": "手术", "offset": "23"}, {"mention": "宫颈低分化鳞状细胞癌,内生浸润型", "label": "疾病和诊断", "offset": "52"}, {"mention": "宫", "label": "解剖部位", "offset": "93"}, {"mention": "阴道", "label": "解剖部位", "offset": "103"}, {"mention": "宫", "label": "解剖部位", "offset": "111"}, {"mention": "右闭孔淋巴结", "label": "解剖部位", "offset": "123"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "137"}, {"mention": "右髂血管淋巴结", "label": "解剖部位", "offset": "153"}, {"mention": "左髂血管淋巴结", "label": "解剖部位", "offset": "168"}, {"mention": "(宫腔)子宫内膜息肉", "label": "疾病和诊断", "offset": "191"}, {"mention": "子宫内膜", "label": "解剖部位", "offset": "206"}, {"mention": "(两侧)输卵管", "label": "解剖部位", "offset": "211"}, {"mention": "卵巢", "label": "解剖部位", "offset": "219"}, {"mention": "力朴素", "label": "药物", "offset": "241"}, {"mention": "顺铂", "label": "药物", "offset": "245"}, {"mention": "腹胀", "label": "症状", "offset": "283"}, {"mention": "腹痛", "label": "症状", "offset": "286"}, {"mention": "宫颈癌术后", "label": "疾病和诊断", "offset": "303"}]}
{"text": ",缘于入院前2月余于我院诊断为胃癌,于2015年01月02日在全麻上行远端胃大部切除术(b-ii式),手术顺利。术后病理(201500055),示:远端胃),:胃窦小弯侧溃疡型低分化腺癌(双灶),侵出浆膜层,累及神经,手术标本下、上切端未见癌浸润。找到小弯淋巴结12/13个,大弯淋巴结0/1个,幽门上淋巴结1/1个见癌转移。,基因测结果:计数肿瘤细胞20个her2/cen17=1.10her2/cell=2.3cen17/cell=2.1,结论:her2基因无扩增,17号染色体呈二倍体。术后恢复可,于2015.02.04、2015.02.27行“盐酸伊立替康注射液280mg静滴d1+替吉奥胶囊(艾奕)60.00mg口服bid*d1-14天”方案化疗,辅以保肝、制酸、免疫支持等对症处理后,化疗过程顺利,无特殊化疗副反应。目前患者无进食可,无特殊不适,要求进一步行化疗,拟“胃癌术后”入院。患者出院后饮食、夜休可,无腹痛、腹胀、发热,体重较前无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "远端胃大部切除术(b-ii式)", "label": "手术", "offset": "35"}, {"mention": "胃", "label": "解剖部位", "offset": "76"}, {"mention": "胃窦小弯侧溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "126"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "138"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "148"}, {"mention": "盐酸伊立替康注射液", "label": "药物", "offset": "276"}, {"mention": "替吉奥胶囊", "label": "药物", "offset": "295"}, {"mention": "艾奕", "label": "药物", "offset": "301"}, {"mention": "肝", "label": "解剖部位", "offset": "332"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "390"}, {"mention": "腹痛", "label": "症状", "offset": "411"}, {"mention": "腹胀", "label": "症状", "offset": "414"}]}
{"text": ",入院前9天(2016.10.25)因“宫颈鳞癌ib1期”于我院气静全麻上行“腹式广泛全子宫切除术+右输卵管切除术+盆腔淋巴结清扫术+两侧卵巢移位术+肠粘连松解术+阴道顶悬吊术”。,术中见:腹腔内无腹水,子宫正常大小,表面光滑,右侧输卵管积水,呈腊肠状,右阔韧带前方粘连,左侧输卵管伞部与左卵巢粘连,峡部见一膨出瘤体,大小约1.5cm×1.5cm,表面光滑,质稍硬;两侧卵巢未见明显异常;肝、脾、膈上、肠管、肠系膜、腹膜等未见明显异。术顺,术后病理(201638443),示:(全子宫+右侧输卵管),:宫颈内生浸润性角化性鳞状细胞癌ii级(水平浸润约5cm,垂直浸润深度约1.5cm,约>1/2肌层)。手术标本阴道切端及两侧宫旁组织未见癌浸润。找到左宫旁淋巴结1个,及另送(右盆腔)淋巴结10个,(左盆腔)淋巴结10个,(右髂总)淋巴结2个,(左髂总)淋巴结7个,均未见癌转移。现无发热、咳嗽、咳痰,无腹痛、腹胀、腹泻,无胸闷、心悸,无恶心、呕吐等不适。为行化疗再次就诊于我院,门诊遂拟“宫颈鳞癌ib1期术后”收入院。自下次出院以来,患者精神、饮食、睡眠尚可,留置导尿,尿管通畅,尿色清,大便正常,体重无明显变化。", "mention_data": [{"mention": "宫颈鳞癌ib1期", "label": "疾病和诊断", "offset": "20"}, {"mention": "腹式广泛全子宫切除术+右输卵管切除术+盆腔淋巴结清扫术+两侧卵巢移位术+肠粘连松解术+阴道顶悬吊术", "label": "手术", "offset": "39"}, {"mention": "腹腔", "label": "解剖部位", "offset": "95"}, {"mention": "子宫", "label": "解剖部位", "offset": "102"}, {"mention": "右侧输卵管", "label": "解剖部位", "offset": "114"}, {"mention": "右阔韧带", "label": "解剖部位", "offset": "127"}, {"mention": "左侧输卵管伞部", "label": "解剖部位", "offset": "136"}, {"mention": "左卵巢", "label": "解剖部位", "offset": "144"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "183"}, {"mention": "肝", "label": "解剖部位", "offset": "194"}, {"mention": "脾", "label": "解剖部位", "offset": "196"}, {"mention": "膈上", "label": "解剖部位", "offset": "198"}, {"mention": "肠", "label": "解剖部位", "offset": "201"}, {"mention": "肠", "label": "解剖部位", "offset": "204"}, {"mention": "腹", "label": "解剖部位", "offset": "208"}, {"mention": "全子宫", "label": "解剖部位", "offset": "239"}, {"mention": "右侧输卵管", "label": "解剖部位", "offset": "243"}, {"mention": "宫颈内生浸润性角化性鳞状细胞癌ii级", "label": "疾病和诊断", "offset": "251"}, {"mention": "阴道", "label": "解剖部位", "offset": "305"}, {"mention": "宫", "label": "解剖部位", "offset": "312"}, {"mention": "左宫旁淋巴结", "label": "解剖部位", "offset": "324"}, {"mention": "(右盆腔)淋巴结", "label": "解剖部位", "offset": "336"}, {"mention": "(左盆腔)淋巴结", "label": "解剖部位", "offset": "348"}, {"mention": "(右髂总)淋巴结", "label": "解剖部位", "offset": "360"}, {"mention": "(左髂总)淋巴结", "label": "解剖部位", "offset": "371"}, {"mention": "腹痛", "label": "症状", "offset": "401"}, {"mention": "腹胀", "label": "症状", "offset": "404"}, {"mention": "腹泻", "label": "症状", "offset": "407"}, {"mention": "胸闷", "label": "症状", "offset": "411"}, {"mention": "心悸", "label": "症状", "offset": "414"}, {"mention": "宫颈鳞癌ib1期术后", "label": "疾病和诊断", "offset": "444"}]}
{"text": ",缘于入院前2年患者于我院诊断为“胃癌”,于2013年11月22日在全麻上行“腹腔镜根治性远端胃大部切除术(毕i式d2r0)”,,术中见:无腹水,盆底、膀胱、未及结节;肝表面光滑,腹膜后、空回肠未见结节,肿瘤位于胃小弯侧胃角处,大小3×3×1.5cm,浸润溃疡型,侵出浆膜层,侵及邻近脂肪组织,腹腔动脉周围见数个0.8-1cm大小不一肿大淋巴结。术后病理(201336699),:(远端胃)胃角溃疡型低分化腺癌,侵出浆膜层,侵犯神经,脉管内见癌栓,手术标本下、上切端及另送(下切端)、(上切端)均未见癌浸润。找到小弯淋巴结10/15个,大弯淋巴结1/7个,幽门上淋巴结5/5个,及另送(第七组)淋巴结1/2个,(第八组)淋巴结2/7个,(第九组)淋巴结0/4个,(第十二组)淋巴结0/1个,(第十五组)淋巴结0/1个见癌转移。,免疫组化结果:ck7(++),ck20(-),villin(+++),cea(-),cdx-2(+++),cga(-),cd56(-),sy(-),ki67(70%+),her-2(++)。术后恢复良好,于我院行“多柔比星40mgd1+奥沙利铂(艾恒)150mgd2+希罗达1000mgbidd1-14”方案行术后化疗8次。化疗后出院后,饮食睡眠可,一般情况可。3天前突发腹痛,伴腹胀,肛门停止排气排便,无恶心呕吐,无畏冷寒战,遂就诊我院,门诊拟“胃癌术后化疗后”收住入院,自发病以来,精神欠佳,饮食欠佳,大便未解,小便如常。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "17"}, {"mention": "腹腔镜根治性远端胃大部切除术(毕i式d2r0)", "label": "手术", "offset": "39"}, {"mention": "腹水", "label": "症状", "offset": "70"}, {"mention": "盆底", "label": "解剖部位", "offset": "73"}, {"mention": "膀胱", "label": "解剖部位", "offset": "76"}, {"mention": "肝", "label": "解剖部位", "offset": "84"}, {"mention": "腹", "label": "解剖部位", "offset": "90"}, {"mention": "空回肠", "label": "解剖部位", "offset": "94"}, {"mention": "胃小弯侧胃角", "label": "解剖部位", "offset": "106"}, {"mention": "腹腔动脉", "label": "解剖部位", "offset": "147"}, {"mention": "(远端胃)胃角溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "190"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "256"}, {"mention": "大弯淋巴结", "label": "解剖部位", "offset": "268"}, {"mention": "幽门上淋巴结", "label": "解剖部位", "offset": "278"}, {"mention": "(第七组)淋巴结", "label": "解剖部位", "offset": "292"}, {"mention": "(第八组)淋巴结", "label": "解剖部位", "offset": "305"}, {"mention": "(第九组)淋巴结", "label": "解剖部位", "offset": "318"}, {"mention": "(第十二组)淋巴结", "label": "解剖部位", "offset": "331"}, {"mention": "(第十五组)淋巴结", "label": "解剖部位", "offset": "345"}, {"mention": "多柔比星", "label": "药物", "offset": "471"}, {"mention": "奥沙利铂", "label": "药物", "offset": "482"}, {"mention": "艾恒", "label": "药物", "offset": "487"}, {"mention": "希罗达", "label": "药物", "offset": "498"}, {"mention": "腹痛", "label": "症状", "offset": "550"}, {"mention": "腹胀", "label": "症状", "offset": "554"}, {"mention": "肛门", "label": "解剖部位", "offset": "557"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "588"}]}
{"text": "缘于入院前2月余于我院诊断“乙状结肠癌”,于2016-7-25行“腹腔镜上乙状结肠切除术”,术顺,术后予营养支持、制酸保胃、增强免疫及维持电解质平衡等治疗,术后恢复良好。术后病理:大肠溃疡型管状腺癌ii级,侵及外膜层。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15个,及另送(肠系膜上a根部)淋巴结1个、(中间组)淋巴结2个,未见癌转移。于2016.08.21、2016.09.13予“奥沙利铂200mgivgttd1+卡培他滨1500mgpobidd1-14”方案化疗2周期,疗程顺利,未出现明显化疗副作用,今为行术后第3次化疗再诊我院,门诊拟“乙状结肠癌术后化疗”收住入院。自下次出院以来,精神、睡眠、食欲尚可,二便正常,体重无明显变化。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "腹腔镜上乙状结肠切除术", "label": "手术", "offset": "33"}, {"mention": "胃", "label": "解剖部位", "offset": "60"}, {"mention": "大肠溃疡型管状腺癌ii级", "label": "疾病和诊断", "offset": "90"}]}
{"text": ",患者2016-07-07于我院在全麻上行\\\"腹腔镜探查+(全胃)胃癌根治术\\\",,术后病理回报:“(大体)镜检为低分化腺癌,部分为印戒细胞癌,lauren,分型:弥漫型,浸润至胃壁浆膜上层,可见神经束侵犯,未见明确脉管内癌栓;网膜组织未见癌。淋巴结51枚,10枚见癌。(远、近切缘)未见癌”,诊断“全胃癌(pt3n3m0,iiib)”。于2016-08-10、2016-09-07、2016-10-08予以sox方案化疗三程,化疗过程顺利,现患者无返酸、嗳气、恶心、呕吐、黑便等不适,现为行进一步治疗收入我科。起病以来,患者精神尚可,食欲欠佳,大小便正常,近期体重无明显改变。", "mention_data": [{"mention": "腹腔镜探查+(全胃)胃癌根治术", "label": "手术", "offset": "23"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "57"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "66"}, {"mention": "lauren,分型:弥漫型", "label": "疾病和诊断", "offset": "72"}, {"mention": "胃壁", "label": "解剖部位", "offset": "89"}, {"mention": "全胃癌(pt3n3m0,iiib)", "label": "疾病和诊断", "offset": "150"}]}
{"text": ",患者因2013-1-13外院查ca125叒623叒u/ml叒ca199叒522叒u/ml,01-21,盆腔mr平扫示:1.盆腔右侧附件区占位,考虑来源于右侧附件,以囊性成分为主,伴少许实性壁结节叒2.盆腔少量积液.后于*****行分段诊刮,该院及我院病理检查均提示腺癌。完善检查后于2013年01月30日在全身麻醉上行广泛性子宫切除、两侧输卵管卵巢切除及盆腔淋巴结清扫术,,术后组织病理检查报告:1、子宫内膜腺癌诊刮术后全子宫标本,内膜未见癌残留,宫颈、颈管、右左宫旁、阴道壁残端及两输卵管未见癌累及,两卵巢见癌累及。2、右髂内(0/2)、右腹股沟(0/1)、右髂总(0/1)、左闭孔(0/2)、左髂外(0/2)、左腹股沟(0/2)、左髂总(0/2)淋巴结未见癌转移。术后予tp方案化疗4周期,有恶心呕吐及骨髓抑制不良反应,对症支持治疗后好转,今患者为求上一周期化疗再来我院我科住院治疗。\\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,大便正常,小便正常,体重无明显变化。", "mention_data": [{"mention": "ca125", "label": "实验室检验", "offset": "16"}, {"mention": "ca199", "label": "实验室检验", "offset": "31"}, {"mention": "盆腔mr", "label": "影像检查", "offset": "52"}, {"mention": "盆腔右侧附件区占位", "label": "疾病和诊断", "offset": "62"}, {"mention": "右侧附件", "label": "解剖部位", "offset": "77"}, {"mention": "盆腔少量积液", "label": "疾病和诊断", "offset": "101"}, {"mention": "分段诊刮", "label": "手术", "offset": "116"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "133"}, {"mention": "广泛性子宫切除、两侧输卵管卵巢切除及盆腔淋巴结清扫术", "label": "手术", "offset": "160"}, {"mention": "子宫内膜腺癌诊刮术后", "label": "疾病和诊断", "offset": "201"}, {"mention": "全子宫", "label": "解剖部位", "offset": "211"}, {"mention": "宫颈", "label": "解剖部位", "offset": "225"}, {"mention": "颈管", "label": "解剖部位", "offset": "228"}, {"mention": "宫", "label": "解剖部位", "offset": "233"}, {"mention": "阴道", "label": "解剖部位", "offset": "236"}, {"mention": "两输卵管", "label": "解剖部位", "offset": "242"}, {"mention": "两卵巢", "label": "解剖部位", "offset": "252"}, {"mention": "右髂内", "label": "解剖部位", "offset": "262"}, {"mention": "右腹股沟", "label": "解剖部位", "offset": "271"}, {"mention": "右髂总", "label": "解剖部位", "offset": "281"}, {"mention": "左闭孔", "label": "解剖部位", "offset": "290"}, {"mention": "左髂外", "label": "解剖部位", "offset": "299"}, {"mention": "左腹股沟", "label": "解剖部位", "offset": "308"}, {"mention": "左髂总", "label": "解剖部位", "offset": "318"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "326"}]}
{"text": ",患者2月前因“胃癌”于2014-07-01在在全麻上行胃癌根治术,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:病理诊断叒,:(胃幽门小弯侧)腺癌(中度分化),浸润溃疡型,体积2*2*0.3cm,侵达深肌层。叒双端切线及另送“远端”切线未查见癌。叒呈五组(1/1个)淋巴结癌转移。叒四组(9个)、六组(4个)及另送“1、3、7组”(11个)淋巴结未查见癌。叒,免疫组化染色示癌组织:cerbb-2(2+)、syn(-)、ercc1弥漫(+)、β-tubulin-iii(-)、ts多量(+)、rrm1少量(+)、topoii较多(+)。根据患者病情具有化疗指征,于2014-07-15开始第一周期化疗,,方案为:奥沙利铂150mg叒d1,亚叶酸钙0.3g+替加氟1.0g叒d2-d6,同时给与升白细胞、护肝、止吐、免疫增强治疗,注意观察患者病情变化,给予升白、止吐等药物,患者化疗耐受可,无明显化疗副反应。叒叒叒院外期间患者一般情况好,无恶心,无腹痛腹胀不适,现患者为行复查及化疗再次来院就诊,门诊以“胃癌术后”收入院。叒叒叒近期患者精神可,饮食可,大便次数多,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "胃癌根治术", "label": "手术", "offset": "28"}, {"mention": "(胃幽门小弯侧)腺癌(中度分化),浸润溃疡型", "label": "疾病和诊断", "offset": "73"}, {"mention": "五组(1/1个)淋巴结", "label": "解剖部位", "offset": "135"}, {"mention": "四组(9个)、六组(4个)及另送“1、3、7组”(11个)淋巴结", "label": "解剖部位", "offset": "151"}, {"mention": "奥沙利铂", "label": "药物", "offset": "316"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "329"}, {"mention": "替加氟", "label": "药物", "offset": "338"}, {"mention": "肝", "label": "解剖部位", "offset": "362"}, {"mention": "腹痛", "label": "症状", "offset": "433"}, {"mention": "腹胀", "label": "症状", "offset": "435"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "461"}]}
{"text": "缘于入院前3月余就诊我院行胃镜检查示:“胃癌”,腹部ct提示“胃体局部管壁不规则增厚,符合胃癌,侵犯浆膜面,伴邻近的网膜种植转移可能及胃周、下腹膜后多发淋巴结转移;病变与肝右外叶、胰头间脂肪间隙模糊”。考虑诊断为“胃癌伴腹腔种植转移”并于2015.04.06、2015.04.29、2015.05.26、2015.06.19予行“奥沙利铂(艾恒)150mg静滴d1+紫杉醇注射液(安素泰)180mg静滴d2+卡培他滨片(希罗达)1000.00mg口服bidd1-14”方案化疗,期间辅以止吐、保肝、营养支持等治疗,化疗后无特殊不适,今为返院复查行第5周期化疗,门诊拟“胃癌”收治入院。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": "胃癌", "label": "疾病和诊断", "offset": "20"}, {"mention": "腹部ct", "label": "影像检查", "offset": "24"}, {"mention": "胃体", "label": "解剖部位", "offset": "31"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "45"}, {"mention": "胃", "label": "解剖部位", "offset": "67"}, {"mention": "下腹", "label": "解剖部位", "offset": "70"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "85"}, {"mention": "胰头", "label": "解剖部位", "offset": "90"}, {"mention": "胃癌伴腹腔种植转移", "label": "疾病和诊断", "offset": "107"}, {"mention": "奥沙利铂", "label": "药物", "offset": "165"}, {"mention": "艾恒", "label": "药物", "offset": "170"}, {"mention": "紫杉醇", "label": "药物", "offset": "183"}, {"mention": "安素泰", "label": "药物", "offset": "190"}, {"mention": "卡培他滨片", "label": "药物", "offset": "204"}, {"mention": "希罗达", "label": "药物", "offset": "210"}, {"mention": "肝", "label": "解剖部位", "offset": "247"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "284"}]}
{"text": ",患者于2013年6月16日因“停经21周中央型前置胎盘在我院引产”,住院期间(6月18日)行子宫动脉造影术及子宫动脉栓塞术及利凡诺羊膜腔穿刺引产术,,6月22日14:50引产分娩一死婴,当时胎盘粘连剥离不完整,于6月24日在b超监测上行清宫术,因胎盘粘连重,清宫不全,术后患者发热1天,最高38.6℃,胎盘组织送病检,,病检结果:胎盘组织局灶玻变,大量炎细胞浸润;给予“益保世灵”抗感染治疗,口服补佳乐增加子宫内膜等治疗,本拟择日复查b超后清宫;但后患者及家属签字出院,办理出院后,患者突然阴道流血增加,约60ml,伴头晕,乏力,心悸不适,无恶心呕吐,无呼吸困难,无晕厥,无畏寒发热等不适;故再次办理入院,入院时患者一般情况可,生命体征正常;\\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,体重无明显变化。", "mention_data": [{"mention": "中央型前置胎盘", "label": "疾病和诊断", "offset": "21"}, {"mention": "子宫动脉造影术及子宫动脉栓塞术及利凡诺羊膜腔穿刺引产术", "label": "手术", "offset": "47"}, {"mention": "b超", "label": "影像检查", "offset": "113"}, {"mention": "清宫术", "label": "手术", "offset": "119"}, {"mention": "胎盘组织局灶玻变,大量炎细胞浸润", "label": "疾病和诊断", "offset": "166"}, {"mention": "益保世灵", "label": "药物", "offset": "186"}, {"mention": "补佳乐", "label": "药物", "offset": "199"}, {"mention": "子宫内膜", "label": "解剖部位", "offset": "204"}, {"mention": "b超", "label": "影像检查", "offset": "218"}, {"mention": "阴道", "label": "解剖部位", "offset": "246"}, {"mention": "头晕", "label": "症状", "offset": "260"}, {"mention": "心悸", "label": "症状", "offset": "266"}]}
{"text": ",患者因“肝恶性肿瘤术后11月余,腹胀10余天”于2014-05-31第1次入院。,查体:腹部平坦,下腹部可见一长约25cm“反l”型手术切口,愈合良好。腹软,上腹轻压痛,无反跳痛,肝、脾肋上未触及,murphy's征阴性,肝、肾区无叩痛,肠鸣音无亢进,移动性浊音阴性。两上肢无水肿。患者入院后完善相关检查检验,,腹部彩超:肝硬化部分切除术后;肝硬化;胆囊切除术后;腹腔积液(少量)。,心电图:1.窦性心律2.大致正常心电图。,明确诊断为:1.肝恶性肿瘤术后2.胆囊切除术后状态。给予保肝、降酶、抗病毒、利尿及对症支持治疗。2014.6.5行dsa上选择性肝动脉造影及tace术,并行cik体细胞治疗术。患者病情好转出院。叒叒叒出院后患者继续服用“恩替卡韦分散片、熊去氧胆酸胶囊”,间断服用“螺内酯片、呋塞米片”,病情稳定,偶有两上肢凹陷性水肿。为行cik细胞治疗术,分别于2014-07-19、2014-08-23第二、三次入院。入院后完善相关辅助检查,给予保肝、抗病毒、调节免疫、cik体细胞回输及对症支持治疗,病情好转后出院。叒叒叒患者出院后病情平稳,为复查及进一步诊治分别于2014-12-04、2015-04-16、2015-09-28、2015-10-28、2015-12-13、2016-04-07、2016-05-19、2016-8-16、2016-12-14、2017-03-15第四-十三次住院。入院后完善相关检查,给予抗病毒、调节免疫及对症支持治疗,行dsa上选择性肝动脉造影及tace术,并行cik体细胞治疗术及tace术。经治疗患者病情好转出院。叒叒叒患者出院后继续服用“恩替卡韦分散片”,病情稳定。因“肝恶性肿瘤术后4年余”于2017-7-10第14次入院。,查体:心肺查体未见明显异常,腹部平坦,下腹部可见一长约25cm“反l”型手术疤痕,愈合良好。腹软,无压痛,无反跳痛。肝、脾肋上未触及,murphy's征阴性,肝、肾区无叩痛,肠鸣音无亢进,移动性浊音阴性。患者入院后完善相关化验检查,下腹部mri平扫+,增强:肝左叶异常信号,符合肝ca.mr表现,结合病史考虑转移瘤可能,肝右左叶交界处异常信号,考虑肝ca治疗后改变,较前变化不明显,符合肝内多发小囊肿表现,脾大。给予保肝、降酶、抗病毒、调节免疫及对症支持治疗。于2017年7月12日行dsa上选择性肝动脉造影+tace术。经治疗患者症状好转,因个人原因自动出院,并签署自动出院协议。叒叒叒患者出院后病情稳定,继续服用“恩替卡韦分散片”,无发热,无腹痛、腹胀、腹泻,无恶心、呕吐,无乏力、纳差,无反酸、烧心,无呕血、黑便,无心悸、胸闷、胸痛,无头晕、头痛、黑朦、晕厥等。现为复查及进一步治疗今来我院,门诊以“phc”收入院。叒叒叒患者自本次发病以来,神志清,精神可,饮食睡眠佳,大小便未见异常,近期体重无明显变化。", "mention_data": [{"mention": "肝恶性肿瘤术后", "label": "疾病和诊断", "offset": "5"}, {"mention": "腹胀", "label": "症状", "offset": "17"}, {"mention": "腹部", "label": "解剖部位", "offset": "45"}, {"mention": "下腹部", "label": "解剖部位", "offset": "50"}, {"mention": "腹", "label": "解剖部位", "offset": "77"}, {"mention": "上腹", "label": "解剖部位", "offset": "80"}, {"mention": "肝", "label": "解剖部位", "offset": "91"}, {"mention": "脾", "label": "解剖部位", "offset": "93"}, {"mention": "肋上", "label": "解剖部位", "offset": "94"}, {"mention": "肝", "label": "解剖部位", "offset": "112"}, {"mention": "肾", "label": "解剖部位", "offset": "114"}, {"mention": "肠鸣", "label": "症状", "offset": "120"}, {"mention": "两上肢", "label": "解剖部位", "offset": "135"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "157"}, {"mention": "肝硬化部分切除术后", "label": "疾病和诊断", "offset": "162"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "172"}, {"mention": "胆囊切除术后", "label": "疾病和诊断", "offset": "176"}, {"mention": "腹腔积液(少量)", "label": "疾病和诊断", "offset": "183"}, {"mention": "心电图", "label": "影像检查", "offset": "193"}, {"mention": "窦性心律", "label": "疾病和诊断", "offset": "199"}, {"mention": "心电图", "label": "影像检查", "offset": "209"}, {"mention": "肝恶性肿瘤术后", "label": "疾病和诊断", "offset": "222"}, {"mention": "胆囊切除术后", "label": "疾病和诊断", "offset": "231"}, {"mention": "肝", "label": "解剖部位", "offset": "243"}, {"mention": "dsa上选择性肝动脉造影及tace术", "label": "手术", "offset": "271"}, {"mention": "恩替卡韦分散片", "label": "药物", "offset": "324"}, {"mention": "熊去氧胆酸胶囊", "label": "药物", "offset": "332"}, {"mention": "螺内酯片", "label": "药物", "offset": "346"}, {"mention": "呋塞米片", "label": "药物", "offset": "351"}, {"mention": "两上肢", "label": "解剖部位", "offset": "364"}, {"mention": "肝", "label": "解剖部位", "offset": "431"}, {"mention": "dsa上选择性肝动脉造影及tace术", "label": "手术", "offset": "637"}, {"mention": "tace术", "label": "手术", "offset": "668"}, {"mention": "恩替卡韦分散片", "label": "药物", "offset": "699"}, {"mention": "肝恶性肿瘤术后", "label": "疾病和诊断", "offset": "715"}, {"mention": "心", "label": "解剖部位", "offset": "747"}, {"mention": "肺", "label": "解剖部位", "offset": "748"}, {"mention": "腹部", "label": "解剖部位", "offset": "758"}, {"mention": "下腹部", "label": "解剖部位", "offset": "763"}, {"mention": "腹", "label": "解剖部位", "offset": "790"}, {"mention": "肝", "label": "解剖部位", "offset": "802"}, {"mention": "脾", "label": "解剖部位", "offset": "804"}, {"mention": "肋上", "label": "解剖部位", "offset": "805"}, {"mention": "肝", "label": "解剖部位", "offset": "823"}, {"mention": "肾", "label": "解剖部位", "offset": "825"}, {"mention": "肠鸣", "label": "症状", "offset": "831"}, {"mention": "下腹部mri", "label": "影像检查", "offset": "860"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "873"}, {"mention": "肝ca", "label": "疾病和诊断", "offset": "883"}, {"mention": "mr", "label": "影像检查", "offset": "887"}, {"mention": "肝右左叶", "label": "解剖部位", "offset": "904"}, {"mention": "肝ca治疗后", "label": "疾病和诊断", "offset": "918"}, {"mention": "肝", "label": "解剖部位", "offset": "937"}, {"mention": "脾大", "label": "症状", "offset": "947"}, {"mention": "肝", "label": "解剖部位", "offset": "953"}, {"mention": "dsa上选择性肝动脉造影+tace术", "label": "手术", "offset": "986"}, {"mention": "恩替卡韦分散片", "label": "药物", "offset": "1053"}, {"mention": "腹痛", "label": "症状", "offset": "1067"}, {"mention": "腹胀", "label": "症状", "offset": "1070"}, {"mention": "腹泻", "label": "症状", "offset": "1073"}, {"mention": "心悸", "label": "症状", "offset": "1105"}, {"mention": "胸闷", "label": "症状", "offset": "1108"}, {"mention": "胸痛", "label": "症状", "offset": "1111"}, {"mention": "头晕", "label": "症状", "offset": "1115"}, {"mention": "头痛", "label": "症状", "offset": "1118"}, {"mention": "phc", "label": "疾病和诊断", "offset": "1147"}]}
{"text": "患者于6月前因“解稀烂便”完善检查发现结肠癌伴肝转移,2月2日行结肠癌手术切除,手术顺利,术后行folfox方案化疗2程。2月前复查ct发现肝内病灶较前进展,故于2012-4-17、5-3予以folfiri化疗2程,过程顺利。复查ct提示肝脏病变较前增大,考虑pd。故予folfiri+avastin方案化疗3程,过程顺利。今日为求进一步诊治来我院。患者发病以来,无症状。精神佳,饮食睡眠佳,大小便正常,体重无减轻。", "mention_data": [{"mention": "结肠癌伴肝转移", "label": "疾病和诊断", "offset": "19"}, {"mention": "结肠癌手术", "label": "手术", "offset": "32"}, {"mention": "ct", "label": "影像检查", "offset": "66"}, {"mention": "肝", "label": "解剖部位", "offset": "70"}, {"mention": "ct", "label": "影像检查", "offset": "115"}, {"mention": "肝脏", "label": "解剖部位", "offset": "119"}, {"mention": "avastin", "label": "药物", "offset": "143"}]}
{"text": "患儿1年余前无诱因出现体重逐渐上降,由35kg逐渐上降至25kg,无多饮多尿,无低热,无咳嗽,无腹泻,未予治疗,半年前出现反复腹痛,中下腹为主,有夜间痛醒情况,与进食无关,排便后腹痛稍缓解,在我院住院完善检查后诊断为“炎症性肠病”,5.19在我院用第一次类克,现为进一步治疗再次入院。病程中患儿无发热,无咳嗽,无呕吐,无便血,无明显腹痛,患儿目前精神食欲可,睡眠可,大便有少量粘液,日约2次,无便血,小便无殊。患儿近1年余来口水多,近1年内体重上降10kg。叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒第一次入院录(2016.4.28-2016.5.12)患儿因“体重上降1年余,腹痛半年”入院,入院后予以低纤维半流质饮食,头孢他啶联合奥硝唑抗感染,于5-4行胃镜、肠镜检查术,术顺安返。内镜上见横结肠弥漫性息肉样隆起,溃疡性改变。考虑炎症性肠病,予以加用常乐康调节肠道菌群。病理报告符合炎症性肠病。患儿无发热,无明显腹痛腹胀,呕血黑便,家属因经济问题,要求出院,待部分血报告回,再次入院考虑行生物制剂治疗原发病。叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒叒第二次入院录(2016.5.17-2016.5.21)。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "48"}, {"mention": "腹痛", "label": "症状", "offset": "63"}, {"mention": "中下腹", "label": "解剖部位", "offset": "66"}, {"mention": "腹痛", "label": "症状", "offset": "89"}, {"mention": "炎症性肠病", "label": "疾病和诊断", "offset": "109"}, {"mention": "类克", "label": "药物", "offset": "127"}, {"mention": "腹痛", "label": "症状", "offset": "166"}, {"mention": "腹痛", "label": "症状", "offset": "290"}, {"mention": "头孢他啶", "label": "药物", "offset": "312"}, {"mention": "奥硝唑", "label": "药物", "offset": "318"}, {"mention": "横结肠", "label": "解剖部位", "offset": "348"}, {"mention": "炎症性肠病", "label": "疾病和诊断", "offset": "368"}, {"mention": "常乐康", "label": "药物", "offset": "378"}, {"mention": "肠", "label": "解剖部位", "offset": "383"}, {"mention": "炎症性肠病", "label": "疾病和诊断", "offset": "394"}, {"mention": "腹痛", "label": "症状", "offset": "409"}, {"mention": "腹胀", "label": "症状", "offset": "411"}]}
{"text": ",入院前3月,患者曾因“反复呕吐”于我院住院治疗,并于2016.03.17于我科行腹腔镜上胃癌根治术,手术顺利,,术后病理提示:(胃)溃疡型中分化管状腺癌,浸及胃壁全层,双切端未见癌累及,胃大小弯淋巴结未见癌转移(分别为0/10、0/10),网膜组织未见癌累及。,诊断为:溃疡型中分化管状腺癌(t3n0m0),术后患者行静脉化疗1次,化疗过程中无恶心、呕吐等不适,今日患者为求第2次化疗入院,门诊遂以“胃癌术后化疗”收住。\\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": "腹腔镜上胃癌根治术", "label": "手术", "offset": "41"}, {"mention": "(胃)溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "胃壁", "label": "解剖部位", "offset": "80"}, {"mention": "胃大小弯淋巴结", "label": "解剖部位", "offset": "94"}, {"mention": "溃疡型中分化管状腺癌(t3n0m0)", "label": "疾病和诊断", "offset": "136"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "201"}]}
{"text": "缘于入院前1月余因“胆石症、急性胆囊炎”就诊我院,下腹部ct示:1、胆总管上段多发结石,伴肝内外胆管扩张。2、急性胆囊炎,胆囊多发结石。入院后予抗感染,保肝,抑制胰酶分泌,营养支持等治疗,于2014.01.16在b超定位上行“胆囊穿刺造瘘术”,术顺,术后症状好转,家属要求出院。此次为行进一步治疗再次就诊我院,门诊拟“胆石症ptcd术后”收入院,自发病以来神志清,精神不振,饮食少,睡眠可,二便正常,体重未见明显增减。", "mention_data": [{"mention": "胆石症", "label": "疾病和诊断", "offset": "10"}, {"mention": "急性胆囊炎", "label": "疾病和诊断", "offset": "14"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "25"}, {"mention": "胆总管上段多发结石", "label": "疾病和诊断", "offset": "34"}, {"mention": "肝内外胆管扩张", "label": "疾病和诊断", "offset": "45"}, {"mention": "急性胆囊炎", "label": "疾病和诊断", "offset": "55"}, {"mention": "胆囊多发结石", "label": "疾病和诊断", "offset": "61"}, {"mention": "肝", "label": "解剖部位", "offset": "77"}, {"mention": "胰", "label": "解剖部位", "offset": "81"}, {"mention": "b超", "label": "影像检查", "offset": "106"}, {"mention": "胆囊穿刺造瘘术", "label": "手术", "offset": "113"}, {"mention": "胆石症ptcd术后", "label": "疾病和诊断", "offset": "159"}]}
{"text": ",缘于入院前2月无明显诱因出现便秘,无里急后重、排便不尽感,偶伴有血便,为鲜血便,大便附于大便表面。无腹痛、腹胀,无腹泻,无恶心、呕吐,无呕血、黑便,无肛门停止排气、排便,无畏冷、发热。就诊于我院,,行肠镜:“乙状结肠癌”,,病理:“大肠管状腺瘤下皮呈高级别下皮内瘤变伴癌变”,遂门诊拟乙状结肠癌收入院,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": "腹痛", "label": "症状", "offset": "51"}, {"mention": "腹胀", "label": "症状", "offset": "54"}, {"mention": "腹泻", "label": "症状", "offset": "58"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "105"}, {"mention": "大肠管状腺瘤下皮呈高级别下皮内瘤变伴癌变", "label": "疾病和诊断", "offset": "117"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "143"}]}
{"text": ",患者2年前无明显诱因出现大便异常,为青色成形软便,约2-3次/天,无粘液脓血便,无发热,无腹痛、腹泻、腹胀,无反酸、烧心,无恶心、呕吐,无进食阻挡感及哽噎感,无胸骨后疼痛,无乏力、纳差,无呕血、黑便,无停止排便、排气、腹胀,未诊疗。患者下述症状持续存在,未诊治。为明确病情,患者20天前于我院查体中心体检,,查体示:幽门螺旋杆菌抗体阳性。为求进一步治疗就诊于我院门诊,查凝血四项、乙肝五项未见明显异常,,心电图:1.窦性心律2.大致正常心电图,建议行胃肠镜检查。患者今日于内镜室行胃肠镜检查,胃镜提示慢性胃炎,,结肠镜提示:结肠息肉,并行结肠息肉内镜上切除治疗,操作顺利,报告未回,为进一步诊治,门诊以“肠息肉”收住院。叒叒叒患者自发病以来,神志清,精神可,饮食、睡眠可,大、小便如前所述,体重近期无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹泻", "label": "症状", "offset": "49"}, {"mention": "腹胀", "label": "症状", "offset": "52"}, {"mention": "胸骨后疼痛", "label": "症状", "offset": "81"}, {"mention": "腹胀", "label": "症状", "offset": "110"}, {"mention": "幽门螺旋杆菌抗体", "label": "实验室检验", "offset": "159"}, {"mention": "心电图", "label": "影像检查", "offset": "203"}, {"mention": "窦性心律", "label": "疾病和诊断", "offset": "209"}, {"mention": "心电图", "label": "影像检查", "offset": "219"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "251"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "263"}, {"mention": "结肠息肉内镜上切除", "label": "手术", "offset": "270"}, {"mention": "肠息肉", "label": "疾病和诊断", "offset": "303"}]}
{"text": ",患者1月前无明显诱因出现腹泻,5-6次/日,量少,不成形,混有粘液,无脓血,伴左上腹痛,无明显放射痛,无发热,无恶心、呕吐,无腹胀,于我院急诊科就诊,,行腹部彩超示:符合急性阑尾炎声像图表现。给予“来立信”、“甲硝唑”治疗1周,患者左上腹痛消失,仍有腹泻,5-6次/日,混有粘液,无脓血,未再系统治疗。1周前于我门诊就诊,,行电子结肠镜示:溃疡性结肠炎;镜上取活检2块,,病理结果示:(直肠)粘膜充血、水肿,急慢性发炎,局部粘膜糜烂。建议其住院治疗,患者因个人原因,未能入院。患者仍有腹泻,为求系统治疗今来我院,门诊以“溃疡性结肠炎”收入院。叒叒叒患者自发病以来,神志清,精神可,饮食睡眠可,大便同下,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "13"}, {"mention": "左上腹", "label": "解剖部位", "offset": "40"}, {"mention": "腹胀", "label": "症状", "offset": "64"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "78"}, {"mention": "急性阑尾炎", "label": "疾病和诊断", "offset": "86"}, {"mention": "来立信", "label": "药物", "offset": "100"}, {"mention": "甲硝唑", "label": "药物", "offset": "106"}, {"mention": "左上腹", "label": "解剖部位", "offset": "117"}, {"mention": "腹泻", "label": "症状", "offset": "126"}, {"mention": "溃疡性结肠炎", "label": "疾病和诊断", "offset": "171"}, {"mention": "直肠", "label": "解剖部位", "offset": "194"}, {"mention": "急慢性发炎", "label": "疾病和诊断", "offset": "205"}, {"mention": "腹泻", "label": "症状", "offset": "243"}, {"mention": "溃疡性结肠炎", "label": "疾病和诊断", "offset": "261"}]}
{"text": "患者1余年前无明显诱因出现大便排出困难,同时伴有排便不尽感,遂至我院诊治,行纤维结肠镜检查示:结肠息肉,电凝切除,并予“痔疮栓”等治疗(具体不详),效果尚可,回家后大便困难症状复现,症状逐渐加重,未予系统诊治。现为系统治疗,进一步缓解病情,特来我院,门诊以“便秘”收入院患者自发病以来,神志清,精神可,饮食量及夜间睡眠可,小便可,大便每日1次,质软排出欠通畅,无恶心、呕吐,体重无明显减轻。", "mention_data": [{"mention": "结肠息肉", "label": "疾病和诊断", "offset": "47"}, {"mention": "电凝切除", "label": "手术", "offset": "52"}]}
{"text": "患者于50年前渐出现两上肢浅表蚯蚓状肿物,以久立、劳累后明显,休息并抬高患肢后可减轻。无患肢水肿、皮肤搔痒不适、脱屑、颜色改变。无上肢酸痛、疼痛、发热、头痛、恶心。无特殊治疗。于3年前渐出现两小腿皮肤颜色加深,站立容易疲劳感觉,无上肢疼痛、肿胀,无头晕、头痛、胸闷、气促等不适,于2年前就诊我院门诊,门诊以两侧上肢静脉曲张收入院。入院后行上肢静脉造影,术中见:1.左髂总静脉血栓,中度阻塞,右腘静脉附壁血栓12.87*53.88mm大小,中度阻塞,右髂总静脉下段95%狭窄,右髂外静脉上段后前向75%狭窄,右下下肺动脉栓塞。予行上腔静脉滤器置入、两侧髂静脉支架置入等治疗。术后予抗凝、改善循环等治疗。患者恢复顺利出院,出院后口服华法林抗凝治疗,两上肢浅表蚯蚓状肿物无明显改善,2月前于我科行“左上肢大隐静脉手术”,手术顺利,恢复良好出院,今为进一步治疗,再次就诊我院,门诊拟“右大隐静脉曲张;左大隐静脉曲张术后;两侧髂静脉支架术后;上腔静脉滤器置入术后”收住入院。患者自发病以来无明显胸闷、气短,无发烧,精神状态一般,食欲一般,睡眠良好,体重无明显变化,大便正常,小便正常。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "10"}, {"mention": "上肢", "label": "解剖部位", "offset": "65"}, {"mention": "头痛", "label": "症状", "offset": "76"}, {"mention": "两小腿", "label": "解剖部位", "offset": "95"}, {"mention": "上肢", "label": "解剖部位", "offset": "115"}, {"mention": "头晕", "label": "症状", "offset": "124"}, {"mention": "头痛", "label": "症状", "offset": "127"}, {"mention": "胸闷", "label": "症状", "offset": "130"}, {"mention": "两侧上肢静脉曲张", "label": "疾病和诊断", "offset": "153"}, {"mention": "上肢静脉造影", "label": "影像检查", "offset": "169"}, {"mention": "左髂总静脉血栓", "label": "疾病和诊断", "offset": "182"}, {"mention": "右腘静脉附壁血栓", "label": "疾病和诊断", "offset": "195"}, {"mention": "右髂总静脉", "label": "解剖部位", "offset": "224"}, {"mention": "右髂外静脉", "label": "解剖部位", "offset": "237"}, {"mention": "右下下肺动脉栓塞", "label": "疾病和诊断", "offset": "253"}, {"mention": "上腔静脉滤器置入、两侧髂静脉支架置入", "label": "手术", "offset": "264"}, {"mention": "华法林", "label": "药物", "offset": "314"}, {"mention": "两上肢", "label": "解剖部位", "offset": "322"}, {"mention": "左上肢大隐静脉手术", "label": "手术", "offset": "346"}, {"mention": "右大隐静脉曲张", "label": "疾病和诊断", "offset": "388"}, {"mention": "左大隐静脉曲张术后", "label": "疾病和诊断", "offset": "396"}, {"mention": "两侧髂静脉支架术后", "label": "疾病和诊断", "offset": "406"}, {"mention": "上腔静脉滤器置入术后", "label": "疾病和诊断", "offset": "416"}, {"mention": "胸闷", "label": "症状", "offset": "442"}]}
{"text": "入院前55天因“肝内外胆管结石伴急性胆管炎”于我科行“胆囊切除+胆总管切口取石术+t管引流术”,术顺,术后予抗感染、保肝、营养支持等处理。40天前出现左上腹手术切口开裂,并出现黄白色脓性液体流出,量较多,伴切口部位胀痛不适,无畏寒、寒战、发热,无恶心、呕吐,无眼黄、尿黄、皮肤黄等,诊断“术后切口感染”,予行术后伤口切开清创处理,并予营养支持、补液、加强换药等治疗,后腹痛缓解、切口愈合良好,出院后无腹痛、腹胀、切口红肿流脓,无恶心、呕吐、眼黄、尿黄、畏冷、发热等。今为进一步行“胆道镜检查”,门诊拟“胆石症术后”收住院。前次出院以来,精神、睡眠、食欲尚可,大小便如常,体重无明显变化。", "mention_data": [{"mention": "肝内外胆管结石伴急性胆管炎", "label": "疾病和诊断", "offset": "8"}, {"mention": "胆囊切除+胆总管切口取石术+t管引流术", "label": "手术", "offset": "27"}, {"mention": "肝", "label": "解剖部位", "offset": "59"}, {"mention": "左上腹", "label": "解剖部位", "offset": "75"}, {"mention": "术后切口感染", "label": "疾病和诊断", "offset": "144"}, {"mention": "腹痛", "label": "症状", "offset": "184"}, {"mention": "腹痛", "label": "症状", "offset": "200"}, {"mention": "腹胀", "label": "症状", "offset": "203"}, {"mention": "眼", "label": "解剖部位", "offset": "220"}, {"mention": "胆石症术后", "label": "疾病和诊断", "offset": "251"}]}
{"text": ",患者因“腹痛2天”于2017-4-6第1次入院,既往“高血压病”病史14年,血压最高达180/110mmhg,在家间断服用保健品(具体不详),血压控制欠佳;14年前有“酒精性脂肪肝、下消化道出血”病史,9年前双次因“急性胰腺炎”入院治疗,7年前及6年前双次因“慢性胰腺炎急性发作”入院治疗,查体发现“2型糖尿病”病史9年,未服用降糖药物,血糖控制欠佳。否认冠心病等慢性病病史,否认肝炎、结核等传染病及其接触史,6年前行“胆囊切除术、胆总管空肠roux-en-y吻合术”。,查体:t叒,:叒37.2℃,p叒,:叒71次/分,r叒,:叒17次/分,bp叒,:叒153/88mmhg。心肺查体未见异常。腹部平坦,左侧腹部可见一长约20cm纵行手术疤痕,愈合良好。全腹压痛,无反跳痛,以中下腹为重。肝、脾肋上未触及,murphy's征阴性,肝区无叩痛,肠鸣音无亢进,移动性浊音阴性。脊柱无畸形,四肢无畸形,两上肢无水肿。两上肢足背动脉搏动正常。,患者入院后完善相关辅助检查:c反应蛋白叒87叒mg/l,叒葡萄糖叒8.52叒mmol/l,同型半胱氨酸叒26.30叒umol/l,血浆凝血酶原时间活动度叒61.50叒%,活化部分凝血活酶时间叒40.8叒秒,活化部分凝血活酶比率叒1.54叒,血浆d二聚体测定叒0.72叒mg/l,降钙素原叒0.601ng/ml,中性粒细胞百分比叒0.889叒,淋巴细胞计数叒0.27×叒10^9/l,血小板计数叒48叒×10^9/l,hbcab(eclia)叒0.008阳性coi,大便潜血阳性叒,,尿常规:粒细胞叒+1叒,尿糖叒+-叒,酮体+2叒,白细胞叒80叒/ul,鳞状下皮细胞叒15叒/ul,消化道肿瘤未见明显异常。,心电图诊断:1.窦性心律2.st-t改变。腹部立位片(20170406),:考虑不完全性肠梗阻,请结合临床。腹部,ct:胰腺异常改变,考虑慢性胰腺炎急性发作,请结合临床;胆囊术后ct所见;脂肪肝、脾大。给予抗感染、抑酸、补液、加强营养、提高免疫力等治疗。经治疗患者病情好转,2017-04-18,行肠镜示:1.结肠多发憩室2.降结肠病变性质?,胃镜示:1.早期食管癌2.慢性萎缩性胃炎3.十二指肠球炎4.十二指肠球部胃黏膜异位。行早期食管癌(癌前病变)内镜上切除术,,病理诊断:(食管距门齿28cm)鳞状下皮高级别下皮内瘤变(中度不典型增生)。(十二指肠球部)粘膜水肿,轻度慢性发炎,腺体轻度增生。(降结肠1、2)粘膜水肿及慢性发炎,局部浅表溃疡形成,肉芽组织增生,另见片状渗出物。继续抑酸、补液、抗感染等治疗。于2017-04-24行食管早期病变内镜上切除术。术后生命体征平稳,给予禁食、胃肠减压3天,并给予抑酸、抗感染、补液及对症支持治疗。,术后病理示:(食管距门齿28cm)鳞状下皮高级别下皮内瘤变(面积0.5×0.4cm),未累及切缘及底部切除面。经治疗患者症状好转,未诉明显不适,予以出院。叒叒叒患者出院后病情稳定,无腹痛、腹胀,无恶心、呕吐,无反酸、烧心,无头晕、头痛,无发热、畏寒,无心慌、胸闷、胸痛,无肩部及腰背部放射痛,无进食阻挡感及哽噎感,无尿频、尿急、尿痛,尿色、尿量无明显异常,无腹泻、便秘,排便1次/天,为黄色成形软便,肛门未停止排便排气。今为复查,前来我院就诊,门诊以“食管恶性肿瘤esd术后”收入我科。叒叒叒患者自发病以来,神志清,精神可,饮食、睡眠尚可,大小便如前所述。近期体重未见明显减轻。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "5"}, {"mention": "高血压病", "label": "疾病和诊断", "offset": "28"}, {"mention": "酒精性脂肪肝", "label": "疾病和诊断", "offset": "85"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "92"}, {"mention": "急性胰腺炎", "label": "疾病和诊断", "offset": "109"}, {"mention": "慢性胰腺炎急性发作", "label": "疾病和诊断", "offset": "131"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "151"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "179"}, {"mention": "肝炎", "label": "疾病和诊断", "offset": "191"}, {"mention": "结核", "label": "疾病和诊断", "offset": "194"}, {"mention": "胆囊切除术、胆总管空肠roux-en-y吻合术", "label": "手术", "offset": "211"}, {"mention": "心", "label": "解剖部位", "offset": "290"}, {"mention": "肺", "label": "解剖部位", "offset": "291"}, {"mention": "腹部", "label": "解剖部位", "offset": "299"}, {"mention": "左侧腹部", "label": "解剖部位", "offset": "304"}, {"mention": "腹", "label": "解剖部位", "offset": "330"}, {"mention": "中下腹", "label": "解剖部位", "offset": "340"}, {"mention": "肝", "label": "解剖部位", "offset": "346"}, {"mention": "脾", "label": "解剖部位", "offset": "348"}, {"mention": "肋上", "label": "解剖部位", "offset": "349"}, {"mention": "肝区", "label": "解剖部位", "offset": "367"}, {"mention": "肠鸣", "label": "症状", "offset": "373"}, {"mention": "脊柱", "label": "解剖部位", "offset": "388"}, {"mention": "四肢", "label": "解剖部位", "offset": "394"}, {"mention": "两上肢", "label": "解剖部位", "offset": "400"}, {"mention": "两上肢足背动脉", "label": "解剖部位", "offset": "407"}, {"mention": "c反应蛋白", "label": "实验室检验", "offset": "434"}, {"mention": "葡萄糖", "label": "实验室检验", "offset": "449"}, {"mention": "同型半胱氨酸", "label": "实验室检验", "offset": "465"}, {"mention": "血浆凝血酶原时间活动度", "label": "实验室检验", "offset": "485"}, {"mention": "活化部分凝血活酶时间", "label": "实验室检验", "offset": "505"}, {"mention": "活化部分凝血活酶比率", "label": "实验室检验", "offset": "523"}, {"mention": "血浆d二聚体测定", "label": "实验室检验", "offset": "540"}, {"mention": "降钙素原", "label": "实验室检验", "offset": "559"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "575"}, {"mention": "淋巴细胞计数", "label": "实验室检验", "offset": "591"}, {"mention": "血小板计数", "label": "实验室检验", "offset": "611"}, {"mention": "hbcab", "label": "实验室检验", "offset": "628"}, {"mention": "大便潜血", "label": "实验室检验", "offset": "652"}, {"mention": "粒细胞", "label": "实验室检验", "offset": "665"}, {"mention": "尿糖", "label": "实验室检验", "offset": "673"}, {"mention": "酮体", "label": "实验室检验", "offset": "680"}, {"mention": "白细胞", "label": "实验室检验", "offset": "686"}, {"mention": "鳞状下皮细胞", "label": "实验室检验", "offset": "697"}, {"mention": "消化道肿瘤", "label": "疾病和诊断", "offset": "711"}, {"mention": "心电图", "label": "影像检查", "offset": "724"}, {"mention": "窦性心律", "label": "疾病和诊断", "offset": "732"}, {"mention": "st-t改变", "label": "疾病和诊断", "offset": "738"}, {"mention": "腹部立位片", "label": "影像检查", "offset": "745"}, {"mention": "不完全性肠梗阻", "label": "疾病和诊断", "offset": "764"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "778"}, {"mention": "胰腺", "label": "解剖部位", "offset": "784"}, {"mention": "慢性胰腺炎急性发作", "label": "疾病和诊断", "offset": "793"}, {"mention": "胆囊术后ct", "label": "影像检查", "offset": "809"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "818"}, {"mention": "脾大", "label": "症状", "offset": "822"}, {"mention": "结肠多发憩室", "label": "疾病和诊断", "offset": "879"}, {"mention": "降结肠病变", "label": "疾病和诊断", "offset": "887"}, {"mention": "早期食管癌", "label": "疾病和诊断", "offset": "902"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "909"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "918"}, {"mention": "十二指肠球部胃黏膜异位", "label": "疾病和诊断", "offset": "926"}, {"mention": "早期食管癌(癌前病变)内镜上切除术", "label": "手术", "offset": "939"}, {"mention": "食管", "label": "解剖部位", "offset": "964"}, {"mention": "门齿", "label": "解剖部位", "offset": "967"}, {"mention": "鳞状下皮高级别下皮内瘤变", "label": "疾病和诊断", "offset": "974"}, {"mention": "十二指肠球部", "label": "解剖部位", "offset": "997"}, {"mention": "轻度慢性发炎", "label": "疾病和诊断", "offset": "1009"}, {"mention": "降结肠", "label": "解剖部位", "offset": "1024"}, {"mention": "慢性发炎", "label": "疾病和诊断", "offset": "1036"}, {"mention": "食管早期病变内镜上切除术", "label": "手术", "offset": "1092"}, {"mention": "胃", "label": "解剖部位", "offset": "1119"}, {"mention": "肠", "label": "解剖部位", "offset": "1120"}, {"mention": "食管", "label": "解剖部位", "offset": "1154"}, {"mention": "门齿", "label": "解剖部位", "offset": "1157"}, {"mention": "鳞状下皮高级别下皮内瘤变", "label": "疾病和诊断", "offset": "1164"}, {"mention": "腹痛", "label": "症状", "offset": "1238"}, {"mention": "腹胀", "label": "症状", "offset": "1241"}, {"mention": "头晕", "label": "症状", "offset": "1259"}, {"mention": "头痛", "label": "症状", "offset": "1262"}, {"mention": "心慌", "label": "症状", "offset": "1273"}, {"mention": "胸闷", "label": "症状", "offset": "1276"}, {"mention": "胸痛", "label": "症状", "offset": "1279"}, {"mention": "肩部", "label": "解剖部位", "offset": "1283"}, {"mention": "腰背部", "label": "解剖部位", "offset": "1286"}, {"mention": "腹泻", "label": "症状", "offset": "1326"}, {"mention": "肛门", "label": "解剖部位", "offset": "1347"}, {"mention": "食管恶性肿瘤esd术后", "label": "疾病和诊断", "offset": "1373"}]}
{"text": "患者无明显诱因出现中下腹隐痛下腹隐痛不适,为阵发性(持续时间不详),进食后加重,无反射痛,与时间及活动无关,伴腹胀、反酸及嗳气,感恶心,无呕吐,无呕血及黑便,无明显咳嗽,有痰,不易咳出,无咯血,时感心悸,无胸闷,院外行冠脉造影、腹部彩超未见异常,给予抑酸、护胃等对症支持治疗后症状无明显好转。后腹痛反复发作(症状同前),院外行胃镜检查示“浅表性胃窦炎”,心电图无异常,现为求进一步诊疗,收入我院。\\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,解黄色软便,小便正常,体重无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "9"}, {"mention": "下腹", "label": "解剖部位", "offset": "14"}, {"mention": "腹胀", "label": "症状", "offset": "55"}, {"mention": "心悸", "label": "症状", "offset": "99"}, {"mention": "胸闷", "label": "症状", "offset": "103"}, {"mention": "冠脉造影", "label": "影像检查", "offset": "109"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "114"}, {"mention": "胃", "label": "解剖部位", "offset": "129"}, {"mention": "腹痛", "label": "症状", "offset": "147"}, {"mention": "浅表性胃窦炎", "label": "疾病和诊断", "offset": "169"}, {"mention": "心电图", "label": "影像检查", "offset": "177"}]}
{"text": "患者于2012年2月17日因“右上腹阵发性隐痛1月余”入我院就诊,诊断为结肠脾曲mt,并于2012年2月21日行右半结肠根治术。术后患者一般情况好,无腹痛腹胀等不适,生命体征平稳,切口愈合良好,腹部平软,无压痛。患者于2012年2月29日突发腹胀腹痛伴寒战高热,原引流管处可见粪渣样物渗出,认为吻合口瘘明确,予急行横结肠造瘘术,术中伤口粪块感染,术后入外科监护室,于2012年3月5日转入我科。经诊治,患者生命体征平稳,一般情况可,无腹痛腹胀等不适症状,切口愈合良好,腹部平软,无压痛,于2012年4月9日出院。现患者为行造瘘肠段回纳术入院。出院至今,病人精神睡眠佳,胃纳可,大便成形,颜色无殊,小便正常。", "mention_data": [{"mention": "右上腹", "label": "解剖部位", "offset": "15"}, {"mention": "结肠脾曲mt", "label": "疾病和诊断", "offset": "36"}, {"mention": "右半结肠根治术", "label": "手术", "offset": "56"}, {"mention": "腹痛", "label": "症状", "offset": "75"}, {"mention": "腹胀", "label": "症状", "offset": "77"}, {"mention": "腹部", "label": "解剖部位", "offset": "97"}, {"mention": "腹胀", "label": "症状", "offset": "121"}, {"mention": "腹痛", "label": "症状", "offset": "123"}, {"mention": "横结肠造瘘术", "label": "手术", "offset": "157"}, {"mention": "腹痛", "label": "症状", "offset": "217"}, {"mention": "腹胀", "label": "症状", "offset": "219"}, {"mention": "腹部", "label": "解剖部位", "offset": "234"}, {"mention": "造瘘肠段回纳术", "label": "手术", "offset": "261"}]}
{"text": ",缘于入院前2月余前无明显诱因出现中下腹部闷痛不适,为持续性隐,可放射至后背部,与进食无关,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,未予治疗,症状无明显好转。1,周前至我院门诊行胃镜检查示:“胃角溃疡型ca可能,慢性萎缩性胃炎,霉菌性食管炎”,病理(胃角,201418212),:“送检6小块胃黏膜,其中一块胃黏膜见有少量低分化腺癌浸润,其余为浅表胃黏膜呈慢性炎症活动期,增生颈腺呈低级别下皮内瘤变”,遂门诊拟“胃癌”收入院。自发病以来,精神、睡眠可,食欲一般,大小便如常,体重减轻5kg。", "mention_data": [{"mention": "中下腹部", "label": "解剖部位", "offset": "17"}, {"mention": "后背部", "label": "解剖部位", "offset": "36"}, {"mention": "腹泻", "label": "症状", "offset": "68"}, {"mention": "胃角溃疡型ca", "label": "疾病和诊断", "offset": "121"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "131"}, {"mention": "霉菌性食管炎", "label": "疾病和诊断", "offset": "139"}, {"mention": "胃角", "label": "解剖部位", "offset": "150"}, {"mention": "胃", "label": "解剖部位", "offset": "171"}, {"mention": "胃", "label": "解剖部位", "offset": "179"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "186"}, {"mention": "浅表胃黏膜呈慢性炎症活动期", "label": "疾病和诊断", "offset": "197"}, {"mention": "颈腺", "label": "解剖部位", "offset": "213"}, {"mention": "低级别下皮内瘤变", "label": "疾病和诊断", "offset": "216"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "231"}]}
{"text": ",3+年前,患者绝经后出现同房后阴道流血,量少,无血凝块、腹痛,无头晕、眼花、乏力等不适,伴轻微外阴瘙痒、少量阴道流液,无异味,患者未予重视,未就诊,2月前,患者出现不规则阴道流血,量同月经,无头晕、眼花、乏力、血凝块、腹痛及腹胀,遂至我院门诊就诊,查hpv16型阳性,,阴道镜提示:宫颈重度糜烂,薄的醋酸白色下皮,妇科彩超提示宫颈偏低回声区;建议行宫颈活检术,,宫颈活检术后病检提示:(宫颈)鳞状细胞癌。1月前,患者来我院住院治疗,完善相关检查后于2016.2.22行腹腔镜上广泛性子宫切除术+两侧附件切除+盆腔淋巴结清扫术+盆腔粘连松解术,术后病检(病理号1601341),示:(宫颈)中分化鳞状细胞癌,侵及宫颈壁全层,脉管内见癌栓,颈管内见癌累及,右、左宫旁,骶韧带,阴道壁切缘未见癌累及,(右、左盆腔淋巴结)未见癌转移(0/6、0/10),右、左附件,老年期宫内膜。建议术后化疗,待阴道顶端愈合后放疗。术后予头孢美唑钠抗感染、止血及补液等对症支持治疗,于2016.2.27行tp(紫杉醇270mg+柰达铂140mg)静脉化疗,予护肝、护胃、止吐等对症支持治疗,后复查血常规及电解质无异常予以出院,出院后,患者常感恶心、食欲差,上腹坠胀,。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "16"}, {"mention": "腹痛", "label": "症状", "offset": "29"}, {"mention": "头晕", "label": "症状", "offset": "33"}, {"mention": "眼花", "label": "症状", "offset": "36"}, {"mention": "外阴瘙痒", "label": "症状", "offset": "48"}, {"mention": "阴道", "label": "解剖部位", "offset": "55"}, {"mention": "阴道", "label": "解剖部位", "offset": "86"}, {"mention": "头晕", "label": "症状", "offset": "97"}, {"mention": "眼花", "label": "症状", "offset": "100"}, {"mention": "腹痛", "label": "症状", "offset": "110"}, {"mention": "腹胀", "label": "症状", "offset": "113"}, {"mention": "宫颈", "label": "解剖部位", "offset": "142"}, {"mention": "妇科彩超", "label": "影像检查", "offset": "158"}, {"mention": "宫颈", "label": "解剖部位", "offset": "164"}, {"mention": "宫颈活检术", "label": "手术", "offset": "175"}, {"mention": "宫颈活检术", "label": "手术", "offset": "182"}, {"mention": "(宫颈)鳞状细胞癌", "label": "疾病和诊断", "offset": "193"}, {"mention": "腹腔镜上广泛性子宫切除术+两侧附件切除+盆腔淋巴结清扫术+盆腔粘连松解术", "label": "手术", "offset": "235"}, {"mention": "(宫颈)中分化鳞状细胞癌", "label": "手术", "offset": "291"}, {"mention": "宫颈", "label": "解剖部位", "offset": "306"}, {"mention": "颈", "label": "解剖部位", "offset": "319"}, {"mention": "宫", "label": "解剖部位", "offset": "330"}, {"mention": "骶韧带", "label": "解剖部位", "offset": "333"}, {"mention": "阴道", "label": "解剖部位", "offset": "337"}, {"mention": "右、左盆腔淋巴结", "label": "解剖部位", "offset": "349"}, {"mention": "右、左附件", "label": "解剖部位", "offset": "374"}, {"mention": "宫", "label": "解剖部位", "offset": "383"}, {"mention": "阴道", "label": "解剖部位", "offset": "395"}, {"mention": "头孢美唑钠", "label": "药物", "offset": "408"}, {"mention": "紫杉醇", "label": "药物", "offset": "444"}, {"mention": "柰达铂", "label": "药物", "offset": "453"}, {"mention": "静脉", "label": "解剖部位", "offset": "462"}, {"mention": "肝", "label": "解剖部位", "offset": "469"}, {"mention": "胃", "label": "解剖部位", "offset": "472"}, {"mention": "上腹", "label": "解剖部位", "offset": "517"}]}
{"text": ",患者因“胸闷、憋气2个月,加重1周”于2014.9.9就诊于我院。,入院查体:全身皮肤无黄染、无瘀点、无出血点。全身浅表淋巴结未触及肿大。两肺呼吸音粗糙,有湿性啰音。心界无扩大,心律不规整,心音强弱不等,各瓣膜听诊区未闻及病理性杂音。腹部平坦,腹软,无压痛,无反跳痛。肝、脾肋上未触及,murphy's征阴性,肝、肾区无叩痛,肠鸣音无亢进,移动性浊音阴性。两上肢无水肿。,入院后行腹部ct示:贲门及胃小弯壁增厚,小网膜囊区及胰腺后下方多发大小不等结节。,行胃镜检查示:胃癌;胃窦隆起(腔外压迫)。,病理示:腺癌。给予抑酸、护胃、调节免疫、利尿、抗感染等对症支持治疗后,患者自觉不适好转,家属要求出院,予以出院。叒叒叒患者出院后仍反复腹痛,为下腹部闷痛,不伴放射痛,偶有进食阻挡感,伴纳差,伴恶心,因“反复下腹痛半年余”于2014.12.2再次入院。,查体:贫血貌,眼睑及口唇苍白。右侧锁骨下窝可触及一花生大小的淋巴结,质地韧,与周围边界清,余身浅表淋巴结未触及肿大。两肺呼吸音粗糙,两上肺可闻及湿性啰音,未闻及干性啰音。心率118次/分,节律规整,各瓣膜听诊区无闻及病理性杂音。腹部平坦,未见胃肠型及蠕动波。腹软,中下腹部部有压痛,无反跳痛,中下腹可触及一包块,质地韧,与周围组织分界不清。肝、脾肋上未触及,murphy's征阴性,肝、肾区无叩痛,肠鸣音无亢进,移动性浊音阴性。两上肢轻度凹陷性水肿。两上肢足背动脉搏动减弱。,辅助检查:(2014-9-18,本院),胃镜:1、胃癌;2、胃窦隆起;病理示腺癌;(2014-9-22,本院)腹部,ct:1、胆囊多发小结石,胆囊炎;2、贲门及胃小弯壁增厚,小网膜囊区及胰后下方多发大小不等结节,建议增强扫描。,患者入院后完善相关化验检查:,血细胞分析:白细胞计数叒10.26×10^9/l,中性粒细胞%叒0.829,中性粒细胞叒8.51×10^9/l,红细胞计数叒2.70×10^12/l,血红蛋白叒65.0叒g/l;,降钙素原:叒0.107叒ng/ml;,crp:115.00叒mg/l;,大便分析:隐血叒+;癌胚抗原叒21.44叒ng/ml;,肝功:总蛋白叒51.2叒g/l;胸部ct+腹部,ct:1、两肺上叶炎症、胸腔积液;2、贲门及胃小弯病增厚,小网膜囊区及胰腺后下方多发大小不等结节,符合胃癌并发转移ct表现;3、胆囊多发小结石,胆囊炎;,痰培养:**不动杆菌。患者入院后给予抗感染、抑酸、保护胃粘膜、补充白蛋白、利尿、补钾、止咳化痰、调节免疫及对症支持治疗,并于2014.12.9输注“b型悬浮去白细胞红细胞2u”,咳嗽、咳痰、纳差较前减轻,住院29天出院。叒叒叒患者出院后继续口服“螺内酯叒一次3片,一天3次”,病情相对平稳。1周前患者出现黑便,为柏油样便,量多少不等,次数不详,伴进食明显减少,无呕血、便血,无恶心、呕吐,无反酸、烧心。4天前患者无明显诱因地出现咳嗽、咳痰,为白色粘痰,易咳出,2天前出现发热,体温最高达38.5℃,昨日最高体温达38.0℃。现为求进一步系统诊治,再次就诊,门诊以“胃癌,肺炎”收入院。叒叒叒患者自本次发病以来,神志清,精神欠佳,饮食差,夜间睡眠尚可,小便量约少(具体不详),近期体重减轻约20kg。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "5"}, {"mention": "全身浅表淋巴结", "label": "解剖部位", "offset": "57"}, {"mention": "两肺", "label": "解剖部位", "offset": "70"}, {"mention": "心", "label": "解剖部位", "offset": "84"}, {"mention": "心", "label": "解剖部位", "offset": "90"}, {"mention": "心", "label": "解剖部位", "offset": "96"}, {"mention": "瓣膜", "label": "解剖部位", "offset": "104"}, {"mention": "腹部", "label": "解剖部位", "offset": "118"}, {"mention": "腹", "label": "解剖部位", "offset": "123"}, {"mention": "肝", "label": "解剖部位", "offset": "135"}, {"mention": "脾", "label": "解剖部位", "offset": "137"}, {"mention": "肋上", "label": "解剖部位", "offset": "138"}, {"mention": "肝", "label": "解剖部位", "offset": "156"}, {"mention": "肾", "label": "解剖部位", "offset": "158"}, {"mention": "肠鸣", "label": "症状", "offset": "164"}, {"mention": "两上肢", "label": "解剖部位", "offset": "179"}, {"mention": "腹部ct", "label": "影像检查", "offset": "191"}, {"mention": "贲门", "label": "解剖部位", "offset": "197"}, {"mention": "胃小弯", "label": "解剖部位", "offset": "200"}, {"mention": "胰腺", "label": "解剖部位", "offset": "213"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "235"}, {"mention": "胃窦", "label": "解剖部位", "offset": "238"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "254"}, {"mention": "胃", "label": "解剖部位", "offset": "263"}, {"mention": "腹痛", "label": "症状", "offset": "317"}, {"mention": "下腹部", "label": "解剖部位", "offset": "321"}, {"mention": "下腹痛", "label": "症状", "offset": "353"}, {"mention": "眼睑", "label": "解剖部位", "offset": "383"}, {"mention": "口唇苍白", "label": "症状", "offset": "386"}, {"mention": "右侧锁骨", "label": "解剖部位", "offset": "391"}, {"mention": "浅表淋巴结", "label": "解剖部位", "offset": "423"}, {"mention": "两肺", "label": "解剖部位", "offset": "434"}, {"mention": "两上肺", "label": "解剖部位", "offset": "442"}, {"mention": "心", "label": "解剖部位", "offset": "461"}, {"mention": "瓣膜", "label": "解剖部位", "offset": "476"}, {"mention": "腹部", "label": "解剖部位", "offset": "490"}, {"mention": "胃", "label": "解剖部位", "offset": "497"}, {"mention": "肠", "label": "解剖部位", "offset": "498"}, {"mention": "腹", "label": "解剖部位", "offset": "505"}, {"mention": "中下腹部", "label": "解剖部位", "offset": "508"}, {"mention": "中下腹", "label": "解剖部位", "offset": "522"}, {"mention": "肝", "label": "解剖部位", "offset": "546"}, {"mention": "脾", "label": "解剖部位", "offset": "548"}, {"mention": "肋上", "label": "解剖部位", "offset": "549"}, {"mention": "肝", "label": "解剖部位", "offset": "567"}, {"mention": "肾", "label": "解剖部位", "offset": "569"}, {"mention": "肠鸣", "label": "症状", "offset": "575"}, {"mention": "两上肢", "label": "解剖部位", "offset": "590"}, {"mention": "两上肢足背动脉", "label": "解剖部位", "offset": "601"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "639"}, {"mention": "胃窦", "label": "解剖部位", "offset": "644"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "652"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "669"}, {"mention": "胆囊多发小结石", "label": "疾病和诊断", "offset": "677"}, {"mention": "胆囊炎", "label": "疾病和诊断", "offset": "685"}, {"mention": "贲门", "label": "解剖部位", "offset": "691"}, {"mention": "胃小弯", "label": "解剖部位", "offset": "694"}, {"mention": "胰", "label": "解剖部位", "offset": "707"}, {"mention": "白细胞计数", "label": "实验室检验", "offset": "749"}, {"mention": "中性粒细胞", "label": "实验室检验", "offset": "768"}, {"mention": "中性粒细胞", "label": "实验室检验", "offset": "781"}, {"mention": "红细胞计数", "label": "实验室检验", "offset": "799"}, {"mention": "血红蛋", "label": "实验室检验", "offset": "818"}, {"mention": "降钙素原", "label": "实验室检验", "offset": "833"}, {"mention": "crp", "label": "实验室检验", "offset": "852"}, {"mention": "隐血", "label": "实验室检验", "offset": "874"}, {"mention": "癌胚抗原", "label": "实验室检验", "offset": "879"}, {"mention": "总蛋白", "label": "实验室检验", "offset": "900"}, {"mention": "胸部ct", "label": "影像检查", "offset": "913"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "918"}, {"mention": "两肺上叶炎症", "label": "疾病和诊断", "offset": "926"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "933"}, {"mention": "贲门", "label": "解剖部位", "offset": "940"}, {"mention": "胃小弯", "label": "解剖部位", "offset": "943"}, {"mention": "胰腺", "label": "解剖部位", "offset": "956"}, {"mention": "胃癌并发转移", "label": "疾病和诊断", "offset": "972"}, {"mention": "ct", "label": "影像检查", "offset": "978"}, {"mention": "胆囊多发小结石", "label": "疾病和诊断", "offset": "985"}, {"mention": "胆囊炎", "label": "疾病和诊断", "offset": "993"}, {"mention": "痰培养", "label": "实验室检验", "offset": "998"}, {"mention": "胃粘膜", "label": "解剖部位", "offset": "1025"}, {"mention": "螺内酯", "label": "药物", "offset": "1121"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "1280"}, {"mention": "肺炎", "label": "疾病和诊断", "offset": "1283"}]}
{"text": "患者既往月经规律,13岁,4-5天/28天,45岁绝经,经量中,无痛经病史,绝经后无异常阴道流血。1+月前,患者因“盆腔巨内巨大囊性包块”于我院全麻上行经腹全子宫切除术+两侧附件切除术。术后将子宫及附件送病检。病检报告回:1、子宫平滑肌瘤。叒2、萎缩性宫内膜。叒3、慢性宫颈炎。叒4、(左)附件。5.右附件附件卵巢交界性粘液性囊腺瘤,局灶癌变。同侧输卵管未见癌累及。术后予以tp方案(紫杉醇210mg+顺铂100mg)化疗2日,水化2日,患者化疗过程中呕吐较明显,毛发脱落较明显。余无畏寒、发热、反酸、嗳气,无尿频、尿急、尿痛,无腹痛、腹泻、腹胀不适,完成化疗后予以出院,出院后,患者稍感上腹疼痛不适,毛发脱落较明显,无明显恶心呕吐,无畏寒发热,无头昏乏力等不适,现患者入院要求行第二次化疗,门诊以“卵巢癌术后”收治入院。\\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,体重无明显变化。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "44"}, {"mention": "盆腔巨内巨大囊性包块", "label": "疾病和诊断", "offset": "58"}, {"mention": "经腹全子宫切除术+两侧附件切除术", "label": "手术", "offset": "76"}, {"mention": "子宫", "label": "解剖部位", "offset": "96"}, {"mention": "附件", "label": "解剖部位", "offset": "99"}, {"mention": "子宫平滑肌瘤", "label": "疾病和诊断", "offset": "113"}, {"mention": "萎缩性宫内膜", "label": "疾病和诊断", "offset": "123"}, {"mention": "慢性宫颈炎", "label": "疾病和诊断", "offset": "133"}, {"mention": "(左)附件", "label": "解剖部位", "offset": "142"}, {"mention": "右附件附件卵巢交界性粘液性囊腺瘤,局灶癌变", "label": "疾病和诊断", "offset": "150"}, {"mention": "输卵管", "label": "解剖部位", "offset": "174"}, {"mention": "紫杉醇", "label": "药物", "offset": "192"}, {"mention": "顺铂", "label": "药物", "offset": "201"}, {"mention": "腹痛", "label": "症状", "offset": "265"}, {"mention": "腹泻", "label": "症状", "offset": "268"}, {"mention": "腹胀", "label": "症状", "offset": "271"}, {"mention": "上腹", "label": "解剖部位", "offset": "294"}, {"mention": "头昏", "label": "症状", "offset": "324"}, {"mention": "卵巢癌术后", "label": "疾病和诊断", "offset": "350"}]}
{"text": "患者于2014-12-21起床小便时突发头晕,呈视物旋转,伴恶心、呕吐,呕吐物为非咖啡色胃内容物,随即意识丧失、摔倒在地,被家属发现后急呼120来我院,急诊行脑、肺ct示“1.左基底节区低密度灶2.左肺下叶病变,较前无明显变化3.两肺炎症伴纤维灶4.两肺上叶钙化灶、轻度肺气肿5.心包积液、两侧胸腔积液”,急诊以“晕厥原因待查”收住我科,患者醒后发现右侧肢体活动不灵,2014-12-22在我科做脑dwi示“左侧大脑半球多发急性梗塞灶”,考虑“1.急性脑梗死2.高血压病(2级叒很高危)3.冠状动脉粥样硬化性心脏病叒心房颤动4.肺炎叒两侧胸腔积液5.心包积液6.慢性肾功能不全7.胃ca术后8.直肠ca术后9.胆囊摘除术”,给予“拜阿司匹林、氟伐他汀钠缓释片、低分子肝素钙、神经节苷酯、疏血通、舒普深、沐舒坦”等输液治疗,2014-12-30因呼吸衰竭行气管插管呼吸机辅助呼吸,病情平稳后于2015-01-23转入icu行气管切开后再转入我科继续治疗后好转出院。叒叒叒患者出院后病情仍有反复,反复多次入我科治疗,均治疗好转后出院。现患者为气管切开状态,右侧肢体仍活动不灵,为求进一步治疗,我院门诊以“脑梗死、冠状动脉粥样硬化性心脏病、心房颤动、肺部感染”收入我科。叒叒叒患者自发病以来,神志清,精神尚可,气管切开状态,鼻饲饮食,留置导尿,大便正常。", "mention_data": [{"mention": "头晕", "label": "症状", "offset": "20"}, {"mention": "胃", "label": "解剖部位", "offset": "44"}, {"mention": "脑、肺ct", "label": "影像检查", "offset": "79"}, {"mention": "左肺下叶病变", "label": "疾病和诊断", "offset": "99"}, {"mention": "两肺炎症伴纤维灶", "label": "疾病和诊断", "offset": "115"}, {"mention": "两肺上叶钙化灶", "label": "疾病和诊断", "offset": "125"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "135"}, {"mention": "心包积液、两侧胸腔积液", "label": "疾病和诊断", "offset": "140"}, {"mention": "晕厥原因待查", "label": "疾病和诊断", "offset": "157"}, {"mention": "右侧肢体", "label": "解剖部位", "offset": "175"}, {"mention": "脑dwi", "label": "影像检查", "offset": "198"}, {"mention": "左侧大脑半球多发急性梗塞灶", "label": "疾病和诊断", "offset": "204"}, {"mention": "急性脑梗死", "label": "疾病和诊断", "offset": "224"}, {"mention": "高血压病(2级叒很高危)", "label": "疾病和诊断", "offset": "231"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "245"}, {"mention": "心房颤动", "label": "疾病和诊断", "offset": "258"}, {"mention": "肺炎", "label": "疾病和诊断", "offset": "264"}, {"mention": "两侧胸腔积液", "label": "疾病和诊断", "offset": "267"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "275"}, {"mention": "慢性肾功能不全", "label": "疾病和诊断", "offset": "281"}, {"mention": "胃ca术后", "label": "疾病和诊断", "offset": "290"}, {"mention": "直肠ca术后", "label": "疾病和诊断", "offset": "297"}, {"mention": "胆囊摘除术", "label": "手术", "offset": "305"}, {"mention": "拜阿司匹林", "label": "药物", "offset": "315"}, {"mention": "氟伐他汀钠缓释片", "label": "药物", "offset": "321"}, {"mention": "低分子肝素钙", "label": "药物", "offset": "330"}, {"mention": "神经节苷酯", "label": "药物", "offset": "337"}, {"mention": "疏血通", "label": "药物", "offset": "343"}, {"mention": "舒普深", "label": "药物", "offset": "347"}, {"mention": "沐舒坦", "label": "药物", "offset": "351"}, {"mention": "呼吸衰竭", "label": "疾病和诊断", "offset": "372"}, {"mention": "气管", "label": "解剖部位", "offset": "377"}, {"mention": "气管切开", "label": "手术", "offset": "411"}, {"mention": "气管切开", "label": "手术", "offset": "469"}, {"mention": "右侧肢体", "label": "解剖部位", "offset": "476"}, {"mention": "脑梗死", "label": "疾病和诊断", "offset": "500"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "504"}, {"mention": "心房颤动", "label": "疾病和诊断", "offset": "517"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "522"}, {"mention": "气管切开", "label": "手术", "offset": "552"}, {"mention": "鼻", "label": "解剖部位", "offset": "559"}]}
{"text": ",1年余出现接触性阴道出血,伴轻微腹痛,有少量阴道排液,无异味。,在外院行宫颈活检提示:中分化鳞癌。后转我院妇科于2012-07-09行“宫颈癌根治术+两侧附件切除术+盆腔淋巴结清扫术”,,术后病理提示:宫颈中分化鳞癌,浸润宫颈深肌层,累及宫颈管未见明确脉管癌栓及神经侵犯。遵原主诊教授意见于2012-07-26、2012-8-16、2012-9-11行tp方案辅助化疗3程。2012-9-19开始行放射治疗。现按原主诊教授意见返院继续行tp方案化疗。患者一般情况可,饮食入眠可,大小便正常,体重无明显改变。", "mention_data": [{"mention": "阴道出血", "label": "症状", "offset": "9"}, {"mention": "腹痛", "label": "症状", "offset": "17"}, {"mention": "阴道", "label": "解剖部位", "offset": "23"}, {"mention": "宫颈", "label": "解剖部位", "offset": "37"}, {"mention": "中分化鳞癌", "label": "疾病和诊断", "offset": "44"}, {"mention": "宫颈癌根治术+两侧附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "69"}, {"mention": "宫颈中分化鳞癌", "label": "疾病和诊断", "offset": "102"}, {"mention": "宫颈", "label": "解剖部位", "offset": "112"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "120"}]}
{"text": "患者1月余前因“间断下腹部疼痛1年,加重十余天”就诊,1腹痛呈阵发性绞痛,无发热,无恶心、呕吐,当时未作治疗,疼痛间断发作,在来我院行b超及mri检查提示胆囊泥沙样结石、胆总管末端可疑结石,入院后完善相关化验检查,于2013.4.2在全麻上行胆囊切除、胆总管探查取石、t管引流术。术中见胆囊张力高,胆囊壁充血水肿,周围血管曲张,胆总管粗约2cm,壁厚,术后给予禁食、胃肠减压、抗感染、保肝、止血、抑酸等治疗,病人恢复良好,术后病理回示:急性单纯性胆囊炎,现为进一步治疗今来我院就诊,门诊以\\\"胆石症术后\\\"收入院。叒叒叒患者自出院以来,饮食睡眠良好,大小便正常,体重无减轻。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "10"}, {"mention": "腹痛", "label": "症状", "offset": "28"}, {"mention": "b超", "label": "影像检查", "offset": "67"}, {"mention": "mri检查", "label": "影像检查", "offset": "70"}, {"mention": "胆囊泥沙样结石", "label": "疾病和诊断", "offset": "77"}, {"mention": "胆总管末端可疑结石", "label": "疾病和诊断", "offset": "85"}, {"mention": "胆囊切除、胆总管探查取石、t管引流术", "label": "手术", "offset": "121"}, {"mention": "胆囊", "label": "解剖部位", "offset": "143"}, {"mention": "胆囊", "label": "解剖部位", "offset": "149"}, {"mention": "胆总管", "label": "解剖部位", "offset": "164"}, {"mention": "胃", "label": "解剖部位", "offset": "183"}, {"mention": "肠", "label": "解剖部位", "offset": "184"}, {"mention": "肝", "label": "解剖部位", "offset": "193"}, {"mention": "急性单纯性胆囊炎", "label": "疾病和诊断", "offset": "218"}, {"mention": "胆石症术后", "label": "疾病和诊断", "offset": "246"}]}
{"text": ",患者2015-04-26无明显诱因出现肉眼血尿,无腰痛、发热等不适,稍有尿频、尿急、尿痛。,行急诊超声及ct示:\\\"膀胱占位病变,大小37*29mm\\\"。考虑膀胱癌可能。完善相关检查并于2015-4-29行经尿道膀胱肿瘤电切术,,术后病理示:“浸润性高级别尿路下皮癌”,有根治性膀胱切除术指征,遂于2015-5-5于全麻上行根治性膀胱切除术+回肠原位新膀胱术,手术顺利,术后恢复可。2015-06-11在本科行“顺铂+吉西他滨”化疗治疗,化疗过程顺利。现为进一步治疗入住本科。起病以来,患者精神尚可,饮食睡眠尚可,无发冷发热,无咳嗽、咳痰、胸痛及心慌气短,大便正常,小便如下所述,体重无减轻。", "mention_data": [{"mention": "腰痛", "label": "症状", "offset": "26"}, {"mention": "超声", "label": "影像检查", "offset": "50"}, {"mention": "ct", "label": "影像检查", "offset": "53"}, {"mention": "膀胱占位病变", "label": "疾病和诊断", "offset": "59"}, {"mention": "膀胱癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "经尿道膀胱肿瘤电切术", "label": "手术", "offset": "104"}, {"mention": "浸润性高级别尿路下皮癌", "label": "疾病和诊断", "offset": "123"}, {"mention": "根治性膀胱切除术", "label": "手术", "offset": "137"}, {"mention": "根治性膀胱切除术+回肠原位新膀胱术", "label": "手术", "offset": "163"}, {"mention": "顺铂", "label": "药物", "offset": "207"}, {"mention": "吉西他滨", "label": "药物", "offset": "210"}, {"mention": "胸痛", "label": "症状", "offset": "271"}, {"mention": "心慌气短", "label": "症状", "offset": "274"}]}
{"text": ",入院前3年余患者出现左上腹刺痛,伴左侧臀部放射痛,难以忍受,伴腹胀、里急后重不适,月经周期延长,不伴恶心、呕吐、腹泻腹胀等不适,行mri诊断盆腔内囊实性占位病变,浆液性囊腺癌?累及子宫后壁及直肠左侧壁,,ca125:335.4u/ml,,行腹部ct提示:肝左叶后段病灶,考虑转移可能,遂于2010年6月2日行“全子宫+右附件切除+直肠切除术”,术后病检回示“盆腔中低分化腺癌,卵巢来源性大,直肠外膜中见癌侵润”。术后予以6周期紫杉醇210mg+顺铂100mg化疗,化疗结束时间为2010年11月。2011-12-19患者因复查ca-125叒185.4u/ml,盆腔b超未见异常,遂行3周期多西他赛120mg+奥沙利铂200mg化疗,末次化疗时间2012年3月,化疗期间行腹部ct提示肝左叶转移灶,遂于院外行肝转移灶伽马刀治疗。院外无腹痛等不适。2月余前患者因无明显诱因出现左上腹疼痛,呈持续性刀割样疼痛,坐位或平卧时可稍缓解,无呕心呕吐,无腹泻便秘,无发热寒颤,无全身骨痛等不适,遂于门诊行盆腔彩超示盆腔内混合性包块,腹部ct提示两侧附件区多发囊状占位灶,左输尿管盆腔段与左附件区占位灶关系密切伴管壁增厚,考虑卵巢癌复发伴左输尿管受累可能,肝左叶异常强化影。ca-125、ca-199升高。提示病情进展,遂于我科行一周期吉西他滨+奈达铂化疗,化疗后患者出现骨髓抑制,予以升血小板治疗后好转出院。出院后患者左上腹疼痛较前明显缓解,无恶心呕吐,无咳嗽咳痰,无腹痛腹胀等不适,今为进一步治疗入院。\\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,体重无明显变化。", "mention_data": [{"mention": "左上腹", "label": "解剖部位", "offset": "11"}, {"mention": "左侧臀部", "label": "解剖部位", "offset": "18"}, {"mention": "腹胀", "label": "症状", "offset": "32"}, {"mention": "腹泻", "label": "症状", "offset": "57"}, {"mention": "腹胀", "label": "症状", "offset": "59"}, {"mention": "mri", "label": "影像检查", "offset": "66"}, {"mention": "盆腔内囊实性占位病变", "label": "疾病和诊断", "offset": "71"}, {"mention": "浆液性囊腺癌", "label": "疾病和诊断", "offset": "82"}, {"mention": "子宫", "label": "解剖部位", "offset": "91"}, {"mention": "直肠", "label": "解剖部位", "offset": "96"}, {"mention": "ca125", "label": "实验室检验", "offset": "103"}, {"mention": "腹部ct", "label": "影像检查", "offset": "121"}, {"mention": "肝左叶后段病灶,考虑转移可能", "label": "疾病和诊断", "offset": "128"}, {"mention": "全子宫+右附件切除+直肠切除术", "label": "手术", "offset": "156"}, {"mention": "盆腔中低分化腺癌", "label": "疾病和诊断", "offset": "180"}, {"mention": "卵巢", "label": "解剖部位", "offset": "189"}, {"mention": "直肠", "label": "解剖部位", "offset": "196"}, {"mention": "紫杉醇", "label": "药物", "offset": "214"}, {"mention": "顺铂", "label": "药物", "offset": "223"}, {"mention": "ca-125", "label": "实验室检验", "offset": "264"}, {"mention": "盆腔b超", "label": "影像检查", "offset": "281"}, {"mention": "多西他赛", "label": "药物", "offset": "295"}, {"mention": "奥沙利铂", "label": "药物", "offset": "305"}, {"mention": "腹部ct", "label": "影像检查", "offset": "336"}, {"mention": "肝左叶转移灶", "label": "疾病和诊断", "offset": "342"}, {"mention": "肝转移", "label": "症状", "offset": "354"}, {"mention": "腹痛", "label": "症状", "offset": "367"}, {"mention": "左上腹", "label": "解剖部位", "offset": "387"}, {"mention": "腹泻", "label": "症状", "offset": "421"}, {"mention": "骨痛", "label": "症状", "offset": "435"}, {"mention": "盆腔彩超", "label": "影像检查", "offset": "446"}, {"mention": "盆腔", "label": "解剖部位", "offset": "451"}, {"mention": "腹部ct", "label": "影像检查", "offset": "460"}, {"mention": "两侧附件", "label": "解剖部位", "offset": "466"}, {"mention": "左输尿管", "label": "解剖部位", "offset": "479"}, {"mention": "盆腔", "label": "解剖部位", "offset": "483"}, {"mention": "左附件", "label": "解剖部位", "offset": "487"}, {"mention": "卵巢癌复发伴左输尿管受累", "label": "疾病和诊断", "offset": "506"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "521"}, {"mention": "ca-125", "label": "实验室检验", "offset": "530"}, {"mention": "ca-199", "label": "实验室检验", "offset": "537"}, {"mention": "吉西他滨", "label": "药物", "offset": "561"}, {"mention": "奈达铂", "label": "药物", "offset": "566"}, {"mention": "骨髓抑制", "label": "症状", "offset": "579"}, {"mention": "左上腹", "label": "解剖部位", "offset": "603"}, {"mention": "腹痛", "label": "症状", "offset": "628"}, {"mention": "腹胀", "label": "症状", "offset": "630"}]}
{"text": ",缘于入院前半月体检查电子肠镜示:肝曲见一宽基息肉样隆起,大小约3×1.5cm,约环1/3周,表面充血,,内镜诊断:结肠侧向发育型肿瘤(lst);查cea、afp、ca199、ca125均正常;无畏冷、寒战、发热,无恶心、呕吐,无腹痛、腹胀、腹泻,无关节肿痛、消瘦。今为进一步行内镜治疗求诊我院,门诊拟以“结肠侧向发育型肿瘤”收治入院。近半年来,精神、睡眠欠佳,食欲尚可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "肝曲", "label": "解剖部位", "offset": "17"}, {"mention": "结肠侧向发育型肿瘤(lst)", "label": "疾病和诊断", "offset": "58"}, {"mention": "cea", "label": "实验室检验", "offset": "74"}, {"mention": "afp", "label": "实验室检验", "offset": "78"}, {"mention": "ca199", "label": "实验室检验", "offset": "82"}, {"mention": "ca125", "label": "实验室检验", "offset": "88"}, {"mention": "腹痛", "label": "症状", "offset": "115"}, {"mention": "腹胀", "label": "症状", "offset": "118"}, {"mention": "腹泻", "label": "症状", "offset": "121"}, {"mention": "关节", "label": "解剖部位", "offset": "125"}, {"mention": "结肠侧向发育型肿瘤", "label": "疾病和诊断", "offset": "153"}]}
{"text": "患者半年前无明显诱因发现便中带血,呈鲜红色,大便成形,不伴里急后重感,无腹痛、腹泻,恶心呕吐等不适,此后下述症状持续存在,未系统诊治。10天前我院门诊行肠镜检查示“结肠多发息肉”,行病理检查示:“横结肠增生性腺瘤性息肉叒乙状结肠低级别管状腺瘤”,遂入我院要求行结肠镜电切手术治疗。患者病来无发热寒战,无咳嗽咳痰,无腹痛、腹泻,无恶心、呕吐,无尿频、尿急及尿痛等不适,饮食睡眠可,精神体力可,近期体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "36"}, {"mention": "腹泻", "label": "症状", "offset": "39"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "82"}, {"mention": "横结肠增生性腺瘤性息肉叒乙状结肠低级别管状腺瘤", "label": "疾病和诊断", "offset": "98"}, {"mention": "结肠镜电切手术", "label": "手术", "offset": "130"}, {"mention": "腹痛", "label": "症状", "offset": "157"}, {"mention": "腹泻", "label": "症状", "offset": "160"}]}
{"text": "入院前2月患者无明显诱因开始出现吞咽哽咽感,能正常进食,伴有中下腹隐痛下腹隐痛不适,程度轻微,不影响睡眠,进食后加重,可逐渐自行缓解,无反酸、嗳气,无胸骨后烧灼感,无恶心、呕吐,无呕血,无黑便、血便,无里急后重感,无咳嗽、咳痰,无心悸、胸闷、胸痛,无喘累、气促、呼吸困难。入院前半月,患者自觉吞咽哽咽感加重,仍能正常进食,进食时感下腹部及胸骨后胀痛不适,可向左肩背部放射,可自行缓解,无恶心、呕吐,无呕血,无黑便、血便,无心悸、胸闷。未治疗。今日来我院行胃镜检查提示:食管癌?(活检已取),浅表性胃窦炎伴糜烂。今日为进一步治疗收治入院。\\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,至患病以来体重减轻约2.5公斤。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "30"}, {"mention": "下腹", "label": "解剖部位", "offset": "35"}, {"mention": "胸骨", "label": "解剖部位", "offset": "75"}, {"mention": "心悸", "label": "症状", "offset": "115"}, {"mention": "胸闷", "label": "症状", "offset": "118"}, {"mention": "胸痛", "label": "症状", "offset": "121"}, {"mention": "下腹部", "label": "解剖部位", "offset": "165"}, {"mention": "胸骨", "label": "解剖部位", "offset": "169"}, {"mention": "左肩背部", "label": "解剖部位", "offset": "179"}, {"mention": "心悸", "label": "症状", "offset": "211"}, {"mention": "胸闷", "label": "症状", "offset": "214"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "234"}, {"mention": "浅表性胃窦炎伴糜烂", "label": "疾病和诊断", "offset": "245"}]}
{"text": "入院前1+年,患者无明显诱因出现剑突上疼痛,餐后为甚,呈持续性隐痛,尚可忍受,伴下腹胀、纳差、反酸、嗳气,无进行性吞咽困难,无恶心、呕吐、呕血、黑便、腹泻,无肛门停止排便、排气,无胸痛、胸闷、咯血、呼吸困难,遂于我院就诊,行胃镜检查提示:胃癌可能性大,病检回示胃腺癌,患者家属要求保守治疗,经治疗后,好转出院。病程中下述症状反复发作,性质同前,自购药物服用(具体药物不详)后下述症状可缓解。入院前1+小时,患者无明显诱因出现呕血,为咖啡色样胃内容物,量大,具体不详,有中下腹痛,性质同前,伴头昏、乏力,无晕厥、意识障碍等,无皮肤黏膜、牙龈出血。至我科就诊,以“下消化道出血”收入我科住院治疗。叒叒叒发病以来,精神欠佳,未进食,睡眠可,大小便正常,体重上降,具体不详。", "mention_data": [{"mention": "剑突", "label": "解剖部位", "offset": "16"}, {"mention": "下腹", "label": "解剖部位", "offset": "40"}, {"mention": "腹泻", "label": "症状", "offset": "75"}, {"mention": "肛门", "label": "解剖部位", "offset": "79"}, {"mention": "胸痛", "label": "症状", "offset": "90"}, {"mention": "胸闷", "label": "症状", "offset": "93"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "119"}, {"mention": "胃腺癌", "label": "疾病和诊断", "offset": "130"}, {"mention": "胃", "label": "解剖部位", "offset": "220"}, {"mention": "中下腹", "label": "解剖部位", "offset": "234"}, {"mention": "头昏", "label": "症状", "offset": "245"}, {"mention": "牙龈出血", "label": "症状", "offset": "267"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "280"}]}
{"text": "患者因下腹部不适在我院完善相关检查后确诊“胃癌”,于2015-09-23全麻上行\\\"胃癌根治术\\\"(远端胃大部切除),术程顺利,术后预防感染、抑制分泌、静脉营养等对症支持处理,术后第一天上午开始出现心律加快,最高180多次,查心肌损伤项目心衰项目未见明显异常,心电图提示快速房颤,icu会诊后予可达龙控制心律,效果一般,另患者诉全身皮肤瘙痒,未见皮疹及其他过敏症状,抗过敏治疗效果欠佳。后出现一过性心前区疼痛,程度中等,复查心肌损伤,心电图等未提示有心梗,患者数天来,心律血压有波动,心律在54-140多次每分,仍可达龙维持治疗。血压在100-154/70-100mmhg之间,舌上含服心痛定等可维持在正常血压。9月27日晚出现全身皮疹伴瘙痒,抗过敏治疗欠佳,后停止原有补液后皮疹消退瘙痒改善。术后第六天,一般情况尚可,已进食流质拔除引流管患者。出院时患者生命体征平稳心律64次/分,血压正常,进食半流胃纳可,二便正常。出院至今患者自诉恢复尚可,进食半流质为主,大小便正常,体重上降约4斤。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "3"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "21"}, {"mention": "胃癌根治术\\\"(远端胃大部切除)", "label": "手术", "offset": "42"}, {"mention": "心", "label": "解剖部位", "offset": "99"}, {"mention": "心肌", "label": "解剖部位", "offset": "113"}, {"mention": "心", "label": "解剖部位", "offset": "119"}, {"mention": "心电图", "label": "影像检查", "offset": "130"}, {"mention": "快速房颤", "label": "疾病和诊断", "offset": "135"}, {"mention": "可达龙", "label": "药物", "offset": "147"}, {"mention": "心", "label": "解剖部位", "offset": "152"}, {"mention": "心前区", "label": "解剖部位", "offset": "199"}, {"mention": "心肌", "label": "解剖部位", "offset": "212"}, {"mention": "心电图", "label": "影像检查", "offset": "217"}, {"mention": "心梗", "label": "疾病和诊断", "offset": "225"}, {"mention": "心", "label": "解剖部位", "offset": "234"}, {"mention": "心", "label": "解剖部位", "offset": "242"}, {"mention": "可达龙", "label": "药物", "offset": "257"}, {"mention": "舌", "label": "解剖部位", "offset": "289"}, {"mention": "心痛定", "label": "药物", "offset": "293"}, {"mention": "胃", "label": "解剖部位", "offset": "401"}]}
{"text": ",患者于2011年4月份因\\\"大便次数增多2月余,ct发现盆腔占位10天\\\"入住我院综合科,于5月3日行剖腹探查术,见肿物位于距回盲部150cm回肠处,行肿物及双端5cm空肠切除术,术后恢复可,,术后病理:胃肠间质肿瘤,3个核分裂/50hpf,,免疫组化:cd34-、cd117+,s-100(-)、sam+/-,des(-),hhf35-;2011-5-11起口服格列卫400mg叒qd治疗至今,耐受可。偶有心前区不适,随访心电图、心功酶等均未见明显异常。无颜面水肿及皮肤瘙痒,无恶心、呕吐、腹痛不适。现入院继续格列卫化疗。患者起病以来,无发热、乏力、咳嗽、气促、身目黄染等,精神睡眠可,胃纳欠佳,小便正常,大便1-2次/天,体重无明显上降。", "mention_data": [{"mention": "ct", "label": "影像检查", "offset": "25"}, {"mention": "盆腔", "label": "解剖部位", "offset": "29"}, {"mention": "剖腹探查术", "label": "手术", "offset": "52"}, {"mention": "回盲部", "label": "解剖部位", "offset": "64"}, {"mention": "回肠", "label": "解剖部位", "offset": "72"}, {"mention": "空肠切除术", "label": "手术", "offset": "85"}, {"mention": "胃肠间质肿瘤", "label": "疾病和诊断", "offset": "103"}, {"mention": "格列卫", "label": "药物", "offset": "183"}, {"mention": "心前区", "label": "解剖部位", "offset": "205"}, {"mention": "心电图", "label": "影像检查", "offset": "213"}, {"mention": "面", "label": "解剖部位", "offset": "231"}, {"mention": "腹痛", "label": "症状", "offset": "247"}, {"mention": "格列卫", "label": "药物", "offset": "257"}, {"mention": "身", "label": "解剖部位", "offset": "283"}, {"mention": "目", "label": "解剖部位", "offset": "284"}, {"mention": "胃", "label": "解剖部位", "offset": "295"}]}
{"text": "2016-04患者因确诊胃癌于我院术前检查发现左下肺阴影,患者无自觉症状,无咳嗽、咳痰,无咯血、气促,无呼吸困难、胸闷,无发热、消瘦、午后盗汗,无胸痛、骨痛、头痛、声嘶,无眼睑上垂、颜面浮肿、吞咽困难。患者行胃癌根治术后,今为进一步手术治疗肺部病灶,门诊拟“左下肺肿物”收入我科。起病以来,患者精神、睡眠、食欲尚可,大小便正常,体重近期无明显上降。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "左下肺", "label": "解剖部位", "offset": "23"}, {"mention": "胸闷", "label": "症状", "offset": "57"}, {"mention": "胸痛", "label": "症状", "offset": "73"}, {"mention": "骨痛", "label": "症状", "offset": "76"}, {"mention": "头痛", "label": "症状", "offset": "79"}, {"mention": "眼睑", "label": "解剖部位", "offset": "86"}, {"mention": "面", "label": "解剖部位", "offset": "92"}, {"mention": "胃癌根治术", "label": "手术", "offset": "104"}, {"mention": "肺部病灶", "label": "疾病和诊断", "offset": "120"}, {"mention": "左下肺肿物", "label": "疾病和诊断", "offset": "129"}]}
{"text": ",患者绝经10年,于2012-12月无明显诱因出现阴道不规则出血,量同月经.在外院行子宫内膜分段诊刮病理示子宫内膜癌.我院病理会诊为恶性苗勒氏混合瘤。为求进一步诊治2013-02-21收入我院,入院后完善相关检查,于2013-02-28在全麻上行全子宫+两附件切除+盆腔淋巴结清扫+大网膜切除+腹主动脉旁淋巴结活检术,,术后病理示:子宫内膜样腺癌(中分化)浸润至浅肌层,未见癌肉瘤成份。未予特殊治疗,于2013-03-15复查既往子宫内物活检组织诊断为癌肉瘤。2013-04-03~06行iap方案(ifod1-d3+里葆多d1+ddpd1-d4)化疗一程,行里葆多化疗初始出现一过性心悸、胸闷、气促不适,于抗过敏治疗后缓解。患者自起病以来,精神、胃纳、睡眠可,无头晕头痛,胸闷气促,恶心呕吐,腹胀腹痛,尿频尿急,里急后重等不适,大小便正常,体重无明显改变。`,外院治疗经过:无。", "mention_data": [{"mention": "阴道不规则出血", "label": "症状", "offset": "25"}, {"mention": "子宫内膜分段诊刮", "label": "手术", "offset": "42"}, {"mention": "子宫内膜癌", "label": "疾病和诊断", "offset": "53"}, {"mention": "恶性苗勒氏混合瘤", "label": "疾病和诊断", "offset": "66"}, {"mention": "全子宫+两附件切除+盆腔淋巴结清扫+大网膜切除+腹主动脉旁淋巴结活检术", "label": "手术", "offset": "123"}, {"mention": "子宫内膜样腺癌(中分化)", "label": "疾病和诊断", "offset": "166"}, {"mention": "子宫", "label": "解剖部位", "offset": "215"}, {"mention": "癌肉瘤", "label": "疾病和诊断", "offset": "226"}, {"mention": "ifo", "label": "药物", "offset": "250"}, {"mention": "里葆多", "label": "药物", "offset": "259"}, {"mention": "ddp", "label": "药物", "offset": "265"}, {"mention": "里葆多", "label": "药物", "offset": "280"}, {"mention": "心悸", "label": "症状", "offset": "292"}, {"mention": "胸闷", "label": "症状", "offset": "295"}, {"mention": "头晕", "label": "症状", "offset": "332"}, {"mention": "头痛", "label": "症状", "offset": "334"}, {"mention": "胸闷", "label": "症状", "offset": "337"}, {"mention": "腹胀", "label": "症状", "offset": "347"}, {"mention": "腹痛", "label": "症状", "offset": "349"}]}
{"text": "2014-4因肾结石查体,胃镜示胃底占位,病理低分化腺癌。2014-5胃部介入治疗2次(具体不详),家属诉复查无变化,2014-7口服药物治疗(具体不详),2014-10复查胃镜侵及食道,给予含奥沙利铂方案化疗4周期,家属诉复查无变化,末次2015-1。家属诉后口服化疗药至2015-9(具体不详)。2015-9进食哽噎、呕吐,钡餐见食管堵塞大部分,给予放疗20余天。2015-10-2当地查ct发现肝转移。目前进食较前好转,可进普食,无明显哽噎感,无呕吐。近1月自觉右肩部疼痛,口服止痛药物后效果欠佳,口服阿司匹林后疼痛可缓解4-5小时。", "mention_data": [{"mention": "肾结石", "label": "疾病和诊断", "offset": "7"}, {"mention": "胃底", "label": "解剖部位", "offset": "16"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "胃部", "label": "解剖部位", "offset": "35"}, {"mention": "食道", "label": "解剖部位", "offset": "91"}, {"mention": "奥沙利铂", "label": "药物", "offset": "97"}, {"mention": "食管", "label": "解剖部位", "offset": "167"}, {"mention": "ct", "label": "影像检查", "offset": "196"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "200"}, {"mention": "右肩部", "label": "解剖部位", "offset": "234"}, {"mention": "阿司匹林", "label": "药物", "offset": "254"}]}
{"text": "患者2014-05无明显诱因出现粘液血便,量少,伴大便次数增加至4-5次/天,稀烂,偶有里急后重,伴阵发性腹痛。无恶心、发热等不适。外院肠镜检查提示距肛门30cm结肠肿物,肠镜不能通过。活检病理提示腺癌。患者遂来我院,门诊查ct提示:结肠肝曲、乙状结肠肠壁增厚,考虑结肠癌。结肠病灶邻近系膜区域淋巴结肿大,考虑淋巴结转移。腹主动脉旁、肠系膜区淋巴结,转移?右下肺叶斑片影,炎症?患者2014-07-03于我院全麻上行“腹腔镜上全结肠切除术”,术后诊断“多原发结肠癌叒pt3n1am0,iiib”期,于2014-08-11予xelox方案化疗1程。现为行上一程化疗收住入院,起病以来无发热,胃纳可,睡眠一般,小便正常,体重上降5公斤。", "mention_data": [{"mention": "阵发性腹痛", "label": "症状", "offset": "50"}, {"mention": "肛门", "label": "解剖部位", "offset": "75"}, {"mention": "结肠", "label": "解剖部位", "offset": "81"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "99"}, {"mention": "ct", "label": "影像检查", "offset": "112"}, {"mention": "结肠", "label": "解剖部位", "offset": "117"}, {"mention": "肝曲", "label": "解剖部位", "offset": "119"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "122"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "133"}, {"mention": "结肠", "label": "解剖部位", "offset": "137"}, {"mention": "系膜区域淋巴结", "label": "解剖部位", "offset": "143"}, {"mention": "淋巴结转移", "label": "疾病和诊断", "offset": "155"}, {"mention": "腹主动脉旁、肠系膜区淋巴结,转移", "label": "疾病和诊断", "offset": "161"}, {"mention": "右下肺叶斑片影,炎症", "label": "疾病和诊断", "offset": "178"}, {"mention": "腹腔镜上全结肠切除术", "label": "手术", "offset": "209"}, {"mention": "多原发结肠癌叒pt3n1am0,iiib", "label": "疾病和诊断", "offset": "226"}, {"mention": "胃", "label": "解剖部位", "offset": "294"}]}
{"text": "患者于入院前2月余在我院胃肠外科因“胃底升结肠印戒细胞癌”行化疗期间发现右乳一拳头大小的无痛包块,无红肿压痛,无皮肤破溃,无乳房橘皮样外观,无乳头凹陷,无乳头溢液。转入我科行了右乳包块活检术,病检结果为:(右乳)分泌粘液癌(印戒细胞癌),叒er(-)叒pr(-)叒cerbb-2(-)cea(+++)叒,并行“紫杉醇+希罗达”化疗双个疗程,化疗期间乳房皮肤有轻微发红,无明显骨髓抑制及胃肠道反应,化疗后肿块有所缩小,出院后发现乳房肿块又开始缓慢增大,且乳头回缩,今日患者为求进一步治疗入我院,门诊以“右乳印戒细胞癌”收入住院。\\u0004叒叒叒患者于入院前8月我院行左腹股沟肿大淋巴结活检提示转移性癌,并行胃镜、结肠镜检查并取活检,提示为胃底、升结肠印戒细胞癌,并于胃肠外科行数个疗程化疗,未行胃肠道手术。曾用卡培他滨、奥沙利铂、倍伐单抗等药物治疗。\\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": "胃底升结肠印戒细胞癌", "label": "疾病和诊断", "offset": "18"}, {"mention": "右乳", "label": "解剖部位", "offset": "36"}, {"mention": "乳房", "label": "解剖部位", "offset": "62"}, {"mention": "乳头", "label": "解剖部位", "offset": "71"}, {"mention": "乳头溢液", "label": "症状", "offset": "77"}, {"mention": "右乳包块活检术", "label": "手术", "offset": "88"}, {"mention": "(右乳)分泌粘液癌(印戒细胞癌)", "label": "疾病和诊断", "offset": "102"}, {"mention": "紫杉醇", "label": "药物", "offset": "155"}, {"mention": "希罗达", "label": "药物", "offset": "159"}, {"mention": "乳房皮肤", "label": "解剖部位", "offset": "174"}, {"mention": "骨髓抑制", "label": "症状", "offset": "187"}, {"mention": "胃肠道", "label": "解剖部位", "offset": "192"}, {"mention": "乳房肿块", "label": "症状", "offset": "213"}, {"mention": "乳头", "label": "解剖部位", "offset": "226"}, {"mention": "右乳印戒细胞癌", "label": "疾病和诊断", "offset": "250"}, {"mention": "左腹股沟肿大淋巴结活检", "label": "手术", "offset": "283"}, {"mention": "转移性癌", "label": "疾病和诊断", "offset": "296"}, {"mention": "胃底、升结肠印戒细胞癌", "label": "疾病和诊断", "offset": "319"}, {"mention": "胃肠道", "label": "解剖部位", "offset": "347"}, {"mention": "卡培他滨", "label": "药物", "offset": "355"}, {"mention": "奥沙利铂", "label": "药物", "offset": "360"}, {"mention": "倍伐单抗", "label": "药物", "offset": "365"}, {"mention": "胃", "label": "解剖部位", "offset": "396"}]}
{"text": ",缘于入院2年前因“呕血、排黑便”就诊于我院,无畏冷、发热,无口干、多饮、多尿,无多食、易饥,查“,末梢血糖:high,,尿常规:尿糖3+,酮体3+,蛋白质1+,,血气分析示:ph7.0,be-29,lac3.65mmol/l,hco3-1.9mmol/l,,粪常规:隐血试验阳性(3+),,胃镜:出血性胃炎,慢性萎缩性胃炎,未见活动性出血”,诊断为“糖尿病糖尿病酮症酸中毒、下消化道出血”,予输血、降糖、补液、制酸保胃、止血等治疗,下述症状好转,复查尿酮体转阴,监测空腹末梢血糖7mmol/l下上,餐后末梢血糖7-14mmol/l,出院后予“来得时16u、诺和锐三餐前6u”降糖治疗,规律注射胰岛素,监测空腹末梢血糖7mmol/l右左,未监测餐后血糖。1年半前无明显诱因出现恶心、呕吐,呕吐物为胃内容物,无头晕、头痛,无畏冷、发热,无咳嗽、咳痰,就诊我院,查“末梢血糖high,,血气分析:ph7.122,paco219.5mmhg,pao2110mmhg,be-23mmol/l,,尿常规:尿糖3+,酮体3+,,血常规:wbc26.8*10^9/l,ne87.7%,hb138g/l。,糖尿病抗体:谷氨酸脱羧酶抗体阳性(+)。胰岛素、c,肽检查:1.胰岛素(空腹)&lt;0.2mu/l,2.胰岛素(2h)&lt;0.2mu/l,3.c肽(空腹)&lt;0.02ug/l,c肽(2h)0.02ug/l”,诊断为“1型糖尿病糖尿病酮症酸中毒”,予降糖、补液、感染、制酸保胃等治疗,下述症状好转,出院后予“诺和锐特充9u早11u午9u晚+来得时7u睡前”降糖治疗,后规律注射胰岛素,未监测血糖。1年前自测末梢血糖均偏高,餐后2小时末梢血糖16-18mmol/l,无口干、多饮,无多食、易饥,无多尿、泡沫尿,就诊我院,予“降糖、改善微循环、营养心肌、抗凝”等治疗后,血糖控制稳定后出院,出院后予“诺和锐特充三餐前5u-9u-4u+来得时9u睡前”,未规律监测血糖,偶测空腹末梢血糖10mmol/l下上。1月前无明显诱因出现泡沫尿,无尿频、尿急、尿痛,无发热、寒战,无多饮、多食,未予重视,未处理。今求进一步诊治,就诊我院,门诊“糖尿病糖尿病性肾病?”收入院。自发病以来,精神、食欲、睡眠尚可,小便如下述,大便正常,体重无明显改变。", "mention_data": [{"mention": "呕血、排黑便", "label": "疾病和诊断", "offset": "10"}, {"mention": "口干", "label": "症状", "offset": "31"}, {"mention": "末梢血糖", "label": "实验室检验", "offset": "50"}, {"mention": "尿糖", "label": "实验室检验", "offset": "65"}, {"mention": "酮体", "label": "实验室检验", "offset": "70"}, {"mention": "蛋白质", "label": "实验室检验", "offset": "75"}, {"mention": "ph", "label": "实验室检验", "offset": "88"}, {"mention": "be", "label": "实验室检验", "offset": "94"}, {"mention": "lac", "label": "实验室检验", "offset": "100"}, {"mention": "hco3-", "label": "实验室检验", "offset": "114"}, {"mention": "隐血试验", "label": "实验室检验", "offset": "134"}, {"mention": "出血性胃炎", "label": "疾病和诊断", "offset": "149"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "155"}, {"mention": "糖尿病糖尿病酮症酸中毒", "label": "疾病和诊断", "offset": "176"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "188"}, {"mention": "尿酮体", "label": "影像检查", "offset": "226"}, {"mention": "空腹末梢血糖", "label": "实验室检验", "offset": "234"}, {"mention": "餐后末梢血糖", "label": "实验室检验", "offset": "250"}, {"mention": "来得时", "label": "药物", "offset": "272"}, {"mention": "诺和锐", "label": "药物", "offset": "279"}, {"mention": "胰岛素", "label": "药物", "offset": "297"}, {"mention": "空腹末梢血糖", "label": "实验室检验", "offset": "303"}, {"mention": "餐后血糖", "label": "实验室检验", "offset": "322"}, {"mention": "胃", "label": "解剖部位", "offset": "348"}, {"mention": "头晕", "label": "症状", "offset": "354"}, {"mention": "头痛", "label": "症状", "offset": "357"}, {"mention": "末梢血糖", "label": "实验室检验", "offset": "381"}, {"mention": "ph", "label": "实验室检验", "offset": "396"}, {"mention": "paco2", "label": "实验室检验", "offset": "404"}, {"mention": "pao2", "label": "实验室检验", "offset": "418"}, {"mention": "be", "label": "实验室检验", "offset": "430"}, {"mention": "尿糖", "label": "实验室检验", "offset": "447"}, {"mention": "酮体", "label": "实验室检验", "offset": "452"}, {"mention": "wbc", "label": "实验室检验", "offset": "462"}, {"mention": "ne", "label": "实验室检验", "offset": "477"}, {"mention": "谷氨酸脱羧酶抗体阳性", "label": "实验室检验", "offset": "501"}, {"mention": "胰岛素(空腹)", "label": "实验室检验", "offset": "527"}, {"mention": "胰岛素(2h)", "label": "实验室检验", "offset": "548"}, {"mention": "c肽(空腹)", "label": "实验室检验", "offset": "569"}, {"mention": "c肽(2h)", "label": "实验室检验", "offset": "588"}, {"mention": "1型糖尿病糖尿病酮症酸中毒", "label": "疾病和诊断", "offset": "608"}, {"mention": "胃", "label": "解剖部位", "offset": "636"}, {"mention": "诺和锐", "label": "药物", "offset": "653"}, {"mention": "来得时", "label": "药物", "offset": "669"}, {"mention": "胰岛素", "label": "药物", "offset": "687"}, {"mention": "血糖", "label": "实验室检验", "offset": "694"}, {"mention": "末梢血糖", "label": "实验室检验", "offset": "702"}, {"mention": "末梢血糖", "label": "实验室检验", "offset": "715"}, {"mention": "口干", "label": "症状", "offset": "732"}, {"mention": "心肌", "label": "解剖部位", "offset": "771"}, {"mention": "血糖", "label": "实验室检验", "offset": "782"}, {"mention": "诺和锐", "label": "药物", "offset": "797"}, {"mention": "来得时", "label": "药物", "offset": "814"}, {"mention": "血糖", "label": "实验室检验", "offset": "828"}, {"mention": "空腹末梢血糖", "label": "实验室检验", "offset": "833"}, {"mention": "糖尿病糖尿病性肾病", "label": "疾病和诊断", "offset": "913"}]}
{"text": "患者2年前无明显诱因出现左上腹隐痛,间断性,无放散,自服止痛药物后可缓解,于外院检查发现子宫肌瘤,行子宫次全切除术,术后切口愈合不良,时有脓性液体流出,半年后切口愈合,仍有左上腹隐痛,间断性,较术前频繁,向腰骶部放散,自服止痛药物可缓解。近4日左上腹隐痛加重,较剧烈,持续性,自服止痛药物未缓解,于外院就诊发现左侧盆腔直径约10cm囊性包块。现为求进一步诊治入院。患者平素便秘,时有尿频、尿急、尿痛等尿路感染症状,白带可,否认合房出血。病来无发热乏力,无头晕头痛,无胸闷气短,无腹胀,饮食睡眠可,体重无减轻。", "mention_data": [{"mention": "左上腹", "label": "解剖部位", "offset": "12"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "44"}, {"mention": "子宫次全切除术", "label": "手术", "offset": "50"}, {"mention": "左上腹", "label": "解剖部位", "offset": "86"}, {"mention": "腰骶部", "label": "解剖部位", "offset": "103"}, {"mention": "左上腹", "label": "解剖部位", "offset": "122"}, {"mention": "左侧盆腔", "label": "解剖部位", "offset": "155"}, {"mention": "头晕", "label": "症状", "offset": "227"}, {"mention": "头痛", "label": "症状", "offset": "229"}, {"mention": "胸闷气短", "label": "症状", "offset": "233"}, {"mention": "腹胀", "label": "症状", "offset": "239"}]}
{"text": "缘于3天前无明显诱因感左上肢肿痛,为持续性钝痛,以左小腿为重,久立或久行后症状加重,抬高患肢可略缓解。无患肢发凉、浅表血管曲张、紫绀,伴间歇性跛行,无腰痛、咳嗽、咯血等不适。未行特殊治疗患肢肿胀无明显变化。今来我院就诊,行上肢深静脉彩超检查示左上肢深静脉血栓形成,为进一步治疗,遂收入我科。自发病以来无明显胸闷、气短,无发烧,精神状态一般,食欲一般,睡眠良好,体重无明显变化,大便正常,小便正常。", "mention_data": [{"mention": "左上肢", "label": "解剖部位", "offset": "11"}, {"mention": "左小腿", "label": "解剖部位", "offset": "25"}, {"mention": "腰痛", "label": "症状", "offset": "75"}, {"mention": "上肢深静脉彩超", "label": "影像检查", "offset": "111"}, {"mention": "左上肢深静脉血栓形成", "label": "疾病和诊断", "offset": "121"}, {"mention": "胸闷", "label": "症状", "offset": "153"}]}
{"text": ",患者9月余前于我院行全膀胱切除根治术+回肠导管术,,术后病理提示:膀胱浸润性癌,结合免疫组化结果,符合高级别浸润性尿路下皮癌,左闭孔淋巴结、左髂外淋巴结、左髂内淋巴结见癌转移,并侵出至淋巴结包膜外结缔组织。左髂总淋巴结见癌转移,脉管内见癌栓。左髂总淋巴结见癌转移,脉管内见癌栓。4月前,患者于我院复查,ct:膀胱术后缺如,局部未见明显肿物;左上腹壁见肠管造瘘口。直肠下段前方新增软组织灶与直肠分界不清,增强扫描强化稍明显,大小约41mm×17mm。直肠系膜见多发淋巴结,边界清,较大者约10mm×7mm,密度均匀。2月前患者出现腹部剧烈疼痛,患者为求进一步诊治再次入院,复查ct示膀胱癌根治术后,膀胱术后缺失,直肠下段前方软组织灶,较前明显增大,考虑腹膜种植可能性大,直肠系膜多发小淋巴结,较前增大,腹主动脉旁及小肠系膜根肠系膜根部淋巴结,较前未见明显变化,两侧髂血管旁结节,考虑淋巴结转移,并两肾盂、两输尿管积水,左上上肺内基底段类结节较前变化不明显。遂于2014-11-13、2014.12.03、2014-12-23、2015-01-13行gc方案动脉化疗(吉西他滨1.2gd1,顺铂20mg,d1-d3)双周期,化疗后患者回家休养。今为求进一步治疗再次来我院,门诊以\\\"膀胱癌综合治疗后\\\"收入我科。患者发病以来,精神好,饮食睡眠可,无发冷发热,无咳嗽、咳痰、胸痛及心慌气短,大便正常,小便如下所述,体重无减轻。", "mention_data": [{"mention": "全膀胱切除根治术+回肠导管术", "label": "手术", "offset": "11"}, {"mention": "膀胱浸润性癌", "label": "疾病和诊断", "offset": "34"}, {"mention": "高级别浸润性尿路下皮癌", "label": "疾病和诊断", "offset": "52"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "64"}, {"mention": "左髂外淋巴结", "label": "解剖部位", "offset": "71"}, {"mention": "左髂内淋巴结", "label": "解剖部位", "offset": "78"}, {"mention": "左髂总淋巴结", "label": "解剖部位", "offset": "104"}, {"mention": "左髂总淋巴结", "label": "解剖部位", "offset": "122"}, {"mention": "ct", "label": "影像检查", "offset": "152"}, {"mention": "膀胱术后", "label": "疾病和诊断", "offset": "155"}, {"mention": "左上腹", "label": "解剖部位", "offset": "171"}, {"mention": "肠管", "label": "解剖部位", "offset": "176"}, {"mention": "直肠", "label": "解剖部位", "offset": "182"}, {"mention": "直肠", "label": "解剖部位", "offset": "195"}, {"mention": "直肠", "label": "解剖部位", "offset": "225"}, {"mention": "腹部", "label": "解剖部位", "offset": "265"}, {"mention": "ct", "label": "影像检查", "offset": "288"}, {"mention": "膀胱癌根治术后", "label": "疾病和诊断", "offset": "291"}, {"mention": "膀胱术后", "label": "疾病和诊断", "offset": "299"}, {"mention": "直肠", "label": "解剖部位", "offset": "306"}, {"mention": "腹膜种植", "label": "疾病和诊断", "offset": "326"}, {"mention": "直肠", "label": "解剖部位", "offset": "335"}, {"mention": "腹主动脉旁", "label": "解剖部位", "offset": "351"}, {"mention": "小肠系膜根肠系膜根部淋巴结", "label": "解剖部位", "offset": "357"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "380"}, {"mention": "两肾盂", "label": "解剖部位", "offset": "398"}, {"mention": "两输尿管", "label": "解剖部位", "offset": "402"}, {"mention": "左上上肺内基底段", "label": "解剖部位", "offset": "409"}, {"mention": "吉西他滨", "label": "药物", "offset": "483"}, {"mention": "顺铂", "label": "药物", "offset": "494"}, {"mention": "膀胱癌综合治疗后", "label": "疾病和诊断", "offset": "540"}, {"mention": "胸痛", "label": "症状", "offset": "585"}]}
{"text": ",缘于入院前[主诉单一时间1月主诉单一时间]前无明显诱因出现中下腹部闷痛部闷痛不适,为持续性隐痛,无其它部位放射,与进食无关,无恶心、呕吐、返酸、嗳气、纳差、乏力、消瘦、腹痛、腹泻、便秘,无呕血、黑便,无发热、咳嗽、咳痰,,此次至我院门诊行胃镜检查示:“吻合口溃疡”,,病理:腺癌,遂门诊拟“残胃癌”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": "中下腹部", "label": "解剖部位", "offset": "30"}, {"mention": "腹痛", "label": "症状", "offset": "85"}, {"mention": "腹泻", "label": "症状", "offset": "88"}, {"mention": "吻合口溃疡", "label": "疾病和诊断", "offset": "127"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "138"}, {"mention": "残胃癌", "label": "疾病和诊断", "offset": "146"}]}
{"text": ",患者入院前6年无明显诱因出现腹痛,主要为左下腹及左上腹阵发性隐痛不适,疼痛与进食、活动及体位改变无明显关系,无反酸、嗳气、烧心、恶心、呕吐等不适,无肩背部放射痛,,曾于我院行胃镜示:1.食管浅溃疡;2.浅表性胃窦炎伴糜烂;3.十二指肠球部多发息肉。并行十二指肠球部息肉消融术,,术后活检示:十二指肠球部息肉伴柱状下皮化生。后腹痛反复出现,予对症治疗后缓解,患者入院前3月无明显诱因再发腹痛,部位同前,疼痛程度较前加重,无厌油、纳差、乏力、反酸、嗳气等不适,,于我院行胃镜示:1.慢性非萎缩性胃炎;2.十二指肠球部息肉。今日患者为求进一步诊治收入我科治疗。\\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,体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "15"}, {"mention": "左下腹", "label": "解剖部位", "offset": "21"}, {"mention": "左上腹", "label": "解剖部位", "offset": "25"}, {"mention": "肩背部", "label": "解剖部位", "offset": "75"}, {"mention": "食管浅溃疡", "label": "疾病和诊断", "offset": "94"}, {"mention": "浅表性胃窦炎伴糜烂", "label": "疾病和诊断", "offset": "102"}, {"mention": "十二指肠球部多发息肉", "label": "疾病和诊断", "offset": "114"}, {"mention": "十二指肠球部息肉消融术", "label": "手术", "offset": "127"}, {"mention": "十二指肠球部息肉伴柱状下皮化生", "label": "疾病和诊断", "offset": "146"}, {"mention": "腹痛", "label": "症状", "offset": "163"}, {"mention": "腹痛", "label": "症状", "offset": "193"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "240"}, {"mention": "十二指肠球部息肉", "label": "疾病和诊断", "offset": "251"}]}
{"text": "患者因\\\"直肠癌同期放化疗后\\\"于2012年5月25日在我院在全麻上行dixon手术,术后病理显示直肠中分化腺癌,癌组织浸润至肠壁外膜层,淋巴结及切缘未见转移。因术后10余天发现“阴道中有大便排出”于2012年6月25日行“横结肠两腔造瘘术+阴道修补术”。患者术后已于2012年8月3日行xelox方案化疗一程,过程顺利,患者诉化疗后自觉手麻木3天,现已恢复。患者自发病以来,食欲、睡眠及精神良好,小便正常,体力无上降,体重无明显上降。", "mention_data": [{"mention": "直肠癌同期放化疗后", "label": "疾病和诊断", "offset": "5"}, {"mention": "dixon手术", "label": "手术", "offset": "35"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "49"}, {"mention": "肠", "label": "解剖部位", "offset": "63"}, {"mention": "阴道", "label": "解剖部位", "offset": "90"}, {"mention": "横结肠两腔造瘘术+阴道修补术", "label": "手术", "offset": "112"}, {"mention": "手麻", "label": "症状", "offset": "169"}]}
{"text": ",缘于入院前1个月无明显诱因出现食物反流,偶于睡觉时从嘴角流出,为胃内容物,伴咳嗽,乏力,进食后、卧位以及夜间明显,无反酸、烧心,无吞咽困难、进食障碍,无胸闷、胸痛,无发热、畏冷,无咳痰,无腹胀、腹痛,就诊我院,予“世福素、甘草合剂”等治疗后无明显好转。入院前7天就诊我院消化科,,查腹部ct示:1、右下下腹部残胃腔管壁明显增厚伴轻度强化,最厚约24mm,管腔变窄,食管轻度扩张,考虑残胃癌,建议内镜检查,残胃周围未见明显肿大淋巴结。,胃镜检查:食管腔见大量液体残留,影响观察;距门齿40cm处见一隆起性病灶,表面糜烂、出血,质地组织脆,活检易出血,管腔狭窄,内镜不能通过,无法观察全貌。,考虑:胃癌术后复发?,胃镜病理示:(距门齿40cm),:乳头状-管状腺癌。予“右卡尼汀、力素营养心肌,氨基酸、脂肪乳营养支持,胸腺五肽增强免疫力,潘妥洛克制酸保胃、头孢替安抗感染”等处理后症状稍好转。今为求进一步诊治,就诊我院,门诊拟“贲门癌”收住入院。自发病以来,精神、饮食、睡眠一般,大小便正常,体重减轻3kg。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "33"}, {"mention": "胸闷", "label": "症状", "offset": "77"}, {"mention": "胸痛", "label": "症状", "offset": "80"}, {"mention": "腹胀", "label": "症状", "offset": "95"}, {"mention": "腹痛", "label": "症状", "offset": "98"}, {"mention": "世福素", "label": "药物", "offset": "108"}, {"mention": "甘草合剂", "label": "药物", "offset": "112"}, {"mention": "腹部ct", "label": "影像检查", "offset": "142"}, {"mention": "右下下腹部", "label": "解剖部位", "offset": "150"}, {"mention": "胃", "label": "解剖部位", "offset": "156"}, {"mention": "食管", "label": "解剖部位", "offset": "183"}, {"mention": "胃", "label": "解剖部位", "offset": "193"}, {"mention": "胃", "label": "解剖部位", "offset": "204"}, {"mention": "食管", "label": "解剖部位", "offset": "223"}, {"mention": "门齿", "label": "解剖部位", "offset": "240"}, {"mention": "胃癌术后复发", "label": "疾病和诊断", "offset": "298"}, {"mention": "门齿", "label": "解剖部位", "offset": "314"}, {"mention": "乳头状-管状腺癌", "label": "疾病和诊断", "offset": "323"}, {"mention": "右卡尼汀", "label": "药物", "offset": "334"}, {"mention": "力素", "label": "药物", "offset": "339"}, {"mention": "氨基酸", "label": "药物", "offset": "346"}, {"mention": "脂肪乳", "label": "药物", "offset": "350"}, {"mention": "胸腺五肽", "label": "药物", "offset": "358"}, {"mention": "潘妥洛克", "label": "药物", "offset": "368"}, {"mention": "头孢替安", "label": "药物", "offset": "377"}, {"mention": "贲门癌", "label": "疾病和诊断", "offset": "413"}]}
{"text": "患者4年前因上肢疼痛就诊我院,诊断“上肢动脉粥样硬化闭塞症状”,于2013年于全麻上行“两侧上肢动脉支架置入术+术中溶栓术”,术顺,术后顺利出院。患者1月前无明显诱因于行走100m时出现右侧上肢疼痛,休息后好转,行走后症状反复。患者近日症状加重,行走50m出现右上肢疼痛症状,休息后症状好转。无上肢肿胀,无上肢静脉曲张,无胸腹部疼痛,无腰部疼痛。现患者为进一步治疗就诊我院,门诊拟以“上肢动脉粥样硬化闭塞症”收住入院。患者自发病以来,饮食睡眠可,大小便无明显异常,运动耐量明显上降。", "mention_data": [{"mention": "上肢", "label": "解剖部位", "offset": "6"}, {"mention": "上肢动脉粥样硬化闭塞症状", "label": "疾病和诊断", "offset": "18"}, {"mention": "两侧上肢动脉支架置入术+术中溶栓术", "label": "手术", "offset": "44"}, {"mention": "右侧上肢", "label": "解剖部位", "offset": "93"}, {"mention": "右上肢", "label": "解剖部位", "offset": "130"}, {"mention": "上肢", "label": "解剖部位", "offset": "147"}, {"mention": "上肢静脉", "label": "解剖部位", "offset": "153"}, {"mention": "胸腹部", "label": "解剖部位", "offset": "161"}, {"mention": "腰部", "label": "解剖部位", "offset": "168"}, {"mention": "上肢动脉粥样硬化闭塞症", "label": "疾病和诊断", "offset": "192"}]}
{"text": ",患者无明显诱因上自觉中下腹疼痛不适,腹痛性质为阵发性绞痛,剧烈难忍,伴大汗淋漓,伴左肩胛部放射痛,进食油腻食物后无加重。有发热、恶心、呕吐史,发热最高度数不详。数年前出现皮肤巩膜黄染史。2010年5月23日,至我院门诊查ct示:肝内外胆管多发结石伴胆管扩张,慢性肝病,脾肿大,,查b超示:肝内胆管及胆总管多发结石伴远端胆管扩张,2010/6/29在肝外科行复杂粘连松解、胆总管切开取石、胆道镜探查、t管引流术,因患者右肝代偿性增大明显,切除右肝患者肝功能无法耐受,故手术未取出嵌顿于右肝管内的结石,术后恢复可。现为求进一步诊治,收入本病房。患者发病以来精神可,胃纳可,双便如常,睡眠可,否认明显体重变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "11"}, {"mention": "腹痛", "label": "症状", "offset": "19"}, {"mention": "左肩胛", "label": "解剖部位", "offset": "42"}, {"mention": "巩膜", "label": "解剖部位", "offset": "88"}, {"mention": "ct", "label": "影像检查", "offset": "111"}, {"mention": "肝内外胆管多发结石伴胆管扩张", "label": "疾病和诊断", "offset": "115"}, {"mention": "慢性肝病", "label": "疾病和诊断", "offset": "130"}, {"mention": "脾肿大", "label": "症状", "offset": "135"}, {"mention": "b超", "label": "影像检查", "offset": "141"}, {"mention": "肝内胆管及胆总管多发结石伴远端胆管扩张", "label": "疾病和诊断", "offset": "145"}, {"mention": "复杂粘连松解、胆总管切开取石、胆道镜探查、t管引流术", "label": "手术", "offset": "179"}, {"mention": "右肝", "label": "解剖部位", "offset": "209"}, {"mention": "右肝", "label": "解剖部位", "offset": "221"}, {"mention": "右肝管", "label": "解剖部位", "offset": "242"}, {"mention": "胃", "label": "解剖部位", "offset": "281"}]}
{"text": "患者于2009.7.22因残胃异时性原发癌在全麻上行胃癌根治术(全胃切除+区域淋巴结清扫+roux-en-y消化道重建术),术后恢复好,病理类型(印戒细胞癌),分期t4、n3、m0。术后18天行全身化疗(folfiri),共1次,有特别化疗反应,轻微恶心呕吐,食欲上降。3天前化疗结束自动要求出院。出院后感反复下腹痛,为阵发性绞痛,可自行缓解。伴有食欲不佳,恶心,未呕吐。今为明确诊治入院。\\u0004叒叒叒患者自起病以来,精神略差,胃纳略差,大便次数增多,小便如常,体重未见明显上降。", "mention_data": [{"mention": "残胃异时性原发癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "胃癌根治术(全胃切除+区域淋巴结清扫+roux-en-y消化道重建术)", "label": "手术", "offset": "26"}, {"mention": "(印戒细胞癌),分期t4、n3、m0", "label": "疾病和诊断", "offset": "72"}, {"mention": "下腹痛", "label": "症状", "offset": "155"}, {"mention": "胃", "label": "解剖部位", "offset": "217"}]}
{"text": ",患者约于10月前无明显诱因出现消化不良,餐后饱胀,伴嗳气,偶有反酸,无发热,无恶心、呕吐,无腹泻、黑便,无肛门上坠感及里急后重感,未规范治疗。现患者为求明确诊疗来我院就诊,,门诊行胃镜检查示:胃体大弯侧见一直径约0.8cm息肉样隆起,,超声示:隆起为粘膜上层来源等回声光团,并有颗粒感,,检查诊断:1.萎缩性胃炎伴急性活动;2.胃体隆起,smt?3.十二指肠炎。现为行进一步治疗,门诊以\\\"胃息肉\\\"收入我科。患者自发病以来,精神可,饮食可,睡眠可,二便正常,体重无明显改变。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "47"}, {"mention": "肛门", "label": "解剖部位", "offset": "54"}, {"mention": "胃体大弯", "label": "解剖部位", "offset": "97"}, {"mention": "萎缩性胃炎伴急性活动", "label": "疾病和诊断", "offset": "152"}, {"mention": "胃体隆起", "label": "疾病和诊断", "offset": "165"}, {"mention": "smt", "label": "疾病和诊断", "offset": "170"}, {"mention": "十二指肠炎", "label": "疾病和诊断", "offset": "176"}, {"mention": "胃息肉", "label": "疾病和诊断", "offset": "196"}]}
{"text": "入院前10+年患者开始出现咳嗽、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,于下坡时出现。2014年4月患者曾因下诉症状发作在我科住院治疗,当时查“心脏彩超示右房、左房、左室增大,主动脉瓣、二尖瓣轻度反流,三尖瓣重度反流,肺动脉重度高压,心包腔积液,右室舒张功能减退。腹部彩超未见明显异常。胸片示1.右肺中上野团片影,建议ct检查;2.考虑左下肺感染性病变,肺气肿;3.心影增大,主动脉少许钙化;4.考虑左侧水平裂少量包裹性积液或水平裂增厚,右上胸壁条片影,考虑少量胸腔积液或胸膜增厚;5.两膈面粘连,胸椎骨质增生。完善胸部ct示1.考虑左下叶感染,两上肺支气管扩张伴感染,以右上肺为甚;2.右心缘不规则低密度影,考虑囊性病变,支气管囊肿?心包囊肿?心包积液?囊性畸胎瘤?;3.符合慢支炎、肺气肿伴左上肺大泡形成;4.心影增大,主动脉壁钙化;5.右侧胸腔积液及叶间积液,部分包裹”,考虑诊断“1、慢性阻塞性肺病(急性加重期)肺源性心脏病叒2、冠心病叒缺血性心肌病型叒心脏增大叒心房纤颤叒心衰叒心包腔积液叒心功能ⅲ级叒3、支气管扩张叒4.叒右肺中上野团片影原因待查”,予以吸氧、抗感染、平喘、改善循环、调节代谢、对症治疗后好转出院。出院后患者曾间断服用利尿剂,未长期服用止咳化痰药物及家庭氧疗。入院前4天,患者受凉后喘累、气促再发,伴咳嗽、咳痰,自诉痰呈白色丝状,不易咳出,无咯血,感夜间难以平卧位休息,喜高枕卧位,无畏寒发热,无潮热盗汗,无心慌心悸,无胸闷胸痛,无腹胀腹痛,无上肢浮肿等,曾在外诊所输液治疗2天,自觉症状缓解,但昨日夜间再次感咳嗽明显,伴气促,故就诊我院门诊,查“血气分析全套:二氧化碳总量叒39mmol/l、酸碱度叒7.360、二氧化碳分压叒66mmhg、氧分压叒163mmhg、碳酸氢根叒37.3mmol/l、标准碳酸氢根叒31.90mmol/l、细胞外液碱剩余叒11.9mmol/l、全血碱剩余叒8.90mmol/l、血氧饱和度叒99%、乳酸叒1.00mmol/l,血常规:白细胞数叒8.3叒10^9/l、血红蛋白浓度叒139g/l、血小板数叒181叒10^9/l、中性粒细胞百分比叒84.21%、淋巴细胞百分比叒11.02%,肾功:尿素叒9.23mmol/l、肌酐叒63.6μmol/l、尿酸叒289.2μmol/l,电解质:钾叒3.59mmol/l、钠叒147.1mmol/、氯叒104.9mmol/l。胸片示1.左下肺感染性病变,侧位肺门增大增浓,建议ct或治疗后复查。2.肺气肿征。3.左侧胸膜增厚。4.胸椎骨质增生,部分椎体楔形变”,为进一步诊疗收入我科住院。患者此次起病后精神、食欲、睡眠一般,大小便正常,体力体重无明显变化。", "mention_data": [{"mention": "心脏彩超", "label": "影像检查", "offset": "114"}, {"mention": "右房", "label": "解剖部位", "offset": "119"}, {"mention": "左房", "label": "解剖部位", "offset": "122"}, {"mention": "左室", "label": "解剖部位", "offset": "125"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "130"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "135"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "143"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "151"}, {"mention": "心包腔积液", "label": "疾病和诊断", "offset": "159"}, {"mention": "右室", "label": "解剖部位", "offset": "165"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "174"}, {"mention": "胸片", "label": "影像检查", "offset": "185"}, {"mention": "右肺", "label": "解剖部位", "offset": "190"}, {"mention": "ct", "label": "影像检查", "offset": "201"}, {"mention": "左下肺感染性病变", "label": "疾病和诊断", "offset": "210"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "219"}, {"mention": "心", "label": "解剖部位", "offset": "225"}, {"mention": "主动脉", "label": "解剖部位", "offset": "230"}, {"mention": "左侧水平裂", "label": "解剖部位", "offset": "242"}, {"mention": "水平裂", "label": "解剖部位", "offset": "255"}, {"mention": "右上胸壁", "label": "解剖部位", "offset": "261"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "273"}, {"mention": "胸膜增厚", "label": "疾病和诊断", "offset": "278"}, {"mention": "两膈面", "label": "解剖部位", "offset": "285"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "291"}, {"mention": "胸部ct", "label": "影像检查", "offset": "300"}, {"mention": "左下叶感染", "label": "疾病和诊断", "offset": "309"}, {"mention": "两上肺支气管扩张伴感染", "label": "疾病和诊断", "offset": "315"}, {"mention": "右上肺", "label": "解剖部位", "offset": "328"}, {"mention": "右心缘", "label": "解剖部位", "offset": "336"}, {"mention": "囊性病变", "label": "疾病和诊断", "offset": "349"}, {"mention": "支气管囊肿", "label": "疾病和诊断", "offset": "354"}, {"mention": "心包囊肿", "label": "疾病和诊断", "offset": "360"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "365"}, {"mention": "囊性畸胎瘤", "label": "疾病和诊断", "offset": "370"}, {"mention": "慢支炎", "label": "疾病和诊断", "offset": "381"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "385"}, {"mention": "左上肺", "label": "解剖部位", "offset": "389"}, {"mention": "心", "label": "解剖部位", "offset": "399"}, {"mention": "主动脉壁", "label": "解剖部位", "offset": "404"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "415"}, {"mention": "慢性阻塞性肺病(急性加重期)", "label": "疾病和诊断", "offset": "438"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "452"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "461"}, {"mention": "缺血性心肌病型", "label": "疾病和诊断", "offset": "465"}, {"mention": "心脏增大", "label": "症状", "offset": "473"}, {"mention": "心房纤颤", "label": "疾病和诊断", "offset": "478"}, {"mention": "心衰", "label": "疾病和诊断", "offset": "483"}, {"mention": "心包腔积液", "label": "疾病和诊断", "offset": "486"}, {"mention": "心功能ⅲ级", "label": "疾病和诊断", "offset": "492"}, {"mention": "支气管扩张", "label": "疾病和诊断", "offset": "500"}, {"mention": "右肺", "label": "解剖部位", "offset": "509"}, {"mention": "利尿剂", "label": "药物", "offset": "565"}, {"mention": "心慌", "label": "症状", "offset": "660"}, {"mention": "心悸", "label": "症状", "offset": "662"}, {"mention": "胸闷", "label": "症状", "offset": "666"}, {"mention": "胸痛", "label": "症状", "offset": "668"}, {"mention": "腹胀", "label": "症状", "offset": "672"}, {"mention": "腹痛", "label": "症状", "offset": "674"}, {"mention": "上肢", "label": "解剖部位", "offset": "678"}, {"mention": "二氧化碳总量", "label": "实验室检验", "offset": "737"}, {"mention": "酸碱度", "label": "实验室检验", "offset": "753"}, {"mention": "二氧化碳分压", "label": "实验室检验", "offset": "763"}, {"mention": "氧分压", "label": "实验室检验", "offset": "777"}, {"mention": "碳酸氢根", "label": "实验室检验", "offset": "789"}, {"mention": "标准碳酸氢根", "label": "实验室检验", "offset": "805"}, {"mention": "细胞外液碱剩余", "label": "实验室检验", "offset": "824"}, {"mention": "全血碱剩余", "label": "实验室检验", "offset": "843"}, {"mention": "血氧饱和度", "label": "实验室检验", "offset": "860"}, {"mention": "乳酸", "label": "实验室检验", "offset": "870"}, {"mention": "白细胞数", "label": "实验室检验", "offset": "888"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "904"}, {"mention": "血小板", "label": "实验室检验", "offset": "918"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "934"}, {"mention": "淋巴细胞百分比", "label": "实验室检验", "offset": "950"}, {"mention": "尿素", "label": "实验室检验", "offset": "968"}, {"mention": "肌酐", "label": "实验室检验", "offset": "982"}, {"mention": "尿酸", "label": "实验室检验", "offset": "996"}, {"mention": "钾", "label": "实验室检验", "offset": "1015"}, {"mention": "钠", "label": "实验室检验", "offset": "1028"}, {"mention": "氯", "label": "实验室检验", "offset": "1041"}, {"mention": "胸片", "label": "影像检查", "offset": "1055"}, {"mention": "左下肺", "label": "解剖部位", "offset": "1060"}, {"mention": "肺门", "label": "解剖部位", "offset": "1071"}, {"mention": "ct", "label": "影像检查", "offset": "1080"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "1091"}, {"mention": "左侧胸膜", "label": "解剖部位", "offset": "1098"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "1107"}, {"mention": "椎体", "label": "解剖部位", "offset": "1116"}]}
{"text": "入院前3+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。反复因黑便多次在我院内二科住院,住院后诊断“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2016-03-14行右前臂动静脉内瘘吻合术,2016-04-06自动出院转我科行长期维持性血液透析治疗。1-月前受凉后出现咳嗽,家属在药店购买“消炎止咳”等药物给其服用,具体不详,服药后症状无好转,起床后出现面部浮肿,咳嗽时腹部疼痛,伴有腹泻,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,为进一步治疗到我院透析室检查透析后患者症状无好转,后收入我科住院,使用依替米星抗感染(7天),查胸部ct:1、考虑两肺感染性病变,建议治疗后复查。2、两侧少-中量胸腔积液。3、右肺尖条片状及纤维条索状影,右下肺门稍牵拉下移。4、心影增大,主动脉及冠状动脉壁钙化。5、少量心包积液。6、两侧胸膜增厚,左侧少许胸膜钙化。胸椎骨质增生。7、脾脏稍增大。因不除外肺部结核,建议转往******医院就诊,于2017-10-13转入******医院,予以胸腔闭式引流术,莫西沙星抗感染(14天),胎盘多肽增强抵抗力,多索茶碱舒张支气管,厄贝沙坦氢氯噻嗪、氨氯地平降压等治疗,查胸水一般细菌涂片、找抗酸杆菌、腺苷脱氨酶测定、cea、afp、ca125无明显异常,t-spot弱阳性,复查胸部ct提示:1、气管左移,肺内血管支气管束增多增粗,两侧肺较多散在的斑片状、条索状高密度影,考虑感染性病变可能;2、胸腔内可见明显中量积液,密度不均,邻近胸膜粘连;2、心脏血管及主动脉钙化。*******医院评估,目前暂不考虑肺结核诊断;患者目前间断咳嗽,少许白色粘痰,不易咳出,精神欠佳,食欲差,感活动后心累,气促较前缓解,无意识障碍大小便失禁,无胸闷胸痛,无心悸、恶心呕吐,无腹胀腹痛腹泻,无尿痛尿频等不适,建议患者继续抗感染治疗,但患者家属要求转回我院,今日转入我院继续治疗。病程中患者精神欠佳,饮食差,昨日解黄色稀便2次,小便约400ml,体重无明显上降。", "mention_data": [{"mention": "高血压肾病", "label": "疾病和诊断", "offset": "27"}, {"mention": "尿毒症", "label": "疾病和诊断", "offset": "82"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "86"}, {"mention": "高血压肾病", "label": "疾病和诊断", "offset": "91"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "97"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "103"}, {"mention": "心功能不全", "label": "疾病和诊断", "offset": "110"}, {"mention": "营养不良", "label": "疾病和诊断", "offset": "116"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "162"}, {"mention": "尿素氮", "label": "实验室检验", "offset": "176"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "196"}, {"mention": "血钾", "label": "实验室检验", "offset": "211"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "229"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "237"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "242"}, {"mention": "高血压3级很高危", "label": "疾病和诊断", "offset": "248"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "257"}, {"mention": "尿路感染", "label": "疾病和诊断", "offset": "264"}, {"mention": "低蛋白血症", "label": "疾病和诊断", "offset": "269"}, {"mention": "右前臂动静脉内瘘吻合术", "label": "手术", "offset": "342"}, {"mention": "面部浮肿", "label": "症状", "offset": "436"}, {"mention": "腹部", "label": "解剖部位", "offset": "444"}, {"mention": "腹泻", "label": "症状", "offset": "451"}, {"mention": "腹痛", "label": "症状", "offset": "455"}, {"mention": "腹胀", "label": "症状", "offset": "457"}, {"mention": "心悸", "label": "症状", "offset": "474"}, {"mention": "两上肢", "label": "解剖部位", "offset": "480"}, {"mention": "依替米星", "label": "药物", "offset": "521"}, {"mention": "胸部ct", "label": "影像检查", "offset": "534"}, {"mention": "两肺感染性病变", "label": "疾病和诊断", "offset": "543"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "567"}, {"mention": "右肺尖", "label": "解剖部位", "offset": "574"}, {"mention": "右下肺门", "label": "解剖部位", "offset": "588"}, {"mention": "心", "label": "解剖部位", "offset": "600"}, {"mention": "主动脉及冠状动脉壁钙化", "label": "疾病和诊断", "offset": "605"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "621"}, {"mention": "两侧胸膜", "label": "解剖部位", "offset": "628"}, {"mention": "胸膜钙化", "label": "疾病和诊断", "offset": "639"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "644"}, {"mention": "脾脏", "label": "解剖部位", "offset": "653"}, {"mention": "肺部", "label": "解剖部位", "offset": "663"}, {"mention": "胸腔闭式引流术", "label": "手术", "offset": "707"}, {"mention": "莫西沙星", "label": "药物", "offset": "715"}, {"mention": "胎盘多肽", "label": "药物", "offset": "728"}, {"mention": "多索茶碱", "label": "药物", "offset": "738"}, {"mention": "厄贝沙坦氢氯噻嗪", "label": "药物", "offset": "748"}, {"mention": "氨氯地平", "label": "药物", "offset": "757"}, {"mention": "胸水一般细菌涂片", "label": "实验室检验", "offset": "768"}, {"mention": "抗酸杆菌", "label": "实验室检验", "offset": "778"}, {"mention": "腺苷脱氨酶测定", "label": "实验室检验", "offset": "783"}, {"mention": "cea", "label": "实验室检验", "offset": "791"}, {"mention": "afp", "label": "实验室检验", "offset": "795"}, {"mention": "ca125", "label": "实验室检验", "offset": "799"}, {"mention": "胸部ct", "label": "影像检查", "offset": "822"}, {"mention": "气管", "label": "解剖部位", "offset": "831"}, {"mention": "肺内血管支气管束", "label": "解剖部位", "offset": "836"}, {"mention": "两侧肺", "label": "解剖部位", "offset": "849"}, {"mention": "胸腔", "label": "解剖部位", "offset": "881"}, {"mention": "胸膜粘连", "label": "症状", "offset": "900"}, {"mention": "心脏血管及主动脉钙化", "label": "疾病和诊断", "offset": "907"}, {"mention": "肺结核", "label": "疾病和诊断", "offset": "936"}, {"mention": "胸闷", "label": "症状", "offset": "998"}, {"mention": "胸痛", "label": "症状", "offset": "1000"}, {"mention": "心悸", "label": "症状", "offset": "1004"}, {"mention": "腹胀", "label": "症状", "offset": "1013"}, {"mention": "腹痛", "label": "症状", "offset": "1015"}, {"mention": "腹泻", "label": "症状", "offset": "1017"}]}
{"text": "入院前5+小时,患者被家属发现呼之不应,无恶心、呕吐,无四肢抽搐。家属家中自测血糖3.2mmol/l,家属给予\\\"糖水\\\"口服后,复查血糖6.5mmol/l,但仍然呼之不应,家属拨打120接回。入室后立即予以心电监护,吸氧,建立静脉通道,床旁心电图示:室下性心动过速。急查血常规、肾功、电解质、心肌酶谱、肌钙蛋白、d-二聚体,血气分析,头颅及胸部ct,于14:23接放射科危急值报告血气分析:血氧饱和度83.00叒%↓、氧分压45叒mmhg↓↓、二氧化碳分压30叒mmhg↓、乳酸11.40叒mmol/l↑↑,氧饱和度逐渐上降,告诉患者家属患者目前情况需要紧急气管插管,患者家属表示同意,于14:35分行气管插管,但患者牙关紧闭,口中假牙无法取出。行血常规:wbc叒7.5叒10^9/l、rbc叒4.51叒10^12/l、hgb叒128叒g/l↓、plt叒213叒10^9/l,肾功:urea叒5.44叒mmol/l、crea叒57.5叒μmol/l、ua叒208.8叒μmol/l↓,电解质1:k叒5.07叒mmol/l、na叒141.4叒mmol/、cl叒98.1叒mmol/l↓,心肌酶谱:ast叒34.0叒u/l、ck叒360.7叒u/l↑、ck-mb叒15叒u/l、ldh叒222.9叒u/l,高敏肌钙蛋白:tnt-hsstt叒38.29叒pg/ml↑,d_2聚体:d-d叒1.90叒μg/ml↑,凝血试验:pt叒12.3叒秒、inr叒1.04叒、aptt叒17.7叒秒↓、fib叒3.41叒g/l、tt叒16.4叒秒,血气分析全套:tco2叒21叒mmol/l↓、ph叒7.440叒、pco2叒30叒mmhg↓、po2叒45叒mmhg↓↓、hco3叒20.4叒mmol/l↓、sbc叒22.40叒mmol/l、be(ecf)叒-3.8叒mmol/l↓、be(b)叒-2.80叒mmol/l、so2%叒83.00叒%↓、lac叒11.40叒mmol/l↑↑、glu叒5.80叒mmol/l、na+叒138叒mmol/l、k+叒5.0叒mmol/l、ca++叒1.07叒mmol/l↓.头颅ct:考虑右侧基底节区脑梗死;左侧基底节腔隙性脑梗死。2、脑白质脱髓鞘改变;脑萎缩。3、考虑两肺感染性病变,建议治疗后复查。4、两侧少量胸腔积液。5、主动脉及冠状动脉壁钙化。6、胸椎骨质增生。给予补液,营养神经等治疗,请我科会诊,交代患者病情危重,随时有生命危险,家属对病情表示理解,同意转icu治疗。", "mention_data": [{"mention": "四肢抽搐", "label": "症状", "offset": "28"}, {"mention": "血糖", "label": "实验室检验", "offset": "39"}, {"mention": "血糖", "label": "实验室检验", "offset": "67"}, {"mention": "心电监护", "label": "影像检查", "offset": "104"}, {"mention": "心电图", "label": "影像检查", "offset": "121"}, {"mention": "室下性心动过速", "label": "疾病和诊断", "offset": "126"}, {"mention": "头颅及胸部ct", "label": "影像检查", "offset": "168"}, {"mention": "血氧饱和度", "label": "实验室检验", "offset": "196"}, {"mention": "氧分压", "label": "实验室检验", "offset": "210"}, {"mention": "二氧化碳分压", "label": "实验室检验", "offset": "223"}, {"mention": "乳酸", "label": "实验室检验", "offset": "238"}, {"mention": "氧饱和度", "label": "实验室检验", "offset": "255"}, {"mention": "气管插管", "label": "手术", "offset": "280"}, {"mention": "气管插管", "label": "手术", "offset": "302"}, {"mention": "wbc", "label": "实验室检验", "offset": "329"}, {"mention": "rbc", "label": "实验室检验", "offset": "344"}, {"mention": "hgb", "label": "实验室检验", "offset": "361"}, {"mention": "plt", "label": "实验室检验", "offset": "374"}, {"mention": "urea", "label": "实验室检验", "offset": "392"}, {"mention": "crea", "label": "实验室检验", "offset": "409"}, {"mention": "ua", "label": "实验室检验", "offset": "426"}, {"mention": "k", "label": "实验室检验", "offset": "448"}, {"mention": "na", "label": "实验室检验", "offset": "462"}, {"mention": "cl", "label": "实验室检验", "offset": "477"}, {"mention": "ast", "label": "实验室检验", "offset": "498"}, {"mention": "ck", "label": "实验室检验", "offset": "511"}, {"mention": "ck-mb", "label": "实验室检验", "offset": "525"}, {"mention": "ldh", "label": "实验室检验", "offset": "538"}, {"mention": "tnt-hsstt", "label": "实验室检验", "offset": "559"}, {"mention": "d-d", "label": "实验室检验", "offset": "588"}, {"mention": "pt", "label": "实验室检验", "offset": "609"}, {"mention": "inr", "label": "实验室检验", "offset": "619"}, {"mention": "aptt", "label": "实验室检验", "offset": "629"}, {"mention": "fib", "label": "实验室检验", "offset": "642"}, {"mention": "tt", "label": "实验室检验", "offset": "655"}, {"mention": "tco2", "label": "实验室检验", "offset": "672"}, {"mention": "ph", "label": "实验室检验", "offset": "688"}, {"mention": "pco2", "label": "实验室检验", "offset": "698"}, {"mention": "po2", "label": "实验室检验", "offset": "712"}, {"mention": "hco3", "label": "实验室检验", "offset": "726"}, {"mention": "sbc", "label": "实验室检验", "offset": "744"}, {"mention": "be(ecf)", "label": "实验室检验", "offset": "761"}, {"mention": "be(b)", "label": "实验室检验", "offset": "782"}, {"mention": "so2%", "label": "实验室检验", "offset": "801"}, {"mention": "lac", "label": "实验室检验", "offset": "815"}, {"mention": "glu", "label": "实验室检验", "offset": "834"}, {"mention": "na", "label": "实验室检验", "offset": "850"}, {"mention": "k", "label": "实验室检验", "offset": "865"}, {"mention": "ca", "label": "实验室检验", "offset": "879"}, {"mention": "头颅ct", "label": "影像检查", "offset": "897"}, {"mention": "右侧基底节区脑梗死", "label": "疾病和诊断", "offset": "904"}, {"mention": "左侧基底节腔隙性脑梗死", "label": "疾病和诊断", "offset": "914"}, {"mention": "脑白质脱髓鞘改变", "label": "疾病和诊断", "offset": "928"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "937"}, {"mention": "两肺感染性病变", "label": "疾病和诊断", "offset": "945"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "967"}, {"mention": "主动脉及冠状动脉壁钙化", "label": "疾病和诊断", "offset": "974"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "988"}]}
{"text": "入院前1年,患者因咯血于**医院诊断“肺癌”(未见报告、具体不详)。未给予手术、放化疗治疗,间断服用中药治疗。病程中反复咳嗽、咳痰,痰中带鲜红色血液。不伴发热、畏寒、寒战、反酸、烧心、嗳气、呃逆、头昏、头痛、乏力、胸闷、胸痛、心悸、气促、腹痛、腹泻、黑便,无晕厥、黑朦、意识丧失。1月前,患者进食火锅后出现脐周阵发性隐痛,以脐周偏左侧为主,无肩背部放射痛,与进食及体位无关,疼痛持续时间不定。伴恶心、纳差,饮食较前减少约1/2,以流质为主,伴嗳气,无反酸、烧心、呕吐、腹泻、黑便、心悸、气促、胸闷、胸痛,无畏寒、发热,肛门未停止排便排气。于我院消化科住院,复查胸部ct平扫提示“左肺下叶后段团片状影、右肺上叶肿块影及两肺散在多发类圆形影,纵隔及主动脉弓旁多发肿大淋巴结影,考虑肺ca伴两肺及纵隔淋巴结转移”。全腹部增强ct示“胆总管及胰管轻度扩张,胰头上方及邻近十二指肠腹壶周围见增多软组织影,考虑为淋巴结转移;邻近十二指肠壁肿胀,提示肿瘤受侵,右侧肾下腺稍增大,转移可能大;右侧腹股沟淋巴结转移,两上肺结节考虑肺内转移;胸9椎体及附件骨质破坏、转移,右侧髂骨多发骨质破坏伴周围软组织肿胀,累及邻近骶髂关节面。右侧股骨转子间骨质破坏,考虑骨转移”。遂转入**医院,完善相关检查后诊断考虑为“肺癌伴全身多处转移”(具体不详),并逐渐出现皮肤、巩膜黄染。10+天前,患者无明显诱因出现解黑便,2-3次/天,量少,无粘液、脓血,伴头昏、乏力、纳差,偶有嗳气,无呕血、腹痛、腹胀,无反酸、烧心,未予特殊处理。3+小时前,患者无明显诱因出现恶心、呕吐3次,呕吐物为咖啡色胃内容物,无鲜红色血液及血凝块,不呈喷射状,伴腹痛,为持续性隐痛,脐周为主,伴头昏,如厕时晕厥2次,由家属搀扶,持续约数十秒后意识恢复,无抽搐,无大小便失禁,无肢体活动障碍。呼叫120送入我院急诊科,查指血糖:26.0mmol/l,粪便隐血试验叒阳性,血常规:wbc叒13.4*109/l,rbc叒1.9*1012/l,plt叒507*109/l,hb叒48g/l,n叒92.44%,hct叒15.6%。遂以“肺癌伴全身多处转移、消化道出血、重度贫血”收入住院。患者此次患病以来,精神、食欲、睡眠欠佳,大便如下述,小便颜色加深,尿量可。体重上降约5kg。", "mention_data": [{"mention": "肺癌", "label": "疾病和诊断", "offset": "19"}, {"mention": "头昏", "label": "症状", "offset": "98"}, {"mention": "头痛", "label": "症状", "offset": "101"}, {"mention": "胸闷", "label": "症状", "offset": "107"}, {"mention": "胸痛", "label": "症状", "offset": "110"}, {"mention": "心悸", "label": "症状", "offset": "113"}, {"mention": "腹痛", "label": "症状", "offset": "119"}, {"mention": "腹泻", "label": "症状", "offset": "122"}, {"mention": "脐周", "label": "解剖部位", "offset": "153"}, {"mention": "脐周", "label": "解剖部位", "offset": "162"}, {"mention": "肩背部", "label": "解剖部位", "offset": "171"}, {"mention": "腹泻", "label": "症状", "offset": "234"}, {"mention": "心悸", "label": "症状", "offset": "240"}, {"mention": "胸闷", "label": "症状", "offset": "246"}, {"mention": "胸痛", "label": "症状", "offset": "249"}, {"mention": "肛门", "label": "解剖部位", "offset": "259"}, {"mention": "胸部ct", "label": "影像检查", "offset": "280"}, {"mention": "左肺下叶后段", "label": "解剖部位", "offset": "289"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "300"}, {"mention": "两肺", "label": "解剖部位", "offset": "308"}, {"mention": "纵隔", "label": "解剖部位", "offset": "319"}, {"mention": "主动脉弓", "label": "解剖部位", "offset": "322"}, {"mention": "肺ca伴两肺及纵隔淋巴结转移", "label": "疾病和诊断", "offset": "338"}, {"mention": "全腹部增强ct", "label": "影像检查", "offset": "354"}, {"mention": "胆总管", "label": "解剖部位", "offset": "363"}, {"mention": "胰管", "label": "解剖部位", "offset": "367"}, {"mention": "胰头上方", "label": "解剖部位", "offset": "374"}, {"mention": "十二指肠腹壶", "label": "解剖部位", "offset": "381"}, {"mention": "十二指肠壁", "label": "解剖部位", "offset": "408"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "423"}, {"mention": "右侧腹股沟淋巴结转移", "label": "疾病和诊断", "offset": "438"}, {"mention": "两上肺结节考虑肺内转移", "label": "疾病和诊断", "offset": "449"}, {"mention": "胸9椎体及附件骨质破坏、转移", "label": "疾病和诊断", "offset": "461"}, {"mention": "右侧髂骨多发骨质破坏", "label": "疾病和诊断", "offset": "476"}, {"mention": "周围软组织", "label": "解剖部位", "offset": "487"}, {"mention": "骶髂关节面", "label": "解剖部位", "offset": "499"}, {"mention": "右侧股骨转子间骨质破坏", "label": "疾病和诊断", "offset": "505"}, {"mention": "骨转移", "label": "疾病和诊断", "offset": "519"}, {"mention": "肺癌伴全身多处转移", "label": "疾病和诊断", "offset": "545"}, {"mention": "巩膜", "label": "解剖部位", "offset": "570"}, {"mention": "头昏", "label": "症状", "offset": "612"}, {"mention": "腹痛", "label": "症状", "offset": "630"}, {"mention": "腹胀", "label": "症状", "offset": "633"}, {"mention": "胃", "label": "解剖部位", "offset": "680"}, {"mention": "腹痛", "label": "症状", "offset": "703"}, {"mention": "脐周", "label": "解剖部位", "offset": "713"}, {"mention": "头昏", "label": "症状", "offset": "719"}, {"mention": "肢体", "label": "解剖部位", "offset": "760"}, {"mention": "血糖", "label": "实验室检验", "offset": "782"}, {"mention": "粪便隐血试验", "label": "实验室检验", "offset": "796"}, {"mention": "wbc", "label": "实验室检验", "offset": "810"}, {"mention": "rbc", "label": "实验室检验", "offset": "825"}, {"mention": "plt", "label": "实验室检验", "offset": "840"}, {"mention": "hb", "label": "实验室检验", "offset": "854"}, {"mention": "n", "label": "实验室检验", "offset": "863"}, {"mention": "hct", "label": "实验室检验", "offset": "872"}, {"mention": "肺癌伴全身多处转移", "label": "疾病和诊断", "offset": "885"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "895"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "901"}]}
{"text": "患者入院前6年余无明显诱因出现心累、气促,起病初多以活动后明显,伴胸闷,无明显胸痛,需胸骨后压榨感,无上肢浮肿,无夜间阵发性呼吸困难,患者休息后症状可减轻,曾于*******医院就诊,考虑“冠状动脉粥样硬化性心脏病”,并办理特病,但平素未行相关治疗。入院前1年患者因心累加重,并全身多处瘀斑,于******医院住院治疗,行心脏彩超提示“右房增大,室间隔、右室后壁增厚,左室流出道增宽,二尖瓣及主动脉瓣狭窄,二尖瓣及三尖瓣重度反流,反流压差增高,肺动脉瓣及主动脉瓣轻度反流,心包积液,右室收缩功能正常”,具体治疗不详,出院后患者长期服用“单硝酸异山梨酯缓释片、阿托伐他汀钙、厄贝沙坦、曲美他嗪”等药物,仍有活动后心累不适。半年前患者因活动后胸闷伴胸痛在我科住院,予以改善循环、降脂稳定斑块、利尿减轻心脏负荷等对症治疗后好转出院。近1周患者诉咳嗽、咳痰,痰中偶有鲜红色血丝,入院前3小时,患者无明显诱因出现心悸、气促,伴右侧胸痛,右下臂及右后背疼痛,无明显上肢浮肿,无畏寒发热,无潮热盗汗,无意识障碍,无恶心呕吐等不适,遂来我院就诊,急诊科查血常规:白细胞数叒12.6×10^9/l、血红蛋白浓度叒116叒g/l、血小板数叒103×10^9/l、中性粒细胞百分比叒76.74叒%,心肌酶谱:肌酸激酶同工酶叒41叒u/l。肾功、高敏肌钙蛋白、电解质未见明显异常,心电图示快速型房颤,予以强心、利尿、改善心肌血供等对症处理后患者自觉症状稍缓解。现为进一步治疗收入我科住院。患者1年前因全身多处瘀斑,于******医院就诊,完善检查发现血小板减少、贫血,查血常规(2016-03-01)plt叒63×109/l、hb叒63g/l;住院期间予以骨髓穿刺,考虑缺铁性贫血、血小板减少性紫癜,予以输红细胞悬液2u,并激素治疗(目前已停用),自诉复查指标好转。并于住院期间检查发现肾功能异常叒bun叒19.6mmol/l叒crea叒223umol/l,原因不明确,因血小板减少未能肾活检,出院诊断考虑慢性肾脏病(ckd3期),急性肾损害不除外。患者自发病以来精神、食欲较差,大小便未诉异常。近期体重无明显减轻。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "33"}, {"mention": "胸痛", "label": "症状", "offset": "39"}, {"mention": "胸骨", "label": "解剖部位", "offset": "43"}, {"mention": "上肢", "label": "解剖部位", "offset": "51"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "95"}, {"mention": "心", "label": "解剖部位", "offset": "133"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "161"}, {"mention": "右房", "label": "解剖部位", "offset": "168"}, {"mention": "室间隔", "label": "解剖部位", "offset": "173"}, {"mention": "右室后壁", "label": "解剖部位", "offset": "177"}, {"mention": "左室", "label": "解剖部位", "offset": "184"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "192"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "196"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "203"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "207"}, {"mention": "肺动脉瓣", "label": "解剖部位", "offset": "222"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "227"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "236"}, {"mention": "右室收缩功能正常", "label": "疾病和诊断", "offset": "241"}, {"mention": "单硝酸异山梨酯缓释片", "label": "药物", "offset": "268"}, {"mention": "阿托伐他汀钙", "label": "药物", "offset": "279"}, {"mention": "厄贝沙坦", "label": "药物", "offset": "286"}, {"mention": "曲美他嗪", "label": "药物", "offset": "291"}, {"mention": "心", "label": "解剖部位", "offset": "305"}, {"mention": "胸闷", "label": "症状", "offset": "319"}, {"mention": "胸痛", "label": "症状", "offset": "322"}, {"mention": "心悸", "label": "症状", "offset": "401"}, {"mention": "右侧胸", "label": "解剖部位", "offset": "408"}, {"mention": "右下臂", "label": "解剖部位", "offset": "413"}, {"mention": "右后背", "label": "解剖部位", "offset": "417"}, {"mention": "上肢", "label": "解剖部位", "offset": "426"}, {"mention": "白细胞", "label": "实验室检验", "offset": "473"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "490"}, {"mention": "血小板", "label": "实验室检验", "offset": "505"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "521"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "543"}, {"mention": "心电图", "label": "影像检查", "offset": "578"}, {"mention": "快速型房颤", "label": "疾病和诊断", "offset": "582"}, {"mention": "血小板减少", "label": "疾病和诊断", "offset": "663"}, {"mention": "贫血", "label": "疾病和诊断", "offset": "669"}, {"mention": "plt", "label": "实验室检验", "offset": "688"}, {"mention": "hb", "label": "实验室检验", "offset": "701"}, {"mention": "骨髓穿刺", "label": "手术", "offset": "716"}, {"mention": "缺铁性贫血", "label": "疾病和诊断", "offset": "723"}, {"mention": "血小板减少性紫癜", "label": "疾病和诊断", "offset": "729"}, {"mention": "bun", "label": "实验室检验", "offset": "787"}, {"mention": "crea", "label": "实验室检验", "offset": "802"}, {"mention": "血小板减少", "label": "疾病和诊断", "offset": "824"}, {"mention": "慢性肾脏病(ckd3期)", "label": "疾病和诊断", "offset": "841"}, {"mention": "急性肾损害", "label": "疾病和诊断", "offset": "854"}]}
{"text": "患者于入院半年前发现两上肢浮肿、尿量减少、喘累,到****医院查血常规:叒hb:87g/l,肾功:血肌酐:394umol/l,考虑肾功能不全、肾性贫血,后到**********医院就诊,查肾功:血肌酐:330umol/l,血常规:hb:89g/l,甲状旁腺激素叒55.5pg/ml,内生肌酐清除率:14.49ml/min,腹部彩超:两肾结构欠清,实质回声稍增强,腹腔少量积液;心脏彩超:右室肥厚,少许心包积液;胸部ct平扫:右肺上叶炎症,心脏增大,两侧胸腔积液,给予血液净化治疗、降压、降糖、纠正贫血、改善循环等治疗后好转出院。5月前曾因胸闷心悸于我科住院,考虑诊断“1、慢性肾脏病5期叒肾性贫血叒2、原发性高血压3级很高危叒高血压性心脏病叒3、2型糖尿病叒糖尿病周围神经病变叒糖尿病视网膜病变叒4、甲状腺功能减退叒5、心包积液”,予以深静脉置管、血液透析,纠正贫血,改善心功能,降糖,降压后症状好转出院。入院前半月患者无明显诱因开始出现咳嗽咳白色粘痰,量少,伴心累气促,活动后加重,伴颜面及两上肢水肿,今于我院血透室行透析治疗,查血常规:白细胞数叒8.8叒10^9/l、红细胞数叒3.17叒10^12/l、血红蛋白浓度叒91叒g/l、血小板数叒200叒10^9/l、中性粒细胞百分比叒86.61叒%,肾功:尿素叒15.26叒mmol/l、肌酐叒331.2叒μmol/l,电解质2:钾叒4.87叒mmol/l、钠叒137.1叒mmol/、氯叒107.4叒mmol/l,透析后感心累气促减轻,为进一步治疗,门诊收入我科住院治疗。患者自患病以来,精神、睡眠可,食欲差,大便结燥,院外服用泻药,具体不详,后今日解稀便2次,小便偏少,量约500ml/d,体重无明显变化。22年前因手足麻木在当地医院查血糖升高,值不详,诊断为2型糖尿病,先后服用格列齐特、消渴丸降糖,偶测血糖20+mmol/l,曾服用二甲两胍出现恶心、呕吐停用,后开始出现视物模糊、两上肢水肿,2年前开始使用优思林降血糖,血糖控制不详,现改为诺和锐30叒16u/早,12u/晚降血糖,血糖控制可。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "10"}, {"mention": "hb", "label": "实验室检验", "offset": "37"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "49"}, {"mention": "肾功能不全", "label": "疾病和诊断", "offset": "65"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "71"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "97"}, {"mention": "hb", "label": "实验室检验", "offset": "115"}, {"mention": "甲状旁腺激素", "label": "实验室检验", "offset": "124"}, {"mention": "内生肌酐清除率", "label": "实验室检验", "offset": "141"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "161"}, {"mention": "两肾", "label": "解剖部位", "offset": "166"}, {"mention": "腹腔", "label": "解剖部位", "offset": "181"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "188"}, {"mention": "右室肥厚", "label": "症状", "offset": "193"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "200"}, {"mention": "胸部ct", "label": "影像检查", "offset": "205"}, {"mention": "右肺上叶炎症", "label": "疾病和诊断", "offset": "212"}, {"mention": "心脏增大", "label": "症状", "offset": "219"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "226"}, {"mention": "胸闷", "label": "症状", "offset": "269"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "286"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "294"}, {"mention": "原发性高血压3级很高危", "label": "疾病和诊断", "offset": "301"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "313"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "323"}, {"mention": "糖尿病周围神经病变", "label": "疾病和诊断", "offset": "329"}, {"mention": "糖尿病视网膜病变", "label": "疾病和诊断", "offset": "339"}, {"mention": "甲状腺功能减退", "label": "疾病和诊断", "offset": "350"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "360"}, {"mention": "颜面", "label": "解剖部位", "offset": "443"}, {"mention": "两上肢", "label": "解剖部位", "offset": "446"}, {"mention": "白细胞", "label": "实验室检验", "offset": "470"}, {"mention": "红细胞", "label": "实验室检验", "offset": "486"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "504"}, {"mention": "血小板", "label": "实验室检验", "offset": "518"}, {"mention": "中性粒细胞", "label": "实验室检验", "offset": "534"}, {"mention": "尿素", "label": "实验室检验", "offset": "554"}, {"mention": "肌酐", "label": "实验室检验", "offset": "570"}, {"mention": "钾", "label": "实验室检验", "offset": "591"}, {"mention": "钠", "label": "实验室检验", "offset": "605"}, {"mention": "氯", "label": "实验室检验", "offset": "619"}, {"mention": "手足麻木", "label": "症状", "offset": "736"}, {"mention": "血糖升高", "label": "疾病和诊断", "offset": "746"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "758"}, {"mention": "格列齐特", "label": "药物", "offset": "768"}, {"mention": "消渴丸", "label": "药物", "offset": "773"}, {"mention": "血糖", "label": "实验室检验", "offset": "781"}, {"mention": "二甲两胍", "label": "药物", "offset": "796"}, {"mention": "两上肢", "label": "解剖部位", "offset": "820"}, {"mention": "优思林", "label": "药物", "offset": "833"}, {"mention": "诺和锐30", "label": "药物", "offset": "850"}]}
{"text": "患者10+年前始逐渐出现慢性咳嗽、咳痰,每日均咳白色泡沫痰,受凉后症状加重,偶咳嗽加剧时伴喘累,未特殊治疗。5年前患者感体力耐量明显上降,爬坡及平地快步活动不能耐受,受凉后喘累明显加重,反复住院治疗,最近一次于2017-10-29于我院泌尿外科住院,给予保留导尿,头孢唑肟抗感染、血必净抗炎,抗前列腺增生,止咳祛痰、雾化对症等治疗,11月5日转我科给予哌拉西林他坐巴坦加强抗感染、解痉改善通气、祛痰、改善微循环、改善排尿困难、调脂稳定斑块、抗血小板聚等治疗后好转出院,出院诊断为:1、慢性阻塞性肺疾病急性加重期;2、泌尿道感染;3、感染性休克叒代偿期;4、前列腺增生;5、慢性前列腺炎;6、慢性尿潴留;7、冠心病叒冠脉支架及起搏器置入术后;8、高血压病;9、轻度贫血;10、电解质紊乱;11、两肾积水;12、慢性膀胱炎叒膀胱憩室;13、两肺结节待查;14、肝囊肿。1天前,患者无明显诱因出现发热,自测体温37.9℃,伴有咳嗽,咳白色泡沫痰,痰不易咳出,喘息明显,端坐呼吸,无畏寒、寒战,无恶心、呕吐,无咳嗽、咳痰,无腰痛不适,尿管导尿中,家人发现尿管中无尿,家属遂送入我院急诊,查血气分析:ph叒7.42,pao2叒93mmhg,paco2叒31mmhg,标准碳酸氢根22.1mmol/l,实测碳酸氢根20.1mmol/l,be3.7mmol/l。血常规:白细胞数叒14.2×10^9/l、红细胞数叒2.94×10^12/l、血红蛋白浓度叒92叒g/l、血小板数叒194×10^9/l、中性粒细胞百分比叒92.74叒%,crp:22叒mg/l叒。肾功、心肌酶未见明显异常,电解质:钾叒3.47叒mmol/l、钠叒127.2mmol/l、氯叒88.2mmol/l,遂以“发热待查:肺部感染?尿路感染?感染性休克?”收入我科。有“高血压”病史7年,口服药物控制,自诉血压控制尚可,有“冠心病”病史,2年前行“冠脉支架置入术及起搏器置入术”,术后心率控制在85次/分右左,患者本次患病来,精神、睡眠、食欲欠佳,大便正常,小便如下述,体重无明显改变。", "mention_data": [{"mention": "头孢唑肟", "label": "药物", "offset": "132"}, {"mention": "血必净", "label": "药物", "offset": "140"}, {"mention": "哌拉西林他坐巴坦", "label": "药物", "offset": "176"}, {"mention": "慢性阻塞性肺疾病急性加重期", "label": "疾病和诊断", "offset": "242"}, {"mention": "泌尿道感染", "label": "疾病和诊断", "offset": "258"}, {"mention": "感染性休克叒代偿期", "label": "疾病和诊断", "offset": "266"}, {"mention": "前列腺增生", "label": "疾病和诊断", "offset": "278"}, {"mention": "慢性前列腺炎", "label": "疾病和诊断", "offset": "286"}, {"mention": "慢性尿潴留", "label": "疾病和诊断", "offset": "295"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "303"}, {"mention": "冠脉支架及起搏器置入术后", "label": "疾病和诊断", "offset": "307"}, {"mention": "高血压病", "label": "疾病和诊断", "offset": "322"}, {"mention": "轻度贫血", "label": "疾病和诊断", "offset": "329"}, {"mention": "电解质紊乱", "label": "疾病和诊断", "offset": "337"}, {"mention": "两肾积水", "label": "疾病和诊断", "offset": "346"}, {"mention": "慢性膀胱炎", "label": "疾病和诊断", "offset": "354"}, {"mention": "膀胱憩室", "label": "疾病和诊断", "offset": "360"}, {"mention": "两肺结节待查", "label": "疾病和诊断", "offset": "368"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "378"}, {"mention": "腰痛", "label": "症状", "offset": "458"}, {"mention": "ph", "label": "实验室检验", "offset": "495"}, {"mention": "pao2", "label": "实验室检验", "offset": "503"}, {"mention": "paco2", "label": "实验室检验", "offset": "515"}, {"mention": "标准碳酸氢根", "label": "实验室检验", "offset": "528"}, {"mention": "实测碳酸氢根", "label": "实验室检验", "offset": "545"}, {"mention": "be", "label": "实验室检验", "offset": "562"}, {"mention": "白细胞", "label": "实验室检验", "offset": "578"}, {"mention": "红细胞", "label": "实验室检验", "offset": "595"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "613"}, {"mention": "血小板", "label": "实验室检验", "offset": "627"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "643"}, {"mention": "crp", "label": "实验室检验", "offset": "660"}, {"mention": "钾", "label": "实验室检验", "offset": "690"}, {"mention": "钠", "label": "实验室检验", "offset": "704"}, {"mention": "氯", "label": "实验室检验", "offset": "718"}, {"mention": "发热待查", "label": "疾病和诊断", "offset": "734"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "739"}, {"mention": "尿路感染", "label": "疾病和诊断", "offset": "744"}, {"mention": "感染性休克", "label": "疾病和诊断", "offset": "749"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "763"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "790"}, {"mention": "冠脉支架置入术及起搏器置入术", "label": "手术", "offset": "802"}]}
{"text": "患者30+年前检查发现血压高,最高时收缩压超过200/?mmhg,长期服用降压药物(硝苯地平缓释片、替米沙坦等),自诉血压控制尚可,起初无头昏、头痛,无心悸、无活动后心累、乏力等不适。2016.9.3天患者无明确诱因反复出现头晕,急诊头部ct:两侧基底节区腔隙性脑梗死叒2、脑白质轻度脱髓鞘改变,脑萎缩。3、基底动脉钙化,随访。收入内1科行胸片:1.两上肺纹理增多。2.主动脉弓迂曲、钙化。心脏彩超:室间隔增厚(13.5mm);三尖瓣轻度反流;肺动脉轻度高压;右室舒张功能减退。出院诊断:1、原发性高血压3级极高危,高血压性心脏病叒2、脑动脉供血不足叒3、腔隙性脑梗死叒4、2型糖尿病叒5、冠状动脉粥样硬化性心脏病,慢性心衰。院外服药:苯磺酸右旋氨氯地平2.5mg每日一次,厄贝沙坦氢氯噻嗪1片每日一次,二甲两胍缓释片0.5每日双次,阿卡波糖50mg每日三次,氢氯噻嗪25mg每日一次,螺内酯20mg每日一次;1周前患者感头昏阵性发作,无视物旋转、视物模糊,无恶心呕吐,2天前患者头昏症状加重,恶心,纳差,心慌,无偏瘫,无视野缺损,无四肢抽搐,无黑矇晕厥,为求进一步治疗,遂入我院急诊科,查血压190/96mmhg,血糖(静脉血):葡萄糖叒4.2mmol/l叒,血常规:白细胞数叒6.0×10^9/l、血红蛋白浓度叒113叒g/l叒↓、血小板数叒181×10^9/l、crp:c反应蛋白叒<1叒mg/l,血气分析:ph叒7.36,pco2叒28mmhg,po2叒126mmhg,碳酸氢根:15.8mmol/l,全血碱剩余叒-8mmol/l,乳酸:10.3mmol/l,胸片:1,两上肺感染,右上肺可疑环状或结节状稍高密度影,不除外支扩,随访复查或必要时ct进一步检查。2,肺气肿征。3,主动脉球钙化。4,胸椎骨质增生。以“高血压叒糖尿病叒乳酸酸中毒”收入我科。患者此次患病以来精神食欲差,大便正常,夜尿次数增多,睡眠尚可,体力及体重无明显改变.近来诉咳嗽,少痰。", "mention_data": [{"mention": "硝苯地平缓释片", "label": "药物", "offset": "42"}, {"mention": "替米沙坦", "label": "药物", "offset": "50"}, {"mention": "头昏", "label": "症状", "offset": "69"}, {"mention": "头痛", "label": "症状", "offset": "72"}, {"mention": "心悸", "label": "症状", "offset": "76"}, {"mention": "心", "label": "解剖部位", "offset": "83"}, {"mention": "头晕", "label": "症状", "offset": "112"}, {"mention": "头部ct", "label": "影像检查", "offset": "117"}, {"mention": "两侧基底节区腔隙性脑梗死", "label": "疾病和诊断", "offset": "122"}, {"mention": "脑白质轻度脱髓鞘改变", "label": "疾病和诊断", "offset": "137"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "148"}, {"mention": "基底动脉钙化", "label": "疾病和诊断", "offset": "154"}, {"mention": "胸片", "label": "影像检查", "offset": "170"}, {"mention": "两上肺", "label": "解剖部位", "offset": "175"}, {"mention": "主动脉弓迂曲", "label": "症状", "offset": "185"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "195"}, {"mention": "室间隔", "label": "解剖部位", "offset": "200"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "214"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "222"}, {"mention": "右室舒张功能减退", "label": "疾病和诊断", "offset": "230"}, {"mention": "原发性高血压3级极高危", "label": "疾病和诊断", "offset": "246"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "258"}, {"mention": "脑动脉供血不足", "label": "疾病和诊断", "offset": "268"}, {"mention": "腔隙性脑梗死", "label": "疾病和诊断", "offset": "278"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "287"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "295"}, {"mention": "慢性心衰", "label": "疾病和诊断", "offset": "308"}, {"mention": "苯磺酸右旋氨氯地平", "label": "药物", "offset": "318"}, {"mention": "厄贝沙坦氢氯噻嗪", "label": "药物", "offset": "337"}, {"mention": "二甲两胍缓释片", "label": "药物", "offset": "352"}, {"mention": "阿卡波糖", "label": "药物", "offset": "367"}, {"mention": "氢氯噻嗪", "label": "药物", "offset": "380"}, {"mention": "螺内酯", "label": "药物", "offset": "393"}, {"mention": "头昏", "label": "症状", "offset": "411"}, {"mention": "头昏", "label": "症状", "offset": "440"}, {"mention": "四肢抽搐", "label": "症状", "offset": "467"}, {"mention": "葡萄糖", "label": "实验室检验", "offset": "516"}, {"mention": "白细胞", "label": "实验室检验", "offset": "535"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "551"}, {"mention": "血小板", "label": "实验室检验", "offset": "568"}, {"mention": "c反应蛋白", "label": "实验室检验", "offset": "588"}, {"mention": "ph", "label": "实验室检验", "offset": "607"}, {"mention": "pco2", "label": "实验室检验", "offset": "615"}, {"mention": "po2", "label": "实验室检验", "offset": "627"}, {"mention": "碳酸氢根", "label": "实验室检验", "offset": "639"}, {"mention": "全血碱剩余", "label": "实验室检验", "offset": "655"}, {"mention": "乳酸", "label": "实验室检验", "offset": "670"}, {"mention": "胸片", "label": "影像检查", "offset": "684"}, {"mention": "两上肺感染", "label": "疾病和诊断", "offset": "689"}, {"mention": "右上肺", "label": "解剖部位", "offset": "695"}, {"mention": "支扩", "label": "疾病和诊断", "offset": "715"}, {"mention": "ct", "label": "影像检查", "offset": "726"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "736"}, {"mention": "主动脉球钙化", "label": "疾病和诊断", "offset": "743"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "752"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "761"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "765"}, {"mention": "乳酸酸中毒", "label": "疾病和诊断", "offset": "769"}]}
