第479例——认知功能下降,呼吸衰竭,结肠占位  

The 479th case:cognitive impairment,respiratory failure,colon mass

作　　者：孙鹿希 朱以诚[2] 吴婵媛[3] 芮曦 林国乐[5] 李海龙[6] 吴东[7] Sun Luxi;Zhu Yicheng;Wu Chanyuan;Rui Xi;Lin Guole;Li Hailong;Wu Dong(Department of Internal Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Neurology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Rheumatology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Intensive Care Unit,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of General Surgery,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Clinical Nutrition,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院内科,100730 [2]中国医学科学院,北京协和医学院,北京协和医院神经科,100730 [3]中国医学科学院,北京协和医学院,北京协和医院风湿免疫科,100730 [4]中国医学科学院,北京协和医学院,北京协和医院重症医学科,100730 [5]中国医学科学院,北京协和医学院,北京协和医院基本外科,100730 [6]中国医学科学院,北京协和医学院,北京协和医院临床营养科,100730 [7]中国医学科学院,北京协和医学院,北京协和医院消化科,100730

出　　处：《中华内科杂志》2020年第9期741-744,共4页Chinese Journal of Internal Medicine

基　　金：北京协和医学院新型八年制医学教育专项教学改革项目(2019zlgc0132)。

摘　　要：患者男,78岁,因发热伴双下肢乏力、言语减少、记忆力下降于北京协和医院住院治疗。病程中抗菌药物治疗后体温恢复正常,但认知障碍及意识障碍快速进展,继发重症肺部感染、呼吸衰竭、感染性休克。粪便潜血阴性,血癌胚抗原阴性,抗核抗体阳性,PET-CT提示乙状结肠代谢增高灶,双侧额叶、颞叶、顶叶、后部扣带回代谢减低,结肠镜活检明确乙状结肠中分化腺癌,考虑乙状结肠癌继发神经系统副肿瘤综合征。经神经科、消化内科、基本外科、重症医学科、风湿免疫科、临床营养科等多科协作,完成全麻下腹腔镜乙状结肠癌根治切除术及围术期并发症诊治,患者最终神志明显改善,体温、氧合恢复正常。A 78-year-old man was admitted to Peking Union Medical College Hospital with fever,weakness of lower extremities,less speech,loss of memory.Fever was relieved after antibiotic treatment,while cognitive impairment and disorder of consciousness progressed rapidly,followed by critical pulmonary infections,respiratory failure,and septic shock.Lab tests showed negative occult blood,normal serum CEA level and positive Anti-nuclear-antibody.PET-CT suggested that strong FDG uptake signals were seen at sigmoid,while bilateral frontal lobe,temporal lobe,parietal lobe,posterior cingulate gyrus showed lower metabolic activity.Colonoscopy biopsy revealed differentiated adenocarcinoma of sigmoid colon.Therefore,paraneoplastic syndrome of nervous system secondary to colon cancer was considered.Rapid and proper diagnosis and treatment were completed by multidisciplinary team including departments of neurology,gastroenterology,general surgery,ICU,rheumatology,clinical nutrition.The laparoscopic sigmoid colectomy was performed under general anesthesia.The patient finally presented with significant improvement of cognition and consciousness.Respiratory function was totally recovered.

关 键 词：认知障碍 呼吸功能不全 乙状结肠肿瘤 

分 类 号：R735.35[医药卫生—肿瘤] R742.9[医药卫生—临床医学]