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患者男性,21岁。巩膜黄染、乏力、腹泻2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,AKP93.1U,γ-GT1064U,黄胆指数50U,总胆红素323μmol/L,直接胆红素204μmol/L,尿胆红素阳性,尿胆原弱阳性。B超:肝内胆管明显扩张,胰管扩张,壶腹部占位待排。CT扫描:壶腹区梗阻病变可能,先天性总胆管囊肿不除外。胃镜:瓦特氏壶腹癌?十二指肠乳头刷片找到腺癌细胞。1985年7月5日行胰腺、十二指肠及胃次全切
Male patient, 21 years old. Yellow sclera, fatigue, diarrhea in February. 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 tests: ESR67mm, AKP93.1U, γ-GT1064U, yellow gall index 50U, total bilirubin 323μmol/L, direct bilirubin 204μmol/L, urinary bilirubin positive, urine gallbladder weak positive. B-ultrasound: Intrahepatic bile ducts are significantly dilated, pancreatic ducts are expanded, and the ampulla is occupied. CT scan: lesions in the ampullary area may be possible, and congenital common bile duct cysts are not excluded. Gastroscope: Watt’s ampulla cancer? Duodenal papillae brush to find adenocarcinoma cells. On July 5, 1985, pancreas, duodenum and stomach were cut