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患者,男,57岁。主诉纳差、恶心、腹胀10天,皮肤黄染4天于1991年4月30日入院。患者5个月前发现左颈部有一核桃大肿块,在某肿瘤医院确诊为恶性淋巴瘤。应用CHOP方案(环磷酰胺200mg静注第1天,阿霉素50mg静注第1天,长春新碱2mg静注第1天,强地松40mg/日口服1～5天。5天1疗程,间歇16天)4个疗程。颈部肿块明显缩小,期间复查4次肝功均正常。在进行第5个疗程中,患者食欲减退,恶心,呕吐,腹胀,肝区不适。查ALT56单位(正常40u以下)。给予10％葡萄糖、肌苷、肝泰乐、维生素C、B_1、B_6等护肝处置,症状无改善,后皮肤黄染不退转入我院。查体:T37.5℃,BP17.1/12kPa,精神萎靡,皮肤巩膜重度黄染,无出血点及蜘蛛痣,心肺(-),肝脾未触及,肝区叩痛(++),移动性浊音(±),下肢浮肿(-)。化验:总胆红素288μmol/L,结合胆红
Patient, male, 57 years old. The main complaint of anorexia, nausea, bloating 10 days, yellow skin 4 days in April 30, 1991 admission. The patient had a large mass of walnuts in the left neck five months earlier and was diagnosed with a malignant lymphoma in a tumor hospital. CHOP program (cyclophosphamide 200mg intravenous 1 day, doxorubicin 50mg intravenous 1 day, vincristine 2mg intravenous 1 day, prednisone 40mg / day oral 1 to 5 days .5 days a course of treatment , Intermittent 16 days) 4 courses. Neck mass was significantly reduced during the review of 4 liver function were normal. During the 5th course of treatment, the patient experienced loss of appetite, nausea, vomiting, bloating and discomfort in the liver area. Check ALT56 units (under normal 40u). Given 10% glucose, inosine, liver Tailor, vitamin C, B_1, B_6 and other liver protection, no improvement in symptoms, after the skin yellow dye returned to our hospital. Examination: T37.5 ℃, BP17.1 / 12kPa, apathetic, skin sclera severe yellow dye, no bleeding and spider nevus, cardiopulmonary (-), liver and spleen not touched, Voiced (±), lower extremity edema (-). Assay: total bilirubin 288μmol / L, combined with bile red