NEJM:肝内胆管扩张-病例报道

2020-01-23 xing.T MedSci原创

考虑到许多考虑因素,包括肝动脉和门静脉均已受累,医务人员认为该肿瘤不可切除。除胆道引流外,该患者只进行了支持性姑息治疗。

患者为一名72岁的妇女,因腹痛、黄疸和瘙痒症到医院就诊。她报告称在过去两个月中体重减轻了6公斤。

实验室检查发现直接胆红素水平为14.3 mg/dL(正常范围为0.1到0.3),碱性磷酸酶水平为223 U/L,天冬氨酸转氨酶水平为55 U/L,丙氨酸氨基转移酶水平为56 U/L。腹部的磁共振成像检查发现肝内胆管扩张明显,在肺门附近逐渐变细和截止(如箭头所示),还可观察到血管受累的肝门肿块(未显示)。影像学检查与肝门胆管癌或Klatskin’s瘤的诊断一致。



该患者接受了经胆道引流的经皮肝穿刺胆道造影,并从肺门肿块中获得了活检标本。组织病理学检查证实了胆管癌的诊断,还观察到了肺转移。

考虑到许多考虑因素,包括肝动脉和门静脉均已受累,医务人员认为该肿瘤不可切除。除胆道引流外,该患者只进行了支持性姑息治疗。
 
原始出处:

Umberto G. Rossi,et al.Intrahepatic Biliary Ductal Dilatation.N Engl J Med 2020;https://www.nejm.org/doi/full/10.1056/NEJMicm1906186

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    2020-07-29 lsj637
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    2020-03-04 1474f4afm33暂无昵称

    报道的这病例有啥特殊吗

    0

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  6. [GetPortalCommentsPageByObjectIdResponse(id=1957985, encodeId=af73195e985e3, content=<a href='/topic/show?id=9bc283509dc' target=_blank style='color:#2F92EE;'>#胆管扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83509, encryptionId=9bc283509dc, topicName=胆管扩张)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93e223, createdName=bluefate121, createdTime=Thu May 14 03:40:00 CST 2020, time=2020-05-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1807803, encodeId=a6e9180e8034c, content=<a href='/topic/show?id=0d77811e23d' target=_blank style='color:#2F92EE;'>#肝内胆管扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81172, encryptionId=0d77811e23d, topicName=肝内胆管扩张)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=310e209, createdName=yzh399, createdTime=Tue Jul 28 04:40:00 CST 2020, time=2020-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1684820, encodeId=1df01684820cf, content=<a href='/topic/show?id=794754e74f4' target=_blank style='color:#2F92EE;'>#扩张#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54774, encryptionId=794754e74f4, topicName=扩张)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=699d28086811, createdName=lsj637, createdTime=Wed Jul 29 16:40:00 CST 2020, time=2020-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=380049, encodeId=7e2e38004963, content=报道的这病例有啥特殊吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0de55206789, createdName=1474f4afm33暂无昵称, createdTime=Wed Mar 04 04:39:05 CST 2020, time=2020-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628415, encodeId=41aa16284158a, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Sat Jan 25 00:40:00 CST 2020, time=2020-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378468, encodeId=6e7e3e846823, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Fri Jan 24 14:19:33 CST 2020, time=2020-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=378467, encodeId=56a33e846705, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Fri Jan 24 13:22:37 CST 2020, time=2020-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035096, encodeId=dc32103509623, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jan 23 12:40:00 CST 2020, time=2020-01-23, status=1, ipAttribution=)]
    2020-01-24 一天没事干

    很好的学习机会

    0

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    2020-01-24 一天没事干

    很好的学习机会

    0

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    2020-01-23 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0