{"text": "入院前1+年无明显诱因逐渐出现活动障碍、反应迟钝、与人交流减少,对周围事物缺乏兴趣、记忆减退,同时有纳差、逐渐消瘦,未述明显腹痛、腹胀、吞咽梗阻,无胸闷、心悸、发热,患者长期卧床、有大小便失禁,5月前因纳差在我院住院,作胸腹部ct:1、考虑左肺中叶及上叶少许慢性感染。2、左肺下叶尖段外侧胸膜上梭形突起,考虑脂肪瘤。3、主动脉及冠状动脉壁钙化。4、肺气肿征。5、胸椎骨质增生,左侧多根肋骨陈旧骨折。6、左侧甲状腺可疑结节影。7、肝右叶内侧段小片状稍低密度影,建议增强扫描。8、两肾多发小结石;左肾囊肿。9、胆囊结石。10、肝左叶上段见两边影,考虑呼吸动度伪影,不除外少许腹腔积液可能。11、腹主动脉壁钙化。腰椎骨质增生。12、骶管内类圆形稍低密度影,考虑良性病变,骶管囊肿可能。建议结合临床。因患者呼吸动度较大,扫描范围内胸腹部部分图像较模糊,建议随访复查。诊断为“1.高渗性脱水叒2.急性肾功能不全叒3.老年痴呆症叒4叒.重度营养不良”,予纠正电解质、营养支持治疗好转出院。出院后患者反复有食纳差,无恶心、呕吐,无黄染、厌油,近期患者不愿进食,未述明显腹痛、腹胀,无畏寒、发热、胸痛、呼吸困难、黑便、呕血等,今日患者稍有恶心、呕吐、烦躁不安,无意识障碍,家属将其送入我院,在门诊查血常规:白细胞数叒13.0×10^9/l、中性粒细胞百分比叒86.04叒%,心肌酶谱:谷草转氨酶叒49.0叒u/l、肌酸激酶叒247.7叒u/l、乳酸脱氢酶叒343.3叒u/l,肾功:尿素叒27.62叒mmol/l、肌酐叒309.1叒μmol/l、尿酸叒592.5叒μmol/l,高敏肌钙蛋白:高敏肌钙蛋白t叒130.70叒pg/ml,电解质1:钠叒168.7叒mmol/l、氯叒128.0叒mmol/l。心电图提示:快速性房颤。为进一步就诊,我院急诊科以“老年痴呆、重度营养不良”收入住院。病程中患者精神差,睡眠差,长期大小便失禁,体重减轻不祥。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "62"}, {"mention": "腹胀", "label": "症状", "offset": "65"}, {"mention": "胸闷", "label": "症状", "offset": "74"}, {"mention": "心悸", "label": "症状", "offset": "77"}, {"mention": "胸腹部ct", "label": "影像检查", "offset": "110"}, {"mention": "左肺中叶及上叶少许慢性感染", "label": "疾病和诊断", "offset": "120"}, {"mention": "左肺下叶尖段", "label": "解剖部位", "offset": "136"}, {"mention": "胸膜", "label": "解剖部位", "offset": "144"}, {"mention": "脂肪瘤", "label": "疾病和诊断", "offset": "154"}, {"mention": "主动脉及冠状动脉壁钙化", "label": "疾病和诊断", "offset": "160"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "174"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "181"}, {"mention": "左侧多根肋骨陈旧骨折", "label": "疾病和诊断", "offset": "188"}, {"mention": "左侧甲状腺", "label": "解剖部位", "offset": "201"}, {"mention": "肝右叶内侧段", "label": "解剖部位", "offset": "214"}, {"mention": "两肾多发小结石", "label": "疾病和诊断", "offset": "238"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "246"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "253"}, {"mention": "肝左叶上段", "label": "解剖部位", "offset": "261"}, {"mention": "腹腔积液", "label": "疾病和诊断", "offset": "285"}, {"mention": "腹主动脉壁钙化", "label": "疾病和诊断", "offset": "295"}, {"mention": "腰椎骨质增生", "label": "疾病和诊断", "offset": "303"}, {"mention": "骶管", "label": "解剖部位", "offset": "313"}, {"mention": "骶管囊肿", "label": "疾病和诊断", "offset": "332"}, {"mention": "胸腹部", "label": "解剖部位", "offset": "361"}, {"mention": "高渗性脱水", "label": "疾病和诊断", "offset": "385"}, {"mention": "急性肾功能不全", "label": "疾病和诊断", "offset": "393"}, {"mention": "老年痴呆症", "label": "疾病和诊断", "offset": "403"}, {"mention": "重度营养不良", "label": "疾病和诊断", "offset": "412"}, {"mention": "腹痛", "label": "症状", "offset": "477"}, {"mention": "腹胀", "label": "症状", "offset": "480"}, {"mention": "胸痛", "label": "症状", "offset": "490"}, {"mention": "白细胞", "label": "实验室检验", "offset": "545"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "562"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "584"}, {"mention": "肌酸激酶", "label": "实验室检验", "offset": "599"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "614"}, {"mention": "尿素", "label": "实验室检验", "offset": "633"}, {"mention": "肌酐", "label": "实验室检验", "offset": "649"}, {"mention": "尿酸", "label": "实验室检验", "offset": "665"}, {"mention": "高敏肌钙蛋白t", "label": "实验室检验", "offset": "688"}, {"mention": "钠", "label": "实验室检验", "offset": "714"}, {"mention": "氯", "label": "实验室检验", "offset": "729"}, {"mention": "心电图", "label": "影像检查", "offset": "744"}, {"mention": "快速性房颤", "label": "疾病和诊断", "offset": "750"}, {"mention": "老年痴呆", "label": "疾病和诊断", "offset": "770"}, {"mention": "重度营养不良", "label": "疾病和诊断", "offset": "775"}]}
{"text": "入院前6+天患者无明显诱因出现咳嗽、咳痰,易咳出大量白色粘痰,感阵发性胸闷,左季肋间断隐痛,休息可缓解,上肢水肿,无头昏、头痛、发热,无胸痛,无腹痛腹泻,今日为进一步治疗,遂来我院,急诊查x线:左上肺可疑类圆形浅淡密度影,建议ct进一步检查。血常规:白细胞数叒3.3叒10^9/l叒↓、红细胞数叒2.70叒10^12/l叒↓、血红蛋白浓度叒98叒g/l叒↓、血小板数叒32叒10^9/l叒↓、淋巴细胞绝对值叒0.84叒10^9/l叒↓、红细胞压积叒27.7叒%叒↓、平均红细胞体积叒102.6叒fl叒↑、平均红细胞血红蛋白量叒36.3叒pg叒↑、红细胞体积分布宽度叒56.5叒fl叒↑、红细胞体积分布宽度百分比叒15.4叒%叒↑,crp:c反应蛋白叒5叒mg/l,未予处理,以“咳嗽待查”收入我科住院治疗。2年前在外院及我院确诊“肝癌”,故诉长期闷油、牙龈易出血,易鼻出血,凝血功能异常。2月22日我院肿瘤标志物:甲胎蛋白叒16.90叒ng/ml叒↑,3月12日我院查乙肝三对:乙肝表面抗原定性叒阳性、乙肝核心抗体定性叒阳性,肝功3:谷草转氨酶叒87.5叒u/l叒↑、碱性磷酸酶叒172.5叒u/l叒↑、总胆红素叒44.7叒μmol/l叒↑、直接胆红素叒28.2叒μmol/l叒↑、总胆汁酸叒106.84叒μmol/l叒↑。2015年2月20日我院查全腹增强ct:1,考虑为肝硬化、脾脏轻度增大,建议结合临床或必要时进一步检查。2,胰头体积稍增大,形态欠规则,不除外肿瘤。3,大量腹水,腹膜后及网膜、系膜内多个小结节影,考虑为增大的淋巴结可能,建议ct增强进一步明确。4,右侧中上腹部分小肠积气,伴小液平形成,提示不全性肠梗阻可能大,结合临床随访或ct增强检查。5,前列腺钙化。6,腰椎骨质增生。7,扫描野右肺底少许慢性炎症或纤维化;右侧胸壁胸膜稍增厚。病程中精神、食欲一般,大小便正常,无明显体重上降。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "35"}, {"mention": "左季肋", "label": "解剖部位", "offset": "38"}, {"mention": "上肢水肿", "label": "症状", "offset": "52"}, {"mention": "头昏", "label": "症状", "offset": "58"}, {"mention": "头痛", "label": "症状", "offset": "61"}, {"mention": "胸痛", "label": "症状", "offset": "68"}, {"mention": "腹痛", "label": "症状", "offset": "72"}, {"mention": "腹泻", "label": "症状", "offset": "74"}, {"mention": "x线", "label": "影像检查", "offset": "94"}, {"mention": "左上肺", "label": "解剖部位", "offset": "97"}, {"mention": "ct", "label": "影像检查", "offset": "113"}, {"mention": "白细胞", "label": "实验室检验", "offset": "125"}, {"mention": "红细胞", "label": "实验室检验", "offset": "143"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "163"}, {"mention": "血小板", "label": "实验室检验", "offset": "179"}, {"mention": "淋巴细胞绝对值", "label": "实验室检验", "offset": "196"}, {"mention": "红细胞压积", "label": "实验室检验", "offset": "218"}, {"mention": "平均红细胞体积", "label": "实验室检验", "offset": "233"}, {"mention": "平均红细胞血红蛋白量", "label": "实验室检验", "offset": "252"}, {"mention": "红细胞体积分布宽度", "label": "实验室检验", "offset": "273"}, {"mention": "红细胞体积分布宽度百分比", "label": "实验室检验", "offset": "293"}, {"mention": "c反应蛋白", "label": "实验室检验", "offset": "319"}, {"mention": "咳嗽待查", "label": "疾病和诊断", "offset": "339"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "365"}, {"mention": "牙龈", "label": "解剖部位", "offset": "376"}, {"mention": "鼻出血", "label": "症状", "offset": "383"}, {"mention": "甲胎蛋白", "label": "实验室检验", "offset": "407"}, {"mention": "乙肝表面抗原定性", "label": "实验室检验", "offset": "439"}, {"mention": "乙肝核心抗体定性", "label": "实验室检验", "offset": "451"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "467"}, {"mention": "碱性磷酸酶", "label": "实验室检验", "offset": "484"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "502"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "521"}, {"mention": "总胆汁酸", "label": "实验室检验", "offset": "541"}, {"mention": "全腹增强ct", "label": "影像检查", "offset": "575"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "587"}, {"mention": "脾脏", "label": "解剖部位", "offset": "591"}, {"mention": "胰头", "label": "解剖部位", "offset": "616"}, {"mention": "腹水", "label": "症状", "offset": "640"}, {"mention": "腹膜", "label": "解剖部位", "offset": "643"}, {"mention": "网膜", "label": "解剖部位", "offset": "647"}, {"mention": "系膜", "label": "解剖部位", "offset": "650"}, {"mention": "ct", "label": "影像检查", "offset": "674"}, {"mention": "右侧中上腹", "label": "解剖部位", "offset": "686"}, {"mention": "小肠积气", "label": "疾病和诊断", "offset": "693"}, {"mention": "不全性肠梗阻", "label": "疾病和诊断", "offset": "707"}, {"mention": "ct", "label": "影像检查", "offset": "724"}, {"mention": "前列腺钙化", "label": "疾病和诊断", "offset": "733"}, {"mention": "腰椎骨质增生", "label": "疾病和诊断", "offset": "741"}, {"mention": "右肺底", "label": "解剖部位", "offset": "753"}, {"mention": "右侧胸壁胸膜", "label": "解剖部位", "offset": "767"}]}
{"text": "入院前3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。反复因黑便多次在我院内二科住院,住院后诊断“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2016-03-14行右前臂动静脉内瘘吻合术,2016-04-06自动出院转我科行长期维持性血液透析治疗,4天前受凉后出现咳嗽,家属在药店购买“消炎止咳”等药物给其服用,具体不详,服药后症状无好转,今日起床后出现面部浮肿,咳嗽时腹部疼痛,伴有腹泻,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,为进一步治疗到我院透析室检查肾功:尿素叒9.27叒mmol/l、肌酐叒540.5叒μmol/l、尿酸叒313.4叒μmol/l,电解质:钾叒4.15叒mmol/l、钠叒140.3叒mmol/l、氯叒104.1叒mmol/l、二氧化碳叒22.6叒mmol/l、钙叒2.11叒mmol/l、磷叒1.13叒mmol/l,血常规:白细胞数叒4.1×10^9/l、红细胞数叒3.97×10^12/l、血红蛋白浓度叒121叒g/l、血小板数叒101×10^9/l、中性粒细胞百分比叒82.91叒%,透析后患者症状无好转,门诊以\\\"慢性肾脏病5期,肺炎\\\"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": "81"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "85"}, {"mention": "高血压肾病", "label": "疾病和诊断", "offset": "90"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "96"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "102"}, {"mention": "心功能不全", "label": "疾病和诊断", "offset": "109"}, {"mention": "营养不良", "label": "疾病和诊断", "offset": "115"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "161"}, {"mention": "尿素氮", "label": "实验室检验", "offset": "175"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "195"}, {"mention": "血钾", "label": "实验室检验", "offset": "210"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "228"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "236"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "241"}, {"mention": "高血压3级很高危", "label": "疾病和诊断", "offset": "247"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "256"}, {"mention": "尿路感染", "label": "疾病和诊断", "offset": "263"}, {"mention": "低蛋白血症", "label": "疾病和诊断", "offset": "268"}, {"mention": "右前臂动静脉内瘘吻合术", "label": "手术", "offset": "341"}, {"mention": "面部浮肿", "label": "症状", "offset": "436"}, {"mention": "腹部", "label": "解剖部位", "offset": "444"}, {"mention": "腹泻", "label": "症状", "offset": "451"}, {"mention": "腹痛", "label": "症状", "offset": "455"}, {"mention": "腹胀", "label": "症状", "offset": "457"}, {"mention": "心悸", "label": "症状", "offset": "474"}, {"mention": "胸闷", "label": "症状", "offset": "476"}, {"mention": "两上肢", "label": "解剖部位", "offset": "480"}, {"mention": "尿素", "label": "实验室检验", "offset": "503"}, {"mention": "肌酐", "label": "实验室检验", "offset": "518"}, {"mention": "尿酸", "label": "实验室检验", "offset": "534"}, {"mention": "钾", "label": "实验室检验", "offset": "554"}, {"mention": "钠", "label": "实验室检验", "offset": "568"}, {"mention": "氯", "label": "实验室检验", "offset": "583"}, {"mention": "二氧化碳", "label": "实验室检验", "offset": "598"}, {"mention": "钙", "label": "实验室检验", "offset": "615"}, {"mention": "磷", "label": "实验室检验", "offset": "629"}, {"mention": "白细胞", "label": "实验室检验", "offset": "647"}, {"mention": "红细胞", "label": "实验室检验", "offset": "663"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "681"}, {"mention": "血小板", "label": "实验室检验", "offset": "696"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "712"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "745"}, {"mention": "肺炎", "label": "疾病和诊断", "offset": "753"}]}
{"text": "入院前10余天患者无明显诱因出现下腹胀,伴纳差、大便未解,无反酸、嗳气、烧心,无腹痛、腹泻、呕吐,无黑便、呕吐咖啡色物质及胆汁,未予重视治疗。入院前半天患者服用“通便药物”后出现解暗红色稀糊样便,共5次,总量约300g,伴头昏、乏力、冷汗,伴下腹部不适、心悸、胸闷,伴心悸、气促,无黑曚、晕厥、呕吐,为进一步诊治遂至我院急诊,急诊科查心肌酶谱:谷草转氨酶叒27.7叒u/l、肌酸激酶叒175.9叒u/l、肌酸激酶同工酶叒22叒u/l、乳酸脱氢酶叒287.8叒u/l,肾功:尿素叒27.48叒mmol/l、肌酐叒92.4叒μmol/l、尿酸叒340.8叒μmol/l,凝血试验:凝血酶原时间叒14.4叒秒、国际标准化比值叒1.21、活化部分凝血酶原时间叒22.1叒秒、纤维蛋白原叒2.50叒g/l、凝血酶时间叒15.3叒秒,高敏肌钙蛋白:高敏肌钙蛋白t叒77.89叒pg/ml,血常规:白细胞数叒9.5×10^9/l、红细胞数叒2.85×10^12/l、血红蛋白浓度叒82叒g/l、血小板数叒130×10^9/l、中性粒细胞百分比叒88.24叒%、红细胞压积叒25.9叒%,腹部彩超提示胆囊壁增厚毛糙,考虑“1.急性下消化道出血2.慢性心力衰竭叒房颤3.肺部感染4.肠梗阻?”,给予速尿20mg静推后收入我科。入院前10余年患者反复出现劳力性心累气促,伴间断夜间阵发性呼吸困难、两上肢水肿,在外院诊断“冠状动脉粥样硬化性心脏病叒心衰叒房颤”,2+年前患者在我院住院诊断“1.冠状动脉粥样硬化性心脏病叒缺血性心肌病型叒心功能不全叒心功能iii级叒心律失常叒心房纤颤伴ii°房室传导阻滞叒2.原发性高血压2级叒极高危叒3.肺部感染叒4.前列腺增生症”。院外长期服用“单硝酸异山梨酯、利尿剂”等治疗,稳定期时患者仅能耐受轻度体力活动。病程以来患者精神食欲差,大便同前,小便尚可,体重无改变,体力上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "17"}, {"mention": "腹痛", "label": "症状", "offset": "40"}, {"mention": "腹泻", "label": "症状", "offset": "43"}, {"mention": "头昏", "label": "症状", "offset": "111"}, {"mention": "下腹部", "label": "解剖部位", "offset": "121"}, {"mention": "心悸", "label": "症状", "offset": "127"}, {"mention": "胸闷", "label": "症状", "offset": "130"}, {"mention": "心悸", "label": "症状", "offset": "134"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "172"}, {"mention": "肌酸激酶", "label": "实验室检验", "offset": "187"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "202"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "217"}, {"mention": "尿素", "label": "实验室检验", "offset": "236"}, {"mention": "肌酐", "label": "实验室检验", "offset": "252"}, {"mention": "尿酸", "label": "实验室检验", "offset": "267"}, {"mention": "凝血酶原时间", "label": "实验室检验", "offset": "288"}, {"mention": "国际标准化比值", "label": "实验室检验", "offset": "302"}, {"mention": "活化部分凝血酶原时间", "label": "实验室检验", "offset": "315"}, {"mention": "纤维蛋白原", "label": "实验室检验", "offset": "333"}, {"mention": "凝血酶时间", "label": "实验室检验", "offset": "348"}, {"mention": "高敏肌钙蛋白", "label": "实验室检验", "offset": "368"}, {"mention": "白细胞数", "label": "实验室检验", "offset": "392"}, {"mention": "红细胞数", "label": "实验室检验", "offset": "408"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "426"}, {"mention": "血小板数", "label": "实验室检验", "offset": "440"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "456"}, {"mention": "红细胞压积", "label": "实验室检验", "offset": "473"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "486"}, {"mention": "胆囊壁", "label": "解剖部位", "offset": "492"}, {"mention": "急性下消化道出血", "label": "疾病和诊断", "offset": "505"}, {"mention": "慢性心力衰竭", "label": "疾病和诊断", "offset": "515"}, {"mention": "房颤", "label": "疾病和诊断", "offset": "522"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "526"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "532"}, {"mention": "速尿", "label": "药物", "offset": "540"}, {"mention": "心", "label": "解剖部位", "offset": "570"}, {"mention": "两上肢", "label": "解剖部位", "offset": "588"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "600"}, {"mention": "心衰", "label": "疾病和诊断", "offset": "613"}, {"mention": "房颤", "label": "疾病和诊断", "offset": "616"}, {"mention": "冠状动脉粥样硬化性心脏病叒缺血性心肌病型", "label": "疾病和诊断", "offset": "636"}, {"mention": "心功能不全", "label": "疾病和诊断", "offset": "657"}, {"mention": "心功能iii级", "label": "疾病和诊断", "offset": "663"}, {"mention": "心律失常", "label": "疾病和诊断", "offset": "671"}, {"mention": "心房纤颤伴ii°房室传导阻滞", "label": "疾病和诊断", "offset": "676"}, {"mention": "原发性高血压2级叒极高危", "label": "疾病和诊断", "offset": "693"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "708"}, {"mention": "前列腺增生症", "label": "疾病和诊断", "offset": "715"}, {"mention": "单硝酸异山梨酯", "label": "药物", "offset": "730"}]}
{"text": "患者7+年前开始出现受凉后咳嗽、伴喘累,需输液治疗缓解,缓解后未长期口服药物,每年冬春季及天气变化时易于发病,无胸痛、咯血,多次在外院就诊考虑“慢支炎、肺气肿”。病程中逐渐出现劳力性气促,初为爬坡及重体力劳动时出现,后平地活动亦感气促,受凉后喘累气促明显加重,反复在当地医院输液治疗。近1+年患者先后多次在我院住院治疗,诊断“慢性支气管炎急性发作”,经抗感染、止咳祛痰、平喘等治疗病情稍缓解。入院前10天患者无明显诱因咳嗽咯痰症状加重,咯痰费力,伴有心慌胸闷,喘累气促,在*****医院住院治疗1周后病情好转于昨日出院。入院前4小时患者感咳嗽加重,喉头有痰不能咯出,剧烈咳嗽后感腹痛,喘累气促明显,伴有呼吸困难,大汗淋漓,无畏寒发热,无恶心呕吐,无胸痛咯血,无咯粉红色泡沫痰。家属呼叫120接入我院,接诊途中予以静推“地塞米松10mg”。到达我院急救部后查血气分析全套:二氧化碳总量叒38叒mmol/l、酸碱度叒7.350、二氧化碳分压叒65叒mmhg、氧分压叒231叒mmhg、碳酸氢根叒35.9叒mmol/l、标准碳酸氢根叒30.70叒mmol/l、全血碱剩余叒7.30叒mmol/l、血氧饱和度叒100.00叒%;血常规:白细胞数叒8.7叒10^9/l、红细胞数叒5.34叒10^12/l、血红蛋白浓度叒148叒g/l、血小板数叒191叒10^9/l、中性粒细胞百分比叒82.81叒%;肾功:尿素叒6.11叒mmol/l、肌酐叒58.0叒μmol/l、尿酸叒406.8叒μmol/l;电解质1:钾叒4.45叒mmol/l、钠叒142.7叒mmol/、氯叒101.0叒mmol/l;c反应蛋白叒<1叒mg/l。为进一步诊疗急诊以“慢支炎急发、肺气肿”收我科住院。本次发病以来患者精神食欲较差,大小便如常,睡眠较差,体力上降,体重无明显改变。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "56"}, {"mention": "慢支炎", "label": "疾病和诊断", "offset": "72"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "76"}, {"mention": "慢性支气管炎急性发作", "label": "疾病和诊断", "offset": "163"}, {"mention": "心慌", "label": "症状", "offset": "225"}, {"mention": "胸闷", "label": "症状", "offset": "227"}, {"mention": "喉头", "label": "解剖部位", "offset": "274"}, {"mention": "腹痛", "label": "症状", "offset": "289"}, {"mention": "胸痛", "label": "症状", "offset": "324"}, {"mention": "地塞米松", "label": "药物", "offset": "359"}, {"mention": "二氧化碳总量", "label": "实验室检验", "offset": "385"}, {"mention": "酸碱度", "label": "实验室检验", "offset": "402"}, {"mention": "二氧化碳分压", "label": "实验室检验", "offset": "412"}, {"mention": "氧分压", "label": "实验室检验", "offset": "427"}, {"mention": "碳酸氢根", "label": "实验室检验", "offset": "440"}, {"mention": "标准碳酸氢根", "label": "实验室检验", "offset": "457"}, {"mention": "全血碱剩余", "label": "实验室检验", "offset": "477"}, {"mention": "血氧饱和度", "label": "实验室检验", "offset": "495"}, {"mention": "白细胞", "label": "实验室检验", "offset": "514"}, {"mention": "红细胞", "label": "实验室检验", "offset": "530"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "548"}, {"mention": "血小板", "label": "实验室检验", "offset": "563"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "579"}, {"mention": "尿素", "label": "实验室检验", "offset": "599"}, {"mention": "肌酐", "label": "实验室检验", "offset": "614"}, {"mention": "尿酸", "label": "实验室检验", "offset": "629"}, {"mention": "钾", "label": "实验室检验", "offset": "650"}, {"mention": "钠", "label": "实验室检验", "offset": "664"}, {"mention": "氯", "label": "实验室检验", "offset": "678"}, {"mention": "c反应蛋白", "label": "实验室检验", "offset": "693"}, {"mention": "慢支炎急发", "label": "疾病和诊断", "offset": "717"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "723"}]}
{"text": "患者入院前半月患者可能受凉后感咳嗽,咯少许白色粘痰,无痰中带血,并乏力,轻微认知功能障碍,余否认畏寒发热,无潮热盗汗,无胸痛,无呼吸困难,无上肢浮肿。于*****老年科住院治疗,完善辅助检查,2018-01-15血常规叒wbc叒8.28x10^9/l、rbc叒3.65x10^12/l;bnp叒875ng/l;2018-01-15ct提示:右侧半卵圆中心及两侧基底节区多发腔隙性脑梗死灶可能。脑萎缩,两侧脑白质脱髓鞘改变。左侧下颌窦及筛窦炎症。甲状腺左叶稍低密度结节;峡部增厚。两肺散在炎症,以两肺上叶为甚,建议治疗后复查,两肺散在纤维灶,左肺下叶后段、右肺下叶及右肺上叶背段小结节状钙化灶,左肺中叶肺大泡形成,两肾囊肿。结肠内较多内容物,随访。主动脉、弓下动脉、右左冠状动脉、腹腔干、肝固有动脉、肝动脉、肠系膜下动脉、两肾动脉、脾动脉及两侧髂总动脉髂内外动脉管壁多发钙化。两上肢血管彩超:两上肢动脉硬化伴粥样斑点形成。两上肢深静脉未见异常。心脏彩超提示:右室肥厚伴顺应性减退、二尖瓣环、主动脉瓣钙化;颈动脉彩超提示:两侧颈动脉斑块形成右侧颈内动脉内膜增厚。头颅mri提示两侧额顶叶、半卵圆中心、脑室体旁及基底节区、脑桥多发缺血灶及腔梗灶。脑萎缩。考虑诊断“肺部感染”,予以莫西沙星抗感染治疗,并继续改善认知、营养神经、祛痰、冠心病二级预防、控制血糖等处理,治疗近9天,患者咳嗽症状缓解,复查血色素较入院时上降,家属诉其有黑便表现,复查维生素b12叒220.0pg/ml,叶酸>23.9ng/ml。铁生化:血清铁叒3.4umol/l叒总铁结合力叒47.7umol/l。骨髓穿刺提示骨髓增生活跃,内外铁阴性。因患者不配合,家属为方便照顾要求转入我科继续住院治疗。患者此次患病以来精神、食欲、睡眠一般,大便干结,小便正常,体力及体重无明显改变。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "60"}, {"mention": "上肢", "label": "解剖部位", "offset": "70"}, {"mention": "wbc", "label": "实验室检验", "offset": "110"}, {"mention": "rbc", "label": "实验室检验", "offset": "126"}, {"mention": "bnp", "label": "实验室检验", "offset": "143"}, {"mention": "ct", "label": "影像检查", "offset": "165"}, {"mention": "右侧半卵圆中心及两侧基底节区多发腔隙性脑梗死灶", "label": "疾病和诊断", "offset": "170"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "196"}, {"mention": "两侧脑白质脱髓鞘改变", "label": "疾病和诊断", "offset": "200"}, {"mention": "左侧下颌窦及筛窦炎症", "label": "疾病和诊断", "offset": "211"}, {"mention": "甲状腺左叶稍低密度结节", "label": "疾病和诊断", "offset": "222"}, {"mention": "峡部", "label": "解剖部位", "offset": "234"}, {"mention": "两肺散在炎症", "label": "疾病和诊断", "offset": "239"}, {"mention": "两肺上叶", "label": "解剖部位", "offset": "247"}, {"mention": "两肺", "label": "解剖部位", "offset": "262"}, {"mention": "左肺下叶后段", "label": "解剖部位", "offset": "270"}, {"mention": "右肺下叶", "label": "解剖部位", "offset": "277"}, {"mention": "右肺上叶背段", "label": "解剖部位", "offset": "282"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "296"}, {"mention": "两肾囊肿", "label": "疾病和诊断", "offset": "306"}, {"mention": "结肠", "label": "解剖部位", "offset": "311"}, {"mention": "主动脉", "label": "解剖部位", "offset": "323"}, {"mention": "弓下动脉", "label": "解剖部位", "offset": "327"}, {"mention": "右左冠状动脉", "label": "解剖部位", "offset": "332"}, {"mention": "腹腔干", "label": "解剖部位", "offset": "339"}, {"mention": "肝固有动脉", "label": "解剖部位", "offset": "343"}, {"mention": "肝动脉", "label": "解剖部位", "offset": "349"}, {"mention": "肠系膜下动脉", "label": "解剖部位", "offset": "353"}, {"mention": "两肾动脉", "label": "解剖部位", "offset": "360"}, {"mention": "脾动脉", "label": "解剖部位", "offset": "365"}, {"mention": "两侧髂总动脉", "label": "解剖部位", "offset": "369"}, {"mention": "髂内外动脉管壁", "label": "解剖部位", "offset": "375"}, {"mention": "两上肢血管彩超", "label": "影像检查", "offset": "387"}, {"mention": "两上肢动脉硬化伴粥样斑点", "label": "疾病和诊断", "offset": "395"}, {"mention": "两上肢", "label": "解剖部位", "offset": "410"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "421"}, {"mention": "右室肥厚", "label": "疾病和诊断", "offset": "428"}, {"mention": "二尖瓣环、主动脉瓣钙化", "label": "疾病和诊断", "offset": "439"}, {"mention": "颈动脉彩超", "label": "影像检查", "offset": "451"}, {"mention": "两侧颈动脉", "label": "解剖部位", "offset": "459"}, {"mention": "右侧颈内动脉", "label": "解剖部位", "offset": "468"}, {"mention": "头颅mri", "label": "影像检查", "offset": "479"}, {"mention": "两侧额顶叶", "label": "解剖部位", "offset": "486"}, {"mention": "半卵圆中心", "label": "解剖部位", "offset": "492"}, {"mention": "脑室体旁", "label": "解剖部位", "offset": "498"}, {"mention": "基底节区", "label": "解剖部位", "offset": "503"}, {"mention": "脑桥", "label": "解剖部位", "offset": "508"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "520"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "529"}, {"mention": "莫西沙星", "label": "药物", "offset": "537"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "563"}, {"mention": "维生素b12", "label": "实验室检验", "offset": "618"}, {"mention": "叶酸", "label": "实验室检验", "offset": "636"}, {"mention": "血清铁", "label": "实验室检验", "offset": "653"}, {"mention": "总铁结合力", "label": "实验室检验", "offset": "667"}, {"mention": "骨髓穿刺", "label": "手术", "offset": "684"}]}
{"text": "入院前30+年,患者常在受凉后出现咳嗽、咳痰,多为白色泡沫痰,并逐渐出现喘累、气促,好发于冬春季节,每年累计发病时间超过3月,外院诊断为“慢支炎、肺气肿”,予以抗感染、止咳平喘等治疗后可好转。患者喘累、气促症状逐年加重,并逐渐出现间断两上肢水肿,外院考虑为“肺源性心脏病”,未利尿、长期低流量吸氧及吸入剂治疗。7+年前,患者喘累、呼吸困难明显,于外院诊断为“支气管哮喘”(具体检查报告及诊治经过不详),开始使用沙丁胺醇气雾剂治疗。后患者下述症状反复发作,反复住院治疗,完善检查:心脏彩超:全心增大;主动脉窦部增宽;室间隔、右室后壁动度降低;主动脉瓣钙化;二尖瓣、三尖瓣重度反流;主动脉瓣中度反流;右室收缩、舒张功能减退;肺动脉收缩轻度高压。ef31%。肺功能检查提示重度阻塞性通气功能障碍,舒张试验阳性(fev1叒41.7%,fev1%fvc59.14%)。最近一次于2017-12-30于我科住院治疗,给予抗感染、化痰、平喘、改善循环等治疗后于2018-1-6因患者个人原因自动出院,出院诊断为:1、慢性阻塞性肺疾病急性加重期;2、慢性肺源性心脏病;3、支气管哮喘;4、冠状动脉粥样硬化性心脏病叒心律失常叒心功能ⅲ-ⅳ级;5、慢性胃炎急发。出院后用药情况不详。入院前1天,患者再次感下述症状较前加重,咳嗽、咳白色粘痰,喘累明显,不能平卧位休息,夜间阵发性呼吸困难,腹胀纳差,进食量明显上降,轻微下腹部疼痛,无畏寒寒战、发热,无咯血,无潮热盗汗,无恶心呕吐,无胸闷、胸痛,无尿频、尿急、尿痛等不适,自行服用“平喘药”(具体不详),下述症状无明显好转,遂来我院就诊,门诊以“aecopd”收入我科进一步治疗。患者此次患病以来精神、食欲、睡眠差,大小便正常,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "慢支炎", "label": "疾病和诊断", "offset": "69"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "73"}, {"mention": "两上肢", "label": "解剖部位", "offset": "117"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "129"}, {"mention": "支气管哮喘", "label": "疾病和诊断", "offset": "179"}, {"mention": "沙丁胺醇", "label": "药物", "offset": "205"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "239"}, {"mention": "主动脉窦部", "label": "解剖部位", "offset": "249"}, {"mention": "室间隔", "label": "解剖部位", "offset": "257"}, {"mention": "右室后壁", "label": "解剖部位", "offset": "261"}, {"mention": "主动脉瓣钙化", "label": "疾病和诊断", "offset": "270"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "277"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "281"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "289"}, {"mention": "右室", "label": "解剖部位", "offset": "298"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "310"}, {"mention": "ef", "label": "实验室检验", "offset": "320"}, {"mention": "重度阻塞性通气功能障碍", "label": "疾病和诊断", "offset": "333"}, {"mention": "慢性阻塞性肺疾病急性加重期", "label": "疾病和诊断", "offset": "451"}, {"mention": "慢性肺源性心脏病", "label": "疾病和诊断", "offset": "467"}, {"mention": "支气管哮喘", "label": "疾病和诊断", "offset": "478"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "486"}, {"mention": "心律失常", "label": "疾病和诊断", "offset": "499"}, {"mention": "心功能ⅲ-ⅳ级", "label": "疾病和诊断", "offset": "504"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "514"}, {"mention": "腹胀", "label": "症状", "offset": "583"}, {"mention": "下腹部", "label": "解剖部位", "offset": "598"}, {"mention": "胸闷", "label": "症状", "offset": "630"}, {"mention": "胸痛", "label": "症状", "offset": "633"}, {"mention": "aecopd", "label": "疾病和诊断", "offset": "686"}]}
{"text": "入院前5+年,患者因右侧肢体乏力,伴口齿不清,在外院明确诊断“脑梗死”,经治疗后好转出院,出院后遗留右侧肢体活动轻度障碍及口齿稍含糊,生活可自理。入院前半月,患者反复出现头昏,阵发性发作,发作时自觉乏力、站立不稳、心悸,并出现左下肢抽动,伴流涎,在我科住院,诊断:脑梗死后遗症、短暂性脑缺血发作、高血压病、颈动脉多发硬化性斑块形成、高脂血症、2型糖尿病?查糖化血红蛋白:7.1叒%。血脂:甘油三酯叒3.74叒mmol/l、总胆固醇叒5.89叒mmol/l、低密度脂蛋白胆固醇叒3.39叒mmol/l,头颈部cta示1、两侧基底节区及侧脑室体旁腔隙性脑梗死。右侧颞、枕叶慢性脑梗死;右侧顶叶软化灶。脑白质脱髓鞘改变;脑萎缩。右侧下颌窦炎症或息肉。两侧筛窦炎。食道中段壁增厚,食道旁软组织增多,建议胃镜检查。cta:主动脉壁较多软硬斑块形成,并见多个深大溃疡;头臂干、左侧颈内动脉起始部、右侧锁骨上动脉起始段广泛软、硬斑块形成,局部管腔轻度狭窄;颈内动脉颅内各段、大脑前、中、后动脉各段血管硬化。心脏彩超示右房增大;主动脉窦部增宽;二尖瓣及肺动脉瓣局限性反流;主动脉瓣中度反流,提示右室舒张功能减退。腹部彩超示脂肪肝;胆囊结石叒胆囊肿大;左肾结石。颈动脉彩超示颈动脉粥样硬化;左侧颈动脉中段粥样斑块,右侧颈动脉多发粥样斑块;左侧椎动脉流速减慢。予以改善循环、改善头昏等对症治疗后好转出院。入院前1天,患者无明显诱因再次出现头昏,伴肢体乏力,发作时伴站立不稳、头昏加重、眼花,持续1小时右左,无恶心、呕吐,无大小便失禁、意识丧失,无畏寒、无胸闷、胸痛,无喘累、气促,无晕厥等,今晨患者活动后再次发作头昏,故收入我科住院。患者自发病以来精神、食欲一般,大小便未诉异常。近期体重无明显减轻。", "mention_data": [{"mention": "右侧肢体", "label": "解剖部位", "offset": "10"}, {"mention": "脑梗死", "label": "疾病和诊断", "offset": "31"}, {"mention": "右侧肢体", "label": "解剖部位", "offset": "50"}, {"mention": "头昏", "label": "症状", "offset": "85"}, {"mention": "心悸", "label": "症状", "offset": "107"}, {"mention": "左下肢", "label": "解剖部位", "offset": "113"}, {"mention": "脑梗死后遗症", "label": "疾病和诊断", "offset": "132"}, {"mention": "短暂性脑缺血发作", "label": "疾病和诊断", "offset": "139"}, {"mention": "高血压病", "label": "疾病和诊断", "offset": "148"}, {"mention": "颈动脉多发硬化性斑块形成", "label": "疾病和诊断", "offset": "153"}, {"mention": "高脂血症", "label": "疾病和诊断", "offset": "166"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "171"}, {"mention": "糖化血红蛋白", "label": "实验室检验", "offset": "178"}, {"mention": "甘油三酯", "label": "实验室检验", "offset": "194"}, {"mention": "总胆固醇", "label": "实验室检验", "offset": "211"}, {"mention": "低密度脂蛋白胆固醇", "label": "实验室检验", "offset": "228"}, {"mention": "头颈部cta", "label": "影像检查", "offset": "250"}, {"mention": "两侧基底节区及侧脑室体旁腔隙性脑梗死", "label": "疾病和诊断", "offset": "259"}, {"mention": "右侧颞、枕叶慢性脑梗死", "label": "疾病和诊断", "offset": "278"}, {"mention": "右侧顶叶软化灶", "label": "疾病和诊断", "offset": "290"}, {"mention": "脑白质脱髓鞘改变", "label": "疾病和诊断", "offset": "298"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "307"}, {"mention": "右侧下颌窦炎症或息肉", "label": "疾病和诊断", "offset": "311"}, {"mention": "两侧筛窦炎", "label": "疾病和诊断", "offset": "322"}, {"mention": "食道中段", "label": "解剖部位", "offset": "328"}, {"mention": "食道旁", "label": "解剖部位", "offset": "336"}, {"mention": "cta", "label": "影像检查", "offset": "352"}, {"mention": "主动脉壁", "label": "解剖部位", "offset": "356"}, {"mention": "头臂干", "label": "解剖部位", "offset": "378"}, {"mention": "左侧颈内动脉", "label": "解剖部位", "offset": "382"}, {"mention": "右侧锁骨上动脉起始段", "label": "解剖部位", "offset": "392"}, {"mention": "颈内动脉", "label": "解剖部位", "offset": "421"}, {"mention": "大脑前、中、后动脉", "label": "解剖部位", "offset": "430"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "446"}, {"mention": "右房", "label": "解剖部位", "offset": "451"}, {"mention": "主动脉窦部", "label": "解剖部位", "offset": "456"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "464"}, {"mention": "肺动脉瓣", "label": "解剖部位", "offset": "468"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "478"}, {"mention": "右室舒张功能减退", "label": "疾病和诊断", "offset": "489"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "498"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "503"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "507"}, {"mention": "胆囊肿大", "label": "疾病和诊断", "offset": "512"}, {"mention": "左肾结石", "label": "疾病和诊断", "offset": "517"}, {"mention": "颈动脉彩超", "label": "影像检查", "offset": "522"}, {"mention": "颈动脉粥样硬化", "label": "疾病和诊断", "offset": "528"}, {"mention": "左侧颈动脉中段", "label": "解剖部位", "offset": "536"}, {"mention": "右侧颈动脉", "label": "解剖部位", "offset": "548"}, {"mention": "左侧椎动脉", "label": "解剖部位", "offset": "560"}, {"mention": "头昏", "label": "症状", "offset": "579"}, {"mention": "头昏", "label": "症状", "offset": "609"}, {"mention": "肢体", "label": "解剖部位", "offset": "613"}, {"mention": "头昏", "label": "症状", "offset": "627"}, {"mention": "胸闷", "label": "症状", "offset": "667"}, {"mention": "胸痛", "label": "症状", "offset": "670"}, {"mention": "头昏", "label": "症状", "offset": "696"}]}
{"text": "入院8年前患者受凉后出现咳嗽、伴喘累,需输液治疗缓解,缓解后未长期口服药物,每年冬春季及天气变化时易于发病,无胸痛、咯血,多次在外院就诊考虑“慢支炎、肺气肿”。病程中逐渐出现劳力性气促,初为爬坡及重体力劳动时出现,后平地活动亦感气促,受凉后喘累气促明显加重,反复在当地医院输液治疗。近2年患者先后多次在我院住院治疗,诊断“慢性支气管炎急性发作”,经抗感染、止咳祛痰、平喘等治疗病情稍缓解。入院前10天患者受凉后咳嗽咯痰症状加重,咳黄色痰液,咯痰费力。伴有心慌胸闷,喘累气促,夜间不能平卧。伴纳差,饮食较前明显减少,每餐进食3-4口饭,伴活动耐力明显上降,未上床活动。无畏寒、发热、咳血、胸痛、流涕、打喷嚏。未予诊治。入院前5天出现两上肢水肿。今日患者感气促明显,端坐位易气促,家属遂呼120送入我院就诊,查“血气分析:pco2:66mmhg,po2:38mmhg,ph:7.35,so2:68%。心电图示:窦性心动过速,不完全性左束支传导阻滞,左室肥大,右房肥大。血常规:wbc:9.0*10^9/l,n:74.64%,neut:6.75*10^9/l。电解质示:k:5.97mmol/l,na:135.7mmol/l,cl:94.3mmol/l。肾功、心肌酶谱无异常。胸片示:两肺广发感染,两侧肺门增大增浓,建议结合临床后复查或ct检查除外其它。”诊断“慢性阻塞性肺病急性加重,2型呼吸衰竭。”给予“呋塞米利尿、多索茶碱平喘、地塞米松平喘”对症处理,患者呼吸衰竭明显,需入住icu行无创呼吸机治疗,但家属拒绝。请内一科会诊后因内一科无床,经沟通后收入我科治疗。本次发病以来患者精神食欲较差,大小便如常,睡眠差,体力上降,体重无明显改变", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "55"}, {"mention": "慢支炎", "label": "疾病和诊断", "offset": "71"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "75"}, {"mention": "慢性支气管炎急性发作", "label": "疾病和诊断", "offset": "161"}, {"mention": "心慌", "label": "症状", "offset": "227"}, {"mention": "胸闷", "label": "症状", "offset": "229"}, {"mention": "胸痛", "label": "症状", "offset": "293"}, {"mention": "两上肢", "label": "解剖部位", "offset": "315"}, {"mention": "pco2", "label": "实验室检验", "offset": "359"}, {"mention": "po2", "label": "实验室检验", "offset": "371"}, {"mention": "ph", "label": "实验室检验", "offset": "382"}, {"mention": "so2", "label": "实验室检验", "offset": "390"}, {"mention": "心电图", "label": "影像检查", "offset": "398"}, {"mention": "窦性心动过速", "label": "疾病和诊断", "offset": "403"}, {"mention": "不完全性左束支传导阻滞", "label": "疾病和诊断", "offset": "410"}, {"mention": "左室肥大", "label": "疾病和诊断", "offset": "422"}, {"mention": "右房肥大", "label": "疾病和诊断", "offset": "427"}, {"mention": "wbc", "label": "实验室检验", "offset": "436"}, {"mention": "n", "label": "实验室检验", "offset": "451"}, {"mention": "neut", "label": "实验室检验", "offset": "460"}, {"mention": "k", "label": "实验室检验", "offset": "482"}, {"mention": "na", "label": "实验室检验", "offset": "495"}, {"mention": "cl", "label": "实验室检验", "offset": "510"}, {"mention": "胸片", "label": "影像检查", "offset": "535"}, {"mention": "两肺广发感染", "label": "疾病和诊断", "offset": "539"}, {"mention": "两侧肺门", "label": "解剖部位", "offset": "546"}, {"mention": "ct", "label": "影像检查", "offset": "565"}, {"mention": "慢性阻塞性肺病急性加重", "label": "疾病和诊断", "offset": "578"}, {"mention": "2型呼吸衰竭", "label": "疾病和诊断", "offset": "590"}, {"mention": "呋塞米", "label": "药物", "offset": "601"}, {"mention": "多索茶碱", "label": "药物", "offset": "607"}, {"mention": "地塞米松", "label": "药物", "offset": "614"}, {"mention": "呼吸衰竭", "label": "疾病和诊断", "offset": "628"}]}
{"text": "入院前3+月,患者无明显诱因出现剑突上阵发性隐痛,无肩背部放射痛,疼痛无规律,与进食及体位无关,持续约数十分钟后可自行缓解,伴嗳气,无反酸烧心、恶心呕吐、纳差、黑便、消瘦、腹胀,无心悸、气促、胸闷胸痛,于我院门诊查胃镜示:贲门肿瘤可能?活检示:贲门腺癌(均未见原报告)。故于我院消化内科住院治疗,完善胸腹部ct:1.贲门及邻近胃壁增厚,增强后轻度强化,周围淋巴结肿大,考虑肿瘤性病变,胃ca?2.左肺中叶外侧段及两肺上叶少许炎症。3.左肺下叶尖后段少许纤维、钙化灶;右肺上叶胸膜上可疑浅淡小结节影。4.纵隔及左肺门区淋巴结钙化。5.脂肪肝,肝左后缘斑点状钙化。6.主动脉、冠状动脉及两侧髂动脉壁钙化,胸椎、腰椎骨质增生。患方拒绝手术治疗,经对症处理后好转出院,院外患者病情相对稳定。入院前5+天,患者再发下诉腹痛不适,伴恶心欲吐,纳差乏力明显,伴明显头昏,严重时致体位不能维持,卧床休息后好转,否认呕血及便血,无反酸烧心,无心悸、气促、胸闷胸痛,无咳嗽咯痰,无畏寒发热等不适,故于*******医院就诊治疗,完善胸片:1.双肺纹理增多;2.左侧第7肋间腋侧走行皱褶;3.主动脉增宽钙化。心电图:窦性心律,正常心电图。腹部增强ct:胃底及贲门曲占位性性病变,考虑恶性肿瘤(胃癌可能性大),胃及食管远端,伴肝脏及淋巴结多发转移,门静脉左干及主干、脾静脉、胃引流静脉(注入门静脉)多发癌栓。血常规:hb69.2g/l。给予输注红细胞悬液2u,白蛋白纠正低蛋白血症等处理后好转,建议当地治疗,遂来我院,门诊以“胃癌伴转移”收入我科住院治疗。患者自患病以来,精神、睡眠一般,饮食如下,大小便未见明显异常,近期体重未见明显变化。", "mention_data": [{"mention": "剑突", "label": "解剖部位", "offset": "16"}, {"mention": "肩背部", "label": "解剖部位", "offset": "26"}, {"mention": "腹胀", "label": "症状", "offset": "86"}, {"mention": "心悸", "label": "症状", "offset": "90"}, {"mention": "胸闷", "label": "症状", "offset": "96"}, {"mention": "胸痛", "label": "症状", "offset": "98"}, {"mention": "贲门肿瘤可能", "label": "疾病和诊断", "offset": "111"}, {"mention": "贲门腺癌", "label": "疾病和诊断", "offset": "122"}, {"mention": "腹部ct", "label": "影像检查", "offset": "151"}, {"mention": "贲门", "label": "解剖部位", "offset": "158"}, {"mention": "胃壁增厚", "label": "症状", "offset": "163"}, {"mention": "胃ca", "label": "疾病和诊断", "offset": "192"}, {"mention": "左肺中叶外侧段及两肺上叶少许炎症", "label": "疾病和诊断", "offset": "198"}, {"mention": "左肺下叶尖后段", "label": "解剖部位", "offset": "217"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "233"}, {"mention": "胸膜", "label": "解剖部位", "offset": "237"}, {"mention": "纵隔及左肺门区淋巴结钙化", "label": "疾病和诊断", "offset": "251"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "266"}, {"mention": "肝左后缘斑点状钙化", "label": "疾病和诊断", "offset": "270"}, {"mention": "主动脉、冠状动脉及两侧髂动脉壁钙化", "label": "疾病和诊断", "offset": "282"}, {"mention": "胸椎、腰椎骨质增生", "label": "疾病和诊断", "offset": "300"}, {"mention": "腹痛", "label": "症状", "offset": "354"}, {"mention": "头昏", "label": "症状", "offset": "375"}, {"mention": "心悸", "label": "症状", "offset": "412"}, {"mention": "胸闷", "label": "症状", "offset": "418"}, {"mention": "胸痛", "label": "症状", "offset": "420"}, {"mention": "胸片", "label": "影像检查", "offset": "456"}, {"mention": "双肺", "label": "解剖部位", "offset": "461"}, {"mention": "左侧第7肋间", "label": "解剖部位", "offset": "470"}, {"mention": "主动脉增宽钙化", "label": "疾病和诊断", "offset": "485"}, {"mention": "心电图", "label": "影像检查", "offset": "493"}, {"mention": "窦性心律", "label": "疾病和诊断", "offset": "497"}, {"mention": "心电图", "label": "影像检查", "offset": "504"}, {"mention": "腹部增强ct", "label": "影像检查", "offset": "508"}, {"mention": "胃底", "label": "解剖部位", "offset": "515"}, {"mention": "贲门曲", "label": "解剖部位", "offset": "518"}, {"mention": "恶性肿瘤", "label": "疾病和诊断", "offset": "530"}, {"mention": "胃", "label": "解剖部位", "offset": "543"}, {"mention": "食管远端", "label": "解剖部位", "offset": "545"}, {"mention": "肝脏", "label": "解剖部位", "offset": "551"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "554"}, {"mention": "门静脉左干", "label": "解剖部位", "offset": "562"}, {"mention": "主干", "label": "解剖部位", "offset": "568"}, {"mention": "脾静脉", "label": "解剖部位", "offset": "571"}, {"mention": "胃引流静脉", "label": "解剖部位", "offset": "575"}, {"mention": "癌栓", "label": "疾病和诊断", "offset": "589"}, {"mention": "hb", "label": "实验室检验", "offset": "596"}, {"mention": "胃癌伴转移", "label": "疾病和诊断", "offset": "651"}]}
{"text": "患者入院前6年无明显诱因出现心累、气促,起病初多以活动后明显,伴胸闷,无明显胸痛,需胸骨后压榨感,无上肢浮肿,无夜间阵发性呼吸困难,患者休息后症状可减轻,曾于*******医院就诊,考虑“冠状动脉粥样硬化性心脏病”,并办理特病,但平素未行相关治疗。入院前半年患者因心累加重,并全身多处瘀斑,于******医院住院治疗,行心脏彩超提示“右房增大,室间隔、右室后壁增厚,左室流出道增宽,二尖瓣及主动脉瓣狭窄,二尖瓣及三尖瓣重度反流,反流压差增高,肺动脉瓣及主动脉瓣轻度反流,心包积液,右室收缩功能正常”,具体治疗不详,出院后患者长期服用“单硝酸异山梨酯缓释片、阿托伐他汀钙、厄贝沙坦、曲美他嗪”等药物,仍有活动后心累不适,近1月患者自觉心累加重,平路缓步行走感心累难以忍受,日常一般活动,如做饭等不能从事,夜间需高枕卧位,感胸闷,时有端坐呼吸,活动后伴有咳嗽,气喘,痰中偶有鲜红色血丝,无明显上肢浮肿,无畏寒发热,无潮热盗汗等不适,今日来院就诊,为进一步治疗收入我科住院。患者半年前因全身多处瘀斑,于******医院就诊,完善检查发现血小板减少、贫血,查血常规(2016-03-01)plt叒63×109/l、hb叒63g/l;住院期间予以骨髓穿刺,考虑缺铁性贫血、血小板减少性紫癜,予以输红细胞悬液2u,并激素治疗(目前服用甲泼尼龙叒2片/日),自诉复查指标好转。另外此次住院期间检查发现肾功能异常叒bun叒19.6mmol/l叒crea叒223umol/l,原因不明确,因血小板减少未能肾活检,出院诊断考虑慢性肾脏病(ckd3期),急性肾损害不除外。患者自发病以来精神、食欲可,大小便未诉异常。近期体重无明显减轻。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "14"}, {"mention": "胸闷", "label": "症状", "offset": "32"}, {"mention": "胸痛", "label": "症状", "offset": "38"}, {"mention": "胸骨", "label": "解剖部位", "offset": "42"}, {"mention": "上肢", "label": "解剖部位", "offset": "50"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "94"}, {"mention": "心", "label": "解剖部位", "offset": "132"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "160"}, {"mention": "右房", "label": "解剖部位", "offset": "167"}, {"mention": "室间隔", "label": "解剖部位", "offset": "172"}, {"mention": "右室后壁", "label": "解剖部位", "offset": "176"}, {"mention": "左室", "label": "解剖部位", "offset": "183"}, {"mention": "二尖瓣及主动脉瓣狭窄", "label": "疾病和诊断", "offset": "191"}, {"mention": "二尖瓣及三尖瓣重度反流", "label": "疾病和诊断", "offset": "202"}, {"mention": "肺动脉瓣及主动脉瓣轻度反流", "label": "疾病和诊断", "offset": "221"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "235"}, {"mention": "右室收缩功能正常", "label": "疾病和诊断", "offset": "240"}, {"mention": "单硝酸异山梨酯缓释片", "label": "药物", "offset": "267"}, {"mention": "阿托伐他汀钙", "label": "药物", "offset": "278"}, {"mention": "厄贝沙坦", "label": "药物", "offset": "285"}, {"mention": "曲美他嗪", "label": "药物", "offset": "290"}, {"mention": "心", "label": "解剖部位", "offset": "304"}, {"mention": "心", "label": "解剖部位", "offset": "328"}, {"mention": "胸闷", "label": "症状", "offset": "360"}, {"mention": "上肢", "label": "解剖部位", "offset": "394"}, {"mention": "plt", "label": "实验室检验", "offset": "490"}, {"mention": "hb", "label": "实验室检验", "offset": "503"}, {"mention": "骨髓穿刺", "label": "手术", "offset": "518"}, {"mention": "缺铁性贫血", "label": "疾病和诊断", "offset": "525"}, {"mention": "血小板减少性紫癜", "label": "疾病和诊断", "offset": "531"}, {"mention": "甲泼尼龙", "label": "药物", "offset": "561"}, {"mention": "bun", "label": "实验室检验", "offset": "599"}, {"mention": "crea", "label": "实验室检验", "offset": "614"}, {"mention": "慢性肾脏病(ckd3期)", "label": "疾病和诊断", "offset": "653"}, {"mention": "急性肾损害", "label": "疾病和诊断", "offset": "666"}]}
{"text": "入院前半天患者被家属发现失语、阵发性大汗淋漓,无大小便失禁,无呕吐,无抽搐,家属遂拨打120,由我院120接回,查血气分析:ph叒7.41,pao2叒53mmhg,paco2叒43mmhg,乳酸1.4mmol/l,肾功:未见明显异常,肝功:白球比叒1.2,电解质:氯叒110.6叒mmol/l,血常规:白细胞数叒9.4×10^9/l、红细胞数叒4.41×10^12/l、血红蛋白浓度叒131叒g/l、血小板数叒140×10^9/l、中性粒细胞百分比叒77.61叒%,凝血试验:纤维蛋白原叒4.62叒g/l,心肌酶正常。高敏肌钙蛋白t叒33.10叒pg/ml,crp:69叒mg/l,d_2聚体:7.07叒μg/ml,胸部ct:1,两侧基底节及侧脑室体旁少许散在小腔隙灶,结合临床随访复查或必要时mri进一步检查。2,脑白质脱髓鞘,脑萎缩,随访。3,左肺下叶、中叶及两上肺感染,随访复查。4,肺气肿征,右下肺小肺大泡形成。5,主动脉及冠状动脉壁钙化。6,两侧胸膜稍增厚,胸椎骨质增生。心电图:极端的窦性心律不齐,窦性心动过缓,完全性左束支传导阻滞。予以吸氧、心电监护,指脉氧由85%下升至90%,复查血气分析:ph叒7.41,pao2叒52mmhg,paco2叒36mmhg,乳酸2.0mmol/l,请我科会诊后建议转icu进一步治疗,家属拒绝,急诊以“i型呼吸衰竭,肺部感染,缺血缺氧性脑病?急性脑梗死?”收入我科。与患者家属进一步沟通后同意住院,随后以“肺部感染”收入我科住院治疗。患者自发病以来精神、食欲差,睡眠可,大便,小便未诉异常。近半年患者懒言少语,反应迟钝,但能正确对答。近期体重无明显减轻。", "mention_data": [{"mention": "ph", "label": "实验室检验", "offset": "62"}, {"mention": "pao2", "label": "实验室检验", "offset": "70"}, {"mention": "paco2", "label": "实验室检验", "offset": "82"}, {"mention": "乳酸", "label": "实验室检验", "offset": "95"}, {"mention": "白球比", "label": "实验室检验", "offset": "120"}, {"mention": "氯", "label": "实验室检验", "offset": "132"}, {"mention": "白细胞", "label": "实验室检验", "offset": "151"}, {"mention": "红细胞", "label": "实验室检验", "offset": "167"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "185"}, {"mention": "血小板", "label": "实验室检验", "offset": "200"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "216"}, {"mention": "纤维蛋白原", "label": "实验室检验", "offset": "238"}, {"mention": "高敏肌钙蛋白t", "label": "实验室检验", "offset": "259"}, {"mention": "crp", "label": "实验室检验", "offset": "279"}, {"mention": "d_2聚体", "label": "实验室检验", "offset": "291"}, {"mention": "胸部ct", "label": "影像检查", "offset": "308"}, {"mention": "两侧基底节", "label": "解剖部位", "offset": "315"}, {"mention": "侧脑室体", "label": "解剖部位", "offset": "321"}, {"mention": "mri", "label": "影像检查", "offset": "347"}, {"mention": "脑白质脱髓鞘", "label": "疾病和诊断", "offset": "358"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "365"}, {"mention": "左肺下叶、中叶及两上肺感染", "label": "疾病和诊断", "offset": "374"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "395"}, {"mention": "右下肺", "label": "解剖部位", "offset": "400"}, {"mention": "主动脉及冠状动脉壁钙化", "label": "疾病和诊断", "offset": "412"}, {"mention": "两侧胸膜", "label": "解剖部位", "offset": "426"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "434"}, {"mention": "心电图", "label": "影像检查", "offset": "441"}, {"mention": "窦性心律不齐", "label": "疾病和诊断", "offset": "448"}, {"mention": "窦性心动过缓", "label": "疾病和诊断", "offset": "455"}, {"mention": "完全性左束支传导阻滞", "label": "疾病和诊断", "offset": "462"}, {"mention": "ph", "label": "实验室检验", "offset": "504"}, {"mention": "pao2", "label": "实验室检验", "offset": "512"}, {"mention": "paco2", "label": "实验室检验", "offset": "524"}, {"mention": "乳酸", "label": "实验室检验", "offset": "537"}, {"mention": "i型呼吸衰竭", "label": "疾病和诊断", "offset": "576"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "583"}, {"mention": "缺血缺氧性脑病", "label": "疾病和诊断", "offset": "588"}, {"mention": "急性脑梗死", "label": "疾病和诊断", "offset": "596"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "628"}]}
{"text": "患者于入院10月前发现两上肢浮肿、尿量减少、喘累,到****医院查血常规:叒hb:87g/l,肾功:血肌酐:394umol/l,考虑肾功能不全、肾性贫血,后到**********医院就诊,查肾功:血肌酐:330umol/l,血常规:hb:89g/l,甲状旁腺激素叒55.5pg/ml,内生肌酐清除率:14.49ml/min,腹部彩超:两肾结构欠清,实质回声稍增强,腹腔少量积液;心脏彩超:右室肥厚,少许心包积液;胸部ct平扫:右肺上叶炎症,心脏增大,两侧胸腔积液,给予血液净化治疗、降压、降糖、纠正贫血、改善循环等治疗后好转出院。8月前前患者再次出现心悸、胸闷,伴恶心、纳差,无咳嗽、咳痰,无腹痛、腹胀,无肉眼血尿,无头昏、头痛,无皮上出血、牙龈出血等不适。在我科住院规律透析治疗,3月前因个人原因回当地,但未行透析治疗,给予口服药及胰岛素控制血糖等,5天前因活动后气促在*****就医,急诊入院后给予无创呼吸机、西地兰强心、呋塞米利尿、改善循环、持续血液净化,补充蛋白等治疗后,患者生命体征平稳,水肿消退,但仍诉心悸不适、血糖波动较大,家属为进一步诊治,到我院就诊,门诊以\\\"尿毒症、糖尿病、高血压\\\"收入我科住院治疗。患者自患病以来,精神、睡眠可,食欲差,大便正常,小便偏少,量不详,体重无明显变化。22年前因手足麻木在当地医院查血糖升高,值不详,诊断为2型糖尿病,先后服用格列齐特、消渴丸降糖,偶测血糖20+mmol/l,曾服用二甲两胍出现恶心、呕吐停用,后开始出现视物模糊、两上肢水肿,2年前开始使用优思林降血糖,血糖控制不详,现改为诺和锐30叒16u/早,12u/晚降血糖,血糖控制可。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "11"}, {"mention": "hb", "label": "实验室检验", "offset": "38"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "50"}, {"mention": "肾功能不全", "label": "疾病和诊断", "offset": "66"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "72"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "98"}, {"mention": "hb", "label": "实验室检验", "offset": "116"}, {"mention": "甲状旁腺激素", "label": "实验室检验", "offset": "125"}, {"mention": "内生肌酐清除率", "label": "实验室检验", "offset": "142"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "162"}, {"mention": "两肾", "label": "解剖部位", "offset": "167"}, {"mention": "腹腔", "label": "解剖部位", "offset": "182"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "189"}, {"mention": "右室肥厚", "label": "症状", "offset": "194"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "201"}, {"mention": "胸部ct", "label": "影像检查", "offset": "206"}, {"mention": "右肺上叶炎症", "label": "疾病和诊断", "offset": "213"}, {"mention": "心脏增大", "label": "症状", "offset": "220"}, {"mention": "两侧胸腔积液", "label": "疾病和诊断", "offset": "225"}, {"mention": "心悸", "label": "症状", "offset": "275"}, {"mention": "胸闷", "label": "症状", "offset": "278"}, {"mention": "腹痛", "label": "症状", "offset": "296"}, {"mention": "腹胀", "label": "症状", "offset": "299"}, {"mention": "头昏", "label": "症状", "offset": "309"}, {"mention": "头痛", "label": "症状", "offset": "312"}, {"mention": "牙龈出血", "label": "症状", "offset": "321"}, {"mention": "胰岛素", "label": "药物", "offset": "367"}, {"mention": "西地兰", "label": "药物", "offset": "407"}, {"mention": "呋塞米", "label": "药物", "offset": "413"}, {"mention": "心悸", "label": "症状", "offset": "457"}, {"mention": "尿毒症", "label": "疾病和诊断", "offset": "489"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "493"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "497"}, {"mention": "手足麻木", "label": "症状", "offset": "557"}, {"mention": "血糖升高", "label": "疾病和诊断", "offset": "567"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "579"}, {"mention": "格列齐特", "label": "药物", "offset": "589"}, {"mention": "消渴丸", "label": "药物", "offset": "594"}, {"mention": "血糖", "label": "实验室检验", "offset": "602"}, {"mention": "二甲两胍", "label": "药物", "offset": "617"}, {"mention": "两上肢", "label": "解剖部位", "offset": "641"}, {"mention": "优思林", "label": "药物", "offset": "654"}, {"mention": "诺和锐30", "label": "药物", "offset": "671"}]}
{"text": "入院前14年患者检查发现血糖升高,血糖具体值不详,有口干、多饮、多尿等症状,伴四肢麻木,并有感觉异常,自觉肢体冰凉,伴视物模糊,于外院诊断为“2型糖尿病叒糖尿病周围神经病变叒糖尿病眼病”,后长期服用“格列美脲、伏格列波糖、罗格列酮”等降血糖,半年前于我科住院,出院后使用“来得时+阿卡波糖”降糖,但院外患者自行加用“格列美脲”降糖,偶有心慌冒汗症状。1+年前患者因活动后心累心悸,偶有干咳,感肢体麻木冰凉较明显,伴有腰部及上肢疼痛,自觉健忘症状加重,于我院内一科住院,查肾功:尿素叒16.00叒mmol/l、肌酐叒141.7叒μmol/l,诊断为“糖尿病肾病、原发性高血压3级极高危叒高血压性心脏病”,治疗后好转出院;半年前因腹泻于我科住院,检查肾功:尿素叒19.79叒mmol/l、肌酐叒225.2叒μmol/l及其他检查,诊断“1.2型糖尿病叒糖尿病周围神经病变叒糖尿病眼病叒糖尿病肾病叒糖尿病植物神经病变叒2.原发性高血压3级叒很高危叒高血压性心脏病叒3.重度骨质疏松叒4、甲状腺功能减退叒5、冠状动脉粥样硬化心脏病”,治疗后好转出院,出院后未定期随访复查,并自行停用相关药物。3+月前患者感活动及爬坡后心累、气促明显,稍休息后能好转,并出现头昏痛,无视物旋转,无耳鸣,无发热,无呕吐,无黑便等,在院外自行服药(具体药名不详),效果欠佳,今为求治疗,来我科要求住院治疗。以“2型糖尿病、糖尿病肾病”收入院。患者此次发病以来精神食欲一般,长期睡眠差,经常服用“安眠药”,大便正常,诉长期解小便色偏黄,尿量不详,体重无明显上降。", "mention_data": [{"mention": "血糖升高", "label": "疾病和诊断", "offset": "12"}, {"mention": "四肢麻木", "label": "症状", "offset": "39"}, {"mention": "肢体", "label": "解剖部位", "offset": "53"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "71"}, {"mention": "糖尿病周围神经病变", "label": "疾病和诊断", "offset": "77"}, {"mention": "糖尿病眼病", "label": "疾病和诊断", "offset": "87"}, {"mention": "格列美脲", "label": "药物", "offset": "100"}, {"mention": "伏格列波糖", "label": "药物", "offset": "105"}, {"mention": "罗格列酮", "label": "药物", "offset": "111"}, {"mention": "来得时", "label": "药物", "offset": "136"}, {"mention": "阿卡波糖", "label": "药物", "offset": "140"}, {"mention": "格列美脲", "label": "药物", "offset": "158"}, {"mention": "心慌", "label": "症状", "offset": "168"}, {"mention": "心", "label": "解剖部位", "offset": "185"}, {"mention": "心悸", "label": "症状", "offset": "187"}, {"mention": "肢体", "label": "解剖部位", "offset": "196"}, {"mention": "腰部", "label": "解剖部位", "offset": "208"}, {"mention": "上肢", "label": "解剖部位", "offset": "211"}, {"mention": "尿素", "label": "实验室检验", "offset": "238"}, {"mention": "肌酐", "label": "实验室检验", "offset": "254"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "274"}, {"mention": "原发性高血压3级极高危", "label": "疾病和诊断", "offset": "280"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "292"}, {"mention": "腹泻", "label": "疾病和诊断", "offset": "313"}, {"mention": "尿素", "label": "实验室检验", "offset": "326"}, {"mention": "肌酐", "label": "实验室检验", "offset": "342"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "368"}, {"mention": "糖尿病周围神经病变", "label": "疾病和诊断", "offset": "374"}, {"mention": "糖尿病眼病", "label": "疾病和诊断", "offset": "384"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "390"}, {"mention": "糖尿病植物神经病变", "label": "疾病和诊断", "offset": "396"}, {"mention": "原发性高血压3级叒很高危", "label": "疾病和诊断", "offset": "408"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "421"}, {"mention": "重度骨质疏松", "label": "疾病和诊断", "offset": "431"}, {"mention": "甲状腺功能减退", "label": "疾病和诊断", "offset": "440"}, {"mention": "冠状动脉粥样硬化心脏病", "label": "疾病和诊断", "offset": "450"}, {"mention": "心", "label": "解剖部位", "offset": "505"}, {"mention": "头昏", "label": "症状", "offset": "524"}, {"mention": "耳鸣", "label": "症状", "offset": "535"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "590"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "596"}]}
{"text": "入院前16年患者因“肝昏迷”(具体不详)在“**********医院”就诊,诊断为“乙肝后肝硬化”,给予血浆置换等对症处理后好转出院。院外未再发作下述疾病,无腹胀、消化道出血等。院外未再口服药物治疗。入院前半年无明显诱因出现肝区持续性隐痛不适,无阵发性加重,无肩背部放射痛,与进食及体位无关,无明显缓解方式。无恶心、呕吐、黑便、反酸、烧心、嗳气、纳差、黄疸、畏寒、发热。在“**********医院”就诊,完善相关检查后诊断“肝癌”,无手术指征,给予“介入术”治疗后腹痛稍缓解,院外口服“抗病毒、保肝、抗肿瘤”药物治疗。病程中出现黄疸、纳差,查肝功异常,总共给予2次介入术,1次海扶刀治疗。入院前10天患者再次出现纳差,饮食较前减少,食欲减退,伴剑突上阵发性隐痛,无肩背部放射痛,与进食无关。伴全身乏力、心悸,皮肤逐渐出现黄染,无恶心、呕吐、黑便。未予诊治。家属发现患者精神变差,乏力明显,遂送来我院就诊,查“血常规:白细胞数叒2.9*10^9/l叒↓、红细胞数叒3.49叒*10^12/l叒↓、血红蛋白浓度叒109叒g/l叒↓、血小板数叒97叒*10^9/l叒↓、中性粒细胞百分比叒87.01叒%叒↑,肝功1:白球比叒1.2叒↓、谷草转氨酶叒334.0叒u/l叒↑、谷氨酰转肽酶叒538.2叒u/l叒↑、总胆红素叒67.6叒μmol/l叒↑、直接胆红素叒48.8叒μmol/l叒↑、间接胆红素叒18.80叒μmol/l叒↑。电解质正常。”,门诊以“肝癌”收入我科。病程中精神、饮食稍差,大便基本正常,小便色黄,体重较前稍减轻。", "mention_data": [{"mention": "肝昏迷", "label": "疾病和诊断", "offset": "10"}, {"mention": "乙肝后肝硬化", "label": "疾病和诊断", "offset": "42"}, {"mention": "腹胀", "label": "症状", "offset": "79"}, {"mention": "肝区", "label": "解剖部位", "offset": "112"}, {"mention": "肩背部", "label": "解剖部位", "offset": "130"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "213"}, {"mention": "介入术", "label": "手术", "offset": "226"}, {"mention": "腹痛", "label": "症状", "offset": "233"}, {"mention": "介入术", "label": "手术", "offset": "283"}, {"mention": "海扶刀", "label": "手术", "offset": "289"}, {"mention": "剑突", "label": "解剖部位", "offset": "323"}, {"mention": "肩背部", "label": "解剖部位", "offset": "333"}, {"mention": "心悸", "label": "症状", "offset": "352"}, {"mention": "白细胞", "label": "实验室检验", "offset": "409"}, {"mention": "红细胞", "label": "实验室检验", "offset": "427"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "448"}, {"mention": "血小板", "label": "实验室检验", "offset": "465"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "483"}, {"mention": "白球比", "label": "实验室检验", "offset": "506"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "516"}, {"mention": "谷氨酰转肽酶", "label": "实验室检验", "offset": "534"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "553"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "572"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "592"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "625"}]}
{"text": "患者于入院前40+年,常于受凉后出现咳嗽、咳痰,痰呈白色泡沫痰,下述症状反复发作,多在冬春季节反复发作,常予以抗炎止咳等药物治疗后可缓解。病程中患者逐渐出现喘累气促,活动耐力上降,曾在我院行胸部ct提示肺气肿、肺大泡形成。心脏彩超提示射血分数上降,考虑“慢性阻塞性肺疾病、肺源性心脏病”。院外未使用平喘药物及吸氧。入院前4+月患者因咳嗽、咳痰、喘累复发在我院心内科住院治疗,给予“头孢呋辛抗感染、痰热清及溴己新祛痰、多索茶碱平喘、甲泼尼龙平喘”等对症处理后好转,因心率快未行冠脉cta检查,给予出院。院外长期口服“阿司匹林肠溶片(100mg/片)每天1次叒每次1片、富马酸比索洛尔片(5mg/片)每天1次叒每次半片、辛伐他汀叒每晚1次叒每次1片、螺内酯(20mg/片)叒每日1次叒每次1片、呋塞米(20mg/片)叒每日1次叒每次1片”治疗。入院前10+天患者无明显诱因出现中下腹阵发性隐痛,以上午饥饿后明显,无肩背部放射痛,进食后腹痛可稍缓解。伴偶有嗳气、反酸,伴大便改变,每日3次,起始2次解成形黄色大便,后解黄色糊状大便。无粘液脓血便,无黑便、里急后重、腹胀。在外未予处理。入院前5天患者受凉后出现明显喘累、气促,伴咳嗽,咳白色粘液痰,无胸痛咯血,无心慌胸闷,无恶心呕吐,无呼吸困难。在家口服下述药物后无缓解。今日来院就诊,为进一步治疗门诊以“慢性阻塞性肺疾病、腹痛待查”收入我科。患者自发病以来精神稍差,食欲尚可,睡眠一般,大便3次/日,时干时稀,无粘液脓血便,小便正常。近期体力上降,体重无明显减轻。", "mention_data": [{"mention": "胸部ct", "label": "影像检查", "offset": "95"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "101"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "111"}, {"mention": "射血分数", "label": "实验室检验", "offset": "117"}, {"mention": "慢性阻塞性肺疾病", "label": "疾病和诊断", "offset": "127"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "136"}, {"mention": "头孢呋辛", "label": "药物", "offset": "190"}, {"mention": "痰热清", "label": "药物", "offset": "198"}, {"mention": "溴己新", "label": "药物", "offset": "202"}, {"mention": "多索茶碱", "label": "药物", "offset": "208"}, {"mention": "甲泼尼龙", "label": "药物", "offset": "215"}, {"mention": "冠脉cta", "label": "影像检查", "offset": "237"}, {"mention": "阿司匹林肠溶片", "label": "药物", "offset": "257"}, {"mention": "富马酸比索洛尔片", "label": "药物", "offset": "283"}, {"mention": "辛伐他汀", "label": "药物", "offset": "308"}, {"mention": "螺内酯", "label": "药物", "offset": "323"}, {"mention": "呋塞米", "label": "药物", "offset": "345"}, {"mention": "下腹", "label": "解剖部位", "offset": "387"}, {"mention": "肩背部", "label": "解剖部位", "offset": "405"}, {"mention": "腹痛", "label": "症状", "offset": "415"}, {"mention": "胸痛", "label": "症状", "offset": "521"}, {"mention": "心慌", "label": "症状", "offset": "527"}, {"mention": "胸闷", "label": "症状", "offset": "529"}, {"mention": "慢性阻塞性肺疾病", "label": "疾病和诊断", "offset": "574"}, {"mention": "腹痛待查", "label": "疾病和诊断", "offset": "583"}]}
{"text": "入院前14年患者检查发现血糖升高,血糖具体值不详,有口干、多饮、多尿等症状,伴四肢麻木,并有感觉异常,自觉肢体冰凉,伴视物模糊,于外院诊断为“2型糖尿病叒糖尿病周围神经病变叒糖尿病眼病”,后长期服用“格列美脲、伏格列波糖、罗格列酮”等降血糖,半年前于我科住院,出院后使用“来得时+阿卡波糖”降糖,但院外患者自行加用“格列美脲”降糖,偶有心慌冒汗症状。1+年前患者因活动后心累心悸,偶有干咳,感肢体麻木冰凉较明显,伴有腰部及上肢疼痛,自觉健忘症状加重,于我院内一科住院,查肾功:尿素叒16.00叒mmol/l、肌酐叒141.7叒μmol/l,诊断为“糖尿病肾病、原发性高血压3级极高危叒高血压性心脏病”,治疗后好转出院;半年前因腹泻于我科住院,检查肾功:尿素叒19.79叒mmol/l、肌酐叒225.2叒μmol/l及其他检查,诊断“1.2型糖尿病叒糖尿病周围神经病变叒糖尿病眼病叒糖尿病肾病叒糖尿病植物神经病变叒2.原发性高血压3级叒很高危叒高血压性心脏病叒3.重度骨质疏松叒4、甲状腺功能减退叒5、冠状动脉粥样硬化心脏病”,治疗后好转出院,出院后未定期随访复查,并自行停用相关药物。半月前患者无明显诱因开始出现咳嗽,几乎无痰,伴有咽痒,咳嗽时有溢尿,无畏寒发热,无胸闷胸痛,无腹胀腹痛,无腹泻黑便,无上肢水肿,于我院就诊,遂门诊以\\\"糖尿病,咳嗽待查\\\"收入我科住院治疗。患者此次发病以来精神食欲可,长期睡眠差,经常服用“安眠药”,大便正常,诉长期解小便色偏黄,伴有尿灼热尿痛,体重无明显上降", "mention_data": [{"mention": "血糖升高", "label": "疾病和诊断", "offset": "12"}, {"mention": "四肢麻木", "label": "症状", "offset": "39"}, {"mention": "肢体", "label": "解剖部位", "offset": "53"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "71"}, {"mention": "糖尿病周围神经病变", "label": "疾病和诊断", "offset": "77"}, {"mention": "糖尿病眼病", "label": "疾病和诊断", "offset": "87"}, {"mention": "格列美脲", "label": "药物", "offset": "100"}, {"mention": "伏格列波糖", "label": "药物", "offset": "105"}, {"mention": "罗格列酮", "label": "药物", "offset": "111"}, {"mention": "来得时", "label": "药物", "offset": "136"}, {"mention": "阿卡波糖", "label": "药物", "offset": "140"}, {"mention": "格列美脲", "label": "药物", "offset": "158"}, {"mention": "心慌", "label": "症状", "offset": "168"}, {"mention": "心", "label": "解剖部位", "offset": "185"}, {"mention": "心悸", "label": "症状", "offset": "187"}, {"mention": "肢体", "label": "解剖部位", "offset": "196"}, {"mention": "腰部", "label": "解剖部位", "offset": "208"}, {"mention": "上肢", "label": "解剖部位", "offset": "211"}, {"mention": "尿素", "label": "实验室检验", "offset": "238"}, {"mention": "肌酐", "label": "实验室检验", "offset": "254"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "274"}, {"mention": "原发性高血压3级极高危", "label": "疾病和诊断", "offset": "280"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "292"}, {"mention": "腹泻", "label": "症状", "offset": "313"}, {"mention": "尿素", "label": "实验室检验", "offset": "326"}, {"mention": "肌酐", "label": "实验室检验", "offset": "342"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "368"}, {"mention": "糖尿病周围神经病变", "label": "疾病和诊断", "offset": "374"}, {"mention": "糖尿病眼病", "label": "疾病和诊断", "offset": "384"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "390"}, {"mention": "糖尿病植物神经病变", "label": "疾病和诊断", "offset": "396"}, {"mention": "原发性高血压3级叒很高危", "label": "疾病和诊断", "offset": "408"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "421"}, {"mention": "重度骨质疏松", "label": "疾病和诊断", "offset": "431"}, {"mention": "甲状腺功能减退", "label": "疾病和诊断", "offset": "440"}, {"mention": "冠状动脉粥样硬化心脏病", "label": "疾病和诊断", "offset": "450"}, {"mention": "咽", "label": "解剖部位", "offset": "516"}, {"mention": "胸闷", "label": "症状", "offset": "533"}, {"mention": "胸痛", "label": "症状", "offset": "535"}, {"mention": "腹胀", "label": "症状", "offset": "539"}, {"mention": "腹痛", "label": "症状", "offset": "541"}, {"mention": "腹泻", "label": "症状", "offset": "545"}, {"mention": "上肢水肿", "label": "症状", "offset": "551"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "568"}, {"mention": "咳嗽待查", "label": "疾病和诊断", "offset": "572"}]}
{"text": "入院前4年患者院外测血压高,最高达230/?mmhg,院外服用坎地沙坦、氨氯地平、卡维地洛药物控制血压(具体剂量不详),院外自测血压约150-160mmhg,平素未感视物模糊,未感头昏。2天前患者骑车时不慎跌倒,至两膝、两手掌、上巴处擦伤,感头昏痛,遂于我院门诊就诊,查血压170/100mmhg,血脂:甘油三酯叒3.72叒mmol/l叒↑、总胆固醇叒6.26叒mmol/l叒↑、载脂蛋白b叒1.48叒g/l叒↑,血糖(静脉血):葡萄糖叒9.27叒mmol/l叒↑,肝功1:谷丙转氨酶叒34.3叒u/l、谷草转氨酶叒20.9叒u/l、谷氨酰转肽酶叒112.6叒u/l叒↑,血常规:白细胞数叒4.6×10^9/l、红细胞数叒5.24×10^12/l、血红蛋白浓度叒160叒g/l、血小板数叒256×10^9/l、中性粒细胞百分比叒57.80叒%、淋巴细胞百分比叒35.90叒%,肾功能未见异常,予以硝苯地平缓释片降压处理后好转。1天前患者感头昏减轻,再次于我院就诊,查糖化血红蛋白:糖化血红蛋白叒8.7叒%,血糖(静脉血):葡萄糖叒13.90叒mmol/l,尿微量白蛋白定量:尿微量白蛋白叒451叒mg/l,尿常规:酮体叒-、尿胆原叒+、蛋白叒+、葡萄糖叒+++。无意识障碍大小便失禁,无肢体活动受限,否认多饮多食,否认多尿消瘦,无胸闷胸痛,无腹胀腹痛,无上肢水肿,为进一步治疗,门诊以“高血压、糖尿病”收入我科住院治疗。病程中患者精神、饮食一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "坎地沙坦", "label": "药物", "offset": "31"}, {"mention": "氨氯地平", "label": "药物", "offset": "36"}, {"mention": "卡维地洛", "label": "药物", "offset": "41"}, {"mention": "头昏", "label": "症状", "offset": "90"}, {"mention": "两膝", "label": "解剖部位", "offset": "107"}, {"mention": "两手掌", "label": "解剖部位", "offset": "110"}, {"mention": "上巴", "label": "解剖部位", "offset": "114"}, {"mention": "头昏", "label": "症状", "offset": "121"}, {"mention": "甘油三酯", "label": "实验室检验", "offset": "152"}, {"mention": "总胆固醇", "label": "实验室检验", "offset": "171"}, {"mention": "载脂蛋白b", "label": "实验室检验", "offset": "190"}, {"mention": "葡萄糖", "label": "实验室检验", "offset": "215"}, {"mention": "谷丙转氨酶", "label": "实验室检验", "offset": "237"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "252"}, {"mention": "谷氨酰转肽酶", "label": "实验室检验", "offset": "267"}, {"mention": "白细胞", "label": "实验室检验", "offset": "290"}, {"mention": "红细胞", "label": "实验室检验", "offset": "306"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "324"}, {"mention": "血小板", "label": "实验室检验", "offset": "339"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "355"}, {"mention": "淋巴细胞百分比", "label": "实验室检验", "offset": "372"}, {"mention": "硝苯地平缓释片", "label": "药物", "offset": "398"}, {"mention": "头昏", "label": "症状", "offset": "419"}, {"mention": "糖化血红蛋白", "label": "实验室检验", "offset": "440"}, {"mention": "葡萄糖", "label": "实验室检验", "offset": "461"}, {"mention": "尿微量白蛋白", "label": "实验室检验", "offset": "487"}, {"mention": "酮体", "label": "实验室检验", "offset": "507"}, {"mention": "尿胆原", "label": "实验室检验", "offset": "512"}, {"mention": "蛋白", "label": "实验室检验", "offset": "518"}, {"mention": "葡萄糖", "label": "实验室检验", "offset": "523"}, {"mention": "肢体", "label": "解剖部位", "offset": "543"}, {"mention": "胸闷", "label": "症状", "offset": "565"}, {"mention": "胸痛", "label": "症状", "offset": "567"}, {"mention": "腹胀", "label": "症状", "offset": "571"}, {"mention": "腹痛", "label": "症状", "offset": "573"}, {"mention": "上肢水肿", "label": "症状", "offset": "577"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "593"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "597"}]}
{"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。半年多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。近半年多来,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3月患者感颜面部浮肿,程度不重,于我科治疗,考虑为下腔静脉栓塞。给予治疗后可消退,但反复出现。入院前1+月,患者再次感颜面部浮肿及咳嗽、咳痰、气促、纳差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。出院后仍感纳差、活动后气促,可耐受10余米距离行走。入院前12天,患者促、水肿症状加重,就诊我科,诊断“1、左肺周围型肺癌叒2、转移性淋巴癌叒3、慢性阻塞性肺疾病急性加重叒4、矽肺叒5、陈旧性肺结核叒6、压疮”,给予抗感染、止咳祛痰、止痛治疗后好转出院。入院前2天,患者再次出现喘累、气促加重,伴有两下肢及左上肢明显水肿,腹胀,腹泻,稀水样大便。无明显咳嗽咳痰,今为求诊治,就诊我院我科。本次发病以来患者精神食欲睡眠差,小便量少色黄,腹泻,稀水样大便,约5-6次/天。体重变化不明显。", "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": "182"}, {"mention": "左侧颈部", "label": "解剖部位", "offset": "207"}, {"mention": "颜面部", "label": "解剖部位", "offset": "287"}, {"mention": "下腔静脉栓塞", "label": "疾病和诊断", "offset": "307"}, {"mention": "颜面部", "label": "解剖部位", "offset": "341"}, {"mention": "左肺周围型肺癌", "label": "疾病和诊断", "offset": "444"}, {"mention": "转移性淋巴癌", "label": "疾病和诊断", "offset": "454"}, {"mention": "慢性阻塞性肺疾病急性加重", "label": "疾病和诊断", "offset": "463"}, {"mention": "矽肺", "label": "疾病和诊断", "offset": "478"}, {"mention": "陈旧性肺结核", "label": "疾病和诊断", "offset": "483"}, {"mention": "压疮", "label": "疾病和诊断", "offset": "492"}, {"mention": "两下肢", "label": "解剖部位", "offset": "539"}, {"mention": "左上肢", "label": "解剖部位", "offset": "543"}, {"mention": "腹胀", "label": "症状", "offset": "551"}, {"mention": "腹泻", "label": "症状", "offset": "554"}, {"mention": "腹泻", "label": "症状", "offset": "607"}]}
{"text": "患者入院前3+天患者受凉后感咽痛,并咳嗽,痰液较少,偶咳出少许白色粘痰,无痰中带血,并畏寒发热,体温未测,无胸痛,无胸骨后压榨感,无明显心累,无上肢浮肿,入院前1天患者在乘坐公交车时,突发晕倒一次,起病前感头晕,无黑朦,症状持续1分钟右左,无大小便失禁,无抽搐,醒后无遗留言语、肢体功能障碍,今日为求进一步治疗收入我科住院。入院前3+年,患者无明确诱因反复出现胸闷、心累,活动后加重,发作时伴头晕、肢体麻木、视物模糊,2014年4月在我院查心电图提示“心房纤颤”,住院治疗症状好转。后就诊于“**医院”,冠脉造影检查提示“四支血管病变”,最严重者狭窄85%(具体不详),于**医院行“冠脉搭桥手术及射频消融术”,术后常感伤口疼痛,胸闷、心累好转。院外长期遵瞩服用“阿司匹林肠溶片、氯吡格雷、瑞舒伐他汀、美托洛尔缓释片”,日常平地活动耐受较好,爬楼约4层感胸闷、气短明显,需休息缓解,否认肢体水肿、黑朦、晕厥史。近1月来患者无明显诱因活动后心累气促较前加重,在我院就诊,动态心电图示:偶发房性早搏,室性早搏(两源),加速的室性逸搏,st-t未见明显改变。胸片:1.两上肺纹理增多,建议结合临床。2.右侧胸膜增厚或右侧胸腔少量积液。3.胸骨区域多个环状金属密度影,考虑术后改变。心脏彩超:右房增大;主动脉窦部增宽;室间隔动度降低;二尖瓣、三尖瓣轻度反流;肺动脉瓣局限性反流;提示右室舒张功能减退。本次发病以来患者精神食欲尚可,大小便如常,睡眠较差,体重无明显上降。", "mention_data": [{"mention": "咽痛", "label": "症状", "offset": "14"}, {"mention": "胸痛", "label": "症状", "offset": "54"}, {"mention": "胸骨", "label": "解剖部位", "offset": "58"}, {"mention": "心", "label": "解剖部位", "offset": "68"}, {"mention": "上肢", "label": "解剖部位", "offset": "72"}, {"mention": "头晕", "label": "症状", "offset": "103"}, {"mention": "胸闷", "label": "症状", "offset": "180"}, {"mention": "心", "label": "解剖部位", "offset": "183"}, {"mention": "头晕", "label": "症状", "offset": "196"}, {"mention": "心电图", "label": "影像检查", "offset": "220"}, {"mention": "心房纤颤", "label": "疾病和诊断", "offset": "226"}, {"mention": "冠脉造影", "label": "影像检查", "offset": "252"}, {"mention": "四支血管病变", "label": "疾病和诊断", "offset": "261"}, {"mention": "冠脉搭桥手术及射频消融术", "label": "手术", "offset": "292"}, {"mention": "胸闷", "label": "症状", "offset": "315"}, {"mention": "心", "label": "解剖部位", "offset": "318"}, {"mention": "阿司匹林肠溶片", "label": "药物", "offset": "332"}, {"mention": "氯吡格雷", "label": "药物", "offset": "340"}, {"mention": "瑞舒伐他汀", "label": "药物", "offset": "345"}, {"mention": "美托洛尔缓释片", "label": "药物", "offset": "351"}, {"mention": "胸闷", "label": "症状", "offset": "377"}, {"mention": "心", "label": "解剖部位", "offset": "419"}, {"mention": "动态心电图", "label": "影像检查", "offset": "434"}, {"mention": "偶发房性早搏", "label": "疾病和诊断", "offset": "441"}, {"mention": "室性早搏(两源)", "label": "疾病和诊断", "offset": "448"}, {"mention": "加速的室性逸搏", "label": "疾病和诊断", "offset": "457"}, {"mention": "胸片", "label": "影像检查", "offset": "476"}, {"mention": "两上肺", "label": "解剖部位", "offset": "481"}, {"mention": "右侧胸膜", "label": "解剖部位", "offset": "498"}, {"mention": "右侧胸腔", "label": "解剖部位", "offset": "505"}, {"mention": "胸骨", "label": "解剖部位", "offset": "516"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "537"}, {"mention": "右房", "label": "解剖部位", "offset": "542"}, {"mention": "主动脉窦部", "label": "解剖部位", "offset": "547"}, {"mention": "室间隔", "label": "解剖部位", "offset": "555"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "563"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "567"}, {"mention": "肺动脉瓣", "label": "解剖部位", "offset": "575"}, {"mention": "右室舒张功能减退", "label": "疾病和诊断", "offset": "587"}]}
{"text": "1年前,患者不明原因出现记忆力减退,主要表现为近事记忆减退明显,远期记忆正常,当时未引起重视,未予以治疗。并进行性加重,半月前出现性格改变,暴躁、易怒,无幻觉、被害妄想;日常基本生活不能自理,且对自己熟悉的家人不认识,不知道何处下厕所;曾到*********神经内科门诊就诊,行头颅ct检查后诊断“老年痴呆”,具体服药情况不详。在回家服药治疗观察过程中出现2次跌倒,无发作先兆,无明显的头昏、视物旋转、恶心、呕吐,无肢体活动障碍及抽搐,无大小便失禁及意识障碍。家属自觉患者病情重,再次到*********就诊,并住入神经内科,住院过程中出现左侧肢体活动障碍,不能行走,进食出现吞咽困难,饮水呛咳,行头颅ct及mri检查,诊断“急性脑梗死”,予以“阿司匹林”抗血小板聚集、“阿托伐他汀”调脂,“依达拉奉”抗自由基氧化等对症治疗。由于患者不能进食,予以胃管鼻饲,但胃管内抽出暗红色胃液,考虑“消化道出血”,予以“奥美拉唑、凝血酶粉”等对治疗。3天前,患者出现咳嗽、咯痰,咯黄色粘稠痰,且发热,体温38.1℃,并出现意识加深,呼之不应,行血气分析提示呼吸衰竭,转入重症监护室进一步治疗,予以气管插管,呼吸机辅助呼吸,并予以“莫西沙星”抗感染、营养支持治疗。患者病情重,家属要求转入我院进一步治疗,遂由我院120转入,门诊以“急性脑梗死、急性呼吸衰竭、肺部感染、消化道出血”收住我科。患者患病以来,精神差,一直胃管进食流质,小便正常,大便未解。", "mention_data": [{"mention": "头颅ct", "label": "影像检查", "offset": "139"}, {"mention": "老年痴呆", "label": "疾病和诊断", "offset": "149"}, {"mention": "头昏", "label": "症状", "offset": "193"}, {"mention": "头颅ct", "label": "影像检查", "offset": "299"}, {"mention": "mri", "label": "影像检查", "offset": "304"}, {"mention": "急性脑梗死", "label": "疾病和诊断", "offset": "313"}, {"mention": "阿司匹林", "label": "药物", "offset": "323"}, {"mention": "阿托伐他汀", "label": "药物", "offset": "336"}, {"mention": "依达拉奉", "label": "药物", "offset": "346"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "394"}, {"mention": "奥美拉唑", "label": "药物", "offset": "404"}, {"mention": "凝血酶粉", "label": "药物", "offset": "409"}, {"mention": "呼吸衰竭", "label": "疾病和诊断", "offset": "472"}, {"mention": "气管插管", "label": "手术", "offset": "492"}, {"mention": "莫西沙星", "label": "药物", "offset": "509"}, {"mention": "急性脑梗死", "label": "疾病和诊断", "offset": "559"}, {"mention": "急性呼吸衰竭", "label": "疾病和诊断", "offset": "565"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "572"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "577"}]}
{"text": "入院前9月患者无明显诱因出现腹胀,无腹痛、腹泻、黑便,无纳差、厌油,无恶心、呕吐,无反酸、嗳气、烧心。在**医院就诊,完善相关检查后诊断“乙肝后肝硬化失代偿期”,给予“保肝、放腹水、抗病毒”等对症处理后好转。入院前2月因中下腹隐痛及腹胀在我院内四科住院,行“胃镜示:慢性非萎缩性胃炎,轻度食管静脉曲张可能。乙肝三对:乙肝表面抗原定性叒阳性,乙肝核心抗体定性叒阳性。乙肝dna<5e+02,腹部彩超:肝实质回声异常,符合肝硬化超声表现,胆囊壁增厚毛糙,脾大;”,诊断“肝硬化失代偿期”,给予“泮托拉唑抑酸、还原型谷胱甘肽及甘利欣、门冬氨酸鸟氨酸保肝、保护胃黏膜、改善腹胀等对症处理”后好转出院。院外口服“恩替卡韦片”抗病毒治疗。病程中未出现黑便、呕血、黄疸等。于2014-12-02在**医院复诊肝硬化,查“肾功、血脂、电解质、afp无明显异常。血常规:wbc:3.59*10^9/l,hb:138g/l。肝功:alt:44iu/l,ggt:134iu/l。alb:42.9g/l。”。入院前4小时患者劳动时突然出现肝区持续性胀痛,伴阵发性加重,感左侧背部放射痛,无肩膀放射痛,与饮食及体位无关。无畏寒、发热,无嗳气、反酸、烧心,无纳差、乏力。遂来我院就诊,门诊查腹部彩超示“肝硬化,胆囊壁毛糙增厚,脾大,胰腺未见异常。”,为进一步诊治,门诊以“肝硬化失代偿期”收入我科。病程中精神、饮食尚可,大小便正常。体重无明显上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "14"}, {"mention": "腹痛", "label": "症状", "offset": "18"}, {"mention": "腹泻", "label": "症状", "offset": "21"}, {"mention": "乙肝后肝硬化失代偿期", "label": "疾病和诊断", "offset": "69"}, {"mention": "下腹", "label": "解剖部位", "offset": "111"}, {"mention": "腹胀", "label": "症状", "offset": "116"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "133"}, {"mention": "轻度食管静脉曲张", "label": "疾病和诊断", "offset": "142"}, {"mention": "乙肝表面抗原定性", "label": "实验室检验", "offset": "158"}, {"mention": "乙肝核心抗体定性", "label": "实验室检验", "offset": "170"}, {"mention": "乙肝dna", "label": "实验室检验", "offset": "182"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "194"}, {"mention": "肝", "label": "解剖部位", "offset": "199"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "209"}, {"mention": "胆囊壁", "label": "解剖部位", "offset": "217"}, {"mention": "脾大", "label": "症状", "offset": "225"}, {"mention": "肝硬化失代偿期", "label": "疾病和诊断", "offset": "233"}, {"mention": "泮托拉唑", "label": "药物", "offset": "245"}, {"mention": "还原型谷胱甘肽", "label": "药物", "offset": "252"}, {"mention": "甘利欣", "label": "药物", "offset": "260"}, {"mention": "门冬氨酸鸟氨酸", "label": "药物", "offset": "264"}, {"mention": "胃", "label": "解剖部位", "offset": "276"}, {"mention": "腹胀", "label": "症状", "offset": "282"}, {"mention": "恩替卡韦片", "label": "药物", "offset": "301"}, {"mention": "wbc", "label": "实验室检验", "offset": "376"}, {"mention": "hb", "label": "实验室检验", "offset": "392"}, {"mention": "alt", "label": "实验室检验", "offset": "405"}, {"mention": "ggt", "label": "实验室检验", "offset": "416"}, {"mention": "alb", "label": "实验室检验", "offset": "428"}, {"mention": "肝", "label": "解剖部位", "offset": "457"}, {"mention": "左侧背部", "label": "解剖部位", "offset": "473"}, {"mention": "肩膀", "label": "解剖部位", "offset": "482"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "531"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "537"}, {"mention": "胆囊壁毛糙", "label": "症状", "offset": "541"}, {"mention": "脾大", "label": "症状", "offset": "549"}, {"mention": "胰腺", "label": "解剖部位", "offset": "552"}, {"mention": "肝硬化失代偿期", "label": "疾病和诊断", "offset": "572"}]}
{"text": "患者入院前4年活动后感心累、气促,不伴明显胸痛,无胸骨后压榨感,无慢性咳嗽咳痰,经******转诊至*****就诊,具体检查及治疗情况不详,自诉诊断“冠心病、房颤、高血压”,经治疗后症状缓解出院。出院当时服药情况不详,否认服用“华法林”,有服用“阿司匹林肠溶片”病史,近期服用“地高辛、依那普利”,但患者依从性差,常有自行停药情况。入院前4天患者受凉后感心累加重,平路缓步走即感心累,夜间不能平卧,需高枕卧位,并心前区闷胀感,食欲不振,无饥饿感,伴咳嗽,咯白色粘痰,无痰中带血,无畏寒发热,无潮热盗汗,无胸痛,无胸骨后压榨感,无明显上肢浮肿,今日来院就诊,门诊查心电图提示快速型房颤。胸片提示1.两上肺肺纹增多、2.主动脉硬化,心脏重度增大,结合临床、3.两侧肋膈角欠锐利。血常规:白细胞数叒6.8叒10^9/l、中性粒细胞百分比叒78.34叒%,心肌酶谱:谷草转氨酶叒44.8叒u/l、肌酸激酶叒198.7叒u/l、肌酸激酶同工酶叒14叒u/l、乳酸脱氢酶叒241.6叒u/l,肾功:尿素叒4.48叒mmol/l、肌酐叒43.0叒μmol/l,高敏肌钙蛋白t叒11.93叒pg/ml,电解质1:钾叒3.77叒mmol/l,d_2聚体叒0.54叒μg/ml。门诊予以静推“胺碘酮叒150mg”,静滴“丹参川芎嗪5ml”,为进一步治疗收入我科住院。病程中患者精神、饮食一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "11"}, {"mention": "胸痛", "label": "症状", "offset": "21"}, {"mention": "胸骨", "label": "解剖部位", "offset": "25"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "75"}, {"mention": "房颤", "label": "疾病和诊断", "offset": "79"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "82"}, {"mention": "华法林", "label": "药物", "offset": "114"}, {"mention": "阿司匹林肠溶片", "label": "药物", "offset": "123"}, {"mention": "地高辛", "label": "药物", "offset": "139"}, {"mention": "依那普利", "label": "药物", "offset": "143"}, {"mention": "心", "label": "解剖部位", "offset": "177"}, {"mention": "心", "label": "解剖部位", "offset": "189"}, {"mention": "心前区", "label": "解剖部位", "offset": "206"}, {"mention": "胸痛", "label": "症状", "offset": "252"}, {"mention": "胸骨", "label": "解剖部位", "offset": "256"}, {"mention": "上肢", "label": "解剖部位", "offset": "266"}, {"mention": "心电图", "label": "影像检查", "offset": "281"}, {"mention": "快速型房颤", "label": "疾病和诊断", "offset": "286"}, {"mention": "胸片", "label": "影像检查", "offset": "292"}, {"mention": "两上肺", "label": "解剖部位", "offset": "298"}, {"mention": "主动脉硬化", "label": "疾病和诊断", "offset": "308"}, {"mention": "心脏", "label": "解剖部位", "offset": "314"}, {"mention": "两侧肋膈角", "label": "解剖部位", "offset": "328"}, {"mention": "白细胞", "label": "实验室检验", "offset": "341"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "357"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "379"}, {"mention": "肌酸激酶", "label": "实验室检验", "offset": "394"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "409"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "424"}, {"mention": "尿素", "label": "实验室检验", "offset": "443"}, {"mention": "肌酐", "label": "实验室检验", "offset": "458"}, {"mention": "高敏肌钙蛋白t", "label": "实验室检验", "offset": "473"}, {"mention": "钾", "label": "实验室检验", "offset": "498"}, {"mention": "d_2聚体", "label": "实验室检验", "offset": "512"}, {"mention": "胺碘酮", "label": "药物", "offset": "536"}, {"mention": "丹参川芎嗪", "label": "药物", "offset": "550"}]}
{"text": "入院前1+月,患者无明显诱因出现吞咽梗阻,进食固体食物时明显,偶有恶心,呕吐少许白色粘液,不呈喷射状,不含隔夜宿食,无咖啡色物质及血凝块,偶有下腹部隐痛,伴腹胀,伴反酸,伴纳差,饮食较前减少1/2,以流质为主,无烧心、嗳气,无呕血、黑便,无黄疸,无腹泻,无乏力、心悸、头晕、头痛,无胸闷、胸痛、呼吸困难,无畏寒、发热等不适,于1月前就诊于我院,完善腹部彩超提示“两肾结石”,予以口服ppt及曲美布汀治疗,患者症状无明显好转。半月前再次就诊于我院,完善碳14呼气试验阳性,予以“维三联+ppi”抗hp治疗2周,今日于我院完善胃镜检查提示“胃底、胃体巨大溃疡伴出血可能,考虑胃癌可能”(未见报告),为求进一步诊治,遂以“吞咽哽噎原因待查”收入住院。患者此次患病以来精神食欲差,大小便正常,睡眠尚可,体力明显上降,体重无明显改变。入院前10年,患者常在受凉后出现咳嗽、咳痰,并逐渐出现喘累气促,好发于冬春季节,每年累计发病时间超过3月,常就诊于******医院及我院,诊断为“慢支炎、支气管哮喘”,予以抗感染、止咳平喘等治疗后可好转。院外长期服用氨茶碱等药物治疗。半月前,患者于我院行肺功能提示“重度混合性通气功能障碍以阻塞为主(fev1/fvc叒38.28%),舒张试验阳性”。近期患者受凉后感活动后喘累、气促较前加重,有咳嗽,咳白色黏痰,痰不易咯出,无畏寒、寒战、发热,无咯血、胸痛、呼吸困难等不适。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "71"}, {"mention": "腹胀", "label": "症状", "offset": "78"}, {"mention": "腹泻", "label": "症状", "offset": "124"}, {"mention": "心悸", "label": "症状", "offset": "131"}, {"mention": "头晕", "label": "症状", "offset": "134"}, {"mention": "头痛", "label": "症状", "offset": "137"}, {"mention": "胸闷", "label": "症状", "offset": "141"}, {"mention": "胸痛", "label": "症状", "offset": "144"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "174"}, {"mention": "两肾结石", "label": "疾病和诊断", "offset": "181"}, {"mention": "曲美布汀", "label": "药物", "offset": "195"}, {"mention": "维三联+ppi", "label": "药物", "offset": "238"}, {"mention": "胃底", "label": "解剖部位", "offset": "268"}, {"mention": "胃体", "label": "解剖部位", "offset": "271"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "285"}, {"mention": "吞咽哽噎原因待查", "label": "疾病和诊断", "offset": "308"}, {"mention": "慢支炎、支气管哮喘", "label": "疾病和诊断", "offset": "435"}, {"mention": "氨茶碱", "label": "药物", "offset": "470"}, {"mention": "重度混合性通气功能障碍以阻塞为主(fev1/fvc叒38.28%)", "label": "疾病和诊断", "offset": "495"}, {"mention": "胸痛", "label": "症状", "offset": "588"}]}
{"text": "患者于入院前1年余即开始反复出现胸痛症状,心前区压榨感,均在活动及进食后出现,不能耐受平地快走,发作后含服“速效救心丸”或休息后可逐渐缓解。病程中曾多次出现突发呼吸困难、大汗、濒死感,在****医院等住院治疗好转。9月前,患者进餐后再次突然出现呼吸困难,全身大汗、胸痛,诊断为心力衰竭,于我科住院,给予扩管、抗血小板、降压、控制心室率治疗后好转出院。入院前1天,患者感气促加重,有夜间阵发性呼吸困难,如厕即可诱发喘累,伴有咳嗽、咳痰、中下腹疼痛。无心前区压榨感,无恶心、呕吐,无发热、畏寒,肛门有排气排便。家属拨打120由*****医院120送入我院急诊科,查血气分析ph7.43,po2叒104mmhg,pco2叒35mmhg。血常规:白细胞数叒6.2×10^9/l、中性粒细胞百分比叒78.51叒%,心肌酶谱:谷草转氨酶叒38.0叒u/l、肌酸激酶同工酶叒10叒u/l、乳酸脱氢酶叒279.5叒u/l,肾功:肌酐叒115.1叒μmol/l,高敏肌钙蛋白:264.30叒pg/ml。电解质、crp无异常。胸片提示两肺中上野感染,以左上肺明显。腹部彩超提示胆总管增宽。给予呋塞米20mg静推利尿、单硝酸异山梨酯25mg静滴后患者症状有所缓解。为进一步治疗收治我科。患者此次患病以来精神食欲睡眠差,大便正常,小便量偏少,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "16"}, {"mention": "心前区", "label": "解剖部位", "offset": "21"}, {"mention": "速效救心丸", "label": "药物", "offset": "54"}, {"mention": "胸痛", "label": "症状", "offset": "132"}, {"mention": "心力衰竭", "label": "疾病和诊断", "offset": "138"}, {"mention": "中下腹", "label": "解剖部位", "offset": "217"}, {"mention": "心前区", "label": "解剖部位", "offset": "224"}, {"mention": "肛门", "label": "解剖部位", "offset": "245"}, {"mention": "ph", "label": "实验室检验", "offset": "284"}, {"mention": "po2", "label": "实验室检验", "offset": "291"}, {"mention": "pco2", "label": "实验室检验", "offset": "303"}, {"mention": "白细胞", "label": "实验室检验", "offset": "319"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "335"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "357"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "372"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "387"}, {"mention": "肌酐", "label": "实验室检验", "offset": "406"}, {"mention": "高敏肌钙蛋白", "label": "实验室检验", "offset": "422"}, {"mention": "胸片", "label": "影像检查", "offset": "453"}, {"mention": "两肺中上野感染", "label": "疾病和诊断", "offset": "457"}, {"mention": "左上肺", "label": "解剖部位", "offset": "466"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "472"}, {"mention": "胆总管", "label": "解剖部位", "offset": "478"}, {"mention": "呋塞米", "label": "药物", "offset": "486"}, {"mention": "单硝酸异山梨酯", "label": "药物", "offset": "498"}]}
{"text": "入院前9月患者无明显诱因出现腹胀,无腹痛、腹泻、黑便,无纳差、厌油,无恶心、呕吐,无反酸、嗳气、烧心。在**医院就诊,完善相关检查后诊断“乙肝后肝硬化失代偿期”,给予“保肝、放腹水、抗病毒”等对症处理后好转。入院前2月因中下腹隐痛及腹胀在我院内四科住院,行胃镜示:慢性非萎缩性胃炎,轻度食管静脉曲张可能。乙肝三对:乙肝表面抗原定性叒阳性,乙肝核心抗体定性叒阳性。乙肝dna<5e+02,腹部彩超:肝实质回声异常,符合肝硬化超声表现,胆囊壁增厚毛糙,脾大。诊断“肝硬化失代偿期”,给予“泮托拉唑抑酸、还原型谷胱甘肽及甘利欣、门冬氨酸鸟氨酸保肝、保护胃黏膜、改善腹胀等对症处理”后好转出院。院外口服“恩替卡韦片”抗病毒治疗。病程中未出现黑便、呕血、黄疸等。于2014-12-02在**医院复诊,查“肾功、血脂、电解质、afp无明显异常。血常规:wbc:3.59*10^9/l,hb:138g/l。肝功:alt:44叒iu/l,ggt:134叒iu/l。alb:42.9g/l。”。2天前劳动时出现肝区持续性胀痛,在我院治疗好转后出院,半天前患者再次出现肝区胀痛,无阵发性加重,无放射痛,与饮食及体位无关。无嗳气、反酸、烧心,无纳差、乏力,无皮肤黄染。为进一步诊治,门诊以“肝硬化失代偿期”收入我科。病程中精神、饮食尚可,大小便正常。体重无明显上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "14"}, {"mention": "腹痛", "label": "症状", "offset": "18"}, {"mention": "腹泻", "label": "症状", "offset": "21"}, {"mention": "乙肝后肝硬化失代偿期", "label": "疾病和诊断", "offset": "69"}, {"mention": "下腹", "label": "解剖部位", "offset": "111"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "132"}, {"mention": "轻度食管静脉曲张可能", "label": "疾病和诊断", "offset": "141"}, {"mention": "乙肝表面抗原定性", "label": "实验室检验", "offset": "157"}, {"mention": "乙肝核心抗体定性", "label": "实验室检验", "offset": "169"}, {"mention": "乙肝dna", "label": "实验室检验", "offset": "181"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "193"}, {"mention": "肝", "label": "解剖部位", "offset": "198"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "208"}, {"mention": "胆囊壁", "label": "解剖部位", "offset": "216"}, {"mention": "脾大", "label": "症状", "offset": "224"}, {"mention": "肝硬化失代偿期", "label": "疾病和诊断", "offset": "230"}, {"mention": "泮托拉唑", "label": "药物", "offset": "242"}, {"mention": "还原型谷胱甘肽", "label": "药物", "offset": "249"}, {"mention": "甘利欣", "label": "药物", "offset": "257"}, {"mention": "门冬氨酸鸟氨酸", "label": "药物", "offset": "261"}, {"mention": "胃", "label": "解剖部位", "offset": "273"}, {"mention": "腹胀", "label": "症状", "offset": "279"}, {"mention": "恩替卡韦片", "label": "药物", "offset": "298"}, {"mention": "wbc", "label": "实验室检验", "offset": "370"}, {"mention": "hb", "label": "实验室检验", "offset": "386"}, {"mention": "alt", "label": "实验室检验", "offset": "399"}, {"mention": "ggt", "label": "实验室检验", "offset": "411"}, {"mention": "alb", "label": "实验室检验", "offset": "424"}, {"mention": "肝区", "label": "解剖部位", "offset": "446"}, {"mention": "肝区", "label": "解剖部位", "offset": "474"}, {"mention": "肝硬化失代偿期", "label": "疾病和诊断", "offset": "534"}]}
{"text": "入院前7年无明显诱因患者感活动后乏力、气促,不伴头昏、头痛、胸闷、心悸、胸痛、晕厥、黑曚、呃逆、反酸、嗳气、烧心、恶心、呕吐、腹痛、腹胀、腹泻、黑便。患者于*****医院诊断“溶血性贫血”,给予输血等处理后病情缓解。病程中如下症状反复发生,多次给予输血治疗后病程好转。2013年4月*****胸片检查:两肺纹理增多,心影轻度增大。心脏彩超:右房、右室稍增大,ef正常。血库: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:总胆红素叒50umol/l,直接胆红素叒10umol/l,alt叒40u/l,ast叒18u/l。诊断“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、气促不适,反复经输注洗涤红细胞后缓解。7天前可疑受凉后出现血尿,患者未予处理。今再次出现四肢乏力,活动后气促伴耳鸣。为求进一步治疗今日入我院门诊,门诊以“g-6-pd酶缺乏症”收入我科。患者此次患病以来,精神状态差,大小便正常,体重无明显减轻。", "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": "33"}, {"mention": "胸痛", "label": "症状", "offset": "36"}, {"mention": "腹痛", "label": "症状", "offset": "63"}, {"mention": "腹胀", "label": "症状", "offset": "66"}, {"mention": "腹泻", "label": "症状", "offset": "69"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "88"}, {"mention": "胸片", "label": "影像检查", "offset": "146"}, {"mention": "两肺", "label": "解剖部位", "offset": "151"}, {"mention": "心", "label": "解剖部位", "offset": "158"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "165"}, {"mention": "右房", "label": "解剖部位", "offset": "170"}, {"mention": "右室", "label": "解剖部位", "offset": "173"}, {"mention": "ef", "label": "实验室检验", "offset": "179"}, {"mention": "间接coomb’s试验", "label": "实验室检验", "offset": "187"}, {"mention": "新生儿g6pd活性试验", "label": "实验室检验", "offset": "321"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "344"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "358"}, {"mention": "alt", "label": "实验室检验", "offset": "373"}, {"mention": "ast", "label": "实验室检验", "offset": "383"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "396"}, {"mention": "贫血性心脏病", "label": "疾病和诊断", "offset": "407"}, {"mention": "肝功能不全", "label": "疾病和诊断", "offset": "414"}, {"mention": "四肢", "label": "解剖部位", "offset": "492"}, {"mention": "耳鸣", "label": "症状", "offset": "503"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "525"}]}
{"text": "患者于入院前40+年,常于受凉后出现咳嗽、咳痰,痰呈白色泡沫痰,下述症状反复发作,多在冬春季节反复发作,常予以抗炎止咳等药物治疗后可缓解。病程中患者逐渐出现喘累气促,活动耐力上降,曾在我院行胸部ct提示肺气肿、肺大泡形成,多次在我院住院治疗,经抗感染等治疗后好转。病程中曾出现上肢浮肿、气促,考虑肺源性心脏病。入院前半年,患者因下诉症状再发于我科住院,行心脏彩超示ef叒25%,室间隔、右室后壁增厚;室间隔、右室后壁动度降低;二尖瓣、三尖瓣中度反流;右室舒张、收缩功能减退。考虑“慢性阻塞性肺疾病、肺源性心脏病、冠心病?”,予以抗感染、祛痰、利尿等治疗后好转,建议患者进一步完善冠脉造影,但患者未遵医嘱。患者曾于2017年5月2日在我院行胸部ct提示:1.两肺上叶感染,治疗后复查。2.慢支炎、肺气肿,肺大泡形成。3.两下肺纤维斑块病灶;左肺下叶及右肺上叶支气管局段性扩张。4.左侧肺门及心后软组织块影,建议患者定期复查,患者此后未再复查。入院前2天患者受凉感冒,自觉咳嗽,咯黄痰,并觉畏寒发热,喘累症状加重,无胸痛咯血,无心慌胸闷,无恶心呕吐,无腹痛纳差,无呼吸困难。今日来院就诊,为进一步治疗今日到我科住院。患者自发病以来精神、食欲可,进食好,睡眠一般,大便4-5次/日,时干时稀,无粘液脓血便,小便正常。近期体力上降,体重无明显减轻。", "mention_data": [{"mention": "胸部ct", "label": "影像检查", "offset": "95"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "101"}, {"mention": "上肢", "label": "解剖部位", "offset": "138"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "148"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "177"}, {"mention": "ef", "label": "实验室检验", "offset": "182"}, {"mention": "室间隔", "label": "解剖部位", "offset": "189"}, {"mention": "右室后壁", "label": "解剖部位", "offset": "193"}, {"mention": "室间隔", "label": "解剖部位", "offset": "200"}, {"mention": "右室后壁", "label": "解剖部位", "offset": "204"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "213"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "217"}, {"mention": "右室舒张、收缩功能减退", "label": "疾病和诊断", "offset": "225"}, {"mention": "慢性阻塞性肺疾病", "label": "疾病和诊断", "offset": "240"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "249"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "256"}, {"mention": "冠脉造影", "label": "影像检查", "offset": "289"}, {"mention": "胸部ct", "label": "影像检查", "offset": "319"}, {"mention": "两肺上叶感染", "label": "疾病和诊断", "offset": "328"}, {"mention": "慢支炎", "label": "疾病和诊断", "offset": "343"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "347"}, {"mention": "两下肺", "label": "解剖部位", "offset": "359"}, {"mention": "左肺下叶", "label": "解剖部位", "offset": "369"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "374"}, {"mention": "支气管", "label": "解剖部位", "offset": "378"}, {"mention": "左侧肺门", "label": "解剖部位", "offset": "389"}, {"mention": "心后软组织", "label": "解剖部位", "offset": "394"}, {"mention": "胸痛", "label": "症状", "offset": "456"}, {"mention": "心慌", "label": "症状", "offset": "462"}, {"mention": "胸闷", "label": "症状", "offset": "464"}, {"mention": "腹痛", "label": "症状", "offset": "474"}]}
{"text": "入院前30+年,患者常在受凉后出现咳嗽、咳痰,多为白色泡沫痰,并逐渐出现喘累、气促,好发于冬春季节,每年累计发病时间超过3月,外院诊断为“慢支炎、肺气肿”,予以抗感染、止咳平喘等治疗后可好转。患者喘累、气促症状逐年加重,并逐渐出现间断两上肢水肿,外院考虑为“肺源性心脏病”,未利尿、长期低流量吸氧及吸入剂治疗。7+年前,患者喘累、呼吸困难明显,于外院诊断为“支气管哮喘”(具体检查报告及诊治经过不详),开始使用沙丁胺醇气雾剂治疗。后患者下述症状反复发作,反复住院治疗,最近一次于2017-10-29于我科住院治疗,给予抗感染、化痰、平喘、改善循环等治疗后好转出院,出院诊断为:1.慢性阻塞性肺疾病急性加重期;2、慢性肺源性心脏病;3、支气管哮喘叒;4、冠心病叒频发多源性房早,频发室早?院外长期平喘化痰对症治疗。入院前2天前,患者受凉后下述症状较前加重,咳嗽、咳黄白色粘痰,喘累明显,不能平卧位休息,夜间阵发性呼吸困难,伴有头昏,偶有头疼,无畏寒、寒战、发热,无咯血,无潮热、盗汗,无恶心、呕吐,无腹胀、腹痛,无胸闷、胸痛,无尿频、尿急、尿痛等不适,自行服用“平喘药”(具体不详),下述症状无明显好转,遂来我院就诊,门诊以“aecopd”收入我科进一步治疗。患者此次患病以来精神、食欲、睡眠差,大小便正常,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "慢支炎", "label": "疾病和诊断", "offset": "69"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "73"}, {"mention": "两上肢", "label": "解剖部位", "offset": "117"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "129"}, {"mention": "支气管哮喘", "label": "疾病和诊断", "offset": "179"}, {"mention": "沙丁胺醇气雾剂", "label": "药物", "offset": "205"}, {"mention": "慢性阻塞性肺疾病急性加重期", "label": "疾病和诊断", "offset": "290"}, {"mention": "慢性肺源性心脏病", "label": "疾病和诊断", "offset": "306"}, {"mention": "支气管哮喘", "label": "疾病和诊断", "offset": "317"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "326"}, {"mention": "频发多源性房早", "label": "疾病和诊断", "offset": "330"}, {"mention": "频发室早", "label": "疾病和诊断", "offset": "338"}, {"mention": "头昏", "label": "症状", "offset": "412"}, {"mention": "头", "label": "解剖部位", "offset": "417"}, {"mention": "腹胀", "label": "症状", "offset": "449"}, {"mention": "腹痛", "label": "症状", "offset": "452"}, {"mention": "胸闷", "label": "症状", "offset": "456"}, {"mention": "胸痛", "label": "症状", "offset": "459"}, {"mention": "aecopd", "label": "疾病和诊断", "offset": "512"}]}
{"text": "入院前10余年,患者无明显诱因出现活动后心累、气促,间断出现两上肢水肿、夜间喜高枕卧位,偶有胸闷,于当地医院就诊,考虑为“冠心病”。5年前因“心累、气促”加重,于“**医院”就诊,查“心率30次/分”右左,给予安置“起搏器”,后喘累症状稍所好转,平素缓慢走平路即感气促,无明显胸闷、胸痛等不适。院外长期口服心脏疾病相关药物(具体不详)治疗。近1年来,患者反复因喘累、气促在我院住院治疗,予以改善循环、利尿、营养心肌等对症治疗后好转出院。入院前10+天,患者受凉后诉心累、气促症状加重,夜间明显,夜间高枕卧位,难以平卧,伴心悸、胸闷,伴中下腹部不适,伴咳嗽、咳痰,咳出白色粘痰,否认胸痛、心前区压榨感,无恶心、呕吐,无咯血、腹泻等,遂就诊于我院急诊科,查血常规:wbc叒3.9×109/l,hgb叒117g/l、n叒66.2%。凝血试验、d2聚体、肾功、电解质、心肌酶谱、肌钙蛋白均未见明显异常。腹部彩超示肝胆胰脾肾未见明显异常。胸片示1.两肺中上野感染,建议治疗后复查。2.心影稍增大,主动脉弓少许钙化;心脏人工起搏器术后改变,结合临床。3.胸椎骨质增生。予以平喘、改善循环后症状稍有改善,为进一步治疗,门诊以“高血压、肺部感染”收入我科住院治疗。患者此次患病以来精神食欲欠佳,大小便未诉异常,睡眠尚可,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "20"}, {"mention": "两上肢", "label": "解剖部位", "offset": "30"}, {"mention": "胸闷", "label": "症状", "offset": "46"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "61"}, {"mention": "心", "label": "解剖部位", "offset": "71"}, {"mention": "胸闷", "label": "症状", "offset": "138"}, {"mention": "胸痛", "label": "症状", "offset": "141"}, {"mention": "心", "label": "解剖部位", "offset": "232"}, {"mention": "心悸", "label": "症状", "offset": "260"}, {"mention": "胸闷", "label": "症状", "offset": "263"}, {"mention": "中下腹部", "label": "解剖部位", "offset": "267"}, {"mention": "胸痛", "label": "症状", "offset": "290"}, {"mention": "心前区", "label": "解剖部位", "offset": "293"}, {"mention": "腹泻", "label": "症状", "offset": "311"}, {"mention": "wbc", "label": "实验室检验", "offset": "330"}, {"mention": "hgb", "label": "实验室检验", "offset": "344"}, {"mention": "n", "label": "实验室检验", "offset": "355"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "397"}, {"mention": "胸片", "label": "影像检查", "offset": "414"}, {"mention": "两肺中上野感染", "label": "疾病和诊断", "offset": "419"}, {"mention": "心", "label": "解剖部位", "offset": "437"}, {"mention": "主动脉弓", "label": "解剖部位", "offset": "443"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "471"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "506"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "510"}]}
{"text": "患者4月前发现皮肤、巩膜黄染,伴食欲上降,晚餐后明显,时有阵发性腹痛、恶心,无腹泻、呕吐,时有胸闷、憋气、头晕,无头痛,无视物旋转,无发热、咳嗽,无胸痛、喘憋,大便颜色较前变浅。于我科住院,行腹部增强mri+mrcp:胆总管末端占位,胆管癌可能性大,右肾下腺结节,考虑腺瘤,右肾囊肿,两侧胸腔积液。请肝胆外科会诊,认为患者无手术指征,于2017-4-24全麻上行ercp+胆总管金属支架植入,术后患者恢复良好。并给以抗感染、抗肿瘤、免疫调节、平稳降糖、降压等对症治疗,全身及巩膜黄染逐渐减轻,化验指标逐渐改善,办理周转后继续于我科巩固治疗,黄疸逐渐消失,症状改善,请肿瘤科会诊,认为胆总管癌并两肺转移,患者高龄,多种慢性疾病,不宜放化疗,对症支持治疗为主,向患者家属详细说明病情,家属亦不同意放化疗。因患者住院时间较长再次办理**,继续于我科住院巩固治疗。门诊以“胆管癌”收入我科。叒叒叒患者自发病以来,饮食差,睡眠可,小便正常,大便便秘,口服杜密克及外用开塞露治疗,平均每3天大便一次,大便干结,体重无明显变化。", "mention_data": [{"mention": "巩膜", "label": "解剖部位", "offset": "10"}, {"mention": "阵发性腹痛", "label": "症状", "offset": "29"}, {"mention": "腹泻", "label": "症状", "offset": "39"}, {"mention": "胸闷", "label": "症状", "offset": "47"}, {"mention": "头晕", "label": "症状", "offset": "53"}, {"mention": "头痛", "label": "症状", "offset": "57"}, {"mention": "胸痛", "label": "症状", "offset": "74"}, {"mention": "腹部增强mri+mrcp", "label": "影像检查", "offset": "96"}, {"mention": "胆总管", "label": "解剖部位", "offset": "109"}, {"mention": "胆管癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "右肾下腺结节", "label": "疾病和诊断", "offset": "125"}, {"mention": "腺瘤", "label": "疾病和诊断", "offset": "134"}, {"mention": "右肾", "label": "解剖部位", "offset": "137"}, {"mention": "两侧胸腔积液", "label": "疾病和诊断", "offset": "142"}, {"mention": "ercp+胆总管金属支架植入", "label": "手术", "offset": "181"}, {"mention": "巩膜", "label": "解剖部位", "offset": "237"}, {"mention": "胆总管癌并两肺转移", "label": "疾病和诊断", "offset": "291"}, {"mention": "胆管癌", "label": "疾病和诊断", "offset": "382"}, {"mention": "杜密克", "label": "药物", "offset": "422"}, {"mention": "开塞露", "label": "药物", "offset": "428"}]}
{"text": ",患者于10月前无明显诱因出现进食吞咽困难,伴呕心,嗳气,呕吐。无泛酸、呕血,无腹泻、腹胀,无黑便、便血、粘液便,,于外院行胃镜检查示:胃底贲门癌。为进一步诊治来我院就诊。,我院ct示:胃底病变,符合胃癌表现;胃右动脉旁淋巴结肿大,考虑淋巴结转移。起病以来,患者无头晕、头痛,无发热、咳嗽、咳痰、胸闷、胸痛,精神体力一般,食欲上降,睡眠一般,小便正常,体重较前上降5+公斤。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "40"}, {"mention": "腹胀", "label": "症状", "offset": "43"}, {"mention": "胃底贲门癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "ct", "label": "影像检查", "offset": "89"}, {"mention": "胃底", "label": "解剖部位", "offset": "93"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "胃右动脉旁淋巴结", "label": "解剖部位", "offset": "105"}, {"mention": "头晕", "label": "症状", "offset": "132"}, {"mention": "头痛", "label": "症状", "offset": "135"}, {"mention": "胸闷", "label": "症状", "offset": "148"}, {"mention": "胸痛", "label": "症状", "offset": "151"}]}
{"text": "患者2009年1月于本院诊断为十二指肠间质瘤,2009年1月12日行胰十二指肠切除术术,当时未发现肝转移,术后病理示十二指肠间质瘤。并于术后开始行伊马替尼400mg叒qd方案靶向治疗。2011年2月前在外院复查pet-ct提示肝左叶前段占位,当时未予重视。2011年7月于外院复查ct发现肝左叶多发环形强化结节病灶,考虑转移瘤。予以换用索坦靶向治疗,12月于本院复查腹部mri,发现肿瘤较化疗前增大,于2011年12月21日在行肝肿瘤切除术。2012年5月10日pet/ct示“肝ss3段结节状高代谢,考虑转移灶”。现为进一步治疗入院。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,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": "十二指肠间质瘤", "label": "疾病和诊断", "offset": "15"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "34"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "49"}, {"mention": "十二指肠间质瘤", "label": "疾病和诊断", "offset": "58"}, {"mention": "伊马替尼", "label": "药物", "offset": "73"}, {"mention": "pet-ct", "label": "影像检查", "offset": "105"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "113"}, {"mention": "ct", "label": "影像检查", "offset": "140"}, {"mention": "肝左叶多发环形强化结节病灶,考虑转移瘤", "label": "疾病和诊断", "offset": "144"}, {"mention": "索坦", "label": "药物", "offset": "168"}, {"mention": "腹部mri", "label": "影像检查", "offset": "183"}, {"mention": "肝肿瘤切除术", "label": "手术", "offset": "214"}, {"mention": "pet/ct", "label": "影像检查", "offset": "231"}, {"mention": "肝ss3段结节状高代谢,考虑转移灶", "label": "疾病和诊断", "offset": "239"}, {"mention": "腹痛", "label": "症状", "offset": "279"}, {"mention": "腹胀", "label": "症状", "offset": "283"}]}
{"text": "患者自述于4年3个月前(2011-7)体检时行腹部超声发现胃区回声不均匀,后查胃镜检查示胃窦部巨大溃疡性病变,取病理为低分化腺癌,`2011-7-4于我院肿瘤外科行胃癌根治术,术中见肿物位于胃窦部大弯侧,已侵透浆膜,腹腔粘连较轻,术后病理为进展期胃癌,中、低分化腺癌及粘液腺癌,淋巴结3/27枚转移,病理号为126582。术后入我科行奥沙利铂联合替吉奥方案化疗8周期,具体为奥沙利铂(乐沙定)叒250毫克叒d1静点,替吉奥(爱斯万)叒60毫克叒d1-d14日双次口服,期间未见ii°以下不良反应,末次化疗时间2012-1.化疗结束后于我科行生物治疗,期间复查未见复发及转移病灶,2012-4入院复查ca724下升达98.3ng/ml,予替吉奥60毫克日二次口服d1-d14化疗7周期,后复查ca724为15.49ng/ml,停止服替吉奥,末次化疗时间:2012-10-8。现已行生物治疗12周期,定期复查,未见疾病转移及复发.现为进一步治疗入我科。患者近1月饮食睡眠一般,精神体力可,周身无疼痛,二便基本正常,体重无明显变化,ecog评分1分。", "mention_data": [{"mention": "腹部超声", "label": "影像检查", "offset": "23"}, {"mention": "胃区", "label": "解剖部位", "offset": "29"}, {"mention": "胃窦部巨大溃疡性病变", "label": "疾病和诊断", "offset": "44"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "59"}, {"mention": "胃癌根治术", "label": "手术", "offset": "82"}, {"mention": "胃窦", "label": "解剖部位", "offset": "95"}, {"mention": "腹腔", "label": "解剖部位", "offset": "108"}, {"mention": "进展期胃癌,中、低分化腺癌及粘液腺癌", "label": "疾病和诊断", "offset": "120"}, {"mention": "奥沙利铂", "label": "药物", "offset": "167"}, {"mention": "替吉奥", "label": "药物", "offset": "173"}, {"mention": "奥沙利铂", "label": "药物", "offset": "187"}, {"mention": "乐沙定", "label": "药物", "offset": "192"}, {"mention": "替吉奥", "label": "药物", "offset": "208"}, {"mention": "爱斯万", "label": "药物", "offset": "212"}, {"mention": "ca724", "label": "实验室检验", "offset": "299"}, {"mention": "替吉奥", "label": "药物", "offset": "318"}, {"mention": "ca724", "label": "实验室检验", "offset": "345"}, {"mention": "替吉奥", "label": "药物", "offset": "365"}]}
{"text": ",患者2014年9月无明显诱因出现腹胀、腹痛,为阵发性隐痛,上腹为主,无明显规律性,伴有恶心,呕吐,进食后明显,且肛门排气排便减少,无明显便血、便条变细,无里急后重感。遂到外院就诊,,查肠镜示:回盲瓣充血水肿;部分直肠、乙状结肠肿胀狭窄;,病理示:直肠粘膜慢性炎。ct,示:腹部回肠局部管壁普遍性增厚,周围脂肪间隙模糊,考虑炎症性病变可能性大,建议进一步检查。叒经治疗后症状反复,2014-11-27于我院行急诊空回肠侧侧吻合+横结肠造口术,术后第12天患者伤口有墨绿色渗液,考虑为吻合口漏,行急诊剖腹探查,见漏口位于原粘连扭曲段回肠,行空肠造瘘术,放置脾窝、盆腔及回肠漏口旁引流管各1条。患者下次出院以来,诉腹胀,偶有脐上腹部一过性疼痛,程度轻,食欲、睡眠及精神差,小便正常,体重较下次入院上降6.5kg。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "17"}, {"mention": "腹痛", "label": "症状", "offset": "20"}, {"mention": "上腹", "label": "解剖部位", "offset": "30"}, {"mention": "肛门", "label": "解剖部位", "offset": "57"}, {"mention": "回盲瓣", "label": "解剖部位", "offset": "97"}, {"mention": "直肠", "label": "解剖部位", "offset": "107"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "110"}, {"mention": "直肠粘膜慢性炎", "label": "疾病和诊断", "offset": "124"}, {"mention": "ct", "label": "影像检查", "offset": "132"}, {"mention": "腹部", "label": "解剖部位", "offset": "137"}, {"mention": "回肠", "label": "解剖部位", "offset": "139"}, {"mention": "炎症性病变", "label": "疾病和诊断", "offset": "162"}, {"mention": "空回肠侧侧吻合+横结肠造口术", "label": "手术", "offset": "206"}, {"mention": "剖腹探查", "label": "手术", "offset": "249"}, {"mention": "回肠", "label": "解剖部位", "offset": "265"}, {"mention": "空肠造瘘术", "label": "手术", "offset": "269"}, {"mention": "脾", "label": "解剖部位", "offset": "277"}, {"mention": "盆腔", "label": "解剖部位", "offset": "280"}, {"mention": "回肠", "label": "解剖部位", "offset": "283"}, {"mention": "腹胀", "label": "症状", "offset": "305"}, {"mention": "脐上腹部", "label": "解剖部位", "offset": "310"}]}
{"text": "患者2年前行肠镜诊断为“直肠癌”行直肠癌根治术,术前ct可见左上肺2个病灶,无咳嗽、咳痰,无寒战、发热等。术后予forfox化疗6程,后因化疗副反应大停止,化疗后评价肺部病灶疗效为pr。后继续口服xeloda维持。2010年12月因粘连性肠梗阻再次行手术治疗。术后继续予xeloda治疗至今。现为进一步诊疗就诊于我院,门诊拟“直肠癌左上肺转移”收入院。患者自起病以来,肺部病灶较前无明显变化,无头晕、头痛等,精神、食纳、睡眠较差,大小便如常,体力体重无明显上降。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "17"}, {"mention": "ct", "label": "影像检查", "offset": "26"}, {"mention": "左上肺", "label": "解剖部位", "offset": "30"}, {"mention": "肺部", "label": "解剖部位", "offset": "83"}, {"mention": "xeloda", "label": "药物", "offset": "98"}, {"mention": "粘连性肠梗阻", "label": "疾病和诊断", "offset": "116"}, {"mention": "xeloda", "label": "药物", "offset": "135"}, {"mention": "直肠癌左上肺转移", "label": "疾病和诊断", "offset": "163"}, {"mention": "肺部", "label": "解剖部位", "offset": "184"}, {"mention": "头晕", "label": "症状", "offset": "197"}, {"mention": "头痛", "label": "症状", "offset": "200"}]}
{"text": "患者11个月前出现进食哽噎感,逐渐加重,8个月余前就诊于我院,行胃镜检查提示“食管上段恶性肿瘤”,病理回报:“食管鳞癌;胃角低级别绒毛状管状腺瘤”,患者及家属放弃手术治疗,要求行化疗治疗。于我院胸外科行多西他赛130mg+奈达铂140mg化疗3周期。化疗3周后就诊于我科行局部放疗1疗程,同时予同步dp方案化疗1周期(多西他赛100mg第1日,顺铂30mg连3日)。放化疗于4个月余前结束。1个月余前患者复查发现腹腔淋巴结肿大,诊断为腹腔淋巴结转移,就诊于我科行局部放疗,同时予同步替加氟联合顺铂方案化疗(替加氟1.0连5日,顺铂30mg连3日)。现放疗20次,化疗后3周,来诊拟进一步治疗。患者病来精神状态可,无明显乏力,现可进普食,无前胸、后背痛,无胸闷、气短,饮食、睡眠尚可,二便可,体重无明显变化。", "mention_data": [{"mention": "食管上段恶性肿瘤", "label": "疾病和诊断", "offset": "39"}, {"mention": "食管鳞癌", "label": "疾病和诊断", "offset": "55"}, {"mention": "胃角低级别绒毛状管状腺瘤", "label": "疾病和诊断", "offset": "60"}, {"mention": "多西他赛", "label": "药物", "offset": "101"}, {"mention": "奈达铂", "label": "药物", "offset": "111"}, {"mention": "多西他赛", "label": "药物", "offset": "159"}, {"mention": "顺铂", "label": "药物", "offset": "172"}, {"mention": "腹腔淋巴结", "label": "解剖部位", "offset": "206"}, {"mention": "腹腔淋巴结转移", "label": "疾病和诊断", "offset": "217"}, {"mention": "替加氟", "label": "药物", "offset": "241"}, {"mention": "顺铂", "label": "药物", "offset": "246"}, {"mention": "替加氟", "label": "药物", "offset": "253"}, {"mention": "顺铂", "label": "药物", "offset": "263"}, {"mention": "前胸", "label": "解剖部位", "offset": "319"}, {"mention": "后背", "label": "解剖部位", "offset": "322"}, {"mention": "胸闷", "label": "症状", "offset": "327"}]}
{"text": "缘于入院前5个月于我院确诊“食管癌”,于2013.10.27行“食管癌切除、胃食管弓下吻合术”,手术顺利,术后恢复良好后出院,无胸闷、憋气;无胸背痛;无腹痛、腹胀;无呕血、黑便,偶有返酸,无呼吸困难等不适,2013.11.23、2013.12.20、2014.01、17、2014.02.09于我院按“洛铂50mgd1-d3+安素泰240mgd1”方案化疗4次,化疗过程顺利,无明显恶心、呕吐,无心前区闷痛等不适。7天前患者吞咽困难,行胃镜检查示“食管吻合口狭窄”,门诊遂拟“食管癌术后(pt3n0m0ii期)”收住入院,发病以来,饮食睡眠尚可,大小便正常。体重无明显减轻。", "mention_data": [{"mention": "食管癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "食管癌切除、胃食管弓下吻合术", "label": "手术", "offset": "32"}, {"mention": "胸闷", "label": "症状", "offset": "64"}, {"mention": "胸背痛", "label": "症状", "offset": "71"}, {"mention": "腹痛", "label": "症状", "offset": "76"}, {"mention": "腹胀", "label": "症状", "offset": "79"}, {"mention": "洛铂", "label": "药物", "offset": "151"}, {"mention": "安素泰", "label": "药物", "offset": "163"}, {"mention": "心前区", "label": "解剖部位", "offset": "198"}, {"mention": "食管吻合口狭窄", "label": "疾病和诊断", "offset": "224"}, {"mention": "食管癌术后(pt3n0m0ii期)", "label": "疾病和诊断", "offset": "238"}]}
{"text": "患者2014年7月无明显诱因出现腹部隐痛,部位不定,可自行缓解,伴腹泻,大便3-4次/天,患者到外院诊断为\\\"胃病\\\",予对症处理未见好转,腹痛局限在下腹部,伴腹胀,胃纳差。外院肠镜检查提示肝曲结肠肿物,肠镜不能通过。另见距肛门40cm、15cm双个息肉,已切除。2014-09-23日于我院行左半结肠切除+wipple术,术后病理:(肝曲结肠癌侵犯周围脏器)镜检为结肠中至低分化管状腺癌,少部分为印戒细胞癌,癌组织侵犯至肠壁浆膜层外结缔组织,并累及胆囊壁外膜层;胃壁浆膜层、十二指肠浆膜层与胰腺包膜间见大量纤维增生、慢性炎症细胞浸润,伴脓肿形成;胃壁、十二指肠、胰腺及肝组织均未见癌侵犯;可见脉管内癌栓,未见明确神经束侵犯;间质有多量淋巴细胞、组织细胞浸润,伴淋巴滤泡形成,建议临床进一步检查以除外lynch综合征可能。淋巴结见1枚腺癌转移。手术后患者出现肝功能损害,alt和ast最高分别为122.2和182.1u/l,tb和db最高分别为104.5和87.9umol/l。2014年11月6日-2015-04-22于我院行xelox辅助化疗。患者下次出院以来,精神食欲睡眠可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "16"}, {"mention": "腹泻", "label": "症状", "offset": "33"}, {"mention": "胃病", "label": "疾病和诊断", "offset": "55"}, {"mention": "腹痛", "label": "症状", "offset": "70"}, {"mention": "下腹部", "label": "解剖部位", "offset": "75"}, {"mention": "腹胀", "label": "症状", "offset": "80"}, {"mention": "胃", "label": "解剖部位", "offset": "83"}, {"mention": "肝曲", "label": "解剖部位", "offset": "95"}, {"mention": "结肠", "label": "解剖部位", "offset": "97"}, {"mention": "肛门", "label": "解剖部位", "offset": "112"}, {"mention": "左半结肠切除+wipple术", "label": "手术", "offset": "147"}, {"mention": "肝曲结肠癌", "label": "疾病和诊断", "offset": "168"}, {"mention": "结肠中至低分化管状腺癌", "label": "疾病和诊断", "offset": "183"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "199"}, {"mention": "肠", "label": "解剖部位", "offset": "211"}, {"mention": "胆囊", "label": "解剖部位", "offset": "225"}, {"mention": "胃", "label": "解剖部位", "offset": "232"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "238"}, {"mention": "胰腺", "label": "解剖部位", "offset": "246"}, {"mention": "胃", "label": "解剖部位", "offset": "274"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "277"}, {"mention": "胰腺", "label": "解剖部位", "offset": "282"}, {"mention": "肝", "label": "解剖部位", "offset": "285"}, {"mention": "lynch综合征", "label": "疾病和诊断", "offset": "350"}, {"mention": "肝", "label": "解剖部位", "offset": "379"}, {"mention": "alt", "label": "实验室检验", "offset": "385"}, {"mention": "ast", "label": "实验室检验", "offset": "389"}, {"mention": "tb", "label": "实验室检验", "offset": "412"}, {"mention": "db", "label": "实验室检验", "offset": "415"}, {"mention": "xelox", "label": "药物", "offset": "464"}]}
{"text": "患者1年前因胃癌在本院行胃癌根治术(全胃切除术+间置空肠吻合术),手术恢复顺利,术后病理示:胃体后壁溃疡型低分化腺癌伴印戒细胞癌,大小2.5*1.5cm,侵入至浆膜层,未见脉管癌栓,淋巴结未见转移。1月前无明显诱因的出现腹痛,呈阵发性,无向它处放射,并腹胀、肛门停止排气,在外院治疗,考虑肠梗阻,予以保守治疗,具体用药不详,症状缓解,此后反复发作2次。为求手术治疗入住我科。起病以来,进食欠佳,无呕吐,睡眠可,大、小便正常,精神佳,体重减轻5kg。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "胃癌根治术(全胃切除术+间置空肠吻合术)", "label": "手术", "offset": "12"}, {"mention": "胃体后壁溃疡型低分化腺癌伴印戒细胞癌", "label": "疾病和诊断", "offset": "46"}, {"mention": "腹痛", "label": "症状", "offset": "110"}, {"mention": "腹胀", "label": "症状", "offset": "126"}, {"mention": "肛门", "label": "解剖部位", "offset": "129"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "144"}]}
{"text": ",缘于入院前1月余无明显诱因出现中下腹部闷痛部闷痛不适,为持续性隐痛,无其它部位放射,与进食无关,无恶心、呕吐,无返酸、嗳气,无纳差、乏力,无腹泻、便秘,无呕血、黑便,无发热、咳嗽、咳痰,未予进一步诊治,症状可自行缓解,但反复发作。入院前20天就诊我院,,查腹部ct示:胃底贲门部小弯侧及窦部胃壁不均匀增厚伴周围多发小淋巴结,可能为胃癌未累及浆膜层,建议胃镜检查。,进一步行胃镜检查示:胃窦溃疡,,病理回报:低分化腺癌。现为求进一步诊治,门诊拟“胃窦癌”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": "中下腹部", "label": "解剖部位", "offset": "16"}, {"mention": "腹泻", "label": "症状", "offset": "71"}, {"mention": "腹部ct", "label": "影像检查", "offset": "129"}, {"mention": "胃底", "label": "解剖部位", "offset": "135"}, {"mention": "贲门", "label": "解剖部位", "offset": "137"}, {"mention": "窦部", "label": "解剖部位", "offset": "144"}, {"mention": "胃", "label": "解剖部位", "offset": "146"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "166"}, {"mention": "胃窦溃疡", "label": "疾病和诊断", "offset": "193"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "204"}, {"mention": "胃窦癌", "label": "疾病和诊断", "offset": "223"}]}
{"text": "患者8个月前在我院诊断为直肠癌伴肝脏多发转移,完善检查后于2009-1-4在全麻上行剖腹探查,姑息性直肠癌切除术,术后病理回报直肠溃疡型中分化腺癌,大小5*3.5cm,侵透肠壁全层,淋巴结8/17见转移,未见脉管癌栓。患者术后恢复较好,已按照希罗达联合紫杉醇方案化疗数周期(具体不详),1个月前复查腹部ct提示肝脏病变进展,改行folfiri+erbitux方案化疗2周期,于2009-9-10在我院复查腹部ct提示肝脏病变明显进展,故为进一步治疗收住我科。自手术以来患者精神、睡眠、食欲可,二便正常,体重减轻二公斤。", "mention_data": [{"mention": "直肠癌伴肝脏多发转移", "label": "疾病和诊断", "offset": "12"}, {"mention": "剖腹探查", "label": "手术", "offset": "42"}, {"mention": "姑息性直肠癌切除术", "label": "手术", "offset": "47"}, {"mention": "直肠溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "肠", "label": "解剖部位", "offset": "86"}, {"mention": "淋巴结8/17见转移", "label": "疾病和诊断", "offset": "91"}, {"mention": "希罗达", "label": "药物", "offset": "121"}, {"mention": "紫杉醇", "label": "药物", "offset": "126"}, {"mention": "腹部ct", "label": "影像检查", "offset": "149"}, {"mention": "肝脏病变", "label": "疾病和诊断", "offset": "155"}, {"mention": "folfiri", "label": "药物", "offset": "164"}, {"mention": "erbitux", "label": "药物", "offset": "172"}, {"mention": "腹部ct", "label": "影像检查", "offset": "202"}, {"mention": "肝脏病变", "label": "疾病和诊断", "offset": "208"}]}
{"text": ",患者9个月前因“大便习惯性状改变10月余”就诊我院,,诊断为:乙状结肠癌肝转移。患者于2011年7月4日行姑息性\\\"乙状结肠癌切除术\\\"。,术后病理结果回报:中分化腺癌,浸润至肠壁浆膜层。淋巴结未见转移。患者术后恢复可,于2011-7-26、2011-8-9、2011-8-23、2011-9-6、2011-9-20、2011-10-10、2011-10-26及2011-11-16予folfox+avastin方案化疗8程,于2011-12-7行肝转移瘤微波消融术+放射性i125粒子植入术,手术过程顺利,术后无诉不适。于2012-02-17于全麻上行“肝转移瘤切除+胆囊切除”,术顺,术后病理示肝s6、7见腺癌浸润,肝s5、8见凝固性坏死。现术后1月余,2012-3-22行folfox方案一程。患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,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": "乙状结肠癌肝转移", "label": "疾病和诊断", "offset": "32"}, {"mention": "乙状结肠癌切除术", "label": "手术", "offset": "59"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "肠", "label": "解剖部位", "offset": "89"}, {"mention": "avastin", "label": "药物", "offset": "200"}, {"mention": "肝转移瘤微波消融术+放射性i125粒子植入术", "label": "手术", "offset": "225"}, {"mention": "肝转移瘤切除+胆囊切除", "label": "手术", "offset": "279"}, {"mention": "肝s6、7", "label": "解剖部位", "offset": "300"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "306"}, {"mention": "肝s5、8", "label": "解剖部位", "offset": "311"}, {"mention": "腹痛", "label": "症状", "offset": "356"}, {"mention": "腹胀", "label": "症状", "offset": "360"}]}
{"text": "患者于2年余前受凉后出现发热,体温最高39.5℃,伴咳嗽、咳痰,在社区门诊诊断为“呼吸道感染”,给予抗炎及退热(具体药物不详)等治疗,效果差。发病当日遂来我院就诊,收入“保健科”治疗。入院后治疗效果不佳,2天后患者呼吸衰竭,遂转icu继续治疗。转入后给抗感染、提高机体免疫力、化痰、平喘、营养支持等治疗,经口气管插管接呼吸机辅助呼吸纠正呼吸衰竭。经过治疗,患者逐渐脱离呼吸机,但自主咳痰能力差,遂行气管切开术(2012-02-22),患者病情趋于稳定。但因高龄、长期卧床、自主咳痰能力差等因素,反复出现发热,即根据细菌学培养结果调整抗生素治疗方案,经抗生素治疗后疾病控制理想。患者肺炎、呼吸衰竭时有反复,间断应用呼吸机辅助呼吸。患者痰液较多且无法去除人工气道。2014年11月份患者出现急性肾损伤状况,行crrt治疗。需继续在icu治疗,反复办理出入院,继续住院治疗。叒叒叒患者自发病以来,先后鼻饲及胃造瘘饮食,睡眠不规律,大便基本正常。", "mention_data": [{"mention": "呼吸道感染", "label": "疾病和诊断", "offset": "41"}, {"mention": "呼吸衰竭", "label": "疾病和诊断", "offset": "107"}, {"mention": "口", "label": "解剖部位", "offset": "153"}, {"mention": "气管", "label": "解剖部位", "offset": "154"}, {"mention": "气管切开术", "label": "手术", "offset": "199"}, {"mention": "肺炎", "label": "疾病和诊断", "offset": "290"}, {"mention": "呼吸衰竭", "label": "疾病和诊断", "offset": "293"}, {"mention": "气道", "label": "解剖部位", "offset": "327"}, {"mention": "急性肾损伤", "label": "疾病和诊断", "offset": "343"}, {"mention": "鼻", "label": "解剖部位", "offset": "397"}, {"mention": "胃", "label": "解剖部位", "offset": "400"}]}
{"text": "缘于入院前1个月无明显诱因出现中下腹部闷痛不适,为持续性隐痛,无其它部位放射,与进食无关,无恶心、呕吐,无返酸、嗳气,无纳差、乏力、消瘦,无腹痛、腹泻、便秘,无呕血、黑便,无发热、咳嗽、咳痰,未予治疗,症状无明显好转,此次至我院门诊行胃镜检查示:“贲门肿物”(报告单及病理未出),遂门诊拟“贲门肿物”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": "中下腹部", "label": "解剖部位", "offset": "15"}, {"mention": "腹痛", "label": "症状", "offset": "70"}, {"mention": "腹泻", "label": "症状", "offset": "73"}, {"mention": "贲门", "label": "解剖部位", "offset": "124"}, {"mention": "贲门肿物", "label": "疾病和诊断", "offset": "145"}]}
{"text": "患者1年前出现下腹部不适,以中下腹部明显,进食后明显,伴有返酸,轻度腹胀,无发热,无嗳气,无恶心、呕吐,无腹泻,无便血,无心慌、胸闷,无胸闷、胸痛,无吞咽困难,无呃逆,曾口服中草药调理,服“吗丁啉、质子泵抑制剂(具体不详)”,效果好,症状时好时差,仍有阵发性腹部不适,今日遂来我院行胃镜检查示“浅表萎缩性胃炎、胃息肉”,发现胃部息肉8个,行内镜上息肉切除术。为进一步系统治疗,门诊以“胃炎”收入院。叒叒叒患者自发病以来,神志清,精神可,饮食睡眠正常,二便可,体重近期无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "7"}, {"mention": "中下腹部", "label": "解剖部位", "offset": "14"}, {"mention": "腹胀", "label": "症状", "offset": "34"}, {"mention": "腹泻", "label": "症状", "offset": "53"}, {"mention": "心慌", "label": "症状", "offset": "61"}, {"mention": "胸闷", "label": "症状", "offset": "64"}, {"mention": "胸闷", "label": "症状", "offset": "68"}, {"mention": "胸痛", "label": "症状", "offset": "71"}, {"mention": "吗丁啉", "label": "药物", "offset": "95"}, {"mention": "腹部不适", "label": "症状", "offset": "129"}, {"mention": "浅表萎缩性胃炎", "label": "疾病和诊断", "offset": "147"}, {"mention": "胃息肉", "label": "疾病和诊断", "offset": "155"}, {"mention": "胃部息肉", "label": "疾病和诊断", "offset": "162"}, {"mention": "内镜上息肉切除术", "label": "手术", "offset": "170"}, {"mention": "胃炎", "label": "疾病和诊断", "offset": "192"}]}
{"text": "患者1年半余前因“原发性肝癌”于2012年3月16日在全麻上行经典原位非转流式肝移植术,手术,顺利,术后给予抗感染、抗排异、保肝、营养支持等治疗。术后出现短期肾功能不全,经积极护肾、透析治疗后肾功能明显好转。后患者出现低热,行甲状腺穿刺结果:桥本式甲状腺炎。给予抗炎对症治疗后病情逐渐恢复,康复出院。11月前患者无明显诱因出现皮肤瘙痒,再次来我院,行胆道造影示肝内胆管显示欠佳,给予更换引流管,于2013年3月28日在介入科行胆管造影并再次置换引流管,好转后出院。于9月24日在介入科行胆管造影并置换左肝内引流管,引流通畅,患者无不适,于10月9日在介入科行胆管造影并置换引流管,7天前患者不慎将引流管拖出,自行重新置入,现患者为进一步治疗来我院,门诊以“肝移植术后”为求进一步治疗来我院。叒叒叒患者自下次出院以来,患者精神可,睡眠可,饮食可,大小便无异常,体重无减轻。", "mention_data": [{"mention": "原发性肝癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "经典原位非转流式肝移植术", "label": "手术", "offset": "31"}, {"mention": "肝", "label": "解剖部位", "offset": "63"}, {"mention": "肾", "label": "解剖部位", "offset": "79"}, {"mention": "肾", "label": "解剖部位", "offset": "89"}, {"mention": "肾", "label": "解剖部位", "offset": "96"}, {"mention": "甲状腺", "label": "解剖部位", "offset": "113"}, {"mention": "桥本式甲状腺炎", "label": "疾病和诊断", "offset": "121"}, {"mention": "胆道造影", "label": "影像检查", "offset": "175"}, {"mention": "肝", "label": "解剖部位", "offset": "180"}, {"mention": "胆管", "label": "解剖部位", "offset": "182"}, {"mention": "胆管造影", "label": "影像检查", "offset": "213"}, {"mention": "胆管造影", "label": "影像检查", "offset": "243"}, {"mention": "左肝", "label": "解剖部位", "offset": "250"}, {"mention": "胆管造影", "label": "影像检查", "offset": "279"}, {"mention": "肝移植术后", "label": "疾病和诊断", "offset": "328"}]}
{"text": "患者于2016年9月底因停服“洛索洛芬钠片”出现恶心伴胸骨后疼痛,晨起及餐后加重,头痛,无头晕,无反酸烧心,无恶心呕吐,无发热寒战,于当地诊所口服药物治疗,具体药物不详,头痛症状消失,其余症状仍在,为寻进一步治疗,于2016-10-05门诊以“慢性胃炎”收入院。入院后给予抑酸、促进粘膜修复等药物治疗,行胃镜检查提示慢性萎缩性胃炎,食管乳头状瘤,未予处理,病情好转出院。出院后未再复查,未系统服药,时有下腹部不适,现为行“食管乳头状瘤”胃镜上切除来院,门诊以“食管息肉”收入院。叒叒叒患者自发病以来,神志清,精神一般,饮食、睡眠一般,大便、小便正常。近期体重无明显变化。", "mention_data": [{"mention": "洛索洛芬钠片", "label": "药物", "offset": "15"}, {"mention": "胸骨后疼痛", "label": "症状", "offset": "27"}, {"mention": "头痛", "label": "症状", "offset": "41"}, {"mention": "头晕", "label": "症状", "offset": "45"}, {"mention": "头痛", "label": "症状", "offset": "85"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "122"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "158"}, {"mention": "食管乳头状瘤", "label": "疾病和诊断", "offset": "166"}, {"mention": "下腹部", "label": "解剖部位", "offset": "201"}, {"mention": "“食管乳头状瘤”胃镜上切除", "label": "手术", "offset": "210"}, {"mention": "食管息肉", "label": "疾病和诊断", "offset": "230"}]}
{"text": "缘于入院前1月于外院体检行lct检查示非典型鳞状下皮细胞,遂行阴道镜上活检,病理(b-184256)提示宫颈及宫颈管部分鳞状下皮高级别下皮内瘤变(ciniii级,伴挖空细胞,广泛累及腺体。阴道壁示鳞状下皮高级别下皮内瘤变(vainii级)伴挖空细胞,hpv58(+)。当地建议行宫颈锥形切除,因个人原因予以拒绝。我院病理(h201600305)会诊示宫颈及宫颈管鳞状下皮高级别下皮内瘤变,阴道壁鳞状下皮vainii-iii级,表面见挖空细胞。平素无接触性出血,绝经后无异常出血、排液,今为进一步诊治,前来我院,门诊拟“ciniii级”收入院。自发病以来,精神、睡眠、食欲尚可,大便、小便正常,体重无明显减轻。", "mention_data": [{"mention": "非典型鳞状下皮细胞", "label": "疾病和诊断", "offset": "19"}, {"mention": "阴道", "label": "解剖部位", "offset": "31"}, {"mention": "宫颈及宫颈管部分鳞状下皮高级别下皮内瘤变(ciniii级,", "label": "疾病和诊断", "offset": "52"}, {"mention": "阴道", "label": "解剖部位", "offset": "94"}, {"mention": "鳞状下皮高级别下皮内瘤变(vainii级)", "label": "疾病和诊断", "offset": "98"}, {"mention": "宫颈锥形切除", "label": "手术", "offset": "139"}, {"mention": "宫颈及宫颈管鳞状下皮高级别下皮内瘤变", "label": "疾病和诊断", "offset": "175"}, {"mention": "阴道壁鳞状下皮vainii-iii级", "label": "疾病和诊断", "offset": "194"}, {"mention": "ciniii级", "label": "疾病和诊断", "offset": "259"}]}
{"text": ",入院前1年余于我院体检肠镜发现于距肛门25cm以远见多发扁平状息肉,大小约0.3-0.5cm,欲行内镜上息肉切除术,切除其中较大者三枚。于距肛门15cm见一宽基息肉,大小约1.2cm,予行内镜上黏膜切除术,将其完整顺利切除,,术后病理:“肠管状腺瘤,伴低级别下皮内瘤变”,,术后诊断:“结肠多发息肉内镜上息肉切除术(部分)”。平素常有便秘,3-5天排便1次,排便费力,大便干结不易排出,无腹痛、腹泻,无便血、排黑便、粘液脓血便,无恶心、呕吐、呕血,无眼黄、尿黄、皮肤黄,今为进一步行内镜上治疗,门诊拟结肠多发息肉收治我科。自发病来,精神好,饮食好,小便无异常,体重无明显变化。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "18"}, {"mention": "内镜上息肉切除术", "label": "手术", "offset": "50"}, {"mention": "肛门", "label": "解剖部位", "offset": "71"}, {"mention": "内镜上黏膜切除术", "label": "手术", "offset": "95"}, {"mention": "肠管状腺瘤,伴低级别下皮内瘤变", "label": "疾病和诊断", "offset": "120"}, {"mention": "结肠多发息肉内镜上息肉切除术", "label": "手术", "offset": "144"}, {"mention": "腹痛", "label": "症状", "offset": "195"}, {"mention": "腹泻", "label": "症状", "offset": "198"}, {"mention": "眼", "label": "解剖部位", "offset": "226"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "251"}]}
{"text": "入院前8天,患者于晨起时出现腹痛,腹痛主要位于下腹,为持续胀痛,进食后疼痛无明显加剧,疼痛向腰部放射,伴有恶心及呕吐,呕吐物为胃内容物,不含咖啡样物质,非喷射状,无畏寒、发热、心悸、尿少、腹泻等不适、否认既往皮肤巩膜黄染史,否认消化道溃疡史,否认下腹腹部外伤史,否认肛门停止排气、排便。遂入我院就诊,淀粉酶叒349.53叒u/l,脂肪酶叒579.79u/l,血常规叒白细胞叒12.00×10~9/l,n%叒93%,考虑重症急性胰腺炎,在我科住院诊治,给予禁食禁饮、抑酸、抑酶、护胃、补液、抗感染、胃肠减压等对症支持治疗,因患者病情危重,合并ards可能,于6天前转*****继续诊治。在附一院icu给予气管插管呼吸机辅助通气、禁食禁饮、胃肠减压、抗感染、抑酸抑酶、持续血液滤过灌流、输血浆、输白蛋白、保肝等对症支持治疗后,患者症状缓解。今日,患者及其家属要求转回我院继续治疗,门诊以“重症急性胰腺炎、mods”收入院。\\u0004叒叒叒患者本次发病以来,无进食,叒神志清醒,精神欠佳,睡眠欠佳,未解大便,小便正常,体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "14"}, {"mention": "腹痛", "label": "症状", "offset": "17"}, {"mention": "下腹", "label": "解剖部位", "offset": "23"}, {"mention": "腰部", "label": "解剖部位", "offset": "46"}, {"mention": "胃", "label": "解剖部位", "offset": "63"}, {"mention": "心悸", "label": "症状", "offset": "88"}, {"mention": "腹泻", "label": "症状", "offset": "94"}, {"mention": "巩膜", "label": "解剖部位", "offset": "106"}, {"mention": "消化道溃疡", "label": "疾病和诊断", "offset": "114"}, {"mention": "下腹", "label": "解剖部位", "offset": "123"}, {"mention": "腹部", "label": "解剖部位", "offset": "125"}, {"mention": "肛门", "label": "解剖部位", "offset": "133"}, {"mention": "淀粉酶", "label": "实验室检验", "offset": "150"}, {"mention": "脂肪酶", "label": "实验室检验", "offset": "165"}, {"mention": "白细胞", "label": "实验室检验", "offset": "183"}, {"mention": "重症急性胰腺炎", "label": "疾病和诊断", "offset": "209"}, {"mention": "胃", "label": "解剖部位", "offset": "239"}, {"mention": "胃", "label": "解剖部位", "offset": "248"}, {"mention": "肠", "label": "解剖部位", "offset": "249"}, {"mention": "ards", "label": "疾病和诊断", "offset": "270"}, {"mention": "气管", "label": "解剖部位", "offset": "301"}, {"mention": "胃", "label": "解剖部位", "offset": "318"}, {"mention": "肠", "label": "解剖部位", "offset": "319"}, {"mention": "肝", "label": "解剖部位", "offset": "351"}, {"mention": "重症急性胰腺炎", "label": "疾病和诊断", "offset": "392"}, {"mention": "mods", "label": "疾病和诊断", "offset": "400"}]}
{"text": ",入院前1月余因“肝内外胆管结石伴急性胆管炎”在全麻上行“胆总管切开取石+术中胆道镜取石+左肝部分切除+右肝内叶‘十字’切开取石”术,术顺,,术后病理示:(肝组织),:肝内胆管结石伴慢性炎症,汇管区小胆管及纤维组织增生伴少量慢性炎症细胞浸润,肝组织呈结节性肝硬化改变。术后恢复良好,无恶心、呕吐,无返酸、嗳气,无纳差、乏力、消瘦,无腹胀、腹泻、便秘,无呕血、黑便,无畏冷、寒战、发热,今为入院复查,求诊我院,门诊拟“胆道术后收住入院。自发病以来,精神、食欲、睡眠尚可,大小便如常,体重无明显变化。", "mention_data": [{"mention": "肝内外胆管结石伴急性胆管炎", "label": "疾病和诊断", "offset": "9"}, {"mention": "胆总管切开取石+术中胆道镜取石+左肝部分切除+右肝内叶‘十字’切开取石", "label": "手术", "offset": "29"}, {"mention": "肝", "label": "解剖部位", "offset": "78"}, {"mention": "肝内胆管结石伴慢性炎症", "label": "疾病和诊断", "offset": "84"}, {"mention": "胆管", "label": "解剖部位", "offset": "100"}, {"mention": "肝", "label": "解剖部位", "offset": "121"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "128"}, {"mention": "腹胀", "label": "症状", "offset": "166"}, {"mention": "腹泻", "label": "症状", "offset": "169"}, {"mention": "胆道术后", "label": "疾病和诊断", "offset": "208"}]}
{"text": "入院前4+月,患者因“直肠腺癌”于2014.9.27在全麻上行腹腔镜上直肠癌根治术(dixon)。术后抗感染补液及营养支持治疗,术后病检(1407878):(乙状结肠30cm处)息肉,(直肠)腺癌。于,10月11日、11月13日、1月6日行化疗(奥沙利铂+替加氟,疗程5天方案),患者化疗反应轻,化疗后精神、食欲、睡眠尚可,未有发热,未明显见脱发,无咳嗽、咳痰,今日患者为拟行第4次化疗,到我院门诊就诊,门诊以“直肠癌术后,拟行第4次化疗”收入我科住院治疗。", "mention_data": [{"mention": "直肠腺癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "腹腔镜上直肠癌根治术(dixon)", "label": "手术", "offset": "31"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "79"}, {"mention": "息肉", "label": "疾病和诊断", "offset": "89"}, {"mention": "(直肠)腺癌", "label": "疾病和诊断", "offset": "92"}, {"mention": "奥沙利铂", "label": "药物", "offset": "123"}, {"mention": "替加氟", "label": "药物", "offset": "128"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "206"}]}
{"text": "患者自述半年前无明显原因出现烧心,无下腹痛,时有胃胀,半月前无明显诱因出现嗳气频作,伴有进食时哽咽感,下腹部胀满不适,无恶心、呕吐,无腹痛,无发热,无心慌、胸闷,无咳嗽、咳痰,无发热,无全身乏力,期间未作特殊诊疗,今日于我院门诊就诊,行电子胃镜检查,超声内镜结果示:贲门胃底占位(恶性可能,待病理),现为求进一步治疗,门诊以“贲门胃底占位”收入院。叒叒叒患者自发病以来,食欲可,睡眠可,小便可,大便每日1次,呈黄色不成形软便自诉大便不成形半年余,无粘液脓血,体重减轻近3kg。", "mention_data": [{"mention": "下腹痛", "label": "症状", "offset": "18"}, {"mention": "胃", "label": "解剖部位", "offset": "24"}, {"mention": "下腹部", "label": "解剖部位", "offset": "51"}, {"mention": "腹痛", "label": "症状", "offset": "67"}, {"mention": "心慌", "label": "症状", "offset": "75"}, {"mention": "胸闷", "label": "症状", "offset": "78"}, {"mention": "超声内镜", "label": "影像检查", "offset": "125"}, {"mention": "贲门胃底占位(恶性可能", "label": "疾病和诊断", "offset": "133"}, {"mention": "贲门胃底占位", "label": "疾病和诊断", "offset": "163"}]}
{"text": ",患者于2月前无明显诱因出现大便性状改变,伴轻度腹部不适感,排便后可稍缓解,伴有大便变稀,不成形,大便次数约1-3次/天。时有轻微恶心、下腹轻微腹痛不适感。无黑便、粘液血便等;无畏寒发热、无明显纳差腹胀、消瘦乏力、体重减轻等不适;无肩背放射痛。患者自觉大便不成形及次数增多,故来我院门诊做胃镜及肠镜检查,,胃镜检查报告提示:浅表性胃窦炎伴糜烂;,肠镜检查提示:结肠多发息肉.患者为进一步结肠息肉摘除术治疗,收住我院我消化内科。\\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,,小便正常,体重无明显变化。", "mention_data": [{"mention": "腹部不适", "label": "症状", "offset": "24"}, {"mention": "下腹", "label": "解剖部位", "offset": "68"}, {"mention": "腹痛", "label": "症状", "offset": "72"}, {"mention": "腹胀", "label": "症状", "offset": "99"}, {"mention": "肩背", "label": "解剖部位", "offset": "116"}, {"mention": "浅表性胃窦炎伴糜烂", "label": "疾病和诊断", "offset": "162"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "180"}, {"mention": "结肠息肉摘除术", "label": "手术", "offset": "193"}]}
{"text": "患者3年前无明显诱因出现尿频、尿急,白天排尿10余次,夜间排尿2-3次,无叒尿痛。逐渐出现排尿踌躇,自觉排尿费力,尿线变细,排尿时间延长,并伴有尿末滴沥现象。1年前于我科住院因psa为15ng/ml行超声引导上经直肠前列腺穿刺活检术,术后病理为前列腺增生。后一直服用哈乐,保列治至今,下述症状未见明显好转,患者为求进一步诊治入院。病来不伴有肉眼血尿,不伴有发热及腰痛,不伴有排尿中断现象,不伴有食欲不振。睡眠差,大便正常。叒叒叒高血压病史10余年,未系统药物治疗,血压控制可。叒叒叒冠心病史10余年,未系统药物治疗,近半年无心前区不适症状。", "mention_data": [{"mention": "psa", "label": "实验室检验", "offset": "88"}, {"mention": "超声引导上经直肠前列腺穿刺活检术", "label": "手术", "offset": "100"}, {"mention": "前列腺增生", "label": "疾病和诊断", "offset": "122"}, {"mention": "哈乐", "label": "药物", "offset": "133"}, {"mention": "保列治", "label": "药物", "offset": "136"}, {"mention": "腰痛", "label": "症状", "offset": "181"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "214"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "241"}, {"mention": "心前区", "label": "解剖部位", "offset": "262"}]}
{"text": "患者五个月前以直肠恶性肿瘤于我院行直肠癌根治术,术后一个月因腹腔脓肿于我院行抗炎抑酸补液对症治疗一月余后出院,11月22日因“不完全肠梗阻”入院,经保守治疗症状缓解后12月8日出院,今自述一周前为做肠镜服用和爽1小时后开始恶心,呕吐,腹痛,腹泻,呕吐物为胃内容物,同时开始发热,体温最高可达39℃,自服“美林”后可降至37.5℃。三日来不停打嗝,现为求进一步诊治,来我院就诊。患者病来无头晕、头痛,无胸闷、心慌、气短,无呼吸困难,四肢乏力,精神状态较差,纳差,小便尚可,睡眠不佳。", "mention_data": [{"mention": "直肠恶性肿瘤", "label": "疾病和诊断", "offset": "7"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "17"}, {"mention": "腹腔脓肿", "label": "疾病和诊断", "offset": "30"}, {"mention": "不完全肠梗阻", "label": "疾病和诊断", "offset": "63"}, {"mention": "和爽", "label": "药物", "offset": "103"}, {"mention": "腹痛", "label": "症状", "offset": "117"}, {"mention": "腹泻", "label": "症状", "offset": "120"}, {"mention": "胃", "label": "解剖部位", "offset": "127"}, {"mention": "美林", "label": "药物", "offset": "152"}, {"mention": "头晕", "label": "症状", "offset": "193"}, {"mention": "头痛", "label": "症状", "offset": "196"}, {"mention": "胸闷", "label": "症状", "offset": "200"}, {"mention": "心慌", "label": "症状", "offset": "203"}, {"mention": "四肢", "label": "解剖部位", "offset": "215"}]}
{"text": "患者40余年前开始出现胃脘部不适,于当地门诊行胃镜检查结果示:“慢性胃炎”,未系统住院治疗,自行服用抑酸、保护胃黏膜药物治疗,病情好转后即停药,后胃脘部不适反复发作,均自行口服药物治疗,病情时轻时重。后于我院复查胃镜示“慢性萎缩性胃炎”,病情进一步进展,6月前患者复查胃镜示“胃早癌”,遂于我院肝胆外科行“胃早癌剥离术”,术后患者一般情况尚可,偶有胃脘部胀痛,伴嗝气,无乏力,无反酸、烧心,无恶心、呕吐,无头晕、头痛,无心慌、胸闷,现为复查胃镜及求术后进一步内科巩固诊治来我科就诊,门诊以“胃早癌剥离术后”收入院。叒叒叒患者自发病以来,神志清,精神可,食欲差,睡眠可,大小便未见明显异常,发病以来体重未见上降。", "mention_data": [{"mention": "胃脘部", "label": "解剖部位", "offset": "11"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "32"}, {"mention": "胃", "label": "解剖部位", "offset": "55"}, {"mention": "胃脘部", "label": "解剖部位", "offset": "73"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "110"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "138"}, {"mention": "胃早癌剥离术", "label": "手术", "offset": "153"}, {"mention": "胃脘部", "label": "解剖部位", "offset": "174"}, {"mention": "头晕", "label": "症状", "offset": "203"}, {"mention": "头痛", "label": "症状", "offset": "206"}, {"mention": "心慌", "label": "症状", "offset": "210"}, {"mention": "胸闷", "label": "症状", "offset": "213"}, {"mention": "胃早癌剥离术后", "label": "疾病和诊断", "offset": "245"}]}
{"text": "患者2011年4月因\\\"体检发现肝占位5天\\\"于本院诊断为肝癌,2012年4月13日行肝癌+胆囊切除,术中发现肿瘤大小约3.7x3.5cm,无卫星灶,无血管侵犯,术后病理中分化肝细胞癌。患者术前afp1459ng/ml,术后降至正常。术后未行其它抗肿瘤治疗。4月19日在本院复查ct提示肝癌术后肝s4小结节,10x9mm,较前增大,怀疑复发,现为进一步治疗入院。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,,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": "16"}, {"mention": "肝", "label": "解剖部位", "offset": "29"}, {"mention": "肝癌+胆囊切除", "label": "手术", "offset": "43"}, {"mention": "血管", "label": "解剖部位", "offset": "76"}, {"mention": "肝", "label": "解剖部位", "offset": "88"}, {"mention": "ct", "label": "影像检查", "offset": "139"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "143"}, {"mention": "肝s4", "label": "解剖部位", "offset": "147"}, {"mention": "腹痛", "label": "症状", "offset": "192"}, {"mention": "腹胀", "label": "症状", "offset": "196"}]}
{"text": "患者于5年前无明显诱因出现返酸、烧心症状,时有恶心、剑突上疼痛疼痛不适,自服“胃炎颗粒”后下述症状减轻,每日大便2次,分别于晨起及早餐后一段时间出现,有里急感,大便粘腻不成形,无嗳气,无腹胀,无头痛、头晕,无心慌、胸闷,曾于2013-04-15于我院门诊行胃肠镜检查,胃镜示:反流性食管炎(la-b)、糜烂性胃炎,结肠镜示升结肠近肝曲见一无蒂息肉,大小约0.4cm*0.5cm,并行内镜上切除术,术后未规律口服药物治疗,自觉术后大便好转,无明显里急感,近5年来仍有反酸、烧心、剑突上疼痛、恶心不适,一般于下午出现,无午夜痛。近半年来患者出现起床后及早餐后需立即大便的情况,里急感明显,大便呈糊状,粘腻,有时呈淡黑色,非柏油样便,午餐及晚餐后无便意,今为求进一步治疗遂来我院就诊,门诊以“反流性食管炎、慢性胃炎、结肠息肉术后”收住我科病房住院治疗。叒叒叒患者自发病以来,神志清,精神可,饮食、睡眠可,小便无异常,大便同前,体重无明显变化。", "mention_data": [{"mention": "剑突", "label": "解剖部位", "offset": "26"}, {"mention": "胃炎颗粒", "label": "药物", "offset": "39"}, {"mention": "腹胀", "label": "症状", "offset": "93"}, {"mention": "头痛", "label": "症状", "offset": "97"}, {"mention": "头晕", "label": "症状", "offset": "100"}, {"mention": "心慌", "label": "症状", "offset": "104"}, {"mention": "胸闷", "label": "症状", "offset": "107"}, {"mention": "反流性食管炎(la-b)", "label": "疾病和诊断", "offset": "138"}, {"mention": "糜烂性胃炎", "label": "疾病和诊断", "offset": "151"}, {"mention": "升结肠", "label": "解剖部位", "offset": "161"}, {"mention": "肝曲", "label": "解剖部位", "offset": "165"}, {"mention": "内镜上切除术", "label": "手术", "offset": "191"}, {"mention": "剑突", "label": "解剖部位", "offset": "238"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "343"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "350"}, {"mention": "结肠息肉术后", "label": "疾病和诊断", "offset": "355"}]}
{"text": "患者于2009-2-1于本院胃胰科行胃癌根治术,术后胃癌术后pt3n2m0,术后奥沙利铂+卡培他滨联合化疗5疗程,化疗毒副作用大未完成化疗,定期复查未见复发,2月余前患者出现腰骶部疼痛不适,就诊我院行盆腔ct示骶椎骨质破坏并软组织肿块,符合骨转移瘤,期间予羟考酮口服镇痛治疗后疼痛较前缓解,于2017-02-15在超声引导上行骶尾部肿物穿刺术,术后病理示转移性低分化腺癌,今为进一步治疗,2月以来,患者精神、食欲、睡眠欠佳,大小便不畅,体重上降不详。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "18"}, {"mention": "胃癌术后pt3n2m0", "label": "疾病和诊断", "offset": "26"}, {"mention": "奥沙利铂", "label": "药物", "offset": "40"}, {"mention": "卡培他滨", "label": "药物", "offset": "45"}, {"mention": "腰骶部", "label": "解剖部位", "offset": "87"}, {"mention": "盆腔ct", "label": "影像检查", "offset": "100"}, {"mention": "骶椎骨", "label": "解剖部位", "offset": "105"}, {"mention": "骨转移瘤", "label": "疾病和诊断", "offset": "120"}, {"mention": "羟考酮", "label": "药物", "offset": "128"}, {"mention": "超声", "label": "影像检查", "offset": "157"}, {"mention": "骶尾部肿物穿刺术", "label": "手术", "offset": "163"}, {"mention": "转移性低分化腺癌", "label": "疾病和诊断", "offset": "177"}]}
{"text": ",患者2017年1月开始出现进食有哽噎感,伴进食后胸骨后疼痛,伴反酸,无恶心、呕吐,无呕血、黑便,无咳嗽、气促,无声嘶、呛咳。当时未重视,后进食哽噎感较前加重,并出现2次进食后呕血,为鲜红色血块,量约数毫升,遂来我院就诊,做超声胃镜提示“距门齿25-29cm食管右后壁菜花样肿物,因胃腔大量食物潴留,未行超声胃镜”,ct提示“食管胸下段管壁不均匀增厚,考虑食管癌可能大。两侧气管食管沟小淋巴结”,于2017年02月13日行机器人辅助上三切口食管癌根治术。术程顺利,,术后病理:(食管大体)镜检为食管低分化鳞状细胞癌,癌组织浸润至食管壁外膜层;可见脉管内癌栓及神经束侵犯;切缘(-);淋巴结阳性(0/19)。,诊断:胸下段食管低分化鳞癌(pt3n0m0,iib)。术后恢复良好。2017-4-13、2017-5-13行tp方案辅助化疗2程。现为上程化疗入院,起病以来,患者精神、食欲、睡眠尚可,术后食管有异物感,食量有所减少,大小便正常。近期体重上降约7kg。", "mention_data": [{"mention": "胸骨后疼痛", "label": "症状", "offset": "25"}, {"mention": "超声胃镜", "label": "影像检查", "offset": "112"}, {"mention": "门齿", "label": "解剖部位", "offset": "120"}, {"mention": "食管", "label": "解剖部位", "offset": "129"}, {"mention": "胃", "label": "解剖部位", "offset": "141"}, {"mention": "ct", "label": "影像检查", "offset": "158"}, {"mention": "食管", "label": "解剖部位", "offset": "163"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "178"}, {"mention": "两侧气管食管沟小淋巴结", "label": "解剖部位", "offset": "185"}, {"mention": "机器人辅助上三切口食管癌根治术", "label": "手术", "offset": "211"}, {"mention": "食管", "label": "解剖部位", "offset": "239"}, {"mention": "食管低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "247"}, {"mention": "食管", "label": "解剖部位", "offset": "264"}, {"mention": "胸下段食管低分化鳞癌(pt3n0m0,iib)", "label": "疾病和诊断", "offset": "307"}, {"mention": "食管", "label": "解剖部位", "offset": "398"}]}
{"text": ",患者于5月前无明显诱因出现下腹隐痛,与饮食无明显相关,无泛酸、嗳气,无恶心、呕吐、呕血,无腹泻、腹胀,无黑便、便血、粘液便,,于我院行胃镜检查示:胃体下部小弯肿物,大小3×3㎝。,病理:低分化腺癌。为进一步诊治来我院就诊。起病以来,患者无头晕、头痛,无发热、咳嗽、咳痰、胸闷、胸痛,精神体力一般,食欲上降,睡眠一般,小便正常,体重较前无明显上降。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "14"}, {"mention": "腹泻", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "胃体", "label": "解剖部位", "offset": "74"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "94"}, {"mention": "头晕", "label": "症状", "offset": "120"}, {"mention": "头痛", "label": "症状", "offset": "123"}, {"mention": "胸闷", "label": "症状", "offset": "136"}, {"mention": "胸痛", "label": "症状", "offset": "139"}]}
{"text": "患者4年前因乙状结肠癌于我院行结肠癌根治术,术后定期化疗。8月前于我院就诊,行相关检查后提示结肠癌术后两肺多发转移,给予化疗5周期,方案为伊替立康200mg叒d1、d8+亚叶酸钙300mg叒d2-6+替加氟1000mg叒d2-6同时给予升白、止吐,保肝等对症治疗。院外期间,患者无发热,仍有腹痛不适,无恶心呕吐,现患者为求进一步诊治再次来我院就诊,门诊以“结肠癌术后复发”收住入院。叒叒患者自发病以来,神志清、精神可,饮食、睡眠可,大便、小便无明显异常,体重无明显改变。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "6"}, {"mention": "结肠癌根治术", "label": "手术", "offset": "15"}, {"mention": "结肠癌术后两肺多发转移", "label": "疾病和诊断", "offset": "46"}, {"mention": "伊替立康", "label": "药物", "offset": "69"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "85"}, {"mention": "替加氟", "label": "药物", "offset": "100"}, {"mention": "肝", "label": "解剖部位", "offset": "125"}, {"mention": "腹痛", "label": "症状", "offset": "145"}, {"mention": "结肠癌术后复发", "label": "疾病和诊断", "offset": "178"}]}
{"text": "患者5月前于我院行腹腔镜辅助上探查+直肠癌根治术叒,术后恢复好,叒病理检查回示:直肠溃疡型中-低分化管状腺癌,浸及肠壁深肌层,脉管内见癌栓。下切端及肛门均未见癌累及。肠壁下淋巴结未见癌转移(0/15),分期t2n0m0,于下月在我院行第1次化疗,化疗期间及出院后无恶心、呕吐,无腹胀、腹泻,无手臂及口周麻木,今日患者为求第2次化疗治疗,至我院就诊,门诊以“直肠腺癌术后”收入院。\\u0004叒叒叒患者发病以来,神志清晰,精神可,胃纳可,睡眠可,大便如下所诉,小便正常,体重较前无明显变化。", "mention_data": [{"mention": "腹腔镜辅助上探查+直肠癌根治术", "label": "手术", "offset": "9"}, {"mention": "直肠溃疡型中-低分化管状腺癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "肠", "label": "解剖部位", "offset": "57"}, {"mention": "肛门", "label": "解剖部位", "offset": "74"}, {"mention": "肠壁下淋巴结", "label": "解剖部位", "offset": "83"}, {"mention": "腹胀", "label": "症状", "offset": "139"}, {"mention": "腹泻", "label": "症状", "offset": "142"}, {"mention": "手臂", "label": "解剖部位", "offset": "146"}, {"mention": "口", "label": "解剖部位", "offset": "149"}, {"mention": "直肠腺癌术后", "label": "疾病和诊断", "offset": "178"}, {"mention": "胃", "label": "解剖部位", "offset": "214"}]}
