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患者,女,20岁。主因上腹部疼痛1年,全身皮肤及巩膜黄染1周入院。患者于1年前即出现间断性上腹部钝痛,主要表现在脐上部,以后逐渐伴有腹胀,腰背部酸痛,曾于当地医院行腹部B超检查,诊断为上腹肿物,于1周前国全身及巩膜黄染转来我院。入院时查体:全身皮肤及巩膜黄染,全身淋巴结未见肿大,心肺无异常,上腹膨隆可触及一20×15 cm肿物,质地硬,压痛(+),活动度差,肝脾肋下未触及,肠鸣音正常。血色素、血糖、出凝血时间及凝血酶原时问均正常。肝功能:ALT、AST、ALP均明显异常,血脂正常。腹部B超示:梗阻性黄疸,肝内、外胆管扩张,腹腔囊实混合包块。CT示:腹膜后巨大实性占位。于1996年8月29日在全麻下行剖腹探查术,术中所见:肿物位于胰腺体上部,约20×15×10cm,囊实混合,硬,边缘不光滑,与胃、十二指肠、胆总管明显粘连,行胆总管部分切除术,胰腺部分切除术,十二指肠全切除术,胃大部切除术,胆道-空肠、胰腺-空肠、胃-空肠吻合术。术后病理诊断:胰腺乳头状囊腺癌伴炎性出血、坏死。胰腺癌绝大部分来源于胰腺外分泌系统,导管细胞腺癌最常见。扁平细胞癌、肉瘤、巨细胞癌、腺泡细胞癌、囊腺癌等较少见,
Patient, female, 20 years old. The main cause was pain in the upper abdomen for 1 year. The body skin and sclera were dyed for 1 week. The patient appeared intermittent dull epigastric pain 1 year ago, mainly in the upper part of the umbilical cord, and gradually accompanied by bloating, lower back pain, had abdominal ultrasound examination at the local hospital, diagnosed as upper abdominal mass, 1 week ago The whole body and yellow sclera were transferred to our hospital. Examination on admission: body skin and yellow sclera, no enlargement of systemic lymph nodes, no abnormalities of heart and lung, abdominal bulge can touch a 20×15 cm tumor, hard texture, tenderness (+), poor activity, liver and spleen No ribs were touched, and bowel sounds were normal. The hemoglobin, blood glucose, clotting time, and prothrombin time were all normal. Liver function: ALT, AST, ALP were all abnormal and blood lipids were normal. Abdominal B-show: obstructive jaundice, intrahepatic and extrahepatic bile duct dilatation, abdominal cystic mixed mass. CT shows: large retroperitoneal space occupation. On August 29, 1996, laparotomy was performed under general anesthesia. The intraoperative findings showed that the tumor was located in the upper part of the pancreas, approximately 20 × 15 × 10 cm. The capsule was mixed and hard, the edges were not smooth, and the stomach and the twelve fingers were Intestinal and common bile duct adhesions, partial choledochotomy, partial pancreatectomy, total duodenal resection, subtotal gastrectomy, biliary-jejunal, pancreatic-jejunal, and gastro-jejunal anastomosis were performed. Postoperative pathological diagnosis: Pancreatic papillary cystadenocarcinoma with inflammatory bleeding and necrosis. The vast majority of pancreatic cancer originates from the pancreatic exocrine system, and adenocarcinoma of the ductal cells is the most common. Squamous cell carcinoma, sarcoma, giant cell carcinoma, acinar cell carcinoma, cystadenocarcinoma, etc. are rare.