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患者男性,79岁。因上腹肿胀伴腹壁肿物突出2年,当地拟诊:“腹壁肿物,胆瘘”,遂转入我院。患者于2年前出现右上腹肿胀不适,约2个月后腹壁皮肤溃破,突出一肿物,如粟米大小,进行性增大,表面有淡绿色液体流出,无疼痛、恶心、呕吐及腹泻,亦无畏寒、发热。胃纳好,大小便正常,无明显消瘦。体格检查:T36.5℃,一般情况良好。腹平软,右上腹局部溃烂,见一肿物突出,大小约5×4cm,表面不平,菜花状,呈淡红色肉芽样,表面见绿色胆汁样分泌物及少许脓液渗出。剑突下可扪及肿物,质硬。移动性浊音阴性。血检验:AFP＜μg/ml。
The patient is 79 years old. Due to swelling of the upper abdomen with abdominal masses protruding for 2 years, the local hospital was diagnosed with: “Abdominal wall mass, bile convulsions” and transferred to our hospital. The patient presented with swelling and discomfort of the right upper quadrant two years ago. The abdominal wall skin collapsed about 2 months later. A tumor, such as the size of corn, was progressively enlarged. There was a light green liquid on the surface, no pain, nausea, vomiting, and diarrhea. There is no chills or fever. Good appetite, normal urine, no significant weight loss. Physical examination: T36.5°C, generally good. The abdomen was soft and the upper right abdomen was locally fester. See a prominent tumor with a size of about 5×4 cm. The surface was uneven, cauliflower-like, pale red granulation, and bile-like secretions and a few pus exuded on the surface. The xiphoid can be swollen with mass and hard. Mobile dullness is negative. Blood test: AFP <μg/ml.