{"text": ",患者于8个月前出现腹痛、呕吐、腹胀,可排大便。腹痛阵发性剧烈绞痛,伴有呕吐,呕吐物为食物或胃液,间歇出现,呕吐后腹痛有所缓解。曾在我院急诊行保守治疗好转出院。7个月前病人下诉症状再次出现,并伴有便血症状,不伴有发热。入我院肝胆外科,于2012-8-10行根治性左半结肠切除术,术中见盆腔内无转移结节,肝脏无转移结节。肿瘤位于结肠肝区,大小约3*1.5cm,已经绕肠管近2/3,部分浆膜受侵。术后病理为(左半结肠)高中分化腺癌,侵及浆膜,术中未见淋巴结转移,病理号z0439304。,免疫组化:,a2:ck7(灶状+)ck20(+)ca199(+)cea(+)ki67(+50%)p53(+)。,术后分期:pt4anxm0。术后腹泻、血便等不适症状改善,恢复良好。2012-10-31始入我科进行xelox方案术后辅助化疗5周期,,具体为:奥沙利铂200毫克d1,希罗达3000毫克日二次口服。下周期后出现ii度手足综合症,ii度骨髓抑制,中度乏力,给予对症处理后好转。现为进一步治疗入我科。患者病来饮食一般,睡眠差,精神体力差,周身无疼痛,二便基本正常,体重无明显变化,kps评分80分。\\u0004患者冠心病、高血压病史6年,具体用药不详,控制可。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "10"}, {"mention": "腹胀", "label": "症状", "offset": "16"}, {"mention": "腹痛", "label": "症状", "offset": "24"}, {"mention": "胃", "label": "解剖部位", "offset": "46"}, {"mention": "腹痛", "label": "症状", "offset": "57"}, {"mention": "根治性左半结肠切除术", "label": "手术", "offset": "128"}, {"mention": "盆腔", "label": "解剖部位", "offset": "142"}, {"mention": "肝脏", "label": "解剖部位", "offset": "151"}, {"mention": "结肠", "label": "解剖部位", "offset": "163"}, {"mention": "肝区", "label": "解剖部位", "offset": "165"}, {"mention": "肠管", "label": "解剖部位", "offset": "182"}, {"mention": "(左半结肠)高中分化腺癌", "label": "疾病和诊断", "offset": "201"}, {"mention": "淋巴结转移", "label": "疾病和诊断", "offset": "223"}, {"mention": "腹泻", "label": "症状", "offset": "314"}, {"mention": "奥沙利铂", "label": "药物", "offset": "370"}, {"mention": "希罗达", "label": "药物", "offset": "382"}, {"mention": "手足综合症", "label": "疾病和诊断", "offset": "406"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "415"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "503"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "507"}]}
{"text": "患者2010年8月12日于我科全麻上行全子宫、两附件、大网膜及阑尾切除术,术后诊断为卵巢腺癌(包含移行细胞癌及浆液性腺癌成分)iiic期(左卵巢及输卵管、大网膜),术后行4次化疗,末次化疗时间2011年1月4日。2年前出现肝转移,于介入科先后共行3次肝动脉化疗栓塞术,手术顺利。术后行8次化疗,末次化疗时间2013-06-14。1年前复查彩超提示阴道断端见类圆形低密度影,直径约2cm,遂于2014-1-16、2014-2-20、2014-3-5、2014-04-04行tp化疗,2014年4月3日于介入科在局部麻醉上行经皮肝穿胆道引流术,现为求进一步治疗入我科。患者出院至今自述肝区疼痛,未处置,无发热,无恶心呕吐,饮食睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "全子宫、两附件、大网膜及阑尾切除术", "label": "手术", "offset": "19"}, {"mention": "卵巢腺癌", "label": "疾病和诊断", "offset": "42"}, {"mention": "移行细胞癌", "label": "疾病和诊断", "offset": "49"}, {"mention": "浆液性腺癌", "label": "疾病和诊断", "offset": "55"}, {"mention": "左卵巢", "label": "解剖部位", "offset": "69"}, {"mention": "输卵管", "label": "解剖部位", "offset": "73"}, {"mention": "大网膜", "label": "解剖部位", "offset": "77"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "111"}, {"mention": "肝动脉化疗栓塞术", "label": "手术", "offset": "125"}, {"mention": "阴道", "label": "解剖部位", "offset": "173"}, {"mention": "经皮肝穿胆道引流术", "label": "手术", "offset": "260"}, {"mention": "肝区", "label": "解剖部位", "offset": "290"}]}
{"text": "患者3月前因“进食哽噎感1月余”第1次入院,完善相关辅助检查,根据患者病史、症状体征、影像学表现、胃镜检查及活检病理,诊断食管癌明确,排除手术禁忌后,于2014.12.26在全麻上行食管癌根治术,术后病理(201420400)示“食管鳞状细胞癌(低分化)”,术后给予抗炎、胃肠减压、化痰、雾化、止酸及营养支持等治疗,术后恢复良好。考虑患者脉管内查见癌栓,给予“恩度”抗肿瘤、口服“替吉奥”及“奈达铂120mg叒d1”全身化疗治疗,同时给予止吐、保肝及提高免疫力等综合治疗,患者恢复良好,顺利出院,于2015-02-27日给予“奈达铂120mg叒d1”化疗治疗,患者恢复良好,顺利出院。叒叒叒患者自下次出院以来,精神、饮食睡眠可,无声音嘶哑及饮水呛咳,无胸闷、胸痛,无恶心、呕吐,无胸骨后不适,无腹痛、腹泻,今为求进一步治疗,再次来我院就诊,门诊以“食管癌术后”收入院。患者自出院后,精神、饮食睡眠可,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "食管癌", "label": "疾病和诊断", "offset": "61"}, {"mention": "食管癌根治术", "label": "手术", "offset": "91"}, {"mention": "食管鳞状细胞癌(低分化)", "label": "疾病和诊断", "offset": "115"}, {"mention": "胃肠", "label": "解剖部位", "offset": "136"}, {"mention": "恩度", "label": "药物", "offset": "180"}, {"mention": "替吉奥", "label": "药物", "offset": "190"}, {"mention": "奈达铂", "label": "药物", "offset": "196"}, {"mention": "肝", "label": "解剖部位", "offset": "223"}, {"mention": "奈达铂", "label": "药物", "offset": "263"}, {"mention": "胸闷", "label": "症状", "offset": "326"}, {"mention": "胸痛", "label": "症状", "offset": "329"}, {"mention": "胸骨后", "label": "解剖部位", "offset": "340"}, {"mention": "腹痛", "label": "症状", "offset": "347"}, {"mention": "腹泻", "label": "症状", "offset": "350"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "374"}]}
{"text": "患者6月前主因“陶土样大便21天,皮肤黄染、尿黄14天。”入我院感染科治疗,行下腹部ct提示1.肝门区占位,考虑胆管细胞癌可能,并肝内胆管明显扩张,完善相关辅助检查,排除手术禁忌,于2015-8-17行肝门部胆管癌根治术,术后病人病情恢复可,遵医嘱出院。3天前,患者无明显诱因发现原肝门部胆管癌手术瘢痕处大小约3cm包块,伴疼痛,疼痛呈持续性进行性加重,伴红肿,包块呈进行性增大,触之皮肤增高,可触及波动感,无全身发热、寒战,无恶心、呕吐,无心悸、气促,无纳差等不适,患者未予以重视,未做特殊处理。1天前,患者下述症状加重,遂就诊于我院门诊,门诊行腹部彩超提示切口处皮上软组织水肿,大小约6.0*1.9cm,其内无回声区,考虑积液可能,建议患者住院治疗。今日患者为求来我院门诊就诊,门诊以“腹壁包块待查”收治入院。\\u0004叒叒叒患者神志清晰,精神可,胃无纳差,大便如常,小便可,体重无明显变化。", "mention_data": [{"mention": "皮肤", "label": "解剖部位", "offset": "17"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "39"}, {"mention": "肝门区占位", "label": "疾病和诊断", "offset": "48"}, {"mention": "胆管细胞癌", "label": "疾病和诊断", "offset": "56"}, {"mention": "肝内胆管", "label": "解剖部位", "offset": "65"}, {"mention": "肝门部胆管癌根治术", "label": "手术", "offset": "101"}, {"mention": "肝门部胆管癌手术", "label": "手术", "offset": "141"}, {"mention": "皮肤", "label": "解剖部位", "offset": "192"}, {"mention": "心悸", "label": "症状", "offset": "221"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "274"}, {"mention": "腹壁", "label": "解剖部位", "offset": "345"}, {"mention": "胃", "label": "解剖部位", "offset": "377"}]}
{"text": "患者诉10年前无明显诱因出现反酸、烧心,胸闷、憋气,无恶心、呕吐,无肢体活动障碍及意识丧失,无咳嗽、咳痰,下述症状呈阵发性,多发作于活动及平卧时。2011.5.12因“反复下腹部隐痛伴烧心泛酸”于我院消化内科住院治疗,行胃镜检查提示:浅表萎缩性胃炎伴急性活动。病理诊断叒(胃窦)慢性萎缩性胃炎(中度),局部腺体肠下皮化生。给予抑酸、保护胃黏膜及补液对症支持治疗,症状缓解后出院。出院后患者未规律服药,后下述症状反复发作,患者未接受规律服药治疗。15天前患者自觉反酸症状加重,伴有胸骨后异物感,无意识丧失,无心前区疼痛及颈部紧缩感,无恶心、呕吐,无咳嗽、咳痰及其他不适,遂来我院就诊,给予“艾司奥美拉唑镁肠溶片”口服治疗,患者症状稍缓解,现为行进一步诊治,复来我院就诊,门诊以“反流性食管炎叒冠心病”收入院。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "20"}, {"mention": "肢体", "label": "解剖部位", "offset": "34"}, {"mention": "下腹部", "label": "解剖部位", "offset": "86"}, {"mention": "浅表萎缩性胃炎", "label": "疾病和诊断", "offset": "117"}, {"mention": "(胃窦)慢性萎缩性胃炎(中度)", "label": "疾病和诊断", "offset": "135"}, {"mention": "胃黏膜", "label": "解剖部位", "offset": "168"}, {"mention": "胸骨后", "label": "解剖部位", "offset": "239"}, {"mention": "心前区", "label": "解剖部位", "offset": "253"}, {"mention": "颈部", "label": "解剖部位", "offset": "259"}, {"mention": "艾司奥美拉唑镁肠溶片", "label": "药物", "offset": "294"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "338"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "345"}]}
{"text": ",患者于1月前因“下腹部不适伴发热1天”入住我院消化内科,,检查示mrcp示:符合胆囊及胆总管多发结石并胆系扩张mr及mrcp表现。,诊断为:胆源性胰腺炎、胆总管结石;给予保肝、补液、抑酸等对症治疗一般情况好转。经我科**主任会诊转入我科行手术治疗。排除手术禁忌,于2016-09-28在全麻上行腹腔镜胆囊切除+胆总管切开取石+t管引流术,术后给予保肝等支持治疗,,行t管造影示:胆道通畅,未见明显狭窄。给予出院。自下次出院后患者无发热、腹痛、腹胀等不适,t管引流通畅,引流出约500ml/d金黄色液体。现患者为求进一步诊疗来我院就诊,门诊以“胆石症术后”收入我科。叒叒叒患者自发下次出院以来,神志清,精神一般,大、小便正常,饮食欠佳,睡眠可,近期体重无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "9"}, {"mention": "mrcp", "label": "影像检查", "offset": "33"}, {"mention": "胆囊", "label": "解剖部位", "offset": "41"}, {"mention": "胆总管", "label": "解剖部位", "offset": "44"}, {"mention": "mr", "label": "影像检查", "offset": "56"}, {"mention": "mrcp", "label": "影像检查", "offset": "59"}, {"mention": "胆源性胰腺炎", "label": "疾病和诊断", "offset": "71"}, {"mention": "胆总管结石", "label": "疾病和诊断", "offset": "78"}, {"mention": "肝", "label": "解剖部位", "offset": "87"}, {"mention": "腹腔镜胆囊切除+胆总管切开取石+t管引流术", "label": "手术", "offset": "148"}, {"mention": "肝", "label": "解剖部位", "offset": "175"}, {"mention": "t管造影", "label": "影像检查", "offset": "184"}, {"mention": "胆道", "label": "解剖部位", "offset": "190"}, {"mention": "腹痛", "label": "症状", "offset": "219"}, {"mention": "腹胀", "label": "症状", "offset": "222"}, {"mention": "胆石症术后", "label": "疾病和诊断", "offset": "272"}]}
{"text": "患者4+月前以\\\"腹痛20天,发现左侧附件包块2天\\\",于4个半月前在全麻上行输尿管d-j管置入+剖腹探查+肠粘连分解+盆腔包块切除+放射性粒子置入术。术后病检回示倾向于颗粒细胞瘤。行bep方案化疗,化疗顺利。化疗期间患者生命体征平稳,患者有恶心呕吐等药物毒副反应,化疗后复查血图分析示白细胞上降,予特尔津升白治疗。现患者一般情况好,无发热畏寒,无恶心呕吐,大小便正常,生命体征正常,心肺未见明显异常。3月17日血图wbc叒0.7×109/l,在我院血液内科行升白细胞治疗,今日遵出院医嘱为第5次化疗入院。\\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,睡眠欠佳,大便正常,小便正常,体重增加。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "9"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "17"}, {"mention": "输尿管d-j管置入+剖腹探查+肠粘连分解+盆腔包块切除+放射性粒子置入术", "label": "手术", "offset": "39"}, {"mention": "颗粒细胞瘤", "label": "疾病和诊断", "offset": "85"}, {"mention": "特尔津", "label": "药物", "offset": "150"}, {"mention": "心", "label": "解剖部位", "offset": "192"}, {"mention": "肺", "label": "解剖部位", "offset": "193"}, {"mention": "wbc", "label": "实验室检验", "offset": "208"}]}
{"text": "缘于10年前因“胃癌”在**总院行“全胃切除术”,术后恢复良好。1年前在总院复查全腹ct未见异常。1月前出现纳差,伴明显消瘦、乏力,无下腹痛,不伴畏寒、发热、腹胀、返酸、烧心、嗳气、呃逆、恶心、呕吐,无午后低热、盗汗,无尿频、尿急、尿痛,未行进一步检查及治疗。今为求进一步诊治就诊我院,门诊拟“胃癌术后”收入我科。自发病来,精神欠佳,饮食欠佳,睡眠欠佳,大便如前述,小便如前述,体重减少15kg。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "全胃切除术", "label": "手术", "offset": "18"}, {"mention": "全腹ct", "label": "影像检查", "offset": "40"}, {"mention": "下腹痛", "label": "症状", "offset": "67"}, {"mention": "腹胀", "label": "症状", "offset": "79"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "147"}]}
{"text": ",患者约50天前因“查体发现胆总管结石、胆囊结石4月余。”入院,患者当时无腹痛、腰背部及肩背部放射痛,无心前区疼痛,无心慌、胸闷,无发热、寒战,无反酸,无吞咽困难,无呕血、黑便,无咳嗽、咳痰,无尿频、尿急、尿痛。患者当时胆囊引流管每天引流出400ml胆汁,患者入院后完善检查,胆总管结石、胆囊结石伴胆囊炎诊断明确,给予抗感染及保肝等治疗,患者病情逐渐稳定。于2013-07-31在全麻上行胆囊切除术+胆总管切开取石+t管引流。手术顺利,术后恢复良好。术后病理(,病理号:9501.2013),:慢性胆囊炎。病情稳定后好转出院。患者出院后,服用消炎利胆片药物治疗,一般情况尚可,未诉明显不适,t管已夹闭,患者皮肤无黄染,无发热,无恶心呕吐,无明显腹痛、腹胀,患者为求复查治疗,来我院就诊,以“胆石症术后”入院。叒叒叒患者发病以来,神志清,精神可,饮食睡眠可,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "胆总管结石", "label": "疾病和诊断", "offset": "14"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "20"}, {"mention": "腹痛", "label": "症状", "offset": "37"}, {"mention": "腰背部", "label": "解剖部位", "offset": "40"}, {"mention": "肩背部", "label": "解剖部位", "offset": "44"}, {"mention": "心前区", "label": "解剖部位", "offset": "52"}, {"mention": "心慌", "label": "症状", "offset": "59"}, {"mention": "胸闷", "label": "症状", "offset": "62"}, {"mention": "胆囊", "label": "解剖部位", "offset": "110"}, {"mention": "胆总管结石", "label": "疾病和诊断", "offset": "138"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "144"}, {"mention": "胆囊炎", "label": "疾病和诊断", "offset": "149"}, {"mention": "肝", "label": "解剖部位", "offset": "164"}, {"mention": "胆囊切除术+胆总管切开取石+t管引流", "label": "手术", "offset": "194"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "247"}, {"mention": "消炎利胆片", "label": "药物", "offset": "271"}, {"mention": "皮肤", "label": "解剖部位", "offset": "303"}, {"mention": "腹痛", "label": "症状", "offset": "322"}, {"mention": "腹胀", "label": "症状", "offset": "325"}, {"mention": "胆石症术后", "label": "疾病和诊断", "offset": "345"}]}
{"text": "患者因“便血3月余”入院,经肠镜及病理检查确诊乙状结肠腺癌。外院影像学检查提示肝肺多发转移。分期为ct4n1m1,iv期。患者经综合科病例讨论建议先行手术治疗。2012年6月1日全麻上行腹腔镜dixon术,术后恢复良好。病理示:中分化腺癌,浸润至浆膜上层,6/15ln+,可疑脉管癌栓。分期pt3n2m1b,ivb,后于2012-6-21行xelox方案化疗1次,后分别于2012-7-16、2012-8-6、8-27、9-18行xelox+avastin化疗4程,过程顺利,患者现为行上一程化疗入院。自下次出院以来,患者无恶心、呕吐等,无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,大便3次/天,体重上降不明显。", "mention_data": [{"mention": "乙状结肠腺癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "肝肺多发转移", "label": "疾病和诊断", "offset": "39"}, {"mention": "腹腔镜dixon术", "label": "手术", "offset": "93"}, {"mention": "ln", "label": "解剖部位", "offset": "132"}, {"mention": "avastin", "label": "药物", "offset": "221"}, {"mention": "骶部", "label": "解剖部位", "offset": "282"}]}
{"text": ",患者于5个月前无明显诱因出现腹痛,为餐后痛,伴夜间痛,伴反酸烧心,无恶心、呕吐,无发热,无肩膀及后背痛,在我院查胃镜示复合溃疡,胃溃疡表面覆血痂,反流性食管炎;,病理示:(胃体)粘膜充血糜烂,轻度急慢性发炎,hp(-);,结肠镜检查示:直肠炎,直肠息肉。,肝胆胰脾肾超声:左肾多发囊肿。入院后给予抑酸、保护胃黏膜、抗溃疡治疗18天后,复查胃镜示溃疡已愈合。出院后继续口服“铝碳酸镁片、替普瑞酮胶囊、埃索美拉唑肠溶片”药物治疗半月,自行停药,3天前患者出现反酸烧心,为进一步治疗来我院,门诊以“反流性食管炎”收入院。叒叒叒患者自发病以来,饮食、睡眠尚可,大便2-3天1次,小便正常,体重上降约5公斤。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "15"}, {"mention": "肩膀", "label": "解剖部位", "offset": "46"}, {"mention": "后背", "label": "解剖部位", "offset": "49"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "65"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "74"}, {"mention": "胃体", "label": "解剖部位", "offset": "87"}, {"mention": "直肠炎", "label": "疾病和诊断", "offset": "119"}, {"mention": "直肠息肉", "label": "疾病和诊断", "offset": "123"}, {"mention": "肝胆", "label": "解剖部位", "offset": "129"}, {"mention": "胰", "label": "解剖部位", "offset": "131"}, {"mention": "脾", "label": "解剖部位", "offset": "132"}, {"mention": "肾", "label": "解剖部位", "offset": "133"}, {"mention": "左肾多发囊肿", "label": "疾病和诊断", "offset": "137"}, {"mention": "胃黏膜", "label": "解剖部位", "offset": "154"}, {"mention": "铝碳酸镁片", "label": "药物", "offset": "187"}, {"mention": "替普瑞酮胶囊", "label": "药物", "offset": "193"}, {"mention": "埃索美拉唑肠溶片", "label": "药物", "offset": "200"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "247"}]}
{"text": ",患者2015.1无明显诱因出现右下腹胀痛不适,无寒战发热,无恶心呕吐,无反酸嗳气,休息后可缓解,大便未见明显异常,饮食无明显异常。2015.7.14患者骑车出行时,右下腹突然出现剧烈绞痛感,无寒战高热,休息后缓解,食欲差,进食少,恶心,嗳气,无反酸呕吐,无大便。2015.7.16患者发热至37.7℃,就诊于**********,,行腹部超声示:“右腹混合性团块”,,血常规示:“白细胞11.9*10^9/l,血红蛋白92g/l”。2015.7.17大便1次,大便呈黄色条状质硬干燥便,量少,未见鲜血。患者随后于2015.7.18就诊于我院,行腹盆ct平扫+,强化示:“右肾小囊肿,脾大,降结肠占位”。排除手术禁忌后于2015.7.28在全麻上行根治性右半结肠切除术+空肠部分切除术,,病理检查结果:(结肠)中低分化腺癌,溃疡型,肿瘤切面积8*2.5cm。侵透外膜达周围脂肪组织。下上切缘未查见癌,肠周淋巴结呈0/18转移。(空肠)肠壁充血出血及较多急慢性炎细胞浸润。(肠系膜上根部血管)淋巴结呈0/3转移。患者后为行进一步治疗入我科,排除化疗禁忌后于2015.9.1、2015.9.29、2015.10.21、2015-11-14、2015-12-08行folfox方案化疗5周期。现患者为行进一步治疗入院。患者自发病以来,患者一般情况可,睡眠一般,饮食前述,大便前述,小便正常,体重无明显变化。", "mention_data": [{"mention": "右下腹", "label": "解剖部位", "offset": "16"}, {"mention": "右下腹", "label": "解剖部位", "offset": "83"}, {"mention": "腹部超声", "label": "影像检查", "offset": "168"}, {"mention": "右腹", "label": "解剖部位", "offset": "175"}, {"mention": "白细胞", "label": "实验室检验", "offset": "191"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "206"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "273"}, {"mention": "右肾小囊肿", "label": "疾病和诊断", "offset": "286"}, {"mention": "脾大", "label": "症状", "offset": "292"}, {"mention": "降结肠占位", "label": "疾病和诊断", "offset": "295"}, {"mention": "根治性右半结肠切除术", "label": "手术", "offset": "324"}, {"mention": "空肠部分切除术", "label": "手术", "offset": "335"}, {"mention": "(结肠)中低分化腺癌", "label": "疾病和诊断", "offset": "351"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "400"}, {"mention": "(空肠)肠壁", "label": "解剖部位", "offset": "413"}, {"mention": "肠系膜上根部血管", "label": "解剖部位", "offset": "436"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "445"}]}
{"text": "患者自述1年前无明显诱因出现反酸烧心伴有恶心,未吐,未系统诊治,自服抑酸药物可缓解。于2013年1月前因腹泻就诊于我院,行胃镜检查示胃窦溃疡伴高级别下皮内肿瘤。后2013-1-11于我院肝胆外科行胃癌根治术,术后病理为进展期胃癌,低分化腺癌,肿物浸透浆膜,淋巴结5/5枚转移,病理号为z0446836,临床分期为胃腺癌(t3an2m0,iiib期)。术后不适消失。现恢复良好,为进一步治疗入我科。患者近1月来饮食睡眠一般,精神体力可,无痛,二便基本正常,体重无明显变化,ps评分1分。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "胃窦溃疡", "label": "疾病和诊断", "offset": "66"}, {"mention": "肝", "label": "解剖部位", "offset": "93"}, {"mention": "胆", "label": "解剖部位", "offset": "94"}, {"mention": "胃癌根治术", "label": "手术", "offset": "98"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "112"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "128"}, {"mention": "胃腺癌", "label": "疾病和诊断", "offset": "156"}]}
{"text": "缘于入院1周前突感左上肢肿痛并逐渐加重,为持续性钝痛,以左小腿为重,伴左小腿红肿、皮温高,皮肤色素沉着,久立或久行后症状加重,抬高患肢可略缓解。无患肢发凉、浅表血管曲张、紫绀,无间歇性跛行,无腰痛、咳嗽、咯血等不适。未行特殊治疗患肢肿胀无明显变化。今为进一步治疗,门诊拟“急性左上肢深静脉血栓形成伴感染”遂收入我科。自发病以来无明显胸闷、气短,无发烧,精神状态一般,食欲一般,睡眠良好,体重无明显变化,大便正常,小便正常。", "mention_data": [{"mention": "左上肢", "label": "解剖部位", "offset": "9"}, {"mention": "左小腿", "label": "解剖部位", "offset": "28"}, {"mention": "左小腿", "label": "解剖部位", "offset": "35"}, {"mention": "皮肤", "label": "解剖部位", "offset": "45"}, {"mention": "腰痛", "label": "症状", "offset": "96"}, {"mention": "急性左上肢深静脉血栓形成伴感染", "label": "疾病和诊断", "offset": "136"}, {"mention": "胸闷", "label": "症状", "offset": "166"}]}
{"text": "患者近4.5年前无明显诱因出现左上腹坠痛,同时伴有大便性状改变,形状变细,大便带血,呈暗红色,大便次数无明显改变,行肠镜示肿瘤可能性大,遂于我院普外科行根治性左半结肠切除术,术中见肿物6*7厘米,侵透浆膜,术后病理示印戒细胞癌,断端未见癌。手术后无明显不适。后入我科诊断为结肠癌术后(pt4nxm0),遂给予folfox方案化疗12周期,具体为艾恒150毫克d1,同奥0.3d1,方克6.2d1泵控5毫升/小时,化疗过程中曾出现iii度骨髓抑制,无其他不适,化疗期间及化疗后复查未见疾病复发转移,患者近1月前常规复查行腹部ct示疾病复发,遂给予伊力替康联合雷替曲塞方案化疗1周期,具体为:伊力替康(忆迈林)280毫克d1,雷替曲塞(塞维健)5.1d1,化疗后无明显不适,现距末次化疗3周,现为进一步治疗入我科,近1月来神志清,精神可,自述无痛,大、小便正常,饮食可,体重无明显变化,kps评分90分。", "mention_data": [{"mention": "左上腹", "label": "解剖部位", "offset": "15"}, {"mention": "大便带血", "label": "解剖部位", "offset": "37"}, {"mention": "根治性左半结肠切除术", "label": "手术", "offset": "76"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "136"}, {"mention": "艾恒", "label": "药物", "offset": "172"}, {"mention": "同奥", "label": "药物", "offset": "182"}, {"mention": "方克", "label": "药物", "offset": "190"}, {"mention": "骨髓抑制", "label": "症状", "offset": "218"}, {"mention": "腹部ct", "label": "影像检查", "offset": "259"}, {"mention": "伊力替康", "label": "药物", "offset": "272"}, {"mention": "雷替曲塞", "label": "药物", "offset": "278"}, {"mention": "伊力替康", "label": "药物", "offset": "294"}, {"mention": "忆迈林", "label": "药物", "offset": "299"}, {"mention": "雷替曲塞", "label": "药物", "offset": "311"}, {"mention": "塞维健", "label": "药物", "offset": "316"}]}
{"text": "患者5+月前因“阵发性腹痛,伴肛门停止排气、排便2天”入院。入院后腹部ct检查提示:乙状结肠降结肠交界处局部肠壁增厚,管腔狭窄,浆膜面毛糙,遂行右半结肠根治性切除术,术后恢复好,病理提示t4n0m0。已于我可行规律化疗4次,未诉特殊不适,现患者一般情况可,无腹痛、腹胀、恶心、呕吐、畏寒、发热等症状,拟行第5次化疗入院。\\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,小便正常,体重未见明显上降。", "mention_data": [{"mention": "阵发性腹痛", "label": "症状", "offset": "8"}, {"mention": "腹部ct", "label": "影像检查", "offset": "33"}, {"mention": "乙状结肠降结肠交界处", "label": "解剖部位", "offset": "42"}, {"mention": "肠壁", "label": "解剖部位", "offset": "54"}, {"mention": "管腔", "label": "解剖部位", "offset": "59"}, {"mention": "右半结肠根治性切除术", "label": "手术", "offset": "72"}, {"mention": "腹痛", "label": "症状", "offset": "129"}, {"mention": "腹胀", "label": "症状", "offset": "132"}]}
{"text": "患者5月前因“大便性状改变伴便血1月”于2014-06-30在全麻上行腹腔辅助上直肠癌根治术(dixon)+放射性粒子植入术,手术顺利,安返病房,术后病检:直肠中-低分化管状腺癌(含粘液腺癌成份),浸及肠壁全层,癌侵犯脉管及神经。双切端未见癌累及。肠壁下淋巴结见癌转移(2/11)。cea(++)叒ck(++)叒lck(+++)叒ki-67(++)50%叒p53(+++)叒cerbb-2(-)叒egfr(+)叒gst-π(+)叒pgp(+)叒topoii(++)叒ab(+)叒pas(+)。患者前3次化疗期间无明显恶心呕吐、腹胀腹痛等不适,下次化疗期间患者出现恶心呕吐,无腹胀腹痛,现患者一般情况尚可,精神、睡眠、食欲可,无腹痛、腹胀、恶心、呕吐、寒战、发热等。患者为求第5次化疗,遂来我院,门诊以“直肠癌术后”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": "腹腔辅助上直肠癌根治术(dixon)+放射性粒子植入术", "label": "手术", "offset": "35"}, {"mention": "直肠中-低分化管状腺癌(含粘液腺癌成份)", "label": "疾病和诊断", "offset": "78"}, {"mention": "肠壁全层", "label": "解剖部位", "offset": "101"}, {"mention": "肠壁下淋巴结", "label": "解剖部位", "offset": "124"}, {"mention": "腹胀", "label": "症状", "offset": "263"}, {"mention": "腹痛", "label": "症状", "offset": "265"}, {"mention": "腹胀", "label": "症状", "offset": "287"}, {"mention": "腹痛", "label": "症状", "offset": "289"}, {"mention": "腹痛", "label": "症状", "offset": "313"}, {"mention": "腹胀", "label": "症状", "offset": "316"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "351"}, {"mention": "胃", "label": "解剖部位", "offset": "388"}]}
{"text": ",缘于入院前2个月因“肝内外胆管结石伴急性胆管炎胆囊结石伴急性胆囊炎肝脓肿伴肝周积液”于我科诊治,因患者腹腔炎症脓肿严重,无法行肝叶切除术,故行“胆总管切开取石+胆囊切除+肝上脓肿切开引流+腹腔粘连松解+t管引流术”,,术后病理:(膈肌),:送检组织镜上为增生伴玻璃样变的纤维组织和少量横纹肌组织,间质多量慢性炎症细胞浸润及泡沫样组织细胞形成。,免疫组化:ki67(5%+),cd68(+++),cd163(组织细胞阳性+++),ck(pan)(-),ema(个别细胞阳性),sma(+++),actin(pan)(++),desmin(-)。(胆囊),:慢性胆囊炎,浆膜面血管扩张充血,肉芽组织增生。术后患者切口愈合欠佳,腹腔引流管持续有脓液流出,,复查t管造影示:胆道呈术后改变,胆总管上段外侧改变,考虑占位性病变,残留结石?胆管炎。现患者切口愈合良好,腹腔引流管仍有偏脓性液体流出,今为复查,求诊我院,门诊拟“胆道术后肝内胆管结石”收住入院。自下次出院以来,精神、饮食欠佳,睡眠一般,大便5日未排,小便正常,体重未见明显减轻。", "mention_data": [{"mention": "肝内外胆管结石", "label": "疾病和诊断", "offset": "11"}, {"mention": "急性胆管炎", "label": "疾病和诊断", "offset": "19"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "24"}, {"mention": "急性胆囊炎", "label": "疾病和诊断", "offset": "29"}, {"mention": "肝脓肿", "label": "疾病和诊断", "offset": "34"}, {"mention": "肝周积液", "label": "疾病和诊断", "offset": "38"}, {"mention": "腹腔", "label": "解剖部位", "offset": "52"}, {"mention": "肝叶切除术", "label": "手术", "offset": "64"}, {"mention": "胆总管切开取石+胆囊切除+肝上脓肿切开引流+腹腔粘连松解+t管引流术", "label": "手术", "offset": "73"}, {"mention": "膈肌", "label": "解剖部位", "offset": "116"}, {"mention": "胆囊", "label": "解剖部位", "offset": "273"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "278"}, {"mention": "血管", "label": "解剖部位", "offset": "287"}, {"mention": "腹腔", "label": "解剖部位", "offset": "312"}, {"mention": "胆道", "label": "解剖部位", "offset": "334"}, {"mention": "胆总管上段", "label": "解剖部位", "offset": "342"}, {"mention": "胆管炎", "label": "疾病和诊断", "offset": "365"}, {"mention": "腹腔", "label": "解剖部位", "offset": "379"}, {"mention": "胆道术后肝内胆管结石", "label": "疾病和诊断", "offset": "408"}]}
{"text": "患者于半年前无明显诱因出现下腹部烧灼感,伴烧心,易恶心、呕吐,无腹痛、腹泻,无反酸,遂来我院就诊,行电子胃镜检查,结果示:十二指肠球炎(报告未见)。给予奥美拉唑抑酸治疗,效果可。10余日前无明显诱因出现大便后滴血,最大量约40-50滴,鲜红色,偶有喷血,鲜红色,伴肛门坠胀感,伴乏力,偶有恶心、嗝气,大便次数较前增加,3次/天,无反酸、烧心,无腹痛、腹泻,无发热。现为进一步治疗,门诊以“便血原因待查”收入我科。患者自发病以来,饮食、睡眠尚可。小便未见明显异常。体重较前减少1kg。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "13"}, {"mention": "腹痛", "label": "症状", "offset": "32"}, {"mention": "腹泻", "label": "症状", "offset": "35"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "61"}, {"mention": "奥美拉唑", "label": "药物", "offset": "76"}, {"mention": "肛门坠胀", "label": "症状", "offset": "132"}, {"mention": "腹痛", "label": "症状", "offset": "172"}, {"mention": "腹泻", "label": "症状", "offset": "175"}]}
{"text": "患者因“反复下腹痛10余年”于2015-10-12第一次收入我科,入院查体:心肺查体无明显异常。腹部平坦,腹软,下腹部有压痛,无反跳痛。肝、脾肋上未触及,murphy's征阴性,肝、肾区无叩痛,肠鸣音无亢进,移动性浊音阴性。两上肢不肿。入院后给予抑酸、护胃等治疗,并行内镜上胃息肉切除术,病情好转,出院。叒叒叒出院后继续口服“雷贝拉唑肠溶片、l-谷氨酰胺颗粒”治疗。2月前无明显诱因再次出现间断下腹痛,呈隐痛,偶感针刺样疼痛,与进食无明显相关性,伴黑便,约3次/天,无黏液脓血便,偶感胸闷,无反酸、烧心,无进食梗阻感,无恶心、呕吐,无腹胀、腹泻,无胸痛、发热,无咳嗽、咳痰,现为求进一步诊治,遂来我院,门诊以“黑便”收入院。叒叒叒患者自起病以来,神志清,精神可,饮食、睡眠可,大便如下所述,小便无明显异常,近期体重无明显变化。", "mention_data": [{"mention": "下腹痛", "label": "症状", "offset": "6"}, {"mention": "心", "label": "解剖部位", "offset": "38"}, {"mention": "肺", "label": "解剖部位", "offset": "39"}, {"mention": "腹部", "label": "解剖部位", "offset": "48"}, {"mention": "腹", "label": "解剖部位", "offset": "53"}, {"mention": "下腹部", "label": "解剖部位", "offset": "56"}, {"mention": "肝", "label": "解剖部位", "offset": "68"}, {"mention": "脾", "label": "解剖部位", "offset": "70"}, {"mention": "肋上", "label": "解剖部位", "offset": "71"}, {"mention": "肝", "label": "解剖部位", "offset": "89"}, {"mention": "肾区", "label": "解剖部位", "offset": "91"}, {"mention": "肠鸣", "label": "症状", "offset": "97"}, {"mention": "两上肢", "label": "解剖部位", "offset": "112"}, {"mention": "胃", "label": "解剖部位", "offset": "127"}, {"mention": "内镜上胃息肉切除术", "label": "手术", "offset": "134"}, {"mention": "雷贝拉唑肠溶片", "label": "药物", "offset": "163"}, {"mention": "l-谷氨酰胺颗粒", "label": "药物", "offset": "171"}, {"mention": "下腹痛", "label": "症状", "offset": "197"}, {"mention": "胸闷", "label": "症状", "offset": "242"}, {"mention": "腹胀", "label": "症状", "offset": "267"}, {"mention": "腹泻", "label": "症状", "offset": "270"}, {"mention": "胸痛", "label": "症状", "offset": "274"}]}
{"text": "缘于入院前1年进食后觉腹胀、嗳气,偶有下腹痛,为轻度阵发性隐痛,可耐受,与体位无关,无放射痛,持续时间半小时到3小时不等。无畏冷、发热、气促,无反酸、恶心、呕吐,无呕血、黑便、腹泻。无胸闷、胸痛、心悸。于我院门诊就诊,行胃镜检查示慢性萎缩性胃炎,予保胃、促进胃肠动力等治疗后症状改善。但随后腹胀、嗳气仍反复发作,自行服用“胃药”(具体不详)后症状可改善。近期来再次感腹胀、嗳气、早饱,无胸闷、胸痛、心悸,无腹痛、腹泻、黑便等不适。今为求进一步治疗,门诊拟“慢性萎缩性胃炎”收入院。发病以来,精神、饮食、睡眠一般,大小便正常,体重无明显变化。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "11"}, {"mention": "下腹痛", "label": "症状", "offset": "19"}, {"mention": "腹泻", "label": "症状", "offset": "88"}, {"mention": "胸闷", "label": "症状", "offset": "92"}, {"mention": "胸痛", "label": "症状", "offset": "95"}, {"mention": "心悸", "label": "症状", "offset": "98"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "115"}, {"mention": "胃", "label": "解剖部位", "offset": "125"}, {"mention": "胃肠", "label": "解剖部位", "offset": "129"}, {"mention": "腹胀", "label": "症状", "offset": "145"}, {"mention": "胃", "label": "解剖部位", "offset": "161"}, {"mention": "腹胀", "label": "症状", "offset": "183"}, {"mention": "胸闷", "label": "症状", "offset": "193"}, {"mention": "胸痛", "label": "症状", "offset": "196"}, {"mention": "心悸", "label": "症状", "offset": "199"}, {"mention": "腹痛", "label": "症状", "offset": "203"}, {"mention": "腹泻", "label": "症状", "offset": "206"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "228"}]}
{"text": "患者8个月前因消化道梗阻,皮肤巩膜黄染诊断胰头占位,于2012-4-24在我院全麻上行胰十二指肠切除术,上腔静脉癌残留,病理示胰头中低分化腺癌,肿瘤最大径3.4cm,侵犯壶腹区肠壁全层及胰周脂肪,淋巴结可见癌转移(1/11);患者术后半年上腔静脉残余肿瘤增长至静脉栓塞,行抗凝治疗。患者2天前出现停止排气排便,伴有腹痛腹胀,考虑肠梗阻。患者自行肌注300u胰岛素,现为行进一步治疗急诊收住院。患者自诊断肠梗阻以来,神清,精神差,未进饮食,未排便。体重无变化。", "mention_data": [{"mention": "消化道梗阻", "label": "疾病和诊断", "offset": "7"}, {"mention": "皮肤", "label": "解剖部位", "offset": "13"}, {"mention": "巩膜", "label": "解剖部位", "offset": "15"}, {"mention": "胰头占位", "label": "疾病和诊断", "offset": "21"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "43"}, {"mention": "上腔静脉", "label": "解剖部位", "offset": "52"}, {"mention": "胰头中低分化腺癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "壶腹", "label": "解剖部位", "offset": "85"}, {"mention": "肠壁", "label": "解剖部位", "offset": "88"}, {"mention": "胰周脂肪", "label": "解剖部位", "offset": "93"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "98"}, {"mention": "上腔静脉", "label": "解剖部位", "offset": "119"}, {"mention": "腹痛", "label": "症状", "offset": "157"}, {"mention": "腹胀", "label": "症状", "offset": "159"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "164"}, {"mention": "胰岛素", "label": "药物", "offset": "178"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "201"}]}
{"text": ",入院前1个月于我院体检胃镜发现“胃体小弯侧前壁见一糜烂灶,中央稍凹陷”,,活检病理提示:“中度不典型增生”,,内镜诊断:“胃体糜烂伴中度不典型增生”,无反酸、嗳气,无胸部闷痛,无腹痛、腹胀,无恶心、呕吐、心悸、气促,无吞咽困难、进食阻塞感,无呕血、黑便,无消瘦、食欲减退等,予口服“制酸、保胃”药物(具体不详)治疗后,1天前于我院行放大胃镜检查提示“病灶中央腺管结构紊乱,微血管较密集,可见边界线”。今为行内镜上进一步治疗,门诊拟“胃体糜烂伴中度不典型增生”收我科。自发病以来,精神、睡眠、饮食尚可,二便正常,体重无明显改变。", "mention_data": [{"mention": "胃体小弯侧前壁", "label": "解剖部位", "offset": "17"}, {"mention": "胃体糜烂伴中度不典型增生", "label": "疾病和诊断", "offset": "62"}, {"mention": "胸部", "label": "解剖部位", "offset": "84"}, {"mention": "腹痛", "label": "症状", "offset": "90"}, {"mention": "腹胀", "label": "症状", "offset": "93"}, {"mention": "心悸", "label": "症状", "offset": "103"}, {"mention": "胃", "label": "解剖部位", "offset": "146"}, {"mention": "血管", "label": "解剖部位", "offset": "188"}, {"mention": "胃体糜烂伴中度不典型增生", "label": "疾病和诊断", "offset": "217"}]}
{"text": "患者于6月前因饮酒、辛辣饮食后出现便血,为鲜红色,患者未重视,未行任何治疗,5月前就诊于我院,行肠镜提示:直肠肿瘤,行“腹腔镜辅助上直肠癌根治术(dixon)+回肠襻氏造瘘+放射粒子置入术”,术后恢复可,目前已行4次化疗治疗,期间患者一般状况可,今患者为行上一步治疗,门诊以“直肠肿瘤术后为行第5次化疗”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": "直肠肿瘤", "label": "疾病和诊断", "offset": "53"}, {"mention": "直肠癌根治术(dixon)+回肠襻氏造瘘+放射粒子置入术", "label": "手术", "offset": "66"}, {"mention": "直肠肿瘤术后", "label": "疾病和诊断", "offset": "138"}, {"mention": "胃", "label": "解剖部位", "offset": "183"}]}
{"text": "患者2月前无明显诱因出现腹泻,4-5次/天,稀水样便,服药治疗未见缓解。1月前自行扪及左上腹部包块,伴间歇夜间发热、体温最高39度,可自行缓解,无血便,无腹痛、腹胀,无恶心、呕吐,恶心等,无头晕、乏力、发热等不适。外院肠镜检查提示距肛58cm环周肿物,内镜无法通过,活检病理提示腺癌。遂于2015-09-24行腹腔镜上左半结肠切除术,术后恢复可,有排气排便。2015-10-15、2015-11-03予xelox方案化疗2程,现遵主诊教授意见继续行术后辅助化疗入院。患者起病以来,无发热、乏力、咳嗽、气促、身目黄染等,精神睡眠可,胃纳一般,小便可,体重上降2kg。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "12"}, {"mention": "左上腹部", "label": "解剖部位", "offset": "43"}, {"mention": "腹痛", "label": "症状", "offset": "77"}, {"mention": "腹胀", "label": "症状", "offset": "80"}, {"mention": "头晕", "label": "症状", "offset": "95"}, {"mention": "肛", "label": "解剖部位", "offset": "116"}, {"mention": "腹腔镜上左半结肠切除术", "label": "手术", "offset": "155"}, {"mention": "胃", "label": "解剖部位", "offset": "265"}]}
{"text": "缘于4月前无明显诱因出现两上肢疼痛、发凉、麻木、水肿,尤以活动后明显,休息后可略缓解,无明显苍白、活动障碍,无发热、纳差、消瘦、腰痛、放射痛,伴有间歇性跛行,行走30米后出现小腿乏力,疼痛,呈进行性加重,夜间无疼痛。3个月前出现右足第1、2趾远端色泽变暗,伴肿胀、疼痛,进行性加重,且范围逐渐扩大,颜色渐变深至黑色。就诊于***治疗,予输液治疗后好转,具体药物不详。1月前右第1、2足趾变黑处皮肤破溃,伴黄白色脓性分泌物流出,量约2ml/日。遂就诊我院血管外科,诊断两上肢动脉硬化闭塞症伴坏疽,于2015年03月13日在局麻上行右上肢动脉造影+右上肢动脉置管溶栓术,2015年03月17日在局麻上行右侧上肢动脉pta+stent+右上肢动脉置管溶栓术,因右股浅动脉远端严重闭塞,术后予溶栓治疗后,于2015年03月20日在局麻上再次行右侧上肢动脉pta+stent术,术后予抗凝、抗血小板、补液、制酸等处理,术后右足发凉、肿胀、疼痛等症状明显改善,右第1、2足趾疼痛减轻,变黑范围无再扩大。今为进一步治疗,门诊拟以“右第1、2足趾坏疽”收住院。病后精神状态较差,食欲较差,睡眠较差,大便正常,小便正常,体重无明显变化。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "12"}, {"mention": "腰痛", "label": "症状", "offset": "64"}, {"mention": "小腿乏力", "label": "症状", "offset": "87"}, {"mention": "右足第1、2趾远端", "label": "解剖部位", "offset": "114"}, {"mention": "右第1、2足趾", "label": "解剖部位", "offset": "186"}, {"mention": "皮肤", "label": "解剖部位", "offset": "196"}, {"mention": "血管", "label": "解剖部位", "offset": "226"}, {"mention": "两上肢动脉硬化闭塞症伴坏疽", "label": "疾病和诊断", "offset": "233"}, {"mention": "右上肢动脉造影+右上肢动脉置管溶栓术", "label": "手术", "offset": "264"}, {"mention": "右侧上肢动脉pta+stent+右上肢动脉置管溶栓术", "label": "手术", "offset": "299"}, {"mention": "右股浅动脉远端", "label": "解剖部位", "offset": "327"}, {"mention": "右侧上肢动脉pta+stent术", "label": "手术", "offset": "367"}, {"mention": "右足", "label": "解剖部位", "offset": "406"}, {"mention": "右第1、2足趾", "label": "解剖部位", "offset": "424"}, {"mention": "右第1、2足趾坏疽", "label": "疾病和诊断", "offset": "458"}]}
{"text": "患者3个多月前因\\\"便血1年余,加重3月\\\"我院就诊,经完善检查诊断为乙状结肠癌,于2011-9-28全麻上行手术,术中发现肿瘤位于乙状结肠,固定,侵犯输尿管、膀胱,术中请泌尿科会诊,无法分离输尿管,遂行乙状结肠造瘘,术后恢复顺利,术后于2011-10-17至2011-11-17起行放疗共46gy/23次,并同期于2011-10-13给予xelox方案、2011-11-8给予folfox6方案化疗2周期,末次放疗时间2011.11.17,末次化疗时间2011.11.8,疗程顺利,复查mr示肿物缩小,现为求进一步诊治入住我院,患者自发病以来,食欲、睡眠及精神良好,小便正常,体力无上降,体重无明显上降。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "66"}, {"mention": "输尿管", "label": "解剖部位", "offset": "76"}, {"mention": "膀胱", "label": "解剖部位", "offset": "80"}, {"mention": "输尿管", "label": "解剖部位", "offset": "96"}, {"mention": "乙状结肠造瘘", "label": "手术", "offset": "102"}, {"mention": "mr", "label": "影像检查", "offset": "244"}]}
{"text": ",入院前4+天患者因饮酒后出现阵发性中下腹胀痛,每次持续数秒钟,自行缓解,伴嗳气,无反酸、恶心、呕吐、呕血、黑便,无头晕、心悸、面色苍白,无黄疸、尿黄、腹胀、纳差、厌油,无消瘦、乏力,无胸闷、胸痛、心前区压榨感、濒死感,无畏寒、发热、寒战,未予任何处理。1天前出现黑便,共1次,约200g,无呕血,无头晕、心悸、面色苍白,,昨日于我院门诊行2014-10-14门诊胃镜检查:急性胃黏膜病变;心电图未见明显异常;,腹部彩超:1.肝回声增多2.左肾囊肿3.胆胰脾右肾未见异常后予抑酸护胃治疗后黑便好转,但仍有阵发性腹痛,现为进一步治疗门诊以“急性胃黏膜病变”收入我科。患病以来精神食欲睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "18"}, {"mention": "头晕", "label": "症状", "offset": "58"}, {"mention": "心悸", "label": "症状", "offset": "61"}, {"mention": "腹胀", "label": "症状", "offset": "76"}, {"mention": "胸闷", "label": "症状", "offset": "93"}, {"mention": "胸痛", "label": "症状", "offset": "96"}, {"mention": "心前区", "label": "解剖部位", "offset": "99"}, {"mention": "头晕", "label": "症状", "offset": "150"}, {"mention": "心悸", "label": "症状", "offset": "153"}, {"mention": "胃黏膜", "label": "解剖部位", "offset": "189"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "206"}, {"mention": "肝", "label": "解剖部位", "offset": "213"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "220"}, {"mention": "胆", "label": "解剖部位", "offset": "226"}, {"mention": "胰", "label": "解剖部位", "offset": "227"}, {"mention": "脾", "label": "解剖部位", "offset": "228"}, {"mention": "右肾", "label": "解剖部位", "offset": "229"}, {"mention": "胃", "label": "解剖部位", "offset": "240"}, {"mention": "阵发性腹痛", "label": "症状", "offset": "252"}, {"mention": "胃黏膜", "label": "解剖部位", "offset": "271"}]}
{"text": ",2016-01-20患者在我院体检胃镜发现胃窦、胃体各见一约1-1.2cm宽基息肉,,胃窦息肉活检病理示:胃粘膜慢性炎。,胃体息肉活检病理示:胃粘膜慢性活动性炎。患者无腹痛,无恶心、呕吐,无腹泻、便秘,无呕血、黑便。各项检查无禁忌,今日下午10am行内镜上胃多发息肉切除,过程顺利,术后为进一步观察收入院,患者起病以来,精神、胃纳、睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "胃窦", "label": "解剖部位", "offset": "22"}, {"mention": "胃体", "label": "解剖部位", "offset": "25"}, {"mention": "胃窦", "label": "解剖部位", "offset": "44"}, {"mention": "胃粘膜", "label": "解剖部位", "offset": "54"}, {"mention": "胃体", "label": "解剖部位", "offset": "62"}, {"mention": "胃粘膜", "label": "解剖部位", "offset": "72"}, {"mention": "腹痛", "label": "症状", "offset": "85"}, {"mention": "腹泻", "label": "症状", "offset": "96"}, {"mention": "内镜上胃多发息肉切除", "label": "手术", "offset": "126"}, {"mention": "胃", "label": "解剖部位", "offset": "164"}]}
{"text": "患者于2014-12-21日起床小便时突发头晕,呈视物旋转,伴恶心、呕吐,呕吐物为非咖啡色胃内容物,随即意识丧失、摔倒在地,被家属发现后急呼120来我院,急诊行脑、肺ct示“1.左基底节区低密度灶2.左肺下叶病变,较前无明显变化3.两肺炎症伴纤维灶4.两肺上叶钙化灶、轻度肺气肿5.心包积液、两侧胸腔积液”,急诊以“晕厥原因待查”收住我科,患者醒后发现右侧肢体活动不灵,2014-12-22日在我科做脑dwi示“左侧大脑半球多发急性梗死灶”,考虑“1.急性脑梗死2.高血压病(2级叒很高危)3.冠状动脉粥样硬化性心脏病叒心房颤动4.肺炎叒两侧胸腔积液5.心包积液6.慢性肾功能不全7.胃ca术后8.直肠ca术后9.胆囊摘除术”,给予“拜阿司匹林、氟伐他汀钠缓释片、低分子肝素钙、神经节苷酯、疏血通、舒普深、沐舒坦”等输液治疗,2014-12-30日因呼吸衰竭行气管插管呼吸机辅助呼吸,病情平稳后于2015-01-23日转入icu行气管切开后再转入我科继续治疗,患者好转后病情反复,反复多次入我科治疗,均治疗好转后出院。1月前患者因咳嗽咳痰、意识障碍较前加重,右侧肢体仍活动不灵,为求进一步治疗,我院门诊以“脑梗死、冠状动脉粥样硬化性心脏病、心房颤动、肺部感染”收入我科。叒叒叒患者自发病以来,神志清,精神尚可,气管切开状态,鼻饲饮食,留置导尿,大便正常。", "mention_data": [{"mention": "头晕", "label": "症状", "offset": "21"}, {"mention": "胃", "label": "解剖部位", "offset": "45"}, {"mention": "脑、肺ct", "label": "影像检查", "offset": "80"}, {"mention": "左基底节区", "label": "解剖部位", "offset": "89"}, {"mention": "左肺下叶", "label": "解剖部位", "offset": "100"}, {"mention": "两肺", "label": "解剖部位", "offset": "116"}, {"mention": "两肺上叶", "label": "解剖部位", "offset": "126"}, {"mention": "肺", "label": "解剖部位", "offset": "136"}, {"mention": "心包积液", "label": "症状", "offset": "141"}, {"mention": "两侧胸腔", "label": "解剖部位", "offset": "146"}, {"mention": "右侧肢体", "label": "解剖部位", "offset": "176"}, {"mention": "脑", "label": "解剖部位", "offset": "200"}, {"mention": "左侧大脑半球", "label": "解剖部位", "offset": "206"}, {"mention": "急性脑梗死", "label": "疾病和诊断", "offset": "226"}, {"mention": "高血压病", "label": "疾病和诊断", "offset": "233"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "247"}, {"mention": "肺炎", "label": "疾病和诊断", "offset": "266"}, {"mention": "两侧胸腔积液", "label": "疾病和诊断", "offset": "269"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "277"}, {"mention": "慢性肾功能不全", "label": "疾病和诊断", "offset": "283"}, {"mention": "胃ca术后", "label": "疾病和诊断", "offset": "292"}, {"mention": "直肠ca术后", "label": "疾病和诊断", "offset": "299"}, {"mention": "胆囊摘除术", "label": "手术", "offset": "307"}, {"mention": "拜阿司匹林", "label": "药物", "offset": "317"}, {"mention": "氟伐他汀钠缓释片", "label": "药物", "offset": "323"}, {"mention": "低分子肝素钙", "label": "药物", "offset": "332"}, {"mention": "神经节苷酯", "label": "药物", "offset": "339"}, {"mention": "疏血通", "label": "药物", "offset": "345"}, {"mention": "舒普深", "label": "药物", "offset": "349"}, {"mention": "沐舒坦", "label": "药物", "offset": "353"}, {"mention": "气管插管", "label": "手术", "offset": "380"}, {"mention": "气管切开", "label": "手术", "offset": "415"}, {"mention": "右侧肢体", "label": "解剖部位", "offset": "479"}, {"mention": "脑梗死", "label": "疾病和诊断", "offset": "503"}, {"mention": "冠状动脉粥样硬化性心脏病", "label": "疾病和诊断", "offset": "507"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "525"}, {"mention": "气管切开", "label": "手术", "offset": "555"}]}
{"text": "患者于5年前出现右上肢浅表蚯蚓状肿物,以久立、劳累后明显,休息并抬高患肢后可减轻。无患肢水肿、皮肤搔痒不适、脱屑、颜色改变。无上肢酸痛、疼痛、发热、头痛、恶心。未经诊治;7个月前右小腿前部出现一溃疡伤口,约黄豆大小,无出血、肿胀、皮肤搔痒不适、脱屑、颜色改变,就诊我院,查上肢静脉造影示:1、右上肢深静脉瓣膜关闭不全。2、右上肢大隐静脉曲张。3、右侧髂静脉压迫综合征。诊断“髂静脉压迫综合征、右上肢大隐静脉曲张”并行“右侧髂静脉球囊扩张成形术+支架置入术”术顺,术后恢复尚可,右上肢静脉仍有屈曲,小腿前部可见溃疡伤口,今为进一步治疗来我院门诊就诊,门诊以右上肢静脉曲张伴溃疡感染收入院。患者自发病以来精神、饮食、睡眠一般,体重无明显变化,大便正常,小便正常。", "mention_data": [{"mention": "右上肢", "label": "解剖部位", "offset": "8"}, {"mention": "皮肤", "label": "解剖部位", "offset": "47"}, {"mention": "上肢", "label": "解剖部位", "offset": "63"}, {"mention": "头痛", "label": "症状", "offset": "74"}, {"mention": "右小腿前部", "label": "解剖部位", "offset": "89"}, {"mention": "皮肤", "label": "解剖部位", "offset": "115"}, {"mention": "上肢静脉造影", "label": "影像检查", "offset": "136"}, {"mention": "右上肢深静脉瓣膜", "label": "解剖部位", "offset": "146"}, {"mention": "右上肢大隐静脉曲张", "label": "疾病和诊断", "offset": "161"}, {"mention": "右侧髂静脉压迫综合征", "label": "疾病和诊断", "offset": "173"}, {"mention": "髂静脉压迫综合征", "label": "疾病和诊断", "offset": "187"}, {"mention": "右上肢大隐静脉曲张", "label": "疾病和诊断", "offset": "196"}, {"mention": "右侧髂静脉球囊扩张成形术", "label": "手术", "offset": "209"}, {"mention": "支架置入术", "label": "手术", "offset": "222"}, {"mention": "右上肢静脉", "label": "解剖部位", "offset": "238"}, {"mention": "小腿前部", "label": "解剖部位", "offset": "248"}, {"mention": "右上肢静脉曲张伴溃疡感染", "label": "疾病和诊断", "offset": "277"}]}
{"text": "患者半年前起无明显诱因开始出现反复腹胀,症状多于午餐后出现,伴头昏、头痛、恶心、嗳气、便秘,大便约3天1次,黄色软便,量少,不带血或粘液,偶为黑便。无眩晕、耳鸣、黑曚,无畏寒、发热、黄疸,无反酸、腹痛、腹泻。患者自服“头痛粉、布洛芬”治疗头昏、头痛,并于我院就诊,行胃镜检查示“胃炎、胃溃疡”(未见报告),予以“奥美拉唑、泮托拉唑、西沙必利”等对症治疗,患者腹胀明显缓解,但停药后仍有反复发作。1周前患者患者停用“泮托拉唑”后腹胀加重,余症状同前,遂来我院就诊。\\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,大便如下所述,小便正常,体重无明显变化。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "17"}, {"mention": "头昏", "label": "症状", "offset": "31"}, {"mention": "头痛", "label": "症状", "offset": "34"}, {"mention": "腹痛", "label": "症状", "offset": "98"}, {"mention": "腹泻", "label": "症状", "offset": "101"}, {"mention": "头痛粉", "label": "药物", "offset": "109"}, {"mention": "布洛芬", "label": "药物", "offset": "113"}, {"mention": "头昏", "label": "症状", "offset": "119"}, {"mention": "头痛", "label": "症状", "offset": "122"}, {"mention": "胃炎", "label": "疾病和诊断", "offset": "139"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "142"}, {"mention": "奥美拉唑", "label": "药物", "offset": "156"}, {"mention": "泮托拉唑", "label": "药物", "offset": "161"}, {"mention": "西沙必利", "label": "药物", "offset": "166"}, {"mention": "腹胀", "label": "症状", "offset": "179"}, {"mention": "泮托拉唑", "label": "药物", "offset": "207"}, {"mention": "腹胀", "label": "症状", "offset": "213"}]}
{"text": ",患者于2011年12月12日在我院因诊断为“原发性肝癌”行肝癌切除术+胆囊切除术+门静脉置泵术,术后病理为低分化肝细胞肝癌,脉管内见癌栓,术后恢复良好,好转出院。2012年1月11日、2月13日、3月7日、3月31日、5月2日、5月28日、7月23日、9月20日、11月15日、2013年1月10日、3月12日、5月2日、7月4日、8月22日行酪丝亮肽临床试验14程,2012年5月2日复查ct提示肺转移瘤进展,2012年5月9日开始口服多吉美至今。2014-06-12日,查ct示:肝癌术后复查,对比2013-8-22叒,片:术区邻近包膜上积液,较前未见明显变化。两肺多发转移瘤,较前增多、增大。于6月16日转入我科,2014年6月17日在ct引导上左肺肿瘤射频消融术。后定期复查,2014-11-19胸腹部ct提示,左肺中叶病灶较前增大,考虑转移瘤。右肺下叶前段小结节,较前稍增大,考虑转移瘤可能。现为进一步诊治入我科。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,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": "原发性肝癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "肝癌切除术+胆囊切除术+门静脉置泵术", "label": "手术", "offset": "30"}, {"mention": "低分化肝细胞肝癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "酪丝亮肽", "label": "药物", "offset": "173"}, {"mention": "ct", "label": "影像检查", "offset": "196"}, {"mention": "肺转移瘤", "label": "疾病和诊断", "offset": "200"}, {"mention": "多吉美", "label": "药物", "offset": "220"}, {"mention": "ct", "label": "影像检查", "offset": "239"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "243"}, {"mention": "两肺多发转移瘤", "label": "疾病和诊断", "offset": "284"}, {"mention": "ct", "label": "影像检查", "offset": "322"}, {"mention": "左肺肿瘤射频消融术", "label": "手术", "offset": "327"}, {"mention": "胸腹部ct", "label": "影像检查", "offset": "353"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "361"}, {"mention": "右肺下叶", "label": "解剖部位", "offset": "378"}, {"mention": "腹痛", "label": "症状", "offset": "424"}, {"mention": "腹胀", "label": "症状", "offset": "428"}]}
{"text": "患者2小时前因“健康查体”就诊于我院,行胃肠镜检查显示,胃内多发息肉,行内镜上多发息肉切除,息肉不大,出血不多,肠镜检查显示有肠息肉,行内镜上切除。患者无明显腹痛、腹胀,无寒战、发热,无恶心、呕吐,无呕血、便血,无胸闷、憋喘。现为求进一步观察来我院,门诊以“腹痛”收住我院。叒叒叒叒叒叒叒患者神志清醒,精神良好,饮食正常,睡眠正常,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "胃内多发息肉", "label": "疾病和诊断", "offset": "28"}, {"mention": "内镜上多发息肉切除", "label": "手术", "offset": "36"}, {"mention": "肠息肉", "label": "疾病和诊断", "offset": "63"}, {"mention": "腹痛", "label": "症状", "offset": "79"}, {"mention": "腹胀", "label": "症状", "offset": "82"}, {"mention": "胸闷", "label": "症状", "offset": "107"}, {"mention": "腹痛", "label": "症状", "offset": "129"}]}
{"text": "缘于入院前60天出现左足第三趾红肿、疼痛,为阵发性针刺样疼痛,夜间为甚,并出现红肿疼痛处皮肤破溃、变黑,破溃变黑处流出黄白色脓液,量较少,伴有左足麻木、发凉,无法行走。无发热、畏冷、寒战等不适。后就诊我院,分别于2016年06月13日在局麻上行左侧足第3趾趾离断术+vsd置入术,术后查两上肢cta提示:两上肢cta粥样硬化改变,其中左侧腓动脉及右侧胫后动脉、腓动脉基本闭塞,余管腔不同程度狭窄,遂于2016年06月21日在局麻上行左侧上肢动脉造影+球囊扩张术,术后上肢皮温恢复。后于2016年06月27日及2016年07月16日行左侧皮肤及皮上组织清创术+vsd置入术。后因住院周期较久遂办理**手续。现为继续住院治疗拟“左足慢性溃疡伴感染”收入院。自发病以来,精神正常、食欲正常、睡眠正常、大小便正常,体重无明显改变。", "mention_data": [{"mention": "左足第三趾", "label": "解剖部位", "offset": "10"}, {"mention": "皮肤", "label": "解剖部位", "offset": "44"}, {"mention": "左足", "label": "解剖部位", "offset": "71"}, {"mention": "左侧足第3趾趾离断术+vsd置入术", "label": "手术", "offset": "122"}, {"mention": "两上肢cta", "label": "影像检查", "offset": "143"}, {"mention": "两上肢cta粥样硬化", "label": "疾病和诊断", "offset": "152"}, {"mention": "左侧腓动脉", "label": "解剖部位", "offset": "167"}, {"mention": "右侧胫后动脉", "label": "解剖部位", "offset": "173"}, {"mention": "腓动脉", "label": "解剖部位", "offset": "180"}, {"mention": "管腔", "label": "解剖部位", "offset": "189"}, {"mention": "左侧上肢动脉造影+球囊扩张术", "label": "手术", "offset": "216"}, {"mention": "上肢", "label": "解剖部位", "offset": "233"}, {"mention": "左侧皮肤及皮上组织清创术+vsd置入术", "label": "手术", "offset": "266"}, {"mention": "左足慢性溃疡伴感染", "label": "疾病和诊断", "offset": "312"}]}
{"text": "患者因\\\"直肠癌同期放化疗后\\\"于2012年5月25日在我院在全麻上行dixon手术,术后病理显示直肠中分化腺癌,癌组织浸润至肠壁外膜层,淋巴结及切缘未见转移。因术后10余天发现“阴道中有大便排出”于2012年6月25日行“横结肠两腔造瘘术+阴道修补术”。患者术后已于2012年8月3日始行xelox方案化疗二程,过程顺利,患者诉化疗后自觉手麻木3天,现已恢复。患者自发病以来,食欲、睡眠及精神良好,小便正常,体力无上降,体重无明显上降。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "dixon手术", "label": "手术", "offset": "35"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "49"}, {"mention": "肠壁外膜层", "label": "解剖部位", "offset": "63"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "69"}, {"mention": "阴道", "label": "解剖部位", "offset": "90"}, {"mention": "横结肠两腔造瘘术+阴道修补术", "label": "手术", "offset": "112"}, {"mention": "手麻", "label": "症状", "offset": "170"}]}
{"text": ",患者于2014-02-20在我院行腹腔镜上“广泛性全子宫+两附件切除术+盆腔淋巴结清扫术”,,病理组织报告提示:宫颈中分化鳞癌,浸及肌层2/3,累及颈管,脉管中见癌栓,神经未见癌侵犯,阴道壁残端未见癌累及,两侧宫旁,附件未见癌转移。送检淋巴结未见癌转移(0/9)。,术后诊断:宫颈鳞状细胞癌ib1期。予以“头孢唑肟钠叒奥硝唑氯化钠叒”抗炎、补液、对症治疗,患者体温骤升骤降,,阴道分泌物培养提示:大肠埃希氏菌多重耐药,后予以“亚胺培南(泰能)西斯他丁钠粉针”静滴治疗,体温恢复正常,复查血象恢复。分别于2014-03-14和201-04-12行“紫杉醇、奥沙利铂”静滴化疗,加用“奥美拉唑”护胃、“地塞米松”防过敏、“苯海拉明”防紫杉醇过敏、“托烷司琼”止吐、\\\"胸腺五肽\\\"增强免疫力叒补液叒对症等治疗,化疗后患者未诉恶心呕吐、腹痛腹泻等化疗副反应。出院后患者无头痛头晕、无乏力、无发热寒战、无胸闷气促、无腰背疼痛、无阴道流血、无上腹坠胀感、无尿频尿急等不适。现患者要求第3次化疗,门诊以“宫颈鳞癌术后三次化疗”收入我科。\\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,体重无明显变化。", "mention_data": [{"mention": "广泛性全子宫+两附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "23"}, {"mention": "宫颈中分化鳞癌", "label": "疾病和诊断", "offset": "57"}, {"mention": "颈管", "label": "解剖部位", "offset": "75"}, {"mention": "阴道壁", "label": "解剖部位", "offset": "93"}, {"mention": "两侧宫旁", "label": "解剖部位", "offset": "104"}, {"mention": "附件", "label": "解剖部位", "offset": "109"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "119"}, {"mention": "宫颈鳞状细胞癌ib1期", "label": "疾病和诊断", "offset": "139"}, {"mention": "头孢唑肟钠", "label": "药物", "offset": "154"}, {"mention": "奥硝唑氯化钠", "label": "药物", "offset": "160"}, {"mention": "阴道", "label": "解剖部位", "offset": "189"}, {"mention": "大肠", "label": "解剖部位", "offset": "199"}, {"mention": "亚胺培南", "label": "药物", "offset": "214"}, {"mention": "泰能", "label": "药物", "offset": "219"}, {"mention": "西斯他丁钠粉针", "label": "药物", "offset": "222"}, {"mention": "紫杉醇", "label": "药物", "offset": "274"}, {"mention": "奥沙利铂", "label": "药物", "offset": "278"}, {"mention": "奥美拉唑", "label": "药物", "offset": "291"}, {"mention": "胃", "label": "解剖部位", "offset": "297"}, {"mention": "地塞米松", "label": "药物", "offset": "300"}, {"mention": "苯海拉明", "label": "药物", "offset": "310"}, {"mention": "紫杉醇", "label": "药物", "offset": "316"}, {"mention": "托烷司琼", "label": "药物", "offset": "323"}, {"mention": "胸腺五肽", "label": "药物", "offset": "333"}, {"mention": "腹痛", "label": "症状", "offset": "366"}, {"mention": "腹泻", "label": "症状", "offset": "368"}, {"mention": "头痛头晕", "label": "症状", "offset": "383"}, {"mention": "胸闷", "label": "症状", "offset": "399"}, {"mention": "腰背", "label": "解剖部位", "offset": "405"}, {"mention": "阴道", "label": "解剖部位", "offset": "411"}, {"mention": "上腹", "label": "解剖部位", "offset": "417"}, {"mention": "宫颈鳞癌", "label": "疾病和诊断", "offset": "447"}]}
{"text": "入院前3周,患者因“反复中下腹痛2+年,加重3天”入我院消化科,行胃镜提示胃角巨大胃溃疡、局部结节样增生、胃壁僵硬、触之易出血,取病检提示胃腺癌,转入我科后于2014-11-14在全麻上行“腹腔镜上胃癌根治术(billroths叒ii式)”,术后病检(1409438):胃低分化腺癌浸润深肌层、淋巴结转移(2/14),术后分期为t3n1m0。术后恢复佳,无发热、恶心、腹痛、血便等不适,现患者为求进一步化疗求治我院,门诊以“胃癌术后,拟行第1次化疗”收入我科。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "12"}, {"mention": "胃角巨大胃溃疡", "label": "疾病和诊断", "offset": "37"}, {"mention": "胃壁", "label": "解剖部位", "offset": "53"}, {"mention": "胃腺癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "腹腔镜上胃癌根治术(billroths叒ii式)", "label": "手术", "offset": "95"}, {"mention": "胃低分化腺癌", "label": "疾病和诊断", "offset": "135"}, {"mention": "淋巴结转移", "label": "疾病和诊断", "offset": "147"}, {"mention": "腹痛", "label": "症状", "offset": "184"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "212"}]}
{"text": ",患者于1个月前于排便后滴鲜血,少量,大便正常,自述粪便与鲜血不混合,1-2次/日,伴肛门瘙痒感,无里急后重感,无腹痛、无发热,用肛泰栓后症状见好,并于盆浴时可摸到带蒂息肉,质软。,患者2016-3-15日于我院行胃镜检查示:浅表性胃炎,贲门糜烂,性质待定,良性病变可能大。,纤维结肠镜检查示:直肠息肉。于2016-03-18行13碳尿素呼气试验(幽门杆菌)dob值24.70,遂以2周为疗程服用抗酸、抗幽门螺杆菌和抗生素药物,近2日大便干结,不成形,颜色发黑,停用药物后症状好转,现为行息肉切除术入我科治疗。病来无发热、无恶心、呕吐,无腹痛,小便正常,精神、食欲可,体重无明显变化。叒高血压病病史6年,最高达180/120mmhg,自服硝苯地平缓释片后,血压控制可,维持在100/80mmhg右左。", "mention_data": [{"mention": "肛门瘙痒", "label": "症状", "offset": "43"}, {"mention": "腹痛", "label": "症状", "offset": "57"}, {"mention": "肛泰栓", "label": "药物", "offset": "65"}, {"mention": "浅表性胃炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "贲门", "label": "解剖部位", "offset": "119"}, {"mention": "直肠息肉", "label": "疾病和诊断", "offset": "147"}, {"mention": "息肉切除术", "label": "手术", "offset": "244"}, {"mention": "腹痛", "label": "症状", "offset": "269"}, {"mention": "硝苯地平缓释片", "label": "药物", "offset": "319"}]}
{"text": "患者五年前因“便血2月”入院,入院后完善肠镜等检查,经活检诊断为脾曲结肠癌,于2006-09-25行右半结肠切除术,术后未见明显不适,病理报告粘液腺癌累及肠壁全层,3/15ln(+)。术后于2006-11-01~2007-04-04行xelox化疗方案6程,化疗期间未见明显不良反应。患者一月前复查ct、b超发现“右结肠旁沟肿物”,经穿刺活检为粘液腺癌浸润;盆底结节穿刺活检报告为粘液腺癌。2012-05-18起予安维汀+folfiri化疗4次,曾有恶心、呕吐,对症处理后好转,3天前复查ct评价sd,现为求进一步诊治转来我院。自发病以来,患者无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,体重上降不明显。", "mention_data": [{"mention": "脾曲结肠癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "右半结肠切除术", "label": "手术", "offset": "50"}, {"mention": "肠壁全层", "label": "解剖部位", "offset": "77"}, {"mention": "ln", "label": "解剖部位", "offset": "86"}, {"mention": "ct", "label": "影像检查", "offset": "149"}, {"mention": "b超", "label": "影像检查", "offset": "152"}, {"mention": "右结肠", "label": "解剖部位", "offset": "157"}, {"mention": "盆底", "label": "解剖部位", "offset": "179"}, {"mention": "安维汀", "label": "药物", "offset": "207"}, {"mention": "ct", "label": "影像检查", "offset": "244"}, {"mention": "骶部", "label": "解剖部位", "offset": "285"}]}
{"text": "患者3年前无明显诱因反复出现反酸、中下腹不适,伴有恶心、嗳气,无呕吐、吞咽困难,无烧心,无腹痛、腹泻,曾行胃镜检查提示“慢性胃窦炎”(具体不详)。自服“吗丁啉”后症状缓解。1天前患者进食火锅及少量饮酒后感明显恶心、反酸,呕吐1次,为酸臭味胃内容物,量约250ml,伴下腹间断性隐痛。遂于我院就诊,门诊予以“奥美拉唑、依替米星、复合磷酸氢钾”静脉输液治疗后症状有所缓解,今为求进一步诊治,遂拟“呕吐待查”收入我科。\\u0004叒叒叒患者本次发叒病以来,食欲可,神志清,精神可,睡眠不佳,大便如常,小便如常,体重无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "17"}, {"mention": "腹痛", "label": "症状", "offset": "45"}, {"mention": "腹泻", "label": "症状", "offset": "48"}, {"mention": "慢性胃窦炎", "label": "疾病和诊断", "offset": "60"}, {"mention": "吗丁啉", "label": "药物", "offset": "76"}, {"mention": "胃", "label": "解剖部位", "offset": "119"}, {"mention": "下腹", "label": "解剖部位", "offset": "133"}, {"mention": "奥美拉唑", "label": "药物", "offset": "153"}, {"mention": "依替米星", "label": "药物", "offset": "158"}, {"mention": "复合磷酸氢钾", "label": "药物", "offset": "163"}]}
{"text": "患者于8月前我院诊断为“胃癌伴出血”,经积极准备后于2013.09.10腹腔镜辅助上胃癌根治术+区域淋巴结清扫+横结肠肠段切除+放射性粒子植入术,手术顺利,术后予以止血、抑酸、补液等对症支持治疗。2013-9-17叒组织病理检查报告:(胃大弯、小弯)溃疡型中分化管状腺癌,浸及胃壁全层达周围组织,侵犯粘连肠管,脉管、神经未见癌侵犯,双切端未见癌累及。胃大弯脂肪中见癌结节一枚,网膜中见多个癌结节,胃大、小弯淋巴结未见癌转移(0/6)。另送组织中未见癌。患者已进行4次化疗,1天前患者无明显诱因出现持续性腹胀,伴轻度腹痛,中上腹为主,无缓解因素,无恶心呕吐、无发热寒战、无腹泻等不适,昨日大便1次,为求进一步治疗,遂如我科。\\u0004叒叒叒患者自起病以来,精神可,进食稀饭,大便如常,小便正常,体重未见明显上降。", "mention_data": [{"mention": "胃癌伴出血", "label": "疾病和诊断", "offset": "12"}, {"mention": "胃癌根治术+区域淋巴结清扫+横结肠肠段切除+放射性粒子植入术", "label": "手术", "offset": "42"}, {"mention": "(胃大弯、小弯)溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "胃壁全层", "label": "解剖部位", "offset": "138"}, {"mention": "肠管", "label": "解剖部位", "offset": "152"}, {"mention": "脉管", "label": "解剖部位", "offset": "155"}, {"mention": "神经", "label": "解剖部位", "offset": "158"}, {"mention": "胃大弯脂肪", "label": "解剖部位", "offset": "175"}, {"mention": "胃", "label": "解剖部位", "offset": "198"}, {"mention": "小弯淋巴结", "label": "解剖部位", "offset": "201"}, {"mention": "腹胀", "label": "症状", "offset": "251"}, {"mention": "腹痛", "label": "症状", "offset": "257"}, {"mention": "中上腹", "label": "解剖部位", "offset": "260"}, {"mention": "腹泻", "label": "症状", "offset": "285"}]}
{"text": "患者入院15天前,因皮肤感染自服中药(具体不详)后出现中下腹不适,持续腹胀,无腹痛,无自行缓解因素,餐前餐后无加重,伴有恶心、反酸,无呕吐,无畏寒、发热,无咳嗽、咳痰,无胸闷、气促、呼吸困难;患者未予以重视,下述症状持续存在,入院双天前,患者出现便秘,无肛门坠胀感,今为求进一步诊治,遂入我院门诊就诊,行无痛性电子胃镜检查提示:慢性非萎缩性胃炎伴糜烂。腹部彩超提示胆囊炎、肝功异常。遂门诊以“胃炎、肝功异常”收入我科治疗。", "mention_data": [{"mention": "皮肤", "label": "解剖部位", "offset": "10"}, {"mention": "中下腹", "label": "解剖部位", "offset": "27"}, {"mention": "腹胀", "label": "症状", "offset": "35"}, {"mention": "腹痛", "label": "症状", "offset": "39"}, {"mention": "胸闷", "label": "症状", "offset": "85"}, {"mention": "肛门坠胀", "label": "症状", "offset": "127"}, {"mention": "慢性非萎缩性胃炎伴糜烂", "label": "疾病和诊断", "offset": "164"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "176"}, {"mention": "胆囊炎", "label": "疾病和诊断", "offset": "182"}, {"mention": "肝功异常", "label": "疾病和诊断", "offset": "186"}, {"mention": "胃炎", "label": "疾病和诊断", "offset": "196"}, {"mention": "肝功异常", "label": "疾病和诊断", "offset": "199"}]}
{"text": "患者2011-12开始无明显诱因出现胸闷气短,阵发性,可自行缓解,反复发作,无向腰背部放射,不伴返酸、饱胀感,无恶心,无吞咽困难,无呕血黑便,未服用药物治疗。2012-6-25到外院就诊,行胃镜检查示“胃体上部大弯侧见一1.6×1.2cm亚蒂息肉,表面充血水肿,活检示中度肠化,中度萎缩,局灶伴重度不典型增生”,未行进一步治疗,于2012-7-2在我院门诊就诊,行超声胃镜检查示“胃体大弯侧见1.5×1.2cm息肉,表面充血,超声示该处粘膜层增厚,与粘膜上层分解清晰,粘膜上层回声连续完整。活检示形态符合慢性萎缩性胃炎伴部分腺体轻度不典型增生”。现为进一步诊治收入我科。起病以来,患者无畏寒发热,无咳嗽咳痰,胃纳精神尚可,二便正常,体重较前无明显上降。", "mention_data": [{"mention": "胸闷气短", "label": "症状", "offset": "18"}, {"mention": "腰背部", "label": "解剖部位", "offset": "40"}, {"mention": "胃体上部大弯侧", "label": "解剖部位", "offset": "101"}, {"mention": "胃体大弯侧", "label": "解剖部位", "offset": "190"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "252"}, {"mention": "胃", "label": "解剖部位", "offset": "304"}]}
{"text": "患者于11个月余前(2012年9月1日)在我院保健科住院期间出现误吸,伴呼吸频率减慢、血压及心率上降,给予呼吸兴奋剂、升压等治疗,效果差,随后自主呼吸消失,急行心肺复苏,并给予经口气管插管,患者心跳、呼吸恢复后,转icu科治疗。入icu后给予呼吸机辅助呼吸、抗感染、营养支持、促进脑功能恢复、保护各脏器功能、维持内环境稳定等治疗,病情逐渐平稳,但神志无改善,始终处于昏迷状态,且无法脱离呼吸机,遂于2012年9月6日行气管切开术,随后逐渐脱离呼吸机。患者无法去除人工气道,持续在icu治疗,住院期间间断出现发热,根据痰培养、血培养、胸片等化验,曾诊断为肺炎、导管相关性感染等,根据细菌学培养+药敏结果,先后给予抗生素(头孢哌酮钠/舒巴坦钠、头孢他啶及比阿培南、替考拉宁、伏立康唑)抗感染治疗,感染可逐渐得到控制。患者在我科住院期间多次办理出入院手续。近日患者体温有波动,两肺啰音较前增多,目前患者应用哌拉西林/他唑巴坦钠抗感染治疗,体温计血象控制良好,且患者意识障碍未恢复,始终处于昏迷状态,自主咳痰能力差,保留金属气管套管。现为求进一步诊治,患者家属再次办理出入院手续,患者继续住院治疗。叒叒叒患者自发病以来,昏迷状态,经胃造瘘处饮食,持续导尿,大小便正常,体重较发病前降低。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "80"}, {"mention": "肺", "label": "解剖部位", "offset": "81"}, {"mention": "气管插管", "label": "手术", "offset": "90"}, {"mention": "脑", "label": "解剖部位", "offset": "140"}, {"mention": "气管切开术", "label": "手术", "offset": "209"}, {"mention": "肺炎", "label": "疾病和诊断", "offset": "276"}, {"mention": "头孢哌酮钠", "label": "药物", "offset": "309"}, {"mention": "舒巴坦钠", "label": "药物", "offset": "315"}, {"mention": "头孢他啶", "label": "药物", "offset": "320"}, {"mention": "比阿培南", "label": "药物", "offset": "325"}, {"mention": "替考拉宁", "label": "药物", "offset": "330"}, {"mention": "伏立康唑", "label": "药物", "offset": "335"}, {"mention": "两肺", "label": "解剖部位", "offset": "385"}, {"mention": "哌拉西林", "label": "药物", "offset": "400"}, {"mention": "他唑巴坦钠", "label": "药物", "offset": "405"}, {"mention": "胃", "label": "解剖部位", "offset": "512"}]}
{"text": "入院前8年患者因纳差、乏力在外院体检时发现肝功异常,多次查乙肝双对半、丙肝与抗原阴性,余检查不详,诊断为“隐源性肝硬化”。6年前患者开始出现间断呕血、黑便,多次在我院进行治疗并先后行9次行食管胃底曲张静脉套扎术。6月前患者再次因黑便入院,行下消化道钡餐示食道上段局部粘膜稍增粗紊乱,考虑食管静脉曲张破裂出血,经止血、补液、输血等治疗后复查大便隐血阴性,好转出院。1天前,患者无明显诱因开始解暗红色大便,呈稀糊状,每次量约50g,共2次,伴乏力,伴中下腹不适,无恶心、呕吐,无心悸、气促,无胸闷、胸痛,无腹胀,无头昏、头痛等。为进一步诊治今入我院,门诊以“便血待查”收入我科。\\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,大便如下所述,小便正常,体重无明显变化。", "mention_data": [{"mention": "肝", "label": "解剖部位", "offset": "21"}, {"mention": "乙肝", "label": "疾病和诊断", "offset": "29"}, {"mention": "丙肝", "label": "疾病和诊断", "offset": "35"}, {"mention": "隐源性肝硬化", "label": "疾病和诊断", "offset": "53"}, {"mention": "食管胃底曲张静脉套扎术", "label": "手术", "offset": "94"}, {"mention": "下消化道", "label": "解剖部位", "offset": "120"}, {"mention": "食道", "label": "解剖部位", "offset": "127"}, {"mention": "食管静脉曲张", "label": "疾病和诊断", "offset": "143"}, {"mention": "中下腹", "label": "解剖部位", "offset": "223"}, {"mention": "心悸", "label": "症状", "offset": "237"}, {"mention": "胸闷", "label": "症状", "offset": "244"}, {"mention": "胸痛", "label": "症状", "offset": "247"}, {"mention": "腹胀", "label": "症状", "offset": "251"}, {"mention": "头昏", "label": "症状", "offset": "255"}, {"mention": "头痛", "label": "症状", "offset": "258"}]}
{"text": "缘于6天前无明显诱因后出现腹痛,为剑上阵发性绞痛,程度剧烈,无他处放射,与体位无关,无呕吐,无发热、寒战,无眼黄、尿黄、大便黄,无反酸、嗳气、腹胀、腹泻、皮疹、皮上出血、胸闷、憋气、烦躁不安、意识障碍,就诊于我院行b超:1.肝内外胆管扩张2.胆囊切除术后3.脾胰腺所见部分、门静脉及腹膜后所见部分、上腔静脉所见部分未见明显占位性病变。4.腹主动脉粥样硬化声像改变。给予抗炎对症治疗后腹痛好转,但反复发作。1天前再发,性质同前,程度较前加重,病后急来我院就诊,门诊拟“急性胆管炎”收入院。自发病以来神志清,精神不振,饮食少,二便正常,体重未见明显变化。。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "13"}, {"mention": "眼", "label": "解剖部位", "offset": "54"}, {"mention": "腹胀", "label": "症状", "offset": "71"}, {"mention": "腹泻", "label": "症状", "offset": "74"}, {"mention": "皮上", "label": "解剖部位", "offset": "80"}, {"mention": "胸闷", "label": "症状", "offset": "85"}, {"mention": "b超", "label": "影像检查", "offset": "107"}, {"mention": "肝内外胆管", "label": "解剖部位", "offset": "112"}, {"mention": "胆囊切除术", "label": "手术", "offset": "121"}, {"mention": "脾", "label": "解剖部位", "offset": "129"}, {"mention": "胰腺", "label": "解剖部位", "offset": "130"}, {"mention": "门静脉", "label": "解剖部位", "offset": "137"}, {"mention": "腹膜后", "label": "解剖部位", "offset": "141"}, {"mention": "上腔静脉", "label": "解剖部位", "offset": "149"}, {"mention": "腹主动脉粥样硬化", "label": "疾病和诊断", "offset": "169"}, {"mention": "腹痛", "label": "症状", "offset": "191"}, {"mention": "急性胆管炎", "label": "疾病和诊断", "offset": "233"}]}
{"text": "患者10年余前无明显诱因出现间断性下腹部隐痛不适,与饱食、饥饿无明显关系,无反酸、烧心、嗳气,无恶心、呕吐,无胸闷、憋喘,无胸痛、后背痛,无腹泻,无发热、畏寒,无呕血、便血,2015年6月30日因下腹部疼痛症状较前明显加重,第一次入住我院我科,行胃镜检查示“1.慢性萎缩性胃炎;2.食管裂孔疝”,并行结肠多发息肉镜上切除,病理结果示“(胃窦)慢性萎缩性胃炎(中度),少部分腺体肠下皮化生;幽门螺杆菌染色(-);2.(结肠肝曲、降结肠)腺管状腺瘤”,给予抑酸护胃、消炎、补液及对症支持治疗,患者下腹痛明显好转,于2015年7月8日出院。叒叒叒患者出院后规律门诊复诊,间断口服中药治疗,下腹疼痛明显缓解,近半年来无明显诱因出现间断上腹部疼痛,与饮食无明显关系,伴大便不成形,水样或糊状,每日2-3次,无粘液脓血便,无恶心、呕吐,无发热,症状持续无缓解,为求进一步诊治,再次来我院,门诊以“结肠息肉”收入院。叒叒叒患者自本次发病以来,饮食食欲可,睡眠欠佳,精神体力可,大便如下述,小便正常,体重无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "17"}, {"mention": "胸闷", "label": "症状", "offset": "55"}, {"mention": "胸痛", "label": "症状", "offset": "62"}, {"mention": "后背", "label": "解剖部位", "offset": "65"}, {"mention": "腹泻", "label": "症状", "offset": "70"}, {"mention": "下腹部", "label": "解剖部位", "offset": "98"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "131"}, {"mention": "食管裂孔疝", "label": "疾病和诊断", "offset": "141"}, {"mention": "结肠多发息肉镜上切除", "label": "手术", "offset": "150"}, {"mention": "(胃窦)慢性萎缩性胃炎(中度)", "label": "疾病和诊断", "offset": "167"}, {"mention": "(结肠肝曲、降结肠)腺管状腺瘤", "label": "疾病和诊断", "offset": "207"}, {"mention": "胃", "label": "解剖部位", "offset": "229"}, {"mention": "下腹痛", "label": "症状", "offset": "246"}, {"mention": "下腹疼痛", "label": "症状", "offset": "291"}, {"mention": "上腹部疼痛", "label": "症状", "offset": "313"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "392"}]}
{"text": "患者10余年前始出现进食凉食、饮酒后出现下腹部疼痛不适,疼痛为胀痛,无放射性疼痛,阵发性发作,可自行缓解,曾多次行胃镜检查示:慢性萎缩性胃炎(具体不详),未行系统治疗。3天前患者饮酒后再次出现下述症状发作,无恶心、呕吐,无反酸、烧心,无呕血、黑便,无寒战、发热,无黄疸,无呕血、黑便,无里急后重,无咳嗽、咳痰,无胸闷、憋气,无尿频尿急尿痛,无意识障碍及肢体活动困难,现患者为求系统治疗,来我院就诊,门诊以“胃炎”收入我科。叒叒叒患者自发病以来,神志清,精神可,饮食睡眠差,大小便正常,体重无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "20"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "63"}, {"mention": "胸闷", "label": "症状", "offset": "156"}, {"mention": "胃炎", "label": "疾病和诊断", "offset": "203"}]}
{"text": ",入院前2个月于***立金山分院体检行胃镜检查示贲门隆起:粘膜上肿物可能(贲门大弯侧后壁见一隆起,约0.8cm,表面光滑,触之可滑动),慢性萎缩性胃炎。,病理:(窦小)送检胃移动区粘膜,呈中度慢性萎缩性胃炎,中度肠化。,进一步行超声胃镜示:食管-贲门交界处粘膜上肿物,平滑肌瘤可能(eus示病灶来源于固有肌层,均匀低回声,边界清晰,大小约1.2cm*0.7cm)。无进食阻塞感、胸骨后不适,无腹痛、腹胀,无反酸、嗳气,无恶心、呕吐、消瘦、食欲减退等不适,未予治疗。今为求进一步行内镜治疗求诊我院,门诊拟“贲门粘膜上肿物”收住院。近2个月以来,精神、食欲尚可,睡眠欠佳,大小便如常,体重无明显变化。", "mention_data": [{"mention": "贲门", "label": "解剖部位", "offset": "24"}, {"mention": "贲门大弯侧后壁", "label": "解剖部位", "offset": "37"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "68"}, {"mention": "胃", "label": "解剖部位", "offset": "86"}, {"mention": "中度慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "94"}, {"mention": "食管-贲门交界处", "label": "解剖部位", "offset": "120"}, {"mention": "胸骨后", "label": "解剖部位", "offset": "189"}, {"mention": "腹痛", "label": "症状", "offset": "196"}, {"mention": "腹胀", "label": "症状", "offset": "199"}, {"mention": "贲门粘膜", "label": "解剖部位", "offset": "252"}]}
{"text": ",患者因1月前无明显诱因出现腹泻不适,无血便,无恶心、呕吐,无腹痛、腹胀,无大便困难、肛门坠胀感,无里急后重,,遂于2011-11-01外院肠镜检查示:距肛门22cm乙状结肠见一肿物,环绕肠壁2/3生长,大小约为3.5*4.5cm,肠腔明显狭窄,肠镜尚能通过;病理示中分化腺癌;2012-11-20在我院行dixon术,术后恢复可,有排气排便,,术后病理示:乙状结肠中分化腺癌,浸润至肠壁浆膜上层,未见神经束侵犯和管内癌栓,中央淋巴结(0/1),肠旁淋巴结(0/3)。2012-12-14、2013-01-04入院行化疗,方案为xelox(乐沙定150mg叒qd+希罗达叒1500mg叒bid),化疗过程顺利,诉有两手轻微麻木不适,无恶心、呕吐,无腹痛、腹胀,今为进一步化疗遂入我科。患者起病以来,无发热、乏力、咳嗽、气促、身目黄染等,精神睡眠可,胃纳一般,小便可,今日有排少量便,有排气,体重无明显上降。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "14"}, {"mention": "腹痛", "label": "症状", "offset": "31"}, {"mention": "腹胀", "label": "症状", "offset": "34"}, {"mention": "肛门坠胀", "label": "症状", "offset": "43"}, {"mention": "肛门", "label": "解剖部位", "offset": "77"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "83"}, {"mention": "肠壁", "label": "解剖部位", "offset": "94"}, {"mention": "肠腔", "label": "解剖部位", "offset": "116"}, {"mention": "dixon术", "label": "手术", "offset": "153"}, {"mention": "乙状结肠中分化腺癌", "label": "疾病和诊断", "offset": "179"}, {"mention": "肠壁浆膜上层", "label": "解剖部位", "offset": "192"}, {"mention": "中央淋巴结", "label": "解剖部位", "offset": "212"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "223"}, {"mention": "乐沙定", "label": "药物", "offset": "270"}, {"mention": "希罗达", "label": "药物", "offset": "282"}, {"mention": "两手", "label": "解剖部位", "offset": "307"}, {"mention": "腹痛", "label": "症状", "offset": "324"}, {"mention": "腹胀", "label": "症状", "offset": "327"}, {"mention": "胃", "label": "解剖部位", "offset": "374"}]}
{"text": "患者于1年前发现大便带血,为红色糊状,便意频繁,里急后重,无发热、无腹胀腹痛。患者自述于2010年9月3日就诊于我院肝胆外科,行肠镜检查示结肠肿物,病理为单分化管状腺癌。后行右半结肠切除术,术后病理为乙状结肠粘液腺癌,侵至深肌层,病理号(408540)。术后腹泻、血便等不适改善。现恢复良好,为进一步治疗入我科。患者近来饮食睡眠一般,精神体力可,二便基本正常,体重无明显变化,kps评分90。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "34"}, {"mention": "腹痛", "label": "症状", "offset": "36"}, {"mention": "肝胆", "label": "解剖部位", "offset": "58"}, {"mention": "结肠", "label": "解剖部位", "offset": "69"}, {"mention": "右半结肠切除术", "label": "手术", "offset": "87"}, {"mention": "乙状结肠粘液腺癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "腹泻", "label": "症状", "offset": "129"}]}
{"text": "患者1天前无明显诱因出现下腹部疼痛不适。疼痛呈持续性烧灼样痛,强度尚可忍受,疼痛以下腹正中最为明显,伴恶心,无呕吐,肛门有排气,无排便。无发热,无腹泻,、便血,无胸闷,咳嗽。患者于今日来我院就诊,门诊行“胃镜检查”未见异常,门诊化验转氨酶高。为求进一步诊治,门诊以“腹痛原因待查”收入我科。叒叒叒患者精神欠佳,半流质饮食,大小便正常,体重较前无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "12"}, {"mention": "下腹正中", "label": "解剖部位", "offset": "41"}, {"mention": "肛门", "label": "解剖部位", "offset": "58"}, {"mention": "腹泻", "label": "症状", "offset": "73"}, {"mention": "胸闷", "label": "症状", "offset": "81"}, {"mention": "腹痛", "label": "症状", "offset": "133"}]}
{"text": ",患者2011年7月因\\\"下腹部疼痛4月,加重2月\\\"来我院就诊,,患者入院后超声胃镜示:\\\"胃底贲门癌\\\",ct,示:\\\"贲门、胃小弯侧胃壁不均匀增厚,考虑胃癌。胃右动脉旁、胃小弯侧肿大淋巴结,考虑转移可能性大。右肾小囊肿\\\"。患者诊断胃癌基本明确,于2011-7-29行全麻上近端胃癌根治术+空肠间置术,手术过程顺利,,术后病理示:\\\"可见溃疡型肿物大小4*2.5*1cm,侵犯浅肌层,符合神经内分泌癌,g3,高级别,核分裂数42/1ohpf,脉管内可见癌栓形成,淋巴结7+/17\\\",诊断胃神经内分泌癌术后(pt2n3m0,iiia期)。患者术后恢复可,2011-8-23复查ct示肝转移,于2011-8-24、9-15行ep方案化疗2程,过程顺利。2,程化疗后ct检查示:肝转移瘤,较前增多、增大。右侧肾下腺肢体增粗,可疑转移瘤。疗效评价pd。2011-10-9及2011-11-1分别行cav方案化疗1程,过程顺利,化疗后出现2度白细胞上降,1度恶心。2011-11-17复查ct示肝内转移瘤较前增大增多,右侧肾下腺增粗,较前无明显变化,现为进一步治疗入院,目前一般情况良好,无畏寒、发热,无腹痛、腹胀,精神、胃纳、睡眠可,大小便正常,体重较前无。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "13"}, {"mention": "胃底贲门癌", "label": "疾病和诊断", "offset": "47"}, {"mention": "ct", "label": "影像检查", "offset": "55"}, {"mention": "贲门", "label": "解剖部位", "offset": "62"}, {"mention": "胃小弯侧胃壁", "label": "解剖部位", "offset": "65"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "胃右动脉", "label": "解剖部位", "offset": "82"}, {"mention": "胃小弯侧", "label": "解剖部位", "offset": "88"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "94"}, {"mention": "右肾小囊肿", "label": "疾病和诊断", "offset": "107"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "119"}, {"mention": "近端胃癌根治术", "label": "手术", "offset": "140"}, {"mention": "空肠间置术", "label": "手术", "offset": "148"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "234"}, {"mention": "胃神经内分泌癌术后", "label": "疾病和诊断", "offset": "247"}, {"mention": "ct", "label": "影像检查", "offset": "291"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "294"}, {"mention": "ct", "label": "影像检查", "offset": "334"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "340"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "353"}, {"mention": "肢体", "label": "解剖部位", "offset": "358"}, {"mention": "ct", "label": "影像检查", "offset": "443"}, {"mention": "肝内转移瘤", "label": "疾病和诊断", "offset": "446"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "458"}, {"mention": "腹痛", "label": "症状", "offset": "501"}, {"mention": "腹胀", "label": "症状", "offset": "504"}, {"mention": "胃", "label": "解剖部位", "offset": "510"}]}
{"text": ",患者2月前因“反复腹痛腹胀半月”入我院,,行下腹部ct示:1.胰头结节影,胰头癌可能,并胰体尾部胰管轻度扩张,胰周脂肪间隙稍模糊、周围少许稍大淋巴结显示,请结合临床。叒2.肝左左叶肝内胆管轻度扩张。叒3.肝右左叶比例失调,请结合临床。叒4.胃窦壁稍增厚。,诊断为:1.,胰腺占位:胰腺癌?叒2.胃多发息肉切除术后叒3.慢性胃炎叒4.原发性高血压3级叒很高危,手术指征明确,无绝对手术禁忌症,于2016-1-22日行胰十二指肠切除术,手术顺利,术后安放病房,,术后病检示:胰头低分化导管腺癌。术后恢复良好出院,今患者为求拔除胰管支撑管,门诊以“胰十二指肠切除术后”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": "腹痛", "label": "症状", "offset": "10"}, {"mention": "腹胀", "label": "症状", "offset": "12"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "23"}, {"mention": "胰头", "label": "解剖部位", "offset": "32"}, {"mention": "胰头癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "胰体尾部", "label": "解剖部位", "offset": "45"}, {"mention": "胰管", "label": "解剖部位", "offset": "49"}, {"mention": "胰", "label": "解剖部位", "offset": "56"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "72"}, {"mention": "肝左左叶肝内胆管", "label": "解剖部位", "offset": "87"}, {"mention": "肝右左叶", "label": "解剖部位", "offset": "103"}, {"mention": "胃窦壁", "label": "解剖部位", "offset": "121"}, {"mention": "胰腺占位:胰腺癌", "label": "疾病和诊断", "offset": "136"}, {"mention": "胃多发息肉切除术", "label": "手术", "offset": "148"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "160"}, {"mention": "原发性高血压3级叒很高危", "label": "疾病和诊断", "offset": "167"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "208"}, {"mention": "胰头低分化导管腺癌", "label": "疾病和诊断", "offset": "236"}, {"mention": "胰", "label": "解剖部位", "offset": "262"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "272"}, {"mention": "胃", "label": "解剖部位", "offset": "308"}]}
{"text": "患者2013年12月因“腹部隐痛”行肠镜检查发现距肛门70cm处肿物,活检为管状腺瘤伴下皮内瘤变;ct及pet-ct未发现明确远处转移,2013-12-16在**六院行根治性左半结肠切除术,术后病理:粘液腺癌iii级,浸润肠壁全层,未突破浆膜层,未见脉管及神经侵犯,淋巴结3/32,分期pt3n1m0;后患者于2014-01-10、2014-01-27、2014-02-17、2014-03-10、2014-04-10、2014-05-02、2014-05-22行xelox方案化疗七程,化疗后出现ii度骨髓抑制,经对症治疗后恢复。现为进一步诊治入我院;述近期无特殊不适,精神睡眠可,食欲可,二便正常,体重无明显减轻。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "12"}, {"mention": "肛门", "label": "解剖部位", "offset": "25"}, {"mention": "ct", "label": "影像检查", "offset": "49"}, {"mention": "pet-ct", "label": "影像检查", "offset": "52"}, {"mention": "根治性左半结肠切除术", "label": "手术", "offset": "84"}, {"mention": "肠壁全层", "label": "解剖部位", "offset": "111"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "骨髓抑制", "label": "症状", "offset": "252"}]}
{"text": "患者于我院2014-06-16因\\\"直肠癌\\\"在全麻上行\\\"经腹会阴直肠癌根治术\\\",术程顺利,术后预防感染支持对症等处理,恢复好,术后病理示:\\\"直肠癌,pt4an2bm0,iiic期(ln+叒16/24)\\\"。2014-7-17、2014-8-7、2014-08-28、2014-09-19、2014-10-16、2014-11-06、2014-12-04返院行xelox方案(乐沙定150mg叒ivdrip叒q3w+希罗达叒1500mg叒po叒bid叒d1-14)化疗7程,化疗后出现1°食欲上降,余无明显不适。现在为行上程化疗来我院,拟\\\"直肠癌综合治疗后\\\"入我科。于下次出院以来,患者无头晕、头痛,无发热、咳嗽、咳痰、胸闷、胸痛,无腹痛、腹胀,无腹泻、粘液血便,无发热、黄疸,精神体力一般,睡眠一般,大小便大致正常,体重较前无明显上降。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "18"}, {"mention": "经腹会阴直肠癌根治术", "label": "手术", "offset": "30"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "74"}, {"mention": "ln", "label": "解剖部位", "offset": "94"}, {"mention": "乐沙定", "label": "药物", "offset": "191"}, {"mention": "希罗达", "label": "药物", "offset": "211"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "274"}, {"mention": "头晕", "label": "症状", "offset": "299"}, {"mention": "头痛", "label": "症状", "offset": "302"}, {"mention": "胸闷", "label": "症状", "offset": "315"}, {"mention": "胸痛", "label": "症状", "offset": "318"}, {"mention": "腹痛", "label": "症状", "offset": "322"}, {"mention": "腹胀", "label": "症状", "offset": "325"}, {"mention": "腹泻", "label": "症状", "offset": "329"}]}
{"text": "13月前,患者因“左下腹持续性隐痛3月”入我科诊治,诊断为原发性肝癌,于2011.3.24日在超声引导上行肝癌放射性粒子置入术。并于2011.3.28日在全身麻醉上行原发性肝癌姑息性hifu治疗。术后予保肝、抑酸、抗感染、改善循环、抗肿瘤等对症支持治疗。治疗期间,患者反复解黑大便,胃镜检查后示轻-中度食管静脉曲张,请消化科会诊后建议暂不行曲张静脉结扎,经止血、抑酸、营养支持、对症等治疗后好转出院,院外长期服用安达。2011年11月患者无诱因出现解黑便,4次,成形,伴中下腹隐痛,不伴恶心、呕吐、呕血等,入院后给予止血、抑酸等对症支持治疗,患者恢复情况良好出院,4月前患者为求复查入院,予以抑酸、增强免疫、补充营养对症支持治疗。患者于2012年04月26日在局麻上行原发性肝癌粒子植入术。术后给予保肝、抑酸、增强免疫、营养对症支持治疗后好转出院,8小时前患者突然出现中下腹疼痛,伴大汗淋漓,无恶心、呕吐,无头昏、乏力,为求进一步诊治收入我科。\\u0004叒叒叒患者自起病以来,精神可,胃纳略差,大便如常,小便如常,体重未见明显上降。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "9"}, {"mention": "原发性肝癌", "label": "疾病和诊断", "offset": "29"}, {"mention": "肝癌放射性粒子置入术", "label": "手术", "offset": "53"}, {"mention": "原发性肝癌姑息性hifu治疗", "label": "手术", "offset": "83"}, {"mention": "肝", "label": "解剖部位", "offset": "102"}, {"mention": "轻-中度食管静脉曲张", "label": "疾病和诊断", "offset": "147"}, {"mention": "安达", "label": "药物", "offset": "206"}, {"mention": "中下腹", "label": "解剖部位", "offset": "235"}, {"mention": "原发性肝癌粒子植入术", "label": "手术", "offset": "334"}, {"mention": "肝", "label": "解剖部位", "offset": "350"}, {"mention": "中下腹", "label": "解剖部位", "offset": "384"}, {"mention": "头昏", "label": "症状", "offset": "404"}, {"mention": "胃", "label": "解剖部位", "offset": "443"}]}
{"text": "患者因行肠镜上息肉切除术后出现腹痛,行腹部立位片发现膈上游离气体,考虑肠穿孔。于2016-08-22行剖腹探查+结肠穿孔修补术。术后于抗感染、补液等对症支持处理。术后患者恢复情况尚可,肛门有排气排便,伴有低热,最高38.0℃,无畏寒、乏力,无头痛头晕,无恶心呕吐,进食少量流质饮食无不适。于今日发现腹部切口愈合欠佳,红肿,有渗液流出。现患者及家属为进一步诊治,转入我院诊治。经我科会诊后,拟以“腹部切口感染”收入院。叒叒叒患病后患者精神、睡眠差,饮食较差,大便如下述,小便正常,体重无明显变化。", "mention_data": [{"mention": "肠镜上息肉切除术", "label": "手术", "offset": "4"}, {"mention": "腹痛", "label": "症状", "offset": "15"}, {"mention": "腹部", "label": "解剖部位", "offset": "19"}, {"mention": "膈", "label": "解剖部位", "offset": "26"}, {"mention": "肠穿孔", "label": "症状", "offset": "35"}, {"mention": "剖腹探查+结肠穿孔修补术", "label": "手术", "offset": "51"}, {"mention": "肛门", "label": "解剖部位", "offset": "92"}, {"mention": "头痛头晕", "label": "症状", "offset": "121"}, {"mention": "腹部", "label": "解剖部位", "offset": "149"}, {"mention": "腹部切口感染", "label": "疾病和诊断", "offset": "197"}]}
{"text": "缘于入院前3月因“结肠肝曲癌”于2016-01-07行“腹腔镜上左半结肠切除术(扩大根治)”,术后病理(左半结肠):大肠溃疡型粘液腺癌,侵及浆膜层,侵犯神经,手术切除标本双切端及另送(下切端)、(上切端)均未见癌侵犯。找到肠周淋巴结37个,及另送(回肠动脉根部)淋巴结4个,均未见癌转移。术后予以预防感染、补液、营养支持、调节免疫等治疗。于术后10天出现左侧腹痛,伴发热,最高体温39℃,腹腔引流管引出脓性液体,引流液细菌培养提示大肠埃希菌及屎肠球菌感染,考虑吻合口瘘,予以腹腔持续引流冲洗,引流液逐渐清亮,无畏寒、发热、腹痛、腹胀、恶心、呕吐、腹泻等不适,左侧腹腔引流管每日引出少许淡红色液体。出院后腹腔引流管自行脱落,无脓性分泌物,无畏寒、发热、腹痛、腹胀。入院前1天无明显诱因再发左侧腹痛,无畏寒、发热,遂就诊我院。今为进一步治疗,门诊拟“结肠肝曲癌术后吻合口瘘”收入院。下次出院来,精神状态良好,体力情况良好,食欲食量良好,睡眠情况良好,体重无明显变化,大便正常,小便正常。", "mention_data": [{"mention": "结肠肝曲癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "腹腔镜上左半结肠切除术(扩大根治)", "label": "手术", "offset": "28"}, {"mention": "左半结肠", "label": "解剖部位", "offset": "52"}, {"mention": "大肠溃疡型粘液腺癌", "label": "疾病和诊断", "offset": "58"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "111"}, {"mention": "(回肠动脉根部)淋巴结", "label": "解剖部位", "offset": "123"}, {"mention": "左侧腹", "label": "解剖部位", "offset": "177"}, {"mention": "腹腔", "label": "解剖部位", "offset": "194"}, {"mention": "大肠", "label": "解剖部位", "offset": "215"}, {"mention": "肠", "label": "解剖部位", "offset": "222"}, {"mention": "腹腔", "label": "解剖部位", "offset": "237"}, {"mention": "腹痛", "label": "症状", "offset": "261"}, {"mention": "腹胀", "label": "症状", "offset": "264"}, {"mention": "腹泻", "label": "症状", "offset": "273"}, {"mention": "左侧腹腔", "label": "解剖部位", "offset": "279"}, {"mention": "腹腔", "label": "解剖部位", "offset": "301"}, {"mention": "腹痛", "label": "症状", "offset": "325"}, {"mention": "腹胀", "label": "症状", "offset": "328"}, {"mention": "左侧腹", "label": "解剖部位", "offset": "343"}, {"mention": "结肠肝曲癌术后", "label": "疾病和诊断", "offset": "373"}]}
{"text": ",患者因“反复嗳气反酸、腹胀腹痛4月余”,在我院诊断胃食管结合部癌,并于2015-06-15在全麻上行胃癌根治术(近端胃大切,食管胃吻合),术程顺利,术后预防感染支持对症等处理,恢复好。,术后病理:胃低分化腺癌(lauren,分型:弥漫型),pt3n3m0叒iiib期。现已进食普食,无发热、腹痛、腹胀、恶心、呕吐、黑便等不适。现为上一步治疗收入我科,拟“胃癌术后”收入我科。起病以来,患者精神尚可,食欲欠佳,大、小便正常,体重稍上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "12"}, {"mention": "腹痛", "label": "症状", "offset": "14"}, {"mention": "胃食管结合部癌", "label": "疾病和诊断", "offset": "26"}, {"mention": "胃癌根治术(近端胃大切,食管胃吻合)", "label": "手术", "offset": "51"}, {"mention": "胃低分化腺癌(lauren,分型:弥漫型)", "label": "疾病和诊断", "offset": "99"}, {"mention": "腹痛", "label": "症状", "offset": "146"}, {"mention": "腹胀", "label": "症状", "offset": "149"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "178"}]}
{"text": "患者于2年前因胃底贲门癌在我科行胃癌近端胃切除+食管残胃吻合+放射性粒子植入术,术后病检提示:胃溃疡型低分化管状腺癌(t4n0m0),术后患者恢复可,术后行folfox方案化疗5次,化疗期间无明显化疗副反应,1周前,患者无明显诱因出现纳差,食欲逐渐上降,伴进食后哽咽感明显,伴全身乏力、反酸,无明显缓解及加重因素,患者无腹胀、腹痛,无肛门停止排气排便,无头晕、摔倒等不适。患者患病期间未行任何治疗,现患者为求进一步治疗来我院就诊,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,胃纳较差,大便如常,小便如常,1周内体重上降2kg。", "mention_data": [{"mention": "胃底贲门癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "胃癌近端胃切除+食管残胃吻合+放射性粒子植入术", "label": "手术", "offset": "16"}, {"mention": "胃溃疡型低分化管状腺癌", "label": "疾病和诊断", "offset": "47"}, {"mention": "腹胀", "label": "症状", "offset": "160"}, {"mention": "腹痛", "label": "症状", "offset": "163"}, {"mention": "肛门", "label": "解剖部位", "offset": "167"}, {"mention": "头晕", "label": "症状", "offset": "177"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "219"}, {"mention": "胃", "label": "解剖部位", "offset": "250"}]}
{"text": ",患者于入院前3年因右肺下叶肿物入院,于2007-9-20行右肺下叶切除术,术后病理回报右肺下叶中心型低分化鳞状细胞癌,淋巴结未见转移,术后化疗双周期,患者于入院前5月无明显诱因出现进食后吞咽不顺,,于2010年11月行胃镜提示:距门齿25-26cm食管溃疡隆起型肿物,,活检病理提示:(食管)鳞状细胞癌,于2010-12-21至2011-2-9予以放疗66gy/33f/50d,于2011-5-19,2011-7-4开始行第二周期tp方案(紫杉醇+顺铂,1、8、15天方案),现为第二周期第8天化疗收入院。患者自发病以来精神良好,睡眠良好,食欲正常,大小便正常,体重无明显变化。", "mention_data": [{"mention": "右肺下叶", "label": "解剖部位", "offset": "10"}, {"mention": "右肺下叶切除术", "label": "手术", "offset": "30"}, {"mention": "右肺下叶中心型低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "44"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "60"}, {"mention": "门齿", "label": "解剖部位", "offset": "116"}, {"mention": "食管溃疡", "label": "症状", "offset": "125"}, {"mention": "(食管)鳞状细胞癌", "label": "疾病和诊断", "offset": "143"}, {"mention": "紫杉醇", "label": "药物", "offset": "221"}, {"mention": "顺铂", "label": "药物", "offset": "225"}]}
{"text": "患者2008年10月因“肝左前叶占位”于我科行肝左叶切除术+胆囊切除术,2009年12月因肿瘤复发于我科行tace术,术中发现多发复发病灶,2010年9月于我科行射频消融治疗,定期复查。2014-4-23日于我院复查血alt叒134u/l、ast叒134叒u/l;肿瘤标志物叒ca19-9叒228.8u/ml。2014-4-25我院复查下腹部ct示:肝s4结节,考虑为复发灶。肝门区、腹腔干旁、腹主动脉旁及胰头旁多发小淋巴结,建议随诊。现为进一步治疗入我科。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,,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": "肝左前叶占位", "label": "疾病和诊断", "offset": "12"}, {"mention": "肝左叶切除术+胆囊切除术", "label": "手术", "offset": "23"}, {"mention": "tace术", "label": "手术", "offset": "53"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "168"}, {"mention": "肝s4", "label": "解剖部位", "offset": "175"}, {"mention": "肝门区", "label": "解剖部位", "offset": "188"}, {"mention": "腹腔干旁", "label": "解剖部位", "offset": "192"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "197"}, {"mention": "胰头", "label": "解剖部位", "offset": "203"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "209"}, {"mention": "腹痛", "label": "症状", "offset": "240"}, {"mention": "腹胀", "label": "症状", "offset": "244"}]}
{"text": "缘于2010年11月患者因腹泻在****行肠镜检查,病理活检考虑\\\"直肠腺癌\\\",遂来我院就诊,并于2011-12-3在我院行dixon手术,术程顺利,术后未进行辅助化疗。术后偶有腹痛,未引起注意。2012年10月因“腹痛较前明显,大便困难”遂来我院复诊。复查肠镜及mri,结果提示:吻合口复发。2012-12-4复诊时建议手术治疗,但患者拒绝。鉴于患者年龄偏大,遂建议行姑息性化疗。近期已完成2周期xelox化疗,耐受尚可,无中度以下不良反应。现为行上周期化疗就诊我科,门诊拟“直肠癌术后复发”程化疗。近10余天来,患者精神可,进食可,仍感上腹正中疼,体力、体重无明显改变,大小便正常。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "13"}, {"mention": "直肠腺癌", "label": "疾病和诊断", "offset": "34"}, {"mention": "dixon手术", "label": "手术", "offset": "63"}, {"mention": "腹痛", "label": "症状", "offset": "90"}, {"mention": "腹痛", "label": "症状", "offset": "109"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "240"}, {"mention": "上腹正中", "label": "解剖部位", "offset": "271"}]}
{"text": "缘于20年前行胃癌切除术后出现胸骨上段烧灼感,伴反酸,无吞咽困难、呛咳,无胸闷、心悸、气促,无头晕、头痛,无腹痛、腹泻、恶心、呕吐,未重视,未治疗。后胸骨上段烧灼感渐加重,于3年前出现吞咽困难,伴反酸,无嗳气、呕吐,无头晕、头痛、晕厥,无腹痛、腹泻、黑便。今为治疗,就诊我院,查血常规、生化、血肿瘤标记物、血凝大致正常,胃肠钡餐:1.胃癌+部分切除术后,食道上返流性炎症?2.残胃炎?3.慢支伴少许感染?肺气肿。4.主动脉硬化。5.左侧第6前肋腋前段可疑陈旧性骨折?拟“反流性食管炎”收住入院。自发病来,精神、睡眠正常,大小便正常,纳差,渐消瘦,体重较前减轻约10kg。", "mention_data": [{"mention": "胃癌切除术", "label": "手术", "offset": "7"}, {"mention": "胸骨上段", "label": "解剖部位", "offset": "15"}, {"mention": "胸闷", "label": "症状", "offset": "37"}, {"mention": "心悸", "label": "症状", "offset": "40"}, {"mention": "头晕", "label": "症状", "offset": "47"}, {"mention": "头痛", "label": "症状", "offset": "50"}, {"mention": "腹痛", "label": "症状", "offset": "54"}, {"mention": "腹泻", "label": "症状", "offset": "57"}, {"mention": "胸骨上段", "label": "解剖部位", "offset": "75"}, {"mention": "头晕", "label": "症状", "offset": "109"}, {"mention": "头痛", "label": "症状", "offset": "112"}, {"mention": "腹痛", "label": "症状", "offset": "119"}, {"mention": "腹泻", "label": "症状", "offset": "122"}, {"mention": "胃肠", "label": "解剖部位", "offset": "160"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "167"}, {"mention": "食道上返流性炎症", "label": "疾病和诊断", "offset": "177"}, {"mention": "残胃炎", "label": "疾病和诊断", "offset": "188"}, {"mention": "慢支伴少许感染", "label": "疾病和诊断", "offset": "194"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "202"}, {"mention": "主动脉硬化", "label": "疾病和诊断", "offset": "208"}, {"mention": "左侧第6前肋腋前段", "label": "解剖部位", "offset": "216"}, {"mention": "骨折", "label": "症状", "offset": "230"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "235"}]}
{"text": "2011年9月在外院超促排卵治疗不孕症。2012-1月左附件区扪及5cm大小包块。外院肠镜、胃镜未见恶性肿瘤。2012-2-14日行肿瘤细胞减灭术,术后病理:两侧卵巢浆液性乳头状囊腺癌,转移至右侧输卵管及大网膜,术后行卡铂0.5g腹化+多西他赛100mg静脉化疗。2012-3-14、4-9日予卡铂0.5g+多西他赛100mg静脉化疗2程。2012-05-03行“卵巢癌肿瘤细胞减灭术+腹腔热灌注术”+多西他赛100mg静脉化疗1程,2012-5-31、2012-6-25、2012-7-20、2012-8-9、2012-8-29、2012-9-27、2012-10-19行“卡铂+多西他赛”方案化疗7程,期间白细胞最低上降至1.8×109/l,血小板低至18×109/l.入院给予输血、血小板、血浆、升白、升血小板治疗后恢复好.2013-9-3复查提示复发,2013-09-12、10-9、10-30、12-10给予力朴素、鲁贝方案化疗4程。2014-07-31返我院复查提示病情进展,遂于2014-08-07,8-29在我科行泽菲+鲁贝叒方案化疗2程,过程顺利。2014-09-19行泽菲+顺铂方案化疗1程。今为进一步治疗入院。近期患者饮食入眠可,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "不孕症", "label": "疾病和诊断", "offset": "16"}, {"mention": "左附件区", "label": "解剖部位", "offset": "27"}, {"mention": "肿瘤细胞减灭术", "label": "手术", "offset": "66"}, {"mention": "两侧卵巢浆液性乳头状囊腺癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "右侧输卵管", "label": "解剖部位", "offset": "96"}, {"mention": "大网膜", "label": "解剖部位", "offset": "102"}, {"mention": "卡铂", "label": "药物", "offset": "109"}, {"mention": "腹", "label": "解剖部位", "offset": "115"}, {"mention": "多西他赛", "label": "药物", "offset": "118"}, {"mention": "静脉", "label": "解剖部位", "offset": "127"}, {"mention": "卡铂", "label": "药物", "offset": "147"}, {"mention": "多西他赛", "label": "药物", "offset": "154"}, {"mention": "静脉", "label": "解剖部位", "offset": "163"}, {"mention": "卵巢癌肿瘤细胞减灭术+腹腔热灌注术", "label": "手术", "offset": "182"}, {"mention": "多西他赛", "label": "药物", "offset": "201"}, {"mention": "卡铂", "label": "药物", "offset": "288"}, {"mention": "多西他赛", "label": "药物", "offset": "291"}, {"mention": "力朴素", "label": "药物", "offset": "409"}, {"mention": "鲁贝", "label": "药物", "offset": "413"}, {"mention": "泽菲", "label": "药物", "offset": "465"}, {"mention": "鲁贝", "label": "药物", "offset": "468"}, {"mention": "泽菲", "label": "药物", "offset": "494"}, {"mention": "顺铂", "label": "药物", "offset": "497"}]}
{"text": "患者半个月前无诱因出现腹痛,为游走性刺痛,伴腹胀及腰酸,无发热及恶心呕吐,近1周腹围较前增大,4天前外院就诊,行胃肠镜检查未见异常,盆腔超声提示盆腔包块合并腹水,为求进一步治疗入院。患者既往月经规律,周期30天,行经3天,量少,无痛经,末次月经2015-11-8,行经3天,末前次月经2015-10-20。无性交后阴道流血,白带正常。病来,无头晕头迷,近1周纳差,饱腹感明显,睡眠可,近半个月大便不成形,为黄色软便,每日3-4次,偶有排尿后尿痛,无尿频尿急及排尿困难,体重减轻约5公斤。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "11"}, {"mention": "腹胀", "label": "症状", "offset": "22"}, {"mention": "腰酸", "label": "症状", "offset": "25"}, {"mention": "胃肠", "label": "解剖部位", "offset": "56"}, {"mention": "盆腔", "label": "解剖部位", "offset": "66"}, {"mention": "盆腔包块", "label": "症状", "offset": "72"}, {"mention": "腹水", "label": "症状", "offset": "78"}, {"mention": "阴道", "label": "解剖部位", "offset": "157"}, {"mention": "头晕", "label": "症状", "offset": "171"}, {"mention": "头", "label": "解剖部位", "offset": "173"}]}
{"text": "患者3年前无明显诱因出现反酸、烧心,症状多在进食后出现,无恶心、呕吐,无腹痛、腹泻,患者间断服用“奥美拉唑”等药物治疗,患者症状时轻时重,1年前患者再次出现反酸、烧心症状,于我院行电子胃镜检查,结果示胃息肉,给予胃镜上息肉切除,后间断服用“洛赛克、施维舒”治疗,4个月前患者复查电子胃镜发现胃息肉11枚,给予胃镜上切除8枚,后患者服用“达喜”治疗,现患者仍有反酸、烧心,今日为行进一步诊治入病房。患者自发病来饮食睡眠可,大小便正常,体重自觉无明显变化。发现颈动脉粥样斑块6年,服用“可定5mg叒qd”治疗;高血压病史3年,血压最高160/90mmhg,服用“络活喜5mg叒qd”治疗,血压控制良好;糖耐量异常病史1年,通过饮食及运动控制,监测血糖及糖化血红蛋白正常。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "36"}, {"mention": "腹泻", "label": "症状", "offset": "39"}, {"mention": "奥美拉唑", "label": "药物", "offset": "49"}, {"mention": "胃息肉", "label": "疾病和诊断", "offset": "100"}, {"mention": "胃镜上息肉切除", "label": "手术", "offset": "106"}, {"mention": "洛赛克", "label": "药物", "offset": "120"}, {"mention": "施维舒", "label": "药物", "offset": "124"}, {"mention": "胃息肉", "label": "疾病和诊断", "offset": "145"}, {"mention": "达喜", "label": "药物", "offset": "168"}, {"mention": "颈动脉", "label": "解剖部位", "offset": "228"}, {"mention": "可定", "label": "药物", "offset": "241"}, {"mention": "络活喜", "label": "药物", "offset": "279"}]}
{"text": "缘于入院2年余前在我院行全腹ct示“肝右内叶、左叶多发占位性病变,多考虑原发性肝癌”,afp321.1ng/ml,腹部mri示“肝右内叶及左前叶下段占位性病变,为恶性肿瘤合并瘤内出血,为原发性肝细胞癌可能性大;肝左前叶上段包膜上小结节灶,可能为子灶”。完善术前准备,排除手术禁忌,于2013.05.08在全麻上行“肝癌切除术+胆囊切除术”,术中探查:腹腔内无腹水,盆底未触及转移结节,胃十二指肠,结肠,直肠未触及肿物。胆囊大小约6×4cm,壁厚,内有结石。肝脏呈肝硬化结节改变。左肝vii段膈面可见一大小约4×3cm肿物,质硬,呈实性。肝右内叶(iv段)、左后叶(vi段)各见一类圆形病灶,边界较清楚,突向局部肝包膜外,大小分别约5cm×4cm×3cm及1cm×1cm,质硬,呈实性。肝十二指肠韧带未触及肿大淋巴结。手术顺利,术后病理示“肝脏原发性结节型中分化肝细胞癌并大片坏死,侵及肝被膜。送检(右肝断面)未见癌组织浸润。(胆囊)慢性腺性胆囊炎”。术后恢复良好,定期我科随诊复查,下次出院后至今无腹痛、腹胀、腹泻、便秘,无恶心、呕吐、呕血、黑便,无畏冷、发热等不适,今为第7次复查再次就诊我院,门诊拟“肝癌术后”收住我科。近来精神、睡眠、饮食尚可,大小便如常,体重无明显变化。", "mention_data": [{"mention": "全腹ct", "label": "影像检查", "offset": "12"}, {"mention": "肝右内叶、左叶多发占位性病变", "label": "疾病和诊断", "offset": "18"}, {"mention": "原发性肝癌", "label": "疾病和诊断", "offset": "36"}, {"mention": "腹部mri", "label": "影像检查", "offset": "57"}, {"mention": "肝右内叶及左前叶下段占位性病变", "label": "疾病和诊断", "offset": "64"}, {"mention": "原发性肝细胞癌", "label": "疾病和诊断", "offset": "93"}, {"mention": "肝左前叶上段包膜", "label": "解剖部位", "offset": "105"}, {"mention": "肝癌切除术+胆囊切除术", "label": "手术", "offset": "157"}, {"mention": "腹腔", "label": "解剖部位", "offset": "175"}, {"mention": "腹水", "label": "症状", "offset": "179"}, {"mention": "盆底", "label": "解剖部位", "offset": "182"}, {"mention": "胃", "label": "解剖部位", "offset": "192"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "193"}, {"mention": "结肠", "label": "解剖部位", "offset": "198"}, {"mention": "直肠", "label": "解剖部位", "offset": "201"}, {"mention": "胆囊", "label": "解剖部位", "offset": "209"}, {"mention": "肝脏", "label": "解剖部位", "offset": "228"}, {"mention": "肝", "label": "解剖部位", "offset": "231"}, {"mention": "左肝vii段膈面", "label": "解剖部位", "offset": "239"}, {"mention": "肝右内叶(iv段)", "label": "解剖部位", "offset": "268"}, {"mention": "左后叶(vi段)", "label": "解剖部位", "offset": "278"}, {"mention": "肝包膜", "label": "解剖部位", "offset": "305"}, {"mention": "肝十二指肠韧带", "label": "解剖部位", "offset": "342"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "354"}, {"mention": "肝脏原发性结节型中分化肝细胞癌并大片坏死", "label": "疾病和诊断", "offset": "369"}, {"mention": "肝被膜", "label": "解剖部位", "offset": "392"}, {"mention": "右肝", "label": "解剖部位", "offset": "399"}, {"mention": "(胆囊)慢性腺性胆囊炎", "label": "疾病和诊断", "offset": "412"}, {"mention": "腹痛", "label": "症状", "offset": "449"}, {"mention": "腹胀", "label": "症状", "offset": "452"}, {"mention": "腹泻", "label": "症状", "offset": "455"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "502"}]}
{"text": "患者于7年前无明显诱因出现间歇性跛行,跛行距离大约500m,后逐渐加重,于2010年我科行上肢动脉内支架置入术,术后患者恢复良好。患者2015-6-1于我院复查,行髂总动脉cta显示两侧髂总动脉及两侧股动脉节段性狭窄及闭塞性改变,行上肢动脉置管溶栓术,患者近双月出现两上肢麻木,跛行,跛行距离约100米,右上肢较左上肢重,无夜间静息痛。现为求进一步介入治疗入我科,患者病来饮食睡眠可,大小便正常,精神体力可,体重无明显减轻。", "mention_data": [{"mention": "上肢动脉内支架置入术", "label": "手术", "offset": "45"}, {"mention": "髂总动脉cta", "label": "影像检查", "offset": "82"}, {"mention": "两侧髂总动脉", "label": "解剖部位", "offset": "91"}, {"mention": "两侧股动脉", "label": "解剖部位", "offset": "98"}, {"mention": "上肢动脉置管溶栓术", "label": "手术", "offset": "116"}, {"mention": "两上肢", "label": "解剖部位", "offset": "133"}, {"mention": "右上肢", "label": "解剖部位", "offset": "152"}, {"mention": "左上肢", "label": "解剖部位", "offset": "156"}]}
{"text": "患者于1年余前(2014.12)开始出现黑便,伴腹胀、食欲减低,伴心慌、胸闷、乏力,无明显消瘦,无明显腹痛,无下腹部烧灼感,到我院就诊,因心动过缓等原因未能行胃镜、ct等检查,临床诊断为“下消化道出血”,予抑酸护胃止血等治疗后黑便停止,复查大便隐血阴性而出院,平时未作特殊处理。1年前前,患者因突发呕血,量较大,到我院消化科治疗,经抑酸、止血、输血等治疗后黑便停止,未进一步检查。此后患者2次因反复黑便在我科住院。4月前于住院期间行下腹部ct检查考虑胃癌可能。经抑酸、保护胃粘膜、止血、并间断输注红细胞悬液共7.5单位。1月前行胃镜检查提示胃窦巨大溃疡,病理检查:局部见恶性肿瘤细胞,结合免疫组化结果符合低分化癌。外科考虑手术风险极高,家属亦不愿手术治疗,肿瘤科考虑无化疗指针。遂予对症支持治疗。2小时前,患者诉下腹部不适,恶心、呕吐白色胃液,伴咳嗽咳痰。为继续诊治入院。\\u0004叒叒叒患者本次发病以来,食欲上降,叒神志清醒,精神差,睡眠欠佳,,小便量少,体重变化不明确。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "24"}, {"mention": "心慌", "label": "症状", "offset": "33"}, {"mention": "胸闷", "label": "症状", "offset": "36"}, {"mention": "腹痛", "label": "症状", "offset": "51"}, {"mention": "下腹部", "label": "解剖部位", "offset": "55"}, {"mention": "ct", "label": "影像检查", "offset": "82"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "94"}, {"mention": "胃", "label": "解剖部位", "offset": "106"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "216"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "225"}, {"mention": "胃粘膜", "label": "解剖部位", "offset": "236"}, {"mention": "胃窦巨大溃疡", "label": "疾病和诊断", "offset": "270"}, {"mention": "下腹部", "label": "解剖部位", "offset": "356"}, {"mention": "胃", "label": "解剖部位", "offset": "369"}]}
{"text": "3月前,患者因“间断腹痛1年,再发4天”在我院就诊,诊断为:1.肝内外胆管结石;2.2型糖尿病。积极完善相关检查,于2015年12月18日,在全麻上行“胆道探查术+t管引流术+胆道镜取石术+腹腔粘连松解术+剖腹探查术”。手术顺利,安返病房,患者术后恢复可。于2016年1月29日于我院行t管造影提示肝内胆管多发结石可能,胆道镜检查提示右左肝管内通畅,未见结石。目前患者t管**,食纳可,大小便正常,无身黄尿黄,无皮肤巩膜黄染,无腹胀腹痛,无恶心呕吐,无呕血黑便,无恶心,厌油,无发热、畏寒,现为进一步治疗,我院门诊以“胆道探查术后”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": "腹痛", "label": "症状", "offset": "10"}, {"mention": "肝内外胆管结石", "label": "疾病和诊断", "offset": "32"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "42"}, {"mention": "胆道探查术+t管引流术+胆道镜取石术+腹腔粘连松解术+剖腹探查术", "label": "手术", "offset": "76"}, {"mention": "t管造影", "label": "影像检查", "offset": "143"}, {"mention": "肝内胆管多发结石", "label": "疾病和诊断", "offset": "149"}, {"mention": "右左肝管", "label": "解剖部位", "offset": "167"}, {"mention": "皮肤", "label": "解剖部位", "offset": "206"}, {"mention": "巩膜", "label": "解剖部位", "offset": "208"}, {"mention": "腹胀", "label": "症状", "offset": "214"}, {"mention": "腹痛", "label": "症状", "offset": "216"}, {"mention": "胆道探查术", "label": "手术", "offset": "259"}, {"mention": "胃", "label": "解剖部位", "offset": "292"}]}
{"text": ",患者于3+月前因大便习惯改变、上腹部疼痛不适于我院就诊,完善相关检查后诊断为乙状结肠腺癌,予以folfox方案化疗一疗程,化疗后患者出现发热、恶心、呕吐,予以对症处理后症状缓解(具体不详),并于2016-03-25在全麻上行剖腹探查+乙状结肠肿瘤根治术+放射性粒子置入,手术顺利,,术后病检示:(乙状结肠)溃疡型中分化管状腺癌,侵及肠壁全层,双切端未见癌累及,神经见癌侵犯,肠壁淋巴结未见癌转移(0/8)。术后予以腹腔热灌注、抑酸、抗感染、营养支持等对症支持治疗,术后患者恢复情况可,无腹痛、腹泻,无恶心、呕吐,食欲可,精神佳,遂出院,出院后患者一般情况可,未诉特殊不适。患者于2016-03-16、2016-04-18、2016-06-07已完成静脉化疗(folfox方案)3次。患者复查腹部ct平扫+,增强示:1.肝脏多发结节结节影伴环形强化,与2016.4.6片比较结节有所增多、增大,结合病史考虑转移可能。于05月13日行肝脏选择性肝动脉造影术、肝癌肿瘤滋养动脉超选择性插管化疗栓塞术。患者今日为求第4次化疗入院,门诊以“乙状结肠癌”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,大便次数增多,小便如常,体重未见明显上降。", "mention_data": [{"mention": "上腹部疼痛", "label": "症状", "offset": "16"}, {"mention": "乙状结肠腺癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "剖腹探查+乙状结肠肿瘤根治术+放射性粒子置入", "label": "手术", "offset": "113"}, {"mention": "(乙状结肠)溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "148"}, {"mention": "肠壁全层", "label": "解剖部位", "offset": "167"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "188"}, {"mention": "腹腔", "label": "解剖部位", "offset": "208"}, {"mention": "腹痛", "label": "症状", "offset": "244"}, {"mention": "腹泻", "label": "症状", "offset": "247"}, {"mention": "腹部ct", "label": "影像检查", "offset": "346"}, {"mention": "肝脏", "label": "解剖部位", "offset": "360"}, {"mention": "肝脏选择性肝动脉造影术、肝癌肿瘤滋养动脉超选择性插管化疗栓塞术", "label": "手术", "offset": "416"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "466"}, {"mention": "胃", "label": "解剖部位", "offset": "503"}]}
{"text": "患者入院前1+前因排便次数增多,并里急后重感,于我院就诊行结肠镜检查提示,直肠息肉并,建议患者行直肠息肉切除术。患者未行手术治疗。1+年来患者感排便次数增多,里急后重,每日解3-4次,大便性状未见明显改变。今日患者为求直肠息肉切除术,入我院住院治疗。\\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,体重无明显变化。", "mention_data": [{"mention": "直肠息肉", "label": "疾病和诊断", "offset": "37"}, {"mention": "直肠息肉切除术", "label": "手术", "offset": "48"}, {"mention": "直肠息肉切除术", "label": "手术", "offset": "109"}]}
{"text": ",患者因“停止排便3天”于2015-5-17第一次入院,伴腹胀,入院后完善相关辅助检查,腹部b超示未见明显异常。排除禁忌后行胃肠镜检查,,肠镜:结肠息肉,并给予内镜上切除术;,胃镜:1.贲门炎,2.浅表萎缩性胃炎;术后予以禁食24小时,加强抑酸、补液及对症支持等治疗,患者病情好转出院。叒叒叒患者自下次出院后一般情况可,无腹痛、腹胀等不适,1周期患者无明显诱因再次出现腹胀,进食后加重,无恶习、呕吐,无反酸、烧心,无发热、寒战,无腹痛、腹泻,现为进一步诊治来我院门诊,门诊以“结肠息肉术后、腹胀”收入院。叒叒叒患者自本次发病以来,饮食、睡眠可,大小便正常,体重上降约1公斤。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "29"}, {"mention": "腹部b超", "label": "影像检查", "offset": "44"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "72"}, {"mention": "贲门炎", "label": "疾病和诊断", "offset": "93"}, {"mention": "浅表萎缩性胃炎", "label": "疾病和诊断", "offset": "99"}, {"mention": "腹痛", "label": "症状", "offset": "161"}, {"mention": "腹胀", "label": "症状", "offset": "164"}, {"mention": "腹胀", "label": "症状", "offset": "184"}, {"mention": "腹痛", "label": "症状", "offset": "215"}, {"mention": "腹泻", "label": "症状", "offset": "218"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "238"}, {"mention": "腹胀", "label": "症状", "offset": "245"}]}
{"text": ",入院前2天患者无明显诱因出现腹痛,中下腹隐痛,为持续性,不伴腹胀腹泻、恶心呕吐,不伴反酸嗳气,不伴胸痛胸闷、畏寒发热,腹痛与进食及体位无明显关系,患者未予重视未诊治。入院前1天患者腹痛加重,仍为中下腹为主,呈阵发性剧痛,仍不伴腹胀腹泻、恶心呕吐、反酸嗳气、胸痛胸闷、畏寒发热等,患者就诊于我院急诊,注射“盐酸曲马多及山莨菪碱”后患者腹痛可缓解,,门诊行胃镜检查提示:食管炎伴糜烂;食管粘膜隆起待查(性质待定)?;糜烂性出血性全胃炎十二指肠球部霜斑样溃疡。,腹部彩超:1.肝回声增多,随访2.左肾囊肿伴囊壁钙化,随访;3.胆、胰、脾、右肾未见异常。患者为进一步明确诊治,以“食管粘膜隆起待查”收入。\\u0004叒叒叒患者本次发病以来,食欲减退,叒神志清醒,精神欠佳,睡眠尚可,大便未解,小便正常,体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "15"}, {"mention": "中下腹", "label": "解剖部位", "offset": "18"}, {"mention": "腹胀", "label": "症状", "offset": "31"}, {"mention": "腹泻", "label": "症状", "offset": "33"}, {"mention": "胸痛", "label": "症状", "offset": "50"}, {"mention": "胸闷", "label": "症状", "offset": "52"}, {"mention": "腹痛", "label": "症状", "offset": "60"}, {"mention": "腹痛", "label": "症状", "offset": "91"}, {"mention": "中下腹", "label": "解剖部位", "offset": "98"}, {"mention": "腹胀", "label": "症状", "offset": "114"}, {"mention": "腹泻", "label": "症状", "offset": "116"}, {"mention": "胸痛", "label": "症状", "offset": "129"}, {"mention": "胸闷", "label": "症状", "offset": "131"}, {"mention": "盐酸曲马多", "label": "药物", "offset": "153"}, {"mention": "山莨菪碱", "label": "药物", "offset": "159"}, {"mention": "腹痛", "label": "症状", "offset": "167"}, {"mention": "食管炎伴糜烂", "label": "疾病和诊断", "offset": "184"}, {"mention": "食管粘膜", "label": "解剖部位", "offset": "191"}, {"mention": "糜烂性出血性全胃炎", "label": "疾病和诊断", "offset": "207"}, {"mention": "十二指肠球部霜斑样溃疡", "label": "疾病和诊断", "offset": "216"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "229"}, {"mention": "肝", "label": "解剖部位", "offset": "236"}, {"mention": "左肾囊肿伴囊壁钙化", "label": "疾病和诊断", "offset": "246"}, {"mention": "胆", "label": "解剖部位", "offset": "261"}, {"mention": "胰", "label": "解剖部位", "offset": "263"}, {"mention": "脾", "label": "解剖部位", "offset": "265"}, {"mention": "右肾", "label": "解剖部位", "offset": "267"}, {"mention": "食管粘膜", "label": "解剖部位", "offset": "287"}]}
{"text": ",患者于2月余前,因闭经1+年,体检发现腹部包块于我院就诊,,我院全腹ct示:1.盆腔囊性占位,考虑卵巢囊腺瘤可能大,请结合临床随访。2.肝左前叶上段条状低密度影,建议随访复查或mri检查。3.肠系膜根部多发淋巴结显示。4.盆腔少量积液。,考虑诊断:卵巢肿瘤,于2014-08-12在全麻上腹腔镜镜上卵巢囊肿剥除术。术后予以抗感染、补液等对症治疗,患者一般情况可,术后恢复好,办理出院,患者术后月经恢复,,lmp:2014-10-8,量中,无痛经,持续7天干净,,术后组织病理结果回报:(右卵巢)符合幼年性颗粒细胞瘤,建议患者进一步手术治疗,今日患者为行进一步治疗于我院就诊,门诊拟“卵巢颗粒细胞瘤”收治入院。\\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,体重无明显变化。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "20"}, {"mention": "全腹ct", "label": "影像检查", "offset": "33"}, {"mention": "盆腔囊性占位", "label": "疾病和诊断", "offset": "41"}, {"mention": "卵巢囊腺瘤", "label": "疾病和诊断", "offset": "50"}, {"mention": "肝左前叶上段", "label": "解剖部位", "offset": "69"}, {"mention": "mri", "label": "影像检查", "offset": "89"}, {"mention": "肠系膜根部", "label": "解剖部位", "offset": "97"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "104"}, {"mention": "盆腔", "label": "解剖部位", "offset": "112"}, {"mention": "卵巢肿瘤", "label": "疾病和诊断", "offset": "125"}, {"mention": "腹腔镜镜上卵巢囊肿剥除术", "label": "手术", "offset": "145"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "244"}, {"mention": "卵巢颗粒细胞瘤", "label": "疾病和诊断", "offset": "292"}]}
{"text": "患者6周前因“反复中下腹痛6+月,加重1月”于我院就诊,完善相关检查诊断为“胰腺占位”,于2015-12-16行“胰十二指肠切除术”,术后病理回示:1、(胰腺)导管粘液腺癌,未侵犯胆管壁,切端未见癌累及,十二指肠及胃未见癌累及。叒2、慢性胆囊炎,胆囊结石。叒3、(肝门部)淋巴结未见癌转移(0/5)。术后予以抗炎、抑酸抑酶、保肝营养支持治疗。患者于2015-12-28*尼莫斯汀化疗一次,3周前入院行生物治疗1次,期间未诉特殊不适。病情好转后出院,出院后食欲可,精神佳,二便正常。现患者为行生物治疗,再来我院就诊,门诊以“胰十二指肠切除术后”收入我科。\\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,体重无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "9"}, {"mention": "胰腺占位", "label": "疾病和诊断", "offset": "38"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "57"}, {"mention": "(胰腺)导管粘液腺癌", "label": "疾病和诊断", "offset": "76"}, {"mention": "胆管壁", "label": "解剖部位", "offset": "90"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "102"}, {"mention": "胃", "label": "解剖部位", "offset": "107"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "117"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "123"}, {"mention": "(肝门部)淋巴结", "label": "解剖部位", "offset": "131"}, {"mention": "肝", "label": "解剖部位", "offset": "163"}, {"mention": "尼莫斯汀", "label": "药物", "offset": "185"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "261"}]}
{"text": "患者1年前无明显诱因出现腹痛,位于部位部位,为持续性绞痛,程度可忍受,有放射痛,向部位放射,多于进食后出现,每次持续1天,进食后可以缓解,不伴恶心、纳差、腹胀、反酸、烧心、腹泻。恶心多于空腹出现,不伴呕吐物。呕血为鲜血,每日1次,每次约多少ml,不伴头晕、黑曚、晕厥、心悸、出汗。于我院行胃镜检查发现胃底单发息肉,呈山田i型,直径数字cm,表面光滑,活检病理示胃底腺息肉,不伴轻度异型增生,为进一步诊治入院。发病以来,精神、饮食、睡眠正常,大便正常,尿色正常,体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "12"}, {"mention": "腹胀", "label": "症状", "offset": "77"}, {"mention": "腹泻", "label": "症状", "offset": "86"}, {"mention": "空腹", "label": "症状", "offset": "93"}, {"mention": "头晕", "label": "症状", "offset": "125"}, {"mention": "心悸", "label": "症状", "offset": "134"}, {"mention": "胃底", "label": "解剖部位", "offset": "150"}, {"mention": "胃底腺息肉", "label": "疾病和诊断", "offset": "180"}]}
{"text": "患者8月前因“反复腹部胀痛10余天,加重3天”入院,入院后完善相关检查,诊断为盲肠腺癌,并于2013年3月29日在全麻上行手术治疗,术中见肿瘤位于盲肠,可推动,大小约4.0×4.5cm大小,浆膜面受侵,管腔明显狭窄,近端小肠扩张,术中考虑盲肠恶性肿瘤致肠梗阻,遂行根治性左半结肠切除+区域淋巴结清扫术,手术顺利。术后病理诊断:1、(盲肠)低分化腺癌(含印戒细胞癌成分),浸及肠壁全层,脉管、神经可见癌侵犯,切端未见累及。叒2、肠壁淋巴结未见癌转移(0/5)。患者术后恢复可。5天前患者突发左上腹疼痛不适,呈阵发性绞痛感,无放射至身体其他部位,无明显缓解因素,无恶心、呕吐及畏寒、发热,肛门排气、排便通畅,大小便正常。患者腹痛症状无明显缓解,且逐渐转化为持续性胀痛不适,少量饮食后即感不适。今患者为求进一步治疗,来我院,门诊以“腹痛待查”收入我科。\\u0004叒叒叒患者本次发病以来,神志清楚,精神可,胃纳差,大小便正常,体重无明显变化。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "9"}, {"mention": "盲肠腺癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "盲肠", "label": "解剖部位", "offset": "73"}, {"mention": "管腔", "label": "解剖部位", "offset": "101"}, {"mention": "近端小肠", "label": "解剖部位", "offset": "108"}, {"mention": "盲肠", "label": "解剖部位", "offset": "119"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "126"}, {"mention": "根治性左半结肠切除+区域淋巴结清扫术", "label": "手术", "offset": "132"}, {"mention": "(盲肠)低分化腺癌(含印戒细胞癌成分)", "label": "疾病和诊断", "offset": "165"}, {"mention": "肠壁全层", "label": "解剖部位", "offset": "187"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "213"}, {"mention": "左上腹", "label": "解剖部位", "offset": "244"}, {"mention": "肛门", "label": "解剖部位", "offset": "292"}, {"mention": "腹痛", "label": "症状", "offset": "310"}, {"mention": "腹痛", "label": "症状", "offset": "363"}, {"mention": "胃", "label": "解剖部位", "offset": "400"}]}
{"text": "入院前12天,患者因肛门坠胀于我院肛肠科行肠镜检查,提示结肠多发息肉,无腹泻、便血及黑便,无畏寒、发热,无恶心、呕吐、黄疸,无腰痛、肉眼血尿、尿频、尿急、尿痛,无白带异常,患病检为腺瘤样息肉,建议其手术治疗。今为行肠镜上结肠息肉切除术,患者来我院就诊,门诊以“结肠息肉”收入我科住院治疗。叒叒叒发病以来,精神、食欲可,睡眠可,大便如下所述,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "肛门坠胀", "label": "症状", "offset": "10"}, {"mention": "肛肠", "label": "解剖部位", "offset": "17"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "28"}, {"mention": "腹泻", "label": "症状", "offset": "36"}, {"mention": "腰痛", "label": "症状", "offset": "63"}, {"mention": "眼", "label": "解剖部位", "offset": "67"}, {"mention": "肠镜上结肠息肉切除术", "label": "手术", "offset": "107"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "130"}]}
{"text": "患者于2月前开始,因肝mt入住我院,并于2015年12月8日在全麻上行“特殊肝段切除术(iv、v、viii段)+胆囊切除术+肝十二指肠韧带内肿大淋巴结切除术”,术后病理:(肝左叶)叒肝内胆管癌,ii级,叒肝切缘未见癌累及,伴钙化。周围肝组织早期肝硬化(g2s4e)。(胆囊)慢性炎。送检肝门淋巴结1枚,未见癌转移(0/1)。病情恢复尚好出院,在家无明显不适变化,1月14日入住我院化疗,化疗方案为盐酸吉西他滨+奥沙利铂,化疗顺利,无明显不适。1月29日入我院行第二次化疗,化疗方案为盐酸吉西他滨,化疗顺利,无明显不适。为行第三次化疗前来我科。自发病以来,患者大小便可,饮食正常,体重无明显变化。", "mention_data": [{"mention": "肝mt", "label": "疾病和诊断", "offset": "10"}, {"mention": "特殊肝段切除术(iv、v、viii段)+胆囊切除术+肝十二指肠韧带内肿大淋巴结切除术", "label": "手术", "offset": "36"}, {"mention": "(肝左叶)叒肝内胆管癌", "label": "疾病和诊断", "offset": "85"}, {"mention": "肝", "label": "解剖部位", "offset": "102"}, {"mention": "肝", "label": "解剖部位", "offset": "117"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "122"}, {"mention": "(胆囊)慢性炎", "label": "疾病和诊断", "offset": "133"}, {"mention": "肝门淋巴结", "label": "解剖部位", "offset": "143"}, {"mention": "盐酸吉西他滨", "label": "药物", "offset": "198"}, {"mention": "奥沙利铂", "label": "药物", "offset": "205"}, {"mention": "盐酸吉西他滨", "label": "药物", "offset": "241"}]}
{"text": ",患者入院前4个月突然出现上腹剧痛,伴恶心呕吐,无发热发冷,于急诊行手术治疗,术中见肿物透浆膜并出现穿孔,遂行乙状结肠癌根治术,远端闭锁,近端造瘘术,,术后病理:低分化腺癌(印戒细胞癌,浸润浆膜层),断端未见癌,淋巴结转移不详。于2016年4月5日行xelox方案化疗4周期,,具体为:艾恒200mgd1,希罗达1500mg日二次口服,化疗过程顺利,无明显不适。今为求进一步治疗入我科,患者近来饮食睡眠可,精神体力可,二便正常,周身无痛,体重未见明显上降,ecog评分1分。", "mention_data": [{"mention": "上腹", "label": "解剖部位", "offset": "13"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "55"}, {"mention": "远端闭锁,近端造瘘术", "label": "手术", "offset": "64"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "106"}, {"mention": "艾恒", "label": "药物", "offset": "143"}, {"mention": "希罗达", "label": "药物", "offset": "153"}]}
{"text": "患者于2011-9-8叒全麻上行姑息性乙状结肠癌切除术,术中见大网膜多发转移,较大的为5.0*5.0*5.0cm,盆底腹膜多发种植性转移,肿瘤位于乙状结肠,大小约6.0*6.0*5.0cm,行姑息性乙状结肠切除术,降结肠末端封闭、直肠远端封闭;因患者腹壁较厚、降结肠长度受限,遂行横结肠造口术。病理:(乙状结肠)溃疡型中分化腺癌,共双灶,大小分别为5×4cm及1.8×1.5cm,癌侵及肠周纤维脂肪组织,未见脉管癌栓,肠周淋巴结可见癌转移(3/15),网膜组织可见癌转移,结肠双断端未见特殊;术后横结肠造口排便通畅,切口愈合较好。出院后间断发热,午后体温最高在38-叒39摄氏度,多次查wbc不高,考虑术后吸收热,给予抗炎、补液、营养支持、nsaid类退热等治疗。术后2周时患者切口愈合良好,已拆线,同时出现横结肠造口血性便、伴肛门少量血性便,考虑nsaid类相关粘膜炎,停nsaid类药、止血对症治疗后好转。2天前患者切口上段出现直径1cm红肿破溃,排出中等量粪性渗出,伴窦道口排气;横结肠有少量排气,无排便;肛门可排出较多稀便,性质与切口上段渗出相同,为小肠内容物。目前午后体温仍有间断升高,昨日于我院急诊留观时体温高达39摄氏度,查血rt提示wbc叒正常,ne叒77%,hgb叒90g/l;急诊给予切口上段窦道换药处理。生化未见明显异常。体重较手术时上降15kg右左,进食量少,排尿正常。", "mention_data": [{"mention": "姑息性乙状结肠癌切除术", "label": "手术", "offset": "16"}, {"mention": "大网膜", "label": "解剖部位", "offset": "31"}, {"mention": "盆底", "label": "解剖部位", "offset": "57"}, {"mention": "腹膜", "label": "解剖部位", "offset": "59"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "73"}, {"mention": "姑息性乙状结肠切除术", "label": "手术", "offset": "96"}, {"mention": "降结肠末端", "label": "解剖部位", "offset": "107"}, {"mention": "直肠远端", "label": "解剖部位", "offset": "115"}, {"mention": "腹壁", "label": "解剖部位", "offset": "125"}, {"mention": "降结肠", "label": "解剖部位", "offset": "130"}, {"mention": "横结肠造口术", "label": "手术", "offset": "140"}, {"mention": "(乙状结肠)溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "150"}, {"mention": "肠", "label": "解剖部位", "offset": "193"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "209"}, {"mention": "结肠", "label": "解剖部位", "offset": "236"}, {"mention": "横结肠", "label": "解剖部位", "offset": "248"}, {"mention": "横结肠", "label": "解剖部位", "offset": "354"}, {"mention": "肛门", "label": "解剖部位", "offset": "364"}, {"mention": "横结肠", "label": "解剖部位", "offset": "443"}, {"mention": "肛门", "label": "解剖部位", "offset": "456"}, {"mention": "小肠", "label": "解剖部位", "offset": "479"}, {"mention": "wbc", "label": "实验室检验", "offset": "524"}, {"mention": "ne", "label": "实验室检验", "offset": "531"}, {"mention": "hgb", "label": "实验室检验", "offset": "538"}]}
{"text": "患者2个月前以“上腹胀痛2个月,逐渐加重”为主诉入院,于2016-4-25行大网膜穿刺病理检查术,术后病理(b0708513):(大网膜组织)结合免疫组化结果,转移性腺癌,建议查胃肠道等,自诉于外院行胃肠镜检查,未发现异常。于42天前给予tp化疗方案,化疗后无明显胃肠道反应。于21天前再次给予tp化疗方案,化疗后恶心3到4天。现为求手术治疗入我科。患者绝经2年,无绝经后阴道流血,出院至今无发热,无头晕头迷,偶有腹胀及胃胀感,于餐后明显,偶有上腹部坠胀感,间断性,无放散,无上肢水肿,大小便正常,纳差,睡眠可,体重无明显改变。", "mention_data": [{"mention": "上腹", "label": "解剖部位", "offset": "8"}, {"mention": "大网膜穿刺病理检查术", "label": "手术", "offset": "38"}, {"mention": "大网膜", "label": "解剖部位", "offset": "65"}, {"mention": "胃肠道", "label": "解剖部位", "offset": "89"}, {"mention": "胃肠道", "label": "解剖部位", "offset": "132"}, {"mention": "阴道", "label": "解剖部位", "offset": "186"}, {"mention": "头晕", "label": "症状", "offset": "200"}, {"mention": "头", "label": "解剖部位", "offset": "202"}, {"mention": "腹胀", "label": "症状", "offset": "207"}, {"mention": "胃", "label": "解剖部位", "offset": "210"}, {"mention": "上腹部", "label": "解剖部位", "offset": "222"}, {"mention": "上肢水肿", "label": "症状", "offset": "238"}]}
{"text": "患者约1月前因“胆囊结石”于我院在气管插管全麻上行腹腔镜胆囊切除+胆总管切开取石+t管引流术,手术顺利,术中未输血,术后安返病房,术后病理示(201518151):胆囊结石。慢性胆囊炎。给予补液、抗感染、抑酸等对症治疗后,病情明显好转出院,出院后患者口服利胆药物继续治疗,“胆石利通片叒,0.45*6片,每日三次,口服”,恢复良好,无下腹部疼痛不适,无恶心呕吐,无寒战发热,无腰背部放射痛,现患者为行复查及进一步诊疗,遂来我院门诊就诊,门诊以“胆囊切除术后”收入我科。叒叒患者发病以来,神志清,精神可,饮食睡眠可,大小便正常,体重减轻约3kg。", "mention_data": [{"mention": "胆囊结石", "label": "疾病和诊断", "offset": "8"}, {"mention": "气管插管", "label": "手术", "offset": "17"}, {"mention": "腹腔镜胆囊切除+胆总管切开取石+t管引流术", "label": "手术", "offset": "25"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "82"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "87"}, {"mention": "胆石利通片", "label": "解剖部位", "offset": "137"}, {"mention": "下腹部", "label": "解剖部位", "offset": "167"}, {"mention": "腰背部", "label": "解剖部位", "offset": "188"}, {"mention": "胆囊切除术", "label": "手术", "offset": "222"}]}
{"text": ",患者于2012年12月份无明显诱因出现下腹隐痛、饥饿与餐后明显,程度较轻,无向腰背部放射,与体位改变无明显关系,伴泛酸、无呕吐,呕血,无腹泻、腹胀,无黑便、便血、粘液便,自行“奥美拉唑”症状好转,2013年1月份疼痛加重,曾有呕吐为黑色内容物、伴有黑便、,遂于广州中医药大学行胃镜检查示:胃窦中分化腺癌。2013-3-4日在我院胃胰科行“剖腹探查术+胃空肠吻合术”,术中见肿瘤位于胃窦部,大小约4*4cm,侵犯浆膜及胰头,伴胃周淋巴结广泛肿大融合,及幽门梗阻。术后分期ct4bn3m0叒iiic期。术后恢复可,于2013-04-12、05-06、06-01行乐沙定+爱斯万化疗3程,化疗过程顺利,第1程化疗后患者出现左侧下肢麻木伴疼痛,持续3-4天消退,未出现明显的恶心、呕吐、腹痛、腹泻等不良反应,2,程后复查ct示:胃癌化疗后,胃窦部病变较前增大;肝门区、腹腔干周围、门腔间隙多发淋巴结,较前缩小;两肺未见明确病变;纵隔、左肺门多发小淋巴结;左肾囊肿;副脾;盆腔未见明确病变。叒ct疗效评价pr。今为行上程化疗入院。下次出院来,患者精神体力可,食欲上降,睡眠一般,小便正常,体重无明显变化。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "20"}, {"mention": "腰背部", "label": "解剖部位", "offset": "40"}, {"mention": "腹泻", "label": "症状", "offset": "69"}, {"mention": "腹胀", "label": "症状", "offset": "72"}, {"mention": "奥美拉唑", "label": "药物", "offset": "89"}, {"mention": "胃窦中分化腺癌", "label": "疾病和诊断", "offset": "145"}, {"mention": "胃", "label": "解剖部位", "offset": "165"}, {"mention": "胰", "label": "解剖部位", "offset": "166"}, {"mention": "剖腹探查术+胃空肠吻合术", "label": "手术", "offset": "170"}, {"mention": "胃窦部", "label": "解剖部位", "offset": "191"}, {"mention": "胰头", "label": "解剖部位", "offset": "209"}, {"mention": "胃周淋巴结", "label": "解剖部位", "offset": "213"}, {"mention": "幽门梗阻", "label": "疾病和诊断", "offset": "226"}, {"mention": "行乐沙定", "label": "药物", "offset": "279"}, {"mention": "爱斯万", "label": "药物", "offset": "284"}, {"mention": "左侧下肢", "label": "解剖部位", "offset": "309"}, {"mention": "腹痛", "label": "症状", "offset": "340"}, {"mention": "腹泻", "label": "症状", "offset": "343"}, {"mention": "ct", "label": "影像检查", "offset": "357"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "361"}, {"mention": "胃窦部", "label": "解剖部位", "offset": "367"}, {"mention": "肝门区", "label": "解剖部位", "offset": "377"}, {"mention": "腹腔干", "label": "解剖部位", "offset": "381"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "387"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "393"}, {"mention": "两肺", "label": "解剖部位", "offset": "402"}, {"mention": "纵隔", "label": "解剖部位", "offset": "411"}, {"mention": "左肺门", "label": "解剖部位", "offset": "414"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "420"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "424"}, {"mention": "副脾", "label": "疾病和诊断", "offset": "429"}, {"mention": "盆腔", "label": "解剖部位", "offset": "432"}, {"mention": "ct", "label": "影像检查", "offset": "442"}]}
{"text": "患儿3年前无明显诱因出现肛门排气增多,酸臭味,无明显规律,无腹痛、呕吐,大便成形,2-3天1次,曾外院就诊,考虑消化不良,予口服益生菌(具体不详)治疗,无缓解。2月前患儿出现腹胀,无腹痛,肛门排气较前增多,无发热,无腹泻,呕吐,大便2-3天1次,成形,未予重视。后腹胀逐渐加重,1周前我院门诊就诊,查腹部立位平片提示“肠腔充气明显,腹部未见明显液平”,门诊予抗感染、开塞露胃肠减压等对症支持治疗,患儿现腹胀较前缓解,为进一步明确腹胀原因收入我科。叒叒叒患儿起病以来,精神、食欲可,二便无殊。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "12"}, {"mention": "腹痛", "label": "症状", "offset": "30"}, {"mention": "消化不良", "label": "疾病和诊断", "offset": "56"}, {"mention": "腹胀", "label": "症状", "offset": "87"}, {"mention": "腹痛", "label": "症状", "offset": "91"}, {"mention": "肛门", "label": "解剖部位", "offset": "94"}, {"mention": "腹泻", "label": "症状", "offset": "108"}, {"mention": "腹胀", "label": "症状", "offset": "132"}, {"mention": "腹部立位平片", "label": "影像检查", "offset": "150"}, {"mention": "肠腔", "label": "解剖部位", "offset": "159"}, {"mention": "腹部", "label": "解剖部位", "offset": "166"}, {"mention": "开塞露", "label": "药物", "offset": "183"}, {"mention": "胃肠", "label": "解剖部位", "offset": "186"}, {"mention": "腹胀", "label": "症状", "offset": "201"}, {"mention": "腹胀", "label": "症状", "offset": "214"}]}
{"text": "患者1月余前因“嗝逆、返酸并进食后呕吐”来我院就诊,行胃镜检查,发现食管鳞状细胞癌。入院后完善检查,排除禁忌,于2013.5.21在全麻上经左胸部+下腹部行食管癌根治术,术后给予抗感染、静脉营养支持等对症支持治疗,胸部及腹部手术刀口定期换药,已经拆线。病理诊断(6034.2013):食管鳞状细胞癌(低度分化),浸润溃疡型,体积4.5*4*1.6cm,侵达外膜。双端切线未查见癌。淋巴结未查见癌,pt3n0m0,iia期。患者术后恢复顺利,于2013.6.2出院。叒叒叒患者于2013.6.17、2013.7.16先后第2、3次来我科就诊,入院后完善检查,排除化疗禁忌,给予奈达铂+吉西他滨方案化疗,同时给予保肝、升白细胞、止吐、增强免疫力等对症治疗,患者对化疗耐受良好,复查血常规及肝肾功未见明显异常。患者顺利出院。叒叒叒患者自下次出院后饮食及睡眠可,无胸闷憋气,无呼吸困难,无恶心呕吐,无进食阻挡,无腹胀腹泻腹痛等症状,饮食及睡眠可,大小便正常,体重较术前减轻。", "mention_data": [{"mention": "食管鳞状细胞癌", "label": "疾病和诊断", "offset": "34"}, {"mention": "左胸部", "label": "解剖部位", "offset": "70"}, {"mention": "下腹部", "label": "解剖部位", "offset": "74"}, {"mention": "食管癌根治术", "label": "手术", "offset": "78"}, {"mention": "胸部", "label": "解剖部位", "offset": "107"}, {"mention": "腹部", "label": "解剖部位", "offset": "110"}, {"mention": "食管鳞状细胞癌(低度分化)", "label": "疾病和诊断", "offset": "142"}, {"mention": "奈达铂", "label": "药物", "offset": "287"}, {"mention": "吉西他滨", "label": "药物", "offset": "291"}, {"mention": "肝", "label": "解剖部位", "offset": "305"}, {"mention": "胸闷憋气", "label": "症状", "offset": "378"}, {"mention": "腹胀", "label": "症状", "offset": "402"}, {"mention": "腹泻", "label": "症状", "offset": "404"}, {"mention": "腹痛", "label": "症状", "offset": "406"}]}
{"text": "患者入院前1月,因“直肠癌伴穿孔、感染性休克、弥漫性腹膜炎”入院,于2014-10-05在全麻上行剖腹探查+直肠癌根治术(hartmann术)+肠粘连松解术,手术顺利,术后病理诊断:(直肠)溃疡型中分化管状腺癌,浸及肠壁全层,脉管、神经未见癌侵犯,双切端未见癌累及,肠壁淋巴结未见癌转移(0/7)。术后病情恢复佳,目前患者造瘘口存活好,无恶心呕吐,身体状况佳,如期返院行第一次全身静脉化疗,门诊以“直肠癌术后”收住入院。\\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": "直肠癌伴穿孔", "label": "疾病和诊断", "offset": "10"}, {"mention": "感染性休克", "label": "疾病和诊断", "offset": "17"}, {"mention": "弥漫性腹膜炎", "label": "疾病和诊断", "offset": "23"}, {"mention": "剖腹探查+直肠癌根治术(hartmann术)+肠粘连松解术", "label": "手术", "offset": "49"}, {"mention": "(直肠)溃疡型中分化管状腺癌", "label": "疾病和诊断", "offset": "91"}, {"mention": "肠", "label": "解剖部位", "offset": "108"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "199"}, {"mention": "胃", "label": "解剖部位", "offset": "231"}]}
{"text": "患者1周前无明显诱因出现下腹部隐痛隐痛不适,进食后加重,无头痛、头晕,无咳嗽、咳痰,无心慌、胸闷、胸痛,无反酸、嗳气,无恶心、呕吐,无腹胀、腹泻,无尿频、尿急、尿痛,无发热、畏寒、寒战,今日行电子结肠镜检查,发现结肠息肉5枚,给予内镜上息肉切除术,送病理诊断,为进一步治疗来诊,门诊以“肠息肉内镜上切除术”收入我科。叒叒叒患者自发现本次发病以来,神志清,精神可,饮食、睡眠可,大小便无异常,体重无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "12"}, {"mention": "头痛", "label": "症状", "offset": "29"}, {"mention": "头晕", "label": "症状", "offset": "32"}, {"mention": "心慌", "label": "症状", "offset": "43"}, {"mention": "胸闷", "label": "症状", "offset": "46"}, {"mention": "胸痛", "label": "症状", "offset": "49"}, {"mention": "腹胀", "label": "症状", "offset": "67"}, {"mention": "腹泻", "label": "症状", "offset": "70"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "106"}, {"mention": "内镜上息肉切除术", "label": "手术", "offset": "115"}, {"mention": "肠息肉内镜上切除术", "label": "手术", "offset": "143"}]}
{"text": "缘于入院3年前无明显诱因出现反复下腹痛,呈阵发性,休息与进食后可缓解,无反射他处,伴有恶心、呕吐,无畏冷、发热,无黄疸,无腹胀、腹泻,无稀水样便、血便等,就诊外院,考虑胃炎,自行服用中药治疗(具体不详),症状反复。1年前就诊我院行胃镜检查回报:慢性萎缩性胃炎,十二指肠球部多发溃疡,予保守治疗后,下腹痛症状有好转。1周前自觉腹痛加剧,今为进一步治疗来我院就诊,门诊以慢性萎缩性胃炎、十二指肠球部溃疡收入院。自发病以来,精神状态一般,体力情况良好,食欲食量良好,睡眠情况良好,体重无明显变化,大便正常,小便正常。", "mention_data": [{"mention": "下腹痛", "label": "症状", "offset": "16"}, {"mention": "腹胀", "label": "症状", "offset": "61"}, {"mention": "腹泻", "label": "症状", "offset": "64"}, {"mention": "胃炎", "label": "疾病和诊断", "offset": "84"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "122"}, {"mention": "十二指肠球部多发溃疡", "label": "疾病和诊断", "offset": "130"}, {"mention": "下腹痛", "label": "症状", "offset": "148"}, {"mention": "腹痛", "label": "症状", "offset": "162"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "183"}, {"mention": "十二指肠球部溃疡", "label": "疾病和诊断", "offset": "191"}]}
{"text": "1+月前患者于我院因“腹胀2月,加重20+天”行腹腔镜上盆腔粘连分离术、右侧输卵管切除术、左侧卵巢囊肿剥除术、腹膜病灶活检术,术后病检报告:1、(右输卵管)炎性改变。叒2、(腹膜病灶)少许坏死物,丰富的钙化物和散在乳头状肿瘤。3、(左卵巢)子宫内膜异位囊肿。根据检查结果考虑腹膜恶性间皮瘤。遂以pt方案化疗,过程中无恶心、呕吐,有脱发。现要求第二次化疗,遂入我院。\\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,体重无明显变化。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "11"}, {"mention": "腹腔镜上盆腔粘连分离术、右侧输卵管切除术、左侧卵巢囊肿剥除术、腹膜病灶活检术", "label": "手术", "offset": "24"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "73"}, {"mention": "腹膜", "label": "解剖部位", "offset": "87"}, {"mention": "乳头状肿瘤", "label": "疾病和诊断", "offset": "107"}, {"mention": "(左卵巢)子宫内膜异位囊肿", "label": "疾病和诊断", "offset": "115"}, {"mention": "腹膜恶性间皮瘤", "label": "疾病和诊断", "offset": "137"}]}
{"text": "入院1+月前,患者出现大便次数增多,4-5次/天,量少,成形,不伴黏液、脓血,无肛门坠胀、里急后重,伴有右侧腹胀,便后缓解,无腹痛、腹泻,无呕血、黑便,无头晕、头痛、发热等症状,患者遂就诊于我院,完善相关检查,诊断为直肠腺癌,并于2016-8-26日经全麻上行腹腔镜直肠癌根治术(miles术)+肠粘连松解术,手术顺利,术后恢复可,术后于2016.09.21行奥沙利铂+卡培他滨化疗,过程顺利,无特殊不适。今日患者为行第2次化疗入院,门诊以“直肠癌术后第1次化疗后”收入我科住院治疗。叒叒叒近期患者精神、食欲、睡眠好,大小便正常,近期体重无明显减轻。", "mention_data": [{"mention": "肛门坠胀", "label": "症状", "offset": "40"}, {"mention": "右侧腹", "label": "解剖部位", "offset": "52"}, {"mention": "腹痛", "label": "症状", "offset": "63"}, {"mention": "腹泻", "label": "症状", "offset": "66"}, {"mention": "头晕", "label": "症状", "offset": "77"}, {"mention": "头痛", "label": "症状", "offset": "80"}, {"mention": "直肠腺癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "腹腔镜直肠癌根治术(miles术)+肠粘连松解术", "label": "手术", "offset": "130"}, {"mention": "奥沙利铂", "label": "药物", "offset": "180"}, {"mention": "卡培他滨", "label": "药物", "offset": "185"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "221"}]}
{"text": "患者半年前发现下腹部包块,约鸡蛋大小,无疼痛,伴腹胀及嗳气,进食后加重,无恶心呕吐,无发热,未系统治疗,近1个月来下述症状加重,伴上腹、前胸及左肩部疼痛,后就诊于我院肿瘤外科,行胃镜检查取病理为胃角低分化腺癌(病理号115738),行腹部ct示胃癌伴腹腔盆腔转移,不宜手术,入我科进一步治疗。患者现精神状态及体力可,偶有发热,最高37.4度,因腹胀进食少,食欲可,睡眠可,排便不成形,1天1-2次,小便正常,近4个月体重减轻10斤,kps评分90分。", "mention_data": [{"mention": "下腹部包块", "label": "症状", "offset": "7"}, {"mention": "腹胀", "label": "症状", "offset": "24"}, {"mention": "上腹", "label": "解剖部位", "offset": "65"}, {"mention": "前胸", "label": "解剖部位", "offset": "68"}, {"mention": "左肩部", "label": "解剖部位", "offset": "71"}, {"mention": "胃角低分化腺癌", "label": "疾病和诊断", "offset": "97"}, {"mention": "腹部ct", "label": "影像检查", "offset": "117"}, {"mention": "胃癌伴腹腔盆腔转移", "label": "疾病和诊断", "offset": "122"}, {"mention": "腹胀", "label": "症状", "offset": "172"}]}
{"text": "患者无明显原因及诱因的出现反酸烧心,持续10余年,无规律,饮食后减轻,口服雷尼替丁和胃必治后好转,一直未行进一步治疗,2月余前反酸烧心症状加重,伴有轻度恶心呕吐,无呕血,偶有黑便,腹痛无腹胀,到我院行胃镜检查,病理为低分化腺癌,腹部ct示肝内多发结节,考虑转移。虑患者为iv期胃癌,行术前新辅助化疗。已行2周期紫杉醇+希罗达方案化疗,紫杉醇134mg叒d1,d8,希罗达叒1.5g叒bid叒d1-d14。此次为行术前第3周期化疗入院。患者自发病以来饮食睡眠可,大小便正常,精神佳,体重未有明显减轻。", "mention_data": [{"mention": "雷尼替丁", "label": "药物", "offset": "37"}, {"mention": "胃必治", "label": "药物", "offset": "42"}, {"mention": "腹痛", "label": "症状", "offset": "90"}, {"mention": "腹胀", "label": "症状", "offset": "93"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "腹部ct", "label": "影像检查", "offset": "114"}, {"mention": "肝内多发结节", "label": "疾病和诊断", "offset": "119"}, {"mention": "iv期胃癌", "label": "疾病和诊断", "offset": "135"}, {"mention": "紫杉醇", "label": "药物", "offset": "155"}, {"mention": "希罗达", "label": "药物", "offset": "159"}, {"mention": "紫杉醇", "label": "药物", "offset": "167"}, {"mention": "希罗达", "label": "药物", "offset": "182"}]}
{"text": "患者2009年因\\\"右颈肿物2月\\\"入到我院就诊,完善相关检查后确诊为鼻咽分化型非角化癌t4n2m0叒iva期,在我院行2疗程pf方案诱导化疗后,在门诊行根治性放疗(详见放疗病历),过程顺利,达临床治愈出院。出院后定期复查,2010-3患者左侧上颚开始出现红肿,并逐渐形成溃疡,窦道与口腔相通,难以愈合,曾到外院治疗(具体不详)3月,无明显效果,期间患者开始出现声嘶,进食呛咳等症状加重,并开始面部麻木,听力上降等并发症。患者溃疡逐渐增大,现面积达2.5×2.0cm,进食时食物可从窦道流出。2012-4-13在我院门诊就诊,行经胃镜上营养管置入术,过程顺利,现为解决进食,收入我科拟行内镜上胃造瘘术。患者发病以来,精神较差,饮食睡眠一般,大小便正常,体重减轻约17kg。", "mention_data": [{"mention": "右颈", "label": "解剖部位", "offset": "10"}, {"mention": "鼻咽分化型非角化癌t4n2m0叒iva期", "label": "疾病和诊断", "offset": "35"}, {"mention": "左侧上颚", "label": "解剖部位", "offset": "120"}, {"mention": "口腔", "label": "解剖部位", "offset": "142"}, {"mention": "面部麻木", "label": "症状", "offset": "197"}, {"mention": "经胃镜上营养管置入术", "label": "手术", "offset": "264"}, {"mention": "内镜上胃造瘘术", "label": "手术", "offset": "293"}]}
{"text": "患者3年余前无明显原因出现大便次数增多,每次小便均有大便排出,走路时也有大便挤出,不成形,无粘液脓血便,偶伴腹部隐痛,排便后可缓解,无明显腹胀不适,偶伴有反酸、烧心,无恶心、呕吐,无呕血,院外未行诊治。今来我院就诊,行胃肠镜检查于内镜上息肉切除并取组织送病理,为行系统治疗。门诊以“肠息肉叒内镜上切除术”收入院。叒叒叒患者自发病以来,饮食、睡眠可,大便如下所述,小便正常,体重无明显改变。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "54"}, {"mention": "腹胀", "label": "症状", "offset": "69"}, {"mention": "内镜上息肉切除", "label": "手术", "offset": "115"}, {"mention": "肠息肉叒内镜上切除术", "label": "手术", "offset": "141"}]}
{"text": ",患者2年前因子宫肌瘤在外院行子宫切除术及右侧附件切除术,术后病检子宫肌瘤良性病变(具体不详),术后1年来反复出现腹痛,隐痛,无放射,无发热,无尿频、尿急、尿痛,,复查b超示:左侧附件包块,大小约2cm(具体不详),在我院服药治疗后腹痛好转,反复腹痛,定期复查b超,左侧附件包块逐渐增多,5月6日,复查b超示:左侧附件包块,双个囊性灶,30*24mm、26*25mm,包裹性积液及卵巢黄体囊肿可能。现门诊以“盆腔包块”收住院。起病以来,患者一般情况良好,无特殊不适,饮食睡眠可,二便正常,近期体重无明显改变。,外院治疗经过:无。", "mention_data": [{"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "7"}, {"mention": "子宫切除术及右侧附件切除术", "label": "手术", "offset": "15"}, {"mention": "子宫肌瘤良性病变", "label": "疾病和诊断", "offset": "33"}, {"mention": "腹痛", "label": "症状", "offset": "57"}, {"mention": "b超", "label": "影像检查", "offset": "84"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "88"}, {"mention": "腹痛", "label": "症状", "offset": "116"}, {"mention": "腹痛", "label": "症状", "offset": "123"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "133"}, {"mention": "b超", "label": "影像检查", "offset": "151"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "155"}, {"mention": "卵巢黄体囊肿", "label": "疾病和诊断", "offset": "190"}, {"mention": "盆腔包块", "label": "症状", "offset": "204"}]}
{"text": "缘于1+月前患者因“ciniii级”在我院行“leep”术,术后病理报告(2014.10.27):(宫颈组织)宫颈粘膜慢性炎伴纳氏囊肿、糜烂,鳞状下皮ciniii级累及腺体,并伴局部区域微小浸润,宫颈管切端未见病变累及。建议行“残余子宫切除术”。遂今就诊我院,要求住院手术治疗,无阴道出血、异常排液,无发热、腹痛、腹胀、尿频、尿急等不适,故门诊拟“ciniii级”收入院。发病以来精神、睡眠、食欲尚可,大便如下述,小便正常,体重有明显减轻。", "mention_data": [{"mention": "ciniii级", "label": "疾病和诊断", "offset": "10"}, {"mention": "“leep”术", "label": "手术", "offset": "22"}, {"mention": "(宫颈组织)宫颈粘膜慢性炎伴纳氏囊肿、糜烂,鳞状下皮ciniii级累及腺体", "label": "疾病和诊断", "offset": "49"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "98"}, {"mention": "残余子宫切除术", "label": "手术", "offset": "114"}, {"mention": "阴道出血", "label": "症状", "offset": "140"}, {"mention": "腹痛", "label": "症状", "offset": "154"}, {"mention": "腹胀", "label": "症状", "offset": "157"}, {"mention": "ciniii级", "label": "疾病和诊断", "offset": "174"}]}
{"text": ",患者2008年11月17日因“肝细胞癌”行肝癌切除(肝中叶)+胆囊切除术。术后接受细胞免疫生物治疗cik细胞。随后复查未见重要病变。3周余前外院chest叒x-ray发现左下肺肿块。遂到我院检查,2011.07.01胸、,下腹部ct提示:“肝癌切除术后改变。左肺下叶前段肿块,考虑肺癌可能性大。心包少量积液”。一直未诉有咳嗽、咳血丝痰、发热、胸痛,盗汗、食欲不振、骨关节疼痛。为了进一步诊治收住我科。起病以来,一般情况好,未诉不适,大小便正常,体重无明显变化。,肿瘤治疗史:2008年11月“肝细胞癌”切除术后接受细胞免疫生物治疗cik细胞。", "mention_data": [{"mention": "肝细胞癌", "label": "疾病和诊断", "offset": "16"}, {"mention": "肝癌切除(肝中叶)+胆囊切除术", "label": "手术", "offset": "22"}, {"mention": "chest叒x-ray", "label": "影像检查", "offset": "73"}, {"mention": "左下肺", "label": "解剖部位", "offset": "86"}, {"mention": "胸、,下腹部ct", "label": "影像检查", "offset": "109"}, {"mention": "肝癌切除术后", "label": "疾病和诊断", "offset": "121"}, {"mention": "左肺下叶前段", "label": "解剖部位", "offset": "130"}, {"mention": "肺癌", "label": "疾病和诊断", "offset": "141"}, {"mention": "心包少量积液", "label": "疾病和诊断", "offset": "148"}, {"mention": "胸痛", "label": "症状", "offset": "172"}, {"mention": "骨关节", "label": "解剖部位", "offset": "183"}, {"mention": "“肝细胞癌”切除术后", "label": "疾病和诊断", "offset": "246"}]}
{"text": ",入院前10+年,患者无明显诱因出现腹胀、腹痛,伴有反酸、嗳气,无纳差,无腹泻,无恶心、呕吐、呕血,无畏寒、发热,有排便、排气。遂至我院就诊,,诊断为:慢性胃炎,具体治疗不详,好转后出院。10年来,患者反复间断出现腹痛、腹胀症状,自行服用口服药物后缓解,具体药物不详。2015年8月26日,于我院行13c呼气试验检验报告:幽门杆菌监测为阳性。,胃镜检查提示:1.胃体多发性小息肉;2.慢性非萎缩性胃炎,,病理检查报告:胃体息肉。入院前1月,患者因食用辛辣食物后,出现腹胀、腹痛症状加重,伴反酸、嗳气,无纳差,无腹泻,无恶心、呕吐、呕血,无畏寒、发热,有排便、排气。予以口服药后无明显缓解。今为行胃镜上氩气刀胃体息肉切除术,入我院治疗。叒叒叒发病以来,精神、食欲、睡眠尚可,大、小便正常,近期体重无明显变化。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "18"}, {"mention": "腹痛", "label": "症状", "offset": "21"}, {"mention": "腹泻", "label": "症状", "offset": "37"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "76"}, {"mention": "腹痛", "label": "症状", "offset": "107"}, {"mention": "腹胀", "label": "症状", "offset": "110"}, {"mention": "幽门杆菌监测", "label": "实验室检验", "offset": "161"}, {"mention": "胃体多发性小息肉", "label": "疾病和诊断", "offset": "181"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "192"}, {"mention": "胃体息肉", "label": "疾病和诊断", "offset": "209"}, {"mention": "腹胀", "label": "症状", "offset": "233"}, {"mention": "腹痛", "label": "症状", "offset": "236"}, {"mention": "腹泻", "label": "症状", "offset": "255"}, {"mention": "胃镜上氩气刀胃体息肉切除术", "label": "手术", "offset": "297"}]}
{"text": "患者于1月前无明显诱因出现中下腹饱胀不适,伴嗳气、纳差(饭量减为原来的一半),无反酸、烧心、腹痛、腹泻,无恶心、呕吐、黑便等不适,院外行服中药(具体不详)治疗,症状缓解不明显,7天前于我科门诊就诊,行胃镜检查,提示“食管炎(i级)、胃底粘膜上隆起(性质待定)、浅表性胃窦炎”,超声胃镜提示:胃底间质瘤可能性大,予以抑酸、护胃等对症治疗后症状有所缓解,为进一步处理胃底间质瘤,入我科,门诊以“胃间质瘤”收治入院。\\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1月体重减少3公斤。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "13"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹泻", "label": "症状", "offset": "49"}, {"mention": "食管炎(i级)", "label": "疾病和诊断", "offset": "108"}, {"mention": "胃底粘膜", "label": "解剖部位", "offset": "116"}, {"mention": "浅表性胃窦炎", "label": "疾病和诊断", "offset": "130"}, {"mention": "胃底间质瘤", "label": "疾病和诊断", "offset": "145"}, {"mention": "胃", "label": "解剖部位", "offset": "161"}, {"mention": "胃底间质瘤", "label": "疾病和诊断", "offset": "181"}, {"mention": "胃间质瘤", "label": "疾病和诊断", "offset": "195"}]}
{"text": "患者2012年7月无明显诱因出现下腹部不适,在外院通过胃镜诊断为胃窦癌,遂于2013-1-31在我院行胃癌根治术(远端胃大切),术后病理:低分化腺癌,小灶为粘液腺癌,侵及胃壁粘膜上层,1/33(+),pt1bn1m0,ib期。术后恢复良好,于2013-3-1、2013-03-26、2013-04-24行单药希罗达辅助化疗3程,化疗后患者耐受性良好,今遵原主诊医师意见继续行原方案化疗。近期患者精神、睡眠、食欲可,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": "16"}, {"mention": "胃窦癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "胃癌根治术(远端胃大切)", "label": "手术", "offset": "51"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "78"}, {"mention": "胃", "label": "解剖部位", "offset": "85"}, {"mention": "希罗达", "label": "药物", "offset": "154"}]}
{"text": "患者于2016年6月开始无明显诱因出现不规则阴道出血。于**一院经完善盆腔ct、阴道彩超、宫颈肿物活检等检查,诊断明确为\\\"宫颈癌肉瘤iib期\\\",遂于2016-9-1至**一院行\\\"经腹次广泛子宫切除术+两侧附件切除\\\",术后病理示:(子宫)高级别恶性肿瘤,考虑恶性苗勒氏管瘤(癌肉瘤),fish检测结果排除了滑膜肉瘤。(子宫宫颈及左侧附件)考虑为低分化鳞状细胞癌,肿瘤呈外生性生长为主,浸润宫颈深度&lt;1/2,双侧宫旁及阴道残端未见癌。增殖期子宫内膜,子宫腺肌症,左卵巢子宫内膜异位症,左侧输卵管积水改变。术后分别于2016-9-5及2016-9-29行\\\"奈达铂叒40mg叒+叒ctx叒0.4叒+叒5-fu叒500mg叒qd叒x叒2d\\\"化疗双程。2016-10-16复查未见肿瘤复发转移征象。遂于2016-11-08开始在我院放疗科行术后放疗(共25次)。因考虑患者为癌肉瘤,易复发转移,我院妇科***教授建议患者行术后辅助化疗,遂2017-01-01、2017-2-4、2017-3-2、2017-03-23于我科行ai方案辅助化疗4程,过程顺利,主要副反应为iv°白细胞减少,无发热。2017-2-15复查腹盆腔mri未见肿瘤复发及转移。患者现按约返院继续化疗。起病以来,患者大小便正常,精神、胃纳可,体力、体重无明显变化。", "mention_data": [{"mention": "阴道出血", "label": "症状", "offset": "22"}, {"mention": "盆腔ct", "label": "影像检查", "offset": "35"}, {"mention": "阴道彩超", "label": "影像检查", "offset": "40"}, {"mention": "宫颈肿物", "label": "疾病和诊断", "offset": "45"}, {"mention": "宫颈癌肉瘤", "label": "疾病和诊断", "offset": "62"}, {"mention": "经腹次广泛子宫切除术+两侧附件切除", "label": "手术", "offset": "92"}, {"mention": "(子宫)高级别恶性肿瘤", "label": "疾病和诊断", "offset": "118"}, {"mention": "恶性苗勒氏管瘤(癌肉瘤)", "label": "疾病和诊断", "offset": "132"}, {"mention": "滑膜肉瘤", "label": "疾病和诊断", "offset": "156"}, {"mention": "子宫宫颈", "label": "解剖部位", "offset": "162"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "167"}, {"mention": "低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "175"}, {"mention": "宫颈", "label": "解剖部位", "offset": "197"}, {"mention": "双侧宫旁", "label": "解剖部位", "offset": "209"}, {"mention": "阴道", "label": "解剖部位", "offset": "214"}, {"mention": "子宫内膜", "label": "解剖部位", "offset": "225"}, {"mention": "子宫腺肌症", "label": "疾病和诊断", "offset": "230"}, {"mention": "左卵巢子宫内膜异位症", "label": "疾病和诊断", "offset": "236"}, {"mention": "左侧输卵管积水", "label": "疾病和诊断", "offset": "247"}, {"mention": "奈达铂", "label": "药物", "offset": "283"}, {"mention": "ctx", "label": "药物", "offset": "294"}, {"mention": "5-fu", "label": "药物", "offset": "304"}, {"mention": "癌肉瘤", "label": "疾病和诊断", "offset": "390"}, {"mention": "白细胞", "label": "实验室检验", "offset": "490"}, {"mention": "腹盆腔mri", "label": "影像检查", "offset": "511"}]}
{"text": "患者1年前无明显诱因发现盆腔包块,无腹痛、伴腹胀。当时未予以重视。2月前出现腹痛,伴腹胀,无恶心,呕吐等不适,遂就诊**三院行b超示:盆腔巨大包块,大小约14.4*12.5cm,考虑卵巢肿瘤。入院后予以完善相关检查,遂于2016-03-24在全麻上行卵巢癌全面分期手术(“全子宫两附件切除+盆腔淋巴结清扫术”)。手术顺利,根据患者术中病理及术中所见,考虑患者诊断为卵巢低分化腺癌,遂于2016-03-28、2016-04-20、2016-05-23予以tc方案化疗3程,化疗顺利。今为进一步治疗,就诊我院我科。起病来患者精神可,食欲可,睡眠可,大小便正常。体重无明显变化。", "mention_data": [{"mention": "盆腔包块", "label": "症状", "offset": "12"}, {"mention": "腹痛", "label": "症状", "offset": "18"}, {"mention": "腹胀", "label": "症状", "offset": "22"}, {"mention": "腹痛", "label": "症状", "offset": "38"}, {"mention": "腹胀", "label": "症状", "offset": "42"}, {"mention": "b超", "label": "影像检查", "offset": "63"}, {"mention": "盆腔", "label": "解剖部位", "offset": "67"}, {"mention": "卵巢肿瘤", "label": "疾病和诊断", "offset": "91"}, {"mention": "卵巢癌", "label": "疾病和诊断", "offset": "125"}, {"mention": "全子宫两附件切除+盆腔淋巴结清扫术", "label": "手术", "offset": "136"}, {"mention": "卵巢低分化腺癌", "label": "疾病和诊断", "offset": "182"}]}
{"text": ",患者于9个月余前,因查体发现cea升高,且有大便习惯改变,就诊于我院胃肠外科,完善相关检查,于2016年5月20日行胃镜检查,,病理示:胃窦腺癌,排除手术禁忌,于2016年5月24日在全麻上行手术治疗(具体术式不详)。手术过程顺利,,术后病理示:胃窦大弯侧腺癌(中-低度分化),大部分呈乳头状腺癌,浸润溃疡型,体积3*3*0.5cm,侵达深肌层。双端切线未查见癌。呈六组(1/4个)淋巴结癌转移。三组(1个)、四组(5个)、五组(3个)、“1、3、7组”(4个)淋巴结未查见癌。术后于2016年6月25日行1周期化疗,,方案:奥沙利铂200mg叒d1+亚叶酸钙0.3g叒d2-6叒+替加氟1000mg叒d2-6,同时辅以保肝、保胃及止吐等对症支持治疗,化疗过程顺利。化疗结束后出院。患者为求放疗于2016年7月20日入住我科,完善相关辅助检查,排除禁忌,于2016年7月21日行全身化疗,,方案:奥沙利铂200mgd1+替吉奥60mg叒bid叒d1-d14,同时辅以保肝、保胃及止吐等对症处理,患者胃肠道反应轻,化疗过程顺利,化疗结束后于2016年8月9日开始行局部放疗,共放疗14次,dt2520cgy,同步口服替吉奥40mg叒bid化疗,未见明显放化疗反应,耐受可,患者于2016年8月29日拒绝继续放疗,经反复劝说无效,签字为证。排除禁忌,于2016年9月1日行原方案全身化疗,化疗过程顺利,好转出院。5天前患者无明显诱因的出现头晕、头痛症状,此次为行后续治疗,前来我院就诊,门诊收入病房。叒叒叒患者自下次出院后,病情尚稳定,未述特殊不适,饮食睡眠尚可,大小便正常。体重未见明显减轻。", "mention_data": [{"mention": "cea", "label": "实验室检验", "offset": "15"}, {"mention": "胃窦腺癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "胃窦大弯侧腺癌(中-低度分化)", "label": "疾病和诊断", "offset": "124"}, {"mention": "乳头状腺癌", "label": "疾病和诊断", "offset": "144"}, {"mention": "奥沙利铂", "label": "药物", "offset": "264"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "277"}, {"mention": "替加氟", "label": "药物", "offset": "292"}, {"mention": "肝", "label": "解剖部位", "offset": "312"}, {"mention": "胃", "label": "解剖部位", "offset": "315"}, {"mention": "奥沙利铂", "label": "药物", "offset": "399"}, {"mention": "替吉奥", "label": "药物", "offset": "411"}, {"mention": "肝", "label": "解剖部位", "offset": "435"}, {"mention": "胃", "label": "解剖部位", "offset": "438"}, {"mention": "胃肠道", "label": "解剖部位", "offset": "450"}, {"mention": "替吉奥", "label": "药物", "offset": "508"}, {"mention": "头晕", "label": "症状", "offset": "618"}, {"mention": "头痛", "label": "症状", "offset": "621"}]}
{"text": "患者于3年前无明显诱因开始出现下腹部隐痛不适,进行性加重,未行诊疗。2012年6月症状加重,外院行胃镜检查提示胃癌可能,病理提示胃底腺癌,查ct提示肝转移。此后到我院行6*多西他赛+s-1方案化疗,评价为pr。遂行s-1维持治疗3程后,复查ct提示肝转移灶进展,考虑pd,2013.02.26、2013-03-19给予多西他赛+s-1方案化疗2程,2程后复查ct疗效评价为pd。2013-04-17、2013-5-7行培美曲赛方案化疗2程,随后门诊行folfiri方案化疗9程,无诉不适,评价sd。现根据原主诊教授意见入院行单药cpt11维持化疗。患者近期精神、食欲、睡眠可,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": "15"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "55"}, {"mention": "胃底腺癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "ct", "label": "影像检查", "offset": "70"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "74"}, {"mention": "多西他赛", "label": "药物", "offset": "86"}, {"mention": "s-1", "label": "药物", "offset": "91"}, {"mention": "s-1", "label": "药物", "offset": "107"}, {"mention": "ct", "label": "影像检查", "offset": "120"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "124"}, {"mention": "多西他赛", "label": "药物", "offset": "159"}, {"mention": "s-1", "label": "药物", "offset": "164"}, {"mention": "ct", "label": "影像检查", "offset": "179"}, {"mention": "培美曲赛", "label": "药物", "offset": "209"}, {"mention": "cpt1", "label": "药物", "offset": "264"}]}
