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例1 男,74岁。胆管扩张18年,2个月前内镜检查见十二指肠乳突部腺瘤样肿物,活检病理提示“黏膜慢性炎症伴小区域管状腺瘤形成”。2周前上腹痛加重伴发热1 d。实验室检查:血清淀粉酶升高(314 U/L),碱性磷酸酶升高(54 U/L),γ-谷胺酰转肽酶升高(22 U/L)。多层螺旋 CT(MSCT)检查:肝内胆管轻度扩张,胆总管扩张(直径约2.0 cm),胆囊增大,乳突壶腹部可见一明显强化的分叶状软
Example 1 Male, 74 years old. Bile duct dilatation 18 years, 2 months ago, endoscopic examination of duodenal papilla adenoma-like mass, biopsy suggested “mucosal chronic inflammation with small area tubular adenoma ”. 2 weeks ago, aggravating abdominal pain with fever 1 d. Laboratory tests showed elevated serum amylase (314 U / L), elevated alkaline phosphatase (54 U / L) and elevated gamma glutamyl transpeptidase (22 U / L). Multi-slice spiral CT (MSCT) examination: slight expansion of the intrahepatic bile duct, common bile duct dilatation (diameter of about 2.0 cm), gallbladder enlargement, a markedly enhanced amygdalus