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患者,女,31岁,因腹痛1个月于2000年9月27日入院。1周来腹痛加剧,尿色深黄,无发热。既往无胰腺炎病史。体检:无黄染,腹软,右上腹压痛(+),肝区叩痛(+)。丙氨酸转移酶215u/L,门冬氨酸转移酶96u/L,碱性磷酸酶249u/L,γ-谷氨酰转肽酶264u/L,总胆红素26.7μmol/L,淀粉酶360u/L。CT:肝内外胆管扩张,胆囊增大,胆总管内见结石影。29日行经内镜逆行胰胆管造影(ERCP):十二指肠降部多量深绿色胆汁。肝内胆管扩张,胆总管直径15mm,内无结石影,下端呈锥形。其下方为扩张的腹头部胰管(7mm),并见7×10mm椭圆形充盈缺损,体尾部胰管正常。胰胆管共同开口,共同管长9mm。10月2日患者腹痛加重,伴黑便,巩膜黄染,大便潜血(+)。5日腹痛及黄疸渐缓解。8日复查ERCP:十二指肠乳头充血水肿,开口边缘一处糜烂。胆总管直径12mm,胰头部胰管最大径4mm,无充盈缺损。20日复查血生化正常。
Patient, female, 31 years old, admitted to hospital on September 27, 2000 due to abdominal pain for 1 month. 1 week to aggravate abdominal pain, dark yellow urine, no fever. No past history of pancreatitis. Physical examination: no yellow dye, abdominal soft, right upper quadrant tenderness (+), liver percussion pain (+). Alanine aminotransferase 215u / L, aspartate aminotransferase 96u / L, alkaline phosphatase 249u / L, γ-glutamyl transpeptidase 264u / L, total bilirubin 26.7μmol / L, 360u / L. CT: Intrahepatic bile duct dilatation, gallbladder enlargement, common bile duct stones. On the 29th by endoscopic retrograde cholangiopancreatography (ERCP): duodenal descent a large amount of dark green bile. Intrahepatic bile duct dilatation, common bile duct diameter 15mm, no shadow within the stone, the lower cone. Below the expansion of the abdominal head of the pancreatic duct (7mm), and see 7 × 10mm oval filling defects, the body of the tail of the pancreatic duct normal. Pancreatic duct common opening, common tube length 9mm. October 2 patients with abdominal pain aggravated, with melena, scleral yellow dye, fecal occult blood (+). On the 5th abdominal pain and jaundice gradually relieve. On the 8th review ERCP: duodenal congestion and edema, the edge of a erosion edge. Common bile duct diameter 12mm, pancreatic head pancreatic duct diameter 4mm, no filling defect. On the 20th review of blood biochemistry normal.