{"text": ",缘于入院前11个月因“左肝癌”于我院行胆囊切除、左半肝切除术,,术后病理示:1.(左肝)肝脏原发性胆管细胞癌ii级,浸润周围肝组织,侵犯肝被膜,周围肝组织肝细胞轻度水肿变性及脂肪变性。另送(肝十二指肠韧带)淋巴结2个均未见癌转移。2.(胆囊),:慢性腺性胆囊炎,另见淋巴结2个未见癌转移。术后恢复可。出院后无腹痛、腹胀,无恶心、呕吐,无畏冷、寒战,无眼黄、尿黄、皮肤黄染,无反酸、嗳气等不适。定期返院复查。4天前无明显诱因出现左下腹痛,呈持续性隐痛,无向他处放射,伴发热,最高体温38.5℃,无畏寒,无恶心、呕吐、呕血、便血、眼黄、尿黄、皮肤黄,无胸闷、气促、意识不清等不适,就诊我院,门诊以肝癌术后收入院。自下次出院以来,食欲可,精神可,睡眠良好,体重无明显上降,大、小便正常。", "mention_data": [{"mention": "左肝癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "胆囊切除、左半肝切除术", "label": "手术", "offset": "20"}, {"mention": "(左肝)肝脏原发性胆管细胞癌ii级", "label": "疾病和诊断", "offset": "41"}, {"mention": "肝", "label": "解剖部位", "offset": "63"}, {"mention": "肝", "label": "解剖部位", "offset": "69"}, {"mention": "肝", "label": "解剖部位", "offset": "75"}, {"mention": "肝", "label": "解剖部位", "offset": "78"}, {"mention": "(肝十二指肠韧带)淋巴结", "label": "解剖部位", "offset": "95"}, {"mention": "胆囊", "label": "解剖部位", "offset": "119"}, {"mention": "慢性腺性胆囊炎", "label": "疾病和诊断", "offset": "124"}, {"mention": "腹痛", "label": "症状", "offset": "155"}, {"mention": "腹胀", "label": "症状", "offset": "158"}, {"mention": "左下腹", "label": "解剖部位", "offset": "214"}, {"mention": "胸闷", "label": "症状", "offset": "275"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "297"}]}
{"text": "患者1个多月前开始出现进食有胸骨后哽噎感,饮水后缓解,偶有呕吐,2周前症状加重,进食米饭困难,改食流质,无恶心,无呕血、黑便,无咳嗽、气促,无声嘶、呛咳。遂到外院查胃镜考虑食管癌。为求进一步诊疗来我院就诊,做超声胃镜提示“距门齿35cm以上见食管环周肿物,管腔狭窄,累及肌层,外膜层清楚,于胸主动脉、肺动脉分界清,食管肿物旁、主动脉窗、隆突上见淋巴结,7.4*4.4mm、5.8*6.8mm和6.9*4.8mm,均质,界清,见淋巴结结构”,取病理活检提示“中分化鳞状细胞癌”,ct提示“胸上段食管局限性增厚,考虑食管癌;隆突上及贲门右小淋巴结;左下肺后段小类结节灶,考虑增殖灶可能大。”2周前入院查心脏ct示心肌桥形成,遂到**一院心内科就诊,查冠脉造影示:右侧第一对角支近端狭窄50-80%,评估后认为现可耐受手术治疗,现为手术治疗再次入院。起病以来,患者精神、食欲、睡眠尚可,大小便正常,近期体重无明显增减,目前可进食半流质饮食。", "mention_data": [{"mention": "胸骨", "label": "解剖部位", "offset": "14"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "86"}, {"mention": "门齿", "label": "解剖部位", "offset": "112"}, {"mention": "食管", "label": "解剖部位", "offset": "121"}, {"mention": "胸主动脉", "label": "解剖部位", "offset": "145"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "150"}, {"mention": "食管", "label": "解剖部位", "offset": "157"}, {"mention": "主动脉窗", "label": "解剖部位", "offset": "163"}, {"mention": "隆突上见淋巴结", "label": "解剖部位", "offset": "168"}, {"mention": "中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "228"}, {"mention": "ct", "label": "影像检查", "offset": "238"}, {"mention": "胸上段食管", "label": "解剖部位", "offset": "243"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "256"}, {"mention": "隆突上", "label": "解剖部位", "offset": "260"}, {"mention": "贲门右小淋巴结", "label": "解剖部位", "offset": "264"}, {"mention": "左下肺后段", "label": "解剖部位", "offset": "272"}, {"mention": "心脏ct", "label": "影像检查", "offset": "299"}, {"mention": "心肌桥", "label": "疾病和诊断", "offset": "304"}, {"mention": "冠脉造影", "label": "影像检查", "offset": "323"}, {"mention": "右侧第一对角支近端", "label": "解剖部位", "offset": "329"}]}
{"text": "患者1月前因腹痛、发热来我院就诊,诊断为胆石症并胆系感染,给予抗感染治疗后于2013,12.18在全麻上行胆囊切除+胆总管切开取石+t管引流术,术后给予抗感染、补液等对症处理,治愈后出院。患者自出院后,无发热,无恶心、呕吐,无腹痛、腹泻等不适,今为求进一步诊治来我院就诊,门诊以“胆石症术后”收入院。叒叒叒患者自出院以来,神志清,精神好,饮食睡眠好,大便未见明显异常,体重较前无明显改变。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "6"}, {"mention": "胆石症并胆系感染", "label": "疾病和诊断", "offset": "20"}, {"mention": "胆囊切除+胆总管切开取石+t管引流术", "label": "手术", "offset": "53"}, {"mention": "腹痛", "label": "症状", "offset": "113"}, {"mention": "腹泻", "label": "症状", "offset": "116"}, {"mention": "胆石症术后", "label": "疾病和诊断", "offset": "140"}]}
{"text": ",患者1月前出现阴道流血,量中,到******就诊,体检发现宫颈病变,,活检病理示:宫颈cin3改变累及腺体,之后于10月21日行冷刀宫颈锥切术,,术后病理示:宫颈中分化鳞癌,浸润肌层。此病理经我院病理科会诊为中分化鳞状细胞癌,浸润浅肌层,现为求进一步诊治收入我院,患者自起病以来,精神、胃纳可,无胸闷气促,腹胀腹痛,尿频尿急,里急后重等不适,大小便正常,体重无明显改变。,外院治疗经过:无。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "8"}, {"mention": "宫颈", "label": "解剖部位", "offset": "30"}, {"mention": "宫颈cin3改变累及腺体", "label": "疾病和诊断", "offset": "42"}, {"mention": "冷刀宫颈锥切术", "label": "手术", "offset": "65"}, {"mention": "宫颈中分化鳞癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "105"}, {"mention": "胃", "label": "解剖部位", "offset": "144"}, {"mention": "胸闷", "label": "症状", "offset": "149"}, {"mention": "腹胀", "label": "症状", "offset": "154"}, {"mention": "腹痛", "label": "症状", "offset": "156"}]}
{"text": ",患者4年前无明显诱因出现口干,多饮,日饮水量达3000ml,尿量增多,约等同于饮水量,伴有体重上降,1月内上降约5千克,无多食易饥,入我院就诊,测空腹血糖在13mmol/l,诊断为“糖尿病”,给予胰岛素(具体剂量应用不详)控制血糖,空腹血糖在7mol/l患者出院后未坚持应用胰岛素及其他降糖药物,未控制饮食,未规律监测,半月前患者出现腹痛,以下腹部为主,阵发性绞痛,休息后缓解,1天前为求明确诊断及治疗,来我院,,测血糖示:15.3mmol/l,,今行电子胃镜及肠镜示:胃多发溃疡,直肠多发息肉。并行内镜上直肠息肉切除术,术后为求控制血糖,促进愈合,以“糖尿病,直肠息肉切除术”收入我科。叒叒叒患者自发病以来,神志清,精神尚可,大小便正常,体重较前上降5kg.。", "mention_data": [{"mention": "口干", "label": "症状", "offset": "13"}, {"mention": "空腹血糖", "label": "实验室检验", "offset": "74"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "92"}, {"mention": "胰岛素", "label": "药物", "offset": "99"}, {"mention": "空腹血糖", "label": "实验室检验", "offset": "117"}, {"mention": "胰岛素", "label": "药物", "offset": "138"}, {"mention": "腹痛", "label": "症状", "offset": "168"}, {"mention": "下腹部", "label": "解剖部位", "offset": "172"}, {"mention": "血糖", "label": "实验室检验", "offset": "209"}, {"mention": "胃多发溃疡", "label": "疾病和诊断", "offset": "236"}, {"mention": "直肠多发息肉", "label": "疾病和诊断", "offset": "242"}, {"mention": "内镜上直肠息肉切除术", "label": "手术", "offset": "251"}, {"mention": "血糖", "label": "实验室检验", "offset": "268"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "278"}, {"mention": "直肠息肉切除术", "label": "手术", "offset": "282"}]}
{"text": ",患者1年前无明显诱因出现腹部阵发性疼痛不适,渐加重,无恶心、呕吐,无明显排便习惯改变,无血便,无头晕、乏力、发热等不适。后症状加重,并出现呕吐,排便减少。外院肠镜检查提示距离肛门68cm升结肠肿物,肠腔狭窄,肠镜不能通过,活检病理提示中分化腺癌。后为求进一步诊治,来我院结直肠科就诊,入院完善相关检查,未见明确远处脏器转移,2016-07-15行“左半结肠切除术+回肠减压”术。术程顺利,,术后病理示:1(肠大体)镜检为肠中至低分化腺癌,部分为粘液腺癌,癌组织浸润至肠壁浆膜上层,可见脉管内癌栓,未见明确神经束侵犯;(中间淋巴结)3枚,1/3见腺癌转移。,分期:pt3n1am0叒iiib期。术后恢复顺利,2016-8-9、2016-08-30、2016-09-19、2016-10-15予xelox方案辅助化疗4程,经过顺利。现患者按约返院复查及继续化疗。自下次出院来,精神、饮食好,二便正常,近期体重无明显变化。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "13"}, {"mention": "头晕", "label": "症状", "offset": "49"}, {"mention": "肛门", "label": "解剖部位", "offset": "88"}, {"mention": "升结肠", "label": "解剖部位", "offset": "94"}, {"mention": "肠", "label": "解剖部位", "offset": "100"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "118"}, {"mention": "“左半结肠切除术+回肠减压”术", "label": "手术", "offset": "174"}, {"mention": "肠", "label": "解剖部位", "offset": "204"}, {"mention": "肠中至低分化腺癌", "label": "疾病和诊断", "offset": "211"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "223"}, {"mention": "肠", "label": "解剖部位", "offset": "234"}, {"mention": "腺癌转移", "label": "疾病和诊断", "offset": "273"}]}
{"text": ",患者2012-11因“大便性状改变1月”于*********检查ct及结肠镜提示乙状结肠癌,2012-11-28行“腹腔镜乙状结肠切除术”,术后病理示乙状结肠中-低分化腺癌,肠周淋巴结可见癌转移。手术顺利,术后行“mfolfox-7”化疗,化疗3程后复查,cea:17.44ng/ml,ct提示肝内占位,考虑转移瘤。2013-02-29行\\\"伊立替康+氟尿嘧啶\\\"化疗2程,2013-04-15复查ct提示肝s8叒结节,考虑转移瘤。,cea:74ng/ml,现为进一步治疗入院。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,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": "ct", "label": "影像检查", "offset": "33"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "41"}, {"mention": "腹腔镜乙状结肠切除术", "label": "手术", "offset": "59"}, {"mention": "乙状结肠中-低分化腺癌", "label": "疾病和诊断", "offset": "76"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "88"}, {"mention": "cea", "label": "实验室检验", "offset": "129"}, {"mention": "ct", "label": "影像检查", "offset": "144"}, {"mention": "肝", "label": "解剖部位", "offset": "148"}, {"mention": "伊立替康", "label": "药物", "offset": "172"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "177"}, {"mention": "ct", "label": "影像检查", "offset": "200"}, {"mention": "肝s8", "label": "解剖部位", "offset": "204"}, {"mention": "cea", "label": "实验室检验", "offset": "218"}, {"mention": "腹痛", "label": "症状", "offset": "251"}, {"mention": "腹胀", "label": "症状", "offset": "255"}]}
{"text": ",入院前2周,,患者在我院行胃镜检查提示:浅表性胃窦炎,食管息肉?,建议行息肉切除,超声胃镜检查。患者无反酸、嗳气、烧心、恶心、呕吐、腹痛、腹胀、腹泻、便秘、畏寒、发热、咳嗽、咳痰、头昏、心悸等不适,院外未予特殊治疗,,于2天前我院门诊行超声内镜示:“食管息肉”;为进一步诊治,遂来我院,门诊以“食管息肉、慢性胃炎”收入住院。\\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,体重无明显变化。", "mention_data": [{"mention": "浅表性胃窦炎", "label": "疾病和诊断", "offset": "21"}, {"mention": "食管息肉", "label": "疾病和诊断", "offset": "28"}, {"mention": "息肉切除", "label": "手术", "offset": "37"}, {"mention": "腹痛", "label": "症状", "offset": "67"}, {"mention": "腹胀", "label": "症状", "offset": "70"}, {"mention": "腹泻", "label": "症状", "offset": "73"}, {"mention": "头昏", "label": "症状", "offset": "91"}, {"mention": "心悸", "label": "症状", "offset": "94"}, {"mention": "食管息肉", "label": "疾病和诊断", "offset": "126"}, {"mention": "食管息肉", "label": "疾病和诊断", "offset": "148"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "153"}]}
{"text": "患者3月前因“左腹隐痛并血便20天”入院,入院后完善相关检查,于2011.03.23在全麻上“dixon”术,术程顺利,术后安返病房。术后病理:中低分化腺癌(dukes叒c期。患者术后第四天出现寒战、高热,腹部压痛、反跳痛,腹腔引流液为粪性,浑浊,诊断为吻合口瘘,遂于2011.03.27在全麻上行“剖腹探查术+回肠造瘘术”术程顺利,术后安返病房,术后患者恢复良好,于2011.04.27出院。现患者术后4月余,行xelox辅助化疗4程,患者无诉腹部疼痛、无腹胀,无恶心、呕吐,无反酸、嗳气,无头晕、乏力,全身无黄染不适,造瘘口通畅,每日有适量粪便流出,黄色、稀烂便,无黑便,造瘘口粘膜鲜红色。现为进一步诊治收入我科,近4月来,患者精神尚可,食欲如常。二便无异常,体重增加16kg。", "mention_data": [{"mention": "左腹", "label": "解剖部位", "offset": "7"}, {"mention": "“dixon”术", "label": "手术", "offset": "46"}, {"mention": "中低分化腺癌(dukes叒c期", "label": "疾病和诊断", "offset": "72"}, {"mention": "腹部压痛", "label": "症状", "offset": "103"}, {"mention": "腹腔", "label": "解剖部位", "offset": "112"}, {"mention": "吻合口瘘", "label": "疾病和诊断", "offset": "127"}, {"mention": "剖腹探查术+回肠造瘘术", "label": "手术", "offset": "150"}, {"mention": "腹部", "label": "解剖部位", "offset": "223"}, {"mention": "腹胀", "label": "症状", "offset": "229"}, {"mention": "头晕", "label": "症状", "offset": "247"}]}
{"text": "患者于入院1年前,因无明显诱因出现腹痛,以脐周为主,程度轻度,伴腹胀及肛门停止排气、排便,伴恶心、呕吐1次,呕吐物为少量胃液,无反酸、嗳气,无放射痛,无畏寒、发热,无尿频、尿急、尿痛,等伴随症状。以“肠梗阻”收入我科。于2012.9.1在全麻上行剖腹探查+肠粘连松解+扩大左半结肠切除+肠外置术。今次来我科住院拟行造口回纳术。\\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,尿急、小便如常,体重未见明显上降。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "17"}, {"mention": "脐周", "label": "解剖部位", "offset": "21"}, {"mention": "腹胀", "label": "症状", "offset": "32"}, {"mention": "肛门", "label": "解剖部位", "offset": "35"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "100"}, {"mention": "剖腹探查+肠粘连松解+扩大左半结肠切除+肠外置术", "label": "手术", "offset": "123"}, {"mention": "造口回纳术", "label": "手术", "offset": "157"}, {"mention": "胃", "label": "解剖部位", "offset": "189"}]}
{"text": ",患者于2017-04-25在我院全麻上行降结肠癌根治术,手术顺利,,术后病理示:乙状结肠中分化腺癌,侵达浆膜上层,淋巴结未见转移。术后化疗指征存在,依情于2017-05-09行首疗程化疗,,具体方案: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,同时辅以镇吐、升血、免疫调节等对症支持治疗。病情好转出院。后入院先后行多次化疗,第2次化疗过程中出现肠梗阻,予保守治疗后缓解出院,化疗未满疗程。现为进一步复查治疗再次我院就诊,门诊以“结肠癌术后”收住院。患者自发病以来,无发热、畏寒,无明显腹痛腹胀及恶心、呕吐,无反复腹泻及便秘,亦未现反复咳嗽咳痰;无尿频排尿费力感。目前患者精神状态良好并情绪稳定,食欲及自主饮食可,夜间休息睡眠好;自解小便正常;间断性肛门排气排便并粪便性状良好。否认近期明显体重变化。", "mention_data": [{"mention": "降结肠癌根治术", "label": "手术", "offset": "21"}, {"mention": "乙状结肠中分化腺癌", "label": "疾病和诊断", "offset": "41"}, {"mention": "奥沙利铂", "label": "药物", "offset": "101"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "114"}, {"mention": "替加氟", "label": "药物", "offset": "129"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "197"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "239"}, {"mention": "腹痛", "label": "症状", "offset": "267"}, {"mention": "腹胀", "label": "症状", "offset": "269"}, {"mention": "腹泻", "label": "症状", "offset": "281"}, {"mention": "肛门", "label": "解剖部位", "offset": "349"}]}
{"text": "患者于4年前无明显诱因出现下腹部不适,主要为腹胀、隐痛不适,无嗳气、反酸、烧心、恶心、呕吐,于“*****”行胃镜检查提示“胃窦炎”(未见报告),自诉服用“铝碳酸镁片后”症状明显缓解,3月前患者再次出现下腹部胀,偶感隐痛不适,无恶心、呕吐,无嗳气、反酸、烧心,无胸闷、气促、头晕、头痛,无畏寒、发热,今日于我院行胃镜检查:浅表性胃窦、角炎伴糜烂,胃底多发息肉。碳13呼气试验叒阴性。为进一步诊治,门诊以“胃息肉”收住入院。\\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,体重无明显变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "13"}, {"mention": "腹胀", "label": "症状", "offset": "22"}, {"mention": "胃窦炎", "label": "疾病和诊断", "offset": "62"}, {"mention": "铝碳酸镁片", "label": "药物", "offset": "78"}, {"mention": "下腹部", "label": "解剖部位", "offset": "101"}, {"mention": "胸闷", "label": "症状", "offset": "131"}, {"mention": "头晕", "label": "症状", "offset": "137"}, {"mention": "头痛", "label": "症状", "offset": "140"}, {"mention": "浅表性胃窦、角炎伴糜烂", "label": "疾病和诊断", "offset": "161"}, {"mention": "胃底多发息肉", "label": "疾病和诊断", "offset": "173"}, {"mention": "胃息肉", "label": "疾病和诊断", "offset": "202"}]}
{"text": "患者自诉于一月前因“子宫内膜非典型增生”在我科行腹腔镜上全子宫两附件切除+盆腔粘连松解术,术后恢复好,于7月27日出院。出院后遵医嘱服用替勃龙,偶有少许淡红色分泌物。4天前无明显诱因出现阴道流血,少于月经量,未湿透卫生巾,色鲜红,不伴血凝块,当时未作特殊处理,未就诊;今晨再次出现阴道流血,多于月经量,色鲜红,不伴血凝块,不伴腹痛、腹胀,不伴头晕、眼花,急诊到我院,建议住院治疗。患者为求进一步治疗,今日以“阴道顶端切口出血伴感染”收入我科住院治疗。", "mention_data": [{"mention": "子宫内膜非典型增生", "label": "疾病和诊断", "offset": "10"}, {"mention": "全子宫两附件切除+盆腔粘连松解术", "label": "手术", "offset": "28"}, {"mention": "替勃龙", "label": "药物", "offset": "68"}, {"mention": "阴道", "label": "解剖部位", "offset": "93"}, {"mention": "阴道", "label": "解剖部位", "offset": "140"}, {"mention": "腹痛", "label": "症状", "offset": "163"}, {"mention": "腹胀", "label": "症状", "offset": "166"}, {"mention": "头晕", "label": "症状", "offset": "171"}, {"mention": "阴道顶端切口出血伴感染", "label": "疾病和诊断", "offset": "204"}]}
{"text": "患者2年前因查体发现结肠多发息肉,行结肠息肉apc术,半年前于**二院复查肠镜,结果示:距肛门40cm可见一直径约0.2cm息肉,直肠乙状结肠可见数枚直径0.1-0.3cm扁平息肉,肛管可见一带蒂球形肿物,表面光滑。患者发病以来无大便带血,无里急后重感,进食辛辣后大便次数增多伴大便不成形,大便后肛门肿物脱出十余年,需用手还纳,无腹痛腹胀,无恶心呕吐,现为求进一步诊治来我院就诊,门诊以“结肠息肉”收入院,自发病以来,饮食睡眠可,小便正常,体重无明显变化。", "mention_data": [{"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "10"}, {"mention": "结肠息肉apc术", "label": "手术", "offset": "18"}, {"mention": "肛门", "label": "解剖部位", "offset": "45"}, {"mention": "直肠乙状结肠", "label": "解剖部位", "offset": "65"}, {"mention": "肛管", "label": "解剖部位", "offset": "91"}, {"mention": "肛门", "label": "解剖部位", "offset": "148"}, {"mention": "手", "label": "解剖部位", "offset": "160"}, {"mention": "腹痛", "label": "症状", "offset": "165"}, {"mention": "腹胀", "label": "症状", "offset": "167"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "194"}]}
{"text": ",患者入院前4月在我院因盲肠癌(,癌症分期为:t3n3m1)全麻上行“剖腹探查+左半结肠切除+肠粘连松解术”,,术后病理报告示:(左半结肠)粘液腺癌,侵及肠壁全层,双切端未见癌累及,肠壁淋巴结见癌转移(17/27)。阑尾未见癌转移,患者术后恢复可,无恶心、呕吐,无腹痛,腹胀,无腹泻,无便血,大便正常,现患者一般情况可,今日拟行第4次化疗入院。\\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": "盲肠癌(,癌症分期为:t3n3m1)", "label": "疾病和诊断", "offset": "12"}, {"mention": "剖腹探查+左半结肠切除+肠粘连松解术", "label": "手术", "offset": "35"}, {"mention": "(左半结肠)粘液腺癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "肠", "label": "解剖部位", "offset": "77"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "91"}, {"mention": "阑尾", "label": "解剖部位", "offset": "108"}, {"mention": "腹痛", "label": "症状", "offset": "132"}, {"mention": "腹胀", "label": "症状", "offset": "135"}, {"mention": "腹泻", "label": "症状", "offset": "139"}, {"mention": "胃", "label": "解剖部位", "offset": "198"}]}
{"text": "患者入院27日前于我科行远端胃癌d2根治术(毕i式),术后患者恢复良好,给予生物治疗一次,于2015-11-07出院,期间患者术后恢复良好,未诉特殊不适,精神食欲可,大便较少,无畏寒、发热,无恶心、呕吐,无腹痛、腹胀。患者于11日开始出现饮水及进食后呕吐,开始症状较轻,每日呕吐约4-5次,呕吐物为胃内容物,未进食不呕吐,患者病情进行性加重,目前休息时仍感恶心、呕吐,呕吐物为墨绿色消化液,遂来我院,以“胃ca术后,喟瘫?”收入我科治疗。\\u0004叒叒叒患者自起病以来,精神可,胃纳极差,自下次出院后自今大便不解,肛门排气正常。小便如常,体重未见明显上降。", "mention_data": [{"mention": "远端胃癌d2根治术(毕i式)", "label": "手术", "offset": "12"}, {"mention": "腹痛", "label": "症状", "offset": "103"}, {"mention": "腹胀", "label": "症状", "offset": "106"}, {"mention": "胃", "label": "解剖部位", "offset": "149"}, {"mention": "胃ca术后", "label": "疾病和诊断", "offset": "202"}, {"mention": "喟瘫", "label": "疾病和诊断", "offset": "208"}, {"mention": "肛门", "label": "解剖部位", "offset": "258"}]}
{"text": "患者1月前因胆总管结石在我院行“胆囊切除+胆总管探查+t管引流术”,术后给予抗感染、保肝邓对症治疗,患者留置t管治愈出院。出院后无畏寒发热,无恶心、呕吐,无腹痛、黄疸,无心慌、心悸,无尿频、尿痛等症状,今日来我院行t管胆道造影检查并行t管拔除,遂门诊以“胆道探查术后”收入我科。患者自起病以来,精神可,胃纳略差,大便如常,小便如常,体重未见明显上降。", "mention_data": [{"mention": "胆总管结石", "label": "疾病和诊断", "offset": "6"}, {"mention": "胆囊切除+胆总管探查+t管引流术", "label": "手术", "offset": "16"}, {"mention": "肝", "label": "解剖部位", "offset": "43"}, {"mention": "腹痛", "label": "症状", "offset": "78"}, {"mention": "心悸", "label": "症状", "offset": "88"}, {"mention": "胆道", "label": "解剖部位", "offset": "109"}, {"mention": "胆道探查术后", "label": "疾病和诊断", "offset": "127"}, {"mention": "胃", "label": "解剖部位", "offset": "151"}]}
{"text": "患者一月前因“排便习惯改变一年余”,完善术前检查,确诊为右半结肠癌,于2013.01.06全麻上行右半结肠切除术术,术后病理示:结肠中分化腺癌,部分为粘液腺癌,浸润至肠壁浆膜上层,未见明确脉管及神经束侵犯,中央淋巴结(1/6),中间淋巴结(4/7),肠旁淋巴结(4/4),pt3n2bm0叒iiic期;术后恢复可,排气、排便,无发热、腹痛不适。现为求进一步化疗来本院就诊。患者自发病以来,无发热、黄疸、腰骶部疼痛,食欲、睡眠及精神良好,小便正常,体力无上降,体重上降不明显。", "mention_data": [{"mention": "右半结肠癌", "label": "疾病和诊断", "offset": "28"}, {"mention": "右半结肠切除术术", "label": "手术", "offset": "49"}, {"mention": "结肠中分化腺癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "肠", "label": "解剖部位", "offset": "83"}, {"mention": "中央淋巴结", "label": "解剖部位", "offset": "103"}, {"mention": "中间淋巴结", "label": "解剖部位", "offset": "114"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "125"}, {"mention": "腹痛", "label": "症状", "offset": "167"}, {"mention": "腰骶部", "label": "解剖部位", "offset": "201"}]}
{"text": ",患者6个月前无明显诱因出现下腹部疼痛,以餐后为主,无恶心、呕吐,无呕血、黑便,无腹胀,口服奥美拉唑好转,排气、排便正常。后症状逐渐加重,,于我院门诊行胃镜检查病理报告提示:胃窦腺癌。病理号(159450)。于2013-12-09在我院肿瘤外科行胃癌根治术,,术后病理:,进行期胃窦癌:侵润溃疡型,中-低分化腺癌,断端无癌,淋巴结见转移癌(6/27枚)病理号(160018)。术后切口愈合良好,体重降低约8公斤,术后21天入我科行sox方案化疗5周期,,具体用药:奥沙利铂150毫克,日1次静点d1;维康达40毫克,日2次口服d1-d14.患者无明显骨髓抑制,但出现i度乏力,患者精神体力可,今为求进一步治疗入我院,病来患者偶有乏力,饮食睡眠正常,二便正常。体重较下次入院增加1公斤,周身无疼痛,ecog评分1分。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "14"}, {"mention": "腹胀", "label": "症状", "offset": "41"}, {"mention": "奥美拉唑", "label": "药物", "offset": "46"}, {"mention": "胃窦腺癌", "label": "疾病和诊断", "offset": "87"}, {"mention": "胃癌根治术", "label": "手术", "offset": "123"}, {"mention": "进行期胃窦癌", "label": "疾病和诊断", "offset": "136"}, {"mention": "中-低分化腺癌", "label": "疾病和诊断", "offset": "149"}, {"mention": "奥沙利铂", "label": "药物", "offset": "232"}, {"mention": "维康达", "label": "药物", "offset": "250"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "275"}]}
{"text": "入院前1年多,患者无明显诱因出现腹部疼痛不适,以中下腹,右上腹阵发性隐痛不适为主,不伴肩背部放射痛,与饮食、体位无明显相关,伴反酸,嗳气、腹胀症状,无呕吐、腹泻、黑便表现,无发热、胸闷、胸痛、咳嗽症状,在我院行胃镜检查示“食管多发溃疡,胃溃疡”,口服“雷贝拉唑、安达”等药物治疗后症状明显好转。但病情有所反复,3月前,再次感下腹部不适,复查胃镜示“胃角溃疡,萎缩性胃窦炎、浅表性胃体炎、十二指肠球炎”再次口服“雷贝拉唑、阿拉坦五味丸”等治疗,病情有所好转,但1周前,再次感右上腹疼痛不适伴大便干结,为求进一步诊治入我院门诊行肠镜示“结肠、直肠多发性息肉”,收入我科治疗。\\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,大便较干结,2-3天/次,小便正常,体重无明显变化。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "16"}, {"mention": "中下腹", "label": "解剖部位", "offset": "24"}, {"mention": "右上腹", "label": "解剖部位", "offset": "28"}, {"mention": "肩背部", "label": "解剖部位", "offset": "43"}, {"mention": "腹胀", "label": "症状", "offset": "69"}, {"mention": "腹泻", "label": "症状", "offset": "78"}, {"mention": "胸闷", "label": "症状", "offset": "90"}, {"mention": "胸痛", "label": "症状", "offset": "93"}, {"mention": "食管多发溃疡", "label": "疾病和诊断", "offset": "111"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "118"}, {"mention": "雷贝拉唑", "label": "药物", "offset": "126"}, {"mention": "安达", "label": "药物", "offset": "131"}, {"mention": "下腹部", "label": "解剖部位", "offset": "162"}, {"mention": "胃角溃疡", "label": "疾病和诊断", "offset": "174"}, {"mention": "萎缩性胃窦炎", "label": "疾病和诊断", "offset": "179"}, {"mention": "浅表性胃体炎", "label": "疾病和诊断", "offset": "186"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "193"}, {"mention": "雷贝拉唑", "label": "药物", "offset": "205"}, {"mention": "阿拉坦五味丸", "label": "药物", "offset": "210"}, {"mention": "右上腹", "label": "解剖部位", "offset": "236"}, {"mention": "结肠、直肠多发性息肉", "label": "疾病和诊断", "offset": "266"}]}
{"text": ",患者约6年前开始无明显诱因出现下腹部饱胀不适,伴有左肩背部撑胀感,进食后明显,偶有阵发性锐痛,能够自行缓解,无反酸、恶心,无吞咽困难,无呕吐,无黄疸及发热,无呕血、黑便,无咳嗽、咳痰,无尿频、尿急、尿痛。当时就诊于我院,行b超检查提示有胆囊结石,于2015-09-09行腹腔镜胆囊切除术。术后仍诉腹部不适,,行胃镜检查:胃角病变,,病理:(胃角)粘膜浅层散在印戒样异型细胞,结合免疫组化,符合印戒细胞癌(201515863)。现患者为求进一步诊断及治疗,来我院就诊,门诊以“胃癌”收入我科治疗。叒叒叒患者发病以来,神志清,精神可,饮食睡眠可,大小便正常,体重减轻约10kg。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "16"}, {"mention": "左肩背部", "label": "解剖部位", "offset": "26"}, {"mention": "b超", "label": "影像检查", "offset": "112"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "119"}, {"mention": "腹腔镜胆囊切除术", "label": "手术", "offset": "136"}, {"mention": "腹部不适", "label": "症状", "offset": "149"}, {"mention": "胃角", "label": "解剖部位", "offset": "161"}, {"mention": "胃角", "label": "解剖部位", "offset": "171"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "197"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "238"}]}
{"text": ",患者3年余前无明显诱因地出现下腹胀,伴烧心,空腹时明显,无腹痛、腹泻,无恶心、呕吐,无返酸、返食,无呕血、黑便,在我院行胃镜检查,示“十二指肠溃疡”(未见报告单),给予“安斯菲、膜固斯达”治疗1月,效果可,此次后病情相对平稳。,后在我院行胃镜检查示:1.浅表萎缩性胃炎伴急性活动,为多发性息肉(**ii型),十二指肠多发溃疡;,病理诊断:(胃窦)慢性萎缩性胃炎(中度),幽门螺旋杆菌染色阴性。自服“膜固斯达”效果一般。为求进一步系统诊治,于2015-01-06第1次在我院住院治疗,入院后给予抑酸、改善胃肠动力、保护胃粘膜等治疗,病情好转后于2015-01-12出院。叒叒叒出院后患者规律用药,口服“安斯菲、膜固思达、吗丁啉”等治疗,病情相对稳定,无恶心、呕吐,无反酸、烧心,无腹痛、腹胀。现患者为行胃肠镜复查再次来我院就诊,门诊以“十二指肠溃疡、胃息肉”收治入院。叒叒叒患者自发病以来,神志清,精神可,饮食略差,夜间睡眠可,大便无明显异常,约1次/天,为成形黄色软便,小便正常,体重近来无明显改变。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "15"}, {"mention": "空腹", "label": "症状", "offset": "23"}, {"mention": "腹痛", "label": "症状", "offset": "30"}, {"mention": "腹泻", "label": "症状", "offset": "33"}, {"mention": "十二指肠溃疡", "label": "疾病和诊断", "offset": "68"}, {"mention": "安斯菲", "label": "药物", "offset": "86"}, {"mention": "膜固斯达", "label": "药物", "offset": "90"}, {"mention": "浅表萎缩性胃炎", "label": "疾病和诊断", "offset": "128"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "155"}, {"mention": "(胃窦)慢性萎缩性胃炎(中度)", "label": "疾病和诊断", "offset": "170"}, {"mention": "膜固斯达", "label": "药物", "offset": "200"}, {"mention": "胃", "label": "解剖部位", "offset": "252"}, {"mention": "肠", "label": "解剖部位", "offset": "253"}, {"mention": "胃", "label": "解剖部位", "offset": "259"}, {"mention": "安斯菲", "label": "药物", "offset": "301"}, {"mention": "膜固思达", "label": "药物", "offset": "305"}, {"mention": "吗丁啉", "label": "药物", "offset": "310"}, {"mention": "腹痛", "label": "症状", "offset": "340"}, {"mention": "腹胀", "label": "症状", "offset": "343"}, {"mention": "十二指肠溃疡", "label": "疾病和诊断", "offset": "368"}, {"mention": "胃息肉", "label": "疾病和诊断", "offset": "375"}]}
{"text": "患者1年前因大便带血于我科入院,入院后完善相关化验检查,行结肠镜检查示:溃疡性直肠炎、内痔,给予美沙拉嗪**肛及激素盐水保留灌肠治疗,用药后症状明显改善,患者好转出院,院外期间病人一般情况良好,坚持每日自行以美沙拉嗪**肛,患者现为复查结肠镜,并进一步调整治疗方案,特来我院就诊,门诊以“溃疡性直肠炎、混合痔术后”收入院。叒叒叒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1天1次,多质软成形,排出通畅,无便血及脓血粘液,便时无疼痛及肿物脱出,无恶心呕吐,无腹胀腹痛,近期体重无明显改变。", "mention_data": [{"mention": "溃疡性直肠炎", "label": "疾病和诊断", "offset": "36"}, {"mention": "内痔", "label": "疾病和诊断", "offset": "43"}, {"mention": "美沙拉嗪", "label": "药物", "offset": "48"}, {"mention": "肛", "label": "解剖部位", "offset": "54"}, {"mention": "肠", "label": "解剖部位", "offset": "63"}, {"mention": "美沙拉嗪", "label": "药物", "offset": "104"}, {"mention": "肛", "label": "解剖部位", "offset": "110"}, {"mention": "溃疡性直肠炎", "label": "疾病和诊断", "offset": "144"}, {"mention": "混合痔术后", "label": "疾病和诊断", "offset": "151"}, {"mention": "腹胀", "label": "症状", "offset": "242"}, {"mention": "腹痛", "label": "症状", "offset": "244"}]}
{"text": ",患者于1月余前因“中下腹胀痛6小时”入院,入院完善相关检查,,诊断为:慢性结石性胆囊炎急性发作,并于2012-07-11行胆囊造瘘术,,术中见:腹腔内吸出约100mln脓性腹水,肝大小正常,胆囊水肿重,表面可见大量脓苔。胆囊三角水肿重,结构不清,胆总管不粗,其内未扪及结石,周围胃肠未探及明显异常。手术顺利,术后留置胆囊造瘘管,患者好转后出院。现患者术后恢复可,术后半月遵医嘱间断夹闭胆囊造瘘管,每天流出黄色胆汁约40ml右左,无恶心、呕吐、寒战、高热、腹胀、腹泻、皮肤巩膜黄染等不适,今患者为拔出胆囊造瘘管入院,门诊以“胆囊造瘘术后”收治入科。\\u0004叒叒叒患者自起病以来,睡眠、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": "中下腹", "label": "解剖部位", "offset": "10"}, {"mention": "慢性结石性胆囊炎急性发作", "label": "疾病和诊断", "offset": "36"}, {"mention": "胆囊造瘘术", "label": "手术", "offset": "62"}, {"mention": "腹腔", "label": "解剖部位", "offset": "73"}, {"mention": "腹水", "label": "症状", "offset": "87"}, {"mention": "肝大", "label": "症状", "offset": "90"}, {"mention": "胆囊", "label": "解剖部位", "offset": "96"}, {"mention": "胆囊三角", "label": "解剖部位", "offset": "111"}, {"mention": "胆总管", "label": "解剖部位", "offset": "124"}, {"mention": "胃肠", "label": "解剖部位", "offset": "140"}, {"mention": "胆囊", "label": "解剖部位", "offset": "159"}, {"mention": "胆囊", "label": "解剖部位", "offset": "193"}, {"mention": "腹胀", "label": "症状", "offset": "228"}, {"mention": "腹泻", "label": "症状", "offset": "231"}, {"mention": "皮肤", "label": "解剖部位", "offset": "234"}, {"mention": "巩膜", "label": "解剖部位", "offset": "236"}, {"mention": "胆囊", "label": "解剖部位", "offset": "250"}, {"mention": "胆囊造瘘术后", "label": "疾病和诊断", "offset": "262"}, {"mention": "胃", "label": "解剖部位", "offset": "298"}]}
{"text": "入院前半年,患者无明显诱因出现嗳气,伴口苦,无腹痛、腹胀,无恶心、呕吐等不适,未予特殊处理,下述症状反复发作。1月前患者出现左下腹间断隐痛,与进食无明显关系,无放射痛,无皮肤巩膜黄染,偶有间断中下腹按压痛,为进一步诊治,今入我院,行胃镜检查示:浅表性胃窦炎伴糜烂,胃窦多发溃疡(forrest叒iia),十二指肠多发息肉,十二指肠球炎伴糜烂。门诊以“胃窦多发溃疡”收入我科。\\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,体重无明显变化。", "mention_data": [{"mention": "口苦", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "23"}, {"mention": "腹胀", "label": "症状", "offset": "26"}, {"mention": "左下腹", "label": "解剖部位", "offset": "62"}, {"mention": "巩膜", "label": "解剖部位", "offset": "87"}, {"mention": "中下腹", "label": "解剖部位", "offset": "96"}, {"mention": "浅表性胃窦炎伴糜烂", "label": "疾病和诊断", "offset": "122"}, {"mention": "胃窦多发溃疡(forrest叒iia)", "label": "疾病和诊断", "offset": "132"}, {"mention": "十二指肠多发息肉", "label": "疾病和诊断", "offset": "152"}, {"mention": "十二指肠球炎伴糜烂", "label": "疾病和诊断", "offset": "161"}, {"mention": "胃窦多发溃疡", "label": "疾病和诊断", "offset": "175"}]}
{"text": ",入院5年余前,,患者于我院体检行腹部彩超提示:胆囊结石,直径约1.2cm(未见报告)。病程中患者有饥饿时下腹部疼痛,呈持续性胀痛,伴腰背部放射痛,伴反酸、呃逆、腹泻,无恶心、呕吐,无发热、寒战,无眼黄、身黄、尿黄,无黑便、呕血,无咳嗽、咳痰,无心悸、气促、胸闷等不适。,遂行胃镜检查示:胃溃疡(未见报告)。给予胃溃疡相关治疗(具体不详),未复查。以下症状仍偶有发作,仍伴腰背部放射痛。4月前,,患者再次于我院行腹部彩超:胆囊结石,直径约1.7cm。未予特殊处理。为求进一步治疗,遂于我院就诊,门诊以“胆囊结石伴慢性胆囊炎”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": "腹部彩超", "label": "影像检查", "offset": "17"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "24"}, {"mention": "下腹部", "label": "解剖部位", "offset": "53"}, {"mention": "腰背部", "label": "解剖部位", "offset": "67"}, {"mention": "腹泻", "label": "症状", "offset": "81"}, {"mention": "心悸", "label": "症状", "offset": "123"}, {"mention": "胸闷", "label": "症状", "offset": "129"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "144"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "156"}, {"mention": "腰背部", "label": "解剖部位", "offset": "186"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "206"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "211"}, {"mention": "胆囊结石伴慢性胆囊炎", "label": "疾病和诊断", "offset": "251"}, {"mention": "胃", "label": "解剖部位", "offset": "288"}]}
{"text": "患者平素月经规律,12岁,5/27天,lmp2012.12.12,偶感痛经。4年前患者因“右输卵管壶腹部妊娠”行手术治疗。术中发现2个子宫肌瘤,术中将较大子宫肌瘤剥除,另一大小约1cm右左子宫肌瘤未予处理。后患者定期复查b超。8月前,患者自然流产1次,行b超发现子宫肌瘤明显增大。1月前患者经期腹痛稍加重,无经量增多,无经期延长,无月经周期紊乱,无畏寒、发热,无阴道流液等不适。现为求手术治疗入我科。\\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,体重无明显变化。", "mention_data": [{"mention": "右输卵管壶腹部妊娠", "label": "疾病和诊断", "offset": "45"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "67"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "77"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "94"}, {"mention": "b超", "label": "影像检查", "offset": "110"}, {"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "131"}, {"mention": "腹痛", "label": "症状", "offset": "147"}, {"mention": "阴道", "label": "解剖部位", "offset": "181"}]}
{"text": "患者6+年前因“纳差并左下腹部胀痛不适2月余”在我院就诊为“1.原发性肝癌叒2.胆囊结石”,于2006年5月30日在全麻上行肝癌+胆囊切除术,术后病理诊断为:肝细胞性肝癌。患者术后恢复好,于2006年6月15日出院。术后定期来院复查,给予方克、替加氟、丝裂霉素、波贝等药物化疗3次,肝肿瘤无水酒精注射治疗3次及射频治疗5次,均恢复顺利好转出院。14个月前来我院复查,化验afp升高,b超提示左肝占位,考虑肝癌术后复发,给予保肝、抗病毒及营养支持治疗,于2011-11-21在介入中心行肝癌介入治疗(tace),2011-11-23行肝肿瘤射频消融治疗,同时给予保肝、止血、抗炎、抑酸、免疫、镇痛等治疗,恢复顺利,好转出院。后多次住院复查,先后行肝癌介入治疗(tace)3次,肝肿瘤射频消融治疗4次,肝肿瘤无水酒精注射治疗1次,同时给予保肝、免疫等对症治疗,均恢复顺利好转出院。叒叒叒患者自下次出院后一般情况好,偶有下腹隐痛不适,无腹胀、腹泻及肝区不适,无发热、黄疸,无厌食、乏力,今为复查再次收住院。患者自发病以来,精神可,饮食可,大小便无异常,体重无明显上降。", "mention_data": [{"mention": "左下腹部", "label": "解剖部位", "offset": "11"}, {"mention": "原发性肝癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "40"}, {"mention": "肝癌+胆囊切除术", "label": "手术", "offset": "62"}, {"mention": "肝细胞性肝癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "方克", "label": "药物", "offset": "119"}, {"mention": "替加氟", "label": "药物", "offset": "122"}, {"mention": "丝裂霉素", "label": "药物", "offset": "126"}, {"mention": "波贝", "label": "药物", "offset": "131"}, {"mention": "肝肿瘤", "label": "疾病和诊断", "offset": "141"}, {"mention": "无水酒精", "label": "药物", "offset": "144"}, {"mention": "afp", "label": "实验室检验", "offset": "185"}, {"mention": "b超", "label": "影像检查", "offset": "191"}, {"mention": "左肝", "label": "解剖部位", "offset": "195"}, {"mention": "肝癌术后复发", "label": "疾病和诊断", "offset": "202"}, {"mention": "肝", "label": "解剖部位", "offset": "212"}, {"mention": "肝癌介入治疗(tace)", "label": "手术", "offset": "242"}, {"mention": "肝肿瘤射频消融", "label": "手术", "offset": "266"}, {"mention": "肝", "label": "解剖部位", "offset": "281"}, {"mention": "肝癌介入治疗(tace)", "label": "手术", "offset": "322"}, {"mention": "肝肿瘤射频消融", "label": "手术", "offset": "337"}, {"mention": "肝肿瘤", "label": "疾病和诊断", "offset": "349"}, {"mention": "无水酒精", "label": "药物", "offset": "352"}, {"mention": "肝", "label": "解剖部位", "offset": "368"}, {"mention": "下腹", "label": "解剖部位", "offset": "407"}, {"mention": "腹胀", "label": "症状", "offset": "415"}, {"mention": "腹泻", "label": "症状", "offset": "418"}, {"mention": "肝区", "label": "解剖部位", "offset": "421"}]}
{"text": ",患者半年前(2015-10-13)因“1.直肠癌,2.乙状结肠息肉,3.肝囊肿,4.胆囊结石并胆囊炎”于我院行腹腔镜胆囊切除+直肠癌根治术,,术后常规病理示:(直肠)中分化腺癌,溃疡型,肿物切面积5*1.5cm,侵透浆膜达周围脂肪组织。手术双端切线、吻合器切线及环周切线均未查见癌。肠周19枚淋巴结中13枚查见转移。(胆囊)慢性胆囊炎并腺肌病。(36734.15)。术后给予营养支持治疗。术后第3天,左上肢疼痛,,行上肢动静脉彩超示:左上肢肌间静脉血栓形成。请血管外科会诊,给予上肢制动、绝对卧床休息、皮上注射速碧林治疗。术后第10天,恶心呕吐,腹部立位平片及腹盆部ct示肠腔胀气、肠梗阻。给予禁饮食、肠外营养支持治疗。后患者肠梗阻症状缓解,进流质饮食无,明显不适症状,无绝对化疗禁忌,于2015-12-07行奥沙利铂+cf+替加氟方案化疗,化疗过程平稳,耐受可,好转后出院。后患者再次入院行奥沙利铂+cf+替加氟方案化疗5周期,耐受良好。现为行进一步治疗再次来我院就诊,门诊以“直肠癌术后”收入院。自下次出院来,患者饮食睡眠尚可,大小便无明显异常,体重较下次入院无明显改变。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "乙状结肠息肉", "label": "疾病和诊断", "offset": "28"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "37"}, {"mention": "胆囊结石并胆囊炎", "label": "疾病和诊断", "offset": "43"}, {"mention": "腹腔镜胆囊切除", "label": "手术", "offset": "56"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "64"}, {"mention": "(直肠)中分化腺癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "肠", "label": "解剖部位", "offset": "142"}, {"mention": "(胆囊)慢性胆囊炎并腺肌病", "label": "疾病和诊断", "offset": "159"}, {"mention": "左上肢", "label": "解剖部位", "offset": "201"}, {"mention": "上肢动静脉彩超", "label": "影像检查", "offset": "209"}, {"mention": "左上肢肌间静脉", "label": "解剖部位", "offset": "218"}, {"mention": "上肢", "label": "解剖部位", "offset": "240"}, {"mention": "速碧林", "label": "药物", "offset": "256"}, {"mention": "腹部立位平片", "label": "影像检查", "offset": "274"}, {"mention": "腹盆部ct", "label": "影像检查", "offset": "281"}, {"mention": "肠", "label": "解剖部位", "offset": "287"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "292"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "314"}, {"mention": "奥沙利铂", "label": "药物", "offset": "356"}, {"mention": "cf", "label": "药物", "offset": "361"}, {"mention": "替加氟", "label": "药物", "offset": "364"}, {"mention": "奥沙利铂", "label": "药物", "offset": "397"}, {"mention": "cf", "label": "药物", "offset": "402"}, {"mention": "替加氟", "label": "药物", "offset": "405"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "441"}]}
{"text": ",患者15天前无明显诱因出现下腹部疼痛,呈胀痛,阵发性,餐后明显,食欲正常,无发热、乏力,无畏寒、寒战,无咳嗽、咳痰,无胸痛及肩背部放射痛。无恶心、呕吐,无反酸、烧心。无停止排便、排气。未诊治。下述症状反复出现并逐渐加重,3天前来我院就诊,,门诊行胃镜检查结果示:贲门炎;胃溃疡(a2期);慢性萎缩性胃炎伴急性活动;十二指肠球炎;,hp:+++。,病理示:慢性萎缩性胃炎(重度),伴明显急性活动、淋巴组织增生,个别腺体肠下皮化生,局部黏膜糜烂;hp,染色示:阳性(3+)。为进一步诊治,门诊以“胃溃疡”收入院。叒叒叒患者自发病以来,神志清,精神好,平时大便次数增多,1天3次,大便偏稀,小便正常,体重近期无明变化。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "14"}, {"mention": "胸痛", "label": "症状", "offset": "60"}, {"mention": "肩背部", "label": "解剖部位", "offset": "63"}, {"mention": "贲门炎", "label": "疾病和诊断", "offset": "132"}, {"mention": "胃溃疡(a2期)", "label": "疾病和诊断", "offset": "136"}, {"mention": "慢性萎缩性胃炎伴急性活动", "label": "疾病和诊断", "offset": "145"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "158"}, {"mention": "慢性萎缩性胃炎(重度)", "label": "疾病和诊断", "offset": "178"}, {"mention": "肠下皮化生", "label": "疾病和诊断", "offset": "209"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "247"}]}
{"text": "患者5+月余前因“大便性状及习惯改变1年”于外院行肠镜检查,活检病理经我院确诊为“直肠中分化腺癌”。经多学科讨论,考虑患者临床分期ct3n1m0,iiib期,建议行术前同期放化疗。遂于2016-08-05至2016-09-09行局部放疗,总剂量50gy。期间于2016-08-05、2016-09-26xelox方案化疗联合化疗4程。第4程化疗开始出现臀部、背部皮疹,伴瘙痒,停止奥沙利铂后逐渐自行好转。2016-11-21我院结直肠外科全麻上行dixons’术式+回肠两腔造瘘术。术后病理:直肠中分化腺癌ypt2n1cm0叒iii期。2016-12-13我科行xelox方案化疗1程,耐受可。现患者为求上一程化疗入住我科。自下次化疗结束以来,无发热,无乏力、咳嗽、气促、身目黄染等,有臀部、背部起皮疹,伴瘙痒,。精神睡眠一般,胃纳尚可,大小便无殊,体重无明显增减。", "mention_data": [{"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "41"}, {"mention": "臀部", "label": "解剖部位", "offset": "176"}, {"mention": "背部", "label": "解剖部位", "offset": "179"}, {"mention": "奥沙利铂", "label": "药物", "offset": "190"}, {"mention": "dixons’术式+回肠两腔造瘘术", "label": "手术", "offset": "223"}, {"mention": "直肠中分化腺癌ypt2n1cm0叒iii期", "label": "疾病和诊断", "offset": "246"}, {"mention": "臀部", "label": "解剖部位", "offset": "343"}, {"mention": "背部", "label": "解剖部位", "offset": "346"}, {"mention": "胃", "label": "解剖部位", "offset": "364"}]}
{"text": ",患者于2012年03月15日在本院行“经左胸下腹部分食管切除术+胃食管吻合术”,,术后肿瘤标志物示:afp叒142.3ng/ml;术后定期检查afp,发现afp逐渐升高,未予特殊处理。2015年8月4日,至本院复查mr提示:肝s6/7病灶,考虑小肝癌。肝s6结节,考虑肝硬化结节癌变可能性大。afp叒2777ng/ml。2015年08月19日于局麻上行肝动脉栓塞化疗(tace)术,术中用药表阿霉素50mg,洛铂50mg,碘油5ml。术后一般情况良好后出院。2015年9月29日,复查ct示:食管癌术后、肝癌介入术后,肝s6/7结节,碘油沉积良好,门脉期肝s6病灶,建议mr复查。病程中无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热、无皮肤搔痒等不适,现为进一步诊治收入我科,起病以来,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": "经左胸下腹部分食管切除术+胃食管吻合术", "label": "手术", "offset": "20"}, {"mention": "afp", "label": "实验室检验", "offset": "51"}, {"mention": "afp", "label": "实验室检验", "offset": "72"}, {"mention": "afp", "label": "实验室检验", "offset": "78"}, {"mention": "mr", "label": "影像检查", "offset": "108"}, {"mention": "肝s6/7", "label": "解剖部位", "offset": "113"}, {"mention": "小肝癌", "label": "疾病和诊断", "offset": "123"}, {"mention": "肝s6", "label": "解剖部位", "offset": "127"}, {"mention": "肝硬化结节癌变可能性大", "label": "疾病和诊断", "offset": "135"}, {"mention": "afp", "label": "实验室检验", "offset": "147"}, {"mention": "肝动脉栓塞化疗(tace)术", "label": "手术", "offset": "177"}, {"mention": "表阿霉素", "label": "药物", "offset": "196"}, {"mention": "洛铂", "label": "药物", "offset": "205"}, {"mention": "碘油", "label": "药物", "offset": "212"}, {"mention": "ct", "label": "影像检查", "offset": "243"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "247"}, {"mention": "肝癌介入术后", "label": "疾病和诊断", "offset": "253"}, {"mention": "肝s6/7", "label": "解剖部位", "offset": "260"}, {"mention": "碘油", "label": "药物", "offset": "268"}, {"mention": "门脉", "label": "解剖部位", "offset": "275"}, {"mention": "肝s6", "label": "解剖部位", "offset": "278"}, {"mention": "mr", "label": "影像检查", "offset": "286"}, {"mention": "腹痛", "label": "症状", "offset": "297"}, {"mention": "腹胀", "label": "症状", "offset": "301"}]}
{"text": "患者自述因乏力体重减轻胃部不适就诊于我院,9个月前行胃镜检查诊断为胃癌,进一步行超声检查示胃窦周围可见多个低回声,大者2.83*1.45cm,进一步行肝胆脾胰超声提示胰头周围肿大淋巴结,8个月前入我科,行紫杉醇脂质体联合替吉奥方案化疗6周期,具体用药为紫杉醇脂质体270毫克d1,替吉奥60毫克日二次口服d1-d14,化疗间期出现ii°恶心呕吐,使用托烷司琼联合异丙嗪止吐效果良好,2周期评效为pr,4,6周期评效为维持pr,后改为单药替吉奥(维康达)口服治疗3周期,无明显不适,现为进一步治疗入我科。患者近1月来饮食睡眠一般,精神体力一般,二便基本正常,体重未见明显减轻,kps评分80分。", "mention_data": [{"mention": "胃部", "label": "解剖部位", "offset": "11"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "33"}, {"mention": "胃窦", "label": "解剖部位", "offset": "45"}, {"mention": "肝胆脾胰超声", "label": "影像检查", "offset": "75"}, {"mention": "胰头", "label": "解剖部位", "offset": "83"}, {"mention": "紫杉醇脂质体", "label": "药物", "offset": "102"}, {"mention": "替吉奥", "label": "药物", "offset": "110"}, {"mention": "紫杉醇脂质体", "label": "药物", "offset": "126"}, {"mention": "替吉奥", "label": "药物", "offset": "140"}, {"mention": "托烷司琼", "label": "药物", "offset": "175"}, {"mention": "异丙嗪", "label": "药物", "offset": "181"}, {"mention": "替吉奥", "label": "药物", "offset": "218"}, {"mention": "维康达", "label": "药物", "offset": "222"}]}
{"text": "患者1年前因大便带血在我院诊断为“结肠息肉”,遂电子结肠镜上行结肠息肉电切术,病理示管状腺瘤,今患者为术后复查来诊,门诊以“结肠息肉术后、内痔”收入院。患者自发病以来神志清,精神可,饮食、睡眠可,小便正常,大便每日1次,质软排出通畅,不带脓血及粘液,无肛门肿物脱出、肛门上坠感,无肛周**、肛周瘙痒,无恶心、呕吐,无腹痛、腹胀,体重无明显减轻。", "mention_data": [{"mention": "结肠息肉", "label": "疾病和诊断", "offset": "17"}, {"mention": "结肠息肉电切术", "label": "手术", "offset": "31"}, {"mention": "管状腺瘤", "label": "疾病和诊断", "offset": "42"}, {"mention": "结肠息肉术后", "label": "疾病和诊断", "offset": "62"}, {"mention": "内痔", "label": "疾病和诊断", "offset": "69"}, {"mention": "肛门", "label": "解剖部位", "offset": "126"}, {"mention": "肛门", "label": "解剖部位", "offset": "133"}, {"mention": "肛周", "label": "解剖部位", "offset": "140"}, {"mention": "肛周", "label": "解剖部位", "offset": "145"}, {"mention": "腹痛", "label": "症状", "offset": "158"}, {"mention": "腹胀", "label": "症状", "offset": "161"}]}
{"text": ",入院前6天,患者无明显诱因出现左下腹部疼痛,呈刺痛,不能耐受,疼痛持续不缓解,向脐部放射,无肩背部放射痛,伴有大汗淋漓,伴有畏寒、发热(具体温度不详,未测),无头昏、头痛,无面色苍白、四肢乏力,无恶心、呕吐,无呕血及黑便,皮肤巩膜无黄染,当时未予重视,未治疗。2天前,患者就诊于我院消化内科,,行腹部彩超检查提示:1.肝实质回声密集增强、欠均质改变,门静脉栓子形成,建议进一步检查;2.右肾结石。,电子胃镜检查提示:食管炎,慢性非萎缩性胃窦炎,hp(+)。行下腹部增强ct初步报告怀疑肝门部胆管癌?我科会诊后,为明确诊断及进一步治疗,建议住院治疗,急诊科遂以“,肝门占位性病变:肝门部胆管癌?”收入我科住院治疗。叒叒叒自患病以来,患者精神一般,睡眠及食欲欠佳,大小便正常,近期体重无明显变化。", "mention_data": [{"mention": "左下腹部", "label": "解剖部位", "offset": "16"}, {"mention": "脐部", "label": "解剖部位", "offset": "41"}, {"mention": "肩背部", "label": "解剖部位", "offset": "47"}, {"mention": "头昏", "label": "症状", "offset": "81"}, {"mention": "头痛", "label": "症状", "offset": "84"}, {"mention": "四肢", "label": "解剖部位", "offset": "93"}, {"mention": "巩膜", "label": "解剖部位", "offset": "114"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "149"}, {"mention": "肝实质", "label": "解剖部位", "offset": "160"}, {"mention": "门静脉", "label": "解剖部位", "offset": "176"}, {"mention": "右肾结石", "label": "疾病和诊断", "offset": "194"}, {"mention": "食管炎", "label": "疾病和诊断", "offset": "209"}, {"mention": "慢性非萎缩性胃窦炎", "label": "疾病和诊断", "offset": "213"}, {"mention": "下腹部增强ct", "label": "影像检查", "offset": "230"}, {"mention": "肝门部胆管癌", "label": "疾病和诊断", "offset": "243"}, {"mention": "肝门", "label": "解剖部位", "offset": "282"}, {"mention": "肝门部胆管癌", "label": "疾病和诊断", "offset": "290"}]}
{"text": "患者半年前无明显诱因发现便中带血,呈鲜红色,大便成形,不伴里急后重感,无腹痛、腹泻,恶心呕吐等不适,此后下述症状持续存在,未系统诊治。10天前我院门诊行肠镜检查示“结肠多发息肉”,行病理检查示:“横结肠增生性腺瘤性息肉叒乙状结肠低级别管状腺瘤”,遂入我院要求行结肠镜电切手术治疗。患者病来无发热寒战,无咳嗽咳痰,无腹痛、腹泻,无恶心、呕吐,无尿频、尿急及尿痛等不适,饮食睡眠可,精神体力可,近期体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "36"}, {"mention": "腹泻", "label": "症状", "offset": "39"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "82"}, {"mention": "横结肠增生性腺瘤性息肉", "label": "疾病和诊断", "offset": "98"}, {"mention": "乙状结肠低级别管状腺瘤", "label": "疾病和诊断", "offset": "110"}, {"mention": "结肠镜电切手术", "label": "手术", "offset": "130"}, {"mention": "腹痛", "label": "症状", "offset": "157"}, {"mention": "腹泻", "label": "症状", "offset": "160"}]}
{"text": "患者约1年余前因“皮肤黏膜及巩膜黄染”入院,入院后积极完善相关入院检查,考虑患者壶腹周围癌并梗阻性黄疸诊断明确,排除手术禁忌后于2015.12.11在全麻上行胰十二指肠切除术,手术过程顺利,病理回示:壶腹部腺癌,中度分化,体积1.5*1.5*1.3cm,侵达肌层。胃切线、十二指肠切线、胆总管切线及胰腺切除面未查见癌。胃周围(3个)、胰腺周围(3个)、胆总管旁(2个)、“第十二组”(5个)、“肝十二指肠韧带”(1个)淋巴结未查见癌。慢性胆囊炎。患者自手术后多次接受吉西他滨化疗和细胞回输治疗。患者自下次出院以来,无腹痛、腹胀,无恶心、呕吐,无发热、寒战,无咳嗽、咳痰、呼吸困难,无尿频、尿急、排尿困难,现患者为求入院复查,来我院就诊,门诊以“胰十二指肠术后”收入我科。叒叒叒患者自发病以来,神志清,精神可,饮食欠佳,睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "巩膜", "label": "解剖部位", "offset": "14"}, {"mention": "壶腹周围癌并梗阻性黄疸", "label": "疾病和诊断", "offset": "40"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "79"}, {"mention": "壶腹部腺癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "胃", "label": "解剖部位", "offset": "132"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "136"}, {"mention": "胆总管", "label": "解剖部位", "offset": "143"}, {"mention": "胰腺", "label": "解剖部位", "offset": "149"}, {"mention": "胃", "label": "解剖部位", "offset": "159"}, {"mention": "胰腺", "label": "解剖部位", "offset": "167"}, {"mention": "胆总管", "label": "解剖部位", "offset": "176"}, {"mention": "“第十二组”(5个)、“肝十二指肠韧带”(1个)淋巴结", "label": "解剖部位", "offset": "185"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "217"}, {"mention": "吉西他滨", "label": "药物", "offset": "233"}, {"mention": "腹痛", "label": "症状", "offset": "258"}, {"mention": "腹胀", "label": "症状", "offset": "261"}, {"mention": "胰十二指肠术后", "label": "疾病和诊断", "offset": "322"}]}
{"text": "2008年8月19日开始出现中下腹痛,主要表现为隐痛,疼痛发作无明显规律性,近期逐渐加重,不向其他身体部位放射或牵涉。伴有恶心,有呕吐胃内容物,无呕血;无黑便;有嗳气,有返酸;无腹胀;无腹泻。无发热。2009年1月13日行胃镜检查报告提示:胃角mt,胃镜活检病理报告(2009-1-14)为(胃角)腺癌。现为行进一步检查收治入院。发病以来,患者食欲渐差,大便习惯性状尚正常,小便如常,体重略有减轻。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "14"}, {"mention": "胃", "label": "解剖部位", "offset": "67"}, {"mention": "腹胀", "label": "症状", "offset": "89"}, {"mention": "腹泻", "label": "症状", "offset": "93"}, {"mention": "胃角mt", "label": "疾病和诊断", "offset": "120"}, {"mention": "(胃角)腺癌", "label": "疾病和诊断", "offset": "145"}]}
{"text": "入院前5年,患者无明显诱因出现嗳气,伴饥饿时剑突上不适,无明显反酸、烧心,无腹胀、腹痛、腹泻,患者先后就诊于我院及外院治疗及自服中药治疗(具体不详),嗳气症状可缓解,期间患者嗳气及饥饿时剑突上不适反复发作,入院前半年余前,患者于我院行胃镜检查提示:1.十二指肠球部息肉;2.浅表性胃炎,快速尿素酶检测(+++),予以对症支持治疗(具体不详),患者嗳气症状逐渐缓解,现患者为进一步治疗十二指肠息肉入院。\\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,体重无明显变化。", "mention_data": [{"mention": "剑突上", "label": "解剖部位", "offset": "22"}, {"mention": "腹胀", "label": "症状", "offset": "38"}, {"mention": "腹痛", "label": "症状", "offset": "41"}, {"mention": "腹泻", "label": "症状", "offset": "44"}, {"mention": "剑突上", "label": "解剖部位", "offset": "93"}, {"mention": "十二指肠球部息肉", "label": "疾病和诊断", "offset": "126"}, {"mention": "浅表性胃炎", "label": "疾病和诊断", "offset": "137"}, {"mention": "十二指肠息肉", "label": "疾病和诊断", "offset": "191"}]}
{"text": "患者2010年5月无明显诱因出现大便带血,呈暗红至鲜红色,量不多,症状一直存在,无明显减轻或加重。未诉腹痛腹泻,无便秘。2011年4月于**六院检查上腹部盆腔mri及肠镜检查提示直肠肿物,于2011-5-5行全麻上直肠癌根治术(dixon术),术后病理提示直肠高分化腺癌,浸润至粘膜上层,送检淋巴结均未出现癌转移,术后分期为pt1n0m0叒i期。术后未行辅助化疗,予每3个月定期复查ct及肠镜,病情一直稳定,未见复发或转移征象。近一个月患者出现咳嗽咳痰,痰量不多,无胸痛气促等症状。2012-5复查盆腔mr及腹部ct无复发转移征象,行胸部ct检查,示:右下肺舌段1个、左下肺前段2个转移瘤。查kras基因为野生型。考虑“直肠中分化腺癌(pt1n0m0)术后两肺转移,iv期”,于2012-05-17、2012-06-01、2012-6-19、2012-07-10、2012-7-25行folfox方案化疗5程。1程化疗后患者出现腹泻3天,每天5-6次,食欲上降约5天,第2-5程化疗后无明显不适。3程化疗后ct评价sd。现为进一步治疗收入我科。目前患者无头晕头痛,无恶心呕吐、无腹痛腹泻,精神食欲可,二便正常,体重较前无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "51"}, {"mention": "腹泻", "label": "症状", "offset": "53"}, {"mention": "上腹部盆腔mri", "label": "影像检查", "offset": "74"}, {"mention": "直肠", "label": "解剖部位", "offset": "89"}, {"mention": "直肠癌根治术(dixon术)", "label": "手术", "offset": "107"}, {"mention": "直肠高分化腺癌", "label": "疾病和诊断", "offset": "128"}, {"mention": "ct", "label": "影像检查", "offset": "191"}, {"mention": "胸痛", "label": "症状", "offset": "233"}, {"mention": "盆腔mr", "label": "影像检查", "offset": "249"}, {"mention": "腹部ct", "label": "影像检查", "offset": "254"}, {"mention": "胸部ct", "label": "影像检查", "offset": "267"}, {"mention": "右下肺舌段", "label": "解剖部位", "offset": "276"}, {"mention": "左下肺前段", "label": "解剖部位", "offset": "284"}, {"mention": "直肠中分化腺癌(pt1n0m0)术后两肺转移,iv期", "label": "疾病和诊断", "offset": "310"}, {"mention": "腹泻", "label": "症状", "offset": "414"}, {"mention": "头晕", "label": "症状", "offset": "477"}, {"mention": "头痛", "label": "症状", "offset": "479"}, {"mention": "腹痛", "label": "症状", "offset": "489"}, {"mention": "腹泻", "label": "症状", "offset": "491"}]}
{"text": "患者于2年前因“大便习惯性质改变半年余”入院,入院后完善相关检查,考虑诊断直肠癌,于2013-11-21行腹腔镜辅助上直肠癌根治术+放射粒子植入术,病理分期(t4n1m1),术后发现直肠吻合口口瘘,于2013-12-30行横结肠造口术,术后恢复可,于血管外科行右上肢、上腔静脉造影+上腔静脉滤器取出术,手术顺利,术后恢复可。后规律行6次化疗,一般情况可,5月前于我院门诊行ct检查提示:两上肺新增小结节影;住院后诊断直肠癌肺转移。已行4次化疗,未诉特殊不适,无畏寒、发热,无反酸、嗳气,无咳嗽、咳痰等不适,现行第5次化疗入院。\\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": "直肠癌", "label": "疾病和诊断", "offset": "37"}, {"mention": "腹腔镜辅助上直肠癌根治术+放射粒子植入术", "label": "手术", "offset": "53"}, {"mention": "直肠吻合口口瘘", "label": "疾病和诊断", "offset": "91"}, {"mention": "横结肠造口术", "label": "手术", "offset": "111"}, {"mention": "右上肢、上腔静脉造影+上腔静脉滤器取出术", "label": "手术", "offset": "130"}, {"mention": "ct", "label": "影像检查", "offset": "186"}, {"mention": "两上肺", "label": "解剖部位", "offset": "193"}, {"mention": "直肠癌肺转移", "label": "疾病和诊断", "offset": "208"}, {"mention": "胃", "label": "解剖部位", "offset": "284"}]}
{"text": ",患者2011年8月患者无明显诱因出现黏液血便,纳差、厌油、腹胀,不伴有腹痛、里急后重、腹泻、便秘、呕吐、发热等症状。2011-10-12日,下腹部ct检查示:肝内多发病灶,最大病灶6cm*8cm,考虑转移瘤可能大。2011-10-12日,肠镜示:乙状结肠可见0.6cm*0.8cm肿物,乙状结肠(距肛门口约20-26cm)可见环肠腔生长肿物;直肠距肛门口8cm处可见大小约0.5×0.6cm粘膜上隆起。乙状结肠肿物活检病理为中分化腺癌。2011-10-14日我院病理会诊为中分化腺癌,未行特殊治疗。2011-10-25在我院行结肠肿块切除术,2011-11-14、2011-11-29、2011-12-14、2011-12-30在我科行folferi+c225方案4疗程,治疗后全身出现1度皮疹,现为继续治疗入院。患者近来精神、睡眠尚可,食欲一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "30"}, {"mention": "腹痛", "label": "症状", "offset": "36"}, {"mention": "腹泻", "label": "症状", "offset": "44"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "71"}, {"mention": "肝", "label": "解剖部位", "offset": "80"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "124"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "144"}, {"mention": "肛门", "label": "解剖部位", "offset": "150"}, {"mention": "肠", "label": "解剖部位", "offset": "165"}, {"mention": "直肠", "label": "解剖部位", "offset": "172"}, {"mention": "肛门", "label": "解剖部位", "offset": "175"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "202"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "213"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "237"}, {"mention": "结肠肿块切除术", "label": "手术", "offset": "264"}, {"mention": "c225", "label": "药物", "offset": "327"}]}
{"text": "患者6年前无明显诱因出现腹泻,每天约3-4次,呈糊状便,无发热,无反酸、烧心,无恶心、呕吐,无进食阻挡感及哽噎感,无胸骨后疼痛,无乏力、纳差,无呕血、黑便,无停止排便、排气、腹痛、腹胀,遂就诊于我院,行电子肠镜提示肠息肉,并于术中行肠息肉切除术(未见具体报告单)。此后患者仍反复出现腹泻,每天约3-5次,不成形,多次于我院行结肠镜,并于术中行肠息肉切除术(具体不详)。患者近1月余再次出现腹泻,性质同前,为进一步诊治,门诊以“结肠息肉叒内镜上切除术后”收住院。叒叒叒患者自发病以来,神志清,精神尚可,饮食睡眠可,大便如前所述,小便正常。体重近期无明显变化。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "12"}, {"mention": "胸骨后疼痛", "label": "症状", "offset": "58"}, {"mention": "腹痛", "label": "症状", "offset": "87"}, {"mention": "腹胀", "label": "症状", "offset": "90"}, {"mention": "肠息肉", "label": "疾病和诊断", "offset": "107"}, {"mention": "肠息肉切除术", "label": "手术", "offset": "116"}, {"mention": "腹泻", "label": "症状", "offset": "141"}, {"mention": "肠息肉切除术", "label": "手术", "offset": "171"}, {"mention": "腹泻", "label": "症状", "offset": "194"}, {"mention": "结肠息肉叒内镜上切除术后", "label": "疾病和诊断", "offset": "213"}]}
{"text": "缘于入院前[主诉单一时间1个月主诉单一时间]前无明显诱因出现中下腹部闷痛不适,为持续性隐痛,无其它部位放射,与进食无关,无恶心、呕吐、返酸、嗳气、纳差、乏力、消瘦、腹痛、腹泻、便秘,无呕血、黑便,无发热、咳嗽、咳痰,未予治疗,症状无明显好转,此次至我院门诊行胃镜检查示:“胃底间质瘤”,遂门诊拟“胃间质瘤”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": "中下腹部", "label": "解剖部位", "offset": "30"}, {"mention": "腹痛", "label": "症状", "offset": "82"}, {"mention": "腹泻", "label": "症状", "offset": "85"}, {"mention": "胃底间质瘤", "label": "疾病和诊断", "offset": "136"}, {"mention": "胃间质瘤", "label": "疾病和诊断", "offset": "148"}]}
{"text": "患者1年余前无明显诱因出现左颈部淋巴结肿大,约1-2厘米大小,无发热、盗汗,无涕中带血,无呛咳、声音嘶哑,当时未予重视,后颈部淋巴结未明显增大,2015-4-14在我院行左颈部淋巴结活检,病理形态结合免疫组化提示慢性淋巴细胞白血病/小细胞淋巴瘤(cll/sll)。因患者有吞咽困难,行胃镜检查发现慢性浅表性胃炎伴糜烂、胆汁返流,食管粘膜活检提示粘膜慢性炎症,伴鳞状下皮轻度不典型增生。2015-4-23行骨髓涂片并免疫流式细胞学检查符合cll/sll诊断。综合病史诊断明确cll/sll(rai叒i期)。现患者按期入院复诊。患者自发病以来,精神、胃纳尚可,二便正常,体重无明显上降。", "mention_data": [{"mention": "左颈部淋巴结", "label": "解剖部位", "offset": "13"}, {"mention": "颈部淋巴结", "label": "解剖部位", "offset": "61"}, {"mention": "左颈部淋巴结", "label": "解剖部位", "offset": "85"}, {"mention": "慢性淋巴细胞白血病/小细胞淋巴瘤(cll/sll)", "label": "疾病和诊断", "offset": "106"}, {"mention": "慢性浅表性胃炎伴糜烂、胆汁返流", "label": "疾病和诊断", "offset": "148"}, {"mention": "食管", "label": "解剖部位", "offset": "164"}, {"mention": "cll/sll", "label": "疾病和诊断", "offset": "218"}, {"mention": "cll/sll(rai叒i期)", "label": "疾病和诊断", "offset": "236"}, {"mention": "胃", "label": "解剖部位", "offset": "273"}]}
{"text": ",缘于入院前13天无明显诱因出现右侧腰部疼痛,为持续性绞痛,放射至右上腹部,无发作性血尿、无畏寒、发热,无明显尿频、尿急、尿痛,无少尿及面部、四肢浮肿、无排尿困难及中断,,于外院查泌尿系彩超示:1.右肾输尿管中段结石伴右肾积水(中度)2.右肾结石3.左肾积水(轻度)4.子宫切除术后声像,经解痉止痛治疗后腰腹痛缓解(具体不详),今为求进一步诊治,就诊我院,,门诊查ctu示:右肾多发结石伴右肾、右输尿管下段轻度扩张、积水,右输尿管中上段炎性不全性狭窄可能,先天发育异常待除。门诊拟“右输尿管结石”收住院。发病以来,神可,食欲、睡眠正常,大便无异常,体重未见明显变化。", "mention_data": [{"mention": "右侧腰部", "label": "解剖部位", "offset": "16"}, {"mention": "右上腹部", "label": "解剖部位", "offset": "33"}, {"mention": "面部", "label": "解剖部位", "offset": "68"}, {"mention": "四肢", "label": "解剖部位", "offset": "71"}, {"mention": "右肾输尿管中段结石伴右肾积水(中度)", "label": "疾病和诊断", "offset": "99"}, {"mention": "右肾结石", "label": "疾病和诊断", "offset": "119"}, {"mention": "左肾积水(轻度)", "label": "疾病和诊断", "offset": "125"}, {"mention": "子宫切除术后", "label": "疾病和诊断", "offset": "135"}, {"mention": "腰腹", "label": "解剖部位", "offset": "152"}, {"mention": "ctu", "label": "影像检查", "offset": "182"}, {"mention": "右肾多发结石伴右肾、右输尿管下段轻度扩张、积水", "label": "疾病和诊断", "offset": "187"}, {"mention": "右输尿管中上段", "label": "解剖部位", "offset": "211"}, {"mention": "右输尿管结石", "label": "疾病和诊断", "offset": "241"}]}
{"text": "患者2016.3因喉癌、舌癌复查时,于****二院2016-03-11行mri结果示舌癌术后复查,食管下段巨大软组织肿物,肿瘤侵犯周围组织,考虑恶性肿瘤,食管癌可能大,并右侧锁骨下上、纵膈淋巴结转移。右舌、口底术后改变、左侧杓会厌壁增厚,考虑炎症可能。行胃镜检查病理结果示食管癌(多源性)。2016.3.31就诊于我院,2016.4.7给予多西他赛120mg叒d1,患者一般情况可。现为进一步治疗来我科。患者自发病以来,饮食及睡眠差,大小便正常,体重较前有所减轻。", "mention_data": [{"mention": "喉癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "舌癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "mri", "label": "影像检查", "offset": "36"}, {"mention": "舌癌术后", "label": "疾病和诊断", "offset": "42"}, {"mention": "食管下段", "label": "解剖部位", "offset": "49"}, {"mention": "恶性肿瘤,食管癌可能大,并右侧锁骨下上、纵膈淋巴结转移", "label": "疾病和诊断", "offset": "72"}, {"mention": "右舌、口底术后", "label": "疾病和诊断", "offset": "100"}, {"mention": "左侧杓会厌壁", "label": "解剖部位", "offset": "110"}, {"mention": "食管癌(多源性)", "label": "疾病和诊断", "offset": "136"}, {"mention": "多西他赛", "label": "药物", "offset": "170"}]}
{"text": ",患者2017-2-26傍晚无明显诱因出现腹痛、腹胀不适,腹痛呈阵发性,上腹为主,有便意未排便,后出现呕吐数次,自述量较多,呕吐物先为胃内容物后为胆汁,至27日患者腹痛、腹胀未有缓解遂至当地医就诊,查腹平片提示肠梗阻可能(未见单),患者为求进一步诊治至我院就诊,,查腹部平片示:考虑直肠梗阻可能,建议复查。腹部立位片未见消化道穿孔征象。患者今晨排稀水便双次,量少,未排气,目前禁食中,仍有腹胀,血压偏低,心率偏快,四肢发冷,排尿1次约50ml。追问病史,患者2016-2-2因“直肠癌”行hartmann+乙状结肠造瘘术,,术后病理示:腺癌pt4an2am0叒iiic期,术后行xelox方案化疗6程,过程顺利,于2016-11-24行乙状结肠造口回纳术,术后患者恢复可,排便排气正常,偶有便秘,近期油腻饮食较多。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "21"}, {"mention": "腹胀", "label": "症状", "offset": "24"}, {"mention": "腹痛", "label": "症状", "offset": "29"}, {"mention": "上腹", "label": "解剖部位", "offset": "36"}, {"mention": "胃", "label": "解剖部位", "offset": "67"}, {"mention": "腹痛", "label": "症状", "offset": "82"}, {"mention": "腹胀", "label": "症状", "offset": "85"}, {"mention": "腹平片", "label": "影像检查", "offset": "100"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "105"}, {"mention": "腹部平片", "label": "影像检查", "offset": "133"}, {"mention": "直肠梗阻", "label": "疾病和诊断", "offset": "141"}, {"mention": "腹部立位片", "label": "影像检查", "offset": "153"}, {"mention": "消化道穿孔", "label": "疾病和诊断", "offset": "160"}, {"mention": "腹胀", "label": "症状", "offset": "194"}, {"mention": "四肢发冷", "label": "症状", "offset": "207"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "239"}, {"mention": "hartmann+乙状结肠造瘘术", "label": "手术", "offset": "244"}, {"mention": "腺癌pt4an2am0叒iiic期", "label": "疾病和诊断", "offset": "268"}, {"mention": "乙状结肠造口回纳术", "label": "手术", "offset": "318"}]}
{"text": "患者于4月余前因“升结肠腺癌破裂穿孔致急性弥漫性腹膜炎”在我院行剖腹探查+腹腔粘连松解+肠间脓肿引流+升结肠肿瘤切除+末段小肠造口术,手术顺利,术后病理检查结果示:(升结肠)中分化管状腺癌浸及肠壁全层,双切端未见癌累及,肠壁淋巴结未见癌转移(0/8)。术后患者恢复可,今日拟行第四次化疗,特来我院就诊。\\u0004叒叒叒患者自起病以来,精神可,胃纳可,大便如下述,小便如常,体重未见明显上降。", "mention_data": [{"mention": "升结肠腺癌破裂穿孔致急性弥漫性腹膜炎", "label": "疾病和诊断", "offset": "9"}, {"mention": "剖腹探查+腹腔粘连松解+肠间脓肿引流+升结肠肿瘤切除+末段小肠造口术", "label": "手术", "offset": "32"}, {"mention": "肠", "label": "解剖部位", "offset": "96"}]}
{"text": "患者于今年5月因发现“身目黄染2周,发现肝门区占位1周”在我院诊断为原发性肝癌,并于2011.5.27行肝癌切除术+胆囊切除术+胆总管切开取栓术,术后病理为肝细胞性肝癌伴胆管癌栓,术后定期复查,未见明显复发及残留。现为进一步治疗入院。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,,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": "20"}, {"mention": "原发性肝癌", "label": "疾病和诊断", "offset": "34"}, {"mention": "肝癌切除术+胆囊切除术+胆总管切开取栓术", "label": "手术", "offset": "52"}, {"mention": "肝细胞性肝癌伴胆管癌栓", "label": "疾病和诊断", "offset": "78"}, {"mention": "腹痛", "label": "症状", "offset": "128"}, {"mention": "腹胀", "label": "症状", "offset": "132"}]}
{"text": ",患者既往月经规律,14岁,7/30天,,lmp:2012.7.25,因患“子宫腺肌症”于2012-08-09于我院行子宫全切术。手术顺利,术后恢复可。15天前,患者无明显诱因感右侧腰部胀痛不适,呈持续性,不能自行缓解,阴道分泌物未见明显异常。不伴发热,恶心、呕吐、腹泻,无尿频、尿急、尿痛等症状。期间患者自行口服抗生素,药物名不详,症状无明显缓解。2012-09-17来我院门诊就诊,,妇科彩超示:1、左卵巢囊肿,2、右附件区囊性包块。今日患者为求进一步诊治,收入我科。\\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,体重无明显变化。", "mention_data": [{"mention": "子宫腺肌症", "label": "疾病和诊断", "offset": "38"}, {"mention": "子宫全切术", "label": "手术", "offset": "59"}, {"mention": "右侧腰部", "label": "解剖部位", "offset": "89"}, {"mention": "阴道", "label": "解剖部位", "offset": "110"}, {"mention": "腹泻", "label": "症状", "offset": "133"}, {"mention": "妇科彩超", "label": "影像检查", "offset": "194"}, {"mention": "左卵巢囊肿", "label": "疾病和诊断", "offset": "202"}, {"mention": "右附件", "label": "解剖部位", "offset": "210"}]}
{"text": ",患者20年前自述因使用某减肥药物(具体不详)后出现体重增加(当时体重52kg),约每年增加约5-10kg,后患者于16年前曾行抽脂手术,术后因腹部疼痛,自述卧床休息近3年,体重依旧进行性增加。至今年,患者体重增加至105kg,病程期间,患者出现数次阵发性室下速,于外院治疗后好转,近半年来未再发作。1月前至我院就诊完善相关检查,acth-f节律基本正常,,血脂:,总胆固醇:叒4.72mmol/l;,甘油三酯:叒1.80mmol/l;,高密度脂蛋白胆固醇:叒1.25mmol/l;,低密度脂蛋白胆固醇:叒2.65mmol/l;,非高密度脂蛋白胆固醇:叒3.47mmol/l,肝脏mrs叒提示lfc叒21%,诊断单纯性肥胖,经患者及家属同意,于2014.6.5日到外科行袖状胃手术,2014.6.6安返回我科,并给予补液等支持治疗。,胃肠道碘水造影示:袖状胃切除术后,造影剂通过顺利。予停静脉补液,饮水,无明显不适,逐渐过渡到流质饮食,伤口愈合良好。同时给予指导饮食方案,并予补充善存、维生素d、钙片、叶酸及铁剂等。07-24日患者无明显诱因上出现高热,最高体温39.8度,无咳嗽、咳痰,无腹胀、腹痛,无恶心呕吐等不适。现患者为行进一步诊治入住我院。发病以来,患者饮食、睡眠可,二便无殊,术后体重减轻15kg。", "mention_data": [{"mention": "抽脂手术", "label": "手术", "offset": "64"}, {"mention": "腹部", "label": "解剖部位", "offset": "72"}, {"mention": "阵发性室下速", "label": "疾病和诊断", "offset": "125"}, {"mention": "总胆固醇", "label": "实验室检验", "offset": "183"}, {"mention": "甘油三酯", "label": "实验室检验", "offset": "201"}, {"mention": "高密度脂蛋白胆固醇", "label": "实验室检验", "offset": "219"}, {"mention": "低密度脂蛋白胆固醇", "label": "实验室检验", "offset": "242"}, {"mention": "非高密度脂蛋白胆固醇", "label": "实验室检验", "offset": "265"}, {"mention": "肝脏mrs", "label": "影像检查", "offset": "288"}, {"mention": "单纯性肥胖", "label": "疾病和诊断", "offset": "306"}, {"mention": "袖状胃手术", "label": "手术", "offset": "335"}, {"mention": "胃肠道碘水造影", "label": "影像检查", "offset": "367"}, {"mention": "袖状胃切除术后", "label": "疾病和诊断", "offset": "376"}, {"mention": "善存", "label": "药物", "offset": "440"}, {"mention": "维生素d", "label": "药物", "offset": "443"}, {"mention": "钙片", "label": "药物", "offset": "448"}, {"mention": "叶酸", "label": "实验室检验", "offset": "451"}, {"mention": "铁剂", "label": "药物", "offset": "454"}, {"mention": "腹胀", "label": "症状", "offset": "495"}, {"mention": "腹痛", "label": "症状", "offset": "498"}]}
{"text": "患者于2014-2-25在我科行根治性膀胱切除+回肠导管术,术中顺利,术后恢复好,切口愈合佳。患者出院后出现便秘并会阴部坠胀不适,口服药物或食物后便秘症状缓解但会阴部坠胀不适感无明显改善,到我院行了肠镜检查提示:结肠息肉。患者常规复查,除了上腹部切口疝以外无特殊不适;今为拔除pcs盒来我院,门诊以\\\"1、膀胱癌根治术后叒2、pcs盒植入术后\\\"收入我科。患者发病以来,精神好,饮食睡眠佳,无咳嗽、咳痰、胸痛及心慌气短,大便正常,小便如下所述,体重无减轻。", "mention_data": [{"mention": "根治性膀胱切除+回肠导管术", "label": "手术", "offset": "16"}, {"mention": "会阴部", "label": "解剖部位", "offset": "57"}, {"mention": "会阴部", "label": "解剖部位", "offset": "80"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "106"}, {"mention": "上腹部切口疝", "label": "疾病和诊断", "offset": "120"}, {"mention": "膀胱癌根治术后", "label": "疾病和诊断", "offset": "153"}, {"mention": "pcs盒植入术后", "label": "疾病和诊断", "offset": "163"}, {"mention": "胸痛", "label": "症状", "offset": "202"}, {"mention": "心慌气短", "label": "症状", "offset": "205"}]}
{"text": "患者2年余前因“直肠癌”于我院胃肠外科行根治术,术后出现吻合口瘘,后行结肠造口术。出院后患者口服化疗药物4个月,并进行放疗1疗程。患者于19个月前复查腹部ct时发现肝转移,后化疗4周期,再次复查腹部ct,见肝内转移病变无明显吸收。患者于16个月前行结肠还瘘术及肝部分切除术,术后化疗6周期。4个月前患者复查肺部ct,发现左肺上叶结节,化疗4周期后再次复查肺部ct,见左肺上叶结节无明显变化,现为求进一步诊治来院。患者近来饮食、睡眠及二便如常,体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "吻合口瘘", "label": "疾病和诊断", "offset": "28"}, {"mention": "结肠造口术", "label": "手术", "offset": "35"}, {"mention": "腹部ct", "label": "影像检查", "offset": "75"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "82"}, {"mention": "腹部ct", "label": "影像检查", "offset": "97"}, {"mention": "肝", "label": "解剖部位", "offset": "103"}, {"mention": "结肠还瘘术及肝部分切除术", "label": "手术", "offset": "124"}, {"mention": "肺部ct", "label": "影像检查", "offset": "153"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "160"}, {"mention": "肺部ct", "label": "影像检查", "offset": "177"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "183"}]}
{"text": "4年前开始患者无明显诱因出现中下腹疼痛,每次持续时间不等,饥饿时较明显,进食后有加重,偶有打嗝,无反酸、烧心、嗳气,无恶心、呕吐,无呕血、黑便,自行服用药物(具体不详)后缓解,未予以重视。7天前,患者无明显诱因再次出现中下腹疼痛,偶有打嗝,无腹胀、烧心,不伴反酸、嗳气、呃逆,不伴呕吐、腹泻,不伴呕血、黑便,无心悸、胸闷、咳嗽、咳痰,今日于我院行胃镜检查提示“浅表性胃窦炎伴糜烂、十二指肠降段口粘膜隆起待查、十二指肠球部对吻溃疡(forrest叒ib叒)叒”,为进一步治疗,门诊以“消化性溃疡”收治入院。\\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,体重无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "14"}, {"mention": "中下腹", "label": "解剖部位", "offset": "109"}, {"mention": "腹胀", "label": "症状", "offset": "121"}, {"mention": "腹泻", "label": "症状", "offset": "143"}, {"mention": "心悸", "label": "症状", "offset": "155"}, {"mention": "浅表性胃窦炎伴糜烂", "label": "疾病和诊断", "offset": "180"}, {"mention": "十二指肠降段口粘膜隆起待查", "label": "疾病和诊断", "offset": "190"}, {"mention": "十二指肠球部对吻溃疡(forrest叒ib叒)", "label": "疾病和诊断", "offset": "204"}, {"mention": "消化性溃疡", "label": "疾病和诊断", "offset": "241"}]}
{"text": "患者2+月前于我科诊断为“左肝原发性肝癌”,行剖腹探查、左肝肿瘤切除、胆囊切除、左肝结节射频消融术(术中彩超引导上),术后恢复顺利,术后病检(1410644)结果示:高分化肝细胞性肝癌,肝硬化,慢性胆囊炎,出院后低脂饮食,无腹痛等不适,现患者无咳嗽咳痰,无恶心、呕吐,无肝区疼痛,无厌油、纳差、乏力,无胸闷、胸痛,无腹痛、腹胀,无尿频、尿急、尿痛,现拟行介入治疗,遂来我院门诊就诊,以“肝癌术后”收住我科。叒叒叒患病以来,精神食欲可,睡眠较好,大便正常,小便如下诉。体重无明显增减。", "mention_data": [{"mention": "左肝原发性肝癌", "label": "疾病和诊断", "offset": "13"}, {"mention": "剖腹探查、左肝肿瘤切除、胆囊切除、左肝结节射频消融术", "label": "手术", "offset": "23"}, {"mention": "高分化肝细胞性肝癌", "label": "疾病和诊断", "offset": "83"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "93"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "97"}, {"mention": "腹痛", "label": "症状", "offset": "112"}, {"mention": "肝区", "label": "解剖部位", "offset": "135"}, {"mention": "胸闷", "label": "症状", "offset": "151"}, {"mention": "胸痛", "label": "症状", "offset": "154"}, {"mention": "腹痛", "label": "症状", "offset": "158"}, {"mention": "腹胀", "label": "症状", "offset": "161"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "193"}]}
{"text": ",缘于入院前半个月主诉单一时间]前无明显诱因感中下腹部闷痛不适,为持续性隐痛,无其它部位放射,伴进食时恶心,食欲上降,分量为原来1/4,无呕吐,无腹痛、腹泻、便秘,无发热、咳嗽、咳痰,未予治疗,症状无明显好转,3,天前至我院门诊行胃镜检查示:“胃窦溃疡浸润型癌侵及胃角、幽门,慢性萎缩性胃炎”,,病理:(窦小),:胃低分化癌,遂门诊拟“胃癌”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4kg。", "mention_data": [{"mention": "中下腹部", "label": "解剖部位", "offset": "23"}, {"mention": "腹痛", "label": "症状", "offset": "73"}, {"mention": "腹泻", "label": "症状", "offset": "76"}, {"mention": "胃窦溃疡浸润型癌侵及胃角、幽门", "label": "疾病和诊断", "offset": "122"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "138"}, {"mention": "胃低分化癌", "label": "疾病和诊断", "offset": "157"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "168"}]}
{"text": "患者于2009-12-18在我院行直肠癌低位前切除术+预防性回肠造瘘术,术中见肿瘤位于腹膜反折下方3cm,无梗阻穿孔表现,术后病理为隆起型高中分化腺癌,无脉管癌栓,侵犯肠壁至浆膜上,淋巴结无癌转移0/16,未行进一步治疗,定期复查。2010-3-19再次入院行回肠造口还纳术,术后排便习惯较前改变,大便干,需口服润肠药协助排便。一月余前患者复查cea升高22ng/ml,无不适主诉,行pet-ct检查提示肝内高代谢,考虑转移,无肝外转移表现。进一步行mri检查提示肝s4/8交界转移瘤,3.8x3.8cm\\u007f肝脏多发囊肿,患者本次为行第二周期mfolfox6化疗入院,患者自患病以来,精神可,饮食睡眠可,二便如常,体重无明显减轻。", "mention_data": [{"mention": "直肠癌低位前切除术+预防性回肠造瘘术", "label": "手术", "offset": "17"}, {"mention": "隆起型高中分化腺癌", "label": "疾病和诊断", "offset": "66"}, {"mention": "肠", "label": "解剖部位", "offset": "84"}, {"mention": "回肠造口还纳术", "label": "手术", "offset": "130"}, {"mention": "cea", "label": "实验室检验", "offset": "172"}, {"mention": "pet-ct", "label": "影像检查", "offset": "192"}, {"mention": "肝", "label": "解剖部位", "offset": "202"}, {"mention": "肝", "label": "解剖部位", "offset": "214"}, {"mention": "mri检查", "label": "影像检查", "offset": "225"}, {"mention": "肝s4/8交界转移瘤", "label": "疾病和诊断", "offset": "232"}, {"mention": "肝脏", "label": "解剖部位", "offset": "258"}]}
{"text": "患者2小时前于我院行胃肠镜体检时发现结肠息肉,直径约0.6cm,于镜上切除,并于胃镜上取部分组织活检。患者无恶心、呕吐,无反酸、嗳气,无腹痛、腹泻,无黑便、血便,无发热、咳嗽,无胸闷、气促,无头晕、头痛,为进一步治疗门诊以“结肠息肉内镜上切除术后”收入院。叒叒叒患者自发病以来精神状态良好,大小便正常,体重无明显变化。叒叒叒自发病以来,患者神志清,精神可,饮食睡眠尚正常。小便量可,体重无明显改变。", "mention_data": [{"mention": "结肠息肉", "label": "疾病和诊断", "offset": "18"}, {"mention": "腹痛", "label": "症状", "offset": "68"}, {"mention": "腹泻", "label": "症状", "offset": "71"}, {"mention": "胸闷", "label": "症状", "offset": "89"}, {"mention": "头晕", "label": "症状", "offset": "96"}, {"mention": "头痛", "label": "症状", "offset": "99"}, {"mention": "结肠息肉内镜上切除术后", "label": "疾病和诊断", "offset": "112"}]}
{"text": ",半年前,患者服用元胡止痛片后解鲜红色约200ml血便1次,伴头昏、心慌、气促,无恶心、呕吐、呕血,无腹痛、腹泻等症状,无里急后重,无肛门坠胀感,无畏寒发热,无皮肤黏膜黄染,入我院胃肠外科,,行胃镜检查示:糜烂性全胃炎,予以输血、补液等治疗后好转出院;出院后患者再次因反复便血入我科治疗,,行肠镜检查示:慢性结肠炎;,考虑诊断:1.上消化道出血原因待查;2.慢性结肠炎叒3.十二指肠乳头神经内分泌癌切除术后;予以抑酸、护胃、止血等治疗后症状缓解出院;出院后患者未再出现便血等情况,今日为求复查了解病情恢复情况入我科,门诊以“便血待查”收入我科。\\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,体重无明显变化。", "mention_data": [{"mention": "元胡止痛片", "label": "药物", "offset": "9"}, {"mention": "头昏", "label": "症状", "offset": "31"}, {"mention": "心慌", "label": "症状", "offset": "34"}, {"mention": "腹痛", "label": "症状", "offset": "51"}, {"mention": "腹泻", "label": "症状", "offset": "54"}, {"mention": "肛门坠胀", "label": "症状", "offset": "67"}, {"mention": "糜烂性全胃炎", "label": "疾病和诊断", "offset": "103"}, {"mention": "慢性结肠炎", "label": "疾病和诊断", "offset": "152"}, {"mention": "上消化道出血原因待查", "label": "疾病和诊断", "offset": "166"}, {"mention": "慢性结肠炎", "label": "疾病和诊断", "offset": "179"}, {"mention": "十二指肠乳头神经内分泌癌切除术后", "label": "疾病和诊断", "offset": "187"}, {"mention": "胃", "label": "解剖部位", "offset": "210"}, {"mention": "便血待查", "label": "疾病和诊断", "offset": "262"}]}
{"text": "患者半年前因“乙肝病史9年,查体发现肝占位1周”来我院就诊,经检查诊断“原发性肝癌、乙肝肝硬化”收住院,于2015-09-25在全麻上行左肝肿瘤切除+胆囊切除术。手术顺利,病理结果:(左肝)肝细胞肝癌(ii级),结节型,体积2*1.5*1.5cm,未累及切除面;结节性肝硬化;胆囊胆固醇性息肉、慢性胆囊炎(201516700)。术后给予抗感染、保肝、补液、营养支持及对症处理,恢复顺利出院。4月及2月前来院复查,分别行肝介入治疗(tai),治疗后行替加氟+亚叶酸钙+泽菲静脉序贯化疗,同时给予保肝、升白、止吐、护胃及增强免疫等对症治疗,好转后出院。叒叒叒患者自下次出院后,一般情况好,无发热,无腹痛、腹胀、腹泻及肝区不适,无恶心、呕吐,无黄疸,饮食睡眠可,大小便正常,体重无减轻。今为复查再次来我院就诊,门诊以“肝癌术后”收住院。", "mention_data": [{"mention": "肝", "label": "解剖部位", "offset": "18"}, {"mention": "原发性肝癌", "label": "疾病和诊断", "offset": "36"}, {"mention": "乙肝肝硬化", "label": "疾病和诊断", "offset": "42"}, {"mention": "左肝肿瘤切除+胆囊切除术", "label": "手术", "offset": "68"}, {"mention": "(左肝)肝细胞肝癌(ii级)", "label": "疾病和诊断", "offset": "91"}, {"mention": "结节性肝硬化", "label": "疾病和诊断", "offset": "131"}, {"mention": "胆囊胆固醇性息肉", "label": "疾病和诊断", "offset": "138"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "147"}, {"mention": "肝", "label": "解剖部位", "offset": "173"}, {"mention": "肝介入治疗(tai)", "label": "手术", "offset": "209"}, {"mention": "替加氟", "label": "药物", "offset": "224"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "228"}, {"mention": "泽菲", "label": "药物", "offset": "233"}, {"mention": "肝", "label": "解剖部位", "offset": "247"}, {"mention": "胃", "label": "解剖部位", "offset": "256"}, {"mention": "腹痛", "label": "症状", "offset": "297"}, {"mention": "腹胀", "label": "症状", "offset": "300"}, {"mention": "腹泻", "label": "症状", "offset": "303"}, {"mention": "肝区", "label": "解剖部位", "offset": "306"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "356"}]}
{"text": "缘于入院前6年,就诊我院诊断“降结肠癌”,后行“右半结肠切除术”.半天前小时前无明显诱因发生腹痛,呈持续性闷痛,阵发性加剧,伴腹胀、恶心感,无明显呕吐,肛门暂未排气、排便,无呕血、黑便,无心悸、气促,无畏冷、发热,无肉眼血尿、尿频、尿急、尿痛。就诊于我院急诊,行立位腹部平片示:“不全性肠梗阻可能。”为进一步诊治,门诊拟粘连性肠梗阻收入院,发病以来,精神、睡眠、食欲差,大便如下述,小便正常,体重无明显变化。", "mention_data": [{"mention": "降结肠癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "右半结肠切除术", "label": "手术", "offset": "24"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "63"}, {"mention": "肛门", "label": "解剖部位", "offset": "76"}, {"mention": "心悸", "label": "症状", "offset": "94"}, {"mention": "腹部平片", "label": "影像检查", "offset": "133"}, {"mention": "不全性肠梗阻", "label": "疾病和诊断", "offset": "140"}, {"mention": "粘连性肠梗阻", "label": "疾病和诊断", "offset": "160"}]}
{"text": ",患者自述于7.5个月前出现下腹疼痛,伴反酸,无放射痛,期间未就诊。4.5个月前腹痛症状加重,并呕吐2次胃内容物,就诊于我院,,行胃镜检查示:胃巨大溃疡性病变,恶性可能大;十二指肠球部息肉,钳除。,病理示:十二指肠球部炎性息肉;胃体溃疡,淋巴组织异型增生,不除外淋巴瘤。,免疫组化支持胃黏膜相关b细胞淋巴瘤:ck下皮(+)cd3散在(+)cd20(++)pax-5(++)cd68散在(+)ki67(+)>80%叒cd5(+/-)cyclind1(-)。于2012年12月7日始行cop方案化疗2周期,,具体为:环磷酰胺0.6gd1d4,长春新碱2mgd1,醋酸泼尼松片100mg日一次口服d1-d5,并予卓迪、耐信片、甲硝唑、阿莫西林抗hp治疗,化疗后无明显不适。2周期后评效疾病部分缓解(pr),第3-6周期改为chop方案化疗,,具体为:环磷酰胺1.2gd1,表阿霉素(艾达生)50mgd1、d2,长春新碱2mgd1,醋酸泼尼松100mgd1-d5,并予高舒达抑酸对症治疗。,第4周期评效:维持pr。化疗后患者出现ii度腹泻,眼睑水肿,对症治疗后好转。现为进一步治疗入我科。患者近来偶有饭后下腹部不适,饮食可,睡眠一般,精神体力可,周身其他部位无疼痛,二便正常,体重无明显变化,kps评分80分,ecog1分。", "mention_data": [{"mention": "下腹疼痛", "label": "症状", "offset": "14"}, {"mention": "腹痛", "label": "症状", "offset": "40"}, {"mention": "胃", "label": "解剖部位", "offset": "52"}, {"mention": "胃巨大溃疡性病变,恶性可能大", "label": "疾病和诊断", "offset": "71"}, {"mention": "十二指肠球部息肉", "label": "疾病和诊断", "offset": "86"}, {"mention": "十二指肠球部炎性息肉", "label": "疾病和诊断", "offset": "103"}, {"mention": "胃体溃疡", "label": "疾病和诊断", "offset": "114"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "131"}, {"mention": "胃", "label": "解剖部位", "offset": "142"}, {"mention": "b细胞淋巴瘤", "label": "疾病和诊断", "offset": "147"}, {"mention": "环磷酰胺", "label": "药物", "offset": "256"}, {"mention": "长春新碱", "label": "药物", "offset": "269"}, {"mention": "醋酸泼尼松片", "label": "药物", "offset": "279"}, {"mention": "卓迪", "label": "药物", "offset": "303"}, {"mention": "耐信片", "label": "药物", "offset": "306"}, {"mention": "甲硝唑", "label": "药物", "offset": "310"}, {"mention": "阿莫西林", "label": "药物", "offset": "314"}, {"mention": "环磷酰胺", "label": "药物", "offset": "372"}, {"mention": "表阿霉素", "label": "药物", "offset": "383"}, {"mention": "艾达生", "label": "药物", "offset": "388"}, {"mention": "长春新碱", "label": "药物", "offset": "402"}, {"mention": "醋酸泼尼松", "label": "药物", "offset": "412"}, {"mention": "高舒达", "label": "药物", "offset": "430"}, {"mention": "腹泻", "label": "症状", "offset": "463"}, {"mention": "眼睑", "label": "解剖部位", "offset": "466"}, {"mention": "下腹部", "label": "解剖部位", "offset": "498"}]}
{"text": "患者2015-03因左侧股动脉假性动脉瘤于我院就诊,行左上肢截肢手术。术后患者定期复查,于2016-02-26查腹部血管cta提示:腹主动假性动脉瘤,右侧髂总动脉起始处管腔狭窄;右肾动脉假性动脉瘤。患者偶有上腹部隐痛,有排尿、排便不尽感,无恶心呕吐,无呕血便血黑便,无头痛头晕、黑朦晕厥,四肢感觉活动可。患者现为行进一步诊疗收入病房。病程中,患者神清,精神可,食欲睡眠可,二便无殊,体重无明显变化。", "mention_data": [{"mention": "左侧股动脉假性动脉瘤", "label": "疾病和诊断", "offset": "10"}, {"mention": "左上肢截肢手术", "label": "手术", "offset": "27"}, {"mention": "腹部血管cta", "label": "影像检查", "offset": "56"}, {"mention": "腹主动假性动脉瘤", "label": "疾病和诊断", "offset": "66"}, {"mention": "右侧髂总动脉起始处管腔狭窄", "label": "疾病和诊断", "offset": "75"}, {"mention": "右肾动脉假性动脉瘤", "label": "疾病和诊断", "offset": "89"}, {"mention": "上腹部", "label": "解剖部位", "offset": "103"}, {"mention": "头痛头晕", "label": "症状", "offset": "134"}]}
{"text": "患者2年前无明显诱因出现腹痛,为脐周持续性隐痛,伴腹胀不适,无恶心、呕吐,无反酸、烧心,腹痛于当地诊所就诊,诊断为“肠炎”给予抗感染、抑酸补、对症处理后病情好转出院,院外未继续应用药物治疗;患者2015.11.5无明显诱因再次出现腹痛,性质同前,于我院消化内科就诊,诊断为“肠易激综合征”,行胃肠镜检查结果示:慢性萎缩性胃炎,入院后给予抑酸、抗氧化、对症治疗,患者病情好转出院。叒叒叒现患者一月余前再次出现腹痛,为脐周持续性疼痛,伴下腹饱胀感,食欲不振,无腹泻、腹水,无发热、头痛,无胸闷、胸痛,无恶心、呕吐,无反酸、烧心,为行进一步诊治于我院就诊。叒叒叒患者发病以来,饮食差,睡眠可,大便2次/天,体重减轻2kg。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "12"}, {"mention": "脐周", "label": "解剖部位", "offset": "16"}, {"mention": "腹胀", "label": "症状", "offset": "25"}, {"mention": "腹痛", "label": "症状", "offset": "44"}, {"mention": "肠炎", "label": "疾病和诊断", "offset": "58"}, {"mention": "腹痛", "label": "症状", "offset": "115"}, {"mention": "肠易激综合征", "label": "疾病和诊断", "offset": "137"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "155"}, {"mention": "腹痛", "label": "症状", "offset": "203"}, {"mention": "脐周", "label": "解剖部位", "offset": "207"}, {"mention": "下腹", "label": "解剖部位", "offset": "216"}, {"mention": "腹泻", "label": "症状", "offset": "228"}, {"mention": "腹水", "label": "症状", "offset": "231"}, {"mention": "头痛", "label": "症状", "offset": "238"}, {"mention": "胸闷", "label": "症状", "offset": "242"}, {"mention": "胸痛", "label": "症状", "offset": "245"}]}
{"text": "患者自今年3月起无明显诱因出现上腹部隐痛,呈持续性,向腰骶部放散,经量增多为原来的1.5倍。2012年5月24日,于外院行宫腔镜上子宫内膜息肉切除术,术后病理提示子宫内膜呈增生反应。术后未口服激素类药物,术后至今腹痛未缓解,2012年11月26日我院门诊超声提示子宫内膜回声不均,其内高回声团,注意内膜息肉。现患者为求手术治疗入我科。患者平素月经规律,周期30日,经期4-5日,量中等,色鲜红,偶有经期上腹痛,可忍受。末次月经2012年12月11日。患者近3个月自觉尿频,每日4-5次,不伴尿急尿痛,病来无头晕头迷,无胸闷气短,无恶心呕吐,偶有便秘2-3天/次,饮食睡眠可,无明显体重变化。", "mention_data": [{"mention": "上腹部", "label": "解剖部位", "offset": "15"}, {"mention": "腰骶部", "label": "解剖部位", "offset": "27"}, {"mention": "宫腔镜上子宫内膜息肉切除术", "label": "手术", "offset": "61"}, {"mention": "子宫", "label": "解剖部位", "offset": "81"}, {"mention": "腹痛", "label": "症状", "offset": "106"}, {"mention": "超声", "label": "影像检查", "offset": "127"}, {"mention": "子宫", "label": "解剖部位", "offset": "131"}, {"mention": "息肉", "label": "疾病和诊断", "offset": "151"}, {"mention": "上腹痛", "label": "症状", "offset": "201"}, {"mention": "头晕", "label": "症状", "offset": "253"}, {"mention": "头", "label": "解剖部位", "offset": "255"}, {"mention": "胸闷气短", "label": "症状", "offset": "259"}]}
{"text": ",3个月前患者因皮肤粘膜及巩膜黄染就诊于我院,排除手术禁忌症后,2016年2月17日于我院全麻上行胆囊切除+胆肠吻合+胃肠吻合术,,术后病理示:慢性腺性胆囊炎(,病理号:叒201602691)。患者术后病情平稳,顺利出院。出院后患者无寒战、发热,无腹胀、腹痛,无恶心、呕吐,无咳嗽、咳痰,无胸闷、憋喘,无尿频、尿急、尿痛。现患者为术后复查来我科就诊,门诊以“壶腹周围恶性肿瘤术后”入院。叒叒叒患者自出院以后,神志清,精神可,饮食睡眠可,大小便正常,体重较前未见明显减轻。", "mention_data": [{"mention": "巩膜", "label": "解剖部位", "offset": "13"}, {"mention": "胆囊切除+胆肠吻合+胃肠吻合术", "label": "手术", "offset": "49"}, {"mention": "慢性腺性胆囊炎", "label": "疾病和诊断", "offset": "72"}, {"mention": "腹胀", "label": "症状", "offset": "124"}, {"mention": "腹痛", "label": "症状", "offset": "127"}, {"mention": "胸闷", "label": "症状", "offset": "145"}, {"mention": "壶腹周围恶性肿瘤术后", "label": "疾病和诊断", "offset": "179"}]}
{"text": "患者于30年前渐出现右上肢浅表血管迂曲扩张,以久立、劳累后明显,休息并抬高患肢后可减轻。无患肢水肿、皮肤搔痒不适、脱屑、颜色改变。无上肢酸痛、疼痛、发热、头痛、恶心。无特殊治疗。近2年渐出现小腿皮肤颜色加深;站立容易易疲劳感觉;3月前就诊我院,行上肢静脉造影及ctv检查提示右髂静脉压迫,行“右侧髂静脉造影+髂静脉支架置入术+球囊扩张”,术后恢复良好,为进一步治疗来我院门诊就诊,门诊以右上肢静脉曲张收入院。患者自发病以来无明显胸闷、气短,无发烧,精神状态一般,食欲一般,睡眠良好,体重无明显变化,大便正常,小便正常。", "mention_data": [{"mention": "右上肢浅表血管", "label": "解剖部位", "offset": "10"}, {"mention": "上肢", "label": "解剖部位", "offset": "66"}, {"mention": "头痛", "label": "症状", "offset": "77"}, {"mention": "小腿", "label": "解剖部位", "offset": "95"}, {"mention": "上肢静脉造影", "label": "影像检查", "offset": "123"}, {"mention": "ctv检查", "label": "影像检查", "offset": "130"}, {"mention": "右髂静脉", "label": "解剖部位", "offset": "137"}, {"mention": "右侧髂静脉造影+髂静脉支架置入术+球囊扩张", "label": "手术", "offset": "146"}, {"mention": "右上肢静脉曲张", "label": "疾病和诊断", "offset": "193"}, {"mention": "胸闷", "label": "症状", "offset": "214"}]}
{"text": ",患者于半月前无明显诱因出现进食后中下腹不适,每次持续数分钟自行缓解,无恶心、呕吐、反酸、嗳气、烧心,无腹痛、腹胀、腹泻、便秘,无厌油、纳差,未予重视,未特殊处理。,半前至我院门诊行胃镜检查提示:浅表性胃窦炎伴糜烂,十二指肠球炎,,腹部彩超:肝回声增多,胆囊息肉样变。为进一步诊治,门诊“胃炎”收入我科。\\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,体重无明显变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "17"}, {"mention": "腹痛", "label": "症状", "offset": "52"}, {"mention": "腹胀", "label": "症状", "offset": "55"}, {"mention": "腹泻", "label": "症状", "offset": "58"}, {"mention": "浅表性胃窦炎伴糜烂", "label": "疾病和诊断", "offset": "98"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "108"}, {"mention": "肝", "label": "解剖部位", "offset": "121"}, {"mention": "胆囊息肉", "label": "疾病和诊断", "offset": "127"}, {"mention": "胃炎", "label": "疾病和诊断", "offset": "144"}]}
{"text": "患者2年前行乙状结肠癌根治术,术后病理为乙状结肠中分化腺癌,病理分期为pt3n2。术后恢复良好,进行了8周期辅助化疗(方案不详),化疗过程顺利。之后患者规律复查,未见肿瘤复发转移征象。患者2月前复查胸部ct时发现右上肺纵隔旁小结节,约2mm大小,1月后复查胸部ct发现该结节增大为8*5mm,考虑转移可能大。现为进一步治疗而来我院。患者病程中精神好,无咳嗽咳痰、咳血,无胸痛、头晕、恶心、呕吐,无胸闷及呼吸困难,无声音嘶哑、肩臂麻木疼痛、头面浮肿,睡眠食欲正常,大小便正常,体重无明显变化。", "mention_data": [{"mention": "乙状结肠癌根治术", "label": "手术", "offset": "6"}, {"mention": "乙状结肠中分化腺癌", "label": "疾病和诊断", "offset": "20"}, {"mention": "胸部ct", "label": "影像检查", "offset": "99"}, {"mention": "右上肺", "label": "解剖部位", "offset": "106"}, {"mention": "纵隔", "label": "解剖部位", "offset": "109"}, {"mention": "胸部ct", "label": "影像检查", "offset": "128"}, {"mention": "胸痛", "label": "症状", "offset": "185"}, {"mention": "头晕", "label": "症状", "offset": "188"}, {"mention": "胸闷", "label": "症状", "offset": "198"}, {"mention": "肩臂", "label": "解剖部位", "offset": "212"}, {"mention": "头面", "label": "解剖部位", "offset": "219"}]}
{"text": ",患者2个月前因“左下腹疼痛12小时”来院就诊,以“1.急性胆囊炎2.胆总管结石?”收住我科,入院后完善检查,给予保肝、护胃、抗感染及对症营养支持等治疗,ct,检查示:肝脏大小形态正常,胆囊饱满,壁不厚,内未见异常密度影;左肺中叶小结节;肝囊肿;右侧肾下腺区异常密度,考虑良性病变可能大。腹部mri+mrcp检查示胆总管上端肿瘤待排。2016-06-30在全麻上手术,术中证实为胰头癌,行胰十二指肠切除术,手术顺利,,病理:胰头中分化腺癌,慢性胆囊炎(201613511)。术后给予抗感染、保肝、抑酸、抑制胰酶分泌、免疫、营养支持及对症处理,恢复顺利,好转出院。出院后病人无明显不良反应,饮食睡眠可,大小便正常,体重无明显变化,无恶心、呕吐,无腹痛、腹胀、腹泻,无寒战、发热,无黄疸,今为复查再次来我院就诊,门诊以“胰头癌术后”收入院。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "9"}, {"mention": "急性胆囊炎", "label": "疾病和诊断", "offset": "28"}, {"mention": "胆总管结石", "label": "疾病和诊断", "offset": "35"}, {"mention": "肝", "label": "解剖部位", "offset": "58"}, {"mention": "胃", "label": "解剖部位", "offset": "61"}, {"mention": "ct", "label": "影像检查", "offset": "77"}, {"mention": "肝脏", "label": "解剖部位", "offset": "84"}, {"mention": "胆囊", "label": "解剖部位", "offset": "93"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "111"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "119"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "123"}, {"mention": "腹部mri+mrcp", "label": "影像检查", "offset": "144"}, {"mention": "胆总管上端肿瘤", "label": "疾病和诊断", "offset": "157"}, {"mention": "胰头癌", "label": "疾病和诊断", "offset": "189"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "194"}, {"mention": "胰头中分化腺癌", "label": "疾病和诊断", "offset": "212"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "220"}, {"mention": "肝", "label": "解剖部位", "offset": "246"}, {"mention": "腹痛", "label": "症状", "offset": "322"}, {"mention": "腹胀", "label": "症状", "offset": "325"}, {"mention": "腹泻", "label": "症状", "offset": "328"}, {"mention": "胰头癌术后", "label": "疾病和诊断", "offset": "358"}]}
{"text": "患者2012年7月无明显诱因出现下腹部不适,在外院通过胃镜诊断为胃窦癌,遂于2013-1-31在我院行胃癌根治术(远端胃大切),术后病理:低分化腺癌,小灶为粘液腺癌,侵及胃壁粘膜上层,1/33(+),pt1bn1m0,ib期。术后恢复良好,于2013-3-1、2013-03-26、2013-04-24、2013-05-28、2013-06-28行单药希罗达辅助化疗5程,化疗后患者耐受性良好,今遵原主诊医师意见继续行原方案化疗。近期患者精神、睡眠、食欲可,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": "16"}, {"mention": "胃窦癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "胃癌根治术(远端胃大切)", "label": "手术", "offset": "51"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "78"}, {"mention": "胃", "label": "解剖部位", "offset": "85"}, {"mention": "希罗达", "label": "药物", "offset": "176"}]}
{"text": "患者于1年余前饥饿后出现下腹隐痛,进食后可缓解,无泛酸、嗳气,无恶心、呕吐、呕血,无腹泻、腹胀,无黑便、便血、粘液便,间断予以药物治疗,症状略有缓解,10天前外院行胃镜检查提示胃窦溃疡,活检病理提示低分化腺癌。为进一步诊治来我院就诊,门诊超声胃镜提示胃窦后壁溃疡型肿物,活检提示低分化腺癌。起病以来,患者无头晕、头痛,无发热、咳嗽、咳痰、胸闷、胸痛,精神体力一般,食欲上降,睡眠一般,小便正常,体重较前无明显上降。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "12"}, {"mention": "腹泻", "label": "症状", "offset": "42"}, {"mention": "腹胀", "label": "症状", "offset": "45"}, {"mention": "胃窦溃疡", "label": "疾病和诊断", "offset": "88"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "99"}, {"mention": "胃窦后壁", "label": "解剖部位", "offset": "125"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "139"}, {"mention": "头晕", "label": "症状", "offset": "153"}, {"mention": "头痛", "label": "症状", "offset": "156"}, {"mention": "胸闷", "label": "症状", "offset": "169"}, {"mention": "胸痛", "label": "症状", "offset": "172"}]}
{"text": "入院前10年,患者无明显诱因出现大便次数、性状改变,约5~6次/天,大便黄色,糊状,无粘液、脓血,时有里急后重,伴腹痛、腹胀,解大便后缓解,无反酸、嗳气,无恶心、呕吐,无黑便、血便,无尿频、尿急、尿痛。未引起患者重视,未行诊治,症状可自行好转,大便次数1-2次/天,之后反复发作,性质同前,未诊治。入院前8天,患者于我院就诊,行肠镜检查提示:结肠扁平息肉(0.1cm叒x叒0.3cm)。今为行肠镜上息肉切除术,来我院就诊,门诊以“结肠息肉”收入我科住院治疗。叒叒叒发病以来,精神、食欲可,睡眠可,大便如下所述,小便正常,近期体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "57"}, {"mention": "腹胀", "label": "症状", "offset": "60"}, {"mention": "结肠扁平息肉", "label": "疾病和诊断", "offset": "171"}, {"mention": "肠镜上息肉切除术", "label": "手术", "offset": "196"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "215"}]}
{"text": "患者2012年7月因\\\"下腹痛1月\\\"于本院诊断为肝癌,于2012-8-7行肝癌切除+胆囊切除+胆管旁淋巴结切除术,术后病理提示低分化鳞癌,考虑为混合性肝细胞癌(肝细胞性肝癌与胆管细胞癌混合),侵犯肝被摸,未见明确癌栓,未见卫星结节;胆管旁淋巴结1枚见癌转移。9月11日ct示:腹主动脉旁主动脉腹主动脉旁淋巴结肿大,较前增大,考虑转移。患者于10月8日开始行腹部放疗共15次,期间行mri检查发现右侧肩胛骨转移,遂行右肩部放疗共10次。放疗过程顺利,患者未诉特殊不适。2012-11-02复查ct示肝s8强化灶,较前新发。患者1月前开始服用索拉菲尼(多吉美)治疗,右肩部、背部、上肢出现皮疹,予以外用药膏(具体不详)涂擦后,症状缓解。现为进一步治疗入院。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,,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": "下腹痛", "label": "症状", "offset": "12"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "25"}, {"mention": "肝癌切除+胆囊切除+胆管旁淋巴结切除术", "label": "手术", "offset": "38"}, {"mention": "低分化鳞癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "混合性肝细胞癌(肝细胞性肝癌与胆管细胞癌混合)", "label": "疾病和诊断", "offset": "73"}, {"mention": "肝", "label": "解剖部位", "offset": "99"}, {"mention": "胆管旁淋巴结", "label": "解剖部位", "offset": "117"}, {"mention": "ct", "label": "影像检查", "offset": "135"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "139"}, {"mention": "主动脉", "label": "解剖部位", "offset": "144"}, {"mention": "腹主动脉旁淋巴结", "label": "解剖部位", "offset": "147"}, {"mention": "腹部", "label": "解剖部位", "offset": "179"}, {"mention": "mri", "label": "影像检查", "offset": "191"}, {"mention": "右侧肩胛骨转移", "label": "疾病和诊断", "offset": "198"}, {"mention": "右肩部", "label": "解剖部位", "offset": "208"}, {"mention": "ct", "label": "影像检查", "offset": "246"}, {"mention": "肝s8", "label": "解剖部位", "offset": "249"}, {"mention": "索拉菲尼(多吉美)", "label": "药物", "offset": "270"}, {"mention": "右肩部", "label": "解剖部位", "offset": "282"}, {"mention": "背部", "label": "解剖部位", "offset": "286"}, {"mention": "上肢", "label": "解剖部位", "offset": "289"}, {"mention": "腹痛", "label": "症状", "offset": "338"}, {"mention": "腹胀", "label": "症状", "offset": "342"}]}
{"text": ",患者于2015-6无明显诱因出现腹泻,2-3次/天,成形软便,偶伴黑便,,于2015-08-11于外院行肠镜示:直肠距肛门9-11cm可见一半围大肿物,乙状结肠距肛门20cm处及直肠距肛门13cm处可见5个息肉。病理提示直肠中分化腺癌,大肠多发息肉。,胃镜示:十二指肠球部溃疡。2015-8-20外院行下、上、,腹盆ct示:肝右叶巨大肿物,考虑肝癌与转移瘤鉴别,拟门脉右支癌栓.直肠近段肠壁偏心性增厚。2015-9-22至2015-12-23予folfox化疗6程,第2程因4度粒细胞上降予以减量(取消5-fu叒0.5g叒推注),第2程因4度粒细胞上降予以减量(取消5-fu叒0.5g叒推注),患者化疗耐受可,4、6程化疗后复查评价pr。后于2016-01-12全麻上行“腹腔镜上直肠癌根治术+右半肝切除术+胆囊切除术”,,术后病理示:(直肠)病变符合中分化腺癌,浸润肠壁全层至浆膜层内,淋巴结0/9(+),癌旁淋巴结1枚,未见癌,切缘阴性。(肝转移,右半肝)可见腺癌浸润,符合直肠腺癌肝转移。术后复查ct未见复发转移征象。术后恢复可,现为行上一步诊治来院,自起病以来,患者精神、食欲、睡眠可,二便如常,体重近2周来无明显上降。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "17"}, {"mention": "直肠", "label": "解剖部位", "offset": "57"}, {"mention": "肛门", "label": "解剖部位", "offset": "60"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "77"}, {"mention": "肛门", "label": "解剖部位", "offset": "82"}, {"mention": "直肠", "label": "解剖部位", "offset": "90"}, {"mention": "肛门", "label": "解剖部位", "offset": "93"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "111"}, {"mention": "大肠多发息肉", "label": "疾病和诊断", "offset": "119"}, {"mention": "十二指肠球部溃疡", "label": "疾病和诊断", "offset": "131"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "157"}, {"mention": "肝右叶", "label": "解剖部位", "offset": "163"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "173"}, {"mention": "门脉右支", "label": "解剖部位", "offset": "183"}, {"mention": "直肠", "label": "解剖部位", "offset": "190"}, {"mention": "5-fu", "label": "药物", "offset": "252"}, {"mention": "5-fu", "label": "药物", "offset": "284"}, {"mention": "腹腔镜上直肠癌根治术+右半肝切除术+胆囊切除术", "label": "手术", "offset": "337"}, {"mention": "直肠", "label": "解剖部位", "offset": "370"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "377"}, {"mention": "肠", "label": "解剖部位", "offset": "385"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "423"}, {"mention": "右半肝", "label": "解剖部位", "offset": "427"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "433"}, {"mention": "直肠腺癌肝转移", "label": "疾病和诊断", "offset": "440"}, {"mention": "ct", "label": "影像检查", "offset": "452"}]}
{"text": "患者因“腹痛3周余”我院完善检查诊断“直肠癌叒ct4n1m0”,2014-03-17我院行横结肠造瘘术,术后恢复可,2014-03-24行xelox方案化疗1程,患者化疗耐受可。1天前患者出现血便。鲜红色,当时较多,约200ml,于门诊止血等对症处理。现为求进一步诊治转来我院。自发病以来,患者无恶心、呕吐等,无发热、咳嗽、身目黄染,无骶部痛等,精神、纳眠稍差,小便无异常,体重近半年上降不明显。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "4"}, {"mention": "直肠癌叒ct4n1m0", "label": "疾病和诊断", "offset": "19"}, {"mention": "横结肠造瘘术", "label": "手术", "offset": "45"}, {"mention": "骶部", "label": "解剖部位", "offset": "168"}]}
{"text": "1997-8-6行胃癌根治术,2010.11发现ca724叒升高最高1295叒,复查pet-ct检查未见复发转移,之后多次复查ca724叒波动在500-800之间,多次查胃镜提示吻合口炎,给予对症治疗,患者感左下腹隐痛下腹隐痛不适,2013.10.15复查血ca724叒147叒ca199叒13.62叒,2013.10.23复查腹部ct检查提示胰腺占位,考虑恶性,胰头周围,肝门,腹膜后多发多发淋巴结转移。pet-ct提示:胰头区高代谢,考虑恶性病变。患者近10天出现午饭后左下腹部胀痛,持续2-3小时候可自行缓解。体重近1月上降2kg.患者胰腺穿刺取病理示低分化腺癌,免疫组化示cea+,cga+/-,cd56+/-,syn+/-,对手术有顾虑,且手术风险较大,2013-11-26行放疗30次,2014-1-7放疗结束。2013-11-28始行单药吉西他滨化疗4周期。末次2014-1-7.放化疗中出现黄疸,对症治疗后好转。化疗后患者出现ii度白细胞降低、ii度血小板降低。2014-1-24复查胰头区病灶及腹腔淋巴结均较强缩小,胰腺穿刺病理中低分化腺癌,免疫组化ca19+,ck7+,cga-,syn-,cd56-,ca199+,符合胆、胰导管来源浸润性腺癌。ca72.4叒明显上降。2014-1-27病理比对原胃切除标本报告与胰腺肿瘤存在较大形态差异。考虑患者明确胰腺癌,于2014-2-7行第5周期gem化疗,2014-2复查后病灶缩小sd,于2014-2-21开始第六周期化疗,因第八天白细胞减少推迟到2014-3-3。2014-4-7第8周期化疗。末次给药2014-4-14.2014-4-21复查评效sd,略有缩小,ca72.4降低至11.12.2014-4-28继续单药gem化疗,末次给药时间2014-9-1.gem双周一次,2014-7-24复查胰腺病灶继续缩小,评效pr。现患者无明显不适,饮食、睡眠可,体重较前上降约4kg。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "9"}, {"mention": "ca724", "label": "实验室检验", "offset": "24"}, {"mention": "pet-ct", "label": "影像检查", "offset": "42"}, {"mention": "ca724", "label": "实验室检验", "offset": "63"}, {"mention": "吻合口炎", "label": "疾病和诊断", "offset": "89"}, {"mention": "左下腹", "label": "解剖部位", "offset": "104"}, {"mention": "下腹", "label": "解剖部位", "offset": "109"}, {"mention": "ca724", "label": "实验室检验", "offset": "129"}, {"mention": "ca199", "label": "实验室检验", "offset": "139"}, {"mention": "腹部ct", "label": "影像检查", "offset": "164"}, {"mention": "胰腺占位", "label": "疾病和诊断", "offset": "172"}, {"mention": "胰头", "label": "解剖部位", "offset": "182"}, {"mention": "肝门", "label": "解剖部位", "offset": "187"}, {"mention": "腹膜", "label": "解剖部位", "offset": "190"}, {"mention": "pet-ct", "label": "影像检查", "offset": "203"}, {"mention": "胰头区", "label": "解剖部位", "offset": "212"}, {"mention": "左下腹", "label": "解剖部位", "offset": "237"}, {"mention": "胰腺", "label": "解剖部位", "offset": "271"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "279"}, {"mention": "吉西他滨", "label": "药物", "offset": "376"}, {"mention": "白细胞", "label": "实验室检验", "offset": "424"}, {"mention": "血小板", "label": "实验室检验", "offset": "433"}, {"mention": "胰头区", "label": "解剖部位", "offset": "450"}, {"mention": "腹腔淋巴结", "label": "解剖部位", "offset": "456"}, {"mention": "胰腺", "label": "解剖部位", "offset": "467"}, {"mention": "中低分化腺癌", "label": "疾病和诊断", "offset": "473"}, {"mention": "胆、胰导管", "label": "解剖部位", "offset": "520"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "530"}, {"mention": "ca72.4", "label": "实验室检验", "offset": "533"}, {"mention": "胃", "label": "解剖部位", "offset": "559"}, {"mention": "胰腺肿瘤", "label": "疾病和诊断", "offset": "567"}, {"mention": "胰腺癌", "label": "疾病和诊断", "offset": "586"}, {"mention": "gem", "label": "药物", "offset": "604"}, {"mention": "白细胞", "label": "实验室检验", "offset": "649"}, {"mention": "ca72.4", "label": "实验室检验", "offset": "716"}, {"mention": "gem", "label": "药物", "offset": "744"}, {"mention": "gem", "label": "药物", "offset": "765"}, {"mention": "胰腺", "label": "解剖部位", "offset": "784"}]}
{"text": "患者于2013年3月因进食时下腹疼痛疼痛不适于我院行胃镜检查示距门齿20-22cm右侧壁见约环1/3管腔粘膜粗糙糜烂,活检取病理(病理号:146968)为(食管)鳞状下皮重度不典型增生,癌变。超声示胃窦部与胰腺之间淋巴结肿大,大小约1.71*1.61cm。肺ct示食管中下段管壁略增厚,因病变位置较高,不适合手术,于我科行放射治疗,同步替吉奥化疗,放疗后行替吉奥序贯化疗2周期,其后定期复查。近1个月自觉头麻,乏力,拟进一步诊治入院。现精神状态可,自觉乏力,饮食二便睡眠可,病后体重无明显上降。", "mention_data": [{"mention": "下腹疼痛", "label": "症状", "offset": "14"}, {"mention": "门齿", "label": "解剖部位", "offset": "32"}, {"mention": "(食管)鳞状下皮重度不典型增生,癌变", "label": "疾病和诊断", "offset": "77"}, {"mention": "胃窦部与胰腺之间淋巴结", "label": "解剖部位", "offset": "99"}, {"mention": "肺ct", "label": "影像检查", "offset": "128"}, {"mention": "食管中下段", "label": "解剖部位", "offset": "132"}, {"mention": "替吉奥", "label": "药物", "offset": "168"}, {"mention": "替吉奥", "label": "药物", "offset": "178"}, {"mention": "头", "label": "解剖部位", "offset": "202"}]}
{"text": ",2015年12月出现间断便血,,外院肠镜提示:据肛门8cm肿物,,活检病理:中分化腺癌,完善分期检查,ct3n+m0,因身体状态不考虑手术治疗,现为行根治性放疗,gtv叒50gy叒ctv叒45gy/25f后缩野加量10gy/5f,同时口服卡培他滨。因肾功能不全,放疗20次后暂停化疗.2016-7-28复查胸腹ct病情平稳,肿标正常。2016-12复查肠镜及腹盆ct提示病情进展.16-12-26行雷替曲塞单药减量化疗,iv度骨髓抑制/心律失常/肺部感染,此后最佳支持治疗.化疗后便血消失,2017-2-14复查ct提示肠壁较前变薄.中药治疗.,现症:乏力倦怠明显,畏寒怕冷,消瘦,上腹坠痛较前加重,纳差,头晕,体质状况欠佳,ecog叒3分,大便尚可,睡眠良好。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "25"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "卡培他滨", "label": "药物", "offset": "120"}, {"mention": "胸腹ct", "label": "影像检查", "offset": "154"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "180"}, {"mention": "雷替曲塞", "label": "药物", "offset": "200"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "214"}, {"mention": "心律失常", "label": "疾病和诊断", "offset": "219"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "224"}, {"mention": "ct", "label": "影像检查", "offset": "257"}, {"mention": "肠", "label": "解剖部位", "offset": "261"}, {"mention": "上腹", "label": "解剖部位", "offset": "292"}, {"mention": "头晕", "label": "症状", "offset": "304"}]}
{"text": ",患者于2014-9出现右上腹痛,就诊******健院查b超提示右附件区见4.5*3.8*5.1cm混合性包块,形态不规则,内部回声强弱不等。2014-11-20复查mri提示右附件区囊实性肿块,考虑卵巢癌。2014-11-25行pet-ct提示右附件区团块状局灶高代谢病灶,考虑卵巢癌可能大,子宫直肠窝及左中腹部肠系膜间多个局灶性高代谢病灶,考虑为多发转移病灶;肝包膜上结节状低密度影,代谢增高,考虑肝包膜转移病灶,两侧后胸膜增厚。胃镜提示胃多发息肉。肠镜未见明显异常。于12月8日行彩超引导上盆腔肿物穿刺活检,,病理示:(盆腔肿物穿刺活检)镜检为低分化腺癌,可见砂粒体及钙盐沉积,考虑为卵巢来源,,诊断为:卵巢癌。于2014-12-12及2015-01-05予tc方案(力朴素+卡铂)化疗2程,过程顺利。为进一步治疗入院,起病以来,精神可,二便正常,体重无明显变化。", "mention_data": [{"mention": "右上腹痛", "label": "症状", "offset": "12"}, {"mention": "b超", "label": "影像检查", "offset": "28"}, {"mention": "右附件", "label": "解剖部位", "offset": "32"}, {"mention": "mri", "label": "影像检查", "offset": "83"}, {"mention": "右附件", "label": "解剖部位", "offset": "88"}, {"mention": "卵巢癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "pet-ct", "label": "影像检查", "offset": "115"}, {"mention": "右附件", "label": "解剖部位", "offset": "123"}, {"mention": "卵巢癌", "label": "疾病和诊断", "offset": "140"}, {"mention": "子宫直肠窝", "label": "解剖部位", "offset": "147"}, {"mention": "左中腹部肠系膜间", "label": "解剖部位", "offset": "153"}, {"mention": "肝", "label": "解剖部位", "offset": "182"}, {"mention": "肝包膜转移", "label": "疾病和诊断", "offset": "201"}, {"mention": "胸膜增厚", "label": "症状", "offset": "212"}, {"mention": "胃多发息肉", "label": "疾病和诊断", "offset": "221"}, {"mention": "彩超", "label": "影像检查", "offset": "243"}, {"mention": "盆腔", "label": "解剖部位", "offset": "248"}, {"mention": "盆腔", "label": "解剖部位", "offset": "263"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "275"}, {"mention": "卵巢", "label": "解剖部位", "offset": "295"}, {"mention": "卵巢癌", "label": "疾病和诊断", "offset": "305"}, {"mention": "力朴素", "label": "药物", "offset": "337"}, {"mention": "卡铂", "label": "药物", "offset": "341"}]}
{"text": "患者1年前出现呕血,为鲜血,混有胃内容物。每日多少次,每次约多少ml。不伴头晕、黑曚、晕厥、心悸、出汗。不伴腹痛。不伴消瘦。不伴发热。不伴皮疹、皮肤紫癜、关节痛、鼻衄。于我院就诊,查血红蛋白多少g/l,尿素氮多少mmol/l,便潜血阴性,行胃镜检查提示提示内容,行结肠镜检查提示提示内容,行胶囊内镜检查提示提示内容,行两气囊小肠镜检查提示提示内容,行核素检查提示提示内容,行血管造影检查提示提示内容,予补液治疗,出血停止。此后,患者间断出现呕血,每次总量约多少ml,性质同前,于我院行胃镜检查提示提示内容,行结肠镜检查提示提示内容,行胶囊内镜检查提示提示内容,行两气囊小肠镜检查提示提示内容,行核素检查提示提示内容,行血管造影检查提示提示内容。1年前,患者再次出现呕血,鲜血,混有胃内容物,共数字次,总量约多少ml。不伴头晕、黑曚、晕厥、心悸、出汗,为求进一步治疗收入院。发病以来,精神、饮食、睡眠正常,大便正常,尿色正常,体重无明显变化。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "16"}, {"mention": "头晕", "label": "症状", "offset": "37"}, {"mention": "心悸", "label": "症状", "offset": "46"}, {"mention": "腹痛", "label": "症状", "offset": "54"}, {"mention": "皮肤", "label": "解剖部位", "offset": "72"}, {"mention": "关节痛", "label": "症状", "offset": "77"}, {"mention": "鼻衄", "label": "疾病和诊断", "offset": "81"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "91"}, {"mention": "尿素氮", "label": "实验室检验", "offset": "101"}, {"mention": "血管造影", "label": "影像检查", "offset": "187"}, {"mention": "血管造影", "label": "影像检查", "offset": "309"}, {"mention": "胃", "label": "解剖部位", "offset": "340"}, {"mention": "头晕", "label": "症状", "offset": "360"}, {"mention": "心悸", "label": "症状", "offset": "369"}]}
{"text": ",2015-4出现进食后下腹饱胀不适,2015-4-22,当地胃镜:贲门不规则糜烂,胃角约1*1cm溃疡,活检病理(贲门)腺癌,(胃角)印戒细胞癌,2015-5-13行根治性全胃切除术,术中见贲门约2*2cm质硬肿物,未侵出浆膜,胃角约3*3cm质硬肿物,侵出浆膜,,术后病理:贲门小弯侧腺癌ii-iii级,lauren混合型,2.5*2.5*1cm,达浆膜外,脉管内可见癌栓,未见明确神经受侵,her2(1+),ki67(+70%);胃体神经内分泌癌,低分化,3*2*1.5cm,侵全层达浆膜外,未见明确脉管癌栓及神经侵犯,网膜(-),syn(+),cga(小灶+),ck(+),cdx2(+),cam5.2(+),her2(0),ki67(+40%);断端阴性,淋巴结1/29。术前cea叒12.93(0-3),ca242叒41.49(0-12)。2015-6-15行xelox*1,2015-7-8起folfox*7,复查未见明确复发转移征象,cea叒6.28,但调整方案txt+ddp*3,末次2015-12-14。出现左肩部疼痛,2016-01-05外院pet/,ct:多发骨代谢异常,但多考虑为良性病变;升结肠代谢不均匀升高,建议肠镜。复查肠镜未见明显异常,骨mri未见明确骨破坏2016-9外院复查未见明确肿瘤征象现食纳可,进食后无明显不适,便秘,体重稳定。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "12"}, {"mention": "贲门", "label": "解剖部位", "offset": "34"}, {"mention": "胃角", "label": "解剖部位", "offset": "42"}, {"mention": "(贲门)腺癌", "label": "疾病和诊断", "offset": "57"}, {"mention": "(胃角)印戒细胞癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "根治性全胃切除术", "label": "手术", "offset": "84"}, {"mention": "贲门", "label": "解剖部位", "offset": "96"}, {"mention": "胃角", "label": "解剖部位", "offset": "115"}, {"mention": "贲门小弯侧腺癌ii-iii级,lauren混合型", "label": "疾病和诊断", "offset": "139"}, {"mention": "胃体神经内分泌癌,低分化", "label": "疾病和诊断", "offset": "218"}, {"mention": "cea", "label": "实验室检验", "offset": "343"}, {"mention": "ca242", "label": "实验室检验", "offset": "358"}, {"mention": "cea", "label": "实验室检验", "offset": "425"}, {"mention": "txt", "label": "药物", "offset": "439"}, {"mention": "ddp", "label": "药物", "offset": "443"}, {"mention": "左肩部", "label": "解剖部位", "offset": "464"}, {"mention": "pet/,ct", "label": "影像检查", "offset": "482"}, {"mention": "骨", "label": "解剖部位", "offset": "492"}, {"mention": "升结肠", "label": "解剖部位", "offset": "508"}, {"mention": "骨mri", "label": "影像检查", "offset": "535"}, {"mention": "骨", "label": "解剖部位", "offset": "543"}]}
{"text": ",患者4月前因“宫颈癌ib1期”2015-11-06于我院在全身麻醉上行经腹广泛子宫切除+两侧输卵管切除+盆腔淋巴结清扫术。,术中探查见:子宫前位,如孕50天大小,形态不规则,两侧附件未见异常,宫颈增粗,两侧主韧带、宫骶韧带无异常,两侧闭孔区及右侧髂血管区触及肿大淋巴结。术后病理39974.,15:结合40009.15(宫颈)中-低分化鳞状细胞癌,内生浸润型,肿瘤切面积6.5*1cm,浸润深度大于宫颈壁厚度1/2,脉管内未见明显癌栓,阴道断端、右左宫旁、子宫内膜及肌层、两侧输卵管均未查见癌。另送右闭孔淋巴结4枚、左闭孔淋巴结5枚、右髂髂血管淋巴结4枚及左髂血管淋巴结3枚,均未见转移;另送“右髂总及左髂总淋巴结”组织内未查见淋巴结,未查见癌。增殖状态子宫内膜,子宫腺肌病,两侧输卵管充血,未见明显病变,两侧输卵管系膜囊肿。术后8天未拆线、带尿管出院。术后行多西他赛+卡铂方案化疗3周期。2016-1-20入院后完善相关检查,给予宫颈癌术后局部适型放疗。对症处理放疗不良反应。现放疗结束,今患者为求进一步治疗来我院,门诊以“宫颈癌术后”收入院。患者自下次出院以来,活动时感头晕、乏力,一直口服红源达、复方地茯口服液、长春胺缓释胶囊补血及对症治疗,饮食睡眠可,大便成形,性状可,持续导尿通畅,尿液清,体重无明显减轻。", "mention_data": [{"mention": "宫颈癌ib1期", "label": "疾病和诊断", "offset": "8"}, {"mention": "经腹广泛子宫切除+两侧输卵管切除+盆腔淋巴结清扫术", "label": "手术", "offset": "36"}, {"mention": "子宫前位", "label": "症状", "offset": "69"}, {"mention": "两侧附件", "label": "解剖部位", "offset": "88"}, {"mention": "宫颈", "label": "解剖部位", "offset": "97"}, {"mention": "两侧主韧带", "label": "解剖部位", "offset": "102"}, {"mention": "宫骶韧带", "label": "解剖部位", "offset": "108"}, {"mention": "两侧闭孔", "label": "解剖部位", "offset": "116"}, {"mention": "右侧髂血管", "label": "解剖部位", "offset": "122"}, {"mention": "(宫颈)中-低分化鳞状细胞癌,内生浸润型", "label": "疾病和诊断", "offset": "160"}, {"mention": "宫颈", "label": "解剖部位", "offset": "200"}, {"mention": "阴道", "label": "解剖部位", "offset": "219"}, {"mention": "子宫", "label": "解剖部位", "offset": "229"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "237"}, {"mention": "右闭孔淋巴结", "label": "解剖部位", "offset": "250"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "259"}, {"mention": "右髂髂血管淋巴结", "label": "解剖部位", "offset": "268"}, {"mention": "左髂血管淋巴结", "label": "解剖部位", "offset": "279"}, {"mention": "右髂总及左髂总淋巴结", "label": "解剖部位", "offset": "298"}, {"mention": "子宫", "label": "解剖部位", "offset": "328"}, {"mention": "子宫腺肌病", "label": "疾病和诊断", "offset": "333"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "339"}, {"mention": "两侧输卵管系膜囊肿", "label": "疾病和诊断", "offset": "354"}, {"mention": "多西他赛", "label": "药物", "offset": "381"}, {"mention": "卡铂", "label": "药物", "offset": "386"}, {"mention": "宫颈癌术后", "label": "疾病和诊断", "offset": "417"}, {"mention": "宫颈癌术后", "label": "疾病和诊断", "offset": "464"}, {"mention": "头晕", "label": "症状", "offset": "488"}, {"mention": "红源达", "label": "药物", "offset": "498"}, {"mention": "复方地茯口服液", "label": "药物", "offset": "502"}, {"mention": "长春胺缓释胶囊", "label": "药物", "offset": "510"}]}
{"text": "2015.8确诊胃体胃角印戒细胞癌及管状腺癌,弥漫型,her-2(0),ct4an+,2015.9始s1*3-xelox*2,sd,cea曾升高,症状略好转,c2曾oxa期间可疑过敏。2015-12-15根治性全胃切除术,p0,中低分化腺癌部分印戒,混合型;ypt4an3b,afp(-),cmet(0),eber(-),egfr(+),her2(0),mss,pdl-1(-)。术后基线ct见腹腔干下方软组织影约23*20mm?术后选择xeloda*7,末次2016.6;此处结节渐缩小,末次复查2016.9约为17*8mm,cea进行性升高,2017.3为57,左侧新见少量胸水,左肺中叶炎性改变好转,体重稳定。", "mention_data": [{"mention": "胃体胃角印戒细胞癌及管状腺癌,弥漫型", "label": "疾病和诊断", "offset": "8"}, {"mention": "cea", "label": "实验室检验", "offset": "66"}, {"mention": "oxa", "label": "药物", "offset": "82"}, {"mention": "根治性全胃切除术", "label": "手术", "offset": "102"}, {"mention": "中低分化腺癌部分印戒,混合型", "label": "疾病和诊断", "offset": "114"}, {"mention": "ct", "label": "影像检查", "offset": "194"}, {"mention": "腹腔干", "label": "解剖部位", "offset": "197"}, {"mention": "xeloda", "label": "药物", "offset": "219"}, {"mention": "cea", "label": "实验室检验", "offset": "264"}, {"mention": "胸水", "label": "症状", "offset": "289"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "292"}]}
{"text": ",于2014年?月予以直肠癌手术,,术后病理:直肠肿物(活检,2014-01-24),:-叒浸润性中分化腺癌。2.叒直肠距肛门5厘米(活检,2014-01-24),:-叒管状腺瘤。术后予以?周期化疗。2016年10月因肺肿物,予以(左肺上叶),切除:术后病理-叒肺腺癌,以实性生长方式为主,送检肿物最大径2.1cm;-叒癌累及脏层胸膜;-叒可见脉管癌栓;-叒淋巴结未见癌转移(第10组0/5、第11组0/2、第7组0/1、4r叒0/2、2r叒0/2、第8组0/3、第12组0/1);-叒,肿瘤病理分期:pt2an0。,免疫组化结果显示:叒alk-ventana(-),cdx2(-),ck20(-),ck7(+),napsin叒a(-),satb-2(-),ttf-1(+),免疫组化表型支持肺原发腺癌。术后予以?周期化疗。于2017-1月10日复查发现术后复发,ct,显示:,胸部增强:左肺上叶术后,支气管断端处见结节状灶,范围约15x14mm(ima31),左肺门新见肿大淋巴结,约30x16mm(ima27),不能除外肿瘤复发伴淋巴结转移,需进一步检查明确。左肺下叶后段新见小片状灶,中央见空洞,大小约18x15mm(ima24),边缘模糊不清,其性质待定,建议抗炎后短期复查。右肺未见新发结节。纵隔、右肺门、锁骨下区及两腋上未见肿大淋巴结。左侧胸膜多处局限增厚同前相仿。左侧见少量胸腔积液。右侧未见胸水征象。于2017-1-25日因浅表淋巴结无肿大(1),左肺上叶原发腺癌术后:pt2an0m0,左肺门淋巴结转移;(2)直肠浸润性中分化腺癌术后,已测egfr突变阴性,kras突变,予以奈达铂75mg/m*2(分为2天用,70mg/d1,60mg/d2)+培美曲塞500mg/m*2叒800mg+恩度15患者近4日出现便秘,口服乳果糖,番泻叶及甘油灌肠剂治疗效果不佳,无明显腹胀,有排气。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "直肠", "label": "解剖部位", "offset": "23"}, {"mention": "浸润性中分化腺癌", "label": "疾病和诊断", "offset": "46"}, {"mention": "直肠", "label": "解剖部位", "offset": "58"}, {"mention": "肛门", "label": "解剖部位", "offset": "61"}, {"mention": "管状腺瘤", "label": "疾病和诊断", "offset": "85"}, {"mention": "肺", "label": "解剖部位", "offset": "109"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "116"}, {"mention": "肺腺癌", "label": "疾病和诊断", "offset": "131"}, {"mention": "肺原发腺癌", "label": "疾病和诊断", "offset": "346"}, {"mention": "ct", "label": "影像检查", "offset": "382"}, {"mention": "胸部", "label": "解剖部位", "offset": "389"}, {"mention": "左肺上叶术后", "label": "疾病和诊断", "offset": "394"}, {"mention": "支气管", "label": "解剖部位", "offset": "401"}, {"mention": "左肺门", "label": "解剖部位", "offset": "431"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "438"}, {"mention": "肿瘤复发伴淋巴结转移", "label": "疾病和诊断", "offset": "462"}, {"mention": "左肺下叶后段", "label": "解剖部位", "offset": "482"}, {"mention": "右肺", "label": "解剖部位", "offset": "542"}, {"mention": "纵隔", "label": "解剖部位", "offset": "551"}, {"mention": "右肺门", "label": "解剖部位", "offset": "554"}, {"mention": "锁骨下区", "label": "解剖部位", "offset": "558"}, {"mention": "两腋上", "label": "解剖部位", "offset": "563"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "594"}, {"mention": "胸水", "label": "症状", "offset": "603"}, {"mention": "浅表淋巴结", "label": "解剖部位", "offset": "620"}, {"mention": "左肺上叶原发腺癌术后", "label": "疾病和诊断", "offset": "632"}, {"mention": "左肺门淋巴结转移", "label": "疾病和诊断", "offset": "652"}, {"mention": "直肠浸润性中分化腺癌术后", "label": "疾病和诊断", "offset": "664"}, {"mention": "奈达铂", "label": "药物", "offset": "697"}, {"mention": "培美曲塞", "label": "药物", "offset": "732"}, {"mention": "恩度", "label": "药物", "offset": "752"}, {"mention": "乳果糖", "label": "药物", "offset": "768"}, {"mention": "番泻叶", "label": "药物", "offset": "772"}, {"mention": "甘油灌肠剂", "label": "药物", "offset": "776"}, {"mention": "腹胀", "label": "症状", "offset": "791"}]}
{"text": ",患者1年余前出现腹泻,伴间断血便,2012-07-12,于外院行肠镜示:距肛门5-10cm见环状肿物,肠腔狭窄,,行活检病理示:中分化腺癌。胸片示两肺多发结节,盆腔ct示直肠癌可能性大。遂至我院就诊,,我院病理会诊示:中分化腺癌。于2012-8-15,2012-9行xelox方案化疗2程,同时行放疗,过程顺利无不适,今遵原主诊医生意见为行检查入院。患者发病以来,精神一般,饮食睡眠欠佳,大便次数增多,偶有便秘,小便正常,体重无明显变化。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "9"}, {"mention": "肛门", "label": "解剖部位", "offset": "38"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "65"}, {"mention": "胸片", "label": "影像检查", "offset": "71"}, {"mention": "两肺", "label": "解剖部位", "offset": "74"}, {"mention": "盆腔ct", "label": "影像检查", "offset": "81"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "86"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "110"}]}
{"text": ",2014-4-30行胃癌根治术。中低分化腺癌,pt3n0m0,cmet(-),egfr(+),her2(+),未行辅化。2014-12-10考虑腹膜后lnm?2015-3-12入组行sp*6,继续s-1维持治疗,内科建议行肝门淋巴结及腹腔病灶放疗,gtv叒55gy叒ctv叒50gy/27f,同期替吉奥叒40mg叒bid叒d1-d5/w,患者未诉明显不适,,血常规:3.01*109/l叒plt叒46*109/l。暂停s-1化疗,,给予特比澳升血小板治疗3天后复查血常规:wbc叒2.34*109/l叒plt叒38*109/l,暂停放疗,,给予升血细胞治疗后复查:wbc叒3.28*109/l叒plt叒60*109/l,给予单纯放疗,,复查血常规:plt叒181*109/l叒wbc叒3.73*109/l,目前放疗结束,血小板低上iii度,白细胞ii度,中性粒细胞叒i度。2016-6-23,血细胞分析:血小板总数叒59.00*10^9/l,白细胞总数叒2.97*10^9/l,,肾功三项:丙氨酸氨基转换酶叒42iu/l。2016-6-21,与2016-03-16腹盆腔ct比较:未见复发及转移病灶。2016-6-21,与2015-12-11胸部ct比较:未见复发及转移病灶。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "11"}, {"mention": "中低分化腺癌", "label": "疾病和诊断", "offset": "17"}, {"mention": "腹膜后lnm", "label": "疾病和诊断", "offset": "73"}, {"mention": "sp", "label": "药物", "offset": "92"}, {"mention": "s-1", "label": "药物", "offset": "99"}, {"mention": "肝门淋巴结", "label": "解剖部位", "offset": "112"}, {"mention": "腹腔", "label": "解剖部位", "offset": "118"}, {"mention": "替吉奥", "label": "药物", "offset": "149"}, {"mention": "plt", "label": "实验室检验", "offset": "195"}, {"mention": "s-1", "label": "药物", "offset": "210"}, {"mention": "特比澳", "label": "药物", "offset": "219"}, {"mention": "血小板", "label": "实验室检验", "offset": "223"}, {"mention": "wbc", "label": "实验室检验", "offset": "237"}, {"mention": "plt", "label": "实验室检验", "offset": "252"}, {"mention": "wbc", "label": "实验室检验", "offset": "283"}, {"mention": "plt", "label": "实验室检验", "offset": "298"}, {"mention": "plt", "label": "实验室检验", "offset": "325"}, {"mention": "wbc", "label": "实验室检验", "offset": "339"}, {"mention": "血小板", "label": "实验室检验", "offset": "361"}, {"mention": "白细胞", "label": "实验室检验", "offset": "371"}, {"mention": "中性粒细胞", "label": "实验室检验", "offset": "378"}, {"mention": "血小板总数", "label": "实验室检验", "offset": "403"}, {"mention": "白细胞总数", "label": "实验室检验", "offset": "422"}, {"mention": "丙氨酸氨基转换酶", "label": "实验室检验", "offset": "446"}, {"mention": "腹盆腔ct", "label": "影像检查", "offset": "483"}, {"mention": "胸部ct", "label": "影像检查", "offset": "522"}]}
{"text": ",2005.6.8行结肠癌根治术,,术后病理:升结肠中分化腺癌,侵及深肌层,断端阴性,淋巴结转移0/10,术后身体状况不佳,未行放化疗。\\u0004\\u0004叒2010-10月复查,考虑右肺多发转移,行xelox化疗共7周期;复查胸部ct示病变略缩小,2011-5-16右肺转移灶手术。术后体重上降约5kg。(2012.1.12),cea:4.74ng/ml.2012-3-22叒cea叒11.26ng/ml.2012-4-5复查cea14.37ng/ml.ct发现肺结节较前略增大。因患者体质较弱,口服希罗达单药治疗6周期,耐受性尚可,4cs后复查评效sd。", "mention_data": [{"mention": "结肠癌根治术", "label": "手术", "offset": "10"}, {"mention": "升结肠中分化腺癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "右肺多发转移", "label": "疾病和诊断", "offset": "94"}, {"mention": "胸部ct", "label": "影像检查", "offset": "116"}, {"mention": "右肺转移灶手术", "label": "手术", "offset": "136"}, {"mention": "cea", "label": "实验室检验", "offset": "167"}, {"mention": "cea", "label": "实验室检验", "offset": "191"}, {"mention": "cea", "label": "实验室检验", "offset": "216"}, {"mention": "ct", "label": "影像检查", "offset": "230"}, {"mention": "肺", "label": "解剖部位", "offset": "234"}, {"mention": "希罗达", "label": "药物", "offset": "253"}]}
{"text": ",便秘,便血伴里急后重2月余,肠镜诊断直肠癌,距肛门2-8cm肿物,累及3/4管腔。表面溃疡形成,周边不规则隆起,,活检病理:为中-低分化腺癌。腹部,ct:肝脏s8微小低密度结节影。胸部ct未见异常。盆腔,ct:直肠管壁不规则增厚,周围筋膜未见明显增厚,盆腔内未见明显肿大淋巴结。,盆腔mri结果:直肠中上段占位,符合直肠癌(ct4bn2b),累及前列腺,肛门内括约肌及右侧肛提肌可疑受累,与精囊腺关系密切。2015.11.,18开始放疗gtv:50.6gy/gtv41.8gy/22f.2015.12.01放疗9次,患者自诉食欲差,考虑与口服化疗药物有关。,复查肝功:alt叒43。2015.12.14放疗18次。2015-3-4行miles术+肝转移灶切除。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "19"}, {"mention": "肛门", "label": "解剖部位", "offset": "24"}, {"mention": "中-低分化腺癌", "label": "疾病和诊断", "offset": "64"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "72"}, {"mention": "肝脏s8", "label": "解剖部位", "offset": "78"}, {"mention": "胸部ct", "label": "影像检查", "offset": "91"}, {"mention": "盆腔,ct", "label": "影像检查", "offset": "100"}, {"mention": "直肠", "label": "解剖部位", "offset": "106"}, {"mention": "盆腔", "label": "解剖部位", "offset": "127"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "136"}, {"mention": "盆腔mri", "label": "影像检查", "offset": "141"}, {"mention": "直肠", "label": "解剖部位", "offset": "149"}, {"mention": "直肠癌(ct4bn2b)", "label": "疾病和诊断", "offset": "159"}, {"mention": "前列腺", "label": "解剖部位", "offset": "174"}, {"mention": "肛门内括约肌", "label": "解剖部位", "offset": "178"}, {"mention": "右侧肛提肌", "label": "解剖部位", "offset": "185"}, {"mention": "精囊腺", "label": "解剖部位", "offset": "196"}, {"mention": "alt", "label": "实验室检验", "offset": "285"}, {"mention": "miles术+肝转移灶切除", "label": "手术", "offset": "317"}]}
{"text": ",2016-1查体发现直肠占位,肠镜提示肛门1-2处直肠可见隆起病变,行局部活检,,我院病理会诊:直肠粘膜黑色素瘤合并印戒细胞癌;全面检查未见明确远处转移征象。2016-1-20行扩大切除术,,术后病理:(直肠腹会阴联合切除),:-叒直肠恶性黑色素瘤,并印戒细胞癌,大小2.3×xxx1.5×xxx0.8cm;-叒恶性黑色素瘤侵及肠壁固有肌层,肿瘤浸润厚度约1.1cm;-叒印戒细胞癌局限于粘膜层;-叒脉管内未见瘤栓,未见神经侵犯;-叒直肠断端、皮肤断端及环周切缘均未见肿瘤;-叒肠周淋巴结可见恶性黑色素瘤转移(1/10)。-叒,免疫组化恶性黑色素瘤显示:hmb-45(+),ki-67(+30%),melan-a(+),s100(+)。-叒,免疫组化印戒细胞癌显示:ck(+),cea(+),cdx2(+),ck20(+),ck7(-),vimentin(-),,特殊染色显示:pas(+)。,消化肿瘤内科就诊意见为:患者直肠肿瘤,复合肿瘤成分,印戒细胞癌仅侵犯粘膜层,目前相对于印戒细胞癌,黑色素瘤分期相对偏晚,同时合并淋巴结转移,建议治疗以黑色素瘤治疗为主,印戒细胞癌目前无辅助治疗指征。2016-3开始辅助化疗2周期,2017-2复查未见明确转移征象。2017-4复查示肝门区、盆腔、腹膜后、两侧髂血管旁新见多发肿大淋巴结,较大约15x10mm(im69),余未见明确转移征象。基因检测均为野生型。2017-7复查示腹盆腔、腹膜后及两侧髂血管旁多发肿大淋巴结较前增大,考虑转移进展。s5新见结节,考虑转移。2017-7-10行tc方案化疗,2017-9复查评效sd。现为进一步治疗就诊.。", "mention_data": [{"mention": "直肠", "label": "解剖部位", "offset": "11"}, {"mention": "肛门", "label": "解剖部位", "offset": "20"}, {"mention": "直肠", "label": "解剖部位", "offset": "26"}, {"mention": "直肠粘膜黑色素瘤合并印戒细胞癌", "label": "疾病和诊断", "offset": "49"}, {"mention": "直肠腹会阴联合切除", "label": "手术", "offset": "103"}, {"mention": "直肠恶性黑色素瘤,并印戒细胞癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "恶性黑色素瘤", "label": "疾病和诊断", "offset": "157"}, {"mention": "肠", "label": "解剖部位", "offset": "165"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "187"}, {"mention": "直肠", "label": "解剖部位", "offset": "218"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "240"}, {"mention": "恶性黑色素瘤转移", "label": "疾病和诊断", "offset": "247"}, {"mention": "恶性黑色素瘤", "label": "疾病和诊断", "offset": "269"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "326"}, {"mention": "直肠肿瘤", "label": "疾病和诊断", "offset": "412"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "424"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "441"}, {"mention": "黑色素瘤", "label": "疾病和诊断", "offset": "447"}, {"mention": "黑色素瘤", "label": "疾病和诊断", "offset": "473"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "482"}, {"mention": "肝门", "label": "解剖部位", "offset": "539"}, {"mention": "盆腔", "label": "解剖部位", "offset": "543"}, {"mention": "腹膜后", "label": "解剖部位", "offset": "546"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "550"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "562"}, {"mention": "腹", "label": "解剖部位", "offset": "612"}, {"mention": "盆腔", "label": "解剖部位", "offset": "613"}, {"mention": "腹", "label": "解剖部位", "offset": "616"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "620"}, {"mention": "s5", "label": "解剖部位", "offset": "645"}]}
{"text": ",2012-5-15我院行乙状结肠癌根治术。,术后病理:右半结肠溃疡型中低分化腺癌伴粘液腺癌,3.0*2.5厘米,浸润肠壁全层,未见脉管癌栓,ln(1/22).2012-6-12始xelox*6,末次2012-9-25。化疗期间ca724叒cea叒进行性增高。2012-10-12再次口服希罗达单药1周期,后停止治疗。,2013-1-28复查腹部ct:右上肺多发小结节,左肺上叶肺大泡,余腹部情况同前。瘤标正常。2013.6复查胸腹盆未见明确复发转移,胃小弯侧淋巴结略大,cea叒5.36ng/ml,ca72.4叒16.93u/ml.2013-12-16腹盆腔、胸,ct:结肠癌术后,吻合口管壁复发征象,余同前。cea叒5.10。2015-1,复查:cea叒5.27ng/ml;nse叒15.99ng/ml;胃镜提示反流性食管炎、慢性胃炎;胸腹盆ct较前未见明显变化。2016-1-13叒胸,ct:两肺多发小结节,部分稍显饱满,仍考虑陈旧灶可能大。2016-1-8叒腹盆叒,ct:未见复发及转移征象。近来觉进食咽部不适,胸骨后烧灼感,饮食可,大小便正常,近1年来体重无变化。", "mention_data": [{"mention": "乙状结肠癌根治术", "label": "手术", "offset": "13"}, {"mention": "右半结肠溃疡型中低分化腺癌伴粘液腺癌", "label": "疾病和诊断", "offset": "28"}, {"mention": "ca724", "label": "实验室检验", "offset": "114"}, {"mention": "cea", "label": "实验室检验", "offset": "120"}, {"mention": "希罗达", "label": "药物", "offset": "144"}, {"mention": "腹部ct", "label": "影像检查", "offset": "171"}, {"mention": "右上肺", "label": "解剖部位", "offset": "176"}, {"mention": "左肺上叶肺大泡", "label": "解剖部位", "offset": "185"}, {"mention": "腹部", "label": "解剖部位", "offset": "194"}, {"mention": "胸腹盆", "label": "解剖部位", "offset": "214"}, {"mention": "胃小弯侧淋巴结", "label": "解剖部位", "offset": "226"}, {"mention": "cea", "label": "实验室检验", "offset": "236"}, {"mention": "ca72.4", "label": "实验室检验", "offset": "250"}, {"mention": "腹盆腔、胸,ct", "label": "影像检查", "offset": "277"}, {"mention": "结肠癌术后", "label": "疾病和诊断", "offset": "286"}, {"mention": "cea", "label": "实验室检验", "offset": "306"}, {"mention": "cea", "label": "实验室检验", "offset": "325"}, {"mention": "nse", "label": "实验室检验", "offset": "339"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "358"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "365"}, {"mention": "胸腹盆ct", "label": "影像检查", "offset": "370"}, {"mention": "胸,ct", "label": "影像检查", "offset": "394"}, {"mention": "两肺", "label": "解剖部位", "offset": "399"}, {"mention": "腹盆叒,ct", "label": "影像检查", "offset": "433"}, {"mention": "咽部", "label": "解剖部位", "offset": "455"}, {"mention": "胸骨", "label": "解剖部位", "offset": "460"}]}
{"text": ",2014.12.25叒行左半结肠切除。,病理:叒结肠溃疡型中-低分化腺癌,伴有粘液分泌,大小5×xxx7.5cm;癌侵及肠管浆膜层;肠周淋巴结见有癌转移(3/9),另见多枚癌结节形成;,病理分期:pt4an2。患者在当地化疗,术后xelox方案6周期后复查。,末次化疗时间:2015-5-22.外周神经毒性毒性i度,胃肠道反应i度。2015.6.11叒肠镜检查提示结肠息肉,活检良性。2015.6.2叒腹部超声提示肝多发占位。2015-6-25叒,与2014-12-15腹部ct比较:1.升结肠术后,肠壁未见异常增厚、结节及肿块。2.肝缘腹膜欠光滑,可疑不均匀增厚伴轻度强化,肝周见少量积液。转移待除外,追查。3.肝脏形态、大小正常,s5强化灶同前,约29x28mm。s2强化灶同前,约11mm。见肝内多发无强化低密度灶同前,较大约17x10mm。肝内未见新增占位及异常强化灶,血管及胆管未见异常。2015-8复查腹腔转移,腹水。2015-07-07甲胎蛋白叒3.32ng/ml;癌胚抗原叒5.89ng/ml。患者目前自感肝区疼痛半月,体重未见减轻。", "mention_data": [{"mention": "左半结肠切除", "label": "疾病和诊断", "offset": "13"}, {"mention": "结肠溃疡型中-低分化腺癌", "label": "疾病和诊断", "offset": "25"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "67"}, {"mention": "胃肠道", "label": "解剖部位", "offset": "159"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "183"}, {"mention": "腹部超声", "label": "影像检查", "offset": "202"}, {"mention": "腹部ct", "label": "影像检查", "offset": "236"}, {"mention": "升结肠术后", "label": "疾病和诊断", "offset": "245"}, {"mention": "肝", "label": "解剖部位", "offset": "268"}, {"mention": "肝", "label": "解剖部位", "offset": "289"}, {"mention": "肝脏", "label": "解剖部位", "offset": "308"}, {"mention": "s5", "label": "解剖部位", "offset": "318"}, {"mention": "s2", "label": "解剖部位", "offset": "335"}, {"mention": "肝", "label": "解剖部位", "offset": "350"}, {"mention": "肝", "label": "解剖部位", "offset": "375"}, {"mention": "腹腔转移", "label": "疾病和诊断", "offset": "408"}, {"mention": "腹水", "label": "症状", "offset": "413"}, {"mention": "甲胎蛋白", "label": "实验室检验", "offset": "426"}, {"mention": "癌胚抗原", "label": "实验室检验", "offset": "441"}, {"mention": "肝", "label": "解剖部位", "offset": "462"}]}
{"text": ",2010-7出现左颈淋巴结肿大,渐吞咽困难、声嘶及呛咳。我院行ct、,胃镜确诊:食管中上段鳞癌叒iv期叒两锁骨下、纵隔淋巴结转移叒左侧胸腔积液叒心包积液叒下腔静脉压迫综合征。于2010-9-14起行2周期紫衫+ddp化疗。末次化疗2010-11-9.iii°骨髓抑制,低钾血症,对症支持后恢复。,2010-10-16ct:食管胸中段管壁增厚较前减轻,纵隔及两锁骨下淋巴结较前缩小。,我科计划放疗:gtv55gy/ctv50gy/27f,已放疗24次。放疗后骨髓抑制ii度,予对症处理后好转.颈部淋巴结较前缩小.放疗27次后局部缩野加量到gtv69gy.右腋上淋巴结肿大,约5x4cm,计划放gtv60gy/ctv55gy/28f,头皮顶部转移,大小约3x3cm,9e放疗dt=54gy/18f,已放疗9次。2011-7-20开始右锁骨下及左中颈淋巴结放疗,6e放疗dt=56gy/28f,已放疗3次。考虑肿瘤发展,转移较快,建议口服化疗药同步治疗。2011-7-11开始行同步泰欣生200mg治疗,每周1次.近期食欲差。骨扫描提示骨转移。放疗20次,,骨扫描提示:t3骨盐代谢旺盛灶伴t4可疑溶骨改变.恶性病变不除外.。", "mention_data": [{"mention": "左颈淋巴结", "label": "解剖部位", "offset": "9"}, {"mention": "ct", "label": "影像检查", "offset": "32"}, {"mention": "食管中上段鳞癌叒iv期叒两锁骨下、纵隔淋巴结转移", "label": "疾病和诊断", "offset": "41"}, {"mention": "左侧胸腔积液", "label": "疾病和诊断", "offset": "66"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "73"}, {"mention": "下腔静脉压迫综合征", "label": "疾病和诊断", "offset": "78"}, {"mention": "紫衫", "label": "药物", "offset": "103"}, {"mention": "ddp", "label": "药物", "offset": "106"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "130"}, {"mention": "低钾血症", "label": "疾病和诊断", "offset": "135"}, {"mention": "ct", "label": "影像检查", "offset": "159"}, {"mention": "食管胸中段", "label": "解剖部位", "offset": "162"}, {"mention": "纵隔及两锁骨下淋巴结", "label": "解剖部位", "offset": "176"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "229"}, {"mention": "颈部淋巴结", "label": "解剖部位", "offset": "246"}, {"mention": "右腋上淋巴结", "label": "解剖部位", "offset": "277"}, {"mention": "头皮顶部转移", "label": "疾病和诊断", "offset": "316"}, {"mention": "右锁骨下及左中颈淋巴结", "label": "解剖部位", "offset": "365"}, {"mention": "泰欣生", "label": "药物", "offset": "439"}, {"mention": "骨", "label": "解剖部位", "offset": "461"}, {"mention": "骨转移", "label": "疾病和诊断", "offset": "466"}, {"mention": "骨", "label": "解剖部位", "offset": "477"}]}
{"text": ",患者2003年2月因左乳腺肿块在外院诊断为左乳腺癌。于2003年3月份行左侧乳腺癌改良根治术,,术后病理示:,ln叒0/8(+).,术后分期:pt1n0m0,i期。,免疫组化:er(2+),pr(+),her-2(3+),ki67(30%+)。于2003-04-22、05-16、06-06、07-07行ac方案(thp90mg+ctx叒1.0g)方案辅助化疗4程,化疗结束后开始口服他莫昔芬至2007年停止。于2010年发现左颈部淋巴结肿大,行局麻上区域淋巴结切除术,,术后病理示:03690.3cm。,镜上:淋巴结4枚,1/4见低分化腺癌。,免疫组化:er(3+),pr(2+),her-2(4+),ki67(5%+)。并行两侧卵巢切除术,口服来曲唑。随后定期复查。2010-11-25,查ct示:左乳癌术后,局部未见明显软组织肿块。右侧腋窝、两侧锁骨下窝、胸骨下窝小淋巴结。2013-7月复查胸部ct提示左前纵隔淋巴结肿大,考虑转移,较前进展,遂于门诊行希罗达+赫赛丁方案化疗,于2014-05-28复查胸下腹ct,提示左前纵隔、左侧锁骨下窝、左下气管旁转移淋巴结较前增大。于2014-06开始门诊改服用依西美坦片至今,近期患者出现声音嘶哑,少许咳嗽。2014-09-04,我院复查ct示:左乳癌术后、,化疗后复查:纵隔、两侧锁骨下、左下气管旁转移淋巴结转移,邻近胸骨破坏,较前相仿;左侧胸骨旁胸壁肿物,考虑转移,较前相仿;颈部多发小淋巴结,较前稍增多增大。2014-09-11,外院spect示:胸骨柄溶骨性病变,考虑骨转移灶可能性大。遂于2014-09-2在我科行多西他赛单药化疗1程,化疗过程顺利,无明显毒副反应。现为进一步治疗收入无科。食欲睡眠尚可,无视物旋转,无黑曚,无恶心、呕吐,无畏寒、发热等,大小便无明显异常,体重较前上降3-4kg。", "mention_data": [{"mention": "左乳腺", "label": "解剖部位", "offset": "11"}, {"mention": "左乳腺癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "左侧乳腺癌改良根治术", "label": "手术", "offset": "37"}, {"mention": "thp", "label": "药物", "offset": "158"}, {"mention": "ctx", "label": "药物", "offset": "166"}, {"mention": "他莫昔芬", "label": "药物", "offset": "193"}, {"mention": "左颈部淋巴结", "label": "解剖部位", "offset": "214"}, {"mention": "区域淋巴结切除术", "label": "手术", "offset": "227"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "267"}, {"mention": "两侧卵巢切除术", "label": "手术", "offset": "315"}, {"mention": "来曲唑", "label": "药物", "offset": "325"}, {"mention": "ct", "label": "影像检查", "offset": "348"}, {"mention": "左乳癌术后", "label": "疾病和诊断", "offset": "352"}, {"mention": "右侧腋窝、两侧锁骨下窝、胸骨下窝小淋巴结", "label": "解剖部位", "offset": "370"}, {"mention": "胸部ct", "label": "影像检查", "offset": "400"}, {"mention": "左前纵隔淋巴结", "label": "解剖部位", "offset": "406"}, {"mention": "希罗达", "label": "药物", "offset": "431"}, {"mention": "赫赛丁", "label": "药物", "offset": "435"}, {"mention": "胸下腹ct", "label": "影像检查", "offset": "456"}, {"mention": "左前纵隔", "label": "解剖部位", "offset": "464"}, {"mention": "左侧锁骨下窝", "label": "解剖部位", "offset": "469"}, {"mention": "左下气管", "label": "解剖部位", "offset": "476"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "483"}, {"mention": "依西美坦片", "label": "药物", "offset": "506"}, {"mention": "ct", "label": "影像检查", "offset": "545"}, {"mention": "左乳癌术后", "label": "疾病和诊断", "offset": "549"}, {"mention": "纵隔", "label": "解剖部位", "offset": "562"}, {"mention": "两侧锁骨", "label": "解剖部位", "offset": "565"}, {"mention": "左下气管", "label": "解剖部位", "offset": "571"}, {"mention": "胸骨", "label": "解剖部位", "offset": "586"}, {"mention": "胸骨", "label": "解剖部位", "offset": "598"}, {"mention": "颈部", "label": "解剖部位", "offset": "616"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "621"}, {"mention": "spect", "label": "影像检查", "offset": "646"}, {"mention": "胸骨柄", "label": "解剖部位", "offset": "653"}, {"mention": "骨转移", "label": "症状", "offset": "664"}, {"mention": "多西他赛", "label": "药物", "offset": "688"}]}
{"text": ",患者2月余前无明显诱因出现左下腹隐痛,间歇性发作,诉起床后1-2小时更严重,与进食、体位无关,无牵涉及放射痛。2013-7-11,外院下消化道造影示:胃窦癌(溃疡型)。2013-7-18,于我院行胃镜示:小弯侧见2×1.6cm溃疡,表面白苔,周围粘膜充血水肿。,病理活检示:(胃窦)低分化腺癌,lauren分型混合型。现为进一步诊治收入我科。患者自起病以来无明显恶心、呕吐,无呕血、黑便,无发热、黄疸,无腹胀、腹泻。食欲睡眠尚可,大便次数减少,2-3天一次,小便无殊,体重略有减轻。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "14"}, {"mention": "下消化道造影", "label": "影像检查", "offset": "68"}, {"mention": "胃窦癌(溃疡型)", "label": "疾病和诊断", "offset": "76"}, {"mention": "(胃窦)低分化腺癌", "label": "疾病和诊断", "offset": "138"}, {"mention": "腹胀", "label": "症状", "offset": "203"}, {"mention": "腹泻", "label": "症状", "offset": "206"}]}
{"text": ",缘于入院前4月于我院确诊诊为直肠癌伴肝转移,,病理示:(201407122)管状腺癌。,腹部ct示:1、直肠中、上段部分管壁不规则增厚,考虑直肠ca,周围及两侧盆壁、腹股沟区及腹膜后多发肿大淋巴结征。2、肝内多发类圆形低密度影,多考虑转移瘤。考虑肿瘤晚期,不宜手术切除,于2014.03.20在我院胃肠外科行“奥沙利铂150mgivgttd1+希罗达1000mgpobidd2-15”方案化疗,我科继续行氟尿嘧啶1gd1-d4保留灌肠,予以“艾恒200mgd1+希罗达1500mgpobidd1-14”方案化疗5个周期,过程顺利,效果良好,未见明显化疗副反应。,1个月前复查肝脏mri:1、肝内多发异常信号,结合病史,符合转移瘤并囊变,与2014-7-2旧片对比无明显变化。2、肝多发小囊肿。3、右肾小囊肿。盆腔,mri:1、中上段直肠癌化疗后改变,部分癌组织存活可能,右后侧壁病灶与右侧肛提肌分界欠清,直肠系膜内多发小淋巴结。建议治疗后复查。2、子宫直肠陷凹少量积液。化疗效果良好,并于2014.08.09行腹腔镜上直肠癌根治术(miles),术顺。术后病理(201426224)1、(直肠+肛门),:送检带肛门的直肠切除标本一份,大肠乳头状管状腺瘤,大部分腺体低级别下皮内瘤变,小部分腺体高级别下皮内瘤变。部分区域大肠粘膜慢性炎症,表面糜烂。肠周找到淋巴结2/8个见癌转移,肠周脂肪内找到2个癌结节。2、(提肌组织),:送检为平滑肌组织和少量脂肪脉管结缔组织。术后恢复良好。今为复查再次就诊我院,门诊以“直肠癌伴肝转移化疗后术后”收入院。下次出院以来精神、睡眠、饮食可,大便如下术,小便正常,体力稍差、体重较前无明显变化。", "mention_data": [{"mention": "直肠癌伴肝转移", "label": "疾病和诊断", "offset": "15"}, {"mention": "管状腺癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "腹部ct", "label": "影像检查", "offset": "45"}, {"mention": "直肠中、上段", "label": "解剖部位", "offset": "53"}, {"mention": "直肠ca", "label": "疾病和诊断", "offset": "71"}, {"mention": "腹股沟", "label": "解剖部位", "offset": "84"}, {"mention": "腹", "label": "解剖部位", "offset": "89"}, {"mention": "肝", "label": "解剖部位", "offset": "103"}, {"mention": "奥沙利铂", "label": "药物", "offset": "156"}, {"mention": "希罗达", "label": "药物", "offset": "173"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "203"}, {"mention": "艾恒", "label": "药物", "offset": "222"}, {"mention": "希罗达", "label": "药物", "offset": "232"}, {"mention": "肝脏mri", "label": "影像检查", "offset": "288"}, {"mention": "肝", "label": "解剖部位", "offset": "296"}, {"mention": "肝多发小囊肿", "label": "疾病和诊断", "offset": "340"}, {"mention": "右肾小囊肿", "label": "疾病和诊断", "offset": "349"}, {"mention": "盆腔,mri", "label": "影像检查", "offset": "355"}, {"mention": "中上段直肠癌", "label": "疾病和诊断", "offset": "364"}, {"mention": "右侧肛提肌", "label": "解剖部位", "offset": "393"}, {"mention": "直肠", "label": "解剖部位", "offset": "403"}, {"mention": "子宫直肠陷凹", "label": "解剖部位", "offset": "425"}, {"mention": "腹腔镜上直肠癌根治术(miles)", "label": "手术", "offset": "456"}, {"mention": "直肠", "label": "解剖部位", "offset": "495"}, {"mention": "肛门", "label": "解剖部位", "offset": "498"}, {"mention": "肛门", "label": "解剖部位", "offset": "506"}, {"mention": "直肠", "label": "解剖部位", "offset": "509"}, {"mention": "大肠乳头状管状腺瘤", "label": "疾病和诊断", "offset": "518"}, {"mention": "低级别下皮内瘤变", "label": "疾病和诊断", "offset": "533"}, {"mention": "高级别下皮内瘤变", "label": "疾病和诊断", "offset": "547"}, {"mention": "大肠", "label": "解剖部位", "offset": "560"}, {"mention": "肠", "label": "解剖部位", "offset": "590"}, {"mention": "直肠癌伴肝转移化疗后术后", "label": "疾病和诊断", "offset": "655"}]}
{"text": ",左锁骨下淋巴结肿大半年,pet-ct示代谢增高,全身其他部位未见明显占位及高代谢病灶。,胸ct示:纵膈多发小淋巴结;,胃镜示:食管距门齿30cm处粘膜粗糙,胃窦部粘膜粗糙分别取活检。,病理示:食管粘膜慢性炎、胃慢性炎症伴hp感染。鼻咽镜及气管镜检查未见明显异常。经特需门诊联合会诊,,考虑:原发不明左锁骨下淋巴结转移癌,拟局部放疗,gtv60gy/30f/42d。现已完成10f。近腹胀明显。", "mention_data": [{"mention": "左锁骨下淋巴结", "label": "解剖部位", "offset": "1"}, {"mention": "pet-ct", "label": "影像检查", "offset": "13"}, {"mention": "胸ct", "label": "影像检查", "offset": "45"}, {"mention": "纵膈", "label": "解剖部位", "offset": "50"}, {"mention": "食管", "label": "解剖部位", "offset": "64"}, {"mention": "门齿", "label": "解剖部位", "offset": "67"}, {"mention": "胃窦部", "label": "解剖部位", "offset": "79"}, {"mention": "食管粘膜慢性炎", "label": "疾病和诊断", "offset": "97"}, {"mention": "胃慢性炎症伴hp感染", "label": "疾病和诊断", "offset": "105"}, {"mention": "左锁骨下淋巴结转移癌", "label": "疾病和诊断", "offset": "150"}, {"mention": "腹胀", "label": "症状", "offset": "192"}]}
{"text": ",2011.3行直肠癌手术;术后行xelox方案化疗6周期,,末次化疗时间:2011.7。2013.11.22门诊复查示cea及ca199升高,癌胚抗原叒11.36ng/ml;癌抗原199叒80.38u/ml。行pet-ct检查示肺、右肾下腺、左额叶转移。多学科会诊后考虑首先完善颅脑mr检查明确诊断后行全脑放疗。,2013-12头颅mri:考虑转移瘤。2013.12.5开始行全脑放疗。2013-12-26行伊立替康+希罗达化疗5周期。因神经毒性iii°xxx,第四周期希罗达改为1.5g叒bid叒po,于2014-03-21给予第6周期xeliri方案化疗,,具体用药为:s叒1.95㎡叒伊立替康(开普拓)180mg/㎡叒340mg叒d1+希罗达1g/㎡叒1.5g叒bid叒d1-7,q14d。3周期评效叒缩小sd?6,周期评效:2014.4.1,与2014-2-18比较:右肺上叶结节缩小,原约10*7mm,现约7*6mm,左肺点状结节(ima43),纵隔、腋上淋巴结同前,小于10mm。叒叒腹盆,ct:,与2014-2-19比较:肝脏动脉期肝s8强化结节,约13mm(ima8),门脉期及延迟期呈等密度,血管瘤?异常灌注?建议追查或mri检查。右肾下腺不均匀强化肿块略缩小,现约37x24mm,原约40x30mm,与胰腺尾部及右侧膈肌脚分界不清。腹膜后多发小淋巴结同前,较大者约10x6mm(ima77)。肿标待回报。患者明显不适,进食可,二便正常,体重6周期上降11kg。", "mention_data": [{"mention": "直肠癌手术", "label": "手术", "offset": "8"}, {"mention": "cea", "label": "实验室检验", "offset": "60"}, {"mention": "ca199", "label": "实验室检验", "offset": "64"}, {"mention": "癌胚抗原", "label": "实验室检验", "offset": "72"}, {"mention": "癌抗原199", "label": "实验室检验", "offset": "88"}, {"mention": "pet-ct", "label": "影像检查", "offset": "106"}, {"mention": "肺、右肾下腺、左额叶转移", "label": "疾病和诊断", "offset": "115"}, {"mention": "颅脑mr", "label": "影像检查", "offset": "140"}, {"mention": "脑", "label": "解剖部位", "offset": "153"}, {"mention": "头颅mri", "label": "影像检查", "offset": "165"}, {"mention": "脑", "label": "解剖部位", "offset": "190"}, {"mention": "伊立替康", "label": "药物", "offset": "205"}, {"mention": "希罗达", "label": "药物", "offset": "210"}, {"mention": "希罗达", "label": "药物", "offset": "236"}, {"mention": "伊立替康(开普拓)", "label": "药物", "offset": "296"}, {"mention": "希罗达", "label": "药物", "offset": "322"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "389"}, {"mention": "左肺", "label": "解剖部位", "offset": "415"}, {"mention": "纵隔、腋上淋巴结", "label": "解剖部位", "offset": "429"}, {"mention": "腹盆,ct", "label": "影像检查", "offset": "449"}, {"mention": "肝脏动脉", "label": "解剖部位", "offset": "469"}, {"mention": "肝s8", "label": "解剖部位", "offset": "474"}, {"mention": "门脉", "label": "解剖部位", "offset": "494"}, {"mention": "血管瘤", "label": "疾病和诊断", "offset": "506"}, {"mention": "mri", "label": "影像检查", "offset": "520"}, {"mention": "右肾下腺", "label": "解剖部位", "offset": "526"}, {"mention": "胰腺尾部", "label": "解剖部位", "offset": "562"}, {"mention": "右侧膈肌脚", "label": "解剖部位", "offset": "567"}, {"mention": "腹", "label": "解剖部位", "offset": "577"}]}
{"text": ",5月前患者出现腰部疼痛,对症治疗效果差,,2014-8行胸部ct:纵膈及两肺多发肿大淋巴结,两侧胸腔积液,心包积液,胸椎及其附件、左侧肩胛骨、胸骨多发骨质破坏。气管隆突前淋巴结,ebus-tbna:转移性腺癌,,ihc:ck7(+),ttf-1(-),cdx2(+),pax8(-),cga(-),syn(-)。完善腹部,ct:肝左叶低密度影,性质待定,胸腰骶椎骨、右侧髋骨多发骨质破坏。头mri未见异常。骨扫描提示全身广泛骨转移。2014-8-19,胃镜:胃角溃疡。,病理活检:胃角低分化腺癌及印戒细胞癌。cea叒1.9ng/ml,ca199叒23u/ml。目前患者腰部疼痛5级,食纳可,二便如常,体重无明显增减。", "mention_data": [{"mention": "腰部", "label": "解剖部位", "offset": "8"}, {"mention": "胸部ct", "label": "影像检查", "offset": "29"}, {"mention": "纵膈", "label": "解剖部位", "offset": "34"}, {"mention": "两肺", "label": "解剖部位", "offset": "37"}, {"mention": "两侧胸腔积液", "label": "疾病和诊断", "offset": "47"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "54"}, {"mention": "胸椎及其附件", "label": "解剖部位", "offset": "59"}, {"mention": "左侧肩胛骨", "label": "解剖部位", "offset": "66"}, {"mention": "胸骨", "label": "解剖部位", "offset": "72"}, {"mention": "骨质破坏", "label": "症状", "offset": "76"}, {"mention": "气管隆突前淋巴结", "label": "解剖部位", "offset": "81"}, {"mention": "转移性腺癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "159"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "165"}, {"mention": "胸腰骶椎骨", "label": "解剖部位", "offset": "178"}, {"mention": "右侧髋骨", "label": "解剖部位", "offset": "184"}, {"mention": "骨质破坏", "label": "症状", "offset": "190"}, {"mention": "头mri", "label": "影像检查", "offset": "195"}, {"mention": "骨", "label": "解剖部位", "offset": "204"}, {"mention": "骨转移", "label": "疾病和诊断", "offset": "213"}, {"mention": "胃角溃疡", "label": "疾病和诊断", "offset": "230"}, {"mention": "胃角低分化腺癌及印戒细胞癌", "label": "疾病和诊断", "offset": "241"}, {"mention": "cea", "label": "实验室检验", "offset": "255"}, {"mention": "ca199", "label": "实验室检验", "offset": "268"}, {"mention": "腰部", "label": "解剖部位", "offset": "285"}]}
{"text": "患者20天前因“大便带血3月。”入院,经肠镜及病理检查确诊降结肠腺癌。影像学分期为ct3n1m0,iiib。临床表现有不全性肠梗阻。2013年1月24日全麻上行右半结肠切除术。病理示:降结肠中分化腺癌,浸润浆膜上层,0/16ln+。分期pt3n0m0,iia。术后有排气排便,能进半流后出院。5天前无明显诱因出现恶心、呕吐,伴下腹部胀痛,呕吐物为胆汁及胃液,最多一天约500ml,未见食物残渣。肛门有排气,少量排便,无阵发性绞痛、发热等。为进一步治疗入院。自出院以来,患者无发热、咳嗽、身目黄染,无骶部痛等,精神可,睡眠差,小便量少,体重上降具体不详。", "mention_data": [{"mention": "降结肠腺癌", "label": "疾病和诊断", "offset": "29"}, {"mention": "不全性肠梗阻", "label": "疾病和诊断", "offset": "59"}, {"mention": "右半结肠切除术", "label": "手术", "offset": "80"}, {"mention": "降结肠中分化腺癌", "label": "疾病和诊断", "offset": "92"}, {"mention": "下腹", "label": "解剖部位", "offset": "163"}, {"mention": "胃", "label": "解剖部位", "offset": "176"}, {"mention": "肛门", "label": "解剖部位", "offset": "197"}, {"mention": "骶部", "label": "解剖部位", "offset": "249"}]}
