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1 病例报告女,33岁。因全身皮肤、巩膜黄染15d入院,伴全身搔痒,尿呈深黄色,近日有一次陶土色大便,无发热、腹疼腹泻及恶心呕吐,初诊为梗阻性黄疸、壶腹癌。查体:全身重度黄染,无出血点,浅表淋巴结无肿大,但全身皮肤广泛性赘疣及咖啡斑样色素沉着,小如高梁米,大如梨子,多达数百;尤以胸腹及腰背为甚,面部赘疣及色素沉着较少;无压疼,质地较软,深部固定。全腹软,上腹正中有深压疼,无肌卫及反跳疼,无包块。ALT313nkat·L~(-1),AKP 405 nkat·L~(-1),GGT 562 nkat·L~(-1),总胆红素267 umol·L~(-1),直接胆红素179 umol·L~(-1);HBV五项阴性。B超显示:肝内外胆管扩张,胆囊增大。胆道CT平扫及MRI:肝内外胆管扩张,胆总管直径2.5cm,胆囊增大,胆总管下端及十二指肠乳头可见软组织块影,CT值65Hu,大小约2.5cm×
1 Case report Female, 33 years old. Due to systemic skin and scleral yellow staining for 15 days, she was accompanied by general pruritus and dark yellow urine. Recently, there was a clay-colored stool, no fever, abdominal pain, diarrhea, and nausea and vomiting. The newly diagnosed patients were obstructive jaundice and ampullary cancer. Physical examination: The body was severely stained with yellow stains, no bleeding points, no enlargement of superficial lymph nodes, but the generalized skin blemishes and coffee spot pigmentation were as small as sorghum meters, as large as pears, as many as several hundred; especially in the chest The abdomen and lumbar dorsal aspect are very bad, with less facial spasm and pigmentation; no pressure pain, soft texture, deep fixation. The whole abdomen is soft, there is deep pressure pain in the middle of the upper abdomen, no muscle guard and rebound pain, no mass. ALT313nkat·L~(-1), AKP 405 nkat·L~(-1), GGT 562 nkat·L~(-1), total bilirubin 267 umol·L~(-1), direct bilirubin 179 umol·L~(-1); HBV was negative in five items. B-mode ultrasound showed that the bile ducts inside and outside of the liver expanded and the gallbladder increased. Biliary CT plain scan and MRI: Intrahepatic bile duct dilatation, common bile duct diameter 2.5cm, gallbladder enlargement, soft tissue mass visible at the bottom of common bile duct and duodenal papilla, CT value 65Hu, size about 2.5cm ×