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患者男,72岁,以右上腹痛12年,加重两周入院。患者于1985年始有劳累后右上腹持续性隐痛和食欲不振,经B超、CT检查均示肝右后叶有一个实性肿块,检测AFP240mg/L,诊断为“原发性肝癌。给予5-Fu 0.5g静脉输液化疗15天,出院后一般情况尚可,可以从事轻体力劳动,其间曾用5-Fu静脉输液化疗2个疗程。近两周,右上腹痛加重,为持续性,尤其体位变动时为著,难以忍受,并食欲减退、发热,体质消瘦,以“晚期肝癌全身广泛转移”收入院。查体:体温37.8℃,脉搏99次/分,血压14/10kPa,慢性病容、消瘦,皮肤粘膜无黄染,左锁骨上、双腋下均可触及花生米大小的淋巴结,质硬、活动度差、无压痛,心肺未发现异常,腹平软、肝区有压痛和叩击痛,肝肋下2cm,剑下4cm,脾肋下2cm,腹水征阴性。B超、CT检查均示肝右后叶有一个4.9×3.0cm,左内叶有一个4.2×1.6cm实质性强回声团块。检验HBsAg>107.6mIu/ml,抗-HBe32Ncu/ml,抗-HBc>128Ncu/ml,T-Bill5.5umol/L,ALT 27u/L,AST 51u/L,Tp8.23g/L,A 27.1g/L,G 55.2g/L,BS 4.3mmol/L,AFP 1Hg/L,CEA 7ug/L.X线胸片示两肺纹理增强、紊乱。腋下淋巴
Male patient, 72 years old, with right upper quadrant pain for 12 years, increased two weeks admitted. Patients with persistent pain and loss of appetite in the right upper quadrant after exerting exertion in 1985, B ultrasound, CT examination showed a solid mass in the right posterior lobe of the liver, AFP240mg / L, diagnosed as “primary liver cancer.” 5- Fu 0.5g intravenous infusion of chemotherapy for 15 days, after discharge from the general situation is acceptable, can be engaged in light manual labor, during which 5-Fu intravenous infusion chemotherapy has been used for 2 courses.In the past two weeks, right upper quadrant pain aggravated for the continuity, especially in postural changes When the time, unbearable, and loss of appetite, fever, weight loss, “late liver cancer extensive body metastasis.” Physical examination: body temperature 37.8 ℃, pulse 99 beats / min, blood pressure 14 / 10kPa, Skin and mucous membrane without yellow dye, the left clavicle, double armpit can reach the size of peanut lymph nodes, hard, poor mobility, no tenderness, no abnormal heart and lung, abdominal soft, liver tenderness and percussion pain, 2cm under the ribs, 4cm under the sword, 2cm under the splenic ribs, and negative ascites.B-scan and CT scan showed that the right posterior lobe of the liver had a 4.9 × 3.0cm and the left inner lobe had a 4.2 × 1.6cm substantial echogenic mass Anti-HBe32Ncu / ml, anti-HBc> 128Ncu / ml, T-Bill 5.5 umol / L, ALT 27u / L, AST 51u / L, Tp 8.23g / L, A 27.1g / L, G 55.2g / L, BS 4.3mmol / L, AFP 1Hg / L, CEA 7ug / L. X-ray showed enhanced lung tissue,