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男子喉咙痛、腹痛，胃镜表现是食管癌晚期，病理却不支持，结果出乎意料...

2018-12-24 梁宝松 消化界

喉咙痛腹痛胃镜食管癌
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那是二十几天以前，一位64岁的王老汉高高兴兴地去一个朋友的家里吃喜宴，那家的宴席还真的很丰盛，老人吃的也很开心！可是，就在那顿喜餐之后，老人就出现了腹部疼痛，这可急坏了他的子女们！他们问老人在宴席上都吃了什么？

那是二十几天以前，一位64岁的王老汉高高兴兴地去一个朋友的家里吃喜宴，那家的宴席还真的很丰盛，老人吃的也很开心！可是，就在那顿喜餐之后，老人就出现了腹部疼痛，这可急坏了他的子女们！他们问老人在宴席上都吃了什么？

可是，这位老人平时有糖尿病，在2011年和2015年两次发生脑梗塞，所以老人的反应有些迟钝，再加上年龄的因素，老人有些健忘，只记得自己吃了“蝦壳”，其他什么都记不得了！因为老人的子女也有医务工作者，他们详细询问了老人，并没有腹泻和其他的不舒服，于是就带着老人到了郑州的某大医院看诊。



到了那家医院，医生看诊之后，觉得老人肚子疼痛不好解释，就给老人开了腹部螺旋CT检查，结果肝胆胰腺都没有发现大毛病，这时候老人说自己吃东西的时候喉咙疼痛，难受，难不成是食管出现了问题？

因为患者曾经有过两次脑梗，担心做胃镜的风险太大，这家医院的医生就优先给患者开了钡餐检查，结果发现：食管钡剂通过顺利，上段局部形态欠规整，管壁略僵硬。

其他食管和胃十二指肠未见明显异常。

放射科的医生拿不定主意，怀疑是不是上段食管癌？

于是建议消化内科医生做胃镜进一步检查并且活检做病理学确诊。



事已至此，消化内科的医生就只好冒着风险给患者做胃镜了，谁知道这胃镜刚刚插进食管，消化内科的医生就看到了如下的病变：

食管距门齿20～35cm可见菜花状隆起，表面糜烂粗糙，覆厚白苔污秽苔，占据管腔1/3，内镜顺利通过，触之易出血，活检，质地脆，弹性差。

作为消化内科的医生，几乎没有疑问，这就是食管癌，而且是晚期！

可是，过了两天，病理检查的结果出来了：“食管”鳞状上皮黏膜慢性炎局部急性炎及上皮增生。这下子矛盾来了，这眼看着的食管癌，可是病理却连个不典型增生都没有发现，开刀？放疗？化疗？没有病理证实是万万不可能的！

无奈之下，患者只好住到了我们医院的消化内科，打算让我们再给他重新做胃镜取组织，再做病理学检查。为了给将来进一步的治疗做准备， 我们的医生还给患者开了胸部的螺旋CT检查，想了解食管病变壁外的情况。



一切准备就绪，那天的胃镜是我们消化内科的丁辉博士做的，当丁博士把胃镜插入食管，展现在眼前的情景把他惊呆了！

天呐，这患者的食管上段竟然横挂着一根弯弯的骨头！这可不能随便取！万一骨头扎进了主动脉，贸然取出会当场大出血死人的！



因为已经做了胸部螺旋CT，丁博士赶紧联系放射科，经过仔细寻找，在食管的部位发现了骨头，虽然已经刺破食管，有了穿孔，万幸的却是骨头并没有在主动脉内，于是丁博士使出了洪荒之力，终于巧妙地通过胃镜艰难地把这个骨头取了出来！



骨头取出来了，所有在场的麻醉医生和护士都放下了那颗悬在喉咙口的心！我们的帅男护，文学功底非常雄厚的桂林看了看这个长达5cm骨头，幽默地说，这分明就是个印第安人使用的“回旋镖”嘛！只是这次的回旋镖飞错了地方，差点要了老人的命！



过后，我仔细看了看这个骨骼，从形态上看，很可能是一块老鳖的骨头。

我一贯反对事后诸葛，因为如果从结果反推原因，我们总会说出这样那样的错误！不过，我还是想啰嗦一下，假如这位老人患的是食管癌，他的病情进展速度，是不是太快了点？如果医生做胃镜的时候感觉病变不清楚，适当冲洗，也许这病变就露出了真面目。



再有就是病史，每次检查之前，我都会不厌其烦地翻阅申请单，如果做胃镜的医生知道患者刚刚做了钡餐检查，也许他会想的更多一些，再者，根据我的推理，患者可能是吃的带肉的骨头，那骨头上的肉，粘上白色的硫酸钡，确实够迷惑人的！

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    2019-11-05 xzw122

    #喉咙痛#

    0

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    2019-04-07 一个字-牛

    学习了谢谢分享

    0

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    2018-12-26 crystal0562

    #腹痛#

    0

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    2018-12-26 zhouqu_8

    #食管#

    0

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    2018-12-26 克勤

    不错

    0

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    2018-12-24 flysky120

    学习知识，癌症

    0

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