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患者,男性,63岁。反复右上腹痛12余年。B超 诊断:慢性胆囊炎合并结石,治疗后多次反复。近来 发作渐频。查体:右上腹压痛,可触及一“核桃”大 小的肿物。超声显示:胆囊内径5.7cm×2.6cm,胆囊 底部可见一约3.0cm×2.7cm的实性肿块向胆囊外隆 起,肿块内见一约0.7cm强光团,后方伴声影。CDFI: 显示其内有星点状血流信号,PS 20cm/s,RI0.59(图 1),提示为胆囊实质性病变(胆囊癌可能)。患者在全 麻下胆囊摘除术。术中见胆囊与大网膜粘连,暴露后 顺利切除胆囊,囊壁质地柔软,剖开后见一3.2cm× 2.5cm的病灶,表面不光整,呈实质性。病理结果:慢 性胆囊炎,胆囊乳头状癌。
Patient, male, 63 years old. Repeated right upper abdominal pain for more than 12 years. B-diagnosis: Chronic cholecystitis with stones, repeated several times after treatment. Recently, episodes have become more frequent. Examination: The right upper quadrant tenderness can reach a large size of a “walnut” tumor. Ultrasound showed that the inner diameter of the gallbladder was 5.7cm x 2.6cm, and a solid mass of about 3.0cm x 2.7cm was seen on the bottom of the gallbladder. The mass was about 0.7cm in height and was behind the gallbladder. CDFI: Shows star-like blood flow signals within it, PS 20cm/s, RI0.59 (Figure 1), suggesting substantial gallbladder disease (probable gallbladder cancer). The patient underwent gallbladder removal under general anesthesia. During the operation, gallbladder and omentum adhesions were observed. After the exposure, the gallbladder was successfully removed and the wall of the capsule was soft. After the incision, a 3.2 cm x 2.5 cm lesion was seen, and the surface was not completely smooth. Pathological findings: chronic cholecystitis, gallbladder papillary carcinoma.