{"text": ",主因”腹痛”就诊,诊断胃癌,于2013.6.11行全胃切除术,未见手术记录,,术后病理:胃未分化癌,部分低分化癌,侵及胃壁肌层,伴网膜淋巴结可见癌转移,断端-,,**三院病理会诊:胃低分化腺癌,大部分为印戒细胞癌,浸润至浆膜上层,未见脉管癌栓及神经侵犯,淋巴结0/4。术后恢复可。饮食少。2013.7.26口服ts-1叒50mg叒bid,完成1周期。自觉头晕、胃肠不适。因白细胞减少2度、粒细胞减少2度,贫血1度,血象恢复慢,停药3周,2013-8-31起行第2周期ts-1叒40mgbid口服。2013-9-4,复查血常规:wbc3.88,ne2.2,hgb126,plt205。\\u0004\\u0004叒进食较前好转,体重不足70斤。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "4"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "全胃切除术", "label": "手术", "offset": "26"}, {"mention": "胃未分化癌,部分低分化癌", "label": "疾病和诊断", "offset": "45"}, {"mention": "胃", "label": "解剖部位", "offset": "60"}, {"mention": "网膜淋巴结", "label": "解剖部位", "offset": "66"}, {"mention": "胃低分化腺癌,大部分为印戒细胞癌", "label": "疾病和诊断", "offset": "91"}, {"mention": "ts-1", "label": "药物", "offset": "156"}, {"mention": "头晕", "label": "症状", "offset": "178"}, {"mention": "胃肠", "label": "解剖部位", "offset": "181"}, {"mention": "白细胞", "label": "实验室检验", "offset": "187"}, {"mention": "贫血", "label": "疾病和诊断", "offset": "203"}, {"mention": "ts-1", "label": "药物", "offset": "234"}, {"mention": "wbc", "label": "实验室检验", "offset": "264"}, {"mention": "ne", "label": "实验室检验", "offset": "272"}, {"mention": "hgb", "label": "实验室检验", "offset": "278"}, {"mention": "plt", "label": "实验室检验", "offset": "285"}]}
{"text": ",缘于入院前2周(2015.07.28)无明显诱因出现声音嘶哑,无吞咽阻塞感,无胸闷、心悸、气促、咳嗽、咯血,无恶心呕吐,无畏冷、发热等不适,未重视,入院前5天,声音嘶哑加剧,就诊我院门诊,,查:,电子喉镜:左声带麻痹。颈部,mri:左侧上颈部及所见下纵隔(食管)肿瘤,为恶性可能,建议胸部ct及食管镜检查。,胃镜:食管癌(口头回报)。颈部+胸部,ct:1、食管全程管壁明显增厚,考虑食管ca可能,建议食管镜检查;病灶右旁、左侧锁骨锁骨下窝、纵隔内、肝胃间隙多发结节、肿块影,考虑淋巴结转移。2、两肺下叶肺气肿;两肺下叶及左肺中叶慢性炎症。3、右肺上叶结节影,考虑炎性肉芽肿可能,建议hrct随访复查。4、两侧颈动脉鞘间隙、颌上间隙多发结节影,考虑淋巴结慢性炎性增生可能,建议随访复查。今为进一步治疗,就诊我科,门诊拟“食管癌可能”收住入院,发病来,精神尚可,睡眠尚可,食欲尚可,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "40"}, {"mention": "心悸", "label": "症状", "offset": "43"}, {"mention": "左声带", "label": "解剖部位", "offset": "104"}, {"mention": "颈部,mri", "label": "影像检查", "offset": "110"}, {"mention": "左侧上颈部", "label": "解剖部位", "offset": "117"}, {"mention": "下纵隔(食管)肿瘤", "label": "疾病和诊断", "offset": "125"}, {"mention": "胸部ct", "label": "影像检查", "offset": "143"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "158"}, {"mention": "颈部+胸部,ct", "label": "影像检查", "offset": "168"}, {"mention": "食管", "label": "解剖部位", "offset": "179"}, {"mention": "食管ca", "label": "疾病和诊断", "offset": "192"}, {"mention": "左侧锁骨", "label": "解剖部位", "offset": "212"}, {"mention": "锁骨下窝", "label": "解剖部位", "offset": "216"}, {"mention": "纵隔", "label": "解剖部位", "offset": "221"}, {"mention": "肝胃间隙", "label": "解剖部位", "offset": "225"}, {"mention": "两肺下叶肺气肿", "label": "疾病和诊断", "offset": "248"}, {"mention": "两肺下叶", "label": "解剖部位", "offset": "256"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "261"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "272"}, {"mention": "hrct", "label": "影像检查", "offset": "292"}, {"mention": "两侧颈动脉鞘间隙", "label": "解剖部位", "offset": "303"}, {"mention": "颌上间隙", "label": "解剖部位", "offset": "312"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "360"}]}
{"text": ",2011.3.4行结肠癌根治术,术后辅助化疗6周期,定期复查。2013-3腹部淋巴结增大,开始folfiri+bev化疗6周期。3周期、6周期,评效pr,消化道反应重,,末次化疗时间:2013.6.18,,2013-6-28复查腹盆ct:腹部多发淋巴结同前相仿。胸部ct扫描未见占位征象。改为希罗达+bev维持治疗20周期,末次化疗时间2014-5-4。2013-8-14复查肿瘤较前继续缩小,无明显不良反应。2013.10.25复查腹盆ct示肿瘤稳定,2013-12-13行腹盆ct提示病变sd。2014-2-24复查评效为sd。2014-5-5叒复查腹盆ct见肝门区肿大淋巴结,肠系膜血管旁淋巴结。xx主任医生建议继续希罗达+bev联合治疗及拟行腹膜后局部放疗。现患者一般情况可,进食可,大便3-5次/天,体重较前无明显变化。,计划:直肠癌腹膜后淋巴结ptv54gy/27f.5-26放疗2次。", "mention_data": [{"mention": "结肠癌根治术", "label": "手术", "offset": "10"}, {"mention": "腹部淋巴结", "label": "解剖部位", "offset": "38"}, {"mention": "bev", "label": "药物", "offset": "56"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "115"}, {"mention": "腹", "label": "解剖部位", "offset": "120"}, {"mention": "胸部ct", "label": "影像检查", "offset": "132"}, {"mention": "希罗达", "label": "药物", "offset": "147"}, {"mention": "bev", "label": "药物", "offset": "151"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "218"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "239"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "278"}, {"mention": "肝门", "label": "解剖部位", "offset": "283"}, {"mention": "肠系膜血管旁淋巴结", "label": "解剖部位", "offset": "292"}, {"mention": "希罗达", "label": "药物", "offset": "312"}, {"mention": "bev", "label": "药物", "offset": "316"}, {"mention": "腹", "label": "解剖部位", "offset": "326"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "370"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "373"}]}
{"text": ",发现右膝肿物10年,逐渐增大。,mri:右侧胫骨平台明显骨质破坏,呈稍长t1稍长t2信号,周围见较大软组织肿块,较大层面约92*82mm(se8叒im12),增强明显不均匀强化,累及下上径约7cm,关节面受侵。右侧股骨远端内侧髁见类圆形长t1长t2信号,增强明显结节状强化,右侧胫骨骨干见环状强化结节,约10mm(se9叒im44)。我院化疗2周期后肿物无明显缩小。2015.1.4我院右大腿截肢右膝肿物切除及右腹股沟淋巴结清扫术,,术后病理:梭形细胞恶性肿瘤(g2级),大小8×xxx6×xxx2.5cm,伴灶状坏死(约30%)及钙化,核分裂像约5个/10hpf;结合免疫组化结果考虑为滑膜肉瘤;可见脉管内瘤栓;淋巴结可见肿瘤转移(9/,27:右腹股沟7/14,右侧髂血管旁1/7,右侧闭孔*/6);,肿瘤病理分期:ypt2bn1。,免疫组化结果显示:vimentin(+),b-catenin(胞膜+),bcl2(局部+),cd34(-),cd99(+),ck7(+),desmin(-),ema(+),s100(-),sma(-),ki67(+20%)。术后复查,ct:右腹股沟区及右髂髂外血管旁术后,可见索条影,未见明显肿大淋巴结。余腹膜后散在少许长径不足1cm小淋巴结,未见明显肿大者。2015.2.16,放疗:右腹股沟、右侧髂血管旁、右侧闭孔淋巴结区域6+10mv-x叒dt50gy/25f/5w。", "mention_data": [{"mention": "右膝", "label": "解剖部位", "offset": "3"}, {"mention": "mri", "label": "影像检查", "offset": "17"}, {"mention": "右侧胫骨平台", "label": "解剖部位", "offset": "21"}, {"mention": "右侧股骨远端内侧髁", "label": "解剖部位", "offset": "106"}, {"mention": "右侧胫骨骨干", "label": "解剖部位", "offset": "138"}, {"mention": "右大腿截肢右膝肿物切除及右腹股沟淋巴结清扫术", "label": "手术", "offset": "194"}, {"mention": "梭形细胞恶性肿瘤(g2级)", "label": "疾病和诊断", "offset": "223"}, {"mention": "滑膜肉瘤", "label": "疾病和诊断", "offset": "295"}, {"mention": "右腹股沟", "label": "解剖部位", "offset": "324"}, {"mention": "右侧髂血管", "label": "解剖部位", "offset": "333"}, {"mention": "右侧闭孔", "label": "解剖部位", "offset": "343"}, {"mention": "ct", "label": "影像检查", "offset": "486"}, {"mention": "右腹股沟区", "label": "解剖部位", "offset": "489"}, {"mention": "右髂髂外血管", "label": "解剖部位", "offset": "495"}, {"mention": "腹", "label": "解剖部位", "offset": "522"}, {"mention": "右腹股沟", "label": "解剖部位", "offset": "562"}, {"mention": "右侧髂血管", "label": "解剖部位", "offset": "567"}, {"mention": "右侧闭孔淋巴结", "label": "解剖部位", "offset": "574"}]}
{"text": ",患者于2012.11因“腹泻、腹痛1月余”到我院就诊,2012.11.27,肠镜示:距肛门10cm可见菜花样隆起肿物,占肠腔2/3圈,活检病理示腺癌。叒2012.12.04,胸腹ct示:乙状结肠壁不均匀增厚,考虑乙状结肠癌,侵犯浆膜层;肠周及两侧髂血管旁髂血管旁淋巴结淋巴结肿大,考虑转移;肝s7/8及肝s2病灶,考虑肝转移瘤。2012.12.11在我院行剖腹探查+术中灌肠+dixon+阑尾切除术,术后病理为直肠中至低分化腺癌,浸润至肠壁外膜层,可见神经侵犯及脉管内癌栓,肠系膜结节见腺癌浸润,淋巴结6/9(+),分期t3n2m1,iv期。术后恢复可,于2013.1.16至3.19行xelox方案化疗4程(后3程加用avastin),过程顺利。2013.4.,8复查ct:直肠癌术后改变,肝脏转移瘤,较前缩小。2013.4.11至4.25行xelox方案化疗第5程(因拟行手术,停用avastin)。2013.5.,3mr:肝左叶病灶较前缩小,肝s2叒病灶,较前未见明显变化。于2013.5.21行肝转移瘤切除术,术程顺利,,术后病理为:肝左静脉断端提示直肠腺癌肝转移;肝s2肿瘤中分化腺癌,结合病史及免疫组化结果,提示直肠腺癌肝转移,侵犯肝被膜;肝s8肿瘤符合中分化腺癌,结合病史及免疫组化结果,提示直肠腺癌肝转移,侵犯肝被膜。术后患者出现发热、咳嗽,ct示左胸腔积液、左上肺不张合并感染,予对症支持、抗感染、胸腔穿刺抽液后,症状缓解。术后于2013.6.24-9.5行xelox方案化疗10次。2013.10-2014.1在我科行cik细胞免疫治疗8程,过程顺利。2013.12.26复查ct、mr等未见明确复发转移征象。2014.3.22复查pet-ct提示直肠癌肝转移术后化疗后,肝脏s2、s7/8病灶代谢活跃,右侧肾下腺结节代谢活跃,考虑转移。骶前及直肠旁数个小结节部分代谢略活跃,右下肺前段小结节代谢未见异常,不排除转移;考虑疾病进展。患者于2014.4.11-7.22行folfiri+c225方案化疗七程,过程顺利。2014.6.27,行下腹部mri检查:,直肠癌多发转移化疗后复查:肝s8叒异常信号灶,考虑术后改变可能性大,大致同前。肝s2、s8叒病灶,较前明显缩小。右侧肾下腺病灶,考虑转移瘤,较前缩小。现返院化疗,诉疲乏,精神一般,食欲可,睡眠可,二便正常,近期体重无明显减轻。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "13"}, {"mention": "腹痛", "label": "症状", "offset": "16"}, {"mention": "肛门", "label": "解剖部位", "offset": "44"}, {"mention": "肠", "label": "解剖部位", "offset": "61"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "73"}, {"mention": "胸腹ct", "label": "影像检查", "offset": "88"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "94"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "107"}, {"mention": "肠", "label": "解剖部位", "offset": "119"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "122"}, {"mention": "髂血管旁淋巴结", "label": "解剖部位", "offset": "128"}, {"mention": "肝s7/8", "label": "解剖部位", "offset": "146"}, {"mention": "肝s2", "label": "解剖部位", "offset": "152"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "160"}, {"mention": "剖腹探查+术中灌肠+dixon+阑尾切除术", "label": "手术", "offset": "179"}, {"mention": "直肠中至低分化腺癌", "label": "疾病和诊断", "offset": "206"}, {"mention": "肠", "label": "解剖部位", "offset": "219"}, {"mention": "肠", "label": "解剖部位", "offset": "238"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "249"}, {"mention": "avastin", "label": "药物", "offset": "311"}, {"mention": "ct", "label": "影像检查", "offset": "336"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "339"}, {"mention": "肝脏转移瘤", "label": "疾病和诊断", "offset": "347"}, {"mention": "avastin", "label": "药物", "offset": "394"}, {"mention": "mr", "label": "影像检查", "offset": "412"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "415"}, {"mention": "肝s2", "label": "解剖部位", "offset": "425"}, {"mention": "肝转移瘤切除术", "label": "手术", "offset": "452"}, {"mention": "肝左静脉", "label": "解剖部位", "offset": "472"}, {"mention": "直肠腺癌肝转移", "label": "疾病和诊断", "offset": "480"}, {"mention": "肝s2肿瘤中分化腺癌", "label": "疾病和诊断", "offset": "488"}, {"mention": "直肠腺癌肝转移", "label": "疾病和诊断", "offset": "513"}, {"mention": "肝", "label": "解剖部位", "offset": "523"}, {"mention": "肝s8肿瘤", "label": "疾病和诊断", "offset": "527"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "534"}, {"mention": "直肠腺癌肝转移", "label": "疾病和诊断", "offset": "554"}, {"mention": "肝", "label": "解剖部位", "offset": "564"}, {"mention": "ct", "label": "影像检查", "offset": "580"}, {"mention": "左胸腔积液", "label": "疾病和诊断", "offset": "583"}, {"mention": "左上肺不张合并感染", "label": "疾病和诊断", "offset": "589"}, {"mention": "ct", "label": "影像检查", "offset": "699"}, {"mention": "mr", "label": "影像检查", "offset": "702"}, {"mention": "pet-ct", "label": "影像检查", "offset": "727"}, {"mention": "直肠癌肝转移术后化疗后", "label": "疾病和诊断", "offset": "735"}, {"mention": "肝脏s2、s7/8", "label": "解剖部位", "offset": "747"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "763"}, {"mention": "骶前", "label": "解剖部位", "offset": "780"}, {"mention": "直肠", "label": "解剖部位", "offset": "783"}, {"mention": "右下肺前段", "label": "解剖部位", "offset": "799"}, {"mention": "c225", "label": "药物", "offset": "853"}, {"mention": "下腹部mri", "label": "影像检查", "offset": "880"}, {"mention": "直肠癌多发转移化疗后", "label": "疾病和诊断", "offset": "890"}, {"mention": "肝s8", "label": "解剖部位", "offset": "903"}, {"mention": "肝s2、s8", "label": "解剖部位", "offset": "929"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "946"}]}
{"text": ",患者2007.4因“右下颈肿物1月”诊断为鼻咽未分化型非角化行癌(t3n2m0),在我院行tp全身化疗2周期,根治性imrt,dt6800cgy/30f/7.5w,区域淋巴结dt6400cgy/30f/7.5w,临床疗效评价为cr,定期复查未见异常。2011.1出现黄疸,于我院pet/ct,检查示:鼻咽癌并肝、腹腔积腹膜后淋巴结转移。遂于2011.3.11行ercp+胆管支架植入术,术后于2011.3.22、2011.4.12、2011.5.4、2011.5.25行tpf化疗4程。2011.6.10,复查ct示:肝s4病灶,考虑转移瘤。肝s4叒病灶,考虑肝转移瘤,对比2011.4.29叒日ct,较前稍缩小。肝门区、门腔间隙、腹膜后淋巴结肿大,较前缩小。鼻咽癌治疗后,鼻咽腔未见明确占位性病变。于2011.6.14、2011.7.5行紫杉醇+顺铂+5-fu化疗2程。定期复查,2011.10.18复查鼻咽、,颈部及下腹部ct提示:肝s4叒病灶,考虑肝转移瘤,较前无大变化。肝门区、门腔间隙、腹膜后淋巴结肿大,较前无大变化。于2011.10.26在我院ct室行肝转移瘤微波消融术;2011.12.,19我院下腹部ct:肝s4病灶较前无明显改变。肝门区、门腔间隙、腹主动脉旁多发淋巴结,部分病灶增大提示肿瘤进展,于2011-12-29予gd(艾素135mg叒d1+泽菲1.8叒d1,8)方案化疗1程、2012-01-19、2012-02-14,2012-3-6开始在我科行4程gd方案化疗,过程顺利。今日入我科继续化疗。自起病以来,患者精神、睡眠可,食欲如常,大小便正常,体重无上降。", "mention_data": [{"mention": "右下颈", "label": "解剖部位", "offset": "11"}, {"mention": "鼻咽未分化型非角化行癌(t3n2m0)", "label": "疾病和诊断", "offset": "22"}, {"mention": "区域淋巴结", "label": "解剖部位", "offset": "83"}, {"mention": "pet/ct", "label": "影像检查", "offset": "140"}, {"mention": "鼻咽癌并肝、腹腔积腹膜后淋巴结转移", "label": "疾病和诊断", "offset": "151"}, {"mention": "ercp+胆管支架植入术", "label": "手术", "offset": "181"}, {"mention": "ct", "label": "影像检查", "offset": "256"}, {"mention": "肝s4", "label": "解剖部位", "offset": "260"}, {"mention": "肝s4", "label": "解剖部位", "offset": "272"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "281"}, {"mention": "ct", "label": "影像检查", "offset": "299"}, {"mention": "肝门区", "label": "解剖部位", "offset": "308"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "312"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "317"}, {"mention": "鼻咽癌治疗后", "label": "疾病和诊断", "offset": "331"}, {"mention": "鼻咽", "label": "解剖部位", "offset": "338"}, {"mention": "紫杉醇", "label": "药物", "offset": "371"}, {"mention": "顺铂", "label": "药物", "offset": "375"}, {"mention": "5-fu", "label": "药物", "offset": "378"}, {"mention": "鼻咽、,颈部及下腹部ct", "label": "影像检查", "offset": "404"}, {"mention": "肝s4", "label": "解剖部位", "offset": "419"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "428"}, {"mention": "肝门区", "label": "解剖部位", "offset": "440"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "444"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "449"}, {"mention": "ct", "label": "影像检查", "offset": "479"}, {"mention": "肝转移瘤微波消融术", "label": "手术", "offset": "483"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "506"}, {"mention": "肝s4", "label": "解剖部位", "offset": "512"}, {"mention": "肝门区", "label": "解剖部位", "offset": "525"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "529"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "534"}, {"mention": "艾素", "label": "药物", "offset": "573"}, {"mention": "泽菲", "label": "药物", "offset": "584"}]}
{"text": ",患者于2011年1月28日因“回盲部肿物”行左半结肠切除术,术后病理证实为弥漫大b细胞淋巴瘤,予\\\"r-chop\\\"方案化疗六程,定期复查未见明显复发征像。2013年3月复查pet/ct,提示:十二指水平段高代谢灶,考虑淋巴瘤浸润可能。,我院超声胃镜检查示:十二指肠降段起始部肿物,病理提示中分化腺癌。遂于2013-04-25在我院胃胰科行胰十二指肠切除术(whipple术),术程顺利。,术后病理诊断为:十二指肠中分化腺癌(pt2n0m0)。术后*卡培他滨辅助化疗5程。后因手足综合症停药。2014年4月患者无明显诱因出现下腹痛,呈阵发性钝痛,进食后明显,后可自行逐渐缓解。,于我院行ct示:,十二指肠腺癌术后:吻合口区未见明显肿瘤复发。肠系膜区和腹主动脉旁多发淋巴结,考虑肿瘤复发。肝内多发转移瘤。肝囊肿。于2014-05-30、2014-06-20、2014-07-11、2014-08-04、2014-08-25、2014-09-22予以替吉奥+奥沙利铂方案化疗6程。化疗过程顺利。2014-07-15至2014-08-16同期放疗,计划采用vmat,,放疗范围:gtv包括腹腔干、腹主动脉旁、肠系膜区肿大淋巴结;ctv为gtv外扩1.0cm,适当避开周围肠管等危及器官。gtv和ctv均予以剂量45gy/25f。过程顺利,第1程化疗后患者自觉腹痛症状缓解。第4程化疗后出现iii°血小板上降,予升血小板治疗后恢复。6,程化疗结束后复查ct示:十二指肠腺癌术后、,放化疗后:吻合口区未见明显肿瘤复发。肠系膜区和腹主动脉旁多发淋巴结,考虑肿瘤复发,较前缩小。肝内多发转移瘤,部分较前增大。肝囊肿。左下肺近叶间裂斑片影,范围较前增大;两肺类结节,较前为新发,可疑转移瘤;左肺门淋巴结,考虑转移瘤可能性大。前列腺钙化。右股骨颈骨质密度异常,考虑良性可能性大。评价pd。于2014-11-1更改化疗方案为贝伐珠单抗+folfiri,过程顺利。现患者为行上一程化疗入院。患者近期精神,食欲,睡眠可,大小便正常,体重较前无明显上降。", "mention_data": [{"mention": "回盲部", "label": "解剖部位", "offset": "16"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "23"}, {"mention": "弥漫大b细胞淋巴瘤", "label": "疾病和诊断", "offset": "38"}, {"mention": "pet/ct", "label": "影像检查", "offset": "88"}, {"mention": "十二指水平段", "label": "解剖部位", "offset": "98"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "111"}, {"mention": "十二指肠降段起始部", "label": "解剖部位", "offset": "130"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "146"}, {"mention": "胰十二指肠切除术(whipple术)", "label": "手术", "offset": "171"}, {"mention": "十二指肠中分化腺癌(pt2n0m0)", "label": "疾病和诊断", "offset": "204"}, {"mention": "卡培他滨", "label": "药物", "offset": "226"}, {"mention": "手足综合症", "label": "疾病和诊断", "offset": "239"}, {"mention": "下腹痛", "label": "症状", "offset": "263"}, {"mention": "ct", "label": "影像检查", "offset": "294"}, {"mention": "十二指肠腺癌术后", "label": "疾病和诊断", "offset": "299"}, {"mention": "吻合口", "label": "解剖部位", "offset": "308"}, {"mention": "肠", "label": "解剖部位", "offset": "321"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "326"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "333"}, {"mention": "肝内多发转移瘤", "label": "疾病和诊断", "offset": "344"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "352"}, {"mention": "替吉奥", "label": "药物", "offset": "424"}, {"mention": "奥沙利铂", "label": "药物", "offset": "428"}, {"mention": "腹腔干", "label": "解剖部位", "offset": "492"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "496"}, {"mention": "肠", "label": "解剖部位", "offset": "502"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "508"}, {"mention": "肠", "label": "解剖部位", "offset": "533"}, {"mention": "腹痛", "label": "症状", "offset": "577"}, {"mention": "血小板", "label": "实验室检验", "offset": "596"}, {"mention": "血小板", "label": "实验室检验", "offset": "604"}, {"mention": "ct", "label": "影像检查", "offset": "623"}, {"mention": "十二指肠腺癌术后", "label": "疾病和诊断", "offset": "627"}, {"mention": "吻合口", "label": "解剖部位", "offset": "642"}, {"mention": "肠", "label": "解剖部位", "offset": "655"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "660"}, {"mention": "肝内多发转移瘤", "label": "疾病和诊断", "offset": "683"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "698"}, {"mention": "左下肺近叶间裂", "label": "解剖部位", "offset": "702"}, {"mention": "两肺", "label": "解剖部位", "offset": "720"}, {"mention": "左肺门淋巴结", "label": "解剖部位", "offset": "738"}, {"mention": "前列腺钙化", "label": "疾病和诊断", "offset": "755"}, {"mention": "右股骨颈", "label": "解剖部位", "offset": "761"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "803"}]}
{"text": ",3年前大便带血,,肠镜:距肛门约8、9cm各见一肿物,,咬检病理:恶性肿瘤,倾向未分化癌,术前,ct:盆腔未见明显肿大淋巴结。于2009-4-30行直肠癌根治术,,术中见:子宫与腹壁粘连,肝脏表面满布小结节,肿块位于直肠腹膜反折处,未侵透浆膜,直肠下动脉旁多发淋巴结,,术后病理:直肠中分化腺癌,侵及深肌层,切缘(-),淋巴结(1/3),pt2n1mo。术后xelox化疗7周期(希罗达叒4.0叒奥沙利铂叒不详叒),神经毒性叒ii度。末次2009-11。术后手术切口破溃,自行好转。此后定期复查。2012-5复查发现右上腹肿物,,2012-5-25mri:盆腔右后方上部结节样信号异常灶,2012-6-5,结肠镜:结肠黑变病,未见占位。,2012-6-11外院pet-ct:沿上腹部切口分布多发结节影,右侧盆壁增大淋巴结。2012-6-25,我院b超:右盆腔髂血管深方可见低回声占位,,穿刺病理:小圆细胞肿瘤,不除外神经内分泌肿瘤转移,,免疫组化:ck(+),syn(+),cga(-),cd56(+),cdx-2(+),ki67(+5%)。2012-7-11,就诊我院肿标:nse叒ca199叒cea叒ca125叒均正常,,直肠术后我院病理会诊:直肠神经内分泌肿瘤(who分级叒g2),,免疫组化:ki-67叒约3%。术后即出现便秘,药物通便,大便未见脓血。进食可,体重无明显变化。2012.7入组法米替尼治疗5周期,评效sd。治疗后甲状腺功能低上ii度,2013-12尿蛋白3+终止治疗。2013-3ct示盆腔淋巴结较前增大,pd。2013-3-5开始善宁20mg治疗,至今一直予善龙治疗。2013-11-21住院复查建议继续善龙治疗.2014-2-18腹、盆,ct:右侧髂内闭孔区肿大淋巴结同前,约32x27mm(im118),前腹壁手术切口皮上及腹直肌多发斑片及结节强化灶同前,右侧腹直肌增厚、上缘与子宫底及膀胱前壁粘连同前。拟2014-5-15继续善龙治疗。2014-7改为兰瑞肽治疗10次,目前无不适主诉,饮食、大小便正常,体重较前无变化。2014-11-21综合评效稳定sd,继续兰瑞肽治疗。2015-6叒发现肝转移,开始希罗达+替莫唑胺治疗1周期。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "14"}, {"mention": "ct", "label": "影像检查", "offset": "49"}, {"mention": "盆腔", "label": "解剖部位", "offset": "52"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "75"}, {"mention": "子宫", "label": "解剖部位", "offset": "87"}, {"mention": "腹", "label": "解剖部位", "offset": "90"}, {"mention": "肝脏", "label": "解剖部位", "offset": "95"}, {"mention": "直肠腹膜反折处", "label": "解剖部位", "offset": "109"}, {"mention": "直肠下动脉", "label": "解剖部位", "offset": "123"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "141"}, {"mention": "希罗达", "label": "药物", "offset": "191"}, {"mention": "奥沙利铂", "label": "药物", "offset": "199"}, {"mention": "右上腹", "label": "解剖部位", "offset": "259"}, {"mention": "mri", "label": "影像检查", "offset": "275"}, {"mention": "盆腔", "label": "解剖部位", "offset": "279"}, {"mention": "结肠黑变病", "label": "疾病和诊断", "offset": "308"}, {"mention": "pet-ct", "label": "影像检查", "offset": "331"}, {"mention": "上腹部", "label": "解剖部位", "offset": "339"}, {"mention": "右盆腔髂血管", "label": "解剖部位", "offset": "377"}, {"mention": "神经内分泌肿瘤转移", "label": "疾病和诊断", "offset": "409"}, {"mention": "nse", "label": "实验室检验", "offset": "489"}, {"mention": "ca199", "label": "实验室检验", "offset": "493"}, {"mention": "cea", "label": "实验室检验", "offset": "499"}, {"mention": "ca125", "label": "实验室检验", "offset": "503"}, {"mention": "直肠术后", "label": "疾病和诊断", "offset": "514"}, {"mention": "直肠神经内分泌肿瘤", "label": "疾病和诊断", "offset": "525"}, {"mention": "法米替尼", "label": "解剖部位", "offset": "601"}, {"mention": "甲状腺功能低上ii度", "label": "疾病和诊断", "offset": "619"}, {"mention": "尿蛋白", "label": "实验室检验", "offset": "637"}, {"mention": "ct", "label": "影像检查", "offset": "653"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "656"}, {"mention": "善宁", "label": "药物", "offset": "679"}, {"mention": "善龙", "label": "药物", "offset": "693"}, {"mention": "善龙", "label": "药物", "offset": "716"}, {"mention": "腹、盆,ct", "label": "影像检查", "offset": "730"}, {"mention": "右侧髂内闭孔区", "label": "解剖部位", "offset": "737"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "746"}, {"mention": "前腹壁", "label": "解剖部位", "offset": "768"}, {"mention": "腹直肌", "label": "解剖部位", "offset": "778"}, {"mention": "右侧腹直肌", "label": "解剖部位", "offset": "794"}, {"mention": "子宫底", "label": "解剖部位", "offset": "805"}, {"mention": "膀胱前壁", "label": "解剖部位", "offset": "809"}, {"mention": "善龙", "label": "药物", "offset": "830"}, {"mention": "兰瑞肽", "label": "药物", "offset": "843"}, {"mention": "兰瑞肽", "label": "药物", "offset": "898"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "913"}, {"mention": "希罗达", "label": "药物", "offset": "919"}, {"mention": "替莫唑胺", "label": "药物", "offset": "923"}]}
{"text": "因下腹不适半年就诊,2012.2胃镜ct示胃体小弯溃疡,局部进展期胃ca。2012.2.28行“腹腔镜辅助,剖腹胃癌根治术”,术前cea叒1000,2012.3.7叒降至328,2012.3.9叒105.术后病理:胃窦溃疡溃疡型中分化腺癌,侵全层,切缘(-),ln8/11叒t4an3m0叒iiia。her2免疫组化(-)。2012-4-11于我院开始行3周期化疗,方案替吉奥单药口服2周期。服用药物无明显不适。6-20肿标叒afp叒15.63(渐进性升高)。叒6-21因患者体重上降明显,暂未行第4周期化疗。7-4我院复查血常规、肝肾功(-)。目前患者无明显不适,进半流质饮食,进食后略感腹胀,二便正常,体重近2周未上降。已行第4周期替吉奥治疗。\\u0004\\u0004。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "1"}, {"mention": "ct", "label": "影像检查", "offset": "18"}, {"mention": "胃体小弯溃疡", "label": "疾病和诊断", "offset": "21"}, {"mention": "胃ca", "label": "疾病和诊断", "offset": "33"}, {"mention": "腹腔镜辅助,剖腹胃癌根治术", "label": "手术", "offset": "48"}, {"mention": "cea", "label": "实验室检验", "offset": "65"}, {"mention": "胃窦溃疡溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "107"}, {"mention": "替吉奥", "label": "药物", "offset": "185"}, {"mention": "afp", "label": "实验室检验", "offset": "213"}, {"mention": "腹胀", "label": "症状", "offset": "295"}, {"mention": "替吉奥", "label": "药物", "offset": "318"}]}
{"text": ",2012-1因胸痛行下消化道造影示胃体癌,2012-1-16行胃癌根治术,术中见病灶位于胃体后壁约7cm,侵及胰腺体尾部并与横结结肠系膜粘连,脾门多发淋巴结肿大,,术后病理:中低分化腺癌,8.8*8*1.8cm,侵及全层,脉管(+),胰腺可见癌侵及,淋巴结27/45,her-2(-)。2012-3-17开始替吉奥至今年5月,,末次化疗时间:2013.5,未放疗。\\u0004\\u0004叒叒,2012-7-27:腹部ct示肠系膜,大网膜多发淋巴结淋巴结影。,肿标:cea叒8.11叒余正常。胸片未见异常。\\u0004\\u0004叒叒,2013-1-29颈部ct:右侧颈侧深可见多发肿大淋巴结,较大约19*10mm腹盆ct未见明确复发转移征象,肝实质内多发低密度密度小结节,考虑囊肿。超声示右腋上淋巴结,1.6*0.6cm。pet-ct定位显示咽后壁及口咽部suv值明显升高,最高10.5,腹部未见明显异常,不能排除头颈部肿瘤。行支气管镜检查口咽鼻咽未见明显异常,未行病理,建议颈部淋巴结穿刺活检。外科考虑淋巴结位置并较小穿刺困难。叒\\u0004\\u0004叒叒2013.7.12b,超:右颈根至锁骨下多发淋巴结,较前变化不大。腹盆,ct:未见新生病灶。\\u0004\\u0004叒叒目前饮食可,大小便正常,体重增加1kg.为行复查就诊。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "8"}, {"mention": "下消化道造影", "label": "影像检查", "offset": "11"}, {"mention": "胃体癌", "label": "疾病和诊断", "offset": "18"}, {"mention": "胃癌根治术", "label": "手术", "offset": "32"}, {"mention": "胃体", "label": "解剖部位", "offset": "45"}, {"mention": "胰腺体尾部", "label": "解剖部位", "offset": "56"}, {"mention": "横结结肠", "label": "解剖部位", "offset": "63"}, {"mention": "脾门", "label": "解剖部位", "offset": "72"}, {"mention": "中低分化腺癌", "label": "疾病和诊断", "offset": "88"}, {"mention": "胰腺", "label": "解剖部位", "offset": "118"}, {"mention": "替吉奥", "label": "药物", "offset": "155"}, {"mention": "腹部ct", "label": "影像检查", "offset": "208"}, {"mention": "肠", "label": "解剖部位", "offset": "213"}, {"mention": "cea", "label": "实验室检验", "offset": "234"}, {"mention": "胸片", "label": "影像检查", "offset": "247"}, {"mention": "颈部ct", "label": "影像检查", "offset": "278"}, {"mention": "右侧颈", "label": "解剖部位", "offset": "283"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "308"}, {"mention": "肝", "label": "解剖部位", "offset": "323"}, {"mention": "右腋上淋巴结", "label": "解剖部位", "offset": "346"}, {"mention": "pet-ct", "label": "影像检查", "offset": "363"}, {"mention": "咽后壁", "label": "解剖部位", "offset": "373"}, {"mention": "口咽部", "label": "解剖部位", "offset": "377"}, {"mention": "腹部", "label": "解剖部位", "offset": "396"}, {"mention": "头颈部肿瘤", "label": "疾病和诊断", "offset": "409"}, {"mention": "口咽", "label": "解剖部位", "offset": "422"}, {"mention": "鼻咽", "label": "解剖部位", "offset": "424"}, {"mention": "颈部淋巴结", "label": "解剖部位", "offset": "440"}, {"mention": "右颈根", "label": "解剖部位", "offset": "495"}, {"mention": "锁骨", "label": "解剖部位", "offset": "499"}, {"mention": "腹盆,ct", "label": "影像检查", "offset": "515"}]}
{"text": ",患者2015-7在我院确诊为“结肠癌”,于2015-8-12在我院行“腹腔镜右半结肠切除术+dixon术”,术中见肿瘤位于降结肠中段,约4*5cm,侵犯浆膜。,探查腹盆腔:肝见2枚巨大转移灶,位于左肝,大小分别为4*5cm,8*10cm。,术后病理:(降结肠大体)中至低分化腺癌,伴坏死,癌浸润至肠壁浆膜上层,见神经束侵犯,未见明确脉管内癌栓;另双枚息肉管状-绒毛状腺瘤。手术切缘阴性,淋巴结10/18(+),pms2(+),mlh1(+),msh2(+),msh6(+)。,多基因分型:未见阳性突变位点。,确诊为:降结肠癌伴肝转移(pt3n2bm1,iv期pmmr,ras野生型)。术后于2015-09-30至2016-02-02行“c225+mfolfox6”化疗7程。4程后疗效评价pr,4程、7程后复查mri提示肝s2、4、8虑转移瘤,较前缩小,疗效pr。2016-2-14,行mri示:结肠癌姑息切除术后、,肝转移化疗中:肝s2、4、8虑转移瘤,较前缩小。2016年03月16日在我院行扩大右半肝切除术,,术后病理:1(s2、3肿物),镜上:肝见中分化腺癌浸润,结合病史及免疫组化结果,符合肠腺癌肝转移;2(s4肿物),镜上:肝组织中见中分化腺癌浸润,结合病史及免疫组化,符合肠腺癌肝转移,另见部分癌细胞退变,考虑为治疗后改变;癌旁肝组织呈慢性肝炎g2s3改变。3(肝动脉旁淋巴结)1枚,未见癌。术后于2016-06-01、2016-06-15、2016-08-01行folfox化疗第8-10程,过程顺利。2017-04-24复查结肠镜示“升结肠见一长蒂息肉,约2.0x2.0cm,活检1块。肝曲见一长蒂息肉,约1.2x2.0cm,活检1块”,病理示“1(升结肠长蒂息肉活检),镜上:形态符合管状腺瘤。2(结肠肝曲**息肉活检),镜上:形态符合管状腺瘤”。患者为求内镜上息肉切除收入我科。近来患者精神、睡眠、食欲可,大小便如常,体重无明显变化。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "16"}, {"mention": "腹腔镜右半结肠切除术+dixon术", "label": "手术", "offset": "36"}, {"mention": "降结肠中段", "label": "解剖部位", "offset": "62"}, {"mention": "腹盆腔", "label": "解剖部位", "offset": "83"}, {"mention": "肝", "label": "解剖部位", "offset": "87"}, {"mention": "左肝", "label": "解剖部位", "offset": "99"}, {"mention": "(降结肠大体)中至低分化腺癌", "label": "疾病和诊断", "offset": "126"}, {"mention": "肠", "label": "解剖部位", "offset": "149"}, {"mention": "管状-绒毛状腺瘤", "label": "疾病和诊断", "offset": "178"}, {"mention": "降结肠癌伴肝转移(pt3n2bm1,iv期pmmr,ras野生型)", "label": "疾病和诊断", "offset": "259"}, {"mention": "c225", "label": "药物", "offset": "319"}, {"mention": "肝s2、4、8", "label": "解剖部位", "offset": "361"}, {"mention": "mri", "label": "影像检查", "offset": "394"}, {"mention": "结肠癌姑息切除术后", "label": "疾病和诊断", "offset": "399"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "410"}, {"mention": "肝s2、4、8", "label": "解剖部位", "offset": "417"}, {"mention": "扩大右半肝切除术", "label": "手术", "offset": "449"}, {"mention": "s2、3", "label": "解剖部位", "offset": "466"}, {"mention": "肝", "label": "解剖部位", "offset": "477"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "479"}, {"mention": "肠腺癌肝转移", "label": "疾病和诊断", "offset": "501"}, {"mention": "s4", "label": "解剖部位", "offset": "510"}, {"mention": "肝", "label": "解剖部位", "offset": "519"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "524"}, {"mention": "肠腺癌肝转移", "label": "疾病和诊断", "offset": "544"}, {"mention": "肝", "label": "解剖部位", "offset": "572"}, {"mention": "肝动脉旁淋巴结", "label": "解剖部位", "offset": "589"}, {"mention": "升结肠", "label": "解剖部位", "offset": "677"}, {"mention": "肝曲", "label": "解剖部位", "offset": "703"}, {"mention": "升结肠", "label": "解剖部位", "offset": "735"}, {"mention": "管状腺瘤", "label": "疾病和诊断", "offset": "753"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "760"}, {"mention": "管状腺瘤", "label": "疾病和诊断", "offset": "779"}]}
{"text": ",2009-6-19当地胃癌手术,术中见大网膜及部分小肠粘连,术后病理低分化腺癌,淋巴结3/4,术后行化疗3周期(不详)。术后即出现进食剑上胀满,反酸。2010.11.3,复查胃镜:返流性食管炎。腹部ct(-),b,超:右锁骨下淋巴结(0.7*0.4cm)。肿标ca72-4叒9.95,余(-)。\\u0004\\u0004叒叒2012.3.21,复查胃镜:返流性食管炎。,病理:(-)。肿标ca72-4叒16.79,余(-)。\\u0004\\u0004叒近来仍进食后剑上胀满,伴反酸,食纳少,服耐信症状无缓解,术后体重稳定。\\u0004\\u0004叒服泮托拉唑后症状开始有缓解,但近日再发。", "mention_data": [{"mention": "胃癌手术", "label": "手术", "offset": "12"}, {"mention": "小肠", "label": "解剖部位", "offset": "26"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "返流性食管炎", "label": "疾病和诊断", "offset": "91"}, {"mention": "腹部ct", "label": "影像检查", "offset": "98"}, {"mention": "右锁骨下淋巴结", "label": "解剖部位", "offset": "110"}, {"mention": "ca72-4", "label": "实验室检验", "offset": "131"}, {"mention": "返流性食管炎", "label": "疾病和诊断", "offset": "177"}, {"mention": "ca72-4", "label": "实验室检验", "offset": "194"}, {"mention": "耐信", "label": "药物", "offset": "245"}, {"mention": "泮托拉唑", "label": "药物", "offset": "274"}]}
{"text": "2011-11因下腹部不适伴黑便就诊,胃窦部腺癌伴腹腔lnm,右锁骨下lnm。于2011-12-24始dcs,叒bm叒iv度,因判效sd症状无缓解,改为sox*3+腹腔热化疗3次(顺铂+氟尿嘧啶均减量),症状缓解。于2012-6-18我院行胃癌姑息切除术,术中见肠系膜根部及腹主动脉旁lnm,行全胃+d2(腹膜后未清扫?),胃体小弯侧溃疡型低分化腺癌,3.5cm,及胃周围脂肪组织,未侵透浆膜,脉管癌栓(+),9/25,her-2叒弱阳性。mdt建议口服s1,未进行,于外院行生物免疫治疗。2012-8-1复查腹主动脉旁多发ln进展。现腰背部疼痛,2012.8.8叒始行folfiri化疗7周期,1cs化疗后4°骨髓抑制,第二周期减量,仍出现iii度骨髓抑制,后续化疗均调整剂量,末次化疗2012-11-17。3周期评效:缩小sd(右锁骨下ln明显缩小),7周期后复查评效结果不详。我科查房建议放疗。进一步咨询。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "8"}, {"mention": "胃窦部腺癌伴腹腔lnm", "label": "疾病和诊断", "offset": "19"}, {"mention": "右锁骨下lnm", "label": "疾病和诊断", "offset": "31"}, {"mention": "腹", "label": "解剖部位", "offset": "82"}, {"mention": "顺铂", "label": "药物", "offset": "90"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "93"}, {"mention": "胃癌姑息切除术", "label": "手术", "offset": "120"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "137"}, {"mention": "全胃+d2", "label": "手术", "offset": "147"}, {"mention": "腹", "label": "解剖部位", "offset": "153"}, {"mention": "胃体小弯侧溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "162"}, {"mention": "胃", "label": "解剖部位", "offset": "183"}, {"mention": "s1", "label": "药物", "offset": "227"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "255"}, {"mention": "腰背部", "label": "解剖部位", "offset": "268"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "306"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "325"}, {"mention": "右锁骨下ln", "label": "解剖部位", "offset": "366"}]}
{"text": ",2011-2-16直肠上段癌,ct3n2m0?叒新辅助放疗30gy/10f,2011-3-23本院行直肠癌低位前切除术,溃疡中分化腺癌,淋巴结2/16。her2(2+),因吻合口瘘行横结肠造瘘术。2011-4叒xelox*8,末次化疗2012.3。期间2011.7还纳。术前cr(-),化疗期间2011.10胸片疑m,ct证实两肺m,但未更换方案,继续化疗到2012.3.4.\\u0004\\u0004叒叒,2012-4-9ct:肺内转移灶进展明显,腹部ct(-),肿标略高cea叒6.78叒ca199叒42。目前患者无明显不适。\\u0004\\u0004叒叒k-ras叒,:12、13密码子野生型,braf叒野生型。\\u0004\\u0004叒叒ugt1a1*28叒ta(6)/ta(7)叒ugt1a1*6叒211g/g。\\u0004\\u0004叒叒家属拒绝应用靶向治疗叒\\u0004\\u0004叒叒folfiri叒?化疗3周期叒\\u0004\\u0004。", "mention_data": [{"mention": "直肠上段癌,ct3n2m0", "label": "疾病和诊断", "offset": "10"}, {"mention": "直肠癌低位前切除术", "label": "手术", "offset": "51"}, {"mention": "溃疡中分化腺癌", "label": "疾病和诊断", "offset": "61"}, {"mention": "吻合口瘘", "label": "疾病和诊断", "offset": "87"}, {"mention": "横结肠造瘘术", "label": "手术", "offset": "92"}, {"mention": "胸片", "label": "影像检查", "offset": "155"}, {"mention": "ct", "label": "影像检查", "offset": "160"}, {"mention": "两肺", "label": "解剖部位", "offset": "164"}, {"mention": "ct", "label": "影像检查", "offset": "212"}, {"mention": "肺", "label": "解剖部位", "offset": "215"}, {"mention": "腹部ct", "label": "影像检查", "offset": "225"}, {"mention": "cea", "label": "实验室检验", "offset": "237"}, {"mention": "ca199", "label": "实验室检验", "offset": "246"}]}
{"text": ",于2006.6.5行乙状结肠癌根治术,术后病理分期pt3n0,术后行folfox7*6,之后xel*3,定期复查。2013.1便血,2013.2.20,复查肠镜:(距肛门14-17cm)中分化腺癌;(升结肠)管状腺瘤,i级。2013.3.25行直肠癌低位前切除术,,术后病理:直肠(切除)浸润性中分化腺癌,大小6.6cm;癌浸及肠周脂肪组织;脉管(-),淋巴结(0/15);断端(-)。4月前我院行吻合口扩张,扩张后患者排便困难有缓解,此次为复查来诊。我院内镜上切除肛管病变,术后病理为绒毛状腺瘤,基底切缘净。", "mention_data": [{"mention": "乙状结肠癌根治术", "label": "手术", "offset": "11"}, {"mention": "xel", "label": "药物", "offset": "47"}, {"mention": "肛门", "label": "解剖部位", "offset": "84"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "94"}, {"mention": "(升结肠)管状腺瘤,i级", "label": "疾病和诊断", "offset": "100"}, {"mention": "直肠癌低位前切除术", "label": "手术", "offset": "123"}, {"mention": "直肠(切除)浸润性中分化腺癌", "label": "疾病和诊断", "offset": "139"}, {"mention": "肠", "label": "解剖部位", "offset": "165"}, {"mention": "吻合口扩张", "label": "手术", "offset": "200"}, {"mention": "内镜上切除肛管病变", "label": "手术", "offset": "229"}, {"mention": "绒毛状腺瘤", "label": "疾病和诊断", "offset": "244"}]}
{"text": ",2010.10.27胃癌根治手术,,术后病理:全胃低分化腺癌,癌组织侵透肌层达周围脂肪,切缘(-),,ln:10/18,大网膜未见癌。介入6次,2011.11叒腰肌转移,化疗9次(,第1周期:s-1,,第2周期:ptx+s-1;第3,4,周期:奥沙利铂+s-1;叒,第5周期:奥沙利铂+希罗达;第6.7,周期:ptx+s-1;第8,9,周期:多西他赛).2012-8-1开始放疗叒5次,目前pet-ct提示腹腔播散转移,右侧竖脊肌不均质肿块影较前增大。今为进一步诊治入院。叒食欲可,前段时间便血,现大小便正常,体重变化不大,2012.7.26第一次基因治疗,未发热;7月30热疗,8.2第二次注射发热40度,8月6日。疼痛未加重叒,8.9第三次基因,10日热疗,2012.8.13热疗中,8.16四次基因治疗,her2+++建议内科会诊化疗靶向治疗,头晕好转,疼痛减轻。2012.8.20腰疼肿块缩小,2012.8.28放疗20次,2012.9.3放疗27次。", "mention_data": [{"mention": "胃癌根治手术", "label": "手术", "offset": "11"}, {"mention": "全胃低分化腺癌", "label": "疾病和诊断", "offset": "24"}, {"mention": "腰肌转移", "label": "疾病和诊断", "offset": "81"}, {"mention": "s-1", "label": "药物", "offset": "97"}, {"mention": "ptx", "label": "药物", "offset": "107"}, {"mention": "s-1", "label": "药物", "offset": "111"}, {"mention": "奥沙利铂", "label": "药物", "offset": "123"}, {"mention": "s-1", "label": "药物", "offset": "128"}, {"mention": "奥沙利铂", "label": "药物", "offset": "139"}, {"mention": "希罗达", "label": "药物", "offset": "144"}, {"mention": "ptx", "label": "药物", "offset": "156"}, {"mention": "s-1", "label": "药物", "offset": "160"}, {"mention": "多西他赛", "label": "药物", "offset": "172"}, {"mention": "pet-ct", "label": "影像检查", "offset": "196"}, {"mention": "腹腔播散转移", "label": "疾病和诊断", "offset": "204"}, {"mention": "右侧竖脊肌", "label": "解剖部位", "offset": "211"}, {"mention": "头晕", "label": "症状", "offset": "376"}, {"mention": "腰", "label": "解剖部位", "offset": "395"}]}
{"text": ",患者定期体检,2012年4月体检b超发现肝内占位,5月8日,在我院查mri提示:肝右叶占位性病变,考虑肝癌可能性大,afp叒5303ng/ml,诊断“肝癌”,于2012-5-16于我院肝胆科行“解剖性右半肝切除+胆囊切除术”,,术后病理示:混合性肝细胞和胆管细胞癌(中-低分化)。术后于2012-6-28复查afp降至29.07ng/ml。2012-07至08月患者在我科行cik细胞免疫治疗6程,过程顺利。2012-08-31复查afp为76.6ng/ml,,肝脏mr示:肝癌术后改变,未见明确复发征象;肝s6叒病灶,考虑海绵状血管瘤;肝s8叒囊肿。2012-09-20复查afp升至61.9ng/ml,考虑肿瘤复发,遂于2012-09-24在我院肝胆科行局麻上tace术,术中注入表阿霉素50mg,丝裂霉素6mg,洛铂50mg,术程顺利,术后恢复可。2012-11-28,复查mr示:切缘左旁肝s5新见结节,考虑复发。遂于2012-12-06在我院肝胆一区行肝脏肿瘤微波固化术,手术顺利,术后恢复可。术后继续行cik细胞免疫治疗。2013-11-6复查下腹mri示切缘旁复发,于2013-11-22日我院肝胆外科行肝癌切除术,术程顺利,术后病理示中分化肝细胞性肝癌。2013-12起继续行cik细胞免疫治疗。2014-05-22我院复查mr提示肝s5、s6、s7、s8叒多发结节,考虑肿瘤复发。现为行进一步治疗收入院。患者近期无腹痛、腹胀、恶心、呕吐,无畏寒、无发热、皮肤瘙痒等不适,精神可,食欲如常,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "b超", "label": "影像检查", "offset": "17"}, {"mention": "肝", "label": "解剖部位", "offset": "21"}, {"mention": "mri", "label": "影像检查", "offset": "35"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "52"}, {"mention": "afp", "label": "实验室检验", "offset": "59"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "76"}, {"mention": "解剖性右半肝切除+胆囊切除术", "label": "手术", "offset": "98"}, {"mention": "混合性肝细胞和胆管细胞癌(中-低分化)", "label": "疾病和诊断", "offset": "121"}, {"mention": "afp", "label": "实验室检验", "offset": "155"}, {"mention": "afp", "label": "实验室检验", "offset": "217"}, {"mention": "肝脏mr", "label": "影像检查", "offset": "232"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "238"}, {"mention": "肝s6", "label": "解剖部位", "offset": "254"}, {"mention": "海绵状血管瘤", "label": "疾病和诊断", "offset": "263"}, {"mention": "肝s8叒囊肿", "label": "疾病和诊断", "offset": "270"}, {"mention": "afp", "label": "实验室检验", "offset": "289"}, {"mention": "tace术", "label": "手术", "offset": "333"}, {"mention": "表阿霉素", "label": "药物", "offset": "343"}, {"mention": "丝裂霉素", "label": "药物", "offset": "352"}, {"mention": "洛铂", "label": "药物", "offset": "360"}, {"mention": "mr", "label": "影像检查", "offset": "391"}, {"mention": "肝s5", "label": "解剖部位", "offset": "399"}, {"mention": "肝脏肿瘤微波固化术", "label": "手术", "offset": "432"}, {"mention": "下腹mri", "label": "影像检查", "offset": "479"}, {"mention": "肝癌切除术", "label": "手术", "offset": "510"}, {"mention": "中分化肝细胞性肝癌", "label": "疾病和诊断", "offset": "526"}, {"mention": "mr", "label": "影像检查", "offset": "571"}, {"mention": "肝s5、s6、s7、s8", "label": "解剖部位", "offset": "575"}, {"mention": "腹痛", "label": "症状", "offset": "617"}, {"mention": "腹胀", "label": "症状", "offset": "620"}]}
{"text": ",2009.1.1医肿胃癌根治术,术后即发现腹膜后lnm,dcf入组,pr后放疗(末次化疗2009.7,末次放疗2009.8.31)。自2011.3叒始ca199及ca242渐升高,多次复查ct胃镜等(-),,2012-4-13:,cea:11.81,,ca199:1723,,ca242:307.5。半年前觉背痛,2012.7.31胸ct左肺下叶6cm肿块,左肺门及左锁骨下及纵隔多发ln,气管镜(-),头颅mri(-)隆突上ln穿刺为低分化癌转移,结合病史考虑胃癌转移。2012-7-26,肿标:cea叒30,,ca199:3485,,ca724:19.56叒ca242叒325.2。,2012-8-9:胃镜食管探查可见纵隔内龙突上低回声结节,,病理:(隆突上淋巴结)可见低分化癌转移,,考虑胃癌转移颈部b超:左颈根至锁骨下淋巴结肿大,考虑转移;右锁骨下多发淋巴结。,2012-7-31:胸部ct示左下肺癌,左肺门纵隔及锁骨下淋巴结转移可能大,左侧胸膜多发结节,转移可能大。。2012-8-3,支气管镜:未见明显占位性病变。2012-8-27开始行紫杉醇+顺铂化疗,已完成3周期,自觉咳嗽、背痛症状部分好转,肿瘤评估提示左肺转移及纵隔淋巴结均明显缩小,判效pr,2012.11.9复查血常规正常。拟行明日化疗。目前已完成四周期化疗,腹泻2度,持续4天,已恢复。复查判效。ca199叒58.17u/l,cea正常,腹部超声提示左肾囊肿,胸部ct提示左肺病灶较前明显缩小,肺门淋巴结缩小。2012.11.,29复查ca199:58.17u/ml,,ca242:37.29u/ml。叒口服ts-1叒3周期,无不良反应,无不适主诉,复查血常规、肝肾功能正常。2013.2复查肿瘤标志物正常,胸部ct提示左肺转移,今已行放疗复位,4月2日开始放疗,gtv60gy/30f,同时行替吉奥口服增敏。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "11"}, {"mention": "腹膜后lnm", "label": "疾病和诊断", "offset": "22"}, {"mention": "ca199", "label": "实验室检验", "offset": "76"}, {"mention": "ca242", "label": "实验室检验", "offset": "82"}, {"mention": "ct", "label": "影像检查", "offset": "95"}, {"mention": "cea", "label": "实验室检验", "offset": "116"}, {"mention": "ca199", "label": "实验室检验", "offset": "127"}, {"mention": "ca242", "label": "实验室检验", "offset": "139"}, {"mention": "背痛", "label": "症状", "offset": "155"}, {"mention": "胸ct", "label": "影像检查", "offset": "167"}, {"mention": "左肺下叶", "label": "解剖部位", "offset": "170"}, {"mention": "左肺门", "label": "解剖部位", "offset": "180"}, {"mention": "左锁骨", "label": "解剖部位", "offset": "184"}, {"mention": "纵隔", "label": "解剖部位", "offset": "189"}, {"mention": "ln", "label": "解剖部位", "offset": "193"}, {"mention": "头颅mri", "label": "影像检查", "offset": "203"}, {"mention": "隆突上ln", "label": "解剖部位", "offset": "211"}, {"mention": "低分化癌转移", "label": "疾病和诊断", "offset": "219"}, {"mention": "胃癌转移", "label": "疾病和诊断", "offset": "232"}, {"mention": "cea叒30", "label": "实验室检验", "offset": "250"}, {"mention": "ca199", "label": "实验室检验", "offset": "258"}, {"mention": "ca724", "label": "实验室检验", "offset": "270"}, {"mention": "ca242", "label": "实验室检验", "offset": "282"}, {"mention": "食管", "label": "解剖部位", "offset": "306"}, {"mention": "纵隔内龙突上", "label": "解剖部位", "offset": "312"}, {"mention": "(隆突上淋巴结)可见低分化癌转移", "label": "疾病和诊断", "offset": "328"}, {"mention": "胃癌转移", "label": "疾病和诊断", "offset": "348"}, {"mention": "颈部b超", "label": "影像检查", "offset": "352"}, {"mention": "左颈根至锁骨下淋巴结", "label": "解剖部位", "offset": "357"}, {"mention": "右锁骨下", "label": "解剖部位", "offset": "375"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "381"}, {"mention": "胸部ct", "label": "影像检查", "offset": "396"}, {"mention": "左下肺癌", "label": "疾病和诊断", "offset": "401"}, {"mention": "左肺门纵隔及锁骨下淋巴结转移", "label": "疾病和诊断", "offset": "406"}, {"mention": "胸", "label": "解剖部位", "offset": "426"}, {"mention": "紫杉醇", "label": "药物", "offset": "476"}, {"mention": "顺铂", "label": "药物", "offset": "480"}, {"mention": "背痛", "label": "症状", "offset": "497"}, {"mention": "左肺转移", "label": "疾病和诊断", "offset": "512"}, {"mention": "纵隔淋巴结", "label": "解剖部位", "offset": "517"}, {"mention": "腹泻", "label": "症状", "offset": "568"}, {"mention": "ca199", "label": "实验室检验", "offset": "587"}, {"mention": "cea", "label": "实验室检验", "offset": "602"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "614"}, {"mention": "胸部ct", "label": "影像检查", "offset": "619"}, {"mention": "左肺", "label": "解剖部位", "offset": "625"}, {"mention": "肺门淋巴结", "label": "解剖部位", "offset": "636"}, {"mention": "ca199", "label": "实验室检验", "offset": "657"}, {"mention": "ca242", "label": "实验室检验", "offset": "674"}, {"mention": "ts-1", "label": "药物", "offset": "693"}, {"mention": "胸部ct", "label": "影像检查", "offset": "743"}, {"mention": "左肺转移", "label": "疾病和诊断", "offset": "749"}, {"mention": "替吉奥", "label": "药物", "offset": "786"}]}
{"text": ",2007年3患者出现大便干结,外院腹盆,ct:直肠侧后壁管壁增厚,,超声肠镜提示:直肠距肛门3cm后壁可见3*4cm隆起,,超声所见:病灶处可见低回声团块,呈椭圆形,向腔内突出,起源于肌层,直肠肿物穿刺涂片考虑间叶来源肿瘤,可能为间质瘤,2007.3.12给予直肠肿物切除术,,术后病理:直肠梭形细胞肿瘤,最大径6.5cm,核分裂>5/50hpf,低恶性度,术后未给予格列卫治疗。\\u0004\\u0004叒2012.9患者出现排便不成形,,在外院肠镜:肛门3cm可见粘膜上隆起,大小2*2cm,超声上见肿物起源于固有肌层,考虑间质瘤可能性大。未治疗\\u0004\\u0004叒2013.10.25患者出现腹胀,排便不成形,,超声肠镜:直肠后壁巨大分叶隆起病变,局部糜烂,侵及肛管1/2,,超声上:内部回声不均匀,5*8cm考虑间质瘤,距肛门3cm.。", "mention_data": [{"mention": "腹盆,ct", "label": "影像检查", "offset": "18"}, {"mention": "直肠", "label": "解剖部位", "offset": "24"}, {"mention": "直肠", "label": "解剖部位", "offset": "42"}, {"mention": "肛门", "label": "解剖部位", "offset": "45"}, {"mention": "直肠", "label": "解剖部位", "offset": "96"}, {"mention": "间质瘤", "label": "疾病和诊断", "offset": "116"}, {"mention": "直肠肿物切除术", "label": "手术", "offset": "131"}, {"mention": "直肠梭形细胞肿瘤", "label": "疾病和诊断", "offset": "145"}, {"mention": "格列卫", "label": "药物", "offset": "185"}, {"mention": "肛门", "label": "解剖部位", "offset": "227"}, {"mention": "间质瘤", "label": "疾病和诊断", "offset": "264"}, {"mention": "腹胀", "label": "症状", "offset": "302"}, {"mention": "直肠", "label": "解剖部位", "offset": "317"}, {"mention": "肛管", "label": "解剖部位", "offset": "337"}, {"mention": "超声", "label": "影像检查", "offset": "344"}, {"mention": "间质瘤", "label": "疾病和诊断", "offset": "363"}, {"mention": "肛门", "label": "解剖部位", "offset": "368"}]}
{"text": ",患者2月余前无明显诱因出现排便欠通畅,并有肛门堵塞感,无便血及肛门肿物脱出,为行治疗于2017-06-19就诊于我院肛肠科,,肛诊见:截石位,肛门12点至5点位瘢痕组织,范围约4cm×4cm,皮肤发白,指诊肛管1点位至7点位可触及高低不平肿物隆起,质韧,固定,移动度差,无明显触痛,下界距肛门约4cm,退指指套无染血。,行肛周mr示:肛管右侧壁异常改变;尾骨后方软组织内异常信号,考虑炎性改变;盆腔内略大淋巴结。患者后于2017.06.21,行电子结肠镜检查示:肛管肿物;取部分组织送病理,病理(201714160),示:(肛管)符合派杰氏病(paget's病);部分为大肠粘膜,呈水肿及慢性发炎,局部粘膜糜烂。排除相关手术禁忌后,患者于2017.06.26叒,09:45在腰硬联合麻醉上行直肠病损切除术。术后病理(,病理号:201714675),示:(肛管肿物)低分化腺癌,部分为印戒细胞癌,部分为粘液腺癌。术后应用头孢替安及替硝唑控制局部感染,应用核黄素补充能量、促进伤口愈合等综合治疗后,患者恢复可。后为行进一步治疗转入我科,排除相关放疗禁忌后,于2017-07-18开始局部放疗,dt5000cgy/25f,放疗过程顺利,病情平稳出院。今患者为求进一步治疗再次就诊于我院,门诊以“肛管恶性肿瘤”收入我科。叒叒患者自发病以来神志清,精神、饮食好,夜间睡眠可,无发热,二便未见明显异常体重无明显改变。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "22"}, {"mention": "肛门", "label": "解剖部位", "offset": "32"}, {"mention": "肛门", "label": "解剖部位", "offset": "72"}, {"mention": "肛管", "label": "解剖部位", "offset": "104"}, {"mention": "肛门", "label": "解剖部位", "offset": "145"}, {"mention": "肛周mr", "label": "影像检查", "offset": "162"}, {"mention": "肛管", "label": "解剖部位", "offset": "168"}, {"mention": "尾骨", "label": "解剖部位", "offset": "178"}, {"mention": "盆腔", "label": "解剖部位", "offset": "198"}, {"mention": "肛管", "label": "解剖部位", "offset": "232"}, {"mention": "(肛管)符合派杰氏病(paget's病)", "label": "疾病和诊断", "offset": "262"}, {"mention": "大肠", "label": "解剖部位", "offset": "286"}, {"mention": "腰", "label": "解剖部位", "offset": "338"}, {"mention": "直肠病损切除术", "label": "手术", "offset": "346"}, {"mention": "肛管", "label": "解剖部位", "offset": "378"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "383"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "392"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "401"}, {"mention": "头孢替安", "label": "药物", "offset": "410"}, {"mention": "替硝唑", "label": "药物", "offset": "415"}, {"mention": "核黄素", "label": "药物", "offset": "427"}, {"mention": "肛管恶性肿瘤", "label": "疾病和诊断", "offset": "545"}]}
{"text": ",2014.6体检发现肝多发转移,肠镜提示乙状结肠癌,2014.7.10行原发灶切除术,2014-8-6开始行7周期xelox+bev化疗,2014-12-30复查腹部mri提示肝脏病灶较前略缩小。胸部cr未见异常。治疗期间神经炎2度。后换用希罗达+bev维持治疗7周期,末次化疗时间2015-6-15,患者耐受性可。2015.5.11复查肿瘤标志物提示cea较前升高,2015.5.7复查mri提示肝转移变化不大。2015.7复查cea较前增长,2015-7-6给予xelox+bev化疗2cs。,2015-7-10盆腔mri:乙状结肠术后改变,局部未见复发征象。化验血常规、肝肾功指标正常。2015-07-15,腹腔mri与2015-05-07腹部mr对比:肝脏多发转移瘤较前略缩小。2015.9复查ct提示病灶稳定,2015.9.28换为bev+xeloda维持治疗至今。现患者精神食欲可,大小便正常,体重近期无变化。", "mention_data": [{"mention": "肝多发转移", "label": "疾病和诊断", "offset": "11"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "21"}, {"mention": "bev", "label": "药物", "offset": "64"}, {"mention": "腹部mri", "label": "影像检查", "offset": "82"}, {"mention": "肝脏", "label": "解剖部位", "offset": "89"}, {"mention": "胸部cr", "label": "影像检查", "offset": "99"}, {"mention": "希罗达", "label": "药物", "offset": "121"}, {"mention": "bev", "label": "药物", "offset": "125"}, {"mention": "cea", "label": "实验室检验", "offset": "177"}, {"mention": "mri", "label": "影像检查", "offset": "195"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "200"}, {"mention": "cea", "label": "实验室检验", "offset": "216"}, {"mention": "bev", "label": "药物", "offset": "240"}, {"mention": "盆腔mri", "label": "影像检查", "offset": "259"}, {"mention": "乙状结肠术后", "label": "疾病和诊断", "offset": "265"}, {"mention": "腹腔mri", "label": "影像检查", "offset": "308"}, {"mention": "腹部mr", "label": "影像检查", "offset": "324"}, {"mention": "肝脏多发转移瘤", "label": "疾病和诊断", "offset": "331"}, {"mention": "ct", "label": "影像检查", "offset": "352"}, {"mention": "bev", "label": "药物", "offset": "372"}, {"mention": "xeloda", "label": "药物", "offset": "376"}]}
{"text": ",患者于2014年5月无意中出现吞咽异物感,近几月来出现吞咽疼痛,无饮水呛咳,无呼吸困难,无咳嗽、咳痰等不适。至当地行消炎治疗,未见明显缓解。2014-07-07,外院行病理活检结果示:(左侧口口咽部)非角化型鳞状细胞癌。2014-07-11,我院病理会诊示:中分化鳞状细胞癌。2014-07-21,我院ct检查结果示:左侧扁桃体占位,考虑扁桃体癌,侵犯左侧舌根、部分舌体、软腭、牙龈。两颈ib叒区、ii叒区、iii区见多个淋巴结,部分稍大者不除外转移。右侧乳突炎。2014-07-25,我院胃镜活检病理:(末段食管、贲门、胃底肿物活检)镜检为中分化鳞状细胞癌。2014-07-29我院pet/,ct:左扁桃体病灶代谢活跃,符合中分化鳞癌;左颈ii区数个淋巴结代谢活跃,考虑转移;右颈ii区淋巴结代谢较活跃,疑转移。胸上段食管及胃贲门部病灶代谢活跃,符合中分化鳞癌;胃小弯侧数个淋巴结代谢略活跃,考虑转移。胸下段食管局部代谢略活跃,恶性病变待排;右侧气管食管沟旁数个小淋巴结代谢略活跃,转移待排。遂于2014-08-06、2014-08-27、2014-09-17行tpf方案化疗3程,疾病进展,2014-10-29行吉西他滨+卡铂化疗1程,过程顺利。现遵主诊教授意见来我科行第3程化疗,患者自发病以来,一般情况可,精神可,体重无明显减轻,大小便正常。", "mention_data": [{"mention": "(左侧口口咽部)非角化型鳞状细胞癌", "label": "疾病和诊断", "offset": "93"}, {"mention": "中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "130"}, {"mention": "ct", "label": "影像检查", "offset": "152"}, {"mention": "左侧扁桃体占位", "label": "疾病和诊断", "offset": "160"}, {"mention": "扁桃体癌", "label": "疾病和诊断", "offset": "170"}, {"mention": "左侧舌根", "label": "解剖部位", "offset": "177"}, {"mention": "舌体", "label": "解剖部位", "offset": "184"}, {"mention": "软腭", "label": "解剖部位", "offset": "187"}, {"mention": "颈", "label": "解剖部位", "offset": "194"}, {"mention": "右侧乳突炎", "label": "疾病和诊断", "offset": "227"}, {"mention": "末段食管", "label": "解剖部位", "offset": "254"}, {"mention": "贲门", "label": "解剖部位", "offset": "259"}, {"mention": "胃底", "label": "解剖部位", "offset": "262"}, {"mention": "中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "272"}, {"mention": "pet/,ct", "label": "影像检查", "offset": "293"}, {"mention": "左扁桃体", "label": "解剖部位", "offset": "301"}, {"mention": "中分化鳞癌", "label": "疾病和诊断", "offset": "314"}, {"mention": "颈", "label": "解剖部位", "offset": "321"}, {"mention": "右颈ii区淋巴结", "label": "解剖部位", "offset": "340"}, {"mention": "胸上段食管", "label": "解剖部位", "offset": "358"}, {"mention": "胃贲门部", "label": "解剖部位", "offset": "364"}, {"mention": "中分化鳞癌", "label": "疾病和诊断", "offset": "377"}, {"mention": "胃小弯侧", "label": "解剖部位", "offset": "383"}, {"mention": "胸下段食管", "label": "解剖部位", "offset": "403"}, {"mention": "右侧气管食管沟", "label": "解剖部位", "offset": "423"}, {"mention": "吉西他滨", "label": "药物", "offset": "509"}, {"mention": "卡铂", "label": "药物", "offset": "514"}]}
{"text": ",患者2011年05月于外院诊断为直肠癌肝转移,并行直肠癌根治+肝转移瘤切除术。术后病理具体不详,术后于2011年06月至2011年11月行folfori方案化疗,共6疗程。期间2011年7月行肝转移瘤rfa术,2012年3月因肝内再次复发行rfa术,术后开始口服“希罗达”治疗至今。2012年06月05日,在本院复查ct提示:肝s5.8叒交界区病灶,较前为新发,考虑转移瘤可能性大;肝s4叒异常密度影,可疑转移瘤。2012-7,我院ct示:肝s2.4.6.8低密度影,考虑为治疗后改变。肝s8病灶,肝s5.8交界区病灶,肝s4异常密度影,较前无大改变。叒2012-10,我院肝脏超声造影:肝s2,s4,s8符合肝转移瘤。肝s3病灶考虑治疗后改变。,介入科会诊意见:介入难以根治,,多学科讨论后意见:先行全身化疗。现为进一步治疗入院。2012-10-27、2012-11-13、2012-12-11予folfox化疗3程。化疗过程顺利,无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,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": "直肠癌肝转移", "label": "疾病和诊断", "offset": "17"}, {"mention": "直肠癌根治+肝转移瘤切除术", "label": "手术", "offset": "26"}, {"mention": "肝转移瘤rfa术", "label": "手术", "offset": "97"}, {"mention": "肝", "label": "解剖部位", "offset": "114"}, {"mention": "rfa术", "label": "手术", "offset": "121"}, {"mention": "希罗达", "label": "药物", "offset": "133"}, {"mention": "ct", "label": "影像检查", "offset": "159"}, {"mention": "肝s5.8叒交界区", "label": "解剖部位", "offset": "164"}, {"mention": "肝s4", "label": "解剖部位", "offset": "192"}, {"mention": "ct", "label": "影像检查", "offset": "217"}, {"mention": "肝s2.4.6.8", "label": "解剖部位", "offset": "221"}, {"mention": "肝s8", "label": "解剖部位", "offset": "244"}, {"mention": "肝s5.8交界区", "label": "解剖部位", "offset": "250"}, {"mention": "肝s4", "label": "解剖部位", "offset": "261"}, {"mention": "肝脏超声", "label": "影像检查", "offset": "288"}, {"mention": "肝s2,s4,s8", "label": "解剖部位", "offset": "295"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "306"}, {"mention": "肝s3", "label": "解剖部位", "offset": "311"}, {"mention": "腹痛", "label": "症状", "offset": "421"}, {"mention": "腹胀", "label": "症状", "offset": "425"}]}
{"text": ",2011-3因腹痛腹胀诊为乙状结肠癌卵巢占位,2011-8-24行乙状结肠癌根治、子宫两附件切除术,结肠溃疡型粘液腺癌,全层,系膜内癌结节,6/15,两卵巢卵巢粘液腺癌。术后xelox*6,至2012-5-11。5-30腹部ct提示大网膜、肠系膜种植转移,腹水,肝脏多发m。cea叒350ng/ml,ca叒199叒206.6u/ml,ca叒724叒2270u/ml,ca叒242叒115.73u/ml,her-2+。2012-6-12给予folfiri+贝伐*6,期间,cea:318,,ca199:313,,ca125:100,,ca724:1648,6周期评效缩小sd。2012-09-10开始予以贝伐联合氟尿嘧啶维持治疗2周期,因锁穿管脱出,拟调整为希罗达联合贝伐珠单抗维持治疗。\\u0004\\u0004叒现饮食睡眠二便尚可,体重无变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "8"}, {"mention": "腹胀", "label": "症状", "offset": "10"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "14"}, {"mention": "乙状结肠癌根治、子宫两附件切除术", "label": "手术", "offset": "34"}, {"mention": "结肠溃疡型粘液腺癌", "label": "疾病和诊断", "offset": "51"}, {"mention": "卵巢粘液腺癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "腹部ct", "label": "影像检查", "offset": "111"}, {"mention": "肠系膜种植转移", "label": "疾病和诊断", "offset": "121"}, {"mention": "腹水", "label": "症状", "offset": "129"}, {"mention": "肝脏", "label": "解剖部位", "offset": "132"}, {"mention": "cea", "label": "实验室检验", "offset": "138"}, {"mention": "ca叒199", "label": "实验室检验", "offset": "151"}, {"mention": "ca叒724", "label": "实验室检验", "offset": "168"}, {"mention": "ca叒242", "label": "实验室检验", "offset": "184"}, {"mention": "贝伐", "label": "药物", "offset": "228"}, {"mention": "cea", "label": "实验室检验", "offset": "236"}, {"mention": "ca199", "label": "实验室检验", "offset": "245"}, {"mention": "ca125", "label": "实验室检验", "offset": "256"}, {"mention": "ca724", "label": "实验室检验", "offset": "267"}, {"mention": "贝伐", "label": "药物", "offset": "302"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "306"}, {"mention": "希罗达", "label": "药物", "offset": "329"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "334"}]}
{"text": ",2011-11-1因频发呕吐就诊,,行消化道造影:考虑小肠占位,2011-11-1于我院行部分小肠切除术,,术后病理:小肠隆起型高中分化腺癌,3.5x2.5cm,侵透肠壁全层,未见脉管癌栓,淋巴结(4/15),两断端(-)。2011-12开始奥沙利铂+希罗达化疗8周期,末次化疗2012-5-7。后定期复查,影像学未见异常,术前,cea:7ng/ml,2012-12叒cea开始逐渐升高,2013-4-2叒,cea:38ng/ml,,ca199:120.2u/ml。,2013-2-22pet-ct:t11椎体低密度伴代谢增高(骨扫描倾向良性病变),两肺多发小结节,磨玻璃小结节影,模糊类小结节。,小肠镜:未见明确复发征象。13.4.12,复查彩超:肝左叶结节无变化,肝s4偏强回声,观察。,2014-11-6腹盆ct:小肠及直肠术后改变较前相仿,两侧髂血管旁、腹股沟多发小淋巴结同前。,2014-11-10胸ct:两肺未见新发结节及斑片影。肿标未见异常。继续卡培他滨维持治疗,复查cea较前升高。昨日受凉后腹泻,未予特殊治疗,未发热。", "mention_data": [{"mention": "消化道造影", "label": "影像检查", "offset": "20"}, {"mention": "小肠", "label": "解剖部位", "offset": "28"}, {"mention": "部分小肠切除术", "label": "手术", "offset": "46"}, {"mention": "小肠隆起型高中分化腺癌", "label": "疾病和诊断", "offset": "60"}, {"mention": "肠", "label": "解剖部位", "offset": "84"}, {"mention": "奥沙利铂", "label": "药物", "offset": "122"}, {"mention": "希罗达", "label": "药物", "offset": "127"}, {"mention": "cea", "label": "实验室检验", "offset": "166"}, {"mention": "cea", "label": "实验室检验", "offset": "185"}, {"mention": "cea", "label": "实验室检验", "offset": "205"}, {"mention": "ca199", "label": "实验室检验", "offset": "218"}, {"mention": "pet-ct", "label": "影像检查", "offset": "244"}, {"mention": "t11椎体", "label": "解剖部位", "offset": "251"}, {"mention": "两肺", "label": "解剖部位", "offset": "276"}, {"mention": "彩超", "label": "影像检查", "offset": "323"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "326"}, {"mention": "肝s4", "label": "解剖部位", "offset": "335"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "356"}, {"mention": "小肠及直肠术后", "label": "疾病和诊断", "offset": "361"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "375"}, {"mention": "腹股沟", "label": "解剖部位", "offset": "382"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "388"}, {"mention": "胸ct", "label": "影像检查", "offset": "405"}, {"mention": "两肺", "label": "解剖部位", "offset": "409"}, {"mention": "卡培他滨", "label": "药物", "offset": "431"}, {"mention": "cea", "label": "实验室检验", "offset": "442"}, {"mention": "腹泻", "label": "症状", "offset": "455"}]}
{"text": "左乳腺癌术后5年,骨、肝转移2年。2009-11-26txt+tspa2周期,疗效评价不明显,改用txt+ddp共用5周期,2周期评效pr,5周期评效维持pr。2010-6-30行两侧卵巢切除术,2010-7-14始服来曲唑至2011-11,复查pd。患者要求门诊化疗,给予gx方案(gem叒850mg/m2叒1.6叒d1,8,叒xeloda叒1250mg/m2叒2.0叒bid叒d1-14),因经济困难,未行gx方案化疗。于2011-11-22始给予xeloda叒1250mg/m2叒bid叒d1-14(2g叒bid)叒q21d叒7周期,末次化疗时间:2012.04.17。2、4周期疗效评价缩小的sd。6周期疗效评效sd。拟继续第8周期xeloda化疗。\\u0004\\u0004叒叒患者诉第7疗程出现足底部皮肤浅皲裂,伴瘙痒,右足底为着。", "mention_data": [{"mention": "左乳腺癌术后", "label": "疾病和诊断", "offset": "0"}, {"mention": "骨、肝转移", "label": "疾病和诊断", "offset": "9"}, {"mention": "txt", "label": "药物", "offset": "27"}, {"mention": "tspa", "label": "药物", "offset": "31"}, {"mention": "txt", "label": "药物", "offset": "49"}, {"mention": "ddp", "label": "药物", "offset": "53"}, {"mention": "两侧卵巢切除术", "label": "手术", "offset": "90"}, {"mention": "来曲唑", "label": "药物", "offset": "109"}, {"mention": "gem", "label": "药物", "offset": "142"}, {"mention": "xeloda", "label": "药物", "offset": "165"}, {"mention": "xeloda", "label": "药物", "offset": "226"}, {"mention": "xeloda", "label": "药物", "offset": "320"}, {"mention": "足底", "label": "解剖部位", "offset": "352"}, {"mention": "右足底", "label": "解剖部位", "offset": "365"}]}
{"text": ",体检提示(2015-11-16)afp叒17.34,ca199叒114.1升高,后复查2015-11-23叒afp叒19.69,ca199叒122.6,2015-12-7叒afp叒22.85。2015-12-3,行胃镜检查示:反流性食管炎,食管裂孔障碍,贲门炎(重度),贲门溃疡,浅表性胃炎,,病理示:胃窦幽门型粘膜慢性炎,hp-。肠镜未见异常。腹部,ct:肝左叶近肝区稍低密度影,局灶性脂肪肝可能,两侧少量胸腔积液。给予抑酸,保胃等治疗。叒叒叒2015-12-21叒ca199叒142.2,afp叒29.08。2015-12-26,超声:肝门部可见多发低回声淋巴结,最大2.5x1.2cm。肝占位,考虑malignant,肝门部多发淋巴结,m不除外。,2015-12-25胸部ct:纵隔多发淋巴结,两侧少量胸腔积液,建议追查。肝脏穿刺活检示低分化腺癌,免疫组化示胆管癌可能性大。pet-ct示肝内胆管癌可能。2016-1-25行肝动脉泵植入术+1-27和3-1和3-28和4-30肝动脉化疗(gp方案)4cs。2cs后评效示肝内病变缩小pr。4cs后pd。动脉化疗afp升高,ca199先降后升。2016-5-30~9-5行动脉化疗(oxa+5fu)4cs。治疗后afp和ca199均明显上降。2cs后评效肝大pr明显缩小。afp和ca199均降至正常。4cs后(2016-10-9)评效维持pr(继续缩小).叒外科再次评估不能切除。停止动脉化疗3个月,复查肝内病变进展(肝s8,肝门病变)。2016-12-27复位,计划igtv(s8病变及肝门病变)50gy/20f,建议同步口服化疗。", "mention_data": [{"mention": "afp", "label": "实验室检验", "offset": "17"}, {"mention": "ca199", "label": "实验室检验", "offset": "27"}, {"mention": "afp", "label": "实验室检验", "offset": "55"}, {"mention": "ca199", "label": "实验室检验", "offset": "65"}, {"mention": "afp", "label": "实验室检验", "offset": "87"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "114"}, {"mention": "食管裂孔", "label": "解剖部位", "offset": "121"}, {"mention": "贲门炎(重度)", "label": "疾病和诊断", "offset": "128"}, {"mention": "贲门溃疡", "label": "疾病和诊断", "offset": "136"}, {"mention": "浅表性胃炎", "label": "疾病和诊断", "offset": "141"}, {"mention": "胃窦", "label": "解剖部位", "offset": "152"}, {"mention": "幽门", "label": "解剖部位", "offset": "154"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "174"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "180"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "195"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "205"}, {"mention": "胃", "label": "解剖部位", "offset": "216"}, {"mention": "ca199", "label": "实验室检验", "offset": "235"}, {"mention": "afp", "label": "实验室检验", "offset": "247"}, {"mention": "肝门", "label": "解剖部位", "offset": "271"}, {"mention": "肝", "label": "解剖部位", "offset": "297"}, {"mention": "肝门", "label": "解剖部位", "offset": "313"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "318"}, {"mention": "胸部ct", "label": "影像检查", "offset": "338"}, {"mention": "纵隔", "label": "解剖部位", "offset": "343"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "347"}, {"mention": "胸腔积液", "label": "疾病和诊断", "offset": "355"}, {"mention": "肝脏", "label": "解剖部位", "offset": "365"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "372"}, {"mention": "胆管癌", "label": "疾病和诊断", "offset": "383"}, {"mention": "pet-ct", "label": "影像检查", "offset": "391"}, {"mention": "肝内胆管癌", "label": "疾病和诊断", "offset": "398"}, {"mention": "肝动脉泵植入术", "label": "手术", "offset": "416"}, {"mention": "肝动脉", "label": "解剖部位", "offset": "442"}, {"mention": "肝", "label": "解剖部位", "offset": "464"}, {"mention": "afp", "label": "实验室检验", "offset": "484"}, {"mention": "ca199", "label": "实验室检验", "offset": "490"}, {"mention": "oxa", "label": "药物", "offset": "519"}, {"mention": "5fu", "label": "药物", "offset": "523"}, {"mention": "afp", "label": "实验室检验", "offset": "534"}, {"mention": "ca199", "label": "实验室检验", "offset": "538"}, {"mention": "肝大", "label": "症状", "offset": "555"}, {"mention": "afp", "label": "实验室检验", "offset": "564"}, {"mention": "ca199", "label": "实验室检验", "offset": "568"}, {"mention": "肝", "label": "解剖部位", "offset": "631"}, {"mention": "肝s8", "label": "解剖部位", "offset": "638"}, {"mention": "肝门", "label": "解剖部位", "offset": "642"}, {"mention": "s8", "label": "解剖部位", "offset": "668"}, {"mention": "肝门", "label": "解剖部位", "offset": "673"}]}
{"text": "5+月前无诱因出现同房后阴道出血,量不多,未在意。3+月前单位体检tct提示hsil,遂于外院行阴道镜检查及宫颈活检,病理经我院会诊提示ciniii,外院查hpv阳性。于2010-6-7行宫颈冷刀锥切术,术后病理:(宫颈1°5°6°8°9°10°11°12°)cin3级,累及腺体;(宫颈2°)叒cin2级;(宫颈7°)鳞状下皮粘膜慢性炎;(宫颈3°4°)鳞状下皮及柱状下皮粘膜慢性炎;各内口及外口切缘净。现要求切除子宫治疗故收入院。饮食睡眠好,大/小便正常,体重无明显减轻。", "mention_data": [{"mention": "阴道出血", "label": "症状", "offset": "12"}, {"mention": "hsil", "label": "疾病和诊断", "offset": "38"}, {"mention": "宫颈", "label": "解剖部位", "offset": "54"}, {"mention": "ciniii", "label": "疾病和诊断", "offset": "68"}, {"mention": "hpv", "label": "实验室检验", "offset": "78"}, {"mention": "宫颈冷刀锥切术", "label": "手术", "offset": "94"}, {"mention": "宫颈", "label": "解剖部位", "offset": "108"}, {"mention": "宫颈", "label": "解剖部位", "offset": "142"}, {"mention": "宫颈", "label": "解剖部位", "offset": "155"}, {"mention": "宫颈", "label": "解剖部位", "offset": "171"}]}
{"text": ",5年前出现血便,1年前出现进食后下腹不适。2013.8.16,我院肠镜检查提示:距肛门15cm乙状结肠腺瘤,直径约1.0cm,,活检病理:乙状结肠绒毛状腺瘤(ii级),2013.8.30给予肠镜上腺瘤电切术。2013.26,我院胃镜检查提示:胃窦粘膜红白相间,花斑样改变,小片状糜烂,,活检病理:幽门型粘膜慢性萎缩性炎伴轻度肠化。2014.5.23行结肠镜检查后出现腹部不适,腹痛,自诉阴道有淡黄色粪便样物流出,不伴发热。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "17"}, {"mention": "肛门", "label": "解剖部位", "offset": "42"}, {"mention": "乙状结肠腺瘤", "label": "疾病和诊断", "offset": "48"}, {"mention": "乙状结肠绒毛状腺瘤(ii级)", "label": "疾病和诊断", "offset": "70"}, {"mention": "肠镜上腺瘤电切术", "label": "手术", "offset": "96"}, {"mention": "胃窦", "label": "解剖部位", "offset": "122"}, {"mention": "幽门型粘膜慢性萎缩性炎伴轻度肠化", "label": "疾病和诊断", "offset": "149"}, {"mention": "腹部不适", "label": "症状", "offset": "184"}, {"mention": "腹痛", "label": "症状", "offset": "189"}, {"mention": "阴道", "label": "解剖部位", "offset": "194"}]}
{"text": ",2014.2诊断直肠癌肝转移,术前予xelox+bev*2。2014年6月行直肠癌手术(本院)。2014-10-22、2014-11-14、2014-12-17行肝转移介入治疗。与叒2015-02-17,腹部mri比较:肝脏多发转移较前增多,大部分增大,小部分略缩小,2015-11-18叒tace,治疗后评效pd。2016.1开始行xeliri+bev*4,末次2016.02.29。化疗期间消化道反应大,乏力,2016-3,本院复查:叒肝脏多发多发转移灶较前缩小。2016-3-21始希罗达+bev,末次2016.6中。2016-5复查sd。2016.7.12复查肺部ct(-);腹盆,ct:吻合口左前上方结节较前略增大,原约11x7mm,现约16*10mm。肝多发转移转移灶介入治疗后,病灶内可见少许碘油沉积;肝脏多发转移灶较前增大,s5段病灶较大层面原约50*33mm,现约62*38mm。叒cea叒1224(2016-5叒300)16-7-25至16-8-15叒化疗xelox叒+叒bev(500mg)*2.无明显不良反应。复查ct提示病灶略增大,评估sd。肿瘤标志物未查。16-9-12至16-10-10叒化疗xelox叒+叒bev(500mg)*2.无明显不良反应。2016-10-29复查胸部ct未见转移征象;腹盆增强ct提示吻合口左前上方结节大致同前;肝脏多发多发转移灶较前略增大,s5病灶原约65x43mm,现约68*43mm。cea叒1247;,ca199:3916。(2016.9.9叒cea叒892.2叒ca199叒2766)2016-11-04叒plt叒77叒未处理,2016-12-02叒plt叒50叒给予巨和粒1支/日*3天,2016-12-06叒plt叒49,治疗后plt叒86。2016-11-7至2016-12-19叒化疗xelox叒+叒贝伐珠单抗(500mg)*2.无明显不良反应。2016-12-26叒总胆红素叒23.3μxxxmol/l,门冬氨酸氨基转移酶叒52iu/l,丙氨酸氨基转移酶叒60iu/l2016-12-26叒,8:33叒,尿常规:尿蛋白叒+-2016-12-2叒ca72.4叒11.94,nse叒34.36ng/ml,cea叒1660ng/ml2017.1.10,复查ct提示:肝脏多发多发转移灶较前增大,s5病灶原约68x43mm,现约76x45mm(im59)。左肺上叶背段小结节灶同前,约4x2mm。双肺未见新发结节及实变影.2017-01-13叒plt叒71叒alt叒68叒ast叒58叒叒cea叒23572017.2复查cea继续升高2017-1-23叒行xelox叒+贝伐珠单抗500mg治疗,过程顺利,无不良反应。2017-2-13叒因病情进展行xiliri+贝伐珠单抗治疗500mg1周期。过程顺利,无不良反应。2017-3-17叒cea叒3039,ca199叒6401,ca72-4叒19.79,ca125叒45.92,nse叒32.19。2017-3-17叒tbil叒50.5,dbil叒26.2,ibil叒24.3,nse叒522017-3-20行xiliri+贝伐珠单抗500mg治疗,2017-4-10行xiliri+贝伐珠单抗500mg治疗,2017-3-27叒tbil叒27.8,dbil叒17.9,ibil叒9.9,alt叒41,ast叒59。wbc叒3.33。2017-4-5叒tbil叒23.2,dbil叒14.4,alt叒41,ast叒59。wbc叒3.08,,neut:1.87。,cea:1969,,ca199:3700,,ca125:39.852017-04-17叒tbil叒39.2,dbil叒21.2,alt叒36,ast叒44。plt叒61。,cea:2698,,ca199:5077,,ca125:45.322017-04-17叒tbil叒21.7,dbil叒13.8,alt叒14,ast叒31。plt叒127。", "mention_data": [{"mention": "直肠癌肝转移", "label": "疾病和诊断", "offset": "9"}, {"mention": "bev", "label": "药物", "offset": "25"}, {"mention": "直肠癌手术(本院)", "label": "手术", "offset": "39"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "82"}, {"mention": "腹部mri", "label": "影像检查", "offset": "103"}, {"mention": "肝脏多发转移", "label": "疾病和诊断", "offset": "111"}, {"mention": "bev", "label": "药物", "offset": "175"}, {"mention": "肝脏", "label": "解剖部位", "offset": "221"}, {"mention": "始希罗达", "label": "药物", "offset": "244"}, {"mention": "bev", "label": "药物", "offset": "249"}, {"mention": "肺部ct", "label": "影像检查", "offset": "285"}, {"mention": "腹盆,ct", "label": "影像检查", "offset": "293"}, {"mention": "肝", "label": "解剖部位", "offset": "333"}, {"mention": "肝脏", "label": "解剖部位", "offset": "359"}, {"mention": "s5段", "label": "解剖部位", "offset": "371"}, {"mention": "cea", "label": "实验室检验", "offset": "401"}, {"mention": "bev", "label": "药物", "offset": "447"}, {"mention": "ct", "label": "影像检查", "offset": "470"}, {"mention": "bev", "label": "药物", "offset": "520"}, {"mention": "胸部ct", "label": "影像检查", "offset": "553"}, {"mention": "腹盆增强ct", "label": "影像检查", "offset": "564"}, {"mention": "吻合口", "label": "解剖部位", "offset": "572"}, {"mention": "肝脏", "label": "解剖部位", "offset": "586"}, {"mention": "s5", "label": "解剖部位", "offset": "601"}, {"mention": "cea", "label": "实验室检验", "offset": "625"}, {"mention": "ca199", "label": "实验室检验", "offset": "635"}, {"mention": "cea", "label": "实验室检验", "offset": "656"}, {"mention": "ca199", "label": "实验室检验", "offset": "666"}, {"mention": "plt", "label": "实验室检验", "offset": "688"}, {"mention": "巨和粒", "label": "药物", "offset": "719"}, {"mention": "plt", "label": "实验室检验", "offset": "741"}, {"mention": "plt", "label": "实验室检验", "offset": "751"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "789"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "823"}, {"mention": "门冬氨酸氨基转移酶", "label": "实验室检验", "offset": "842"}, {"mention": "丙氨酸氨基转移酶", "label": "实验室检验", "offset": "859"}, {"mention": "尿蛋白", "label": "实验室检验", "offset": "896"}, {"mention": "ca72.4", "label": "实验室检验", "offset": "912"}, {"mention": "nse", "label": "实验室检验", "offset": "925"}, {"mention": "cea", "label": "实验室检验", "offset": "940"}, {"mention": "ct", "label": "影像检查", "offset": "965"}, {"mention": "肝脏", "label": "解剖部位", "offset": "970"}, {"mention": "s5", "label": "解剖部位", "offset": "984"}, {"mention": "左肺上叶背段", "label": "解剖部位", "offset": "1014"}, {"mention": "双肺", "label": "解剖部位", "offset": "1034"}, {"mention": "plt", "label": "实验室检验", "offset": "1058"}, {"mention": "alt", "label": "实验室检验", "offset": "1065"}, {"mention": "ast", "label": "实验室检验", "offset": "1072"}, {"mention": "cea", "label": "实验室检验", "offset": "1080"}, {"mention": "cea", "label": "实验室检验", "offset": "1096"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "1121"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "1168"}, {"mention": "cea", "label": "实验室检验", "offset": "1205"}, {"mention": "ca199", "label": "实验室检验", "offset": "1214"}, {"mention": "ca72-4", "label": "实验室检验", "offset": "1225"}, {"mention": "ca125", "label": "实验室检验", "offset": "1238"}, {"mention": "nse", "label": "实验室检验", "offset": "1250"}, {"mention": "tbil", "label": "实验室检验", "offset": "1270"}, {"mention": "dbil", "label": "实验室检验", "offset": "1280"}, {"mention": "ibil", "label": "实验室检验", "offset": "1290"}, {"mention": "nse", "label": "实验室检验", "offset": "1300"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "1323"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "1353"}, {"mention": "tbil", "label": "实验室检验", "offset": "1376"}, {"mention": "dbil", "label": "实验室检验", "offset": "1386"}, {"mention": "ibil", "label": "实验室检验", "offset": "1396"}, {"mention": "alt", "label": "实验室检验", "offset": "1405"}, {"mention": "ast", "label": "实验室检验", "offset": "1412"}, {"mention": "wbc", "label": "实验室检验", "offset": "1419"}, {"mention": "tbil", "label": "实验室检验", "offset": "1437"}, {"mention": "dbil", "label": "实验室检验", "offset": "1447"}, {"mention": "alt", "label": "实验室检验", "offset": "1457"}, {"mention": "ast", "label": "实验室检验", "offset": "1464"}, {"mention": "wbc", "label": "实验室检验", "offset": "1471"}, {"mention": "neut", "label": "实验室检验", "offset": "1481"}, {"mention": "cea", "label": "实验室检验", "offset": "1492"}, {"mention": "ca199", "label": "实验室检验", "offset": "1502"}, {"mention": "ca125", "label": "实验室检验", "offset": "1514"}, {"mention": "tbil", "label": "实验室检验", "offset": "1536"}, {"mention": "dbil", "label": "实验室检验", "offset": "1546"}, {"mention": "alt", "label": "实验室检验", "offset": "1556"}, {"mention": "ast", "label": "实验室检验", "offset": "1563"}, {"mention": "plt", "label": "实验室检验", "offset": "1570"}, {"mention": "cea", "label": "实验室检验", "offset": "1578"}, {"mention": "ca199", "label": "实验室检验", "offset": "1588"}, {"mention": "ca125", "label": "实验室检验", "offset": "1600"}, {"mention": "tbil", "label": "实验室检验", "offset": "1622"}, {"mention": "dbil", "label": "实验室检验", "offset": "1632"}, {"mention": "alt", "label": "实验室检验", "offset": "1642"}, {"mention": "ast", "label": "实验室检验", "offset": "1649"}, {"mention": "plt", "label": "实验室检验", "offset": "1656"}]}
{"text": ",ca199升高,,2016-2-18盆腔ct:右附件占位4.7*4.2cm。,ca199:611.2u/ml。,ca125:91u/ml。月经7天/23天,量中。盆腹,ct:未见异常。,ca199:51.53u/ml。,ca125:44.57u/ml。盆腔,mri:右侧卵巢占位,考虑内膜异位症合并软组织成分待除外肿瘤(参阅2016-2-18外院ct报告,此占位增长不明显)。无不规则出血。无不适。3-6卵巢癌分期术,术后恢复好,偶有腹痛,便秘。阴道少量流液,约1cm大小卫生巾。,术后病理:(全子宫+两附件),切除:叒-叒子宫中分化子宫内膜样腺癌,周围子宫内膜呈增生改变;叒-叒癌浸润肌层(<1/2肌层);叒-叒未见脉管癌栓;叒-叒右左宫旁、大网膜未见癌;叒-叒宫颈粘膜慢性炎;叒-叒右卵巢中分化子宫内膜样腺癌;叒-叒两侧输卵管,左侧卵巢未见癌;叒-叒阑尾慢性炎;叒-叒淋巴结未见癌转移(腹主动脉左旁0/2,腹主动脉右旁0/4,左侧髂总髂外0/4,左侧腹股沟深0/1,左侧髂内闭孔0/2,右侧髂总髂外0/2,右侧腹股沟深0/0,右侧髂内闭孔0/6)。于2017-3-31、4-25、5-17、2017-6-7行紫杉醇+卡铂方案化疗。化验大致正常.2017-6-28再次化疗。今日化疗前检查结果大致正常.。", "mention_data": [{"mention": "ca199", "label": "实验室检验", "offset": "1"}, {"mention": "盆腔ct", "label": "影像检查", "offset": "19"}, {"mention": "右附件", "label": "解剖部位", "offset": "24"}, {"mention": "ca199", "label": "实验室检验", "offset": "40"}, {"mention": "ca125", "label": "实验室检验", "offset": "57"}, {"mention": "盆腹,ct", "label": "影像检查", "offset": "82"}, {"mention": "ca199", "label": "实验室检验", "offset": "94"}, {"mention": "ca125", "label": "实验室检验", "offset": "111"}, {"mention": "盆腔,mri", "label": "影像检查", "offset": "127"}, {"mention": "右侧卵巢", "label": "解剖部位", "offset": "134"}, {"mention": "内膜异位症", "label": "疾病和诊断", "offset": "143"}, {"mention": "ct", "label": "影像检查", "offset": "174"}, {"mention": "卵巢癌分期术", "label": "手术", "offset": "203"}, {"mention": "腹痛", "label": "症状", "offset": "218"}, {"mention": "阴道", "label": "解剖部位", "offset": "224"}, {"mention": "全子宫", "label": "解剖部位", "offset": "248"}, {"mention": "两附件", "label": "解剖部位", "offset": "252"}, {"mention": "子宫中分化子宫内膜样腺癌", "label": "疾病和诊断", "offset": "263"}, {"mention": "子宫", "label": "解剖部位", "offset": "278"}, {"mention": "宫颈", "label": "解剖部位", "offset": "333"}, {"mention": "右卵巢中分化子宫内膜样腺癌", "label": "疾病和诊断", "offset": "344"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "361"}, {"mention": "左侧卵巢", "label": "解剖部位", "offset": "367"}, {"mention": "阑尾慢性炎", "label": "疾病和诊断", "offset": "378"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "396"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "406"}, {"mention": "左侧髂总髂外", "label": "解剖部位", "offset": "416"}, {"mention": "左侧腹股沟", "label": "解剖部位", "offset": "426"}, {"mention": "左侧髂内闭孔", "label": "解剖部位", "offset": "436"}, {"mention": "右侧髂总髂外", "label": "解剖部位", "offset": "446"}, {"mention": "右侧腹股沟", "label": "解剖部位", "offset": "456"}, {"mention": "右侧髂内闭孔", "label": "解剖部位", "offset": "466"}, {"mention": "紫杉醇", "label": "药物", "offset": "507"}, {"mention": "卡铂", "label": "药物", "offset": "511"}]}
{"text": ",患者4个月前因“腹痛2天,加重半天”就诊我科,于2012-10-15全子宫两附件大网膜阑尾切除、腹壁病灶切除术,,术中见:盆腹腔无液体。肝脾胃未及病灶;肠管表面及肠系膜可见散在小的粟粒结节。子宫常大,子宫膀胱反折腹膜明显癌样增厚,与子宫前壁粘连。子宫后壁与肠管前壁粘连。左卵巢瘤手拳大,与阔韧带后叶及肠管粘连,右卵巢鸡卵大,与周围组织粘连,大网膜末端增厚,可见癌灶,左侧腹壁穿刺点病灶大小4-5cm,侵及腹膜,未达肌层,与大网膜末端病灶致密粘连。手术顺利,病理回报(z0442250),:c叒宫壁内见腺样癌巢叒de叒卵巢浆液性囊腺癌(中分化)叒f叒囊壁组织内见腺样癌巢叒g叒网膜组织内见腺样癌巢叒h叒阑尾浆膜面见腺样癌巢。,出院诊断:卵巢浆液性囊腺癌(中分化)iiic期(两侧卵巢、大网膜、盆腔腹膜、肠系膜、阑尾)2次化疗后1个月。患者术前行多西他赛+卡铂方案化疗2次,术后化疗2次,末次化疗时间2012-11-26,现为求补充治疗入我科。出院至今化疗副反应轻微,无头晕头迷,无恶心呕吐,无腹胀腹泻,大小便正常,饮食睡眠可,近期无明显体重变化。\\u0004高血压病史5年。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "9"}, {"mention": "全子宫两附件大网膜阑尾切除、腹壁病灶切除术", "label": "手术", "offset": "35"}, {"mention": "肝", "label": "解剖部位", "offset": "69"}, {"mention": "脾", "label": "解剖部位", "offset": "70"}, {"mention": "胃", "label": "解剖部位", "offset": "71"}, {"mention": "肠", "label": "解剖部位", "offset": "77"}, {"mention": "子宫", "label": "解剖部位", "offset": "96"}, {"mention": "子宫", "label": "解剖部位", "offset": "101"}, {"mention": "膀胱", "label": "解剖部位", "offset": "103"}, {"mention": "子宫", "label": "解剖部位", "offset": "117"}, {"mention": "子宫", "label": "解剖部位", "offset": "124"}, {"mention": "左卵巢瘤", "label": "疾病和诊断", "offset": "136"}, {"mention": "阔韧带后叶", "label": "解剖部位", "offset": "145"}, {"mention": "肠", "label": "解剖部位", "offset": "151"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "156"}, {"mention": "腹", "label": "解剖部位", "offset": "186"}, {"mention": "卵巢浆液性囊腺癌(中分化)", "label": "疾病和诊断", "offset": "259"}, {"mention": "阑尾", "label": "解剖部位", "offset": "301"}, {"mention": "卵巢浆液性囊腺癌(中分化)iiic期", "label": "疾病和诊断", "offset": "318"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "337"}, {"mention": "盆腔", "label": "解剖部位", "offset": "346"}, {"mention": "腹", "label": "解剖部位", "offset": "348"}, {"mention": "肠", "label": "解剖部位", "offset": "351"}, {"mention": "阑尾", "label": "解剖部位", "offset": "355"}, {"mention": "多西他赛", "label": "药物", "offset": "372"}, {"mention": "卡铂", "label": "药物", "offset": "377"}, {"mention": "头晕", "label": "症状", "offset": "434"}, {"mention": "头", "label": "解剖部位", "offset": "436"}, {"mention": "腹胀", "label": "症状", "offset": "446"}, {"mention": "腹泻", "label": "症状", "offset": "448"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "479"}]}
{"text": "2013年4月7日患者因发现胰腺占位3天入我院,4月10日在全麻上行胰十二指肠联合切除术。术后病理:胰腺中分化腺癌伴粘液腺癌,累及胰腺周围脂肪组织及神经组织,有脉管癌栓,胰腺周围淋巴结癌转移3/6,术后病理分期pt3n1。患者恢复顺利,术后行辅助化疗4周期,方案为健择联合替吉奥,复查提示cea升高,行ct检查未见明显异常,继续化疗2周期,再次复查cea继续升高至17ng/ml,复查ct未见明显异常,与家属沟通后,现为行第7次化疗入院,自发病以来,患者精神可,小便可,大便可,饮食可,睡眠可。", "mention_data": [{"mention": "胰腺", "label": "解剖部位", "offset": "14"}, {"mention": "胰十二指肠联合切除术", "label": "手术", "offset": "34"}, {"mention": "胰腺中分化腺癌伴粘液腺癌", "label": "疾病和诊断", "offset": "50"}, {"mention": "胰腺", "label": "解剖部位", "offset": "65"}, {"mention": "胰腺", "label": "解剖部位", "offset": "85"}, {"mention": "健择", "label": "药物", "offset": "132"}, {"mention": "替吉奥", "label": "药物", "offset": "136"}, {"mention": "cea", "label": "实验室检验", "offset": "144"}, {"mention": "ct", "label": "影像检查", "offset": "151"}, {"mention": "cea", "label": "实验室检验", "offset": "174"}, {"mention": "ct", "label": "影像检查", "offset": "192"}]}
{"text": ",患者7月余前无明显诱因出现粘液便血,暗红色,量少,伴大便次数增加至5-8次/天,稀烂,无腹痛、恶心、发热等不适。外院肠镜检查提示距肛门6-10cm肿物,肠镜能通过,活检病理为腺癌。,我院03-16日超声肠镜提示:距肛门约3.5-10cm直肠见环周隆起溃疡型肿物,管腔狭窄,内镜勉强通过,累及外膜层及周围脂肪结缔组织。肿物与前列腺及精囊腺分界尚清,直肠旁见双枚肿大淋巴结低回声,椭圆形,较大约11.6mmx8.5mm,均质,界清,未见淋巴结结构。03-21日ct,示:左肺中叶外侧段、左肺斜裂胸膜上小结节,增殖灶可能性大,不排除转移。mr,提示:直肠中下段肠壁不规则增厚,符合直肠癌(t3n2),环周切缘小于2mm;直肠周围系膜内、骶前多发淋巴结,考虑淋巴结转移可能性大。拟诊断为直肠癌ct3n2mx,为局部晚期,不除外肺转移。我科***教授会诊后拟行同期放化疗。遂于216-03-31、2016-4-21、2016-5-12行xelox方案化疗3程,疗程顺利,2016-04-22,至2016-5-26采用vmat技术:gtv叒50gy/25f,ctv叒46gy/25f。现为上一步化疗特来我院。自下次出院以来,患者精神、睡眠、胃纳可,二便如常,体重无明显上降。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "45"}, {"mention": "肛门", "label": "解剖部位", "offset": "66"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "88"}, {"mention": "肛门", "label": "解剖部位", "offset": "108"}, {"mention": "直肠", "label": "解剖部位", "offset": "119"}, {"mention": "前列腺", "label": "解剖部位", "offset": "162"}, {"mention": "精囊腺", "label": "解剖部位", "offset": "166"}, {"mention": "直肠", "label": "解剖部位", "offset": "174"}, {"mention": "ct", "label": "影像检查", "offset": "229"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "234"}, {"mention": "左肺", "label": "解剖部位", "offset": "242"}, {"mention": "mr", "label": "影像检查", "offset": "267"}, {"mention": "直肠", "label": "解剖部位", "offset": "273"}, {"mention": "直肠癌(t3n2)", "label": "疾病和诊断", "offset": "288"}, {"mention": "直肠", "label": "解剖部位", "offset": "308"}, {"mention": "骶前", "label": "解剖部位", "offset": "316"}, {"mention": "直肠癌ct3n2mx", "label": "疾病和诊断", "offset": "340"}, {"mention": "肺转移", "label": "疾病和诊断", "offset": "360"}, {"mention": "胃", "label": "解剖部位", "offset": "515"}]}
{"text": ",1月前无明显诱因出现腹泻稀薄便,便末带少量鲜血,下午为着,日4-5次,里急后重感明显,无腹痛,无恶心呕吐,无“痔疮”病史,2012-7-9,我院门诊肠镜示:距肛门8-12cm直肠见菜花样肿物,病变累及1/2圈,,活检病理示:中分化腺癌;2012-7-11,盆腔mri提示:直肠中下段占位,考虑直肠癌,侵透浆膜;直肠系膜、直肠下动脉旁、两侧髂血管旁多发淋巴结,转移可能大。,胸部ct示:两肺多发结节结节灶,考虑转移可能大,右上肺原发灶不能除外;肝脏多发低密度灶,考虑囊肿。,cea:18.82ng/ml,余正常,患者为进一步治疗入院,现患者饮食可,大便稀薄便,便末少量带鲜血,日4-5次,小便无明显异常,睡眠可,体重无增减。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "11"}, {"mention": "腹痛", "label": "症状", "offset": "45"}, {"mention": "痔疮", "label": "疾病和诊断", "offset": "56"}, {"mention": "肛门", "label": "解剖部位", "offset": "80"}, {"mention": "直肠", "label": "解剖部位", "offset": "88"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "113"}, {"mention": "盆腔mri", "label": "影像检查", "offset": "129"}, {"mention": "直肠", "label": "解剖部位", "offset": "137"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "147"}, {"mention": "直肠", "label": "解剖部位", "offset": "156"}, {"mention": "直肠下动脉", "label": "解剖部位", "offset": "161"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "168"}, {"mention": "胸部ct", "label": "影像检查", "offset": "187"}, {"mention": "两肺", "label": "解剖部位", "offset": "193"}, {"mention": "右上肺", "label": "解剖部位", "offset": "211"}, {"mention": "肝脏", "label": "解剖部位", "offset": "222"}, {"mention": "cea", "label": "实验室检验", "offset": "237"}]}
{"text": ",患者2015-03-31因“黑便半年”就诊于我院结直肠科,2015-03-31,腹盆mr示:升结肠肿物,考虑为升结肠癌;升结肠系膜多发淋巴结,考虑转移,遂2015-04-09行全麻上“腹腔镜左半结肠切除术”,过程顺利,,术后病理示:符合中分化腺癌,浸润至肠壁浆膜上层,可见脉管内癌栓,未见明确神经束侵犯;淋巴结(2/23)可见癌转移,,分期为:pt3n1bm0叒iiib期,术后恢复可。2015-05-13、2015-06-03、2015-06-28、2015-07-20、2015-08-13、2015-09-09起行xelox方案化疗6程,过程顺利。5程化疗后出现ii度白细胞减少,予升白治疗后恢复。期间3程化疗后于2015-07-15行胸腹盆ct复查未见肿瘤复发转移征象。现为行第7程xelox方案辅助化疗入我科。患者3周来,无发热,胃纳可,睡眠一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "腹盆mr", "label": "影像检查", "offset": "41"}, {"mention": "升结肠", "label": "解剖部位", "offset": "47"}, {"mention": "升结肠癌", "label": "疾病和诊断", "offset": "56"}, {"mention": "升结肠", "label": "解剖部位", "offset": "61"}, {"mention": "腹腔镜左半结肠切除术", "label": "手术", "offset": "93"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "119"}, {"mention": "肠", "label": "解剖部位", "offset": "128"}, {"mention": "白细胞", "label": "实验室检验", "offset": "288"}, {"mention": "胸腹盆ct", "label": "影像检查", "offset": "322"}, {"mention": "胃", "label": "解剖部位", "offset": "371"}]}
{"text": "患者于2016-08下旬,无明显诱因出现下腹痛,以右下腹为主,晚餐进食后明显,与呼吸、运动无明显关系,无放射痛,伴食欲减退,无吞咽梗阻,无恶心呕吐,无呕血黑便,感疲乏困倦,有全身皮肤瘙痒,未见皮疹,无畏寒发热,无盗汗,于2016-08底至2016-09初在当地诊所予“吗丁啉,1粒,bid;藿安正气丸,1粒,bid”口服10天,下述症状有所改善;患者停药后,下述症状再次出现,在当地拟诊为“胃溃疡”,自10.9-10.17予“替普瑞酮,1粒,tid;冸托拉唑,2粒,qd;蒲元和胃胶囊,4粒,bid”护胃治疗,腹痛可有所改善,但仍反复发作,患者遂于2016-11初来我院就诊,完善电子胃镜示胃体、胃窦多发溃疡,考虑淋巴瘤可能性大,hp(2+);行病理活检后回报示弥漫大b细胞性淋巴瘤,gcb型,pet-ct示胃壁部规则增厚代谢活跃,符合淋巴瘤;全身骨髓代谢较活跃,浸润待排;骨髓结果回报示:1.骨髓增生活跃,涂片未见淋巴瘤细胞侵犯骨髓.2.巨系血小板形成过多,但形态未见明显异常。2016-12-23予r-chop方案化疗1程。化疗后出现1度骨髓抑制(wbc3.1*10^9/l),现为为行进一步治疗收住我科拟行化疗。近期患者精神可,无明显腹痛,胃纳改善,无发热、盗汗、无头晕、头痛,无恶心、呕吐,无胸闷、心悸。精神、食欲欠佳,睡眠欠佳。大小便正常。体重上降2kg。", "mention_data": [{"mention": "下腹痛", "label": "症状", "offset": "20"}, {"mention": "右下腹", "label": "解剖部位", "offset": "25"}, {"mention": "吗丁啉", "label": "药物", "offset": "134"}, {"mention": "藿安正气丸", "label": "药物", "offset": "145"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "195"}, {"mention": "替普瑞酮", "label": "药物", "offset": "213"}, {"mention": "冸托拉唑", "label": "药物", "offset": "225"}, {"mention": "蒲元和胃胶囊", "label": "药物", "offset": "236"}, {"mention": "腹痛", "label": "症状", "offset": "255"}, {"mention": "胃体、胃窦多发溃疡", "label": "疾病和诊断", "offset": "295"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "307"}, {"mention": "弥漫大b细胞性淋巴瘤", "label": "疾病和诊断", "offset": "331"}, {"mention": "pet-ct", "label": "影像检查", "offset": "347"}, {"mention": "胃", "label": "解剖部位", "offset": "354"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "368"}, {"mention": "骨髓", "label": "解剖部位", "offset": "374"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "408"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "471"}, {"mention": "腹痛", "label": "症状", "offset": "520"}, {"mention": "胃", "label": "解剖部位", "offset": "523"}, {"mention": "头晕", "label": "症状", "offset": "536"}, {"mention": "头痛", "label": "症状", "offset": "539"}, {"mention": "胸闷", "label": "症状", "offset": "550"}, {"mention": "心悸", "label": "症状", "offset": "553"}]}
{"text": ",因下腹部痛行胃镜提示:胃窦巨大溃疡,病理示中分化腺癌。,腹部ct提示:肝脏实性占位。腹腔淋巴结肿大,考虑转移。cea叒101。2015-4-27叒入组heloise,行xp+赫赛汀*4,,末次:2015-6-29;pd。入组吡咯替尼治疗。2016-02-25叒,15:,27:07叒叒,ct:468437,对比2015-12-25腹盆ct比较,,较前进展:1.胃窦部胃壁不规则增厚,较前加重,较厚处现约55mm(im75),表面溃疡同前,与胃周淋巴结部分融合;病变向下累及胃角、与正常胃壁分界不清同前,浆膜面模糊;胃壁后方局部与胰腺脂肪间隙消失;肝胃韧带密度增高,多发索条影同前相仿。腹腔及腹膜后多发淋巴结,较前增大、增多,如原约37x23mm,现约42x40mm(im75),大网膜略增厚加重。少量盆腔积液征象。2.肝多发转移灶,较前增大、增多,如原约102x77mm,现约133x105mm(im59)。", "mention_data": [{"mention": "下腹部痛", "label": "症状", "offset": "2"}, {"mention": "胃窦巨大溃疡", "label": "疾病和诊断", "offset": "12"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "腹部ct", "label": "影像检查", "offset": "29"}, {"mention": "肝脏", "label": "解剖部位", "offset": "36"}, {"mention": "腹腔淋巴结", "label": "解剖部位", "offset": "43"}, {"mention": "cea", "label": "实验室检验", "offset": "56"}, {"mention": "赫赛汀", "label": "药物", "offset": "88"}, {"mention": "吡咯替尼", "label": "药物", "offset": "113"}, {"mention": "ct", "label": "影像检查", "offset": "144"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "166"}, {"mention": "胃窦部", "label": "解剖部位", "offset": "181"}, {"mention": "胃", "label": "解剖部位", "offset": "184"}, {"mention": "胃周淋巴结", "label": "解剖部位", "offset": "221"}, {"mention": "胃角", "label": "解剖部位", "offset": "237"}, {"mention": "胃", "label": "解剖部位", "offset": "243"}, {"mention": "胃", "label": "解剖部位", "offset": "258"}, {"mention": "胰腺", "label": "解剖部位", "offset": "265"}, {"mention": "肝胃韧带", "label": "解剖部位", "offset": "274"}, {"mention": "腹腔", "label": "解剖部位", "offset": "293"}, {"mention": "腹", "label": "解剖部位", "offset": "296"}, {"mention": "盆腔积液", "label": "疾病和诊断", "offset": "351"}, {"mention": "肝多发转移", "label": "疾病和诊断", "offset": "360"}]}
{"text": "2015-11自及左腹股沟肿物,当地穿刺病理提示反应性增生,其后发现左髂外占位,petct提示恶性。2016-4-7当地骨科腹膜外左髂窝占位活检,病理经我院会诊提示转移性腺癌。ck7-,ck20-。当地tct及hpv无异常。无阴道异常出血或排液。cea、ca199及ca72.4升高。我院复查pet/ct仍未发现原发灶。2016-5-16我院妇科手术,大网膜\\\\左侧结肠旁沟腹膜活检\\\\左附件\\\\左侧盆腔淋巴结\\\\右侧结肠旁沟腹膜\\\\后陷凹腹膜\\\\阑尾\\\\胃壁外生性结节\\\\全子宫+右附件手术切除,结合外院及本院免疫组化结果符合淋巴结转移性低分化腺癌,肿瘤细胞分化差,考虑原发病灶不明的转移性低分化腺癌。2016-6-14开始放疗:ctv(盆腔引流区+左腹股沟淋巴结)叒45gy/25f。放疗20次,左腹股沟区压痛。2016-6-21tp方案化疗,紫杉醇过敏(颜面部水肿),停用,2016-6-22改用培美曲赛化疗.无恶心呕吐,腹泻明显,5-6次/日。2016-7-14多西他赛+ddp。2016-8-18我科行多西他赛+伯尔定化疗1疗程,化疗后无不适。", "mention_data": [{"mention": "左腹股沟", "label": "解剖部位", "offset": "9"}, {"mention": "petct", "label": "影像检查", "offset": "40"}, {"mention": "腹膜外左髂窝", "label": "解剖部位", "offset": "62"}, {"mention": "转移性腺癌", "label": "疾病和诊断", "offset": "82"}, {"mention": "阴道", "label": "解剖部位", "offset": "113"}, {"mention": "cea", "label": "实验室检验", "offset": "123"}, {"mention": "ca199", "label": "实验室检验", "offset": "127"}, {"mention": "ca72.4", "label": "实验室检验", "offset": "133"}, {"mention": "pet/ct", "label": "影像检查", "offset": "146"}, {"mention": "结肠旁沟", "label": "解剖部位", "offset": "183"}, {"mention": "左附件", "label": "解剖部位", "offset": "193"}, {"mention": "左侧盆腔淋巴结", "label": "解剖部位", "offset": "198"}, {"mention": "结肠旁沟", "label": "解剖部位", "offset": "209"}, {"mention": "腹", "label": "解剖部位", "offset": "220"}, {"mention": "阑尾", "label": "解剖部位", "offset": "224"}, {"mention": "胃", "label": "解剖部位", "offset": "228"}, {"mention": "全子宫+右附件手术切除", "label": "手术", "offset": "237"}, {"mention": "淋巴结转移性低分化腺癌", "label": "疾病和诊断", "offset": "264"}, {"mention": "转移性低分化腺癌", "label": "疾病和诊断", "offset": "293"}, {"mention": "盆腔", "label": "解剖部位", "offset": "320"}, {"mention": "左腹股沟淋巴结", "label": "解剖部位", "offset": "326"}, {"mention": "左腹股沟区", "label": "解剖部位", "offset": "350"}, {"mention": "紫杉醇", "label": "药物", "offset": "374"}, {"mention": "培美曲赛", "label": "药物", "offset": "401"}, {"mention": "腹泻", "label": "症状", "offset": "414"}, {"mention": "多西他赛", "label": "药物", "offset": "435"}, {"mention": "ddp", "label": "药物", "offset": "440"}, {"mention": "多西他赛", "label": "药物", "offset": "456"}, {"mention": "伯尔定", "label": "药物", "offset": "461"}]}
{"text": "体检发现宫颈病变2月,hpv(+),hsil,宫颈活检提示局灶可疑早期浸润。我院病理会诊提示宫颈镜上微小浸润癌。平时白带无明显异常,无同房出血。近来经前及经后阴道少许淋漓出血。2015-9-7宫颈冷刀锥切,术后病理7°xxx8°xxxg2鳞癌。术后阴道出血不多,月经来潮1次,lmp2015-9-20右左,正常。2015-11-2行腹腔镜宫颈癌根治术,术后病理未及癌残余,淋巴结未及转移。排尿可。阴道分泌物不多。大便干燥,偶有服药及局部开塞露治疗,近来未特殊处理,可自行排大便。无两上肢浮肿。", "mention_data": [{"mention": "宫颈", "label": "解剖部位", "offset": "4"}, {"mention": "hpv", "label": "实验室检验", "offset": "11"}, {"mention": "hsil", "label": "疾病和诊断", "offset": "18"}, {"mention": "宫颈", "label": "解剖部位", "offset": "23"}, {"mention": "阴道", "label": "解剖部位", "offset": "79"}, {"mention": "宫颈冷刀锥切", "label": "手术", "offset": "96"}, {"mention": "鳞癌", "label": "疾病和诊断", "offset": "119"}, {"mention": "阴道出血", "label": "症状", "offset": "124"}, {"mention": "腹腔镜宫颈癌根治术", "label": "手术", "offset": "166"}, {"mention": "开塞露", "label": "药物", "offset": "218"}, {"mention": "两上肢", "label": "解剖部位", "offset": "240"}]}
{"text": ",患者于今年9月因“绝经后阴道出血”,在******健院行宫颈活检示:(宫颈)恶性肿瘤,符合腺癌。,查hpv示:未发现人乳头瘤病毒感染。遂转诊我院,行病理会诊(h147151)(宫颈)病变符合低分化腺癌。,查ct示:宫颈肿块,符合宫颈癌;少量盆腔积液;双侧宫旁未见明显肿大淋巴结;肝s2囊肿;右肾小囊肿;叒左前心膈角、腹主动脉旁淋巴结稍大;两上肺慢性炎症、坠积性改变。叒拟“宫颈腺癌ib1期”于2014年12月9日行\\\"腹腔镜上探查+开腹全子宫两附件切除+大网膜切除术\\\"。术中见子宫形状规则,大小6*5*4cm,形态无异常,右卵巢肉眼观无明显异常,右输卵管输卵管壶腹部见大小4*3*3cm菜花状肿物,左附件肉眼观无明显异常,大网膜见一大小6*5*4cm肿物,乙状结肠前壁、直肠前壁、膀胱后壁、直肠窝及部分肠系膜表面见直径0.2-1cm不等种植结节。,术后剖视标本:子宫大小6*5*4cm,内膜未见明显病变,宫颈糜烂状,右输卵管输卵管壶腹部4*3*3cm大小菜花状肿物,质脆。术程顺利,术后予防感染、补液治疗。叒,术后病理示:(直肠表面结节),镜上:纤维结缔组织中见高级别浆液性癌浸润。(肠表面结节)镜上为脂肪结缔组织,未见癌。(子宫+右附件),镜上:输卵管及卵巢组织中见癌组织呈片状或乳头状生长,细胞有异型,核分裂像易见,结合免疫组化结果,符合高级别浆液性癌,另于宫颈外膜及宫颈浆膜层中见高级别浆液性癌浸润;宫颈粘膜慢性炎;子宫平滑肌瘤;萎缩性宫内膜。(左附件),镜上:输卵管及卵巢组织中见高级别浆液性癌浸润。(大网膜),镜上:脂肪结缔组织中见高级别浆液性癌浸润。(乙状结肠肠脂垂),镜上:脂肪结缔组织中见高级别浆液性癌浸润。,诊断:右输卵管输卵管浆液性腺癌iiic期。于2014-12-15、2015-01-06、2015-02-03及2015-02-26予tc方案(泰素210mg+卡铂500mg)化疗4程,过程顺利。出院后定期复查血常规无异常。今为行上一程化疗入住我科。今患者精神、胃纳、睡眠可,大小便正常,近期体重无明显减轻。", "mention_data": [{"mention": "阴道出血", "label": "症状", "offset": "13"}, {"mention": "(宫颈)恶性肿瘤", "label": "疾病和诊断", "offset": "35"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "46"}, {"mention": "hpv", "label": "实验室检验", "offset": "51"}, {"mention": "宫颈", "label": "解剖部位", "offset": "89"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "96"}, {"mention": "ct", "label": "影像检查", "offset": "104"}, {"mention": "宫颈", "label": "解剖部位", "offset": "108"}, {"mention": "宫颈癌", "label": "疾病和诊断", "offset": "115"}, {"mention": "盆腔积液", "label": "疾病和诊断", "offset": "121"}, {"mention": "肝s2囊肿", "label": "疾病和诊断", "offset": "140"}, {"mention": "右肾小囊肿", "label": "疾病和诊断", "offset": "146"}, {"mention": "左前心膈角", "label": "解剖部位", "offset": "153"}, {"mention": "腹主动脉旁淋巴结", "label": "解剖部位", "offset": "159"}, {"mention": "两上肺", "label": "解剖部位", "offset": "170"}, {"mention": "宫颈腺癌ib1期", "label": "疾病和诊断", "offset": "187"}, {"mention": "腹腔镜上探查+开腹全子宫两附件切除+大网膜切除术", "label": "手术", "offset": "210"}, {"mention": "子宫", "label": "解剖部位", "offset": "240"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "263"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "275"}, {"mention": "输卵管壶腹部", "label": "解剖部位", "offset": "279"}, {"mention": "左附件", "label": "解剖部位", "offset": "301"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "330"}, {"mention": "直肠", "label": "解剖部位", "offset": "337"}, {"mention": "膀胱", "label": "解剖部位", "offset": "342"}, {"mention": "直肠窝", "label": "解剖部位", "offset": "347"}, {"mention": "肠", "label": "解剖部位", "offset": "353"}, {"mention": "子宫", "label": "解剖部位", "offset": "383"}, {"mention": "宫颈", "label": "解剖部位", "offset": "404"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "410"}, {"mention": "输卵管壶腹部", "label": "解剖部位", "offset": "414"}, {"mention": "直肠", "label": "解剖部位", "offset": "464"}, {"mention": "子宫", "label": "解剖部位", "offset": "515"}, {"mention": "右附件", "label": "解剖部位", "offset": "518"}, {"mention": "输卵管", "label": "解剖部位", "offset": "526"}, {"mention": "卵巢", "label": "解剖部位", "offset": "530"}, {"mention": "浆液性癌", "label": "疾病和诊断", "offset": "576"}, {"mention": "宫颈", "label": "解剖部位", "offset": "583"}, {"mention": "宫颈", "label": "解剖部位", "offset": "588"}, {"mention": "宫颈", "label": "解剖部位", "offset": "605"}, {"mention": "子宫平滑肌瘤", "label": "疾病和诊断", "offset": "613"}, {"mention": "左附件", "label": "解剖部位", "offset": "628"}, {"mention": "输卵管", "label": "解剖部位", "offset": "636"}, {"mention": "卵巢", "label": "解剖部位", "offset": "640"}, {"mention": "乙状结肠肠脂垂", "label": "解剖部位", "offset": "684"}, {"mention": "右输卵管输卵管浆液性腺癌iiic期", "label": "疾病和诊断", "offset": "718"}, {"mention": "泰素", "label": "药物", "offset": "786"}, {"mention": "卡铂", "label": "药物", "offset": "794"}, {"mention": "胃", "label": "解剖部位", "offset": "845"}]}
{"text": ",患者于4个月(2014-1)前无明显诱因出现右上腹疼痛症状,间歇性痛,大便前及排气前疼痛,大便后及排气后疼痛缓解,伴里急后重感,无腹胀,无肛周疼痛,无恶心呕吐。并出现黑便,便细,1次/天,无便血。患者自述曾经平卧位时可触及右上腹肿块。,后就诊于****行肠镜提示:距肛门30cm见一隆起性病变,环肠壁3/4,表面凹凸不平,有糜烂、破溃及出血。,病理诊断:结肠锯齿状腺瘤,结肠腺癌(中分化)。,全腹增强ct提示:肠腔占位性病变。3个月前(2014-3-12)于全麻上行d3直肠癌前切除术。,术后病理:,浸润深度:ss。,进展期直肠癌:浸润溃疡型,中分化管状腺癌,断端无癌,淋巴结未见转移癌(0/32枚),dukes“b”期。(,病理号:164000)。1月余前于(2014-4)行xelox方案化疗2周期,,具体为:奥沙利铂(艾恒)200毫克d1,卡培他滨(希罗达)1.5,日2次d1-14。病人为求进一步诊治入我科,自病来无发热,精神、睡眠尚可,饮食尚可,小便如常,大便如前所述,体重未见明显改变。叒近1个月患者血压值偏高,最高值达160/90mmhg,自服络活喜降压药物。", "mention_data": [{"mention": "右上腹", "label": "解剖部位", "offset": "23"}, {"mention": "腹胀", "label": "症状", "offset": "66"}, {"mention": "肛周", "label": "解剖部位", "offset": "70"}, {"mention": "右上腹", "label": "解剖部位", "offset": "112"}, {"mention": "肛门", "label": "解剖部位", "offset": "134"}, {"mention": "肠", "label": "解剖部位", "offset": "149"}, {"mention": "结肠锯齿状腺瘤", "label": "疾病和诊断", "offset": "178"}, {"mention": "结肠腺癌(中分化)", "label": "疾病和诊断", "offset": "186"}, {"mention": "全腹增强ct", "label": "影像检查", "offset": "197"}, {"mention": "肠", "label": "解剖部位", "offset": "206"}, {"mention": "直肠癌前切除术", "label": "手术", "offset": "236"}, {"mention": "进展期直肠癌:浸润溃疡型,中分化管状腺癌", "label": "疾病和诊断", "offset": "260"}, {"mention": "奥沙利铂", "label": "药物", "offset": "358"}, {"mention": "艾恒", "label": "药物", "offset": "363"}, {"mention": "卡培他滨", "label": "药物", "offset": "374"}, {"mention": "希罗达", "label": "药物", "offset": "379"}, {"mention": "络活喜", "label": "药物", "offset": "480"}]}
{"text": "3月前因便秘,发现直肠肿物,mri示直肠中上段肿物。行肠镜上穿刺检查,病理结果示直肠上段中分化腺癌伴粘液分泌,乙状结肠腺瘤。盆腔ct示直肠上段占位,肛提肌受累不除外,直肠肠周及直肠下动脉走行区见多发肿大淋巴结。腹部mr示肝内多发低密度密度结节。胸部ct扫面未见占位征象,完善分期检查,ct4an2a,现为行术前放化疗。放疗计划:gtv50.6gy/ctv41.8gy/22f,3-2放疗结束。现患者已放疗后3月。患者诉拒绝肠造口。", "mention_data": [{"mention": "直肠", "label": "解剖部位", "offset": "9"}, {"mention": "mri", "label": "影像检查", "offset": "14"}, {"mention": "直肠", "label": "解剖部位", "offset": "18"}, {"mention": "直肠上段中分化腺癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "乙状结肠腺瘤", "label": "疾病和诊断", "offset": "55"}, {"mention": "盆腔ct", "label": "影像检查", "offset": "62"}, {"mention": "直肠", "label": "解剖部位", "offset": "67"}, {"mention": "肛提肌", "label": "解剖部位", "offset": "74"}, {"mention": "直肠", "label": "解剖部位", "offset": "83"}, {"mention": "直肠下动脉", "label": "解剖部位", "offset": "88"}, {"mention": "腹部mr", "label": "影像检查", "offset": "105"}, {"mention": "肝", "label": "解剖部位", "offset": "110"}, {"mention": "胸部ct", "label": "影像检查", "offset": "122"}, {"mention": "肠", "label": "解剖部位", "offset": "211"}]}
{"text": ",患者2012.01因宫颈癌2程化疗后27天入院,2012.01.29在气管内吸入麻醉行宫颈癌根治术+两侧输卵管切除术+两侧卵巢悬吊术。,病理结果:宫颈粘膜见溃疡形成,伴有组织细胞增生,多点区域见ciniii累及腺体,未见明确间质浸润;子宫平滑肌瘤;增殖期子宫内膜。盆腔淋巴结未见癌,两侧输卵管粘膜慢性炎。2月6日予艾素110mg、ddp110mg(分d1-d3)化疗。之后定期复查,于2013.01.21复查发现阴道残端赘生物,,行活检病理示:符合乳头状鳞状细胞癌,因肿瘤以外生性生长为主,未见明确间质浸润,今为求进一步放疗来我科就诊。患者发病以来饮食睡眠尚可,大小便正常,体重无减轻。", "mention_data": [{"mention": "宫颈癌", "label": "疾病和诊断", "offset": "11"}, {"mention": "气管", "label": "解剖部位", "offset": "36"}, {"mention": "宫颈癌根治术+两侧输卵管切除术+两侧卵巢悬吊术", "label": "手术", "offset": "44"}, {"mention": "宫颈", "label": "解剖部位", "offset": "74"}, {"mention": "ciniii", "label": "疾病和诊断", "offset": "98"}, {"mention": "子宫平滑肌瘤", "label": "疾病和诊断", "offset": "118"}, {"mention": "子宫", "label": "解剖部位", "offset": "128"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "133"}, {"mention": "两侧输卵管", "label": "解剖部位", "offset": "142"}, {"mention": "艾素", "label": "药物", "offset": "158"}, {"mention": "ddp", "label": "药物", "offset": "166"}, {"mention": "阴道", "label": "解剖部位", "offset": "207"}, {"mention": "乳头状鳞状细胞癌", "label": "疾病和诊断", "offset": "225"}]}
{"text": ",2012-10-16外院行全子宫+两附件切除+盆腔淋巴结清扫术+肠粘连分解术,术后病理示子宫内膜混合性癌,2012-11-6我院病理会诊示子宫内膜浆液性癌;浆液性癌侵犯至深肌层(癌距离子宫浆膜表面的距离少于1毫米);可见大量脉管癌栓。转移性子宫浆液性癌3/11。2012-11-16行tp方案化疗1周期,2012-12-3至2013-1-9放疗50gy/25f。2012-12-12、2013-1-9行tp化疗2周期.2014-6-24患者右锁下下淋巴结淋巴结肿大,约2*2cm大小。2014-7-24至2014-8-28放疗,gtv60gy/ctv50gy/25f/35d。,复查颈部超声:右颈根至锁骨下多发肿大淋巴结,较前稍小。盆腔,mri:盆腔内多发结节,转移?密切追查。2014-10-08叒癌抗原125叒25.74u/ml恢复正常。,2014-10-29腹部ct:扫及胰头下方结节。,2014-10-31盆腔mr:盆腔内散在、多发稍长t1稍长t1稍长t2信号长t2信号结节较前增大、增多,原较大约9x7mm(se6叒im5),现约15x11mm(se4叒im4),现较大约16x13mm(se4叒im11),原约6mm(se6叒im12),考虑转移。2014-11-17复查血常规及肝肾功正常,cea34.54ng/ml。2014-11-19tp(多帕菲120mgd1+奈达铂60mgd1-3)化疗一周期,化疗后恶心、呕吐、便秘。2014-12-22第2周期tp化疗。化疗后恶心、呕吐,乏力。12-30复查血常规示白细胞2.65*10^9/l。", "mention_data": [{"mention": "全子宫+两附件切除+盆腔淋巴结清扫术+肠粘连分解术", "label": "手术", "offset": "14"}, {"mention": "子宫内膜混合性癌", "label": "疾病和诊断", "offset": "45"}, {"mention": "子宫内膜浆液性癌", "label": "疾病和诊断", "offset": "70"}, {"mention": "子宫", "label": "解剖部位", "offset": "93"}, {"mention": "转移性子宫浆液性癌", "label": "疾病和诊断", "offset": "118"}, {"mention": "右锁下下淋巴结", "label": "解剖部位", "offset": "221"}, {"mention": "颈", "label": "解剖部位", "offset": "298"}, {"mention": "锁骨", "label": "解剖部位", "offset": "301"}, {"mention": "盆腔,mri", "label": "影像检查", "offset": "317"}, {"mention": "盆腔", "label": "解剖部位", "offset": "324"}, {"mention": "癌抗原125", "label": "实验室检验", "offset": "351"}, {"mention": "腹部ct", "label": "影像检查", "offset": "383"}, {"mention": "胰头", "label": "解剖部位", "offset": "390"}, {"mention": "盆腔mr", "label": "影像检查", "offset": "408"}, {"mention": "盆腔", "label": "解剖部位", "offset": "413"}, {"mention": "cea", "label": "实验室检验", "offset": "553"}, {"mention": "多帕菲", "label": "药物", "offset": "580"}, {"mention": "奈达铂", "label": "药物", "offset": "591"}, {"mention": "白细胞", "label": "实验室检验", "offset": "663"}]}
{"text": ",2015-03因大便带血行相关检查诊断直肠癌,距肛不详,当地2015-03-31行直肠癌根治术(dixon),,术后病理:中低分化腺癌,肠壁全层,断端阴性,淋巴结0/10。mss。ki67叒80%。,术后化疗:xelox叒5周期,末次2015-08。无放疗。因便血,当地2015-10-23复查腹盆ct未见明显复发转移征象,2015-11-02复查肠镜提示距肛4cm吻合口处充血、糜烂,,活检病理:轻中度急慢性炎,肉芽组织增生。近期肿标正常。15-10-23叒当地复查ct无明显复发转移征象。近期进食尚可,仍有大便带血,体重稳定。2016.2.29,复查肠镜示:吻合口炎16-6叒本院复查,。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "20"}, {"mention": "肛", "label": "解剖部位", "offset": "25"}, {"mention": "直肠癌根治术(dixon)", "label": "手术", "offset": "42"}, {"mention": "中低分化腺癌", "label": "疾病和诊断", "offset": "62"}, {"mention": "肠", "label": "解剖部位", "offset": "69"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "148"}, {"mention": "肛", "label": "解剖部位", "offset": "180"}, {"mention": "吻合口", "label": "解剖部位", "offset": "184"}, {"mention": "ct", "label": "影像检查", "offset": "235"}, {"mention": "吻合口炎", "label": "疾病和诊断", "offset": "282"}]}
{"text": ",患者3月前发现小便颜色变红,不伴尿痛等,当时未予重视。2月前患者自觉排尿时烧灼感,伴排尿中断,至我院门诊就诊,,查前列腺特异性抗原:24.540;b,超:前列腺增生;左肾囊肿;残余尿50ml。怀疑良性前列腺增生、前列腺炎症,予盐酸坦洛新缓释胶囊1#qd,乳酸右氧氟沙星片1#qd口服。后症状未缓解,1月前复诊,,查前列腺特异性抗原:27.200;,血常规:红细胞计数叒3.91x10^12/l;血红蛋白叒128g/l;红细胞压积叒37.2%;,心电图:1.窦性心动过缓叒2.t波改变(以r波为主导联t波均低平、两相)。予头孢克肟胶囊1#bid,肾下腺色腙片1#tid口服。行经直肠超声引导上前列腺穿刺活检,,次日病理结果显示:前列腺腺癌,gleason's评分4+4=8分。予比卡鲁胺片口服,出现皮疹后停药。2014-4-17行全身骨显像+,骨断层显像:右侧第10后肋及腰椎多发放射性略浓聚灶;胸12椎体,骶骨转移可能;胸腰椎退变。,2014-04-22本院ct:前列腺增生,左后外周带隆起伴强化,建议mr。2,天前查前列腺特异性抗原:3.560。现为行两侧睾丸切除术收住入院。患者自起病来,精神胃纳可,小便同前所述,大便正常,体重无明显上降。", "mention_data": [{"mention": "前列腺特异性抗原", "label": "实验室检验", "offset": "58"}, {"mention": "b,超", "label": "影像检查", "offset": "74"}, {"mention": "前列腺增生", "label": "疾病和诊断", "offset": "78"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "84"}, {"mention": "良性前列腺增生", "label": "疾病和诊断", "offset": "99"}, {"mention": "前列腺", "label": "解剖部位", "offset": "107"}, {"mention": "盐酸坦洛新缓释胶囊", "label": "药物", "offset": "114"}, {"mention": "乳酸右氧氟沙星", "label": "药物", "offset": "128"}, {"mention": "前列腺特异性抗原", "label": "实验室检验", "offset": "158"}, {"mention": "红细胞计数", "label": "实验室检验", "offset": "179"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "198"}, {"mention": "红细胞压积", "label": "实验室检验", "offset": "210"}, {"mention": "心电图", "label": "影像检查", "offset": "223"}, {"mention": "窦性心动过缓", "label": "疾病和诊断", "offset": "229"}, {"mention": "头孢克肟胶囊", "label": "药物", "offset": "261"}, {"mention": "肾下腺色腙片", "label": "药物", "offset": "273"}, {"mention": "前列腺腺癌", "label": "疾病和诊断", "offset": "314"}, {"mention": "比卡鲁胺片", "label": "药物", "offset": "339"}, {"mention": "全身骨显像+,骨断层显像", "label": "影像检查", "offset": "365"}, {"mention": "右侧第10后肋", "label": "解剖部位", "offset": "378"}, {"mention": "腰椎", "label": "解剖部位", "offset": "386"}, {"mention": "胸12椎体,骶骨转移", "label": "疾病和诊断", "offset": "398"}, {"mention": "胸腰椎", "label": "解剖部位", "offset": "411"}, {"mention": "ct", "label": "影像检查", "offset": "430"}, {"mention": "前列腺增生", "label": "疾病和诊断", "offset": "433"}, {"mention": "mr", "label": "影像检查", "offset": "452"}, {"mention": "前列腺特异性抗原", "label": "实验室检验", "offset": "460"}, {"mention": "两侧睾丸切除术", "label": "手术", "offset": "478"}]}
{"text": "患者因“进食后阻塞感2周”在我院诊断为胸下段食管鳞癌,于2011-6-9行力朴素+奥先达化疗一程。并于2011-6-13至2011-7-19行根治性反射治疗,原发灶65gy,区域淋巴结50gy,过程顺利。放疗后吞咽困难症状缓解。1月前又出现吞咽困难,进食流质困难,偶有饮水呛咳,行胃镜检查示食管距门齿约20cm右前壁见结节样肿物,活检为鳞状细胞癌。诊断为食管癌放化疗后复发,于2011-12-1行力朴素+奥先达化疗一程。效果差,于内科就诊,内科认为患者现不适合化疗,建议行胃造瘘术。行胃镜检查示食管距门齿约16-25cm见食管肿物,覆盖大量白色坏死物,距门齿约20cm见瘘口,窦道形成。现为行胃造瘘术收入我科。现患者诉吞咽困难,进食流质困难,咳嗽,咳白色粘液痰,量多,无发热,气促,无胸痛,胸闷,无恶心,呕吐,无腹痛,腹泻。精神一般,胃纳差,二便正常。体重上降约5kg。", "mention_data": [{"mention": "胸下段食管鳞癌", "label": "疾病和诊断", "offset": "19"}, {"mention": "力朴素", "label": "药物", "offset": "37"}, {"mention": "奥先达", "label": "药物", "offset": "41"}, {"mention": "食管", "label": "解剖部位", "offset": "145"}, {"mention": "门齿", "label": "解剖部位", "offset": "148"}, {"mention": "鳞状细胞癌", "label": "疾病和诊断", "offset": "168"}, {"mention": "食管癌放化疗后复发", "label": "疾病和诊断", "offset": "177"}, {"mention": "力朴素", "label": "药物", "offset": "198"}, {"mention": "奥先达", "label": "药物", "offset": "202"}, {"mention": "胃造瘘术", "label": "手术", "offset": "236"}, {"mention": "食管", "label": "解剖部位", "offset": "247"}, {"mention": "门齿", "label": "解剖部位", "offset": "250"}, {"mention": "食管", "label": "解剖部位", "offset": "261"}, {"mention": "门齿", "label": "解剖部位", "offset": "277"}, {"mention": "胃造瘘术", "label": "手术", "offset": "296"}, {"mention": "胸痛", "label": "症状", "offset": "342"}, {"mention": "胸闷", "label": "症状", "offset": "345"}, {"mention": "腹痛", "label": "症状", "offset": "356"}, {"mention": "腹泻", "label": "症状", "offset": "359"}, {"mention": "胃", "label": "解剖部位", "offset": "367"}]}
{"text": ",2012-6-19行开腹探查,直肠癌切除,结肠造瘘术,术中疑有肝转移。,术后病理:直肠溃疡型中分化腺癌,约4.0*3.5cm,侵及肠壁全层并与两侧卵巢炎性粘连,可见脉管癌栓,淋巴结3/15,断端未见癌。术后于2012-7-9开始xelox方案化疗5周期,未放疗,4周期后于2012-11行肝转移灶射频消融术。2013-1因肝转移灶增大,予贝伐珠单抗+伊立体\\u0004\\u0004替康化疗一周期,因肝转氨酶升高,停用贝伐,后又单用伊立替康化疗一周期。,2013-6-25复查ct:肝转移灶增多、增大,骶前多发软组织结节,转移?盆腔少量积液,右肺上叶小结节性质待定。kras野生型。\\u0004\\u0004目前肛门坠胀感,饮食可,睡眠差,体重上降2kg。2013-6开始爱必妥/***7周期,末次治疗时间2013-8-27.评效缩小的sd,。", "mention_data": [{"mention": "开腹探查,直肠癌切除,结肠造瘘术", "label": "手术", "offset": "11"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "32"}, {"mention": "直肠溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "42"}, {"mention": "肠", "label": "解剖部位", "offset": "66"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "72"}, {"mention": "肝转移灶射频消融术", "label": "手术", "offset": "145"}, {"mention": "肝转移", "label": "症状", "offset": "162"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "170"}, {"mention": "伊立体\\u0004\\u0004替康", "label": "药物", "offset": "176"}, {"mention": "肝转氨酶", "label": "实验室检验", "offset": "200"}, {"mention": "贝伐", "label": "药物", "offset": "209"}, {"mention": "伊立替康", "label": "药物", "offset": "216"}, {"mention": "ct", "label": "影像检查", "offset": "238"}, {"mention": "肝转移", "label": "症状", "offset": "241"}, {"mention": "骶前", "label": "解剖部位", "offset": "251"}, {"mention": "盆腔", "label": "解剖部位", "offset": "264"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "271"}, {"mention": "肛门坠胀", "label": "症状", "offset": "305"}, {"mention": "爱必妥", "label": "药物", "offset": "335"}]}
{"text": ",2016-4月间断便血1月。外院肠镜见距肛门10cm。病理为高级别下皮内瘤变,部分可见黏膜内癌,完善分期检查,ct3n2b,外科建议术前放化疗,2016-5-12至2016-6-3完成gtv叒51gy叒ctv叒40.8gy/34f叒bid叒d1-d5/w。2016-8-11行lar手术,,术后病理:直肠中分化腺癌,部分伴细胞外黏液,,肿瘤消退分级:轻度反应,未见脉管癌栓及神经侵犯;肠周淋巴结7/9,另见多个癌结节(>10),病理分期ypt3n2b,cm0。术后辅以化疗8周期(xelox*5,卡培他滨单药*3),末次化疗时间2017-1;治疗结束后定期复查,ct未见明显异常;2017-7-11至2017-10-13期间多次复查cea由7.32升至22.69;ca125由15.10升至55.38;ca199由57.10升至152.70;ca74-2由37.75升至23.55;,2017-9-18:外院,pet-ct:直肠术后,右侧肠壁增厚伴代谢活性稍高,上腹部沿大网膜及肠系膜走形多发结节影伴代谢活性轻度增高,考虑转移可能性大,腹膜后淋巴结显示,不伴代谢升高,骶前软组织密度影伴环形代谢活性增强,考虑包裹性积液;2017-10月叒我院行xelox+安维汀治疗2周期。", "mention_data": [{"mention": "肛门10cm", "label": "解剖部位", "offset": "21"}, {"mention": "高级别下皮内瘤变", "label": "疾病和诊断", "offset": "31"}, {"mention": "lar手术", "label": "手术", "offset": "139"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "151"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "193"}, {"mention": "卡培他滨", "label": "药物", "offset": "249"}, {"mention": "ct", "label": "影像检查", "offset": "282"}, {"mention": "cea", "label": "实验室检验", "offset": "317"}, {"mention": "ca125", "label": "实验室检验", "offset": "333"}, {"mention": "ca199", "label": "实验室检验", "offset": "352"}, {"mention": "ca74-2", "label": "实验室检验", "offset": "372"}, {"mention": "pet-ct", "label": "影像检查", "offset": "406"}, {"mention": "直肠术后", "label": "疾病和诊断", "offset": "413"}, {"mention": "肠", "label": "解剖部位", "offset": "420"}, {"mention": "上腹部", "label": "解剖部位", "offset": "432"}, {"mention": "肠", "label": "解剖部位", "offset": "440"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "469"}, {"mention": "骶前", "label": "解剖部位", "offset": "485"}, {"mention": "安维汀", "label": "药物", "offset": "529"}]}
{"text": ",患者于2015年3月无明显诱因出现大便带鲜血,量少,大便变细、大便习惯改变,2-4天一次,无腹痛、恶心、发热等不适。外院肠镜检查提示距肛门22-24cm肿物,环绕肠腔3/5,肠镜能通过,活检病理提示腺癌。于2015-06-09在我院行腹腔镜上dixon术,术后恢复可,,术后病理示:乙状结肠大体镜检为中分化腺癌,累及肠壁浆膜上层,淋巴结0/6(+);另见癌结节3枚。,免疫组化:msh2(+),msh6(+),pms2(+),mlh1(+),ki67(40%+),er(-),ercc1(+)。术后诊断pt3n1m0叒iiib期叒pmmr,诉术后半年口服5-fu治疗(具体不详)。,2016-12-10我院复查mt:“肝s1病灶,考虑转移瘤”。2016-12-10行pet/,ct:“吻合口代谢较活跃,请结合临床;右侧髂总血管旁数个淋巴结代谢活跃,考虑转移,累及右侧输尿管,右肾盂及右输尿管中下段扩张积液;肝s1低密度结节代谢活跃,考虑转移”。诊断为rt3n1m1ivb期叒pmmr,于2016-12-30、2017-01-14、2017-02-10、2017-02-24、2017-03-10给予folfox方案化疗5程,4程化疗后疗效评价pr,化疗后无明显周围神经毒性,监测血常规无骨髓抑制。现为上一程治疗入院,下次治疗至今,患者无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热,患者精神尚可,食欲如常。大小便正常。体重近半年无明显上降。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "47"}, {"mention": "肛门", "label": "解剖部位", "offset": "68"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "腹腔镜上dixon术", "label": "手术", "offset": "118"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "142"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "151"}, {"mention": "肠", "label": "解剖部位", "offset": "159"}, {"mention": "5-fu", "label": "药物", "offset": "278"}, {"mention": "肝s1", "label": "解剖部位", "offset": "310"}, {"mention": "pet/,ct", "label": "影像检查", "offset": "334"}, {"mention": "吻合口", "label": "解剖部位", "offset": "343"}, {"mention": "右侧髂总血管", "label": "解剖部位", "offset": "358"}, {"mention": "右侧输尿管", "label": "解剖部位", "offset": "382"}, {"mention": "右肾盂", "label": "解剖部位", "offset": "388"}, {"mention": "右输尿管", "label": "解剖部位", "offset": "392"}, {"mention": "肝s1", "label": "解剖部位", "offset": "404"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "544"}, {"mention": "腹痛", "label": "症状", "offset": "571"}, {"mention": "腹胀", "label": "症状", "offset": "575"}]}
{"text": ",患者于2010-11无明显诱因出现阵发性隐痛不适,2011-1自觉右下腹包块,不伴发热,无黄染,无恶心、呕吐,无腹胀、腹泻。在我院门诊检查ct示右肝外叶肿物,符合肝癌,肝门区,胃右动脉旁淋巴结转移。afp297ng/ml。于2011-2-18在全麻上行右半肝巨大肝癌切除+逆行性胆囊切除+肝门淋巴结清扫术+胃壁修补术,术程顺利。,术后病理示:肝细胞肝癌。定期复查,术后1月afp降至正常。2011-4-8我院pet/ct示肝癌术后,腹膜后淋巴结代谢活跃,考虑转移瘤。于2011-4-22在我院影像介入科行ct引导上淋巴结射频消融术,同期行cik细胞免疫治疗2程。后定期自2011-5-24始继续行cik细胞免疫治疗14程,过程顺利。期间定期复查,未见明确肿瘤复发及转移征象,末次复查时间为2013-03-14,,胸腹mr示:胰腺体部后方类圆形结节,考虑淋巴结转移可能性大,建议继续观察。现患者为继续行cik细胞免疫治疗入我科。患者近来精神睡眠可,胃纳可,无发热,腹痛、腹泻,无恶心、厌食,二便正常,体重无明显上降。", "mention_data": [{"mention": "右下腹", "label": "解剖部位", "offset": "34"}, {"mention": "腹胀", "label": "症状", "offset": "57"}, {"mention": "腹泻", "label": "症状", "offset": "60"}, {"mention": "ct", "label": "影像检查", "offset": "70"}, {"mention": "右肝外叶", "label": "解剖部位", "offset": "73"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "82"}, {"mention": "肝门区,胃右动脉旁淋巴结转移", "label": "疾病和诊断", "offset": "85"}, {"mention": "afp", "label": "实验室检验", "offset": "100"}, {"mention": "右半肝巨大肝癌切除+逆行性胆囊切除+肝门淋巴结清扫术+胃壁修补术", "label": "手术", "offset": "127"}, {"mention": "肝细胞肝癌", "label": "疾病和诊断", "offset": "172"}, {"mention": "afp", "label": "实验室检验", "offset": "187"}, {"mention": "pet/ct", "label": "影像检查", "offset": "205"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "212"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "217"}, {"mention": "ct引导上淋巴结射频消融术", "label": "手术", "offset": "253"}, {"mention": "胸腹mr", "label": "影像检查", "offset": "357"}, {"mention": "胰腺体部", "label": "解剖部位", "offset": "363"}, {"mention": "胃", "label": "解剖部位", "offset": "424"}, {"mention": "腹痛", "label": "症状", "offset": "432"}, {"mention": "腹泻", "label": "症状", "offset": "435"}]}
{"text": ",患者半月余前无明显诱因出现右上腹疼痛,为阵发性隐痛,伴轻度排便困难,患者无发热、恶心呕吐,无腹胀,大便1-3次/日,无脓血便,随就诊于我院消化内科,,行肠镜检查示:进境30cm到乙状结肠近端,可见巨大不规则粘膜隆起,环周致管腔狭窄,继续进境困难,取病理结果过未回,,行胃镜检查示:胃息肉,非萎缩性胃炎并胆汁反流。2016.3.19,于我院东院区行肠镜病理结果回示:(乙状结肠)腺癌。ct,结果回示:肝脏巨大不规则混杂密度灶并肝内胆管扩张,考虑转移;乙状结肠局部壁不规则增厚并壁毛糙、周围多发略肿大淋巴结,结肠ca并侵透浆膜、并周围淋巴结转移可能,建议结合肠镜;腹膜后多发略肿大淋巴结;门静脉左支显示欠清;左肾小囊肿;右侧附件囊性密度灶,建议结合超声;盆腔积液。分析患者结肠癌肝脏转移,无手术根治条件,转入我科行化疗治疗,自2016.3.24起行安维汀+mfolfox6方案化疗2周期,,具体为:安维汀200mgd1+奥沙利铂150mgd1+右亚叶酸钙300mgd1+氟尿嘧啶0.6d1,3.5维持46小时泵入。现患者为求进一步诊疗来我院,门诊以“乙状结肠癌”收入院,患者近日来,饮食睡眠可,小便正常,体重较前无明显改变。", "mention_data": [{"mention": "右上腹", "label": "解剖部位", "offset": "14"}, {"mention": "腹胀", "label": "症状", "offset": "47"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "90"}, {"mention": "胃息肉", "label": "疾病和诊断", "offset": "141"}, {"mention": "非萎缩性胃炎并胆汁反流", "label": "疾病和诊断", "offset": "145"}, {"mention": "(乙状结肠)腺癌", "label": "疾病和诊断", "offset": "183"}, {"mention": "ct", "label": "影像检查", "offset": "192"}, {"mention": "肝脏", "label": "解剖部位", "offset": "200"}, {"mention": "肝内胆管", "label": "解剖部位", "offset": "213"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "225"}, {"mention": "结肠ca", "label": "疾病和诊断", "offset": "253"}, {"mention": "腹", "label": "解剖部位", "offset": "281"}, {"mention": "门静脉左支", "label": "解剖部位", "offset": "293"}, {"mention": "左肾小囊肿", "label": "疾病和诊断", "offset": "303"}, {"mention": "右侧附件", "label": "解剖部位", "offset": "309"}, {"mention": "盆腔积液", "label": "疾病和诊断", "offset": "326"}, {"mention": "结肠癌肝脏转移", "label": "疾病和诊断", "offset": "335"}, {"mention": "安维汀", "label": "药物", "offset": "373"}, {"mention": "安维汀", "label": "药物", "offset": "398"}, {"mention": "奥沙利铂", "label": "药物", "offset": "409"}, {"mention": "右亚叶酸钙", "label": "药物", "offset": "421"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "434"}, {"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "474"}]}
{"text": ",因“体检左肝占位”当地确诊hcc?,术前未见远处m,afp(-),2014.3.23行肝部分切除及胆囊切除术,术中探查无腹水,小结节性肝硬变,s6近脏面,约4*3cm,病理示左叶肝细胞性肝癌,中分化,afp(-),hepotocyte(-),术后未治疗。术后行肝血管造影(-)。外院2014-12-28腹ct示腹膜后lnm,3.1cm?2015.1.5始行腹膜后lnm放疗6300cgy/35f,2015.2.28结束,2015.3.29叒ct报告示稳定33*29mm,现afp正常。2015.4.20口服sorafinib,2015.4.20叒,ct:腹膜后占位相仿,肝肾之间占位新发?侵及十二指肠,间断黑便,饮食可,大小便正常,体重无明显变化。,15-5-5叒,当地胃镜:十二指肠肿物,病理待报。此次来咨询进一步治疗。", "mention_data": [{"mention": "左肝", "label": "解剖部位", "offset": "5"}, {"mention": "hcc", "label": "疾病和诊断", "offset": "14"}, {"mention": "肝部分切除及胆囊切除术", "label": "手术", "offset": "44"}, {"mention": "腹水", "label": "症状", "offset": "61"}, {"mention": "肝", "label": "解剖部位", "offset": "68"}, {"mention": "左叶肝细胞性肝癌,中分化", "label": "疾病和诊断", "offset": "88"}, {"mention": "肝血管造影", "label": "影像检查", "offset": "131"}, {"mention": "腹ct", "label": "影像检查", "offset": "152"}, {"mention": "腹膜后lnm", "label": "疾病和诊断", "offset": "156"}, {"mention": "腹膜后lnm", "label": "疾病和诊断", "offset": "179"}, {"mention": "ct", "label": "影像检查", "offset": "221"}, {"mention": "afp", "label": "实验室检验", "offset": "237"}, {"mention": "ct", "label": "影像检查", "offset": "275"}, {"mention": "腹", "label": "解剖部位", "offset": "278"}, {"mention": "肝", "label": "解剖部位", "offset": "286"}, {"mention": "肾", "label": "解剖部位", "offset": "287"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "297"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "339"}]}
{"text": ",2016-6初外院常规体检腹部超声发现左肝占位,hbsag(-),anti-hcv(-),afp叒573,cea、ca199正常。2016-06-14我院pet/,ct:肝右内叶至肝左叶交界处巨大低密度肿块,考虑恶性(肝癌?)。肝s2低密度结节,囊肿?肝门区、门腔静脉间少许小淋巴结,性质待定。两肺散在小结节,未见高代谢,随访。2016-6-21行肝中叶切除+胆囊切除术,术中肝s5-8约6cm质软肿物,侵犯局部肝被膜,包膜完整,超声探查其旁另见一约1cm肿物,,术后病理:肝中叶(10x8x7cm)、肝s5部分恶性肿瘤(1cm),可见坏死。,免疫组化结果显示:cd56(-),cga(+),ck(+),ki-67(80%+),mgmt(+50~75%),sstr2(+>75%),syn(+),hep(-),arginase(-),gpc3(-),afp(灶状+),符合肝脏低分化大细胞神经内分泌癌(g3),需排除转移癌。2016-07-25复查ct肝部分切除术后,局部见少量积液,追查。现术后恢复好,时有后背隐痛,乏力,无恶心呕吐,进食后下腹胀,食欲好,食量可,体重术后增加1kg。现体重71kg,身高175cm。大小便可,睡眠质量差,活动量可。,化验血:2016-07-02叒钾叒3.38mmol/l,丙氨酸氨基转换酶叒103iu/l,前白蛋白叒0.09g/l,血红蛋白叒107.00g/,lpet-ct:空腹6小时以下,静脉注射显像剂,平静休息60min后行躯干pet及ct断层显像,pet图像经衰减校正及重建后,将pet及ct图像行多平面、,多幅显示:两下颌窦粘膜增厚,未见高摄取。口咽部双侧腺体显影对称,垂体及甲状腺伴生理性摄取。两颈部及锁骨下区未见明显异常淋巴结浓聚。双肺显影清晰,肺纹理正常,右肺斜裂胸膜上微小结节,未见高摄取。左肺下叶钙化灶。纵隔及双侧肺门未见异常肿大淋巴结或淋巴结浓聚。胸膜无增厚,胸水征阴性。肝神经内分泌肿瘤术后,术区见不规则液性密度影,放射性分布稀疏缺损。余部肝实质内可见小囊性密度结节,未见高摄取。左下腹腹膜内多发索条影,前腹壁呈术后改变,未见异常高摄取。腹腔内、腹膜后及盆腔内未见肿大淋巴结或淋巴结浓聚。盆腔内未见液性密度影。胃充盈好,胃壁显影如常。胰腺形态放射性分布尚好,胰管不扩张。脾放射性分布均匀。双侧肾脏显影可,肾实质密度均匀,肾盂、肾盏及输尿管无扩张。双侧肾下腺显影大致正常。腹部可见条索状肠影。膀胱放射性浓聚如常,膀胱壁无增厚。前列腺大小正常,放射性分布大致正常。视野内轴心骨未见异常放射性浓聚。下、上肢关节带大致正常。左股骨头骨岛。叒1、肝神经内分泌肿瘤术后,术区可见积液,未见生长抑素受体异常高表达灶。左下腹腹膜及前腹壁呈术后改变。叒2、右肺斜裂胸膜上微小结节,随诊。叒3、两下颌窦炎症;左肺下叶钙化灶;肝囊肿;左股骨头骨岛。", "mention_data": [{"mention": "左肝占位", "label": "疾病和诊断", "offset": "20"}, {"mention": "afp", "label": "实验室检验", "offset": "46"}, {"mention": "cea", "label": "实验室检验", "offset": "54"}, {"mention": "ca199", "label": "实验室检验", "offset": "58"}, {"mention": "pet/,ct", "label": "影像检查", "offset": "78"}, {"mention": "肝右内叶至肝左叶交界处", "label": "解剖部位", "offset": "86"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "110"}, {"mention": "肝s2", "label": "解剖部位", "offset": "115"}, {"mention": "肝门区", "label": "解剖部位", "offset": "127"}, {"mention": "门腔静脉间", "label": "解剖部位", "offset": "131"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "139"}, {"mention": "两肺", "label": "解剖部位", "offset": "148"}, {"mention": "肝中叶切除+胆囊切除术", "label": "手术", "offset": "175"}, {"mention": "肝s5-8", "label": "解剖部位", "offset": "189"}, {"mention": "肝", "label": "解剖部位", "offset": "207"}, {"mention": "肝中叶", "label": "解剖部位", "offset": "238"}, {"mention": "肝s5部分恶性肿瘤", "label": "疾病和诊断", "offset": "252"}, {"mention": "肝脏低分化大细胞神经内分泌癌(g3)", "label": "疾病和诊断", "offset": "387"}, {"mention": "ct", "label": "影像检查", "offset": "425"}, {"mention": "肝部分切除术后", "label": "疾病和诊断", "offset": "427"}, {"mention": "后背", "label": "解剖部位", "offset": "455"}, {"mention": "下腹", "label": "解剖部位", "offset": "472"}, {"mention": "钾", "label": "实验室检验", "offset": "542"}, {"mention": "丙氨酸氨基转换酶", "label": "实验室检验", "offset": "555"}, {"mention": "前白蛋白", "label": "实验室检验", "offset": "572"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "585"}, {"mention": "pet-ct", "label": "影像检查", "offset": "600"}, {"mention": "空腹", "label": "症状", "offset": "607"}, {"mention": "pet及ct", "label": "影像检查", "offset": "636"}, {"mention": "pet", "label": "影像检查", "offset": "647"}, {"mention": "pet及ct", "label": "影像检查", "offset": "663"}, {"mention": "两下颌窦", "label": "解剖部位", "offset": "682"}, {"mention": "口咽部双侧腺体", "label": "解剖部位", "offset": "697"}, {"mention": "垂体", "label": "解剖部位", "offset": "709"}, {"mention": "甲状腺", "label": "解剖部位", "offset": "712"}, {"mention": "两颈部", "label": "解剖部位", "offset": "722"}, {"mention": "锁骨下区", "label": "解剖部位", "offset": "726"}, {"mention": "双肺", "label": "解剖部位", "offset": "742"}, {"mention": "肺", "label": "解剖部位", "offset": "749"}, {"mention": "右肺斜裂", "label": "解剖部位", "offset": "755"}, {"mention": "左肺下叶", "label": "解剖部位", "offset": "773"}, {"mention": "纵隔", "label": "解剖部位", "offset": "781"}, {"mention": "双侧肺门", "label": "解剖部位", "offset": "784"}, {"mention": "胸", "label": "解剖部位", "offset": "804"}, {"mention": "肝神经内分泌肿瘤术后", "label": "疾病和诊断", "offset": "816"}, {"mention": "肝", "label": "解剖部位", "offset": "851"}, {"mention": "左下腹", "label": "解剖部位", "offset": "871"}, {"mention": "腹", "label": "解剖部位", "offset": "884"}, {"mention": "腹", "label": "解剖部位", "offset": "900"}, {"mention": "腹", "label": "解剖部位", "offset": "904"}, {"mention": "盆腔", "label": "解剖部位", "offset": "908"}, {"mention": "盆腔", "label": "解剖部位", "offset": "925"}, {"mention": "胃", "label": "解剖部位", "offset": "936"}, {"mention": "胃", "label": "解剖部位", "offset": "941"}, {"mention": "胰腺", "label": "解剖部位", "offset": "948"}, {"mention": "胰管", "label": "解剖部位", "offset": "960"}, {"mention": "脾", "label": "解剖部位", "offset": "966"}, {"mention": "双侧肾脏", "label": "解剖部位", "offset": "975"}, {"mention": "肾", "label": "解剖部位", "offset": "983"}, {"mention": "肾盂", "label": "解剖部位", "offset": "991"}, {"mention": "肾盏", "label": "解剖部位", "offset": "994"}, {"mention": "输尿管", "label": "解剖部位", "offset": "997"}, {"mention": "双侧肾下腺", "label": "解剖部位", "offset": "1004"}, {"mention": "腹", "label": "解剖部位", "offset": "1016"}, {"mention": "肠", "label": "解剖部位", "offset": "1023"}, {"mention": "膀胱", "label": "解剖部位", "offset": "1026"}, {"mention": "膀胱", "label": "解剖部位", "offset": "1036"}, {"mention": "前列腺", "label": "解剖部位", "offset": "1043"}, {"mention": "骨", "label": "解剖部位", "offset": "1066"}, {"mention": "下、上肢关节", "label": "解剖部位", "offset": "1077"}, {"mention": "左股骨头骨岛", "label": "疾病和诊断", "offset": "1089"}, {"mention": "肝神经内分泌肿瘤术后", "label": "疾病和诊断", "offset": "1099"}, {"mention": "左下腹", "label": "解剖部位", "offset": "1132"}, {"mention": "腹", "label": "解剖部位", "offset": "1139"}, {"mention": "右肺斜裂", "label": "解剖部位", "offset": "1150"}, {"mention": "两下颌窦", "label": "解剖部位", "offset": "1168"}, {"mention": "左肺下叶", "label": "解剖部位", "offset": "1175"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "1183"}, {"mention": "左股骨头骨岛", "label": "疾病和诊断", "offset": "1187"}]}
{"text": ",2010-9-21行胃癌根治术,术后病理叒低分化腺癌,侵及肌层,达浆膜外,淋巴结1/29.术后肿标ca724叒7.74叒。术后sox方案化疗2周期。末次化疗2010-11-23。因肝功能损害i度,neut叒2°,腹泻叒1°,色素沉着,低血糖。第3周期改为单药s-1服药至2011.2.15,不良反应明显,停用ts-1,末次化疗时间2011.4.11。暂停化疗未再服药.不良反应基本恢复.2011-10-31复查肿瘤标志物正常,颈部超声提示右锁骨下靶环状淋巴结,腹盆ct未见复发转移征象。2011-11,颈部b超:右颈至锁骨下多发淋巴结.盆腔b超未见异常,腹部,ct:未见新发病灶,,肿标:正常.2011-12-13颈部b超示,右颈部至锁骨下淋巴结略增大.ca72.4叒9.41\\u0004\\u0004叒现乏力气短,食欲可,夜尿多好转,大便2次,睡眠欠佳,早醒,夜间口干。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "11"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "ca724", "label": "实验室检验", "offset": "50"}, {"mention": "腹泻", "label": "症状", "offset": "107"}, {"mention": "s-1", "label": "药物", "offset": "130"}, {"mention": "ts-1", "label": "药物", "offset": "155"}, {"mention": "右锁骨下", "label": "解剖部位", "offset": "220"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "231"}, {"mention": "右颈至锁骨下", "label": "解剖部位", "offset": "257"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "265"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "278"}, {"mention": "颈部b超", "label": "影像检查", "offset": "308"}, {"mention": "右颈部至锁骨下", "label": "解剖部位", "offset": "314"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "321"}, {"mention": "ca72.4", "label": "实验室检验", "offset": "328"}]}
{"text": ",2017-1-24,外院胃镜示:距门齿32-35cm鳞癌。影像学检查提示两颈部、纵隔、淋巴结转移,多发骨转移。2017-2开始行紫杉醇+顺铂方案化疗2周期。,末次化疗时间:2017-32周期后复查,纵隔淋巴结转移灶较前缩小,腹腔淋巴结无法对比。2017-5-3,本院胸ct示:食管胸中上段癌,伴纵隔2-8组、两肺门、锁骨下区、右腋区及胃周弥漫肿大淋巴结转移。2017-5-8,腹部ct示:肝脏多发结节,考虑转移。腹腔及腹膜后肿大淋巴结,考虑转移。胸12、多个腰椎多发异常密度灶,考虑转移。现病人进食困难,睡眠可。", "mention_data": [{"mention": "门齿", "label": "解剖部位", "offset": "18"}, {"mention": "鳞癌", "label": "疾病和诊断", "offset": "27"}, {"mention": "颈部、纵隔、淋巴结转移", "label": "疾病和诊断", "offset": "38"}, {"mention": "骨转移", "label": "疾病和诊断", "offset": "52"}, {"mention": "紫杉醇", "label": "药物", "offset": "65"}, {"mention": "顺铂", "label": "药物", "offset": "69"}, {"mention": "纵隔淋巴结", "label": "解剖部位", "offset": "100"}, {"mention": "腹腔淋巴结", "label": "解剖部位", "offset": "113"}, {"mention": "胸ct", "label": "影像检查", "offset": "134"}, {"mention": "食管胸中上段癌", "label": "疾病和诊断", "offset": "139"}, {"mention": "纵隔", "label": "解剖部位", "offset": "148"}, {"mention": "两肺门", "label": "解剖部位", "offset": "155"}, {"mention": "锁骨下区", "label": "解剖部位", "offset": "159"}, {"mention": "右腋区", "label": "解剖部位", "offset": "164"}, {"mention": "胃", "label": "解剖部位", "offset": "168"}, {"mention": "腹部ct", "label": "影像检查", "offset": "189"}, {"mention": "肝脏", "label": "解剖部位", "offset": "195"}, {"mention": "腹", "label": "解剖部位", "offset": "207"}, {"mention": "腹", "label": "解剖部位", "offset": "210"}, {"mention": "胸12", "label": "解剖部位", "offset": "224"}, {"mention": "腰椎", "label": "解剖部位", "offset": "230"}]}
{"text": "2016.1曾经出现小肠穿孔,保守治疗后好转。2016-9-27叒因颅内占位,病理活检诊断dlbcl。2016.10.petct显示颅内无明确占位,但是回肠末端代谢活跃,考虑淋巴瘤侵及,suv叒20.99.叒2016.11出现肠梗阻,2016.11.15行因肠梗阻加重行部分小肠切除术,术后病理dlbcl。我院病理会诊dlbcl.叒无发热、盗汗及消瘦。2016.12.16行第1周期r-tho化疗,疗后无不适,12.26血常规提示wbc叒2.15*10e9/l,neu叒0.87*10e9/l,plt及hb正常。", "mention_data": [{"mention": "小肠穿孔", "label": "疾病和诊断", "offset": "10"}, {"mention": "颅", "label": "解剖部位", "offset": "34"}, {"mention": "petct", "label": "影像检查", "offset": "59"}, {"mention": "颅", "label": "解剖部位", "offset": "66"}, {"mention": "回肠", "label": "解剖部位", "offset": "76"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "87"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "113"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "129"}, {"mention": "部分小肠切除术", "label": "手术", "offset": "135"}, {"mention": "wbc", "label": "实验室检验", "offset": "215"}, {"mention": "neu", "label": "实验室检验", "offset": "231"}, {"mention": "plt", "label": "实验室检验", "offset": "247"}, {"mention": "hb", "label": "实验室检验", "offset": "251"}]}
{"text": ",剖宫产术后4月(孕期体重增加20kg),常规产后检查发现宫颈病变,2014.1.29因宫颈癌行手术治疗(广泛子宫全切+腹主动脉旁淋巴结取样+盆腔淋巴结切除+两侧卵巢悬吊)。,我院会诊病理:中分化鳞状细胞癌,可见脉管癌栓,浸润深度1.4cm,累及宫颈,淋巴结无转移。患者现术后恢复良好,现大小便正常。,14-3-5盆腹mri:阴道残端左下方不规则信号,大网膜及腹膜弥漫增厚,较大42*28mm。腹膜弥漫增厚转移可能。14-3-10pet-ct复查阴道残端及残端左侧不规则软组织影伴代谢活跃,腹膜考虑非转移,行盆腔放疗,,计划:ctv45gy/25f,2014-3-27开始放疗,放疗7次,大便次数多,2-3次/天。", "mention_data": [{"mention": "宫颈", "label": "解剖部位", "offset": "29"}, {"mention": "宫颈癌", "label": "疾病和诊断", "offset": "44"}, {"mention": "广泛子宫全切+腹主动脉旁淋巴结取样+盆腔淋巴结切除+两侧卵巢悬吊", "label": "手术", "offset": "53"}, {"mention": "中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "95"}, {"mention": "宫颈", "label": "解剖部位", "offset": "123"}, {"mention": "盆腹mri", "label": "影像检查", "offset": "157"}, {"mention": "阴道", "label": "解剖部位", "offset": "163"}, {"mention": "腹", "label": "解剖部位", "offset": "180"}, {"mention": "腹", "label": "解剖部位", "offset": "197"}, {"mention": "pet-ct", "label": "影像检查", "offset": "215"}, {"mention": "阴道", "label": "解剖部位", "offset": "223"}, {"mention": "腹", "label": "解剖部位", "offset": "245"}, {"mention": "盆腔", "label": "解剖部位", "offset": "254"}]}
{"text": "乙状结肠癌,不完全性肠梗阻,2012.4.18行乙状结肠根治术,肝转移,肺转移。术后行folfox化疗9周期。目前肿瘤进展。\\u0004\\u0004叒入组folfiri叒+叒aflibercept后pd,2013-4入组帕尼单抗,化疗11次。皮疹\\u0004\\u0004叒2013-9-4ct:肝左叶转移灶较前增大,现约7.5x6.7cm(im52),原为5.3x5.2cm(im52),内部碘油沉积减少,仍呈不均匀异常强化。腰1椎体左前下缘骨皮质模糊、部分消失,骨质密度不均匀减低,周边增高,转移可能大。肺部病灶大致同前。叒帕尼单抗治疗后评估肝转移进展,评效pd,肺转移较小,发展较慢,建议介入科治疗,优先控制肝转移\\u0004\\u0004叒目前无明显不适。", "mention_data": [{"mention": "乙状结肠癌", "label": "疾病和诊断", "offset": "0"}, {"mention": "不完全性肠梗阻", "label": "疾病和诊断", "offset": "6"}, {"mention": "乙状结肠根治术", "label": "手术", "offset": "24"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "32"}, {"mention": "肺转移", "label": "疾病和诊断", "offset": "36"}, {"mention": "aflibercept", "label": "药物", "offset": "87"}, {"mention": "帕尼单抗", "label": "药物", "offset": "110"}, {"mention": "ct", "label": "影像检查", "offset": "144"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "147"}, {"mention": "碘油", "label": "药物", "offset": "196"}, {"mention": "腰1椎体左前下缘", "label": "解剖部位", "offset": "213"}, {"mention": "骨", "label": "解剖部位", "offset": "232"}, {"mention": "肺", "label": "解剖部位", "offset": "253"}, {"mention": "帕尼单抗", "label": "药物", "offset": "263"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "272"}, {"mention": "肺转移", "label": "疾病和诊断", "offset": "283"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "306"}]}
{"text": ",患者2年余前(2009.11)因“腹泻”就诊********查肠镜提示升结肠癌,行升结肠癌根治术,手术及术后病理不详,术后行9个周期folfox化疗,末次化疗2010.4结束。化疗后患者出现ii度的神经毒性,主要表现为手足麻木明显。患者2011.1.6复查ct发现肝脏转移瘤,2011.1.12行肝转移瘤微波固化术,2011.2.22ct提示肝转移,两上肺转移瘤,2011.2.23再次行肝转移瘤微波固化术。2011.3.1起行folfiri方案化疗8次,末次2011.7.28,总体疗效sd。此后患者停止化疗。2011-11-24,我院ct示:“,与2011-10-21片对比:两肺多发转移瘤较前增大;肝内多发病灶,较前明显增多、增大。腹腔干旁及肠系膜根部软组织影及结节灶,考虑淋巴结转移可能性大,较前明显。子宫直肠窝内多发结节,考虑种植转移可能性大。膀胱后壁结节状增厚,考虑转移瘤可能性大。右侧髂内外血管旁淋巴结,可疑转移。”于2011-11-25、12-9、12-27、2012-1-12行cpt-11+c225化疗4程。近来,患者自觉左中上腹疼痛,胃纳食欲不佳,大便干,血尿,伴尿频、尿痛,偶有尿失禁,近2天乏力明显,体重近期上降2kg。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "18"}, {"mention": "升结肠癌", "label": "疾病和诊断", "offset": "36"}, {"mention": "升结肠癌根治术", "label": "手术", "offset": "42"}, {"mention": "手足麻木", "label": "症状", "offset": "110"}, {"mention": "ct", "label": "影像检查", "offset": "129"}, {"mention": "肝脏转移瘤", "label": "疾病和诊断", "offset": "133"}, {"mention": "肝转移瘤微波固化术", "label": "手术", "offset": "149"}, {"mention": "ct", "label": "影像检查", "offset": "168"}, {"mention": "肝转移,两上肺转移瘤", "label": "疾病和诊断", "offset": "172"}, {"mention": "肝转移瘤微波固化术", "label": "手术", "offset": "195"}, {"mention": "ct", "label": "影像检查", "offset": "270"}, {"mention": "两肺多发转移瘤", "label": "疾病和诊断", "offset": "291"}, {"mention": "肝", "label": "解剖部位", "offset": "303"}, {"mention": "腹腔干旁", "label": "解剖部位", "offset": "320"}, {"mention": "肠", "label": "解剖部位", "offset": "325"}, {"mention": "子宫直肠窝", "label": "解剖部位", "offset": "356"}, {"mention": "膀胱", "label": "解剖部位", "offset": "378"}, {"mention": "右侧髂内外血管旁淋巴结", "label": "解剖部位", "offset": "398"}, {"mention": "cpt-11", "label": "药物", "offset": "449"}, {"mention": "c225", "label": "药物", "offset": "456"}, {"mention": "左中上腹", "label": "解剖部位", "offset": "472"}, {"mention": "胃", "label": "解剖部位", "offset": "479"}]}
{"text": "2014年2月在当地行左侧卵巢癌手术,两侧附件及子宫切除,术后病理见卵巢癌及淋巴结转移,局部无放疗,已行化疗,手术后予以6周期脂质体紫杉醇+卡铂,化疗中因腹膜后淋巴结肿大尔后予以thp2周期。近期于2015年3月3日查b超见腹膜后淋巴结转移,盆腔无复发。2015-3-12始行第1周期吉西他滨+顺铂,具体:吉西他滨1000mg/m2叒1.6g叒d1,d8叒+顺铂40mg/m2叒66mg叒d1,d8叒q21d。用药后皮肤瘙痒,给予抗过敏治疗。3月19行第1周期第8天治疗。因药物过敏,于2015年4月2日予以第2周期gp化疗,具体同第1周期.拟于4月23日予以2周期化疗复查。2周期疗效短径缩小总疗效sd(短径缩小),故于2015年4月27日予以gp+恩度治疗,拟于2015-5-18日行复查腹部ct疗效为sd(较一个月前略变平,余病灶无变化),改为tamoxifen治疗+腹膜后淋巴结放疗。", "mention_data": [{"mention": "左侧卵巢癌手术,两侧附件及子宫切除", "label": "手术", "offset": "11"}, {"mention": "卵巢癌及淋巴结转移", "label": "疾病和诊断", "offset": "34"}, {"mention": "脂质体紫杉醇", "label": "药物", "offset": "63"}, {"mention": "卡铂", "label": "药物", "offset": "70"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "77"}, {"mention": "thp", "label": "药物", "offset": "89"}, {"mention": "腹膜后淋巴结转移", "label": "疾病和诊断", "offset": "112"}, {"mention": "盆腔", "label": "解剖部位", "offset": "121"}, {"mention": "吉西他滨", "label": "药物", "offset": "142"}, {"mention": "顺铂", "label": "药物", "offset": "147"}, {"mention": "吉西他滨", "label": "药物", "offset": "153"}, {"mention": "顺铂", "label": "药物", "offset": "179"}, {"mention": "恩度", "label": "药物", "offset": "326"}, {"mention": "腹部ct", "label": "影像检查", "offset": "346"}, {"mention": "tamoxifen", "label": "药物", "offset": "375"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "387"}]}
