目的 探讨多原发恶性肿瘤(MPMN)的临床特点,提高该类型肿瘤的认识,为临床诊断及治疗提供一定的经验。方法 分析2021年12月广州市第一人民医院呼吸与危重症学科二区收治的1例乳腺、甲状腺及肺三重多原发恶性肿瘤的临床特点及诊治经过,并结合相关文献进行回顾分析。结果 该例首患乳腺导管内癌并予手术切除,9年后再同时患肺癌及甲状腺癌,最终确诊为三重多原发恶性肿瘤。结论 通过对多原发恶性肿瘤的临床特点的分析研究,可一定程度提高临床医生对MPMN的认知以及早期临床鉴别的能力,亦为肿瘤患者早期诊断、早期治疗提供更好的时机,改善患者生活质量。

Objective To explore the clinical characteristics of multiple primary malignant neoplasms (MPMN), to improve the understanding of this type of tumors, and to provide some experience for clinical diagnosis and treatment. Methods The clinical characteristics, diagnosis and treatment of a case with triple MPMN of breast, thyroid and lung treated in the Respiratory and Critical Care Department (Area 2) of Guangzhou First People's Hospital in December 2021 were analyzed retrospectively. Results The breast intraductal carcinoma was the first tumor of that case and had been resected, and 9 years later, lung cancer and thyroid cancer occured at the same time, which were diagnosed as triple MPMN. Conclusions The analysis and study of the clinical characteristics of MPMN can improve the clinicians' cognition and the ability of early clinical differentiation, and provide a better opportunity for early diagnosis and early treatment of tumor patients, and improve their quality of life.

目的 观察改良直接抽吸取栓术（ADAPT）治疗急性前循环大动脉栓塞性脑卒中的有效性与安全性。方法 回顾性分析2022年3月—2023年2月在广州市第一人民医院采用改良ADAPT治疗急性前循环大动脉栓塞性脑卒中的12例患者临床资料。该改良技术核心是血栓抽吸导管或颅内支持导管管头明确越过血栓后才开始直接使用20 mL的注射器进行手动持续抽吸;所有患者术后依据临床症状和影像表现启动规范抗凝药物治疗,每月门诊随访观察有无再发卒中。结果 12例患者闭塞血管均成功再通,其中改良脑梗死溶栓（mTICI ）2b~2c级3例（25%）,mTICI 3级9例（75%）;从穿刺到血管再通平均时间为37.7 min,首次取栓再通8例（66.7%）,其中颈内动脉闭塞首次取栓再通成功率达80%,出院时平均美国国立卫生研究院卒中量表（NIHSS）评分（9.00±9.22）分,与术前基础NIHSS评分相比,平均下降7分,术后90 d功能恢复良好（mRS评分0~2分）9例（75%）;术后脑出血3例（25%）,其中1例为小点状出血（HI1）而无明显症状、1例为血肿<梗死面积的30%并有轻微占位效应的出血（PH1）恢复良好、1例为血肿>梗死面积的30%并有明显占位效应的出血（PH2）术后自动出院,12例患者筛查病因均发现有心房纤颤,9例患者术后依据临床症状和影像表现在早期开展规范抗凝二级预防管理后无再复发。结论 改良ADAPT是治疗急性大动脉栓塞性脑卒中的一种安全可行选择,血管再通效率高,血栓逃逸概率低、临床疗效良好。对心房纤颤患者实施规范抗凝管理可有效预防脑卒中复发。

Objective To observe the efficacy and safety of modified-a direct aspiration first-pass technique（ADAPT）in the treatment of acute anterior circulation aorta embolic stroke．Methods The clinical data of 12 patients with acute anterior circulation arterial embolic stroke treated by modified-ADAPT in our hospital from March 2022 to February 2023 were analyzed retrospectively．The core of the modified technique is that the head of the thrombus aspiration catheter or intracranial support catheter clearly crosses the thrombus before manual continuous suction with a 20 mL syringe．After operation,all patients started standard anticoagulant therapy according to clinical symptoms and imaging manifestations,and monthly outpatient follow-up was conducted to observe whether there was recurrent stroke．Results Occlusive vessels were successfully recanalized in 12 patients,including 3 cases（25%）of mTICI 2b-2c grade and 9 cases（75%）of mTICI 3 grade．The average time from puncture to vascular recanalization was 37.7 min,and the first thrombectomy and recanalization was performed in 8 cases（66.7%）．The success rate of internal carotid artery occlusion was 80%．The average NIHSSS score at discharge was（9.00±9.22）．Compared with the preoperative NIHSS score,the average score decreased by 7 points．90 days after operation,the function recovered well in 9 cases（75%）．Postoperative cerebral hemorrhage occurred in 3 cases（25%）,including 1 case of punctate hemorrhage without obvious symptoms,1 case of good recovery of PH1 and 1 case of automatic discharge after PH2．12 patients were found to have atrial fibrillation after screening,9 patients had no recurrence after anticoagulation secondary prevention management according to clinical symptoms and imaging manifestations．Conclusions Modified-ADAPT is a safe and feasible choice for the treatment of acute arterial embolism stroke,with high recanalization efficiency,low thrombus escape probability and good clinical effect．Standardized anticoagulation management can effectively prevent the recurrence of stroke in patients with atrial fibrillation．