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1 病例报告 患者,女,54岁,因右上腹包块伴发热3个月于2000年3月21日入院。查体:体温37.8℃,脉搏82次/min,营养状况一般,皮肤及巩膜无黄染,未触及肿大的体表淋巴结,无颈静脉怒张,心肺未见异常。腹软,右上腹局部隆起,未见曲张的腹壁静脉。血常规:Hb 8.6g/L,WBC 9.8×10~9,中性白细胞0.68。AFP阴性。T-Bil 32.6μmol/L。D-bil 24.6μmol/L。AKP 105μ/L。X线胸片和心电图未见异常。B超示右肝内回声增强,不均匀,有少量液性区和包膜光整的包块。CT结果为:右肝巨大高密度影、中央区密度减低、边界清楚,无明显增强改变。临床诊断:肝占位性病变(1)结节样增生(2)肝恶性变。腹腔镜活检,病理学诊断为肝纤维肉瘤。术中见肝右叶明显肿大,其内有灰白色、包膜完整、边界清楚、质硬的结节状肿块。顺利切下肿块。
1 Case report Patients and women, 54 years old, were admitted to hospital on March 21, 2000 due to fever in the upper right abdomen for 3 months. Physical examination: Body temperature 37.8°C, pulse 82 beats/min, general nutritional status, no yellow staining of skin and sclera, no swelling of surface lymph nodes, no jugular vein engorgement, no abnormalities of heart and lung. The abdomen was soft and the right upper abdomen bulged locally. There was no varicose abdominal wall vein. Blood routine: Hb 8.6g/L, WBC 9.8×10~9, neutrophils 0.68. AFP is negative. T-Bil 32.6 μmol/L. D-bil 24.6 μmol/L. AKP 105μ/L. X-ray and ECG showed no abnormalities. B ultrasound showed that the right hepatic echo was enhanced, uneven, with a small amount of fluid area and coated smooth mass. The CT result was: a large high-density shadow of the right liver, a decrease in the density of the central region, a clear boundary, and no significant enhancement. Clinical diagnosis: Liver occupying lesions (1) Nodular hyperplasia (2) Liver malignancy. Laparoscopic biopsy, pathological diagnosis of hepatic fibrosarcoma. During the operation, the right lobe of the liver was obviously swollen, and there were nodules in the gray, white, enveloped, well-defined, and hard-edged masses. Successfully cut the lump.