患者,男性,50岁,因反复上腹痛21年,右上腹包块5年余,黄疸、腹胀3月于1989年8月15日入院。患者于1968年10月因进食油腻食物后出现中上腹剧痛,向腰背部放射,并有血淀粉酶及脂肪酶升高,以“急性胰腺炎”给予治疗,之后每年发作一次。1976年2月复发后,淀粉酶、脂肪酶长时间不正常,行ERCP检查,示“胰管明显增粗,呈串珠样改变”。1984年5月因腹痛而行B超检查,提示“胰头外上方有一前后约4.5cm的边缘不清、分叶状低回声区”,钡餐造影提示“十二指肠降部粘膜稍僵硬,有压迹,且向前推移”,CT结果与B超类似。即行手术,术中见胰头体部有一囊性、实质性肿物,约10×10cm,使十二指肠移位。肿物与周围组织粘连,肿物内抽出物为粘液,无法切除。病理提示为恶性病变,随将患者转入消化科行化疗。化疗一周右上腹的包块缩小到触不到,用5 The patient, male, 50 years old, was admitted to the hospital on August 15, 1989 because of repeated epigastric pain for 21 years and mass in the right upper abdomen for more than 5 years. In October 1968, the patient experienced severe pain in the upper abdomen after eating greasy food, radiated to the lower back, and had elevated serum amylase and lipase. He was treated with “acute pancreatitis” and then had an episode once a year. After the recurrence in February 1976, amylase and lipase were abnormal for a long time, and ERCP examination was performed, indicating that the pancreatic duct was significantly thickened and showed a bead-like change. In May 1984, B-ultrasound was performed for abdominal pain, suggesting that there is an unclear, lobulated hypoechoic region about 4.5 cm above and beyond the head of the pancreas. Barium meal imaging suggests that the mucosa of the descending duodenum is slightly stiff. There is a pressure trace and it moves forward." The CT result is similar to B ultrasound. The surgery was performed. During the operation, the head of the pancreas was shown to have a cystic, solid mass, approximately 10×10 cm, which shifted the duodenum. The tumor adhered to the surrounding tissue and the material in the tumor was mucus and could not be removed. The pathology suggested a malignant lesion, and the patient was transferred to gastroenterology for chemotherapy. The mass of the right upper quadrant of chemotherapy was reduced to a point where it could not be touched, with 5