{"text": ",患者2月前无明显诱因出现腹部阵发性隐痛不适,渐加重,无恶心、呕吐等,大便1次/日,成形便为主,无血便,无头晕、乏力、发热等不适。就诊外院,ct提示左上肺结节,右中上腹病变考虑小肠来源恶性肿瘤可能性大。为求进一步诊治转来我院,ct提示左肺上叶外基底段肿物,考虑周围型肺肺癌癌可能性大。左肺中叶、右肺下叶舌段、两肺上叶条索灶,考虑慢性炎症。左下气管旁、两上气管旁、隆突上、左肺门淋巴结,可疑淋巴结转移。甲状腺两叶病变,考虑结节性甲状腺肿可能性大。结肠镜检查未见异常。2016-05-26行肺部肿瘤穿刺结果提示非霍奇金淋巴瘤,t细胞性。2016-06-13pet/ct提示右中上腹小肠病变代谢活跃,符合淋巴瘤,左肺上叶病灶代谢活跃,考虑浸润,肠系膜多发淋巴结代谢活跃,左肺门淋巴结代谢活跃,疑浸润。2016-06-30全麻上行剖腹探查术,术中肿瘤固定,浸润小肠系膜,肿瘤不可切除,肿瘤近远端空肠回肠侧侧吻合术。于叒2016-07-20至2016-07-23叒给予叒chop(,环磷酰胺:1g,,长春地辛:6mg,,吡柔比星:70mg)叒方案化疗1程。化疗后出现iv°骨髓抑制,发热,最高达39°大便潜血阳性,后给予患者升白,抗感染(万古霉素,舒普深,右氧氟沙星)、抑酸护胃,生长抑素等治疗后,体温降至正常,大便潜血转为阴性。第一程化疗后,腹痛消失,腹部肿物较前明显缩小。2016-08-19开始予第二程imvp-16方案化疗(,ifp:7g,,vp-16:300mg,,mtx:45mg*2次,,dxm:20mg*3d),化疗后出现iv度白细胞降低,伴发热,大便潜血阳性,,2016-08-22复查ct:对比2016-5-24叒,片:右中上腹小肠病灶,考虑符合淋巴瘤,浸润肠系膜,包绕、部分包绕腹主动脉、两侧髂总血管。病灶周围、肠系膜、大网膜、腹主动脉周围、两侧髂总动脉周围多发淋巴结,考虑肿瘤浸润可能性大。左肺上叶外基底段肿物,考虑淋巴瘤浸润可能性大,较前增大。左肺多发小结节、小斑片状影及右肺上叶片状影,淋巴瘤浸润与炎症鉴别,建议复查。左肺中叶、右肺下叶舌段、两肺上叶条索灶,考虑慢性炎症,大致同前。右锁骨下区、纵隔、左肺门淋巴结,较前未见明显变化。肝肿大。肝s7叒囊肿。盆腔积液。予泰能、伏立康唑抗感染,g-csf升白,丙球提升免疫力治疗后好转。近几日患者仍有反复发热,体温最高38.8度,未予抗生素治疗可自行退热。现患者再次就诊,患者现流质饮食中,饮食睡眠可,大小二便如常。体重上降4kg。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "13"}, {"mention": "头晕", "label": "症状", "offset": "53"}, {"mention": "ct", "label": "影像检查", "offset": "70"}, {"mention": "左上肺", "label": "解剖部位", "offset": "74"}, {"mention": "右中上腹", "label": "解剖部位", "offset": "80"}, {"mention": "小肠", "label": "解剖部位", "offset": "88"}, {"mention": "ct", "label": "影像检查", "offset": "113"}, {"mention": "左肺上叶外基底段", "label": "解剖部位", "offset": "117"}, {"mention": "周围型肺肺癌癌", "label": "疾病和诊断", "offset": "130"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "142"}, {"mention": "右肺下叶舌段", "label": "解剖部位", "offset": "147"}, {"mention": "两肺上叶", "label": "解剖部位", "offset": "154"}, {"mention": "左下气管", "label": "解剖部位", "offset": "169"}, {"mention": "两上气管", "label": "解剖部位", "offset": "175"}, {"mention": "隆突", "label": "解剖部位", "offset": "181"}, {"mention": "左肺门淋巴结", "label": "解剖部位", "offset": "185"}, {"mention": "甲状腺两叶", "label": "解剖部位", "offset": "200"}, {"mention": "结节性甲状腺肿", "label": "疾病和诊断", "offset": "210"}, {"mention": "肺部", "label": "解剖部位", "offset": "243"}, {"mention": "非霍奇金淋巴瘤,t细胞性", "label": "疾病和诊断", "offset": "253"}, {"mention": "pet/ct", "label": "影像检查", "offset": "276"}, {"mention": "右中上腹小肠", "label": "解剖部位", "offset": "284"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "299"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "303"}, {"mention": "肠", "label": "解剖部位", "offset": "319"}, {"mention": "左肺门淋巴结", "label": "解剖部位", "offset": "332"}, {"mention": "剖腹探查术", "label": "手术", "offset": "361"}, {"mention": "小肠", "label": "解剖部位", "offset": "376"}, {"mention": "空肠回肠侧侧吻合术", "label": "手术", "offset": "393"}, {"mention": "环磷酰胺", "label": "药物", "offset": "436"}, {"mention": "长春地辛", "label": "药物", "offset": "445"}, {"mention": "吡柔比星", "label": "药物", "offset": "455"}, {"mention": "大便潜血", "label": "实验室检验", "offset": "495"}, {"mention": "万古霉素", "label": "药物", "offset": "514"}, {"mention": "舒普深", "label": "药物", "offset": "519"}, {"mention": "右氧氟沙星", "label": "药物", "offset": "523"}, {"mention": "生长抑素", "label": "药物", "offset": "535"}, {"mention": "大便潜血", "label": "实验室检验", "offset": "551"}, {"mention": "腹部", "label": "解剖部位", "offset": "572"}, {"mention": "ifp", "label": "药物", "offset": "612"}, {"mention": "vp-16", "label": "药物", "offset": "620"}, {"mention": "mtx", "label": "药物", "offset": "633"}, {"mention": "dxm", "label": "药物", "offset": "646"}, {"mention": "大便潜血", "label": "实验室检验", "offset": "677"}, {"mention": "ct", "label": "影像检查", "offset": "697"}, {"mention": "右中上腹小肠", "label": "解剖部位", "offset": "715"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "728"}, {"mention": "肠", "label": "解剖部位", "offset": "734"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "745"}, {"mention": "髂总血管", "label": "解剖部位", "offset": "752"}, {"mention": "肠", "label": "解剖部位", "offset": "762"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "770"}, {"mention": "两侧髂总动脉", "label": "解剖部位", "offset": "777"}, {"mention": "左肺上叶外基底段", "label": "解剖部位", "offset": "802"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "815"}, {"mention": "左肺", "label": "解剖部位", "offset": "830"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "844"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "852"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "868"}, {"mention": "右肺下叶舌段", "label": "解剖部位", "offset": "873"}, {"mention": "两肺上叶", "label": "解剖部位", "offset": "880"}, {"mention": "右锁骨下区、纵隔、左肺门淋巴结", "label": "解剖部位", "offset": "900"}, {"mention": "肝肿大", "label": "症状", "offset": "925"}, {"mention": "肝s7叒囊肿", "label": "疾病和诊断", "offset": "929"}, {"mention": "盆腔积液", "label": "疾病和诊断", "offset": "936"}, {"mention": "泰能", "label": "药物", "offset": "942"}, {"mention": "伏立康唑", "label": "药物", "offset": "945"}, {"mention": "g-csf", "label": "药物", "offset": "953"}, {"mention": "丙球", "label": "药物", "offset": "961"}]}
{"text": ",缘于入院4个月因渐进性消瘦就诊我院,查全身,pet-ct:1、肝左叶前段高代谢结节;肝胃间隙、胰头周边、腹膜后、左侧锁骨锁骨下窝多发高代谢肿大淋巴结;盆腔内膀胱直肠陷窝高代谢结节;以下征象考虑恶性肿瘤多发转移可能性大,建议必要时左侧锁骨下窝淋巴结活检。2、纵隔内、两侧肺门区多发结节影,部分伴钙化,代谢增高,不除外淋巴结转移。3、“脾脏切除术后”改变,右下下腹部多发结节影,代谢未见增高,考虑副脾代偿性增生可能。4、右肾下极形态欠规则,代谢未见增高。5、四肢近端骨髓代谢增高,两侧髂骨代谢轻度增高,考虑反应性改变可能,肿瘤浸润待排除,建议随访复查或骨穿检查。于(2016.6.1)行b超引导上左颈部肿物粗针活检术,左颈部肿物活检病理结果回报(201618813)(左颈),:送检淋巴结穿刺标本,其内见特异性肉芽肿性炎,并见干酪样坏死及多核巨细胞,考虑淋巴结肉芽肉芽肿性炎症,不排除淋巴结结核病可能。,特殊染色结果:该病例结核分枝杆菌(tb),核酸检测结果:阴性。查麻醉胃镜示内镜诊断食管中段早癌、贲门癌,行贲门及食管中段占位活检,胃镜病理(201619435),:1、(贲门)浅表贲门粘膜,间质中量急、慢性炎症细胞细胞浸润,表面粘膜糜烂,局部腺下皮呈高级别下皮内瘤变。2、(食管中段)送检少量食管粘膜,间质少量急、慢性炎症细胞浸润,鳞状细胞轻度增生并局灶高级别下皮内瘤变。结合相关检查回报,考虑“贲门癌伴肝脏、盆底种植、多发淋巴结转移可能;食管癌”,将情况详告知患者及家属,其表示理解,同意按贲门癌iv期开始全身化疗,分别于(2016.6.14、07.09、08.11、09.05)予“里葆多35mg静滴d1+奥沙利铂200mg静滴d1+替吉奥60mg口服d1-d14q3w”一线姑息化疗4个周期,过程顺利,期间化疗2个周期后复查疗效评价sd。目前无明显腹痛、腹胀、恶心、呕吐,无黑便、腹泻,无畏冷、发热、寒战,现为进一步治疗,求诊我院,门诊拟“贲门癌”收入住院。自下次出院以来,精神尚可,睡眠尚可,食欲尚可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "全身,pet-ct", "label": "影像检查", "offset": "20"}, {"mention": "肝左叶前段", "label": "解剖部位", "offset": "32"}, {"mention": "肝胃间隙", "label": "解剖部位", "offset": "43"}, {"mention": "胰头", "label": "解剖部位", "offset": "48"}, {"mention": "腹", "label": "解剖部位", "offset": "53"}, {"mention": "左侧锁骨", "label": "解剖部位", "offset": "57"}, {"mention": "锁骨下窝", "label": "解剖部位", "offset": "61"}, {"mention": "盆腔", "label": "解剖部位", "offset": "76"}, {"mention": "膀胱直肠陷窝", "label": "解剖部位", "offset": "79"}, {"mention": "左侧锁骨下窝淋巴结", "label": "解剖部位", "offset": "115"}, {"mention": "纵隔内", "label": "解剖部位", "offset": "129"}, {"mention": "两侧肺门区", "label": "解剖部位", "offset": "133"}, {"mention": "脾脏切除术后", "label": "疾病和诊断", "offset": "167"}, {"mention": "右下下腹部", "label": "解剖部位", "offset": "177"}, {"mention": "副脾", "label": "疾病和诊断", "offset": "197"}, {"mention": "右肾下极", "label": "解剖部位", "offset": "209"}, {"mention": "四肢", "label": "解剖部位", "offset": "228"}, {"mention": "两侧髂骨", "label": "解剖部位", "offset": "239"}, {"mention": "b超引导上左颈部肿物粗针活检术", "label": "手术", "offset": "292"}, {"mention": "左颈部", "label": "解剖部位", "offset": "308"}, {"mention": "左颈", "label": "解剖部位", "offset": "333"}, {"mention": "淋巴结结核病", "label": "疾病和诊断", "offset": "391"}, {"mention": "核酸检测", "label": "实验室检验", "offset": "422"}, {"mention": "食管中段早癌、贲门癌", "label": "疾病和诊断", "offset": "442"}, {"mention": "贲门", "label": "解剖部位", "offset": "454"}, {"mention": "食管中段", "label": "解剖部位", "offset": "457"}, {"mention": "贲门", "label": "解剖部位", "offset": "486"}, {"mention": "高级别下皮内瘤变", "label": "疾病和诊断", "offset": "526"}, {"mention": "食管中段", "label": "解剖部位", "offset": "538"}, {"mention": "食管", "label": "解剖部位", "offset": "547"}, {"mention": "鳞状细胞轻度增生并局灶高级别下皮内瘤变", "label": "疾病和诊断", "offset": "567"}, {"mention": "贲门癌伴肝脏、盆底种植、多发淋巴结转移", "label": "疾病和诊断", "offset": "599"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "621"}, {"mention": "贲门癌iv期", "label": "疾病和诊断", "offset": "647"}, {"mention": "里葆多", "label": "药物", "offset": "694"}, {"mention": "奥沙利铂", "label": "药物", "offset": "706"}, {"mention": "替吉奥", "label": "药物", "offset": "720"}, {"mention": "腹痛", "label": "症状", "offset": "778"}, {"mention": "腹胀", "label": "症状", "offset": "781"}, {"mention": "腹泻", "label": "症状", "offset": "794"}, {"mention": "贲门癌", "label": "疾病和诊断", "offset": "824"}]}
{"text": ",2014-5-19因乏力,便秘,便血半年,伴两上肢水肿,外院2014-5-19hgb叒40+,予输血,盆mri发现肠道病变。我院2014-5肠镜确诊乙状结肠中分化腺癌。术前锁穿置管后晕厥,出现不全肠梗阻,对症好转治疗后。2014-6-16行乙状结肠癌手术。2014-6-23,术后病理:侵及周围纤维脂肪组织;未见脉管癌栓;(近端)及(远端)切缘未见肿瘤;肠周淋巴结可见癌转移(6/13);肿瘤病理分期pt3n2a。,免疫组化结果显示:cd44(+),cmet(+),cox2(++),egfr(++),hep(-),her2(0+),ki-67(+25~50%),mlh1(+>75%),msh2(+>75%),msh6(+>75%),p170(++),p27(+>75%),p53(+>75%),topoii(+25~50%),ttf-1(-)。2014-6-4叒cea叒36.29。术后恢复好,饮食好,体力可,二便正常,术后体重略有增加。2014-7-22叒腹盆部,ct:乙状结肠术后,吻合口未见异常增厚及强化。肝内多发微小结节,追查。2014-7-24,腹部超声:肝内多发结节,观察;左肾结节,错构瘤?肿瘤标志物正常。考虑患者高龄,体质弱,考虑单药术后辅助治疗。2014-7-25开始希罗达叒1g/早,1.5g/晚叒d1-14叒q3w叒。2014-8-1血常规正常,总胆红素叒23.5μxxxmol/l;间接胆红素叒19.10μxxxmol/l,k叒5.53。患者多次血钾高,无不适,嘱减少进食香蕉,多饮水排尿,暂无特殊处理。患者复查后血常规、肝肾功能基本正常。2014-8-14第2周期,8-14总胆红素叒27.9μxxxmol/l;间接胆红素叒22.70μxxxmol/l。8-21总胆红素叒38.3μxxxmol/l;直接胆红素叒7.0μxxxmol/l;间接胆红素叒31.30μxxxmol/l。血常规正常。停希罗达保肝治疗1周,2014-8-28血常规正常,总胆红素叒29.8μxxxmol/l;直接胆红素叒8.1μxxxmol/l;间接胆红素21.7μxxxmol/l,较前上降。最后1日希罗达2014-9-3,2周期化疗后,轻度食欲上降,进食可,二便正常,体重无明显变化。9-4中性粒细胞绝对值1.81*10^9/l,总胆红素叒46.8μxxxmol/l;直接胆红素叒6.1μxxxmol/l;间接胆红素叒40.70μxxxmol/l。2014-9-5,腹部肿瘤标志:癌抗原72.4叒7.40u/ml。2014-9-5超声示肝内多发结节,继续观察。建议必要时结合增强影像学检查左肾结节,错构瘤?较前变化不大。9-11胆红素较前略有上降。2014-9-18血常规正常,总胆红素叒45.7μxxxmol/l;直接胆红素叒8.3μxxxmol/l;间接胆红素叒37.40μxxxmol/l。2014-9-19血常规正常叒总胆红素叒33.4叒叒叒叒叒直接胆红素叒5.6叒叒叒叒叒间接胆红素叒27.8,腹部b超:肝内多发结节,继续观察。建议必要时结合增强影像学检查左肾结节,错构瘤?较前变化不大。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "23"}, {"mention": "hgb", "label": "实验室检验", "offset": "40"}, {"mention": "盆mri", "label": "影像检查", "offset": "52"}, {"mention": "肠道", "label": "解剖部位", "offset": "58"}, {"mention": "乙状结肠中分化腺癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "锁穿置管", "label": "手术", "offset": "87"}, {"mention": "不全肠梗阻", "label": "疾病和诊断", "offset": "97"}, {"mention": "乙状结肠癌手术", "label": "手术", "offset": "121"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "178"}, {"mention": "cea", "label": "实验室检验", "offset": "384"}, {"mention": "腹盆部,ct", "label": "影像检查", "offset": "432"}, {"mention": "乙状结肠术后", "label": "疾病和诊断", "offset": "439"}, {"mention": "肝", "label": "解剖部位", "offset": "459"}, {"mention": "肝", "label": "解剖部位", "offset": "486"}, {"mention": "错构瘤", "label": "疾病和诊断", "offset": "501"}, {"mention": "希罗达", "label": "药物", "offset": "546"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "587"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "606"}, {"mention": "血钾", "label": "实验室检验", "offset": "638"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "703"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "722"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "747"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "766"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "785"}, {"mention": "希罗达", "label": "药物", "offset": "813"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "838"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "857"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "876"}, {"mention": "希罗达", "label": "药物", "offset": "904"}, {"mention": "中性粒细胞绝对值", "label": "实验室检验", "offset": "950"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "970"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "989"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "1008"}, {"mention": "肝", "label": "解剖部位", "offset": "1073"}, {"mention": "错构瘤", "label": "疾病和诊断", "offset": "1104"}, {"mention": "胆红素", "label": "实验室检验", "offset": "1119"}, {"mention": "血常规", "label": "实验室检验", "offset": "1138"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "1144"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "1163"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "1182"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "1218"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "1232"}, {"mention": "间接胆红素", "label": "实验室检验", "offset": "1246"}, {"mention": "肝", "label": "解剖部位", "offset": "1262"}, {"mention": "错构瘤", "label": "疾病和诊断", "offset": "1293"}]}
{"text": ",2015-6-25胃癌术,术后化疗8周期,末次2015-12。2016-7,复查胃镜:吻合口炎,胃潴留2016-11纳差,消瘦,后来出现腹痛,,排便不畅2017-02头部皮上结节:增生的纤维组织内可见异型细胞单层“列兵”样或围绕皮肤附属器“靶环”样浸润,结合免疫组化符合低分化腺癌,结合病史考虑胃癌转移。her2(0),cemt(1+),egfr(1+),cam5.2(+),ck(+),ck20(散在+),ck7(+),cea(散在+)。2017-3-20pet-ct叒1、胃癌术后,胃肠吻合口略增厚,代谢近周围本底水平,炎症?请结合胃镜检查;腹盆腔多发小结节/小淋巴结,腹膜后小淋巴结,伴或不伴轻度代谢,请对比既往老片以除外转移;腹盆腔少量积液,伴代谢,不除外转移;枕后皮肤小结节,未见明显高代谢,请结合病理。2、左肺下叶及右肺上叶结节、类结节,未见高代谢,随访。3、脑部未见明显异常代谢征象。两基底节区钙化灶。肝多发小囊肿。肝s6钙化。左肾囊肿。右股骨肌腱附着处炎性或非特异性摄取。2017-3-23,2017.4.24,2017.5.16给予单药紫杉醇化疗3周期,现觉食纳差,乏力,现发热。", "mention_data": [{"mention": "胃癌术", "label": "手术", "offset": "10"}, {"mention": "胃潴留", "label": "疾病和诊断", "offset": "49"}, {"mention": "腹痛", "label": "症状", "offset": "69"}, {"mention": "头部皮上", "label": "解剖部位", "offset": "84"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "136"}, {"mention": "胃癌转移", "label": "疾病和诊断", "offset": "148"}, {"mention": "pet-ct", "label": "影像检查", "offset": "230"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "239"}, {"mention": "胃肠吻合口", "label": "解剖部位", "offset": "244"}, {"mention": "腹盆腔", "label": "解剖部位", "offset": "274"}, {"mention": "腹膜后小淋巴结", "label": "解剖部位", "offset": "288"}, {"mention": "腹盆腔", "label": "解剖部位", "offset": "318"}, {"mention": "枕后", "label": "解剖部位", "offset": "336"}, {"mention": "左肺下叶", "label": "解剖部位", "offset": "360"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "365"}, {"mention": "脑部", "label": "解剖部位", "offset": "387"}, {"mention": "两基底节", "label": "解剖部位", "offset": "400"}, {"mention": "肝多发小囊肿", "label": "疾病和诊断", "offset": "409"}, {"mention": "肝s6", "label": "解剖部位", "offset": "416"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "422"}, {"mention": "右股骨肌腱附着处", "label": "解剖部位", "offset": "427"}, {"mention": "紫杉醇", "label": "药物", "offset": "478"}]}
{"text": ",下腹胀痛,2014-8-28因腹痛行胃镜确诊“胃体窦不规则肿物(印戒细胞癌,弥漫型)”,ca199:199,,ca724:3409,,cea:13,ct4bnxm0?2014-9-18始sox*2,末次2014-10-31,症状未好转,ca199略升高,ca724略上降,胃壁增厚略加重。2014-11-20我院行远端胃癌根治术,15*15cm,侵透浆膜,,部分侵及胰腺:印戒细胞癌伴粘液腺癌,弥漫型,部分肿瘤细胞变性坏死,侵犯浆膜层,脉管癌栓及神经侵犯,11/30,转移灶her-2(0),ypt4an3a。2014-1-9始px*4--2015.4.8因神经毒性iii度改为xeloda单药,耐受改善,,neu:1.19。", "mention_data": [{"mention": "下腹胀痛", "label": "症状", "offset": "1"}, {"mention": "胃体窦", "label": "解剖部位", "offset": "24"}, {"mention": "印戒细胞癌,弥漫型", "label": "疾病和诊断", "offset": "33"}, {"mention": "ca199", "label": "实验室检验", "offset": "45"}, {"mention": "ca724", "label": "实验室检验", "offset": "56"}, {"mention": "cea", "label": "实验室检验", "offset": "68"}, {"mention": "ca199", "label": "实验室检验", "offset": "119"}, {"mention": "ca724", "label": "实验室检验", "offset": "128"}, {"mention": "胃壁增厚", "label": "症状", "offset": "137"}, {"mention": "远端胃癌根治术", "label": "手术", "offset": "158"}, {"mention": "胰腺", "label": "解剖部位", "offset": "184"}, {"mention": "印戒细胞癌伴粘液腺癌,弥漫型", "label": "疾病和诊断", "offset": "187"}, {"mention": "xeloda", "label": "药物", "offset": "290"}, {"mention": "neu", "label": "实验室检验", "offset": "305"}]}
{"text": ",2016-3出现进食吞咽困难,,2016-4-23外院胸ct:食管中下段占位,气管旁、腔静脉旁、隆突前未见肿大淋巴结。2016-4-19,胃镜:肿物距门齿25cm,表面溃烂出血,上缘未描述,活检病理未回报。3周期ptx+卡铂治疗后,2周期评效获益。先第3周期化疗已完成。2016.8.1开始局部放疗,予食管病灶及纵膈肿大淋巴结,gtv60gy/ctv50gy/28f,已完成8f,未诉明显不适。拟同步ptx45mg/m^2叒单药每周方案化疗。现吞咽困难较前缓解,尚可进普食,可小口进食,偶有反流、呃逆,近期体重未上降。", "mention_data": [{"mention": "胸ct", "label": "影像检查", "offset": "28"}, {"mention": "食管中下段", "label": "解剖部位", "offset": "32"}, {"mention": "气管旁", "label": "解剖部位", "offset": "40"}, {"mention": "腔静脉旁", "label": "解剖部位", "offset": "44"}, {"mention": "隆突前", "label": "解剖部位", "offset": "49"}, {"mention": "门齿", "label": "解剖部位", "offset": "76"}, {"mention": "ptx", "label": "药物", "offset": "107"}, {"mention": "卡铂", "label": "药物", "offset": "111"}, {"mention": "食管", "label": "解剖部位", "offset": "152"}, {"mention": "纵膈", "label": "解剖部位", "offset": "157"}, {"mention": "ptx", "label": "药物", "offset": "201"}]}
{"text": ",患者2015年1月无明显诱因出现腹泻,大便稀烂,带血,偶有里急后重,伴间歇腹部绞痛。外院肠镜检查提示距肛门10cm肿物,肠镜不能通过,遂转诊我院,行盆、腹腔ct平扫+增强(2015-05),:符合直肠癌,侵犯浆膜层及肠周系膜;肠周多发淋巴结,考虑转移瘤;肝s8结节,考虑转移瘤。,诊断考虑:直肠癌并肝转移(ct4n+m1a),于2015-05至2015-6给予xexlox(乐沙定200mg+希罗达1500mg叒bid叒d1-14)方案2程,评价pr,2015-08-10全麻上行腹腔镜dixon+开腹肝转移瘤切除术。术中探查肿瘤位于腹膜反折下2cm处直肠,肿瘤突破浆膜,固定,大小4cm×5cm,肝s8实质内2枚肿物,分别1cm及2cm,予切除。,术后病理:1(直肠大体),镜上:肠壁粘膜层至深肌层见少量粘液腺癌浸润,未见明确脉管及神经束侵犯;另于肠壁粘膜至外膜层见多量粘液湖形成,伴纤维组织增生及炎症细胞浸润,结合病史,符合治疗后改变,mandard,分级:trg3级。(中间淋巴结)镜上见2个癌结节。淋巴结0/5阳性。mlh1(+),pms2(+),msh2(+),msh6(+);(肝肿物),镜上:肝组织中见粘液腺癌浸润,结合病史及免疫组化,符合肠癌肝转移,癌旁肝组织部分肝细胞脂肪变性。,术后分期:pt2n1cm1a,iv期。2015-09-02、2015-09-24、2015-10-30、2015-12-04给予xelox方案4程。2016-03-16,复查肝mri提示:肝s6结节,考虑转移瘤,较前为新发病灶。遂于2016-4-5行介入消融治疗,治疗后未继续化疗。2016-6-6mr,示:直肠癌肝转移瘤消融术后,肝s6异常信号灶,呈消融术后改变,未见明显活性。肝内多发结节,考虑转移瘤,部分较前新发,肝s4病灶较前增大。右肺下叶、上叶类结节灶,建议必要时行胸部ct检查。2016-6-21,复查ct示:两肺结节,考虑转移瘤。肝多发转移瘤。2016-7-5、07-26、8-12、2016-09-01给予folfiri方案4程,化疗过程顺利无特殊不适。末次化疗至今,患者精神、睡眠、食欲可,二便如常,体重无明显上降。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "17"}, {"mention": "腹部", "label": "解剖部位", "offset": "38"}, {"mention": "肛门", "label": "解剖部位", "offset": "52"}, {"mention": "盆、腹腔ct平扫+增强", "label": "影像检查", "offset": "75"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "99"}, {"mention": "肠", "label": "解剖部位", "offset": "114"}, {"mention": "肝s8", "label": "解剖部位", "offset": "128"}, {"mention": "直肠癌并肝转移(ct4n+m1a)", "label": "疾病和诊断", "offset": "146"}, {"mention": "乐沙定", "label": "药物", "offset": "188"}, {"mention": "希罗达", "label": "药物", "offset": "197"}, {"mention": "腹腔镜dixon+开腹肝转移瘤切除术", "label": "手术", "offset": "241"}, {"mention": "腹膜反折下2cm处直肠", "label": "解剖部位", "offset": "268"}, {"mention": "肝s8", "label": "解剖部位", "offset": "300"}, {"mention": "直肠", "label": "解剖部位", "offset": "333"}, {"mention": "肠", "label": "解剖部位", "offset": "342"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "354"}, {"mention": "肠", "label": "解剖部位", "offset": "376"}, {"mention": "中间淋巴结", "label": "解剖部位", "offset": "439"}, {"mention": "肝", "label": "解剖部位", "offset": "496"}, {"mention": "肝", "label": "解剖部位", "offset": "504"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "509"}, {"mention": "肠癌肝转移", "label": "疾病和诊断", "offset": "528"}, {"mention": "肝", "label": "解剖部位", "offset": "536"}, {"mention": "肝", "label": "解剖部位", "offset": "541"}, {"mention": "肝mri", "label": "影像检查", "offset": "637"}, {"mention": "肝s6", "label": "解剖部位", "offset": "644"}, {"mention": "介入消融", "label": "手术", "offset": "675"}, {"mention": "mr", "label": "影像检查", "offset": "699"}, {"mention": "直肠癌肝转移瘤消融术后", "label": "疾病和诊断", "offset": "704"}, {"mention": "肝s6", "label": "解剖部位", "offset": "716"}, {"mention": "肝", "label": "解剖部位", "offset": "740"}, {"mention": "肝s4", "label": "解剖部位", "offset": "760"}, {"mention": "右肺下叶、上叶", "label": "解剖部位", "offset": "770"}, {"mention": "胸部ct", "label": "影像检查", "offset": "788"}, {"mention": "ct", "label": "影像检查", "offset": "807"}, {"mention": "两肺", "label": "解剖部位", "offset": "811"}, {"mention": "肝多发转移瘤", "label": "疾病和诊断", "offset": "822"}]}
{"text": ",缘于入院前4个月(2015.9)因排便次数增多伴血便,就诊我院胃肠外科,,查腹部ct示:直肠上段右前壁偏心性管壁增厚,符合直肠癌改变,病变下上范围约40mm,累及周径约50%,病变直肠上缘距肛门口约61mm,病变直肠前缘与前列腺及精囊腺界限较清楚,两侧提肛肌无明显受累及,直肠周围间隙少许淋巴结轻度增大。,盆腔mri示:直肠浸润性病变,符合直肠癌(t3期),病灶上缘距离肛门约5.4cm,请结合临床。诊断为“直肠癌”,(2015年9月29日)在全麻上行“腹腔镜上直肠癌根治术miles”,术顺,术后病理回报(201535378),:(直肠),:大肠溃疡型乳头状腺癌ii级,侵及外膜层,手术标本下、上切端及另送(下切端)均未见癌浸润。找到肠周淋巴结1/12个见癌转移,另于肠粘膜面见双个息肉样隆起,镜上分别为肠管状腺瘤,伴低级别下皮内瘤变及肠增生性息肉。2、(肠系膜上动脉根部淋巴结),:送检为脂肪、脉管、纤维结缔组织。术后(11.10)查盆腔,mri:术区、肛周及臀部浸润性病变,为感染性病变合并多发脓肿、瘘管形成,累及前列腺、精囊腺、部分肠管及尾骨。予中医中药治疗后,复查盆腔mr(11.30),:术区、肛周及臀部浸润性病变,为感染性病变合并多发脓肿、瘘管形成,累及前列腺、精囊腺、部分肠管及尾骨。与2015-11-10旧片比较,病变范围较前缩小,部分脓腔缩小、吸收,前列腺后下方脓腔较前增大。考虑患者无腹痛、发热等临床症状,血炎症指标正常,与患者及家属沟通后开始辅助化疗。(2015-12-02)开始予“奥沙利铂150mg静滴d1+氟尿嘧啶3500mg微量泵泵入d1+亚叶酸钙250mg静滴d1-2q2w”辅助化疗4个周期,过程顺利。目前无明显腹痛、腹胀,无畏冷、发热,无肛门坠胀感,现为继续治疗求诊我科,门诊以“直肠癌术后”收住入院。自下次出院以来,精神、食欲、睡眠尚可,大小便如常,体重无明显增减。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "32"}, {"mention": "肠", "label": "解剖部位", "offset": "33"}, {"mention": "腹部ct", "label": "影像检查", "offset": "39"}, {"mention": "直肠上段", "label": "解剖部位", "offset": "45"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "62"}, {"mention": "直肠上缘", "label": "解剖部位", "offset": "91"}, {"mention": "肛门口", "label": "解剖部位", "offset": "96"}, {"mention": "直肠前缘", "label": "解剖部位", "offset": "107"}, {"mention": "前列腺", "label": "解剖部位", "offset": "112"}, {"mention": "精囊腺", "label": "解剖部位", "offset": "116"}, {"mention": "两侧提肛肌", "label": "解剖部位", "offset": "125"}, {"mention": "直肠", "label": "解剖部位", "offset": "137"}, {"mention": "盆腔mri", "label": "影像检查", "offset": "154"}, {"mention": "直肠", "label": "解剖部位", "offset": "161"}, {"mention": "直肠癌(t3期)", "label": "疾病和诊断", "offset": "171"}, {"mention": "肛门", "label": "解剖部位", "offset": "186"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "205"}, {"mention": "腹腔镜上直肠癌根治术miles", "label": "手术", "offset": "228"}, {"mention": "直肠", "label": "解剖部位", "offset": "268"}, {"mention": "大肠溃疡型乳头状腺癌ii级", "label": "疾病和诊断", "offset": "273"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "319"}, {"mention": "肠", "label": "解剖部位", "offset": "336"}, {"mention": "肠管状腺瘤,伴低级别下皮内瘤变及肠增生性息肉", "label": "疾病和诊断", "offset": "354"}, {"mention": "肠系膜上动脉根部淋巴结", "label": "解剖部位", "offset": "380"}, {"mention": "盆腔,mri", "label": "影像检查", "offset": "420"}, {"mention": "肛周", "label": "解剖部位", "offset": "430"}, {"mention": "臀部", "label": "解剖部位", "offset": "433"}, {"mention": "前列腺", "label": "解剖部位", "offset": "461"}, {"mention": "精囊腺", "label": "解剖部位", "offset": "465"}, {"mention": "肠管", "label": "解剖部位", "offset": "471"}, {"mention": "尾骨", "label": "解剖部位", "offset": "474"}, {"mention": "盆腔mr", "label": "影像检查", "offset": "488"}, {"mention": "肛周", "label": "解剖部位", "offset": "504"}, {"mention": "臀部", "label": "解剖部位", "offset": "507"}, {"mention": "前列腺", "label": "解剖部位", "offset": "535"}, {"mention": "精囊腺", "label": "解剖部位", "offset": "539"}, {"mention": "肠管", "label": "解剖部位", "offset": "545"}, {"mention": "尾骨", "label": "解剖部位", "offset": "548"}, {"mention": "前列腺", "label": "解剖部位", "offset": "586"}, {"mention": "腹痛", "label": "症状", "offset": "604"}, {"mention": "奥沙利铂", "label": "药物", "offset": "655"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "669"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "687"}, {"mention": "腹痛", "label": "症状", "offset": "725"}, {"mention": "腹胀", "label": "症状", "offset": "728"}, {"mention": "肛门坠胀", "label": "症状", "offset": "739"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "760"}]}
{"text": ",2014-9进食哽噎,胃镜示距门齿41cm低分化腺癌,2014-11-15行食管胃结合部癌根治术,术后病理;中-低分化腺癌,混合型,侵及肌层外脂肪纤维组织,癌栓+,14/40,切缘-;pt3n3a,cmet(+),egfr(+),her2(2+),本院fish未扩增。,2014-12-15术后基线ct:食道癌术后,吻合口壁增厚,周围片状软组织密度,右上包裹性液气胸,术后改变?术前后肿标正常。2014-12-19始xelox*6,食欲减退i度,自诉xeloda减量一片仍耐受差,末次2015.3.8,体重上降16kg。2015.4.28复查(-),2015-8-5,我院胃镜:吻合口狭窄,择期扩张。ca72.,4:8.13。现半流食,停化疗后近5月内体重5kg。", "mention_data": [{"mention": "门齿", "label": "解剖部位", "offset": "16"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "食管胃结合部癌根治术", "label": "手术", "offset": "39"}, {"mention": "中-低分化腺癌,混合型", "label": "疾病和诊断", "offset": "55"}, {"mention": "基线ct", "label": "影像检查", "offset": "148"}, {"mention": "食道癌术后", "label": "疾病和诊断", "offset": "153"}, {"mention": "液气胸", "label": "症状", "offset": "181"}, {"mention": "xeloda", "label": "药物", "offset": "226"}, {"mention": "ca72.,4", "label": "实验室检验", "offset": "301"}]}
{"text": ",2010-04-01行胃癌根治术(胃全切),,术后病理:低分化腺癌,术后化疗,腹腔灌注2次,静脉化疗8次。后定期复查。现发现盆腔肿物,心包区肿物,肝脏前方软组织影。2017-10-07出现腹痛,以右下腹及左上腹为主,2017-10-17叒,ct:左肾盂积液伴输尿管扩张,左肾周炎症。梗阻于输尿管盆段水平。左侧附件区实性占位性病变(4.5cm),心包前方不规则肿块,考虑肿瘤性病变。盲肠后方、盆底多发强化结节,种植转移?腹膜后淋巴结略肿大,盆腔少量积液。予抗感染治疗后疼痛明显好转。,2017-10-19pet-ct:肝脏前方软组织影,恶性病变转移待除外,左侧附件区软组织,腹膜后及盆腔内多发淋巴结及小结节影,无代谢增高。2017-10-25,超声引导肿物穿刺病理:符合胃癌转移,ca125(-),cdx2(+),pax2(-),ck7(+)现食纳可,觉左侧腹部胀痛不适,不能右侧卧位,右侧胸部疼痛,无咳嗽、胸闷,大小便正常,无阴道不规则出血,体重无上降。", "mention_data": [{"mention": "胃癌根治术(胃全切)", "label": "手术", "offset": "12"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "29"}, {"mention": "腹腔", "label": "解剖部位", "offset": "40"}, {"mention": "盆腔", "label": "解剖部位", "offset": "63"}, {"mention": "心包区", "label": "解剖部位", "offset": "68"}, {"mention": "肝脏", "label": "解剖部位", "offset": "74"}, {"mention": "腹痛", "label": "症状", "offset": "95"}, {"mention": "右下腹", "label": "解剖部位", "offset": "99"}, {"mention": "左上腹", "label": "解剖部位", "offset": "103"}, {"mention": "ct", "label": "影像检查", "offset": "121"}, {"mention": "左肾盂", "label": "解剖部位", "offset": "124"}, {"mention": "输尿管扩张", "label": "症状", "offset": "130"}, {"mention": "左肾周", "label": "解剖部位", "offset": "136"}, {"mention": "输尿管盆段水平", "label": "解剖部位", "offset": "145"}, {"mention": "左侧附件区", "label": "解剖部位", "offset": "153"}, {"mention": "心包前方", "label": "解剖部位", "offset": "173"}, {"mention": "盲肠后方", "label": "解剖部位", "offset": "191"}, {"mention": "盆底", "label": "解剖部位", "offset": "196"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "210"}, {"mention": "盆腔", "label": "解剖部位", "offset": "220"}, {"mention": "pet-ct", "label": "影像检查", "offset": "252"}, {"mention": "肝脏", "label": "解剖部位", "offset": "259"}, {"mention": "左侧附件区软组织", "label": "解剖部位", "offset": "278"}, {"mention": "腹", "label": "解剖部位", "offset": "287"}, {"mention": "盆腔", "label": "解剖部位", "offset": "291"}, {"mention": "超声", "label": "影像检查", "offset": "322"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "335"}, {"mention": "左侧腹部", "label": "解剖部位", "offset": "377"}, {"mention": "右侧胸部", "label": "解剖部位", "offset": "393"}, {"mention": "胸闷", "label": "症状", "offset": "404"}, {"mention": "阴道不规则出血", "label": "症状", "offset": "414"}]}
{"text": ",因体检发现便潜血阳性就诊,2013-8-20于我院行结肠肝区癌切除术,,术后病理:横结肠结肠溃疡型中分化腺癌,伴粘液分泌、坏死及钙化灶,大小3.8×xxx3.1cm,侵及肠周纤维脂肪组织,可见脉管癌栓及神经侵犯,肠管双断端未见肿瘤,淋巴结见癌转移3/14(肿物周围1/5、肠周2/9),,肿瘤病理分期:pt3n1b,恢复良好,自觉伤口处稍硬。2013-10-19行xelox化疗4周期,无明显不适,继续口服希罗达,末次化疗2014-2-13。现咽部有痰,不易咳,易困,食欲可,大便可,时有腹痛,睡眠欠佳。", "mention_data": [{"mention": "便潜血", "label": "实验室检验", "offset": "6"}, {"mention": "结肠肝区癌切除术", "label": "手术", "offset": "27"}, {"mention": "横结肠结肠溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "42"}, {"mention": "肠周", "label": "解剖部位", "offset": "86"}, {"mention": "肠管", "label": "解剖部位", "offset": "107"}, {"mention": "肠周", "label": "解剖部位", "offset": "137"}, {"mention": "希罗达", "label": "药物", "offset": "204"}, {"mention": "咽部", "label": "解剖部位", "offset": "223"}, {"mention": "腹痛", "label": "症状", "offset": "245"}]}
{"text": ",患者1+年前经常上腹痛伴上坠感,未引起重视,未做任何检查。于7月20号右左给予健康查体发现卵巢囊肿大小约120mm×90mm右左(具体大小不详),建议进一步诊疗,遂于2017年8月5日来我院就诊,,门诊b超示:子宫切除术后,膀胱后方探及大小约128mm×96mm×110mm的囊性回声,内见分离,透声可。,cdfi:囊壁及分离未见明显血流信号。两侧卵巢显示不清。,超声提示:子宫切除术后;膀胱后方囊性包块。现患者仍有上腹部隐痛,无阴道流血,无发热等不适,门诊以“卵巢囊肿”收入院。叒叒叒患者自发病以来,精神、饮食好,睡眠欠佳,大小便无异常,体重无明显改变。", "mention_data": [{"mention": "上腹痛", "label": "症状", "offset": "9"}, {"mention": "卵巢囊肿", "label": "疾病和诊断", "offset": "46"}, {"mention": "b超", "label": "影像检查", "offset": "102"}, {"mention": "子宫切除术后", "label": "疾病和诊断", "offset": "106"}, {"mention": "膀胱后方", "label": "解剖部位", "offset": "113"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "173"}, {"mention": "超声", "label": "影像检查", "offset": "183"}, {"mention": "子宫切除术后", "label": "疾病和诊断", "offset": "188"}, {"mention": "膀胱", "label": "解剖部位", "offset": "195"}, {"mention": "上腹部", "label": "解剖部位", "offset": "209"}, {"mention": "阴道", "label": "解剖部位", "offset": "216"}, {"mention": "卵巢囊肿", "label": "疾病和诊断", "offset": "232"}]}
{"text": "患者因“子宫平滑肌肉瘤”于2015.11.11在全身麻醉上行经腹子宫+两附件+盆腔淋巴结清扫+大网膜部分切除术。手术顺利,病理结果(40522.15)(子宫)平滑肌肉瘤,体积约9*7.6*6.5cm,细胞密集区,核分裂象>10个/10hpf。右左宫旁、(右左骨盆漏斗)结缔组织,均未查见肿瘤细胞。右闭孔淋巴结3枚、左闭孔淋巴结5枚、右髂血管淋巴结4枚、左髂血管淋巴结3枚、右髂总淋巴结1枚及左髂总淋巴结2枚,其内均未查见肿瘤。慢性宫颈炎伴腺体鳞化。子宫平滑肌瘤。(两侧)输卵管急慢性炎,卵巢黄体,左侧卵巢并单纯性囊肿。第一次化疗前查ca-125:40.65u/ml,2015.12.8,2015.12.29行多西他赛120mg+吉西他滨1.2g叒d1叒d8方案化疗,2016-01-21行多西他赛120mg+吉西他滨1.2g及2016-01-30行吉西他滨1.0g方案化疗;2016-2-15行多帕菲120mg+吉西他滨1.2g及2016-02-22行吉西他滨1.0g方案化疗;2016-3-9行多帕菲120mg+吉西他滨1.2g及2016-03-17行吉西他滨1.0g方案化疗。叒现患者为求化疗,来我院就诊,门诊以“子宫平滑肌肉瘤”收入院。患病以来,精神尚可,饮食睡眠可,大小便正常,体重无明显改变。", "mention_data": [{"mention": "子宫平滑肌肉瘤", "label": "疾病和诊断", "offset": "4"}, {"mention": "经腹子宫+两附件+盆腔淋巴结清扫+大网膜部分切除术", "label": "手术", "offset": "30"}, {"mention": "(子宫)平滑肌肉瘤", "label": "疾病和诊断", "offset": "75"}, {"mention": "右左宫旁", "label": "解剖部位", "offset": "121"}, {"mention": "右左骨盆漏斗", "label": "解剖部位", "offset": "127"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "157"}, {"mention": "右髂总淋巴结", "label": "解剖部位", "offset": "186"}, {"mention": "左髂总淋巴结", "label": "解剖部位", "offset": "195"}, {"mention": "慢性宫颈炎伴腺体鳞化", "label": "疾病和诊断", "offset": "213"}, {"mention": "子宫平滑肌瘤", "label": "疾病和诊断", "offset": "224"}, {"mention": "(两侧)输卵管急慢性炎,卵巢黄体,左侧卵巢并单纯性囊肿", "label": "疾病和诊断", "offset": "231"}, {"mention": "ca-125", "label": "实验室检验", "offset": "266"}, {"mention": "多西他赛", "label": "药物", "offset": "344"}, {"mention": "吉西他滨", "label": "药物", "offset": "354"}, {"mention": "多帕菲", "label": "药物", "offset": "397"}, {"mention": "吉西他滨", "label": "药物", "offset": "406"}, {"mention": "吉西他滨", "label": "药物", "offset": "426"}, {"mention": "多帕菲", "label": "药物", "offset": "448"}, {"mention": "吉西他滨", "label": "药物", "offset": "457"}, {"mention": "子宫平滑肌肉瘤", "label": "疾病和诊断", "offset": "509"}]}
{"text": ",患者2月前因“进食梗阻感半月余”于2015.12.29在全麻上行近端胃癌根治术,手术顺利,术后患者恢复良好,术后常规病理示(胃)低-中分化腺癌伴神经内分泌分化,溃疡型,肿瘤切面积3*0.8cm,侵达浆膜。下、上切缘及吻合器切缘未查见癌。小弯侧淋巴结12枚,大弯侧淋巴结1枚及另送食管旁淋巴结1枚,均未查见转移癌。网膜组织未查见癌。,免疫组化:ck19(+),e-cad(+),her-2(0),syn(+),cga(-)。,病理号:47508.15。现患者为行进一步治疗来我院就诊,门诊以“胃癌术后”收入院。患者近期饮食睡眠可,大小便无明显异常,体重较前略有减轻。", "mention_data": [{"mention": "近端胃癌根治术", "label": "手术", "offset": "33"}, {"mention": "(胃)低-中分化腺癌伴神经内分泌分化,溃疡型", "label": "疾病和诊断", "offset": "62"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "129"}, {"mention": "食管旁淋巴结", "label": "解剖部位", "offset": "140"}]}
{"text": ",患者5月余前因“粘液血便2月余。”入我院,完善检查考虑横结肠腺癌,遂于203-10-29我院行腹腔镜上横结肠切除手术,,术后病理:中分化腺癌,浸润至肠壁浆膜上层,未见明确脉管及神经束侵犯。(中央组淋巴结)7枚,6/7见腺癌转移;(中间组淋巴结)2枚,1/2见腺癌转移;(肠旁淋巴结)8枚,8/8见腺癌转移,脉管内见癌栓;,术后分期:pt3n2bm0叒iiic期。术后外院行xelox方案化疗5程;化疗过程中发现右上腹包块,遂行pet-ct检查吻合口放射性摄取升高,右侧腹壁内放射性摄取升高;外院行肠镜检查提示吻合口复发,中分化腺癌浸润。为求进一步治疗,随来我院。自发病以来,患者无恶心、呕吐等,无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,体重上降不明显。", "mention_data": [{"mention": "横结肠腺癌", "label": "疾病和诊断", "offset": "28"}, {"mention": "腹腔镜上横结肠切除手术", "label": "手术", "offset": "48"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "66"}, {"mention": "中央组淋巴结", "label": "解剖部位", "offset": "96"}, {"mention": "中间组淋巴结", "label": "解剖部位", "offset": "116"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "136"}, {"mention": "右上腹", "label": "解剖部位", "offset": "206"}, {"mention": "pet-ct", "label": "影像检查", "offset": "214"}, {"mention": "右侧腹", "label": "解剖部位", "offset": "233"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "261"}, {"mention": "骶部", "label": "解剖部位", "offset": "311"}]}
{"text": ",病史见前,2008.1行结肠癌手术,术后,定期复查。2010.3.17发现肝转移,行手术,口服希罗达*8。2010.9末次。2012.2.28复查肿标正常。,ct:左髂血管旁及左腹股沟腹股沟淋巴结增大叒(42*23mm,2011.11叒34*17mm)3月查瘤标一项略升高(具体不详)。2012.3.12,多学科查房意见:根据影像检查考虑淋巴结转移可能性较大,但肿标正常,建议随访复查暂不予特殊治疗。2012-5-29我院复查腹盆ct示左侧髂血管旁及左侧腹股沟淋巴结较前增大(44*26mm,2012.2叒42*23mm),2012-5-31肿标均正常。\\u0004\\u0004叒叒2012-09-07来院复查,,今结果已归:肿标正常。胸片未见异常。腹盆ct与2012-05-29比较未见肿瘤进展表现。\\u0004\\u0004叒叒现时有左下腹不适,乏力,食欲差,近期体重有上降。", "mention_data": [{"mention": "结肠癌手术", "label": "手术", "offset": "13"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "38"}, {"mention": "希罗达", "label": "药物", "offset": "48"}, {"mention": "ct", "label": "影像检查", "offset": "80"}, {"mention": "左髂血管", "label": "解剖部位", "offset": "83"}, {"mention": "左腹股沟", "label": "解剖部位", "offset": "89"}, {"mention": "腹股沟淋巴结", "label": "解剖部位", "offset": "93"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "214"}, {"mention": "左侧髂血管旁及左侧腹股沟淋巴结", "label": "解剖部位", "offset": "219"}, {"mention": "胸片", "label": "影像检查", "offset": "319"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "326"}, {"mention": "左下腹", "label": "解剖部位", "offset": "369"}]}
{"text": ",患者1+月前因子宫纵隔行宫腔镜子宫纵隔电切术。,术前查tct示:低度鳞状下皮内病变。,术后复查行阴道镜宫颈活检病理示:慢性宫颈炎,部分鳞状下皮增生活跃,符合低级别鳞状下皮内病变,局灶不除外高级别鳞状下皮内瘤变(cinii);,免疫组化:p16(局部鳞状下皮及腺体鳞状下皮全层+),ki67+,结合he形态,结果支持局部高级别鳞状下皮内病变(cinii),累及腺体。患者术后阴道流血淋漓不净,无腹痛,无接触性出血。为求进一步治疗来我院就诊,门诊遂以“宫颈病变”收入院。患者自发病以来,无头晕、乏力,无恶心、呕吐,无腹痛、腹泻,饮食睡眠可,大小便无异常,体重无增减。", "mention_data": [{"mention": "子宫纵隔", "label": "疾病和诊断", "offset": "8"}, {"mention": "宫腔镜子宫纵隔电切术", "label": "手术", "offset": "13"}, {"mention": "低度鳞状下皮内病变", "label": "疾病和诊断", "offset": "33"}, {"mention": "宫颈", "label": "解剖部位", "offset": "52"}, {"mention": "慢性宫颈炎", "label": "疾病和诊断", "offset": "60"}, {"mention": "低级别鳞状下皮内病变", "label": "疾病和诊断", "offset": "79"}, {"mention": "高级别鳞状下皮内瘤变(cinii)", "label": "疾病和诊断", "offset": "95"}, {"mention": "高级别鳞状下皮内病变(cinii)", "label": "疾病和诊断", "offset": "160"}, {"mention": "阴道", "label": "解剖部位", "offset": "187"}, {"mention": "腹痛", "label": "症状", "offset": "197"}, {"mention": "宫颈病变", "label": "疾病和诊断", "offset": "225"}, {"mention": "头晕", "label": "症状", "offset": "243"}, {"mention": "腹痛", "label": "症状", "offset": "257"}, {"mention": "腹泻", "label": "症状", "offset": "260"}]}
{"text": ",患者2011年12月因“腹部胀痛半年余”于外院行超声、mr检查发现两侧卵巢肿物伴腹水。随后于我院就诊,,行肠镜检查示:结肠肝区处粘膜充血肿胀,周围见白斑,肠腔明显变性狭窄,内镜无法通过。,活检病理:中至低分化腺癌。胃镜未见明显异常。经全院专家大会诊后于2011.12.15行剖腹探查术,术中见肝区结肠肿物及两卵巢肿物,盆、腹腔腹膜广泛种植,腹水约1500ml。遂行左半结肠切除+两卵巢切除。术中及术后腹腔热灌注化疗3次(43℃1小时,,术中:5-fu叒2g叒,,术后:5-fu叒1g叒2次)。,末次腹腔热灌注化疗时间:2011.12.19。,术后病理示:1、右卵巢15×12×7cm,叒左卵巢13×9×6cm,镜检为低分化腺癌,大部分为粘液腺癌,符合肠腺癌转移。2、肝曲结肠肿物大小为4×4×2cm,镜检为粘液腺癌,浸润至肠壁外膜层,未见明确血管及神经束侵犯。淋巴结7/25(+),,k-ras:野生型。经院内专家大会诊后建议行c225+folfiri方案化疗。现为求进一步治疗入院。患者精神、纳眠可,大小便正常,近期体重无明显上降。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "13"}, {"mention": "超声", "label": "影像检查", "offset": "25"}, {"mention": "mr", "label": "影像检查", "offset": "28"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "34"}, {"mention": "腹水", "label": "症状", "offset": "41"}, {"mention": "结肠肝区", "label": "解剖部位", "offset": "60"}, {"mention": "肠腔", "label": "解剖部位", "offset": "78"}, {"mention": "中至低分化腺癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "剖腹探查术", "label": "手术", "offset": "138"}, {"mention": "肝区结肠", "label": "解剖部位", "offset": "147"}, {"mention": "两卵巢", "label": "解剖部位", "offset": "154"}, {"mention": "盆、腹腔腹膜广泛种植", "label": "疾病和诊断", "offset": "160"}, {"mention": "腹水", "label": "症状", "offset": "171"}, {"mention": "左半结肠切除+两卵巢切除", "label": "手术", "offset": "183"}, {"mention": "腹腔", "label": "解剖部位", "offset": "201"}, {"mention": "5-fu", "label": "药物", "offset": "222"}, {"mention": "5-fu", "label": "药物", "offset": "235"}, {"mention": "腹腔", "label": "解剖部位", "offset": "250"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "280"}, {"mention": "左卵巢", "label": "解剖部位", "offset": "294"}, {"mention": "低分化腺癌,大部分为粘液腺癌,符合肠腺癌转移", "label": "疾病和诊断", "offset": "309"}, {"mention": "肝曲结肠", "label": "解剖部位", "offset": "334"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "354"}, {"mention": "c225", "label": "药物", "offset": "415"}]}
{"text": "2011年4月起患者出现无诱因大便带血,诊断为乙状结肠腺癌,2011.7.13我院全麻上行腹腔镜dixon术,左侧附件切除术,术中诊断为直肠下段癌晚期,肝转移。术后病理示:(直肠)溃疡型腺癌,分化iii级,伴大片坏死,侵及全层及周围脂肪组织,脉管内见癌栓,神经见癌累及;双切缘未见癌累及。术后门诊全身化疗五次。2011-10-28mri乙状结肠mt病例,肝内多发转移瘤;肝、两肾多发小囊肿,肝内胆管轻度扩张。为进一步诊治收入我院,患病以来精神胃纳可,体重无明显减轻。", "mention_data": [{"mention": "乙状结肠腺癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "腹腔镜dixon术,左侧附件切除术", "label": "手术", "offset": "45"}, {"mention": "直肠下段癌晚期,肝转移", "label": "疾病和诊断", "offset": "68"}, {"mention": "(直肠)溃疡型腺癌,分化iii级", "label": "疾病和诊断", "offset": "86"}, {"mention": "mri", "label": "影像检查", "offset": "165"}, {"mention": "肝内多发转移瘤", "label": "疾病和诊断", "offset": "177"}, {"mention": "肝、两肾多发小囊肿", "label": "疾病和诊断", "offset": "185"}, {"mention": "肝内胆管", "label": "解剖部位", "offset": "195"}]}
{"text": ",2012.12.21行手术探查,术中见回盲部肿物,肿物与大网膜粘连,行左半结肠切除术,,病理:中分化腺癌,网膜组织见癌结节。侵及浆膜上断端净,淋巴结0/21。2013-1-15行folfox*10周期。,末次:2013-6-4.已行dc-cik回输3次。治疗期间复查未见肿瘤复发转移征象。\\u0004\\u0004叒10周期后患者出现神经毒性ii度,持续不缓解,停止化疗。此次入院复查,2013-6-27,外院查盆腔b超:左卵巢囊肿。胸部cr未见异常。腹部b超未查。\\u0004\\u0004。", "mention_data": [{"mention": "回盲部", "label": "解剖部位", "offset": "20"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "36"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "48"}, {"mention": "盆腔b超", "label": "影像检查", "offset": "206"}, {"mention": "左卵巢囊肿", "label": "疾病和诊断", "offset": "211"}, {"mention": "胸部cr", "label": "影像检查", "offset": "217"}, {"mention": "腹部b超", "label": "影像检查", "offset": "226"}]}
{"text": "患者1个月前因腹部疼痛伴发热、寒战于我科住院治疗,胆囊结石、胆囊穿孔、胆总管结石于我科住院治疗,给予抗生素治疗并行胆囊穿刺置管引流术,术后患者病情平稳,带管出院。13天前患者再次出现腹痛伴发热,胆囊引流管不通畅,于我院给予生理盐水冲管后仍不通畅,2016-2-4行ct检查提示“左肺大泡,冠状动脉钙化;两肺间质性病变;心包积液并心包增厚;胆总管结石;胆囊结石并胆囊炎;胆囊穿孔不除外,清结合临床;腹水,腹膜增厚;肠管扩张,胃窦壁厚,请结合临床”,给予抗生素治疗4天,腹痛好转,未再发热,胆囊穿刺引流管仍不通。现患者为求进一步诊疗,来我科门诊,以“胆囊结石、胆总管结石”收入院。患者自发病以来,患者饮食、睡眠差,大小便未见明显异常,体重较前有所减轻,具体不详。既往糖尿病史10余年,平时服用二甲两胍、格列齐脲,血糖控制可。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "7"}, {"mention": "胆囊结石、胆囊穿孔、胆总管结石", "label": "疾病和诊断", "offset": "25"}, {"mention": "胆囊穿刺置管引流术", "label": "手术", "offset": "57"}, {"mention": "腹痛", "label": "症状", "offset": "91"}, {"mention": "胆囊", "label": "解剖部位", "offset": "97"}, {"mention": "ct", "label": "影像检查", "offset": "132"}, {"mention": "左肺大泡", "label": "解剖部位", "offset": "139"}, {"mention": "冠状动脉", "label": "解剖部位", "offset": "144"}, {"mention": "两肺", "label": "解剖部位", "offset": "151"}, {"mention": "心包积液并心包增厚", "label": "疾病和诊断", "offset": "159"}, {"mention": "胆总管结石;胆囊结石并胆囊炎;胆囊穿孔", "label": "疾病和诊断", "offset": "169"}, {"mention": "腹水", "label": "症状", "offset": "198"}, {"mention": "腹", "label": "解剖部位", "offset": "201"}, {"mention": "肠管", "label": "解剖部位", "offset": "206"}, {"mention": "胃窦", "label": "解剖部位", "offset": "211"}, {"mention": "腹痛", "label": "症状", "offset": "233"}, {"mention": "胆囊", "label": "解剖部位", "offset": "243"}, {"mention": "胆囊结石、胆总管结石", "label": "疾病和诊断", "offset": "273"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "331"}, {"mention": "二甲两胍", "label": "药物", "offset": "344"}, {"mention": "格列齐脲", "label": "药物", "offset": "349"}, {"mention": "血糖", "label": "实验室检验", "offset": "354"}]}
{"text": "患者因“便血10年余,加重2月”于2013年5月到我院就诊,经完善检查诊断为直肠腺癌(ct3nxm0),予2013-05-17日起行术前xelox方案化疗3程+同期放疗共50gy/25次,末次放疗时间2013-08-01,末次化疗时间2013-08-06,疗程顺利,自诉便血减少,现大便3-4次/天,复查mr示肿物有所缩小,于2013-11-21给予希罗达方案化疗1程,2013-12-11全麻上行腹腔镜探查+横结肠两腔造口术+经阴直肠阴道瘘修补术。术后希罗达单药化疗至今5程,现为求进一步诊治入住我院。近双月,患者精神、食欲、睡眠尚可,小便正常,体重上降2kg。", "mention_data": [{"mention": "直肠腺癌(ct3nxm0)", "label": "疾病和诊断", "offset": "38"}, {"mention": "mr", "label": "影像检查", "offset": "152"}, {"mention": "希罗达", "label": "药物", "offset": "175"}, {"mention": "腹腔镜探查+横结肠两腔造口术+经阴直肠阴道瘘修补术", "label": "手术", "offset": "199"}, {"mention": "希罗达", "label": "药物", "offset": "227"}]}
{"text": ",患者因\\\"体检发现宫颈癌3周。\\\"于2014-2-11在我院全麻上行\\\"腹腔镜上宫颈癌根治术(ii型子宫切除+两侧附件切除+盆腔淋巴结清扫术)\\\"。,术后病理示:宫颈低分化鳞状细胞癌,癌组织侵犯至宫颈浅肌层并累及宫颈管浅肌层,未累及阴道穹窿,未见明确脉管及神经束侵犯;盆腔淋巴结未见癌;两附件,两侧主韧带、骶韧带,阴道残端未见癌。2014-2-26、2014-3-19、2014-4-8予以tp方案化疗一程,化疗过程顺利,现为进一步化疗入院。患者无发热畏寒,无腹痛腹泻,无胸闷气促,精神可,睡眠可,胃纳可,大小便无异常,体重无明显减轻。,既往化疗及肿瘤标志物情况:,化疗药物毒副反应:。", "mention_data": [{"mention": "宫颈癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "腹腔镜上宫颈癌根治术(ii型子宫切除+两侧附件切除+盆腔淋巴结清扫术)", "label": "手术", "offset": "37"}, {"mention": "宫颈低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "82"}, {"mention": "宫颈", "label": "解剖部位", "offset": "99"}, {"mention": "宫颈", "label": "解剖部位", "offset": "107"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "117"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "135"}, {"mention": "两附件", "label": "解剖部位", "offset": "144"}, {"mention": "两侧主韧带", "label": "解剖部位", "offset": "148"}, {"mention": "骶韧带", "label": "解剖部位", "offset": "154"}, {"mention": "阴道", "label": "解剖部位", "offset": "158"}, {"mention": "腹痛", "label": "症状", "offset": "231"}, {"mention": "腹泻", "label": "症状", "offset": "233"}, {"mention": "胸闷", "label": "症状", "offset": "237"}, {"mention": "胃", "label": "解剖部位", "offset": "250"}]}
{"text": ",患者3月前无明显诱因出现恶心,进食后腹胀明显,无呕吐,无进食困难,无腹痛、腹泻。当时未予重视。1月前前患者就诊于我院,门诊行胃镜检查,,镜上诊断:食管病变待病理,慢性非萎缩性胃炎。,病理诊断:(食管)鳞状下皮呈重度不典型增生。2016-3-8行共聚焦胃镜检查,,镜上诊断:食管糜烂,非萎缩性胃炎。,病理诊断:(食管)粘膜鳞状下皮呈中度至重度不典型增生伴慢性炎症。后为行内镜上治疗,于我院消化内科住院治疗。给予抑酸对症治疗,查胸部ct示发现纵隔及左肺门淋巴结肿大,转移瘤不除外,2016-3-29行左侧颈部淋巴结穿刺活检,,病理示:淋巴结内查见转移的低分化癌,建议检查肺。随后患者门诊行支气管镜检查,刷检物未见病理细胞,建议行ebus-tbna检查,近患者为求进一步诊治再次来我院,门诊以“纵隔淋巴结肿大”收入我科。患者自发病来饮食上降,睡眠可,大小便无改变,体重无减轻。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "35"}, {"mention": "腹泻", "label": "症状", "offset": "38"}, {"mention": "食管", "label": "解剖部位", "offset": "74"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "82"}, {"mention": "(食管)鳞状下皮呈重度不典型增生", "label": "疾病和诊断", "offset": "97"}, {"mention": "食管糜烂,非萎缩性胃炎", "label": "疾病和诊断", "offset": "137"}, {"mention": "(食管)粘膜鳞状下皮呈中度至重度不典型增生伴慢性炎症", "label": "疾病和诊断", "offset": "155"}, {"mention": "胸部ct", "label": "影像检查", "offset": "213"}, {"mention": "纵隔及左肺门淋巴结", "label": "解剖部位", "offset": "220"}, {"mention": "左侧颈部淋巴结", "label": "解剖部位", "offset": "249"}, {"mention": "低分化癌", "label": "疾病和诊断", "offset": "275"}, {"mention": "肺", "label": "解剖部位", "offset": "284"}, {"mention": "纵隔淋巴结肿大", "label": "疾病和诊断", "offset": "345"}]}
{"text": ",患者3年余前(2010年)无明显诱因出现左下腹疼痛,呈针刺样疼痛,持续时间短暂,可自行缓解,无腹胀、呕吐,未特殊检查治疗。2013-7出现左下腹疼痛疼痛加重,呈阵发性绞痛,无放射痛,伴腹胀,饮食量减少或适当活动腹胀可缓解,无呕吐及发热。并有便血,遂就诊于我院,,结肠镜示:结肠肝曲占位,肠腔环周狭窄,肠镜不能通过。腹盆腔,ct:1、升结肠肠壁增厚,考虑结肠癌,侵犯浆膜。2、升结肠肠周、肠系膜根部及腹膜后多发肿大淋巴结,考虑转移。胸部ct未见转移征象。术前,cea:19.87ng/ml;,术前分期:ct4an+m0。2013-7-25于我院行“全麻上剖腹探查、左半结肠切除术”,术中见腹膜、大网膜多发转移,腹腔多发淋巴结肿大。术中予氟尿嘧啶植入剂、防粘连贴膜、可吸收止血纱/海绵、铜绿假单胞菌注射液。患者术后间断低热,伤口局部疼痛,2013-8-7行伤口拆线,后每日午后低热,体温最高38.5℃,物理降温可降至正常,现伤口局部发红,自服右氧氟沙星后略好转。现为进一步诊治收入院。患者病来饮食睡眠好,大小便如常,体重无减轻。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "21"}, {"mention": "腹胀", "label": "症状", "offset": "48"}, {"mention": "左下腹", "label": "解剖部位", "offset": "70"}, {"mention": "腹胀", "label": "症状", "offset": "93"}, {"mention": "腹胀", "label": "症状", "offset": "106"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "137"}, {"mention": "肠腔", "label": "解剖部位", "offset": "144"}, {"mention": "肠", "label": "解剖部位", "offset": "151"}, {"mention": "腹盆腔,ct", "label": "影像检查", "offset": "158"}, {"mention": "升结肠", "label": "解剖部位", "offset": "167"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "177"}, {"mention": "升结肠肠周", "label": "解剖部位", "offset": "188"}, {"mention": "肠系膜根部", "label": "解剖部位", "offset": "194"}, {"mention": "腹", "label": "解剖部位", "offset": "200"}, {"mention": "胸部ct", "label": "影像检查", "offset": "216"}, {"mention": "cea", "label": "实验室检验", "offset": "230"}, {"mention": "全麻上剖腹探查、左半结肠切除术", "label": "手术", "offset": "274"}, {"mention": "腹", "label": "解剖部位", "offset": "294"}, {"mention": "腹腔", "label": "解剖部位", "offset": "305"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "318"}, {"mention": "铜绿假单胞菌注射液", "label": "药物", "offset": "342"}, {"mention": "右氧氟沙星", "label": "药物", "offset": "420"}]}
{"text": "患者于2010-6-13在我院诊断为\\\"右乳浸润性导管癌\\\",完善检查后于2010-6-25、2010-7-16、2010-8-6行tec方案新辅助化疗3程,2010-8-26全麻上行右乳癌改良根治术+右锁骨下淋巴结活检术,术后病理示浸润性导管癌,er++/pr++,her-2(-),ypt1n3m0,iiic期,于2010-9-9、2010-9-30行tec化疗2程,因3度骨髓抑制改gx方案化疗2程,2010-12-14~2011-1-20原发灶及区域淋巴结50gy放射治疗。后定期随诊,2012年5月发现ca153升高,2012-6-4我院pet/ct检查示肝viii段考虑转移。2012-6-6乳腺科联合会诊建议排除妇科疾病后行两侧卵巢切除去势手术。2012-6-18行\\\"腹腔镜上两侧卵巢切除术\\\"。于2012-7-2、7-25、8-16、9-5、9-26、10-18、11-06、11-29给予nvb+xeloda方案姑息性化疗8程。现8程后已行ct复查,结果未回。下程化疗后出现恶心、食欲上降、右肩关节不适等,现为继续治疗入院。入院时患者一般情况良好,偶有胸闷,无气促等不适,诉周身游走性疼痛,因今晨滑到,诉有右侧肘部及踝关节疼痛。患者精神、胃纳、睡眠可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "右乳浸润性导管癌", "label": "疾病和诊断", "offset": "20"}, {"mention": "右乳癌改良根治术+右锁骨下淋巴结活检术", "label": "手术", "offset": "92"}, {"mention": "浸润性导管癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "ca153", "label": "实验室检验", "offset": "256"}, {"mention": "pet/ct", "label": "影像检查", "offset": "274"}, {"mention": "肝viii段", "label": "解剖部位", "offset": "283"}, {"mention": "两侧卵巢切除去势手术", "label": "手术", "offset": "319"}, {"mention": "腹腔镜上两侧卵巢切除术", "label": "手术", "offset": "342"}, {"mention": "nvb", "label": "药物", "offset": "404"}, {"mention": "xeloda", "label": "药物", "offset": "408"}, {"mention": "ct", "label": "影像检查", "offset": "430"}, {"mention": "右肩关节", "label": "解剖部位", "offset": "455"}, {"mention": "胸闷", "label": "症状", "offset": "486"}, {"mention": "右侧肘部", "label": "解剖部位", "offset": "513"}, {"mention": "踝关节疼痛", "label": "症状", "offset": "518"}, {"mention": "胃", "label": "解剖部位", "offset": "529"}]}
{"text": "患者自述于2年7个月前因体检时查腹部超声发现胃区回声不均匀,后查胃镜检查示胃窦部巨大溃疡性病变取病理为低分化腺癌,`后于我院肿瘤外科行胃癌根治术(2011-7-4),术中见肿物位于胃窦部大弯侧,已侵透浆膜,腹腔粘连较轻,术后病理为进展期胃癌,中、低分化腺癌及粘液腺癌,肿物浸透浆膜,淋巴结3/27枚转移,病理号为126582。后入我科行乐沙定联合替吉奥方案化疗8周期,具体为奥沙利铂(乐沙定)叒250毫克叒d1静点,替吉奥(爱斯万)叒60毫克叒d1-d14日双次口服,末次化疗时间2012-1,化疗结束后于我科行生物治疗1周期,定期复查未见复发转移征象,1年8个月前入院复查ca724下升达98.3ng/ml,予替吉奥60毫克日二次口服d1-d14,并行生物治疗9周期。近来患者偶有乏力,现为进一步治疗入我科。患者近1月饮食睡眠一般,精神体力可,周身无疼痛,二便基本正常,体重无明显变化,ecog评分1分。", "mention_data": [{"mention": "腹部超声", "label": "影像检查", "offset": "16"}, {"mention": "胃", "label": "解剖部位", "offset": "22"}, {"mention": "胃窦部", "label": "解剖部位", "offset": "37"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "51"}, {"mention": "胃癌根治术", "label": "手术", "offset": "67"}, {"mention": "胃窦部大弯侧", "label": "解剖部位", "offset": "90"}, {"mention": "腹腔", "label": "解剖部位", "offset": "103"}, {"mention": "进展期胃癌,中、低分化腺癌及粘液腺癌", "label": "疾病和诊断", "offset": "115"}, {"mention": "乐沙定", "label": "药物", "offset": "168"}, {"mention": "替吉奥", "label": "药物", "offset": "173"}, {"mention": "奥沙利铂", "label": "药物", "offset": "187"}, {"mention": "乐沙定", "label": "药物", "offset": "192"}, {"mention": "替吉奥", "label": "药物", "offset": "208"}, {"mention": "爱斯万", "label": "药物", "offset": "212"}, {"mention": "ca724", "label": "实验室检验", "offset": "287"}, {"mention": "替吉奥", "label": "药物", "offset": "306"}]}
{"text": "因“体检左肝占位”当地确诊hcc?,术前未见远处m,afp(-),2014.3.23行肝部分切除及胆囊切除术,术中探查无腹水,小结节性肝硬变,s6近脏面,约4*3cm,病理示左叶肝细胞性肝癌,中分化,afp(-),hepotocyte(-),术后未治疗。术后行肝血管造影(-);外院2014-12-28腹ct示腹膜后lnm,3.1cm?2015.1.5始行腹膜后lnm放疗6300cgy/35f,2015.2.28结束,2015.3.29叒ct报告示稳定33*29mm,现afp正常。2015.4.20口服sorafinib,同时2015.4.20叒ct:腹膜后占位相仿,肝肾之间占位新发?侵及十二指肠,间断黑便,饮食可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "hcc", "label": "疾病和诊断", "offset": "13"}, {"mention": "afp", "label": "实验室检验", "offset": "26"}, {"mention": "肝部分切除及胆囊切除术", "label": "手术", "offset": "43"}, {"mention": "腹水", "label": "症状", "offset": "60"}, {"mention": "肝", "label": "解剖部位", "offset": "67"}, {"mention": "s6近脏面", "label": "解剖部位", "offset": "71"}, {"mention": "左叶肝细胞性肝癌,中分化", "label": "疾病和诊断", "offset": "87"}, {"mention": "afp", "label": "实验室检验", "offset": "100"}, {"mention": "hepotocyte", "label": "实验室检验", "offset": "107"}, {"mention": "肝血管造影", "label": "影像检查", "offset": "130"}, {"mention": "腹ct", "label": "影像检查", "offset": "151"}, {"mention": "腹膜后lnm", "label": "疾病和诊断", "offset": "155"}, {"mention": "腹膜后lnm", "label": "疾病和诊断", "offset": "178"}, {"mention": "ct", "label": "影像检查", "offset": "220"}, {"mention": "afp", "label": "实验室检验", "offset": "236"}, {"mention": "sorafinib", "label": "药物", "offset": "253"}, {"mention": "ct", "label": "影像检查", "offset": "275"}, {"mention": "腹", "label": "解剖部位", "offset": "278"}, {"mention": "肝肾之间", "label": "解剖部位", "offset": "286"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "297"}]}
{"text": "患者宫颈癌iib期。2012-7-13于外院行tp方案化疗1周期。2012-8-31行广泛性全子宫切除+盆腔淋巴结清扫术,术后病理会诊示子宫、两附件及淋巴结:1.宫颈,浸润性低分化鳞癌,癌浸润宫颈壁全层,局部延伸到宫旁组织,可见脉管癌栓,手术切缘未见肿瘤,转移性宫颈鳞癌见于2个淋巴结/57,右髂内1/1,右闭孔1/14。2012-9-29复查腹部增强ct示腹主动脉旁多发淋巴结,较大者转移待排;左侧肾盂、输尿管轻度积水。盆腔增强mr示两侧腹股沟多发小淋巴结。2012-10-18行tp方案化疗1周期。后于当地行放疗,具体不详。2015-4我院复查示右肺上叶转移,纵膈淋巴结转移。2015-4-12,5-8,6-8,7-15、2015-9-14多西他赛120mgd1+奈达铂50mgd1-2化疗5程。2015-6-2胸ct示右肺上叶不规则结节明显缩小。2015-8-31复查胸部增强ct右肺上叶结节继续减小。", "mention_data": [{"mention": "宫颈癌iib期", "label": "疾病和诊断", "offset": "2"}, {"mention": "全子宫切除+盆腔淋巴结清扫术", "label": "手术", "offset": "46"}, {"mention": "子宫", "label": "解剖部位", "offset": "68"}, {"mention": "两附件", "label": "解剖部位", "offset": "71"}, {"mention": "宫颈,浸润性低分化鳞癌", "label": "疾病和诊断", "offset": "81"}, {"mention": "宫颈", "label": "解剖部位", "offset": "96"}, {"mention": "宫旁", "label": "解剖部位", "offset": "107"}, {"mention": "转移性宫颈鳞癌", "label": "疾病和诊断", "offset": "128"}, {"mention": "右髂内", "label": "解剖部位", "offset": "146"}, {"mention": "右闭孔", "label": "解剖部位", "offset": "153"}, {"mention": "腹部增强ct", "label": "影像检查", "offset": "172"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "179"}, {"mention": "左侧肾盂", "label": "解剖部位", "offset": "198"}, {"mention": "输尿管", "label": "解剖部位", "offset": "203"}, {"mention": "盆腔增强mr", "label": "影像检查", "offset": "211"}, {"mention": "两侧腹股沟", "label": "解剖部位", "offset": "218"}, {"mention": "右肺上叶转移,纵膈淋巴结转移", "label": "疾病和诊断", "offset": "275"}, {"mention": "多西他赛", "label": "药物", "offset": "322"}, {"mention": "奈达铂", "label": "药物", "offset": "334"}, {"mention": "胸ct", "label": "影像检查", "offset": "358"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "362"}, {"mention": "胸部增强ct", "label": "影像检查", "offset": "387"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "393"}]}
{"text": ",缘于4月前(2016.07.14)因食管胃交界部腺癌于我院行根治性全胃切除+食管-空肠roux-en-y吻合术,,术中探查:无腹水,肝脏表面光滑,未触及结节。大网膜与右侧腹腔粘连,腹膜后、空回肠未见明显病变,贲门未触及明显肿块,术前贲门癌诊断明确,遂决定行贲门癌根治术。术顺,术后予禁食、胃肠减压、抗感染、制酸、肠内外营养支持等治疗。术后病理(201624597),:(全胃),:食管胃交界早期浅表隆起型(0-iia型,肿瘤主体位于胃)管状腺癌ii级,局部为黏液腺癌,侵及黏膜上层。手术标本下切端、上切端及另送(下切端)均未见癌浸润。找到贲门周淋巴结0/5个,小弯侧淋巴结1/1个,大弯侧淋巴结0/2个,见癌转移。于2016.07.26腹腔引流袋有淡黄色液体流出,数字胃肠示根治性全胃切除术+食管-空肠吻合术后,吻合口瘘。予腹腔引流、舒普深联合甲硝唑加强抗感染治疗,多次复查消化道提示吻合口愈合良好,病情好转、稳定。于2016.10.11行“泰素240mgivgttd1+顺铂60mgivgttd1、2q3w”方案化疗1周期,辅以保肝、护胃、止吐、对症支持等治疗。过程顺利,2016.10.13出院。出院后患者出现骨髓抑制,白细胞低至1.1×10^9/l,血红蛋白低至77g/l,血小板低至46×10^9/l,予住院治疗恢复白细胞至8×10^9/l,血红蛋白至85g/l,血小板低108×10^9/l后出院。今为行第二周期化疗就诊我院,门诊拟食管胃交界部腺癌术后化疗后收住我科。近来,精神、睡眠、饮食一般,大小便如常,体重无明显增减。", "mention_data": [{"mention": "食管胃交界部腺癌", "label": "疾病和诊断", "offset": "19"}, {"mention": "根治性全胃切除+食管-空肠roux-en-y吻合术", "label": "手术", "offset": "31"}, {"mention": "腹水", "label": "症状", "offset": "64"}, {"mention": "肝脏", "label": "解剖部位", "offset": "67"}, {"mention": "右侧腹腔", "label": "解剖部位", "offset": "84"}, {"mention": "腹", "label": "解剖部位", "offset": "91"}, {"mention": "空回肠", "label": "解剖部位", "offset": "95"}, {"mention": "贲门", "label": "解剖部位", "offset": "105"}, {"mention": "贲门癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "贲门癌根治术", "label": "手术", "offset": "129"}, {"mention": "胃", "label": "解剖部位", "offset": "145"}, {"mention": "肠", "label": "解剖部位", "offset": "146"}, {"mention": "肠", "label": "解剖部位", "offset": "157"}, {"mention": "胃", "label": "解剖部位", "offset": "187"}, {"mention": "食管胃交界早期浅表隆起型(0-iia型,肿瘤主体位于胃)管状腺癌ii级,局部为黏液腺癌", "label": "疾病和诊断", "offset": "191"}, {"mention": "贲门周淋巴结", "label": "解剖部位", "offset": "270"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "281"}, {"mention": "大弯侧淋巴结", "label": "解剖部位", "offset": "292"}, {"mention": "腹腔", "label": "解剖部位", "offset": "319"}, {"mention": "根治性全胃切除术+食管-空肠吻合术后,吻合口瘘", "label": "手术", "offset": "338"}, {"mention": "腹腔", "label": "解剖部位", "offset": "363"}, {"mention": "舒普深", "label": "药物", "offset": "368"}, {"mention": "甲硝唑", "label": "药物", "offset": "373"}, {"mention": "消化道", "label": "解剖部位", "offset": "388"}, {"mention": "泰素", "label": "药物", "offset": "422"}, {"mention": "顺铂", "label": "药物", "offset": "437"}, {"mention": "肝", "label": "解剖部位", "offset": "467"}, {"mention": "胃", "label": "解剖部位", "offset": "470"}, {"mention": "白细胞", "label": "实验室检验", "offset": "513"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "529"}, {"mention": "血小板", "label": "实验室检验", "offset": "541"}, {"mention": "白细胞", "label": "实验室检验", "offset": "563"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "576"}, {"mention": "血小板", "label": "实验室检验", "offset": "587"}, {"mention": "食管胃交界部腺癌术后", "label": "疾病和诊断", "offset": "622"}]}
{"text": ",患者于8月前无明显诱因出现腹痛,遂就诊**六院,,行胃镜检查示:距门齿36cm处可见一肿物,,活检病理示:低分化鳞状细胞癌。,行ct示:肝、腹膜及腹膜后淋巴结转移。2013-06-21至2013-12-05行dcx方案化疗6程。5程化疗后出现声嘶。6程化疗后出现味觉消失。对症处理后缓解。2、5,程化疗后ct示:转移瘤较前缩小。2013-12-05行dx方案化疗1程。后予希罗达维持4个月。后再改为dcx方案化疗2程,2程后评价为pd。于2014-09-22行folfipi方案化疗1程。今为求进一步诊治来我院。患者发病以来。精神佳,饮食睡眠不佳,大小便正常,体重无减轻。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "14"}, {"mention": "门齿", "label": "解剖部位", "offset": "34"}, {"mention": "低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "ct", "label": "影像检查", "offset": "65"}, {"mention": "肝、腹膜及腹膜后淋巴结转移", "label": "疾病和诊断", "offset": "69"}, {"mention": "ct", "label": "影像检查", "offset": "153"}, {"mention": "希罗达", "label": "药物", "offset": "187"}]}
{"text": ",2010年2月患者因“进行性身目黄染2+月”于我院就诊,行mr(2010-2-8),示:“肝内外胆管、胆总管扩张,十二指肠大乳头占位性病变,腺瘤与腺癌鉴别。门腔间隙淋巴结肿大”。遂于2010-3-1我院行“胰十二指肠切除术”,手术过程顺利,术后病理示“十二指肠乳头中分化腺癌,浸润肠壁浅肌层;未累及胰腺及胃壁组织;网膜组织未见癌。淋巴结(0/9)阳性。”术后分期t2n0m0。于2010-4-28至2010-11-5口服希罗达8程,化疗耐受可。2012年1月底,患者无明显诱因出现右下腹阵发性针刺状疼痛并腰背部疼痛,偶影响睡眠,2012-3-20我院pet/ct,提示:“右锁下、腹腔肝门区及腹主动脉旁多个淋巴结代谢活跃,考虑转移瘤。胰腺略肿大,代谢略活跃,请结合临床。”,右锁下下淋巴结活检示:“破碎的淋巴细胞及结缔组织中见分化腺癌浸润”。2012-4-18行folfox方案化疗1程,下程化疗后骨髓抑制0度,现患者进一步治疗入我院。目前患者一般情况可,胃纳、睡眠一般,大小便正常,体重上降约2.5kg。", "mention_data": [{"mention": "目", "label": "解剖部位", "offset": "16"}, {"mention": "mr", "label": "影像检查", "offset": "30"}, {"mention": "肝内外胆管", "label": "解剖部位", "offset": "46"}, {"mention": "胆总管", "label": "解剖部位", "offset": "52"}, {"mention": "十二指肠大乳头", "label": "解剖部位", "offset": "58"}, {"mention": "腺瘤", "label": "疾病和诊断", "offset": "71"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "74"}, {"mention": "门腔间隙淋巴结", "label": "解剖部位", "offset": "79"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "104"}, {"mention": "十二指肠乳头中分化腺癌", "label": "疾病和诊断", "offset": "127"}, {"mention": "肠", "label": "解剖部位", "offset": "141"}, {"mention": "胰腺", "label": "解剖部位", "offset": "150"}, {"mention": "胃", "label": "解剖部位", "offset": "153"}, {"mention": "希罗达", "label": "药物", "offset": "211"}, {"mention": "右下腹", "label": "解剖部位", "offset": "241"}, {"mention": "腰背部", "label": "解剖部位", "offset": "253"}, {"mention": "pet/ct", "label": "影像检查", "offset": "276"}, {"mention": "右锁下", "label": "解剖部位", "offset": "287"}, {"mention": "腹腔肝门区", "label": "解剖部位", "offset": "291"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "297"}, {"mention": "胰腺", "label": "解剖部位", "offset": "318"}, {"mention": "右锁下下淋巴结", "label": "解剖部位", "offset": "338"}, {"mention": "胃", "label": "解剖部位", "offset": "429"}]}
{"text": "患者2011年4月因肝癌于我院行复杂肝癌切除(肝中叶切除)+胆总管探查+t管引流术,术中见肿瘤位于肝中叶,iv、v、viii段,左侧紧靠胆囊床底部,向上紧贴骑跨肝总管右左肝管分叉并压迫第一肝门右外叶,大小约10*9*8cm,界清,无包膜。术后病理检查示(肝左叶)腺癌伴大片坏死,脉管内见癌栓,结合病史及酶标结果,考虑胆囊癌肝转移。术后患者恢复可,常规随访,2012-8-27患者于我院行腹部mri检查示肝右外叶见直径约1.1cm结节状长t1长t2信号,边界不清,增强扫描动脉期边缘强化,放射学诊断原发性肝癌术后,肝右外叶结节,考虑复发灶可能,为求进一步治疗收入院。患者自发病以来,胃纳双便可,精神睡眠可,体重无明显变化。", "mention_data": [{"mention": "肝癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "复杂肝癌切除(肝中叶切除)+胆总管探查+t管引流术", "label": "手术", "offset": "16"}, {"mention": "肝中叶,iv、v、viii段", "label": "解剖部位", "offset": "49"}, {"mention": "胆囊床底部", "label": "解剖部位", "offset": "68"}, {"mention": "肝总管右左肝管分叉", "label": "解剖部位", "offset": "80"}, {"mention": "第一肝门右外叶", "label": "解剖部位", "offset": "92"}, {"mention": "(肝左叶)腺癌", "label": "疾病和诊断", "offset": "126"}, {"mention": "胆囊癌肝转移", "label": "疾病和诊断", "offset": "158"}, {"mention": "腹部mri", "label": "影像检查", "offset": "193"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "201"}, {"mention": "原发性肝癌术后", "label": "疾病和诊断", "offset": "248"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "256"}, {"mention": "胃", "label": "解剖部位", "offset": "290"}]}
{"text": ",患者半年前出现下腹部不适,,行胃镜:胃小弯、胃角不规则溃疡,,病理:中低分化腺癌。2012-3-14行胃癌根治术+肝转移切除,,术中见:胃小弯、胃角胃壁增厚,侵出浆膜。,术后病理:低分化腺癌,侵出浆膜,切缘(-),淋巴结1/4,肝转移低分化腺癌。\\u0004\\u0004叒术后予以4周期sox化疗,末次化疗时间2012-07-5.未予以继续化疗。叒2012-10-09叒cea叒117.8,较前升高。,pet-ct:肝门区及胃小弯淋巴结转移,肝多发转移瘤。2012.11.2开始我科住院行“紫杉醇+希罗达”方案二线化疗5周期。消化道反应i度,轻微指端麻木i度,hfs叒ii度。2周期评效sd,4周期评效缩小sd。,末次化疗时间:2013-1-29.此后建议局部放疗,未行。2013-3-11当地复查ct。cea较前升高80+至200+。2013-3-14pet/ct,电话回报:肝门区、肝左后叶高代谢,考虑转移,腹腔淋巴结肿大,性质待定,第10棘突轻度代谢,性质待定。,给予肝转移病灶及腹腔淋巴结精确放疗叒gtv叒55gy叒ctv叒50gy/28f,希罗达叒825mg/m2叒bid叒d1-d5/w,目前放疗7次\\u0004\\u0004。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "8"}, {"mention": "胃小弯", "label": "解剖部位", "offset": "19"}, {"mention": "胃角", "label": "解剖部位", "offset": "23"}, {"mention": "中低分化腺癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "胃癌根治术+肝转移切除", "label": "手术", "offset": "52"}, {"mention": "胃小弯", "label": "解剖部位", "offset": "69"}, {"mention": "胃角", "label": "解剖部位", "offset": "73"}, {"mention": "胃壁增厚", "label": "症状", "offset": "75"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "91"}, {"mention": "肝转移低分化腺癌", "label": "疾病和诊断", "offset": "115"}, {"mention": "cea", "label": "实验室检验", "offset": "186"}, {"mention": "pet-ct", "label": "影像检查", "offset": "202"}, {"mention": "肝门区及胃小弯淋巴结转移,肝多发转移瘤", "label": "疾病和诊断", "offset": "209"}, {"mention": "紫杉醇", "label": "药物", "offset": "246"}, {"mention": "希罗达", "label": "药物", "offset": "250"}, {"mention": "消化道", "label": "解剖部位", "offset": "264"}, {"mention": "指端", "label": "解剖部位", "offset": "274"}, {"mention": "hfs", "label": "疾病和诊断", "offset": "281"}, {"mention": "ct", "label": "影像检查", "offset": "350"}, {"mention": "cea", "label": "实验室检验", "offset": "353"}, {"mention": "pet/ct", "label": "影像检查", "offset": "378"}, {"mention": "肝门区", "label": "解剖部位", "offset": "390"}, {"mention": "肝左后叶", "label": "解剖部位", "offset": "394"}, {"mention": "腹腔淋巴结", "label": "解剖部位", "offset": "407"}, {"mention": "第10棘突", "label": "解剖部位", "offset": "420"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "438"}, {"mention": "腹腔淋巴结", "label": "解剖部位", "offset": "444"}, {"mention": "希罗达", "label": "药物", "offset": "476"}]}
{"text": ",患者因“宫颈癌iia1期”于2011年05月26日在我院行“全麻上宫颈癌根治术(保留神经iii型广泛子宫切除术+两侧附件切除术+盆腔淋巴结清扫术)”,,术后病理回报示:宫颈低至中分化鳞状细胞癌,浸润至宫颈及颈管外膜层,脉管内见癌栓,右左髂总、右左髂外、左闭孔淋巴结见鳞状细胞癌转移,阴道残端前见鳞状细胞癌转移。患者有术后放化疗指征,于家属商量后计划行序贯放化疗。遂于2011年6月8日予tp方案(详见上表)化疗1程,过程顺利。患者于2011年6月23日及7月11日出现2次“不全肠梗阻”在我院给予保守治疗后好转。2011年7月18日继续按原方案化疗1程。scc于第1程化疗后由8.7ng/ml降至正常。于2011年8月11日至10月14日给予外照射+后装放疗(原发灶60gy,区域淋巴结60gy,后装12gy),放疗过程顺利,患者无不适。2011年12月14日入院行第3程化疗,方案同前,入院时查scc升高至2.0ng/ml,胸片示右肺少许增殖灶,为排除复发已行pet-ct检查(尚未见单)。现为求进一步治疗再次收入院。现患者睡眠可,精神可,食欲可,大小便正常,体重无明显变化。,既往化疗及肿瘤标志物情况:。", "mention_data": [{"mention": "宫颈癌iia1期", "label": "疾病和诊断", "offset": "5"}, {"mention": "全麻上宫颈癌根治术(保留神经iii型广泛子宫切除术+两侧附件切除术+盆腔淋巴结清扫术)", "label": "手术", "offset": "31"}, {"mention": "宫颈低至中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "85"}, {"mention": "宫颈及颈管", "label": "解剖部位", "offset": "101"}, {"mention": "右左髂总、右左髂外、左闭孔淋巴结", "label": "解剖部位", "offset": "117"}, {"mention": "鳞状细胞癌转移", "label": "疾病和诊断", "offset": "134"}, {"mention": "阴道", "label": "解剖部位", "offset": "142"}, {"mention": "鳞状细胞癌转移", "label": "疾病和诊断", "offset": "148"}, {"mention": "不全肠梗阻", "label": "疾病和诊断", "offset": "238"}, {"mention": "scc", "label": "实验室检验", "offset": "278"}, {"mention": "scc", "label": "实验室检验", "offset": "399"}, {"mention": "胸片", "label": "影像检查", "offset": "414"}, {"mention": "右肺", "label": "解剖部位", "offset": "417"}, {"mention": "pet-ct", "label": "影像检查", "offset": "432"}]}
{"text": ",2007-6-14,肠镜:距肛门60cm见肿物,2007年6月21日行右半结肠切除术,,术后病理:结肠溃疡型中高分化腺癌,部分粘液腺癌,侵及浆膜外,切缘阴性,淋巴结1/18。pt4n1m0。术后folfox4化疗8周期,第8周期出现皮疹、呼吸困难,停止化疗,末次化疗2008-1-25。2008-4-29复查mri发现肝多发结节,血管瘤可能。ca199叒305叒cea(-)。2008-6-19肿标正常,肝结节无变化。之后定期复查。\\u0004\\u0004叒2011-9-14,血生化示:胆红素、ggt、alt、ast略增高。肿标cea叒7.09,,血常规:,wbc:2.66,plt叒57。胸片、腹盆b超(-)。\\u0004\\u0004叒2012-8-2外院查cea叒正常,血常规wbc叒1.82叒n1.0叒plt叒55叒。未服药治疗。\\u0004\\u0004叒患者饮食睡眠好,二便正常。常规复查。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "15"}, {"mention": "右半结肠切除术", "label": "手术", "offset": "36"}, {"mention": "结肠溃疡型中高分化腺癌,部分粘液腺癌", "label": "疾病和诊断", "offset": "50"}, {"mention": "mri", "label": "影像检查", "offset": "155"}, {"mention": "肝", "label": "解剖部位", "offset": "160"}, {"mention": "血管瘤", "label": "疾病和诊断", "offset": "166"}, {"mention": "ca199", "label": "实验室检验", "offset": "172"}, {"mention": "cea", "label": "实验室检验", "offset": "182"}, {"mention": "肝结节", "label": "症状", "offset": "203"}, {"mention": "胆红素", "label": "实验室检验", "offset": "245"}, {"mention": "ggt", "label": "实验室检验", "offset": "249"}, {"mention": "alt", "label": "实验室检验", "offset": "253"}, {"mention": "ast", "label": "实验室检验", "offset": "257"}, {"mention": "cea", "label": "实验室检验", "offset": "266"}, {"mention": "wbc", "label": "实验室检验", "offset": "281"}, {"mention": "胸片", "label": "影像检查", "offset": "297"}, {"mention": "腹盆b超", "label": "影像检查", "offset": "300"}, {"mention": "cea", "label": "实验室检验", "offset": "332"}, {"mention": "wbc", "label": "实验室检验", "offset": "342"}]}
{"text": "2005-8-25行贲门癌根治术,术后病理:中分化腺癌,侵及肌层,脉管未见癌栓,淋巴结未见转移。术后未行放化疗,定期复查,未发现异常。偶有反酸、嗳气。目前复查胃镜近端胃术后,吻合口溃疡,反流行食管炎.病理未见癌细胞.颈部超声示右颈根部多发淋巴结.盆腔超声示前列腺钙化.胸部ct两肺结节,较前无变化.余未见异常.腹部ct示贲门癌术后,未见复发,转移.肿标示cea5.16.c13呼气试验阴性.。", "mention_data": [{"mention": "贲门癌根治术", "label": "手术", "offset": "10"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "22"}, {"mention": "近端胃术后,吻合口溃疡,反流行食管炎", "label": "疾病和诊断", "offset": "81"}, {"mention": "颈部超声", "label": "影像检查", "offset": "108"}, {"mention": "右颈根部", "label": "解剖部位", "offset": "113"}, {"mention": "盆腔超声", "label": "影像检查", "offset": "123"}, {"mention": "前列腺钙化", "label": "症状", "offset": "128"}, {"mention": "胸部ct", "label": "影像检查", "offset": "134"}, {"mention": "两肺", "label": "解剖部位", "offset": "138"}, {"mention": "腹部ct", "label": "影像检查", "offset": "155"}, {"mention": "贲门癌术后", "label": "疾病和诊断", "offset": "160"}, {"mention": "cea", "label": "实验室检验", "offset": "177"}, {"mention": "c13呼气试验", "label": "实验室检验", "offset": "185"}]}
{"text": "2014-4叒胃癌出血叒胃全切术。术后化疗3周期,末次复查是2014-12?2017-02-20叒ca199叒61.34,ca724叒189.2,2017-03-03腹盆ct:全胃术后,吻合口未见异常增厚强化。吻合口上方腹主动脉右前方见软组织团块影,边界模糊,包绕脾血管,与腹腔干分界不清,范围约67*37mm。病灶与胰腺、脾脏、右肾下腺及腹主动脉分界不清。肝、肾囊肿。2017-03叒进展,紫杉醇叒+s1叒*叒5叒末次2017.06.72017-7-7开始腹腔转移病灶放疗gtv叒50gy/ctv叒45gy/25f,同步叒替吉奥60mg叒bid叒d1-5/w。2017-7-17放疗7次,患者未诉明显不适。白细胞叒1度,2017-7-25放疗13次,患者诉进食轻度不畅。2017-8-1完成18次,血小板减低1度。2017-8-8完成23次。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "胃全切术", "label": "手术", "offset": "12"}, {"mention": "ca199", "label": "实验室检验", "offset": "49"}, {"mention": "ca724", "label": "实验室检验", "offset": "61"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "83"}, {"mention": "胃", "label": "解剖部位", "offset": "89"}, {"mention": "腹主动脉右前方", "label": "解剖部位", "offset": "110"}, {"mention": "脾血管", "label": "解剖部位", "offset": "132"}, {"mention": "腹腔干", "label": "解剖部位", "offset": "137"}, {"mention": "胰腺", "label": "解剖部位", "offset": "159"}, {"mention": "脾脏", "label": "解剖部位", "offset": "162"}, {"mention": "右肾下腺", "label": "解剖部位", "offset": "165"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "170"}, {"mention": "肝、肾囊肿", "label": "疾病和诊断", "offset": "179"}, {"mention": "紫杉醇", "label": "药物", "offset": "196"}, {"mention": "s1", "label": "药物", "offset": "201"}, {"mention": "腹腔", "label": "解剖部位", "offset": "229"}, {"mention": "替吉奥", "label": "药物", "offset": "262"}, {"mention": "白细胞", "label": "实验室检验", "offset": "304"}, {"mention": "血小板", "label": "实验室检验", "offset": "350"}]}
{"text": ",2016.9因进食梗咽就诊,外院胃镜检查提示食管鳞癌,于2016.9.29开始2周期tp+泰欣生方案化疗,末次化疗10.21。化疗反应不重,化疗后进食梗咽症状减轻。患者2周期复查评效,经全科查房讨论,患者原发病灶及胃周淋巴结较前缩小,但纵隔淋巴结较前增大,结合患者近期声音嘶哑,较前加重。建议行纵隔淋巴结放疗,放疗同时根据个人经济情况加用泰欣生。2016-11-22今日复位;2016-11-23叒开始放疗叒gtv食管病灶及阳性淋巴结;ctv亚临床病灶及淋巴引流区;95%ptv50.4gy叒ctv50.4gy叒gtv56gy/28f;同步放化疗txt/ndp叒20mg/m2,qw。患者输注氨磷汀恶心,停输。2016-12-01完成放疗2次,已行第2周期同步化疗。昨晚患者出现打嗝,持续3小时自行缓解,无其他不适主诉。2016-11-16,血常规:白细胞总数叒8.73*10^9/l,血红蛋白叒95.00g/l,血小板总数叒419.00*10^9/l。,肝肾功:总胆汁酸叒11.9μxxxmol/l。", "mention_data": [{"mention": "食管鳞癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "泰欣生", "label": "药物", "offset": "46"}, {"mention": "胃周淋巴结", "label": "解剖部位", "offset": "108"}, {"mention": "纵隔淋巴结", "label": "解剖部位", "offset": "119"}, {"mention": "纵隔淋巴结", "label": "解剖部位", "offset": "148"}, {"mention": "泰欣生", "label": "药物", "offset": "170"}, {"mention": "食管", "label": "解剖部位", "offset": "208"}, {"mention": "txt", "label": "药物", "offset": "274"}, {"mention": "ndp", "label": "药物", "offset": "278"}, {"mention": "氨磷汀", "label": "药物", "offset": "297"}, {"mention": "白细胞总数", "label": "实验室检验", "offset": "376"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "394"}, {"mention": "血小板总数", "label": "实验室检验", "offset": "408"}, {"mention": "总胆汁酸", "label": "实验室检验", "offset": "433"}]}
{"text": ",患者于2009.5.25在我院行腹腔镜上结肠癌切除。术中发现肝转移,,术后病理:乙状结肠溃疡型高中分化腺癌伴粘液分泌,6*5cm,侵及肠壁全层,未见脉管癌栓,切缘(-),ln叒5/17;肝转移灶内见中分化腺癌浸润,直径1cm,符合结肠癌转移,切缘(-)。患者术后行3周期folfox化疗,复查示肝内病灶较前进展。并于2010-05-06在我科行tace+肝动脉留管化疗,,化疗方案为:,化疗方案:oxa叒100mg叒ia叒h0-6,cf叒0.3g叒iv叒h4-6,5-fu叒1.5g叒ia叒h6-48,7-10天一次,共2次,化疗结束后出院。此次患者现为进一步行介入治疗收住我科,自出院以来食欲可,睡眠佳,大小便尚可,体重未见明显减轻。", "mention_data": [{"mention": "腹腔镜上结肠癌切除", "label": "手术", "offset": "17"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "31"}, {"mention": "乙状结肠溃疡型高中分化腺癌伴粘液分泌", "label": "疾病和诊断", "offset": "41"}, {"mention": "肠", "label": "解剖部位", "offset": "68"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "94"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "结肠癌转移", "label": "疾病和诊断", "offset": "116"}, {"mention": "tace+肝动脉留管", "label": "手术", "offset": "173"}, {"mention": "oxa", "label": "药物", "offset": "199"}, {"mention": "5-fu", "label": "药物", "offset": "233"}]}
{"text": ",10+天前,患者因“咳嗽、呼吸困难”就诊于我院呼吸内科,,行胸部ct增强:左肺中央型肺ca,伴左肺下叶阻塞性肺不张,纵隔内及降主动脉动脉旁多发淋巴结转移,左肺上叶动脉内癌栓可能,两侧胸腔积液,心包积液;颅脑增强,ct:左额、顶叶及右颞、顶叶病变,多系转移瘤;颈部,ct:颈部多发淋巴结肿大。行左侧颈部颈部淋巴结活检,病理示(1504186),:左侧淋巴结转移性腺癌,考虑肺来源,诊断左肺中央型肺腺癌叒iv期叒纵膈、颈部淋巴结及脑转移,予以胸腔穿刺、心包穿刺等姑息治疗,请我科会诊后建议转科治疗,但患者及家属拒绝;后患者出院。出院后患者无明显咳嗽、咳痰,活动后呼吸困难明显,口服红豆杉中成药抗肿瘤。4天前,患者无明显诱因出现左上肢肿胀,无皮肤红肿、皮温高,患者未予重视及诊治,肿胀继续加重,患者今日为进一步治疗就诊于呼吸科,行彩超示两侧胸腔大量积液,上肢彩超示左上肢深静脉血栓形成,门诊以肺癌收入我科。叒叒叒自患病以来,患者精神、食欲欠佳,睡眠差,大、小便正常,体重上降12kg。", "mention_data": [{"mention": "胸部ct", "label": "影像检查", "offset": "31"}, {"mention": "左肺中央型肺ca,伴左肺下叶阻塞性肺不张,纵隔内及降主动脉动脉旁多发淋巴结转移,左肺上叶动脉内癌栓", "label": "疾病和诊断", "offset": "38"}, {"mention": "两侧胸腔积液", "label": "疾病和诊断", "offset": "90"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "97"}, {"mention": "颅脑增强,ct", "label": "影像检查", "offset": "102"}, {"mention": "左额", "label": "解剖部位", "offset": "110"}, {"mention": "顶叶", "label": "解剖部位", "offset": "113"}, {"mention": "右颞", "label": "解剖部位", "offset": "116"}, {"mention": "顶叶", "label": "解剖部位", "offset": "119"}, {"mention": "颈部,ct", "label": "影像检查", "offset": "130"}, {"mention": "颈部", "label": "解剖部位", "offset": "136"}, {"mention": "左侧颈部", "label": "解剖部位", "offset": "147"}, {"mention": "颈部淋巴结", "label": "解剖部位", "offset": "151"}, {"mention": "左侧淋巴结转移性腺癌", "label": "疾病和诊断", "offset": "173"}, {"mention": "肺", "label": "解剖部位", "offset": "186"}, {"mention": "左肺中央型肺腺癌叒iv期叒纵膈、颈部淋巴结及脑转移", "label": "疾病和诊断", "offset": "192"}, {"mention": "胸腔穿刺", "label": "手术", "offset": "220"}, {"mention": "心包穿刺", "label": "手术", "offset": "225"}, {"mention": "红豆杉", "label": "药物", "offset": "289"}, {"mention": "左上肢", "label": "解剖部位", "offset": "312"}, {"mention": "两侧胸腔大量积液", "label": "疾病和诊断", "offset": "366"}, {"mention": "上肢彩超", "label": "影像检查", "offset": "375"}, {"mention": "左上肢深静脉血栓", "label": "疾病和诊断", "offset": "380"}, {"mention": "肺癌", "label": "疾病和诊断", "offset": "394"}]}
{"text": "患者2015.12无意中发现右侧腋窝有一约2*2cm的肿块,质硬,活动可,无疼痛及压痛,伴有咳痰,痰中可见黑色颗粒,偶有腹痛、反酸,无发热,无恶心、呕吐等明显不适,行胃镜检查示慢性非萎缩性胃炎,后自觉肿块逐渐增大,于2016.4.27行右侧腋窝肿块切除术,术后病理示:(右腋窝)淋巴结内转移性鳞状细胞癌,ct示符合右肺上叶纤维灶影像表现,双侧胸腔积液,为求进一步治疗收入我科。患者自发病以来,饮食睡眠可,大小便正常。", "mention_data": [{"mention": "右侧腋窝", "label": "解剖部位", "offset": "14"}, {"mention": "腹痛", "label": "症状", "offset": "60"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "88"}, {"mention": "右侧腋窝肿块切除术", "label": "手术", "offset": "118"}, {"mention": "(右腋窝)淋巴结内转移性鳞状细胞癌", "label": "疾病和诊断", "offset": "134"}, {"mention": "ct", "label": "影像检查", "offset": "152"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "157"}, {"mention": "双侧胸腔积液", "label": "疾病和诊断", "offset": "169"}]}
{"text": ",2013-4-20行左半结肠癌切除术,术后olf化疗2周期,sox4周期,末次2013-10.2014-10左附件转移。2014-11-4左卵巢+全子宫切除术。术后环磷酰胺+顺铂化疗2周期,tp4周期。2015-8上腹痛,,ct:卵巢癌术后复发,行局部放疗。复查ct提示肝左叶转移瘤。dp化疗2周期。,2015-12-31mri:肝转移,阴道残端复发,盆腔多发结节,髂血管旁旁淋巴结肿大,考虑转移,直肠壁增厚,考虑转移。mfolfox6化疗5周期,末次2016-4-15。期间复查sd。目前患者阴道出血较前增多,肛门坠胀感。", "mention_data": [{"mention": "左半结肠癌切除术", "label": "手术", "offset": "11"}, {"mention": "左附件转移", "label": "疾病和诊断", "offset": "55"}, {"mention": "左卵巢+全子宫切除术", "label": "手术", "offset": "70"}, {"mention": "环磷酰胺", "label": "药物", "offset": "83"}, {"mention": "顺铂", "label": "药物", "offset": "88"}, {"mention": "上腹痛", "label": "症状", "offset": "108"}, {"mention": "ct", "label": "影像检查", "offset": "113"}, {"mention": "卵巢癌术后", "label": "疾病和诊断", "offset": "116"}, {"mention": "ct", "label": "影像检查", "offset": "132"}, {"mention": "肝左叶转移瘤", "label": "疾病和诊断", "offset": "136"}, {"mention": "mri", "label": "影像检查", "offset": "162"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "166"}, {"mention": "阴道残端复发", "label": "疾病和诊断", "offset": "170"}, {"mention": "盆腔", "label": "解剖部位", "offset": "177"}, {"mention": "髂血管旁旁淋巴结", "label": "解剖部位", "offset": "184"}, {"mention": "直肠", "label": "解剖部位", "offset": "200"}, {"mention": "阴道出血", "label": "症状", "offset": "248"}, {"mention": "肛门坠胀", "label": "症状", "offset": "257"}]}
{"text": "患者约1月前开始无明显诱因出现皮肤黏膜及巩膜黄染明,遂来我院就诊,诊断为胆管癌,排除手术禁忌后,于2014-12-22在全麻上行胰十二指肠切除术,手术过程顺利,术后给予抗感染、营养支持、补液、保肝等治疗,术后病理示:胆总管中分化腺癌。患者术后出现消化道出血,于2014-12-30行腹腔动脉造影+栓塞术。患者现恢复良好,因医保政策变更,办理出入院手续。叒叒叒患者现神志清,精神尚可,禁饮食,睡眠可,小便色黄,大便正常,体重较前减轻约5kg。", "mention_data": [{"mention": "巩膜", "label": "解剖部位", "offset": "20"}, {"mention": "胆管癌", "label": "疾病和诊断", "offset": "36"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "64"}, {"mention": "肝", "label": "解剖部位", "offset": "97"}, {"mention": "胆总管中分化腺癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "123"}, {"mention": "腹腔动脉造影+栓塞术", "label": "手术", "offset": "141"}]}
{"text": "患者2011年行直肠癌手术治疗,具体不详。2014年6月无明显诱因出现肛周疼痛,为阵发性疼痛,性质表述不清。不伴有腹痛、腹泻等其他不适。疼痛发作与天气变化无关。未行诊治。2014年11月疼痛加重,疼痛性质同前。疼痛程度较重,影响日常生活及睡眠。2015-1-23患者入院后完善各项辅助检查,ct检查结果示:肝囊肿,叒两肾囊肿,肝内胆管轻度扩张,胆囊炎叒胰腺脂肪浸润,直肠癌术后改变,盆腔及侧腹股沟淋巴结肿大,膀胱壁增厚,前列腺增生并钙化,右侧腹股沟疝,明确诊断后给予镇痛、营养神经等治疗。2015.04.01患者因“神经痛”再次入院,给予盆腔病灶适形放疗,dt60gy/30f方案放疗。疼痛较前明显减轻,病情好转,生活质量改善,准予出院。患者近1个月以来,肛周疼痛,食欲差,大便可,小便失禁1月,眠可,近3个月体重未见明显减轻。", "mention_data": [{"mention": "直肠癌手术", "label": "手术", "offset": "8"}, {"mention": "肛周", "label": "解剖部位", "offset": "35"}, {"mention": "腹痛", "label": "症状", "offset": "57"}, {"mention": "腹泻", "label": "症状", "offset": "60"}, {"mention": "ct", "label": "影像检查", "offset": "145"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "153"}, {"mention": "两肾囊肿", "label": "疾病和诊断", "offset": "158"}, {"mention": "肝内胆管", "label": "解剖部位", "offset": "163"}, {"mention": "胆囊炎", "label": "疾病和诊断", "offset": "172"}, {"mention": "胰腺", "label": "解剖部位", "offset": "176"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "183"}, {"mention": "盆腔", "label": "解剖部位", "offset": "191"}, {"mention": "腹股沟淋巴结肿大", "label": "症状", "offset": "195"}, {"mention": "膀胱", "label": "解剖部位", "offset": "204"}, {"mention": "前列腺增生", "label": "症状", "offset": "210"}, {"mention": "右侧腹股沟疝", "label": "疾病和诊断", "offset": "219"}, {"mention": "神经痛", "label": "疾病和诊断", "offset": "258"}, {"mention": "盆腔", "label": "解剖部位", "offset": "269"}, {"mention": "肛周", "label": "解剖部位", "offset": "328"}]}
{"text": ",宫内孕不全流产清宫(2015-3-12)时,,宫颈活检:低分化鳞癌,宫腔少许低分化鳞癌,已经月经来潮。2015-4-14腹腔镜宫颈癌根治术。,病理:低分化癌。脉管癌栓。术后恢复好。术后化疗3程,7-13末次化疗。停化疗后复查盆腹ct未见明显异常。,盆腔b超:膀胱充盈可,子宫切除术后。两侧附件区未见明显占位。两侧髂血管周围未见明显肿大淋巴结。盆腔可见少量积液,范围约5.7x1.6cm。盆腔少量积液。腹部b超提示右锁骨下、两侧腹股沟淋巴结,继续观察。scc结果未出。2016-8复查未见异常。现听力上降,大小便可。", "mention_data": [{"mention": "宫内孕不全流产", "label": "疾病和诊断", "offset": "1"}, {"mention": "清宫", "label": "手术", "offset": "8"}, {"mention": "宫颈", "label": "解剖部位", "offset": "24"}, {"mention": "低分化鳞癌", "label": "疾病和诊断", "offset": "29"}, {"mention": "宫腔", "label": "解剖部位", "offset": "35"}, {"mention": "低分化鳞癌", "label": "疾病和诊断", "offset": "39"}, {"mention": "腹腔镜宫颈癌根治术", "label": "手术", "offset": "61"}, {"mention": "低分化癌", "label": "疾病和诊断", "offset": "75"}, {"mention": "盆腹ct", "label": "影像检查", "offset": "113"}, {"mention": "盆腔b超", "label": "影像检查", "offset": "125"}, {"mention": "膀胱", "label": "解剖部位", "offset": "130"}, {"mention": "子宫切除术后", "label": "疾病和诊断", "offset": "136"}, {"mention": "两侧附件区", "label": "解剖部位", "offset": "143"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "155"}, {"mention": "盆腔", "label": "解剖部位", "offset": "172"}, {"mention": "盆腔", "label": "解剖部位", "offset": "194"}, {"mention": "腹部b超", "label": "影像检查", "offset": "201"}, {"mention": "右锁骨下、两侧腹股沟淋巴结", "label": "解剖部位", "offset": "207"}, {"mention": "scc", "label": "实验室检验", "offset": "226"}]}
{"text": "2013.5叒直肠癌同时性右肺两发m,新辅助放化疗(folfox+直肠放疗),肺m进展,原发灶好转,2013.8.13直肠癌根治术,folfox*2,肺m增大,2013.10.10叒行胸腔镜上切除右下肺m切除,术后行folfiri+c225*4,肺m为sd,我院mdt考虑肺m行伽马刀,2013.11.26~12.7同时完成末次化疗。放疗后sd,2014.1.17叒完成回纳术。2014-3-13叒我院ct见右上肺m约15*13mm(同外院),腹盆腔ct(-)。因右肺m邻近血管,放疗后病灶,口服xeloda观察,因经济原因未联合贝伐,2014.3.17始xeloda*4,复查示右上肺m仍13mm,但周围新见片状实变,放疗后改变?现一般可,大便4-6次/天。", "mention_data": [{"mention": "直肠癌同时性右肺两发m", "label": "疾病和诊断", "offset": "7"}, {"mention": "直肠", "label": "解剖部位", "offset": "33"}, {"mention": "肺m", "label": "疾病和诊断", "offset": "39"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "59"}, {"mention": "肺m", "label": "疾病和诊断", "offset": "75"}, {"mention": "胸腔镜上切除右下肺m切除", "label": "手术", "offset": "92"}, {"mention": "c225", "label": "药物", "offset": "116"}, {"mention": "肺m", "label": "疾病和诊断", "offset": "123"}, {"mention": "肺m", "label": "疾病和诊断", "offset": "136"}, {"mention": "伽马刀", "label": "手术", "offset": "139"}, {"mention": "回纳术", "label": "手术", "offset": "185"}, {"mention": "ct", "label": "影像检查", "offset": "201"}, {"mention": "右上肺", "label": "解剖部位", "offset": "204"}, {"mention": "腹盆腔ct", "label": "影像检查", "offset": "222"}, {"mention": "右肺m", "label": "疾病和诊断", "offset": "232"}, {"mention": "xeloda", "label": "药物", "offset": "248"}, {"mention": "贝伐", "label": "药物", "offset": "265"}, {"mention": "xeloda", "label": "药物", "offset": "278"}, {"mention": "右上肺", "label": "解剖部位", "offset": "290"}]}
{"text": "患者2010年11月22日因发现直肠癌于外院行dixon术,术后病理经我院会诊为中分化腺癌,浸润至外膜程,ln(+)0/4。术后分期pt4n0m0。术后予替加氟+cf+cpt-11化疗6程(3周方案)。末次2011年7月。近2月患者大便变细,带血,转诊我院,行肠镜示乙状结肠粘膜隆起,病理示高级别下皮内瘤变,取材浅表。胸部ct示两肺多发转移可能。盆腔mr示吻合口左旁肿块,考虑局部复发可能性大。2012-7-24、2012-08-07、2012-8-21、2012-9-4、2012-9-25、2012-10-09、2012-10-23、2012-11-6及2012-11-26行folfox方案化疗9程,2012-8-30ct示两肺病灶较前缩小,疗效评价为sd.第5程化疗后出现血小板降低,经治疗后好转,予辅助放疗后,给予希罗达口服3片bid叒po,治疗2疗程,现为进一步治疗来我科就诊。患者发病以来,精神、饮食睡眠可,小便时有困难,大便带血,体重无明显减轻。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "16"}, {"mention": "dixon术", "label": "手术", "offset": "23"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "替加氟", "label": "药物", "offset": "77"}, {"mention": "cf", "label": "药物", "offset": "81"}, {"mention": "cpt-11", "label": "药物", "offset": "84"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "133"}, {"mention": "高级别下皮内瘤变", "label": "疾病和诊断", "offset": "145"}, {"mention": "胸部ct", "label": "影像检查", "offset": "159"}, {"mention": "两肺多发转移", "label": "疾病和诊断", "offset": "164"}, {"mention": "盆腔mr", "label": "影像检查", "offset": "173"}, {"mention": "ct", "label": "影像检查", "offset": "312"}, {"mention": "两肺", "label": "解剖部位", "offset": "315"}, {"mention": "血小板", "label": "实验室检验", "offset": "340"}, {"mention": "希罗达", "label": "药物", "offset": "362"}]}
{"text": ",患者1个月余前无明显诱因出现大便带鲜血,量少,伴大便次数增加至4次/天,不成形,偶有里急后重。无腹痛、恶心、发热等不适。2014-11-07外院肠镜检查提示距肛门18cm肿物,肠镜不能通过。活检病理提示腺癌。我院进一步完善胸部ct及腹盆mri,未见远处转移。未见手术禁忌,2014-12-15全麻上行乙状结肠切除术,,术后病理回报:(乙状结肠大体)镜检为中分化腺癌,浸润至浆膜上层,未见明确脉管内癌栓及神经束侵犯;近远切缘未见癌,区域淋巴结(2/16)。,免疫组化:pms2(+),叒msh2(+),msh6(+),mlh1(+)。,术后分期:乙状结肠癌(pt3n1m0)。患者术后恢复可,现为求进一步诊治来本院就诊并入住本科。起病以来无发热,胃纳可,睡眠一般,小便正常,体重上降3公斤。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "49"}, {"mention": "肛门", "label": "解剖部位", "offset": "80"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "102"}, {"mention": "胸部ct", "label": "影像检查", "offset": "112"}, {"mention": "腹盆mri", "label": "影像检查", "offset": "117"}, {"mention": "乙状结肠切除术", "label": "手术", "offset": "151"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "168"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "178"}, {"mention": "乙状结肠癌(pt3n1m0)", "label": "疾病和诊断", "offset": "273"}, {"mention": "胃", "label": "解剖部位", "offset": "323"}]}
{"text": ",患者1月余(2016-3-17)前因胃癌于我院行腹腔镜胃癌根治术(毕i),,术后常规病理示:,病理号:09731.16。(胃)低分化粘液腺癌,溃疡型,肿物切面积5.2*1.5cm,侵及胃壁深肌层。双端切缘、吻合器切缘及网膜组织均未查见癌。小弯侧淋巴结12枚及网膜内淋巴结1枚,均未查见转移。,免疫组化:ck(+),her-2(0),e-cad(+)。术后第1天患者出现心梗,给予对症处理,患者无不适后出院。出院后患者无发热,无恶心呕吐,无腹痛腹胀等不适,现患者为行化疗治疗来我院,门诊以“胃癌术后化疗”收入院。自发病来,患者饮食睡眠尚可,二便无明显异常,体重较前稍减轻。高血压30余年,冠心病5年余,口服络活喜、倍他乐克、硝酸异山梨酯、阿司匹林等药物治疗。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "19"}, {"mention": "腹腔镜胃癌根治术(毕i)", "label": "手术", "offset": "25"}, {"mention": "(胃)低分化粘液腺癌,溃疡型", "label": "疾病和诊断", "offset": "61"}, {"mention": "胃", "label": "解剖部位", "offset": "93"}, {"mention": "小弯侧淋巴结", "label": "解剖部位", "offset": "120"}, {"mention": "网膜内淋巴结", "label": "解剖部位", "offset": "130"}, {"mention": "心梗", "label": "疾病和诊断", "offset": "185"}, {"mention": "腹痛", "label": "症状", "offset": "220"}, {"mention": "腹胀", "label": "症状", "offset": "222"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "245"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "286"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "294"}, {"mention": "络活喜", "label": "药物", "offset": "303"}, {"mention": "倍他乐克", "label": "药物", "offset": "307"}, {"mention": "硝酸异山梨酯", "label": "药物", "offset": "312"}, {"mention": "阿司匹林", "label": "药物", "offset": "319"}]}
{"text": ",外院确诊胃癌1周,2016年3月1日胃大部切除\\\\胃空肠吻合,空肠空肠吻合术,,术后病理:胃窦大弯侧,4.5cm,印戒细胞癌,弥漫型,浆膜上浸润,可见脉管癌栓并神经侵犯,胃周小弯侧2/4,大弯侧5/25,残端阴性,大网膜未见癌。pt3n3m0。目前恢复可。her2-。血液肿瘤标志物不高。术后化疗3周期,便秘,自觉有腰背部疼痛不适。血小板降低52*109/l。,末次化疗时间:2016-5-27.2016-7-13开始给予术后放疗,ctv叒45gy/25f/35d,同期替吉奥叒40mg叒bid叒d1-d5/w,2016叒08叒01wbc叒2.1*109/l叒暂停化疗叒生白治疗后复查叒2016-8-8叒,9:54叒(紫)血细胞分析(五分类),:中性粒细胞百分数叒73.90%,白细胞总数叒2.44*10^9/l,血红蛋白叒123.00g/l目前放疗18次。患者诉恶心,乏力,失眠。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "胃大部切除\\\\胃空肠吻合,空肠空肠吻合术", "label": "手术", "offset": "19"}, {"mention": "胃窦大弯侧", "label": "解剖部位", "offset": "46"}, {"mention": "印戒细胞癌,弥漫型", "label": "疾病和诊断", "offset": "58"}, {"mention": "胃周小弯侧", "label": "解剖部位", "offset": "86"}, {"mention": "大弯侧", "label": "解剖部位", "offset": "95"}, {"mention": "腰背部", "label": "解剖部位", "offset": "159"}, {"mention": "血小板", "label": "实验室检验", "offset": "167"}, {"mention": "替吉奥", "label": "药物", "offset": "236"}, {"mention": "wbc", "label": "实验室检验", "offset": "267"}, {"mention": "中性粒细胞", "label": "实验室检验", "offset": "324"}, {"mention": "白细胞总数", "label": "实验室检验", "offset": "340"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "358"}]}
{"text": "绝经后阴道出血半年。患者外院就诊超声示子宫内膜增厚,两附件囊实性团块6+cm。外院行分段诊刮,病理回报宫腔为高分化内膜样腺癌。2017-8-23行开腹子宫内膜癌分期手术+大网膜切除术,术后病理回报:叒高分化子宫内膜样癌,大小5×xxx2×xxx1.5cm;未见脉管癌栓及神经侵犯;癌组织大部分局限于内膜层,部分浸润浅肌层<内1/2肌壁厚,癌组织未累及宫颈内口,骶韧带断端未见癌;宫旁未见癌;两侧漏斗韧带未见癌;大网膜未见癌;子宫平滑肌瘤多枚,直径0.2-0.4cm;淋巴结未见癌转移0/40;两侧卵巢子宫内膜样腺癌,术后诊断,子宫内膜高分化内膜样腺癌iiia期,建议术后补充放化疗,因msh阳性,建议基因检查除外lynch综合征。2017-9-7妇科行紫杉醇+伯尔定化疗1次。我科2017-9-25开始放疗,95%ptv(全盆腔)叒45gy/25f,现已放疗17次,患者诉肛周疼痛,大便次数增多,排尿不适感,白细胞减少3度,中性减少2度。2017-10-31放疗结束,现无不适主诉,今日查血常规大致正常。2017-11-15于妇科化疗1周期,11-21血常规示wbc叒0.90,ne叒0.79,hb叒98。", "mention_data": [{"mention": "阴道出血", "label": "症状", "offset": "3"}, {"mention": "超声", "label": "影像检查", "offset": "16"}, {"mention": "子宫", "label": "解剖部位", "offset": "19"}, {"mention": "两附件", "label": "解剖部位", "offset": "26"}, {"mention": "宫腔", "label": "解剖部位", "offset": "51"}, {"mention": "高分化内膜样腺癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "开腹子宫内膜癌分期手术+大网膜切除术", "label": "手术", "offset": "73"}, {"mention": "高分化子宫内膜样癌", "label": "疾病和诊断", "offset": "100"}, {"mention": "宫颈内口", "label": "解剖部位", "offset": "175"}, {"mention": "骶韧带", "label": "解剖部位", "offset": "180"}, {"mention": "宫旁", "label": "解剖部位", "offset": "189"}, {"mention": "两侧漏斗韧带", "label": "解剖部位", "offset": "195"}, {"mention": "子宫平滑肌瘤", "label": "疾病和诊断", "offset": "212"}, {"mention": "两侧卵巢子宫内膜样腺癌", "label": "疾病和诊断", "offset": "246"}, {"mention": "子宫内膜高分化内膜样腺癌iiia期", "label": "疾病和诊断", "offset": "263"}, {"mention": "紫杉醇", "label": "药物", "offset": "326"}, {"mention": "伯尔定", "label": "药物", "offset": "330"}, {"mention": "盆腔", "label": "解剖部位", "offset": "362"}, {"mention": "肛周", "label": "解剖部位", "offset": "386"}, {"mention": "白细胞", "label": "实验室检验", "offset": "404"}, {"mention": "wbc", "label": "实验室检验", "offset": "480"}, {"mention": "ne", "label": "实验室检验", "offset": "489"}, {"mention": "hb", "label": "实验室检验", "offset": "497"}]}
{"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2014-01-25,2014-02-18、03-12、04-02行pf方案化疗4程,过程顺利,化疗后无诉特殊不适。2,程后ct疗效评价:pr。4,程化疗后ct评价:pr。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": "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"}, {"mention": "ct", "label": "影像检查", "offset": "401"}, {"mention": "ct", "label": "影像检查", "offset": "417"}, {"mention": "胃", "label": "解剖部位", "offset": "447"}]}
{"text": ",患者自述于2016年2月因发热、腹痛就诊于我院急诊外科,完善相关检查示乙状结肠占位、乙状结肠穿孔,遂于2016-2-26于我院胃肠外科行乙状结肠癌切除术、远端闭锁、近端造瘘术,,术后病理:低分化管状腺癌,肿物浸透侵及外膜,肠壁组织伴炎性改变,淋巴结转移不详,病理号z0520138,,术后分期:pt4bnxm0。,免疫组化:,a2:ck(+)cdx2(+)s-100(-)cd34(血管+v0)ki-67(约30%+)p53(+++)synaptopl(+),术后腹痛等不适消失。于2016-4-8予患者xelox方案化疗1周期,,具体为:奥沙利铂200mgd1静滴,希罗达1500mgd1-14日双次口服,化疗过程顺利。于2016年4月17日因胆囊炎入我院急诊对症治疗,停希罗达口服治疗。现为进一步治疗入我科。患者1个月来饮食较差,睡眠可,精神体力可,造瘘口偶有腹泻症状,排尿正常,体重减轻4kg,周身无疼痛,ecog评分1分。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "17"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "36"}, {"mention": "乙状结肠穿孔", "label": "疾病和诊断", "offset": "43"}, {"mention": "乙状结肠癌切除术、远端闭锁、近端造瘘术", "label": "手术", "offset": "69"}, {"mention": "低分化管状腺癌", "label": "疾病和诊断", "offset": "95"}, {"mention": "肠", "label": "解剖部位", "offset": "112"}, {"mention": "腹痛", "label": "症状", "offset": "233"}, {"mention": "奥沙利铂", "label": "药物", "offset": "271"}, {"mention": "希罗达", "label": "药物", "offset": "285"}, {"mention": "胆囊炎", "label": "疾病和诊断", "offset": "324"}, {"mention": "希罗达", "label": "药物", "offset": "338"}, {"mention": "腹泻", "label": "症状", "offset": "383"}]}
{"text": ",患者2016年7月4日腹部外伤后出现左侧下腹痛伴肉眼血尿,2016-07-05就诊***三院,,急诊ct检查示:左肾肿瘤(约8.4*7.9cm)并肾出血、左侧肾静脉受累可能性大。,胸片示:两肺纹理增粗,两肺未见实性病变。于2016-07-08在全麻上行左肾根治性切除+肾周粘连松解+肠粘连松解+阑尾切除术+腹膜后淋巴结活检术。,术后病理示:(左侧)肾脏伴左两相分化的恶性肿瘤,考虑肾母细胞瘤,癌组织侵犯肾门脂肪组织,肾门部血管内可见瘤栓,输尿管断端未见肿瘤侵犯。腹主动脉旁淋巴结可见肿瘤转移(1/1),阑尾未见肿瘤转移。术后恢复可。术后未行化疗及放疗。,送我院病理会诊:符合肾母细胞瘤[以胚芽细胞为主,可见局灶原始下皮分化(约占5%)];肿瘤累及纤维脂肪组织,可见脉管内瘤栓及神经组织侵犯;送检淋巴结(约2枚)2/2见肿瘤转移。术后复查,ct:未见肿瘤。,临床诊断为:左肾母细胞瘤叒iiib期。于2016-08-03行act-d+vcr方案化疗1程。现为行上程化疗收入我科。患者现一般可,无发热、咳嗽,无腹痛、腹泻,无头痛、头晕,无血尿,无叒尿痛,饮食可,大小便正常。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "12"}, {"mention": "左侧下腹", "label": "解剖部位", "offset": "19"}, {"mention": "ct", "label": "影像检查", "offset": "51"}, {"mention": "左肾肿瘤", "label": "疾病和诊断", "offset": "57"}, {"mention": "肾出血", "label": "疾病和诊断", "offset": "74"}, {"mention": "左侧肾静脉", "label": "解剖部位", "offset": "78"}, {"mention": "胸片", "label": "影像检查", "offset": "91"}, {"mention": "两肺", "label": "解剖部位", "offset": "95"}, {"mention": "两肺", "label": "解剖部位", "offset": "102"}, {"mention": "左肾根治性切除+肾周粘连松解+肠粘连松解+阑尾切除术+腹膜后淋巴结活检术", "label": "手术", "offset": "127"}, {"mention": "(左侧)肾脏伴左两相分化的恶性肿瘤,考虑肾母细胞瘤", "label": "疾病和诊断", "offset": "171"}, {"mention": "肾门", "label": "解剖部位", "offset": "202"}, {"mention": "肾门部血管", "label": "解剖部位", "offset": "209"}, {"mention": "输尿管", "label": "解剖部位", "offset": "220"}, {"mention": "腹主动脉旁淋巴结", "label": "解剖部位", "offset": "232"}, {"mention": "阑尾", "label": "解剖部位", "offset": "252"}, {"mention": "肾母细胞瘤", "label": "疾病和诊断", "offset": "288"}, {"mention": "ct", "label": "影像检查", "offset": "370"}, {"mention": "左肾母细胞瘤叒iiib期", "label": "疾病和诊断", "offset": "385"}, {"mention": "act-d", "label": "药物", "offset": "410"}, {"mention": "vcr", "label": "药物", "offset": "416"}, {"mention": "腹痛", "label": "症状", "offset": "453"}, {"mention": "腹泻", "label": "症状", "offset": "456"}, {"mention": "头痛", "label": "症状", "offset": "460"}, {"mention": "头晕", "label": "症状", "offset": "463"}]}
{"text": ",患者因2017年2月初感觉上腹部不适,遂到**********就诊行肠镜检查,结果提示局部炎症。后仍有上腹部不适腹部不适感,并渐加重。遂再次行肠镜检查,提示回盲部肿物,病理仍未能明确诊断。遂来我院腹部外科就诊,***教授建议手术切除肠肿物已明确病变性质。于2017-03-01在**********行升结肠肿物切除术。,术后病理经我院会诊后示:(回盲部肿物),镜上见淋巴细胞弥漫浸润;细胞大,异型明显;核大核仁明显;核分裂可见。淋巴细胞浸润肠壁黏膜层、肌层深层。考虑弥漫大b细胞淋巴瘤,非gcb亚型,ki67(90%+)。fish,分子检测:bcl-2、bcl-6及c-myc均(-)。bm,穿刺及活检:未见肿瘤细胞。2017-03-24叒我院pet/ct,示:,弥漫大b细胞淋巴瘤回盲部切除术后:回盲部术后缺如,吻合口、残余升结肠及回肠呈条状放射性较浓密,suv约5.1,肠壁略增厚。左上腹术区数个淋巴结放射性略浓密,suv约1.9,大者约0.5×0.6cm,疑炎性病变;两侧扁桃体放射性浓密,suv约11.1,考虑炎性病变。,临床诊断:(回盲部)弥漫大b细胞淋巴瘤,非gcb亚型ia期叒。2017-04-11行r-cdop方案化疗1程,现为行上一程化疗入院。起病以来,一般情况可,有腹部不适感,无明显腹痛,梗阻,无肉眼血便,黑便等症状。患者起病以来无发热、盗汗、体重减轻等b症状。", "mention_data": [{"mention": "上腹部", "label": "解剖部位", "offset": "14"}, {"mention": "上腹部", "label": "解剖部位", "offset": "52"}, {"mention": "腹部不适", "label": "症状", "offset": "57"}, {"mention": "回盲部", "label": "解剖部位", "offset": "79"}, {"mention": "腹部", "label": "解剖部位", "offset": "99"}, {"mention": "肠", "label": "解剖部位", "offset": "117"}, {"mention": "升结肠肿物切除术", "label": "手术", "offset": "151"}, {"mention": "回盲部", "label": "解剖部位", "offset": "174"}, {"mention": "肠", "label": "解剖部位", "offset": "221"}, {"mention": "弥漫大b细胞淋巴瘤,非gcb亚型", "label": "疾病和诊断", "offset": "234"}, {"mention": "pet/ct", "label": "影像检查", "offset": "323"}, {"mention": "弥漫大b细胞淋巴瘤回盲部切除术后", "label": "疾病和诊断", "offset": "333"}, {"mention": "回盲部术后", "label": "疾病和诊断", "offset": "350"}, {"mention": "升结肠", "label": "解剖部位", "offset": "364"}, {"mention": "回肠", "label": "解剖部位", "offset": "368"}, {"mention": "肠", "label": "解剖部位", "offset": "388"}, {"mention": "左上腹", "label": "解剖部位", "offset": "394"}, {"mention": "两侧扁桃体", "label": "解剖部位", "offset": "438"}, {"mention": "(回盲部)弥漫大b细胞淋巴瘤,非gcb亚型ia期", "label": "疾病和诊断", "offset": "471"}, {"mention": "腹部不适", "label": "症状", "offset": "544"}, {"mention": "腹痛", "label": "症状", "offset": "553"}]}
{"text": ",患者6个月前无意间扪及右上腹包块,约8*8厘米,触之不痛,就诊于****行全腹ct及胃镜检查取病理示胃癌,就诊于我院肿瘤外科,行全胃切除术,,术中见:肿物位于胃小弯后壁,约4*4*2.5厘米,侵及浆膜层。,术后病理为:进展期胃癌,隆起型,高-中分化管状腺癌,淋巴结4/33枚转移。术后恢复良好,于我科行xelox方案化疗5周期,,具体用药为:奥沙利铂200毫克d1,希罗达1.5日二次d1-d14,2周期患者出现ii度腹泻,将希罗达改为早1.0,晚1.5口服d1-d14;术后3月评效无复发。现为进一步治疗入我科,患者近一个月无周身疼痛,饮食正常,睡眠不佳,排尿正常,稀便2-4次/日,精神体力一般,体重未见明显上降,kps评分80分。叒患者诊断慢性粒细胞白血病4个月,口服羟基尿1.0日一次,白细胞控制于3.6*10~9/l,粒细胞控制于2.4*10~9/l。", "mention_data": [{"mention": "右上腹", "label": "解剖部位", "offset": "12"}, {"mention": "全腹ct", "label": "影像检查", "offset": "38"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "51"}, {"mention": "全胃切除术", "label": "手术", "offset": "65"}, {"mention": "胃小弯", "label": "解剖部位", "offset": "80"}, {"mention": "进展期胃癌,隆起型,高-中分化管状腺癌", "label": "疾病和诊断", "offset": "110"}, {"mention": "奥沙利铂", "label": "药物", "offset": "172"}, {"mention": "希罗达", "label": "药物", "offset": "184"}, {"mention": "腹泻", "label": "症状", "offset": "210"}, {"mention": "希罗达", "label": "药物", "offset": "214"}, {"mention": "慢性粒细胞白血病", "label": "疾病和诊断", "offset": "324"}, {"mention": "羟基尿", "label": "药物", "offset": "338"}, {"mention": "白细胞", "label": "实验室检验", "offset": "348"}, {"mention": "粒细胞", "label": "实验室检验", "offset": "365"}]}
{"text": ",患者2年前开始出现进食后胸骨后不适,梗塞感,稍觉胸背部麻涨感,无恶心、呕吐,无咳嗽气促,无声嘶、呛咳。于**六院就诊行胃镜检查,胃镜提示距门齿30-35cm处食管肿物,病理为“鳞癌”,ct示食管中段局限性增厚伴肿块形成,管腔狭窄,考虑食管癌。随后入我院胸科治疗,2013-03-01行全麻上“经右胸食管癌切除术+食管胃弓下吻合术”,,术后病理:贲门旁淋巴结1枚,见鳞状细胞癌转移,余淋巴结未见转移。,食管肿物大体:镜检为中至低分化鳞状细胞癌,浸润至食管壁外膜层,未见明确脉管及神经束侵犯。术后常规复查。3周前无明显诱因上出现声嘶,无吞咽梗阻,无饮水呛咳,无胸背疼痛,无咳嗽气促,无恶心呕吐等不适,2015-01-13于我院查胸+下腹,ct:食管癌术后,吻合口未见明显异常;左侧气管食管沟肿大淋巴结,考虑转移瘤。右肺纤维灶;左肺下叶小斑片影,考虑增殖灶可能性大;肝s2、4、6、8囊肿;右肾囊肿;甲状腺两叶多发结节,考虑结节性甲状腺肿可能性大。考虑患者食管癌术后复发,我科拟放疗收治入院。起病以来,患者精神、食欲、睡眠尚可,目前可进食普食,大小便正常,近1月体重减轻(具体不详)。", "mention_data": [{"mention": "胸骨后", "label": "解剖部位", "offset": "13"}, {"mention": "胸背部", "label": "解剖部位", "offset": "25"}, {"mention": "门齿", "label": "解剖部位", "offset": "70"}, {"mention": "食管", "label": "解剖部位", "offset": "80"}, {"mention": "鳞癌", "label": "疾病和诊断", "offset": "89"}, {"mention": "ct", "label": "影像检查", "offset": "93"}, {"mention": "食管中段", "label": "解剖部位", "offset": "96"}, {"mention": "管腔", "label": "解剖部位", "offset": "111"}, {"mention": "食管癌", "label": "疾病和诊断", "offset": "118"}, {"mention": "经右胸食管癌切除术+食管胃弓下吻合术", "label": "手术", "offset": "147"}, {"mention": "贲门旁淋巴结", "label": "解剖部位", "offset": "173"}, {"mention": "鳞状细胞癌", "label": "疾病和诊断", "offset": "183"}, {"mention": "食管", "label": "解剖部位", "offset": "201"}, {"mention": "中至低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "211"}, {"mention": "食管", "label": "解剖部位", "offset": "225"}, {"mention": "胸背", "label": "解剖部位", "offset": "279"}, {"mention": "胸+下腹,ct", "label": "影像检查", "offset": "313"}, {"mention": "食管癌术后", "label": "疾病和诊断", "offset": "321"}, {"mention": "左侧气管食管沟", "label": "解剖部位", "offset": "337"}, {"mention": "右肺", "label": "解剖部位", "offset": "356"}, {"mention": "左肺下叶", "label": "解剖部位", "offset": "362"}, {"mention": "肝s2、4、6、8囊肿", "label": "疾病和诊断", "offset": "381"}, {"mention": "右肾囊肿", "label": "疾病和诊断", "offset": "393"}, {"mention": "甲状腺两叶", "label": "解剖部位", "offset": "398"}, {"mention": "结节性甲状腺肿", "label": "疾病和诊断", "offset": "410"}, {"mention": "食管癌术后复发", "label": "疾病和诊断", "offset": "426"}]}
{"text": ",患者于2014年12月因“绝经4年,阴道少量出血15天”为主诉,至南方医科大学附属*****健院就诊,,行宫腔诊刮术后病理示:子宫内膜腺癌i级。于2014-12-12在全麻上行全宫+两附件+盆腔淋巴结清扫术,术中情况不详。,术后病理示:子宫符合浆液性腺癌并子宫内膜样腺癌,侵犯肌层全层,脉管内见癌栓,子宫上段见癌累及,子宫颈间质及脉管见癌,两侧卵巢见癌,腹主+髂总淋巴结见癌(右1/8,左2/8),余盆腔淋巴结阴性。确诊为iiic2期。术后于我院2015-1-14、2015-2-10各一程tc方案化疗(力扑素叒210叒mg+铂乐定叒450mg),现患者二程化疗后三周,患者及家属要求进一步治疗入院。患者自发病以来,精神欠佳,饮食及睡眠尚佳,大小便正常。无明显体重减轻。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "19"}, {"mention": "宫腔诊刮术", "label": "手术", "offset": "54"}, {"mention": "子宫内膜腺癌i级", "label": "疾病和诊断", "offset": "64"}, {"mention": "全宫+两附件+盆腔淋巴结清扫术", "label": "手术", "offset": "89"}, {"mention": "子宫", "label": "解剖部位", "offset": "119"}, {"mention": "浆液性腺癌并子宫内膜样腺癌", "label": "疾病和诊断", "offset": "123"}, {"mention": "子宫上段", "label": "解剖部位", "offset": "151"}, {"mention": "子宫颈", "label": "解剖部位", "offset": "160"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "171"}, {"mention": "腹主+髂总淋巴结", "label": "解剖部位", "offset": "178"}, {"mention": "盆腔淋巴结", "label": "解剖部位", "offset": "201"}, {"mention": "力扑素", "label": "药物", "offset": "253"}, {"mention": "铂乐定", "label": "药物", "offset": "264"}]}
{"text": ",自述平素体健,月经规则,3月前无诱因始出现阴道流血,2011年6月3日******健院就诊,,宫颈活检示:宫颈鳞癌。2011年6月9日在我院拟诊为1、宫颈鳞癌1b2期,2、中度贫血。分别于6月10日及6月30日予tp方案(力朴素270mg+ddp120mg)新辅助化疗2程,化疗顺利。于07月28日在我院行宫颈癌根治术+两附件切除术(ii型全子宫切除术),08月05日tp方案补充化疗1疗程。化疗后血象持续在正常范围,现收住院进一步治疗。患者近期精神、睡眠可,食欲如常,大小便正常。,既往化疗及肿瘤标志物情况:,化疗药物毒副反应:。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "22"}, {"mention": "宫颈", "label": "解剖部位", "offset": "48"}, {"mention": "宫颈鳞癌", "label": "疾病和诊断", "offset": "54"}, {"mention": "宫颈鳞癌1b2期", "label": "疾病和诊断", "offset": "76"}, {"mention": "中度贫血", "label": "疾病和诊断", "offset": "87"}, {"mention": "力朴素", "label": "药物", "offset": "112"}, {"mention": "ddp", "label": "药物", "offset": "121"}, {"mention": "宫颈癌根治术+两附件切除术(ii型全子宫切除术)", "label": "手术", "offset": "154"}]}
{"text": "因“便血1年”在**行直肠活检提示黑色素瘤,于2016.4.6在全麻上行腹腔镜探查,经腹会阴直肠癌联合根治术,术后病理:直肠黑色素瘤,侵透肠壁全层达周围脂肪组织,紧邻环周切缘,淋巴结转移,肠周8/14,结肠下动脉根部0/3。目前伤口恢复尚好,会阴部伤口仍有少量渗液。2016-5入院开始t1方案辅助治疗6周期。近期出现左腰背部及放射性疼痛,当地腰椎发现多发椎体转移,咨询诊治。2017-5-4行l5椎体介入治疗(骨水泥),拟行局部放疗,5.9在我科行tp+恩度治疗*2周期,2017-5-18开始骨转移灶放疗ptv30gy/10f。2017.6复查腰5椎体固化,自述疼痛消失,感觉好。拟行第3周期化疗,预约检查及入院.。", "mention_data": [{"mention": "直肠活检", "label": "手术", "offset": "11"}, {"mention": "腹腔镜探查,经腹会阴直肠癌联合根治术", "label": "手术", "offset": "36"}, {"mention": "直肠黑色素瘤", "label": "疾病和诊断", "offset": "60"}, {"mention": "肠", "label": "解剖部位", "offset": "69"}, {"mention": "肠", "label": "解剖部位", "offset": "94"}, {"mention": "结肠下动脉根部", "label": "解剖部位", "offset": "101"}, {"mention": "会阴部", "label": "解剖部位", "offset": "121"}, {"mention": "左腰背部", "label": "解剖部位", "offset": "159"}, {"mention": "腰椎", "label": "解剖部位", "offset": "172"}, {"mention": "椎体转移", "label": "疾病和诊断", "offset": "178"}, {"mention": "l5椎体", "label": "解剖部位", "offset": "197"}, {"mention": "骨", "label": "解剖部位", "offset": "206"}, {"mention": "恩度", "label": "药物", "offset": "228"}, {"mention": "骨转移", "label": "症状", "offset": "248"}, {"mention": "腰5椎体", "label": "解剖部位", "offset": "274"}]}
{"text": ",患者于2012-9-24以“停经后不规则阴道流血14个月,咳嗽咯血3个月”为主诉入院,完善相关化验检查,甲胎蛋白测定>1210.00ng/ml,血清人绒毛膜促性腺激素测定20127.00miu/ml。,确定诊断为:盆腔包块(卵巢生殖细胞恶性肿瘤可能大);肺转移及脑转移不除外,脑血栓不除外。于2012-9-26至2012-12-4行bep(博莱霉素+依托伯苷+顺铂)联合静脉化疗3次。化疗过程顺利,副反应轻微。化疗后咳嗽咳痰较前减轻。于2012-12-19全麻上行左侧附件切除术。,术后病理号:z0445679abe(左侧卵巢)大片坏死组织中见少量变性的异型细胞,可符合化疗后恶性肿瘤组织。术后行bep(博莱霉素+依托伯苷+顺铂)联合静脉化疗3次,现为求补充治疗入院。患者出院至今咳嗽咳痰较前减轻,近日着凉后感冒,饮食欠佳,睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "21"}, {"mention": "甲胎蛋白测定", "label": "实验室检验", "offset": "53"}, {"mention": "血清人绒毛膜促性腺激素测定", "label": "实验室检验", "offset": "73"}, {"mention": "卵巢生殖细胞恶性肿瘤", "label": "疾病和诊断", "offset": "113"}, {"mention": "肺转移", "label": "疾病和诊断", "offset": "128"}, {"mention": "脑转移", "label": "疾病和诊断", "offset": "132"}, {"mention": "脑血栓", "label": "疾病和诊断", "offset": "139"}, {"mention": "博莱霉素", "label": "药物", "offset": "171"}, {"mention": "依托伯苷", "label": "药物", "offset": "176"}, {"mention": "顺铂", "label": "药物", "offset": "181"}, {"mention": "左侧附件切除术", "label": "手术", "offset": "233"}, {"mention": "左侧卵巢", "label": "解剖部位", "offset": "260"}, {"mention": "博莱霉素", "label": "药物", "offset": "303"}, {"mention": "依托伯苷", "label": "药物", "offset": "308"}, {"mention": "顺铂", "label": "药物", "offset": "313"}]}
{"text": ",患者9月前无明显诱因出现腹泻伴便秘,到外院就诊,,病理示:中分化腺癌。2010-8-10行左半结肠切除术+有附件切除术,,术后病检示:(升结肠)中分化腺癌,左附件考虑结肠癌转移。2010-9-26至2010-11-15行盆腔及原发灶放射治疗。2010-9-27,2010-10-18,2010-11-10行xelox方同期化疗3程。2010-12-10复查ct,疗效评价为pr,2011-3-18开始予单药希罗达化疗。现遵主诊教授医嘱入院希罗达化疗。患者发病以来,精神佳,饮食睡眠可,大小便如常,体重无明显减轻。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "13"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "30"}, {"mention": "左半结肠切除术+有附件切除术", "label": "手术", "offset": "46"}, {"mention": "(升结肠)中分化腺癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "左附件", "label": "解剖部位", "offset": "79"}, {"mention": "结肠癌转移", "label": "疾病和诊断", "offset": "84"}, {"mention": "盆腔", "label": "解剖部位", "offset": "111"}, {"mention": "ct", "label": "影像检查", "offset": "179"}, {"mention": "希罗达", "label": "药物", "offset": "204"}, {"mention": "希罗达", "label": "药物", "offset": "220"}]}
{"text": "2011年10月31日行左半结肠切除、直肠癌切除(harttmann)术,术后直肠残端漏,行腹盆腔冲洗引流术,术后行希罗达化疗。此次复查腹盆腔ct提示:1、直肠、左半结肠切除术后,骶前低密度区范围同前,现约36x23mm(im112),其周围多发索条影同前。左半结肠吻合口未见增厚及异常强化。右上腹造瘘口未见异常强化。2、肝多发转移灶较前增多、增大,如原较大约20x18mm(im55),现约42x31mm(im49)现较大病变约为54x43mm(im55)。肝囊肿较前无变化,现约24x20mm(im57)。3、腹膜、网膜及系膜增厚,并见小结节灶,约为9mm(im67),腹腔内见腹水。腹主动脉内斑块影较前略大(im57)。\\u007f4、左肾盂、下段输尿管轻度扩张缓解,两肾小囊肿、膀胱前壁增厚同前。脾、胰腺、胆囊、肾下腺、前列腺、精囊腺未见异常。\\u007f5、腹腔、腹膜后、盆腔未见肿大淋巴结。扫及诸骨未见明确骨质破坏征象。此次肿瘤标志物较2012-8均明显升高。\\u0004\\u0004。", "mention_data": [{"mention": "左半结肠切除、直肠癌切除(harttmann)术", "label": "手术", "offset": "12"}, {"mention": "直肠残端漏", "label": "疾病和诊断", "offset": "39"}, {"mention": "腹盆腔冲洗引流术", "label": "手术", "offset": "46"}, {"mention": "希罗达", "label": "药物", "offset": "58"}, {"mention": "腹盆腔ct", "label": "影像检查", "offset": "68"}, {"mention": "直肠、左半结肠切除术后", "label": "疾病和诊断", "offset": "78"}, {"mention": "骶前", "label": "解剖部位", "offset": "90"}, {"mention": "左半结肠", "label": "解剖部位", "offset": "129"}, {"mention": "右上腹", "label": "解剖部位", "offset": "146"}, {"mention": "肝多发转移", "label": "疾病和诊断", "offset": "161"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "230"}, {"mention": "腹", "label": "解剖部位", "offset": "257"}, {"mention": "腹腔", "label": "解剖部位", "offset": "287"}, {"mention": "腹水", "label": "症状", "offset": "291"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "294"}, {"mention": "左肾盂", "label": "解剖部位", "offset": "321"}, {"mention": "下段输尿管", "label": "解剖部位", "offset": "325"}, {"mention": "两肾小囊肿", "label": "疾病和诊断", "offset": "337"}, {"mention": "膀胱", "label": "解剖部位", "offset": "343"}, {"mention": "脾", "label": "解剖部位", "offset": "352"}, {"mention": "胰腺", "label": "解剖部位", "offset": "354"}, {"mention": "胆囊", "label": "解剖部位", "offset": "357"}, {"mention": "肾下腺", "label": "解剖部位", "offset": "360"}, {"mention": "前列腺", "label": "解剖部位", "offset": "364"}, {"mention": "精囊腺", "label": "解剖部位", "offset": "368"}, {"mention": "腹腔", "label": "解剖部位", "offset": "384"}, {"mention": "腹", "label": "解剖部位", "offset": "387"}, {"mention": "盆腔", "label": "解剖部位", "offset": "391"}, {"mention": "骨", "label": "解剖部位", "offset": "404"}, {"mention": "骨质破坏", "label": "症状", "offset": "409"}]}
{"text": ",患者自述于2.5月前因发热就诊于我院,体温波动于37-38摄氏度之间,无咳嗽咳痰,无腹痛腹泻,检查提示血沉升高,盗汗,肺腹ct提示胃壁增厚伴胃周淋巴结肿大,进一步行胃镜检查提示胃体后壁不规则溃疡并隆起,胃窦中段大弯见2处溃疡,病理诊断为胃粘膜相关淋巴瘤,,免疫组化:cd20(-)。入我科完善相关检查分期为胃黏膜相关淋巴瘤(ii1b期),行cop方案化疗3周期,,具体为:环磷酰胺1100毫克d1静点,长春新碱2毫克d1静点,醋酸泼尼松100毫克d1-5口服。无明显不良反应。2周期评效稳定。末次化疗(2011-3-26)距今3周,患者现一般状态可,饮食二便正常,现体温正常,无盗汗,体重上降1公斤,kps评分90分。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "43"}, {"mention": "腹泻", "label": "症状", "offset": "45"}, {"mention": "血沉", "label": "实验室检验", "offset": "52"}, {"mention": "肺腹ct", "label": "影像检查", "offset": "60"}, {"mention": "胃壁增厚", "label": "症状", "offset": "66"}, {"mention": "胃周淋巴结", "label": "解剖部位", "offset": "71"}, {"mention": "胃体", "label": "解剖部位", "offset": "89"}, {"mention": "胃窦中段大弯", "label": "解剖部位", "offset": "102"}, {"mention": "胃粘膜相关淋巴瘤", "label": "疾病和诊断", "offset": "119"}, {"mention": "胃黏膜相关淋巴瘤(ii1b期)", "label": "疾病和诊断", "offset": "154"}, {"mention": "环磷酰胺", "label": "药物", "offset": "187"}, {"mention": "长春新碱", "label": "药物", "offset": "202"}, {"mention": "醋酸泼尼松", "label": "药物", "offset": "214"}]}
{"text": "2010-9-21我院行直肠癌根治术,术前分期?术前放疗10次,ypt4an0m0,术后folfox*3-xeloda*3,末次2011.2.\\u0004\\u0004叒2012-4两肺多发小m,行bev+xelox*4,治疗后血压最高160/100mmhg,2周期缩小sd,4周期又略缩小,未达pr?末次用药2012.8。叒2012-9-3在空总行左肺3处m-r刀治疗。2012-11-16胸ct,左肺治疗后病灶缩小,但右肺门新发转移灶约2.5cm,腹ct未见新发m。\\u0004\\u0004叒叒目前乏力,无咳嗽,体重无明显上降。拟2013-1-10行右肺门转移灶放疗gtv叒60gy/15f,同步口服希罗达1.5g叒bid叒增敏化疗。\\u0004\\u0004。", "mention_data": [{"mention": "直肠癌根治术", "label": "手术", "offset": "12"}, {"mention": "xeloda", "label": "药物", "offset": "53"}, {"mention": "两肺", "label": "解剖部位", "offset": "90"}, {"mention": "bev", "label": "药物", "offset": "98"}, {"mention": "左肺", "label": "解剖部位", "offset": "174"}, {"mention": "m-r刀", "label": "手术", "offset": "178"}, {"mention": "胸ct", "label": "影像检查", "offset": "195"}, {"mention": "左肺", "label": "解剖部位", "offset": "199"}, {"mention": "右肺门", "label": "解剖部位", "offset": "210"}, {"mention": "腹ct", "label": "影像检查", "offset": "225"}, {"mention": "右肺门转移", "label": "疾病和诊断", "offset": "276"}, {"mention": "希罗达", "label": "药物", "offset": "301"}]}
{"text": ",患者自诉于2013-08-30在**一院因“直乙交界癌”行肠癌根治术,,术后病理:直肠中分化腺癌(t4n0m0iib期),并且检查口服希罗达化疗,已经化疗8个疗程。术后一个月,患者开始自觉大便不畅,偶不成形,稀便,偶有便血,余无特殊不适。遂来我院门诊就诊,行胸部ct平扫+,增强检察:两肺下叶肺气肿,肝多发低密度病变,考虑肝囊肿,左肾囊肿。盆腔mr平扫+,增强检察:直肠癌术后,直肠下段吻合口处软组织影,考虑复发可能性大。,心脏彩超及心功能测定:右左心房稍增大,主动脉增宽并主动脉关闭不全,二尖瓣前叶脱垂并关闭不全(轻微,右心室收缩功能正常,舒张功能减低(i级)。,行结肠肿物病理活检:结肠粘膜可见腺癌浸润。2014-7-4、7-31、8-26行“xelox”方案化疗3程,过程顺利,化疗后未见明显不适。患者目前放疗中,已放疗23次,诉有里急后重感。今为求进一步诊治来我院,拟“直肠癌术后吻合口复发”收住我科,患者发病以来,精神佳,饮食睡眠佳,小便正常,体重无减轻。", "mention_data": [{"mention": "直乙交界癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "肠癌根治术", "label": "手术", "offset": "30"}, {"mention": "直肠中分化腺癌(t4n0m0iib期)", "label": "疾病和诊断", "offset": "42"}, {"mention": "希罗达", "label": "药物", "offset": "68"}, {"mention": "胸部ct平扫+,增强", "label": "影像检查", "offset": "130"}, {"mention": "两肺下叶肺气肿", "label": "疾病和诊断", "offset": "143"}, {"mention": "肝", "label": "解剖部位", "offset": "151"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "162"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "166"}, {"mention": "盆腔mr平扫+,增强", "label": "影像检查", "offset": "171"}, {"mention": "直肠癌术后", "label": "疾病和诊断", "offset": "184"}, {"mention": "直肠下段", "label": "解剖部位", "offset": "190"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "213"}, {"mention": "心", "label": "解剖部位", "offset": "218"}, {"mention": "右左心房稍增大,主动脉增宽并主动脉关闭不全,二尖瓣前叶脱垂并关闭不全", "label": "疾病和诊断", "offset": "224"}, {"mention": "右心室", "label": "解剖部位", "offset": "262"}, {"mention": "结肠", "label": "解剖部位", "offset": "285"}, {"mention": "结肠", "label": "解剖部位", "offset": "294"}, {"mention": "直肠癌术后吻合口复发", "label": "疾病和诊断", "offset": "390"}]}
{"text": "患者于2011年8月因“间隙便血4月”在我院行肠镜检查示:直肠肿物,活检为高分化腺癌;升结肠见一粗蒂0.8×0.8cm息肉,横结肠见一1.2×1.5cm长蒂息肉,病理活检为管状腺瘤;乙状结肠见1.0×1.0cm粗蒂息肉,活检为管状-绒毛状腺瘤。在我院行经腹直肠癌根治术(dixon术),术后病理为中分化腺癌,浸润肠壁浅肌层,淋巴结未见转移,诊断为直肠中分化腺癌ducka期,术后定期复查。现为行内镜上治疗结肠息肉收入院,患者无发热,盗汗,无便血、黑便,无腹痛,腹胀,无恶心,呕吐,无头痛,头晕等。睡眠、精神、胃纳尚可,小便正常,体重无明显改变。", "mention_data": [{"mention": "直肠", "label": "解剖部位", "offset": "29"}, {"mention": "高分化腺癌", "label": "疾病和诊断", "offset": "37"}, {"mention": "升结肠", "label": "解剖部位", "offset": "43"}, {"mention": "横结肠", "label": "解剖部位", "offset": "62"}, {"mention": "管状腺瘤", "label": "疾病和诊断", "offset": "86"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "91"}, {"mention": "管状-绒毛状腺瘤", "label": "疾病和诊断", "offset": "113"}, {"mention": "经腹直肠癌根治术(dixon术)", "label": "手术", "offset": "126"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "148"}, {"mention": "肠", "label": "解剖部位", "offset": "156"}, {"mention": "直肠中分化腺癌ducka期", "label": "疾病和诊断", "offset": "173"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "202"}, {"mention": "腹痛", "label": "症状", "offset": "227"}, {"mention": "腹胀", "label": "症状", "offset": "230"}, {"mention": "头痛", "label": "症状", "offset": "241"}, {"mention": "头晕", "label": "症状", "offset": "244"}, {"mention": "胃", "label": "解剖部位", "offset": "254"}]}
{"text": ",因便血,2014-7-1,外院肠镜:乙状结肠距肛门27cm菜花样病变,3*4cm,,活检病理:高分化腺癌。未见术前肿标。2015-7-4行乙状结肠癌根治术。,术中:肿瘤位于乙状结肠,3cm叒,侵透浆膜,系膜根部质硬,不除外转移。,术后病理:溃疡型中分化腺癌。大小3*2.5*1cm,浸润肠壁全层达外膜,有浆膜被覆处未突破间皮层,可见神经侵犯及脉管癌栓,淋巴结3/12,cea+++叒ca199+++叒egfr-叒her2)(sp3)-叒p53-叒top11a叒20-30%,ki6780%叒msh1+叒msh2+叒msh叒6+叒pms2+。术后伤口愈合差,至2015-3伤口完全愈合.2015-4口服希罗达*6,末次2015-7-15.术后未复查。2015-10-23叒腹部,ct:乙状结肠术后,右侧髂血管旁及腹膜后淋巴结肿大,转移?。右肾下腺结节,性质待定。2015-10-15叒癌抗原199叒45.38u/ml,癌抗原125叒41.32u/ml目前患者食欲可,无不适,乏力明显叒体重无变化。", "mention_data": [{"mention": "乙状结肠", "label": "解剖部位", "offset": "19"}, {"mention": "肛门", "label": "解剖部位", "offset": "24"}, {"mention": "高分化腺癌", "label": "疾病和诊断", "offset": "48"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "70"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "87"}, {"mention": "溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "121"}, {"mention": "肠", "label": "解剖部位", "offset": "144"}, {"mention": "希罗达", "label": "药物", "offset": "301"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "336"}, {"mention": "乙状结肠术后", "label": "疾病和诊断", "offset": "342"}, {"mention": "右侧髂血管", "label": "解剖部位", "offset": "349"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "356"}, {"mention": "右肾下腺", "label": "解剖部位", "offset": "369"}, {"mention": "癌抗原199", "label": "实验室检验", "offset": "392"}, {"mention": "癌抗原125", "label": "实验室检验", "offset": "409"}]}
{"text": ",患者3-4年前发现大便不成型,无便中带血,不伴有粘液,无黑便,无腹痛,易腹泻,无里急后重。无恶心、呕吐,无发热,下述症状与饮食无明显关系。患者未在意,未系统诊治。2012年3月于本院行结肠镜发现直肠息肉0.3×0.6cm,未予特殊处置。,一周前患者于**复查结肠镜示:,升结肠:近盲肠见多处瘢痕改变,近回盲盲瓣见1指状息肉,大小约1.5*0.5cm,光滑,取材1块。,病理示:升结肠炎性息肉。今为进一步诊治及行肠息肉电切术入我科。患者病来精神可,饮食睡眠可,尿量正常,近期体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "33"}, {"mention": "腹泻", "label": "症状", "offset": "37"}, {"mention": "直肠息肉", "label": "疾病和诊断", "offset": "98"}, {"mention": "升结肠", "label": "解剖部位", "offset": "136"}, {"mention": "盲肠", "label": "解剖部位", "offset": "141"}, {"mention": "回盲盲瓣", "label": "解剖部位", "offset": "152"}, {"mention": "升结肠炎性息肉", "label": "疾病和诊断", "offset": "189"}, {"mention": "肠息肉电切术", "label": "手术", "offset": "206"}]}
{"text": ",患者自述于3年3个月因无意扪及左乳一肿物,于我院行乳腺超声及钼靶怀疑恶性可能性大,后于我院乳腺外科行乳腺根治性切除术(2008.2.23)。术中见肿物5.5×4.0×3.5厘米,,术后病理为:浸润性导管癌,淋巴结6/12枚转移(病理号381609),免疫组化:er(+++),pr(+++),,her-2:阴性。术后在乳腺外科行ce方案化疗4周期,,具体方案为:环磷酰胺1.0毫克,表阿霉素130毫克。期间行放疗1周期。后序贯紫杉醇4周期(具体计量不详).化疗时出现脱发,轻度恶心。化疗结束后口服他莫西芬。1年余前常规体检中发现肝有一病灶,约1.0cm,未行系统治疗。11个月前行卵巢去势术,9个月前开始口服瑞宁德。8个月前复查,病情进展,遂入我科行gx方案化疗8周期,,具体方案为:吉西他滨(健泽)1.6d1,1.2d8,卡培他滨(希罗达)1.5日二次口服d1-14,因骨髓抑制较重,第2周期*吉西他滨改量为1.4d1,d8,并用唑来膦酸钠(盖宁)抗骨转移治疗,期间评效,病情稳定,末次化疗距今3周,未出现ii度以下不良反应,为继续治疗入我科。近1个月来饮食睡眠正常,二便基本正常,体重正常。kps评分90分。", "mention_data": [{"mention": "左乳", "label": "解剖部位", "offset": "16"}, {"mention": "乳腺超声", "label": "影像检查", "offset": "26"}, {"mention": "钼靶", "label": "影像检查", "offset": "31"}, {"mention": "乳腺根治性切除术", "label": "手术", "offset": "51"}, {"mention": "浸润性导管癌", "label": "疾病和诊断", "offset": "97"}, {"mention": "环磷酰胺", "label": "药物", "offset": "182"}, {"mention": "表阿霉素", "label": "药物", "offset": "192"}, {"mention": "紫杉醇", "label": "药物", "offset": "214"}, {"mention": "他莫西芬", "label": "药物", "offset": "249"}, {"mention": "肝", "label": "解剖部位", "offset": "265"}, {"mention": "卵巢去势术", "label": "手术", "offset": "291"}, {"mention": "瑞宁德", "label": "药物", "offset": "305"}, {"mention": "吉西他滨", "label": "药物", "offset": "343"}, {"mention": "健泽", "label": "药物", "offset": "348"}, {"mention": "卡培他滨", "label": "药物", "offset": "363"}, {"mention": "希罗达", "label": "药物", "offset": "368"}, {"mention": "吉西他滨", "label": "药物", "offset": "399"}, {"mention": "唑来膦酸钠", "label": "药物", "offset": "417"}, {"mention": "盖宁", "label": "药物", "offset": "423"}, {"mention": "骨转移", "label": "症状", "offset": "427"}]}
{"text": ",患者2014年1月因\\\"左下腹痛10天\\\"于本院诊断为肝癌,2014年1月22日行tace术,术中用药表阿霉素50mg,丝裂霉素6mg,伯尔定300mg,碘油20ml。并于2014年02月12日于全麻上行肝癌切除+胆囊切除术,术程顺利,,术后病理提示:中分化肝细胞性肝癌。术后恢复良好出院。2015-1-6于局麻上行肝动脉栓塞化疗(tace)术,术中用药法玛新50mg,伯尔定300mg,碘化油7ml。术后定期复查,,我院2015年01月22日ct示:对比2015.01.04叒日mr,肝癌综合治疗后,肝s2、6叒段碘油沉积较致密结节,考虑介入治疗后改变,未见明显肿瘤活性。肝s6叒段结节,考虑肿瘤活性结节可能。为求进一步诊治收入我科病房。患者下次出院以来食欲睡眠可,精神可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "13"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "28"}, {"mention": "tace术", "label": "手术", "offset": "42"}, {"mention": "表阿霉素", "label": "药物", "offset": "52"}, {"mention": "丝裂霉素", "label": "药物", "offset": "61"}, {"mention": "伯尔定", "label": "药物", "offset": "69"}, {"mention": "碘油", "label": "药物", "offset": "78"}, {"mention": "肝癌切除+胆囊切除术", "label": "手术", "offset": "103"}, {"mention": "中分化肝细胞性肝癌", "label": "疾病和诊断", "offset": "127"}, {"mention": "肝动脉栓塞化疗(tace)术", "label": "手术", "offset": "159"}, {"mention": "法玛新", "label": "药物", "offset": "178"}, {"mention": "伯尔定", "label": "药物", "offset": "186"}, {"mention": "碘化油", "label": "药物", "offset": "195"}, {"mention": "ct", "label": "影像检查", "offset": "223"}, {"mention": "mr", "label": "影像检查", "offset": "241"}, {"mention": "肝癌", "label": "疾病和诊断", "offset": "244"}, {"mention": "肝s2、6叒段", "label": "解剖部位", "offset": "252"}, {"mention": "碘油", "label": "药物", "offset": "259"}, {"mention": "肝s6", "label": "解剖部位", "offset": "288"}]}
{"text": ",患者于20天前无明显诱因出现进食固体食物时吞咽梗咽感,进食半流质食物顺利,无胸痛,无气促,无声音嘶哑,无发热。到本院就诊,,行胃镜检查示:距门齿29-35cm前壁右侧见粘膜隆起,表面高低不平,溃疡形成,质硬,易出血,食管腔轻度狭窄;病理为鳞癌。,胸部ct示:食管中上段mt。今为进一步诊治入院。起病以来,精神睡眠可,胃纳一般,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "39"}, {"mention": "门齿", "label": "解剖部位", "offset": "71"}, {"mention": "食管腔", "label": "解剖部位", "offset": "109"}, {"mention": "鳞癌", "label": "疾病和诊断", "offset": "120"}, {"mention": "胸部ct", "label": "影像检查", "offset": "124"}, {"mention": "食管中上段mt", "label": "疾病和诊断", "offset": "130"}]}
{"text": "患者一个月前因“腹痛、腹泻一月”就诊外院,肠镜提示距肛门15cm肿物,内镜无法通过;活检病理腺癌。腹ct示肝s7占位,考虑转移瘤。诊断“直肠癌肝转移”为求进一步诊治来本院就诊,mdt会诊建议先行手术解除梗阻因素,再行化疗。遂于2014-06-05行腹腔镜上dixon术,术后第五日出现吻合口微小漏,经对症处理后好转。术后病理示:直肠中至低分化腺癌,侵犯浆膜上层,可见脉管内癌栓及神经束侵犯,5/10ln(+)pt3n2am1a叒iva期。2014-07-04行mfolfox6(乐沙定+5-fu)方案一程。自下次出院以来,食欲、睡眠及精神一般,排便大致正常,无明显腹胀、呕吐,小便正常,体重上降改变不明显。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "8"}, {"mention": "腹泻", "label": "症状", "offset": "11"}, {"mention": "肛门", "label": "解剖部位", "offset": "26"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "46"}, {"mention": "腹ct", "label": "影像检查", "offset": "49"}, {"mention": "肝s7占位", "label": "疾病和诊断", "offset": "53"}, {"mention": "直肠癌肝转移", "label": "疾病和诊断", "offset": "68"}, {"mention": "腹腔镜上dixon术", "label": "手术", "offset": "124"}, {"mention": "直肠中至低分化腺癌", "label": "疾病和诊断", "offset": "164"}, {"mention": "乐沙定", "label": "药物", "offset": "239"}, {"mention": "5-fu", "label": "药物", "offset": "243"}, {"mention": "腹胀", "label": "症状", "offset": "282"}]}
{"text": ",患者因“不规则阴道流血伴阴道排液1+年”,,诊断性刮宫病理提示:(宫腔)子宫内膜样腺癌,g2;,我院病理会诊提示:子宫内膜样腺癌g2-3,宫颈管搔刮组织见少量粘膜组织及少量异型的内膜腺体。于2011-12-21在我院行\\\"ii型全子宫切除+两侧附件切除+盆腔淋巴结清扫+腹主动脉旁淋巴结活检术\\\",,术后病理示:(子宫)中至低分化子宫内膜样腺癌,浸润子宫深肌层;宫颈及宫颈管粘膜慢性炎;两附件未见明显病变;右闭孔淋巴结见癌转移(1/3)。,诊断:子宫内膜腺癌iiic期(g3),有放化疗指征,已预约2012-03-13开始放疗。并于2011-12-29、2012-01-20予tp方案(泰素270mgd1,ddp60mgd1-2)化疗2程,过程顺利,反应较轻。并予高孕激素治疗。现为行第3程化疗收入院。出院以来,患者无发热、头痛、咳嗽、腹痛、腹胀、腰酸、上肢疼痛等不适,无明显恶心、呕吐,精神、胃纳好,大便较秘结,小便正常,体重无明显减轻。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "8"}, {"mention": "阴道", "label": "解剖部位", "offset": "13"}, {"mention": "(宫腔)子宫内膜样腺癌,g2", "label": "疾病和诊断", "offset": "33"}, {"mention": "子宫内膜样腺癌g2-3", "label": "疾病和诊断", "offset": "58"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "70"}, {"mention": "ii型全子宫切除+两侧附件切除+盆腔淋巴结清扫+腹主动脉旁淋巴结活检术", "label": "手术", "offset": "112"}, {"mention": "(子宫)中至低分化子宫内膜样腺癌", "label": "疾病和诊断", "offset": "157"}, {"mention": "子宫", "label": "解剖部位", "offset": "176"}, {"mention": "宫颈", "label": "解剖部位", "offset": "182"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "185"}, {"mention": "两附件", "label": "解剖部位", "offset": "194"}, {"mention": "右闭孔淋巴结", "label": "解剖部位", "offset": "204"}, {"mention": "子宫内膜腺癌iiic期(g3)", "label": "疾病和诊断", "offset": "224"}, {"mention": "泰素", "label": "药物", "offset": "294"}, {"mention": "ddp", "label": "药物", "offset": "304"}, {"mention": "孕激素", "label": "药物", "offset": "334"}, {"mention": "头痛", "label": "症状", "offset": "363"}, {"mention": "腹痛", "label": "症状", "offset": "369"}, {"mention": "腹胀", "label": "症状", "offset": "372"}, {"mention": "腰酸", "label": "症状", "offset": "375"}, {"mention": "上肢", "label": "解剖部位", "offset": "378"}, {"mention": "胃", "label": "解剖部位", "offset": "398"}]}
{"text": ",患者于2012-01出现胃胀、便血等症状,2012-02-20就诊于**三院,行胃镜病理活检提示胃底贲门癌。2012-02-23,**一院ct检查示:胃底贲门-小弯侧恶性肿瘤,可疑周围淋巴结转移。2012-03-06,行pet-ct示:胃底贲门部-胃小弯恶性肿瘤(胃癌?);胃周围淋巴结转移。后于2012-03-08在**一院气管内麻醉上行“胃癌根治术”,术程顺利。,术后病理示:胃印戒细胞癌,侵及胃壁全层,并穿透浆膜层;伴淋巴结转移(10/42)。,术后分期:t4an3am0,iii期。2012-03至2012-08行化疗8程(奥沙利铂+替吉奥4程,因胃肠道反应大,后改口服替吉奥4程)。患者2012-11起在我院行cik细胞免疫治疗,2014-3-,3复查ct:右腋窝淋巴结稍肿大,考虑转移瘤。腹腔干右旁、腹主动脉右旁、两侧髂血管旁淋巴结,较前增多、增大,考虑转移,可疑右侧肾下腺受侵犯。现为继续治疗收入我科。自起病以来,患者精神、睡眠可,食欲如常,大小便正常,体重无明显上降。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "13"}, {"mention": "胃底贲门癌", "label": "疾病和诊断", "offset": "49"}, {"mention": "胃底贲门-小弯侧恶性肿瘤", "label": "疾病和诊断", "offset": "76"}, {"mention": "pet-ct", "label": "影像检查", "offset": "111"}, {"mention": "胃底贲门部-胃小弯恶性肿瘤(胃癌?)", "label": "疾病和诊断", "offset": "119"}, {"mention": "胃", "label": "解剖部位", "offset": "138"}, {"mention": "气管", "label": "解剖部位", "offset": "164"}, {"mention": "胃癌根治术", "label": "手术", "offset": "172"}, {"mention": "胃印戒细胞癌", "label": "疾病和诊断", "offset": "191"}, {"mention": "胃", "label": "解剖部位", "offset": "200"}, {"mention": "奥沙利铂", "label": "药物", "offset": "267"}, {"mention": "替吉奥", "label": "药物", "offset": "272"}, {"mention": "胃肠道", "label": "解剖部位", "offset": "279"}, {"mention": "替吉奥", "label": "药物", "offset": "290"}, {"mention": "ct", "label": "影像检查", "offset": "332"}, {"mention": "右腋窝淋巴结", "label": "解剖部位", "offset": "335"}, {"mention": "腹腔干", "label": "解剖部位", "offset": "351"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "357"}, {"mention": "两侧髂血管旁淋巴结", "label": "解剖部位", "offset": "364"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "389"}]}
{"text": "2011-8突发呕血,就诊外院完善检查后诊为胃间质瘤;2011-8-18行胃大部切除术,术后病理:胃肠道间质瘤,呈多结节状分布,累及胃及大网膜,大小直径1-7cm,肿瘤细胞中度异型,未见明确坏死,偶见核分裂像(2-3个/50hp),周围淋巴结可见肿瘤侵犯1/9,免疫组化;ck-,cd117+,cd34+,s-100-,ki67叒5%,脂肪、血管及淋巴组织未见肿瘤,2011.9.6开始服格列卫术后予格列卫10天(9-17停药),但恶心、呕吐明显。2011-9-30出现发热,外院考虑呼吸道感染,查血常规示骨髓抑制ii,外院予升白、抗感染治疗后好转。2011-12-13复查腹ct示小肠多发软组织密度影,考虑多发间质瘤,肝门区多发结节,转移?为进一步治疗就诊。昨天起开始服格列卫。", "mention_data": [{"mention": "胃间质瘤", "label": "疾病和诊断", "offset": "22"}, {"mention": "胃大部切除术", "label": "手术", "offset": "37"}, {"mention": "胃肠道间质瘤", "label": "疾病和诊断", "offset": "49"}, {"mention": "胃", "label": "解剖部位", "offset": "66"}, {"mention": "格列卫", "label": "药物", "offset": "194"}, {"mention": "格列卫", "label": "药物", "offset": "200"}, {"mention": "呼吸道", "label": "解剖部位", "offset": "242"}, {"mention": "腹ct", "label": "影像检查", "offset": "287"}, {"mention": "小肠", "label": "解剖部位", "offset": "291"}, {"mention": "间质瘤", "label": "疾病和诊断", "offset": "306"}, {"mention": "肝门区", "label": "解剖部位", "offset": "310"}, {"mention": "格列卫", "label": "药物", "offset": "336"}]}
{"text": ",患者2012年03月无明显诱因出现进食后呕吐,无腹痛腹胀,无腹泻黑便,无大便性状改变。2012-05下述症状加重,出现左上腹阵发性隐痛。现为进一步诊治随来我院,我院门诊现为进一步治疗入院。2012年05月16日胸部、下腹、上腹部、盆腔,ct:左上腹部肠壁明显增厚,考虑肠癌可能性大,肠周脂肪间隙结节,考虑淋巴结转移;肝右外叶病灶,可疑转移瘤;胸部、盆腔未见明确占位性病变;左侧阴囊稍增大并异常密度影。2012.5.24行“左半结肠切除+乙状结肠部分切除+盆腔结节切除+腹腔热灌注化疗术”,过程顺利。,术后病理:盲肠中至低分化腺癌,术后分期为叒pt4bn0m1b,ivb期。2012年7月2日至2013年12月4日予mfolfox6化疗12周期,第二周期开始,加用贝伐珠单抗11次,过程顺利,2012年12月27日至2014年03月12日予贝伐珠单抗加卡培他滨化疗19周期。下次化疗后,患者恢复良好,手足稍脱皮,未见渗液,评价手足综合症较前稍好转。现为进一步治疗入院。自下次出院以来,患者精神、睡眠可,胃纳如常,小便正常,体重未见明显改变。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "25"}, {"mention": "腹胀", "label": "症状", "offset": "27"}, {"mention": "腹泻", "label": "症状", "offset": "31"}, {"mention": "左上腹", "label": "解剖部位", "offset": "60"}, {"mention": "胸部、下腹、上腹部、盆腔,ct", "label": "影像检查", "offset": "106"}, {"mention": "左上腹部", "label": "解剖部位", "offset": "122"}, {"mention": "肠", "label": "解剖部位", "offset": "126"}, {"mention": "肠癌", "label": "疾病和诊断", "offset": "135"}, {"mention": "肠周", "label": "解剖部位", "offset": "142"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "159"}, {"mention": "胸部", "label": "解剖部位", "offset": "172"}, {"mention": "盆腔", "label": "解剖部位", "offset": "175"}, {"mention": "左侧阴囊", "label": "解剖部位", "offset": "187"}, {"mention": "左半结肠切除+乙状结肠部分切除+盆腔结节切除+腹腔热灌注化疗术", "label": "手术", "offset": "212"}, {"mention": "盲肠中至低分化腺癌,术后分期为叒pt4bn0m1b,ivb期", "label": "疾病和诊断", "offset": "256"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "332"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "370"}, {"mention": "卡培他滨", "label": "药物", "offset": "376"}, {"mention": "手", "label": "解剖部位", "offset": "400"}, {"mention": "足", "label": "解剖部位", "offset": "401"}, {"mention": "手足综合症", "label": "疾病和诊断", "offset": "413"}, {"mention": "胃", "label": "解剖部位", "offset": "451"}]}
{"text": "患者于一月前无明显诱因出现胸背痛,外院ct示左肺上叶团块影,大小约3.7*4.2*3.3cm,边缘毛糙并可见毛刺,增强后见轻度强化。无咳嗽咳痰咯血,无胸闷气促,无胸痛声嘶,无发热盗汗,无头晕乏力等症状。我院pet/ct示左上肺肿块代谢活跃,考虑左上肺癌;隆突上淋巴结代谢活跃,考虑转移;t2转移灶代谢活跃,侵犯相邻椎管;胸下段食管局部代谢活跃。ect示t2代谢活跃,可疑骨转移。声胃镜示食管下段未见明显占位,纵隔多发淋巴结肿大;肺肿物穿刺活检示左上肺中至低分化腺癌。egfr基因为野生型。诊断为左上肺低分化腺癌,ct2n2m1,iv期。2012-6-14予ap方案化疗一程,2012-6-19起行胸椎放疗,未结束。现为行第二程化疗来我院。末次化疗后,精神食欲睡眠可,大小便正常,体力体重无明显改变。", "mention_data": [{"mention": "胸背痛", "label": "症状", "offset": "13"}, {"mention": "ct", "label": "影像检查", "offset": "19"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "22"}, {"mention": "胸闷", "label": "症状", "offset": "75"}, {"mention": "胸痛", "label": "症状", "offset": "81"}, {"mention": "头晕", "label": "症状", "offset": "93"}, {"mention": "pet/ct", "label": "影像检查", "offset": "103"}, {"mention": "左上肺", "label": "解剖部位", "offset": "110"}, {"mention": "左上肺癌", "label": "疾病和诊断", "offset": "122"}, {"mention": "隆突上淋巴结", "label": "解剖部位", "offset": "127"}, {"mention": "t2", "label": "解剖部位", "offset": "143"}, {"mention": "椎管", "label": "解剖部位", "offset": "157"}, {"mention": "胸下段食管", "label": "解剖部位", "offset": "160"}, {"mention": "ect", "label": "影像检查", "offset": "172"}, {"mention": "t2", "label": "解剖部位", "offset": "176"}, {"mention": "骨转移", "label": "疾病和诊断", "offset": "185"}, {"mention": "食管下段", "label": "解剖部位", "offset": "193"}, {"mention": "纵隔", "label": "解剖部位", "offset": "204"}, {"mention": "肺", "label": "解剖部位", "offset": "214"}, {"mention": "左上肺中至低分化腺癌", "label": "疾病和诊断", "offset": "222"}, {"mention": "左上肺低分化腺癌,ct2n2m1,iv期", "label": "疾病和诊断", "offset": "247"}, {"mention": "胸椎", "label": "解剖部位", "offset": "298"}]}
{"text": ",患者2016-6无明显诱因出现腹部阵发性疼痛不适,无恶心、呕吐,治疗后好转。近1月来疼痛加重,阵发性绞痛,无恶心、呕吐等,无伴大便习惯改变,无血便,无头晕、乏力、发热等不适。外院肠镜检查提示距离肛门30cm肿物,肠腔狭窄,肠镜无法通过,活检病理提示考虑腺癌。外院ct胸腹盆腔未见明显异常。患者于2016-08-11全麻上行右半结肠切除+恶性肿瘤腔内灌注治疗,,术后病理回报:1(肠大体)镜检为肠中至低分化腺癌,部分为粘液腺癌,癌组织浸润至肠壁浆膜上层,可见神经束侵犯,未见明确脉管内癌栓。2(近切缘)未见癌。3(远切缘)未见癌。4(中央淋巴结)6枚,2/6见腺癌转移。5(中间淋巴结)10枚,未见癌。6(肠旁淋巴结)镜上为脂肪结缔组织,未见淋巴结,未见癌。,免疫组化:er(-),ercc1(+),mlh1(+),msh2(+),msh6(+),pms2(+),ki67(约65%)。现遵原主诊教授行术后辅助化疗.患者于2016-09-02、2016-09-23、2016-10-20、2016-11-11、2016-12-05行xelox方案化疗5程.起病以来胃纳尚可,睡眠一般,小便正常,体重有所上降。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "16"}, {"mention": "头晕", "label": "症状", "offset": "76"}, {"mention": "肛门", "label": "解剖部位", "offset": "98"}, {"mention": "肠腔", "label": "解剖部位", "offset": "107"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "127"}, {"mention": "ct", "label": "影像检查", "offset": "132"}, {"mention": "胸腹", "label": "解剖部位", "offset": "134"}, {"mention": "盆腔", "label": "解剖部位", "offset": "136"}, {"mention": "右半结肠切除+恶性肿瘤腔内灌注治疗", "label": "手术", "offset": "162"}, {"mention": "肠", "label": "解剖部位", "offset": "190"}, {"mention": "肠中至低分化腺癌,部分为粘液腺癌", "label": "疾病和诊断", "offset": "197"}, {"mention": "肠", "label": "解剖部位", "offset": "220"}, {"mention": "中央淋巴结", "label": "解剖部位", "offset": "267"}, {"mention": "中间淋巴结", "label": "解剖部位", "offset": "287"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "303"}, {"mention": "胃", "label": "解剖部位", "offset": "482"}]}
{"text": ",患者2014-10-7行胃癌根治术,,术后病理:食管贲门小弯侧溃疡型中分化腺癌,侵及浆膜外纤维脂肪组织,癌向下累及贲门齿状线下部分食管壁。切缘阴性,大网膜未见癌种植,淋巴结8/28转移。术前术后血肿标不详。术后未行基线影像检查。术后行多西他赛100mg+奥沙利铂100mg方案化疗4周期,末次化疗2015-1,化疗反应不重。2015-5ct家属诉无特殊,未见报告和片子。2015-6-29胃镜示返流性食管炎,残胃炎。2015-8上旬出现右侧肋部出现肿物,无压痛,不活动,质硬。,2015-9-2脑胸腹ct:后纵隔和腹膜后淋巴结较前明显。左肺上叶结节较前增大。现进食可,二便正常,体重较前上降。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "13"}, {"mention": "食管贲门小弯侧溃疡型中分化腺癌", "label": "疾病和诊断", "offset": "25"}, {"mention": "贲门齿状线下部分食管", "label": "解剖部位", "offset": "58"}, {"mention": "多西他赛", "label": "药物", "offset": "118"}, {"mention": "奥沙利铂", "label": "药物", "offset": "128"}, {"mention": "返流性食管炎,残胃炎", "label": "疾病和诊断", "offset": "198"}, {"mention": "右侧肋部", "label": "解剖部位", "offset": "219"}, {"mention": "脑胸腹ct", "label": "影像检查", "offset": "248"}, {"mention": "后纵隔", "label": "解剖部位", "offset": "254"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "258"}, {"mention": "左肺上叶", "label": "解剖部位", "offset": "269"}]}
{"text": "患者自述于2年半前因腹泻、血便就诊于我院,行肠镜检查示乙状结肠肿物,病理为(乙状结肠)腺癌,直肠低级别绒毛管状腺瘤,病理号为107993。后于我院肿瘤外科行乙状结肠癌根治术,左卵巢囊肿切除术,术中见病灶3*4.5*1.5厘米,浸润浆膜,术后病理为乙状结肠癌,浸润溃疡型,中分化管状腺癌,淋巴结0/20枚转移,断端无癌,直肠低级别管状腺瘤,左卵巢包涵囊肿,病理号108417。术后腹泻、血便等不适改善,恢复良好。术后4周入我科行mfolfox7方案化疗共6周期,用药为奥沙利铂150毫克,同奥300毫克,方克5.0,末次化疗距时间为2010-6,化疗过程中出现2度骨髓抑制,对症处理后好转。半月前出现上腹疼痛不适,呈间断性疼痛,疼痛可忍受,评分为2分。现为进一步诊治入我科。患者1个月来饮食睡眠正常,精神体力可,二便基本正常,体重无明显变化,kps评分90分。", "mention_data": [{"mention": "腹泻", "label": "症状", "offset": "10"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "27"}, {"mention": "(乙状结肠)腺癌,直肠低级别绒毛管状腺瘤", "label": "疾病和诊断", "offset": "37"}, {"mention": "乙状结肠癌根治术", "label": "手术", "offset": "78"}, {"mention": "左卵巢囊肿切除术", "label": "手术", "offset": "87"}, {"mention": "乙状结肠癌,浸润溃疡型,中分化管状腺癌", "label": "疾病和诊断", "offset": "123"}, {"mention": "直肠低级别管状腺瘤", "label": "疾病和诊断", "offset": "159"}, {"mention": "左卵巢", "label": "解剖部位", "offset": "169"}, {"mention": "腹泻", "label": "症状", "offset": "189"}, {"mention": "奥沙利铂", "label": "药物", "offset": "233"}, {"mention": "同奥", "label": "药物", "offset": "243"}, {"mention": "方克", "label": "药物", "offset": "251"}, {"mention": "上腹", "label": "解剖部位", "offset": "299"}]}
{"text": ",患者约于2011年7月上旬发现右颈部肿物,渐增大,大小约6*10cm。遂来我院就诊,我院行胃镜病理示胃角腺癌,,行颈胸部部ct示:右锁骨下窝团块状,大小约6*10cm。2011-08-02,行颈部胸部下腹部上腹部盆腔ct示:符合胃癌,右锁下,隆突上,胃小弯侧,膈脚后,食管旁,腹主动脉旁广泛淋巴结转移。遂入住本科,,诊断:胃癌并右锁骨下、纵膈、腹腔淋巴结转移。于2011.8.10、2011.9.2予\\\"爱斯万+多帕菲\\\"化疗二程。第一程化疗后曾出现血白细胞ii度降低、肝功能轻度受损;治疗后恢复;第二程化疗后出现iii度腹泻,在当地予抗感染等治疗后好转。化疗后患者右侧颈部肿物较前缩小。现应约复入院继续化疗。患者近来精神、睡眠可,食欲一般,无恶心、呕吐,无吞咽梗阻,无腹胀腹痛,大小便无明显异常,体重较下程治疗前上降约4斤。", "mention_data": [{"mention": "右颈部", "label": "解剖部位", "offset": "16"}, {"mention": "胃角腺癌", "label": "疾病和诊断", "offset": "51"}, {"mention": "颈胸部部ct", "label": "影像检查", "offset": "58"}, {"mention": "右锁骨下窝", "label": "解剖部位", "offset": "66"}, {"mention": "颈部胸部下腹部上腹部盆腔ct", "label": "影像检查", "offset": "97"}, {"mention": "胃癌,右锁下,隆突上,胃小弯侧,膈脚后,食管旁,腹主动脉旁广泛淋巴结转移", "label": "疾病和诊断", "offset": "115"}, {"mention": "胃癌并右锁骨下、纵膈、腹腔淋巴结转移", "label": "疾病和诊断", "offset": "162"}, {"mention": "爱斯万", "label": "药物", "offset": "203"}, {"mention": "多帕菲", "label": "药物", "offset": "207"}, {"mention": "白细胞", "label": "实验室检验", "offset": "227"}, {"mention": "腹泻", "label": "症状", "offset": "262"}, {"mention": "右侧颈部", "label": "解剖部位", "offset": "284"}, {"mention": "腹胀", "label": "症状", "offset": "336"}, {"mention": "腹痛", "label": "症状", "offset": "338"}]}
