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Abstract: Adenocarcinoma of the lung belongs to non-small cell lung cancer, and factors such as long-term smoking and chronic diseases of the lung are common causes of its development. This patient had a history of smoking in the past and was admitted to the hospital with cough and hemoptysis, which was poorly treated with anti-infective and hemostatic drugs. After perfecting various other examinations, an occupying lung lesion with cavitation was found, which was then promptly resected and the postoperative pathology suggested adenocarcinoma of the lung. Due to early detection, the patient’s prognosis was good, and his condition was controlled and all indicators improved.
Basic information】Male, 45 years old
Type of disease】Adenocarcinoma of the lung
Hospital】The First Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Medication (cefoperazone sodium sulbactam sodium for injection) + surgery (radical surgery for left lung adenocarcinoma)
Treatment period】18 days of inpatient treatment and outpatient follow up
Effectiveness】The disease is under control and all indicators are improving
I. Initial consultation
A patient came to our hospital and reported coughing and coughing with blood in the sputum for more than 40 days. The sputum was bright red and bloody, and the volume of sputum was about 10 ml/d. He had taken Yunnan Baiyao capsules and antibiotics orally at home, but still had bloody sputum. The patient was thin, with no cyanosis of the lips and mouth, and had a history of perennial smoking. Before admission, PET-CT was performed at an outside hospital, and the results suggested that the patient had a cavernous lesion in the lower lobe of the left lung with enlarged mediastinal lymph nodes, which was considered more likely to be an infectious lesion. In order to further improve the patient’s symptoms, the patient was admitted to the hospital for the next step of treatment, which focused on controlling the lung infection and at the same time administering symptomatic treatment to stop the bleeding.
II. Treatment history
Since the patient had a history of coughing sputum and blood in sputum for more than 40 days, and considering that the patient was a middle-aged male with a long history of smoking, and that the CT examination of the lung suggested cavitary lesions in the lung, and that the anti-infection treatment was ineffective, the patient and his family were informed of his condition, and were told that the possibility of cavitary lesions in the lung causing sputum and blood was higher, and that it was necessary to continue to improve electronic bronchoscopy, send alveolar lavage fluid for NGS test, antinuclear antibody series, anti-neutrophil cytoplasmic antibody test, T-cell test for tuberculosis infection, sputum exfoliative cell test, etc. should be performed to focus on tuberculosis, pulmonary fungal infection, vasculitis, and tumor diseases. However, pathological tissues were not obtained because of the high amount of bloody secretions viewed under bronchoscopy. After empirical anti-infective treatment (intravenous cefoperazone sodium sulbactam sodium), the patient’s sputum volume decreased and the infection index improved, but hemoptysis was still present. Considering that the patient’s cavitary lung lesion was confined to the lower left lung lobe, a thoracic surgery consultation was requested and the patient was advised to have the lower left lung lobe removed and pathological tissues were sent for intraoperative examination, and the pathological return suggested adenocarcinoma of the lung. The patient was advised to avoid violent coughing, pay attention to sputum excretion, and pay attention to diet and nutrition.
III. Treatment effect
After a series of anti-infection, hemostatic treatment and surgical resection of lung lesions, the patient’s lung CT was reviewed and the results showed good lung reopening, and after early detection and early surgical treatment, the patient had no more hemoptysis and the inflammatory indexes were basically normalized on review, and early radical lung cancer surgical treatment was achieved because of timely early treatment and limited lesions. After 18 days of hospitalization, the patient’s condition improved and reached the discharge standard, and was instructed to review the lung CT and follow up regularly after discharge, and to perform comprehensive medical oncology treatment in time if necessary.
IV. Notes
We are glad that after a series of treatments, the cause of the patient’s blood in sputum was found, and the patient’s cancer was detected and resected in time, which enabled the patient’s condition to be controlled and her symptoms to improve without spreading the cancer, and achieved early eradication. After discharge from the hospital, the patient still needs to pay attention to the following conditions because the postoperative recovery is still not complete.
1. Patients should quit smoking immediately after discharge, and at the same time reduce passive smoking, pay attention to their surroundings, reduce environmental pollution in their life or work, and at the same time need to wear a mask in crowded places to prevent pollution stimulation.
2.After discharge, patients still need to pay close attention to the recovery of respiratory function, and their family members can buckle their backs to discharge sputum every day to avoid excessive respiratory secretions and further induced infection.
3. In order to prevent venous thrombosis of the lower limbs, patients should be properly discharged from bed to promote blood circulation in the lower limbs and also to prevent intestinal adhesions.
4, patients should maintain a positive and optimistic attitude in daily life, do not feel sorry for themselves, a good mood will help the recovery of the disease.
5. Pay attention to regular review after discharge, including lung CT, tumor markers, etc. If there is any discomfort, you should go to the hospital in time.
V. Personal insight
At present, the incidence of lung adenocarcinoma is high and its cause is still not completely clear. However, maintaining good living habits, quitting smoking and drinking, avoiding polluted environment, exercising reasonably and keeping a healthy mind can greatly reduce the chance of cancer occurrence. In addition, when abnormal signals occur in the body, one should seek medical attention in time, which will have a great impact on the prognosis and survival of patients. Earlier detection of the lesion will have a better chance of early eradication, and in this case, it is because of early detection and timely treatment that the patient recovered so well later. From the perspective of our doctors, the clinical symptoms of lung adenocarcinoma are more complicated, and we need to have a keen perception when facing the disease. For patients with repeated sputum and blood with poor treatment results, we should focus on investigating the possibility of malignant tumor in order to get more chances for patients to get radical surgery.