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患者,男性,38岁,入院前1个月感右上腹隐痛,黄疸,食欲下降,全身乏力,体重下降5.0kg,在外院误诊为“急性肝炎”,治疗二十天症状不改善,黄疸不退。体检,皮肤巩膜黄染,未见腹壁静脉曲张和痴蛛痣,腹部未触及肿块,肝肋缘下2cm,质地中等,肝区叩击痛(+)。Hb100g/L,ALB40g/L,ALT64u,AKP46KA,DBILT34.2μmol/L,TBILT85.5μmol/L,CEA3.6μg/L。B超、CT、ERCP均提示胆管、胰管扩张,未见明显占位。拟梗阻性黄疸剖腹探查,见胆总
Patient, male, 38 years old, 1 month before admission, feeling right upper quadrant pain, jaundice, loss of appetite, generalized fatigue, weight loss 5.0kg, misdiagnosed as “acute hepatitis” in the external hospital, symptoms did not improve in the treatment for 20 days, jaundice did not retreat . Physical examination, yellow skin and sclera, no abdominal varicose veins and spider paralysis, abdominal mass without touch, 2 cm below the costal margin, medium texture, liver pain (+). Hb100 g/L, ALB40 g/L, ALT64u, AKP46KA, DBILT 34.2 μmol/L, TBLLT 85.5 μmol/L, CEA 3.6 μg/L. B-ultrasonography, CT, and ERCP all indicated that the bile ducts and pancreatic ducts were dilated and no obvious placeholders were found. Obstructive jaundice exploratory laparotomy, see the total bile