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患者女,46岁。左上腹间歇性痛4个月,伴发热、黄疸1 周。体检:体温38.5℃,血压120／80 mmHg,皮肤及巩膜明 显黄染,左上腹压痛、肌紧张及反跳痛,肝脾肋下未扪及。实 验室检查:WBC1.52×10 9／L,中性粒细胞88％;总胆红素 131.7μmol／L,直接胆红素100.9 μmol／L,丙氨酸转氨酶157 u／L,天冬氨酸转氨酶21 3 u／L;血淀粉酶、血脂肪酶在正常 值范围。胸片及腹部超声检查发观该患者同时合并全内脏 异位。腹部B超发现肝内外胆管扩张,胆总管直径1.5 cm, 胆总管内有一1.6 cm×1.2 cm×1.0 cm结石,胆囊正常。诊 断:胆总管结石伴急性胆管炎。
Female patient, 46 years old. Left upper quadrant intermittent pain for 4 months, with fever, jaundice for 1 week. Physical examination: body temperature 38.5 ℃, blood pressure 120/80 mmHg, the skin and sclera significantly yellow dye, left upper quadrant tenderness, muscle tension and rebound tenderness, liver and spleen ribs palpable. Laboratory tests: WBC1.52 × 10 9 / L, neutrophils 88%; total bilirubin 131.7μmol / L, direct bilirubin 100.9 μmol / L, alanine aminotransferase 157 u / L, aspartate Acid aminotransferase 21 3 u / L; blood amylase, lipase in the normal range. Chest radiography and abdominal ultrasound examination of the patient combined with total visceral ectopic. Abdominal B-extrahepatic bile duct expansion, common bile duct diameter 1.5 cm, common bile duct with a 1.6 cm × 1.2 cm × 1.0 cm stones, normal gallbladder. Diagnosis: Common bile duct stones with acute cholangitis.