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患者女性,59岁。因上腹部疼痛伴恶心、呕吐3天,以胆囊炎之诊断收入院。查体:巩膜无黄染,腹平坦而柔软,剑突下及胆囊区有压痛,莫非氏征(+)。反跳痛(-),肝区叩击痛(+),右上腹未扪及包块。入院第二天,T38℃,巩膜轻度黄染,大便浅黑色,潜血试验(++)。B超:肝内胆管轻度扩张,胆总管直径1.0cm,胆囊10cm×4.0cm,胆囊后方可见一7.0cm×5.3cm的肿块,与胆囊不易分开。CT:肝下缘、胆囊下后方、肾前有一7.0cm×6.5cm包块,与胆囊分界不清。手术所见:胆囊下后方,有一实质性肿瘤。瘤蒂于
Female patient, 59 years old. Due to epigastric pain with nausea and vomiting for 3 days, the hospital was diagnosed with cholecystitis. Physical examination: The sclera is yellow-stained, the abdomen is flat and soft, and there is tenderness under the xiphoid and gallbladder areas. Bounceback (-), hepatic percussion pain (+), right upper quadrant palpation and mass. On the second day of admission, T38°C, mild yellow sclera, light black stool, and occult blood test (++). B-mode ultrasound: The intrahepatic bile duct was slightly dilated, the diameter of the common bile duct was 1.0 cm, the gallbladder was 10 cm x 4.0 cm, and a 7.0 cm x 5.3 cm lump was seen behind the gallbladder. It was not easy to separate from the gallbladder. CT: There is a 7.0cm x 6.5cm mass in the lower hepatic margin, posterior to the gallbladder, and in front of the kidney, and the boundary between the gallbladder is unclear. Surgical findings: Behind the gallbladder, there is a substantial tumor. Tumory