Matepukupuku pūkahukahu pūtau iti kua horapa-01

I te marama o Hune 2022, i tirotirohia he tūroro tāne 65-tau te pakeke, ā, i kitea i roto i te karapa CT he pona i raro i te pleura i te pito matau o runga o te pukahukahu. I te marama o Hanuere 2023, ka tīmata te tūroro ki te pāngia e ngā tohu pēnei i te reo pārūrū, te mare, me te poto o te manawa. I te marama o Mei 2023, kua kino haere te mare me te poto o te manawa. I whakaatuhia e ngā karapa te pikinga nui o te mahi pākia i roto i te pona pukahukahu o te pito matau o runga, he tohu tino pai mō te mate pukupuku pukahukahu. I tua atu, i kitea te pikinga o te mahi pākia i roto i ngā pona lymph maha, tae atu ki te rohe supraclavicular matau, mediastinum, trachea, para-aortic area, me te vena cava raro. I whakaatuhia hoki e ngā whakaahua he maha ngā matotoru o te pona i roto i te pleura matau me te pikinga o te mahi pākia. I whakaatuhia e ngā hua o te whakamātautau he metastasis pleural matau me te pleural effusion, ā, i whakaūtia te tātaritanga whakamutunga o te mate pukupuku pukahukahu pūtau iti metastatic mā te whakamātautau pathological, te whakaahua, me te immunohistochemistry. I muri mai ka whiwhi te tūroro i te maimoatanga.

E rima marama i muri mai, kua tino heke te rahi o te pukupuku, ā, kua ngaro te nuinga o ngā whara kua horapa. Ko te tikanga maimoatanga ko te rongoā ārai mate atezolizumab tuatahi me te rongoā arotahi anlotinib. I tukuna te atezolizumab i te horopeta o te 1200 mg i te rā tuatahi, ā, i muri mai ka mutu te maimoatanga. I hoatu ā-waha a Anlotinib i te horopeta o te 10 mg i ia rā mō ngā wiki e rua karapīpiti, ā, i muri mai ka okioki mō ngā rā e whitu, ka hanga he huringa maimoatanga 21-rā. I muri i ngā wāhanga 15 o te radiotherapy, i whakaatu ngā whakaahua CT i te hekenga nui o te whara i roto i te pukahukahu matau, ā, kua tino heke hoki te mediastinum me ngā kōpū lymph matau. I whakaatuhia e te karapa CT whai muri i te 10 o Hepetema, 2023, ngā huringa pai: he hekenga o te pleural effusion matau, he hekenga o te matotoru o te pleural matau, me te iti haere o ngā kōpū lymph mediastinal me supraclavicular matau, me te kore he whakanui o ngā kōpū lymph puku me te retroperitoneal.

Ki te whakatauritea ki te matawai i te 7 o Mei, 2023, i whakaatuhia e te matawai i te 10 o Oketopa, 2023 he whakahekenga nui o te pukupuku. Ina koa, i kitea te whakahekenga i roto i te pona i te taha matau o runga me etahi pona lymph e tata ana ki te trachea, nga oko toto, te rohe para-aortic, me te vena cava o raro. Ko te matotoru o te pona i kitea i mua i roto i te peritoneum rohe, te pakitara uma o mua matau, me te waahi intercostal 11-12 kua tino heke. I tua atu, kua tino heke te atarangi pona iti-kiato i roto i te uaua pakihiwi matau. E whakaatu ana ēnei hua he whai hua te tikanga maimoatanga pūnaha, me te ngaro o te nuinga o ngā whara metastatic me te whakahekenga nui o ngā whara e toe ana. E whakaatu ana ngā aromatawai whakaahua he angitu te tikanga maimoatanga, ā, kei roto te pukupuku i te wā whakaora wāhanga.