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1 病例介绍 患者男,57岁.因全身黄染、黑便20天,于1993年11月18日入院.B超检查:肝内外胆管扩张,胆囊增大,B超诊断:胆管末端梗阻.CT检查:肝内胆管不扩张,肝外胆管明显扩张,扩张的胆总管于胰头段突然消失,胆囊肿大;CT诊断:壶腹部癌.GPT25u,TTT 3u,HBsAg(-),总胆红素51.30μmol/L.直接胆红素41.04μmo1/L.于1993年11月29日行剖腹探查,发现十二指肠降部靠近乳头2cm处有带蒂肿瘤约3.5×1.5×2.5cm,压迫乳头致胆总管扩张约1.5cm.行胰十二指肠切除。病理回报十二指肠Brunner腺瘤.术后曾出现胰漏.经引流、抗炎、支持,补液治疗好转出院,出院1年内常感上腹部不适、隐痛.来院复查予对症处理.
1 Case presentation Male patient, 57 years old. He was admitted to hospital on November 18th, 1993 because of systemic jaundice and black stools. Ultrasonic examination: Bile duct dilatation, gallbladder enlargement, B-ultrasound diagnosis: bile duct obstruction. CT Examination: Intrahepatic bile ducts do not dilate, extrahepatic bile ducts expand significantly, dilated common bile ducts suddenly disappear in the head of the pancreas, and gallbladder enlargement; CT diagnosis: ampulla cancer. GPT25u, TTT 3u, HBsAg(-), total bilirubin 51.30μmol/L. direct bilirubin 41.04μmo1/L. was examined by laparotomy on November 29th, 1993. It was found that the pedunculated tumor was about 3.5 × 1.5 × 2.5cm near the nipple of the descending part of the duodenum and the nipple was compressed. The common bile duct dilates about 1.5cm. Pancreatoduodenectomy is performed. Pathology report duodenal Brunner adenoma. Postoperative pancreatic leakage occurred. After drainage, anti-inflammatory, support, rehydration therapy was improved and discharged. Discomfort, epigastric discomfort, and pain were often felt within one year after discharge. The hospital was reviewed for symptomatic treatment.