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患者,男,57岁。因上腹部不适、纳差2周,加重伴黑便1周入院。查体:重度贫血貌,皮肤粘膜苍白,无黄染。全腹无压痛,未扪及包块。Hb49g/L,RBC1.18×10~(12)/L。X线钡餐检查疑十二指肠降段病变。B超示胰头体问有一2.5cm×2.5cm光团。胃镜检查未见异常。于入院后1周行剖腹探查,术中见十二指肠降段明显扩大,纵行切开其前壁,见其后壁有一约7cm×4.5cm×3.5cm之带蒂肿物,质软,表面较光滑,肠壁无浸润,故行粘膜下肿瘤及其周围正常肠粘膜及粘膜下组织切除。病理报告为十二指肠管状绒毛状腺瘤伴灶性出血坏死。患者术后恢复良好,随访5年无复发。
Patient, male, 57 years old. Due to discomfort in the upper abdomen and an accommodative difference of 2 weeks, he was admitted to hospital with aggravated black stool for 1 week. Physical examination: Severe anaemia appearance, pale skin and mucous membranes, no yellow staining. There was no tenderness in the entire abdomen, no palpable mass. Hb 49g/L, RBC 1.18×10 12/L. X-ray barium meal examination suspect duodenal descending lesions. B ultrasound showed pancreatic head asked a 2.5cm x 2.5cm light mass. No abnormal gastroscopy. A laparotomy was performed 1 week after admission. During the operation, the descending segment of the duodenum was clearly enlarged. The anterior wall of the duodenum was incised longitudinally. A 7 cm × 4.5 cm × 3.5 cm pedicled mass was seen on the posterior wall. The surface is relatively smooth, and there is no infiltration of the intestinal wall, so submucosal tumors and the surrounding normal mucosa and submucosal tissue are removed. The pathology report was a duodenal tubular villous adenoma with focal hemorrhage and necrosis. The patient recovered well after surgery and there was no recurrence after 5 years of follow-up.