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高某,男,45岁。因消瘦、肝区不适半月住院。体检:慢性病容,心肺(-),肝剑突下5.5cm,肝右肋下3.0cm,莫菲氏征(±)。实验室检查:AKP25金氏单位,AFP(-).血清总胆红素37.6μmol/L,一分钟胆红素17.1μmol/L,TTT2单位。B超:肝脏中度肿大,边缘不光滑,肝内呈不均质小光团反射:毛细胆管扩张呈“双枪征”,胆囊2.1×5.6cm~2,壁不光滑,壁厚0.6cm,囊内(-)。临床诊断:①肝内占位性病变,②胆囊炎。转院后腹部CT扫描;胰头大,分叶,边缘不规则;胆囊增大,肝内肝管扩张。疑诊胰头癌。又经腹部B超检查提示:①胆总管末端阻塞性全胆管扩张,②胰头实质性占位,③右肝
High a, male, 45 years old. Due to weight loss, liver discomfort half hospitalized. Physical examination: Chronic disease, cardiopulmonary (-), liver xiphoid 5.5cm, liver right rib 3.0cm, Murphy’s sign (±). Laboratory tests: AKP25 Gold unit, AFP (-). Serum total bilirubin 37.6μmol / L, one minute bilirubin 17.1μmol / L, TTT2 units. B super: moderate enlargement of the liver, the edge is not smooth, the liver was heterogeneous small light group reflection: dilated capillary bile was “double gun sign”, gallbladder 2.1 × 5.6cm ~ 2, the wall is not smooth, wall thickness 0.6cm , Intracapsular (-). Clinical diagnosis: ① intrahepatic space-occupying lesions, ② cholecystitis. Transabdominal abdominal CT scan; pancreatic head large, lobulated, irregular edge; gallbladder enlargement, intrahepatic hepatic duct dilatation. Suspected pancreatic cancer. B-ultrasound examination of the abdomen again prompted: ① common bile duct obstruction of the common bile duct dilatation, ② pancreatic head substantive occupancy, ③ right liver