病例　男性 ,38岁。因右上腹不适伴乏力、纳差、腹胀、消瘦 1月余入院。患者于 1月前无明显诱因出现上述症状 ,并感双侧腰背部胀痛 ,未予任何诊治 ,病情迅速恶化而送入我院。入院时查体 :慢性重病容 ,消瘦 ,精神差 ,皮肤巩膜无黄染 ,左锁骨上可触及 3个蚕豆大小淋巴结 ,质硬 ,? Case male, 38 years old. Due to right upper quadrant discomfort with fatigue, anorexia, abdominal distension, weight loss more than 1 month admission. The patient had no obvious predisposing symptoms one month ago, and felt bilateral lower back pain, without any diagnosis and treatment, his condition deteriorated rapidly and sent to our hospital. Admission examination: chronic severe disease, weight loss, poor spirit, sclera skin without yellow dye, the left clavicle can reach 3 beans size lymph nodes, hard,?