{"text": ",患者于2007年4月因肝内胆管细胞癌在外院行肝左叶部分切除术+胆囊切除术,术后恢复良好,于2007年6月行tace.2007年7月患者随访出现梗阻性黄疸(考虑可能与化疗或肿瘤复发有关),经激素使用后好转.2007年9月患者黄疸又出现升高,行ptcd引流,并在右左肝管内留置金属支架.2007年12月患者黄疸再次升高,给予更换ptcd引流管,但效果不佳。于2008年1月25日行原位肝移植术。2008年3月10肝功能异常,tb/,cb:48.3/41.6,a/,g:37/31,alt/,ast:380/219,,r-gt:304。,肝穿刺病理示:肝组织内可见12个肝小叶,其间门管区可见较多单核细胞浸润(pi=2),小胆管炎可见(bi=1),小静脉内膜炎较显著(vi=2),细胞性排斥(rai=5/9)存在.叒肝小叶内肝细胞广泛淤胆,伴羽毛样变,灶性坏死及细胞凋亡显著.建议排除病毒性损伤.予保肝叒服用联苯两脂,抗病毒,调整排异药物后肝功能正常。2008年5月23日肝功能示tb/,cb:81.3/62.5,a/,g:42/28,叒alt/ast叒,:33/88,,r-gt:276.叒,fk506:11.9,现为保肝,调整抗排异治疗收住入院。", "mention_data": [{"mention": "肝内胆管细胞癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "肝左叶部分切除术+胆囊切除术", "label": "手术", "offset": "23"}, {"mention": "tace", "label": "手术", "offset": "54"}, {"mention": "梗阻性黄疸", "label": "疾病和诊断", "offset": "72"}, {"mention": "ptcd引流", "label": "手术", "offset": "121"}, {"mention": "右左肝管内留置金属支架", "label": "手术", "offset": "130"}, {"mention": "更换ptcd引流管", "label": "手术", "offset": "161"}, {"mention": "原位肝移植术", "label": "手术", "offset": "189"}, {"mention": "tb", "label": "实验室检验", "offset": "211"}, {"mention": "cb", "label": "实验室检验", "offset": "215"}, {"mention": "a/,g", "label": "实验室检验", "offset": "228"}, {"mention": "alt", "label": "实验室检验", "offset": "239"}, {"mention": "ast", "label": "实验室检验", "offset": "244"}, {"mention": "r-gt", "label": "实验室检验", "offset": "257"}, {"mention": "肝", "label": "解剖部位", "offset": "267"}, {"mention": "肝", "label": "解剖部位", "offset": "274"}, {"mention": "肝小叶", "label": "解剖部位", "offset": "283"}, {"mention": "门管区", "label": "解剖部位", "offset": "289"}, {"mention": "胆管炎", "label": "疾病和诊断", "offset": "310"}, {"mention": "肝小叶", "label": "解剖部位", "offset": "356"}, {"mention": "肝", "label": "解剖部位", "offset": "360"}, {"mention": "肝", "label": "解剖部位", "offset": "398"}, {"mention": "联苯两脂", "label": "药物", "offset": "402"}, {"mention": "tb", "label": "实验室检验", "offset": "438"}, {"mention": "cb", "label": "实验室检验", "offset": "442"}, {"mention": "a/,g", "label": "实验室检验", "offset": "455"}, {"mention": "alt/ast", "label": "实验室检验", "offset": "467"}, {"mention": "r-gt", "label": "实验室检验", "offset": "484"}, {"mention": "fk506", "label": "实验室检验", "offset": "495"}, {"mention": "肝", "label": "解剖部位", "offset": "509"}]}
{"text": ",患者半月前无明显诱因上发现腹部包块,无疼痛不适、无反酸烧心,肿块呈进行性生长,患者未行正规检查治疗,现自感肿块增大明显,求治我院门诊,,查肿瘤标志物提示:ca125叒2306叒u/ml,ca15-3叒259.5叒u/ml,ca19-9叒2736叒u/ml,ca72-4叒66.06叒u/ml,cea叒23.77叒ng/ml叒,nse叒32.38叒ng/ml,he4叒&gt;1500pmol/l。,门诊拟诊断为:“,腹腔肿物:左侧卵巢癌?”收入我院胃胰科。2014-09-29全麻上行卵巢癌肿瘤细胞减灭术(盆腔巨大肿物切除术+子宫两附件切除+盆腔淋巴结清扫+大网膜切除+腹主动脉旁淋巴结活检术)。,术后病理提示:(左卵巢)高级别浆液性腺癌,(大网膜)未见癌,(两侧盆腔淋巴结、腹主动脉旁淋巴结)均见腺癌转移。术后诊断为卵巢高级别浆液性腺癌iiia1(ii)期。2014年10月18日、2014年11月8日行tc方案(伯尔定700mg+力朴素270mgd3)静脉化疗一程,过程顺利,患者化疗后未尊嘱定期复查血常规。现为行上一步治疗入院。起病以来,患者精神尚可,食欲可,大小便正常,身体无明显消瘦。,既往化疗及肿瘤标志物情况:,化疗药物毒副反应:。", "mention_data": [{"mention": "腹部", "label": "解剖部位", "offset": "14"}, {"mention": "ca125", "label": "实验室检验", "offset": "78"}, {"mention": "ca15-3", "label": "实验室检验", "offset": "94"}, {"mention": "ca19-9", "label": "实验室检验", "offset": "112"}, {"mention": "ca72-4", "label": "实验室检验", "offset": "129"}, {"mention": "cea", "label": "实验室检验", "offset": "147"}, {"mention": "nse", "label": "实验室检验", "offset": "164"}, {"mention": "he4叒&gt", "label": "实验室检验", "offset": "180"}, {"mention": "腹腔肿物:左侧卵巢癌", "label": "疾病和诊断", "offset": "209"}, {"mention": "卵巢癌肿瘤细胞减灭术(盆腔巨大肿物切除术+子宫两附件切除+盆腔淋巴结清扫+大网膜切除+腹主动脉旁淋巴结活检术)", "label": "手术", "offset": "243"}, {"mention": "(左卵巢)高级别浆液性腺癌", "label": "疾病和诊断", "offset": "307"}, {"mention": "两侧盆腔淋巴结", "label": "解剖部位", "offset": "331"}, {"mention": "腹主动脉旁淋巴结", "label": "解剖部位", "offset": "339"}, {"mention": "卵巢高级别浆液性腺癌iiia1(ii)期", "label": "疾病和诊断", "offset": "360"}, {"mention": "伯尔定", "label": "药物", "offset": "409"}, {"mention": "力朴素", "label": "药物", "offset": "418"}]}
{"text": ",缘于入院前2年半因“右肾下腺区占位”住我院泌尿外科,查腹部,ct:1、胃底大弯侧肿瘤性病变,多考虑间质瘤,2、两肾下腺未见明显占位性病变,后转我院肿瘤外科,于2013年09月27日在全麻上行“腹腔镜上胃体间质瘤切除术”,,术中见:无腹水,盆底、膀胱、未及结节,肝表面光滑,空回肠未见结节,腹腔动脉周围未见明显肿大淋巴结,肿瘤位于胃体大弯侧,外生型,大约3cm×4cm,包膜完整,表面可见肿瘤坏死,遂行下术,手术顺利,术后予预防感染、补液、营养支持等治疗,术后恢复好,术后病理(201330085),:,肿瘤来源:原发;,部位:胃;,肿瘤大小:5cm(最大直径);,核分裂数:5/50hpf;,组织学诊断:梭形细胞型;,手术切缘:阴性;,肿瘤性坏死:无;,肿瘤细胞显著异型:无;,肿瘤浸润部位:肌层至浆膜层;,免疫组化:cd117(+++),cd34(+++),desmin(-),s-100(-),ki-67(5%+),h-caldesmon(++),dog1(+++);,病理诊断:胃间质瘤,危险程度中等。术后予“格列卫400mgqd”靶向辅助治疗,期间偶有呕吐、腹泻,对症处理后好转。现无腹痛、恶心、呕吐,无腹泻,无纳差、乏力,无发热,今为进一步诊治,门诊拟“胃间质瘤术后”收住入院。自下次出院以来,精神、睡眠、食欲尚可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "右肾下腺", "label": "解剖部位", "offset": "11"}, {"mention": "腹部,ct", "label": "影像检查", "offset": "28"}, {"mention": "胃底", "label": "解剖部位", "offset": "36"}, {"mention": "大弯侧", "label": "解剖部位", "offset": "38"}, {"mention": "间质瘤", "label": "疾病和诊断", "offset": "50"}, {"mention": "两肾下腺", "label": "解剖部位", "offset": "56"}, {"mention": "腹腔镜上胃体间质瘤切除术", "label": "手术", "offset": "97"}, {"mention": "腹水", "label": "症状", "offset": "117"}, {"mention": "盆底", "label": "解剖部位", "offset": "120"}, {"mention": "膀胱", "label": "解剖部位", "offset": "123"}, {"mention": "肝", "label": "解剖部位", "offset": "131"}, {"mention": "空回肠", "label": "解剖部位", "offset": "137"}, {"mention": "腹腔动脉", "label": "解剖部位", "offset": "145"}, {"mention": "胃体大弯侧", "label": "解剖部位", "offset": "165"}, {"mention": "胃", "label": "解剖部位", "offset": "264"}, {"mention": "胃间质瘤", "label": "疾病和诊断", "offset": "443"}, {"mention": "格列卫", "label": "药物", "offset": "459"}, {"mention": "腹泻", "label": "症状", "offset": "484"}, {"mention": "腹痛", "label": "症状", "offset": "497"}, {"mention": "腹泻", "label": "症状", "offset": "507"}, {"mention": "胃间质瘤术后", "label": "疾病和诊断", "offset": "533"}]}
{"text": "患者因患“直肠癌”于2012.11.29于我院在全麻上行腹腔镜上直肠癌根治术(miles)+放射粒子植入术,术后病理检查报告:直肠蕈样型中分化管状腺癌浸及深肌层,未见明确血管神经侵犯,肛门及下切缘未见癌累及,肠壁淋巴结未见癌转移(0/17)。患者病理提示为t2n0m0,根据ajcc分期第七版为i期。术后恢复可,患者术前曾行一次新辅助化疗,故本次入院拟行第二次化疗。\\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": "直肠癌", "label": "疾病和诊断", "offset": "5"}, {"mention": "腹腔镜上直肠癌根治术(miles)+放射粒子植入术", "label": "手术", "offset": "28"}, {"mention": "直肠蕈样型中分化管状腺癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "肛门", "label": "解剖部位", "offset": "92"}, {"mention": "肠壁淋巴结", "label": "解剖部位", "offset": "104"}, {"mention": "胃", "label": "解剖部位", "offset": "209"}]}
{"text": "患者2月前因酒后腹痛、大便发黑,呕血1次伴眩晕,行胃镜检查确诊为胃低分化腺癌,遂于2009-7-2在我院行远端胃癌根治+b-i式吻合术,术后恢复良好,病理回报:胃窦部溃疡型低分化腺癌,大小约2.7*1.7cm,侵透浆膜,淋巴结2/28可见转移,并于2009-8-14开始行folfox7方案化疗,化疗后副反应评价食欲不振1°,恶心1°,呕吐2°,手足综合症1°。现为行第2周期辅助化疗入院。患者自前次出院以来精神,睡眠,饮食可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "8"}, {"mention": "胃低分化腺癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "远端胃癌根治+b-i式吻合术", "label": "手术", "offset": "53"}, {"mention": "胃窦部溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "手足综合症", "label": "疾病和诊断", "offset": "173"}]}
{"text": ",患者门诊,2011-1-4因胃癌于外院行胃癌根治术,术后恢复可。术后行化疗3次,2012-9因阑尾炎行手术,,术后病理:可见癌细胞(未见癌)。2013年1月余出现大便困难,就诊于外院查腹盆部,ct:1,肝内胆管扩张,胆管中段狭窄,考虑占位性病变,2.腹水。mrcp提示肝内外胆管扩张,考虑胆总管中段狭窄。直肠壁增厚。近期腹部疼痛加重明显,向腰、臀、上肢放射,影响休息,目前口服泰勒宁2片后只能5小时略好,饮食少,大便差,腹胀、气鼓,脱肛;小便困难,尿痛,尿急,轻度黄染。忍痛习惯,同理沟通。办麻卡,指导用药。(5200)。", "mention_data": [{"mention": "胃癌", "label": "疾病和诊断", "offset": "15"}, {"mention": "胃癌根治术", "label": "手术", "offset": "21"}, {"mention": "阑尾炎", "label": "疾病和诊断", "offset": "48"}, {"mention": "腹盆部,ct", "label": "影像检查", "offset": "93"}, {"mention": "肝内胆管扩张", "label": "疾病和诊断", "offset": "102"}, {"mention": "胆管中段狭窄", "label": "疾病和诊断", "offset": "109"}, {"mention": "腹水", "label": "症状", "offset": "126"}, {"mention": "mrcp", "label": "影像检查", "offset": "129"}, {"mention": "肝内外胆管扩张", "label": "疾病和诊断", "offset": "135"}, {"mention": "胆总管中段狭窄", "label": "疾病和诊断", "offset": "145"}, {"mention": "直肠", "label": "解剖部位", "offset": "153"}, {"mention": "腹", "label": "解剖部位", "offset": "161"}, {"mention": "腰", "label": "解剖部位", "offset": "171"}, {"mention": "臀", "label": "解剖部位", "offset": "173"}, {"mention": "上肢", "label": "解剖部位", "offset": "175"}, {"mention": "泰勒宁", "label": "药物", "offset": "189"}, {"mention": "腹胀", "label": "症状", "offset": "211"}, {"mention": "脱肛", "label": "症状", "offset": "217"}]}
{"text": ",患者2个月前因\\\"阴道接触性出血3+月\\\"就诊**一院,,活检提示:宫颈鳞状细胞原位癌累及腺体,局部见小灶浸润癌。遂于2011-12-12行\\\"广泛全宫切+两侧附件切除术+盆腔淋巴结清扫术\\\"。,手术后病理:宫颈低分化鳞状细胞癌,癌组织浸润宫颈1cm,盆腔各淋巴结未见异常。2011-12-27给予tp方案化疗一程,现入我科行辅助放疗。。患者自起病以来,精神胃纳食欲可,大小便正常,体重无明显上降。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "10"}, {"mention": "宫颈鳞状细胞原位癌累及腺体", "label": "疾病和诊断", "offset": "35"}, {"mention": "广泛全宫切+两侧附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "73"}, {"mention": "宫颈低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "105"}, {"mention": "宫颈", "label": "解剖部位", "offset": "121"}, {"mention": "盆腔", "label": "解剖部位", "offset": "127"}]}
{"text": ",患者5个月前因降结肠癌,不全肠梗阻,肝转移,肺转移,在我科行右半结肠切除术,术中见肿瘤位于降结肠近脾曲,透浆膜,环周,近端肠管略增粗,肠壁水肿,呈不全梗阻状,肠系膜上血管根部及腹主动脉前方淋巴结肿大融合成团,浸润固定。,术后病理进展期结肠癌:浸润溃疡型,中分化腺癌,淋巴结见转移癌(5/12枚)dukes“c”期。(,病理号:163101)。术后行xelox方案化疗2个周期后,改为folfiri方案继续化疗术后恢复良好,现为行化疗入院。病来进食可,睡眠佳,二便正常。", "mention_data": [{"mention": "降结肠癌", "label": "疾病和诊断", "offset": "8"}, {"mention": "不全肠梗阻", "label": "疾病和诊断", "offset": "13"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "19"}, {"mention": "肺转移", "label": "疾病和诊断", "offset": "23"}, {"mention": "右半结肠切除术", "label": "手术", "offset": "31"}, {"mention": "降结肠近脾曲", "label": "解剖部位", "offset": "46"}, {"mention": "肠", "label": "解剖部位", "offset": "62"}, {"mention": "肠", "label": "解剖部位", "offset": "68"}, {"mention": "肠系膜上血管根部", "label": "解剖部位", "offset": "80"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "89"}, {"mention": "进展期结肠癌:浸润溃疡型,中分化腺癌", "label": "疾病和诊断", "offset": "115"}]}
{"text": "患者因进食哽噎感20日来诊,既往有间断声音嘶哑2-3年,近日加重1月外院胃镜检查提示食管胃癌(病理回报示鳞状下皮上可见低分化腺癌浸润),胸部ct示食管占位性病变,腹水。腹部b超提示肝硬化,腹水。进食目前能进食固体食物,体重有上降。\\u0004\\u0004我院胃镜示胃食管结合部隆起溃疡型肿物(病理未回),瘤标示cea5.44,ca724叒7288u/ml,ca125叒100.2u/ml,nse叒38.22ng/ml,cyfra21-1叒10.87ng/ml。her2(3+).\\u0004\\u0004腹部ct示胃食管交界癌,肿瘤侵透浆膜可能大,腹膜弥漫转移。胃周多发淋巴结,考虑转移可能大。肝脏低密度小结节,囊肿?追查。\\u007f\\u0004\\u0004腹腔大量积液。胸部增强示:胃腔充盈扩张欠佳,食道上段、胃底贲门壁增厚。右侧少量胸水。\\u007f\\u0004\\u0004\\u007f\\u0004\\u0004。", "mention_data": [{"mention": "食管胃癌", "label": "疾病和诊断", "offset": "42"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "59"}, {"mention": "胸部ct", "label": "影像检查", "offset": "68"}, {"mention": "食管", "label": "解剖部位", "offset": "73"}, {"mention": "腹水", "label": "症状", "offset": "81"}, {"mention": "腹部b超", "label": "影像检查", "offset": "84"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "90"}, {"mention": "腹水", "label": "症状", "offset": "94"}, {"mention": "胃食管结合部", "label": "解剖部位", "offset": "132"}, {"mention": "cea", "label": "实验室检验", "offset": "155"}, {"mention": "ca724", "label": "实验室检验", "offset": "163"}, {"mention": "ca125", "label": "实验室检验", "offset": "178"}, {"mention": "nse", "label": "实验室检验", "offset": "194"}, {"mention": "cyfra21-1", "label": "实验室检验", "offset": "209"}, {"mention": "腹部ct", "label": "影像检查", "offset": "251"}, {"mention": "胃食管交界癌", "label": "疾病和诊断", "offset": "256"}, {"mention": "腹膜弥漫转移", "label": "疾病和诊断", "offset": "273"}, {"mention": "胃", "label": "解剖部位", "offset": "280"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "284"}, {"mention": "肝脏", "label": "解剖部位", "offset": "296"}, {"mention": "腹腔大量积液", "label": "疾病和诊断", "offset": "329"}, {"mention": "胸部", "label": "解剖部位", "offset": "336"}, {"mention": "胃", "label": "解剖部位", "offset": "342"}, {"mention": "胃底", "label": "解剖部位", "offset": "356"}, {"mention": "贲门", "label": "解剖部位", "offset": "358"}, {"mention": "胸水", "label": "症状", "offset": "368"}]}
{"text": "2011-7出现大便带血,伴腹痛,2011-12-20肠镜诊断直肠癌,2012-1-6行直肠癌前切术,术中见肿瘤位于腹膜反折下3cm,术后病理:直肠隆起型神经内分泌瘤,g2,大小2.5*2.59*1.2,侵犯浆膜层,切缘阴性,肠系膜淋巴结5/5,癌结节1枚,免疫组化cga+,syn++,cd56+,ck18+++,ki-67<10%。术后xelox方案化疗6周期,末次2012-6-27,2013-5-23pet-ct检查时肝内多发转移,2013-6-9给予xeiri方案化疗2周期,评效pd。2013-7-10叒奥曲肽扫描见阳性病灶,2013-8-1给予善龙20mg治疗1次。2013-09-01及9-29给予善龙30mg治疗.2013-11-14和2014-1-2行tae治疗,2013-12评效腹部ct示肝左叶病变基本无活性。2014-2-8复查腹部ct示肝右左叶病变均明显缩小,均无明显活性。2014-5-8随访复查腹部ct示肝内病变均继续缩小,未见明显活性。2014-8复查ct肝内病灶较前明显增大有活性;2014-8月和9月行双次ep方案动脉化疗.2014-10-13腹部ct示肝内病变明显增大.2014-10-16和2014-11-18行肝动脉tace术2次.。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "14"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "31"}, {"mention": "直肠癌前切术", "label": "手术", "offset": "44"}, {"mention": "腹膜", "label": "解剖部位", "offset": "58"}, {"mention": "直肠隆起型神经内分泌瘤", "label": "疾病和诊断", "offset": "72"}, {"mention": "肠系膜淋巴结", "label": "解剖部位", "offset": "113"}, {"mention": "pet-ct", "label": "影像检查", "offset": "204"}, {"mention": "肝内多发转移", "label": "疾病和诊断", "offset": "213"}, {"mention": "奥曲肽", "label": "药物", "offset": "258"}, {"mention": "善龙", "label": "药物", "offset": "279"}, {"mention": "善龙", "label": "药物", "offset": "307"}, {"mention": "tae", "label": "手术", "offset": "336"}, {"mention": "腹部ct", "label": "影像检查", "offset": "351"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "356"}, {"mention": "腹部ct", "label": "影像检查", "offset": "377"}, {"mention": "肝右左叶", "label": "解剖部位", "offset": "382"}, {"mention": "腹部ct", "label": "影像检查", "offset": "413"}, {"mention": "肝", "label": "解剖部位", "offset": "418"}, {"mention": "ct", "label": "影像检查", "offset": "443"}, {"mention": "肝", "label": "解剖部位", "offset": "445"}, {"mention": "腹部ct", "label": "影像检查", "offset": "491"}, {"mention": "肝", "label": "解剖部位", "offset": "496"}, {"mention": "肝动脉tace术", "label": "手术", "offset": "527"}]}
{"text": "2012.2行xelox+avastin结肠癌新辅助化疗,共计2周期,2012.4.12行乙状结肠癌+部分膀胱切除手术,术后病理:中分化腺癌,侵及全层及膀胱,脉管(-),切缘(-)lnm0/21.术后行xelox共计4周期,末次化疗2012.8.18。\\u0004\\u0004术前及现在标志物正常。腹水内细胞学阴性,但ca125>300\\u0004\\u0004\\u0004\\u0004\\u0004\\u0004恶心,呕吐,腹胀,淋巴结转移\\u0004\\u0004外院超声提示腹水,腹穿放腹水后未在涨,继续化疗叒\\u0004\\u0004复查血常规提示白细胞减少1度,血小板减少1度,转氨酶升高1度。", "mention_data": [{"mention": "结肠癌", "label": "疾病和诊断", "offset": "20"}, {"mention": "乙状结肠癌+部分膀胱切除手术", "label": "手术", "offset": "45"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "65"}, {"mention": "膀胱", "label": "解剖部位", "offset": "76"}, {"mention": "腹水", "label": "症状", "offset": "149"}, {"mention": "ca125", "label": "实验室检验", "offset": "159"}, {"mention": "腹胀", "label": "症状", "offset": "210"}, {"mention": "腹水", "label": "症状", "offset": "236"}, {"mention": "腹", "label": "解剖部位", "offset": "239"}, {"mention": "腹水", "label": "症状", "offset": "242"}, {"mention": "白细胞", "label": "实验室检验", "offset": "273"}, {"mention": "血小板减少", "label": "症状", "offset": "281"}, {"mention": "转氨酶", "label": "实验室检验", "offset": "289"}]}
{"text": ",患者2007.4因“右下颈肿物1月”诊断为鼻咽未分化型非角化行癌(t3n2m0),在我院行tp全身化疗2周期,根治性imrt,dt6800cgy/30f/7.5w,区域淋巴结dt6400cgy/30f/7.5w,临床疗效评价为cr,定期复查未见异常。2011.1出现黄疸,于我院pet/ct,检查示:鼻咽癌并肝、腹腔积腹膜后淋巴结转移。遂于2011.3.11行ercp+胆管支架植入术,术后于2011.3.22、2011.4.12、2011.5.4、2011.5.25行tpf化疗4程。2011.6.10,复查ct示:肝s4病灶,考虑转移瘤。肝s4叒病灶,考虑肝转移瘤,对比2011.4.29叒日ct,较前稍缩小。肝门区、门腔间隙、腹膜后淋巴结肿大,较前缩小。鼻咽癌治疗后,鼻咽腔未见明确占位性病变。于2011.6.14、2011.7.5行紫杉醇+顺铂+5-fu化疗2程。定期复查,2011.10.18复查鼻咽、,颈部及下腹部ct提示:肝s4叒病灶,考虑肝转移瘤,较前无大变化。肝门区、门腔间隙、腹膜后淋巴结肿大,较前无大变化。于2011.10.26在我院ct室行肝转移瘤微波消融术;2011.12.,19我院下腹部ct:肝s4病灶较前无明显改变。肝门区、门腔间隙、腹主动脉旁多发淋巴结,部分病灶增大。现为进一步治疗入院。自起病以来,患者精神、睡眠可,食欲如常,大小便正常,体重无上降。", "mention_data": [{"mention": "右下颈", "label": "解剖部位", "offset": "11"}, {"mention": "鼻咽未分化型非角化行癌(t3n2m0)", "label": "疾病和诊断", "offset": "22"}, {"mention": "pet/ct", "label": "影像检查", "offset": "140"}, {"mention": "鼻咽癌并肝、腹腔积腹膜后淋巴结转移", "label": "疾病和诊断", "offset": "151"}, {"mention": "行ercp+胆管支架植入术", "label": "手术", "offset": "180"}, {"mention": "ct", "label": "影像检查", "offset": "256"}, {"mention": "肝s4", "label": "解剖部位", "offset": "260"}, {"mention": "肝s4", "label": "解剖部位", "offset": "272"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "281"}, {"mention": "ct", "label": "影像检查", "offset": "299"}, {"mention": "肝门区", "label": "解剖部位", "offset": "308"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "312"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "317"}, {"mention": "鼻咽癌", "label": "疾病和诊断", "offset": "331"}, {"mention": "鼻咽", "label": "解剖部位", "offset": "338"}, {"mention": "紫杉醇", "label": "药物", "offset": "371"}, {"mention": "顺铂", "label": "药物", "offset": "375"}, {"mention": "5-fu", "label": "药物", "offset": "378"}, {"mention": "鼻咽", "label": "解剖部位", "offset": "404"}, {"mention": "颈部及下腹部ct", "label": "影像检查", "offset": "408"}, {"mention": "肝s4", "label": "解剖部位", "offset": "419"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "428"}, {"mention": "肝门区", "label": "解剖部位", "offset": "440"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "444"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "449"}, {"mention": "ct", "label": "影像检查", "offset": "479"}, {"mention": "肝转移瘤微波消融术", "label": "手术", "offset": "483"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "506"}, {"mention": "肝s4", "label": "解剖部位", "offset": "512"}, {"mention": "肝门区", "label": "解剖部位", "offset": "525"}, {"mention": "门腔间隙", "label": "解剖部位", "offset": "529"}, {"mention": "腹主动脉旁", "label": "解剖部位", "offset": "534"}, {"mention": "淋巴结", "label": "解剖部位", "offset": "541"}]}
{"text": ",患者4月前无明显诱因出现全腹隐痛,自行缓解,症状反复,大便1-2次/天,成形,无血便、黑便、恶心等,无头晕、乏力、发热等不适。外院肠镜检查提示升结肠肿物。活检病理提示腺癌。,我院钡灌肠提示:升结肠癌。,我院行腹盆mr检查示:升结肠病变,考虑升结肠癌。左半结肠系膜区淋巴结,考虑转移可能性大。肝s6异常信号灶,考虑囊肿可能性大,建议复查。患者入院完善相关检查,诊断“升结肠腺癌叒ct3n1m0”,未见手术禁忌,2014-10-30全麻上行腹腔镜左半结肠切除术,,术后病理分期:升结肠中至低分化腺癌伴粘液腺癌,pt3n1m0,iii期。于2014-12-04给予xelox方案化疗1程顺利,现遵原主诊教授意见入院行上次化疗。患者自起病以来无发热,胃纳可,睡眠一般,大小便正常,体重上降3kg。", "mention_data": [{"mention": "腹", "label": "解剖部位", "offset": "14"}, {"mention": "头晕", "label": "症状", "offset": "52"}, {"mention": "升结肠", "label": "解剖部位", "offset": "72"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "84"}, {"mention": "升结肠癌", "label": "疾病和诊断", "offset": "96"}, {"mention": "腹盆mr", "label": "影像检查", "offset": "105"}, {"mention": "升结肠", "label": "解剖部位", "offset": "113"}, {"mention": "升结肠癌", "label": "疾病和诊断", "offset": "121"}, {"mention": "左半结肠系膜区淋巴结", "label": "解剖部位", "offset": "126"}, {"mention": "肝s6", "label": "解剖部位", "offset": "146"}, {"mention": "升结肠腺癌叒ct3n1m0", "label": "疾病和诊断", "offset": "183"}, {"mention": "腹腔镜左半结肠切除术", "label": "手术", "offset": "219"}, {"mention": "升结肠中至低分化腺癌伴粘液腺癌,pt3n1m0,iii期", "label": "疾病和诊断", "offset": "238"}, {"mention": "胃", "label": "解剖部位", "offset": "322"}]}
{"text": ",入院前2月余,患者因“中下腹疼痛伴恶心半天”入我院消化内科。予以禁食禁饮,抑酸护胃及抑制胰液分泌、抑制胰酶活性、维持水电解质、酸碱平衡及补液等对症治疗。,mrcp:1.胰腺体尾部稍增大,胰周少许渗出影,提示胰腺炎,结合临床随访。2.胆总管上端多发小结石并胆总管轻度扩张。3.胆囊多发结石。4.左肾下极小囊肿。5.肝周少许积液。请我科会诊后于转入我科,完善术前相关检查,排除手术禁忌后于6月20日在全麻上行胆道探查+术中胆道镜取石检查+胆囊切除术+t管引流术。,术后组织病理学检查报告:慢性胆囊炎。院外患者间断夹闭t管,t管引流金黄色胆汁,量可。现患者因胆道术后近2月,为拔t管入院。\\u0004叒叒叒患者自起病以来,精神略差,胃纳略差,大便如常,小便如常,体重未见明显上降。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "12"}, {"mention": "胃", "label": "解剖部位", "offset": "41"}, {"mention": "胰", "label": "解剖部位", "offset": "45"}, {"mention": "胰", "label": "解剖部位", "offset": "52"}, {"mention": "mrcp", "label": "影像检查", "offset": "78"}, {"mention": "胰腺体尾部", "label": "解剖部位", "offset": "85"}, {"mention": "胰腺炎", "label": "疾病和诊断", "offset": "104"}, {"mention": "胆总管上端多发小结石并胆总管轻度扩张", "label": "疾病和诊断", "offset": "117"}, {"mention": "胆囊多发结石", "label": "疾病和诊断", "offset": "138"}, {"mention": "左肾下极小囊肿", "label": "疾病和诊断", "offset": "147"}, {"mention": "肝周少许积液", "label": "疾病和诊断", "offset": "157"}, {"mention": "胆道探查+术中胆道镜取石检查+胆囊切除术+t管引流术", "label": "手术", "offset": "203"}, {"mention": "慢性胆囊炎", "label": "疾病和诊断", "offset": "243"}, {"mention": "胆道术后", "label": "疾病和诊断", "offset": "277"}]}
{"text": "入院前3年,患者因肝癌于我院行肝癌射频消融术,术中见肝脏萎缩,大小约23×12×7cm,以肝右叶萎缩明显,肝脏色暗红,表面布满大小不等结节,边缘锐利,肝左叶第viii段位置可扪及一质硬包块,大小约2×3cm,边界较清晰。遂行开腹射频消融术+胆囊切除术+化疗泵置入术。术后恢复可,规律行化疗及口服抗肿瘤药物,定期复查,入院前2年余因肝癌复发于我院行介入手术,现因肝癌复发,拟行第三次介入手术入院,患者患病以来精神差,饮食差,二便正常。\\u0004叒叒叒患者自起病以来,精神可,食欲欠佳,睡眠可,大小便可,体重未见明显上降。", "mention_data": [{"mention": "肝癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "肝癌射频消融术", "label": "手术", "offset": "15"}, {"mention": "肝脏萎缩", "label": "疾病和诊断", "offset": "26"}, {"mention": "肝右叶萎缩", "label": "疾病和诊断", "offset": "45"}, {"mention": "肝脏", "label": "解剖部位", "offset": "53"}, {"mention": "肝左叶第viii段", "label": "解剖部位", "offset": "75"}, {"mention": "开腹射频消融术+胆囊切除术+化疗泵置入术", "label": "手术", "offset": "112"}, {"mention": "肝癌复发", "label": "疾病和诊断", "offset": "165"}, {"mention": "介入手术", "label": "手术", "offset": "173"}, {"mention": "肝癌复发", "label": "疾病和诊断", "offset": "180"}, {"mention": "介入手术", "label": "手术", "offset": "190"}]}
{"text": ",患者于3月余前,因查体发现cea升高,且有大便习惯改变,就诊于我院胃肠外科,完善相关检查,于2016年5月20日行胃镜检查,,病理示:胃窦腺癌,排除手术禁忌,于2016年5月24日在全麻上行手术治疗(具体术式不详)。手术过程顺利,,术后病理示:胃窦大弯侧腺癌(中-低度分化),大部分呈乳头状腺癌,浸润溃疡型,体积3*3*0.5cm,侵达深肌层。双端切线未查见癌。呈六组(1/4个)淋巴结癌转移。三组(1个)、四组(5个)、五组(3个)、“1、3、7组”(4个)淋巴结未查见癌。术后于2016年6月25日行1周期化疗,,方案:奥沙利铂200mg叒d1+亚叶酸钙0.3g叒d2-6叒+替加氟1000mg叒d2-6,同时辅以保肝、保胃及止吐等对症支持治疗,化疗过程顺利。化疗结束后出院。患者为求放疗于2016年7月20日入住我科,完善相关辅助检查,排除禁忌,于2016年7月21日行全身化疗,,方案:奥沙利铂200mgd1+替吉奥60mg叒bid叒d1-d14,同时辅以保肝、保胃及止吐等对症处理,患者胃肠道反应轻,化疗过程顺利,化疗结束后于2016年8月9日开始行局部放疗,共放疗14次,dt2520cgy,同步口服替吉奥40mg叒bid化疗,未见明显放化疗反应,耐受可,患者于2016年8月29日拒绝继续放疗,经反复劝说无效,签字为证。排除禁忌,于2016年9月1日行原方案全身化疗,化疗过程顺利,好转出院。叒叒叒患者自下次出院后,病情尚稳定,未述特殊不适,饮食睡眠尚可,大小便正常。体重未见明显减轻。", "mention_data": [{"mention": "cea", "label": "实验室检验", "offset": "14"}, {"mention": "胃窦腺癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "胃窦大弯侧腺癌(中-低度分化)", "label": "疾病和诊断", "offset": "123"}, {"mention": "乳头状腺癌", "label": "疾病和诊断", "offset": "143"}, {"mention": "奥沙利铂", "label": "药物", "offset": "263"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "276"}, {"mention": "替加氟", "label": "药物", "offset": "291"}, {"mention": "肝", "label": "解剖部位", "offset": "311"}, {"mention": "胃", "label": "解剖部位", "offset": "314"}, {"mention": "奥沙利铂", "label": "药物", "offset": "398"}, {"mention": "替吉奥", "label": "药物", "offset": "410"}, {"mention": "肝", "label": "解剖部位", "offset": "434"}, {"mention": "胃", "label": "解剖部位", "offset": "437"}, {"mention": "替吉奥", "label": "药物", "offset": "507"}]}
{"text": ",患者5月余前(2013年6月)于我院肛肠外科确诊直肠癌伴肝转移,,肝脏增强mr示:肝脏内可见多发大小不一的类圆形长t1长t2信号影,最大者位于肝右外叶,呈不规则团块状,大小4.47×3.13cm,增强扫描病灶边缘明显不均匀强化,中心强化不明显。于我院肛肠外科行folfox新辅助化疗2周期。复查全腹ct提示肝脏多发占位缩小,最大者位于肝右外叶,大小2.8×2.1cm,3月余前(2013年8月8日)于我院肛肠外科行直肠癌低位前切除术,术后恢复良好,,术后病理回报:进展期直肠癌,溃疡浸润型,中分化腺癌,ii级,断端无癌,,浸润深度:透浆膜,脉管癌栓(+),肌间神经节侵犯(+),结外肿瘤种植(+),淋巴结可见癌转移(3/12枚),dukes,分期:c2期,(,病理号:508)。患者术后拒绝行基因检测及应用靶向药物,继续folfox辅助化疗2周期。2013年10月28日复查全腹ct提示肝脏多发占位,较大者位于右外叶,大小约4.0*2.8cm,提示疾病进展,后转入我科,行folfox辅助化疗1周期。下周期化疗后出现肝功异常,口服两环醇进行保肝降酶治疗。末次化疗距今3周,现为求进一步治疗收入我科,饮食睡眠可,精神体力可,小便正常,大便日一次略干燥,近来体重未见明显减轻。ecog,评分:1分。", "mention_data": [{"mention": "直肠癌伴肝转移", "label": "疾病和诊断", "offset": "25"}, {"mention": "增强mr", "label": "影像检查", "offset": "36"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "72"}, {"mention": "肝右外叶", "label": "解剖部位", "offset": "168"}, {"mention": "直肠癌低位前切除术", "label": "手术", "offset": "208"}, {"mention": "进展期直肠癌,溃疡浸润型,中分化腺癌,ii级", "label": "疾病和诊断", "offset": "233"}, {"mention": "全腹ct", "label": "影像检查", "offset": "388"}, {"mention": "肝脏", "label": "解剖部位", "offset": "394"}, {"mention": "肝", "label": "解剖部位", "offset": "472"}]}
{"text": ",患者2015年3月18日于外院行卵巢癌减灭术,具体手术情况不详,,术后病理示:冰冻及常规石蜡结果报告(冰冻盆腔肿物、大网膜及后送的两侧卵巢肿瘤)病变符合中分化腺癌。术后未进行上一步处理。1月余前出现上腹胀,无呼吸困难,无头晕眼花,来我院门诊就诊,2015-07-29,我院ct提示:盆底巨大不规则团块状囊实性肿物,考虑肿瘤复发灶;盆腔内见少量积液;大网膜及肠系膜密度增高,可疑种植转移;左侧腹股沟区肿大淋巴结,考虑转移瘤。现为进一步治疗,依主诊教授意见收入我科行化疗,2015-10-20更换方案为“顺铂+伊立替康”,疗效欠佳,按主诊教授意见更换为“里葆多+洛铂”,入院化疗。起病以来,患者精神、饮食可,睡眠稍差,大小便正常,体重较术前增加4kg。", "mention_data": [{"mention": "卵巢癌减灭术", "label": "手术", "offset": "17"}, {"mention": "盆腔", "label": "解剖部位", "offset": "54"}, {"mention": "两侧卵巢肿瘤", "label": "疾病和诊断", "offset": "66"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "77"}, {"mention": "上腹", "label": "解剖部位", "offset": "100"}, {"mention": "头晕", "label": "症状", "offset": "111"}, {"mention": "眼花", "label": "症状", "offset": "113"}, {"mention": "ct", "label": "影像检查", "offset": "137"}, {"mention": "盆底", "label": "解剖部位", "offset": "142"}, {"mention": "盆腔", "label": "解剖部位", "offset": "166"}, {"mention": "肠", "label": "解剖部位", "offset": "179"}, {"mention": "左侧腹股沟区", "label": "解剖部位", "offset": "194"}, {"mention": "顺铂", "label": "药物", "offset": "251"}, {"mention": "伊立替康", "label": "药物", "offset": "254"}, {"mention": "里葆多", "label": "药物", "offset": "276"}, {"mention": "洛铂", "label": "药物", "offset": "280"}]}
{"text": "患儿1天前无明显诱因出现阵发性哭闹,伴呕吐,呕吐物为胃内容物,无咖啡样物,共5次。发热体温最高38.5℃,无腹泻,无咳嗽、咳痰。患儿家属急带患儿到我院儿急诊就诊,b超检查示:下腹略偏左探及一约类圆形包块,纵切面呈椭圆形,周围商清晰,范围约39*18*16mm,考虑肠套叠可能。为求进一步治疗,急诊以“肠套叠”收入我科行空气灌肠整复术。患儿自发病以来,神志清,精神可,饮食不佳,小便可,大便1次,伴血丝。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "26"}, {"mention": "腹泻", "label": "症状", "offset": "54"}, {"mention": "下腹", "label": "解剖部位", "offset": "87"}, {"mention": "肠套叠", "label": "疾病和诊断", "offset": "132"}, {"mention": "肠套叠", "label": "疾病和诊断", "offset": "150"}, {"mention": "空气灌肠整复术", "label": "手术", "offset": "159"}]}
{"text": ",术前“贫血,肠梗阻”,术前未行肠镜,2013-12-15行降结肠根治术,术中见降乙交界处约4x3x2cm肿物,近段结肠及部分小肠扩张积气,术后“(降结肠)中分化绒毛状管状腺癌,伴部分粘液腺癌及部分印戒细胞癌,肿瘤侵及浆膜,断端-,1/29,另送腹主a旁0/3,静脉内癌栓,her2(1+)”,术前cea叒12.49(0-3.4),术后正常,xelox*5,末次2014-5-14,医肿ct考虑肝单发m,但pet-ct未见肝异常高代谢,切口处软组织影suv叒4.4,延迟5.6。现cea叒2.4。,我院会诊:中分化腺癌伴黏液腺癌侵透浆膜层;her-2(2+),fish叒无扩增,免疫组化msi,kras、nras、braf均野生型。肝造影示肝左叶膈面病灶倾向m。腹壁取病理为炎症。,nse:34.9.我院2014-7-7mdt考虑目前肝脏病灶性质不明,且原病理提示部分粘液腺癌,建议密切随访。现复查ct可疑肝新发模糊结节,但mri未考虑。2016-1-26复查核磁未见异常。", "mention_data": [{"mention": "贫血", "label": "疾病和诊断", "offset": "4"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "7"}, {"mention": "降结肠根治术", "label": "手术", "offset": "30"}, {"mention": "降乙交界处", "label": "解剖部位", "offset": "40"}, {"mention": "结肠", "label": "解剖部位", "offset": "58"}, {"mention": "小肠", "label": "解剖部位", "offset": "63"}, {"mention": "(降结肠)中分化绒毛状管状腺癌,伴部分粘液腺癌及部分印戒细胞癌", "label": "疾病和诊断", "offset": "73"}, {"mention": "腹主a", "label": "解剖部位", "offset": "123"}, {"mention": "cea", "label": "实验室检验", "offset": "149"}, {"mention": "ct", "label": "影像检查", "offset": "193"}, {"mention": "肝", "label": "解剖部位", "offset": "197"}, {"mention": "pet-ct", "label": "影像检查", "offset": "203"}, {"mention": "肝", "label": "解剖部位", "offset": "211"}, {"mention": "cea", "label": "实验室检验", "offset": "240"}, {"mention": "中分化腺癌伴黏液腺癌", "label": "疾病和诊断", "offset": "254"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "320"}, {"mention": "腹", "label": "解剖部位", "offset": "331"}, {"mention": "nse", "label": "实验室检验", "offset": "341"}, {"mention": "肝脏", "label": "解剖部位", "offset": "367"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "384"}, {"mention": "ct", "label": "影像检查", "offset": "399"}, {"mention": "肝", "label": "解剖部位", "offset": "403"}, {"mention": "mri", "label": "影像检查", "offset": "412"}, {"mention": "核磁", "label": "影像检查", "offset": "430"}]}
{"text": "患者1月前无明显诱因出左上腹隐痛,排便后有缓解,外院ct示升结肠占位,腹水。12-3就诊予我院,胸腹盆ct:升结肠近肝曲肠壁肿物,考虑结肠癌,侵犯肠系膜。肝包膜、肠系膜、大网膜、壁层腹膜见呈结节状不均匀增厚,考虑肿瘤种植。腹腔、盆腔积液。诊断为升结肠腺癌腹腔多发种植,伴不完全肠梗阻,为解除梗阻、改善症状、减轻肿瘤负荷,2014-12-12探查腹盆腔,原发病灶位于升结肠,质硬,肠周系膜多发种植灶,固定,与十二指肠及胰腺关系不清,腹壁、大网膜、肝包膜多发种植灶,考虑肿瘤晚期,原发灶无法完整切除,行“大网膜切除+胃空肠吻合术+回肠-横结肠吻合术”,术后恢复可。2014-12-30、2015-01-15、2015-01-30给予folfox方案化疗3程顺利,无不适。3程后复查疗效评价为sd。现为行第4程化疗入院。患者起病以来,精神睡眠一般,胃纳一般,小便可。", "mention_data": [{"mention": "左上腹", "label": "解剖部位", "offset": "11"}, {"mention": "ct", "label": "影像检查", "offset": "26"}, {"mention": "升结肠占位", "label": "疾病和诊断", "offset": "29"}, {"mention": "腹水", "label": "疾病和诊断", "offset": "35"}, {"mention": "胸腹盆ct", "label": "影像检查", "offset": "48"}, {"mention": "升结肠", "label": "解剖部位", "offset": "54"}, {"mention": "肝曲", "label": "解剖部位", "offset": "58"}, {"mention": "肠壁", "label": "解剖部位", "offset": "60"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "67"}, {"mention": "肠", "label": "解剖部位", "offset": "73"}, {"mention": "肝", "label": "解剖部位", "offset": "77"}, {"mention": "肠", "label": "解剖部位", "offset": "81"}, {"mention": "腹", "label": "解剖部位", "offset": "91"}, {"mention": "腹腔、盆腔积液", "label": "疾病和诊断", "offset": "111"}, {"mention": "升结肠腺癌腹腔多发种植,伴不完全肠梗阻", "label": "疾病和诊断", "offset": "122"}, {"mention": "腹", "label": "解剖部位", "offset": "172"}, {"mention": "盆腔", "label": "解剖部位", "offset": "173"}, {"mention": "升结肠", "label": "解剖部位", "offset": "182"}, {"mention": "肠", "label": "解剖部位", "offset": "189"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "203"}, {"mention": "胰腺", "label": "解剖部位", "offset": "208"}, {"mention": "腹", "label": "解剖部位", "offset": "215"}, {"mention": "肝", "label": "解剖部位", "offset": "222"}, {"mention": "大网膜切除+胃空肠吻合术+回肠-横结肠吻合术", "label": "手术", "offset": "250"}, {"mention": "胃", "label": "解剖部位", "offset": "371"}]}
{"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:(胸下段食管)送检食管一段长10cm,距一端3cm处可见一大小4.5*3*1.5cm肿物;镜检为食管中分化鳞状细胞癌,左喉返神经旁淋巴结(2/5)转移。分期为pt3n1m0,iii期。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。2012-8-13起患者于我科行cik细胞免疫治疗至今,既往回输后曾出现发热,体温最高达39.5度,对症治疗后好转。后回输过程顺利。现为继续行cik细胞免疫治疗入我科。自下次治疗以来,患者无吞咽不适,无发热、畏寒,精神、睡眠可,大小便基本正常,体重无明显上降。", "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": "胸下段食管", "label": "解剖部位", "offset": "121"}, {"mention": "食管", "label": "解剖部位", "offset": "129"}, {"mention": "食管中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "168"}, {"mention": "左喉返神经旁淋巴结", "label": "解剖部位", "offset": "179"}, {"mention": "泰素帝", "label": "药物", "offset": "229"}, {"mention": "奈达铂", "label": "药物", "offset": "233"}]}
{"text": "患者于2005年9月在**一院行胃癌d2根治术,术后分期t3n2m0,术后病理示低分化腺癌,浸润全层,6、7、8、11组淋巴结见转移,术后2005-11-14始xelox方案化疗3程,2005-12改行folfox方案化疗3程(末次化疗时间2006-3-16),后定期复查。患者2011年12月6日复查ct示:吻合口周围胃壁增厚,肝s3转移瘤,肝门区及腹膜后淋巴结转移。pet/ct示吻合口代谢增高,吻合口炎。肝s3转移,肝门区及腹膜后淋巴结转移,胃镜示吻合口病变,遂来我院诊治,行s-1口服11程,诉恶心,手足麻木。现患者食欲较差,睡眠尚可,精神可,体重上降3kg。", "mention_data": [{"mention": "胃癌d2根治术", "label": "手术", "offset": "16"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "ct", "label": "影像检查", "offset": "151"}, {"mention": "胃壁增厚", "label": "症状", "offset": "160"}, {"mention": "肝s3转移瘤", "label": "疾病和诊断", "offset": "165"}, {"mention": "肝门区及腹膜后淋巴结转移", "label": "疾病和诊断", "offset": "172"}, {"mention": "pet/ct", "label": "影像检查", "offset": "185"}, {"mention": "吻合口炎", "label": "疾病和诊断", "offset": "200"}, {"mention": "肝s3转移", "label": "疾病和诊断", "offset": "205"}, {"mention": "肝门区及腹膜后淋巴结转移", "label": "疾病和诊断", "offset": "211"}, {"mention": "s-1", "label": "药物", "offset": "241"}, {"mention": "手足麻木", "label": "症状", "offset": "254"}]}
{"text": ",患者2014-05无明显诱因出现大便带鲜红血,量较少,伴少量粘液,有大便习惯改变,表现为大便次数增多,约2-3次/天,大便形状变细,间有解稀烂便,轻微腹胀,无腹痛、无恶心、呕吐,无气促、胸闷等。未予重视。近5月余来下述症状逐渐加重,大便频繁,伴里急后重感。外院肠镜检查提示距肛门7cm直肠肿物,大小3cm×2cm,肠镜能通过。活检病理提示腺癌。后于外科完善相关检查,经解释病情患者同意入组希罗达联合奥沙利铂新辅助化疗对比术前放疗+希罗达低危局部晚期直肠癌的随机对照临床试验。于2014-10-15至2014-11-17行术前放疗,同期予希罗达口服化疗,期间出现纳差、恶心、呕吐1次。2015-01-04全麻上行腹腔镜dixon+回肠造瘘术,,术后病理回报:镜检为中分化腺癌,浸润至肠壁外膜层,未见脉管内癌栓及神经束侵犯,trg级,:ii级。ypt3n0mo,iia期,2015-02-15、2015-03-10行2程xelox化疗方案。为行第3程xelox化疗方案,现转入我科。患者自末次化疗后,食欲、睡眠及精神尚好,小便正常,体力、体重无明显上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "76"}, {"mention": "腹痛", "label": "症状", "offset": "80"}, {"mention": "胸闷", "label": "症状", "offset": "94"}, {"mention": "肛门", "label": "解剖部位", "offset": "138"}, {"mention": "直肠", "label": "解剖部位", "offset": "143"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "170"}, {"mention": "希罗达", "label": "药物", "offset": "195"}, {"mention": "奥沙利铂", "label": "药物", "offset": "200"}, {"mention": "希罗达", "label": "药物", "offset": "216"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "225"}, {"mention": "希罗达", "label": "药物", "offset": "269"}, {"mention": "腹腔镜dixon+回肠造瘘术", "label": "手术", "offset": "306"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "332"}, {"mention": "肠", "label": "解剖部位", "offset": "341"}]}
{"text": ",患者半年前无明显诱因出现大便次数增多,4-5/日,偶排血便,无恶心呕吐,无腹胀腹痛等不适。,在外院行肠镜检查示:距肛10-15cm菜花样肿物,堵塞肠腔,,病理结果为:腺癌。于2016年3-1月就诊我院,,行结肠镜检查示:距肛10-15cm菜花样肿物,堵塞肠腔,,病理结果为:腺癌.。2016-3-8,盆腔mri示:直肠下段-乙状结肠病变,符合肠癌。于2016-3-10行全麻上行腹腔镜上dixon术,,术后病理示:(肠大体)镜检为中至低分化腺癌。患者术后病理分期为pt4an0m0叒iib期。术后于2016-03-31给予1次folfox方案化疗现患者返院行进一步治疗。精神食纳可,无里急后重,体重增加约1kg。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "38"}, {"mention": "腹痛", "label": "症状", "offset": "40"}, {"mention": "肛", "label": "解剖部位", "offset": "58"}, {"mention": "肠", "label": "解剖部位", "offset": "74"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "84"}, {"mention": "肛", "label": "解剖部位", "offset": "112"}, {"mention": "肠", "label": "解剖部位", "offset": "128"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "138"}, {"mention": "盆腔mri", "label": "影像检查", "offset": "151"}, {"mention": "直肠下段", "label": "解剖部位", "offset": "158"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "163"}, {"mention": "肠癌", "label": "疾病和诊断", "offset": "172"}, {"mention": "腹腔镜上dixon术", "label": "手术", "offset": "190"}, {"mention": "肠", "label": "解剖部位", "offset": "209"}, {"mention": "中至低分化腺癌", "label": "疾病和诊断", "offset": "216"}]}
{"text": ",2017-1-24,外院胃镜示:距门齿32-35cm鳞癌。影像学检查提示两颈部、纵隔、淋巴结转移,多发骨转移。2017-2开始行紫杉醇+顺铂方案化疗2周期。,末次化疗时间:2017-3。2周期后复查,纵隔淋巴结转移灶较前缩小,腹腔淋巴结无法对比。2017-5-3,本院胸ct示:食管胸中上段癌,伴纵隔2-8组、两肺门、锁骨下区、右腋区及胃周弥漫肿大淋巴结转移。2017-5-8,腹部ct示:肝脏多发结节,考虑转移。腹腔及腹膜后肿大淋巴结,考虑转移。胸12、多个腰椎多发异常密度灶,考虑转移。2017-5-23行第1周期tp方案化疗。2017-6-15行第2周期化疗。4周期后复查,原发灶及纵隔、腹腔、腹膜后淋巴结转移灶较前变化不大,肝转移灶较前增多增大,肺新见多发小结节,考虑转移;综合判效pd。患者目前进食哽噎明显,经全科查房讨论建议行放疗或支架置入解决进食问题。2017-7-10叒流食。放疗科拟行放疗。2017-7-17叒已完成定位。2017-7-20叒放疗计划复位验证无误,准备放疗。", "mention_data": [{"mention": "门齿", "label": "解剖部位", "offset": "18"}, {"mention": "鳞癌", "label": "疾病和诊断", "offset": "27"}, {"mention": "两颈部", "label": "解剖部位", "offset": "37"}, {"mention": "纵隔", "label": "解剖部位", "offset": "41"}, {"mention": "多发骨转移", "label": "疾病和诊断", "offset": "50"}, {"mention": "紫杉醇", "label": "药物", "offset": "65"}, {"mention": "顺铂", "label": "药物", "offset": "69"}, {"mention": "纵隔淋巴结", "label": "解剖部位", "offset": "101"}, {"mention": "腹腔淋巴结", "label": "解剖部位", "offset": "114"}, {"mention": "胸ct", "label": "影像检查", "offset": "135"}, {"mention": "食管胸中上段癌", "label": "疾病和诊断", "offset": "140"}, {"mention": "纵隔", "label": "解剖部位", "offset": "149"}, {"mention": "两肺门", "label": "解剖部位", "offset": "156"}, {"mention": "锁骨下区", "label": "解剖部位", "offset": "160"}, {"mention": "右腋区", "label": "解剖部位", "offset": "165"}, {"mention": "胃", "label": "解剖部位", "offset": "169"}, {"mention": "腹部ct", "label": "影像检查", "offset": "190"}, {"mention": "肝脏", "label": "解剖部位", "offset": "196"}, {"mention": "腹腔", "label": "解剖部位", "offset": "208"}, {"mention": "腹", "label": "解剖部位", "offset": "211"}, {"mention": "胸12", "label": "解剖部位", "offset": "225"}, {"mention": "腰椎", "label": "解剖部位", "offset": "231"}, {"mention": "纵隔", "label": "解剖部位", "offset": "295"}, {"mention": "腹腔", "label": "解剖部位", "offset": "298"}, {"mention": "腹膜后淋巴结", "label": "解剖部位", "offset": "301"}, {"mention": "肝转移", "label": "症状", "offset": "317"}, {"mention": "肺", "label": "解剖部位", "offset": "328"}]}
{"text": ",2012-6肠镜示直乙交界占位(距肛门10-15cm),印戒细胞癌。盆腔mri提示子宫附件占位,,肿标:ca724叒10.77,,ca125:112,2012-7-4行乙状结肠癌切除+两侧附件占位切除,术中肿物固定于前方膀胱后壁、盆腔侧壁,具体不详。7-19始行xelox+泰欣生600mg*8周期,末次化疗2012-12-20。叒自2013-1-11单药希罗达1.5g叒bid叒d1-14叒q3w+泰欣生600mg/周维持治疗中。叒2013-5-20,多学科会诊:建议盆腔放疗,同时联合泰欣生治疗。放疗前可以继续希罗达1.5g叒bid叒d1-14叒q3w+泰欣生600mg/周治疗。叒现进食、体力可,无明显不适,一般情况可。放疗计划50gy/25次,2013-6-14开始放疗,2013.7.18放疗结束。现乏力,腰酸,食欲差,大便可,无便血。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "18"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "29"}, {"mention": "盆腔mri", "label": "影像检查", "offset": "35"}, {"mention": "子宫", "label": "解剖部位", "offset": "42"}, {"mention": "附件", "label": "解剖部位", "offset": "44"}, {"mention": "ca724", "label": "实验室检验", "offset": "53"}, {"mention": "ca125", "label": "实验室检验", "offset": "66"}, {"mention": "乙状结肠癌切除+两侧附件占位切除", "label": "手术", "offset": "85"}, {"mention": "膀胱", "label": "解剖部位", "offset": "111"}, {"mention": "盆腔", "label": "解剖部位", "offset": "116"}, {"mention": "泰欣生", "label": "药物", "offset": "138"}, {"mention": "希罗达", "label": "药物", "offset": "179"}, {"mention": "泰欣生", "label": "药物", "offset": "201"}, {"mention": "盆腔", "label": "解剖部位", "offset": "236"}, {"mention": "泰欣生", "label": "药物", "offset": "245"}, {"mention": "希罗达", "label": "药物", "offset": "258"}, {"mention": "泰欣生", "label": "药物", "offset": "280"}, {"mention": "腰酸", "label": "症状", "offset": "359"}]}
{"text": ",患者2016.11体检发现肝内占位,病程中无明显腹痛、无腹胀、无恶心、无呕吐、无畏寒、无发热、无皮肤搔痒等不适,岁就诊于我院,2016年11月18日于全麻上行肝癌切除+胆囊切除术,术程顺利,术后予护肝、护胃,抗感染,调节免疫对症治疗后好转,,术后病理提示:中至低分化肝细胞癌(梁索型),癌组织侵犯肝被膜上方,未见明确坏死及卫星结节,可见脉管内癌栓,未见明确神经束侵犯。2017.4.28,复查增强ct提示:肝癌术后改变,肝s5术区少量积液,较前减少;肝s5近切缘处新增低密度结节,考虑复发灶可能性大。肝s2低密度结节,考虑囊肿可能性大。肝硬化;脾肿大。肝周、脾周少量积液;肝周腹膜稍增厚、模糊,请结合临床。上腔静脉旁、门腔间隙淋巴结稍大,较前相仿。t10右侧椎弓根致密灶,考虑骨岛,较前相仿。左上肺条片灶,考虑局限性肺不张。现为进一步诊治收入我科,起病以来,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": "14"}, {"mention": "腹痛", "label": "症状", "offset": "25"}, {"mention": "腹胀", "label": "症状", "offset": "29"}, {"mention": "肝癌切除+胆囊切除术", "label": "手术", "offset": "80"}, {"mention": "肝", "label": "解剖部位", "offset": "100"}, {"mention": "胃", "label": "解剖部位", "offset": "103"}, {"mention": "中至低分化肝细胞癌(梁索型)", "label": "疾病和诊断", "offset": "129"}, {"mention": "肝", "label": "解剖部位", "offset": "149"}, {"mention": "ct", "label": "影像检查", "offset": "199"}, {"mention": "肝癌术后", "label": "疾病和诊断", "offset": "204"}, {"mention": "肝s5", "label": "解剖部位", "offset": "211"}, {"mention": "肝s5", "label": "解剖部位", "offset": "226"}, {"mention": "肝s2", "label": "解剖部位", "offset": "251"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "269"}, {"mention": "肝", "label": "解剖部位", "offset": "277"}, {"mention": "脾", "label": "解剖部位", "offset": "280"}, {"mention": "肝", "label": "解剖部位", "offset": "287"}, {"mention": "上腔静脉", "label": "解剖部位", "offset": "304"}, {"mention": "门腔间隙淋巴结", "label": "解剖部位", "offset": "310"}, {"mention": "t10右侧椎弓根", "label": "解剖部位", "offset": "325"}, {"mention": "左上肺", "label": "解剖部位", "offset": "347"}]}
{"text": ",术前,ca199:38,,cea:6.5,2010.6.28行升结肠癌根治术,隆起型中分化腺癌,0/31,pt3n0m0,未辅化。2013.7末次肠镜(-),定期复查。2013-10-15腹ct曾疑有s8结节m?经mri考虑良性,及肝多发囊肿。2012.10始ca199升高约50,至2014.5为91,tpsa叒6.25,且alt,ast约300,对症后上降;2014.11复查ca199同前,但mri示肝s8富血供结节由11mm增至22mm,m?超声造影肝s8结节为转移。2014-12-16于我院行肝rfa治疗。复查。", "mention_data": [{"mention": "ca199", "label": "实验室检验", "offset": "4"}, {"mention": "cea", "label": "实验室检验", "offset": "14"}, {"mention": "升结肠癌根治术", "label": "手术", "offset": "32"}, {"mention": "隆起型中分化腺癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "腹ct", "label": "影像检查", "offset": "95"}, {"mention": "mri", "label": "影像检查", "offset": "108"}, {"mention": "肝多发囊肿", "label": "疾病和诊断", "offset": "117"}, {"mention": "ca199", "label": "实验室检验", "offset": "131"}, {"mention": "tpsa", "label": "实验室检验", "offset": "153"}, {"mention": "alt", "label": "实验室检验", "offset": "164"}, {"mention": "ast", "label": "实验室检验", "offset": "168"}, {"mention": "ca199", "label": "实验室检验", "offset": "191"}, {"mention": "mri", "label": "影像检查", "offset": "200"}, {"mention": "肝s8", "label": "解剖部位", "offset": "204"}, {"mention": "超声", "label": "影像检查", "offset": "226"}, {"mention": "肝s8", "label": "解剖部位", "offset": "230"}, {"mention": "肝rfa", "label": "手术", "offset": "253"}]}
{"text": ",间断下腹不适5年,2015-8-25,我院胃镜:十二指肠球部多发浅溃疡,降段乳头远端对侧溃疡病变,,病理:降部形态结合ihc,符合神经内分泌肿瘤,ki-67(+15%);ct示肝左叶多发转移,奥曲肽扫描(-)?2015-9-9在我院行胰十二指肠切除+左肝部分切除,,术后病理:net叒g3,3.2*3.0cm,伴表面溃疡,核分裂像12个/10hpf,十二直肠壁外脂肪组织;瘤栓及神经+,:未侵及胰腺,2/18,ki-67(25%)。术后mri(-),,nse:18.8。2015.10始善龙至今,末次2015.2.17.现复查ct肝s8新见5mm结节,余无不适.。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "3"}, {"mention": "十二指肠球部多发浅溃疡", "label": "疾病和诊断", "offset": "25"}, {"mention": "神经内分泌肿瘤", "label": "疾病和诊断", "offset": "66"}, {"mention": "ct", "label": "影像检查", "offset": "86"}, {"mention": "肝左叶多发转移", "label": "疾病和诊断", "offset": "89"}, {"mention": "奥曲肽", "label": "药物", "offset": "97"}, {"mention": "胰十二指肠切除+左肝部分切除", "label": "手术", "offset": "118"}, {"mention": "net叒g3", "label": "疾病和诊断", "offset": "139"}, {"mention": "胰腺", "label": "解剖部位", "offset": "198"}, {"mention": "mri", "label": "影像检查", "offset": "219"}, {"mention": "nse", "label": "实验室检验", "offset": "227"}, {"mention": "善龙", "label": "药物", "offset": "244"}, {"mention": "ct", "label": "影像检查", "offset": "264"}, {"mention": "肝s8", "label": "解剖部位", "offset": "266"}]}
{"text": "患者于2008-10-7在外院行两侧卵巢+两侧附件+大网膜切除术,术后分期iiic期,术后tp方案化疗7程,末次化疗时间2009年7月。后定期复查,2010年8月复查ca125升高,彩超提示盆腔肿块。2010年9月26日全麻上行再次卵巢癌细胞减灭术,术后病理提示两侧附件浆液性乳头状腺癌ii-iii级,直肠旁沟肿物,镜上见纤维组织中见低分化腺癌浸润,考虑卵巢浆液性乳头状腺癌浸润,术后行tp方案辅助化疗。现患者于2012-12-25复查pet-ct提示复发,为进一步化疗就诊。", "mention_data": [{"mention": "两侧卵巢+两侧附件+大网膜切除术", "label": "手术", "offset": "16"}, {"mention": "ca125", "label": "实验室检验", "offset": "83"}, {"mention": "盆腔肿块", "label": "症状", "offset": "95"}, {"mention": "卵巢癌细胞减灭术", "label": "手术", "offset": "116"}, {"mention": "两侧附件浆液性乳头状腺癌ii-iii级", "label": "疾病和诊断", "offset": "131"}, {"mention": "直肠", "label": "解剖部位", "offset": "151"}, {"mention": "低分化腺癌", "label": "疾病和诊断", "offset": "167"}, {"mention": "卵巢浆液性乳头状腺癌", "label": "疾病和诊断", "offset": "177"}, {"mention": "pet-ct", "label": "影像检查", "offset": "218"}]}
{"text": ",患者1月前体检发现直肠肿物,,外院肠镜提示:直肠距肛门5-9cm肿物,,活检病理:腺癌,完善分期检查,ct3n+m0,2016-3-23给予xelox方案化疗1周期,现为行术前放化疗,2016-4-14至2016-5-14给予术前放疗叒gtv叒51gy/ctv叒40.8gy/34f叒bid,目前放疗结束,2016-4-25,20165-5-16同期xelox方案化疗2周期,患者诉大便次数同前,便意较前增加。腹泻叒1度,皮肤反应1度,恶心0度,乏力1度,泌尿系0度,骨髓抑制0度,2016-6-2继续给予巩固化疗1周期。2016-7-22直肠癌根治术,,手术病理:(直肠,放化疗后),切除:-叒肠壁粘膜层至固有肌肌层内散在中分化腺癌组织(癌残留约15%),伴纤维组织增生及慢性炎细胞浸润,符合治疗后改变,nccn叒trg,分级:2级;-叒未见脉管内癌栓及神经侵犯;-叒近端、(远端切缘)未见癌;-叒肠周淋巴结未见癌转移(0/4);-叒,肿瘤病理分期:ypt2n0。卡培他滨化疗2周期。", "mention_data": [{"mention": "直肠", "label": "解剖部位", "offset": "10"}, {"mention": "直肠", "label": "解剖部位", "offset": "23"}, {"mention": "肛门", "label": "解剖部位", "offset": "26"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "42"}, {"mention": "腹泻", "label": "症状", "offset": "206"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "235"}, {"mention": "直肠癌根治术", "label": "手术", "offset": "271"}, {"mention": "直肠", "label": "解剖部位", "offset": "285"}, {"mention": "肠", "label": "解剖部位", "offset": "299"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "313"}, {"mention": "肠", "label": "解剖部位", "offset": "401"}, {"mention": "卡培他滨", "label": "药物", "offset": "434"}]}
{"text": ",患者2012-05-25前因“便血3月余”入院,经肠镜及病理检查确诊乙状结肠腺癌。外院影像学检查提示肝肺多发转移,分期ct4n1m1iv期。患者经综合科病例讨论建议先行手术治疗。2012年6月1日全麻上行腹腔镜dixon术,术后恢复良好。,病理示:中分化腺癌,浸润至浆膜上层,6/15ln+,可疑脉管癌栓。分期pt3n2m1b,ivb,后于2012年6月21日行xelox方案化疗1周期,后分别于2012年7月16日至2013年02月17日行xelox+贝伐珠单抗化疗11周期,过程顺利,复查肿瘤评价sd。2013年3月13日、2013年4月02日、2013年4月23日、2013年5月16日、2013年6月5日、2013年06月25日为维持治疗,予卡培他滨+贝伐珠单抗化疗六周期。2013-07-14ct示两肺多发占位,考虑转移,较前进展,右肺门淋巴结较前增大,肝多发占位,考虑转移,较前相仿。临床未达pd标准,疗效总体评价为sd,继续原方案化疗,于2013-7-16至2013-11-27继续行卡培他滨+贝伐珠单抗化疗7程。2013-12-31,我院mdt会诊:结合患者外院ct,评估患者肿瘤进展pd,建议患者行xelox或folfiri基础化疗,遂于2014-02-10至2015-1-14我院行folfiri+贝伐珠单抗化疗19程,化疗后耐受尚可。于2015-1-26复查ct,,提示:乙状结肠癌术后改变,局部未见明确复发征。肝、肺转移灶较前无明显改变。2015-01-28、2015-02-11、2015-02-26、2015-03-11、2015.03.25、2015.04.15再行folfiri+贝伐珠单抗化疗6程,疗效sd。现为行上程化疗入院。患者发病以来,精神佳,饮食睡眠佳,大小便正常,体重无减轻。", "mention_data": [{"mention": "乙状结肠腺癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "肝肺多发转移", "label": "疾病和诊断", "offset": "51"}, {"mention": "腹腔镜dixon术", "label": "手术", "offset": "103"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "125"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "228"}, {"mention": "卡培他滨", "label": "药物", "offset": "326"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "331"}, {"mention": "ct", "label": "影像检查", "offset": "352"}, {"mention": "两肺多发占位", "label": "疾病和诊断", "offset": "355"}, {"mention": "右肺门淋巴结", "label": "解剖部位", "offset": "372"}, {"mention": "肝", "label": "解剖部位", "offset": "383"}, {"mention": "卡培他滨", "label": "药物", "offset": "450"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "455"}, {"mention": "ct", "label": "影像检查", "offset": "490"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "560"}, {"mention": "ct", "label": "影像检查", "offset": "591"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "598"}, {"mention": "肝", "label": "解剖部位", "offset": "618"}, {"mention": "肺", "label": "解剖部位", "offset": "620"}, {"mention": "贝伐珠单抗", "label": "药物", "offset": "707"}]}
{"text": ",患者2个月余前无明显诱因出现左上腹隐痛,后自行缓解,患者未予进一步诊治,后症状反复,按压左上腹有疼痛,偶有大便带血,伴头晕,乏力,无腹胀、恶心,无发热等不适。外院肠镜检查提示距肛70cm肿物,肠镜不能通过,活检病理提示腺癌。于2015-04-29在我院全麻上行左半结肠切除术+左侧卵巢切除术+盆底结节切除术+腹腔热灌注化疗,于2015-05-04再次行腹腔热灌注化疗术,,术后病理:中分化腺癌,癌组织累及肠壁浆膜上层,可见脉管内癌栓,左卵巢囊肿。,镜上:卵巢组织中见中分化腺癌浸润,结合病史及免疫组化结果,符合肠腺癌转移。(盆底结节2),镜上:纤维结缔组织中见腺癌浸润。2015-05-27、2015-06-17给予xelox方案化疗2程顺利.现患者为进一步诊治来我院就诊,起病以来,无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,体力体重无明显上降。", "mention_data": [{"mention": "左上腹", "label": "解剖部位", "offset": "15"}, {"mention": "左上腹", "label": "解剖部位", "offset": "45"}, {"mention": "头晕", "label": "症状", "offset": "60"}, {"mention": "腹胀", "label": "症状", "offset": "67"}, {"mention": "肛", "label": "解剖部位", "offset": "89"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "110"}, {"mention": "左半结肠切除术+左侧卵巢切除术+盆底结节切除术+腹腔热灌注化疗", "label": "手术", "offset": "131"}, {"mention": "腹腔热灌注化疗术", "label": "手术", "offset": "177"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "192"}, {"mention": "肠", "label": "解剖部位", "offset": "203"}, {"mention": "左卵巢囊肿", "label": "疾病和诊断", "offset": "218"}, {"mention": "卵巢", "label": "解剖部位", "offset": "228"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "234"}, {"mention": "肠腺癌转移", "label": "疾病和诊断", "offset": "256"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "281"}, {"mention": "骶部", "label": "解剖部位", "offset": "356"}]}
{"text": ",患者1年2月前因乏力,进食后上腹部胀痛就诊于我院门诊,,行肠镜检查示:结肠癌,结肠多发息肉,后就诊于我院肿瘤外科行左半结肠切除术、胃肠吻合术(手术日期为2010年10月15日),术后病理为进展期左半结肠癌,浸润溃疡性,低-中分化腺癌,淋巴结7/26枚转移,病理号为118494。术后恢复良好,术后2.5个月于我院慢性病院行单药卡培他滨(希罗达)口服化疗一周期,后入我科行folfox方案化疗3周期,具体用药为奥沙利铂(艾恒)150毫克,亚叶酸钙(同奥)0.3,替加氟4.0,化疗后曾出现1度腹泻,后改为xelox方案化疗4周期,,具体为:奥沙利铂(艾恒)150毫克,卡培他滨(希罗达)3.0日二次口服,因血小板减少不能耐受改希罗达口服化疗3周期,今为再次化疗入院。患者近一月来饮食睡眠可,精神体力可,大小便正常,体重无明显上降。kps评分80分。", "mention_data": [{"mention": "上腹", "label": "解剖部位", "offset": "15"}, {"mention": "结肠癌", "label": "疾病和诊断", "offset": "36"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "40"}, {"mention": "左半结肠切除术、胃肠吻合术", "label": "手术", "offset": "58"}, {"mention": "进展期左半结肠癌,浸润溃疡性,低-中分化腺癌", "label": "疾病和诊断", "offset": "95"}, {"mention": "卡培他滨(希罗达)", "label": "药物", "offset": "164"}, {"mention": "奥沙利铂(艾恒)", "label": "药物", "offset": "205"}, {"mention": "亚叶酸钙(同奥)", "label": "药物", "offset": "219"}, {"mention": "替加氟", "label": "药物", "offset": "231"}, {"mention": "腹泻", "label": "症状", "offset": "246"}, {"mention": "奥沙利铂(艾恒)", "label": "药物", "offset": "270"}, {"mention": "卡培他滨(希罗达)", "label": "药物", "offset": "284"}, {"mention": "血小板减少", "label": "症状", "offset": "303"}, {"mention": "希罗达", "label": "药物", "offset": "313"}]}
{"text": ",患者于1月余前无明显诱因出现间断下腹部隐痛,可耐受,无规律,不影响睡眠,无伴腹胀、嗳气,无恶心、呕吐等;1周前开始出现身目黄染,进行性加重,伴小便颜色加深,无伴畏寒、寒战、发热,无陶土样大便,无头昏、头痛。2017-04-13,于我院门诊行胃镜检查示:十二指肠乳头处见隆起型肿物,表面见溃疡,周边粘膜粗糙充血,活检病理未出;,行ct检查示:十二指肠乳头部增厚并见结节状软组织影,范围约14mm×13mm×22mm,部分边界欠清,增强扫描各期较明显强化,胰管、胆总管、胆囊管、胆囊及肝内胆管不同程度扩张;,诊断:十二指肠乳头部占位性病变,伴肝内外胆管、胰管扩张,壶腹癌?肝小囊肿。左肺中叶局限性肺不张;左肺中叶钙化灶。左肺上叶后基底段斑片灶,考虑炎症。右肺尖增殖灶。盆腔未见明确病变。,生化检查示:alt/ast明显升高,tbil/dbil升高,肿瘤标志物,ca199:292.4u/ml,后于2017-04-18在我院内镜科行“ercp术+胆道支架置入术”,术程顺利,术后予暂禁食、预防感染及营养支持等治疗。现患者恢复可,黄疸较前消退,复查alt/ast明显上降,tbil/ibil较前明显上降,无述不适,今为进一步治疗入我科。自起病以来,患者精神、睡眠稍差,食欲上降,大便正常,小便黄呈茶色,体重有上降约10kg。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "17"}, {"mention": "腹胀", "label": "症状", "offset": "39"}, {"mention": "头昏", "label": "症状", "offset": "98"}, {"mention": "头痛", "label": "症状", "offset": "101"}, {"mention": "十二指肠乳头", "label": "解剖部位", "offset": "127"}, {"mention": "ct", "label": "影像检查", "offset": "165"}, {"mention": "十二指肠乳头部", "label": "解剖部位", "offset": "171"}, {"mention": "胰管", "label": "解剖部位", "offset": "227"}, {"mention": "胆总管", "label": "解剖部位", "offset": "230"}, {"mention": "胆囊管", "label": "解剖部位", "offset": "234"}, {"mention": "胆囊", "label": "解剖部位", "offset": "238"}, {"mention": "肝内胆管", "label": "解剖部位", "offset": "241"}, {"mention": "十二指肠乳头部", "label": "解剖部位", "offset": "256"}, {"mention": "肝内外胆管、胰管扩张", "label": "疾病和诊断", "offset": "270"}, {"mention": "壶腹癌", "label": "疾病和诊断", "offset": "281"}, {"mention": "肝小囊肿", "label": "疾病和诊断", "offset": "285"}, {"mention": "左肺中叶局限性肺不张", "label": "疾病和诊断", "offset": "290"}, {"mention": "左肺中叶", "label": "解剖部位", "offset": "301"}, {"mention": "左肺上叶后基底段", "label": "解剖部位", "offset": "309"}, {"mention": "右肺尖", "label": "解剖部位", "offset": "326"}, {"mention": "盆腔", "label": "解剖部位", "offset": "333"}, {"mention": "alt/ast", "label": "实验室检验", "offset": "349"}, {"mention": "tbil/dbil", "label": "实验室检验", "offset": "361"}, {"mention": "ca199", "label": "实验室检验", "offset": "379"}, {"mention": "ercp术+胆道支架置入术", "label": "手术", "offset": "415"}, {"mention": "alt/ast", "label": "实验室检验", "offset": "471"}, {"mention": "tbil/ibil", "label": "实验室检验", "offset": "483"}]}
{"text": ",患者于2015年4月行检查胃镜示:胃窦、胃体交界大弯偏后壁见一处不规则隆起性病变,大小约2.0*2.5cm。,后于2015年5月入我院肿瘤外科行胃镜病理回报:腺癌。院外pet-ct示腹盆腔内多发结节,不除外富粘液成分肿瘤转移。外科考虑患者胃癌伴腹腔多发转移可能性大,不适于手术治疗,后多次行化疗。16-2-17日行下消化道全程造影(dr)(钡剂),提示:胃全切除术后。食管上段管腔变细,狭窄,考虑良性改变。今为求进一步治疗入我科,患者近来进食后吞咽困难,疼痛,呕吐,为白色泡沫状,睡眠一般,精神体力尚可,二便正常。体重较前减轻约5kg。", "mention_data": [{"mention": "胃窦、胃体交界", "label": "解剖部位", "offset": "18"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "80"}, {"mention": "pet-ct", "label": "影像检查", "offset": "85"}, {"mention": "腹", "label": "解剖部位", "offset": "92"}, {"mention": "盆腔", "label": "解剖部位", "offset": "93"}, {"mention": "胃癌伴腹腔多发转移", "label": "疾病和诊断", "offset": "120"}, {"mention": "下消化道全程造影(dr)(钡剂)", "label": "影像检查", "offset": "158"}, {"mention": "胃全切除术后", "label": "疾病和诊断", "offset": "178"}, {"mention": "食管", "label": "解剖部位", "offset": "185"}]}
{"text": ",缘于入院2个月前因胃癌就诊我院于2015.4.29全麻上行“腹腔镜上根治性全胃切除术roux-en-yd2r0”,,术中见:腹腔内无腹水,盆地、膀胱、系膜均未见明显种植结节,肝脏表面所见部分光滑,空回肠未见结节,肿瘤位于胃体大弯侧,浸润溃疡型,大小约7*5*4cm,侵出浆膜层,肝总动脉、胃右动脉旁见数个0.8-1.0cm大小淋巴结。术后病理(201515896),回报示:胃体溃疡型管状腺癌2-3级,侵及浆膜层,脉管内癌栓,累及神经,手术标本下上切端均未见癌浸润。找到贲门左淋巴结3/8,贲门右淋巴结2/6,大弯侧淋巴结9/9,第7组淋巴结2/4,第9组淋巴结1/4,见癌转移。术后于2015.5.23、2015.6.16予奥沙利铂200mgivgttd1+希罗达3000mgpod1-14方案术后化疗2周期,辅助以制酸保肝增强免疫等对症治疗。今为求术后第3次化疗,求诊我科,门诊拟“胃癌术后化疗”收住入院。自发病来,患者精神好,饮食好,睡眠好,大小便无异常,体重无变化。", "mention_data": [{"mention": "腹腔镜上根治性全胃切除术roux-en-yd2r0", "label": "手术", "offset": "31"}, {"mention": "腹", "label": "解剖部位", "offset": "63"}, {"mention": "腹水", "label": "症状", "offset": "67"}, {"mention": "膀胱", "label": "解剖部位", "offset": "73"}, {"mention": "肝脏", "label": "解剖部位", "offset": "88"}, {"mention": "空回肠", "label": "解剖部位", "offset": "99"}, {"mention": "胃体", "label": "解剖部位", "offset": "111"}, {"mention": "肝总动脉", "label": "解剖部位", "offset": "140"}, {"mention": "胃右动脉", "label": "解剖部位", "offset": "145"}, {"mention": "胃体溃疡型管状腺癌2-3级", "label": "疾病和诊断", "offset": "188"}, {"mention": "贲门左淋巴结", "label": "解剖部位", "offset": "236"}, {"mention": "贲门右淋巴结", "label": "解剖部位", "offset": "246"}, {"mention": "奥沙利铂", "label": "药物", "offset": "314"}, {"mention": "希罗达", "label": "药物", "offset": "331"}, {"mention": "肝", "label": "解剖部位", "offset": "363"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "394"}]}
{"text": ",2010-7-8行乙状结肠癌根治术,,病理:中分化腺癌,侵及层外结缔组织,未见癌栓,淋巴结0/11。2010-9-7术后基因检测mss(******),:稳定。2010-8起口服希罗达辅助化疗7周期。用药期间出现一度手足综合症,i度恶心,体重无变化。2011.1停药。\\u0004\\u00042011-11复查结肠镜示结肠多发息肉,病理示回盲部升结肠腺瘤,考虑腺瘤较小,未行切除。2012-2复查肿标、生化正常,胸片示主动脉弓前下方结节、左下下肺可疑结节大致同前。\\u0004\\u0004叒叒叒2012-4-19于三院行结肠镜上结肠息肉钳切。,病理:管状腺瘤1-2级。肿标正常。腹b超、胸片(-)。\\u0004\\u0004叒叒叒2012-8-9,我院复查腹部b超:肝右叶低回声区,非均匀性脂肪肝?盆腔b超、肿标(-)。胸,ct:两肺多发小结节无变化。\\u0004\\u0004叒叒叒目前患者无不适,2012/11/14,复查:肿瘤标志物正常,血常规正常,肝肾功正常。\\u0004\\u0004。", "mention_data": [{"mention": "乙状结肠癌根治术", "label": "手术", "offset": "10"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "23"}, {"mention": "希罗达", "label": "药物", "offset": "90"}, {"mention": "手足综合症", "label": "疾病和诊断", "offset": "109"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "160"}, {"mention": "回盲部升结肠腺瘤", "label": "疾病和诊断", "offset": "170"}, {"mention": "腺瘤", "label": "疾病和诊断", "offset": "181"}, {"mention": "胸片", "label": "影像检查", "offset": "207"}, {"mention": "主动脉弓", "label": "解剖部位", "offset": "210"}, {"mention": "左下下肺", "label": "解剖部位", "offset": "220"}, {"mention": "结肠镜上结肠息肉钳切", "label": "手术", "offset": "261"}, {"mention": "管状腺瘤1-2级", "label": "疾病和诊断", "offset": "276"}, {"mention": "腹b超", "label": "影像检查", "offset": "290"}, {"mention": "胸片", "label": "影像检查", "offset": "294"}, {"mention": "腹部b超", "label": "影像检查", "offset": "328"}, {"mention": "肝右叶", "label": "解剖部位", "offset": "333"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "345"}, {"mention": "盆腔b超", "label": "影像检查", "offset": "349"}, {"mention": "胸,ct", "label": "影像检查", "offset": "360"}, {"mention": "两肺", "label": "解剖部位", "offset": "365"}]}
{"text": ",2013-12体检发现结肠肿物.术前化疗xelox次,2cs叒缩小sd,4cspd.2014-07-28我院外科行乙状结肠癌切除、肝部分切除。,术中见:无腹水,无腹腔粘连,有肝转移,无腹膜、大网膜转移、无腹盆脏器转移、无腹腔多发淋巴结肿大、有小肠、结肠梗阻、扩张、无肿瘤局部穿孔。,病灶:肿瘤位于直肠-乙状结肠交界处、侵犯盆壁、肠系膜环周、未见肿物穿孔、可见近端结肠梗阻、伴扩张水肿、距肛缘约15cm,与侧腹壁关系、相对活动、肿瘤侵犯至肌层、手术性质为根治性。,术后病理:,乙状结肠:隆起型中分化腺癌,大小5x8cm,侵及周围脂肪组织,近端、远端切缘未见肿瘤、未见脉管癌栓、淋巴结转移(-)。肝s6肝组织,中分化腺癌转移,,肿瘤病理分期:pt3n0m1.叒,免组化结果:cd44+,cmet+,egfr+,hep-,her2叒(1+),ki-67(叒+75%),mlh1(+50~75%)topoii叒+25~50%叒ttf-1叒-。近期饮食可,二便如常。术后体重减低15kg。求进一步治疗就诊。14-9本院复查,,pet:吻合口高代谢,肝内多发结节,盆腔多发结节,肺内多发结节。", "mention_data": [{"mention": "结肠", "label": "解剖部位", "offset": "12"}, {"mention": "乙状结肠癌切除、肝部分切除", "label": "手术", "offset": "58"}, {"mention": "腹水", "label": "症状", "offset": "78"}, {"mention": "腹", "label": "解剖部位", "offset": "82"}, {"mention": "肝转移", "label": "疾病和诊断", "offset": "88"}, {"mention": "腹", "label": "解剖部位", "offset": "93"}, {"mention": "腹", "label": "解剖部位", "offset": "103"}, {"mention": "腹", "label": "解剖部位", "offset": "111"}, {"mention": "小肠、结肠梗阻", "label": "疾病和诊断", "offset": "122"}, {"mention": "直肠-乙状结肠交界处", "label": "解剖部位", "offset": "149"}, {"mention": "肠", "label": "解剖部位", "offset": "165"}, {"mention": "近端结肠梗阻", "label": "疾病和诊断", "offset": "180"}, {"mention": "腹", "label": "解剖部位", "offset": "204"}, {"mention": "乙状结肠:隆起型中分化腺癌", "label": "疾病和诊断", "offset": "238"}, {"mention": "肝s6", "label": "解剖部位", "offset": "297"}, {"mention": "肝", "label": "解剖部位", "offset": "300"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "304"}, {"mention": "pet", "label": "影像检查", "offset": "459"}, {"mention": "肝", "label": "解剖部位", "offset": "470"}, {"mention": "盆腔", "label": "解剖部位", "offset": "477"}, {"mention": "肺", "label": "解剖部位", "offset": "484"}]}
{"text": ",患者因便血2014-10-23在**一院行“直肠癌根治术”,,术后病理:粘液腺癌,浸润肠壁全层并突破浆膜层,达浆膜外脂肪组织。淋巴结转移(1/1)。诊断“pt4nxm0”,术后恢复可,便血消失。后s1/希罗达辅助化疗6月,末次化疗时间2015-3。后定期复查未见复发、转移。2016-4出现嗳气,无腹痛、腹泻,饮食正常,未进一步诊治。2016-11-25,我院pet-ct示:吻合口左旁子宫后方、右梨状肌内缘骶前及左腹腔升结肠旁多个病灶代谢较活跃,脾脏结节代谢较活跃,考虑转移;左附件区小片状软组织影代谢较活跃。mri,示:肝内多发病变,可疑囊性转移瘤可能性大。脾脏多发异常信号灶,考虑转移瘤可能性大。左结肠旁沟结节,可疑转移瘤。,基因分子诊断示:kras基因为突变型,突变亚型为g13d。其余基因均为野生型。诊断“直肠癌综合治疗后肝、脾、腹膜等多发转移叒krasg13d突变型”,2017-01-07开始予folfox+avastin化疗,今日为进一步治疗入院,术后患者神清,精神可,睡眠、饮食可,二便正常,体重无明显变化。", "mention_data": [{"mention": "直肠癌根治术", "label": "手术", "offset": "23"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "37"}, {"mention": "肠", "label": "解剖部位", "offset": "44"}, {"mention": "s1", "label": "药物", "offset": "99"}, {"mention": "希罗达", "label": "药物", "offset": "102"}, {"mention": "腹痛", "label": "症状", "offset": "150"}, {"mention": "腹泻", "label": "症状", "offset": "153"}, {"mention": "pet-ct", "label": "影像检查", "offset": "181"}, {"mention": "子宫", "label": "解剖部位", "offset": "194"}, {"mention": "右梨状肌", "label": "解剖部位", "offset": "199"}, {"mention": "骶前", "label": "解剖部位", "offset": "205"}, {"mention": "腹", "label": "解剖部位", "offset": "209"}, {"mention": "升结肠", "label": "解剖部位", "offset": "211"}, {"mention": "脾脏", "label": "解剖部位", "offset": "225"}, {"mention": "左附件", "label": "解剖部位", "offset": "240"}, {"mention": "mri", "label": "影像检查", "offset": "257"}, {"mention": "肝", "label": "解剖部位", "offset": "263"}, {"mention": "脾脏", "label": "解剖部位", "offset": "282"}, {"mention": "左结肠旁", "label": "解剖部位", "offset": "302"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "359"}, {"mention": "肝", "label": "解剖部位", "offset": "367"}, {"mention": "脾", "label": "解剖部位", "offset": "369"}, {"mention": "腹", "label": "解剖部位", "offset": "371"}]}
{"text": ",2014-11-6外院全麻上行结肠癌根治术,术后病理分期pt4an0m0,iib期,术后xelox辅助化疗6周期。定期复查,未见明显异常。2017-1-16,复查胸部ct提示:右肺上叶背段肿物,性质待定。腹部ct未查2017.1.16,肠镜:直肠、乙状结肠息肉。,行息肉切除后病理:生化性息肉行xeliri+bev方案化疗6周期,,不良反应:鼻粘膜出血、食欲不振。2017-6-13行右肺上叶背段病变穿刺活检+微波消融术,术后发烧39.5度,术后1周胸部ct示消融坏死区完全覆盖肿瘤组织。周围炎性渗出。抗炎治疗后好转,。", "mention_data": [{"mention": "结肠癌根治术", "label": "手术", "offset": "16"}, {"mention": "胸部ct提", "label": "影像检查", "offset": "82"}, {"mention": "右肺上叶背段", "label": "解剖部位", "offset": "89"}, {"mention": "腹部ct", "label": "影像检查", "offset": "103"}, {"mention": "直肠、乙状结肠息肉", "label": "疾病和诊断", "offset": "122"}, {"mention": "bev", "label": "药物", "offset": "155"}, {"mention": "鼻粘膜出血", "label": "症状", "offset": "172"}, {"mention": "右肺上叶背段病变穿刺活检+微波消融术", "label": "手术", "offset": "193"}, {"mention": "胸部ct", "label": "影像检查", "offset": "226"}]}
{"text": ",2,周前于我院行胃镜检查发现:胃底、胃体见数十个息肉,半球形,大小约0.4-1.0cm,粘液湖色清,少量。,胃镜诊断:1.慢性萎缩性胃炎2.胃多发息肉3.十二指肠球部炎症。,病理诊断:(窦大)胃窦粘膜,呈轻度慢性萎缩性胃炎。无腹痛、腹胀,无恶心、呕吐,无反酸、嗳气,无呕血、排黑便,今为进一步诊治,门诊拟“胃多发息肉”收住入院。近2周来,精神、睡眠正常,大便正常,小便正常,体重无明显变化。", "mention_data": [{"mention": "胃底", "label": "解剖部位", "offset": "16"}, {"mention": "胃体", "label": "解剖部位", "offset": "19"}, {"mention": "慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "62"}, {"mention": "胃多发息肉", "label": "疾病和诊断", "offset": "71"}, {"mention": "十二指肠球部炎症", "label": "疾病和诊断", "offset": "78"}, {"mention": "胃窦", "label": "解剖部位", "offset": "97"}, {"mention": "轻度慢性萎缩性胃炎", "label": "疾病和诊断", "offset": "103"}, {"mention": "腹痛", "label": "症状", "offset": "114"}, {"mention": "腹胀", "label": "症状", "offset": "117"}, {"mention": "胃多发息肉", "label": "疾病和诊断", "offset": "154"}]}
{"text": ",患者3个月前(2014年2月)因腹胀进行性加重就诊于我院,,行胃镜检查示:贲门低分化腺癌。遂于我院胃肠外科行根治性全胃切除术。术中见肿物位于贲门小弯侧,侵及浆膜。,术后病理:(胃)低分化腺癌,(淋巴结)淋巴结转移癌(3/14),另见淋巴结旁癌结节一枚,,病理号:z0470555。,术后分期:t3n2m0叒iiia期。术后腹痛消失,胃区偶有牵拉样疼痛。体能恢复良好,为进一步治疗入我科。完善相关检查,患者肾功能略有异常,为减少肾功能损伤,予sox方案化疗2周期,,用药为:奥沙利铂200毫克d1静点,替吉奥120毫克日二次口服d1-7。末次化疗前7日患者出现i°恶心、呕吐,7日后逐渐好转。化疗后未出现骨髓抑制,现患者化疗结束3周,为求再次化疗入院。患者近2周来饮食睡眠一般,精神体力可,二便正常,病来体重上降15公斤,ecog评分1分。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "17"}, {"mention": "贲门低分化腺癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "根治性全胃切除术", "label": "手术", "offset": "55"}, {"mention": "贲门小弯侧", "label": "解剖部位", "offset": "71"}, {"mention": "(胃)低分化腺癌,(淋巴结)淋巴结转移癌", "label": "疾病和诊断", "offset": "88"}, {"mention": "腹痛", "label": "症状", "offset": "162"}, {"mention": "胃", "label": "解剖部位", "offset": "167"}, {"mention": "奥沙利铂", "label": "药物", "offset": "237"}, {"mention": "替吉奥", "label": "药物", "offset": "251"}, {"mention": "骨髓抑制", "label": "疾病和诊断", "offset": "302"}]}
{"text": ",患者2012年2月16日于南方医科大学体检ct、,彩超发现:肝左叶占位性病变,考虑为结节型原发性肝癌可能性大;肝内多发囊肿。肿瘤标志物,afp:5.01。后于2012.3.6在我院行“肝左叶肝癌切除+胆囊切除术”,术程顺利,术后恢复可,,术后病理:中分化肝细胞性肝癌,梁索型;未见脉管内癌栓及神经束侵犯;癌旁肝组织呈结节性肝硬化改变。术后一直行日达仙免疫治疗至今。为巩固治疗,于2012-4-10起在我科行cik细胞回输治疗至今,过程顺利。术后定期复查无肿瘤复发转移征象,afp正常,末次复查时间为2015-03-18。现为继续行cik细胞治疗入院。3月来,患者精神、纳眠可,大小便正常,近期体重无明显上降。", "mention_data": [{"mention": "ct", "label": "影像检查", "offset": "22"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "31"}, {"mention": "结节型原发性肝癌", "label": "疾病和诊断", "offset": "43"}, {"mention": "肝内多发囊肿", "label": "疾病和诊断", "offset": "56"}, {"mention": "afp", "label": "实验室检验", "offset": "69"}, {"mention": "肝左叶肝癌切除+胆囊切除术", "label": "手术", "offset": "93"}, {"mention": "中分化肝细胞性肝癌", "label": "疾病和诊断", "offset": "125"}, {"mention": "肝", "label": "解剖部位", "offset": "155"}, {"mention": "结节性肝硬化", "label": "疾病和诊断", "offset": "159"}, {"mention": "日达仙", "label": "药物", "offset": "173"}, {"mention": "afp", "label": "实验室检验", "offset": "237"}]}
{"text": "患者于2008年行原发性肝癌切除术,2012-11月于我科行肝动脉化疗栓塞术,术后恢复良好,20天前患者皮肤巩膜黄染,肝区轻度疼痛,发热,体温最高为39.5度,于外院行抗炎降黄及保肝等保守治疗无效,于2013-08-08在局麻上行经皮经肝胆道支架置入术及外引流术。现03-10化验示总胆红素114umol/l,直接胆红素91umol/l,并皮肤及巩膜黄染,小便色深,大便可。现为求再次介入治疗入我科住院。患者精神状态尚可,肝区轻度压痛,无反跳痛及肌紧张,睡眠尚可,近一月体重减轻月4kg。", "mention_data": [{"mention": "原发性肝癌切除术", "label": "手术", "offset": "9"}, {"mention": "肝动脉化疗栓塞术", "label": "手术", "offset": "30"}, {"mention": "肝", "label": "解剖部位", "offset": "59"}, {"mention": "肝", "label": "解剖部位", "offset": "90"}, {"mention": "经皮经肝胆道支架置入术及外引流术", "label": "手术", "offset": "115"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "141"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "155"}, {"mention": "肝", "label": "解剖部位", "offset": "211"}]}
{"text": ",因“胸闷”就诊,2013-5-21ct发现胰头钩突部占位,考虑为pnet,2013-5-31奥曲肽扫描提示胰头部ssr阳性灶,2013-06-05行胰十二指肠切除术,术中见胰头区约2-3cm肿物,,术后病理:神经内分泌肿瘤,2.6x2cm,局限于胰腺组织内,核分裂像2/10hpf,未见脉管癌栓及坏死,断端均阴性,淋巴结0/3,syn(+),cga(-),cd56(+),ck(+),map2(+),nse(+),ki67(+5%)。术前肿标基本正常(未查nse)。术后未进一步治疗,定期复查。2015-10起腰背部疼痛,进行性加重,对症治疗效果欠佳。,2015-11-23复查ct:肝门部异常软组织影,转移可能大。肝内外胆管扩张,考虑胆肠肠吻合口处梗阻可能。肝脏多发动脉期强化灶,异常灌注?腹腔多发淋巴结肿大,转移?2015-12-2进一步查f18-pet/ct及ga68-pet/ct均见肝门部软组织影及肠系膜多发淋巴结肿大,但无高摄取;c7-t2骨转移,给予唑来磷酸治疗。患者已放疗科会诊,目前行放疗前准备,活动后背痛明显,服用泰勒宁、贴用多瑞吉,目前饮食可,大小便正常,近2月体重上降约3kg。", "mention_data": [{"mention": "胸闷", "label": "症状", "offset": "3"}, {"mention": "ct", "label": "影像检查", "offset": "18"}, {"mention": "胰头钩突部", "label": "解剖部位", "offset": "22"}, {"mention": "pnet", "label": "疾病和诊断", "offset": "33"}, {"mention": "奥曲肽", "label": "药物", "offset": "47"}, {"mention": "胰头部", "label": "解剖部位", "offset": "54"}, {"mention": "胰十二指肠切除术", "label": "手术", "offset": "75"}, {"mention": "胰头", "label": "解剖部位", "offset": "87"}, {"mention": "神经内分泌肿瘤", "label": "疾病和诊断", "offset": "105"}, {"mention": "胰腺", "label": "解剖部位", "offset": "124"}, {"mention": "nse", "label": "实验室检验", "offset": "229"}, {"mention": "腰背部", "label": "解剖部位", "offset": "256"}, {"mention": "ct", "label": "影像检查", "offset": "290"}, {"mention": "肝门", "label": "解剖部位", "offset": "293"}, {"mention": "肝内外胆管扩张", "label": "疾病和诊断", "offset": "309"}, {"mention": "胆肠肠吻合口处梗阻", "label": "疾病和诊断", "offset": "319"}, {"mention": "肝脏", "label": "解剖部位", "offset": "331"}, {"mention": "腹腔", "label": "解剖部位", "offset": "347"}, {"mention": "pet/ct", "label": "影像检查", "offset": "377"}, {"mention": "pet/ct", "label": "影像检查", "offset": "389"}, {"mention": "肝门", "label": "解剖部位", "offset": "397"}, {"mention": "肠", "label": "解剖部位", "offset": "405"}, {"mention": "c7-t2骨转移", "label": "疾病和诊断", "offset": "422"}, {"mention": "唑来磷酸", "label": "药物", "offset": "433"}, {"mention": "后背", "label": "解剖部位", "offset": "460"}, {"mention": "泰勒宁", "label": "药物", "offset": "468"}, {"mention": "多瑞吉", "label": "药物", "offset": "474"}]}
{"text": ",进食哽咽感,我院确诊egj中低分化腺癌伴印戒细胞癌,混合型,ut4an2,siwertii型,并见十二指肠降部smt,2016.8.8行esd切除1cm占位,病理为绒毛状管状腺瘤;术前肿标正常,2016.8.11行全胃切除术,未见腹腔m,cy0,resolve叒b,,术后病理:中低分化腺癌伴印戒细胞癌,混合型,2.5×xxx2cm;外膜纤维脂肪组织;脉管癌栓及神经侵犯+;18/49;afp(-),cmet(1+),egfr(-),her2(0),pdl-1(5%+),mss,eber(-)。术后恢复可,腹胀,,ca125:49;易呃逆。体重稳定。术后1月行化疗替吉奥+奥沙利铂化疗3周期,末次化疗时间2016.11.嗳气,进食可,睡眠可,大小便无明显异常。术后体重增加5kg。", "mention_data": [{"mention": "egj中低分化腺癌伴印戒细胞癌,混合型", "label": "疾病和诊断", "offset": "11"}, {"mention": "十二指肠降部smt", "label": "疾病和诊断", "offset": "50"}, {"mention": "esd", "label": "手术", "offset": "69"}, {"mention": "绒毛状管状腺瘤", "label": "疾病和诊断", "offset": "83"}, {"mention": "全胃切除术", "label": "手术", "offset": "108"}, {"mention": "腹", "label": "解剖部位", "offset": "116"}, {"mention": "中低分化腺癌伴印戒细胞癌,混合型", "label": "疾病和诊断", "offset": "140"}, {"mention": "腹胀", "label": "症状", "offset": "255"}, {"mention": "ca125", "label": "实验室检验", "offset": "259"}, {"mention": "替吉奥", "label": "药物", "offset": "284"}, {"mention": "奥沙利铂", "label": "药物", "offset": "288"}]}
{"text": ",患者3月余前无明显诱因出现排便习惯改变,表现为里急后重,间歇伴有便血,量少,色暗红,伴粘液,外院肠镜检查提示距离肛门10-15cm直肠肿物,肠腔狭窄,肠镜勉强可通过。活检病理提示中分化腺癌。2016-9-6我院病理会诊示中分化腺癌。2016-9-6我院胸部+全腹部+盆腔ct示直肠中下段~乙状结肠管壁明显增厚,考虑直肠~结肠癌,可疑浸润肠周间隙。骶前、直肠周围系膜区数个淋巴结,考虑转移瘤。右下肺尖后段、左中肺叶内侧段结节,可疑转移。于2016-09-18行“腹腔镜上dixon术”,,术后病理示:1(肠大体)镜检为中分化腺癌,癌组织浸润至肠壁浆膜上层,可见脉管内癌栓及神经束侵犯;切缘未见癌。区域淋巴结3/11(+),并浸润结外脂肪结缔组织。,免疫组化:er(-),ercc1(+),pms2(+),mlh1(+),msh2(+),msh6(+),ki67(40%+)。2016-10-25、2016-11-16、2016-12-07、2017-1给予xelox方案化疗4程顺利,现为进一步治疗而来我院。出院以来,胃纳、睡眠可,小便正常,偶有大便困难,4-5次/天成形大便,体重上降5kg。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "57"}, {"mention": "直肠", "label": "解剖部位", "offset": "66"}, {"mention": "肠", "label": "解剖部位", "offset": "71"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "90"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "111"}, {"mention": "胸部+全腹部+盆腔ct", "label": "影像检查", "offset": "127"}, {"mention": "直肠", "label": "解剖部位", "offset": "139"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "145"}, {"mention": "直肠~结肠癌", "label": "疾病和诊断", "offset": "158"}, {"mention": "肠", "label": "解剖部位", "offset": "169"}, {"mention": "骶前", "label": "解剖部位", "offset": "174"}, {"mention": "直肠", "label": "解剖部位", "offset": "177"}, {"mention": "右下肺尖后段", "label": "解剖部位", "offset": "196"}, {"mention": "左中肺叶", "label": "解剖部位", "offset": "203"}, {"mention": "腹腔镜上dixon术", "label": "手术", "offset": "231"}, {"mention": "肠", "label": "解剖部位", "offset": "252"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "259"}, {"mention": "肠", "label": "解剖部位", "offset": "271"}, {"mention": "胃", "label": "解剖部位", "offset": "459"}]}
{"text": ",患者于3个月前因“肝占位”于我院行“胆囊切除+右半肝切除+门静脉切开取栓术”,手术过程顺利,标本送病理。,术后病理示:1.(右半肝),:肝脏原发性巨块型中分化肝细胞癌,伴坏死,侵及肝被膜,周边肝组织呈结节性肝硬化表现。另送的(门静脉旁)淋巴结1个,未见癌转移。2.(门静脉),:送检组织中见癌细胞浸润。3.(胆囊),:送检胆囊组织。,免疫组化:ck18(+++),glypican-3(+++),cd10(血管+),cea(-),ki67(60%+)。术后患者恢复良好。11月6日就诊我院,行“tace”,示:动脉期肝内见新生血管,主要集中于右、左肝交界处,部分融合成块,范围约5.0*2.5cm,门静脉主干及肝内分支显影清楚,未见明显癌栓形成征象。碘油灌注后大部分沉积于结节染色区,手术顺利。无恶心、呕吐,无腹痛、腹胀,无眼黄、尿黄、皮肤黄。今为行介入治疗来我院,门诊拟“肝癌术后复发”收住入院。患者自发病以来,神志清,精神好,饮食睡眠好,大小便正常。", "mention_data": [{"mention": "肝", "label": "解剖部位", "offset": "10"}, {"mention": "胆囊切除+右半肝切除+门静脉切开取栓术", "label": "手术", "offset": "19"}, {"mention": "右半肝", "label": "解剖部位", "offset": "63"}, {"mention": "肝脏原发性巨块型中分化肝细胞癌", "label": "疾病和诊断", "offset": "69"}, {"mention": "肝", "label": "解剖部位", "offset": "91"}, {"mention": "肝", "label": "解剖部位", "offset": "97"}, {"mention": "结节性肝硬化", "label": "疾病和诊断", "offset": "101"}, {"mention": "(门静脉旁)淋巴结", "label": "解剖部位", "offset": "113"}, {"mention": "门静脉", "label": "解剖部位", "offset": "134"}, {"mention": "胆囊", "label": "解剖部位", "offset": "155"}, {"mention": "胆囊", "label": "解剖部位", "offset": "162"}, {"mention": "tace", "label": "手术", "offset": "248"}, {"mention": "肝", "label": "解剖部位", "offset": "259"}, {"mention": "右、左肝交界处", "label": "解剖部位", "offset": "272"}, {"mention": "门静脉主干", "label": "解剖部位", "offset": "300"}, {"mention": "肝", "label": "解剖部位", "offset": "306"}, {"mention": "碘油", "label": "药物", "offset": "326"}, {"mention": "腹痛", "label": "症状", "offset": "356"}, {"mention": "腹胀", "label": "症状", "offset": "359"}, {"mention": "眼", "label": "解剖部位", "offset": "363"}, {"mention": "肝癌术后复发", "label": "疾病和诊断", "offset": "388"}]}
{"text": ",患者11月前因\\\"下腹部疼痛1月余\\\"于本院诊断为胰腺癌,2015年06月15日于全麻上行姑息性胰十二指肠切除术,术中发现肿瘤侵犯smv,及门静脉与脾静脉交汇处,长度约4cm,肿瘤侵犯结肠中动、静脉,术中病理提示为腺癌,向家属说明病情及手术范围,需切除血管、横结肠等器官,患者家属表示考虑手术风险较大,放弃行根治性手术,改行姑息性胰十二指肠切除术,术程顺利,术后予护肝、护胃,抗感染,调节免疫对症治疗后好转,,术后病理提示:中至低分化腺癌,结合免疫组化结果,考虑为胰腺导管来源,浸润胰腺组织及十二指肠至肠壁粘膜上层,可见神经束侵犯及脉管内癌栓。术后未行化疗及放疗。3天余前无明显诱因出现呕血,鲜红色,量约500ml,于我院急诊处理后病情稳定。,2016年05月25日我院ct:胰头占位wipple术后,,对比2015-8-3片:腹膜后软组织影,较前增大,转移瘤可能性大。胃-空肠吻合处肠劈头增厚,术后改变可能性大。现为进一步治疗入院。下次治疗至今患者无明显腹痛、无腹胀、无恶心、无畏寒、无发热,,患者精神尚可,食欲如常。大小便正常,体重有上降约2kg。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "10"}, {"mention": "胰腺癌", "label": "疾病和诊断", "offset": "26"}, {"mention": "姑息性胰十二指肠切除术", "label": "手术", "offset": "46"}, {"mention": "smv", "label": "解剖部位", "offset": "66"}, {"mention": "门静脉与脾静脉交汇处", "label": "解剖部位", "offset": "71"}, {"mention": "结肠中动、静脉", "label": "解剖部位", "offset": "93"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "108"}, {"mention": "横结肠", "label": "解剖部位", "offset": "130"}, {"mention": "姑息性胰十二指肠切除术", "label": "手术", "offset": "163"}, {"mention": "肝", "label": "解剖部位", "offset": "184"}, {"mention": "胃", "label": "解剖部位", "offset": "187"}, {"mention": "中至低分化腺癌", "label": "疾病和诊断", "offset": "213"}, {"mention": "胰腺导管", "label": "解剖部位", "offset": "233"}, {"mention": "胰腺", "label": "解剖部位", "offset": "242"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "247"}, {"mention": "肠", "label": "解剖部位", "offset": "252"}, {"mention": "ct", "label": "影像检查", "offset": "336"}, {"mention": "胰头占位wipple术后", "label": "疾病和诊断", "offset": "339"}, {"mention": "腹", "label": "解剖部位", "offset": "365"}, {"mention": "胃-空肠吻合处", "label": "解剖部位", "offset": "386"}, {"mention": "肠", "label": "解剖部位", "offset": "393"}, {"mention": "腹痛", "label": "症状", "offset": "429"}, {"mention": "腹胀", "label": "症状", "offset": "433"}]}
{"text": ",患者于6月前行因便血到我院就诊,行直肠癌根治切除术,,术后病理结果:直肠中分化腺癌,浸及深肌层,见脉管内癌栓形成。直肠切缘未见癌累及,肠周淋巴结见癌转移4/8(iiib期))。分期t2、n2、m0。术后2周行全身化疗(folfox,方案:奥沙利铂130mgd1+亚叶酸钙600mgd1+氟尿嘧啶2000mgd1d2泵入),共9次,有恶心不适,有脱发,肝功不全;无腹泻、细胞降低、肝功能损害等不良反应。患者有肛门坠胀不适。本次拟行10次化疗收住入院。\\u0004叒叒叒患者自起病以来,精神略差,胃纳略差,大便成形,便条较细,小便如常,体重未见明显上降。", "mention_data": [{"mention": "直肠癌根治切除术", "label": "手术", "offset": "18"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "35"}, {"mention": "直肠", "label": "解剖部位", "offset": "58"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "68"}, {"mention": "奥沙利铂", "label": "药物", "offset": "120"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "132"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "144"}, {"mention": "腹泻", "label": "症状", "offset": "182"}, {"mention": "肛门坠胀", "label": "症状", "offset": "204"}, {"mention": "胃", "label": "解剖部位", "offset": "247"}]}
{"text": ",患者因诊断为直肠癌2014-9-27行剖腹探查,术中见癌灶以下肠管增粗、胀气,于腹膜反折下上触及巨大质硬肿瘤,无活动度,肠周可触及多发肿大淋巴结,肠系膜根部淋巴结稍增大,肿瘤与周围组织粘连、固定,手术无根治切除,遂行乙状结肠单腔造口,远端封闭。术后行folfox方案化疗4周期,外科建议术前放化疗,2014-12-23于外科行奥沙利铂+替吉奥方案化疗,2014-12-25起在我科开始放疗,,方案:gtv叒50.6gy叒ctv叒41.8gy/22f,期间同步口服替吉奥口服60mg叒bid,d1-5/w。患者便血症状基本缓解。完善常规检查,于2015-03-31日全麻满意,行开腹探查、直肠癌hartmann切除术,术程顺利,术后患者恢复可,已进半流食,排气排便通畅,医嘱出院.,术后病理:直肠癌放疗,结肠造口术后,直肠(切除),:叒-叒经多点取材,未见癌组织残留;叒-叒肠壁全层见慢性炎细胞及组织细胞浸润,伴黏液池形成,符合治疗后改变;叒-叒ajcc/nccn叒,trg:叒0级;叒-叒未见脉管癌栓;叒-叒肠周淋巴结未见癌转移(0/6);叒-叒近肿物断端及远肿物断端未见癌;叒-叒,肿瘤病理分期:ypt0n0。术后未行化疗,复查肠镜,现为行造瘘还纳入院。患者自发病以来,饮食睡眠好,体重无减轻。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "7"}, {"mention": "剖腹探查", "label": "手术", "offset": "20"}, {"mention": "肠", "label": "解剖部位", "offset": "32"}, {"mention": "腹膜反折", "label": "解剖部位", "offset": "41"}, {"mention": "肠", "label": "解剖部位", "offset": "61"}, {"mention": "肠系膜根部淋巴结", "label": "解剖部位", "offset": "74"}, {"mention": "乙状结肠单腔造口,远端封闭", "label": "手术", "offset": "109"}, {"mention": "奥沙利铂", "label": "药物", "offset": "164"}, {"mention": "替吉奥", "label": "药物", "offset": "169"}, {"mention": "替吉奥", "label": "药物", "offset": "232"}, {"mention": "开腹探查、直肠癌hartmann切除术", "label": "手术", "offset": "289"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "346"}, {"mention": "结肠造口术后", "label": "疾病和诊断", "offset": "352"}, {"mention": "直肠", "label": "解剖部位", "offset": "359"}, {"mention": "肠", "label": "解剖部位", "offset": "387"}, {"mention": "肠周淋巴结", "label": "解剖部位", "offset": "455"}]}
{"text": ",2016年7月患者无诱因出现进食梗咽感,未诊治,后患者哽咽感加重,,外院行胃镜检查:进镜30cm可见食管中段见一3/4周不规则溃疡性病变,底凹凸不平,镜身不能通过,活检4块,,病理:(食管中段)低分化鳞癌,,钡餐:食管中段可见长度约6cm病变,管壁僵硬,胸、腹部,ct:胸中段食管管壁环周性增厚。2016-12-15叒昨日放疗结束.1月后复查胸部、腹部ct及锁骨下b超未见肿瘤复发征象,食管局部肿瘤较前缩小。", "mention_data": [{"mention": "食管中段", "label": "解剖部位", "offset": "51"}, {"mention": "(食管中段)低分化鳞癌", "label": "疾病和诊断", "offset": "92"}, {"mention": "食管中段", "label": "解剖部位", "offset": "108"}, {"mention": "胸、腹部,ct", "label": "影像检查", "offset": "128"}, {"mention": "胸中段食管", "label": "解剖部位", "offset": "136"}, {"mention": "胸部、腹部ct", "label": "影像检查", "offset": "172"}, {"mention": "锁骨下b超", "label": "影像检查", "offset": "180"}, {"mention": "食管", "label": "解剖部位", "offset": "194"}]}
{"text": ",患者2010-5月体检发现肝脏占位,2010-05-17,我院b超:肝左叶实质占位-考虑mt可能大,肝硬化,脾肿大;afp(-)。2010-5-18我院肝外科行“肝动脉结扎插管+肿瘤活捡术+肝肿瘤无水酒精注射术+胆囊切除术”,:术中探查肿瘤位于vi段,大小3.5×3×3cm,单结节型,边界清,无子灶,肝硬化结节0.8-1.0cm。无癌栓,未见肿大淋巴结,肝门无阻断。,穿刺病理:肝细胞肝癌,分化ii级。术后(2010.5.27-2010.10.18)导管化疗6次,化疗过程中出现血小板、白细胞ii二级降低。规律随访无复发征象,,2014-10-28腹部ct:肝左叶mt治疗后,肝右叶复发灶可能大(1.4*1.4cm低密度灶,动态增强后动脉期轻度强化,延迟期相对低密度);肝硬化,脾肿大,门脉高压;afp(-)。2014-10-29叒b,超:右叶实质占位-考虑mt可能;肝左叶实质占位-考虑mt综合治疗后改变,肝硬化,脾肿大。2014-11-4,行rfa术:在b超引导上肝肿瘤射频消融毁损术,针对肝右叶20×12mm病灶现为行rfa入院。12-10叒我院下腹部,mri:肝mt综合治疗后,肝左叶多枚复发灶,肝右叶病灶基本坏死,肝硬化伴多发硬化结节形成,脾大,门脉高压。现为行介入治疗收住我院。病程中患者精神、食欲、睡眠可,大小便如常,体重无明显上降。", "mention_data": [{"mention": "肝脏", "label": "解剖部位", "offset": "14"}, {"mention": "b超", "label": "影像检查", "offset": "32"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "35"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "51"}, {"mention": "肝动脉结扎插管+肿瘤活捡术+肝肿瘤无水酒精注射术+胆囊切除术", "label": "手术", "offset": "82"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "152"}, {"mention": "肝门", "label": "解剖部位", "offset": "179"}, {"mention": "肝细胞肝癌,分化ii级", "label": "疾病和诊断", "offset": "191"}, {"mention": "血小板", "label": "实验室检验", "offset": "241"}, {"mention": "白细胞", "label": "实验室检验", "offset": "245"}, {"mention": "腹部ct", "label": "影像检查", "offset": "276"}, {"mention": "肝左叶mt治疗后", "label": "疾病和诊断", "offset": "281"}, {"mention": "肝右叶", "label": "解剖部位", "offset": "290"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "337"}, {"mention": "b,超", "label": "影像检查", "offset": "368"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "386"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "406"}, {"mention": "rfa术", "label": "手术", "offset": "425"}, {"mention": "b超引导上肝肿瘤射频消融毁损术", "label": "手术", "offset": "431"}, {"mention": "肝右叶", "label": "解剖部位", "offset": "449"}, {"mention": "rfa", "label": "手术", "offset": "464"}, {"mention": "下腹", "label": "解剖部位", "offset": "478"}, {"mention": "mri", "label": "影像检查", "offset": "482"}, {"mention": "肝mt综合治疗后", "label": "疾病和诊断", "offset": "486"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "495"}, {"mention": "肝右叶", "label": "解剖部位", "offset": "504"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "514"}]}
{"text": "9月年前患者于外院因cea升高查体发现乙状结肠mt肝转移,肝内为单发病灶,于外院行乙状结肠mt切除术,术后病理为乳头状腺癌。术后患者恢复好,未行任何治疗。3月前者复查肝脏mri示肝内病灶明显增多、增大,cea持续升高,于5月9日、6月17日及8月4日在我科行3次介入治疗,术后予保肝、止吐、抑酸等治疗后,恢复可。2008-08-12,psa升高,检查诊断前列腺癌,无行两侧睾丸切除手术,给药物去势+康士德治疗出院,今再来我科检查行介入治疗,现患者一般情况好,纳可,眠可,二便无殊。<?xml:namespace叒prefix叒=叒o叒/>。", "mention_data": [{"mention": "乙状结肠mt肝转移", "label": "疾病和诊断", "offset": "19"}, {"mention": "乙状结肠mt切除术", "label": "手术", "offset": "41"}, {"mention": "乳头状腺癌", "label": "疾病和诊断", "offset": "56"}, {"mention": "肝脏mri", "label": "影像检查", "offset": "83"}, {"mention": "肝", "label": "解剖部位", "offset": "89"}, {"mention": "cea", "label": "实验室检验", "offset": "101"}, {"mention": "前列腺癌", "label": "疾病和诊断", "offset": "177"}, {"mention": "两侧睾丸切除手术", "label": "手术", "offset": "184"}, {"mention": "康士德", "label": "药物", "offset": "199"}]}
{"text": ",患者6个月前诊断“网膜浆液性腺癌”,于2011年5月27日、6月20日行tp化疗(多西他赛+卡铂)2次,化疗过程顺利,于2011-7-18于我科行全子宫切除、两侧骨盆漏斗韧带高位结扎、大网膜、阑尾切除术。,手术评价:无肉眼残留。,术后病理:卵巢浆液性腺癌。术后恢复良好。术后于2011-8-15至2011-9-29行tp方案化疗3次,过程顺利,现为补充化疗入我科。出院至今,轻微恶心乏力,无腹痛腹胀,饮食差,睡眠可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "网膜浆液性腺癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "多西他赛", "label": "药物", "offset": "42"}, {"mention": "卡铂", "label": "药物", "offset": "47"}, {"mention": "全子宫切除、两侧骨盆漏斗韧带高位结扎、大网膜、阑尾切除术", "label": "手术", "offset": "74"}, {"mention": "卵巢浆液性腺癌", "label": "疾病和诊断", "offset": "121"}, {"mention": "腹痛", "label": "症状", "offset": "196"}, {"mention": "腹胀", "label": "症状", "offset": "198"}]}
{"text": ",患者因月经淋漓不尽1年于2014-10-19就诊******健院,行tct检查结果为hsil,行阴道镜检查+宫颈活检,病理为(宫颈12点)中分化鳞状细胞癌,(宫颈3、6、9点)hsil。2014-10-24就诊我院,行腹盆ct,提示宫颈增大,局部可见软组织肿块,大小约19mm×20mm×29mm,边界不清,病灶侵犯后穹窿,考虑为宫颈癌。,会诊外院宫颈活检病理:(宫颈)鳞状下皮呈cin叒iii改变,伴少许间质浸润,因组织破碎,难以评估浸润范围。2014年11月3日在我院行宫颈leep治疗,,术后病理:中分化鳞状细胞癌,癌组织侵润宫颈肌层,可见脉管内癌栓。11月13日于全麻上行ii型改良根治性子宫切除+两附件切除,,术后病理:(子宫+两附件)镜检为宫颈中至低分化鳞状细胞癌,浸润宫颈及颈管深肌层(&gt;1/2肌层),并累及宫体上段浅肌层(&lt;1/2肌层),未累及阴道穹窿,可见脉管内癌栓,未见明确神经束侵犯;右闭孔淋巴结见鳞状细胞癌转移。向患者及家属交代病情,充分知情后,患者及家属同意入5010,随机后入序贯放化疗组。于2014-11-21、2014-12-23予tp(艾素+顺铂)方案化疗,并于2015-1至2015-3行辅助放疗45gy/25f。现为行上一程化疗入院。近来患者一般情况可,睡眠、食欲可,二便正常,体重无明显变化。", "mention_data": [{"mention": "hsil", "label": "疾病和诊断", "offset": "43"}, {"mention": "阴道镜检查+宫颈活检", "label": "手术", "offset": "49"}, {"mention": "(宫颈12点)中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "(宫颈3、6、9点)hsil", "label": "疾病和诊断", "offset": "79"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "110"}, {"mention": "宫颈", "label": "解剖部位", "offset": "117"}, {"mention": "宫颈癌", "label": "疾病和诊断", "offset": "166"}, {"mention": "宫颈", "label": "解剖部位", "offset": "175"}, {"mention": "宫颈", "label": "解剖部位", "offset": "183"}, {"mention": "宫颈leep", "label": "手术", "offset": "238"}, {"mention": "中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "253"}, {"mention": "宫颈", "label": "解剖部位", "offset": "267"}, {"mention": "ii型改良根治性子宫切除+两附件切除", "label": "手术", "offset": "291"}, {"mention": "子宫", "label": "解剖部位", "offset": "317"}, {"mention": "两附件", "label": "解剖部位", "offset": "320"}, {"mention": "宫颈中至低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "327"}, {"mention": "宫颈", "label": "解剖部位", "offset": "342"}, {"mention": "宫体", "label": "解剖部位", "offset": "365"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "387"}, {"mention": "右闭孔淋巴结", "label": "解剖部位", "offset": "410"}, {"mention": "鳞状细胞癌", "label": "疾病和诊断", "offset": "417"}, {"mention": "艾素", "label": "药物", "offset": "492"}, {"mention": "顺铂", "label": "药物", "offset": "495"}]}
{"text": ",患者2013年7月无明显诱因,逐渐出现便次增多,未予系统诊治,其后病情反复发作。2014年6月始,下述症状加重,一日10余次,大便不成形,夹有黏液,偶有便中带血,偶有腹痛腹胀,以上腹为主,便后减轻,无恶心呕吐,无反酸烧心,就诊于本院,在门诊行肠镜(2014-7-20),检查示:乙状结肠,,直肠:距肛缘17-10cm可见不规则隆起样病变,环周,表面溃疡形成,覆污秽苔,取材6块,质脆,易出血。于2014-08-04全麻上直肠癌低位前切除术,术后病理回报进展期直肠癌,粘液腺瘤及中分化管状腺癌,断端无癌,淋巴结未见转移癌,送检盆壁组织见转移癌。2014-9-14开始行放疗,同步化疗2周期(奥沙利铂150mgd1+替吉奥60mg日双次口服d1-14),现放疗中,为行第3周期化疗入院。病来精神状态可,无乏力,无发热,饮食睡眠尚可,体重术后至今无明显改变。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "84"}, {"mention": "腹胀", "label": "症状", "offset": "86"}, {"mention": "上腹", "label": "解剖部位", "offset": "90"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "140"}, {"mention": "直肠", "label": "解剖部位", "offset": "146"}, {"mention": "直肠癌低位前切除术", "label": "手术", "offset": "211"}, {"mention": "进展期直肠癌,粘液腺瘤及中分化管状腺癌", "label": "疾病和诊断", "offset": "227"}, {"mention": "奥沙利铂", "label": "药物", "offset": "295"}, {"mention": "替吉奥", "label": "药物", "offset": "307"}]}
{"text": ",患者2011年5月1日因尿频尿急在外院检查,行b超及ct检查提示盆腔包块,建议进一步检查。遂就诊于我院,于2011-5-27全麻上行全子宫+两侧附件切除+大网膜切除+盆腔淋巴结清扫+腹主动脉旁淋巴结切除术。,术中探查:腹水500ml,淡黄。左卵巢肿瘤融合大小约12×7×6cm,实性,表面光滑,分叶状,质脆,左侧输卵管与盆腔肿块融合,右卵巢4*4*3cm。子宫大小约7×6×5cm,后壁与左侧附件肿物粘连紧密,余未见明显异常。,术中冰冻病理报告:左卵巢中分化浆液性腺癌。术后病理回报两侧卵巢中分化浆液性乳头状腺癌。盆地结节见癌转移。送检各组淋巴结未见癌转移。腹水细胞学可疑癌细胞。,术后诊断:两卵巢腺癌iib期。患者术后恢复可,于2011-6-7、2011-6-30、2011-8-9行tp(北华素240mg叒iv+伯尔定600mg叒ip)化疗方案三程,过程顺利。出院后定期复查血常规白细胞最低3.4x10~9/l,血小板正常,现为进一步化疗再次住院。近期食欲、精神、睡眠可,小便无明显异常,大便规律,成形,软,体重无明显上降。,既往化疗及肿瘤标志物情况:,化疗药物毒副反应:。", "mention_data": [{"mention": "b超", "label": "影像检查", "offset": "24"}, {"mention": "ct", "label": "影像检查", "offset": "27"}, {"mention": "盆腔包块", "label": "症状", "offset": "33"}, {"mention": "全子宫+两侧附件切除+大网膜切除+盆腔淋巴结清扫+腹主动脉旁淋巴结切除术", "label": "手术", "offset": "67"}, {"mention": "腹水", "label": "症状", "offset": "110"}, {"mention": "左卵巢肿瘤", "label": "疾病和诊断", "offset": "121"}, {"mention": "左侧输卵管", "label": "解剖部位", "offset": "155"}, {"mention": "盆腔肿块", "label": "症状", "offset": "161"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "168"}, {"mention": "子宫", "label": "解剖部位", "offset": "179"}, {"mention": "左侧附件", "label": "解剖部位", "offset": "195"}, {"mention": "左卵巢中分化浆液性腺癌", "label": "疾病和诊断", "offset": "224"}, {"mention": "两侧卵巢中分化浆液性乳头状腺癌", "label": "疾病和诊断", "offset": "242"}, {"mention": "腹水", "label": "症状", "offset": "280"}, {"mention": "两卵巢腺癌iib期", "label": "疾病和诊断", "offset": "297"}, {"mention": "北华素", "label": "药物", "offset": "347"}, {"mention": "伯尔定", "label": "药物", "offset": "359"}, {"mention": "白细胞", "label": "实验室检验", "offset": "393"}, {"mention": "血小板", "label": "实验室检验", "offset": "409"}]}
{"text": ",患者2015.11.18因胃癌并肝转移于我院行全胃切除术,,术后常规病理示:(胃)中低分化腺癌,溃疡型,肿瘤切面积9*2cm,侵透浆膜达周围脂肪组织,脉管内查见癌栓并查见神经侵犯。下上切缘吻合器切缘及术中送检食管切缘未查见癌。小弯侧淋巴结17枚,其中3枚查见转移(3/17);大弯侧淋巴结4枚,均未查见转移(0/4),网膜组织未查见癌。免疫组化;ck19(+)、e-cad(+)、her-2(3+)。,病理号:41745.15。术后给予消炎营养支持治疗,病情好转后出院。后行sox方案化疗1周期,,具体药物为:奥沙利铂150mg叒d1+替吉奥3粒叒bid*14天,后患者肿瘤指标较前明显增高,考虑进展,行多西他赛+卡培他滨方案化疗2周期,,具体药物为:多西他赛120mg叒d1+卡培他滨3粒叒bid*14天,耐受良好。2016.4复查ct示胃ca治疗后,考虑左肺门淋巴结、肝脏多发转移,较前片病变进展,两肺小结节,较前片无明显变化,建议随访,纵隔淋巴结略肿大,左肺局限性炎症,两肺纤维灶,右肾多发囊肿,腹腔及盆腔积液,改用伊立替康+顺铂化疗1周期,,具体药物为:伊立替康360mg叒d1+顺铂40mg叒d2-4,化疗后无明显不适,现患者为行上一周期化疗收入院。自下次出院来,患者饮食睡眠可,二便无明显异常,体重较前无明显改变。神经性头痛20余年,发作时自行口服止痛药物治疗。", "mention_data": [{"mention": "胃癌并肝转移", "label": "疾病和诊断", "offset": "14"}, {"mention": "全胃切除术", "label": "手术", "offset": "24"}, {"mention": "(胃)中低分化腺癌,溃疡型", "label": "疾病和诊断", "offset": "39"}, {"mention": "食管", "label": "解剖部位", "offset": "105"}, {"mention": "奥沙利铂", "label": "药物", "offset": "256"}, {"mention": "替吉奥", "label": "药物", "offset": "269"}, {"mention": "多西他赛", "label": "药物", "offset": "303"}, {"mention": "卡培他滨", "label": "药物", "offset": "308"}, {"mention": "多西他赛", "label": "药物", "offset": "327"}, {"mention": "卡培他滨", "label": "药物", "offset": "340"}, {"mention": "ct", "label": "影像检查", "offset": "368"}, {"mention": "胃ca治疗后", "label": "疾病和诊断", "offset": "371"}, {"mention": "左肺门淋巴结", "label": "解剖部位", "offset": "380"}, {"mention": "肝脏多发转移", "label": "疾病和诊断", "offset": "387"}, {"mention": "两肺", "label": "解剖部位", "offset": "402"}, {"mention": "纵隔淋巴结", "label": "解剖部位", "offset": "422"}, {"mention": "左肺", "label": "解剖部位", "offset": "431"}, {"mention": "两肺", "label": "解剖部位", "offset": "439"}, {"mention": "右肾多发囊肿", "label": "疾病和诊断", "offset": "445"}, {"mention": "腹腔及盆腔积液", "label": "疾病和诊断", "offset": "452"}, {"mention": "伊立替康", "label": "药物", "offset": "462"}, {"mention": "顺铂", "label": "药物", "offset": "467"}, {"mention": "伊立替康", "label": "药物", "offset": "482"}, {"mention": "顺铂", "label": "药物", "offset": "495"}]}
{"text": ",患者于2010年10月因\\\"上腹痛伴大便习惯改变\\\"外院行肠镜,病理示中分化腺癌;,外院b超示:盆腔内双个巨大团块,左侧145*101mm,右侧94*85mm,考虑卵巢来源可能性大;盆腔大量积液。为进一步治疗来我院就诊,考虑乙状结肠癌伴不完全梗阻、盆腔肿物,2010-10-25我院行\\\"子宫切除+两附件切除+dixon术+大网膜切除术开腹恶性肿瘤特殊治疗术\\\",术中5-fu1000mg肠腔化疗,门静脉5-fu250mg化疗,中人氟安800mg腹腔化疗,病理回报乙状结肠中分化腺癌,两侧卵巢转移瘤,中央组淋巴结转移4/15,pt4bn2m1。术后恢复良好,,2010-11-10我院ct:乙状结肠癌术后,肝s5、6段肝转移。遂2010-11-16至2011-5-19行forfiri方案化疗8程,过程顺利。2011-1-13,我院ct复查:乙状结肠癌术后、化疗后,肝转移瘤较前缩小、好转(较大病灶),较小病灶较前无明显变化,不排除为肝囊肿。疗效评价为sd。2011-4-6转外科行\\\"肝转移瘤切除术\\\",术后病理(463585),:符合肠癌肝转移。后于2011-05-20至2011-08-05继续forfiri方案化疗4程,2011-09-05复查ct未见肿瘤复发情况。2012-02-21复查ct提示右下肺及右上肺结节、左前丅壁结节,考虑转移瘤,两肺肺多发结节状小空洞影未排除转移。考虑肿瘤复发,今收住院进一步治疗,入院患者自觉无不适,胃纳、睡眠可,二便如常。", "mention_data": [{"mention": "上腹痛", "label": "症状", "offset": "15"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "36"}, {"mention": "b超", "label": "影像检查", "offset": "45"}, {"mention": "盆腔", "label": "解剖部位", "offset": "49"}, {"mention": "卵巢", "label": "解剖部位", "offset": "83"}, {"mention": "盆腔大量积液", "label": "疾病和诊断", "offset": "92"}, {"mention": "乙状结肠癌伴不完全梗阻", "label": "疾病和诊断", "offset": "113"}, {"mention": "盆腔", "label": "解剖部位", "offset": "125"}, {"mention": "子宫切除+两附件切除+dixon术+大网膜切除术开腹恶性肿瘤特殊治疗术", "label": "手术", "offset": "145"}, {"mention": "5-fu", "label": "药物", "offset": "185"}, {"mention": "肠", "label": "解剖部位", "offset": "195"}, {"mention": "门静脉", "label": "解剖部位", "offset": "200"}, {"mention": "5-fu", "label": "药物", "offset": "203"}, {"mention": "中人氟安", "label": "药物", "offset": "215"}, {"mention": "腹", "label": "解剖部位", "offset": "224"}, {"mention": "乙状结肠中分化腺癌", "label": "疾病和诊断", "offset": "233"}, {"mention": "两侧卵巢转移瘤", "label": "疾病和诊断", "offset": "243"}, {"mention": "ct", "label": "影像检查", "offset": "293"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "296"}, {"mention": "肝s5、6段肝转移", "label": "疾病和诊断", "offset": "304"}, {"mention": "ct", "label": "影像检查", "offset": "367"}, {"mention": "乙状结肠癌术后", "label": "疾病和诊断", "offset": "372"}, {"mention": "肝转移瘤", "label": "疾病和诊断", "offset": "384"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "418"}, {"mention": "肝转移瘤切除术", "label": "手术", "offset": "444"}, {"mention": "肠癌肝转移", "label": "疾病和诊断", "offset": "470"}, {"mention": "ct", "label": "影像检查", "offset": "527"}, {"mention": "ct", "label": "影像检查", "offset": "550"}, {"mention": "右下肺", "label": "解剖部位", "offset": "554"}, {"mention": "右上肺", "label": "解剖部位", "offset": "558"}, {"mention": "两肺", "label": "解剖部位", "offset": "577"}, {"mention": "肺", "label": "解剖部位", "offset": "579"}, {"mention": "胃", "label": "解剖部位", "offset": "622"}]}
{"text": ",下次入院,患者于今年5月,患者因腹痛于我院住院治疗,诊断为胰腺癌和2型糖尿病,因患者胰腺肿瘤侵犯血管,难以行根治手术,于2012-05-21日在全麻上行剖腹探查+胆肠吻合+胃肠吻合+胆囊切除术。术后患者恢复良好,无特殊不适。\\u0004叒叒本次入院,入院前半月前,患者无明显诱因出现两上肢水肿,呈凹陷性,中度,伴面色苍白,两眼睑浮肿,全身乏力,食欲减退,无咳嗽、咳痰,无身黄、眼黄、尿黄,无恶心、呕吐,无腹胀、腹痛等不适,夜间能平卧入睡,无端坐呼吸,下述症状持续存在,未给予特殊治疗,两上肢浮肿及面色苍白症状缓慢加重,为求进一步治疗,2012年12月24日,我院查血常规:,wbc:8.62×109/l,,n:29.9%,,rbc:2.37×1012/l,,hb:73g/l,,plt:252×109/l。门诊因“浮肿原因待查,中度贫血”收入院。\\u0004叒叒叒患者自起病以来,精神较萎,睡眠差,胃纳极差,大便次数减少,色基本正常,尿量减少,体重上降。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "17"}, {"mention": "胰腺癌", "label": "疾病和诊断", "offset": "30"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "34"}, {"mention": "胰腺", "label": "解剖部位", "offset": "43"}, {"mention": "剖腹探查+胆肠吻合+胃肠吻合+胆囊切除术", "label": "手术", "offset": "77"}, {"mention": "两上肢", "label": "解剖部位", "offset": "142"}, {"mention": "两眼睑", "label": "解剖部位", "offset": "162"}, {"mention": "腹胀", "label": "症状", "offset": "203"}, {"mention": "腹痛", "label": "症状", "offset": "206"}, {"mention": "两上肢", "label": "解剖部位", "offset": "243"}, {"mention": "wbc", "label": "实验室检验", "offset": "288"}, {"mention": "n", "label": "实验室检验", "offset": "304"}, {"mention": "rbc", "label": "实验室检验", "offset": "313"}, {"mention": "hb", "label": "实验室检验", "offset": "330"}, {"mention": "plt", "label": "实验室检验", "offset": "340"}, {"mention": "中度贫血", "label": "疾病和诊断", "offset": "365"}, {"mention": "胃", "label": "解剖部位", "offset": "400"}]}
{"text": ",缘于入院前6小时于进食后出现中下腹部痛,疼痛剧烈,呈刀割样、持续性,无阵发性加剧,伴肩部放射痛,无恶心、呕吐、呕血,无腹泻、黑便、便血,无发热、畏冷、寒战,无咳嗽、咳痰,无尿频、尿急、尿痛,遂急诊我院,,急查腹部立位平片示:两膈上游离气体,考虑消化道穿孔。,腹部彩超:1.急诊腹腔内大量气体干扰;2.肝实质回声增粗、增亮;3.胆囊体积增大,壁毛糙;4.肝内外胆管扩张;5.胰腺稍大、回声异常;6.少量腹水;7.脾多发钙化斑;8.前列腺轻度增生并结石;9.腹主动脉粥样硬化声像改变。,心电图:窦性心律。,肝肾功能:alt124u/l,ast96u/l,ldh639u/l,bun11.5mmol/l,cre127umol/l,ua697umol/l;血常规、dic+血凝未见明显异常。考虑“消化道穿孔可能”,予禁食、胃肠减压、“生长抑素”抑制消化液分泌,“舒普深、奥硝唑”抗感染及制酸、补液等处理后,腹痛稍缓解。现为行手术治疗,急诊拟“,腹痛待查:消化道穿孔?”收住我科。自发病以来,精神、睡眠差,进食状态,大便未解,小便正常,体重无变化。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "15"}, {"mention": "肩部", "label": "解剖部位", "offset": "43"}, {"mention": "腹泻", "label": "症状", "offset": "60"}, {"mention": "腹部立位平片", "label": "影像检查", "offset": "105"}, {"mention": "膈", "label": "解剖部位", "offset": "114"}, {"mention": "消化道穿孔", "label": "疾病和诊断", "offset": "123"}, {"mention": "腹", "label": "解剖部位", "offset": "139"}, {"mention": "肝", "label": "解剖部位", "offset": "151"}, {"mention": "胆囊", "label": "解剖部位", "offset": "164"}, {"mention": "肝内外胆管扩张", "label": "疾病和诊断", "offset": "177"}, {"mention": "胰腺", "label": "解剖部位", "offset": "187"}, {"mention": "腹水", "label": "症状", "offset": "201"}, {"mention": "脾", "label": "解剖部位", "offset": "206"}, {"mention": "前列腺轻度增生并结", "label": "疾病和诊断", "offset": "215"}, {"mention": "腹主动脉粥样硬化", "label": "疾病和诊断", "offset": "228"}, {"mention": "alt", "label": "实验室检验", "offset": "257"}, {"mention": "ast", "label": "实验室检验", "offset": "267"}, {"mention": "ldh", "label": "实验室检验", "offset": "276"}, {"mention": "bun", "label": "实验室检验", "offset": "286"}, {"mention": "cre", "label": "实验室检验", "offset": "300"}, {"mention": "ua", "label": "实验室检验", "offset": "313"}, {"mention": "消化道穿孔", "label": "疾病和诊断", "offset": "345"}, {"mention": "生长抑素", "label": "药物", "offset": "364"}, {"mention": "舒普深", "label": "药物", "offset": "378"}, {"mention": "奥硝唑", "label": "药物", "offset": "382"}, {"mention": "腹痛", "label": "症状", "offset": "400"}, {"mention": "腹痛", "label": "症状", "offset": "419"}, {"mention": "消化道穿孔", "label": "疾病和诊断", "offset": "424"}]}
{"text": "患者一个月前因“白带混血,性交后阴道流血”于外院行宫颈锥切术,术后病理我院会诊:浸润癌深度约3—4mm,有脉管浸润,鳞癌(中分化)。因盆腔炎性重,不宜手术,于4月14日行bep方案化疗,过程顺利,复查血常规回报正常,准予出院。出院后口服拜复乐及西黄丸3***治疗。末次月经为2010年1月,具体日期不详。出院至今,无发热,无明显消瘦乏力及腹痛腹胀,饮食睡眠良好,大小便正常。", "mention_data": [{"mention": "阴道", "label": "解剖部位", "offset": "16"}, {"mention": "宫颈锥切术", "label": "手术", "offset": "25"}, {"mention": "鳞癌(中分化)", "label": "疾病和诊断", "offset": "58"}, {"mention": "盆腔", "label": "解剖部位", "offset": "67"}, {"mention": "拜复乐", "label": "药物", "offset": "118"}, {"mention": "西黄丸", "label": "药物", "offset": "122"}, {"mention": "腹痛", "label": "症状", "offset": "169"}, {"mention": "腹胀", "label": "症状", "offset": "171"}]}
{"text": ",患者主因3周前因“贫血”,行胃镜检查提示:十二指肠球部粘膜光滑,降段后壁见一半球样隆起,约3*2cm大小,表面粘膜充血伴糜烂,,病理提示:管状绒毛状腺瘤型息肉,,肠镜检查提示:横结肠见一溃疡型隆起型病变,充满管腔全周,镜身无法通过,,提示:横结肠癌,,病理提示:腺癌,,我院病理会诊提示:(结肠)高级别绒毛管状腺瘤,伴癌变和粘膜肌浸润;,我院ct提示:结肠肝曲肠壁不规则增厚及强化,较厚约25mm(图81),浆膜面模糊,部分层面与肝上缘及胆囊关系密切;邻近可见散在小淋巴结,较大约13*7mm,,提示:叒结肠肝曲肠壁不规则增厚及强化,符合癌,肝上缘及胆囊受侵?为求进一步手术治疗入院。患者自发病以来精神睡眠尚好,纳差,小便如常,大便褐色,近1个月体重上降5kg。", "mention_data": [{"mention": "贫血", "label": "疾病和诊断", "offset": "10"}, {"mention": "十二指肠球部", "label": "解剖部位", "offset": "22"}, {"mention": "管状绒毛状腺瘤型息肉", "label": "疾病和诊断", "offset": "70"}, {"mention": "横结肠", "label": "解剖部位", "offset": "89"}, {"mention": "横结肠癌", "label": "疾病和诊断", "offset": "121"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "132"}, {"mention": "(结肠)高级别绒毛管状腺瘤", "label": "疾病和诊断", "offset": "145"}, {"mention": "ct", "label": "影像检查", "offset": "172"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "177"}, {"mention": "肝", "label": "解剖部位", "offset": "216"}, {"mention": "胆囊", "label": "解剖部位", "offset": "220"}, {"mention": "结肠肝", "label": "解剖部位", "offset": "253"}, {"mention": "肝", "label": "解剖部位", "offset": "272"}, {"mention": "胆囊", "label": "解剖部位", "offset": "276"}]}
{"text": ",患者因子宫肌瘤于2014-01-08在我院手术探查,术中快速冰冻提示子宫平滑肌肉瘤,遂行全子宫+两侧附件切除术+盆腔淋巴结清扫术。,术后病理回示:(全子宫),镜上:肿瘤细胞呈束状或编织状排列,瘤细胞梭形或卵圆形,核深染,异型性明显,可见瘤巨细胞,核分裂像易见,可见坏死,结合免疫组化结果,病变诊断为平滑肌肉瘤;未见明确脉管及神经束侵犯;增殖期子宫内膜;子宫多发性平滑肌瘤。两附件及淋巴结未见肿瘤。术后诊断“子宫平滑肌肉瘤ib期”。于2014-01-27、2014-02-25行脂质体多柔比星+异环磷酰胺方案化疗2程。化疗过程顺利,无明显化疗反应,定期复查血常规提示白细胞正常。今遵嘱返院行上一疗程化疗。患者病来,精神好,饮食睡眠及大小便正常,体重无明显减轻。,外院治疗经过:无。", "mention_data": [{"mention": "子宫肌瘤", "label": "疾病和诊断", "offset": "4"}, {"mention": "子宫平滑肌肉瘤", "label": "疾病和诊断", "offset": "35"}, {"mention": "全子宫+两侧附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "45"}, {"mention": "全子宫", "label": "解剖部位", "offset": "75"}, {"mention": "平滑肌肉瘤", "label": "疾病和诊断", "offset": "150"}, {"mention": "子宫", "label": "解剖部位", "offset": "172"}, {"mention": "子宫多发性平滑肌瘤", "label": "疾病和诊断", "offset": "177"}, {"mention": "两附件", "label": "解剖部位", "offset": "187"}, {"mention": "子宫平滑肌肉瘤ib期", "label": "疾病和诊断", "offset": "204"}, {"mention": "脂质体多柔比星", "label": "药物", "offset": "239"}, {"mention": "环磷酰胺", "label": "药物", "offset": "248"}, {"mention": "白细胞", "label": "实验室检验", "offset": "283"}]}
{"text": ",患者2011年09月在本院诊断为肝内胆管细胞癌,并于2011年11月01日、2012年02月28日行肝动脉灌注化疗术双次,术中用药5-,fu:0.5mg,,健择:1.2g,2012年04月11日,复查ct提示:胆管癌介入治疗后;右肝管内病变较前稍缩小;肝右叶肝内胆管扩张。于2012-04-19于全麻上行胆管癌切除术。后定期复查。2016.12.16患者无明显诱因出现眼黄、皮肤黄,2017-1-11在我科行ptcd术,术程顺利。复查,ct:,右肝内胆管细胞癌术后综合治疗后复查:左肝管近端管腔内软组织灶,较前增大,复发肿瘤可能性大。肝左叶肝内胆管扩张程度较前减低。脾稍大。于2017-2-6行肝肿瘤微波消融术。叒患者目前无腹痛腹胀、无恶心呕吐、无畏寒发热,精神尚可,食欲如常。大小便正常。体重无明显上降。", "mention_data": [{"mention": "肝内胆管细胞癌", "label": "疾病和诊断", "offset": "17"}, {"mention": "肝动脉灌注化疗术", "label": "手术", "offset": "51"}, {"mention": "5-,fu", "label": "药物", "offset": "66"}, {"mention": "健择", "label": "药物", "offset": "79"}, {"mention": "ct", "label": "影像检查", "offset": "101"}, {"mention": "胆管癌介入治疗后", "label": "疾病和诊断", "offset": "106"}, {"mention": "右肝管", "label": "解剖部位", "offset": "115"}, {"mention": "肝右叶肝内胆管扩张", "label": "疾病和诊断", "offset": "127"}, {"mention": "胆管癌切除术", "label": "手术", "offset": "153"}, {"mention": "ptcd术", "label": "手术", "offset": "205"}, {"mention": "ct", "label": "影像检查", "offset": "219"}, {"mention": "右肝内胆管细胞癌术后综合治疗后", "label": "疾病和诊断", "offset": "223"}, {"mention": "左肝管", "label": "解剖部位", "offset": "241"}, {"mention": "肝左叶肝内胆管", "label": "解剖部位", "offset": "268"}, {"mention": "脾", "label": "解剖部位", "offset": "284"}, {"mention": "肝肿瘤微波消融术", "label": "手术", "offset": "298"}, {"mention": "腹痛", "label": "症状", "offset": "313"}, {"mention": "腹胀", "label": "症状", "offset": "315"}]}
{"text": "2011-4-2因盲肠癌行左半结肠癌根治术手,术后病理示回盲部中低分化腺癌,部分伴粘液腺癌分化,浆膜层,脉管癌栓,未侵及阑尾,断端-,0/18,术前肿标均正常,pt3n0m0,化疗*6,具体不详,末次2011.8。2012-2出现肛门上坠感,右侧腹痛,体重同前。2012-2-28腹部ct示右侧结肠旁沟及横结肠内转移可能,查pet/ct示横结肠上方/右结肠/直肠前方软组织肿块并代谢活跃,考虑转移,肿标正常.2012.3.15始行xeliri化疗7周期;腹盆ct:腹盆腔系膜内多发结节及肿块,m。评效sd\\u0004\\u0004叒现饮食可,两手胀痛1级,两脚水泡,口腔溃疡1级。近3天大便稀,1-2次/天。\\u0004\\u0004叒预期复查判效。", "mention_data": [{"mention": "盲肠癌", "label": "疾病和诊断", "offset": "9"}, {"mention": "左半结肠癌根治术", "label": "手术", "offset": "13"}, {"mention": "回盲部中低分化腺癌,部分伴粘液腺癌分化", "label": "疾病和诊断", "offset": "28"}, {"mention": "阑尾", "label": "解剖部位", "offset": "60"}, {"mention": "肛门", "label": "解剖部位", "offset": "115"}, {"mention": "腹痛", "label": "症状", "offset": "123"}, {"mention": "腹部ct", "label": "影像检查", "offset": "140"}, {"mention": "右侧结肠旁沟", "label": "解剖部位", "offset": "145"}, {"mention": "横结肠", "label": "解剖部位", "offset": "152"}, {"mention": "pet/ct", "label": "影像检查", "offset": "162"}, {"mention": "横结肠", "label": "解剖部位", "offset": "169"}, {"mention": "右结肠", "label": "解剖部位", "offset": "175"}, {"mention": "直肠", "label": "解剖部位", "offset": "179"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "227"}, {"mention": "腹", "label": "解剖部位", "offset": "232"}, {"mention": "盆腔", "label": "解剖部位", "offset": "233"}, {"mention": "两手", "label": "解剖部位", "offset": "270"}, {"mention": "两脚", "label": "解剖部位", "offset": "277"}, {"mention": "口腔溃疡", "label": "疾病和诊断", "offset": "282"}]}
{"text": ",患者3个月前因“腹痛2天,加重半天”就诊我科,于2012-10-15全子宫两附件大网膜阑尾切除、腹壁病灶切除术,,术中见:盆腹腔无液体。肝脾胃未及病灶;肠管表面及肠系膜可见散在小的粟粒结节。子宫常大,子宫膀胱反折腹膜明显癌样增厚,与子宫前壁粘连。子宫后壁与肠管前壁粘连。左卵巢瘤手拳大,与阔韧带后叶及肠管粘连,右卵巢鸡卵大,与周围组织粘连,大网膜末端增厚,可见癌灶,左侧腹壁穿刺点病灶大小4-5cm,侵及腹膜,未达肌层,与大网膜末端病灶致密粘连。手术顺利,病理回报(z0442250),:c叒宫壁内见腺样癌巢叒de叒卵巢浆液性囊腺癌(中分化)叒f叒囊壁组织内见腺样癌巢叒g叒网膜组织内见腺样癌巢叒h叒阑尾浆膜面见腺样癌巢。,出院诊断:卵巢浆液性囊腺癌(中分化)iiic期(两侧卵巢、大网膜、盆腔腹膜、肠系膜、阑尾)2次化疗后1个月。患者术前行多西他赛+卡铂方案化疗2次,术后化疗1次,末次化疗时间2012-10-24,现为求补充治疗入我科。出院至今化疗副反应轻微,无头晕头迷,无恶心呕吐,无腹胀腹泻,大小便正常,饮食睡眠可,近期无明显体重变化。叒高血压病史5年。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "9"}, {"mention": "全子宫两附件大网膜阑尾切除、腹壁病灶切除术", "label": "手术", "offset": "35"}, {"mention": "腹", "label": "解剖部位", "offset": "63"}, {"mention": "肝", "label": "解剖部位", "offset": "69"}, {"mention": "脾", "label": "解剖部位", "offset": "70"}, {"mention": "胃", "label": "解剖部位", "offset": "71"}, {"mention": "肠", "label": "解剖部位", "offset": "77"}, {"mention": "肠", "label": "解剖部位", "offset": "82"}, {"mention": "子宫", "label": "解剖部位", "offset": "96"}, {"mention": "子宫", "label": "解剖部位", "offset": "101"}, {"mention": "膀胱", "label": "解剖部位", "offset": "103"}, {"mention": "腹", "label": "解剖部位", "offset": "107"}, {"mention": "子宫", "label": "解剖部位", "offset": "117"}, {"mention": "子宫", "label": "解剖部位", "offset": "124"}, {"mention": "肠", "label": "解剖部位", "offset": "129"}, {"mention": "左卵巢瘤", "label": "疾病和诊断", "offset": "136"}, {"mention": "阔韧带后叶", "label": "解剖部位", "offset": "145"}, {"mention": "肠", "label": "解剖部位", "offset": "151"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "156"}, {"mention": "腹", "label": "解剖部位", "offset": "186"}, {"mention": "腹", "label": "解剖部位", "offset": "203"}, {"mention": "卵巢浆液性囊腺癌(中分化)", "label": "疾病和诊断", "offset": "259"}, {"mention": "阑尾", "label": "解剖部位", "offset": "301"}, {"mention": "卵巢浆液性囊腺癌(中分化)iiic期", "label": "疾病和诊断", "offset": "318"}, {"mention": "两侧卵巢", "label": "解剖部位", "offset": "337"}, {"mention": "盆腔", "label": "解剖部位", "offset": "346"}, {"mention": "肠", "label": "解剖部位", "offset": "351"}, {"mention": "阑尾", "label": "解剖部位", "offset": "355"}, {"mention": "多西他赛", "label": "药物", "offset": "372"}, {"mention": "卡铂", "label": "药物", "offset": "377"}, {"mention": "头晕", "label": "症状", "offset": "434"}, {"mention": "头", "label": "解剖部位", "offset": "436"}, {"mention": "腹胀", "label": "症状", "offset": "446"}, {"mention": "腹泻", "label": "症状", "offset": "448"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "474"}]}
{"text": ",患者于2011年4月份因\\\"大便次数增多2月余,ct发现盆腔占位10天\\\"入住我院综合科,于5月3日行剖腹探查术,见肿物位于距回盲部150cm回肠处,行肿物及双端5cm空肠切除术,术后恢复可,,术后病理:胃肠间质肿瘤,3个核分裂/50hpf,,免疫组化:cd34-、cd117+,s-100(-)、sam+/-,des(-),hhf35-;2011-5-11起口服格列卫400mg叒qd治疗,耐受可。偶有心前区不适,随访心电图、心功酶等均未见明显异常。无颜面水肿及皮肤瘙痒,无恶心、呕吐、腹痛不适。现入院继续格列卫化疗。患者起病以来,无发热、乏力、咳嗽、气促、身目黄染等,精神睡眠可,胃纳欠佳,小便正常,大便1次/天,体重无明显上降。", "mention_data": [{"mention": "ct", "label": "影像检查", "offset": "25"}, {"mention": "盆腔", "label": "解剖部位", "offset": "29"}, {"mention": "剖腹探查术", "label": "手术", "offset": "52"}, {"mention": "回盲部", "label": "解剖部位", "offset": "64"}, {"mention": "回肠", "label": "解剖部位", "offset": "72"}, {"mention": "空肠切除术", "label": "手术", "offset": "85"}, {"mention": "胃肠间质肿瘤", "label": "疾病和诊断", "offset": "103"}, {"mention": "格列卫", "label": "药物", "offset": "183"}, {"mention": "心", "label": "解剖部位", "offset": "203"}, {"mention": "腹痛", "label": "症状", "offset": "245"}, {"mention": "格列卫", "label": "药物", "offset": "255"}]}
{"text": "2006年6月发现胃mt,行胃大部切除术后,2月前胃镜显示未见肿瘤复发征象。双年前外院发现肝内占位,考虑胃mt肝转移,曾在外院及我院行多次化疗。复查ct肝内病灶及腹膜后病灶sd。于2011-5-5患者仰卧位,以4f叒rh导管插管至腹腔干影示膈动脉与腹腔动脉共干,肝左叶单发巨大肿瘤血管染色,超选择插管至肿瘤血管支,灌注注入拓喜14mg,另以奥铂150mg+thp30mg+超液化碘油4ml制成混悬液行栓塞,碘油沉积良好。为进一步巩固治疗,收住入院。目前,患者神清,食欲可,睡眠正常,二便正常,体重无明显减轻。", "mention_data": [{"mention": "胃mt肝转移", "label": "疾病和诊断", "offset": "52"}, {"mention": "ct", "label": "影像检查", "offset": "74"}, {"mention": "腹腔动脉", "label": "解剖部位", "offset": "124"}, {"mention": "拓喜", "label": "药物", "offset": "161"}, {"mention": "thp", "label": "药物", "offset": "178"}, {"mention": "碘油", "label": "药物", "offset": "203"}]}
{"text": ",患者平素月经规则,lmp叒2015-11-07,量中,无明显异常。患者2015-11-13就诊*********中心,行妇科检查,,宫颈tct检查提示:有非典型腺细胞,怀疑腺癌。,盆腔彩超:子宫小肌瘤,宫颈前唇异常回声(17×19×16mm),性质待查。两侧附件暂未见明显异常。进一步行阴道镜检查+宫颈活检,,术后病理提示:宫颈3、6、9、11点均为高-中分化腺癌。后于我院就诊,考虑为宫颈腺癌iia1期,遂于2015-11-22在我院全麻上行“经腹iii型全子宫切除+两侧附件切除+两侧盆腔淋巴结清扫+腹主动脉旁淋巴结切除术”,术程顺利,,术后病理示:(全子宫)镜检为高至中分化腺癌,形态与(右附件)结节相似,结合免疫组化结果,符合浆液性癌;癌组织浸润宫颈全层至外膜层及脂肪结缔组织,并累及阴道穹窿及子宫体上段;可见脉管内癌栓及神经束侵犯。术后于2015-12-03行“紫杉醇+顺铂”方案化疗1程,同时配合行cik细胞免疫治疗。化疗后因两上肢疼痛,考虑深静脉血栓,予2015-12-10至2015-12-16在**一院行抗血栓治疗,2015-12-16复查彩超示两上肢血管通畅。2015-12-16开始继续在我科行cik细胞免疫治疗。定期复查未见肿瘤复发、转移,末次复查时间2016-02-15。现患者为行cik细胞回输入我科。起病以来,患者精神、胃纳可,大小便无明显异常,体重无明显变化。", "mention_data": [{"mention": "腺癌", "label": "疾病和诊断", "offset": "87"}, {"mention": "子宫小肌瘤", "label": "疾病和诊断", "offset": "96"}, {"mention": "宫颈前唇", "label": "解剖部位", "offset": "102"}, {"mention": "两侧附件", "label": "解剖部位", "offset": "128"}, {"mention": "阴道镜检查+宫颈活检", "label": "手术", "offset": "144"}, {"mention": "宫颈3、6、9、11点", "label": "解剖部位", "offset": "163"}, {"mention": "高-中分化腺癌", "label": "疾病和诊断", "offset": "176"}, {"mention": "宫颈腺癌iia1期", "label": "疾病和诊断", "offset": "194"}, {"mention": "经腹iii型全子宫切除+两侧附件切除+两侧盆腔淋巴结清扫+腹主动脉旁淋巴结切除术", "label": "手术", "offset": "224"}, {"mention": "全子宫", "label": "解剖部位", "offset": "279"}, {"mention": "高至中分化腺癌", "label": "疾病和诊断", "offset": "286"}, {"mention": "右附件", "label": "解剖部位", "offset": "298"}, {"mention": "宫颈", "label": "解剖部位", "offset": "328"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "347"}, {"mention": "子宫体", "label": "解剖部位", "offset": "352"}, {"mention": "紫杉醇", "label": "药物", "offset": "387"}, {"mention": "顺铂", "label": "药物", "offset": "391"}, {"mention": "两上肢", "label": "解剖部位", "offset": "420"}, {"mention": "深静脉血栓", "label": "疾病和诊断", "offset": "428"}, {"mention": "彩超", "label": "影像检查", "offset": "480"}, {"mention": "两上肢血管", "label": "解剖部位", "offset": "483"}, {"mention": "胃", "label": "解剖部位", "offset": "576"}]}
{"text": ",患者2006-11无明显诱因便血2周,,外院肠镜示:至肛门2-3cm肿物,直肠中分化腺癌。2006-11在我院行miles术,病理示中分化腺癌,浸润深肌层,淋巴结0/3,脉管内见癌栓,pt2n0m0,i期.术后于2007-05至2008-01-28行xeloda单药化疗4程。后定期复查。,2013-03-26复查ct:两肺转移;纵隔及两肺门多发淋巴结转移;腹主动脉及两髂血管旁多发淋巴结转移。,肺部病灶穿刺活检示:中分化腺癌,提示肠癌转移可能性大。遂于2013-04-27至2013-10-09在我科行一线folfox方案化疗9程,3程后评价sd,6程后评价pr,9程后评价pd。患者拟参加阿柏西普临床试验,因血小板偏低,不符合入组筛选条件。2013-11-04行二线cpt-11单药化疗1程,11-27、2013-12-17、1-3行cpt-11+安维汀化疗3程,4程化疗后ct评价示sd。下程化疗后出现i度呕吐,经对症处理后恢复。现为继续上程化疗收入院。现患者一般情况可,大小便正常,体重无明显变化。", "mention_data": [{"mention": "肛门", "label": "解剖部位", "offset": "28"}, {"mention": "直肠中分化腺癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "miles术", "label": "手术", "offset": "57"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "67"}, {"mention": "xeloda", "label": "药物", "offset": "126"}, {"mention": "ct", "label": "影像检查", "offset": "158"}, {"mention": "两肺转移", "label": "疾病和诊断", "offset": "161"}, {"mention": "纵隔", "label": "解剖部位", "offset": "166"}, {"mention": "两肺门", "label": "解剖部位", "offset": "169"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "180"}, {"mention": "两髂血管", "label": "解剖部位", "offset": "185"}, {"mention": "肺部", "label": "解剖部位", "offset": "199"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "209"}, {"mention": "肠癌", "label": "疾病和诊断", "offset": "217"}, {"mention": "阿柏西普", "label": "药物", "offset": "297"}, {"mention": "血小板", "label": "实验室检验", "offset": "307"}, {"mention": "cpt-11", "label": "药物", "offset": "336"}, {"mention": "cpt-11", "label": "药物", "offset": "370"}, {"mention": "安维汀", "label": "药物", "offset": "377"}, {"mention": "ct", "label": "影像检查", "offset": "390"}]}
{"text": ",间断腹痛,2016-10我院pet-ct及外院胃镜等确诊胃体下段后壁大弯溃疡,印戒细胞癌,弥漫型;腹腔腹膜后lnm及腹膜卵巢m;,ca199:128;2016-10-19腹腔镜上两卵巢切除术+腹腔热灌注,cy0,右腹腔数枚结节,胃体病灶未侵透浆膜,,术后病理:右左卵巢约4cm,印戒细胞癌及低分化腺癌;伞端+;右输卵管系膜内脉管癌栓,左侧未累及;术后sox*2(腹痛纳差腹泻呕吐,s1未完成)--xelox*2(奥沙利铂较前减量,n上降iii度,xeloda仅7日),末次2017-2-9。休息至今,2017.3胸腹盆ct示稳定,基本无不适,体重增加3kg。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "3"}, {"mention": "pet-ct", "label": "影像检查", "offset": "15"}, {"mention": "胃体", "label": "解剖部位", "offset": "29"}, {"mention": "印戒细胞癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "腹", "label": "解剖部位", "offset": "50"}, {"mention": "腹膜后lnm", "label": "疾病和诊断", "offset": "52"}, {"mention": "腹", "label": "解剖部位", "offset": "59"}, {"mention": "卵巢", "label": "解剖部位", "offset": "61"}, {"mention": "ca199", "label": "实验室检验", "offset": "66"}, {"mention": "腹腔镜上两卵巢切除术+腹腔热灌注", "label": "手术", "offset": "86"}, {"mention": "腹", "label": "解剖部位", "offset": "108"}, {"mention": "胃体", "label": "解剖部位", "offset": "115"}, {"mention": "卵巢", "label": "解剖部位", "offset": "133"}, {"mention": "印戒细胞癌及低分化腺癌", "label": "疾病和诊断", "offset": "140"}, {"mention": "右输卵管", "label": "解剖部位", "offset": "156"}, {"mention": "腹痛", "label": "症状", "offset": "182"}, {"mention": "腹泻", "label": "症状", "offset": "186"}, {"mention": "s1", "label": "药物", "offset": "191"}, {"mention": "奥沙利铂", "label": "药物", "offset": "207"}, {"mention": "xeloda", "label": "药物", "offset": "224"}, {"mention": "胸腹盆ct", "label": "影像检查", "offset": "257"}]}
{"text": ",胃癌根治术术后复查。2014-4-28胃癌手术,,术后肿瘤病理分期:pt3n3b。术后行sox方案2周期。末次化疗2014-6月。2015-6-5b,超:腹膜后多发淋巴结,倾向m肝内钙化灶,肝囊肿,胆囊淤胆.2015-6-9,与2014-05-12腹部ct比较:1叒胃癌术后较前相仿,吻合口壁未见增厚及异常强化。2叒腹腔内积气消失,盆腔内见少量积液。肝门静脉及腹膜后新见多发肿大融合淋巴结,较大约46x26mm,考虑转移。两侧髂血管旁未见肿大淋巴结。3叒肝右叶低密度灶较前增大,仍未见强化,原约8x4mm,现约11x9mm。", "mention_data": [{"mention": "胃癌根治术", "label": "手术", "offset": "1"}, {"mention": "胃癌手术", "label": "手术", "offset": "20"}, {"mention": "b,超", "label": "影像检查", "offset": "74"}, {"mention": "腹", "label": "解剖部位", "offset": "78"}, {"mention": "肝内钙化", "label": "症状", "offset": "90"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "96"}, {"mention": "胆囊", "label": "解剖部位", "offset": "100"}, {"mention": "腹部ct", "label": "影像检查", "offset": "125"}, {"mention": "胃癌术后", "label": "疾病和诊断", "offset": "134"}, {"mention": "腹", "label": "解剖部位", "offset": "159"}, {"mention": "盆腔", "label": "解剖部位", "offset": "167"}, {"mention": "肝门静脉", "label": "解剖部位", "offset": "176"}, {"mention": "腹", "label": "解剖部位", "offset": "181"}, {"mention": "两侧髂血管", "label": "解剖部位", "offset": "212"}, {"mention": "肝右叶", "label": "解剖部位", "offset": "228"}]}
{"text": ",患者16年4月因“大便次数增多2月”于我院诊断为直肠癌,2016-04-21我院超声肠镜考虑直肠癌(ut3n1)结肠多发息肉。病理提示中分化腺癌。2016-04-22,我院mri示:考虑直肠上段病变,符合直肠癌,侵及肠壁全层。直肠周小淋巴结,转移可能性大。于2016-05-05至07-13行4程xelox方案化疗,,同期2016-05-27至2016-06-30行放疗:ptv1叒50gy/25f;ptv2叒46gy/25f,复查病灶较前缩小。2016-08-24全麻上行腹腔镜dixon,,术后病理:1(肠大体),镜上:肠壁粘膜上层中见少许异型腺体浸润,结合病史及免疫组化结果,符合中分化腺癌,未见明确脉管内癌栓及神经束侵犯;另见纤维组织增生,伴钙化及淋巴细胞、多核巨细胞等炎症细胞浸润,符合治疗后改变;,肿瘤消退分级:mandard叒trg叒2级。2(近切缘)未见癌。3(远切缘)未见癌。4(中央组淋巴结)镜上为脂肪结缔组织,未见淋巴结,未见癌。5(中间组淋巴结)1枚,未见癌。6(肠旁淋巴结)1枚,未见癌;另见少许肠壁组织,未见癌。,免疫组化:ck(+),ck20(+),cdx-2(+)。患者术后恢复可。2016-9-29在我院行奥沙利铂+卡培他滨方案化疗1程,过程顺利。现为进一步治疗入院。自起病以来,患者诉有上腹痛,无腹胀,无恶心、呕吐,无发热、畏寒。精神、睡眠良好,胃纳可,体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "25"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "47"}, {"mention": "结肠多发息肉", "label": "疾病和诊断", "offset": "57"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "68"}, {"mention": "mri", "label": "影像检查", "offset": "87"}, {"mention": "直肠上段", "label": "解剖部位", "offset": "94"}, {"mention": "直肠癌", "label": "疾病和诊断", "offset": "103"}, {"mention": "肠", "label": "解剖部位", "offset": "109"}, {"mention": "直肠周小淋巴结", "label": "解剖部位", "offset": "114"}, {"mention": "腹腔镜dixon", "label": "手术", "offset": "238"}, {"mention": "肠", "label": "解剖部位", "offset": "255"}, {"mention": "肠", "label": "解剖部位", "offset": "263"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "294"}, {"mention": "肠旁淋巴结", "label": "解剖部位", "offset": "445"}, {"mention": "肠", "label": "解剖部位", "offset": "462"}, {"mention": "奥沙利铂", "label": "药物", "offset": "521"}, {"mention": "卡培他滨", "label": "药物", "offset": "526"}, {"mention": "上腹痛", "label": "症状", "offset": "562"}, {"mention": "腹胀", "label": "症状", "offset": "567"}, {"mention": "胃", "label": "解剖部位", "offset": "592"}]}
{"text": ",患者因“直肠癌放疗后”于2017-2-22在全麻上行腹腔镜辅助直肠癌低位前切除,末段回肠预防性造口联合右侧卵巢切除术,手术过程顺利,,术后病理提示:2017-02-27叒1、(直肠,放化疗后),切除:叒-叒瘤床充分取材,各层均见粘液湖,散在少量退变的癌细胞簇,间质纤维组织增生,伴炎细胞浸润,符合治疗后反应,ajcc/nccn叒trg叒,分级:1级;叒-叒未见脉管癌栓及神经侵犯;叒-叒癌浸润至肌层外的维脂肪组织。叒-(近端)、(远端)及环周切缘未见癌;叒-叒淋巴结未见癌转移(肠周0/6、肠系膜上动脉根部0/1);叒-叒,肿瘤病理分期:ypt3n0;2、(右卵巢),切除:叒-叒输卵管副中肾管囊肿双枚,直径1.5-2.5cm;叒-叒输卵管未见特殊;叒-叒未见卵巢组织。术后恢复顺利。术后行1周期xelox化疗,,化疗后出现严重反应:消化道反应iv级,头晕卧床一周余,希罗达未口服。改用予更改单药口服希罗达2.5g,qd,d1-14。已服用希罗达2月,目前已停药。术后3月行复查行胸部ct检查见右肺上叶占位,考虑转移。1周前复查,血常规、生化、凝血、感筛未见明显异常,腹部ct未见肿瘤复发或转移,,肠镜:未见吻合口狭窄、新生物,直肠及乙状结肠结肠粘膜充血糜烂,已取病理。,胸部ct见:右肺上叶占位21mm*16mm,较前增大。现患者为求造口还纳收入我院。患者术后一般情况可,饮食、睡眠可,精神食欲可,未见明显体重变化。", "mention_data": [{"mention": "直肠癌放疗后", "label": "疾病和诊断", "offset": "5"}, {"mention": "腹腔镜辅助直肠癌低位前切除,末段回肠预防性造口联合右侧卵巢切除术", "label": "手术", "offset": "27"}, {"mention": "直肠", "label": "解剖部位", "offset": "89"}, {"mention": "肠", "label": "解剖部位", "offset": "240"}, {"mention": "肠系膜上动脉", "label": "解剖部位", "offset": "246"}, {"mention": "右卵巢", "label": "解剖部位", "offset": "280"}, {"mention": "输卵管副中肾管囊肿", "label": "疾病和诊断", "offset": "291"}, {"mention": "输卵管", "label": "解剖部位", "offset": "318"}, {"mention": "卵巢", "label": "解剖部位", "offset": "331"}, {"mention": "希罗达", "label": "药物", "offset": "385"}, {"mention": "希罗达", "label": "药物", "offset": "401"}, {"mention": "希罗达", "label": "药物", "offset": "421"}, {"mention": "胸部ct", "label": "影像检查", "offset": "441"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "448"}, {"mention": "腹部ct", "label": "影像检查", "offset": "485"}, {"mention": "直肠", "label": "解剖部位", "offset": "515"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "518"}, {"mention": "结肠", "label": "解剖部位", "offset": "522"}, {"mention": "胸部ct", "label": "影像检查", "offset": "537"}, {"mention": "右肺上叶", "label": "解剖部位", "offset": "543"}]}
{"text": ",患者因绝经后阴道出血2015-03-31外院行“诊断性刮宫”,,病理提示:宫腔腺癌,结合镜检和免疫组化,考虑来源于宫颈。在我科于2015-04-21在全麻上行“经腹全子宫两两侧附件切除附件切除术+盆腔淋巴结清扫术”,手术顺利,,术后病理提示:宫颈病变诊断为中至低分化腺癌,部分为粘液腺癌,累及宫颈外膜层,未累及阴道穹窿,可见脉管内癌栓及神经束侵犯;萎缩性宫内膜;(左闭孔深淋巴结)9枚,1/9见腺癌转移。术后诊断“宫颈腺癌ib1期”,有术后放化疗指征。之后患者在我院完成同期放化疗,末次治疗时间为2015年6月。之后患者定期复查,2015年12月发现ca199叒581umol/l,pet/ct,检查提示:,宫颈癌术后放化疗后:阴道残端局部代谢较活跃,疑复发;腹主动脉右旁淋巴结代谢略活跃,疑转移。,诊断:宫颈腺癌综合治疗后复发。2016年1月6-7日、2月2-3日及2月26-27日行“tp”方案化疗3疗程,第3程化疗出现ii度腹泻,ii度贫血,两上肢水肿。3程化疗后我院ct示腹主动脉右旁淋巴结,可疑转移瘤。,2016-05-21我院pet-ct:,复发性宫颈癌放疗中:阴道病灶代谢较活跃,腹主动脉右旁淋巴结代谢较活跃,疑残留,请结合临床;骶前淋巴结代谢较活跃,疑转移。左上肺斑片影代谢略活跃,疑炎性病变。l4椎体压缩性骨折。l4/5、l5/s1椎间盘突出。叒今为行放疗收入我科。发病以来,患者精神、胃纳差,大小便无明显异常,体重无明显变化。", "mention_data": [{"mention": "阴道出血", "label": "症状", "offset": "7"}, {"mention": "诊断性刮宫", "label": "手术", "offset": "25"}, {"mention": "宫腔腺癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "宫颈", "label": "解剖部位", "offset": "58"}, {"mention": "经腹全子宫两两侧附件切除附件切除术+盆腔淋巴结清扫术", "label": "手术", "offset": "81"}, {"mention": "宫颈", "label": "解剖部位", "offset": "122"}, {"mention": "中至低分化腺癌", "label": "疾病和诊断", "offset": "129"}, {"mention": "粘液腺癌", "label": "疾病和诊断", "offset": "140"}, {"mention": "宫颈", "label": "解剖部位", "offset": "147"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "156"}, {"mention": "左闭孔深淋巴结", "label": "解剖部位", "offset": "183"}, {"mention": "宫颈腺癌ib1期", "label": "疾病和诊断", "offset": "208"}, {"mention": "ca199", "label": "实验室检验", "offset": "276"}, {"mention": "pet/ct", "label": "影像检查", "offset": "292"}, {"mention": "宫颈癌术后", "label": "疾病和诊断", "offset": "305"}, {"mention": "阴道", "label": "解剖部位", "offset": "315"}, {"mention": "腹主动脉右旁淋巴结", "label": "解剖部位", "offset": "331"}, {"mention": "宫颈腺癌综合治疗后复发", "label": "疾病和诊断", "offset": "354"}, {"mention": "腹泻", "label": "症状", "offset": "416"}, {"mention": "贫血", "label": "疾病和诊断", "offset": "422"}, {"mention": "两上肢", "label": "解剖部位", "offset": "425"}, {"mention": "ct", "label": "影像检查", "offset": "438"}, {"mention": "腹主动脉右旁淋巴结", "label": "解剖部位", "offset": "441"}, {"mention": "pet-ct", "label": "影像检查", "offset": "470"}, {"mention": "复发性宫颈癌", "label": "疾病和诊断", "offset": "478"}, {"mention": "阴道", "label": "解剖部位", "offset": "488"}, {"mention": "腹主动脉右旁淋巴结", "label": "解剖部位", "offset": "498"}, {"mention": "骶前淋巴结", "label": "解剖部位", "offset": "523"}, {"mention": "左上肺", "label": "解剖部位", "offset": "538"}, {"mention": "l4椎体压缩性骨折", "label": "疾病和诊断", "offset": "556"}, {"mention": "l4/5、l5/s1椎间盘突出", "label": "疾病和诊断", "offset": "566"}, {"mention": "胃", "label": "解剖部位", "offset": "603"}]}
{"text": ",患者2014-12因行体检发现肿瘤标记物增高,,遂于外院行肠镜检查示:乙状结肠距肛门约16cm处息肉,距肛门60cm结肠肝曲处菜花样肿物。2015-01-06在我院全麻上行腹腔镜左半结肠切除术+tem,,术后病理:(结肠大体)镜检为结肠中分化腺癌,浸润至肠壁浆膜上层,未见明确脉管及神经束侵犯;淋巴结24枚,未见癌。另直肠肿物镜检为管状-绒毛状腺瘤,部分区域呈高级别下皮内肿瘤改变。,免疫组化:er(-),ercc1(+),mlh1(+),msh2(+),msh6(+),pms2(+),ki67(70%+)。2015-02-04、03-03、2015-03-30行xelox方案化疗3程,化疗后出现周围神经毒性hfs1度。现为求进一步诊治来本院就诊并入住本科。患者自发病以来,食欲、睡眠及精神良好,小便正常,体力、体重无明显上降。", "mention_data": [{"mention": "乙状结肠", "label": "解剖部位", "offset": "36"}, {"mention": "肛门", "label": "解剖部位", "offset": "41"}, {"mention": "肛门", "label": "解剖部位", "offset": "53"}, {"mention": "结肠肝曲", "label": "解剖部位", "offset": "59"}, {"mention": "腹腔镜左半结肠切除术+tem", "label": "手术", "offset": "87"}, {"mention": "结肠", "label": "解剖部位", "offset": "109"}, {"mention": "结肠中分化腺癌", "label": "疾病和诊断", "offset": "117"}, {"mention": "肠", "label": "解剖部位", "offset": "128"}, {"mention": "直肠", "label": "解剖部位", "offset": "160"}, {"mention": "管状-绒毛状腺瘤", "label": "疾病和诊断", "offset": "167"}]}
{"text": ",患者2009年罹患\\\"左梨状窝鳞癌\\\"(ct3nomo),2009.06.10,2009.07.02予以\\\"ddp叒30mg叒d1-5+5-fu叒800mg叒d1-5+博安霉素10mg叒d1,3,5\\\"2程新辅助化疗后,2009.07.31行\\\"全喉切除术+左颈根治性颈清扫术\\\"。术后病理(426431),:左梨状窝鳞癌(ypt3n2m0,iva期)。2009.08.31-2009.10.15行术后辅助放疗(原发灶60gy/30次/46days+区域淋巴结50gy/25次/40days)。治疗结束后,多次随访,颈部mri提示无转移及复发表现。2012年01月因\\\"气管造瘘口见血丝痰1月余\\\"入我院住院治疗,2012年01月18日行\\\"胸腔镜辅助上右下肺叶切除及纵隔淋巴结清扫术\\\",,术后病理示:中分化鳞状细胞癌,pt2an0m0,ib期。术后恢复顺利,治疗后多次随访无复发。2015-4发现左侧颈部肿块,逐渐增大,入我院复查,,行颈部胸部ct检查报提示:甲状腺左叶及后方肿物,淋巴结转移侵犯甲状腺?甲状腺原发恶性肿瘤并淋巴结转移?右侧气管食管沟及隆突上淋巴结肿大,考虑淋巴结转移可能性大;胸上段上段食管壁肿物。行胃镜检查发现食管多发肿物。,颈部iv区肿物穿刺活检病理提示:甲状腺组织见癌浸润,符合鳞状细胞癌。,食管右侧壁肿物活检病理提示:中分化鳞状细胞癌。于2015-05-12、6-3给予力扑素+顺铂+氟尿嘧啶方案化疗2程顺利,复查ct示sd,2015-06-25继续完成第3程化疗。现按期入院化疗。发病以来,患者精神尚可,饮食尚可,二便正常,睡眠尚可,体重上降约2kg。", "mention_data": [{"mention": "左梨状窝鳞癌", "label": "疾病和诊断", "offset": "12"}, {"mention": "ddp", "label": "药物", "offset": "55"}, {"mention": "5-fu", "label": "药物", "offset": "69"}, {"mention": "博安霉素", "label": "药物", "offset": "85"}, {"mention": "全喉切除术+左颈根治性颈清扫术", "label": "手术", "offset": "124"}, {"mention": "左梨状窝鳞癌(ypt3n2m0,iva期)", "label": "疾病和诊断", "offset": "156"}, {"mention": "颈部mri", "label": "影像检查", "offset": "259"}, {"mention": "气管", "label": "解剖部位", "offset": "286"}, {"mention": "胸腔镜辅助上右下肺叶切除及纵隔淋巴结清扫术", "label": "手术", "offset": "322"}, {"mention": "中分化鳞状细胞癌,pt2an0m0,ib期", "label": "疾病和诊断", "offset": "353"}, {"mention": "左侧颈部", "label": "解剖部位", "offset": "401"}, {"mention": "颈部胸部ct", "label": "影像检查", "offset": "421"}, {"mention": "甲状腺左叶", "label": "解剖部位", "offset": "433"}, {"mention": "甲状腺", "label": "解剖部位", "offset": "451"}, {"mention": "甲状腺原发恶性肿瘤并淋巴结转移", "label": "疾病和诊断", "offset": "455"}, {"mention": "右侧气管食管沟及隆突上淋巴结", "label": "解剖部位", "offset": "471"}, {"mention": "胸上段上段食管", "label": "解剖部位", "offset": "500"}, {"mention": "食管", "label": "解剖部位", "offset": "518"}, {"mention": "颈部iv区", "label": "解剖部位", "offset": "526"}, {"mention": "甲状腺", "label": "解剖部位", "offset": "542"}, {"mention": "鳞状细胞癌", "label": "疾病和诊断", "offset": "554"}, {"mention": "食管", "label": "解剖部位", "offset": "561"}, {"mention": "中分化鳞状细胞癌", "label": "疾病和诊断", "offset": "575"}, {"mention": "力扑素", "label": "药物", "offset": "601"}, {"mention": "顺铂", "label": "药物", "offset": "605"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "608"}, {"mention": "ct", "label": "影像检查", "offset": "623"}]}
{"text": ",患者2008-8-29因“血便2月”入我院,术前诊断为盲肠癌,完善术前检查,排除手术禁忌症后于2008-9-3行左半结肠切除术,,术后病理:回盲部中分化腺癌,浸润至肠壁全层,淋巴结未见癌转移(0/20),p-t3n0m0叒iia期。术后拒绝进一步行辅助化疗,定期随访。2013-11-5因“腹痛1周,加重1天”,就诊我院门诊查腹部ct示:横结肠肠壁明显不均匀增厚,考虑肠癌可能性大,侵犯肠周间隙;肠系膜根部、腹主动脉周围多发团片影,考虑转移瘤;,肠镜:横结肠近吻合口见一15*15mm肿物,穿刺病理中分化腺癌。,结直肠癌单病种全科会诊意见:患者横结肠癌腹腔多发转移瘤,考虑手术完整切除肿瘤的可能性小,建议行全身化疗。于2013-11-28、2013-12-13、2014-1-7给予folfox方案化疗3程,过程顺利。第2程化疗后出现4度中性粒细胞上降,予g-csf升白后恢复正常;并出现口腔粘膜溃烂,对症处理后好转。3程时予行减量化疗。今为行上程化疗入院,目前患者一般情况尚可,饮食、精神、睡眠可,小便正常,大便每日1次,不成形,无血便,无明显腹痛、腹胀,无咳嗽发热等不适,近期体力体重无明显变化。", "mention_data": [{"mention": "盲肠癌", "label": "疾病和诊断", "offset": "28"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "57"}, {"mention": "回盲部中分化腺癌", "label": "疾病和诊断", "offset": "71"}, {"mention": "肠", "label": "解剖部位", "offset": "83"}, {"mention": "腹痛", "label": "症状", "offset": "146"}, {"mention": "腹部ct", "label": "影像检查", "offset": "164"}, {"mention": "横结肠", "label": "解剖部位", "offset": "170"}, {"mention": "肠癌", "label": "疾病和诊断", "offset": "185"}, {"mention": "肠", "label": "解剖部位", "offset": "194"}, {"mention": "肠", "label": "解剖部位", "offset": "199"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "205"}, {"mention": "横结肠", "label": "解剖部位", "offset": "227"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "250"}, {"mention": "横结肠癌腹腔多发转移瘤", "label": "疾病和诊断", "offset": "273"}, {"mention": "中性粒细胞", "label": "实验室检验", "offset": "370"}, {"mention": "g-csf", "label": "药物", "offset": "379"}, {"mention": "口腔", "label": "解剖部位", "offset": "395"}, {"mention": "腹痛", "label": "症状", "offset": "474"}, {"mention": "腹胀", "label": "症状", "offset": "477"}]}
{"text": "患者于今晨起床时无明显诱因突然出现头迷,视物下上晃动,不伴视物旋转、不伴耳鸣、伴恶心未吐。患者头迷与头位、体位无关。于我院急诊行头ct检查,未见确切异常。给予患者改善脑循环、营养脑神经治疗。下述症状好转。为进一步诊治入院,病来无发热,无头痛,无意识障碍,无复视,无肢体活动不灵,无肢体麻木。精神状态可,饮食差,睡眠可,二便正常,近期体重无明显变化。叒血脂高,平素服用血脂康;冠心病6-7年,否认高血压、糖尿病病史;特发性震颤;叒服用他汀类药物后走路踩棉花感;叒2002年因子宫内膜鳞状下皮异常增生行子宫全切术;。", "mention_data": [{"mention": "头", "label": "解剖部位", "offset": "17"}, {"mention": "头", "label": "解剖部位", "offset": "47"}, {"mention": "头", "label": "解剖部位", "offset": "50"}, {"mention": "头ct", "label": "影像检查", "offset": "64"}, {"mention": "脑", "label": "解剖部位", "offset": "83"}, {"mention": "脑", "label": "解剖部位", "offset": "89"}, {"mention": "头痛", "label": "症状", "offset": "118"}, {"mention": "血脂康", "label": "药物", "offset": "183"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "187"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "197"}, {"mention": "糖尿病", "label": "疾病和诊断", "offset": "201"}, {"mention": "特发性震颤", "label": "疾病和诊断", "offset": "207"}, {"mention": "子宫", "label": "解剖部位", "offset": "236"}, {"mention": "子宫全切术", "label": "手术", "offset": "249"}]}
{"text": ",患者于2012-9-14给予宫颈癌根治术+两侧卵巢切除术,,术后病理回报:(全子宫)宫颈中至低分化鳞状细胞癌,浸润宫颈深肌层,累及阴道穹窿部及宫颈管深肌层;脉管内见癌栓;子宫平滑肌瘤;右闭孔淋巴结2/6(+)、左闭孔淋巴结3/8(+),阴道残端前壁见鳞状细胞癌浸润,阴道残端后壁见鳞状下皮原位癌,阴道残端右见可疑癌细胞。患者有外照射、后装及化疗指征,于2012-09-21予tp(力扑素+顺铂)方案术后辅助化疗一程,过程顺利。出院后每天均有阴道流血水,少量,每天换3-4张护垫,精神、食欲可,睡眠欠佳。无腹痛、腹泻、呕吐、发热、咳嗽,觉手脚麻木,大小便正常,体重减轻4斤。,既往化疗及肿瘤标志物情况:,化疗药物毒副反应:。", "mention_data": [{"mention": "宫颈癌根治术+两侧卵巢切除术", "label": "手术", "offset": "15"}, {"mention": "(全子宫)宫颈中至低分化鳞状细胞癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "宫颈", "label": "解剖部位", "offset": "58"}, {"mention": "阴道穹窿", "label": "解剖部位", "offset": "66"}, {"mention": "宫颈管", "label": "解剖部位", "offset": "72"}, {"mention": "子宫平滑肌瘤", "label": "疾病和诊断", "offset": "86"}, {"mention": "右闭孔淋巴结", "label": "解剖部位", "offset": "93"}, {"mention": "左闭孔淋巴结", "label": "解剖部位", "offset": "106"}, {"mention": "阴道", "label": "解剖部位", "offset": "119"}, {"mention": "鳞状细胞癌", "label": "疾病和诊断", "offset": "126"}, {"mention": "阴道", "label": "解剖部位", "offset": "134"}, {"mention": "鳞状下皮原位癌", "label": "疾病和诊断", "offset": "141"}, {"mention": "阴道", "label": "解剖部位", "offset": "149"}, {"mention": "力扑素", "label": "药物", "offset": "191"}, {"mention": "顺铂", "label": "药物", "offset": "195"}, {"mention": "阴道", "label": "解剖部位", "offset": "221"}, {"mention": "腹痛", "label": "症状", "offset": "253"}, {"mention": "腹泻", "label": "症状", "offset": "256"}, {"mention": "手脚", "label": "解剖部位", "offset": "269"}]}
{"text": ",2016-11-09顺产一活男婴。2016-11-18复查彩超提示宫腔内异常团块,35*23mm、51*12mm,2016-12-23复查彩超提示宫腔内异常团块19*15mm。产后一直恶露不净。2017-01-31出现阴道出血多,2017-02-04复查彩超提示宫颈部混合回声团33*25*28mm。2017-02-20复查宫颈实质性低回声团30*27*30mm(疑子宫粘膜上肌瘤),2017-2-21行宫腔镜上子宫粘膜上肿物切除术,术中见宫颈口一4*4*5cm组织物堵塞,蒂粗,位于子宫上段。术后病理提示骨外尤文肉瘤/原始神经外胚叶肿瘤(es/pnet)。后病理送**一院会诊(宫颈)小圆细胞恶性肿瘤,考虑为软组织尤文肉瘤可能性大。fish,检测结果:ews基因易位fish检测阳性。我科全科讨论建议行pet-ct检查,如无远处转移则行手术切除子宫及区域淋巴结,卵巢可保留。pet-ct,提示疑子宫肉瘤术后:子宫上段代谢略活跃,术后改变与残留鉴别,请结合临床;盆腔少量积液。子宫内膜区代谢略活跃,左附件区低密度影代谢较活跃,疑生理性改变。两侧乳腺体积增大代谢活跃,结合临床,符合哺乳期生理性改变。两腋窝数个小淋巴结代谢略活跃,疑炎性病变。于2017-04-05入我科住院治疗,住院期间请骨与软组织肿瘤科会诊后建议先行新辅助化疗6程,于2017.4.12-4.16,行ai化疗:表柔比星90mg叒d1+异环磷酰胺3.2g叒d1-d5。过程顺利出院。现患者为进一步诊治,收入院。起病以来,患者一般情况良好,睡眠可,食欲好,二便正常,体重无明显变化。", "mention_data": [{"mention": "彩超", "label": "影像检查", "offset": "30"}, {"mention": "阴道出血", "label": "症状", "offset": "110"}, {"mention": "宫颈部", "label": "解剖部位", "offset": "132"}, {"mention": "宫颈", "label": "解剖部位", "offset": "163"}, {"mention": "子宫粘膜上肌瘤", "label": "疾病和诊断", "offset": "184"}, {"mention": "宫腔镜上子宫粘膜上肿物切除术", "label": "手术", "offset": "203"}, {"mention": "宫颈口", "label": "解剖部位", "offset": "221"}, {"mention": "子宫", "label": "解剖部位", "offset": "243"}, {"mention": "骨外尤文肉瘤/原始神经外胚叶肿瘤(es/pnet)", "label": "疾病和诊断", "offset": "254"}, {"mention": "(宫颈)小圆细胞恶性肿瘤", "label": "疾病和诊断", "offset": "290"}, {"mention": "尤文肉瘤", "label": "疾病和诊断", "offset": "309"}, {"mention": "pet-ct", "label": "影像检查", "offset": "353"}, {"mention": "子宫", "label": "解剖部位", "offset": "374"}, {"mention": "卵巢", "label": "解剖部位", "offset": "383"}, {"mention": "pet-ct", "label": "影像检查", "offset": "389"}, {"mention": "子宫肉瘤术后", "label": "疾病和诊断", "offset": "399"}, {"mention": "子宫", "label": "解剖部位", "offset": "406"}, {"mention": "盆腔", "label": "解剖部位", "offset": "432"}, {"mention": "子宫", "label": "解剖部位", "offset": "439"}, {"mention": "左附件区", "label": "解剖部位", "offset": "450"}, {"mention": "两侧乳腺", "label": "解剖部位", "offset": "471"}, {"mention": "两腋窝", "label": "解剖部位", "offset": "500"}, {"mention": "表柔比星", "label": "药物", "offset": "590"}, {"mention": "异环磷酰胺", "label": "药物", "offset": "602"}]}
{"text": ",入院前1+月,患者因便血在我院住院治疗,行肠镜、活检等检查提示直肠癌,遂在准备充分情况上,于2014.10.29在全麻上行经腹会阴联合直肠癌根治术,,术中见:肿瘤位于腹膜返折上方,直肠下段,距离肛缘小于6厘米,下段直肠肠壁不规则增厚,长度约为8cm,管腔狭窄,管壁僵硬,浆膜面被肿瘤侵犯,见米粒样小结节。术后病检结果(病理号201440454),:<直肠>腺癌,中分化,浸润全层,肠系膜下见癌结节,淋巴结见癌转移,为6/6,近切缘及远切缘未见癌累及。tnm分期为iii期(t3n2m0),有化疗指征,术后患者一般情况恢复可,遂于2014.11.17开始folfox叒6叒方案化疗(奥沙利铂叒150mg叒d1,亚叶酸钙叒700mg叒d1,氟尿嘧啶叒2g叒d1-d2)。化疗过程中诉精神欠佳、纳差、恶心,化疗完成后逐渐恢复,化疗间期精神、食欲恢复可,无头昏、头痛、胸痛、腹痛、四肢痛,大便成形,无血便及黑便。现化疗间期已到,为行第2次化疗来院。\\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,体重无明显变化。", "mention_data": [{"mention": "直肠癌", "label": "疾病和诊断", "offset": "32"}, {"mention": "经腹会阴联合直肠癌根治术", "label": "手术", "offset": "62"}, {"mention": "腹", "label": "解剖部位", "offset": "84"}, {"mention": "直肠", "label": "解剖部位", "offset": "91"}, {"mention": "直肠", "label": "解剖部位", "offset": "108"}, {"mention": "<直肠>腺癌", "label": "疾病和诊断", "offset": "175"}, {"mention": "肠", "label": "解剖部位", "offset": "191"}, {"mention": "奥沙利铂", "label": "药物", "offset": "291"}, {"mention": "亚叶酸钙", "label": "药物", "offset": "305"}, {"mention": "氟尿嘧啶", "label": "药物", "offset": "319"}, {"mention": "头昏", "label": "症状", "offset": "375"}, {"mention": "头痛", "label": "症状", "offset": "378"}, {"mention": "胸痛", "label": "症状", "offset": "381"}, {"mention": "腹痛", "label": "症状", "offset": "384"}, {"mention": "四肢", "label": "解剖部位", "offset": "387"}]}
