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患者男,21岁。巩膜黄染、乏力、腹泻2个月,体重减轻10kg。体检:巩膜及全身皮肤黄染,心肺阴性,腹部未触及包块,肝脾不肿大。实验室检查:ESR67mm/小时,AKP93.1u,γ-GT1064u,黄疸指数50u,总胆红素19.0mg%,直接胆红素12.0mg%,尿胆红素阳性,尿胆原弱阳性。B 超示肝内胆管明显扩张,胰管扩张,壶腹部占位待排。CT 扫描示壶腹区梗阻病变可能,先天性胆总管囊肿不能排除。胃镜示乏特氏壶腹癌?十二指肠乳头刷片找到腺癌细胞。1988年7月5日行胰腺,十二指肠及胃次全切除吻合术。病理检查:大体见肿块呈乳头状突入胆总管及壶腹开口处,并累及十二指肠,大小为3.5×1.2×1.2cm,灰红色,质地较硬。切除的部分胃见胃窦粘膜水肿,表
Male patient, 21 years old. Yellow sclera, fatigue, diarrhea for 2 months, weight loss 10kg. Physical examination: yellowing of the sclera and body skin, negative heart and lungs, no mass in the abdomen, no enlargement of the liver and spleen. Laboratory examination: ESR 67mm/hour, AKP93.1u, γ-GT1064u, jaundice index 50u, total bilirubin 19.0mg%, direct bilirubin 12.0mg%, urinary bilirubin positive, urinary gallbladder weak positive. B super showed significant expansion of the intrahepatic bile duct, pancreatic duct expansion, ampulla occupying position to be discharged. CT scans showed that the ampulla area obstruction lesions may be congenital choledochal cysts can not be ruled out. A gastroscope shows a carcinoma of the ampulla of Vater and a duodenal papillae brush to find the adenocarcinoma cells. On July 5, 1988, the pancreas, duodenum, and subtotal gastrectomy were performed. Pathological examination: In general, the tumor showed a papillary protrusion into the common bile duct and the ampulla of the opening, and involved the duodenum with a size of 3.5 x 1.2 x 1.2 cm, grayish red, and a hard texture. Gastric mucosal edema seen in the resected portion of the stomach, table