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1病例资料:1.1女,57岁,因纳差、上腹部胀满不适1月就诊。经上消化道造影,胃镜检查,初步诊断为浅表性胃炎,胃下垂。给予对症治疗1月,疗效不明显。患者逐渐消瘦,体重下降4 kg。再次入院。查体:T 36.8℃,P 80次/min,R 20次/min,BP 120/70mmHg,皮肤巩膜无黄染,右上腹深压痛,未扪及明显包块。血常规:白细胞5.5×10~9/L,中性粒细胞0.73,血小板80.6×10~9/L,血红蛋白98 g/L。肝功能:总胆红素、直接胆红素正常,丙氨酸转移酶60 u/L,碱性磷酸酶647 u/L。B超检查:胆囊增大,肝内外胆管扩张。CT、MR检查:十二指肠降段占位,多考虑十二指肠癌,并胰头部分受侵,致肝内外胆管、胰管扩张。腹膜后淋巴结肿大。后经上级医院十二指肠镜活检确诊为十
1 Case Information: 1.1 female, 57 years old, due to anorexia, upper abdominal discomfort in January treatment. The upper gastrointestinal imaging, gastroscopy, the initial diagnosis of superficial gastritis, stomach ptosis. Symptomatic treatment given January, the effect is not obvious. Patients gradually weight loss, weight loss 4 kg. Admitted to hospital again. Examination: T 36.8 ℃, P 80 times / min, R 20 times / min, BP 120 / 70mmHg, scleral no yellow dye, right upper quadrant deep tenderness, palpable mass was not palpable. Blood: white blood cells 5.5 × 10 ~ 9 / L, neutrophils 0.73, platelet 80.6 × 10 ~ 9 / L, hemoglobin 98 g / L. Liver function: Total bilirubin, normal direct bilirubin, alanine aminotransferase 60 u / L, alkaline phosphatase 647 u / L. B-ultrasound: increased gallbladder, intrahepatic bile duct dilatation. CT, MR examination: duodenal descending place, consider Duodenal cancer, and pancreatic head part of the invasion, resulting in extrahepatic bile duct, pancreatic duct dilatation. Retroperitoneal lymph nodes. After the higher hospital duodenoscopy biopsy diagnosed as ten