{"text": ",患者3月前无明显诱因出现下腹隐痛,用餐后疼痛加重,伴恶性、呕吐,反酸、嗳气及少量黑便,2月,余前于外院行胃镜检查:考虑胃癌,肺部发现可疑结节;,行pet-ct检查示:胃癌,左肺多发结节,fdg代谢无增高,考虑转移可能性大。,转来我院行ct检查示:胃癌,两肺类结节,考虑炎性病变可能性大。2月25日胃胰科收住入院后按“胃窦癌伴不全梗阻”之诊断于2014年2月28日行“胃癌姑息性切除术”,术中见肿瘤呈浸润溃疡型,3×5cm大小,浆膜浸润s2,并见肿瘤侵犯十二指肠球部及十二指肠韧带弥漫性增厚,胃大部切除后行毕ii式吻合,手术操作顺利,术后恢复顺利。,术后病理结果回报:(胃大体)镜检为胃中至低分化腺癌(lauren,分型:混合型),癌组织侵犯胃壁浆膜上层,可见脉管内癌栓及神经束侵犯;网膜组织未见癌;ln(+)10/31。之后于4月1日入住我科行奥沙利铂+替吉奥方案化疗一程,化疗顺利,化疗后未出现明显化疗副反应。今再来我科求治要求继续治疗。患者近来精神及食欲尚可,无发热及呕血黑便,无恶心呕吐及腹痛,大小便无异常,体重较下次住院减少2.5kg。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "13"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "60"}, {"mention": "肺", "label": "解剖部位", "offset": "63"}, {"mention": "pet-ct", "label": "影像检查", "offset": "74"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "84"}, {"mention": "左肺", "label": "解剖部位", "offset": "87"}, {"mention": "fdg", "label": "药物", "offset": "94"}, {"mention": "ct", "label": "影像检查", "offset": "118"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "124"}, {"mention": "两肺", "label": "解剖部位", "offset": "127"}, {"mention": "胃窦癌伴不全梗阻", "label": "疾病和诊断", "offset": "159"}, {"mention": "胃癌姑息性切除术", "label": "手术", "offset": "184"}, {"mention": "s2", "label": "解剖部位", "offset": "218"}, {"mention": "十二指肠球部", "label": "解剖部位", "offset": "227"}, {"mention": "十二指肠韧带", "label": "解剖部位", "offset": "234"}, {"mention": "胃大部切除后行毕ii式吻合", "label": "手术", "offset": "246"}, {"mention": "胃", "label": "解剖部位", "offset": "285"}, {"mention": "胃中至低分化腺癌(lauren,分型:混合型)", "label": "疾病和诊断", "offset": "292"}, {"mention": "胃", "label": "解剖部位", "offset": "321"}, {"mention": "奥沙利铂", "label": "药物", "offset": "373"}, {"mention": "替吉奥", "label": "药物", "offset": "378"}, {"mention": "腹痛", "label": "症状", "offset": "448"}]}
{"text": ",2011.7.6因胃窦癌手术,,病理:胃窦溃疡型低分化腺癌,可见脉管癌栓,淋巴结6/16。断端净,术后sox化疗4周期,因胃肠反应严重,调整为s-1单药化疗4周期。末次化疗时间2012.6.。化疗期间体重减轻5kg。化疗后体重稳定。2012-7-23叒复查腹盆ct未见复发转移征象。胸片无异常。7-4胃镜提示吻合口炎,未见复发。,超声:右锁骨下淋巴结同前。进食可,大小便正常,体重无上降。复查彩超胆囊多发结石,余未见肿瘤复发及转移表现。\\u0004\\u0004叒叒叒2012.10.复查胸片及腹盆腔b超、颈部b超未见复发及转移。2012.11.28复查肿标正常。\\u0004\\u0004叒叒叒2012.12.12,胃镜:胃癌远端胃切除术后,残胃炎。\\u0004\\u0004叒叒目前患者近1月来,进食后反酸,食欲欠佳。大小便正常。", "mention_data": [{"mention": "胃窦癌", "label": "疾病和诊断", "offset": "10"}, {"mention": "胃窦溃疡型低分化腺癌", "label": "疾病和诊断", "offset": "20"}, {"mention": "s-1", "label": "药物", "offset": "72"}, {"mention": "腹盆ct", "label": "影像检查", "offset": "129"}, {"mention": "胸片", "label": "影像检查", "offset": "142"}, {"mention": "吻合口炎", "label": "疾病和诊断", "offset": "155"}, {"mention": "右锁骨下淋巴结", "label": "解剖部位", "offset": "169"}, {"mention": "胆囊多发结石", "label": "疾病和诊断", "offset": "199"}, {"mention": "胸片", "label": "影像检查", "offset": "244"}, {"mention": "腹盆腔b超", "label": "影像检查", "offset": "247"}, {"mention": "颈部b超", "label": "影像检查", "offset": "253"}, {"mention": "胃癌远端胃切除术后", "label": "疾病和诊断", "offset": "311"}, {"mention": "残胃炎", "label": "疾病和诊断", "offset": "321"}]}
{"text": ",2016-8-5行经肛直肠肿物切除术。,术后病理:(直肠肿物),切除:-叒中分化腺癌,伴粘液腺癌,大小6×xxx5×xxx4cm;-叒癌累及固有肌层;-叒未见脉管癌栓;-叒各切缘未见癌;-叒,肿瘤病理分期:pt2nx。,免疫组化结果显示肿瘤细胞:braf(-),cd147(+),cmet(2+),egfr(2+),her2(0),ki-67(90%+),mlh1(+>75%),msh2(+>75%),msh6(+>75%),pms2(+>75%)。术前,mri:直肠上段前壁可见菜花状肿物,较大层面约47x37mm(se5叒im34),长度范围约42mm(se3叒im12),病变表面可见较多长t2信号成分。病变区外膜面光滑,病变上缘向上达肛提肌与直肠交界水平,与肛门内外括约肌及肛提肌分界清;直肠周围系膜内、直肠下动脉走行区见散在小淋巴结,小于5mm,信号均匀。2016-9-8开始放疗,,计划瘤床及淋巴引流区:ctv叒50gy/25f,2016-9-20放疗7次。已经放疗21次。目前尿频。2016-10-14结束放疗.2016-11-10化验cea8.78ng/ml。", "mention_data": [{"mention": "经肛直肠肿物切除术", "label": "手术", "offset": "10"}, {"mention": "直肠", "label": "解剖部位", "offset": "27"}, {"mention": "中分化腺癌,伴粘液腺癌", "label": "疾病和诊断", "offset": "38"}, {"mention": "直肠", "label": "解剖部位", "offset": "234"}, {"mention": "肛提肌", "label": "解剖部位", "offset": "323"}, {"mention": "直肠", "label": "解剖部位", "offset": "327"}, {"mention": "肛门内外括约肌", "label": "解剖部位", "offset": "335"}, {"mention": "肛提肌", "label": "解剖部位", "offset": "343"}, {"mention": "直肠", "label": "解剖部位", "offset": "350"}, {"mention": "直肠下动脉", "label": "解剖部位", "offset": "358"}, {"mention": "cea", "label": "实验室检验", "offset": "477"}]}
{"text": "患者1个多月前无明显诱因出现大便困难,变细,成形,有里急后重,大便2-3次/天。无伴粘液血便、腹痛、恶心呕吐等不适。在外院予肠镜检查,示距肛26cm乙状结肠见菜花样肿物,肠镜不能通过,病理腺癌;距肿物5cm处见已息肉,大小1x1x0.5cm。ct提示肝脏多发占位,考虑转移瘤。于2012-2-20在我院行全麻上行“dixon+结肠灌洗术”,手术顺利,病理示:乙状结肠中分化腺癌,浸润至浆膜层,息肉为管状绒毛状腺瘤,3/12ln(+),分期pt4n1m1,iv期。术后拟以folfox+avastin方案化疗。因术后6周内,于2012.3.12及3.27行folfox方案化疗二程,2012.4.16行folfox+avastin化疗一程,过程顺利。叒2012-04-27复查ct评价疗效为sd。今为进一步治疗入院。下次出院以来,患者每日排便4-5次,成形。无恶心、呕吐等,无发热、咳嗽、身目黄染,无骶部痛等,精神可,纳眠可,小便无异常,体重上降不明显。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "47"}, {"mention": "乙状结肠", "label": "解剖部位", "offset": "74"}, {"mention": "腺癌", "label": "疾病和诊断", "offset": "94"}, {"mention": "ct", "label": "影像检查", "offset": "121"}, {"mention": "肝脏", "label": "解剖部位", "offset": "125"}, {"mention": "dixon+结肠灌洗术", "label": "手术", "offset": "157"}, {"mention": "乙状结肠中分化腺癌", "label": "疾病和诊断", "offset": "179"}, {"mention": "管状绒毛状腺瘤", "label": "疾病和诊断", "offset": "199"}, {"mention": "avastin", "label": "药物", "offset": "242"}, {"mention": "avastin", "label": "药物", "offset": "307"}, {"mention": "ct", "label": "影像检查", "offset": "337"}, {"mention": "骶部", "label": "解剖部位", "offset": "399"}]}
{"text": ",2014-05-27全麻上行左肝部分切除、胆囊切除术。术后予以保肝、静脉营养、抗感染等治疗,患者术后恢复可,已恢复饮食,伤口缝线未拆除,愈合可。,病理回报:中-低分化肝细胞肝癌(ii~iii级;2灶,直径2-4cm);未见脉管癌栓;肝切缘及肝被膜未见肿瘤;胆囊多发性胆固醇息肉,直径0.1-0.2cm,胆囊粘膜慢性炎。考虑癌活性灶。2014-6-26、2014-7-28于我科行介入治疗。,于2014-11-26门诊mri检查示:肝左叶局部切除术后,残余肝实质内见散在多发稍长t1稍长t1稍长t2信号t2信号结节,较大者约9,x7mm:,afp:54.65(ng/ml),升高明显,于2014-12-9于我科行介入治疗,dsa造影未显示病灶,行肝脏动脉灌注化疗后症状好转出院。,于2015-1-28于我院复查:afp170.8(ng/ml)。于2015-03-18叒,腹部mri比较:肝左叶局部切除术后,肝脏介入治疗后,残余肝实质内散在多发稍长t1稍长t1稍长t2信号长t2信号结节较前增多增大,较大者现约21x15mm(se5叒im10),原约12x8mm(se11叒im9),增强扫描动脉期强化较前明显,门脉及延迟期仍呈边缘强化。(黄),血清ca19-9测定:甲胎蛋白叒369.5(ng/ml)↑,癌胚抗原叒3.45(ng/ml),癌抗原199叒33.05(u/ml);肝内多发转移较前进展。现患者为行上一次介入治疗入院。患者自发病以来精神、睡眠、食欲尚好,大小便如下述,体重无明显改变。", "mention_data": [{"mention": "左肝部分切除、胆囊切除术", "label": "手术", "offset": "15"}, {"mention": "肝", "label": "解剖部位", "offset": "33"}, {"mention": "中-低分化肝细胞肝癌", "label": "疾病和诊断", "offset": "79"}, {"mention": "肝", "label": "解剖部位", "offset": "117"}, {"mention": "肝", "label": "解剖部位", "offset": "121"}, {"mention": "胆囊多发性胆固醇息肉", "label": "疾病和诊断", "offset": "129"}, {"mention": "胆囊", "label": "解剖部位", "offset": "152"}, {"mention": "mri", "label": "影像检查", "offset": "209"}, {"mention": "肝左叶局部切除术后", "label": "疾病和诊断", "offset": "216"}, {"mention": "肝", "label": "解剖部位", "offset": "228"}, {"mention": "afp", "label": "实验室检验", "offset": "270"}, {"mention": "肝脏动脉", "label": "解剖部位", "offset": "323"}, {"mention": "afp", "label": "实验室检验", "offset": "356"}, {"mention": "腹部mri", "label": "影像检查", "offset": "385"}, {"mention": "肝左叶局部切除术后", "label": "疾病和诊断", "offset": "393"}, {"mention": "肝脏", "label": "解剖部位", "offset": "403"}, {"mention": "肝", "label": "解剖部位", "offset": "413"}, {"mention": "门脉", "label": "解剖部位", "offset": "505"}, {"mention": "ca19-9", "label": "实验室检验", "offset": "524"}, {"mention": "甲胎蛋白", "label": "实验室检验", "offset": "533"}, {"mention": "癌胚抗原", "label": "实验室检验", "offset": "552"}, {"mention": "癌抗原199", "label": "实验室检验", "offset": "569"}, {"mention": "肝内多发转移", "label": "疾病和诊断", "offset": "588"}]}
{"text": ",2天前,患者无明显诱因出现左下腹痛,为隐痛,阵断性发作,坐立位疼痛好转,夜间腹胀,伴有恶心,呕吐,为饭后呕吐,呕吐物为胃内容物,伴有反酸,嗳气,伴有烧心,无闷油,无腹泻,无头昏头痛,无发热盗汗,无咳嗽咳痰,无胸闷心悸。一天前发现小便颜色改变,变为浓茶色,尿量无改变,仍感腹痛,与前一天无改变。来我院门诊就诊,,行相关检查示:,肝功:,谷丙转氨酶:1189u/l,,谷草转氨酶:661u/l,,碱性磷酸酶:201u/l,,γ-谷氨酰胺转移酶:457u/l,,总胆红素:85.6μmol/l,,直接胆红素:65.9μmol/l,,σ胆红素:25.5μmol/l;,彩超示:1.肝回声增多,随访;2.胆囊摘除术后;3.脾偏大;4.胆管、胰、肾未见异常。,胃镜示:1.反流性食管炎(2级);2.浅表性胃炎伴糜烂;3.十二指肠球炎伴糜烂。\\u0004叒叒叒患者1月前自行服用阴阳五行散(肉桂,苦杏仁,薏仁,莲米,桑葚),出现下述症状后停药,停药后症状无好转。门诊以“肝功能减退,胃炎”收入我科。\\u0004叒患者本次发病以来,食欲差,神志清,精神佳,睡眠欠佳,小便呈浓茶色,大便颜色正常、不成形,体重无明显改变。", "mention_data": [{"mention": "左下腹", "label": "解剖部位", "offset": "14"}, {"mention": "腹胀", "label": "症状", "offset": "39"}, {"mention": "胃", "label": "解剖部位", "offset": "60"}, {"mention": "腹泻", "label": "症状", "offset": "83"}, {"mention": "头昏", "label": "症状", "offset": "87"}, {"mention": "头痛", "label": "症状", "offset": "89"}, {"mention": "胸闷", "label": "症状", "offset": "105"}, {"mention": "心悸", "label": "症状", "offset": "107"}, {"mention": "腹痛", "label": "症状", "offset": "136"}, {"mention": "谷丙转氨酶", "label": "实验室检验", "offset": "168"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "183"}, {"mention": "碱性磷酸酶", "label": "实验室检验", "offset": "197"}, {"mention": "γ-谷氨酰胺转移酶", "label": "实验室检验", "offset": "211"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "229"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "246"}, {"mention": "σ胆红素", "label": "实验室检验", "offset": "264"}, {"mention": "彩超", "label": "影像检查", "offset": "281"}, {"mention": "肝", "label": "解剖部位", "offset": "287"}, {"mention": "胆囊摘除术后", "label": "疾病和诊断", "offset": "298"}, {"mention": "脾", "label": "解剖部位", "offset": "307"}, {"mention": "胆管", "label": "解剖部位", "offset": "313"}, {"mention": "胰", "label": "解剖部位", "offset": "316"}, {"mention": "肾", "label": "解剖部位", "offset": "318"}, {"mention": "反流性食管炎", "label": "疾病和诊断", "offset": "331"}, {"mention": "浅表性胃炎伴糜烂", "label": "疾病和诊断", "offset": "344"}, {"mention": "十二指肠球炎伴糜烂", "label": "疾病和诊断", "offset": "355"}, {"mention": "阴阳五行散", "label": "药物", "offset": "383"}, {"mention": "肝功能减退", "label": "疾病和诊断", "offset": "429"}, {"mention": "胃炎", "label": "疾病和诊断", "offset": "435"}]}
{"text": "1.5月前患者因“下腹胀痛2月,查体发现胰腺占位5天”入院。入院后完善各项必须化验检查,明确胰腺占位诊断。7月30日手术,探查见胰腺前方组织呈炎性粘连,胰腺质硬,呈慢性炎症改变,肿块位于胰头,约5*3cm,包绕肠系膜下动、静脉血管,侵及周围组织,无法根治切除。行胰腺肿瘤射频消融、无水酒精注射+胆总管十二指肠吻合,胃空肠吻合+胆囊切除术。过程顺利,术后给予营养抗炎保肝对症支持治疗,病情逐渐恢复,按时拆线切口甲级愈合,后因腹腔积液于8-10行腹腔穿刺术+闭式引流。引出淡黄色腹水,量减少后予以拔除腹腔引流。患者进食后有下腹饱胀感,8-21叒行下消化道泛影葡胺造影检查,提示胃蠕动无力,禁食静脉营养治疗,促进胃功能恢复。后行下消化道造影见胃肠蠕动有改善,进食软食后无明显腹部不适,好转出院。现为术后1.5月,近一周饮食欠佳,下腹饱胀感明显,为进一步诊治今来我院就诊,门诊以“胰腺肿瘤”收入院。", "mention_data": [{"mention": "下腹胀痛", "label": "症状", "offset": "9"}, {"mention": "胰腺", "label": "解剖部位", "offset": "20"}, {"mention": "胰腺", "label": "解剖部位", "offset": "46"}, {"mention": "胰腺", "label": "解剖部位", "offset": "64"}, {"mention": "胰腺", "label": "解剖部位", "offset": "76"}, {"mention": "胰头", "label": "解剖部位", "offset": "93"}, {"mention": "肠系膜下动、静脉血管", "label": "解剖部位", "offset": "105"}, {"mention": "胰腺肿瘤射频消融、无水酒精注射+胆总管十二指肠吻合,胃空肠吻合+胆囊切除术", "label": "手术", "offset": "131"}, {"mention": "肝", "label": "解剖部位", "offset": "183"}, {"mention": "腹腔积液", "label": "疾病和诊断", "offset": "211"}, {"mention": "腹腔穿刺术+闭式引流", "label": "手术", "offset": "221"}, {"mention": "腹水", "label": "症状", "offset": "237"}, {"mention": "腹腔", "label": "解剖部位", "offset": "248"}, {"mention": "下腹", "label": "解剖部位", "offset": "259"}, {"mention": "下消化道泛影葡胺造影", "label": "影像检查", "offset": "271"}, {"mention": "胃", "label": "解剖部位", "offset": "286"}, {"mention": "胃", "label": "解剖部位", "offset": "303"}, {"mention": "下消化道造影", "label": "影像检查", "offset": "311"}, {"mention": "腹部不适", "label": "症状", "offset": "334"}, {"mention": "下腹", "label": "解剖部位", "offset": "361"}, {"mention": "胰腺肿瘤", "label": "疾病和诊断", "offset": "386"}]}
{"text": ",患者2011-5月因“下腹部不适”就诊于**三院,胃镜诊断“胃窦癌”,于2011-5-20**三院行胃癌根治术,,术后病理:中分化腺癌,ln(5/17),pt4an2am0,iiib期,术后予mfolfox化疗6程(末次化疗2011-10-20)。术后恢复可,后定期复查。于2012年6月开始感下腹部,后背部疼痛,疼痛评分6-7分。2012-6-13,外院ct示:胰头部占位,遂转至我院,2012-6-18,我院ct示:胰头左旁吻合处软组织影,考虑复发,侵犯胰头,查cea叒13.34叒u/l,ast,alt,胆红素,总胆汁酸明显升高。为进一步治疗收入我院外科,腹部超声示肝内胆管普遍扩张,遂于2012年7月5日行ercp胆道支架植入术,术后alt,ast,胆红素,胆汁酸明显降低。于2012年7月16日至2012-11-19行s1+lv化疗9程。3程及6程后评价为sd。化疗中患者感1度乏力,并轻度恶心,无明显白细胞,血红素,血小板上降。2012-12-1复查ct示“胰头区软组织影,较2012-10-08增大”。评价为pd。患者为晚期胃癌,一线治疗进展,遂于2012-12-04、12-21行二线化疗folfox方案2程,化疗中出现ii°恶心呕吐,对症处理后好转,近来患者腹部疼痛明显,现仍予多瑞吉8.4mg叒可维持无疼痛约48小时。患者精神可、食纳差,双便正常,病来体重上降十余斤。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "12"}, {"mention": "胃窦癌", "label": "疾病和诊断", "offset": "31"}, {"mention": "胃癌根治术", "label": "手术", "offset": "51"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "63"}, {"mention": "下腹部", "label": "解剖部位", "offset": "148"}, {"mention": "后背部", "label": "解剖部位", "offset": "152"}, {"mention": "ct", "label": "影像检查", "offset": "179"}, {"mention": "胰头", "label": "解剖部位", "offset": "183"}, {"mention": "ct", "label": "影像检查", "offset": "207"}, {"mention": "胰头", "label": "解剖部位", "offset": "211"}, {"mention": "胰头", "label": "解剖部位", "offset": "230"}, {"mention": "cea", "label": "实验室检验", "offset": "234"}, {"mention": "ast", "label": "实验室检验", "offset": "248"}, {"mention": "alt", "label": "实验室检验", "offset": "252"}, {"mention": "胆红素", "label": "实验室检验", "offset": "256"}, {"mention": "总胆汁酸", "label": "实验室检验", "offset": "260"}, {"mention": "腹部超声", "label": "影像检查", "offset": "282"}, {"mention": "肝内胆管", "label": "解剖部位", "offset": "287"}, {"mention": "ercp胆道支架植入术", "label": "手术", "offset": "308"}, {"mention": "alt", "label": "实验室检验", "offset": "322"}, {"mention": "ast", "label": "实验室检验", "offset": "326"}, {"mention": "胆红素", "label": "实验室检验", "offset": "330"}, {"mention": "胆汁酸", "label": "疾病和诊断", "offset": "334"}, {"mention": "s1", "label": "药物", "offset": "365"}, {"mention": "lv", "label": "药物", "offset": "368"}, {"mention": "白细胞", "label": "实验室检验", "offset": "407"}, {"mention": "血红素", "label": "实验室检验", "offset": "411"}, {"mention": "血小板", "label": "实验室检验", "offset": "415"}, {"mention": "ct", "label": "影像检查", "offset": "432"}, {"mention": "胰头", "label": "解剖部位", "offset": "436"}, {"mention": "晚期胃癌", "label": "疾病和诊断", "offset": "468"}, {"mention": "腹", "label": "解剖部位", "offset": "539"}, {"mention": "多瑞吉", "label": "药物", "offset": "549"}]}
{"text": ",患者于2011年1月28日因“回盲部肿物”行左半结肠切除术,术后病理证实为弥漫大b细胞淋巴瘤,予\\\"r-chop\\\"方案化疗六程,定期复查未见明显复发征像。2013年3月复查pet/ct,提示:十二指水平段高代谢灶,考虑淋巴瘤浸润可能。,我院超声胃镜检查示:十二指肠降段起始部肿物,病理提示中分化腺癌。遂于2013-04-25在我院胃胰科行胰十二指肠切除术(whipple术),术程顺利。,术后病理诊断为:十二指肠中分化腺癌(pt2n0m0)。术后*卡培他滨辅助化疗5程。后因手足综合症停药。2014年4月患者无明显诱因出现下腹痛,呈阵发性钝痛,进食后明显,后可自行逐渐缓解。,于我院行ct示:,十二指肠腺癌术后:吻合口区未见明显肿瘤复发。肠系膜区和腹主动脉旁多发淋巴结,考虑肿瘤复发。肝内多发转移瘤。肝囊肿。于2014-05-30、2014-06-20、2014-07-11予以替吉奥+奥沙利铂方案化疗第1、2、3程。化疗过程顺利。7月15日开始同期放疗计划采用vmat,,放疗范围:gtv包括腹腔干、腹主动脉旁、肠系膜区肿大淋巴结;ctv为gtv外扩1.0cm,适当避开周围肠管等危及器官。gtv和ctv均予以剂量45gy/25f。现已放疗14次。今患者为进一步诊治收入我科。放化疗以来,患者无头晕、头痛,无咳嗽、咳痰、胸闷、胸痛,精神体力可,食欲可,睡眠一般,大小便正常,体重较前无明显上降。", "mention_data": [{"mention": "回盲部", "label": "解剖部位", "offset": "16"}, {"mention": "左半结肠切除术", "label": "手术", "offset": "23"}, {"mention": "弥漫大b细胞淋巴瘤", "label": "疾病和诊断", "offset": "38"}, {"mention": "pet/ct", "label": "影像检查", "offset": "88"}, {"mention": "十二指水平段", "label": "解剖部位", "offset": "98"}, {"mention": "淋巴瘤", "label": "疾病和诊断", "offset": "111"}, {"mention": "十二指肠降段", "label": "解剖部位", "offset": "130"}, {"mention": "中分化腺癌", "label": "疾病和诊断", "offset": "146"}, {"mention": "胰十二指肠切除术(whipple术)", "label": "手术", "offset": "171"}, {"mention": "十二指肠中分化腺癌(pt2n0m0)", "label": "疾病和诊断", "offset": "204"}, {"mention": "卡培他滨", "label": "药物", "offset": "226"}, {"mention": "手足综合症", "label": "疾病和诊断", "offset": "239"}, {"mention": "下腹痛", "label": "症状", "offset": "263"}, {"mention": "ct", "label": "影像检查", "offset": "294"}, {"mention": "十二指肠腺癌术后", "label": "疾病和诊断", "offset": "299"}, {"mention": "肠", "label": "解剖部位", "offset": "321"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "326"}, {"mention": "肝内多发转移瘤", "label": "疾病和诊断", "offset": "344"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "352"}, {"mention": "替吉奥", "label": "药物", "offset": "391"}, {"mention": "奥沙利铂", "label": "药物", "offset": "395"}, {"mention": "腹腔干", "label": "解剖部位", "offset": "449"}, {"mention": "腹主动脉", "label": "解剖部位", "offset": "453"}, {"mention": "肠", "label": "解剖部位", "offset": "459"}, {"mention": "肠", "label": "解剖部位", "offset": "490"}, {"mention": "头晕", "label": "症状", "offset": "550"}, {"mention": "头痛", "label": "症状", "offset": "553"}, {"mention": "胸闷", "label": "症状", "offset": "563"}, {"mention": "胸痛", "label": "症状", "offset": "566"}]}
{"text": "患者2个月前因下腹不适及黑便发现胃癌,于2009-11-24在我科行远端胃癌根治术,术后病理结果为:胃窦小弯侧溃疡型低分化腺癌伴印戒细胞癌,大小4.0×2.6cm,侵及胃壁全层,未侵透浆膜层,可见脉管癌栓,淋巴结可见癌转移(1/38,第1组0/2,第3组1/11,4sb叒0/2,4sd叒0/5,第5组0/2,第6组0/5,第7组0/7,第8组0/0,8p叒0/3,12组0/0,12a叒0/0,14组0/1,系膜前叶0/0),胃断端及(十二指肠残端)未见癌;网膜未见特殊。术后恢复顺利。术后行2周期辅助化疗,方案mfolfox7(oxa100mg/m,cf400mg/m,5fu2400mg/m),过程顺利。今天为行术后第三周期化疗入院。自发以来精神食欲可,小便正常,体重无明显上降。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "7"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "16"}, {"mention": "远端胃癌根治术", "label": "手术", "offset": "34"}, {"mention": "胃窦小弯侧溃疡型低分化腺癌伴印戒细胞癌", "label": "疾病和诊断", "offset": "50"}, {"mention": "胃", "label": "解剖部位", "offset": "84"}, {"mention": "胃", "label": "解剖部位", "offset": "214"}, {"mention": "十二指肠", "label": "解剖部位", "offset": "219"}, {"mention": "oxa", "label": "药物", "offset": "266"}, {"mention": "cf", "label": "药物", "offset": "278"}, {"mention": "5fu", "label": "药物", "offset": "289"}]}
{"text": "入院前10余年患者开始出现劳力性心累气促、伴有胸痛,多为心前区疼痛,无颜面四肢浮肿,无咯粉红色泡沫痰,患者曾在*******医院就诊,考虑“冠心病、心绞痛”(具体诊疗情况不详)。患者近双年下述症状发作较频繁,安静休息及夜间均有发作,含服“速效救心丸”症状能缓解。入院前6+小时患者无明显诱因再次出现心悸心累,自诉胸腹部疼痛,但具体部位及疼痛性质描述不清,无恶心、呕吐、腹泻,无畏寒、发热,无潮热、盗汗,无尿频、尿急、尿痛,无喘累、气促,无端坐呼吸、阵发性呼吸困难等,家属喂服“消炎利胆片、速效救心丸”后症状逐渐缓解。入院前3小时患者下述症状再次加重,呻吟不止,伴有喘累气促,大汗,仍有胸腹部疼痛,无恶心呕吐,无腹泻,无咯粉红色泡沫痰,无晕厥黑朦,家属再次喂服“消炎利胆片、速效救心丸”无效,随后呼叫120。我院120急救人员到达后予以舌上含服“硝酸甘油0.5mg”后接回急救部,查血常规示wbc叒6.8×109/l,n叒69.9%,plt179*109/l;肾功、电解质、心肌酶谱、凝血试验均正常;肌钙蛋白32.97pg/ml,d-二聚体1.6ug/ml。腹部彩超示肝回声欠均质;胆囊结石。心电图提示快速型心房纤颤,完全性右束支传导阻滞。为进一步诊疗收入我科住院。患者自发病以来精神、食欲差,大小便未诉异常。近期体重无明显减轻。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "16"}, {"mention": "胸痛", "label": "症状", "offset": "23"}, {"mention": "心前区", "label": "解剖部位", "offset": "28"}, {"mention": "颜面", "label": "解剖部位", "offset": "35"}, {"mention": "四肢", "label": "解剖部位", "offset": "37"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "70"}, {"mention": "心绞痛", "label": "疾病和诊断", "offset": "74"}, {"mention": "速效救心丸", "label": "药物", "offset": "119"}, {"mention": "心悸", "label": "症状", "offset": "149"}, {"mention": "心", "label": "解剖部位", "offset": "151"}, {"mention": "胸腹部", "label": "解剖部位", "offset": "156"}, {"mention": "腹泻", "label": "症状", "offset": "184"}, {"mention": "消炎利胆片", "label": "药物", "offset": "238"}, {"mention": "速效救心丸", "label": "药物", "offset": "244"}, {"mention": "胸腹部", "label": "解剖部位", "offset": "292"}, {"mention": "腹泻", "label": "症状", "offset": "305"}, {"mention": "消炎利胆片", "label": "药物", "offset": "330"}, {"mention": "速效救心丸", "label": "药物", "offset": "336"}, {"mention": "硝酸甘油", "label": "药物", "offset": "372"}, {"mention": "wbc", "label": "实验室检验", "offset": "394"}, {"mention": "n", "label": "实验室检验", "offset": "408"}, {"mention": "plt", "label": "实验室检验", "offset": "416"}, {"mention": "肌钙蛋白", "label": "实验室检验", "offset": "449"}, {"mention": "d-二聚体", "label": "实验室检验", "offset": "464"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "478"}, {"mention": "胆囊结石", "label": "疾病和诊断", "offset": "490"}, {"mention": "心电图", "label": "影像检查", "offset": "495"}, {"mention": "快速型心房纤颤", "label": "疾病和诊断", "offset": "500"}, {"mention": "完全性右束支传导阻滞", "label": "疾病和诊断", "offset": "508"}]}
{"text": "入院2+年前患者出现反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。1年前在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理,反复出现黑便,口服“埃索美拉唑肠溶胶囊、云南白药胶囊、斑蝥胶囊”等对症处理可缓解。因“黑便、贫血”多次在我科住院给予抑酸止血输血处理好转出院。7天前患者再次出现解黑便,每2日1次黑色不成型大便,感头昏、四肢乏力。在我院门诊就诊,给予“卡络黄钠及兰索拉唑”治疗后无好转,查血常规:wbc:1.9*10^/9l,hb:47g/l,为进一步治疗,门诊以“胃癌伴出血,失血性贫血”收入我科。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "90"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "102"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "108"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "172"}, {"mention": "胃体", "label": "解剖部位", "offset": "192"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "202"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "207"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "215"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "235"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "306"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "337"}, {"mention": "胃切除术", "label": "手术", "offset": "346"}, {"mention": "埃索美拉唑肠溶胶囊", "label": "药物", "offset": "380"}, {"mention": "云南白药胶囊", "label": "药物", "offset": "390"}, {"mention": "斑蝥胶囊", "label": "药物", "offset": "397"}, {"mention": "头昏", "label": "症状", "offset": "468"}, {"mention": "四肢", "label": "解剖部位", "offset": "471"}, {"mention": "卡络黄钠", "label": "药物", "offset": "487"}, {"mention": "兰索拉唑", "label": "药物", "offset": "492"}, {"mention": "wbc", "label": "实验室检验", "offset": "509"}, {"mention": "hb", "label": "实验室检验", "offset": "524"}, {"mention": "胃癌伴出血", "label": "疾病和诊断", "offset": "544"}, {"mention": "失血性贫血", "label": "疾病和诊断", "offset": "550"}]}
{"text": "入院前8年无明显诱因患者感活动后乏力、气促,不伴头昏、头痛、胸闷、心悸、胸痛、晕厥、黑曚、呃逆、反酸、嗳气、烧心、恶心、呕吐、腹痛、腹胀、腹泻、黑便。患者于*****医院诊断“溶血性贫血”,给予输血等处理后病情缓解。病程中如下症状反复发生,多次给予输血治疗后病程好转。2013年4月*****胸片检查:两肺纹理增多,心影轻度增大。心脏彩超:右房、右室稍增大,ef正常。血库: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:总胆红素叒50umol/l,直接胆红素叒10umol/l,alt叒40u/l,ast叒18u/l。诊断“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、气促不适,反复经输注洗涤红细胞后缓解。3天前患者再次出现乏力、气促,伴腹胀、小便色红。为求进一步治疗今日入我院门诊,门诊以“g-6-pd酶缺乏症”收入我科。患者此次患病以来,精神状态差,小便色红,大便正常,体重无明显减轻。", "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": "33"}, {"mention": "胸痛", "label": "症状", "offset": "36"}, {"mention": "腹痛", "label": "症状", "offset": "63"}, {"mention": "腹胀", "label": "症状", "offset": "66"}, {"mention": "腹泻", "label": "症状", "offset": "69"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "88"}, {"mention": "胸片", "label": "影像检查", "offset": "146"}, {"mention": "两肺", "label": "解剖部位", "offset": "151"}, {"mention": "心", "label": "解剖部位", "offset": "158"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "165"}, {"mention": "右房", "label": "解剖部位", "offset": "170"}, {"mention": "右室", "label": "解剖部位", "offset": "173"}, {"mention": "ef", "label": "实验室检验", "offset": "179"}, {"mention": "间接coomb’s试验", "label": "实验室检验", "offset": "187"}, {"mention": "新生儿g6pd活性试验", "label": "实验室检验", "offset": "321"}, {"mention": "总胆红素", "label": "实验室检验", "offset": "344"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "358"}, {"mention": "alt", "label": "实验室检验", "offset": "373"}, {"mention": "ast", "label": "实验室检验", "offset": "383"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "396"}, {"mention": "贫血性心脏病", "label": "疾病和诊断", "offset": "407"}, {"mention": "肝功能不全", "label": "疾病和诊断", "offset": "414"}, {"mention": "腹胀", "label": "症状", "offset": "483"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "510"}]}
{"text": "入院前1+天,患者于受凉后出现咳嗽,未见咳痰,纳差,拒绝进食,伴恶心呕吐胃内容物,吐词欠清晰,否认呕血及黑便,否认咯血,否认畏寒发热,否认寒战,否认疼痛呻吟,余症状不能表述,遂就诊我院,急诊科查头胸部ct:1.两侧半卵圆中心及两侧基底节区腔隙性脑梗死,部分为陈旧性腔隙性脑梗死;脑干陈旧性腔隙性脑梗死。2.脑白质脱髓鞘改变;脑萎缩。3.两侧额顶颞部蛛网膜上腔增宽或硬膜上积液。4.两侧筛窦及额窦炎。5.右肺下叶及两肺上叶感染性病变,建议结合临床。6.两肺下叶陈旧病灶。8.心影稍增大,主动脉壁及冠状动脉壁钙化;9.两侧胸膜稍增厚,胸椎骨质增生。10.甲状腺右叶小结节影。故以“肺部感染”收入我科住院治疗。患者自患病以来,精神、饮食、睡眠差,大小便失禁,近期体重无明显变化。入院前8+年,患者因跌倒于**医院就诊,诊断为脑梗死,之后患者反复出现头晕不适,阵性加重,受凉后易诱发加重,自行服用“眩晕片”后症状可缓解,曾检查发现颈脑血管狭窄,失去支架植入治疗指征,长期服用“血塞通、阿司匹林肠溶片”控制病情。多次于我院内一科住院治疗,诊断“1.脑动脉供血不足叒2.腔隙性脑梗死叒3.原发性高血压3级叒极高危”,近3+年逐渐出现四肢活动受限,长期卧床,饮水稍呛咳,偶有主动言语,近1+天病情加重后吐词欠清晰,大小便失禁。", "mention_data": [{"mention": "头胸部ct", "label": "影像检查", "offset": "97"}, {"mention": "两侧半卵圆中心及两侧基底节区腔隙性脑梗死", "label": "疾病和诊断", "offset": "105"}, {"mention": "陈旧性腔隙性脑梗死", "label": "疾病和诊断", "offset": "129"}, {"mention": "脑干陈旧性腔隙性脑梗死", "label": "疾病和诊断", "offset": "139"}, {"mention": "脑白质脱髓鞘改变", "label": "疾病和诊断", "offset": "153"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "162"}, {"mention": "两侧额顶颞部蛛网膜上腔增宽或硬膜上积液", "label": "疾病和诊断", "offset": "168"}, {"mention": "两侧筛窦及额窦炎", "label": "疾病和诊断", "offset": "190"}, {"mention": "右肺下叶及两肺上叶感染性病变", "label": "疾病和诊断", "offset": "201"}, {"mention": "两肺下叶", "label": "解剖部位", "offset": "225"}, {"mention": "心", "label": "解剖部位", "offset": "236"}, {"mention": "主动脉壁", "label": "解剖部位", "offset": "242"}, {"mention": "冠状动脉壁", "label": "解剖部位", "offset": "247"}, {"mention": "两侧胸膜", "label": "解剖部位", "offset": "257"}, {"mention": "甲状腺右叶", "label": "解剖部位", "offset": "275"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "288"}, {"mention": "脑梗死", "label": "疾病和诊断", "offset": "359"}, {"mention": "眩晕片", "label": "药物", "offset": "395"}, {"mention": "颈脑血管狭窄", "label": "疾病和诊断", "offset": "411"}, {"mention": "血塞通", "label": "疾病和诊断", "offset": "434"}, {"mention": "阿司匹林肠溶片", "label": "药物", "offset": "438"}, {"mention": "脑动脉供血不足", "label": "疾病和诊断", "offset": "469"}, {"mention": "腔隙性脑梗死", "label": "疾病和诊断", "offset": "479"}, {"mention": "原发性高血压3级叒极高危", "label": "疾病和诊断", "offset": "488"}, {"mention": "四肢", "label": "解剖部位", "offset": "510"}]}
{"text": "患者入院前2年,无明显诱因开始出现反复咳嗽、咳脓痰、活动后气促,伴两上肢水肿、腹胀、纳差,平卧位时咳嗽明显,不能耐受日常活动,无畏寒、发热及潮热、盗汗,无胸痛、咯血等不适。于我院内二科就诊,行胸部ct提示左侧胸腔积液,给予抽液及抗炎等治疗后症状好转出院。但患者依从性差,未规律服药,此后气促、咳嗽反复发作,多次住院治疗。患者于2015.10月下述症状再次加重,于**医院就诊,行心脏彩超提示:全心增大,室壁动度减低,三尖瓣重度返流,卵圆孔未闭。bnp、转氨酶及肿瘤标志物异常增高。给予强心、利尿等治疗后症状好转出院。后患者反复因下诉症状多次在我院住院治疗。1月前(2017.04.20)患者因再发咳嗽、气促入院,诊断“1、扩张型心肌病叒全心扩大叒慢性心功能不全叒心功能iii级叒2、肺部感染叒3、胃溃疡叒4.右侧腘静脉血栓形成(急性期)”,建议患者至下级医院进一步治疗静脉血栓,患者至**医院行上肢静脉彩超示上肢静脉未见血栓,遂回我科继续治疗并症状好转出院。入院前10天,患者受凉后感咳嗽、咳痰,气促症状加重,活动耐量较前明显减少,两上肢水肿明显,伴腹部不适、头昏痛,无咯血、胸痛,无发热、畏寒,无恶心呕吐、腹泻等,现患者为进一步治疗收治我科。患者此次患病以来精神食欲差,大小便正常,睡眠欠佳,体重无明显上降。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "33"}, {"mention": "腹胀", "label": "症状", "offset": "39"}, {"mention": "胸痛", "label": "症状", "offset": "77"}, {"mention": "胸部ct", "label": "影像检查", "offset": "96"}, {"mention": "左侧胸腔积液", "label": "疾病和诊断", "offset": "102"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "189"}, {"mention": "心", "label": "解剖部位", "offset": "197"}, {"mention": "室壁", "label": "解剖部位", "offset": "201"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "208"}, {"mention": "卵圆孔", "label": "解剖部位", "offset": "216"}, {"mention": "扩张型心肌病", "label": "疾病和诊断", "offset": "311"}, {"mention": "全心扩大", "label": "疾病和诊断", "offset": "318"}, {"mention": "慢性心功能不全", "label": "疾病和诊断", "offset": "323"}, {"mention": "心功能iii级", "label": "疾病和诊断", "offset": "331"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "341"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "348"}, {"mention": "右侧腘静脉血栓形成(急性期)", "label": "疾病和诊断", "offset": "354"}, {"mention": "上肢静脉彩超", "label": "影像检查", "offset": "397"}, {"mention": "两上肢", "label": "解剖部位", "offset": "466"}, {"mention": "腹部不适", "label": "症状", "offset": "475"}, {"mention": "头昏", "label": "症状", "offset": "480"}, {"mention": "胸痛", "label": "症状", "offset": "488"}, {"mention": "腹泻", "label": "症状", "offset": "504"}]}
{"text": "入院前10+年患者体检时发现血压升高,最高血压收缩压达180mmhg,诊断为“原发性高血压病”,无心悸、气促、胸闷、胸痛、头昏、头痛。在外口服“罗布麻”降压治疗血压控制差,病程中间断出现两上肢水肿,在外口服“利尿药”后可缓解。偶有心悸,因血压控制差在“*********”就诊,给予“厄贝沙坦氢氯噻嗪片150mg叒每次1片每天1次口服,美托洛尔缓释片47.5mg叒每天次1片每天1次口服,右旋氨氯地平片(施慧达)2.5mg叒每次1片每天1次口服,麝香保心丸22.5mg叒每次2片每天3次口服”等对症治疗。监测血压可。入院前4天饮入冷水后出现腹泻,每天解10余次黄色稀水样便,无粘液脓血便,无腹痛、恶心、呕吐,无畏寒、发热。在外口服“止泻药”(具体不详)后腹泻好转。入院前2天出现心悸,偶有胸前区压榨感,伴纳差、四肢乏力,感眼花,无黑朦、眩晕,无胸痛、夜间阵发性呼吸困难,无畏寒、发热,无腹痛、腹胀、恶心、呕吐。在外口服“麝香保心丸叒45mg叒每天3次口服、美托洛尔缓释片47.5mg叒每天1次口服”等处理后无缓解。在“*****医院”就诊,查“心电图提示快速型心房纤颤”,遂来我院就诊,为进一步诊治,门诊以“纳差待查,高血压、心房纤颤”收入我科。病程中精神、饮食较差,大便目前正常,小便正常,体重无明显改变。", "mention_data": [{"mention": "原发性高血压病", "label": "疾病和诊断", "offset": "39"}, {"mention": "心悸", "label": "症状", "offset": "49"}, {"mention": "胸闷", "label": "症状", "offset": "55"}, {"mention": "胸痛", "label": "症状", "offset": "58"}, {"mention": "头昏", "label": "症状", "offset": "61"}, {"mention": "头痛", "label": "症状", "offset": "64"}, {"mention": "罗布麻", "label": "药物", "offset": "72"}, {"mention": "两上肢", "label": "解剖部位", "offset": "93"}, {"mention": "心悸", "label": "症状", "offset": "115"}, {"mention": "厄贝沙坦氢氯噻嗪片", "label": "药物", "offset": "142"}, {"mention": "美托洛尔缓释片", "label": "药物", "offset": "168"}, {"mention": "右旋氨氯地平片(施慧达)", "label": "药物", "offset": "194"}, {"mention": "麝香保心丸", "label": "药物", "offset": "223"}, {"mention": "腹泻", "label": "症状", "offset": "270"}, {"mention": "腹痛", "label": "症状", "offset": "295"}, {"mention": "心悸", "label": "症状", "offset": "339"}, {"mention": "胸前区", "label": "解剖部位", "offset": "344"}, {"mention": "四肢", "label": "解剖部位", "offset": "355"}, {"mention": "胸痛", "label": "症状", "offset": "372"}, {"mention": "腹痛", "label": "症状", "offset": "393"}, {"mention": "腹胀", "label": "症状", "offset": "396"}, {"mention": "麝香保心丸", "label": "药物", "offset": "410"}, {"mention": "美托洛尔缓释片", "label": "药物", "offset": "428"}, {"mention": "心电图", "label": "影像检查", "offset": "472"}, {"mention": "快速型心房纤颤", "label": "疾病和诊断", "offset": "477"}, {"mention": "纳差待查", "label": "疾病和诊断", "offset": "504"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "509"}, {"mention": "心房纤颤", "label": "疾病和诊断", "offset": "513"}]}
{"text": "入院前2+年患者反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。后反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。入院前1+年在**医院就诊,行胃镜及病理活检提示“胃早癌”,未行手术治疗出院。又在**********就诊,仍提示“胃早癌”,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理,反复出现黑便,口服“埃索美拉唑肠溶胶囊、云南白药胶囊、斑蝥胶囊”等对症处理可缓解。因“黑便、贫血”多次在我科住院给予抑酸、止血、输血处理好转出院。入院前6天患者再次出现解黑便1次,具体量不详,感头昏、四肢乏力加重。今日在我院门诊就诊,查血常规:wbc:1.4*10^/9l,hb:38g/l,为进一步治疗,门诊以“下消化道出血、胃癌伴出血,肝硬化”收入我科。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "17"}, {"mention": "腹痛", "label": "症状", "offset": "44"}, {"mention": "腹胀", "label": "症状", "offset": "47"}, {"mention": "腹泻", "label": "症状", "offset": "50"}, {"mention": "颜面", "label": "解剖部位", "offset": "67"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "88"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "100"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "106"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "111"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "169"}, {"mention": "胃体", "label": "解剖部位", "offset": "189"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "199"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "204"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "212"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "232"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "307"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "340"}, {"mention": "胃切除术", "label": "手术", "offset": "350"}, {"mention": "埃索美拉唑肠溶胶囊", "label": "药物", "offset": "384"}, {"mention": "云南白药胶囊", "label": "药物", "offset": "394"}, {"mention": "斑蝥胶囊", "label": "药物", "offset": "401"}, {"mention": "头昏", "label": "症状", "offset": "471"}, {"mention": "四肢", "label": "解剖部位", "offset": "474"}, {"mention": "wbc", "label": "实验室检验", "offset": "496"}, {"mention": "hb", "label": "实验室检验", "offset": "511"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "531"}, {"mention": "胃癌伴出血", "label": "疾病和诊断", "offset": "538"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "544"}]}
{"text": "入院前16年患者发现血糖高,最高时20mmol/l右左,后给予降糖药物,未监测血糖,未重视及正规治疗。于1+年前因头昏在我院内一科住院治疗,完善检查后诊断1、脑动脉供血不足2、高血压病3级极高危组叒室间隔增厚3、2型糖尿病叒糖尿病肾病叒糖尿病周围神经病变4、腔隙性脑梗死5、高脂血症。给予门冬胰岛素早14iu中14iu晚12iu,重组甘精胰岛素注射液(长秀霖笔芯)叒每次14iu,皮上注射/晚,病程过程中伴有两眼视物模糊、飞蚊症、视力上降,伴远段肢体麻木,伴夜尿增多(每晚3次),10月前因“血糖高,两上肢水肿”于我院住院,诊断为“2型糖尿病叒叒糖尿病眼病叒叒糖尿周围病神经病变叒糖尿病肾病叒肾性贫血、原发性高血压3级极高危叒高血压心脏病叒心功能ⅱ级”。2周前患者无明显诱因突感头晕、伴视物旋转,行走站立不稳,伴舌头麻木,无耳鸣,无恶心、呕吐,无肢体偏瘫,无口齿不清,无吞咽困难、饮水呛咳,自行服用“脑络通胶囊”后逐渐缓解,当仍感阵发性头昏不适及舌麻,且反复出现两上肢水肿,无乏力、发热、无头昏头痛、无视物旋转、无心悸气促、无咳嗽、咳痰、无腹痛、腹泻,无尿频、尿急、尿痛,无胸闷、胸痛,无活动后气促,为进一步治疗,今日来我院就诊,门诊收入我科住院治疗。患病来精神、饮食可,大小便如常,体重无明显上降。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "57"}, {"mention": "脑动脉供血不足", "label": "疾病和诊断", "offset": "79"}, {"mention": "高血压病3级极高危组", "label": "疾病和诊断", "offset": "88"}, {"mention": "室间隔增厚", "label": "疾病和诊断", "offset": "99"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "106"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "112"}, {"mention": "糖尿病周围神经病变", "label": "疾病和诊断", "offset": "118"}, {"mention": "腔隙性脑梗死", "label": "疾病和诊断", "offset": "129"}, {"mention": "高脂血症", "label": "疾病和诊断", "offset": "137"}, {"mention": "门冬胰岛素", "label": "药物", "offset": "144"}, {"mention": "重组甘精胰岛素注射液(长秀霖笔芯)", "label": "药物", "offset": "165"}, {"mention": "两眼", "label": "解剖部位", "offset": "204"}, {"mention": "两上肢", "label": "解剖部位", "offset": "250"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "266"}, {"mention": "糖尿病眼病", "label": "疾病和诊断", "offset": "273"}, {"mention": "糖尿周围病神经病变", "label": "疾病和诊断", "offset": "280"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "290"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "296"}, {"mention": "原发性高血压3级极高危", "label": "疾病和诊断", "offset": "301"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "313"}, {"mention": "心功能ⅱ级", "label": "疾病和诊断", "offset": "320"}, {"mention": "头晕", "label": "症状", "offset": "339"}, {"mention": "舌头", "label": "解剖部位", "offset": "356"}, {"mention": "耳鸣", "label": "症状", "offset": "362"}, {"mention": "脑络通胶囊", "label": "药物", "offset": "400"}, {"mention": "头昏", "label": "症状", "offset": "418"}, {"mention": "舌", "label": "解剖部位", "offset": "423"}, {"mention": "两上肢", "label": "解剖部位", "offset": "431"}, {"mention": "头昏", "label": "症状", "offset": "445"}, {"mention": "头痛", "label": "症状", "offset": "447"}, {"mention": "心悸", "label": "症状", "offset": "457"}, {"mention": "腹痛", "label": "症状", "offset": "470"}, {"mention": "腹泻", "label": "症状", "offset": "473"}, {"mention": "胸闷", "label": "症状", "offset": "487"}, {"mention": "胸痛", "label": "症状", "offset": "490"}]}
{"text": "入院1+年前患者服用“头痛粉”后解黑色成形大便,共3次,量约250g/次,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院查“hb32g/l”,诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院住院8次余,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。2+月前患者因再次解黑便在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。入院1+月前在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。1周前出现全身乏力、活动后心悸不适,无黑便、腹痛、纳差、畏寒、发热。在*******医院就诊查血常规提示hb:49g/l(未见报告)。今日为行输血治疗遂来我科住院,门诊以“胃癌”收入我科。病程中精神稍查,饮食可,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "头痛粉", "label": "药物", "offset": "11"}, {"mention": "头昏", "label": "症状", "offset": "38"}, {"mention": "腹痛", "label": "症状", "offset": "65"}, {"mention": "腹胀", "label": "症状", "offset": "68"}, {"mention": "腹泻", "label": "症状", "offset": "71"}, {"mention": "颜面", "label": "解剖部位", "offset": "88"}, {"mention": "hb", "label": "实验室检验", "offset": "105"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "120"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "132"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "138"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "143"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "211"}, {"mention": "胃体", "label": "解剖部位", "offset": "231"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "241"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "246"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "254"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "274"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "354"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "390"}, {"mention": "胃切除术", "label": "手术", "offset": "399"}, {"mention": "心悸", "label": "症状", "offset": "436"}, {"mention": "腹痛", "label": "症状", "offset": "445"}, {"mention": "hb", "label": "实验室检验", "offset": "475"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "509"}]}
{"text": "患者于入院前2年即开始反复出现胸痛症状,有心前区压榨感,均在活动及进食后出现,不能耐受平地快走,发作后含服“速效救心丸”或休息后可逐渐缓解。病程中曾多次出现突发呼吸困难、大汗、濒死感,在****医院等住院治疗好转。1+年前患者进餐后再次突然出现呼吸困难,全身大汗、胸痛,诊断为“冠心病、心力衰竭”,于我科住院,给予扩管、抗血小板聚集、降压、控制心室率等治疗后好转出院。入院前3月及入院前1月患者因气促伴呼吸困难在我科住院,心脏彩超提示:右房、右室、左房增大;肺动脉增宽;主动脉瓣钙化;肺动脉瓣轻度反流;二尖瓣、三尖瓣中度反流;右室收缩功能减退,心包腔积液。经扩冠利尿等治疗病情好转出院。入院前10天患者受凉后出现咳嗽、咳痰,为白色泡沫痰,无发热、畏寒,无喘累,无心悸、胸闷等不适。自行口服“强力枇杷露”等药物后自觉咳嗽有所好转。今日患者感心累气促加重,伴纳差,感心前区紧缩感,持续数分钟,含服速效救心丸后症状可缓解,无畏寒发热,无反酸嗳气,无明显胸痛,无夜间阵发性呼吸困难,无颜面四肢浮肿。养老院医生送其入我院,急诊科查心电图:房扑,心率69次/分。指血糖7.9mmol/l。为进一步诊治,收治我科。患者此次患病以来精神一般,食欲差,大小便正常,睡眠尚可,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "15"}, {"mention": "速效救心丸", "label": "药物", "offset": "54"}, {"mention": "胸痛", "label": "症状", "offset": "132"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "139"}, {"mention": "心力衰竭", "label": "疾病和诊断", "offset": "143"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "211"}, {"mention": "右房", "label": "解剖部位", "offset": "218"}, {"mention": "右室", "label": "解剖部位", "offset": "221"}, {"mention": "左房", "label": "解剖部位", "offset": "224"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "229"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "235"}, {"mention": "肺动脉瓣", "label": "解剖部位", "offset": "242"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "251"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "255"}, {"mention": "右室收缩功能减退", "label": "疾病和诊断", "offset": "263"}, {"mention": "心包腔积液", "label": "疾病和诊断", "offset": "272"}, {"mention": "心悸", "label": "症状", "offset": "331"}, {"mention": "胸闷", "label": "症状", "offset": "334"}, {"mention": "强力枇杷露", "label": "药物", "offset": "345"}, {"mention": "心", "label": "解剖部位", "offset": "369"}, {"mention": "心前区", "label": "解剖部位", "offset": "381"}, {"mention": "速效救心丸", "label": "药物", "offset": "396"}, {"mention": "胸痛", "label": "症状", "offset": "423"}, {"mention": "颜面", "label": "解剖部位", "offset": "438"}, {"mention": "四肢", "label": "解剖部位", "offset": "440"}, {"mention": "心电图", "label": "影像检查", "offset": "460"}, {"mention": "房扑", "label": "疾病和诊断", "offset": "464"}, {"mention": "血糖", "label": "实验室检验", "offset": "476"}]}
{"text": "入院1+年前患者出现反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。随后在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。2天前患者出现解黑色稀便,每天一次,总量约500g,伴头昏、四肢乏力。在我院门诊输液(卡洛磺、奥美拉唑)后仍解黑便,查:血常规:白细胞数叒2.2×10^9/l、红细胞数叒2.57×10^12/l、血红蛋白浓度叒57叒g/l。现为进一步治疗,门诊以“胃癌,失血性贫血”收入我科。病程中精神差,饮食可,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "90"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "102"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "108"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "180"}, {"mention": "胃体", "label": "解剖部位", "offset": "200"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "210"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "215"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "223"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "243"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "313"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "344"}, {"mention": "胃切除术", "label": "手术", "offset": "353"}, {"mention": "头昏", "label": "症状", "offset": "404"}, {"mention": "四肢", "label": "解剖部位", "offset": "407"}, {"mention": "卡洛磺", "label": "药物", "offset": "420"}, {"mention": "奥美拉唑", "label": "药物", "offset": "424"}, {"mention": "白细胞", "label": "实验室检验", "offset": "441"}, {"mention": "红细胞", "label": "实验室检验", "offset": "457"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "475"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "501"}, {"mention": "失血性贫血", "label": "疾病和诊断", "offset": "504"}]}
{"text": "患者入院前1+年(2015.5),无明显诱因开始出现反复咳嗽、咳脓痰、活动后气促,伴两上肢水肿、腹胀、纳差,平卧位时咳嗽明显,不能耐受日常活动,无畏寒、发热及潮热、盗汗,无胸痛、咯血等不适。于我院内二科就诊,行胸部ct提示左侧胸腔积液,给予抽液及抗炎等治疗后症状好转出院。但患者依从性差,未规律服药,此后气促、咳嗽反复发作,多次住院治疗。患者于2015.10月下述症状再次加重,于**医院就诊,行心脏彩超提示:全心增大,室壁动度减低,三尖瓣重度返流,卵圆孔未闭。bnp、转氨酶及肿瘤标志物异常增高。给予强心、利尿等治疗后症状好转出院。后患者反复因下诉症状在我院住院治疗。入院前9天,患者受凉后感咳嗽、咳痰,为白色粘痰,气促症状加重,活动耐量较明显减少,有夜间阵发性呼吸困难,两上肢水肿明显,无咯血、胸痛,无发热、畏寒,无头晕、头痛等,并于2天前在我科住院,诊断“1、扩张型心肌病叒全心扩大叒慢性心功能不全叒心功能iii级叒2、肺部感染叒3、胃溃疡叒4.右侧腘静脉血栓形成(急性期)”,建议患者至下级医院进一步治疗静脉血栓。今日患者出院后至**医院行上肢静脉彩超示上肢静脉未见血栓。现患者为继续治疗肺部感染及心衰收治我科。患者此次患病以来精神食欲差,大小便正常,睡眠欠佳,体重变化不详。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "42"}, {"mention": "腹胀", "label": "症状", "offset": "48"}, {"mention": "胸痛", "label": "症状", "offset": "86"}, {"mention": "胸部ct", "label": "影像检查", "offset": "105"}, {"mention": "左侧胸腔积液", "label": "疾病和诊断", "offset": "111"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "198"}, {"mention": "心", "label": "解剖部位", "offset": "206"}, {"mention": "室壁", "label": "解剖部位", "offset": "210"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "217"}, {"mention": "卵圆孔", "label": "解剖部位", "offset": "225"}, {"mention": "两上肢", "label": "解剖部位", "offset": "337"}, {"mention": "胸痛", "label": "症状", "offset": "349"}, {"mention": "头晕", "label": "症状", "offset": "360"}, {"mention": "头痛", "label": "症状", "offset": "363"}, {"mention": "扩张型心肌病", "label": "疾病和诊断", "offset": "383"}, {"mention": "全心扩大", "label": "疾病和诊断", "offset": "390"}, {"mention": "慢性心功能不全", "label": "疾病和诊断", "offset": "395"}, {"mention": "心功能iii级", "label": "疾病和诊断", "offset": "403"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "413"}, {"mention": "胃溃疡", "label": "疾病和诊断", "offset": "420"}, {"mention": "右侧腘静脉血栓形成(急性期)", "label": "疾病和诊断", "offset": "426"}, {"mention": "上肢静脉彩超", "label": "影像检查", "offset": "474"}, {"mention": "上肢", "label": "解剖部位", "offset": "481"}, {"mention": "肺部感染", "label": "症状", "offset": "498"}]}
{"text": "患者于入院1-月前发现两上肢浮肿、尿量减少、喘累,到****医院查血常规:叒hb:87g/l,肾功:血肌酐:394umol/l,考虑肾功能不全、肾性贫血,后到**********医院就诊,查肾功:血肌酐:330umol/l,血常规:hb:89g/l,甲状旁腺激素叒55.5pg/ml,内生肌酐清除率:14.49ml/min,腹部彩超:两肾结构欠清,实质回声稍增强,腹腔少量积液;心脏彩超:右室肥厚,少许心包积液;胸部ct平扫:右肺上叶炎症,心脏增大,两侧胸腔积液,给予血液净化治疗、降压、降糖、纠正贫血、改善循环等治疗后好转出院。1天前患者再次出现心悸、胸闷,伴恶心、纳差,无咳嗽、咳痰,无腹痛、腹胀,无肉眼血尿,无头昏、头痛,无皮上出血、牙龈出血等不适。今为进一步治疗,到我院就诊,门诊收入我科住院治疗。患者自患病以来,精神、睡眠可,食欲差,大便正常,小便偏少,量不详,体重无明显变化。22年前因手足麻木在当地医院查血糖升高,值不详,诊断为2型糖尿病,先后服用格列齐特、消渴丸降糖,偶测血糖20+mmol/l,曾服用二甲两胍出现恶心、呕吐停用,后开始出现视物模糊、两上肢水肿,2年前开始使用优思林降血糖,血糖控制不详,现改为诺和锐30叒16u/早,12u/晚降血糖,血糖控制可。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "11"}, {"mention": "hb", "label": "实验室检验", "offset": "38"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "50"}, {"mention": "肾功能不全", "label": "疾病和诊断", "offset": "66"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "72"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "98"}, {"mention": "hb", "label": "实验室检验", "offset": "116"}, {"mention": "甲状旁腺激素", "label": "实验室检验", "offset": "125"}, {"mention": "内生肌酐清除率", "label": "实验室检验", "offset": "142"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "162"}, {"mention": "两肾", "label": "解剖部位", "offset": "167"}, {"mention": "腹腔", "label": "解剖部位", "offset": "182"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "189"}, {"mention": "右室肥厚", "label": "症状", "offset": "194"}, {"mention": "心包积液", "label": "疾病和诊断", "offset": "201"}, {"mention": "胸部ct平扫", "label": "影像检查", "offset": "206"}, {"mention": "右肺上叶炎症", "label": "疾病和诊断", "offset": "213"}, {"mention": "心脏增大", "label": "症状", "offset": "220"}, {"mention": "两侧胸腔积液", "label": "疾病和诊断", "offset": "225"}, {"mention": "心悸", "label": "症状", "offset": "274"}, {"mention": "胸闷", "label": "症状", "offset": "277"}, {"mention": "腹痛", "label": "症状", "offset": "295"}, {"mention": "腹胀", "label": "症状", "offset": "298"}, {"mention": "头昏", "label": "症状", "offset": "308"}, {"mention": "头痛", "label": "症状", "offset": "311"}, {"mention": "牙龈出血", "label": "症状", "offset": "320"}, {"mention": "手足麻木", "label": "症状", "offset": "399"}, {"mention": "血糖升高", "label": "疾病和诊断", "offset": "409"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "421"}, {"mention": "格列齐特", "label": "药物", "offset": "431"}, {"mention": "消渴丸降糖", "label": "药物", "offset": "436"}, {"mention": "血糖", "label": "实验室检验", "offset": "444"}, {"mention": "二甲两胍", "label": "药物", "offset": "459"}, {"mention": "两上肢", "label": "解剖部位", "offset": "483"}, {"mention": "优思林", "label": "药物", "offset": "496"}, {"mention": "诺和锐30", "label": "药物", "offset": "513"}]}
{"text": "患者于入院前2年即开始反复出现胸痛症状,有心前区压榨感,均在活动及进食后出现,不能耐受平地快走,发作后含服“速效救心丸”或休息后可逐渐缓解。病程中曾多次出现突发呼吸困难、大汗、濒死感,在****医院等住院治疗好转。1+年前患者进餐后再次突然出现呼吸困难,全身大汗、胸痛,诊断为“冠心病、心力衰竭”,于我科住院,给予扩管、抗血小板聚集、降压、控制心室率等治疗后好转出院。入院前3月及入院前1月患者因气促伴呼吸困难在我科住院,心脏彩超提示:右房、右室、左房增大;肺动脉增宽;主动脉瓣钙化;肺动脉瓣轻度反流;二尖瓣、三尖瓣中度反流;右室收缩功能减退,心包腔积液。经扩冠利尿等治疗病情好转出院。入院前半月患者受凉后出现咳嗽、咳痰,为白色泡沫痰,无发热、畏寒,无喘累,无心悸、胸闷等不适。自行口服“强力枇杷露”等药物后自觉咳嗽有所好转。入院前1周,患者因下诉症状在我院住院治疗,经治疗后好转出院。今日患者感心累气促加重,感心前区紧缩感,持续数分钟,含服速效救心丸后症状可缓解,无畏寒发热,无反酸嗳气,无明显胸痛,无夜间阵发性呼吸困难,无颜面四肢浮肿。养老院医生送其入我院,为进一步诊治,收治我科。患者此次患病以来精神一般,食欲差,大小便正常,睡眠尚可,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "15"}, {"mention": "心前区", "label": "解剖部位", "offset": "21"}, {"mention": "速效救心丸", "label": "药物", "offset": "54"}, {"mention": "胸痛", "label": "症状", "offset": "132"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "139"}, {"mention": "心力衰竭", "label": "疾病和诊断", "offset": "143"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "211"}, {"mention": "右房", "label": "解剖部位", "offset": "218"}, {"mention": "右室", "label": "解剖部位", "offset": "221"}, {"mention": "左房", "label": "解剖部位", "offset": "224"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "229"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "235"}, {"mention": "肺动脉瓣", "label": "解剖部位", "offset": "242"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "251"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "255"}, {"mention": "右室收缩功能减退", "label": "疾病和诊断", "offset": "263"}, {"mention": "心包腔积液", "label": "疾病和诊断", "offset": "272"}, {"mention": "心悸", "label": "症状", "offset": "330"}, {"mention": "胸闷", "label": "症状", "offset": "333"}, {"mention": "强力枇杷露", "label": "药物", "offset": "344"}, {"mention": "心", "label": "解剖部位", "offset": "398"}, {"mention": "心前区", "label": "解剖部位", "offset": "406"}, {"mention": "速效救心丸", "label": "药物", "offset": "421"}, {"mention": "胸痛", "label": "症状", "offset": "448"}, {"mention": "颜面", "label": "解剖部位", "offset": "463"}, {"mention": "四肢", "label": "解剖部位", "offset": "465"}]}
{"text": "入院前5小时,患者躺在厕所背家属发现呼之不应,无四肢抽搐,无大小便失禁,周围环境未见呕吐物,家属立即送入我院急诊科。查心率230次/分,心电图提示房颤伴快速心室率,血压测不出,给予维拉帕米5mg静推后患者心率逐渐上降至120-130次/分,意识逐渐恢复,查血气分析全套:酸碱度叒7.320、二氧化碳分压叒23叒mmhg、氧分压叒145叒mmhg、标准碳酸氢根叒15.60叒mmol/l、乳酸叒6.40叒mmol/l,血常规:白细胞数叒11.2叒10^9/l、中性粒细胞百分比叒86.24叒%,心肌酶谱:谷草转氨酶叒71.0叒u/l、肌酸激酶叒1569.1叒u/l、肌酸激酶同工酶叒60叒u/l、乳酸脱氢酶叒329.4叒u/l,肾功:尿素叒32.95叒mmol/l、肌酐叒319.4叒μmol/l,高敏肌钙蛋白:高敏肌钙蛋白t叒353.40叒pg/ml,电解质1:钠叒160.4叒mmol/、氯叒119.6叒mmol/l,d_2聚体叒2.20叒μg/ml。头部ct提示:左侧中叶前回小片密度减低病灶,考虑脑梗死。脑萎缩、脑白质脱髓鞘改变。给予脑苷肌肽静滴,5%葡萄糖静滴补液,为进一步诊治收治我科。患者此次起病以来精神、食欲、睡眠一般,大小便正常,体力及体重无明显改变。", "mention_data": [{"mention": "四肢抽搐", "label": "症状", "offset": "24"}, {"mention": "心电图", "label": "影像检查", "offset": "68"}, {"mention": "房颤伴快速心室率", "label": "疾病和诊断", "offset": "73"}, {"mention": "维拉帕米", "label": "药物", "offset": "90"}, {"mention": "酸碱度", "label": "实验室检验", "offset": "135"}, {"mention": "二氧化碳分压", "label": "实验室检验", "offset": "145"}, {"mention": "氧分压", "label": "实验室检验", "offset": "160"}, {"mention": "标准碳酸氢根", "label": "实验室检验", "offset": "173"}, {"mention": "乳酸", "label": "实验室检验", "offset": "193"}, {"mention": "白细胞数", "label": "实验室检验", "offset": "212"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "229"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "251"}, {"mention": "肌酸激酶", "label": "实验室检验", "offset": "266"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "282"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "297"}, {"mention": "尿素", "label": "实验室检验", "offset": "316"}, {"mention": "肌酐", "label": "实验室检验", "offset": "332"}, {"mention": "高敏肌钙蛋白t", "label": "实验室检验", "offset": "355"}, {"mention": "钠", "label": "实验室检验", "offset": "381"}, {"mention": "氯", "label": "实验室检验", "offset": "395"}, {"mention": "d_2聚体", "label": "实验室检验", "offset": "410"}, {"mention": "头部ct", "label": "影像检查", "offset": "427"}, {"mention": "左侧中叶", "label": "解剖部位", "offset": "434"}, {"mention": "脑梗死", "label": "疾病和诊断", "offset": "451"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "455"}, {"mention": "脑白质脱髓鞘改变", "label": "疾病和诊断", "offset": "459"}, {"mention": "脑苷肌肽", "label": "药物", "offset": "470"}, {"mention": "5%葡萄糖", "label": "药物", "offset": "477"}]}
{"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。半年多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。近半年多来,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3+月患者感颜面部浮肿,程度不重,于我科治疗,考虑为下腔静脉栓塞。给予治疗后可消退,现浮肿较重加重。近2月患者反复因颜面部浮肿及咳嗽、咳痰、气促、纳差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。最近1次住院患者病情相对稳定于昨日出院,院外患者仍感气促,伴腹胀、纳差,无发热、畏寒,无明显咳嗽、咳痰,无心悸、胸闷、胸痛,无腹痛、腹泻等。家属拨打我院120接入我院,为进一步诊治再次收入我科。本次发病以来患者精神食欲睡眠差,小便量少色黄,腹泻,稀水样大便,约5-6次/天。体重变化不明显。", "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": "182"}, {"mention": "左侧颈部", "label": "解剖部位", "offset": "207"}, {"mention": "颜面部", "label": "解剖部位", "offset": "288"}, {"mention": "下腔静脉栓塞", "label": "疾病和诊断", "offset": "308"}, {"mention": "颜面部", "label": "解剖部位", "offset": "340"}, {"mention": "腹胀", "label": "症状", "offset": "419"}, {"mention": "心悸", "label": "症状", "offset": "442"}, {"mention": "胸闷", "label": "症状", "offset": "445"}, {"mention": "胸痛", "label": "症状", "offset": "448"}, {"mention": "腹痛", "label": "症状", "offset": "452"}, {"mention": "腹泻", "label": "症状", "offset": "455"}, {"mention": "腹泻", "label": "症状", "offset": "509"}]}
{"text": "1天前患者因“便秘、乏力”到**医院就诊,查:血常规:血红蛋白浓度叒84叒g/l叒↓、红细胞压积叒26.9%叒↓,肾功:尿素叒6.33叒mmol/l、肌酐叒146.8叒μmol/l叒↑、尿酸叒317.3叒μmol/l,凝肝功4:白蛋白叒28.6叒g/l叒↓、球蛋白叒29.2叒g/l。大便常规:颜色:黑色。性状:稀。红细胞:1+,隐血:阳性。心电图:正常。胸部ct:1.慢性支气管炎、肺气肿伴两肺上叶感染。2.主动脉钙化。3.两侧胸膜增厚。诊断为\\\"慢性支气管炎急性发作,高血压病、肾功能不全、消化道出血\\\"予对症治疗(具体治疗不详),住院期间出现解黑色稀便,约10次,每次量约20-50g,后解双次暗红色血便,含血凝块,总量约100g,感头昏、乏力加重。出现呕吐可疑褐色胃内容1次,无血凝块,总量约100g,病程中未诉腹痛、胸痛、呼吸困难、畏寒、发热、阴道流血等。下述情况无改善,遂建议转我院就诊,要求住院治疗。门诊测p71次/分,bp:132/73mmhg,门诊给予静脉注射蛇毒血凝酶注射液叒2u,兰索拉唑叒40mg叒静脉滴注,为进一步诊治,以“消化道出血”收入我科。患者此次患病以来,精神状态欠佳,小便同前。近期体重无明显减轻.长期服用头痛粉,每2-3包/天。", "mention_data": [{"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "27"}, {"mention": "红细胞压积", "label": "实验室检验", "offset": "43"}, {"mention": "尿素", "label": "实验室检验", "offset": "60"}, {"mention": "肌酐", "label": "实验室检验", "offset": "75"}, {"mention": "尿酸", "label": "实验室检验", "offset": "93"}, {"mention": "白蛋白", "label": "实验室检验", "offset": "114"}, {"mention": "球蛋白", "label": "实验室检验", "offset": "129"}, {"mention": "大便常规", "label": "实验室检验", "offset": "142"}, {"mention": "红细胞", "label": "实验室检验", "offset": "158"}, {"mention": "隐血", "label": "实验室检验", "offset": "165"}, {"mention": "心电图", "label": "影像检查", "offset": "171"}, {"mention": "胸部ct", "label": "影像检查", "offset": "178"}, {"mention": "慢性支气管炎", "label": "疾病和诊断", "offset": "185"}, {"mention": "肺气肿伴两肺上叶感染", "label": "疾病和诊断", "offset": "192"}, {"mention": "主动脉钙化", "label": "疾病和诊断", "offset": "205"}, {"mention": "两侧胸膜", "label": "解剖部位", "offset": "213"}, {"mention": "慢性支气管炎急性发作", "label": "疾病和诊断", "offset": "225"}, {"mention": "高血压病", "label": "疾病和诊断", "offset": "236"}, {"mention": "肾功能不全", "label": "疾病和诊断", "offset": "241"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "247"}, {"mention": "头昏", "label": "症状", "offset": "320"}, {"mention": "胃", "label": "解剖部位", "offset": "336"}, {"mention": "腹痛", "label": "症状", "offset": "360"}, {"mention": "胸痛", "label": "症状", "offset": "363"}, {"mention": "阴道", "label": "解剖部位", "offset": "377"}, {"mention": "蛇毒血凝酶注射液", "label": "药物", "offset": "439"}, {"mention": "兰索拉唑", "label": "药物", "offset": "451"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "475"}, {"mention": "头痛粉", "label": "药物", "offset": "521"}]}
{"text": "患者入院前3天被家属发现多于活动时心累、气促,未示意胸闷、胸痛,无明天咳嗽咳痰,无畏寒发热,无咽痛流涕,无腹胀、无腹痛等其他不适,患者家属自行给予服用“感冒药、头孢”无明显好转。入院前半天患者家属察觉其喘累加重,送至******就诊,给予“氨茶碱、地塞米松、甲泼尼龙”等药物治疗后缓解不明显,遂来院急诊科,急诊查心电图提示快速性房颤。心室率132次/分,st段改变。查心肌酶谱:谷草转氨酶叒39.6叒u/l、肌酸激酶叒157.6叒u/l、肌酸激酶同工酶叒12叒u/l、乳酸脱氢酶叒283.4叒u/l,肾功:尿素叒11.67叒mmol/l、肌酐叒67.3叒μmol/l、尿酸叒408.3叒μmol/l,凝血试验:国际标准化比值叒1.18,电解质1:钾叒3.69叒mmol/l,d_2聚体:d_2聚体叒30.05叒μg/ml,血常规:白细胞数叒8.4×10^9/l、血红蛋白浓度叒101叒g/l、中性粒细胞百分比叒86.84叒%,高敏肌钙蛋白t叒46.61叒pg/ml;急诊血压叒203/141mmhg,给予硝酸甘油静滴降压,并静推呋塞米叒20mg后,患者喘累逐渐减轻,为进一步治疗收入我科住院。病程中患者精神、饮食一般,大小便正常,体力明显上降,体重无明显上降。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "17"}, {"mention": "胸闷", "label": "症状", "offset": "26"}, {"mention": "胸痛", "label": "症状", "offset": "29"}, {"mention": "咽痛", "label": "症状", "offset": "47"}, {"mention": "腹胀", "label": "症状", "offset": "53"}, {"mention": "腹痛", "label": "症状", "offset": "57"}, {"mention": "氨茶碱", "label": "药物", "offset": "120"}, {"mention": "地塞米松", "label": "药物", "offset": "124"}, {"mention": "甲泼尼龙", "label": "药物", "offset": "129"}, {"mention": "心电图", "label": "影像检查", "offset": "156"}, {"mention": "快速性房颤", "label": "疾病和诊断", "offset": "161"}, {"mention": "st段改变", "label": "疾病和诊断", "offset": "177"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "189"}, {"mention": "肌酸激酶", "label": "实验室检验", "offset": "204"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "219"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "234"}, {"mention": "尿素", "label": "实验室检验", "offset": "253"}, {"mention": "肌酐", "label": "实验室检验", "offset": "269"}, {"mention": "尿酸", "label": "实验室检验", "offset": "284"}, {"mention": "国际标准化比值", "label": "实验室检验", "offset": "305"}, {"mention": "钾", "label": "实验室检验", "offset": "323"}, {"mention": "d_2聚体", "label": "实验室检验", "offset": "343"}, {"mention": "白细胞", "label": "实验室检验", "offset": "365"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "381"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "396"}, {"mention": "敏肌钙蛋白t", "label": "实验室检验", "offset": "414"}, {"mention": "硝酸甘油", "label": "药物", "offset": "452"}, {"mention": "呋塞米", "label": "药物", "offset": "464"}]}
{"text": "入院前30+年,患者常在受凉后出现咳嗽、咳痰,多为白色泡沫痰,并逐渐出现喘累、气促,好发于冬春季节,每年累计发病时间超过3月,外院诊断为“慢支炎、肺气肿”,予以抗感染、止咳平喘等治疗后可好转。患者喘累、气促症状逐年加重,并逐渐出现间断两上肢水肿,外院考虑为“肺源性心脏病”,未利尿、长期低流量吸氧及吸入剂治疗。7+年前,患者喘累、呼吸困难明显,于外院诊断为“支气管哮喘”(具体检查报告及诊治经过不详),开始使用沙丁胺醇气雾剂治疗。入院前3小时,患者受凉后下述症状较前加重,咳嗽、咳黄白色粘痰,咳痰费力,喘累、气促、呼吸困难明显,不能平卧位休息,无畏寒、寒战、发热,无头昏、头痛,无咯血,无潮热、盗汗,无恶心、呕吐,无腹胀、腹痛,无胸闷、胸痛,无尿频、尿急、尿痛等不适,自行服用“感冒药”(具体不详),下述症状无明显好转,遂就诊于我院急诊科,查血气分析:ph叒7.44,pco2叒40mmhg,po2叒112mmhg,spo2叒99%,予以甲强龙叒80mg抗炎平喘、多索茶碱叒0.2g解痉舒张支气管、布地奈德+异丙托溴铵雾化吸入治疗,患者喘累较前稍有缓解,现收入我科进一步治疗。患者此次患病以来精神、食欲、睡眠差,大小便正常,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "慢支炎", "label": "疾病和诊断", "offset": "69"}, {"mention": "肺气肿", "label": "疾病和诊断", "offset": "73"}, {"mention": "两上肢", "label": "解剖部位", "offset": "117"}, {"mention": "肺源性心脏病", "label": "疾病和诊断", "offset": "129"}, {"mention": "支气管哮喘", "label": "疾病和诊断", "offset": "179"}, {"mention": "沙丁胺醇气雾剂", "label": "药物", "offset": "205"}, {"mention": "头昏", "label": "症状", "offset": "283"}, {"mention": "头痛", "label": "症状", "offset": "286"}, {"mention": "腹胀", "label": "症状", "offset": "308"}, {"mention": "腹痛", "label": "症状", "offset": "311"}, {"mention": "胸闷", "label": "症状", "offset": "315"}, {"mention": "胸痛", "label": "症状", "offset": "318"}, {"mention": "ph", "label": "实验室检验", "offset": "376"}, {"mention": "pco2", "label": "实验室检验", "offset": "384"}, {"mention": "po2", "label": "实验室检验", "offset": "396"}, {"mention": "spo2", "label": "实验室检验", "offset": "408"}, {"mention": "甲强龙", "label": "药物", "offset": "419"}, {"mention": "多索茶碱", "label": "药物", "offset": "432"}, {"mention": "布地奈德", "label": "药物", "offset": "449"}, {"mention": "异丙托溴铵", "label": "药物", "offset": "454"}]}
{"text": "入院前4+年,患者因足底外伤后经久不愈于**医院就诊发现血糖高,明确诊断“2型糖尿病”,患者无典型多饮、多食、多尿、消瘦等不适,口服“二甲两高、格列齐特、阿卡波糖片”降血糖,偶测空腹血糖13mmol/l右左,餐后血糖未监测。平素饮食控制欠佳,病程中逐渐出现四肢指端皮肤闪电样针刺感,无口渴、多饮、多食、多尿,体重无明显变化,无明显视力上降、便秘腹泻交替等。入院前半年因自发性胰腺炎住院治疗期间,改诺和锐30叒三餐前皮上注射降血糖,院外监测血糖空腹波动于6-9mmol/l右左。入院前1周患者于受凉后出现全身酸痛、多汗、发热,未测体温,伴口渴、多饮、多食、多尿,无头昏、头痛、流涕、鼻塞,无恶心、呕吐、反酸、嗳气、烧心,无胸闷、心悸、胸痛,无腹胀、腹痛、黑便等。未特殊诊治。入院前3+天下述症状逐渐加重,今日感口渴、乏力、全身酸痛明显,自测血糖26.6mmol/l。为进一步诊治入院,门诊以“2型糖尿病”收入我科。自患病患者精神、食欲差,大便正常,偶有腹泻,小便正常,体重无明显变化。有高脂血症,平素未口服降脂药。1+年前发现“轻度贫血”未特殊诊治,入院前3+月因贫血输血治疗。入院前3+月患者于我院行胃镜示:慢性非萎缩性胃炎,行肠镜检查示:结肠息肉。", "mention_data": [{"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "37"}, {"mention": "格列齐特", "label": "药物", "offset": "72"}, {"mention": "阿卡波糖片", "label": "药物", "offset": "77"}, {"mention": "空腹血糖", "label": "实验室检验", "offset": "89"}, {"mention": "四肢", "label": "解剖部位", "offset": "128"}, {"mention": "指端", "label": "解剖部位", "offset": "130"}, {"mention": "腹泻", "label": "症状", "offset": "172"}, {"mention": "自发性胰腺炎", "label": "疾病和诊断", "offset": "184"}, {"mention": "诺和锐30", "label": "药物", "offset": "198"}, {"mention": "头昏", "label": "症状", "offset": "281"}, {"mention": "头痛", "label": "症状", "offset": "284"}, {"mention": "鼻塞", "label": "症状", "offset": "290"}, {"mention": "胸闷", "label": "症状", "offset": "310"}, {"mention": "心悸", "label": "症状", "offset": "313"}, {"mention": "胸痛", "label": "症状", "offset": "316"}, {"mention": "腹胀", "label": "症状", "offset": "320"}, {"mention": "腹痛", "label": "症状", "offset": "323"}, {"mention": "血糖", "label": "实验室检验", "offset": "369"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "395"}, {"mention": "腹泻", "label": "症状", "offset": "425"}, {"mention": "高脂血症", "label": "疾病和诊断", "offset": "442"}, {"mention": "轻度贫血", "label": "疾病和诊断", "offset": "463"}, {"mention": "贫血", "label": "疾病和诊断", "offset": "481"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "504"}, {"mention": "结肠息肉", "label": "疾病和诊断", "offset": "520"}]}
{"text": "入院前9小时患者安静休息时突然出现恶心、呕吐,共呕吐4次,起始2次呕吐咖啡色胃内容物,内含血凝块,后呕吐鲜红色血液,具体量不详。伴解黑色糊状大便3次,具体量不详。伴心悸,无腹痛、腹胀、反酸、嗳气、烧心,无气促、胸闷、胸痛,无畏寒、发热。患者未引起重视,在家口服“阿莫西林、感冒药”等处理后无缓解。于4小时前进食后再次出现呕吐1次胃内容物,内含血液及血凝块,伴心悸、头昏、出汗,家属急送入我院急诊科,查“心肌酶谱:肌酸激酶同工酶叒96叒u/l叒↑↑、乳酸脱氢酶叒466.1叒u/l叒↑,肾功:尿素叒22.82叒mmol/l叒↑,肝功1:白球比叒1.2叒↓、谷草转氨酶叒59.9叒u/l叒↑、谷氨酰转肽酶叒1684.1叒u/l叒↑、直接胆红素叒12.3叒μmol/l叒↑,电解质1:钾叒5.93叒mmol/l叒↑,血常规:白细胞数叒7.8×10^9/l、血红蛋白浓度叒128叒g/l叒↓、红细胞压积叒38.2叒%叒↓,凝血试验正常。腹部彩超:脂肪肝,脾稍大。”查bp:96/58mmhg,心率104次/分,考虑“下消化道出血,失血性休克”给予“止血、补液扩容抗休克”处理后收入我科治疗。病程中患者精神差,进入少许稀饭,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "胃", "label": "解剖部位", "offset": "38"}, {"mention": "心悸", "label": "症状", "offset": "82"}, {"mention": "腹痛", "label": "症状", "offset": "86"}, {"mention": "腹胀", "label": "症状", "offset": "89"}, {"mention": "胸闷", "label": "症状", "offset": "105"}, {"mention": "胸痛", "label": "症状", "offset": "108"}, {"mention": "阿莫西林", "label": "药物", "offset": "131"}, {"mention": "胃", "label": "解剖部位", "offset": "164"}, {"mention": "心悸", "label": "症状", "offset": "179"}, {"mention": "头昏", "label": "症状", "offset": "182"}, {"mention": "肌酸激酶同工酶", "label": "实验室检验", "offset": "206"}, {"mention": "乳酸脱氢酶", "label": "实验室检验", "offset": "224"}, {"mention": "尿素", "label": "实验室检验", "offset": "245"}, {"mention": "白球比", "label": "实验室检验", "offset": "267"}, {"mention": "谷草转氨酶", "label": "实验室检验", "offset": "277"}, {"mention": "谷氨酰转肽酶", "label": "实验室检验", "offset": "294"}, {"mention": "直接胆红素", "label": "实验室检验", "offset": "314"}, {"mention": "钾", "label": "实验室检验", "offset": "339"}, {"mention": "白细胞", "label": "实验室检验", "offset": "359"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "375"}, {"mention": "红细胞压积", "label": "实验室检验", "offset": "392"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "414"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "419"}, {"mention": "脾", "label": "解剖部位", "offset": "423"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "454"}, {"mention": "失血性休克", "label": "疾病和诊断", "offset": "461"}]}
{"text": "入院前2年于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。半年前患者因黑便于我院内二科住院,经治疗后好转。入院前2月前因恶心呕吐伴黑便再次于我院内二科住院,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,叒肾性贫血,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,出院后患者间断解黑便,偶有咳嗽咳痰,并仍感活动后心累,无畏寒发热,无胸闷胸痛,今日复诊透析时,查隐血试验叒弱阳性,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250ml,体重无明显上降。", "mention_data": [{"mention": "高血压肾病", "label": "疾病和诊断", "offset": "24"}, {"mention": "尿毒症", "label": "疾病和诊断", "offset": "111"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "115"}, {"mention": "高血压肾病", "label": "疾病和诊断", "offset": "120"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "126"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "132"}, {"mention": "心功能不全", "label": "疾病和诊断", "offset": "139"}, {"mention": "营养不良", "label": "疾病和诊断", "offset": "145"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "191"}, {"mention": "尿素氮", "label": "实验室检验", "offset": "205"}, {"mention": "血红蛋白", "label": "实验室检验", "offset": "225"}, {"mention": "血钾", "label": "实验室检验", "offset": "240"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "258"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "267"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "272"}, {"mention": "高血压3级很高危", "label": "疾病和诊断", "offset": "278"}, {"mention": "高血压心脏病", "label": "疾病和诊断", "offset": "287"}, {"mention": "尿路感染", "label": "疾病和诊断", "offset": "294"}, {"mention": "低蛋白血症", "label": "疾病和诊断", "offset": "299"}, {"mention": "右前臂动静脉内瘘吻合术", "label": "手术", "offset": "367"}, {"mention": "胸闷", "label": "症状", "offset": "423"}, {"mention": "胸痛", "label": "症状", "offset": "425"}, {"mention": "隐血试验", "label": "实验室检验", "offset": "437"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "458"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "466"}]}
{"text": "入院前1+年余患者出现两上肢凹陷性水肿,在外院查血肌酐大于300umol/l,彩超示两肾缩小,诊断为“肾功能不全、高血压肾病”,予降压、保肾等治疗后好转出院(具体不详)。病程中患者未予特殊重视及治疗。4月前患者发作心累、气促、乏力,入*******医院就诊,查血肌酐大于800umol/l,诊断为“慢性肾脏病5期”,行右前臂动静脉内瘘成形术及左颈内静脉置管术,后行3次/周维持性血液透析治疗,并长期服用“替米沙坦”等药物控制血压,收缩压维持在140-160mmhg;血红蛋白逐渐上降(具体不详),长期使用促红素纠正肾性贫血。2月余前患者出现咳嗽、咳痰不适,咳黄色脓痰,易咳出,于外院抗感染等治疗后好转(具体不详)。1月前患者突发心累、气促不适,在我科诊断“慢性肾脏病5期叒肾性贫血、高血压3级、急性右心衰、高钾血症”,予以对症治疗后好转,患者好转出院后遂转入我科行维持性血液净化治疗。2天前患者透析治疗后自觉心累、气促加重,伴夜间睡眠障碍,端坐呼吸,无两上肢水肿,无咯粉红色泡沫痰,无胸痛、咯血,无发热、咳嗽,遂今日来我院住院进一步检查及治疗。患者自患病以来,精神、食欲较差,大便正常,小便约500ml/天,体重无明显改变。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "11"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "24"}, {"mention": "彩超", "label": "影像检查", "offset": "39"}, {"mention": "两肾", "label": "解剖部位", "offset": "42"}, {"mention": "肾功能不全", "label": "疾病和诊断", "offset": "51"}, {"mention": "高血压肾病", "label": "疾病和诊断", "offset": "57"}, {"mention": "心", "label": "解剖部位", "offset": "107"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "130"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "149"}, {"mention": "右前臂动静脉内瘘成形术及左颈内静脉置管术", "label": "手术", "offset": "159"}, {"mention": "替米沙坦", "label": "药物", "offset": "202"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "257"}, {"mention": "心", "label": "解剖部位", "offset": "314"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "328"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "336"}, {"mention": "高血压3级", "label": "疾病和诊断", "offset": "341"}, {"mention": "急性右心衰", "label": "疾病和诊断", "offset": "347"}, {"mention": "高钾血症", "label": "疾病和诊断", "offset": "353"}, {"mention": "两上肢", "label": "解剖部位", "offset": "426"}, {"mention": "胸痛", "label": "症状", "offset": "442"}]}
{"text": "入院1+年前患者出现反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。随后在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。1周前患者感头昏、乏力,面色苍白,未解黑便,无腹痛、腹胀,无晕厥,门诊查叒血常规:白细胞数叒1.7×10^9/l、血红蛋白浓度叒37叒g/l、红细胞压积叒15.1叒%,现为进一步治疗,以“胃癌,贫血”收入我科。病程中精神差,饮食可,大便正常,小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "90"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "102"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "108"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "180"}, {"mention": "胃体", "label": "解剖部位", "offset": "200"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "210"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "215"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "223"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "243"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "313"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "344"}, {"mention": "胃切除术", "label": "手术", "offset": "353"}, {"mention": "头昏", "label": "症状", "offset": "383"}, {"mention": "腹痛", "label": "症状", "offset": "400"}, {"mention": "腹胀", "label": "症状", "offset": "403"}, {"mention": "白细胞", "label": "实验室检验", "offset": "418"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "434"}, {"mention": "红细胞压积", "label": "实验室检验", "offset": "448"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "471"}, {"mention": "贫血", "label": "疾病和诊断", "offset": "474"}]}
{"text": "患者于入院前2年即开始反复出现胸痛症状,有心前区压榨感,均在活动及进食后出现,不能耐受平地快走,发作后含服“速效救心丸”或休息后可逐渐缓解。病程中曾多次出现突发呼吸困难、大汗、濒死感,在****医院等住院治疗好转。1年前患者进餐后再次突然出现呼吸困难,全身大汗、胸痛,诊断为“冠心病、心力衰竭”,于我科住院,给予扩管、抗血小板聚集、降压、控制心室率等治疗后好转出院。入院前2月患者因气促伴呼吸困难在我科住院,心脏彩超提示:右房、右室、左房增大;肺动脉增宽;主动脉瓣钙化;肺动脉瓣轻度反流;二尖瓣、三尖瓣中度反流;右室收缩功能减退,心包腔积液。经扩冠利尿等治疗病情好转出院。入院前1天患者无明显诱因感心累气促加重,中下腹疼痛,活动时腹部牵扯痛,感恶心,干呕一次,无畏寒发热,无反酸嗳气,无咳嗽咯痰,无心前区压榨感,无颜面四肢浮肿,无呼吸困难。家属护送患者到我院就诊,测随机指血糖7.2mmol/l,心电图提示窦性心动过速,轻度st段压低,t波倒置(v5-6)。为进一步治疗以“冠心病叒心力衰竭”收入我科。患者此次患病以来精神食欲较差,睡眠一般,大便正常,小便量偏少,伴有轻微尿痛,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "胸痛", "label": "症状", "offset": "15"}, {"mention": "心前区", "label": "解剖部位", "offset": "21"}, {"mention": "速效救心丸", "label": "药物", "offset": "54"}, {"mention": "胸痛", "label": "症状", "offset": "131"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "138"}, {"mention": "心力衰竭", "label": "疾病和诊断", "offset": "142"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "204"}, {"mention": "右房", "label": "解剖部位", "offset": "211"}, {"mention": "右室", "label": "解剖部位", "offset": "214"}, {"mention": "左房", "label": "解剖部位", "offset": "217"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "222"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "228"}, {"mention": "肺动脉瓣", "label": "解剖部位", "offset": "235"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "244"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "248"}, {"mention": "右室收缩功能减退", "label": "疾病和诊断", "offset": "256"}, {"mention": "心包腔积液", "label": "疾病和诊断", "offset": "265"}, {"mention": "心", "label": "解剖部位", "offset": "299"}, {"mention": "中下腹", "label": "解剖部位", "offset": "306"}, {"mention": "腹部", "label": "解剖部位", "offset": "315"}, {"mention": "心前区", "label": "解剖部位", "offset": "349"}, {"mention": "颜面", "label": "解剖部位", "offset": "357"}, {"mention": "四肢", "label": "解剖部位", "offset": "359"}, {"mention": "血糖", "label": "实验室检验", "offset": "386"}, {"mention": "心电图", "label": "影像检查", "offset": "398"}, {"mention": "窦性心动过速", "label": "疾病和诊断", "offset": "403"}, {"mention": "轻度st段压低", "label": "疾病和诊断", "offset": "410"}, {"mention": "t波倒置(v5-6)", "label": "疾病和诊断", "offset": "418"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "437"}, {"mention": "心力衰竭", "label": "疾病和诊断", "offset": "441"}]}
{"text": "入院1+年前患者出现反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。7月前在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。1周前患者开始出现解黑色软便,总计5次,总量约1000g,感头昏、四肢乏力。活动后加重,到我院门诊输液治疗2天,仍反复黑便,今日到我科就诊,现为进一步治疗,门诊以“丙肝后肝硬化,胃癌,失血性贫血”收入我科。病程中精神差,饮食可,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "90"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "102"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "108"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "172"}, {"mention": "胃体", "label": "解剖部位", "offset": "192"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "202"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "207"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "215"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "235"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "306"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "337"}, {"mention": "胃切除术", "label": "手术", "offset": "346"}, {"mention": "头昏", "label": "症状", "offset": "400"}, {"mention": "四肢", "label": "解剖部位", "offset": "403"}, {"mention": "丙肝后肝硬化", "label": "疾病和诊断", "offset": "452"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "459"}, {"mention": "失血性贫血", "label": "疾病和诊断", "offset": "462"}]}
{"text": "入院前1+年患者无明显诱因出现腹胀,无腹痛、腹泻、黑便,无纳差、厌油,无恶心、呕吐,无反酸、嗳气、烧心。在**医院就诊,完善相关检查后诊断“乙肝后肝硬化失代偿期”,给予“保肝、放腹水、抗病毒”等对症处理后好转。既往在我院行“胃镜示:慢性非萎缩性胃炎,轻度食管静脉曲张可能。乙肝三对:乙肝表面抗原定性叒阳性,乙肝核心抗体定性叒阳性。乙肝dna<5e+02,腹部彩超:肝实质回声异常,符合肝硬化超声表现,胆囊壁增厚毛糙,脾大;诊断“肝硬化失代偿期”,给予“泮托拉唑抑酸、还原型谷胱甘肽及甘利欣、门冬氨酸鸟氨酸保肝、保护胃黏膜、改善腹胀等对症处理”后好转出院。院外口服“恩替卡韦片”抗病毒治疗。病程中未出现黑便、呕血、黄疸等。入院前6小时患者突然出现肝区持续性胀痛,无阵发性加重,感左侧背部放射痛,与饮食及体位无关。无畏寒、发热,有嗳气、反酸、烧心,无纳差、乏力,无皮肤黄染。遂来我院就诊,门诊查腹部彩超示“符合肝硬化改变,胆囊壁增厚粗糙,脾脏轻度增大,腹腔未见积液。”,血常规:血小板数叒45叒10^9/l。为进一步诊治,门诊以“肝硬化失代偿期”收入我科。病程中精神、饮食欠佳,大小便正常。体重无明显上降。", "mention_data": [{"mention": "腹胀", "label": "症状", "offset": "15"}, {"mention": "腹痛", "label": "症状", "offset": "19"}, {"mention": "腹泻", "label": "症状", "offset": "22"}, {"mention": "乙肝后肝硬化失代偿期", "label": "疾病和诊断", "offset": "70"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "116"}, {"mention": "轻度食管静脉曲张可能", "label": "疾病和诊断", "offset": "125"}, {"mention": "乙肝表面抗原定性", "label": "实验室检验", "offset": "141"}, {"mention": "乙肝核心抗体定性", "label": "实验室检验", "offset": "153"}, {"mention": "乙肝dna", "label": "实验室检验", "offset": "165"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "177"}, {"mention": "肝", "label": "解剖部位", "offset": "182"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "192"}, {"mention": "胆囊壁", "label": "解剖部位", "offset": "200"}, {"mention": "脾大", "label": "症状", "offset": "208"}, {"mention": "肝硬化失代偿期", "label": "疾病和诊断", "offset": "214"}, {"mention": "泮托拉唑", "label": "药物", "offset": "226"}, {"mention": "还原型谷胱甘肽", "label": "药物", "offset": "233"}, {"mention": "甘利欣", "label": "药物", "offset": "241"}, {"mention": "门冬氨酸鸟氨酸", "label": "药物", "offset": "245"}, {"mention": "腹胀", "label": "症状", "offset": "263"}, {"mention": "恩替卡韦片", "label": "药物", "offset": "282"}, {"mention": "肝区", "label": "解剖部位", "offset": "322"}, {"mention": "左侧背部", "label": "解剖部位", "offset": "338"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "395"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "403"}, {"mention": "胆囊壁", "label": "解剖部位", "offset": "409"}, {"mention": "脾脏", "label": "解剖部位", "offset": "417"}, {"mention": "腹腔", "label": "解剖部位", "offset": "424"}, {"mention": "血小板", "label": "实验室检验", "offset": "437"}, {"mention": "肝硬化失代偿期", "label": "疾病和诊断", "offset": "463"}]}
{"text": "入院1+年前患者出现反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。7月前在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。1周前患者开始出现解黑色软便,总计3次,总量约800g,感头昏、四肢乏力。活动后加重,到我院门诊输液治疗6天,仍反复黑便,今日到我科就诊,现为进一步治疗,门诊以“丙肝后肝硬化,胃癌,失血性贫血”收入我科。病程中精神差,饮食可,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "90"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "102"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "108"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "172"}, {"mention": "胃体", "label": "解剖部位", "offset": "192"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "202"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "207"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "215"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "235"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "306"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "337"}, {"mention": "胃切除术", "label": "手术", "offset": "346"}, {"mention": "头昏", "label": "症状", "offset": "399"}, {"mention": "四肢", "label": "解剖部位", "offset": "402"}, {"mention": "丙肝后肝硬化", "label": "疾病和诊断", "offset": "451"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "458"}, {"mention": "失血性贫血", "label": "疾病和诊断", "offset": "461"}]}
{"text": "入院前5月,患者无明显诱因出现咳嗽,咯白色黏液痰,伴痰中少量带血,无发热、咳嗽,无夜间盗汗,在**医院检查诊断为“肺癌?”,予以对症治疗后好转,遂到**医院检查,完善胸部ct检查后仍诊断“肺癌及肺部感染”,但细胞分型不详,未行手术治疗,后予以“头孢、云南白药胶囊”等药物对症治疗,好转出院。曾于2017.1在我院住院查胸部ct:1.左肺下叶近肺门处占位性病变伴下叶支气管狭窄、闭塞,考虑肺ca伴阻塞性肺不张,建议结合临床。2.肺气肿征;两肺上叶少许感染,建议治疗后复查。3.纵隔内及左肺门多个淋巴结影,部分肿大,考虑转移可能大;两肺散在细小结节,考虑肺内转移可能?左侧第3后肋骨质转移,随访。4.心包少量积液;左侧胸膜增厚或少许积液;主动脉壁及冠状动脉壁钙化。5.肝囊肿。6.肝左后叶斑片状稍低密度影,不除外转移,建议进一步下腹部ct平扫+增强检查。因咯血治疗效果差到***二院就诊诊断:中央型占位病变。阻塞性肺炎。其后患者仍反复咳嗽、伴少量咯血,2月前患者感右上肢乏力,活动喘累明显,今日来我院门诊检查,门诊以“肺癌”收入我科进一步检查及治疗。病程中患者精神、饮食差,大、小便正常,体重明显上降。", "mention_data": [{"mention": "肺癌", "label": "疾病和诊断", "offset": "57"}, {"mention": "胸部ct", "label": "影像检查", "offset": "83"}, {"mention": "肺癌及肺部感染", "label": "疾病和诊断", "offset": "94"}, {"mention": "头孢", "label": "药物", "offset": "122"}, {"mention": "云南白药胶囊", "label": "药物", "offset": "125"}, {"mention": "胸部ct", "label": "影像检查", "offset": "159"}, {"mention": "左肺下叶近肺门处占位性病变伴下叶支气管狭窄、闭塞", "label": "疾病和诊断", "offset": "166"}, {"mention": "肺ca伴阻塞性肺不张", "label": "疾病和诊断", "offset": "193"}, {"mention": "肺气肿征", "label": "疾病和诊断", "offset": "213"}, {"mention": "两肺上叶少许感染", "label": "疾病和诊断", "offset": "218"}, {"mention": "纵隔内", "label": "解剖部位", "offset": "237"}, {"mention": "左肺门", "label": "解剖部位", "offset": "241"}, {"mention": "两肺", "label": "解剖部位", "offset": "264"}, {"mention": "肺内转移可能", "label": "疾病和诊断", "offset": "275"}, {"mention": "左侧第3后肋骨质转移", "label": "疾病和诊断", "offset": "282"}, {"mention": "心包少量积液", "label": "疾病和诊断", "offset": "298"}, {"mention": "左侧胸膜", "label": "解剖部位", "offset": "305"}, {"mention": "主动脉壁及冠状动脉壁钙化", "label": "疾病和诊断", "offset": "317"}, {"mention": "肝囊肿", "label": "疾病和诊断", "offset": "332"}, {"mention": "肝左后叶", "label": "解剖部位", "offset": "338"}, {"mention": "下腹部ct平扫+增强", "label": "影像检查", "offset": "362"}, {"mention": "中央型占位病变", "label": "疾病和诊断", "offset": "394"}, {"mention": "阻塞性肺炎", "label": "疾病和诊断", "offset": "402"}, {"mention": "右上肢", "label": "解剖部位", "offset": "430"}, {"mention": "肺癌", "label": "疾病和诊断", "offset": "457"}]}
{"text": "入院1+年前患者因反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。2天前出现全身乏力、活动后心悸不适,有头昏,无意识障碍,解黑色软便,无腹痛、无恶心、呕吐,无畏寒、发热。在我院门诊输液(具体不详)无好转,现为进一步治疗,门诊以“胃癌,消化道出血”收入我科。病程中精神稍查,饮食可,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "18"}, {"mention": "腹痛", "label": "症状", "offset": "45"}, {"mention": "腹胀", "label": "症状", "offset": "48"}, {"mention": "腹泻", "label": "症状", "offset": "51"}, {"mention": "颜面", "label": "解剖部位", "offset": "68"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "89"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "101"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "107"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "112"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "179"}, {"mention": "胃体", "label": "解剖部位", "offset": "199"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "209"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "214"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "222"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "242"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "310"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "341"}, {"mention": "胃切除术", "label": "手术", "offset": "350"}, {"mention": "心悸", "label": "症状", "offset": "387"}, {"mention": "头昏", "label": "症状", "offset": "393"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "455"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "458"}]}
{"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。半年多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。近半年多来,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3月患者感颜面部浮肿,程度不重,于我科治疗,考虑为下腔静脉栓塞。给予治疗后可消退,但反复出现。1+月前患者再次感颜面部浮肿及咳嗽、咳痰、气促、纳差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。出院后仍感纳差、活动后气促,可耐受10余米距离行走。1天前患者气促、水肿症状加重,现为求进一步治疗来我院住院。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,呈黄色稀便,约2次/天。体重变化不明显。", "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": "182"}, {"mention": "左侧颈部", "label": "解剖部位", "offset": "207"}, {"mention": "颜面部", "label": "解剖部位", "offset": "287"}, {"mention": "下腔静脉栓塞", "label": "疾病和诊断", "offset": "307"}, {"mention": "颜面部", "label": "解剖部位", "offset": "338"}]}
{"text": "无明显诱因反复全身疼痛5+年,以颈、腰、两膝、两上肢为主,感两上肢冷痛、麻木,时轻时重,受凉后加重,两上肢乏力,阵发性头昏痛,有下肢麻木症状,视物模糊,长期睡眠差,记忆力减退,无心慌、胸闷、咳嗽、发热、盗汗等,无间歇性跛行及大小便障碍,先后在*******医院及我科住院治疗诊断为“重度骨质疏松症,腰椎间盘突出症、两膝退行性骨关节炎、老年性痴呆、腔隙性脑梗死”,经治疗后症状缓解(具体不详);无诱因以下复发加重7天,为进一步治疗,遂来我科就诊,门诊以“骨质疏松症”收治入院。2型糖尿病13年,目前口服阿卡波糖片、格列美脲及甘精胰岛素降血糖,明确有糖尿病眼病、糖尿病肾病叒糖尿病周围神经病,目前血糖控制可,病程中患者出现四肢麻木,视物模糊多年,并有感觉异常,上肢发冷。高血压病史13年,血压最高180/?mmhg,未规律服药降压药,目前口服坎地沙坦酯片降血压,自诉血压控制可,于*******医院诊断为“原发性高血压3级叒极高危叒高血压性心脏病叒”,1月前活动后心累心悸,自觉心跳明显,于我院内科住院治疗,治疗后症状缓解。患者患病以来精神一般,食欲可,大小便正常,近期无明显体重减轻。", "mention_data": [{"mention": "颈", "label": "解剖部位", "offset": "16"}, {"mention": "腰", "label": "解剖部位", "offset": "18"}, {"mention": "两膝", "label": "解剖部位", "offset": "20"}, {"mention": "两上肢", "label": "解剖部位", "offset": "23"}, {"mention": "两上肢", "label": "解剖部位", "offset": "30"}, {"mention": "两上肢", "label": "解剖部位", "offset": "50"}, {"mention": "头昏", "label": "症状", "offset": "59"}, {"mention": "下肢麻木", "label": "症状", "offset": "64"}, {"mention": "心慌", "label": "症状", "offset": "89"}, {"mention": "胸闷", "label": "症状", "offset": "92"}, {"mention": "重度骨质疏松症", "label": "疾病和诊断", "offset": "141"}, {"mention": "腰椎间盘突出症", "label": "疾病和诊断", "offset": "149"}, {"mention": "两膝退行性骨关节炎", "label": "疾病和诊断", "offset": "157"}, {"mention": "老年性痴呆", "label": "疾病和诊断", "offset": "167"}, {"mention": "腔隙性脑梗死", "label": "疾病和诊断", "offset": "173"}, {"mention": "骨质疏松症", "label": "疾病和诊断", "offset": "226"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "237"}, {"mention": "阿卡波糖片", "label": "药物", "offset": "250"}, {"mention": "格列美脲", "label": "药物", "offset": "256"}, {"mention": "甘精胰岛素", "label": "药物", "offset": "261"}, {"mention": "糖尿病眼病", "label": "疾病和诊断", "offset": "273"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "279"}, {"mention": "糖尿病周围神经病", "label": "疾病和诊断", "offset": "285"}, {"mention": "四肢麻木", "label": "症状", "offset": "309"}, {"mention": "上肢", "label": "解剖部位", "offset": "328"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "333"}, {"mention": "坎地沙坦酯片", "label": "药物", "offset": "369"}, {"mention": "原发性高血压3级叒极高危", "label": "疾病和诊断", "offset": "401"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "414"}]}
{"text": "患者入院前1+年(2015.5),无明显诱因开始出现反复咳嗽、咳浓痰、活动后气促,伴两上肢水肿、腹胀、纳差,平卧位时咳嗽明显,不能耐受日常活动,无畏寒、发热及潮热、盗汗,无胸痛、咯血等不适。于我院内二科就诊,行胸部ct提示左侧胸腔积液,给予抽液及抗炎等治疗后症状好转出院。但患者依从性差,未规律服药,此后气促、咳嗽反复发作,多次住院治疗。患者于2015.10月下述症状再次加重,于**医院就诊,行心脏彩超提示:全心增大,室壁动度减低,三尖瓣重度返流,卵圆孔未闭。bnp、转氨酶及肿瘤标志物异常增高。给予强心、利尿等治疗后症状好转出院。入院前2小时,患者咳嗽、气促症状再次发作,伴剑突上疼痛,无咯血、胸痛及端坐呼吸,无两上肢水肿等不适,遂为进一步治疗就诊于我院,急诊查胸片示:1.左上肺感染,结合临床或必要时复查。2.左侧胸腔少量积液;左膈面似稍抬高,结合临床或必要时进一步ct检查。3.心影增大,主动脉弓钙化。4.胸椎骨质增生。并为进一步治疗,以“扩张型心肌病叒心功能衰竭叒肺部感染”收入我科住院。患者此次患病以来精神食欲差,大小便正常,睡眠尚可,体力明显上降,体重无明显改变。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "42"}, {"mention": "腹胀", "label": "症状", "offset": "48"}, {"mention": "胸痛", "label": "症状", "offset": "86"}, {"mention": "胸部ct", "label": "影像检查", "offset": "105"}, {"mention": "左侧胸腔积液", "label": "疾病和诊断", "offset": "111"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "198"}, {"mention": "心", "label": "解剖部位", "offset": "206"}, {"mention": "室壁", "label": "解剖部位", "offset": "210"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "217"}, {"mention": "卵圆孔", "label": "解剖部位", "offset": "225"}, {"mention": "剑突", "label": "解剖部位", "offset": "289"}, {"mention": "胸痛", "label": "症状", "offset": "299"}, {"mention": "两上肢", "label": "解剖部位", "offset": "308"}, {"mention": "胸片", "label": "影像检查", "offset": "333"}, {"mention": "左上肺感染", "label": "疾病和诊断", "offset": "339"}, {"mention": "左侧胸腔少量积液", "label": "疾病和诊断", "offset": "358"}, {"mention": "左膈面", "label": "解剖部位", "offset": "367"}, {"mention": "ct检查", "label": "影像检查", "offset": "386"}, {"mention": "心", "label": "解剖部位", "offset": "393"}, {"mention": "主动脉弓", "label": "解剖部位", "offset": "398"}, {"mention": "胸椎骨质增生", "label": "疾病和诊断", "offset": "407"}, {"mention": "扩张型心肌病", "label": "疾病和诊断", "offset": "424"}, {"mention": "心功能衰竭", "label": "疾病和诊断", "offset": "431"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "437"}]}
{"text": "10+小时前,患者进食油腻食物后出现腹痛,以中下腹为著,呈持续性胀痛,伴阵发性加剧,伴大汗淋漓,伴恶心、呕吐4-5次,呕吐物为胃内容物,非喷射状,无咖啡色及胆汁样液体,无畏寒、发热、心悸、胸闷、胸痛,无咳嗽、咯痰、呼吸困难,无腹泻、解黑大便。在“***医院”输液治疗(具体药物及剂量不详)后无明显缓解,遂由我院120急救入院,急诊行腹部彩超:脂肪肝;胰头增大,胰周积液,建议结合淀粉酶检查密切随访;胆囊壁毛糙;脾大。腹腔积液。电解质2:钾叒3.74叒mmol/l、钠叒135.7叒mmol/、氯叒101.8叒mmol/l、葡萄糖:21.63叒mmol/l,血淀粉酶:326.7u/l叒乳糜血,血常规:白细胞数叒9.6叒10^9/l、红细胞数叒4.88叒10^12/l、中性粒细胞百分比叒83.31叒%、中性粒细胞绝对值叒8.02叒10^9/l,尿常规:酮体++,蛋白+-,葡萄糖:++++叒比重:1.020叒尿胰蛋白酶原-ii叒阳性,尿淀粉酶l:1260.5u/l。急诊以“急性重症胰腺炎”收住我科。自发病以来,患者神志清晰,精神差,未进食,小便正常,未解大便,体重无明显改变。", "mention_data": [{"mention": "腹痛", "label": "症状", "offset": "18"}, {"mention": "中下腹", "label": "解剖部位", "offset": "22"}, {"mention": "胃", "label": "解剖部位", "offset": "63"}, {"mention": "心悸", "label": "症状", "offset": "91"}, {"mention": "胸闷", "label": "症状", "offset": "94"}, {"mention": "胸痛", "label": "症状", "offset": "97"}, {"mention": "腹泻", "label": "症状", "offset": "113"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "166"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "171"}, {"mention": "胰头", "label": "解剖部位", "offset": "175"}, {"mention": "胰周", "label": "解剖部位", "offset": "180"}, {"mention": "胆囊壁毛糙", "label": "症状", "offset": "199"}, {"mention": "脾大", "label": "症状", "offset": "205"}, {"mention": "腹腔积液", "label": "疾病和诊断", "offset": "208"}, {"mention": "钾", "label": "实验室检验", "offset": "218"}, {"mention": "钠", "label": "实验室检验", "offset": "232"}, {"mention": "氯", "label": "实验室检验", "offset": "246"}, {"mention": "葡萄糖", "label": "实验室检验", "offset": "261"}, {"mention": "血淀粉酶", "label": "实验室检验", "offset": "278"}, {"mention": "白细胞", "label": "实验室检验", "offset": "300"}, {"mention": "红细胞", "label": "实验室检验", "offset": "316"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "334"}, {"mention": "中性粒细胞绝对值", "label": "实验室检验", "offset": "351"}, {"mention": "酮体", "label": "实验室检验", "offset": "376"}, {"mention": "蛋白", "label": "实验室检验", "offset": "381"}, {"mention": "葡萄糖", "label": "实验室检验", "offset": "386"}, {"mention": "比重", "label": "实验室检验", "offset": "395"}, {"mention": "尿胰蛋白酶原-ii", "label": "实验室检验", "offset": "404"}, {"mention": "尿淀粉酶l", "label": "实验室检验", "offset": "417"}, {"mention": "急性重症胰腺炎", "label": "疾病和诊断", "offset": "437"}]}
{"text": "1年前患者无明显诱因解黑色成形大便,量约250g/次,伴头昏、乏力、皮肤黏膜苍白,无呕血、腹痛、腹胀、腹泻,无反酸、嗳气、烧心,无口干、颜面肢体水肿、腹围增大。于我院查“hb32g/l”,诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。3月前,患者无明显诱因再次出现解黑便,为黑色糊状大便,每天1次,每次量约100-150g,伴头昏、乏力、心悸。于我院查“hb叒53叒g/l,无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。1天前,患者无明显诱因再次出现解黑大便1次,黑色成形大便,量约100g,无黏液脓血,无晕厥、黑朦、意思丧失。今晨再次解黑色软便约50g。于我院门诊查大便常规:黑色叒软便,隐血试验叒阳性。为进一步就诊,遂于我院就诊,拟“下消化道出血”收入住院。病程中精神、睡眠欠佳,饮食尚可,大便如下述,小便正常。体重无明显减轻。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "28"}, {"mention": "腹痛", "label": "症状", "offset": "45"}, {"mention": "腹胀", "label": "症状", "offset": "48"}, {"mention": "腹泻", "label": "症状", "offset": "51"}, {"mention": "颜面", "label": "解剖部位", "offset": "68"}, {"mention": "hb", "label": "实验室检验", "offset": "85"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "100"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "112"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "118"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "123"}, {"mention": "头昏", "label": "症状", "offset": "213"}, {"mention": "心悸", "label": "症状", "offset": "219"}, {"mention": "hb", "label": "实验室检验", "offset": "227"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "242"}, {"mention": "胃体", "label": "解剖部位", "offset": "262"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "272"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "277"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "285"}, {"mention": "大便常规", "label": "实验室检验", "offset": "407"}, {"mention": "隐血试验", "label": "实验室检验", "offset": "418"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "442"}]}
{"text": "入院前1+年患者无明显诱因反复出现两上肢水肿,间断出现鼻衄,无心悸、气促,无胸闷、胸痛,无厌油、纳差、黄疸、消瘦,无皮肤瘀斑瘀点,无腹痛、腹胀、腹泻,无恶心、呕吐,无血尿、脓尿,在外院就诊具体不详。入院前2月无明显诱因出现腹胀,无腹痛、反酸、嗳气、烧心,于2015-08-28在“*******医院”就诊,查“腹部彩超:肝实质回声不均质增强,脾大,门脉系增宽。下腹部ct:肝硬化,门脉高压并胃底-食道上段静脉曲张、脾大。腹膜水肿增厚,腹腔中量积液,慢性肝病性胆囊。乙肝提示小三阳。肝功:白蛋白:25.5g/l。凝血:凝血酶原时间:23.4秒,aptt:43.7秒。血常规:血小板:21*10^9/l,hb:91g/l,wbc:2.96*10^9/l。”,诊断为“乙肝后肝硬化失代偿期,低白蛋白血症。”,给予“保肝、输人血白蛋白、纠正贫血、抑酸”等对症处理后缓解出院。院外口服“中药”治疗,口服中药后解暗褐色稀糊状大便,无恶心、呕血。入院前1天患者再次觉腹胀明显,无腹痛、恶心、呕吐,遂来我院住院治疗,门诊以“肝硬化”收入我科。病程中精神、饮食尚可,大小便正常,体重无明显改变。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "17"}, {"mention": "鼻衄", "label": "症状", "offset": "27"}, {"mention": "心悸", "label": "症状", "offset": "31"}, {"mention": "胸闷", "label": "症状", "offset": "38"}, {"mention": "胸痛", "label": "症状", "offset": "41"}, {"mention": "腹痛", "label": "症状", "offset": "66"}, {"mention": "腹胀", "label": "症状", "offset": "69"}, {"mention": "腹泻", "label": "症状", "offset": "72"}, {"mention": "腹胀", "label": "症状", "offset": "111"}, {"mention": "腹痛", "label": "症状", "offset": "115"}, {"mention": "腹部彩超", "label": "影像检查", "offset": "155"}, {"mention": "肝", "label": "解剖部位", "offset": "160"}, {"mention": "脾大", "label": "症状", "offset": "171"}, {"mention": "门脉", "label": "解剖部位", "offset": "174"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "180"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "186"}, {"mention": "门脉高压并胃底-食道上段静脉曲张", "label": "疾病和诊断", "offset": "190"}, {"mention": "脾大", "label": "症状", "offset": "207"}, {"mention": "腹膜", "label": "解剖部位", "offset": "210"}, {"mention": "腹腔中量积液", "label": "疾病和诊断", "offset": "217"}, {"mention": "慢性肝病性胆囊", "label": "疾病和诊断", "offset": "224"}, {"mention": "白蛋白", "label": "实验室检验", "offset": "243"}, {"mention": "凝血酶原时间", "label": "实验室检验", "offset": "258"}, {"mention": "aptt", "label": "实验室检验", "offset": "271"}, {"mention": "血小板", "label": "实验室检验", "offset": "286"}, {"mention": "hb", "label": "实验室检验", "offset": "300"}, {"mention": "wbc", "label": "实验室检验", "offset": "309"}, {"mention": "乙肝后肝硬化失代偿期", "label": "疾病和诊断", "offset": "331"}, {"mention": "低白蛋白血症", "label": "疾病和诊断", "offset": "342"}, {"mention": "人血白蛋白", "label": "药物", "offset": "358"}, {"mention": "腹胀", "label": "症状", "offset": "426"}, {"mention": "腹痛", "label": "症状", "offset": "432"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "454"}]}
{"text": "入院前8年无明显诱因患者感活动后乏力、气促,不伴头昏、头痛、胸闷、心悸、胸痛、晕厥、黑曚、呃逆、反酸、嗳气、烧心、恶心、呕吐、腹痛、腹胀、腹泻、黑便。患者于*****医院诊断“溶血性贫血”,给予输血等处理后病情缓解。病程中如下症状反复发生,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)。肝功能提示轻度异常。诊断“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、气促不适,反复经输注洗涤红细胞后缓解。7天前患者再次出现乏力、气促,伴胸闷、腹胀,无腹痛、腹泻、血便、血尿。为求进一步治疗今日入我院门诊,门诊以“g-6-pd酶缺乏症”收入我科。患者此次患病以来,精神状态差,大小便正常,体重无明显减轻。", "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": "33"}, {"mention": "胸痛", "label": "症状", "offset": "36"}, {"mention": "腹痛", "label": "症状", "offset": "63"}, {"mention": "腹胀", "label": "症状", "offset": "66"}, {"mention": "腹泻", "label": "症状", "offset": "69"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "88"}, {"mention": "间接coomb’s试验", "label": "实验室检验", "offset": "149"}, {"mention": "新生儿g6pd活性试验", "label": "实验室检验", "offset": "283"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "316"}, {"mention": "贫血性心脏病", "label": "疾病和诊断", "offset": "327"}, {"mention": "肝功能不全", "label": "疾病和诊断", "offset": "334"}, {"mention": "胸闷", "label": "症状", "offset": "403"}, {"mention": "腹胀", "label": "症状", "offset": "406"}, {"mention": "腹痛", "label": "症状", "offset": "410"}, {"mention": "腹泻", "label": "症状", "offset": "413"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "441"}]}
{"text": "入院前1年余患者出现两上肢凹陷性水肿,在外院查血肌酐大于300umol/l,彩超示两肾缩小,诊断为“肾功能不全、高血压肾病”,予降压、保肾等治疗后好转出院(具体不详)。病程中患者未予特殊重视及治疗。5月前患者发作心累、气促、乏力,入*******医院就诊,查血肌酐大于800umol/l,诊断为“慢性肾脏病5期”,行右前臂动静脉内瘘成形术及左颈内静脉置管术,后行3次/周维持性血液透析治疗,并长期服用“替米沙坦”等药物控制血压,收缩压维持在140-160mmhg;血红蛋白逐渐上降(具体不详),长期使用促红素纠正肾性贫血。后患者多次因突发心累、气促,入我院予对症治疗后好转出院,出院后遂转入我科行维持性血液净化治疗。2天前患者透析治疗后自觉心累、气促明显,如走平路十余步即感心累、气促,伴胸闷,常在活动时发作,持续约十几分钟或含服速效救心丸可好转,伴夜间睡眠障碍,无两上肢水肿,无咯粉红色泡沫痰,无胸痛、咯血,无发热、咳嗽。2小时前患者感心累、气促明显加重。遂来我院住院进一步治疗。患者自患病以来,精神、食欲较差,大便正常,小便约300-400ml/天,体重无明显改变。", "mention_data": [{"mention": "两上肢", "label": "解剖部位", "offset": "10"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "23"}, {"mention": "彩超", "label": "影像检查", "offset": "38"}, {"mention": "两肾", "label": "解剖部位", "offset": "41"}, {"mention": "肾功能不全", "label": "疾病和诊断", "offset": "50"}, {"mention": "高血压肾病", "label": "疾病和诊断", "offset": "56"}, {"mention": "心", "label": "解剖部位", "offset": "106"}, {"mention": "血肌酐", "label": "实验室检验", "offset": "129"}, {"mention": "慢性肾脏病5期", "label": "疾病和诊断", "offset": "148"}, {"mention": "右前臂动静脉内瘘成形术及左颈内静脉置管术", "label": "手术", "offset": "158"}, {"mention": "替米沙坦", "label": "药物", "offset": "201"}, {"mention": "肾性贫血", "label": "疾病和诊断", "offset": "256"}, {"mention": "心", "label": "解剖部位", "offset": "269"}, {"mention": "心", "label": "解剖部位", "offset": "320"}, {"mention": "心", "label": "解剖部位", "offset": "337"}, {"mention": "胸闷", "label": "症状", "offset": "344"}, {"mention": "速效救心丸", "label": "药物", "offset": "365"}, {"mention": "两上肢", "label": "解剖部位", "offset": "383"}, {"mention": "胸痛", "label": "症状", "offset": "399"}, {"mention": "心", "label": "解剖部位", "offset": "419"}]}
{"text": "5小时前无明显诱因患者解暗红色血便2次,约250ml,伴心悸,无头晕、黑曚,无腹痛,无里急后重、肛门坠胀,无反酸、嗳气、烧心,无呕血,无意识丧失,自诉近1月两上肢轻度凹陷性水肿,未引起重视。急诊120接入院,入院后解暗红色血便150ml,急查肝功2:tp叒60.9叒g/l、alb叒30.0叒g/l叒↓、alt叒28.1叒u/l、ast叒54.0叒u/l叒↑、ggt叒289.2叒u/l叒↑,电解质1:k叒2.56叒mmol/l叒↓、na叒136.5叒mmol/叒↓、cl叒95.2叒mmol/l叒↓,血型:abo叒\\\"b\\\"型、rhd叒阳性,血常规:wbc叒2.6叒10^9/l叒↓、hgb叒63叒g/l叒↓、plt叒56叒10^9/l叒↓、neut%叒64.30叒%、hct叒20.3叒%叒↓、mcv叒79.0叒fl叒↓、mch叒24.5叒pg叒↓、mchc叒310叒g/l叒↓,肾功、凝血象无明显异常。下腹部彩超:脂肪肝;脾大;腹腔少量积液。为进一步诊治,门诊以“中度贫血,消化道出血”收入我科。患者此次患病以来,精神状态欠佳,小便正常,大便如下。体重无明显减轻。", "mention_data": [{"mention": "心悸", "label": "症状", "offset": "28"}, {"mention": "头晕", "label": "症状", "offset": "32"}, {"mention": "腹痛", "label": "症状", "offset": "39"}, {"mention": "肛门坠胀", "label": "症状", "offset": "48"}, {"mention": "两上肢", "label": "解剖部位", "offset": "78"}, {"mention": "tp", "label": "实验室检验", "offset": "125"}, {"mention": "alb", "label": "实验室检验", "offset": "137"}, {"mention": "alt", "label": "实验室检验", "offset": "152"}, {"mention": "ast", "label": "实验室检验", "offset": "165"}, {"mention": "ggt", "label": "实验室检验", "offset": "180"}, {"mention": "k", "label": "实验室检验", "offset": "201"}, {"mention": "na", "label": "实验室检验", "offset": "217"}, {"mention": "cl", "label": "实验室检验", "offset": "234"}, {"mention": "abo", "label": "实验室检验", "offset": "254"}, {"mention": "rhd", "label": "实验室检验", "offset": "265"}, {"mention": "wbc", "label": "实验室检验", "offset": "276"}, {"mention": "hgb", "label": "实验室检验", "offset": "293"}, {"mention": "plt", "label": "实验室检验", "offset": "306"}, {"mention": "neut%", "label": "实验室检验", "offset": "322"}, {"mention": "hct", "label": "实验室检验", "offset": "336"}, {"mention": "mcv", "label": "实验室检验", "offset": "349"}, {"mention": "mch", "label": "实验室检验", "offset": "363"}, {"mention": "mchc", "label": "实验室检验", "offset": "377"}, {"mention": "下腹部彩超", "label": "影像检查", "offset": "404"}, {"mention": "脂肪肝", "label": "疾病和诊断", "offset": "410"}, {"mention": "脾大", "label": "症状", "offset": "414"}, {"mention": "腹腔少量积液", "label": "疾病和诊断", "offset": "417"}, {"mention": "中度贫血", "label": "疾病和诊断", "offset": "435"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "440"}]}
{"text": "患者于入院前1天,患者受凉后出现发热、精神萎靡,无咳嗽、咽痛、畏寒、寒战等不适,遂就诊于当地诊所,测体温提示:39.5℃,给予“头孢呋辛”等治疗后症状无好转。患者出现嗜睡,呼之有反应,不能应答,无四肢抽搐、大小便失禁、口吐白沫等,遂就诊于我院急诊科,测体温:41℃,出现寒战、抽搐,无口吐白沫、大小便失禁及意识丧失等不适、肢体偏瘫等不适。查头颅ct及胸部ct提示:右侧顶部蛛网膜上腔增宽,脑萎缩,两上肺感染,纵膈可见小淋巴结,两侧胸膜稍增厚。血气分析+乳酸:酸碱度叒7.530叒↑、二氧化碳分压叒33.6叒mmhg叒↓、碱剩余,5mmol/l叒↑,高敏肌钙蛋白t叒33.02叒pg/ml叒↑,血常规:白细胞数叒12.2叒10^9/l叒↑、中性粒细胞绝对值叒8.76叒10^9/l叒↑,超敏c反应蛋白叒<1叒mg/l。给予“脑苷激肽、神经节苷脂、甘露醇、奥美拉唑、清开灵、安定”等治疗后,未再发热,仍意识欠清,呈嗜睡状,呼之有反应,可简单对答,遂为进一步治疗,以“肺部感染”收入我科住院治疗。患者自发病以来精神、食欲欠佳,睡眠可,大小便未诉异常。近期体重无明显减轻。", "mention_data": [{"mention": "咽痛", "label": "症状", "offset": "28"}, {"mention": "头孢呋辛", "label": "药物", "offset": "64"}, {"mention": "四肢抽搐", "label": "症状", "offset": "98"}, {"mention": "头颅ct", "label": "影像检查", "offset": "170"}, {"mention": "胸部ct", "label": "影像检查", "offset": "175"}, {"mention": "右侧顶部蛛网膜上腔", "label": "解剖部位", "offset": "182"}, {"mention": "脑萎缩", "label": "疾病和诊断", "offset": "194"}, {"mention": "两上肺感染", "label": "疾病和诊断", "offset": "198"}, {"mention": "纵膈", "label": "解剖部位", "offset": "204"}, {"mention": "两侧胸膜", "label": "解剖部位", "offset": "213"}, {"mention": "酸碱度", "label": "实验室检验", "offset": "229"}, {"mention": "二氧化碳分压", "label": "实验室检验", "offset": "241"}, {"mention": "碱剩余", "label": "实验室检验", "offset": "260"}, {"mention": "高敏肌钙蛋白t", "label": "实验室检验", "offset": "274"}, {"mention": "白细胞", "label": "实验室检验", "offset": "300"}, {"mention": "中性粒细胞绝对值", "label": "实验室检验", "offset": "319"}, {"mention": "超敏c反应蛋白", "label": "实验室检验", "offset": "342"}, {"mention": "脑苷激肽", "label": "药物", "offset": "361"}, {"mention": "神经节苷脂", "label": "药物", "offset": "366"}, {"mention": "甘露醇", "label": "药物", "offset": "372"}, {"mention": "奥美拉唑", "label": "药物", "offset": "376"}, {"mention": "清开灵", "label": "药物", "offset": "381"}, {"mention": "安定", "label": "药物", "offset": "385"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "431"}]}
{"text": "入院前1+年患者无明显诱因反复下腹阵发性疼痛,无放射痛,伴腹胀、反酸、嗳气,进食后明显,同时出现乏力、劳累感、全身浮肿,无恶心、呕吐,无胸闷、心悸,无咯血、发热。入院前1+月前患者因腹痛、乏力、全身浮肿在我科住院,作下腹部ct提示胃小弯及胃窦壁不规则增厚,部分向腔内突入的软组织影,伴胃窦腔变窄,考虑恶性肿瘤可能大,不完全除外淋巴瘤;腹腔较多积液,下腹部肠壁增厚、水肿;左侧肾下腺结节影,右侧肾下腺稍增粗,考虑转移?腺瘤均不除外;左肾下极较大囊肿;右肾小囊肿;两上肺感染,两侧胸腔少量积液;胸椎及腰椎骨质增生,胸、腹主动脉壁钙化,因患者一般情况差未做胃镜及病理检查,诊断为“1、胃恶性肿瘤叒2、中度贫血叒3、肺部感染叒4、重度营养不良”,予奥美拉唑抑酸,溴己新祛痰,强力枇杷露止咳,螺内酯、呋塞米利尿消肿治疗后好转出院。入院前10天患者下腹疼痛加重,伴腹胀、纳差、乏力,伴头昏、乏力、心累气促,仍有四肢水肿,无咯血、发热、夜间端坐呼吸,无腹泻、黑便,现为进一步治疗,门诊以“胃恶性肿瘤”收入我科住院治疗。病程中患者精神、饮食、睡眠差,大小便正常,体重无明显上降。", "mention_data": [{"mention": "下腹", "label": "解剖部位", "offset": "15"}, {"mention": "腹胀", "label": "症状", "offset": "29"}, {"mention": "胸闷", "label": "症状", "offset": "68"}, {"mention": "心悸", "label": "症状", "offset": "71"}, {"mention": "腹痛", "label": "症状", "offset": "91"}, {"mention": "下腹部ct", "label": "影像检查", "offset": "108"}, {"mention": "胃小弯", "label": "解剖部位", "offset": "115"}, {"mention": "胃窦壁", "label": "解剖部位", "offset": "119"}, {"mention": "胃窦腔", "label": "解剖部位", "offset": "142"}, {"mention": "腹腔", "label": "解剖部位", "offset": "167"}, {"mention": "下腹部", "label": "解剖部位", "offset": "174"}, {"mention": "肠壁", "label": "解剖部位", "offset": "177"}, {"mention": "左侧肾下腺", "label": "解剖部位", "offset": "185"}, {"mention": "右侧肾下腺", "label": "解剖部位", "offset": "194"}, {"mention": "腺瘤", "label": "疾病和诊断", "offset": "208"}, {"mention": "左肾下极", "label": "解剖部位", "offset": "215"}, {"mention": "右肾", "label": "解剖部位", "offset": "224"}, {"mention": "两上肺感染", "label": "疾病和诊断", "offset": "230"}, {"mention": "两侧胸腔少量积液", "label": "疾病和诊断", "offset": "236"}, {"mention": "胸椎及腰椎骨质增生", "label": "疾病和诊断", "offset": "245"}, {"mention": "胸、腹主动脉壁钙化", "label": "疾病和诊断", "offset": "255"}, {"mention": "胃恶性肿瘤", "label": "疾病和诊断", "offset": "289"}, {"mention": "中度贫血", "label": "疾病和诊断", "offset": "297"}, {"mention": "肺部感染", "label": "疾病和诊断", "offset": "304"}, {"mention": "重度营养不良", "label": "疾病和诊断", "offset": "311"}, {"mention": "奥美拉唑", "label": "药物", "offset": "320"}, {"mention": "溴己新", "label": "药物", "offset": "327"}, {"mention": "强力枇杷露", "label": "药物", "offset": "333"}, {"mention": "螺内酯", "label": "药物", "offset": "341"}, {"mention": "呋塞米", "label": "药物", "offset": "345"}, {"mention": "下腹疼痛", "label": "症状", "offset": "368"}, {"mention": "腹胀", "label": "症状", "offset": "376"}, {"mention": "头昏", "label": "症状", "offset": "386"}, {"mention": "心", "label": "解剖部位", "offset": "392"}, {"mention": "四肢", "label": "解剖部位", "offset": "399"}, {"mention": "腹泻", "label": "症状", "offset": "419"}, {"mention": "胃恶性肿瘤", "label": "疾病和诊断", "offset": "437"}]}
{"text": "8+年前无明显诱因患者感活动后乏力、气促,不伴头昏、头痛、胸闷、心悸、胸痛、晕厥、黑曚、呃逆、反酸、嗳气、烧心、恶心、呕吐、腹痛、腹胀、腹泻、黑便。患者于*****医院诊断“溶血性贫血”,给予输血等处理后病情缓解。病程中如下症状反复发生,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。诊断“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,反复经输注洗涤红细胞后缓解。7天前患者再次出现乏力、气促、精神差,伴血尿,无腹痛、腹泻、血便。为求进一步治疗今日入我院门诊,门诊以“g-6-pd酶缺乏症”收入我科。患者此次患病以来,精神状态差,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "头痛", "label": "症状", "offset": "26"}, {"mention": "胸闷", "label": "症状", "offset": "29"}, {"mention": "心悸", "label": "症状", "offset": "32"}, {"mention": "胸痛", "label": "症状", "offset": "35"}, {"mention": "腹痛", "label": "症状", "offset": "62"}, {"mention": "腹胀", "label": "症状", "offset": "65"}, {"mention": "腹泻", "label": "症状", "offset": "68"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "87"}, {"mention": "间接coomb’s试验", "label": "实验室检验", "offset": "148"}, {"mention": "新生儿g6pd活性试验", "label": "实验室检验", "offset": "282"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "313"}, {"mention": "贫血性心脏病", "label": "疾病和诊断", "offset": "324"}, {"mention": "肝功能不全", "label": "疾病和诊断", "offset": "331"}, {"mention": "腹痛", "label": "症状", "offset": "406"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "434"}]}
{"text": "入院1+年前患者出现反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。6月齐纳在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。1天前患者出现解黑色软便1次,总量约500g,感头昏、四肢乏力。活动后加重,自服云南白药,今日到我院就诊,现为进一步治疗,门诊以“胃癌,失血性贫血”收入我科。病程中精神差,饮食可,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "90"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "102"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "108"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "172"}, {"mention": "胃体", "label": "解剖部位", "offset": "192"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "202"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "207"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "215"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "235"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "307"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "338"}, {"mention": "胃切除术", "label": "手术", "offset": "347"}, {"mention": "头昏", "label": "症状", "offset": "395"}, {"mention": "四肢", "label": "解剖部位", "offset": "398"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "436"}, {"mention": "失血性贫血", "label": "疾病和诊断", "offset": "439"}]}
{"text": "入院前10月,患者服用“头痛粉”后解黑色成形大便,共3次,量约250g/次,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院查“hb32g/l”,诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。2月前,患者无明显诱因再次出现解黑便,为黑色糊状大便,每天1次,每次量约100-150g,伴头昏、乏力、心悸。于我院查“hb叒53叒g/l,无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。2天前,患者无明显诱因再次出现解黑大便1次,呈糊状,量约100g,无黏液脓血,伴乏力、头昏,于**医院输液治疗后无明显好转(具体不详),遂于我院就诊,拟“下消化道出血”收入住院。病程中精神、睡眠欠佳,饮食尚可,大便如下述,小便正常。体重无明显减轻。", "mention_data": [{"mention": "头痛粉", "label": "药物", "offset": "12"}, {"mention": "头昏", "label": "症状", "offset": "39"}, {"mention": "腹痛", "label": "症状", "offset": "66"}, {"mention": "腹胀", "label": "症状", "offset": "69"}, {"mention": "腹泻", "label": "症状", "offset": "72"}, {"mention": "颜面", "label": "解剖部位", "offset": "89"}, {"mention": "hb", "label": "实验室检验", "offset": "106"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "121"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "133"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "139"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "144"}, {"mention": "头昏", "label": "症状", "offset": "234"}, {"mention": "心悸", "label": "症状", "offset": "240"}, {"mention": "hb", "label": "实验室检验", "offset": "248"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "263"}, {"mention": "胃体", "label": "解剖部位", "offset": "283"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "293"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "298"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "306"}, {"mention": "贫血", "label": "疾病和诊断", "offset": "326"}, {"mention": "头昏", "label": "症状", "offset": "397"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "431"}]}
{"text": "入院前1年患者无明显诱因出现腹部不适,中下腹胀痛、脐周胀气明显,偶有阵发性加重,多自行缓解,伴早饱,但无明显进食量上降,伴每日解黄色软便1次/日,无反酸、嗳气、烧心,无恶心、呕吐、腹泻,无呕血、黑便、消瘦,在我科住院行胃镜提示“慢性非萎缩性胃炎,hp(+)”,结肠镜提示“结肠直肠多发性息肉”,并行“肠镜上结肠直肠多发性息肉氩气刀治疗术”,腹部增强ct提示“1.胰腺尾部丰满,强化略微减低,肠区及腹膜数个小淋巴结显影,密切随访;2.肝左叶多发小囊肿;3.两肾多发囊肿;4.两肺底少许炎症,结合临床;5.腰椎骨质增生”。住院期间给予抑酸、改善胃肠道动力等治疗后症状缓解出院。入院前2周患者再次出现腹部不适,主要为剑突上紧缩感,每次持续数小时可自行缓解,进餐后可减轻,改变体位及按压症状无加重及减轻,伴头昏、乏力。入院前半天患者出现上腹胀痛,无腹泻、黑便、肛门停止排气排便,无反酸、嗳气、烧心,无厌油、呕吐,无潮热、盗汗,无纳差、粘液脓血便、进行性消瘦,门诊以“腹胀原因待查”收入我科。患者此次患病以来,精神状态欠佳,食欲正常,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "腹部不适", "label": "症状", "offset": "14"}, {"mention": "中下腹", "label": "解剖部位", "offset": "19"}, {"mention": "脐周", "label": "解剖部位", "offset": "25"}, {"mention": "腹泻", "label": "症状", "offset": "90"}, {"mention": "慢性非萎缩性胃炎", "label": "疾病和诊断", "offset": "114"}, {"mention": "hp", "label": "实验室检验", "offset": "123"}, {"mention": "结肠直肠多发性息肉", "label": "疾病和诊断", "offset": "136"}, {"mention": "肠镜上结肠直肠多发性息肉氩气刀治疗术", "label": "手术", "offset": "150"}, {"mention": "腹部增强ct", "label": "影像检查", "offset": "170"}, {"mention": "胰腺尾部", "label": "解剖部位", "offset": "181"}, {"mention": "肠区", "label": "解剖部位", "offset": "195"}, {"mention": "肝左叶", "label": "解剖部位", "offset": "216"}, {"mention": "两肾", "label": "解剖部位", "offset": "227"}, {"mention": "两肺底", "label": "解剖部位", "offset": "236"}, {"mention": "腰椎骨质增生", "label": "疾病和诊断", "offset": "251"}, {"mention": "腹部不适", "label": "症状", "offset": "297"}, {"mention": "剑突", "label": "解剖部位", "offset": "305"}, {"mention": "头昏", "label": "症状", "offset": "349"}, {"mention": "上腹", "label": "解剖部位", "offset": "364"}, {"mention": "腹泻", "label": "症状", "offset": "370"}, {"mention": "肛门", "label": "解剖部位", "offset": "376"}, {"mention": "腹胀原因待查", "label": "疾病和诊断", "offset": "429"}]}
{"text": "入院8+年前无明显诱因患者感活动后乏力、气促,不伴头昏、头痛、胸闷、心悸、胸痛、晕厥、黑曚、呃逆、反酸、嗳气、烧心、恶心、呕吐、腹痛、腹胀、腹泻、黑便。患者于*****医院诊断“溶血性贫血”,给予输血等处理后病情缓解。病程中如下症状反复发生,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。诊断“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,反复经输注洗涤红细胞后缓解。7天前患者再次出现乏力、气促、精神差,无腹痛、腹泻、血便。为求进一步治疗今日入我院门诊,门诊以“g-6-pd酶缺乏症”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": "25"}, {"mention": "头痛", "label": "症状", "offset": "28"}, {"mention": "胸闷", "label": "症状", "offset": "31"}, {"mention": "心悸", "label": "症状", "offset": "34"}, {"mention": "胸痛", "label": "症状", "offset": "37"}, {"mention": "腹痛", "label": "症状", "offset": "64"}, {"mention": "腹胀", "label": "症状", "offset": "67"}, {"mention": "腹泻", "label": "症状", "offset": "70"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "89"}, {"mention": "间接coomb’s试验", "label": "实验室检验", "offset": "150"}, {"mention": "新生儿g6pd活性试验", "label": "实验室检验", "offset": "284"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "315"}, {"mention": "贫血性心脏病", "label": "疾病和诊断", "offset": "326"}, {"mention": "肝功能不全", "label": "疾病和诊断", "offset": "333"}, {"mention": "腹痛", "label": "症状", "offset": "404"}, {"mention": "腹泻", "label": "症状", "offset": "407"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "432"}]}
{"text": "入院1+年前患者出现反复解黑色大便,伴头昏、乏力、皮肤黏膜苍白,无反酸、嗳气、烧心,无呕血、腹痛、腹胀、腹泻,无恶心、呕吐、晕厥,无口干、颜面肢体水肿、腹围增大。于我院诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。期间反复因解黑便于我院多次住院,我院无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,下消化道出血原因不能明确,建议行小肠镜、腹部血管dsa检查,患者拒绝,给予止血、纠正贫血、抑酸等对症处理后症状好转出院,未再正规检查及治疗。随后在**医院就诊,行胃镜及病理活检提示胃早癌,未行手术治疗出院。又在**********就诊,仍提示胃早癌,建议患者行胃切除术,但患者拒绝。院外口服“中药”对症处理。2天前患者出现解黑色稀便,伴头昏、四肢乏力。在我院门诊输液(具体不详)无好转,现为进一步治疗,门诊以“胃癌,失血性贫血”收入我科。病程中精神差,饮食可,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "19"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "90"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "102"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "108"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "113"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "180"}, {"mention": "胃体", "label": "解剖部位", "offset": "200"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "210"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "215"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "223"}, {"mention": "腹部血管dsa", "label": "影像检查", "offset": "243"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "313"}, {"mention": "胃早癌", "label": "疾病和诊断", "offset": "344"}, {"mention": "胃切除术", "label": "手术", "offset": "353"}, {"mention": "头昏", "label": "症状", "offset": "391"}, {"mention": "四肢", "label": "解剖部位", "offset": "394"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "428"}, {"mention": "失血性贫血", "label": "疾病和诊断", "offset": "431"}]}
{"text": "入院前4月患者无明显诱因出现活动后气促,偶有心悸,无明显胸闷、心前区压榨感,无恶心、呕吐,无发热、畏寒,无咳嗽、咳痰,无黑朦、晕厥等不适。未引起重视。2天前下述症状加重,伴纳差、尿量减少,有夜间阵发性呼吸困难等,均未就医。入院前半天患者气促、喘累明显,伴心悸,不能平卧,尿量较少,无发热、畏寒,无咳嗽、咳痰,无恶心、呕吐等不适。家属送其入我院急诊科,查体温37.8℃,氧饱和度78%,血压169/69mmhg。血气分析:ph叒7.39,pao2叒46mmhg,paco2叒28mmhg,hco3-叒19.2mmol/l。血常规:wbc叒30.1*10^9/l,hgb叒97g/l,neut%叒9.54%,lymph叒87.31%。电解质、肾功、心肌酶谱、肌钙蛋白未见异常。心电图:房颤伴快速心室率。给予呋塞米20mg静推利尿,生理盐水20ml+西地兰0.2mg静推,生理盐水250ml+硝酸甘油10mg静滴后患者自觉气促症状好转,解小便200余ml。为进一步诊治收治我科。此次起病以来患者精神、饮食、睡眠差,大小便如下述,体重无明显上降。", "mention_data": [{"mention": "心悸", "label": "症状", "offset": "22"}, {"mention": "胸闷", "label": "症状", "offset": "28"}, {"mention": "心前区", "label": "解剖部位", "offset": "31"}, {"mention": "心悸", "label": "症状", "offset": "127"}, {"mention": "ph", "label": "实验室检验", "offset": "210"}, {"mention": "pao2", "label": "实验室检验", "offset": "218"}, {"mention": "paco2", "label": "实验室检验", "offset": "230"}, {"mention": "hco3-", "label": "实验室检验", "offset": "243"}, {"mention": "wbc", "label": "实验室检验", "offset": "264"}, {"mention": "hgb", "label": "实验室检验", "offset": "280"}, {"mention": "neut%", "label": "实验室检验", "offset": "290"}, {"mention": "lymph", "label": "实验室检验", "offset": "302"}, {"mention": "心电图", "label": "影像检查", "offset": "336"}, {"mention": "房颤伴快速心室率", "label": "疾病和诊断", "offset": "340"}, {"mention": "呋塞米", "label": "药物", "offset": "351"}, {"mention": "生理盐水", "label": "药物", "offset": "363"}, {"mention": "西地兰", "label": "药物", "offset": "372"}, {"mention": "生理盐水", "label": "药物", "offset": "383"}, {"mention": "硝酸甘油", "label": "药物", "offset": "393"}]}
{"text": "入院前4小时患者在刷牙时突然出现晕厥1次,伴意识障碍,自述数分钟后自行清醒,因无家属在旁,具体情况不详。但患者否认四肢抽搐、口吐白沫、大小便失禁、偏瘫等。无大汗淋漓、心悸、气促、头昏、发热。自行口服1粒“升血药”(具体不全)后未再处理。病程中逐渐出现下腹部阵发性隐痛不适,无肩背部放射痛,疼痛持续时间不定。入院前2小时出现解黑色稍成型大便1次,量约500g,伴全身大汗、心悸,无恶心、呕血、反酸、烧心。遂来我院急诊急诊,急诊查“血型:abo血型叒\\\"a\\\"型、rhd血型叒阳性,血常规:白细胞数叒10.5×10^9/l叒↑、红细胞数叒4.18×10^12/l叒↓、血红蛋白浓度叒126叒g/l叒↓、血小板数叒88×10^9/l叒↓、中性粒细胞百分比叒84.61叒%叒↑、红细胞压积叒39.3叒%叒↓,肾功:尿素叒15.14叒mmol/l叒↑,电解质1:钾叒4.47叒mmol/l。凝血试验正常。自描心电图正常。”考虑“下消化道出血”,给予抑酸止血后急诊以“下消化道出血”收入我科。病程中精神差,未进食,大便如下述,小便正常,体重无改变。", "mention_data": [{"mention": "四肢抽搐", "label": "症状", "offset": "57"}, {"mention": "心悸", "label": "症状", "offset": "83"}, {"mention": "头昏", "label": "症状", "offset": "89"}, {"mention": "下腹部", "label": "解剖部位", "offset": "125"}, {"mention": "肩背部", "label": "解剖部位", "offset": "137"}, {"mention": "心悸", "label": "症状", "offset": "185"}, {"mention": "abo血型", "label": "实验室检验", "offset": "217"}, {"mention": "rhd血型", "label": "实验室检验", "offset": "230"}, {"mention": "白细胞", "label": "实验室检验", "offset": "243"}, {"mention": "红细胞", "label": "实验室检验", "offset": "262"}, {"mention": "血红蛋白浓度", "label": "实验室检验", "offset": "282"}, {"mention": "血小板", "label": "实验室检验", "offset": "299"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "316"}, {"mention": "红细胞压积", "label": "实验室检验", "offset": "335"}, {"mention": "尿素", "label": "实验室检验", "offset": "353"}, {"mention": "钾", "label": "实验室检验", "offset": "376"}, {"mention": "心电图", "label": "影像检查", "offset": "399"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "409"}, {"mention": "下消化道出血", "label": "疾病和诊断", "offset": "428"}]}
{"text": "7+月前患者无明显诱因出现下腹部隐痛,伴反酸,纳差,与*******医院行胃镜:胃窦低分化腺癌;院外自服中药,为进一步治疗。病程中进食量少,腹胀不适,自诉解稀糊大便,伴粘液,未予重视。20天前患者无明显诱因出现下腹部伴脐周疼痛,阵发性加重,进食后明显,伴后背放射痛,稍进食后干呕,饮食量急剧上降,几乎未进食,感肛门坠胀,有便意,未解便,与我院就诊,2017-12-29日复查胃镜,胃窦:叒查见环周隆起、僵硬,触之易出血,表面散在溃疡病灶,取活检4块。活检胃窦腺癌。腹部ct增强:1、胃窦壁局限性增厚,增强扫描明显强化;中上腹部部分小肠管壁明显增厚、水肿;腹腔及盆腔少量积液;腹膜后多个肿大淋巴。入院后给予禁食,抑酸,抗感染,止痛治疗,患者腹痛明显好转,住院5天后自动出院。院外间断呕吐胃内容物,无呕血。4天前患者持续脐周疼痛,阵发性加重,进食后明显,饮食量上降原来2/3,少量流质,伴腰背胀痛,有肛门排便,精神差,夜间疼痛明显,故以“胃癌”收入我科。病程以来患者精神、食欲欠佳,1日前解黄色成形大便,小便正常,近半月体重体力上降2斤。", "mention_data": [{"mention": "下腹部", "label": "解剖部位", "offset": "13"}, {"mention": "胃窦低分化腺癌", "label": "疾病和诊断", "offset": "40"}, {"mention": "腹胀", "label": "症状", "offset": "70"}, {"mention": "下腹部", "label": "解剖部位", "offset": "105"}, {"mention": "脐周疼痛", "label": "症状", "offset": "109"}, {"mention": "后背", "label": "解剖部位", "offset": "127"}, {"mention": "肛门坠胀", "label": "症状", "offset": "155"}, {"mention": "胃窦", "label": "解剖部位", "offset": "190"}, {"mention": "胃窦腺癌", "label": "疾病和诊断", "offset": "227"}, {"mention": "腹部ct增强", "label": "影像检查", "offset": "232"}, {"mention": "胃窦壁", "label": "解剖部位", "offset": "241"}, {"mention": "中上腹部", "label": "解剖部位", "offset": "259"}, {"mention": "小肠管壁", "label": "解剖部位", "offset": "265"}, {"mention": "腹腔", "label": "解剖部位", "offset": "277"}, {"mention": "盆腔", "label": "解剖部位", "offset": "280"}, {"mention": "腹膜后", "label": "解剖部位", "offset": "287"}, {"mention": "腹痛", "label": "症状", "offset": "319"}, {"mention": "胃", "label": "解剖部位", "offset": "342"}, {"mention": "脐周疼痛", "label": "症状", "offset": "358"}, {"mention": "腰背", "label": "解剖部位", "offset": "392"}, {"mention": "肛门", "label": "解剖部位", "offset": "398"}, {"mention": "胃癌", "label": "疾病和诊断", "offset": "417"}]}
{"text": "入院前7年无明显诱因患者感活动后乏力、气促,偶有头昏,偶有胸闷、心悸,偶有反酸、嗳气,无头痛、胸痛、晕厥、黑曚、烧心、恶心、呕吐、腹痛、腹胀、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程好转。2013年4月*****胸片检查:两肺纹理增多,心影轻度增大。心脏彩超:右房、右室稍增大,ef正常。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)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,结合临床确诊“g-6-pd酶缺乏症,贫血性心脏病,肝功能不全”。输洗涤红细胞后病情好转。出院后患者反复出现乏力、气促不适,心悸、胸闷不适,在我院多次输洗涤红细胞悬液后好转。近1周患者再次出现下述症状,为求进一步治疗,门诊以“g-6-pd酶缺乏症,溶血性贫血”收入我科。患者患病以来,精神状态欠佳,大小便正常,体重无明显减轻。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "24"}, {"mention": "胸闷", "label": "症状", "offset": "29"}, {"mention": "心悸", "label": "症状", "offset": "32"}, {"mention": "头痛", "label": "症状", "offset": "44"}, {"mention": "胸痛", "label": "症状", "offset": "47"}, {"mention": "腹痛", "label": "症状", "offset": "65"}, {"mention": "腹胀", "label": "症状", "offset": "68"}, {"mention": "腹泻", "label": "症状", "offset": "71"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "88"}, {"mention": "胸片", "label": "影像检查", "offset": "146"}, {"mention": "两肺", "label": "解剖部位", "offset": "151"}, {"mention": "心", "label": "解剖部位", "offset": "158"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "165"}, {"mention": "右房", "label": "解剖部位", "offset": "170"}, {"mention": "右室", "label": "解剖部位", "offset": "173"}, {"mention": "ef", "label": "实验室检验", "offset": "179"}, {"mention": "间接coomb’s试验", "label": "实验室检验", "offset": "184"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "307"}, {"mention": "贫血性心脏病", "label": "疾病和诊断", "offset": "318"}, {"mention": "肝功能不全", "label": "疾病和诊断", "offset": "325"}, {"mention": "心悸", "label": "症状", "offset": "361"}, {"mention": "胸闷", "label": "症状", "offset": "364"}, {"mention": "g-6-pd酶缺乏症", "label": "疾病和诊断", "offset": "412"}, {"mention": "溶血性贫血", "label": "疾病和诊断", "offset": "423"}]}
{"text": "患者入院前2+年多于活动后感心累,心悸,自觉“心跳”明显,休息后可减轻,并胸闷,偶有心前区隐痛,自觉胸骨后压榨感,含服“速效救心丸”后症状可减轻,不伴反酸、嗳气、恶心呕吐等不适,患者未正规治疗。近半年来患者逐渐出现上肢浮肿,于*****医院就诊,具体治疗不详,考虑“冠心病”,平时服用药物情况不详。入院前1周患者自觉心累、心悸症状加重,再次就诊于该院,查血常规叒rbc叒3.42×1012/l叒凝血试验叒pt叒15.8s叒inr叒1.31叒肝功叒ast叒11.5u/l,心肌酶谱、血糖、血脂、甲功5相正常;心脏彩超提示右心房、左心房增大,右室舒张顺应性降低,二尖瓣、三尖瓣及主动脉瓣、肺动脉返流,ef叒53%;给予利尿、营养心肌、控制心室率等治疗(据患者提供出院记录),该院诊断“冠心病、心脏扩大、房颤、慢性心功能不全、心功能叒2-3级,高血压2级很高危、腔隙性脑梗死、脑动脉供血不足、慢性胃炎”。患者自觉症状有所缓解,但仍有心悸不适,今日家属要求转入我院继续治疗。病程中患者精神、饮食一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "心", "label": "解剖部位", "offset": "14"}, {"mention": "心悸", "label": "症状", "offset": "17"}, {"mention": "胸闷", "label": "症状", "offset": "37"}, {"mention": "心前区隐痛", "label": "症状", "offset": "42"}, {"mention": "胸骨后", "label": "解剖部位", "offset": "50"}, {"mention": "速效救心丸", "label": "药物", "offset": "60"}, {"mention": "上肢", "label": "解剖部位", "offset": "107"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "133"}, {"mention": "心", "label": "解剖部位", "offset": "158"}, {"mention": "心悸", "label": "症状", "offset": "161"}, {"mention": "rbc", "label": "实验室检验", "offset": "181"}, {"mention": "pt", "label": "实验室检验", "offset": "202"}, {"mention": "inr", "label": "实验室检验", "offset": "211"}, {"mention": "ast", "label": "实验室检验", "offset": "223"}, {"mention": "心脏彩超", "label": "影像检查", "offset": "253"}, {"mention": "右心房", "label": "解剖部位", "offset": "259"}, {"mention": "左心房", "label": "解剖部位", "offset": "263"}, {"mention": "右室", "label": "解剖部位", "offset": "269"}, {"mention": "二尖瓣", "label": "解剖部位", "offset": "279"}, {"mention": "三尖瓣", "label": "解剖部位", "offset": "283"}, {"mention": "主动脉瓣", "label": "解剖部位", "offset": "287"}, {"mention": "肺动脉", "label": "解剖部位", "offset": "292"}, {"mention": "ef", "label": "实验室检验", "offset": "298"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "340"}, {"mention": "心脏扩大", "label": "疾病和诊断", "offset": "344"}, {"mention": "房颤", "label": "疾病和诊断", "offset": "349"}, {"mention": "慢性心功能不全", "label": "疾病和诊断", "offset": "352"}, {"mention": "心功能叒2-3级", "label": "疾病和诊断", "offset": "360"}, {"mention": "高血压2级很高危", "label": "疾病和诊断", "offset": "369"}, {"mention": "腔隙性脑梗死", "label": "疾病和诊断", "offset": "378"}, {"mention": "脑动脉供血不足", "label": "疾病和诊断", "offset": "385"}, {"mention": "慢性胃炎", "label": "疾病和诊断", "offset": "393"}, {"mention": "心悸", "label": "症状", "offset": "413"}]}
{"text": "2天前无明显诱因患者感中下腹隐痛,呈持续性,伴腹胀,阵发性加重。有肛门排气排便。不伴发热、畏寒、寒战、反酸、烧心、嗳气、呃逆、头昏、头痛、乏力、胸闷、胸痛、心悸、气促、腹泻、黑便。腹痛与进食、活动、体位无明显关系,无肩背部放射痛。5小时前腹痛加重,呈剧痛,立即入我院急诊,查血常规:白细胞数叒11.6×10^9/l、中性粒细胞百分比叒77.64叒%、淋巴细胞百分比叒18.32叒%、嗜酸性粒细胞百分比叒0.24叒%、中性粒细胞绝对值叒9.02×10^9/l,肾功:尿素叒2.32叒mmol/l、尿酸叒522.7叒μmol/l,血淀粉酶叒58.6叒u/l,电解质1:钾叒2.26叒mmol/l、钠叒127.6叒mmol/、氯叒84.1叒mmol/l。腹部平片:上腹部肠曲积气、扩张,提示肠梗阻?结合临床或必要时进一步ct检查;腰椎骨质增生;考虑两上肺炎症,结合临床。彩超:中度脂肪肝;胆囊轻度增大叒请结合临床;左肾囊肿;右肾切除术后。急诊以“腹痛待查”收入我科。患者此次患病以来,精神状态欠佳,大小便正常。体重无明显减轻。", "mention_data": [{"mention": "中下腹", "label": "解剖部位", "offset": "11"}, {"mention": "腹胀", "label": "症状", "offset": "23"}, {"mention": "肛门", "label": "解剖部位", "offset": "33"}, {"mention": "头昏", "label": "症状", "offset": "63"}, {"mention": "头痛", "label": "症状", "offset": "66"}, {"mention": "胸闷", "label": "症状", "offset": "72"}, {"mention": "胸痛", "label": "症状", "offset": "75"}, {"mention": "心悸", "label": "症状", "offset": "78"}, {"mention": "腹泻", "label": "症状", "offset": "84"}, {"mention": "腹痛", "label": "症状", "offset": "90"}, {"mention": "肩背部", "label": "解剖部位", "offset": "108"}, {"mention": "腹痛", "label": "症状", "offset": "119"}, {"mention": "白细胞", "label": "实验室检验", "offset": "141"}, {"mention": "中性粒细胞百分比", "label": "实验室检验", "offset": "158"}, {"mention": "淋巴细胞百分比", "label": "实验室检验", "offset": "175"}, {"mention": "嗜酸性粒细胞百分比", "label": "实验室检验", "offset": "191"}, {"mention": "中性粒细胞绝对值", "label": "实验室检验", "offset": "208"}, {"mention": "尿素", "label": "实验室检验", "offset": "232"}, {"mention": "尿酸", "label": "实验室检验", "offset": "247"}, {"mention": "血淀粉酶", "label": "实验室检验", "offset": "263"}, {"mention": "钾", "label": "实验室检验", "offset": "282"}, {"mention": "钠", "label": "实验室检验", "offset": "296"}, {"mention": "氯", "label": "实验室检验", "offset": "310"}, {"mention": "腹部平片", "label": "影像检查", "offset": "324"}, {"mention": "上腹部", "label": "解剖部位", "offset": "329"}, {"mention": "肠梗阻", "label": "疾病和诊断", "offset": "342"}, {"mention": "ct", "label": "影像检查", "offset": "357"}, {"mention": "腰椎骨质增生", "label": "疾病和诊断", "offset": "362"}, {"mention": "两上肺炎症", "label": "疾病和诊断", "offset": "371"}, {"mention": "彩超", "label": "影像检查", "offset": "382"}, {"mention": "中度脂肪肝", "label": "疾病和诊断", "offset": "385"}, {"mention": "胆囊", "label": "解剖部位", "offset": "391"}, {"mention": "左肾囊肿", "label": "疾病和诊断", "offset": "404"}, {"mention": "右肾切除术", "label": "手术", "offset": "409"}, {"mention": "腹痛待查", "label": "疾病和诊断", "offset": "420"}]}
{"text": "入院前13年患者检查发现血糖升高,血糖具体值不详,有口干、多饮、多尿等症状,伴四肢麻木,并有感觉异常,自觉肢体冰凉,伴视物模糊,于外院诊断为“2型糖尿病叒糖尿病周围神经病变叒糖尿病眼病”,后长期服用“格列美脲、伏格列波糖、罗格列酮”等降血糖,血糖控制情况不详。病程中患者无颜面四肢浮肿,无皮肤瘙痒,无肢体乏力,无恶心呕吐,无腹胀腹痛,无便秘腹泻交替,无心累气促等不适,既往长期在***第三人民医院住院。8月前患者因活动后心累心悸,偶有干咳,感肢体麻木冰凉较明显,伴有腰部及上肢疼痛,自觉健忘症状加重,于我院内一科住院,查肾功:尿素叒16.00叒mmol/l、肌酐叒141.7叒μmol/l,诊断为“糖尿病肾病”,治疗后好转出院。1月前患者出现活动后心累,以下坡明显,无两上肢水肿,无胸闷、胸痛,无黑曚、晕厥,无夜间不能平卧,小便量正常。今为进一步诊治,以“1、2型糖尿病叒糖尿病肾病叒2、高血压叒高血压性心脏病”收入我科住院治疗。患者此次发病以来精神食欲可,长期睡眠差,经常服用“安眠药”,大小便正常,体重无明显上降。", "mention_data": [{"mention": "四肢麻木", "label": "症状", "offset": "39"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "71"}, {"mention": "糖尿病周围神经病变", "label": "疾病和诊断", "offset": "77"}, {"mention": "糖尿病眼病", "label": "疾病和诊断", "offset": "87"}, {"mention": "格列美脲", "label": "药物", "offset": "100"}, {"mention": "伏格列波糖", "label": "药物", "offset": "105"}, {"mention": "罗格列酮", "label": "药物", "offset": "111"}, {"mention": "颜面", "label": "解剖部位", "offset": "136"}, {"mention": "四肢", "label": "解剖部位", "offset": "138"}, {"mention": "腹胀", "label": "症状", "offset": "162"}, {"mention": "腹痛", "label": "症状", "offset": "164"}, {"mention": "腹泻", "label": "症状", "offset": "170"}, {"mention": "心", "label": "解剖部位", "offset": "176"}, {"mention": "心", "label": "解剖部位", "offset": "210"}, {"mention": "心悸", "label": "症状", "offset": "212"}, {"mention": "腰部", "label": "解剖部位", "offset": "233"}, {"mention": "上肢", "label": "解剖部位", "offset": "236"}, {"mention": "尿素", "label": "实验室检验", "offset": "263"}, {"mention": "肌酐", "label": "实验室检验", "offset": "279"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "299"}, {"mention": "心", "label": "解剖部位", "offset": "324"}, {"mention": "两上肢", "label": "解剖部位", "offset": "334"}, {"mention": "胸闷", "label": "症状", "offset": "341"}, {"mention": "胸痛", "label": "症状", "offset": "344"}, {"mention": "2型糖尿病", "label": "疾病和诊断", "offset": "380"}, {"mention": "糖尿病肾病", "label": "疾病和诊断", "offset": "386"}, {"mention": "高血压", "label": "疾病和诊断", "offset": "394"}, {"mention": "高血压性心脏病", "label": "疾病和诊断", "offset": "398"}]}
{"text": "1+年前患者无明显诱因解黑色成形大便,量约250g/次,伴头昏、乏力、皮肤黏膜苍白,无呕血、腹痛、腹胀、腹泻,无反酸、嗳气、烧心,无口干、颜面肢体水肿、腹围增大。于我院查“hb32g/l”,诊断为“1、消化道出血原因待查叒2、重度贫血3、肝硬化4、慢性丙型肝炎”,拒绝行胃镜检查,给予止血、纠正贫血、抑酸等对症治疗,未解黑便后自动出院。病程中多次出现黑便即来我科住院治疗,曾于2015-06-17行“无痛胃镜示胃底静脉曲张(1条),f1,红色征阴性;胃体黏膜隆起,不除外静脉曲张;十二指肠球炎”,考虑下消化道出血原因不能明确,给予“止血、纠正贫血、抑酸”等对症处理后症状好转出院,未再正规检查及治疗。入院半天前,患者再次解黑大便1次,黑色成形大便,量约50g,无黏液脓血,无恶心、呕吐、呕血,无晕厥、黑朦,无出冷汗、心悸表现。于我院门诊查“大便常规:黑色叒软便,隐血试验叒阳性(+)。”为进一步就诊,遂于我院就诊,拟“消化道出血”收入住院。病程中精神、睡眠欠佳,饮食尚可,大便如下述,小便正常。体重无明显减轻。", "mention_data": [{"mention": "头昏", "label": "症状", "offset": "29"}, {"mention": "腹痛", "label": "症状", "offset": "46"}, {"mention": "腹胀", "label": "症状", "offset": "49"}, {"mention": "腹泻", "label": "症状", "offset": "52"}, {"mention": "颜面", "label": "解剖部位", "offset": "69"}, {"mention": "hb", "label": "实验室检验", "offset": "86"}, {"mention": "消化道出血原因待查", "label": "疾病和诊断", "offset": "101"}, {"mention": "重度贫血", "label": "疾病和诊断", "offset": "113"}, {"mention": "肝硬化", "label": "疾病和诊断", "offset": "119"}, {"mention": "慢性丙型肝炎", "label": "疾病和诊断", "offset": "124"}, {"mention": "胃底静脉曲张", "label": "疾病和诊断", "offset": "205"}, {"mention": "胃体", "label": "解剖部位", "offset": "225"}, {"mention": "静脉曲张", "label": "疾病和诊断", "offset": "235"}, {"mention": "十二指肠球炎", "label": "疾病和诊断", "offset": "240"}, {"mention": "下消化道出血原因不能明确", "label": "疾病和诊断", "offset": "250"}, {"mention": "贫血", "label": "疾病和诊断", "offset": "271"}, {"mention": "心悸", "label": "症状", "offset": "358"}, {"mention": "大便常规", "label": "实验室检验", "offset": "370"}, {"mention": "隐血试验", "label": "实验室检验", "offset": "381"}, {"mention": "消化道出血", "label": "疾病和诊断", "offset": "409"}]}
{"text": "患者入院前2年无明显诱因检查时发现\\\"肺部结节\\\",当时患者无明显咳嗽、胸痛等不适,建议患者定期随访或进一步检查,患者未遵医嘱。入院前1月患者感咳嗽,多以干咳为主,偶可咳出少许白色泡沫痰,并痰中带血,活动后感气喘,无畏寒发热,无胸痛,无潮热盗汗等不适,于我院复查胸部ct发现肺部结节与2015年对比明显增大,考虑“恶性肿瘤”,于8天前患者于*****行pet/ct,诊断“左肺上叶近肺门处及左肺上叶后基底段占位性病变,代谢活性增高,考虑恶性肿瘤可能”,检查当晚患者突发胸痛,以剑突上剧烈疼痛,并胸闷、大汗淋漓,于*****急诊就诊,考虑“急性上壁、后壁、左室心肌梗死”,急诊行发现左冠近中段完全闭塞,植入支架1枚,术后患者胸痛好转,继续冠心病二级预防强化治疗,此次住院请该院呼吸内科会诊,考虑“有创检查”风险较高,未建议进一步检查及特殊治疗,入院前1天患者自该院心内科出院,但患者仍觉咳嗽,咯痰,痰中无出血,今日到我院就诊,为进一步治疗收入我科住院。。病程中患者精神、饮食一般,大小便正常,体重无明显上降。", "mention_data": [{"mention": "肺部结节", "label": "疾病和诊断", "offset": "19"}, {"mention": "胸痛", "label": "症状", "offset": "36"}, {"mention": "胸痛", "label": "症状", "offset": "114"}, {"mention": "胸部ct", "label": "影像检查", "offset": "131"}, {"mention": "肺部结节", "label": "疾病和诊断", "offset": "137"}, {"mention": "pet", "label": "影像检查", "offset": "176"}, {"mention": "ct", "label": "影像检查", "offset": "180"}, {"mention": "左肺上叶近肺门处及左肺上叶后基底段占位性病变,代谢活性增高,考虑恶性肿瘤可能", "label": "疾病和诊断", "offset": "186"}, {"mention": "胸痛", "label": "症状", "offset": "234"}, {"mention": "剑突上", "label": "解剖部位", "offset": "238"}, {"mention": "胸闷", "label": "症状", "offset": "247"}, {"mention": "急性上壁、后壁、左室心肌梗死", "label": "疾病和诊断", "offset": "269"}, {"mention": "左冠近中段", "label": "解剖部位", "offset": "290"}, {"mention": "植入支架", "label": "手术", "offset": "300"}, {"mention": "胸痛", "label": "症状", "offset": "311"}, {"mention": "冠心病", "label": "疾病和诊断", "offset": "318"}]}