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患者,女,69岁,因左上腹包块,间歇性疼痛1年,加重16小时急症入院。1年前发现左上腹一约拳头大小包块,伴腹痛多次发作,但能忍受,包块渐增至婴儿头颅大小,未行治疗。于16小时前,因翻身活动,出现左上腹持续性剧痛,向左下腹放射,伴恶心,呕吐,出冷汗来诊。既往无胃、十二指肠病史及腹部外伤史。体检:T36.7℃.P98次/分,R24次/分,BP10/7kPa。面色苍白,四肢厥冷,左侧腹部隆起,可扪及22cm×19cm大小包块,表面光滑,质硬,不活动,有深压痛,无反跳痛,肝脾不肿大,无移动性浊音,肠鸣音正常。血RBC1.75×10~(12)/L,WBC 16.0×10~(9)/L 0.90,L0.10.Hb45g/L,腹部MRI示左腹腹膜后一约172mm×119mm肿物,边界清楚,包膜完整;左肾受压轻度变形。意见:左侧腹膜后良性占位,考虑畸胎瘤、肾血管肌肉脂肪瘤。住院后,经补液、输血、抗休克治疗,在硬膜外麻醉下行剖腹探查术,术中见左侧腹膜后有一巨大瘤体突出,沿左侧结肠沟切开后腹膜,剥离瘤体上部,见肾下极被肿瘤包
Patient, female, 69 years old, due to left upper quadrant mass, intermittent pain for 1 year, increased 16 hours emergency admission. A year ago found that the left upper quadrant about the size of a fist mass, with abdominal pain, multiple attacks, but can tolerate, mass gradually increased to the size of infant head, not treatment. 16 hours ago, due to turning over activities, persistent pain in the left upper abdomen, left lower quadrant radiance, with nausea, vomiting, cold sweating clinic. Past without stomach, duodenal history and history of abdominal trauma. Physical examination: T36.7 ℃ .P98 times / min, R24 times / min, BP10 / 7kPa. Pale, limbs Jueleng, left abdomen bulge, palpable 22cm × 19cm size of the mass, the surface smooth, hard, not active, deep tenderness, no rebound pain, no enlargement of liver and spleen, no dull dullness , Bowel sounds normal. Blood RBC1.75 × 10-12 / L, WBC 16.0 × 10-9 / L 0.90, L0.10.Hb45g / L, abdominal MRI showed a left peritoneal about 172mm × 119mm tumor, the boundary is clear , Complete capsule; left renal compression mild deformation. Opinion: The left retroperitoneal space-occupying, consider teratoma, renal vascular muscle lipoma. After hospitalization, after rehydration, blood transfusion, anti-shock treatment, laparotomy under epidural anesthesia, the surgery see the left retroperitoneal tumor has a prominent, along the left colon ditch after the peritoneum, stripping the upper part of the tumor, See the kidney is extremely tumor package